Complications of Regional Anesthesia — MCQs

10 questions

A patient is brought to the emergency following a head-on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

Methemoglobinemia is associated with:

A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

All are absolute contraindications for regional anesthesia EXCEPT:

The Anaesthesia technique of choice in severely preeclamptic women for cesarean delivery -

Most commonly used approach of brachial plexus block?

What clinical sign is used to confirm the success of an epidural block?

Which of the following techniques is appropriate for the reduction of the shoulder?

80-year-old patient is admitted for open reduction and internal fixation of a fracture of the femur. Which one of the following techniques is the ideal anesthetic technique for this patient?

Q10

Most common cause of maternal mortality in spinal anesthesia is ?

Complications of Regional Anesthesia Indian Medical PG Practice Questions and MCQs

Question 1: A patient is brought to the emergency following a head-on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

A. SDH
B. EDH
C. Intra-abdominal bleeding (Correct Answer)
D. Intra cranial hemorrhage

Explanation: ***Intra-abdominal bleeding*** - Following a **head-on collision**, hypotension (BP 90/60 mmHg) and tachycardia are classic signs of **hypovolemic shock**, most commonly due to significant internal bleeding. - The **abdomen** is a common site for massive blood loss after blunt trauma, as it can contain large volumes of blood without obvious external signs. *SDH (Subdural Hematoma)* - While a subdural hematoma can occur after head trauma, significant **intracranial bleeding** typically causes signs of increased intracranial pressure (e.g., headache, altered mental status, neurological deficits), and often leads to **hypertension with bradycardia** (Cushing's reflex), not hypotension and tachycardia. - The primary hemodynamic response to an isolated SDH would not be profound hypotension and tachycardia unless there was a co-existing systemic injury. *EDH (Epidural Hematoma)* - An epidural hematoma is also an intracranial injury that causes signs of **increased intracranial pressure**, such as headache, vomiting, and a potential "lucid interval." - Like SDH, it would not typically cause **hypotension and tachycardia** as the primary hemodynamic response, as it does not lead to significant blood loss from the circulatory system. *Intracranial hemorrhage* - This is a general term for bleeding within the skull, encompassing conditions like SDH and EDH. - While it is a severe injury, isolated intracranial hemorrhage generally does not cause **hypotension and tachycardia** because the cranial vault has limited space, and therefore, blood loss is not sufficient to produce systemic shock. Instead, it often leads to signs of **increased intracranial pressure** including **hypertension and bradycardia**.

Question 2: Methemoglobinemia is associated with:

A. Aminoester local anesthetic
B. Prilocaine (Correct Answer)
C. Bupivacaine
D. Mepivacaine

Explanation: ***Prilocaine*** - **Prilocaine** is a local anesthetic known to cause **methemoglobinemia** at higher doses due to its metabolite, **o-toluidine**. - This metabolite oxidizes iron in hemoglobin from the ferrous (Fe2+) to the ferric (Fe3+) state, rendering it unable to bind oxygen. *Aminoester local anesthetic* - While some aminoester local anesthetics can cause allergic reactions, they are not typically associated with **methemoglobinemia**. - **Methemoglobinemia** is more commonly linked with aminoamide local anesthetics containing specific chemical structures. *Bupivacaine* - **Bupivacaine** is an aminoamide local anesthetic primarily known for its potential to cause **cardiotoxicity** at high systemic concentrations. - It does not commonly induce **methemoglobinemia**. *Mepivacaine* - **Mepivacaine** is another aminoamide local anesthetic, chemically similar to lidocaine. - While it can cause CNS toxicity and cardiovascular effects at high doses, it is not a significant cause of **methemoglobinemia**.

Question 3: A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

A. ECPR with calcium
B. ECPR with dobutamine
C. ECPR with 20% intralipid (Correct Answer)
D. ECPR with sodium bicarbonate

Explanation: ***ECPR with 20% intralipid*** - The scenario describes **Local Anesthetic Systemic Toxicity (LAST)**, likely due to bupivacaine, leading to cardiovascular collapse. - **Intralipid 20%** is the first-line treatment for LAST-induced cardiovascular toxicity, as it acts as a lipid sink for the lipophilic local anesthetic. *ECPR with calcium* - While calcium may be used in certain cardiac arrest scenarios, it is **not the primary treatment for bupivacaine-induced cardiovascular collapse** and LAST. - Calcium might offer some cardiac support but does not directly neutralize the local anesthetic's toxic effects. *ECPR with dobutamine* - **Dobutamine is an inotropic agent** used to improve cardiac contractility but is not indicated as a primary rescue therapy for severe LAST. - It would not address the underlying toxicity caused by bupivacaine and could potentially worsen the situation by increasing myocardial oxygen demand without reversing toxin effects. *ECPR with sodium bicarbonate* - **Sodium bicarbonate** is used to treat metabolic acidosis and can be beneficial in certain drug overdoses to enhance excretion or stabilize cardiac membranes. - However, it is **not the primary or most effective treatment for bupivacaine-induced LAST** and cardiovascular collapse compared to lipid emulsion therapy.

Question 4: All are absolute contraindications for regional anesthesia EXCEPT:

A. Lack of resuscitation facilities
B. INR > 2 in ophthalmic procedures (Correct Answer)
C. Infection at injection site
D. Patient refusal

Explanation: ***INR > 2 in ophthalmic procedures*** - While a high INR (international normalized ratio) indicates increased bleeding risk, an INR > 2 is generally considered a **relative contraindication** for most regional anesthesia procedures, especially in ophthalmic cases where the risk of significant hemorrhage might be lower compared to deeper blocks. - The decision to proceed often depends on the specific procedure, patient's overall condition, and a careful risk-benefit analysis, rather than being an absolute bar. *Lack of resuscitation facilities* - The absence of proper **resuscitation equipment and trained personnel** is an absolute contraindication for regional anesthesia, as serious complications (e.g., local anesthetic systemic toxicity, respiratory depression) can occur, requiring immediate intervention. - Performing regional anesthesia in such a setting puts the patient at extreme risk of irreversible harm or death in the event of an adverse reaction. *Infection at injection site* - Performing regional anesthesia through an infected area carries a high risk of introducing bacteria into deeper tissues, including the **neuraxial space** or surrounding nerves, leading to serious complications like **abscess formation, meningitis, or osteomyelitis**. - This is an **absolute contraindication** to prevent the spread of infection. *Patient refusal* - **Informed consent** is a fundamental ethical and legal principle in medicine; a competent patient's refusal to undergo a procedure, including regional anesthesia, must always be respected. - Proceeding against a patient's wishes constitutes **assault and battery** and is an absolute contraindication for any medical intervention.

Question 5: The Anaesthesia technique of choice in severely preeclamptic women for cesarean delivery -

A. Spinal Anaesthesia (Correct Answer)
B. General Anaesthesia
C. Epidural Anaesthesia
D. Pudendal block

Explanation: ***Spinal Anaesthesia*** - **Spinal anaesthesia** is generally preferred due to its rapid onset, excellent muscle relaxation, and better hemodynamic stability compared to general anaesthesia when careful fluid management is in place. - It avoids the risks associated with **difficult airway management** and aspiration in preeclamptic patients and minimizes fetal drug exposure. *General Anaesthesia* - **General anaesthesia** carries a higher risk of **rapid, unpredictable increases in blood pressure** during tracheal intubation and extubation, which can be dangerous in preeclampsia with an already compromised cardiovascular system. - It is associated with increased risks of **aspiration**, **difficult airway**, and **postoperative respiratory complications** in preeclamptic women. *Epidural Anaesthesia* - While generally safe, **epidural anaesthesia** has a slower onset compared to spinal anaesthesia, which may not be ideal in emergency situations requiring rapid delivery. - The titration of an epidural can be more challenging in patients with severe preeclampsia, where rapid changes in blood pressure need careful management. *Pudendal block* - A **pudendal block** provides local anaesthesia to the perineum, vulva, and lower vagina. - It is used for pain relief during vaginal delivery and is unsuitable for a **cesarean section**, which requires anaesthesia of the abdominal wall and uterus.

Question 6: Most commonly used approach of brachial plexus block?

A. Interscalene
B. Infraclavicular
C. Supraclavicular
D. Axillary (Correct Answer)

Explanation: ***Axillary*** - The **axillary approach** is the most frequently utilized technique for **brachial plexus block** due to its relatively superficial location, making it safer and easier to perform. - This approach is particularly effective for procedures involving the **forearm and hand**, as it reliably blocks the terminal branches of the brachial plexus. *Interscalene* - The **interscalene block** is primarily used for **shoulder surgery** as it provides excellent anesthesia to the shoulder, clavicle, and upper arm. - It carries a higher risk of complications like **phrenic nerve palsy** and **hoarseness** due to its proximity to vital structures. *Supraclavicular* - The **supraclavicular block** targets the **trunks** of the brachial plexus, making it suitable for procedures involving the **upper arm, forearm, and hand**. - This approach has a higher risk of **pneumothorax** due to its close proximity to the pleura. *Infraclavicular* - The **infraclavicular block** targets the **cords** of the brachial plexus, offering good anesthesia for surgeries of the **distal upper arm, forearm, and hand**. - It involves a deeper approach compared to axillary and is often guided by ultrasound to minimize risks, but is not as commonly used as the axillary for general procedures.

Question 7: What clinical sign is used to confirm the success of an epidural block?

A. Inability to dorsiflex the foot
B. Loss of sensation in the T10 dermatome (Correct Answer)
C. Loss of resistance (used during block placement)
D. Westphal's sign (diminished patellar reflex)

Explanation: ***Loss of sensation in the T10 dermatome*** - The **T10 dermatome** is a common and reliable landmark for assessing the spread and effectiveness of an epidural block, especially for surgical procedures or labor analgesia impacting the abdominal and pelvic regions. - A successful epidural block should produce a **bilateral, symmetric sensory deficit** to pinprick or cold sensation within the target dermatomes, indicating proper anesthetic distribution. *Inability to dorsiflex the foot* - This symptom suggests a motor block primarily affecting the **deep peroneal nerve** (L4-L5 nerve roots), which would be a sign of a dense spinal block rather than a typical epidural, or an overly extensive epidural block, especially if it's bilateral. - While some motor weakness is expected with an epidural block, a complete inability to dorsiflex the foot is not the primary or most sensitive indicator of its success for general pain relief. *Loss of resistance (used during block placement)* - **Loss of resistance** is a technique used *during the placement* of an epidural needle to identify the epidural space (passing through the ligamentum flavum). - It is a procedural step for correct needle positioning, not a clinical sign used *after* injection to confirm the block's effect. *Westphal's sign (diminished patellar reflex)* - **Westphal's sign** refers to the absence or diminution of the patellar reflex (an L2-L4 reflex), which can indicate a neurological issue involving the quadriceps muscles or the femoral nerve pathway. - While a dense epidural block can affect motor function and reflexes, Westphal's sign is not typically used as the primary or most accurate indicator of a successful epidural block's sensory coverage.

Question 8: Which of the following techniques is appropriate for the reduction of the shoulder?

A. Spinal anesthesia
B. Interscalene block (Correct Answer)
C. Axillary brachial block
D. Bier block

Explanation: ***Interscalene block*** - An **interscalene block** targets the brachial plexus at the level of the neck, providing excellent anesthesia for shoulder procedures. - This technique effectively blocks the nerves innervating the shoulder joint, allowing for **muscle relaxation** and pain control necessary for reduction. *Spinal anesthesia* - **Spinal anesthesia** provides anesthesia to the lower body and is primarily used for procedures below the waist. - It does not provide adequate **analgesia or muscle relaxation** for a shoulder reduction. *Axillary brachial block* - An **axillary brachial block** anesthetizes the distal arm and hand, but it often spares the more proximal shoulder innervation. - While useful for forearm and hand surgery, it typically does not provide sufficient **anesthesia for the shoulder** joint itself. *Bier block* - A **Bier block**, or intravenous regional anesthesia, is suitable for procedures on the distal extremities, such as the hand or foot. - It involves tourniquet inflation and intravenous injection of local anesthetic, making it **unsuitable for shoulder reduction** due to the large muscle mass and proximal location.

Question 9: 80-year-old patient is admitted for open reduction and internal fixation of a fracture of the femur. Which one of the following techniques is the ideal anesthetic technique for this patient?

A. Local infiltration
B. Regional anesthesia (Correct Answer)
C. General anesthesia
D. Paracervical block

Explanation: ***Regional anesthesia*** - **Regional anesthesia** offers advantages in elderly patients undergoing hip fracture repair, including reduced risks of **postoperative cognitive dysfunction** and **cardiovascular complications**. - It provides **effective pain control** during and after surgery, potentially leading to faster recovery and fewer opioid-related side effects. *Local infiltration* - **Local infiltration** alone is typically inadequate for surgical pain control during an **open reduction and internal fixation of a fractured femur**. - It would not provide sufficient **muscle relaxation** or **sensory block** for such an invasive procedure. *General anesthesia* - While an option, **general anesthesia** in an 80-year-old patient carries a higher risk of **postoperative delirium** and **cardiopulmonary complications** compared to regional techniques. - It may also prolong recovery time and increase the need for **postoperative ventilation**. *Paracervical block* - A **paracervical block** is primarily used for **gynecological procedures**, such as cervical dilation and uterine procedures, due to its localized anesthetic effect around the cervix. - It is completely unsuitable for **femur fracture surgery**, as it would not provide any pain relief or surgical anesthesia to the lower limb.

Question 10: Most common cause of maternal mortality in spinal anesthesia is ?

A. Allergy to local anesthesia
B. Nerve injury
C. Hypotension (Correct Answer)
D. High block

Explanation: ***Hypotension*** - **Profound hypotension** due to sympathetic blockade is the most common cause of maternal mortality in spinal anesthesia. - This can lead to **decreased placental perfusion**, fetal distress, and maternal cardiovascular collapse if not promptly managed. *Allergy to local anesthesia* - True allergic reactions to local anesthetics are **extremely rare**, especially to ester-type anesthetics used in spinal anesthesia. - While possible, it is not the most common cause of maternal mortality. *Nerve injury* - **Direct nerve injury** during spinal anesthesia is a rare complication, usually resulting in localized neurological deficits rather than mortality. - It does not represent the primary cause of maternal death. *High block* - A **high spinal block** can cause severe hypotension and respiratory compromise, which can lead to mortality. - However, the underlying mechanism for the life-threatening aspects of a high block is often **severe hypotension** and subsequent cardiovascular collapse.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free