p.12
Management of Intra-operative Tachyarrhythmias
What is the initial treatment for critical incidents with onset less than 24 hours and normal haemodynamics?
Heparinise and administer amiodarone IV 300 mg over 1 hour; consider flecainide.
p.3
Management of Malignant Hyperpyrexia
What is malignant hyperpyrexia classified as?
An anaesthetic emergency.
p.4
Needlestick Injury Protocols
What are the implications of a needlestick injury?
Disease transmission, impact on employment, anxiety, and psychological strain while waiting for test results.
p.1
Local Anaesthetic Toxicity Management
What should be done regarding the administration of local anaesthetic in case of toxicity?
Stop injecting the local anaesthetic.
p.10
Management of Intra-operative Tachyarrhythmias
What are some patient factors that increase the risk of intra-operative tachyarrhythmias?
Pre-existing cardiac disease, pre-existing arrhythmia, electrolyte disturbances, and endocrine disease.
p.9
ST Segment Changes in ECG
What does the ST segment of the ECG represent?
Repolarisation of the ventricles.
p.3
Management of Malignant Hyperpyrexia
How should you ventilate the patient during malignant hyperpyrexia management?
Begin hand hyperventilation with 100% oxygen to reduce PaCO2.
p.14
Management of Venous Air Embolism
What should be administered to the patient during a vAE?
100% oxygen and discontinue nitrous oxide.
p.8
Post-Dural Puncture Headache Causes and Management
What should women be warned about before the blood patch procedure?
They often complain of back pain.
p.10
Management of Intra-operative Tachyarrhythmias
What types of pre-existing cardiac conditions can increase the risk of intra-operative tachyarrhythmias?
Ischaemic heart disease and valvular heart disease.
p.10
Management of Intra-operative Tachyarrhythmias
What are some anaesthetic factors that can affect cardiac function during surgery?
Drug-induced alterations in preload, contractility, afterload, and effects on coronary perfusion pressure.
p.9
ST Segment Changes in ECG
What are the common causes of myocardial ischaemia intra-operatively?
Rate-related ischaemia and hypotension.
p.1
Local Anaesthetic Toxicity Management
How should the airway be managed in local anaesthetic toxicity?
Maintain and, if necessary, secure the airway with a cuffed endotracheal tube.
p.13
Venous Air Embolism Risk Factors and Diagnosis
What is venous air embolism (VAE)?
A potential complication of many surgical procedures that can range from sub-clinical to life-threatening cardiovascular collapse.
p.13
Venous Air Embolism Risk Factors and Diagnosis
What are the primary symptoms and signs of VAE?
Cardiovascular collapse symptoms such as hypotension, tachycardia, arrhythmias, and arterial desaturation.
p.4
Needlestick Injury Protocols
What should you do with the wound after a needlestick injury?
Encourage free bleeding and wash the wound with soap and water (do not scrub or suck).
p.9
ST Segment Changes in ECG
What should be assessed in a patient with ST segment changes?
Look for precipitating causes like hypoxia, tachycardia, hypotension, and acute blood loss.
p.14
Management of Venous Air Embolism
What position should the patient be placed in to help manage a vAE?
Left lateral head-down position, if feasible.
p.6
Post-Dural Puncture Headache Causes and Management
What is the immediate management step if a dural puncture is suspected?
Confirm the dural puncture by checking for CSF leakage or testing the fluid's characteristics.
p.9
ST Segment Changes in ECG
What is the goal of managing ST segment changes intra-operatively?
To correct and optimise coronary blood flow and reduce myocardial work.
p.11
Management of Intra-operative Tachyarrhythmias
What is the management for critical atrial fibrillation with a ventricular rate >150?
Heparinize if feasible, administer synchronized DC cardioversion, and give amiodarone.
p.7
Post-Dural Puncture Headache Causes and Management
What should be done if a woman develops a headache during labor?
Assisted delivery may be advised to avoid excessive pushing that might worsen the CSF leak.
p.13
Venous Air Embolism Risk Factors and Diagnosis
What are some surgical procedures associated with a high risk of VAE?
Neurosurgery (especially in the sitting position), laparoscopic surgery, head and neck surgery, orthopedic surgery, and insertion of intravascular devices.
p.8
Post-Dural Puncture Headache Causes and Management
What is the ideal location to perform a blood patch?
As close to the puncture site as possible, ideally one space below.
p.14
Management of Venous Air Embolism
What is the first step in managing a suspected venous air embolism (vAE)?
Call for senior anaesthetic assistance and make a rapid but thorough assessment of the patient.
p.10
Management of Intra-operative Tachyarrhythmias
What is the general management principle for intra-operative tachyarrhythmias?
Consider calling for assistance based on the haemodynamic consequences of the arrhythmia.
p.14
Management of Venous Air Embolism
How can the surgeon help prevent further embolisation during a vAE?
By compressing the surgical site or flooding it with saline.
p.14
Management of Venous Air Embolism
Why should nitrous oxide be discontinued during a vAE?
Because it increases bubble size due to its high solubility.
p.5
Needlestick Injury Protocols
What should you do if you are a known responder to hepatitis B?
You should be given a hepatitis B vaccine booster.
p.6
Post-Dural Puncture Headache Causes and Management
What should be done once a dural puncture is confirmed?
Remove the needle/catheter and re-site the epidural at a different interspace.
p.14
Management of Venous Air Embolism
What should be done with the surgery during a vAE?
Terminate surgery as soon as safely possible.
p.7
Post-Dural Puncture Headache Causes and Management
What should be prescribed to avoid raising intracranial pressure (ICP) in patients with PDPH?
Laxatives to avoid straining at stool.
p.12
Management of Intra-operative Tachyarrhythmias
What is the treatment for low-risk AF with a ventricular rate less than 100 and onset less than 24 hours?
Heparinise and administer amiodarone IV 300 mg over 1 hour; consider flecainide.
p.10
Management of Intra-operative Tachyarrhythmias
What surgical factors can lead to intra-operative tachyarrhythmias?
Pneumoperitoneum effects, hypercapnia, rapid fluid shifts, and systemic inflammatory response syndrome (SIRS).
p.13
Venous Air Embolism Risk Factors and Diagnosis
What is the significance of transoesophageal echocardiography (TOE) in diagnosing VAE?
It is possibly the gold standard for localizing air to a specific cardiac chamber while assessing cardiac function.
p.11
Management of Intra-operative Tachyarrhythmias
What is the fastest method to obtain potassium concentration in cases of tachyarrhythmias?
Arterial blood gas analysis.
p.10
Management of Intra-operative Tachyarrhythmias
What types of arrhythmias may develop during surgery?
Benign arrhythmias like occasional ventricular ectopics or potentially malignant arrhythmias like ventricular tachycardia.
p.4
Needlestick Injury Protocols
What should be examined during a risk assessment?
Tattoos, needle track marks, and lymphadenopathy.
p.1
Local Anaesthetic Toxicity Management
What is the initial bolus dose of intralipid® 20% for a 70 kg patient?
1.5 mL/kg (100 mL bolus).
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What triggers malignant hyperpyrexia during anaesthesia?
All inhalational agents and depolarising muscle relaxants.
p.12
Management of Intra-operative Tachyarrhythmias
What should be done for critical incidents with onset greater than 24 hours?
Control rate initially with digoxin, verapamil, or β-blockers; heparinise and later perform synchronised DC cardioversion.
p.3
Management of Malignant Hyperpyrexia
What is the purpose of using a 'vapour-free' anaesthetic machine?
To ensure it is free of inhalational agents.
p.3
Management of Malignant Hyperpyrexia
What are some active cooling measures that can be used?
Cold intravenous fluids, cold body cavity lavages, ice packs, and cooling blankets.
p.9
ST Segment Changes in ECG
What is the immediate management for an anaesthetised patient with ST segment changes?
Give 100% oxygen, call for help, and inform surgeons to conclude surgery as soon as possible.
p.5
Needlestick Injury Protocols
What are some serious side effects of PEP agents?
Jaundice, diabetes, vomiting, and profound fatigue.
p.4
Needlestick Injury Protocols
What are the transmission rates for HIV, HCV, and HBV?
0.3% for HIV, 3% for HCV, and 30% for HBV.
p.14
Management of Venous Air Embolism
What documentation is required after managing a vAE?
Document events and complete a critical incident form.
p.14
Management of Venous Air Embolism
What should be explained to the patient after a vAE event?
Explain the event when possible.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What are the two main presentations of malignant hyperpyrexia?
Excessive muscle rigidity and signs of hypermetabolism.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
How quickly can the patient's temperature rise in malignant hyperpyrexia?
By as much as 1 °C every 10 minutes.
p.13
Venous Air Embolism Risk Factors and Diagnosis
How can VAE be diagnosed during high-risk procedures?
By monitoring for audible hissing, ECG changes, capnography, CVP increases, precordial stethoscope sounds, pulmonary artery pressure increases, and using esophageal Doppler or transoesophageal echocardiography.
p.11
Management of Intra-operative Tachyarrhythmias
What is the first step in managing tachyarrhythmias?
Identify and treat the cause of the arrhythmia, such as adjusting the CVP line tip position or correcting electrolyte disturbances.
p.5
Needlestick Injury Protocols
What is the first step to take after a needlestick injury?
Have your blood taken shortly after the injury to confirm your current status.
p.11
Management of Intra-operative Tachyarrhythmias
How can myocardial oxygen delivery be maximized in tachyarrhythmias?
By maintaining arterial oxygen content and coronary perfusion pressure.
p.3
Management of Malignant Hyperpyrexia
What is the initial dose of dantrolene sodium for malignant hyperpyrexia?
1 mg/kg IV, with repeat doses every 5-10 minutes as needed.
p.7
Post-Dural Puncture Headache Causes and Management
What are the advantages of threading the epidural catheter into the subarachnoid space?
Excellent analgesia, no risk of repeating dural puncture, and reduced chance of PDPH due to fibroblast proliferation.
p.4
Needlestick Injury Protocols
What is the purpose of a risk assessment after a needlestick injury?
To identify individuals more likely to be infected with HIV, HBV, or HCV.
p.11
Management of Intra-operative Tachyarrhythmias
What should be done for intermediate atrial fibrillation with a ventricular rate of 100-150 and hemodynamic compromise?
If onset <24 hours, heparinize and administer synchronized DC cardioversion; consider amiodarone.
p.5
Needlestick Injury Protocols
What are the major risk factors associated with the transmission of blood-borne viruses?
Exposure to high-risk fluids, mechanism of injury, type of instrument, and patient viral load.
p.7
Post-Dural Puncture Headache Causes and Management
What should be considered if a woman develops PDPH after 24 hours?
Offering an epidural blood patch to treat it.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What is a common early sign of excessive muscle rigidity in malignant hyperpyrexia?
Masseter spasm following suxamethonium.
p.10
Management of Intra-operative Tachyarrhythmias
How can electrolyte disturbances contribute to intra-operative tachyarrhythmias?
They can be pre-existing or iatrogenic from fluid therapy.
p.6
Post-Dural Puncture Headache Causes and Management
What is a common cause of post-dural puncture headache (PDPH)?
Leakage of cerebrospinal fluid (CSF) from a tear in the dura.
p.10
Management of Intra-operative Tachyarrhythmias
What should be checked to diagnose the arrhythmia and establish its haemodynamic consequences?
Blood pressure and end-tidal CO2.
p.6
Post-Dural Puncture Headache Causes and Management
What is the incidence of accidental dural puncture during epidural anaesthesia?
0–2.6%, inversely proportional to the experience of the anaesthetist.
p.3
Management of Malignant Hyperpyrexia
What should be monitored to manage hyperkalaemia and acidosis?
Regular arterial blood gas analysis and electrolyte measurements.
p.3
Management of Malignant Hyperpyrexia
What is the gold standard diagnostic test for malignant hyperpyrexia?
In vitro muscle contracture testing using caffeine and halothane.
p.12
Management of Intra-operative Tachyarrhythmias
What monitoring is required post-operatively for patients who have suffered significant intra-operative arrhythmias?
Cardiac monitoring in the initial post-operative period, including 12-lead ECG and relevant cardiac follow-up if indicated.
p.5
Needlestick Injury Protocols
When should post-exposure prophylaxis (PEP) be started after a needlestick injury?
Ideally within 1 hour of injury.
p.7
Post-Dural Puncture Headache Causes and Management
What is the preferred approach for managing post-dural puncture headache (PDPH) according to the authors?
Continue and thread the epidural catheter into the subarachnoid space.
p.5
Needlestick Injury Protocols
What is the current treatment for suspected or confirmed exposure to hepatitis C?
There is currently no official treatment.
p.9
ST Segment Changes in ECG
What should be documented after managing a patient with ST segment changes?
Document events clearly in the notes.
p.8
Post-Dural Puncture Headache Causes and Management
What should be offered to the woman after discharge?
A follow-up to ensure there are no ongoing complications.
p.8
Post-Dural Puncture Headache Causes and Management
What should be done before removing the needle after a blood patch?
Flush the needle with 2 mL saline.
p.7
Post-Dural Puncture Headache Causes and Management
What is a disadvantage of managing the spinal catheter for PDPH?
Further management is labor-intensive for the anaesthetist, and all top-up doses must be administered by an anaesthetist.
p.1
Local Anaesthetic Toxicity Management
What is the recommended treatment for seizures in local anaesthetic toxicity?
Use a benzodiazepine (e.g., lorazepam) or small incremental doses of thiopentone or propofol.
p.14
Management of Venous Air Embolism
What should be done if the situation deteriorates during a vAE?
Cardiopulmonary resuscitation (CPR) may become necessary.
p.3
Management of Malignant Hyperpyrexia
What should you do immediately when managing malignant hyperpyrexia?
Call for senior help urgently and inform the theatre team of the emergency.
p.9
ST Segment Changes in ECG
What causes changes in the appearance of the ST segment?
Myocardial ischaemia or myocardial infarction.
p.1
Local Anaesthetic Toxicity Management
What is the first step in managing local anaesthetic toxicity?
Call for senior anaesthetic assistance and make a rapid but thorough assessment of the patient.
p.6
Post-Dural Puncture Headache Causes and Management
What are the typical symptoms of a post-dural puncture headache?
Severe headache, often frontal/occipital/retrobulbar, worsens when sitting or standing, and improves when lying down, with possible nausea, vomiting, and photophobia.
p.6
Post-Dural Puncture Headache Causes and Management
What are the characteristics of cerebrospinal fluid (CSF) compared to saline?
CSF is warm, pH 7.5–8.5, with trace/ + glucose and +/++ protein; saline is cool, pH 5–7.5, with no glucose and no protein.
p.9
ST Segment Changes in ECG
What post-operative actions should be taken for a patient with ST segment changes?
Transfer to high dependency care, perform a 12-lead ECG, and check troponin I levels.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What is the incidence of genetic susceptibility to malignant hyperpyrexia?
Between 1:5000 and 1:10,000.
p.5
Needlestick Injury Protocols
What precautions can be taken to reduce the risk of infection?
Universal precautions, avoid resheathing needles, cover open skin lesions, and hepatitis B vaccination.
p.12
Management of Intra-operative Tachyarrhythmias
What should be done for low-risk AF with onset greater than 24 hours?
Heparinise and then later perform synchronised DC cardioversion.
p.4
Needlestick Injury Protocols
What is the first immediate action to take after sustaining a needlestick injury?
Call for help to relieve you and look after the patient.
p.5
Needlestick Injury Protocols
What is the triple-therapy regime for PEP?
Zidovudine, lamivudine, and indinavir taken for 4 weeks.
p.4
Needlestick Injury Protocols
What should you do after washing the wound from a needlestick injury?
Follow local policy and inform occupational health to report the incident and seek further advice.
p.5
Needlestick Injury Protocols
What should be established regarding hepatitis B status after a needlestick injury?
All healthcare professionals should be vaccinated prior to starting work.
p.14
Management of Venous Air Embolism
What cardiovascular support may be required during a vAE?
Fluid and inotropic support.
p.1
Management of Malignant Hyperpyrexia
What should be done in case of cardiac arrest due to local anaesthetic toxicity?
Commence cardiopulmonary resuscitation (CPR) following advanced life support (ALS) protocols.
p.5
Needlestick Injury Protocols
What should you do after a suspected exposure to blood-borne viruses?
Inform your clinical lead as it may preclude you from performing certain procedures.
p.7
Post-Dural Puncture Headache Causes and Management
What is the recommended conservative treatment for PDPH?
Bed rest and avoiding dehydration.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What are the earliest signs of hypermetabolism in malignant hyperpyrexia?
Unexplained tachycardia, tachypnoea, rising end-tidal CO2, and falling arterial O2 tensions.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What is malignant hyperpyrexia (MH)?
An autosomal dominant disorder of skeletal muscle that is a life-threatening anaesthetic emergency.
p.6
Post-Dural Puncture Headache Causes and Management
Why should only an anaesthetist give top-ups after a dural puncture?
To avoid intrathecal spread of local anaesthetic.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
How do gene mutations affect skeletal muscle in malignant hyperpyrexia?
They affect calcium release channels in the sarcoplasmic reticulum, leading to increased intracellular calcium levels.
p.1
Local Anaesthetic Toxicity Management
What should be done if adequate circulation has not been restored after the initial bolus of intralipid®?
Repeat the bolus injection (100 mL) twice at 5 min intervals.
p.1
Local Anaesthetic Toxicity Management
What follow-up actions should be taken after managing local anaesthetic toxicity?
Inform the patient of the event, complete medical documentation, and report the case to the National Patient Safety Agency (NPSA).
p.11
Management of Intra-operative Tachyarrhythmias
What is the treatment for broad complex tachycardia with a pulse and systolic <90 mmHg?
Synchronized DC cardioversion (up to three shocks) and consider amiodarone.
p.11
Management of Intra-operative Tachyarrhythmias
What should be administered for narrow complex tachycardia if there is a pulse?
Assess hemodynamic consequences and consider vagal maneuvers or adenosine boluses.
p.7
Post-Dural Puncture Headache Causes and Management
What should be the initial dose when topping up the spinal catheter?
Start with doses of 1–2 mL of a standard low-dose mixture (0.125% bupivacaine + 2 μg/mL fentanyl).
p.4
Needlestick Injury Protocols
What history should be taken during a risk assessment?
HIV, HBV, and HCV status, sexuality, intravenous drug use, tattoos, blood transfusions, history of jaundice, and recent travel to high HIV incidence areas.
p.4
Needlestick Injury Protocols
What is required before taking blood for HIV, HBV, and HCV testing?
The patient's consent and appropriate counselling.
p.7
Post-Dural Puncture Headache Causes and Management
Who should perform the blood patch for PDPH?
The most senior anaesthetist available.
p.3
Management of Malignant Hyperpyrexia
What should be documented after an episode of malignant hyperpyrexia?
Events in clinical notes and inform the general practitioner.
p.1
Local Anaesthetic Toxicity Management
How should the infusion of intralipid® 20% be started after the initial bolus?
At 0.25 mL/kg/min (400 mL over 20 min).
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What metabolic changes occur due to excessive muscle rigidity in malignant hyperpyrexia?
Rhabdomyolysis, increased serum potassium, increased creatinine kinase, and potential acute renal failure.
p.2
Malignant Hyperpyrexia Pathophysiology and Recognition
What complications arise from increased oxygen consumption in malignant hyperpyrexia?
Hypoxaemia, cyanosis, metabolic acidosis, and respiratory acidosis.
