Anesth

1. PHYSIOLOGICAL SCIENCES
A. PHYSIOLOGY
1. Respiration
2. Cardiovascular
3. Central and Peripheral Nervous Systems
4. Hepatic Function
5. Renal Function
6. Endocrine Function
7. Temperature Regulation
8. Aging
B. PHARMACOLOGY
1. General Concepts
2. Anesthetics - Gases and Vapors
3. Anesthetic - Intravenous
4. Anesthetics - Local
5. Muscle Relaxants
6. Autonomic Drugs
7. Cardiovascular Drugs
8. CNS Drugs
9. Diuretics
10. Immunosuppressive and Anti-Rejection Drugs
11. Drug Interactions
12. Pharmacogenetics
13. Drug Reactions
II.PHYSICAL SCIENCES
A. ANATOMY
1. Topographical Anatomy
2. Radiological Anatomy
3. Respiratory System
4. Cardiovascular System
5. Nervous System
6. Regional Anesthesia
B. BIOCHEMISTRY
1. Normal Body Metabolism
2. Acid-Base Regulation
3. Water and Electrolytes
4. Nutritional Support
C. PHYSICS
1. Mechanics
2. Flow Velocity
3. Properties of Liquids, Gases, and Vapor
4. Gas Laws
5. Vaporizers
6. Uptake and Distribution of Inhalation Agents

7. Design of Anesthesia Machines

8. Physics of Breathing System
9. Monitoring Methods
10. Instrumentation
11. Ventilators
12. Alarms
13. Defibrillators
14. Pacemakers
15. Electrical
D. Mathematics
1. Simple Math
2. Statistics
3. Computer
III. CLINICAL SCIENCES
A. ANESTHESIA PROCEDURES, METHODS AND TECHNIQUES
1. Evaluation of the Patient and Preoperative Preparation
2. Regional Anesthesia
3. General Anesthesia
4. Intravenous Fluid Therapy During Anesthesia
5. Complications
6. Special Techniques
7. Postoperative Period
8. Anesthesia Record Keeping and Quality Assurance
B. DISEASE STATES - CLINICAL PROBLEMS AND THEIR MANAGEMENT
1. Painful Disease States
2. Respiratory System
3. Cardiovascular
4. Central Nervous System
5. Other Entities
6. Special Problems

I. PHYSIOLOGICAL SCIENCES
A. PHYSIOLOGY
1. Respiration : Lung Functions and Cellular Processes
a) Lung Volumes
1) definitions ; methods of measurement ; normal values ; time constants
2) spirometry ; static and dynamic volumes ; deadspace ; nitrogen washout,
body plethysmography, O2 uptake, CO2 production, exercise testing
b) Lung Mechanics
1) compliance, pleural pressure gradient, flow - volume loops and hysteresis,
surfactant, La Place law
2) resistances ; principles of gas flow measurement
3) methods of measurement
4) work of breathing
5) regulation of airway caliber
c) Ventilation - Perfusion

1) distribution of ventilation
2) distribution of perfusion, zones, hypoxic pulmonary vasoconstriction
3) measurement of V/Q ratio, implications of A-aDO2 a-ADCO2, VD/Vr, Qs/QT
lung scan
d) Diffusion
1) defintion : gas laws
2) pulmonary diffusion capacity
3) apneic oxygenation, diffusion hypoxia
e) Blood Gas Transport
1) O2 transport ; physical solubility ; saturation ; Hb - O2 dissociation curve ;
2,3 - DPG,P50 ,respiratory enzymes ; Hb as a buffer
2) CO2 transport ; blood CO2 content ; carbonic anhydrase ; CO2 dissociation
Curve ; Bohr effect, normal acid - base balance and compensation
3) Temperature effect on blood gases
f) Regulation of Ventilation
1) respiratory center
2) central and peripheral chemoreceptors ; proprioceptive receptors ;
respiratory muscles and reflexes ; innervation
3) CO2 and O2 response curves
g) Non-respiratory Functions of Lungs
2. Cardiovascular
a) Cardiac Cycle
1) control of heart rate
2) synchronicity of pressure, flow, ECG, sounds, valve action
3) impulse propagation
4) normal ECG
5) eletrophysiology
b) Ventricular Function
1) Frank-Starling law ; pre afterload, intracardiac pressure
2) force, velocity, length, rate of shortening
3) myocardial contractility, measurement limitations
4) cardiac output ; determinants and regulation
5 ) myocardial oxygen utilization
c) Venous Return
1) venous tone ; controlling factors
2) muscle action ; intrathoracic pressure ; body posittion
3) blood volume
d) Blood Perssure
1) systolic, diastolic, mean, perfusion
2) intracardiac, pulmonary, venous (systemic, pulmonary)
3) systemic resistance, viscosity
4) baroreceptor function
e) Micro-Circulation
1) capillary diffusion ; osmotic pressure
2) pre-post capillary sphincter control
3) viscosity ; rheology
f) Organ perfusion
1) cerebral and spinal cord
2) coronary

3) pulmonary
4) renal
5) splanchnic - hepatic
6) muscle and skin
7) erine and placental
g) Regulstion of Circulation and Blood Volume
1) central : vasomotor center, pituitary renal axis
2) peripheral : receptors and reflexes
3) hormonal control
4) mixed venous oxygen tension and saturation
3. Central and Peripheral Nervous Systems
a) Brain
1) cerebral cortex ; functional organization
2) EEG
(a) wave patterns, frequency and amplitude, raw and processed
(b) sleep, convulsions ; O2 and CO2 ; brain death
(c) depth of anesthesia ; specific anesthetic and drug effects
3) sensory and motor evoked response
b) Spinal Cord
1) eneral organization ; brain stem ; reticular activating system
2) spinal reflexes
3) spinal cord tracts
4) evoked potentials
c) Cerebrospinal Fluid
1) formation, volume, composition, flow and pressure
2) blood brain barrier
3) brain volume, compliance
4) elation to blood composition and acid - base balance
d) Neuromuscular and Synaptic Transmission
1) morphology ; receptors
2) membrane potential ; mechanism
3) action potential ; characteristics, ions flux
4) synapse ; transmitters, precursors, ion, termination of action, tranmission
characteristics
e) Skeletal Muscle Contractions ; Depolarization Role of Ca, Actin, Myosin ;
Energy
Source and Release
f) Pain Mechanism and Pathways
1) nociceptors and nociceptive afferent neurons
2) dorsal horn modulation
3) spinal and supraspinal neurotransmission ; opioid receptors
4) autonomic contributions to pain ; visceral pain perception and transmission
5) social, vocational and psychological influences on pain perception
g) Autonomic Nervous System
1) sympathetic ; receptors ; transmitters, synthesis ; storage ; release ;
responses ; termination of action parasympathetic ; receptors ; transmitters
; synthesis ; release ; responses ; termination of action
2) ganglionic transmission
3) reflexes ; afferent and efferent limbs

4. Hepatic Function
a) Dual Blood Supply and its Regulation
b) Metabolic and Synthetic Functions
c) Excretory Functions
d) Mechanisms of Drug Metabolism and Excretion
e) Liver Function Tests
5. Renal Function
a) Blood Flow, Glomerular Filtration, Tubular Reabsorption and Secretion
b) Renal Function Tests
c) Hormonal Regulation of Extracellular Fluid
d) Hormonal Regulation of Osmolality
e) Regulation of Acid - Base Balance
f) Drug Excretion
6. Endocrine Function (Pituitary ; Thyroid ; Parathyroid, Adrenal Medulla,
Adrenal Cortex and Pancreas)
7. Temperature Regulation
a) Temperature Sensing ; Central, Peripheral
b) Temperature Regulating Centers : Concept of Set Point
c) Heat Production and Conservation
d) Heat Loss ; Mechanisms
e) Body Temperature Measurement ; Sites ; Gradients
f) Special Pediatric Considerations
8. Aging : Physiological and Pharmacological Implications

B. PHARMACOLOGY
1. General Concepts
a) Pharmacokinetics ; Protein Binding ; Partition Coeffcients ; pKa ; lonization ;
Tissue Uptake
b) Elimination ; Biotransformation ; Termination of Action
2. Anesthetics - Gases and Vapors
a) Physical properties
b) Mechanism of Action
c) Effects on CNS
d) Effects on Circulation
e) Effects on Respiration
f) Effects on Neuromuscular Function
g) Effects on Renal Function
h) Effects on Hepatic Function
i) Effects on Hematologic and Immune Systems
j) Biotransformation - Toxicity
k) Minimum Alveolar Concentration
l) Trace Concentrations, OR Pollution, Personnel Hazards
3. Anesthetic - Intravenous (Opioid and Non - Opioid Induction and
Anesthetic Agents)
a) Mechanism of Action
b) Pharmacokinetics and Phamacodynamics
c) Metabolism and Excretion

d) Effects on Circulation
e) Effects on Respiration
f) Effects on Other Organs
g) Adverse Effects
4. Anesthetics - Local
a) Mode of Action
b) Biotransformation and Excretion
c) Comparison of Drugs and Chemical Groups
d) Prolongation of Action
e) Toxicity
1) CNS
2) Cardiac
3) Allergy
4) Preservatives
5) Fetal
5. Muscle Relaxants (Depolarizing, Non - Depolarizing)
a) Mechanism of Action
b) Non - relaxant Side Effects
c) Abnormal Responses
d) Biotransformation and Excretion
e) Prolongation of Action ; Termination of Action
f) Antagonism
g) Drug Interactions (Antibiotics, H2 Blockers, Magnesium)
6. Autonomic Drugs
a) Sympathetic
(1) transmitters and types of receptors
(2) target organ effects : metabolic effects
(3) agonists : peripheral and central actions
(4) antagonists : alpha and beta blockers, antihypertensives, ganglionic
blockers,
peripheral vasodilators
(5) tocolytic uses
b) Parasympathetic
(1) transmitters
(2) muscarinic effects
(3) nicotinic effects
(4) agonists : cholinergic and anticholinesterases
(5) antagonists
7. Cardiovascular Drugs
a) Digitalis : Actions and Toxicity
b) Positive Inotropes
c) Antiarrhythmics
d) Antianginal Drugs
e) Vasodilators
f) Electrolytes (Cardiac Effects)
g) Vasoconstrictors
8. CNS Drugs (Major Actions, Comparison of Drugs : Effect on Respiration :
Circulation, Adverse
Effects)

a) Pre-and Postanesthetic Medications

1) opioids
2) opioid antagonists, agonist-antagonists
3) barbiturates
4) tranquilizers : phenothiazines : butyrophenones : benzodiazepines
b) Antidepressants, Anti-Parkinson Drugs
c) Ethyl alcohol
d) Hypnotics : Barbiturate and Non-Barbiturate : Anticonvulsants
e) Analeptics : physostigmine, Benzodiazepine Antagonists
f) Antiemetics : Phenothiazinew : Butyrophenores : Metoclopramide :
Anticholinergics : Serotonin Antagonists
g) Antihistamines (H1, H2, Mixed)
h) Drug Abuse and Addiction : Tolerance : Dependence
9. Diuretics
a) Mechanism of Action
b) Comparison of Drugs
c) Adverse Effects
d) Effect on Electroyte and Acid-Base Balance
e) Ultrafilteration
10. Immunosuppressive and Anti-Rejection Drugs
11. Drug Interactions
a) Protein Binding
b) pH Effect
c) Enzyme Induction and Inhibition
d) Hepatic Blood Flow
12. Pharmacogenetics
a) Malignant Hyperthermia (including diagnosis and therapy)
b) Pseudochokinesterase Deficinecy
13. Drug Reactions (Anaphylactoid, Anaphylaxis)

II PHYSICAL SCIENCES
A. ANATOMY
1. Topographical Anatomy as Landmarks
(a) Neck : Cranical Nerves, Tracheotomy Site, Cricoid Membrane, Internal and
External Jugular
Veins, Thoracic Duct, Carotid and Vertebral Arteries, Stellate Ganglion
(b) Chest : Pulmonary Lobes, Cardiac Landmarks, Auscultation Sites, Subclavian
Vein
(c) Spinal cord and Related Structures
(d) Extremities : Relationship of Bones, Nerves, and Arteries
2. Radiological Anatomy
a) Chest
b) Brain and Skull (including CT)
c) Spine (Cervical, Thoracic, Lumbar)
3. Respiratory System
a) Nose

b) Pharynx : Subdivisions : Innervation

c) Larynx
1) innervation : muscles : blood supply : cartilages
2) vocal cords, positions with paralysis
3) differences between infant and adult
d) Trachea
1) structure and relationships in neck and chest
e) Lungs
1) divisions and bronchoscopic anatomy
2) bronchial and pulmonary circulations
3) microscopic anatomy
f) Muscles of Respiration, Accessory Muscles
4. Cardiovascular System
a) Normal Anatomy of Heart and Major Vessels
b) Heart Conduction System : External innervation ; Coronary Circulation
c) Blood Supply of Other Major Organs
5. Nervous System
a) Brain
1) major nuclel and pathways
2) respiratory center
3) cerebral circulation, circle of Willis ; venous drainage
b) Spinal cord and Spine
1) variations in vertebral configurations
2) spinal nerves (level of exit, covering, sensory distribution)
3) blood supply
c) Meninges
1) epidural, subdural and subarachnoid spaces
2) parasympathetic ; location of ganglia
a) cranial nerves ; eyd, salivary glands, larynx
b) sacral nerves ; innervation of pelvic structures
c) vagal reflex pathways
3) carotid and aortic bodies, carotid sinus
6. Regional Anesthesia ; Main Nerve Blocks
a) Autonomic ; Stellate, Celiac, Lumbar Sympathetic
b) Head and Neck : Cervical, Superior Laryngeal, Transtracheal
c) Extremities : Brachial Plexus, Ulnar, Radial, Median, Sciatic, Femoral, Lateral
Femoral Cutaneous, Obturator, llio - Inguinal
d) Trunk : Intercostal, Paravertebral Somatic
e) Spine : Epidural, Caudal, Spinal

B. BIOCHEMISTRY
1. Normal Body Metabolism
a) Carbohydrates
1) aerobic and anaerobic utilization : chemical processes, enzymes
2) relationship to hormones : insulin : human growth hormone, glcocorticoids ;
glucagon, epinephrine
3) effect of stress

b) Proteins
1) functions, hormones, antibodies
2) RNA-DNA ; genetics
3) Cyclic AMP ; function
c) Specific Organ Metabolism (Brain, Heart)
2. Acid-Base Regulation : Buffeer Systems : Effects of Imbalance on
Electrolytes
and Organ Perfusion
3. Water and Electrolytes : Districution and Balance ; Compartments
4. Nutritional Support
C. PHYSICS
1. Mechanics
a) Pressure Measurement of Gases, Liquids
b) Transducers, Regulators, Medical Gas Cylinders
c) Pipeline System
2. Flow Velocity
a) Viscosity - Density ; Laminar - Turbulent
b) Flowmeters : Rotameter, Electromagnetic, Ultrasonic ; Pneumotachogram
3. Properties of Liquids, Gases, and Vapor
a) Diffustion of Gases
b) Solubility Coefficients
c) Relative and Absolute Humidity
d) Critical Temperature, Critical Pressure
4. Gas Laws
5. Vaporizers
a) Vapor Pressure and Calculation of Anesthetic Concentrations
b) Vaporizer Types
6. Uptake and Distribution of Inhalation Agents
a) Uptake and Elimination Curves ; Effect of Ventilation, Circulation, Anesthetic
Systems
b) Concentration Effect
c) Second Gas Effect
d) Nitrous Oxide and Closed Spaces
7. Design of Anesthesia Machines
8. Physics of Breathing System
a) Principles : Resistance, Turbulent Flow, Mechanical Deadspace, Rebreathing,
Dilution, Leaks,
Gas Mixtures, Humidity, Heat
b) Components : Connectors, Adaptors, Mask, Endotracheal Tube, Reseervoir
Bag,
Unidirectional Valves, Breathing Tubes, Relief Valve
c) Characteristics
1) Circle systems : closed (low flow) and semi - closed ; adult ; pediatric
2) non - circle systems : Insuffation ; open ; semi - open
3) non - rebreathing valves
4) CO2 absorption : principles, cannisters, efficiency
d) Oxygen Supply Systems : FIO2
e) Waste Gas Evacuation Systems

f) Fail Safe and Other Safety Features

9. Monitoring Methods
a) Vascular Pressures : Arterial, CVP, PAP, LAP, LVEDP
b) Heart Function : Heart Tones, ECG, Echocardiography, Cardiac Output
c) Brain and Spinal Cord Function : EEG (raw and processed), Evoked Potentials,
Wake - up Test, ICP, Cerebral Function Monitor
d) Neuromuscular Function : Nerve Stimulators, EMG
e) Ventilation : Respirometoers, Inspiratory Force
f) Gas Concentrations : O2 : CO2 Nitrogen, Anesthetic Gases and Vapors
g) Temperature
h) Oxyben : Oximetry, Transcutaneous O2
10. Instrumentation
a) Blood Gases : Electrodes for pH, PO2 , PCO2, Calibration, Temperature
Corrrections, Errors
b) Gas Concentration : Infrared Absorption, Molecular Broadening Effects, Mass
Spectrometry,
Gas Chromatography, Nitrogen Capnography
c) Cardiac Output : Fick, Dye Dilution, Thermodilution, Doppier
d) Pressure Transducers : Overshoot, Resonnance, Damping
e) Doppler, Oscillometry
f) Blood Warmers, Cell Savers
g) Echocardiography
h) Coagulation Monitors
11. Ventilators
a) Classifications
b) Principles of Action : Assistors, Controllers ; Pressure Limited, Volume Pre - Set
: FIO2 Control ; Periodic Sigh ; Monitors ; Pressure , Oxyben, Apnea, Insp/Exp
Rotio ; Bacterial Filters ; IMV, CPAP, PEEP, Pressure Support, High Frequency
Ventilation : Maintenance ; Microbiology ; complications ; Pediatric Adaptation
c) Nebulizers, Humidifiers
d) Pipeline
12. Alarms : Operation Room, Electrical, Anesthesia Machine, Ventilators,
Oxygen
13. Defibrillators : Internal, External, Implantable ; Energy, Cardioversion ;
Paddle Size and Position
14. Pacemakers
a) Temporary ; Permenent (Epicardia, Endocardial) ; Transcutaneous
b) Types : Fixed Rate, Synchronized, Ventricular, Atrial, A - V Sequential
c) Standard Nomenclature
d) Reasons for Failure or Malfunction
15. Electrical ; Fire and Explosion Hazards
a) Source of lgnition ; Static, Misuse of Oxygen Cylinders
b) Prevention : Grounding, Isolation Transformers
c) Macro and Micro Current Hazards
d) Safety Regulations
e) Lasers

D. Mathematics
1. Simple Math : Logarithms ; Graph of Simple Equations ; Exponential
Function, Analysis of
Biologic Curves
2. Statistics : simple and Population ; Probability ; Mean and Mode ; Standard
Deviation and Error ; T - Test ; Chi - Square ; Correlation ; Analysis of Variance
3. Computer : Data Handing ; Data Processing ; Data Analysis ; Anesthesia
Applications
III CLINICAL SCIENCES
A. ANESTHESIA PROCEDURES, METHODS AND TECHNIQUES
1. Evaluation of the Patient and Preoperative Preparation
a) Physical Status
b) Premedication
1) interaction with chronic drug therapy ; anesthetic agents
2) adverse reactions to premedications ; patient variability, dose response
curves, side effects
3) specific problems in disease states ; hyper and hypothyroid, drug abuse,
glaucoma, uremia, increase CSF pressure, chronic steroid ingestion, obesity,
depression,
COPD
4) pediatric and geriatric doses, routes of administration
5) role in patients with allergies
6) alteration of gastric fluid volume and pH, sphincter tone
c) NPO Recommendations
2. Regional Anesthesia
a) General : Premedication, Patient Position, Equipment
b) Spinal, Eqidral, Caudal
1) indications, contraindications, techniques, complications, comparison of
techniques
2) sites of actions
3) factors influencing onset, duration, and termination of action
4) systemic toxicity, test dose
5) complications : precipitating factors, prevention, therapy
c) Peripheral and Autonomic Nerva Block : Indications, Contraindications,
Techniques, Clinical Assessment Complications
d) IV Regional : Mechanism, Agents, Indications, Contraindications, Techniques,
Complications
3. General Anesthesia
a) Stages and Signs of Anesthesia ; Awareness Under Anesthesia
b) Airway Management ; Intubation, Fiberoptic Techniques, Awake ; Techniques
for
Difficult Intubation ; Laryngeal Mask Airway ; Endobronchial Intubation ;
Complications
c) Hypocarbia - Hypocarbia : Systemic Effects
d) Hypoxemia ; Systemic Effects
4. Intravenous Fluid Therapy During Anesthesia : Water, Electrolyte,
Glucose Requirements and Disposition

5. Complications (Etiology, Prevention, Treatment)

a) Trauma
1) upper airway, epistaxis
2) larynx and trachea ; stridor ; laryngospasm
3) eyes
4) vascular ; arterial and venous thrombosis ; thrombophlebitis ; sheared
catheter, intra - arterial injuries, air embolism
5) neurological : pressure injuries of mask, tourniquet, body position, intraneural
injections, retractors
6) burns
b) Chronic Environmental Exposure ; Mutagenicity, Teratogenicity,
Carcinogenicity,
Scavenging
c) Temperature
1) Hypothermia : etiology, treatment, prognosis
2) Shivering
d) Nausea and Vomiting
1) physiology ; etiology ; gastroesophageal sphincter ; gastric emptying time
2) preoperative ; full stomach and induction of anesthesia
3) use of antacids, H2 blockers, metoclopramide, transdermal scopolamine,
droperidol
ondansetron
4) pulmonary aspiration
e) Bronchospasm, Laryngospasm
6. Special Techniques
a) Controlled Hypotension ; Choice of Drugs, Use of Posture, Ventilation
b) Controlled Hypothermia ; Techniques, Systemic Effect, Shivering, Rewarming,
Complications
c) Hyperbaric Oxygen and Anesthesia Care, High Altitude Anesthesia
d) Barbiturate Coma
7. Postoperative Period
a) Pain Relief
1) Pharmacologic
a) drug : opiods, agonist - antagonists, local anesthetics, alpha - 2 agonists,
nonsteroidal
anti - inflammatory drugs
b) routes : oral, SC, IM, IV (PCA), epidural, spinal, intrapleural, other regional
techniques
c) risks and benefits
2) other techniques ; TENS ; cryotherapy ; acupuncture
b) Respiratory Consequences of Anesthesia
8. Anesthesia Record Keeping and Quality Assurance

B. DISEASE STATES - CLINICAL PROBLEMS AND THEIR MANAGEMENT

1. Painful Disease States
a) Pathophysiology
1) Acute postoperative and posttraumatic pain

2) Cancer related pain

3) Chronic pain states
(a) Radicular and neuropathic pain : low back pain, postherpetic neuralgia
(b) Visceral pain
(c) Sympathetically mediated pain : reflex sympathetic dystrophy, causalgia
(d) Other somatic pain condition ; myofascial, arthropathy, etc.
( e) Central and deafferentation pain : phantom limb pain
b) Treatment
1) Cancer Pain
(a) Systemic medications
(b) Continous spinal and epidural analgesia
(c) Neurolytic and non - neurolytic blocks
2) Chronic pain
(a) Systemic medications : analgesics, anticonvulsants, psychotropics, etc.
(b) Spinal and epidural analgesics
(c) Peripheral nerve blocks
(d) Sympathetic nerve blocks
(e) Other techniques ; TENS, epidural stimulation, neuroablation (surgircal and
chemical neurolysis) etc.
2. Respiratory System
a) Obstructive Disease
1) upper airway : congenital, infectious, neoplastic, traumatic, foreign body
2) tracheobronchial : congenital, infectious, neoplastic, traumatic, foreign body
3) parenchymal : asthma, bronchitis, emphysema, lung abscess,
bronchiectasis, cystic fibrosis, mediastinal masses
b) Restrictive Disease
1) neurologic : CNS depression, spinal cord dysfunction, peripheral nervous
system
2) musculoskeletal : muscular, skeletal, obesity, chest trauma
3) parenchymal : atelectasis, pneumonia, interstitial pneumonitis, pulmonary
fibrosis,
respiratory distress syndrome, bronchopulmonary dysplasia
4) pleural and mediastinal : pneumo-, hemo-, and chylothorax, pleural effusion,
empyema,
bronchopleural fistula, cardiomegaly
5) other : pain, abdominal distention
c) Management of the Patient with Respiratory Disease
1) evaluation : H&P, CXR, ABGs, PFTs ; assessment of perioperative risk
2) anesthetic management
a) preoperative preparation : respiratory therapy, drug therapy (antibiotics,
bronchodilator,
mucolytics)
b) intraoperative management
(1) monitoring
(2) choice of anesthesia
(3) anesthetic techniques : nonpulmonary surgery, thoracic and
pulmonary surgery, one - lung ventilation, lung transplantation
b) postoperative care : pain management, respiratory therapy, ventilator
support, extubation

criteria
3) management of respiratory failure
a) supportive medical therapy
b) monitoring
c) nonventilatory respiratory management : O2 therapy and toxicity,
tracheobronchial toilet,
positive airway pressure, respiratpry drugs
d) ventilatory management
(1) criteria for ventilatory commitment and weaning
(2) choice of ventilator
(3) mode of ventilation : conventional mechnical ventilation,
PEEP, CPAP, IMV, SIMP, pressure support, high frequency
ventilation (positive pressure, jet, oscillation)
(4) complications of mechanical ventilation
3. Cardiovascular
a) Ischemic Heart Disease
1) risk factors
2) manifestations
3) diagnosis of myocardial infarction ; clinical, ECG, enzymes
4) anesthesia risk
5) treatment of angina ; drugs, surgical
6) determinants of myocardial oxygen requirements and delivery, silent
ischemia, postoperative ischemia
7) intraoperative diagnosis and treatment of ischemia
b) Valvular Heart Disease
1) classification
2) diagnosis
3) anesthetic consideration
c) Rhytem Disorders and Conduction Defects
1) electrophysiology
2) chronic abnormalities : etiology, diagnosis, therapy
3) intraoperative dysrhythmia : etiology, diagnosis, therapy
4) perioperative use of pacemaker : indications, complications
d) Heart Failure and Cardiomyopathy (Ischemic, Viral, Hypertrophic)
1) definition and functional classification
2) compensatory responses
3) right or left ventricular dysfunction
a) etiology
b) signs and symptoms
c) diagnostic tests
4) treatment
a) pulmonary edema
b) pulmonary hypertension
c) cardiogenic shock
d) cardiac transplantation
e) cardiac Tamponade and Constrictive Pericarditis
1) etiology
2) diagnosis
3) anesthetic management

f) Circulatory Assist
1) cardiopulmonary bypass
a) components (pump, oxygenator, heat exchanger, filters)
b) mechanisms of gas exchange
c) priming solutions
d) anticoagulation and antagonism ; ACT, heparin assays, antithrombin III,
protamine reactions
e) anesthetic considerations during bypass
2) intraaortic balloon : rationale, indications, limitations
3) artificail heart and ventricular assist devices : internal and external
g) Myocardial Preservation : physiology, techniques, complications
h) Pulmonary Embolism
1) etiology : thrombosis air, fat, plague, anmiotic fluid
2) diagnosis
3) treatment ; acute, preventive
i) Hypertension
1) etiology, pathophysiology, course of disease
2) drug treatment, interactions with anesthetics, risk of anesthesia
3) intra or postoperative hypertension
a) differential diagnosis and treatment
j) Peripheral Circulatory Failure
1) etiology, classification, pathophysiology
2) anesthetic management of patient in shock
k) Vascular Diseases
1) cerebral circulation ; luxury perfusion, steals, infarcts, intracranial
hemorrhage
2) carotid endarterectomy : anesthetic management, monitoring of cerebral
perfusion,
complications
3) abdominal aneurysm resection : anesthetic management
4) arterial occlusive disease
5) aneurysms of ascending, descending and arch of aorta
l) Cardiopulmonary Resuscitation
1) recognition
2) management - drugs, defibrillators, monitors, ACLS guidelines
3) complications of therapy
4. Central Nervous System
a) Seizures
b) Coma : Traumatic, Infectious, Metabolic, CVA, Cerebral Hypoxia
1) Glasgow Coma Scale
c) Drug Intoxication (CNS Drugs, Carbon Monoxide, Insecticides)
d) Paraplegia, Quadriplegia, Spinal Shock, Autonomic Hyperreflexia
e) Neuromuscular Diseases
f) Tetanus
g) Special Problems of Anesthesia for Neurosurgery
1) increased intracranial pressure
2) posture
3) air embolism
4) neuroradiological investigative procedures ; CT scan, MRI

5)
6)
7)
8)
9)

cerebral protection from hypoxia, ischemia, glucose effects

meningomyelocele
aneurysms and A-V malformations, cerebral vasospasm
anesthetic and ventilatory effects on cerebral blood flow and metabolism
fluid management

5. Other Entities :
a) Morbid Obesity
b) Hepatic Disease
1) preoperative laboratory values
2) anesthesia choice (hepatocellular disease, ascites, portal, hypertension)
3) postoperative hepatic dysfunction, hepatorenal syndrome
4) hepatic transplantation
c) Diabetes Mellitus
1) pathophtsiology
2) control of blood glucose
3) elective anesthesia - perioperative management
4) emergency anesthesia perioperative - hypoglycemia ; hyperglycemia
and ketoacidosis management
5) hyperosmolar coma
6) pancreas transplantation
d) Renal Disease
1) pathophysiology of renal disease and uremia
2) anesthetic choice in reduced renal function
3) anesthetic management in renal failure, A-V shunts
4) anesthetic management in renal transplantation
5) postoperative oliguria and anuria
6) inappropriate ADH secretion
7) pharmacokinetic implications
e) Endocrine Disorders
1) pituitary disease
a) hypopituitarism, pituitary removal - substituition therapy
1) diabetes insipidus
b) hyperpituitarism
1) acromegaly - airway management
2) inappropriate ADH secretion
2) thyroid disease
a) hyperthyroidism
1) metabolic and circulatory effects
2 ) anesthetic management
3) thyroid storm
b) hypothyroidism
1) circulatory and metabolic effects
2) substitution therapy
3) anesthetic implications
c) airway management
3) parathyroid

a) hyperparathyroid ; physiological effects

b) hypoparathroid ; postop manifestations
4) adrenal disease
a) cushing's Syndrome
b) Primary aldosteroniem
c) Addison's Disease
d) Pheochromocytoma
1) circulatory and metabolic manifestations
2) diagnosis
3) anesthetic management
5) carcinoid syndrome
f) Intestinal Obstruction
1) causes, paralytic ileus ; mechanical ; vascular
2) physiological changes ; fluid and electrolyte ; respiratory
3) anesthesia management : full stomach ; fluid therapy ; nitrous oxide
g) Hematologic Disorders
1) disease of blood
a) anemias ; compensatory mechanisms
b) polycythemias ; primary vs. secondary
c) clotting disorders : congenital, acquired, pharmacologic
(antiplatelets anticoagulant and antagonists)
d) hemoglobinopathies
2) transfusions
a) blood preservation, storage
b) blood filters and pumps
c) effects of cooling and heating ; blood warmers
d) blood components, volume expanders
e) preparation for transfusion : type and cross, type and screen,
uncrossmatched
blood, autologous blood, designated donors
3) reactions to transfusions
a) febrile
b) allergic
c) hemolytic acute and delayed
4) complications of transfusions
a) infections : hepatitis, AIDS, CMV, others
b) citrate intoxication
c) electrolyte and acid base abnormalities
d) massive transfusion : coagulopathies, hypothermia
e) pulmonary
5) alternatives to transfusion : hemodilution, sequestertion, autotransfusion,
blood
substitutes
h) Pediatric Anesthesia
1) apparatus : breathing circuits, humidity, thermal control
2) premedication : drugs, dosage, routes, vehicles
3) agent and techniques
a) anesthetic : actions different from adults
b) neuromuscular blockers ( sensitivity, congenital diseases)

c) regional anesthesia
4) fluid therapy and blood replacement, physiologic anemia
5) problems in intubation ( full stomach, diaphragmatic hernia, T-E
fistula, Pierre-Robin, awake intubation)
6) neonatal physiology
a) respiratory
1) development, anatomy, surfactant
2) pulmonary oxygen toxicity
3) pulmonary function
4) lung volumes vs. adult
5) airway differences, infant vs. adult
b) cardiovascular
1) transition, fetal to adult
2) persistent fetal circulation
c) retinopathy of prematurity : anesthetic implications
d) metabolism, fluid distribution and renal function
e) thermal regulation (neutral temperature, brown fat)
f) fetal hemoglobin
g) apnea of prematurity
7) congenital heart disease
a) cyanotic defects, primary pulmonary hypertension
b) acyanotic defects
c) altered uptake/distribution of IV and inhalation anesthetics
d) other anesthetic considerations
8) emergencies in the newborn
a) diaphragmatic hernia
b) T-E fistula
c) neonatal lobar emphysema
d) pyloric stenosis
e) necrotizing enterocolitis
f) omphalocele / gastroschisis
g) RDS : etiology, management, ventilation techniques
h) myelomeningocele
9) postoperative analgesia
i) Obstetrical Anesthesia
1) maternal physiology
a) effects on uptake and distribution
b) respiratory (anatomy, blood gas, acid base)
c) cardiovascular (aorto-caval compression, regulation of uterine blood flow)
d) renal
e) liver (A/G ratio, drug binding)
f) gastrointestinal (gastric acid, motility, anatomic position, gastroesophageal
function
g) coagulation
h) placenta
1) placental exchange - gases, O2, CO2
2) placental blood flow
2) maternal - fetal
a) pharmacology

1) anesthetic drugs and adjuvants

2) oxytocics, interactions
3) tocolytics
4) antitoxemic drug ; interactions
5) mechanisms of placental transfer
6) fetal disposition of drugs
7) drug effects on newborn
b) amniotic fluid (L/S ratio)
c) anesthetic techniques and risks (elective vs. emergency)
cantacids, general, regional, local, nerve blodks
d) physiology of labor
e) influence of anesthetic techniques on labor
f) fetal monitoring
3) pathophysiology and complicated pregnancy
a) problems during pregnancy
1) anesthesia for the non - obstetric procedure
2) endocrine (thyroid, diabetes)
3) hypertension
4) rheumatic or congenital heart disease
5) neurologic (seizures, myasthenia, paraplegia)
6) respiratory (asthma)
7) renal
8) Rh and ABO incompatibilities
9) ectopic pregnancy
b) problum of term and delivery
1) evaluation of fetus
2) toxemia
3) placenta previa
4) supine hypotensive syndrome
5) aspiration of gastric contents
6) amniotic fluid embolism, DIC
7) dystocia and malposition ; multiple pregnancy
8) abruptio placenta
9) retained placenta
10) cord prolapse;
11) uterine atony
12) breech presentation
c) resuscitation of newborn
1) evaluation and Apgar scoring
2) neurobehavioral testing
3) techniques and pharmacology of resuscitation
4) intrauterine surgery

6. Special Problems in :
a) ENT Surgery : Airway Endoscopy ; Microlaryngeal Surgery ; Laser Surgery,
Hazards,
Complications

b) Plastic Surgery
c) Laparoscopic Surgery ; Cholecystectomy ; Thoracoscopy ; Gynecologic
Surgery
Anesthetic Management ; Complications
d) Urologic Surgery ; Lithotripsy
e) Ophthalmologic Surgery, Retrobulbar Block; Open Eye Injuries
f) Orthopedic Surgery ; Tourniquet Management, Complications
g) Trauma, Burn Management
h) Radiologic Procedured ; CT Scan ; MRI - Anesthetic Implications, Management
i) Ambulatory Surgery : Patient Selection ; Anesthetic Management ; Discharge
Criteria
j) Electroconvulsive Therapy
k) Nutrition in the Surgical or Critically III Patient
l) Adverse Outcomes ; Anesthetic Accidents ; Closed Claims Findings ;
Professional Liability, Risk management
m) Costs of Medical/Anesthesia Care
n) Occupational Hazard
o) Infection control

PHYSIOLOGICAL SCIENCES
A.

PHYSIOLOGY

1. Respiration : Lung Functions and Cellular Processes

a)

Lung Volumes

1) definitions ; methods of measurement ; normal

values ; time constants

2) spirometry ; static and dynamic volumes ; dead

space ;nitrogen washout , body plethysmography ,

O uptake , CO production , exercise testing
2

b) Lung Mechanics

1) compliance , pleural pressure gradient , flow

volume loops and hysteresis , surfactant , La
Place law

2) resistance ; principles of gas flow measurement

3) methods of measurement
4) work of breathing

5) regulation of airway caliber

c) Ventilation Perfusion

1) distribution of ventilation

2) distribution of perfusion , zones , hypoxic pulmonary

vasoconstriction

3) measurement of V/Q ratio , implications of A

aDO aADCO , V /V , Qs/Q ,
2

lung scan

d) Diffusion

1) definition : gas laws

2) pulmonary diffusion capacity

3) apneic oxygenation , diffusion hypoxia

e) Blood Gas Transport

1) O transport ; physical saturation ; Hb

2

O dissociation curve ; 2,3 DPG , P , respiratory

2

50

enzymes ; Hb as a buffer

2) CO transport ; blood CO content ; carbonic

2

anhydrase ; CO dissociation curve ; Bohr effect ,

2

normal acid base balance and compensation

3) Temperature effect on blood gases

f) Regulation of ventilation
1) respiratory center

2) central and peripheral chemoreceptors ;

proprioceptive receptors ; respiratory muscles and

reflexes ; innervation

3) CO and O response curves

2

g)

Non respiratory functions of lungs

2. Cardiovascular

a) Cardiac Cycle

1) control of heart rate

2) synchronicity of pressure , flow , ECG , sounds ,

valve action

3) impulse propagation
4) normal ECG

5) electrophysiology

b) Ventricular Function

1) Frank Starling law ; pre- and after-load ,

intracardiac pressure

2) Force , velocity , length , rate of shortening

3) Myocardial contractility , measurement limitations

4) Cardiac output ; determinants and regulation
5) Myocardial oxygen utilization

c) Venous Return

1) venous tone ; controlling factors

2) muscle action ; pulmonary , venous ( systemic ,

pulmonary )

3) blood volume

d) Blood Pressure

1) systolic , diastolic , mean , perfusion

2) intracardiac , pulmonary , venous ( systemic ,

pulmonary )

3) systemic resistance , viscosity

4) baroreceptor function

e) Micro Circulation

1) capillary diffusion ; osmotic pressure

2) pre post capillary sphincter control

3) viscosity ; rheology

f) Organ Perfusion

1) cerebral and spinal cord

2) coronary

3) pulmonary
4) renal

5) splanchnic hepatic
6) muscle and skin

7) uterine and placental

g) Regulation of Circulation and Blood Volume

1)

reflexes

central : vasomotor center , pituitary renal axis

2)

peripheral : receptors and

3)

hormonal control

and saturation

4)
3.

mixed venous oxygen tension

Central and Peripheral Nervous Systems

a)

Brain

cortex ; functional organization

1)

cerebral

2)

EEG

(a)

wave patterns , frequency and amplitude , raw and processed

(b) sleep , convulsions ; O and CO ; brain death

2

(c) depth of anesthesia ; specific anesthetic and

drag effects

motor evoked response

3)
b)

sensory and

Spinal Cord

1) general organization ; brain stem ; reticular

activating system

2) spinal reflexes

3) spinal cord tracts

4) evoked potentials

c)

Cerebrospinal Fluid

1) formation , volume , composition , flow and

pressure

2) blood brain barrier

3) brain volume , compliance

4) relation to blood composition and acid base

balance

Transmission

d)

Neuromuscular and Synaptic

1) morphology ; receptors

2) membrane potential ; mechanism

3) action potential ; mechanism

4) synapse ; transmitters , precursors , ion termination

of action , tranmission characteristics
e)

Skeletal Muscle Contractions ;

Depolarization Role of Ca , Actin , Myosin ;

Source

and Release

and Pathways

f)

Energy

Pain Mechanism

1) nociceptors and nociceptive afferent neurons

2) dorsal horn modulation

3) spinal and supraspinal neurotransmission ; opioid

receptors

4) autonomic contributions to pain ; visceral pain

perception and transmission

5) social , vocational and psychological influences on

pain perception

Nervous System

g)

Autonomic

1) sympathetic ; receptors ; transmitters , synthesis ;

storage ; release ; responses ; termination of

action parasympathetic ; receptors ; transmitters ;

synthesis ; release ; responses ; termination of
action

2) ganglionic transmission

3) reflexes ; afferent and efferent limbs

4.

Hepatic Function

a) Dual Blood Supply and its Regulation

b) Metabolic and Synthetic Functions
c) Excretory Functions

d) Mechanisms of Drug Metabolism and Excretion

e) Liver Function Tests

1. Renal Function

a) Blood Flow Glomerular Filtration , Tubular

Reabsorption and Secretion

b) Renal Function Tests

c) Hormonal Regulation of Extracellular Fluid

d) Hormonal Regulation of Osmolality

e) Regulation of Acid Base Balance

f) Drug Excretion

2. Endocrine Function ( Pituitary ; Thyroid ;

Parathyroid , Adrenal Medulla , Adrenal

Cortex and Pancreas )

3. Temperature Regulation

a) Temperature Sensing ; Central , Peripheral

b) Temperature Regulating Centers : Concept of Set

Point

c) Heat Production and Conservation

d) Heat Loss ; Mechanisms

e) Body Temperature Measurement ; Sites ;

Gradients

4.

f) Special Pediatric Considerations

Aging : Physiological and Pharmacological lmplications

B. PHARMACOLOGY

1. General Concepts

a) Pharmacokinetics ; Protein Binding ; Partition

coefficients ; pK ; lonization ; Tissue Uptake

a

b) Elimination ; Biotransformation ; Termination of Action

2. Anesthetics Gases and Vapors

a) Physical properties

b) Mechanism of Action
c) Effects on CNS

d) Effects on Circulation

e) Effects on Respiration

f) Effects on Neuromuscular Function

g) Effects on Renal Function

h) Effects on Hepatic Function

i) Effects on Hematologic and lmmune Systems

j) Biotransformation Toxicity

k) Minimum Alveolar Concentration

l) Trace Concentration , OR Pollution , Personnel

Hazards

3. Anesthetic Intravenous ( Opioid and Non Opioid

Induction and Anesthetic Agents )
a) Mechanism of Action

b) Pharmacokinetics and Phamacodynamics

c) Metabolism and Excretion

d) Effects on Circulation

e) Effects on Respiration

f) Effects on Other Organs

g) Adverse Effects

4. Anesthetics Local

a) Mode of Action

b) Biotransformation and Excretion

c) Comparison of Drugs and Chemical Groups

d) Prolongation of Action
e) Toxicity

1) CNS

2) Cardiac
3) Allergy

4) Preservatives
5) Fetal

5.

Muscle

Relaxants ( Depolarizing , Non Depolarizing )

a) Mechanism of Action

b) Non relaxant Side Effects

c) Abnormal Responses

d) Biotransformation and Excretion

e) Prolongation of Action ; Termination of Action

f) Antagonism

g) Drug Interactions ( Antibiotics , H Blockers ,

2

Magnesium )

a) Sympathetic

6.

Autonomic Drugs

1) transmitters and types of receptors

2) target organ effects ; metabolic effects

3) agonists : peripheral and central actions

4) antagonists : alpha and beta blockers ,

antihypertensives , ganglionic blockers , peripheral

vasodilators

5) tocolytic uses

b) Parasympathetic
1) transmitters

2) muscarinic effects
3) nicotinic effects

4) agonists : cholinergic and anticholinesterases

5) antagonists

7.

Cardiovascular Drugs

a) Digitalis ; Actions and Toxicity

b) Positive Inotropes
c) Antiarrhythmics

d) Antianginal Drugs
e) Vasodilators

f) Electrolytes ( Cardiac Effects )

g) Vasoconstrictors

8. CNS Drugs ( Major Action ,

Comparison of Drugs ; Effects on Respiration ; Circulation ,

Adverse Effects )

a) Pre and Post-anesthetic Medications

1) opioids

2) opioid antagonists , agonist antagonists

3) barbiturates

4) tranquilizers : phenothiazines ; butyrophenones ;

benzodizepines

b) Antidepressants , Anti Parkinson Drugs

c) Ethyl alcohol

d) Hypnotics : Barbiturate and Non Barbiturate ;

Anticonvulsants

e) Analeptics ; Physostigmine , Benzodiazepine

Antagonists

f) Antiemetics : Phenothiazines ; Butyrophenones ;

Metoclopramide ; Anticholinergics ; Serotonin
Antagonists

g) Antihistamines ( H , H , Mixed )
1

h) Drug Abuse and Addiction ; Tolerance ; Dependence

9. Diuretics

a) Mechanism of Action

b) Comparison of Drugs
c) Adverse Effects

d) Effects on Electrolyte and Acid Base Balance

e) Ultrafilteration

10. Immunosuppressive and Anti Rejection Drugs

11. Drug Interactions
a) Protein Binding

and Inhibition
12. Pharmacogenetics

b)

PH Effects

c)

Enzyme Induction

d)

Hepatic Blood Flow

a) Malignant Hyperthermia ( including diagnosis and

therapy )

b) Pseudocholinesterase Deficiency

13. Drug Reactions ( Anaphylactoid , Anaphyaxis )

II

PHYSICAL SCIENCES

A. ANATOMY

1. Topographical Anatomy as Landmarks

a) Neck : Cranical Nerves , Tracheotomy Site , Cricoid

Membrane , Internal and External Jugular Veins ,
Thoracic Duct , Carotid and Vertebral Arteries ,
Stellate Ganglion

b) Chest : Pulmonary Lobes , Cardiac Landmarks ,

Auscultation Sites , Subclavian Vein

c) Spinal cord and Related Structures

d) Extremities : Relationship of Bones , Nerves , and

Arteries

Anatomy

2.

Radiological

a) Chest

b) Brain and Skull ( including CT )

3.

c) Spine ( Cervical , Thoracic , Lumbar )

Respiratory System

a) Nose

b) Pharynx : Subdivisions ; Innervation

c) Larynx

1) innervation ; muscles ; blood supply ; cartilages

2) vocal cords , positions with paralysis

3) differences between infant and adult

d) Trachea

1) structure and relationships in neck and chest

e) Lungs

1) divisions and bronchoscopic anatomy

2) bronchial and pulmonary circulations
3) microscopic anatomy

f) Muscles of Respiration , Accessory Muscles

4. Cardiovascular System

a) Normal Anatomy of Heart and Major Vessels

b) Heart Conduction System : External Innervation :

Coronary Circulation

c) Blood Supply of Other Major Organs

a) Brain

5.

Nervous System

1) major nuclei and pathways

2) respiratory center

3) cerebral circulation , circle of Willis ; venous

drainage

b) Spinal Cord and Spine

1) variations in vertebral configurations

2) spinal nerves ( level of exit , covering , sensory

distribution )

3) supply

c) Meninges

1) epidural , subdural and subarachnoid spaces

2) parasympathetic ; location of ganglia

(a) cranial nerves ; eye , salivary glands larynx

(b) sacral nerves ; innervation of pelvic structures

(c) vagal reflex pathways

3) carotid and aortic bodies , carotid sinus

6.

Anesthesia ; Main Nerve Blocks

Regional

a) Autonomic ; Stellate, Celiac , Lumbar Sympathetic

b) Head and : Cervical , Superior Laryngeal ,
Transtracheal

c) Extremities : brachial Plexus , Ulnar , Radial

Median , Sciatic , Femoral , Lateral Femoral
Cutaneous , Obturator , llio Inguinal

d) Trunk : Intercostal , Paravertebral ,Somatic

e) Spine : Epidural , Caudal , Spinal
B.

BIOCHEMISTRY

1.

Metabolism

Normal Body

a) Carbohydrates

1) aerobic and anaerobic utilization ; chemical

processes , enzymes

2) relationship to hormones ; insulin ; human growth

hormone , glucocorticoids ; glucagon , epinephrine

b) Proteins

1) functions , hormones , antibodies

2) RNA DNA ; genetics

3) Cyclic Organ Metabolism ( Brain ,

Heart )

2. Acid Base Regulation : Buffer Systems ; Effects of

Imbalance on Electrolytes and Organ

Perfusion

3. Water and Electrolytes : Distribution and Balance ;

compartments

4. Nutritional Support
C.

PHYSICS

1. Mechanics

a) Pressure Measuremant of Gases , Liquids

b) Transducers , Regulators , Medical Gas Cylinders

c) Pipeline System

2.

Flow Velocity

a) Viscosity Density ; Laminar Turbulent

b) Flowmeters : Rotameter, Electromagnetic ,

Ultrasonic ; Pneumotachogram

, and Vapors

3.

Properties of Liquids , Gases

a) Diffusion of Gases

b) Solubility coefficients

c) Relative and Absolute Humidity

d) Critical Temperature , Critical Pressure

4.
5.

Gas Laws

Vaporizers

a) Vapor Pressure and Calculation of Anesthetic

Concentrations

b) Vaporizer Types
6.

Distribution of Inhalation Agents

Uptake and

a) Uptake and Elimination Curves ; Effect of

Ventilation , Circulation , Anesthetic Systems

b) Concentration Effect
c) Second Gas Effect

d) Nitrous Oxide and Closed Spaces

Anesthesia Machines
Breathing System

7.

Design of

8.

Physics of

a)

Principles : Resistance ,

Turbulent Flow , Mechanical Dead space , Rebreathing ,

Dilution , Leaks , Gas Mixtures , Humidity , Heat
b)

Components : Connectors ,

Adaptors , Mask , Endotracheal Tube , Reservoir Bag ,

Unidirectional Valves , Breathing Tubes , Relief Valve
c)

1)

Characteristics

Circie systems

: closed ( low flow ) and semi closed ; adult ; pediatric

systems : insufflation ; open ; semi open
3)

non circle

non rebreathing valves

4)

CO absorption : principles , canisters ,

2

efficiency

Systems : FIO

2)

d)

e) Waste Gas Evacuation Systems

Oxygen Supply

f)

Safety Features

Fail Safe and Other

9. Monitoring Methods
a)

Vascular Pressures :

b)

Heart Function : Heart

c)

Brain and Spinal Cord

Arterial , CVP , PAP , LAP , LVEDP

Tones , ECG , Echocardiography , Cardiac Output

Function : EEG ( raw and processed ) , Evoked Potentials ,

ICP , Cerebral Function Monitor
d)

Neuromuscular Function

e)

Ventilation : Respirometers ,

f)

Gas Concentrations , O ,

g)

Temperature

:Nerve Stimulation Monitor

Inspiratory Force

Wake up Test ,

CO Nitrogen , Anesthetic Gases and Vapors

2

h)

Transcutaneous O
10.

Oxygen : Oximetry ,

Instrumentation

a)

b)

Blood Gases : Electrodes for pH , Po , Pco ,

2

Calibration , Temperature Corrections ,

Errors

Gas Concentrations : Infrared Adsorption ,

Molecular , Broadening Effects , Mass Spectrometry ,

Gas Chromatography , Nitrogen Capnography

c) Cardiac Output : Fick , Dye Dilution , Thermodilution

, Doppler

d) Pressure Transducers ; Overshoot , Resonance ,

Damping

e) Doppler ,Oscillometry

f) Blood Warmers , Cell Savers

g) Echocardiography

h) Coagulation Monitors
11.

b)

Ventilators

a) Classifications

Principles of Action : Assistors , Controllers ;

Pressure Limited , Volume Pre set ; FIO Control ;

2

Periodic Sigh ; Monitors ; Pressure , Oxygen , Apnea ,

Inspired/Expired Ratio ; Bacterial ; Filters ; IMV , CPAP

, PEEP , Pressure Support , High Frequency Ventilation

; Maintenance ; Maintenance ; Microbiology

Complications ; Pediatric Adaptation
c)

12.

d)

Nebulizers , Humidifiers
Pipeline

Alarms : Operating Room ,

Electrical Anesthesia Machine Ventilators , Oxygen

13.

Defibrillators : Internal , External ,

Implantable ; Energy , Cardiversion ; Paddle Size and Position

14.

a)

Pacemakers

Temporary ; Permanent

( Epicardial , Endocardial ) ; Transcutaneous

b)

Types : Fixed Rate

c)

Standard Nomenclature

Synchronized Ventricular , Atrial A V Sequential

d)

Malfunction

Hazards

15.

Oxygen Cylinders

Reasons for Failure or

Electrical ; Fire and Explosion

a)

Source of lgnition ; Static of

Isolation Transformers
Hazards
f)

D.

b)

Prevention : Grounding ,

c)

Macro and Micro Current

d)

Safety Regulations
Lasers

MATHEMATICS

1. Simple Math : Logarithms ; Graph of Simple Equations ;

Exponential Function , Analysis of

2. Statistics : Sample and Population ; Probability ; Mean

and Mode ; Standard Deviation and Error ; T Test ;
Chi Square ; Correlation ; Analysis of Variance

3. Computer : Data Handing ; Data Processing ; Data

Analysis ; Anesthesia Applications

III

CLINICAL SCIENCES
A. ANESTHESIA PROCEDURES , METHODS AND
TECHNIQUES

Evaluation of the Patient and Preoperative Preparation

a) Physical Status
b) Premedication

1) interaction with chronic drug therapy ; anesthetic

agents

2) adverse reactions to premedications ; patient

variability , dose response curves , side effects

3) specific problems in disease states ; hyper and

hypothyroid , drug abuse , glaucoma , uremia

,increased CSF pressure , chronic steroid ingestion

, obesity depression , COPD

4) pediatric and geriatric doses ,routes of

administration

5) role in patients with allergies

6) alteration of gastric fluid volume and pH ,

sphincter tone

c) NPO Recommendations

Regional Anesthesia

a) General : Premedication ,Patient Position ,

Equipment

b) Spinal , Epidural , Caudal

1) indications , contraindications , techniques ,

comparison of techniques

2) sites of actions

3) factors influencing onset duration and termination

of action

4) systemic toxicity , test dose

5) complications : precipitating factors , prevention ,

therapy

c) Peripheral and Autonomic Nerve Blocks : Indications

,Contraindications ,Techniques , Clinical Assessment
Complications

d) IV Regional : Mechanism , Agents , Indications ,

Contraindications , Techniques ,
Complications

General Anesthesia

a) Stages and Signs of Anesthesia ; Awareness Under

Anesthesia

b) Airway Management ; Intubation , Fiberoptic

Techniques , Awake ; Techniques
for

Difficult Intubation ; Laryngeal Mask

Airway ; Endotracheal Intubation ;

Complications

Systemic Effects
4.

c)

Hypocarbia Hypercarbia :
d)

Hypoxemia ; Systemic Effects

Intravenous Fluid Therapy

During Anesthesia : Electrolyte , Glucose Requirements and

Disposition

5.

Prevention , Treatment )

Complications ( Etiology ,
a)

Trauma

1)

airway , epistaxis
and trachea ; stridor ; laryngospasm

3)

upper
2)

larynx

eyes

4) vascular ; arterial and venous thrombosis ;

thrombophlebitis sheared catheter ,

intra-arterial injections , air embolism

retractors
b)

5)

neurological injections ,

6)

burns

Chronic Environmental

Exposure ; Mutagenicity , Teratogenicity ,

Carcinogenicity ,

Scavenging
c)

pothermia : etiology , treatment , prognosis

ivering

Temperature

1)

Hy

2)

Sh

Vomiting

d)

Nausea and
1)

ph

2)

pre

ysiology ; etiology ; gastroesophageal sphincter ; gastric

emptying time

operative ; full stomach and induction of anesthesia

3)

e of antacids , H2 blockers , metoclopramide , transdermal

scopolamine , droperidol , ondansetron
monary aspiration
Laryngospasm
Techniques

e)

4)

pul

Bronchospasm ,
6.

Special

a)

Controlled

Hypotension ; Choice of Drugs , Use of Posture ,

Ventilation

b)

us

Controlled Hypothermia ; Techniques,

Systemic Effects, Shivering, Rewarming ,Complications

c)

Hyperbaric Oxygen and

d)

Barbiturate Coma

Anesthesia Care , High Attitude Anesthesia

7.

Postoperative Period

a)
a)

1)

Pain Relief

Pharmacologic

drugs : opioids , agonist

antagonists , local anesthetics , alpha 2 agonists , nonsteroidal anti

inflammatory drugs

b)

route

s : oral , SC , IM , IV ( PCA ) , epidural , spinal , intrapleural

, other regional techniques

c)

risks and benefits

2)

er techniques ; TENS ; cryotherapy ; acupuncture

Consequences of Anesthesia

b)

Respiratory

8.

Anesthesia

Record Keeping and Quality Assurance

B DISEASE STATES CLINICAL PROBLEMS AND THEIR

MANAGEMENT

oth

1.

States

Painful Disease
a)

thophysiology

Acute postoperative and posttraumatic pain

Cancer related pain

1)
2)
3)

Chronic pain states

(a)

Pa

Redicular and neuropathic pain : low back pain ,

postherpetic neuralgia

(b)
(c)

Visceral pain

Sympathetically mediated pain : reflex

sympathetic dystrophy , Causalgia

(d)

Other somatic pain

(e)

Central and

condition ; myofascial , arthropathy , etc.

deafferentation pain : phantom limb pain

b)

eatment

1)

Cancer Pain
(a)

Systemic medications

(b)

Continuous spinal and epidural

analgesia
(c)

Neurolytic and non neurolytic blocks

Chronic pain
(a)

Tr

Systemic medications : analgesics ,

anticonvulsants , psychotropics , etc.

(b)

Spinal and epidural analgesia

(c)

Peripheral nerve blocks

(d)

Sympathetic nerve blocks

2)

(e)

Other techniques : TENS , epidural stimulation , neuroablation

( surgical and chemical neurolysis ) etc.

2.

System

Respiratory
a)

structive Disease

Ob
1)

upper airway : congenital , infectious , neoplastic ,

traumatic , foreign body

2)

tracheobron

chial : congenital , infectious , neoplastic , traumatic ,

foreign body

3)

paren

chymal : asthma , bronchitis , emphysema , lung abscess

, bronchiectasis , cystic fibrosis , mediastinal masses
Restrictive Disease

b)

1)

neurologic : CNS

depression , spinal cord dysfunction , peripheral nervous

system

2)

musculoskeletal : muscular , skeletal , obesity , chest

trauma

3)

arenchymal : atelectasis , pneumonia , interstitial pneumonitis ,

pulmonary fibrosis

, respiratory distress syndrome ,

bronchopulmonary dysplasia

4)

pleural and mediastinal : pneumo - , hemo - , and

chylothorax , pleural effusion , empyema , bronchopleural

fistula , cardiomegaly
5)

other : pain , abdominal distention

c)

Management of the Patient with Respiratory Disease

1)

evaluation : H & P , CXR , ABGs , PFTs ;

2)

anesthetic management

assessment of perioperative risk

a)

perioperative preparation : respiratory therapy , drug

therapy ( antibiotics , bronchodilators , mucolytics )

b)

intraoperative management

ng

of anesthesia
(3)

(1)

monitori

(2)

choice

anesthetic techniques : nonpulmonary

surgery , thoracic and pulmonary surgery , one lung

ventilation , lung transplantation

c)

postoperative care : pain management , respiratory

therapy , ventilator support , extubation criteria

3)

management of respiratory failure

a)

supportive medical therapy

b)

monitoring

c)

nonventilatory respiratory management : O therapy and

2

toxicity ,

tracheobronchial toilet , positive airway

pressure , respiratory drugs

d)

ventilatory management
(1)

criteria

(2)

choice

for ventilatory commitment and weaning

of ventilator

(3) mode of ventilation : conventional

mechanical ventilation , PEEP , CPAP , IMV

, SIMV , pressure support , high frequency
ventilation

( positive pressure , jet , oscillation )

(4) complications of mechanical ventilation

3. Cardiovascular

a ) Ischemic Heart

Disease

1 )risk

factors

2 )

manifestation

3 )

diagnosis of myocardial infarction

4 ) anesthesia risk

5
)

treatment of angina ; drugs , surgical

6 )

determinants of myocardial oxygen requirements

and delivery , silent ischemia , postoperative
ischemia
7

intraooperative ischemia
b )

alvular Heart Disease

1
)

classification
2

diagnosis
3

anesthetic consideration
c )

Rhythm

Disorders and Conduction Defects

1) electrophysiology
2) chronic abnormalities : etiology , diagnosis
,therapy
3) intraoperative dysrhythmia : etiology , diagnosis ,
therapy
4) perioperative use of pacemaker : indication ,
complications
d)

Heart Failure

and Cardiomyopathy ( Ischemic , Viral , Hypertrophic )

1) definition and functional classifcation
2) compensatory responses
3) right or left ventricular dysfunction
a) etiology

b) signs

and symptoms

c) diagnostic tests
4 )
treatment
a )

pulmonary

b )

pulmonary

c )

cardiogenic shock

d )

cardiac

edema

hypertension

transplantation
e )

Cardiac

Tamponade

and

Constrictive Pericarditis
1

cardiopulmonary
a )

components

bypass

( pump , oxygenator , heat

exchanger , filters )
b )

mechanisms of gas

exchange

c )

priming

solutions
d )

anticoagulation and

antagonism ; ACT , heparin assays , antithrombin III ,

protamine reactions
e )

anesthetic considerations during bypass

2

intraaortic ballon : rationale , indications ,

limitations
3
)

artificial heart and ventricular assist devices ;

internal and external

g )

Myocardial

Preservation : physiology , techniques , complications

h )
Pulmonary Embolism
1 )
etiology : thrombosis air , fat , plague , anmiotic fluid
2
)

diagnosis

3
)

treatment ; acute , preventive

i )

Hypertension
1
)

etiology , pathophysiology , course of disease

2

drug treatment , interactions with anesthetics ,

risk of anesthesia
3
)

intra or postoperative hypertension

a )

differential diagnosis and treatment

j )

Peripheral Circulatory Failure

1
)

etiology , classification , pathophysiology

2

anesthetic management of patient in shock

k )

ascular Diseases

1
)

cerebral circulation ; luxury perfusion , steals ,

infarcts , intracranial
2 )

hermorrhage

carotid endarterectomy : anesthetic

management , monitoring of cerebral perfusion ,

complications
3
)

abdominal aneurysm resection : anesthetic management

4

arterial occlusive disease

5

aneurysms of ascending , descending and arch of aorta

l )

Cardiopulmonary Resuscitation
1
)

recognition
2

management drugs , defibrillators , monitors ,

ACLS guidelines
3
)

complications of therapy

4.

Central Nervous System

a )

Seizures

b )

Coma :

Traumatic , Infectious , Metabolic , CVA , Cerebral Hypoxia

1
)

Glasgow Coma Scale

c )

Drug

Intoxication ( CNS Drugs , Carbon Monoxide , Insecticides )

d )

Paraplegia ,

Quadriplegia , Spinal Shock , Autonomic Hyperreflexia

e)
Neuromuscular Diseases
f)

Tetanus
g)

Special

Problems of Anesthesia for Neurosurgery

1)
increased intracranial pressure
2)
posture

3)
air embolism
4)
neuroradiological invastigative procedures ; CT scan ,
MRI
5)
cerebral protection from hypoxia , ischemia , glucose
effecs
6)
meningomyelocele
7)
aneurysms and A V malformations , cerebral
vasospasm
8)
anesthetic and ventilatory effects on cerebral blood
flow and metabolism
9)
fluid management
5.

Other Entities :
a)

Massive Obesity

b)

He

patic Disease
1)
preoperative laboratory values
2) anesthesia choice
( hepatocelluar disease , ascites , portal hypertension )
3)
postoperative hepatic dysfunction , hepatorenal syndrome
4) hepatic transplantation
c)

Diabetes Mellitus

1) pathophysiology
2) control of blood glucose
3) elective anesthesia perioperative management
4) emergency anesthesia perioperative hypoglycemia
; hyperglycemia

and ketoacidosis management

5) hyperosmolar coma
6) pancreas transplantation
d)

Renal Disease

1) pathophysiology of renal disease and uremia

2) anesthetic choice in reduced renal function

3) anesthetic management in renal failure , A V

shunts
4) anesthetic management in renal transplantation
5) postoperative oliguria and anuria
6) inappropriate ADH secretion
7) pharmacokinetic implications
e)

Endocrine Disorders

1) pituitary disease
a)

hypopituitarism , pituitary removal substitution

therapy
1) diabetes insipidus
b)
hyperpituitarism
1) acromegaly airway management
2) inappropriate ADH secretion
2)
thyroid disease
a) hyperthyroidism
1) metabolic and circulatory effects
2) anesthetic management
3) thyroid storm
b) hypothyroidism

1) circulatory and metabolic effects

2) substitution therapy
3) anesthetic implication
3)
parathyroid
a) hyperparathyroid ;physiological effects
b) hypoparathyroid ; postop manifestations
4)
adrenal disease
a) Cushing s Syndrome
b) Primary aldosteronism
c) Addison s Disease
d) Pheochromocytoma
1) circulatory and metabolic manifestations
2) diagnosis
3) anesthetic management
5)
carcinoid syndrome
f)
stinal Obstruction
1) causes , paralytic ileus ; mechanical ; vascular

Inte

2) physiological changes ; fluid and electrolyte ;

respiratory
3) anesthesia management : full stomach ; fluid
therapy ; nitrous oxide
g)

He

matologic Disorders
1) disease of blood
a) anemias ; compensatory mechanisms
b) polycythemias ; primary vs. secondary
c) clotting disorders : congenital , acquired ,
pharmacologic ( antiplatelets anticoagulant and
antagonists )
d) hemoglobinopathies
2) transfusions
a) blood preservation , storage
b) blood filters and pumps
c) effects of cooling and heating ; blood warmers
d) blood components , volume expanders
e) preparation for transfusion : type and cross , type
and screen , uncrossmatched blood , autologous
blood , designated donors
3) reactions to transfusions

a) febrile
b) allergic
c) hemolytic acute and delayed
4) complications of transfusions
a) infections : hepatitis , AIDS , CMV , others
b) citrate intoxication
c) electrolyte and acid base abnormalities
d) massive transfusion : coagulopathies ,
hypothermia
e) pulmonary
7)
congenital heart disease
a) cyanotic defects , primary pulmonary hypertension
b) non-cyanotic defects
c) altered uptake/distribution of IV and inhalation
anesthetics
d) other anesthetic considerations
8) emergencies in the newborn
a) diaphragmatic hernia
b) T E fistula
c) neonatal lobar emphysema
d) pyloric stenosis

e) necrotizing enterocolitis
f) omphalocele / gastroschisis
g) RDS : etiology , management , ventilation
techniques
h) Myelomeningocele
9) postoperative analgesia
i)

Obs

tetrical Anesthesia
1)

maternal physiology
a)

effects on uptake and distribution

b)

respiratory ( anatomy , blood gas

, acid base )
c)

cardiovascular ( aorto caval

compression , regulation of uterine blood flow )

d)

renal
e) liver ( A/G ratio , drug binding)
f) gastrointestinal ( gastric acid , motility , anatomic
position , gastroesophageal function )
g) coagulation

h) placenta
1) placental exchange gases , O ,CO
2

2) placental blood flow

2)
maternal fetal
a) pharmacology
1) anesthetic drugs and adjuvants
2) oxytocics , interactions
3) tocolytics
4) antitoxemic drug ; interactions
5) mechanisms of placental transfer
6) fetal disposition of drugs
7) drug effects on newborn
b) amniotic fluid ( L/S ratio )
c) anesthetic techniques and risks ( elective vs.
emergency ) antacids , general , regional , local ,
nerve blocks
d) physiology of labor
e) influence of anesthetic technique on labor
f) fetal monitoring

3)
pathophysiology and complicated
pregnancy
a) problems during pregnancy
1) anesthesia for the non obstetric procedure
2) endocrine ( thyroid , diabetes )
3) hypertension
4) rheumatic or congenital heart disease
5) neurologic ( seizures , myasthenia , paraplegia )
6) respiratory ( asthma )
7) renal
8) Rh and ABO incompatibilities
9) Ectopic pregnancy
b) problems of term and delivery
1) evaluation of fetus
2)

toxemia

3)

placenta previa

4)

supine hypotensive syndrone

5)

aspiration of gastric contents

6)

amniotic fluid embolism , DIC

7)

dystocia and malposition ; multiple pregnancy

8)

abruptio placenta

9)

retained placenta

10)

cord prolapse ;
11) uterine atony
12) breech presentation
6.

Special

Problems in :
a) ENT Surgery : Airway Endoscopy ; Microlaryngeal
Surgery ; Laser Surgery , Hazards ,
Complications
b) Plastic Surgery
c) Laparoscopic Surgery ; cholecystectomy ;
Thoracoscopy ; Gynecologic Surgery ; Anesthetic ;
Complications
d) Urologic Surgery ; Lithotripsy
e) Ophthalmologic Surgery , Retrobular Block ; Open
Eye Injuries
f) Orthopedic Surgery ; Tourniquet Management ,
Complications
g) Trauma , Burn Management

h) Radiologic Procedured ; CT Scan ; MRI Anesthetic

Implications , Management
i) Ambulatory Surgery : Patient Selection ; Anesthetic
Management ; Discharge Criteria
j) Electroconvulsive Therapy
k) Nutrition in the Surgical or Critically III Patient
l) Adverse Outcomes ; Anesthetic Accidents ; Closed
Claims Findings ; Professional Liability , Risk
management
m) Costs of Medical/Anesthesia Care
n) Occupational Hazard
o) Infection control

VII //

E-journal / Anesthesia - Related

Links

A.

Aitkenhead AR, Smith G. Textbook of Anaesthesia.

3 ed. New York : Churchill Livingstone ; 1996.
rd

Barash PG, Cullen BF, Stoelting RK. Handbook of Clinical

Anesthesia. 4 ed. Philadelphia : Lippincott Williams &
th

Wilkins ; 2001.

Bready LL, Mullins RM, Noorily SH, Smith RB. Decision

Making in Anesthesia, An Algorithmic Approach. 3 ed.
rd

Mosby ; 2000.

Fischer HB, Pinnock CA. Fundamental of Regional

Anesthesia. 1 ed. Cambridge university press ; 2004.

st

James D. Anesthesia Secrets. 2 ed. Philadelphia : Hanley

nd

& Belfus ; 2000.

Miller RD. Millers Anesthesia. 6 ed. New York : Churchill

th

Livingstone : 2005.

Morgan GE(Jr). Clinical Anesthesiology. 3 ed. Singapore :

rd

McGraw-Hill ; 2002.

Roizen MF, Fleisher LA. Essence of Anesthesia Practice.

1 ed. Philadelphia : W.B. Saunders ; 1997.
st

, .

.
3. ; 2548.

1. GRENVIK A,ED. TEXTBOOK OF CRITICAL CARE ,

4 ED.PHILADELPHIA : W.B.SAUNDERS COMPANY,2000.

TH

2. STOELTING RK,ED. ANESTHESIA AND CO EXISTING

DISEASE , 3 . NEW YORK : CHURCHILL
RD

LIVINGSTONE,1995.

KAPLAN JA,ED.CARDIAC

ANESTHESIA,4 ED.PHILADELPHIA :W.B.SAUNDERS

TH

COMPANY

YENTIS SM,ED. ANESTHESIA A TO Z. LONDON :

BUTTER WORTH HEINEMANN,1996.

3. , , .

. : . . , 2543.

4. BENUMOF JL,ED. ANESTHESIA FOR THORACIC

SURGERY. PHILADELPHIA : W.B.SAUNDERS
COMPANY,1988.

5. ROBERT CP,ED. INTERNATIONAL PRACTICE OF

ANESTHESIA. OXFORD : BUTTER WORTH
HEINEMANN,1996.

6. Katz J,ED. ANESTHESIOLOGY A COMPREHENSIVE

STUDY GUIDE.U.S.A.: THE MCGRAW-HILL,INC,1997.

7. YAO FSF,ED. ANESTHESIOLOGY,4 ED. PHILADELPHIA :

TH

LIPPINCOTT RAVEN ,1998.

8. ,.THE COMMON CHRONIC

PAIN PROBLEMS AND MANAGEMENT. :

,2539.

9. WALL PD,ED.TEXTBOOK OF PAIN, 2 ED.NEW YORK :

ND

CHURCHILL LIVINGSTONE,1989.

10.

HEALY TEJ,ED.A PRACTICE OF

ANESTHESIA,6 ED.LONDON : EDWARD ARNOLD,1995.

TH

11.

HALL CJ,ED.PHAMACOKINETICS FOR

ANESTHESIA.OXFORD : BUTTER WORTH

HEINEMANN,1991.

B.

/ E-journal
1.American Journal of

Anesthesiology : www.amjanesthesiology.com
Anaesthesia : www.blackwell-

science.com/products/journals/anae.htm

Anesthesia & Analgesia: www.anesthesia-analgesia.org/

Anesthesiology: www.anesthesiology.org/

British Journal of Anaesthesia: www.bja.oupjournals.org/

Internet Journal of

Anesthesiology: www.ispub.com/journals/ija.htm

Journal of Neurosurgical Anesthesiology: www.jnsa.com/

Thai Journal of Anesthesiology : www.rcat.org

C.

Anesthesia - Related Links

1. American Society of Anesthesiologists

(ASA):

www.asahq.org

2. American Society of Regional Anesthesia & Pain

Medicine (ASRA):

www.asra.com/

3. The European Society of Regional Anaesthesia & Pain

Therapy :

www.esraeurope.org

4. The International Association for the study of

pain:

www.halcyon.com/iasp

5. Pain.com :

www.pain.com

6. Anesthesia Patient Safety Foundation

(APSF) : www.gasnet.med.yale.edu/societies/apsf/index.ht
ml

7. American Society of Critical Care Anesthesiologists

(ASCCA) :

www.ascca.org/

8. Global Anesthesia Server Network (GASNet) :

http://gasnet.med.yale.edu/

9. International Anesthesia Research Society

(IARS) : www.iars.org/

10.

International Society for Anesthetic Pharmacology

11.

International Trauma Anesthesia & Critical Care

12.

Society for Ambulatory Anesthesia (SAMBA) :

13.

Society for Obsteric Anesthesia & Perinatology

14.

Society for Pediatric Anesthesia

15.

Society of Cardiovascular Anesthesiologists

16.

Society of Neurosurgical Anesthesia & Critical Care

(ISAP) :

www.isaponline.org/

Society :

www.trauma.itaccs.com/index1.html

www.sambahq.org/

(SOAP) : www.soap.org/
(SPA) :

www.pedsanesthesia.org/

(SCA) :

www.scahq.org/

(SNACC) : www.scahq.org/

17. Virtual Anaesthesia textbook : www.virtual-anaesthesiatextbook.com/