Anaes · Topics

Topics

265 units across 58 domains — 265 topics for Anaesthesia.

265Units

58Domains

Vascular anaesthesia Applied anatomy Depth of anaesthesia & awareness Applied cardiovascular & respiratory physiology Acute pain & multimodal analgesia Anaesthetic adjuncts Airway management Obstetric anaesthesia Cardiac anaesthesia Thoracic anaesthesia Head & neck / ECT General surgery anaesthesia Neuroanaesthesia Perioperative medicine Ophthalmic anaesthesia Anaesthesia for the elderly and the co-morbid patient Anaesthetic ventilators Critical incidents Orthopaedic anaesthesia Neuromuscular blockade & reversal Measurement & monitoring physics Breathing systems & circuits Plastics and burns anaesthesia Cardiac anaesthesia & cardiopulmonary bypass Neuraxial anaesthesia Chronic & cancer pain Regional anaesthesia Volatile & inhalational agents Paediatric anaesthesia Physiology TIVA & target-controlled infusion Electricity, diathermy & theatre safety Ethics, consent & medicolegal Intravenous induction agents Extubation & recovery Invasive monitoring Head & neck / ENT anaesthesia Local anaesthetic pharmacology Head & neck / trauma airway Medical gases & gas supply Opioids & analgesics Patient safety, human factors & CRM Perioperative cardiac arrest Perioperative fluid & goal-directed therapy Regional / perioperative medicine Postoperative nausea & vomiting Preoperative assessment & risk Neuro / orthopaedic anaesthesia The anaesthetic machine Airway management & difficult airway Applied physiology Applied physiology — thermoregulation and heat balance Thoracic anaesthesia & one-lung ventilation Trauma and massive haemorrhage Ultrasound-guided peripheral nerve blocks Vaporisers Vasopressors & inotropes Patient safety

Exam-exhaustive spinal cord protection in TAAA/TEVAR for ANZCA Final.

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Neuraxial anaesthesia — spinal, epidural and combined spinal-epidural — depends entirely on knowing the layered anatomy from skin to cerebrospinal fluid. The framework rests on six exam-critical ideas. First, the vertebral column is built of 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral fused, 4 coccygeal) with four curvatures (cervical and lumbar lordotic, thoracic and sacral kyphotic); a typical vertebra has a body anteriorly, a vertebral arch posteriorly forming the vertebral canal, and seven processes (two transverse, four articular, one spinous). Second, the spinal cord is shorter than the vertebral canal: it ends as the conus medullaris at the L1/L2 disc in the adult (lower, around L3, in the neonate), and below it the lumbar and sacral nerve roots form the cauda equina — which is why a lumbar puncture or spinal needle is inserted at or below L3/L4 to avoid the cord. Third, three meningeal layers invest the cord: the tough dura mater outermost, the delicate arachnoid mater in the middle, and the pia mater adherent to the cord; CSF lies in the subarachnoid space between arachnoid and pia. Fourth, the epidural space lies outside the dura and contains fat, lymphatics, the internal vertebral venous plexus (Batson's valveless plexus) and the spinal nerve roots as they exit; its depth from the skin varies with body habitus and is measurable by ultrasound or MRI. Fifth, the ligamentum flavum (yellow ligament) is the tough elastic ligament joining the laminae of adjacent vertebrae and is the key resistance landmark for loss-of-resistance in epidural placement. Sixth, a midline neuraxial needle passes in order through skin, subcutaneous tissue, the supraspinous ligament, the interspinous ligament, the ligamentum flavum (the epidural endpoint), and then — if a spinal is intended — the dura mater and arachnoid mater into the subarachnoid space. Built on the MRI epidural-space-depth study (Alsaati 2026), the ligamentum-flavum study (Gu 2026), the tethered-spinal-cord anaesthetic-management report (Alessi 2026), the loss-of-resistance technique study (Goksu 2026), the inadvertent-dural-puncture report (Greenspon 2026), the ultrasound combined-spinal-epidural study (Sethi 2026), the myodural-bridge meningeal histology study (Rodriguez-Vazquez 2026), and the lumbar-puncture simulation-training study (Lopez-Brotons 2026).

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Processed electroencephalogram monitors — the bispectral index (BIS), spectral entropy and related indices — estimate the depth of anaesthesia by quantifying the shift of the frontal EEG from fast, low-amplitude awake activity to slow, high-amplitude, synchronised anaesthetic activity. They reduce the risk both of awareness and of overdose, but only when the dimensionless index is read alongside the raw trace and the clinical signs, because each is confounded by age, electromyographic activity, electrocautery and paradoxical excitation.

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Gas exchange requires that ventilation and perfusion are matched, and most clinical hypoxaemia is a disorder of that matching. The framework rests on five exam-critical ideas: the ventilation-perfusion (V/Q) ratio is normally about 0.8 to 1.0, and both ventilation and perfusion increase from apex to base, but perfusion more, so the apex is high V/Q and the base low V/Q; ventilation-perfusion mismatch spans a spectrum from shunt (V/Q of zero, perfusion without ventilation) through normal to dead space (V/Q very high, ventilation without perfusion); true shunt is hypoxaemia that is NOT corrected by 100 percent oxygen, whereas low-V/Q mismatch IS corrected by oxygen — the test that distinguishes them; dead space is ventilated lung that does not exchange gas, raised by pulmonary embolism; and the five causes of hypoxaemia are low inspired oxygen, hypoventilation, diffusion impairment, shunt, and ventilation-perfusion mismatch — separated by the alveolar-arterial oxygen gradient. Built on the acute-hypoxaemic-respiratory-failure imaging review (Coppola 2026), the Eisenmenger-syndrome review (the classic pulmonary shunt, Baino 2026), the patent-foramen-ovale platypnea study (right-to-left shunt hypoxaemia, Ramidi 2026), the pulmonary-embolism perfusion-imaging study (Evans 2026), the portopulmonary-gas-exchange study (Lacoste-Palasset 2026), and the partial-pressure-of-oxygen review (Hoecker 2026).

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Acute pain & multimodal analgesia

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Acute pain & multimodal analgesia

Exam-exhaustive acute pain: WHO-style ladder adapted to acute surgical pain, multimodal components with doses, PCA principles, regional integration, and brief opioid-tolerant patient strategy.

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Vasopressin (antidiuretic hormone, ADH) is an endogenous PEPTIDE hormone released from the posterior pituitary that is fundamentally NOT a catecholamine — it acts through a completely separate, non-adrenergic receptor family. Its three receptors define its three actions: V1 (V1a) on vascular smooth muscle produces Gq-coupled vasoconstriction, V2 on the renal collecting duct produces Gs-coupled water reabsorption through aquaporin-2, and V3 (V1b) on the anterior pituitary drives ACTH release. As a vasopressor it works through V1 INDEPENDENT of adrenergic receptors, which is its defining advantage: it remains effective when adrenergic receptors are downregulated in septic shock and vasoplegia, the basis of its role as the catecholamine-sparing, catecholamine-resistant agent (Hiroto 2026, Dong 2026). The principal use is as a SECOND-LINE vasopressor in septic shock, added to noradrenaline when noradrenaline alone is insufficient — given at a FIXED dose of 0.03 to 0.04 units per min (NOT titrated to effect) and catecholamine-sparing, reducing the noradrenaline requirement (Hiroto 2026). Other uses are vasoplegia after cardiopulmonary bypass, variceal bleeding (splanchnic vasoconstriction), and — via its V2-selective synthetic analogue desmopressin (DDAVP) — central diabetes insipidus, haemophilia and von Willebrand disease (factor VIII and vWF release), and nocturnal enuresis (Yahya 2026, Parkinson 2026). It has a half-life of about 10 to 20 minutes, is metabolised by tissue peptidases in the liver and kidney, and is given by IV infusion. The adverse-effect profile is the direct consequence of V1 vasoconstriction (peripheral, digital and MESENTERIC ISCHAEMIA) plus V2 water retention (HYPONATRAEMIA at high or prolonged doses), with decreased cardiac output from increased afterload and reflex bradycardia. Against noradrenaline, vasopressin is non-adrenergic (no tachyarrhythmia, effective when adrenergic receptors are downregulated) where noradrenaline is alpha-plus-beta-1 adrenergic — the two are used TOGETHER in septic shock. Against adrenaline the mechanism differs entirely (peptide versus catecholamine). Built on the septic-shock noradrenaline-and-vasopressin timing and dose study (Hiroto 2026), the neonatal fluid-refractory septic shock first-line vasopressor study (Yahya 2026), the vasopressor selection and postoperative delirium in older adults study (Dong 2026), the cost and environmental comparison of anaesthetic emergency drugs (Parkinson 2026), the machine-learning intraoperative hypotension prediction model (Liu 2026), and the carbon-monoxide-as-stress-axis-regulator study (Mancuso 2026).

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Video laryngoscopy is the technique of laryngoscopy in which a camera mounted at the tip of the blade transmits an indirect view of the glottis to a monitor, dissolving the geometric constraint — the alignment of the oral, pharyngeal and laryngeal axes — that direct laryngoscopy imposes. The framework rests on six ideas: the principle of the indirect view from a tip-mounted camera on a hyperangulated blade; the two families of device — the channelled (Airtraq, Pentax AWS) that guide the tube through a built-in channel, and the non-channelled or hyperangulated (GlideScope, McGrath, C-MAC) that provide the view but leave tube delivery to the operator; the distinguishing features of each named device; the advantages over direct laryngoscopy — a better Cormack-Lehane view, no need to align the axes, less cervical-spine movement, a shared view for teaching and supervision, and recording; the disadvantages — fogging and secretions, the defining 'can see but cannot tube' failure of the non-channelled device, screen and power dependence, cost, and a learning curve; and the evidence, which reliably shows an improved glottic view but a conditional effect on outcome — large in the predicted difficult airway, modest in the routine case, and dependent on operator training and on the optimisation of the pharmacological conditions. Anchored to contemporary evidence on the optimisation of video laryngoscopy intubating conditions, the role of video laryngoscopy in infants, the soiled airway, and the airway management of neuromuscular disease.

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Anaesthetic plan for pre-eclampsia and eclampsia with exact MgSO4 Pritchard/Zuspan regimens, BP control, fluid restriction, neuraxial versus GA decisions, and airway risk.

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RRRAC weaning framework, TOE-guided optimisation, vasoplegia, RV failure, and escalation to IABP/ECMO when unable to wean from CPB.

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Anaesthesia for VATS lobectomy with lung isolation, protective OLV, and multimodal analgesia comparing thoracic epidural, paravertebral, ESP and systemic opioid-sparing strategies.

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Head & neck / ECT

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Anaesthesia for electroconvulsive therapy (ECT)

Exam-exhaustive ECT anaesthesia: biphasic autonomic response, induction agent versus seizure quality, suxamethonium-modified technique, bite block, hyperventilation, post-ictal catecholamine surge control, and recovery airway protection for ANZCA Final.

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Exam-exhaustive TURP syndrome and major gynae anaesthesia for ANZCA Final: glycine 1.5 percent absorption, hyponatraemia treatment with hypertonic saline, bipolar saline systems, spinal versus GA, lithotomy nerve injury, and major haemorrhage/TXA principles.

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Sitting-position neurosurgery risks, VAE pathophysiology, detection hierarchy from TOE to EtCO2, PFO and paradoxical embolism, Durant manoeuvre management, multi-orifice CVP aspiration, and prevention for fellowship exams.

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Exam-pass sepsis under anaesthesia: Sepsis-3 framing, SSC hour-1 principles, induction of the septic patient, source control, noradrenaline and MAP targets, lactate interpretation, and ICU handover for ANZCA Final and equivalents.

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Exam-exhaustive malignant hyperthermia: RYR1 calcium storm, absolute trigger list, early ETCO2/masseter signs, EMHG/MHAUS crisis bundle, exact dantrolene dosing, cooling and hyperkalaemia/DIC management, trigger-free technique, and family counselling with MH unit referral for ANZCA Final and equivalents.

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Orthopaedic anaesthesia

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Arthroplasty anaesthesia, ERAS, and blood conservation

Arthroplasty ERAS combines optimised comorbidities, preferred neuraxial or regional plus light GA, TXA for blood conservation (typical 1 g IV or 10–15 mg/kg with local protocols), multimodal opioid-sparing analgesia, early mobilisation, and VTE prophylaxis timed safely with neura

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Tourniquet physiology, bone cement implantation syndrome, and fat embolism

Exam-exhaustive orthopaedic triple crisis: tourniquet inflation/deflation physiology and ~2 h limit; Donaldson BCIS grades 1–3 at cementation; fat embolism syndrome triad (respiratory, neuro, petechiae) — prevention, recognition, and supportive care for ANZCA Final.

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Suxamethonium (succinylcholine, sux) is the ONLY depolarising neuromuscular blocker in clinical use — structurally it is two acetylcholine molecules joined back-to-back as a di-acetylcholine ester, and it activates the postsynaptic nicotinic (muscle) receptor to produce an initial depolarisation (the visible fasciculation) followed by a sustained depolarisation that inactivates the surrounding sodium channels and produces a phase I block and flaccid paralysis. It has the FASTEST onset of any neuromuscular blocker at 30 to 60 seconds and the SHORTEST duration at 5 to 10 minutes, which makes it the rapid-sequence induction agent of choice for the full-stomach or aspiration-risk patient and for the difficult airway (O'Connell 2026; Marcus 2026). It is not hydrolysed by synaptic acetylcholinesterase but by plasma butyrylcholinesterase synthesised in the liver, so butyrylcholinesterase deficiency — genetic (dibucaine-resistant, autosomal recessive) or acquired (liver disease, pregnancy, organophosphates) — produces prolonged apnoea lasting hours (Snak de Souza 2026; Abbasi 2026). Repeated boluses or large total doses convert the block into a phase II (desensitisation) block that resembles a non-depolariser. The exam-critical adverse-effect and contraindication list is long and high-yield: severe hyperkalaemia in burns (beyond 24 hours and up to about 2 years), denervation, spinal-cord injury, prolonged immobility and critical illness from upregulated extrajunctional acetylcholine receptors (Puxty 2026); malignant hyperthermia — sux is a potent RYR1-mediated trigger (Fang 2026); bradycardia; raised intraocular pressure (contraindicated in the open-eye injury); raised intracranial and intragastric pressure; fasciculation and postoperative myalgia; masseter spasm; anaphylaxis. Rocuronium 1.2 mg/kg reversed by sugammadex is the standard sux-sparing alternative (Kronauer 2026; Zhang 2026).

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Anaesthesia is the science of gases under pressure — the contents of a cylinder, the volume in a breathing system, the partial pressures that drive uptake and diffusion, and the physics of altitude and hyperbaric therapy all obey the gas laws. The framework rests on six exam-critical ideas. First, the ideal-gas assumption: a gas is a cloud of point molecules in random motion exerting a pressure by collision with the walls, and its state is summarised by the four variables pressure (P), volume (V), temperature (T) and amount (n). Second, BOYLE'S LAW holds that at constant temperature the pressure of a fixed mass of gas is inversely proportional to its volume (P times V is constant) — the basis of how a gas is compressed into a cylinder and how a squeeze-bag ventilator works. Third, CHARLES'S LAW holds that at constant pressure the volume is proportional to the absolute temperature (V divided by T constant), and GAY-LUSSAC'S LAW that at constant volume the pressure is proportional to the absolute temperature — together explaining why a gas warms as it is compressed and cools as it expands. Fourth, AVOGADRO'S HYPOTHESIS — equal volumes of different gases at the same temperature and pressure contain equal numbers of molecules — links the amount of gas to its volume and defines the mole and the molar volume at STP (22.4 litres per mole). Fifth, these combine into the UNIVERSAL (IDEAL) GAS EQUATION, PV equals nRT (where R is the universal gas constant, 8.314 joules per mole per kelvin), from which any one variable can be found given the other three. Sixth, two mixture laws govern the behaviour of gas mixtures: DALTON'S LAW, that the total pressure of a gas mixture is the sum of the partial pressures of its individual gases (so the partial pressure of oxygen in air is 21 percent of the total), and HENRY'S LAW, that the amount of a gas dissolved in a liquid is proportional to its partial pressure — the basis of oxygen and anaesthetic uptake by the blood and of decompression sickness. Real gases deviate from ideal behaviour at high pressure or low temperature; nitrous oxide, whose critical temperature is above room temperature, liquefies in the cylinder and so shows a constant pressure (its saturated vapour pressure) until the liquid is exhausted, unlike oxygen which remains gaseous and shows a pressure proportional to its contents. Built on the partial-pressure-of-oxygen primer (Hoecker 2026), the hyperbaric-physics review (Jones 2026), the hypobaric-oxygenator physics study (Chotimol 2025), the nitrous-oxide-piped-supply-loss report (Hirata 2026), the greener-nitrous-oxide report (Yadav 2026), the chronic-hypoxaemia study (Ricco 2026), the decompression-sickness-at-altitude report (Ben-Ari 2026), and the pulse-oximetry review (Moon 2026).

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Breathing systems & circuits

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Breathing systems & circuits

The breathing system is the interface between the anaesthetic machine and the patient — it delivers the fresh gas and the volatile agent, removes the carbon dioxide, and provides the means for spontaneous and controlled ventilation. The framework rests on four exam-critical ideas: the Mapleson classification (A to F) organises the non-rebreathing and the partial-rebreathing systems by the arrangement of the components; the circle system (the modern standard adult system) uses the unidirectional valves and the CO2 absorber to allow the rebreathing of the exhaled gas at the low fresh gas flows; the efficiency of each Mapleson system is determined by the fresh gas flow requirement relative to the minute ventilation (the Mapleson A is the most efficient for the spontaneous ventilation, the Mapleson D for the controlled ventilation); and the CO2 absorption chemistry (the soda lime and the modern absorbents) underpins the safe rebreathing. Built on the CO2 absorption review (Feldman 2021), the closed-circuit review (Parthasarathy 2013), and the AAGBI checking guidelines (2012).

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Exam-exhaustive suxamethonium hyperkalaemia risk after burns for ANZCA Final: extrajunctional AChR upregulation, exact time window, peak risk period, rocuronium/sugammadex alternative, and hyperkalaemic arrest algorithm.

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Cardiac anaesthesia & cardiopulmonary bypass

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Cardiac anaesthesia and cardiopulmonary bypass

Exam-pass cardiac anaesthesia hub (SS_CS): CPB circuit order, heparin/ACT, cardioplegia, TOE-guided weaning (RRAC), protamine reactions, TRICS III restrictive transfusion, valves/CABG leaf links, and mechanical support escalation.

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Spinal anaesthesia is the injection of a small dose of local anaesthetic into the cerebrospinal fluid of the subarachnoid space to produce a rapid, dense and predictable block of the sensory, motor and sympathetic nerves that the solution reaches. It is the standard anaesthetic for lower-body surgery and caesarean section, and its mastery rests on the anatomy of the neuraxial approach, the determinants of block height, the physiology of the sympathetic block and its hypotension, and the prevention and management of the post-dural puncture headache and the high spinal.

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Chronic & cancer pain

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Chronic & cancer pain

The chronic and the cancer pain is the persistent pain (over 3 months) that differs from the acute pain in the mechanisms and the management. The framework rests on the pain types (the nociceptive, the neuropathic, the nociplastic), the neuropathic pharmacotherapy (the gabapentinoids, the SNRIs, the TCAs), the cancer pain and the WHO analgesic ladder, the chronic opioid therapy and its risks, the interventional techniques (the neuraxial, the neurolytic blocks, the neuromodulation — the spinal cord stimulation and the intrathecal drug delivery), and the multidisciplinary biopsychosocial management. The FFPM (the Faculty of Pain Medicine) is the link to the specialty.

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Exam-exhaustive upper-limb brachial plexus anaesthesia: interscalene, supraclavicular, infraclavicular, axillary; ultrasound landmarks, phrenic and pneumothorax risk, LAST rescue with lipid 1.5 mL/kg, incomplete-block rescue, and ANZCA Final viva stems.

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Xenon (Xe, element 54) is an inert noble-gas inhalational anaesthetic whose blood-gas partition coefficient of 0.115 is the LOWEST of any agent, giving extremely rapid onset and offset and clear emergence (Baima 2026; Chen 2026). Its MAC is around 71 percent (about 63 percent in the elderly), so it is a weaker anaesthetic than the halogenated volatiles and is given at high inspired concentrations. It is completely inert, not metabolised, with no toxic metabolites; it does not trigger malignant hyperthermia; and it is neither a greenhouse gas nor ozone-depleting. It is haemodynamically very stable, with minimal myocardial depression and no catecholamine sensitisation, making it useful in cardiac disease and the elderly (Hendrix 2026). As an NMDA receptor antagonist it provides analgesia (Ma 2025), and through NMDA antagonism, two-pore-domain potassium-channel (TREK) activation and preconditioning it is neuroprotective and cardioprotective — studied in neonatal hypoxic-ischaemic encephalopathy with cooling, cardiac arrest, traumatic brain injury and myocardial preservation (Chen 2026; Ponomarev 2025; Zamora 2026; Sienel 2026). The main limitations are COST and SCARCITY: xenon is a trace atmospheric gas extracted by fractional distillation of liquid air, expensive, and needs a specialised low-flow closed-circuit delivery system.

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Anaesthesia for the critically ill child covering septic shock resuscitation (Surviving Sepsis Campaign paediatrics), induction of the septic child, and congenital heart disease principles including shunt balance, air precautions, and NAP7 high-risk context.

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Physiology

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Distribution, clearance and half-life

Distribution, clearance and half-life are the three pharmacokinetic parameters that govern how much drug to give, how often to give it, how long it takes to reach steady state, and how quickly it wears off. The framework rests on eight exam-critical ideas. First, the body can be modelled as a single compartment in which the drug distributes instantaneously and is eliminated by first-order kinetics (a constant FRACTION, not a constant amount, removed per unit time), giving an exponential concentration-time decline and a half-life of 0.693 divided by the elimination rate constant. Second, intravenous anaesthetic drugs behave as TWO or more compartments: a central (vessel-rich, blood and well-perfused tissues) compartment into which the drug is injected and from which it is sampled, and a peripheral compartment into which it distributes; the concentration-time curve therefore shows a steep distribution phase (alpha) followed by a slower elimination phase (beta), described by the transfer rate constants k12, k21 and k10. Third, the volume of distribution Vd equals dose divided by the initial concentration and is an apparent, not a real, volume: lipid-soluble tissue-bound drugs (thiopental, propofol, fentanyl) have Vd of many litres per kilogram, whereas polar muscle relaxants stay in extracellular fluid with Vd around 0.1 to 0.3 L per kg. Fourth, clearance CL is the volume of blood plasma completely cleared of drug per unit time, equals the rate of elimination divided by the concentration, and equals Vd times the elimination rate constant; hepatic clearance is liver blood flow times the extraction ratio, separating drugs into flow-dependent (high extraction: morphine, lignocaine, propranolol) and capacity-dependent (low extraction: diazepam, warfarin, theophylline) classes. Fifth, the elimination half-life equals 0.693 times Vd divided by CL, steady state is reached in about five half-lives, and the loading dose equals Vd times the target concentration while the maintenance rate equals CL times the target concentration. Sixth, the context-sensitive half-time (Hughes 1992) is the time for the plasma concentration to fall by 50 per cent AFTER stopping an infusion designed to hold a constant concentration; it rises with infusion duration for fentanyl and thiopental as the peripheral compartment fills and redistribution slows, but stays essentially flat at about three minutes for remifentanil because non-specific esterases metabolise it independently of organ blood flow. Seventh, bioavailability F is the fraction of the administered dose reaching the systemic circulation unchanged: it is one for intravenous drugs and less than one for oral drugs because of first-pass hepatic and gut-wall metabolism. Eighth, the clinical relevance is direct: target-controlled infusion of propofol and remifentanil is built on compartment models, and the context-sensitive half-time explains why remifentanil allows rapid, predictable recovery regardless of infusion duration. Built on the foundational clearance papers (Rowland, Benet and Graham 1973; Wilkinson and Shand 1975; Pang and Rowland 1977; Benet 2010), the opioid pharmacokinetic analysis (Shafer and Varvel 1991), the context-sensitive half-time paper (Hughes, Glass and Jacobs 1992), the remifentanil pharmacokinetic study (Egan 1993), the measured context-sensitive half-times of remifentanil and alfentanil (Kapila 1995), and the propofol pharmacokinetic models used in target-controlled infusion (Marsh 1991; Schnider 1999).

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Total intravenous anaesthesia by target-controlled infusion delivers a drug to a predicted plasma or effect-site concentration computed from a compartment pharmacokinetic model. Understanding the three-compartment mamillary model, context-sensitive half-time, the named propofol models (Marsh, Schnider, Eleveld) and effect-site targeting is what separates safe TIVA practice from blind infusion.

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Electricity, diathermy & theatre safety

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Electricity, diathermy & theatre safety

The electrical safety in the operating theatre covers the risks of the electric shock (the macroshock and the microshock), the diathermy (the electrosurgery) physics, and the fire and the explosion risk. The framework rests on five exam-critical ideas: the macroshock (the whole-body current through the skin) and the microshock (the tiny current delivered directly to the heart); the protective measures (the earthing, the line isolation monitor, the residual current device); the diathermy physics (the monopolar and the bipolar, the cutting and the coagulation currents); the pacemaker and the implanted-device interaction; and the surgical fire (the fire triangle of the fuel, the oxidiser, and the ignition).

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Thiopental (sodium thiopentone) is the classic barbiturate induction agent — the first true intravenous induction drug, introduced in 1934, and still the agent of choice for rapid-sequence induction in obstetric general anaesthesia, for status epilepticus, and for barbiturate-coma neuroprotection. The framework rests on four exam-critical ideas: it is a thiobarbiturate whose sulfur atom at position 2 confers ultra-high lipophilicity, and it acts at the GABA-A receptor by INCREASING the DURATION of chloride channel opening (distinct from the benzodiazepines, which increase the FREQUENCY), with direct channel opening at high doses; its signature speed — onset in 10 to 30 seconds and recovery in 5 to 10 minutes — is the property of instant blood-brain-barrier penetration followed by rapid redistribution from the vessel-rich to the muscle compartment, while its hepatic metabolism has a low extraction ratio so the context-sensitive half-time rises steeply and the drug accumulates with repeated boluses or infusion, making it unsuitable for maintenance; it causes a 10 to 25 percent drop in blood pressure from myocardial depression and venodilation with reflex tachycardia (less hypotension than propofol but more tachycardia) yet is remarkably safe in pregnancy, sparing the uteroplacental circulation; and acute intermittent porphyria is the absolute contraindication because barbiturates induce ALA synthase and precipitate a porphyric crisis, while intra-arterial injection is catastrophic from crystallisation in arterioles. Built on the caesarean-section general-anaesthesia practice review (Helmer 2026), the obstetric GA pharmacology best-practice paper (Craig 2026), the vagus-nerve-stimulation refractory status epilepticus study (Parak 2026), the neuro-sedation for intracranial hypertension work (Ravaux 2026), the anaesthetic allergy review (Lisiecka 2026), the barbiturate reference (Lewis 2026), the GABA-A receptor gallic-acid/diazepam work (Yana 2026), and the ketamine-versus-etomidate RSI comparison (Chilingarashvili 2026).

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Extubation & recovery

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Extubation & recovery

The extubation and the recovery are the high-risk phases of the anaesthetic that close the perioperative airway and the consciousness. The framework rests on the recognition of the extubation as the high-risk airway event (the DAS extubation guidelines), the extubation criteria, the awake versus the deep extubation, the extubation of the difficult airway (the planned, the staged, the airway-exchange-catheter, the leak test), the laryngospasm and the post-extubation stridor, the emergence and the emergence agitation, and the recovery-room (the PACU) management of the common complications (the PONV, the pain, the shivering, the hypoxaemia) and the discharge.

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Recovery and the post-anaesthesia care unit

Exam-pass PACU hub: structured SBAR handover, continuous monitoring, airway obstruction and hypoxaemia, emergence hypertension/hypotension, Apfel PONV prophylaxis, shivering, OSA-safe recovery, emergence delirium, and Aldrete/PADSS discharge criteria for ANZCA Final and equivalents.

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Invasive monitoring

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Invasive monitoring

Invasive monitoring provides the continuous, real-time, beat-to-beat measurement of the haemodynamic variables that the non-invasive cuff and the pulse oximeter cannot. The framework rests on four exam-critical ideas: the arterial line gives the continuous, accurate blood pressure and the waveform analysis (the pulse contour); the central venous pressure, though much debated, gives the right-heart filling estimate and the access for the drugs; the cardiac output monitoring (the thermodilution, the pulse contour analysis, the oesophageal Doppler, the TOE) provides the flow and the volume responsiveness that underpin the goal-directed therapy; and the depth-of-anaesthesia monitoring (the BIS, the entropy) titrates the hypnotic depth. Built on the CVP measurement review (Lloyd-Donald 2025), the non-invasive BP accuracy meta-analysis (Lischker 2026), the arterial monitoring in the elderly study (Kane 2026), and the personalised haemodynamic management review (Wichmann 2026).

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Anaesthesia for surgical and percutaneous tracheostomy, laryngectomy airway transition, tube selection, and emergency management of displaced tracheostomy or laryngectomy stoma.

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Venous thromboembolism prophylaxis

Exam-exhaustive perioperative VTE prophylaxis: risk stratification, mechanical and pharmacological options, extended prophylaxis after major ortho/cancer surgery, and ASRA timing principles with neuraxial anaesthesia and catheter removal for ANZCA Final and equivalents.

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