Order Anesthesia for Special Indications
1. All of the following qualities make carbon dioxide a suitable gas for
intraperitoneal insufflation EXCEPT which one?
B. High blood solubility
C. Clear and colorless
D. Lack of cardiopulmonary effects
2. A 70-year-old woman is scheduled for total abdominal hysterectomy for
endometrial cancer. Her medical history is significant ischemic cardiomyopathy
with an ejection fraction of 25% and severe mitral regurgitation. Which of the
following is a common effect of pneumoperitoneum seen with laparoscopic
surgical procedures that would be least deleterious for her?
A. Pneumoperitoneum-induced increase in systemic vascular resistance (SVR)
B. Release of pneumoperitoneum-related decrease in SVR
C. Hypercapnia-related decrease in arrhythmia threshold
D. Hypercapnia-related increase in pulmonary vascular resistance (PVR)
3. Which of the following patients is likely to be the most negatively affected by
the effects of carbon dioxide insufflation?
A. A 78-year-old with severe COPD undergoing extraperitoneal laparoscopic
inguinal lymph node dissection
B. A 32-year-old with morbid obesity undergoing laparoscopic gastric bypass
C. A 52-year-old with asthma undergoing laparoscopic appendectomy
D. A 72-year-old with congestive heart failure undergoing laparoscopic Nissen
Order Anesthesia for Special Indications
4. A 62-year-old man is undergoing laparoscopic Nissen fundoplication. During the
procedure, the patient becomes progressively hypoxemic with an oxygenation
saturation that falls to 82%. You note a significant rise in end-tidal CO 2 despite
hyperventilation, increased peak inspiratory pressure, and unequal chest
expansion with ventilation. What should your first action be?
A. Suction the endotracheal tube.
B. Give albuterol.
C. Change the CO2 absorbent.
D. Stop the surgery and deflate the pneumoperitoneum.
5. 5. A 65-year-old woman with a history of hypertension and chronic kidney
disease is undergoing a laparoscopic liver resection for hepatocellular
carcinoma. You record 100 cc of urine output after positioning at the beginning
of the case. Three hours into the procedure, you note the patient has not had
any further urine output. The patient is hemodynamically stable, oxygenating
and ventilating well, and has no pulse pressure variation in her arterial line
tracing. Which of the following is most likely contributing to her low urine
A. High central venous pressure
B. Elevated intra-abdominal pressure (IAP) of 22 mm Hg
C. Kinked foley catheter
D. Reverse Trendelenburg position
6. A 24-year-old woman is scheduled to undergo a laparoscopic appendectomy.
The surgeon inserts the Veress needle and insufflates the abdomen to an IAP of
15 mm Hg without incident. As the surgeon proceeds with insertion of the other
ports, you note the patients’ blood pressure drops precipitously. The end-tidal
CO2 remains stable at 38 mm Hg. Given this clinical scenario, what is the most
likely cause of the hypotension?
A. CO2 embolism
C. Deep anesthesia
7. All of the following are benefits of laparoscopic versus open surgical
procedures EXCEPT which one?
A. Decrease in hypothermia
B. Decrease in postoperative pain
C. Decrease in time to ambulation
D. Minimize surgical incision and stress response
8. A 64-year-old woman with obesity and obstructive sleep apnea is undergoing a
laparoscopic low anterior resection for colon cancer. Your anesthetic consists
of 1.2 minimum alveolar concentration of sevoflurane. Three hours into the
procedure, you note her blood pressure and heart rate start to rise. You treat
this with 2 mg of hydromorphone. Thirty minutes later they are still elevated
and you administer another 2 mg of hydromorphone. You are relieved for a
lunch break, and when you return, your colleague tells you he gave another
2 mg of hydromorphone. The heart rate and blood pressure are not improved.
Which of the following is the next best step?
A. Increase the sevoflurane.
B. Start a propofol infusion.
C. Give 200 µg of fentanyl.
D. Ensure adequate ventilation to maximize CO2
9. Changes in pulmonary function during laparoscopic procedures include all of the
following EXCEPT which one?
A. Reduction in lung volume
B. Reduction in lung compliance
C. Reduction in ventilation-perfusion mismatch
D. Increase in airway pressures
10. 10. A 64-year-old woman with a medical history significant for COPD, coronary
artery disease, and diastolic congestive heart failure is undergoing laparoscopic
lysis of adhesions and partial colectomy for recurrent colon cancer. You are
assigned to take over the case, which has been going for over 8 hours. You find
a woman in steep Trendelenburg position covered by drapes. Your colleague
signs out that the patient developed a low-dose vasopressor requirement a half
hour ago. Over the next hour, the patient becomes more hypotensive requiring
increasing dose of vasopressor, and you note the end-tidal CO2 has continued to
rise despite maximizing your ventilation strategy. Upon examination of the
patient’s chest and neck under the drapes, you note extensive subcutaneous
emphysema. Which of the following statements is true regarding this clinical
A. Treatment with sodium bicarbonate is appropriate.
B. Prolonged operative times is a risk factor for developing subcutaneous
C. Subcutaneous emphysema does not have postoperative implications.
D. Subcutaneous emphysema is assumed to be isolated to the chest and neck