This document summarizes anesthesia considerations for parotidectomy surgery. It discusses the anatomy of the parotid gland and facial nerve. Parotidectomy is usually indicated for parotid tumors and may require facial nerve monitoring. The document presents a case of performing parotidectomy under local anesthesia in a high-risk patient with hypertension. It describes blocking the maxillary and cervical plexus nerves along with local infiltration to anesthetize the area. The surgery was performed successfully without complications under local anesthesia. Advantages of this technique include avoiding risks of general anesthesia and facilitating identification and protection of the facial nerve.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
A patient with pacemaker presents a complex challenge to the attending anaesthesiologist. The mode of management will be according to the type of pacemaker implanted. This presentation discusses in brief the peri-operative consideration in a patient with pacemaker.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
A patient with pacemaker presents a complex challenge to the attending anaesthesiologist. The mode of management will be according to the type of pacemaker implanted. This presentation discusses in brief the peri-operative consideration in a patient with pacemaker.
Short description about awake craniotomy, its indications, contraindications, complications,various techniques of providing awake craniotomy and drugs used.
There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Background
• The parotid gland is a primarily serous salivary gland that is
located high in the neck in the preauricular area extending
towards the cheek. The extratemporal facial nerve and its
branches pass through the parotid gland and supply motor
innervation to the muscles of facial expression, as well as to the
postauricular muscles, the posterior belly of the digastric muscle,
and the stylohyoid muscles
3. CONTINUE…
• The motor branches to the face are divided into cervicofacial and
temporofacial branches, with the former supplying the muscles of
the mouth and neck and the latter supplying the muscles of the
forehead and eye (there is some overlap in the nasal region).
There is no anatomic feature that formally separates the parotid
gland into superficial and deep lobes, but the plane of the facial
nerve (see the image below) generally serves for demarcation of
the superficial and deep portions of the gland.
• Parotid gland surgery often requires nerve monitoring (facial
nerve) and may require nasotracheal intubation so that the
mandible can be dislocated.
4.
5. INDICATION
• Neoplasms are the most common indication for parotidectomy. The vast
majority of primary parotid tumors are benign, but approximately 20%
are found to be malignant. In addition, regional and distant disease can
metastasize to the parotid and necessitate removal for diagnosis or cure.
• Inflammatory processes (eg, chronic parotitis, deep salivary calculi, or
parotid abscess) are occasionally treated with total parotidectomy, with
the recognition that surgery in an inflamed gland probably carries a
higher risk of postoperative facial nerve dysfunction. [1]
• Sialorrhea is rarely treated with parotidectomy; more often, it is
medically managed with antisialagogues or botulinum toxin or treated
with duct ligation
6. Contraindications
• Patients with benign tumors who are at high anesthetic risk may
be observed on a case-by-case basis.
• Patients with multiple parotid cysts should be tested for HIV
before undergoing surgical excision. Benign lymphoepithelial cysts
are relatively common in the HIV-positive population but
otherwise uncommon. Because these cysts are usually multiple
and tend to recur, they are typically managed by means of
repeated aspiration or sclerotherapy rather than parotidectomy;
they may also respond to antiretroviral therapy
7. Total parotidectomy under local anesthesia: a
novel technique.
• Abstract
• Parotidectomy is a common procedure usually done for a parotid mass
necessitating a histological diagnosis. Operation is normally performed under
General anesthesia with a nerve stimulator to facilitate facial nerve
stimulation. We describe a new technique with reports of three cases, making
total parotidectomy under local anesthesia possible. The ascending cervical
branch of cervical plexus and the auriculotemporal nerve were anesthetized by
bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective
onset of anesthesia was within 15-25 minutes and the operations lasted
between 2-3 hours without any complications. This offers advantage in high-risk
patients where general anesthesia is contraindicated. The facial nerve can be
easily identified with on command movements by the patient rendering the use
of nerve stimulator or injection of the dye superfluous. This technique makes
total parotidectomy an outpatient procedure and facilitates an early discharge
8. Abstract
• For superficial parotidectomy general anesthesia is ideal, but certain
patients may be unfit. The present case had
uncontrolled hypertension together with difficult airway. To avoid any
suspected complications, we decided to do the operation under local
anesthesia. We planned to block the maxillary nerve and superficial
cervical plexus with greater auricular nerve together with incision site
infiltration. A mixture of bupivacaine 0.25% and lignocaine 1% with
adrenaline 1: 200,000 was prepared. The block was effective after about
15–20 min and the surgery was performed uneventfully using only
the nerve blocks with mild sedation.
9. Introduction
• The percentage of occurrence of primary parotid malignancies is about
1–3% of all head and neck malignancies. The surgical management is
individualized due to wide variability in the clinical behavior and
presentation and influenced by tumor location, histological grade,
extent, and spread. The surgical management includes
superficial parotidectomy, total conservative parotidectomy, and radical
parotidectomy, palliative biopsy only, and neck dissection [1].
• One of the most common procedures of the parotid is superficial
parotidectomy. General anesthesia is ideal but certain patients may be
at risk or unfit for general anesthesia [2].
10. • A method of obtaining an effective anesthesia for such cases
is nerve block. To effectively block the parotid area, the maxillary,
superficial cervical including greater auricular nerve block and
local skin infiltration were planned to be performed. A written
consent had been obtained from the patient for the publication of
this case report.
11. Case description
• 62 years old male complained from swelling just below angle of mandible right
side which was gradually increasing for 6 months, with no relation with meals.
The swelling was cystic in some and solid in other areas, non-tender, non-
fluctuant, and partially mobile swelling. Stensen’s and Warthin’s duct openings
were normal. Ultrasound examination revealed 2.3 × 5.3 × 3.4 cm well-defined
lobulated margined soft tissuemass with cystic component and multiple tiny
irregular sponge like anechoic areas.
• Preoperative evaluation showed the following: 1- Obese patient weighed 130 kg
with BMI of 47.8. 2- history of obstructive sleep apnea. 3- Poorly controlled
chronic hypertensive (BP was 200/110 mmHg) on
double antihypertensive medications (Calcium channel blocker and angiotensin
converting enzyme inhibitor). 4- Poor R wave progression and left ventricular
hypertrophy in ECG. 5- Airway evaluation revealed short neck, large
tongue, Mallampati score of III, limited neck mobility and mentosternal distance
of 9.5 cm.
12. CONTINUE..
• All Laboratory investigations were within normal except mild
elevation in serum creatinine (1.6 mg/dl).
• The patient postponed twice for blood pressure control. On the
day of surgery his BP was 160/100 mmHg.
• The increased risk for complications from a general anesthetic,
gave rise to use local or regional anesthesia. We decided to
perform maxillary, superficial cervical including greater
auricular nerve block and local skin infiltration for excision biopsy
of the parotid tumor, after a discussion with the patient and
surgeon to avoid general anesthesia and complications related to
hypertension and difficult airway
13.
14. Operation technique
• The surgery was done in a fully equipped operation theatre with
full support of general anesthesia and all
emergency resuscitation measures. A plan was made to manage
the suspected difficult airway according to ASA guidelines.
Different blade sizes, Mc Coy’s laryngoscope, fiberoptic, and an
assistant anesthesiologist were all ready.
• The plan was to block the maxillary nerve and superficial cervical
plexus with greater auricular nerve together with incision site
infiltration. The posterior border of sternomastoid muscle was
marked at the middle and at the junction of the upper and middle
one-third
15.
16. Premedication
• Premedication with midazolam 3 mg with 40 μg fentanyl
and Ringers lactate 1000 ml. Patient was positioned with head
turned to the opposite side on a headrest. An injection
of bupivacaine 0.25% (2 mg/kg) and lignocaine 1% with adrenaline
1: 200,000 (7 mg/kg) was prepared.
•
17. Discussion
• Parotidectomy is generally indicated
for histopathological diagnosis of a parotid mass. Parotid masses
are generally benign, the incidence of which is around 2.4 per
100,000 [3].
• Factors determining the extent of surgery include tumor size and
degree of local extension. Facial nerve and its peripheral branches
are at risk during superficial parotidectomy surgery under GA.
About 30–65% of patients suffer from transient facial nerve
paralysis and 3–6% has permanent dysfunction of the facial nerve
following total superficial parotidectomy
18. CONTINUE..
• Preservation of facial nerve peripheral branches requires high
surgical skills and it can be done by using nerve stimulator which
is costlier and usually available at tertiary care hospitals. Local or
regional anesthesia can be used to preserve facial nerve. Under
LA, patient complaints of pain and discomfort if dissection
involves facial nerve sheath or its peripheral branches thus helping
in its identification and prevention of iatrogenic nerve injury
• There have been a few reports of parotid surgeries under local
anesthesia [5–7] using different techniques [5–7] with the use of a
mixture of bupivacaine and lidocaine for local anesthesia
19. • Bupivacaine is four times more potent than lidocaine and has a
longer duration of action of 6 h. However, lidocaine has a faster
onset of action within 3–5 min. Offering a mixture of both to the
patient provides a quick onset with a larger duration of action,
adequate for the surgery. Recently parotidectomy under LA has
come in vogue
• Surgical anesthesia or supplemental pain control can be provided
for any surgery involving the inferior portion of the external ear,
the area overlying the mastoid process, procedures of the parotid
gland, or procedures involving the angle of the mandible by
blocking greater auricular nerve
20. CONTINUE…
• We found that LA technique can be really helpful if patient is at
risk during general anesthesia like in our case of uncontrolled high
BP. It also had an advantage of avoiding airway manipulations in
case of suspected difficult intubation as in our case. Smooth
recovery postoperatively with less usage of narcotics and other
drugs with less pain and complications leading to shorter hospital
stay with early healing are added advantages
21. Steckler had enumerated the advantages
of a parotidectomy using local anesthesia:
• 1) No muscle relaxants are required as the surgery is conducted in a
relatively superficial plane. This allows for easy testing of the integrity
of the facial nerve.
• Various manoeuvres for identifying the facial nerve, such as use of a
nerve stimulator or injecting a dye into the parotid duct are rendered
superfluous
• Chances of drug overdose are minimised as not more than 20–25 ml of
0.5% of bupivacaine are required
• The present-day concept of out-patient parotidectomy is promoted, as a
procedure under local anesthesia facilitates early discharge
22. Conclusion
• Parotidectomy under LA is an effective alternative to general
anesthesia that can be considered in patients who are at high risk
during GA. It gives the advantage as patient is conscious and
awake thus maintaining good airway. Discomfort if dissection is
too near to the facial nerve help in protection of it from injury.