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
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:
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 patient comes to the casualty with a severe headache. His BP was found to be 160/100 mmHg. CT scan revealed a subarachnoid hemorrhage. What is the next best step in the management of this patient?
Which of the following can be used as a pre-anesthetic medication to decrease secretions and reflux bronchospasm during general anesthesia?
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: 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 3: 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 4: 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 5: 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 6: 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 7: 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 8: 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.
Question 9: A patient comes to the casualty with a severe headache. His BP was found to be 160/100 mmHg. CT scan revealed a subarachnoid hemorrhage. What is the next best step in the management of this patient?
- A. Nimodipine
- B. Angiography (Correct Answer)
- C. Surgery
- D. Fibrinolytic therapy
Explanation: ***Angiography*** - Following the diagnosis of **subarachnoid hemorrhage (SAH)** by CT scan, **cerebral angiography** is the next crucial step to identify the source of bleeding. - This procedure helps locate and characterize the **aneurysm** or other vascular malformations, which is essential for planning definitive treatment. *Nimodipine* - **Nimodipine** is a calcium channel blocker used to prevent and treat **vasospasm**, a common complication after SAH. - While important in SAH management, it is typically initiated after the source of bleeding has been identified and secured, or as an adjunct immediately after diagnosis, but not the *next best step* before identifying the source. *Surgery* - **Surgical clipping** or **endovascular coiling** are definitive treatments for ruptured aneurysms after SAH. - However, surgery is performed *after* the aneurysm has been identified and localized through angiography, making angiography the prerequisite next step. *Fibrinolytic therapy* - **Fibrinolytic therapy** is used to dissolve blood clots in conditions like ischemic stroke or myocardial infarction. - It is **contraindicated** in hemorrhagic stroke, including subarachnoid hemorrhage, as it would worsen the bleeding.
Question 10: Which of the following can be used as a pre-anesthetic medication to decrease secretions and reflux bronchospasm during general anesthesia?
- A. Ipratropium.
- B. Tiotropium.
- C. Glycopyrrolate. (Correct Answer)
- D. Atropine.
Explanation: ***Glycopyrrolate*** - It is a **quaternary ammonium anticholinergic** that reduces salivary, tracheobronchial, and pharyngeal secretions effectively. - Due to its **limited ability to cross the blood-brain barrier**, it has fewer central nervous system side effects compared to atropine. *Ipratropium* - This medication is a **short-acting muscarinic antagonist** primarily used as a bronchodilator for conditions like asthma and COPD. - While it can reduce secretions, it's typically administered via inhalation for its local bronchodilatory effects and is not a common systemic pre-anesthetic antisialagogue. *Tiotropium* - **Tiotropium** is a **long-acting muscarinic antagonist** used for maintenance treatment of COPD, administered via inhalation. - Its primary role is sustained bronchodilation, and it is not employed as a systemic pre-anesthetic antisialagogue. *Atropine* - While atropine is an antipsychotic that can reduce secretions and counteract **bradycardia**, it readily **crosses the blood-brain barrier**, leading to more central nervous system side effects such as confusion and delirium. - Its use has decreased in favor of agents like glycopyrrolate that have a better side effect profile for reducing secretions in the perioperative setting.
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