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Cardiac tamponade anaesthesia — FRCA Final MCQ

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HardCardiothoracic and Vascular AnaesthesiaCardiac tamponade anaesthesiaFRCA Final

A 58-year-old man with large pericardial effusion and tamponade physiology requires urgent pericardial window. He is sitting upright, tachycardic, hypotensive and becomes more breathless when lying flat. Echocardiography shows right atrial and right ventricular diastolic collapse. What is the most appropriate anaesthetic technique?

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Correct answer: E — Maintain spontaneous ventilation with cautious titration until drainage

Tamponade patients depend on sympathetic tone, preload and spontaneous ventilation; induction, paralysis and positive pressure ventilation can precipitate collapse. The safest technique uses cautious titration, invasive readiness and drainage as early as possible. High spinal and vasodilation are hazardous. The surgical and anaesthetic teams should plan rescue cannulation or immediate drainage if decompensation occurs.

Reference: Association for Cardiothoracic Anaesthesia and Critical Care guidance; RCoA Final FRCA Syllabus 2026