Home > Anaesthesia, Gasclass > Term 4 Week 3 (w/c 17/9/12)

Term 4 Week 3 (w/c 17/9/12)

Good Morning. Welcome to week 3 of this term

You have been asked by the pre-assessment clinic to see a 62 year old lady who requires a laparotomy for an ovarian malignancy.

As you head to the clinic to see the lady what are your initial thoughts?

Thank you for your your comments so far.

The lady has been listed for a laparotomy and pelvic clearance. Her weight is 55kg and her BMI 23. She has completed 3 cycles of chemotherapy.

She has significant ascities and is breathless at rest.

What are your thoughts now? What else would you like to know?

Thank you for the additional comments. Thoughts at present relate to the stage of her disease, the prognosis with surgery and the causes of her breathlessness. on further questioning she has become increasingly breathless over the last  month, more so with the progressive distension of her abdomen with ascities.  She is unable to lie flat in bed and sleeps on 4 pillows.

SpO2 is 94% on Room air and she has a RR of 23. Hb 9.5g/dl PLT 155 WBC 4.2 Na 136 K 3.9 Ur 2.2 Cr 65

CXR and CT findings are shown below

What are your thoughts now? What would be your anaesthetic plan?

So we have had some thoughts regarding the management of this lady. What would you do with the ascities / effusion?

Vote in our poll and tweet your reasons. More information tomorrow.

The ascities and the effusion are drained and she proceeds to surgery.

How are you going to manage her intra-operative and post-operative care? 

There are no trick questions in #gasclass. It is an educational tool only. Everyone’s 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 specialties and you can send us a direct message if you would prefer to remain anonymous.

@gasclass

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Categories: Anaesthesia, Gasclass
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