Common Complications After Ambulatory Surgery — MCQs
Postoperative nausea and vomiting are uncommon with
All of the following are complications of epidural anaesthesia, EXCEPT:
All are early complications of tracheostomy except:
Which of the following is the LEAST significant risk factor for postoperative pulmonary complications?
Which of the following is the LEAST significant risk factor for postoperative pulmonary complications?
The complication which will not occur after PCNL surgery:
Early complications of Tracheostomy are all EXCEPT
Which Benzodiazepine decreases post-operative nausea & vomiting:-
A patient with multiple gallstones shows 8 mm dilation and has 4 stones in the common bile duct (CBD). What is the best treatment modality?
Which of the following is used for day care surgery?
Common Complications After Ambulatory Surgery Indian Medical PG Practice Questions and MCQs
Question 1: Postoperative nausea and vomiting are uncommon with
- A. Propofol (Correct Answer)
- B. Etomidate
- C. Thiopentone
- D. All of the options
Explanation: ***Propofol*** - **Propofol** is known for its antiemetic properties, which contributes to a lower incidence of **postoperative nausea and vomiting (PONV)**. - Its mechanism involves modulating **dopaminergic activity** in the chemoreceptor trigger zone and possibly direct effects on serotonin receptors. *Etomidate* - While etomidate is a fast-acting induction agent, it does not inherently possess antiemetic properties. - Its use does not significantly reduce the risk of **PONV** compared to other induction agents, and some studies suggest it may even increase the risk slightly. *Thiopentone* - **Thiopentone**, a barbiturate, is typically associated with a higher incidence of **PONV** compared to propofol. - It does not offer any protective effect against nausea and vomiting and can contribute to these side effects in the postoperative period. *All of the options* - This option is incorrect because **etomidate** and **thiopentone** do not share the **antiemetic properties** of propofol. - Only **propofol** is specifically known to reduce the incidence of **PONV**.
Question 2: All of the following are complications of epidural anaesthesia, EXCEPT:
- A. Urinary retention
- B. Total spinal analgesia
- C. Hypopnoea
- D. Hypertension (Correct Answer)
Explanation: ***Hypertension*** - Epidural anesthesia commonly causes **vasodilation** and a subsequent drop in **blood pressure** (hypotension), not hypertension, due to sympathetic blockade. - While hypertension can occur due to pain or anxiety during the procedure, it is not a direct physiological complication of the epidural anesthetic itself. *Urinary retention* - Epidural anesthesia can affect the nerves controlling the **bladder**, leading to temporary **urinary retention**. - This is a common complication, often requiring catheterization until the epidural wears off. *Total spinal analgesia* - This occurs if the epidural needle inadvertently punctures the **dura** and a large dose of local anesthetic is injected into the **subarachnoid space**. - It results in widespread **sensory and motor blockade**, potentially leading to respiratory arrest and hemodynamic collapse. *Hypopnoea* - High epidural blocks or accidental **intrathecal administration** can cause paralysis of **intercostal muscles** and the diaphragm. - This can lead to **respiratory depression** (hypopnoea) or even apnea, necessitating ventilatory support.
Question 3: All are early complications of tracheostomy except:
- A. Hemorrhage
- B. Pneumothorax
- C. Injury to esophagus
- D. Tracheal stenosis (Correct Answer)
Explanation: ***Tracheal stenosis*** - **Tracheal stenosis** is typically considered a **late complication** of tracheostomy, developing weeks to months after the procedure due to scar tissue formation. - It arises from chronic irritation or pressure from the tracheostomy tube, leading to narrowing of the trachea. *Hemorrhage* - **Hemorrhage** can occur intraoperatively or in the immediate postoperative period due to injury to blood vessels. - It is considered an **early complication** of tracheostomy. *Pneumothorax* - **Pneumothorax** can be an early technical complication resulting from accidental pleural injury during the tracheostomy procedure. - This typically manifests shortly after the surgery. *Injury to esophagus* - **Esophageal injury** is a rare but serious **early complication** that can occur during tracheostomy, often due to misplacement of surgical instruments. - It can lead to tracheoesophageal fistula formation if not promptly identified and managed.
Question 4: Which of the following is the LEAST significant risk factor for postoperative pulmonary complications?
- A. Age >70
- B. Patient with 7 pack years of smoking
- C. Upper abdominal surgery
- D. BMI>30 (Correct Answer)
Explanation: ***BMI>30*** - While **obesity (BMI >30)** is associated with some surgical risks, it is generally considered a less significant independent risk factor for postoperative pulmonary complications compared to other factors like age, smoking, and surgical site. - The impact of obesity on pulmonary function is complex and varies depending on the type of surgery and presence of comorbid conditions like **sleep apnea**. *Age >70* - **Advanced age (>70)** is a significant independent risk factor due to decreased physiological reserve, reduced pulmonary function (e.g., decreased lung elasticity, impaired cough reflex), and increased prevalence of comorbidities. - Older patients are more susceptible to **atelectasis**, **pneumonia**, and **respiratory failure** postoperatively. *Patient with 7 pack years of smoking* - Even a relatively low cumulative smoking history of **7 pack-years** can impair mucociliary clearance, increase bronchial secretions, and cause airway inflammation, significantly increasing the risk of pulmonary complications. - Smoking compromises lung function and increases the risk of **bronchospasm** and infection. *Upper abdominal surgery* - **Upper abdominal surgery** is a significant risk factor because incisions close to the diaphragm interfere with diaphragmatic movement, leading to reduced lung volumes, impaired cough, and increased risk of **atelectasis** and **pneumonia**. - Pain from the incision further restricts deep breaths and coughing, contributing to pulmonary complications.
Question 5: Which of the following is the LEAST significant risk factor for postoperative pulmonary complications?
- A. Age > 60 years (Correct Answer)
- B. ASA class 3 and 4 patients
- C. Longer surgeries >2 hr
- D. Upper Abdominal surgery
Explanation: ***Age > 60 years*** - While age is a factor, it is generally considered **less significant** than other comorbid conditions or surgical factors in predicting postoperative pulmonary complications. - Pulmonary function naturally declines with age, but healthy elderly individuals may still tolerate surgery well if other risk factors are controlled. *ASA class 3 and 4 patients* - Patients classified as **ASA (American Society of Anesthesiologists) 3 or 4** have severe systemic disease or life-threatening systemic disease, respectively. - This significantly increases their risk of **postoperative pulmonary complications** due to their underlying health issues. *Longer surgeries >2 hr* - **Prolonged duration of surgery** (typically defined as >2-3 hours) is a significant independent risk factor for pulmonary complications. - This is due to longer periods of **immobility**, ventilation, and exposure to anesthetics, contributing to atelectasis and pneumonia risk. *Upper Abdominal surgery* - **Upper abdominal surgery** is one of the highest risk categories for postoperative pulmonary complications. - Incisions in this area can cause *diaphragmatic dysfunction*, pain leading to shallow breathing, and impaired cough reflex.
Question 6: The complication which will not occur after PCNL surgery:
- A. Organ injury
- B. Urethral stricture (Correct Answer)
- C. Bleeding
- D. Sepsis
Explanation: ***Urethral stricture*** - **Urethral stricture** is a complication typically associated with transurethral procedures involving instrumentation through the urethra, such as a **Transurethral Resection of the Prostate (TURP)** or repeated urethral catheterisation. - **PCNL (Percutaneous Nephrolithotomy)** involves direct access to the kidney through the skin in the flank, bypassing the urethra entirely, therefore, making urethral stricture not a direct complication of this procedure. *Organ injury* - **Organ injury**, particularly to adjacent organs like the **colon**, **pleura**, or **spleen/liver**, can occur during PCNL if the access tract is misdirected or during instrumentation. - This is a well-recognised but infrequent complication requiring careful pre-operative planning and imaging guidance. *Bleeding* - **Bleeding** is a common complication of PCNL due to the invasive nature of the procedure, involving puncture of the kidney and fragmentation of stones. - It can range from minor self-limiting bleeding to significant haemorrhage requiring transfusion or further intervention such as **angiography** and **embolization**. *Sepsis* - **Sepsis** is a serious potential complication, particularly if the patient has pre-existing urinary tract infection or if bacteria are dislodged during stone fragmentation. - **Infection** can disseminate into the bloodstream, leading to severe systemic inflammatory response syndrome and septic shock.
Question 7: Early complications of Tracheostomy are all EXCEPT
- A. Pneumothorax
- B. Apnoea
- C. Haemorrhage
- D. Stenosis (Correct Answer)
Explanation: ***Stenosis*** - **Stenosis** (tracheal or subglottic) is a **late complication** of tracheostomy, typically developing **weeks to months** after the procedure due to scar tissue formation - Results from **granulation tissue** at the stoma site, trauma from the tracheostomy tube, or prolonged cuff inflation - Requires long-term follow-up and may need intervention with dilation or surgical correction *Pneumothorax* - **Early and acute complication** occurring during or immediately after tracheostomy - Caused by accidental puncture of the **pleura** during incision or dissection, especially in patients with a high-riding pleura or short neck - Requires immediate recognition with chest X-ray and management (chest tube if significant) *Apnoea* - **Early complication** occurring shortly after tracheostomy placement - Particularly seen in patients with **chronic respiratory failure** and CO2 retention when there is sudden reduction in **PaCO2** - Mechanism: Removal of upper airway resistance and improved ventilation leads to rapid CO2 washout, suppressing the hypercapnic respiratory drive *Haemorrhage* - Common **early complication** occurring during the procedure or within the **first 24-48 hours** - Can range from minor oozing to severe bleeding from thyroid vessels, anterior jugular veins, or rarely the innominate artery - Early bleeding usually from small vessels; late bleeding (>48 hours) may indicate tracheo-innominate fistula
Question 8: Which Benzodiazepine decreases post-operative nausea & vomiting:-
- A. Midazolam (Correct Answer)
- B. Diazepam
- C. Lorazepam
- D. All of the options
Explanation: ***Midazolam*** - **Midazolam** is a commonly used benzodiazepine in anesthesia that has been shown to have **antiemetic properties** and can decrease the incidence of **postoperative nausea and vomiting (PONV)**. - Its mechanism may involve its sedative and anxiolytic effects, indirectly reducing the triggers for nausea. *Diazepam* - While **diazepam** is a benzodiazepine with sedative and anxiolytic effects, it is not primarily known for reducing PONV. - Its longer duration of action compared to midazolam can also contribute to unwanted **postoperative sedation**. *Lorazepam* - **Lorazepam** is another benzodiazepine used for anxiolysis and sedation but is not a primary agent for the prevention of PONV. - Like diazepam, its prolonged effects can lead to **delayed recovery** and drowsiness, which may not be desirable in the postoperative period. *All of the options* - While all listed drugs are benzodiazepines, only **midazolam** is consistently recognized and utilized for its ability to reduce PONV in the perioperative setting. - The other benzodiazepines do not demonstrate the same consistent benefit in PONV reduction and may have other side effects that limit their utility for this specific purpose.
Question 9: A patient with multiple gallstones shows 8 mm dilation and has 4 stones in the common bile duct (CBD). What is the best treatment modality?
- A. ESWL
- B. ERCP followed by cholecystectomy (Correct Answer)
- C. None of the options
- D. Cholecystectomy with choledocholithotomy at the same setting
Explanation: ***ERCP followed by cholecystectomy*** - This is the **current standard of care** for managing choledocholithiasis with cholecystolithiasis - **ERCP with sphincterotomy** effectively clears CBD stones with success rates >90% - Followed by **laparoscopic cholecystectomy** (either during same admission or within 2 weeks) - This approach is **minimally invasive**, has lower morbidity, and shorter hospital stay compared to open surgery - Pre-operative ERCP is preferred when CBD stones are confirmed pre-operatively *Cholecystectomy with choledocholithotomy at the same setting* - This represents **open surgical approach** which is now largely **outdated** - Reserved only for cases where ERCP fails or is unavailable - Associated with higher morbidity, longer recovery, and larger incisions - **Laparoscopic CBD exploration** is preferred over open approach if surgical clearance is needed *ESWL (Extracorporeal Shock Wave Lithotripsy)* - ESWL is **not indicated for CBD stones** - Primarily used for **kidney stones** and occasionally for large gallbladder stones - CBD stones require endoscopic or surgical removal - Risk of stone fragments causing obstruction or pancreatitis *None of the options* - ERCP followed by cholecystectomy is the appropriate modern management - This option is not applicable as a correct option exists
Question 10: Which of the following is used for day care surgery?
- A. Thiopentone
- B. Ketamine
- C. Etomidate
- D. Propofol (Correct Answer)
Explanation: ***Propofol*** - **Propofol** is favored for **day care surgery** due to its **rapid onset** and **rapid recovery** profile, allowing patients to be discharged quickly. - It produces a **clear-headed recovery** with less postoperative nausea and vomiting compared to other agents. *Thiopentone* - **Thiopentone** has a **longer recovery time** and greater potential for **postoperative sedation** and **nausea**, making it less suitable for day care surgery. - Its use often leads to a **delayed discharge** from the recovery unit. *Ketamine* - **Ketamine** can cause **psychomimetic effects** (e.g., hallucinations, vivid dreams) and **delirium** during emergence, which are undesirable for day care procedures. - It also leads to **increased heart rate** and **blood pressure**, which may prolong recovery and observation time. *Etomidate* - **Etomidate** is known to cause **adrenocortical suppression** and can be associated with **pain on injection** and **myoclonus**, which are not ideal for routine day care use. - While it has a relatively **stable cardiovascular profile**, these side effects limit its widespread use in short procedures where rapid, smooth recovery is paramount.
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