An epidural for labor pain is requested for a 32-year old primipara who is on a magnesium sulphate infusion. Her blood pressure is 150/90 mmHg.
1. Are coagulation studies needed prior to epidural placement? Why or why not?
2. What is your choice of local anesthetic?
3. Would you use epinephrine? Explain.
4. Emergency cesarean section is needed because of a prolapsed cord.
5. Would you extend the epidural, or induce general anesthesia? Explain.
Reflex sympathetic dystrophy
A 25-year old man is sent to you because he has burning pain in his right hand four months following a gunshot wound to the arm.
1. How would you evaluate the patient?
2. What is your differential diagnosis? 3. What is your treatment?
Anesthesia for electroconvulsive therapy
1. Is methohexital preferable to thiopental for electroconvulsive therapy? Why or why not?
2. Which relaxant do you prefer? Explain.
3. What would you do differently in a patient with chronic hypertension and coronary artery disease? Explain your rationale.