Clinical Cases in Anesthesia by Allan P. Reed, Francine S. Yudkowitz

By Allan P. Reed, Francine S. Yudkowitz

Prepare for the oral forums with the completely up to date Clinical instances in Anesthesia. This finished and present anesthesia evaluate device provides case reports representing contemporary most typically encountered scientific occasions, equipping you to master the newest anesthesia remedy protocols and perform guidance and achieve your best possible score.

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Sample text

3. What are the treatment options for hypertrophic obstructive cardiomyopathy? A 28-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) presented for labor and delivery. She was initially managed by the obstetrician with intravenous butorphanol but became progressively more uncomfortable. The anesthesiologist was consulted for further management. 1. Describe the anatomic abnormalities in hypertrophic obstructive cardiomyopathy. HOCM is the most common genetic cardiovascular disease, with a prevalence of approximately 1 in 500 young people in the United States.

Even brief episodes of hypotension may lead to hemodynamic decompensation. , phenylephrine) should be attempted to preserve CPP and avoid the vicious cycle of irreversible ischemia. Generally, pure a-adrenergic receptor agonists are the preferred vasoconstrictor agents because they do not cause tachycardia, which preserves diastolic filling time. 7. How would you anesthetize this patient for cardiac or noncardiac surgery? Premedication in patients with AS should be administered carefully. Oversedation may lead to hypotension 4 Aortic Stenosis 19 TABLE 4-2 Hemodynamic Goals in Aortic Stenosis Parameter Goal Indicated Relatively Contraindicated Heart rate Normal to slow sinus rhythm Restore sinus rhythm b blockers Potent volatile agents (high doses) Preload Normal to high Intravenous fluids Nitroglycerin Thiopental Propofol Afterload High Phenylephrine Nitroprusside Contractility Normal to increased Epinephrine (careful of increased heart rate) Norepinephrine High-dose b-adrenergic blockers Potent volatile agents (high doses) and decreased CPP, whereas undersedation may result in anxiety, tachycardia, and myocardial ischemia.

Using echocardiography, the aortic valve area can be calculated using the continuity equation, which is based on the principle that the stroke volume is equal in the left ventricular outflow tract (LVOT) and the aortic valve: Velocity-time-integral(LVOT) 3 area(LVOT) 5  velocity-time-integral(aortic valve) 3 area(aortic valve) Transvalvular peak-to-peak gradients are calculated using the modified Bernoulli equation: Transvalvular gradient 5 4 3 (maximum velocity)2 Transvalvular gradients underestimate the degree of AS in low cardiac output states because of diminished flow across the valve.

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