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Intraoperative MI GTN Treatment — FRCA Final MCQ

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ModerateGeneral AnaesthesiaIntraoperative MI GTN TreatmentFRCA Final

A 60-year-old man (ASA III) develops intraoperative ST elevation during major abdominal surgery. He is haemodynamically stable. Troponin is sent. While awaiting results, which intraoperative intervention may help treat acute myocardial ischaemia?

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

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Correct answer: A — No intervention until troponin result available

Intraoperative management of acute myocardial ischaemia includes: GTN infusion (reduces preload and relieves coronary vasospasm), optimise haemodynamics (correct anaemia, maintain BP, avoid tachycardia), deepen anaesthesia if light (reduce sympathetic activation and myocardial O2 demand), and consider esmolol if tachycardic. IV thrombolysis is contraindicated during surgery due to catastrophic bleeding risk. Intraoperative coronary angiography is logistically impractical. Cardiology should be consulted immediately. The decision to continue or abbreviate surgery depends on the clinical response and surgical stage.

Reference: RCOA – 2023 – Perioperative cardiac events; NICE – 2020 – NG185 ACS