Manual of Clinical Anesthesiology: The Anesthetic Plan and Induction of Anesthesia

Question 1

In which patients might ketamine be useful?

Answer 1

Asthmatics

Ketamine has broncho-dilating properties.

Question 2

What is glycopyrrolate?

Answer 2

It is an antimuscarinic that does not cross the BBB. It is therefore useful in decreasing salivary secretions (an antisialogogue) without causing CNS effects.

Question 3

List some things to consider in preoperative assessment/planning.

Answer 3

• Planning:

• Type of anesthesia: peripheral nerve block may be ok for minor procedures, neuraxial for shorter procedures where the patient can be prone, and general anesthesia is necessary for long procedures or those in which the patient would get uncomfortable
• Size of IV access: for procedures that may require significant volume replacement, use a bigger IV.
• Need for A-line or CVP monitor: procedures that entail a risk of sudden hypotension (like neurosurgical procedures or those with lots of blood loss) necessitate an A-line.

• Assessment:

• Airway ease
• History of respiratory problems: OSA, asthma, snoring, COPD
• History of anesthesia: vomiting, nausea, malignant hyperthermia
• Cardiac history

Question 4

These two agents can be used to counteract laryngospasm: _______________.

Answer 4

beta-blockers and opioids (particularly fentanyl)

Question 5

Go through the MSMAIDS mnemonic for induction anesthesia.

Answer 5

• Machine (confirm high-flow O2 on, confirm bag mask available, confirm anesthesia machine functioning and on)
• Suction (check yankauer for positive, audible suction)
• Monitor (have recent set of vitals and know baseline vitals for patient)
• Airway (have airway equipment –laryngoscope, tube, stylet, syringe, and connecting tubes –at hand)
• IV (make sure it is connected and patent)
• Drugs (induction, paralytic, narcotics, rescue [phenylephrine, epinephrine])
• Special (anything unique to case)

Question 6

After going through the MSMAIDS mnemonic, you then ______________ before titrating induction anesthesia.

Answer 6

preoxygenate for 8 breaths at 100% FiO2

Question 7

At what point in induction anesthesia do you administer paralytics?

Answer 7

After titrating

Non-invasive airways –like LMAs –do not require paralytics.

Question 8

A heavy meal requires _______ hours before elective surgery.

Ingestion of clear liquids requires only ___________ hours.

Answer 8

8; 2

Question 9

In rapid-sequence intubations, you put pressure on _____________ to prevent food regurgitation.

Answer 9

cricoid

This closes the esophagus.

Question 10

What are some things that are different in RSI from standard intubation?

Answer 10

• Do not bag-mask the person before intubation (at risk of causing reflux)
• Press on the cricoid to prevent reflux
• No titrations: give standard amounts of sedative and paralytics based on weight