Anesthetic Techniques (General, Regional, Neuraxial, Monitored Anesthesia Care)
General Anesthesia
Understand the triad of hypnosis, analgesia, and muscle relaxation, and the concept of balanced anesthesia. Know the MAC concept and factors that alter MAC (age, pregnancy, hypothermia, drugs). Understand the phases of anesthesia and the importance of adequate depth to prevent awareness.
Regional Anesthesia
Know the pharmacology of local anesthetics, including maximum doses, the role of epinephrine, and the presentation and treatment of local anesthetic systemic toxicity (LAST). Understand the difference between spinal, epidural, and combined spinal-epidural techniques, and the dermatomal levels required for different surgeries. Know the anatomy of the brachial plexus and the relevant blocks (interscalene, supraclavicular, infraclavicular, axillary).
Neuraxial
Understand the physiology of spinal anesthesia: sympathetic blockade, hypotension, bradycardia (Bezold-Jarisch reflex), and the risk of high spinal. Know contraindications to neuraxial blockade (coagulopathy, infection at the site, raised intracranial pressure, patient refusal).
Monitored Anesthesia Care
Know the indications, the need for appropriate monitoring, and the importance of patient selection and airway access. Understand the risk of oversedation and the need for capnography.
Traps
Questions often test the maximum dose of bupivacaine or lidocaine and the treatment of LAST (lipid emulsion). Another trap is the assumption that spinal anesthesia is safe in a patient on clopidogrel; timing of discontinuation matters. Also know that a high spinal can cause hypotension and bradycardia requiring epinephrine, not just fluids.
Worked Example
A 70 kg patient receives 20 mL of 0.5% bupivacaine for a supraclavicular block: 100 mg, which exceeds the maximum recommended single dose (about 2 mg/kg = 140 mg without epinephrine is often cited, but 100 mg is within limits; the trap is that 0.5% × 20 mL = 100 mg). If signs of LAST appear, stop injection, secure the airway, and give 20% lipid emulsion 1.5 mL/kg bolus.