General Anesthesia: Techniques and Airway Management
What you must understand
General anesthesia is a continuum of sedation, hypnosis, amnesia, and immobility, achieved by balanced technique (induction agent, maintenance with volatile or TIVA, opioid, muscle relaxant). Know the airway algorithm: assess, plan, and have a rescue plan. Learn difficult airway predictors, direct and video laryngoscopy, supraglottic airways, and the failed-intubation/failed-ventilation pathway (supraglottic rescue, then surgical airway). Understand rapid-sequence induction and its indications (full stomach, aspiration risk), cricoid pressure controversies, and the choice of induction agent in hemodynamic instability (etomidate vs ketamine vs propofol). Understand neuromuscular blockade monitoring (train-of-four) and reversal (sugammadex vs neostigmine).
Traps in questions
Common traps: assuming succinylcholine is safe in hyperkalemia risk states (burns, crush injury, denervation, prolonged immobility) - it is not. Another is confusing train-of-four count with depth of block: 4 twitches = adequate recovery only if ratio is >0.9. Questions often test that a supraglottic airway is a rescue, not a definitive airway, and that "cannot intubate, cannot ventilate" mandates a surgical airway, not more attempts with a laryngoscope. Watch for propofol in hypovolemia (hypotension) and ketamine in severe hypertension.
Rule of thumb
For any airway emergency, follow the algorithm stepwise and do not repeat a failed technique more than twice - move to the next rescue. For RSI, remember the "7 Ps" (preparation, preoxygenation, pretreatment, paralysis, protection, placement, post-intubation care).
Worked example: A trauma patient with a full stomach needs induction. Use RSI with preoxygenation, a rapidly acting induction agent, and succinylcholine (if no contraindication), with cricoid pressure per protocol.