Anesthesia Tutorial of the Week Quiz

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Quarterly quiz ATOTW 528 – 534 – Test your knowledge!

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Quiz: Quarterly quiz ATOTW 528 – 534 – Test your knowledge!

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Quarterly quiz ATOTW 528 – 534 – Test your knowledge!

Dec 09, 2024

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1) Questions 1 to 5 relate to ATOTW 533: Perioperative lignocaine
The potency of local anaesthetic depends on its pKa.

True False

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The potency of local anesthetic depends on its lipid solubility and speed of onset of its action depends on its pKa

Correct

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2) Lignocaine has a wide therapeutic index.

True False

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Lignocaine has a narrow therapeutic range of 2.5 to 3.5 μg/ml.

Correct

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3) Cardiotoxicity of lignocaine is seen at levels above 10 μg/ml.

True False

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Signs of neurotoxicity begin at plasma concentrations above 5 μg/ml with cardiotoxicity seen at levels above 10 μg/ml.

Correct

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4) Lignocaine used intraoperatively can result in faster extubation.

True False

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Administration of intravenous lignocaine at the time of extubation has been associated with delayed emergence, possibly due to better airway tolerance.

Correct

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5) The context sensitive half-life after 3-day infusion of lignocaine is 20-40 minutes.

True False

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The context sensitive half-life after a 72-hour infusion is 20-40 minutes.

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6) Questions 6 to 10 relate to ATOTW 531: Magnesium and pain
In pain pathways second order neurones are stimulated by primary A beta and C fibres.

True False

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Second order neurones are stimulated by A DELTA and C fibres.

Correct

Incorrect

7) The NMDA receptor is activated by magnesium ions to inhibit pain signaling.

True False

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Magnesium blocks the central pore of the NMDA receptor, preventing the passage of calcium ions and producing inhibition of pain signaling.

Correct

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8) NMDA receptors involved in pain pathways are located on post-synaptic membranes in the ventral horn of the spinal cord.

True False

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NMDA receptors are located in the DORSAL horn of the spinal cord, as well as in the brain.

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9) Magnesium has an established role in chronic pain.

True False

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This has not yet been established.

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10) ‘Wind up’ is a phenomenon involving reduced descending inhibitory signalling leading to pain hypersensitivity.

True False

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Wind up results from sustained depolarisation of the secondary neurone due to high frequency stimulation by C-fibres. This leads to the removal of the magnesium ‘plug’ from NMDA receptors.

Correct

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11) Questions 11 to 15 relate to ATOTW 530: Anaesthesia for Children with Skin Disorders
Lubricating the airway instruments when providing anaesthesia for a child with EB makes intubation easier.

True False

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For children with skin diseases such as EB, lubrication can help to prevent skin trauma from shear forces. The facemask, laryngoscope and endotracheal tube or laryngeal mask airway should be lubricated for this reason. The patient’s lips and the anaesthetist’s gloves should also be lubricated. However, this could make the airway more difficult to manage as it will be slippery.

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12) Ichthyosis is always inherited as an autosomal recessive condition.

True False

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Ichthyosis is a term used to describe skin which continually scales. There are over twenty conditions which are characterised by ichthyosis which can be congenital or acquired. The genetic inheritance can be autosomal dominant (e.g ichthyosis vulgaris), X-linked recessive (e.g. X-linked ichthyosis) or autosomal recessive (e.g. Harlequin-type ichthyosis, congenital ichthyosiform erythroderma and Lamellar ichthyosis).

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13) A collodian membrane needs surgical removal.

True False

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“Collodian babies” are born covered in a collodian membrane, which is a tight yellow film over the skin. Treatment is medical and aims to prevent the complications of fissures which can result in infection, temperature dysregulation and fluid loss. The collodian membrane should not be debrided.

Correct

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14) Children with severe skin disease are always anaesthetised in a specialist centre.

True False

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Children with severe disease should be anaesthetised in a specialist centre if possible. However, children may present as emergencies to their local hospital and so all anaesthetists should be familiar with the principles of anaesthesia for children with severe skin disease. Communication between theatre staff and ward staff is vital in the non-specialist centre with clear plans disseminated throughout the perioperative period. Advice may still be sought from the specialist centre to guide treatment.

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15) Topical local anaesthetic cream is contraindicated in severe skin disease.

True False

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Topical local anaesthetic cream is not contraindicated but should not be applied overactive bullae or infected or broken skin. Avoid the use of adherent dressings; cling-film is preferable.

Correct

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16) Questions 16 to 21 relate to ATOTW 529: Adjuvant medications for use with propofol-based total intravenous anaesthesia
Fentanyl has a context-sensitive half-time (CSHT) that rises rapidly after just 1 hour of infusion to 260 minutes

True False

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Fentanyl has a context-sensitive half-time (CSHT) that rises to 260 minutes after 8 hours of infusion, meaning its use for the analgesic component TIVA requires careful titration to provide the most favourable recovery profile.

Correct

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17) 50% decrement time displayed on a target-controlled infusion (TCI) pump is equal to the context-sensitive half-time CSHT.

True False

Feedback

TCI pumps have an inbuilt decrement function that displays the estimated time it would take, after stopping the infusion, for the current plasma concentration to decline to a chosen plasma concentration. This can be useful when titrating infusions at the end of a case to aid in a timely emergence from anaesthesia. 50% decrement time is equal to CSHT

Correct

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18) Remifentanil has a CSHT of 6 minutes and is rapidly metabolised by plasma esterases.

True False

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Remifentanil is an ultra-short acting opioid analgesic with a CSHT of around 3 minutes due to its rapid metabolism by plasma esterases.

Correct

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19) Alfentanil is a pure mu receptor opioid agonist that has one-fourth the potency of fentanyl, a brief duration of action, is readily titratable and has a pKa of 8.

True False

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Alfentanil is a pure mu receptor opioid agonist that has one-fourth the potency of fentanyl, a brief duration of action and is readily titratable. Alfentanil has a pKa of 6.5, which explains its rapid onset due to a large proportion remaining unionised at physiological pH

Correct

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20) When titrating down a propofol-alfentanil combination for TIVA at the end of surgery, the propofol infusion should be reduced first.

True False

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Down titration towards the end of surgery with alfentanil is required before propofol given its longer context-sensitive half-time (CSHT). This sequence is opposite to propofol- remifentanil based TIVA, where the propofol infusion is reduced first. CSHT after 3-hour infusion for remifentanil: 3 minutes, alfentanil: 40 minutes, propofol 9 minutes.

Correct

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21) Fentanyl can be administered by a manual or target controlled infusion, with the Minto target-controlled infusion (TCI) model described.

True False

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Fentanyl can be administered by a manual or target controlled infusion, with the Minto target-controlled infusion (TCI) model described.

Correct

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22) Questions 22 to 25 relate to ATOTW 528: Perioperative management of patients undergoing orthopaedic oncological surgeries
Blood conservation strategies are routinely employed during orthopaedic oncological surgeries.

True False

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Preoperative autologous donation and acute normovolaemic hemodilution are rarely employed due to the increased incidence of anaemia in oncological patients. Cell salvage carries the theoretical risk of tumour cell dissemination by transfusions.

Correct

Incorrect

23) Inhalational anaesthesia is preferred while using neurophysiological monitoring during spinal tumour resection.

True False

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Neurophysiological monitoring like SSEP, MEP and electromyogram (EMG) is often used intraoperatively and thus, total intravenous anaesthesia without the use of muscle relaxants is required in these cases. Constant communication between surgeons, anaesthesiologists and electrophysiologists is essential.

Correct

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24) Bone cement implantation syndrome is more common in long stem bone prosthesis placement in metastatic diseases than standard hip prosthesis.

True False

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Multiple aetiologies have been proposed to explain the increased susceptibility to this syndrome. Patients’ factors like poor preoperative physical condition, prior chemotherapy and radiotherapy, anaemia, dehydration and bone modification by the tumour. Surgical factors include increased cement use for fixation of long stem prosthesis.

Correct

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25) NSAIDs are the first-line drug used for the treatment of phantom limb pain.

True False

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Gabapentinoids, antidepressants, anticonvulsants (carbamazepine), steroids and NMDA antagonists have been used as pharmacological modalities. Cognitive behaviour therapy, transcutaneous stimulation and acupuncture therapy are other nonpharmacological methods with unproven benefits.

Correct

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26) Questions 26 to 30 relate to ATOTW 534: Capnography in the non-intubated patient
Capnography is less useful in non-intubated patients compared to intubated patients because the accuracy is significantly reduced.

True False

Feedback

Capnography remains useful in non-intubated patients for monitoring ventilation, detecting airway issues and response to airway manoeuvres.

Correct

Incorrect

27) The Beer-Lambert Law describes the relationship of components of gas mixtures using mass spectroscopy.

True False

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The Beer-Lambert Law describes the logarithmic relationship of components of gas mixtures and solutions with light absorbed, which is fundamental to infrared capnography.

Correct

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28) The Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommends mandatory use of capnography for all patients with endotracheal tubes or supraglottic airway devices, but to consider using capnography for deep sedation.

True False

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The AAGBI statement upgraded in 2015 states that “Capnography monitoring is essential at all times in patients with endotracheal tubes, supraglottic airway devices and those who are deeply sedated.”

Correct

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29) Partial airway obstruction will present with a high PetCO₂ on the capnography waveform.

True False

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Partial airway obstruction presents a falsely low PetCO₂ and distorted waveform. The obstruction affects the measurement of CO₂ levels.

Correct

Incorrect

30) In non-intubated patients, mainstream capnography gives a more accurate reading of PaCO₂ compared to sidestream.

True False

Feedback

Mainstream capnography corresponds more closely to PaCO₂ than side-stream. However, in non-intubated patients, the precise value is of less importance than ensuring adequate ventilation by observing a regular capnography waveform.

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