ANESTHESIA QUICK REVISION NOTES

MKT ( MUST KNOW TOPICS) : INSTRUMENTS IN ANESTHESIA :

Drugs and Instruments in Pre-Anesthesia Evaluation LMA (Laryngeal mask airway ) / SAD (Supraglottic
Anesthesia airway device )
Monitoring in Anesthesia Cardiopulmonary Scientist who invented it - Archie Brain
resuscitation
Types of LMAs : ( Active recall – try to identify and
recall important points about each of these )

First generation LMA LMA, Fast trach LMA or Intubating LMA

•• Example – LMA classicQ •• Important features - They have airway tube

and gastric tube
•• Important features - single tube present
(airway tube ), which can be used for ventilation •• They create a better seal with the larynx than
only - Demerit : cannot prevent aspiration first generation LMAs
•• They are safer and protects better against
Second generation LMA aspiration
•• Examples - LMA supreme, Proseal LMA, I gel
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Cerebellum Quick Revision Notes
LMA CLASSIC
•• First generation LMA
•• Important features - single tube present
(airway tube )
•• Demerit : cannot prevent aspiration
LMA supreme
•• Second generation LMAQ
•• Disposable
Fast track LMA or Intubating LMA
•• Made up of Silicone
•• Non disposable
•• Can be used upto 40 times
•• Pilot Balloon is present
•• It has a special endotracheal tube used for
intubating ‘through’ the LMA
•• It is sterilized by Autoclaving
PROSEAL LMA
•• It is made up of Silicone
•• It is reusable / non disposable
•• Pilot balloon is present
•• It forms a good seal with the larynx preventing
aspiration of gastric contents. Hence, it is
called as ‘Proseal’
It is the LMA preferred for Day care Surgery /
Laproscopic Surgery
I - gel LMA
•• Main identification feature – It does not have
a pilot balloon
•• It is made up of Thermoelastic polymer
Recommended size of the laryngeal mask airway
according to the patient's body weightQ.
Size Patient's weight
1 <5 kg
1.5 5-9 kg
2 10-19 kg
2.5 20-29 kg
3 30-49 kg
4 50-69 kg
5 Large adult, 70-100 kg
Ideal patient position preferred for intubation :
Sniffing the morning air position / barking dog
position Q
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Anesthesia

Flexion of
cervical spine

Extension of
atlanto
occipital joint

Flexion at Atlantoaxial joint and extension at Atlanto- MacIntosh laryngoscope

occipital joint •• It has a Curved blade

Steps of Intubation •• It is used in Adults

1. Insert the Laryngoscope in the right corner of

the mouth
2. Sweep the tongue from right to leftQ
3. Then lift the laryngoscope
4. 
Once the vocal cords are seen pass the
endotracheal tube
5. Inflate the cuff of the endotracheal tube and
connect the anesthesia circuit
6. Confirm intubation by capnography (gold standard) McCoy laryngoscopeQ
or by auscultation or chest XrayQ •• It has a curved blade with a lever which helps in
lifting the epiglottis
Identification of types of
laryngoscope: (Active recall) •• It is used for difficult intubation

Millers laryngoscope
•• It has a straight blade
•• It is used in pediatric patients
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Cerebellum Quick Revision Notes

Video laryngoscope

TYPES OF ENDOTRACHEAL TUBES (ETT ) - Active recall

(if the cuff puts to much pressure over the trachea,

it can cause tracheal mucosal ischemia leading to
tracheal stenosis )
2. Use of Murphy’s eye
If the distal end of the tube is blocked, ventilation
still can be carried out by Murphy’s eye which is
alternate opening for ventilation.
3. Use of Radiopaque line on ETT
It helps to see the tube in X-ray imaging .
It confirms the position of the endotracheal tube on
COMMON QUESTIONS ASKED X-ray
ABOUT ENDOTRACHEAL TUBES 4. Gold standard method for confirmation of
1. Cuff of normal ETT - Low pressure, high volume Endotracheal intubation -Capnography
cuffQ
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Anesthesia

•• Uncuffed endotracheal tube •• It has metallic wires inside which make the tube
highly malleable and Kink resistant.
It is used in Pediatric patients as subglottic area (
below vocal cords ) is very narrow in children, thus we
prefer to use uncuffed tube otherwise the excessive INDICATIONS
pressure of the cuff can cause SUBGLOTTIC
•• Neurosurgery
STENOSIS
•• Head & Neck surgery
RING- ADAIR-ELWYN TUBES ( RAE tubes ) - South
pole tube / North pole tube •• Surgeries in prone position

•• Specially used for Head & neck surgery DOUBLE LUMEN TUBEQ
•• South Pole tube - used mainly in Tonsillectomy

FLEXOMETALLIC TUBE

•• Used in Thoracic surgery

•• It is used for one lung ventilation in thoracic
surgeries to separate one lung from the other .
•• Also called as Armored tube •• It has 2 lumens – tracheal and bronchial lumen

AIRWAY ADJUCTS
Active recall
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Cerebellum Quick Revision Notes

•• ORAL AIRWAY –

Example : GUEDEL’S AIRWAYQ

•• An oral airway is a device used to maintain an
open airway in a patient who is at risk of airway
obstruction.
•• It is commonly used during anesthesia, sedation,
or in emergency situations to facilitate
breathing.

BOUGIE
•• A bougie is a thin, flexible, and cylindrical
instrument used to guide the placement of an
endotracheal tube during intubation.

•• Oral airways can also be as a bite block to

prevent tongue bite during seizures
•• To check the size of an oral airway, you can
measure it against the patient’s face by placing
STYLETTE
the tip of the device at the center of the mouth •• A stylette is a thin, flexible, and rigid device
and the flange against the lips. used to shape the endotracheal tube during
intubation.
NASOPHARYNGEAL AIRWAY •• It is commonly used to help navigate the airway
and improve the success of intubation by
•• A nasopharyngeal airway is a flexible tube
providing support and shape to the tube.
inserted through the nostril into the back of
the throat to maintain an open airway.
•• It is commonly used in emergency situations,
during anesthesia, or in patients with upper
airway obstruction.
•• Correct size of nasopharyngeal airway : The
correct size should extend from the tip of the
nose to the earlobe

ANESTHESIA MACHINE :
Active recall from this picture
1. An anesthesia machine is a medical device used to
deliver anesthesia to patients during surgery. It
typically consist of a stand, gas supply cylinders,
and various valves, regulators, and monitors.
2. They are designed to deliver a precise mixture of
anesthetic gases and oxygen to the patient’s lungs.
3. Scavenging system - to remove waste gases, from
the operating room.
4. Oxygen supply system - provides high-pressure
oxygen to the machine for mixing with other gases.
5. Vaporizer - converts liquid anesthetic into a gas
and mixes it with oxygen.
6. Breathing circuit - delivers the anesthetic gases
and oxygen to the patient’s lungs and removes
exhaled gases.
7. Anesthesia machines have various monitors, such as
pulse oximeters, capnographs, and blood pressure
monitors, to measure the patient’s vital signs.
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Anesthesia
8. They have safety features, such as pressure relief
valves and oxygen failure alarms, to prevent over-
pressurization or loss of oxygen supply.
9. Flowmeter: A flowmeter is a device that measures
and regulates the flow of gases, such as oxygen and
air, delivered to the patient during anesthesia.
10. Carbon dioxide absorber: The carbon dioxide
absorber is a component of the anesthesia machine
that removes carbon dioxide from the exhaled
gases of the patient. It contains a substance, such
as soda lime or barium hydroxide, that absorbs
carbon dioxide and prevents its buildup in the
breathing circuit.
11. Bellows: Bellows are part of the anesthesia machine
that delivers air and anesthetic gases to the
patient’s lungs during anesthesia. They are made of
a flexible material, such as rubber or silicone, and
are manually or mechanically operated to deliver
the gases in a controlled manner.
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Cerebellum Quick Revision Notes

Active recall of Vaporizers and MAC

COLOR of INHALATIONAL AGENT

VAPORIZER

RED Halothane

BLUE Desflurane

YELLOW Sevoflurane

PURPLE Isoflurane

Desflurane uses a special vaporizer → TEC 6

•• TYPES OF CIRCUITS :
1. Open circuit: Also known as a “rebreathing circuit,”
this system allows the exhaled gases to escape into
the room and not be recycled.
3. Mapleson circuit / Semiclosed circuits : Named
after the British anesthetist, Jack Mapleson,
these circuits are classified from Type A to Type
E. They are categorized based on the location of
the fresh gas inlet and the patient’s expiratory
valve. Each type of circuit has its own advantages
and disadvantages and is used for specific types of
surgeries or patient conditions.

2. Closed circuit: Also known as a “non-rebreathing

circuit,” this system recycles the exhaled gases
and conserves heat and moisture. It consists of a
carbon dioxide absorber, unidirectional valves, and
tubing.
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Anesthesia

MAPLESON A / MAGILL’S CIRCUIT

•• Preferred in adults – for Spontaneous ventilation
MAPLESON D / BAIN’S CIRCUITQ
•• Preferred in adults – for Controlled ventilation
MAPLESON F/ JACKSON REES CIRCUIT
•• Preferred in pediatrics for :
–– Spontaneous ventilation
–– Controlled ventilation

OXYGEN DELIVERY DEVICESQ

Active recall

Oxygen Delivery Device Maximum FiO2 Delivery AIRWAY TESTS

(Percentage)Q
MALLAMPATI CLASSIFICATIONQ
Nasal Cannula 40%
•• The Modified Mallampati classification is a
Simple Face Mask 60% tool used to assess a patient’s airway prior to
Venturi Mask 24 - 66% anesthesia or other procedures that may require
intubation. It is based on the visualization of the
Non-Rebreather Mask 80%
patient’s oropharyngeal structures, specifically
High-Flow Nasal Cannula 100% the base of the tongue, uvula, and soft palate.
Bag-Mask Ventilation 100% (with reservoir) •• The Modified Mallampati classification consists
of four classes, with Class I indicating a full
view of the oropharyngeal structures and Class
IV indicating that the structures are not visible
at all. Patients with higher Modified Mallampati
scores may have a more difficult airway
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Cerebellum Quick Revision Notes

CORMACK-LEHANE GRADINGQ:
Cormack Lehane grading is a system used to classify the view obtained during laryngoscopy and endotracheal
intubation, with Grade I indicating a clear view of the vocal cords and Grade IV indicating that the vocal cords
are not visible at all.

CRICOID PRESSURE / SELLICKS CRICOTHYROIDOTOMY :

MANOUVERQ
Sellick’s maneuver, also known as cricoid pressure, is
a technique used during endotracheal intubation to
compress the esophagus against the vertebrae and
prevent regurgitation of stomach contents into the
airway.
•• It is done in Rapid sequence induction for
Emergency surgery
Cricothyroidotomy is a procedure used to establish
an emergency airway in patients who are unable to
breathe spontaneously and cannot be intubated using
traditional methods.
This procedure involves making a small incision in the
skin overlying the cricothyroid membrane, which is
located between the thyroid and cricoid cartilages in
the neck.
A specialized needle or scalpel is then used to
puncture the membrane, and a catheter or other
device is inserted through the opening to allow air to
enter the lungs.
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Anesthesia

•• Extra neck extension is given by placing a pillow

under the shoulders
•• This is done to improve visualization of tonsils
and also to reduce bleeding.

RAMP POSITION
•• Given in obese patients
•• Sternal notch and the tragus of the ear are in
the same line, this gives a proper alignment to
the head of a obese patient for easy intubation
RECOVERY POSITIONQ
•• This is used when we shift the patient to the
recovery room / post anesthesia care unit from
the operation theatre.
•• Pulse is stable, Respiration is stable in these
patients .

ROSE POSITIONQ
•• Given in tonsillectomy surgery

POSITIONING UNDER ANESTHESIA

Active recall
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Cerebellum Quick Revision Notes

a- Supine e- Lateral
b- Trendelenburg f,g- Kidney position
c- Reverse Trendelenburg h-Prone
d- Lithotomy i- Sitting/ Beach chair position

Position Advantages Disadvantages

Supine Easy access to airway and surgical increased risk of pressure ulcers at dependent sites
site
Trendelenburg Improves surgical exposure in Increased risk of aspiration, decreased respiratory function,
certain procedures increased intracranial pressure and intraocular pressure
Reverse Improves respiratory function, Increased risk of venous air embolism, hypotension or cerebral
Trendelenburg reduces risk of aspiration hypoperfusion
Prone Improved surgical access and Risk of eye injury
visualization
Lateral Improved surgical access and potential for nerve compression or pressure ulcers
ventilation in some patients
Sitting Improved surgical exposure and Increased risk of air embolism, decreased venous return and
ventilation in certain procedures hypotensionQ

REGIONAL ANESTHESIA INSTRUMENTS

1. SPINAL NEEDLE – QUINCKE for regional anesthesia or pain management.

1. A spinal needle is a long, thin needle with a beveled
tip that is used to puncture the dura mater of
the spinal cord and access the cerebrospinal fluid
(CSF) for diagnostic or therapeutic purposes.
2. Most commonly used spinal needle is the Quincke
Babcock cutting needle.
2. Epidural needles are identified by presence of
flange / wings for better support while holding
needle.
3. Most commonly used types is Tuohys needle Q

Epidural Needle
1. An epidural needle is a long, thin needle with a
blunt or rounded tip that is used to puncture the
ligamentum flavum and access the epidural space
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Anesthesia

3. EPIDURAL SET Structures pierced from outside to inside while

performing SPINAL ANESTHESIA / LUMBAR
PUNCTUREQ
1. Skin
2. Subcutaneous tissue
3. Supraspinous ligament
4. Interspinous ligament
5. Ligamentum flavum
6. Epidural space
7. Duramater
8. Arachnoid mater (Last structure to be pierced
before spinal anesthesia)
9. Subarachnoid space

Structures pierced from outside to inside

while performing EPIDURAL ANESTHESIA
1. Skin
2. Subcutaneous tissue
4, CAUDAL ANESTHESIA
3. Supraspinous ligament
•• Caudal anesthesia is a type of regional anesthesia
that involves injecting local anesthetic into the 4. Interspinous ligament
epidural space near the sacrum through an 5. Ligamentum flavum (Last structure to be pierced
opening called sacral hiatus. before epidural anesthesia)
•• This results in anesthesia of the lower half of 6. Epidural space
the body, including the perineum, buttocks, and
lower extremities. CONTRAINDICATIONS TO CENTRAL
•• It is preferred to be given below 8 years of age NEURAXIAL BLOCKAGEQ
•• The structure that is pierced to enter into •• Patient refusal
caudal space is called Sacrococcygeal ligament •• Platelet count low; < 75,000
•• Coagulopathy INR > 1.5
•• Infection on the site of puncture
•• Raised intracranial pressure
•• Uncorrected hypotension
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Cerebellum Quick Revision Notes

NAME THE FOLLOWING : NAME THE FOLLOWING :

INTRAVENOUS INDUCTION AGENTS INHALATIONAL AGENTS :
QUESTION INTRAVENOUS Question Inhalational Agent
INDUCTION
Second Gas Effect, Diffusion Nitrous Oxide
AGENT
HypoxiaQ
Barbiturate used as an IV Thiopentone
Contraindicated In Closed Nitrous Oxide
anesthetic
Cavity Surgeries
Preferred IV induction agent for Thiopentone
Preferred For Induction In Sevoflurane
neurosurgery
Children, Agent Of Choice
Accidental intra-arterial Thiopentone For Cardiac Surgery
injection causes intense
Preferred For Induction In Desflurane
vasospasm
ObeseQ
Not used in patients with egg Propofol
Lowest Blood: Gas Partition Desflurane (0.45)
allergyQ
CoefficientQ
Should be discarded if kept open Propofol
Preferred For Induction In Halothane
for more than 6 hours
Asthma
MC used in Day care anesthesiaQ Propofol
Causes Liver Damage Halothane
Contraindicated in Porphyrias Thiopentone
Preferred For Induction Isoflurane
Causes adrenal suppression Etomidate In Neurosurgery And Liver
Surgery
Most cardiostable IV induction Etomidate
Preferred For Induction In Desflurane
agentQ
RenalQ And/Or Liver Failure
Causes hallucinations, post Ketamine
Preferred For Induction In Sevoflurane
operative deliriumQ
Day Care Surgery
Most painful on IV injection Propofol

Increases intracranial and Ketamine NAME THE FOLLOWING:

intraocular pressureQ
MUSCLE RELAXANTS:
Bets bronchodilatorQ Ketamine
Information Answer
Best in hypotension, bleeding, Ketamine
Most resistant muscle to NM Diaphragm
emergency
blockade

MAC of INHALATIONAL AGENTSQ Most sensitive muscle to NM Small muscles of the

blockade hand and eye (e.g.
AGENT MAC orbicularis oculi)
Longest acting NM blocker Pancuronium
SEVOFLURANE 2
Muscle relaxant that causes Succinylcholine
DESFLURANE 6 Bradycardia
ISOFLURANE 1.4 DOC for RSIQ Succinylcholine

HALOTHANE 0.75 Fastest acting NM blocker Succinylcholine

Shortest acting NM blockerQ Depolarizing:
NITROUS OXIDE 104 Succinylcholine
Non-depolarizing:
Mivacurium

Information
Hoffman’s elimination and
maximum Histamine releaseQ
Muscle relaxant metabolized by Succinylcholine
plasma cholinesterase
Metabolite of Atracurium that
causes seizures
Muscle relaxant that triggers
Malignant HyperthermiaQ
Most cardiostable muscle
relaxant
Scoline should be avoided in
patients with which electrolyte
abnormality?
MC used nerve for clinical
monitoring of NM blockadeQ
NAME THE FOLLOWING :
LOCAL ANAESTHETICS :
Information
First local anesthetic used
Only naturally derived LA
having a sympathomimetic
effect
Most cardiotoxic LAQ
MC used LA, also used
to treat ventricular
arrhythmias and can
precipitate Malignant
hyperthermia
EMLA cream contains
Type B > Type C > Type A
delta
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Anesthesia
Answer LOCAL ANESTHESIA SYSTEMIC
Atracurium TOXICITY
A picture is worth more than a
thousand words’
Laudanosine
Succinylcholine, rarely
triggered by volatile
anesthetics
Vecuronium
Hyperkalemia
Ulnar nerve
Answer
Cocaine
Cocaine 1. Local anesthesia systemic toxicity is a rare
but potentially life-threatening complication
that can occur when local anesthetic agents
are administered in excessive amounts or
Bupivacaine inadvertently injected into a blood vessel.
Lidocaine 2. Symptoms of LAST may include CNS depression
(e.g., confusion, seizures), cardiovascular effects
(e.g., bradycardia, hypotension, arrhythmias), and
respiratory distress.
3. The risk of LAST is higher with certain types of
2.5% lignocaine and 2.5% local anesthetics, such as bupivacaine
prilocaine
4. Treatment of LAST includes stopping
Order of nerve fiber administration of the local anesthetic, providing
susceptibility to local supportive care such as airway management and
anesthesia, with Type B cardiopulmonary resuscitation as needed, and
fibers being the most administering specific medications such as 20%
susceptible, followed by Intralipid emulsionQ therapy to sequester the
Type C fibers, and then local anesthetic and reduce toxicity.
Type A delta fibers.
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Cerebellum Quick Revision Notes

MALIGNANT HYPERTHERMIA and muscle rigidity, among other symptoms.

4. Treatment of MH includes discontinuing triggering
‘A picture is worth more than a thousand
medications, providing supportive care such
words’
as cooling measures and respiratory support,
malignant hyperpyrexia and administering specific medications such as
dantrolene to counteract the hypermetabolic
state.
5. Anesthesia of choice in a patient with MH- TIVA

MEDICAL GASES AND THEIR

IDENTIFICATION
ACTIVE RECALL :

1. Malignant hyperthermia (MH) is a rare but

potentially life-threatening condition that can
occur in response to certain medications used during
anesthesia, such as succinylcholine and inhalational
anesthetics like halothane or sevoflurane.
2. Patients with a family history of MH or genetic
mutation in Ryanodine receptor gene are at
increased risk for developing MH.Q
3. The clinical presentation of MH may include
tachycardia, tachypnea, hypercapnia, hyperthermia,
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Anesthesia

PRE ANESTHESIA ORDERS CHIN-LIFT AND HEAD-TILT

REGARDING MEDICATIONS : MANOUVER :
“Medications: The right dose can cure, the
wrong dose can harm.”

DRUGS TO BE CONTINUED /
OMITTED ON DAY OF
SURGERY

ANTIHYPERTENSIVES ACE-I AND ARBs

are omitted, rest are
continued on day of
surgery

OHAs and Insulin Omitted on day of surgery

as patient is fasting

All psychiatric medications Continued on day of

except MAO inhibitors surgery

Thyroid medications Continued on day of

(for Hyper and surgery
Hypothyroidism)

Anti- TB drugs (AKT) Continued on day of

surgery and do Liver
function tests

Clopidogrel Stop 7 days prior to

surgery

Warfarin Stop 5 days prior to

surgery

Low molecular weight Last dose – 12 hours prior

heparin to surgery

Unfractionated heparin Last dose – 4 hours prior

to surgery