Complications in Anesthesia Practice Questions

Q: An eye surgery was performed using propofol as the intravenous anaesthetic agent and succinylcholine as the muscle relaxant. Recovery from anaesthesia was uneventful. However, the patient complains of pain in the muscles. Which of the following is the likely reason for this?

Succinylcholine. ### Explanation **Correct Option: B. Succinylcholine** The patient is experiencing **postoperative myalgia (POM)**, a well-documented side effect of Succinylcholine (Suxamethonium). Succinylcholine is a depolarizing neuromuscular blocker that acts by mimicking acetylcholine at the nicotinic receptors. This results in persistent depolarization, clinically visible as **fasciculations** (uncoordinated muscle contractions). These intense contractions lead to micro-trauma of muscle fibers and the release of lactic acid and potassium, resulting in muscle pain that typically appears 24–48 hours post-surgery. It is most common in young adults undergoing minor "day-care" procedures (like eye surgery) where early mobilization occurs. **Why other options are incorrect:** * **A. Propofol:** Propofol is an intravenous anesthetic agent known for its rapid recovery profile. While it can cause pain *on injection*, it does not cause generalized postoperative muscle pain. In fact, propofol is sometimes used to reduce the incidence of succinylcholine-induced fasciculations. * **C. Muscle infarction:** This is a rare, severe condition usually associated with vascular compromise or compartment syndrome. It would present with localized, excruciating pain, swelling, and potentially skin changes, rather than generalized muscle soreness following a routine eye surgery. **NEET-PG High-Yield Pearls:** * **Prevention:** POM can be minimized by "pre-curarization"—administering a small dose of a non-depolarizing muscle relaxant (e.g., Vecuronium) before Succinylcholine. * **Risk Factors:** Highest incidence is seen in females and "ambulatory" patients. It is ironically *less* common in children and the elderly. * **Other Side Effects of Succinylcholine:** Hyperkalemia, bradycardia (especially in children), increased intraocular/intragastric pressure, and it is a potent trigger for **Malignant Hyperthermia**.

Q: Which anaesthetic agent should NOT be used in a patient with a previous history of halothane-induced hepatitis?

Methoxyflurane. **Explanation:** The correct answer is **Methoxyflurane**. **1. Why Methoxyflurane is the correct choice:** Halothane-induced hepatitis is believed to be an immune-mediated reaction triggered by the metabolism of halothane into **trifluoroacetylated (TFA) proteins**. These proteins act as haptens, leading to the formation of autoantibodies. There is a high degree of **cross-sensitivity** between volatile anesthetics that undergo significant metabolism into TFA intermediates. Methoxyflurane, along with Halothane and Enflurane, undergoes significant hepatic metabolism (up to 50-70% for Methoxyflurane) and shares similar metabolic pathways. Therefore, it is strictly contraindicated in patients with a history of halothane-induced hepatitis to avoid a potentially fatal recurrent hepatic injury. **2. Analysis of Incorrect Options:** * **Sevoflurane:** It is not metabolized into TFA intermediates. It is primarily metabolized into inorganic fluoride and hexafluoroisopropanol, making it the safest volatile agent regarding halothane-related cross-reactivity. * **Isoflurane:** While it does produce a very small amount of TFA proteins, the metabolism is extremely low (0.2%). While caution is advised, it is not as strictly contraindicated as Methoxyflurane or Enflurane. * **Ketamine:** This is an intravenous induction agent, not a halogenated ether. It does not share the metabolic pathway or the chemical structure responsible for halothane-induced hepatitis. **3. Clinical Pearls for NEET-PG:** * **Metabolism Rule:** The risk of hepatitis correlates with the degree of hepatic metabolism: Halothane (20%) > Enflurane (2%) > Isoflurane (0.2%) > Desflurane (0.02%). * **Methoxyflurane** is also notorious for **nephrotoxicity** due to the release of inorganic fluoride ions (High-output renal failure). * **Risk Factors for Halothane Hepatitis:** Female gender, obesity, middle age, and multiple exposures to halothane.

Q: What is true about post-spinal headache?

Low incidence with thin (25 G) needles. **Post-Dural Puncture Headache (PDPH)** is a common complication following spinal anesthesia, caused by the persistent leakage of cerebrospinal fluid (CSF) through the dural hole. This leads to low CSF pressure and compensatory cerebral vasodilation. ### **Explanation of Options** * **Correct Option (C):** The incidence of PDPH is directly proportional to the diameter of the needle used. Using **thinner needles (e.g., 25 G, 27 G)** or non-cutting (pencil-point) needles like **Whitacre or Sprotte** significantly reduces the size of the dural rent, thereby lowering the incidence of headache. * **Option A:** PDPH is typically **occipital or frontal**, but it characteristically radiates to the neck and shoulders. * **Option B:** A hallmark of PDPH is its **orthostatic nature**. It is worsened by sitting or standing and is characteristically **relieved by lying flat**. * **Option D:** Abdominal compression (or the Girdle test) actually **decreases** the severity of the headache. It increases intra-abdominal pressure, which is transmitted to the epidural space, thereby reducing CSF leakage and increasing intracranial pressure. ### **High-Yield Clinical Pearls for NEET-PG** * **Gold Standard Treatment:** **Epidural Blood Patch** (15–20 ml of autologous blood injected into the epidural space). * **Needle Type:** Pencil-point needles (Whitacre/Sprotte) have a lower incidence of PDPH compared to cutting-tip needles (Quincke) because they separate rather than cut dural fibers. * **Risk Factors:** Young age, female gender, pregnancy, and a history of previous PDPH. * **Conservative Management:** Bed rest, aggressive hydration, oral/IV caffeine (causes cerebral vasoconstriction), and analgesics.

Q: A patient is not breathing after anesthesia. This is most likely due to which of the following?

All of the above. **Explanation:** Post-operative apnea or delayed recovery from anesthesia is a common clinical scenario in the PACU (Post-Anesthesia Care Unit). The correct answer is **All of the above** because each option represents a distinct physiological or mechanical cause for a patient failing to breathe spontaneously. 1. **Prolonged Anesthesia:** Excessive depth of anesthesia or the residual effect of intravenous/inhalational agents (like Opioids or Propofol) can cause central respiratory depression. Opioids, in particular, decrease the sensitivity of the respiratory center to carbon dioxide ($CO_2$), leading to hypoventilation or apnea. 2. **Neuromuscular Blockade:** This is the most common cause of post-operative respiratory failure. Residual neuromuscular block (due to non-depolarizing muscle relaxants like Vecuronium or Rocuronium) results in peripheral muscle weakness. If the diaphragm and intercostal muscles are still blocked, the patient cannot generate enough tidal volume to breathe independently. 3. **Recurrent Intubation/Cord Failure:** Repeated attempts at intubation can cause laryngeal trauma, glottic edema, or vocal cord injury/palsy. This leads to upper airway obstruction. While the patient may attempt to breathe, the mechanical failure of the "airway gate" prevents effective ventilation, appearing as a lack of clinical breathing. **High-Yield Clinical Pearls for NEET-PG:** * **Scored Assessment:** Always check the **Train-of-Four (TOF) ratio**; a ratio of **>0.9** is required for safe extubation. * **Reversal Agents:** Neostigmine (with Glycopyrrolate) or Sugammadex (specifically for Rocuronium/Vecuronium) are used to reverse neuromuscular blockade. * **Dual Block:** Remember that Succinylcholine can cause a "Phase II block" in patients with atypical pseudocholinesterase, leading to prolonged apnea. * **Hypothermia & Acidosis:** Both conditions can potentiate the effects of muscle relaxants and delay recovery.

Q: What is the drug of choice for treating malignant hyperthermia?

Dantrolene. **Explanation:** **Malignant Hyperthermia (MH)** is a life-threatening pharmacogenetic hypermetabolic crisis triggered by volatile anesthetics (e.g., Halothane, Isoflurane) and the depolarizing muscle relaxant Succinylcholine. **Why Dantrolene is the Correct Answer:** Dantrolene is the specific antidote and the drug of choice for MH. It acts as a **ryanodine receptor (RyR1) antagonist** on the sarcoplasmic reticulum of skeletal muscle. By blocking these receptors, it inhibits the massive release of intracellular calcium that causes the characteristic muscle rigidity, hypercarbia, and hyperthermia seen in MH. **Analysis of Incorrect Options:** * **Nikethamide:** A respiratory stimulant once used for CNS depression; it has no role in muscle metabolism or MH. * **Baclofen:** A GABA-B receptor agonist used for chronic spasticity (acting centrally). It does not affect the peripheral calcium release mechanism involved in MH. * **Propofol:** An intravenous anesthetic agent. While it is a "safe" drug to use in MH-susceptible patients, it cannot treat the condition once it has started. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** The earliest and most sensitive indicator of MH is an **unexplained rise in End-Tidal CO2 (ETCO2)**. * **Genetic Mutation:** Most commonly associated with the **RYR1 gene** on Chromosome 19. * **Dosing:** The initial dose of Dantrolene is **2.5 mg/kg IV**, repeated every 5–10 minutes until symptoms subside. * **Gold Standard Test:** The **Caffeine-Halothane Contracture Test (CHCT)** performed on a muscle biopsy is the definitive diagnostic tool for susceptibility.

Q: Which of the following is NOT a complication of massive blood transfusion?

Hypercalcemia. **Explanation:** Massive blood transfusion (MBT) is defined as the replacement of one total blood volume within 24 hours or 10 units of PRBCs within 24 hours. The correct answer is **Hypercalcemia** because MBT actually causes **Hypocalcemia**. **1. Why Hypercalcemia is the Correct Answer (The Concept):** Stored blood contains **Sodium Citrate** as an anticoagulant. When large volumes are infused rapidly, the citrate binds to the patient’s ionized calcium, forming calcium citrate. This leads to a decrease in serum ionized calcium levels (**Hypocalcemia**). It is a classic complication, especially in patients with impaired liver function who cannot metabolize citrate efficiently. **2. Why the other options are complications:** * **Hyperkalemia (Option A):** During storage, the RBC membrane becomes leaky, causing potassium to move from the intracellular to the extracellular space. Therefore, stored blood has high potassium levels. * **Acidosis (Option C):** Stored blood is acidic due to the accumulation of lactic acid and the presence of Citrate-Phosphate-Dextrose (CPD) preservative. * **Alkalosis (Option B):** While initial infusion causes acidosis, the late metabolic response is **Metabolic Alkalosis**. This occurs because the liver metabolizes the infused citrate into bicarbonate. **Clinical Pearls for NEET-PG:** * **Hypothermia:** The most common complication of MBT (due to cold blood infusion). * **Dilutional Coagulopathy:** MBT leads to a deficiency of platelets and Factors V and VIII. * **TRALI:** Transfusion-Related Acute Lung Injury is the leading cause of transfusion-related mortality. * **Shift to Left:** Stored blood has low 2,3-DPG, shifting the Oxygen Dissociation Curve to the left (increased affinity, decreased release to tissues).

Question 1

An eye surgery was performed using propofol as the intravenous anaesthetic agent and succinylcholine as the muscle relaxant. Recovery from anaesthesia was uneventful. However, the patient complains of pain in the muscles. Which of the following is the likely reason for this?

Accepted Answer

Succinylcholine

Answer

Propofol

Answer

Muscle infarction

Answer

None of the above

Question 2

Which anaesthetic agent should NOT be used in a patient with a previous history of halothane-induced hepatitis?

Accepted Answer

Methoxyflurane

Answer

Sevoflurane

Answer

Isoflurane

Answer

Ketamine

Question 3

While inserting a central venous catheter, a patient develops respiratory distress. Which of the following is the most likely cause?

Accepted Answer

Pneumothorax

Answer

Hemothorax

Answer

Hypovolemia

Answer

Pleural effusion

Question 4

A severely ill patient was maintained on an infusional anesthetic agent. On the 2nd day, the patient started deteriorating. What is the probable culprit?

Accepted Answer

Etomidate

Answer

Propofol

Answer

Opioid

Answer

Barbiturate

Question 5

What is true about post-spinal headache?

Accepted Answer

Low incidence with thin (25 G) needles

Answer

Frontal location

Answer

Worse when lying down

Answer

Increased by abdominal compression

Question 6

A patient is not breathing after anesthesia. This is most likely due to which of the following?

Accepted Answer

All of the above

Answer

Prolonged anesthesia

Answer

Neuromuscular blockade

Answer

Recurrent intubation leading to cord's failure

Question 7

What is the drug of choice for treating malignant hyperthermia?

Accepted Answer

Dantrolene

Answer

Nikethamide

Answer

Baclofen

Answer

Propofol

Question 8

A patient undergoing surgical procedure under general anesthesia suddenly develops tachycardia, hypertension, sweating, and tachypnea. What is the best immediate step to manage the situation?

Accepted Answer

Deepen the plane of anesthesia

Answer

Administer an IV beta-blocker

Answer

Abandon the surgery

Answer

No intervention is required

Question 9

Which of the following is NOT a complication of massive blood transfusion?

Accepted Answer

Hypercalcemia

Answer

Hyperkalemia

Answer

Alkalosis

Answer

Acidosis

Question 10

Succinylcholine causes hyperkalemia in patients with which of the following conditions?

Accepted Answer

All of the above

Answer

Burns

Answer

Severe infection

Answer

High velocity trauma

Complications in Anesthesia — MCQs

Complications in Anesthesia — MCQs

On this page

Practice by Chapter

Want unlimited practice?