Question: Bone marrow depression is seen with.


Question: The regional anaesthesia technique that would not be expected to provide appropriate analgesic benefit during the first stage of labor is

Pudendal nerve block during delivery mitigates somatic pain during second stage of labor.


Question: Recommended maximum dose of Lignocaine + adrenaline for peripheral nerve shock.

Local Anesthetic Maximum dose Over 24 hours Plain With Adrenaline Lidocaine 300mg 4.5mg/kg 500mg 7mg/kg Mepivacaine 300mg 4.5mg/kg 500mg 7mg/kg Prilocaine 600mg 8mg/kg 600mg 2-chloroprocaine 800mg 12mg/kg 1000mg Bupivacaine 175mg 3mg/kg 225mg 400mg Levobupivacaine 150mg 400mg Ropivacaine 225mg 3mg/kg 800mg maximum dose of plain lidocaine is mentioned differently in different anesthesia books - 3mg/kg BW ( Miller TEXT BOOK of Anesthesia) or 4.5 mg/kg BW (Morgan and Mikhail's Clinical Anesthesiology)


Question: Local anaesthetic with prolonged action

Dibucaine is the longest acting local anaestheticChlorprocaine is the shoest acting local anaestheticDecreasing order of duration: Dibucaine >Bupivacine= Tetracaine = Ropivacaine=Etidocaine > Prilocaine = lignocaine =Mepivacaine = Cocaine >Procaine >Chloprocaine(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.290,304)


Question: In venturi mask maximum O2 concentration attained is

Maximum concentration delivered by ventimask (venturimask) is 60%.


Question: Percentage of lidocaine in eutectic mixture

Eutectic mixture of local AnaestheticsThis is unique topical preparation which can anaesthetize the intact skinIt is a mixture of 2.5% lidocaine and 2.5 prilocaineIt acts slowly and the cream must held in contact with skin for at least 1 hourEMLA is used: to make venepuncture painless especially in children, and for the procedure like skin grafting & circumcision As systemic absorption of prilocaine can cause methemoglobinemia, EMLA should not be used on mucocutaneous membrane or in the very small child.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 754, 856)


Question: Following group of drugs is not the first line in the management of chronic


Question: Most commonly used nerve for neuromuscular monitoring under anesthesia is

Monitoring of Neuromuscular block Done by nerve stimulator Different stimulation - Single Twitch Tetanus Train of four stimulus (most common) Double burst stimulation Post - tetanic count Nerves used - ulnar nerve (most common) (Adductor pollicis muscle ) Facial nerve Posterior tibial nerve External peroneal nerve Response of stimulation


Question: Anaesthesia used in microlaryngoscopy is

C i.e. Pollarad tube with infiltration block When fire breaks out during laser vocal cord surgery, oxygen should be turned off, ventilation stopped, tracheal tube removed and submerged in water and the patient should be ventilated with facemasK. Airway damage is assessed with bronchoscopy and bronchial lavage, steroids, can be used for treatment. Anesthesia for Endoscopic Surgeries of Airway Endoscopy includes laryngoscopy, microlaryngoscopy (i.e. aided by an operating microscope), bronchoscopy & oesophagoscopy. These procedures may be accompanied by laser surgery. Microlaryngoscopic surgeries include biopsy / surgery of laryngeal malignancy, vocal cord polyps etc. It is associated with some specific problems as - common field for anesthetist & surgeon, already reduced glottic opening d/t growth, laryngospasm (mediated by superior laryngeal nerve) d/t laryngeal stimulation, very high chances of aspiration and myocardial ischemia (- 4% due to sympethetic stimulation). Preoperative Considerations - Sedative premedication is contraindicated in any patient with any significant degree of upper airway obstructionQ, d/t fear of aspiration. Glycopyrrolate, 1 hour before surgery minimize secretions, thereby facilitate ventilation. Pethidine & promethazine are only given if there is no airway obstruction. Laser Precautions General laser precautions include wearing protective spectacles to prevent retinal damage and evacuation of toxic fumes (laser plume) from tissue vaporization which may have potential to transmit microbacterial diseases. Greatest fear during laser airway surgery is a tracheal tube fire. This can be avoided by using a technique of ventilation that does not involve a flammable tube or catheter (eg intermittent apnea or jet ventilation through the laryngoscope side po). The potential fuel source should have laser resistant propeies (laser tubes or wrapping a tracheal tube with metallic tape) or be removed (supraglottic jet ventilation technique). The only non inflammable, laser proof tube is the all metal. Noon tube, which has no cuff. Most laser tubes have laser resistant propeies around the shaft, but the cuff is not protected and can ignite. So there are double cuffs to seal the airway- if upper cuff is struck by laser and saline escapes, the lower cuff will continue to seal the airway. No cuffed tracheal tube, or any currently available tube protection is completely laser proof. Therefore, whenever laser airway surgery is being performed with a tracheal tube in place, the following precaution should be observed. - Inspired 02 conc. should be as low as possible may be upto 21% - N20 suppo combustion & should be replaced with air (N2) or heliumQ - Tracheal tube cuffs should be filled with saline dyed with methylene blue to dessipate heat & signal cuff rupture - A cuffed tube will minimize 02 conc. in the parynx. The addition of 2% lidocaine jelly (1:2 mixture with saline) can seal small laser induced cuff leaks, potentially preventing combustion - Laser intensity & duration should be limited as much as possible. - Saline soaked pledgets (completely saturated) should be placed in the airway to limit risk of ignition. - A source of water (60 ml) should be immediately available in case of fire. Muscle Relaxation Profound muscle relaxation is the aim to provide masseter muscle relaxation for introduction of suspension laryngoscope & an immobile surgical field. - Anesthesia is induced with IV induction agent followed by a non depolarizing muscle relaxant; the vocal cords are sprayed with 3 ml lidocaine 4% to assist smooth anesthesia & to minimize the possibility of postextubation laryngospasmQ - Alternatively the cords may be painted with 3% cocaine at the end of procedure, which has the added advantage of reducing bleeding from operative site. Oxygentation & Ventilation - Microlaryngoscopy tubes are long, have a small internal and external diameter, and are designed specifically for endoscopic procedures (but not suitable for laser surgery). Typically 4 to 5 mm internal diameter tubes with high volume, low pressure cuffs are used in nasal or oral versions. The most popular anesthetic technique use a Coplan's microlaryngoscopy tube (5mm ID, 31cm long, 10m1 cuff volume and constructed from soft plastic). It is designed for micro laryngeal surgery or for patient whose airway has been narrowed to such an extent that a normal sized tracheal tube cannot be inseed. The small tube diameter provides better visibility and access to surgical field but may lit incomplete exhalation and occlusion. - Most commonly the patients are intubated with small diameter (4 - 6 mm) tracheal tubesQ; - Standandard tracheal tubes of this size, however, are designed for pediatric patients. They tend to be too sho for adult trachea (in length)Q with a low volume cuff that will exe high pressure against it - A 4 - 6 mm microlaryngea tracheal (MLT) tubes (Mallinckrodt critical Care) is the same length as the adult tube, has dispropoionately large high volume low pressure cuff, and is stiffer and less prone to compression than a regular tracheal tube. - The advantages of intubation include - protection against aspiration, and the ability to administer inhalational anesthetics and enable monitoring of ventilation by capnography and spirometry, by measuring end tidal CO2Q - In some cases (eg those involving posterior commissure), intubation may interfere with surgeon's visualization and then alternatives are: 1.Insufflation of high flows of oxygen through small catheter placed in the trachea 2. Intermittent apnea technique. Jet ventilation through laryngoscope High frequency positive pressure ventilation (HFPPV)

Pollarad tube of 10 mm diameter with heavy sedation

Pollarad tube of 15 mm diameter with topical xylocaine

Heavy sedation on and Endotracheal intubation


Question: Shortest acting muscle relaxant is

Ans) aSuccinylcholine is the only available depolarizing neuromuscular blocker. It is characterized by rapid onset of effect and ultrashort duration of ac-tion because of its rapid hydrolysis by butyryl cholinesterase.Classification of nondepolarizing neuromuscular blockers according to duration of action (time to T1 = 25% of control) after twice the ED95Class of BlockerLong-Acting (>50 min)Intermediate- Acting (20-50 min)Short-Acting (15-12 min)Ultrashort- acting (<10-12min)Steroidal compoundPancuronium pipecuroniumVecuronium Rocuronium Benzylisoquinolinium compoundsd-Tubocurarine Metocurine DoxacuriumAtracurium CisatrucuriumMivacurium Others Asymmetrical mixed-onium chlorofumarates GantacuriumPhenolic etherGallamine Diallyl derivative of toxiferineAlcuromum


Question: Muscle relaxant with ganglion blocker action are A/E


Question: Anaesthetic without epileptogenic potential

Ans:A.)Desflurane. Sevoflurane,Enflurane and Isoflurane have Epileptogenic potential.


Question: Induction agent of choice in day care surgery is

(Propofol) 585 - Lee's 13th) (375-KDT6th)* Geneal anaesthesia for day surgery should use agents that are rapidly eliminated and titratable* Most of those in common use are appropriate intravenous propofol or inhalation sevoflurane are both highly suitable for induction of anaesthesia in adults and childrenAdvantages of propofol over Thiopentone1. Rapid and smooth recovery2. Completely eliminated from body in 4 hours so patient is ambulatory early3. Antiemetic4. Antipruritic5. BronchodilatorDisadvantages of Day Surgery* Where day surgery is not well established, it may promote an over cautions attitude* May encourage poor management of operating list order* Surplus overnight capacity can attract emergency out liers and block beds* Antisocial hours may deter - day care nursing staff


Question: Most appropriate mode of ventilation for head injury patient


Question: Clayton is used in a close breathing system for the purpose of


Question: Least soluble anaesthetic agent is

Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. Newer anesthetics (such as desflurane) typically have smaller blood-gas paition coefficients than older ones (such as ether); these are preferred because they lead to faster onset of anesthesia and faster emergence from anesthesia once application of the anesthetic is stopped. If an anesthetic has a high coefficient, then a large amount of it will have to be taken up in the body's blood before being passed on to the fatty (lipid) tissues of the brain where it can exe its effect. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Supreme LMA characteristic is

LMA Supreme is one of the most advanced laryngeal mask airway (LMA)It has features of usual LMA with additional Built-in drain tube and a bite blockIt has high volume/ low-pressure cuff which generates higher seal pressureIt also provides a conduit for active suctioning of stomachIt can be used in infants as well as in adults.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 317, 318)


Question: A 65 year old man is scheduled for emergency laparoscopic appendectomy. He is a chronic smoker with history of severe COPD, diabetic and hypertensive, on insulin, metformin and antihypertensive medications, not on regular follow up. He also complains of dyspnea on walking more than a few meters. This patient would be assigned

Elderly male patient –poorly controlled diabetic and hypertensive, known smoker with COPD. His co-morbidities are constant threat to life.  And since emergency appendectomy is done, it falls under ASA 4E.


Question: Capnography is used for assessment of

Capnography is the method of determining CO2 levels in exhaled gases (PACO2) but NOT blood.It is the ideal confirmatory method of endotracheal intubation(VENTILATION OF LUNG AFTER INTUBATION) Aeral blood gas analysis is used to measure CO2 levels in Blood (PaCO2) Pulse oxymetry is used to measure oxygen saturation of blood and hea rate.

Preoperative assessment and monitoring in anaesthesia


Question: Contraindication for laryngeal mask airway is

LMA INDICATIONS : .Sho procedures where endotracheal tube is not necessary,Difficult airway , Cardiac arrest ,conduit for intubation, Contraindications Absolute :Complete Upper airway obstruction,Locked jaw relative : increased risk of aspiration like in full stomach, 2nd n 3rd trimester of pregnancy ,morbid obesity,Upper GI bleed, Hiatus hernia, Suspected or known Supraglottic anatomical abnormalities


Question: Most cardiostable among the following is

Thiopentone, propofol, ketamine cardio unstable Etomidate cardio stable Etomidate is the most cardiac stable intravenous agent due to its lack of effect on the sympathetic nervous system and on the function of the baroreceptor. The myocardial oxygen supply-to-demand ratio is well maintained. Hence, etomidate is the intravenous agent of choice in patients with coronary aery disease, cardiomyopathy and cerebral vascular disease.


Question: Hyperbaric Oxygen is not useful in

Hyperbaric oxygen is not useful in veigo.


Question: Most common complication of celiac plexus block

Postural hypotension : due to lumbar sympathetic chain blockade leading to upper abdominal vessel dilation and venous pooling. So intravenous fluids are required preblock


Question: The physiological dead space is decreased by

Dead space is defined as the volume of the airway that doesnot paicipate in gas exchange (It is nothing but ventilation occurs but perfusion doesnot occur) Anatomical Dead Space : from nasopharynx to respiratory bronchioles.average adult,normally 150ml Alveolar dead space : Alveoli that are ventilated but not perfused.usually it is absent Physiological or total dead space : Anatomical + Alveolar dead space Factors that increase dead space : upright position neck extension advanced age positive pressure ventilation decreased pulmonary perfusion (pulmonary emboli or pulmonary hypeension) lung diseases (emphysema or cystic fibrosis ) FACTORS THAT DECREASE DEAD SPACE : supine position , neck flexion , intubation Anatomical dead space is measured by single breath nitrogen test , physiological dead space is measured by modified bohr's equation.


Question: In spinal anaesthesia the drug is deposited between

Ans. is 'b' i.e., Pia and arachnoid matter Spinal anaesthesia In spinal anaesthesia LA is injected into subarachnoid space (space between pia matter and arachnoid matter). Structure pierced during SA (from outside in) - Skin - Subcutaneous tissue --> Supraspinous & intraspinous ligament --> Ligamentum falvum --> Duramater -->Arachnoidmater. Site of spinal anaesthesia L2_3 or L3_4 interveebral space in adult (In adult spinal cord ends at lower border of Ll veebrae). L4_5 interveebral space in children (spinal cord ends at lower border of L3 veebrae in children). Spinal anaesthesia leads to creation of a zone of differential blockade, ie motor fibres are blocked two levels lower and autonomic fibres are blocked two levels higher than the sensory blockade due to different sensitivity of different fibres.


Question: Muscle relaxant with ganglion blocker action is

Curare is an example of a non-depolarizing muscle relaxant that blocks the nicotinic acetylcholine receptor (nAChR), one of the two types of acetylcholine (ACh) receptors, at the neuromuscular junction


Question: In Phrenic nerve block, it is best to infiltrate near

Phrenic nerve is blocked 3 cm above the clavicle at the posterior border of sternomastoid. Used for intractable hiccups


Question: Pulse oximetry monitors

Pulse oxymetry monitors hea rate, oxygen saturation of hemoglobin and gives aerial waveform. It works on the principle of transmission spectrophotometry and optical plethysmography. It has 2light emitting diodes.one is red with the wavelength of 660nm and other one is infrared with the wavelength of 940nm.


Question: Most cardiotoxic local anesthetic

Bupivacaine is the most cardiotoxic LA (Ropivacaine is a newer bupivacaine congenial with less cardiotoxicity).(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294)


Question: Characteristic of an ideal gas is

D i.e. Obeys Charles, boyle's & avogadro's laws

Volume is directly propoional to change in pressure

Volume is inversely propoional to change in temperature


Question: For Foreign bodies are retained in the larynx causing choking, first line of management is


Question: Not a sign of stellate ganglion block

Horner syndrome is a sign of stellate ganglion block (miosis, enopthalmos,ptosis, anhydrosis and absence of cliospinal reflex


Question: This manouver helps to

This is BURP manouver . here thyroid cartilage is pushed back up with right pressure to improve laryngoscopic view.


Question: Arrange following according to increasing order of their total body water as percentage of body weight 1. 6 month baby 2. neonate 3. young female 4. young male

Age Total body water (%) ECF(%) Blood volume(%) Neonate 80 45 9 6 mo old 70 35 1 yr 60 28 5 yr 65 25 8 Young male 60 22 7 Young female 50 20 7 Elderly 50 20


Question: Ether was first used by

Ether was used for frivolous purposes ("ether frolics"), but not as an anesthetic agent in humans until 1842, when Crawford W. Long and William E. Clark independently used it on patients for surgery and dental extraction, respectively. However, neither Long nor Clark publicized his discovery. Four years later, in Boston, on October 16, 1846, William T.G. Moon conducted the first publicized demonstration of general anesthesia for surgical operation using ether. The dramatic success of that exhibition led the operating surgeon to exclaim to a skeptical audience: "Gentlemen, this is no humbug!" Joseph Priestley produced nitrous oxide in 1772, and Humphry Davy first noted its analgesic propeies in 1800. Gardner Colton and Horace Wells are credited with having first used nitrous oxide as an anesthetic for dental extractions in humans in 1844. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: High airway resistance is seen in

Resistance impedes airflow into (and out of) the lung. The major component of resistance is the resistance exeed by the airways (large and small), and a minor component is the sliding of the lung and the chest wall tissue elements during inspiration (and expiration). Resistance is overcome by (driving) pressure. In spontaneous breathing, Resistance (R) is calculated as driving pressure (DP) divided by the resultant gas flow (F): R = DP/F The value of airway resistance is approximately 1 cm H2O/L/sec, and is higher in obstructive lung disease (e.g., COPD, asthma); in severe asthma, it is elevated approximately tenfold. The presence of an endotracheal tube adds a resistance of 5 (or 8) cm H2O/L/min for a tube with an internal diameter of size 8 (or 7) cm. For any tube for which the airflow is laminar (smooth, streamlined), the resistance increases in direct propoion to the tube length and increases dramatically (to the fouh power) as the diameter of the tube is reduced. Two factors explain why most (approximately 80%) of the impedance to gas flow occurs in the large airways. First, as bronchi progressively branch, the resistances are arranged in parallel and the total cross-sectional area at the level of the terminal bronchioles adds up to almost tenfold that at the trachea. Second, in tubes that are large, irregular or branched, the flow is often turbulent, not laminar. When flow is laminar: F(lam) = DP/R In contrast, when the flow is turbulent: F(turb) = DP/R2 Therefore, for a given radius, far more pressure is required to achieve comparable flow where the flow is turbulent; thus, the effo required is greater, and if prolonged or severe, respiratory failure is more likely. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Secondary action of Superior Rectus Muscle is

Ans. is c i.e., Adduction & intorsion Muscle Primary ction Secondary Action Superior rectus Elevation Adduction and intorsion Inferior rectus Depression Adduction and extorsion Medial rectus Adduction Lateral rectus Abduction Superior oblique Intorsion Abduction and depression Inferior oblique Extorsion Abduction and elevation


Question:
Optimum oxygenation is maintained by adjusting following parameters
a — Tidal volume,b — PEEP,c — FiO2,d — respiratory rate

PEEP and FiO2 determine optimum oxygenation.


Question: No effect on hea


Question: Local anaesthesia causing methemoglobinemia

Prilocaine Prilocaine is an amide local anaesthetic that is metabolized to ohotolidine. Ohotolidine is an oxidizing compound capable of conveing hemoglobin to methemoglobin. As methemoglobinemia reduces the amount of hemoglobin that is available for oxygen transpo this side effect is potentially life threatening. Therefore dose limits for prilocaine should be strictly observed. Drugs causing methemoglobinemia Anilines Aminophenois Aminoph enon es Chlorates/dapsone Prilocaine/benzocaine Nitrates/nitrites/naphthalene Nitrobenzene Phenazopyridine Primaquine and related antimalarials Sulfonamides


Question: The most potent synthetic opioid is

Sufentanil has a high affinity for the mu receptor, higher than that of any other opioid.


Question: Modality best utilized for neuromuscular monitoring during maintenance of anaesthesia is

Neuromuscular monitoring, also known as a train of four monitoring, is a technique used during recovery from the application of general anaesthesia to objectively determine how well a patient&;s muscles are able to function.


Question: In a patient with fixed respiratory obstruction Helium is used along with Oxygen instead of plain oxygen because


Question: 100 % Oxygen therapy used in

(A) Cluster headache # CLUSTER HEADACHES are rare, extremely painful, & debilitating headaches that occur in groups or clusters.> These headaches affect one side of the head (unilateral) & may involve tearing of the eyes & a stuffy nose.> Unlike migraines, more men experience this type of headache than women.> They can affect people of any age, but are most common between adolescence & middle age.> No discernable pattern can be found among families in the development of cluster headaches.> While no specific cause has been found for the disorder, it appears to be related to a sudden release of histamine or serotonin by the body tissue.> Onset is sudden & most commonly happens during the dreaming (REM) phase of sleep.> Headaches may occur daily for months, alternating with periods without the headaches (episodic), or they can recur for a year or more without stopping (chronic).> A person may experience alternating chronic & episodic phases.> Some people who experience cluster headaches are heavy smokers.> Alcohol, glare, stress, or certain foods may trigger an attack.> The goal of treatment is to relieve the symptoms.> Smoking, alcohol use, specific foods, and other factors that seem to trigger cluster headaches should be avoided.> A headache diary may be helpful in identifying triggers.> When a headache occurs, record the date and time it starts.> In addition, list all activities, substances used, and food/drink consumed within the previous 24 hours, as well as any other factors that seem significant.> HBOT seems to be useful in the treatment of cluster headaches, particularly for frequent headaches that occur at night.> Side effects of mild ear and sinus pressure have been reported


Question: Intravenous anaesthetic agent of choice in status epilepticus

Propofol produces coical EEG changes. Propofol appears to possess profound anticonvulsant propeies. CBF ICP CMRO2 Seizure Thiopentone ||| ||| ||| ||| Ketamine || || | | Halothane || || | | Nitrous oxide | | | | Previously thiopentone was used nowerdays propofol is used.


Question: Critical temperature for liquid nitrogen is

Critical temperature (Tc) of substance is the temperature at and above which vapor of that substance cannot be liquefied, no matter how much pressure is applied (Note: Below critical temperature a substance can exist as a liquid or gas depending on pressure).Critical temperature of N2 is-146.9degC; that means N2 can b3e liquefied below -146.9degC - So, liquid nitrogen must be stored below -146.9degC(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no 11 -12)


Question: Hepatotoxic inhalational agent

All inhalational agent cause maild hepatotoxicity by decreasing hepatic blood flowIsoflurane is the agent of choice in liver disease as it has least effect on Hepatic blood flowDirect hepatotoxicity (Hepatitis, hepatic necrosis) is caused by- halothane, chloroform, trilene, methoxyflurane(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167-169)


Question: Shoest acting non depolarizing muscle relaxant is

Suxamethonium (succinylcholine) is the shoest acting skeletal muscle relaxantMivacurium is the shoest acting nondepolarizing skeletal muscle relaxant.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.139)


Question: Anesthesia agent with least analgesic propey


Question: Laudanosine is metabolic end product of

Laudanosine is metabolic end product of atracurium.


Question: Not compatible with soda lime


Question: Flat capnogram found in A/E

in bronchospasm,there is prolonged expiratory upstroke(abscence of phase 3 plateau). in tube displacement,disconnection,accidental extubation,ventilation failure,it is flat.

Preoperative assessment and monitoring in anaesthesia


Question: Spinal anesthesia should be injected into the space between

Spinal anesthesia is usually injected at L3-L4, L2-L3


Question: Maximum vital capacity decreased in

C i.e. Trendelenberg Trendelenburg (head down) position causes cephalad shift of abdominal viscera and diaphragm leading to marked decrease in lung capacities (i.e. vital capacity, functional residual capacity, total lung volume, lung compliance) Q Respiratory rate is not affected in any position.Q Physiological effects of patient position Trendelenburg Horizontal Lithotomy Prone Lateral decubitus * Cardiac : Activation of * Cardiac * Cardiac * Cardiac * Cardiac baroreceptors produce - Decreased hea rate - Increase in - Decrease - Cardiac output unchanged decrease in - Decreased peripheral circulating preload, cardiac unless venous return - Cardiac output resistance blood volume output, blood obstructed. - Hea output - Equalization of and preload. pressure due to - Aerial blood pressure - B.P. pressure through out - Effect on peripheral may fall as a result of - Peripheral vascular resistance the aerial system blood pooling of blood. decreased vascular * Respiratory : Cephalad shift of - Increased right sided pressure and * Respiratory resistance. abdominal viscera produces filling & cardiac cardiac - Decreases total * Respiratory - Marked decrease in lung output. output lung compliance - Decreased volume of capacities (VC, FRC, Total * Respiratory depends on and increases dependent lung. lung volume, lung - Diaphragm is volume work of - Increased perfusion of compliance)Q displaced cephalad status. breathing. dependent lung. - Atelactasis by abdominal viscus * Respiratory - Increased ventilation of - Increase ventilation perfusion - Increase perfusion of - Decreased dependent lung in awake mismatch dependent vital capacity. patient (No v/q mismatch) - Increase likelihood of (posterior) segment - Increase - Decreased ventilation of regurgitation - Functional residual likelihood of dependent lung in * Others - Increase intraocular pressure in glaucoma - Increase in intracranial Pressure & decrease in cerebral blood flow. capacity decreases aspiration anaesthetized patient (v/q mismatch) - Fuher decrease in dependent lung ventilation with paralysis and open chest.


Question: The term "balanced anaesthesia" has been given by

Term 'balanced anaesthesia' was introduced by Lundy in 1926Balanced anaestesiaThe cardinal feature of general anaesthetics are:-Loss of all sensations, especially painSleep (unconsciousness) and amnesiaImmobility and muscle relaxationAbolition of reflexesIn the modern practice of balanced anaesthesia these modalities are achieved by using the combination of inhaled and i.v. drugs.


Question: Shoest acting nondepolarising muscle relaxant

Suxamethonium (succinylcholine) is the shoest acting skeletal muscle relaxantMivacurium is the shoest acting nondepolarizing skeletal muscle relaxant(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.214,218,219 )


Question: Modern monitors to measure ETCO2 make use of

Measurements of variations in the respiratory cycle of expired carbon dioxide by displayed waveform and by absolute numerical values is defined as Capnography and Capnometry respectivelyMeasurement of the exhaled CO2 at the level of upper airway at the end of expiration (when CO2 is at its maximum) is referred to as 3end tidal CO2 (EtCO2)Modern monitors used to measure EtCO2 in the exhaled air make use of infrared absorption spectroscopy(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 126)


Question: Propofol infusion syndrome is characterized by

Propofol infusion syndrome occurs when propofol infusion is continued for more than 48 hours

Severe metabolic acidosis
Acute cardiacfailure
Hyperkalemia
Hyperlipidemia
Skeletal myopathy
Refractory bradycardia.


Question: Fixed performance device is

venturi mask is a device used to deliver designated oxygen concentration to patients on controlled oxygen therapy. It is designed with wide bore tubes with various colour adapters. Each colour code responds to the precise oxygen concentration and specific litre flow.


Question: A 25 year old male is undergoing incision and drainage of abscess under general anaesthesia with Spontaneous respiration. The most efficient anaesthetic circuit is

Mapelson breathing systems are classified as Mapelson A, B, C, D, E, F Mapelson A also known as Magill&;s circuit. Ranking of Mapelson&;s systems based on superiority as follows : Spontaneous ventilation : A>D,F,E>C,B Controlled ventilation : D, F, E>B,C>A Mapelson A is more efficient in spontaneous ventilation Mapelson D is more efficient in Controlled ventilation


Question: Sciatic nerve blockade provides sensory loss of the

Sciatic nerve blockade results in sensory loss to the posterior thigh by blocking the posterior cutaneous nerve along with everything below the knee, except for the medial lower leg, which is innervated by the saphenous nerve.

Posterior thigh and majority of the leg below the knee


Question: A 23 years old male presents with ingrown nail. The ingrown nail was removed after administering a ring block. The mechanism of action of the local anesthetic used is

Answer: b) Blockage of activated sodium channelsLOCAL ANESTHETICSInterfere with the excitation process in a nerve membrane in one or more of the following ways:Altering the basic resting potential of the nerve membraneAltering the threshold potential (firing level)Decreasing the rate of depolarizationProlonging the rate of repolarizationLA's are weak bases carrying a positive charge at the tertiary amine group at physiological pH.MOA: Blocks voltage gated Na+ channels from inside of cell membrane by binding to a-subunit.Nerve block produced by local anesthetics is called a nondepolarizing nerve block.LA's are weak bases; they act by penetrating the axonal membrane in the unionized form.After penetration, they get ionized and block the activated sodium channels from within, thereby preventing the propagation of action potentials.

Increased frequency of GABA activated chloride channels

Increased duration of GABA activated chloride channels


Question: % of thiopentone used in induction


Question: Emergency oxygen flush in anaesthetic machine provides

Emergency oxygen flush delivers more than normal amount of oxygen at higher pressure to stabilize the patient.

35-75L/min oxygen at 55 to 60 Psi pressure

25-35L/min oxygen at 10 to 12 Psi pressure

55-75L/min oxygen at 55 to 60 Psi pressure

10-20L/min oxygen at 10 to 12Psi pressure


Question: Best anaesthetic agent for out patient anasthesia is


Question: Pseudocholinesterase acts on

Mivacurium is metabolised by pseudocholinesterase. Rest all are metabolisedby non specific esterase.


Question: Commonly used in narcoanalysis


Question: Least absorbed from mucous membrane are

Hydrophobicity is a primary determinant of intrinsic anesthetic potency because the anesthetic molecule must penetrate into the nerve membrane and bind at a paially hydrophobic site on the Na+ channel. Clinically, however, the correlation between hydrophobicity and anesthetic potency is not as precise as in an isolated nerve. Differences between in vitro and in vivo potency may be related to a number of factors, including local anesthetic charge and hydrophobicity (which influence paitioning into and transverse diffusion across biologic membranes) and vasodilator or vasoconstrictor propeies (which influence the initial rate of vascular uptake from injection sites into the central circulation). Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Mac Intosh curved blade laryngoscope is a type of

The Macintosh laryngoscope has a curved blade which allows exposure of the larynx by positioning the tip in the vallecula, anterior to the epiglottis, lifting it out of view. This laryngoscope is designed to lessen the difficulty of exposing the larynx to pass an endotracheal tube


Question: For a 78 yr old man for trans urethral resection of prostate, ideal anesthetic method is spinal anesthesia, this is because

TURP syndrome may occur at any time perioperatively and has been observed as early as few minutes after surgery has staed and as late as several hours after surgery has been completed. When under regional anesthesia, the patient characteristically complains of Dizziness Headache Nausea Tight feeling in the chest and throat Shoness of breath Restlessness Confusion Retching Abdominal paint thus regional anaesthesia is preferred.

General anesthesia causes more bleeding than spinal

Signs of hyponatremia can easily be detected under spinal

Spinal anesthesia abolishes the obturator nerve stimulation by electro cautery

Obstructive uropathy and renal failure may be associated with prostatic enlargement


Question: In relation to the drug Sugammadex

There is currently no data available regarding the use of sugammadex for the 'immediate reversal' of vecuronium. However, sugammadex is recommended for reversal of vecuronium once spontaneous T2 twitch has been achieved, using a dose of 4mg/kg to reverse 0.1mg/kg of vecuronium.Sugammadex is not effective against benzyl-isoquinolinium muscle relaxants (e.g. cisatracurium and mivacurium).Phase I-IV trials have shown sugammadex to be effective for rapid reversal of rocuronium-induced neuromuscular blockade (16mg/kg).Sugammadex is a member of the g-cyclodextrin family, which encapsulates aminosteroid neuromuscular blocking agents (rocuronium, vecuronium, pancuronium).

It is recommended for immediate reversal of Vecuronium

It can effectively reverse Cisatracurium

16mg/kg is recommended intravenously for the immediate reversal of Rocuronium

It is an a-cyclodextrin that encapsulates amino-steroid neuromuscular blocking agents


Question: Index of potency of general anaesthesia


Question: Induction agent of choice in bronchial asthma

Ketamine is a bronchial smooth muscle relaxant. When it is given to patients with reactive airway disease and bronchospasm, pulmonary compliance is improved. Ketamine is as effective as halothane or enflurane in preventing experimentally induced bronchospasm. The mechanism for this effect is probably a result of the sympathomimetic response to ketamine, but isolated bronchial smooth muscle studies showed that ketamine can directly antagonize the spasmogenic effects of carbachol and histamine. Because of its broncho-dilating effect, the administration of ketamine can treat status asthmaticus unresponsive to conventional therapy. A potential respiratory problem, especially in children, is the increased salivation that follows ketamine administration; this effect can be modulated by an anticholinergic drug such as atropine or glycopyrrolate. Racemic ketamine is a potent bronchodilator, making it a good induction agent for asthmatic patients; however, S(+) ketamine produces minimal bronchodilation. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Day care anesthesia is best achieved with


Question: Vasponstricator L.A. is

All local anaesthetics are vasodilators except cociane which is a vasoconstrictor

Preoperative assessment and monitoring in anaesthesia


Question: The recommended size of endotracheal tube for 1 year old child is

Tube diameter in mm
= Age in years/4 + 4
= 1/4 + 4
= 17/4
= 4.2


Question: Nasal intubation is contra indicated in

A i.e. CSF Rhinorrhea Nasal (naso-tracheal) intubation is required when oral (orotracheal) tube will interfere with surgery (eg intraoral surgery) and may be indicated when oral intubation is difficult (eg inability to open month). It provides good oral hygiene and more secure fixation with less chances of displacement and extubation. But it is more commonly a/w significant nasaVmucosal bleeding, submucosal placement, transient bacteremia (infection), sinusitis and otitis mediaQ. These side effects make nasotracheal intubation contraindicated in base of skull fracture, CSF rhinorrheaQ, nasal abnormalities and trauma and coagulopathy.


Question: Visual analogue scale  most widely used to measure


Question: Arrange following pas of Anesthesia machine according increasing pressure system wise i) Vaporize mounting devices ii) Hanger yoke assembly iii) Flow indicators iv) Pipe line indicator

Anesthesia machine according increasing pressure system iii) Flow indicators i) Vaporize mounting devices iv) Pipe line indicator ii) Hanger yoke assembly


Question: Intubation dose of pancuronium

D i.e. 0.08 mg/Kg Pancuronium is commonly used MR. d/t lack of S/E like flushing, bronchospasm as it causes less histamine release. It causes hypeension by releasing Noradrenaline and is safe in malignant hyperpyrexia. Dose for intubation is 0.08-0.12 mg/kgQ


Question: Drug of choice for treating malignant hypehermia

Dantrolene sodiumis thedrug of choicefor malignant hypehermia but it is to be reconstituted withsterile distilled water, not saline as it can precipitate in saline or other salt solutions. It is given at a dose of2.5 mg/ kgintravenously and can be repeated every 5-10 minutes (upto 10mg/kg) till the attack subsides. All anesthetic agents should be cut off and the patient is given 100% oxygen. Bicarbonate at a dose of 1 to 4 mEq/kg IV can be used to treat metabolic acidosis. If the body temperature is high, it should be brought down using cold intravenous fluids, cooling body cavities with sterile iced fluids, surface cooling with ice packs and cooling blankets.


Question: After hyperventilation for some time holding the breath is dangerous since

B i.e. Due to lack of stimulation by CO2, anoxia can go into dangerous level

due to lack of stimulation by CO2, anoxia can go into dangerous level

I-0O2 shift 0 dissociation curve to left.


Question: Size in < 6 years old child, of endotracheal tube is


Question: Least soluble anesthetic agent is

Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. It is inversely propoional to the induction rate. It determines the onset of induction and recovery. anesthetic blood gas solubility Nitrous oxide 0.47 Halothane 2.4 Isoflurane 1.4 Sevoflurane 0.65 Desflurane 0.45 Methoxyflurane 12 Enflurane 1.9


Question: Sodalime in breathing circuit is contraindicated with

Chloroform produces phosphogene gas with soda lime, so soda lime is contraindicated with it.


Question: Ketamine is useful as an anesthetic agent in

Ketamine is a potent bronchodilator and relieves bronchospasm -Intravenous anaesthetic agent of choice in asthmatic Ketamine increases ICT, IOP and cardiac oxygen demand, therefore contraindicated in other three conditionsNote-Inhalation anaesthetic agent of choice in asthmatics is halothane.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 182 - 184)


Question: Coronary steal syndrome is associated with

Coronary steal phenomenonInpatient with coronary aery stenosis, isoflurane causes coronary aery vasodilatation in non-ischemic area, thereby diveing the blood away from ischemic zone.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.169)


Question: The proseal LMA has advantage over normal LMA

Advantage of proseal LMA over classical LMA is that it is comparable to ETT in preventing aspiration. The PLMA shows several modifications from the cLMA: The drain tube runs through the device from the tip to the proximal end. When the PLMA is correctly positioned, the tip of the device forms a high-pressure seal with the oesophageal inlet and the drain tube runs in continuity with the oesophageal lumen . oesophageal drain tube posterior inflatable cuff reinforced airway tube integral bite block introducer this reduces the risk of aspiration and hence may be suitable in non-supine positions (e.g., lateral, prone), in laparoscopic surgery (e.g., cholecystectomy, gynecological surgery), and in patients who are obese.

Comparable to endotracheal tube in preventing aspiration


Question: Pudendal Nerve Block Involve


Question: Minimal mandatory Percentage of oxygen used in general anaesthesia is

minimum mandatory is 30% oxygen. Less than 30 % can only is allowed in surgeries with high risk of fire hazard. There we decrease oxygen under strict monitoring.


Question: Most common complication of spinal anesthesia is


Question: Preclampsia patient at 38 weeks of gestation is started on oxytocin to augment her labor and the patient is now requesting for epidural analgesia. Anaesthetic considerations include

Always ensure adequate hemostasis prior to epidural anaesthesia. Platelet count less than <50000/microliter is contraindicated to neuroxial interventions due to high risk epidural hematoma.

No work up is required prior to performing epidural anaesthesia, as this will treat her hypertension

The presence of hypertension and oedema requires further workup before proceeding.

Neuraxial anaesthesia should be avoided, as there is increased risk of bleeding

Avoid systemic opiates, as the risk of respiratory depression is too high


Question: Pain rating index is provided by


Question: During cesarean section under general endotracheal anaesthesia, venous air embolism

Expired Nitrogen is the most sensitive venous-air embolism detection method, as the largest component of air is nitrogen.


Question: Most common complication of central venous catheter


Question: If thiopentone is injected accidently into an aery the first symptom is


Question: Percentage of adrenaline with lignocaine for local infilteration is

The most common concentrations of epinephrine combined with local anaesthetics are 1:50000 (0.02 mg/ml), 1:100,000 (0.01mg/ml) and 1:20000 (0.005 mg/dml)The 1:50000 concentration is manufactured in combination with 2% lidocaineThe 1:100,000 concentration is manufactured in combination with 2% lidocaine and 4% aicaineThe 1:200,000 concentration is manufacture in combination with 4% prilocaine, 4% aicaine and 0.5% bupivacaine.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.523,126,127)


Question: Semiclosed circuit system

Semiclose breathing circuit is less economical, causes more environmental pollution. It is simple portable and no need of advanced monitoring.


Question: Post dural (spinal) puncture headache is due to

(Seepage of CSF) (517 - Lee's 13th) (360-KDT 6th)* Post spinal headache is due to seepage of CSF: can be minimised by using smaller bore needle (KDT)* Typical location is bifrontal and / or occipital* It is more common in Young pregnant patients and with accidental dural puncture rate during epidural anaesthesia using Touhyneedle (60 - 80%) Reduced by introduction of size 25 G and 27 - G whitacre pencil point needles. Which replaced cutting needles* Paralysis of cranial nerve. All cranial nerves except 1st, 9, 10th can be involved after spinal Anaesthesia. Most commonly (90%) 6th nerve is involved (Because of the longest course of 6th nerve)


Question: Most common injection site infection in spinal anaesthesia

Streptococcal infection is most common in spinal anaesthesia.


Question: Diffusion hypoxia is a type of ...............hypoxia

Hypoxic hypoxia also called aerial hypoxiais a result of insufficient oxygen available to the lungs. Diffusion hypoxia occurs during recovery from nitrous oxide anesthesia when nitrous oxide is suddenly cut off. Nitrous oxide diffuses from the blood to the alveoli and replaces the oxygen which reduces alveolar O2 concentration, resulting in relative hypoxemia. This can be avoided by providing supplemental O2 for the first 10 minutes of recovery. Diffusion hypoxia is less common with xenon because its rate of diffusion from the blood to the alveoli is slower.


Question: Muscle relaxant of choice in patient suffering from chronic liver disease

Atracurium is preferred in CLD patients since it is metabolised by Hoffmann elimination.


Question: The cardiovascular side effect of Dexmedetomidine is following

Dexmetetomidine is a highly selective alpha2 - adrenoceptor against thus can cause hypotension and Bradycardia. Dexmedetomidine * Highly selective alpha - 2 adrenoreceptor agonist * Used mainly as IV adjunct during induction and /or maintenance of general anesthetics * Minimal respiratory and cardiovascular depression * Good sedation , good analgesic, sympatholytic effects * Selectivity for alpha1: alpha 2 receptors is 1:1640


Question: Merits of nasotracheal intubation is

Good oral hygine Intubation can be done in two ways : Orotracheal intubation Nasotracheal intubation Orotracheal intubation is the preferred technique in most cases. It is most suited to emergency situation (nasotracheal intubation requires a little extra time. Orotracheal intubation under direct laryn goscopy is generally the easier route and the one of choice in unstable patients when rapid re-establishment of the airway is essential. Nasatracheal intubation is better tolerated during pralonged mechanical ventilation. Nasotracheal intubation has ceain drawbacks :? - Increased risk of nosocomial sinusitis - Increased risk of mensal damage and bleeding therefore nasotracheal intubation should be avoided in coagulopathies - Restricted movement of the endotracheal tube Complications of orotracheal tube occurs due to - Occlusion or displacement of the tube and airway trauma.

More movement or displacement of endotracheal t ube


Question: Most cardiotoxic local anaesthetic is

Bupivacaine (Sensoricaine, Marcaine)Bupivacaine is 2nd most commonly used local anaesthetic (after lidocaine)Bupivacaine has the highest local tissue irritancy amongst local anaestheticsIt is the most cardiotoxic local anaestheticLevobupivacaine (The S(-) enantiomer of bupivacaine) is less cardiotoxic and less prone to cause seizureConcentrations used for bupivacaine are:- Nerve block: 0.5%, epidural: 0.25 -0.5%, and spinal: 0.5%Maximum safe dose is 2mg/kg without adrenaline and 3mg/kg with epinephrine (Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294)


Question: Pin index system for oxygen

Ans: (b) 2,5Ref: Miller's Anaesthesia 7th ed. / 675* Pin index for oxygen is 2, 5.* Cylinder of oxygen is black body with white shoulder.GasColor CodePin index positionBodyShoulderOxygenBlackWhite2,5Nitrous oxideBlueBlue3, 5CO2GrayGray1,6HeliumBrownBrown2,5AirGreyWhite/black quartered1,5


Question: The site of action of local anaesthetic in epidural anesthesia is

Local anaesthetic in maximal blockade is believed to act in spinal nerve root. Mechanism of action of central neuraxial blockade. The mechanisms of spinal and epidural are believed to be the nerve roots. Blockade of neural transmission in the posterior nerve root fibers interrupt somatic and visceral sensation, whereas blockade of anterior nerve root fibers prevent efferent motor & autonomic outflow.


Question: The treatment of choice in diagnosed ventricular fibrillation is

Defibrillation.The delivery of an electrical shock through the chest wall to the hea momentarily stops the hea and the chaotic rhythm. This often allows the normal hea rhythm to resume. If a public-use automated external defibrillator (AED) is available, anyone can administer it. Most public-use AEDs voice instructions as you use them. Public-use AEDs are programmed to recognize ventricular fibrillation and send a shock only when needed.


Question: Index of potency of general anesthesia

Minimal alveolar concentrationIt is the lowest concentration of the anaesthetic in pulmonary alveoli needed to produce immobility in response to a painful stimulus (surgical incision) in 50% individualsIt is the measure of potency of inhalation Gas.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 162 - 163)


Question: A intravenous anesthetic agent that is associated with hemodynamic stability, maintenence of CPP with post operative nausea, vomiting and myoclonus


Question: A child with bladder exstrophy and chronic renal failure. The Anesthesia of choice for the child while operating exstrophy is aEUR'

Atracurium "Atracurium and cisatracurium are muscle relaxants of choice for both liver and kidney failure".


Question: Sodium Thiopentone is ultra sho acting d/t

Barbiturate pharmacokinetics has been described in physiologic and compament models. Both these pharmacokinetic models describe rapid redistribution as the primary mechanism that terminates the action of a single induction dose. Physiologic models of barbiturates describe a rapid mixing of the drug within the central blood volume followed by a quick distribution of the drug to highly perfused, low-volume tissues (i.e., brain), with a slower redistribution of the drug to lean tissue (muscle), which terminates the effect of the initial (induction of anesthesia) dose. In these models, adipose tissue uptake and metabolic clearance (elimination) play only minor roles in the termination of the effects of the induction dose. The reasons are the minimal perfusion ratio of adipose tissue compared with other tissues and the slow rate of removal. Ref: Miller's anesthesia 8th edition


Question: Complete neuromuscular blocking agent with shortest duration of action

Ans. c (Mivacurium) (Ref. Anaesthesia by Ajay Yadav, 2nd/pg. 90)Mivacurium is a nondepolarizing neuromuscular blocking agent with a short duration of action. Mivacurium is indicated as an adjunct to anesthesia to facilitate endotracheal intubation and to induce skeletal muscle relaxation in the surgical field.Neuromuscular blocking agentsAcetylcholineNicotinic Cholinergic Receptor# Release- Mechanism: Ca2+ entry and halting of K+ exit at presynaptic terminal -ACh release- Inhibitors of ACh release: Mg2+ blocks Ca2+ channels of presynaptic neurons in heart | ACh release- Promoters of ACh release: |-aminopyridine blocks K+ channels of presynaptic neurons | ACh release# Metabolism - In Blood: Butyrylcholinesterase, pseudocholinesterase or plasma cholinesterase (identical enzymes)- In neuromuscular cleft: Acetylcholinesterase- Dibucaine : Dibucaine acts to inhibit normal acety Icholinesterase, and therefore will be unable to inhibit abnormal acetylcholinesterase. Persons w/abnl acetylcholinesterases have dibucaine value at approx 50, instead of 80-90 for normal acetylcholinesterases# Structrure- Composed of b subunits, where ACh binds the a subunits# Location- Presynaptic neuron in neuromuscular junction: causes positive feedback on ACh release, usually constitutes a negative feedback mechanism. Postsynaptic neuron in neuromuscular junction: causes propagation of action potential to myofibrilsOverview of Neuromuscular Blocking Agents# Depolarizing drugs - Noncompetitive depolarization of nicotinic cholinergic receptor - Not effective in Myasthenia Gravis pts since there is a |in postsyn ACh receptors & therefore not enough receptors to activate# Non-depolarizing Drugs- Competitive blockade of nicotinic-cholinergic receptors- Not effective in Eaton-Lambert pts since there is an | in postsyn ACh receptors & not enough non-depolarizing drug to inhibit all# Reversal of Muscle Relaxant Activity- AChesterase inhibitors only for non-depolarizing drugs, but inhibitors have no selectivity for NMJ & will inhibit AChesterases in heart & plasma -| non depolarizing in plasma must give an anti-muscarinic to prevent heart effects- Recombinant pseudocholinesterase for pts w/atypical cholinesteraseMivacurium & rocuronium can be used as muscle relaxant in 'rapid sequence induction'.Skeletal Muscle RelaxantsSubclassMechanism of actionEffectsClinical applicationsPharmacokinetics, toxicities, interactionsDepolarizing neuromuscular blocking agentSuccinylcholineAgonist at nicotinic acetylcholine (ACh) receptors, especially at neuromuscular junction depolarizes may stimulate ganglionic nicotinic ACh and cardiac muscarinic ACh receptorsInitial depolarization causes transient contractions, followed by prolonged flaccid paralysis depolarization is then followed by repolarization that is also accompanied by paralysisPlacement of tracheal tube at start of anesthetic procedure rarely, control of muscle contractions in status epilepticusRapid metabolism by plasm cholinesterase normal duration, 5 min arrhythmias hyperkalemia transient increased intrabdominal, intraocular pressure postoperative muscle painNondepolarizing neuromuscular blocking agentsd-TubocurarineCompetitive antagonist at ACh receptors, especially at neuromuscular junctionsPrevents depolarization by ACh, causes flaccid paralysis can cause histamine release with hypotension weak block of cardiac muscarinic Ach receptorsProlonged relaxation for surgical procedures superseded by newer nondepolarizing agentsRenal excretion duration, 40-60 min toxicities: histamine release hypotension prolonged agentsCisatracuriumSimilar to tubocurarineLike tubocurarine but locks histamine release and antimuscarnic effectsProlonged relaxation of surgical procedures relaxation of respiratory muscles to facilitate mechanical ventilation in intensive care unitNot dependent on renal or hepatic function duration 25-45 min toxicities: Prolonged apnea but less to than atacuriumRocuroniumSimilar to cisatracuriumLike cisatracurium but slight antimuscarinic effectLike cisatracurium useful in patients with renal impairmentHepatic metabolism duration 20-35 min Toxicities: like cisatracuriumMivacurium: Rapid onset, short duration (10-20 min); metabolized by plasma cholinesteraseVecuronium: Intermediate duration; metabolized in liverCentrally acting spasmolytic drugsBaclofenGABA agonist, facilitates spinal inhibition of motor neuronsPre- and postsynaptic inhibition of motor outputSevere spasticity due to cerebral palsy, multiple sclerosis, strokeOral, intrathecal toxicities: sedation, weaknessCyclobenzaprinePoorly understood inhibition of muscle stretch reflex in spinal cordReduction in hyperactive muscle reflexes antimuscarinic effectsAcute spasm due to muscle injury inflammationHepatic metabolism duration 4-6 h toxicities: strong antimuscarinic effectsChlorphenesin, methocarbamol, orphenadrine, other: Like cyclobenzaprine with varying degrees of antimuscarinic effectDiazepamFacilitates GABAergic transmission in central nervous systemIncreases interneuron inhibition of primary motor afferents in spinal cord central sedationChronic spasm due to cerebral palsy, stroke, spinal cord injury acute spasm due to muscle injuryHepatic metabolism duration 12-24 hTizanidinea2-Adrenoceptor agonist in the spinal cordPresynaptic and postsynaptic inhibition of reflex motor outputSpasm due to multiple sclerosis, stroke, amyotrophic lateral sclerosisRenal and hepatic elimination duration, 3-6 h toxicities: Weakness, sedation hypotensionDirect-acting muscle relaxantsDantroleneBlocks RyRl Ca2+ release channels in the sarcoplasmic reticulum of skeletal muscleReduces actin-myosin interaction weakness skeletal muscle contractionIV: Malignant hyperthermia Oral spasm due to cerebral palsy spinal cord injury multiple sclerosisIV, oral duration, 4-6 h Toxicities: Muscle weakness.Mivacurium. another isoquinoline compound, has the shortest duration of action of all nondepolarizing muscle relaxants. However, its onset of action is significantly slower than that of succinylcholine. In addition, the use of a larger dose to speed the onset can be associated with profound histamine release leading to hypotension, flushing, and bronchospasm. Clearance of mivacurium by plasma cholinesterase is rapid and independent of the liver or kidney. However, because patients with renal failure often have decreased levels of plasma cholinesterase, the short duration of action of mivacurium may be prolonged in patients with impaired renal function. Although mivacurium is no longer in widespread clinical use, an investigational ultra-short-acting isoquinoline nondepolarizing muscle relaxant, gantacurium, is currently in phase III clinical testing. This novel compound has a very rapid onset and short duration of action


Question: Rebreathing systems are WE

D i.e. Mapleson F - Calcium hydroxide is the main component of both sodalime (94%) and baralimeQ (80%). - Ba(OH)2 is not a constituent of soda lime, it is used in baralime. Water (of crystalization) is used to produce hardening in baralimeQ. - Clayton, mimosaQ, ethyl violet, phenolphthalein & ethyl orange are indicators.


Question: Chest compression to ventilation ratio in resuscitation of children with 2 rescuers is

In CPR of children compression to ventilation ratio if single rescuer is 30:2 and if double rescuer is 15:2.


Question: Maximum does of lidocaine as local anesthesia is


Question: Thiopentone is absolutely contraindicated in

(Porphyria): (381 -- KDT 7th edition; 536- Goodman 12th7or variegate)Thiopentone can precipitate acut intermittent or variegate porphyria in susceptible individuals therefore contraindicated. The abnormal synthesis of protoporphyrin (important in hemoglobin production) results in excess porphobilinogen. Barbiturates induce amino levulinic acid synthase, an enzyme responsible for phosphobilinogen synthesis, This leads to excessive porphobilinogen levels and can precipitate acute porphyric crises, that are manifested by severe abdominal pain, nausea, vomiting, psychiatric disorders and neurologic abnormalities


Question: MAC stands for

Minimum alveolar concentration is defined as the alveolar concentration of an inhaled anesthetic agent that prevents movement in 50% of patients in response to a standardized surgical stimulus. Low MAC - High potency MAC values of adult Halothane: 0.75 Sevoflurane: 2.0 Isoflurane: 1.2 Desflurane: 6.0 Enflurane: 1.7 Xenon: 70 N2O: 104 Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: The potency of an inhalational anaesthetic agent depends upon

Meyer-Oveon correlation of anesthetic potency with solubility in olive oil interpreted by the majority of researchers as an indicator that lipids are likely the anesthetic target. This interpretation focused attention on anesthetic effects on the bulk physical propeies of cell membranes, which were known at that time to consist primarily of lipid molecules. Such nonspecific or "lipoid-based" anesthetic theories dominated the field from the 1960s to the 1980s. Moreover, the simple elegance of the relationship between MAC and lipid solubility graphically illustrated Meyer and Oveon's conclusion that "All chemically indifferent substances that are soluble in fat are anesthetics ... their relative potency as anesthetics will depend on their affinity to fat on the one hand and water on the other hand, that is, on the fat/water paition coefficient". This was interpreted as oring lipids as the primary targets of anesthetics and a single nonspecific theory to explain anesthesia. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Drug used to prolong the action of LA in Hypeensive pts

Vasoconstrictor are used along with local anaestheticsAdrenaline is the most commonly used vasoconstrictor. Less commonly phenylephrine is also used. Felypressin (synthetic vasopressin) does not affect BP & HR - Preferred in patients with cardiovascular disease(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.270-271)


Question: Capnography is useful for

capnography is the ideal method of determining the correct placemet of endotracheal tube. Identification : loss of waveform of capnogram.decline in End tidal CO2 levels.

Determining Vaporizer malfunction or contamination

Determining the appropriate placement of endotracheal

Detecting concentration of oxygen in the anesthetic circuit.

Preoperative assessment and monitoring in anaesthesia


Question: Intravenous anesthetic agent of choice in this below given procedure

Methohexitone is IV anesthetic agent of choice for electroconvulsive therapy because, compared to thiopental and propofol, methohexitone produces less depression of EEG activity. intravenous injection is painful.


Question: The following combination of agents are the most preferred for sho day care surgeries


Question: For high pressure storage of compressed gases cylinders are made up of.


Question: Most potent cerebral vasodilator is


Question: Inducing agent with maximum incidence of vomiting

Postoperative nausea and vomiting are more common following etomidate than following propofol or barbiturate induction. Propofol also possesses significant antiemetic activity with small (sub hypnotic) doses (i.e., 10 mg in adults). The median concentration of propofol with an antiemetic effect was 343 ng/mL, which also causes a mild sedative effect. This concentration can be achieved by an initial dose of propofol infusion of 10 to 20 mg followed by 10 ug/kg/minute. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: The Heidbrink meter in Boyle&;s machine

Heidbrink is a flowmeter used in past. It consists of a metal tapered tube with inveed black float. The upper-end projects in the glass tube. Other type of flowmeter used in past was Connell which has round bobin.


Question: Atracurium is metabolized and excreted by

Ans. d (Hoffman's elimination). (Ref. Harrisons, Medicine, 18th/735)ATRACURIUM BESYLATE# Long acting and non-depolarising muscle relaxant.# Muscle relaxant of choice in renal failure or anephric patients.# pH of solution is 3.5.# Stored at 4degC.# Duration of action doubled at 25degC.# Metabolism mainly by Hofmann elimination (a chemical degradation) and hydrolysis in plasma and elsewhere in body.# Major metabolite is laudanosine, which is CNS- stimulant.


Question: Maximum dose of lignocaine with adrenaline (in mg/kg)

Maximum safe dose of plain lidocaine - 300 mg (4.5 mg/kg)Maximum safe dose of lidocaine with epinephrine- 500 mg (7mg/kg)(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 754, 856)


Question: Maximum interval between bare metal cardiac stent and elective surgery is

1 month is ideal interval between bare metal cardiac stent and any elective surgery.


Question: The definite contraindication of Thiopentone

(D) Acute intermittant porphyria # Barbiturates are Contraindicated in -- H/O Barbiturate hypersensitivity H/O Acute intermittent porphyria (cause LMN paralysis or CVS collapse);Anticipated airway obstruction> Care: Fixed cardiac output states; Shock states; Hepatic/Renal dysfunction; Asthmatic/Myxoedema; Adrenocortical failure; Myotonia dystrophia; Extremes of age.


Question: Bronchospasm is not caused by


Question: Sodalime circuit is not used with


Question: Minimum Alveolar concentration of halothane is

Halothane is a potent anesthetic with a MAC of 0.74%. Its blood/gas paition coefficient of 2.4 makes it an agent with moderate induction and recovery time. It is not a good analgesic and its muscle relaxation effect is moderate.


Question: In epidural anaesthesia drug is injected

Epidural (extradural anaesthesia)Local anaesthetic is injected in epidural space, i.e., outside the dura mater with Tuohy&;s needleIn extradural space, LA acts on the nerve rootsIt is used in thoracic, lumbar and sacral (caudal) regions (in contrast to spinal anaesthesia which is given in lumbar region)Continuous analgesia is achieved by mixing the LA with an opioid, eg fentanylIt is mainly used to control postoperative pain (by continuous epidural anaesthesia)It can also b used for all surgeries which can be performed under spinal anaesthesia.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.189)


Question: Minimum Alveolar concentration  of halothane is

Halothane is a potent anesthetic with a MAC of 0.74%. Its blood/gas partition coefficient of 2.4 makes it an agent with moderate
induction and recovery time. It is not a good analgesic and its muscle relaxation effect is moderate.


Question: In venturi mask maximum 02 concentration attained is

In Venturi mask normal O2 concentration is between 24 and 60% . In non breathing masks oxygen saturation is between 80 and 90%.


Question: Adiministration of Scoline (Sch) produces dangerous hyperkalamia in


Question: Emergence delirium is associated with

Ketamine causes postoperative delirium and hallucinations. It is also contraindicated in delirium tremens and head injury. Ketamine increases cerebral metabolism, CBF, and ICP. So contraindicated in neurosurgeries. Ketamine, like other phencyclidines, produces undesirable psychological reactions, which occur during awakening from ketamine anesthesia and are termed emergence reactions. The common manifestations of these reactions, which vary in severity and classification, are vivid dreaming, extracorporeal experiences (sense of floating out of body), and illusions (misinterpretation of a real, external sensory experience). These incidents of dreaming and illusion are often associated with excitement, confusion, euphoria, and fear. They occur in the first hour of emergence and usually abate within 1 to several hours. These psychic emergence reactions are secondary to ketamine-induced depression of auditory and visual relay nuclei, thus leading to misperception or misinterpretation of auditory and visual stimuli. The incidence of the psychic emergence reactions ranges from 3% to 100%. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Minimum alveolar concentration (MAC) is a measure of

Minimum alveolar concentration (MAC) - Measure of potencyBlood: Gas paition coefficient -Blood solubility of anaesthetic agent and determines the speed of induction & recoveryOil: Gas paition coefficient - Lipid solubility of anaesthetic agent and is related to potency of anaesthetic agent.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 160, 268, 510)


Question: Most potent antiemetic agent used in preoperative period

the most potent anti-emetic used is hyoscine . the most commonly used anti-emetics are metochlopramide,ondensetron.

Preoperative assessment and monitoring in anaesthesia


Question: The most important determinant of carbon dioxide elimination is

Fresh gas flow is important determinant of carbon dioxide elimination in breathing circuits.


Question: In a 2 months old infant undergoing surgery for biliary atresia, you would avoid one of the following anaesthetic

B i.e. Halothane Among all these options only halothane is hepatotoxic so it should be avoided Lets revise some impoant facts. All coagulation factors with exception of factor VIII (8) & von wille brand factor are produced by liverQ Vit K is necessary for synthesis of prothrombin (factor II) and factor VII, IX and XQ. PT is normally 11-14 seconds, mesures the activity of fibrinogen, prothrombin and factors, V, VII, and XQ All opioids cause spasm of sphincter of oddi & increase biliary pressure Halothane hepatitis is more common in middle age, obese, female sex, and a repeated exposure (esp with in 28 days)


Question: In volume controlled ventilation, the inspiratory flow rate is

In most patients, inspiratory flow rates is 60 L/min are adequate. Higher flow rates are required in patients with higher ventilator demands.

Preoperative assessment and monitoring in anaesthesia


Question: Shoest acting NDMR

Rapacuronium Among the given options Rapacuronium is the shoest ating drug. Rapacuronium has been withdrawn from the market because it produces intense bronchospasm in a significant number of patients. Alcuronium is a relatively sho acting muscle relaxant. Always remember this


Question: Following group of drugs is the first line in the management of schizophrenia

Most antipsychotics are dopamine antagonists, and as such they have found use in treatingschizophrenia, bipolar disorder, and stimulant psychosis.


Question: Most potent bronchodilator among inhalational anesthetic agents is

Effect of inhalational agents on respiratory systemAll inhalational agents are bronchodilators -Halothane cause maximum bronchodilatation. The inhalational agent of choice in asthmatics (intravenous anaesthtic of choice is ketamine).All inhalational agents cause respiratory depression to some extent - Maximum depression of respiration is seen with enflurane, on the other hand, maximum inhibition of ventilator response to increased CO2 and hypoxia is caused by halothaneAll inhalational agents vasodilate pulmonary vascular bed by blunting the hypoxic pulmonary vasoconstriction (HPV) response. Halothane has maximum effect: Isoflurane, Enflurane, desflurane, sevoflurane have similar effect.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167 - 169)


Question: Anesthetic agent (s) safe to use in ICP

Anesthetic agents safe to use in raised intracranial pressure (ICP) are thiopentone, propofol & etomidate. Ref: Manuel C Pardo Jr and Ronaldo D Miller 7th Ed.


Question: Concentration of adrenaline used with local anaesthetic

Concentration of adrenaline used for local anaesthetic is 1 in 2 lakhs, (that of phenylephrine is 1 in 20,000).


Question: Anaesthetic of choice for day care surgery is

“Propofol is parcularly suitable for day care surgery’ because residual impairment is less marked and shorter lasng Propofol
 Propofol is a milky white powder that is preservave free; therefore, it must be used within 6 hours. It is an oil based preparaon, therefore injecon is painful.
 Propofol is the most frequently used intravenous anaesthec today. — Miller 6 th /e-3l8  It can be used for both inducon as well as maintenace.
 It does not possess anconvulsive acon (unlike thiopentone),
 It causes fall in BP and bradycardia, o Like thiopental it does not possess muscle relaxant acon.
 Propofol possess significant anemec and anpruric acon. — Miller 6 th /e - 324
 Propofol decreases polymorphonuclear leukocyte chemotoxis but not aherence, phagocytosis and killing (Thiopentone blocks all these) increased life threatning infecons.
 Propofol is parcularly suitable for outpaent surgery. Intermient injecon or connuous infusion of propofol is frequently used for total iv. anaesthesia (TIVA) when supplemented by fentanyl.
 It is anaesthecs of choice for intubaon in ICU and for paents with malignant hyperthermia.  Side effects - pain on injecon, myoclonus, apnea, X BP and rarely thrombophlebis,
 Propofol infusion syndrome A lethal syndrome, associated with infusion of propofol for 48 hours or longer.
Occurs in children and crically ill It occurs as a result of failure of free fay acid metabolism and failure of the mitochondrial respiratory chain. Features are -
cardiomyopathy with acute cardiac failure, metabolic acidosis, skeletal myopathy, hyperkalemia, hepatomegaly and lipemia


Question: Fluoride content is least in

(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.170-171)


Question: Fasciculation are caused by

Fasciculations are the characteristic feature of depolarising block. Succinylcholine is the depolarising muscle relaxant. d-tubocurare, vecuronium and pancuronium are the non-depolarising muscle relaxants.


Question: Induction agent that may cause adrenal coex suppression is

The specific endocrine effects manifested by etomidate consist of a dose-dependent reversible inhibition of the enzyme 11b-hydroxylase, which results in decreased biosynthesis of coisol. Blockade of the cytochrome P450-dependent enzyme 11b-hydroxylase also results in decreased mineralocoicoid production and increased formation of intermediaries (11-deoxycoicosterone). Subsequent research has shown that etomidate is far more potent as an inhibitor of steroid synthesis than as a sedative-hypnotic agent. The etomidate concentrations associated with adrenocoical suppression are less than 10 ng/mL, which are much lower than the concentrations needed for hypnosis (>200 ng/mL). Ref: Miller's anesthesia 8th edition


Question: Reynolds number is related to

Flow through a tube can be described by the modified Bernoulli Equation, which states: Po = P + 1/2 r*U^2 Where Po is a constant called the "stagnation pressure," P is pressure, r is density, U and is equal to fluid velocity. Pressure does not always decrease in the direction of flow - if one assumes friction is negligible (and thus the total energy of the system remains constant), any change in the kinetic energy of a fluid (ex. a reduction as U^2 falls) must be accompanied by an oppositional change in potential energy increases(P rises) Whether flow is laminar or turbulent is dependent on the Reynolds Number (Re), defined as: Re = rUL/u Where r is density, U is equal to fluid velocity, L is the length of the tubing, and u is the viscosity of the fluid. Note that the modified Bernoulli Equation applies to laminar flow (ReD < 2300, parabolic flow profile), but not to turbulent flow (ReD > 4000, blunted flow profile) Flowmeters based on a Venturi tube (circular tube with a gradual contraction and expansion in diameter, ex. those used in aircraft) maintain laminar flow at normal flow rates - since conservation of mass and energy is assumed to apply, restriction of the diameter leads to increased speed of gas flow and a corresponding decrease in the pressure on the walls The floating bobbin rotameter that is familiar to anesthesiologists is known as the Thorpe tube - the sudden restriction caused by the bobbin leads to a propoional increase in velocity and the Bernoulli equation does not apply (flow is propoionate to the square root of the pressure drop). Because the pressure drop across the orifice is inversely propoional to orifice area squared, the pressure change across the bobbin will decrease as the bobbin rises (and the area of the tube increases). The bobbin reaches a steady state when the pressure drop exactly opposes the gravitational force on the bobbin - at this steady state the pressure drop is always the same (because gravitational forces are constant), however as flow rates increase, the bobbin will move higher because this critical pressure drop will occur over a larger cross-sectional area (since velocity is higher)


Question: Most potent bronchodilator among inhalational anesthetic agent is

Halothane is considered a potent bronchodilator, as it often reverses asthma-induced bronchospasm. This action is not inhibited by b-adrenergic blocking agents. Halothane attenuates airway reflexes and relaxes bronchial smooth muscle by inhibiting intracellular calcium mobilization. Halothane also depresses clearance of mucus from the respiratory tract (mucociliary function), promoting postoperative hypoxia and atelectasis. Morgan clinical anesthesia 5e pg: 16


Question: In infant (full term) diameter (mm) length (cm) of ETT used are

C i.e. 3.5 mm, 12 cm Endotracheal Intubation Endotracheal tube is sterilized by boilingQ and cuffed E.T. tube is inflated at pressure 15-22 mmHg In neurosurgical operations Armoured Endotracheal tubeQ is used. For quick intubation, DOC is Suxamethonium.Q


Question: Upper Lid Retractors include

Ans. is 'd' i.e., Levator palpabrae superioris & muller muscle The levator palpebrae superioris is the impoant upper eye lid retractor. Injury or weakness to this muscle leads to ptosis. This muscle is supplied by occulomotor (3') nerve. Deep pa of the elevator muscle is the Muller's muscle, which is sympathetically innvervated. In hypehyroidism, sensitization of the Muller muscle leads to upper eyelid retraction and pseudoproptosis. On the other hand, in Horner's syndrome loss of this muscle action leads to ptosis. The capsulopalpebral fascia assists in lower eyelid retraction and coordinates with eyeball movement. It arises as an extension of the inferior rectus and inses into the lower edge of the lower tarsus and the adjacent orbital septum.

Levator palpabrae superioris and superior oblique


Question: The triad of general anaesthesia includes

The triad of general anesthesia : Unconsciousness (narcosis) analgesia muscle relaxation The pentad of anesthesia: Loss of consciousness loss of reflex response amnesia muscle relaxation analgesia Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e

Unconsciousness, analgesia and muscle relaxation

Anxiolysis, analgesia and unconsciousness

Muscle relaxation, sedation and analgesia

Dissociation, analgesia and muscle relaxation


Question: In renal failure, IV anesthetic used

Ans. D Cis-Atracurium Atracurium & cisatracurium both undergo Hoffman elimination & therefore both are safe in liver and kidney compromise. Additionally cisatracurium has lesser risk of causing seizures, so it's preferred over atracurium

Non-depolarising Neuromuscular Blocking Agents


Question: Amount of K+ in ringer lactate is

Ringer lactate solution include a concentration of 4mEq/L.

Preoperative assessment and monitoring in anaesthesia


Question: Drug used in treatment of malignant hypehermia is

MH is a pharmacogenetic clinical syndrome that, in its classic form occurs during anesthesia with a volatile halogenated alkane such as halothane and/or the administration of the depolarizing muscle relaxant succinylcholine.The fulminant MH episode observed clinically produces rapidly increasing body temperature (by as much as 1deg C in 5 minutes) and extreme acidosis as a result of an acute loss of control of intracellular calcium levels and compensatory uncontrolled increases in skeletal muscle metabolism that may proceed to severe rhabdomyolysis. Although MH was initially associated with a moality rate of 60%, earlier diagnosis and the use of dantrolene have reduced the moality to less than 1.4%. Current cases of MH are restricted in severity because of diagnostic awareness, early detection through end-expired carbon dioxide (CO2), the use of less potent anesthetic triggers, and the administration of drugs that attenuate the progression of the fulminant episode. The incidence of fulminant MH was repoed to be 1 case per 62,000 anesthetics administered when triggering agents were not used, but the number of suspected cases was 1 case per 4500 anesthetics administered when triggering agents were administered. Clinical signs of malignant hypehermia: Treatment of malignant hypehermia: Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: High air way resistance is seen in

D i.e. Main bronchus Medium size airways like main bronchus has maximum resistanceQ


Question: This pattern of capnograph is seen in

The shark finn pattern capnograph is seen in endotracheal tube obstruction


Question: Dextrose is added to the spinal anesthetic drugs to

By adding dextrose we maKe local anaesthetic hyperbaric and prevent uncontrolled ascending of local anaesthetics The local anesthetic solutions can be made hyperbaric by the addition of glucose or hypobaric by the addition of sterile water or fentanyl. A hyperbaric solution of local anesthetic is denser (heavier) than CSF, whereas a hypobaric solution is less dense (lighter) than CSF. Significance: Hyperbaric solutions tend to move to the most dependent area of the spine. With the patient in a head-down position, a hyperbaric solution spreads cephalad, and a hypobaric anesthetic solution moves caudal. A head-up position causes a hyperbaric solution to settle caudally and a hypobaric solution to ascend cephalad. An isobaric solution tends to remain at the level of injection.

Reduce plasma levels of local anesthetic to prevent toxicity


Question: Repeated use of halothane causes


Question: With a fixed performance mask such as a ventimask

Dead space in ventimask is low and rebreathing is not possible because of high flow of gas.

Plugging side holes increases the oxygen concentration

Total gas flow is higher than the patient’s peak inspiratory flow


Question: Stages of anesthesia were established by


Question: This is used in treatment of

This is autologous epidural blood patch, used in treatment of post dural puncture headache.


Question: For high pressure Storage of compressed gases cylinders are made up of

To withstand high pressure cylinders are made up of molybdenum and steel.


Question: Minimum Alveolar Concentration of sevoflurane in % is

Minimum alveolar concentration is defined as alveolar concentration of an inhaled anesthetic agent that prevents movement in 50% of patients in response to a standardized surgical stimulus. Low MAC - High potency MAC values of adult Halothane : 0.75 Sevoflurane : 2.0 Isoflurane : 1.2 Desflurane : 6.0 Enflurane : 1.7


Question: If a patient starts getting convulsions following the use of Lignocaine as local anaesthetic, the Drug of choice for the control of convulsions would be

(A) Diazepam > If a patient starts getting convulsions following the use of Lignocaine as local anaesthetic, the Drug of choice for the cortrol of convulsions is the> diazepam# DIAZEPAM> Relatively lipid soluble, water insoluble; crosses placenta.> Should be administered orally or i.v. as i.v. route is slow, incomplete, erratic.> Elimination half life 20-40 hours. (Enterohepatic recirculation),> Its metabolite N-desmethyldiazepam is pharmacologically active with half life of 100 hours; Age tends to reduce clearance of Diazepam> Complications of Diazepam: i.v. Injection causes high incidence of thrombophlebitis and pain.


Question: The most suitable agent for IV induction and maintenance in a day care surgery

PROPOFOL The active ingredient in propofol, 2,6-diisopropylphenol, is essentially insoluble in aqueous solutions and is formulated only for IV administration as a 1% (10 mg/ml) emulsion in 10% soybean oil, 2.25% glycerol, and 1.2% purified egg phosphatide. In the United States, disodium EDTA (0.05 mg/ml) or sodium metabisulfite (0.25 mg/ml) is added to inhibit bacterial growth. The induction dose of propofol in a healthy adult is 1.5 to 2.5 mg/kg and it has an onset and duration of anesthesia similar to thiopental. As with barbiturates, dosages should be reduced in the elderly and in the presence of other sedatives and increased in young children. Because of its reasonably sho elimination half-life, propofol often is used for maintenance of anesthesia as well as for induction. For sho procedures, small boluses (10% to 50% of the induction dose) every 5 minutes or as needed are effective. An infusion of propofol produces a more stable drug level (100 to 300 mg/kg per minute) and is better suited for longer-term anesthetic maintenance. Infusion rates should be tailored to patient response and the levels of other hypnotics. Sedating doses of propofol are 20% to 50% of those required for general anesthesia. However, even at these lower doses, caregivers should be vigilant and prepared for all of the side effects of propofol discussed below, paicularly airway obstruction and apnea. Propofol elicits pain on injection that can be reduced with lidocaine and the use of larger arm and antecubital veins. Excitatory phenomena during induction with propofol occur at about the same frequency as with thiopental, but much less frequently than with methohexital. Side Effects: Nervous System: The CNS effects of propofol are similar to those of barbiturates. Propofol decreases CMRO2, cerebral blood flow, and intracranial and intraocular pressures by about the same amount as thiopental. Like thiopental, propofol has been used in patients at risk for cerebral ischemia; however, no human outcome studies have been performed to determine its efficacy as a neuroprotectant. Results from studies on the anticonvulsant effects of propofol have been mixed; some data even suggest it has proconvulsant activity when combined with other drugs. Thus, unlike thiopental, propofol is not a proven acute intervention for seizures. Cardiovascular. Propofol produces a dose-dependent decrease in blood pressure that is significantly greater than that produced by thiopental. The fall in blood pressure can be explained by both vasodilation and mild depression of myocardial contractility. Propofol appears to blunt the baroreceptor reflex or is directly vagotonic because smaller increases in hea rate are seen for any given drop in blood pressure after doses of propofol. As with thiopental, propofol should be used with caution in patients at risk for or intolerant of decreases in blood pressure. Respiratory and Other Side Effects: At equipotent doses, propofol produces a slightly greater degree of respiratory depression than thiopental. Patients given propofol should be monitored to ensure adequate oxygenation and ventilation. Propofol appears to be less likely than barbiturates to provoke bronchospasm. It has no clinically significant effects on hepatic, renal, or endocrine organ systems. Unlike thiopental, propofol appears to have significant anti-emetic action and is a good choice for sedation or anesthesia of patients at high risk for nausea and vomiting. Propofol provokes anaphylactoid reactions and histamine release at about the same low frequency as thiopental. Although propofol does cross placental membranes, it is considered safe for use in pregnant women, and like thiopental, only transiently depresses activity in the newborn.


Question: Success of Block 1 is assessed by

Westphal's sign (Block 1 is Epidural block)


Question: Inducing agent contraindicated in asthma is

D i.e. Althesin Contraindications Steroidal agent (Althesin) is contraindicated in Porphyria and AsthamaQ Adernaline is C/I with Halothane and Ring block is C/I in finger Ether and Cylopropane are C/I with cauery Trilene is C/I with sodalime In pregnancy Gallamine and Morphine In Diabetics Ether (better answer) & Chloroform as both causes hyperglycemia In liver damage Choloroform (1st ) & Halothane In renal damageMethoxyflurane & Morphine as both leads to High Output renal failure. Gallamine is also C/I Thiopentone is C/I in acute intermittent porphyria


Question: Colour code of oxygen cylinder is

Color coding of cylinders is introduced to prevent accidental misplacement of cylinders.


Question: As compared to a 10 year old child, a 1 year old child will have higher

Metabolic rate and oxygen consumption are higher in infants than in older children. Rest of the parameters in question remain the same.


Question: Non depolarizing neuromuscular blocker is

Non depolarising neuromuscular blocker is competitive antagonist at nicotinic cholinergic receptor. It doesn’t cause fasciculations . it is reversed by neostigmine.

Persistent stimulator of nicotinic cholinergic receptors


Question: VAS is most widely used to measure

The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain."

Preoperative assessment and monitoring in anaesthesia


Question: Gas used in rapid airbag inflation

Chemistry of airbagsThe inclusion of airbags in the modern automobiles has led to decrease in the automobile injuries The term airbag is a misnomer as air is not involved in the inflation processRather an airbag inflates rapidly (in about 30ms) due to explosive production of N2 gas. Sodium azide is used which rapidly decomposed to nitrogen gas(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition)


Question: Anaphylaxis is caused by

AlthesinAlthesis is a neurosteroidIt was used as a parenteral anaestheticIt was withdrawn from the market because of several severe anaphylactic reactions(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition)


Question: Most common site of Curling's ulcer

Duodenum [Ref Robbins 7/e p819; Curling's ulcer is acute peptic ulcer of the duodenum described in 1842 by Curling as a complication of burns. Cushing's ulcer is acute peptic ulcer of stomach, duodenum and esophagus seen in intracranial injury, operations or tumor.


Question: Bradycardia during anaesthesia seen ina) Pancuronium b) Vecuronium c) Atracuriumd) Propofole) Succinylcholine

Bradycardia is caused by → Succinylcholine, propofol, opioids anaesthetics (Morphine, fentanyl and its cogneres).
Tachycardia is caused by → Gallamine, Pancuronium, Rocuronium, Ketamine, Thiopentone, Methohexitone.


Question: Second gas effect is

The increase in the paial pressures of the other gases in the alveolar mixture resulting from the rapid uptake of high concentrations of nitrous oxide during inhalational anesthesia induction is known as the second gas effect. The second gas effect is also evident in this example: the rapid uptake of N2O and reduced alveolar gas volume sustains Piso near its original inspired value and increases alveolar PO2, thereby augmenting uptake of these gases. Note also that the rapid uptake of N2O into blood results in an effective increase in minute ventilation, because more circuit gas is passively drawn into alveoli as alveolar gas is absorbed rapidly. These effects have been demonstrated in humans and animals, and theoretically, are sho-lived and peain only to the period of initial rapid transfer of N2O from alveoli to blood. The second gas effect may persist beyond the initial rapid phase of N2O uptake. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e

Facilitation of inhalation of Halothane by N20

Removal of oxygen by N20 from alveoli during recovery from general anaesthesia


Question: Intravenous regional anaesthesia is contraindicated in

As tourniquet application can precipitate sickling and hypoxia, IVRA is contraindicated in sickle cell anemia.


Question: The opioid contraindicated in patients on MAO inhibitor is

Some opioid analgesics are associated with a risk of serotonin syndrome in combinations with MAOIs due to their serotonergic propeies. 1. Dextromethorphan, 2. methadone, 3. pethidine, 4. tramadol or 5. fentanyl should be avoided in patients on MAO inhibitor.


Question: Inhalation agent incompatable with sodaline

B i.e. Trichloro ethylene Sodalime with trilene forms phosgene (neurotoxic) gas.Q So this combination is contraindicated. Sodalime is a mixture of 94% (Ca(OH)2 + 5% NaOH as catalyst + 1% KOHQ; with granule size of 4-8 meshQ. It should not be used with : The drier the sodalime, the more likely it will degrade & absorb volatile anesthetics. It produces compound A with sevofluraneQ (clinically significant) and carbon monoxide with desflurane, isoflurane & enflurane (clinically insignificant). However, desflurae can be broken down to CO by dry barium hydroxide lime to such an extent that it is capable of causing clinically significant CO poisoning.


Question: Malampatti grading is for

D i.e. Inspection of oral cavity before intubation Malampatti grading is for assessment of difficult air way (inspection of oral cavity for intubation)Q

Assessment of free rotation of neck before intubation


Question: O2 delivery is regulated by WE

D i.e. Noval Catheter - Nasal catheter is used for 02 delivery not novel catheter. O2 is delivered through various devices. The common used methods are.


Question: Hepatotoxic agent is

The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, It is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, and massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Only anticholinergic commonly used to reverse the action of neuromuscular blocker

All the given drugs are used for neuromuscular blockade reversal, However neostigmine is the most commonly used one.


Question: Local anaesthetics act on

Local anaesthetics act on open state > inactivated state > resting state, votage gated sodium channels.

Inactivated voltage gated sodium channels

Inactivated ligand gated potassium channels


Question: Risk of adverse effects of SCOLINE is greater in

Ans. a (Spinal cord injury) (Ref. Lee Anesthesia 12th/pg. 223 & Anaesthesia by Ajay Yadav 2nd/pg. 86-88)Potassium release following use of scoline is especially seen in patients with the following, hence the risk of adverse effects greater in them:# Burns# Cerebral palsy# Duchenne's muscular dystrophy# Spinal cord trauma# Severe abdominal sepsis# Tetanus# UMN and LMN lesions# Wasting secondary to chronic arterial insufficiency.


Question: Percentage of thiopentone used for induction is

The usual concentration of thiopental is 2.5%. The usual doses of thiopental (3 to 4 mg/kg) and thiamylal (3 to 4 mg/kg) are approximately twice the dose of methohexital (1 to 2 mg/kg). In dose-response studies, the ED50 for thiopental ranged from 2.2 to 2.7 mg/kg, and the ED50 for methohexital was 1.1 mg/kg. Less interpatient variability is seen in the dose-response to barbiturates than to benzodiazepines when used for anesthesia induction, but significant variability remains in the dose of thiopental required to induce anesthesia. Interpatient dose variability is related to the presence of hemorrhagic shock, cardiac output, lean body mass, obesity, gender, and age. Hemorrhagic shock, lean body mass, age, and obesity explain the variability of patients' responses resulting from a decrease in the central volume of distribution. Finally, patients who have severe anemia, burns, malnutrition, widespread malignant disease, uremia, ulcerative colitis, or intestinal obstruction also require smaller induction doses of barbiturates. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Fastest route of absorption of local anaesthetic is

The fastest route for absorption of LA is intercostal block, due to close location of blood vessel around the nerve, so that is why LA are rapidly taken by in intercostal block.


Question: Post Spinal Headache can last for


Question: The cuff used in Endotracheal tube is following

Low pressure - high volume type cuffs have a comparatively large volumes and consequently large contact areas between cuff and trachea. Advantage of high volume, low pressure cuff is lesser incidence of tracheal mucosal damage. Disadvantages of high volume, low pressure cuff include: Sore throat (due to larger mucosal contact area) Aspiration Spontaneous extubation Difficulty in inseion (because of the floppy cuff)


Question: Mendelson's syndrome is

D i.e. Aspiration of gastric content - Mendelson's syndrome is d/t aspiration of gastric contentQ - It is prevented by Sellick's maneuver i.e. backward pressure on cricoid cailageQ.


Question: Sellick's maneuver is used for

Ans. (b) To prevent gastric aspirationRef : Miller's Anaesthesia 7th ed. 12430* Sellick s manuever is a method of preventing regurgitation of an anesthesized patient during endotracheal intubation by applying pressure to the cricoid cartilage.* Or in other words, Sellicks maneuver is application of backward pressure on cricoid cartilage to prevent gastric aspiration (Mandelson s syndrome).