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Oral case 16

Created: 6/9/2004

Regional anesthesia for femoral-popliteal bypass

A 64-year old male is scheduled for a femoral-popliteal bypass and he will be heparinized. He asks about postoperative pain management.

1. Will you use epidural narcotics?

2. Would you insert the epidural at the beginning or at the end of the case? Explain.

3. You elect to use epidural with a light general for the case. Your first epidural attempt is a bloody tap. What do you do now?

Protamine reaction

A patient who underwent coronary artery bypass graft surgery develops generalized erythema, wheezing and hypotension five minutes after protamine is given.

1. How would you manage the patient?

2. The patient is re-heparinized and "crashed" onto the bypass machine for resuscitation. How do you manage heparin antagonism after weaning from bypass?

Missing tooth

Following a difficult intubation, you note that the patient's right lateral incisor is missing.

1. What do you do?

2. What if the tooth cannot be found?

3. What do you tell the patient when he awakens?


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