Term 6 Week 2 (w/c 06/05/13)
Wecome to this weeks #gasclass.
You are helping in the pre-assessment clinic. Your next patient is a a 68 year old man who is listed for an open cystectomy and formation of ilieal conduit.
To start this week – What are the potential surgical / procedure issues relevant to an anaesthetist?
Thank you for all your comments so far. We all agree that it will be a long case and has the potential for major blood loss.
The patient attends the clinic. As he walks into the room you hear an audible wheeze.
He is a retired chemist and ex 40 pack year smoker. He is 85kg and Height is 1.76m.
PMH include hypertension and type 2 DM.
What are your thoughts? What else would you like to know & what investigations will you order?
Thank you for comments yesterday. Further questioning reveals a gradual onset of SOB over the last 6 months. His exercise tolerance has not been reduced, although he comments that it now takes him longer to walk the same distance to the shops. He sleeps on 2 pillows. BP 176/88 P85 reg CXR is unremarkable. ECG shows NSR with mild LVH
Hb 110g/l WBC 5.3 PLTS 150 Na 130 K 3.6 Ur 7.8 Cr 120 HBA1C 8.9
What else would you like to know? What is your anaesthetic plan?
We had a few thoughts and ideas yesterday.
His PFTs reveal an obstructive pattern with an FEV1 of 1.2L His echo revealed moderate LVH and mild LV systolic dysfunction.
You discuss with him the options for anaesthesia and he agrees to have an epidural followed by GA with invasive monitoring.
A week later the man arrives in your anaesthetic room. You insert the epidural and induce anaesthesia. During the procedure there is suddenly major blood loss ~2L and he develops ST segment elevation and hypotension.
What are your thoughts now and what are you going to do?
Please remember to add the hashtag #gasclass to all correspondence on Twitter. Please also take turns to put your thoughts. Try to keep to one issue and then wait until another Tweeter has contributed before giving more thoughts.
Everyone’s views are welcome. We really would like to welcome more contributions this term so new people are very welcome whatever your background or grade.
The Gasclass Team
The Storify summary for this weeks case can be found here