BCA Anesthesia Complications & Management 3

Question 1

A 45-year-old patient develops seizures and cardiovascular collapse after an axillary nerve block. Which local anesthetic has the narrowest margin between CNS toxicity and cardiovascular toxicity?

Accepted Answer

Bupivacaine

Answer

Bupivacaine has the narrowest therapeutic index because its high lipid solubility and protein binding cause rapid cardiac sodium channel blockade that is difficult to reverse, making cardiac toxicity appear at doses close to CNS toxicity doses.

Question 2

During laryngoscopy, the patient develops sudden bradycardia to 32 bpm. What is the most likely mechanism?

Accepted Answer

Vagal stimulation from laryngeal instrumentation

Answer

Laryngoscopy can trigger a vagally mediated reflex bradycardia through stimulation of the superior laryngeal nerve, which is particularly pronounced in pediatric patients or lightly anesthetized adults.

Question 3

A patient undergoing laparoscopic surgery develops sudden hemodynamic instability with a 'mill-wheel' murmur. What has occurred?

Accepted Answer

Venous air embolism from CO2 insufflation

Answer

A mill-wheel murmur is pathognomonic for venous air (or gas) embolism, where gas enters the right heart and creates a churning sound as the gas-blood mixture circulates.

Question 4

Which intervention is CONTRAINDICATED in the management of local anesthetic systemic toxicity (LAST)?

Accepted Answer

Propofol as the preferred agent for cardiac arrest

Answer

Propofol is contraindicated in LAST because it contains lipid but also has direct myocardial depressant effects and should not substitute for 20% lipid emulsion; it can worsen cardiac depression.

Question 5

A patient emerges from general anesthesia with oxygen saturation of 88% and increased work of breathing. Auscultation reveals diffuse wheezing. The most likely diagnosis is:

Accepted Answer

Bronchospasm

Answer

Diffuse expiratory wheezing with hypoxemia after extubation indicates bronchospasm, often triggered by airway secretions, blood, or the extubation stimulus in susceptible patients.

(BCA) Board of Certification in Anesthesiology Practice Test

(BCA) Board of Certification in Anesthesiology Practice Test

BCA Anesthesia Complications & Management 3