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Final clinical long case 32

Created: 5/8/2010
A 60-year-old male presenting with tingling and numbness in the hands for the past few months is scheduled for posterior cervical decompression.

Past history
Unstable angina
Two previous cardiac ablations
Known atrial fibrillation
Hypertensive blood pressure was 150/90 mmHg
Poor exercise tolerance

Ventolin inhalers

High haemoglobin
Low potassium
High sodium
ECG: Atrial fibrillation (AF) with right bundle branch block with Q waves in inferior leads
X-ray: Cervical spine lateral flexion and normal view
Osteophytes; subluxation


1. Summarise the case.
2. What are the risk factors?
3. Discuss adequacy of control and stages of hypertension
4. Describe the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors, doses used and side effects.
5. Why is warfarin used? Describe the risk reduction by giving warfarin to patients in atrial fibrillation, the dose used and the international normalised ratio (INR) aimed for.
6. Discuss the rate control of AF, and the drugs used.
7. What are the causes for a high Na+ and low K+?
8. What possible drug interactions might occur?
9. Give a brief description of the procedure for laminectomy.
10. What would be your anaesthetic goals?
11. Discuss your airway management.
12. What are the problems of prone positioning?
13. Discuss intraoperative spinal cord monitoring.
14. How is somatosensory evoked potential measurement performed?
15. Discuss intraoperative and postoperative pain management.

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