Term 5 Week 2 (w/c 21/01/13)
Welcome to week 2 of this weeks #Gasclass.
We are in threatre again this week. You are going to anaesthetise a 45 year old lady for a laparoscopy.
What are the potential risk factors for post operative nausea and vomiting (PONV)?
Thank you for your responses yesterday – we have covered a lot of the potential causes of PONV and asked a few more questions as to why. You go and see the lady, she is 120kg with a BMI of 37. She has had multiple previous anaesthetics for various Gynaecology procedures and is having a laparoscopy for pain. Each of these anaesthetics has been followed by severe PONV.
What else do you want to know? What is your anaesthetic plan?
A lot of discussion yesterday as to the management of PONV including the suggestion of some agents that many people may not have used or considered.
You have made the decision to use TIVA as this may reduce her PONV. Her previous anaesthetics have been volatile based. On insertion of the initial port, her blood pressure drops rapidly and her ETCO2 drops.
What are your thoughts? What do you do next?
Thanks for the initial thoughts – HR 120 BP 70/30 ETT in satisfactory position. You instigate initial resucutation measures and the surgeons proceed to laparotomy where they discover that the port has gone into her IVC and there has also been bowel perforation. She never required CPR.
What do you need to do now? What is your postoperative plan?
You decide to wake the patient at the end of the case. Following extubation she is taken to recovery. Once she is awake in recovery she informs the recovery staff that she could hear people talking through her operation and that she knew something had gone wrong.
There are no trick questions in #Gasclass. Everyone’s contribution is welcome. Please do not forget to add the ‘hashtag’ #gasclass to every Tweet so that it is included in the conversation. To help give new contributors an opportunity to join in we would advise that you should only add one idea per tweet and not contribute until another Tweeter has joined in.