Intraoperative Complications & Emergency Management Flashcards

What is the pathophysiology of succinylcholine-induced life-threatening hyperkalemia?

Answer: Upregulation of extrajunctional acetylcholine receptors causing massive potassium efflux

In burns, denervation, or prolonged immobility, extrajunctional ACh receptors proliferate, and succinylcholine activation causes massive potassium efflux.

When should cricoid pressure be released during a rapid sequence induction?

Answer: After confirming correct endotracheal tube placement via capnography

Cricoid pressure should be maintained until correct ETT placement is confirmed by capnography and direct visualization, providing continuous aspiration protection.

What is the primary hazard of using nitrous oxide in a patient with pneumothorax?

Answer: N2O diffuses into air-filled spaces, expanding the pneumothorax

Nitrous oxide diffuses into closed gas spaces more rapidly than nitrogen exits, causing dangerous expansion of a pneumothorax or venous air emboli.

What systematic approach guides evaluation of a 'cannot ventilate' situation after intubation?

Answer: Evaluate tube position, suction, bronchospasm, and tension pneumothorax (DOPES)

Systematic evaluation using DOPES (Displacement, Obstruction, Pneumothorax, Equipment failure, Stacking) addresses the most common causes of post-intubation ventilation failure.

What is the immediate management priority for suspected tension pneumothorax intraoperatively?

Answer: Needle decompression of the affected side immediately

Tension pneumothorax causes cardiovascular collapse and requires immediate needle decompression without waiting for imaging confirmation.

Which parameter best guides intraoperative volume resuscitation in a hemodynamically unstable patient?

Answer: Dynamic fluid responsiveness indices such as pulse pressure variation

Dynamic fluid responsiveness indices such as pulse pressure variation are superior to static measures for guiding intraoperative volume resuscitation.