ABSITE - ANESTHESIA – QUESTIONS WITH
CORRECT ANSWERS
Local anesthetics are essential agents used in current surgical practice. Which of the following stateme
nts is true concerning the use of local anesthetic agents?
A. The addition of epinephrine to a local anesthetic agent increases the toxicity and decreases the dur
ation of local anesthesia.
B. Complications caused by excessive plasma concentration can result only from inadvertent intravascu
lar injection of the agent.
C. Bupivacaine has a slow onset but a long duration
D. Hypotension that occurs when a local anesthetic is administered in the form of a spinal epidural blo
ck is the result of myocardial depression - CORRECT ANSWER -
Bupivacaine has a slow onset but a long duration
Correct.
Local anesthetics constitute a class of drugs that produce temporary blockage of nerve conduction by
binding to neuronal sodium channels. Adverse consequences associated with the use of local anestheti
cs fall into three categories: acute central nervous system toxicity caused by excessive plasma concentr
ation, hemodynamic and respiratory consequences caused by excessive conduction block of the sympa
thetic or motor nerves, and allergic reactions. Whenever a local anesthetic is injected, there can be un
intentional intravascular injection or an overdose of the drug resulting from rapid uptake from the tiss
ues. Both of these effects can cause seizures. Complications can be minimized by means of aspiration
before injection to avoid intravascular injection and limiting the doses to the safe range. When local a
nesthetics are administered for a spinal or epidural block, progressive blockade of the sympathetic ner
vous system produces systemic vasodilation. If the block travels along the thoracolumbar region, symp
athetic blockade results in marked systemic vasodilation and bradycardia with resultant hypotension. L
ocal anesthetics are divided into two groups: esters and amides. The more commonly used agents, the
amides, include lidocaine and bupivacaine. Lidocaine has a fast onset of action but a short duration,
whereas bupivacaine has a slower onset but lasts 4 to 12 hours. Addition of epinephrine (100µg) decr
eases the toxicity and increases the duration of a local anesthetic.
During an airway examination when the patient opens his mouth, his uvula is partially seen. This findi
ng is called:
A. Mallampati II
, B. Mallampati I
C. Mallampati V
D. Mallampati IV
E. Mallampati III - CORRECT ANSWER -Mallampati II
Correct.
The preprocedure evaluation should include a review of current medications and coexisting disease an
d a brief physical examination, including evaluation of the airway. It is important to determine how diff
icult it may be to obtain control of the airway if apnea should occur. Although there is no absolute sta
ndard for predicting difficult intubation, a simple four-
step examination helps to determine the likelihood. First, the patient should have a normal mouth ope
ning. Second, the patient should have normal neck flexion and extension. Third, the physician should b
e able to fit three finger-
widths under the patient's chin between the thyroid cartilage and the mentum. Finally, when the patie
nt opens his or her mouth and is asked to stick out the tongue, the airway can be classified depending
on whether the uvula can be completely seen (Mallampati class I), only partly seen (class II), not seen
with only the hard and soſt palate visible (class III), or only the hard palate visible (class IV). This class
ification is roughly predictive of progressive difficulty in intubation resulting from difficulty in visualizin
g the larynx.
Musclexrelaxantsx arex ax classx ofxanestheticx agentsx usedx tox preventx movementx andx facilitatex surgicalx ex
p
osure.xWhichx ofxthex followingx statementsx isxtruex concerningx thex usexofxmusclexrelaxantsx inx surgicalx p
ro
cedures?
A.xThex bestx clinicalx testx forx completex reversalx ofx neuromuscularx blockadex isx thexabilityx ofxthex patien
tx t
ox raisex hisxorxherxheadx forx5x seconds
B.x Pancuroniumx canx bex reversedx byx increasingx acetylcholinex concentrationxwithxanx anticholinesterase
xi
nhibitorx (neostigmine)
C.x Prolongedx periodsxofxmusclex relaxationx forx patientsx requiringx prolongedx ventilationxshouldx bex used
xi
nx conjunctionxwithx analgesicsx andx amnesicx agents
D.x Succinylcholinex producesx rapidx obviousx musclex fasciculations
CORRECT ANSWERS
Local anesthetics are essential agents used in current surgical practice. Which of the following stateme
nts is true concerning the use of local anesthetic agents?
A. The addition of epinephrine to a local anesthetic agent increases the toxicity and decreases the dur
ation of local anesthesia.
B. Complications caused by excessive plasma concentration can result only from inadvertent intravascu
lar injection of the agent.
C. Bupivacaine has a slow onset but a long duration
D. Hypotension that occurs when a local anesthetic is administered in the form of a spinal epidural blo
ck is the result of myocardial depression - CORRECT ANSWER -
Bupivacaine has a slow onset but a long duration
Correct.
Local anesthetics constitute a class of drugs that produce temporary blockage of nerve conduction by
binding to neuronal sodium channels. Adverse consequences associated with the use of local anestheti
cs fall into three categories: acute central nervous system toxicity caused by excessive plasma concentr
ation, hemodynamic and respiratory consequences caused by excessive conduction block of the sympa
thetic or motor nerves, and allergic reactions. Whenever a local anesthetic is injected, there can be un
intentional intravascular injection or an overdose of the drug resulting from rapid uptake from the tiss
ues. Both of these effects can cause seizures. Complications can be minimized by means of aspiration
before injection to avoid intravascular injection and limiting the doses to the safe range. When local a
nesthetics are administered for a spinal or epidural block, progressive blockade of the sympathetic ner
vous system produces systemic vasodilation. If the block travels along the thoracolumbar region, symp
athetic blockade results in marked systemic vasodilation and bradycardia with resultant hypotension. L
ocal anesthetics are divided into two groups: esters and amides. The more commonly used agents, the
amides, include lidocaine and bupivacaine. Lidocaine has a fast onset of action but a short duration,
whereas bupivacaine has a slower onset but lasts 4 to 12 hours. Addition of epinephrine (100µg) decr
eases the toxicity and increases the duration of a local anesthetic.
During an airway examination when the patient opens his mouth, his uvula is partially seen. This findi
ng is called:
A. Mallampati II
, B. Mallampati I
C. Mallampati V
D. Mallampati IV
E. Mallampati III - CORRECT ANSWER -Mallampati II
Correct.
The preprocedure evaluation should include a review of current medications and coexisting disease an
d a brief physical examination, including evaluation of the airway. It is important to determine how diff
icult it may be to obtain control of the airway if apnea should occur. Although there is no absolute sta
ndard for predicting difficult intubation, a simple four-
step examination helps to determine the likelihood. First, the patient should have a normal mouth ope
ning. Second, the patient should have normal neck flexion and extension. Third, the physician should b
e able to fit three finger-
widths under the patient's chin between the thyroid cartilage and the mentum. Finally, when the patie
nt opens his or her mouth and is asked to stick out the tongue, the airway can be classified depending
on whether the uvula can be completely seen (Mallampati class I), only partly seen (class II), not seen
with only the hard and soſt palate visible (class III), or only the hard palate visible (class IV). This class
ification is roughly predictive of progressive difficulty in intubation resulting from difficulty in visualizin
g the larynx.
Musclexrelaxantsx arex ax classx ofxanestheticx agentsx usedx tox preventx movementx andx facilitatex surgicalx ex
p
osure.xWhichx ofxthex followingx statementsx isxtruex concerningx thex usexofxmusclexrelaxantsx inx surgicalx p
ro
cedures?
A.xThex bestx clinicalx testx forx completex reversalx ofx neuromuscularx blockadex isx thexabilityx ofxthex patien
tx t
ox raisex hisxorxherxheadx forx5x seconds
B.x Pancuroniumx canx bex reversedx byx increasingx acetylcholinex concentrationxwithxanx anticholinesterase
xi
nhibitorx (neostigmine)
C.x Prolongedx periodsxofxmusclex relaxationx forx patientsx requiringx prolongedx ventilationxshouldx bex used
xi
nx conjunctionxwithx analgesicsx andx amnesicx agents
D.x Succinylcholinex producesx rapidx obviousx musclex fasciculations
