*Extracted from comprehensive anesthesia notes.*

Preparatory Mindset

Focus on: physiologic effects of anesthesia, drug mechanisms, airway management, and complication recognition. Exam questions often test classification systems (ASA, airway assessment) and complication management.

Core Concepts

• ▪ Complications: arrhythmia, coagulopathy, infection, delayed healing


• ▪ Malignant hyperthermia: triggered by inhaled anesthetics/succinylcholine; treat with dantrolene


• - Depth of Anesthesia


• ▪ ◦ BIS: sedation 60–85; general anesthesia 45–60


• - Urinary Output


• ▪ Normal: ≥0.5 mL/kg/hr


• ▪ Indication: major surgery, shock, heart/renal/hepatic disease


• ▪ Reflects renal perfusion & volume status

Invasive Arterial BP (IBP)

• - Sites: radial, ulnar, brachial, femoral, axillary artery


• - Indications: unstable BP, frequent blood gas, beat-to-beat monitoring


• - Complications: thrombosis, ischemia, infection, aneurysm

• - Normal: 3–10 cmH₂O


• - Sites: internal jugular, subclavian, femoral vein


• - High CVP: fluid overload, heart failure, tamponade


• - Low CVP: hypovolemia, vasodilation


• - Complications: pneumothorax, bleeding, infection, air embolism

• - Continuous monitoring of circulation, oxygenation, ventilation


• - NIBP interval ≤5 minutes

Cue

• A clinical situation in which a conventionally trained anesthesiologist has difficulty with mask ventilation,


• tracheal intubation, or both.

• - L: Look externally (trauma, large tongue, teeth)


• - E: Evaluate 3-3-2 rule


• ▪ Inter-incisor distance: ≥3 fingers (>5 cm)


• ▪ Hyoid-mental distance: ≥3 fingers


• ▪ Thyroid-hyoid distance: ≥2 fingers


• - M: Mallampati classification


• - O: Obstruction (abscess, edema, mass)


• - N: Neck mobility (>35° extension)

• - Class I: uvula, fauces, soft and hard palate visible


• - Class II: uvula, soft and hard palate visible


• - Class III: only soft and hard palate visible


• - Class IV: only hard palate visible → III–IV: high risk of difficult intubation

• - Inter-incisor distance: >5 cm; <3 cm → difficult


• - Thyromental distance: >6 cm; <6 cm → difficult


• - Neck extension: >35°; <35° → difficult


• - Mandibular protrusion: Class A (good), B (fair), C (poor)

• - E-C clamp technique: thumb + index = C; 3rd–5th fingers = E (lift mandible)


• - Proper seal: correct mask size, pull jaw into mask, avoid soft tissue pressure


• - One-handed & two-handed technique

• - Preoxygenation


• - Sniffing position


• - Lifting upward and Forward


• - "Pen like" grip on tube


• - Confirm placement

• - Male: 22–24 cm at lips


• - Female: 20–22 cm at lips

• - Direct visualization passing vocal cords


• - Bilateral chest movement


• - Tube fogging


• - Auscultation (chest & epigastrium)


• - EtCO₂ waveform (gold standard)

• - Hypoxia, laryngospasm


• - Esophageal intubation


• - Dental/oral soft tissue injury


• - Aspiration


• - Cardiovascular response

• - Bougie (Eichmann stylet)


• - Light wand


• - Flexible fiberoptic bronchoscope (first choice for difficult airway)


• - Laryngeal mask airway (LMA)


• - Esophageal-Tracheal Combitube (ETC)


• - Surgical airway: tracheostomy, retrograde intubation

• - If you can ventilate, you have time.


• - Limit intubation attempt to <30 seconds; re-oxygenate between attempts.

High-Yield Points

• ASA classification is a must-know for exam


• Understand differences between general vs regional anesthesia


• Complications and their management are frequently tested


• Know the Mallampati score and airway assessment criteria