1. The document discusses examination of the pupil, including causes of abnormal pupil size and shape such as anisocoria, polycoria, microcoria, and corectopia.
2. Pupillary light reflex is controlled by a four-order neuronal pathway from the retina to the sphincter pupillae muscle. Disorders can occur at different points along this pathway.
3. Tests of pupillary function including light reflex, near response, cocaine and hydroxyamphetamine, and pilocarpine are used to localize lesions and diagnose conditions like Horner's syndrome and Adie's tonic pupil.
1. The document discusses examination of the pupil, including causes of abnormal pupil size and shape such as anisocoria, polycoria, microcoria, and corectopia.
2. Pupillary light reflex is controlled by a four-order neuronal pathway from the retina to the sphincter pupillae muscle. Disorders can occur at different points along this pathway.
3. Tests of pupillary function including light reflex, near response, cocaine and hydroxyamphetamine, and pilocarpine are used to localize lesions and diagnose conditions like Horner's syndrome and Adie's tonic pupil.
This document discusses non-invasive guided goal-directed therapy (GDT) for hemodynamic monitoring and optimization. It describes using a bedside monitor to continuously and non-invasively estimate cardiac output and stroke volume based on pulse wave transit time analysis of ECG and pulse oximetry signals. The method is calibrated using intermittent non-invasive blood pressure readings. Studies show this approach can guide fluid administration and help achieve hemodynamic goals like those used in invasive GDT protocols to improve outcomes. The document provides details on set up, use, and limitations of this non-invasive GDT method for perioperative hemodynamic optimization.
The document provides an overview of opioid-free anesthesia (OFA), including who is currently using it, protocols used to achieve OFA, and outcomes compared to opioid anesthesia. A survey of over 600 anesthesiologists found that OFA is used in 26 countries, with methods including ketamine, lidocaine, clonidine, and dexmedetomidine. Studies in Belgium found OFA resulted in less postoperative nausea, better pain scores, and less morphine use compared to opioid anesthesia in 50 patients. A study of 500 patients found better quality of recovery scores with OFA. A retrospective analysis of over 5000 patients found fewer complications with OFA. The document discusses dosing of adjuncts used for OFA and
This document discusses non-invasive guided goal-directed therapy (GDT) for hemodynamic monitoring and optimization. It describes using a bedside monitor to continuously and non-invasively estimate cardiac output and stroke volume based on pulse wave transit time analysis of ECG and pulse oximetry signals. The method is calibrated using intermittent non-invasive blood pressure readings. Studies show this approach can guide fluid administration and help achieve hemodynamic goals like those used in invasive GDT protocols to improve outcomes. The document provides details on set up, use, and limitations of this non-invasive GDT method for perioperative hemodynamic optimization.
The document provides an overview of opioid-free anesthesia (OFA), including who is currently using it, protocols used to achieve OFA, and outcomes compared to opioid anesthesia. A survey of over 600 anesthesiologists found that OFA is used in 26 countries, with methods including ketamine, lidocaine, clonidine, and dexmedetomidine. Studies in Belgium found OFA resulted in less postoperative nausea, better pain scores, and less morphine use compared to opioid anesthesia in 50 patients. A study of 500 patients found better quality of recovery scores with OFA. A retrospective analysis of over 5000 patients found fewer complications with OFA. The document discusses dosing of adjuncts used for OFA and
12. NHOÙM ÑÖÔØNG MAÙU CAO COÙ TYÛ LEÄ BIEÁN CHÖÙNG
VAØ TÖÛ VONG CAO HÔN
**
PCM
37%
1,2
3,2
5,9
1,8
4,2
9,6
1,8 2,8
4,4
13,4
20,5
23,4
5,2
9,8
15
0
10
20
30
%
Suy ña c ô
quan
Töû Nhoài maùu c ô
tim
Vieâm phoåi Suy thaän
G/s < 200 mg/dl
G/s 200-250 mg/dl
G/s > 250 mg/dl
R. Ascione, Inadequate blood glucose control is associated with in-hospital mortality and morbidity in
diabetic and nondiabetic patients undergoing cardiac surgery. Circulation. 2008 July 8; 118(2): 113–
123.
P< 0,001
13. MUÏC TIEÂU KIEÅM SOAÙT ÑÖÔØNG
NGÖÔØI LÔÙN
Lazar et al. Society of Thoracic Surgeons Blood Glucose Guideline Task Force. The Society of
Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac
surgery. Ann Thorac Surg 2009;87(2):663–669.
XAÁP XÓ 140 MG/DL (7,8 MMOL/L)
TREÛ EM 90- 180 MG/DL (5-10 MMOL/L)
Betts P. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium Management of
children and adolescents with diabetes requiring surgery.Pediatric Diabetes 2009: 10(Suppl.
12): 169–174
14. BIEÄN PHAÙP KIEÅM SOAÙT ÑÖÔØNG
LIEÀU NAÏP CARBOHYDRATE
Jose. Reducing preoperative fasting time: A trend based on evidence. World J Gastrointest
Surg 2010 March 27; 2(3): 57-60.
LIEÀU NAÏP GLUTAMIN-CARBOHYDRATE 3 GIÔØ TRÖÔÙC PHAÅU THUAÄT
ÑEÂM TRÖÔÙC PT 800 ml Malto hay Glucose 12.5%
3 GIÔØ TRÖÔÙC PT 400 ml Malto hay Glucose 12.5%
15 g Glutamin
3,5 g Soy protein
TÆNH MAÏCH Truyeàn Glucose 20%, 0,3g/kg/giôø
(Ngöôøi 50kg, toác ñoä truyeàn 25 gioït/phuùt)
ÑEÂM TRÖÔÙC PTTIEÂU HOÙA 800 ml Malto hay Glucose 12.5%
2 GIÔØ TRÖÔÙC PT 400 ml Malto hay Glucose 12.5%
3 GIÔØ TRÖÔÙC PT 400 ml Malto hay Glucose 12.5%
BEÄNH NHAÂN ÑAÙI
THAÙO ÑÖÔØNG
15. LIEÀU NAÏP CARBOHYDRATE ÔÛ BEÄNH ÑAÙI
THAÙO ÑÖỜNG 3 GIÔØ TRÖÔÙC KHÔÛI MEÂ
Gustafsson . Pre-operative carbohydrate loading may be used in type 2 diabetes patients.
. Acta Anaesthesiol Scand. 2008 Aug;52(7):946-51
Ñöôønghuyeát(mmol/l)
GIÔØ sau naïp 400 ml Carbohydrate 12,5%
0,5
16. LIEÀU NAÏP CARBOHYDRATE ÔÛ BEÄNH ÑAÙI
THAÙO ÑÖỜNG HIEÄU QUAÛ
Jodlowski T. Preoperative oral carbohydrate load in colorectal surgery reduces insulin resistance and
may improve outcomes – preliminary results of prospective randomized study. Clin Nutr
2011;6(Supplements PP052):134.
Thôøigian(ngaøy)
P=0,018
P=0,056
P=0,002
- Caûi thieän hoaït ñoäng ruoät sau PT ñöôøng tieâu hoùa
17. LIEÀU NAÏP CARBOHYDRATE ÔÛ BEÄNH ÑAÙI
THAÙO ÑÖỜNG HIEÄU QUAÛ
Jodlowski T. Preoperative oral carbohydrate load in colorectal surgery reduces insulin resistance and
may improve outcomes – preliminary results of prospective randomized study. Clin Nutr
2011;6(Supplements PP052):134.
P=0,039
P=0,002
- Giaûm ñeà khaùng insulin Giaûm phaûn öùng vieâm