Term 5 Week 6 (w/c 18/02/13)
Hi everyone. Thanks again for a useful discussion last week. As always we will ultimately be having a clinical discussion but this week we are going to start with a quick refresher over some basic science..
What are the factors that prolong / augment neuromuscular blockade?
You are informed by the surgical team that there is a patient on the list with Myasthenia Gravis.
1.What is the pathophysiology of Myasrhenia Gravis?
2. What symptoms do they present with?
3. How is it diagnosed?
You find out some more information about your next case.. He is an 82 year old male with mild to moderate MG diagnosed 10 years ago taking pyridostigmine.
He has had 2 hernia operations many years previous without problem. His only other medical problem of note is that he takes Doxazosin for hypertension.
He presented to the hospital 36 hours ago with acute bowel obstruction on the background of a 2 month history of vague abdominal pain and weightloss.
FBC and electrolytes are normal. He has an IV and NG tube and looks well hydrated. Airway assessment is normal and he is 72kg
A CT scan shows an obstrucing caecal tumor. The general surgeons wish to perform a right hemicolectomy.
He is the next patient on the emergency list.
Are you happy to proceed with anaesthesia and how will you anaesthetise him? For those wanting to delay, what else would you like to know before proceeding?
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