Ilustrasi Kasus 2
A 27-year-old woman presents to the emergency department complaining of abdominal pain, nausea, and vomiting. Her pain began in the peri-umbilical region and has now migrated toward the right lower quadrant of the abdomen. Her serum HCG is negative. A surgery consult is obtained, and based on her history, physical, and findings suggestive of acute appendicitis seen on abdominal CT scan, she is scheduled for emergency appendectomy. The patient is otherwise healthy and takes no regular medications. Her surgical history includes a tonsillectomy at age 10, and a dilatation and curettage (D&C) at age 25. She has not had problems with previous anesthetics.
➤ What would you include in your preoperative evaluation of this patient?
➤ What medications will you use for induction and maintenance of anesthesia?
➤ How will you manage postoperative pain in this patient?
Comprehension Questions
1. During a rapid sequence induction, when would it be appropriate to release cricoid pressure?
A. When the patient becomes unconscious.
B. After the induction agent has been given but before the neuromuscular blocking drug is given.
C. After proper placement of the endotracheal tube has been confirmed.
D. Cricoid pressure is not indicated in this instance.
2. Which of the following is the most significant risk factor for postoperative nausea and vomiting?
A. Female gender
B. Surgery on the breast
C. Smoking
D. Nonsteroidal anti-inflammatory agents given during surgery
E. Age over 60 years
3. Which of the following is the major advantage of spinal anesthetic in the pregnant patient?
A. A peripheral neuraxial block minimizes central sensitization to pain.
B. The level of a spinal anesthesia necessary for an appendectomy is quite low.
C. Spinals rarely cause headaches in pregnant patients.
D. A spinal anesthetic allows for anesthesia without significant plasma concentrations of the anesthetic.
➤ What would you include in your preoperative evaluation of this patient?
➤ What medications will you use for induction and maintenance of anesthesia?
➤ How will you manage postoperative pain in this patient?
Comprehension Questions
1. During a rapid sequence induction, when would it be appropriate to release cricoid pressure?
A. When the patient becomes unconscious.
B. After the induction agent has been given but before the neuromuscular blocking drug is given.
C. After proper placement of the endotracheal tube has been confirmed.
D. Cricoid pressure is not indicated in this instance.
2. Which of the following is the most significant risk factor for postoperative nausea and vomiting?
A. Female gender
B. Surgery on the breast
C. Smoking
D. Nonsteroidal anti-inflammatory agents given during surgery
E. Age over 60 years
3. Which of the following is the major advantage of spinal anesthetic in the pregnant patient?
A. A peripheral neuraxial block minimizes central sensitization to pain.
B. The level of a spinal anesthesia necessary for an appendectomy is quite low.
C. Spinals rarely cause headaches in pregnant patients.
D. A spinal anesthetic allows for anesthesia without significant plasma concentrations of the anesthetic.