CAPA Perianesthesia Complications & Emergency Response 1 — Questions and Answers
Question 1: What is the earliest and most sensitive sign of malignant hyperthermia (MH) in the perioperative setting?
- Hyperthermia greater than 40°C
- Masseter muscle rigidity after succinylcholine
- Unexplained rise in end-tidal CO2 (Correct answer)
- Tachycardia with hypertension
Correct answer: Unexplained rise in end-tidal CO2
An unexplained rise in end-tidal CO2 is the earliest and most sensitive indicator of MH, reflecting the hypermetabolic crisis before temperature elevation occurs.
Question 2: What is the primary pharmacological treatment for malignant hyperthermia?
- Calcium gluconate IV
- Dantrolene sodium IV (Correct answer)
- Sodium bicarbonate IV
- Propofol infusion
Correct answer: Dantrolene sodium IV
Dantrolene sodium is the specific antidote for MH, inhibiting calcium release from the sarcoplasmic reticulum to halt the hypermetabolic cascade.
Question 3: Which of the following is a known triggering agent for malignant hyperthermia in susceptible individuals?
- Propofol
- Succinylcholine (Correct answer)
- Nitrous oxide
- Ketamine
Correct answer: Succinylcholine
Succinylcholine, along with volatile halogenated anesthetic agents, is a known triggering agent for MH in genetically susceptible individuals.
Question 4: What is the recommended initial IV dose of dantrolene when treating a confirmed malignant hyperthermia crisis?
- 0.5 mg/kg IV
- 1 mg/kg IV
- 2.5 mg/kg IV (Correct answer)
- 5 mg/kg IV
Correct answer: 2.5 mg/kg IV
The initial dose is 2.5 mg/kg IV, repeated every 5 minutes as needed to a maximum of 10 mg/kg until symptoms resolve.
Question 5: A PACU patient develops complete laryngospasm after extubation. What is the FIRST-LINE nursing intervention?
- Insert an oral airway immediately
- Apply firm positive pressure with jaw thrust and 100% oxygen (Correct answer)
- Administer atropine IV to reduce secretions
- Prepare for emergency surgical airway
Correct answer: Apply firm positive pressure with jaw thrust and 100% oxygen
Sustained positive pressure with jaw thrust is the first-line intervention to mechanically break laryngospasm while providing 100% oxygen.
Question 6: A patient in the PACU develops acute bronchospasm. What is the FIRST nursing action?
- Administer IV methylprednisolone 125 mg
- Apply supplemental oxygen and notify the anesthesia provider (Correct answer)
- Prepare for emergency intubation
- Administer IV epinephrine immediately
Correct answer: Apply supplemental oxygen and notify the anesthesia provider
The initial priority is to support oxygenation and promptly notify the anesthesia provider, who will order bronchodilator therapy and further management.
Question 7: Post-extubation stridor heard in the PACU most commonly indicates which underlying problem?
- Pulmonary embolism
- Subglottic edema or partial laryngospasm (Correct answer)
- Lower airway bronchospasm
- Pneumothorax
Correct answer: Subglottic edema or partial laryngospasm
Stridor is a high-pitched inspiratory sound indicating upper airway obstruction, most commonly from subglottic edema or incomplete laryngospasm after extubation.
CAPA Perianesthesia Complications & Emergency Response 1
What is the earliest and most sensitive sign of malignant hyperthermia (MH) in the perioperative setting?