FANZCA FANZCA Perioperative Care and Management 2 — Questions and Answers
Question 1: What is the Mallampati classification system used for in anesthetic preoperative assessment?
- Assessing the degree of hepatic dysfunction before surgery
- Predicting the ease of tracheal intubation based on oropharyngeal visibility (Correct answer)
- Classifying the severity of cardiac disease for risk stratification
- Grading the extent of surgical field for regional anesthesia planning
Correct answer: Predicting the ease of tracheal intubation based on oropharyngeal visibility
The Mallampati score (classes I–IV) assesses visibility of oropharyngeal structures with maximal mouth opening, correlating with difficulty of laryngoscopy and intubation.
Question 2: In perioperative anesthetic management, which strategy is recommended for patients at high risk of postoperative nausea and vomiting (PONV)?
- Inhalational anesthesia with high-dose opioids
- Multimodal prophylaxis including TIVA with propofol, ondansetron, and dexamethasone (Correct answer)
- Restriction of IV fluids to reduce gastric distension
- Routine nasogastric tube placement postoperatively
Correct answer: Multimodal prophylaxis including TIVA with propofol, ondansetron, and dexamethasone
Multimodal PONV prophylaxis combining TIVA (propofol-based), antiemetics from different classes (5-HT3 antagonists, corticosteroids), and minimizing opioids is recommended for high-risk patients.
Question 3: What does a bispectral index (BIS) value of 40–60 indicate during general anesthesia?
- The patient is awake and alert
- An adequate level of hypnosis with low risk of awareness (Correct answer)
- The patient is in burst suppression with potential for oversedation
- The patient requires more neuromuscular blockade
Correct answer: An adequate level of hypnosis with low risk of awareness
A BIS value of 40–60 reflects adequate anesthetic depth for surgical stimulation with a low probability of intraoperative awareness, according to manufacturer and clinical guidelines.
Question 4: Which parameter most reliably indicates return of adequate neuromuscular function before tracheal extubation using quantitative monitoring?
- Ability to sustain a 5-second head lift
- Train-of-four ratio (TOF ratio) ≥ 0.9 (Correct answer)
- Return of spontaneous breathing
- Visual confirmation of four twitches on train-of-four stimulation
Correct answer: Train-of-four ratio (TOF ratio) ≥ 0.9
A quantitative TOF ratio of ≥ 0.9 measured by acceleromyography is the gold standard for confirming adequate neuromuscular recovery before extubation, as clinical tests are unreliable for detecting residual block.
Question 5: In perioperative cardiac risk assessment, what does the Revised Cardiac Risk Index (RCRI) estimate?
- Intraoperative blood loss requiring transfusion
- Risk of major adverse cardiac events (MACE) after noncardiac surgery (Correct answer)
- Likelihood of postoperative respiratory failure requiring reintubation
- Preoperative cardiac medication adjustment requirements
Correct answer: Risk of major adverse cardiac events (MACE) after noncardiac surgery
The RCRI uses six independent predictors (ischemic heart disease, heart failure, cerebrovascular disease, diabetes on insulin, creatinine >2 mg/dL, high-risk surgery) to estimate perioperative MACE risk.
Question 6: What is the significance of measuring lactate levels perioperatively in critically ill or high-risk surgical patients?
- It directly measures oxygen delivery to individual organs
- Elevated lactate indicates tissue hypoperfusion and anaerobic metabolism, guiding resuscitation targets (Correct answer)
- Lactate is a measure of hepatic synthetic function during surgery
- It is used exclusively to titrate vasopressor infusions
Correct answer: Elevated lactate indicates tissue hypoperfusion and anaerobic metabolism, guiding resuscitation targets
Perioperative hyperlactatemia (>2 mmol/L) reflects inadequate tissue oxygen delivery and anaerobic metabolism, serving as a resuscitation endpoint and predictor of morbidity and mortality.
FANZCA FANZCA Perioperative Care and Management 2
What is the Mallampati classification system used for in anesthetic preoperative assessment?