Perioperative care: hypotension after spinal anaesthesia: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Perioperative care: hypotension after spinal anaesthesia

Sample item

Ten minutes after a subarachnoid block for a groin operation, with a sensory level to T4, a patient has a blood pressure of 78/40 and a heart rate of 46. What is the best immediate treatment?

ANaloxoneBIntravenous fluid, head-down tilt and ephedrineCDantroleneDIntravenous hydrocortisone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous fluid, head-down tilt and ephedrine

A high spinal block causes sympathetic blockade, with vasodilatation and, at T4, loss of cardiac accelerator fibres, leading to hypotension and bradycardia. Treatment is a fluid bolus, leg elevation or head-down tilt, and a vasopressor such as ephedrine, with atropine if bradycardia persists.

Option by option

A. Naloxone
Naloxone reverses opioid effects, which do not explain this picture.
B. Intravenous fluid, head-down tilt and ephedrine (correct)
Correct. Fluid, positioning and a vasopressor reverse the effects of sympathetic blockade.
C. Dantrolene
Dantrolene treats malignant hyperthermia, which causes hyperthermia and rigidity rather than hypotension and bradycardia.
D. Intravenous hydrocortisone
Hydrocortisone is for adrenal insufficiency or anaphylaxis and not the cause here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Intravenous fluid, head-down tilt and ephedrine. A high spinal block causes sympathetic blockade, with vasodilatation and, at T4, loss of cardiac accelerator fibres, leading to hypotension and bradycardia.

Why is "Naloxone" not the answer?

Naloxone reverses opioid effects, which do not explain this picture.

Why is "Dantrolene" not the answer?

Dantrolene treats malignant hyperthermia, which causes hyperthermia and rigidity rather than hypotension and bradycardia.

Why is "Intravenous hydrocortisone" not the answer?

Hydrocortisone is for adrenal insufficiency or anaphylaxis and not the cause here.

What concept does this question test?

It tests Perioperative care: hypotension after spinal anaesthesia in General Surgery. Treatment is a fluid bolus, leg elevation or head-down tilt, and a vasopressor such as ephedrine, with atropine if bradycardia persists.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Perioperative care: hypotension after spinal anaesthesia?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.