A 3-year-old boy, Jessie James is admitted at 0700hrs for elective adenotonsillectomy on the morning of surgery. Apart from chronic symptoms relating to enlarged tonsils and adenoids he is generally...

A 3-year-old boy, Jessie James is admitted at 0700hrs for elective adenotonsillectomy on the morning of surgery. Apart from chronic symptoms relating to enlarged tonsils and adenoids he is generally fit, well, alert and communicative.


Medical history:
He has had 2 previous anaesthetics at age of 2 and 3 years old for cautery of nose to treat epistaxis.

His mother was instructed that Jessie be nil by mouth (NBM) from 12midnight, but he has had nothing since 1830hrs last night. He has had no pre-medication. On admission he is taken to the playroom where he plays Nintendo Wii with Captain Starlight.

At 1045hrs Jessie’s mother returns him to his room. He is drowsy, confused, cold, clammy, and sweaty. He lies curled up with severe abdominal pain. His mother rings the call bell for the nurse.
Q2. Explain the pathophysiological changes that causes the patient to be cold, clammy, and sweaty