Dive into the intricate world of 'Cardiac Cases for Non-Cardiac Surgery' in our engaging presentation. Uncover the complexities and considerations involved when managing cardiac patients undergoing non-cardiac surgical procedures.
Dive into the intricate world of 'Cardiac Cases for Non-Cardiac Surgery' in our engaging presentation. Uncover the complexities and considerations involved when managing cardiac patients undergoing non-cardiac surgical procedures.
Anaesthetic considerations for pelvic endoscopic surgeryAtul Dixit
This presentation encapsulates how to proceed with anaesthesia for pelvic endoscopies. It outlines the do's and the dont's for these simple set of procedures which can turn into a nightmare if handled in an off-hand way.
Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
Brain tumor is an abnormal growth of the tissue in the brain.
The brain tumors can be mainly divided into two primary brain tumors and secondary/metastatic brain tumor
Anaesthetic considerations for pelvic endoscopic surgeryAtul Dixit
This presentation encapsulates how to proceed with anaesthesia for pelvic endoscopies. It outlines the do's and the dont's for these simple set of procedures which can turn into a nightmare if handled in an off-hand way.
Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
Brain tumor is an abnormal growth of the tissue in the brain.
The brain tumors can be mainly divided into two primary brain tumors and secondary/metastatic brain tumor
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3.thyroid case presentation for coimbatore PG assembly (1).pptx
1. Thyroid case presentation
Dr Aruna Parameshwari
SRMC, Chennai,
Dr C L Gurudatt
JSSMC, Mysore
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2. Case scenario
• A 48 years old woman with multinodular
goiter has palpitations, tremors, dyspnoea,and
dysphagia.
• She is posted for total thyroidectomy.
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3. 1. What other information you would
like to know in the history?
• 1. Duration of the swelling and development of
symptoms.
• Differentiate Primary and secondary
hyperthyroidism
• Longer the duration - ↑ chances of
tracheomalacia and malignancy
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4. • 2. Difficulty to breath while sleeping
• Stridor in a particular position – do not
allow the patient to lie down in that position
during induction
• 3. Drug therapy and anaesthetic implications
• beta blockers
• Carbimazole
• Propyl thio uracil
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5. • Duration of drug therapy
• Improvement in the symptoms after the drug
therapy.
• Anaesthetic implications
• 4. Any muscle weakness
• Hyperthyroid patients especially Grave’s
disease patients can have myasthenia
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6. 2. What are the Different methods of
examination of thyroid
• Lahey’s method
• Cryle’s method
• Pizzello’s method
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7. • Lahey’s method – for examination of each
lobe of the thyroid.
• The examiner stands in front of the patient. In
order to palpate the left lobe , thyroid gland is
pushed to the left from the right side, to make
the lobe more prominent and palpated with
the other hand.
• The opposite manuvere is done for the right
side.
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8. • Crile (Junior) method –
• Slight enlargement of the thyroid gland or the
presence of nodules in its substance can be
appreciated by simply placing the thumb on
the swelling while the patient swallows.
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9. • Pizzillo’s method –
• Done in case of obese and short necked
individuals where inspection of thyroid gland
becomes difficult.
• In this method the patient is asked to place
her hands behind the head and asked to push
her head backwards against the clasped hands
on the occiput.
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10. 3. Why getting underneath the
swelling is important to know?
• To rule out retrosternal extension
• Pemburton’s test – how to do it?
• Patient is asked to rise his upper limbs above
his head with the arms touching the ears.
• If there is substernal extension, due to the
venous obstruction at the thoracic inlet, the
patient will have congestion of the face and
goes for distress.
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11. 4. What are the importance of Kocher’s
test and Berry’s sign?
• Kocher’s test : Slight pressure on the lateral
lobes producing stridor is kocher’s test.
• This will be positive when thyroid swelling has
compressed the trachea from both sides
giving rise to scabbard trachea.
• Importance –
• a. Smaller size of ETT
• b. ETT should be placed beyond the narrowing
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12. • Berry’s sign :
• Malignant thyroid engulfs the carotid sheath
completely so that no pulsation of the artery
can be detected. This is Berry’s sign.
• A benign swelling of the thyroid gland merely
displaces the carotid sheath backwards where
the pulsation of the carotid artery can be felt
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13. 5. What are the different eye signs in
Grave’s Orbitopathy?
– Von Graefe’s sign – lagging behind of the upper
eyelid when the patient looks downward.
– Stellwag’s sign - retraction of the upper eyelid
with infrequent blinking .
– Joffroy’s sign – absence of wrinkling of the
forehead on looking upwards with the face
inclined downwards.
– Dalrymple’s sign - sclera visible above cornea
– Moebius sign – absence convergence of eye balls
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14. 6. Why patients with goitres are
considered to have a difficult airway?
1. Any huge thyroid swelling can produce an
antero posterior compression and hence can
produce difficult mask ventilation once the
patient becomes unconscious and the
complete weight of the gland falling on the
trachea producing obstruction.
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15. • 2. Difficulty in introducing the laryngoscope as
the tumour may come in the way.
• 3. Any lateral deviation of the trachea will
distort the anatomy of the larynx and produce
difficult visualization.
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16. • 4. Lateral deviation of the trachea and larynx will
produce improper positioning of an LMA . This
will make a difficulty in ventilating the patient
using a supraglottic device and also produces
difficulty in intubating the patient using ILMA.
• 5. Presence of the swelling over the front of the
neck will produce an impossible access for
surgical airway and retrograde wire intubation.
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17. 7. What is the importance of sleeping
pulse rate and how is it recorded?
• She should be well sedated to ensure that
recording the pulse does not wake her up.
• Severity of hyperthyroidism
• Mild – 80 - 90,
• Moderate - between 90-110 or
• Severe - above 110/min .
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18. 8. What Investigations are required?
• Haemoglobin –
• Total count and differential count
• ECG
• X-ray neck AP & Lateral
• CT scan
• Liver function tests
• Indirect laryngoscopy
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19. • Thyroid function tests –
• T 4 – 8-12 micro gm/dl
• T 3 - 70 to 195ng/dl
• TSH – 2 – 5 micro I U/ml
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20. 9. Describe the Steps of thyroid
hormone synthesis
• Absroption of iodine from GI tract &
conversion to iodide
• Iodide trapping
• Oxydation of iodide
• Organification and coupling
• Storage and release
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21. 10 . What are the Differences
between T4 & T3?
• T4
• 100% released from
thyroid
• Half life 7days
• Less active
• T3
• 20% released from
thyroid, 80%
peripheral conversion
of T4 to T3
• Half life -24 hours
• More active
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22. 11. How do you prepare a hyperthyroid
patient for surgery?
• All patients are first treated with antithyroid
drugs & Beta blockers for 6-8wks till made
euthyroid.
• Lugol’s iodine – 5% iodine in 10% potassium
iodide – 8mg iodide/drop Dose – 3-5 drops
thrice a day.
• Advantages
– Reduces the size of the swelling
– Decreases the vascularity
– Makes the gland more firm.
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23. 12. What is Wolff –Chaikoff effect &
Jade Basedow effect
• Iodide decreases T3 & T4 synthesis by inhibiting
iodide oxidation and organification –Wolff –
Chaikoff effect or thyroid constipation.
• Iodine to be given for not more than 14 days
before the surgery. If given for more days , can
produce a recurrence of hyperthyroidism – Jade
Basedow effect or thyroid escape.
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24. 13. How do you premedicate the
patient?
• Oral diazepam 10mg in the previous night and
10mg early in he morning.
• beta blockers and antithyroid drugs are continued
on the day of surgery
• I.V line is taken with 18G cannula placed over the
left hand / forearm under LA cover with a long
connector or extension for easy access during
surgery.
• Inj fentanyl 1-2µg/kg and inj midazolam 0.01-
0.02 mg/kg given intravenously before induction.
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25. 14. What are the different monitors
used?
• SPO2,
• NIBP,
• ECG in lead II,
• temperature monitoring,
• ETCO2,
• peripheral nerve stimulator.
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26. 15. What anaesthetic preparations to be
done before induction?
• A difficult airway cart containing LMA, ILMA, I-
GEL, fibreoptic bronchoscope, optical stylet ,
gum elastic bougies to be kept ready.
• 2 working laryngoscopes and the
endotracheal tubes 1-2 sizes smaller than
required and stillettes to be kept.
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27. • In anticipating thyroid strom 4 units of cold
saline for I.V infusion and ice cubes to be kept
ready in the refrigerator. Esmolol, propranolol,
hydrocortisone, propylthiouracil/ carbimazole,
ryle’s tube to be kept on the work station.
• One unit of crossmatched packed cells also to
be arranged.
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28. 16. How is the patient induced?
• I.V. induction is the first choice.
• If difficult intubation is anticipated then
inhalational induction is preferred.
• If patient gives history of obstructive
symptoms and snoring, then awake intubation
is preferred.
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29. 17. Which IV induction agent is ideal?
• Thiopentone is the induction agent of choice
because of thio group producing antithyroid
effect.
• Propofol also can be used.
• The advantages are - decreased sympathetic
response to laryngoscopy and intubation,
antiarrhythmic effect and decreased incidence
of post op nausea and vomiting.
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30. 18. Any specific type of endotracheal
tube is preferred?
• A kink resistant armoured tube (reinforced
tube) is the ETT of choice for head and neck
surgeries, with changes in neck position.
• North pole oral tracheal tubes are an
alternative as they keep the respiratory filter
away from the surgical field.
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31. 19.Is there any role for LMA in thyroid
surgeries?
• The advantage of using LMA and maintaining
the patient on spontaneous ventilation will be
monitoring of the movements of vocal cords
in response to stimulation of recurrent
laryngeal nerves.
• Relative contraindication to the use of LMA
are tracheal narrowing and/or deviation
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32. 20. What are the precautions to be taken
during intubation ?
• It is necessary to make sure that the bevel of the
tube is beyond the tracheal narrowing.
Otherwise, during surgery due to the pressure
exerted by the surgeon it may become impossible
to ventilate the patient.
• So an intentional endobronchial placement is
done and then the tube is gradually withdrawn
till one hears breath sounds on either side.
• Prevents auto extubation during positioning
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33. • Suppression of intubation response
• Proper fixation of the tube is very important.
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34. 21. What is the position used for
thyroidectomy and its importance?
• Patient is positioned with a sandbag between the
shoulder blades and the head resting on a
padded horseshoe, so that the neck is extended.
• - auto extubation
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35. • Head end of the table is elevated by 25° and
the arms are placed by the side, as the
surgeon will need to stand on either side of
the patient.
• Head end elevation of the table is mainly done
to assist venous drainage away from the site
of surgery.
• - hypotension
• air embolism
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36. 22. How should the patient be
maintained during surgery?
• Patient should be maintained with sufficient
depth of anaesthesia as any lighter planes can
produce complications like dysrhythmias and
thyroid storm
• Patient should be ventilated with O2, N2O and
volatile anaesthetics preferably isoflurane or
sevoflurane. Halothane to be avoided as it can
produce sensitization of myocardicum and
cause dysrhythmias.
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37. • Continuous monitoring of ETCO2 is necessary
to avoid hypo or hypercarbia as both can
induce dysrhythmias.
• Patient should be normoventilated.
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38. 23. What are the intraoperative
complications in these patients ?
• Haemorrhage - when the gland is very large
• Dysrrhythmias – sinus tachycardia, SVT &
atrial fibrillation
• Air embolism
• Thyroid storm
• delayed recovery from muscle relaxants
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39. 24. What is thyroid storm or
hyperthyroid crisis?
• Thyroid storm is a life threatening exacerbation
of hyperthyroidism, characterized by abrupt
onset and precipitated by stress e.g. surgery ,
infection or trauma.
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40. 25. What are the Clinical features of
thyroid storm
• Fever, increased CO2 production, acidosis,
hyperventilation
• CVS - tachycardia, arrhythmia, CCF , shock.
• CNS - agitation, tremor, delirium coma
• GIT - diarrhoea, abdominal pain, vomiting
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41. 26. How do you recognize hyperthyroid
crisis under anaesthesia?
• Early exhaustion of soda lime,
• Canister becoming very hot,
• Hyperpyrexia,
• Increased ETCO2 ,
• Patient requiring increased muscle relaxants
and anaesthetics,
• Unexplained tachycardia and dysrrythmias,
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42. 27. How do you manage thyroid crisis?
– Reduction of circulating thyroid hormone levels.
– Inhibition of the peripheral effects of circulating
thyroid hormones
– Supportive care
– Treatment of the underlying precipitating event.
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43. 28. What are the causes of stridor
after extubation?
• Recurrent laryngeal nerve palsy
• Tracehomalacia
• Larngospasm
• Laryngeal oedema
• Hypocalcemic tetany
• After 2-3 hours - haematoma
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44. 29. How do you manage stridor as a
result of bilateral abductor palsy?
• Patient should be reintubated with a smaller
tube using succinylcholine
• After 24 hours trial extubation
• For Tracheomalacia - tracheostomy
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