Post-Anaesthesia Care Unit (PACU) Crises, Delayed Emergence, Hypothermia, and Residual Neuromuscular Blockade — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style post-anaesthesia care unit (pacu) crises, delayed emergence, hypothermia, and residual neuromuscular blockade viva scenarios with examiner probes…

Scenarios covered

• SCENARIO 1: A healthy 26-year-old male undergoes uneventful open reduction and internal fixation of a fractured femur. Immediately following extubation in the operating theatre, he develops severe inspiratory stridor, chest wall retractions, and desaturation to 75%. After relief of the obstruction with positive-pressure mask ventilation, he coughs up copious pink, frothy sputum and develops tachypnoea (RR 36/min, SpO₂ 82% on room air). Explain the pathophysiology and outline your immediate resuscitation plan.
• SCENARIO 2: A 55-year-old female remains completely unarousable, flaccid, and apnoeic 45 minutes after the completion of an elective 2-hour total abdominal hysterectomy under balanced general anaesthesia with isoflurane, fentanyl, and rocuronium. Step-by-step, explain your diagnostic algorithm to determine the cause of delayed emergence and detail your management.
• SCENARIO 3: A 68-year-old male arrives in the PACU following a 5-hour radical prostatectomy. His core temperature is 34.1°C, BP 170/95 mmHg, HR 112 bpm with frequent premature ventricular contractions, and he is shivering violently. What are the deleterious physiological consequences of hypothermia and shivering in this patient, and how will you manage him?
• SCENARIO 4: A 40-year-old female is admitted to the PACU following thyroidectomy. Thirty minutes post-admission, she develops progressive stridor, dyspnoea, agitation, and a rapidly expanding swelling in the anterior neck beneath the surgical dressing. What is your immediate bedside management algorithm?