Tiêu đề peri-operative.pdf ✅

A 48 year old lady has a metallic heart valve and requires a paraumbilical hernia repair. Perioperatively she is receiving intra venous unfractionated heparin. To perform the surgery safely a normal coagulation state is required. Which of the following strategies is routine standard practice? Administration of 10 mg of vitamin K the night prior to surgery and stopping the heparin infusion 6 hours pre operatively Stopping the heparin infusion 6 hours pre operatively Stop the heparin infusion on induction of anaesthesia Stopping the heparin infusion 6 hours pre operatively and administration of intravenous protamine sulphate on commencing the operation None of the above Patients with metallic heart valves will generally stop unfractionated heparin 6 hours pre operatively. Unfractionated heparin is generally cleared from the circulation within 2 hours so this will allow plenty of time and is the method of choice in the elective setting. Protamine sulphate will reverse heparin but is associated with risks of anaphylaxis and is thus not generally used unless immediate reversal of anticoagulation is needed, e.g. coming off bypass. Heparin Causes the formation of complexes between antithrombin and activated thrombin/factors 7,9,10,11 & 12 Advantages of low molecular weight heparin Question 1 of 64   Please rate this question:  Discuss and give feedback Next question  gathered by dr. elbarky, for free, not intended for profit by anybody elsewhere.
Better bioavailability Lower risk of bleeding Longer half life Little effect on APTT at prophylactic dosages Less risk of HIT Complications Bleeding Osteoporosis Heparin induced thrombocytopenia (HIT): occurs 5-14 days after 1st exposure Anaphylaxis In surgical patients that may need a rapid return to theatre, administration of unfractionated heparin is preferred; as low molecular weight heparins have a longer duration of action and are harder to reverse. Display my notes on this topic Save my notes Next question             Question stats A 15% B 45.4% C 10.7% D 20.7% E 8.3% 45.4% of users answered this question correctly Search eMRCS gathered by dr. elbarky, for free, not intended for profit by anybody elsewhere.
A 63 year old lady is undergoing colonoscopy with midazolam sedation. Her respiratory rate slows and she becomes hypoxic and the decision is made to reverse her sedation. What is the most appropriate agent to administer? Flumazenil Doxapram Naloxone Procyclidine Etomidate Flumazenil antagonises the effects of benzodiazepines by competition at GABA binding sites. Since many benzodiazepines have longer half lives than flumazenil patients still require close monitoring after receiving the drug. Whilst doxapram would increase the respiratory rate, it is not an agent for reversal of midazolam. Anaesthetic agents The table below summarises some of the more commonly used IV induction agents Agent Specific features  Question 2 of 64   Please rate this question:  Discuss and give feedback Next question  gathered by dr. elbarky, for free, not intended for profit by anybody elsewhere.
Propofol Rapid onset of anaesthesia Pain on IV injection Rapidly metabolised with little accumulation of metabolites Proven anti emetic properties Moderate myocardial depression Widely used especially for maintaining sedation on ITU, total IV anaesthesia and for daycase surgery Sodium thiopentone Extremely rapid onset of action making it the agent of choice for rapid sequence of induction Marked myocardial depression may occur Metabolites build up quickly Unsuitable for maintenance infusion Little analgesic effects Ketamine May be used for induction of anaesthesia Has moderate to strong analgesic properties Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable May induce state of dissociative anaesthesia resulting in nightmares Etomidate Has favorable cardiac safety profile with very little haemodynamic instability No analgesic properties Unsuitable for maintaining sedation as prolonged (and even brief) use may result in adrenal suppression Post operative vomiting is common Display my notes on this topic Save my notes Next question             gathered by dr. elbarky, for free, not intended for profit by anybody elsewhere.