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Final clinical short case 5

Created: 7/4/2004

 A 23 year old woman with Down syndrome presents with a pale, painful right leg.


1. What is the likely diagnosis?
2. What is Eisenmenger's syndrome?
3. What are the problems with anaesthetising a Down syndrome patient?
4. What would the surgeon want to do?
5. What type of anaesthesia would you choose?

 You are shown the chest X-ray of a 26 year old female who has undergone a thoracic sympathectomy by the transaxillary approach. This shows:

– An endotracheal tube in situ (flexometallic)
– Pneumomediastinum (air around the heart and great vessels)
– A globular cardiac silhouette


1. What is likely to be the diagnosis?
2. How would you manage the patient?

 A patient presents with interpleural block.


1. What are the indications?
2. Describe the procedure you would perform, in terms of the site, position and type of needle, and the catheter used. What would be the relation of the needle to the rib, which space would you choose?
3. What would be your choice of anaesthetic?
4. What volume of anaesthetic would you administer? What rate of infusion would you choose?
5. What complications might you encounter?

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