COST COST Anesthesia and Medications in Ophthalmic Surgery 2 — Questions and Answers
Question 1: A patient undergoing cataract surgery under monitored anesthesia care (MAC) suddenly becomes confused and agitated. What is the most likely cause?
- Malignant hyperthermia
- Paradoxical reaction to benzodiazepines or oversedation (Correct answer)
- Corneal perforation
- Allergic reaction to OVD
Correct answer: Paradoxical reaction to benzodiazepines or oversedation
Paradoxical excitation from benzodiazepines or hypoxia/hypercapnia from oversedation can cause agitation and confusion in patients under MAC during ophthalmic procedures.
Question 2: Which antibiotic is most commonly used as intracameral prophylaxis against endophthalmitis at the close of cataract surgery in the United States?
- Vancomycin
- Moxifloxacin (Correct answer)
- Gentamicin
- Erythromycin
Correct answer: Moxifloxacin
Intracameral moxifloxacin has become widely adopted in US practice for endophthalmitis prophylaxis due to its broad-spectrum coverage and favorable safety profile.
Question 3: Triamcinolone acetonide is injected intravitreally or subconjunctivally in ophthalmic surgery primarily as which type of agent?
- Antifungal
- Corticosteroid anti-inflammatory (Correct answer)
- Mydriatic
- Viscoelastic
Correct answer: Corticosteroid anti-inflammatory
Triamcinolone acetonide is a long-acting corticosteroid used to reduce intraocular inflammation, treat macular edema, and visualize vitreous during vitreoretinal surgery.
Question 4: Which ocular hypotensive agent class lowers IOP by increasing uveoscleral outflow of aqueous humor?
- Beta-blockers
- Carbonic anhydrase inhibitors
- Prostaglandin analogs (Correct answer)
- Alpha-2 agonists
Correct answer: Prostaglandin analogs
Prostaglandin analogs (e.g., latanoprost, bimatoprost) lower IOP primarily by enhancing uveoscleral (unconventional) outflow and are the most potent topical IOP-lowering agents.
Question 5: Preoperative NSAIDs (non-steroidal anti-inflammatory drops) are used before cataract surgery primarily to:
- Dilate the pupil
- Prevent intraoperative miosis and reduce postoperative inflammation (Correct answer)
- Sterilize the conjunctiva
- Lower intraocular pressure
Correct answer: Prevent intraoperative miosis and reduce postoperative inflammation
Topical NSAIDs inhibit prostaglandin synthesis, helping maintain pupil dilation (preventing miosis) during phacoemulsification and reducing postoperative inflammation and CME risk.
Question 6: Which reversal agent is used to antagonize opioid-induced respiratory depression in the perioperative setting?
- Flumazenil
- Neostigmine
- Naloxone (Correct answer)
- Sugammadex
Correct answer: Naloxone
Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression, sedation, and analgesia in the perioperative period.
COST COST Anesthesia and Medications in Ophthalmic Surgery 2
A patient undergoing cataract surgery under monitored anesthesia care (MAC) suddenly becomes confused and agitated.
What is the most likely cause?