ANESTHESIA

 most commonly used technique for induction of general anesthesia in CHILDREN:

— Inhalational

 What inhalational agent has the FASTEST SPEED of induction, high minimal alveolar concentration,
and low potency?
— Nitrous oxide (NO2)

 Name the only DEPOLARIZING PARALYTIC

— Succinylcholine

 most common side effect of PANCURONIUM:

— Tachycardia (vagolytic effect)

 Most feared side effect of BUPIVACAINE (Marcaine) after intravascular injection:

— Fatal refractory dysrhythmia

 Earliest symptom of LIDOCAINE TOXICITY:

— Perioral numbness or tingling of the tongue are early symptoms. This may progress to
lightheadedness and visual disturbances
— CNS-related symptoms are more common and occur before cardiovascular-related symptoms
such as cardiac arrhythmias and arrest.

 Severe signs seen with a large overdose of LIDOCAINE:

— Tonic-clonic seizures, unconsciousness, and eventually coma (cardiovascular toxicity less
common)

 Major advantage of EPIDURAL ANESTHESIA:

— Analgesia without decreased cough reflex

 What is the BEST DETERMINANT of esophageal versus tracheal intubation?

— Disconnection from ventilator, kinking of ETT, pulmonary embolism (PE), significant hypotension,
CO2 embolus

 Treatment for HYPOTENSION from epidural anesthesia:

— Turn down epidural dose, IV fluids, and phenylephrine

 MORPHINE in an epidural can contribute to this untoward effect:

— Respiratory depression

 LIDOCAINE in an epidural can contribute to these untoward effects:

— Bradycardia and hypotension

 In patients on MONOAMINE OXIDASE INHIBITORS, the concurrent use of narcotics can cause:
— Hyperpyrexic coma

 HISTAMINE RELEASE is characteristic of this narcotic:

— Morphine
 Name of the metabolite of DEMEROL that can cause seizures:
— Normeperidine

 Overdose of NARCOTIC can be treated with this drug:

— Narcan

 Which benzodiazepine (BZ) is CONTRAINDICATED IN PREGNANCY because it crosses the placenta?

— Versed (midazolam)

 Competitive inhibitor of BZs that can be given to treat an OVERDOSE:

— Flumazenil

 How is CISATRACURIUM metabolized?

— Hofmann elimination

 How is MIVACURIUM metabolized?

— Hydrolyzed by plasma cholinesterase

 Maximum dose of lidocaine without epinephrine? Lidocaine with epinephrine (1:100,000)?

— 5 mg/kg (remember 1% of drug = 10 mg/mL) 7 mg/kg

 Where is LIDOCAINE WITH EPINEPHRINE contraindicated?

— Fingers, penis, nose, pinna of ear, and toes (vasoconstriction can lead to ischemia/necrosis)

 Which inhalational agent can cause EOSINOPHILIA, fever, increased liver function tests, and jaundice
and is associated with the highest degree of cardiac depression and arrhythmias?
— Halothane

 Which inhalational agent has a PLEASANT SMELL and is ideal for mask induction in CHILDREN?
— Sevoflurane

 What induction agent should not be used in patients with an EGG ALLERGY?
— Propofol

 What induction agent is contraindicated in HEAD INJURY?

— Ketamine

 Which induction agent can cause ADRENOCORTICAL SUPPRESSION with continuous infusion?
— Etomidate

 First muscle to be PARALYZED after administration of a paralytic? Last muscle?

— Face and neck muscles
— Diaphragm

 First muscle to RECOVER after administration of a paralytic? Last muscle?

— Diaphragm
— Face and neck muscles
 TRIGGERING AGENTS for malignant hyperthermia:
— Volatile anesthetics (halothane, enflurane, isoflurane, sevoflurane, desflurane) and depolarizing
paralytic succinylcholine

 What is the mechanism leading to MALIGNANT HYPERTHERMIA?

— Mutation of the ryanodine receptors located on the sarcoplasmic reticulum resulting in a drastic
increase in intracellular calcium levels inducing an uncontrolled increase in skeletal muscle
oxidative metabolism

 First sign seen with MALIGNANT HYPERTHERMIA?

— Increase in end-tidal CO2
— Other signs: Acidosis, fever, hyperkalemia, rigidity, tachycardia

 Treatment for MALIGNANT HYPERTHERMIA:

— First stop offending agent, cooling blankets, dantrolene (10 mg/kg IV), glucose, HCO3, IV fluids,
supportive care

 What is the optimal distance above the carina for an ENDOTRACHEAL TUBE (ETT)?
— 2 cm above the carina”

 Define MINIMUM ALVEOLAR CONCENTRATION (MAC):

— The smallest concentration of gas at which 50% of patients will not move to painful stimuli such as
incision

 Relate lipid solubility, speed of induction, and potency for an inhalational agent with a LOW MAC:
— Low MAC means that the agent is more lipid-soluble and more potent but slower speed of
induction
MCQ: ANESTHESIA

1. Which of the following drugs should be avoided in patients with inherited atypical pseudocholinesterase?
A. Succinylcholine
B. Cisatracurium
C. Pancuronium
D. Rocuronium

2. Which of the following drugs may trigger malignant hyperthermia?

A. Sevoflurane
B. Midazolam
C. Etomidate
D. Ketamine

3. While providing local anesthesia in a 60-kg patient, what is the maximum volume of lidocaine 1% that can
be used?
A. 20 cc
B. 30 cc
C. 60 cc
D. 80 cc

4. Local anesthetics act on which of the following to block nerve conduction?

A. Na+ K+ 2Cl– transporter
B. H+ K+ ATPase
C. Calcium channel
D. Sodium channel

5. Spinal and epidural block all of the following nerves except which of the following?
A. Parasympathetic nerves
B. Sympathetic nerves
C. Sensory nerves
D. Motor nerves

6. What is the common mechanism for neuromuscular blockade reversal agents?

A. Increased metabolism of the neuromuscular blocking agent
B. Increased resistance to the neuromuscular blocking agent
C. Increased concentration of acetylcholine at the neuromuscular junction
D. Efflux of the neuromuscular blocking agent from the axon

7. Select the inhalational agent with the lowest potency and fastest onset from among the following:
A. Desflurane
B. Sevoflurane
C. Nitrous oxide
D. Halothane
8. Which of the following local anesthetic agents is least likely to cause an allergic reaction?
A. Chloroprocaine
B. Lidocaine
C. Cocaine
D. Benzocaine

9. Which of the following is associated with an abrupt drop in exhaled carbon dioxide to zero in an intubated
patient?
A. Atelectasis
B. Flash pulmonary edema
C. Circuit disconnection
D. Hypoxia

10. A 54-year-old male is intubated and general anesthesia is induced. After 2 minutes, his pulse oximeter
reads 93%, systolic blood pressure decreases to 40 mm Hg, and his heart rate decreases to 35 bpm. Which of
the following is the next best step?
A. Synchronized cardioversion
B. Place the patient in Trendelenberg position with the left side down
C. Assess ETT placement
D. Rapid IV push of α agonist
E. Administer atropine followed by epinephrine

11. A 60-year-old man undergoes an elective right carotid endarterectomy under a cervical plexus block with
bupivacaine. Five seconds after injecting lidocaine 0.5% into the carotid bulb to decrease blood pressure
lability, the patient becomes unresponsive and experiences a generalized tonic-clonic seizure particularly of
the right side lasting 30 seconds. What is the most likely cause for the seizure?
A. Overdose from bupivacaine cervical plexus block
B. Cerebral ischemia from embolized plaque
C. Intraarterial injection of lidocaine
D. Development of new-onset seizure disorder