Anesthesia

Historical Milestones

1. First local anaesthetic used is cocaine.

2. Intubationlvan Magill.
3. World anaesthesia day 16th October.
4. Balanced anesthesiadohn Lundy&Ralph M. Waters.
5. First muscle relaxant D-tubo curare.

Preoperative Assessment, Premedication &

Monitoring

Preoperative Assessment
1. Mala-D should be stopped 4 weeks before hysterectomy.
2. Smoking should preferably be stopped8 weeks before surgery.
3. Aspirin should not be stopped now a day.
4. Clopidogrel to be stopped7 days before surgery.
5. Urgent reversal of warfarin therapy can be done by administration of fresh
frozen plasma.

Premedication
1. Atropine decreases salivation and cause bronchodilatation.
2. Dose of atropine per kg body weight is 0.01 mg.
3. Flushing of face is encountered in children following premedication occurs
with Atropine.
4. Dose of glycopyrrolate for premedication on per kg body weight is 0.005
mg.
5. The amnesia produced by midazolam is Antegrade Amnesia.
6. Drug acts through alpha subunit of GABA receptor Benzodiazepine.

Temperature Monitoring
1. Core body temperature It is one degree higher than rectal temperature.
2. Brain temperature is most accurately measured through Tympanic
membrane.
3. Hypothermia may be defined as core body temperature less than 35°C.
4. For each degree fall in temperature below 37°C cerebral blood flow
decrease by 7%.
5. A 10°C decrease in temperature causes decrease in cerebral metabolic rate
by 70%.
6. Optimal operation theatre temperature should be 21°C.
7. Neuromuscular monitoring during maintenance of anaesthesia is Train of
four.
8. Intraoperative myocardial infarction is best diagnosed by Trans esophageal
echocardiography.
9. During blood pressure monitoring deflation rate of cuff should be 3-5
mmHg/sec.
10. Blood pressure during anaesthesiais monitored commonly by Radial artery.
11. Pulse oximeter measures Oxygen saturation of arterial blood.
12. Somatosensory evoked potential will be very useful during Aneurysm
clipping of thoracic aorta.
13. Vein of choice for central venous pressure monitoring is Right internal
jugular.
14. Most commonly used muscle for neuromuscular monitoring is Adductor
pollicis.
15. During anaesthesia, Brainstem evoked response is least affected.
16. Depth of anaesthesia is measured by Bispectral index.
17. Monitoring of concentration of exhaled CO2- Capnography.
18. Torr can be used as measuring unit in place of mmHg for the measurement
of Gaseous pressure.
19. Noninvasive cardiac output monitoring is by Thoracic Bioimpedance.
 20. Best lead to detect ischemia during anaesthesia monitoring Lead V5.
21. CO2 is primarily transported in the arterial blood asBicarbonate.
22. In a patient with mild hypertension which is not effecting his functional
activity will be classified asASA II.
23. Test to demonstrate the presence of collateral circulation of hand is Allen's
test.
24. Full soaked sponge indicates blood loss of 100 ml.
25. Sudden decrease in end tidal CO2 under GA suggests Accidental
extubation.

General Anaesthesia

1. Percentage of thiopentone used in induction 25%.

2. pH ofThiopentone is alkaline (pH=10.5).
3. Thiopentone does not cause Analgesia.
4. Thiopentone crosses the placenta very quickly.
5. Pentothal sodium should be injected into veins over the outer aspect of
forearm'.
6. Accidental intra-arterial injection of thiopentone causes Vasospasm.
7. Hyperkalemic periodic paralysis is not a contraindication of thiopentone.
8. In epilepsy patents Thiopentone can be given safely.
9. Thiopentone can be used safely in Porphyria cutanea tarda.
10. Short half- life of thiopentone is due to Redistribution.
11. Intravenous anaesthetic of choice for electroconvulsive therapy
Methohexitone.

Propofol
1. Propofol intravenous injection causes pain.
2. Propofol is nota Water based preparation.
3. Propofol vial once opened should be used within 6 hours.
4. Agent of choice for day care surgery isPropofol.

Etomidate
1. Etomidate has High incidence of nausea and vomiting.
2. Cardio stable anaesthetic Etomidate.
3. Intravenous Anaesthetic agent safe in heart disease Etomidate.
Ketamine
1. Intravenous dose of ketamine is 2 mg/kg.
2. Anaesthetic agent which can be given by both intravenous and
intramuscular routes Ketamine.
3. Ketamine has a very High analgesic effect.
4. Muscle relaxation is not a property of ketamine.
5. Intravenous agent of choice for uncontrolled asthmatics is Ketamine.
6. Ketamine Increased intracranial tension.
7. Ketamine specifically avoided in patients with head trauma.
8. Intravenous agent has two steroids in structureAlthesin.
9. The incidence of hallucinations after ketamine40%.
10. Most common type of hallucinations after ketamine Auditory.
11. Agent of choice for decreasing hallucinations after ketamine isMidazolam.
12. Ketamine most appropriate choice for Hypothyroidism.
13. Increased cerebral 02 consumption is cause by Ketamine.

Benzodiazepines
1. Inverse agonist of benzodiazepine receptor is Beta-carboline.
2. Not an effect of benzodiazepines Analgesia.
3. In neuroleptanalgesiadroperidol and fentanyl are in ratio of 50: 1.
4. Muscle relaxation will be seen with Midazolam.
5. Post anaesthetic delirium is treated by Diazepam.
6. Decrease gastric emptying time Diazepam.
7. The specific antagonist for benzodiazepines is Flumazenil.
8. Reversal of which benzodiazepine is most, difficult isLorazepam.
9. Amnesia Not fully reversed with flumazenil.
10. The chances of resedation after flumazenil antagonism are minimum
withMidazolam.

Dexmedetomidine
1. Dexmedetomidine is used as an adjuvant
Opioids
1. Narcotic of choice for outpatientanaesthesia is Remifentanil.
2. The mu (p) opioid receptor is responsible for bronco constriction.
3. Opioids in spinal cord acts on Dorsal horn cells.
4. Most common cause of death in morphine poisoningRespiratory
depression.
5. Morphine Increases intracranial tension.
6. Muscle relaxation Not a property of opioids.
7. Morphine is relatively contraindicated in Biliary colic.
8. Sufentanil opioid has maximum plasma protein binding capacity.
9. Fentanyl is used to produce epidural analgesia.
10. Late medullary depression following epidural anaesthesia may be caused
by Morphine.
11. Dose of morphine for epidural analgesia is3-5 mg.
12. In morphine epidural anaesthesia, analgesic effect last for 6-12 hours.
13. Opioid which can cause convulsions is Pethidine.
14. Pethidine should not give with MAO inhibitors.
15. Meperidine less spasmogenic action than morphine.
16. Bradycardia is not seen with Pentazocine.
17. Sufentanil is potent opiod.
18. Opioid of choice for inhibiting stress response to laryngoscopy and
intubation is Sufentanil.
19. Shortest acting intravenous analgesic Remifentanil.
20. Analgesic 100 times potent than morphine is Fentanyl.
21. Buprenorphine has ceiling effect
22. Minimum respiratory depression is caused by Pentazocine.
23. Naloxone does not completely reverse the actions of Buprenorphine.

Inhalational Anesthesia
1. Stage of surgical anaesthesia is Stage III plane 3.
2. The stage of surgical anaesthesia is best indicated by Regular respiration.
3. Nystagmoid eye movement are seen in stage of anaesthesia is Stage II.
4. Dissolved oxygen and total oxygen content in the plasma of the patient will
be, and when he is breathing 100% oxygen (i.e., FIO2 = 1.0) at normal
atmospheric pressure (1 atm)1.7 ml/dl and 21.2 ml/dl.
5. Lacrimation during anaesthesia indicates Light anaesthesia.
6. Stages of anaesthesia were described by Guedel.
7. Stages of anaesthesia were established with Ether.
8. First reflex to goEyelash.

Minimum alveolar concentration (Mac)

1. Blood gas partition coefficient of anaesthetic agent te'ls about Time lag of
induction of anaesthesia.
2. Potency of anaesthetic agent can be estimated by Minimal alveolar
concentration.
3. Minimum oxygen concentration used in anaesthetic mixture to maintain
oxygenation is25%.
4. Blood gas partition coefficientSevoflurane>desflurane.
5. Second gas effect is classically seen with Halothane and nitrous oxide.
6. Inhalational agents are fluorinated to Make them non inflammable.

N2O (Nitrous Oxide)

1. Nitrous, oxide Fast induction.
2. Non inflammable agent is Nitrous oxide.
3. Highest minimum alveolar concentrationNitrous oxide.
4. Least potent inhalationalanaesthetic isNitrous oxide.
5. Diffusion hypoxia is caused byN2O.
6. Diffusion hypoxia is seen during Post-operative period.
7. Inhalational agent not metabolized by human body Nitrous oxide.
8. Subacute degeneration of spinal cord is seen with Nitrous oxide.
9. Nitrous oxide is more soluble than nitrogen.
10. Anaesthetic agent contraindicated in volvulus of gut Nitrous oxide.
11. Bone marrow depression is caused by prolonged administration of Nitrous
oxide.
12. Nitrous oxide is not Safe in middle ear surgery.

Halothane
1. Side effect of halothane countered by atropine is Bradycardia.
2. The anaesthetic agent that is Cl in the presence of jaundice Halothane.
3. Malignant hyperthermia is caused by Halothane.
4. Halothane is not recommended for obstetric anaesthesia.
5. Thymol is preservative used for Halothane.
6. Halothane: Beta blocker action.
7. True about halothane is Colorless liquid stored in amber colour bottles
8. Anaesthetic agent that predisposes maximum to arrhythmias is Halothane.
9. Tissue blood solubility coefficient of halothane is greatest in human Fat.
10. Anaesthetic agent maximally absorbed by PVC endotracheal tube
Halothane.
11. Halothane is a poor analgesic.
12. Shivering is observed in early part of post- operative period due to
Halothane.
13. Most acceptable theory for halothane hepatitis Immunologic.
14. Minimum interval between two halothane exposure should be3 months.
15. Increase in intracranial tension is maximum with Halothane.
16. The anaesthetic agent which dissolves in rubberis Halothane.
17. Smooth induction can be given byHalothane.
18. Halothane inhibits hypoxic pulmonary vasoconstriction in a dose related
fashion.
19. Halothane is hepatotoxic.
20. For surgery of pheochromocytoma, Halothane should not be used.
21. Halothane decreased portal flow most.

Isoflurane
1. Agent of choice for cardiac patient is Isoflurane.
2. Maximum vasodilatation is caused by Isoflurane.
3. Least alteration of cardiovascular status is seen with Isoflurane.
4. Isoflurane increases intracranial tension.

Enfiurane
1. Spike and wave pattern in EEG is shown by Enfiurane.
2. Maximum decrease in cardiac output is caused1 by Enfiurane.
Desflurane
1. The fastest acting inhalational agent is Desflurane.
2. Desflurane minimally metabolized.
3. In Desflurane rapid induction of anaesthesia occurs.
4. Desflurane: Inhaled anaesthetic of choice for shock.
5. Induction is not smooth with desflurane.
6. Desflurane is structural analogue of isoflurane
7. The anaesthetic agent of choice in renal failure Desflurane.

Sevoflurane
1. Maximum bronchodilatation in non- asthmatics is produced bySevoflurane.
2. Induction agent of choice in childrenSevoflurane.
3. Sevoflurane degradation to compound A is increased by Use of beryline
instead soda lime.
4. Sevoflurane is more cardio depressant than Isoflurane.

Methoxyflurane
1. Slowest induction and recovery is with Methoxyflurane.
2. Methoxyflurane cannot be used in patients suffering from the renal
disease, Nephrotoxicity is caused by Methoxyflurane.
3. Methoxyflurane has boiling point more than water.
4. Methoxyflurane is maximally metabolized.

Ether
1. Highly inflammable Ether.
2. Ether is not used in modern surgical practice because it is Highly explosive.
3. Ether does not inhibit the ciliary activity.
4. Ether is the complete anaesthetic agent.
5. Maximum emesis causing anaesthetic is Diethyl ether.

Complications of General Anaesthesia

1. Preventable complication during inhalational anaesthesia Aspiration.
2. Complication of inhalational anaesthesia in post- operative period is
Hypotension.
3. Foreign body in supine position causes part of the lung to be most
commonly effected: Apical part of right lower lobe.
4. Critical gastric pressure for aspiration is 20 cmH2O.
5. Tracheal tug is seen in Respiratory obstruction.
6. During endotracheal intubation in children, the pressure in the cuff should
not be raised above 30cmH2O.
7. Ultrashort acting beta blocker most commonly used in anaesthesia is
Esmolol.(selective beta blocker).
8. Laminar flow is mainly dependent on Viscosity.
9. Most common type of hypoxia seen during anaesthesia isHypoxic hypoxia
10. Breuer Lockhart reflex is Reflex bronchospasm due to parasympathetic
stress at different site.
11. Most common pulmonary complication in postoperative period is
Pulmonary atelectasis.
12. Most common nerve injured during anaesthesia Ulnar.
13. Most common complication in post-operative period is Nausea and
vomiting.
14. Nitrous oxide does not cause malignant hyperthermia.
15. In malignant hyperthermia the increased heat production is due to
Increased muscle metabolism by excess of calcium ions.
16. Malignant hyperthermia is abnormality of calcium channel.
17. Postoperative restlessness is not seen in Narcotic analgesia.
18. Sodium nitroprusside may result in Cyanide toxicity.
19. Postoperative shivering may increase metabolic rate by factor of4.
20. Most rapid method to reduce raised intracranial tension Hyperventilation.
21. To reduce raised intracranial tension can be detrimental in head injury by
Mannitol.
22. In a patient with air embolism Transesophageal echo (TEE) is the most
sensitive investigation.
23. The most common rhythm disturbance during early post-operative period
is Tachycardia.
24. The most common cause of morbidity and mortality in patient undergoing
major vascular surgery is Cardiac complications.
25. Most common cause of metabolic acidosis in anaesthesia is Hypotension.
26. The neurons may get irreversibly damaged if exposed to significant hypoxia
for6 min.
 Muscle Relaxant

Neuromuscular-blocking drugs
1. First to be blocked by muscle relaxants and First to recover after muscle
relaxantsis Laryngeal muscles.
2. Site of action of muscle relaxants isMyoneural junction.
3. Mechanism of action of d-tubo curare is Non -depolarizing.
4. Train of four' is characteristically used in concern with Non-depolarizing
neuromuscular blockers.
5. Drug used for reversal of tubo curare -induced neuromuscular block is
Neostigmine.
6. During anaesthesia with muscle relaxants the vocal cord isinMid position.

Suxamethonium (Succinylchoiine)
1. Suxamethonium is A short acting muscle relaxant.
2. Succinylchoiine is short acting due to Rapid hydrolysis.
3. Fasciculations with succinylchoiine are first seen over Eyelids.
4. Pseudocholinesterase is synthesized by Liver.
5. Succinylchoiine is used in anaesthesia for Intubation.
6. Succinylcholine(suxamethonium) Should be given very rapidly.
7. Systemic effect of succinylchoiine: Hyperkalemia, increased intracranial
tension, masseter spasm.
8. Suxamethonium causes postanesthetic muscular aches.
9. A boy undergoes eye surgery under day care anesthesia with succinyl
choline and propofol and after 8 hours he starts walking and develops
muscle pain. Occur with Succinyl choline.

Non - Depolarizing Agents

1. Muscle relaxant which can cause convulsionsis Atracurium.
2. Anaesthesia of choice is renal failure cisatracurium.
3. Laudanosine is metabolite ofAtracurium.
4. Histamine release is one of the common features with administration
ofAtracurium.
5. Maximum histamine release occurs withd-Tubo curare.
6. A young male on atracurium on ventilator for 3 days develops epilepsy.
Cause of epilepsy is Laundosine.
7. Hoffman degradation is shown byAtracurium.
8. Non-depolarizer of choice for newbornAtracurium.

Cisatracurium
1. Cis atracurium is preferred over atracurium due to advantage of No
histamine release

Mivacurium
1. Mivacurium Onset of action is late.
2. Mivacurium causes Hypotension.
3. Drug used for reversal of tubo curare -induced neuromuscular block is
Neostigmine.
4. Dose of neostigmine per kg body weight is 0.0.8 mg.
5. Atropine/glycopyrrolate is given along with neostigmine to prevent
muscarinic side effects.
6. Myasthenia gravis sensitivity to curare is increased and scoline is decreased.
7. Most sensitive for patients of myasthenia gravis isGallamine.
8. Non depolarizer of choice for myastheniais Mivacurium.
9. Magnesium and muscle relaxants interaction is Hypermagnesemia
potentiates both depolarizers and non-Depolarizers.

Cylinder & Anesthesia Machine

02 & N2O cylinder

1. Pressure of nitrous oxide cylinder is760 psi.
2. Colour of nitrous oxide cylinder is Blue.
3. 'Tare weight' is the term used in anaesthetic A apparatus forGas cylinders.
Low pressure system
1. The Heidbrink meter in Boyle's machine Indicates flow of gases.
2. Pressure reducing valve of Boyle's machine reduces the pressure to60 psi
3. Pin index for nitrous oxide is3, 5.
4. Boyle's machine is Continuous flow.
5. Emergency oxygen flush delivers more than 35 liters/minute.
6. Pin index for oxygen 2,5.
7. Rotameter measures quantity (flow) of gases.
8. In Boyle's ether vaporizer the U tube is made of copper, the function of
which is Anticatalyst.
9. Colour of halothane vaporizer is Red.

Breathing System
1. Mapleson circuit are Semiclosed.
2. Magill attachment is aMapleson A system.
3. Magill circuit airflow is Equal to minute volume.
4. Fresh airflow rate in Magill circuit should be 10 liters.
5. Bain circuit is modification of Mapleson Type D.
6. Jackson Rees is modification of Type E.
7. Rate of flow of fresh gases through Ayre' s T piece in 1-year-old
spontaneously breathing child is6-7 liters/min.
8. No valves are used to decrease the resistance of airways in children.
9. Jackson Rees is not a coaxial circuit.
10. The most appropriate circuit for ventilating a spontaneously breathing,
infant during anaesthesia isJackson Rees modification of Ayre's T piece.
11. Lack system is modification of type A.

Closed Circuit
1. Soda lime is not used in anaesthesia with Trilene.
2. Sodium hydroxide in soda lime acts as A catalyst.
3. Barylime Less efficient than soda lime.
4. Soda lime used in India (Dura sorb) when fresh is Pink.
5. 100 g of soda lime can absorb liters of carbon dioxideis 25 titres.
6. The optimal size of soda lime is 4-8 mesh.
7. The constitution of soda lime is Ca (OH)2-80%, NaOH -4%.
8. Desiccatedsoda lime can produce carbon monoxide with Desflurane.
Instruments
1. Resuscitation bag for neonate should not exceed 250 ml.
2. Volume of adult AMBU bag 1,200 ml.
3. Artificial nose is Heat and moisture exchanger.
4. Most commonly used laryngoscope is Macintosh.
5. Type of laryngoscope blade most suitable for newborn isStraight.

E.T. intubation
1. Hypotension is Not seen during laryngoscopy.
2. Normal Thyro mental distance is 6.5 cm.
3. Mallampati score is used in to assess difficulty in intubation in oral cavity.
4. Laryngoscopy requires Flexion at cervical spine.
5. Commonest post- operative complication of intubation is Sore throat.
6. Blind nasal intubation is indicated in TM ankylosis.
7. Endotracheal tube insertion level is 4 cm above carina.
8. Both oral and nasal intubation is Contraindicated in Laryngeal edema.
9. Armored enforced endotracheal tube is used forNeurosurgical anaesthesia.
10. Surest sign of confirmation of intubationCapnography.
11. Gold standard surgical procedure for prevention of aspiration is
Tracheostomy.
12. The narrowest part of trachea in a newborn is at the level ofSub glottis.
13. The adult trachea has diameter of 1.2-1.6 cm.
14. Length of an adult trachea is 10-11 cm.
15. Carina in adult is at the level of T4.
16. In a neonate both bronchi are angled from the vertical at55°.
17. Semon's law indicates that in partial paralysis of bilateral recurrent
laryngeal nerve Abductors go before adductors.
18. In complete bilateral paralysis of recurrent laryngeal nerve there is
Complete loss of speech with stridor and dyspnea.
19. In an adult right bronchus is angled from vertical at 25°.
20. Subglottis is the narrowest part in children up to the age of6 years.
21. During endotracheal intubation in children the pressure in the cuff should
not make it air tight and allow some leakage of air when the pressure is
raised above 30 cmH20.
22. Oral intubation is preferred in children over nasal because There are
increased chances of bleeding from adenoids.
23. The cuff of tracheostomy tube should be Low pressure, high volume.
24. During intubation of newborn to insert endotracheal tube the blade of
laryngoscope isUncuffed tube with straight blade.
25. The pressure required to inflate the cuff of an endotracheal tube is 15-25
mmHg.
26. The purpose of cuff in endotracheal tube is toProvide airtight seal in
trachea.
27. Reasonable tube size required for 3-year child will be number 4.5 mm.
28. 7 number endotracheal tube means its internal diameter will be7 mm.
29. Bronchoscope is best sterilized with Cidex (2%, Glutaraldehyde).
30. Method of choice for sterilization of endotracheal tube is ETO gas.
31. The temperature of ethylene oxide sterilization during warm cycle is 49-
63°C.

Laryngeal mask airway

1. Contraindication to laryngeal mask airway is Increased risk of gastric
regurgitation.
2. Laryngeal mask airway (LMA) is used for Maintenance of airway.
3. Brain mask is Laryngeal mask airway.

Miscellaneous Topics

1. Oxygen delivery is regulated by Venti mask

2. Accurate concentration of delivered oxygen is only possible with Venti
mask
3. Maximum oxygen that can be delivered with nasal cannula is 44%
 Local Anesthesia & Central Neuraxial Blockade

Local Anesthetics
1. Na Bicarbonate given as an adjunct to local anesthetics because 4- onset
time and increase the duration.
2. Shortest duration local anaesthetic is Chloroprocaine.
3. Methemoglobinemia caused by- Prilocaine.
4. Fastest route of absorption of local anaesthetic in nerve blocks is
Intercostalblock.
5. EMLA cream containsXylocaine + prilocaine.
6. In digital block Adrenaline is contraindicated.
7. Local anaestheticwhich is sympathomimeticis Cocaine.
8. First local anaesthetic used was Cocaine.
9. Local anaesthetic agent which has antimuscarinic action on heart muscle
receptors is Cocaine.
10. LA causing vasoconstriction is Cocaine.

Lignocaine / Lidocaine
1. Local anaesthetic is more safe in surface and infiltrating anaesthesia
Lignocaine.
2. Cardiac or central nervous system toxicity may result when standard
lidocaine doses are administrated to patient with circulatory failure. This is
due to Lidocaine concentration are initially higher in relatively well
perfused tissues such as brain and heart.
3. Maximum safe dose of Lignocaine with adrenaline 7 mg / kg.
4. Concentration of lignocaine used for Bier's block 0.5%.
5. Max permissible concentration of lignocaine when given as topical
application with adrenalineis 10%.

Bupivacaine
1. Maximum safe dose of bupivacaine2 mg/kg.
2. Longest acting local anaesthetic is Dibucaine.
3. Bupivacaine does not Produces methemoglobinemia.
4. The drug of choice in bupivacaine induced VTis Bretylium
 Ropivacaine

Ropivacaine is pharmacologically similar toBupivacaine

Regional Anesthesia
1. Total spinal nerves are31.
2. Dura extends up toS2.
3. In infant's spinal cord extends up to L3.
4. Adult level of spinal cord is achieved by the age of2 years.
5. Spinal anaesthesia is usually given at L3 - L4.
6. Spinal anaesthesia is preferred in lower abdominal surgeries because it
Shrinks intestines so that other viscera are seen.
7. Patient factor does not affect the height of spinal block isSex.
8. The duration of effect of spinal anaesthesia depends onType of drug used
9. Last to recover in spinal anaesthesiais Preganglionic sympathetic.
10. Most common complication of spinal anaesthesiais Hypotension.
11. Post spinal headache is due to CSF leak from dura.
12. Post spinal headache has occipital and nuchal components.
13. Post spinal headache can be prevented by Use of thinner needle.
14. Average time for persistence of post spinal headache 7-10 days.
15. Most common causative agent for meningitis after spinal subarachnoid
block isStreptococusviridians.
16. Lumbar puncture is dangerous in Intracranial tumours.
17. spinal anaesthesia is not a contraindication Myasthenia gravis.
18. Minidose aspirin Not a contraindication for spinal anaesthesia.
19. Tuohy’s needle is used for Epidural block.
20. Concerning Barbotage Fluid (CSF) is alternately withdrawn and reinjected
under pressure.
21. Caudal block is a kind of Epidural block.
22. Site of action of opioids after epiduralisSubstantia gelatinosa of dorsal horn
cells.
23. Treatment of broken epidural catheteris Leave in situ.
24. Most preferred anaesthesia technique for total hip replacement isCombined
spinal epidural.
 25. Central neuraxial anesthesia is not contra indicated inPlatelet count
<80.000, patients on oral anticoagulant or iv heparin.
26. Epidural space has negative pressure in80%.
27. Lignocaine can be accumulated in foetus in very significant amount if given
to pregnant mother.
28. Vasopressor of choice for spinal hypotension in pregnancyphenylephrine.

Nerve blocks
1. Highest incidence of pneumothorax occurs when branchial plexus is
blocked by Supraclavicular.
2. For brachial plexus block needie is inserted Lateral to subclavian artery.
3. Nerve spared with axillary approach Musculocutaneous.

Blocks of head & neck

1. Chassaignac's tubercle is landmark for Stellate ganglion block.

Intravenous Regional Anaesthesia (Bier's block)

1. Tourniquet cannot be released before 30 minutes after Bier's block

Perioperative Fluid Replacement

1. False statement about colloids is not Isotonic solutions.
2. Composition of Ringer lactateSodiuml31 mEq/L, chloridellO mEq/L,
calcium3 mEq/L, potassium 4.0 mEq/L, lactate 28 mEq/L.
3. In Haemaccel, degraded gelatin used is3.5%.
4. Fluid which can increase the chances of bleedingisDextran
5. Fluid improving microcirculation is Hydroxy ethyl starch.
6. Best fluid for hypovolemic shockis Ringer lactate.
7. Colloids are initially avoided in Burns & ARDS.
8. Hypovolemic shock occurs when intravascular volume is decreased by 15-
25%.
9. Commonest complication of IV infusion in a comatose child is Hypothermia.
10. Fluid of choice for maintenance during intraoperative period RL.
Blood Transfusion
1. Blood replacement (transfusion) is necessary only when the loss is more
than 20%, of estimated blood volume.
2. Acid citrate dextrose blood can be kept for 21 days.
3. Mismatch blood transfusion during surgery is manifested by Tachycardia.
4. Blood transfusion set's pore size is 170 microns.
5. The complication of massive blood transfusion is Hyponatremia.
6. Maximum possibility of hepatitis and AIDS are with which blood product
isCryoprecipitate.
7. Most common hepatitis after blood transfusion Hepatitis C.
8. The incidence of AIDS with transfusion 1:1,00000 .
9. Blood should not salvaged (saved) for autologous transfusion if it contains’
Malignant cancer.
10. Blood product which should be stored at room temperature Platelets.
11. ABO compatibility is least important in Fresh frozen plasma.
12. 1 unit of platelets increase platelet count by 10,000.
13. Cryoprecipitate does not contain Factor IX .
14. Mismatched blood transfusion during anaesthesia leads to Hypotension
and increased bleeding from the wound site.
15. Blood transfusion borne endotoxemia and septicemia is usually due to
Pseudomonas.
16. 1 unit of fresh blood increases Hb by0.8 g% (almost 1 g%).
17. Fluosol DA is an Agent to increase oxygen delivery to tissue.

Anesthesia with Medical Diseases

Cardio vascular diseases

1. The induction agent of the choice for cyanotic heart disease by Ketamine.
2. The most appropriate inhalational anaesthetic agent of choice with minimal
hemodynamic alteration for induction of anaesthesia is Patent ductus
arteriosus (PDA) with congestive cardiac failure. Isoflurane.
3. Elective surgery in a patient of Ml should be done after6 weeks.
 ICU Management

Endotracheal tube care in ICU

1. First change in tracheostomy tube should not be done before 5 days.
2. Maximum permissible time for which an endotracheal tube can be kept 14
days.
3. Importance of CVP measurement is to assess the need forTitration of
infusion rate.
4. Pulmonary capillary wedge pressure denotes pressure of Left atrium.
5. Minimum pressure in left atrium for development of pulmonary edema 30
mmHg.
6. Oxygen analyzers measure oxygen concentration of Inspired gases.
7. Best clinical guide for cardiac output is Urine output.
8. The blood gas analysis in hyperventilation shows Reduced pCO2.
9. Nitric oxide is used in the management of ARDS.
10. CVP monitoring: Tip of catheter should not lie in right atrium.
11. Intubation is indicated if respiration is Paradoxical.
12. Paul Bert effect due to oxygen toxicity manifest as Convulsions.
13. Ventilators nowadays in common use are Volume preset, time cycle
14. In volume cycled ventilator the inspiratory flow rate is set at 60-100 L/mi
15. Most common cause of ARDS in India is Sepsis
16. There is no benefit of oxygen therapy inHistotoxic hypoxia
17. The most common pathogens responsible for nosocomial pneumonia in
the ICU are Gram negative organism
18. Not to be done in the management of COPD patient Flow rate of 8-10 liters
during oxygen therapy
19. Normal anion gap 12 mmol/l
 Miscellaneous Topics

1. Most commonly injured nerve during anesthesiais Ulnar nerve>brachial

plexus.
2. Route of administration of patient controlled analgesia islntravenous
3. Visual analogue scale is most commonly used to measure Pain intensity.
4. The intra-abdominal pressure (TAP) during laparoscopy should be set
between 10-15 mmHg.
5. In pregnancy lung volume does not changes Minute ventilation.
6. A pregnant woman should be best nursed in Supine with wedge below right
hip.
7. Best time to perform elective surgery in pregnant patientis post-partum.
8. Usually cyanosis appears when partial pressure of oxygen falls below 50
mmHg.
9. Cyanosis appears if reduced hemoglobin level is more than5 g%.
10. Earliest indication of hypoxia is Change in pulse rate.
11. Alderate scale score is for Post anaesthesia recovery.
12. Carbon dioxide production per minute is200 ml.
13. Oxygen content of arterial blood per dl is 20 ml.
14. High airway resistance is seen in Main bronchus.
15. The physiological dead space is decreased byNeck flexion.
16. Blood goes to brain in a normal healthy conscious individual 1/6 cardiac
output.
17. Total lung compliance is Less than chest wall compliance.
18. Lung volume is same in male and female's Tidal volume.
19. Body plethysmography is required to measure Functional residual capacity
(FRC).
20. The normal value of P50 on the oxyhemoglobin dissociation curve in an
adult is 3.6 kPa.
21. Ventilation perfusion ratio is0.8.
22. Total Cerebral Metabolic failure occurs at cerebral blood flow of 10
mL/lOOmg/min.
23. The most potent cerebral vasodilator is Hypercarbia.
 Miscellaneous Topics

1. Most commonly injured nerve during anesthesiais Ulnar nerve>brachial

plexus.
2. Route of administration of patient controlled analgesia islntravenous
3. Visual analogue scale is most commonly used to measure Pain intensity.
4. The intra-abdominal pressure (TAP) during laparoscopy should be set
between 10-15 mmHg.
5. In pregnancy lung volume does not changes Minute ventilation.
6. A pregnant woman should be best nursed in Supine with wedge below right
hip.
7. Best time to perform elective surgery in pregnant patientis post-partum.
8. Usually cyanosis appears when partial pressure of oxygen falls below 50
mmHg.
9. Cyanosis appears if reduced hemoglobin level is more than5 g%.
10. Earliest indication of hypoxia is Change in pulse rate.
11. Alderate scale score is for Post anaesthesia recovery.
12. Carbon dioxide production per minute is200 ml.
13. Oxygen content of arterial blood per dl is 20 ml.
14. High airway resistance is seen in Main bronchus.
15. The physiological dead space is decreased byNeck flexion.
16. Blood goes to brain in a normal healthy conscious individual 1/6 cardiac
output.
17. Total lung compliance is Less than chest wall compliance.
18. Lung volume is same in male and female's Tidal volume.
19. Body plethysmography is required to measure Functional residual capacity
(FRC).
20. The normal value of P50 on the oxyhemoglobin dissociation curve in an
adult is 3.6 kPa.
21. Ventilation perfusion ratio is0.8.
22. Total Cerebral Metabolic failure occurs at cerebral blood flow of 10
mL/lOOmg/min.
23. The most potent cerebral vasodilator is Hypercarbia.
 Miscellaneous Topics

1. Most commonly injured nerve during anesthesiais Ulnar nerve>brachial

plexus.
2. Route of administration of patient controlled analgesia islntravenous
3. Visual analogue scale is most commonly used to measure Pain intensity.
4. The intra-abdominal pressure (TAP) during laparoscopy should be set
between 10-15 mmHg.
5. In pregnancy lung volume does not changes Minute ventilation.
6. A pregnant woman should be best nursed in Supine with wedge below right
hip.
7. Best time to perform elective surgery in pregnant patientis post-partum.
8. Usually cyanosis appears when partial pressure of oxygen falls below 50
mmHg.
9. Cyanosis appears if reduced hemoglobin level is more than5 g%.
10. Earliest indication of hypoxia is Change in pulse rate.
11. Alderate scale score is for Post anaesthesia recovery.
12. Carbon dioxide production per minute is200 ml.
13. Oxygen content of arterial blood per dl is 20 ml.
14. High airway resistance is seen in Main bronchus.
15. The physiological dead space is decreased byNeck flexion.
15. Blood goes to brain in a normal healthy conscious individual 1/6 cardiac
output.
17. Total lung compliance is Less than chest wall compliance.
18. Lung volume is same in male and female's Tidal volume.
19. Body plethysmography is required to measure Functional residual capacity
(FRC).
20. The normal value of P50 on the oxyhemoglobin dissociation curve in an
adult is 3.6 kPa.
21. Ventilation perfusion ratio is0.8.
22. Total Cerebral Metabolic failure occurs at cerebral blood flow of 10
mL/lOOmg/min.
23. The most potent cerebral vasodilator is Hypercarbia.
 Recent Advances

1. Sternum should be depressed by 2 inches in adults while doing cardiac

massage.
2. Successful cardiac massage can produce30% of normal cardiac output.
3. Recent and advanced method for assessing successful cardiac output End
tidal CO2.
4.
Drug of choice for PSVTis Adenosine.
5.
Most common cause of electromechanical dissociation isHypovolemia.
6.
Not a complication of total parenteral nutrition isRespiratory alkalosis.
7.
8. Vein of choice for parenteral routeis Subclavian.
After contrast media injection in radiology department a patient develops
severe hypotension, bronchospasm and cyanosis, Treatment m
Adrenaline.
9. Sodium bicarbonate is not given to be done in cardiac arrest caused by
ventricular fibrillation.
10. First step in CPR (cardio pulmonary resuscitation) should beCardiac
massage.
11. IN CPR drug of choice is Adrenaline.
12.
Concentration of adrenaline in CPR is 1:10000 .
13.
Drugs not recommended for in tracheal administration during
cardiopulmonary resuscitationis Sodium bicarbonate.
14.
During cardiac resuscitation Disseminated intravascular coagulation does
15. not occur.
During cardiopulmonary resuscitation, cardiac massage is givenLower
third of sternum.
 Recerit & High Yield Updated LMRPs

1. Cardio stable:AnaestheticEtomidate.
2. Ketamine used as anaesthetic in Cyanotic Heart Disease (Rt. to Lt. Shunt).
3. The reflex reverts back after a spinal anaesthesiaisBulbocavernosus reflex.
4. In a Trauma patient grey color of cannula will resident use to obtain
maximum flow rate.
5. Best position to insert Ryle's tubeissitting with neck flexion.
6. MaHampati grading for airway assessment is grade 4 only hard palate
seen.
7. Murphy's eye is seen in Endotracheal tube.
8. Modified MaHampati grading is used in assessment of difficult airway.
9. Most effective circuit in spontaneous anaesthesia in adult is Mapleson A.
10. Mechanism of action of Curanium drugs as muscle relaxant Act
competitively on Ach receptors blocking post-synaptically.
11. Nerve to be used for monitoring anaesthesia is ulnar nerve.
12. A3 yrs old child with heart rate 140/minundergo squint surgery, after
anaesthesia heart rate becomes 40/min, next appropriate stepis inj.
Atropine.
13. Trilene is degraded by chemical degradation.