ASPS ASPS Anesthesia, Pain Management & Perioperative Care 1 — Questions and Answers
Question 1: Which anesthetic technique is most commonly used for outpatient aesthetic procedures to allow rapid recovery?
- General anesthesia with endotracheal intubation
- Total intravenous anesthesia (TIVA) with propofol (Correct answer)
- Spinal anesthesia
- Ketamine-only sedation
Correct answer: Total intravenous anesthesia (TIVA) with propofol
TIVA with propofol provides smooth induction, rapid emergence, and reduced postoperative nausea and vomiting (PONV), making it ideal for outpatient aesthetic surgery.
Question 2: The tumescent technique in liposuction uses large volumes of dilute solution primarily to:
- Provide systemic antibiotic prophylaxis
- Create hydrostatic tissue separation and local anesthesia while reducing blood loss (Correct answer)
- Increase cardiac output during the procedure
- Prevent deep vein thrombosis
Correct answer: Create hydrostatic tissue separation and local anesthesia while reducing blood loss
Tumescent solution (dilute lidocaine + epinephrine in saline) causes vasoconstriction to minimize bleeding, provides local anesthesia, and mechanically separates fat for easier removal.
Question 3: A patient undergoing rhinoplasty develops sudden intraoperative hypotension and tachycardia after epinephrine injection. The MOST likely cause is:
- Anaphylaxis to lidocaine
- Intravascular injection of epinephrine (Correct answer)
- Malignant hyperthermia
- Vasovagal episode
Correct answer: Intravascular injection of epinephrine
Inadvertent intravascular injection of epinephrine causes rapid systemic absorption, producing tachycardia and initial hypertension followed by reflex hypotension.
Question 4: Which multimodal analgesic approach is recommended to reduce opioid requirements after major reconstructive surgery?
- High-dose opioid infusion only
- Combination of NSAIDs, acetaminophen, regional nerve blocks, and low-dose opioids (Correct answer)
- Benzodiazepine-based sedation alone
- Ketamine infusion without supplemental analgesia
Correct answer: Combination of NSAIDs, acetaminophen, regional nerve blocks, and low-dose opioids
Multimodal analgesia targets different pain pathways simultaneously, reducing total opioid consumption and associated side effects like respiratory depression and constipation.
Question 5: Lidocaine toxicity in a tumescent liposuction patient most commonly first presents as:
- Cardiac arrhythmia
- Perioral numbness and tinnitus (Correct answer)
- Seizure
- Respiratory arrest
Correct answer: Perioral numbness and tinnitus
Early signs of lidocaine toxicity are CNS-related, including perioral numbness, tinnitus, metallic taste, and light-headedness, preceding more serious cardiac or seizure effects.
Question 6: Pre-operative fasting guidelines (NPO) before elective plastic surgery typically require abstaining from solid food for:
- 2 hours
- 4 hours
- 6–8 hours (Correct answer)
- 12 hours
Correct answer: 6–8 hours
Current ASA guidelines recommend at least 6 hours NPO for solid food (8 hours for fatty meals) and 2 hours for clear liquids before elective procedures under general anesthesia.
ASPS ASPS Anesthesia, Pain Management & Perioperative Care 1
Which anesthetic technique is most commonly used for outpatient aesthetic procedures to allow rapid recovery?