CONCLUSIONS:
- Cardiologist, obstetrician and anestesiologist should cooperate to each other
- The advantage of regional anesthesia is patients can communicate if symptoms occur
- If palpitations, chest pain and shortness of breath happened, immediate action should be performed
- RA should be given using lower dose of local anesthetics opioids and slow induction
- GA : standard technique “rapid sequence induction”
Anesthesia Considerations in Pregnancy with Heart DiseaseMahdi Najafi
Physiology of pregnancy/ Epidemiology of Cardiac Problems in Pregnancy/ Diagnosis/ Management/ Anesthesia consideration in Cardiac & Non-cardiac Operations during pregnancy
Anesthesia Considerations in Pregnancy with Heart DiseaseMahdi Najafi
Physiology of pregnancy/ Epidemiology of Cardiac Problems in Pregnancy/ Diagnosis/ Management/ Anesthesia consideration in Cardiac & Non-cardiac Operations during pregnancy
Airway management in obstetrics patientHASSAN RASHID
OBSTETRICAL PATIENTS POSE A CHALLENGE TO THE ANAESTHESIA PROVIDER. APART FROM VARIOUS PHYSIOLOGICAL CHANGES, AIRWAY CHANGES ALSO ARE OF IMPORTANT CONSIDERATION
diagnostic criteria and pathophysiology of hellp syndrome. Its anesthetic management both pre-operatively and post operatively. complication and differential diagnosis of hellp
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.
Airway management in obstetrics patientHASSAN RASHID
OBSTETRICAL PATIENTS POSE A CHALLENGE TO THE ANAESTHESIA PROVIDER. APART FROM VARIOUS PHYSIOLOGICAL CHANGES, AIRWAY CHANGES ALSO ARE OF IMPORTANT CONSIDERATION
diagnostic criteria and pathophysiology of hellp syndrome. Its anesthetic management both pre-operatively and post operatively. complication and differential diagnosis of hellp
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.
HOTEL of TYPES
Planning considerations of hotels
Design considerations of hotels
STRUCTURE SYSTEM of hotels
examples of hotel ( AGORY GARDEN HOTEL + Eskisehir Hotel and Spa + Carlota Hotel + Whitepod hotel )
Amniotic Fluid Embolism [AFE] Approach to ManagementArun Vasireddy
Amniotic fluid embolism (AFE) is a life threatening obstetric emergency characterized by sudden cardiorespiratory collapse and disseminated intravascular coagulation.
Steiner and Luschbaugh first described AFE in 1941, after they found fetal debris in the pulmonary circulation of women who died during labor. Data from the National Amniotic Fluid Embolus Registry (USA) suggest that the process is more similar to anaphylaxis than to embolism, and the term anaphylactoid syndrome of pregnancy has been suggested because fetal tissue or amniotic fluid components are not universally found in women who present with signs and symptoms attributable to AFE.
The diagnosis of AFE has traditionally been made at autopsy when fetal squamous cells are found in the maternal pulmonary circulation; however, fetal squamous cells are commonly found in the circulation of laboring patients who do not develop the syndrome. The diagnosis is essentially one of exclusion based on clinical presentation. Other causes of hemodynamic instability should not be neglected.
A presentation by Ulf Thilén at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
INADEQUATE PAIN TREATMENT STILL A FACT IN INDONESIA HEALTH SERVICES
PAIN AS A COMPLEX PROBLEM NEED MULTIDISCIPLINARY APPROACH FOR BETTER RESULT BASED INDIVIDUALLY PATIENT NEEDED
THERE IS A BIG ROLE OF PHYSICIAN AND HOSPITAL FOR BETTER PAIN MANAGEMENT
CHANGE PARADIGM TO MULTIDISCIPLINARY PAIN TREATMENT IS AN OBLIGATE FOR ALL PHYSICIAN
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Pain is the production (out put ) of the brain.
Pain is invisible disease, we can’t see it like other disease, such as struma, fracture or blind.
What you have to do is to believe what ever the patient says.
Pain is what ever the patient says it is
Pain is invisible diseases, but is real for patient.
NUTRITIONAL THERAPY IN CRITICAL ILL PATIENTS
However, significant barriers can impede the enteral administration of nutrients, including gastroduodenal dysfunction reflected by high gastric residual volumes, and diarrhoea and constipation.
Possible solutions are suggested. In case of contraindication or failure of enteral nutrition, parenteral nutrition is indicated -----as a replacement or a supplement to failing enteral feeding.
The perfect timing of supplemental parenteral nutrition (early or late) remains uncertain, and parenteral nutrition should be carefully monitored
Solution of inadequate postoperative pain relief lies in developing Acute Pain Service.
APS has been shown to reduced morbidity and
mortality, increased out put and out come of
postoperative pain patients
Increased stisfaction of the patients
Shorten LOS in ICU and Hopital low cost
Nyeri adalah penggabungan perasaan sensorik dan emosional yang dipengaruhi oleh berbagai faktor.
Nyeri memiliki dua dimensi yg jelas, dimensi inderawi dan emosional
Peran dimensi emosional lebih dominan dibanding inderawi utamanya pada nyeri kronik.
History taking
Adequate time
Listen carefully
Empathetic
Trust building
Do not intervere
Pschosocioeconomic & spiritual codition
- quantity: VAS
- quality: nociceptive
- mode of onset and location
- duration & chronicity
- provocating & relieving factors
- special character
- timing of pain
- relation with posture
- associated complaints
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
Clossing
By 3 step ladder WHO cancer pain management, 90 % of cancer pain can be relief.
Since cancer patients cannot be cured, our main task is to let them die free of pain with Iman
Ideal pain clinic
Promoting multidisciplinary team approach
Coordinating all specialist effort
Measuring the outcome of treatment offered
Promoting palliative model rather than curative models of pain treatments
Identifying complications of IPM and promoting safe and base-evidence intervention
PiCCO tidak hanya memberikan informasi tentang curah jantung (CO) tapi bisa memberi pengukuran untuk menilai preload, kontraktilitas, afterload, dan air paru ekstravaskular (ELWI)
Role of the thalamus in propofol-induced unconsciousness relates primarily to the functional connections of nonspecific nuclei to the cortex (i.e., mediating multimodal integration of information)
The Anesthetized Brain is less Vulnerable to ischemic injury than the awake brain.
EEG changes suggestive of severe ischemia are present.
Basic Methode Brain Protection are “ Corner Stone “
CPP, CBF, CBV maintained in “Normal Range”, MAP may increased up to 10 – 20 %.
Anesthetics Drugs may have Brain Protectection effect.
Volatile anesthetics do provide some Transient Protection (< 1,5 MAC)
Barbiturates, although long considered to be the gold standard.
Hypothermic methode are controversial, Hyperthermia should be avoided.
Insulin is Administered if glucose values exceed 180 mg/dl.
Close monitoring of BSL to ensure that Hypoglycemia does not develop
Anesthesiologists should concern about the risk of POCD by making prevention and attentive to the potential risk factors.
It should be remembered that research in animal models which represent the specific characteristics of POCD in human remains unclear.
With many factors still unknown, there is still a chance for sinchronized preclinical and clinical research on POCD.
a better understanding of sleep and coma may lead to new approaches to general anesthesia based on new ways to alter consciousness,29,97,98 provide analgesia,99,100 induce amnesia, and provide muscle relaxation.66
More from Department of Anesthesiology, Faculty of Medicine Hasanuddin University (20)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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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.
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
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!
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 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
anesthesia management for maternal with heart disease
1. Anesthesia Management
for Maternal with Heart Diseases
Purwoko
Dept. of Anesthesiology and Intensive Therapy
Dr. Moewardi General Hospital / Sebelas Maret Univ
Surakarta
2014
2. Introduction
Latest management for maternal with heart
disease requiring surgery.
Techniques of regional anesthesia in patients
with heart disease need little adjustment.
Monitoring of fluid and several heart function.
3. The prevalence of heart disease in
pregnancy is 0.4 - 1%
High risk maternal requires an
understanding of the impact of pregnancy
and heart lesions on hemodynamic
response
Objective : To discuss anesthesia
management for maternal with common
heart lesions which requires non cardiac
surgery.
4. Physiological changes in pregnancy
• Stroke volume ↑↑, Heart rate ↑↑.
• Cardiac output ↑↑
• Sistemic vascular resistance ↓ ± 20%
• Blood flow to uterus ↑↑ 700-900 ml / hour
(increasing heart load)
• - Healthy heart no problem
- Abnormal heart problem
5. 1. Congenital Heart Disease
Patent ductus arteriosus (PDA), Atrial
Septal Defect (ASD) and Ventricular Septal
Defect (VSD) are common congenital heart
diseases
Increased cardiovascular volume during
pregnancy →increasing atrial volume that
leads to enlargement of both atria and
susceptibility of supraventriculare
dysrhythmias
6. Actions performed on the CHD patients :
1. Prevention of air bubbles into the intravenous
access.
2. Epidural anesthesia is better using NaCl, slow
onset of epidural analgesia
3. Oxygen supplementation
4. Antibiotic prophylaxis is recommended.
7. Tetralogy of Fallot (TOF)
Minimizing hemodynamic changes that
leads to increased R to L shunt.
It is important to prevent decreased in SVR,
venous return or myocardial depression
Both GA or RA techniques can be used.
8. • For GA, induction agents chosen are
those that cause the most minimal
hemodynamic changes, for examples
narcotics and etomidate.
• Regional anesthesia techniques can be
used with special attention.
• Single Shot spinal anesthesia should be
avoided.
• Slow induction of epidural anesthesia is
recommended
9. Eisenmenger Syndrome
Abnormalities : pulmonary hypertension,
right-to-left shunting produces arterial
hypoxemia.
Clinical manifestations include dyspnoea,
clubbing, polycythemia, peripheral edema
and cyanosis.
Avoid decreased of SVR.
10. RA or GA may be used if only there are no
contraindications . RA can be done using
epidural dose titration.
Oxygen should be given
Blood loss should be replaced with colloid,
crystalloid or blood components.
Invasive Monitoring should be done such as
arterial Line and CVP
Ampycillin and Gentamicin should be given as
prophylaxis drugs against infective
endocarditis and repeated every 8 hours after
the initial dose.
11. Valvular Heart Diseases
1. Mitral stenosis
Maintain heart rate, venous return and
SVR remained low (slow)
Avoid aorto caval compression,
aggressive treatment of atrial fibrillation,
maintaining sinus rhythm.
prevent pain, hypoxemia, hypercarbia
and acidosis ↑↑ SVR.
Both RA or GA can be used.
12. Epidural anesthesia is an option
Vasopressors: low dose of phenylephrine.
GA also provide stable hemodynamics,
Etomidate is best used as an induction
agent.
Beta blockers such as esmolol and
moderate dose of opioids should be
administered before induction
13. 2. Mitral regurgitation
• Pregnancy will induce a state of hyper
coagulation and systemic embolism.
• Epidural anesthesia can prevent an increase in
SVR, and prevent pulmonary congestion.
• Invasive blood pressure monitoring
• Antibiotics profilaxis is recommended
• GA : Ketamin and Pancuronium
14. • The main consideration is maintaining
slight increase in heart rate to prevent an
increase in SVR and central blood volume.
• Prevent hypoxemia, hypercarbia, acidosis
that will lead to an increase in PVR.
• Avoiding Aortocaval compression and
myocardial depression.
15. 3. Aorta Stenosis
In aorta stenosis, transvascular gradient will
progressively increased during pregnancy, this
is due to an increase in blood volume and
decrease in SVR.
Avoid tachycardia and bradycardia, maintain
intravascular volume and "venous return", avoid
aortocaval compression and myocardial
depression, maintain heart rate as the normal
condition because decrease in heart rate will
decrease cardiac output
16. GA: combination of etomidate and mid-dose
opioids with succinylcholine for
"Rapid Sequence intubation".
Myocardial depression due to volatile
anesthetic agents should be avoided
Pulmonary artery catheter monitoring is
controversial, CVP monitoring is needed
and must be maintained at high normal
level
17. 4. Aorta Insufficiency
Pathophysiology that occurs due to the "volume overload" on
the LV, with hypertrophy and dilatation and increased LVEDV,
decreased ejection fraction (EF) and signs and symptoms of
edema pumonal.
Minimalizing pain is an attempt to prevent release of
catecholamines , which may increase SVR
Avoid bradycardia because it can lead to an increase in
regurgitant flow.
18. • Epidural anesthesia is
preferable/recommended
• Induction agent using etomidate,
endotracheal intubation using
suxamethonium
• Remifentanyl for analgesia
19. 5. Prosthetic Valves
The high risk of fetal and maternal
complications
The use of anticoagulant therapy is contra
indication for regional anesthesia.
GA: the use of an additional monitoring tool
such as CVP, PA catheter and A-Line
20. Peripartum Cardiomyopathy (PPCM)
Heart failure can occurs in the 3rd trimester, EF less
than 45% and diastolic dimensions greater than
2.72cm / m2
Avoiding myocardial depression and attention to fluid
management with the use of diuretics and
vasodilators, as well as keeping the heart rate within
the normal range with sinus rhythm.
Titration slowly CSA / CEA
GA: monitoring invasive, PA Line, A Line
Narcotics for the induction and maintenance of
anesthesia
21. Maternal arrhythmias during pregnancy
Cathecolamine Sensitive Ventricular Tachycardia (VT)
Often due to the VT re-entry (ca)
Patients with a history of VT are required to continue the
anti-arrhythmia medication during pregnancy.
CSE drug delivery slowly (slow incremental)
22. Congenital Heart Block and Bradyarrhytmia
The use of pacemaker; QT interval lengthening or
if there is enlargement of the left atrium.
Access CVC and "trans Venous Pacing wires
should be prepared in addition to the patient
during the surgery
Epidural analgesia is recommended for surgery
and postoperative pain.
23. Maternal postoperative period in
heart disease
Patients with less - severe cardiac dysfunction that undergo
surgery should be monitored in Intensive Care Unit (ICU)
The first 24-72 hours of fluid displacement will appear
significantly.
Adequate postoperative analgesia should be provided in the
form of "continuous epidural analgesia" or "patient controlled
IV analgesia”.
Provision of early ambulation to minimize the occurrence of
"deep vein thrombosis and paradoxical emboli"
24. "Outcome" of fetal and maternal heart disease
requiring surgery
• Mortality that is less than 1% have been
reported in patients with NYHA Class I and
II, whereas in NYHA Class III and IV are
about 5-15%.
25. Conclusions
Cardiologist, obstetrician and anestesiologist should
cooperate to each other
The advantage of regional anesthesia is patients can
communicate if symptoms occur
If palpitations, chest pain and shortness of breath
happened, immediate action should be performed
RA should be given using lower dose of local
anesthetics opioids and slow induction
GA : standard technique “rapid sequence induction”