Neuromuscular Blockade, Train-of-Four (TOF) Monitoring, and Reversal Strategies — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style neuromuscular blockade, train-of-four (tof) monitoring, and reversal strategies viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 45-year-old male with known end-stage renal disease on thrice-weekly haemodialysis presents for exploratory laparotomy due to perforated peptic ulcer disease. Compare and contrast your choices of neuromuscular blocking agents for induction and maintenance, detailing their pharmacokinetic pathways.
• SCENARIO 2: A 30-year-old female undergoing elective laparoscopic cholecystectomy receives 50 mg rocuronium at induction. At the end of the 45-minute procedure, you apply an acceleromyograph to the ulnar nerve and detect zero twitches on TOF, but a Post-Tetanic Count (PTC) of 2. The surgeon asks for immediate extubation. How do you evaluate and manage this situation?
• SCENARIO 3: A 22-year-old male receives 100 mg succinylcholine for rapid sequence induction during an emergency appendicectomy. At the conclusion of the 40-minute case, he exhibits zero spontaneous respiratory effort and no response to peripheral nerve stimulation. Walk the panel through your differential diagnosis, diagnostic investigations, and management strategy.
• SCENARIO 4: You are administering neostigmine and atropine to reverse a moderate neuromuscular block (TOF count 4 with palpable fade) in a 60-year-old female with severe coronary artery disease. Explain the pharmacological interactions, dosing calculations, timing, and cardiovascular risks associated with this reversal combination.