Quiz 5 Flashcards
What is the most common tachyarrhythmia seen in children?
A. A. Fib
B. V. tach
C. A. Flutter
D. SVT
Answer: D. SVT
The most common arrhythmia seen in children is SVT. SVT is a supraventricular, narrow QRS complex arrhythmia with a consistent heart rate and normal P-waves; however, depending on the rate, the P-wave may be hidden underneath the QRS complex. Children with this arrhythmia are often symptomatic due to poor cardiac reserve. Children with persistent SVT episodes are frequently treated using radio-frequency catheter ablation.
What is the optimal shock dose for initial cardioversion of A-flutter and other supraventricular tachycardia?
A) 25 - 50 J
B) 50 - 100 J
C) 150 - 200 J
D) 200 - 250 J
Answer: B) 50 - 100 J
Rationale: The optimal shock dose for cardioversion of A-flutter and other supraventricular tachycardia is 50 - 100 J. Energy shocks are delivered initially at 50 - 100 J, then titrated progressively to 360 J as necessary after observation of the effectiveness of the synchronized shock.
During the anesthetization of a patient with atrial fibrillation undergoing an ablation procedure in an electrophysiology laboratory or suite, the anesthetist must remain vigilant for which of the following major complications?
Select all that apply:
A) Atrioesophageal fistula
B) Vagus nerve injury
C) Hemorrhage
D) Atrial perforation leading to cardiac tamponade
E) Phrenic nerve injury
Correct Answers: A) Atrioesophageal fistula, D) Atrial perforation leading to cardiac tamponade E) Phrenic nerve injury
Rationale: “Three major complications that may arise from ablations: atrioesophageal fistula, atrial perforation leading to tamponade, and phrenic nerve injury. The procedurals may request spontaneous ventilation to monitor phrenic nerve integrity. (Butterworth, 2022)”
Select all that apply: Which of the following are the most frequent postoperative complications in pediatric dental patients?
A) Nausea and vomiting
B) Hypothermia
C) Crying
D) Bleeding
Correct Answer: A, C, D
Rationale: Postoperative nausea and vomiting (PONV), crying, and bleeding are common complications in pediatric dental anesthesia. Antiemetics, long-acting pain medications such as opioids or toradol, along with careful monitoring during recovery, can help reduce these risks.
Which of the following is acceptable according to fasting guidelines for a patient prior to electroconvulsive therapy (ECT)
a. Patient takes oral medications with water two hours prior to procedure
b. Patient has breakfast three hours prior to procedure
c. Patient eats a midnight snack the night before his procedure at 0500
d. Patient has a glass of water before getting in the car to drive 30 minutes to the procedure
Answer: A
Rationale: ECT fasting guidelines state that patients must fast from solid foods for six hours and abstain from water for 2 hours prior to ECT procedure (Elisha, 2023)
What medication should be held when a patient is undergoing a CT scan with IV contrast, and why?
A. Propofol, because it reacts with the IV contrast.
B. Zofran, because it will cause worse nausea and vomiting.
C. Metformin, because of the risk of lactic acidosis.
D. No medications need to be held with IV contrast use.
Answer: C. Metformin, because of the risk of lactic acidosis.
Rationale: A thorough preanesthetic assessment for a patient about to undergo CT should include questions pertaining to asthma, allergies, and any previous reactions to contrast media. Diabetic patients taking metformin must withhold the medication because of the risk of lactic acidosis. This problem is mainly observed in patients with diabetic nephropathy.
Which MRI Suite Zone is described here?
“This is the area where patients are greeted, histories obtained, and questions answered. Movement by non-MRI personnel and patients is under the supervision of MRI personnel.
A) Zone I
B) Zone II
C) Zone III
D) Zone IV
Correct answer: B) Zone II
BOX 58.13 Zone II is The area between the uncontrolled zone I and the strictly controlled zone III. This is the area where patients are greeted, histories obtained, and questions answered. Movement by non-MRI personnel and patients is under the supervision of MRI personnel.
When considering anesthesia in the pediatric population, which age group has the greatest risk of adverse events?
A. Children under 10 years of age
B. Children under 5 years of age
C. Children ages 2 to 5 years of age
D. Age is not a factor in the pediatric population
Answer: B. Children under 5 years of age
Rationale: Children under 5 years of age, with no underlying disease, are at the greatest risk for adverse events. Adverse events occur more commonly with the use of multiple sedative agents and the adverse events most often encountered are respiratory events, such as respiratory depression, respiratory obstruction, and/or apnea.
Which of the following anesthetics may cause problems with In vitro fertilization procedures and should be avoided?
A. Fentanyl
B. Remifentanil
C. Alfentanil
D. Morphine
Answer: D. Morphine
Rationale: Morphine has been shown to adversely affect fertilization of sea urchin eggs in vitro by allowing more than one sperm to enter the oocyte in 30% of cases; therefore it is not used because of the existence of safe alternatives such as fentanyl, alfentanil and remifentanil (Elisha et al., 2023).
Which of the following factors can increase the risk of adverse effects during anesthetic care in pediatric patients? Select two.
A. Utilization of multiple anesthetic agents
B.Assessment of any recent upper respiratory tract infections
C. Absence of nitrous oxide usage in combination with other sedatives
D. Procedural duration is greater than one hour
Correct Answer: A & D
The length of a procedure has been researched to have a correlation with the adverse effects that occur within pediatric anesthesia. Adverse effects have been shown to be decreased in procedures under one hour, while procedures over this period can increase the occurrence of adverse events (Elisha et al., 2023). The utilization of multiple anesthetic agents has been shown to be responsible for most adverse anesthesia events (Elisha et al., 2023). The other two answer choices are assessments and anesthetic delivery techniques that can aid in the prevention of adverse effects in pediatrics (Elisha et al., 2023).
Which of the following statements regarding perioperative management of cardiac patients is correct?
A. Beta blockers should be discontinued perioperatively to prevent bradycardia.
B. Angiotensin-converting enzyme inhibitors should always be discontinued due to the risk of intraoperative hypotension.
C. Antiplatelet therapy in patients with stents should only be discontinued after discussion between the patient, cardiologist, and surgeon.
D. Pacemakers do not require any special considerations during ambulatory procedures.
Answer: C. Antiplatelet therapy in patients with stents should only be discontinued after discussion between the patient, cardiologist, and surgeon.
Rationale: Patients with cardiac stents are typically on antiplatelet therapy, which should not be discontinued without coordination between the surgeon, cardiologist, and anesthesiologist due to the risk of discontinuation of antiplatelet therapy and the necessity of surgery. Beta blockers should be continued perioperatively; pacemakers require assessment for potential electromagnetic interference risks; and the continuation or discontinuation of angiotensin-converting enzyme inhibitors remains controversial.
In the PACU, A patient has the following clinical presentation: Dyspnea with shallow breathing, 3L Nasal Canula with O2 Saturation of 91%, Blood pressure 10 mmHg lower than preanesthetic level, opens eyes to voice and is able to move only their hands/arms to command. What would the Modified Aldrete score be for this patient?
A. 5
B. 6
C. 7
D. 8
Answer: B. 6
Rationale: The Modified Aldrete score given in the PACU looks at 5 different categories: Activity, Respiration, Circulation, Consciousness, and O2 Saturation. Each of these categories gets a score from 0 to 2 and they are all added up to get an overall score. In this example, the patient had a score of 1 for Activity (2 extremities moved to command), 1 for respirations (dyspnea/shallow breathing), 2 for circulatory (bp + or – 20 mmHg of preanesthetic level, 1 for consciousness (arousable to calling), and 1 for O2 saturation (needs inhaled O2 to maintain sats over 90%). These scores combined equals a Modified Aldrete of 6. See Table 44-6 (Butterworth et al., 2022)
Which of the following are the two most frequent causes of unplanned hospital admission from ambulatory surgery centers (ASCs) and office surgery practices? (select 2)
A) Surgical site infections
B) Inadequately controlled pain
C) Delayed wound healing
D) Postoperative nausea and vomiting
Answer: B & D
Rational: Ambulatory surgery patients occasionally require transfer to a nearby hospital. Some instances are due to surgical complications that can’t be repaired in the ambulatory operating suite, but the two most frequent causes of unplanned hospital admission from ASCs and from office surgery practices are due to inadequately controlled pain and postoperative nausea and vomiting. Due to the risk of unplanned hospital admissions, accreditation agencies mandate that office-based operating rooms have appropriate emergency equipment, drugs, and protocols for patient transfer to a nearby hospital.
What position should the patient be in during a colonoscopy?
A. Left lateral decubitus position
B. Prone position
C. Semiprone position
D. Supine position
Answer: A. Left lateral decubitus position
Rationale: Patients are usually asked to assume a left lateral decubitus position and will typically remain on a transport stretcher for the colonoscopy procedure. Prone, semi-prone, or slightly left lateral decubitus position are for Endoscopic Retrograde Cholangiopancreatography (ERCP). Supine or left lateral decubitus position can be assumed for endoscopic procedures.
Which patient is at the highest risk for obstructive sleep apnea (OSA)?
A. A 23 y/o female with a BMI of 23 kg/m2
B. A 60 y/o male with a BMI of 28 and neck circumference of 30 cm
C. A 55 y/o male with a BMI of 38 kg/m2 who reports lethargy and snoring frequently during the night
D. A 70 y/o female with a BMI of 25 kg/m2 being treated for HTN
Answer: C, Screening for sleep apnea is vital, especially in outpatient surgery settings. It is highly possible that patients with OSA have not been formally diagnosed, and complications could occur if the patient’s airway is not managed appropriately (difficult airway management, cardiopulmonary arrest, brain injury, etc.). The STOP-BANG questionnaire is a useful tool to determine the patient’s risk for sleep apnea: Snoring, Tiredness, Observed apnea, Pressure, BMI (>35 kg/m2), Aget (>50 years), Neck (circumference >40 cm), Gender (male gender). While all answers had one or two risk factors, option C had five risk factors.
Which of the following best describes the primary advantage of multimodal analgesia in postoperative pain management?
A) It relies solely on opioids for pain control.
B) It targets different pain pathways to produce a synergistic effect at lower analgesic doses.
C) It is only effective for major surgical procedures.
D) It eliminates the need for pharmacologic interventions in pain management.
Answer: B) It targets different pain pathways to produce a synergistic effect at lower analgesic doses.
Rationale: Anesthesia providers are equipped with a varied toolbox to help patients in managing pain in the perioperative period. Traditional pharmacotherapy works by affecting the transduction, transmission, modulation, and perception of pain. Multimodal analgesia has been shown in multiple clinical situations to have strong efficacy in the treatment of postoperative pain. This form of pain con trol works by targeting different pain pathways to produce a synergistic effect at lower analgesic doses. In addition to the use of opioids in pain control, multimodal analgesia utilizes acetaminophen, gabapentinoids, nonsteroidal antiinflammatory drugs (NSAIDs), and ketamine to augment analgesia.
When is the appropriate time to administer succinylcholine, or other forms of neuromuscular blocking agents, during electroconvulsive therapy (ECT)?
A. Before applying the blood pressure cuff to the lower extremity
B. Immediately after induction, but before applying the blood pressure cuff
C. After the blood pressure cuff is applied and inflated on the lower extremity
D. After the seizure has been induced to prevent excessive muscle contractions
Answer: C. After the blood pressure cuff is applied and inflated on the lower extremity
Rationale: In ECT, a second blood pressure cuff is inflated on a lower extremity higher than the patient’s before administering succinylcholine. This effectively isolates the extremity distal to the blood pressure cuff so that the neuromuscular blocking agent does not affect the area. This allows providers to observe motor seizure activity despite systemic muscle paralysis.
A, B, and D are incorrect steps since you must first wait for the extremity to be isolated before administering the neuromuscular agent.
Which of the following describes the most often used anesthetic plan for a patient undergoing radiofrequency catheter ablation (RFCA) using general anesthesia?
A. Inhaled volatile anesthetics with antiemetics to reduce postop nausea and vomiting (PONV)
B. Total intravenous anesthesia (TIVA) to optimize hemodynamic stability during pulmonary artery occlusion and reduce PONV
C. A balanced combination of volatile anesthetic and intravenous anesthetic to maintain appropriate anesthetic depth while optimizing hemodynamic stability and reduction of PONV
D. A balance of volatile anesthetic and opioid to decrease the chance of hemodynamic instability during the case
Answer: B – Total intravenous anesthesia (TIVA) to optimize hemodynamic stability and reduce PONV
Rationale: During the cryoablation, up to 25% of cardiac output is transiently lost due to occlusion of the pulmonary artery. Because of this occlusion, patients can develop significant hemodynamic instability. The occlusion of the pulmonary artery will also interfere with the uptake and distribution of inhaled volatile anesthetics, making TIVA the preferred technique. TIVA with propofol and ondansetron has been shown to reduce the rate of PONV when compared with the combination of inhaled anesthetic and antiemetic (Elisha et al., 2023).
