Seadtion

Question 1

Definition of each depths of anesthesia

Minimal
Moderate / conscious
Deep
GA

Answer 1

• NL response to verbal and intact airway.
• purposeful response to verbal or tactile stimulation. Airway and HD intact.
• purposeful response to repeated or painful stimulation. -/+ airway intervention
• unable to arouse even with pain stimulation, inadequate spontaneous ventilation, -/+ HD impairment

Question 2

What is the major type of heat loss in operative period?

Most effective prevention of heat loss due to redistribution caused by induction meds?

Answer 2

Radiation

Forced air warming in preop area for 30 min at least

Question 3

Consequences of hypothermia (<35) intraop?

Answer 3

• Coagulation(cold induced platlate dysfunction)
• impairment of drug metabolism
• wound infection (most serious)
• decrease immune system function and wound o2 delivery.
• shivering increase o2 consumption and can lead to ischemia in risky patients (MI/strokes).

Question 4

FiO2 and it’s flow for each of the following

Nasal cannula
Simple mask
Partial rebreathing
Non rebreathing mask

Answer 4

NC: 25-40% with flow up to 6L/min (mouth breathers will have less FiO2). Any flow above 6L won’t increase FiO2 and it’ll be irritating to ptn

Simple face mask: 35-50% with flow 5-10 L/min

Partial rebreathing mask: 40-80% with O2 flow of >6 L/min

Nonrebreathing: 60-80% with minimum 10 L/min.

Rebreathing CO2 & other gases then O2 is possible with flow <5L/min

Question 5

Contraindications to LMA?

Answer 5

Improper noo status
Morbid obesity 
>14 was pregnant 
Recent GI surgery
Sever GERD
Hiatal hernia
Slow gastric emptying (poorly controlled DM, opioid users)

Question 6

Medication causes methemoglobinemia?

Local anesthetic?

Answer 6

Prilocaine (dose dependent >500 mg)

Benzocaine (not dose dependent)

Others; metoclopramide, NO, NYtroglycerine, dapsone, chloroquine, sulfonamide.

Congenital either MetHgb reductase deficiency or G6PD deficiency

Question 7

Patient risk factors for intraoperative awareness, according to the ASA Practice Advisory, include:

Answer 7

Cocaine/BZDs use or abuse, 
Prior intraoperative awareness, 
History of difficult intubation or anticipated one, 
Chronic pain patients using high doses of opioids, 
ASA  IV or V,
limited hemodynamic reserve.  
cesarean delivery, 
trauma and emergency surgery, 
use of neuromuscular blockade, 
total intravenous anesthesia