Anesthesia for Emergency Surgery Practice Questions

Q: A 19-year-old boy requires emergency repair of a ruptured globe. The patient had their last meal 5 hours ago. Which of the following is the anesthetic technique of choice in this patient?

General anesthesia. **Explanation:** The primary goal in managing a **ruptured globe** (open eye injury) is to prevent any increase in **Intraocular Pressure (IOP)**, which could lead to the extrusion of intraocular contents (vitreous or iris) and permanent blindness. **Why General Anesthesia (GA) is the correct choice:** 1. **Airway Protection:** The patient had a meal 5 hours ago. In emergency surgery, any patient who has not met the fasting guidelines (6 hours for solids) is considered to have a **"full stomach."** GA with **Rapid Sequence Induction (RSI)** and endotracheal intubation is mandatory to protect the airway from aspiration. 2. **IOP Control:** GA provides a controlled environment where coughing, straining, or movement—all of which acutely spike IOP—can be prevented through the use of muscle relaxants and deep anesthesia. **Why the other options are incorrect:** * **Retrobulbar, Peribulbar, and Subtenon Blocks (A, B, D):** These regional techniques are **contraindicated** in an open globe injury. Injecting local anesthetic into the confined orbital space increases the volume and pressure behind the eye. This external pressure can squeeze the globe, causing the expulsion of intraocular contents through the rupture site. Additionally, these blocks do not address the aspiration risk associated with the patient's "full stomach" status. **High-Yield Clinical Pearls for NEET-PG:** * **Succinylcholine Controversy:** While Succinylcholine can slightly increase IOP, the priority in a full-stomach emergency is securing the airway. If a difficult airway is anticipated, Succinylcholine is still used, though **Rocuronium** is often preferred if a rapid-acting alternative is available. * **Pre-medication:** Avoid morphine (causes vomiting) and use IV Ondansetron to prevent postoperative nausea/vomiting (PONV), which can cause wound dehiscence. * **Induction:** Use a smooth induction; avoid Ketamine as it may increase IOP and cause blepharospasm.

Q: A patient was operated for right upper lobe resection. He was shifted to post awakening recovery after completion of surgery with vitals- BP 100/70 mm of Hg, HR - 94bpm, SPO2 100. After 2 hrs when he was assessed ,his vitals was BP 70/50 mm of Hg. HR-126 bpm ,SPO2 92 and surgical drain was filled with blood. Immediate re-exploration was planned. IV anaesthetic agent of choice -

Ketamine. ***Ketamine*** - The patient is experiencing **hypovolemic shock** due to hemorrhage, characterized by **hypotension** (BP 70/50), **tachycardia** (HR 126), and **hypoxia** (SpO2 92). Ketamine is the preferred agent in this scenario due to its **sympathomimetic effects**, which help to **maintain hemodynamic stability** by increasing heart rate and systemic vascular resistance. - Unlike other intravenous anesthetics, ketamine typically **preserves pharyngeal and laryngeal reflexes** and causes minimal respiratory depression, which is advantageous in a critically ill patient. *Thiopentone* - This drug is a **barbiturate** known for its significant **myocardial depressant effects** and tendency to cause marked **vasodilation**, both of which would further exacerbate the patient's existing hypotension and shock state. - It also causes direct **respiratory depression** and abolished airway reflexes, making it unsuitable for a hemodynamically unstable patient. *Propofol* - Propofol is a potent **vasodilator** and **myocardial depressant**, leading to a dose-dependent decrease in blood pressure through reduction of systemic vascular resistance and cardiac output. - It lacks analgesic properties and can cause significant **respiratory depression** and apnea, which would be detrimental to a patient with compromised oxygen saturation. *Etomidate* - While etomidate is known for its **hemodynamic stability** and minimal impact on blood pressure, it causes **adrenocortical suppression** by inhibiting 11-beta-hydroxylase, which can be detrimental in a stressed patient requiring an adequate stress response. - It also has a high incidence of **myoclonus** and **postoperative nausea and vomiting**, which are undesirable in a patient requiring emergency re-exploration when other options with more beneficial effects are available.

Q: A patient undergoing emergency laparotomy requires rapid-sequence induction. Which drug is preferred for its rapid onset and short duration of action?

Etomidate (rapid onset and short duration of action). ***Etomidate*** - **Etomidate** is a preferred induction agent for **rapid-sequence induction** due to its **ultrafast onset** (30-60 seconds) and **short duration of action**, allowing for quick intubation and minimal hemodynamic instability. - It maintains **cardiovascular stability**, making it particularly advantageous in emergency settings or hemodynamically compromised patients. *Ketamine* - **Ketamine** provides **analgesia** and **sympathomimetic effects**, which can be beneficial in certain emergency situations, but its psychomimetic side effects and longer emergence can be undesirable for a smooth rapid-sequence induction. - While it can maintain blood pressure, its **longer duration of action** and emergence delirium make it less ideal for rapid, controlled intubation compared to etomidate. *Propofol* - **Propofol** has a **rapid onset** but can cause significant **hypotension** due to vasodilation, which is often a concern in emergency patients who may already be hypovolemic or critically ill. - While it offers a smooth induction and rapid recovery, its hemodynamic effects limit its use as the **primary choice** for rapid-sequence induction in unstable patients. *Thiopentone* - **Thiopentone** is a **short-acting barbiturate** that was historically used for rapid-sequence induction, but it has a less favorable hemodynamic profile and can cause significant **myocardial depression** and hypotension. - Its use has largely been replaced by newer agents like etomidate and propofol due to its **less predictable cardiovascular effects** and a greater risk of adverse events.

Q: A 50-year-old patient undergoing emergency surgery for a ruptured abdominal aneurysm becomes hypotensive. Which vasopressor is the most appropriate?

Norepinephrine. ***Norepinephrine*** - It is often considered the **first-line vasopressor** in hypotensive states, particularly in septic shock, due to its potent **alpha-1 adrenergic agonist** effects leading to significant vasoconstriction and increased mean arterial pressure. - While dopamine, epinephrine, and phenylephrine have roles, norepinephrine generally demonstrates a more favorable risk-benefit profile in terms of increasing blood pressure with less detrimental effects on **cardiac output** and **arrhythmias** in critical settings. *Dopamine* - Its effects are dose-dependent; at lower doses, it can increase renal perfusion, but at higher doses, it acts similarly to norepinephrine but with a higher incidence of **tachycardia** and **arrhythmias**. - Not typically the first choice for significant hypotension in a critical surgical setting due to its less predictable pressor response and increased risk of **cardiac side effects**. *Epinephrine* - Increases mean arterial pressure, cardiac output, and heart rate, making it useful in cardiac arrest and anaphylaxis, but it can cause significant **tachycardia**, **arrhythmias**, and increased myocardial oxygen demand. - Its potent beta-adrenergic effects can be problematic in patients with **coronary artery disease** or those prone to tachyarrhythmias, making it a second-line agent for general shock. *Phenylephrine* - A pure **alpha-1 adrenergic agonist**, causing vasoconstriction without significant cardiac stimulation, which can initially seem appealing to avoid tachycardia. - However, it can cause **reflex bradycardia** and a decrease in cardiac output, which may be detrimental in contexts where cardiac output is already compromised, such as in significant hemorrhage.

Question 1

An 8-year-old child presents with testicular torsion and has not eaten for 6 hours. The surgeon wishes to operate immediately. What is the appropriate anesthetic management regarding fasting and urgency?

Accepted Answer

Take the child to the operating room immediately, deem it emergent, and perform rapid-sequence intubation.

Answer

Wait for 2 more hours, deem it urgent, and perform rapid-sequence intubation.

Answer

The child is adequately fasted; consider elective intubation.

Answer

Wait for 2 hours and consider elective intubation.

Question 2

A 19-year-old boy requires emergency repair of a ruptured globe. The patient had their last meal 5 hours ago. Which of the following is the anesthetic technique of choice in this patient?

Accepted Answer

General anesthesia

Answer

Retrobulbar block

Answer

Subtenon block

Answer

Peribulbar block

Question 3

A patient was operated for right upper lobe resection. He was shifted to post awakening recovery after completion of surgery with vitals- BP 100/70 mm of Hg, HR - 94bpm, SPO2 100. After 2 hrs when he was assessed ,his vitals was BP 70/50 mm of Hg. HR-126 bpm ,SPO2 92 and surgical drain was filled with blood. Immediate re-exploration was planned. IV anaesthetic agent of choice -

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

Etomidate

Question 4

A patient with massive bleeding due to a ruptured aortic aneurysm is in the operating room. The anesthesiologist suggests using fresh frozen plasma (FFP) to correct coagulopathy. What is the rationale behind this decision?

Accepted Answer

FFP provides necessary clotting factors and volume expansion

Answer

FFP increases platelet count to prevent bleeding

Answer

FFP provides erythrocytes to improve oxygen delivery

Answer

FFP contains fibrinogen, which is needed for clot formation

Question 5

A patient undergoing emergency laparotomy requires rapid-sequence induction. Which drug is preferred for its rapid onset and short duration of action?

Accepted Answer

Etomidate (rapid onset and short duration of action)

Answer

Ketamine (provides analgesia)

Answer

Propofol (quick but can cause hypotension)

Answer

Thiopentone (short-acting agent)

Question 6

A 50-year-old patient undergoing emergency surgery for a ruptured abdominal aneurysm becomes hypotensive. Which vasopressor is the most appropriate?

Accepted Answer

Norepinephrine

Answer

Dopamine

Answer

Epinephrine

Answer

Phenylephrine

Anesthesia for Emergency Surgery — MCQs

Anesthesia for Emergency Surgery — MCQs

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