Anesthetic Complications and Crisis Management Flashcards

Intraoperative hypotension most commonly defined as MAP <65 mmHg is most rapidly treated with which initial intervention?

Answer: IV fluid bolus and phenylephrine or ephedrine based on heart rate

A fluid bolus addresses hypovolemia while a vasopressor (phenylephrine for tachycardia, ephedrine for bradycardia) corrects vasodilation or reduced SVR; the choice depends on the underlying cause.

Pulmonary embolism (PE) occurring intraoperatively presents with which characteristic hemodynamic pattern?

Answer: Sudden hypotension, increased airway pressure, and decreased ETCO2

Massive PE causes acute right heart obstruction, reducing pulmonary blood flow; ETCO2 drops (dead space increase), airway pressures rise (from pulmonary hypertension), and systemic BP falls.

Venous air embolism (VAE) is detected earliest by which monitor?

Answer: Precordial Doppler ultrasound

Precordial Doppler detects as little as 0.05 mL of intracardiac air as a characteristic 'mill-wheel' murmur, earlier than any other clinical or monitoring sign.

Postoperative cognitive dysfunction (POCD) is most strongly associated with which patient population?

Answer: Elderly patients (>65 years) undergoing major surgery

POCD predominantly affects elderly patients; age-related neuroinflammatory vulnerability, combined with surgical stress and anesthetic exposure, leads to persistent cognitive deficits lasting weeks to months.

Intraoperative ST-segment depression >1 mm in two contiguous leads suggests:

Answer: Myocardial ischemia requiring immediate assessment of hemodynamics and coronary perfusion

New horizontal or down-sloping ST depression >1 mm in ≥2 contiguous leads indicates subendocardial ischemia; immediate intervention to restore coronary perfusion pressure (increase MAP, reduce heart rate) is required.

The most common cause of intraoperative bradycardia during general anesthesia is:

Answer: Vagal stimulation from surgical manipulation or deep inhalation anesthesia

Vagotonic reflexes triggered by peritoneal stretch, ocular manipulation, or laryngoscopy — combined with the inherent vagotonic effect of volatile anesthetics — make vagal stimulation the most frequent cause of intraoperative bradycardia.