8 Anesthesia
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Questions and Answers

Which type of anesthesia induction agent has the smallest MAC?

  • Nitrous oxide
  • Sevoflurane (correct)
  • Propofol
  • Halothane

    • Which inhalational induction agent is known for causing fever, eosinophilia, and jaundice?

  • Isoflurane
  • Enflurane
  • Sevoflurane
  • Halothane (correct)

    • Which intravenous induction agent is known for its rapid distribution and on/off effects?

  • Propofol (correct)
  • Sevoflurane
  • Isoflurane
  • Enflurane

    • Which inhalational induction agent is associated with minimal myocardial depression but may cause tremors at induction?

    <p>Sevoflurane</p> Signup and view all the answers

    Which inhalational induction agent is considered suitable for neurosurgery due to its effect on brain oxygen consumption and intracranial pressure?

    <p>Isoflurane</p> Signup and view all the answers

    Which intravenous induction agent is associated with side effects such as hypotension, respiratory depression, and metabolic acidosis?

    <p>Propofol</p> Signup and view all the answers

    Which inhalational induction agent is known for its fast onset and offset and is less pungent compared to other agents?

    <p>Sevoflurane</p> Signup and view all the answers

    Which inhalational induction agent should be avoided in patients with small bowel obstruction or pneumothorax due to its tendency to diffuse into closed spaces?

    <p>Nitrous oxide</p> Signup and view all the answers

    Which intravenous induction agent should be avoided in patients with egg allergy, pregnancy, or Parkinson's disease?

    <p>Propofol</p> Signup and view all the answers

    What is the mechanism of action for local anesthetics?

    <p>Increasing action potential threshold, preventing Na influx</p> Signup and view all the answers

    Which muscle is the last to recover from paralytics?

    <p>Diaphragm</p> Signup and view all the answers

    Which medication is considered safe for use in patients with head injury?

    <p>Ketamine</p> Signup and view all the answers

    Which medication can be indicated for rapid sequence intubation in patients with delayed gastric emptying?

    <p>Etomidate</p> Signup and view all the answers

    Which of the following is a side effect of succinylcholine?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which medication is used as a selective relaxant binding agent to reverse Rocuronium and Vecuronium only?

    <p>Sugammadex</p> Signup and view all the answers

    What is the maximum dosing of lidocaine without epinephrine?

    <p>$4 mg/kg$</p> Signup and view all the answers

    Which of the following is a side effect of local anesthetics?

    <p>Perioral paresthesias</p> Signup and view all the answers

    What is the mechanism of action for dexmedetomidine (Precedex)?

    <p>CNS alpha-2 receptor agonist</p> Signup and view all the answers

    Which muscle is the first to go down and last to recover from paralytics?

    <p>Neck muscles and face</p> Signup and view all the answers

    What is the most common postoperative complication in the Post-Anesthesia Care Unit (PACU)?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which surgical setting is considered the safest in terms of minimizing the risk of electrical burns?

    <p>Bipolar cautery</p> Signup and view all the answers

    What is the recommended pain level for adequate pain control postoperatively?

    <p>3/10</p> Signup and view all the answers

    What is the leading cause of postoperative hypoxemia?

    <p>Atelectasis</p> Signup and view all the answers

    What is the most appropriate treatment for visceral pain postoperatively?

    <p>Opioids</p> Signup and view all the answers

    In an intubated patient undergoing surgery, a sudden drop in end-tidal CO2 (ETCO2) could be due to all of the following except:

    <p>Malignant hyperthermia</p> Signup and view all the answers

    What is the recommended management for a small pneumothorax noticed after a laparoscopic Nissen procedure?

    <p>Observe and repeat chest X-ray in 8 hours</p> Signup and view all the answers

    What could be a potential cause of a sudden transient rise in end-tidal CO2 (ETCO2) in an intubated patient undergoing surgery?

    <p>Hypoventilation</p> Signup and view all the answers

    What is the most common cause of hypotension and a sudden drop in ETCO2 during a laparoscopic procedure?

    <p>$\text{CO}_2$ embolus</p> Signup and view all the answers

    Which of the following medications is an amide?

    <p>Bupivacaine</p> Signup and view all the answers

    Which opioid should not be used in patients on monoamine oxidase inhibitors (MAOIs)?

    <p>Demerol (meperidine)</p> Signup and view all the answers

    What is the primary function of benzodiazepines?

    <p>Anticonvulsant</p> Signup and view all the answers

    What are potential complications of spinal or epidural anesthesia?

    <p>Respiratory depression, hypotension, headache</p> Signup and view all the answers

    What is the biggest risk factor for postoperative myocardial infarction (MI)?

    <p>Uncompensated heart failure</p> Signup and view all the answers

    What is the primary effect of opioids on the body?

    <p>Respiratory depression</p> Signup and view all the answers

    What makes esters more likely to cause allergic reactions?

    <p>Presence of PABA analogues</p> Signup and view all the answers

    Which opioid is fast acting and has a strength 80 times that of morphine?

    <p>Fentanyl</p> Signup and view all the answers

    What should be delayed for at least 6-8 weeks after myocardial infarction (MI)?

    <p>Elective surgery</p> Signup and view all the answers

    Which medication is contraindicated during pregnancy due to placental crossing?

    <p>Midazolam (Versed)</p> Signup and view all the answers

    Which inhalational induction agent is known for its slow onset/offset, highest degree of cardiac depression and arrhythmias, and least pungent odor, making it suitable for children?

    <p>Halothane</p> Signup and view all the answers

    Which intravenous induction agent provides anesthesia and amnesia but is not an analgesic, and is associated with side effects such as hypotension, respiratory depression, and metabolic acidosis?

    <p>Propofol</p> Signup and view all the answers

    Which inhalational induction agent is fast, less pungent, and has less laryngospasm, making it suitable for mask induction?

    <p>Sevoflurane</p> Signup and view all the answers

    Which intravenous induction agent has side effects including hypotension, respiratory depression, and metabolic acidosis, and should be avoided in patients with egg allergy, pregnancy, or Parkinson’s disease?

    <p>Propofol</p> Signup and view all the answers

    Which inhalational induction agent is good for neurosurgery as it lowers brain oxygen consumption without increasing intracranial pressure?

    <p>Isoflurane</p> Signup and view all the answers

    Which inhalational induction agent is known for its high degree of cardiac depression and arrhythmias and is contraindicated in patients with liver dysfunction due to the risk of hepatotoxicity?

    <p>Halothane</p> Signup and view all the answers

    Which intravenous induction agent is associated with rapid distribution and on/off effects and can cause side effects including hypotension, respiratory depression, and metabolic acidosis?

    <p>Propofol</p> Signup and view all the answers

    Which inhalational induction agent diffuses into closed spaces and should be avoided in patients with small bowel obstruction or pneumothorax?

    <p>Enflurane</p> Signup and view all the answers

    Which intravenous induction agent should be avoided in patients with egg allergy, pregnancy, or Parkinson's disease?

    <p>Propofol</p> Signup and view all the answers

    Which inhalational induction agent is known for its minimal myocardial depression but may cause tremors at induction?

    <p>Isoflurane</p> Signup and view all the answers

    In an intubated patient undergoing surgery with a sudden transient rise in end-tidal CO2 (ETCO2), what is the most likely cause?

    <p>Hypoventilation</p> Signup and view all the answers

    What is the recommended management for a small pneumothorax noticed after a laparoscopic Nissen procedure?

    <p>Observe and repeat chest X-ray in 8 hours</p> Signup and view all the answers

    What is the most common postoperative complication in the Post-Anesthesia Care Unit (PACU)?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which of the following medications is an amide?

    <p>Lidocaine</p> Signup and view all the answers

    What is the primary effect of opioids on the body?

    <p>Analgesia</p> Signup and view all the answers

    What is the primary cause of hypotension and a sudden drop in ETCO2 during a laparoscopic procedure?

    <p>Air embolism</p> Signup and view all the answers

    Which medication can be indicated for rapid sequence intubation in patients with delayed gastric emptying?

    <p>Etomidate</p> Signup and view all the answers

    Which intravenous induction agent should be avoided in patients with egg allergy, pregnancy, or Parkinson's disease?

    <p>Thiopental</p> Signup and view all the answers

    Which muscle is the last to recover from paralytics?

    <p>Diaphragm</p> Signup and view all the answers

    What is the mechanism of action for local anesthetics?

    <p>Blockade of sodium channels</p> Signup and view all the answers

    Which inhalational induction agent is known for its fast onset and offset and is less pungent compared to other agents?

    <p>Desflurane</p> Signup and view all the answers

    What could be a potential cause of a sudden transient rise in end-tidal CO2 (ETCO2) in an intubated patient undergoing surgery?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which medication is used as a selective relaxant binding agent to reverse Rocuronium and Vecuronium only?

    <p>Sugammadex</p> Signup and view all the answers

    What could be a potential cause of a sudden transient rise in end-tidal CO2 (ETCO2) in an intubated patient undergoing surgery?

    <p>CO2 embolus</p> Signup and view all the answers

    What is the recommended management for a small pneumothorax noticed after a laparoscopic Nissen procedure?

    <p>Observation and supplemental oxygen</p> Signup and view all the answers

    Which muscle is the last to recover from paralytics?

    <p>Extraocular muscles</p> Signup and view all the answers

    Which opioid should not be used in patients on monoamine oxidase inhibitors (MAOIs)?

    <p>Meperidine</p> Signup and view all the answers

    What is the most common cause of hypotension and a sudden drop in ETCO2 during a laparoscopic procedure?

    <p>'Pneumoperitoneum'</p> Signup and view all the answers

    What is the primary function of benzodiazepines?

    <p>Anxiolysis</p> Signup and view all the answers

    What is the maximum dosing of lidocaine without epinephrine?

    <p>4.5 mg/kg</p> Signup and view all the answers

    Which medication is known for dissociation of thalamic/limbic systems, placing the patient in a cataleptic state with amnesia and analgesia?

    <p>Ketamine</p> Signup and view all the answers

    Which muscle is the last to go down and the first to recover from paralytics?

    <p>Diaphragm</p> Signup and view all the answers

    Which medication is a selective relaxant binding agent used to reverse Rocuronium and Vecuronium only?

    <p>Sugammadex</p> Signup and view all the answers

    Which local anesthetic has a length of action that is longer than lidocaine but shorter than bupivacaine?

    <p>Ropivacaine</p> Signup and view all the answers

    Which medication is considered safe for use with head injury and is good for children?

    <p>Ketamine</p> Signup and view all the answers

    Which muscle group is the first to go down and the last to recover from paralytics?

    <p>Neck muscles</p> Signup and view all the answers

    Which medication inhibits neuromuscular junction by competing with acetylcholine?

    <p>Cis-atracurium</p> Signup and view all the answers

    Which medication undergoes Hoffman elimination and can be used in liver and renal failure due to its breakdown in the blood?

    <p>Cis-atracurium</p> Signup and view all the answers

    Study Notes

    • Certain medications, such as epinephrine, should not be used in patients with arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals in the penis and ears, or uteroplacental insufficiency.

    • Amides, which have an "i" in the first part of their names, include lidocaine, bupivacaine, and mepivacaine. They rarely cause allergic reactions.

    • Esters, which do not have an "i" in the first part of their names, include tetracaine, procaine, and cocaine. They increase the risk of allergic reactions due to the presence of PABA analogues.

    • Opioids, also known as narcotics, include morphine, fentanyl, Demerol (meperidine), codeine, and hydromorphone (Dilaudid). They are all CNS mu-opioid receptor agonists, providing profound analgesia and respiratory depression with no cardiac effects.

    • Opioids are metabolized by the liver and excreted via the kidneys. Overdose of opioids can be treated with the mu-opioid receptor antagonist Narcan (naloxone).

    • Opioids, especially Demerol, should not be used in patients on monoamine oxidase inhibitors (MAOIs) due to the risk of hyperpyrexic coma.

    • Morphine offers analgesia, euphoria, respiratory depression, miosis (pupil constriction), constipation, and histamine release. Demerol provides analgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, and convulsions.

    • Methadone and fentanyl are also opioids. Methadone simulates morphine and is less euphoric. Fentanyl is fast acting, and its strength is 80 times that of morphine.

    • Benzodiazepines are used as anticonvulsants, amnesics, anxiolytics, and muscle relaxants. They are respiratory depressants but not analgesics. They act on the GABA receptor in the CNS.

    • Versed (midazolam) is a short-acting benzodiazepine and is contraindicated during pregnancy due to placental crossing.

    • Epidural anesthesia allows analgesia through sympathetic denervation and vasodilation, but it can cause respiratory depression and hypotension. Morphine in epidural anesthesia can lead to respiratory depression. Lidocaine in epidural anesthesia can cause decreased heart rate and blood pressure.

    • Epidural and spinal anesthesia have complications, such as hypotension, headache, urinary retention, and respiratory depression. Spinal headaches are a common complication caused by CSF leaks after spinal or epidural anesthesia.

    • Preoperative complications include renal failure and congestive heart failure, which are associated with most postoperative hospital mortality. Postoperative MI can happen intraoperatively or postoperatively and may cause no chest pain, hypotension, arrhythmias, elevated filling pressures, oliguria, and bradycardia.

    • Elective surgery should be delayed for at least 6-8 weeks after myocardial infarction (MI). Biggest risk factors for postoperative MI are uncompensated CHF, recent MI, age > 70, DM, previous MI, unstable angina, Cr > 2, stroke/TIA, or aortic and peripheral vascular surgeries.

    • Beta-blockers are effective agents for preventing intraoperative and postoperative cardiovascular events.

    • ASA Physical Status (PS) classes range from healthy (Class 1) to moribund (Class 5), and most aortic and peripheral vascular surgeries are considered high risk. Carotid endarterectomy (CEA) is considered moderate risk surgery.

    • Certain medications, such as epinephrine, should not be used in patients with arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals in the penis and ears, or uteroplacental insufficiency.

    • Amides, which have an "i" in the first part of their names, include lidocaine, bupivacaine, and mepivacaine. They rarely cause allergic reactions.

    • Esters, which do not have an "i" in the first part of their names, include tetracaine, procaine, and cocaine. They increase the risk of allergic reactions due to the presence of PABA analogues.

    • Opioids, also known as narcotics, include morphine, fentanyl, Demerol (meperidine), codeine, and hydromorphone (Dilaudid). They are all CNS mu-opioid receptor agonists, providing profound analgesia and respiratory depression with no cardiac effects.

    • Opioids are metabolized by the liver and excreted via the kidneys. Overdose of opioids can be treated with the mu-opioid receptor antagonist Narcan (naloxone).

    • Opioids, especially Demerol, should not be used in patients on monoamine oxidase inhibitors (MAOIs) due to the risk of hyperpyrexic coma.

    • Morphine offers analgesia, euphoria, respiratory depression, miosis (pupil constriction), constipation, and histamine release. Demerol provides analgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, and convulsions.

    • Methadone and fentanyl are also opioids. Methadone simulates morphine and is less euphoric. Fentanyl is fast acting, and its strength is 80 times that of morphine.

    • Benzodiazepines are used as anticonvulsants, amnesics, anxiolytics, and muscle relaxants. They are respiratory depressants but not analgesics. They act on the GABA receptor in the CNS.

    • Versed (midazolam) is a short-acting benzodiazepine and is contraindicated during pregnancy due to placental crossing.

    • Epidural anesthesia allows analgesia through sympathetic denervation and vasodilation, but it can cause respiratory depression and hypotension. Morphine in epidural anesthesia can lead to respiratory depression. Lidocaine in epidural anesthesia can cause decreased heart rate and blood pressure.

    • Epidural and spinal anesthesia have complications, such as hypotension, headache, urinary retention, and respiratory depression. Spinal headaches are a common complication caused by CSF leaks after spinal or epidural anesthesia.

    • Preoperative complications include renal failure and congestive heart failure, which are associated with most postoperative hospital mortality. Postoperative MI can happen intraoperatively or postoperatively and may cause no chest pain, hypotension, arrhythmias, elevated filling pressures, oliguria, and bradycardia.

    • Elective surgery should be delayed for at least 6-8 weeks after myocardial infarction (MI). Biggest risk factors for postoperative MI are uncompensated CHF, recent MI, age > 70, DM, previous MI, unstable angina, Cr > 2, stroke/TIA, or aortic and peripheral vascular surgeries.

    • Beta-blockers are effective agents for preventing intraoperative and postoperative cardiovascular events.

    • ASA Physical Status (PS) classes range from healthy (Class 1) to moribund (Class 5), and most aortic and peripheral vascular surgeries are considered high risk. Carotid endarterectomy (CEA) is considered moderate risk surgery.

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    Test your knowledge of anesthesia and narcotics with this quiz covering drug contraindications, classifications, and effects. Learn about amides, esters, and opioids in anesthesia practice.

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