Certified Surgical Technologist Surgical Pharmacology and Anesthesia Questions and Answers — Questions and Answers
Question 1: During a procedure on a patient's hand, the surgeon requests "Xylocaine with epinephrine." The surgical technologist notes the scheduled procedure is a digital nerve block for the index finger. What is the most critical concern with this request?
- Epinephrine can cause severe vasoconstriction, leading to digital ischemia. (Correct answer)
- The patient may have an allergic reaction to Xylocaine.
- Epinephrine will shorten the duration of the anesthetic effect.
- The combination is only effective for spinal anesthesia.
Correct answer: Epinephrine can cause severe vasoconstriction, leading to digital ischemia.
Epinephrine is a potent vasoconstrictor. Its use in areas with end-arterial circulation, such as fingers, toes, the nose, and the penis, is traditionally contraindicated because it can restrict blood flow to the point of causing tissue necrosis.
Question 2: A surgeon performing a coronary artery bypass graft requests papaverine to be applied topically to the internal mammary artery. The primary function of papaverine in this application is to:
- act as a local anesthetic.
- prevent vasospasm. (Correct answer)
- promote blood coagulation.
- sterilize the vessel surface.
Correct answer: prevent vasospasm.
Papaverine is a direct-acting smooth muscle relaxant and vasodilator. In vascular surgery, it is applied topically to harvested vessels, like the internal mammary artery or saphenous vein, to prevent or reverse spasms of the vessel wall, which ensures adequate blood flow through the graft.
Question 3: During a vascular procedure, the anesthesia provider announces that they are administering protamine sulfate. The surgical technologist should recognize that this drug is being used to reverse the effects of which medication?
- Warfarin (Coumadin)
- Thrombin
- Heparin (Correct answer)
- Epinephrine
Correct answer: Heparin
Protamine sulfate is a specific antidote for heparin. It binds with the strongly acidic heparin to form a stable, inactive salt, thereby neutralizing heparin's anticoagulant effect. It is commonly used after cardiovascular or vascular procedures where systemic heparinization was required.
Question 4: Which of the following is a depolarizing neuromuscular blocking agent characterized by a rapid onset and very short duration of action, often used for endotracheal intubation?
- Rocuronium (Zemuron)
- Pancuronium (Pavulon)
- Vecuronium (Norcuron)
- Succinylcholine (Anectine) (Correct answer)
Correct answer: Succinylcholine (Anectine)
Succinylcholine is the only depolarizing neuromuscular blocker in common clinical use. It works by binding to acetylcholine receptors, causing initial muscle fasciculations followed by paralysis. Its rapid onset and short duration make it ideal for facilitating rapid sequence intubation.
Question 5: The surgical technologist is preparing a hemostatic agent by mixing a powder with thrombin. The final product is a spongy material that will be applied topically to an oozing surface. The circulator reminds the team, "This should never be injected." Which of the following agents fits this description?
- Absorbable gelatin sponge (Gelfoam) (Correct answer)
- Injectable normal saline with epinephrine
- Oxidized regenerated cellulose (Surgicel)
- Microfibrillar collagen (Avitene)
Correct answer: Absorbable gelatin sponge (Gelfoam)
Absorbable gelatin sponges like Gelfoam are often soaked in a thrombin solution to enhance their hemostatic properties. The product labeling explicitly warns against placing it in intravascular compartments because if this combination were injected, it would cause extensive clotting (thrombosis) and could lead to a fatal embolism.
Question 6: A patient is given atropine sulfate preoperatively. What is the primary purpose of this medication in this context?
- To induce sedation and amnesia
- To provide postoperative pain relief
- To reduce oral and respiratory secretions (Correct answer)
- To reverse the effects of narcotics
Correct answer: To reduce oral and respiratory secretions
Atropine is an anticholinergic drug that blocks the action of acetylcholine. A primary preoperative use is to inhibit salivary and bronchial secretions (an antisialagogue effect), which helps maintain a clear airway during anesthesia. It also blocks vagal reflexes on the heart, which can prevent bradycardia.
Certified Surgical Technologist Surgical Pharmacology and Anesthesia Questions and Answers
During a procedure on a patient's hand, the surgeon requests "Xylocaine with epinephrine." The surgical technologist notes the scheduled procedure is a digital nerve block for the index finger.
What is the most critical concern with this request?