Anaesthesia on the Move

256 Pages·2012·2.8 MB·English

by  Sally Keat

Anaesthesia
on the move
This page intentionally left blank
Anaesthesia
on the move
Authors: Sally Keat, Simon Townend Bate,
Alexander Bown and Sarah Lanham
Editorial Advisor: Peter Matthews
Series Editors: Rory Mackinnon, Sally Keat,
Thomas Locke and Andrew Walker
First published in GreatBritain in2012by
Hodder Arnold, animprint ofHodder Education, adivision ofHachette UK
338EustonRoad, LondonNW13BH
http://www.hodderarnold.com
#2012Keat, Townend Bate,Bown, Lanham
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Contents
Preface ix
Acknowledgements xi
List of abbreviations xiii
An explanation of the text xvii
PART I: PRE-OPERATIVE 1
1. Physiology 3
1.1 Homeostasis 3
1.2 Respiratory physiology 4
1.3 Cardiovascular physiology 16
1.4 Neurophysiology 24
2. Preparing for surgery 36
2.1 Basic principles of anaesthesia 36
2.2 Pre-operative assessment 36
2.3 Assessment of surgical risk 39
2.4 Assessment of airways 41
2.5 Investigations to consider 43
2.6 Pre-operative medications 44
2.7 Management of regular medications 45
2.8 Management of pre-operative conditions 47
2.9 Reduction of aspiration risk 51
2.10 Informed consent 52
PART II: PRACTICE OF ANAESTHESIA 55
3. In the anaesthetic room 57
3.1 Introduction 57
3.2 Induction 58
4. Airways and ventilation 65
4.1 Airways 65
4.2 Ventilation 71
5. Oxygen 76
5.1 Initiating oxygen therapy 76
5.2 Administering oxygen 77
5.3 Monitoring saturation of haemoglobin with oxygen 79
vi Contents
6. Local and regional anaesthesia 84
6.1 Advantages to regional anaesthesia 84
6.2 Anaesthesia and analgesia within the spinal column:
central neural blockade 84
7. Drugs in the anaesthetic room 89
7.1 General anaesthetics 89
7.2 Muscle relaxants: neuromuscular blockers 93
7.3 Anti-cholinesterases 94
7.4 Local anaesthetics 95
8. In the operating theatre 100
8.1 Delivering anaesthesia 100
8.2 Intra-operative monitoring 105
8.3 Intra-operative emergencies and complications 110
PART III: ON THE WARDS 117
9. Post-operative complications 119
9.1 Common complications 119
9.2 Sepsis 121
9.3 Pain 123
9.4 Analgesia 127
9.5 Post-operative nausea and vomiting 131
9.6 Acute blood loss 133
10. Post-operative fluids 135
10.1 Fluid requirements 135
10.2 Fluid compartments 136
10.3 Replacement fluids 138
10.4 Fluid prescribing 139
10.5 Fluid balance abnormalities 139
10.6 Electrolytes 142
11. Recognizing and managing ill patients 153
11.1 Introduction 153
PART IV: INTENSIVE THERAPY UNIT/CRITICAL CARE 159
12. Structure of an intensive therapy unit 161
12.1 Introduction 161
12.2 Admission 162
12.3 Staff 162
Contents vii
13. Principles of critical care 165
13.1 Organ support 165
PART V: SELF-ASSESSMENT 173
14. Pre-operative 177
Questions 177
Pre-assessment: EMQS 177
Pre-assessment: SBAS 178
Answers 180
Pre-assessment: EMQS 180
Pre-assessment: SBAS 181
15. In the anaesthetic room 183
Questions 183
Airway management: EMQS 183
Airway management: SBAS 184
Answers 185
Airway management: EMQS 185
Airway management: SBAS 187
16. Practice of anaesthesia 188
Questions 188
Maintenance of anaesthesia: EMQS 188
Maintenance of anaesthesia: SBAS 189
General anaesthesia: EMQS 189
Fluid: EMQS 190
Fluid: SBAS 191
Electrolytes: EMQS 191
ECG: SBAS 192
Oxygen: EMQS 193
Oxygen: SBAS 194
Answers 195
Maintenance of anaesthesia: EMQS 195
Maintenance of anaesthesia: SBAS 196
General anaesthesia: EMQS 196
Fluid: EMQS 196
Fluid: SBAS 197
Electrolytes: EMQS 198
ECG: SBAS 198
viii Contents
Oxygen: EMQS 199
Oxygen: SBAS 199
17. Drugs in the anaesthetic room 201
Questions 201
Induction of anaesthesia: EMQS 201
Induction of anaesthesia: SBAS 203
Answers 204
Induction of anaesthesia: EMQS 204
Induction of anaesthesia: SBAS 206
18. On the wards 207
Questions 207
Pain management: EMQS 207
SEPSIS: EMQS 209
Volatile gases: EMQS 211
Regional anaesthesia: SBAS 212
Regional anaesthesia: EMQS 213
Pre-operative medications: EMQS 213
Answers 214
Pain management: EMQS 214
SEPSIS: EMQS 215
Volatile gases: EMQS 217
Regional anaesthesia: SBAS 218
Regional anaesthesia: EMQS 218
Pre-operative Medications: EMQS 219
19. Resuscitation and emergencies 220
Questions 220
Intra-operative emergencies: SBA 220
Muscle relaxants: EMQS 220
Advanced life support: EMQS 221
Advanced life support: SBAS 222
Answers 223
Intra-operative emergencies: SBAS 223
Muscle relaxants: EMQS 223
Advanced life support: EMQS 223
Advanced life support: SBAS 224
Index 225
Preface
Anaesthesiaisanexciting,rapidlychangingspecialty.Itislovedbystudentsfor
its practical nature and reputation as being at the sharp end of patient care.
Anaestheticsisalsoinextricablylinkedwithphysiologyandpharmacology.This
makesitanidealtopictohelpbridgethegapbetweenbasicsciencesandclinical
medicine.Writtenbystudentsforstudents,thisshortguidetoanaestheticsalso
gives awhirlwind tourofhuman physiology. We aimedto giveinformation in
as many different styles as possible, keeping the text engaging. We hope this
briefguide willgive you:thetoolstohandleanemergency situation,theablity
to optimise a patient both peri-operatively and on the ward and, most
importantly (!), withstand a grilling on your anaesthetics placement.
AUTHORS:
Sally Keat BMedSci MBChB (cid:2) Foundation Year 1 doctor, Northern General
Hospital, Sheffield, UK
Simon Townend Bate BMedSciMBChB (cid:2) Foundation Year 1 doctor, Barnsley
Hospital, UK
Alexander Bown MBChB (cid:2) Foundation Year 2 doctor, Sheffield Teaching
Hospitals, UK
Sarah Lanham MBChB (cid:2) Foundation Year 2 doctor, Sheffield Teaching
Hospitals, UK
EDITORIAL ADVISOR:
Peter Matthews (cid:2) Consultant Anaesthetist, Rotherham NHS Foundation
Trust, Rotherham, UK
EDITOR-IN-CHIEF
Rory Mackinnon BSc MBChB (cid:2) Foundation Year 2 doctor, Northern General
Hospital, Sheffield, UK
SERIES EDITORS:
Sally Keat BMedSci MBChB (cid:2) Foundation Year 1 doctor, Northern General
Hospital, Sheffield, UK
Thomas Locke BSc MBChB (cid:2) Foundation Year 1 doctor, Northern General
Hospital, Sheffield, UK
Andrew Walker BMedSciMBChB (cid:2) Specialist Trainee Year 1 doctor in
Medicine, Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK