BCA Anesthesia Techniques & Patient Management 2 — Questions and Answers
Question 1: Which nerve block is most appropriate for postoperative analgesia following a total knee arthroplasty to preserve quadriceps strength?
- Femoral nerve block
- Adductor canal block (Correct answer)
- Sciatic nerve block
- Lateral femoral cutaneous block
Correct answer: Adductor canal block
The adductor canal block targets sensory fibers of the saphenous nerve, providing analgesia while largely preserving quadriceps motor function.
Question 2: A patient with a full stomach requires emergency surgery. Which modification to RSI is most appropriate when succinylcholine is contraindicated?
- High-dose vecuronium (0.3 mg/kg)
- Rocuronium 1.2 mg/kg (Correct answer)
- Pancuronium 0.15 mg/kg
- Cisatracurium 0.2 mg/kg
Correct answer: Rocuronium 1.2 mg/kg
Rocuronium 1.2 mg/kg provides intubating conditions comparable to succinylcholine within 60 seconds and can be reversed with sugammadex.
Question 3: During epidural placement, the anesthesiologist notices CSF returning through the needle. The most appropriate next step is:
- Remove the needle and attempt at another level
- Proceed with epidural dosing through the needle
- Convert to a continuous spinal technique with an intrathecal catheter (Correct answer)
- Inject a blood patch immediately
Correct answer: Convert to a continuous spinal technique with an intrathecal catheter
An inadvertent dural puncture with an epidural needle can be managed by threading the catheter intrathecally and using it as a continuous spinal, with appropriate dose adjustments.
Question 4: Which factor most significantly increases the risk of postoperative pulmonary complications (PPCs) in a patient undergoing abdominal surgery?
- ASA physical status II
- Preoperative oxygen saturation of 96%
- Surgical duration greater than 3 hours (Correct answer)
- Age under 50 years
Correct answer: Surgical duration greater than 3 hours
Prolonged surgical duration (>3 hours) is a major independent risk factor for postoperative pulmonary complications.
Question 5: In a patient undergoing awake craniotomy, which anesthetic technique provides adequate sedation during skull pin placement while allowing rapid awakening for cortical mapping?
- Propofol/remifentanil infusion (asleep-awake-asleep) (Correct answer)
- High-dose volatile anesthetic with N2O
- Ketamine bolus with midazolam
- Dexmedetomidine infusion alone
Correct answer: Propofol/remifentanil infusion (asleep-awake-asleep)
The asleep-awake-asleep technique using propofol/remifentanil allows deep sedation for painful skull fixation and craniotomy, then rapid offset for awake neurological testing.
Question 6: A patient with obstructive sleep apnea (OSA) is scheduled for laparoscopic cholecystectomy. Which postoperative disposition is most appropriate?
- Routine discharge home after 1 hour
- Admit for 23-hour observation with continuous pulse oximetry (Correct answer)
- Discharge with written instructions only
- Transfer to ICU regardless of intraoperative course
Correct answer: Admit for 23-hour observation with continuous pulse oximetry
Patients with OSA are at increased risk for postoperative respiratory events and should be monitored with continuous oximetry, with admission for 23-hour observation often recommended.
Question 7: When performing a transversus abdominis plane (TAP) block, the local anesthetic is deposited in which fascial plane?
- Between the skin and external oblique fascia
- Between the internal oblique and transversus abdominis muscles (Correct answer)
- Deep to the transversus abdominis muscle
- Between the external and internal oblique muscles
Correct answer: Between the internal oblique and transversus abdominis muscles
The TAP block targets the neurovascular plane between the internal oblique and transversus abdominis muscles where T7–L1 anterior rami travel.
BCA Anesthesia Techniques & Patient Management 2
Which nerve block is most appropriate for postoperative analgesia following a total knee arthroplasty to preserve quadriceps strength?