General Anesthesia Practice Questions

Q: Which drug is used for anesthesia in a hypotensive patient?

Ketamine. ***Ketamine*** - **Ketamine** is preferred in hypotensive patients due to its **sympathomimetic effects**, which typically increase **heart rate** and **blood pressure**, thereby supporting cardiovascular stability. - It maintains **cardiac output** and **systemic vascular resistance**, making it a safer option for induction in hemodynamically unstable individuals. *Thiopentone* - **Thiopentone** is a barbiturate that causes significant **cardiovascular depression**, including **hypotension** and decreased cardiac output, making it unsuitable for hypotensive patients. - It can lead to severe drops in **blood pressure**, especially in patients with compromised cardiovascular function or hypovolemia. *Propofol* - **Propofol** is known for its potent **vasodilatory effects** and direct myocardial depression, frequently leading to profound **hypotension**. - Its use is generally avoided in hypotensive patients due to the risk of exacerbating **hemodynamic instability**. *None of the options* - This option is incorrect as **Ketamine** is a well-established anesthetic agent used specifically for its beneficial cardiovascular profile in hypotensive patients.

Q: In porphyria all the following drugs are safe Except

Pentazocine. Pentazocine - Pentazocine is known to induce delta-aminolevulinic acid (ALA) synthase activity, leading to increased porphyrin precursor production, making it unsafe in porphyria. - Due to its potential to trigger acute porphyric attacks, it should be avoided in patients with a history of porphyria [2]. Propofol - Propofol is considered a safe anesthetic agent for patients with porphyria as it does not significantly induce ALA synthase or exacerbate symptoms. - Its metabolism does not interfere with the heme biosynthesis pathway, making it a preferred choice for induction and maintenance of anesthesia. Alfentanil - Alfentanil, an opioid analgesic, is generally considered safe in porphyria. - It does not induce hepatic ALA synthase activity, thus avoiding the accumulation of porphyrin precursors. Midazolam - Midazolam, a benzodiazepine, is generally considered safe for use in patients with porphyria [1]. - It does not interact negatively with the heme synthesis pathway and can be used for sedation or as an anxiolytic.

Q: The reversal by sugammadex is possible with all the following neuromuscular blocker except-

Atracurium. ***Atracurium*** - **Sugammadex** is a modified gamma-cyclodextrin that specifically encapsulates and inactivates **aminosteroid neuromuscular blocking agents**. - **Atracurium** is a **benzylisoquinolinium** agent, not an aminosteroid, therefore it cannot be reversed by sugammadex. *Vecuronium* - **Vecuronium** is an **aminosteroid neuromuscular blocker**, which means it can be effectively encapsulated and reversed by **sugammadex**. - Its chemical structure allows for a high affinity binding with sugammadex, leading to rapid reversal of neuromuscular blockade. *Pancuronium* - **Pancuronium** is an **aminosteroid neuromuscular blocker** that can be effectively reversed by **sugammadex**. - Although sugammadex has a lower affinity for pancuronium compared to rocuronium, it can still effectively reverse its blockade. *Rocuronium* - **Rocuronium** is an **aminosteroid neuromuscular blocker** with the **highest affinity for sugammadex**, making it the most rapidly and effectively reversed by this agent. - The strong, non-covalent binding between sugammadex and rocuronium forms a stable complex, preventing rocuronium from interacting with acetylcholine receptors.

Q: What is the typical pH of Hartmann's solution?

Has a pH of approximately 6.5. Everything mentioned here pertains to pH values of biological fluids and intravenous solutions. ***Has a pH of approximately 6.5*** - Hartmann's solution, also known as **Lactated Ringer's solution**, typically has a pH of about **6.0 to 7.5**, with 6.5 being a good approximation. - Its slightly acidic nature, compared to physiological pH, is due to the presence of **lactic acid** which is later metabolized to bicarbonate. *Has a pH of approximately 5.5* - A pH of 5.5 is more **acidic** than typical Hartmann's solution and might be found in some other IV fluids like **0.9% normal saline**. - While Hartmann's is slightly acidic, it's generally not as acidic as 5.5. *Has a pH of approximately 7.4* - A pH of 7.4 is the **physiological pH of blood** [1]. - While Hartmann's solution is designed to be **isotonic** and help correct acidosis, its pH is not exactly 7.4 before infusion and metabolism. *Has a pH of approximately 8.0* - A pH of 8.0 is **alkaline** and significantly higher than the typical pH of Hartmann's solution. - Such a high pH would not be safe for routine intravenous administration. *Has a pH of approximately 4.5* - A pH of 4.5 is quite **acidic** and would be much more acidic than Hartmann's solution. - Infusion of a solution with such a low pH could lead to significant **acidosis** and other adverse effects in a patient.

Q: Anaesthesia contraindicated In volvulus of gut is

Nitrous oxide. ***Nitrous oxide*** - **Nitrous oxide** diffuses rapidly into gas-filled spaces, which can exacerbate bowel distension in cases of volvulus, increasing the risk of perforation or tension pneumoperitoneum. - Its use can lead to a significant increase in bowel volume and pressure, which is particularly dangerous when the gut is already obstructed and potentially ischemic. *Pancuronium* - **Pancuronium** is a non-depolarizing muscle relaxant that provides good muscle relaxation for surgery, which is often beneficial during abdominal procedures like volvulus repair. - It does not significantly affect bowel volume or blood flow, making it a safe choice for muscle paralysis. *Halothane* - **Halothane** is an inhaled anesthetic that causes general anesthesia and muscle relaxation. - While it can cause some myocardial depression and arrhythmias, it does not directly expand bowel gas and can be used safely in volvulus if cardiovascular status is stable. *Ketamine* - **Ketamine** is a dissociative anesthetic that can be used for induction and maintenance of anesthesia. - It does not cause gas expansion within the bowel and can be a suitable choice, especially in hypotensive patients due to its sympathomimetic effects which help maintain cardiovascular stability.

Q: Anaesthetic agent causing analgesia?

Ketamine. ***Ketamine*** - Ketamine provides excellent **analgesia** by acting as an **NMDA receptor antagonist**, making it unique among commonly used intravenous anesthetics [1]. - It induces a state of **dissociative anesthesia**, where the patient is conscious but detached from painful stimuli, maintaining cardiovascular stability [1]. *Thiopentone* - Thiopentone is a **barbiturate** that causes rapid **induction of anesthesia** and profound **sedation** but has no analgesic properties. - Its primary action is through potentiation of GABA-A receptor activity, leading to central nervous system depression. *Propofol* - Propofol is a widely used intravenous anesthetic known for its rapid onset and short duration of action, but it lacks significant **analgesic effects** [3]. - It primarily works by enhancing GABA-A receptor function, leading to **sedation** and hypnosis. *Etomidate* - Etomidate is an intravenous anesthetic characterized by its minimal cardiovascular depression, making it suitable for patients with **hemodynamic instability**, but it provides **no analgesia** [1], [2]. - Its anesthetic effect is mediated through GABA-A receptor potentiation, resulting in rapid loss of consciousness.

Q: The anesthetic agent which can cause massive hepatic necrosis?

Halothane. ***Halothane*** - Halothane can be metabolized into toxic intermediates through oxidative pathways, leading to **halothane hepatitis** or fulminant hepatic necrosis. - This idiosyncratic reaction is more likely after repeated exposures and presents as severe liver injury, possibly due to **immune-mediated mechanisms** triggered by trifluoroacetylated proteins. *N 2 O* - **Nitrous oxide** (N2O) is generally considered very safe regarding hepatic effects and does not cause massive hepatic necrosis. - Its primary metabolism involves no significant liver pathways that would generate toxic metabolites affecting hepatocytes. *Methoxyflurane* - Methoxyflurane is known to cause **nephrotoxicity** due to its metabolism to fluoride ions, which can impair renal concentrating ability. - While it can be hepatotoxic, its effects are generally less severe and less common than halothane-induced necrosis, with **renal toxicity** being its most prominent adverse effect. *Isoflurane* - Isoflurane is a commonly used volatile anesthetic with a **very low incidence of hepatotoxicity** compared to halothane. - It undergoes minimal metabolism, reducing the likelihood of producing toxic metabolites that could harm the liver.

Q: All are used to produce controlled hypotension except

Propofol. ***Propofol*** - While propofol can cause hypotension, it is primarily used as an **intravenous anesthetic** for induction and maintenance and for sedation. - Its hypotensive effect is a common side effect due to **vasodilation** and decreased cardiac output, but it is not typically optimized or used as a primary agent for controlled hypotension in a surgical setting. *Nitroglycerine* - **Nitroglycerine** is a potent vasodilator, primarily acting on veins, and is commonly used to induce **controlled hypotension** during surgery by reducing preload and afterload. - Its rapid onset and short duration of action make it suitable for titrating blood pressure. *Isoflurane* - **Isoflurane** is an inhaled anesthetic that causes dose-dependent myocardial depression and vasodilation, leading to a decrease in blood pressure. - It is frequently used to provide **controlled hypotension** during surgical procedures. *Esmolol* - **Esmolol** is a rapid-acting, ultra-short-acting beta-blocker that can reduce blood pressure by decreasing heart rate and myocardial contractility. - It is often used to manage **hypertension** and to induce controlled hypotension, especially when a rapid and reversible effect is desired.

Q: In Jorgenson technique drugs given by IV routes are:

Pethidine, Pentobarbital, and Scopolamine. ***Pethidine, Pentobarbital, and Scopolamine*** - The Jorgensen technique, a method of intravenous (IV) sedation for dental procedures, typically involves a combination of **Pethidine (Meperidine)**, a short-acting **barbiturate** like **Pentobarbital**, and an **anticholinergic** agent like **Scopolamine (Hyoscine)**. - This specific drug cocktail provides a synergistic effect, offering **analgesia**, **sedation**, and **amnesia** while reducing secretions. *Scopalamine (Hyoscine)* - While Scopolamine is a component, it is usually administered as part of a **drug combination** with an opioid and a sedative/hypnotic in the Jorgensen technique, not as a sole agent. - Its primary role in this technique is to induce **amnesia** and reduce salivation, contributing to patient comfort. *Pentobarbitol* - Pentobarbital is a key sedative in the Jorgensen technique, providing **hypnotic and anxiolytic effects**. - However, it is typically combined with an opioid like Pethidine and an anticholinergic like Scopolamine to achieve the full desired sedation profile. *Mepiridine* - Meperidine, also known as **Pethidine**, is indeed a component of the Jorgensen cocktail, providing **analgesia and sedation**. - This option is partially correct but does not represent the complete combination of drugs used in the technique. *Pethidine* - Pethidine is an **opioid analgesic** that is a crucial part of the Jorgensen sedative regimen, contributing to pain relief and sedation. - However, the Jorgensen technique utilizes a **multi-drug approach**, making this option incomplete as it excludes the sedative and anticholinergic components.

Q: Bone marrow depression is seen with:

N2O. ***N2O*** - **Nitrous oxide (N2O)** can cause **bone marrow depression** due to its interference with **vitamin B12 metabolism**. - Prolonged or repeated exposure to N2O **inactivates methionine synthase**, an enzyme crucial for **DNA synthesis** and **erythropoiesis**. *Ether* - **Ether** is an older anesthetic agent known for its **cardiovascular depression** and **irritating effects** on the respiratory tract. - It does not typically cause direct **bone marrow depression**. *Isoflurane* - **Isoflurane** is a volatile anesthetic that primarily affects the **cardiovascular system** by causing **vasodilation** and **myocardial depression**. - It is not associated with **bone marrow suppression**. *Halothane* - **Halothane** is a potent anesthetic that can cause **dose-dependent myocardial depression** and is known for its potential to induce **halothane hepatitis**. - **Bone marrow depression** is not a characteristic side effect of halothane.

Question 1

Which drug is used for anesthesia in a hypotensive patient?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

None of the options

Question 2

In porphyria all the following drugs are safe Except

Accepted Answer

Pentazocine

Answer

Propofol

Answer

Alfentanil

Answer

Midazolam

Question 3

The reversal by sugammadex is possible with all the following neuromuscular blocker except-

Accepted Answer

Atracurium

Answer

Vecuronium

Answer

Pancuronium

Answer

Rocuronium

Question 4

What is the typical pH of Hartmann's solution?

Accepted Answer

Has a pH of approximately 6.5

Answer

Has a pH of approximately 5.5

Answer

Has a pH of approximately 7.4

Answer

Has a pH of approximately 8.0

Answer

Has a pH of approximately 4.5

Question 5

Anaesthesia contraindicated In volvulus of gut is

Accepted Answer

Nitrous oxide

Answer

Pancuronium

Answer

Halothane

Answer

Ketamine

Question 6

Anaesthetic agent causing analgesia?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

Etomidate

Question 7

The anesthetic agent which can cause massive hepatic necrosis?

Accepted Answer

Halothane

Answer

N 2 O

Answer

Methoxyflurane

Answer

Isoflurane

Question 8

All are used to produce controlled hypotension except

Accepted Answer

Propofol

Answer

Nitroglycerine

Answer

Isoflurane

Answer

Esmolol

Question 9

In Jorgenson technique drugs given by IV routes are:

Accepted Answer

Pethidine, Pentobarbital, and Scopolamine

Answer

Scopalamine (Hyoscine)

Answer

Pentobarbitol

Answer

Mepiridine

Answer

Pethidine

Question 10

Bone marrow depression is seen with:

Accepted Answer

N2O

Answer

Ether

Answer

Isoflurane

Answer

Halothane

General Anesthesia — MCQs

General Anesthesia — MCQs

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