MBBS 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 MBBS, 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 MBBS

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

1. Who is credited with the first successful public demonstration of ether anesthesia, and where and when did it take place?

   William T. G. Morton demonstrated ether anesthesia on October 16, 1846 ("Ether Day") at the Massachusetts General Hospital, Boston, removing a neck tumor from patient Gilbert Abbott in an amphitheater later named the "Ether Dome."

2. Which physician first used the term "anaesthesia," and which agent did James Young Simpson introduce in 1847?

   Oliver Wendell Holmes proposed the term "anaesthesia" in 1846. James Young Simpson introduced chloroform for obstetric and surgical anesthesia in 1847.

3. What are the three core components (the "triad") of balanced general anesthesia?

   The triad is (1) hypnosis/unconsciousness (amnesia), (2) analgesia (pain control), and (3) muscle relaxation (areflexia/akinesia), often supplemented by control of autonomic responses.

4. What are the four classic Guedel stages of ether anesthesia?

   Stage I: analgesia (induction to loss of consciousness). Stage II: excitement/delirium (loss of consciousness to onset of automatic breathing). Stage III: surgical anesthesia (4 planes). Stage IV: medullary/respiratory paralysis (overdose, leading to death if not reversed).

5. What does the ASA Physical Status (ASA-PS) classification I through VI describe?

   ASA I: normal healthy patient. ASA II: mild systemic disease. ASA III: severe systemic disease. ASA IV: severe systemic disease that is a constant threat to life. ASA V: moribund, not expected to survive without the operation. ASA VI: declared brain-dead organ donor. The suffix "E" denotes emergency surgery.

6. Define the Minimum Alveolar Concentration (MAC) of an inhalational anesthetic.

   MAC is the alveolar concentration of an inhaled anesthetic (at 1 atm) that prevents movement in response to a surgical (skin) incision in 50% of subjects. It is a measure of anesthetic potency: lower MAC means higher potency.

7. List the approximate MAC values (in % atm) of nitrous oxide, sevoflurane, isoflurane, and desflurane.

   Nitrous oxide $\approx 104\%$, desflurane $\approx 6\%$, sevoflurane $\approx 2\%$, isoflurane $\approx 1.2\%$, halothane $\approx 0.75\%$. Lower MAC = more potent.

8. Name at least four physiological/clinical factors that INCREASE MAC (raise anesthetic requirement).

   Factors that increase MAC: hyperthermia, chronic alcohol use, acute amphetamine/cocaine use, hypernatremia, red hair, infancy (peak around 6 months), and CNS stimulants.

9. Name at least four factors that DECREASE MAC (lower anesthetic requirement).

   Factors that decrease MAC: increasing age (elderly), hypothermia, pregnancy, hypotension/anemia, hypoxia, opioids and other sedatives, acute alcohol intoxication, lithium, $\alpha_2$-agonists (clonidine/dexmedetomidine), and hyponatremia.

10. What is the Meyer-Overton correlation regarding inhalational anesthetic potency?

    The Meyer-Overton rule states anesthetic potency correlates directly with lipid solubility: the more lipid-soluble (higher oil:gas partition coefficient) an agent, the lower its MAC and the greater its potency.

11. What does the blood:gas partition coefficient of an inhalational agent determine?

    It determines speed of induction and recovery. A LOW blood:gas coefficient (e.g., desflurane 0.42, nitrous oxide 0.46) means low solubility, faster equilibration, and rapid onset/offset. A HIGH coefficient (e.g., halothane 2.4) means slower induction and recovery.

12. What is the standard induction dose of IV propofol, and what is its most notable cardiovascular side effect?

    Propofol induction dose is approximately $1.5\text{--}2.5\ \mathrm{mg/kg}$ IV. Its most notable side effect is dose-dependent hypotension (from decreased systemic vascular resistance and myocardial depression), plus apnea and pain on injection.

13. Which IV induction agent best preserves hemodynamic stability, and what endocrine side effect limits its repeated use?

    Etomidate (induction dose $\approx 0.3\ \mathrm{mg/kg}$) preserves cardiovascular stability, making it useful in shock/cardiac patients. It causes adrenocortical suppression (inhibits $11\beta$-hydroxylase), so continuous infusion/repeated dosing is avoided. It also causes myoclonus and high incidence of PONV.

14. What is the mechanism and key clinical feature of ketamine anesthesia?

    Ketamine is an NMDA receptor antagonist producing "dissociative anesthesia" with profound analgesia and amnesia. It maintains airway reflexes and respiration, is a bronchodilator, and raises BP/HR (sympathomimetic). Side effects include emergence delirium/hallucinations and increased secretions.

15. What is the mechanism of action common to most general anesthetics and benzodiazepines at the GABA receptor?

    Most IV anesthetics (propofol, etomidate, barbiturates) and benzodiazepines potentiate the inhibitory $\mathrm{GABA_A}$ receptor, increasing chloride conductance and hyperpolarizing neurons. Benzodiazepines increase the FREQUENCY of channel opening; barbiturates increase the DURATION of channel opening.

16. What chemical property distinguishes ester from amide local anesthetics, and how can amide LAs be remembered?

    Esters have one "i" in the name and are metabolized by plasma pseudocholinesterase (producing PABA, higher allergy risk). Amides have two "i"s in the name (e.g., lIdocaIne, bupIvacaIne) and are metabolized by the liver.

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

    Local anesthetics reversibly block voltage-gated $\mathrm{Na^{+}}$ channels from the intracellular side, preventing membrane depolarization and propagation of the action potential. They preferentially bind channels in the open/inactivated state (use-dependent block).

18. In what order are nerve fiber functions typically lost during local anesthetic blockade?

    Order of loss: autonomic (B fibers) $\to$ pain and temperature $\to$ touch $\to$ pressure $\to$ motor function. Smaller, myelinated fibers are blocked before large fibers; recovery occurs in reverse order.

19. State the maximum safe dose of lidocaine with and without epinephrine.

    Lidocaine maximum dose: $\approx 4.5\ \mathrm{mg/kg}$ (up to $300\ \mathrm{mg}$) WITHOUT epinephrine, and $\approx 7\ \mathrm{mg/kg}$ (up to $500\ \mathrm{mg}$) WITH epinephrine (which prolongs action and reduces systemic absorption).

20. What is Local Anesthetic Systemic Toxicity (LAST), and what is its specific antidote/treatment?

    LAST results from excessive plasma LA levels, causing CNS signs (perioral numbness, tinnitus, seizures) progressing to cardiovascular collapse (bupivacaine is especially cardiotoxic). Treatment: stop injection, ABCs, and give 20% intravenous lipid emulsion ("lipid rescue").

21. Why is epinephrine contraindicated in local anesthesia of end-arterial regions (fingers, toes, nose, penis, ears)?

    Epinephrine causes vasoconstriction of end-arteries with no collateral supply, risking ischemia and tissue necrosis. The traditional teaching is to avoid epinephrine in "fingers, toes, nose, penis, and ears" (end-organs).

22. Compare depolarizing vs non-depolarizing neuromuscular blockers by mechanism and the prototype of each.

    Depolarizing (prototype succinylcholine): an acetylcholine receptor AGONIST that causes persistent depolarization (initial fasciculations then flaccid paralysis); NOT reversed by neostigmine. Non-depolarizing (e.g., rocuronium, vecuronium, atracurium): competitive ACh receptor ANTAGONISTS, reversed by anticholinesterases or sugammadex.

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