Anaesthesia And Pain Management

Front 1

What are the key principle of anaesthesia?

Back 1

1. Use of who surgery safety checklist in surgery to reduce unwanted events

2. Act as perioperative physician

3. Optimise patient for surgery.

2. Assess and minimise the risk

4. Manage pain and homeostasis in post operative periods

Front 2

Say something about propofol.

Back 2

1. Smooth induction

2. Better hemodynamic stability

3. Blunting of autonomic reflexes

4. It can be use as continuous infusion

Front 3

Say something about thiopentone?

Back 3

Benefit:

1. Rapid induction

2. Reduce metabolic ratea and icp in neurosurgery.

Demerit :

1. Myocardial depression

Front 4

Say something about etomidate?

Back 4

Benefit

1. Good hemodynamic stability

2. Short duration of action

Demerit: adrenocortical depression

Front 5

Say something about ketamin? What isnthe other name of it?

Back 5

Benefit:

Ideal anesthetic for field anaesthesia due to

1. Preservation of blood pressure and respiratory reflexes.

Demerit: emergence delirium.

Front 6

What are the ground rule for anaestheaia?

Back 6

1. Safe surgery is achieved by a team work between surgeon, anaesthetic and perioperative care giver.

2. Safety checklist ensures that things are not forgotten.

3. Risk assessment allows to choose best strategy

4. Anaesthetics are extending their care into the pre and post operative phase.

Front 7

What are the general anesthesia triad?

Back 7

1. Amnesia

2. Analgesia

3. Muscle relaxation

Front 8

What are the mathod of induction in general anesthesia?

Back 8

1. Induction by intravenous drug: propofol, thiopen, etomidate, ketamin

2. Induction by inhalational agents: sevoflurane

Front 9

When sevoflurane is used?

Back 9

1. Chieldren

2. Needle phobic person

3. Difficult airway.

Front 10

What is RSI?

Back 10

Rapid sequence induction

Use of predetermined dose of intravenous anaesthetic agent togather with rapidly acting muscle relaxant.

Front 11

What are the benefits of RSI?

Back 11

In Emergency

1. In A patient that has a high risk of regurgitation

2. Secure the airway quickly.

In non emergency :

In a patient with delayed gastric emptying.

Front 12

What is TIVA?

Back 12

Total intravenous anaesthesia

Use of propofol and short acting opiods remifentanil.

Front 13

What are the advantages of Tiva?

Back 13

1. No cumulative effect

2. Better hemodynamic stability.

3. Excellent recovery profile

4. No environmental effect like inhalational agent.

Front 14

What are the scope for TIVA?

Back 14

1. In Day case surgery.

2. In neurosurgery.

3. Airway laser surgery.

4. During cardiopulmonary bypass

Front 15

How maintainace of anaesthesia can be done?

Back 15

By intravenous agent: propofol

By inhalational agent: isoflurane, sevoflurane, or desflurane.

Front 16

Why nitric oxide is not used routinely now?

Back 16

1. Weak anaesthetic propertise

2. PONV

3. Increase size of air bubble

4. Strong greenhouse gas.

Front 17

Tell about maintance of airway during anaesthesia?

Back 17

Due muscle relaxation, patint can not breathe himself. So use of first oropharengeal airway with bag and mask ventilation is done. When the induction is done then laryngeal mask or endotracheal tube is inserted to maintain the airway.

Front 18

Use of laryngeal mask?

Back 18

1. Emergency condition by paramesics

2. Less irritation

3. Less trauma

Front 19

What is Difficult intubation? How to deal with that?

Back 19

1.when intubation of a patient is difficult or impossible due to any means

2. Use of fibroptic intubating bronchoscope.

Front 20

Where double lumen tube or endobronchial tube is used?

Back 20

1. During thorasic surgery

2. During pulmonary surgery

3. During oesophageal surgery.

To isolate the healthy lung

1. Pyopnuemothorax

2. Bronchoplueral fistula.

Front 21

What are the technique of maintaining the airway?

Back 21

1. Chin lift and jaw thrust: suitable for short term when no aid is available.

2. Guedel airway: holds tongue forward but does not prevent aspiration.

3. Supra glottic device: easy insertion, reliable airway, allows ventilation.

4. Endotracheal intubation: secure and protective airway.

Front 22

What are the complication of intubation?

Back 22

1. Failed intubation

2. Accidental broncheal intubation

3. Trauma to teeth, pharynx, larynx

4. Aspiration of gastric content during intubation.

5. Disconnection, blockage and kinking of the airway.

6. Delayed tracheal stenosis.

Front 23

When mechanical ventilation is required?

Back 23

1. When spontaneous ventilation is inadequate

2. Inability of respiration due to general anaesthesia.

Front 24

What are the types of intermittent positive pressure ventilation?

Back 24

1. Volumn controlled ippv

2. Pressure controlled ippv

3. Positive end expiratory pressure ippv

Front 25

What is volumn controlled ippv?

Back 25

1. Volumn is controlled irrespective of the airway pressure.

More change of barrotrauma if the lung volumn is compromised due to tendelenberg position or obese patient or existing lung disease.

Front 26

What is pressure controlled ippv?

Back 26

1. Pressure is controlled, actual tidal volumn is delivered is variable which depends on airway resistance, intra abdominal pressure, or degree of relaxation.

Only demerits is it may cause inadequate ventilation

Front 27

What is Positive end expiratory pressure ventilation?

Back 27

Reduce alveolar collapse and prevent vascular shunting, so improve perfusion.

Front 28

What are the commonly use muscle relaxant?

Back 28

1. Suxamethonium

2. Vecuronium

3. Atracurium

4. Rocuronium

Front 29

What are the propertise of suxamethonium?

Back 29

1. Quickest onset, Ultra short duration of action, spontaneous recovery

2. Ideal for rapid intubation and ahort procedure.

Complication:

1. Muscle pain, hyperkalemia

2. Prolong apnea

3. Malignant hyperthermia.

Front 30

What are the propertise of vecuronium?

Back 30

1. Long acting

2. Minimal cardiovascular effect

3. Less allergic

Complication:

1. Depends on hepatic and renal clearence.

Front 31

What are the propertise of atracurium?

Back 31

1. Intermediate acting

2. Non enzymatic hoffman degradation reaction

3. Suitable for hepatic and renal failure.

Complication:

1. Histamin release and allergic reaction.

Front 32

What are the propertise of rocurinium?

Back 32

1. Rapid onset

2. Intermediate action

3. Suitable for rapid intubation

4. Rapid recovery possible using sugamadex

Complication:

Allergic reaction

2. Excrwated unchanged via bile and urine.

Front 33

How you monitor a patient during anaesthesia?

Back 33

Vascular:

1. Ecg

2. Blood pressure

Adequacy of ventilation :

Inspired Oxygen concentration

Spo2

End tidal co2 concentration.

Others:

temparature

Ventilation parameter

Delivery of anaesthetic agent

In major surgery:

Urine output

Cvp

Front 34

What is multimodal analgesia?

Back 34

Use of various kinds of painkiller from preoperative to postoperative periods to relief pain

Front 35

How multimodal analgesia can helps in day care surgery?

Back 35

As we know it begins from the preoperative period. If not contraindicated, a dose of paracetamol or nsaids can be given. In intra operative period any traditional inhalational agent can be used as anaestheaia. Propofol can be the best option as it reduces the chance of PONV and Smooth recovery. For intraoperative analgesia short acting opiods can be used.where morphine is indicated, small dose < 0.1mg/kg can be used. In a wound a long acting local anesthetic as bupi can be injected

In post operative area, pc/ fentanyl/ low dose morphine can be used to minimise the pain.

Front 36

What are technique of local anaesthesia?

Back 36

1. Topical

2. Local infiltration

3. Regional nerve block

4. Central neuroaxial block ( spinal & epidural).

Front 37

Lignocaine, propertise, safe dose?

Back 37

1. Early onset

2. Short acting

3. Good sensory block.

Safe: 3/7

Front 38

Bupivacaine, propertise, safe dose?

Back 38

1. Long acting

2. More cardiotoxic

3. Never use in intravenously.

Safe: 2

Front 39

Prilocaine, property, safe dose?

Back 39

Least systemic toxicity

Causes methhemoglobinurea

Safe: 6/9

Front 40

Ropivacaine, property safe dose?

Back 40

Less cardiotoxic, greater sensory motor separation.

Safe: 3/4

Front 41

Levobupivacaine, property, safedose?

Back 41

1. Less cardiotoxic

Safe: 2

Front 42

Complication of local anaesthesia?

Back 42

Local:

1. infection

2. Hematoma

Systemic:

1. cardiovascular: cardiac arrythmia, cardiac arrest.

2. Nuerological: depressed conciousness, convulsion

Specific:

Prilocaine: methhemoglobinurea

Bupi: treatment resistant ventrycular arrythmia, cardiac arrest.

Front 43

Why adrenaline is used with local anaesthetic?

Back 43

1. To hastens the onset

2. Prolong the duration of action

3. Permits a higher dose

Front 44

When the use of adrenaline is contraindicated?

Back 44

1. Cardiovascular disease

2. Taking TCA abd mono amino oxidase imhibutor drugs.

3. In end artery

Front 45

What is must of givin local?

Back 45

1. Skilled person

2. Resuscitation equipment

3. Oxygen.

Front 46

What involve regional anaesthesia?

Back 46

1. Central nuero axial block

2. Peripheral nerve block

3. Plexus block

Front 47

What is the indication or candidate for regional anaesthesia?

Back 47

1. Debilitating respiratory disease patient

2. Cardiovascular disease

3. Obstetic

Front 48

What are the agent of topical anesthesia and their use?

Back 48

1. EMLA( eutactic mixure of local anaesthetics): lidocaine and prilocaine mixture used in venepucture in children.

2. Coccain: used as moffats solution used in nasal surgery.

3. Lignocain 2/4/10% spay: used in fibrooptic intubation.

Front 49

What are the technique of nerve block?

Back 49

1. Intersceleni block: for shoulder joint

But can produce horner syndrome, phrenic nerve block accidentally.

2. Axillary brachial plexus block: for upper arm

2. Femoral and sciatic block: for lower limb surgery.

Front 50

What TAP block?

Back 50

Transversus abdominis block

It is done through triangle of petit just medial to the anterior axillary line. It blocks T6-L1 segment of nerve. It is done Through fascial plane of transverse abdominis and internal oblique muscle

Front 51

What is BIERS BLOCK? How it is done?

Back 51

Biers block produces excellent anesthesia for short surgery particularly for upper limb, like carpal tunnel release.

Anaesthetic : prilocain

First: exsanguination is done by the esmarch bandage.then inflation of the proximal cuff of the double bandage followed by injection of the drug. Then after 5-10 minutes distal cuff is inflated and then proximal cuff is defleted. Then even the surgery is over cuff is remain inflated for tissue bounding ( 20 minutes). Lignocaine used be used in caution, but bupi never.

Front 52

Tell about Spinal anesthesia, how the action can be prolonged?

Back 52

It can be used solely or with general anesthesia.

Addition of opiods can prolong it action but can causes late respiratory depression.

Front 53

What are the indication of spinal anesthesia?

Back 53

1. Lower limb

2. Pelvic

3. Obstetic surgery.

Front 54

What are the complications of spinal anesthesia? How to overcome them?

Back 54

1. Hypotension: due to autonomic sympathetic blockage: hydration, below T10 level puncture.

2. Headache: limit the number of puncture attemps, use fine bore pencil tip needle.

Front 55

Tell some thing about epidural anesthesia? Why is preferable than spinal anesthesia?

Back 55

Epidual anesthesia is slower in onset but has a advantage of prolong anesthesia by multiple dosing or contineous infusion. As it is slow hypotension is better control and reduce blood loss.

It can be used as a route of post op analgesia by opiod.it can be used in high thorasic region that used in abdominal, thorasic surgery and early mobilization.

Front 56

What are the complications of epidural anesthesia?

Back 56

1. Technically difficult

2. High failure rates

3. Nerve damage

4. Spinal injury.

5. Accidental injection of large volumn of anaesthetic

6. Infection

7. Hematoma