Afghanistan Anesthesia Technology Exit Exam cheat sheet

Ideal gas law: PV = nRT; at constant temperature, pressure and volume are inversely related (Boyle's law).

Oxygen content of blood: CaO2 = (1.34 × Hb × SaO2) + (0.003 × PaO2); dissolved oxygen contributes little at room air.

Hagen-Poiseuille law: flow through a tube is proportional to the fourth power of the radius, so small reductions in airway or tube diameter markedly increase resistance.

Most local anesthetics are weak bases; the uncharged form crosses the nerve membrane, and the charged cation blocks the sodium channel from inside.

Minimum alveolar concentration (MAC) is the alveolar concentration at which 50% of patients do not move to a standard surgical stimulus; MAC values are additive.

Functional residual capacity is the sum of expiratory reserve volume and residual volume; it is the main oxygen reservoir during apnea.

Nerve fibers are classified A (myelinated, fast), B, and C (unmyelinated, slow); C fibers mediate slow burning pain and are most sensitive to local anesthetic block.

Renal clearance and hepatic metabolism determine drug offset; propofol and remifentanil are terminated largely by redistribution and ester hydrolysis respectively.

ASA physical status I–VI applies to the patient's systemic disease, not to the procedure; suffix E denotes emergency surgery.

Mallampati class III–IV, thyromental distance under 6 cm, and limited mouth opening (under 3 cm) predict difficult laryngoscopy.

A patient with a recent myocardial infarction has elevated perioperative cardiac risk; elective surgery is generally deferred for at least 6 months.

Metformin is commonly continued, but insulin and sulfonylureas may need dose adjustment to avoid perioperative hypoglycemia.

Anticoagulants: neuraxial block requires adherence to guideline-based interruption intervals for antiplatelet and anticoagulant drugs.

Check for allergies, prior anesthetic complications (malignant hyperthermia, difficult airway), and family history of anesthesia-related deaths.

Informed consent requires discussion of the planned technique, alternatives, and material risks, documented before sedation.

Preoperative fasting: clear fluids up to 2 hours, breast milk 4 hours, light meal 6 hours before elective anesthesia.

Difficult airway algorithm: call for help, optimize oxygenation, limit intubation attempts (commonly up to 3), and use a supraglottic device or surgical airway if needed.

Confirm tracheal placement with sustained waveform capnography plus auscultation; capnography is the standard, not optional.

Cormack-Lehane grades I–IV describe laryngeal view; grade III–IV indicates difficult direct laryngoscopy.

Sellick maneuver (cricoid pressure) is applied at the cricoid cartilage to reduce aspiration risk during rapid sequence induction.

Laryngeal mask airway (LMA) is a supraglottic device used for rescue ventilation and short procedures; it does not protect against aspiration.

Cricothyrotomy is the emergency surgical airway of choice in adults; in children under 8–10 years, needle cricothyrotomy or tracheostomy is preferred.

Preoxygenation with 100% oxygen for 3–5 minutes or 4 vital-capacity breaths raises the safe apnea time.

End-tidal CO2 (ETCO2) normally approximates PaCO2 within 2–5 mmHg in healthy patients.

Propofol induction dose is 1.5–2.5 mg/kg IV in adults; it causes hypotension and apnea, so titrate and preoxygenate.

Ketamine 1–2 mg/kg IV provides dissociative anesthesia and preserves airway reflexes and respiratory drive.

Succinylcholine 1–1.5 mg/kg IV has rapid onset and short duration; it is contraindicated in hyperkalemia, burns over 24 hours old, and malignant hyperthermia susceptibility.

Rocuronium 0.6 mg/kg IV for routine intubation; 1.2 mg/kg provides rapid-sequence conditions.

Bupivacaine maximum dose is about 2–3 mg/kg (with epinephrine); exceeding it risks cardiotoxicity.

Spinal anesthesia typically uses a lower dose than epidural; a T10 sensory level is adequate for lower abdominal and lower limb surgery.

Lidocaine with epinephrine 1:100,000 prolongs block and reduces systemic absorption; do not use epinephrine in digital or end-arterial areas.

Nitrous oxide should be avoided in bowel obstruction, pneumothorax, and middle-ear surgery because it diffuses into gas-filled spaces.

Minimum standards: continuous pulse oximetry, capnography, ECG, blood pressure, and inspired oxygen concentration throughout anesthesia.

Capnography waveform changes: sudden loss of ETCO2 suggests disconnection or esophageal intubation; a rising ETCO2 suggests hypoventilation or hyperthermia.

Pulse oximetry reads falsely high in carboxyhemoglobin and falsely low in poor perfusion, motion, and methemoglobinemia.

The anesthesia record should document pre- and post-induction vital signs, agents and doses, fluid and blood given, events, and a handover.

Equipment check before each case: self-inflating bag, suction, oxygen supply, vaporizers, breathing circuit, and scavenging system.

Alarms must never be silenced without identifying the cause; a low-pressure alarm suggests a leak or disconnection.

Anesthesia machine leak test and oxygen failure alarm check are performed daily and after any change of circuit or absorbent.

Noninvasive blood pressure cuff width should be about 40% of arm circumference; a cuff too small overestimates blood pressure.

Maintenance crystalloid (4-2-1 rule): 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg thereafter.

Isotonic crystalloids (0.9% saline, Ringer's lactate) are first-line for resuscitation; colloids are reserved for specific indications.

Blood products: packed red cells raise Hb by roughly 1 g/dL per unit in an average adult.

Transfusion reaction: stop the transfusion, maintain the airway and IV access, send the unit and samples, and report to the blood bank.

Massive transfusion protocol uses balanced ratios (e.g., 1:1:1 red cells, plasma, platelets) and prevents hypothermia, hypocalcemia, and dilutional coagulopathy.

Hyperkalemia is a risk of stored blood; calcium chloride or gluconate may be needed during rapid transfusion.

Type O negative red cells are the universal donor; AB plasma is the universal donor plasma.

Fluid overload signs include crackles, rising central venous pressure, and hypoxemia; slow or stop fluids and consider diuresis.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV, stop triggering agents, hyperventilate with 100% oxygen, and cool the patient.

Anaphylaxis: epinephrine 0.5 mg IM (1:1000) in adults, stop the trigger, give oxygen, fluids, and antihistamines as adjuncts.

Cardiac arrest: high-quality CPR at 100–120 compressions/min, depth 5–6 cm, ratio 30:2, and early defibrillation for shockable rhythms.

Hypotension under anesthesia: assess depth, rhythm, bleeding, and anaphylaxis before giving vasopressors.

Laryngospasm: remove stimulus, apply continuous positive airway pressure with 100% oxygen, and use small-dose succinylcholine if it persists.

Aspiration: suction, secure the airway, and treat with supportive care; antibiotics are not routine.

Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg bolus, and support circulation.

Awareness under anesthesia: document the event, inform the patient, and refer for psychological support.

Discharge criteria from PACU: stable vital signs, adequate oxygenation, alertness, controlled pain, and minimal nausea.

Aldrete score assesses activity, respiration, circulation, consciousness, and oxygen saturation; a score of 9–10 is commonly required for discharge.

Multimodal analgesia combines paracetamol, NSAIDs, opioids, and regional blocks to reduce opioid requirements.

Opioid side effects include respiratory depression, nausea, constipation, and pruritus; naloxone reverses opioid-induced respiratory depression.

Postoperative nausea and vomiting prophylaxis includes ondansetron, dexamethasone, and droperidol; risk factors include female sex and nonsmoking status.

Numeric rating scale (0–10) is a simple validated measure of pain intensity; reassess after each intervention.

Shivering in PACU is treated with active warming, meperidine, or clonidine; it increases oxygen consumption.

Delayed awakening: check oxygenation, ventilation, glucose, temperature, and residual drug effect before assuming a neurological cause.

Hand hygiene is the single most effective measure to prevent healthcare-associated infection; use the WHO five moments.

Single-use items must not be reused; laryngoscope blades and breathing circuits require disinfection between patients per local policy.

Anesthesia providers must verify patient identity, procedure, and site against the surgical safety checklist before induction.

Needlestick injury: wash immediately, report, and follow post-exposure prophylaxis protocol for HIV and hepatitis B.

Informed consent, confidentiality, and truthfulness are core ethical duties; documentation should be contemporaneous and accurate.

Patient safety reporting systems are nonpunitive; near misses should be reported to improve systems.

Universal precautions treat all blood and body fluids as potentially infectious; gloves and eye protection are standard.

A culture of safety emphasizes teamwork, speaking up, and structured handover (e.g., SBAR) to prevent errors.

Scope of practice: anesthesia technologists support the anesthesiologist and do not independently perform anesthesia or prescribe drugs.

Documentation must be legible, timed, and signed; corrections should be made with a single line and initials, not erased.

Emergency drugs and equipment should be checked and restocked at the start of each shift and after each use.

Effective handover uses a structured format (SBAR) covering situation, background, assessment, and recommendation.

Respect for patient autonomy includes allowing refusal of treatment and providing information in understandable language.

Reporting adverse events and near misses is a professional obligation; concealment is an ethical violation.

Continuing education and competency checks maintain safe practice; expired equipment or drugs must be removed from service.

Cultural competence and privacy (confidentiality of health information) are required in all patient interactions.

Quality improvement uses plan-do-study-act (PDSA) cycles to test changes on a small scale before spread.

Clinical audits compare practice against a defined standard and feed results back to clinicians.

Evidence-based practice integrates best evidence, clinical expertise, and patient values.

Checklists and standardized protocols reduce omission errors and improve team communication.

Benchmarking compares outcomes against peer institutions to identify improvement targets.

Root cause analysis investigates serious incidents to identify system failures rather than blame individuals.

Outcome measures in anesthesia include unplanned intubation, PACU length of stay, and patient satisfaction.

Documentation of quality data must be accurate and de-identified where required.

Triage uses color codes (red immediate, yellow delayed, green minor, black deceased/expectant) to prioritize care.

Mass casualty response requires rapid airway, breathing, and circulation assessment with damage-control principles.

Emergency trolley must contain airway adjuncts, oxygen, suction, defibrillator, and first-line resuscitation drugs.

Fire in the operating room: stop the case, remove the patient, and use the correct extinguisher (CO2 for electrical fires).

Power failure: switch to backup oxygen and battery-powered monitors and manually ventilate.

Chemical or biological exposure requires decontamination before routine care.

Emergency drills and equipment checks improve readiness and reduce response time.

Communication in emergencies uses closed-loop confirmation to avoid errors.

Pediatric airway: the larynx is higher and more anterior; a straight (Miller) blade is often preferred.

Pediatric fluid maintenance uses the 4-2-1 rule; blood volume is about 80 mL/kg in neonates and 70 mL/kg in children.

Infant endotracheal tube size (uncuffed) approximates age/4 + 4 mm internal diameter.

Neonates and infants are prone to hypothermia and bradycardia; active warming is essential.

Elderly patients have reduced MAC and drug clearance; titrate agents and expect delayed recovery.

Pregnancy: left uterine displacement after 20 weeks improves venous return; aspiration risk is increased.

Obese patients require weight-adjusted dosing (use lean body weight for many drugs) and careful positioning.

Day surgery selection excludes uncontrolled comorbidities and procedures with high postoperative pain or bleeding risk.

Post-dural puncture headache: conservative treatment, caffeine, and epidural blood patch if persistent.

Spinal hematoma presents with back pain and progressive weakness; urgent imaging and neurosurgical review are required.

High spinal or total spinal: support airway, ventilation, and circulation with vasopressors and fluids.

Local anesthetic systemic toxicity presents with tinnitus, perioral numbness, seizures, and cardiac arrest; treat with lipid emulsion.

Peripheral nerve block complications include nerve injury, hematoma, and infection; document baseline neurological status.

Epidural abscess presents with fever, back pain, and neurological deficit; urgent imaging and antibiotics are needed.

Using epinephrine-containing solutions in blocks prolongs duration and serves as an intravascular marker.

Aseptic technique and ultrasound guidance reduce block-related complications.

Laparoscopy: insufflation raises intra-abdominal pressure and reduces venous return; monitor for vagal response and hypercapnia.

Cesarean section: neuraxial anesthesia is preferred; left uterine displacement and rapid sequence induction if general anesthesia is needed.

Craniotomy: maintain cerebral perfusion pressure and avoid hypercapnia; hyperventilation is used briefly for herniation.

Thoracic surgery often requires one-lung ventilation; check double-lumen tube position with bronchoscopy.

Cardiac surgery: monitor for arrhythmias and bleeding; transesophageal echocardiography guides management.

Day-case surgery: choose short-acting agents and ensure adequate analgesia and antiemetic prophylaxis.

Head and neck surgery: shared airway; consider awake fiberoptic intubation if the airway is difficult.

Trauma: assume full stomach; use rapid sequence induction and cervical spine precautions.

Atropine 0.5–1 mg IV treats bradycardia; glycopyrrolate 0.2 mg IV reduces secretions without central effects.

Neostigmine 0.05 mg/kg IV reverses nondepolarizing blockade; co-administer an antimuscarinic to prevent bradycardia.

Ondansetron 4 mg IV is a first-line antiemetic; dexamethasone 4–8 mg IV is an adjunct.

Naloxone 0.04–0.4 mg IV titrated reverses opioid effects; watch for re-narcotization.

Flumazenil 0.2 mg IV reverses benzodiazepines; risk of seizures in chronic users.

Phenylephrine 50–100 mcg IV treats hypotension with tachycardia; ephedrine 5–10 mg IV treats hypotension with bradycardia.

Dexmedetomidine provides sedation without respiratory depression; monitor for bradycardia and hypotension.

Magnesium sulfate can potentiate neuromuscular blockade; monitor with a nerve stimulator.

Train-of-four (TOF) count of 4 with a ratio ≥0.9 indicates adequate recovery from nondepolarizing blockade.

Sustained tetanus and post-tetanic count assess deep blockade when TOF count is zero.

Succinylcholine causes phase I block (fade absent) and phase II block with prolonged use (fade present).

Residual paralysis increases postoperative pulmonary complications; always confirm reversal before extubation.

Nerve stimulator electrodes should be placed over the ulnar nerve with the thumb response observed.

Hypothermia and acidosis prolong neuromuscular blockade; correct before assuming underdosing.

Aminoglycosides and magnesium potentiate blockade; monitor closely.

Quantitative neuromuscular monitoring is more reliable than clinical signs such as head lift.

Tidal volume for lung-protective ventilation is about 6–8 mL/kg of predicted body weight.

Positive end-expiratory pressure (PEEP) recruits alveoli and improves oxygenation but can reduce venous return.

Hypoxemia causes include shunt, dead space, hypoventilation, and diffusion impairment.

Permissive hypercapnia is often tolerated in ARDS but is avoided in raised intracranial pressure.

Pulse oximetry is a late indicator of hypoxemia; capnography detects apnea earlier.

Peak airway pressure rise suggests obstruction; plateau pressure rise suggests reduced compliance.

Oxygen toxicity risk increases with prolonged high FiO2; titrate to target saturation.

Atelectasis after anesthesia is reduced by recruitment maneuvers and early mobilization.

Mean arterial pressure ≈ diastolic pressure + 1/3 (systolic − diastolic); target ≥65 mmHg for organ perfusion.

Cardiac output = heart rate × stroke volume; stroke volume depends on preload, afterload, and contractility.

Invasive arterial line provides beat-to-beat pressure and allows blood gas sampling.

Central venous pressure is a poor sole guide to fluid responsiveness; use dynamic measures.

Sinus bradycardia with hypotension is treated with atropine or ephedrine.

Hypertension under anesthesia may indicate light anesthesia, pain, or bladder distension.

ECG ST-segment changes suggest myocardial ischemia; act promptly.

Pulse pressure variation and stroke volume variation help predict fluid responsiveness in ventilated patients.

Normal core temperature is about 36.5–37.5 °C; hypothermia is below 36 °C.

Active warming devices include forced-air blankets and warmed IV fluids.

Malignant hyperthermia presents with rising ETCO2, tachycardia, and hyperthermia; give dantrolene.

Shivering increases oxygen consumption and carbon dioxide production.

Hyperthermia may indicate infection, transfusion reaction, or MH; investigate the cause.

Hypothermia impairs coagulation and drug metabolism and increases surgical site infection risk.

Monitor glucose in diabetic and pediatric patients; treat hypoglycemia promptly.

Maintain normothermia in neonates and the elderly, who lose heat rapidly.

The anesthesia record is a legal document; entries should be made contemporaneously and never altered retrospectively.

Record drug name, dose, route, time, and effect for every agent administered.

Document informed consent, allergies, and airway assessment before induction.

Adverse events and near misses must be documented and reported.

Patient confidentiality is protected by law; share information only on a need-to-know basis.

Corrections should be made with a single line, initials, and date, not by erasure or correction fluid.

Handover documentation should include current status, plan, and pending issues.

Retain records per institutional and national policy.

Supine, prone, lateral, and lithotomy positions each carry specific nerve and pressure injury risks.

Pad bony prominences and support limbs to prevent pressure and nerve injury.

Brachial plexus injury risk increases with arm abduction beyond 90° and with head rotation.

Common peroneal nerve injury occurs with lithotomy or lateral positioning; pad the fibular head.

Prone position requires careful eye and facial protection and abdominal decompression.

Document baseline neurological status and any postoperative deficit.

Position changes require reassessment of airway, lines, and monitors.

Trendelenburg position increases venous return and intracranial pressure.

Nasal cannula delivers roughly 1–6 L/min, adding about 4% FiO2 per liter.

Simple face mask delivers 6–10 L/min with FiO2 about 35–60%.

Non-rebreather mask delivers high FiO2 (up to 90–100%) with a reservoir bag.

Venturi mask provides precise FiO2 (24–60%) for controlled oxygen therapy.

Oropharyngeal airway prevents tongue obstruction; measure from incisors to angle of mandible.

Nasopharyngeal airway is better tolerated in patients with intact gag reflex.

Bag-valve-mask ventilation requires a tight seal and two-person technique for difficult cases.

Humidification prevents mucosal drying during prolonged oxygen therapy.

Normal arterial pH is 7.35–7.45; PaCO2 35–45 mmHg; HCO3− 22–26 mEq/L.

Respiratory acidosis: low pH with high PaCO2; treat by improving ventilation.

Respiratory alkalosis: high pH with low PaCO2; consider hyperventilation or pain.

Metabolic acidosis: low pH with low HCO3−; calculate anion gap to identify cause.

Metabolic alkalosis: high pH with high HCO3−; often from vomiting or diuretics.

Compensation is partial if pH remains abnormal; it is complete when pH returns to normal.

Base excess reflects metabolic component; a negative value indicates metabolic acidosis.

Sample air bubbles and delay in analysis alter blood gas results.

Neuraxial anesthesia is preferred for cesarean delivery when not contraindicated.

Left uterine displacement after 20 weeks prevents aortocaval compression.

Aspiration risk is increased in pregnancy; use rapid sequence induction for general anesthesia.

Magnesium therapy potentiates neuromuscular blockade; monitor with a nerve stimulator.

Postpartum hemorrhage is managed with uterotonics, fluids, blood products, and surgery if needed.

Preeclampsia requires careful blood pressure control and monitoring for pulmonary edema.

Fetal heart rate monitoring guides intraoperative decisions.

Documentation of block level and maternal vital signs is essential.

Pediatric drug doses are weight-based; verify weight and use a length-based tape if needed.

Uncuffed endotracheal tube size approximates age/4 + 4 mm.

Children are prone to bradycardia from hypoxia; treat with oxygen and atropine if needed.

Maintain normothermia with warming devices and warmed fluids.

Postoperative nausea and vomiting prophylaxis is important in children.

Emergence delirium is common; provide a calm environment and parental presence.

Fluid boluses in children are typically 10–20 mL/kg of isotonic crystalloid.

Document weight, dose, and response for all drugs.

Assume full stomach; use rapid sequence induction with cricoid pressure.

Cervical spine precautions are maintained during airway management.

Damage-control resuscitation prioritizes hemorrhage control and balanced transfusion.

Hypothermia, acidosis, and coagulopathy form the lethal triad.

Focused assessment with ultrasound (FAST) guides management of internal bleeding.

Secure the airway early in severe head injury while maintaining cerebral perfusion.

Document mechanism, injuries, and interventions.

Anticipate difficult airway from facial trauma and prepare backup plans.

Vaporizers deliver a set concentration; they are agent-specific and temperature-compensated.

Flowmeters are calibrated for specific gases; oxygen is usually the last in the sequence to prevent hypoxic mixtures.

Scavenging systems remove waste anesthetic gases to protect staff.

Pulse oximeter uses two wavelengths of light to estimate hemoglobin oxygen saturation.

Capnography measures infrared absorption by carbon dioxide.

Defibrillator energy for adults is typically 120–200 J biphasic or 360 J monophasic.

Electrical safety: equipment must be grounded; avoid flammable agents near electrocautery.

Regular calibration and servicing of monitors ensure accuracy.

Atelectasis is the most common postoperative pulmonary complication; encourage deep breathing and mobilization.

Postoperative hypoxia requires assessment of airway, breathing, and circulation.

Wound dehiscence and infection require prompt surgical review.

Urinary retention is common after neuraxial anesthesia; monitor and catheterize if needed.

Postoperative delirium is common in the elderly; identify and treat reversible causes.

Venous thromboembolism prophylaxis includes early mobilization and anticoagulation when indicated.

Document vital signs and interventions in the PACU record.

Escalate care when the patient fails to meet discharge criteria.

Spinal anesthesia produces rapid onset and dense block; hypotension is common.

Epidural anesthesia allows catheter placement for continuous analgesia.

Peripheral nerve blocks provide targeted analgesia with fewer systemic effects.

Ultrasound guidance improves block success and reduces complications.

Test dose with epinephrine helps detect intravascular injection.

Monitor for local anesthetic systemic toxicity after every block.

Document block level, sensory and motor assessment, and complications.

Aseptic technique is essential for all neuraxial and peripheral blocks.

Diabetes: monitor glucose and avoid hypoglycemia; adjust insulin perioperatively.

Cardiac disease: assess exercise tolerance and optimize medications.

Renal disease: adjust drug doses and monitor fluid balance.

Hepatic disease: altered drug metabolism and coagulation; monitor closely.

Asthma and COPD: optimize bronchodilators and avoid triggers.

Obstructive sleep apnea: plan postoperative monitoring and analgesia.

Document comorbidities and perioperative plan.

Multidisciplinary communication improves outcomes.

Use closed-loop communication for critical instructions.

Structured handover (SBAR) reduces information loss.

Speak up when patient safety is at risk.

Respect roles and responsibilities within the team.

Document communication and decisions.

Debrief after critical events to improve performance.

Maintain confidentiality during all communications.

Cultural sensitivity improves patient trust and cooperation.