Anesthesia Key Concepts

• Summarized notes to help you in your studies
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ASA Score for a 70-Year-Old Male with Uncontrolled Hypertension and Diabetes Mellitus

• The appropriate ASA (American Society of Anesthesiologists) score for a 70-year-old male with uncontrolled hypertension and diabetes mellitus, scheduled for emergency aneurysmorrhaphy, should be determined based on the severity of his systemic diseases and the urgency of the surgery.
• Higher ASA scores reflect poorer health and increased surgical risk.

Medications to Discontinue Before Surgery

• Certain medications may interact adversely with anaesthetic drugs and surgical procedures and should be discontinued.
• Examples of such medications include aspirin and captopril.

Conditions Associated with Diabetes Mellitus

• Diabetes mellitus can lead to the following conditions, except; hypercreatininaemia
• These include delayed gastric emptying, hyperuricaemia, obesity, and albuminuria

Risk of Aspiration and Mendelson's Syndrome

• The risk of aspiration of gastric content and subsequent development of Mendelson's syndrome in patients undergoing urgent surgery is increased by manual ventilation post-induction of anaesthesia in a patient having emergency surgery

Acute Left Ventricular Failure and Elective Surgery

• Pulmonary oedema is associated with acute left ventricular failure, and elective surgery would be cancelled.

Airway Management Difficulty

• Mouth opening of 4 cm predicts a difficulty with airway management and possible difficulty with tracheal intubation in an adult patient.

Sodium Bicarbonate (NaHCO3) Use

• A usual dose of sodium bicarbonate (NaHCO3) is 1-2 mmol/Kg body weight.

Rapid Sequence Induction of Anaesthesia

• Rapid sequence induction should follow the sequence of pre-oxygenation, induction, cricoid pressure, muscle relaxation, and intubation

Massive Blood Transfusion

• Severe metabolic acidosis is likely to occur as a result of a massive blood transfusion.

Autologous Blood Transfusion

• One potential risk may include the expiration of the blood

Uncorrected Hypokalaemia

• Cardiac dysrhythmias are likely to occur if hypokalaemia remains uncorrected before anaesthesia and surgery

Nitrous Oxide for General Anaesthesia

• Nitrous oxide is commonly known to cause depression of the bone marrow and is used mainly for providing analgesia intra-operatively.

Propofol

• Propofol can be used as the sole agent for induction and maintenance of anaesthesia and can cause respiratory depression.

Immediate Cervical Stabilization

• Immediate cervical stabilization includes all except skull callipers and weights

Antibiotics for Intestinal Perforation

• Metronidazole offers the best coverage against anaerobic organisms

Sickle Cell Disease and Urgent Cholecystectomy

• Hypothermia is likely to cause sickling peri-operatively for a patient with sickle cell disease and scheduled for urgent cholecystectomy.

Spinal Anaesthesia with Bupivacaine

• Spinal anaesthesia is available as a 4-ml ampoule of a 0.5% bupivacaine at some hospitals

Bupivacaine Dosage in Ampoule

• Bupivacaine 20mg is available in a 4ml ampoule.

Premedicant Drugs

• The main reason for administration of premedicant drugs is for the analgesic and anxiolytic effects.

Physiological Response to Blood Loss

• Decreased blood pressure and pulse rate physiological response to sudden blood loss Intra-operatively.

CVP Values After Blood Loss

• The CVP value after sudden blood loss Intra-operatively is most likely 0-6 cmH20.

Capnography

• Confirming or ruling out endotracheal intubation is the best explanation for use of capnography in anaesthesia.

Acute Respiratory Distress Syndrome

• Spinal shock is not usually associated with adult acute respiratory distress syndrome.

Intraoperative ECG

• Ventricular size is one element of information which is not usually obtained from the ECG intra operatively

Anesthetic Agents and Bronchospasm

• Thiopentone is likely to worsen bronchospasm in an asthmatic patient

Management of Pulseless Patient

• Cardia compression is the first step in the management of a patient who is pulseless and non-breathing after brought into the Emergency department

Poisoning and Drug Overdose

• Kerosene is not a common agent in Jamaica of poisoning and drug overdose

When to avoid Activated charcoal

• Digoxin should be avoided when using Activated charcoal

Tracheal Intubation

• A patient with drowsiness after an overdose of drugs needs tracheal intubation

Anti-inflammatory, Analgesic and Antiemetic Drugs

• Dexamethasone have the properties of anti-inflammatory, analgesic and antiemetic

COX-2 inhibitors

• Colecoxib is an example of a cylooxygenase-2 (COX-2) inhibitor

Neuromuscular Blocking Antibiotics

• Gentamycin has neuromuscular blocking property and should be avoided when impaired renal function

Thiopentone Solution

• The pH of a 2.5% solution of thiopentone is 10.

Thiopentone Facts

• Thiopentone is a phenol derivative that is available as a white oil-in-water emulsion.

Inadequate General Anaesthesia Signs

• Signs of inadequate general anaesthesia include all except pupillary constriction

Cranial Nerves and Anesthesia

• The last cranial nerve sense to disappear as a patient becomes more deeply anesthetized is hearing

Intravenous Solution

• 5% dextrose 0.2% saline is most appropriate for a neonate undergoing bilateral hernia repair

Local Anaesthetic Agents

• Local anaesthetic agents' effects are on the nerve membrane.

Preparing for Regional Anaesthesia

• A history of neurological disease may lead to a decision not to proceed.

Total Spinal Blockade

• Hypotension suggests that total spinal blockade

Spinal Blockade

• The most appropriate drug to administer to counteract vasodilatation and bradycardia associated with spinal blockade is ephedrine

Respiratory Acidosis

• Arterial blood analysis can yield results that indicate respiratory acidosis

Ischemic Heart Disease

• Severe angina to the list of possible causes, in a patient who has known ischemic heart disease while undergoing treatment in the Emergency Department

Cardiopulmonary Resuscitation

• Adrenaline 2.0 MG should be given early for cardiopulmonary resucitation in an above mentioned patient

Cardiac Arrest

• Hypoxia, in its severe form, is the most likely cause of pulseless electrical activity

Neuromuscular Blockade

• Strong hand grip is the best test for adequate muscle power after neuromuscular blockage

Pediatric ASA Score

• A small child comes in with congenital defect, the appropriate score is set to II

Pediatric Medications

• For a 7-year-old you the most appropriate medication is Midazolam because of the anxiolytics and calm effect

Aspiration Of Gastric Content

• Clear fluids don't reduce amount of risk of aspiration by the amount of aspiration in the gastric content

Associated with Diabetes Mellitus

• Obesity is not associated with Diabetes Mellitus

Symptoms of Upper Airway Obstruction

• Crepitations is not a symptom that is usually associated with airway obstruction

Acute Cardiogenic Shock

• The key symptoms are what' is shown with heart increase blood pressure is what happens with a patient in cardio-genic

Glycosuria

• Glycosuria in the preoperative can be detected through echocardiogram.

Spinal Anesthesia

• It is very inappropriate when history suggest that you continue the procedure

Spinal block Admnistration

• When you think of any of these procedures the most important thing is what? The size/strength

Administering Spinal Anesthesia

• Hypertension, the next symptoms after the patient becomes unconscious or is hard to breath

Spinal Anesthesia Drug

• For spinal blocks the best drug is ephedrine because it is a very good option

True About Hyperkalemia

• The last item from the list of options it what make it accurate.

Massive Blood Transfusion effects

• One result of massive blood transfusion effects the polycythemia

Restlessness and Muscle Relaxants

• Reversal of Muscle Relaxants is a known side affect that you can run into.

Tachycardia

• Phenylephrine will give a direct result of causing tachycardia intra-operative

Elderly Patient Respiratory

• Respiratory Acidosis can happen 20 min with 100 mg of Pethidine intramusculary

Chest Injuries

• Pneumothorax with trauma victims will most likely cause electrical activity

Allergic Reaction

• This is not specific because it can lead to r honchi and crepatations

Balanced IV

• Hyperoxima is the true action for surgery during fluid reduction

Powerful Analgesic Agent

• Is not that great and effective at reducing pain

Pulse Oximeter

• The key tool and part to know if oxyhemoglobin absorb light at wavelengths 940 and 660 nm

Arterial Gases

• The answer about diagnosis in the test to know it can not be measured comes from it not being in the measurement

O2 and Fixed Performance

• Ventilmasks are the best perform of a fixed system

Rapid Sequence issues

• Some tools during rapid sequence are tracheal inhalation and ventilation

Manage fibrillation

• Fibrillation after Joules is key to know

Blood Gases

• Face mask is the best option for the gases.

Fall From The Roof

• Cardio compression is most of the time correct for a 60 foot fall building

Peri-Orbital Discoloration

• To take X-Ray check

Response and Pain Level

• The answer to that question is 2 as the key points.

Blood Loss

• Decompeteing with the blood is the effect

CVP Response

• 6-8 is what is expected

Hip Replacement.

• It may happen with post- operative to lead to the answer

Anesthetic Agent

• The agent you want is Ketamine the one to avoid.

The best CUFF size

• Most CUff for post-operation is related to other issues.

The Conditions Does NOT Cause

• So does what it say as is it shock

Pre-Operations

• It does lead you to know because the point in knowing if there card is good at time this is a good way

Test To Be Done

• What you would expect to be able to see what needs to happened.

Larnygeal Mask

• Everything about endotrachael tube

Ethical

• Look at any item but it may have affect

Risk of

• What ever it is and where it is has to align to what kind you would expect

To Do At Donate

• Always review your options

Oxygen

• Always look to make logical sense on some things.

Radio

• Do the opposite and take the chance