Anesthesia: GA/RA

Pearls for Providing General Anesthesia and Regional Anesthesia for the Written Boards

Regional Anesthesia

  • Spinal, Epidural, Caudal, Combined Spinal/Epidural: Indications, Contraindications
  • Premedication, Positioning, Equipment, Monitoring, Sedation
  • Sites of Action
  • Factors Influencing Onset, Duration, and Termination of Action
  • Systemic Toxicity, Test Dose
  • Complications; Precipitating Factors, Prevention, Therapy, Implications of Anticoagulants and
    Platelet Inhibitors: American Society of Regional Anesthesia and Pain Medicine (ASRA)

General Anesthesia

  • Stages and Signs of Anesthesia; Awareness Under Anesthesia
  • Techniques: Inhalational, Total Intravenous, Combined Inhalational/Intravenous
  • Assessment/Identification of Difficult Airway: Anatomic Correlates, Mallampati Classification,
    Range of Motion
  • Techniques for Managing Airway: Awake vs. Asleep, Use vs. Avoidance of Muscle
    Relaxants, Drug Selection, Retrograde Intubation Techniques, ASA Difficult Airway
  • Devices: Flexible Fiberoptic, Rigid Fiberoptic, Transillumination, Laryngoscope Blades,
    Alternative Intubating Devices
  • Alternatives and Adjuncts: Laryngeal Mask Airway (Traditional and Modified), Esophageal
    Obturator Airways, Occlusive Pharyngeal Airways
  • Transcutaneous Or Surgical Airway: Tracheostomy, Cricothyroidotomy, Translaryngeal Or
    Transtracheal Jet Ventilation
  • Endobronchial Intubation: Double-Lumen Endobronchial Tubes; Bronchial Blockers (Integral
    to Endotracheal Tube Or Separate), Placement and Positioning Considerations,
    Postoperative Considerations
  • Intubation and Tube Change Adjuncts: Bougies, Jet Stylettes, Soft and Rigid Tube Change
    Devices; Complications
  • ETT Types: Tube Material (Polyvinyl Chloride, Silicone, Laser-Resistant, Silver
    Impregnated, Other), Tube Tip Design (Murphy Eyes, Flexible Tip, Moveable Tip, Short-
    Bevel), Cuff Design (High vs. Low Volume/Pressure, Cuffed Vs Uncuffed, Cuff Shape),
    Cuff Pressure Management (Lanz Valves, Active Management, Pilot Balloon, Inflation
    Valve), Specific Tube Types (Wire-Reinforced, Nasal and Oral Rae, Microlaryngeal,
    Supraglottic Secretion Suctioning, Other)
  • Monitored Anesthesia Care and Sedation: ASA Guidelines for Sedation, Sedation Guidelines for
  • Intravenous Fluid Therapy During Anesthesia: Water, Electrolyte, Glucose Requirements and
    Disposition, Crystalloid vs. Colloid

Postoperative Period

  • Pain Drugs: Opioids, Agonist-Antagonists, Local Anesthetics, Alpha-2 Agonists,
    Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), N-Methyl-D-Aspartate (NMDA)
    Receptor Blockers, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitor
  • Routes: Oral, Subcutaneous (SC), Transcutaneous, Transmucosal, Intramuscular
    (IM), Intravenous (IV), Including Patient-Controlled Analgesia (PCA), Epidural, Spinal,
    Interpleural, Other Regional Techniques
  • Other Techniques: Transcutaneous Electrical Nerve Stimulation (TENS), Cryotherapy,
    Acupuncture, Hypnosis
  • Respiratory Consequences of Anesthesia and of Surgical Incisions
  • Cardiovascular Consequences of General and Regional Anesthesia: Differential Diagnosis and
    Treatment of Postoperative Hypertension and Hypotension
  • PONV: Physiology, Etiology, Risk Factors, Preventive Strategies, Use of Antacids, Histamine-2 (H2) Blockers, Metoclopramide, Transdermal Scopolamine, Droperidol, Serotonin Antagonists, Proton Pump Inhibitors, Dexamethasone, Multimodal Therapy, Acupressure/Acupuncture
  • Neuromuscular Consequences: Residual Paralysis, Muscle Soreness, Recovery of Airway
  • Neurologic Consequences of Anesthesia: Confusion, Delirium, Cognitive Dysfunction, Failure to
    emerge from anesthesia

Special Problems/Issues in Anesthesiology

  • Physician Impairment Or Disability: Substance Abuse, Fatigue, Aging, Visual and Auditory
    Impairment, American Disabilities Act
  • Ethics, Practice Management, and Medicolegal Issues: Professionalism and Licensure, Ethics, Advance Directives/Do Not Resuscitate (DNR) Orders; Suspended DNR, Patient Privacy Issues, e.g., Health Insurance Portability and Accountability Act (HIPAA)
  • Informed consent (principles, components)
  • Patient Safety: Medication Errors (Assessment and Prevention), Disclosure of Errors to Patients
Anesthesia: GA/RA
Course Information
Dr. Michael Ho
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