Perioperative Patient Management Flashcards

A patient develops bronchospasm under general anesthesia with severe wheezing and rising peak airway pressures. After deepening anesthesia, which pharmacological intervention is MOST appropriate?

Answer: Inhaled albuterol via the ETT

Inhaled albuterol administered via the endotracheal tube is the first-line bronchodilator for intraoperative bronchospasm after ensuring adequate anesthetic depth.

Which of the following preoperative findings most significantly increases the risk of postoperative pulmonary complications?

Answer: FEV₁/FVC ratio < 0.7 with FEV₁ 45% predicted

Severe obstructive lung disease (FEV₁ < 50% predicted) is a major independent risk factor for postoperative pulmonary complications, especially with thoracic or upper abdominal surgery.

A 70-year-old patient on warfarin for atrial fibrillation (INR 2.8) requires emergent appendectomy. The FASTEST way to reverse anticoagulation is:

Answer: 4-factor prothrombin complex concentrate (PCC) plus vitamin K IV

4-factor PCC provides immediate reversal of all vitamin K–dependent factors with a smaller volume than FFP; IV vitamin K ensures sustained reversal.

During a right hepatectomy, the surgeon temporarily occludes the portal triad (Pringle maneuver). The MOST expected hemodynamic change is:

Answer: Decrease in cardiac preload and blood pressure

The Pringle maneuver excludes portal and hepatic arterial flow, reducing venous return and causing hypotension that requires vasopressor or fluid support.

Which electrolyte disturbance is MOST commonly associated with massive transfusion of packed red blood cells?

Answer: Hypocalcemia due to citrate chelation

Citrate used as an anticoagulant in stored PRBCs chelates ionized calcium, causing hypocalcemia during massive transfusion, impairing cardiac contractility.

A patient receiving a total intravenous anesthetic (TIVA) with propofol and remifentanil for a 4-hour craniotomy develops sudden movement. The MOST appropriate immediate response is:

Answer: Increase the propofol infusion rate and check TCI or pump function

Movement during TIVA most commonly indicates inadequate depth from pump malfunction or disconnection; increasing propofol and verifying pump/line integrity is the primary response.

Which sign or symptom is MOST suggestive of local anesthetic systemic toxicity (LAST) presenting in the cardiovascular phase?

Answer: Wide-complex ventricular arrhythmia refractory to standard ACLS

Cardiovascular LAST characteristically causes sodium channel blockade leading to wide-complex ventricular arrhythmias (e.g., ventricular fibrillation) that are resistant to standard resuscitation and require lipid emulsion therapy.