Types Of Anaes

Question 1

Types anaesthesia

Answer 1

General anaes
- elective
- emergency

Regional anaes
- peripheral n block
- central n block: spinal, epidural, combined

Question 2

Stages of general anaesthesia

Answer 2

Induction
- intravenous
- induction agent: propofol, sodium thiopentate
- opioid: fentanyl, remifentanil
- +/- muscle relaxant: atracurium, rocuronium
- gas induction: sevoflurane

Maintenance
- anaesthesia
- inhalational agent: sevoflurane, desflurane
- infusion of iv propofol: TIVA technique
- multimodal analgesia
- +/- muscle relaxant
- anti emetics

Reversal (if muscle relaxant is used)
- neostigmine and atropine (or glycopyrulate)

Question 3

Elective vs emergency (difference and examples)

Answer 3

Elective:
- there is time for pt’s preparation and premed
- ie: tonsillectomy, mastectomy

Emergency
- no pt’s preparation and no premed
- considered full stomach
- RSI if GA
- ie: laporotomy, emergency caesarean

Question 4

Indication for RSI

Answer 4

Condition that has risk of aspiration (thus, use RSI to prevent aspiration)

• full stomach (fasting time less than 6hrs) or delayed gastric emptying
• morbid obesity
• pregnant
• history of hiatus hernia or symptomatic GERD
• intestinal obstruction
• huge intra abdominal tumour/ascites

Question 5

Steps/method in RSI

Answer 5

• pre oxygenation: breath for 3 mins
• administer iv pre-calculated dose of induction agent (propofol)
• cricoid pressure
• suxamethonium/ rocuronium (depolarizing muscle relaxant)
• intubate and confirm endotracheal tube (ETT) placement

Question 6

Indication of epidural

Answer 6

• operations of lower limbs, perineum, pelvis, lower abdomen
• pain relief in labour
• post op pain relief in abdomen and thoracic surgery (combine with general anaesthesia)
• pain relief in rib or sternal fracture

Question 7

Indication of spinal

Answer 7

operations below umbilicus, lasting less than 2 hours
- open hernia repair
- gynae operations: hysteroscopy
- urological operations: TURP
- perineal operations: bartholins cyst
- genitalia operations: orchidectomy
- lower limb operations: wound debridement

Question 8

CI in spinal/epidural

Answer 8

Absolute
- patient refusal
- coagulopathy
- localised skin infection or generalised sepsis
- fixed cardiac output
- allergy to LA used for the block

Relative
- uncorrected hypovolemia
- anatomical abnormality

Question 9

Site to insert needle in spinal technique

Answer 9

Adult: below L2
Children: L3

Question 10

Complications of epidural

Answer 10

Procedure related to
- hypotension
- postdural puncture headache (PDPH)
- failed or segmental block
- neurological deficit (rare, usually temporary)
- epidural hematoma (rare)
- epidural abscess (rare)

Drug related
- nausea and vomiting
- pruritis
- local anaesthetic toxicity (rare)

Question 11

Complications of spinal

Answer 11

1.same as epidural

2.high spinal block (around T1-T4)
- hypotension
- bradycardia
- increase anxiety
- numbness or weakness of upper limbs

3.total spinal block (rare) (around brainstem)
- stop breathing (apnea)
- LOC

4.Permanent neuro damage (rare)
5.Meningitis (septic and aseptic) (rare)

Question 12

Epidural vs spinal
-needle
-needle size
-onset
-endpoint/technique
-duration
-commonly used LA

Answer 12

Touhy needle | spinal needle

18G | 25-27G

LOR/more difficult and less definite | CSF flow/ easier and more definite

Can be prolonged | short (2hrs)

Levo-bupivacaine, ropivacaine, lignocaine | heavy bupivacaine (mixed with glucose)

Question 13

CSE

Answer 13

Spinal (fast onset and definite block) + epidural (allows the block to be extended -> for long operation and for postoperative pain relief

Question 14

Types of local anaesthetic
- potency
- onset
- duration

Answer 14

• lignocaine: ++ / rapid / short
• bupivacaine: ++++ / slow / long
• cocaine: ++ / rapid / shortest