20 High-Yield Anesthesia  Flashcards NEET PG 2025

Flashcard 1 

History of Anaesthesia

• WTG MORTON: Father of Modern Anaesthesia
• Morton gave the public demonstration of Ether Anaesthesia
• 16th Oct 1846: World Anaesthesia Day
• August Bier father of spinal Anaesthesia
• IVRA is also called as Biers block
• Horace Wells gave the clinical demonstration of N2O anesthesia

Flashcard 2 

Things to do in Airway Assessment

• Tell the patient to open the mouth
  • As he opens the mouth (look for 2 parameters)
  • As he lift the chin (look for 2 parameters)
• Mallampati classification and interincisor distance

Flashcard 3

 Mallampati Classification

• Tell the patient to open the mouth
• If the doctor is able to see all the structures in the patient's mouth
• Then the patient has adequate space
• Put the laryngoscope and lift the tongue for intubation
• Visual classification of the structures - Mallampati classification

Flashcard 4

ASA Classification 

• ASA class 1
  • The patient is free from systemic illness
  • Diabetes, BP, hypertension, heart disease
  • No comorbidities
• ASA class 2
  • Having systemic illness- well under control
  • Ex: diabetic - FBL-90, pbs- 120
• ASA class 3
  • Having systemic illness- not under control
  • Ex: Diabetic: FBL - 200, pbs 380
• ASA class 4
  • Having systemic illness - a constant threat to his life
  • EX: having a history of recent stroke or coronary artery disease
• ASA class 5
  • Moribund patient - multiple comorbidities
  • EX: ruptured abdominal aortic aneurysm
• ASA class 6
  • Brain dead patient
• Add suffix' E' depends on the emergency
• EX: A lady has a ruptured ectopic pregnancy management having no comorbidities - class '1E’

Flashcard 5

Spinal Anaesthesia

• Indication: used for below umbilical short-duration surgery
  • Appendectomy
  • LSCS
  • Hernia
  • Hydrocele
• Duration: 2-3 hours
• The patient is made to sit and choose a space for inserting the needle
  • Locate Tuffier's line
• Given below spinal cord
• Sitting or lateral position
• Clean the site, locate the site
• Site: L3-L5 space
  • L4, L5 easy to identify
• Landmark: Tuffier's line
  • Keep hands on the highest point of the iliac crest back of the patient
• Introduce the Dura separating needle
  • A thin bore

Layers Pierced in Spinal Anaesthesia

○ Skin → Subcutaneous tissue → Supraspinous ligament → Inter/Intra/Infra spinous ligament → Ligamentum flavum (toughest ligament) → feel snap/sudden loss of resistance → Dura → Arachnoid membrane (last layer) → Subarachnoid space (CSF).

Flashcard 6

Epidural Anaesthesia

• Indication: Most commonly used for below umbilical long-duration surgeries
  • Total hip replacement
  • Total knee replacement
• In spinal, single shot technique is used
• In epidural, the needle enters into epidural space, and a catheter is placed
• One end of the catheter is in epidural space, other end is lying outside
• Top-up doses of the drug are given through the catheter
• Length: 9-10 cm

Layers Involved: Skin → Subcutaneous tissue → Supraspinous ligament→ Inter/Intra/Infra spinous ligament → Ligamentum flavum (toughest ligament) → feel snap/sudden loss of resistance (last layer) → Dura

Flashcard 7

Surface Anesthetic Cream

• Commonly used as Emla cream
  • Equal/Eutectic Mixture of Local Anaesthesia
  • 5% EMLA= Eutectic : 2.5% Lignocaine + 2.5% Prilocaine
• EMLA is usually used in pediatrics
  • IV cannula refusal
• Contraindicated in Neonates
  • Not needed
  • Prilocaine absorbed into the skin causes Methemoglobinemia

Flashcard 8

Ketamine

• Acts on NMDA receptor blocker
• Effects opposite to Sodium thiopentone
  • CNS: worst enemy
    • Contraindicated in CNS
    • Damages, increase ICP
      • Contraindicated in head injury and neurosurgery
  • Increases IOP
    • Contraindicated in Glaucoma
  • Increased risk of epilepsy, epileptic properties
    • Contraindicated in epilepsy
  • Hallucinations and delusions are seen
    • Contraindicated in Schizophrenic patients
  • Friend of all other systems
  • CVS: IV induction agent of choice in shock, cyanotic heart diseases
    • Contraindicated in IHD
    • Cannot tolerate extreme changes in BP, HR
  • Cause hypotension, tachycardia
  • Respiratory: induction agent choice in bronchial asthma
    • Causes bronchodilation
  • Muscular: increases muscle tone
  • Pain & Analgesic: only drug having analgesic effect
    • Painless IV induction agent

Flashcard 9

• Muscle relaxants releasing Histamine
  • D.tubocurarine: maximum
  • Mivacurium
  • Scholene
  • Atracurium
• Allergic reactions are seen
• The most common causes of allergic reactions are seen with muscle relaxants
  • Followed by latex products

Flashcard 10

Malignant Hyperthermia

• Abnormally high temperature with sustained muscle contraction
• Seen in autosomal dominant patient
  • Due to abnormal triggering of Ryanodine receptors
    • Calcium released
    • Muscle contracts/spasm starts in the Masseter muscle
• Triggers of malignant hyperthermia
  • Local anesthetic causing malignant hyperthermia is Lignocaine, the most common
    • Safest LA is procaine
  • Muscle relaxants: Scholine
  • Inhalational agents: almost all agents
    • Maximum seen with Halothane
• Treatment of Malignant hyperthermia
  • IV Dantrolene sodium

Flashcard 11

Desflurane

• Day care surgery
  • Least metabolized
  • Airway irritation
    • Not used
  • Sevoflurane is used
• Best for cardiac surgery
  • Vaporiser is Expensive
  • Isoflurane is used
• Hepatic surgery
  • Least metabolized in the liver
• Long duration surgeries
  • Doesn't stay in the body

Flashcard 12

Nitrous oxide

• Stored in Blue color cylinders
• Good analgesic agents
• Contraindicated in
  • In Pregnancy, can cause teratogenic effects in the fetus
    • Bone marrow deformity
  • Avoid closed-loop surgeries
    • Intestinal obstruction surgery
    • One part is obstructed
    • Another part is filled with air
    • Nitrous oxide expands air-filled cavities
    • Lead to perforation
• The second gas effect is seen
  • Used as carrier gas
    • Least potent
  • Add another inhalational agent
  • Increases concentration of other agents
• Diffusion hypoxia is seen
  • Does not cause hypoxia during surgery
  • Stop inhalational agents in the reversal phase
    • Oxygen saturation falls
    • ® Nitrous oxide has better diffusion than oxygen into alveoli
  • 100% oxygen is given to prevent diffusion hypoxia

Flashcard 13

Summary of General Anaesthetics

Flashcard 14

Laryngeal Mask Airway (LMA)

• Other Name: Supraglottic airway device
• Inserted through mouth and mask is fitted on supraglottic area
• Indications
  • Failed intubation/Difficult intubation
  • Minor surgeries: Squint surgery
• Sizes of LMA: Depend on the weight
  • Adults
    • Size 4: 50 to 70 kgs
    • Size 5: 70 to 100 kgs
• 1st generation LMA: LMA classic
  • Has only one port

Flashcard 15

Tracheoesophageal Combitube

• Used in emergency situations
• No laryngoscopy is required

Inserted either into the esophagus or trachea

↓

Inflate the cuff

↓

Inflate the other cuff if the tube is inserted into the esophagus

↓

Prevent aspiration by blocking the esophagus

↓

Ventilation is done through the pores

To Remember the Best way to secure the airway: Endotracheal tube

Flashcard 16

Capnograph

• The best test to confirm endotracheal intubation
• Measures exhaled CO2 (ETCO2)
• Normal capnograph: Has four phases
  • Phase 1: Dead space ventilation
  • Phase 2: Expiratory upstroke
    • Angle: Alpha
  • Phase 3: Alveolar plateau
  • Phase 0: Inspiratory downstream
    • Angle: Beta
      • Measures exhaled Co2

Flashcard 17

Double lumen tube

• Left lung cancer: General anesthesia
• Long endotracheal tube
  • Pass it through the vocal cord until you feel resistance
    • Change the direction of the tube
    • Inflate the bronchial and tracheal cuff
• Used the surgeries that require one-lung ventilation
• Have bronchial and tracheal opening
• Ventilation of the tracheal pore: Gas moves into the both lungs
• Most common cause of hypoxia during one-lung ventilation: Displacement of tube
• It is confirmed by fiber optic bronchoscope

Flashcard 18

ACLS Algorithm

Flashcard 19

Monitoring in Anesthesia

• Oxygenation: Pulse oximeter
• Ventilation: Capnography
• Circulation:
  • BP: IBP (Radial artery), NIBP
  • ECG
    • Lead II: Detect arrhythmia
    • Lead IV: Detect ischemia
  • Transesophageal echocardiography: Venous air embolism
    • Major surgery
• Temperature
  • Peripheral temperature:
  • Core temperature: Major surgery
    • Best site: Pulmonary artery
• Awareness: Bis monitoring
  • Bi-spectral index monitoring
  • Calculate the sum of the EEG

Flashcard 20

Positive End Expiratory Pressure

• Pressure required to keep the alveoli open
  • At the end of expiration
• Uses
  • ARDS patients
  • Pulmonary edema
• Disadvantage
  • Decreases the venous return
  • Decrease the cardiac output
  • Causes hypotension
  • Increases the intracranial pressure

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