Paravertebral Cevical Sympathetic Block
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The document discusses paravertebral cervical sympathetic block, including: - Its history dating back to 1905-1910 with further developments in the 1920s and 1930s. - Applied anatomy of the sympathetic chain and ganglia in the cervical region, including the stellate ganglion. - Indications for stellate ganglion block such as CRPS, ischemic diseases, and hyperhidrosis. - Techniques for the block including the anterior paratracheal approach using local anesthetic. - Potential side effects include Horner's syndrome and diffusion of the local anesthetic to nearby nerves.
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This document discusses stellate ganglion block, a technique used to interrupt cervical sympathetic nerves. It can be used diagnostically and therapeutically, including to treat electrical storm. The stellate ganglion is located anterior to C7-T1 and near important structures. Techniques discussed include surface landmark, fluoroscopy, and ultrasound guidance. Complications include Horner's syndrome, pneumothorax, and hematoma. Bilateral blocks are not recommended due to risk of hypotension. The case study describes using stellate ganglion block to successfully treat recurrent ventricular tachycardia in a patient with an implantable cardioverter-defibrillator.
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- Local anesthetics injected into the epidural space spread horizontally to nearby dermatomes and vertically in a preferentially cephalad direction.
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Careful evaluation of sympathetic involvement in disease process should be done before deciding to perform block.
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This document discusses long QT syndrome (LQTS) in children, including causes, diagnosis, treatment, and considerations for anesthesia management. It describes how LQTS results from genetic mutations affecting cardiac ion channels, causing prolonged ventricular repolarization and risk of dangerous arrhythmias. Diagnosis involves calculating the QT interval from ECG and applying the Schwartz criteria. Treatment focuses on beta-blockers, antiarrhythmic drugs, pacemakers or ICDs. Anesthesia requires avoiding triggers of arrhythmias and prolonging the QT interval through careful drug selection and electrolyte management.
Update in Central Neuraxial Blockade in Pediatrics
This document discusses central neuraxial blockade techniques in pediatrics. It begins by noting key anatomical and physiological differences between children and adults that impact neuroaxial techniques. It then covers indications, contraindications, preoperative management, safety measures, technical procedures, advantages, disadvantages and complications of central neuraxial blockade in pediatrics. The document emphasizes the need to understand pediatric spinal anatomy and physiology to safely perform these techniques.
Ultrasound Guided Regional Anesthesia
1. The document describes ultrasound guided regional anesthesia techniques for the upper and lower extremities. It covers anatomy, pharmacology, physics of ultrasound, and specific nerve block procedures for the arms, legs, and trunk.
2. Upper extremity nerve blocks described include axillary, supraclavicular, interscalene, infraclavicular, mid humeral, elbow/forearm, and wrist blocks. Lower extremity blocks include femoral, sciatic, and obturator nerve blocks.
3. The document provides details on ultrasound guidance, local anesthetic doses and volumes, and needle insertion approaches for each nerve block.
Anesthetic management of Tracheo Esophageal fistula and Eosphageal Atresia
1. Tracheo-esophageal fistula and esophageal atresia are congenital anomalies where the esophagus fails to connect to the stomach and connects abnormally to the trachea instead.
2. Anesthetic management involves preoperative assessment and stabilization, intraoperative ventilation techniques to prevent gastric distention, and postoperative respiratory support and monitoring for complications.
3. The goal of surgery is to ligate the fistula and reconnect the esophagus, which may require staged procedures in some cases. Long-term complications can include tracheal abnormalities or esophageal strictures.
Anaesthetic Management of Diabetes Mellitus in Pediatrics
This document discusses the anesthetic management of pediatric diabetes mellitus. The key goals are providing balanced glycemic control to avoid hypoglycemia and hyperglycemia. Various insulin regimens and preparations are outlined. Preoperative assessment focuses on blood glucose, metabolic control, and electrolyte balance. Intraoperatively, blood glucose is closely monitored and IV insulin may be used. Postoperatively, the child's usual insulin or oral medication regimen is restarted once oral intake resumes. Hypoglycemia is avoided through careful glucose monitoring during all phases of care.
Cuffed vs Uncuffed Endotrachael Tubes in Pediatric Anesthesia
The document discusses the debate around using cuffed versus uncuffed endotracheal tubes in pediatric anesthesia. It summarizes the traditional view that uncuffed tubes should be used in children under 8-10 years old due to laryngeal anatomy. However, recent research shows the pediatric airway is more cylindrical than funnel-shaped, and the glottis is usually narrower than the cricoid. Studies find cuffed tubes can create a reliable seal, reduce the need for tube changes, and do not increase risk of post-extubation stridor compared to uncuffed tubes. Most textbooks now acknowledge cuffed tubes can be used safely in children of all ages if appropriately sized and monitored. The author concludes cuffed tubes should be
Quitting Smoking
The document provides information on how to quit smoking and the health benefits of doing so. It states that within 20 minutes of quitting, heart rate drops and carbon monoxide levels return to normal. Various health risks are reduced over time, with stroke risk decreasing to that of a non-smoker within 5-15 years. It also outlines 5 steps to quitting smoking: getting ready, getting support, learning new skills, using medication if recommended, and avoiding relapse. Managing withdrawal symptoms and cravings is important, as is getting support and being prepared to make lifestyle changes. Quitting smoking significantly improves long term health and life expectancy.
Problem Based Learning in Pediatric Anesthesia
This document discusses the anesthetic approach for a 4 year old girl requiring a lumbar puncture who has a history of cough and fever. It recommends doing the case today with precautions to ensure safety. It also discusses causes, presentation, compression risks, evaluation, and anesthetic management of mediastinal masses in children, noting the high risk of cardio-respiratory complications during anesthesia. The objective in managing these cases is to minimize airway and cardiovascular compression through strategies like steroids, chemotherapy, radiotherapy, securing the airway, maintaining spontaneous breathing, and having facilities for decompression.
Problem Based Discussion in Pediatric Anesthesia
A 4 week old infant weighing 4.5kg is presenting with bilious vomiting for 24 hours and requires another laparotomy for malrotation repair. The surgeons want to take the infant to theatre that night after performing a circumcision on a 5 year old child. The document discusses assessing the infant's history and condition, preparing for the surgery including fluid resuscitation and monitoring, planning anesthesia and analgesia, considerations for critical care, and postoperative care.
Modified stellate ganglion block
The document discusses modified stellate ganglion block as a treatment for complex regional pain syndromes and other conditions. It provides details on the anatomy involved and describes the modified technique of performing the block at the C7 transverse process instead of at the stellate ganglion. The document concludes by summarizing results from 9 case studies where the modified technique was used to treat CRPS patients, with all patients experiencing clinical improvement and no serious complications.
Bronchial Asthma
Bronchial asthma is a clinical syndrome characterized by increased responsiveness of the tracheobronchial tree to various stimuli. The primary physiological manifestation is variable airway obstruction. Pathologically, asthma is defined as a disorder of the airways characterized by chronic inflammation with infiltration of lymphocytes, eosinophils and mast cells. Asthma has many potential triggers including allergens, infections, pollutants, exercise and emotions.
Anesthesia for Pediatric Airway Surgery
This document discusses pediatric airway surgery, including:
- The special equipment, techniques, and considerations required for airway surgery in infants and children due to their narrow anatomical airways.
- Common diagnostic and therapeutic surgical procedures performed on the pediatric airway.
- The requirements for pediatric airway anesthesia including pre-operative assessment, equipment, induction, maintenance and monitoring techniques.
- Potential problems that may arise such as airway obstruction, desaturation, or inadequate CO2 monitoring due to the child beginning with some degree of airway obstruction.
Smoking Cessation
1) Smoking is an addiction caused by nicotine binding to acetylcholine receptors in the brain. This results in the release of dopamine and creates dependence.
2) Smoking cessation requires motivation, easing withdrawal symptoms, and preventing relapse as smoking is a chronic disease similar to other disorders.
3) Effective smoking cessation approaches include counseling and pharmacotherapy. Combining the two gives the best results, such as using nicotine replacements and drugs like varenicline.
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Muscles of Upper Extremities
The document provides detailed information about the anatomy of the brachial plexus and the nerves of the upper limb. It describes the formation and branches of the brachial plexus, including the roots, trunks, divisions, cords and branches. It also discusses the muscles, arteries, veins and ligaments associated with the shoulder and upper limb.
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The document provides detailed information about the anatomy of the brachial plexus and the nerves of the upper limb. It describes the formation and branches of the brachial plexus, including the roots, trunks, divisions, cords and branches. It also discusses the muscles, arteries, veins and ligaments associated with the shoulder and upper limb.
SPINAL CORD NEUROANATOMY BY Dr.Deepika.T
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Brachial plexus block new
The document discusses brachial plexus block techniques and reviews relevant anatomy, history, approaches, and complications. It provides an overview of the brachial plexus anatomy and different block techniques like interscalene, supraclavicular, infraclavicular, and axillary blocks. Complications discussed include nerve injuries from mechanical trauma, ischemia, or chemical toxicity from local anesthetics. Proper technique and drug administration are important to minimize risks.
Anatomy of brachial plexus
The document discusses the brachial plexus, which is a network of nerves that supplies sensation and motor function to the upper extremity. It is formed from the lower cervical and upper thoracic spinal nerves. The document details the anatomy of the brachial plexus including its roots, trunks, divisions, cords and branches. It also discusses clinical conditions involving brachial plexus injury and techniques for brachial plexus nerve blocks such as interscalene and supraclavicular blocks.
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CT procedure of neck
CT imaging of the neck provides detailed anatomical information and is useful for evaluating neck masses, lymphadenopathy, thyroid diseases and trauma. The neck is divided into triangles and spaces which radiologists use to characterize abnormalities. CT protocols involve intravenous contrast administration and thin slices through the neck. MRI is also used and has advantages over CT such as better soft tissue contrast without radiation, though CT remains superior for assessing bone.
Anatomy of spine for spinal anaesthesia
The vertebral column consists of 33 vertebrae that provide structural support, protect the spinal cord, and allow mobility. Each vertebra is composed of a vertebral body, processes, and joints that connect to adjacent vertebrae. The spinal cord runs through the vertebral column and is segmented into cervical, thoracic, lumbar, sacral and coccygeal regions. Surrounding structures include the ligaments, discs, dura mater, arachnoid mater, pia mater, epidural space, and subarachnoid space. Knowledge of the vertebral column's anatomy is essential for performing spinal and epidural procedures safely and effectively.
Neuraxial block
The document provides information on moderators and presenters for a discussion on neuraxial blocks. It then summarizes the history and types of neuraxial blocks including spinal and epidural anesthesia. Key details are provided on the anatomy related to neuraxial blocks including vertebrae, spinal cord, meninges, blood supply and cerebrospinal fluid. Advantages and disadvantages of regional anesthesia over general anesthesia are highlighted. Levels of blocks required for different surgeries and surface anatomy landmarks are outlined.
Peripheral nerve blocks
The document discusses various peripheral nerve blocks including:
- Cervical plexus block which targets nerves arising from C1-C4 including the lesser occipital nerve, greater auricular nerve, and supraclavicular nerve.
- Superficial and deep cervical plexus blocks are used for neck surgeries and procedures. The superficial block targets cutaneous branches while the deep block targets the paravertebral region from C2-C4.
- Stellate ganglion block provides sympathetic blockade for chronic pain syndromes and is performed at the C6 level, targeting the stellate ganglion. Complications include Horner's syndrome and injury to nearby structures.
Chapter 8-spinal anaesthesia
This document provides information about spinal anesthesia including:
- Definitions and the advantages of spinal anesthesia such as reduced risk of respiratory complications.
- Indications for spinal anesthesia including lower body and pelvic surgeries.
- Relevant anatomy including dermatomes, vertebrae, and spinal cord landmarks.
- How to perform a spinal anesthetic including patient positioning, identifying the injection site, and inserting the spinal needle.
- Factors that influence the level and duration of the spinal block such as drug choice, dosage, and patient characteristics.
- Potential complications of spinal anesthesia.
Sympathectomy
This document discusses the surgical anatomy and history of surgical sympathectomy. It begins with the anatomy of the sympathetic nervous system and sympathetic trunks. It then discusses the historical approaches to thoracic sympathectomy including open and minimally invasive techniques. The key points are:
- Thoracoscopic sympathectomy has high success rates for treating hyperhidrosis with low complication rates.
- It involves clipping or cutting the sympathetic chain and rami between T2-T3 to denervate the hands. Care must be taken to preserve T1 to avoid Horner's syndrome.
- Compensatory hyperhidrosis is a common complication but most others are rare if T1 is preserved.
Thoracic outlet syndrome
The document discusses thoracic outlet syndrome (TOS), which occurs when there is neurovascular compression in the thoracic outlet area leading to symptoms in the upper extremities. It notes that TOS can be predominantly neurogenic (95% of cases), arterial (1%), or venous (4%). The symptoms vary depending on the structure compressed but can include pain, paresthesias, weakness, and changes in pulse. The document outlines various clinical tests to evaluate for TOS and notes that imaging studies like MRI, ultrasound, and angiography can help identify anatomical abnormalities and assess vascular involvement. Precise diagnosis is important to guide appropriate treatment, which may include physical therapy, medications, or surgery.
Basic spine injections
The document discusses various spine injection procedures and techniques. It provides details on trigger point injections, lumbar epidural steroid injections (ESIs), transforaminal ESIs, cervical ESIs, medial branch blocks, radiofrequency ablation (RFA) of medial branches, and sacroiliac (SI) joint injections. The risks of these procedures include infection, bleeding, dural puncture, nerve injury, and steroid side effects. Proper positioning, needle placement using fluoroscopy, and injection of local anesthetic with or without steroid are emphasized.
CRANIOSPINAL IRRADIATION-PART 1
The document discusses craniospinal irradiation (CSI) for treating tumors that can spread through the cerebrospinal fluid (CSF), such as medulloblastoma. It describes how CSI was developed to treat the entire nervous system by irradiating the brain, spinal cord, and CSF spaces. Key points covered include tumor types treated with CSI, techniques for delivering CSI safely and uniformly, matching fields at junctions, and dose schedules for average and high-risk patients.
Spinal injuries
This document discusses the anatomy and function of the spinal cord and vertebrae. It describes the different types of spinal cord injuries, including complete transection and incomplete injuries that can cause central cord syndrome, anterior cord syndrome, posterior cord syndrome, or Brown-Sequard syndrome. Risk factors for spinal cord injury are discussed as well as assessment and treatment considerations.
Brachial plexus injury
This document discusses the anatomy, types of injuries, clinical presentation, investigations and classification of brachial plexus injuries.
It describes the formation of the brachial plexus from the cervical nerve roots and its divisions. Injuries can be preganglionic or postganglionic, and include traction injuries, avulsions or lacerations. Clinical exam focuses on assessing motor and sensory deficits. Investigations include imaging like MRI/CT, myelography and EMG/NCV to localize the lesion. Seddon's classification is used to describe the severity of injury.
CT procedure of neck, Avinesh Shrestha
This presentation discusses briefly about the anatomy of neck and about different protocols used for CT examination of neck. Also, some pathology are shown in the presentation.
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This document provides an overview of congenital heart disease (CHD) in children, including:
- The incidence of CHD is 7-10 per 1000 live births, with some forms being more common in premature infants. The most common types are ventricular septal defects and atrial septal defects.
- CHD can be classified based on the direction of blood shunting (left-to-right or right-to-left), presence of mixing lesions, or obstructive lesions. Examples of different types of CHD are provided with diagrams.
- Management of CHD depends on whether the heart defect is uncorrected, partially corrected, or completely corrected. A multidisciplinary approach is needed and
Child with OSA Anesthetic considerations
This document discusses considerations for anesthesia in children with obstructive sleep apnea (OSA). It provides background on OSA, including definitions and classifications. It notes that children with OSA are at risk of postoperative complications like hypertension and pulmonary edema. The document recommends careful preoperative evaluation in high risk children. It suggests avoiding sedative premedication and using techniques like jaw thrust and CPAP at induction to relieve airway obstruction. Maintenance should use low doses of opioids and extubation when fully awake. Postoperative monitoring on a high dependency unit is important due to risk of reobstruction.
Role of ultrasound in ICU
Ultrasound has many advantages for critically ill patients in the ICU. It enables rapid, repeated, and inexpensive bedside evaluation. There are two main probe types: B-mode produces 2D images while M-mode shows motion over time, analogous to video. Ultrasound can assess volume status by measuring the diameter and collapse of the inferior vena cava. It can diagnose pneumothorax by lung sliding signs or stratosphere and seashore artifacts. Ultrasound is also used for vascular access, intubation, diaphragm assessment, and identifying pleural effusions and hemothorax. Critical care physicians should receive training to utilize ultrasound's benefits for critically ill patients.
Anesthesia during the first year of Life
This document discusses anesthesia considerations for neonates and infants under 1 year of age undergoing surgery. It covers age-specific anatomical and physiological differences, preoperative evaluation and preparation, induction and maintenance techniques, monitoring, fluid management, temperature control, and postoperative care. Special conditions like congenital anomalies requiring surgery are also reviewed.
The Lung & Diabetes Mellitus
The document discusses the effects of diabetes mellitus on lung health and function. Diabetes can damage the lungs through microvascular complications and cause structural changes in the lungs over time. It increases risks of various pulmonary infections due to impaired immune function in diabetics. Lung function tests often show reduced volumes, elasticity, gas exchange and diffusion in diabetic patients compared to healthy individuals.
Acute Lung Injury & ARDS
The document provides an overview of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), including definitions, risk factors, pathogenesis, management approaches, and results from major clinical trials. It discusses how lower tidal volume ventilation as tested in the ARDS Network trial was the first intervention shown to improve survival for patients with ALI/ARDS.
Pulmonary Embolism
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
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Sequelae & Complications of Pneumonectomy
Pneumonectomy, or surgical removal of an entire lung, carries several potential sequelae and complications. Post-pneumonectomy pulmonary edema, which occurs within 72 hours of surgery and has a mortality rate over 50%, may be due to high oxygen levels or reperfusion injury. Over months, the remaining lung expands and the mediastinum shifts to fill the space, potentially leading to post-pneumonectomy syndrome through tracheal compression years later. Pulmonary function generally declines less than 50% with FEV1 and FVC decreasing the least. Mortality risk depends on preoperative lung function tests and cardiopulmonary exercise capacity.
Mechanical Ventilation in ARDS vs COPD
The document compares mechanical ventilation strategies for acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD). For ARDS, the strategies aim to prevent volutrauma and barotrauma by limiting tidal volumes and airway pressures. Positive end-expiratory pressure (PEEP) is used to recruit alveoli and keep airways open. For COPD, the goal is to increase oxygen levels while allowing longer expiration to prevent auto-PEEP. Non-invasive ventilation can help both conditions but invasive ventilation may be needed for severe COPD exacerbations or if non-invasive methods fail.
Thoracoscopy
Medical thoracoscopy is an invasive procedure used to visualize the pleural space and lungs through small incisions in the chest wall. It allows physicians to biopsy pleural surfaces and diagnose conditions causing pleural effusions. The procedure was originally developed in 1910 and was widely used until the 1950s to divide pleural adhesions in tuberculosis patients. Modern thoracoscopy uses video imaging and improved instruments to perform biopsies and pleurodesis under local anesthesia. It provides fast diagnoses but carries risks of pain, infection and failed procedures if not performed carefully in suitable patients.
Dyspnea
Dyspnea, or shortness of breath, is a common symptom that can be caused by many cardiac and pulmonary conditions. A thorough diagnostic evaluation of dyspnea involves taking a detailed patient history, conducting a physical exam, and obtaining initial tests like an electrocardiogram, chest x-ray, and blood tests to evaluate for conditions involving the heart, lungs, blood, and other potential causes and to guide further testing if needed. Grading scales are used to characterize the severity of a patient's dyspnea. The pathophysiology of dyspnea involves an imbalance between the perceived need to breathe and the ability to breathe.
Smoking
This document summarizes the health effects of smoking. It states that smoking is a learned habit that is culturally established, and is the leading cause of avoidable illness and death worldwide. Smoking causes over 60 million deaths between 1950-2000 in developed countries, and tobacco-caused deaths are expected to increase to 10 million per year by 2030, most occurring in developing countries. Half of regular smokers will eventually be killed by their habit.
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