You are preparing to provide general anesthesia for a 40- years-old
woman undergoing an abdominal hysterectomy. She is otherwise healthy. She had two uncomplicated vaginal deliveries in the past, both with uncomplicated epidural analgesia. She had uneventful general anesthesia for a laparoscopic tubal ligation 4 years ago. Your attending is willing to let you perform as much of the anesthetic as you are able to describe in detail.
❖ Upon meeting the patient in the preop area and reviewing the history and physical examination, you find no important new information. What steps will you take to prepare the patient for surgery prior to any interventions? ❖ labs ( cross match hysterectomy is a bloody operation) ❖ ECG - xray chest ❖ airway examination ( malbati score) ❖ Anthesia plan ( premedications antiemetic/ antibiotic – paim killer pump- surgical consent and Anthesia consent ) - fasting hours ( at least 8 hours)
❖ You have brought the patient into the OR. Describe the steps you will take prior to induction of anesthesia? -IV access - Bp - pulse oximeter- ECG all monitors is attached - ventilator checking - prepare drug and airway intubation ket - check position ( supine / prone / lithotomy ) ❖ How will you induce anesthesia? IV propofol ( anthetic drug ) +fentanyl ( opioid ) – rocuronium ( muscle relaxant ) ❖ Following induction, what else will you do prior to the beginning of the surgical procedure? Following intraoperative monitoring -normal capnography and pulse oximeter – BP – Heart rate - patent endotracheal tube and fixation - checking level of consciousness – hypnosis – muscle relaxation - warmer to prevent hypothermia in long operations ❖ How will you maintain anesthesia? -inhalation ( sevoflorane ) - if pt is pain increase opioids dose - fluids if needed - muscle relaxant if needed ❖ The operation has gone well and is ending. How will you conclude the anesthetic? stop inhalation gas - reverse muscle relaxation ( neostagmine + atropine ) -make sure that patient started spontaneous breathing before extubation ❖ What will you do on arrival to the PACU? - Aldert score 8 or more - pain free - send to other anthesiologist / anthesia nurse - good monitors - equipped PACU
Case 2
An ASA II 45 years old female, with BMI of 24, is scheduled for
elective cholecystectomy, she is known hypertensive and her blood pressure is well controlled on Inderal (propranolol) 40 mg / day. You are asked to help your attending anesthetist to conduct general anesthesia for this lady. She is lying on the operative bed waiting for the anesthetist to put her to sleep. Please chose one best answer from the following questions.
1. This lady is ASA score II because of:
A. Her age. B. Her cholecystitis. C. Her blood pressure. D. Her antihypertensive medication.
2. The first thing you will do is:
A. Check her vital signs. B. Insert intravenous cannula. C. Introduce yourself. D. Auscultate her lungs.
3. What is your choice of Anesthesia induction? Asked the attending
anesthetist. Your answer should be: A. Inhalational induction. B. Intravenous induction. C. Intramuscular induction. D. Spinal anesthesia induction.
4. What is your choice of Anesthesia maintenance? Asked the attending
anesthetist. Your answer should be: A. Laryngeal mask airway and inhalational sevoflurane. B. Endotracheal tube and inhalation sevoflurane. C. Endotracheal tube and propofol. D. Laryngeal mask airway and inhalational sevoflurane. 5. When are you going to start anesthesia maintenance? A. After securing airway. B. Before securing airway. C. Before induction of anesthesia. D. During induction of anesthesia.
Case 3 A 15 years old female is scheduled for appendectomy. She is diabetic with controlled blood sugar measurements. You are asked to help your attending anesthetist to conduct general anesthesia for this patient. She is lying anxiously on the operative bed waiting for the anesthetist to put her to sleep.
Please chose one best answer from the following questions.
Goals of premedication include:
A. Anxiety relief. B. Sedation. C. Analgesia. D. Drying of airway secretions. E. Antiemetic effects. F. All of the above.
Which of the following intravenous induction agents is the most suitable for day care surgery?
E. Morphine F. Ketamine G. Propofol. H. Diazepam.
Which of the following is not an indication for endotracheal intubation?
A. Maintenance of a patent airway.
B. Provide positive pressure ventilation. C. Pulmonary toilet or suction. D. Pneumothorax Which of the following inhalational agents is the induction agent of choice in children?
A. Methyoxyfurane. B. Sevofurane. C. Desflurane. D. Isoflurane.
Muscle relaxant of choice used for rapid sequence intubation is:
A. Succinyl choline. Or Ruecuronium B. Vecuronium. C. Pancuronium. D. Diazepam.. E. Halothane.
This patient is ASA :
A. ASA I B. ASA II C. ASA III D. ASA IV E. ASA V Case 4 You are asked to see a 40-year-old lady in recovery after an elective right hemicolectomy. The nurse is concerned because her blood pressure is 80/40.
All of the following are standard monitors during anesthesia recovery except:
1-pulse oximeter 2-ECG 3-EEG 4-Noninvasive blood pressure During anesthesia all the following should be continuously evaluated except:
1-ventilation 2- temperature 3- circulation 4- gastric motility
The following determines when the patient able to transfer to ward:
1-temperature 2- Muscle activity 3-stand without help 4-Eat soft food Case 5 61 years old female hypothyroidism on Eltroxin, presented by large neck mass 35 years duration.On examination the mass is thyroid with retrosternal extension, On airway assessment patient is Mallampati 3 for awake fibro-optic intubation
All of the following are to assess airway except:
1-thyromental distance styromental 2-Mallampati score 3-neck extension 4-neck flexion Which of these used in cases of difficult intubation 1-Guedal airway 2-laryngeal mask airway 3-nasal canula 4-venturi mask
All of the following are postoperative complication of thyroidectomy except:
1-hypoparathyroidism 2-bleeding 3-hoarsness of voice 4-shoulder pain Case 6 53 years old female diabetic on oral hypoglycemic drugs, her blood sugar is controlled ,listed for elective laproscopic cholycystectomy, the operation passed uneventful but on recovery the patient’s recovery is delayed. All of the following may cause delayed recovery except:
1-hypercarpia 2-hyperglycemia 3-opioids 4- NSAIDs
the following is the patient capnogragh
Hypoventilation to manage this situation you suggest to 1-transfer 1 unit RBCs 2-increase tidal volume and respiratory rate
3-give patient bronchodilators
4-change position into head down
All of the following may participate in patient situation except:
EVALUATION OF THE INFLUENCE OF TWO DIFFERENT SYSTEMS OF ANALGESIA AND THE NASOGASTRIC TUBE ON THE INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING IN CARDIAC SURGERY
EVALUATION OF THE INFLUENCE OF TWO DIFFERENT SYSTEMS OF ANALGESIA AND THE NASOGASTRIC TUBE ON THE INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING IN CARDIAC SURGERY
