Anesthesia for Interventional Radiology — MCQs
Premedication is prescribed to – a) Allay anxiety b) Make the patient asleep before coming for operation c) Reduce the dose of induction agents d) Produce amnesia
Artery cannulated most commonly for invasive blood pressure monitoring is:
Which of the following anesthetic agents causes the LEAST severe complications when accidentally injected intra-arterially?
Which pre-operative investigation is recommended before surgical procedures in a patient on warfarin therapy?
IVRA is contraindicated in -
Anesthetic agent contraindicated in raised ICT is?
A 40–year female has to undergo incisional hernia surgery under general anaesthesia. She complains of awareness during her past cesarean section. Which of the following monitoring techniques can be used to prevent such awareness ?
Problems which may result from hypotensive anesthesia include:
Most commonly used nerve for monitoring during anesthesia
What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT
Anesthesia for Interventional Radiology Indian Medical PG Practice Questions and MCQs
Question 1: Premedication is prescribed to – a) Allay anxiety b) Make the patient asleep before coming for operation c) Reduce the dose of induction agents d) Produce amnesia
- A. Reduce the dose of induction agents
- B. Allay anxiety (Correct Answer)
- C. Produce amnesia
- D. Make the patient asleep before coming for operation
Explanation: ***Allay anxiety*** - Premedication frequently includes anxiolytic agents like **benzodiazepines** to calm the patient before surgery. - Reducing anxiety helps in achieving a smoother induction of anesthesia and can improve the patient's overall experience. *Reduce the dose of induction agents* - While some premedication agents like **opioids** or sedatives can have an anesthetic-sparing effect, this is a secondary benefit, not the primary goal. - The main aim is patient comfort and psychological preparation, not primarily dose reduction. *Produce amnesia* - Amnesia, particularly **anterograde amnesia**, is a desirable side effect of some premedication drugs like **midazolam**. - However, it's a consequence of the anxiolytic effect rather than the sole or primary reason for prescribing premedication. *Make the patient asleep before coming for operation* - While some premedication agents can cause **somnolence** or light sleep, the goal is not to have the patient fully asleep before entering the operating room. - The primary aim is to make the patient relaxed and comfortable, not unconscious.
Question 2: Artery cannulated most commonly for invasive blood pressure monitoring is:
- A. Radial artery (Correct Answer)
- B. Femoral artery
- C. Ulnar artery
- D. Carotid artery
Explanation: ***Radial artery*** - The **radial artery** is the most common site due to its **superficial location**, ease of access, and presence of collateral circulation via the **ulnar artery** (Allen's test). - This allows for safe cannulation with a low risk of **ischemia** to the hand, even if the radial artery becomes thrombosed. *Femoral artery* - The **femoral artery** is used, especially in emergencies or when radial access is not possible, but it carries a higher risk of **infection** and hematoma. - Its deep location can make cannulation more challenging, and complications like **retroperitoneal hemorrhage** are possible. *Ulnar artery* - The **ulnar artery** is generally avoided for primary arterial cannulation because the radial artery is the more dominant blood supply to the hand. - Cannulating the ulnar artery carries a higher risk of **ischemia** to the hand if an anatomical anomaly exists or if the radial artery's collateral flow is compromised. *Carotid artery* - The **carotid artery** is rarely, if ever, cannulated for routine invasive blood pressure monitoring due to the significant risk of **neurological complications** such as stroke or cerebral embolism. - This artery supplies blood directly to the brain, and any damage or clot formation during cannulation could have devastating consequences.
Question 3: Which of the following anesthetic agents causes the LEAST severe complications when accidentally injected intra-arterially?
- A. Thiopentone
- B. Propofol (Correct Answer)
- C. Methohexitone
- D. Midazolam
Explanation: **Propofol** * **Propofol** has a relatively low incidence and severity of complications if accidentally injected intra-arterially because of its **lipid emulsion formulation** and mild irritant properties compared to other agents. * While any intra-arterial injection can cause problems, the milder venoconstriction and less direct tissue damage make its intra-arterial complication profile less severe than alternative agents. *Thiopentone* * **Thiopentone** (Thiopental) is highly alkaline, and accidental intra-arterial injection can cause **intense pain**, **vasospasm**, and **gangrene** due to precipitation in the arterioles and widespread endothelial damage. * This severe complication arises from its extreme pH and crystal formation, leading to profound ischemia. *Midazolam* * Accidental intra-arterial injection of **Midazolam** can cause **pain**, **spasm**, and **local tissue damage** due to its relatively acidic pH and solvent properties, though generally less severe than thiopentone. * While not as catastrophic as thiopentone, it can still lead to significant discomfort and localized vascular issues. *Methohexitone* * **Methohexitone** is also an alkaline barbiturate derivative, similar in nature to thiopentone, and its intra-arterial injection carries a significant risk of **vasospasm**, **pain**, and potentially **tissue necrosis**. * Its strong irritant properties and ability to precipitate within the vasculature make it a dangerous agent for inadvertent intra-arterial administration.
Question 4: Which pre-operative investigation is recommended before surgical procedures in a patient on warfarin therapy?
- A. International Normalized Ratio (INR) (Correct Answer)
- B. Partial Thromboplastin Time (PTT)
- C. Clotting Time
- D. Differential Count
Explanation: ***International Normalized Ratio (INR)*** - The **INR** is specifically used to monitor the effectiveness of **warfarin** therapy, as it standardizes the prothrombin time (PT) for variations in thromboplastin reagents. - Before surgery, an INR measurement helps assess the patient's **coagulation status** and guides decisions on temporary cessation or bridging therapy to minimize bleeding risk. *Partial Thromboplastin Time (PTT)* - **PTT** primarily measures the **intrinsic and common pathways** of coagulation and is used to monitor **heparin** therapy, not warfarin. - While prolonged in some bleeding disorders, it is not the standard test for assessing warfarin's anticoagulant effect. *Clotting Time* - **Clotting time** is a very general and less precise measure of overall coagulation that is **rarely used** in modern clinical practice due to its low sensitivity and specificity. - It does not offer sufficient detail or standardization to guide pre-operative management for patients on warfarin. *Differential Count* - A **differential count** measures the different types of **white blood cells** within a blood sample and is used to diagnose infections, inflammatory conditions, or hematologic disorders. - It provides no information about a patient's coagulation status or the effects of anticoagulant medications like warfarin.
Question 5: IVRA is contraindicated in -
- A. Sickle cell disease (Correct Answer)
- B. Cancer of hematogenous system
- C. Coagulopathy
- D. Hypertension
Explanation: ***Sickle cell disease*** - **Intravenous regional anesthesia (IVRA)** involves injecting local anesthetic into an isolated limb, which can lead to **stasis** and **ischemia** when the tourniquet is inflated. - In sickle cell disease, **hypoxia** and **acidosis** from stasis can precipitate or worsen a **sickle cell crisis**, leading to severe pain and potential organ damage. *Cancer of the hematogenous system* - While certain cancers of the hematogenous system might indirectly affect anesthetic choice, there is **no direct contraindication** for IVRA in these conditions. - Local anesthetics used in IVRA do not typically interfere with the systemic treatment or progression of hematological malignancies. *Coagulopathy* - Coagulopathy is a relative contraindication to regional anesthesia due to the risk of **hematoma formation** if a nerve block is performed or if there is trauma during venipuncture. - However, IVRA primarily uses **intravenous access**, and the major risk is generally not hematoma due to bleeding at the injection site but rather systemic effects if the tourniquet fails. *Hypertension* - **Hypertension** itself is not a contraindication for IVRA. - While local anesthetics, if they escape the tourniquet, can cause systemic effects, properly performed IVRA has minimal systemic absorption until the tourniquet is released.
Question 6: Anesthetic agent contraindicated in raised ICT is?
- A. Thiopentone
- B. Etomidate
- C. Ketamine (Correct Answer)
- D. Sevoflurane
Explanation: ***Ketamine*** - **Ketamine** is known to increase **cerebral blood flow** and metabolic rate, which can lead to a significant increase in **intracranial pressure (ICP)**. - This effect makes **ketamine** contraindicated in situations of elevated ICP, as it can worsen neurological outcomes. *Thiopentone* - **Thiopentone** is a barbiturate that typically causes a dose-dependent **decrease in cerebral blood flow** and **metabolic rate**, leading to a *reduction* in ICP. - It is often used to *lower* ICP in neurosurgical settings rather than being contraindicated. *Etomidate* - **Etomidate** also causes a **reduction in cerebral blood flow** and **cerebral metabolic rate**, leading to a *decrease* in ICP. - It is considered a relatively **hemodynamically stable** induction agent, making it suitable in many cases with neurological concerns. *Sevoflurane* - **Sevoflurane**, an inhaled anesthetic, can cause **cerebral vasodilation** at higher concentrations, potentially *increasing* ICP. - However, this effect is often *attenuated* by concurrent hyperventilation, and its overall impact on ICP is less pronounced than **ketamine's** and often manageable.
Question 7: A 40–year female has to undergo incisional hernia surgery under general anaesthesia. She complains of awareness during her past cesarean section. Which of the following monitoring techniques can be used to prevent such awareness ?
- A. Color doppler
- B. Transesophageal echocardiography
- C. Bispectral index monitoring (Correct Answer)
- D. Pulse plethysmography
Explanation: ***Bispectral index monitoring*** - **Bispectral Index (BIS) monitoring** is a technology that processes electroencephalogram (EEG) signals to provide a numerical value (0-100) indicating the patient's **level of consciousness or depth of anesthesia**. - A lower BIS value (typically 40-60) indicates a suitable depth of anesthesia for surgery, helping to prevent **intraoperative awareness**, especially in patients with a history of it. *Color doppler* - **Color Doppler** is an imaging technique used to visualize blood flow in vessels and assess the speed and direction of flow. - It is primarily used to diagnose conditions like **deep venous thrombosis**, *arterial stenosis*, or to evaluate blood flow to organs, and has no direct role in monitoring depth of anesthesia. *Transesophageal echocardiography* - **Transesophageal echocardiography (TEE)** is an invasive imaging technique that uses ultrasound from a probe inserted into the esophagus to provide detailed images of the heart. - TEE is critical for assessing **cardiac function**, *valvular heart disease*, or *aortic dissection* during surgery, but it does not monitor brain activity or the depth of anesthesia. *Pulse plethysmography* - **Pulse plethysmography** is a non-invasive method that measures changes in blood volume in a part of the body, often used to determine **heart rate** and assess peripheral perfusion. - While it is a component of pulse oximetry, it does not provide information about the **depth of anesthesia** or brain activity.
Question 8: Problems which may result from hypotensive anesthesia include:
- A. Deep vein thrombosis
- B. Reactionary hemorrhage
- C. Retraction anemia
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - Hypotensive anesthesia is a technique used to reduce **blood pressure** during surgery, aiming to decrease **blood loss** and improve the **surgical field visibility**. - While beneficial, it carries inherent risks including **deep vein thrombosis (DVT), reactionary hemorrhage**, and complications like **retraction anemia** if not managed properly. *Deep vein thrombosis (DVT)* - While hypotension might seem to reduce the risk by lowering **blood flow velocity**, prolonged immobility and potential for **venous stasis** during any surgery, especially under hypotension, can increase DVT risk. - The combination of **endothelial dysfunction** and **hypercoagulability** often seen in surgical patients, coupled with reduced peripheral blood flow due to hypotension, can contribute to DVT formation. *Reactionary hemorrhage* - This is a common post-operative complication where bleeding restarts hours after surgery. With hypotensive anesthesia, **blood vessels** are constricted and may not be actively bleeding during the surgery. - As the patient's **blood pressure** returns to normal post-operatively, these previously undetected bleeds can manifest as significant **hemorrhage** due to the increased pressure. *Retraction anemia* - This term is less commonly used in medical literature. However, it likely refers to the complications arising from prolonged tissue retraction during surgery, which, when combined with reduced **perfusion** from hypotensive anesthesia, can lead to **tissue ischemia** or damage akin to anemia in the affected area. - The reduced **oxygen delivery** to tissues during hypotensive states, especially when further compromised by retraction, may result in localized tissue injury or contribute to systemic complications if severe or prolonged.
Question 9: Most commonly used nerve for monitoring during anesthesia
- A. Facial nerve
- B. Ulnar nerve (Correct Answer)
- C. Radial nerve
- D. Median nerve
Explanation: ***Ulnar nerve*** - The **ulnar nerve** is most commonly used for **neuromuscular monitoring** during anesthesia due to its accessibility at the wrist and predictable response to stimulation. - Stimulation typically elicits an adductor pollicis contraction, which is easily observed and quantified with various monitoring devices. *Facial nerve* - The **facial nerve** is primarily monitored during **neurosurgical procedures** where facial nerve integrity is at risk, such as parotidectomy or acoustic neuroma resection. - While it can be monitored, it is not the standard choice for general neuromuscular blockade assessment due to its complex innervation patterns and the need for specific electrode placement. *Radial nerve* - The **radial nerve** is less frequently used for standard neuromuscular monitoring compared to the ulnar nerve. - Its stimulation can lead to more variable and less quantifiable thumb or finger extension, making it less ideal for precise assessment of blockade depth. *Median nerve* - The **median nerve** can be used for neuromuscular monitoring, often stimulating the thenar muscles to produce thumb flexion. - However, it is generally considered a secondary site compared to the ulnar nerve due to greater anatomical variability in electrode placement and response.
Question 10: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT
- A. 2,1,4,3
- B. 1,3,2,4
- C. 2,1,3,4
- D. 1,2,3,4 (Correct Answer)
Explanation: ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.
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