Pediatrics- nasolacrimal duct probe

An ophthalmologist wishes to probe the nasolacrimal duct of a four-week old, 4 kg infant. This is to include injection of fluid to confirm patency. He states the procedure is to last 45 seconds. The child has no IV.

1. Would intramuscular ketamine be a satisfactory way to anesthetize the patient? Why or why not?

2. Do you need to intubate the trachea?

3. How will you monitor?

Family history of unknown anesthetic problem

A 28-year old woman scheduled for an elective gynecologic procedure relates an "allergy to anesthesia" in her family. After an emergency gastrectomy, her mother required intensive care and a breathing machine for three days.

1. Is any further workup indicated?

2. What further workup would you want?

3. What will you tell the patient?

Complication of transurethral resection of the prostate

A 70-year old man undergoing transurethral resection of the prostate under subarachnoid block becomes disoriented and hypotensive.

1. What is your differential diagnosis?

2. What is your management?

IV. A patient is given 0.2 mg scopolamine preoperatively, and arrives to the preoperative holding area anxious and delirious.

1. Why is the patient delirious?

The patient probably has central anticholinergic crisis.

2. What is the treatment?

Neostigmine, physostigmine, and pyridostigmine are all anticholinesterase agents, but physostigmine is the only one which crosses the blood-brain barrier and can treat the delerium. The dose is 1 mg slow intravenously, and may be repeated in fifteen minutes.