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The Anaesthesia Science Viva Book - part 4

Những mái nhà (từ trên xuống) bao gồm da, mô dưới da, và sâu fascia, bao gồm các-mạc bicipital. ● Trong thời hạn hố nằm gân của cơ bắp tay và một phần các thiết bị đầu cuối của động mạch cánh tay, nằm ở trung tâm của hố trước khi phân chia của nó vào động mạch trụ xuyên tâm và đối diện với cổ của bán kính. | CHAPTER 3 The anaesthesia science viva book who have previously been taking an HPA suppressant dose but have discontinued this within 3 months from surgery should be assumed to have residual suppression. They should be tested wherever possible because exogenous steroid supplementation is not innocuous. Patients on high dose immunosuppressant doses must continue these peri-operatively. If taking more than 10 mg prednisolone daily and undergoing minor to moderate surgery Continue the usual dose pre-operatively. Give hydrocortisone 25 mg intravenously at induction. Prescribe hydrocortisone 100 mg in first 24h by continuous infusion . If taking more than 10 mg daily and undergoing major surgery Continue the usual dose pre-operatively. Give hydrocortisone 25 mg intravenously at induction. Prescribe hydrocortisone 100 mg day 1 for 48-72 h by continuous infusion . Further direction the viva could take You may be asked finally about the dangers of supraphysiological doses of exogenous corticosteroids. Complications of steroid therapy make for a long list although this question relates to problems related to acute administration. Complications of acute therapy Excess catabolism hyperglycaemia immunosuppression peptic ulceration delayed wound healing myopathy which can occur acutely steroid psychosis which is related to sudden large increases in blood level fluid retention and electrolyte disturbance including hypokalaemia. If there remains time you may be asked to fill it with a list of the numerous complications related to long-term treatment. Complications of chronic therapy In addition to the above these include immunosuppression hypertension increased skin fragility posterior subcapsular cataract formation osteoporosis hypocalcaemia due to reduced gastrointestinal absorption negative nitrogen balance and Cushing s syndrome. 98 CHAPTER 3 Oxygen delivery Commentary An organism survives by means of effective oxygen delivery to mitochondria. There has been considerable .