Presentation deals with pharmacokinetics of Inhalational agents , starting from pre-anaesthesia era ,developments of inhalational agents , structural significance.
Prof. Mridul Panditrao wants to share his much acclaimed CME lecture in ISACON 2014, Madurai, India and many other places, on one of the very very important but often ununderstood and neglected essential topics in Anesthesia..... Vaporizers!!
Prof. Mridul Panditrao wants to share his much acclaimed CME lecture in ISACON 2014, Madurai, India and many other places, on one of the very very important but often ununderstood and neglected essential topics in Anesthesia..... Vaporizers!!
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
uptake and distribution of inhalational agents.pptxAnanthu22
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Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
5. •Fanny Brawne(English Author,1811)
“When the dreadful steel was plunged
into the breast ,cutting through
veins,arteries ,flesh , nerves I needed
no injunction not to restrain my cries. I
began a scream that lasted
unintermittingly during the
whole time of the incision and ……
6.
7. 1540-Ethyl Ether was first created in a laboratory by a
german scientist “Valerius Cordes”.
1773- Joseph Priestly discovered N2O.
1798-Sir Humphary Day experimented with N2O
reported “loss of Pain and Euphoria”.
8. •Sir William Thomas GreenMorton
“The Public Demonstration of Ether Anaesthesia” on
Oct. 16 , 1846 at Bullfineh Amphitheatre of the
Massachusetts General Hospital.
13. DEVELOPMENTAL HISTORY
NO , Diethyl Ether , Chloroform
discovered and used in 1840s.
Till 1950 , all inhalational agents
were inflammable and toxic to
liver.
Break-Through with the recognition of
replace of H-Atom with the F-atom
decreases flammability led to advent of
Fluroxene.
80yr
1951
14. HALOTHANE- used in 1956
Increases arrythmogenic effects
of epinephrine
Ether derivative - Methoxyflurane .
Not increase arrythmogenic effects of
Epinephrine.
Analgesia at low concentration.
Withdrawn due to its increased blood and
lipid solubility .
Hepato-toxic .
Inc. metabolism increases fluoride
Nephrotoxic
Led
15. Enflurane – 1973
No Arrythmogenic ,No Hepatotoxic
Metabolite-Fluoride, Increases
seizure
Structural isomer Isoflurane -1981
Fewer Side Effects
Resistant to Metabolism.
Totally Fluorinated Desflurane
&Sevoflurane-1994.
16. Pharmacology of Inhalational Agents
• Drug dose
• Tissue concentration
• Time Elapsed
PHARMACO-
KINETICS
• Drug action on organ
system.PHARMACO-
LOGY
17. PHARMACOKINETICS
• From Alveoli into
Pulmonary
capillary
Absorption
(Uptake)
• Throughout Body
Distribu-
tion
(Biotransfor
mation)
18. • Principally Via lungs
Excretion
(Elimination)
• Lowering of drugs in
one compartment by
delivery into another
compartment
Redistribution
19. Alveolar Partial Pressure Of Anaesthesia(PA)
P(Brain ) = P(Alveolar)
Partial pressure of Inhalational Agents delivered by Arterial Blood(Pa)
EQUILIBRATES
Effects of Inhalational agents depends on therapeutic tissue conc. of CNS(PBrain)
EQUILIBRATES
20.
21. Determinant of Partial Pressue Gradient
From
Anaesthetic
Machine to
Alveoli
Anaesthetic
Breathing
System
Alveolar
Ventilation
Functional
Residual
Capacity
Inspired
Partial
Pressure
24. Factor Affecting Inspiratiory Conc.(Fi)
Fresh Gas Flow
Rate
Depends on
Vaporizer &
Flowmeter
settings
Higher the rate
of FGF , closer
the inspired gas
conc.(Fi=FGC)
Breathing
Circuit Volume
Corresponds
(Apparatus Dead
Space)
Smaller the
volume
Fi=FGC
26. Alveolar Ventilation
Increase in Alveolar Ventilation promotes
increased input of anaesthetic agents
increasing rate of PA Towards PI
It decreases Pco2 due to
hyperventilation.
Decreased Cerebral blood flow
and consequently decreased
delivery of anaesthetic to Brain
But
Results
27. Anaesthetic Breathing System
Volume of External
Breathing Sys.
• Increased volume
increases dead
space.
Solubility of
Anaesthetic to
Rubber or Plastic
• It decreases PA
Gas Flow from
Machine
28. Factors Affecting Alveolar Conc(PA)
Alveolar membrane poses no barrier to the transfer of
anaesthetic gases in pulmonary circulation.
PA depends on the uptake of anaesthetic agents by
pulmonary circulation.
Greater the uptake
Slower the rate of rise of PA
Slower the rate of Induction
29. Concentration Effect
It is another factor affecting Alveolar partial pressure.
It is the effect of PI on the rise of PA.
Higher the Inhalational Partial Pressure ,the more
rapid PA approaches PI
It depends on the conc. of the inhaled agents in the
small lungs due to uptake of all gases in the lung.
It also depends on the tracheal inflow augmentation to
fill the space created after the uptake of gases.
30. SECOND-GAS EFFECT
It is the ability of one Gas (Fisrt Gas) when taken in
high volume to increase the uptake of another gas
(Second Gas) administered simultaneously.
Example – If NO is administered in high volume
along with O2 …..uptake of O2 increases.
31.
32. Solubility of Inhalational Agents
Solubility of inhalational agents is expressed by
Partition Coefficient.
It is the distribution of the inhaled agents between two
phases at equilibrium.
Partition Coefficient is temp. dependent i.e., solubility
of gas in a liquid is decreased with the increase of
temp. of liquid.
Example- Halothane has a blood gas coeffiecient of 2.4
means halothane conc. in blood 2.4 times as its conc.
In alveolar gas
33.
34. Blood:Gas Partition Coefficients
Pa and PA approaching PI is inversely related to the
solubility of the anaesthetic agents in blood.
Higher the blood solubility of the agents, lesser is the
availability of the agents for equilibration between PA
and PA to PI.
By increasing the PI above the pressure required for
maintenance of anaesthesia may resolve this
discrepancy upto some extent- Overpressure.
35.
36. Factor affecting Blood:Gas partition coefficient
• Decreased solubility of volatile anaesthetics
in anaemic blood results increase in PA and
thus rapid induction.
Hematocrit
• Ingestion of fatty meal alters the composition of
blood resulting 20% increase on the solubility of
volatile anaesthetics in blood
Lipid and
Protein content
• Blood solubility of Halothane ,Enflurane ,Methoxyflurane,
Isoflurane are 18% less in Neonates and Elderly.
• However , remains constant for Sevoflurane in Neonates and
Elderly.
Age
38. Cardiac Output
Increased
C.O>Rapid
uptake>Decreased
PA and slow
Induction
Cardiac output
more influences
the rate of change
of PA of soluble
gases
Volatile Agents
depressing C.O
exerts +feedback
i.e, Volatile agents
depresses c.o
>Increases
PA>Increases
depth of
anaesthesia
39. ALVEOLAR TO VENOUS PARTIAL PRESSURE
DIFFERENCE
It reflects tissue uptake of the inhaled anaesthetics.
Tissue uptake affects uptake at the lungs.
Vessel rich tissues (Brain ,Heart, Kidney) accounts approx
10% of the body tissues but receives 75% of the cardiac
output.
Results rapid equilibrium with Pa within 3 time constant.
So, uptake of volatile anaesthetic decreases greatly after 3
time constant.
Continued uptake of anaesthetic after the saturation of
vessel rich tissues suggest the entrance of anaesthetic into
skeletal muscle and the fat.
So Anaesthetic uptake continues maintain PA-VD.
40. RECOVERY FROM ANAESTHESIA
Depicted by rate of decrease of PBrain= PA
Factors affecting Recovery from
Anaesthesia
Tissue conc. Of
Inhaled
anaesthetic.
Solubility of
agents & duration
Failure to reach
equilibrium by
certain Tissues
continue to draw
agents from blood
even during
recovery.
Anaesthesia
Breathing System
Exhaled Gases
Metabolism of
Anaesthetics
41. DIFFUSION HYPOXIA
Abrupt discontinuation
of N2O.
Decrease in
PN2O(Blood)leads to
diffusion of N2O from
Blood to Alveoli.
Diffusion leads to
decrease PO2 in the
Alveoli due to dilution
and results Hypoxia
Simultaneous decrease
in PCO2 due to dilution
leads to decrease in
ventilation drive
worsening Hypoxia
All these events are
prominent in first 1 to 5
mints after
discontinuation.