Ambulatory Anesthesia — MCQs

Q: The following combination of agents is preferred for short day care surgeries –

Propofol, fentanyl, isoflurane. ***Propofol, fentanyl, isoflurane*** - This combination is preferred due to the **rapid onset and offset** characteristics of its components, which is crucial for **short day care surgeries**. - **Propofol** provides rapid induction and smooth maintenance, **fentanyl** offers effective analgesia with a short duration of action, and **isoflurane** allows for precise control of anesthesia depth with quick emergence. *Thiopentone sodium, morphine, halothane* - **Thiopentone social** has a slower recovery profile than propofol, which is less ideal for **day care surgery** settings. - **Morphine** has a longer duration of action and a higher incidence of postoperative nausea and vomiting compared to fentanyl. *Ketamine, pethidine, halothane* - **Ketamine** can cause significant psychomimetic side effects and a longer recovery time, making it less suitable for **short day care surgeries**. - **Pethidine** also has a longer duration of action and can lead to more problematic sedative effects post-operatively compared to fentanyl. *Propofol, morphine, halothane* - While **propofol** is an excellent choice for induction and maintenance, **morphine's** longer duration of action and potential for more significant postoperative side effects like nausea and vomiting make it less favorable for quick recovery in **day care surgery**. - **Halothane** is rarely used currently due to its association with **hepatotoxicity** and **cardiac arrhythmias**.

Q: Best anesthetic drug to be given in day-care surgery is:

Propofol. **Propofol** - **Propofol** is favored for day-care surgery due to its **rapid onset** and **short duration of action**, allowing for quick recovery and discharge. - It provides a **smooth induction** and emergence from anesthesia with a low incidence of postoperative nausea and vomiting (PONV). *Ketamine* - **Ketamine** can cause psychomimetic effects (e.g., hallucinations, vivid dreams) and **hypertension**, making it less suitable for day-care surgery where a rapid, clean recovery is desired. - Its longer recovery profile compared to propofol can delay patient discharge. *Sevoflurane* - While **sevoflurane** offers a rapid induction and recovery, its use in day-care surgery can be associated with a higher incidence of **postoperative nausea and vomiting (PONV)** compared to propofol, hindering quick discharge. - It requires an anesthesia machine for administration and reversal, which might be less efficient for quick turnovers compared to IV anesthetics. *Fentanyl* - **Fentanyl** is a strong opioid analgesic used primarily for pain control and as a supplement to general anesthesia, not as a primary anesthetic for induction and maintenance. - While effective for pain, its use alone would not provide adequate anesthesia for surgery and it can cause **respiratory depression** and delayed recovery if not used carefully, making it less ideal as the sole agent for rapid discharge.

Q: Which of the following intravenous induction agents is the most suitable for day-care surgery?

Propofol. ***Propofol*** - **Propofol** is an excellent choice for day-care surgery induction due to its **rapid onset** and **rapid recovery profile**, allowing for quicker patient discharge. - It also has a low incidence of **postoperative nausea and vomiting (PONV)**, which is crucial for patient comfort and discharge criteria in day-care settings. *Morphine* - **Morphine** is an opioid used primarily for pain management and not typically as a primary induction agent due to its slow onset and profound effects on respiration. - Its prolonged duration of action and potential for significant **postoperative respiratory depression** and **nausea/vomiting** make it unsuitable for day-care surgery. *Ketamine* - **Ketamine** is a dissociative anesthetic that can cause **psychomimetic side effects** (e.g., hallucinations, vivid dreams) during emergence, which are undesirable for day-care surgery. - It also has a longer recovery time and can lead to **increased heart rate and blood pressure**, posing challenges for rapid discharge. *Diazepam* - **Diazepam** is a benzodiazepine primarily used for sedation and anxiolysis, not as an sole induction agent for general anesthesia. - It has a **prolonged duration of action** and can cause significant **postoperative drowsiness** and cognitive impairment, delaying patient recovery and discharge from day-care surgery.

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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