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Primary Viva 22 (Clinical)

Created: 10/4/2008
Updated: 10/4/2008
A 52-year-old woman who has been bleeding per rectum presents for an elective hemicolectomy on the following day’s list. Her blood pressure is 180/120 mmHg on the ward, and she is a member of a hill walking club. She has not seen a doctor for the past 30 years.

- How would you approach this case? Describe your preoperative assessment.
- What would you do about the patient’s high blood pressure reading?
- What are the causes of hypertension?
- What complications might arise in a hypertensive patient as a result of anaesthesia?
- Would you have concerns over the patient’s history of bleeding per rectum?
- How would you weigh up the urgency of surgery and the hypertension risk?
- How would you anaesthetise her?
- What postoperative pain relief would you administer?

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