p.5
Legal and Ethical Considerations in Medical Treatment
What are anaesthetists expected to do in emergency situations involving Jehovah's Witnesses?
They are expected to provide care to Jehovah's Witnesses and fully abide by their wishes once these have been verified.
p.19
Elderly Patient Care in Anaesthesia
What organization updated their guidelines on the ‘Peri-operative Care of the Elderly’ in 2014?
The AAGBI (Association of Anaesthetists of Great Britain and Ireland).
p.8
Obesity and Its Impact on Anaesthesia
What pre-medication is recommended for obese patients before induction?
Antacid prophylaxis or a proton pump inhibitor.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
What is the holy text of Jehovah's Witnesses?
'The New World Translation' of the Bible.
p.17
Pregnancy and Anaesthesia Management
What should be done pre-operatively for a 24-week pregnant woman undergoing an appendicectomy?
Inform the anaesthetic consultant, confirm the diagnosis with surgeons, inform obstetricians and arrange fetal monitoring, and take consent for rapid sequence induction of general anaesthesia.
p.10
Paediatric Anaesthesia Considerations
What is the formula to estimate the weight of children aged 1-10 years?
Weight (kg) = (Age + 4) × 2
p.17
Pregnancy and Anaesthesia Management
What is the purpose of pre-oxygenating a pregnant woman at 30° head up before induction?
To maintain functional residual capacity (FRC) and ensure adequate oxygenation due to reduced FRC and increased oxygen consumption in pregnant women.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
Do Jehovah's Witnesses accept the concept of the Holy Trinity?
No, they do not accept the concept of the Holy Trinity.
p.14
Paediatric Anaesthesia Considerations
For what age groups is Propofol licensed for induction and infusion?
Propofol is licensed for induction in infants over 1 month and for infusion in children aged 3 years and above.
p.19
Elderly Patient Care in Anaesthesia
Who should be available to anaesthetise and operate on elderly patients?
Appropriately experienced senior personnel.
p.18
Pregnancy and Anaesthesia Management
What is the effect of thiopentone on uteroplacental blood flow?
It causes a fall in uteroplacental blood flow (up to 35%), which is not sustained.
p.11
Paediatric Anaesthesia Considerations
What type of syringe should be used for administering small volumes of drugs to paediatric patients?
A 1 ml syringe should be used, and the drugs should be drawn up undiluted.
p.19
Elderly Patient Care in Anaesthesia
What factors contribute to the complexity of elderly patients in peri-operative care?
Age-related physiological decline, co-morbidities, cognitive impairment, frailty, and polypharmacy.
p.11
Paediatric Anaesthesia Considerations
What equipment should be prepared in advance for paediatric anaesthesia?
Airway equipment, breathing circuit (e.g., T-piece), monitoring equipment, and a paediatric Ambu bag with an alternative oxygen supply.
Why is sufficient analgesia important post-operatively?
To ensure the patient can cough and breathe easily, avoiding chest infection, hyperventilation causing respiratory alkalosis, or hypoventilation causing acidosis.
p.11
Paediatric Anaesthesia Considerations
Why is a calm, friendly environment important during the induction of anaesthesia in paediatric patients?
It helps reduce anxiety in both the child and parent, facilitating a smoother induction process.
p.8
Obesity and Its Impact on Anaesthesia
What ventilation technique is recommended for obese patients during maintenance?
Ventilate using PEEP (Positive End-Expiratory Pressure).
p.14
Paediatric Anaesthesia Considerations
Why is a higher dose of suxamethonium needed in infants?
A higher dose of suxamethonium (2 mg/kg) is needed due to decreased sensitivity from increased volume of distribution and immature neuromuscular junction.
p.9
Paediatric Anaesthesia Considerations
What are the different age groups included in paediatric patients?
Premature (less than 37 weeks post-conception), Neonate (first 28 days of life or <44 weeks post-conception), Infant (1 month to 1 year), Child (>1 year to 12 years), Adolescent (13 to 16 years).
p.19
Elderly Patient Care in Anaesthesia
What is essential in reducing the risk of morbidity and mortality in elderly patients after surgery?
Good peri-operative care.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
Why do Jehovah's Witnesses refuse blood transfusions?
Their refusal is based on scriptures from Genesis 9:3–4, Leviticus 17:11–12, and Acts 15:28–29.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
Which blood products are generally unacceptable to Jehovah's Witnesses?
Whole blood, packed cells, white cells, platelets, fresh frozen plasma, and autotransfusion of blood that has been taken and stored.
p.4
Legal and Ethical Considerations in Medical Treatment
What should be monitored in the post-operative period for special patient groups?
Ongoing blood loss, and surgical re-exploration must not be delayed if bleeding is suspected.
p.5
Legal and Ethical Considerations in Medical Treatment
Do anaesthetists have the right to refuse to undertake elective anaesthesia on Jehovah's Witnesses?
Yes, but they are duty-bound to refer such cases to someone with the appropriate expertise who is willing to be involved.
p.9
Paediatric Anaesthesia Considerations
Why is it important to explain the planned approach to induction to both parent and child?
So they know what to expect, especially during the 'excitatory' phase of gas induction where the child may wriggle and try to push the mask away.
Why should you check for an air leak with the cuff deflated post-operatively?
To ensure there is no laryngeal oedema.
p.14
Paediatric Anaesthesia Considerations
What can be added to Propofol to reduce injection pain?
A small amount of 1% lignocaine can be added to Propofol to reduce injection pain.
p.17
Pregnancy and Anaesthesia Management
What induction drugs are recommended for a 24-week pregnant woman undergoing an appendicectomy?
Thiopentone 5 mg/kg and suxamethonium 2 mg/kg.
p.11
Paediatric Anaesthesia Considerations
Why is it important to prepare anaesthetic and emergency drugs in advance for paediatric patients?
Drugs need to be calculated according to the child's weight and documented, including the volume of the drug.
p.9
Paediatric Anaesthesia Considerations
What are the approximate weight estimates for children under 1 year?
Neonates: 3–3.5 kg, 3 months: 6 kg, 6 months: 7–8 kg, 9 months: 9 kg, 12 months: 10 kg.
p.11
Paediatric Anaesthesia Considerations
What environmental preparation is recommended for paediatric anaesthesia?
Warming the theatre and preparing any warming devices.
p.8
Obesity and Its Impact on Anaesthesia
What type of anaesthetic agents should be used for maintenance in obese patients?
Short-acting anaesthetic agents like desflurane, sevoflurane, propofol, and remifentanil.
p.2
Legal and Ethical Considerations in Medical Treatment
What are the legal consequences for a doctor who wilfully transfuses a Jehovah's Witness against their wishes?
The doctor is liable to criminal and civil prosecution for assault and could be subject to GMC disciplinary proceedings.
p.17
Pregnancy and Anaesthesia Management
Why is it important to avoid hypoxia or hypercarbia during surgery for a pregnant woman?
Hypoxia can lead to fetal hypoxia, and hypercarbia can result in fetal respiratory acidosis as CO2 passes freely across the placenta.
p.19
Pre-operative Assessment for Jehovah's Witness Patients
How can a collaborative history be useful in the pre-operative assessment of elderly patients?
A collaborative history from family members or carers can provide important medical information.
p.18
Pregnancy and Anaesthesia Management
Are amide local anaesthetics teratogenic?
No, they are not teratogenic.
p.9
Paediatric Anaesthesia Considerations
Why is the pre-operative visit important for paediatric patients?
It is important to develop trust and rapport with the child and parent, and to alleviate parental and child anxiety.
p.19
Elderly Patient Care in Anaesthesia
Why can't age alone be used as a sole indicator of peri-operative risk in elderly patients?
Because elderly patients are not a homogenous group and a 20-year-old can have more significant co-morbidities than a 90-year-old.
p.8
Obesity and Its Impact on Anaesthesia
What type of laryngoscope is recommended for obese patients?
A short-handle laryngoscope with a long blade.
p.17
Pregnancy and Anaesthesia Management
Why should the operating table be placed on a left lateral tilt during induction for a pregnant woman?
To reduce the risk of aorto-caval compression by the gravid uterus.
p.18
Pregnancy and Anaesthesia Management
Which volatile agents are generally advocated for use during pregnancy?
Isoflurane or sevoflurane.
p.11
Paediatric Anaesthesia Considerations
What is the MAC value of sevoflurane in infants, children, and adults?
3.3 in infants, 2.5 in children, and 1.7 in adults.
p.17
Pregnancy and Anaesthesia Management
Which muscle relaxants are recommended for maintaining relaxation during surgery in pregnant women?
Atracurium, rocuronium, or vecuronium, as they do not cross the placenta in significant amounts.
p.16
Pregnancy and Anaesthesia Management
What is the effect of anaesthesia on pregnancy less than 2 weeks' gestation?
Anaesthesia will have an 'all or nothing effect' on the pregnancy, i.e., it will continue apparently unaffected or will be lost.
p.16
Pregnancy and Anaesthesia Management
What is the risk of anaesthesia during the third trimester?
Increased risk of precipitating premature labour.
p.9
Paediatric Anaesthesia Considerations
What should be covered in the medical and anaesthetic history for paediatric patients?
Preterm/term baby status, developmental milestones, medical conditions including congenital anomalies, recent respiratory illness, current medication, recent immunisations, allergies, any previous problems with anaesthetics including family history, loose teeth, and fasting times.
p.9
Paediatric Anaesthesia Considerations
What is the significance of gaining consent for suppositories in paediatric anaesthesia?
It ensures that parents are informed and agree to the use of suppositories for their child's treatment.
p.19
Elderly Patient Care in Anaesthesia
Who should make the decision to operate on an elderly patient?
The decision should be made at consultant level in conjunction with the patient, family, and multidisciplinary team (MDT).
p.14
Paediatric Anaesthesia Considerations
Why do opioids require caution in preterm babies and neonates?
Opioids require caution due to increased sensitivity from reduced protein binding, reduced hepatic metabolism, and an immature blood-brain barrier, increasing the risk of apnoea.
p.12
Paediatric Anaesthesia Considerations
What are the challenges of intravenous induction in toddlers?
Gaining intravenous access can be challenging, especially in toddlers with chubby hands and feet. Patients may also desaturate more quickly compared with a gas induction.
p.10
Paediatric Anaesthesia Considerations
What analgesic pre-medications are becoming more routinely used in children?
Paracetamol and ibuprofen.
p.17
Pregnancy and Anaesthesia Management
Which vasopressors are considered for use in obstetric anaesthesia, and why?
Ephedrine, phenylephrine, and metaraminol. Ephedrine is thought to have the least effect on placental blood flow, although phenylephrine and metaraminol are used as first-line therapies in many units.
p.12
Paediatric Anaesthesia Considerations
When should infants be intubated?
All infants less than 5 kg or under 44 weeks gestational age should be intubated.
p.4
Legal and Ethical Considerations in Medical Treatment
What is 'Gillick-competence'?
It refers to a child's ability to understand information, weigh it, make a decision, and communicate that decision, allowing them to give consent to treatment.
p.13
Paediatric Anaesthesia Considerations
What alert did the NPSA release in 2007 regarding paediatric patients?
The NPSA released an alert on the risk of hyponatraemia in children receiving intravenous fluids.
p.13
Paediatric Anaesthesia Considerations
How does decreased lean body mass in children affect pharmacokinetics?
It affects the volume of distribution and drug metabolism.
p.19
Elderly Patient Care in Anaesthesia
What report highlighted the substandard peri-operative care elderly patients were receiving?
NCEPOD’s 2010 report on ‘Elective and Emergency Surgery in the Elderly’.
p.11
Paediatric Anaesthesia Considerations
What breathing circuit is used for paediatric patients below 20 kg?
The T-piece breathing circuit, specifically the Mapleson F system or Ayre’s T-piece with Jackson Rees modification.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
Why do Jehovah's Witnesses maintain political neutrality?
They believe that only God, not government, should be in the ultimate position of authority.
p.6
Obesity and Its Impact on Anaesthesia
What is the formula for calculating BMI?
BMI = weight (kg) / height (m^2)
p.19
Pre-operative Assessment for Jehovah's Witness Patients
What challenges might arise during the pre-operative assessment of elderly patients?
Challenges include deafness, aphasia, cognitive impairment, dementia, and patients being poor historians.
p.16
Pregnancy and Anaesthesia Management
When is the ideal time to perform surgery if it cannot be delayed until after delivery?
During the second trimester.
p.14
Paediatric Anaesthesia Considerations
When is intraosseous (IO) access used and why is it important?
Intraosseous access is used in emergency settings when intravenous access cannot be gained, and it can be life-saving.
p.7
Obesity and Its Impact on Anaesthesia
How does obesity affect stomach emptying and intra-abdominal pressure?
Obesity decreases the rate of stomach emptying and raises intra-abdominal pressure, which can cause compartment syndrome.
p.10
Paediatric Anaesthesia Considerations
What factors should be considered when deciding to postpone or proceed with surgery in a child with an upper respiratory tract infection (URTI)?
The child's age, co-morbidities, presenting symptoms, urgency, and type of surgery.
p.6
Obesity and Its Impact on Anaesthesia
What are the respiratory complications associated with obesity during anaesthesia?
Increased O2 consumption and CO2 production, decreased chest wall compliance, decreased functional residual capacity (FRC), increased incidence of obstructive sleep apnoea (OSA), obesity hypoventilation syndrome, increased incidence of asthma, increased incidence of pulmonary hypertension, high risk of peri-operative hypoxia.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How are the pharmacokinetics of sevoflurane and desflurane affected in obese patients?
The pharmacokinetics of sevoflurane and desflurane are not significantly altered.
p.12
Paediatric Anaesthesia Considerations
How can the occurrence of laryngospasm at extubation be minimized?
By ensuring the child is fully awake at the time of extubation.
p.13
Paediatric Anaesthesia Considerations
Why are hypotonic solutions not routinely used in children since 2007?
Because of the risk of hyponatraemia.
p.13
Paediatric Anaesthesia Considerations
What is the maintenance fluid requirement for the first 10 kg of a child's body weight?
4 mL/kg/h (or 100 mL/kg/24 h).
p.13
Paediatric Anaesthesia Considerations
How does increased cardiac output and alveolar ventilation in children affect drug uptake and distribution?
It increases drug uptake and distribution.
p.8
Obesity and Its Impact on Anaesthesia
What should be anticipated regarding intravenous access in obese patients?
Difficult intravenous access; use ultrasound if necessary.
p.9
Paediatric Anaesthesia Considerations
What should be explained to parents regarding post-operative care for paediatric patients?
Post-operative pain management.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
What is the psychological impact of giving blood products to a Jehovah's Witness against their will?
It has been likened to the assault of rape in terms of its psychological impact.
p.16
Pregnancy and Anaesthesia Management
What are the general risks associated with general anaesthesia during pregnancy?
Increased risk of intrauterine growth retardation, early labour, and early infant death.
p.18
Pregnancy and Anaesthesia Management
Why is propofol often used as the first line induction agent for pregnant women despite manufacturer warnings?
Because it does not alter uterine blood flow and is familiar to anaesthetists, along with the decline in the use of thiopentone.
p.14
Paediatric Anaesthesia Considerations
What increases the risk of toxicity with local anaesthetics in infants?
Decreased protein binding and reduced metabolism increase the risk of toxicity with local anaesthetics in infants.
p.8
Obesity and Its Impact on Anaesthesia
What post-operative care should be considered for obese patients?
Admit to a suitable level of care based on risk assessment, thromboprophylaxis, multimodal analgesia, and early physiotherapy and mobilisation.
p.7
Obesity and Its Impact on Anaesthesia
What gastrointestinal issues are more common in obese patients?
Increased incidence of hiatus hernia, gastro-oesophageal reflux disease, fatty liver, and cirrhosis.
p.4
Legal and Ethical Considerations in Medical Treatment
Can a 'Gillick-competent' child refuse life-saving treatment?
In practical terms, courts have never upheld a child's refusal of life-saving treatment.
p.16
Pregnancy and Anaesthesia Management
What should be considered regarding the type of surgery proposed for a pregnant woman?
Whether regional anaesthetic techniques would be appropriate.
p.4
Legal and Ethical Considerations in Medical Treatment
What should be done if there is a conflict between a 16-18 year old patient's wishes and their parents' wishes regarding treatment?
The patient's choice to refuse should be respected if they understand the consequences, but legal advice should be sought if time permits.
p.3
Jehovah's Witnesses and Blood Transfusion Refusal
What is important to document clearly when discussing treatment with a Jehovah's Witness patient?
All discussions with the patient.
p.15
Paediatric Anaesthesia Considerations
What is the IV dose of Paracetamol for paediatric patients weighing more than 10 kg?
15 mg/kg (max 90 mg/kg/day)
p.15
Paediatric Anaesthesia Considerations
What is the dose of Ibuprofen for paediatric patients older than 6 months and weighing more than 7 kg?
5 mg/kg (max 30 mg/kg/day)
p.13
Paediatric Anaesthesia Considerations
What is the maintenance fluid requirement for each subsequent kg of a child's body weight?
1 mL/kg/h (or 20 mL/kg/24 h).
p.8
Obesity and Its Impact on Anaesthesia
What type of intubation should be considered for obese patients?
Awake fibre-optic intubation.
p.6
Obesity and Its Impact on Anaesthesia
How is obesity classified?
Obesity is classified in terms of the body mass index (BMI).
p.8
Obesity and Its Impact on Anaesthesia
What should be ensured regarding pressure areas during maintenance for obese patients?
Ensure pressure areas are padded and monitored.
p.14
Paediatric Anaesthesia Considerations
How does atracurium's pharmacokinetics change in infants?
Atracurium has an increased volume of distribution but also increased clearance, resulting in very little change in overall pharmacokinetics.
p.2
Pre-operative Assessment for Jehovah's Witness Patients
What is important to discuss with a Jehovah's Witness patient before planning anaesthetic and blood loss prevention strategies?
Their individual beliefs regarding acceptable and unacceptable treatments.
p.16
Pregnancy and Anaesthesia Management
Why should anaesthesia be avoided during 3-8 weeks' gestation?
Because organogenesis takes place during this period.
p.12
Paediatric Anaesthesia Considerations
What type of laryngoscope blade is recommended for neonates and infants?
Straight blades (Robertshaw or Miller).
p.6
Obesity and Its Impact on Anaesthesia
What are the airway complications associated with obesity during anaesthesia?
Higher incidence of difficult face mask ventilation and difficult intubation.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How is ideal body weight calculated for adult males and females?
For adult males: Height (cm) – 100. For adult females: Height (cm) – 105.
p.12
Paediatric Anaesthesia Considerations
How should the correct placement of an ETT be confirmed?
With auscultation and ETCO2 monitoring.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
Who should be allocated to anaesthetize Jehovah's Witness patients?
A consultant who is happy to anaesthetize Jehovah's Witnesses.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
What should be done if no advanced directive exists for a Jehovah's Witness patient lacking capacity?
Act in the perceived best interests of the patient, which can mean giving blood/blood products if truly life-saving.
p.18
Pregnancy and Anaesthesia Management
What is the main concern with the use of nitrous oxide during pregnancy?
It inhibits methionine-synthase and tetrahydrofolate reductase and has been shown to be teratogenic in rats at high concentrations for prolonged periods.
p.11
Paediatric Anaesthesia Considerations
What should be done prior to siting an airway during gas induction in paediatric patients?
Intravenous access must be secured to avoid the risk of laryngospasm.
p.16
Pregnancy and Anaesthesia Management
Why is elective surgery contraindicated during pregnancy?
Due to the increased risks of intrauterine growth retardation, early labour, and early infant death.
p.8
Obesity and Its Impact on Anaesthesia
What is the recommended extubation position for obese patients?
Awake and sitting up; consider extubating onto CPAP.
p.17
Pregnancy and Anaesthesia Management
What should guide fluid administration during surgery for a pregnant woman?
Clinical parameters such as blood pressure, heart rate, and urine output.
p.16
Pregnancy and Anaesthesia Management
What is the risk associated with anaesthesia after 8 weeks' gestation?
Risk of growth retardation.
p.15
Paediatric Anaesthesia Considerations
What is the dose of Adrenaline for cardiac arrest in paediatric patients?
10 mcg/kg or 0.1 ml/kg of 1:10,000 solution
p.16
Pregnancy and Anaesthesia Management
Whose needs must take priority when considering anaesthesia for a pregnant woman?
The mother's needs must take priority.
p.12
Paediatric Anaesthesia Considerations
How should the appropriate length of an oral ETT be calculated?
Oral ETT length (in cm) = Age/2 + 12.
p.7
Pre-operative Assessment for Jehovah's Witness Patients
What should be included in the pre-operative assessment for an obese patient?
Involve a multi-disciplinary team, allocate sufficient time, assess co-morbidities, conduct thorough airway assessment, consider regional techniques, optimize the patient, liaise with critical care, ensure a senior anaesthetist is available, and inform theatres to ensure bariatric equipment is available.
p.3
Anaesthetic Techniques for Jehovah's Witness Patients
Why might it be sensible to stagger operations for Jehovah's Witness patients?
To allow for haematological recovery in between each one.
p.11
Paediatric Anaesthesia Considerations
What is a good technique for anaesthesia induction in neonates and infants?
Inhalational gas induction using an oxygen-sevoflurane mix.
p.19
Elderly Patient Care in Anaesthesia
What should be arranged for elderly patients post-operatively?
A suitable level of post-operative care, such as HDU (High Dependency Unit) or ITU (Intensive Therapy Unit).
p.18
Pregnancy and Anaesthesia Management
What is the characteristic of non-depolarising muscle relaxants in pregnancy?
They are non-teratogenic and do not cross the placenta well, but their duration of action may be prolonged due to altered hepatic metabolism.
p.12
Paediatric Anaesthesia Considerations
Why is pre-oxygenation important in small children before induction?
Pre-oxygenation should be undertaken if possible, especially if rapid sequence induction is planned, to prevent desaturation.
p.4
Legal and Ethical Considerations in Medical Treatment
What therapy has been reported for use in the face of very low hemoglobins, although not widely available?
Hyperbaric oxygen therapy.
p.6
Obesity and Its Impact on Anaesthesia
What are the metabolic complications associated with obesity during anaesthesia?
Increased incidence of type 2 diabetes mellitus.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How should fentanyl and morphine be dosed in obese patients?
Fentanyl: use actual body weight. Morphine: use ideal body weight.
p.13
Paediatric Anaesthesia Considerations
What type of intravenous maintenance fluid should be used peri-operatively in children?
A balanced, isotonic solution.
p.3
Anaesthetic Techniques for Jehovah's Witness Patients
How can regional techniques help in surgeries for Jehovah's Witness patients?
They can help reduce blood loss and allow the awake patient to change their mind about receiving blood/blood products if bleeding becomes life-threatening.
p.13
Paediatric Anaesthesia Considerations
Why are gas inductions faster in children?
Due to increased alveolar ventilation compared with FRC, high cardiac output, lower blood/gas solubility, and lower tissue/blood solubility of volatile agents.
p.10
Paediatric Anaesthesia Considerations
When is oral sedative pre-medication like midazolam useful in children?
In children who are very anxious or likely to be uncooperative.
p.10
Paediatric Anaesthesia Considerations
What should be applied to identifiable veins if an intravenous induction is planned?
EMLA or amethocaine (Ametop) cream.
p.14
Paediatric Anaesthesia Considerations
What are some complications of intraosseous access?
Complications include infection, extravasation, dislodgement of needle, embolism, compartment syndrome due to extravasation, fracture, and pain.
p.10
Paediatric Anaesthesia Considerations
When should a chest X-ray (CXR) be considered in paediatric patients?
If there is significant active respiratory disease, scoliosis, or congenital heart disease.
p.12
Paediatric Anaesthesia Considerations
Why are uncuffed tubes typically used until 8-10 years of age?
To minimize the risk of damage to the trachea.
p.10
Paediatric Anaesthesia Considerations
When should surgery be postponed for at least 4 weeks in a child with a URTI?
If the child has purulent nasal discharge, productive cough, fever, or clinical signs suggesting lower respiratory tract involvement such as desaturation or wheeze.
p.16
Pregnancy and Anaesthesia Management
What must be taken into consideration when choosing anaesthetic drugs for a pregnant woman?
The potential effects of the drugs on the fetus.
p.15
Paediatric Anaesthesia Considerations
What is the IV dose of Paracetamol for neonates and infants weighing less than 10 kg?
10 mg/kg (max 60 mg/kg/day)
p.13
Paediatric Anaesthesia Considerations
Do healthy children undergoing short operations (<1 hour) usually require fluids?
No, if pre-operative fasting has not been excessive.
p.10
Paediatric Anaesthesia Considerations
Why is buccal midazolam gaining popularity over oral midazolam?
Because its onset time is quicker (20 minutes).
p.10
Paediatric Anaesthesia Considerations
When should haemoglobin levels be checked in paediatric patients?
If large blood loss is expected, in premature infants, systemic disease, or congenital heart disease.
p.14
Paediatric Anaesthesia Considerations
What are the contraindications for intraosseous access?
Contraindications include fracture of the target bone, recent IO access (in the last 24–48 hours), signs of infection at the insertion site, and osteogenesis imperfecta.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How does obesity alter pharmacokinetics?
Obesity alters the volume of drug distribution (Vd) and elimination.
p.4
Legal and Ethical Considerations in Medical Treatment
According to the Mental Capacity Act 2005, what is assumed about patients aged 16 and over?
They are assumed to have the capacity to make decisions regarding their treatment.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How should the dose of thiopentone be calculated for obese patients?
The suggested dose is 7.5 mg/kg based on ideal body weight.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
What should be done as soon as a Jehovah's Witness is included on a surgical list?
Their wishes should be discussed and the best anaesthetic/surgical technique planned.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
What should be done if a Jehovah's Witness patient has lost 'capacity' by the time of presentation for emergency surgery?
Efforts should be made to find their advanced directive, often lodged with their GP.
p.13
Paediatric Anaesthesia Considerations
What is the maintenance fluid requirement for the next 10 kg of a child's body weight?
2 mL/kg/h (or 50 mL/kg/24 h).
p.13
Paediatric Anaesthesia Considerations
How does increased sensitivity to thiopentone affect children?
It leads to a more prolonged recovery due to reduced volume of distribution and redistribution.
p.2
Jehovah's Witnesses and Blood Transfusion Refusal
Which treatments might be acceptable to some Jehovah's Witnesses?
Blood salvage, dialysis, haemodilution, cardio-pulmonary bypass (non-blood-primed circuit), blood fractions (e.g., albumin, immunoglobulins, clotting factors), transplanted organs, and epidural blood patches.
p.17
Pregnancy and Anaesthesia Management
What analgesics should be provided intra-operatively for a pregnant woman, and which should be avoided?
Provide analgesia with paracetamol and morphine. Avoid NSAIDs in the third trimester as they promote closure of the ductus arteriosus.
p.18
Pregnancy and Anaesthesia Management
Are opioids considered safe for use during pregnancy?
Yes, at appropriate doses.
p.4
Legal and Ethical Considerations in Medical Treatment
What may be required for patients who have suffered excessive blood loss post-operatively?
They may need to be electively ventilated to optimize their oxygen delivery.
p.16
Pregnancy and Anaesthesia Management
What are the concerns regarding exposure to anaesthesia and neurodevelopment?
Exposure to anaesthesia may adversely affect neurodevelopment in the developing brain, though there is limited data.
p.4
Legal and Ethical Considerations in Medical Treatment
What should be done in a life-threatening emergency if a child needs treatment against the parents' wishes?
The child should be treated with whatever means necessary to preserve life.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How should propofol be dosed for induction and maintenance in obese patients?
Induction dose should be based on ideal body weight. For maintenance (TIVA), calculate dose using actual body weight.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
How should suxamethonium and rocuronium be dosed in obese patients?
Suxamethonium: use actual body weight. Rocuronium: use ideal body weight.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
Why should the risks of surgery be discussed with the Jehovah's Witness patient alone?
So that they are under no duress from other members of the church when making decisions about their treatment.
p.13
Paediatric Anaesthesia Considerations
What is the total body water (TBW) percentage at birth compared to adults?
85% at birth vs 60% in adults.
p.11
Paediatric Anaesthesia Considerations
What should parents be informed about regarding the induction phase of anaesthesia?
There is often an excitatory phase during induction, which can be worrying unless explained beforehand.
p.12
Paediatric Anaesthesia Considerations
What are the best sites for intravenous access in children?
The back of the hand, inner wrist, long saphenous vein, and veins on the dorsum of the foot.
p.14
Paediatric Anaesthesia Considerations
What anatomical landmarks are used for intraosseous access in the tibia and femur?
For the tibia: medial side, 2–3 cm below the tibial tuberosity. For the femur: 3 cm above the lateral condyle.
p.7
Obesity and Its Impact on Anaesthesia
What haematological condition has a higher incidence in obese patients?
Higher incidence of venous thromboembolism.
p.16
Pregnancy and Anaesthesia Management
Who should be involved in the discussion and execution of surgery on a pregnant woman?
A senior anaesthetist and a senior surgeon who can complete the procedure in a timely manner.
p.6
Obesity and Its Impact on Anaesthesia
What are the cardiovascular complications associated with obesity during anaesthesia?
Increased blood volume and cardiac output, increased incidence of ischaemic heart disease, arrhythmias, hypertension, hyperlipidaemia, heart failure, and cor pulmonale.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
What is the risk associated with halothane in obese patients?
Increased reductive hepatic metabolism, increasing the risk of halothane hepatitis.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
What must be documented meticulously when making decisions for a Jehovah's Witness patient lacking capacity?
The decision-making process, and a consultant must be involved.
p.13
Paediatric Anaesthesia Considerations
What type of analgesia should be added where appropriate for paediatric patients?
Regional analgesia (e.g., caudal for urological, inguinal hernia and lower limb procedures, axillary blocks for upper limb surgery).
p.12
Paediatric Anaesthesia Considerations
Which drugs can be used for intravenous induction in children?
Propofol, thiopentone, or ketamine.
p.10
Paediatric Anaesthesia Considerations
When should electrolytes be checked in paediatric patients?
If there is renal or metabolic disease or dehydration.
p.12
Paediatric Anaesthesia Considerations
How can the internal diameter (ID) size of an uncuffed endotracheal tube (ETT) be estimated for children aged 1 to 10 years?
Using the formula: ETT size = Age/4 + 4.5.
p.4
Legal and Ethical Considerations in Medical Treatment
What happens if both parents and a 'Gillick-competent' child refuse a blood transfusion?
The medical team can apply for a 'Special Issue Order' via the High Court to give treatment.
p.16
Pregnancy and Anaesthesia Management
Why should a laryngeal mask airway not be used beyond the first trimester?
Because stomach emptying may be delayed from 12 weeks onwards; patients should be intubated.
p.4
Legal and Ethical Considerations in Medical Treatment
What potential conflict could arise for patients aged 16-18 years who are Jehovah's Witnesses?
The patient may refuse blood products while the parents want them to be transfused.
p.3
Anaesthetic Techniques for Jehovah's Witness Patients
What are some options to consider for minimising blood loss in Jehovah's Witness patients?
Arterial tourniquets, careful positioning, hypotensive anaesthesia, vasoconstrictors, haemodilution, meticulous haemostasis, optimising clotting, cell salvage, and drugs that promote clotting.
p.13
Paediatric Anaesthesia Considerations
How does decreased plasma protein binding (PPB) in children affect drug pharmacokinetics?
It can lead to increased free drug concentration.
p.17
Pregnancy and Anaesthesia Management
What are the considerations for fetal monitoring during surgery for a pregnant woman?
Monitoring is useful only if it will change management. If the fetus is viable, monitoring may be considered, but the CTG trace may lose variability due to general anaesthesia. Someone must be present to interpret the monitoring and make necessary decisions.
p.7
Pharmacokinetics and Pharmacodynamics in Obese Patients
What should be considered when calculating drug doses for obese patients?
The use of ‘ideal’ or ‘actual’ body weight during drug dose calculation must be considered.
p.12
Paediatric Anaesthesia Considerations
What is the appropriate internal diameter (ID) size and length for ETT in neonates?
ID size is 3-3.5 and length is 8-10 cm.
p.3
Jehovah's Witnesses and Blood Transfusion Refusal
Who can Jehovah's Witness patients discuss blood products and strategies with?
A committee of elders called the 'Hospital Liaison Committee for Jehovah's Witnesses'.
p.3
Jehovah's Witnesses and Blood Transfusion Refusal
What special form must be used for Jehovah's Witness patients to record their specific wishes?
A special consent form for Jehovah's Witnesses.
p.3
Pre-operative Assessment for Jehovah's Witness Patients
What must be done with the decisions made following a consultation with a Jehovah's Witness patient?
Entered in the notes, dated, timed, and signed by both the doctor and the patient.
p.13
Paediatric Anaesthesia Considerations
When should children receive intravenous fluids during surgery?
During intra-abdominal surgery or when there is anticipated blood loss.
p.13
Paediatric Anaesthesia Considerations
What should be done regarding pre-medication for paediatric patients?
Pre-medicate where possible.
p.13
Paediatric Anaesthesia Considerations
How does increased total body water (TBW) in children affect drug dosing?
It requires a higher initial dose.
p.13
Paediatric Anaesthesia Considerations
How should peri-operative fluid requirements be calculated for children?
By adding fluid lost during the pre-operative fasting period and intra-operative losses to the maintenance fluid requirements.
