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Final clinical long case 19

Created: 9/1/2007
A patient presents for dental clearance. He is on multiple drugs: a tricyclic antidepressant, lithium, an atypical antipsychotic agent and a calcium channel blocker for hypertension. He lives alone, has an unkempt appearance, and has dry mouth and tremor.

ECG: essentially normal.
Chest X-ray: borderline cardiomegaly.
Full blood count: normal, degree of chronic renal failure.
Lithium level: upper limit of normal.

1. How appropriate is the patient for a day-case procedure?
2. Discuss the patient’s medications and their respective side-effects and interactions with anaesthesia.
3. What do his results suggest?
4. What further investigations are needed?

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