ABA Best Practices & Standard Procedures 3 — Questions and Answers
Question 1: Per ASA best practices, which action should be taken FIRST when unexpected intraoperative hypotension occurs?
- Administer vasopressors immediately
- Assess the patient, verify monitoring, and identify the cause (Correct answer)
- Increase volatile anesthetic concentration to blunt the response
- Administer a fluid bolus empirically
Correct answer: Assess the patient, verify monitoring, and identify the cause
Systematic assessment of the patient and identification of the underlying cause (hypovolemia, cardiac dysfunction, vasodilation, etc.) should precede empiric treatment of intraoperative hypotension.
Question 2: The ASA recommends that a qualified anesthesia provider be physically present in the operating room throughout which type of anesthetic?
- Monitored anesthesia care only
- Regional anesthesia only
- General anesthesia only
- All general, regional, and monitored anesthesia care (Correct answer)
Correct answer: All general, regional, and monitored anesthesia care
ASA Standard I requires a qualified anesthesia provider to be present in the room throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care.
Question 3: Which of the following is a component of the 'Universal Protocol' established by The Joint Commission to prevent wrong-site surgery?
- Pre-induction medication reconciliation
- Surgical site marking before the procedure (Correct answer)
- Antibiotic prophylaxis within 60 minutes of incision
- Intraoperative blood glucose monitoring
Correct answer: Surgical site marking before the procedure
The Universal Protocol's three elements are pre-procedure verification, surgical site marking, and a 'time-out' immediately before the procedure; site marking is a core component.
Question 4: According to ASA guidelines on regional anesthesia, which condition most increases the risk of epidural hematoma formation?
- Mild hypertension
- Therapeutic anticoagulation with heparin (Correct answer)
- Chronic NSAID use
- Mild thrombocytopenia (platelets 100,000-150,000/μL)
Correct answer: Therapeutic anticoagulation with heparin
Therapeutic-dose anticoagulation with heparin significantly elevates bleeding risk in the epidural space, requiring specific timing intervals per ASRA guidelines before neuraxial procedures.
Question 5: The ASA practice advisory on preanesthesia evaluation recommends that the history and physical examination be completed:
- Within 24 hours before surgery only
- At least 30 days before surgery
- Within a timeframe appropriate to the patient's condition and procedure (Correct answer)
- On the day of surgery in all cases
Correct answer: Within a timeframe appropriate to the patient's condition and procedure
The ASA advisory specifies that the timing of the preanesthesia evaluation should be individualized based on patient health status, procedure complexity, and setting rather than a fixed interval.
Question 6: Which ASA standard requires that the breathing circuit be assessed for the ability to deliver adequate oxygen and ventilation before each anesthetic?
- ASA Standard I — Qualified Personnel
- ASA Standard II — Oxygenation
- ASA Standard III — Ventilation (Correct answer)
- ASA Standard V — Body Temperature
Correct answer: ASA Standard III — Ventilation
ASA Standard III on ventilation requires that the ability to provide adequate ventilation be verified, including assessment of the breathing circuit, before each anesthetic.
Question 7: According to ASA guidelines, 'monitored anesthesia care' (MAC) differs from general anesthesia primarily because:
- No monitoring is required during MAC
- The patient maintains protective airway reflexes and responds purposefully (Correct answer)
- MAC cannot be converted to general anesthesia once started
- MAC does not require a pre-procedure assessment
Correct answer: The patient maintains protective airway reflexes and responds purposefully
MAC is characterized by the patient maintaining the ability to respond purposefully to verbal or tactile stimulation and retaining protective airway reflexes, unlike general anesthesia.
ABA Best Practices & Standard Procedures 3
Per ASA best practices, which action should be taken FIRST when unexpected intraoperative hypotension occurs?