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Oral case 67

Created: 11/10/2004


A 3-day old, 2.4 kg infant with meconium ileus is scheduled for a transverse colostomy. His abdomen is grossly distended.

1. How would you determine adequacy of preoperative hydration?

A history of NPO status, as well as vomiting, diarrhea, diaphoresis, and a high index of suspicion for hypovolemia should be elicited. Vital signs of tachycardia, blood pressure, temperature, and respiratory rate should be correlated with physical evaluation of skin turgor, mucous membrane moistness, tears with crying, fontanelle depression, and urine output. Laboratory findings necessary in evaluation include preoperative hemoglobin, electrolytes, blood urea nitrogen, creatinine, proteins, urine osmolality, specific gravity, and sodium concentration.

2. Is awake intubation mandatory? Why or why not?

3. What are the hazards of this technique?

4. What anesthetic system would you use? Explain.

5. What is the difference between osmolarity and osmolality?

Osmolarity is the number of osmoles of solute per liter of solution, and osmolality is the number of osmoles of solute per kilogram of solution.

Open eye with a full stomach

A 35-year old man requires closure of a scleral laceration sustained in a fight in a tavern.

1. How would you induce anesthesia and provide airway control?

2. Would you choose succinylcholine or a non-depolarizing muscle relaxant for intubation? Explain.

3. What is the "priming principle"?

4. What are the risks of this technique?

Post-transurethral resection of the prostate bleeding

A 68-year old male returns to the operating room because of uncontrolled bleeding post-transurethral resection of the prostate. He had a spinal anesthetic, and motor function has totally returned, but he has sensory level to pinprick at L1.

1. Would you perform another spinal, or induce general anesthesia?

2. The patient states that he does not want general. Would you give a spinal? Why or why not?

3. What are your concerns about regional anesthesia for this patient?

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