Obstetrics- placenta previa
A patient with placenta previa insists upon lumbar epidural for her cesarean section.
1. What is your response?
2. What factors do you take into account in deciding whether an epidural is appropriate?
A 70-year old woman scheduled for mastectomy is diagnosed pre-operatively with hypothyroidism.
1. What are anesthetic concerns in these patients?
2. Would you postpone surgery?
3. The patient insists upon proceeding. Your response?
Ventilatory care in the intensive care unit
You are called to the intensive care unit to see a patient who is three days post-operative for a laparotomy for blunt trauma. He is intubated, on mechanical ventilation, with the most recent arterial blood gas as follows: pH 7.5, PO2 45 mm Hg, PCO2 30 mm Hg on 100% FIO2.
1. What further evaluation would you recommend?
2. Your impression is pulmonary edema due to increased pulmonary capillary permeability. What recommendations do you have?
3. The attending states that adding positive end-expiratory pressure will "blow out the lungs". What is your response?