Anesthesia Tutorial of the Week Quiz

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False – Older versions of TEG required careful, metered pipetting of blood to achieve reliable results. TEG 6s does not require the sample to be metered which reduces the chance of user error impacting results.

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False – K-time and CFT are measures of clot formation, not clot initiation. A measure of clot initiation is given by the R-time (TEG) or CT (ROTEM).

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True

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False - Anaesthetic technique should be based on patients’ co-morbidities (including a degree of disease of PH) and surgical factors (duration of the procedure, patient position). Whilst there are theoretical advantages for regional / neuraxial techniques in patients with PH, in terms of avoiding alterations in cardiorespiratory physiology that may lead to decompensation, general anaesthesia can still be safely delivered. Neuraxial anaesthesia is therefore not necessarily the first line technique.

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FALSE: Unfortunately medical care slowly adopts changes even when strongly supported by scientific evidence. Punitive approaches,such as reimbusement cuts seem to have a much greater impact as clearly shown by Henderson. In Ganguli’s research they found that factors like higher density of cardiologists in an area increased the rate ordering of unnecessary tests, which were not related to the clinical condition of the patient.
Henderson J et al. Comparison of Payment Changes and Choosing Wisely Recommendations for Use of Low-Value Laboratory Tests in the United States and Canada. JAMA Intern Med 2020;180:524-31

Ganguli I et al. Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries. JAMA Intern Med 2019 179(9):1211-1219.

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False - Although these recommendations are clearly stated and endorsed by major medical societies, most are based on cohort studies and expert opinions.

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False - Light anaesthesia is considered as an independent risk factor for stimulation of the TCR. Other factors including hypercarbia, hypoxia, opioids and acidosis are thought to augment the TCR.

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True - BJR can mimic the picture of venous air embolism (VAE) but the latter is usually accompanied by a significant drop in end-tidal carbon dioxide.

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False. Evidence suggests that it is safe to use propofol instead of other intravenous or inhalational agents. It is also a QT prolonging drug, but is not associated with torsades de pointes (TdP).

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False - In case of haemodynamic instability due to ongoing TdP, electrical cardioversion may be used.

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False - The World Health Organisation (WHO) defines burnout as “a syndrome resulting from chronic workplace stress that has not been successfully managed” and is characterised by a triad of: emotional exhaustion, depersonalization, sense of low personal accomplishment.

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False - Departmental changes can make a significant impact on staff wellbeing, but should be multifactorial and encompass all of the core aspects of wellbeing. A number of changes can be instigated by a dedicated wellbeing team, Including: improved communication, ensuring rest facilities, food and drink supplies, consistent colleagues for each shift providing support to one another.

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False: Pencil point needles cause a traumatic tearing of dural fibres which may create an inflammatory response resulting in closure of the lesion and decreased incidence of Post Dural Puncture Headache (PDPH).

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False: The proposed mechanism of action is a block of the sphenopalatine ganglion parasympathetic induced cerebral vasodilation, thereby reversing one potential cause of PDPH.

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False - Increasing muscle weakness following repetitive muscular movement is a pathognomonic feature of myasthenia gravis, not myopathy

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False - High-flow nasal oxygen therapy is helpful except in patients with type II respiratory failure.

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False - The spinal cord extends below the L1-2 interspace in 20% of adults

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False - The incidence of failed intubation in obstetric patients is 2.23 per 1000 patients

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False - Classical caesarean delivery is an absolute contraindication for a TOLAC/ Vaginal birth after caesarean (VBAC)

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True - Lower incidence of maternal mortality with VBAC (4:100,000) versus elective repeat CD (13.4:100,000)

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False - The drop in blood pressure from supine to sitting should be less than 15%.

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False - Once an epidural regime is established without complications, vital signs can be safely monitored ever hour.

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False - The risk of respiratory depression makes systemic opioids an inappropriate option for labour analgesia in patients with myasthenia gravis

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False - Oral anticholinesterase medications should be converted to equivalent intra-muscular doses during labour due to delayed gastric absorption.

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False – A withdrawal syndrome identical to that of clonidine can be seen on abrupt discontinuation of dexmedetomidine.

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False – There is insufficient data to support safe use in pregnancy at present.

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False - Development of extra-junctional acetylcholine receptors are a concern for HYPERkalaemia after administration of suxamethonium, but these are not shown to develop until at least 72 hours post initial injury.

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Neurogenic shock is due to disruption of the sympathetic fibre pathways, but may lead to hypotension and bradycardia. Autonomic dysreflexia is an inappropriate autonomic response to stimuli below the level of injury, resulting in episodes of malignant hypertension, characterised by headache, flushing, pallor, and sweating above the level of the lesion.

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False – There is decreased overall opiate requirements. However, there may be increased requirements initially within the first 6-8 hours.

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True

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False - All are nerves which supply the anterior capsule but the superior lateral genicular nerve is not a branch of the femoral nerve

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False- The apex of the femoral triangle is defined as the point where medial borders of both sartorius and adductor longus meet

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False - Due to anatomical variation the overlap of innervation means that it is often unwise to rely on the block of a single nerve

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True - The closer to the nerve the local anaesthetic is deposited, it will be less absorbed by fat and less affected by the vascularity of surrounding tissue and fascial layers.

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False - Although antibiotics have no effect against the SARS-CoV-2 virus, the initial presentation of many children with COVID-19 mimics that of sepsis. Antibiotics on initial presentation are indicated and use can be rationalised based on clinical progression.

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FALSE – In hypoxic respiratory failure caused by SARS-CoV-2 the Paediatric Acute Lung Injury Consensus Conference (PALICC) and European Society for Paediatric and Neonatal Intensive Care (ESPNIC) recommendations for paediatric acute respiratory distress syndrome (pARDS) should be followed. Both recommend an initial PEEP setting of around 10 cmH2O.

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False - Whilst Remdesivir has been shown to reduce time to recovery and duration of respiratory support in adults, at this time studies in the paediatric population are ongoing.

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False - Although regional anesthesia can provide analgesia, there is no definite proof that it reduces the incidence of emergence delirium.

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False - Emergence delirium was reported in literature much earlier. Despite over 60 years of studies, it can still be challenging to anticipate, prevent and treat.

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False