An 11-year old boy with sickle cell disease is scheduled for laparoscopic cholecystectomy. He presented to the emergency room the previous night with acute abdominal pain. He has a hemoglobin of 8.1. Temperature is 38.4. The surgeon wants to do procedure ASAP because he is concerned about cholangitis. He has a had one to two painful vaso-occlusive crises a year requiring hospitalization. He is not on any prophylactic regimen. After the completion of the PBLD, the participant should be able to identify the essential components of preoperative evaluation and preparation of the patient with sickle cell disease. Risks and benefits of various transfusion and pain management strategies and causes of perioperative morbidity will be discussed.
A 2-year old girl is scheduled for emergency suspension microlaryngoscopy and laser surgery of the airway because of increasing airway obstruction. She is known to have a history of laryngeal papillomata. On examination, she has stridor during inspiration and expiration. Her voice is a whisper. Her oxygen saturation is 93%. Her mother states she "freaks" out during mask induction. After the completion of the PBLD, the participant should be able to discuss the preoperative concerns regarding infants and children with airway papillomata. The participant will become familiar with anesthetic management strategies for laser airway surgery, including specifics of anesthetic and surgical equipment, and precautions for minimizing risk of airway fire during such surgery.
A 9-year old girl is scheduled for posterior spinal instrumentation for scoliosis with a rapidly progressive curve now measuring 55 degrees. The patient has had three surgeries for congenital heart disease, the last being a Fontan. After the completion of the PBLD, the participant should be able to discuss the preoperative evaluation of patients with complex congenital heart disease; intraoperative monitoring, including neurophysiologic concerns; ventilation and blood volume/replacement issues in light of patients cardiorespiratory pathophysiology will be discussed.
An 8-year old girl is brought to the emergency department after vomiting blood at home. She had lingual tonsillectomy 10 days before and was found to be a difficult airway. She had a hamburger for lunch 2 hours ago. Hemoglobin is 9.2. After the completion of the PBLD, the participant should be familiar with airway management techniques for the difficult airway in young children in light of airway bleeding and/or full stomach concerns.
A 4-week old infant presents for pyloromyotomy. He arrives in the operating room with an IV which appears infiltrated. He has facial features consistent with Pierre Robin anomaly. After the completion of the PBLD, the participant should be able to discuss the important elements of preoperative evaluation in infants with pyloric stenosis, techniques for airway management of neonates with difficult airways, newer surgical techniques and the relative merits of regional anesthesia techniques including spinal.
A 2-year old with trisomy 21 is scheduled for EUA/bronchoscopy because of suspected airway foreign body. She has a h/o RAD. 2 hours ago she was playing with legos and started coughing and became transiently cyanotic. RR is 36, saturation is 96%, bilateral wheezing is heard, R>L. After the completion of the PBLD, the participant will be familiar with preoperative concerns and evaluation of patients with trisomy 21, induction, airway and anesthetic management strategies for infants with suspected airway foreign bodies.
A 4-month old infant severely affected with Apert's syndrome for major craniofacial reconstruction. After the completion of the PBLD, the participant should be able to identify the critical features of perioperative planning for major craniofacial surgery: preoperative assessment; induction concerns including airway management and elevated intracranial pressure; intraoperative monitoring; preparation for massive blood loss and replacement; postoperative expectations.
A 10-week old former 29-week gestation infant for bilateral inguinal herniorrhaphy. Infant has been home for one month prior to surgery on home apnea monitoring. Parents report several alarms, but they are questionable because the baby is fine when they check him. Spinal anesthetic selected. Before surgeons have finished the first side, infant becomes restless and agitated, crying intermittently. After the completion of the PBLD, the participant will be able to develop a management plan for this patient; list the various options and their consequences, including discharge timing; the use and implications of respiratory stimulants; strategies for optimizing success of spinal anesthetics in this scenario.
A 12-year old boy is scheduled for a Nuss procedure. Surgeon requests epidural for postoperative pain management "because these things hurt like the dickens". Parents state that they have heard with a properly placed epidural "our boy will have no pain". After the completion of the PBLD, the participant will be familiar with optimal insertion and positioning of epidural catheters for thoracic surgical procedures: awake vs anesthetized placement; what general anesthetic; drug combinations for epidural administration, both intra- and postoperative; what to do about the imperfect or failed epidural; strategies for transition from epidural to oral analgesia.
A 7-year old presents with h/o poor growth, multiple endocrine abnormalities and is found to have pituitary tumor. Surgeon plans a craniotomy with sub-frontal approach. Patient is on multiple medications, including DDAAVP. After the completion of the PBLD, the participant will be able to develop a preoperative evaluation and management plan for patients with endocrine dysfunction, including diabetes insipidus; intraoperative anesthetic management and monitoring of neurophysiologic function; strategies for emergence and postoperative care.
An 11-year old unrestrained passenger in an MVA presents with multiple traumatic injuries including closed head injury, bilateral femoral fractures and an open elbow fracture. Preoperative chest x-ray shows bilateral pulmonary infiltrates. After the completion of the PBLD, the participant should be able to describe the differential diagnosis of pulmonary infiltrates in multiple trauma patients and prioritize the evaluation and management plans necessary to conduct resuscitation, monitoring and anesthetic care.
An 4-year old, 15kg infant with ESRD due to polycystic kidney disease is scheduled for living-related kidney transplant. Patient has BP 115/75. Hgb is 8.6 Potassium is 5.5. Patient is on peritoneal dialysis. Pt is on Captopril, Epogen, bicitra, vitamins and titralac. Donor is the patient's mother, who weighs 80 kg. After the completion of the PBLD, the participant will be able to discuss appropriate preoperative evaluation and preparation for kidney transplant; differences between cadaveric and living-related transplants; anesthetic management; intra- and postoperative management of hemodyamics and blood loss.