Home > Anaesthesia > Term 3 Week 2 (w/c 7/5/12)

Term 3 Week 2 (w/c 7/5/12)

Welcome to week two. Last week was a great start to the new term. It’s a Bank (public) Holiday in the UK but @Gasclass is still at work.

The orthopaedic junior has nothing better to do this morning, because there are no elective lists, and therefore is rifling through the notes for her consultant’s list for tomorrow. She phones you up as a courtesy to tell you that the 45 year old lady on the end of the list, who is having a knee arthroscopy, has Sickle Cell Disease.

An odd story possibly. What are you thinking about?

Thanks for the thoughts yesterday. Unfortunately this patient has just come to your area from elsewhere in the UK so the notes are fairly limited. Visiting the patient on the morning of admission the facts are as follows:

No Previous GA
FHx Mother definitely had sickle cell anaemia dying aged 38 after a stroke.
Allergies Nil
DH Paracetamol for chronic knee pain
Airway assessment no issues.
Sickledex negative
Hb 10.8

Surgery is for cartilage problems in knee, lots of wear and tear, possibly looking at a total knee replacement at some stage.

What thoughts cross your mind now?

Thanks for the discussion yesterday. Everyone is quite happy to proceed with surgery to the knee in these circumstances. However, the orthopaedic surgeon is trying to think ahead. His intention had been to buy a little more time before joint replacement by doing arthroscopic work. He is now persuaded by case reports of problems with tourniquet in SCT. He would like to consider a Total Knee Replacement instead with some planning.

Do you want to change anything? What will your anaesthesia be now?

Transcript #gasclass – Term 3 Week 2

#gasclass

There are no trick questions in #gasclass. It is an educational tool only. Everyones opinion is as valid as the next person. Follow the conversation by using (or searching for) the hashtag #gasclass on twitter. We welcome input from all specialities and you can send us a direct message if you would prefer to remain anonymous.

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Categories: Anaesthesia
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