Clinical Scenario #1: Informed Consent

In this chapter the essential aspects of informed consent are discussed. This chapter begins with a mock scenario of a patient who is scheduled for a left knee arthroplasty. The scenario is followed by a task statement that describes the specific action that the student must take. In this case, the task is to obtain informed consent for the nerve block. Included in this process is communicating to the patient the benefits, potential complications, and side effects of the procedure and alternatives to it. An action plan for the mock scenario is then presented in a stepwise manner with mock responses and a discussion of the responses. Grading points are also discussed and how to achieve a maximum score.

Additional Topics: Neuroanesthesia

In this chapter several topics related to neuroanesthesia are discussed. Subtopics include management of a partially ruptured cerebral aneurysm, resection of an intracranial tumor, and pathogenesis of autonomic hyperreflexia. Also addressed is triple H therapy for cerebral vasospasm. Ways of preventing transurethral retrograde prostatectomy (TURP) syndrome are presented. Concerns regarding resection of a growth hormone–secreting pituitary tumor are also discussed. Lithium therapy is addressed in the context of electroconvulsive therapy. Anesthetic management in a patient with hyponatremia is discussed, as is evaluation of peripheral neuropathy. Precautions to prevent exacerbation of multiple sclerosis symptoms are outlined. Each scenario is presented as a short, three- to four-question additional topic.

Cardiovascular: Abdominal Aortic Aneurysm

In this chapter the essential aspects of anesthesia for abdominal aortic aneurysm (AAA) repair are discussed. Subtopics include airway management in expanding aneurysm, hemodynamic therapy, monitoring, vasodilator therapy, and bleeding. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include medications, assessment of cardiac status, and hemodynamic goals for this surgery. Issues discussed related to intraoperative management include monitoring, induction, maintenance, and aortic cross-clamping and unclamping. Postoperative concerns discussed include extubation, decreased renal function, spinal cord ischemia, and other complications affecting the cardiovascular, respiratory, renal, and gastrointestinal systems.

Cardiovascular: Coronary Artery Bypass Graft (CABG)

In this chapter the essential aspects of anesthesia for coronary artery bypass graft (CABG) surgery are discussed. Subtopics include monitoring, heparin dose, diagnosis of prolonged activated clotting time, cardiopulmonary bypass machine, and protamine administration. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include the pathophysiology of myocardial ischemia and complications due to chronic obstructive pulmonary disease and diabetes. Issues discussed related to intraoperative management include monitoring, induction, bypass considerations, and coagulation. Postoperative concerns discussed include ICU transfer of care and postoperative management.

Cardiovascular: Aortic Dissection

In this chapter the essential aspects of anesthesia for aortic dissection are discussed. Subtopics include hemodynamic therapy, different dissection subtypes, and vasopressor support. The case presented is a patient with hypertension needing emergent repair of a thoracic aortic dissection. The chapter is divided into preoperative, intraoperative and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include heart murmur, classification for dissection, and assessment of cardiac, pulmonary, and renal status. Issues discussed related to intraoperative management include monitoring, airway management, and aortic cross-clamping. Postoperative concerns discussed include extubation, treatment of postoperative hypothermia, and diagnosing and responding to a patient’s delayed awakening from anesthesia.

Pediatrics: Congenital Diaphragmatic Hernia

In this chapter the essential aspects of anesthesia for congenital diaphragmatic hernia (CDH) are discussed. Subtopics include respiratory management of CDH patients, airway management, and postoperative considerations of CDH patients. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics addressed are assessment of respiratory and circulatory findings, including pulmonary hypertension. Discussion of intraoperative management includes monitoring, induction using inhalational induction, intubation, and maintenance of the patient, airway management, goals for ventilation, treating possible pneumothorax, and fluids used, such as glucose. Postoperative concerns addressed are decompensation and patient outcome.

Trauma: Traumatic Brain Injury

In this chapter the essential aspects of anesthesia for traumatic brain injury are discussed. Subtopics include manifestations and treatment of elevated intracranial pressure (ICP), Glasgow Coma Scale (GCS), drugs used to lower ICP, and patient monitoring. The case presented is an emergent craniotomy. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics discussed are evaluation of trauma, use of the GCS in this case, assessing intracranial hypertension, history of substance abuse, and clearing the cervical spine. Issues related to intraoperative management in this case include induction and use of blood products. Postoperative concerns addressed include polyuria and acute respiratory distress syndrome.

Trauma: The Burn Patient

In this chapter the essential aspects of anesthetic management of the burn patient are discussed. Subtopics include use of the Parkland formula for calculating fluid requirements, airway considerations, and carbon monoxide toxicity. The differences between first-, second-, and third-degree burns are also discussed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues discussed that are related to preoperative evaluation include initial assessment, calculating percentage of body area burned, and airway evaluation. Topics related to intraoperative management include muscle relaxation, monitoring, and fluid therapy. Postoperative issues involve extubation criteria and treatment to induce muscle relaxation.

Orthopedics: Hip Surgery in Aortic Stenosis

In this chapter the essential aspects of aortic stenosis are discussed. Specifically, the hemodynamic consequences of this disease as well as which drugs should be used or avoided are explored. The case discussed is of an older patient needing emergent open reduction internal fixation of a hip fracture. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative issues addressed include evaluation of the patient’s hypertension and cardiac status. Intraoperative topics include spinal versus epidural anesthesia, management of a difficult airway, and treatment of bone cement implantation syndrome and atrial fibrillation. Postoperative issues involve extubation and, in this case, managing hypertension.

Clinical Scenario #5: Communication with Other Health Professionals

In this chapter the essential aspects of communication with other health professionals are discussed. The chapter begins with a mock scenario involving a patient undergoing an elective right inguinal hernia repair. The mock scenario is followed by a task statement that describes the specific action that the student must take. In this case, the task is to present a recommendation to the surgeon to postpone the surgery and determine the best course of action. An action plan is then presented in a stepwise manner with mock responses and a discussion of the responses. Grading points are also discussed and how to achieve maximum score is presented.