1. The document reviews anatomy of the orbit and surrounding structures relevant to ophthalmic anesthesia. It describes nerves, muscles, vasculature and layers within the orbit.
2. Various local anesthetic agents and their properties are discussed. Common techniques for ophthalmic anesthesia including topical, subconjunctival, intracameral, peribulbar, retrobulbar, and facial nerve blocks are explained.
3. Risks associated with different techniques like retrobulbar hemorrhage, globe perforation, and brainstem anesthesia are outlined. The document provides an overview of orbital anatomy and ophthalmic anesthesia techniques and considerations.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
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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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
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O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
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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.
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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.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
13. “The relationship between the muscle insertions and
the ora serrata is clinically important. A misdirected
suture passed through the insertion of the superior
rectus muscle could perforate the retina”
14. Levator is
innervated by
CN III
1. skin
2. eyelid margin
3. subcutaneous connective tissue
4. orbicularis oculi muscle
5. orbital septum
6. levator palpebrae superioris muscle
7. Müller muscle
8. tarsus
9. conjunctiva
16. “The Tenon capsule (the fascia bulbi) is an envelope of elastic
connective tissue that fuses posteriorly with the optic nerve sheath
and anteriorly with a thin layer of tissue called the intermuscular
septum, which is located 3 mm posterior to the limbus”
17. Vascular Supply and Drainage of the Orbit
Vascular Supply and Drainage of the Orbit
21. 3 main outlets of venous system
– Superior and inferior ophthalmic v. cavernous
sinus&cranial system
– Anastomosis of the ophthalmic v.&angular v.
facial venous system
– Inferior orbital fissure pterygoid venous plexus
22.
23.
24. NEUROANATOMY
• Cranial Nerve II
• Cranial Nerve III
• Cranial Nerve IV
• Cranial Nerve V
• Cranial Nerve VI
• Ciliary Ganglion
NEUROANATOMY
30. “The local anesthetic drugs used in
ophthalmology are tertiary amines linked by
either ester or amide bonds to an aromatic
residue”
31. “Protonated form(inside myelin sheath) blocks
the sodium channels on the inner wall of the cell
membrane and increases the threshold for
electrical excitability. As increasing numbers of
sodium channels are blocked, nerve conduction
is impeded and finally blocked”
32. • block the poorly myelinated and narrow
parasym&sym fibers
• Optic nerve is usually not impeded by retrobulbar
block
• Myelinated motor fibers (akinesia)
• Sensory fibers (pain+temp)
33.
34.
35. TOXIC
• The toxic manifestations of local anesthetics
are generally related to dose
• severe hepatic insufficiency
• even at lower doses. These manifestations
include restlessness and tremor that may
proceed to convulsions, and respiratory and
myocardial depression
36. EPINEPHRINE
• local anesthetics block sympathetic vascular
tone and dilate vessels,
• a 1:200,000 concentration of epinephrine is
frequently added to shorter-acting drugs to
retard vascular absorption
37. LIDOCAINE
• Lidocaine is an amide local anesthetic used in
strengths of 0.5%, 1%, and 2% (with or
without epinephrine) for injection
• It yields a rapid (5-minute) retrobulbar or
eyelid block that lasts 1–2 hours.
38. MEPIVACAINE
• Mepivacaine is an amide drug used in
strengths of 1%–3% (with or without a
vasoconstrictor).
• rapid onset and lasts approximately 2–3
hours. The maximum safe dose is 25 mL of a
2% solution.
39. BUPIVACAINE
• poor akinesia but has the advantage of a long
duration of action, up to 8 hours.
• mixture with lidocaine or mepivacaine to
achieve a rapid, complete, and long-lasting
effect.
• The maximum safe dose is 25 mL of a 0.75%
solution.
40. HYALURONIDASE
• combined with local injection of anesthetics to
increase the dispersion of the anesthetic drug
• More dispersion reduce the pressure rise in
the limited orbital space, produce less
distortion of the surgical site, decrease the risk
of postoperative strabismus and myotoxicity,
and increase akinesia of the globe and lid
41. HYALURONIDASE
• lower volumes of anesthetic agent.
• For retrobulbar or peribulbar injection, 1 mL
of hyaluronidase can be added to a syringe of
the anesthetic to be administered.
44. LOCAL ANESTHESIA
• Topical Anesthesia Block
– Block superficial cornea and conjunctiva
– Block long and short ciliary nerve, nasociliary
nerve, lacrimal nerve
– Disrupt intercellular tight junction
45. LOCAL ANESTHESIA
• Subconjunctival block
– Anterior segment is blocked but no akinesia
– At posterior to phaco incision/ perilimbal
conjunctiva
46. LOCAL ANESTHESIA
• Intracameral block
– Anesthetic agent: 0.2-0.5 ml of unpreserved 1%
lidocaine hydrochloride
– If absence of posterior capsulemight cause
transient retinal toxicity “Transient Amaurosis”
47. Regional anesthesia
• Parabulbar block (sub-tenon block)
– Inferonasal, inferotemporal
– Inject anesthetic agent into sub-tenon space
– Patient look upward+outward
– Drug : 2% lidocaine, +hyaluronidase
48. Method
– Grab conjunctiva+Tenon’s capsule with blunt non-
toothed forceps
– Small cut with westcott scissors
– Blunt curved posterior sub-tenon’s cannula with
local anesthetic
– Move along the curvature of the sclera
– Inject anesthetic agent into sub-tenon space
55. • Still!!
– Superonasal block is indicated as supplementary
block
– Locate the needle at upper eyelid vertically above
the medial limbus
– Intermittent of ocular compression (10-
20minutes)
56. Pros cons
Reduce retrobulbar
hemorrhage accident
Might not achieve at
akinesis effect
Reduce risk of injury at
globe or optic nerve
Larger volume is needed
Reduce risk of intradural
injection
More incidence of
periorbital
ecchymosis+chemosis
57. Regional anesthesia
• Peribulbar block (Extraconal block)
– Inject into extraconal spacedrug spread to
whole area including intraconal area
– The larger space to apply, the more volume of
drug is needed.
58. Method
– Patients lies in supine + neutral position
– ¾ inch, 24-26G needle
– Anesthetic agent: 5ml of 0.75%bupivacaine// 5 ml
of 2%lidocaine with 1:200,000 adrenaline//150
units of hyaluronidase
59. Method
– Point at lateral1/3 and the medial 2/3 of the
inferior orbital edge
– Directed to the apex of the orbit
– at equator of globe
60. • Retrobulbar block (intraconal block)
– 25G, 1 ½ inches needle
– Neutral position
– Point at lateral 1/3 and medial 2/3 of inferior orbital
edge
– Posteriorly parallel to the orbital floor, incline of 15
degree
– Pass equatorshift to medially and superiorly angle
of 45 degree
– Depth 25-35 mm
– Compress for 15 sec on5 sec off for 1-2 minutes
Regional anesthesia
61. • Akinesia and Anesthesia are quickly ensure
the complete block
62. Retrobulbar Block - Step 1
• Enter just inferior to the globe and
perpendicular to the plane of the face.
63. Retrobulbar Block - Step 2
• Once you feel the first pop through the orbital
septum, angle 45 degrees medially and 45
degrees superiorly towards the apex of the
orbit until the second pop through the muscle
cone is felt.
64. Retrobulbar Block - Injection
Pull back on the syringe to ensure the needle is
not in a vessel, then inject 3-5 cc of anesthetic,
palpating the globe to assess for posterior
pressure
65. Pros Cons
Low volume of drug Risk of retrobulbar
hemorrhage
High potency of blocking Oculocardiac reflex
Rapid onset CRAO
Puncture into globe,optic
nerve
Risk of brain stem
anesthesia
Epinephrine toxicity
69. Oculocardiac reflex
• rapid distension of the tissues by volume or
haemorrhage provoke it occasionally
• Bradycardia, Junctional Rhythm, Asystole
70. Central Retinal Artery Occlusion
• Sudden, complete, and painless loss of vision
• Must!! immediately reduce the IOP
71. Puncture into globe
• myopic eyes which are longer but also thinner
• globes longer than 26 mm are at risk
• A diagnosis of perforation may be made by
pain at the time the block is performed,
sudden loss of vision, hypotonia, a poor red
reflex or vitreous haemorrhage
74. Brainstem Anesthesia
• Onset can be 2-40 minutes after injection
• symptoms are drowsiness, vomiting,
contralateral blindness caused by reflux of the
drug to the optic chiasm, convulsions,
respiratory depression or arrest, neurological
deficit, cardiac arrest