Anaesthetics

how does intra-op hypothermia cause bleeding to be increased?
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how does intra-op hypothermia cause bleeding to be increased?
proteins and enzymes are designed to work at certain temp and pH, therefore when deviated from this anaesthetic drugs are metabolised more slowly and platelet, coag factos and immune system is less effective
which condition makes patients very sensitive to non-depolarising agents?
myasthenia gravis
which airway measure can be used as bridging in patients with low GCS whilst waiting for an anaesthetist?
oropharyngeal airway - safe to use and reduce aspiration risk
which muscle relaxant is used for rapid sequence induction?
suxamethonium
when can patients begin to shower with a wound dressing after surgery?
48 hours - in the meantime a nurse will use sterile saline up until 48 hours after surgery
what is mx of an anastomotic leak?
surgical emergency and so should be taken back to theatre immediately
how would recurrent laryngeal nerve damage best be identified?
laryngoscopy
which medications can slow bone healing?
NSAIDS
steroids
immunosuppressants
anti-neoplastic drugs
what is a common complication of poor post-op pain management?
pneumonia
why is propofol used in most day case surgeries?
rapidly metabolised
mild/moderate anti-emetic properties
what is the most common complication post op of etomidate?Et-VOM-idate (post-op vomiting)MOA of lidocainesodium channel blocker which leads to pre-synaptic neurone not depolarising and therefore not action potential is producedwhat is the antidote to lidocaine?IV 20% lipid emulsionwhat is the most common cause of a tracheo-oesophageal fistula formation?long term mechanical ventilation in ITUwhich airway adjunct is contraindicated in suspected basal skull fracture?nasopharyngeal airway - risk of inserting into cranial cavitywhy is adrenaline CI in digital operations?risk of digital ischaemia due to vasoconstrictionMOA - AdrenalineCatecholamine. Non specific alpha and beta adrenergic agonist. Causes vasoconstriction that increases blood available for cardiac and cerebral supply. Utilized in cardiac arrest and severe bradycardia.when should a cxr be routinely recommended before surgery?neverwhat is pseudocholinesterase deficiency also known as?suxamethonium apnoeawhich central vein is recommended for parenteral feeding?subclavian veinwhich electrolyte imbalance can suxamethonium cause?hyperkalaemiawhat is the required bowel prep before a colonoscopy?fasting 24 hours before laxatives day before procedurewhen is the 'time out' WHO checklist done?before the first skin incision is madewhat is the best way to reduce adhesions in abdominal surgery?use of a laparoscopic approach over an open surgerywhat does 2% lidocaine mean in terms of strength?there are 2g per 100ml of the solutionhow is post-op ileus managed?conservative with NG tube insertion for stomach decompression and NBM to allow for bowel restwhat days post-op does a VTE most commonly occur in?5-10 dayswhat blood test is important to check in post-op ileus?U&Es - check and replace electrolytes and these should be done dailyhow can patients on insulin with good diabetic control have their insulin managed on the day of day-case surgery?reduce morning insulin Give IV fluids monitor electrolyteswhich airway tool can be used as bridging when there is an acute problem and you are waiting for the anaesthetist?oropharyngeal airwayhow is ASA III different from ASA IV?the severe systemic disease has to be a constant threat to life in grade IVwhere on the op list should patients with poor BM control declining insulin treatment be placed?1stwhen should LMWH be started in the operation period?6-12 hours after the surgeryWhere should you avoid cannulating in a known diabetic?feet - can turn into diabetic ulcer if diabetic peripheral neuropathy is suspectedwhat is the preferred anaesthetic for someone who is haemodynamically unstable?ketamine - preserves blood pressurewhat disturbance can post-op ileus cause before nausea and vomiting present?electrolyte disturbancewhy are PEGs not given for those with oesophagectomies?there is no oesophagus for the endoscope for placing