Pharmacokinetics, Pharmacodynamics, and Intravenous Induction Agents — WACS Viva & Clinical Scenarios (Pharmacology and Applied Pharmacology)

Exam-style pharmacokinetics, pharmacodynamics, and intravenous induction agents viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 28-year-old male with ruptured spleen and Class IV haemorrhagic shock requires emergency laparotomy. His blood pressure is 68/38 mmHg and heart rate is 142 beats per minute. Detail your choice of intravenous induction agent, pharmacological rationale, and dosing strategy.
• SCENARIO 2: A 54-year-old female with Child-Pugh Class B liver cirrhosis and severe hypoalbuminaemia (serum albumin 20 g/L) presents for emergency repair of an incarcerated umbilical hernia. Explain the pharmacokinetic alterations affecting your intravenous anaesthetic drugs and your precise anaesthetic plan.
• SCENARIO 3: A 42-year-old male undergoing a 4-hour elective supratentorial craniotomy is scheduled for total intravenous anaesthesia. You do not have access to an automated target-controlled infusion pump. Describe your manual infusion regimen for propofol and remifentanil or fentanyl, accounting for context-sensitive half-time.
• SCENARIO 4: A 65-year-old hypertensive diabetic male with severe ischaemic cardiomyopathy and left ventricular ejection fraction of 25% requires emergency drainage of a peri-rectal abscess. Defend your selection of induction agent between etomidate, ketamine, and titrated propofol.