Anesthesia

INTRODUCTION

What is the optimal distance above the carina for an endotracheal tube (ETT)?

• 2 cm above the carina

What are the steps of rapid-sequence induction?

• Oxygenation and short-acting induction agent → muscle relaxant → cricoid pressure → intubation → inhalational anesthetic

What is the most commonly used technique for induction of general anesthesia in children?

• Inhalational

What are the steps that both the surgeon and anesthesiologist should take during an airway fire?

• Stop all gas and oxygen flow → extinguish fire with water/saline → remove ETT and any foreign body in airway → perform mask ventilation until patient is reintubated → perform bronchoscopy to assess extent of airway damage

What factors affect the accuracy of pulse oximetry?

• Decreased reading—intense environmental lighting, motion, methylene blue dye, hypothermia, low cardiac output, hypotension, peripheral edema, nail polish

• Increased reading—bilirubin, carbon monoxide

Define minimum alveolar concentration (MAC):

• The smallest concentration of gas at which 50% of patients will not move to painful stimuli such as incision

Relate lipid solubility, speed of induction, and potency for an inhalational agent with a low MAC:

• Low MAC means that the agent is more lipid soluble and more potent but has a slower speed of induction

What inhalational agent has the fastest speed of induction, high minimal alveolar concentration, and low potency?

• Nitrous oxide (NO₂)

Name contraindications to the use of nitrous oxide:

• Middle ear occlusion, pneumothorax, small-bowel obstruction, and any other instance where there is an air-filled body pocket

Which inhalational agent can cause eosinophilia, fever, increased liver function tests, and jaundice and is associated with the highest degree of cardiac depression and arrhythmias?

• Halothane

Which inhalational agent has a pleasant smell and is ideal for mask induction in children?

• Sevoflurane

What induction agent should not be used in patients with an egg allergy?

• Propofol

What induction agent is contraindicated in head injury?

• Ketamine

Which induction agent can cause adrenocortical suppression with continuous infusion?

• Etomidate

First muscle to be paralyzed after administration of a paralytic? Last muscle?

• Face and ...