10. General anesthesia - general anesthesia stages. Intensive care in maxillofacial surgery.

Question 1

10. General anesthesia - general anesthesia stages. Intensive care

Four stages of general anesthesia

Answer 1

1. Minimal Sedation (Anxiolysis):
   * Normal response to verbal stimulation
   * No impact on airway, ventilation, or cardiovascular function
2. Moderate Sedation (Conscious Sedation):
   * Purposeful response to verbal or tactile stimulation
   * Airway and ventilation not compromised
   * Cardiovascular function maintained
3. Deep Sedation/Analgesia:
   * Response after repeated or painful stimulation
   * Possible need for assistance in maintaining airway and ventilation
   * Cardiovascular function is maintained
4. General Anesthesia:
   * Unarousable even with painful stimulation.
   * Airway intervention is required
   * Possible support needed for ventilation and potential impairment of cardiovascular function.

Question 2

10. General anesthesia - general anesthesia stages. Intensive care

Role of an Intensive Care Unit (ICU) in a hospital setting

Answer 2

• Patients with severe and life-threatening illnesses and injuries
• Constant, close monitoring and support from specialist equipment and medications
• Staffed by highly trained doctors and nurses
• Higher staff-to-patient ratio
• Access to advanced medical resources and equipment

Question 3

10. General anesthesia - general anesthesia stages. Intensive care

Types of conditions commonly treated in ICUs

Answer 3

• Acute respiratory distress syndrome (ARDS),
• Trauma, multiple organ failure, and sepsis

Question 4

10. General anesthesia - general anesthesia stages. Intensive care

What is covered in the personal history of a patient

Answer 4

• Habits like chewing tobacco
• Alcohol consumption
• Smoking, drug abuse, and exposure to commercial sex workers

Question 5

10. General anesthesia - general anesthesia stages. Intensive care

Purpose of routine haematological investigations in oral and maxillofacial surgery

Answer 5

• Overall health status
• Detect infections
• Assess nutritional status
• Identify bleeding disorders and evaluate the immune response to facilitate postoperative recovery

Question 6

10. General anesthesia - general anesthesia stages. Intensive care

What haemoglobin (Hb) indicates in a blood test

Answer 6

Indicates the oxygen-carrying capacity of the blood

Question 7

10. General anesthesia - general anesthesia stages. Intensive care

Normal haemoglobin values for males and females

Answer 7

• Females: 12 to 16 g/dL
• Males: 14 to 18 g/dL

g/dL- grams per decilitre

Question 8

10. General anesthesia - general anesthesia stages. Intensive care

Decreased haemoglobin value suggests

Answer 8

• Anaemia=>iron deficiency
• Decreased absorption of vitamins and minerals
• Bone marrow depression, increased blood loss

Question 9

10. General anesthesia - general anesthesia stages. Intensive care

What should be done if a patient has low haemoglobin

Answer 9

Referred to specialists

Question 10

10. General anesthesia - general anesthesia stages. Intensive care

What a complete blood count (CBC) includes

Answer 10

• Red blood cell count
• White blood cell count
• Differential white blood cell count
• Platelet number estimation, and a blood smear description

Question 11

10. General anesthesia - general anesthesia stages. Intensive care

Benefits of performing a CBC

Answer 11

• Helps to determine nutritional status
• Detect infections
• Identify bleeding disorders
• Evaluate the patient’s immune response

Question 12

10. General anesthesia - general anesthesia stages. Intensive care

Normal values for red blood cell count in males and females

Answer 12

• Females: 4.5 to 5.5 million cells per cu mm
• Males: 4.5 to 6.2 million cells per cu mm

cu= cubic millimetres (mm3)

Question 13

10. General anesthesia - general anesthesia stages. Intensive care

Conditions are associated with decrease in red blood cell count

Answer 13

• Anaemia, pellagra
• Haemorrhage, and liver disease

Question 14

10. General anesthesia - general anesthesia stages. Intensive care

Conditions associated with an increase in red blood cell count

Answer 14

• Polycythaemia and extreme dehydration

Question 15

10. General anesthesia - general anesthesia stages. Intensive care

Normal values for white blood cell count in adults and children

Answer 15

• Adults: 5000 to 10000 cells per cu mm
• Children below 7 years: 6000 to 15000 cells per cu mm

Question 16

10. General anesthesia - general anesthesia stages. Intensive care

Conditions that cause an increased white blood cell count (leucocytosis)

Answer 16

• Acute infections
• Uraemia, leukaemia, and steroid therapy

Question 17

10. General anesthesia - general anesthesia stages. Intensive care

Conditions that cause a decreased white blood cell count (leukopenia)

Answer 17

• Aplastic anaemia, radiation therapy
• Infectious mononucleosis, malaria, AIDS

Question 18

10. General anesthesia - general anesthesia stages. Intensive care

Physiological factors can cause an increase in WBC count

Answer 18

• Pregnancy, exposure to heat and cold
• Muscular exercise, and emotional stress

Question 19

Normal distribution of polymorphonuclear leukocytes (neutrophils) in a differential white blood cell count

Answer 19

Neutrophils: 50 to 70 percent

Question 20

10. General anesthesia - general anesthesia stages. Intensive care

Conditions that cause an increase in neutrophils

Answer 20

• Infections, granulocytic leukaemia
• Post-surgery, severe exercise

Question 21

10. General anesthesia - general anesthesia stages. Intensive care

Conditions that cause a decrease in neutrophils

Answer 21

Aplastic anaemia, viral infections, and patients undergoing radiation

Question 22

10. General anesthesia - general anesthesia stages. Intensive care

Normal distribution of lymphocytes

Answer 22

25 to 40 percent

Question 23

10. General anesthesia - general anesthesia stages. Intensive care

Conditions that cause an increase in lymphocytes

Answer 23

Viral infections, tuberculosis, mononucleosis

Question 24

10. General anesthesia - general anesthesia stages. Intensive care

Conditions that cause a decrease in lymphocytes

Answer 24

Stress, uraemia, and steroid therapy

Question 25

# 10. General anesthesia - general anesthesia stages. Intensive care Normal value for platelet count

Answer 25

150,000 to 400,000 cells per cu mm

Question 26

# 10. General anesthesia - general anesthesia stages. Intensive care Conditions that cause an increased platelet count

Answer 26

* Malignancy, post-surgery * Iron deficiency anaemia, trauma

Question 27

# 10. General anesthesia - general anesthesia stages. Intensive care Conditions that cause a decreased platelet count

Answer 27

Viral infections, and infectious mononucleosis

Question 28

# 10. General anesthesia - general anesthesia stages. Intensive care Normal ESR values for males and females using Wintrobe’s method

Answer 28

* Females: 0-20 mm/hour * Males: 0-10 mm/hour

Question 29

# 10. General anesthesia - general anesthesia stages. Intensive care What an elevated ESR indicates

Answer 29

Chronic infections, infarctions, trauma

Question 30

# 10. General anesthesia - general anesthesia stages. Intensive care Normal bleeding time by Duke’s method

Answer 30

3 to 5 minutes

Question 31

# 10. General anesthesia - general anesthesia stages. Intensive care Conditions that cause an increased bleeding time

Answer 31

* Thrombocytopenia * Capillary wall abnormalities (vitamin C deficiency) * Platelet abnormalities (drug-induced, e.g., aspirin, warfarin)

Question 32

# 10. General anesthesia - general anesthesia stages. Intensive care Normal clotting time by Lee-White method

Answer 32

4 to 10 minutes

Question 33

# 10. General anesthesia - general anesthesia stages. Intensive care Conditions that cause prolonged clotting time

Answer 33

Thrombocytopenia, clotting factor deficiency, and use of anticoagulants.

Question 34

# 10. General anesthesia - general anesthesia stages. Intensive care Normal prothrombin time

Answer 34

12-14 seconds

Question 35

# 10. General anesthesia - general anesthesia stages. Intensive care Sites bacterial cultures can be obtained from

Answer 35

Throat, sputum, draining pus,

Question 36

# 10. General anesthesia - general anesthesia stages. Intensive care How cultures from the oral cavity can be obtained

Answer 36

* Gathering exudative material=>by **aspiration w/ a needle and syringe** * or by using a **swab**

Question 37

# 10. General anesthesia - general anesthesia stages. Intensive care Biopsy and why is it important

Answer 37

* Removal of tissue from a living subject for histological evaluation

Question 38

# 10. General anesthesia - general anesthesia stages. Intensive care Punch biopsy and when it is used

Answer 38

* Small part of the lesion is obtained using a punch * Useful for mucosal lesions in inaccessible regions * May cause crushing or distortion of the tissues

Question 39

# 10. General anesthesia - general anesthesia stages. Intensive care When an incisional biopsy performedand how it is done

Answer 39

* **Large diffuse lesion** * **Section** of lesion, along w/ **normal tissue**, incised w/ scalpel

Question 40

# 10. General anesthesia - general anesthesia stages. Intensive care Excisional biopsy and when it is appropriate

Answer 40

* Removal of the entire lesion * Appropriate for extremely small lesions (less than 1 cm)

Question 41

# 10. General anesthesia - general anesthesia stages. Intensive care Normal range for fasting blood glucose values

Answer 41

3.9–5.5 mmol/L

Question 42

# 10. General anesthesia - general anesthesia stages. Intensive care Normal postprandial (after eating) blood glucose level

Answer 42

< 7.8 mmol/L

Question 43

# 10. General anesthesia - general anesthesia stages. Intensive care Conditions associated with increased blood glucose levels

Answer 43

Diabetes mellitus, Cushing’s syndrome, pancreatitis