Anaesthesia

Cylinder Colour
Oxygen -------------------------------------------- Black body with white shoulders
Nitrous oxide --------------------------------------- Blue
Air --------------------------------------------------- Grey body with black & white shoulders
Carbon di oxide ------------------------------------ Grey
Cyclopropane ------------------------------------- Orange
Helium --------------------------------------------- Brown
Entonox --------------------------------------------- Blue body with blue & white shoulders
Ethylene -------------------------------------------- Red/purple
Halothane bottle ---------------------------------- Amber
Thiopentone -------------------------------------- Yellow

Poisons Antidotes
Organophosphates ------------------------------------------------ Atropine
Carbonates -------------------------------------------------------- Atropine
Cyanide ------------------------------------------------------------ Amyl
nitrate,Hydroxycobalamine
Digitalis ------------------------------------------------------------- Digibind
Methanol ----------------------------------------------------------- Ethanol,Fomepizole
Ethyl glycol -------------------------------------------------------- Ethanol,Fomepizole
Carbon monoxide ----------------------------------------------- O2 therapy
Opioid -------------------------------------------------------------- Naloxone
Paracetomol ------------------------------------------------------- N.acetyl cysteine
Heparin --------------------------------------------------------- Protamine sulphate
Warfarin ---------------------------------------------------------- Vit.K / FFP

Depth 4.5cm Cpr rate Cpr-vent ratio

New born 90/min 3:1
Infant Approx 100/min 15:2
Children Approx 100/min 30:2
Adults Approx 100/min 30:2
 Gas Pin Index
Oxygen -------------------------------------------------------------- 2,5
Nitrous oxide -------------------------------------------------------- 3,5
Cyclopropane --------------------------------------------------------- 3,6
Air ------------------------------------------------------------------------ 1,5
Nitrogen ----------------------------------------------------------------- 1,4
Entonox(50%O2+50%NO) ------------------------------------------- 7
Carbon di oxide (<7.5%) --------------------------------------------- 2,6
Carbon di oxide (>7.5%) ---------------------------------------------- 1,6

Parameter Spinal anaesthesia Epidural anaesthesia

Level performed Lumbar Any level
Cost Cheaper Expensive
Onset of effect 2-3 minutes 15-20 minutes
Duration of effect Lesser Prolonged
Quality of Block Total Patchy
Post spinal headache Present Absent
Epidural hematoma Less common More common
Total spinal Rare High chances
IV Injection Rare High chances
Drug Toxicity Less common More common
Catheter complications Absent Present

IV Induction Agents : Sodium thiopentone

Propofol
Etomidate
Ketamine
Methohexitone
Midazolam
Bupivacaine is a local anasthetic agent having high cardiotoxicity
Inflammable inhalational anasthetics - Ether/Ethylene/Ethyl chloride/Cyclopropane & can
be made non inflammable by adding fluorine.
Vecuronium - choice in cardiac pts
 Safe in Hepatic failure
Causes polyneuropathy on long term use
On overdose antidote - Neostigmine
Pancuronium-Avoid in CRF/Useful in Asthma patients/Increases cardiac arrythmias
Atracurium-choice in Hepatic fail/Renal fail/Myasthenia gravis/New Borns & Oldage
Drugs used in CPR - Vasopressors-Adrenaline,Noradrenaline,Ephedrine,Mephentramine
Ionotropes-Dopamine,Dobutamine
Betablockers-propranolol,Esmolol
Anticholinergics-Atropine.Glycopyrolate
Analeptics(Respiratory stimulants)-Doxapram,Ethamivan
Vasodilators-NTG,Nifedipine,potassium chloride,sodiumnitroprusside
Antiarrythmics-Amiodarone,Xylocard,Bretylium,Adenosine
Calcium is contraindicated during CPR.excess calcium worsens cell death
Indications of calcium-Hypocalcaemia,Hyperkalemia,overdosage of Ca.ch.blockers
Nahco3 without ABG should be avoided in CPR,As it worsens neuronal
injury ,increases ICT,worsens intracellular acidosis,cause hypertonicity.
Indications-Metabolic acidosis,Hyperkalemia,CPR after ABG
Indications of Tracheostomy -
Elective procedure-fro prolonged ventilation
Switch over procedure from Intubation- after 21days
Excessive secretions blocking ET tube
If Intubation is not possible/Laryngeal surgeries
Upper Airway obstruction-Laryngitis/Trauma/Edema/Vocal cord paralysis/Impacted foreign
bodies/Tumours-congenital/Abscess-peritonsillar/Ludwig's angina/Ca head&neck
Complications of massive Blood Transfusion :
Hypocalcemia,Hypothermia,Hyperkalemia,Hyperammonemia,Metabolic
alkalosis,ARDS,DIC (MCC of death)

1. MC Thermal disturbance in Anaesthesia - Hypothermia

2. Pulse oximetry measures - Sao2 of Hb
3. Inhalational anaesthetic with highest nephrotoicity - Methoxyflurane
4. MC cause of airway obstruction in unconscious pt. - Tongue fall
5. Most definitive method to maintain airway - ET Tube
6. Most reliable & best indicator of CPR - Capnography
7. Most effective clinical indicator of CPR - Palpation of carotid pulse
8. Best way to maintain airway in cervical cord injury - Tracheostomy
9. Muscle relaxant of choice for cardiac patients - Vecuronium
10. Non-depolarising muscle relaxant of choice for intubation - Rocuronium
11. MC post operative complication of intubation - Sore throat
12. Inhalational anaesthetics are made non inflammable by - addition of fluorine
13. Inhalational agent causing hyperglycemia - Chloroform
14. Inhalational agent for choice in Asthmatics - Halothene
15. Inhalational agent for cardiac pt/hypotension - Isoflurane
16. Severe hypotension is caused by - Halothane
17. Hyperglycemia is caused by - Ether
18. Laughing Gas - Nitrous oxide
19. Only complete anaesthetic agent - Ether
20. Pin index of oxygen is - 2,5
21. Needle used for spinal anaesthesia - Tuohy's needle
22. MC used IV agent for induction - Thiopentone
23. Agent of choice for cerebral protection - Thiopentone
24. IV agent of choice for day care surgery - Propofol
25. Inhalational agent of choice in shock pts - Cyclopropane
26. MC risk factor for spinal epidural abscess - DM
27. IV agent causing max Nausea & vomiting - Etomidate
28. Agent of choice for pre operative sedation - Midazolam
29. DOC for shivering - Pethidine
30. MC used anaesthetic technique - Spinal anesthesia
31. MC source of ICU infections - Urinary catheterisation
32. Last sensation lost during stages of anasthesia - Hearing
33. Anaesthetic agent with anti-emetic property also - Propofol
34. Fastest Induction of Anaesthesia is caused by - Cyclopropane
35. Used in Epidural anaesthesia - 2% lignocaine
36. Epidural is prefered over spinal because - prolonged duration of effect.
37. Spinal epidural abscess is most commonly caused by - Staphylococcus
38. Local anaesthetics act by inhibition of - Na+ channels
39. 1st priority in management of trauma patient is - Airway maintanance
40. During BLS time should be spent looking for carotid pulse - not more than 10 secs
41. Site for external cardiac massage - Lower 3rd sternum/2 fingers above xiphoid
process./1.5 -2.0 inches depth/30% of normal output generated
42. DOC in Neurogenic shock - Phenylepherine
43. Most common cause of death after massive Blood transfusion - Disseminated
intravascular coagulation
44. In patient with cervical cord injury best way to maintain airway-Tracheostomy
45. Lingual nerve block is given in - Neck of mandible
46. Indication for blind Nasotracheal intubation - Ankylosis of TM joint
47. Muscle relaxant of choice in Hepatic & Renal failure - Cis atracurium
48. Shortest acting Non-depolarising musle relaant - Rapacuronium
49. Methemoglobinemia is caused by - Prilocaine
50. Spinal head ache is usually - Occipital
51. First fibers to be blocked in spinal anaesthesia - Sympathetic preganglionic
52. Spinal cord ends at the level lower border of - L1
53. MC nerve used for monitoring during anasthesia-Ulnar nerve
54. Tachypnoea is seen in -Trilene
55. Commonest cranial nerve affected in Spinal anasthesia - 6th
56. High output renal failure is caused by - Methoxyflurane
57. Subarachnoid space is - S2-3
58. Maimum safe dose of lignocaine with adrenaline is - 15mg/kg
59. Mechanism of action of local anasthetic is - Stabilization of membrane
60. Bupivacaine is used for spinal anaesthesia in concentration of -0.5%
61. Percentage of xylocaine used in spinal anasthesia - 5%
62. Most harmful anasthetic for T2DM patient - Ether
63. Shortest acting local anasthesia-Chlorprocaine
64. Epidural space is between - Spinal dura & vertebral column
65. Sequence of recovery from local anesthesia
- Presympathetic ganglion,proprioception,motor
66. Pure antagonist of Morphine is -Naloxone
67. Best anasthetic agent for acute paronychia - Xylocaine+Adrenaline
68. Fastest route of absorption of local anasthetic is - Epidural
69. Early & reliable indication of Air embolism during anasthesia can be obtained by
continuous monitoring of - End Tidal co2
70. Sellick's manoeuvre is used to prevent - Aspiration of gastric content
71. Nasal intubation is contraindicated in - CSF Rhinorrhoea
72. Mendelson's syndrome - Aspiration of gastric contents
73. Pulse oximetry detects inaccurately in presence of -
Nailpolish,methemoglobinemia,skinpigmentation
74. A pot sitting in a hot burner - Conduction
75. How the inside of a green house works - Convection
76. Touching a metal spoon that is sitting in a pot of boiling water - Conduction
77. Using a heat blanket to get warm - Conduction
78. A person placing their cold hands over a warm fire - Radiation
79. Lying out in the sun to get a tan - Radiation
80. Putting your wet shoes on a floor vent to dry them faster - Convection
81. Picking up a hot cup of coffee - Conduction
82. Incubator heat is delivered by all except - Conduction
83. Most potent antiemetic agent used in preoperative period - Metochlorpromide
84. Visual analogue scale most widely used to measure - Pain intensity
85. Site of action of Vecuronium is - Myoneural
86. Mallampatti grading is for - Inspection of oral cavity before intubation
87. Mallampatti criteria r used for assesment of - Difficulty in Intubation
88. Anaesthetic agent associated with Delirium & hallucination - Ketamine
89. Intra occular pressure will be increased by -Ketamine
90. Iv agent with best Analgesic agent - Ketamine
91. IV agent of choice for shock pts - Ketamine
92. IV agent of choice for pts in full stomach - Ketamine
93. IV agent of choice for Asthmatics - Ketamine
94. Dissociative anasthesia is produced by-ketamine
95. Anaesthetic agent used in ICU is - Ketamine
96. Raised ICT is caused by -Ketamine
97. Dose of ketamine - 2mg/kg/iv
98. Muscle pain after anaesthesia is caused by - Suxamethonium
99. Muscle relaxant increasing intra cranial pressure - Suxamethonium
100.Muscle soreness post anasthetic is caused by - Suxamethonium
101.Post operative muscle ache is caused by - Suxamethonium
102.Muscle relaxant increases intra cranial pressure - Suxamethonium
103.Postoperative pain is common with - Suxamethonium
104.Shortest acting muscle relaxant - Succinyl choline
105.Bradycardia is common after injection of - Succinyl choline/propofol/atracurium
106.Neuromuscular blocking agent with shortest onset of action - Succinylcholine
107.Malignant hyperthermia is most commonly precipated by - Succinylcholine
108.MC cause of Malignant hyper thermia - Succinyl coline
109.Hoffman's elimination is for - Atracurium
110.During cardiac resuscitation - rupture of lungs/liver/stomach/spleen.
111.Best anasthesia agent for out patient anasthesia - Alfentanyl
112.Shortest acting IV analgesic - Remifantanil
113.Muscle rigidity is caused by - Fentanyl
114.Method of choice for induction in children is by - Inhalation
115.For high pressure storage of compressed gases,cylinders are made up of
- Molybdenum steel
116.Anasthetic agent safe to use in increased intracranial pressure - Thiopentone
117.In a patient with multiple injuries,first thing to be done is - Patency of Airway
118.Best antagonist of Morphine is - Naloxone
119.In Spinal anasthesia which fiber is lost first - Sympathetic.
120.Drug with ceiling effect - Buprenorphine
121.Least soluble anasthetic agent is - Desflurane
122.Fastest acting agent - Desflurane
123.Fastest acting inhalational agent - Sevoflurane
124.Inhalational agent of choice in children - Sevoflurane
125.Post spinal,Head ache is due to - CSF leak
126.Bone marrow depression is seen with - Nitrous oxide.
127.Halothane causes - Bronchodilation & Hepatitis
128.In high spinal anasthesia - Hypotension & Bradycardia
129.Spinal anasthesia should be injected into the space between - L3-L4
130.Best way to prevent hypotension during spinal anasthesia - Preloading with crystalloids
131.Hepato toxic agent - Halothane
132.MCC of morbidity & mortality in patients undergoing major vascular surgery is
- Cardiac complications
133.First step in CPR should be - Airway maintanence
134.Structures pierce in LP - Lig.Flavum,Duramater,Supraspinous ligament
135.Physiological dead space is decreased by - Neck flexion
136.Choice of anasthesia in decayed tooth extraction - Enflurane
137.Colour of oxygen cylinder - Black & White
138.Anasthesia of choice for manual removal of p[lacenta - GA
139.AOC for alcoholic liver failure - Isoflurane
140.AOC in renal disease - atracurium & Cisatracurium
141.AOC in renal failure - Isoflurane
142.Best anasthesia in status asthmaticus - Ketamine
143.In belladona poisoning antidote is - Physostigmine
144.Atropine is used in - Mushroom poisoning/Malathion poisoning/OPC
145.Local anasthetic acts by - Sodium channel inhibition
146.Shortest acting local anasthetic agent - Procaine
147.Longest acting local anasthetic agent - Tetracaine
148.Pudendal nerve block involve - S2S3S4
149.Pneumothorax is a complication of - Brachial plexus block
150.Post spinal, headache can last for - 7-10 days
151.DOC in status epilepticus - IV Diazepam
152.Epidural anasthesia can cause - Venous pooling,Decreases venous return
153.Spinal anasthesia is given at - L3-L4
154.Post anesthetic emesis is least common with - Propofol
155.Wooden chest syndrome - choice of day care surgery - Alfentanyl
156.Pt was accidentally given high spinal anasthesia.He'l be - Hypotensive&Bradycardia
157.Laryngeal mask is used for - Airway maintanence
158.Cardiac stabilizing anesthetic agent - Etomidate
159.Muscle twitching & deterioration occurs in - Propofol
160.Dissociative anaesthesia - ketamine
161.No. Of chest compressions in CPR - Atleast 100 cpr/minute

Quick Review (Including Probable DNB Questions)

1. IVA which precipitates porphyria: Thiopentone

2. Site of spinal anaesthesia in adults: L2-3/ L3-4
3. Shortest acting muscle relaxant: Succinylcholine
4. Hoffman's elimination is related with: Atracurium
5. Local anaesthetic block sodium channels
6. Dissociative anaesthesia is related with: Ketamine
7. Agent of choice for day care surgery: Propofol
8. Anaesthetic agent causing adrenocortical suppression: Etomidate
9. Surgical anaesthesia is stage: III
10. Anaesthetic agent causing post partum haemorrhage: Halothane
11. PIN index of nitrous oxide: 3, 5
12. Second gas effect/ diffusion hypoxia is seen with: Nitroux oxide
13. Nitric oxide is produced from which amino acid: Aiginine
14. Cause of post dural puncture headache: CSF leak from puncture site
15. Colour of oxygen cylinder: Black body with white shoulders
16. Mallampatti grading is done for: Assessment of oral cavity before intubation
17. Significant hyperkalemia with succinylcholine is seen with: Paraplegia, Crush syndrome etc.
18. Halothane is useful in: Asthmatics
19. Site of SA administration in infants: L4-5
20. Agent of choice for induction in paediatric age group: Sevoflurane
21. Anaesthetic agent having low blood and tissue gas partition coefficient: Desflurane
22. Anaesthetic agent which sensitizes heart to adrenaline: Halothane
23. Etomidate is contraindicated in: Adrenocortical insufficiency
24. Anaesthetic agent which is cerebroprotective: Propofol
25. Anaesthetic agent causing profound analgesia: Ketamine

KEY POINTS »

INTRAVENOUS ANAESTFU AGENTS (IVA)

• IVA used in shock: Ketamine

• IVA used in porphyria:
1. Ketamine,
2. Propofol
• IVA which causes post-operative vomiting: Ketamine
• IVA with high incidence of venous thrombosis: Propofol
• IVA which precipitates porphyria:
1. Thiopentone,
2. Methohexitone

SPINAL ANAESTHESIA
Site of SA in adults: L2-L3/ L3-L4 space
Site of SA in children: L4-L5 space
Site of action of SA: Nerve roots of cauda equine
Fibres which are blocked earliest: Autonomic pre-ganglionic fibres (sympathetic)
Percentage of xylocaine used in SA: 5%
Feature of high spinal anaesthesia:
1. Hypotension and
2. Bradycardia

RELATED ANATOMY

Extent of trachea: C6-T5; diameter is 1.2-1.6 cms

Level of carina: T4
Angle of right main bronchus with vertical: 25 degree
Features of infant larynx:
1. Long and leafy epiglottis,
2. Subglottic region is narrowest and
3. Large tongue
Anatomical dead space: Air which remains in conducting airways and not available
for exchange
Anatomical space is increased by: Inspiration, atropine and halothane

MUSCLE RELAXANTS

• Depolarizing muscle relaxants (Succinylcholine):

1. Usually short acting,
2. No tetanic fade,
3. No post tetanic facilitation
• Non-depolarizing muscle relaxant (Mivacurium):
1. Post tetanic facilitation seen,
2. Diaphragm is resistant to non-depolarizing agents,
3. Train of four fade present
4. Muscle fasciculation absent

• SUCCINYLCHOLINE/SCh
• Depolarizing muscle relaxant,
• Shortest acting depolarizing MR;
• Shortest acting MR
• Dual/ biphasic block,
• Rapidly hydrolyzed by pseudocholinesterase
• Pressure increased by SCh:
1. Intra-cranial pressure,
2. Intra-ocular pressure,
3. Intra-gastric pressure
SCh causes:
1. Muscle pain,
2. Hyperkalemia,
3. Vagal stimulation
Predisposing factors SCh induced hyperkalemia:
1. Massive trauma (rhabdomyolysis),
 2. Burns,
3. Stroke/ encephalitis etc.

ATRACURIUM

Undergo spontaneous non-enzymatic degradation (Hoffman's elimination),

Can be used safely in:
Renal and Liver disease,
Can be used in patient with high serum creatinine
Lau-danosine is the metabolite, responsible for seizure activity,

LOCAL ANAESTHETICS

• Generally blocks: Sodium channels

• Potency of LA depends on: Lipid solubility
• Amide linked LA:
1. Lidocaine,
2. Bupivacaine etc.
• Ester linked LA:
1. Cocaine,
2. Procaine etc.

LIGNOCAINE

• Amide linked LA,

• Concentration used in subarachnoid space: 5%
• Maximum dose with adrenaline is: 7 mg/ kg
• Adverse effects:
1. Convulsions,
2. Cardiac failure etc.

KETAMINE

Is a phencyclidine,
Causes dissociative anaesthesia,
Causes:
Hallucination, Delusion and Illusion
Causes profound analgesia
Increases all pressures:
Intracranial Tension,
Intraocular pressure,
BP
C/l in: Intracerebral mass/ hemorrhage etc

THIOPENTONE

• Ultra short acting barbiturate (because of rapid redistribution),

• Lacks analgesic effect,
• First sign on intra-arterial injection:
o White hands
 • l/V injection presents as:
1. Pain,
2. Hypotension etc.
• C/l in: Porphyria (may precipitate porphyria)

PROPOFOL

Agent of choice for day care anaesthesia

Causes pain on 1/ V administration
Contains egg extract
Safer in porphyria
Antiemetic
Cerebroprotective:
Decreases cerebral blood flow,
Decreases intracranial tension and intraocular tension
Causes dose dependent fall in BP, due to:
Vasodilation and Myocardial depression

ETOMIDATE

Minimal effects on CVS

Causes adrenocortical suppression
It inhibits:
11-beta hydroxylase and 17 alpha hydroxylase
So C/l in adrenal insufficiency

HALOTHANE

Sensitizes heart to adrenaline

Adverse effects:
1. Post partum hemorrhage (relaxes uterine muscle)
2. Bronchodilation (used in asthma)
3. Causes severe liver dysfunction

DESFLURANE

• Fluorinated congener of isoflurane

• Low blood and tissue gas partition coefficient
• Fastest acting
• Less soluble

SEVOFLURANE

• Agent of choice for induction in: Paediatric age group

• Causes respiratory depression

NITROUS OXIDE
Discovered by: Priestly
Cylinder colour: Blue
PIN index (code): 3,5
Also known as: Laughing gas,
Adverse effects:
1. Megaloblastic anemia,
2. Bone marrow suppression,
• Second gas effect/ diffusion hypoxia
• C/l in:
1. Pneumothorax,
2. Air embolism etc.

NITRIC OXIDE/NO

Produced from: Arginine (by enzyme NO synthetase),

Acts via: cGMP pathway
It prevents platelet aggregation
• Drugs forming NO: Sodium nitroprusside

SPINAL ANAESTHESIA/ CENTRINEURAXIAL BLOCKADE

• Site of SA administration in children: L4-L5

• Earliest fibres to be blocked: Sympathetic (autonomiic preganglionic fibres)
• Vasopressor agent of choice: Ephedrine
. C/l:
1. Patients refusal,
2. Severe hypovolumia,
3. Marked coagulopathy,
4. Blood dyscrasia

POSTDUHAL PUNCTURE HEADACHE/PDPH

• Occurs due to low CSF pressure/ CSF leak,

• Lasts 7-10 days,
• Risk reduction is by using: Sprottee needle/whitcare needle

LARYNGEAL MASK AIRWAY

• Used for: Airway maintenance,

• Indicated in: Difficult airway management during CPR