Laryngectomy involves removing the larynx and parts of the trachea for laryngeal cancer. It requires a team approach and optimizing cardiac, respiratory, and nutritional status preoperatively. The procedure involves creating a permanent tracheostomy and repairing the pharynx. Postoperatively, careful monitoring of the airway, ventilation, nutrition, and rehabilitation is needed.
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
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
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
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
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
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
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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.
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.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Anesthesia for laryngectomy
1.
2. Laryngectomy
• Laryngectomy is performed in specialist centres and requires a team
approach to airway management.
• Laryngeal cancer patients frequently have cardiac and respiratory co-
morbidities with limited scope to optimize. Anaemia, malnutrition,
and alcohol dependency are modifiable preoperative risk factors.
• Acute presentations with stridor require a collaborative approach to
the airway that only rarely involves awake fibre-optic intubation.
• Post laryngectomy patients can present for other types of surgery and
a clear plan must be made for the management of such patients.
3. • Total laryngectomy is the removal of the laryngeal structures
including the epiglottis, hyoid, and a variable amount of upper
trachea. The resultant defect requires creation of a permanent
tracheostomy (tracheostome) and repair of the pharynx.
4. Examination
• GPE
• Built / nutritional status
• Vitals
• Oral cavity
• Jugular venous pressure
• Respiratory system –wheeze
• Airway examination: distorted upper airway and obstructed, because
of friable growth with or without tracheostomy.
6. Preoperative preparation
• Optimize lung functions:
• antibiotics, bronchodilators, corticosteroids, chest physiotherapy
including breathing exercises
• Care of nutrition, hydration
• Removal of bad teeth
• Indirect laryngoscopy - review again
• Treatment of associated medical disorders and age related problems
• Counseling-post operative speaking
• Care of tracheostomy
7. Preoperative preparation
• Cessation of smoking
• Time course beneficial effects
• 12-24 hours ↓CO and nico ne levels
• 48-72 hours ↓COHb levels normalizes and bronchociliary functions
improve
• 1-2 weeks sputum production
• 4-6 weeks PFT improves
• 6-8 weeks immune function and drug metabolism normalize
• 8-12 weeks ↓overall PO morbidity
8. Patient Preparation
Anesthesia
• Prior to the induction of anesthesia, an airway management plan is
coordinated with the anesthesiology team. In patients with bulky,
airway obstructing tumors, an awake tracheotomy may need to be
performed. In these cases, the tracheotomy should be performed
using local anesthesia in the area of the planned laryngostoma. Once
general endotracheal anesthesia is induced, the eyes should be taped
shut and padded
9. Cessation of alcohol
• effect on liver, gastric irritation, CVS, therefore pre-medication with
antacids and metachlorpromide
• Effects Acute Chronic
• inhala onal agents, ↓ need ↑MAC
• barbi+benzo+opioids more sensitive cross-tolerance
• suxamethonium - ↑effect
• relaxants: rely on hepatic clearance
• drug of choice: atracurium
11. Surgical plan
• Direct laryngoscopy and biopsy (day care)
• Major surgery
• Partial / total laryngectomy
• Laryngo-pharyngectomy
• RND
• Flap surgery
• Besides normal routine check for Int.
• Stylet , MLS tube
• Tracheostomy set
• Local: 2%, 4%, 10% for awake intubation
• Availability of defibrillator
• Other type and size of laryngoscope
• check the equipment like FOB
• Ready ENT surgeon
12. Major surgery
• Preoperatively arrange
• Blood, Ryle’s tube CVP line, Foley’s catheter
• If already tracheostomised
• Care of tracheostomy tube
• Montendo tube / Montgomery T – tube
• I/V access
• Premedication ±
• Preoxygenation
• Induction
• Propofol / Thiopentone
• Suxamethonium after mask ventilation
• Maintenance on O2, N2O , Halothane or Isoflurane
13. Monitoring
• Routine
• HR, ECG
• SpO2, EtCO2
• NIBP
• Temperature (rectal + axillary probes)
• In addition
• CVP (towards higher side)
• Urine output
• Blood loss
• Arterial line for serial estimation of blood gas and hematocrit
• Airway pressures
• Positioning – head up tilt (15 to 20 degree)
14. Intra-operative problems
• Bleeding (hematocrit 0.25 to .0.27)
• ↓by posi oning of pa ent (pillow under knees, reversed Trendelenburgh
position), 2 mmHg fall in BP for each 2-5 cm rise in head position above the
heart level.
• Induced hypotension – inhalational, i/v (NTG, SNP etc).
• Early, accurate assessment of blood loss: Timely replacement with blood /
colloid.
• Compromised cerebral circulation
• caro d artery infiltra on →↓cerebral arterial pressure
• jugular vein infiltra on →↑cerebral venous pressure
• rota on of neck →↓caro d blood flow
15. • Induced hypotension
• Inhalational
• Isoflurane
• dose dependent hyotensive effect by vasodilatation
• up to 40mmHg in 6 minutes, little change in CO
• Halothane/enflurane
• ↓ BP, CO, Stroke volume →↑right heart filling pressure
• IV agents
• fentanyl 1-3mcg/kg
• propofol 100mcg/kg/minute
• NTG 0.5-3mcg/kg (BP 80-90mmHg)
• SNP 3mcg/kg/minute, ↓es dias. by 30 to 40%
16. During opening of neck veins
• Rapid fall in EtCO2, BP → Air embolism
• ECG: inverted T, tall P, RBBB, RHS→VF
• Treatment
• Stoppage of surgery
• Flood with saline/fluid
• 100 % O2 , stop N2O- why?
• Durhant’s position
• Aspiration of air through CVP catheter
• PPV
17. • Carotid sinus stimulation → cardiac dysrhythmias, bradycardia,
Hypotension
• Denerva on of caro d sinus body→ hypertension and loss of hypoxic
derive.
• Ablation of rt sympathetic ganglion-↑QT interval and malignant
arrhythmias → cardiac arrest
• Treatment – LA infiltration of carotid bulb / vagolytic agents
• cessation of pressure
18. • Intra-operative maintain adequate analgesia
• When trachea is transected, tube is replaced by non kinkable tube
(confirmed by capnography and auscultation)
• ↑ airway pressure: malpositon of tube, bronchspasm, debris
• Loss of airway at induction, midway, extubation, postoperative
• Postoperative problems
• Prolonged recovery – ICU care preferably
• Ventilation care - pneumothorax, subcutaneous emphysema
• Speaking
19. Postoperative care
• Monitoring of vital signs
• Care of tracheostomy
• Chest physiotherapy, suctioning ,
• head up 30° to help venous drainage
• Chest X – ray, within 6 hours
• No tight bandage– airway impingement
• Bronchodilation, nebulisation
• Oxygen and analgesia
21. Positioning
• The patient is laid in the supine position on the operating room table.
A shoulder roll is placed to allow for gentle neck extension. The bed is
rotated 180°
22. Monitoring & Follow-up
• Antibiotics are continued for at least 24 hours following laryngectomy.
Routine postoperative care, including vital signs, intake and output
monitoring, tracheostomy care, air humidification, and wound care is
started for all patients following surgery. Ventilator assistance and
bronchodilator therapy should also be considered in patients with co-
existent chronic obstructive pulmonary disease(COPD). Labs to assess
thyroid function and nutritional status should be ordered, especially
in irradiated patients. Tube feeds are initiated once bowel sounds are
present. Oral feeds are started after 1 week in nonirradiated patients.
Postradiation patients should wait 2-3 weeks before starting oral
feeds.