BCA BCA Thoracic & Vascular Anesthesia 2 — Questions and Answers
Question 1: During carotid endarterectomy (CEA) under general anesthesia, the primary purpose of intraoperative EEG monitoring is to detect:
- Depth of anesthesia
- Cerebral ischemia during carotid cross-clamping (Correct answer)
- Malignant hyperthermia
- Air embolism
Correct answer: Cerebral ischemia during carotid cross-clamping
EEG monitoring detects ipsilateral cortical ischemia during carotid cross-clamp, prompting placement of a carotid shunt to maintain cerebral perfusion.
Question 2: The MOST common indication for insertion of an intra-aortic balloon pump (IABP) in the perioperative setting is:
- Refractory ventricular arrhythmias
- Cardiogenic shock or failure to wean from cardiopulmonary bypass (Correct answer)
- Pulmonary embolism
- Aortic regurgitation
Correct answer: Cardiogenic shock or failure to wean from cardiopulmonary bypass
The IABP augments diastolic coronary perfusion and reduces afterload (systolic unloading), making it the primary mechanical support for cardiogenic shock and post-bypass ventricular failure.
Question 3: During cardiopulmonary bypass (CPB), systemic hypothermia is used primarily to:
- Prevent coagulopathy
- Reduce whole-body oxygen consumption and provide organ protection (Correct answer)
- Prevent air embolism
- Facilitate hemodilution
Correct answer: Reduce whole-body oxygen consumption and provide organ protection
Hypothermia decreases metabolic rate and oxygen demand proportionally, extending safe ischemia time for the heart and other organs during cardiac surgical procedures.
Question 4: Heparin dosing for cardiopulmonary bypass is monitored using:
- PTT (partial thromboplastin time)
- Activated clotting time (ACT) (Correct answer)
- INR
- Anti-Xa levels
Correct answer: Activated clotting time (ACT)
The ACT is the standard point-of-care test for monitoring heparin anticoagulation during CPB; a target ACT of ≥ 480 seconds is typically required before initiating bypass.
Question 5: Protamine sulfate is administered after CPB to reverse heparin. A severe adverse reaction to protamine is MOST associated with:
- Prior penicillin allergy
- History of fish allergy or vasectomy (Correct answer)
- Prior exposure to latex
- Sulfa drug allergy
Correct answer: History of fish allergy or vasectomy
Patients with fish allergy or prior vasectomy (anti-protamine antibodies) are at elevated risk for severe protamine reactions including anaphylaxis and pulmonary vasoconstriction.
Question 6: Which anesthetic technique is MOST associated with reduced blood loss during spine and major vascular surgery?
- High-dose opioid anesthesia
- Deliberate controlled hypotension (Correct answer)
- High-concentration volatile anesthetic
- Ketamine-based anesthesia
Correct answer: Deliberate controlled hypotension
Deliberate controlled hypotension reduces perfusion pressure at surgical sites, significantly decreasing intraoperative blood loss during procedures with large raw surface areas.
BCA BCA Thoracic & Vascular Anesthesia 2
During carotid endarterectomy (CEA) under general anesthesia, the primary purpose of intraoperative EEG monitoring is to detect: