Iran Anesthesiology Specialty Board Exam cheat sheet

Ideal gas law: PV = nRT; at constant temperature, doubling pressure halves volume (Boyle's law), which governs cylinder gas content estimates.

Oxygen cylinder content: full E-cylinder holds ~660 L at 2200 psi; remaining volume ≈ (gauge psi / 2200) × 660 L.

Nernst equation: E = (61.5/z) × log([ion]out/[ion]in) mV at 37°C; determines resting membrane potential contributions of K+, Na+, Cl-.

Henderson-Hasselbalch: pH = 6.1 + log([HCO3-]/(0.03 × PaCO2)); acute PaCO2 rise of 10 mmHg lowers pH ~0.08.

MAC is inversely related to potency and lipid solubility; MAC values are additive (0.5 MAC of two agents = 1.0 MAC total).

Propofol is highly protein-bound (~97-98%) and undergoes hepatic conjugation plus extrahepatic clearance; context-sensitive half-time rises only modestly with infusion duration.

Succinylcholine is hydrolyzed by plasma butyrylcholinesterase; pseudocholinesterase deficiency prolongs block, and dibucaine number <20 suggests homozygous atypical enzyme.

Local anesthetics block Na+ channels from the intracellular side in a use-dependent manner; pKa determines onset, protein binding determines duration, and inflamed tissue (low pH) slows onset.

Revised Cardiac Risk Index (RCRI) predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2 mg/dL, and high-risk surgery; ≥3 predictors indicates elevated risk.

ACC/AHA stepwise approach: estimate surgical risk, assess functional capacity (≥4 METs permits most surgery without further testing), then apply clinical risk indices.

METs: 1 MET ≈ 3.5 mL O2/kg/min; climbing one flight of stairs or walking briskly ≈ 4 METs.

ASA Physical Status: I healthy; II mild systemic disease; III severe systemic disease; IV constant threat to life; V moribund; suffix E for emergency.

Stop smoking at least 4 weeks before surgery for meaningful pulmonary benefit; shorter cessation does not increase complications.

Continue beta-blockers perioperatively; do not initiate high-dose beta-blockade on the day of surgery solely for risk reduction.

STOP-BANG (snoring, tiredness, observed apnea, pressure, BMI >35, age >50, neck circumference >40 cm, gender male); score ≥3 indicates high OSA risk.

Anticoagulation: hold warfarin ~5 days preoperatively with INR check; direct oral anticoagulants are typically held 24-48 h depending on agent and renal function.

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

Rapid sequence induction: preoxygenation, cricoid pressure (debated), and a fast-onset agent (propofol/etomidate/ketamine) plus succinylcholine or rocuronium 1.2 mg/kg.

Sugammadex 16 mg/kg reverses rocuronium deep block within ~3 minutes; 2 mg/kg reverses moderate block (TOF count ≥2).

Awake fiberoptic intubation is preferred when mask ventilation and supraglottic rescue are expected to fail; topicalize the airway and sedate cautiously.

Supraglottic airway leak pressure >20-30 cm H2O suggests adequate seal; higher pressures increase aspiration and gastric insufflation risk.

Spinal anesthesia: block height depends on baricity and patient position; hyperbaric bupivacaine spreads cephalad in sitting-to-supine positioning.

Epidural test dose: 3 mL lidocaine 1.5% with epinephrine 1:200,000; heart rate rise >20 bpm or systolic rise >15-20 mmHg suggests intravascular placement.

MAC (monitored anesthesia care) requires continuous verbal contact, capnography, and immediate availability of airway equipment and vasopressors.

Pulse oximetry: SpO2 90% corresponds to PaO2 ~60 mmHg on the oxyhemoglobin dissociation curve; 75% corresponds to ~40 mmHg.

Capnography waveform: phase I inspiratory baseline, phase II expiratory upstroke, phase III alveolar plateau, phase IV inspiratory downstroke.

End-tidal CO2 falls abruptly with pulmonary embolism, circuit disconnection, or cardiac arrest; rises with hypoventilation, CO2 insufflation, or malignant hyperthermia.

Bispectral index (BIS) target 40-60 for general anesthesia; values may be falsely low with muscle relaxants or hypothermia.

Arterial line: systolic pressure varies with site (radial < brachial < femoral); damping coefficient near 1 is optimal, and underdamping overestimates systolic pressure.

Central venous pressure does not reliably predict fluid responsiveness; dynamic measures (pulse pressure variation, stroke volume variation) are superior in ventilated patients.

Neuromuscular monitoring: train-of-four ratio ≥0.9 indicates adequate recovery; double-burst stimulation is more sensitive than TOF for residual block.

Evoked potentials: somatosensory evoked potentials monitor dorsal column function; motor evoked potentials are sensitive to volatile anesthetics and require total intravenous anesthesia.

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

Isotonic crystalloid distributes ~25% intravascularly; colloid remains mostly intravascular, but evidence does not show outcome benefit over crystalloid.

Pulse pressure variation >13% or stroke volume variation >10% in a ventilated patient suggests fluid responsiveness.

Mean arterial pressure = (SBP + 2×DBP)/3; cerebral and renal autoregulation typically holds between MAP 60-150 mmHg.

Hyperchloremic metabolic acidosis follows large-volume 0.9% saline; balanced solutions (lactated Ringer's, Plasma-Lyte) reduce this risk.

Transfusion threshold: restrictive strategy (Hb 7-8 g/dL) is non-inferior in most critically ill and surgical patients; use 8-10 g/dL in active ischemia.

Massive transfusion: give plasma and platelets in balanced ratios, use calcium replacement (citrate chelation), and warm fluids to prevent hypothermia.

Vasopressor choice: norepinephrine first-line for most distributive shock; phenylephrine for tachyarrhythmia; vasopressin for refractory vasodilatory shock.

Cardiac: maintain coronary perfusion pressure and avoid tachycardia; volatile anesthetics provide preconditioning; TEE guides volume and valve assessment.

One-lung ventilation: protective strategy with tidal volume 4-6 mL/kg predicted body weight, PEEP 5 cm H2O, and permissive hypercapnia to limit volutrauma.

Neuro: maintain cerebral perfusion pressure (CPP = MAP − ICP); hyperventilation to PaCO2 30-35 mmHg is a temporary measure for herniation.

Obstetric: aspiration prophylaxis with nonparticulate antacid and H2 blocker; left uterine displacement after 20 weeks gestation; avoid aortocaval compression.

Obstetric: preeclampsia - neuraxial analgesia preferred; avoid sudden hypotension; magnesium sulfate toxicity reversed with calcium gluconate.

Pediatric: uncuffed tube size ≈ (age/4) + 4 mm; cuffed tube one size smaller; bradycardia from hypoxia is common and treated with oxygen and atropine.

Outpatient: PONV risk factors (female, nonsmoker, history of PONV, postoperative opioids); multimodal prophylaxis with ondansetron, dexamethasone, and droperidol.

Trauma and burns: fluid resuscitation per ATLS; burn patients have hyperkalemia risk with succinylcholine beyond 24-48 h post-injury; use rocuronium instead.

Postoperative respiratory failure: consider residual neuromuscular blockade, opioid-induced hypoventilation, atelectasis, and aspiration.

Postoperative nausea and vomiting: 5-HT3 antagonists, dexamethasone, and droperidol are first-line; rescue with a different class than prophylaxis.

Acute pain management: multimodal analgesia with acetaminophen, NSAIDs, regional blocks, and opioids; PCA reduces total opioid use.

Sepsis: 30 mL/kg crystalloid bolus, broad-spectrum antibiotics within 1 hour, and norepinephrine for MAP <65 mmHg.

Acute respiratory distress syndrome: low tidal volume 4-6 mL/kg predicted body weight, PEEP titration, and prone positioning for severe hypoxemia.

ICU sedation: target Richmond Agitation-Sedation Scale (RASS) 0 to −2; daily sedation interruption reduces ventilator days.

Postoperative delirium: risk factors include age, cognitive impairment, and anticholinergic burden; nonpharmacologic prevention is first-line.

Acute kidney injury: KDIGO stages based on creatinine rise and urine output; avoid nephrotoxins and maintain perfusion pressure.

Obstructive sleep apnea: difficult mask ventilation and intubation risk; use CPAP postoperatively and avoid sedative premedication.

Chronic obstructive pulmonary disease: avoid high FiO2 and prolonged hyperventilation; permissive hypercapnia is acceptable; regional anesthesia preferred when feasible.

Heart failure: avoid myocardial depression and fluid overload; maintain preload, contractility, and afterload balance; consider invasive monitoring.

Diabetes: maintain glucose 140-180 mg/dL perioperatively; avoid hypoglycemia; check glucose hourly during long cases.

Renal failure: avoid succinylcholine if hyperkalemia; dose-adjust renally cleared drugs (morphine, meperidine, vecuronium); use cisatracurium for organ-independent clearance.

Hepatic disease: reduced albumin increases free drug fraction; avoid halothane; monitor coagulation and encephalopathy risk.

Elderly: reduced MAC requirement, decreased clearance, and increased sensitivity to benzodiazepines and opioids; titrate carefully.

Pregnancy: physiologic changes include increased cardiac output, dilutional anemia, and decreased functional residual capacity, accelerating desaturation.

WHO surgical safety checklist: sign-in (before induction), time-out (before incision), sign-out (before leaving OR) reduce surgical morbidity and mortality.

Anesthesia machine checkout: verify oxygen supply, suction, airway equipment, vaporizers, and self-inflating bag before each case.

Medication errors: standardize labeling, use color-coded syringes, and perform independent double-checks for high-alert drugs.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness.

Do-not-resuscitate orders: clarify and document perioperative status; a DNR order may be suspended during anesthesia with patient/family agreement.

Quality metrics: anesthesia-related mortality has declined to very low rates; use incident reporting systems and root cause analysis for improvement.

Professionalism: maintain confidentiality, avoid conflicts of interest, and report impaired colleagues through appropriate channels.

Handoff communication: use structured tools (SBAR) to reduce information loss during transitions of care.

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

Anaphylaxis: epinephrine 0.1-0.5 mg IM (1:1000) or 10-100 mcg IV titrated; fluids, antihistamines, and corticosteroids are adjuncts.

Cardiac arrest: high-quality CPR at 100-120 compressions/min, depth 5-6 cm, minimize interruptions; defibrillate VF/pVT at 200 J biphasic.

Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg bolus then infusion, and avoid vasopressin.

Difficult airway: follow ASA algorithm - optimize oxygenation, call for help, use supraglottic rescue, and proceed to surgical airway if cannot intubate/cannot oxygenate.

Laryngospasm: remove stimulus, apply 100% O2 with CPAP, deepen anesthesia; if persistent, give succinylcholine 0.5-1 mg/kg IV.

Tension pneumothorax: immediate needle decompression at 2nd intercostal space midclavicular line or 5th intercostal space anterior axillary line, then chest tube.

Air embolism: place patient in left lateral Trendelenburg position, aspirate air from central line, and give 100% O2.

Ideal gas law: PV = nRT; at constant temperature, doubling pressure halves volume (Boyle's law), which governs cylinder gas content estimates.

Oxygen cylinder content: full E-cylinder holds ~660 L at 2200 psi; remaining volume ≈ (gauge psi / 2200) × 660 L.

Nernst equation: E = (61.5/z) × log([ion]out/[ion]in) mV at 37°C; determines resting membrane potential contributions of K+, Na+, Cl-.

Henderson-Hasselbalch: pH = 6.1 + log([HCO3-]/(0.03 × PaCO2)); acute PaCO2 rise of 10 mmHg lowers pH ~0.08.

MAC is inversely related to potency and lipid solubility; MAC values are additive (0.5 MAC of two agents = 1.0 MAC total).

Propofol is highly protein-bound (~97-98%) and undergoes hepatic conjugation plus extrahepatic clearance; context-sensitive half-time rises only modestly with infusion duration.

Succinylcholine is hydrolyzed by plasma butyrylcholinesterase; pseudocholinesterase deficiency prolongs block, and dibucaine number <20 suggests homozygous atypical enzyme.

Local anesthetics block Na+ channels from the intracellular side in a use-dependent manner; pKa determines onset, protein binding determines duration, and inflamed tissue (low pH) slows onset.

Revised Cardiac Risk Index (RCRI) predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2 mg/dL, and high-risk surgery; ≥3 predictors indicates elevated risk.

ACC/AHA stepwise approach: estimate surgical risk, assess functional capacity (≥4 METs permits most surgery without further testing), then apply clinical risk indices.

METs: 1 MET ≈ 3.5 mL O2/kg/min; climbing one flight of stairs or walking briskly ≈ 4 METs.

ASA Physical Status: I healthy; II mild systemic disease; III severe systemic disease; IV constant threat to life; V moribund; suffix E for emergency.

Stop smoking at least 4 weeks before surgery for meaningful pulmonary benefit; shorter cessation does not increase complications.

Continue beta-blockers perioperatively; do not initiate high-dose beta-blockade on the day of surgery solely for risk reduction.

STOP-BANG (snoring, tiredness, observed apnea, pressure, BMI >35, age >50, neck circumference >40 cm, gender male); score ≥3 indicates high OSA risk.

Anticoagulation: hold warfarin ~5 days preoperatively with INR check; direct oral anticoagulants are typically held 24-48 h depending on agent and renal function.

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

Rapid sequence induction: preoxygenation, cricoid pressure (debated), and a fast-onset agent (propofol/etomidate/ketamine) plus succinylcholine or rocuronium 1.2 mg/kg.

Sugammadex 16 mg/kg reverses rocuronium deep block within ~3 minutes; 2 mg/kg reverses moderate block (TOF count ≥2).

Awake fiberoptic intubation is preferred when mask ventilation and supraglottic rescue are expected to fail; topicalize the airway and sedate cautiously.

Supraglottic airway leak pressure >20-30 cm H2O suggests adequate seal; higher pressures increase aspiration and gastric insufflation risk.

Spinal anesthesia: block height depends on baricity and patient position; hyperbaric bupivacaine spreads cephalad in sitting-to-supine positioning.

Epidural test dose: 3 mL lidocaine 1.5% with epinephrine 1:200,000; heart rate rise >20 bpm or systolic rise >15-20 mmHg suggests intravascular placement.

MAC (monitored anesthesia care) requires continuous verbal contact, capnography, and immediate availability of airway equipment and vasopressors.

Pulse oximetry: SpO2 90% corresponds to PaO2 ~60 mmHg on the oxyhemoglobin dissociation curve; 75% corresponds to ~40 mmHg.

Capnography waveform: phase I inspiratory baseline, phase II expiratory upstroke, phase III alveolar plateau, phase IV inspiratory downstroke.

End-tidal CO2 falls abruptly with pulmonary embolism, circuit disconnection, or cardiac arrest; rises with hypoventilation, CO2 insufflation, or malignant hyperthermia.

Bispectral index (BIS) target 40-60 for general anesthesia; values may be falsely low with muscle relaxants or hypothermia.

Arterial line: systolic pressure varies with site (radial < brachial < femoral); damping coefficient near 1 is optimal, and underdamping overestimates systolic pressure.

Central venous pressure does not reliably predict fluid responsiveness; dynamic measures (pulse pressure variation, stroke volume variation) are superior in ventilated patients.

Neuromuscular monitoring: train-of-four ratio ≥0.9 indicates adequate recovery; double-burst stimulation is more sensitive than TOF for residual block.

Evoked potentials: somatosensory evoked potentials monitor dorsal column function; motor evoked potentials are sensitive to volatile anesthetics and require total intravenous anesthesia.

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

Isotonic crystalloid distributes ~25% intravascularly; colloid remains mostly intravascular, but evidence does not show outcome benefit over crystalloid.

Pulse pressure variation >13% or stroke volume variation >10% in a ventilated patient suggests fluid responsiveness.

Mean arterial pressure = (SBP + 2×DBP)/3; cerebral and renal autoregulation typically holds between MAP 60-150 mmHg.

Hyperchloremic metabolic acidosis follows large-volume 0.9% saline; balanced solutions (lactated Ringer's, Plasma-Lyte) reduce this risk.

Transfusion threshold: restrictive strategy (Hb 7-8 g/dL) is non-inferior in most critically ill and surgical patients; use 8-10 g/dL in active ischemia.

Massive transfusion: give plasma and platelets in balanced ratios, use calcium replacement (citrate chelation), and warm fluids to prevent hypothermia.

Vasopressor choice: norepinephrine first-line for most distributive shock; phenylephrine for tachyarrhythmia; vasopressin for refractory vasodilatory shock.

Cardiac: maintain coronary perfusion pressure and avoid tachycardia; volatile anesthetics provide preconditioning; TEE guides volume and valve assessment.

One-lung ventilation: protective strategy with tidal volume 4-6 mL/kg predicted body weight, PEEP 5 cm H2O, and permissive hypercapnia to limit volutrauma.

Neuro: maintain cerebral perfusion pressure (CPP = MAP − ICP); hyperventilation to PaCO2 30-35 mmHg is a temporary measure for herniation.

Obstetric: aspiration prophylaxis with nonparticulate antacid and H2 blocker; left uterine displacement after 20 weeks gestation; avoid aortocaval compression.

Obstetric: preeclampsia - neuraxial analgesia preferred; avoid sudden hypotension; magnesium sulfate toxicity reversed with calcium gluconate.

Pediatric: uncuffed tube size ≈ (age/4) + 4 mm; cuffed tube one size smaller; bradycardia from hypoxia is common and treated with oxygen and atropine.

Outpatient: PONV risk factors (female, nonsmoker, history of PONV, postoperative opioids); multimodal prophylaxis with ondansetron, dexamethasone, and droperidol.

Trauma and burns: fluid resuscitation per ATLS; burn patients have hyperkalemia risk with succinylcholine beyond 24-48 h post-injury; use rocuronium instead.

Postoperative respiratory failure: consider residual neuromuscular blockade, opioid-induced hypoventilation, atelectasis, and aspiration.

Postoperative nausea and vomiting: 5-HT3 antagonists, dexamethasone, and droperidol are first-line; rescue with a different class than prophylaxis.

Acute pain management: multimodal analgesia with acetaminophen, NSAIDs, regional blocks, and opioids; PCA reduces total opioid use.

Sepsis: 30 mL/kg crystalloid bolus, broad-spectrum antibiotics within 1 hour, and norepinephrine for MAP <65 mmHg.

Acute respiratory distress syndrome: low tidal volume 4-6 mL/kg predicted body weight, PEEP titration, and prone positioning for severe hypoxemia.

ICU sedation: target Richmond Agitation-Sedation Scale (RASS) 0 to −2; daily sedation interruption reduces ventilator days.

Postoperative delirium: risk factors include age, cognitive impairment, and anticholinergic burden; nonpharmacologic prevention is first-line.

Acute kidney injury: KDIGO stages based on creatinine rise and urine output; avoid nephrotoxins and maintain perfusion pressure.

Obstructive sleep apnea: difficult mask ventilation and intubation risk; use CPAP postoperatively and avoid sedative premedication.

Chronic obstructive pulmonary disease: avoid high FiO2 and prolonged hyperventilation; permissive hypercapnia is acceptable; regional anesthesia preferred when feasible.

Heart failure: avoid myocardial depression and fluid overload; maintain preload, contractility, and afterload balance; consider invasive monitoring.

Diabetes: maintain glucose 140-180 mg/dL perioperatively; avoid hypoglycemia; check glucose hourly during long cases.

Renal failure: avoid succinylcholine if hyperkalemia; dose-adjust renally cleared drugs (morphine, meperidine, vecuronium); use cisatracurium for organ-independent clearance.

Hepatic disease: reduced albumin increases free drug fraction; avoid halothane; monitor coagulation and encephalopathy risk.

Elderly: reduced MAC requirement, decreased clearance, and increased sensitivity to benzodiazepines and opioids; titrate carefully.

Pregnancy: physiologic changes include increased cardiac output, dilutional anemia, and decreased functional residual capacity, accelerating desaturation.

WHO surgical safety checklist: sign-in (before induction), time-out (before incision), sign-out (before leaving OR) reduce surgical morbidity and mortality.

Anesthesia machine checkout: verify oxygen supply, suction, airway equipment, vaporizers, and self-inflating bag before each case.

Medication errors: standardize labeling, use color-coded syringes, and perform independent double-checks for high-alert drugs.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness.

Do-not-resuscitate orders: clarify and document perioperative status; a DNR order may be suspended during anesthesia with patient/family agreement.

Quality metrics: anesthesia-related mortality has declined to very low rates; use incident reporting systems and root cause analysis for improvement.

Professionalism: maintain confidentiality, avoid conflicts of interest, and report impaired colleagues through appropriate channels.

Handoff communication: use structured tools (SBAR) to reduce information loss during transitions of care.

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

Anaphylaxis: epinephrine 0.1-0.5 mg IM (1:1000) or 10-100 mcg IV titrated; fluids, antihistamines, and corticosteroids are adjuncts.

Cardiac arrest: high-quality CPR at 100-120 compressions/min, depth 5-6 cm, minimize interruptions; defibrillate VF/pVT at 200 J biphasic.

Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg bolus then infusion, and avoid vasopressin.

Difficult airway: follow ASA algorithm - optimize oxygenation, call for help, use supraglottic rescue, and proceed to surgical airway if cannot intubate/cannot oxygenate.

Laryngospasm: remove stimulus, apply 100% O2 with CPAP, deepen anesthesia; if persistent, give succinylcholine 0.5-1 mg/kg IV.

Tension pneumothorax: immediate needle decompression at 2nd intercostal space midclavicular line or 5th intercostal space anterior axillary line, then chest tube.

Air embolism: place patient in left lateral Trendelenburg position, aspirate air from central line, and give 100% O2.

Ideal gas law: PV = nRT; at constant temperature, doubling pressure halves volume (Boyle's law), which governs cylinder gas content estimates.

Oxygen cylinder content: full E-cylinder holds ~660 L at 2200 psi; remaining volume ≈ (gauge psi / 2200) × 660 L.

Nernst equation: E = (61.5/z) × log([ion]out/[ion]in) mV at 37°C; determines resting membrane potential contributions of K+, Na+, Cl-.

Henderson-Hasselbalch: pH = 6.1 + log([HCO3-]/(0.03 × PaCO2)); acute PaCO2 rise of 10 mmHg lowers pH ~0.08.

MAC is inversely related to potency and lipid solubility; MAC values are additive (0.5 MAC of two agents = 1.0 MAC total).

Propofol is highly protein-bound (~97-98%) and undergoes hepatic conjugation plus extrahepatic clearance; context-sensitive half-time rises only modestly with infusion duration.

Succinylcholine is hydrolyzed by plasma butyrylcholinesterase; pseudocholinesterase deficiency prolongs block, and dibucaine number <20 suggests homozygous atypical enzyme.

Local anesthetics block Na+ channels from the intracellular side in a use-dependent manner; pKa determines onset, protein binding determines duration, and inflamed tissue (low pH) slows onset.

Revised Cardiac Risk Index (RCRI) predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2 mg/dL, and high-risk surgery; ≥3 predictors indicates elevated risk.

ACC/AHA stepwise approach: estimate surgical risk, assess functional capacity (≥4 METs permits most surgery without further testing), then apply clinical risk indices.

METs: 1 MET ≈ 3.5 mL O2/kg/min; climbing one flight of stairs or walking briskly ≈ 4 METs.

ASA Physical Status: I healthy; II mild systemic disease; III severe systemic disease; IV constant threat to life; V moribund; suffix E for emergency.

Stop smoking at least 4 weeks before surgery for meaningful pulmonary benefit; shorter cessation does not increase complications.

Continue beta-blockers perioperatively; do not initiate high-dose beta-blockade on the day of surgery solely for risk reduction.

STOP-BANG (snoring, tiredness, observed apnea, pressure, BMI >35, age >50, neck circumference >40 cm, gender male); score ≥3 indicates high OSA risk.

Anticoagulation: hold warfarin ~5 days preoperatively with INR check; direct oral anticoagulants are typically held 24-48 h depending on agent and renal function.

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

Rapid sequence induction: preoxygenation, cricoid pressure (debated), and a fast-onset agent (propofol/etomidate/ketamine) plus succinylcholine or rocuronium 1.2 mg/kg.

Sugammadex 16 mg/kg reverses rocuronium deep block within ~3 minutes; 2 mg/kg reverses moderate block (TOF count ≥2).

Awake fiberoptic intubation is preferred when mask ventilation and supraglottic rescue are expected to fail; topicalize the airway and sedate cautiously.

Supraglottic airway leak pressure >20-30 cm H2O suggests adequate seal; higher pressures increase aspiration and gastric insufflation risk.

Spinal anesthesia: block height depends on baricity and patient position; hyperbaric bupivacaine spreads cephalad in sitting-to-supine positioning.

Epidural test dose: 3 mL lidocaine 1.5% with epinephrine 1:200,000; heart rate rise >20 bpm or systolic rise >15-20 mmHg suggests intravascular placement.

MAC (monitored anesthesia care) requires continuous verbal contact, capnography, and immediate availability of airway equipment and vasopressors.

Pulse oximetry: SpO2 90% corresponds to PaO2 ~60 mmHg on the oxyhemoglobin dissociation curve; 75% corresponds to ~40 mmHg.

Capnography waveform: phase I inspiratory baseline, phase II expiratory upstroke, phase III alveolar plateau, phase IV inspiratory downstroke.

End-tidal CO2 falls abruptly with pulmonary embolism, circuit disconnection, or cardiac arrest; rises with hypoventilation, CO2 insufflation, or malignant hyperthermia.

Bispectral index (BIS) target 40-60 for general anesthesia; values may be falsely low with muscle relaxants or hypothermia.

Arterial line: systolic pressure varies with site (radial < brachial < femoral); damping coefficient near 1 is optimal, and underdamping overestimates systolic pressure.

Central venous pressure does not reliably predict fluid responsiveness; dynamic measures (pulse pressure variation, stroke volume variation) are superior in ventilated patients.

Neuromuscular monitoring: train-of-four ratio ≥0.9 indicates adequate recovery; double-burst stimulation is more sensitive than TOF for residual block.

Evoked potentials: somatosensory evoked potentials monitor dorsal column function; motor evoked potentials are sensitive to volatile anesthetics and require total intravenous anesthesia.

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

Isotonic crystalloid distributes ~25% intravascularly; colloid remains mostly intravascular, but evidence does not show outcome benefit over crystalloid.

Pulse pressure variation >13% or stroke volume variation >10% in a ventilated patient suggests fluid responsiveness.

Mean arterial pressure = (SBP + 2×DBP)/3; cerebral and renal autoregulation typically holds between MAP 60-150 mmHg.

Hyperchloremic metabolic acidosis follows large-volume 0.9% saline; balanced solutions (lactated Ringer's, Plasma-Lyte) reduce this risk.

Transfusion threshold: restrictive strategy (Hb 7-8 g/dL) is non-inferior in most critically ill and surgical patients; use 8-10 g/dL in active ischemia.

Massive transfusion: give plasma and platelets in balanced ratios, use calcium replacement (citrate chelation), and warm fluids to prevent hypothermia.

Vasopressor choice: norepinephrine first-line for most distributive shock; phenylephrine for tachyarrhythmia; vasopressin for refractory vasodilatory shock.

Cardiac: maintain coronary perfusion pressure and avoid tachycardia; volatile anesthetics provide preconditioning; TEE guides volume and valve assessment.

One-lung ventilation: protective strategy with tidal volume 4-6 mL/kg predicted body weight, PEEP 5 cm H2O, and permissive hypercapnia to limit volutrauma.

Neuro: maintain cerebral perfusion pressure (CPP = MAP − ICP); hyperventilation to PaCO2 30-35 mmHg is a temporary measure for herniation.

Obstetric: aspiration prophylaxis with nonparticulate antacid and H2 blocker; left uterine displacement after 20 weeks gestation; avoid aortocaval compression.

Obstetric: preeclampsia - neuraxial analgesia preferred; avoid sudden hypotension; magnesium sulfate toxicity reversed with calcium gluconate.

Pediatric: uncuffed tube size ≈ (age/4) + 4 mm; cuffed tube one size smaller; bradycardia from hypoxia is common and treated with oxygen and atropine.

Outpatient: PONV risk factors (female, nonsmoker, history of PONV, postoperative opioids); multimodal prophylaxis with ondansetron, dexamethasone, and droperidol.

Trauma and burns: fluid resuscitation per ATLS; burn patients have hyperkalemia risk with succinylcholine beyond 24-48 h post-injury; use rocuronium instead.

Postoperative respiratory failure: consider residual neuromuscular blockade, opioid-induced hypoventilation, atelectasis, and aspiration.

Postoperative nausea and vomiting: 5-HT3 antagonists, dexamethasone, and droperidol are first-line; rescue with a different class than prophylaxis.

Acute pain management: multimodal analgesia with acetaminophen, NSAIDs, regional blocks, and opioids; PCA reduces total opioid use.

Sepsis: 30 mL/kg crystalloid bolus, broad-spectrum antibiotics within 1 hour, and norepinephrine for MAP <65 mmHg.

Acute respiratory distress syndrome: low tidal volume 4-6 mL/kg predicted body weight, PEEP titration, and prone positioning for severe hypoxemia.

ICU sedation: target Richmond Agitation-Sedation Scale (RASS) 0 to −2; daily sedation interruption reduces ventilator days.

Postoperative delirium: risk factors include age, cognitive impairment, and anticholinergic burden; nonpharmacologic prevention is first-line.

Acute kidney injury: KDIGO stages based on creatinine rise and urine output; avoid nephrotoxins and maintain perfusion pressure.

Obstructive sleep apnea: difficult mask ventilation and intubation risk; use CPAP postoperatively and avoid sedative premedication.

Chronic obstructive pulmonary disease: avoid high FiO2 and prolonged hyperventilation; permissive hypercapnia is acceptable; regional anesthesia preferred when feasible.

Heart failure: avoid myocardial depression and fluid overload; maintain preload, contractility, and afterload balance; consider invasive monitoring.

Diabetes: maintain glucose 140-180 mg/dL perioperatively; avoid hypoglycemia; check glucose hourly during long cases.

Renal failure: avoid succinylcholine if hyperkalemia; dose-adjust renally cleared drugs (morphine, meperidine, vecuronium); use cisatracurium for organ-independent clearance.

Hepatic disease: reduced albumin increases free drug fraction; avoid halothane; monitor coagulation and encephalopathy risk.

Elderly: reduced MAC requirement, decreased clearance, and increased sensitivity to benzodiazepines and opioids; titrate carefully.

Pregnancy: physiologic changes include increased cardiac output, dilutional anemia, and decreased functional residual capacity, accelerating desaturation.

WHO surgical safety checklist: sign-in (before induction), time-out (before incision), sign-out (before leaving OR) reduce surgical morbidity and mortality.

Anesthesia machine checkout: verify oxygen supply, suction, airway equipment, vaporizers, and self-inflating bag before each case.

Medication errors: standardize labeling, use color-coded syringes, and perform independent double-checks for high-alert drugs.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness.

Do-not-resuscitate orders: clarify and document perioperative status; a DNR order may be suspended during anesthesia with patient/family agreement.

Quality metrics: anesthesia-related mortality has declined to very low rates; use incident reporting systems and root cause analysis for improvement.

Professionalism: maintain confidentiality, avoid conflicts of interest, and report impaired colleagues through appropriate channels.

Handoff communication: use structured tools (SBAR) to reduce information loss during transitions of care.

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

Anaphylaxis: epinephrine 0.1-0.5 mg IM (1:1000) or 10-100 mcg IV titrated; fluids, antihistamines, and corticosteroids are adjuncts.

Cardiac arrest: high-quality CPR at 100-120 compressions/min, depth 5-6 cm, minimize interruptions; defibrillate VF/pVT at 200 J biphasic.

Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg bolus then infusion, and avoid vasopressin.

Difficult airway: follow ASA algorithm - optimize oxygenation, call for help, use supraglottic rescue, and proceed to surgical airway if cannot intubate/cannot oxygenate.

Laryngospasm: remove stimulus, apply 100% O2 with CPAP, deepen anesthesia; if persistent, give succinylcholine 0.5-1 mg/kg IV.

Tension pneumothorax: immediate needle decompression at 2nd intercostal space midclavicular line or 5th intercostal space anterior axillary line, then chest tube.

Air embolism: place patient in left lateral Trendelenburg position, aspirate air from central line, and give 100% O2.