Arab Board Anesthesia Final Written cheat sheet

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

Closing capacity rises with age and exceeds functional residual capacity in the supine elderly, promoting airway closure and shunt.

Minimum alveolar concentration (MAC) is the alveolar concentration at 1 atm that abolishes movement to a standard stimulus in 50% of subjects; MAC is additive (0.5 MAC A + 0.5 MAC B = 1 MAC).

Propofol is highly protein-bound and undergoes hepatic and extrahepatic clearance; its context-sensitive half-time rises steeply after infusions beyond ~3 hours.

Succinylcholine is metabolized by plasma butyrylcholinesterase; prolonged block occurs with enzyme deficiency, atypical variants, or dibucaine number <70.

Ohm's law analog for gas flow: turbulent flow is proportional to the square root of pressure gradient, so resistance rises with flow squared.

Poiseuille's law: laminar flow varies with the fourth power of radius and inversely with gas viscosity; helium reduces turbulence in upper airway obstruction.

The Hering-Breuer reflex terminates inspiration via vagal afferents from pulmonary stretch receptors; it is weak in adults but active in neonates.

Revised Cardiac Risk Index (RCRI) components: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2 mg/dL, and high-risk surgery; each scores 1 point.

The 6-minute walk test and cardiopulmonary exercise testing estimate functional capacity; <4 METs is a recognized threshold for increased perioperative risk.

Stop smoking at least 4 weeks before surgery to reduce pulmonary complications; shorter abstinence still lowers carboxyhemoglobin.

Metformin is generally continued perioperatively; it is held if contrast dye or acute kidney injury risk is present because of lactic acidosis concern.

ACE inhibitors and ARBs are often held on the day of surgery to reduce intraoperative hypotension; continuation is debated and individualized.

An A1c >8% predicts higher infectious and wound complications; glucose should be optimized before elective surgery.

Anemia (WHO: Hb <13 g/dL men, <12 g/dL women) independently increases perioperative morbidity; iron studies guide preop iron therapy.

STOP-BANG score ≥3 indicates high obstructive sleep apnea risk; escalation of monitoring and opioid-sparing analgesia are warranted.

Mallampati class III-IV, thyromental distance <6 cm, interincisor gap <3 cm, and limited neck extension predict difficult laryngoscopy.

The 7 Ps of rapid sequence intubation: preparation, preoxygenation, pretreatment, paralysis, placement, post-intubation management, and (often) proof.

Cormack-Lehane grades: I = full glottic view; II = partial; III = epiglottis only; IV = no laryngeal structures visible.

Suxamethonium 1-1.5 mg/kg or rocuronium 1.2 mg/kg provides rapid sequence conditions; rocuronium 16 mg/kg is reversed by sugammadex.

Difficult mask ventilation predictors include age >55, BMI >26, beard, edentulous, snoring, and Mallampati III-IV (MOANS).

Failed airway algorithm: optimize mask ventilation, place supraglottic airway, then attempt surgical airway if cannot intubate/cannot oxygenate.

Video laryngoscopy improves glottic view in difficult airways but does not guarantee easier tube delivery; styletted tubes and external laryngeal manipulation help.

Cricoid pressure is applied at 20-30 N in rapid sequence; it is released if it impedes ventilation or intubation.

Spinal anesthesia block height depends on baricity, patient position, and dose; hyperbaric bupivacaine in sitting position produces a saddle block.

Epidural test dose: 3 mL of lidocaine 1.5% with epinephrine 1:200,000; a rise in HR >20 bpm or SBP >15-20 mmHg suggests intravascular placement.

Maximum recommended lidocaine dose without epinephrine is 4.5 mg/kg (7 mg/kg with epinephrine); bupivacaine is 2-2.5 mg/kg.

Interscalene brachial plexus block reliably anesthetizes C5-C7 but spares the ulnar (C8-T1) distribution; phrenic nerve palsy occurs in nearly all cases.

TAP block targets T10-L1 dermatomes; it is used for abdominal wall analgesia but does not provide visceral analgesia.

MAC (monitored anesthesia care) requires an anesthesia professional to be present throughout; sedation level is titrated to patient response and procedure needs.

Total intravenous anesthesia with propofol and remifentanil provides rapid recovery; bispectral index 40-60 is a common depth target.

Neuraxial opioids: intrathecal morphine 100-300 mcg provides prolonged analgesia; delayed respiratory depression peaks 6-12 hours after administration.

Pulse oximetry relies on differential light absorption of oxyhemoglobin and deoxyhemoglobin; it is unreliable with poor perfusion, motion, or methemoglobinemia.

Capnography waveform has four phases: inspiratory baseline, expiratory upstroke, expiratory plateau, and inspiratory downstroke; a sloping plateau suggests obstruction.

End-tidal CO2 normally is 35-45 mmHg; a sudden drop suggests embolism, hypovolemia, circuit disconnection, or cardiac arrest.

Invasive arterial pressure: systolic pressure varies with transducer height; the transducer should be at the level of the right atrium.

Bispectral index (BIS) 40-60 correlates with hypnosis; raw EEG is affected by hypothermia, ketamine, and neuromuscular blockers.

Neuromuscular monitoring: train-of-four ratio ≥0.9 is required for safe extubation; post-tetanic count assesses deep block.

Pulmonary artery catheter measures cardiac output by thermodilution; normal cardiac index 2.5-4.0 L/min/m2, PCWP 6-12 mmHg.

Near-infrared spectroscopy (NIRS) monitors regional cerebral oxygen saturation; values <20% below baseline may signal cerebral ischemia.

Maintenance crystalloid by 4-2-1 rule: 4 mL/kg/hr for first 10 kg, 2 mL/kg/hr for next 10 kg, 1 mL/kg/hr thereafter.

Isotonic crystalloid distributes ~25% intravascularly; colloids remain in the intravascular space longer but carry allergy and renal risk.

Blood transfusion threshold: restrictive strategy (Hb 7-8 g/dL) is non-inferior to liberal in most critically ill and surgical patients.

Massive transfusion protocol: balanced ratios of PRBC:FFP:platelets (e.g., 1:1:1) reduce dilutional coagulopathy in hemorrhage.

Citrate toxicity from massive transfusion causes hypocalcemia; monitor ionized calcium and replace with calcium chloride or gluconate.

Hyperkalemia can occur with stored blood; potassium rises with storage duration and irradiation.

Trendelenburg position increases venous return and ICP; reverse Trendelenburg reduces aspiration risk and improves respiratory mechanics.

Prone position improves oxygenation in ARDS; pressure points (eyes, ears, genitalia, breasts) require padding to prevent injury.

One-lung ventilation: use lung-protective tidal volumes 4-6 mL/kg predicted body weight, PEEP 5 cmH2O, and permissive hypercapnia.

Cerebral perfusion pressure = MAP - ICP; normal CPP is 60-80 mmHg; hyperventilation to PaCO2 30-35 mmHg reduces ICP.

Carotid endarterectomy: maintain SBP within 20% of baseline; regional block allows awake neurologic monitoring.

Tourniquet inflation >2 hours increases risk of nerve injury and metabolic acidosis; deflation releases potassium and acid into circulation.

Liver transplant reperfusion syndrome: hypotension, hyperkalemia, acidosis, and arrhythmias on graft reperfusion; treat with calcium, bicarbonate, and vasopressors.

Obstetric spinal hypotension is managed with left uterine displacement, fluids, and phenylephrine infusion; ephedrine is preferred in fetal distress.

Pediatric airway: the narrowest point is the cricoid ring; uncuffed tubes allow 0.5 mm leak; formula for ETT size = (age/4) + 4.

Laryngospasm is common in children after extubation; treat with 100% oxygen, jaw thrust, and small-dose propofol or succinylcholine if severe.

Sepsis-3 criteria: suspected infection plus SOFA score ≥2; septic shock requires vasopressors to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite fluids.

ARDS Berlin definition: acute onset within 1 week, bilateral opacities, PaO2/FiO2 ≤300 mmHg on PEEP ≥5 cmH2O.

Ventilator-induced lung injury is reduced with tidal volume 6 mL/kg predicted body weight and plateau pressure ≤30 cmH2O.

Acute kidney injury KDIGO stages: stage 1 = creatinine rise ≥0.3 mg/dL or 1.5-1.9x baseline; stage 3 = ≥3x baseline or creatinine ≥4 mg/dL.

Vasopressor of choice in septic shock is norepinephrine; add vasopressin or epinephrine as needed.

Diabetic ketoacidosis: treat with isotonic fluids, insulin infusion, and potassium replacement once K <5.2 mEq/L; avoid bicarbonate unless pH <6.9.

Status epilepticus: first-line benzodiazepines; second-line phenytoin, levetiracetam, or valproate; refractory requires intubation and propofol or midazolam infusion.

Massive hemoptysis: secure airway with a large-bore ETT, position bleeding lung down, and consider bronchial blocker or rigid bronchoscopy.

Multimodal analgesia combines opioids, NSAIDs, acetaminophen, regional blocks, and adjuvants (ketamine, gabapentinoids, dexmedetomidine) to reduce opioid consumption.

Opioid equianalgesic conversion: oral morphine 30 mg ≈ oral oxycodone 20 mg ≈ IV morphine 10 mg ≈ IV hydromorphone 1.5 mg.

Ketamine at subanesthetic doses (0.1-0.5 mg/kg/hr) provides analgesia and opioid sparing; monitor for psychotomimetic effects.

Neuropathic pain responds to gabapentinoids, tricyclics (amitriptyline), SNRIs (duloxetine), and topical lidocaine; opioids are less effective.

Complex regional pain syndrome (CRPS) diagnosis uses Budapest criteria: sensory, vasomotor, sudomotor, and motor/trophic signs.

Epidural analgesia: catheter tip placement at the dermatome of incision; ropivacaine 0.2% + fentanyl provides labor analgesia.

Acute pain service protocols: daily review of catheter site, sensory level, motor block, and signs of local anesthetic systemic toxicity.

Local anesthetic systemic toxicity (LAST) treatment: stop injection, airway management, lipid emulsion 1.5 mL/kg bolus then infusion, and avoid vasopressin.

WHO surgical safety checklist: sign in, time out, and sign out phases reduce morbidity and mortality.

Anesthesia-related mortality has declined to ~1 per 100,000-200,000 anesthetics in high-income settings; most events are preventable.

Critical incident reporting systems (e.g., AIMS, NAP) identify latent errors and support system-based improvement.

Informed consent requires capacity, disclosure of material risks, understanding, and voluntariness; the anesthesiologist must discuss anesthetic options and risks.

Do-not-resuscitate orders should be reviewed preoperatively; the patient or surrogate must clarify which interventions are acceptable.

Hand hygiene and sterile technique reduce central line-associated bloodstream infection; chlorhexidine skin prep is standard.

Medication errors are reduced by standardized labeling, color-coded syringes, and barcode scanning.

Professionalism includes honesty about complications, respect for patient autonomy, and appropriate management of conflicts of interest.

Obstructive sleep apnea: STOP-BANG ≥3 warrants postoperative monitoring; CPAP should be continued perioperatively.

Chronic obstructive pulmonary disease: optimize bronchodilators and steroids; regional anesthesia and lung-protective ventilation reduce complications.

Heart failure with reduced ejection fraction: continue beta-blockers and ACE inhibitors/ARBs when tolerated; avoid excessive fluid loading.

Diabetes: target glucose 140-180 mg/dL intraoperatively; insulin infusion for prolonged or major surgery; avoid hypoglycemia.

Chronic kidney disease: avoid succinylcholine if hyperkalemia; dose-adjust renally cleared drugs (e.g., morphine, vecuronium).

Liver disease: coagulopathy is common; avoid acetaminophen overdose and benzodiazepines; consider albumin and vitamin K.

Pulmonary hypertension: avoid hypoxemia, hypercapnia, acidosis, and hypothermia, which worsen pulmonary vascular resistance.

Anticoagulation and neuraxial anesthesia: follow ASRA intervals (e.g., stop clopidogrel 5-7 days, LMWH 12 hours prophylactic/24 hours therapeutic).

Adult cardiac arrest: high-quality CPR at 100-120 compressions/min, depth 5-6 cm, minimize interruptions, and early defibrillation for shockable rhythms.

ACLS drug dosing: epinephrine 1 mg IV every 3-5 minutes; amiodarone 300 mg then 150 mg for refractory VF/pVT.

Reversible causes (Hs and Ts): hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis, trauma.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV, stop triggering agents, hyperventilate with 100% O2, and cool the patient.

Anaphylaxis: epinephrine 0.5 mg IM (1:1000) in the anterolateral thigh; repeat every 5-15 minutes; fluids and adjuncts follow.

Local anesthetic systemic toxicity: lipid emulsion 20% 1.5 mL/kg bolus, then 0.25 mL/kg/min infusion; avoid vasopressin and calcium channel blockers.

Difficult airway: call for help, optimize oxygenation, and proceed through supraglottic airway to surgical airway if cannot intubate/cannot oxygenate.

Postoperative crisis: sudden hypotension with tachycardia and hypoxia suggests pulmonary embolism, hemorrhage, or anaphylaxis; act on the most likely cause immediately.

The circle breathing system uses a CO2 absorber (soda lime); exhaustion causes rebreathing and hypercapnia; indicator color change signals replacement.

The Mapleson A (Magill) circuit is efficient for spontaneous ventilation; Mapleson D (Bain) is efficient for controlled ventilation.

Vaporizers are agent-specific; desflurane requires a heated, pressurized vaporizer; sevoflurane has a lower boiling point and uses a standard variable-bypass vaporizer.

Pulse oximeter principles: Beer-Lambert law; ratio of red (660 nm) to infrared (940 nm) absorption distinguishes oxy- and deoxyhemoglobin.

Neuromuscular junction: nicotinic acetylcholine receptor; nondepolarizing blockers compete with acetylcholine; depolarizing agents (succinylcholine) cause sustained depolarization.

Hepatic first-pass metabolism reduces oral bioavailability; propofol undergoes extensive hepatic and extrahepatic metabolism.

The Frank-Starling relationship: increased preload increases stroke volume until the plateau; fluid responsiveness is assessed dynamically (pulse pressure variation, SVV).

Oxygen delivery DO2 = cardiac output × arterial oxygen content (CaO2 = 1.34 × Hb × SaO2 + 0.003 × PaO2).

General anesthesia triad: hypnosis, analgesia, and muscle relaxation; balanced anesthesia combines agents to achieve each component.

Inhalational induction with sevoflurane is preferred in children; rapid sequence induction is preferred when aspiration risk is high.

Supraglottic airway devices (LMA) are contraindicated in full stomach, obesity with reflux, and prolonged procedures.

Regional anesthesia: supraclavicular block anesthetizes the entire brachial plexus but risks pneumothorax; axillary block spares the musculocutaneous nerve unless targeted.

Femoral nerve block provides anterior thigh and knee analgesia; adductor canal block preserves quadriceps strength.

Epidural vs spinal: epidural allows catheter titration and continuous infusion; spinal is faster and denser but limited duration.

MAC sedation: dexmedetomidine provides sedation without respiratory depression; propofol provides titratable sedation but risks apnea.

Postoperative nausea and vomiting prophylaxis: Apfel score factors (female, nonsmoker, history of PONV, postoperative opioids); use ondansetron, dexamethasone, and droperidol.

ECG lead II is best for detecting arrhythmias; V5 is best for detecting ischemia.

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

Arterial line damping: underdamped waveform shows systolic overshoot; overdamped waveform underestimates systolic pressure.

Central venous pressure normal range 2-8 mmHg; trends guide fluid management but do not reliably predict fluid responsiveness.

Capnography is mandatory during general anesthesia; it detects esophageal intubation, disconnection, and circuit leaks.

Temperature monitoring: hypothermia (<36°C) increases surgical site infection, bleeding, and cardiac events; forced-air warming is standard.

Urine output monitoring: adequate output 0.5-1 mL/kg/hr in adults; oliguria prompts assessment of volume, perfusion, and obstruction.

Depth of anesthesia monitoring: BIS or entropy may reduce awareness in high-risk patients receiving total intravenous anesthesia.

Crystalloid composition: normal saline (0.9% NaCl) has Na 154, Cl 154; excessive use causes hyperchloremic metabolic acidosis.

Balanced crystalloids (lactated Ringer's, Plasma-Lyte) have lower chloride and may reduce acidosis compared with saline.

Blood products: PRBC raises Hb ~1 g/dL per unit; platelets raise count ~5,000-10,000/µL per unit; FFP 10-15 mL/kg.

Transfusion reactions: febrile nonhemolytic most common; acute hemolytic from ABO incompatibility causes fever, hypotension, and hemoglobinuria.

TRALI: noncardiogenic pulmonary edema within 6 hours of transfusion; supportive care with oxygen and ventilation.

Positioning injuries: brachial plexus stretch with arm abduction >90°; common peroneal nerve injury with lithotomy; ulnar neuropathy in supine position.

Head-down (Trendelenburg) position increases ICP and intraocular pressure; avoid in raised ICP and glaucoma.

Beach chair position risks cerebral hypoperfusion; keep transducer at the level of the external auditory meatus for cerebral perfusion pressure estimation.

Cardiac surgery: cardiopulmonary bypass causes systemic inflammatory response, coagulopathy, and platelet dysfunction; heparin is reversed with protamine.

Cerebral aneurysm clipping: maintain stable CPP, avoid hypertension before clipping, and use controlled hypotension only with caution.

Vascular surgery: aortic cross-clamping increases afterload and may cause myocardial ischemia; unclamping causes hypotension and acidosis.

Orthopedic surgery: cement implantation syndrome during hip arthroplasty causes hypotension, hypoxia, and arrhythmias.

Transplant: kidney transplant recipients are at risk for hyperkalemia and volume overload; ensure adequate perfusion before reperfusion.

ENT: shared airway with the surgeon; jet ventilation or microlaryngeal surgery requires coordination and total intravenous anesthesia.

Urologic: TURP syndrome from absorption of hypotonic irrigation fluid causes hyponatremia, confusion, and seizures; treat with hypertonic saline if severe.

Pediatric: neonates have immature hepatic and renal function; reduced protein binding increases free drug levels; careful dosing is essential.

Shock types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), and obstructive (tension pneumothorax, tamponade, PE).

Cardiogenic shock: norepinephrine or dobutamine; avoid excessive fluids; treat the underlying cause.

Tension pneumothorax: immediate needle decompression in the second intercostal space midclavicular line or fourth/fifth space anterior axillary line.

Cardiac tamponade: Beck triad (hypotension, distended neck veins, muffled heart sounds); treat with pericardiocentesis.

Pulmonary embolism: massive PE with hypotension requires thrombolysis or embolectomy; heparin for stable patients.

Acute respiratory distress: noninvasive ventilation for COPD exacerbation and cardiogenic pulmonary edema; intubate if worsening.

Sepsis bundle: cultures before antibiotics, broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid for hypotension or lactate ≥4.

Post-intensive care syndrome: cognitive, psychological, and physical impairment after critical illness; early mobilization and sedation minimization reduce risk.

Acute postoperative pain: multimodal approach with scheduled acetaminophen and NSAIDs, regional techniques, and opioids for breakthrough.

Opioid tolerance: patients on chronic opioids require higher doses; consider opioid-induced hyperalgesia and rotate agents.

Patient-controlled analgesia (PCA): morphine demand dose 1 mg with 5-10 minute lockout; no basal infusion in opioid-naive patients.

Chronic low back pain: exercise and cognitive behavioral therapy are first-line; opioids are not first-line.

Fibromyalgia: SNRIs, gabapentinoids, and tricyclics are first-line; opioids are discouraged.

Cancer pain: WHO analgesic ladder (non-opioid, weak opioid, strong opioid); adjuvants for neuropathic components.

Trigger point injection with local anesthetic and steroid provides short-term relief for myofascial pain.

Spinal cord stimulation is used for refractory neuropathic pain (failed back surgery syndrome, CRPS).

Anesthesia awareness: incidence ~1-2 per 1,000 anesthetics; risk higher in cardiac, obstetric, and trauma surgery; BIS monitoring may help.

Medication safety: look-alike/sound-alike drugs (e.g., epinephrine/ephedrine) require distinct labels and storage.

Root cause analysis: identifies system failures rather than individual blame; focuses on latent conditions.

Quality metrics: unplanned reintubation, surgical site infection, and 30-day mortality are common anesthesia quality indicators.

Ethical principles: autonomy, beneficence, nonmaleficence, and justice guide perioperative decisions.

Informed refusal: a competent patient may refuse anesthesia or blood products; document the discussion and alternatives.

Confidentiality: patient information must be protected; disclose only on a need-to-know basis or with consent.

Duty of candor: disclose harmful errors to patients and families promptly and honestly.

Coronary artery disease: continue aspirin in patients with drug-eluting stents; stopping antiplatelet therapy risks stent thrombosis.

Atrial fibrillation: rate control and anticoagulation; follow ASRA/ACC guidance for interruption before neuraxial or invasive procedures.

Asthma: continue inhaled corticosteroids; avoid histamine-releasing drugs (e.g., atracurium, morphine) in severe disease.

Obstructive sleep apnea: use CPAP postoperatively; avoid sedative premedication and long-acting opioids.

Diabetes: hold metformin if contrast or AKI risk; continue basal insulin; monitor glucose hourly during long cases.

Chronic kidney disease: avoid NSAIDs and meperidine; adjust doses of renally cleared drugs.

Cirrhosis: coagulopathy, hypoalbuminemia, and encephalopathy; avoid benzodiazepines and use lactulose for encephalopathy.

Obesity: dose succinylcholine and other drugs by total body weight, but dose propofol and opioids by lean body weight to avoid overdose.

Pediatric cardiac arrest: compression rate 100-120/min, depth 1/3 of chest AP diameter; epinephrine 0.01 mg/kg IV/IO.

Neonatal resuscitation: initial steps (warm, dry, stimulate), then PPV if apnea or HR <100; chest compressions if HR <60 after PPV.

Anaphylaxis: epinephrine IM 0.01 mg/kg (max 0.5 mg) in children; repeat every 5-15 minutes; fluids 20 mL/kg.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV; monitor for hyperkalemia, acidosis, and rhabdomyolysis.

Local anesthetic systemic toxicity: stop injection, secure airway, lipid emulsion, and avoid vasopressin and calcium channel blockers.

Difficult airway: follow the ASA algorithm; call for help, optimize oxygenation, and proceed to surgical airway if needed.

Massive hemorrhage: activate massive transfusion protocol, give tranexamic acid 1 g, and maintain normothermia and calcium.

Postoperative respiratory failure: assess for opioid-induced hypoventilation, residual neuromuscular block, and airway obstruction; reverse with naloxone or sugammadex as appropriate.

Anatomy for neuraxial block: spinal cord ends at L1-L2 in adults; L3-L4 is a safe interspace; conus medullaris and cauda equina considerations.

Anatomy for central line: internal jugular vein lies lateral to carotid artery; trendelenburg and ultrasound reduce pneumothorax risk.

Pharmacology: neostigmine inhibits acetylcholinesterase, increasing acetylcholine at the neuromuscular junction; co-administer glycopyrrolate to prevent bradycardia.

Sugammadex encapsulates rocuronium and vecuronium; dose 2 mg/kg for TOF count 2, 4 mg/kg for post-tetanic count 1-2, 16 mg/kg for immediate reversal.

Physics: laminar flow is silent, turbulent flow is noisy; auscultation of turbulent flow helps identify airway narrowing.

Equipment: oxygen cylinder pressure is proportional to content when full; a full E-cylinder is ~2200 psi and contains ~660 L.

Gas laws: at constant temperature, pressure × volume is constant (Boyle's law); at constant pressure, volume varies with temperature (Charles's law).

Fluid warming and humidification reduce heat loss and airway injury during prolonged mechanical ventilation.

ASA physical status: I = healthy; II = mild systemic disease; III = severe systemic disease; IV = severe disease with constant threat to life; V = moribund; VI = brain-dead organ donor.

Airway assessment: mouth opening ≥3 cm, thyromental distance ≥6 cm, Mallampati I-II, and normal neck extension suggest easy laryngoscopy.

Preoperative labs: CBC, electrolytes, renal function, and coagulation studies are guided by history and surgery, not routine in all patients.

Cardiac risk: RCRI ≥2 warrants cardiology consultation and consideration of stress testing if it will change management.

Pulmonary risk: spirometry and ABG for patients with severe COPD or restrictive disease; optimize bronchodilators preoperatively.

Anticoagulation: bridge with LMWH only in high thrombotic risk patients; follow CHEST/ASRA guidance.

Informed consent: discuss anesthesia options, risks, benefits, and alternatives; document the discussion.

Premedication: midazolam for anxiety; avoid in elderly or OSA patients; consider H2 blockers or metoclopramide for aspiration risk.

Bag-mask ventilation: head tilt-chin lift and jaw thrust; two-person technique improves seal in difficult cases.

Supraglottic airway: LMA Classic is not for positive pressure ventilation >20 cmH2O; ProSeal and i-gel allow higher pressures.

Endotracheal tube size: adult male 8.0-8.5 mm, female 7.0-7.5 mm; pediatric uncuffed size = (age/4) + 4.

Difficult intubation: use video laryngoscopy, bougie, or fiberoptic scope; keep suction and alternative devices immediately available.

Cricothyrotomy: emergency surgical airway at the cricothyroid membrane; use a scalpel-bougie-tube technique.

Extubation criteria: awake, following commands, adequate spontaneous ventilation, stable hemodynamics, and TOF ratio ≥0.9.

Post-extubation stridor: treat with nebulized epinephrine, dexamethasone, and heliox; reintubate if worsening.

Airway fire: stop gases, remove burning material, flush with saline, and reintubate if needed; use lowest feasible FiO2 during airway surgery.

Spinal anesthesia: hyperbaric bupivacaine 0.75% 1.5-2 mL for lower abdominal surgery; block height T4-T10 depending on procedure.

Epidural: loss of resistance to saline or air identifies the epidural space; catheter threaded 3-5 cm into the space.

Combined spinal-epidural: spinal provides rapid dense block; epidural catheter allows extension for prolonged surgery or postoperative analgesia.

Peripheral nerve blocks: ultrasound guidance improves success and reduces local anesthetic volume; use nerve stimulation as adjunct.

Bier block: IV regional anesthesia with lidocaine 0.5% (3 mg/kg) without epinephrine; tourniquet must remain inflated ≥20 minutes.

MAC: patient remains responsive to verbal commands; use propofol, dexmedetomidine, or remifentanil infusion; monitor capnography.

General anesthesia: induction with propofol 2-2.5 mg/kg, maintenance with volatile agent 0.8-1.2 MAC or TIVA.

Muscle relaxation: vecuronium 0.1 mg/kg, rocuronium 0.6-1.2 mg/kg, cisatracurium 0.15-0.2 mg/kg; monitor with TOF.

Pulse oximetry: normal SpO2 95-100%; values <90% require assessment of airway, breathing, and circulation.

Capnography: end-tidal CO2 reflects alveolar ventilation; a sudden rise suggests hypoventilation, fever, or CO2 absorption.

Arterial pressure waveform: dicrotic notch corresponds to aortic valve closure; systolic pressure is affected by compliance and resistance.

Central venous pressure: useful for trends; a sudden rise suggests tamponade, tension pneumothorax, or fluid overload.

Pulmonary artery pressure: normal 15-30/8-15 mmHg; mean 10-20 mmHg; elevated in pulmonary hypertension.

Cardiac output monitoring: thermodilution, pulse contour analysis, and esophageal Doppler; normal CI 2.5-4.0 L/min/m2.

Neuromuscular monitoring: TOF count 0-4; train-of-four ratio ≥0.9 indicates adequate recovery.

Temperature: core temperature monitored with esophageal, nasopharyngeal, or bladder probe; avoid hypothermia <36°C.

Maintenance fluids: 4-2-1 rule; replace deficits with isotonic crystalloid; monitor urine output and hemodynamics.

Colloids: albumin 5% or 25%, hydroxyethyl starch (avoid in sepsis and renal impairment), gelatin; colloids expand plasma volume more than crystalloid.

Blood transfusion: crossmatch, type and screen; verify patient identity and blood product compatibility before transfusion.

Transfusion reactions: stop transfusion, maintain IV access, send samples, and treat according to reaction type.

Massive transfusion: warm fluids and blood, monitor ionized calcium, potassium, and coagulation; use tranexamic acid.

Positioning: supine, prone, lateral, lithotomy, Trendelenburg, reverse Trendelenburg, beach chair; pad pressure points and protect eyes.

Nerve injury prevention: avoid extreme joint positions, pad bony prominences, and check pulses and sensation postoperatively.

Compartment syndrome: pain out of proportion, paresthesia, pallor, pulselessness; emergency fasciotomy.

Thoracic surgery: lung isolation with double-lumen tube or bronchial blocker; confirm position with fiberoptic bronchoscopy.

Neurosurgery: maintain CPP, avoid hypercapnia and hypoxia, and use total intravenous anesthesia for evoked potential monitoring.

Vascular: carotid endarterectomy under regional or general anesthesia; monitor neurologic status and maintain blood pressure.

Orthopedic: total hip and knee arthroplasty; multimodal analgesia, tranexamic acid, and regional blocks reduce blood loss and pain.

Transplant: liver transplant requires invasive monitoring, rapid transfusion, and management of reperfusion syndrome.

ENT: adenotonsillectomy in children; risk of postobstructive pulmonary edema and bleeding; use throat pack and extubate awake.

Urologic: TURP; monitor for TURP syndrome (hyponatremia, hypervolemia, confusion) and treat with hypertonic saline if symptomatic.

Obstetric: labor epidural, cesarean section spinal or epidural; left uterine displacement and phenylephrine for hypotension.

ABCDE approach: airway, breathing, circulation, disability, exposure; prioritize life-threatening problems.

Sepsis: early antibiotics, fluids, vasopressors; lactate clearance and source control.

ARDS: lung-protective ventilation, prone positioning, neuromuscular blockade in severe cases, and conservative fluid strategy.

Acute kidney injury: avoid nephrotoxins, maintain perfusion, and consider renal replacement therapy for refractory acidosis or hyperkalemia.

Status asthmaticus: inhaled beta-agonists, systemic steroids, magnesium, and heliox; intubate with low tidal volumes and long expiratory time.

Diabetic ketoacidosis: fluids, insulin, potassium replacement; monitor glucose and electrolytes hourly.

Upper gastrointestinal bleeding: resuscitate, protect airway, and arrange endoscopy; use PPIs and consider terlipressin for variceal bleeding.

Trauma: primary survey, hemorrhage control, massive transfusion, and damage control surgery.

Acute pain: assess with numeric rating scale; treat with multimodal analgesia and regional techniques.

Opioid side effects: respiratory depression, constipation, nausea, pruritus, and tolerance; monitor with capnography in high-risk patients.

NSAIDs: inhibit COX enzymes; avoid in renal impairment, peptic ulcer disease, and coagulopathy.

Acetaminophen: max 4 g/day in healthy adults; reduce to 2-3 g/day in liver disease or chronic alcohol use.

Neuropathic pain: gabapentin, pregabalin, amitriptyline, duloxetine; titrate slowly and monitor side effects.

Chronic pain: biopsychosocial model; multidisciplinary treatment including physical therapy, psychology, and medication.

Interventional pain: epidural steroid injection, facet joint injection, radiofrequency ablation, and spinal cord stimulation.

Opioid misuse: screen with prescription drug monitoring programs; use urine drug testing and controlled substance agreements.

WHO checklist reduces surgical morbidity and mortality; complete before induction, before incision, and before leaving the operating room.

Anesthesia incident reporting: report near misses and adverse events to improve system safety.

Medication error prevention: standardized concentrations, double checks, and barcode verification.

Quality improvement: Plan-Do-Study-Act (PDSA) cycles test changes; measure outcomes and refine.

Ethics: respect autonomy, beneficence, nonmaleficence, and justice; document informed consent and refusal.

End-of-life care: discuss goals of care, palliative options, and do-not-resuscitate orders preoperatively.

Professionalism: maintain competence, honesty, and respect; manage conflicts of interest and impairment.

Patient safety culture: speak up, report errors, and support a just culture that distinguishes human error from reckless behavior.