BCA Anesthesia Complications & Management 2 — Questions and Answers
Question 1: A patient develops sudden hypotension, bronchospasm, and urticaria 10 minutes after antibiotic administration. What is the first-line treatment?
- IV diphenhydramine 50 mg
- IV epinephrine 0.1–0.5 mg (Correct answer)
- IV hydrocortisone 200 mg
- IV norepinephrine infusion
Correct answer: IV epinephrine 0.1–0.5 mg
Epinephrine is the first-line treatment for anaphylaxis due to its alpha and beta adrenergic effects that counteract vasodilation, bronchospasm, and mast cell mediator release.
Question 2: Which finding is most characteristic of malignant hyperthermia compared to other causes of intraoperative hyperthermia?
- Rising end-tidal CO2 despite increased minute ventilation (Correct answer)
- Core temperature above 39°C
- Tachycardia and diaphoresis
- Muscle rigidity after succinylcholine
Correct answer: Rising end-tidal CO2 despite increased minute ventilation
Rapidly rising end-tidal CO2 that cannot be controlled by increasing ventilation is the earliest and most sensitive sign of malignant hyperthermia, reflecting massively increased skeletal muscle metabolism.
Question 3: A patient on rocuronium has incomplete reversal with neostigmine. Train-of-four shows 2 twitches. What is the best next step?
- Administer additional neostigmine 2.5 mg
- Administer sugammadex 16 mg/kg (Correct answer)
- Wait 15 minutes and reassess
- Administer edrophonium 10 mg
Correct answer: Administer sugammadex 16 mg/kg
Sugammadex 16 mg/kg is indicated for immediate reversal of profound neuromuscular blockade (1–2 twitches on TOF) caused by rocuronium or vecuronium.
Question 4: During spinal anesthesia, a patient complains of difficulty breathing and becomes unresponsive. Blood pressure is 60/40. This presentation is most consistent with:
- Vasovagal syncope
- Total spinal anesthesia (Correct answer)
- Local anesthetic systemic toxicity
- Pulmonary embolism
Correct answer: Total spinal anesthesia
Total spinal anesthesia results from intrathecal spread of local anesthetic to cervical and brainstem levels, causing hypotension, respiratory paralysis, and loss of consciousness.
Question 5: A patient develops ST-segment depression and new regional wall motion abnormalities intraoperatively. After confirming adequate oxygenation, what is the most appropriate initial intervention?
- Administer IV nitroglycerin
- Increase volatile anesthetic concentration
- Correct hemodynamic abnormalities (BP, HR) (Correct answer)
- Administer IV heparin 5000 units
Correct answer: Correct hemodynamic abnormalities (BP, HR)
Correcting hemodynamic derangements (optimizing oxygen supply-demand balance by addressing hypotension, tachycardia, or anemia) is the first priority in managing intraoperative myocardial ischemia.
Question 6: Which mechanism best explains post-dural puncture headache (PDPH)?
- Cerebral vasoconstriction from loss of CSF pressure
- CSF leakage causing intracranial hypotension and meningeal traction (Correct answer)
- Inflammatory reaction at the dural puncture site
- Air entry into the subarachnoid space
Correct answer: CSF leakage causing intracranial hypotension and meningeal traction
PDPH results from CSF leakage through the dural defect causing intracranial hypotension, which leads to downward traction on pain-sensitive intracranial structures when upright.
Question 7: A patient with a full stomach requires emergency intubation. Which sequence best minimizes aspiration risk?
- Awake fiberoptic intubation with topical anesthesia
- Rapid sequence induction with cricoid pressure (Correct answer)
- Inhalation induction with sevoflurane
- IV induction followed by mask ventilation then intubation
Correct answer: Rapid sequence induction with cricoid pressure
Rapid sequence induction (RSI) with cricoid pressure minimizes the time between loss of protective airway reflexes and tracheal intubation, reducing aspiration risk in patients with full stomachs.
BCA Anesthesia Complications & Management 2
A patient develops sudden hypotension, bronchospasm, and urticaria 10 minutes after antibiotic administration.
What is the first-line treatment?