General Anesthesia questions

Question 1

What stage of anesthesia are patients most vulnerable in?

Answer 1

Stage II - because they are hyperexcitable to external stimuli and have lose both airway reflexes and autonomic stability

Question 2

What is mallampati class I?

Answer 2

the uvula is entirely visible

Question 3

What is mallampati class II?

Answer 3

The uvula is partially visible

Question 4

What is mallampati class III?

Answer 4

The uvula is not visible - intubation likely to be difficult

Question 5

What is ASA I?

Answer 5

No systemic disease. Normal Healthy

Question 6

What is ASA II?

Answer 6

Mild systemic disease but no fxnal capacity deficits: smoking, controlled HTN

Question 7

What is ASA III?

Answer 7

Systemic disease with fxnal capacity deficits: CAD, RAD, mild renal or hepatic impairment

Question 8

What is ASA IV?

Answer 8

Unstable CAD, COPD, CF

Question 9

What is ASA V

Answer 9

Imminent death - will die without intervention: ruptured aorta

Question 10

What are the stages of anesthesia?

Answer 10

Induction, Maintenance, Emergence

Question 11

What is Stage I?

Answer 11

Lasts from full consciousness until patient closes his eyes

Induction: analgesia, patient is awake and responsive

Question 12

What is Stage II?

Answer 12

Last from eye closure to regaining autonomic stability
Induction: hyperexcitable, delirium, movement, autonomic instability, loss of airway protection, significant risk of complications, protective airway reflexes lost

Question 13

What is Stage III?

Answer 13

Return of autonomic stability, preservation of vital functions. 4 planes: planes 2 and 3 are surgical anesthesia

Question 14

What is Stage IV?

Answer 14

Maintenance: depression of vital functions, autonomic instability

Question 15

What is Stage V?

Answer 15

Maintenance: cardiac arrest

Question 16

What is emergence?

Answer 16

Stage III, II, I

Question 17

What are the indications for tracheal intubation?

Answer 17

Airway access/airway protection
Need for muscle relaxation during surgery
Length of procedure greater than 2 hours
Need for mechanical ventilation

Question 18

What happens to the cardiovascular system in aging?

Answer 18

Decreased responsiveness in beta receptors - lower HR max for compensation, arterial pressure is more labile

Question 19

What happens to the pulmonary system in aging

Answer 19

Decreased vital capacity/pulmonary reserve, increased air trapping, increased V/Q, increased residual volume, reduced resting PaO2, decreased ventilatory response to hypoxia and decreased ability to cough and clear secretions

Question 20

What classes of drugs are the elderly very sensitive to?

Answer 20

Sedative hypnotics

Question 21

What happens to renal and hepatic function with age?

Answer 21

It declines leading to a reduction in drug elimination from the body

Question 22

What should be assessed for in an obese patient?

Answer 22

Functional capacity because they could have CHF or pulmonary HTN
Social history - tobacco use! Encourage to quit smoking 6 weeks prior

Question 23

What could be helpful to draw in a patient with a BMI over 50?

Answer 23

ABG

Question 24

What are morbidly obese patients at higher risk for?

Answer 24

Intubation difficulty, mask ventilation difficulty, postoperative respiratory failure.

Question 25

What are patients with OSA at higher risk for?

Answer 25

HTN, arrythmias, ACS, CHF, and sudden death due to increased baseline SNS tone.

Question 26

What should be done prior to induction of an obese patient?

Answer 26

3-5 minutes of preoxygenation

Question 27

What does preoxygenation do?

Answer 27

Increase PaO2 | Washes out N2 thereby attenuating hypoxemia

Question 28

Which inhaled anesthetics are preferred in obese patients?

Answer 28

Des or sevo because they have a lower tissue/blood ratio so they wear off quicker. This is important because obese patients need to be fully awake before extubation

Question 29

Why should NMBs be dosed according to lean body mass?

Answer 29

Because obese patients have an increase in pseudocholinesterase activity

Question 30

What happens to opioids in the blood when dosed based on TBW in an obese patient?

Answer 30

they have a higher blood level because the high amount of fat are not well perfused.

Question 31

How should pain be managed in an obese patient postoperatively?

Answer 31

Dose according to lean body mass and deliver via PCA

Question 32

What is the danger of opioid use in an obese patient?

Answer 32

risk of apnea/decreased respiratory drive

Question 33

What other non-opioid drugs can be used for postop pain control?

Answer 33

NSAIDs, ketamine, dexmedetomidine (alpha agonist), local

Question 34

Which drug should be dosed according to TBW in obese patients?

Answer 34

Succinylcholine

Question 35

What is the innervation of the lower extremity?

Answer 35

L2 to S3

Question 36

What are the risk of neuraxial anesthesia in an anticoagulated patient?

Answer 36

local bleeding, epidural hematoma

Question 37

Where does a spinal anesthetic go?

Answer 37

The subarachnoid space