1

An 8-year-old (24 kg) child sustains 40% burns to the trunk and both arms in a shack fire a) He is booked for a sloughectomy of the wounds on day 2 after the burn injury. Discuss your pre-operative approach to this case under the headings i) History, Examination, Special Investigations, Optimisation and Premedication. (30) b) Discuss your Anaesthetic plan under the following headings i) Specific Anaesthetic considerations in burns patients. (10) ii) Intra-operative plan. (Include all drug dosages). (30) iii) Postoperative plan. (10) c) Having completed the sloughectomy of both arms and the anterior chest wall, the Surgeon decides he needs to turn the child prone and debride the posterior chest wall as well. List the considerations and possible complications of turning the child prone and doing further debridement. (20) [100] n 8-Jarige kind (24 kg) het 40% brandwonde aan die lyf en albei arms opgedoen in n plakkershuisbrand. a) Hy is bespreek vir n debridement van die wonde op dag 2 na die brand. Bespreek jou pre-operatiewe benadering tot hierdie geval onder die volgende hoofde i) Geskiedenis, Ondersoek, Spesiale Ondersoeke, Optimalisering en Premedikasie.(30) b) Bespreek jou narkoseplan onder die volgende hoofde i) Spesifieke narkose-oorwegings in brandwondpasinte. (10) ii) Intra-operatiewe plan (gee alle middeldoserings). (30) iii) Post-operatiewe plan. (10) c) Nadat die debridement van die anterior borskaswand en beide arms voltooi is, besluit die chirurg dat hy die kind nou wil omdraai om die posterior borskaswand te debrideer. Lys die oorwegings en moontlike komplikasies om die kind in die maagliggende posisie te plaas vir verdere debridement (20) [100] Physiology a) Briefly list the physiological changes that occur when changing a patient from a supine to lithotomy position under general anaesthetic. (5) b) Describe succinctly, in physiological terms, the short term, intermediate and long term factors which may influence mean arterial pressure (MAP). (10) c) A 23-year-old woman presents for elective caesarian section. You perform a spinal anaesthetic with 2,2ml 0,5% Macaine with dextrose plus 10g fentanyl and then lie her supine. Within 3 min, she has a sensory level to cold at T6, a BP of 70/45 and a pulse rate of 95. Explain the change in her BP. (5) d) A 17-year-old man has been stabbed in the abdomen. His pulse rate is 128, BP 106/53 and Hb 7g%. A junior colleague induces him with 100g fentanyl, 180mg propfol and 100mg suxamethonium. 2 min later, his BP is 60/23. Explain the change in his BP. (5) [25] Fisiologie a) Lys kortliks die fisiologiese veranderinge wat plaasvind wanneer n pasint vanaf n liggende na lithotomie posisie verander word onder algemene narkose. (5) b) Beskryf kortliks, in fisiologiese terme, die kort, medium en lang termyn faktore wat gemiddelde arterile druk (Engels: MAP) benvloed. (10) c) n 23-Jarige vrou presenteer vir n elektiewe kuisersnit. Jy voer n spinale narkose uit met 2,2ml 0,5% Macaine met dextrose plus 10g fentanyl en laat haar op haar rug l. Binne 3 min het sy n sensoriese vlak vir koue tot by T6, n bloeddruk van 70/45 en n pols van 95. Verduidelik die verandering in bloeddruk. (5) d) n 17-Jarige man was gesteek in die buik. Sy pols is 128, bloeddruk is 106/53 en Hb is 7g%. n Junior kollega induseer hom met 100g fentanyl, 180mg propfol en 100mg suxamethonium. 2 Minute later is sy bloeddruk 60/23. Verduidelik die verandering in bloeddruk. (5) [25] Pharmacology

2.1

2.1

2.2

Anti- Emetics a) Why does Droperidol (Inapsin) have a Black Box warning by the F.D.A.? (1) b) How will you treat the complication of Droperidol mentioned in (a)? (1) c) What is a safe anti-emetic dose of Droperidol? (1) d) List three other complications of this group of drugs. (3) e) List four other drugs from different groups that can be used as prophylaxis against postop nausea and vomiting and give the receptors on which they act. (4) f) IVI induction agents Tabulate the properties of 3 intravenous induction agents under the following headings i) Intravenous induction dose. ii) Onset of action. iii) Receptors affected. iv) Cardiovascular system effects. v) Respiratory system effects. vi) Central nervous system effects. vii) Advantages. viii) Disadvantages. (15) [25] Farmakologie Anti-Emetika a) Vir watter rede is daar n Black Box waarskuwing deur die F.D.A. uitgereik vir Droperidol (Inapsin)? (1) b) Hoe sal jy die komplikasie van Droperidol soos genoem in (a) behandel? (1) c) Wat is die veilige anti-emetiese dosis van Droperidol? (1) d) Lys nog drie ander komplikasies van hierdie groep middels. (3) e) Lys nog vier ander middels van verskillende groepe wat gebruik kan word om post-op naarheid en braking te voorkom en die reseptore waarop hulle werk. (4) Intraveneuse Induksiemiddels f) Tabuleer die eienskappe van 3 intraveneuse induksiemiddels onder die volgende opskrifte i) Intraveneuse induksie dosis. ii) Aanvang van werking. iii) Reseptor benvloed. iv) Kardiovaskulre sisteem effekte. v) Respiratoriese sisteem effekte. vi) Sentrale senuwees stelsel effekte. vii) Voordele. viii) Nadele. (15) [25] 2.3 Physics a) Explain how you differentiate between depolarising and non-depolarising muscle relaxation using the nerve stimulator? (6) b) Besides monitoring muscle relaxation, what other indication is the nerve stimulator used for in anaesthesia? What adjustments must be made on the device or the technique of use for it to be safe and effective in this situation? (4) c) Describe briefly how a pulse oximeter works. (5) d) List 4 factors that may influence an accurate reading of the pulse oximeter. (2) e) What is the reason for the gradient between arterial CO2 and the end tidal CO2? Give two conditions that can cause an increase in the gradient. (4) f) Name the two types of capnographs commonly used in anaesthesia and name one disadvatage to each method. (4) [25] Fisika

2.2

2.3

a) Verduidelik hoe u sal onderskei tussen depolariserende en nie-depolariserende spierverslapping deur n senuweestimulator te gebruik. (6) b) Behalwe monitering van spierverslapping, watter ander gebruik is daar vir die senuweestimulator gedurende narkose? Watter veranderings moet gemaak word op die stimulator, of die tegniek van gebruik, om dit veilig en effektief te maak in hierdie situasie? (4) c) Verduidelik kortliks hoe n polsoksimeter werk. (5) d) Lys 4 faktore wat die akkuraatheid van die polsoksimeter kan benvloed. (2) e) Wat is die rede vir die gradint tussen die arterile CO2 en die eind-gety CO2 (ETCO2). Noem twee toestande wat n toename in die gradint sal veroorsaak.(4) f) Noem die twee tipe kapnograwe wat algemeen gebruik word in narkose en noem n nadeel van elk. (4) [25] 2.4 Procedure / Laboratory i) A poly-trauma patient is brought to theatre for emergency laparotomy and internal fixation of a fractured femur. You want to insert an arterial line. a) Briefly describe Allens Test for the collateral blood supply of the hand. (3) b) There is a dampened curve on the monitor. What can be the reasons? (3) c) List three complications of this procedure. (3) d) The delta down reading of the systolic pressure is 8 mmHg. How will you use that to aid your haemodynamic management? (2) A 65-year-old type 2 diabetic is booked for emergency laparotomy for septic abdomen due to diverticular abscess rupture. He vomited for 2 days and appears confused and dehydrated. He weighs 85kg. The laboratory results read as follows Sodium 154 mmol/l Potassium 2,9 mmol/l Urea 17 mmol/l Creatinine 152 mmol/l Random glucose 18 mmol/l a) Calculate the patients osmolarity. (1) b) Using BUN(Blood urea)/Creatinine, and Urine Na, how can you differentiate acute pre-renal from acute intra-renal failure? (4) c) Give a formula to correct the Potassium. (1) d) What are the clinical signs of severe hypernatremia. (4) e) What are the causes of hypernatremia? (4) [25]

ii)

2.4

Prosedure / Laboratorium i) n Poli-trauma pasint word teater toe gebring vir n nood laparotomie en interne fiksasie van femurfraktuur. Jy wil n arterile lyn insit. a) Beskryf kortliks Allen se toets vir die kollaterale sirkulasie van die hand. (3) b) Daar is n gedempte kurwe op die monitor. Wat kan die redes wees? (3) c) Lys drie komplikasies van die prosedure. (3) d) Die delta-af (delta down) lesing van die sistoliese druk is 8 mmHg. Hoe sal jy dit gebruik om te help met die hemodinamiese hantering van die pasint? (2) ii) n 65-Jarige tipe 2 diabeet word bespreek vir nood laparotomie vir septiese buik weens die ruptuur van divertikulre abses. Hy het vir twee dae gebraak en kom verward en gedehidreerd voor. Hy weeg 85kg. Die laboratorium uitslae is as volg: Natrium 154 mmol/l Kalium 2,9 mmol/l Ureum 17 mmol/l Kreatinien 152 mmol/l Lukraak glukose 18 mmol/l a) Bereken die pasint se osmolariteit. (1)

b) Hoe kan jy die BUN(bloed ureum)/Kreatinien en urine Na gebruik om te onderskei tussen akute pre-renale en akute intra-renale nierversaking? (4) c) Gee die formule om die Kalium te korrigeer. (1) d) Wat is die kliniese tekens van erge hipernatremie? (4) e) Wat is die oorsake van hipernatremie? (4) [25] Clinical Scenarios Question 1 Scenario 1.1 a) A 55-year-old male with a BMI (body mass index) of 38 is undergoing an anterior resection for colon cancer. Twenty minutes into the procedure, you notice that his oxygen saturation is falling and is now 86% despite an FIO2 (inspired oxygen) of 0.5. i) How do you classify obesity? (5) ii) Briefly discuss the anaesthetic implications of obesity. (10) iii) What actions can you take to improve his oxygenation? (5) 24 hours post surgery; you are called to high care to see him. He has been given intramuscular morphine, 2 hourly overnight. He is hypoxic with saturation of 87% on room air. His respiratory rate is 8/min. What is your differential diagnosis and action plan for him? (5) [25]

b) c)

Senario 1.1 a) n 55-Jarige man met n BMI van 38 ondergaan n anterior reseksie vir kolon kanker. Na twintig minute let jy op dat sy suurstof saturasie begin daal en ten spyte van n FiO2 (ingasemde suurstof fraksie) van 0.5 is die saturasie nou 86%. i) Hoe klasifiseer jy obesiteit? (5) ii) Bespreek kortliks die narkose implikasies van obesiteit. (10) iii) Watter aksies kan jy neem om sy oksigenasie te verbeter? (5) 24 Uur na die operasie word jy na hosorg geroep om die pasint te sien. Hy het oornag 2 uurlikse intramuskulre dosisse van morfien ontvang. Tans is hy hipoksies met saturasies van 86% op kamerlug en n asemhalingspoed van 8/min. Wat is jou diffirensile diagnose en plan van aksie vir hom? (5) [25]

b) c)

Scenario 1.2 A 35-year-old P4 patient has just been referred to your hospital for a bilateral tubal ligation. She had a normal vaginal delivery at a district hospital 24 hours ago. a) Discuss your peri-operative management under the following headings i) Pre-operative assessment and investigations (give reasons for each test). (6) ii) Would you choose a spinal or general anaesthetic and give reasons for your choice. (2) iii) Give a brief description of your anaesthetic technique for a GA. (12) iv) Give your postoperative analgesia and fluid regime. Be specific about drugs and dosages. (5) [25] Senario 1.2 n 35-Jarige P4 pasint word na jou hospital verwys vir bilaterale afbinding van haar falopiusbuise (tubal ligation). Sy het 24 uur tevore normaal vaginaal gekraam in n distrikshospitaal. a) Bespreek jou peri-operatiewe hantering onder die volgende opskrifte i) Pre-operatiewe kliniese ondersoek en spesile ondersoeke (gee redes vir elke toets). (6) ii) Sal jy spinale of algemene narkose vir die pasient doen? Gee redes vir u keuse. (2) iii) Beskruif kortliks jou narkose tegniek vir algemene narkose in hierdie pasint. (12) iv) Wat is jou plan vir post-operatiewe vog en pynverligting? Wees spesifiek met betreking tot middels en dossise. (5)

[25] Scenario 1.3 A 65-year-old man is scheduled for a TURP (Transuretral Resection of the Prostate) for bladder outlet obstruction. He is a smoker with a smoking history of 40 pack years. a) Name the most important preoperative investigations you will request for this patient and specifically name the objectives for each investigation. (7) b) Which factors would influence your choice of anaesthesia in this case? (5) c) Twenty minutes after the start of the procedure, the patient becomes restless, hypotensive, diaphoretic and dyspnoeic. What is your differential diagnosis at this stage? (3) d) Shortly afterwards, the patient become confused and develops arrhythmias and a low oxygen saturation. A blood gas is taken with the following results pH 7.32 pO2 67mmHg pCO2 34mmHg HCO3- 21 mmHg Hb 10.9 Na+ 118mmol/L K+ 3,7mmol/L Ca2+ 1.2mmmol/L Glc 8.0 mmol/L Lactate 3.25 mmol/L e) f) i) What is the most probable diagnosis now? Explain the cause of this syndrome. Which precautions can be taken to prevent this syndrome? Briefly state how is this syndrome treated? (4) (2) (4) [25]

Senario 1.3 n 65-Jarige man is geskeduleer vir n TURP (Transuretrale Reseksie vd Prostaat) vir blaasuitgang obstruksie. Hy is n roker met `n rookgeskiedenis van 40 pakjare. a) Noem die belangrikste pre-operatiewe ondersoeke wat jy vir hierdie pasint sal aanvra en noem spesifiek die doelwit met elke ondersoek. (7) b) Watter faktore sal jou keuse van narkose in hierdie geval benvloed? (5) c) Twintig minute na die aanvang van die prosedure ontwikkel die pasint rusteloosheid, hipotensie, sweterigheid en dispnee. Wat is jou differensile diagnose op hierdie stadium? (3) d) Kort hierna word die pasint deurmekaar en ontwikkel aritmie en n lae suurstof saturasie. n Bloedgas word geneem en toon die volgende resultate pH 7.32 pO2 67mmHg pCO2 34mmHg HCO321 mmHg Hb 10.9 Na+ 118mmol/L K+ 3,7mmol/L Ca2+ 1.2mmmol/L Glc 8.0 mmol/L Laktaat 3.25 mmol/L e) f) i) Wat is u diagnose nou? Verduidelik die oorsaak van hierdie sindroom. Watter voorsorgmaatrels kan getref word om hierdie sindroom te voorkom? Noem kortliks hoe die sindroom behandel word? (4) (2) (4) [25]

Scenario 1.4

An HIV positive patient with severe pre-eclampsia and abruptio-placenta is booked for emergency caesarian section. The obstetricians would like to do an urgent caesarean section. Her laboratory results read as follows Hemoglobin 7,6 g/dl Platelet count 80 x 109/l Bleeding time 9 min PT 24 sec PTT 45 sec a) Describe your intra-operative anaesthetic approach to this patient, starting with induction and anaesthetic technique for this patient. Be specific about drug dosages and intra-operative fluid management and resuscitation. [25]

Scenario 1.4 n MIV positiewe pasint met erge pre-eklampsie en abruptio word bespreek vir nood keisersnit. Haar laboratorium uitslae is as volg Hemoglobien 7,6 g/dl Plaatjietelling 80 x 10 9 /l Bleeding time 9 min PT 24 sec PTT 45 sec a) Beskryf jou intra-operatiewe narkose benadering tot hierdie pasint. Begin met induksie van narkose en narkose tegniek vir die pasint. Wees spesifiek oor middels, dosisse en intraoperatiewe vog behandeling en resussitasie. [25]

Question 2 2.1 2.2 List 5 recovery room discharge criteria. (5)

Within 1 minute of starting to administer Cephazolin to a patient they develop the following symptoms Bronchospasm. Erythematous rash. Hypotention. Some airway oedema. i) List your treatment plan. (5) You are doing a supraclavicular brachial plexus block, with bupivacaine, on a 80 year old lady. What are the signs and symptoms you are going to look out for to diagnose possible bupivacaine toxicity? (5) List the factors and drugs used during premedication or anaesthesia, which may increase the risk of post-operative nausea and vomiting (PONV)? (5) On emergence from anaesthesia for a breast abscess (with face mask or classic LMA) the patient starts to vomit List your actions. (5) You have an 82-year-old lady on the table for a ORIF fractured neck of femur. She was found at home with a possible 24 hours nil by mouth history. List the physical signs are you going to look for to evaluate her level of dehydration. (5) A 70-year-old patient does not want to wake up after a general anaesthetic list your differential diagnosis. (5) Give at least 5 clinical signs of diabetic autonomic neuropathy. (5)

2.3

2.4 2.5 2.6

2.7 2.8 2.9

List at least 5 contraindications to doing a caudal regional block in a 6 year old for bilateral inguinal hernia repair. (5)

2.10 2.11

A 23 kg child who has been Nil by mouth for 10 hours comes for a circumcision. What is his fluid deficit? (show your equation) (5) State if the following are True or False a) Sodium Thiopentone is an ultra-short acting oxy-barbiturate. b) Methohexital is safe in variegate porphyria. c) Propofol contains egg phosphatide. d) Etomidate suppresses 12- hydroxylase. e) Midazolam binds to GABA-receptors. Regarding Dexmedetomidine- write one sentence under each of the following headings a) Mechanism of action. b) Clinical use. c) Side-effects. d) Dosage. e) Drug interactions. (1) (1) (1) (1) (1) [5] (1) (1) (1) (1) (1) [5]

2.12

2.13

A 65-year-old woman undergoes a laparotomy for bowel obstruction. Before induction the examination of her cardiovascular system was normal. Halfway through the operation her heart rate suddenly increased to 135/minute and palpation of the pulse reveals a pulse that is irregular in rhythm as well as in volume. a) What do we call this dysrhythmia? (1) b) What changes do you expect to see on the ECG on the monitor? (1) c) What change do you expect to see on the CVP curve? (1) d) What is your immediate treatment if the blood pressure drops to 60/30? (2) [5] A 4-year-old child undergoes strabismus repair. 15 minutes into the surgery, the heart rate decreases to 50 beats per minute. a) What is the most likely cause of the bradycardia? (1) b) Which nerves are involved. (2) c) How do you manage this problem? (2) [5] State the drug and dosage that you will administer to a 10 kg child in each of the following circumstances a) Cardiac arrest. (1.5) b) Bradycardia. (1) c) Laryngospasm with complete obstruction. (1.5) d) Reversal of non-depolarising muscle relaxant. (1) [5] Briefly describe the following scores a) Mallampati II. b) Cormack/Lehane II. c) ASA II. d) ASA IIE. e) ASA VI. (1) (1) (1) (1) (1) (5)

2.14

2.15

2.16

2.17

Indicate whether you will expect an increase (), decrease () or no effect () in each of the following parameters during a sevofluorane anaesthetic a) Liver blood flow. (1) b) Nondepolarising blockade. (1) c) Intracranial pressure. (1) d) Respiratory rate (spontaneous breathing). (1) e) Cardiac output. (1) (5)

2.18

Name the drug and initial dose, used to treat the following a) Malignant hyperthermia. b) Midazolam overdose. c) Acute attack of porphyria. d) Pethidine overdose. Draw the expected capnogram in each of the following instances a) Malignant hyperthermia. b) Sudden cardiac arrest. c) Endobronchial intubation. d) Bronchospasm. e) Depleted sodalime.

(2) (1) (1) (1) [5] (1) (1) (1) (1) (1) [5]

2.19

2.20 In terms of the muscle relaxants, choose a drug from the list in column B that bests fits the description in column A Column A 1 Nondepolarising drug contra-indicated in uxamethonium apnoea 2 Metabolites may cause convulsions 3 Hoffman elimination 4 Vagolytic 5 Masseter spasm 6. Inhibition of noradrenalin re-uptake at nerve endings 7. No cardiovascular effects 8 Myalgia 9 Freeze-dried powder 2.1 2.2 Maak n lys van 5 herstelkamer ontslaan kriteria. Column B a). Suxamethonium b). vecuronium c). pancuronium d). atracurium e). Mivacurium

[5] (5)

Met toedienning (binne 1 minuut) van Cefazolien, ontwikkel n pasint die volgende sintome Bronkospasma. Eritemateuse veluitslag. Hipotensie. Lugweg edeem. i) Noem kortliks hoe jy die pasint sal behandel. (5) Jy doen n supraklavikulre bragiale pleksus-blok met bupivikaen op n 80-Jarige vrou. Wat is die tekens en simptome waarvoor jy gaan uitkyk om die moontlikheid van bupivikaen toksisiteit te diagnoseer? (5) Lys die faktore en die middels wat kan gebruik word vir premedikasie en narkose, wat die risiko van na-operatiewe braking en naarheid (PONV) kan verhoog. (5) Met herstel van narkose vir n bors abses (toegedien met n gesigsmasker of Classic LMA), begin die pasint braak. Lys jou aksies. (5) Jy gee narkose vir n 82-Jarige vrou vir n reduksie en interne fiksasie van n femurnek fraktuur. Sy is by die huis gevind met n moontlike 24 uur gesiedenis van nil per os. Lys die fisiese tekens en simptome waarna jy gaan kyk om haar vog toestand te evalueer. (5) n 70-Jarige pasint wil nie wakker word na n algemene narkose nie. Lys jou differensile diagnose. (5) Gee ten minste 5 klieniese tekens van diabetiese outonome neuropatie. (5)

2.3

2.4 2.5 2.6

2.7 2.8 2.9

Lys ten minste 5 kontra-indikasies om n koudale epidurale blok te doen vir n 6-Jarige kind wat kom vir n bilaterale inguinale breuk operasie. (5)

2.10 2.11

n 23kg kind, wat 10 uur nil per os is, kom vir n besnydenis (engels circumcision). What is sy vog agterstand? (Wys hoe jy dit uitwerk). (5) Is die volgende Waar of Onwaar a) Natrium Tiopentoon is n ultrakortwerkende oxy-barbituraat. b) Metoheksitoon (Methohexital) is veilig in pophyria variegata. c) Propofol bevat eier fosfatiede (egg phosphatide). d) Etomidaat onderdruk 12- hidroksilase. e) Midasolam bind met die GABA-reseptor. Met betrekking tot Dexmedetomidine skryf een sin onder die volgende hoofde a) Meganisme van aksie b) Klieniese gebruik. c) Newe-effekte. d) Dosering. e) Middel-interaksies. (1) (1) (1) (1) (1) [5] (1) (1) (1) (1) (1) [5]

2.12

2.13

n 65-Jarige vrou ondergaan n laprotomie vir derm obstruksie. Voor induksie was haar kardiovaskulre ondersoek normaal. Halfpad deur die operasie styg haar polsslag skielik tot 135/minuut. Jy voel die pols en dit wys n oneweredige ritme en volume. a) Wat noem ons die arritmie? (1) b) Watter veranderinge verwag jy van die EKG op die monitor? (1) c) Watter veranderinge verwag jy in die SVD (CVP) kurwe? (1) d) Wat is jou onmiddelike behandeling indien die bloeddruk daal tot 60/30? (2) [5] n 4-Jarige kind ondergaan strabisme chirurgie. 15 minuute na aanslag van narkose, daal die polsslag tot 50/minuut. a) Wat is die mees warskynlike oorsaak van die bradikardie? (1) b) Watter senuwees is betrokke? (2) c) Hoe sal jy die probleem hanteer? (2) [5] Noem die middels en dosis wat jy sal toedien vir n 10 kg kind in elk van die volgende situasies a) Kardiale arres. (1.5) b) Bradikardie. (1) c) Laringospasma met totale obstruksie van die lygweg. (1.5) d) Omkeer van nie-depolariserende spierverslapping. (1) [5] Beskryf kortliks die volgende graderings a) Mallampatie II. b) Cormack/Lehane II. c) ASA II. d) ASA IIE. e) ASA VI. (1) (1) (1) (1) (1) [5]

2.14

2.15

2.16

2.17

Dui aan of jy n verhoging (), n daling () of geen effek () verwag in elk van die volgengde parameters gedurende n Sevofluraan narkose a) Lewer bloedvloei. (1) b) Nie-depolariserende blok. (1) c) Intrakraniale druk. (1) d) Asemhalingspoed (spontaan asemhaling) (1) e) Kardiale omset. [5] Noem die middel en dosis wat jy sak gebruik om die volgende te hanteer a) Maligne hiperpireksie. (2)

2.18

b) c) d) 2.19

Midasolam oordosis. Akute porfirie aanval. Petidien (Pethidine).

(1) (1) (1) [5] (1) (1) (1) (1) (1) [5] pas by die

Teken die kapnograaf kurwe wat jy sal verwag in die volgende instansies a) Maligne hiperpireksie. b) Skielike Kardiale arres. c) Endobrongiale intubasie. d) Brongospasma. e) Natron Kalk is uitgeput. In terme van spierverslappers, kies n middle in kolom B wat die beste beskrywing in kolom A.

2.20

Kolom A 1 Nie-depolariserende middel gekontra-indikeer in suksametonium apnee. 2 Metaboliete mag konvulsies veroorsaak. 3 Hoffman eliminasie 4 Vagolitiese 5 Masseter spasma 6. Inhibisie van noradrenalien heropname by senuwee uitpunte 7. Geen kardiovasulre effekte 8 Mialgie 9 Gevriesdroogde poeier

Kolom B a). Suksametonium b). c). d). e). Vekuronium Pankuronium Atrakurium Mivakurium

[5]