Bariatric, Metabolic and Minimally Invasive Laparoscopic Surgery — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style bariatric, metabolic and minimally invasive laparoscopic surgery viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 38-year-old female with a BMI of 52 kg/m2 (weight 145 kg, height 1.67 m), known obstructive sleep apnoea (STOP-Bang score 6), and type 2 diabetes mellitus is scheduled for elective laparoscopic sleeve gastrectomy. Detail your anaesthetic management plan from pre-oxygenation, induction drug dosing, intraoperative ventilation, to emergence and extubation.
• SCENARIO 2: During an elective laparoscopic cholecystectomy in a 44-year-old woman, 15 minutes after peritoneal insufflation at 14 mmHg CO2, there is a sudden acute increase in peak airway pressure from 18 to 38 cmH2O, SpO2 drops rapidly from 99% to 84%, heart rate rises to 130 bpm, and blood pressure drops to 70/40 mmHg. Outline your differential diagnosis and immediate step-by-step crisis management.
• SCENARIO 3: A 55-year-old male with chronic severe gastro-oesophageal reflux disease and a large hiatal hernia is scheduled for laparoscopic Nissen fundoplication. Discuss your anaesthetic considerations regarding aspiration risk, induction strategy, ventilatory mechanics in steep reverse Trendelenburg, and postoperative nausea and vomiting (PONV) prophylaxis.
• SCENARIO 4: A 28-year-old female undergoes an elective diagnostic laparoscopy for unexplained lower abdominal pain. During initial blind Trocar/Veress needle insertion, there is a sudden catastrophic drop in blood pressure to unrecordable, massive abdominal distension, and dark blood fills the suction port. Outline your immediate resuscitative and anaesthetic actions.