CSFA Surgical Pharmacology and Anesthesia 5 — Questions and Answers
Question 1: During a laparoscopic procedure, the patient's end-tidal CO2 rises to 60 mmHg. The MOST likely cause related to anesthesia/pharmacology is:
- Inadequate neuromuscular blockade
- CO2 insufflation absorption combined with inadequate ventilation (Correct answer)
- Opioid-induced respiratory depression (spontaneous breathing)
- Nitrous oxide diffusion into the abdomen
Correct answer: CO2 insufflation absorption combined with inadequate ventilation
Peritoneal CO2 insufflation is absorbed systemically; if minute ventilation is not increased, end-tidal CO2 rises significantly during laparoscopy.
Question 2: Which local anesthetic is an ESTER type and is metabolized by plasma pseudocholinesterase?
- Bupivacaine
- Lidocaine
- Procaine (Correct answer)
- Ropivacaine
Correct answer: Procaine
Procaine is an ester-type local anesthetic hydrolyzed by plasma pseudocholinesterase, producing PABA metabolites that can cause allergic reactions.
Question 3: A patient develops hypotension immediately after induction with propofol. The BEST initial pharmacological intervention is:
- Epinephrine 1 mg IV push
- Phenylephrine or ephedrine IV bolus (Correct answer)
- Atropine 2 mg IV
- Sodium bicarbonate IV
Correct answer: Phenylephrine or ephedrine IV bolus
Phenylephrine (pure vasopressor) or ephedrine (vasopressor + mild inotrope) are first-line agents for propofol-induced hypotension due to vasodilation.
Question 4: The surgeon irrigates the bladder during a TURP procedure with glycine solution. The CSFA should monitor for TURP syndrome, which includes:
- Hyperkalemia and metabolic acidosis
- Hyponatremia, fluid overload, and CNS toxicity (Correct answer)
- Hypercalcemia and coagulopathy
- Metabolic alkalosis and hyperglycemia
Correct answer: Hyponatremia, fluid overload, and CNS toxicity
Absorption of hypotonic glycine irrigant causes dilutional hyponatremia, fluid overload, and CNS effects from glycine toxicity.
Question 5: Which analgesic mechanism do NSAIDs use that makes them useful as opioid-sparing agents in multimodal analgesia?
- Blocking opioid receptors competitively
- Inhibiting cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis (Correct answer)
- Activating GABA receptors centrally
- Blocking sodium channels in peripheral nerves
Correct answer: Inhibiting cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis
NSAIDs inhibit COX-1 and/or COX-2 enzymes, reducing prostaglandin synthesis and thereby decreasing inflammation and peripheral pain sensitization.
Question 6: Spinal anesthesia is administered for a lower extremity procedure. The CSFA should be prepared for which MOST common immediate complication?
- Malignant hyperthermia
- Hypotension due to sympathetic blockade (Correct answer)
- Hyperglycemia
- Bronchospasm
Correct answer: Hypotension due to sympathetic blockade
Spinal anesthesia blocks sympathetic fibers, causing vasodilation and venous pooling that results in a rapid drop in blood pressure.
Question 7: Which medication is used intraoperatively to treat acute intraoperative anaphylaxis as the DRUG OF CHOICE?
- Diphenhydramine
- Hydrocortisone
- Epinephrine (Correct answer)
- Albuterol
Correct answer: Epinephrine
Epinephrine is the drug of choice for anaphylaxis; it reverses bronchospasm, vasodilation, and urticaria through alpha and beta adrenergic stimulation.
CSFA Surgical Pharmacology and Anesthesia 5
During a laparoscopic procedure, the patient's end-tidal CO2 rises to 60 mmHg.
The MOST likely cause related to anesthesia/pharmacology is: