skip to main content

Stagnara Wake-Up Test — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeuroanaesthesiaStagnara Wake-Up TestFRCA Final

A 55-year-old woman undergoing anterior cervical corpectomy and fusion is maintained with sevoflurane and remifentanil. After instrumentation, the surgeon requests a Stagnara wake-up test. Quantitative neuromuscular monitoring confirms recovery from neuromuscular blockade, with a train-of-four ratio of 0.95. To obtain prompt command-following and purposeful movement of all four limbs, which change to the maintenance anaesthetic is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Temporarily discontinue both sevoflurane and remifentanil

The correct answer is C. A Stagnara wake-up test requires sufficient recovery of consciousness to follow commands and intact neuromuscular transmission to produce purposeful limb movement. Sevoflurane provides hypnosis, while remifentanil can suppress responsiveness and ventilation; both should therefore be temporarily discontinued and allowed to wash out. Recovery from neuromuscular blockade must also be confirmed, as it has been here by a train-of-four ratio of 0.95. Stopping only remifentanil leaves the patient anaesthetised, whereas stopping only sevoflurane while maintaining an unchanged remifentanil infusion may delay reliable command-following. Substitution with propofol continues hypnosis and is counterproductive. Reversal of neuromuscular blockade alone restores the capacity for movement but does not restore consciousness. Modern multimodal SSEP and MEP monitoring is generally preferred, with the wake-up test used as a complementary or fallback assessment.

Reference: Imani F, Jafarian A, Hassani V, Khan ZH. Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test. British Journal of Anaesthesia. 2006;96(5):583-586. https://pubmed.ncbi.nlm.nih.gov/16567343/