APMLE 2 – Anesthesia Questions With Complete Solutions
Anticholinergics for anesthesia Correct Answers -used to
reduce respiratory tract secretions, protect against bradycardia,
sedative/amnesic effects, decrease gastric H+ ion secretion
ex: atropine sulfate, scopolamine, glycopyrrolate
reversal: physostigmine
ASA classification Correct Answers 1 = normal, healthy -->
mortality rate 0.08%
2 = mild to moderate systemic disease --> mortality rate 0.27%
3 = severe systemic disease that limits activity but is not
incapacitating --> mortality 1.8%
Class 4 = incapacitating systemic disease that is a constant threat
to life --> mortality 7.8%
5 = moribund patient who is not expected to live w/ or w/o
surgery
Emergency = any patient in one of the above classes who is
operated on as an emergency
Bupivacaine
duration of action & max dose Correct Answers Long acting (w
or w/o epi)
max dose plain = 2.5 mg/kg
max dose w/ epi = 3.2 mg/kg
, Characteristics of local anesthetics Correct Answers lipid
soluble anesthetics = penetrate more readily and have increased
potency
protein binding = influences duration of action
pKa = agents w/ pKa closer to tissue pH will have rapid onset
CI of using epi w/ local anesthetic Correct Answers
hyperparathyroidism, arteriosclerotic cardiovascular disease,
HTN, PVD, pts on halothane
--> can create vasospasm leading to tissue necrosis
Complications of intubation Correct Answers Acute =
laryngospasm, vocal cord paralysis, perforation of trachea,
dental damage, aspiration of gastric contents
Chronic = vocal cord polyps, vocal cord granuloma,
tracheomalacia
Desflurane
Advantages Correct Answers -fastest induction & emergence
-lowest blood:gas solubility
-very low hepatic metabolism
Desflurane
Disadvantages Correct Answers -very pungent odor
-can cause laryngospasm
-bronchoconstriction (smokers)
-CO formed in CO2 absorbent
-needs special heated vaporizer
-sympathetic stimulation
Anticholinergics for anesthesia Correct Answers -used to
reduce respiratory tract secretions, protect against bradycardia,
sedative/amnesic effects, decrease gastric H+ ion secretion
ex: atropine sulfate, scopolamine, glycopyrrolate
reversal: physostigmine
ASA classification Correct Answers 1 = normal, healthy -->
mortality rate 0.08%
2 = mild to moderate systemic disease --> mortality rate 0.27%
3 = severe systemic disease that limits activity but is not
incapacitating --> mortality 1.8%
Class 4 = incapacitating systemic disease that is a constant threat
to life --> mortality 7.8%
5 = moribund patient who is not expected to live w/ or w/o
surgery
Emergency = any patient in one of the above classes who is
operated on as an emergency
Bupivacaine
duration of action & max dose Correct Answers Long acting (w
or w/o epi)
max dose plain = 2.5 mg/kg
max dose w/ epi = 3.2 mg/kg
, Characteristics of local anesthetics Correct Answers lipid
soluble anesthetics = penetrate more readily and have increased
potency
protein binding = influences duration of action
pKa = agents w/ pKa closer to tissue pH will have rapid onset
CI of using epi w/ local anesthetic Correct Answers
hyperparathyroidism, arteriosclerotic cardiovascular disease,
HTN, PVD, pts on halothane
--> can create vasospasm leading to tissue necrosis
Complications of intubation Correct Answers Acute =
laryngospasm, vocal cord paralysis, perforation of trachea,
dental damage, aspiration of gastric contents
Chronic = vocal cord polyps, vocal cord granuloma,
tracheomalacia
Desflurane
Advantages Correct Answers -fastest induction & emergence
-lowest blood:gas solubility
-very low hepatic metabolism
Desflurane
Disadvantages Correct Answers -very pungent odor
-can cause laryngospasm
-bronchoconstriction (smokers)
-CO formed in CO2 absorbent
-needs special heated vaporizer
-sympathetic stimulation
