General Anaesthesia And Post Op Care

Question 1

What do we do in the induction phase?

Answer 1

Iv and inhalational induction. Also mask vent and endotracheal intubation to secure the airway

Question 2

In the induction phase we monitor spO2, what’s the normal value

Answer 2

Above 95%

Question 3

In the induction phase we monitor End-Tidal CO2, what’s the normal range?

Answer 3

35-45mmHg

Question 4

What’s the use of monitoring EtCo2?

Answer 4

To ensure adequate ventilation and that the endotracheal tube was placed properly

Question 5

We monitor urine output, what’s the range?

Answer 5

0.5mL/Kg/hr is considered adequate

Question 6

We also monitor the BIS, what is it and what’s the range

Answer 6

Details the patients level of consciousness/anesthesia. Range is 40-60

Question 7

What is Total Intravenous anesthesia and who do we give it to?

Answer 7

TIVA is the infusion of propofol or remifentanil in patients for whom inhalational agents are contraindicated

Question 8

In the Emergence phase, how do we reverse the muscle relaxation?

Answer 8

Via neostigmine with glycopyrrolate.

Question 9

In the Post-Anesthesia care unit (PACU) how we do manage the pain?

Answer 9

We use long acting analgesics like Morphine or Oxycodone

Question 10

The IV Anesthetic propofol has a big con, and when should it be discarded?

Answer 10

It’s prime to bacterial contamination, hence must be discarded after 6 hours

Question 11

Explain Propofol’s mechanism of action

Answer 11

Enhances the inhibitory neurotransmitter GABA-A , which leads to sedation

Question 12

Propofol onset and duration

Answer 12

Rapid onset and short acting

Question 13

Propofol side effects

Answer 13

Hypotension, apnea, pain on injection but minimized by co-admin of lidocaine

Question 14

Thiopental is provided in the form of what?

Answer 14

A powder, which is then added to saline or sterile water

Question 15

Thiopental mechanism of action?

Answer 15

Enhances GABA-A activity

Question 16

When do we prefer Thiopental to Propofol?

Answer 16

In neurosurgery for its neuroprotective properties

Question 17

What is the difference in metabolization between Thiopental and Propofol?

Answer 17

Thio is hepatically metabolized, while propofol is metabolized in the liver. Both however, are excreted by the kidneys

Question 18

Thiopental side effects?

Answer 18

Mostly same as Propofol. But with Hangover effect.

Question 19

What is Thiopental’s Hangover Effect?

Answer 19

Prolonged sedation and recovery due to lipid solubility and redistribution

Question 20

How can Ketamine he admined?

Answer 20

IV, IM, or Orally

Question 21

Ketamine mechanism of action?

Answer 21

Non-competitive NMDA receptor antagonist.

Question 22

When do we use Ketamine?

Answer 22

For patients with risk of hypotension or those of trauma. Also adjunct in TIVA

Question 23

Ketamine metabolism?

Answer 23

Liver, by CYP450 enzyme.

Question 24

Ketamine side effect?

Answer 24

Delirium, hallucinations and such. Mainly Psychomimetic stuff

Question 25

IV anesthetic of longest duration?

Answer 25

Midazolam

Question 26

Fastest acting IV anesthetic?

Answer 26

Ketamine

Question 27

Why do we use opioids with IV anesthesia?

Answer 27

Due to them providing analgesia

Question 28

Hepatic enzyme CYP3A4 metabolizes which Opioids?

Answer 28

Fentanyl and Alfentanil.

Question 29

There is only one opioid which is metabolized by Plasma Esterases, what is it?

Answer 29

Remifentanil

Question 30

MAC value reflects the potency of an inhalational agent, explain its values

Answer 30

The lower the value, the more potent the anesthetic

Question 31

What does the blood gas partition mean?

Answer 31

Reflects the solubility of the agent, in the blood, a high number means it’s soluble and hence slower in induction and recovery.

Question 32

What is NO used for? (nitrous oxide)

Answer 32

Smaller procedures like labor or dental things

Question 33

Which inhaled anesthetic is used for children and why?

Answer 33

Halthane, as it has a sweet odor

Question 34

Halothane has been replaced with two newer agents used a lot more, what are they?

Answer 34

Sevoflurane and Desflurane

Question 35

How do we treat Malignant hyperthermia,

Answer 35

Immediately discontinue the triggering agents, and apply Dantrolene.

Question 36

What is the most and least potent Inhalational agent

Answer 36

Halothane and NO

Question 37

What is the fastest onset inhalational agent

Answer 37

Desflurane

Question 38

Why would we use a neuromuscular blockade sometimes?

Answer 38

In cases where we want to do a tracheal intubation

Question 39

Succinylcholine is a rapid neuromuscular block, when do we use it?

Answer 39

Emergency intubations or shorter procedures

Question 40

Succinycholine however, has a big side effect, what is it?

Answer 40

Sometimes Malignant Hyperthermia, or succinylcholine apnea.