The Four Broad Categories
Surgical technologists do not administer anesthesia, but the CST exam tests your understanding of each category so you can anticipate the needs of the anesthesia provider and the phase of the procedure.
General Anesthesia
| Phase | Description |
|---|---|
| Induction | IV agent (e.g., propofol) induces unconsciousness rapidly; the room must be quiet and the sterile field ready in case of an emergent need |
| Maintenance | Inhalation agents (sevoflurane, desflurane, isoflurane) and/or continuous IV agents (TIVA) maintain the anesthetic state |
| Airway management | Endotracheal intubation or supraglottic airway (LMA) secures and protects the airway |
| Neuromuscular blockade | Agents such as rocuronium or succinylcholine produce paralysis for intubation and/or optimal surgical relaxation |
| Emergence | Agents are discontinued/reversed; patient regains consciousness and protective reflexes |
Regional Anesthesia
| Type | Description |
|---|---|
| Spinal (subarachnoid block) | Local anesthetic injected into the subarachnoid space (CSF); dense, rapid-onset block, commonly used for lower extremity, pelvic, and lower abdominal surgery |
| Epidural | Local anesthetic injected into the epidural space, often via catheter for continuous infusion; slower onset than spinal, used for labor, lower extremity, and postoperative pain control |
| Peripheral nerve block | Local anesthetic deposited near a specific nerve or plexus (e.g., brachial plexus block) for regional limb anesthesia/analgesia |
| Bier block (IV regional) | Local anesthetic injected IV into an exsanguinated, tourniquet-isolated limb; used for short upper extremity procedures |
Local Anesthesia
Local anesthetic agents (lidocaine, bupivacaine, ropivacaine) are infiltrated directly into the surgical site to block nerve conduction in a limited area, often for minor procedures or in combination with sedation. Agents may be combined with epinephrine to prolong effect and reduce bleeding through vasoconstriction, but epinephrine is avoided in end-arterial areas (fingers, toes, nose, ears, penis) due to ischemia risk.
Monitored Anesthesia Care (MAC) / Conscious Sedation
The patient receives sedative and analgesic medications (commonly midazolam, fentanyl, or propofol) while maintaining the ability to respond to verbal or tactile stimulation and protect their own airway. An anesthesia provider continuously monitors vital signs and level of consciousness. Often paired with local infiltration at the surgical site.
Common Anesthesia Agents Quick List
| Agent | Category | Note |
|---|---|---|
| Propofol | IV induction/sedation agent | Rapid onset and recovery, milky white appearance |
| Etomidate | IV induction agent | Hemodynamically stable, used in cardiac-compromised patients |
| Ketamine | IV induction/dissociative agent | Preserves airway reflexes and blood pressure; used in trauma/unstable patients |
| Succinylcholine | Depolarizing neuromuscular blocker | Rapid onset/offset; risk of malignant hyperthermia trigger |
| Rocuronium | Nondepolarizing neuromuscular blocker | Reversible with sugammadex |
| Sevoflurane | Inhalation agent | Non-pungent, common for mask induction |
Key Exam Points
- Malignant hyperthermia is a life-threatening hypermetabolic reaction to volatile anesthetics and succinylcholine; the surgical team must know the location of the MH cart and dantrolene.
- The surgical tech should have suction and hemostatic supplies ready during induction and emergence, the highest-risk phases for airway compromise.
- Epinephrine-containing local anesthetic is contraindicated in end-arterial tissue.
- Regional anesthesia reduces general anesthesia risk but requires the patient to remain still and cooperative during placement and the procedure.