Anesthetic Complications and Crisis Management Flashcards

In the management of 'cannot intubate, cannot oxygenate' (CICO), needle cricothyrotomy provides oxygenation but not ventilation unless connected to what?

Answer: High-pressure oxygen source (jet ventilation) to allow exhalation via upper airway

A small-bore needle cricothyrotomy cannot provide adequate tidal ventilation with standard flows; high-pressure jet ventilation is required, and exhalation must occur via the (partially obstructed) upper airway.

Intraoperative hypertension requiring treatment is most commonly caused by what?

Answer: Inadequate analgesia and depth of anesthesia during painful stimulation

The most common intraoperative cause of hypertension is inadequate anesthetic depth or analgesia during surgical stimulation, causing sympathetic activation with increased heart rate and blood pressure.

A patient develops 'awareness under anesthesia' (unintended intraoperative awareness). The CRNA's primary obligation is to:

Answer: Immediately acknowledge, fully inform the patient, provide psychological support, and document the incident

Professional ethical and legal standards require disclosure of awareness events; prompt acknowledgment, empathy, psychological follow-up, and documentation are mandatory components of the response.

PONV (postoperative nausea and vomiting) prophylaxis is most effective when using what approach?

Answer: Multimodal combination antiemetic therapy targeting different receptor mechanisms

Combining antiemetics with different mechanisms (5-HT3 antagonist + dexamethasone + scopolamine patch) provides additive efficacy; each agent reduces PONV by ~26%, and combinations dramatically reduce overall risk.

Hypothermia (core temp <36°C) in the perioperative period increases the risk of which specific surgical complication?

Answer: Surgical site infection, coagulopathy, and increased blood loss

Even mild perioperative hypothermia causes vasoconstriction (tissue hypoxia promoting infection), impairs platelet function, and reduces clotting factor activity, leading to wound infections and increased surgical blood loss.

The cognitive aid (crisis checklist) most recommended for managing intraoperative crises is designed to do what?

Answer: Reduce cognitive load during high-stress events by providing stepwise protocols that prevent critical steps from being missed

Cognitive aids (like the Stanford Emergency Manual) address the well-documented human tendency to experience cognitive overload during emergencies, where critical steps are forgotten; the checklist externalizes the protocol so the team can focus on execution.