General Anesthesia — MCQs

Q: What are the advantages associated with the use of ketamine?

All of the above. ***All of the above*** - Ketamine provides a unique combination of **rapid onset of anesthesia**, potent **analgesia**, and desirable physiological effects, making it versatile for various clinical scenarios. - Its ability to induce **dissociative anesthesia** while maintaining spontaneous respiration and cardiovascular stability distinguishes it from many other anesthetic agents. *Rapid onset of anesthesia and analgesia* - This is a key advantage, as ketamine quickly achieves an anesthetic state and provides robust pain relief. - Its rapid action allows for efficient induction and management in emergency settings or procedures requiring prompt intervention. *Bronchodilation and preserved airway reflexes* - Ketamine's **bronchodilatory effect** makes it a favorable choice in patients with reactive airway diseases like asthma. - The **preservation of airway reflexes** helps protect against aspiration, which is a significant benefit compared to other anesthetics that depress these reflexes. *Cardiovascular stability with minimal respiratory depression* - Ketamine typically causes an increase in **heart rate and blood pressure**, contributing to cardiovascular stability, especially in patients with compromised hemodynamics. - Compared to many other anesthetics, ketamine causes **minimal respiratory depression**, maintaining spontaneous breathing and reducing the need for mechanical ventilation.

Q: Which of the following drugs is most effective in preventing emergence delirium with ketamine?

Midazolam. ***Midazolam*** - **Midazolam**, a short-acting **benzodiazepine**, is highly effective in preventing and treating **emergence delirium** associated with ketamine. - Benzodiazepines like midazolam work by enhancing the effect of **GABA**, leading to anxiolytic, sedative, and amnesic effects that counteract the psychomimetic side effects of ketamine. *Atropine* - **Atropine** is an **anticholinergic drug** primarily used to prevent bradycardia and reduce secretions; it has no direct role in preventing or treating ketamine-induced emergence delirium. - Its mechanism of action involves blocking **muscarinic acetylcholine receptors**, which is unrelated to the psychomimetic effects of ketamine. *Droperidol* - **Droperidol** is a **butyrophenone** (dopamine antagonist) that can cause sedation and reduce the incidence of postoperative nausea and vomiting, but it is not the primary choice for ketamine-induced emergence delirium. - While it can provide sedation, its effectiveness in specifically targeting the psychomimetic effects of ketamine is less pronounced compared to benzodiazepines. *Thiopentone* - **Thiopentone** is a **barbiturate** commonly used for induction of anesthesia due to its rapid onset and short duration of action. - Although it provides sedation and hypnosis, it is not specifically indicated or highly effective in managing or preventing the **emergence delirium** associated with ketamine.

Practice by Chapter

History of Anesthesia

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Preoperative Evaluation

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Pharmacology of Inhalational Anesthetics

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Pharmacology of Intravenous Anesthetics

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Neuromuscular Blocking Agents

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Airway Management

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Endotracheal Intubation

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Difficult Airway Algorithms

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Intraoperative Monitoring

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Depth of Anesthesia Monitoring

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Emergence from Anesthesia

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Postoperative Care

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