FANZCA Safety and Compliance 3 — Questions and Answers
Question 1: According to the WHO Surgical Safety Checklist, the 'Sign In' phase occurs:
- After induction of anaesthesia but before skin incision
- Before induction of anaesthesia in the operating room (Correct answer)
- Immediately before the patient leaves the recovery room
- At the time of patient admission to the hospital
Correct answer: Before induction of anaesthesia in the operating room
The 'Sign In' phase of the WHO Surgical Safety Checklist is performed before anaesthesia induction to verify identity, site, consent, allergies, and airway plan.
Question 2: Malignant hyperthermia (MH) susceptibility is most reliably confirmed by:
- Elevated resting serum creatine kinase alone
- In vitro contracture test (IVCT) on fresh muscle biopsy (Correct answer)
- Genetic testing for RYR1 mutations on a blood sample
- Clinical history of heat intolerance and muscle cramps
Correct answer: In vitro contracture test (IVCT) on fresh muscle biopsy
The in vitro contracture test (IVCT/CHCT) on fresh muscle biopsy remains the gold standard for confirming MH susceptibility.
Question 3: Under ANZCA guidelines, the recommended minimum fasting time for clear fluids before elective surgery in a healthy adult is:
- 1 hour
- 2 hours (Correct answer)
- 4 hours
- 6 hours
Correct answer: 2 hours
ANZCA and most international guidelines recommend a minimum 2-hour fast for clear fluids prior to elective surgery in healthy adults.
Question 4: In the context of medication safety, 'look-alike, sound-alike' (LASA) drugs in anaesthesia are best managed by:
- Relying on colour-coded syringe labels only
- Physical separation, tall-man lettering, and independent double-checks for high-risk agents (Correct answer)
- Removing all LASA drugs from theatre stock
- Verbal orders without written confirmation to save time
Correct answer: Physical separation, tall-man lettering, and independent double-checks for high-risk agents
LASA drug errors are mitigated by physical segregation, tall-man lettering on labels, and independent double-check procedures for high-alert medications.
Question 5: Which Australian standard governs the colour coding of gas pipelines in hospitals?
- AS/NZS 1873
- AS/NZS 2896 (Correct answer)
- AS/NZS 4187
- AS/NZS 3003
Correct answer: AS/NZS 2896
AS/NZS 2896 specifies the design, installation, and colour coding of medical gas pipeline systems in Australian and New Zealand healthcare facilities.
Question 6: A patient develops ST elevation on ECG intraoperatively. After calling for help, the most important immediate anaesthetic action is to:
- Increase volatile agent concentration to deepen anaesthesia
- Optimise haemodynamics, administer oxygen, and prepare for potential cardiac emergency (Correct answer)
- Decrease all vasopressors to reduce cardiac work
- Proceed with surgery to minimise anaesthetic exposure time
Correct answer: Optimise haemodynamics, administer oxygen, and prepare for potential cardiac emergency
Intraoperative ST elevation requires immediate haemodynamic optimisation, high-flow oxygen, and activation of the cardiac emergency team while maintaining anaesthesia.
Question 7: The primary purpose of the ANZCA Mortality Committee review process is to:
- Determine financial penalties for anaesthetists involved in adverse events
- Identify preventable factors in anaesthesia-related deaths to improve future practice (Correct answer)
- Assign legal liability for perioperative deaths
- Publish individual practitioner complication rates publicly
Correct answer: Identify preventable factors in anaesthesia-related deaths to improve future practice
Mortality committee reviews are quality improvement tools designed to identify preventable anaesthetic-related deaths and generate system and practice improvements.
FANZCA Safety and Compliance 3
According to the WHO Surgical Safety Checklist, the 'Sign In' phase occurs: