Upper and Lower Gastrointestinal Oncosurgery and Major Colorectal Surgery — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style upper and lower gastrointestinal oncosurgery and major colorectal surgery viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 64-year-old male with advanced antral adenocarcinoma is booked for an open radical subtotal gastrectomy and D2 lymphadenectomy. He has lost 12% of his body weight over 3 months, his serum albumin is 24 g/L, and haemoglobin is 8.2 g/dL. Describe your comprehensive preoperative workup, optimization, and anaesthetic plan including pain management.
• SCENARIO 2: A 70-year-old male with a history of hypertension and moderate COPD is scheduled for an elective laparoscopic-assisted low anterior resection for middle-third rectal cancer. Operative positioning requires steep Trendelenburg and prolonged pneumoperitoneum. Detail your intraoperative management strategy focusing on respiratory mechanics, haemodynamics, and fluid balance.
• SCENARIO 3: A 52-year-old female undergoing total proctocolectomy and ileoanal pouch anastomosis for refractory ulcerative colitis has been on systemic corticosteroid therapy (prednisolone 40 mg daily) for the past 9 months. Discuss your anaesthetic management with particular reference to perioperative steroid supplementation, fluid homeostasis, and regional analgesia.
• SCENARIO 4: A 48-year-old woman is scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. Outline the physiological derangements associated with hyperthermic chemotherapy and detail your anaesthetic plan to manage temperature changes, massive fluid loss, and metabolic alterations.