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Final clinical short case 28

Created: 30/4/2010
1. A 20-year-old woman with Down's syndrome (with a mental age of 5), patent ductus arteriosus and Eisenmenger’s disease presents with a cold, blue leg.
- Define Eisenmenger’s disease.
- What problems might arise with anaesthesia?
- Why does she have a cold leg? Explain the mechanism.
- How would you anaesthetise her? What intravenous induction agent would you use?

2. You are shown a chest X-ray showing a 20p coin in right main bronchus, but is otherwise normal. You are then told the history: the coin was inhaled about 3 months ago, and the patient is now presenting with a chronic cough, but is otherwise well.
- Discuss the X-ray.
- How would you anaesthetise the patient? Discuss any potential problems that might arise.
- What you do if he stops breathing or goes into spasm?
- What types of bronchoscopes would you use, and what are the options for maintenance?

3. A patient 10 days post-lobectomy coughs up a huge amount of sputum and collapses. He has a bronchopleural fistula.
- What are the causes of bronchopleural fistula?
- How would you treat the patient?
- Would you insert a chest drain? Describe this procedure.
- How would you anaesthetise him? What are the possible options, and the advantages and disadvantages of each?
- If the bronchopleural fistula is on the left side, which type of double-lumen tube would you use?

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