MAC Intraoperative Complications & Emergency Management 2 — Questions and Answers
Question 1: What is the management of a patient who develops complete heart block with hemodynamic compromise intraoperatively?
- Increase volatile agent concentration
- Transcutaneous pacing and atropine IV (Correct answer)
- Lidocaine IV bolus
- Epinephrine infusion as sole therapy
Correct answer: Transcutaneous pacing and atropine IV
Complete heart block with hemodynamic compromise requires immediate transcutaneous pacing and atropine to restore adequate heart rate.
Question 2: What does 'cannot intubate, can oxygenate' indicate for airway management strategy?
- A surgical airway is immediately required
- Continue oxygenation via supraglottic airway and plan awake fiberoptic intubation (Correct answer)
- Administer more succinylcholine
- Attempt retrograde intubation only
Correct answer: Continue oxygenation via supraglottic airway and plan awake fiberoptic intubation
If oxygenation is maintained but intubation fails, a supraglottic airway can temporize while planning definitive management such as awake fiberoptic intubation.
Question 3: Which patient position reduces passive regurgitation risk during induction in a full-stomach patient?
- Trendelenburg (head down)
- Lateral decubitus
- Head-up (reverse Trendelenburg 20-30°) (Correct answer)
- Prone
Correct answer: Head-up (reverse Trendelenburg 20-30°)
Head-up positioning (reverse Trendelenburg) reduces passive regurgitation risk by using gravity to retain gastric contents below the esophagus.
Question 4: What is 'total spinal' anesthesia and its immediate management?
- Intentional high spinal for abdominal surgery; managed with observation
- Unintentional intrathecal overdose causing respiratory arrest; treated with intubation and ventilation (Correct answer)
- Maximum epidural dose administered; reversed with naloxone
- Spinal cord transection; managed surgically
Correct answer: Unintentional intrathecal overdose causing respiratory arrest; treated with intubation and ventilation
Total spinal from unintentional intrathecal overdose causes phrenic nerve block and respiratory arrest requiring immediate intubation and ventilatory support.
Question 5: A patient develops severe bronchospasm during anesthesia. What is the first pharmacologic intervention?
- Epinephrine IV bolus 1 mg
- Deepen anesthesia and administer inhaled albuterol (Correct answer)
- Atropine IV 0.5 mg
- Magnesium sulfate IV infusion
Correct answer: Deepen anesthesia and administer inhaled albuterol
Deepening anesthesia reduces airway reactivity, and inhaled albuterol is the first-line bronchodilator for intraoperative bronchospasm.
Question 6: Which electrolyte abnormality most commonly causes intraoperative cardiac arrhythmias?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypercalcemia
- Hypomagnesemia
Correct answer: Hypokalemia
Hypokalemia increases myocardial excitability and arrhythmia risk, particularly in patients on digoxin or with pre-existing cardiac disease.
MAC Intraoperative Complications & Emergency Management 2
What is the management of a patient who develops complete heart block with hemodynamic compromise intraoperatively?