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Basic Principles
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When do symptoms of ischemic optic neuropathy that result in postoperative vision loss typically occur?
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(A) Immediately postoperatively
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(B) 2 hours postoperatively
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(C) 2 days postoperatively
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(D) 2 weeks postoperatively
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A. Rationale: Symptoms typically start following emergence from anesthesia, but may occur up to 12 days following surgery.
Ref
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Butterworth
J.F., Mackey
D.C., Wasnick
J.D. (2013). Ch 54 Morgan & Mikhail's Clinical Anesthesiology (5th ed.). New York, NY: McGraw-Hill.
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During a general anesthetic you suspect an episode of malignant hyperthermia (MH). What will you do first?
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(A) Call the MHAUS hotline.
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(B) Administer dantrolene.
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(D) Turn off inhalational agents.
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D. Rationale: When suspicion of an episode of malignant hyperthermia exists, each of the responses is in order; however, turning off the inhalational agents is the first priority.
Ref
+
Butterworth
J.F., Mackey
D.C., Wasnick
J.D. (2013). Ch 52 Morgan & Mikhail's Clinical Anesthesiology (5th ed.). New York, NY: McGraw-Hill.
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Longnecker
D.E., Brown
D.L., Newman
M.F., Zapol
W.M. (2012). Ch 87 Anesthesiology (2nd ed.). New York, NY: McGraw-Hill.
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When is body temperature loss the greatest?
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(A) During the preoperative preparation
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(B) During the 1st hour in the operating room
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(C) During the 2nd and 3rd hours in the operating room
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(D) During the 4th hour in the operating room
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B. Rationale: The greatest amount of heat loss occurs during the 1st hour in the operating room (0.5-1.5C). Thereafter temperature decline is gradual and then plateaus.
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BOX 3-1
Management of Patient with Highly Suspicious Episode of MH
Discontinue all potent inhalational agents and succinylcholine. Maintain anesthesia with total intravenous, nontriggering anesthetics.
Increase minute ventilation to at least 10 L/min to flush out volatile anesthetics and to lower ETCO2. Administer 100% oxygen. Insert activated charcoal filters into the inspiratory and expiratory limbs of the breathing circuit. Consider switching to a freestanding ventilator as soon as possible.
Inform the surgeon to expedite or abort the procedure, if possible, and obtain assistance from MHAUS Hotline (1-800-644-9737) for acute crisis.
Administer IV dantrolene, 2.5 mg/kg. Be prepared to repeat this dose until the patient responds with a decrease in ETCO2, rigidity, or heart rate.
Obtain ...