ANESTHIESA NOTES

ANESTHESIA CONTENT

SECTION 1

EQUIPMENTS
ANESTHESIA MACHINE

Boyles major (old version)

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 ANESTHIESA NOTES

ANESTHESIA WORK STATION

Comparison between Semi closed & Closed system

Semi closed (Mapleson Closed (circle system)
system)
Disadvantages
Advantages
1. Light weight Heavy weight
2. Work of breathing is less More
3. Danger of hypercapnia is More
less
4. Can be used safely  Produces Toxic compound with Inhalational
agents
- Dichloroacetyline and phosgene with
Trielene
- Compound A with Sevoflurane
 Desiccated soda lime can produces carbon
monoxide (CO) with Desflurane and burns of

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 ANESTHIESA NOTES

respiratory mucosa with Sevoflurane

Disadvantages Advantages
1. High flows are required 1. Low fresh gas flow required so economical
2. High theatre pollution 2. Low pollution
3. Not well preserved 3. Humidity is preserved

AMBU BAG
Rubber bag

Mask

Airway
 Gudels

Laryngeal mask airway

Pilot balloon

Inflatable cuff

Ventilation port

Available in sizes 1- 5 (total 8 sizes)

Proseal

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 ANESTHIESA NOTES

IGEL

Face Masks
Filling tube

Air cushion

Laryngoscope
Blade

Handle

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 ANESTHIESA NOTES

VIDEO LARYNGOSCOPES

Endotracheal tubes
Machine end
Patient end
Cuff

Inflating tube
Murphy eye Tube connector

Pilot balloon

Red rubber PVC

1. Reusable Disposable
2. Non transparent Transparent
3. Radiolucent Radiopaque
4. Absent Murphy’s eye
(additional side hole)
5. Cuff- low volume high volume low pressure high pressure

Chances of  chances of
Tracheal injury tracheal injury

Nasal intubation: - Indications

(i) Oral surgery
(ii) Inadequate mouth opening
(III) Awake intubation
(IV) Elective tube -prolonged periods (max- 3 weeks)
Advantages
• Better tolerated by awake patients
• Oral hygiene can be maintained
Disadvantages
• Bleeding
• Infection( sinusitis)
• Nasal deformity

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 ANESTHIESA NOTES

C/I for nasal intubation:

• Basal skull fracture
• CSF rhinorrhea
• Nasal mass
• Adenoids
• Coagulopathy
C/I for both oral and nasal intubation:
• Laryngeal edema
• Epiglottitis
• Laryngotracheobronchitis

MCQS
MCQS ON HISTORY, MACHINE, CIRCUITS AND EQUIPMENTS

1. N2O was synthesized by b) 300 kg/cm2

a) Priestly c) 500 kg/cm2
b) Humpry Davy d) 750 kg/cm2
c) Morton
d) Horace wells 7. Bain’s circuit is
a) Type A Mapleson
2. The term anesthesia was coined by b) Type A Mapleson
a) Morton c) Type C Mapleson
b) Oliver Wandell Holmes d) None of the above
c) John Snow
d) Claude Bernard 8. Fresh gas flow in Bain circuit
a) Equal to minute volume
3. Ether demonstration by Morton was given b) Less than minute volume
in c) 1.5 times minute volume
a) 1800 d) 3 times minute volume
b) 1846
c) 1946 9. Phosgene gas is produced if soda lime is
d) 1956 used with
a) Trielene
4. First spinal anesthesia in human b) Cyclopropane
a) L. corning c) Halothane
b) Darriel John d) N2O
c) Karl Koller
d) August Beir 10. Circuit of choice for spontaneous
respiration
5. Color of O2 cylinder a) Magill
a) Black b) Bain’s
b) Blue c) Closed
c) Orange d) Type C
d) Grey
11. In Rotameter flow is measured through
6. Pressure in N2O cylinder a) Upper border of bobbin
a) 50 kg/cm2 b) Mid of bobbin

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 ANESTHIESA NOTES

c) Lower border of bobbin a) Measuring flow of gases

d) Irrespective of bobbin b) Measuring density of gases
12. Circuit not suitable for controlled c) Measuring viscosity of gases
ventilation d) Humidity of gases
a) Type A
b) Type B 20. All of the following can be delivered by
c) Type D vaporizer except
d) Type F a) Ether
b) N2O
13. In Rota meter oxygen flow meter tube c) Halothane
should be d) Isoflurane
a) Most upstream
b) In middle 21. Which is not a semi closed system
c) Most downstream a) Mapleson A
d) Can be anywhere b) Ayre T piece
c) Bain’s circuit
14. Desiccated soda lime can produce burns of d) Universal F
respiratory mucosa with
a) Desflurae 22. Circuit of choice for 4 years child
b) Isoflurane a) Bain’s circuit
c) Sevoflurane b) Ayre’s T piece
d) Halothane c) Magill
d) Jackson Reyes
15. Production of compound A and carbon
monoxide(CO) is not seen with 23. Not the component of soda lime
a) Soda lime a) Ca (OH)2
b) Barylime b) CaCO3
c) Amsorb c) NaOH
d) None of the above d) KOH

16. Pin index system of N2O 24. Central supply of oxygen is at

a) 2,5 a) 60 psi
b) 3,5 b) 100 psi
c) 1,5 c) 2000 psi
d) 1,6 d) 1000 psi

17. DISS in relation to anesthesia machine 25. All are Co-axial except
stands for a) Lack
a) Diameter index safety system b) Bains
b) Diameter index security system c) Humpry ADE
c) Double index security system d) Magill
d) Double index safety system
26. Soda lime (Durasorb) when fresh is
18. Entonox a) White
a) O2 + N2O b) Purple
b) O2 + CO2 c) Pink
c) O2 + Air d) Red
d) O2 + N2O+ Air

19. Rotameter is used for

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 ANESTHIESA NOTES

27. There may be production of carbon c) Nasal cannula

monoxide if the following agent is used with d) None of the above
desiccated sodalime
a) Desflurane
b) Halothane 35. C/I for both oral & nasal intubation
c) Sevoflurane a) CSF rhinnorhea
d) Isoflurane b) Cervical spine fracture
c) Laryngeal edema
28. All of the following is true about LMA d) Fracture mandible
except:
a) Best for full stomach patients 36. All of the following  dead space except:
b) Muscle relaxation not required for a) Mask
insertion b) ET tube
c) Reusable c) Ambo bag
d) Easy to insert d) None of the above

29. Position for laryngoscopy requires 37. Artificial nose is

a) Flexion at cervical spine a) Nose created from cartilage
b) Extension at cervical spine b) Nasal airways
c) Neutral position of cervical spine c) Heat & moisture exchanger
d) Any position of cervical spine d) None of the above

30. Surest confirmation for intubation 38. Teeth most vulnerable for injury during
a) Chest auscultation intubation
b) Pulse oximetry a) Upper incisor
c) Capnography b) Lower incisor
d) Tracheoesophageal echo c) Canines
d) Premolars
31. Most common postoperative complications
of intubation 39. High pressure low volume is characteristic
a) Sore throat of
b) Laryngeal edema a) Red rubber tube
c) Laryngeal web b) PVC tube
d) Vocal cord granuloma c) Spiral embedded tube
d) Comb tube
32. Flexometallic tube will be best for
a) Thyroid surgery 40. Length of tube to be inserted for a 4 yr.
b) Thoractomy child should be
c) Cardiac by pass a) 10 cm
d) Laparotomy b) 12 cm
c) 15 cm
33. Not a absolute C/I for nasal intubation d) 18 cm
a) Hemophilia
b) CSF rhinnorhea 41. Murphy’s eye is seen in
c) Adenoids a) Endotracheal tube Red rubber type
d) Operated case of septoplasty b) Endotracheal tube PVC rubber type
c) Comb tube
34. Fix oxygen delivery is seen with d) Laryngeal mesh airway
a) Ventimask
b) MC mask 42. Laryngoscope suitable for children

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 ANESTHIESA NOTES

a) Macintosh b) To make it visible in dark

b) Miller c) To make it antistatic
c) Magill d) None of the above
d) Oxford
43. Sterilization method of choice for airways 46. Most common cause of hypoxia for double
a) Ethylene oxide lumen tube:
b) 2% Glutraldehyde a) Malposition
c) Autoclave b) V/Q mismatch
d) Boiling c) Blockage
d) Extubation
44. Robershaw tube is used
a) Neurosurgery 47. Not a definite method of ventilation
b) thoracic surgery a) Nasal intubation
c) LSCS b) Oral intubation
d) Urosurgery c) Intubating LMA
d) Tracheostomy
45. Carbon is added to mask & bag
a) To harden it

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SECTION 2
Hard palate
Faucial pillars Soft palate

Uvula
Class I Class II Class III Class IV

Mallampati classification
MCQS ON PAC, MONITORING AND FLUIDS

1. All of the following drugs has to be d. Droperidol

continued except:
a. Antiepileptic
b. Calcium channel blockers 5. Atropine as pre-medication is used to
c. Phenothiazines a. Relieve anxiety
d. Oral anticoagulants b.  oral & tracheal secretion
c. Produce sedation
2. Which of the following drugs should be d.  chances of aspiration
recommended routinely preoperatively for
GA 6. Aspirin to be stopped before surgery
a. Glycopyrolate a. 1 day
b. Ondansteron b. 3 days
c. Metoclopramide c. 7 days
d. None of the above d. Not to be stopped

3. Fasting for minor surgery should be 7. Clopidogrel (plavis) to stop before surgery
a. 8 hours a. Stopped 7 day prior to surgery
b. 4 hours b. Stopped 5 days prior
c. 2 hours c. Stopped 1 days prior
d. Fasting not required for minor d. To be continued
surgeries.
8. Antihypertensive has to be stopped before
4. Antiemetic of choice for preoperative surgery
period a. 48 hours
a. Granisetron b. 24 days
b. Metoclopramide c. 72 days
c. Hyosine d. None of the above

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 ANESTHIESA NOTES

17. PCWP represents pressure of

9. Normal breath holding time a. Right atrium
a. 15 seconds b. Left atrium
b. 25 seconds c. Right ventricle
c. 45 seconds d. Left ventricle
d. 60 seconds
10. Mallampati classification does not involve: 18. During pulmonary artery catheterization,
a. Pharynx entry into pulmonary artery is confirmed by
a. Sudden increase in diastolic pressure
b. Tonsillar pillars
b. Sudden increase in systolic pressure
c. Palate
c. Sudden decrease in systolic pressure
d. Uvula
d. Sudden decrease in diastolic pressure
11. Aim of premedication
19. Best site for measuring brain temperature
a. Allay anxiety a. Ear drum
b. Decrease aspiration b. Nasopharynx
c. Decrease anesthetic requirement c. Scalp
d. To dry up secretions d. Esophagus

12. Lithium to be stopped___ before surgery 20. Most sensitive test to detect intraoperative
a. Not to be stopped MI
b. 24 hours a. Lead II
c. 48 hours b. Lead V5
d. 1 week c. Lead II + V5
d. Transesophageal echocardiography
13. A poorly controlled hypertensive and 21. ETCO2 will be low in all except:
diabetic with neuropathy will be classified a. Cardiac arrest
as b. Extubation
a. ASA1 c. Venous air embolism
b. ASAII d. Defective valve of closed circuit
c. ASAIII
d. ASAIV 22. ECG lead to be monitored for ischemia
during anesthesia
14. Allen’s test is done before a. II
a. Radial A. cannulation b. V1
b. Ulnar A. cannulation c. V2
c. IJV cannulation d. V5
d. Brachial plexus block
23. Capnography is to measure
15. Best vein for CVP monitoring a. Oxygen saturation
a. IJV b. Carbon-dioxide
b. EJV c. Inhalational agent
c. Femoral vein d. Airway pressure
d. Brachial vein
24. Best site for temperature monitoring
16. CVP – 3 cmH2O and BP 80/60 indicates a. Lower esophagus
a. Hypovolemia b. Rectum
b. Congestive heart failure c. Axilla
c. Constrictive pericarditis d. Oral cavity
d. Cardiac tamponade
25. Frontal β waves indicate

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a. Deep anesthesia 28. Best monitor to detect apnea in a patient

b. Light anesthesia on venturi mask
c. Awake state a. Capnography
d. None of the above b. Pulse oximetery
c. Co-oximetery
26. Increased oxygen saturation of mixed d. Electrical impedance pulmonometery
venous blood is seen in
a. Histotoxic hypoxia 29. Best fluid for maintenance in GA
b. Cardiogenic shock a. RL
c. Septic shock b. DNS
d. Hypoventilation c. NS
d. 6% hyroxyethyl starch
27. Best monitor to see depth of anesthesia
a. BIS index 30. Autologous blood transfusion is
b. Entropy contraindicated in:
c. EEG a. Acute lymphocytic leukemia
d. Evoked response b. Myocardial infarction
c. Uncontrolled hypertensive
d. Requirement less than 10%

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SECTION 3- GENERAL ANAESTHESIA

General protocol: premedication→ Pre-oxygenation → Induction with intravenous anesthetics
→ Suxamethonium → intubation
• Maintenance- 75% N2O/Air + Oxygen 25% +inhalational agent +non depolarizer muscle
relaxant
•Reversal with cholinesterase inhibitors (Neostigmine) → Extubation

INTRAVENOUS ANESTHETICS
CLASSIFICATION
Barbiturates
 Thiopentone
 Methohexitone
Non- barbiturates
 Propofol
 Etomidate
 Benzodiazepines
 Ketamine
 opioids

OPIOIDS
Opioid receptor- ,,  and nociceptin
1 – Analgesia, Bradycardia, Miosis, urinary retention and muscle rigidity


2 – Resp. depression, Constipation, Dependence

 - Analgesia (mainly spinal analgesia but supra spinal also)

 Resp. depression
 constipation
 sedation
 Miosis
 Dysphoria
 Hallucination
 Dependence
 (Delta) – Analgesia (mainly spinal but supra spinal also)

Nociceptin (Orphanin FQ) {endogenous opoids act through these receptors}

– Stress response
Acupuncture

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CLASSIFICATION
Naturally occurring
 Morphine
 Codeine
 Thebaine

Semi synthetic
 Heroin
 Dihydromorphone
 Oxymorphone
 Pentamorphone
Synthetic
 Butorphenol
 Levorphanol
 Methadone
 Pentazone
 Pethidine (meperidine)
 Fentanyl. Alpentanyl, Sufentanil
 Tramadol

ON BASIS OF RECEPTOR INTERACTION

Pure Agonist
 Morphine
 Pethidine
 Fentanyl / Alfentanil / Sufentanil/Remifentanil
Pure Antagonist
 Naloxone
 Naltreoxone
 Nalmefene
 Diprenorphine
Agonist – Antagonist (mixed opoids)
 Pentazocine
- Buprenorphine
 Butorphenol
 Nalbuphine
 Nalorphine
 Levallorphan
 Dezocine
 Meptazinol

Drugs and receptor interaction

• Pure agonists are agonist at all receptors with highest propensity for µ
• Pure antagonists are antagonist at all receptors, mainly at µ

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 ANESTHIESA NOTES

• Agonist-antagonist: Up to certain dose- agonist at k,  and µ (partial or complete), after that

dose- antagonist at µ
-mixed opioids produces ceiling to respiratory depression (and analgesia)

MCQS ON I/V ANESTHETICS

1. Early regain of consciousness after 7. I/V anesthetic of choice for shock patients
thiopentone is due to a. Thiopentone
a. Redistribution b. Propofol
b. Metabolism c. Ketamine
c. Lonization d. Methohexital
d. Dissociation
8. Analgesia is mainly mediated by
2. Treatment of intra arterial injection of a. Mu
thiopentone include all except b. κ
a. Immediate stop the further injection c. σ
b. Immediate removal of the needle d. δ
c. Injection of 5-10 ml of Xylocaine
d. Brachial plexus block 9. False about opoid & receptor interaction
a. Morphine is μ agonist
3. Absolute Contraindication of thiopentone b. Pentazocine is μ antagonist
a. Asthma c. Pentazocine is κ antagonist
b. Hypotension d. Buprenorphine is μ agonist
c. Heart block
d. None of the above 10. Opoid of choice for renal disease
a. Morphine
4. Propofol is agent of choice for day care b. Pethidine
surgery because of its c. Pentazocine
a. Short half life d. Remifentanil
b. Inactive products
c. Antiemetic effect 11. Recurrence of respiratory depression will be
d. All of the above seen with all except:
a. Morphine
5. Dissociative anaesthesia is characteristic for b. alfentanil
a. Ketamine c. Fentanyl
b. N2O d. Butorphanol
c. Desflurane
d. Propandid 12. Opoid not preferred for epidural
a. Morphine
6. Drug preferred to decrease the incidence of b. Alfentanil
hallucinations c. Fentanyl
a. Diazepam d. All of the above
b. Morphine
c. Thiopentone 13. Maximum chances of bacterial
d. Propofol contamination are with
a. Ketamine
b. Thiopentone

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c. Propofol 21. Lowest incidence of N & V

d. Etomidate a. Thiopentone
b. Propofol
14. Adrencortical suppression is seen with c. Methohexital
a. Etomidate d. Ketamine
b. Ketamine
c. Thiopentone 22. I/V anesthetic of choice for MI patient
d. Propofol a. Thiopentone
b. Ketamine
15. Agents of choice for cerebral protection c. Etomidate
a. Thiopentone d. Propofol
b. Ketamine
c. Midazolam 23. All is true about Midazolam except
d. Morphine a. Acts mainly on RAS
b. Amnesia is anterograde
16. Ketamine is induction agent of choice for all c. Short acting
except d. Painful injection
a. Full stomach
b. Myocardial ischemia 24. Not a component of neurolept anaesthesia
c. Tetralogy of Fallot a. Droperidol
d. Cardiac tamponade b. Fentanyl
c. N2O
17. Dexmedetomidine is used in anesthesia as d. Thiopentone
a. muscle relaxant
b. adjuvant to anesthetics 25. Incidence of hallucinations after ketamine
c. iv induction agent a. 5%
d. inhalational agent b. 10%
c. 20%
18. False about thiopentone d. 40%
a. Good analgesic
b. More that ¾ bound to plasma proteins 26. All are S/E of ketamine except
c. Anticonvulsant a. Muscle relaxation
d. Highly alkaline b. Emergence delirium
c. ↑ i.c.t
19. Management of transient apnea after d. Tachycardia
thiopentone
a. IPPV 27. Acupuncture is mediated by
b. No management required a. μ1
c. Intubation b. μ2
d. Nikethamide c. κ (Kappa)
d. nociception
20. I/V anesthetic of choice for ECT
a. Thiopentone 28. All of the following are pure agonist except
b. Ketamine a. Pethidine
c. Propofol b. Fentanyl
d. Methohexital c. Pentazocine
d. Alfentanil

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29. True of opoids c. Fentanyl

a. increase i.c.t d. Sufentanil
b. Anticonvulsants
c. Muscle rigidity 33. Most potent opoid
d. Diarrhea a. Morphine
b. Alfentanil
30. Tolerance does not develop to c. Sufentanil
a. Sedation d. Pentazocine
b. Constipation
c. Respiratory depression 34. Induction agent of choice for hyperthyroid
d. Hypotension patient
a. Ketamine
31. Morphine may be contraindicated in b. Thiopentone
a. Renal colic c. Etomidate
b. Post of pain d. Morphine
c. Biliary colic
d. Cardiac asthma 35. False about propofol
a. Available as 5% strength
32. Opoid of choice for intubation b. Cerebroprotective
a. Remifentanil c. White color
b. Alfentanil d. Antipruritic

INHALATIONAL AGENTS
CLASSIFICATION
More commonly used:
 Halothane
 Isoflurane
New Agent
 Desflurane
 Sevoflurane
Obsolete
- Enflurane
- Ether
- Methoxyflurane
- Trielene
- Chloroform

MINIMUM ALVEOLAR CONCENTRATIONS

Methoxyflurane 0.16%
Halothane 0.74%
Isoflurane 1.15%
Sevoflurane 2.05%
N2O 104%
Desflurane 6%

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Concentration Effect, Augmented inflow effect, Second Gas Effect and diffusion hypoxia
 This is seen if an inhalational agent is given with N2O.
 Uptake→ Gradient →Augmented inflow effect→ increased N2O concentration
(Concentration effect) →increased the concentration of inhalational agent (second gas
effect)
 Stopping Nitrous oxide → reversal of gradient →N20 gushes into lungs replacing oxygen
→Diffusion hypoxia (also called as Fink effect) - seen during first 10 minutes after
discontinuation of nitrous oxide.

BLOOD GAS PARTITION COEFFICIENT (BLOOD GAS SOLUBILITY)

N2O 0.47
Xenon 0.14
Desflurane 0.42
Sevoflurane 0.69
Methoxyflurane 15
Isoflurane 1.38
Halothane 2.4

MCQS ON INHALATIONAL ANESTHETICS

1. Triad of anesthesia does not include c) Hyperbaric oxygen

a) Analgesia d) Ether
b) Amnesia
c) Narcosis 6. Second gas effect will be seen with
d) Relaxation a) O2 and N20
b) O2 and halothane
2. Stages of anaesthesia are described by c) N2O and isoflurane
a) Morton d) N2O alone
b) Gudell
c) Simpson 7. Most potent anesthetic is
d) None of the above a) Isoflurane
b) Desflurane
3. Stage of surgical anaesthesia c) Sevoflurane
a) I d) Halothane
b) II
c) III, plane 2 8. Fastest recovery will be with
d) III plane 3 a) Cyclopropane
4. Best indicator for potency of inhalational b) Desflurane
agent c) Halothane
a) MAC d) Isoflurane
b) Lipid solubility
c) Blood gas coefficient 9. Max.  in C.O. is seen with
d) None of the above a) Isoflurane
b) Desflurane
5. Fink effect is characteristic of c) Ether
a) N2O d) Halothane
b) Halothane

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 ANESTHIESA NOTES

10. Agent of choice for asthmatics 18. Inhalational agent to be avoided in

a) sevoflurane myocardial ischemia
b) Halothane a) Isoflurane
c) Isoflurane b) Halothane
d) Ether c) Sevoflurane
d) Nitrous oxide
11. C/I in pneumothorax
a) O2 19. A known case of hepatotoxicity with
b) N2O halothane has to undergo surgery.
c) Desflurane Inhalational agent of choice
d) Isoflurane a) Isoflurane
b) Desflurane
12. Coronary steal is seen with c) Sevoflurane
a) Halothane d) Enflurane
b) Isoflurane
c) Desflurane 20. Inhalational agent causing seizures
d) Ether a) Isoflurane
b) Sevoflurane
13. Agent for choice for neurosurgery c) Desflurane
a) Isoflurane d) Halothane
b) Halothane
c) Ether 21. Inhalational agent of choice for hepatic
d) Sevoflurane failure
a) Isoflurane
14. All of the following liberates fluoride on b) Desflurane
metabolism except c) Sevoflurane
a) Halothane d) Halothane
b) Isoflurane
c) Desflurane 22. Inhalational agent C/I in
d) Sevoflurane pheochromocytoma
a) Isoflurane
15. Hepatitis may be caused by all excepts b) Desflurane
a) Halothane c) Sevoflurane
b) Isoflurane d) Halothane
c) Sevoflurane
d) Desflurane 23. All of the following undergo metabolism
except
16. Desiccated soda lime can produce carbon a) N2O
monoxide with b) Halothane
a) Halothane c) Ether
b) Sevoflurane d) Cyclopropane
c) Desflurane
d) Trielene 24. Sub acute degeneration of spinal cord is
seen
17. False about Xenon a) N2O
a) Slow induction b) Hyperbaric O2
b) Good analgesia c) Trielene
c) No metabolism in human body d) Isoflurane
d) No greenhouse effects

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25. Halothane hepatitis is a because of 33. Stages of anaesthesia are described by

a) Immunologic mechanism. a) Morton
b) Decreased hepatic blood b) Gudell
c) Direct toxicity flow c) Simpson
d) Decreased portal blood flow d) None of the above

26. Agent which can corrode plastic & metal 34. Stage of surgical anaesthesia
a) Halothane a) I
b) Isoflurane b) II
c) Desflurane c) III, plane 2
d) Sevoflurane d) III plane 3
27. Highly output renal failure is seen with
a) Methoxyflurane 35. Retrolental fibroplasia is seen in excess of
b) Trielene a) O2
c) Ether b) CO2
d) Chloroform c) N2O
d) Helium
28. All are true of ether induction except
a) Pleasant 36. CO produces hypoxia
b) Slow a) hypoxic
c)  oral secretions b) histotoxic
d) Irritating c) Anemic
d) Stagnant
29. All of the following are explosive agents
except 37. Helium is useful for
a) Ether a) Tracheal stenosis
b) Cyclopropane b) Lung resection
c) Halothane c) Aneurysm repair
d) None of the above d) Pneumothorax

30. The following sensitizes heart to Adrenaline 38. Induction agent of choice for children
a) Halothane a) Halothane
b) Isoflurane b) Isoflurane
c) Sevoflurane c) Sevoflurane
d) Desflurane d) Desflurane

31. Highest post op. N & V is seen with 39. Inhalational agent which can be given in
a) Ether cardiac patients
b) Isoflurane a) Isoflurane
c) Halothane b) Desflurane
d) Desflurane c) Halothane
d) Enflurane
32. Agent of choice for obese patient:
a) Sevoflurane 40. Uterine relaxation is seen with
b) Desflurane a) Halothane
c) Isoflurane b) Isoflurane
d) Halothane c) Enflurane
d) All of the above

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 ANESTHIESA NOTES

41. Inhalational agent of choice for shock c) Sevoflurane> isoflurane > desflurane>
a) Desflurane halothane
b) Isoflurane d) Isoflurane > desflurane > halothane>
c) Halothane sevoflurane
d) Sevoflurane
44. Xenon should be avoided in
42. All of the following are analgesic except: a) Asthma patients
a) Isoflurane b) Coronary artery disease patients
b) Ether c) Renal patients
c) Trielene d) Hepatic patients
d) N2O
45. Agent of choice for day care surgery
43. Potentiation of effect of muscle relaxants a) Desflurane
by inhalational agents b) Isoflurane
a) Halothane> isoflurane> desflurane> c) Halothane
sevoflurane d) Sevoflurane
b) Desflurane> sevoflurane> isoflurane>
halothane

MUSCLE RELAXANTS

CLASSIFICATION OF MUSCLE RELAXANTS:

Depolarizers and Non- depolarizers

DEPOLARIZERS:
- Dexamethonium-not used
- Suxamethonium (Succinylcholine)
NON-DEPOLARIZIRS
Used for maintenance of surgical relaxation
Steroidal compounds (vagolytic)
- Pancuronium
- Vecuronium
- Pipecuronium
- Rocuronium

Benzylisoquinolinium compounds (releases histamine)

- D tubocurare
- Metocurine
- Doxacurium
- Atracium
- Cis- atrcurium
- Mivacurium

Mixed onium chlorofumrate (430A)

Gantacurium

21
 ANESTHIESA NOTES

MCQS ON MUSCLE RELAXANTS

1. Most commonly used for N-M 8. Mivacurium is

monitoring a. Depolarizing muscle relaxant
a. Facial N b. Metabolized by
b. Phrenic N psecudocholinesterase
c. Ulnar N c. Duration of action –30 min
d. Recurrent laryngeal N d. Structural analogue of
succinylcholine
2. Earliest to recover
a. Laryngeal muscles 9. shortest acting muscle relaxant
b. Diaphragm a. Succinylcholine
c. Abdomen muscles b. gantacurium
d. Trunk muscles c. mivacurium
d. atracurium
3. Local anesthetic used to measure
cholinesterase activity 10. Best clinical sign to assess adequacy of
a. Lignocaine reversal is
b. Bupivacaine a. Able to open eye
c. Dibucaine b. Able to lift head
d. Mepivacaine c. Able to protruded tongue
d. Able to move limbs
4. Pseudocholinesterase is decreased in
a. Liver disease 11. not true of gantacurium
b. Renal disease a. Slow onset
c. Pregnancy b. Short duration
d. All of the above c. Chlorofumrate
d. Metabolized by ester hydrolysis
5. Bovet got noble prize for
a. Suxamethonium 12. Non depolarizer which should not be
b. Insulin used for biliary obstruction
c. Isoflurane a. Pancuronium
d. Pancuronium b. Atracurium
c. Vecuronium
6. All of the following releases histamine d. Gallamine
except:
a. D T c 13. False about Rapacuronium
b. Mivacurium a. Early onset
c. Atracurium b. Short duration
d. Pancuronium c. Isomer of pancuronium
d. None of the above
7. Relaxant which can cause convulsions
a. Atracurium 14. Succinylcholine produces
b. Vecuronium a. Phase I block
c. Gallamine b. Phase II block
d. Mivacurium c. Both
d. None

22
 ANESTHIESA NOTES

15. Which of the following is cardiac stable b. Recent MI

a. Vacuronium c. Recent head injury
b. Rocuronium d. Recent crush injury
c. Rapacuronium
d. All of the above 23. R X of Choice for 
psecudocholinesterase patients
16. Dibucaine no. used to measure a. Continue IPPV and wait for
a. Concentration of spontaneous recovery
butrycholinesterase b. Psecudocholinesterase extract
b. Efficiency of butrycholinesterase c. Fresh frozen plasma
c. Genetic makeup of individual d. RBC’s
d. All of the above
24. Ganglion blockade is max. with
17. Rapacuronium was withdrawn from the a. D T c
market because of its side effect b. Gallamine
a. Myocardial depression c. Pancuronium
b. Myocardial infarction d. Atracurium
c. Bronchospasm
d. Hepatic failure 25. Relaxant of choice in renal failure
a. Atracurium
18. Reversal agent of choice for mivacurium b. Pancuronium
a. No reversal required c. Vecuronium
b. Neostigmine d. Succinylcholine
c. Endrophonium
d. Physostigmine 26. Glycopyrolate is given with neostigmine
a. To block muscarinic effects
19. True of Cyclodextrin is b. To prolong the duration
a. Reversal agent for steroidal type of c. To  the potency
muscle relaxants d. None of the above
b. Most commonly used is gamma
c. Does not require neostigmine 27. Max. vagal blockade will be seen with
d. All of the above a. Gallamine
b. DTC
20. Earliest to paralyze with muscle c. Succinylcholine
relaxant d. Pancuronium
a. Laryngeal muscles
b. Upper limb muscles 28. Histamine releases is maximum with
c. Diaphragm a. D T c
d. Intercostals b. Gallamine
c. Pancuronium
21. All of the following are actions of d. Atracurium
succinylcholine except
a. Bradycardia 29. Muscle relaxant of choice for rapid
b. Hypokalemia sequence intubation
c. Masseter spasm a. Succinylcholine
d. ↑ i.c.t. b. Vecuronium
c. Rocuronium
22. All of the following are C/I of d. Atracurium
Suxamethonium except
a. Recent Burns

23
 ANESTHIESA NOTES

30. Use of reversal (neostigmine) can be 35. False about cis atracurium as compared
avoided with to atracurium
a. Pancuronium a. More potent
b. Vecuronium b. No histamine release
c. Atracurium c. No laudonosine production
d. Pancuronium d. Metabolized by Hoffman
degradation
31. Dual block is caused by
a. Succinylcholine 36. Guaranteed recovery from the effect of
b. Gallamine muscle relaxants
c. A+B a. Head lift > 5 sec.
d. None of the above b. Hand grip > 5 sec.
c. Train of four ratio > 0.9
32. Not a C/I for succinylcholine d. Able to hold tongue depressor
a. Myasthenia gravis between central incisors
b. Tetanus
c. Duchene dystrophy 37. Muscle relaxant of choice for
d. Hemiplegia continuous infusion in ICU
a. Vecuronium
33. Muscle relaxant contraindicated in b. Rocuronium
pregnancy c. Atracurium
a. Succinylcholine d. Pancuronium
b. Gallamine
c. Atracurium 38. Muscle relaxant of choice for
d. A+B precrurarization
a. Vecuronium
34. Muscle relaxant of choice for day care b. Rocuronium
surgery c. Atracurium
a. Atracurium d. Pancuronium
b. Mivacurium
c. Vecuronium 39. Not a long acting muscle relaxant
d. Suxamethonium a. Vecuronium
b. Doxacurium
c. Pipercuronium
d. Pancuronium

COMPLICATIONS OF GA
Indication for RSI or C/I for B & M vent
- Full stomach
- Pregnancy
- Intestinal obstruction
- Obesity
- Abdominal tumour / ascites/Diabetes
- Hiatus hernia/N-m disease
- Diaphragmatic hernia
- Tracheoesophgeal fistula
- Meconium aspiration syndrome
- Pyloric stenosis

24
 ANESTHIESA NOTES

MCQS ON COMPLICATIONS OF GA

1. Maximum cardiac arrest occur during 8. Sellik’s maneuver is

a. Induction a. Cricoid pressure
b. Maintenance b. Awake intubation
c. Recovery c. IXth N.block
d. Post op d. CVP catheterization

2. Maximum complications occurs during 9. Most common arrhythmia in post

a. Induction operative period
b. Maintenance a. Tachycardia
c. Recovery b. Bradycardia
d. Post op c. Atrial premature beats
d. PSVT
3. Most common cause of anesthetic
complications 10. Most common post operative
a. Human error complication in recovery room
b. Equipment failure a. Nausea & vomiting
c. Drug anaphylaxis b. Hypoxia
d. Drug pharmacodynamics c. Hypotension
d. Pain
4. Most common cause of anaphylactic
reactions in perioperative period 11. Risk factor for pulmonary aspiration
a. Antibiotics does not include
b. Opoids a. pH > 2.5
c. Muscle relaxants b. gastric content > 25ml
d. Latex c. Acid food particles
d. Full stomach
5. Most commonly injured nerve during
anesthesia 12. Complication of Trendelenburg position
a. Ulnar a. C.O.
b. Common peroneal b.  intra-cranial tension
c. Brachial plexus c.  FRC
d. Radial d. All of the above

6. Venous air embolism is a complication of 13. Rx of malignant hyperthermia includes

a. Lateral position all except
b. Sitting position a. Dantrolene
c. Prone position b. Hypo ventilation
d. Lithotomy position c. 100% oxygen
d. ice cooling
7. Malignant hyperthermia is seen with
a. Halothane 14. Not seen in malignant hyperthermia
b. Isoflurane a.  ETCO2
c. Desflurane b.  K+
d. All of the above c. Hyperthermia
d.  cretanine kinase

25
 ANESTHIESA NOTES

15. Malignant hyperthermia is because of b. Meconium aspiration syndrome

abnormality of c. Tracheoesophageal fistula
a. Ca2+ receptor d. Lung malformation
b. K+ receptor
c. Na+ receptor 18. All can be used to produce controlled
d. Cl- receptor hypotension except
a. Sodium nitroprusside
16. All of the following  the chances of b. Remifentanil
aspiration except c. Nitroglycerine
a. Diabetes d. Mephenteramine
b. Atropine
c. Pregnancy 19. Which of the following does not
d. Metoclorpramide produce convulsions
a. Thiopentone
17. All of the following are C/I for bag & b. Cis- atracurium
mask ventilation except: c. Sevoflurane
a. Diaphragmatic hernia d. Enflurane

26
 ANESTHIESA NOTES

SECTION 4- REGIONAL ANESTHESIA

LOCAL ANESTHETICS

Classification of Peripheral N.
Fiber class Sub class Myelin Diameter Function
A  + 6-22  Motor, proprioception

 + 6-22  Motor, proprioception

 + 3-6  Muscle tone

 + 1-4  Pain, touch, temp.

B + <3 Autonomic functions
(preganglionic
sympathetic)
C SC - 0.3 – 1.30 Autonomic functions
(postganglionic
sympathetic)

DyC - 0.4 –1.2  Pain, temperature touch

Sequence - A (A gamma → A delta → A alpha = A beta) → B → C

 Peripheral blocks – motor →sensory →autonomic
• Central neuraxial blocks- Automatic → sensory → motor
• Recovery- Reverse order
• Sensory: Pain → temp (cold < hot) → touch → deep pressure → proprioception

Classification of local anaesthetics

Aminoesters
- Procaine
- Chlorprocaine
- Tetracaine (amethocaine)
- Benzocaine
- Cocaine
Aminoamides
- Lidocaine
- Mepivacaine
- Prilocaine
- Bupivacaine
- Etidocaine
- Ropivacaine

Short duration: Low potency

- Procaine

27
 ANESTHIESA NOTES

- Chlorprocaine – Shortest acting

Intermediate duration; Intermediate potency
- Lidocaine
- Mepivacaine
- Prilocaine
- Cocaine
Long duration; High potency
- Bupivacaine
- Tetracaine
- Etidocaine
- Ropivacaine
- Dibucaine – Longest acting

MCQS ON LOCAL ANAESTHESICS

1. Highest susceptibility of N-fibers to be a. 0.5%

blocked by LA b. 2%
a. A gamma c. 5%
b. A  d. 7.5%
c. B
d. C 7. Which Local anesthetic cannot be used as
topical
2. Duration of action of Lignocaine can be a. Xylocaine
increased by addition of b. Dibucaine
a. Adrenaline c. Benzocaine
b. Phenylephrine d. Bupivacaine
c. Soda bicarbonate
d. All of the above 8. Not a right concentration of lignocaine
a. Biers block 1%
3. Methhemoglobinemia is S/E of b. Surface 10%
a. Prilocaine c. Spinal 5%
b. Xylocaine d. Epidural 1.5%
c. Tetracaine
d. Bupivacaine 9. Among the local anesthetics available today
which is vasoconstrictor at clinically used
4. Max dose of Lignocaine without Adr. concentrations
a. 2mg/kg a. Bupivacaine
b. 3mg/kg b. Mepivacaine
c. 4.5mg/kg c. Ropivacaine
d. 7mg/kg d. Prilocaine
e. None of the above
5. False about ropivacaine as compared to
Bupivacaine 10. Maximum neurotoxicity after central
a. More potent neuraxial blocks is seen with
b. Good motor blockade a. Lignocaine
c. Long duration b. Bupivacaine
d. All of the above c. Ropivacaine
d. All produces same
6. Conc. of Bupivacaine used for spinal

28
 ANESTHIESA NOTES

11. Earliest to recover after brachial plexus 18. Most cardio toxic is
block a. Bupivacaine
a. Motor b. Lignocaine
b. Sensory c. Tetracaine
c. Autonomic d. Prilocaine
d. All recovers at same time
19. Conc. of adrenaline with local anesthetics
12. Which LA is not hydrolyzed by a. 1:1000
cholinesterase b. 1:10,000
a. Procaine c. 1:100000
b. Chlorprocaine d. 1:200000
c. Tetracaine
d. Lignocaine 20. All of the following are features of LA
toxicity except:
13. All are long acting LA except a. Convulsions
a. Mepivacaine b. Bradycardia
b. Bupivacaine c. Hypertension
c. Tetracaine d. Vent fibrillation
d. Dibucaine
21. Use of soda bicarbonate to LA
14. Duration of action of Bupivacaine(without a. Enhances the onset
Adrenaline) is b. Decreases the pain
a. 1 hrs. c. Increases the duration
b. 2 hrs. d. All of the above
c. 4 hrs.
d. 8 hrs. 22. EMLA cream contains
a. Prilocaine and lignocaine
15. LA acts on b. Bupivacaine and lignocaine
a. Na+ Channel c. Lignocaine and Etidocaine
b. Ca2+ Channel d. Lignocaine and mepivacaine
c. K+ Channel
d. All of the above 23. O-toluidine is metabolic product of which
local anesthetic
16. Max systemic absorption is seen with a. Bupivacaine
a. Intercostal nerve block b. Ropivacaine
b. Supraclavicular brachial plexus block c. Prilocaine
c. Axillary block d. Lignocaine
d. Epidural
24. Correct sequence of cardiotoxicity in
17. All of the following factors enhances the decreasing order
onset of action except: a. Bupivacaine > Ropivacaine >
a. Dose Levobupivacaine > Lignocaine
b. Acidosis b. Bupivacaine > Levobupivacaine >
c. Nerve stimulation Ropivacaine > Lignocaine
d. Lower pka c. Bupivacaine > Lignocaine >
Levobupivacaine > Ropivacaine
d. Bupivacaine > Levobupivacaine >
Lignocaine > Ropivacaine

29
 ANESTHIESA NOTES

REGIONAL ANESTHESIA
Stellate ganglion block:

Indications:
• Complex regional pain syndromes (Reflex sympathetic dystrophies)
• Intrarterial thiopentone
• arterial cannulation
• Hyperhydrosis
• Anterior to the tubercle of transverse process of c6 (chassaignac tubercle)

Signs of successful block

- Horner syndrome
- Conjunctival congestion – earliest sign
- Nasal stuffiness (guttmann’s sign)
- Tympanic membrane congestion (muller sign)
- Increased skin temp.

Complications
- brachial plexus block
- recurrent laryngeal n. Block
- phrenic nerve block
- epidural & intrathecal injection
- injury to larynx, pharynx
- bradycardia, hypotension

CENTRAL NEURAXIAL BLOCKS

Factors effecting height/level of block of spinal anesthesia
A. Significantly
1. Dosage
2. Baricity
3. Position of patient
4. Space
5. CSF volume- inverse relation
6. Pregnancy
7. Old age

B. Factors which effect the level of block but not very significantly
1. Height
2. Spinal curvature
3. Direction of needle
4. Concentration

C. Factors not effecting the level of block

1. Sex
2. Speed of injection

30
 ANESTHIESA NOTES

3. Increased CSF (Barbotage, coughing or straining)

4. Vasoconstrictor.

C/I OF CENTRAL NEURAXIAL BLOCKS

Absolute
1. Raised i.c.t.
2. Bleeding diatheses
3. PAT on anti-coagulants - Thrombolytic, fibrinolytic, oral anticoagulants, heparin, {12
hours of last dose of LMWH }and antiplatelets other than aspirin ( aspirin is not a C/I as
per current guidelines).
4. severe hypovolemia
5. Infection at local site
6. Refusal of patient
7. Severe fixed cardiac output lesions (MS, AS, Coarctation of aorta, constrictive
pericarditis)

Relative
1 Fixed cardiac output lesions- Mild to moderate
2 Mild to moderate hypotension, hypovolemia
3 Uncontrolled hypertension
4 Severe, recent ischemic heart disease
5. Thrombocytopenia: 50,000 to 80,000/cubic mm- relative contraindication, < 50000-
absolute.
6. Heart blocks and beta blockers
7. Spinal deformity, previous spinal surgery
8. Uncooperative or Psychiatric patients.
9. History of headaches
10. GIT perforation.
11. Neuropathies.
12. CNS disorders
13. Resistant surgeon
14. Chronic backache
15. Septicemia and bacteremia.

31
 ANESTHIESA NOTES

MCQS ON REGIONAL ANESTHESIA

1. True statement regarding site of action 8. Cranial N. most commonly involved in

of drugs during central neuraxial blocks spinal
a. Main site of action of local a. 1st
anesthetics is on nerve roots b. 3rd
b. Main site of action of local c. 5th
anesthetics is dorsal ganglia d. 6th
c. Main site of action of local
anesthetics is on spinal cord 9. In epidural anesthesia drug is injected in
d. Main site of action of opoids is on a. Outside dura
nerve roots b. Subdural space
c. B/w dura & pia
d. None of the above

2. Pneumothorax is highest if Brachial 10. Ropivacaine is pharmacologically similar

plexus is blocked by to
a. Interscalene approach a. Bupivacaine
b. Supraclavicular b. Mepivacaine
c. Axillary c. Lignocaine
d. Infraclavicular (classical approach) d. Etidocaine

3. Dura extends up to 11. Which nerve is most likely to be spared

a. L1 with axillary block
b. L2 a. Ulnar
c. S2 b. Median
d. Coccyx c. Radial
4. Spinal N. are d. Musculocutaneous
a. 30 12. Preferred space for doing lumbar
b. 31 puncture in 1 year child will be
c. 32 a. L1 – L2
d. 33 b. L2 – L3
c. L3 – L4
5. Structure not pierced in spinal d. L4 – L5
a. Posterior longitudinal ligament
b. Interspinous ligament 13. False about epidural blood patch
c. Supraspinous ligament a. 15-20 ml of blood is taken
d. Ligament flavum b. Effective only in 50% of patients
c. Can cause radiculopathy
6. Spinal is given between d. Blood is injected outside the dura
a. Dura & arachnoid
b. Arachnoid & pia 14. Saddle block is
c. Pia & spinal cord a. Kind of spinal block
d. Dura & ligament flavum b. Effective for lower abdominal block
c. Drug is injected in sacral hiatus
7. Cardioaccelator fibers are d. Duration prolonged than epidural
a. C6-C7
b. T1-T4
c. T4-T8
d. Vagus

32
 ANESTHIESA NOTES

15. Caudal block is type of 22. False statement regarding regional

a. Spinal nerve blocks in children
b. Epidural a. C/I if age is less than 8 years
c. Both b. Duration of block is less as
d. None compared to adults
c. Children are more prone for toxicity
16. Drug of choice for ventricular with local anesthetics
tachycardia with Bupivacaine d. Volume required is less
a. Lignocaine
b. Breytilium 23. Which factor does not increases the
c. Amiodarone incidence of post spinal headache
d. Any of the above a. Early ambulation
b. Pregnancy
17. All can be used for treatment of post c. Large gauge of needle
spinal headache except: d. Type of needle
a. Anti trendelenburg
b. CO2 24. What is the safe time after which
c. Epidural blood patch central neuraxial block can be given
d. i/v fluids after low molecular weight heparin?
a. Any time
18. Maximum post spinal headache will be b. 2 hours
with c. 6 hours
a. Quicken Babcock d. 12 hours
b. Pitkin
c. Spate 25. Not a component of Horner syndrome
d. Whitcre a. Mydriasis
b. Ptosis
19. Most common cause of apnea after c. Anhydrosis
spinal d. Absent ciliospinal reflex
a. Hypotension
b. High spinal 26. Dextrose is added to lignocaine in spinal
c. Total spinal a. To make it hyperbaric
d. Systemic toxicity b. To make it hypobaric
c. To make it Isobaric
20. Drug of choice for shivering d. As a nutritional supplement
a. Tramadol
b. Pethidine 27. Height of block is not influenced by
c. Promethazine a. Age
d. Metoclopramide b. Sex
c. Position of pat
21. Which opoid cannot be used for spinal/ d. Height
epidural to produce postoperative
analgesia 28. Most common S/E of spinal
a. Fentanil a. Hypotension
b. Sufentanil b. Bradycardia
c. Remifentanil c. Headache
d. Alfentanil d. Nausea & Vomiting

33
 ANESTHIESA NOTES

29. Not to be done in spinal hypotension 35. Cauda equine syndrome is seen in
a. Dopamine a. Spinal
b. I/v fluids b. Epidural
c. Ephedrine c. Both
d. Mephenteramine d. None

30. False about post spinal headache 36. Chassagnic tubercle is landmark for
a. Usually occurs 4-6 hours after a. Stellate ganglion block
surgery b. Supraclavicular brachial plexus
b. Usually occipital block
c. Lowest with pencil tip needle c. Cervical block
d. In 95% patients relives in 1 week d. Phrenic N Block

31. Absolute C/I for spinal 37. Seen with stellate ganglion block
a. Hypertension a. Miosis
b. Mitral stenosis b. Bradycardia
c. Spinal deformity c. Hoarseness of voice
d. Raised i.c.t d. All of the above

32. Drug not to be used for be Biers block 38. Tuhoys needle is used for
a. Lignocaine a. Spinal
b. Prilocaine b. Epidural
c. Bupivacaine c. Saddle block
d. None of the above d. Para vertebral block

33. Not a contraindication for spinal 39. Accidental dural puncture during
a. Patient refusal epidural is a dreadful complication, all
b. Mitral stenosis of the following can be done to prevent
c. Hemophilia this except
d. Multiple sclerosis a. Aspiration before injection
b. Test dose with 2ml of bupivacaine
34. All are advantages of epidural over c. Drug in incremental doses
spinal except d. Test dose with 2ml of xylocaine
a. Less hypotension
b. Less headaches 40. Most common post op complication of
c. Blood level can be changed spinal anesthesia
d. Cheaper a. Post spinal headache
b. Urinary retention
c. Hypotension
d. Cauda equine syndrome

34
 ANESTHIESA NOTES

SECTION 5
ANESTHETIC MANAGEMENT OF CO-EXISTING DISEASES AND SPECILAITY MANAGEMENT
MCQS

1. Elective surgery is a MI patient is to be 8. Muscle relaxant to be avoided for

deferred for myasthenia graves patient
a) 4 weeks a) Atracurium
b) 6 weeks b) Vecuronium
c) 3 months c) Suxamethonium
d) 6 months d) Pancuronium

2. All of the following agents can be used for 9. Anesthesia of choice for myotonia
induction is MI except: dystrophic patient
a) Etomidate a) O2+N2O + Atracurium + isoflurane
b) Propofol b) O2+N2O+ vecuronium + isoflurane
c) Thiopentone c) O2+N2O + mivacurium + isoflurane
d) Ketamine d) O2+N20+ Atracurium + Halothane

3. Best agent for maintenance in MI 10. Inhalational agent C/I for Duchene muscular
a) Isoflurane dystrophy
b) Fentanyl a) Isoflurane
c) Halothane b) Desflurane
d) Desflurane c) Sevoflurane
d) Halothane
4. Spinal anesthesia is C/I in
a) Aortic stenosis 11. Inhalational agent of choice for patient
b) Aortic regurgitation suffering from liver disease
c) Ischemic heart disease a) Halothane
d) Mitral regurgitation b) Isoflurane
c) Desflurane
5. Anesthesia of choice for a patient of d) Sevoflurane
Asthma for tibia nailing
a) Spinal 12. Muscle relaxant of choice for renal failure:
b) Ketamine a) Atracurium
c) Halothane b) Vecuronium
d) Sevoflurane c) Pancuronium
d) Rocuronium
6. Agent C/I in emphysema
a) Ketamine 13. Induction agent of choice for hyperthyroid
b) Thiopentone patient
c) Isoflurane a) Etomidate
d) N2O b) Thiopentone
c) Ketamine
7. Agent to be avoided for epileptic patient d) Propofol
a) Methohexital
b) Atracurium
c) Ketamine
d) All of the above

35
 ANESTHIESA NOTES

14. Minimum acceptable hemoglobin for elective 21. Inhalational agent of choice for asthma
surgery a) Desflurane
a) 10 gm % b) Halothane
b) 12 gm% c) Isoflurane
c) 8 gm % d) Sevoflurane
d) 14 mg %
22. Which of the following muscle relaxant is safe
15. Anesthesia of choice for hemophilia patient for myasthenia gravis
a) Spinal a) Atracurium
b) Epidural b) Cis- atracurium
c) Combined spinal epidural c) Mivacurium
d) GA d) All of the above

16. Inhalational agent C/I in pheocytochroma 23. Agent to be avoided for head injury
a) Isoflurane a) Thiopentone
b) Desflurane b) Propofol
c) Sevoflurane c) Sevoflurane
d) Halothane d) Halothane

17. What physiological /pharmacological change 24. All of the following techniques are useful for
is not expected in obese patient decreasing i.c.t. except
a) Decrease cardiac output a) Hyperventilation
b) Right ventricular hypertrophy b) Thiopentone
c) Increased metabolism of inhalational c) Lumbar puncture
agents d) Steroids
d) Difficult intubation
e) Polcythemia 25. Very important monitor specially for posterior
fossa surgery
18. Regarding doses in obese patients a) Pulse oximeter
a) iv induction doses are given on actual b) Capnography
weight basis c) Temperature
b) iv maintence doses are given at frequent d) Mass spectrometer
intervals
c) muscle relaxants are given on actual 26. Muscle relaxant of choice for newborn
weight basis a) Atracurium
d) inhalational agents are required in higher b) Vecuronium
concentrations c) Rocuronium
d) Suxamethonium
19. Induction agent of choice for emergency
pericardiocentesis for a cardiac tamponade 27. All can be used for induction in children
patient except:
a) Ketamine a) Isoflurane
b) Propofol b) Halothane
c) Thiopentone c) Sevoflurane
d) Etomidate d) Ketamine

20. Inhalational agent to be avoided for renal 28. Oculocardiac reflex is seen mainly with
failure manipulation of
a) Desflurane a) Lateral rectus
b) Halothane b) Medial rectus
c) Isoflurane c) LPS
d) Sevoflurane d) Superior oblique

36
 ANESTHIESA NOTES

29. Anesthesia of choice of rigid Bronchoscopy 37. Which technique should be avoided for day
a) Convention GA care surgery
b) GA with small size tube a) Spinal
c) Topical b) Epidural
d) GA with high frequency ventilation c) GA with intubation
d) Supraclavicular brachial plexus block
30. Most preferred gas for laparoscopy
a) CO2 38. All of the following are discharge criteria after
b) O2 day care surgery except:
c) N2O a) Vital stable for 60 minutes
d) Helium b) Pat with no attendant
c) Should be well oriented
31. Complication seen with laparoscopy d) Not accepting orally
a) Raised i.c.t
b) Hypotension 39. Anesthetic technique of choice for PIH
c) Arrhythmias a) Spinal
d) All of the above b) Epidural
c) GA with thiopentone
32. Pneumothorax during laparoscopy should be d) Combined spinal epidural
preferably managed by
a) Chest tube in 5th ICS 40. Most preferred method for painless labor
b) Chest tube in 7th ICS a) Lumbar epidural
c) Chest tube in 2nd ICS b) Sacral epidural
d) None of the above c) Lumbar for first stage and sacral epidural
for second stage
33. For rheumatoid arthritis intubation is C/I in d) Para cervical block
a) Flexion position
b) Extension 41. All patient can be taken for day care surgery
c) Neutral except
d) Any of the above a) ASA II
b) Premature
34. NPO guidelines for day care surgery c) Pregnant patient
a) 8 hours d) Diagnostic Laparoscopy
b) 6 hours
c) 4 hours 42. After delivery elective surgery should be
d) Fasting not required postponed for
a) 1week
35. Premedication of choice for day care surgery b) 2 weeks
a) Midazolam c) 4 weeks
b) Diazepam d) 6 weeks
c) Lorazepam
d) Morphine 43. Anesthesia of choice for a 2 month pregnant
36. Total intravenous anesthesia of choice for day patient undergoing appendectomy
care surgery a) Spinal
a) Propofol + Alfentanil b) GA with ketamine
b) Propofol + remifentanil c) GA with propofol
c) Propofol + Fentanyl d) GA with thiopentone
d) Propofol + morphine e) GA with isoflurane

37
 ANESTHIESA NOTES

44. False about induction in pediatric patients 51. Patient controlled analgesia utilizes which
a) Inhalational induction with sevoflurane is route
the most preferred method a) i/v
b) Induction is rapid with inhalational b) i/m
agents as compared to adults c) Epidural
c) Concentration of inhalational agents d) Oral
required is less
d) Induction doses for iv induction are more 52. Which of the following gas is least suitable for
as compared to adults laparoscopy
a) CO2
45. Which of the following inhalational agent b) Air
decreases ICT c) Helium
a) Isoflurane d) Argon
b) Desflurane
c) Halothane 53. During gas insufflation for laparoscopy
d) None of the above pressure intrabdominal pressure should not
exceed
46. Treatment of choice for a patient having a) 5 mmhg
neuralgic pain in distribution of mandibular b) 10 mmhg
branch of trigeminal nerve. c) 15 mmhg
a) Radiofrequency abolition of gasserian d) 20 mmhg
ganglion
b) Phenol abolition of gasserian ganglion 54. Most common post- operative complication
c) Radiofrequency abolition of mandibular of laparoscopy
nerve a) Hypoxia
d) Phenol abolition of mandibular nerve b) Hypotension
c) Nausea and vomiting
47. Anticonvulsant of choice for neuropathic pain d) CO2 embolism
a) Carbamazepine
b) Phenytoin 55. Most common cause of mortality after
c) Gabapentin vascular surgery
d) Valproic acid a) Bleeding
b) Cardiac complications
48. Most common neuropathy c) Neurological complications
a) Diabetic d) Renal failure
b) Phantom limb
c) Post herpetic 56. False statement about regional anesthesia for
d) Causalgia Caserean section
a) Dose of local anesthetics should be
49. CRPS stands for reduced by 30-40%
a) Complex regional pain syndromes b) Increased chances of high spinal
b) Chronic regional pain syndromes c) Increased chances of post spinal
c) Chronic regional pain symptoms headache
d) Complex regional pain symptoms d) Mephenteramine is the vasopressor of
choice for hypotension
50. For neurolytic block
a) 5% phenol is used 57. Anesthesia of choice for MLS
b) 5% Xylocaine is used a) GA with HFJV
c) 50% Alcohol is used b) GA with MLS tube
d) 5% Sensoricaine is used c) Conventional GA
d) Local anesthesia

38
 ANESTHIESA NOTES

CHAPTER 11
CRITICAL CARE
Indications of mechanical ventilation:
On the basis of blood gas analysis:
• pO2 < 50 mmHg on room air {or < 60 mmHg on FIO2 (inspired oxygen) > 0.5 (50%)}.
• pCO2 > 50 mmHg.
• pO2/FIO2 < 250 mmHg ( normal > 400)

On the basis of pulmonary functions:

• Respiratory rate > 35/minute.
• Tidal volume < 5 ml/kg
• Vital capacity < 15 ml/kg.
• Dead space volume (VD/VT) > 0.6 (60%).

Other:
• Excessive fatigue of respiratory muscles.
• Loss of protective airway reflexes making patient vulnerable for aspiration.
• Inability to cough.

Ventilators
(1) Volume preset, time cycled (volume controlled):
(2) Pressure preset, flow cycled (Pressure controlled):
(3) Dual mode – volume as well as pressure mode

MODES OF POSITIVE PRESSURE VENTILATION

1. INTERMITTENT POSITIVE PRESSURE VENTILATION\ CONTROLLED MODE VENTILATION
(CMV)
2. ASSIST CONTROL (AC)
3. SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION (SIMV)
4. PRESSURE SUPPORT (PSV)
5. INVERSE RATIO VENTILATION (IRV)
6. PRESSURE CONTROLLED VENTILATION (PCV)-LESS BAROTRAUMA
7. DUAL MODE- BI-LEVEL VOLUME GUARANTEED

Weaving from Mech. Ventilation

Possible in any mode except CMV
1. Tidal; volume > 5 ml/kg
2. Vital capacity > 15 ml/kg
3. RR <25mt
4. Blood gas analysis-normal values
6. No tachycardia, HT
7. Rapid shallow breathing index = respiratory rate (breath per min.)/ Tidal volume (in
liters/min.). {< 100 - safely weaned, >120 should remain on mechanical ventilation

39
 ANESTHIESA NOTES

CARDIOPULMONARY AND CEREBRAL RESUSCITATION

Cardiac massage
Infants (0 – 1 Year) Children ( 1- 14) Adults
Excluding newborns
Pulse check Brachial Carotid Carotid
Compression area Mid sternum Mid Sternum Lower one third
Compression with 2 – 3 fingers Heel of one hand Both hands (one
over the other)
Depth 1 inch ( no range, ½ - 1 1 ½ inch (no range,1 2 inch(no range 1 ½
inch) – 1 ½ inch) -2 inches){but not
more than 2.4
inches- 2015}
Rate 100 / minute {but not 100 / minute {but 100 / minute {but
more than 120- 2015} not more than 120- not more than 120-
2015} 2015}
Ratio
Without 15:2 (Two rescuers) 15:2 (Two 30:2
advanced airway 30:2 (one) resuscers)
30:2 (one)
With advanced 100 compression with 100 compression 100 compression
airway 10 breath (not 8 – 10 with 10 breath (not with 10 breath (no 8
breaths) 8 – 10 breaths – 10 breaths
With only breath 12 – 20 / minutes 12 – 20 / minutes 10 – 12 / minutes

ALGORITHM FOR CPR –

FOR ADULTS:
• ASSES RESPONSIVENESS → IF UNRESPONSIVE→
ACTIVATE EMS (VIA MOBILE IF POSSIBLE)

• SCAN FOR CHEST MOVEMENTS (NO LOOKING, LISTENING AND FEELING) AND ASSES
CIRCULATION(CAROTID) SIMULTANEOUSLY→IF ABSENT → ACTIVATE EMS AND START
CPR
• DEFIBRILLATE AS EARLY AS POSSIBLE
FOR CHILDREN:
5 CYCLES OF CPR (15:2) AND THEN CALL FOR EMS

Arrhythmia Management
Shockable rhythm (ventricular fibrillation, pulseless ventricular tachycardia and polymorphic
ventricular tachycardia)

Assess responsiveness
↓
Call for help (Activate EMS)
↓
Assess circulation and breathing

40
 ANESTHIESA NOTES

↓
if absent give 30 compressions, 2 rescue breaths and start CPR in ratio of 30:2 without
advanced airway or with compression rate of 100/min and ventilation with 8-10 breath/min
with advanced airway
↓
Defibrillator arrives
↓
Check rhythm (AED, itself check rhythm)

Shockable Not shockable (Pulseless electrical

Activity and Asystole
↓
Manage like non shockable

41
 ANESTHIESA NOTES
Contd.…
Assess Rhythm

Shockable (VF, pulseless V tachycardia) Non shockable (Asystole, PEA)

1. Give one shock Continue CPR

(360 J with monophasic & 200 J with biphasic) Adrenaline 1 mg IV and repeat
every 3-5 minutes (if IV access

not possible than use
Continue CPR for 2 min ( 5 cycles of 30:2 if eous or endotracheal route)
airway is still not maintained by advance r
1st
 or 2nd dose of adrenaline

Check Rhythm - if organized then check pulse 


Keep on checking rhythm every 2
Recovered Still shockable Rhythm becomes min,
 if non shockable, continue
(see footnote) rythmm Non-shockable same
 treatment and if becomes
(Asystole) shockable
 treat like shockable.
Stop CPR Shockable

2. Continue
 CPR( put iv line if not there)
Give
 adrenaline (1:10,000) 1 mg IV, endotracheal or Intraosseous

Give shock (again 360 J with monophasic & 200 J with

Continue CPR for 2

Check rhythm-if organized then check pulse

Recovered Still shockable Non shockable Proceed like non shockable

3. Continue CPR(consider intubation if not intubated)

Repeat
 adrenaline 1 mg ( NO VASOPRESSIN -2015


Shock (360 J – Monophasic, 200 J – Biphasic)

Continue CPR for 2


4. Continue CPR
Give
 amiodarone / lignocaine / magnesium sulphate (for torsade

Shock (with 360 J – monophasic

200J-

Recovered Shockable Non shockable

Go back to stage 2 and

continue same protocol Treat like non shockable

42
 ANESTHIESA NOTES

NON SHOCKABLE RYTHMS (PEA/ASYSTOLE)

PULSELESS ELECTRICAL ACTIVITY (PEA)(Previously called as electromechanical dissociation
Causes - 5H and 5
5H
Hypovolemia (most common cause)
Hypokalemia/ hyperkalemia
Hypothermia
Hypoxia
Hydrogen ion (acidosis)
5HT
Tension pneumothorax
Tamponade (cardiac)
Thrombosis (coronary, pulmonary)
Tablets/ toxin
Trauma
Management of non- shockable rhythms
Continue CPR and consider treatment of possible causes (5 H and 5T)
↓
Adrenaline 1 mg IV/ endotracheal and repeat every 2-3 minutes (NO VASOPRESSIN)
↓
No response for 20 minutes
↓
Consider termination of efforts
-As per 2010 guidelines atropine is no more recommended for Asystole and PEA

Summary of 2010 guidelines

1. C→A→B
2. No listening, looking and feel
3. Quality CPR-Push harder, Push faster, Allow complete recoil after massage, Avoid excess
ventilation, Uninterrupted cardiac massage- (> 10 sec), rotate compressor every 2 min.
4. No mouth to mouth for untrained (hands only)
5. No atropine for Asystole and PEA
6. Capnography mandatory
7. Intraosseous route for all ages, preferred over endotracheal and anything can be given

POST CARDIAC ARREST CARE

1. Optimization of circulation (SBP > 90, MAP > 65 mmHg)
2. Optimization of ventilation (FIO2 to maintain SPO2 >94%)
3. Targeted temperature management - 32-36 degree C for 24 hours for comatose patients
4. Moderate glycemic control (blood sugar- 144- 180mg/dl or 8-10 mmol)
5. Coronary intervention (PCI) if cause is MI (preferably with in 90 minute).
6. Early prognostication of neurologic outcome (to be assessed after 72 hrs.)

CHANGES AS PER 2015 GUIDELINES

1. Chest compression at least 2 inches (5 cm) but not more than 2. 4 inches (6 cm)
2. Compression rate 100 but not more than 120

43
 ANESTHIESA NOTES

3. 10 breaths, not 8-10

4. No vasopressin
5. Extracorporeal techniques should be employed early
6. Temperature 32-36 instead of 32-34, hypothermia called as targeted temperature control
7. Prognosis to be assed only after 72 hours
8. Evaluation for organ donation

Newer concepts in CPR

(1) Calcium C/I as routine – neurological injury
(2) Soda bicarbonate to be given only after ABG – CO2-paradoxical acidosis, increase solute
load
Sodium bicarbonate 0.3 X body wt. X base deficit/2
(3) Intracardiac adrenaline not advocated
(4) Use of steroids only empirical
(5) Fluid- normal saline(avoid dextrose solutions)

MCQS ON MECHANICAL VENTILATION AND C.P.R.

1. Indication for mechanical ventilation 5. Ratio of cardiac compression to breathing

a. Respiratory rate > 40/minute (with bag and mask ventilation) for one
b. pO2< 60 mm Hg resuscitator
c. pCO2> 50 mm Hg a. 30:2
d. All of the above b. 5:2
c. 15:1
2. All of the following modes can be utilized d. 15:2
for weaning except
a. SIMV 6. Concentration of Adrenaline in CPR
b. Asst. control a. 1:1000
c. PSV b. 1:10,000
d. CMV c. 1:1,00,000
d. 1:2,00,000
3. Not a complication of PEEP
a.  cardiac output 7. All of the following can be given by
b.  right ventricular load Endotracheal route except
c.  Dead space a. Adrenaline
d.  mediastinal pressure b. Atropine
c. Naloxone
4. In CPR sequence of management d. Soda bicarbonate
a. ABC
b. CAB 8. Lignocaine is used in the treatment of
c. BAC a. Atrial flutter
d. CBA b. PSVT
c. V.tachycardia
d. All of the above

44
 ANESTHIESA NOTES

9. Drug of choice for vent tachycardia c. 30%

a. Xylocaine d. 50%
b. Breytilium
c. Amiodarone 17. All are included in basic life support except:
d. Digitalis a. Defibrillation with AED
b. Head tilt / chin lift
10. Fluid not be used during CPR c. Bag & mask ventilation
a. Normal saline d. Intubation
b. Ringer lactate
c. 5% dextrose 18. Respiratory rate during CPR for a child with
d. Heamecel advanced airway in place
a. 10 breaths / minute
11. All are the advantages of pressure preset b. 20 breaths / minute
ventilation over volume preset ventilation c. 30 breaths / minute
except d. 40 breaths / minute
a. Less barotrauma
b. Better tolerance 19. False statement for BLS for a child
c. More suitable for children a. 1st step is assess responsiveness
d. Less chances of hypoventilation b. 2nd step is call for EMS
c. 2nd step is 5 cycles of CPR
12. Not an initial desirable ventilator setting for d. 2nd step is assess circulation
ARDS
a. tidal volume 12 ml/kg 20. First energy selected for vent defibrillation
b. FIO2- 0.4-0.5 (Monophasic)
c. PEEP-5-10 cm H20 a. 200 J
d. Rate 10 b. 300 J
c. 360 J
13. There is no patient effort in d. 160 J
a. IPPV (CMV)
b. SIMV 21. False statement for management of VF
c. PSV a. 2nd shock is 360 J
d. Assist control b. 3rd shock is 360 J
c. After defibrillation check rhythm
14. All of the following are indications of PEEP d. After defibrillation continue CPR for 2
except min
a. Pulmonary edema
b. ARDS 22. Cardiac massage is done over
c. To prevent atelectasis a. Lower part of sternum
d. Interstitial lung disease b. 2nd-5th Intercostal space on left side
c. 2nd-5th Intercostal space on right side
15. Barotrauma is more common with d. Cardiac apex
a. Volume ventilators
b. Pressure controlled ventilators 23. Not to be done in Asystole
c. Pressure cycled ventilators a. Atropine
d. Pressure support ventilators b. Defibrillation
c. Isopretonol
16. Oxygen delivered by mouth to mouth d. All of the above
respiration
a. 15%
b. 21%

45
 ANESTHIESA NOTES

24. Giving which of the following in detrimental 28. Most preferred fluid for head injury
during CPR patients
a. Soda bicarbonate a. Ringer lactate
b. Dexamethasone b. Normal saline
c. Atropine c. 5% dextrose
d. Isopretorol d. Dextrose normal saline

25. Most common cause of PEA 29. Most preferred fluid for shock
a. Shock a. Ringer lactate
b. Electrocution b. Normal saline
c. MI c. Hydroxyethyl starch
d. Pneumothorax d. Heamecel

26. Significant irreversible brain damage occurs 30. Targeted temperature for hypothermia
if anoxia last for a. 35-370C
a. 1 min b. 32-36 0C
b. 2 min c. 30-32 0C
c. 6 min d. 28-30 0C
d. 20 min
31. All of the following can be given through
27. Effective cardiac massage produces _____ Intraosseous route except
% of normal cardiac output a. Adrenaline
a. 10% b. Atropine
b. 30% c. Soda bicarbonate
c. 70% d. None of the above
d. 100%
32. Dose of vasopressin in current day CPR
a. 20 IU
b. 40IU
c. 60IU
d. None of the above

46
 ANESTHIESA NOTES

RAPID REVISION
1. First public demonstration of ether d. Grey with white shoulders
anaesthesia was by
a. John Snow 8. Pressure of nitrous oxide cylinder is:
b. Ivan Magill a. 75 psi
c. Morton b. 760 psi
d. HG Wells c. 1250 psi
d. 2000 psi
2. First spinal anaesthesia in human beings
was given by 9. Mapleson’s classification of anaesthetic
a. August Bier breathing systems :
b. Sicard a. Describe four system: A, B, C, D
c. Morton b. Classifies the Bain system as Mapleson D
d. Priestley c. Describes the T-piece as Mapleson D
d. Describes the T -piece system as
3. Fluid of choice for maintenance during requiring a fresh gas flow rate of 1.5-2
intraoperative period during surgery in times the minute volume
regional anesthesia:
a. Ringer lactate 10. Magill circuit airflow is:
b. Normal saline a. Equal to minute volume
c. 5% Dextrose + normal saline (DNS) b. Twice to minute volume
d. 5% Dextrose c. Half of minute volume
e. 5% Dextrose + 1/4 normal saline (D.1/4 d. Equal to alveolar volume
NS)
11. The constitution of sodalime is:
4. C/I for autologus blood transfusion (ABT) a. 5% Ca(OH)2, 95% NaOH
a. coronary artery disease b. 5% NaOH, 95% Ca(OH)2
b. likelihood of blood requirement < 10%
c. 5% KOH, 95% NaOH
c. uncontrolled hypertensive
d. septicemia d. 100% Ca(OH)2
e. all of the above
12. Desiccated soda lime can produce burns of
5. Pin index for nitrous oxide is: respiratory mucosa with
a. 2, 5 a. Desflurane
b. 3, 5 b. Isoflurane
c. 1, 5 c. Sevoflurane
d. 2, 6 d. Halothane

6. Rotameter measures: 13. There may be production of carbon

a. Flow of gases monoxide if the following agent is used with
b. Density of gases desiccated sodalime
c. Volume of gases a. A.Desflurane
d. Humidity of gases b. B.Halothane
c. C.Sevoflurane
7. Colour code for oxygen cylinder is: d. D. Trielene
a. Black with white shoulders
b. Black with grey shoulders 14. Most commonly used laryngoscope is:
c. White with black shoulders a. Miller

47
 ANESTHIESA NOTES

b. Macintosh
c. McCoy 22. All of the following drugs can be continued
d. Oxford before surgery except:
a. Antiepileptics
15. Uncuffed tubes in children are used up to: b. Anithyroid
a. 1 year c. Anticoagulants
b. 2 years d. Antihypertensive
c. 5 years
d. none of the above 23. Preanesthetic medication is used for all of
the following, except:
16. Reasonable tube size required for 3 year a. To decrease secretions
child will be number: b. Produce amnesia
a. 2 mm c. Allay anxiety
b. 4.5 mm d. Reduce the dose of inducing agents
c. 5.5 mm
d. 6 mm 24. 24. Clopidogrel (plavis) to stop before
surgery
17. Laryngeal mask airway (LMA) is used for: a. stopped 7 day prior to surgery
a. Maintenance of airway b. stopped 4 days prior
b. Facilitating laryngeal surgery c. stopped 5 days prior
c. Prevention of aspiration d. to be continued
d. Removal of secretion
25. Triad of anaesthesia are all, except:
18. Pulse oximetery detects inaccurately in the a. Delirium
presence of all except b. Analgesia
a. Hyperbilirubinemia c. Amnesia
b. Nail polish d. Sleep
c. Methemoglobinemia
d. Skin pigmentation 26. Balanced anaesthesia does not include:
a. Amnesia
19. Normal Thyromental distance is: b. Analgesia
a. 5 cm c. Muscle relaxation
b. 6 cm d. Narcosis
c. 6.5 cm e. None of the above
d. 7.5 cm
27. Index of potency of inhalational agent is:
20. Mallampati score is used in: a. Minimum alveolar concentration
a. Thoracoabdorminal angular curvature b. Diffusion coefficient
during respiration c. Alveolar concentration/blood
b. Flexion and extension of neck during concentration
intubation d. Dead space concentration
c. Free rotation
d. To assess difficulty in intubation in oral 28. Rapid induction of anaesthesia occurs with
cavity which of the following anaesthetic:
a. Isoflurane
21. ASA classification is done for: b. Halothane
a. Status of patient c. Desflurane
b. Risk d. Sevoflurane
c. Pain
d. Lung disease 29. Second gas effect is classically seen with:

48
 ANESTHIESA NOTES

a. Halothane and oxygen c. Desflurane

b. Halothane and nitrous oxide d. Isoflurane
c. Nitrous oxide and oxygen
d. Halothane and isoflurane 37. Ether is not used in modern surgical
practice because it is:
30. Maximum bronchodilatation is produced a. Highly explosive
by: b. Poor anaesthetic
a. Halothane c. Expensive
b. Sevoflurane d. Complicated apparatus needed
c. Isoflurane
d. Ether 38. The anaesthetic agent of choice in renal
failure:
31. Agent causing hepatotoxicity: a. Methoxyflurane
a. Halothane b. Desflurane
b. Desflurane c. Sevoflurane
c. Sevoflurane d. Isoflurane
d. Isoflurane
39. Which one of the following agents
32. Inhalational agent of choice for shock in sensitizes the myocardium to
present day anesthesia catecholamines?
a. Halothane a. Isoflurane
b. Sevoflurane b. Ether
c. Desflurane c. Halothane
d. Enflurane d. Propofol

33. Fluoride content is least in: 40. Accidental intra-arterial injection of

a. Methoxyflurane thiopentone causes:
b. Halothane a. Vasodilatation
c. Sevoflurane b. Vasovagal
d. Isoflurane c. Necrosis of wall
d. Vasospasm
34. Agent of choice for neurosurgical
procedures is: 41. Treatment of intra-arterial injection of
a. Halothane thiopentone:
b. Isoflurane a. Papaverine intra-arterially
c. Desflurane b. Heparin
d. Sevoflurane c. Stellate ganglion block
d. All of the above
35. One of the following inhalational agents
causes coronary steal: 42. Not a physical property of Propofol:
a. Halothane a. Water based preparation
b. Enflurane b. Colour of the solution is white
c. Isoflurane c. It contains egg lecithin
d. Ether d. Used as 2% strength

36. 36. Which of the following inhalational 43. Propofol vial once opened should be used
agents is the induction agent of choice in within:
children? a. 6 hours
a. Methoxyflurane b. 24 hours
b. Sevoflurane c. 48 hours

49
 ANESTHIESA NOTES

d. 1 week e. Ventricular septal defect (VSD)

44. Which of the following agent is used to 51. Mu receptors are responsible for all actions
produce street fit person following surgery? except
a. ketamine a. analgesia
b. Propofol b. respiratory depression
c. Alfentanil c. sedation
d. Thiopentone d. diuresis

45. Which anaesthetic decreases cortisol 52. Not a pure agonist at opioid receptors:
levels? a. Pethidine
a. Thiopentone b. Fentanyl
b. Halothane c. Buprenorphine
c. Etomidate d. Morphine
d. Propofol
53. False statement about opioid and receptor
46. True of Etomidate: interaction:
a. High incidence of nausea and vomiting a. Morphine is agonist at mu receptors.
b. Causes tachycardia and hypotension b. Pentazocine is antagonist at kappa
c. Causes tachycardia and hypertension receptors
d. Causes bradycardia and hypotension c. Butorphanol is agonist at kappa
receptors
47. In neuroleptanalgesia Droperidol and d. Nalorphine is antagonist at mu
Fentanyl are in ratio of: receptors
a. 2:1
b. 5:1 54. Not a property of opioids:
c. 10:1 a. Muscle relaxation
d. 50:1 b. Broncho-constriction
c. Shifting of blood from pulmonary to
48. Midazolam has now almost replaced systemic circulation
diazepam from anaesthesia practice d. Urinary retention
because:
a. It is cheaper 55. Opioid of choice for inhibiting stress
b. It is less potent response to laryngoscopy and intubation is:
c. Half- life is shorter than diazepam a. Morphine
d. Less respiratory depression b. Pentazocine
e. All of the above c. Alfentanil
d. Sufentanil
49. Not a property of ketamine:
a. Muscle relaxation 56. Which of the following has ceiling effect?
b. Raises intracranial tension a. Morphine
c. Bronchodilatation b. Fentanyl
d. Increased tracheobronchial secretions c. Buprenorphine
d. Pethidine
50. Ketamine is preferred agent for induction in
all except: 57. First to be blocked by muscle relaxants:
a. Tetralogy of Fallot a. Laryngeal muscles
b. Constrictive pericarditis b. Diaphragm
c. Cardiac tamponade c. Thenar muscles
d. Congestive heart failure d. Intercostals

50
 ANESTHIESA NOTES

c. d-Tubocurare
58. First to recover after muscle relaxants: d. Metocurine
a. Laryngeal muscles
b. Abdominal muscles 66. A short acting non-depolarizing agent is:
c. Diaphragm a. Mivacurium
d. Thenar muscles b. Atracurium
c. Succinylcholine
59. Muscle chosen for neuromuscular d. Vecuronium
monitoring is:
a. Laryngeal muscles 67. Hoffman degradation is shown by:
b. Adductor pollicis a. Mivacurium
c. Diaphragm b. Atracurium
d. Gastronemius c. Vecuronium
d. Pancuronium
60. Which of the following is the
neuromuscular blocking agent with the 68. Anaesthetic agent of choice in patient with
shortest onset of action? renal and hepatic failure:
a. Mivacurium a. Atracurium
b. Vecuronium b. Vecuronium
c. Rapacuronium c. Pipecuronium
d. Succinylcholine d. Cis-atracurium

61. Succinylcholine is used in anaesthesia for: 69. Vecuronium is better than pancuronium
a. Intubation because:
b. Maintenance of muscle relaxation a. It is cardiovascular stable
c. Both of the above b. It is cheaper
d. None of the above c. It is not cumulative even on prolonged
use
62. Not a systemic effect of succinylcholine: d. All of the above
a. Tachycardia
b. Hyperkalemia 70. Non depolarizer muscle relaxant of choice
c. Increased intracranial tension for intubation is:
d. Masseter spasm a. Vecuronium
b. Rocuronium
63. Not a contraindication of succinylcholine: c. Pancuronium
a. Recent burns d. Atracurium
b. Recent cerebral stroke
c. Recent crush injury 71. False about Rapacuronium:
d. Recent myocardial ischemia a. Derivative of Vecuronium
b. Early onset
64. Phase II blocker is: c. Short duration of action
a. Succinylcholine d. None of the above
b. Atracurium
c. Tubocurare 72. Regarding myasthenia gravis what is true
d. Pancuronium about sensitivity to curare and Scoline:
Curare Scoline
65. Muscle relaxant contraindicated in a. Decreased Increased
pregnancy: b. Decreased Normal
a. Gallamine c. Increased Increased
b. Atracurium d. Increased Decreased

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 ANESTHIESA NOTES

80. Which of the following agents is not used to

73. Cyclodextrin is provide induced hypotension during
a. reversal agent for muscle relaxants surgery?
b. I/v induction agent a. Sodium nitroprusside
c. alpha 2 agonist b. Hydralazine
d. local anesthetic c. Mephentermine
d. Esmolol
74. Most common cause of hypoxia in
postoperative period: 81. All are amide linked local anaesthetics,
a. V/Q mismatch except:
b. Hypoventilation a. Procaine
c. Hypotension b. Bupivacaine
d. Anemia c. Lidocaine
d. Dibucaine
75. All of the following are predisposing factors
for aspiration except: 82. Fibers first to be effected by local
a. Full stomach anaesthetics are:
b. Diabetes a. A gamma
c. Hypothyroidism b. B
d. Metoclopramide c. C
d. A alpha
76. During rapid sequence induction of
anaesthesia: 83. Which one of the following local
a. Sellik’s maneuver is not required anaesthetics is highly cardio-toxic -?
b. Preoxygenation is mandatory a. Lignocaine
c. Suxamethonium is CI b. Procaine
d. Patient is mechanically ventilated c. Mepivacaine
before endotracheal intubation d. Bupivacaine

77. Not a epileptogenic anaesthetic: 84. Maximum safe dose of xylocaine with
a. Methohexitone adrenaline:
b. Enflurane a. 3 mg/kg
c. Atracurium b. 4.5 mg/kg
d. Pancuronium c. 5 mg/kg
d. 7 mg/kg
78. All of the following cause malignant
hyperthermia, except: 85. Significant extra-hepatic metabolism is
a. Nitrous oxide shown by:
b. Halothane a. Prilocaine
c. Methoxyflurane b. Lignocaine
d. Isoflurane c. Bupivacaine
d. Ropivacaine
79. Anaphylactic reactions does not occur with
a. IV agents 86. The topical use of which local anaesthetic is
b. inhalational agents not recommended:
c. opioids a. Lignocaine
d. muscle relaxants b. Bupivacaine
c. Cocaine
d. Dibucaine

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 ANESTHIESA NOTES

87. EMLA cream contains: c. Intercostal

a. Xylocaine + Prilocaine d. caudal
b. Xylocaine + bupivacaine
c. Xylocaine + benzocaine 95. Beir’s block is:
d. Xylocaine + Dibucaine a. Subarachnoid block
b. IV regional block
88. Duration of action of xylocaine with c. Extradural block
adrenaline: d. Local anaesthesia
a. 1 hour
b. 2 hours 96. In infants spinal cord extends up to:
c. 5 hours a. L1
d. 7 hours b. L2
c. L3
89. Conc. of lignocaine for spinal d. S2
a. A.1%
b. B. 2% 97. Structures not pierced in lumbar puncture is
c. C. 3% a. Supraspinous ligament
d. D. 5 % b. interspinous ligament
c. Ligamentum flavum
90. False about Ropivacaine: d. Posterior longitudinal ligament
a. Less cardiotoxic than bupivacaine
b. More cardiotoxic than lignocaine 98. High spinal anaesthesia is characterized by:
c. Contains only one (S) enantiomer a. Hypertension, tachycardia
d. More potent than bupivacaine b. Hypertension, bradycardia
c. Hypotension, tachycardia
91. Chassaignac tubercle is landmark for: d. Hypotension, bradycardia
a. Stellate ganglion block
b. Gasserian ganglion block 99. Maximum incidence of post spinal
c. Brachial plexus block headache will be with which needle:
d. Cervical plexus block a. Quincke-Babcock
b. Whitcre
92. All of the following are signs of successful c. Sporte
Stellate ganglion block, except: d. Pitkin
a. Guttmann sign
b. Horner syndrome 100. Factor which does not affect the level
c. tachycardia (height) of block in spinal anaesthesia:
d. Nasal stuffiness a. Dose
b. Baricity
93. Highest incidence of pneumothorax occurs c. Position
when brachial plexus is blocked by which d. Direction of needle
route:
a. Interscalene 101. In all of the following conditions neuraxial
b. Supraclavicular blockade is absolutely contraindicated,
c. Beirs block except:
d. Axillary a. Patient refusal
b. Coagulopahty
94. 94. From which route there is maximum c. Severe hypovolemia
absorption of LA: d. Preexisting neurological deficits
a. epidural
b. brachial

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 ANESTHIESA NOTES

102. Which one of the following anaesthetic d. ARDS

agents causes a rise in intracranial
pressure? 109. The sequence of management in cardiac
a. Sevoflurane arrest is:
b. Thiopentone sodium a. A (airway)> B (breathing) > C
c. Lignocaine (circulation)
d. Propofol b. B> C > A
c. C >A > B
103. The most common cause of death of d. A > C > B
mother undergoing emergency caesarean
section when general anaesthesia is being 110. Ratio of compression to breathing with
administered is: two resuscitators during bag and mask
a. Overdose of inhalational anaesthetic ventilation
b. Circulatory failure a. 5:1
c. Acid aspiration of gastric contents b. 15:1
d. Renal failure c. 15:2
d. 30:2
104. Route of administration of patient
controlled analgesia is: 111. Identify the cylinder:
a. Oral
b. Epidural
c. Intravenous
d. Intramuscular

105. Visual analogue scale is most commonly

used to measure:
a. Sleep
b. Sedation
c. Pain intensity
d. Depth of anaesthesia a. Air
b. Nitrous oxide
106. Which of the following is excluded from c. Entonox
day care surgery? d. Heliox
a. Newborn
b. Very old (more than 80 years) 112. The 1, 2, 3, 4 in the following diagram
c. Both represents:
d. None

107. The intra-abdominal pressure (IAP) during

laparoscopy should be set between:
a. 5-8 mmHg
b. 10-15 mmHg
c. 20-25 mmHg
d. 30-35 mmHg

108. Ventilatory support is indicated in all,

except: a. Pin index system
a. 40-60 ml/kg vital capacity b. Diameter index system
b. RR > 35/min c. Pressure reducing valves
c. pO2< 60 mmHg and pCO2 > 60 mmHg d. Flow control valves

54
 ANESTHIESA NOTES

113. The yellow is vaporizer of: 116. It is:

a. Classical LMA
b. Proseal LMA
a. Sevoflurane c. Intubating LMA
b. Desflurane d. I-gel
c. Halothane
d. Isoflurane 117. The cuff of the following tube is:

114. It is used for:

a. Prevent aspiration
b. Prevent tongue fall a. Low pressure
c. Prevent tongue bite b. High pressure
d. Assist in intubation c. Intermediate pressure
d. None of the above
115. This laryngoscope is:
118. The following equipment is used for:

a. Mccoy a. Humidification
b. Macintosh b. Filtration of dust
c. Miller c. Decrease dead space
d. Magill d. None of the above

55
 ANESTHIESA NOTES

119. The fresh gas flow for the following circuit:

Adjustable pressure limiting valve (expiratory valve)

Fresh gas inlet

Machine end Patient end

Mask

Breathing bag

Fresh gas flow

Expired gases

a. Equal to minute volume

b. Twice
c. Thrice
d. 4 times

120. Not a character of the following circuit

Inspiratory tubing

Soda lime
Pressure relief valve canister
Mask

Expiratory tubing

Breathing bag

a. Economical
b. less pollution
c. Less flow required
d. Safe with trielene

56
 ANESTHIESA NOTES

ONE LINERS

EQUIPMENTS
1. Color of oxygen cylinder is black with white shoulders- True/False
2. The pressure in Entonox cylinder is 760 psi- True/False
3. Central supply of oxygen is at________
4. Rotameter has straight tubes- True/False
5. Anesthesia machine can accommodate only one vaporizer- True/False
6. Fresh gas from machine outlet is delivered at a pressure of ________
7. Minimum percentage of oxygen require in fresh gas flow is 50%- True/False
8. Fresh gas flow required for Bain circuit _________ to minute volume
9. Mapleson E is the most commonly used pediatric circuit- True/ false
10. Fresh gas flow required in closed circuit is equal to minute volume - true/false
11. Trielene can produce carbon monoxide with sodalime- true/false
12. Closed circuit is suitable for spontaneous ventilation- true/false
13. Heat and moisture exchanger is used for ___________
14. Oxygen delivery can be best controlled with Mc Cartney mask – true/false
15. Laryngeal mask airway is definite method of airway. True/false
16. I- gel is kind of __________
17. Endotracheal tube increases the dead space- True/ False
18. Mcoy is the most commonly used laryngoscope for infants. True/false
19. For adult females generally 9 no. endotracheal tube is used. True/false
20. Robertshaw tube is best for ___________(Neuro/Cardiac/Thoracic surgery)
21. Endotracheal tube is best sterilized with ____________
22. Maximum time for which an endotracheal tube can be kept_________
23. Nasal tube is preferred over oral tube for awake intubation. True/false

PHYSIOLOGY
1. Choosing small size tube is important in children. True/false
2. Alveolar dead space is reduced in General Anesthesia. True/false
3. Maximum resistance to airflow occurs in trachea. True/false
4. During GA, functional residual capacity increase. True/false
5. Hypoxia causes vasodilatation in all body vessels except ______________ while hypercarbia
causes vasoconstriction in all body vessels except___________________

FLUIDS
1. Colloids are preferred for shock. True/false
2. All colloids are hypertonic. True/false
3. 500 ml blood loss should be replaced with________ ml of ringer lactate
4. 5% dextrose is best fluid for maintenance during GA. True/false
5. One unit of blood increases Hb by _______
6. Autologus blood transfusion is absolutely contraindicated for sickle cell patients. True /false
7. Haes-steril is available in 20% strength. True/false

PREOPERATIVE ASSESMENT
1. Normal breath holding time ______

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 ANESTHIESA NOTES

2. Normal Thyromental distance __________

3. Mallampati grade II means oral intubation is impossible. True/false
4. ASA grading is related to the outcome of anesthesia. True/false
5. Aspirin should be stopped 48 hours before surgery. True/false
6. Warfarin should be stopped _________ days before surgery
7. All hypertensives has to continued before surgery. True/false
8. All patients must be premedicated with Metoclopramide and ranitidine. True/false
9. As herbal medications has no side effect so they can be safely continued before surgery.
True/false
10. As an antisecretory agent Glycopyrrolate is preferred over atropine. True/false

MONITORING
1. EEG is most reliable to see the depth of analgesia. True/false
2. Latest pulse oximeters functions normally in presence of Methhemoglobinemia. True/false
3. Normal end tidal carbon dioxide _________
4. End tidal carbon dioxide is increased in cardiac arrest. True/false
5. Fading on train of four can be seen in high doses of Suxamethonium. True/false
6. Hypothermia means core body temperature less than_______
7. Best site for measuring core body temperature is pulmonary artery. True/false
8. Depending on the severity ETCO2 may decrease or increase in bronchospasm. True/false
9. Best monitor to detect intraoperative infarction______________
10. Pulmonary artery occlusion pressure is less than pulmonary capillary wedge pressure.
True/false
11. Gold standard method for blood pressure monitoring___________
12. Best clinical monitor to assess the cardiac output________

INHALATIONAL AGENTS
1. Inhalational agent with fast induction should have high blood solubility- True/false
2. Minimum concentration of oxygen in anesthesia mixture should be_______
3. Minimum alveolar concentration is directly proportional to potency. True/false
4. Lesser the age more will be the MAC. True/false
5. Lowest blood coefficient is of xenon. True/false
6. Second gas effect increases the requirement of inhalational agents. True/false
7. Inhalational agent not metabolized in human body is__________
8. Desflurane is an excellent agent for cardiac patients. True/false
9. Halothane is agent of choice in asthmatics. True/false
10. Desflurane has least fluoride content. True/false
11. Isoflurane is an excellent analgesic. True/false
12. Isoflurane is the agent of choice for neurosurgery. True/false
13. Agent of choice for shock patient in modern anesthesia is __________
14. Like nitrous oxide Xenon also causes diffusion hypoxia. True/false
15. Nitrous oxide is contraindicated in patients with pneumothorax because it is ______ soluble
than nitrogen
16. Halothane causes hepatitis because it produces bromide which directly deposit in liver cells.
True/false
17. Pheochromocytoma patients can safely receive halothane. True/false

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 ANESTHIESA NOTES

18. Isoflurane can safely used for induction in children. True/false

19. The modern day inhalational anesthetic causing seizures________
20. The MAC of Desflurane is _______ than Sevoflurane
21. Desflurane is most preferred for obese because it is least metabolized. True/false
22. Ether is obsolete because it is inflammable. True/false
23. Desflurane is considered as complete anesthetic. True/false
24. Trielene should not be used with soda lime as it can produce carbon monoxide. True/false

INTRAVENOUS AGENTS
1. Percentage of thiopentone used in induction_______
2. Acidity of thiopentone is responsible for local complications. True/false
3. Thiopentone is good analgesic. True/false
4. Pentothal when injected into vein is ___________ and when injected into artery is________
Injection of Propofol is ________ (painful/painless)
5. Dose of propofol for induction in anaesthesia is_______
6. The incidence of nausea and vomiting after Propofol is 5-7%. True/false
7. Propofol causes more apnea and more hypotension than thiopentone. True/false
8. IV anesthetic ________ causes Adrenocortical depression
9. Midazolam produces ____________ amnesia
10. ketamine is the agent of choice for full stomach patients because it decreases intragastric
pressure. True/false
11. Ketamine produces good muscle relaxation. True/false
12. incidence of hallucinations after ketamine is________
13. Ketamine is preferred agent for myocardial infarction patients. True/false
14. Ketamine __________ (increases/decreases) shunt fraction in tetrology of fallot
15. Respiratory depression of morphine is mediated by _____ receptors:
16. Pentazocine is agonist at ______ and antagonist at__________ receptors
17. Delayed respiratory depression following epidural opioid is seen with all agonist. True/false
18. Sufentanil is the shortest acting opioid true/false
19. Popofol is contraindicated for egg allergy patients. True/false

MUSCLE RELAXANTS
1. Diaphragm is the first to be blocked by muscle relaxants – True/false
2. ____________is the shortest acting muscle relaxant.
3. Pseudocholinesterase is synthesized in ___________
4. Hyperkalemia is the most prominent effect of succinylcholine- True/false
5. Incidence of muscle soreness (myalgia) after Suxamethonium__________
6. Myasthenia gravis is absolute C/I for Suxamethonium- True/false
7. Atracurium doesn’t release histamine- True/false
8. Mivacurium is metabolized by pseudocholinesterase- True/false
9. Rocuronium is most cardiovascular stable- True/false
10. Lifting of head for > 5 seconds hundred percent confirms the recovery from muscle
relaxants- True/false
11. Gantacurium is shortest acting non depolariser- True/false
12. Cyclodextrin reverses both steroids and benzylisoquionlones- True/false
13. Cisatracurium doesn’t produces laudanosine- True/false

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 ANESTHIESA NOTES

14. Hypomagnesemia prolongs neuromuscular block True/false

COMPLICATIONS OF GA
1. Maximum complications during anaesthesia are reported at the time of induction-
True/false
2. Most common type of hypoxia seen during anaesthesia is hypoxic hypoxia- True/false
3. Most common cause of hypoxia in postoperative period is hypoventilation- True/false
4. Critical gastric pressure for aspiration is___________
5. Most common nerve injured during anaesthesia is Femoral- True/false
6. Hypotension is the most common complication in post- operative period- True/False
7. Halothane is the most commonly implicated drug for malignant hyperthermia- True/false
8. Most common cause of death in malignant hyperthermia is hyperthermia- True/false
9. Malignant hyperthermia is because of abnormality of_______________ channel
10. Alderate scale score is for ______________
11. Bradycardia is the most common rhythm disturbance during post- operative period-
True/false
12. Inhalational agents are the most common cause of anaphylactic reactions during
intraoperative period- True/false
13. Perioperative mortality is defined as death within______ hours of surgery
14. Maximum cardiac arrests occurring during induction- True/false

LOCALANESTHETICS
1. 1.Duration of local anesthetic is inversely proportional to its potency- True/false
2. Ester linked local anesthetics exhibits high incidence of allergic reactions as compared to
amide link- True/false
3. Local anaesthetics only acts on sodium channel- true/false
4. Bupivacaine is ________ (less/more) toxic than Ropivacaine
5. A local anesthetic will act fast in acidic atmosphere- True/false
6. Concentration of adrenaline used with local anaesthetic- 1:_________
7. Maximum safe dose of xylocaine with adrenaline__________
8. The xylocaine and xylocard are differentiated on the basis of concentration- True/false
9. CVS is more sensitive than CNS in local anesthetic toxicity- true/false
10. Addition of adrenaline to bupivacaine increases both sensory and motor block- True/false
11. Concentration of lignocaine used for Beir’s block_________
12. _________ is the drug of choice for ventricular arrhythmias induced by bupivacaine:
13. Ropivacaine is a better vasodilator than bupivacaine- True/false
14. Levobupivacaine and bupivacaine are equipotent in terms of cardiotoxicity- True/false

NERVE BLOCKS
1. Chassaignac tubercle is landmark for__________________ block
2. Highest incidence of pneumothorax occurs when brachial plexus is blocked by Interscalene
approach- true/false
3. Maximum systemic absorption of Local Anesthetic occurs after __________ nerve block
4. ____________nerve is usually spared with axillary approach.
5. Both bupivacaine and lignocaine are safe in Beirs block- True/false
6. In infants spinal cord extends up to______

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 ANESTHIESA NOTES

7. CSF is present between______________ and _____________

8. Like local anesthetics opioids also acts on nerve roots- true/false
9. Cardioaccelerator fibers are ___________
10. Concentration of lignocaine used for spinal anaesthesia______
11. Dextrose is added to lignocaine for spinal to increase the potency- true/false
12. A hypobaric solution will produce ___________ (higher/lower) level (height) of block in
spinal anaesthesia
13. After spinal a pregnant patient achieves the higher level than a non- pregnant patient-
true/false
14. Post spinal headache is __________ (high/low) pressure headache
15. Comparing the incidence of post spinal headache with 22G and 25G needle it will be less
with _________
16. Commonest cranial nerve affected in spinal anaesthesia________
17. Raised ICT is an absolute C/I for spinal as well as epidural- true/false
18. Patients on Aspirin can safely receive spinal- true/false
19. Epidural space has __________ (negative/positive/no) pressure in majority of individuals:
20. Epidural produces _________ (more/less/same) hypotension than spinal
21. Caudal block is a kind of____________(spinal/epidural)
22. Broken epidural catheter should be removed immediately – true/false
23. Heparin can be restarted safely _______ hours of spinal anesthesia

SUBSPECIALTY MANAGEMENT
1. Positive pressure ventilation _____________ (increases/decreases) intracranial tension
2. Transesophageal echo (TEE) is the most sensitive investigation to detect venous air
embolism- true/false
3. When giving spinal for cesarean section the dose of local anesthetic is ____________
(increased/decreased/ remains same)
4. All pregnant patients irrespective of their fasting status should be managed by rapid
sequence induction- True/false
5. For painless labour, level of block should be up to_______
6. Subglottis is the narrowest part in children up to the age of_____
7. In the absence of Sevoflurane, Desflurane is the most preferred method for induction in
pediatric patients- True/false
8. MAC of inhalational agents decreases by 1/3 in obese patient- true/false
9. Visual analogue scale is used to measure the intensity of pain- True/false
10. For neurolytic xylocaine is most frequently used drug- true/false
11. Children less than 3 years of age can’t be considered for day care surgery- True/false
12. Most ideal gas for laparoscopy is__________
13. Allodynia means complete absence of pain- True/false
14. Mitral stenosis patients can safely receive spinal- True/false
15. Halothane is the induction agent of choice in asthma- True/false
16. Isoflurane decreases the ICT- True/false
17. Most common cause of death in perioperative period in diabetic patient is hypoglycaemia-
True/false
18. Minimum acceptable haemoglobin for elective surgery is ________
19. The analgesic requirement of children is _________ (less/more/same) as of adult.

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 ANESTHIESA NOTES

20. Angiotensin II antagonist should be stopped 48 hrs prior to surgery- True/false

21. Laparoscopy should be avoided in children less than 10 years of age- True/false
22. Halothane causes more uterine relaxation than isoflurane- True/false

CRITICAL CARE
1. In type II respiratory failure CO2 is _______ (high/low/normal)
2. Volume ventilators are less prone to cause hypoventilation than pressure ventilators-
True/false
3. During Positive pressure ventilation blood pressure is ____________ (increased/decreased/
not effected)
4. Amino acids should provide 20-25% of energy requirement during parental therapy-
True/false
5. ARDS is characterized by ______ po2 while pco2 may be high, low or normal
6. Majority of infection in mechanically ventilated patient are acquired through pulmonary
route – True/false
7. Defibrillation with automatic external defibrillators (AED) is the part of advanced life
support- true/false
8. End point to stop CPR is return of sinus rhythm- true/false
9. Mouth to mouth breathing is recommended for all patients with absent breathing-
true/false
10. Ratio of compression to breathing with two resuscitators during bag and mask ventilation
is __________
11. Sternum should be depressed by ....... in adults while doing cardiac massage
12. Amiodarone can be used for ventricular as well as supra-ventricular tachycardia- true/false
13. 12.Intraosseous access for drug/fluid administration is recommended only up to 6 years for
age- true/false
14. First shock to revert ventricular fibrillation________
15. 1: ___________ is the concentration of adrenaline for CPR:
16. For cerebral protection hypothermia should be instituted for all cardiac arrests- True/false
17. As per new guidelines al ARDS patients must receive low tidal volume- True/false

62