Anesthesia for Emergency Surgery Practice Questions

Q: What is the dose of adrenaline given intravenously in a cardiac arrest victim?

10 ml of 1 in 10,000 solution. **Explanation:** In the management of cardiac arrest (as per ACLS guidelines), the standard intravenous dose of Adrenaline (Epinephrine) is **1 mg every 3–5 minutes**. To ensure rapid systemic distribution and minimize local irritation during emergency administration, a dilute concentration is used. **Why Option A is correct:** Adrenaline is available in two standard strengths: 1:1,000 and 1:10,000. * **1:10,000 concentration** means 1 gram in 10,000 ml, which equals **0.1 mg/ml**. * Therefore, **10 ml** of a 1:10,000 solution provides exactly **1 mg** of Adrenaline, which is the gold-standard dose for Advanced Cardiac Life Support (ACLS). **Analysis of Incorrect Options:** * **Option B (1 ml of 1:10,000):** This provides only 0.1 mg, which is a sub-therapeutic dose for cardiac arrest (though sometimes used in pediatric cases or for severe anaphylaxis). * **Option C (2 ml of 1:1,000):** This provides 2 mg. While the 1:1,000 concentration is used for IM injections in anaphylaxis, giving it IV in this volume is incorrect and potentially arrhythmogenic. * **Option D (10 ml of 1:1,000):** This provides 10 mg, which is a massive overdose and can cause severe hypertension and fatal arrhythmias post-resuscitation. **High-Yield Clinical Pearls for NEET-PG:** * **Route:** IV/IO is preferred. If given via **Endotracheal tube**, the dose is doubled (2–2.5 mg). * **Mechanism:** Its primary benefit in arrest is **$\alpha$-1 agonist** activity, which causes vasoconstriction, increasing coronary and cerebral perfusion pressure. * **Anaphylaxis Dose:** 0.5 mg (0.5 ml of 1:1,000) **Intramuscularly**. * **Shockable vs. Non-shockable:** In VF/pVT, give after the 2nd shock. In PEA/Asystole, give as soon as possible.

Q: What is the alternative drug for epinephrine in Advanced Cardiac Life Support (ACLS)?

High dose vasopressin. **Explanation:** In the management of cardiac arrest (VF, pulseless VT, Asystole, or PEA), **Epinephrine** is the primary vasopressor used for its $\alpha$-adrenergic effects, which increase coronary and cerebral perfusion pressure. According to ACLS guidelines, **Vasopressin (40 units IV/IO)** can be used as an alternative to the first or second dose of Epinephrine. **Why Vasopressin?** Vasopressin is a potent non-adrenergic peripheral vasoconstrictor that acts on $V_1$ receptors. Unlike Epinephrine, it remains effective in the presence of metabolic acidosis (common during prolonged arrest) and does not increase myocardial oxygen consumption, as it lacks $\beta$-adrenergic effects. **Analysis of Incorrect Options:** * **A. Amiodarone:** This is an anti-arrhythmic drug, not a vasopressor. It is indicated for shock-refractory VF or pulseless VT, but it does not replace Epinephrine. * **B. Atropine:** Previously used for asystole/PEA, it has been removed from the routine ACLS cardiac arrest algorithm because it showed no therapeutic benefit in these scenarios. * **D. Adenosine:** This is the drug of choice for stable Supraventricular Tachycardia (SVT). It causes a transient AV nodal block and has no role in the management of cardiac arrest. **High-Yield Pearls for NEET-PG:** * **Dose:** Vasopressin is given as a single one-time dose of **40 units** (High dose). * **Half-life:** Vasopressin has a longer half-life (10–20 mins) compared to Epinephrine (3–5 mins). * **Current Status:** While the 2015/2020 AHA updates simplified the algorithm by focusing primarily on Epinephrine to reduce complexity, Vasopressin remains the classic "textbook" alternative in exam questions. * **Endotracheal Route:** If IV/IO access is unavailable, drugs like **L**idocaine, **E**pinephrine, **A**tropine, and **N**aloxone (**LEAN**) can be given via the ET tube at 2–2.5 times the IV dose.

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: Rapid Sequence Induction is indicated in:

Emergency surgery for intestinal obstruction. ***Emergency surgery for intestinal obstruction*** - Rapid Sequence Induction (RSI) is indicated in situations where there is a high risk of **pulmonary aspiration** of gastric contents, such as in **intestinal obstruction**, due to a full stomach or impaired gastric emptying. - The goal of RSI is to achieve rapid intubation while minimizing the risk of aspiration by using a specific sequence of medications and techniques (e.g., cricoid pressure). *Cardiopulmonary bypass surgery* - This is an **elective procedure** where patients are typically fasted and have time for a thorough pre-operative assessment and standard induction. - While significant, it does not inherently carry the same immediate high risk of aspiration as an emergency with a full stomach. *Elective open hernia surgery* - This is an **elective procedure** where the patient can be properly fasted, significantly reducing the risk of a full stomach. - A standard, controlled anesthetic induction is generally preferred, allowing for gradual intubation and ventilation. *Elective laparoscopic surgery* - Similar to elective open surgery, patients undergoing **elective laparoscopic procedures** are properly fasted. - The primary concern in laparoscopic surgery is often related to pneumoperitoneum and its effects, rather than a high aspiration risk during induction if fasting guidelines are followed.

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.

Question 1

What is the dose of adrenaline given intravenously in a cardiac arrest victim?

Accepted Answer

10 ml of 1 in 10,000 solution

Answer

1 ml of 1 in 10,000 solution

Answer

2 ml of 1 in 1000 solution

Answer

10 ml of 1 in 1000 solution

Question 2

What is the alternative drug for epinephrine in Advanced Cardiac Life Support (ACLS)?

Accepted Answer

High dose vasopressin

Answer

Amiodarone infusion

Answer

Atropine

Answer

Adenosine

Question 3

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 4

Rapid Sequence Induction is indicated in:

Accepted Answer

Emergency surgery for intestinal obstruction

Answer

Cardiopulmonary bypass surgery

Answer

Elective open hernia surgery

Answer

Elective laparoscopic surgery

Question 5

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

Anesthesia for Emergency Surgery — MCQs

Anesthesia for Emergency Surgery — MCQs

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