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1
Q
A
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2
Q

What are the main intravenous anesthetic induction agents?

A

Propofol, Sodium Thiopental, Ketamine, Etomidate, Benzodiazepines

These agents are primarily used for the induction of anesthesia.

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3
Q

What is a key feature of Propofol?

A

Smooth & rapid recovery

Propofol is the most commonly used IV anesthetic agent.

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4
Q

What is a disadvantage of Propofol?

A

No analgesic effect

While it has an antiemetic effect, it does not provide pain relief.

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5
Q

In which patients should Propofol be avoided?

A

Hypovolemic patients, Fixed cardiac output patients, Epileptic patients

Propofol may trigger seizures in epileptic patients.

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6
Q

What is the appearance of Sodium Thiopental?

A

Yellow powder

Sodium Thiopental is a barbiturate used for induction.

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7
Q

What is a unique feature of Ketamine?

A

Potent analgesic

Ketamine provides excellent pain relief and can be used alone for short procedures.

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8
Q

List two side effects of Ketamine.

A
  • Nausea & vomiting
  • Hallucinations, bad dreams

Ketamine can also increase ICP and IOP.

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9
Q

What is the best inhalational anesthetic agent?

A

Sevoflurane

Sevoflurane is known for its rapid induction and recovery.

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10
Q

What are two advantages of Sevoflurane?

A
  • Less airway irritation
  • Pleasant odor

Sevoflurane is particularly good for children.

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11
Q

What is the classification of muscle relaxants?

A
  • Non-depolarizing
  • Depolarizing

Muscle relaxants are classified based on their mechanism of action.

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12
Q

What is the effect of non-depolarizing muscle relaxants?

A

Compete against acetylcholine at neuromuscular junction

Examples include Atracurium and Rocuronium.

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13
Q

What are the main uses of muscle relaxants?

A
  • Facilitate endotracheal intubation
  • Facilitate mechanical ventilation
  • Achieve muscle relaxation for surgical access

They cause paralysis of skeletal and respiratory muscles.

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14
Q

What are the common complications of anesthesia?

A
  • Airway complications
  • Cardiovascular complications
  • Peripheral nerve injury
  • Anaphylaxis
  • Hepatitis
  • Spinal/Epidural anesthesia complications
  • Other complications

Each category includes specific risks associated with anesthesia.

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15
Q

What is the goal of preoperative evaluation?

A

To gather medical information and assess surgical risk

This aims to minimize morbidity and mortality during surgery.

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16
Q

What is the purpose of premedication?

A

Administration of certain drugs before surgery

This optimizes patient comfort and physiological response.

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17
Q

What mnemonic can help remember the goals of premedication?

A

A SHARP PAC

Goals include anxiety relief, secretion control, hemodynamic stability, analgesia, risk reduction for aspiration, PONV prevention, and antimicrobial control.

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18
Q

What is the Mallampati classification used for?

A

Predicting difficulty of intubation

It assesses visible structures to gauge intubation difficulty.

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19
Q

What is a key feature of the difficult airway assessment?

A

Limited mouth opening < 3 cm

Other factors include limited neck movement and large tongue.

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20
Q

What are the complications associated with Suxamethonium?

A
  • Scoline apnea
  • Malignant hyperthermia

These complications can be life-threatening and limit its use.

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21
Q

What are the effects of atropine in anesthesia?

A
  • Decrease secretions
  • Treat bradycardia

Atropine is combined with Neostigmine to prevent side effects.

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22
Q

What is the antidote for opioid overdose?

A

Naloxone

It is crucial in reversing respiratory depression caused by opioids.

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23
Q

What is the classification of intubation difficulty based on visible structures?

A

I: Soft palate, uvula, anterior & posterior tonsillar pillars
II: Soft palate, uvula, fauces
III: Soft palate and base of uvula
IV: Only hard palate visible

Higher class = increased difficulty of intubation.

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24
Q

What are the methods to confirm correct endotracheal tube placement?

A
  • Capnography: Presence of normal capnograph waveform (CO₂ detection)
  • Chest movement: Symmetrical chest expansion with ventilation
  • Auscultation: Breath sounds heard bilaterally over lungs
  • Fogging: Fog inside the tube with breathing
  • No signs of hypoxia: No cyanosis or oxygen desaturation
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25
What are the normal arterial blood gas (ABG) values for a healthy patient breathing room air at sea level?
* pH: 7.36 – 7.44 * PaCO₂: 33 – 44 mmHg * PaO₂: 75 – 105 mmHg * SaO₂: 95 – 97%
26
What does the mnemonic 'LIMITED' stand for in airway assessment?
* Limited mouth opening * Incisors prominent * Mass or trauma in airway * Inability to extend neck * Thyromental distance < 6 cm * Edema or large tongue * Dentures/loose teeth
27
What is the definition of anaphylaxis in anesthesia?
A severe, life-threatening allergic reaction that occurs unexpectedly during anesthesia, with multi-system involvement.
28
What are the clinical manifestations of anaphylaxis in anesthesia?
* Cardiovascular: Hypotension, Tachycardia, Cardiovascular collapse * Respiratory: Bronchospasm * Cutaneous: Flushing, Urticaria, Angioedema
29
What are the most common causes of anaphylaxis in the operating room?
* Muscle relaxants * Succinylcholine (Scolin) * Rocuronium * Atracurium * Latex exposure ## Footnote Other triggers include antibiotics, propofol, thiopental, local anesthetics, morphine.
30
What factors determine the choice of general anesthesia protocols?
* Type of surgery * Surgical duration * Patient condition * Aspiration risk * Need for muscle relaxation
31
When is endotracheal tube anesthesia used?
Used when: * Full muscle relaxation is required * Protection against aspiration is needed * Surgery is prolonged ## Footnote Examples include appendectomy, hysterectomy, ovarian cyst surgery, cholecystectomy, C-section, thyroidectomy, head and neck surgery, thoracic surgery.
32
When is intravenous + mask anesthesia indicated?
Used when: * Procedure is short * Patient is well-fasted and stable * Minimal aspiration risk ## Footnote Examples include missed loop removal, simple suturing, uterine curettage, abscess drainage.
33
What is the goal of airway management during anesthesia?
Always maintain airway patency and protection, especially under sedation or GA.
34
What airway maneuvers are used for light sedation?
* Jaw thrust * Chin lift * Oropharyngeal airway (only if no gag reflex) * Nasopharyngeal airway
35
What devices are used in general anesthesia?
* Facemask * Laryngeal Mask Airway (LMA) * Endotracheal Tube (oral or nasal)
36
What factors determine the choice of airway device?
* Airway assessment (difficulty of intubation) * Risk of regurgitation/aspiration * Need for positive pressure ventilation * Surgical factors (location, duration, position, need for muscle relaxation)
37
What does the mnemonic 'ARMS' stand for in airway device decision?
* Airway anatomy (Mallampati, TMD, etc.) * Risk of aspiration * Muscle relaxation needed * Surgery duration & site
38
What are the goals of postoperative care?
* Close observation * Frequent vital signs monitoring * Pain management * Urine output & fluid management * Monitor fluid & blood loss * Respiratory physiotherapy * Avoid fluid overload * Prevent hypothermia * Maintain good ventilation * Monitor level of consciousness (LOC) * Pressure sore prevention * Wound care * Postoperative investigations
39
What are the characteristics of spinal anesthesia?
* Injection site: Subarachnoid space (intrathecal) * Onset: Rapid (immediate) * Duration: Single dose – limited duration * Technical difficulty: Easier
40
What are the characteristics of epidural anesthesia?
* Injection site: Epidural space * Onset: Slower (10–20 minutes) * Duration: Can be prolonged with catheter & repeated doses * Technical difficulty: More difficult, higher failure rate
41
What are the hemodynamic effects of spinal and epidural anesthesia?
* Spinal: More pronounced hypotension * Epidural: Less hypotension, more hemodynamic stability
42
What are the advantages of neuraxial anesthesia over general anesthesia?
* ↓ Blood loss during surgery * Better Apgar score in babies * ↓ Risk of DVT & PE postoperatively * Faster return of gut function * Less costly, faster recovery * Avoids airway manipulation and intubation complications * Excellent pain relief, ↓ opioid need and side effects * Awake patients recognize hypoglycemia
43
What are the indications for spinal anesthesia?
* Cesarean section * Ovarian cystectomy * Hysterectomy * Inguinal hernia repair * Lower limb surgeries * Anal and perianal surgeries
44
What are the indications for epidural anesthesia?
* All indications of spinal anesthesia plus: * Higher abdominal surgeries (e.g. cholecystectomy) * Thoracic surgeries * Labor analgesia and postoperative pain control
45
What are common complications of neuraxial anesthesia?
* Hypotension * Bradycardia * Nausea & vomiting * Post-dural puncture headache * Back pain * Cauda equina syndrome * Nerve injury * Total spinal block * Epidural hematoma * Meningitis * Infection at injection site
46
What are the contraindications to neuraxial block?
* Bleeding diathesis / anticoagulation * Severe hypovolemia * Raised intracranial pressure (ICP) * Infection at puncture site * Severe valvular stenosis or outflow obstruction * Allergy to local anesthetics ## Footnote Patient refusal is a relative contraindication.
47
What parameters are monitored during anesthesia?
* Pulse oximeter * Noninvasive BP monitoring * Temperature monitoring * ECG monitoring * Capnography (ETCO₂) * Invasive BP monitoring
48
What is the purpose of ultrasound-guided regional anesthesia?
Uses ultrasound imaging to visualize nerves, vessels, and guide needle accurately.
49
What are the components of basic life support (BLS)?
* Chest compressions * Airway (position, jaw thrust) * Breathing (rescue breaths)
50
What are the components of advanced life support (ALS) for adults?
* 100% O₂ * Cardiac monitoring * Drug administration (e.g. adrenaline, amiodarone) * Advanced airway (ETT, LMA, Combitube, Tracheostomy)
51
What are the types of hypoxia?
* Hypoxic Hypoxia (Hypoxemia) * Anaemic Hypoxia * Stagnant (Ischemic) Hypoxia * Histotoxic Hypoxia
52
What is the ASA physical status classification for a healthy patient?
ASA I: Healthy patient
53
What is the estimated blood volume (EBV) for a full-term neonate?
90 mL/kg
54
What is the recommendation for oral hypoglycemics before surgery?
Continue until the day before surgery. Hold the morning dose on surgery day.
55
What is the traditional protocol for insulin administration on the day of surgery?
Give ½ of the morning dose of insulin and start 5% dextrose infusion at 125 mL/hour.
56
What is the recommendation for oral anticoagulants (Warfarin) before surgery?
Stop 4 days before surgery and check INR before surgery – must be < 1.5.
57
What is the traditional protocol for mixed insulin on the day of surgery?
Give ½ of the morning dose of insulin, start 5% dextrose infusion at 125 mL/hour, monitor blood glucose every 2 hours, correct hyperglycemia with IV regular insulin (1 unit ↓ glucose by ~25–30 mg/dL), watch for hypokalemia.
58
When should oral anticoagulants like Warfarin be stopped before surgery?
4 days before surgery.
59
What is the required INR level before surgery for patients on Warfarin?
Must be < 1.5 to proceed.
60
What is the bridging protocol if Warfarin cannot be stopped?
Bridge with heparin, then stop heparin 12–24 hours pre-op.
61
What should be done to reverse Warfarin effect in an emergency surgery?
Reverse with Vitamin K or Fresh Frozen Plasma (FFP) if urgent.
62
How long before surgery should LMWH (e.g., Enoxaparin) be stopped?
12 hours for prophylactic, 24 hours for therapeutic.
63
How long before surgery should Unfractionated Heparin be stopped?
6–12 hours.
64
What is the pre-op recommendation for Aspirin?
Usually continued due to ischemia risk; some may reduce the dose.
65
When should Clopidogrel be stopped before surgery?
5 days before surgery.
66
What is the fasting time for solid food before surgery?
8 hours.
67
What should be done regarding external accessories before surgery?
Remove artificial dentures, contact lenses, artificial limbs, jewelry, nail polish, and lipstick.
68
What is important to maintain before surgery?
Good oral hygiene.
69
What must be obtained before surgery?
Informed consent.
70
What medications may be used for premedication before surgery?
Benzodiazepines, anticholinergics, antiemetics.
71
What is the patient preparation regarding urinary needs before surgery?
Ensure bladder is emptied; insert Foley catheter if needed.
72
What is the importance of cleaning fingernails before surgery?
Important for SpO₂ monitoring.
73
What is the first step in the Four-Link Chain of Survival?
Early recognition and activation.
74
What is the survival rate if CPR and shock are given within 5 minutes?
49–75%.
75
What is the current protocol for CPR management?
Circulation (compressions) → Airway → Breathing.
76
What is the purpose of chest compressions in CPR?
Helps deliver oxygen present in the blood to vital organs.
77
What is the key position for a patient during chest compressions?
Supine on a hard surface.
78
What is the recommended depth for chest compressions?
At least 5 cm (2 inches), not more than 6 cm.
79
What is the compression to ventilation ratio in CPR?
30:2.
80
What are indications for defibrillation?
Ventricular Fibrillation (VF), Pulseless Ventricular Tachycardia (VT), Polymorphic VT (Torsades).
81
What is the shock energy for a biphasic defibrillator?
150–200 J.
82
What is the preferred venous access in emergencies during CPR?
Central venous access, preferably subclavian.
83
What is the preferred intraosseous (IO) access site?
2–3 cm below tibial tuberosity, using a 16G or 18G needle.
84
What fluid is preferred during CPR?
Normal Saline (0.9% NaCl).
85
What are the indications for using calcium during CPR?
Hypocalcemia, hyperkalemia, calcium channel blocker overdose.
86
What is the contraindication for using intracardiac adrenaline in modern CPR?
Causes myocardial injury, no benefit over IV/IO route.

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