The four stages of anaesthesia were described in 1937 by Guedel. Guedel's staging of anaesthesia was given for ether. Despite newer anaesthetic agents and delivery techniques, which have led to more rapid onset and recovery from anaesthesia, with greater safety margins, the principles remain.
Stage 1 :
Stage 1 anaesthesia, also known as the "induction", is the period between the initial administration of the induction medications and loss of consciousness. During this stage, the patient progresses from analgesia without amnesia to analgesia with amnesia. Patients can carry on a conversation at this time.
Stage 2 :
Stage 2 anaesthesia, also known as the "excitement stage", is the period following loss of consciousness and marked by excited and delirious activity. During this stage, respirations and heart rate may become irregular. In addition, there may be uncontrolled movements, vomiting, breath holding, and pupillary dilation. Since the combination of spastic movements, vomiting, and irregular respirations may lead to airway compromise, rapidly acting drugs are used to minimize time in this stage and reach stage 3 as fast as possible.
Stage 3 :
Stage 3, "surgical anesthesia". During this stage, the skeletal muscles relax, and the patient's breathing becomes regular. Eye movements slow, then stop, and surgery can begin.
It has been divided into 4 planes:
*rolling eye balls, ending with fixed eyeballs
*loss of corneal and laryngeal reflexes
*pupils dilate and loss of light reflex
*intercostal paralysis, shallow abdominal respiration, dilated pupils
Stage 4 :
Stage 4 anesthesia, also known as "overdose", is the stage where too much medication has been given and the patient has severe brain stem or medullary depression. This results in a cessation of respiration and potential cardiovascular collapse. This stage is lethal without cardiovascular and respiratory support.
Monday, July 12, 2010
Saturday, April 10, 2010
43 - AIPGME 2004 Anaesthesia Mcqs
1q: Which of the following volatile anaesthetic agents should be preferred for induction of anaesthesia in children?
a. Enflurane
b. Isoflurane
c. Sevoflurane
d. Desflurane
2q: Which of the following is the best indication for propofol as an intravenous induction agent?
a. Neurosurgery
b. Day care surgery
c. Patients with coronary artery disease
d. In neonates
3q: A patient undergoing caesarean section following prolonged labour under subarachnoid block developed carpopedal spasm. Lignocaine was used as anesthetic agent. The most likely diagnosis is
a. Amniotic fluid embolism
b. Lignocaine toxicity
c. Hypocalcemia
d. Hypokalemia
4q: A 25 year old male with roadside accident underwent debridement and reduction of fractured both bones right forearm under axillary block. On the second postoperative day the patient complained of persistent numbness and paresthesia in the right forearm and hand. The commonest cause of this neurological dysfunction could be all of the following except :
a. Crush injury to the hand and lacerated nerves
b. A tight cast or dressing
c. Systemic toxicity of local anaesthesia
d. Torniquet pressure
5q: When a patient develops supraventricular tachycardia with hypotension under general anaesthesia, all of the following treatments may be instituted except
a. Carotid sinus massage
b. Adenosine 3-12 mg IV
c. Direct current cardioversion
d. Verapamil 5 mg IV
a. Enflurane
b. Isoflurane
c. Sevoflurane
d. Desflurane
2q: Which of the following is the best indication for propofol as an intravenous induction agent?
a. Neurosurgery
b. Day care surgery
c. Patients with coronary artery disease
d. In neonates
3q: A patient undergoing caesarean section following prolonged labour under subarachnoid block developed carpopedal spasm. Lignocaine was used as anesthetic agent. The most likely diagnosis is
a. Amniotic fluid embolism
b. Lignocaine toxicity
c. Hypocalcemia
d. Hypokalemia
4q: A 25 year old male with roadside accident underwent debridement and reduction of fractured both bones right forearm under axillary block. On the second postoperative day the patient complained of persistent numbness and paresthesia in the right forearm and hand. The commonest cause of this neurological dysfunction could be all of the following except :
a. Crush injury to the hand and lacerated nerves
b. A tight cast or dressing
c. Systemic toxicity of local anaesthesia
d. Torniquet pressure
5q: When a patient develops supraventricular tachycardia with hypotension under general anaesthesia, all of the following treatments may be instituted except
a. Carotid sinus massage
b. Adenosine 3-12 mg IV
c. Direct current cardioversion
d. Verapamil 5 mg IV
Tuesday, March 9, 2010
42 - Stellate ganglion block
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Try answering this question from the AIPGME 2009 paper.
Q:Which of the following is not a sign of successful stellate ganglion block?
a. Nasal stuffiness
b. Guttman sign
c. Horner's syndrome
d. Bradycardia
*The nasal stuffiness or nasal congestion that occurs as a result of the obstruction of the ipsilateral half of the nose is called GUTTMAN SIGN. It is an important sign of the successful stellate ganglion block.
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Tuesday, March 2, 2010
41 - Mallampatti grading
*The Mallampati classification is a commonly used means of preoperatively predicting a difficult endotracheal intubation. As the grade increases, the difficulty in intubating the patient also increases.
*A reduced thyromental distance combined with a mallampati class III or IV predicts 80% of difficult intubations.
*The patient is examined in a sitting position, with the head in the neutral position and mouth opened to allow the examination of pharynx. The patient is asked to open his/her mouth as wide as possible and protrude the tongue fully.
Qbase Anaesthesia 4: MCQs for the Primary FRCA
*A reduced thyromental distance combined with a mallampati class III or IV predicts 80% of difficult intubations.
*The patient is examined in a sitting position, with the head in the neutral position and mouth opened to allow the examination of pharynx. The patient is asked to open his/her mouth as wide as possible and protrude the tongue fully.
Qbase Anaesthesia 4: MCQs for the Primary FRCA
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