ABA Perioperative Patient Management 4

Question 1

A patient receiving a thoracic epidural infusion of 0.1% bupivacaine with fentanyl develops hypotension (BP 78/42) and bradycardia (HR 44). The FIRST intervention should be:

Accepted Answer

IV fluid bolus, ephedrine or phenylephrine, and atropine if bradycardia persists

Answer

High thoracic sympathectomy from epidural spread causes hypotension and bradycardia managed with fluids, vasopressors, and atropine; intralipid is reserved for systemic local anesthetic toxicity.

Question 2

During a carotid endarterectomy under general anesthesia, the surgeon asks you to increase blood pressure after carotid cross-clamping. The TARGET MAP should typically be:

Accepted Answer

20% above the patient's baseline MAP

Answer

During carotid cross-clamping, maintaining MAP 20% above baseline helps perfuse the hemisphere via collaterals and is the standard approach.

Question 3

A previously healthy 4-year-old child (18 kg) is extubated after an uneventful tonsillectomy. In PACU, SpO₂ is 88% with inspiratory stridor. The MOST appropriate immediate intervention is:

Accepted Answer

Administer nebulized racemic epinephrine and dexamethasone

Answer

Post-extubation croup (subglottic edema) is treated first with nebulized racemic epinephrine and dexamethasone; reintubation is reserved for failure of conservative measures.

Question 4

Which intraoperative finding on a transesophageal echocardiogram is MOST consistent with acute left ventricular failure?

Accepted Answer

Dilated LV with global hypokinesis and elevated E/e' ratio

Answer

Dilated LV with global hypokinesis and elevated E/e' ratio on TEE indicates impaired systolic function and elevated filling pressures consistent with acute LV failure.

Question 5

A patient with obstructive sleep apnea (AHI 45) is recovering from laparoscopic Roux-en-Y gastric bypass. Which postoperative analgesic strategy is MOST appropriate?

Accepted Answer

Multimodal analgesia with NSAIDs, acetaminophen, and regional techniques to minimize opioid use

Answer

OSA patients are highly sensitive to opioid-induced respiratory depression; multimodal opioid-sparing strategies with continuous monitoring are the standard of care.

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

(ABA) ASA (American Society of Anesthesiologists) Board Certification Practice Test

ABA Perioperative Patient Management 4