3rd Session (Obstetric, Paediatric, Neuroanaesthesia, Anaesthesia for Patients with Comorbidities)

Nov 2024

Station 1

Scenario: A 4 week old infant presents with persistent vomiting and a palpable olive mass in the abdomen
Provisional diagnosis (infantile hypertrophic pyloric stenosis)
Pharmacological and airway/respiratory differences in infants vs adults
Metabolic derangements of pyloric stenosis and its pathophysiology (including paradoxical aciduria)
Preop fluid management
Is this condition a surgical emergency?
General planning and timing of surgery
⁠Anaesthetic concerns
Airway management
Causes of bradycardia/hypotension, other potentially life-threatening cardiac issues in infants/pediatrics vs adults
Postop monitoring
Effects of metabolic alkalosis on oxygen delivery etc
Pain assessment and management for pyloromyotomy

Station 2

Scenario: A young patient presents with a thunderclap headache
Assessments to get the diagnosis
Risk factors of SAH
⁠What is GCS
Grading tools for SAH
Investigations
Systemic complications of SAH
Specific neurological complications of SAH (rebleeding, vasospasm & DCI, hydrocephalus)
Understanding DCI vs vasospasm
Anaesthetics concerns regarding coiling
Main anaesthetic contribution for interventional radiology success
During coiling, IR noted contrast extravasation, what is your diagnosis? What is the subsequent management of the patient
Hypotensive agents that can be used
Measures to reduce ICP
Management for an intraoperative ruptured aneurysm

Station 3

An obese parturient with asthma presents in active phase of labor and is referred for labor pain management
The labour pain pathway
Assessment and concerns in general
Labor analgesic options and their advantages/disadvantages. Ideal choice
Counseling of central neuraxial techniques
Challenges of central neuraxial techniques in the obese
Management of severe contraction pain
⁠Different LA’s and concentrations for epidural analgesia
Epidural modes of drug administration (infusion vs PCEA)

Station 4

An elderly patient with underlying chronic limb ischemia, IHD with 2VD (and history of recent stenting), DM, HTN, and stage 4 CKD is posted for aorto-bifemoral bypass KIV transmetatarsal amputation. Examination of the leg shows gangrenous changes with a foul smell
General approach to manage the patient, including points in the history, physical examination and investigations
Plan of anesthesia and justification
Invasive CO monitoring that can be considered
The patient subsequently develops restless at the OT airlock —> Differentials and subsequent management
ABG shows severe metabolic acidosis with hyperkalemia, hyperlactatemia —> Provisional diagnosis
⁠Principle of sepsis treatment in the surgical patient and role of source control
The surgeon is very keen to proceed with surgery, how do you approach the case?