CRNFA Anesthesia and Patient Safety in the OR 2 — Questions and Answers
Question 1: Intraoperative awareness (unintended consciousness during general anesthesia) is most effectively monitored using which technology?
- Heart rate and blood pressure monitoring alone
- Bispectral Index (BIS) monitor measuring processed EEG (Correct answer)
- Pulse oximetry
- End-tidal CO2 capnography
Correct answer: Bispectral Index (BIS) monitor measuring processed EEG
The Bispectral Index (BIS) processes EEG signals to provide a numerical depth-of-anesthesia estimate, with values of 40–60 indicating adequate anesthesia for most surgical procedures.
Question 2: A patient receiving epidural analgesia develops sudden hypotension, bradycardia, and respiratory distress after a bolus dose. The CRNFA should recognize this as which complication?
- Epidural hematoma
- Total spinal (high spinal block with hemodynamic collapse) (Correct answer)
- Opioid-induced respiratory depression
- Anaphylaxis to the local anesthetic
Correct answer: Total spinal (high spinal block with hemodynamic collapse)
Total spinal (accidental intrathecal injection of an epidural dose) causes rapid-onset profound hypotension, bradycardia, and respiratory failure requiring immediate vasopressor and airway support.
Question 3: Which intraoperative physiologic parameter, if consistently below 95%, requires immediate intervention by the surgical team?
- End-tidal CO2 of 38 mmHg
- SpO2 (pulse oximetry oxygen saturation) (Correct answer)
- Temperature of 36.2°C
- Urine output of 0.5 mL/kg/hr
Correct answer: SpO2 (pulse oximetry oxygen saturation)
SpO2 below 95% indicates hypoxemia requiring immediate airway and ventilatory assessment; the lower alarm limit on most anesthesia monitors is set at 95%.
Question 4: The CRNFA should ensure that which safety device is applied before draping to minimize risk of patient movement causing injury during positioning under anesthesia?
- Heating blanket
- Sequential compression devices
- Safety strap or padded restraint securing the patient to the table (Correct answer)
- Electrosurgical return pad
Correct answer: Safety strap or padded restraint securing the patient to the table
A safety strap or padded restraint must be applied across the patient's thighs before draping to prevent falls if the patient moves, is inadvertently bumped, or the table is repositioned.
Question 5: Which anesthetic technique provides excellent analgesia for total knee arthroplasty while allowing early ambulation and reducing opioid requirements?
- General anesthesia with IV opioids only
- Femoral nerve block or adductor canal block (regional anesthesia) (Correct answer)
- Epidural analgesia with high thoracic placement
- Intrathecal opioids without local anesthetic
Correct answer: Femoral nerve block or adductor canal block (regional anesthesia)
Femoral nerve or adductor canal blocks provide targeted knee analgesia while preserving quadriceps strength for early mobilization and significantly reducing systemic opioid requirements.
Question 6: When a patient is placed in the steep Trendelenburg position for robotic pelvic surgery, which physiologic change should the CRNFA anticipate and assist the anesthesia team in managing?
- Decreased cardiac output and hypotension
- Increased airway pressures and decreased functional residual capacity requiring ventilator adjustments (Correct answer)
- Peripheral vasodilation and hypothermia
- Decreased intracranial pressure
Correct answer: Increased airway pressures and decreased functional residual capacity requiring ventilator adjustments
Steep Trendelenburg shifts abdominal contents cephalad, compressing the diaphragm, increasing airway pressures, decreasing FRC, and requiring higher ventilator pressures to maintain adequate oxygenation.
CRNFA Anesthesia and Patient Safety in the OR 2
Intraoperative awareness (unintended consciousness during general anesthesia) is most effectively monitored using which technology?