Intraoperative Anaesthetic Crises, Malignant Hyperthermia, Anaphylaxis, and Bronchospasm — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style intraoperative anaesthetic crises, malignant hyperthermia, anaphylaxis, and bronchospasm viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 34-year-old woman undergoing an elective laparoscopic cholecystectomy develops sudden unrecordable non-invasive blood pressure, heart rate of 145 beats/min sinus tachycardia, high peak airway pressures (>45 cmH₂O), and generalized cutaneous flushing 3 minutes after induction and administration of cefuroxime and rocuronium. Outline your immediate step-by-step diagnostic and anaesthetic resuscitative management.
• SCENARIO 2: A 14-year-old boy undergoing open reduction and internal fixation of a fractured femur exhibits masseter muscle rigidity following suxamethonium induction, followed 10 minutes later by an exponential rise in EtCO₂ from 38 mmHg to 82 mmHg despite doubling minute ventilation, sinus tachycardia at 150 bpm, and a core body temperature rising to 39.4°C. Detail your definitive anaesthetic crisis management.
• SCENARIO 3: A 48-year-old chronic asthmatic male undergoing emergency exploratory laparotomy for perforated peptic ulcer develops severe intraoperative bronchospasm immediately following endotracheal intubation. The peak airway pressure reaches 50 cmH₂O, expired tidal volumes drop to 120 mL, SpO₂ falls to 86%, and capnography shows a prolonged, shark-fin upstroke. How do you systematically manage this crisis?
• SCENARIO 4: A 28-year-old male with a history of blunt chest and abdominal trauma undergoes laparotomy under general anaesthesia. Ten minutes into the procedure, he experiences sudden refractory hypotension (BP 60/30 mmHg), rising peak airway pressure, distended neck veins, and an abrupt drop in SpO₂ to 78%. Describe your immediate differential diagnosis, diagnostic confirmation, and intraoperative anaesthetic intervention.