Failed spinal anesthesia can occur for several reasons:
1. Anatomical abnormalities of the spine like thickened ligaments or spinal deformities can make proper needle placement difficult.
2. Technical errors like using too small of a needle, improper patient positioning, or inexperience of the practitioner performing the block can lead to failure.
3. Injection issues such as injecting the anesthetic outside of the subarachnoid space, using the wrong drug or dose, bloody taps, or repeated autoclaving altering the drug properties may cause failure. Prevention through careful patient assessment, proper technique and addressing any identified risks is important to reduce failure rates.
Does scorpion bite lead to resistance to action of local anaesthetic agentsby...Minnu Panditrao
Professor Minnu M. Panditrao gives her award winning (SAARC Bengaluru 2011) and recently published paper in Inidan Journal of Anaesthesia 56, 6 Nov.dec 2012, 575-78, paper where she explains the peculear responswe seen by herself and her team, about the developement of resistance to the local anaesthetic agents given via various routes, inpatients who give history of old single/ or usually multiple scorpion bites.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
Does scorpion bite lead to resistance to action of local anaesthetic agentsby...Minnu Panditrao
Professor Minnu M. Panditrao gives her award winning (SAARC Bengaluru 2011) and recently published paper in Inidan Journal of Anaesthesia 56, 6 Nov.dec 2012, 575-78, paper where she explains the peculear responswe seen by herself and her team, about the developement of resistance to the local anaesthetic agents given via various routes, inpatients who give history of old single/ or usually multiple scorpion bites.
A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
Prof. Mridul M. Panditrao adds another presentation to his collection. This is another Faculty lecture that was delivered at International conference on pain ... ISSPCON 2014, at Mumbai/Bombay, 7th Feb to 9th Feb 2014.
A very effective, precise and focused presentation for Calcium abnormalities and approach towards management. Targeted to teach the to the point diagnosis and treatment.
It is requested to download the presentation to run the animation as it is a very interactive presentation
A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected.
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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!
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
Follow us on: Pinterest
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
2. Golden words of 1922
• Two conditions are absolutely necessary to produce
spinal anesthesia:
• puncture of the dura mater and subarachnoid
injection of an anesthetic agent.
• Gaston Labat
• 1922
3. Define it ?
• Spinal Anesthesia is considered to have failed
if anesthesia and analgesia have not effected
within 10 minutes of successful intrathecal
deposition of heavy bupivacaine and 25
minutes for plain bupivacaine
5. Clinical definitions !!
• 1. Not acted at all
• 2. Acted but deficient in
• a) quantity,
• b) Quality or
• c) duration ??
• Incidence -- < 1 % some studies 17 %
• But acceptable is 3 -4 % in many reviews
8. Cant go near !!
• Failed lumbar puncture
• Dry tap ??
• Needle without the stylet – blood tissue clogs
• But not common
9. Faulty position
• Tip of table
• Flexion
• Shoulder straight ?
• Kyphosis , scoliosis ? Fracture hip
• Previous lamina surgery
• The sitting is usually an easier option in ‘difficult’
patients, but sometimes the reverse is true.
• The role of the assistant !!
10.
11. Position and adjuncts
• A calm, relaxed patient is more likely to assume and
maintain the correct position,
• so explanation (before and during the procedure)
• Gentle slow handling
• light anxiolytic premedication
• local anaesthetic infiltration without obscuring the
landmarks, but must include both intradermal and
s.c. injection.
12. Needle insertion
• Which space ?
• Midline , hitting bone
• Cephalad
• Rarely inferior and lateral
• Get the mental picture
• Midline calcification think paramedian
15. Solution injection errors
• Aspiration
• Correct dose
• Correct drug
Get the feel !!
Or
CSF alone is
dripping
16. Dose selection
• Correct dose –
• specific local anaesthetic used
• the baricity of that solution
• the patient’s subsequent posture,
• the type of block intended,
• anticipated duration of surgery
• Mass matters
17. Loss of injectate
• In the needle remains
• Luer lock
• Movement
• Labour pain ?
• Back of the other hand
• Aspirate but don’t displace
18. Pencil point needles problems
Pictures from the internet for closed academic purpose only
23. • The older, ester-type local anesthetics are
chemically labile
• heat sterilization and prolonged storage ?? ,
make them ineffective because of hydrolysis??
• Newer Amides are stable
24. “Resistance”
• Very rarely a failed spinal anaesthetic has
been attributed to physiological ‘resistance’ to
the actions of local anaesthetic drugs,
• Sodium channel mutation
• Scorpion stings !!
• Anecdotal
25. This batch is not good !!
• The neuroscience division of AstraZeneca received
562 ‘Product Defect Notification’ reports in the 6
year to December 31, 2007, all ascribing failed spinal
anaesthetics to ineffective bupivacaine solution
• But chemical analyses proved everything Ok in
all cases
26. Failure of subsequent management
• Level – covert pinch – glance of the eyes
between surgeons and anaes – yes OK – start
• Abdomen cleaning , mopping – sedatives
• Can we stay in an abnormal position for hours
? – table and position are for surgeons
28. Tarlov Cyst
• Fluid-filled nerve root
valved or nonvalved
cysts found most
commonly at the sacral
level of the spine
• Asymptomatic TC are
present in 5-9 %.
Female are more
frequently affected
• Treatment is drainage
of CSF or surgery
32. Can happen !!
• Some pain fibres pass via sympathetic nerve
and then via sympathetic chain to reach the
spinal cord at higher level than the site of
injection and may be the cause of failure.
• Lateral approach -- dural investment of nerve
root resulting in false feeling of placement of
needle tip in the subarachnoid space
33. Rapid sequence spinal anesthesia –
more likely to fail
• IV access , monitors with staff 1
• Chlorhexidine preparation with staff 2
• No local
• Non touch spinal
• No additives
• A larger dose
• Start as the block starts
• Be Ready for GA
• 5-7 minutes
36. Clinical and medicolegal!!
• How and when it is found out
• Tincture of time 15 minutes
• Then alternative arrangement
37. No block:
• the wrong solution,
• the wrong place,
• or it is ineffective.
• Repeating the procedure or conversion to
general anesthesia
• the patient has significant pruritus, - only
opioid injected
38. Good block but less height
• Flex knees and hips and trendelenberg
• Obstetrics – left and right lateral and head
down
39. Patchy blocks
• This term is used to describe a block that appears
adequate in extent, but the sensory and motor
effects are incomplete.
• Some sensory and some motor segments spared and
quality is not that good.
Repeat – GA – sedation or local infiltration
40. When we repeat
• Excessive repeat dose – need to reduce !
• Higher level of injection
• Is it not neurotoxic
• Anesthetised nerves prone for nerve injuries
• Recourse to an epidural in technical
difficulties
41. • Rescue measures and GA – beware of already
existing sympathetic block and hypotension
• Document and explain to patients but avoid
medico legal problems
• Look for local hospital problems
43. • Decide
• Lumbar puncture
• Local injection
• Spread
• Action on nerves
Failure
Failure
Failure
Failure
abnormalities of the spine,
thickened ligamentum flavum,
flexible small spinal needle, and
improper positioning of the patient
or the inexperience of the person
giving the block.
Leaks , partly outside , wrong
drugs ,gauge of needle , subdural
,aspirate
Anatomical changes, position, space
injected ,CSF volume
Bloody taps, high CSF pH, repeated
autoclave. resistance, age, drug
volume, which drug
44. • Alfred E. Barker wrote that for successful spinal
analgesia
• it is necessary ‘to enter the lumbar dural sac
effectually with the point of the needle, and to
discharge through this, all the contemplated dose of
the drug, directly and freely into the cerebrospinal
fluid, below the termination of the cord’
46. Failure -Prevention of failure is the most
important step
• Preoperative noted –
• Assess and assure
• Sedate
• Drugs which increase
• Position, valsalva ,
cough , EVE
• Repeat – dose drug !!
• GA
• Intraoperative noted
• Assess
• Assure
• Local
• Sedate
• GA