INI CET Anesthasia Flashcards

24 sample cards from the Anesthasia deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. In the ASA Difficult Airway Algorithm, what is the priority action in a 'cannot intubate, cannot oxygenate' (CICO) emergency?

   Call for help, attempt supraglottic airway rescue, and if oxygenation still fails, proceed immediately to emergency invasive airway access (cricothyrotomy/front-of-neck access).

2. Name three preoperative predictors of a difficult bag-mask ventilation (mnemonic).

   Using 'MOANS': Mask seal problems (beard), Obesity/Obstruction, Age >55, No teeth, Stiff lungs/Snoring (OSA). Any of these predicts difficult mask ventilation.

3. List the major intraoperative causes of hypotension under anesthesia by category.

   Decreased preload (hypovolemia, hemorrhage, caval compression), decreased afterload (anesthetic-induced vasodilation, anaphylaxis, sepsis, neuraxial block), and decreased contractility/rate (myocardial depression, arrhythmia, ischemia, high spinal).

4. What is the systematic approach (mnemonic) to intraoperative hypoxemia (falling SpO2)?

   'DOPES': Displaced tube, Obstruction of tube, Pneumothorax, Equipment failure, Stacking breaths (and check stomach distension). Also consider hypoventilation, V/Q mismatch, shunt, and diffusion limitation; immediate step is 100% O2 and confirm ventilation.

5. What is malignant hyperthermia, its triggers, and the pathognomonic early sign?

   A pharmacogenetic hypermetabolic crisis (often RYR1 gene/ryanodine receptor mutation) triggered by volatile anesthetics and succinylcholine. The earliest reliable sign is an unexplained rise in end-tidal CO2; masseter spasm, tachycardia, rigidity, and late hyperthermia follow.

6. What is the specific drug treatment for malignant hyperthermia and its initial dose?

   Dantrolene 2.5 mg/kg IV bolus, repeated until the crisis resolves; it inhibits calcium release from the sarcoplasmic reticulum. Stop triggering agents, hyperventilate with 100% O2, and cool the patient.

7. What are the main discharge criteria assessed in the PACU (e.g., Modified Aldrete score components)?

   Activity (movement of limbs), Respiration, Circulation (blood pressure), Consciousness, and Oxygen saturation; each scored 0-2, with a score of 9-10 generally required for discharge.

8. What is the most common postoperative complication addressed in the PACU besides pain, and name two antiemetics used?

   Postoperative nausea and vomiting (PONV). Treated with ondansetron (5-HT3 antagonist), dexamethasone, and droperidol/metoclopramide; risk is predicted by the Apfel score.

9. What is the WHO analgesic ladder, and how is it applied to acute postoperative pain?

   A stepwise approach: Step 1 non-opioids (paracetamol/NSAIDs), Step 2 weak opioids (codeine/tramadol), Step 3 strong opioids (morphine). For severe acute postoperative pain the ladder is often used in reverse (start strong, step down).

10. What is multimodal (balanced) analgesia and why is it preferred?

    Combining analgesics with different mechanisms (e.g., paracetamol, NSAIDs, regional blocks, opioids) to achieve additive/synergistic pain control while minimizing the dose and side effects (sedation, respiratory depression) of any single agent, especially opioids.

11. Why are children more prone to rapid desaturation during anesthesia induction?

    They have a higher oxygen consumption per kg and a lower functional residual capacity (FRC), so their oxygen reserve is depleted quickly during apnea, causing faster desaturation than adults.

12. What is the most common cause of cardiac arrest under anesthesia in children, and the most common perioperative airway complication?

    Respiratory/airway events (hypoxemia from laryngospasm or airway obstruction) are the leading cause; laryngospasm is the most common perioperative airway complication in pediatric patients.

13. What physiological changes of pregnancy increase aspiration and hypoxemia risk during obstetric anesthesia?

    Decreased lower esophageal sphincter tone and delayed gastric emptying increase aspiration risk; reduced FRC with increased oxygen consumption causes rapid desaturation. Aortocaval compression by the gravid uterus also causes supine hypotension.

14. What is the preferred anesthetic technique for cesarean section and its main acute complication?

    Spinal (subarachnoid) anesthesia is preferred for elective cesarean section; its main acute complication is hypotension from sympathetic blockade, managed with left uterine displacement, fluids, and a vasopressor such as phenylephrine.

15. How do anesthetic requirements change in the geriatric patient?

    MAC of inhalational agents decreases (~6% per decade after 40) and sensitivity to opioids/benzodiazepines increases; reduced renal/hepatic clearance, decreased cardiac reserve, and reduced protein binding require dose reduction and slow titration.

16. In cardiothoracic anesthesia, what is the purpose of one-lung ventilation and how is it achieved?

    It collapses the operative (non-dependent) lung to provide surgical access (e.g., thoracotomy/VATS) while ventilating the dependent lung. It is achieved with a double-lumen endotracheal tube or a bronchial blocker.

17. What are the anesthetic goals in a patient with aortic stenosis?

    Maintain sinus rhythm, adequate preload, and systemic vascular resistance (coronary perfusion); avoid tachycardia, hypotension, and large drops in afterload because the fixed obstruction limits cardiac output ('full, slow, and tight').

18. What is the relationship between MAP, ICP, and cerebral perfusion pressure (CPP) in neurosurgical anesthesia?

    CPP = MAP - ICP (or CVP, whichever is higher). Maintaining CPP (typically >60 mmHg) requires supporting MAP and lowering ICP; this guides hemodynamic management during craniotomy.

19. How does PaCO2 affect cerebral blood flow, and how is this used to reduce intracranial pressure?

    Cerebral blood flow varies directly with PaCO2 (vasodilation with hypercapnia, vasoconstriction with hypocapnia). Controlled hyperventilation to a PaCO2 ~30-35 mmHg acutely reduces cerebral blood volume and ICP.

20. What is the deadliest complication associated with the use of a tourniquet and cement in orthopedic (e.g., hip) anesthesia?

    Bone cement implantation syndrome (from methyl methacrylate) and fat/marrow embolism, causing sudden hypoxemia, hypotension, pulmonary hypertension, and possible cardiac arrest, classically during prosthesis insertion.

21. Why is regional anesthesia (neuraxial) often preferred for major lower-limb orthopedic surgery?

    It reduces blood loss, lowers the risk of deep vein thrombosis, provides superior postoperative analgesia, decreases PONV, and avoids airway manipulation compared with general anesthesia.

22. What are the core principles of Enhanced Recovery After Surgery (ERAS) protocols relevant to anesthesia?

    Preoperative carbohydrate loading and avoiding prolonged fasting, multimodal opioid-sparing analgesia and regional techniques, PONV prophylaxis, normothermia and euvolemia (goal-directed fluids), and early mobilization/feeding to speed recovery.

23. List three perioperative uses of point-of-care ultrasound (POCUS) in anesthesia.

    Ultrasound-guided regional nerve blocks and vascular (central/arterial) access, gastric ultrasound to assess aspiration risk, and focused cardiac/lung (e.g., FATE, FoCUS) exams to evaluate hypotension, volume status, or pneumothorax.

24. In ultrasound-guided regional anesthesia, what is the difference between 'in-plane' and 'out-of-plane' needle approaches?

    In-plane: the needle is aligned with the long axis of the probe so the entire shaft and tip are visualized as it advances; out-of-plane: the needle crosses the beam perpendicularly, appearing only as a single bright dot, making tip tracking harder.

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