Challenging Case Coming Up

[sevoflurane]

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GA, aline, +/- epidural, at least one large bore either in the neck (preferably) or peripherally.

 

[Hoya11]

Well there is really. Some pulmonary hypertension guys would disagree with you. And oral examiners wouldnt like it phrased that way either.

By acknowledgement that sedation can exacerbate pulm htn with hypoxia hypercarbia etc, that's probably a better way of phrasing it...

And also with sedation : we haven't yet discussed the potential repercussion injury post clamp release. Sedation could make this even worse.

Lastly with sedative. What would you use? And how? Midaz no, ppf possibly but that has issues. Precede probably best but not as good sedative as ppf

All that to say, epidural and sedative would probably go fine but we have to tip our hat to what could go wrong with it

i think you can safely sedate this patient without clinically significant hypoxia and hypercarbia with an epidural in place to neutralize pain stimulus, using precedex, versed, ketamine, etc...