Important One Liners in Anesthesia 

Groups of Local Anaesthetic and their Classification

It consists of ester and amide groups. Chloroprocaine is the shortest acting. The most widely used are lignocaine, bupivacaine and ropivacaine.

Bupivacaine

It is Added with glucose for spinal anesthesia. It is the most cardiotoxic drug. It is the shorter onset and longer duration. It is used in Labour analgesia. It is the best drug for a differential blockade.

Esters

Ester-type local anesthetics are metabolized by plasma pseudocholinesterase and their metabolites para aminobenzoic acid being one of the main, are excreted through urine.

Amide

Hydrolyzed by Liver microsomal enzymes, even cocaine.

Blocks

In the case of hand surgery, we use brachial plexus, it is the most common type of block. In the case of lower limb surgery, we can give a subarachnoid block. The most common approach is the supraclavicular approach. Use of certain additives required with local anesthetic for various purposes. Eg. sodabicarb for dense blocker for faster onset. And we use adrenaline to Increase the Duration of the Action.

Side Effects of Local Anesthesia

Most common intraoperative complication- Hypotension which can be prevented by Preloading (administering 1-2L of fluid before surgery). Most common postoperative complication- Urinary retention. Other postoperative complications include bradycardia, respiratory distress, high spinal hematoma formation, neurological syndrome, backache, and post-dural puncture headaches. Halothane is the most potent and has slower induction. On the other hand, Desflurane is less potent and has the fastest induction. Desflurane is the inhalational anesthetic agent of choice for daycare surgery. It is least potent. Maximum Hypotension is Caused by Isoflurans.

Also Read: Important Anesthesia Questions for NEET PG/FMG Exam

Intravenous Anesthetics Agents

Non-Opioids

Propofol, thiopentone, Etomidate acts on GABA receptors. GABA is an inhibitory type of neurotransmitter.

Thiopentone

Causes arterial necrosis and gangrene if infected in arteries.

Ketamine

• It causes dissociative anesthesia and causes breakage of the link between the thalamus and cortex.
• Ketamine increases blood pressure and is contraindicated in uncontrolled blood pressure patients.
• Propofol
• Anesthetic agent of choice for day care surgery because it does not have a residual effect.
• Side effects: Propofol leads to pain on the injection site. So, it is combined with lignocaine.

TIVA

• Total Intravenous Anesthesia
• The drug of choice for TIVA is Propofol.
• The most cardiostable IV agent is Etomidate.

Muscle Relaxant

Depolarizing Muscle Relaxant

Depolarization is the process when the nerve cell undergoes an electrical shift or when a contraction happens. Acetylcholinesterase - a depolarizing muscle relaxant, breaks acetylcholine and sends it to the nerve terminal.

Non Depolarizing Muscle Relaxant

Drugs- Pipercuronium, Vecuronium, Atracurium, Rocuronium, Pipercuronium, Vecuronium, Atracurium, Rocuronium, and Cisatracurium are the only drugs that act upon the muscles and do not have any action in providing analgesia, or CNS depression. Aminosteroid category drugs are cardiac stable drugs. They do not have any action on the heart. The fastest-acting NDNMB is Rapacuronium because the onset of action is 70-80 seconds, and the second fastest drug is

Rocuronium (90 seconds). The most common Nerve for Neuromuscular Monitoring is Ulnar Nerve.

Circuit

The most Common Circuit is the Semi Closed Circuit. Semi-closed circuits discovered by Mapleson, were by which is why they are also known as Mapleson circuits. A few types of circuits like semi-closed Type A Type B Type C Type D Type E Type F.

Only Type A Type D and Type F be studied. Type F is the modification of Type E and is known as the JR circuit, named after the scientist Jackson and Rees. It is the circuit of choice for pediatrics. The most used semi-closed Mapleson circuits are adults Type A Type D. Type D semi-closed circuit had a modification and was known as Bain's circuit. Circuit of Choice in most cases are Bain Circuit (Type D). Circuit of Choice for spontaneous ventilation is Maplieson A.

Mandatory Monitors in Monitoring of Anesthesia

• Pulse Oximetry is to Measure the O2 saturation of Hb.
• The most common thermal disturbance disturbance in anesthesia is hypothermia.

ACLS & BLS

• First priority in management of trauma patients.
• M/C Cause of airway obstruction in unconscious patients is tongue fall.
• The most definitive method to maintain airway is E.T.T.
• The most reliable indicator of effectiveness of CPR is capnograph.
• The most effective clinical indicator of CPR is carotid palpitation.
• Chest compression should be 2 inches or 5 cm.
• Compression should range from 100 to 120 /min.
• Ratio of compression for newborn children should be 3:1. The most common technique for giving spinal anesthesia and epidural anesthesia is loss of resistance technique. The most common risk factor for spinal epidural abscess is in those patients suffering from uncontrolled diabetes mellitus. Speed of induction and recovery by the anesthetic depends upon blood gas partition coefficient

Mallampati Classification

The patient is asked to open the mouth widely, to see whether intubation is going to be easy or difficult. There are four grades of MPC. In grade I Tonsillar pillar, hard palate, soft palate, uvula, and fauces everything is visible. As the grade is increasing, structures of the oral cavity keep on decreasing.

Heimlich maneuver

Used to remove foreign bodies from trachea.

LMA

Used for Difficult airway management. It has a suction port. but It cannot protect from aspiration.

Endotracheal tubes

At the end of the tube, it is a bit laterally cut so that we can see whether it is going while introducing it. This is the bevel end. The bevel end can get obstructed due to secretions. It can prevent oxygen administration. Thus, Murphy's eye is an alternative to providing oxygen or an inhalational anesthetic.

Also Read: NEET PG High Yield Questions for Anesthesiology

Anesthesia Machine

Have three pressure system

• High pressure system: Contents of the High-Pressure System are the gas cylinder and yoke assembly system.
• Intermediate Pressure System
• Low Pressure System

Capnography

• Normal range of capnography- 35-45 mmHg (end tidal CO 2 monitoring)
• The roman numbers represent the different stages of the capnograph. There are four stages:
  • Stage 1: Shows the dead space ventilation, which means it is the start of the ventilation. This stage is not helping with any kind of ventilation.
  • Stage 2: Shows the dead space ventilation with the alveolar ventilation; this gaseous exchange now occurs inside the lungs.
  • Stage 3: The graph peaks, marking the total alveolar ventilation.
  • Stage 4: This shows the fall of CO level, which means 2 there is a proper inspiration.

Neuromuscular Blockers

Succinylcholine is the shortest-acting neuromuscular blocker with 2 acetylcholine molecules attached by the acetate methyl group. The fastest-acting NDNMB is Rapacuronium because the onset of action is 70-80 seconds and the second fastest drug is Rocuronium (90 seconds). Fastest NDNMB- Rapacuronium- 75 sec- Not being used. 2 Fastest NDNMB- rocuronium (90sec)- used in RSI. Atracurium undergoes Hofmann degradation.

Central Neuraxial Blockade

Layers pierced during the administration of the central block. Spinal cord → Pia mater → arachnoid mater → dura mater → ligamentum flavum → supra and interspinous ligament → subcutaneous fascia → skin 

• Between the pia mater and arachnoid mater – Subarachnoid space
• Between the dura mater and arachnoid mater – Subdural space

From outside to inside, it includes skin, subcutaneous fascia, supra and interspinous ligament, ligamentum flavum, dura mater, arachnoid mater, pia mater, and spinal cord. Subarachnoid space contains CSF, whereas Epidural space (outside dura mater) is an air-containing cavity.

Fiber

• Most sensitive B > C > A
• Autonomic > Sensory > Motor > Temperature > Pain > Touch > Proprioception.
• Reversal is opposite direction
• Last to first

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