Anesthesia and Perioperative Care
Anesthesia questions test preoperative risk, airway planning, intraoperative physiology, and recognition of rare but lethal complications.
Core rules
- Preoperative assessment: ASA class, airway (Mallampati, mouth opening, thyromental distance), comorbidities, fasting (2 hours clear fluids, 6 hours light meal), medication review - continue beta-blockers and statins, hold DOACs according to procedure risk.
- Airway strategy: plan A laryngoscopy, B supraglottic device, C mask ventilation, D front-of-neck access - declare it before induction.
- Spinal anesthesia: hypotension from sympathectomy; co-load and use vasopressors; a high block causes bradycardia and apnea.
- Malignant hyperthermia: triggered by volatile agents and suxamethonium; hypercarbia and rigidity precede fever; give dantrolene 2.5 mg/kg and stop triggers.
- Local anesthetic systemic toxicity: perioral tingling, metallic taste, seizures, arrhythmia; stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg bolus.
Worked example
During an interscalene block the patient reports tinnitus and a metallic taste, then seizes. Stop the injection, call for help, oxygenate with 100% oxygen, give a benzodiazepine, and give 20% lipid emulsion 1.5 mL/kg followed by infusion. Avoid vasopressin and calcium channel blockers; use small adrenaline doses if needed.
Traps
- Not checking suction and the airway trolley before induction.
- Missing hypercarbia as the earliest sign of malignant hyperthermia.
- Ignoring a full stomach and aspiration risk.
- Overlooking residual neuromuscular blockade and hypothermia in recovery.