Anesthesia Complications & Management Flashcards

A patient scheduled for cervical spine surgery awakens with quadriplegia. The most critical initial management priority is:

Answer: Maintaining mean arterial pressure ≥85 mmHg

Maintaining MAP ≥85 mmHg is the most critical immediate intervention to ensure adequate spinal cord perfusion pressure, as secondary ischemic injury from hypoperfusion worsens neurological outcomes.

A pediatric patient develops severe laryngospasm after extubation. Initial jaw thrust and positive pressure ventilation fail to break the spasm. What medication should be administered?

Answer: Succinylcholine 0.1–0.2 mg/kg IV (or 4 mg/kg IM)

Low-dose succinylcholine (the 'laryngospasm dose') relaxes the vocal cord muscles to break complete laryngospasm when airway maneuvers fail; IM route is used if IV access is unavailable.

Which parameter best guides the adequacy of dantrolene treatment in a malignant hyperthermia crisis?

Answer: Normalization of end-tidal CO2

End-tidal CO2 normalization is the best real-time indicator of MH treatment adequacy, as it reflects the resolution of the underlying hypermetabolic state that drives CO2 production.

A patient with known difficult airway is inadvertently extubated in the ICU. After failed mask ventilation and failed laryngoscopy, the next step following 'can't intubate, can't oxygenate' criteria is:

Answer: Perform emergency surgical airway (cricothyrotomy)

In a 'can't intubate, can't oxygenate' (CICO) emergency where both supraglottic and intubation attempts have failed, emergency surgical airway (front-of-neck access) is mandated to prevent fatal hypoxia.

Which postoperative complication is most specifically associated with prolonged beach chair positioning during shoulder arthroscopy?

Answer: Cerebral hypoperfusion and stroke

Beach chair position causes a hydrostatic gradient between the heart and the brain; blood pressure measured at the arm may be substantially higher than actual cerebral perfusion pressure, leading to cerebral hypoperfusion and stroke.

A patient on chronic opioid therapy for cancer pain develops sudden respiratory depression after epidural morphine administration. What is the most concerning mechanism?

Answer: Rostral migration of morphine in CSF to brainstem respiratory centers

Delayed respiratory depression (6–12 hours after epidural dosing) from neuraxial morphine occurs due to rostral CSF migration of the hydrophilic drug to brainstem respiratory centers, which can be particularly dangerous.

During cardiopulmonary bypass, a patient develops hematuria, hemolysis, and decreasing pump flows. The circuit heat exchanger shows discoloration. What has occurred?

Answer: Blood-water heat exchanger leak causing hemolysis

A heat exchanger leak allows water to enter the blood circuit, causing hemolysis from osmotic and mechanical red blood cell destruction, presenting with hemolysis, hemoglobinuria, and pump dysfunction.