1d awareness problem during operation
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This document discusses the problem of anesthesia awareness during surgery. It defines anesthesia awareness as a patient becoming conscious during a surgical procedure under general anesthesia and having recall of events. Risk factors include women, younger age, use of total intravenous anesthesia, long surgeries, prior awareness history, and natural red hair. Causes can include light anesthesia, increased anesthetic requirements, or anesthesiologist error. Prevention strategies include pre-operative evaluation, prophylactic benzodiazepines, monitoring anesthetic levels, and post-operative interviews. Methods to monitor consciousness include clinical signs, isolated forearm technique, brain monitoring like BIS, and measurements of lower esophageal sphincter contractions.
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The document discusses awareness during anesthesia, including its incidence, causes, detection methods, and prevention. Some key points:
- The incidence of awareness has decreased from around 1% historically to 0.1-0.2% currently with improved monitoring and techniques.
- Awareness can cause significant psychological trauma for patients including PTSD in some cases.
- Light anesthesia, equipment issues, individual variability, and premature discontinuation of anesthetics can all cause awareness.
- Monitoring like BIS and auditory evoked potentials can help detect awareness intraoperatively, though signs like heart rate are unreliable.
- Prevention focuses on adequate dosing, vigilance, limiting paralysis, and using volatile anesthetics to supplement other agents
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This document provides guidelines for moderate sedation/analgesia (conscious sedation). It defines levels of sedation from minimal to general anesthesia. Moderate sedation involves patients responding purposefully to verbal commands with spontaneous breathing. The guidelines discuss patient evaluation, monitoring, personnel, equipment, drugs and discharge criteria for providing moderate sedation. Proper patient screening, credentialed practitioners and personnel, appropriate facilities and emergency equipment are emphasized to minimize risks while allowing benefits of sedation for certain medical procedures.
Preoperative assessment
The document discusses performing a pre-operative assessment of surgical patients to identify medical risks and stratify cardiac risk, outlines factors that increase perioperative cardiovascular risk including patient comorbidities, surgery type and functional status, and recommends tests and treatments to optimize patient safety for anesthesia and surgery.
Unintended Awareness
Unintended awareness during anesthesia is a disturbing event that can permanently change a patient's life. Several factors contribute to the risk of awareness, including the use of muscle relaxants which prevent patients from signaling distress. Depth of anesthesia monitors like BIS and Entropy indexes can help reduce risk but may not prevent all cases of awareness. Maintaining an adequate level of anesthesia through close clinical monitoring and an end-tidal gas concentration of at least 0.7 MAC is important to prevent patient recall. All reports of potential intraoperative awareness should be taken seriously and followed up with counseling to minimize psychological harm.
Overlooked diagnoses after auto accidents
40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
Missed Diagnoses association in Rear end collisions
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
neurological alterations
This document provides information on Guillain-Barre syndrome (GBS), craniotomies, and intracranial hypertension. It defines GBS as an acute inflammatory polyradiculoneuropathy causing weakness and diminished reflexes. It describes the pathophysiology and management of GBS, including plasma exchange and IV immunoglobulin treatment. It then discusses different types of craniotomies and pre, intra, and post-operative care. Finally, it examines the pathophysiology and assessment of intracranial hypertension, management to reduce intracranial volume, and herniation syndromes that can occur if intracranial pressure is not controlled.
P147
Peripheral nerve injury in the upper extremity is common and can result from repetitive strain, direct trauma, or compression. The most common site of injury is the carpal tunnel. A thorough history and physical exam is important to determine the location and nature of symptoms in order to establish a differential diagnosis. While imaging and electrodiagnostic testing may be warranted for persistent or worsening symptoms, most nerve injuries are initially treated conservatively with splinting, injections, or activity modification. Recovery depends on the severity of injury, with mild injuries having better prognosis.
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Anaesthesia for patients with prior stroke (editted).pptx
Anaesthesia for patients with prior stroke (editted).pptx
Missed Diagnoses association in Rear end collisions
Missed Diagnoses association in Rear end collisions
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Airway local blocks
This document discusses airway local blocks and awake intubation. It describes the indications for awake intubation including comorbidities, risk of aspiration, difficult airway assessment, and emergencies. It provides details on the pharmacological agents, equipment, personnel, and techniques used for airway local blocks and awake intubation. Specifically, it outlines common methods for anesthetizing different areas of the airway using lidocaine, including dosage calculations and risks of lidocaine toxicity. The goal is to safely anesthetize the airway to allow for awake intubation.
Endotracheal intubation
This document discusses endotracheal tubes and intubation. It covers indications for intubation including airway protection, optimizing gas exchange, decreasing metabolic demand, and reducing work of breathing. Conditions associated with difficult intubation are described such as congenital anomalies, infections, tumors, injuries, and obesity. Proper equipment, tube sizing, intubation technique including positioning and confirmation of placement are outlined. Golden rules of intubation emphasize preparation, oxygenation, skills, confirmation, and monitoring.
Appropriate airway equipment and techniques.
This document provides an overview of airway anatomy, equipment, and techniques for airway management. It discusses:
1. The importance of airway control and the development of advanced cardiac life support.
2. The objectives of reviewing upper and lower airway anatomy, basic and advanced airway techniques, equipment for difficult airways, and clinical management of the airway.
3. Details of upper airway structures including the nose, oral cavity, pharynx, and larynx. It also reviews lower airway structures like the trachea and lungs.
Airway management
- The laryngeal mask airway (LMA) is a supraglottic airway device that is placed in the hypopharynx to control the airway during general anesthesia or ventilation. It provides an alternative to endotracheal intubation or use of a face mask. The LMA has advantages like ease of insertion, reduced hemodynamic response, and improved oxygenation during emergence from anesthesia. Potential complications include sore throat, coughing, laryngospasm, and airway obstruction. Proper selection of size, lubrication, and insertion technique are important for successful use of the LMA.
Biophysics
This document discusses different types of fluid flow and transport mechanisms in cells. It describes laminar and turbulent fluid flow, how they are characterized, and factors that influence each type. It also outlines different transport mechanisms in cells including diffusion, osmosis, facilitated diffusion, active transport, endocytosis, and exocytosis. Active transport uses carrier proteins and cell energy to move substances against a concentration gradient, while passive transport moves substances down a concentration gradient without cell energy.
Theories of anesthesia
1. The document discusses theories of anesthesia including the unitary theory and modern theories involving interactions with membrane proteins and specific ion channels.
2. It describes the stages of general anesthesia from analgesia to surgical anesthesia to medullary respiratory paralysis. However, it notes that the excitement stage is rarely seen with modern anesthesia.
3. GABA receptors are identified as an important target for many anesthetic agents. General anesthetics bind to these receptors, causing chloride channel opening and neuronal inhibition, resulting in anesthesia.
Endotracheal intubation and laryngoscopy part 2
This document discusses various types of endotracheal tubes and laryngoscopy techniques. It describes specialized tubes like armored tubes, RAE tubes, Oxford tubes, and laser-resistant tubes. It covers direct laryngoscopy using curved and straight blades. Optimal conditions for laryngoscopy are outlined, including using the appropriately sized blade and ensuring good muscle relaxation. Reliable signs of correct endotracheal tube placement include capnography, visualization of the tube passing the vocal cords, and fiberoptic bronchoscopy visualization of tracheal rings.
Intubation part 1.
Endotracheal tubes are used to intubate patients and enable ventilation. They are typically made of PVC or rubber and have features like a Murphy eye, size designations, and a pilot balloon-connected inflation system to create a seal in the trachea. Complications can occur during or after intubation and extubation, like trauma, aspiration, or laryngospasm. Nasotracheal intubation has advantages like patient comfort but risks like trauma or sinusitis. Proper preparation, techniques, and monitoring are important for safe endotracheal intubation.
Complications of artificial applications part 5
This document discusses the complications that can arise from mechanical ventilation through either invasive or non-invasive means. Some key complications mentioned include pneumonia, infections, injuries to the face/lips/pharynx and larynx/trachea, gastrointestinal effects like esophagitis and decreased motility, renal effects from reductions in blood pressure/flow, disrupted sleep, and decubitus ulcers. Proper diagnosis and management of these various complications is important for patients receiving mechanical ventilation support.
Difficult airway management
This document discusses endotracheal tubes and intubation. It covers indications for intubation including airway protection, optimizing gas exchange, decreasing metabolic demand, and reducing work of breathing. Conditions associated with difficult intubation are described such as congenital anomalies, infections, tumors, and injuries. Airway assessment techniques like mallampati classification, laryngoscopy view, and thyromental distance are explained. Equipment for intubation and sizing endotracheal tubes are outlined. The technique of intubation is described involving positioning the patient in sniffing position and using a laryngoscope to visualize the vocal cords. Confirmation of proper tube placement is emphasized using methods like auscultation and capnography.
Airway management part 3.
This document discusses various techniques for airway management. It describes mechanical maneuvers like jaw thrust and head tilt-chin lift to clear obstructions. Common airway adjuncts like oropharyngeal and nasopharyngeal airways are also discussed. Guidelines are provided for sizing and inserting these adjuncts safely. Face masks can be used with one, two, or three hands to maintain a patent airway. Risk factors for difficult mask ventilation and potential complications are also outlined.
Airway assesment part 2
This document discusses airway assessment and difficult airways. It outlines various predictors of difficult airways like obesity, short neck, and facial hair. It describes tests to evaluate the airway like thyromental distance, inter-incisor gap, and Mallampati grading. The document emphasizes the importance of a thorough airway assessment prior to intubation to identify potential difficulties and prepare appropriate management strategies for difficult intubations.
Airway assesment part 1
The document discusses preoperative airway assessment for anesthesia. It notes that 1-3 out of 100 anesthetized patients have difficult intubation, while 1 out of 1000 have failed intubation and 1 out of 10,000 experience cannot intubate cannot ventilate scenarios. Factors that can increase intubation difficulty include congenital syndromes, anatomical features like teeth and neck structure, and acquired conditions such as decreased jaw or neck mobility. A thorough preoperative assessment including tests of mouth opening, neck movement, thyromental distance, and Mallampati score can help predict and prepare for a potentially difficult airway.
History of anesthesia.
- Imhotep, an ancient Egyptian priest from around 2600 BC, is considered the first physician and treated many diseases. He extracted medicines from plants and had knowledge of anatomy. Ancient Egyptians used opium and hyoscyamus for anesthesia and performed trepanation surgery.
- In ancient Greece and Rome, mandrake juice was used for its narcotic effects before surgeries to ensure insensibility to pain. Arabic translations of Greek medicine advanced Islamic medicine in the Middle Ages. Physicians like Al Zahrawi described many surgeries and instruments.
- The modern history of anesthesia began with William Morton using ether in 1846 and John Snow advancing the field through publications on ether and chlor
Local and regional anesthesia
This document discusses different types of anesthesia including local, regional, and general anesthesia. It provides details on common regional anesthesia techniques like spinal blocks, epidurals, and caudal blocks. It also describes local anesthesia techniques such as infiltration, nerve blocks, and intravenous regional anesthesia. The document discusses the mechanisms of local anesthetics and some potential complications as well as benefits of local and regional anesthesia compared to general anesthesia.
1c geriatric patients
- The document discusses various physiological changes that occur with aging and their implications for anesthesia in geriatric patients. Some key points discussed include:
- Cardiovascular changes like decreased cardiac output and increased risk of hypertension. Respiratory changes like reduced lung capacity and cough reflex. Genitourinary changes like reduced kidney function and bladder issues.
- Gastrointestinal changes like decreased motility leading to constipation. Endocrine changes like increased risk of hypothyroidism and bone issues.
- The implications of these changes for anesthesia include risks of hypotension, bradycardia, respiratory complications, slower drug metabolism and clearance, and risks of gastric aspiration and constipation. Careful preoperative evaluation and
1a respiratory system
The document provides information on the respiratory system, including its structures and functions. It discusses the processes of ventilation, external respiration, transport of gases, and cellular respiration. It describes the structures of the upper respiratory tract such as the nose, pharynx and larynx. It also details the trachea, bronchi, bronchioles, and alveoli. Furthermore, it examines the muscles involved in inspiration and expiration, respiratory volumes and capacities, and the control of breathing.
Body temperature mechanism
The document discusses body temperature regulation and abnormalities. It notes that humans maintain a constant core body temperature of around 37°C through heat gain and loss mechanisms controlled by the hypothalamus. When temperature varies by 0.1°C from the set point, the hypothalamus activates heat conservation or dissipation responses. Disorders include hypothermia, where temperature drops below the normal range, and hyperthermia/fever, where the hypothalamus raises the set point in response to pyrogens like bacterial toxins or cytokines. Heat stroke occurs when temperature exceeds the critical threshold of around 105-108°F.
Triage
This document discusses triage, which is the process of sorting patients based on the urgency of their condition to prioritize care. It defines triage and outlines its objectives to identify patients, prioritize their needs, track their progress, and identify hazards. It describes different types of triage including simple, advanced, continuous integrated, and reverse triage. It discusses levels of triage from red to green based on factors like vital signs and Glasgow Coma Scale. Finally, it outlines the role and characteristics of EMTs in effectively conducting triage.
Operation theatre design
The document discusses the design and setup of an operation theatre. It outlines key areas that should be included like an anesthesia room, sterilization room, recovery room, and storeroom. It also describes the daily, weekly, and deep cleaning procedures needed to properly sanitize the operation theatre and prevent infections. Furthermore, it covers the preparation of equipment, instruments, and supplies as well as different sterilization methods like autoclaving, gamma irradiation, and ethylene oxide.
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1d awareness problem during operation
- 1. AWARENESS PROBLEMS DURING OPERATION Dr Nisar Ahmed Arain Assistant Professor Anesthesia/Critical care/ER
- 2. -AWARENESS PROBLEMS WHAT HAPPENS IF WE ARE AWAKE DURING GENERAL ANESTHESIA
- 3. -AWARENESS PROBLEMS -INTRODUCTION ---Awareness in anesthesia during operation occurs, when a patient becomes conscious during a surgical procedure performed under GA and subsequently has recall of these events =A-For Anesthesiologists, AAranks second only to death as a “Dreaded” complication =Incidence:-o.1% to o.2% -Cardiac surgery 1.1% to 1.5% -Obstetric C/S (0.4%) -Surgery in Trauma cases (11% to 43%) =Significantly influence the cognitive and psychological functions of the patients =Medicolegal issue
- 5. -AWARENESS PROBLEMS WHO IS AT RISK FOR -ANESTHESIA AWARENESS --1-Women > Men --2-Age < 60 years --3-TIVA > Inhalational --4-Long Duration of surgery --5-Previous Awareness history --6-People with natural Red Hair
- 6. -AWARENESS PROBLEMS -CAUSES OF AWARENESS A-LIGHT ANESTHESIA a-Cardiac surgeries b-C/S c-Surgery in Trauma d-ASA physical status 4 or 5 e-Premature discontinuation of anesthetic agents
- 7. - AWARENESS PROBLEMS --WHO IS AT RISK FOR -ANESTHESIA AWARENESS B-INCREASED ANESTHETIC REQUIREMENTS a-chronic use of Benzodiazepines or opioids b-Alcoholics c-Severly anxious patients d-Difficult Intubation e-Previous awareness experience C-IMPROPER EQUIPMENT MAINTAINENCE OR ANESTHESIOLOGISTS ERROR a-Failure to fill vaporizers with inhalational agents b-Judgement errors related to drug and volatile agents c-Disconnections and Kinks in tubes from the ventilator
- 8. -AWARENESS PROBLEMS -WHO IS AT RISK FOR ANESTHESIA AWARENESS
- 9. -AWARENESS PROBLEMS -PATIENTS PERCEPTION OF AWARENESS --Recall immediately after surgery, Recovery room or Several days later MOST COMMON a-Sounds and conversations – 89% to 100% b-Sensation of Paralysis – 85% c-Anxiety and Panic d-Helplessness and powerlessness e-Pain 39% LEAST COMMON a-Visual Perceptions b-Intubation or tube c-Feeling the operation without pain
- 10. -AWARENESS PROBLEMS -AFTER EFFECTS --1-Sleep disturbances --2-Repititive nightmares --3-Anxiety and panic attacks --4-Depression --5-Flash backs --6-Avoidence of Medical care --7-Suicide --8-Post-Traumatic stress disorders(PTSD)
- 11. -AWARENESS PROBLEMS -PREVENTION OF AWARENESS --A- PRE-OPERATIVE EVALUATION --1-History(proper and detailed) --2-Thorough Physical examination --3-Identifying patients risk factors for intra-operative awareness --4-Informing high risk patients regarding the possibility of intra-operative awareness --B- PRE-INDUCTION OF GENERAL ANESTHESIA --5-Prophylactic administration of Benzodiazepines --6-Checking the functioning of Anesthesia delivery system
- 12. -AWARENESS PROBLEMS -PREVENTION OF AWARENESS --C- INTRA-OPERATIVE INTERVENTIONS --1-Cautionary use of the Neuromuscular Blocking agents --2-Inhalant Anesthetics must be monitored with End-Tidal-Gas analyzers and the minimum alveolar concentration (MAC) of anesthetic agents should be maintained >0.8 --3-BIS value < 60 --D- POST-OPERATIVE INTERVENTIONS --4-Post-operative interview to report awareness a-What is the last thing you remember before surgery b-What is first thing you remember after surgery c-Do you remember anything during the procedure d-Did you dream during the procedure --5-Providing post-operative counseling or psychological support
- 13. -AWARENESS PROBLEMS METHODS OF MONITORING CONCIOUSNESS DURING GENERAL ANESTHESIA --A- CLINICAL SIGNS --1-Sympathetic activity -HR -BP -SWEATING -PUPILARY DILATATION *-LACRIMATION -UNRELIABLE SIGNS ALSO
- 14. -AWARENESS PROBLEMS METHODS OF MONITORING CONCIOUSNESS DURING GENERAL ANESTHESIA --B---ISOLATED FOREARM TECHNIQUE --1-Tourniquet applied to the patient’s forearm before the administration of muscle relaxants --2-Moves fingers if aware --3-Verbal command to confirm
- 15. -AWARENESS PROBLEMS METHODS OF MONITORING CONCIOUSNESS DURING GENERAL ANESTHESIA --C---MONITORING OF BRAIN ELECTRICAL ACTIVITY --1-BIS (bispectral index monitoring) a-EEG derived multivariant scale b-0 to 100 (For GA 40 to 60) --2-AEP (Auditory evoked potential) --3-Narcotrend
- 16. -AWARENESS PROBLEMS METHODS OF MONITORING CONCIOUSNESS DURING GENERAL ANESTHESIA --D- MEASUREMENTS OF LOWER ESOPHAGEAL SPHINCTER CONTRACTIONS --E- EEG OF FRONTALIS MUSCLE