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Oral case 102

Created: 11/1/2005

A 61-year-old 80 kg man is scheduled for lumbar laminectomy at 11:30 am. He has a history of diabetes, hypertension, and had a myocardial infarction 4 years ago. Medications include an oral hypoglycemic agent, propranolol, and a thiazide diuretic. Blood pressure is 130/90 mmHg, pulse is 72 bpm, temperature is 37 degrees C, hemoglobin is 16.5 g/dl, sodium is 146 mEq/L, chloride is 98 mEq/L, and glucose is 130 mg/dl.

 Preoperative evaluation

I. Evaluation of diabetes

1. What is the significance of the blood glucose?

2. Would you want to carry out other tests? Explain.

3. Describe the pharmacology of oral hypoglycemic agents.

4. What is the need for insulin administration?

5. Would you give an oral hypoglycemic agent preoperatively? Explain.

6. What is the significance of diabetes to anesthesia?

II. Antihypertensive evaluation

1. Has blood pressure treatment been adequate?

2. Do you want to obtain more data? Explain.

3. What is the significance of hypertension to surgical management?

4. What is the significance of prior drug therapy to anesthesia care?

III. Understanding the ASA physical status

1. What ASA status would you assign? Explain.

2. What is the significance of ASA status to anesthetic care?

 Intraoperative course

I. Selection and application of monitors

1. What is the significance of his prior myocardial infarction?

2. Are special monitors indicated? Explain.

3. Discuss interpretation of data regarding these monitors.

II. Eye injury during surgery

1. The patient complains of right eye pain upon awakening. What is your diagnosis?

2. What is your treatment?

III. Assessment of respiratory function 1. The patient is cyanotic unless supplemental oxygen is given. How do you assess this?

2. How will you manage this?

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