BCA Anesthesia Techniques & Patient Management 3 — Questions and Answers
Question 1: Which hemodynamic change is most expected during the induction of neuraxial anesthesia at the T4 level in an otherwise healthy adult?
- Hypertension and bradycardia
- Hypotension and bradycardia (Correct answer)
- Hypertension and tachycardia
- Hypotension and tachycardia
Correct answer: Hypotension and bradycardia
A T4 block abolishes cardioaccelerator fibers (T1-T4) and causes vasodilation, resulting in both bradycardia and hypotension.
Question 2: A patient develops masseter muscle rigidity immediately after succinylcholine administration. The most appropriate next management step is:
- Administer dantrolene 2.5 mg/kg IV immediately
- Cancel surgery and monitor closely for MH
- Proceed with inhalational anesthesia, monitoring for MH triggers
- Switch to a TIVA technique and monitor temperature and end-tidal CO2 (Correct answer)
Correct answer: Switch to a TIVA technique and monitor temperature and end-tidal CO2
Masseter spasm after succinylcholine is a potential MH warning sign; discontinuing volatile agents and switching to TIVA while monitoring for MH is the safest immediate strategy.
Question 3: The Mallampati classification assesses which anatomical structures?
- Thyromental distance and neck mobility
- Visibility of the soft palate, uvula, and faucial pillars (Correct answer)
- Mouth opening and tongue size
- Neck circumference and hyomental distance
Correct answer: Visibility of the soft palate, uvula, and faucial pillars
The Mallampati score classifies airway difficulty based on the visibility of oropharyngeal structures: soft palate, uvula, and faucial pillars.
Question 4: During a laparoscopic procedure, sudden-onset hypotension and hypoxia occur after insufflation. Which diagnosis should be considered first?
- Tension pneumothorax
- CO2 gas embolism (Correct answer)
- Vasovagal reflex
- Pulmonary edema
Correct answer: CO2 gas embolism
CO2 gas embolism is a serious complication of laparoscopy that can cause sudden cardiovascular collapse and hypoxia due to obstruction of the right heart outflow.
Question 5: Which parameter best guides intraoperative fluid resuscitation in a goal-directed fluid therapy (GDT) protocol?
- Central venous pressure (CVP)
- Mean arterial pressure (MAP)
- Stroke volume variation (SVV) or pulse pressure variation (PPV) (Correct answer)
- Heart rate
Correct answer: Stroke volume variation (SVV) or pulse pressure variation (PPV)
SVV and PPV are dynamic predictors of fluid responsiveness that outperform static measures like CVP in mechanically ventilated patients.
Question 6: A patient requires surgery but reports a latex allergy. Which intervention is most critical in preoperative planning?
- Premedicate with diphenhydramine and steroids only
- Schedule the case as the first case of the day in a latex-safe environment (Correct answer)
- Use only synthetic rubber gloves for the surgeon
- Delay surgery until allergy testing is completed
Correct answer: Schedule the case as the first case of the day in a latex-safe environment
Scheduling a latex-allergic patient as the first case minimizes residual latex particle contamination from prior cases in the OR environment.
Question 7: Which mechanism explains why nitrous oxide (N2O) is avoided in patients with a suspected pneumothorax?
- N2O causes bronchospasm
- N2O diffuses into air-filled spaces faster than nitrogen leaves, expanding them (Correct answer)
- N2O inhibits hypoxic pulmonary vasoconstriction
- N2O increases airway resistance
Correct answer: N2O diffuses into air-filled spaces faster than nitrogen leaves, expanding them
N2O is 34 times more soluble than nitrogen in blood, causing it to diffuse into closed gas spaces rapidly and expand them, worsening a pneumothorax.
BCA Anesthesia Techniques & Patient Management 3
Which hemodynamic change is most expected during the induction of neuraxial anesthesia at the T4 level in an otherwise healthy adult?