Anesthesia for Non-Operating Room Procedures

Anesthesia for Non-Operating Room Procedures Indian Medical PG Question 1: Patient was in an accident and put on mechanical ventilation. He is opening his eyes on verbal command and follows motor commands with all four limbs. What is his GCS score?

• A. 12
• B. 11
• C. 9
• D. 10 (Correct Answer)

Anesthesia for Non-Operating Room Procedures Explanation: ***10*** - **Eye-opening on verbal command scores 3 points** on the GCS (E3). - **Following motor commands with all four limbs scores 6 points** on the GCS (M6). - The patient is on **mechanical ventilation, meaning verbal response is untestable** and scores **1 point (V1T)** for intubated patients. - **Total GCS score: E3 + V1T + M6 = 10T** *12* - This score would incorrectly assume a verbal response of 5 (oriented), which is impossible for an intubated patient. - Would require: E3 + V5 + M4 or similar incorrect combinations that don't match the clinical presentation. *11* - This score would result from incorrect component assignment. - For example, E3 + V2 + M6 = 11, but verbal response cannot be 2 in an intubated patient (must be 1T). - Does not align with the untestable verbal response due to mechanical ventilation. *9* - This score underestimates the patient's neurological status. - Would require: E2 + V1 + M6 = 9, which contradicts the finding that the patient opens eyes on verbal command (E3, not E2). - Incorrectly assigns lower eye-opening score than the clinical presentation indicates.

Anesthesia for Non-Operating Room Procedures Indian Medical PG Question 2: Ambulatory patients after a disaster are categorized into what color of triage?

• A. Red
• B. Yellow
• C. Green (Correct Answer)
• D. Black

Anesthesia for Non-Operating Room Procedures Explanation: ***Green*** - **Green tag** is for the walking wounded, meaning those with minor injuries who can move independently and do not require immediate medical attention. - These patients can often assist with **their own care** or aid others, and their treatment can be delayed. *Red* - **Red tag** patients have critical, life-threatening injuries that require immediate intervention to save life or limb. - This category includes conditions like **severe bleeding**, shock, or airway compromise. *Yellow* - **Yellow tag** is assigned to patients with serious injuries that are not immediately life-threatening but require definitive treatment within a few hours. - Examples include **stable fractures**, moderate burns, or significant but controlled bleeding. *Black* - **Black tag** indicates patients who are deceased or have injuries so severe that survival is unlikely even with maximal medical care. - Resources are diverted from these patients to those with a higher chance of survival, to **maximize overall saved lives**.

Anesthesia for Non-Operating Room Procedures Indian Medical PG Question 3: Which of the following drugs produces dissociative anesthesia?

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

Anesthesia for Non-Operating Room Procedures Explanation: ***Ketamine*** - **Ketamine** is a **dissociative anesthetic** that causes a trance-like state characterized by profound analgesia, amnesia, and catatonia, with the patient appearing to be awake but unresponsive. - It works by antagonizing the **NMDA receptor**, leading to a functional dissociation between the limbic and cortical systems. *Propofol* - **Propofol** is a short-acting intravenous anesthetic that produces a rapid loss of consciousness and has sedative-hypnotic properties. - It functions primarily by enhancing the activity of the **GABA-A receptor**, leading to central nervous system depression, not dissociation. *Thiopentone* - **Thiopentone** (Thiopental) is a barbiturate that induces rapid anesthesia and is used for induction and short procedures. - Its mechanism involves potentiation of the **GABA-A receptor**, causing global central nervous system depression without dissociative effects. *Enflurane* - **Enflurane** is an inhaled halogenated ether anesthetic that provides excellent muscle relaxation and analgesia. - It primarily acts by enhancing **GABAergic inhibition** and inhibiting excitatory neurotransmission, producing general anesthesia rather than a dissociative state.

Anesthesia for Non-Operating Room Procedures Indian Medical PG Question 4: Which of the following is used for day care surgery?

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

Anesthesia for Non-Operating Room Procedures Explanation: ***Propofol*** - **Propofol** is favored for **day care surgery** due to its **rapid onset** and **rapid recovery** profile, allowing patients to be discharged quickly. - It produces a **clear-headed recovery** with less postoperative nausea and vomiting compared to other agents. *Thiopentone* - **Thiopentone** has a **longer recovery time** and greater potential for **postoperative sedation** and **nausea**, making it less suitable for day care surgery. - Its use often leads to a **delayed discharge** from the recovery unit. *Ketamine* - **Ketamine** can cause **psychomimetic effects** (e.g., hallucinations, vivid dreams) and **delirium** during emergence, which are undesirable for day care procedures. - It also leads to **increased heart rate** and **blood pressure**, which may prolong recovery and observation time. *Etomidate* - **Etomidate** is known to cause **adrenocortical suppression** and can be associated with **pain on injection** and **myoclonus**, which are not ideal for routine day care use. - While it has a relatively **stable cardiovascular profile**, these side effects limit its widespread use in short procedures where rapid, smooth recovery is paramount.

Anesthesia for Non-Operating Room Procedures Indian Medical PG Question 5: What effect does Propofol have on the EEG?

• A. Causes no significant change in EEG
• B. Causes EEG activation
• C. Induces EEG depression (Correct Answer)
• D. None of the options

Anesthesia for Non-Operating Room Procedures Explanation: ***Induces EEG depression*** - Propofol, an intravenous anesthetic, primarily acts as a **GABA-A receptor agonist**, enhancing inhibitory neurotransmission in the brain. - This leads to a dose-dependent reduction in brain electrical activity, characterized by a decrease in the **amplitude and frequency of EEG waves**, effectively causing EEG depression. *Causes no significant change in EEG* - This statement is incorrect because propofol has profound effects on brain electrical activity, as measured by the EEG. - Its anesthetic properties are directly linked to its ability to alter neuronal excitability significantly. *Causes EEG activation* - EEG activation typically involves an increase in fast-frequency, low-amplitude waves, often associated with states of arousal or epileptic activity. - Propofol's primary effect is to depress brain activity, which is the opposite of activation. *None of the options* - This option is incorrect because propofol has a well-documented and significant effect on the EEG, which is precisely EEG depression.

Anesthesia for Non-Operating Room Procedures Flashcard 1 of 5

Question: The most effective circuit for anesthesia under controlled breathing is Mapleson _____

Answer: DFE

Anesthesia for Non-Operating Room Procedures Flashcard 2 of 5

Question: The click-or-pop sensation in spinal anesthesia is encountered while piercing _____ and _____ mater.

Answer: ligamentum flavum; dura

Anesthesia for Non-Operating Room Procedures Flashcard 3 of 5

Question: 2020 AHA guidelines recommendations:Parameters such as _____ may be used to monitor and optimize CPR quality

Answer: ETCO2

Anesthesia for Non-Operating Room Procedures Flashcard 4 of 5

Question: _____ is the most commonly used depth of anesthesia monitor.

Answer: Bispectral index

Anesthesia for Non-Operating Room Procedures Flashcard 5 of 5

Question: In case of endotracheal intubation or tracheostomy, the _____ component of the score is denoted as NT.

Answer: verbal