A line isolation alarm sounds.
1. Is the patient at risk for electrocution?
2. What should be done?
3. What is an isolation transformer?
4. Will it protect the patient during this alarm?
Transurethral resection of the prostate under spinal
A patient undergoing transurethral resection of the prostate under subarachnoid block develops confusion and agitation.
1. What is your differential diagnosis?
2. The patient is hyponatremic. How will you manage?
Obstetrics- parturient with primary pulmonary hypertension
A 23-year old female at 40 weeks gestation presents for elective cesarean section. She has primary pulmonary hypertension.
1. What anesthetic technique would you use? Explain.
2. You decide to use general anesthesia. What agents will you use?
3. What beta-adrenergic abnormalities can occur due to myocardial dysfunction?
Cardiomyopathies like those due to pulmonary hypertension, coronary artery disease, and aging can significantly desensitize the beta-receptor nucleotide protein cyclase, leading to down regulation of receptors, and redistribution of receptors from outside to inside of the cell.
4. How do catecholamines cause abnormal beta-receptor function?
Elevated catecholamines cause beta-receptor desensitization, perhaps as a protective mechanism. It can be seen in patients with congestive heart failure, before and after cardiopulmonary bypass, and in patients awaiting heart transplant who are on chronic dobutamine infusions.