NEET-PG Anesthesia Previous Year Questions (2017–2026)

Correct answer: D. Remifentanil.

Remifentanil is hydrolysed by nonspecific plasma and tissue esterases, so its clearance is independent of hepatic and renal function. Its context-sensitive half-time stays about 3-4 minutes whatever the infusion duration, giving rapid, predictable recovery that is ideal for day-care and titratable infusions.

Incorrect Options:

• A. Sufentanil: the most potent of these, but hepatically metabolised with an accumulating context-sensitive half-time.
  Sufentanil, a highly potent hepatically cleared opioid.
• B. Alfentanil: rapid onset from high unionised fraction, but liver-metabolised, so it accumulates with prolonged infusion.
  Alfentanil, fast in onset but hepatically metabolised.
• C. Fentanyl: highly lipophilic and hepatically cleared; its context-sensitive half-time lengthens markedly with continuous infusion.
  Fentanyl, which accumulates after prolonged infusion.

High-Yield Facts:

• Remifentanil is the only common opioid metabolised by nonspecific esterases (not plasma pseudocholinesterase).
• Its context-sensitive half-time is essentially flat at 3-4 minutes.
• Because offset is so fast, plan post-operative analgesia before stopping the infusion.
• Metabolism is unaffected by hepatic or renal impairment or by pseudocholinesterase deficiency.

Correct answer: A. Patient refusal. When the option list offers it, a competent adult declining the block is the intended absolute contraindication.

The absolute contraindications to spinal anaesthesia are patient refusal, infection at the puncture site, raised intracranial pressure, uncorrected coagulopathy and severe uncorrected hypovolaemia. Of the choices here, a competent, informed patient who refuses consent is the clear absolute contraindication, because performing a block over a valid refusal violates patient autonomy. The other options are relative issues that are weighed case by case.

Informed consent: a competent patient may decline any procedure, and that refusal is absolute.

Incorrect Options:

• B. Previous spinal surgery: it may distort the anatomy and make needle placement harder, but it is only a relative contraindication, not an absolute bar to a spinal block.

  Prior spinal surgery: only a relative contraindication that may make the block technically harder.

• C. Aspirin use: low-dose aspirin by itself is not a contraindication to neuraxial block; the concern rises mainly when it is combined with therapeutic anticoagulants.

  Aspirin alone does not preclude neuraxial anaesthesia.

• D. Mild hypotension: mild hypotension is a relative caution because the sympathetic block can lower pressure further; frank uncorrected hypovolaemic shock, not mild hypotension, is the absolute concern.

  Mild hypotension is a caution, not an absolute contraindication.

High-Yield Facts:

• Absolute contraindications: patient refusal, local infection, raised intracranial pressure, coagulopathy, severe hypovolaemia.
• Relative contraindications: fixed cardiac output states (severe aortic stenosis), pre-existing neurological disease, prior spine surgery.
• Low-dose aspirin alone does not preclude a neuraxial block; combined anticoagulation does.
• A valid refusal by a competent patient is binding regardless of the anaesthetist opinion.

Correct Answer: C. Sugammadex

Sugammadex, a modified gamma-cyclodextrin, encapsulates steroidal neuromuscular blockers like vecuronium/rocuronium in a 1:1 complex, rapidly reversing blockade; the complex is renally cleared, making it ideal with normal renal function.

Why the other options fail

• A. Neostigmine: is a non-selective acetylcholinesterase inhibitor with a ceiling effect, requiring co-administration of an antimuscarinic to avoid parasympathetic side effects.
• B. Physostigmine: crosses the blood-brain barrier and treats central anticholinergic toxicity, not routine NMB reversal.
• D. Atropine: counteracts neostigmine's side effects but has no direct NMB-reversing action itself.

Pearl: sugammadex selectively encapsulates steroidal muscle relaxants (vecuronium/rocuronium) for rapid, targeted reversal, ideal with normal renal clearance.