Term 4 Week 8 (w/c 22/10/2012)
We have spent the past couple of weeks looking at cases outside of the operating department. For this week we will return to this more familiar environment.
As with most weeks, we will begin with an open ended question before focusing more closely on details specific to the case.
What are the important components of anaesthesia for free flap surgery? (HINT: They can be pre, peri or post op)
You are asked to anaesthetise a patient on the maxillo-facial list. You know she is 48 years old and she has a retromolar SCC eroding into the mandible. She is booked to have mandibular resection with a radial forearm flap.
What further information do you want to know as part of the pre-op visit?
You attend the pre-op visit and discuss the plan with the surgical team.
The patient initially presented with a lesion several years ago which was treated by radiotherapy. She then had a small SCC excised by laser 2 years ago before presenting with this more invasive lesion.
She is a smoker but otherwise well. The surgeons inform you that she is a Jehovah’s Witness and has expressed the wish that she does not wish to receive any blood products. The case has been discusses extensively at MDT and it is agreed that there is no other route forward other than ressection. The surgeons are planning on performing elective tracheostomy.
Her blood results are as follows
PT 12 secs
APTT 14.1 SECS
She has been commenced on ferrous sulphate preoperatively.
How will you proceed?
Thankyou for the input so far. It is great to see that through the collective contributions we are able to tease out most of the learning points from the cases we discuss.
One final question for this week:
Imagine we were dealing with the same patient having emergency surgery of a different nature where concern over flap perfusion is not an issue (emergency laparotomy for instance). You reach the end of the operation and the Haemocue estimates Hb at 5.2 g/dl
Feel free to add any comments on twitter (#gasclass)
Please only provide one suggestion at a time. Wait until someone else has tweeted before adding more. Don’t forget to add #gasclass to tweet.
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.