Anesthesia Complications & Management Flashcards

A patient with acute liver failure requires general anesthesia. Which neuromuscular blocking agent is most appropriate?

Answer: Cisatracurium

Cisatracurium undergoes Hofmann elimination (spontaneous chemical degradation at physiologic pH and temperature) independent of hepatic or renal function, making it ideal for patients with liver failure.

A patient develops severe hypotension after induction with propofol. Which mechanism best explains this effect?

Answer: Direct myocardial depression and vasodilation

Propofol causes hypotension primarily through direct myocardial depression combined with peripheral vasodilation via decreased sympathetic tone and direct vascular smooth muscle relaxation.

Which sign is EARLIEST in the clinical progression of increasing intracranial pressure?

Answer: Altered level of consciousness

Altered level of consciousness (restlessness, confusion, decreased GCS) is the earliest manifestation of rising ICP as the cerebral cortex is sensitive to pressure changes before brainstem herniation signs appear.

A 28-year-old parturient at 36 weeks develops sudden onset severe headache, visual disturbances, and BP 172/110 mmHg during labor. What complication must be immediately ruled out?

Answer: Intracranial hemorrhage from preeclampsia/eclampsia

Severe hypertension with neurological symptoms in pregnancy represents hypertensive emergency from severe preeclampsia, with intracranial hemorrhage being a life-threatening complication requiring immediate management.

A patient develops intraoperative hypotension unresponsive to fluids and vasopressors. Transesophageal echocardiography shows a hyperdynamic left ventricle with near-obliteration of the cavity. What is the diagnosis?

Answer: Dynamic left ventricular outflow tract obstruction

Dynamic LVOT obstruction (including Takotsubo-like physiology or provoked by catecholamines/hypovolemia) shows a hyperdynamic, small-cavity LV on TEE and paradoxically worsens with vasopressors that increase contractility.

Which intraoperative event is most likely to precipitate a hyperkalemic cardiac arrest in a patient with chronic renal failure?

Answer: All of the above

All three scenarios can cause acute hyperkalemia: succinylcholine causes potassium efflux from depolarized muscle, aged blood contains elevated potassium, and tourniquet release flushes ischemic metabolites including potassium into circulation.

A patient develops hypoxemia and hypotension within minutes of placing bilateral femoral nerve blocks with 40 mL of 0.5% bupivacaine. What is the most likely etiology?

Answer: Local anesthetic systemic toxicity from vascular absorption

Large-volume peripheral nerve blocks, especially in highly vascular areas or with inadvertent intravascular injection, can cause LAST due to systemic absorption exceeding the maximum safe dose threshold.