1. Physiologic changes in pregnancy can increase risks during general anesthesia including airway edema, difficulty with intubation, and increased risk of aspiration due to stomach displacement. Regional techniques like epidurals are preferred to avoid these risks.
2. Epidural analgesia during labor provides effective pain relief in over 85% of women but can cause hypotension requiring treatment. Combined spinal epidurals allow rapid pain relief with minimal motor block.
3. For c-sections, regional techniques like epidurals and spinals are preferred over general anesthesia due to benefits for mother and neonate, though hypotension is a risk of spinals requiring treatment. General anesthesia is used for emergencies or if regional is contra
Approach to maternal collapse and cardiac arrest.pptxKTD Priyadarshani
This is a case based discussion on approach to maternal collapse and cardiac arrest. It includes a detailed account on ERC ALS guideline on maternal cardiac arrest and post resuscitation care.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Approach to maternal collapse and cardiac arrest.pptxKTD Priyadarshani
This is a case based discussion on approach to maternal collapse and cardiac arrest. It includes a detailed account on ERC ALS guideline on maternal cardiac arrest and post resuscitation care.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
- 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
2. Physiologic changes of pregnancy
Respiratory system
- Mucosal vascular engorgement which leads to airway
edema and friability.
- Presence of large breasts.
- Increased risk of pulmonary aspiration of stomach
contents due to upward displacement of the stomach.
2
3. Airway complications (difficult intubation, aspiration) are
the most common anesthetic cause of maternal mortality.
The best means of avoiding this outcome is to avoid
general anesthesia. If a general anesthetic is required,
NPO status for eight hours is preferred
Pretreatment of all parturients with a non-particulate
antacid (30 cc sodium citrate p.o.) as well as with a
histamine blocker (ranitidine 50 mg IV) is important.
Finally, a rapid sequence induction is mandatory
3
4. With the apnea that occurs at induction of anesthesia, the
parturient becomes hypoxic much more rapidly than the
non-pregnant patient due to 2 main reasons:
- Oxygen requirement has increased by 20% by term
- Decrease of FRC, which serves as an “oxygen
reserve” by 20% due to upward displacement of the
diaphragm
- Minute ventilation increases to 150% of baseline
leading to a decrease in PaCO2 (32 mmHg)
- The concomitant rightward shift in the oxyhemoglobin
dissociation curve allows increased fetal transfer of O2
4
5. Cardiovascular system
- Blood volume increases by 40% during pregnancy in
preparation for the anticipated average blood loss during
vaginal or Caesarian.
- When the pregnant patient is in the supine position, the
heavy gravid uterus compresses the major vessels in the
abdomen leading to maternal hypotension and fetal distress
(supine hypotensive syndrome)
5
7. Medications that cause uterine contraction
- Vasopressors: large doses of α-adrenergic agents, such as
phenylephrine, in addition to causing uterine arterial
constriction, can produce tetanic uterine contractions
- Ergot Alkaloids- cause intense and prolonged uterine
contractions. It is therefore given only postpartum (single
0.2 mg dose intramuscularly or in dilute form as an
intravenous infusion over 10 minutes) to treat uterine atony.
7
8. - Oxytocin (Pitocin): is usually administered intravenously
to induce or augment uterine contractions or to maintain
uterine tone postpartum.
- It has a half-life of 3–5 min.
- Induction doses for labor are 0.5–8 mU/min
- Prostaglandins: given for PPH
- An initial dose of 0.25 mg intramuscularly may be
repeated every 15–90 min to a maximum of 2 mg
8
9. Analgesia during labour
Inhaled N2O (Entonox®)
Opioids
N2O/O2 (Entonox®)
Pethidine - Has a long half-life in the fetus (18–23hr)
- Reduces fetal heart rate variability in labour
- Associated with changes in neonatal
neurobehaviour, including an effect on breastfeeding
9
10. - Uterine pain is transmitted in sensory fibres, which accompany
sympathetic nerves and end in the dorsal horns of T10–L1.
- Vaginal pain is transmitted via the S2–S4 nerve roots
- Neuraxial techniques; spinal, combined spinal/epidural (CSE)&
epidural; can be expected to provide effective analgesia in over
85% of women
However, neuraxial analgesia was associated with:
- Hypotension
- Increased oxytocin use
- An increased incidence of maternal pyrexia
10
11. Regional labour analgesia
Indications
- Maternal request
- Expectation of operative delivery
- Obstetric disease
- Maternal disease: in particular, conditions in which
sympathetic stimulation may cause deterioration in maternal
or fetal condition
- Specific CVS disease
- Severe respiratory disease
- Conditions in which GA may be life-threatening
11
12. Regional labor analgesia cont.
Contraindications
- Allergy
- Local infection
- Uncorrected hypovolemia
- Raised ICP
- Untreated systemic infection (risk of ‘seeding’ infection
into the epidural space)
12
13. Epidural analgesia for labour
Skin sterilization with 0.5% chlorhexidine
Chlorhexidine must be allowed to dry before the skin is
touched
Locate the epidural space
The incidence of puncturing a blood vessel with the
epidural catheter is reduced if 10mL of saline is flushed
into the epidural space before the catheter is inserted
Introduce 4–5cm of the catheter into the epidural space
13
14. Epidural analgesia cont.
Give an appropriate test dose
Using 0.5% bupivacaine significantly increases motor block.
- There should be no need to use concentrations >0.25%
bupivacaine.
Many anesthetists will use 8–15mL of 0.1% bupivacaine with
a dilute opioid (2 micrograms/mL fentanyl) as both the test
and main doses.
If required, give further LA to establish analgesia
Once the epidural is functioning, it can be maintained by:
- Intermittent top-ups of LA or continuous infusion of LA
(5–12mL/hr of –0.1% bupivacaine with 2 micrograms/mL
fentanyl)
14
15. Epidural analgesia cont.
Main complication
- Hypotension: prolonged or severe hypotension will
cause fetal compromise.
*Give an IV fluid bolus of crystalloid solution, if the
fetus is distressed, mask O2 supplementation.
*Give 6mg IV ephedrine, and repeat as necessary
15
16. Combined spinal/epidural analgesia for
labour
A combination of low-dose subarachnoid LA and/or
opioid, together with subsequent top-ups of weak epidural
LA
Produces a rapid onset of analgesia with minimal motor
block.
16
17. Combined..
Indications
- Establishing rapid analgesia in women who are unable to
cope with labour pain.
- Re-establishing analgesia for women who have had a
failed epidural.
17
18. Combined..
Perform the spinal at L3/4 or below.
Inject the spinal solution
Insert an epidural catheter at a different interspace.
Check the degree of motor and sensory block, and then
administer an epidural test dose
18
19. Total spinal analgesia for labour
• Symptoms are of a rapidly rising block
• Difficulty in coughing may be noted (which is commonly
seen during regional anesthesia for a Caesarean section) -
>loss of hand and arm strength -> difficulty with talking,
breathing, and swallowing.
* Make sure that the equipment for ventilatory and CVS
support are immediately available
19
20. C- section
For category 1 (emergency) sections, the objective should
be to deliver the fetus as quickly as possible, while not
compromising maternal safety.
General anesthesia is commonly used for category 1
sections.
20
21. Regional anesthesia for Cesarean section
Advantages of regional anesthesia
- Minimal risk of aspiration
- Lower risk of anaphylaxis
- The neonate is more alert, which promotes early bonding
and breastfeeding
- Fewer drugs are administered, with less ‘hangover’ than
after GA
- Better post-operative analgesia and earlier mobilization
21
22. Cesarean section: epidural
Indications
Women who already have epidural analgesia established
for labour.
Specific maternal disease (e.g. cardiac disease) where
rapid changes in SVR might be problematic.
22
23. Cesarean section: spinal
Spinal anesthesia is the most commonly used technique
for elective Cesarean sections.
Rapid in onset
Produces a dense block, and, with intrathecal opioids, can
produce long-acting post-operative analgesia.
23
24. Spinal cont.
However, hypotension is much more common than with
epidural anesthesia.
* Use a phenylephrine infusion.
- A simple regime is to use a syringe driver with a
solution of 100 micrograms/mL of phenylephrine.
24
25. General anesthesia
Indications
Maternal request
Urgent surgery
Regional anesthesia contraindicated (e.g. coagulopathy,
maternal hypovolemia)
Failed regional anesthesia
Additional surgery planned at the same time as a
Caesarean section
25
26. Effect of general anesthesia on the fetus
Most anesthetic agents, except for muscle relaxants,
rapidly cross the placenta.
Opioids administered before delivery may cause fetal
depression which can be rapidly reversed with naloxone
(e.g. 200 micrograms IM or 10 micrograms/kg IV)
Hypotension, hypoxia, hypocapnia, and excessive
maternal catecholamine secretion may all be harmful to
the fetus
26
27. Difficulties
- Failed intubation
* When intubation fails, but mask ventilation succeeds, a
decision on whether to continue with the Caesarean section
must be made.
27
28. If the surgery continues, decisions will have to be made
on whether to use 1st- or 2nd-generation laryngeal masks
and whether to use muscle paralysis (if yes, then
rocuronium may be useful)
28
29. Antacid prophylaxis
- Fluid aspiration is commonly associated with chemical
pneumonitis, and the severity of this is dependent on the
volume and acidity of the aspirated fluid.
- Use of antacids and prokinetic agents can elevate the
gastric pH and reduce the intragastric volume ( e.g
Metoclopramide, Ranitidine and Sodium citrate)
29
Use a regional technique
RSI was defined as the administration of a potent induction agent followed immediately by a rapidly acting paralytic agent to induce unconsciousness and motor paralysis for intubation
The increase of intravascular volume may not be tolerated by parturients with concomitant cardiovascular disease, such as mitral stenosis
Left lateral tilt, usually achieved with a pillow under the woman’s right hip, is an important positioning maneuver