The case A 28-year-old female presents for a laparoscopic cholecystectomy for acute cholecystitis. She is 18 weeks pregnant (G1P0). She has no other past medical history and no allergies. She had general anesthesia in the past for a tonsillectomy at age 7, with no anesthetic complications. The patient was symptomatic and a decision was made to do the operation as conservative treatment had failed. Her obstetrician was contacted regarding fetal monitoring. She recommended that fetal heart tones be monitored immediately prior to induction and then postoperatively as well. Once the patient was in the operating room (OR), she was laid supine on the OR table with some lateral uterine displacement, and standard ASA monitors were applied. A labor and delivery nurse recorded the fetal heart rate at approximately 160 beats per minute. The fetal monitoring was then discontinued. The patient received a nonparticulate antacid in the holding area preoperatively. A rapid-sequence induction was performed with propofol, and neuromuscular relaxation was achieved with succinylcholine. Once general anesthesia was attained, the surgery commenced. At conclusion of the operation, the patient was extubated and taken to the postanesthesia recovery unit. The same labor and delivery nurse was available to monitor the fetal heart beat, and it was documented as being within normal limits. The patient did very well postoperatively and was discharged home from the hospital on postoperative day 2. Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
|Original language||English (US)|
|Title of host publication||Core Clinical Competencies in Anesthesiology: A Case-Based Approach|
|Publisher||Cambridge University Press|
|Number of pages||3|
|ISBN (Print)||9780511730092, 9780521144131|
|State||Published - Jan 1 2010|
ASJC Scopus subject areas