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Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
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.
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
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A basic overview on the management of intra-operative bronchospasm: the risk factors, triggers, diagnosis, prevention and management. Includes a case scenario – discussion.
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.
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Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
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Nursing management client with Increased intracranial pressure ( ICP)ANILKUMAR BR
The rigid cranial vault contains brain tissue (1,400 g), blood (75 ml), and CSF (75 ml)
The volume and pressure of these three components are usually in a state of equilibrium and produce the ICP.
ICP is usually measured in the lateral ventricles; normal ICP is 10 to 20 mm hg.
The Monro-kellie hypothesis states that because of the limited space for expansion within the skull, an increase in any one of the components causes a change in the volume of the others.
Increased ICP is a syndrome that affects many patients with acute neurologic conditions.
This is because pathologic conditions alter the relationship between intracranial volume and pressure.
Although an elevated ICP is most commonly associated with head injury, it also may be seen as a secondary effect in other conditions, such as brain tumors, subarachnoid hemorrhage, and toxic and viral encephalopathies.
Defines intracranial pressure, cerebral perfusion pressure and mean arterial pressure. Depict formula for caculating ICP, CPP& MAP. Enumerate both pathological and non- pathological causes for increased ICP. Explain Monroe Kellie hypothesis, pathophysiology of increase Intracranial pressure medical, surgical and nursing management of Increased intracranial pressure.
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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 .
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Childhood and Athletic Beginnings
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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.
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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.
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Importance of Flexibility and Mobility
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2. Dr. M. M. PANDITRAO
PROFESSOR/ HEAD & I/C SICU
DEAN of Faculty of Medicine
DEPT.OF ANAESTHESILOGY & CRITICAL CARE
Pad. Dr. DY PATIL MEDICAL COLLEGE,
HOSITAL & RESEARCH CENTER
( Dr. DY PATIL UNIVERSITY )
PIMPRI, PUNE 411018
MAHARASHTRA
3. Introduction
• Physiology of ICP Maintenance
Cranium:
A Box with only one opening
Opening at the base
No possibility of expansion
Primary Function: Protection of brain
Also maintain an equilibrium
7. Monro-Kellie Hypothesis
Pathologic States that increase the
volume of one component
necessitate decrease in the volume
of another to maintain normal
Intra-Cranial Pressure
8. INTRA CRANIAL PRESSURE
(ICP)
• Measure of CSF Pressure within Cranium
• Normal range 5 – 15 mm Hg
9.
10. CONSEQUENCES
• Internal herniation:- Temporal lobe is
pushed down though Tentorium incisura
• External herniation:- Cerebellar tonsills/
peduncle herniate through foramen
magnum → Compressing over IV ventricle
→ ↓CPP → Death == “CONING”
11. CEREBRAL PERFUSION PRESSURE
(CPP)
• Effective pressure that allows the perfusion of
blood through the brain
• CPP = MAP – ICP
• Mean arterial pressure (MAP) = DP+ (SP-DP)
• DP + PP/3 3
• (ICP ≈ CVP)
• CPP ≈ MAP – CVP
12. CEREBRAL BLOOD FLOW
• Normal CBF 45 – 50 ml / 100 gm /
min
• Range 20 ml / kg / min to 70 ml / kg /
min
• CBF Highest Frontal region
• CBF Medium Parietal region
• CBF Lowest Temporal area
13. HAEMODYNAMIC AUTO
REGULATION
• Cerebral Autoregulation
• Normal range MAP 50 – 150 mm Hg
• In Head injured ~~ Failure of autoregulation
• CBF = < 20ml / kg /min.
• Adverse effect on ICP
25. INTRACRANIAL PRESSURE
MONITORING
• Def:
• Ventricular system
• Sub-arachnoid space
• Epidural space
• Brain parenchyma
26. METHODS OF I.C.P.
MONITORING
• Intraventricular catheter
• Subarachnoid screw or bolt
• Epidural sensor
27.
28. ICP WAVE FORMS
• A, B, & C waves
• Factors influencing waves
Systolic blood pressure
Alterations in respiration
Deteriorating neurological status
• Components of waves
P1 (upward spike)
P2 (tidal wave)
P3 (small notch)
29.
30. ICP WAVE FORMS (CONT.)
A waves
• Plateau waves
• Most life threatening
• Seen in 5-20 min intervals
• Increased I.C.P.
• CPP compromised
• Amplitude 50 – 60 mmHg
34. ICP WAVE FORMS (CONT.)
C waves
• Lowest amplitude
• Occur in 4 – 8 min intervals
• Never get elevated >20 – 25 mmHg
• Clinical significance unknown
35.
36. COMPLICATIONS OF ICP
MONITORING
• Infection
• intracranial hemorrhage or haematoma
• CSF Leakage
• Mechanical failure or blockage
• Over drainage of CSF
41. SECOND TIER THERAPY
• Optimized hyperventilation
• Barbiturate coma
• Decompressive craniectomy
42. OPTIMIZED HYPERVENTILATION
• Increase minute ventilation
• Maintain PaCO2 below 30 mm Hg
• Monitor Jugular venous oxygen saturation
Normal range 65 – 75%
43. BARBITURATES COMA
Pentobarbitone Sodium
• Loading dose:- 10 mg / Kg IV over 30 min
• Infusion :- 5 mg / Kg / hour for 3 hrs
• Maintenance :- 1 – 3 mg / Kg / hour,
Titrated to burst suppression on continuous
bedside EEG
• Suppresses CMR02 & ↓ICP
• Disadvantages
44. DECOMPRESSIVE
CRANIECTOMY
• Alternative therapy
• Allow the brain to swell in a fashion not
harmful to it
• Uni / bilateral Fronto-Temporo-Parietal
Craniectomies
45. INTERVENTION FOR REDUCING
INCREASED ICP
Preliminary Management
• Maintain the patient’s head in midline to facilitate
bilateral blood flow
• Maintain head of bed (H O B) at 30 – 40° to
facilitate venous drainage with minimal effect on
arterial pressure
• Avoid all the activities which will increase /
worsen ICP
excessive light / noise / interference / painful
stimuli
Suctioning
• Decrease hyperthermia if present
46. INTERVENTION FOR REDUCING
INCREASED ICP (Cont.)
• Strict intake / output balance with specific stress
on over hydration which can lead to cerebral
edema.
• Electrolyte monitoring: to avoid Na+
disturbances- hyper as well as hyponatremia,
hypokalemia – especially if on diuretic therapy.
• Glucose level monitoring to avoid hypoglycemia.
• Avoidance of severe hypocapnia to maintain
level of hyperventilation so as to maintain
PaCO2 between 25-35 mmHg (≈ 30± 2 mmHg).
47. INTERVENTION FOR REDUCING
INCREASED ICP (Cont.)
Medical management
• Anticonvulsant therapy for seizures.
• DIURETIC therapy.
• Mannitol, Glycerol, Urea, Hypertonic saline.
• “Barbiturate Coma” Therapy.
• 50% Dextrose for hypoglycemia.
• ICP monitoring & drainage if required.
• Surgical decompression ( Craniotomy ).
• Controversial Corticosteroid Therapy.
49. ANAESTHETIC MANAGEMENT OF
PATIENTS WITH INCREASED I.C.P.
• Polytrauma
• Head injury
• Long bone injuries
• Intra abdominal visceral trauma
50. PRE-OPERATIVE ASSESSMENT
AND PREPARATION
“Patients Undergoing surgery at high risk for
post-operative complication and death”
• Poor pre-operative physiological
condition
• Age
• Type surgery they are supposed to
undergo
51. SHOEMAKER et al CRITERIA
• Current /previous severe cardio
respiratory illness
• Acute abdominal catastrophe with
haemodynamic instability
• Acute renal failure
• Severe multiple trauma (more than 3
major organs involved or more than 2
system or surgical opening of more than 2
body cavities)
• Elderly patients (70 or more years of age)
52. SHOEMAKER et al CRITERIA
(Cont.)
• Shock (MAP < 60 mmHg & urine out put < 0.5
ml/kg/hr)
• Acute respiratory failure
• Evidence of septicemia, colo-rectal injury or
peritoneal soiling, intra-abdominal surgery
• Patients undergoing prolonged surgery > 1½ hrs.
• Emergency surgery
• Inexperienced surgeon
• Lack of post operative I.C.U./critical care facility
53. GOAL DIRECTED CARDIO-RESPIRATORY
OPTIMIZATION
• Cardiac index.
• Oxygen delivery.
• Oxygen consumption
continue till
• Base Deficit ~~~ normal
• Blood Lactate ~~~ normal
• Mixed SVO2 > 70%
55. Summary
• I.C.P. is an important parameter
• Physiology
• Pathology related to increased ICP
• Monitoring of ICP
• Interaction between ICP and anaesthetic
agents
• Anaesthesiologist as Peri-operative
Physician