Anesthetics (General)

Question 1

A variety of drugs are used in general anesthesia with the overall aim of ensuring _____________, _____________, ____________, _______________, and in some cases _________________

Answer 1

Unconsciousness

Analgesia

Amnesia

Loss of reflexes of the autonomic NS

Muscle relaxation/paralysis

Question 2

General anesthesia is a ______________________ resulting from the administration of one or more general anesthetic agents

Answer 2

Medically induced coma (with loss of protective reflexes)

Question 3

Anaesthesia is induced with either a ________ drug or with a(n) _____________-administered drug

Answer 3

volatile

intravenously

Question 4

Anesthesia is maintained with a(n) ____________ or _______________ anaesthetic

Answer 4

intravenous

inhalational

Question 5

Analgesics , usually _______________, are also used in general anesthesia

Answer 5

short-acting opioids

Question 6

In general anesthesia, the use of neuromuscular blocking drugs necessitates ______________.

Answer 6

intermittent positive-pressure ventilation

Question 7

Following surgery, _________________ can be given to reverse the effects of neuromuscular blocking drugs used in GA

Answer 7

acetylcholinesterase inhibitors

Question 8

Individual requirements vary considerably and the recommended doses are only a guide. Smaller doses are indicated in ___________, ____________, or ____________ patients and in significant _____________, while robust individuals may require larger doses.

Answer 8

ill

shocked

debilitated

hepatic impairment

Question 9

A ______________ can be used to reduce pain at the injection site when GA is being administered

Answer 9

local topical anaesthetic

Question 10

The required dose of ____________ may be less if the patient has been premedicated with a sedative agent or if an opioid analgesic has been used.

Answer 10

induction agent

Question 11

The required dose of induction agent may be less if the patient has been _____________ with a ____________ or if a(n) ______________ has been used.

Answer 11

premedicated

sedative agent

opioid analgesic

Question 12

Intravenous anaesthetics may be used either to ____________ anaesthesia or for ____________ of anaesthesia

Answer 12

induce

maintenance

Question 13

Intravenous anaesthetics nearly all produce their effect in one ______________ time.

Answer 13

arm-brain circulation

Question 14

Extreme care is required in surgery of the ____________, ___________, or ___________ where the airway may be difficult to maintain

Answer 14

mouth

pharynx

larynx

Question 15

To facilitate tracheal intubation, induction is usually followed by a ________________ or a ________________.

Answer 15

neuromuscular blocking drug

short-acting opioid

Question 16

The doses of all _____________ drugs should be titrated to effect (except when using ‘rapid sequence induction’); lower doses may be required in premedicated patients.

Answer 16

intravenous anaesthetic

Question 17

What is the purpose of ‘rapid sequence induction and intubation’ (RSII)?

Answer 17

To induce anesthesia in patients who are at higher risk of aspiration of gastric contents into the lungs

The aim is to intubate the trachea as quickly and safely as possible and is employed during emergency surgery

Question 18

What is involved in ‘rapid sequence induction and intubation’ (RSII)? (5)

Answer 18

1. Pre-oxygenation
2. IV induction using predetermined induction dose, followed immediately by NM blocking agent
3. Cricoid pressure (to occlude the esophagus and prevent regurgitation)
4. Insertion of tracheal tube
5. Mechanical ventilation of the lungs

*opioids may be used

Question 19

What is the main difference between rapid sequence intubation and routine tracheal intubation?

Answer 19

In RSI, the practitioner does not typically manually assist the ventilation of the lungs after the onset of GA and cessation of breathing, until the trachea has been incubated and the cuff has been inflated

*this is why pre-oxygenation is so important (maximizes the oxygen available to the patient from their functional residual capacity during induction)

Question 20

_________________ is a technique in which major surgery is carried out with all drugs given intravenously

Answer 20

Total intravenous anesthesia

Question 21

In _________________, respiration can be spontaneous, or controlled with oxygen-enriched air. Neuromuscular blocking drugs can be used to provide relaxation and prevent reflex muscle movements

Answer 21

Total intravenous anesthesia

Question 22

The main problem to be overcome in _________________ is the assessment of depth of anaesthesia.

Answer 22

Total intravenous anesthesia

Question 23

The main problem to be overcome in total intravenous anesthesia is _________________.

Answer 23

the assessment of depth of anaesthesia

Question 24

Which drugs are used for IV anesthesia? (4)

Answer 24

1. Propofol (most widely used)
2. Thiopental sodium
3. Etomidate
4. Ketamine

Question 25

Is propofol used for induction and/or maintenance of anesthesia?

Answer 25

Both induction and maintenance

Question 26

Is thiopental sodium used for induction and/or maintenance of anesthesia?

Answer 26

Induction

Question 27

What side-effects are associated with thiopental sodium induction in GA? (2)

Answer 27

1. Dose-related CV and respiratory depression | 2. Sedative effects that persist for 24 hours (slow recovery especially after repeated doses)

Question 28

____________ is a barbiturate that is used for induction of anaesthesia, but has no analgesic properties

Answer 28

Thiopental sodium

Question 29

Which GA induction agents are administered intravenously? (4)

Answer 29

1. Propofol 2. Ketamine 3. Etomidate 4. Thiopental sodium

Question 30

Is etomidate used for GA induction and/or maintenance?

Answer 30

Induction

Question 31

Is ketamine used for GA induction and/or maintenance?

Answer 31

Induction AND maintenance

Question 32

Which IV anesthetics can be used for induction AND maintenance of GA?

Answer 32

Propofol and ketamine

Question 33

Which IV anesthetics are used for GA induction ONLY?

Answer 33

Etomidate and thiopental sodium

Question 34

_____________ is associated with rapid recovery and less hangover effect than other intravenous anaesthetics

Answer 34

Propofol

Question 35

_____________ can also be used for sedation during diagnostic procedures and sedation in adults in intensive care.

Answer 35

Propofol

Question 36

Thiopental sodium is a barbiturate that is used for induction of anaesthesia, but has no ____________ properties

Answer 36

analgesic

Question 37

Awakening from a moderate dose of thiopental sodium is ___________ (slow/rapid) because the drug redistributes into other tissues, particularly fat.

Answer 37

Rapid

Question 38

Is metabolism of thiopental sodium fast or slow?

Answer 38

Slow; sedative effects can occur particularly after repeated doses

Question 39

Etomidate is an intravenous agent associated with __________ (rapid/slow) recovery __________ (with/without) a hangover effect

Answer 39

Rapid Without

Question 40

Etomidate causes _________ (more/less) hypotension than thiopental sodium and propofol during induction

Answer 40

Less | Like ketamine

Question 41

Etomidate produces a ___________ (high/low) incidence of extraneous muscle movements

Answer 41

High can be minimised by an opioid analgesic or a short-acting benzodiazepine given just before induction

Question 42

_______________ produces a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given just before induction

Answer 42

Etomidate

Question 43

Is ketamine often used in GA?

Answer 43

Rarely used Mainly for pediatric anesthesia, particularly when repeated administration is required

Question 44

Ketamine causes _____________ (more/less) hypotension than thiopental sodium and propofol during induction

Answer 44

Less | Like etomidate

Question 45

Recovery from ketamine is relatively __________ (fast/slow) and there is a ___________ (high/low) incidence of extraneous muscle movements

Answer 45

Slow High

Question 46

What is the main disadvantage of ketamine?

Answer 46

high incidence of hallucinations, nightmares, and other transient psychotic effects

Question 47

The transient psychotic effects of ketamine can be reduced by a ______________

Answer 47

Benzodiazepine (eg diazepam or midazolam)

Question 48

Inhalational anaesthetics include ___________ and ______________

Answer 48

gases volatile liquids

Question 49

Volatile liquid anaesthetics are administered using calibrated vaporisers, using _______, _______, or ____________ as the carrier gas.

Answer 49

air oxygen nitrous oxide-oxygen mixtures

Question 50

To prevent hypoxia, the inspired gas mixture of inhaled anesthetics should contain a minimum of _____% oxygen at all times.

Answer 50

25 Higher concentrations of oxygen (greater than 30%) are usually required during inhalational anaesthesia when nitrous oxide is being administered.

Question 51

Higher concentrations of oxygen (greater than 30%) are usually required during inhalational anaesthesia when ___________ is being administered.

Answer 51

nitrous oxide

Question 52

Are volatile liquid anesthetics used for induction and/or maintenance of anesthesia?

Answer 52

Induction AND maintenance | Also, may be used for maintenance following induction with an IV anesthetic

Question 53

At are the different types of volatile liquid anesthetics? (3)

Answer 53

1. Isoflurane 2. Desflurane 3. Sevoflurane

Question 54

Isoflurane is a(n) ___________ anaesthetic

Answer 54

volatile liquid

Question 55

______________ is generally stable during isoflurane anaesthesia, but heart-rate can rise, particularly in younger patients.

Answer 55

Heart rhythm

Question 56

During administration of isoflurane, ____________ and _____________ can fall, owing to a decrease in _____________

Answer 56

Systemic arterial pressure cardiac output systemic vascular resistance

Question 57

During administration of isoflurane, systemic arterial pressure and cardiac output can _________ (rise/fall), owing to a _____________ (increase/decrease) in systemic vascular resistance

Answer 57

Fall Decrease

Question 58

_________________ occurs with isoflurane administration and the effects of _____________ drugs are potentiated

Answer 58

Muscle relaxation muscle relaxant

Question 59

What is the preferred inhalational anesthetic for use in obstetrics?

Answer 59

Isoflurane

Question 60

How does desflurane compare to isoflurane?

Answer 60

Desflurane is reported to have about one-fifth the potency of isoflurane

Question 61

Emergence and recovery from anaesthesia with desflurane are particularly __________ (slow/rapid) because of its ________ (high/low) solubility.

Answer 61

Rapid Low

Question 62

Desflurane ________ (is/ is not) recommended for induction of anaesthesia as it _______ (is/is not) irritant to the upper respiratory tract

Answer 62

Is not Is

Question 63

How does sevoflurane compare to desflurane?

Answer 63

More potent than desflurane

Question 64

Emergence and recovery from sevoflurane are particularly rapid, but _________ (faster/slower) than desflurane.

Answer 64

Slower

Question 65

Is sevoflurane irritant to the upper respiratory tract?

Answer 65

Non-irritant, therefore often used for inhalational induction of anesthesia (unlike desflurane)

Question 66

_____________ is non-irritant and is therefore often used for inhalational induction of anaesthesia

Answer 66

Sevoflurane

Question 67

Sevoflurane has __________ (little/significant) effect(s) on heart rhythm compared with other volatile liquid anesthetics

Answer 67

Little

Question 68

Is nitrous oxide used for maintenance and/or induction of anesthesia?

Answer 68

Maintenance (in combination with other agents) | And for analgesia in sub-anesthetic concentration

Question 69

For ____________, nitrous oxide is commonly used in a concentration of 50 to 66% in oxygen as part of a balanced technique in association with other inhalational or intravenous agents.

Answer 69

anaesthesia

Question 70

Nitrous oxide is unsatisfactory as a sole anaesthetic owing to lack of ___________, but is useful as part of a combination of drugs since it allows a significant reduction in dosage.

Answer 70

potency

Question 71

Can nitrous oxide be used as a sole anesthetic?

Answer 71

No, should be used in combination with other drugs (and allows a subsequent significant dose reduction of these other drugs)

Question 72

_____________-administration of nitrous oxide using a demand valve is popular in obstetric practice, for changing painful dressings, as an aid to postoperative physiotherapy, and in emergency ambulances.

Answer 72

Self

Question 73

__________ may have a deleterious effect if used in patients with an air-containing closed space since it diffuses into such a space with a resulting increase in pressure (eg pneumothorax, intracranial air after TBI, etc)

Answer 73

Nitrous oxide

Question 74

In which clinical situations should nitrous oxide be avoided? (4)

Answer 74

patients with an air-containing closed space since nitrous oxide diffuses into such a space with a resulting increase in pressure 1. Pneumothorax 2. Intracranial air (after head injury) 3. Entrapped air following recent underwater dive 4. Recent intra-ocular gas injection

Question 75

Which drugs are typically used for maintenance of general anesthesia? (6)

Answer 75

Most commonly inhaled anesthetics… 1. Isoflurane 2. Desflurane 3. Sevoflurane 4. Nitrous oxide (in combination with another) But IV anesthetics may also be used… 5. Propofol 6. Ketamine

Question 76

What are the phases of general anesthesia? (3)

Answer 76

1. Induction 2. Maintenance 3. Emergence

Question 77

What is malignant hyperthermia?

Answer 77

Rare but potentially lethal complication of anesthesia (most commonly volatile anesthetics and suxamethonium chloride) Characterized by a rapid rise in temperature, increased muscle rigidity, tachycardia, acidosis

Question 78

What are the symptoms of malignant hyperthermia? (4)

Answer 78

1. Rapid rise in temperature 2. Increased muscle rigidity 3. Tachycardia 4. Acidosis

Question 79

What are the most common triggers of malignant hyperthermia? (2)

Answer 79

1. Volatile anesthetics | 2. Suxamethonium chloride

Question 80

What is the treatment of malignant hyperthermia?

Answer 80

Dantrolene

Question 81

What are the common or very common side effects of propofol? (6)

Answer 81

1. Apnea 2. Arrhythmias 3. Headache 4. Hypotension 5. Localized pain 6. Nausea/vomiting

Question 82

What are the rare but dangerous side effects of propofol? (6)

Answer 82

1. Epileptiform seizures (may be delayed) 2. Pancreatitis 3. Pulmonary edema 4. Soft tissue necrosis 5. Heart failure 6. Rhabdomyolysis

Question 83

What is propofol infusion syndrome?

Answer 83

Prolonged infusion of propofol (exceeding 4mg/kg/hr) may result in potentially fatal effects, including metabolic acidosis, arrhythmias, cardiac failure, rhabdomyolysis, hyperlipidemia, hyperkalemia, hepatomegaly, and renal failure

Question 84

Is propofol safe to use in pregnancy?

Answer 84

Yes, but may depress neonatal respiration | Max dose for maintenance is 6 mg/kg/hr

Question 85

Is propofol safe to use in patients with hepatic and/or renal impairment?

Answer 85

Use with caution

Question 86

Is monitoring required for patients taking propofol?

Answer 86

If risk of fat overload OR if sedation longer than 3 days

Question 87

What advice should be given to patients and carers regarding propofol? (2)

Answer 87

For a short GA, the risk of driving or undertaking skilled tastes should be considered for at least 24 hours after admission The dangers of taking alcohol should also be emphasized during this period

Question 88

What are the contraindications to using thiopental sodium on a patient? (2)

Answer 88

1. Acute porphyrias | 2. Myotonic dystrophy

Question 89

What are the common side effects of thiopental sodium? (2)

Answer 89

1. Arrhythmias | 2. Myocardial contractility decreased

Question 90

Is thiopental sodium safe to use in hepatic and/or renal impairment?

Answer 90

Consider dose adjustment

Question 91

What are the common or very common side effects of etomidate? (7)

Answer 91

1. Apnea 2. Hypotension 3. Movement disorders 4. Nausea/vomiting 5. Respiratory disorders 6. Skin reactions 7. Vascular pain

Question 92

______________ following administration of etomidate can be reduced by administering an opioid analgesic or a short-acting benzodiazepine just before induction

Answer 92

Extraneous muscle movements

Question 93

What are the contraindications to administering ketamine? (7)

Answer 93

1. Acute porphyrias 2. Eclampsia and pre-eclampsia 3. Head trauma 4. HTN 5. Raised ICP 6. Severe cardiac disease 7. Stroke

Question 94

What are the common or very common side effects of ketamine? (11)

Answer 94

1. Anxiety 2. Abnormal behavior 3. Confusion 4. Diplopia 5. Hallucinations 6. Increased muscle tone 7. N/v 8. Nystagmus 9. Skin reactions 10. Sleep disorders 11. Tonic clonic movements

Question 95

What are the rare but dangerous side effects of ketamine? (4)

Answer 95

1. Apnea 2. Hemorrhagic cystitis 3. Drug-induced liver injury 4. Arrhythmias

Question 96

Incidence of hallucinations following administration of ketamine can be reduced by premedication with a _____________

Answer 96

Benzodiazepine

Question 97

Patients should be advised to avoid breastfeeding for at least ___________ after their last dose of ketamine

Answer 97

12

Question 98

Can ketamine be prescribed in patients with hepatic and/or renal impairment?

Answer 98

Caution and consider dose reduction in hepatic impairment

Question 99

Exposure of patients to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in ________________ owing to interference with the action of vitamin B12

Answer 99

megaloblastic anaemia Depression of white cell formation may also occur

Question 100

In patients receiving nitrous oxide for prolonged periods, ______________ effects can occur without preceding overt haematological changes

Answer 100

neurological toxic; due to interference with the actions of vit B12

Question 101

Is breastfeeding safe for patients taking nitrous oxide?

Answer 101

Yes, may be resumed as soon as mother has recovered sufficitnety from anesthesia

Question 102

Are there any monitoring requirements for patients taking nitrous oxide?

Answer 102

Assessment of plasma B12 concentration should be considered in those at risk of deficiency including the elderly, those who have a poor, vegetarian, or vegan diet, and those with a history of anemia

Question 103

Assessment of plasma-vitamin B12 concentration should be considered in those receiving nitrous oxide who are at risk of deficiency, including _____________, those who have ____________, and those with a _____________.

Answer 103

the elderly a poor, vegetarian, or vegan diet history of anaemia

Question 104

Nitrous oxide should not be given continuously for longer than ____________ or more frequently than every ____________ without close supervision and haematological monitoring.

Answer 104

24 hours 4 days

Question 105

What are the common or very common side effects of volatile inhaled anesthetics? (Eg isoflurane)

Answer 105

1. Agitation 2. Apnea 3. Arrhythmias 4. Chills 5. Cough 6. Dizziness 7. Headache 8. Hypersalivation 9. Hypertension OR hypotension 10. N/V 11. Respiratory disorders

Question 106

What are the dangerous side effects of inhaled volatile anesthetics? (9)

Answer 106

1. Breath holding 2. Cardiac arrest 3. Hemorrhage 4. Hepatic disorders 5. Hyperkalemia 6. Malignant hyperthermia 7. QT interval prolongation 8. Rhabdomyolysis 9. Seizures (Frequency unknown)

Question 107

__________________ is a dangerous side effect specific to isoflurane

Answer 107

Carboxyhaemoglobinaemia

Question 108

Which drug interactions should be avoided when prescribing inhaled volatile anesthetics (eg isoflurane)?

Answer 108

Coadministration with other drugs that may prolong the QT interval or cause hypokalemia, leading to torsades de pointes

Question 109

What common side effects are specific to desflurane?

Answer 109

1. Coagulation disorders | 2. Conjunctivitis

Question 110

What common side effects are specific to sevoflurane?

Answer 110

1. Drowsiness 2. Fever 3. Hypothermia