Leaders:
Case 1:
Surgery and Anaesthesia in the Patient with Hepatic Insufficiency.
A 67-year-old man is scheduled for a right total hip arthroplasty. He consumes approximately 8 cans of beer/day for the last 15 years and has numerous spider angiomas, hepatosplenomegaly, and moderate ascites. His hemoglobin is 11.2 g/dL (13.6-17.2g/dL), platelet count is 87 X 109/L (150-300 X 109/L), total bilirubin is 2.4 mg/dL (0.3-1 mg/dL), AST is 117 F/L (0-35 u/L), ALT 52 F/L (0-35 F/L) and prothrombin time prolonged by 5 seconds with INR of 1.5.
Objective:
Case 2:
Surgery and Anaesthesia in the Patient with lschemic Heart Disease Undergoing Noncardiac Surgery.
A 55 year-old man is scheduled for a hemicolectomy for adenocarcinoma. He is a type II diabetic and has been taking insulin for 2 years and is being treated for hypertension with clonidine patches. He denies any angina but does report shortness of breath when climbing more than one flight of stairs. ECG reveals nonspecific ST changes and left ventricular hypertrophy with one ectopic beat. His hemoglobin is 135 g/dL, platelet count is 192, and he has a normal creatinine, CXR is unremarkable.
Objective:
Case 3:
Surgery and Anaesthesia in the Patient with Abnormal Laboratory Tests.
A 67-year old man is scheduled for elective carotid endarterectomy. He has multiple medical problems including hypertension, diabetes mellitus, peripheral vascular disease and renal insufficiency; all of which appear stable. Preoperative work-up revealed a BP 190/100 mmHg in both arms; an ECG with LVH and non-specific ST-T anomalies; and K+ 5.7mmol/l; glucose l8mmol/l; haemoglobin 92 g/l, INR 1 6.
Objectives: