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SU11.1-6 | Anaesthesia and Pain Management — Graded Quiz
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A surgeon grades a patient about to undergo surgery as ASA III. What does the ASA physical status classification actually describe?
Correct. ASA physical status grades the patient's systemic disease (I = healthy through VI = brain-dead, with 'E' for emergency). It must not be conflated with the Mallampati score, which grades the oropharyngeal view to predict a difficult airway.
ASA (systemic disease severity) and Mallampati (oropharyngeal view / airway difficulty) answer different questions and must never be conflated.
ASA physical status grades how sick the patient is (systemic disease, I–VI, E for emergency). The oropharyngeal view that predicts a difficult airway is the Mallampati score — a different scale answering a different question.
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The WHO Surgical Safety Checklist is used to prevent catastrophic team errors in theatre. At which three points is the checklist performed?
Correct. The WHO checklist has three pauses: 'sign in' before induction of anaesthesia, 'time out' before skin incision (confirming correct patient, site, procedure, antibiotic prophylaxis, anticipated problems), and 'sign out' before the patient leaves theatre (counts, specimens, recovery plan).
WHO Surgical Safety Checklist = sign in (pre-induction), time out (pre-incision), sign out (before leaving theatre). It prevents wrong patient/side/procedure, missed antibiotics, and retained items.
The three WHO checklist points are sign in (before induction), time out (before incision), and sign out (before leaving theatre). These are intraoperative team pauses, not ward or clinic events.
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During preoperative assessment of an elective surgical patient, particular attention must be paid to drugs that need managing around surgery. Which class of medication most importantly needs review because of its bleeding risk?
Correct. Antiplatelet (e.g. aspirin, clopidogrel) and anticoagulant (e.g. warfarin, DOACs) drugs markedly increase intraoperative bleeding and must be identified and managed — continued, withheld, or bridged — as part of the preoperative medication review.
Preoperative drug review must flag antiplatelets and anticoagulants (bleeding risk), plus diabetic and cardiovascular drugs. Plan to continue, stop, or bridge each one before surgery.
The medication class with the most important perioperative bleeding implication is the antiplatelet/anticoagulant group. Bronchodilators, emollients and antihistamines do not carry the same surgical bleeding risk.
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A patient is recovering after an uncomplicated appendicectomy. On day two their pain suddenly escalates far beyond what the operation should cause and now needs much more analgesia than before. What does this change most importantly signify?
Correct. Unexpectedly escalating post-operative pain, or pain needing far more analgesia than the operation should cause, is a clinical sign of a complication — bleeding, compartment syndrome, infection, ischaemia or an anastomotic leak — and demands re-examination, not just more opioid.
Pain that escalates beyond the expected surgical course is a warning sign of a complication. Reassess the patient (bleeding, ischaemia, compartment syndrome, leak, infection) before escalating analgesia.
Disproportionate or escalating post-operative pain is a red flag for a surgical complication and must trigger clinical reassessment. Simply increasing opioids without examining the patient is dangerous because it masks the underlying problem.
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An anaesthetist plans to provide all three components of the general anaesthetic triad using separate, titratable agents rather than a single deep dose of one drug. What is this approach called, and why is it preferred?
Correct. Balanced anaesthesia achieves hypnosis, analgesia and muscle relaxation with separate agents, each titrated to need. This minimises the dose and adverse effects of any one drug compared with using a single agent to do everything.
Balanced anaesthesia delivers the triad (hypnosis, analgesia, relaxation) with separate agents, each titrated independently — lowering the dose and toxicity of any single drug.
Using separate titratable drugs for each component of the GA triad is balanced anaesthesia, which limits the dose and side effects of any single agent. The other terms describe different concepts or techniques.
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