INTRO TO CLINICAL ANESTHESIA
FINAL EXAM PREP QUESTIONS AND
ANSWERS
Anesthesia - Correct Answers -Local or general insensitivity to pain with or without the
loss of consciousness, induced by an anesthetic agent
What are the main components and goals of an anesthetic? - Correct Answers --
Potential loss of consciousness that is reversible (INDUCTION)
- Pain/sensation management (ANALGESIA)
- Provision of optimal surgical conditions (PARALYSIS/MUSCLE RELAXANTS)
- Monitor and manage vital signs
- Amnesia
What type of amnesia do we want during anesthesia? - Correct Answers -Antegrade
amnesia
Anxiolysis - Correct Answers -Relief of anxiety
What are the roles of an Anesthesia Provider? - Correct Answers -- Assess, consult and
prepare patient for anesthesia
- Analgesia (insensitivity to pain)
- Monitor/restore homeostasis in peri-operative and critically ill patients
What is a quick way to tell if a patient remains in Stage 2 during Emergence? - Correct
Answers -Divergent gaze
What do we look for to assess if an Opioid overdose has occurred? - Correct Answers --
Pinpoint pupils
-Slow respiratory rate <12 BPM, or apnea
- Hypercapnia
How do we treat an Opioid overdose? - Correct Answers -Titrate naloxone 0.04 mg
increments to effect or possibly wait longer
What are the six main types of Anesthesia? - Correct Answers -- General Anesthesia
- Neuraxial blockade
,- Peripheral Nerve Block
- Monitored Anesthesia Care (MAC or Sedation)
- Conscious Sedation
- Local Anesthesia
What ultimately determines a general anesthetic plan? - Correct Answers -When the
patient has no response to a stimulus.
Neuraxial Blockade - Correct Answers -Signals are blocked from coming and going in
the nerves but numbing the nerve roots of the lower extremities and lower abdomen
with local anesthetics
Which drugs do you use for Neuraxial Blockades? - Correct Answers -Local anesthetics
such a Lidocaine (all the -caines)
Why is Epinephrine often used in conjunction with a neuraxial blockade? - Correct
Answers -To cause vasoconstriction - this increases the time of the blockade since
more blood flow = more removal of the drugs
Why are Opioids often used with a neuraxial blockade? - Correct Answers -Pain control
for after the surgery
Indications for use of a Neuraxial Blockade? - Correct Answers -- Obstetrics
- Life threatening pulmonary disease (unlikely to wake up after coming down)
- History of Malignant Hyperthermia
- Pain Management
- History of narcotic abuse
Why would you chose to perform a neuraxial blockade for patients with a history of
narcotic abuse? - Correct Answers -Continued use of narcotics creates a tolerance to
use of other Opioids - by using a block, you are managing pain through another means
(aka blocking the signals from reaching the brain)
Contraindications for use of a Neuraxial Blockade? - Correct Answers -- Patient refusal
- Infection at injection site
- Coagulopathy/ blood thinners
- Pre-existing neurological diseases (already has tingling in legs)
- Cardiac disease of hypovolemia (cutting the path to increase blood pressure)
- Extensive spinal or vertebral surgery
Complications for use of a Neuraxial Blockade? - Correct Answers -- Post-Dural-
Puncture Headache
- Infection
- Hematoma
- Nerve damage and paralysis
- "High Spinal" (anesthetic goes too high)
,- "Total Spinal" (epidural anesthetic injected into CSF)
Post-Dural-Puncture Headache - Correct Answers -Caused by a leakage of CSF after
spinal surgery.
Increased pressure on the brain by a decrease of fluid surrounding your brain. More
present when standing versus laying down
What is achieved with neuraxial anesthesia? - Correct Answers -- Motor blockade
- Sensory blockade
- Autonomic blockade
What is another name for an autonomic blockade? - Correct Answers -Sympathectomy
What is the progression of functions blocked in a neuraxial blockade? - Correct Answers
-Autonomic (reduction in heart rate) --> Sensory (can feel a pinch) --> Motor (cannot
move)
What are the three types of neuraxial blockade? - Correct Answers -- Spinal
- Epidural
- Caudal
Spinal Anesthesia - Correct Answers -- A regional anesthetic that is produced by an
injection of local anesthetic directly into the subarachnoid space around the spinal cord.
- Injected low along the spine to avoid damage to the spinal cord. Lumbar
- One time shot
- Small dosages, 1-2 mL
Caudal Anesthesia - Correct Answers -A type of regional anesthesia that is inserted into
the lowest portion of the epidural system and is entered through the sacral hiatus.
Useful in pediatric patients
Epidural Anesthesia - Correct Answers -- Regional anesthesia produced by injecting a
local anesthetic into the epidural space of the spine.
- Can be administered sacral, lumbar, thoracic or even cervical
- Have more control on where you put it and how much to give
- Continuous administration with a catheter
- Larger dosages, 10-20 mL
, For example, in child delivery
What is a bier block? - Correct Answers -A type of a peripheral nerve block where an
extremity is is isolated with a tourniquet and a local anesthetic is administered
intravenously
Peripheral Nerve Block - Correct Answers -- When you are "blocking" the nerve endings
- useful for surgeries on the extremities.
For example, a hand surgery
Why do peripheral nerve blocks typically last longer than neuraxial blockades? - Correct
Answers -There is less vasculature compared to the spine, up to 48 hours.
(Helpful in post-operative management since pain signals are blocked for longer and
less narcotics are needed.)
What are the contraindications of peripheral nerve blocks? - Correct Answers -- Patient
refusal
- Infections
What are the complications of peripheral nerve blocks? - Correct Answers -- Damaging
of nerves
- Intravascular injection (local anesthetic toxicity)
Monitored Anesthesia Care (Sedation/Twilight or MAC) - Correct Answers -The patient
is unconscious but can be aroused when stimulated. "On the edge"
Usually involves the use of a sedative such as F
For example, a colonoscopy or carpal tunnel surgery
What do you need to pay special attention to during MAC anesthesia? - Correct
Answers -Airway management since the airway is not secure (aka oral airway, nasal
airway, jaw thrust, chin lift, etc)
When might you want the patient to be sedated but not necessarily needs to be
unconscious? - Correct Answers -MAC anesthesia during a orthopedic surgery
Volatiles are associated with what type of Anesthesia? - Correct Answers -General
Anesthesia
What is frequently used with monitored anesthesia care? - Correct Answers -Local
anesthesia
FINAL EXAM PREP QUESTIONS AND
ANSWERS
Anesthesia - Correct Answers -Local or general insensitivity to pain with or without the
loss of consciousness, induced by an anesthetic agent
What are the main components and goals of an anesthetic? - Correct Answers --
Potential loss of consciousness that is reversible (INDUCTION)
- Pain/sensation management (ANALGESIA)
- Provision of optimal surgical conditions (PARALYSIS/MUSCLE RELAXANTS)
- Monitor and manage vital signs
- Amnesia
What type of amnesia do we want during anesthesia? - Correct Answers -Antegrade
amnesia
Anxiolysis - Correct Answers -Relief of anxiety
What are the roles of an Anesthesia Provider? - Correct Answers -- Assess, consult and
prepare patient for anesthesia
- Analgesia (insensitivity to pain)
- Monitor/restore homeostasis in peri-operative and critically ill patients
What is a quick way to tell if a patient remains in Stage 2 during Emergence? - Correct
Answers -Divergent gaze
What do we look for to assess if an Opioid overdose has occurred? - Correct Answers --
Pinpoint pupils
-Slow respiratory rate <12 BPM, or apnea
- Hypercapnia
How do we treat an Opioid overdose? - Correct Answers -Titrate naloxone 0.04 mg
increments to effect or possibly wait longer
What are the six main types of Anesthesia? - Correct Answers -- General Anesthesia
- Neuraxial blockade
,- Peripheral Nerve Block
- Monitored Anesthesia Care (MAC or Sedation)
- Conscious Sedation
- Local Anesthesia
What ultimately determines a general anesthetic plan? - Correct Answers -When the
patient has no response to a stimulus.
Neuraxial Blockade - Correct Answers -Signals are blocked from coming and going in
the nerves but numbing the nerve roots of the lower extremities and lower abdomen
with local anesthetics
Which drugs do you use for Neuraxial Blockades? - Correct Answers -Local anesthetics
such a Lidocaine (all the -caines)
Why is Epinephrine often used in conjunction with a neuraxial blockade? - Correct
Answers -To cause vasoconstriction - this increases the time of the blockade since
more blood flow = more removal of the drugs
Why are Opioids often used with a neuraxial blockade? - Correct Answers -Pain control
for after the surgery
Indications for use of a Neuraxial Blockade? - Correct Answers -- Obstetrics
- Life threatening pulmonary disease (unlikely to wake up after coming down)
- History of Malignant Hyperthermia
- Pain Management
- History of narcotic abuse
Why would you chose to perform a neuraxial blockade for patients with a history of
narcotic abuse? - Correct Answers -Continued use of narcotics creates a tolerance to
use of other Opioids - by using a block, you are managing pain through another means
(aka blocking the signals from reaching the brain)
Contraindications for use of a Neuraxial Blockade? - Correct Answers -- Patient refusal
- Infection at injection site
- Coagulopathy/ blood thinners
- Pre-existing neurological diseases (already has tingling in legs)
- Cardiac disease of hypovolemia (cutting the path to increase blood pressure)
- Extensive spinal or vertebral surgery
Complications for use of a Neuraxial Blockade? - Correct Answers -- Post-Dural-
Puncture Headache
- Infection
- Hematoma
- Nerve damage and paralysis
- "High Spinal" (anesthetic goes too high)
,- "Total Spinal" (epidural anesthetic injected into CSF)
Post-Dural-Puncture Headache - Correct Answers -Caused by a leakage of CSF after
spinal surgery.
Increased pressure on the brain by a decrease of fluid surrounding your brain. More
present when standing versus laying down
What is achieved with neuraxial anesthesia? - Correct Answers -- Motor blockade
- Sensory blockade
- Autonomic blockade
What is another name for an autonomic blockade? - Correct Answers -Sympathectomy
What is the progression of functions blocked in a neuraxial blockade? - Correct Answers
-Autonomic (reduction in heart rate) --> Sensory (can feel a pinch) --> Motor (cannot
move)
What are the three types of neuraxial blockade? - Correct Answers -- Spinal
- Epidural
- Caudal
Spinal Anesthesia - Correct Answers -- A regional anesthetic that is produced by an
injection of local anesthetic directly into the subarachnoid space around the spinal cord.
- Injected low along the spine to avoid damage to the spinal cord. Lumbar
- One time shot
- Small dosages, 1-2 mL
Caudal Anesthesia - Correct Answers -A type of regional anesthesia that is inserted into
the lowest portion of the epidural system and is entered through the sacral hiatus.
Useful in pediatric patients
Epidural Anesthesia - Correct Answers -- Regional anesthesia produced by injecting a
local anesthetic into the epidural space of the spine.
- Can be administered sacral, lumbar, thoracic or even cervical
- Have more control on where you put it and how much to give
- Continuous administration with a catheter
- Larger dosages, 10-20 mL
, For example, in child delivery
What is a bier block? - Correct Answers -A type of a peripheral nerve block where an
extremity is is isolated with a tourniquet and a local anesthetic is administered
intravenously
Peripheral Nerve Block - Correct Answers -- When you are "blocking" the nerve endings
- useful for surgeries on the extremities.
For example, a hand surgery
Why do peripheral nerve blocks typically last longer than neuraxial blockades? - Correct
Answers -There is less vasculature compared to the spine, up to 48 hours.
(Helpful in post-operative management since pain signals are blocked for longer and
less narcotics are needed.)
What are the contraindications of peripheral nerve blocks? - Correct Answers -- Patient
refusal
- Infections
What are the complications of peripheral nerve blocks? - Correct Answers -- Damaging
of nerves
- Intravascular injection (local anesthetic toxicity)
Monitored Anesthesia Care (Sedation/Twilight or MAC) - Correct Answers -The patient
is unconscious but can be aroused when stimulated. "On the edge"
Usually involves the use of a sedative such as F
For example, a colonoscopy or carpal tunnel surgery
What do you need to pay special attention to during MAC anesthesia? - Correct
Answers -Airway management since the airway is not secure (aka oral airway, nasal
airway, jaw thrust, chin lift, etc)
When might you want the patient to be sedated but not necessarily needs to be
unconscious? - Correct Answers -MAC anesthesia during a orthopedic surgery
Volatiles are associated with what type of Anesthesia? - Correct Answers -General
Anesthesia
What is frequently used with monitored anesthesia care? - Correct Answers -Local
anesthesia
