By Kerri M. Robertson, David J Lubarsky, Sudharma Ranasinghe

Why waste time guessing at what you must understand for anesthesia in-service and board examination? Maximize your examination practise time with this quick-hit query and resolution evaluation. the original query and single-answer structure gets rid of the guesswork linked to conventional multiple-choice Q&A studies and reinforces in basic terms the proper solutions you will have to grasp on examination day. Emphasis is put on distilling key evidence and scientific pearls crucial for examination good fortune. This high-yield overview is ideal for extreme, streamlined evaluation within the days and weeks ahead of your examination.

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43 44 ANESTHESIOLOGY BOARD REVIEW  A parkinsonian patient requires urgent coronary artery bypass graft surgery while he is taking selegiline (selective inhibitor of monoamine oxidase type B). Should the patient stop taking MAO inhibitors prior to surgery? Although controversial, MAO inhibitors may be continued perioperatively. Decreased presynaptic metabolism of catecholamines and serotonin by MAOIs may be responsible for hemodynamic instability, hyperpyrexia and death when these patients are exposed to stress and anesthesia.

The top five errors are overdose, wrong choice of anesthetic agent, inadequate preparation, inadequate crisis management and inadequate postoperative management.  Why were sodium bicarbonate (NaHCO3) and calcium chloride (CaCl2) removed from cardiac resuscitation protocols? There is concern that NaHCO3 may cause paradoxical intracellular acidosis (leading to myocardial depression), hyperosmolality and hypernatremia. Intracellular influx of calcium is intimately involved in the terminal stages of cell death, and this is a concern in the setting of resuscitation.

Possibilities specific to this procedure include: CO2 gas embolus, massive hemorrhage and pneumothorax or pneumomediastinum. One must attempt to diagnose the problem quickly and provide supportive care and resuscitation in the interim.  A VBAC patient with a well functioning labor epidural infusion complains of persistent breakthrough pain. What are you concerned about? Uterine rupture. Always consider this possibility in patients with persistent breakthrough pain with epidural analgesia. Diaphragmatic irritation from uterine rupture may be referred to the shoulder.

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