Case Synopsis During an open abdominal aortic aneurysm repair, a 71-year-old man suddenly becomes profoundly hypotensive after acute blood loss. The mean arterial blood pressure is 40 mm Hg, and the electrocardiogram (ECG) shows a wide complex rhythm of 35…
Case Synopsis “I thought I was about to die. [One minute] I was wheeled into a fairly routine orthodontic operation. … Suddenly, I was aware something had gone very wrong. I could hear what was going on around me, and…
Case Synopsis A 35-year-old man with T1 spinal cord transection 3 years ago, sustained in a motorcycle accident, is scheduled for elective cystoscopy with removal of a bladder stone. In the preoperative holding area, he feels anxious and has a…
Case Synopsis A 57-year-old hypertensive African American woman with recent initiation of angiotensin-converting enzyme (ACE) inhibitor undergoes laparoscopic cholecystectomy under general endotracheal anesthesia. After 1 hour in the recovery room, the patient complains that her tongue feels “thick.” On examination…
Case Synopsis A 54-year-old woman presents for a hysterectomy and oophorectomy for ovarian mass. She is induced with propofol, fentanyl, and vecuronium. Sevoflurane in air/oxygen is delivered for maintenance. She receives 2 g of cefotetan shortly after intubation. Within the…
Case Synopsis A 23-year-old woman undergoes emergency cesarean section under general anesthesia for fetal bradycardia and placental abruption. She is hypotensive (blood pressure 70/30 mm Hg) and tachycardic (heart rate 150 beats per minute) as the procedure begins. After delivery,…
Case Synopsis An 8-week-old infant is undergoing a craniectomy for sagittal craniosynostosis. As the surgeon is excising the cranial bone segment, precordial Doppler sounds change, and the blood pressure rapidly declines ( Fig. 127.1 ). Problem Analysis Definition Gas bubbles…
Case Synopsis A 38-year-old woman with a history of hypertension and obesity (body mass index 32) is scheduled to undergo a laparoscopic cholecystectomy for chronic recurrent cholecystitis. In the preoperative assessment, she discusses her allergy to penicillin with the anesthesiologist.…
Case Synopsis A 62-year-old man underwent coronary artery bypass graft surgery via a median sternotomy, with harvesting of the internal mammary artery. During a routine postoperative visit, the patient complains of a “tingling” sensation in the fourth and fifth fingers…
Case Synopsis A 68-year-old man with a history of insulin-dependent diabetes mellitus, hypertension, and an 80 pack-year smoking history is scheduled for four-vessel coronary artery bypass grafting (CABG). After uneventful induction of anesthesia, severe aortic atheromatous disease is observed via…