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Module 13 · Anaesthesia Blueprints

Thoracic anaesthesia: exam notes and MCQs

Prepare thoracic anaesthesia for postgraduate anaesthesia examinations with structured notes, exam-style questions and referenced explanations from standard textbooks and current guidelines.

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Exam notes in this module

Thoracic anaesthesia and one-lung ventilation
Pre-operative assessment, lung isolation, OLV physiology and hypoxaemia management.
Chest radiograph interpretation for anaesthetists
Systematic review, lines and tubes, collapse, effusion, pneumothorax and patterns seen in table vivas.
Anterior mediastinal mass, bronchopleural fistula and thoracic analgesia
Life-threatening airway and circulatory collapse with mediastinal masses, ventilation strategies for BPF, and analgesia after thoracic surgery.

Sample questions

Q1. Before lung resection, a predicted post-operative FEV₁ (ppoFEV₁) above which value indicates LOW risk of respiratory complications?

  1. 20%
  2. 30%
  3. 40%
  4. 60%
Show answer

Answer C: 40%

Patients with ppoFEV₁ > 40% are at low risk of post-resection respiratory complications. The high-risk threshold has shifted from < 40% (open thoracotomy) to < 30% for VATS; ppoDLCO is interpreted similarly. Combine with exercise testing (VO₂max) for borderline cases.

Exam style: NEET-SS Anaesthesia

Q2. During one-lung ventilation, hypoxaemia persists despite FiO₂ 1.0, confirmed tube position and PEEP to the ventilated lung. The next most effective step is:

  1. Increase tidal volume to 12 mL/kg
  2. CPAP (1–2 cmH₂O, after recruitment) or O₂ insufflation to the non-ventilated lung
  3. Start a volatile agent at 2 MAC
  4. Give a bolus of sodium nitroprusside
Show answer

Answer B: CPAP (1–2 cmH₂O, after recruitment) or O₂ insufflation to the non-ventilated lung

Oxygen to the non-ventilated (operative) lung — apnoeic O₂ insufflation or low-level CPAP after a recruitment manoeuvre — oxygenates the shunted blood. If still refractory: intermittent two-lung ventilation, or the surgeon clamps the pulmonary artery of the non-ventilated lung.

Exam style: NEET-SS Anaesthesia

Q3. For biopsy of a symptomatic anterior mediastinal mass, the safest anaesthetic principle is:

  1. Rapid sequence induction with suxamethonium
  2. Maintain spontaneous ventilation and avoid muscle relaxants where possible
  3. Deep inhalational anaesthesia with controlled ventilation
  4. Prone positioning for induction
Show answer

Answer B: Maintain spontaneous ventilation and avoid muscle relaxants where possible

Loss of negative intrathoracic pressure and chest wall tone with paralysis can allow the mass to compress the trachea, bronchi or great vessels, causing catastrophic airway or cardiovascular collapse. Maintaining spontaneous ventilation (local anaesthesia, sedation, or inhalational/ketamine techniques) is the cornerstone; have rigid bronchoscopy and position change (lateral/prone) and ECMO/CPB standby planned for high-risk cases.

Exam style: AIIMS INI-SS

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