A 42-year-old male from a group home, who is baseline nonverbal with mental retardation, is brought into the hospital for confusion, muscle weakness, lethargy, poor oral intake, and abdominal pain. The patient is found to have an abdominal hernia. His laboratory results reveal a sodium level of 157 mEq/L. The surgeon is concerned that the hernia is incarcerated and wants to operate immediately. What are your concerns? Would you like to order any more labs or tests? How would you treat the hypernatremia? Would you delay this surgery if it was an elective hernia repair? If this is emergent, what is your anesthetic plan?

A 65-year-old male patient with hypertension, diabetes, and chronic renal failure on hemodialysis presents for an elective left arm arteriovenous fistula grafting. The patient unfortunately missed his dialysis and his last K+ was 6.7 mEq/L. The patient is asymptomatic. What are your concerns? What tests and labs do you want? Would you postpone the surgery? Would you demand hemodialysis first? Would you be less concerned if the patient was not on dialysis? If this case suddenly became an emergency, what is your anesthetic plan?

A 73-year-old female, following a motor vehicle collision, is scheduled for an urgent spine open reduction internal fixation (ORIF) due to a Chance fracture sustained while wearing a lap belt. Her medical history consists of congestive heart failure (ejection fraction is 35%), atrial fibrillation on warfarin (Coumadin) (current INR 3.1), iron deficiency anemia (hematocrit 27), and thrombocytopenia (platelets 78). She also takes aspirin 81 mg. How will you reverse the warfarin for surgery? How will you manage her anemia? Will you transfuse her prior to the surgery? What management strategies will you institute if blood loss is expected to be high? What if she refuses blood transfusion?