Geriatric Anaesthesia, Frailty, Multimorbidity, and Postoperative Cognitive Dysfunction — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style geriatric anaesthesia, frailty, multimorbidity, and postoperative cognitive dysfunction viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: An 84-year-old woman with a history of long-standing hypertension, mild cognitive impairment, and osteoarthritis presents for emergency open repair of a strangulated femoral hernia. Her medications include lisinopril, amlodipine, and amitriptyline. Formulate a comprehensive anaesthetic plan covering preoperative risk stratification, choice of anaesthetic technique, haemodynamic targets, and measures to prevent postoperative delirium.
• SCENARIO 2: An 79-year-old male with severe diastolic dysfunction (HFpEF, left ventricular hypertrophy), type 2 diabetes mellitus, and baseline serum creatinine of 160 micromol/L is scheduled for elective open right hemicolectomy for colon carcinoma. Explain your anaesthetic induction strategy, intraoperative fluid and vasopressor titration, depth of anaesthesia monitoring, and post-anaesthetic recovery plan.
• SCENARIO 3: An 81-year-old male becomes acutely agitated, hallucinating, disoriented, and attempts to pull out his nasogastric tube and abdominal drains in the Post-Anaesthesia Care Unit (PACU) 90 minutes after an elective 4-hour open abdominal aortic aneurysm repair under general anaesthesia. Describe your diagnostic evaluation, exclusion of organic life threats, and pharmacological/non-pharmacological management of this acute delirium.
• SCENARIO 4: Discuss the physiological changes associated with aging in the cardiovascular, respiratory, renal, and central nervous systems, and defend your pharmacological modifications when administering intravenous induction agents, inhalational anaesthetics, opioids, and neuromuscular blocking drugs to a 90-year-old patient.