CAPA Postanesthesia Care 3 — Questions and Answers
Question 1: Which drug is the reversal agent for neuromuscular blockade caused by rocuronium when using sugammadex?
- Neostigmine
- Flumazenil
- Sugammadex encapsulates rocuronium directly (Correct answer)
- Physostigmine
Correct answer: Sugammadex encapsulates rocuronium directly
Sugammadex works by encapsulating and inactivating steroidal neuromuscular blocking agents like rocuronium and vecuronium.
Question 2: A patient develops laryngospasm in Phase I PACU. After applying CPAP with 100% O2, spasm persists. What is the next intervention?
- Administer succinylcholine 0.1–0.2 mg/kg IV (Correct answer)
- Perform emergency tracheotomy
- Administer propofol 1 mg/kg IV
- Increase oxygen flow and wait
Correct answer: Administer succinylcholine 0.1–0.2 mg/kg IV
A small (laryngospasm-breaking) dose of succinylcholine relaxes the laryngeal muscles when positive pressure fails to break laryngospasm.
Question 3: Which electrolyte abnormality is most associated with prolonged QT interval and increased risk of Torsades de Pointes in the postanesthesia period?
- Hypernatremia
- Hypomagnesemia (Correct answer)
- Hyperkalemia
- Hyperphosphatemia
Correct answer: Hypomagnesemia
Hypomagnesemia prolongs the QT interval and is a common, correctable cause of Torsades de Pointes in postoperative patients.
Question 4: A post-thyroidectomy patient develops inspiratory stridor, neck swelling, and dysphagia 2 hours post-op. What is the priority action?
- Administer dexamethasone 10 mg IV
- Open the neck wound at bedside to relieve hematoma pressure (Correct answer)
- Place patient in high Fowler's position and call surgeon stat
- Prepare for immediate reintubation
Correct answer: Open the neck wound at bedside to relieve hematoma pressure
Neck hematoma post-thyroidectomy causing airway compromise requires immediate wound opening to decompress before complete airway obstruction occurs.
Question 5: Which clinical indicator is most reliable for assessing adequate reversal of neuromuscular blockade before PACU discharge?
- Train-of-four ratio ≥ 0.9 (Correct answer)
- Patient can open eyes on command
- SpO2 > 95% on room air
- Respiratory rate > 12 breaths/min
Correct answer: Train-of-four ratio ≥ 0.9
A train-of-four (TOF) ratio of ≥0.9 indicates adequate neuromuscular recovery and significantly reduces the risk of residual paralysis.
Question 6: In the ambulatory PACU, which patient is LEAST appropriate for fast-tracking directly to Phase II recovery?
- ASA I patient after local anesthesia with sedation, Aldrete score 9
- Patient with BMI 42 and OSA after monitored anesthesia care (Correct answer)
- Healthy adult after brief general anesthesia, fully awake and oriented
- Patient after spinal anesthesia for knee arthroscopy with motor function returning
Correct answer: Patient with BMI 42 and OSA after monitored anesthesia care
Patients with OSA and high BMI require closer Phase I monitoring due to elevated risk of airway obstruction and hypoxia during recovery.
Question 7: A patient in the PACU is receiving a diltiazem infusion for atrial fibrillation with rapid ventricular response. Which vital sign requires the most vigilance?
- Temperature
- Blood pressure (Correct answer)
- Oxygen saturation
- Respiratory rate
Correct answer: Blood pressure
Diltiazem is a calcium channel blocker that can cause significant hypotension; blood pressure must be monitored closely during infusion.
CAPA Postanesthesia Care 3
Which drug is the reversal agent for neuromuscular blockade caused by rocuronium when using sugammadex?