MAC Postoperative Care & PACU Management 2 — Questions and Answers
Question 1: What is the first-line pharmacologic treatment for postoperative shivering in the PACU?
- Morphine 2 mg IV
- Meperidine 25 mg IV (Correct answer)
- Propofol sub-hypnotic dose
- Ketorolac IV
Correct answer: Meperidine 25 mg IV
Meperidine at 25 mg IV is the most effective pharmacologic treatment for postoperative shivering via its kappa-opioid receptor activity.
Question 2: How is residual neuromuscular blockade (RNMB) quantitatively detected in the PACU?
- Blood pressure monitoring
- Train-of-four (TOF) ratio with a peripheral nerve stimulator (Correct answer)
- Capnography trend
- ECG monitoring
Correct answer: Train-of-four (TOF) ratio with a peripheral nerve stimulator
Train-of-four ratio measurement with a peripheral nerve stimulator quantitatively assesses residual neuromuscular blockade in the PACU.
Question 3: A PACU patient has SpO2 88% with slow, shallow respirations after large fentanyl doses. What is the appropriate intervention?
- Supplemental oxygen alone
- Naloxone titration plus respiratory support (Correct answer)
- Immediate intubation
- Flumazenil administration
Correct answer: Naloxone titration plus respiratory support
Opioid-induced respiratory depression is treated with careful titration of naloxone to restore ventilation without precipitating acute opioid reversal and pain crisis.
Question 4: What does 'fast-tracking' refer to in postoperative anesthesia care?
- Rapid IV fluid administration postoperatively
- Bypassing traditional Phase 1 PACU to discharge directly from OR or to step-down (Correct answer)
- Expedited surgical technique
- Rapid anesthesia induction protocol
Correct answer: Bypassing traditional Phase 1 PACU to discharge directly from OR or to step-down
Fast-tracking allows selected low-risk patients to bypass Phase 1 PACU and proceed directly to discharge or a lower acuity unit, improving efficiency while maintaining safety.
Question 5: Which postoperative complication presents as high-pitched stridor and inspiratory difficulty in the PACU?
- Pulmonary edema
- Post-extubation laryngeal edema or croup (Correct answer)
- Bronchospasm
- Tension pneumothorax
Correct answer: Post-extubation laryngeal edema or croup
Post-extubation stridor from laryngeal edema or subglottic croup presents as high-pitched inspiratory noise requiring nebulized epinephrine and steroid treatment.
Question 6: What is the postoperative analgesic advantage of effective regional anesthesia in the PACU?
- No additional monitoring required
- Reduced opioid consumption and related side effects (Correct answer)
- Faster discharge without meeting criteria
- Prevention of all wound infections
Correct answer: Reduced opioid consumption and related side effects
Effective regional anesthesia reduces postoperative opioid requirements, decreasing opioid-related side effects like nausea, respiratory depression, and excessive sedation.
MAC Postoperative Care & PACU Management 2
What is the first-line pharmacologic treatment for postoperative shivering in the PACU?