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Clinical Cases in Anesthesia -

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Clinical Cases in Anesthesia
-:- Cardiopulmonary Resuscitation
-:- What is the initial response to a cardiac arrest?
-:- How do chest compressions produce a cardiac output?
-:- What are the recommended rates of compression and ventilation?
-:- What are the complications of CPR?
-:- What is the optimal dose of epinephrine?
-:- What is the indication for vasopressin in CPR?
-:- What are the indications for sodium bicarbonate (NaHCO3) administration?
-:- What are the indications for calcium salt administration?
-:- What is the antidysrhythmic therapy of choice in VF/pulseless VT?
-:- What are the management strategies in bradycardias?
-:- What is the treatment of supraventricular tachydys-rhythmias?
-:- What are the indications for magnesium therapy?
-:- What are the indications for a pacemaker?
-:- Why is it important to monitor serum glucose?
-:- What are the indications for open cardiac massage?
-:- What is the management strategy for pulseless electrical activity (PEA)?
-:- Coronary Artery Disease
-:- What are the determinants of myocardial oxygen supply?
-:- What are the determinants of myocardial oxygen consumption (demand)?
-:- What are the pharmacologic alternatives for treating myocardial ischemia in this patient?
-:- What is coronary steal and what agents might induce it?
-:- Should this patient receive perioperative β-adrenergic blockade?
-:- How should this patient be monitored intraoperatively?
-:- Recent Myocardial Infarction
-:- How do you evaluate the cardiac risk in a patient scheduled for noncardiac surgery?
-:- What is the cardiac risk in this patient? What additional investigations should be performed?
-:- What are the implications for anesthetic management when coronary revascularization is performed before noncardiac surgery?
-:- What intraoperative monitors would you use?
-:- What additional drugs would you have prepared?
-:- What anesthetic technique would you use?
-:- How would you manage this patient postoperatively?
-:- Congestive Heart Failure
-:- What are possible etiologies for dilated cardio-myopathy?
-:- What is the pathophysiology of dilated cardiomyopathy?
-:- How would you monitor this patient during the perioperative period?
-:- How would you anesthetize this patient?
-:- Aortic Stenosis
-:- What are the symptoms and long-term prognosis of aortic stenosis?
-:- What is the etiology of aortic stenosis?
-:- How is the aortic valve area calculated?
-:- Why is it important to maintain sinus rhythm?
-:- What is the treatment for supraventricular tachy-dysrhythmias or bradydysrhythmias?
-:- How is hypotension best treated in the patient with aortic stenosis?
-:- How would you anesthetize this patient for cardiac or noncardiac surgery?
-:- Mitral Stenosis
-:- What is the etiology and pathophysiology of mitral stenosis?
-:- How should preload, afterload, heart rate, and contractility be managed in a patient with mitral stenosis?
-:- How would you optimize this patient’s condition preoperatively?
-:- What intraoperative monitoring would be appropriate?
-:- How would you anesthetize this patient?
-:- How should hypotension be treated in a patient with mitral stenosis?
-:- What is the treatment for perioperative right ventricular failure?
-:- Eisenmenger Syndrome (Subacute Bacterial Endocarditis Prophylaxis)
-:- What are the anesthetic considerations for a patient with Eisenmenger syndrome?
-:- What is the association between bacterial endocarditis and structural heart disease?
-:- Which patients should receive endocarditis prophylaxis?
-:- What are the most likely pathogens involved in subacute bacterial endocarditis and what are the antibiotics of choice for its treatment?
-:- Hypertrophic Obstructive Cardiomyopathy
-:- Describe the anatomic abnormalities in HOCM
-:- What changes in preload, afterload, heart rate, and contractility will optimize hemodynamic performance in a patient with HOCM?
-:- What are the treatment options for HOCM?
-:- What monitoring would be required in HOCM patients?
-:- What considerations should be given in planning the anesthetic management of a patient with HOCM?
-:- What are the special considerations for anesthetic management of labor and delivery in a patient with HOCM?
-:- Cardiac Pacemakers and Defibrillators
-:- What do the first three letters of the pacemaker code represent?
-:- What is the difference between a demand and an asynchronous pacemaker?
-:- What is the difference between ventricular (single-chamber) and dual-chamber pacemakers?
-:- Is a unipolar or bipolar pacemaker more sensitive to electrocautery interference?
-:- How is pacemaker interference by electrocautery prevented?
-:- What is pacemaker hysteresis?
-:- What causes myopotential inhibition of a pacemaker?
-:- What is an automatic implantable cardioverterdefibrillator (AICD)?
-:- How is the patient with an AICD managed in the perioperative period?
-:- Cardiac Tamponade
-:- What is the pathophysiology of cardiac tamponade?
-:- What are the clinical signs and symptoms of cardiac tamponade?
-:- What is the initial management of this patient’s condition?
-:- What intraoperative monitoring techniques should be used?
-:- Describe the implications for the conduct of general anesthesia in this patient
-:- Cardiomyopathy Managed With A Left Ventricular Assist Device
-:- What is a cardiomyopathy?
-:- Distinguish dilated cardiomyopathy from other cardiomyopathies
-:- Explain the treatment options for dilated cardiomyopathies
-:- What is an LVAD?
-:- What are the important anesthetic considerations for patients supported by LVADs?
-:- What intra-anesthetic monitoring might be required for patients with LVADs?
-:- Noncardiac Surgery After Heart Transplantation
-:- Describe the physiology of transplanted hearts
-:- Is reinnervation of the transplanted heart a concern?
-:- Which immunosuppressive medications are typically used following cardiac transplantation?
-:- Explain the pre-anesthetic concerns for patients with a transplanted heart
-:- What anesthetic techniques are applicable to patients with cardiac transplants?
-:- What intraoperative monitors should be used in the patient with a transplanted heart?
-:- What emergency drugs are likely to be effective in the patient with a transplanted heart?
-:- For patients with a transplanted heart, is it necessary to administer anticholinergics when antagonizing neuromuscular blockade?
-:- Coronary Artery Bypass Grafting
-:- What are the major determinants of myocardial oxygen supply and demand?
-:- What types of medications are used to treat coronary artery disease?
-:- What are the pre-anesthetic concerns in the patient with coronary artery disease?
-:- What intraoperative monitoring techniques can be used for the patient undergoing cardiac surgery using cardiopulmonary bypass (CPB)?
-:- What are the common intraoperative monitors for myocardial ischemia?
-:- What are the effects of CPB on the lungs, the brain, and the kidneys?
-:- What are the effects of CPB on hemostasis?
-:- Do-Not-Resuscitate Order
-:- What is meant by temporary revocation of do-not-resuscitate (DNR) orders in the operating room?
-:- What did you discuss with the patient prior to surgery regarding resuscitation efforts in the operating room?
-:- What options are available to the patient and clinician in order to more fully define a patient’s DNR wishes?
-:- What would you do in this case, if the patient could not be adequately ventilated with a mask?
-:- If this patient were intubated for the resuscitation but did not regain consciousness for 48 hours, is it ethical to withdraw mechanical ventilation at this time?
-:- One-Lung Anesthesia
-:- Describe the anesthetic evaluation before lung resection
-:- How are ventilation and oxygenation monitored noninvasively during surgery, and how do these monitors work?
-:- What are the indications for one-lung ventilation?
-:- Describe the use of single-lumen endotracheal tubes for one-lung ventilation
-:- Which sided double-lumen endobronchial tube should be used for this patient?
-:- Describe the proper technique for placing a double-lumen endobronchial tube
-:- How is correct positioning of the double-lumen endobronchial tube assessed?
-:- What clinical problems are associated with the place-ment and use of double-lumen endobronchial tubes?
-:- What complications are related to placing the patient in the lateral decubitus position?
-:- How are pulmonary perfusion and ventilation altered during one-lung ventilation?
-:- What is the treatment for hypoxemia during one-lung anesthesia?
-:- Describe the role of a thoracostomy tube following pulmonary resection, and describe the system used for pleural drainage
-:- Describe a commonly used pleural drainage system
-:- Discuss potential post-thoracotomy complications
-:- Thoracoscopy
-:- What types of operations can be done with VAT?
-:- What are the advantages of performing the surgery utilizing VAT in comparison with traditional thoracotomy?
-:- What anesthetic techniques can be utilized for VAT?
-:- How can hypoxemia due to shunting during one-lung ventilation be treated?
-:- What complications can occur with VAT?
-:- Intracranial Mass, Intracranial Pressure, Venous Air Embolism, And Autoregulation
-:- What is cerebral autoregulation?
-:- What factors contribute to increased intracranial pressure (ICP)?
-:- How do anesthetic agents and vasoactive drugs affect cerebral blood flow (CBF) and ICP?
-:- What are the signs and symptoms of increased ICP?
-:- How is ICP monitored?
-:- How is increased ICP treated?
-:- How is venous air embolism (VAE) detected and treated?
-:- What are the contraindications to the sitting position?
-:- How would you induce and maintain anesthesia in this patient?
-:- Intracranial Aneurysms
-:- How are patients graded following subarachnoid hemorrhage from a ruptured aneurysm?
-:- What are the most serious complications following subarachnoid hemorrhage from aneurysm rupture?
-:- What are the treatment options?
-:- What monitoring is indicated for patients undergoing craniotomy for clipping of intracranial aneurysm?
-:- How is arterial blood pressure controlled?
-:- What is cerebral vasospasm, and how is it treated?
-:- How is aneurysm rupture during aneurysm clipping managed?
-:- Carotid Endarterectomy
-:- What are the indications for surgical carotid endarterectomy (CEA)?
-:- What are the alternatives to surgical CEA?
-:- What are the most serious perioperative complications?
-:- How is the patient’s neurologic status monitored?
-:- What interventions may reduce the risk of neurologic injury?
-:- Electroconvulsive Therapy
-:- What are the physiologic effects of ECT?
-:- What are the anesthetic agents of choice for ECT?
-:- Describe the preanesthetic evaluation of ECT patients
-:- What are the anesthetic implications of psychotropic agents used in patients receiving ECT?
-:- How would you anesthetize this particular patient for ECT?
-:- What are the contraindications to ECT?
-:- Spine Surgery
-:- What are the considerations for surgery in the prone position?
-:- What monitors will you use for this case?
-:- What are somatosensory and motor evoked potentials?
-:- Describe the effects of anesthetics on somatosensory and motor evoked potentials
-:- What is a “wake-up” test?
-:- What is the bispectral index state (BIS)? Is monitoring the BIS useful in this case?
-:- Is this patient at risk for postoperative vision loss?
-:- What modalities exist for pain relief after spine surgery?
-:- Transsphenoidal Hypophysectomy
-:- What is acromegaly?
-:- What symptoms are typical of the disease?
-:- How is the disease treated?
-:- What are the anesthetic considerations of acromegaly?
-:- How would you approach the airway management in this patient?
-:- What structures lie within the transsphenoidal surgical field?
-:- What is diabetes insipidus?
-:- What are the postoperative concerns for this patient?
-:- Depolarizing Neuromuscular Blockade
-:- Describe the anatomy and physiology of normal neuromuscular transmission
-:- How does succinylcholine produce muscle relaxation?
-:- What are extrajunctional receptors?
-:- How is the action of succinylcholine terminated?
-:- What factors may decrease the normal metabolism of succinylcholine?
-:- Describe a phase II block
-:- What is the treatment of phase II blockade?
-:- Describe other recognized side-effects of succinyl-choline
-:- What are the contraindications to succinylcholine administration?
-:- NonDepolarizing NeuroMuscular Blockade
-:- Describe the mechanism by which nondepolarizing neuromuscular blockers produce neuromuscular blockade
-:- Differentiate between the commonly employed non-depolarizing muscle relaxants
-:- Briefly outline the mechanisms by which drugs other than neuromuscular muscle relaxants affect neuro-muscular blockade
-:- What effects do antibiotics have on neuromuscular blockade?
-:- How do drugs other than antibiotics affect neuro-muscular blockade?
-:- What are the metabolic factors that affect antagonism of neuromuscular blockade?
-:- Antagonism of Nondepolarizing Neuromuscular Blockade
-:- Describe the overall strategy for terminating the action of nondepolarizing neuromuscular blockade
-:- List the clinically relevant acetylcholinesterase inhibitors
-:- What is the mechanism of acetylcholinesterase inhibition?
-:- List the proper doses of muscle relaxant antagonists and their duration of action
-:- Explain the need for antimuscarinics used in conjunction with acetylcholinesterase inhibitors
-:- What is the onset of action for acetylcholinesterase inhibitors?
-:- Describe the mechanism of muscle relaxant antagonism by cyclodextrins
-:- Explain the clinical indices of recovery from neuro-muscular blockade
-:- Monitoring the Neuromuscular Junction
-:- Why is monitoring of neuromuscular function necessary in the practice of anesthesia?
-:- What is the mechanomyograph (MMG)?
-:- Describe the electromyograph (EMG)
-:- What kind of nerve stimulator is in common clinical use?
-:- Describe accelerography
-:- What is phonomyography?
-:- Explain the different patterns of nerve stimulation and the relevance of pattern choice
-:- Myasthenia Gravis
-:- What is the lesion of myasthenia gravis (MG)?
-:- How is MG diagnosed?
-:- Explain the treatment alternatives for MG
-:- Why are patients with MG sensitive to nondepolariz-ing muscle relaxants and resistant to depolarizing muscle relaxants?
-:- How are patients with MG premedicated for surgery?
-:- Describe a reasonable anesthetic technique for a patient with MG undergoing transcervical thymectomy
-:- Following emergence from anesthesia and before extubation, how is strength assessed?
-:- What is cholinergic crisis?
-:- Can preoperative evaluation predict the need for postoperative ventilation?
-:- Malignant Hyperthermia
-:- What is malignant hyperthermia (MH)?
-:- How is susceptibility to MH inherited?
-:- What is the pathophysiology of MH?
-:- What characterizes a clinical episode of MH?
-:- Outline the pharmacology of dantrolene
-:- How is MH treated?
-:- How are patients with known MH susceptibility treated?
-:- What are the recognized triggering agents?
-:- What is the significance of masseter muscle rigidity (MMR)?
-:- How is MH definitively diagnosed?
-:- Describe the neurolept malignant syndrome
-:- Diabetes Mellitus
-:- Distinguish among the major types of diabetes mellitus (DM)
-:- Summarize the physiologic effects of insulin
-:- Describe the oral hypoglycemic agents and insulin preparations available to treat DM
-:- How does DM affect perioperative morbidity and mortality?
-:- What are the common causes and associated symptoms of hypoglycemia?
-:- Outline perioperative management alternatives for the diabetic patient
-:- Explain the acute complications of DM
-:- Thyroid Disease
-:- How does the thyroid affect vital organ function?
-:- How is thyroid hormone synthesized and released?
-:- How is thyroid hormone regulated?
-:- How are thyroid disorders evaluated?
-:- What other conditions are associated with thyroid disorders?
-:- What is thyroid storm and how is it treated?
-:- What are the causes of hyperthyroidism?
-:- What are the causes of hypothyroidism?
-:- What are the preoperative considerations in a patient with thyroid disease?
-:- What are appropriate preoperative tests for a patient with thyroid disease?
-:- What are the intraoperative concerns with coexisting thyroid disease?
-:- What are the postoperative concerns?
-:- Thyroid Disease
-:- How does the thyroid affect vital organ function?
-:- How is thyroid hormone synthesized and released?
-:- How is thyroid hormone regulated?
-:- How are thyroid disorders evaluated?
-:- What other conditions are associated with thyroid disorders?
-:- What is thyroid storm and how is it treated?
-:- What are the causes of hyperthyroidism?
-:- What are the causes of hypothyroidism?
-:- What are the preoperative considerations in a patient with thyroid disease?
-:- What are appropriate preoperative tests for a patient with thyroid disease?
-:- What are the intraoperative concerns with coexisting thyroid disease?
-:- What are the postoperative concerns?
-:- Calcium Metabolism
-:- What is the role of calcium in the body?
-:- Where is calcium found in the body?
-:- How is calcium regulated?
-:- What are the symptoms of hypercalcemia? How is this treated?
-:- What are the symptoms of hypocalcemia? How is this treated?
-:- What are the causes of hyperparathyroidism?
-:- What are the anesthetic considerations for parathyroid resection?
-:- What are the postoperative concerns after parathyroid resection?
-:- Perioperative Corticosteroid Administration
-:- Where and what kind of steroids are naturally produced?
-:- What are the physiologic effects of glucocorticosteroids?
-:- What steroids are available for administration and what are their equivalent doses?
-:- How much cortisol is normally produced and what is Addison’s disease?
-:- What are Cushing syndrome and Cushing disease?
-:- Does this patient require “stress” dose steroids?
-:- How long after discontinuation of steroids should a patient be considered adrenally suppressed and treated accordingly?
-:- What clinical scenarios frequently require steroid administration?
-:- How is adrenal reserve evaluated?
-:- If this patient develops septic shock from a bile leak in the postanesthesia care unit (PACU), should steroids be withheld or administered?
-:- Pheochromocytoma
-:- What is a pheochromocytoma?
-:- Describe the clinical presentation of and diagnostic criteria for pheochromocytoma
-:- Pheochromocytoma is associated with what other syndromes?
-:- What conditions may mimic pheochromocytoma?
-:- How are patients with pheochromocytoma prepared for surgery?
-:- Describe the intraoperative management goals
-:- Outline the anesthetic choices for pheochromocytoma
-:- What are the special postoperative problems associated with resection of a pheochromocytoma?
-:- How is a previously unsuspected and undiagnosed pheochromocytoma managed following induction of anesthesia?
-:- Full Stomach
-:- What are the mechanisms a conscious patient has to prevent regurgitation and pulmonary aspiration?
-:- What are the risk factors for regurgitation and pulmonary aspiration under general anesthesia?
-:- When can aspiration occur during the perioperative period?
-:- What are the problems associated with aspiration?
-:- If aspiration occurs, what are the usual course, treat-ment and prognosis?
-:- How should the nasogastric tube (NGT) be managed during induction?
-:- What pharmacologic interventions can be made to decrease the risk of aspiration?
-:- What is the reason for applying cricoid pressure during a rapid sequence induction, and what are some of the problems associated with it?
-:- What is the effect of commonly used pharmacological agents during anesthesia on lower esophageal sphincter tone?
-:- What would be an acceptable anesthetic plan for this patient?
-:- Liver Disease
-:- Describe the basic hepatic functions that are of immediate concern to anesthesiologists
-:- Explain the liver’s detoxifying and first-pass, metabolic functions
-:- Describe common extrahepatic problems associated with chronic liver failure
-:- What should a preoperative evaluation of this patient include?
-:- What effects do surgery and anesthesia have on normal liver function?
-:- What are the concerns associated with viral hepatitis?
-:- Describe acetaminophen- and halothane-associated hepatitis
-:- Is nitrous oxide, enflurane, or isoflurane hepatotoxic?
-:- List the causes of postoperative hepatic dysfunction
-:- Are some anesthetic techniques free of hepatotoxic effects?
-:- What coagulation problems are anticipated and how are they managed?
-:- What intraoperative anesthetic problems occur during liver transplantation?
-:- Abdominal Aortic Aneurysm
-:- What is the natural history of untreated abdominal aortic aneurysm (AAA)?
-:- Outline the preoperative evaluation of the patient with an AAA
-:- Which anesthetic techniques are appropriate for AAA surgery?
-:- Which monitoring devices are recommended for AAA surgery?
-:- Explain the hemodynamic consequences of aortic cross-clamping
-:- Describe the options for postoperative analgesia
-:- Endovascular Aortic Stent Placement
-:- Explain the concept of endovascular aortic repair
-:- What are the recognized perioperative surgical com-plications associated with endovascular repairs?
-:- What are the outcomes following thoracic endovascular aortic repair?
-:- What anesthetic techniques are used for endovascular graft insertions?
-:- What problems are anticipated during proximal graft deployment?
-:- Explain the special role of transesophageal echocar-diography in endovascular stent placement
-:- Is the incidence of spinal cord ischemia different after endovascular thoracic aortic repairs compared to open repairs?
-:- What is the “post-implantation syndrome”?
-:- Transurethral Resection of the Prostate
-:- Describe the TURP syndrome and its treatment
-:- What other complications can occur during a TURP?
-:- What types of irrigating fluids have been used for a TURP?
-:- What are the toxicities associated with glycine?
-:- What are the anesthetic options for a patient under-going a TURP?
-:- If a regional anesthetic is selected, what level of anesthesia is required?
-:- How would one correct the Na+ level to 135 mEq/L?
-:- Morbid Obesity
-:- How is morbid obesity (MO) defined?
-:- Name the diseases associated with MO
-:- Describe the pathophysiology of obstructive sleep apnea
-:- How is obstructive sleep apnea diagnosed?
-:- Outline the effect of MO on functional residual capacity
-:- Is MO an indication for awake intubation?
-:- What special equipment does the anesthesiologist require to anesthetize patients for bariatric surgery?
-:- Describe an anesthetic plan for bariatric surgery
-:- Laparoscopy
-:- What procedures are amenable to the laparoscopic technique?
-:- How is laparoscopy initiated?
-:- Why is carbon dioxide (CO2) the gas used for insufflation?
-:- What are the cardiovascular changes associated with laparoscopic surgery?
-:- What are the regional circulatory changes that occur during laparoscopy?
-:- What are the pulmonary effects associated with laparoscopic surgery?
-:- What are the benefits of laparoscopic surgery?
-:- What are the complications of laparoscopic surgery?
-:- What anesthetic techniques can be used for laparo-scopic surgery?
-:- What is the controversy regarding the use of nitrous oxide?
-:- What is the etiology and treatment of post-laparoscopy pain?
-:- Carcinoid Syndrome
-:- What are carcinoid tumors?
-:- What is carcinoid syndrome?
-:- In what locations do carcinoid tumors occur?
-:- What are the major anesthetic concerns in patients with carcinoid syndrome?
-:- What is the mechanism of action of somatostatin?
-:- What precautions are prudent for anesthetizing patients with carcinoid syndrome?
-:- How is chemoem bolization used to treat metastatic carcinoid syndrome?
-:- Kidney Transplantation
-:- How does diabetes affect renal transplantation?
-:- Why is timing of hemodialysis important for renal transplantation?
-:- Discuss the treatment of hyperkalemia and its associated metabolic problems
-:- What are the major anesthetic concerns for renal transplantation?
-:- What are the implications of long ischemic times during renal transplantation?
-:- What is the mechanism by which intraocular pressure (IOP) is normally maintained?
-:- What pathologic conditions constitute a true ocular emergency versus a relative urgency?
-:- How does one minimize the deleterious side-effects of these agents in the presence of a rup-tured globe?
-:- What non-anesthetic agents might the ophthalmolo-gist use to maximize surgical outcome?
-:- What are the advantages and disadvantages of general anesthesia for scleral buckle repair?
-:- Describe the oculocardiac reflex and its treatment
-:- What are the potential complications of retrobulbar anesthesia?
-:- What types of retinal detachments are amenable to elective repair?
-:- Briefly describe the series of events that occur during retinal detachment surgery
-:- Reattachment of the retina requires intraocular gas
-:- Is the anxious patient a good candidate for surgery under monitored anesthesia care (MAC)?
-:- What general anesthetic techniques are most likely to minimize postopertive nausea and vomiting?
-:- Are regional anesthetics less likely to result in PONV in this patient?
-:- Why is control of blood loss important during middle ear surgery?
-:- Are long-acting neuromuscular blockers contraindi-cated in middle ear surgery?
-:- Describe the conduction of general and regional anesthesia for middle ear surgery
-:- What are the predictors of difficult mask ventilation?
-:- Discuss the risk factors for difficult intubation
-:- Are the risk factors for difficult intubation reliable predictors of difficult intubation?
-:- How is the anticipated difficult intubation approached?
-:- Describe the management options for a patient who, after induction of anesthesia
-:- Following induction of anesthesia, ventilation by facemask and intubation are impossible. What maneuvers may help?
-:- How is successful tracheal intubation verified?
-:- Following a difficult intubation, how is postoperative extubation managed?
-:- What are the indications and contraindications for adenotonsillectomy?
-:- Describe the essential elements of preoperative evaluation for adenotonsillectomy
-:- How is the patient premedicated for adenotonsillectomy?
-:- What anesthetic alternatives are available for patients undergoing adenotonsillectomy?
-:- What are the common postanesthesia care unit problems anticipated following adenotonsillectomy?
-:- Which patients are suitable candidates for ambulatory adenotonsillectomy?
-:- Describe the anesthetic management of a patient presenting with post-tonsillectomy hemorrhage
-:- What is a laser?
-:- Describe the most common types of lasers used in medical practice
-:- Which lasers are used in laryngeal and tracheobronchial surgery?
-:- What are the indications for laser laryngoscopy?
-:- What are the hazards of laser laryngoscopy to patients, operating room personnel, and anesthesia equipment?
-:- What anesthetic techniques are appropriate for patients undergoing laser laryngoscopy?
-:- What maneuvers are instituted to treat an airway fire? Is the risk of fire any less likely with electrocautery?
-:- How are standards for transfusion practice developed?
-:- What steps should be taken when a transfusion reaction occurs?
-:- How does the laboratory determine which direction the investigation should take?
-:- How many different types of crossmatches are there and how does the laboratory decide which should be performed?
-:- What are the immediate and delayed adverse effects of blood transfusion?
-:- What should be included in the preoperative evaluation?
-:- If the screening PT or aPTT are prolonged, which other laboratory tests should be ordered?
-:- What are the most common intraoperative coagulopathies?
-:- Which blood products are used to treat intraoperative coagulopathies?
-:- How is oxygen transported by the circulatory system?
-:- Describe compensatory mechanisms that take place in response to blood loss
-:- What is the minimum acceptable hemoglobin concentration (transfusion trigger)?
-:- List the potential sources of autologous blood
-:- Explain acute isovolemic hemodilution (AIHD)
-:- Outline the physiologic response to AIHD
-:- How is AIHD accomplished?
-:- Which patients are suitable candidates for AIHD?
-:- What is intraoperative cell salvage and how do modern cell salvage devices work?
-:- Outline the characteristics of blood obtained by cell salvage
-:- Describe the indications for use of intraoperative cell salvage
-:- Explain the controversies and contraindications involving intraoperative cell salvage
-:- What is preoperative autologous blood donation (PABD)?
-:- Who is eligible and what are the contraindications for PABD?
-:- Outline the disadvantages and risks of PABD
-:- Describe postoperative blood salvage
-:- Explain the advantages and disadvantages of different autologous blood sources
-:- What is scoliosis?
-:- How is scoliosis classified?
-:- How is the curvature assessed in the patient with scoliosis?
-:- On the issue of blood, what will a JW refuse and accept?
-:- What are the medicolegal issues concerning blood transfusion in the JW who is a minor?
-:- Describe the preoperative evaluation of the patient with scoliosis
-:- Describe the intraoperative anesthetic considerations for posterior spinal fusion surgery
-:- What is the “wake-up test”?
-:- Describe the postoperative anesthetic concerns following scoliosis repair
-:- What blood substitutes are available?
-:- What is the primary deficiency in hemophilia A?
-:- How does the disease present and what are the laboratory findings?
-:- What is the role of factor VIII in the coagulation process?
-:- Describe the treatment options
-:- Discuss von Willebrand disease as another important cause of surgical bleeding
-:- Briefly describe rheumatoid arthritis and its treatment
-:- What are the anesthetic considerations for the rheumatoid arthritis patient?
-:- How is the rheumatoid arthritis patient evaluated for anesthesia?
-:- Discuss the options for induction of anesthesia in a primary hip arthroplasty
-:- Several hours into the case the surgeon complains that he is operating on a moving target. How would you manage this situation?
-:- Discuss the causes and management of fat embolus syndrome
-:- Discuss thromboembolism prophylaxis and the placement of neuraxial anesthesia
-:- Discuss the options for postoperative pain control after total hip arthroplasty. Discuss the use of a lumbar plexus block
-:- Describe the chemistry of local anesthetics
-:- Describe the mechanism of action of local anesthetics
-:- What factors affect the potency, onset, and duration of action of local anesthetics?
-:- Discuss the sequence of clinical anesthesia following neural blockade
-:- What are the clinical differences between the ester and amide local anesthetics?
-:- Describe the pharmacokinetics of local anesthetics
-:- How do factors such as dosage of local anesthetic, addition of vasoconstrictors, carbonation and pH adjustment
-:- Which local anesthetics are appropriate for the various regional anesthetic procedures?
-:- Describe the toxic effects of local anesthetics
-:- How is systemic local anesthetic toxicity treated?
-:- Is it prudent to use regional anesthesia in a patient who reports a Novocain allergy?
-:- What is the treatment for local anesthetic allergic reactions?
-:- Other than the spinal kit, what equipment must be immediately available while performing spinal anesthesia?
-:- When arranging the spinal tray, where is the antiseptic placed in relation to the tray’s other constituents?
-:- What are the advantages of the lateral decubitus position for placing a subarachnoid block?
-:- What are the advantages of the sitting position for placing a subarachnoid block?
-:- Describe a technique for placing a spinal anesthesia
-:- Describe alternative approaches to the subarachnoid space
-:- What factors affect the spread of anesthetic within the subarachnoid space?
-:- What agents are commonly used for subarachnoid block?
-:- Besides local anesthetics, what other agents are administered in the subarachnoid space?
-:- What are the advantages of adding a vasoconstrictor to the spinal anesthetic solution?
-:- What are the recognized complications of spinal anesthesia?
-:- What are the contraindications to spinal anesthesia?
-:- Describe the advantages of spinal anesthesia over general anesthesia
-:- Explain the advantages of spinal anesthesia over epidural anesthesia
-:- Outline the advantages and disadvantages of catheter (continuous) spinal anesthesia
-:- Describe the anatomic course of the brachial plexus
-:- What are the anatomic landmarks of the axilla?
-:- What are the major approaches to blocking the brachial plexus and their indications for use?
-:- Describe the interscalene approach to blocking the brachial plexus
-:- Describe the supraclavicular approach to blocking the brachial plexus
-:- Describe the infraclavicular approach to blocking the brachial plexus
-:- Describe the axillary approach to blocking the brachial plexus
-:- What complications can arise from upper extremity blocks?
-:- What is the Bezold-Jarisch reflex?
-:- What local anesthetics are used for blocks of the brachial plexus and in what doses?
-:- Is chronic obstructive pulmonary disease (COPD) a contraindication to performing an interscalene block?
-:- What are the anesthetic options for this patient?
-:- What are the advantages and disadvantages of the various anesthetic options?
-:- Describe the innervation of the lower extremity
-:- Why is a sciatic nerve block necessary for adequate anesthesia for a total knee arthroplasty?
-:- How are femoral and sciatic nerve blocks performed? Which local anesthetic agents would you use?
-:- Would you sedate the patient for the performance of the femoral and sciatic nerve blocks and/or during the procedure?
-:- After performing the block and starting a propofol infusion, the patient begins to flail about upon surgical incision. Should you induce general anesthesia?
-:- Describe the use of the tourniquet in a total knee arthroplasty and its hemodynamic consequences
-:- What are the options for postoperative pain control?
-:- What options are available to the mother for labor analgesia?
-:- Explain the advantages and disadvantages of various regional anesthetic techniques for labor and delivery
-:- What is a “walking epidural”?
-:- Describe the regional anesthetic techniques that can be employed for cesarean section
-:- Outline the treatment for postdural puncture headache
-:- What are the advantages and disadvantages of general anesthesia for cesarean section?
-:- Describe the elements of placental drug transfer
-:- What techniques can be used for post-cesarean pain relief?
-:- Outline the differential diagnosis of postpartum hemorrhage
-:- Explain the risk factors, presentation, and treatment of uterine atony
-:- Describe the presentation and treatment of retained placenta
-:- Classify the hypertensive disorders of pregnancy
-:- What are the incidence and risk factors of preeclampsia?
-:- Explain the etiology of preeclampsia
-:- Describe the pathophysiology of preeclampsia
-:- Outline the obstetric management of preeclampsia
-:- How is preeclampsia prevented from degenerating into eclampsia?
-:- Explain the management of preeclampsia-related hypertension
-:- What are the potential consequences of epidural anesthesia in the patient with preeclampsia?
-:- Describe the anesthetic options for cesarean section for the preeclamptic patient
-:- Outline the anticipated postpartum problems associated with preeclampsia
-:- Summarize the major causes of third-trimester bleeding
-:- What is abruptio placenta and what are its risk factors?
-:- What are the presenting signs and symptoms of abruptio placenta and how is the diagnosis made?
-:- Describe the obstetric management of abruptio placenta
-:- Describe the effects of pregnancy on coagulation
-:- What is disseminated intravascular coagulopathy and how is it managed?
-:- How is fetal distress diagnosed?
-:- The patient is given a trial of labor, and the obstetrician requests a consult for labor analgesia. What are your concerns and how would you proceed?
-:- How would you anesthetize this patient for an emergency cesarean section?
-:- What is placenta previa?
-:- What is the clinical presentation of placenta previa and how is the diagnosis made?
-:- What is the obstetric management of placenta previa?
-:- How would you anesthetize the patient with placenta previa for cesarean section?
-:- What is the incidence of nonobstetric surgery in the pregnant patient?
-:- What are the anesthetic concerns when anesthetizing a pregnant patient?
-:- What are the physiologic changes during pregnancy and how do they impact on anesthesia?
-:- What is a teratogen and which anesthetic agents are known teratogens?
-:- What precautions should be taken to avoid intrauterine fetal asphyxia?
-:- How is preterm labor prevented?
-:- What monitors should be used when anesthetizing the pregnant patient?
-:- What are the special considerations for laparoscopic surgery?
-:- What general recommendations can be made when anesthetizing the pregnant patient for nonobstetric surgery?
-:- What are the concerns when placing an epidural catheter if the platelet count is low?
-:- Who is at risk for developing an epidural hematoma?
-:- What is considered a low platelet count from the perspective of epidural catheter placement?
-:- What is the expected platelet count during pregnancy?
-:- Describe coagulation and the role that platelets play in the process
-:- What are the causes of thrombocytopenia during pregnancy?
-:- What tests are available to evaluate platelet function?
-:- Describe the bleeding time test and its limitation
-:- Describe the thromboelastogram and its limitations
-:- Describe the platelet function analyzer and its limitations
-:- What is the overall risk of epidural hematoma?
-:- Describe the known cases in the literature of epidural hematoma in the parturient
-:- What is the evidence that initiating an epidural anesthetic in a woman with a platelet count <100,000 mm−3 may be safe?
-:- How do you evaluate the patient who has a platelet count <100,000 mm−3?
-:- What are some practical recommendations regard-ing neuraxial anesthesia in the parturient who presents with a low platelet count?
-:- What is low-molecular-weight heparin (LMWH) and how does it compare with and differ from standard heparin?
-:- Why do some pregnant women take LMWH?
-:- What has been the anesthetic experience with LMWH and neuraxial anesthesia?
-:- What are some of the unique recommendations for anesthetizing the parturient taking LMWH?
-:- Describe the fetal circulation
-:- What are the physiologic changes that occur at birth?
-:- How is neonatal resuscitation managed in the delivery room?
-:- What is the Apgar score?
-:- What are the differences between gastroschisis and omphalocele?
-:- How is this neonate managed preoperatively?
-:- How is the operating room prepared for this newborn?
-:- What is the anesthetic plan, and what are the intra-operative and postoperative concerns in this patient?
-:- Describe the fluid and blood product management for this neonate intraoperatively
-:- Describe the embryology and pathophysiology of congenital diaphragmatic hernia (CDH)
-:- What are the clinical features of CDH?
-:- How is CDH diagnosed?
-:- What is the preoperative management of CDH?
-:- What is permissive hypercapnia?
-:- What are the anesthetic considerations for the neonate with CDH?
-:- What problems may occur intraoperatively and postoperatively?
-:- Describe the techniques for fetal surgery
-:- What is pyloric stenosis?
-:- What is the clinical presentation of pyloric stenosis?
-:- How is the diagnosis made?
-:- What are the metabolic derangements and how are they treated?
-:- What is the surgical treatment of pyloric stenosis?
-:- What are the anesthetic considerations?
-:- What is a tracheoesophageal fistula (TEF)?
-:- How does a patient with a TEF typically present?
-:- What are the preoperative concerns in a patient with TEF?
-:- How is the patient with a TEF managed intraoperatively?
-:- What are the postoperative concerns in TEF patients?
-:- How are innocent and pathologic systolic murmurs differentiated?
-:- What is the incidence of congenital heart disease?
-:- What are the general anesthetic considerations for the common cardiac lesions?
-:- What should be included in the preoperative assessment?
-:- What are the anesthetic implications of intracardiac lesions with left-to-right shunting?
-:- What are the common intracardiac left-to-right shunting lesions?
-:- What are the anesthetic implications of right-to-left shunting lesions?
-:- What are the common right-to-left shunting lesions with reduced pulmonary blood flow?
-:- How are congenital heart lesions repaired?
-:- Discuss the sequelae associated with the repair of specific cardiac lesions
-:- What are the anatomic and physiologic differences between the infant and the adult?
-:- What is the definition of prematurity?
-:- Do the pharmacokinetics and pharmacodynamics of anesthetic drugs differ in this population as compared with adults?
-:- What are the nil per os (NPO) guidelines for this case?
-:- What anesthetic options are available and what are the concerns regarding each option?
-:- If a general anesthetic is planned, what are the induction options?
-:- What are the appropriate monitors for this case?
-:- What are the options for postoperative pain control?
-:- When can this infant be discharged home? Could this procedure have been done as an outpatient after discharge?
-:- What is magnetic resonance imaging (MRI)?
-:- What are the magnetic field problems associated with MRI?
-:- What are the specific problems encountered with physiologic monitors and equipment in the MRI suite?
-:- What are possible patient problems encountered in the MRI scanner?
-:- What are the clinical manifestations of Down syndrome?
-:- Describe the pre-anesthetic evaluation of the child with Down syndrome
-:- What anesthetic alternatives are available for the child with Down syndrome undergoing MRI?
-:- Describe the postanesthetic concerns in the child with Down syndrome after MRI
-:- Why has postoperative pain been undertreated in the past?
-:- Which factors in this patient’s history may impact on postoperative pain management?
-:- Which organ systems are affected by postoperative pain?
-:- Outline the major afferent pain pathways
-:- What are the primary chemical mediators of pain?
-:- What are the advantages and disadvantages of intramuscular opioid therapy?
-:- List alternative postoperative analgesic modalities for this patient
-:- What is patient-controlled analgesia (PCA)?
-:- What are typical dosage schedules for intravenous PCA-administered opioids?
-:- Compare the advantages and disadvantages of PCA opioids with those of intramuscular opioids
-:- Describe the regional analgesic techniques available for postoperative pain relief. Which are applicable to this patient?
-:- By what mechanism does neuraxial (epidural and subarachnoid) opioid administration produce analgesia?
-:- Outline the potential side-effects of neuraxial opioids and their treatment
-:- Describe the advantages and disadvantages of subarachnoid and epidural opioids
-:- Which opioids and adjuvants are commonly used in the subarachnoid and epidural spaces?
-:- What is preemptive analgesia? Can it reliably be performed in this patient?
-:- What is the incidence of low back pain?
-:- List the differential diagnosis of low back pain
-:- Describe the classic presentation of a patient with a herniated nucleus pulposus
-:- Differentiate the clinical presentation of a herniated nucleus pulposus from spinal stenosis
-:- Describe the pathogenesis and treatment of myofascial syndrome (trigger points)
-:- What are the signs and symptoms of sacroiliac disease and how is it treated?
-:- What are the facet joints and how does pathology in them manifest?
-:- What is the mechanism of action by which epidural steroid injections work?
-:- What are the pathogenesis, diagnosis, and treatment of internal disc disruption (IDD)?
-:- Which oral medications are prescribed for low back pain?
-:- What is failed back syndrome (FBS) and how is it managed?
-:- What is the pathogenesis of an acute herpes zoster infection?
-:- How does an acute herpes zoster infection manifest itself?
-:- What is postherpetic neuralgia (PHN)?
-:- Which patients are at risk for the development of PHN?
-:- How does PHN present?
-:- What medications can be used for treatment of PHN? What is the mechanism of action of these medications?
-:- What invasive procedures can be used for the treatment of PHN?
-:- Can PHN be prevented?
-:- Define complex regional pain syndrome (CRPS) type 1 and type 2
-:- What are the pathophysiologic theories leading to CRPS?
-:- Delineate the different stages of CRPS
-:- What are the signs and symptoms of CRPS?
-:- How is the diagnosis of CRPS made?
-:- What different nerve blocks can be used for diagnosis and treatment of CRPS?
-:- What other modalities can be used to treat CRPS?
-:- What is the prevalence of cancer pain?
-:- What is the prevalence of cancer pain by organ system?
-:- What are the different causes of pain in a cancer patient?
-:- What is the WHO ladder?
-:- What guidelines can be followed in devising a chronic analgesic regimen for treating cancer pain?
-:- What are the advantages of set-dose extended-duration opioid management?
-:- Describe the anatomy of the celiac plexus
-:- What are the indications for performing a celiac plexus block?
-:- How is a celiac plexus block performed and what complications can occur?
-:- What are the differences between alcohol and phenol neurolysis?
-:- When would one use intrathecal versus epidural analgesia for cancer pain management?
-:- Are there advantages to performing surgery on an ambulatory basis?
-:- Which patients are considered acceptable candidates for ambulatory surgery?
-:- Are there any patients who should never have surgery on an ambulatory basis?
-:- Are diabetic patients suitable candidates for ambulatory surgery?
-:- What types of surgical procedures are appropriate for ambulatory surgery?
-:- What is the appropriate fasting time before ambulatory surgery that necessitates an anesthetic?
-:- Should drugs be administered to empty the stomach or change gastric acidity or volume before the administration of an anesthetic?
-:- How can patients be appropriately screened for anesthesia when ambulatory surgery is planned?
-:- What preoperative laboratory studies should be obtained before surgery?
-:- Should an internist evaluate each patient before ambulatory surgery?
-:- Is anxiolytic premedication advisable before ambulatory surgery, and what agents are appropriate?
-:- What are the reasons for last-minute cancellation or postponement of surgery?
-:- What is the ideal anesthetic for ambulatory surgery?
-:- Are there relative or absolute contraindications to the administration of a general anesthetic in the ambulatory setting?
-:- What are the advantages and disadvantages to performing a conduction anesthetic in the ambulatory patient?
-:- What are the advantages and disadvantages of selecting a nerve block technique for the ambulatory patient?
-:- Describe the intravenous regional anesthetic technique (Bier block) for surgery on the extremities
-:- What sedatives can be administered to supplement a regional anesthetic?
-:- What complications of nerve block anesthesia are of special concern to the ambulatory patient?
-:- Should patients having ambulatory surgery be tracheally intubated?
-:- What is the role of propofol in ambulatory surgery?
-:- What is total intravenous anesthesia (TIVA), and what are its advantages and disadvantages?
-:- What is moderate sedation, when is it employed, and what advantages does it offer?
-:- When tracheal intubation is required for a short procedure, can one avoid the myalgias associated with succinylcholine?
-:- Can a relative overdose of benzodiazepines be safely antagonized?
-:- Do the newer volatile agents offer advantages over older agents such as enflurane and isoflurane?
-:- What are the etiologies of nausea and vomiting, and what measures can be taken to decrease their incidence and severity?
-:- How is pain best controlled in the ambulatory patient in the PACU?
-:- What discharge criteria must be met before a patient may leave the ambulatory surgery center?
-:- What are the causes of unexpected hospitalization following ambulatory surgery?
-:- When may patients operate a motor vehicle after receiving a general anesthetic?
-:- What is the role of aftercare centers for the ambulatory surgery patient?
-:- Are quality assurance and continuous quality improvement possible for ambulatory surgery?
-:- Why have office-based procedures and anesthesia services grown so rapidly?
-:- What do you need to consider before providing office-based anesthesia (OBA)?
-:- What equipment is necessary to provide safe OBA? Is it the same as for the hospital setting?
-:- Are there any differences in record keeping or documentation as compared with the hospital setting?
-:- Does the history of malignant hyperthermia preclude an office-based procedure and anesthesia?
-:- Are there any limitations set for types of patients/ procedures for office-based surgery?
-:- What method/technique would you choose to provide anesthesia?
-:- How will you treat postoperative nausea and vomiting (PONV)?
-:- How will you determine when the patient is ready to be discharged?
-:- What are the consequences of thoracic trauma?
-:- How are traumatic pneumothorax and/or hemothorax managed in a patient undergoing laparotomy for splenic injury?
-:- What are the mechanisms of morbidity and mortality from flail chest?
-:- What are the management options for flail chest and pulmonary contusion?
-:- What are the perioperative management options for traumatic hemopericardium?
-:- What are the clinical implications of blunt cardiac trauma?
-:- When should traumatic thoracic aortic injury be suspected and how is the diagnosis made?
-:- In blunt trauma patients with multiple injuries that include thoracic aortic injury, how is surgery prioritized?
-:- What are the perioperative clinical and anesthetic pitfalls
-:- Describe the clinical management of transmediastinal gunshot wounds
-:- What is asthma?
-:- How is asthma classified?
-:- How would you distinguish obstructive from restrictive lung disease, and asthma from chronic obstructive pulmonary disease (COPD)
-:- Briefly describe the pharmacology of medications available to treat asthma.
-:- What are the indications for mechanical ventilation in severe asthma (status asthmaticus)?
-:- What preoperative evaluation and preparation would you order for this patient?
-:- Would you choose general anesthesia (with endotra-cheal intubation, with a laryngeal mask airway) or a neuraxial block for this patient?
-:- What are the signs and causes of perioperative bronchospasm?
-:- The patient refused to have “a needle stuck in her back”
-:- What are the determinants of blood pressure?
-:- How should postoperative hypotension be approached?
-:- What is the definition of shock?
-:- What are the different types of shock and the basics of treatment for each type? What would you do for this patient?
-:- A pulmonary artery catheter (PAC) was inserted
-:- What is the classification of hemorrhage according to the American College of Surgeons?
-:- The heart rate suddenly goes up to 170 beats per minute with wide QRS complexes and the blood pressure drops further. What are the diagnostic possibilities?
-:- What are the treatment options for each of the discussed dysrhythmias? What would you do for this patient?
-:- What is the differential diagnosis of bradycardia? What is the treatment for the different types of bradycardia?
-:- What is the differential diagnosis of postoperative hypertension?
-:- What intravenous agents may be administered to treat hypertension?
-:- How is hypothermia defined and graded?
-:- What mechanisms lead to hypothermia in a patient under general anesthesia in the operating room?
-:- What are the physiologic responses to hypothermia?
-:- What are the physiologic consequences of hypothermia?
-:- Are there any benefits to mild intraoperative hypothermia?
-:- What are the different sites at which temperature can be monitored?
-:- What are the modalities to prevent and treat perioperative hypothermia?
-:- Is prevention of hypothermia warranted in a patient who received a central neuraxial block?
-:- What is the cause of nausea and vomiting?
-:- What are the risk factors for postoperative nausea and vomiting (PONV)?
-:- What is the incidence and importance of nausea and vomiting after anesthesia and surgery?
-:- What are the treatment options available for PONV?
-:- What are the main complications occurring in the postanesthesia care unit (PACU)?
-:- What are the discharge criteria for discharge from the PACU?
-:- How is postoperative respiratory failure defined? What are the two main types of acute respiratory failure?
-:- What are the four primary causes of hypoxemia and how are they distin-guished? Which is most likely in this patient, and how would you treat it?
-:- how would this ABG be interpreted? What treatment should be prescribed?
-:- How would you manage this patient?
-:- Briefly describe the most common ventilatory modes
-:- What criteria are used to determine whether extubation will be successful?
-:- What are the possible causes, investigation, and treatment for delayed emergence from anesthesia?
-:- How would you manage this patient in the intensive care unit?
-:- What is your response? What are the criteria for brain death?
-:- What is the mechanism of anaphylaxis? What is the difference between anaphylactic and anaphylactoid reactions?
-:- What treatment should be administered to this patient? What else should be checked on physical examination?
-:- What are the medications most often implicated in anaphylaxis? In anaphylactoid reactions?
-:- What is the percentage of patients allergic to penicillin who will have a reaction when challenged with a cephalosporin?
-:- Should surgery be allowed to proceed or should the case be cancelled? What will you tell the patient postoperatively?