MAKE ANESTHESIA EASY

LONG QUESTION
1. What is general anesthesia? Discuss the stages of general anesthesia.
Describe the mechanism of action and side effects of thiopentone
sodium.
Ans.
General anesthesia is a medical state induced in patients to allow surgeons to
perform procedures that would otherwise be intolerably painful or distressing. It
involves the administration of drugs to induce unconsciousness, amnesia,
analgesia (pain relief), muscle relaxation, and sometimes suppression of reflexes.
General anesthesia is typically used for surgeries, certain medical procedures, and
diagnostic tests.
The stages of general anesthesia are typically categorized into four phases:
Induction: This phase involves administering medications to initiate the process
of anesthesia and transition the patient from consciousness to unconsciousness
rapidly. The drugs are usually given intravenously or via inhalation. During
induction, the patient loses consciousness, and their reflexes are suppressed.
Maintenance: Once the patient is unconscious, the maintenance phase involves
administering a combination of anesthetic agents to sustain the desired level of
anesthesia throughout the procedure. This phase aims to keep the patient
adequately anesthetized while ensuring vital signs remain stable.
Surgical anesthesia: This stage is characterized by the ideal depth of anesthesia
required for surgery. The patient experiences profound unconsciousness, loss of
sensation, and muscle relaxation, allowing the surgical procedure to be performed
without causing discomfort or movement.
Emergence: After the surgery or procedure is completed, the anesthetic agents are
gradually discontinued or reversed, allowing the patient to regain consciousness
and resume spontaneous breathing. During emergence, the patient transitions
from the anesthetized state back to wakefulness.
Now, let's discuss thiopentone sodium:
Mechanism of action: Thiopentone sodium, also known as thiopental, is a short-
acting intravenous anesthetic agent belonging to the barbiturate class of drugs. It
works primarily by enhancing the activity of gamma-aminobutyric acid (GABA),
which is an inhibitory neurotransmitter in the central nervous system. By binding
to specific receptors on GABA channels, thiopentone sodium increases the
inhibitory effects of GABA, leading to neuronal hyperpolarization and ultimately
producing its anesthetic effects.

Side effects:
✓ Respiratory depression: Thiopentone sodium can cause respiratory
depression, which may manifest as slowed breathing or shallow
respiration. This effect can be particularly pronounced during induction
and emergence from anesthesia
✓ Hypotension: Thiopentone sodium can cause a drop in blood pressure,
leading to hypotension. This effect is due to its vasodilatory properties
and suppression of sympathetic nervous system activity.
✓ Bradycardia: The drug can also cause bradycardia, or a slow heart rate,
which may require intervention to stabilize the patient's cardiovascular
function.
✓ Central nervous system depression: Thiopentone sodium can produce
profound central nervous system depression, resulting in loss of
consciousness, sedation, and amnesia.
✓ Allergic reactions: Although rare, allergic reactions to thiopentone
sodium can occur, ranging from mild skin reactions to severe
anaphylaxis.
 ✓ Postoperative nausea and vomiting (PONV): PONV is a common side
effect of general anesthesia, including thiopentone sodium. It can occur
during the immediate postoperative period and may require antiemetic
medications for management.
2. What is balanced anesthesia? Discuss the advantages of using nitrous
oxide, oxygen and a volatile agent like isoflurane for maintenance of
general anesthesia.
Ans.
Balanced anesthesia is an approach to general anesthesia that involves the
administration of multiple drugs in combination to achieve the desired effects of
anesthesia while minimizing the risks and side effects associated with individual
agents. The goal of balanced anesthesia is to provide optimal conditions for
surgery while ensuring the patient's safety and comfort throughout the procedure.
Advantages of using nitrous oxide, oxygen, and a volatile agent like isoflurane
for maintenance of general anesthesia:

Agent Advantages
Nitrous Oxide 1. Rapid onset and offset of action
2. Provides analgesia and reduces the requirement for other anesthetic
agents
3. Maintains cardiovascular stability during anesthesia
4. Allows for easy titration of anesthesia depth
Oxygen 1. Essential for maintaining adequate tissue oxygenation
2. Helps prevent hypoxemia during anesthesia
3. Facilitates rapid emergence from anesthesia
4. Reduces the risk of hypoxic events during surgery
1. Precise control over the depth of anesthesia and rapid adjustment if
Isoflurane necessary
2. Smooth induction and emergence from anesthesia
3. Minimal metabolism and low potential for organ toxicity
 Agent Advantages
4. Maintains stable cardiovascular function and cerebral blood flow
during anesthesia

These agents are often used in combination during the maintenance phase of
general anesthesia to achieve a balanced and controlled anesthetic state. The
combination of nitrous oxide, oxygen, and a volatile agent like isoflurane allows
anesthesiologists to tailor the anesthesia regimen to the specific needs of each
patient and surgical procedure while minimizing the risks of complications and
adverse effects associated with individual agents.

3. Define regional anesthesia. Discuss the anatomy, technique,

advantages and complications of brachial plexus block by
supraclavicular approach.
Ans.
Definition of Regional Anesthesia:
Regional anesthesia involves the administration of anesthetic agents to specific
nerve bundles or nerve pathways to produce reversible loss of sensation and
motor function in a specific region of the body. Unlike general anesthesia, which
affects the entire body, regional anesthesia targets only the area being operated
on, providing pain relief and muscle relaxation while allowing the patient to
remain conscious.

Brachial Plexus Block by Supraclavicular Approach:

Aspect Description
The brachial plexus is a network of nerves formed by the ventral rami
of the lower four cervical nerves (C5-C8) and the first thoracic nerve
Anatomy (T1). These nerves originate from the spinal cord in the neck and
 Aspect Description
extend into the upper extremity. The supraclavicular approach targets
the brachial plexus as it passes over the first rib, deep to the clavicle
and subclavius muscle.
1. The patient is positioned supine with the head turned away from the
Technique side to be blocked.
2. The target area is prepared with antiseptic solution, and sterile
drapes are applied.
3. The landmark for needle insertion is the midpoint of the clavicle,
where the brachial plexus lies just deep to the subclavius muscle.
4. Using ultrasound guidance or nerve stimulation techniques, a
needle is inserted at the midpoint of the clavicle and directed cephalad
and slightly laterally toward the brachial plexus.
5. After confirming appropriate needle placement, local anesthetic is
injected to surround the nerves of the brachial plexus, producing
anesthesia of the entire upper extremity.
1. Provides excellent anesthesia for upper extremity surgeries and
Advantages procedures.
2. Offers rapid onset and reliable anesthesia with a relatively small
volume of local anesthetic.
3. Allows for precise localization of nerve blockade under ultrasound
guidance, minimizing the risk of complications.
4. Reduces the need for systemic analgesics and general anesthesia,
lowering the risk of adverse effects and improving postoperative pain
control.
1. Pneumothorax: Due to the proximity of the lung apex, there is a
Complications risk of accidental puncture leading to pneumothorax.
2. Vascular Injury: Injury to adjacent blood vessels such as the
subclavian artery or vein can occur during needle placement.
3. Nerve Injury: Direct trauma to the brachial plexus or its branches
may result in sensory or motor deficits, which can be temporary or
permanent.
 Aspect Description
4. Local Anesthetic Toxicity: Systemic absorption of local anesthetic
can lead to central nervous system and cardiovascular toxicity,
particularly if large volumes are used or if inadvertent intravascular
injection occurs.
5. Infection: Although rare, infection at the injection site can occur,
leading to local inflammation and systemic infection if left untreated.
Brachial plexus block by the supraclavicular approach is a valuable technique for
providing anesthesia and analgesia for upper extremity surgeries and procedures.
While it offers several advantages, clinicians must be mindful of potential
complications and employ proper techniques to minimize risks and ensure patient
safety.

4. Write about lumbar epidural anesthesia. What is the technique, drug

dosage, level of blockade obtained and complications of lumbar
epidural anesthesia?
Ans.

Aspect Description
1. The patient is positioned in the sitting or lateral decubitus
Technique position to allow access to the lumbar epidural space.
2. The skin overlying the selected lumbar interspace (usually L3-
L4 or L4-L5) is prepared with antiseptic solution, and sterile
drapes are applied.
3. A needle is inserted into the epidural space through the
ligamentum flavum using loss of resistance technique, saline
injection, or ultrasound guidance.
4. Once the epidural space is accessed, a catheter may be threaded
through the needle, allowing continuous administration of local
anesthetics or other medications for prolonged pain relief.
 Aspect Description
The dosage of local anesthetic agents used for lumbar epidural
anesthesia varies depending on the desired level of anesthesia and
the patient's characteristics. Commonly used drugs include
Drug Dosage bupivacaine, ropivacaine, or lidocaine.
Typical doses range from 10 to 20 mL of 0.5-2% solution of local
anesthetic, depending on factors such as patient age, weight, and
the extent of surgical anesthesia required.
Lumbar epidural anesthesia primarily provides sensory blockade
Level of Blockade from the dermatomes corresponding to the lumbar and sacral
Obtained spinal nerves.
Depending on the volume and concentration of the local
anesthetic agent, as well as the injection site, the level of blockade
can range from lower thoracic (T10) to the sacral (S5)
dermatomes.
1. Dural Puncture: Accidental puncture of the dura mater during
needle insertion may result in post-dural puncture headache
Complications (PDPH) and cerebrospinal fluid leakage.
2. Hematoma Formation: Hematoma formation at the site of
needle insertion can occur, especially in patients with
coagulopathies or those receiving anticoagulant therapy.
3. Intravascular Injection: Inadvertent injection of local
anesthetic into blood vessels may lead to systemic toxicity and
cardiovascular collapse.
4. Nerve Damage: Direct trauma to spinal nerves or the spinal
cord can result in temporary or permanent neurologic deficits,
including sensory loss, motor weakness, or bowel and bladder
dysfunction.
5. Infection: Although rare, epidural catheter placement may
introduce pathogens into the epidural space, potentially causing
epidural abscess or meningitis.
6. Local Anesthetic Toxicity: Systemic absorption of local
anesthetics can lead to central nervous system and cardiovascular
 Aspect Description
toxicity, particularly if large volumes or high concentrations of
local anesthetics are used or if inadvertent intravascular injection
occurs.
7. Urinary Retention: Epidural anesthesia may impair bladder
function, resulting in urinary retention, especially in the
postoperative period.

5. Discuss spinal anesthesia. Describe the physiology, drug dosage, level

of blockade and complications of spinal anesthesia.
Ans.

Aspect Description
Spinal anesthesia involves the injection of local anesthetic agents
into the subarachnoid space, typically at the lumbar level, to block
sensory and motor nerve transmission. The local anesthetic
disrupts nerve conduction by blocking sodium channels, leading to
Physiology reversible loss of sensation and motor function in the lower body.
The dosage of local anesthetic drugs used for spinal anesthesia
varies based on factors such as patient age, weight, and the desired
level of blockade. Commonly used drugs include hyperbaric
Drug Dosage bupivacaine, isobaric bupivacaine, and ropivacaine.
Typical doses range from 7.5 to 15 mg of hyperbaric bupivacaine
or 10 to 20 mg of isobaric bupivacaine, with or without adjuvants
such as opioids (e.g., fentanyl or morphine) or epinephrine to
prolong the duration of anesthesia and enhance analgesia.
Spinal anesthesia primarily affects sensory and motor function in
the lower half of the body, including the lower abdomen, pelvis,
Level of perineum, and lower extremities. The level of blockade depends on
Blockade factors such as the site of injection, volume, and concentration of
Obtained the local anesthetic agent.
With lumbar injections, the blockade typically extends from the
 Aspect Description
dermatomes corresponding to the thoracic (T6-T10) to the sacral
(S5) spinal nerves. However, the extent and height of the blockade
may vary among individuals and with different drug formulations.
1. Hypotension: Spinal anesthesia can cause sympathetic
blockade, resulting in hypotension due to vasodilation and
decreased venous return. Measures such as intravenous fluids,
Complications vasopressors, and positioning are used to manage hypotension.
2. Bradycardia: Hypotension may be accompanied by
bradycardia due to decreased sympathetic tone. Atropine or
glycopyrrolate may be administered to counteract bradycardia.
3. Post-Dural Puncture Headache (PDPH): Accidental dural
puncture during needle insertion can lead to leakage of
cerebrospinal fluid, resulting in PDPH characterized by positional
headache, nausea, and visual disturbances. Treatment may include
bed rest, hydration, and epidural blood patching.
4. Nerve Injury: Direct trauma to spinal nerves or the spinal cord
during needle insertion or drug injection can cause temporary or
permanent neurologic deficits, including sensory loss, motor
weakness, or bowel and bladder dysfunction.
5. Urinary Retention: Spinal anesthesia may impair bladder
function, leading to urinary retention, especially in the
postoperative period. Intermittent catheterization or bladder
training techniques may be necessary to manage urinary retention.
6. Infection: Although rare, spinal anesthesia procedures carry a
risk of infection at the injection site or within the subarachnoid
space, leading to conditions such as meningitis or epidural abscess.
Prophylactic measures and aseptic techniques are essential to
minimize the risk of infection.
7. Respiratory Depression: High levels of spinal anesthesia can
lead to respiratory depression, particularly in elderly or debilitated
patients. Continuous monitoring of respiratory function and airway
patency is essential during spinal anesthesia administration.
 6. What is local anesthesia? Describe the ideal properties, classification,
dose, mode of action and toxicity of lignocaine which is commonly
used for local anesthesia.
Ans.
Local Anesthesia:

Local anesthesia involves the administration of anesthetic agents to specific areas

of the body to block sensory perception, allowing for pain-free procedures or
surgeries while the patient remains conscious. It temporarily interrupts nerve
transmission in the vicinity of the injection or application site, resulting in loss of
sensation and motor function without affecting consciousness.

Aspect Description
Ideal
Properties 1. Rapid onset of action
2. Prolonged duration of action
3. Potency (ability to produce anesthesia with low concentrations)
4. Selectivity (ability to block sensory nerves without affecting motor
function)
5. Minimal systemic toxicity
Local anesthetics are classified into two main groups: ester-type and
Classification amide-type.
- Ester-type: Includes drugs like procaine and benzocaine. Metabolized
by plasma esterases.
- Amide-type: Includes drugs like lidocaine, bupivacaine, and
ropivacaine. Metabolized by hepatic enzymes (cytochrome P450).
The dose of local anesthetics varies depending on factors such as the
Dose type of procedure, patient age, weight, and medical condition.
 Aspect Description
For example, the maximum recommended dose of lidocaine for
infiltration anesthesia is typically 4.5 to 7 mg/kg without epinephrine
and 7 to 7.5 mg/kg with epinephrine. For regional anesthesia, the dose
may range from 2 to 5 mg/kg.
Local anesthetics work by reversibly blocking voltage-gated sodium
channels in nerve fibers. This blockade prevents the generation and
Mode of propagation of action potentials, thereby inhibiting the transmission of
Action pain signals along sensory nerves.
Local anesthetics exist in two forms: ionized (charged) and non-ionized
(uncharged). The non-ionized form penetrates nerve membranes and
blocks sodium channels, while the ionized form remains in the
extracellular space and cannot enter the nerve. The equilibrium between
these two forms determines the onset and duration of action of the local
anesthetic.
Local anesthetics can cause systemic toxicity if absorbed in excessive
amounts or if inadvertently injected into blood vessels. Symptoms of
local anesthetic toxicity include CNS excitation (such as restlessness,
agitation, seizures), CNS depression (such as drowsiness, confusion,
respiratory depression), and cardiovascular effects (such as hypotension,
Toxicity bradycardia, cardiac arrest).
Lignocaine (also known as lidocaine) is commonly used for local
anesthesia and is associated with a lower risk of cardiotoxicity
compared to other local anesthetics like bupivacaine. However, caution
should still be exercised to avoid overdose or inadvertent intravascular
injection.
Treatment of local anesthetic toxicity involves supportive measures
such as airway management, oxygen supplementation, intravenous
fluids, and administration of medications to control seizures or stabilize
cardiac function. In severe cases, lipid emulsion therapy (intralipid) may
be used as a rescue therapy to bind and sequester the toxic effects of
local anesthetics.
 7. Define monitored anesthesia care. Discuss the goals, benefits and
limitations of monitored anesthesia care during surgery.
Ans.

Monitored Anesthesia Care (MAC) refers to the administration of

anesthesia by an anesthesiologist or qualified anesthesia provider
while continuously monitoring the patient's vital signs, level of
consciousness, and response to anesthesia during surgical or
diagnostic procedures. MAC involves a spectrum of anesthesia care,
ranging from minimal sedation to moderate sedation (conscious
sedation) and deep sedation, depending on the patient's
Definition requirements and the complexity of the procedure.
1. Ensure patient comfort and alleviate anxiety and pain during
Goals procedures.
2. Maintain hemodynamic stability and adequate oxygenation and
ventilation throughout the procedure.
3. Provide amnesia and analgesia while preserving the patient's ability to
maintain spontaneous ventilation and protective airway reflexes.
4. Facilitate communication between the anesthesia provider, surgical
team, and patient to ensure optimal cooperation and cooperation during
the procedure.
1. Reduced risk of complications associated with general anesthesia,
such as airway trauma, postoperative nausea and vomiting (PONV), and
Benefits delayed emergence.
2. Faster recovery times and shorter post-anesthesia care unit (PACU)
stays compared to general anesthesia, allowing for earlier discharge and
improved patient satisfaction.
3. Enhanced patient safety and comfort, as MAC allows patients to
maintain a level of consciousness and responsiveness throughout the
procedure.
4. Flexibility in anesthesia depth, with the ability to adjust sedation levels
based on the patient's physiological response, procedural requirements,
and surgeon's preferences.
 Monitored Anesthesia Care (MAC) refers to the administration of
anesthesia by an anesthesiologist or qualified anesthesia provider
while continuously monitoring the patient's vital signs, level of
consciousness, and response to anesthesia during surgical or
diagnostic procedures. MAC involves a spectrum of anesthesia care,
ranging from minimal sedation to moderate sedation (conscious
sedation) and deep sedation, depending on the patient's
Definition requirements and the complexity of the procedure.
1. Inadequate sedation or analgesia may result in patient discomfort or
Limitations anxiety during the procedure.
2. Risk of oversedation leading to respiratory depression, airway
obstruction, or hemodynamic instability, especially in patients with
comorbidities or compromised respiratory function.
3. Limited suitability for complex or lengthy procedures that may require
deep sedation or general anesthesia to ensure patient comfort and safety.
4. Requires close monitoring by trained anesthesia personnel throughout
the procedure to promptly recognize and manage any changes in the
patient's condition or response to anesthesia.

8. What are muscle relaxants? Discuss the mechanism of action, dosage,

reversal and side effects of atracurium and vecuronium.
Ans.
Muscle Relaxants:

Muscle relaxants are drugs used during surgical procedures to induce muscle
relaxation, facilitate endotracheal intubation, and improve surgical conditions by
reducing muscle tone and movement. They act at the neuromuscular junction,
interfering with the transmission of nerve impulses to skeletal muscles, leading to
paralysis.
 Aspect Description
Muscle relaxants exert their effects by binding to nicotinic acetylcholine
receptors (nAChRs) at the neuromuscular junction, blocking the action
of acetylcholine and preventing depolarization of the motor end plate.
This blockade results in muscle paralysis, making it easier for the
Mechanism surgeon to perform procedures and allowing for mechanical ventilation
of Action during surgery.
The dosage of muscle relaxants varies depending on factors such as
Dosage patient weight, age, and the type and duration of surgery.
- Atracurium: Initial dose: 0.4 to 0.5 mg/kg intravenously. Maintenance
dose: 0.1 to 0.2 mg/kg every 20 to 40 minutes.
- Vecuronium: Initial dose: 0.08 to 0.1 mg/kg intravenously.
Maintenance dose: 0.01 to 0.02 mg/kg every 20 to 40 minutes.
Muscle relaxants can be reversed using acetylcholinesterase inhibitors
such as neostigmine or edrophonium, along with anticholinergic drugs
such as atropine or glycopyrrolate to prevent bradycardia and excessive
salivation. These agents work by increasing acetylcholine levels at the
neuromuscular junction, counteracting the effects of the muscle relaxant
Reversal and promoting muscle contraction.
1. Histamine Release: Atracurium can cause histamine release, leading
to hypotension, flushing, and bronchospasm in some patients.
Side Effects Vecuronium has minimal histamine-releasing properties.
2. Cardiovascular Effects: Both atracurium and vecuronium may cause
cardiovascular effects such as hypotension and tachycardia, particularly
during rapid administration or in susceptible patients.
3. Respiratory Depression: Muscle relaxants can lead to respiratory
depression, especially if administered in high doses or in patients with
compromised respiratory function.
4. Prolonged Neuromuscular Blockade: In some cases, the effects of
muscle relaxants may persist longer than desired, necessitating careful
titration and monitoring during and after surgery.
5. Allergic Reactions: Rarely, patients may experience allergic reactions
to muscle relaxants, ranging from mild rash to severe anaphylaxis.
 Aspect Description
6. Interactions with Anesthetic Agents: Muscle relaxants can interact
with other drugs used during anesthesia, potentially potentiating or
prolonging their effects. Close monitoring and dose adjustments may be
necessary to prevent complications.
7. Hyperkalemia (Atracurium): Atracurium metabolism can produce
laudanosine, which may lead to elevated serum potassium levels in
patients with renal impairment or prolonged infusions.
8. Hepatotoxicity (Vecuronium): Rare cases of hepatotoxicity,
including hepatitis and liver failure, have been reported with prolonged
use of vecuronium.
Atracurium and vecuronium are commonly used muscle relaxants in clinical
practice, each with its own pharmacokinetic and pharmacodynamic properties.
Understanding their mechanisms of action, dosing regimens, reversal agents, and
potential side effects is essential for safe and effective use during surgical
procedures
9. Write about postoperative nausea and vomiting. Discuss its
pathophysiology, risk factors, prevention and treatment.
Ans.

Postoperative Nausea and Vomiting (PONV):

Aspect Description
The pathophysiology of PONV is multifactorial and involves
complex interactions between patient-related factors, surgical
factors, and anesthetic agents. Mechanisms include stimulation of
the chemoreceptor trigger zone (CTZ) and vomiting center in the
brainstem, disruption of vestibular function, opioid-induced
Pathophysiology nausea, and gastric stasis due to surgery and anesthesia.
Risk Factors 1. Patient-related Factors: History of PONV or motion sickness,
 Aspect Description
female gender, younger age, non-smoking status, and obesity.
2. Surgical Factors: Longer duration of surgery, intra-abdominal
and laparoscopic procedures, and surgeries involving the middle
ear, eye, or tonsils.
3. Anesthetic Factors: Use of volatile anesthetics, opioids, nitrous
oxide, and certain medications such as neuromuscular blocking
agents and droperidol.
Prevention 1. Multimodal Approach: Use of combination antiemetic therapy
Strategies targeting multiple receptors and pathways involved in PONV.
2. Selective Use of Anesthetic Agents: Consideration of
alternative anesthetic techniques and agents with lower emetogenic
potential, such as total intravenous anesthesia (TIVA), propofol,
and regional anesthesia.
3. Prophylactic Antiemetic Therapy: Administration of
antiemetic medications before induction of anesthesia or at the end
of surgery to prevent PONV. Commonly used agents include
serotonin receptor antagonists (e.g., ondansetron), corticosteroids
(e.g., dexamethasone), and neurokinin-1 receptor antagonists (e.g.,
aprepitant).
4. Intraoperative Techniques: Measures such as maintaining
normothermia, minimizing intraoperative opioids, and using
volatile anesthetics judiciously.
5. Acupoint Stimulation: Utilization of acupuncture or
acupressure at specific points (e.g., P6 or PC6) on the body to
alleviate nausea and vomiting.
1. Pharmacologic Therapy: Administration of antiemetic
Treatment medications such as serotonin receptor antagonists, dopamine
Strategies antagonists, corticosteroids, and antihistamines.
2. Intravenous Fluids and Electrolyte Replacement:
Rehydration and correction of electrolyte imbalances in patients
who have experienced significant vomiting.
 Aspect Description
3. Nutritional Support: Provision of small, frequent meals and
fluids to prevent dehydration and promote recovery.
4. Patient Positioning and Comfort Measures: Positioning
patients in a semi-upright position, providing cool air or
ventilation, and offering distraction techniques to alleviate
discomfort associated with nausea and vomiting.
5. Delayed Oral Intake: Temporary restriction of oral intake until
nausea and vomiting resolve to prevent aspiration and further
irritation of the gastrointestinal tract.

Postoperative nausea and vomiting (PONV) is a common complication following

surgery and anesthesia, with significant implications for patient comfort,
satisfaction, and recovery. Effective prevention and management strategies
involve a multimodal approach targeting patient-related, surgical, and anesthetic
factors, as well as the use of pharmacologic and non-pharmacologic interventions
to alleviate symptoms and improve outcomes.
10. What is malignant hyperthermia? Discuss its pathophysiology,
triggering agents, clinical features, treatment and prevention.
Ans.
Malignant Hyperthermia (MH):

Aspect Description
Pathophysiology Malignant hyperthermia (MH) is a rare but life-threatening
hypermetabolic disorder triggered by exposure to certain
triggering agents, most commonly volatile anesthetics (e.g.,
halothane, isoflurane) and depolarizing muscle relaxants (e.g.,
succinylcholine). It is characterized by uncontrolled release of
calcium from the sarcoplasmic reticulum in skeletal muscle,
 leading to sustained muscle contraction, increased metabolism,
heat production, and hyperthermia.
Triggering 1. Volatile Anesthetics: Halothane, isoflurane, sevoflurane.
Agents
2. Depolarizing Muscle Relaxants: Succinylcholine.
Clinical 1. Rapid rise in core body temperature (> 1°C per 5 minutes).
Features
2. Muscle rigidity, particularly in the jaw (masseter spasm) and
extremities.
3. Tachycardia, tachypnea, and hemodynamic instability.
4. Hypercarbia, metabolic and respiratory acidosis.
5. Rhabdomyolysis, myoglobinuria, and acute kidney injury.
Treatment 1. Discontinue Triggering Agents: Immediately stop
administration of triggering agents and provide supportive care.
2. Administer Dantrolene: Dantrolene is the specific antidote
for MH, acting by inhibiting calcium release from the
sarcoplasmic reticulum and reducing muscle hypermetabolism.
3. Cooling Measures: Implement aggressive cooling measures,
such as cold intravenous fluids, ice packs, and cooling blankets,
to lower core body temperature.
4. Correction of Acidosis and Hyperkalemia: Administer
sodium bicarbonate to correct metabolic acidosis and glucose-
insulin therapy to manage hyperkalemia.
5. Monitor and Support Organ Function: Continuously
monitor vital signs, electrolytes, and renal function, and provide
appropriate supportive care for complications such as
rhabdomyolysis and acute kidney injury.
Prevention 1. Genetic Screening: Perform genetic testing for susceptibility
to MH in individuals with a family history of the condition or
personal history of adverse reactions to anesthesia.
2. Preoperative Evaluation: Obtain a thorough preoperative
history to identify patients at risk for MH, including those with a
personal or family history of MH, unexplained fevers, or muscle
disorders.
3. Avoid Triggering Agents: Use alternative anesthetic agents
and muscle relaxants in patients with known or suspected MH
 susceptibility.
4. MH Cart Availability: Ensure availability of a dedicated MH
cart containing dantrolene and necessary equipment for prompt
treatment of MH in operating rooms and other areas where
anesthesia is administered.
5. Staff Training: Provide education and training to healthcare
providers on recognition, management, and prevention of MH,
including the importance of early intervention and coordination
of care in suspected cases.

Malignant hyperthermia is a rare but potentially fatal complication of anesthesia,

characterized by hypermetabolism and muscle rigidity triggered by certain
anesthetic agents. Prompt recognition, treatment with dantrolene, and supportive
care are essential for managing MH and preventing life-threatening
complications. Preoperative evaluation, avoidance of triggering agents, and staff
education are key components of MH prevention strategies in clinical practice.
 SHORT NOTES
1. Regional Anaesthesia. (2020 regular; P-2), Regional anaesthesia.
(2018 regular; P-2), (2016 supplementary; P-2)
Ans.

Regional anesthesia involves the administration of anesthetic

agents to specific nerve bundles or nerve pathways to produce
reversible loss of sensation and motor function in a specific region
of the body. Unlike general anesthesia, which affects the entire
body, regional anesthesia targets only the area being operated on,
providing pain relief and muscle relaxation while allowing the
Definition patient to remain conscious.
1. Epidural Anesthesia: Involves the injection of anesthetic agents
into the epidural space surrounding the spinal cord, providing
anesthesia and analgesia for procedures involving the lower abdomen,
Types pelvis, and lower extremities.
2. Spinal Anesthesia: Involves the injection of anesthetic agents into
the subarachnoid space, typically at the lumbar level, to block sensory
and motor nerve transmission. Spinal anesthesia primarily affects
sensory and motor function in the lower half of the body, including
the lower abdomen, pelvis, perineum, and lower extremities.
3. Peripheral Nerve Blocks: Involve the injection of local anesthetic
agents near peripheral nerves to block sensation in a specific area of
the body. Common peripheral nerve blocks include brachial plexus
blocks for upper extremity surgery, femoral nerve blocks for lower
extremity surgery, and interscalene blocks for shoulder surgery.
4. Local Infiltration: Involves the direct injection of local anesthetic
agents into the tissues surrounding the surgical site to provide
anesthesia and analgesia for minor surgical procedures or for
postoperative pain management.
1. Targeted Pain Relief: Regional anesthesia provides precise and
targeted pain relief to the specific area of the body undergoing
Advantages surgery, minimizing the need for systemic analgesics and reducing the
 Regional anesthesia involves the administration of anesthetic
agents to specific nerve bundles or nerve pathways to produce
reversible loss of sensation and motor function in a specific region
of the body. Unlike general anesthesia, which affects the entire
body, regional anesthesia targets only the area being operated on,
providing pain relief and muscle relaxation while allowing the
Definition patient to remain conscious.
risk of side effects associated with general anesthesia.
2. Reduced Systemic Effects: By avoiding the systemic
administration of anesthetic agents, regional anesthesia minimizes the
risk of complications such as respiratory depression, nausea, and
hypotension commonly associated with general anesthesia.
3. Enhanced Recovery: Regional anesthesia techniques are
associated with faster recovery times, shorter hospital stays, and
improved postoperative outcomes compared to general anesthesia,
allowing for early mobilization and reduced risk of postoperative
complications.
1. Technical Expertise Required: Performing regional anesthesia
techniques requires specialized training and expertise to ensure
accurate needle placement and effective nerve blockade while
minimizing the risk of complications such as nerve injury or systemic
Limitations toxicity.
2. Limited Coverage: Regional anesthesia may not provide adequate
anesthesia for certain surgical procedures or may require
supplementation with sedation or general anesthesia to ensure patient
comfort and safety.
3. Patient Factors: Patient factors such as anatomical variations,
coagulopathies, and patient cooperation can affect the success and
safety of regional anesthesia techniques.
1. Nerve Injury: Direct trauma to peripheral nerves during needle
placement or injection can result in temporary or permanent sensory
Complications or motor deficits.
2. Systemic Toxicity: Systemic absorption of local anesthetic agents
 Regional anesthesia involves the administration of anesthetic
agents to specific nerve bundles or nerve pathways to produce
reversible loss of sensation and motor function in a specific region
of the body. Unlike general anesthesia, which affects the entire
body, regional anesthesia targets only the area being operated on,
providing pain relief and muscle relaxation while allowing the
Definition patient to remain conscious.
can lead to central nervous system and cardiovascular toxicity,
particularly if large volumes or high concentrations of local
anesthetics are used or if inadvertent intravascular injection occurs.
3. Infection: Although rare, regional anesthesia procedures carry a
risk of infection at the injection site or within the nerve sheath,
leading to conditions such as abscess formation or neuritis.
4. Hematoma Formation: Hematoma formation at the injection site
can occur, especially in patients with coagulopathies or those
receiving anticoagulant therapy, leading to compression of nerves and
compromised blood flow.
1. Orthopedic Surgery: Regional anesthesia techniques are
commonly used for orthopedic procedures involving the extremities,
Indications such as total joint replacements, fracture repairs, and hand surgeries.
2. Abdominal Surgery: Epidural and spinal anesthesia are frequently
employed for abdominal surgeries, including cesarean sections, hernia
repairs, and bowel resections.
3. Ambulatory Surgery: Peripheral nerve blocks and local
infiltration are increasingly utilized for ambulatory or outpatient
surgeries due to their rapid onset, prolonged duration of action, and
minimal side effects, allowing for early discharge and improved
patient satisfaction.
4. Pain Management: Regional anesthesia techniques are also used
for postoperative pain management, providing prolonged analgesia
and reducing the need for systemic opioids, thereby minimizing
opioid-related side effects and facilitating early mobilization and
rehabilitation.
 2. Endotracheal intubation. (2020 regular; P-2)
Ans.

Aspect Description
Endotracheal intubation is a medical procedure involving the
Definition insertion of a flexible plastic tube into the trachea.
To establish and maintain a patent airway, facilitate mechanical
Purpose ventilation, and administer anesthesia or oxygen.
- Respiratory failure - Airway protection during surgery - Prevention
Indications of aspiration - Administration of anesthesia
Equipment Endotracheal tube, laryngoscope, stylet, suction catheter, bag-valve-
 Aspect Description
mask device, end-tidal CO2 monitor.
1. Position patient with neck extended. 2. Preoxygenate with 100%
oxygen. 3. Insert laryngoscope, visualize vocal cords. 4. Insert
Procedure endotracheal tube through cords.
- Bilateral breath sounds - Chest rise and fall - Capnography
Confirmation waveform showing CO2 in exhaled breath.
- Esophageal intubation - Trauma to teeth, lips, or larynx -
Complications Hypoxemia - Aspiration - Vocal cord injury.
Continuous assessment of vital signs, auscultation of breath sounds,
Monitoring continuous pulse oximetry, capnography monitoring.
Record the size of the endotracheal tube, insertion depth, cuff
inflation pressure, confirmation method, and any complications
Documentation encountered.

3. Magnetic resonance cholangio-pancreatography(MRCP). (2019

regular; P-2), MRCP. (2017 supplementary; P-2)
Ans.

Magnetic Resonance Cholangio-Pancreatography (MRCP)

Magnetic Resonance Cholangio-Pancreatography (MRCP) is a non-invasive imaging
technique used to visualize the bile ducts and pancreatic ducts without the need for
contrast material or invasive procedures like endoscopic retrograde
cholangiopancreatography (ERCP).
Advantages
Non-invasive
No ionizing radiation
No need for contrast agents
Provides detailed images of bile ducts and pancreatic ducts
Useful for diagnosing biliary and pancreatic pathologies
 Magnetic Resonance Cholangio-Pancreatography (MRCP)
Helps in preoperative planning for surgeries involving the biliary or pancreatic
systems
Indications
Evaluation of suspected biliary obstruction
Assessment of biliary and pancreatic anatomy
Diagnosis of biliary and pancreatic ductal pathologies such as stones, strictures, and
tumors
Evaluation of patients with suspected pancreaticobiliary malignancies
Preoperative planning for pancreatic and biliary surgeries
Procedure
Patients undergo MRCP in a standard MRI scanner, typically in the supine position
No special preparation is required, and the procedure is painless
Images are obtained using specialized MRI sequences to visualize the biliary and
pancreatic ducts
The entire procedure usually takes about 30-60 minutes
Interpretation
MRCP images are interpreted by radiologists, who evaluate the size, shape, and
patency of the bile ducts and pancreatic ducts
Abnormal findings such as strictures, dilatations, stones, or tumors are identified and
characterized
The findings are correlated with clinical history and other imaging studies for
diagnosis and management planning
Conclusion
Magnetic Resonance Cholangio-Pancreatography (MRCP) is a valuable imaging
modality for evaluating biliary and pancreatic ductal pathologies non-invasively. It
provides detailed images without the need for contrast agents or invasive procedures,
making it a preferred choice in many clinical scenarios. However, it has limitations in
spatial resolution and may not detect small lesions compared to invasive techniques
like ERCP. Overall, MRCP plays a crucial role in the diagnosis, preoperative
 Magnetic Resonance Cholangio-Pancreatography (MRCP)
planning, and management of biliary and pancreatic disorders.

Step Description
1. The patient is instructed to fast for a certain period before
the procedure, typically 4-6 hours, to ensure a clear
Patient Preparation visualization of the biliary and pancreatic ducts.
2. Inform the patient about the procedure, including the need
to lie still inside the MRI scanner and the duration of the scan.
1. The patient is positioned on the MRI table, usually lying on
MRI Machine Setup their back.
2. Coil placements are adjusted around the abdomen to
optimize image quality and resolution of the biliary and
pancreatic ducts.
1. The MRI technician initiates the imaging sequence, during
which the patient is required to remain still to avoid motion
Image Acquisition artifacts.
2. The MRI machine generates detailed images of the biliary
and pancreatic ducts using magnetic fields and radio waves.
1. Single-shot Fast Spin-Echo (SSFSE) Sequence: This
sequence is commonly used for MRCP due to its rapid
acquisition time and high sensitivity to fluid-filled structures,
Sequence Types such as bile and pancreatic ducts.
2. Magnetic Resonance Angiography (MRA) Sequence: In
some cases, MRA sequences may be combined with MRCP to
assess vascular structures and detect any abnormalities or
pathologies.
1. After image acquisition, the radiologist reviews the MRCP
images to evaluate the anatomy and integrity of the biliary and
Image Interpretation pancreatic ducts.
2. Any dilatation, strictures, calculi, tumors, or other
 Step Description
abnormalities in the biliary and pancreatic ducts are identified
and documented.
1. The radiologist generates a report detailing the findings of
the MRCP examination, including any abnormalities or
Reporting Findings pathologies detected.
2. The report is communicated to the referring physician, who
then discusses the results with the patient and determines the
appropriate course of action, which may include further
diagnostic tests or treatment interventions.
1. Based on the MRCP findings, the patient may undergo
additional diagnostic procedures, such as endoscopic
retrograde cholangiopancreatography (ERCP) or percutaneous
Follow-Up and transhepatic cholangiography (PTC), for further evaluation
Management and management of biliary and pancreatic disorders.
2. Treatment plans, including medical management, surgical
interventions, or minimally invasive procedures, are tailored to
address specific diagnoses and patient needs.
1. After completion of the MRCP examination and discussion
of the findings, the patient is discharged from the imaging
Patient Discharge facility.
2. Any post-procedure instructions, including medication
regimen, dietary restrictions, and follow-up appointments, are
provided to the patient and documented for continuity of care.

Magnetic Resonance Cholangiopancreatography (MRCP) is a relatively safe and

non-invasive imaging procedure. However, there are some contraindications and
precautions to consider:
Pacemakers and Implantable Cardioverter Defibrillators (ICDs): Patients with
these devices may be contraindicated for MRCP due to potential interactions with
the strong magnetic fields generated by the MRI machine. However, newer
pacemaker and ICD models may be MRI-compatible under certain conditions.
Certain Metallic Implants: Some metallic implants, such as certain aneurysm
clips, cochlear implants, and certain types of metallic prosthetic devices, may be
contraindicated due to potential interactions with the magnetic field or risk of
displacement.
Severe Claustrophobia: Patients with severe claustrophobia may find it
challenging to tolerate the confined space inside the MRI scanner. Sedation or
alternative imaging modalities may be considered in such cases.
Pregnancy: While MRI is generally considered safe during pregnancy, MRCP
may be contraindicated during the first trimester when fetal organs are
developing. The decision to perform MRCP during pregnancy should be carefully
weighed against the potential risks to the fetus and the clinical necessity of the
procedure.
Severe Renal Impairment: Gadolinium-based contrast agents, which are
sometimes used in MRCP, can pose a risk of nephrogenic systemic fibrosis (NSF)
in patients with severe renal impairment or end-stage renal disease. Alternative
imaging techniques may be considered in these patients.
Inability to Remain Still: Patients who are unable to remain still for the duration
of the MRI scan may not be suitable candidates for MRCP, as motion artifacts can
degrade image quality and diagnostic accuracy.
4. Epidural Anesthesia. (2019 regular; P-2), (2016 regular; P-2) (2014
regular; P-2) (2012 supplementary; P-2)
Ans.

Epidural anesthesia is a regional anesthesia technique that

involves the injection of local anesthetic agents into the epidural
space, a potential space outside the dura mater (the outermost
layer of the spinal cord). This results in reversible loss of
Definition sensation and motor function in the lower part of the body.
1. Patient Positioning: Typically, the patient is positioned sitting
Procedure or lying on their side, exposing the lower back.
 2. Skin Preparation: The target area is prepared with antiseptic
solution, and sterile drapes are applied.
3. Needle Insertion: A needle is inserted through the skin and
deeper tissues into the epidural space using loss of resistance
technique or with the guidance of ultrasound.
4. Catheter Placement (Optional): A catheter may be threaded
through the needle into the epidural space to allow continuous
administration of local anesthetic or other medications for
prolonged pain relief.
Local anesthetic agents, such as bupivacaine, ropivacaine, or
lidocaine, are commonly used in epidural anesthesia.
Drug Additionally, opioids or adjuvants may be added to enhance
Administration analgesia.
Epidural anesthesia can provide anesthesia and analgesia from
the lower thoracic (T6-T10) to the sacral (S5) dermatomes,
Level of Blockade depending on the site of injection and the volume and
Obtained concentration of the anesthetic agent used.
1. Pain Relief During Labor: Commonly used for pain
Indications management during childbirth.
2. Surgical Anesthesia: Epidural anesthesia is also employed for
various surgical procedures involving the lower abdomen, pelvis,
and lower extremities.
Advantages 1. Precise control over the depth of anesthesia.
2. Option for continuous pain relief through the use of epidural
catheters.
3. Reduced requirement for systemic analgesics and general
anesthesia.
Complications 1. Hypotension: Due to sympathetic blockade.
2. Urinary Retention: Impaired bladder function.
3. Dural Puncture: Accidental puncture of the dura mater may
lead to post-dural puncture headache.
4. Infection: Risk of infection at the injection site or within the
 epidural space.
5. Neurological Complications: Rare instances of nerve injury
or spinal cord damage.
Continuous monitoring of vital signs, oxygen saturation, and
neurological status is essential during epidural anesthesia. Prompt
Monitoring and recognition and management of complications, such as
Management hypotension, are crucial for patient safety.

5. Endoscopic Retrograde Cholangiopancreatography (ERCP). (2019

supplementary; P-2), E.R.C.P. (2018 regular; P-2)
Ans.

Aspect Description
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a
diagnostic and therapeutic procedure that combines endoscopy and
fluoroscopy to visualize and treat conditions affecting the bile ducts,
Definition pancreatic duct, and gallbladder.
1. Biliary Disorders: Gallstones, strictures, tumors, and other
Indications abnormalities of the bile ducts.
2. Pancreatic Disorders: Chronic pancreatitis, pancreatic tumors, and
pseudocysts.
3. Sphincter of Oddi Dysfunction: Dysfunction or spasm of the
sphincter of Oddi.
4. Pancreaticobiliary Malignancies: Evaluation and staging of
pancreatic and biliary cancers.
Procedure 1. Endoscope Insertion: An endoscope is advanced through the mouth
Steps into the duodenum.
2. Cannulation: A catheter is passed through the ampulla of Vater,
and contrast dye is injected to visualize the biliary and pancreatic
ducts.
3. Fluoroscopic Imaging: X-ray imaging is used to identify
 Aspect Description
abnormalities, stones, or strictures in the biliary and pancreatic ducts.
4. Therapeutic Interventions: ERCP allows for interventions such as
stone removal, stent placement, sphincterotomy, and tissue sampling
(biopsy).
5. Sphincter of Oddi Manometry: Measurement of sphincter of Oddi
pressure may be performed for cases of suspected sphincter of Oddi
dysfunction.
1. Pancreatitis: An inflammatory reaction in the pancreas, a common
Complications complication.
2. Bleeding: Injury to blood vessels may occur during the procedure.
3. Perforation: Perforation of the bile duct or duodenum is a rare but
serious complication.
4. Infection: Infection of the biliary or pancreatic ducts.
5. Allergic Reactions: Reactions to contrast dye or sedation
medications.
1. Minimally Invasive: Compared to surgical approaches, ERCP is
Advantages minimally invasive.
2. Combined Diagnosis and Treatment: Allows for both diagnostic
imaging and therapeutic interventions during the same procedure.
3. Avoidance of Surgery: Many conditions that would traditionally
require surgery can be managed with ERCP.
Limitations 1. Operator Skill: ERCP requires specialized training and experience.
2. Risk of Complications: Complications, though infrequent, can be
serious.
3. Limited Visualization: Limited visualization of the pancreatic duct
in some cases
 Contraindications to ERCP
1. Unstable Cardiovascular Status
2. Severe Coagulopathy or Bleeding Diathesis
3. Acute Pancreatitis with Severe Localized or Systemic Complications
4. Perforation of the Duodenal Wall
5. Hemodynamic Instability
6. Recent Myocardial Infarction or Unstable Angina
7. Severe Pulmonary Disease or Respiratory Distress
8. Allergy to Contrast Media
9. Inability to Provide Informed Consent
10. Severe Ascites
11. Uncontrolled Sepsis
12. Severe Coexisting Medical Conditions
13. Intractable Bleeding from the Papilla of Vater
14. Patients Who are Poor Surgical Candidates

6. Spinal anaesthesia. (2019 supplementary; P-2) (2013 regular; P-2)

Ans.

Aspect Description
Spinal anesthesia, also known as subarachnoid block, involves
the injection of local anesthetic agents into the subarachnoid
space to achieve anesthesia and analgesia for surgical procedures
Definition below the level of the umbilicus.
1. Patient positioning: Usually in the sitting or lateral decubitus
Procedure position.
2. Landmark identification: Palpate and identify the appropriate
vertebral interspace (usually L3-L4 or L4-L5).
 Aspect Description
3. Needle insertion: Insert a spinal needle through the skin and
deeper tissues, between the vertebral spinous processes, and into
the subarachnoid space.
4. Drug administration: Inject a predetermined dose of local
anesthetic solution into the subarachnoid space.
5. Needle removal: Withdraw the needle carefully to avoid post-
dural puncture headache and other complications.
Spinal anesthesia typically produces rapid onset of anesthesia,
with effects manifesting within minutes. Duration of anesthesia
Onset and varies depending on the type and dose of local anesthetic used,
Duration ranging from 1 to 3 hours.
Advantages 1. Rapid onset of anesthesia.
2. Predictable and reliable anesthesia.
3. Minimal systemic absorption of anesthetic agents.
4. Reduced risk of airway complications compared to general
anesthesia.
Disadvantages 1. Limited duration of action.
2. Risk of post-dural puncture headache.
3. Potential for hypotension and bradycardia.
4. Inability to adjust anesthesia depth once administered.
Spinal anesthesia is commonly used for surgeries involving the
lower abdomen, pelvis, and lower extremities, including cesarean
Indications sections, hernia repairs, and lower limb orthopedic procedures.
Contraindications 1. Patient refusal or inability to cooperate.
2. Coagulopathy or bleeding disorders.
3. Infection at the injection site or systemic infection.
4. Increased intracranial pressure.
Complications 1. Post-dural puncture headache.
2. Hypotension and bradycardia.
 Aspect Description
3. Nausea, vomiting, and urinary retention.
4. Rare neurological complications such as nerve injury or
arachnoiditis.

7. Brachytherapy. (2018 regular; P-2), (2016 supplementary; P-2) (2012

supplementary; P-2)
Ans.

Brachytherapy
Brachytherapy is a form of radiation therapy where radioactive
sources are placed in or near the tumor, delivering radiation directly
Definition to the cancerous tissue.
- Interstitial Brachytherapy: Radioactive sources are implanted
Types directly into the tumor or surrounding tissue.
- Intracavitary Brachytherapy: Radioactive sources are placed
inside body cavities, such as the vagina, uterus, or esophagus.
- Surface Brachytherapy: Radioactive sources are placed on the
skin surface, often used for superficial cancers like skin cancer.
Indications - Prostate cancer
- Cervical cancer
- Breast cancer (partial breast irradiation)
- Skin cancer
- Head and neck cancers
- Precise delivery of radiation to the tumor site, sparing surrounding
Advantages healthy tissues.
- High doses of radiation can be delivered to the tumor with minimal
exposure to nearby structures.
- Shorter treatment duration compared to external beam radiation
Brachytherapy
therapy.
- Potential for higher tumor control rates and improved outcomes in
selected cases.
Procedure - Implantation of radioactive sources under imaging guidance.
- Sources may be temporary (removed after treatment) or permanent
(remain in the body).
- Dosage and treatment duration are determined based on the type,
location, and stage of cancer.
- Temporary side effects such as fatigue, skin irritation, and
Complications discomfort at the implantation site.
- Long-term complications can include fibrosis, scarring, and damage
to nearby organs or tissues.
- Risk of radiation exposure to healthcare providers during the
implantation procedure.
- Regular follow-up appointments to monitor treatment response and
Follow-up assess for any complications.
- Imaging studies, blood tests, and physical examinations are used to
evaluate the effectiveness of brachytherapy and detect any recurrence
or adverse effects.
Brachytherapy is a valuable treatment modality for various types of
cancer, offering precise radiation delivery and potential for improved
Conclusion outcomes while minimizing damage to healthy tissues.

8. Complications of spinal anaesthesia. (2017 regular; P-2) (2015

regular; P-2)
Ans.

Complication Description
Post-Dural Puncture Headache occurring after accidental puncture of the dura
 Complication Description
Headache (PDPH) mater during needle insertion, often characterized by
positional exacerbation and relief upon lying flat.
Accidental injection of local anesthetic into blood vessels,
Intravascular Injection leading to systemic absorption and potential toxicity.
Direct trauma to spinal nerves or spinal cord, resulting in
temporary or permanent neurologic deficits, including sensory
Nerve Damage or motor impairment.
Drop in blood pressure due to sympathetic blockade, leading
Hypotension to vasodilation and decreased venous return.
Decreased heart rate due to sympathetic blockade, often
Bradycardia accompanied by hypotension.
Decreased respiratory rate and depth, potentially leading to
Respiratory Depression hypoxemia and respiratory failure.
Impaired bladder function, resulting in inability to void urine
Urinary Retention spontaneously.
Rare but possible risk of infection at the injection site, leading
Infection to local inflammation or systemic infection.
Transient or persistent discomfort in the lumbar region
Back Pain following spinal anesthesia administration.
Spread of local anesthetic to the level of the medulla, resulting
in complete loss of sensation and motor function below the
Total Spinal neck, potentially leading to respiratory arrest and
Anesthesia cardiovascular collapse.

9. PET scan. (2016 supplementary; P-2)

Ans.

PET Scan (Positron Emission Tomography)

Description
 PET Scan (Positron Emission Tomography)
PET scan is a medical imaging technique that uses radioactive tracers to detect
metabolic activity in tissues. It provides information about cellular function and
physiology, allowing visualization of metabolic processes within the body.
Procedure
1. Patient is injected with a radioactive tracer, typically a glucose analog (e.g., FDG)
labeled with a positron-emitting radionuclide.
2. The tracer is absorbed by tissues and accumulates in areas with high metabolic
activity, such as tumors or areas of inflammation.
3. Positrons emitted by the tracer collide with electrons, producing gamma rays.
4. Detectors surrounding the patient's body detect the gamma rays, and a computer
generates images based on the distribution of the tracer in the body.
Applications
1. Cancer Detection and Staging: PET scans are used to identify primary tumors,
detect metastases, and assess the extent of cancer spread.
2. Cardiac Imaging: PET scans can evaluate myocardial perfusion, viability, and
function, aiding in the diagnosis and management of coronary artery disease and heart
conditions.
3. Neurological Disorders: PET imaging is utilized to study brain function and assess
neurological conditions such as Alzheimer's disease, epilepsy, and stroke.
4. Infection and Inflammation: PET scans can detect sites of infection and
inflammation in the body, helping in the diagnosis and monitoring of infectious and
inflammatory diseases.
Advantages
1. Provides functional information about tissues and organs, complementing structural
imaging techniques like CT and MRI.
2. Allows early detection of diseases and monitoring of treatment response.
3. Non-invasive procedure with minimal risks to patients.
4. High sensitivity and specificity for detecting abnormalities.
Limitations
 PET Scan (Positron Emission Tomography)
1. Limited availability and higher cost compared to other imaging modalities.
2. Requires specialized facilities and trained personnel for operation and interpretation.
3. Exposure to ionizing radiation from the radioactive tracer.
4. PET scans may produce false-positive or false-negative results, requiring correlation
with other clinical and imaging findings.

10. Muscle Relaxant. (2014 regular; P-2)

Ans.

Aspect Description
Muscle relaxants are pharmacological agents used to induce muscle
relaxation and paralysis during surgical procedures, facilitate
Definition endotracheal intubation, and improve surgical conditions.
Muscle relaxants are classified into two main groups: depolarizing
Classification and non-depolarizing agents.
- Depolarizing Agents: Include succinylcholine, which acts as a
depolarizing neuromuscular blocker by causing sustained
depolarization of the motor end plate, resulting in muscle paralysis.
- Non-Depolarizing Agents: Include drugs such as vecuronium,
rocuronium, and atracurium, which competitively block nicotinic
acetylcholine receptors at the motor end plate, leading to muscle
relaxation without depolarization.
Mechanism of - Depolarizing agents bind to nicotinic acetylcholine receptors and
Action produce depolarization followed by sustained paralysis.
- Non-depolarizing agents competitively inhibit acetylcholine from
binding to nicotinic receptors, preventing depolarization and muscle
contraction.
Muscle relaxants are used to achieve muscle relaxation during
surgery, facilitate mechanical ventilation in critically ill patients, and
Clinical Use aid in endotracheal intubation.
 Aspect Description
Common side effects of muscle relaxants include respiratory
depression, hypotension, bradycardia, muscle weakness, and
Adverse Effects prolonged paralysis.
Succinylcholine can cause hyperkalemia, malignant hyperthermia,
and increased intraocular pressure. Non-depolarizing agents may
cause histamine release and allergic reactions.
- Acetylcholinesterase inhibitors such as neostigmine and
edrophonium can reverse the effects of non-depolarizing muscle
Reversal relaxants by increasing acetylcholine levels at the neuromuscular
Agents junction.
- Sugammadex is a specific reversal agent for steroidal non-
depolarizing muscle relaxants like rocuronium and vecuronium. It
forms a complex with the muscle relaxant, reducing its plasma
concentration and reversing its effects.

11. C.T. Scan. (2014 supplementary; P-1)

Ans.

Aspect Description
Computed Tomography (CT) scan, also known as a CAT
(Computerized Axial Tomography) scan, is a medical imaging
technique that uses X-rays and computer processing to create detailed
Definition cross-sectional images (slices) of the body.
CT scans combine X-ray data from multiple angles to generate detailed,
three-dimensional images of internal structures. The X-ray source
rotates around the patient, and detectors measure the X-rays that pass
Principle through the body, providing cross-sectional images for diagnosis.
1. Diagnostic Imaging: CT scans are widely used for diagnosing
various conditions, including trauma, infections, tumors, vascular
Uses abnormalities, and musculoskeletal disorders.
 Aspect Description
2. Cancer Detection and Staging: CT scans are valuable in detecting
and staging cancers by visualizing tumors, assessing their size and
extent, and identifying potential metastases.
3. Trauma Assessment: CT scans are crucial in evaluating traumatic
injuries, such as fractures, head injuries, and internal organ damage,
providing detailed information for treatment planning.
4. Guidance for Procedures: CT scans assist in guiding interventional
and surgical procedures by providing real-time imaging, aiding in
precise needle or instrument placement.
1. Contrast-Enhanced CT: Involves the use of contrast agents (iodine-
Types based) to enhance visibility of blood vessels, organs, and abnormalities.
2. Non-Contrast CT: Does not involve the use of contrast agents and
is suitable for certain examinations, such as detecting kidney stones or
assessing bone structures.
3. Helical (Spiral) CT: Allows continuous acquisition of images while
the patient is moved through the scanner, providing faster scans with
improved image quality.
1. The patient lies on a motorized table that moves through the CT
Procedure scanner.
2. X-ray beams pass through the body from different angles, and
detectors measure the amount of radiation that passes through tissues.
3. Computer algorithms process the data to create detailed cross-
sectional images that are reconstructed and displayed on a monitor.
4. For contrast-enhanced scans, a contrast agent may be injected
intravenously to highlight specific structures or abnormalities.
Advantages 1. Provides detailed images of soft tissues, bones, and blood vessels.
2. Rapid imaging, allowing for quick diagnosis and treatment planning.
3. Non-invasive compared to some other diagnostic procedures.
4. Versatile and applicable to various medical specialties.
Limitations 1. Involves exposure to ionizing radiation.
 Aspect Description
2. Some patients may be allergic to contrast agents.
3. Limited in assessing certain physiological functions compared to
other imaging modalities.
1. Ionizing Radiation: CT scans involve exposure to X-rays, which
carry a small risk of radiation-induced cancer, particularly with
Risks repeated scans.
2. Contrast Agent Reactions: Some individuals may experience allergic
reactions to contrast agents, ranging from mild to severe.
Commonly used iodine-based contrast agents for CT scans include
iohexol, iopamidol, and ioversol. These agents enhance the visibility of
Contrast blood vessels and certain tissues, aiding in the diagnosis of various
Agents conditions.

12. Local anaesthesia in inguinal hernia surgery. (2014 supplementary;

P-2)
Ans.
Local anesthesia in inguinal hernia surgery involves the administration of
anesthetic agents to numb the area around the inguinal region, allowing surgeons
to perform the procedure while the patient remains awake and comfortable. This
approach, known as inguinal hernia repair under local anesthesia, offers several
advantages, including reduced risk of general anesthesia-related complications,
faster recovery times, and potential cost savings.

In this technique, the surgeon injects a local anesthetic solution, such as lidocaine
or bupivacaine, into the skin and tissues surrounding the inguinal hernia site. The
anesthetic agent blocks the transmission of pain signals from the surgical area to
the brain, effectively numbing the region and allowing the patient to remain
awake during the procedure. Additionally, the surgeon may use a combination of
sedatives or anti-anxiety medications to help keep the patient relaxed and
comfortable throughout the surgery.

Local anesthesia in inguinal hernia surgery is particularly suitable for patients

who are at higher risk of complications from general anesthesia, such as older
adults or those with significant medical comorbidities. It also allows for
immediate postoperative mobilization and reduces the need for prolonged
recovery in the post-anesthesia care unit (PACU).

While inguinal hernia repair under local anesthesia is generally well-tolerated and
associated with minimal complications, it may not be suitable for all patients or
all types of hernias. Surgeons consider factors such as the size and complexity of
the hernia, patient preference, and the surgeon's expertise when determining the
appropriateness of local anesthesia for inguinal hernia surgery.

Overall, inguinal hernia repair under local anesthesia is a safe and effective
alternative to traditional general anesthesia for select patients, offering numerous
benefits while ensuring optimal surgical outcomes and patient satisfaction.
13. Transluminal USG. (2014 supplementary; P-2) (2012 regular; P-2)
Ans.

Aspect Description
Transluminal ultrasonography (USG) is a minimally invasive imaging
technique that involves the insertion of an ultrasound probe or
transducer through natural body orifices or lumens to visualize internal
organs, structures, or pathology. It allows for real-time imaging and
Definition guidance during various diagnostic and therapeutic procedures.
Procedure 1. Endoscopic Ultrasound (EUS): Involves the insertion of an
 Aspect Description
ultrasound probe attached to the end of an endoscope through the
mouth or anus to obtain high-resolution images of the gastrointestinal
tract, pancreas, liver, and adjacent structures.
2. Transvaginal Ultrasound (TVUS): Utilizes a specialized
ultrasound probe inserted into the vagina to visualize pelvic organs
such as the uterus, ovaries, and fallopian tubes for evaluation of
gynecological conditions and fertility assessment.
1. Diagnosis and Staging: Transluminal USG aids in the diagnosis
and staging of gastrointestinal tumors, pancreatic lesions, liver masses,
and other abdominal pathologies by providing detailed images of the
Applications affected organs and surrounding structures.
2. Guidance for Interventional Procedures: It serves as a valuable
tool for guiding fine-needle aspiration (FNA), biopsies, cyst
aspirations, and therapeutic interventions such as drainage procedures
and placement of stents or fiducial markers.
3. Assessment of Treatment Response: Transluminal USG helps in
monitoring treatment response and disease progression in patients
undergoing chemotherapy, radiation therapy, or other forms of
treatment for gastrointestinal and gynecological malignancies.
1. Minimally Invasive: Transluminal USG procedures are minimally
invasive and generally well-tolerated by patients, reducing the risk of
complications and recovery time compared to traditional surgical
Advantages approaches.
2. Real-Time Imaging: Provides real-time visualization of internal
structures and pathology, allowing for immediate assessment and
guidance during diagnostic and therapeutic procedures.
3. High Resolution: Offers high-resolution imaging with excellent
tissue contrast, enabling accurate identification of lesions,
characterization of tumors, and precise targeting during interventions.
1. Operator Skill: Performing transluminal USG requires specialized
training and expertise to ensure optimal image acquisition,
Limitations interpretation, and safe execution of procedures.
 Aspect Description
2. Anatomical Constraints: The accessibility of certain organs and
structures may be limited by anatomical factors or patient-specific
conditions, potentially affecting the scope and effectiveness of
transluminal USG examinations and interventions.
3. Risk of Complications: While generally safe, transluminal USG
procedures carry inherent risks such as perforation, bleeding, infection,
and adverse reactions to sedation or contrast agents, necessitating
careful patient selection, monitoring, and adherence to established
safety protocols.
1. Advancements in Technology: Continued advancements in
ultrasound technology, including miniaturization of probes, improved
image resolution, and integration of advanced imaging modalities, are
Future expected to enhance the capabilities and clinical utility of transluminal
Directions USG in the diagnosis and management of various medical conditions.
2. Expanding Clinical Applications: With ongoing research and
clinical trials, transluminal USG is likely to find broader applications
in fields such as oncology, gastroenterology, gynecology, and
interventional radiology, offering new insights into disease
pathogenesis, treatment response, and patient outcomes.

14. Anaesthetic monitoring devices. (2012 regular; P-2)

Ans.

Device Description
Measures the oxygen saturation of hemoglobin in arterial blood
(SpO2) by emitting light through a peripheral site (usually finger
or earlobe) and analyzing the absorption pattern. Provides
continuous monitoring of oxygenation status and detects
hypoxemia, a critical parameter during anesthesia and critical
Pulse Oximeter care.
Capnograph Measures the concentration of carbon dioxide (CO2) in exhaled
 Device Description
breath (end-tidal CO2 or EtCO2) through infrared absorption or
mainstream/sidestream technology. Provides real-time
assessment of ventilation, endotracheal tube placement, and
helps detect hypoventilation, bronchospasm, or airway
obstruction during anesthesia.
Records the electrical activity of the heart, displaying waveforms
corresponding to atrial and ventricular depolarization and
repolarization. Helps assess heart rate, rhythm, and identify
Electrocardiogram arrhythmias, conduction abnormalities, and myocardial ischemia
(ECG) during anesthesia and perioperative care.
Utilizes oscillometric or auscultatory methods to measure blood
pressure at regular intervals from an inflatable cuff placed
around a limb (usually the upper arm or wrist). Provides
continuous monitoring of systolic, diastolic, and mean arterial
Non-Invasive Blood pressures, essential for hemodynamic management and detecting
Pressure intraoperative hypotension or hypertension.
Measures core body temperature using various methods such as
oral, tympanic, esophageal, or bladder probes. Continuous
monitoring of body temperature helps detect hypothermia or
hyperthermia, guiding perioperative temperature management
Temperature and preventing complications such as surgical site infections and
Monitor thermal injury.
Utilizes processed electroencephalography (EEG) signals,
evoked potentials, or other proprietary algorithms to assess the
depth of anesthesia and level of consciousness during surgery.
Helps optimize anesthetic dosing, prevent awareness under
Depth of Anesthesia anesthesia, and titrate anesthetic agents to minimize
Monitor intraoperative awareness and postoperative complications.

Anaesthetic monitoring devices play a crucial role in ensuring patient safety,

optimizing anesthesia delivery, and detecting adverse events during surgical
procedures. Continuous monitoring of vital signs, oxygenation, ventilation,
cardiovascular function, and depth of anesthesia allows anesthesiologists to
maintain hemodynamic stability, assess anesthetic depth, and promptly intervene
in case of complications.