Cerebral blood flow is tightly regulated to meet the high metabolic demands of the brain. Blood circulates to the brain through the carotid and vertebral arteries which connect at the circle of Willis. Factors like blood pressure, carbon dioxide levels, oxygen, temperature and various chemicals regulate blood flow. The brain has autoregulatory mechanisms to maintain constant blood flow over a range of pressures. Failure of autoregulation can lead to ischemia or hyperperfusion. Clinical considerations include risks for hypertensive or elderly patients and treatments focus on preventing hypotension and ischemia.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
BLOOD PRESSURE
BY: SAIYED FALAKAARA
ASSISTANT PROFESSOR
DEPARTMENT OF PHARMACY
SUMANDEEP VIDYAPEETH
Definition
Arterial blood pressure can be defined as the lateral pressure exerted by moving the column of blood on the walls of the arteries.
Significance
To ensure the blood flow to various organs
Plays an important role in exchange of nutrients and gases across the capillaries
Required to form urine
Required for the formation of lymph
Normal values
Normal adult range can fluctuate within a wide range and still be normal
Systolic/diastolic
100/60 – 140/80
Unit - mmHg
Pituitary Tumors account for 15% of Braun tumors. Trans sphenoidal endoscopic approach are more common. Post surgery fluid and electrolyte balance is important.
sedation in neuro icu requires frequent interruptions for serial neurological examination. incorporation of inhalational agents in icu improves sedation practices.
pain management after craniotomy and spine surgery. as a neuroanesthesiologist it our duty to manage post operative pain. pain in these patient are under treated.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- 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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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
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2. INTRODUCTION
Brain is a closed structure
Most of it is brain tissue
while some of it is
blood and CSF
Brain comprises 80%
Cerebral blood volume: 12%
CSF contribute to 8% of the
space inside the skull vault
Monro – Kellie doctrine
3. Anatomy :
• Circulation of brain
was first described
by WILLIS in 1664
1. Anterior circulation
and Posterior
circulation via
circle of Willis
2. Collateral arterial
inflow channels
3. Leptomeningial
collaterals- pial to
pial anastomoses
4. Anatomy
Circulation via circle of
Willis: anterior
circulation: via 2 carotid
arteries and their
derivations
Posterior circulations: via 2
vertebral arteries joining
to form basilar artery
It lies in subarachnoid space
and encircles pituitary
gland
Willisian channels:
anterior
communicating artery,
posterior
communicating artery
and ophthalmic artery
via external carotid
artery
6. Collateral circulation
In a normal individuals
there is no net flow of
blood across these
communicating arteries
But to maintain patency
and prevent thrombosis
there is to an fro flow of
blood
Their importance appears
when a pressure
gradient develops
Second collateral flow
appears in surface
connections that bridge
pial arteries.
They bridge major arterial
territories ( ACA – PCA,
ACA- MCA, MCA – PCA)
They are called
leptomeningial
pathways or equal
pressure path ways.
7. Cerebral microcirculation
Capillary density in grey matter is 3 times higher than
white matter
Pre capillary vessels divide and reunite to form
anastomotic circle called as circle of Duret
They are highly tortuous and irregular
Velocity of RBC’s is higher in these capillaries
To facilitate transfer of substrate and nutrients RBC’s
have to traverse longer distance via these capillaries
8. Cerebral microcirculation
Fast capillaries: These are the ones who do not take part
in transfer of substrate
BUT
During cerebral hypoperfusion they have a decrease in
blood velocity , diverting blood to slower functional
capillaries.
9. Venous drainage
3 set of veins drain from
brain
1. Superficial cortical vein
2. Deep cortical veins
3. Dural sinuses
All ultimately drain into
right and left IJV
10. Cerebral blood supply:
Physiological considerations:
Brain accounts for 2% of body
weight yet requires 20% of
resting oxygen consumption
O2 requirement of brain is 3 – 3.5
ml/100gm/min
And in children it goes higher up to
5 ml/100gm/min
Brain has high metabolic rate
That’s why brain requires
higher blood supply
55ml/100gm/min is the rate
of blood supply
requires more
requires
more
substratete
substrate
requires
mlacks of
storage of
energy
substrate
12. Factors regulating cerebral blood flow
• Hemodynamic autoregulation
• Metabolic mediators and chemoregulation
• Neural control
• Circulatory peptides
13. Cerebral blood flow regulation
1. Flow metabolism coupling: Hemodynamic
regulation
Cerebral blood flow (CBF) closely follows
cerebral perfusion pressure (CPP)
Within the range of 50 to 150 mm Hg of CPP ,
blood flow remains constant.
Where CPP = MAP – ICP
MAP :Mean arterial pressure and ICP : Intracranial pressure.
Pure changes in perfusion pressure involve
myogenic response in vascular smooth
muscles (Bayliss effect)
14. Flow metabolism coupling:
Mechanism that CPP responds to:
mean BP
pulsatile pressure
Mediators involved are: H+, K+, adenosine,
glycolytic intermediate and phospholipid
metabolites
Nitric oxide controls the smooth muscles tone
15. Cerebral blood flow regulation
a. Pressure regulation:
Ohm’s law: flow = Pi – Pf
R
Hagen poiseuille relation : R = 8L μ
r⁴
where Pi – Pf is change in pressure,
R is resistance , L is the length of the tube , μ is coefficient of viscosity and r is radius
of the tube.
So we derive that: R = Pi – Pf = 8L μ
flow r⁴
16. Cerebral blood flow regulation
Arteriolar diameter as
well as cerebral vascular
resistance both vary with
CPP but CBF remains
constant in this range.
17. Cerebral blood flow regulation
2. Venous physiology:
Venous system contains
most of the cerebral
blood volume
Slight change in vessel
diameter has profound
effect on intracranial
blood volume
But evidence of their role
is less
Less smooth
muscle content
Less innervations
than arterial
system
18. Cerebral blood flow regulation
Pulsatile perfusion:
Fast and slow components of myogenic
response bring a change in perfusion pressure
Cardiac output:
Cardiac output may be responsible for improved
cerebral blood flow
They are indirectly related via central
venous pressure and large cerebral vessel
tone.
19. Cerebral blood flow regulation
Rheological factors:
Related with blood viscosity.
Hematocrit has main influence on blood
viscosity.
Flow is inversely related with hematocrit.
In small vessels cells move faster than plasma.
This reduces microvascular hematocrit and
viscosity FAHRAEUS LINDQVIST EFFECT
20. Metabolic and chemical regulation
1. Carbon dioxide
coupler between flow
and metabolism
At normal conditions CBF
has linear relationship
with CO2 between 20 –
80 mm Hg
For every mm Hg change
of PaCO2 CBF changes
by 2 – 4 %
22. CARBON DIOXIDE : How it works
ADULT
↑CO2
↑H+ ions
NO
↑nNOS
C GMP
K+ Channel
Ca2+ Channel
↓Ca2+
↓Ca2+
Smooth Ms
Relaxation
↑K+
23. CARBON DIOXIDE : How it works
Neonates
↑CO2
↑H+ ions
PG
↑COX
endothelium
C AMP
K+ Channel
Ca 2+ Channel
↓Ca2+
↓Ca2+
Smooth Ms
Relaxation
↑K+
24. Metabolic and chemical regulation
Oxygen:
Within physiological range PaO2 has no effect on
CBF
Hypoxia is a potent stimulus for arteriolar
dilatation
At PaO2 50 mmHg CBF starts to increase and at
PaO2 30 mm Hg it doubles
26. Metabolic and chemical regulation
Temperature:
Like other organs cerebral metabolism
decreases with temperature
For every 1˚C fall in core body temperature
CMRO2 decreases by 7 %
At temperature < 18 ˚C EEG activity ceases
34. Circulatory peptides:
Vasoactive peptides like angiotensin II do affect
CBF.
Reactive oxygen molecules
Alteration to vasomotor function
Vascular remodeling
De silva et al: effects of angiotensin II on cerebral circulation: role of oxidative
stress; review article – front physiology ; jan 2013
37. Clinical considerations
Elderly patients:
With age CBF decreases
Younger people have increased blood flow in
frontal areas…. Frontal hyperaemia
But with age this increased flow reduces
Flow in other areas are well maintained hence
blood is more uniformly distributed
Autoregulatory failure occurs in morel elderly
38. Auto regulatory failure
For auto regulatory failure to occur vasomotor
paralysis is the end point
• Acute ischemia
• Mass lesions all lead to
• Inflammation vasomotor
• Prematurity paralysis
• Neonatal asphyxia
• Diabetes mellitus
39. Autoregulatory failure
Right sided failure
Hyperperfusion
leads to circulatory
breakthrough
Fluid from capillaries seep
into the extracellular
space leading to edema
e.g. AVM
Left sided failure
Hypoperfusion
Ischemia
Na˖ and Ca 2˖ influx with
water and K+ efflux
leads to cytotoxic
edema and infarction
e.g. ischemic stroke
40. Autoregulatory failure
Two stages before infarction:
a. Penlucida at flow 18 – 23 ml/100gm/min
brain becomes inactive but function can be
restored at any time by reperfusion
b. Penumbra at lower flow rates brain
function can be restored by reperfusion but
only within a time limit
41. Hemodynamic considerations
Cerebral steal: it means blood is diverted from
one area to another if pressure gradient exists
between the two circulatory beds
Vasodilatation in ischemic brain takes blood
from ischemic areas to normal areas causing
more ischemia
Vasoconstriction results in redistribution of
blood from normal to ischemic areas leading
to inverse steal or ROBIN HOOD EFFECT
42. Hemodynamic considerations
Vessel length and viscosity
At breakthrough point flow depends on vessel
length and viscosity
Autoregulation has failed and it behaves like
fluid in a rigid tube
Pressure gradient across the ends are now same
so distal area have the lowest flow
This makes watershed areas more vulnerable to
ischemic changes
43. Considerations for ischemia
Consideration relevant to
global ischemia
Prevent and treat
hypotension as well as
vasogenic & cytotoxic
edema
Induction of mild
hypothermia for 24 hrs
Consideration relevant to
focal ischemia
Barbiturate coma, volatile
anesthetics (xenon),
calcium channel
antagonists
PaCO2 and temperature
44. Therapies for enhancing perfusion
• Induced hypertension
• Inverse steal
• Hypocapnea
• Hemodilution
• Pharmacological agents
• Barbiturates, propofol
• Intra arterial delivery of drugs. Like mannitol
and vasodilators
45. References:
1. Mishra L D; cerebral blood flow and anaesthesia;
Indian J. Anaesth. 2002; 46 (2) : 87-95
2. Joshi et al; cerebral and spinal cord blood flow;
Cottrell and Young’s Neuroanesthesia; 5th ed, 2010:
17 – 59
3. Patel et at; Cerebral physiology and effect of
anesthetic drugs; Miller’s anesthesia 8th ed : 387 –
423
4. De silva et al: Effects of angiotensin II on cerebral
circulation: role of oxidative stress; review article –
front physiology ; jan 2013