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Oral case 101

Created: 11/1/2005

Elective cesarean section - patient desires to be awake

A 29-year-old patient desires to be awake for elective cesarean section. She has a history of laminectomy with recurring lower back pain.

1. What is your anesthetic choice?

2. She complains of pain shooting down her leg on insertion of the epidural needle. What is the cause? Will you proceed with the procedure?

4. What are your next steps?

Myringotomy tubes for a pediatric outpatient

A 4-year-old outpatient for insertion of myringotomy tubes arrives in the morning with nasal drainage and slight fever.

1. Will you cancel the case? Why or why not?

2. What if a productive cough is also present?

3. What are the risks of general anesthesia when a patient has an upper respiratory infection?

Complications of supraclavicular block

A colleague performs a supraclavicular block for wrist surgery in an outpatient. The patient coughs and reports that her breathing is "different". The chest radiogram shows a 5-10% pneumothorax.

1. Is a chest tube required?

2. Would you continue surgery?

3. Would you admit this patient to the hospital?

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