General Surgery Board Review Perioperative Care & Complications Flashcards

What is the most appropriate immediate treatment for suspected malignant hyperthermia intraoperatively?

Answer: Administer dantrolene 2.5 mg/kg IV immediately

Dantrolene 2.5 mg/kg IV is the specific antidote for malignant hyperthermia; it inhibits ryanodine receptor-mediated calcium release from the sarcoplasmic reticulum.

Enhanced Recovery After Surgery (ERAS) protocols reduce surgical stress and hospital length of stay primarily through which mechanism?

Answer: Multimodal, evidence-based care bundles reducing physiologic stress response

ERAS bundles combine preoperative, intraoperative, and postoperative evidence-based interventions (early oral feeding, opioid-sparing analgesia, early mobilization) to blunt surgical stress.

Intraoperative hypotension following pneumoperitoneum establishment in laparoscopic surgery is most commonly caused by:

Answer: Decreased venous return from elevated intra-abdominal pressure

Elevated intra-abdominal pressure from pneumoperitoneum compresses the inferior vena cava, reducing venous return and cardiac preload, causing hypotension.

The Pringle maneuver controls hepatic inflow during liver surgery by clamping which structure?

Answer: Hepatoduodenal ligament containing the portal triad

The Pringle maneuver involves manual or vascular clamp occlusion of the hepatoduodenal ligament, which contains the portal vein, hepatic artery, and common bile duct, temporarily halting hepatic inflow.

Per current Surviving Sepsis Campaign guidelines, which fluid is recommended as first-line resuscitation in septic shock?

Answer: Crystalloid (balanced solutions or normal saline) as first line

Crystalloids (30 mL/kg IV) are the first-line resuscitation fluid in septic shock per SSC guidelines; balanced crystalloids like lactated Ringer's are preferred over normal saline to reduce hyperchloremic acidosis.

Which intraoperative finding is the most reliable indicator of bowel ischemia during surgery?

Answer: Dusky-gray discoloration combined with absent peristalsis

Gray-black discoloration and absence of peristalsis together are the most reliable clinical indicators of full-thickness bowel ischemia; Doppler alone may be falsely reassuring.