ASPS ASPS Anesthesia, Pain Management & Perioperative Care 2 — Questions and Answers
Question 1: Which nerve block is most useful for providing post-operative analgesia after abdominoplasty?
- Femoral nerve block
- Transversus abdominis plane (TAP) block (Correct answer)
- Intercostal nerve block
- Obturator nerve block
Correct answer: Transversus abdominis plane (TAP) block
The TAP block deposits local anesthetic between the internal oblique and transversus abdominis muscles, blocking afferent pain signals from the anterior abdominal wall.
Question 2: Malignant hyperthermia (MH) is triggered by which class of anesthetic agents?
- Propofol and ketamine
- Volatile halogenated agents and succinylcholine (Correct answer)
- Benzodiazepines and opioids
- Local anesthetics and NSAIDs
Correct answer: Volatile halogenated agents and succinylcholine
MH is a pharmacogenetic disorder triggered by volatile anesthetic agents (e.g., sevoflurane) and succinylcholine, causing uncontrolled skeletal muscle metabolism.
Question 3: Dantrolene is the specific treatment for malignant hyperthermia because it:
- Reverses cholinesterase inhibition
- Blocks calcium release from the sarcoplasmic reticulum (Correct answer)
- Reduces volatile anesthetic MAC
- Directly cools muscle tissue
Correct answer: Blocks calcium release from the sarcoplasmic reticulum
Dantrolene inhibits ryanodine receptor-mediated calcium release from the sarcoplasmic reticulum, halting the uncontrolled muscle contraction driving MH.
Question 4: Enhanced Recovery After Surgery (ERAS) protocols in plastic surgery are designed primarily to:
- Reduce operative time only
- Minimize physiologic stress, reduce complications, and speed return to normal function (Correct answer)
- Increase surgeon efficiency
- Eliminate the need for postoperative monitoring
Correct answer: Minimize physiologic stress, reduce complications, and speed return to normal function
ERAS protocols use evidence-based perioperative interventions—pre-op carbohydrate loading, multimodal analgesia, early mobilization—to reduce organ stress and shorten recovery.
Question 5: Which pre-operative medication is commonly used to reduce postoperative nausea and vomiting (PONV) in high-risk patients?
- Midazolam
- Ondansetron (Correct answer)
- Metoprolol
- Furosemide
Correct answer: Ondansetron
Ondansetron, a 5-HT3 receptor antagonist, is a first-line antiemetic given prophylactically to reduce PONV, especially in patients with known risk factors.
Question 6: Patients with obstructive sleep apnea (OSA) undergoing plastic surgery require special consideration primarily because:
- They have higher rates of wound infection
- They are at increased risk of airway obstruction and respiratory depression with opioids (Correct answer)
- They metabolize anesthetic agents faster
- They require longer NPO periods
Correct answer: They are at increased risk of airway obstruction and respiratory depression with opioids
OSA patients have baseline upper airway compromise and are particularly sensitive to opioid-induced respiratory depression, requiring careful airway management and monitoring.
ASPS ASPS Anesthesia, Pain Management & Perioperative Care 2
Which nerve block is most useful for providing post-operative analgesia after abdominoplasty?