General Anesthesia Practice Questions

Q: Which of the following agents is not used to provide induced hypotension during surgery ?

Mephenteramine. ***Mephenteramine*** - **Mephentermine** is a **vasopressor** used to **increase blood pressure**, acting primarily through the release of **norepinephrine**. - Its effects are opposite to what is desired for **induced hypotension** during surgery, as the goal is to lower systemic blood pressure to reduce blood loss and improve surgical field visibility. *Sodium nitroprusside* - **Sodium nitroprusside** is a potent **vasodilator** that directly relaxes both **arterial** and **venous smooth muscle**, leading to a rapid and significant decrease in blood pressure. - Its rapid onset and offset of action make it a valuable agent for **controlled induced hypotension** during surgery. *Hydralazine* - **Hydralazine** is a **direct-acting arterial vasodilator** that primarily relaxes arterial smooth muscle, leading to a decrease in **peripheral vascular resistance** and blood pressure. - It can be used to induce or maintain **hypotension** during surgery, although its onset of action is slower compared to nitroprusside. *Esmolol* - **Esmolol** is a **short-acting beta-1 selective adrenergic blocker** that reduces heart rate and myocardial contractility, thereby decreasing cardiac output. - By reducing cardiac output, esmolol can contribute to **induced hypotension**, often used in conjunction with vasodilators or in situations where controlling heart rate is also desired.

Q: Inhalational anesthetic with highest respiratory irritation is:-

Desflurane. ***Desflurane*** - **Desflurane** has the highest **pungency** among common inhalational anesthetics, leading to significant respiratory irritation. - This irritation can manifest as **coughing**, **laryngospasm**, and **bronchospasm**, particularly during induction. *Halothane* - **Halothane** is a less pungent anesthetic and is generally well-tolerated by the respiratory system. - It was historically known for its **bronchodilating properties**, making it less irritating than Desflurane. *Nitrous oxide* - **Nitrous oxide** is a gaseous anesthetic with a very low solubility and virtually no respiratory irritant properties. - It is often used as a carrier gas and is known for its quick onset and offset without causing airway reactivity. *Sevoflurane* - **Sevoflurane** is known for its sweet smell and is considered a non-pungent agent, making it suitable for inhalational induction, especially in children. - It causes minimal respiratory irritation and has **bronchodilating effects**, which are beneficial in patients with reactive airway disease.

Q: Maximum Airway Irritation caused by:-

Desflurane. ***Desflurane*** - **Desflurane** has a pungent odor and is known to cause significant **airway irritation**, leading to coughing, breath-holding, laryngospasm, and secretions, especially during induction. - Its high volatility and low blood-gas solubility contribute to its rapid onset and offset, but also increase its propensity for airway irritation. *Halothane* - **Halothane** has a sweet, non-pungent odor and is generally well-tolerated during induction, causing minimal airway irritation. - Although it causes myocardial depression and is associated with hepatotoxicity, airway irritation is not a primary concern. *Enflurane* - **Enflurane** has a mild, sweet odor and causes less airway irritation than **desflurane**, but more than halothane or sevoflurane. - It can cause central nervous system excitation at high concentrations, but airway irritation is not its most prominent side effect. *Sevoflurane* - **Sevoflurane** has a pleasant, non-pungent odor and is known for its minimal airway irritation, making it an excellent choice for inhalational inductions, particularly in pediatric patients. - It is often preferred over other volatile anesthetics when airway reactivity is a concern. *Isoflurane* - **Isoflurane** has a pungent odor and can cause moderate airway irritation, but generally less than desflurane. - It is associated with a higher incidence of coughing and breath-holding during induction compared to sevoflurane.

Q: Drug that does not cause cardiac depression:

Etomidate. ***Etomidate*** - Etomidate is known for its **cardiovascular stability**, making it a preferred induction agent in patients with **compromised cardiac function**. - It maintains **myocardial contractility** and does not typically cause a significant drop in blood pressure. *Thiopentone* - Thiopentone causes **dose-dependent myocardial depression** and peripheral vasodilation. - This can lead to a significant **decrease in blood pressure** and cardiac output, especially in hypovolemic patients. *Propofol* - Propofol is a potent **vasodilator** and can cause significant **myocardial depression**, leading to hypotension. - Its cardiovascular effects are often more pronounced than those of other induction agents, necessitating careful titration. *Ketamine* - Ketamine causes indirect cardiovascular stimulation (due to **sympathetic nervous system activation**), but direct myocardial depression. - While it often increases heart rate and blood pressure, this is a compensatory mechanism and its direct effect on the myocardium is depressant.

Q: Which of the following anesthetic agent is not painful on intravenous administration?

Ketamine. ***Ketamine*** - **Ketamine** is known for causing minimal pain on intravenous administration compared to other common induction agents. - Its mechanism of action as an **NMDA receptor antagonist** does not involve irritation of venous endothelium to the same extent as some other anesthetics. *Propofol* - **Propofol** is infamous for causing significant **injection pain** due to its formulation, which contains soybean oil, glycerol, and egg lecithin, acting as a direct irritant to the intima of veins. - The pain is often described as a **burning sensation** and can be severe enough to require pre-treatment with lidocaine. *Etomidate* - **Etomidate**, like propofol, can cause significant pain on injection, although generally less severe than propofol. - The pain is thought to be related to its **propylene glycol vehicle**, which can cause venous irritation. *Methohexital* - **Methohexital**, a barbiturate, is associated with a moderate incidence of **injection site pain and thrombophlebitis**. - Its alkaline pH and direct irritation of the **venous intima** are the primary reasons for patient discomfort during administration.

Q: Which IV anesthetic does not cause cardiac depression?

Etomidate. **Etomidate** - **Etomidate** is known for its **minimal cardiovascular effects**, making it a preferred choice in patients with **pre-existing cardiac disease** or hemodynamic instability. - Unlike other IV anesthetics, it causes very little change in **heart rate**, **blood pressure**, or **cardiac output**. *Propofol* - **Propofol** frequently causes **dose-dependent myocardial depression** and **vasodilation**, leading to significant decreases in blood pressure. - Its cardiovascular effects can be problematic in patients with compromised cardiac function. *Thiopentone* - **Thiopentone**, a barbiturate, typically causes **dose-dependent cardiovascular depression**, including reduced **myocardial contractility** and **vasodilation**. - This can result in a decrease in **blood pressure** and **cardiac output**. *Methohexital* - **Methohexital**, another barbiturate, also causes **cardiovascular depression** similar to thiopentone. - It can lead to decreased **blood pressure** due to both **myocardial depression** and **peripheral vasodilation**.

Q: Which of the following is used as an adjuvant during anesthesia?

Dexmedetomidine. ***Dexmedetomidine*** - **Dexmedetomidine** is an alpha-2 adrenergic agonist commonly used as an **adjuvant** in anesthesia to provide **sedation**, **analgesia**, and **anxiolysis** with minimal respiratory depression. - Its unique properties allow for cooperative sedation, where patients can be aroused and follow commands, making it useful in various anesthetic settings. *Bupivacaine* - **Bupivacaine** is a **local anesthetic** used for regional anesthesia and pain management, not typically as an adjuvant to achieve general anesthetic effects. - It primarily blocks nerve impulse transmission to numb specific areas, rather than contributing to overall anesthetic depth or sedation. *Lorazepam* - **Lorazepam** is a **benzodiazepine** primarily used for **anxiolysis** and **sedation** prior to anesthesia or for treatment of anxiety. - While it can be given before surgery, it is not an anesthetic adjuvant in the same way dexmedetomidine is used during the operative phase to modulate anesthetic requirements and recovery. *Neostigmine* - **Neostigmine** is an **acetylcholinesterase inhibitor** used to **reverse the effects of non-depolarizing neuromuscular blockers** at the end of surgery. - It does not induce anesthesia, sedation, or analgesia, but rather restores muscle function to allow for extubation.

Q: Purpose of giving Glycopyrrolate before GA

Decrease laryngeal secretions. ***Decrease laryngeal secretions*** - Glycopyrrolate is an **anticholinergic** agent that primarily reduces salivary, tracheobronchial, and pharyngeal secretions. - This action helps to prevent accumulation of secretions, which can interfere with airway management and increase the risk of **laryngospasm** during induction of general anesthesia. *Provides analgesia* - Glycopyrrolate has **no analgesic properties** and does not reduce pain. - Its mechanism of action is limited to blocking muscarinic acetylcholine receptors, which does not impact pain pathways. *Prevents aspiration* - While reducing secretions might indirectly lower aspiration risk, glycopyrrolate does **not directly prevent aspiration** by improving gastric emptying or sphincter tone. - Other medications, such as H2 blockers or proton pump inhibitors, are more effective for aspiration prophylaxis related to gastric contents. *Muscle relaxation* - Glycopyrrolate is **not a muscle relaxant** and does not act at the neuromuscular junction. - Muscle relaxation for general anesthesia is provided by **neuromuscular blocking agents** like rocuronium or succinylcholine.

Q: A patient with liver cirrhosis is scheduled for surgery. Which anesthetic agent should be avoided?

Halothane. ***Halothane*** - **Halothane** metabolism produces **trifluoroacetylated proteins**, which can lead to severe **hepatotoxicity**, a critical concern in patients with pre-existing liver disease like cirrhosis. - Its use can exacerbate liver dysfunction due to its **extensive hepatic metabolism** compared to newer volatile anesthetics. *Sevoflurane* - **Sevoflurane** undergoes minimal hepatic metabolism (around 3-5%) and is primarily eliminated via the lungs, making it a safer option for patients with liver disease. - It has a good safety profile with a low incidence of hepatotoxicity. *Propofol* - **Propofol** is primarily metabolized in the liver, but its high hepatic clearance and non-cumulative nature make it suitable for patients with liver cirrhosis, although dosage adjustments may be necessary. - It does not produce toxic metabolites that significantly harm the liver. *Isoflurane* - **Isoflurane** is very minimally metabolized by the liver (around 0.2%), with the majority eliminated unchanged via the lungs. - This low hepatic metabolic load makes it a safe choice for patients with liver impairment.

Q: Which drug is used to reverse the effects of non-depolarizing muscle relaxants?

Neostigmine. ***Neostigmine*** - **Neostigmine** is an **acetylcholinesterase inhibitor** that increases the amount of acetylcholine at the neuromuscular junction. - This increased acetylcholine can then compete with **non-depolarizing muscle relaxants** for receptors, reversing their effects. *Atropine* - **Atropine** is an **anticholinergic drug** that blocks muscarinic receptors. - It is often co-administered with neostigmine to counteract the **parasympathetic side effects** of neostigmine, such as bradycardia and increased salivation, but does not reverse muscle relaxation directly. *Glycopyrrolate* - **Glycopyrrolate** is also an **anticholinergic drug** similar to atropine, but with less central nervous system penetration. - It is co-administered with neostigmine for the same reason as atropine, to mitigate the **cholinergic side effects** of neostigmine, not to reverse muscle paralysis. *Edrophonium* - **Edrophonium** is a short-acting **acetylcholinesterase inhibitor** historically used to reverse non-depolarizing muscle relaxants. - While it can reverse muscle relaxation, it has a **shorter duration of action** compared to neostigmine and is less commonly used for this purpose in modern practice.

Question 1

Which of the following agents is not used to provide induced hypotension during surgery ?

Accepted Answer

Mephenteramine

Answer

Sodium nitroprusside

Answer

Hydralazine

Answer

Esmolol

Question 2

Inhalational anesthetic with highest respiratory irritation is:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Nitrous oxide

Answer

Sevoflurane

Question 3

Maximum Airway Irritation caused by:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Enflurane

Answer

Sevoflurane

Answer

Isoflurane

Question 4

Drug that does not cause cardiac depression:

Accepted Answer

Etomidate

Answer

Thiopentone

Answer

Ketamine

Answer

Propofol

Question 5

Which of the following anesthetic agent is not painful on intravenous administration?

Accepted Answer

Ketamine

Answer

Propofol

Answer

Etomidate

Answer

Methohexital

Question 6

Which IV anesthetic does not cause cardiac depression?

Accepted Answer

Etomidate

Answer

Propofol

Answer

Thiopentone

Answer

Methohexital

Question 7

Which of the following is used as an adjuvant during anesthesia?

Accepted Answer

Dexmedetomidine

Answer

Bupivacaine

Answer

Lorazepam

Answer

Neostigmine

Question 8

Purpose of giving Glycopyrrolate before GA

Accepted Answer

Decrease laryngeal secretions

Answer

Provides analgesia

Answer

Prevents aspiration

Answer

Muscle relaxation

Question 9

A patient with liver cirrhosis is scheduled for surgery. Which anesthetic agent should be avoided?

Accepted Answer

Halothane

Answer

Sevoflurane

Answer

Propofol

Answer

Isoflurane

Question 10

Which drug is used to reverse the effects of non-depolarizing muscle relaxants?

Accepted Answer

Neostigmine

Answer

Atropine

Answer

Glycopyrrolate

Answer

Edrophonium

General Anesthesia — MCQs

General Anesthesia — MCQs

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