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Final basic sciences short case 8

Created: 27/6/2006
Updated: 14/3/2006
1. Why do you require a scavenging system?
- Can you name any other methods of preventing pollution?
- What are the normal acceptable levels of various anaesthetic gases the theatre environment?
- Is it an international system?
- Name the normal parts of the active and passive scavenging system?
- What are the advantages and disadvantages of each?
- What is the Cardiff inhaler?
- What are its advantages and disadvantages?
- Describe the toxicity associated with nitrous oxide (NO)?
- Give details of how NO causes megaloblastic anaemia and subacute combined degeneration of the spinal cord?

2. Describe the anatomy of the cervical plexus.
- Describe the technique for performing cervical plexus block for carotid endarterectomy(both superficial and deep).
- What are the complications of performing this block?
- Describe local anaesthetic toxicity.
- What are the maximum doses that can be used for local anaesthetics?
- What level of bupivacaine causes convulsions?
- What are the advantages and disadvantages of performing carotid endarterectomy with the patient asleep and under local anaesthetic?

3. What are the effects of the following anaesthetic drugs on cerebral blood flow (CBF)?
- Premedication with benzodiazepines.
- Opiates.
- Induction agents.
- Volatile agents.
- Muscle relaxants.
- What other factors affect CBF?
- Draw a graph of mean arterial pressure/O2/CO2 and CBF.
- Describe ways of reducing intracerebral pressure intraoperatively and postoperatively.
- Describe the mechanism of action of drugs such as mannitol and acetazolamide.

4. Describe the mechanism of blood clot formation when a blood vessel is injured.
- What other protective mechanisms are triggered?
- What mediators are released?
- What is Virchows triad?
- Draw a flow chart showing the sequence of events from platelet activation through to clot formation.
- What mediators are released by the platelets?
- Show on this chart where heparin works.
- Which patients will be at high risk for deep vein thrombosis (DVT)?
- How can DVT be prevented, pharmacologically and non-pharmacologically?
- How effective are calf compressors (give a percentage)?
- What is the mechanism of action of heparin, low-molecular weight heparin (LMWH), warfarin and protamine?
- What is the difference between heparin and LMWH?

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