Post-Module Quiz

1) D

The order of induction medications is: 

Medication for pain (fentanyl)  → Medication to sedate the patient/make them "fall asleep" (propofol) → Medication for paralysis (rocuronium)

Midazolam is often administered prior to propofol, while the patient is still awake, to relieve anxiety and supplement sedation. 

2) A, B, C, D, F, G

Propofol, ketamine, and dexmedetomidine have strong sedative-hypnotic effects and are used as the primary sedative agent during the induction phase.

Midazolam and remifentanil, amongst other effects, have sedative properties, and are used to supplement the primary sedative agent. This allows one to reduce the dose of the primary sedative agent and reduce side effects associated with it.

Sevoflurane is a volatile agent used as the primary sedative agent during the maintenance phase. 

3) B, D 

Succinylcholine (NMB) is used to paralyze the skeletal muscle, including the muscles used for breathing. This prevents the patient from coughing and gagging. 

Opioids, including fentanyl, have the same effect, as they reduce airway reflexes (coughing, bronchospasm) and autonomic response to painful stimuli during intubation. 

4) B, D

Succinylcholine is a depolarizing neuromuscular block. Rocuronium is a non-depolarizing neuromuscular block. 

5) A

Some patients have an allergy to volatile anesthetics, including sevoflurane, and will develop malignant hyperthermia. In that case, total intravenous anesthesia can be used. This is when an IV sedative agent is used during the maintenance phase. 

6) A

While propofol and midazolam both have amnesic properties, midazolam has more profound amnesic effects and is ideal for this situation. 

7) D

Naloxone is the most commonly used antidote for an opioid overdose.

8) B, D, E, H

These are the hallmark clinical signs and symptoms of an opioid overdose.

9) C

Flumazenil is a benzodiazepine antagonist.

10) B, F

Overdose classically presents as CNS depression, slurred speech, and normal vitals. 

Unlike with opioid overdose, respiratory depression is uncommon with an isolated benzodiazepine overdose. However, benzodiazepine overdose is often concurrent with co-ingestion of another depressant, such as alcohol or opioids, which can cause potentially fatal respiratory depression.

11) A

The most likely agent is propofol, given the decrease in blood pressure, relatively stable heart rate (within normal range), and decreased respiratory rate.  Ketamine provides stable or increased blood pressure. Dexmedetomidine provides stable respiratory rate. 

Another clue is the fast onset (propofol takes ~30 sec to take effect, which is the fastest onset compared to the other options).