Term 7 Week 6 (w/c 11/11/13)
Good morning class. As we pass the half way point in this weeks term we are pleased to say that we are still recieving more views of our blog page per day than in any previous term. Thanks to everyone for their participation so far. Lets keep it up!
As usual we are going to begin this weeks case exploring some of the wider issues before focusing on specific clinical problems (s). So….
What are the effects of acute and chronic alcohol abuse on the safe delivery of anaesthesia?
You are contacted about a patient who needs urgent surgery for cauda equina syndrome. The referring surgical team tell you that the patient has a past history of alcohol excess and was recently treated for squamous cell carcinoma of the mouth. They fear his spinal compression may be from a tumor metastasis.
What are your thoughts?
Thanks everyone for the input so far. You attend the ward and visit the patient. He is a 53 year old male. 178cm and 107kg in weight. His past medical history includes a history of alcohol abuse and hypertension. He has been prescribed amlodipine by his GP but says he doesn’t always take them. He has had several alcohol related admissions to hospital in the past including one seizure thought to be related to alcohol withdrawl a few years ago. He has no signs of hepatic dysfunction and claims he has cut back on his drinking to almost zero since being diagnosed with his squamous cell carcinoma (mouth)
6 weeks ago he was assessed and felt to be well enough for surgery. He underwent tumor resection (hemiglossectomy) and reconstruction with a radial forearm free flap (RFFF). His previous surgery involved nasal intubation which was performed fibre optically (asleep). There is no documented Cormack Lehane grade of laryngoscopy in the notes. On examination he is mallampati grade 3, normal neck extension, normal thyromental distance. There is some elevation to the floor of the mouth on the side of the RFFF.
The surgical team want to go to theatre for urgent spinal decompression. Time to make your anaesthetic plan?
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