A famous vocalist presents to the operating room for removal of a vocal cord lesion. The surgeon is concerned about further damage to this patient’s vocal cords and requests that the patient not be intubated. Given the shared nature of the airway and assuming the patient is otherwise healthy, how would you manage the anesthesia and the airway for this case? One suggestion by the surgeon is to use high-frequency jet ventilation. How is this managed and what are your concerns with this form of ventilation? Are there any patients for whom this type of ventilation is not appropriate? What additional monitoring is required to perform this type of ventilation?

A 46-year-old female with temporal-mandibular joint (TMJ) disease presents for a TMJ arthroplasty. This patient is a 155 cm, 62 kg woman with no known allergies or medical problems. She conveys to you that when she underwent a tubal ligation 7 years ago she remembers waking up during the surgery. As she describes her previous anesthetic misadventure, her anxiety level increases. What do you make of the previous anesthetic history in this patient? What would you tell this patient to alleviate her fears for this surgery? What are your anesthetic plan and management options for a patient with a prior episode of anesthetic awareness? What patients are at the highest risk of experiencing awareness under anesthesia?

A 69-year-old female is scheduled to undergo a coronary revascularization, as well as an aortic valve replacement for severe aortic stenosis. Her past medical history is significant for a non-ST segment myocardial infarction (MI), hypertension, progressive aortic stenosis with mildly depressed left ventricular function, and diabetes mellitus. Her past surgical history is significant for endoscopic sinus surgery 3 years prior and a left femoral-distal bypass graft 2 years ago. She does not report any adverse anesthetic complications but does report a fall in her platelet count when she was hospitalized for lower extremity ischemia. What are your concerns? What pre-operative workup would you like? How does her medical history affect your intra-operative plans?

A 71-year-old man presents for a right hemicolectomy after a suspicious polyp was found during a routine colonoscopy. He has a past medical history of hypertension and sick-sinus syndrome for which he had a pacemaker placed 8 years ago. He is currently active, has no known drug allergies, and has been NPO for 16 hours except for a bowel prep. He last saw his cardiologist 1 year ago and was without any limitations according to the patient. What are your concerns? Does this patient need to be seen by his cardiologist prior to his surgery? What do you need to know about his pacemaker? Will the pacemaker affect your anesthetic?

A 71-year-old female was scheduled to undergo an elective total hip arthroplasty. Her activity level is minimal due to arthritic changes of her hips. She has a history of hypertension and hypothyroidism, both under good control with medication. Prior to her surgery, a systolic murmur was appreciated, prompting a full cardiac workup. A transthoracic echocardiogram revealed aortic stenosis with a peak gradient across the aortic valve of 48 mm Hg and a left ventricular ejection fraction of 35% with concentric hypertrophy. No evidence of stress-induced ischemia was appreciated on a dobutamine stress test.