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Final clinical long case 37

Created: 29/7/2011
A 50-year-woman presents for oesophagogastrectomy. Her body mass index is 33, she is hypothyroid, hypertensive. She also has Raynaud's disease and scleroderma, and has previously undergone pulmonary valvotomy.

Pulmonary function tests: essentially normal.
FBC and Coagulation: normal
Urea and electrolytes: normal.
Raised thyroid-stimulating hormone

1. Discuss CREST syndrome and its implications
2. How would you check the placement of the double lumen tube?
3. What are the causes of an acute reduction in lung compliance?
4. Discuss your intra-operative management
5. What would be your management plan pre-, peri- and postoperatively?

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