Management of anaesthesia

During general anaesthesia the main circulatory parameters should be monitored and assessed. Blood pressure and pulse rate are checked each 10-15 minutes. Permanent monitoring of the heart functions is vital for patients with cardiac and vascular problems as well as in thoracic surgeries. Electroencephalogram can be used to assess the depth of anaesthesia. To monitor pulmonary ventilation and metabolic changes during anaesthesia and operation, it is necessary to evaluate the acid-base balance (PO2, PCO2, and pH).

During general anaesthesia, the nurse prepares the patient's anaesthetic chart, which should contain the main homeostatic parameters: pulse rate, blood pressure, the central venous pressure, breathing rate and parameters of the artificial ventilation machine. All the stages of operation and anaesthesia should be recorded. The doses of the anaesthetic substances used and muscle relaxants are also registered. All the drugs given during anaesthesia; the duration of each stage of the operation and the time medications are given should be recorded exactly. At the end of operation the total dose of all the drugs given are noted down in the anaesthetic record. All complications that occurred during anaesthesia and the surgery itself are registered. The anaesthetic record should be kept together with the patient's case history.

TESTS

Chapter II. ANAESTHESIA

1. The types of conduction anaesthesia are as follows:

1. Neural trunk anaesthesia.

2. Neural plexus anaesthesia.

3. Paravertebral anaesthesia.

4. Spinal (intradural) anaesthesia.

5. Epidural (extradural) anaesthesia.

Choose the right combination of answers:

A. 1, 2, 3. B. 1, 2, 3, 4. C. 1, 2, 4, 5. D. 1, 2, 5. E. 1, 2, 3, 4, 5.

2. The concentration of novocain used for infiltration anaesthesia should be as follows:

A. 1%.

B. 0, 5%.

C. 0, 25%.

D. 10%.

E. 5%.

Choose the correct answer.

3. Contraindications for local anaesthesia are which of the following:

1. Marked inflammatory and/or cicatricose tissue changes.

2. Heavy internal haemorrhage.

3. Heavy haemorrhage from superficial veins.

4. Patient's marked agitation.

5. Patient's age under 10 years.

Choose the right combination of answers:

A. 2, 4, 5. B. 1, 3, 5. C. 1, 2, 4, 5. D. 3, 4, 5. E. 1, 3, 4, 5.

4. The types of anaesthesia used for incision in mastitis or paraproctitis:

1. Local infiltration anaesthesia.

2. Intratratracheal general anaesthesia.

3. Intravenous anaesthesia.

4. Mask anaesthesia.

5. Conduction anaesthesia.

Choose the right combination of answers:

A. 1, 4. B. 4, 5. C. 1, 2, 3. D. 3, 4. E. 1, 2, 3, 4, 5.

5. Name conduction types of anaesthesia:

1. Lukashevich-Oberst.

2. Paravertebral.

3. Epidural.

4. Intraspinal.

5. Intercostal.

6. Retromammary.

Choose the right combination of answers:

A. 1, 2, 4, 5. B. 2, 3, 5, 6. C. 1, 2, 4, 6. D. 1, 2, 5, 6. E. 1, 2, 3, 5.

6. Case block is used in:

1. Injury of extremities.

2. Inflammatory disease.

3. Costal fractures.

4. Snake bites.

5. Infiltration anaesthesia.

Choose the right combination of answers:

A. 1, 2, 3, 4. B. 2, 3, 4, 5. C. 1, 3, 4, 5. D. 1, 2, 4, 5. E. 1, 2, 3, 4, 5.

7. For spinal anaesthesia, which of the following are used:

1. 5% novocain.

2. 2% lidocain.

3. 2, 5% trimecain.

4. 10% novocain.

5. 0, 5% bupivacain.

Choose the right combination of answers:

A. 1, 2. B. 2, 3. C. 1, 4. D. 1, 2, 3, 5. E. 4, 5.

8. The right position during spinal anaesthesia with the solution of sovcain is which of the following:

A. Lowered upper part of the body.

B. Raised upper part of the body.

C. Horizontal position.

D. On the patient's side.

E. Sitting with the trunk bent forward. Choose he right combination of answer.

9. The late complications of spinal anaesthesia are as follows:

1. Suppurative meningitis.

2. Paresis.

3. Meningism.

4. Headache.

5. Apnoea.

Choose the right combination of answers:

A. 1, 2, 4, 5. B. 2, 3, 4, 5. C. 1, 2, 3, 5. D. 1, 2, 3, 4. E. 1, 2, 3, 4, 5.

10. The aims of premedication are as follows:

1. To prevent vagal effect.

2. To raise sympathetic tone.

3. To depress salivation.

4. To inhibit agitation.

5. To prevent vomiting and gastric regurgutation.

Choose the right combination of answers:

A. 1, 5. B. 1, 4, 5. C. 3, 4. D. 1, 2, 3, 4. E. 1, 2, 3, 4, 5.

11. The general anaesthesia optimal for major abdominal surgeries is one of the following:

A. Ether-oxygen mixture.

B. Halothane-oxygen mixture.

C. Intratracheal general anaesthesia.

D. Neuroleptanalgesia.

E. Fractional ketamine general anaesthesia.

Choose the correct answer.

12. Muscle relaxants are given for which of the following:

1. Enhancement in effect of narcotics.

2. Motor block.

3. Block of autonomous reactions.

4. Stabilization of circulation.

5. Tracheal intubation.

Choose the right combination of answers:

A. 1, 2, 3, 4, 5. B. 1, 3, 4. C. 2, 4, 5. D. 1, 2, 3 E. 2, 5.

A 50-year-old man is being operated on for linea alba hernia. He is given halothane-oxygen mixture. His vital signs are as follows: BP 130/60 mm Hg, PR 78 beats/ minute and RR 18/minute. The pupil response and corneal reflex are sluggish.

Indicate the stage of general anaesthesia:

A. I.

B. II.

D. III₃.

Choose the correct answer.

14. Possible complications of intratracheal general anaesthesia are which of the following:

1. Recurarisation.

2. Vomiting.

3. Vocal ligamental oedema.

4. Asphyxia.

5. Muscle pain.

Choose the right combination of answers:

A. 1, 2. B. 3, 4. C. 2, 3, 4. D. 1, 2, 3. E. 1, 2, 3, 4, 5.

15. Contraindications for intravenous general anaesthesia with ketamine are as follows:

1. History of head injury.

2. Hepatic and renal insufficiency.

3. Seizures.

4. Hypovolaemia and marked blood loss.

5. Hypervolaemia and hypertension.

Choose the right combination of answers:

A. 1, 2. B. 2, 3. C. 1, 3, 5. D. 2, 5. E. 1, 2, 3, 4, 5.

16. Contraindications for intravenous general anaesthesia with barbiturate drugs are as follows:

1. History of anaphylactic reactions.

2. Hypertension.

3. Hypotension.

4. Hepatic insufficiency.

5. Hypovolaemia.

Choose the right combination of answers:

A. 1, 2. B. 3, 4. C. 3, 4, 5. D. 1, 3. E. 1, 2, 3, 4, 5.

17. Which intravenous anaesthetic should be preferred for induction in patients with blood loss above 1, 000 ml, hypo-volaemia, low BP:

A. Hexenal.

B. Thiopentone sodium.

C. Ketamine.

D. Propanidid.

E. Fentanyl + droperidol.

Choose the correct of answer.

18. Which types of anaesthesia are indicated for reduction of shoulder or femoral dislocation:

1. Intratracheal halothane general anaesthesia.

2. Halothane mask general anaesthesia.

3. Neuroleptanalgesia.

4. Intravenous barbiturate general anaesthesia.

5. Peridural anaesthesia.

Choose the right combination of answers:

A. 1, 2, 4, 5. B. 1, 2. C. 3. D. 2, 4. E. 3, 5.

19. Which types of anaesthesia are preferable in operation for felon:

1. Intravenous general anaesthesia (barbiturate, pronanidid, propofol).

2. Conduction anaesthesia.

3. Ethyl chloride (chlorethyl) anaesthesia.

4. Infiltration anaesthesia.

5. Plexus anaesthesia.

Choose the right combination of answers:

A. 1, 2. B. 3, 4. C. 3, 5. D. 3, 4. E. 1, 2, 3, 4, 5.

20. Prevention of mechanical asphyxia due to sticking the tongue inside in early post-anaesthetic period requires the following measures:

1. Intravenous injection of proserin, a muscle relaxant antagonist, postoperatively.

2. Insertion of an airway tube.

3. Patient monitoring for about two hours after general anaesthesia.

4. Breathing stimulation with analeptics.

5. Insertion of a gastric tube.

Choose the right combination of answers:

A. 1, 2. B. 2, 4. C. 1, 3, 4. D. 4, 5. E. 2, 3.

21. The agents used in conventional premedication include the following:

1. Hexenal (thiopentone sodium).

2. Atropine sulphate (methacine).

3. Promedol (morphine fentanyl).

4. Strophanthin (corglucon).

5. Calcium gluconate (calcium chloride).

Choose the right combination of answers:

A. 1, 2, 4. B. 3, 4, 5. C. 2, 3. D. 4, 5. E. 1, 3, 4, 5.

22. The cause of oxygen kindling and explosion of gas bags with oxygen is which of the following:

A. Work with electrical appliances.

B. Absence of earth of respiration and general anaesthesia appliances.

C. Contamination of the reductor of a gas bag with oil (e.g. Vaseline).

D. Static electricity.

Choose the correct answer.

23. Using an electrical knife should be avoided in which of the following types of general anaesthesia:

A. Halothane.

B. Ether.

C. Nitrous oxide with oxygen.

D. Neuroleptanalgesia.

Choose the correct answer.

Regional anaesthesia

24. The types of regional anaesthesia are as follows:

1. Neural trunk anaesthesia.

2. Neural plexus anaesthesia.

3. Paravertebral anaesthesia.

4. Spinal anaesthesia.

5. Epidural anaesthesia.

Choose the right combination of answers:

A. 1, 2, 3. B. 1, 2, 3, 4. C. 1, 2, 4, 5. D. 1, 2, 5. E. 1, 2, 3, 4, 5.

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