DAANCE Office Anesthesia Emergencies 4 — Questions and Answers
Question 1: A patient undergoing IV sedation suddenly develops a widespread urticarial rash, bronchospasm, and a drop in blood pressure to 70/40 mmHg. What is the FIRST drug to administer?
- Diphenhydramine 50 mg IV
- Epinephrine 1:1000 0.3 mg IM (Correct answer)
- Hydrocortisone 100 mg IV
- Albuterol via nebulizer
Correct answer: Epinephrine 1:1000 0.3 mg IM
Epinephrine 1:1000 (0.3 mg IM into the anterolateral thigh) is the first-line treatment for anaphylaxis due to its rapid alpha and beta adrenergic effects.
Question 2: During IV sedation, the capnograph waveform suddenly disappears and SpO2 begins to fall. What is the most likely cause?
- Laryngospasm
- Complete airway obstruction or apnea (Correct answer)
- Bronchospasm
- Pulmonary embolism
Correct answer: Complete airway obstruction or apnea
A flat (absent) capnograph waveform with falling SpO2 indicates apnea or complete airway obstruction, requiring immediate airway intervention.
Question 3: A patient receiving propofol develops muscle rigidity, hyperthermia (40.5°C), and a rising EtCO2. Which condition should be suspected?
- Neuroleptic malignant syndrome
- Malignant hyperthermia (Correct answer)
- Thyroid storm
- Serotonin syndrome
Correct answer: Malignant hyperthermia
Rising EtCO2, hyperthermia, and muscle rigidity following an anesthetic trigger agent are hallmarks of malignant hyperthermia, a life-threatening pharmacogenetic disorder.
Question 4: When performing a jaw-thrust maneuver to relieve airway obstruction, the dental anesthesia assistant should place fingers:
- Under the chin and push upward
- On the angles of the mandible and displace it anteriorly (Correct answer)
- On the malar eminences bilaterally
- On the hyoid bone and lift anteriorly
Correct answer: On the angles of the mandible and displace it anteriorly
The jaw-thrust places fingers behind the angles of the mandible and displaces it anteriorly, lifting the tongue off the posterior pharyngeal wall without neck extension.
Question 5: A patient develops acute respiratory depression after receiving fentanyl during office-based sedation. What is the recommended initial dose of naloxone in an adult?
- 0.4–2 mg IV titrated in 0.1 mg increments (Correct answer)
- 0.01 mg/kg IV as a single bolus
- 4 mg IV as a single bolus
- 2 mg intranasal only
Correct answer: 0.4–2 mg IV titrated in 0.1 mg increments
Naloxone 0.4–2 mg IV is given in small increments (0.1 mg) to reverse opioid-induced respiratory depression while minimizing acute opioid reversal side effects.
Question 6: Which of the following ECG findings during IV sedation monitoring requires IMMEDIATE intervention?
- Sinus bradycardia at 56 bpm
- Pulseless ventricular tachycardia (Correct answer)
- Occasional PVCs (< 6/min)
- First-degree AV block
Correct answer: Pulseless ventricular tachycardia
Pulseless ventricular tachycardia is a shockable cardiac arrest rhythm requiring immediate CPR and defibrillation.
Question 7: During office sedation, a patient becomes unresponsive with clenched teeth and tonic-clonic movements lasting 90 seconds. After the seizure stops, the priority is:
- Administer IV diazepam immediately
- Ensure airway patency, oxygenation, and monitor vital signs (Correct answer)
- Restrain the patient to prevent injury
- Perform sternal rub to assess LOC
Correct answer: Ensure airway patency, oxygenation, and monitor vital signs
Post-ictal management focuses on maintaining a patent airway and adequate oxygenation while monitoring vital signs, as most self-limited seizures do not require immediate anticonvulsants.
DAANCE Office Anesthesia Emergencies 4
A patient undergoing IV sedation suddenly develops a widespread urticarial rash, bronchospasm, and a drop in blood pressure to 70/40 mmHg.
What is the FIRST drug to administer?