SCFHS Anaesthesia Tech Complete Review Guide 2026–2027

4. Pre-induction SOAP-ME: Suction (working, close), Oxygen, Airway, Pharmacy (labelled), Monitors (oximeter, ECG, BP, then capnography after intubation), Equipment; keep the cannula visible and accessible, and the table able to tilt head-down quickly.
5. Propofol TIVA avoids volatiles and lowers PONV; a disconnected infusion line risks awareness; use a one-way valve on the fluid line; propofol 1% = 10 mg/mL.
6. Sevoflurane suits inhalational induction in children (non-pungent, fast); avoid nitrous oxide in pneumothorax because it expands air spaces; raise fresh gas flow to change the volatile concentration faster.
7. Common intra-op findings: a sudden ETCO₂ fall with falling BP suggests low cardiac output or embolism; ETCO₂ rises in laparoscopy from CO₂ absorption; for a high-pressure alarm trace from patient to machine for a kink or blockage.
8. Emergence: need TOF 0.9 or more with adequate breathing and command response before extubation (0.7 means residual block); have suction, a mask with oxygen and airway equipment ready; manage laryngospasm with 100% oxygen and CPAP.
9. Propofol is a white milky emulsion, discard if separated or discoloured; it stings on injection and lowers BP by vasodilation and reduced contractility; ketamine stimulates the sympathetic system and maintains BP; etomidate transiently suppresses the adrenal gland; dexmedetomidine sedates with little respiratory depression.
10. Suxamethonium is stored in the fridge (2–8 °C) and avoided after burns or muscle injury because of hyperkalaemia; rocuronium is non-depolarising and reversed by sugammadex; atracurium breaks down by Hofmann elimination.
11. Neostigmine is given with glycopyrrolate to block bradycardia and secretions; glycopyrrolate does not cross the blood–brain barrier so suits the elderly; naloxone reverses opioids, flumazenil reverses midazolam, ondansetron is a 5-HT₃ antagonist for nausea.
12. A large fast fentanyl bolus can cause chest wall rigidity; fentanyl accumulates with long infusions whereas remifentanil is broken down rapidly (context-sensitive half-time); never flush residual drug in the cannula as it gives a bolus.
13. Calculations: lidocaine 2% in a 10 mL ampoule = 200 mg; atropine 600 micrograms/mL for 300 micrograms = 0.5 mL; fentanyl 50 micrograms/mL for 100 micrograms = 2 mL; ephedrine 50 mg in 10 mL = 5 mg/mL; metaraminol 10 mg in 20 mL = 0.5 mg/mL; phenylephrine 10 mg in 100 mL = 100 micrograms/mL.
14. Drug safety: read the label every time, label with drug name and concentration immediately after drawing up, discard syringes at the end of the case; the five rights are patient, drug, dose, route and time; check expiry and separate look-alikes.
15. Controlled drugs such as fentanyl are stored locked, recorded and any waste witnessed; leftover syringes are discarded with a witness; high-alert drugs such as concentrated potassium are stored separately and reported if found on the trolley.
16. The modified Aldrete score (activity, breathing, circulation, consciousness, SpO₂, each 0–2) needs 9 or more for PACU discharge; minimum monitoring on arrival is SpO₂, heart rate, BP and breathing rate with supplemental oxygen.
17. The commonest airway obstruction is the tongue and soft tissue falling back (jaw thrust); snoring means upper airway obstruction; place an unconscious patient in the lateral position; remove the oral airway when gagging; remove a laryngeal mask when awake with suction ready.
18. Recovery complications: shivering raises oxygen demand (active warming), hypertension prompts checks for pain, bladder and CO₂, vomiting needs the lateral position and suction, emergence delirium in children, urinary retention after spinal, and negative-pressure pulmonary oedema after laryngospasm.
19. Oxygen devices: nasal cannulae 1–4 L/min; simple face mask at least 5 L/min; non-rebreather 15 L/min with the bag filled first (a collapsing bag means too little flow); high-flow nasal oxygen needs heated humidification; every recovery bay needs oxygen, suction, monitor and a self-inflating bag.
20. After thyroidectomy, perioral and finger tingling means low calcium; neck swelling with stridor means a compressing haematoma needing urgent help; a patient with sleep apnoea needs continuous SpO₂ and his own CPAP.

Common mistakes in this chapter

• ✕ Suction is switched on and placed under the pillow within reach of the anaesthesiologist; test it, never assume it works.
• ✕ Preoxygenation delays desaturation during apnoea; an obese patient desaturates faster because of a smaller FRC and higher oxygen consumption.
• ✕ A flat capnograph after intubation means suspect oesophageal intubation first; a flat trace with a low-pressure alarm during the case is usually a disconnection.
• ✕ Sugammadex does not reverse suxamethonium or atracurium; it binds only the steroidal agents (rocuronium, vecuronium).
• ✕ Atracurium breaks down by Hofmann elimination, suiting renal and hepatic failure, and is stored in the fridge like suxamethonium.
• ✕ Drug safety: never assume; read the label, discard any unlabelled syringe, use a filter needle for glass ampoules, and check the strength when a drug (such as ketamine) is stocked in several concentrations.
• ✕ High-flow oxygen in a COPD patient may cause CO₂ retention and drowsiness; a simple face mask runs at no less than about 5 L/min to avoid rebreathing.
• ✕ Drowsiness with a respiratory rate of 6–7/min after morphine is opioid toxicity: stop the pump, alert the team and fetch naloxone; do not give drugs on your own.