INI CET Anesthasia Syllabus

Anesthasia syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Anesthasia in INI CET, not a summary of it.

1. 1

   Introduction to Anesthesia

   2 topics

   • History of Anesthesia
     • Evolution of anesthesia techniques and drugs
   • Principles of Anesthesia
     • Goals of anesthesia (analgesia, amnesia, muscle relaxation, and homeostasis)
     • Stages of anesthesia
     • Monitoring techniques
2. 2

   Preoperative Evaluation

   3 topics

   • Preoperative assessment
     • Patient history (medical, surgical, and anesthesia history), physical examination, and laboratory investigations
   • Assessment of comorbidities
     • Cardiovascular, respiratory, renal, hepatic, and endocrine disorders
   • Optimization of medical conditions
     • Preoperative medication management, control of hypertension, diabetes, and other systemic diseases
3. 3

   Anesthetic Pharmacology

   3 topics

   • General Anesthetics
     • Inhalational Anesthetics
     • Intravenous Anesthetics
     • Adjunctive Drugs
   • Local Anesthetics
     • Mechanism of Action
     • Pharmacokinetics
     • Types
     • Adverse Effects
   • Neuromuscular Blocking Agents
     • Depolarizing Agents
     • Non-Depolarizing Agents
4. 4

   Anesthetic Techniques

   3 topics

   • General anesthesia
     • Inhalational anesthesia
     • Intravenous anesthesia
     • Balanced anesthesia techniques
   • Regional anesthesia
     • Spinal anesthesia
     • Epidural anesthesia
     • Peripheral nerve blocks
     • Local infiltration anesthesia
   • Monitored anesthesia care (MAC)
     • Sedation techniques for conscious sedation during minor procedures
5. 5

   Airway Management

   3 topics

   • Endotracheal Intubation
     • Indications
     • Equipment
     • Techniques
     • Complications
   • Supraglottic Airway Devices
     • Laryngeal Mask Airway (LMA)
     • Intubating LMA
     • Complications
   • Difficult Airway Management
     • Recognition of Difficult Airway
     • Strategies
     • Emergency Airway Algorithms
6. 6

   Anesthetic Complications

   3 topics

   • Hypotension
     • Causes
     • Diagnosis
     • Management
   • Hypoxemia
     • Causes
     • Diagnosis
     • Management
   • Malignant hyperthermia
     • Pathophysiology
     • Clinical features
     • Diagnosis
     • Management
7. 7

   Postoperative Care

   2 topics

   • Post-anesthesia care unit (PACU)
     • Monitoring (vital signs, pain assessment)
     • Management of postoperative complications (pain, nausea, vomiting)
     • Discharge criteria
   • Pain management
     • Analgesic techniques (opioids, nonsteroidal anti-inflammatory drugs)
     • Patient-controlled analgesia (PCA)
     • Regional anesthesia techniques for postoperative pain relief
8. 8

   Special Situations in Anesthesia

   3 topics

   • Pediatric Anesthesia
     • Anesthetic considerations in children (dose calculation, airway management)
     • Management of congenital abnormalities
   • Obstetric Anesthesia
     • Anesthesia techniques for cesarean section (spinal anesthesia, epidural anesthesia)
     • Management of preeclampsia
     • Fetal monitoring
   • Geriatric Anesthesia
     • Anesthetic considerations in elderly patients (physiological changes, comorbidities)
     • Management of postoperative delirium
9. 9

   Anesthesia for Specific Surgical Procedures

   3 topics

   • Cardiothoracic anesthesia
     • Anesthetic management for coronary artery bypass grafting (CABG)
     • Anesthetic management for valve replacement
     • Anesthetic management for thoracic surgery
   • Neurosurgical anesthesia
     • Anesthetic considerations for craniotomy
     • Anesthetic considerations for intracranial aneurysm clipping
     • Anesthetic considerations for spinal surgery
   • Orthopedic anesthesia
     • Anesthetic techniques for joint replacement surgery (total hip arthroplasty)
     • Anesthetic techniques for joint replacement surgery (total knee arthroplasty)
     • Management of acute pain
10. 10

    Emerging Trends in Anesthesia

    2 topics

    • Enhanced Recovery after Surgery (ERAS)
      • Multimodal perioperative care pathways to optimize patient outcomes and reduce length of hospital stay
    • Point-of-Care Ultrasound (POCUS)
      • Use of ultrasound for vascular access
      • Use of ultrasound for nerve localization
      • Use of ultrasound for diagnosis of pneumothorax during anesthesia

Anesthasia flashcards for INI CET

22 of 51 cards from the Anesthasia deck — real questions with worked answers.

1. Who administered the first successful public demonstration of ether anesthesia, and where/when did it occur?

   William T. G. Morton demonstrated ether anesthesia on October 16, 1846, at Massachusetts General Hospital (the 'Ether Dome'), for a neck tumor removal by surgeon John Collins Warren.

2. What is the difference between the MAC of an inhalational agent and the concept of MAC-awake?

   MAC (Minimum Alveolar Concentration) is the alveolar concentration of an agent that prevents movement to a surgical stimulus in 50% of patients; MAC-awake is the concentration at which 50% of patients respond to verbal command, roughly one-third of MAC.

3. What does the ASA Physical Status Classification System grade, and what does ASA III signify?

   It grades a patient's pre-anesthetic fitness from I to VI. ASA III is a patient with severe systemic disease that is not incapacitating (substantive functional limitation), e.g., poorly controlled diabetes or hypertension.

4. What are the standard ASA preoperative fasting guidelines for clear liquids, breast milk, and a light meal?

   Clear liquids 2 hours, breast milk 4 hours, infant formula/non-human milk and a light meal 6 hours, and a heavy/fatty meal 8 hours before anesthesia.

5. According to the revised cardiac risk index (RCRI), name three of the six predictors of perioperative cardiac complications.

   High-risk surgery, ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin-dependent diabetes, and preoperative creatinine >2.0 mg/dL.

6. In preoperative airway assessment, what does the Mallampati classification grade and what does Class IV indicate?

   It grades the visibility of oropharyngeal structures with the mouth open and tongue protruded. Class IV means only the hard palate is visible (soft palate, uvula, and fauces not seen), predicting a potentially difficult intubation.

7. How should chronic beta-blockers and ACE inhibitors generally be managed on the morning of surgery?

   Continue beta-blockers (abrupt withdrawal causes rebound tachycardia/ischemia); ACE inhibitors and ARBs are often held on the morning of surgery to reduce intraoperative hypotension.

8. What perioperative glycemic target and insulin strategy is generally advised for diabetic patients?

   Maintain blood glucose roughly 140-180 mg/dL; hold oral hypoglycemics and short-acting insulin, give a reduced dose of long-acting/basal insulin, and monitor glucose frequently to avoid hypoglycemia.

9. What are the three components ('triad') of balanced general anesthesia?

   Hypnosis (unconsciousness), analgesia (pain relief), and muscle relaxation (areflexia/immobility), often with autonomic stability as a fourth goal.

10. What property of an inhalational agent does the blood:gas partition coefficient predict?

    Speed of induction and emergence. A low blood:gas coefficient (e.g., desflurane 0.42, nitrous oxide 0.47) means faster onset/offset; a high coefficient (e.g., isoflurane 1.4) means slower.

11. Which inhalational anesthetic is contraindicated in malignant hyperthermia-susceptible patients, and which is associated with halothane hepatitis?

    All volatile halogenated agents (and succinylcholine) trigger malignant hyperthermia and are avoided; halothane is the classic cause of halothane hepatitis (immune-mediated hepatic necrosis).

12. What is the mechanism of action of propofol, and what is its hallmark cardiovascular side effect?

    Propofol potentiates GABA-A receptor activity (increasing chloride conductance). Its hallmark effect is dose-dependent hypotension due to vasodilation and myocardial depression; it also causes injection pain and apnea.

13. Why is ketamine described as a 'dissociative' anesthetic, and what makes it useful in hypotensive/asthmatic patients?

    Ketamine is an NMDA receptor antagonist producing dissociation between the thalamocortical and limbic systems. It is a bronchodilator and sympathomimetic (raises BP/HR), useful in shock and asthma, but causes emergence delirium.

14. What is the mechanism of action of local anesthetics?

    They reversibly block voltage-gated sodium channels on the inner axonal membrane, preventing depolarization and propagation of the action potential along the nerve fiber.

15. How does the structural class of a local anesthetic (ester vs amide) affect its metabolism and allergy risk?

    Esters (e.g., procaine, tetracaine; one 'i' in name) are metabolized by plasma pseudocholinesterase into PABA, with higher allergy risk; amides (e.g., lidocaine, bupivacaine; two 'i's) are metabolized by hepatic enzymes with low allergy risk.

16. What are the maximum recommended doses of lidocaine with and without epinephrine?

    Lidocaine without epinephrine: ~4.5 mg/kg (max ~300 mg); with epinephrine: ~7 mg/kg (max ~500 mg). Epinephrine causes vasoconstriction, slowing absorption and prolonging the block.

17. What are the cardinal signs of local anesthetic systemic toxicity (LAST), and what is the specific antidote?

    Early CNS signs: perioral numbness, tinnitus, metallic taste, seizures; later cardiovascular collapse (especially with bupivacaine). Treatment is 20% intravenous lipid emulsion ('lipid rescue') plus supportive ACLS.

18. What is the mechanism of depolarizing versus non-depolarizing neuromuscular blockers?

    Depolarizing agents (succinylcholine) are acetylcholine-receptor agonists causing persistent depolarization (fasciculations then flaccid paralysis); non-depolarizing agents (e.g., rocuronium, vecuronium) are competitive ACh-receptor antagonists.

19. Why is succinylcholine used for rapid sequence intubation, and what are key contraindications?

    It has the fastest onset (~45 s) and shortest duration (~5-10 min). Contraindicated where hyperkalemia is dangerous: burns, crush/denervation injury, prolonged immobilization, and in malignant hyperthermia susceptibility.

20. How does sugammadex reverse rocuronium/vecuronium blockade compared with neostigmine?

    Sugammadex is a modified cyclodextrin that encapsulates aminosteroid (rocuronium/vecuronium) molecules, rapidly reversing even deep block. Neostigmine is an acetylcholinesterase inhibitor that raises ACh and only reverses shallow/moderate block, requiring an antimuscarinic (glycopyrrolate).

21. What are the four classic stages of general (ether) anesthesia described by Guedel?

    Stage I: analgesia/amnesia; Stage II: excitement/delirium (irregular breathing, risk of laryngospasm/vomiting); Stage III: surgical anesthesia (4 planes); Stage IV: medullary paralysis/overdose (apnea, cardiovascular collapse).

22. Compare spinal and epidural anesthesia in terms of injection site, onset, and dose.

    Spinal: single small dose injected into the subarachnoid (intrathecal) space below L2, rapid dense block; epidural: larger dose into the epidural (potential) space, slower onset, catheter allows continuous/titratable block.

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