/practice/cases
Surgical case library
Every surgery, grouped by specialty. Each case: patient phenotype, anesthetic plan, biggest 3-6 anesthesia concerns by phase (preop / induction / intraop / emergence / pacu), and mock-defense scenario openers built from the case. 95 cases live across 15 specialties — actively expanding.
General Surgery
15 casesLap chole, exploratory lap, hernias, bowel resections, appendectomy
Laparoscopic Cholecystectomy
Most commonly female, 30s–50s, BMI often elevated, occasional cardiopulmonary disease. Typical American: GERD, obesity, sometimes diabetes. Outpatient unless conversion or comorbidity.
Exploratory Laparotomy (Emergent)
Acute abdomen — perforated viscus, ischemic bowel, ruptured AAA, gunshot/trauma. Often septic, hypovolemic, full stomach. Age varies wildly.
Laparoscopic Sleeve Gastrectomy
BMI ≥ 40 (or ≥ 35 with comorbidity). Often: T2DM, OSA (frequently undiagnosed), HTN, hypercholesterolemia, GERD, hypothyroidism. Age 30-60 typical.
ECT (Electroconvulsive Therapy)
Severe depression / catatonia / treatment-resistant schizophrenia. Multiple sessions (typically 6-12 across 3-4 weeks). Often elderly + medical comorbidities. Same patient back q2-3 days.
Inguinal Hernia Repair (open or lap)
Adult male predominantly (10:1), elderly more incarceration risk. Outpatient surgery typical. May be elective (reducible) or emergent (incarcerated/strangulated).
Laparoscopic Appendectomy
Most often young adult (15-40), acute appendicitis. May be febrile, dehydrated, leukocytosis. Pediatric appendicitis is the most common surgical emergency in kids 6-15.
Whipple (Pancreaticoduodenectomy)
Typically 60s–70s, painless jaundice, weight loss, often poor nutrition. Most common indication is pancreatic head adenocarcinoma; also ampullary, distal CBD, or duodenal tumors. Often diabetic, frequently with biliary stents already in place.
Colectomy / Bowel Resection
Wide range: colorectal cancer (60s–70s, often anemic, sometimes obstructed), inflammatory bowel disease (younger, on biologics + steroids), diverticular disease. May be open, laparoscopic, or robotic. Mostly elective but can be emergent for perforation/obstruction.
Roux-en-Y Gastric Bypass
BMI ≥ 40 (or ≥ 35 with comorbidities). Almost universally OSA, hypertension, T2DM, GERD, possible obesity hypoventilation, NASH. Usually well-screened in pre-bariatric clinic with optimization done. 30s-60s.
Pheochromocytoma Resection
Catecholamine-secreting adrenal (or extra-adrenal/paraganglioma) tumor. Classic triad: episodic headache + palpitations + diaphoresis with paroxysmal hypertension. Often misdiagnosed for years. May present with stroke, MI, cardiomyopathy, or as incidentaloma. Often associated with MEN2, VHL, NF1.
Splenectomy (Open or Laparoscopic)
Indications: ITP, hereditary spherocytosis, lymphoma staging, traumatic rupture (emergent), splenic abscess. Elective patients often pre-vaccinated (encapsulated organisms). Trauma patients hemodynamically unstable.
Nissen Fundoplication / Hiatal Hernia Repair
GERD refractory to PPI, large hiatal hernia, sometimes Barrett's. Often obese, cardiopulmonary comorbidities. Older patients with paraesophageal hernia at risk for incarceration.
Adrenalectomy (Non-Pheo)
Cushing's syndrome (cortisol excess), Conn's (aldosteronoma → HTN, hypokalemia), incidentaloma, metastasis. Each has distinct preop physiology. Cushing's = obese, fragile skin, hyperglycemia, HTN; Conn's = HTN + low K.
ERCP (Off-Floor / Endoscopy)
Choledocholithiasis, pancreatitis, biliary obstruction, post-cholecystectomy stricture. Often elderly, malnourished, septic. Cholangitis cases very sick.
Mastectomy + Axillary Lymph Node Dissection
Breast cancer, often middle-aged to elderly female. Some on neoadjuvant chemo (cardiotoxic anthracyclines, capecitabine). Often anxious. Comorbidities variable. May be combined with immediate reconstruction.
Vascular
6 casesCEA, AAA, fem-pop, AV fistula, EVAR
Carotid Endarterectomy (CEA)
Typically 60–80, atherosclerotic, often with CAD + HTN + DM + COPD + hyperlipidemia. Symptomatic (TIA, amaurosis fugax) or asymptomatic ≥ 70% stenosis.
Open Abdominal Aortic Aneurysm Repair
Typically male 65–85, multi-vessel CAD, COPD, smoker. Symptomatic = back/flank pain or pulsatile mass. Ruptured = hypotensive + altered mental status (true emergency, separate plan).
Arteriovenous Fistula Creation (Hemodialysis Access)
ESRD pre- or peri-dialysis. Multi-comorbid (HTN, DM, CAD, CHF, anemia). Often elderly + frail. Outpatient or 23-h obs.
EVAR (Endovascular AAA Repair)
60s–80s with infrarenal AAA ≥ 5.5 cm (or symptomatic/rapidly enlarging). Heavy comorbidity load: COPD, CAD, CKD, prior MI/CABG, diabetes. EVAR preferred over open in higher-risk patients given lower short-term mortality.
Femoral-Popliteal Bypass
60s-80s, severe PAD with rest pain, non-healing ulcer, or limb threat. Universal CAD, often diabetes, smoker, CKD, COPD. ASA III-IV.
Carotid Stenting
Symptomatic carotid stenosis (TIA/stroke), or asymptomatic high-grade in poor surgical candidates. Heavy CAD/PAD/COPD comorbidity.
Cardiac
9 casesCABG, valve replacement, TAVR, AICD
CABG (on-pump, elective)
Typically male 55–75, multi-vessel CAD, often diabetic, ex-smoker, on dual antiplatelet + statin + β-blocker. May have preserved or reduced EF. Last meal NPO since midnight.
Surgical Aortic Valve Replacement (SAVR)
Severe aortic stenosis (AVA < 1.0 cm², peak gradient > 40 mmHg) or aortic regurgitation. Typically 70-85, often with CAD, HTN, AF. May have syncope, angina, or CHF as presenting symptom.
TAVR (Transcatheter Aortic Valve Replacement)
Severe AS with high surgical risk (STS score > 8% historically; expanding to intermediate + low risk). Typically 75-95, multi-comorbid, often deemed too sick for SAVR. Outpatient or 1-night admission becoming common.
AICD / Pacemaker Placement
AICD: ICM/NICM with EF < 35%, sustained VT/VF, primary or secondary prevention. PPM: heart block, sick sinus, AF with bradycardia. Often elderly + multi-comorbid.
Mitral Valve Replacement / Repair
Severe mitral regurgitation (degenerative, functional, ischemic) or stenosis (rheumatic — declining incidence). Often AF, pulmonary hypertension, dilated LA. EF preserved early in MR (eccentric hypertrophy compensates), drops late.
LVAD Insertion (HeartMate 3)
End-stage HF, EF < 25%, refractory to medical therapy. Bridge to transplant or destination therapy. Often inotrope-dependent on arrival. Frequent comorbidities: renal dysfunction, pulmonary HTN, RV dysfunction.
Off-Pump CABG (OPCAB)
Selected CAD patients — calcified aorta (avoid manipulation), elderly, renal dysfunction, recent stroke. Increasingly used. Surgeon-dependent.
Pacemaker / ICD Generator Change
Battery depletion (5-10 yr life). HF with CRT/ICD. Prior MI. AF with VVI. Comorbidities significant in this population.
Elective Cardioversion
AF/atrial flutter for rate/rhythm control. Patients have undergone AC therapy (3 wks) or TEE-guided. Often elderly, comorbidities, on beta-blockers or amiodarone.
Thoracic
5 casesLobectomy, VATS, esophagectomy, mediastinoscopy
Lobectomy with One-Lung Ventilation (VATS or open)
Lung cancer or large nodule. Typically 55–80, smoker / ex-smoker, COPD often present, possibly reduced DLCO + FEV1. Consider preop pulmonary rehab + smoking cessation.
Mediastinoscopy
Lung cancer patient for nodal staging, or mediastinal mass biopsy. Often: smoker, COPD, sometimes pre-radiation. Important: anterior mediastinal mass can be life-threatening — separate workup.
Esophagectomy (Ivor Lewis or McKeown)
Esophageal cancer, age 55-75, often smoker, GERD/Barrett's, possibly post-chemoradiation (deconditioned, malnourished). High-risk operation with 5-10% perioperative mortality.
VATS Lobectomy
60s-70s, smoker or former smoker, NSCLC stage I-II most common. Often COPD + CAD + reduced FEV1. PFTs reviewed: predicted postop FEV1 + DLCO matters. Some have completed neoadjuvant chemo.
Open Thoracotomy Lobectomy
Lung cancer not amenable to VATS (large tumor, central, prior surgery, expected LN dissection complexity). Same comorbidity profile as VATS.
Neurosurgery
11 casesCraniotomy, spine fusion, awake crani, aneurysm clipping
Supratentorial Craniotomy (tumor resection)
Usually 40–70, brain tumor (glioma, meningioma, mets). May have raised ICP, seizures, focal neuro deficit. Often on dexamethasone + AEDs (levetiracetam).
Lumbar Spine Fusion (Posterior Instrumented)
Spinal stenosis, spondylolisthesis, herniated disc with failed conservative management. Typically 50-75. Comorbidities common (DM, CAD, smoker). Chronic pain + opioid tolerance frequent.
Posterior Fossa Craniotomy (sitting or lateral)
Tumors of cerebellum, brainstem, CP angle (vestibular schwannoma); aneurysms; trigeminal neuralgia microvascular decompression. Age 30-70. May have cranial nerve deficits, hydrocephalus.
Cerebral Aneurysm Clipping
Two populations: (1) ruptured (SAH) — emergent, often poor neuro grade, vasospasm risk; (2) unruptured — elective, often discovered incidentally. Mean age 50s. Female predominant. HTN + smoking + family history.
Awake Craniotomy
Tumor (often glioma) or epileptic focus near eloquent cortex (motor, sensory, language). Patient must be able to cooperate during awake mapping — no severe anxiety, deafness, severe aphasia, or pediatric (rare). Pre-op neuropsych evaluation + extensive counseling.
Transsphenoidal Pituitary Resection
Pituitary adenoma (functional: prolactin, GH/acromegaly, ACTH/Cushing's, TSH; non-functional: mass effect). Acromegaly = airway concerns. Cushing's = HTN, glucose, OSA. Apoplexy = emergency.
ACDF (Anterior Cervical Discectomy + Fusion)
Cervical radiculopathy or myelopathy from disc herniation, spondylosis. 40s-70s. Often otherwise well; some with significant comorbidities. Myelopathy patients = fall risk, careful positioning.
Deep Brain Stimulator Insertion
Parkinson's disease (most common), essential tremor, dystonia. 50s-70s. Patients often on dopamine agonists, levodopa, sometimes deprenyl (MAOI) — drug interactions.
Ventriculoperitoneal Shunt (Pediatric)
Hydrocephalus: post-IVH preemie, congenital (aqueductal stenosis, Chiari II/myelomeningocele), tumor, post-meningitis. Infants → adolescents. Often emergent for raised ICP.
Burr Hole / Subdural Hematoma Evacuation
Chronic subdural: elderly (60s-90s) with falls, on AC, often dementia. Acute subdural: trauma, often poor neuro grade. Epidural: lucid interval after head trauma.
Endovascular Thrombectomy (Acute Ischemic Stroke)
LVO (large vessel occlusion) acute stroke within thrombectomy window (< 24 hr selected with imaging). NIHSS often ≥ 6. Elderly, AF, HTN, DM common. May be on tPA already.
Orthopedic
6 casesTHA, TKA, ORIF hip, shoulder, scoliosis
Total Knee Arthroplasty (TKA)
Typically 60–80, OA-driven, often obese, frequently HTN + diabetes + sometimes CAD. Outpatient or 1-night admit. Increasing use of regional anesthesia + ERAS pathways.
Total Hip Arthroplasty (THA)
Typically 60–80, OA or AVN, often obese, frequent comorbidities (HTN, DM, CAD). 'Geriatric' THA patients can be 80+ with hip fracture — very different risk profile.
Geriatric Hip Fracture ORIF
80-95 years old, falls from standing height, multiple comorbidities (CAD, AF on anticoagulation, CKD, dementia, sarcopenia). Often delirious from pain + opioids before arrival. Mortality 5-10% at 30 days, 25% at 1 year.
Scoliosis Spinal Fusion (Adolescent Idiopathic)
Adolescent (12-18) with adolescent idiopathic scoliosis (AIS), Cobb angle > 50°. Otherwise healthy in AIS. Or syndromic scoliosis (cerebral palsy, neuromuscular) — much more complex.
Shoulder Arthroscopy with Interscalene Block
Rotator cuff repair, labral repair, acromioplasty. Age 40-70 typical, sometimes athletes younger. Often outpatient. Beach-chair OR lateral decubitus.
Knee Arthroscopy / ACL Reconstruction
Younger (20s-40s) athletic injury most common; older for meniscal repair. Otherwise healthy mostly. Outpatient.
OB / Gynecology
6 casesCesarean, labor epidural, D&C, hysterectomy
Cesarean Section (elective, term)
Term pregnant woman (37+ weeks), repeat C/S or breech or maternal request. Aspiration risk by definition. Possible PIH, GDM, obesity. Most awake under spinal.
Emergent Cesarean Section ('crash C/S')
Acute fetal distress (Cat III tracing, prolonged decel, cord prolapse, placental abruption) requiring delivery within minutes. May or may not have epidural in place. Full stomach by definition. Clock starts ticking.
Labor Epidural Placement
Term pregnant woman in active labor (4-7 cm typically). Wants pain relief. Most are healthy; some with PIH, GDM, BMI 40+, prior failed regional. May be cooperative or in extreme distress.
Total Abdominal Hysterectomy (TAH-BSO)
Indications: fibroids, endometrial cancer, ovarian mass, pelvic pain. Age 40-70 typical. Often: anemic from chronic bleeding, possibly post-radiation, sometimes post-chemo for cancer.
Cesarean — Preeclampsia / HELLP
Preeclampsia: BP ≥ 140/90 + proteinuria or end-organ dysfunction after 20 wk gestation. Severe features: SBP ≥ 160, DBP ≥ 110, plt < 100k, LFTs 2× upper, Cr > 1.1, pulmonary edema, headache, visual changes, RUQ pain. HELLP: hemolysis + elevated liver enzymes + low platelets.
Postpartum Hemorrhage (Operative Management)
Active hemorrhage post-delivery — atony (#1 cause), retained products, lacerations, placenta accreta spectrum, coagulopathy. Often previously stable patient now exsanguinating. Sometimes already with neuraxial in place from labor/cesarean.
Genitourinary
4 casesTURP, prostatectomy, nephrectomy, lithotripsy
TURP (Transurethral Resection of Prostate)
Typically 65-80 year old male with BPH causing obstructive symptoms (hesitancy, weak stream, incomplete emptying). Comorbidities common — CAD, HTN, DM, CKD. Lithotomy position.
Laparoscopic Radical Nephrectomy
Renal cell carcinoma. Age 50-75. Often: smoker, HTN, sometimes paraneoplastic syndrome (anemia, hypercalcemia, polycythemia). Lateral decubitus, kidney rest position.
Robotic-Assisted Radical Prostatectomy
Localized prostate cancer, age 50-75, otherwise often healthy. Steep Trendelenburg + insufflation = unique anesthesia challenge.
Cystoscopy / TURBT
Cystoscopy: any age, often elderly with hematuria workup or surveillance. TURBT (resection of bladder tumor): typically older, smokers, often comorbid. Some recurrent + frequent visits.
ENT
7 casesTonsillectomy, FESS, microlaryngoscopy, thyroidectomy
Total Thyroidectomy
Female > male 4:1, range 30-70. Indications: thyroid cancer, large goiter, hyperthyroidism (Graves) refractory to medical therapy. Patient should be euthyroid before surgery (or risk thyroid storm intraop).
Microlaryngoscopy with Jet Ventilation
Vocal cord lesion (polyp, papilloma, dysplasia, early carcinoma), subglottic stenosis. Often: smoker, GERD, CAD. Shared airway with surgeon; high-stakes airway management.
Awake Fiberoptic Intubation (anticipated difficult airway)
Anticipated difficult airway: anatomy (small mouth, large tongue, limited neck mobility, micrognathia), pathology (oral/laryngeal tumor, RA cervical spine, prior radiation, trauma), or unstable C-spine.
FESS (Functional Endoscopic Sinus Surgery)
Chronic sinusitis refractory to medical therapy, nasal polyposis, mucocele. Often adult 30-60. Some have aspirin-exacerbated respiratory disease (Samter triad: asthma + polyps + ASA sensitivity).
Laryngectomy + Radical Neck Dissection
Advanced laryngeal/hypopharyngeal cancer. 60s-70s, heavy smokers + drinkers, malnourished, often prior radiation. COPD + CAD + cirrhosis common. Often difficult airway preoperatively.
Rigid Bronchoscopy / Foreign Body Removal
Pediatric: foreign body aspiration (peanut classic), often 1-3 yo, witnessed event vs incidentaloma. Adult: massive hemoptysis, central airway tumor, stent placement. Sometimes emergent.
Tonsillectomy (Adult)
Adults: chronic tonsillitis, OSA from large tonsils, tumor. Higher complication rate than pediatric: more pain, more bleeding (delayed). OSA common.
Ophthalmology
4 casesCataract, vitrectomy, oculoplastics
Cataract Extraction (MAC + topical)
Elderly (70-90), often multiple comorbidities (CAD, COPD, dementia, deafness). Outpatient. Simple anesthetic but tricky population — patient needs to stay still + cooperative for ~15 min.
Vitrectomy / Retinal Detachment Repair
Diabetic retinopathy (vitreous hemorrhage, traction detachment), rhegmatogenous retinal detachment, macular hole. Often diabetic, hypertensive, anticoagulated. Awake/MAC commonly preferred but GA selected for long cases or anxiety.
Strabismus Repair (Pediatric)
Children 1-10 years usually. Otherwise healthy. Some with associated syndromes (cerebral palsy, Duane's, congenital fibrosis). Outpatient.
Trabeculectomy / Glaucoma Surgery
Open-angle or angle-closure glaucoma, often elderly, on multiple eye drops (timolol = systemic beta-blocker absorption). Diabetes, HTN common.
Plastics & Reconstructive
4 casesFree flap, reduction mammoplasty, abdominoplasty
Free Flap Microvascular Reconstruction
Post-cancer (head/neck, breast), post-trauma, or chronic wound reconstruction. Often: smoker, chemo-treated, age 40-70. Long surgery (8-14h). Goal: protect the flap.
Bilateral Reduction Mammoplasty
Mostly female, 30-60, BMI often elevated, large pendulous breasts causing back/neck/shoulder pain. Insurance-covered for medical necessity (pain + dermatologic complications) vs. cosmetic.
Cleft Lip / Palate Repair
Cleft lip: typically 3-6 months, healthy infant. Cleft palate: 9-18 months. Some with syndromes (Pierre Robin, 22q11, Stickler, Treacher Collins) — difficult airway. Often otitis media + URI.
DIEP Flap Breast Reconstruction
Post-mastectomy reconstruction (immediate or delayed). 40s-60s. Often post-radiation. Comorbidities: smoking history, DM, prior abdominal surgery (relative contraindication).
Trauma & Emergency
2 casesDamage-control lap, splenectomy, ORIF
Damage-Control Laparotomy (Polytrauma)
Penetrating abdominal trauma, blunt with hemodynamic instability, or 'destruction' injuries. Often: hypotensive, acidotic, coagulopathic, hypothermic on arrival. Time-critical.
Emergent Thoracotomy (Trauma)
Penetrating chest trauma + signs of life lost in ED or shortly after. Massive hemothorax > 1500 mL. Pericardial tamponade. Cardiac wound. Often arrest or peri-arrest. Surviving rate < 10% overall, < 1% in blunt trauma.
Pediatric
11 casesT&A, PE tubes, hypospadias, pyloric stenosis, congenital cardiac
Tonsillectomy & Adenoidectomy (Pediatric)
Usually 3–10 years old. Recurrent tonsillitis or OSA. Often current/recent URI. Mask induction, IV after asleep. Outpatient unless OSA or comorbidity requires admission.
Pyloromyotomy (Pyloric Stenosis)
Infant 3-12 weeks old, projectile non-bilious vomiting, dehydration. Hypochloremic, hypokalemic, metabolic alkalosis classic ('paradoxical aciduria' as a late finding). Surgery is NOT emergent — it's a metabolic emergency that needs correction first.
Myringotomy & Tube Placement (Pediatric)
Toddlers and young children (1-5 yr), recurrent otitis media or chronic effusion. Usually otherwise healthy. Outpatient. Frequent runny nose/URI in this age group.
Tetralogy of Fallot Repair (Infant)
Infant 3-12 months, cyanotic congenital heart disease. Four lesions: VSD, overriding aorta, pulmonary stenosis (RVOTO), RVH. Hypercyanotic 'tet spells' on history. Cardiology + surgery jointly managed.
Necrotizing Enterocolitis Laparotomy (Neonatal)
Premature neonate (24-32 weeks gestation), VLBW (< 1500 g), in NICU. Septic, acidotic, coagulopathic. Often intubated already with chronic lung disease. Highest-acuity pediatric anesthetic.
Hypospadias Repair (Pediatric)
Boys 6-18 months typically (can be older for staged repairs). Otherwise healthy. Hypospadias is congenital — abnormal urethral meatus location. Outpatient procedure.
Tracheoesophageal Fistula Repair (Neonate)
Neonate, often premature, day 1-3 of life. VACTERL association (Vertebral, Anal, Cardiac, TE, Renal, Limb) common. May have other anomalies including cardiac (workup mandatory before OR).
Congenital Diaphragmatic Hernia Repair
Neonate, day 1-7 of life. CDH = abdominal contents in chest → pulmonary hypoplasia + pulmonary HTN. Severity ranges from mild to lethal. Often on HFOV or ECMO before repair. Repair is delayed until physiology stable.
MRI Under General Anesthesia (Pediatric)
Children too young (typically < 6) or unable to cooperate (developmental delay, autism, anxiety) for awake MRI. Some have OSA, syndromes, or cardiac comorbidities.
Pediatric Dental Restoration Under GA
Children unable to tolerate awake dental work — young (< 5), severe caries (early childhood caries), special needs (autism, behavioral). Often have dental abscesses.
Wilms Tumor Resection (Pediatric)
Toddler/young child (typical age 2-5). Abdominal mass, hematuria, HTN. May have post-chemo (vincristine, dactinomycin, doxorubicin — cardiotoxicity). Some with IVC tumor extension.
Burn
1 caseEscharotomy, debridement, grafting
Transplant
4 casesKidney, liver, heart, lung
Orthotopic Liver Transplant
End-stage liver disease (cirrhosis, HCC, alcoholic, NAFLD, viral hepatitis). Hepatorenal syndrome, encephalopathy, coagulopathy, varices, hyperdynamic circulation often present. MELD ≥ 15 typical.
Kidney Transplant (deceased or living donor)
ESRD on dialysis, age 40-70, multiple comorbidities (DM, HTN, secondary cardiac, anemia, electrolyte issues). Dialyzed within 24h before surgery (depending on K). Living-donor recipients usually less ill.
Heart Transplant (Orthotopic)
End-stage HF (ischemic, dilated, valvular cardiomyopathy). Often LVAD-bridged. EF < 20%, sometimes inotrope-dependent. Pulmonary HTN screened (PVR > 5 Wood units = high RV failure risk). UNOS status determines urgency.
Lung Transplant (Single or Bilateral)
End-stage lung disease: COPD/emphysema, IPF, CF, pulmonary HTN, sarcoid. Often on home O₂ + steroids. Donor lung availability dictates timing. Single vs bilateral depends on diagnosis.