Postoperative Care — MCQs
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A 25-year-old overweight female was given fentanyl-pancuronium anesthesia for surgery. After surgery and extubation, she was observed to have limited movement of the upper body and chest wall in the recovery room. She was conscious and alert, but voluntary respiratory effort was limited. Her blood pressure and heart rate were normal. The likely diagnosis is:
"Active core rewarming" refers to
The following are used for treatment of postoperative nausea and vomiting following squint surgery in children except:-
Which of the following is the most common postoperative complication related to intubation:
Why 100% oxygen has to be given to a patient after recovering from N2O anesthesia?
Which of the following agents is used for the treatment of post operative shivering?
Postoperative nausea and vomiting are uncommon with
Shivering observed in the early part of the postoperative period is due to
A 60-year-old patient undergoing thyroid surgery suddenly develops stridor and hypoxia in the recovery room. What is the most appropriate initial intervention?
A patient undergoing major abdominal surgery is at risk for postoperative nausea and vomiting (PONV). Which of the following prophylactic measures is the most effective?
Postoperative Care Indian Medical PG Practice Questions and MCQs
Question 41: A 25-year-old overweight female was given fentanyl-pancuronium anesthesia for surgery. After surgery and extubation, she was observed to have limited movement of the upper body and chest wall in the recovery room. She was conscious and alert, but voluntary respiratory effort was limited. Her blood pressure and heart rate were normal. The likely diagnosis is:
- A. Respiratory depression
- B. Incomplete reversal of pancuronium (Correct Answer)
- C. Pulmonary embolism
- D. Fentanyl-induced chest wall rigidity
Explanation: ***Incomplete reversal of pancuronium*** - **Pancuronium** is a **nondepolarizing neuromuscular blocker** that causes muscle paralysis; incomplete reversal would lead to residual weakness and limited movement, especially of the respiratory muscles. - The patient is **conscious and alert** but has limited voluntary respiratory effort and upper body movement, consistent with residual neuromuscular blockade rather than central respiratory depression. *Respiratory depression* - While opioids like fentanyl can cause respiratory depression, the patient being **conscious and alert** makes primary central respiratory depression less likely. - **Fentanyl-induced respiratory depression** would typically involve a decreased respiratory rate and depth, often with an altered mental status, which is not described. *Pulmonary embolism* - A **pulmonary embolism** would typically present with **dyspnea, tachypnea, tachycardia**, and potentially hypoxemia, which are not mentioned in this scenario. - The patient's **normal blood pressure and heart rate** make an acute, significant pulmonary embolism less probable. *Fentanyl-induced chest wall rigidity* - **Fentanyl-induced chest wall rigidity** ("woody chest syndrome") occurs *during* rapid intravenous administration or high doses of opioids, making ventilation difficult. - This typically occurs **intraoperatively** or immediately post-administration, not in the recovery room after extubation when a patient is conscious and attempting voluntary breathing.
Question 42: "Active core rewarming" refers to
- A. Heated crystalloids (Correct Answer)
- B. Heated humidified O2
- C. Peritoneal dialysis
- D. All of the options
Explanation: ***Heated crystalloids*** - **Heated crystalloids** administered intravenously contribute to active core rewarming by directly introducing warm fluids into the circulatory system, raising the internal body temperature. - This method is particularly effective for **moderate to severe hypothermia** as it rapidly delivers heat to the body's core. *Heated humidified O2* - Administering **heated and humidified oxygen** helps prevent further heat loss from the respiratory tract and contributes to rewarming. - While beneficial, it is generally considered a less aggressive or primary method of **active core rewarming** compared to direct intravenous fluid administration because it does not directly warm the bloodstream. *Peritoneal dialysis* - **Peritoneal dialysis** involves introducing warm dialysate into the peritoneal cavity, allowing for heat exchange. - This is an invasive procedure primarily used when other rewarming methods are insufficient, and it is a specific type of active core rewarming, but not the only one or most common representation of the term itself. *All of the options* - While **heated humidified O2** and **peritoneal dialysis** are methods of active rewarming, the question asks for what "active core rewarming" refers to. - Each of these options represents a specific technique, and while all contribute to rewarming the core, **heated crystalloids** are a more general and common representation encompassed by the term "active core rewarming."
Question 43: The following are used for treatment of postoperative nausea and vomiting following squint surgery in children except:-
- A. Ondansetron
- B. Propofol
- C. Dexamethasone
- D. Ketamine (Correct Answer)
Explanation: ***Ketamine*** - **Ketamine** is an anesthetic and analgesic agent that is known to **increase the incidence of postoperative nausea and vomiting (PONV)**, particularly at higher doses, making it unsuitable for preventing PONV. - Its mechanism of action can stimulate the **chemoreceptor trigger zone** and **vestibular system**, contributing to emetogenic effects. *Ondansetron* - **Ondansetron** is a **serotonin 5-HT3 receptor antagonist** and is a first-line drug for the prevention and treatment of PONV in both adults and children. - It effectively blocks serotonin in the gastrointestinal tract and the **medulla oblongata**, reducing nausea and vomiting. *Propofol* - **Propofol** is an intravenous anesthetic that has **antiemetic properties**, making it useful for reducing PONV when used as part of the anesthetic regimen or as a sub-hypnotic bolus. - Its antiemetic effect is thought to be mediated through **dopamine receptor blockade** and action on the **GABAergic system**. *Dexamethasone* - **Dexamethasone** is a **corticosteroid** with significant antiemetic properties, commonly used as an adjunct for PONV prevention. - It is believed to act by inhibiting **prostaglandin synthesis** and reducing inflammation, thereby modulating pathways involved in nausea and vomiting.
Question 44: Which of the following is the most common postoperative complication related to intubation:
- A. Abductor Paralysis
- B. Sore throat (Correct Answer)
- C. Bleeding
- D. Malposition
Explanation: ***Sore throat*** - **Sore throat** is a very common and usually minor complication that occurs after intubation, due to irritation of the pharyngeal mucosa by the endotracheal tube. - The incidence can be as high as 60% and is often considered a **nuisance complication** rather than a serious one. *Abductor Paralysis* - **Abductor paralysis** of the vocal cords is a rare but serious complication, often resulting from injury to the **recurrent laryngeal nerve**. - This can lead to **stridor** and **airway obstruction**, requiring further intervention. *Bleeding* - Significant **bleeding** related to intubation is uncommon but can occur if there is trauma to the pharynx, larynx, or trachea, especially in the presence of **coagulopathy** or difficult intubation. - Minor epistaxis can occur if a **nasal intubation** is performed. *Malposition* - **Malposition** of the endotracheal tube, such as **esophageal intubation** or **mainstem bronchial intubation**, is a critical complication that can lead to severe hypoxemia or lung collapse. - While serious, it is usually recognized and corrected immediately during or shortly after intubation, making it less frequently a *postoperative* symptom compared to sore throat.
Question 45: Why 100% oxygen has to be given to a patient after recovering from N2O anesthesia?
- A. Second gas effect
- B. Diffusion hypoxia (Correct Answer)
- C. Bronchoconstriction
- D. Atelectasis
Explanation: ***Diffusion hypoxia*** - Upon discontinuation of N2O, its rapid diffusion out of the blood into the **alveoli** can dilute the partial pressures of **oxygen** and **carbon dioxide**, leading to hypoxemia and hypercapnia. - Administering 100% oxygen prevents this, ensuring adequate oxygenation while N2O is exhaled. *Second gas effect* - This phenomenon refers to the rapid uptake of a highly soluble anesthetic (like N2O) from the alveoli, which then concentrates the inspired partial pressure of a co-administered less soluble anesthetic, speeding its induction. - This effect is significant during the **induction phase** of anesthesia, not recovery. *Bronchoconstriction* - This is the narrowing of the airways, which can be caused by various factors like allergies, asthma, or irritants, but is not a direct consequence of recovering from N2O anesthesia or a reason for 100% oxygen administration. - While patients with **reactive airway disease** might experience bronchoconstriction under anesthesia, it is not specifically linked to N2O recovery for the general population. *Atelectasis* - This is the collapse of lung tissue, which can occur during or after surgery due to conditions like hypoventilation, airway obstruction, or pressure on the lungs. - Administering 100% oxygen is not used primarily to prevent atelectasis immediately after N2O cessation, although good ventilation and lung recruitment maneuvers are important in preventing it generally.
Question 46: Which of the following agents is used for the treatment of post operative shivering?
- A. Atropine
- B. Thiopentone
- C. Pethidine (Correct Answer)
- D. Suxamethonium
Explanation: ***Pethidine*** - **Pethidine (meperidine)** is a **synthetic opioid** known for its **mu-receptor agonism** and weak anticholinergic properties, making it effective in treating **post-operative shivering**. - Its mechanism in reducing shivering is thought to involve modulation of the **thermoregulatory center** in the hypothalamus. *Atropine* - **Atropine** is an **anticholinergic drug** that primarily blocks muscarinic acetylcholine receptors, leading to effects like increased heart rate and decreased secretions. - It does not directly act on the thermoregulatory centers or muscle activity responsible for shivering. *Thiopentone* - **Thiopentone** is a **barbiturate** used as an intravenous anesthetic, primarily for induction of anesthesia. - While it has CNS depressant effects, it is not indicated or effective for the specific treatment of post-operative shivering. *Suxamethonium* - **Suxamethonium (succinylcholine)** is a **depolarizing neuromuscular blocker** used to induce muscle paralysis, typically for intubation. - It would prevent shivering by paralyzing skeletal muscles, but this is a dangerous and inappropriate treatment for shivering due to its profound respiratory depressant effects.
Question 47: 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 48: Shivering observed in the early part of the postoperative period is due to
- A. Hypothermia (Correct Answer)
- B. Pain
- C. Emergence delirium
- D. Drug withdrawal
Explanation: **Hypothermia** - Shivering is a primary physiological response to **hypothermia**, an attempt by the body to generate **heat** by increasing muscle activity. - Patients often experience a drop in core body temperature during surgery due to factors like cold operating rooms, exposed body cavities, and anesthetic effects. *Pain* - While pain can cause discomfort and muscle tension, it typically does not manifest as generalized **shivering** in the early postoperative period. - Pain is usually managed with analgesics, and shivering is more indicative of a **thermoregulatory disturbance**. *Emergence delirium* - Emergence delirium is characterized by disorientation, agitation, and non-purposeful movements, but not primarily by **shivering**. - This condition is often related to the residual effects of anesthetic agents or anxiety upon waking. *Drug withdrawal* - Drug withdrawal can cause tremors and agitation, but it is less likely to present as **shivering** in the immediate postoperative period in a patient without a known history of substance dependence. - Withdrawal symptoms typically manifest hours to days after the cessation of the drug, depending on its half-life.
Question 49: A 60-year-old patient undergoing thyroid surgery suddenly develops stridor and hypoxia in the recovery room. What is the most appropriate initial intervention?
- A. Administer high-flow oxygen
- B. Perform emergency tracheostomy
- C. Administer nebulized epinephrine
- D. Re-intubate the patient (Correct Answer)
Explanation: ***Re-intubate the patient*** - The sudden onset of **stridor** and **hypoxia** following thyroid surgery indicates potential **airway obstruction** secondary to laryngeal edema or hematoma, which requires immediate and definitive airway management. - **Re-intubation** provides a secure airway, allowing for controlled ventilation and oxygenation while the underlying cause is investigated and treated. *Administer high-flow oxygen* - While oxygen is crucial for hypoxia, it does not address the underlying **airway obstruction** causing the stridor. - Providing oxygen without establishing a patent airway will not effectively improve oxygenation in cases of significant upper airway compromise. *Perform emergency tracheostomy* - **Emergency tracheostomy** is a more invasive procedure and typically reserved for situations where **oral or nasal intubation** is impossible or contraindicated. - It would not be the immediate first-line intervention, as attempts at less invasive airway management should precede it. *Administer nebulized epinephrine* - Nebulized epinephrine is primarily used for **bronchospasm** or upper airway edema not directly related to surgical trauma, such as in cases of anaphylaxis or croup. - It may temporarily reduce mucosal swelling but does not provide a definitive solution for a potentially rapidly worsening **post-surgical airway obstruction**.
Question 50: A patient undergoing major abdominal surgery is at risk for postoperative nausea and vomiting (PONV). Which of the following prophylactic measures is the most effective?
- A. Administering ondansetron alone
- B. Using a combination of antiemetics (Correct Answer)
- C. Hydration with intravenous fluids
- D. Avoiding opioid analgesics
Explanation: ***Using a combination of antiemetics*** - **Multimodal antiemetic therapy** targets different neurotransmitter pathways involved in nausea and vomiting, such as serotonin, dopamine, and histamine. - This approach has been shown to be more effective than single-agent prophylaxis in reducing the incidence and severity of PONV, especially in high-risk patients. *Administering ondansetron alone* - **Ondansetron**, a 5-HT3 receptor antagonist, is effective in preventing PONV but may not be sufficient for high-risk patients or when multiple emetic triggers are present. - It only targets one specific pathway, leaving other pathways contributing to nausea and vomiting unaddressed. *Hydration with intravenous fluids* - While adequate **hydration** is important for overall patient recovery and can help mitigate some causes of nausea (e.g., dehydration-induced headache), it is not a primary prophylactic measure specifically targeting PONV. - It does not directly counteract the pharmacologic or physiological mechanisms of PONV. *Avoiding opioid analgesics* - While **opioids** are a known risk factor for PONV, completely avoiding them may not be feasible or humane, as they are often crucial for effective postoperative **pain management**. - A strategy of minimizing opioid use or using opioid-sparing techniques is preferred over complete avoidance, and even then, antiemetic prophylaxis may still be necessary.
Practice by Chapter
Post-Anesthesia Care Unit Operations
Practice Questions
Emergence and Recovery from Anesthesia
Practice Questions
Postoperative Respiratory Care
Practice Questions
Postoperative Pain Management
Practice Questions
Postoperative Nausea and Vomiting
Practice Questions
Postoperative Cognitive Dysfunction
Practice Questions
Fluid Management in PACU
Practice Questions
Temperature Management
Practice Questions
Discharge Criteria
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Common PACU Complications
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Fast-Track Recovery
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Postoperative Delirium
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