Ambulatory Anesthesia — MCQs

Q: A 20-year-old patient presents for medical termination of pregnancy in a day care facility. What is the anesthetic induction agent of choice?

Propofol. ### Explanation The correct answer is **Propofol (Option C)**. #### Why Propofol is the Choice Propofol is the induction agent of choice for **day-care (ambulatory) surgeries** like Medical Termination of Pregnancy (MTP). Its selection is based on its unique pharmacokinetic profile: 1. **Rapid Onset and Recovery:** It has a very short distribution half-life, leading to quick awakening. 2. **Clear Head Recovery:** Unlike other agents, it is associated with minimal "hangover" effects, allowing patients to be discharged sooner. 3. **Antiemetic Properties:** It possesses intrinsic antiemetic effects, significantly reducing Postoperative Nausea and Vomiting (PONV), which is crucial for early oral intake and discharge in day-care settings. #### Why Other Options are Incorrect * **Thiopentone (A):** While it has a rapid onset, it undergoes slow metabolism and significant redistribution into fat stores, leading to a "hangover" effect and delayed psychomotor recovery. * **Ketamine (B):** It is associated with **emergence delirium**, hallucinations, and prolonged recovery. It also increases uterine tone, which is generally undesirable during an MTP. * **Diazepam (D):** This is a benzodiazepine used primarily for sedation or premedication. It has a long half-life and active metabolites, making it unsuitable as a primary induction agent for rapid-turnover day-care procedures. #### High-Yield NEET-PG Pearls * **Propofol** is also the agent of choice for **Total Intravenous Anesthesia (TIVA)** and **ECT** (due to its short duration, though it may shorten seizure duration). * **Pain on injection** is the most common side effect of Propofol (minimized by using larger veins or lidocaine). * **Egg/Soy Allergy:** Traditionally, Propofol was avoided in these patients due to its lipid emulsion, though recent guidelines suggest it is safe for most. * **MTP specific:** For MTP, Propofol provides excellent relaxation of the cervix, facilitating the procedure.

Practice by Chapter

Patient Selection for Ambulatory Surgery

Practice Questions

Preoperative Assessment for Outpatients

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Anesthetic Techniques for Ambulatory Surgery

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Fast-Track Recovery Protocols

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Post-Discharge Analgesia

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Preventing PONV in Outpatients

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Perioperative Management of Sleep Apnea

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Discharge Criteria

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Common Complications After Ambulatory Surgery

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Management of Diabetic Patients

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Geriatric Ambulatory Anesthesia

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Quality Improvement in Ambulatory Surgery

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