Kuwait MOH Anesthesia Technician cheat sheet

Oxygen content: CaO2 = (1.34 × Hb × SaO2) + (0.003 × PaO2); normal ≈ 20 mL/dL; anemia reduces CaO2 more than hypoxemia at high PaO2.

Alveolar gas equation: PAO2 = FiO2 × (Patm − PH2O) − PaCO2 / R; at sea level (Patm 760, PH2O 47, R 0.8) PAO2 ≈ 713 × FiO2 − 1.25 × PaCO2.

Ostwald solubility coefficient determines induction speed with inhaled agents: lower blood solubility (desflurane 0.42) gives faster alveolar-to-brain equilibration than higher (isoflurane 1.4).

MAC values in 100% O2: N2O 104%, desflurane 6.0%, sevoflurane 2.0%, isoflurane 1.15%; MAC is reduced ~6% per decade of age and by hypothermia, pregnancy, and opioids.

Poiseuille's law: flow ∝ r^4 / length; halving an IV catheter radius reduces flow 16-fold, so use the largest bore for rapid resuscitation.

Nerve fiber block order: small unmyelinated C fibers (pain, temperature) first, then small myelinated Aδ, then large myelinated Aα motor; explains differential sensory block.

Functional residual capacity is the sum of expiratory reserve volume and residual volume; obesity, supine position, and general anesthesia reduce FRC and promote atelectasis.

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

Cerebral perfusion pressure = MAP − ICP; autoregulation normally holds CBF constant between MAP 50 and 150 mmHg.

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

Mallampati classes I–IV describe visibility of oropharyngeal structures; class III–IV plus thyromental distance <6 cm, mouth opening <3 cm, or neck extension <35° predict difficult laryngoscopy.

Stop smoking at least 4–8 weeks before elective surgery to reduce airway reactivity and wound complications; brief abstinence still lowers carboxyhemoglobin.

Fasting intervals (elective): clear fluids 2 h, breast milk 4 h, infant formula/nonhuman milk 6 h, light meal 6 h; these follow ASA guidance and reduce aspiration risk.

Continue beta-blockers and statins perioperatively; hold ACE inhibitors on the morning of surgery when hypotension is a concern; bridge warfarin only in high thrombotic risk.

Informed consent must document risks, benefits, alternatives, and the patient's questions; in Kuwait, consent is obtained in Arabic or a language the patient understands.

Preoperative checklist: identity, allergies, NPO status, dentures/loose teeth, site marking, blood products available, and anesthesia machine and suction tested.

Daily machine checkout sequence: verify backup ventilation, high-pressure leak test, install scavenging, calibrate O2 sensor, low-pressure leak test, test vaporizers, check breathing circuit and unidirectional valves, confirm suction, then perform a manual and mechanical ventilation trial.

Pipeline color codes (ISO): oxygen white, nitrous oxide blue, medical air black/white, vacuum yellow, nitrogen black; cylinder pin-index safety systems prevent misconnection.

Oxygen cylinder duration: volume (L) = cylinder factor × pressure (bar); an E-cylinder factor ≈ 0.3 L/bar, so 2000 psi (≈138 bar) yields about 660 L.

Mapleson classifications: A (Magill) and D (Bain) are efficient for spontaneous ventilation; B and C are inefficient; Mapleson A is inefficient for controlled ventilation.

Circle system requires unidirectional valves, fresh gas inlet, adjustable pressure-limiting valve, reservoir bag, CO2 absorber, and Y-piece; low fresh gas flows require adequate absorber function.

Soda lime exhaustion signs: color change (ethyl violet), increased inspired CO2, and heat generation; replace when granules crumble or CO2 absorbent is exhausted.

Laryngoscope blades: Macintosh curved (adult), Miller straight (children, anterior larynx); check light brightness and spare batteries before induction.

Difficult airway algorithm: assess, optimize, have a plan A–D; call for help early; limit attempts to avoid trauma; maintain oxygenation over intubation.

Preoxygenation with 100% O2 for 3–5 minutes or 8 vital capacity breaths achieves end-tidal O2 >90% and extends safe apnea time.

Confirm tracheal tube placement with continuous waveform capnography plus auscultation and chest rise; capnography is the standard, not optional.

Cormack–Lehane grades: I full vocal cords, II partial cords, III epiglottis only, IV epiglottis not visible; grade III–IV predicts difficult intubation.

Rescue devices: supraglottic airway (LMA), video laryngoscope, fiberoptic bronchoscope, intubating stylet, and surgical airway kit must be immediately available.

Rapid sequence induction: preoxygenate, apply cricoid pressure if indicated, induce with hypnotic, give neuromuscular blocker, intubate without positive pressure ventilation.

Pediatric airway: large head, small mouth, large tongue, anterior larynx; use uncuffed or appropriately sized cuffed tubes and avoid excessive cuff pressure.

Propofol induction dose 1.5–2.5 mg/kg IV; causes hypotension and apnea; contains egg lecithin and soybean oil, so caution in egg/soy allergy.

Ketamine 1–2 mg/kg IV provides dissociative anesthesia and analgesia; increases heart rate and blood pressure; useful in hypovolemia.

Succinylcholine 1–1.5 mg/kg IV; onset 30–60 s, duration 5–10 min; contraindicated in hyperkalemia, burns >24 h, spinal cord injury, and malignant hyperthermia susceptibility.

Rocuronium 0.6–1.2 mg/kg IV; onset 60–90 s; reversed by sugammadex 2–4 mg/kg (16 mg/kg for deep block) or neostigmine with glycopyrrolate.

Neostigmine 0.04–0.07 mg/kg with glycopyrrolate 0.2 mg per 1 mg neostigmine reverses residual block; avoid in bowel obstruction or bladder outlet obstruction.

Local anesthetic maximum doses: lidocaine 4.5 mg/kg plain, 7 mg/kg with epinephrine; bupivacaine 2–2.5 mg/kg; add epinephrine to slow absorption and prolong block.

Crystalloid vs colloid: isotonic crystalloids distribute across extracellular fluid; colloids stay intravascular longer but carry allergy and cost risks; 4 mL crystalloid ≈ 1 mL blood loss in resuscitation.

Ondansetron 4 mg IV for postoperative nausea and vomiting; dexamethasone 4–8 mg IV as adjunct; both have minimal sedation.

Minimum monitoring: continuous pulse oximetry, capnography, ECG, noninvasive blood pressure, temperature, and inspired/end-tidal agent concentration; plus stethoscope or precordial/esophageal monitor.

Capnography waveform: phase I inspiratory baseline, phase II expiratory upstroke, phase III alveolar plateau (end-tidal), phase IV inspiratory downstroke; loss of waveform suggests disconnection or esophageal intubation.

Pulse oximetry principles: red (660 nm) and infrared (940 nm) absorption; unreliable with poor perfusion, motion, nail polish, or methemoglobinemia.

Blood pressure cuff width should be 40% of arm circumference; too narrow overestimates, too wide underestimates.

Documentation includes preoperative assessment, consent, anesthesia plan, drugs and doses with times, fluids, blood products, vital signs, events, and post-anesthesia plan; entries must be contemporaneous and legible.

Depth of anesthesia monitoring: BIS 40–60 for general anesthesia; end-tidal agent monitoring reduces awareness risk.

Neuromuscular monitoring: train-of-four ratio >0.9 indicates adequate recovery; clinical signs alone are unreliable.

Supine: arms tucked at sides, palms up, avoid pressure on ulnar nerve at elbow; head neutral with eyes taped and padded.

Trendelenburg: head down; risk of increased intracranial pressure, facial edema, and ventilation difficulty; secure patient to prevent sliding.

Prone: eyes and ears free of pressure, abdomen free to reduce inferior vena cava compression, arms abducted <90°; use chest and pelvic supports.

Lateral decubitus: dependent ear and eye protected, axillary roll placed below axilla to avoid brachial plexus injury, upper leg supported.

Lithotomy: legs supported, avoid excessive hip flexion and peroneal nerve compression; risk of compartment syndrome and nerve injury.

Universal precautions: hand hygiene, gloves, gown, mask, eye protection; follow Kuwait MOH infection control policy and sharps disposal regulations.

Surgical safety checklist (WHO-style): sign in, time out, sign out; confirm patient identity, site, allergies, and availability of blood products.

Malignant hyperthermia: triggered by volatile agents and succinylcholine; signs are rising ETCO2, masseter spasm, hyperthermia, tachycardia, acidosis; treat with dantrolene 2.5 mg/kg IV and stop triggers.

Anaphylaxis: epinephrine 0.5 mg IM (1:1000) adult, repeat every 5 min; airway, oxygen, IV fluids, and antihistamines as adjuncts.

Local anesthetic systemic toxicity: stop injection, airway support, 20% lipid emulsion 1.5 mL/kg bolus then infusion 0.25 mL/kg/min; avoid vasopressin.

Cardiac arrest: follow ACLS; chest compressions 100–120/min, depth 5–6 cm, ratio 30:2, minimize interruptions; defibrillate VF/pVT immediately.

Laryngospasm: remove stimulus, apply 100% O2 with CPAP, deepen anesthesia; if persists, succinylcholine 0.5–1 mg/kg IV or 4 mg/kg IM.

Aspiration: head-down lateral position, suction, 100% O2, bronchoscopy if particulate matter; observe for pneumonitis.

Awareness under anesthesia: document, inform patient, provide follow-up; monitor end-tidal agent and consider BIS.

PACU discharge criteria (Aldrete score ≥9): activity, respiration, circulation, consciousness, and oxygen saturation; score each 0–2.

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

Pain assessment: numeric rating scale 0–10; multimodal analgesia combines paracetamol, NSAIDs, opioids, and regional techniques to reduce opioid requirements.

Opioid side effects: respiratory depression, sedation, nausea, pruritus, constipation; monitor sedation and respiratory rate in PACU.

Airway obstruction in PACU: snoring, paradoxical breathing, desaturation; reposition, jaw thrust, oral/nasal airway, suction, and prepare for reintubation.

Post-anesthesia documentation: vital signs, pain score, nausea, urine output, drain output, and readiness for discharge.

Kuwait MOH requires PACU nurse-to-patient ratio and physician coverage per hospital policy; handover should be structured (SBAR).

Scope of practice: anesthesia technicians work under the supervision of an anesthesiologist; they do not independently induce anesthesia or prescribe drugs.

Informed consent: obtain from competent adult; for minors or incapacitated patients, follow legal guardian and Kuwait MOH rules.

Confidentiality: patient information is protected; disclose only to authorized team members and as required by law.

Documentation standards: entries must be accurate, timed, signed, and never altered retrospectively; errors corrected with a single line and initials.

Infection control: comply with Kuwait MOH hand hygiene, sterilization, and waste segregation policies; report needlestick injuries immediately.

Professional development: maintain licensure and continuing education as required by Kuwait MOH and the Ministry of Health's registration system.

Patient safety reporting: report adverse events and near misses through the hospital incident reporting system without blame.