Sedation and Analgesia in ICU — MCQs

10 questions

The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for rating postoperative pain in children under one year excludes all of the following, EXCEPT:

A patient after undergoing thoracotomy complains of severe pain. The BEST method of pain control in this patient would be:

Child with aspiration risk needs emergency surgery. Best induction sequence is:

Which of the following anaesthetic agent lacks analgesic effect? A) N2O B) Thiopentone C) Methohexitone D) Ketamine E) Fentanyl

Which of the following is used as an adjuvant during anesthesia?

Which of the following drugs is contraindicated in a patient with raised intracranial pressure ?

Which of the following is the most suitable anesthetic agent for use in dogs?

Depth of anaesthesia can be best assessed by

The following ventilation modality is used in:

Q10Easy

During cardiopulmonary resuscitation in an adult, at what rate are chest compressions given?

Sedation and Analgesia in ICU Indian Medical PG Practice Questions and MCQs

Question 1: The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for rating postoperative pain in children under one year excludes all of the following, EXCEPT:

A. Oxygen saturation
B. Torso
C. Verbal response (Correct Answer)
D. Cry

Explanation: ***Verbal response*** - The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) is designed for children **under one year of age**, who are typically pre-verbal. - While verbal complaints are not assessed, a child's **verbal response** (e.g., moaning, crying, or not making sounds at all) in relation to pain is a component of the scale, contributing to the interpretation of their comfort level. *Oxygen saturation* - **Physiological parameters** like oxygen saturation are typically not part of behavioral pain scales like CHEOPS, which focus on observable behaviors. - While low oxygen saturation can indicate distress, it is not a direct measure of pain for this scale. *Torso* - The CHEOPS scale assesses **pain-related behaviors** of extremities (e.g., legs, arms) and facial expressions, but does not specifically include observations of the "torso" as a separate category. - Behaviors like stiffening or arching of the torso might be implicitly considered under overall body tension, but it’s not a distinct domain. *Cry* - The **quality and intensity of crying** is a primary behavioral indicator of pain in pre-verbal infants and is a significant component of many pediatric pain scales, including CHEOPS. - A child's cry, along with other behaviors, helps differentiate between various levels of discomfort or pain.

Question 2: A patient after undergoing thoracotomy complains of severe pain. The BEST method of pain control in this patient would be:

A. Oral morphine
B. Diazepam rectal suppository
C. Intercostal cryoanalgesia (Correct Answer)
D. IV fentanyl

Explanation: ***Intercostal cryoanalgesia*** - **Intercostal cryoanalgesia** involves applying extreme cold to the intercostal nerves, leading to temporary nerve denervation and prolonged pain relief. This technique is particularly effective for **post-thoracotomy pain** due to its targeted action and reduced systemic side effects compared to opioids. - The goal is to provide **long-lasting pain control** specifically at the surgical site, allowing for better respiratory mechanics and early mobilization. *Oral morphine* - Oral morphine can provide systemic pain relief, but its onset of action is slower, and it carries the risk of significant **sedation** and **respiratory depression**, which are major concerns in a patient who has just undergone thoracotomy. - While effective, it may not provide optimal local pain control for incisional pain and often requires higher doses to achieve adequate relief, increasing the risk of adverse effects. *Diazepam rectal suppository* - Diazepam is a **benzodiazepine** primarily used for anxiety, muscle spasms, and seizures, not for severe acute surgical pain. It has **no significant analgesic properties**. - Its sedative effects would be contraindicated after thoracotomy due to the risk of respiratory depression and masking potential neurological changes. *IV fentanyl* - IV fentanyl is a potent opioid with a rapid onset and short duration of action, making it useful for breakthrough pain or during immediate post-operative periods. However, it requires **continuous monitoring** and frequent re-dosing. - Like other opioids, it carries risks of **respiratory depression**, nausea, and sedation, making it less ideal for sustained primary pain control immediately after thoracotomy where lung function is critical.

Question 3: Child with aspiration risk needs emergency surgery. Best induction sequence is:

A. Preoxygenation-ketamine-succinylcholine
B. Sevoflurane-propofol-succinylcholine
C. Midazolam-propofol-rocuronium
D. Preoxygenation-propofol-succinylcholine (Correct Answer)

Explanation: ***Preoxygenation-propofol-succinylcholine*** - This sequence describes a **rapid sequence intubation (RSI)**, which is the preferred method for patients at high risk of aspiration, including children needing emergency surgery with an unknown fasting status. - **Preoxygenation** provides an oxygen reserve during the apneic period, **propofol** offers rapid induction with good hemodynamic stability, and **succinylcholine** provides fast-onset, short-acting neuromuscular blockade, crucial for preventing aspiration. *Preoxygenation-ketamine-succinylcholine* - While preoxygenation and succinylcholine are appropriate for RSI, **ketamine** may not be the optimal choice for a child with aspiration risk due to its potential to increase secretions and maintain laryngeal reflexes, which could complicate intubation. - Ketamine can also cause **emergence delirium** in some children, making it less favorable for a smooth anesthetic course compared to propofol. *Sevoflurane-propofol-succinylcholine* - **Sevoflurane** is an inhaled anesthetic often used for mask induction in children due to its non-pungent odor and rapid onset. However, it is generally **not suitable for RSI** in patients with aspiration risk as it has a slower induction time compared to intravenous agents and can cause coughing or laryngospasm. - Using both sevoflurane and propofol for induction in an RSI scenario is redundant and prolongs the induction phase, increasing aspiration risk. *Midazolam-propofol-rocuronium* - **Midazolam** is a benzodiazepine used for anxiolysis and sedation but has a **slower onset** and longer duration of action compared to propofol for rapid induction. - **Rocuronium** is a non-depolarizing neuromuscular blocker with a slower onset of action than succinylcholine, making it less ideal for RSI where immediate paralysis for intubation is critical to prevent aspiration.

Question 4: Which of the following anaesthetic agent lacks analgesic effect? A) N2O B) Thiopentone C) Methohexitone D) Ketamine E) Fentanyl

A. N2O
B. Methohexitone
C. Ketamine
D. Fentanyl
E. Thiopentone (Correct Answer)

Explanation: ***Thiopentone*** - Thiopentone is a **barbiturate** anesthetic primarily used for inducing anesthesia. - It provides significant **hypnosis** and sedation but lacks intrinsic **analgesic properties**, meaning it does not relieve pain. *N2O* - **Nitrous oxide** (N2O) is an inhalation anesthetic that provides good **analgesia** at sub-anesthetic concentrations. - It is often used as an adjunct to other anesthetic agents to enhance pain relief during procedures. *Methohexitone* - Methohexitone is another **barbiturate** similar to thiopentone, used for induction of anesthesia. - While it provides rapid **hypnosis**, it also lacks significant **analgesic effects**. *Ketamine* - Ketamine is a **dissociative anesthetic** known for its potent **analgesic properties**. - It works by blocking **NMDA receptors**, providing pain relief even at sub-anesthetic doses. *Fentanyl* - Fentanyl is a powerful **opioid analgesic** that is commonly used in anesthesia for its strong pain-relieving effects. - It acts on **opioid receptors** in the central nervous system to reduce pain perception.

Question 5: Which of the following is used as an adjuvant during anesthesia?

A. Bupivacaine
B. Dexmedetomidine (Correct Answer)
C. Lorazepam
D. Neostigmine

Explanation: ***Dexmedetomidine*** - **Dexmedetomidine** is an alpha-2 adrenergic agonist commonly used as an **adjuvant** in anesthesia to provide **sedation**, **analgesia**, and **anxiolysis** with minimal respiratory depression. - Its unique properties allow for cooperative sedation, where patients can be aroused and follow commands, making it useful in various anesthetic settings. *Bupivacaine* - **Bupivacaine** is a **local anesthetic** used for regional anesthesia and pain management, not typically as an adjuvant to achieve general anesthetic effects. - It primarily blocks nerve impulse transmission to numb specific areas, rather than contributing to overall anesthetic depth or sedation. *Lorazepam* - **Lorazepam** is a **benzodiazepine** primarily used for **anxiolysis** and **sedation** prior to anesthesia or for treatment of anxiety. - While it can be given before surgery, it is not an anesthetic adjuvant in the same way dexmedetomidine is used during the operative phase to modulate anesthetic requirements and recovery. *Neostigmine* - **Neostigmine** is an **acetylcholinesterase inhibitor** used to **reverse the effects of non-depolarizing neuromuscular blockers** at the end of surgery. - It does not induce anesthesia, sedation, or analgesia, but rather restores muscle function to allow for extubation.

Question 6: Which of the following drugs is contraindicated in a patient with raised intracranial pressure ?

A. Ketamine (Correct Answer)
B. Midazolam
C. Propofol
D. Thiopentone

Explanation: ***Ketamine*** - **Ketamine** typically causes an increase in **cerebral blood flow** and **intracranial pressure (ICP)**, making it contraindicated in patients with raised ICP. - This effect is due to its action as a **dissociative anesthetic** which can lead to cerebral vasodilation. *Midazolam* - **Midazolam**, a benzodiazepine, can decrease **cerebral metabolic rate** and **cerebral blood flow**, thereby reducing ICP, making it a suitable option for sedation in patients with raised ICP. - It provides **sedation** and **anxiolysis** without significantly increasing ICP. *Propofol* - **Propofol** is a common choice for sedation in patients with raised ICP because it significantly reduces **cerebral blood flow**, **cerebral metabolic rate**, and thus **intracranial pressure**. - Its rapid onset and offset allow for precise control of depth of sedation and neurological assessment. *Thiopentone* - **Thiopentone**, a barbiturate, effectively reduces **cerebral blood flow** and **cerebral metabolic rate**, leading to a decrease in **intracranial pressure**. - It is often used for inducing anesthesia and as a neuroprotective agent in situations with acute brain injury.

Question 7: Which of the following is the most suitable anesthetic agent for use in dogs?

A. Propofol (Correct Answer)
B. Medetomidine hydrochloride
C. Ketamine
D. Midazolam

Explanation: ***Propofol*** - **Propofol** is a widely used and highly effective intravenous anesthetic in dogs due to its **rapid induction** and **rapid recovery**. - It produces minimal cumulative effects when administered as a constant rate infusion, making it suitable for both short procedures and maintenance of anesthesia. *Medetomidine hydrochloride* - **Medetomidine** is an **alpha-2 agonist** primarily used as a sedative and analgesic in dogs, not typically as the sole anesthetic agent for general anesthesia. - While it provides profound sedation, it is usually combined with other drugs (e.g., ketamine) to achieve surgical planes of anesthesia, and its effects on reducing heart rate and blood pressure can be significant. *Ketamine* - **Ketamine** is a **dissociative anesthetic** that provides good analgesia and somatic anesthesia but often causes muscle rigidity and can increase sympathetic tone. - It is typically used in combination with other sedatives or tranquilizers (e.g., diazepam, midazolam) to ensure smooth induction and recovery and prevent adverse effects like seizures. *Midazolam* - **Midazolam** is a **benzodiazepine** primarily used as a sedative, anxiolytic, and muscle relaxant, often as a premedicant or co-induction agent, not as a primary anesthetic for general anesthesia in dogs. - It offers minimal cardiovascular and respiratory depression when used alone, but it does not produce sufficient anesthetic depth for surgical procedures.

Question 8: Depth of anaesthesia can be best assessed by

A. ABG analysis
B. Pulse oximeter
C. End tidal Pco2
D. Bispectral index (Correct Answer)

Explanation: ***Bispectral index*** - The **Bispectral Index (BIS)** monitor processes **electroencephalogram (EEG)** signals to provide a numerical value (0-100) indicating the **level of consciousness** and hypnotic depth during anesthesia. - A lower BIS value (typically 40-60) indicates a deeper anesthetic state, helping clinicians avoid **awareness during surgery** and guide anesthetic agent delivery. *ABG analysis* - **Arterial Blood Gas (ABG)** analysis measures parameters like pH, PCO2, PO2, and bicarbonate, reflecting the patient's **acid-base balance** and **oxygenation**. - While important for overall physiological status, ABG analysis does not directly assess the **depth of anesthesia** or the patient's level of consciousness. *Pulse oximeter* - A **pulse oximeter** measures **oxygen saturation (SpO2)** and heart rate, reflecting the adequacy of oxygen delivery. - It does not provide information about the **depth of consciousness** or the hypnotic effect of anesthetic agents. *End tidal Pco2* - **End-tidal PCO2 (EtCO2)** monitors the partial pressure of carbon dioxide at the end of exhalation, providing an indication of **ventilation** and CO2 elimination. - While EtCO2 is crucial for managing ventilation during anesthesia, it does not directly reflect the **depth of anesthesia** or the patient's neurological state.

Question 9: The following ventilation modality is used in:

A. Meconium aspiration syndrome
B. Assessment of extubation potential (Correct Answer)
C. Bronchiolitis obliterans organizing pneumonia
D. Acute exacerbation of chronic bronchitis

Explanation: ***Assessment of extubation potential*** - The image depicts **Continuous Positive Airway Pressure (CPAP)**, as indicated by the "Applied CPAP level" and the continuous positive pressure throughout the respiratory cycle, with slight variations but no distinct inspiratory aid. - CPAP is commonly used as a **weaning modality** to assess a patient's ability to breathe spontaneously and maintain adequate oxygenation and ventilation before extubation. *Meconium aspiration syndrome* - Meconium aspiration syndrome often causes severe respiratory distress, requiring **high-frequency oscillatory ventilation (HFOV)** or **conventional mechanical ventilation** with high PEEP and ventilation strategies to minimize barotrauma and air trapping. - While CPAP might be used in milder cases or during the weaning phase, it is not the primary or defining ventilation modality for initial management of severe MAS. *Bronchiolitis obliterans organizing pneumonia* - **Bronchiolitis obliterans organizing pneumonia (BOOP)**, now known as cryptogenic organizing pneumonia, is a restrictive lung disease that typically responds to **corticosteroids**. - Ventilatory support, if needed, would generally involve conventional mechanical ventilation, not specifically CPAP in its primary management. *Acute exacerbation of chronic bronchitis* - **Acute exacerbations of chronic bronchitis (AECB)**, particularly those leading to hypercapnic respiratory failure, are commonly treated with **non-invasive positive pressure ventilation (NIPPV)**, such as BiPAP, which provides both inspiratory (IPAP) and expiratory (EPAP) pressure support. - While CPAP can be used in some cases, BiPAP is generally preferred for its ability to reduce the work of breathing and improve ventilation in hypercapnic patients.

Question 10: During cardiopulmonary resuscitation in an adult, at what rate are chest compressions given?

A. 72 compressions/min
B. 90 compressions/min
C. 100 compressions/min (Correct Answer)
D. 120 compressions/min

Explanation: **Explanation:** The correct answer is **C. 100 compressions/min**. **Medical Concept:** According to the latest American Heart Association (AHA) and ERC guidelines for Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS), the recommended rate for chest compressions in adults is **100 to 120 compressions per minute**. High-quality CPR is essential to maintain coronary and cerebral perfusion. A rate of at least 100 bpm ensures sufficient cardiac output, while exceeding 120 bpm is discouraged as it reduces the time for ventricular filling and decreases the quality of recoil. **Analysis of Options:** * **A (72/min) & B (90/min):** These rates are too slow. Inadequate compression frequency fails to generate the necessary intrathoracic pressure and arterial perfusion pressure required to restart the heart or protect the brain. * **D (120/min):** While 120 is the upper limit of the recommended range, standard medical examinations (like NEET-PG) traditionally prioritize the baseline "at least 100/min" as the gold standard answer when a range is not provided. **High-Yield Clinical Pearls for NEET-PG:** * **Compression Depth:** 2 to 2.4 inches (5 to 6 cm) in adults. * **Compression-to-Ventilation Ratio:** 30:2 for adults (single or dual rescuer). * **Recoil:** Allow complete chest recoil after each compression to allow the heart to fill. * **Minimize Interruptions:** Keep pauses in compressions to less than 10 seconds. * **EtCO2 Monitoring:** A capnography reading of <10 mmHg during CPR indicates poor quality compressions.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free