Saudi Board Anesthesia Part 1 Complete Review Guide 2026–2027

4. Give neostigmine with glycopyrrolate to block muscarinic bradycardia and secretions; glycopyrrolate does not cross the blood-brain barrier.
5. Cisatracurium undergoes Hofmann elimination independent of liver and kidney, so it suits combined hepatic and renal failure.
6. Myasthenia gravis: resistance to succinylcholine and increased sensitivity to non-depolarising blockers.
7. Etomidate keeps haemodynamics stable but inhibits 11β-hydroxylase even after one dose; avoid it in adrenal insufficiency.
8. Ketamine is an NMDA antagonist; it maintains BP by sympathetic stimulation, bronchodilates and preserves airway reflexes, but causes emergence hallucinations.
9. Propofol infusion syndrome follows long infusions above 4 mg/kg/h: metabolic acidosis, rhabdomyolysis and arrhythmia from impaired mitochondrial fatty acid oxidation.
10. MAC at age 40: sevoflurane about 2%, isoflurane about 1.2%, desflurane about 6%. Pregnancy lowers MAC by about 30%.
11. N2O is 34 times more soluble than nitrogen, so it expands closed air spaces, and causes diffusion hypoxia when stopped; give 100% oxygen.
12. Remifentanil is broken down by plasma and tissue esterases; its context-sensitive half-time is about 3-4 minutes regardless of infusion length.
13. Pethidine with MAOIs can cause serotonin syndrome or a fatal excitatory reaction; morphine-6-glucuronide accumulates in renal failure.
14. Mallampati class III shows soft palate and base of uvula only. Cormack-Lehane grade 3 shows the epiglottis only.
15. Predictors of difficult mask ventilation: beard, obesity, snoring, edentulism and age over 55.
16. Pre-oxygenation is adequate when end-tidal FeO2 reaches 0.9 or more; it denitrogenates the FRC.
17. DAS 2015: Plan A up to 3 laryngoscopy attempts (+1 by a more experienced colleague); Plan B second-generation SAD, max 3 attempts; Plan D in CICO is scalpel-bougie-6.0 mm cuffed tube.
18. Cricoid pressure is 10 N while awake, increasing to 30 N after loss of consciousness.
19. Tube cuff pressure is 20-30 cmH2O. Depth at the lips is about 21 cm in women and 23 cm in men; usual ID 7.0-7.5 mm for women.
20. Capnography: a sudden EtCO2 fall with hypotension suggests embolism; a shark-fin shape suggests bronchospasm; rising inspired CO2 means exhausted absorbent or a faulty valve.
21. Pulse oximetry uses two wavelengths: 660 nm (red) and 940 nm (infrared).
22. Mapleson A is most efficient for spontaneous breathing (fresh gas flow equal to minute ventilation); Mapleson F (Jackson-Rees) is used under 20 kg.
23. ASA fasting: clear fluids 2 h, breast milk 4 h, formula 6 h, light meal 6 h, fatty meal 8 h.
24. Stop SGLT2 inhibitors 3 days before surgery (ertugliflozin 4 days) because of euglycaemic ketoacidosis.

Common mistakes in this chapter

• ✕ Pretreatment with a non-depolariser is often thought to prevent succinylcholine hyperkalaemia in burns. It does not; avoid succinylcholine entirely.
• ✕ SpO2 of 99% in carbon monoxide poisoning is often taken as good oxygenation. Two-wavelength oximeters read COHb as oxyhaemoglobin; request co-oximetry.
• ✕ The N2O cylinder gauge is often used to judge contents, but pressure stays constant while liquid remains. Only weighing shows contents.
• ✕ Bilateral recurrent laryngeal nerve palsy is confused with unilateral palsy. Bilateral palsy causes stridor with cords near midline; unilateral causes hoarseness.
• ✕ Bilateral breath sounds are sometimes taken as proof of intubation. The standard is sustained capnography over several breaths: no trace, wrong place.
• ✕ Starting a beta-blocker the day before surgery is thought to protect the heart. POISE showed more stroke and death; only continue it in patients already taking it.
• ✕ Repeating ondansetron for PONV after it was given as prophylaxis is ineffective within 6 h. Give an antiemetic from a different class.
• ✕ Clinical tests such as a 5-second head lift are used to exclude residual block. Quantitative TOF ratio of 0.9 or more is the accepted standard.