MAC Intraoperative Complications & Emergency Management 1 — Questions and Answers
Question 1: What is the definitive airway management strategy when 'cannot intubate, cannot oxygenate' (CICO) is declared?
- Continue mask ventilation attempts
- Emergency surgical airway (cricothyrotomy) (Correct answer)
- Call for help and reassess after 5 minutes
- Attempt awaken the patient immediately
Correct answer: Emergency surgical airway (cricothyrotomy)
In a CICO emergency, an emergency cricothyrotomy provides the definitive pathway to oxygenation when all conventional airway methods have failed.
Question 2: What are the hallmark early signs of anaphylaxis occurring under general anesthesia?
- Fever and muscle rigidity
- Bronchospasm, hypotension, and urticaria (Correct answer)
- Hypertension and bradycardia
- Muscle fasciculations and tachycardia
Correct answer: Bronchospasm, hypotension, and urticaria
Anaphylaxis under anesthesia typically presents with bronchospasm, cardiovascular collapse, and skin manifestations like urticaria or flushing.
Question 3: What is the first-line drug for treating anaphylaxis under anesthesia?
- Diphenhydramine IV
- Epinephrine IV or IM (Correct answer)
- Hydrocortisone IV
- Ephedrine IV
Correct answer: Epinephrine IV or IM
Epinephrine is the first-line treatment for anaphylaxis, addressing bronchoconstriction, vasodilation, and mast cell mediator release simultaneously.
Question 4: Which intraoperative event is characterized by a sudden decrease in end-tidal CO2?
- Bronchospasm
- Venous air embolism (Correct answer)
- Malignant hyperthermia onset
- Laryngospasm
Correct answer: Venous air embolism
Venous air embolism causes a sudden drop in EtCO2 due to dead space ventilation as air obstructs pulmonary circulation.
Question 5: What is the primary treatment for a massive pulmonary embolism occurring intraoperatively?
- Aggressive diuresis
- Systemic anticoagulation and hemodynamic support (Correct answer)
- Bronchodilators only
- Vasodilators only
Correct answer: Systemic anticoagulation and hemodynamic support
Massive PE requires immediate systemic anticoagulation (or thrombolysis if warranted) and hemodynamic support to maintain cardiac output.
Question 6: Which monitoring parameter is the earliest and most specific sign of malignant hyperthermia?
- Tachycardia alone
- Rapidly rising end-tidal CO2 despite adequate ventilation (Correct answer)
- Hyperthermia above 39°C
- Muscle rigidity
Correct answer: Rapidly rising end-tidal CO2 despite adequate ventilation
Rapidly rising EtCO2 from hypermetabolism is the earliest and most specific sign of MH, preceding significant temperature elevation.
MAC Intraoperative Complications & Emergency Management 1
What is the definitive airway management strategy when 'cannot intubate, cannot oxygenate' (CICO) is declared?