Anesthesiology Instruments and Monitoring Guide

ANESTHESIOLOGY
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ANESTHESIOLOGY INSTRUMENTS
ANESTHESIOLOGY
CONTENTS
ANESTHESIOLOGY INSTRUMENTS................................................................................................................................. 4
GENERAL FEATURES OF ANESTHETIC INSTRUMENTS ............................................................................................... 4
ANESTHETIC CYLINDERS ............................................................................................................................................ 4
PIN INDEX .................................................................................................................................................................. 4
ANESTHETIC GASES ................................................................................................................................................... 4
ANESTHETIC MACHINES AND CIRCUITS .................................................................................................................... 5
MAPLESON SYSTEM .................................................................................................................................................. 5
OXYGEN CONTROL DEVICES ...................................................................................................................................... 5
DEVICES FOR CO2 ABSORPTION ............................................................................................................................... 6
DEAD SPACE .............................................................................................................................................................. 6
ENDOTRACHEAL TUBE .............................................................................................................................................. 7
LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION ............................................................................................... 7
NASOTRACHEAL INTUBATION ................................................................................................................................... 9
LARYNGEAL MASK AIRWAY ....................................................................................................................................... 9
TRENDELENBERG POSITION ...................................................................................................................................... 9
GENERAL FEATURES OF MONITORING DURING ANESTHESIA .................................................................................. 9
CENTRAL VENOUS PRESSURE MONITORING .......................................................................................................... 10
PULMONARY ARTERY CATHETER ............................................................................................................................ 10
CAPNOGRAM .......................................................................................................................................................... 11
ANESTHETIC COMPLICATIONS .................................................................................................................................... 11
AIR EMBOLISM ........................................................................................................................................................ 11
RESPIRATORY COMPLICATIONS .............................................................................................................................. 11
MALIGNANT HYPERTHERMIA ................................................................................................................................. 12
INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS .................................................................................... 12
RESUSCITATION....................................................................................................................................................... 13
MENDELSON SYNDROME........................................................................................................................................ 13
HYPOTHERMIA IN ANESTHESIA............................................................................................................................... 14
CLINICAL ANESTHESIA ................................................................................................................................................. 14
HISTORY OF ANESTHESIA ........................................................................................................................................ 14
STAGES OF ANESTHESIA .......................................................................................................................................... 14
PREANESTHETIC ASSESSMENT ................................................................................................................................ 14
PEDIATRIC ANESTHESIA .......................................................................................................................................... 15
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ANESTHESIOLOGY
ANESTHESIA IN HEAD INJURY ................................................................................................................................. 15

CARDIOVASCULAR ANESTHESIA.............................................................................................................................. 15
ANESTHESIA IN ENT ................................................................................................................................................ 16
OBSTETRIC ANESTHESIA .......................................................................................................................................... 16
ANESTHESIA IN ORTHOPEDICS ................................................................................................................................ 16
RESPIRATORY ANESTHESIA ..................................................................................................................................... 16
DAY CARE ANESTHESIA ........................................................................................................................................... 17
DRUGS OF ANESTHESIA .............................................................................................................................................. 17
PREANESTHETIC DRUGS .......................................................................................................................................... 17
GENERAL FEATURES OF ANESTHETIC DRUGS ......................................................................................................... 17
INHALATIONAL ANESTHETICS ..................................................................................................................................... 18
MINIMUM ALVEOLAR CONCENTRATION ................................................................................................................ 18
PARTITION COEFFICIENT ......................................................................................................................................... 18
GENERAL FEATURES OF INHALATIONAL ANESTHETICS........................................................................................... 18
XENON..................................................................................................................................................................... 19
NITROUS OXIDE ....................................................................................................................................................... 19
TRILENE ................................................................................................................................................................... 20
ETHER ...................................................................................................................................................................... 20
HELIUM ................................................................................................................................................................... 20
CHLOROFORM ......................................................................................................................................................... 20
HALOTHANE ............................................................................................................................................................ 20
ENFLURANE ............................................................................................................................................................. 21
ISOFLURANE ............................................................................................................................................................ 22
DESFLURANE ........................................................................................................................................................... 22
SEVOFLURANE ......................................................................................................................................................... 22
METHOXYFLURANE ................................................................................................................................................. 23
INTRAVENOUS ANESTHETICS ...................................................................................................................................... 23
GENERAL FEATURES OF INTRAVENOUS ANESTHETICS ........................................................................................... 23
PROPOFOL ............................................................................................................................................................... 24
KETAMINE ............................................................................................................................................................... 24
THIOPENTONE ......................................................................................................................................................... 25
ETOMIDATE ............................................................................................................................................................. 26
LOCAL ANESTHETICS ................................................................................................................................................... 26
GENERAL FEATURES OF LOCAL ANESTHETICS......................................................................................................... 26
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ANESTHESIOLOGY
BUPIVACAINE .......................................................................................................................................................... 28
LIGNOCAINE ............................................................................................................................................................ 28
PRILOCAINE ............................................................................................................................................................. 29
COCAINE .................................................................................................................................................................. 29
PROCAINE................................................................................................................................................................ 29
BIERS BLOCK/IVRA ................................................................................................................................................. 29
PERIBULBAR AND RETROBULBAR BLOCK ................................................................................................................ 30
STELLATE GANGLION BLOCK ................................................................................................................................... 30
BRACHIAL PLEXUS BLOCK ........................................................................................................................................ 30
CELIAC PLEXUS BLOCK ............................................................................................................................................. 30
NEUROMUSCULAR BLOCKERS .................................................................................................................................... 31
GENERAL FEATURES OF NEUROMUSCULAR BLOCKERS .......................................................................................... 31
DEPOLARISING MUSCLE RELAXANTS SUCCINLY CHOLINE ................................................................................... 31
FEATURES OF NON DEPOLARIZING MUSCLE BLOCKERS ......................................................................................... 33
D-TUBOCURARINE ................................................................................................................................................... 33
PANCURONIUM ...................................................................................................................................................... 33
VECURONIUM ......................................................................................................................................................... 34
MIVACURIUM.......................................................................................................................................................... 34
ATRACURIUM .......................................................................................................................................................... 34
GALLAMINE ............................................................................................................................................................. 34
ALCURONIUM ......................................................................................................................................................... 35
SPINAL, EPIDURAL AND CAUDAL ANESTHESIA and pain management ...................................................................... 35
SPLANCHNIC BLOCK ................................................................................................................................................ 35
NEURAXIAL BLOCKADE............................................................................................................................................ 35
SPINAL ANESTHESIA ................................................................................................................................................ 35
EPIDURAL ANESTHESIA ........................................................................................................................................... 37
CAUDAL ANESTHESIA .............................................................................................................................................. 37
OTHER BLOCKS ........................................................................................................................................................ 38
PAIN ............................................................................................................................................................................ 38
GENERAL FEATURES OF PAIN .................................................................................................................................. 38
ASSESSMENT OF PAIN ............................................................................................................................................. 38
ANALGESIC DRUGS .................................................................................................................................................. 39
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ANESTHESIOLOGY
GENERAL FEATURES OF ANESTHETIC INSTRUMENTS
Rotameter
Rotameter
MC cause of inaccurate reading in Rotameter
Wright spirometer
Types of Pneumatographs measuring airway resistance
Used to protect airway
Least damage to blood elements
Constant pressure, variable orifice, flow meter for gases

and liquids
Height of bobbin rise indicates flow rate
st
nd
1 Static Electricity, 2 Dirt
Used for calculation of expired volumes
Fleischs type, Venturi type, Turbine type
LMA, endotracheal tube, combitube
Membrane oxygenator
ANESTHETIC CYLINDERS
Filling ratio of anesthetic cylinder
Filling ratio is the weight of the fluid in

the cylinder divided by weight of water
required to fill the cylinder
Black cylinder with white shoulders
Purple
Blue
Orange
Color of oxygen cylinder

Color of ethylene cylinder
Color of nitrous oxide cylinder
Color of cyclopropane cylinder
PIN INDEX
Pin index of nitrous oxide
Pin index
System preventing Incorrect gas Cylinder attachment
3,5
Pin is present on machine, not effective if wrong gas is
filled in cylinder, hole position on cylinder valves
Pin Index Safety system
ANESTHETIC GASES
Gas filled as liquid in cylinders
Gas stored in liquid form
Nitrous oxide
Tare weight is used for
For high pressure storage of gases, cylinders are made
of
Pressure of N2O at 20*C
High pressure in gas cylinder indicate
Critical temperature of air
Critical temperature of oxygen
Critical temperature of N2O
CO2, N20, cyclopropane

N2O
Cylinder blue in color, MAC 105
Gas Cylinders
Molybdenum steel
745 psi
Impurities in N2O
-140.6*C
-119*C
36.5*C
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ANESTHESIOLOGY
ANESTHETIC MACHINES AND CIRCUITS

Anesthesia breathing circuit
Boyles machine
Boyles law
High pressure system in anesthesia machine is delivered
by
Principle of Boyles apparatus
Heidbrink meter in Boyles apparatus
Bernoulli principle
Modified bernoulli
Clayton is used in closed breathing circuit as
Cylinder is a part of high pressure system, O2 flush

delivers < 35 liters
Continuous flow, low resistance
At constant temperature, volume of a given mass varies
inversely with its absolute pressure
Hanger yoke
Continuous Flow
Indicates flow of gases
In laminar flow, velocity of flow through a tube is
inversely related to its pressure against the size of tube
Pressure change = 4 * (velocity)^2
Indicator
MAPLESON SYSTEM
Most efficient anesthetic circuit for GA with
spontaneous respiration
Air flow in Magills circuit (Mapleson A)
Magills circuit
Mapleson A
NOT suited for both controlled and assisted ventilation

No corrugated tube in
Bain circuit
Bain circuit
Mapleson system used in children

Ayres T piece
Features of Ayres T piece
Most appropriate circuit for ventilating spontaneously
breathing infant during anesthesia
Rebreathing prevention valve
Rebreathing circuit
Equal to minute volume

Ideal for adults, semiclosed, spontaneous breathing is
must
Mapleson A
Mapleson C
Mapleson type D, can be used for both controlled and
spontaneous ventilation
Inner tube for inspiration, circuit of
choice for controlled ventilation, light
weight, fresh gas flow should be 1.5 times of
minute volume
Ayer T tube
Mapleson E
No reservoir bag, no expiratory valve
Jackson Rees modification of Ayres T piece
Light, well designed, used at expiratory end of tube
To and fro circuit, circle system, water system
OXYGEN CONTROL DEVICES

Assessment of oxygen in a cylinder attached to
anesthesia machine
Used for proper oxygen flow to patient
System Maintaining O2 concentration by limiting N2O
flow
Bourdon pressure gauge

Proportionator between N2O and O2 control valve,
different pin index, calibrated oxygen corrected analysis
Pneumatic Interlock Oxygen Ratio Monitor Controller
(ORMC)
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ANESTHESIOLOGY
System Maintaining 25% O2 concentration and
Maximum N2O:O2 flow ratio of 3:1
Safety measures to prevent delivery of hypoxic mixture
to patient
Oxygen concentrator
Oxygen content in anesthetic mixture
Fixed performance oxygen provided by
Delivery of oxygen in basic life support
Humidification of air is needed in
Oxygen delivery regulated by
Maximum O2 concentration achieved in venturi mask
Side effects of oxygen therapy
Oxygen given during anesthesia to prevent

90% oxygen by
Safe oxygen concentration in therapy is to achieve
Humidity of dry 100% oxygen
Artificial nose
Link 25 Proportion Limiting system(Datex Ohmeta

System)
Location of oxygen valve after N2O valve, location of fail
safe valve downstream from nitrous oxide supply
source
Zeolite activation, delivers O2,requires power supply
33%
Venturi mask
Through mask
Face mask
Oxygen tent, oxygen apparatus, poly mask, venti mask
60%
Absorption atelectasis, decreased pulmonary
compliance, decreased vital capacity, endothelial
damage
Hypoxia
Non rebreathing mask
PaO2 > 50 mm Hg
0 mg H2O litre
Heat and moisture exchanger
DEVICES FOR CO2 ABSORPTION

CuSO4 present in
Ba (OH)2 present in
Decrease CO2 absorption
Decreases CO2 absorption
Increases CO2 absorption
Soda lime is used to absorb CO2 in
Reacts with soda lime
Main component of soda lime in closed circuit
Composition of soda lime
NOT a component of sodalime
Soda lime does NOT contain
NOT true about soda lime
Water is used for hardening in
Color change in Mimoza 2
Signs of soda lime exhaustion
Amsorb
Baralime
High flow, medium granule, No resistance in circuit
Increased tidal volume, increased dead
space
Resistance in circuit
Closed circuit system
Trilene
Calcium hydroxide
90% Ca(OH)2 + 5% NaOH + 1% KOH
Ba OH2
CaCl
Used in treatment of alkalosis
Soda lime
Red to white
Change of color of granules, rise in ETCO2
in capnography, rise in BP followed by
fall, rise in pulse rate, deepening of
spontaneous respiration, increased oozing
from wound, increased sweating
DEAD SPACE
Normal dead space
30% of tidal ventilation

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ANESTHESIOLOGY
Anatomical dead space is increased by
Dead space is increased by
Physiological dead space is decreased by
Anatomical dead space in Supine position
Anatomical dead space decreased by
Dead space NOT increased by
Least amount of CO2 present in
Atropine, Halothane, Inspiration

Anti cholinergic drugs, standing, hyperextension of neck
Neck flexion
Decreases
Massive pleural effusion
Endotracheal intubation
Anatomical dead space - end inspiration phase
ENDOTRACHEAL TUBE
Size of endotracheal tube in 1 6 months
aged
Size of endotracheal tube in 6 months to 1
year aged
Size of endotracheal tube in 1 6 years
Size of endotracheal tube more than 6
years
Length of endotracheal tube in neonate
Length of endotracheal tube in elder
children
Reasonable size of endotracheal tube in 3 year old
Curved blade in adult laryngoscope is
Endotracheal cuff
Size of endotracheal tube in children less than 6 years
Diameter and length of endotracheal tube in full term
infant
McIntosh tube for
Magills tube
Armoured endotracheal tube is used in
RAE endotracheal tube
RAE tube is used in
Diameter of ET tube in child less than 1000 g
Direct laryngoscope in right handed person
Type of endotracheal tube and blade in children
Cuff pressure in ET tube should not exceed
2 4 mm
3.5 4.5 mm
[Age/3] + 3.5
[Age/4] + 4.5
10 11 cm
[age/2] + 12
4.5 mm
Macintosh
High volume low pressure, low volume high pressure
(Age/3.5)+3.5
3.5 mm and 12 mm
Adults
Children
Neurosurgery
Red
LASER surgery
2.5,3
Left hand
Uncuffed tube with straight blade
23 mm Hg
LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

High airway resistance seen in
Airway assessment
LEMON law
Normal thyromental distance
Mallampatti grading for
Main bronchus
Mallampatti grading, Cormack and
Lehare (based on laryngoscopy), Wilsons
scoring, LEMON law
Look externally, evaluate 3-3-2 rule,
Mallampatti, Obstruction, Neck mobility
>6.5 cm
Inspection of oral cavity before intubation
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ANESTHESIOLOGY
Mallampatti classification is based on
Clinical predictor of a difficult intubation
is postulated to be responsible for a grade
III Mallampatti view of oral cavity
NOT an indication for endotracheal intubation
Both orotracheal and nasotracheal intubation is
contraindicated in
Difficulty in intubation
Features of difficult airway
Used in difficult intubation
Maneuver performed during laryngoscopy and
intubation
Endotracheal intubation in children

NOT seen during laryngoscopy
Sellicks original description of cricoid
pressure
Sellick maneuver is used to prevent
Sellick maneuver is effective in prevention
of
NOT a maneuver performed during laryngoscopy
Effective adjuvant in attenuating
hypertension and tachycardia associated
with laryngoscopy and intubation
High potassium level with scoline for
intubation occurs with
Most accurate measurement of correct placement of ET
tube
Correct placement of endotracheal tube judged by
Speedy intubation, breath sounds were observed to be
decreased on left side and high end tidal CO2
Laryngoscopy and intubation is associated with
Endotracheal intubation
A child has been intubated and connected to anesthesia
machine. A problem has occurred in anesthesia
machine and the child collapsed after 2 minutes. What
to do next
Laryngeal complication of Prolonged ET intubation
Prevention of intubation induced
laryngeal spasm
Drug that can precipitate reflux
Treatment of severe tracheal stenosis due to
endotracheal intubation for more than 2 weeks
Opening of mouth
Large tongue
Pneumothorax
Acute laryngotracheobronchitis
Burns in head and neck, Stills disease, Downs
syndrome
Millers sign, TMJ ankylosis, micrognanthia and
macroglossia
Helium O2 mixture, entoxon, sevoflurane
Flexion of neck, extension of head at atlantooccipital
joint, in straight blade laryngoscope epiglottis is lifted
by tip, upper incisors are most vulnerable to damage by
laryngoscopy so laryngoscope should not be levered
against them
Small morbidity on prolonged intubation
Hypotension
Extending head
Gastric aspiration
Passive regurgitation and subsequent
aspiration
Laryngoscope is lifted upwards levering over the upper
incisors
Succinylcholine
Chronic paraplegia
End Tidal CO2
Arterial CO2, Breath sounds, Chest X ray
Endobronchial intubation
Hypertension and tachycardia, raised IOT, raised ICT,
decreased lower esophageal sphincter tone, arrhythmia
Reduces normal anatomical dead space
Increase the flow
Stenosis, Ulceration, Abductor paralysis

Local anesthesia, fentanyl, diltiazem
Promethazine
Tracheal resection and end to end anastomosis
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ANESTHESIOLOGY
Surgery for extensive tracheal stenosis
Grillo or Barclay procedure
NASOTRACHEAL INTUBATION
Merits of nasotracheal intubation
Nasal intubation is contraindicated in
Good oral hygiene

CSF rhinorrhoea
LARYNGEAL MASK AIRWAY

Supraglottic type of airway management
NOT a definite airway
NOT an advantage of laryngeal mask airway
Laryngeal mask airway NOT used for
Laryngeal mask airway is used for
Laryngeal mask airway
LMA
Plan C of anesthetic airway management
Laryngeal mask airway

Laryngeal mask apparatus
Aspiration is prevented
Large tumor in oral cavity
Maintenance of airway
More reliable than face mask, alternative to
endotracheal tube, does NOT require laryngoscope and
visualization
Intubation can be done, size 1 for neonates, size 3 for
adults
Insertion of laryngeal mask airway and fibroptic
bronchoscopy
TRENDELENBERG POSITION
Maximum vital capacity decreased in
Trendelenberg position decrease
Trendelenberg position does NOT cause decrease in
Position with least vital capacity in GA
Trendelenberg position
Vital capacity, FRC, compliance
Respiratory rate
Trendelenberg
GENERAL FEATURES OF MONITORING DURING ANESTHESIA

Individual operative awareness by
Organ at greatest risk of ischemia under
conditions of normovolemic hemodilution
Best to monitor intraoperative myocardial ischemia
Most sensitive and practical technique to detect
myocardial ischemia in perioperative period
5th vital sign
Pulse oximetry
Pulse oximetry detects inaccurately in presence of
Inadequate ventilation during intraoperative period is
best assessed by
Beer Lambert Law
Bispectral imaging
Heart
Transesophageal echocardiography
Regional wall motion abnormality detected with help of
2D transesophageal echocardiography
Pulse oximetry
At 660 nm, oxyhemoglobin reflect more light than
deoxyhemoglobin, reverse is true at 940 nm
Nail polish, methemoglobinemia, skin pigmentation
Pulse oximetry
Pulse oximetry
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ANESTHESIOLOGY
Oxygen saturation is measured by
Used to monitor respiration in non intubated neonate
Non ventilated baby is in incubator, best way to
monitor babys breathing and detect apnea
A postoperative patient with pH 7.25 MAP 60 mm Hg
treated with
Least affected during anesthesia
Somatosensory evoked potential is
important during
MC nerve used for monitoring during anesthesia
Modality best utilized for neuromuscular
monitoring during maintenance of
anesthesia
NOT a cause of bacterial sepsis in ICU patient on
invasive monitoring
Pulse oximeter
Impedance pulmonometry
Impedance pulmonometry
Fluid therapy with CVP monitoring
Brainstem auditory evoked potential
Thoracic and abdominal aorta surgery
Ulnar nerve
Train of four
Humidified air
CENTRAL VENOUS PRESSURE MONITORING

MC vein for CVP monitoring
While inserting CVP, patient developed respiratory
distress
MC complication of central venous catheter
Complications of CVP line
CVP monitoring is most useful in
In a patient with multisystem trauma, presence of
hypotension with elevated CVP is suggestive of
CVP does NOT indicate
Right Internal Jugular Vein

Pneumothorax
Catheter related infection
Airway injury, hemothorax, septicemia, air embolism,
pulmonary edema
Guiding hemodynamic therapy
Cardiopulmonary problem
Tissue perfusion
PULMONARY ARTERY CATHETER

Swan Ganz catheter measure
While introducing Swan Ganz catheter, its placement in
pulmonary artery can be identified by
Swan Ganz catheter is used to measure
Pulmonary wedge pressure is indirectly

Measurement of intravascular pressure by pulmonary
artery catheter
Left atrial filling pressure closely
resembles
PCWP, mixed venous oxygen saturation, Right atrial

pressure
PA pressure tracing has dicrotic notch from closure of
pulmonary valve > diastolic pressure is higher in PA
than in RV
Pulmonary artery pressure, pressure of
cardiac chambers, pulmonary capillary
wedge pressure, cardiac output and
cardiac index, blood sample for mixed
venous oxygen saturation, to measure
temperature of pulmonary artery
Left atrial pressure
At the end of expiration
Pulmonary capillary wedge pressure
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ANESTHETIC COMPLICATIONS
ANESTHESIOLOGY
CAPNOGRAM
Capnography is based on
NOT a cardiovascular monitoring technique
Flat capnogram
Luft principle
Capnogram
Disconnection of anesthetic tubing, accidental
extubation, mechanical ventilation failure
Phase 0 inspiratory phase, phase 1 dead
space and little or no CO2, phase 2
mixture of alveolar and dead space gas,
phase 3 alveolar plateau with peak
representing end expiratory and end tidal
CO2
Phases of capnogram
AIR EMBOLISM
End tidal CO2 decreased during surgery
Significant air embolism occurs with volume
Diagnosing air embolism with tracheoesophageal
echocardiography
Factors favoring embolism is a patient with major
trauma
Air embolism in neurosurgery is maximum in
Most sensitive investigation for air embolism
Known case of thyrotoxicosis posted for
abdominoperineal resection. sudden drop in BP and
end tidal CO2, Mill Wheel murmur
Most serious complication of sitting position
Transesophageal echocardiography
Air embolism
100 cc
Very sensitive investigation, continuous monitoring to
detect venous embolism, interferes with Doppler when
used together
Mobility of fracture, diabetes
Sitting position
Transesophageal echo > Doppler ultrasound
Air embolism
Air embolism
Can quantify the volume of air embolised, Very
sensitive investigation, Continuous monitoring is
needed to detect venous embolism
RESPIRATORY COMPLICATIONS
Anesthetic complication with respiratory infection
Aspiration pneumonitis
Obstruction of respiration in comatose patients is

mainly due to
NOT a cause of respiratory insufficiency in immediate
post operative period
Bacteremia, Increased mucosal bleeding, laryngospasm

Affected by volume of aspiration and pH of aspiration
fluid, increased incidence during induction,
inflammation, infection
Falling back of tongue
Mild hypovolemia
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ANESTHESIOLOGY
NOT a common cause of respiratory distress in post
operative period
On doing laparoscopic cholecystectomy, patient
developed wheezing, what is used in treatment
Mild hypovolemia
To deepen plane of anesthesia
MALIGNANT HYPERTHERMIA
Does NOT trigger malignant hyperthermia
Drug causing malignant hyperthermia
Hyperthermia is caused by
Earliest sign in development of Malignant hyperthermia
Increased heat production in malignant hyperthermia
NOT seen in malignant hyperthermia
Rise in end tidal CO2 during surgery
Causes of sudden increase in end tidal CO2
End tidal CO2 increased to maximum level in
Difference between malignant hyperthermia and
thyrotoxicosis
Enzyme marker of malignant hyperthermia
Malignant hyperthermia
Treatment of malignant hyperthermia

Drug of choice for Halothane induced Malignant
hyperthermia
N2O
Succinyl choline
MAO inhibitors
Increased CO2
Increased muscle metabolism by excess of calcium ions
Bradycardia
Malignant hyperthermia, thyroid storm, neuroleptic
malignant syndrome
Hyperthyroidism, shivering
Malignant hyperthermia
Elevated CPK level
Serum CPK
Succinlycholine and halothane predispose, dantrolene
used in all cases, propofol is safe, muscle biopsy is
diagnostic, hyperkalemia
Dantrolene, cooling, discontinue inhalational
anesthetic, give O2 therapy with 100% O2
Dantrolene
INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS

Normal urine output
Treatment of postoperative shivering
Shivering is abolished by
Post anesthetic shivering may increase metabolic rate
by factor of
Causes of postoperative hypertension
Most common rhythm disturbance during early
postoperative period
Most common intraoperative complication
reported during anesthesia in ASA I and
ASA II patients
Advantage of Intraoperative anesthesia record
Post anesthetic discharge scoring system includes
Drug of choice for maintaining
intraoperative heart rate
Bradycardia during anesthesia
1 ml/kg/hr
Pethidine
Meperidine
5
Preoperative hypertension, inadequate analgesia,
pheochromocytoma, hypoxemia, hypercarbia
Tachycardia
Dysrhythmia
Test for quality assurance, medicolegal purposes,

Reference for future
Pain, Ambulation, Nausea and vomiting
Esmolol
Atracurium, Propofol, succinylcholine
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ANESTHESIOLOGY
Intraocular pressure is lowered by
Allergic reaction in anesthetic practice
Analgesic effect is absent in
Management of postoperative nausea and
vomiting
Morphine, Thiopentone, Halothane

Atracurium, Thiopentone, Procaine
Thiopentone, methhexitone
Promethazine
RESUSCITATION
Fifth vital sign
Adrenaline in CPR
Does NOT occur during cardiac resuscitation
Compression to breath ratio in adult advanced life
support
Recent CPR guideline
Exact order of CPR

Best chances of successful recovery after CPR in
Drug NOT used in Cardiopulmonary resuscitation
During cardiopulmonary resuscitation, intravenous
calcium gluconate is indicated in
Cardiopulmonary resuscitation
NOT an indicator for adequacy of preoperative
resuscitation
Patient become pulse less after an antibiotic
administration
Outcome of cardiac resuscitation worsen with
Outcome following resuscitation of a cardiac arrest is
worsened if during resuscitation patient is given
Immediate defibrillation is advised when ECG shows
NOT used for cardiac arrest following ventricular
fibrillation
Asynchronous cardioversion given in
NOT true about Bag mask ventilation
Pain
Can be given intrathecally, IV route is better than
intracardiac
DIC
30 : 2
Chest compressions 100 per minute, no breathing, as soon
as VT/VF disappears 300 J (monophasic) or 150 J (biphasic)
defibrillation 5 cycles. If defibrillation fails, adrenaline and
then amiodarone
CAB
Ventricular tachycardia
Sodium bicarbonate
Hypocalcemia, calcium channel blocker toxicity,
electromechanical dissociation
Adrenaline is given if cardioconversion fails
C reactive protein
Immediate chest compression
5% glucose
5% dextrose
Ventricular tachycardia
Atropine, External cardiac pacing
Ventricular fibrillation
Child minimum size 450 ml
MENDELSON SYNDROME
Mendelson syndrome
Critical pH of Mendelson syndrome
Complete bilateral white out in chest X ray in Mendelson
syndrome in
Accidental aspiration of gastric contents
into tracheobronchial tree should be
initially treated by
Aspiration of gastric contents

2.5
8 24 hours
Tracheal intubation and suctioning
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CLINICAL ANESTHESIA
ANESTHESIOLOGY
HYPOTHERMIA IN ANESTHESIA
Hypothermia is used in
Hypothermia is used in
Hypothermia can be
Hyperpyrexia, prolonged surgeries

Hyperthermia, neonatal asphyxia, cardiac surgery
Beneficial to patient
CLINICAL ANESTHESIA
HISTORY OF ANESTHESIA
Anesthesia
World ether day
Anesthetic effects of ether
W.G.Morton (1846)
th
16 October 1846
Morton
STAGES OF ANESTHESIA
Stage II of surgical ether anesthesia
Pupil in second stage of anesthesia
Stage III of surgical anesthesia
Definitive sign of stage III phase 1 of anesthesia
Feature of stage III plane 3 of anesthesia
Loss of consciousness to beginning of spontaneous

respiration
Partially dilated
Beginning of respiration to respiratory
paralysis
Fixation of eye ball
Absent thoracic respiration
PREANESTHETIC ASSESSMENT
POSSIUM scoring system for
ASA classification done for
An hypertensive man on medication not affecting
physical activity
ASA 2
ASA 3
ASA 4
ASA 5
ASA 6
Scoring system for severity of illness
Karnofsky performance index
ECOG performance scale
Smoker scheduled for elective surgery
Smoking should be stopped

Aspirin should be stopped
Anesthesia
Status of patient
ASA II
Mild systemic disease
Severe systemic disease
Severe disease, constant threat to life
Moribund patient
Brain death
APACHE II, SAPS
0 to 100 (moribund 10, dead 0)
0 fully active, 5 - dead
Effect of nicotine on aorta and carotid bodies can
increase sympathetic tone, muscle relaxant dose
requirements are increased, smoking decreases
surfactant levels
6 weeks before surgery
7 days before surgery
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CLINICAL ANESTHESIA
ANESTHESIOLOGY
Clopidogrel should be stopped
Ticlopidine should be stopped
MAO inhibitors should be stopped
Lithium should be stopped
Drugs that can be continued irrespective
of anesthesia
Drug that can be given in normal dose
during anesthesia, as they can prevent MI
Levodopa should be stopped
Important drug to be stopped before

abdominal surgeries
1 day before surgery

10 14 days before surgery
3 weeks before surgery
48 72 hours before surgery
Anti thyroid drugs and anti tubercular
drugs
Calcium channel blockers
4 6 hours before surgery (recent
recommendation is that it can be
continued)
OCP
PEDIATRIC ANESTHESIA
Method of choice for induction in children
NOT used for induction of anesthesia in children
Narrowest part of larynx in infant is at cricoid level, in
administering anesthesia this may lead to
Neonatal circumcision done under
Postoperative pain relief in children by
5 year child, squint correction, induction uneventful,
after conjunctival incision, surgeon grasps medial
rectus, anesthetist looks at cardiac monitor
Most appropriate anesthetic in a 5 year old boy
undergoing tendon lengthening procedure for
Duchenne muscular dystrophy
Anesthesia for ducchene muscular
dystrophy
Inhalational > intravenous

Morphine
Laryngeal edema, trauma to sub epiglottic region, post
operative stridor
General anesthesia
Intravenous narcotic infusion in lower dosage
He wanted to see if there is oculocardiac reflex
Induction with intravenous suxamethonium and N2O

oxygen for maintenance
Halothane and propofol
ANESTHESIA IN HEAD INJURY

RTA , head injury used for induction
Agents used for Non head injury trauma patient
Thiopentone
Ketamine, etomidate
CARDIOVASCULAR ANESTHESIA
Anesthesia for pregnant woman with coarctation of
aorta
Most common cause of mortality and morbidity in
patients undergoing major vascular surgery
Maintenance of anesthesia during triple vessel coronary
artery disease bye pass
52 year male, triple vessel coronary artery disease with
poor left ventricular function. CABG surgery decided.
General anesthesia
Cardiac complication
Opioids > isoflurane
Opioid
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CLINICAL ANESTHESIA
ANESTHESIOLOGY
Preferred for maintenance of anesthesia
NOT used in controlling heart rate intraoperatively
NOT used in controlling heart rate intraoperatively
Anesthesia of choice for hypotension during surgery for
aortic stenosis
Verapamil
Propanolol/Metoprolol
Phenylephrine
ANESTHESIA IN ENT
Anesthesia of choice in infected tooth posted for
extraction
NOT done if fire breaks out during vocal cord surgery
Anesthesia used in microlaryngoscopy
Hypotensive anesthesia in nasopharyngeal carcinoma
given by
Enflurane
100% oxygen after discontinuing anesthetic gases
Pollard tube with infiltration block
Phentolamine, halothane, sodium nitroprusside
OBSTETRIC ANESTHESIA
NOT a cause of decreased anesthetic requirement
during pregnancy
Primigravida with mitral stenosis and mitral
regurgitation in labour, best way to provide anesthesia
for normal delivery
Anesthesia of choice for manual removal of placenta
Most preferred technique for painless
labor
Most adequate anesthesia in breech
A primigravida with rheumatic heart
disease with severe mitral stenosis and is
planned for elective LSCS. Anesthesia of
choice
Anesthesia in LSCS desirable up to
Increased lumbar lordosis

Neuraxial blockade
General anesthesia
Lumbar epidural
General anesthesia
General anesthesia with thiopentone and
succinylcholine
T4
ANESTHESIA IN ORTHOPEDICS
Anesthesia in total hip replacement
Combined spinal and epidural
RESPIRATORY ANESTHESIA
Safest to use in asthmatic
During rapid sequence induction of anesthesia
Inducing agent contraindicated in asthma
Intravenous agent containing two steroids
in structure
After hyperventilation for some time, holding the
Chloral hydrate
Preoxygenation is mandatory
Althesin
Althesin
Due to lack of stimulation by CO2, anoxia can go into
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DRUGS OF ANESTHESIA
ANESTHESIOLOGY
breath is dangerous since
Patients NOT breathing after anesthesia is due to
Drug that may precipitate bronchospasm
in patients with reactive airway
dangerous level
Prolonged anesthesia, Neuromuscular blockage,
Recurrent intubation leading cords failure
Methohexitol
DAY CARE ANESTHESIA

Most preferred for day care surgeries
Propofol, fentanyl, isoflurane
DRUGS OF ANESTHESIA
PREANESTHETIC DRUGS
Main aim of pre anesthetic medication
Drug commonly used in pre anesthetic medication
Pre anesthetic medication
Most potent antiemetic agent used in preoperative
period
Pre anesthetic medication causing longest
amnesia
During GA shivering is abolished by suppression of
Preanesthetic effects of atropine
NOT a preanesthetic agent
Preanesthetic medication is NOT for
To make anesthesia pleasant and safe

Diazepam, scopolamine, morphine
Fentanyl, Diazepam, Atropine
Metoclopromide
Lorazepam
Hypothalamus
Decrease secretion, prevent bradycardia, prevent
hypotension, bronchodilatation
Aspirin
Decreasing dose of inducing agent, decreasing BP
GENERAL FEATURES OF ANESTHETIC DRUGS

Drugs interfering in anesthesia
Calcium channel blockers in anesthesia
Anesthetic agents that does NOT suppress cerebral
metabolic rate
Airway resistance is reduced by
Anesthesia for bariatric surgery
Most important monitoring during

laparoscopic surgery
Minimum O2 requirement during
anesthesia
Calcium channel blockers, beta blockers,

aminoglycosides
Given in normal doses as they prevent MI and angina
preoperatively
Ketamine, Nitrous oxide
Slow flow rate
Anticipated difficult intubation,
Desflurane is an ideal inhalational agent,
High tidal volume, more IV fluid
replacement
Vigilant anesthesiologist
Triservice anesthetic apparatus
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INHALATIONAL ANESTHETICS
ANESTHESIOLOGY
Dexmedetomidine
Alpha 2 agonist, anxiolytic, hypnotic, used

for sedation in ICU, maintains
hemodynamics
MINIMUM ALVEOLAR CONCENTRATION
MAC is an indicator of
MAC refers to
Lowest concentration of anesthetic agent in alveoli to
produce immobility in response to painful stimulus in
50% of individual
MAC 95 is how much times that of MAC
50
Relationship between hypothermia and
minimum alveolar concentration
Alveolar concentration of anesthetic gas is affected by
Factors decreasing MAC
NOT decreasing MAC
Potency
Minimum Alveolar concentration
Minimum alveolar concentration
1.5 times more

MAC decreases 5% per degree centigrade
decrease
Alveolar ventilation, Partition coefficient, Alveolar blood
flow
Hypothermia, hyponatremia, anemia
Hypocalcemia
PARTITION COEFFICIENT
Partition coefficient of gas
Blood gas partition coefficient
Least Blood gas partition coefficient
Oil gas partition coefficient
Measures solubility
Solubility
Desflurane
Potency
GENERAL FEATURES OF INHALATIONAL ANESTHETICS

Route of fastest reversible anesthesia
Ideal gas
Exception to Meyer Overton rule
Maries law
Pungent volatile anesthetic agent
During general anesthesia, FRC decreases by
Respiratory irritation is seen with
Cyclopropane
First reflex to appear in recovery of GA
Increases speed of induction with inhalational agent
Action of inhalation agents can be increased by
Carbogen
Inhalational
Obeys Charles, Boyles, Avagadro laws
Non anesthetics, non immobilizer, cut off effect
Hypovolemia causes tachycardia
Desflurane, isoflurane
15 20%
Desflurane
Explosive
Swallowing reflex
Increased alveolar ventilation
Given along with nitrous oxide
30% CO2 and 70% oxygen
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ANESTHESIOLOGY
Most metabolized anesthetic
Halothane
XENON
Xenon
Anesthesia for mitral stenosis with liver failure

Enhances CT Brain
Important step to prevent Hypoxia while using Xenon
Non explosive, minimum cardiovascular side effects,

low blood gas solubility, rapid induction and recovery,
Heavier than air
Xenon
Xenon
Denitrogenation
NITROUS OXIDE
Inhalational agent with fastest onset of
action
Critical temperature of nitrous oxide
Nitrous Oxide
Distortion of Capnography, Highest MAC
Effects of Nitrous oxide on environment
Type of Oxygen and Nitrous Oxide Cylinders
Diffusion hypoxia occurs due to
Anesthetic agent NOT metabolized in body
Least diffusion coefficient
At the end of anesthesia after discontinuation of nitrous
oxide and removal of endotracheal tube, 100% oxygen
administered to patient to prevent
How long after termination of an
anesthetic that included nitrous oxide,
should you be concerned about diffusion
hypoxia
Second gas effect is characteristically seen
in
Anesthesia for Malignant Hyperthermia
Expands air filled cavities
Hematological manifestation common with
Pneumocephalus created during surgery, Nitrous oxide
avoided for
Use of Nitrous oxide in contraindicated in
Vitamin Deficiency caused by Nitrous oxide
Sub acute combined degeneration is
associated with
Least diffusion coefficient
Contraindicated in Pneumo conditions
Use of nitrous oxide NOT contraindicated in
Nitrous oxide is indicated in
Nitrous oxide
36.5 *C
J.B.Priestly
Nitrous oxide
Green House Effect (Global Warming),No Ozone
Depletion
E
Nitrous oxide
Nitrous oxide
Nitrous oxide
Diffusion hypoxia
5 10 minutes
Nitrous oxide and halothane

Nitrous oxide
Nitrous oxide
Nitrous oxide
7 days
Cochlear implant, microlaryngeal surgeries,
vitreoretinal surgery
Vitamin B12
Nitrous oxide
Nitrous oxide
Nitrous oxide
Exenteration operation
Exenteration operation
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ANESTHESIOLOGY
Side effects of Nitrous oxide
Bone marrow suppression, Megaloblastic anaemia,

Agranulocytosis
Nitrous oxide
Bone marrow depression after prolonged

administration of
Does NOT cause hepatitis
Nitrous oxide
TRILENE
Trilene + Sodalime
Good Analgesia
NOT compatible with sodalime
Phosgene Neurotoxic
Trilene
Trilene
ETHER
Used without Skeletal Muscle Relaxant
Anesthetic agent contraindicated in cauterization
Most effective muscle relaxant
Hyperglycemia is caused by
Maximum emesis
Stages of anesthesia established with
No effect on heart
Disadvantages of ether
NOT true about ether
Ether
Ether
Ether
Ether
Diethyl ether
Ether
Ether
Slow induction, cauterization cannot be used, irritant
nature increases salivary and bronchial secretions
Affects blood pressure and is liable to produce
arrhythmia
HELIUM
In patient with fixed respiratory obstruction helium is
used along with oxygen instead of plain oxygen
Helium
Heliox
Heliox
Decreases turbulence
Atomic number 2, viscosity zero, used in COPD
Inert, low viscosity, decreases airway resistance
Helium is inert gas, mixture of He and O2, reduces work
of breathing
CHLOROFORM
Anesthetic causing maximum emesis
Superseded because of cardiotoxicity
Chloroform
Chloroform
HALOTHANE
Anesthetic agent maximally absorbed by
PVC endotracheal tube
Halothane
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ANESTHESIOLOGY
Tissue blood gas solubility coefficient of
halothane is maximum in
Side effect of halothane
Trifluoric acid in urine caused by
Maximum cardiac depression
Halothane metabolism does NOT cause formation of
Volatility of an anesthetic agent is directly proportional
to lowering the flow in portal vein. Portal flow is
maximally reduced by
Most hepatotoxic anesthetic agent
General anesthesia of choice in children
Anesthetic drug sensitizing heart to adrenaline
Ether Linkage is NOT seen in
NOT a fluorinated agent
Halothane on hydrolysis liberate
Preservative used in halothane
Halothane sensitizes heart to
Halothane
Halothane
No analgesic action
Postoperative rigors
Better to use in thyrotoxic patient
Anesthesia with least analgesic property
Repeated use of Halothane
Agent that corrodes metal in vaporizers and breathing
system
Post operative jaundice because of
Agent dissolving rubber
Maximum uterine relaxation
Avoided in surgery for biliary atresia in 2 year child
Halothane
Smooth induction
Does NOT have analgesic property
Shivering in early part of postoperative period may be
due to
Anesthetic drug when given second time causes
Fulminant hepatitis
Halothane hepatitis is associated with
Contraindications of halothane
Human fat
Hepatotoxicity
Halothane
Halothane
Iodide
Halothane
Halothane
Oxygen + N2O + Halothane
Halothane
Halothane
Halothane
Trifluoroacetate, F2, Br2
Thymol
Exogenous and endogenous adrenaline, dopamine
Sensitizes heart to action of catecholamines, relaxes
bronchi, may cause liver cell necrosis
Non irritant, bronchodilator, vasodilator
Halothane
Halothane
Halothane
Halothane
Hepatitis
Halothane
Halothane
Halothane
Halothane
Halothane
20% metabolized, not given in same patient within 3
months
Halothane
Halothane
Halothane
Halothane
Centrilobular necrosis
Pheochromocytoma, head injury, MS, AS
ENFLURANE
Anesthetic with high epileptogenic potential
Enflurane
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ANESTHESIOLOGY
ISOFLURANE
Anesthesia of choice for liver disease, renal disease and
neurosurgery
Inhalational anesthesia of choice for day care surgery
General anesthesia of choice in Myocardial Ischemia
Least cardiotoxic anesthetic agent
Fluoride content is least in
Agent used in increased ICT
Coronary steal phenomenon is associated with
Liver disease, Renal disease, Neurosurgery, Day care
anesthesia
Isoflurane
Isoflurane
Isoflurane
Isoflurane
Isoflurane
Isoflurane
Isoflurane
Isoflurane
DESFLURANE
Desflurane is a structural analogue of
Fluorinated methyl ethyl ether
Desflurane
Minimally metabolized
Anesthesia of choice in epileptics
Anesthesia of choice in geriatric patients
CO (carbon monoxide) Production
Treatment of status epilepticus
Inhalational agent with rapid induction
70 year old male, surgery for 4-6 hours. Best
inhalational agent
Least soluble
Minimum blood gas solubility coefficient
Minimum Blood gas partition coefficient (0.4) Fastest
acting
Least soluble
MAC of desflurane
Desflurane vaporizer is heated to
Isoflurane
Desflurane
Pungent and irritable to airway
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
Desflurane
6
39*C
SEVOFLURANE
Sevoflurane + Sodalime
Inhalational anesthesia of choice in Pediatric Patients
A patient with elevated liver enzymes
and reduced hepatic venous flow is posted
for a surgery. Inhalational agent
preferred in anesthesia
Prolongation of QT Interval
Nephrotoxic byproduct of Sevoflurane
Volatile agent used for Induction in Children
Should NOT be used with Soda Lime
Compound A
Sevoflurane
Sevoflurane
Sevoflurane
Compound A (Vinyl Ether)
Sevoflurane
Sevoflurane
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INTRAVENOUS ANESTHETICS
ANESTHESIOLOGY
Soda lime circuit NOT used with
Fastest acting inhalational agent
Raise in ICT
6 month child posted for correction of PDA, inhalational
agent
Contraindicated in closed system anesthesiology
Sevoflurane
Sevoflurane
Sevoflurane
Trichloroethylene
Sevoflurane
Sevoflurane
Sevoflurane
Sevoflurane
Isopropyl ether, MAC is 2%, good to use in old age,
formation of compound A with baralime
MAC is higher than isoflurane, Blood gas coefficient is
higher than desflurane, More cardiodepressant than
isoflurane
Nephrotoxic at higher doses
METHOXYFLURANE
Slowest induction and recovery
Methoxyflurane
Methoxyflurane
Least MAC
Maximum Blood gas partition coefficient (15) slowest
acting
Anesthetic agent with boiling temperature more than
75*
Methoxyflurane
Most potent inhalational anesthetic,
highly soluble in rubber tubing of closed
circuit, highest level of fluoride
Nephrotoxicity
Methoxyflurane
Methoxyflurane
Methoxyflurane
GENERAL FEATURES OF INTRAVENOUS ANESTHETICS
NOT an intravenous anesthetic
IV anesthesia with shortest elimination time
NOT contraindicated in renal failure
Intravenous anesthesia of choice in head injury
TIVA
Droperidol + Fentanyl
Ratio of droperidol and fentanyl in
neuroleptic analogue
Neuroleptic analgesia
Droperidol + Nitrous oxide
IV anesthesia causing muscle rigidity
Commonest artery for cannulation
Safely used in porphyria
Rapid induction in emergency LSCS
Cyclopropane
Midazolam
Midazolam
Thiopentone/Propofol
Reduces cerebral metabolism and CBF
Neuroleptic analgesia
50:1
Can be used along with O2 and N2O, Causes focal
dystonia, Cause hypotension
Neuroleptic anesthesia
Fentanyl
Radial
Midazolam, Pethidine
Prevent gastric aspiration
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ANESTHESIOLOGY
Least elimination half life
Total Intravenous Anesthesia
Severely ill patient maintained on infusional anesthetic
nd
agent and started deteriorating on 2 day. The
probable culprit may be
Midazolam
Propofol + Remifentanil
Etomidate, Propofol
PROPOFOL
Nausea and vomiting NOT seen Postoperatively in
IV anesthesia in Porphyria
IV anesthesia in Malignant Hyperthermia
Day care Anesthesia
Laryngeal mask airway used
Related to Egg
Drug of choice for inducing for a case of tooth
extraction under GA for day care
IV anesthetic having maximum antiemetic action
Induction of choice for street fit patient
Propofol is preferred in Day care anesthesia
Induction agent of choice in day care anesthesia
Propofol
Early MTP in day care facility
Causes pain of IV injection
Propofol
Propofol
Administration of drug by intravenous route is painful

Propofol infusion syndrome
Side effect of propofol
Propofol
Propofol
Propofol
Propofol
Propofol
Propofol
Propofol
Propofol
Propofol
Recovery is rapid even if used for long time
Propofol
Does NOT trigger malignant hyperthermia, contains
egg, suitable for day care surgery
Propofol
Propofol
Undergoes hepatic metabolism, Chemically it is
derivative of di-isopropylphenol
Cerebral protector, Pleasant sedation and recovery,
Antiemetic effect, Suppression of airway reflex, Does
not cause airway irritation
Di-isopropylphenol
Lethal disease which constitutes triad of
metabolic acidosis, skeletal myopathy,
acute cardiomyopathy
Profound apnea and hypotension
KETAMINE
Dissociative anesthesia produced by ketamine is
characterized by
Ketamine is a
Ketamine belongs to
IV anesthesia of choice in Asthmatics
IV anesthesia of choice in Shock
IV anesthesia of choice in Cyanotic Heart Disease
Induction agent acts by blocking glutamate requiring
NMDA receptor
Anesthetic agent contraindicated in raised ICT
Emergence phenomenon is seen with
Amnesia, Analgesia with loss of consciousness,

Catatonia
NMDA blocker
Phencyclidine
Ketamine
Ketamine
Ketamine
Ketamine hydrochloride
Ketamine
Ketamine
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ANESTHESIOLOGY
Anesthetic agent with additional smooth muscle
relaxing property
Post procedure delirium is seen with
Emergence delirium
IV anesthesia causes maximum bronchodilatation
Intravenous anesthesia with loss of consciousness
Hallucinations are associated with
Hypotension is NOT caused by
Does NOT cause uterine relaxation
Dissociative anesthesia
Maximum analgesia
Increased ICT
Increased cerebral oxygen consumption is
caused by
NOT used for postoperative nausea and vomiting
Ketamine
Increases cerebral oxygen consumption

Dose of ketamine
Contraindicated in uncontrolled hypertension
Intraocular pressure increased by
Increased cardiac oxygen demand
Ketamine contraindicated in
Ketamine is contraindicated in
Ketamine produces
Profound analgesia
Ketamine acts by
Anesthetic agent causing hypertonia
Rigidity is associated with
Anesthetic agent contraindicated in epilepsy
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Ketamine
Direct myocardial depression, emergence phenomenon
is more likely if anticholinergic premedication is used,
may induce cardiac dysarrythmia in patients receiving
TCA
Ketamine
2 mg/kg iv
Ketamine
Ketamine
Ketamine
Ischemic heart disease, aortic aneurysm
Hypertension
Inotropic effect
Ketamine
Blocking NMDA receptor
Ketamine
Ketamine, fentanyl
Ketamine
THIOPENTONE
IV anesthesia of choice in Pediatric Patients
Cerebral protection
Thiopentone is often used because of the
advantage of
Rapid sequence Induction
Adequate sign of Induction in Thiopentone
Smooth induction
Thiopentones short t is due to
First symptom in accidental intraarterial injection of
Thiopentone
Do NOT trigger malignant hyperthermia
IV thiopentone for induction in antecubital vein, severe
pain on whole hand. Next line
Drug NOT suitable for acute porphyria
Thiopentone
Thiopental sodium
Smooth induction
Thiopentone
Loss of eyelash Reflex
Thiopentone
Redistribution
Pain
Thiopentone
IV lignocaine through same needle
Thiopentone sodium
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LOCAL ANESTHETICS
ANESTHESIOLOGY
Added to thiopentone to improve its solubility
Thiopentone Metabolism
NOT a bronchodilator
Commonly used in narcoanlaysis
Percentage of thiopentone used in induction
Dose of thiopentone for induction
Thiopentone
Intravenous thiopentone cause
Intraarterial thiopentone cause
Primary mechanism of cerebral protection effect of
thiopentone
Barbiturates
Pentothal sodium is preferably injected in to
Commonly used to induce anesthesia
Barbiturate contraindicated in
Thiopentone is NOT indicated in
Cerebral metabolism not affected with use of
Sodium carbonate
Redistribution
Thiopentone
Thiopentone
2.5%
5 mg/kg
Seizure, truth spell, reduction of ICP, cerebral
protection, maintenance of anesthesia
Rash, pain, spasm, hypotension, muscular excitation
Vasospasm
Decreased cerebral metabolism
Anticonvulsant, Brain protection, Induction of
anesthesia
Veins over outer aspect of forearm
Thiopentone
Acute intermittent porphyria
Shock
Thiopentone
ETOMIDATE
Highest Incidence of Vomiting
Intravenous anesthetic induction with minimum effect
on cardiac functions and myocardial oxygen demand
Induction agent that may cause adrenal cortex
suppression
Etomidate
Enzyme blocked by etomidate
Least change in blood pressure produced by
Inducing agent producing cardiac stability
Vitamin deficiency caused by Etomidate
Does NOT cause myocardial depression
Least effect on heart
A Patient has severe Mitral Stenosis. Anesthetic agent
of choice is
Etomidate
Etomidate
Etomidate
Intravenous, inhibits cortisol synthesis, pain at site of
injection
11- Hydroxylase
Etomidate
Etomidate
Vitamin C
Etomidate
Etomidate
Etomidate
LOCAL ANESTHETICS
GENERAL FEATURES OF LOCAL ANESTHETICS
Mechanism of action of local anesthetics
Blockade of voltage dependent sodium

channels, binds to both open and
inactivated sodium channels, slowing of
axonal impulse conduction, increase in
membrane refractory period
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LOCAL ANESTHETICS
ANESTHESIOLOGY
Features of local anesthesia
Speed of onset of local anesthesia is related
to
Duration of onset of local anesthetic is
related to
Potency of local anesthetic is related to
Mechanism of action of local anesthetics
Local anesthetic
Local anesthetic
Amide local anesthetic NOT metabolized by

EMLA
EMLA
EMLA is NOT appropriate for
Anesthetic with vasoconstrictor is contraindicated in
Long acting local anesthetics
Local anesthetics acting more than 2 hours
NOT a cause of postoperative numbness and
paresthesia after fracture forearm reduction
Local anesthesia contraindicated in Porphyria
Paraplegia is associated with Intradural administration
of
Local anesthetic most likely to provide allergic reaction
Anesthetic agent with longer duration of action
Benzocaine
Used for topical administration only
Longest acting local anesthetic
Contraindicated in Neonates
Local anesthetic ineffective topically
Fibers first blocked in Local Anesthesia
Local anesthetics act by
Sequence of recovery from Local anesthesia
Dibucaine test detects
Earliest sensation lost in local anesthesia
Nerve fibers affected by local anesthesia first
Susceptibility to Local Anesthetic
Order of sensitivity of nerve fibres to local anesthesia in
decreasing order
Amide like local anesthetics
Sodium bicarbonate with local anesthetic
Route in which absorption of local anesthetic is
maximum
Local anesthesia cannot be used at site of infection
Blockade of nerve conduction by local anesthetic is
characterized by
Most potent and longest acting anesthetic agent
Mechanism of action of local anesthetics is that they act
on Na+ channels in their
Low kA, fastest action

pkA
Protein binding
Lipid solubility
Stabilization of membrane
Inhibits generation of action potential, toxicity reduced
by addition of vasoconstrictor
Duration depends on protein binding, potency depends
on lipid solubility, low pKa is more active, higher dose
produce more block, signal transduction blockade
Cholinesterase
Mixture of local anesthetics used in children
Xylocaine with prilocaine (5% + 5%)
Laceration repair
Finger block
Bupivacaine, etidocaine, dibucaine, tetracaine
Bupivacaine, etidocaine
Systemic toxicity of local anesthesia
Ropivicaine
Chlorprocaine
Benzocaine
Benzocaine
20%
Benzocaine
Tetracaine
Mepivacaine
Mepivacaine
Autonomic Nervous System (Preganglionic sympathetic)
Inhibiting Sodium Pump
Preganglionic sympathetic, Proprioception, Motor
Percentage inhibition of Pseudocholinesterase activity
Cold sensation
Type C
C>B>A
Preganglionic sympathetic B, Pain C and A-delta,
sensory, motor
Lignocaine, bupivacaine, mepivacaine
Increases speed and quality of anesthesia
Interpleural >Intercostals
Spread of infection, Lowered efficacy
Need to cross the cell membrane to produce the block
Dibucaine
Activated state
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LOCAL ANESTHETICS
ANESTHESIOLOGY
Local anesthetics
Allergic reaction causing local anesthetics
Local anesthesia having highest protein
binding capacity
Block release of sodium into cell

Ester linked drugs
Tetracaine
BUPIVACAINE
Topical use of local anesthetic NOT required
Most cardiotoxic local anesthetic
NOT used topically
Concentration of Bupivacaine used in Spinal anesthesia
Cardiac Resuscitation Toughest
Contraindicated in Regional IV Anesthesia
Anesthetic drug hazardous if used in Biers block
Anesthetic agent for spinal / epidural anesthesia
Maximum dose of Bupivacaine
Levobupivacaine is administered
NOT true about bupivacaine
Treatment of bupivacaine toxicity
Treatment of Bupivacaine induced Arrhythmia
Treatment of hypothermia induced
arrhythmia
Treatment of Bupivacaine Induced Cardiac Toxicity
Bupivacaine poisoning treated with
Bupivacaine
Bupivacaine
Bupivacaine
Bupivacaine
0.5 %
Bupivacaine
Bupivacaine
Bupivacaine
Bupivacaine
3 mg/Kg
Intrathecally, epidurally
Cause methemoglobinemia
Epinephrine, benzodiazepine, isoproternol, bretylium
Bretylium
Bretylium
Rapid Bolus of 20% Intralipid 1.5 ml/Kg
(Weinberg Recommendation)
Esmolol, Sotalol, Diazepam
Must never be injected into a vein, More cardiotoxic
than lignocaine, 0.25 percent is effective for sensory
block
LIGNOCAINE
Local anesthesia more safe in surface and
infiltrating anesthesia
Concentrations of lignocaine
Maximum dose of lignocaine as local anesthesia
Lignocaine in high dose cause
Cardiac Resuscitation Easiest
Concentration of lignocaine
Hyperbaric local anesthesia used for Spinal anesthesia
Percentage of Lignocaine used in Spinal anesthesia
Maximum dose of Lignocaine
Recommended infusion rate of Lignocaine in treatment
of Persistent Ventricular fibrillation
DOC Ventricular tachycardia
Lignocaine
1%,2%,4%,5%
500 mg
Convulsion, respiratory depression, hypotension,
cardiac arrest
Lignocaine
5%
5% Xylocaine with dextrose
5%
4.5 mg/Kg (Plain),7 mg/Kg (With Adrenaline)
1 1.5 mg/Kg/min
Lignocaine
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LOCAL ANESTHETICS
ANESTHESIOLOGY
Cardiac or CNS toxicity when standard doses of
lignocaine administered to patient with circulatory
failure because
Adrenaline is added to lignocaine to prolong its effect
and decrease its absorption into blood stream in a ratio
of
Lignocaine is NOT used in
Lignocaine concentration are initially high in relatively

well perfused tissues such as brain and heart
1 in 2,00,000
Convulsions
PRILOCAINE
Safest local anesthetic
First local anesthetic
Associated with methemoglobinemia
Prilocaine concentration
Prilocaine
Prilocaine
Prilocaine
4%
COCAINE
Only local anesthetic associated with hypertension
Ester Linked Metabolised by Liver
Local anesthetic contraindicated with Adrenaline
Local anesthetic first used clinically
Main disadvantage of using cocaine as LA
Cocaine
Cocaine
Cocaine
Cocaine
Epithelial erosions
PROCAINE
Local Anesthesia of choice for Malignant hyperthermia
Anesthetic agent with no surface action
Drug cannot be used for surface anesthesia
First Synthetic Local anesthetic
Shortest acting local anesthetic
Procaine
Procaine
Procaine
Procaine
Procaine
BIERS BLOCK/IVRA
Biers block
NOT used in IVRA for trigger finger
Local Anesthesia used for Biers block
Anesthetic modality contraindicated in sickle cell
anemia
In Biers block, tourniquet cannot be
released before
Intravenous regional block

Lignocaine + ketorolac
Prilocaine
Intravenous regional anesthesia
30 minutes
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LOCAL ANESTHETICS
ANESTHESIOLOGY
PERIBULBAR AND RETROBULBAR BLOCK

Local Anesthesia for retrobulbar block
Last muscle to be rendered akinetic in retrobulbar block
Peribulbar block is given in
Advantage of peribulbar block
Complication of peribulbar block
Prilocaine + Hyaluronidase
Superior oblique
Periorbital space
Reduces the risk of CNS side effects from
intradural injection, usually obviate the
need for 7th cranial nerve anesthesia,
reduce the risk of retrobulbar hemorrhage
Retrobulbar hemorrhage, globe rupture, optic neuritis,
local anesthesia solution can migrate to brain,
vasovagal syncope
STELLATE GANGLION BLOCK

Successful signs of stellate ganglion block
NOT a sign of stellate ganglion block
ICU, invasive monitoring, intraarterial cannula in radial
artery, swelling and discoloration of right hand. Next
step
Nasal stuffiness, Guttman sign, Horner syndrome

Exophthalmos, Bradycardia
Stellate ganglion block
BRACHIAL PLEXUS BLOCK

In interscalene brachial plexus block, block
is given between
Interscalane approach of brachial plexus block does
NOT provide anesthesia to distribution of
Nerve spared in axillary approach
Pneumothorax is a complication of
Anterior and middle scalene

Ulnar nerve
Musculocutaneous nerve
Brachial plexus block
CELIAC PLEXUS BLOCK

Most common complication of celiac plexus block
MC complication of celiac plexus block
Position best describes celiac trunk
Celiac plexus is located
MC side effect of Celiac Plexus block
Location of celiac plexus
Postural hypotension
Hypotension
Anterolateral to aorta
Anteromedial to lumbar sympathetic chain
Diarrhea and Hypotension
Anterior or anterolateral to aorta
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NEUROMUSCULAR BLOCKERS
ANESTHESIOLOGY
GENERAL FEATURES OF NEUROMUSCULAR BLOCKERS
MC cause of Anaphylactic Reaction
Prejunctional receptors are blocked by
Extrajunctional receptors are blocked by
Drugs increasing neuromuscular blockade
Hypothermia is useful in potentiation of
Intraperitoneal irrigation cause potentiation of curare
effect and results in respiratory distress
Neuromuscular action of curare brought about by
Longest acting Neuromuscular blocker
Muscle relaxant with longest onset of action
Shortest acting neuromuscular blocker
Central muscle relaxants act by
Muscle relaxant having maximum duration of action
Muscle relaxant causing pain on iv injection site
Neostigmine is used for reversing adverse effect of
Train of four is characteristically seen in
Cardiovascular side effects are minimal with
Muscle relaxants
Muscle relaxant with ganglion blocking action
Muscle relaxant acting directly on Muscle
Metabolite of carisoprodol
Features of carisopodol
Metaxolone
Cyclobenzaprine
Baclofen
Least sensitive to muscle relaxant
Post paralytic syndrome
Sugammadex
During anesthesia with muscle relaxants,
vocal cords are in
Rocuronium is inactivated by
Gantacurium is inactivated by
Neuromuscular Blocker
d-tubocurarine
Succinyl choline
Clindamycin, Streptomycin
Neuromuscular block
Kanamycin
Competitive inhibition
Pancuronium
Alcuronium
Mivacurium
Inhibiting spinal polysynaptic reflexes
Doxacurium
Rocuronium
D-tubocurarine + pancuronium
Non depolarising muscle blocker
Rocuronium, doxacurium, vecuronium
Benzodiazepine, Pancuronium, Gallamine
Curare, pancuronium, trimethophan
Dantrolene
Meprobromate
Centrally acting, prodrug of
meprobromate, sedation is common
Centrally acting muscle relaxant
Centrally acting muscle relaxant,
structurally related to TCA, blocks alpha
motor neurons, can be used in whiplash
injuries and fibromyalgia, can cause
aggressive behavior in elderly
Centrally acting muscle relaxant
Diaphragm
Prolonged weakness caused by neuromuscular blockers
Reversal of neuromuscular blocking agent
Mid position
Sugammadex
Cysteine adduction
DEPOLARISING MUSCLE RELAXANTS SUCCINLY CHOLINE

MC anaphylactic Neuromuscular Blocker
Depolarizing muscle relaxant
Succinylcholine
Succinylcholine
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ANESTHESIOLOGY
Succinylcholine NOT contraindicated in
Succinylcholine induced hyperkalemia is associated
with
Depolarizing blockers
Post anesthetic fasciculations
Shortest acting muscle relaxant
Succinylcholine is short acting because of
Completely metabolized
Postoperative muscular pain after use of
Malignant hyperthermia is caused by
Succinyl choline
Train of fasciculation
Muscle relaxant increasing intracranial pressure
A patient with myasthenia gravis who is
managed on oral neostigmine can be
expected to have prolonged response to
Administration of succinylcholine to paraplegic,
appearance of dysrhythmia, conduction abnormalities,
finally cardiac arrest
Extensive soft tissue injury, muscle relaxant that may
lead to cardiac arrest
Treatment of prolonged succinylcholine apnea due to
plasma cholinesterase deficiency
Bradycardia is common after injection of
Succinylcholine apnoea is due to
Condition relatively resistant to muscle relaxation by
suxamethonium
Train of four ratio
Time gap between supramaximal given in
train of four stimuli
Phase II blocker
Muscle relaxant increasing intracranial tension
Contraindication for succinyl choline
Succinylcholine NOT contraindicated in
Administration of succinylcholine in paraplegic cause
Hyperkalemia due to succinylcholine is NOT seen in
Bradycardia is common after injection of
Feature of depolarizing blockade
In pseudocholinesterase deficiency, drug to be used
cautiously is
Pseudocholinesterase
Phase II blockade produced by
Fasciculations with succinyl choline are
first seen over
Scoline asphyxia is due to deficiency of
Shelf Life of Succinyl choline
First treatment for abnormal atypical
Cerebral stroke
Tetanus, Closed head injury, Hepatic failure
Potentiated by isoflurane, cannot be reversed by
neostigmine
Succinylcholine
Succinylcholine
Rapid hydrolysis
Succinylcholine
Succinylcholine
Succinylcholine
No fade on train of four stimulation, no post tetanic
stimulation, train of four ratio >0.4
Scoline
Succinylcholine
Succinyl choline
Hyperkalemia
Succinylcholine
Continue anesthesia and mechanical ventilation till
recovery
Succinyl choline
Decreased pseudocholinesterase
Myasthenia gravis
>0.4
0.5 sec
Scoline
Suxamethonium
Recent burns, recent cerebral stroke,
recent crush injury
Hepatic failure
Dangerous hyperkalemia
Abdominal sepsis
Succinyl choline
Progression to dual blockade
Scoline
Succinylcholine is metabolized by it
Succinyl choline
Eyelids
Pseudocholinesterase
2 years
Continue IPPV
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ANESTHESIOLOGY
pseudocholinesterase
FEATURES OF NON DEPOLARIZING MUSCLE BLOCKERS

Non depolarizing blockade is potentiated by
Action of Non depolarizing muscle relaxants increased
by
Drug depending on total body weight
Long acting non depolarising muscle blocker
Shortest acting Non depolarising muscle blocker
Muscle most resistant to non depolarising block
Non depolarising blockers
Non depolarizing muscle relaxant

AV430A
NOT an amino steroid derivative
Quinidine
Hypothermia, Aminoglycosides, Halogenated
inhalational agents
Succinyl choline
Piperacuronium
Rapacuronium
Diaphragm
Competitive blocker of acetylcholine, Mg++ potentiates
the block, Ca++ antagonises the block, hypothermia
prolongs the block
Ganglion blockade, Histamine release, Interact with
antibodies
Gantacarium, steroidal muscle relaxation,
onset and duration is same as
suxamethonium, can be safely given in
trauma unlike suxamethonium
Alcuronium
D-TUBOCURARINE
Muscle relaxant causing jaundice as an adverse effect
d-tubocurarine acts at
Tubocurarine action is easily reversed by
Antibacterial NOT to be used with d-tubocurarine
Drug used for d tubocurarine reversal
D- tubocurarine
d-tubocurarine acts by
Tubocurare affects which muscle first
Skeletal muscle most sensitive to
tubocurare
Muscle least affected by d-tubocurare
First to recover after muscle relaxants
d-tubocurarine
Myoneural junction
Neostigmine
Streptomycin
Neostigmine
Excreted unchanged in kidney, causes hypotension by
ganglion blocking action, vagolytic action
Inhibiting nicotinic receptors at myoneural junction
Respiratory muscles
Muscles of jaw and larynx
Diaphragm
Diaphragm
PANCURONIUM
Intubation dose of pancuronium
Conscious, alert, voluntary respiratory effort was
limited, BP and Heart rate normal
0.08 mg/kg
Incomplete reversal of pancuronium
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33
ANESTHESIOLOGY
VECURONIUM
Vecuronium
Short duration of neuromuscular block, in usual doses

the dose adjustment is not required to kidney disease,
has high lipophilic property
Low incidence of CVS side effect
Myoneural junction
Vecuronium
Site of action of vecuronium
MIVACURIUM
Mivacurium
Mivacurium
Degraded by Pseudocholinesterase
Shortest acting Non depolarising skeletal muscle
relaxant
Mivacurium
Slow onset of action, short duration of

action
Histamine Release
Mivacurium
Mivacurium
Flushing, bronchospasm, increasing the dose produces
rapid onset of action
ATRACURIUM
Muscle Relaxant in Hepatic Failure
Muscle Relaxant in Renal Failure
Laudonosine is a breakdown product of
Drug excreted by Hoffman elimination
Patient recovered spontaneously from the effect of
muscle relaxant without any reversal
Ideal muscle relaxant for a neonate undergoing
portoenterostomy for biliary atresia
Hypersensitive to neostigmine, elective LSCS under
general anesthesia
NOT eliminated by kidney
Muscle relaxation of choice for operating exstrophy
Cisatracurium preferred over atracurium due to
Seizures after atracurium infusion
Hypersensitive to neostigmine, best muscle relaxant
Drug inactivated in plasma by spontaneous non
enzymatic degradation
Cis atracurium
Cis atracurium
Cisatracurium
Atracurium
Atracurium
Atracurium
Atracurium
Atracurium besylate
Atracurium
No histamine release
Due to accumulation of laudonosine
Atracurium
Atracurium
GALLAMINE
Muscle relaxant contraindicated in renal failure
Mainly excreted by kidney
Muscle relaxant most sensitive to myasthenia gravis
patient
Gallamine
Gallamine
Gallamine
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ANESTHESIOLOGY
SPINAL, EPIDURAL AND CAUDAL ANESTHESIA and pain management
ALCURONIUM
Drug causing anaphylactoid reaction
NOT a synthetic muscle relaxant
Alcuronium
Alcuronium
SPINAL, EPIDURAL AND CAUDAL ANESTHESIA AND PAIN

MANAGEMENT
SPLANCHNIC BLOCK
Naturally employed technique for Splanchnic block
Brauns method
NEURAXIAL BLOCKADE
Contraindications for neuraxial blockade
Neuraxial blockade in NOT contraindicated in
Centrineuraxial (spinal and epidural) anesthesia is NOT
contraindicated in
NOT a contraindication for neuraxial blockade
Patient refusal, coagulopathy, severe hypovolemia,

patient on anticoagulants
Pre existing neurological deficits
Patient on aspirin
Patient on antihypertensive medication
SPINAL ANESTHESIA
First spinal anesthesia
Spinal puncture used to determine
Lumbar puncture is dangerous in
Subarachnoid space ends at
Yellow ligament
Traumatic needle
Atraumatic needle
Deposition of drug in spinal anesthesia
Level of Blockade in Spinal/Epidural anesthesia
Pierced during lumbar puncture
Does NOT pierce lumbar puncture
High spinal anesthesia
Anesthetic block injected for paravertebral block is least
likely to diffuse into
Spinal anesthesia injected into space between
Structures pierced in lumbar spinal puncture
Structure NOT pierced in lumbar
puncture
Augustin Bier
Spinal fluid pressure, types and number of cells present,
protein and sugar levels
Cerebral tumor
S2
Ligamentum flavus
Quincke
Sprotte
Subarachnoid space
T12 L2
Ligamentum flavum, Interspinous ligament,
Supraspinous ligament
Posterior longitudinal ligament
Hypotension and bradycardia
Subarachnoid space
L3-L4
Ligamentum flavum, duramater, supraspinous ligament
Posterior longitudinal ligament
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ANESTHESIOLOGY
Fibre lost first in spinal anesthesia

First blocked in spinal anesthesia
Last affected fibres in spinal anesthesia
Last to recover in spinal anesthesia
Brewer Luckhardt reflex in spinal
anesthesia
Spinal anesthesia
Feature of spinal anesthesia
Spinal anesthesia in children
Paramedian Spinal anesthesia prevents penetration of

Duration of Spinal anesthesia depends on
Post spinal headache due to
Spinal headache is due to
Post spinal headache can last for
Low incidence of post spinal headache with
Post dural puncture headache
Post spinal headache CANNOT be decreased by
Post dural puncture headache is due to
Management of post dural spinal
headache
Sudden aphonia and loss of consciousness during spinal
anesthesia
Best way to prevent hypotension during spinal
anesthesia
MC complication of spinal anesthesia
NOT a management of hypotension during spinal
anesthesia
Management of hypotension due to subarachnoid block
Vasopressor of choice in hypotension produced during

subarachnoid block
NOT a contraindication for Spinal and epidural
anesthesia
Maximum safe dose of lignocaine for spinal anesthesia
Percentage of xylocaine in spinal
anesthesia
Sympathetic
Autonomic preganglionic
Pressure
Preganglionic autonomic
Reflex hypotension due to pooling in
spinal anesthesia
Decline in cardiac output may occur following pooling
of blood in post arteriolar vessels
Autonomic level is 2 segments higher than
sensory which is 2 segments higher than
motor
Can be given at any age, should be given
in lower space, preloading is not required
in children, chances of systemic toxicity is
high
Supraspinous and Interspinous ligament
Site of Injection, Quantity of drug injected, Type of drug
used
CSF leak
Decreased CSF pressure
7 days
Thin needle
Small bore needle prevents it, occurs immediately after
spinal anesthesia, occurs due to low CSF pressure
Supplement of fluids
Seepage of CSF
Extradural autologous blood
Vasovagal attack
Preloading with crystalloids
Hypotension
Lowering head end
Administration of 1 L ringer lactate before block,
vasopressor drug like methoxamine, use of inotropics
like dopamine
Ephedrine
Hypertension
25 100 mg
5%
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ANESTHESIOLOGY
EPIDURAL ANESTHESIA
Analgesia of choice in a pregnant woman with a cardiac
disease for LSCS
Epidural space lies between
Site of action of epidural anesthesia
Touchy needle is for
Methods of epidural anesthesia
In epidural anesthesia, features suggesting

that the needle is in epidural space
Walking epidural
Epidural anesthesia is preferred over Spinal anesthesia
NOT a contraindication for epidural
anesthesia
Epidural anesthesia is NOT indicated in
Complication of Epidural anesthesia
NOT a complication of epidural anesthesia
Does NOT increase ADH output
During epidural anesthesia, sudden hypotension is due
to
Epidural narcotic preferred over epidural LA because
Drug used for epidural analgesia
Epidural anesthesia in pregnancy
Anesthetic of choice in epidural anesthesia during
labour
Epidural opioids
Epidural anesthesia
Treatment of broken epidural catheter
Epidural Anesthesia
Dura and vertebral column
Substantia gelatinosa
Epidural anesthesia
Loss of resistance technique, hanging drop
technique Gutierrzers sign (sudden
sucking of drop in epidural space),
Durants sign rapid injection of drug in
epidural space causes increase in rate and
depth of respiration, Westpal sign
absence of knee jerk after epidural
anesthesia
Loss of resistance sign, negative pressure
sign, mackintosh extradural space
indicator
Ultra low dose epidural used especially for
labor
Dura is NOT penetrated
Previous MI
Patients with hypovolemia
Total Spinous analgesia
DIC
Headache
Epidural and spinal anesthesia
Drug has entered subarachnoid space
No motor paralysis
Morphine, Fentanyl
Decrease venous return, venous pooling
Bupivacaine
Hypertension
Acts on dorsal horn substantia gelatinosa, may cause
pruritis, may cause respiratory depression
Contraindicated in coagulopathies, venous return
decreases
Can be left in situ
CAUDAL ANESTHESIA
Caudal block is a kind of
Caudal block is commonly used in
Epidural block
Children
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PAIN
ANESTHESIOLOGY
LSCS should NOT be carried out under
Drug NOT given in central neuraxial
block or caudal block
Caudal anesthesia
Remifentanyl
OTHER BLOCKS
A 20 year old boxer sustains a lip
laceration during a practice match, the
wound is complex and crosses the
vermilion border. Best way to achieve
anesthesia
Site of phrenic nerve block
Site of block in thyroid surgery
Approach for inferior alveolar nerve block
Nerves blocked in ankle block

Block for injury at medial aspect of foot
Advantages of ilioinginal block for
inguinal hernia
Mental nerve block
3 cm above clavicle at the posterior border

of sternomastoid
Upper cervical ganglion
Approached lateral to pterygomandibular
raphe between buccinator and superior
constrictor
Superficial peroneal nerve, deep peroneal
nerve, saphenous nerve
Posterior tibial nerve
Postoperative analgesia, allows
maneuvers, avoid hypotension, no risk of
GA
PAIN
GENERAL FEATURES OF PAIN
Visceral pain
NOT a feature of visceral pain
Perception of ordinary non noxious stimuli as pain
WHO 3 step ladder is used in management of
Transcutaneous nerve stimulation to control pain by
Neurochemical mechanism of analgesia
Poor localization, Diffuse in nature, High threshold

Very rapid adaptation
Allodynia
Pain
Gateway theory of pain
VR-1, Nicotinic cholinergic, Nociception pattern,
Anandamide
ASSESSMENT OF PAIN
Pain rating index provided by
Best scale to measure pain in children of 5 years of age
Visual analogue scale most widely used to measure
CHEOPS for post operative pain in children. NOT include
McGill questionnaire
CHEOPS
Pain intensity
Oxygen saturation
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38
PAIN
ANESTHESIOLOGY
ANALGESIC DRUGS
Shortest acting intravenous analgesic
Remifentanyl is more potent than
Narcotic of choice for outpatient anesthesia
Analgesic property
Least analgesic
Post thoracotomy pain managed by
Management of chronic pain
Drug of choice for controlling severe pain in cancer

patients
More analgesic effect than morphine
Analgesic suited for hemodynamically unstable patients
Fentanyl
Least likely to cause hypotension at
standard dose
Most potent analgesic
Most potent synthetic opioid
Pain during thoracotomy
Drug for OPD analgesia
Ketorolac
Ketorolac tromethamine is useful as
Tolerant to morphine, Pain management by
Longest acting analgesic in postoperative pain
Percentage of Sucrose for Analgesia
Effective and safe drug for intractable pain in terminal
cancer stage
Analgesic effect is not mediated by opioid
receptors in
Flupirtine
Treatment for severe pain after thoracotomy
Patient controlled anesthesia
Effect of chilling in refridgeration
anesthesia
Remifentanil
Alfentanyl
Alfentanyl
Ketamine, nitrous oxide
Halothane
IV fentanyl
Intrathecal hyperbaric phenol, anterolateral cordotomy,
epidural fentanyl, patient controlled analgesia,
anticonvulsant drugs
Morphine
Heroin
Fentanyl
Rapid onset and shortest duration of
action
Fentanyl
Sulfentanyl
Sulfentanyl
IV fentanyl
Alfentanyl
Its analgesic efficacy is equal to morphine in
postoperative pain
Non narcotic non steroidal
Fentanyl
Opioids
12 50%
Oral morphine
Nefopam
Non opioid analgesic
Intercostal cryoanalgesia
Can be given epidurally, intravenously,
suitable for children
Interference with conduction of nerve
impulse, reduction of metabolic rate and
oxygen requirement, inhibition of
bacterial growth and infection
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39

Anesthesiology Instruments and Monitoring Guide

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Anesthesiology Instruments and Monitoring Guide

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ANESTHESIOLOGY

ANESTHESIA IN HEAD INJURY ................................................................................................................................. 15

Constant pressure, variable orifice, flow meter for gases

Filling ratio is the weight of the fluid in

Color of oxygen cylinder

CO2, N20, cyclopropane

ANESTHETIC MACHINES AND CIRCUITS

Cylinder is a part of high pressure system, O2 flush

NOT suited for both controlled and assisted ventilation

Mapleson system used in children

Equal to minute volume

OXYGEN CONTROL DEVICES

Bourdon pressure gauge

Oxygen given during anesthesia to prevent

Link 25 Proportion Limiting system(Datex Ohmeta

DEVICES FOR CO2 ABSORPTION

30% of tidal ventilation

Atropine, Halothane, Inspiration

LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

Endotracheal intubation in children

Stenosis, Ulceration, Abductor paralysis

Grillo or Barclay procedure

Good oral hygiene

LARYNGEAL MASK AIRWAY

Laryngeal mask airway

GENERAL FEATURES OF MONITORING DURING ANESTHESIA

CENTRAL VENOUS PRESSURE MONITORING

Right Internal Jugular Vein

PULMONARY ARTERY CATHETER

Pulmonary wedge pressure is indirectly

PCWP, mixed venous oxygen saturation, Right atrial

Obstruction of respiration in comatose patients is

Bacteremia, Increased mucosal bleeding, laryngospasm

Treatment of malignant hyperthermia

INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS

Test for quality assurance, medicolegal purposes,

Morphine, Thiopentone, Halothane

Exact order of CPR

Aspiration of gastric contents

Hyperpyrexia, prolonged surgeries

Loss of consciousness to beginning of spontaneous

Smoking should be stopped

Important drug to be stopped before

1 day before surgery

Inhalational > intravenous

Induction with intravenous suxamethonium and N2O

ANESTHESIA IN HEAD INJURY

Increased lumbar lordosis

Combined spinal and epidural

DAY CARE ANESTHESIA

Propofol, fentanyl, isoflurane

To make anesthesia pleasant and safe

GENERAL FEATURES OF ANESTHETIC DRUGS

Most important monitoring during

Calcium channel blockers, beta blockers,

Alpha 2 agonist, anxiolytic, hypnotic, used

1.5 times more

GENERAL FEATURES OF INHALATIONAL ANESTHETICS

Anesthesia for mitral stenosis with liver failure

Non explosive, minimum cardiovascular side effects,

Nitrous oxide and halothane

Bone marrow suppression, Megaloblastic anaemia,

Bone marrow depression after prolonged