Anesthesia Techniques & Patient Management Flashcards

Which mechanism best explains why ketamine is the preferred induction agent in a hemodynamically unstable trauma patient?

Answer: Stimulation of central sympathetic outflow increasing heart rate and blood pressure

Ketamine stimulates the sympathetic nervous system, causing catecholamine release that supports blood pressure and heart rate in hypovolemic patients.

During interscalene brachial plexus block, which adjacent structure's blockade is an expected side effect that must be disclosed?

Answer: Phrenic nerve (C3-C5)

Ipsilateral phrenic nerve palsy occurs in nearly 100% of interscalene blocks, reducing ipsilateral diaphragmatic function by approximately 25%, which is clinically significant in patients with contralateral phrenic nerve palsy or severe pulmonary disease.

A patient on chronic opioid therapy for cancer pain requires general anesthesia. The most appropriate intraoperative opioid management strategy is:

Answer: Provide higher-than-standard opioid doses and consider multimodal adjuncts

Opioid-tolerant patients have higher baseline requirements and reduced sensitivity; they need increased doses plus multimodal agents (ketamine, NSAIDs, nerve blocks) for adequate intraoperative and postoperative analgesia.

Which inhalational agent is most associated with nephrotoxicity due to Compound A production in low-flow anesthesia circuits?

Answer: Sevoflurane

Sevoflurane reacts with dry CO2 absorbents (especially those containing KOH) to produce Compound A, a nephrotoxic olefin, particularly at low fresh gas flow rates.

A patient with myasthenia gravis requires surgery. Which neuromuscular blocking agent strategy is most appropriate?

Answer: Avoid all neuromuscular blocking agents if possible; use greatly reduced NDMB doses if needed

MG patients have reduced acetylcholine receptors, causing resistance to succinylcholine and extreme sensitivity to NDMBs; avoidance with careful monitoring is ideal, with very small NDMB doses if necessary.

Which intervention most effectively reduces the incidence of intraoperative awareness in high-risk patients?

Answer: Using processed EEG monitoring (BIS or entropy) to guide anesthetic depth

Processed EEG monitoring such as BIS helps titrate anesthetic depth and has been shown to reduce awareness rates in high-risk populations when used by trained providers.

When performing a pediatric caudal block for circumcision in a 2-year-old, the correct landmark for needle insertion is:

Answer: The sacrococcygeal ligament at the sacral hiatus

The sacral hiatus, covered by the sacrococcygeal ligament, is the entry point for caudal epidural block, providing reliable sacral and lumbar nerve blockade in pediatric patients.