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Questions and answers

Raffán-Sanabria, Fernandoa,b

Colombian Journal of Anesthesiology: January-March 2019 - Volume 47 - Issue 1 - p 78–80
doi: 10.1097/CJ9.0000000000000095
QUESTIONS AND ANSWERS
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Spanish Version

aAnesthesiology Clinical Professor, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

bAnesthesiology Assistant Professor, Universidad del Bosque and Universidad de los Andes, Bogotá, Colombia.

Correspondence: Carrera 7 No. 117-15, Hospital Universitario Fundación Santa Fe de Bogotá, Departamento de Anestesiologia, Bogotá, Colombia.

How to cite this article: Raffán-Sanabria F. Questions and answers. Colombian Journal of Anesthesiology. 2018;00:00–00.

Read the Spanish version of this article at: http://links.lww.com/RCA/A845.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.www.revcolanest.com.co).

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

(1) Postoperative delirium is defined as an acute state of confusion with attention and awareness alterations. The multivariate analysis of associated variables in a 75-year-old patient, separated for the last 8 years, underwent knee replacement under general anesthesia and presents postoperative pain of 8 in the visual analog scale. Which of the following factors has the highest statistical significance in the development of postoperative delirium?1:

  • Age.
  • Type of anesthesia.
  • Pain.
  • Not having a stable partner.

(2) Which of the following adverse effects of Ketamine as a drug used for sedation analgesia during procedures is more prevalent?2:

  • Vomiting.
  • Desaturation.
  • Bronchoaspiration.
  • Laryngospasm.

(3) The most frequent perioperative complications in pediatric anesthesia are associated with the management of the airway. Which of the following statements is correct?3:

  • The use of the laryngeal mask (ML) significantly increases laryngospasm as compared with endotracheal intubation (EI).
  • The incidence of cardiac arrest is significantly higher with LM than with EI.
  • The superiority of EI over the LM has been claimed with regard to the incidence of laryngospasm and subsequent secondary respiratory complications.
  • The superiority of EI over the LM has not been demonstrated with regard to the incidence of desaturation <90%.

(4) Failed weaning from mechanical ventilation has been reported in around 10% to 20% of patients requiring ventilation support. This population usually depends longer on mechanical ventilation and exhibits higher mortality. From the following risk factors associated with failed weaning, which is the best predictor?4:

  • Associated lung disease.
  • Associated abdominal pathology.
  • Associated cardiovascular disease.
  • Associated renal disease.

(5) A 72-year-old patient with a history of hypertension, controlled with hydrochlorothiazide and losartan, obese—body mass index 33, sleep apnea under treatment with Continuous Positive Airway Pressure (CPAP), American Society of Anesthesiologists (ASA) II, in early postoperative period following appendectomy via laparotomy that lasted 50 minutes, presents 82% desaturation 15 minutes after arriving extubated at the recovery room. Which of the following conditions has the highest statistically significant probability of causing early postoperative hypoxemia in this patient?5:

  • Age.
  • surgical time.
  • Length of anesthesia.
  • A history of obstructive sleep apnea syndrome.

(6) Intraoperative anaphylaxis may be difficult to diagnose in patients who are sedated or under general anesthesia, since many times the skin symptoms are hidden under the surgical drapes or antiseptic solutions. In addition, it is difficult to initially determine the causal agent because of the number of medications used for induction. What percentage of patients develop signs and/or symptoms during the induction of anesthesia?6:

  • 90%.
  • 70%.
  • 50%.
  • 30%.

(7) Which of the following substances is the main cause of hypersensitivity reactions during the perioperative period?7:

  • Chlorhexidine.
  • Antibiotics.
  • Muscle relaxants.
  • Latex.

(8) Dipyrone is associated with the development of agranulocytosis, defined as a granulocyte blood count below8:

  • 150 per 100 mL.
  • 250 per 100 mL.
  • 500 per 100 mL.
  • 1000 per 100 mL.

(9) Catheter ablation of pulmonary veins is one of the most frequently used techniques by interventional cardiologists in the management of various arrhythmias. Which of the following considerations for the management of anesthesia is NOT applicable?9:

  • Intravenous propofol and remifentanil perfusions are commonly used and have shown adequate performance in this scenario, as they do not interfere significantly with the electrophysiological function of the atrioventricular node.
  • It has been shown that there is an inversely proportional relationship between cardiac output and propofol plasma concentrations.
  • This relationship means that if there is an increase in cardiac output during the maintenance of anesthesia, the concentration of anesthetic drugs may decline and expose the patient to a risk of intraoperative awakening.
  • A decline in cardiac output with the use of propanolol (betablocker), increases the time needed to reach the anesthetic intravenous concentrations in the brain, and hence facilitates intraoperative awareness.

(10) In terms of the Uhthoff phenomenon in multiple sclerosis patients, the following statement is true10:

  • It is a classical characteristic of multiple sclerosis that is identified in 60% to 80% of patients associated with rises in body temperature.
  • Any drop in body temperature causes a transient deterioration of the pre-existing signs and symptoms in patients.
  • Body temperature is not involved with this phenomenon.
  • It is accompanied by cardiac arrhythmia, sweating, chills, and seizures.

Answers

  • C.
  • A.
  • D.
  • A.
  • A.
  • A.
  • C.
  • C.
  • D.
  • A.
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References

1. Alvarez-Bastidas L, Morales-Vera E, Valle-Leal JG, et al Delirium in the elderly patient after anesthesia-associated factors. Colomb J Anesthesiol 2018;46:273–278.
2. Ospina-Ochoa MI, Valderrama-Molina CO, Toro-López JE. Ketamine sedation for orthopedic procedures in a high complexity emergency service: a descriptive study. Colomb J Anesthesiol 2018;46:286–291.
3. Casas-Arroyave FD, Giraldo-Salazar OL, Medina-Ramírez S. Laryngospasm in pediatric anaesthesia with laryngeal mask vs. endotracheal tube: non-inferiority clinical trial. Colomb J Anesthesiol 2018;46:292–299.
4. Sandoval-Moreno LM, Díaz-Henao WA. Factors associated with failed weaning from mechanical ventilation in adults on ventilation support during 48 hours or more. Colomb J Anesthesiol 2018;46:300–308.
5. Quintero-Cifuentes IF, Pérez-López D, Victoria-Cuellar DF, et al Incidence of early postanaesthetic hypoxemia in the postanaesthetic care unit and related factors. Case report. Colomb J Anesthesiol 2018;46:309–316.
6. Ramírez-Gonzales R, Del-Castillo-Gervasi RA, Shiraishi-Zapata CJ, et al Two probable anaphylactic events during consecutive cranial surgeries: case report. Colomb J Anesthesiol 2018;46:322–326.
7. Ramirez-Gonzales R, Del-Castillo-Gervasi RA, Shiraishi-Zapata CJ, et al Two probable anaphylactic events during consecutive cranial surgeries: case report. Colomb J Anesthesiol 2018;46:322–326.
8. Machado-Alba JE, Sánchez-Morales LV, Rodríguez-Ramirez LF. Dipyrone-related granulocytopenia. Case report. Colomb J Anesthesiol 2018;46:327–330.
9. Catalá-Ripoll JV, Hidalgo-Olivares VM, Monsalve-Naharro JÁ, et al Intraoperative awareness as an example of the influence of cardiac output on anesthetic dosing: case report. Colomb J Anesthesiol 2018;46:341–344.
10. Gallego-Gallego M, Anillo-Lombana VE, Gómez-Mayordomo V, et al Uhthoff's phenomenon in a patient with multiple sclerosis during the perioperative period for hip surgery. Case report. Colomb J Anesthesiol 2018;46:345–348.

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