Circle

Soda lime: 94% calcium hydroxide, 5% sodium hydroxide, small amount of potassium hydroxide.

pH13.5 moisture 14-19%

silica, dye

newer : zeolite

pink to white or

white to violet

colour changes when pH <10

1L absorb 120L of CO2

CO2 absorbed-->water and heat produced (exothermic)

adult CO2 production:250ml/min

compound A from sevo+sodalime

CIRCLE system

high FGF of several litres to denitrogenate circle and FRC (only if nitrous is used)

can later reduce to 0.5-1L/min

short period of high flows needed to prime patient and circle

T piece

T piece

-20-30kg patient

-high flows required (2-3x MV== 6ml/kgx20 breaths=6x10kgx20===> minimum 3-6L

-minimal resistance, valveless

-can feel compliance?

-no scavenging/difficult

-newer design: closed ended reservoir- effective scavenging

NAP4 -difficult airway society (national audit project)

EPIDURAL PRO CON

peri op anticoagulation

epidural hematoma risk: 1:1700 to 1:200000

spinal cord damage and paraplegia, nerve injury

MASTER trial

Rigg, et al. Lancet 2002; 359:1276-1282

multicentre RCT in Australia 1995-2001

P:high risk patients undergoing major abdominal surgery, 915 patients

I: intraop epid and post op epid for 72 hr

C:GA

O: mortality at 30 days or major post op morbidity

of all complications: only respi failure less frequent, pain scores over first 3 days were significantly lower.- may be some benefit
low risk of serious adverse reactions

NO SIGNIFICANT DIFFERENCE OVERALL

desflurane Tec 6 vaporiser

http://www.equipmentexplained.com/physics/agent_delivery/vaporizer/vaporizers.html#desflurane

Valvular lesions- MR

MR causes

leaflet( MVP/ endocarditis/ rheumatic fever), MI

clinical examination

- displaced forceful apex beat

-AF

-soft S1, PSM radiating to axilla , loud S3

TEE good coz MV closest to esophagus

CXR: dilated LA , +/-

ECG:AF, LA dilatation

SV usually preserved until late

surgery if functional status <4 METS

if mixed lesion- deal with dominant lesion first.

Goals: high normal HR (slower--> more time for diastolic filling and larger volume regurg), adequate preload, low afterload, low PVR

FRCA texts

FRCA texts

General
Companion to Clinical Anaesthesia Exams (FRCA Study Guides) (Charlie Corke)
Clinical Notes for the FRCA (FRCA Study Guides) (Charles Deakin)

MCQ
Final FRCA: Multiple Choice Questions (FRCA Study Guides) (Michael D. Brunner)
QBase Anaesthesia: MCQs for the Final FRCA v. 5 (Edward Hammond)
MCQs for the Final FRCA (Khaled Elfituri)
MCQ's in Anaesthesia (FRCA Study Guides) (A. Ganado)
QBase Anaesthesia: MCQs for the Anaesthesia Final FRCA v. 2 (QBase) (Mark Blunt)
FRCA: MCQs for the Final FRCA: Saunders Self Assessment Series: MCQs for the Final FRCA (FRCA Study Guides) (Karen Henderson)
Practice MCQ's for the Final FRCA (FRCA Study Guides) (Jon Hardman)

SAQ
Anaesthesia & Critical Care (Chris Dodds & Neil Soni)
Short Answer Questions and MCQs in Anaesthesia and Intensive Care (Peter Murphy)
Short Answer Questions in Anaesthesia (Simon Bricker)
Final F.R.C.A.: Short Answer Questions (J. Nickells)

SOE
The Anaesthesia Science Viva Book (Simon Bricker)
The Clinical Anaesthesia Viva Book (Simon J. Mills)

Primary textbooks to use for the Final FRCA:

- The A-Z of Anaesthesia (Smith, Yentis)
- Basic Physics and Measurement in Anaesthesia (Kenny, Davis)
- Essentials of Anaesthetic Equipment (Al-Shaikh, Stacey)
- Pharmacology for Anaesthesia and Intensive Care (Peck, Hill, Williams):
- Respiratory Physiology: The Essentials (West)
- Oxford Handbook of Anaesthesia: the second edition is well-updated topically and contains some interesting extra sections which will aid in exam revision.
- Drugs in Anaesthesia and Intensive Care (Sasada, Smith): again great for viva practive
- The Anaesthesia Viva 1(Urquhart, Blunt, Pinnock, & Dixon): Physiology 7 Pharmacology. Common SOE questions with model answers. Great for last minute SOE revision.
- The Anaesthesia Viva 2(Blunt, Urquhart, Pinnock, & Chong): Physics, Clinical Measurement, Safety, & Clinical Anaesthesia, as above
- The Structured Oral Examination in Anaesthesia (Balasubramanian, Mendonca, & Pinnock): I found this so useful again even for the Final exam – 10 full SOEs divided by topic with model answers.
As stressed before, this list of textbooks is not exhaustive, merely the ones I used. Some of my fellow candidates used additional textbooks such as Anatomy for Anaesthetists (Ellis, Feldman, & Harrop-Griffiths) and various specialist physiology texts.

revised cardiac risk index

pneumoperitoneum

http://www.med.mun.ca/getdoc/a0a607d9-5cd9-4943-9fac-2891170f34ae/Pneumoperitoneum.aspx

physio effects

1) pressure effects from increased IAP on

-respi

-CVS: reduced CO fr reduced preload, increased afterload

-peritoneal stretch: vasovagal

2) CO2

3)air embolism

4) mesenteric perfusion, increased SVR