This page intentionally left blank The Clinical Anaesthesia Viva Book Second edition The Clinical Anaesthesia Viva Book Second edition Julian M. Barker Simon L. Maguire Simon J. Mills and Abdul-Ghaaliq Lalkhen Brendan McGrath Hamish Thomson CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521720182 © J. Barker, S. Maguire, S. Mills et al., 2009 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2009 ISBN-13 978-0-511-64154-1 eBook (NetLibrary) ISBN-13 978-0-521-72018-2 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. v Contents Listofcontributors pageix ForewordbyPeteNightingale xi Preface xiii Acknowledgements xiv 1 PreparationfortheClinicalViva 1 2 TheShortCases 8 Abdominalaorticaneurysmrupture 8 Acromegaly 11 Acuteasthma 13 AcuteC2injury 17 Acutemyocardialinfarct 20 Airwayassessment 24 Airwayblocksinthecontextofawakefibre-opticintubation 27 Amnioticfluidembolism 31 Analgesiaforcircumcision 33 Anaphylaxis 35 Antepartumhaemorrhage 37 Anticoagulantsandneuraxialblockade 39 AspirationwithanLMA 42 Atrialflutter 45 Awareness 48 Bariatricsurgeryanddrugsforobesity 52 Bends 56 Bleedingtonsil 58 Bronchopleuralfistula 59 Burns 62 Carbonmonoxidepoisoning 66 Caudaequinasyndrome 67 Cervicalspineinjury 70 Chronicobstructivepulmonarydisease 72 Chronicrenalfailure 74 Clearingthecervicalspineintheunconsciouspolytrauma victim 77 Coeliacplexusblock 80 Complexregionalpainsyndrome 82 Diabetes:peri-operativemanagement 84 vi Contents Diabeticketoacidosis 85 Down’ssyndrome 89 Duraltap 91 Eisenmenger’ssyndrome 93 Electro-convulsivetherapy 95 Epiduralabscess 98 Epilepsy 100 Guillain–Barre´ syndrome 104 Heartblockandtemporarypacing 107 Heparin-inducedthrombocytopaenia 109 Hypertensionandischaemicheartdisease 114 ICUneuropathy 118 ICUnutrition 119 ICUstressulceration 123 Infantilepyloricstenosis 125 Inhaledpeanut 128 Intracranialpressure 129 Ischaemicheartdisease 131 IVRAforDupuytrenscontractureandLAtoxicity 136 Jehovah’sWitness 139 Laparoscopiccholecystectomy 141 Latexallergy 142 Localanaesthesiaforcarotidendarterectomy 144 Lumbarsympathectomy 147 Lungcyst 149 Majorobstetrichaemorrhage 152 Malignanthyperthermia 155 Massivebloodtransfusion 157 Mitralstenosis 160 Mitralvalvedisease(chestX-ray) 162 Myastheniagravis 163 Myotonicdystrophy 166 Obesity 169 Obstructivesleepapnoea 172 Pacemakers 175 Paediatricday-casesurgery 178 Paediatricfluidmanagement 182 Penetratingeyeinjury 186 Phaeochromocytoma–peri-operativemanagement 189 Pneumonectomy 194 Post-operativeconfusion 196 Post-operativehypotension 198 Post-herpeticneuralgia 201 Pre-eclampsia 202 Pre-medication 205 Previousanaphylaxis 208 Problemsoftheprematurebaby 211 Raisedintracranialpressure 214 Contents vii Rheumatoidarthritis 217 Secondarybraininjury 220 Sicklecell 224 Spontaneouspneumothorax 227 Squintsurgery 233 Statistics–errorsintheinterpretationofdatafromclinical trials 237 Stridorpost-thyroidectomy 239 Tensionpneumothorax 242 Tetanus 243 Thyroidectomy 245 Trauma 248 Trigeminalneuralgia 250 Unconsciouspatient 252 Uncontrolledhypertension 254 Unexpecteddifficultintubation 256 Universalprecautions 260 Valvularheartdisease 262 Vomitinganddaysurgery 263 Wolff–Parkinson–Whitesyndrome 268 3 TheLongCases: ‘Theoneabout...’ 271 1 ...thewomanwithagoitreforanemergencylaparoscopy 271 2 ...themanwithpneumoniawhoneedsalaparotomy 279 3 ...thewomanwithamelanomaonherback 284 4 ...themanwithhypertensionandAFwhoneedsatotalhip replacement 289 5 ...theyoung,thyrotoxicwomanlistedforathyroidectomy 295 6 ...theRTAwithaflailchest 300 7 ...thechesty,obesemanhavingalaparotomy 306 8 ...theoldladywithafracturedhumerus 312 9 ...theobesewomanwithafracturedneckoffemur 318 10 ...theasthmaticchildwithtorsion 324 11 ...themanforatotalhipreplacementwithahistoryof previousDVT 330 12 ...thediabeticmanforTURP 336 13 ...thestridulouswomanforoesophagoscopy 342 14 ...thecollapseddrugaddict 348 15 ...theelderlywomanwithkyphoscoliosisforanurgent cholecystectomy 355 16 ...theelderlywomanforcataractextraction 360 17 ...theguywithchronicbackpain 366 18 ...thesmokerwithbellyacheandsepsis 371 19 ...atrialfibrillationpostAAArepair 378 20 ...pre-opassessmentofIHD 384 21 ...themanicdepressiveforadentalclearance 392 22 ...theunconsciousO/DinA&E 398 23 ...acraniotomyinapatientwithneurofibromatosis 403 viii Contents 24 ...thehead-injuredpatient 411 25 ...thetraumapatientinaccidentandemergency’ 417 Appendix1 AsystemforinterpretingandpresentingchestX-rays 422 Appendix2 InterpretationofcommonlyoccurringPFTs 424 Index 425