Board Questions – 2023 Winter Newsletter

A 32-year-old female patient is undergoing general anesthesia with propofol, rocuronium, and remifentanil for an appendectomy. During the general anesthesia, carbon dioxide (CO2) measurements have started to be recorded even during inhalation. What is the most appropriate action to take?

  1. Increase the fresh gas flow rate.
  2. Ensure that the inspiratory valve is functioning properly.
  3. Replace the currently used propofol with sevoflurane.
  4. Check the color of the carbon dioxide absorbent.
  5. Adjust the ratio to ensure a shorter inspiratory time compared to the expiratory time.

Answer: D

Morgan & Mikhail’s Clinical anesthesiology. 5th ed. pp 127-9.

 

A 65-year-old man has been admitted to the operating room for a liver resection due to liver cancer. One week ago, the patient had a coronary angiogram for chest pain, which revealed significant stenosis in the left anterior descending artery (LAD). It has been decided to insert a coronary stent in the LAD after the surgery. What is the best choice for concurrent ECG monitoring during this patient’s surgery?

  1. I + V3
  2. I + V5
  3. I + III
  4. II + aVF
  5. II + V5

Correct Answer: A

Explanation: The left anterior descending artery (LAD) supplies blood to the front and septal walls of the heart. Myocardial infarction involving the anterior wall typically presents characteristic ECG findings in leads I, V1-3. Myocardial infarction affecting the anterior-septal area may manifest ECG changes primarily in V3-4. Infarction of the inferior wall typically displays characteristic ECG findings in leads II, III, and aVF, with reciprocal changes in V1-2.

Reference: The Korean Society of Anesthesiologists: Anesthesiology I, II, 2nd Edition. p. 870.

 

Parasympathetic nervous system control of airways consists of the 1. _______ nerve releasing the neurotransmitter 2._________ which activates __________ receptors.

  1. trigeminal, acetylcholine, nicotinic
  2. vagus, norepinephrine, beta II
  3. vagus, acetylcholine, muscarinic
  4. phrenic, acetylcholine, beta II
  5. vagus, norepinephrine, nicotinic

Answer: C. Specifically M3 receptors

 

You walk into a patient’s room to perform your preoperative exam. What is a 22 year old, ASA 1, male patient, expected to have regarding pulmonary dead space? Select two.

  1. physiologic dead space
  2. alveolar dead space
  3. apparatus dead space
  4. anatomic dead space

Flood pages 576-577

Answer: A and D

 

A healthy person will have no alveolar dead space. Apparatus dead space will only apply to patients attached to a breathing circuit. Seeing as how you are performing an preoperative exam and he is ASA 1, we can assumed he is not intubated. Anatomic dead space is another term for airway dead space.

Which factor LEAST influences anesthetic uptake?

  • Fresh gas flow
  • Cardiac output
  • Blood/gas solubility
  • Alveolar-venous partial pressure difference

Correct Answer: Fresh gas flow

Rationale: “The primary factors that influence absorption of inhalation anesthetics are ventilation, uptake into the blood, cardiac output, the solubility of the anesthetic drug in the blood and alveolar-to-blood partial-pressure difference” (Nagelhout, 2018, Chapter 7, 73-79.e2).

Reference: Nagelhout, J. J. & Elisha, S. (2018). Nurse Anesthesia, 6th ed. Elsevier, St. Louis, MO.

News, Winter 2023 VANA Newsletter