Clinical Case 56

8/2/2019 Clinical Case 56

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TAMPARIA, Darwin R.


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40 year old male patient

- will undergo mitral valve replacement

- DM, hypertension, renal insufficiency


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-is a kind of metabolic disease that is broughtabout by either the insufficient production ofinsulin or the inability of the body to respond

to the insulin formed within the system.


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-High blood pressure; transitory or sustainedelevation of systemic arterial blood pressure toa level likely to induce cardiovascular damage

or other adverse consequences.


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-malfunction of the kidneys resulting from anyof a number of causes, including infection,trauma, toxins, hemodynamic abnormalities,

and autoimmune disease, and often resultingin systemic symptoms, especially edema,hypertension, metabolic acidosis, and uremia.


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-Echocardiogram

-Color-flow Doppler examination

-Cardiac catheterization

-Chest x-ray

-ECG (may show arrhythmias such as atrialfibrillation)

-Chest MRI -CT scan of the chest


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-surgical treatment of valvular disease. Mitralvalve repair is used to treat regurgitation orstenosis of the mitral valve. It is treated by

removing the diseased valve and implanting anartificial valve (valve replacement).


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Non-pharmacologic:

Diabetes mellitus

- a number of lifestyle modification

- (DPP) diet and exercise for 30 min/day fivetimes/week

-Maintain normal BMI and engage in regularphysical activity


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Pharmacologic:

Diabetes mellitus

- Type 1(or insulin dependent) wide range offormulations of Insulin

- Type 2 Sulphonylurea group (e.g.

chlorpropamide , glibenclamide , tolbutamide -biguanide (e.g metformin)

-alpha-glucosidase inhibitors


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Non-pharmacologic:

Hypertension

- Health promoting lifestyle modifications

- weight loss

- reduction of dietary naCl

- food preference


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Pharmacologic:

Hypertension

- Diuretics

- Beta Blockers

- Calcium channel blocker

- ARB

- Aldosterone Antagonist


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General Anesthesia : Local Anesthesia :

Inhalational IV


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Gaseous Anesthetics:

-Nitrous oxide

-Cyclopropane

Volatile Anesthetics:

A. Non-Halogenated

-Ether

-Chloroform


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B. Halogenated

-Halothane

-Enflurane

-Isoflurane

-Methoxyflurane

-Sevoflurane

-Desflurane


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-Isoflurane (2-chloro-2-(difluoromethoxy)-1,1,1-trifluoro-ethane) is a halogenated ether usedfor inhalational anesthesia.

-Its name comes from being a structural isomerof enflurane

-produce adequate muscle relaxation

-less nephrotoxic enflurane -less hepatotoxic halothane


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Brand names:

-Forane

-Terrell

Drug interactions:

May increase the levels/effects of:

-DOPamine

-Epinephrine

-Ephedrine

-NorEpi


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-absorbtion from alveoli into pulmonarycapillary blood

-distribution in the body

-metabolism -elimination, principally via lungs


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-Onset of action: 7-10 minutes (odor limitsinhalation rate)

-Duration: emergence time: depends on blood

concentration when discontinued -Metabolism: minimally hepatic

-Excretion: primarily as unmetabolized exhaled

gases


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-Shivering, nausea, vomiting and ileus havebeen observed in the postoperative period.Resp depression, hypotension, arrhythmias,

malignant hyperthermia.

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Clinical Case 56