Here are the key issues with the gastrointestinal system after spinal cord injury and brief comments:
- Gastric distention - Increased risk of aspiration
- Gastric emptying delayed - Adversely affect ventilation. Rx: Put NG tube.
- Peptic ulcer disease - One cause is high dose steroids.
- Gastritis, hemorrhage - Rx: PPI, Sucralfate (continued for 4 weeks). Enteral feeding.
- Ileus
This document discusses brain death and the criteria used to diagnose it. It begins by describing different states of consciousness including coma, persistent vegetative state, and locked-in syndrome. It then defines brain death as the total and irreversible loss of brain and brainstem function. The key criteria for determining brain death are the absence of cortical function, absence of brainstem reflexes, and apnea during a specific oxygen challenge. Confirmatory tests like angiography, EEG, transcranial Doppler, and nuclear medicine scans can also support the diagnosis. Precise clinical evaluations and testing are required to distinguish brain death from other severe neurological conditions.
1. Awake craniotomy is a surgical procedure performed with the patient awake to allow mapping of brain functions while removing a brain tumor.
2. During surgery, a neurosurgeon performs cortical mapping to identify vital brain areas that should not be disturbed while removing the tumor.
3. Awake craniotomy provides benefits over surgery under general anesthesia such as higher rates of total tumor resection, fewer permanent neurological deficits, and shorter hospital stays. However, it requires careful patient selection and management of anesthesia to balance pain and cooperation.
Awake craniotomy allows surgeons to map eloquent brain areas and remove tumors near these areas while the patient is awake. It has advantages over surgery under general anesthesia by avoiding postoperative deficits. The technique requires careful planning and multidisciplinary coordination between the surgeon, anesthesiologist, and patient. Anesthesiologists aim to keep the patient comfortable and cooperative while limiting interference with brain mapping. Local anesthesia, sedation, and nerve blocks are used to achieve this balance. Complications can occur but are often avoided with experience and vigilance. Awake craniotomy offers benefits but demands expertise from all involved parties.
Management of Traumatic Brain Injury in ICUDr.Tarek Sabry
This document discusses the management of traumatic brain injury (TBI) patients in the intensive care unit (ICU). It outlines the key aspects of care including general monitoring, intracranial pressure (ICP) monitoring, analgesia and sedation, mechanical ventilation, hemodynamic support, maintaining normothermia and cerebral perfusion pressure, and preventing secondary insults. The goal of management is to stabilize the patient, prevent intracranial hypertension, and maintain adequate cerebral blood flow and oxygenation through various treatment strategies and intensive care measures.
This document discusses the choice of anaesthetic for primary total hip replacement surgery and whether general anaesthesia or regional anaesthesia provides the best perioperative outcomes. It defines general anaesthesia and regional anaesthesia. Regional anaesthesia options for hip replacement include spinal, epidural, and peripheral nerve blocks. Meta-analyses have found regional anaesthesia may reduce the risk of deep vein thrombosis, pulmonary embolism, and blood transfusion requirements compared to general anaesthesia. Regional anaesthesia also provides better immediate postoperative analgesia. However, the choice of anaesthetic depends on each patient's individual factors, medical history, and comorbidities.
It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
1) The document discusses anesthesia considerations for spinal surgery, including pre-operative assessment of airway, respiratory, cardiovascular, and neurological systems, as well as unique challenges like patient positioning and intra-operative monitoring.
2) Key surgical procedures mentioned are laminectomy, discectomy, and instrumentation/fusion, while common spinal conditions requiring surgery include disc lesions, stenosis, tumors, and deformities.
3) Anesthesia techniques aim to maintain a stable depth and avoid sudden changes in anesthetic depth or blood pressure. Intra-operative monitoring discussed includes wake-up tests, SSEP, MEP, and EMGs to evaluate spinal functional integrity.
This document defines complex regional pain syndrome (CRPS) and discusses its epidemiology, types, pathophysiology, stages, diagnostic criteria, investigations, differential diagnosis, and treatment. CRPS is a chronic pain condition that usually affects limbs and is characterized by persistent severe pain, changes in skin color and temperature, and impaired motor function. It is classified into two types and progresses through three stages. The exact mechanisms are unknown but involve both peripheral and central sensitization. Diagnosis is based on clinical criteria and treatment requires a multidisciplinary approach including pharmacotherapy, physical therapy, interventions like sympathetic blocks, and in some cases spinal cord stimulation.
This document discusses brain death and the criteria used to diagnose it. It begins by describing different states of consciousness including coma, persistent vegetative state, and locked-in syndrome. It then defines brain death as the total and irreversible loss of brain and brainstem function. The key criteria for determining brain death are the absence of cortical function, absence of brainstem reflexes, and apnea during a specific oxygen challenge. Confirmatory tests like angiography, EEG, transcranial Doppler, and nuclear medicine scans can also support the diagnosis. Precise clinical evaluations and testing are required to distinguish brain death from other severe neurological conditions.
1. Awake craniotomy is a surgical procedure performed with the patient awake to allow mapping of brain functions while removing a brain tumor.
2. During surgery, a neurosurgeon performs cortical mapping to identify vital brain areas that should not be disturbed while removing the tumor.
3. Awake craniotomy provides benefits over surgery under general anesthesia such as higher rates of total tumor resection, fewer permanent neurological deficits, and shorter hospital stays. However, it requires careful patient selection and management of anesthesia to balance pain and cooperation.
Awake craniotomy allows surgeons to map eloquent brain areas and remove tumors near these areas while the patient is awake. It has advantages over surgery under general anesthesia by avoiding postoperative deficits. The technique requires careful planning and multidisciplinary coordination between the surgeon, anesthesiologist, and patient. Anesthesiologists aim to keep the patient comfortable and cooperative while limiting interference with brain mapping. Local anesthesia, sedation, and nerve blocks are used to achieve this balance. Complications can occur but are often avoided with experience and vigilance. Awake craniotomy offers benefits but demands expertise from all involved parties.
Management of Traumatic Brain Injury in ICUDr.Tarek Sabry
This document discusses the management of traumatic brain injury (TBI) patients in the intensive care unit (ICU). It outlines the key aspects of care including general monitoring, intracranial pressure (ICP) monitoring, analgesia and sedation, mechanical ventilation, hemodynamic support, maintaining normothermia and cerebral perfusion pressure, and preventing secondary insults. The goal of management is to stabilize the patient, prevent intracranial hypertension, and maintain adequate cerebral blood flow and oxygenation through various treatment strategies and intensive care measures.
This document discusses the choice of anaesthetic for primary total hip replacement surgery and whether general anaesthesia or regional anaesthesia provides the best perioperative outcomes. It defines general anaesthesia and regional anaesthesia. Regional anaesthesia options for hip replacement include spinal, epidural, and peripheral nerve blocks. Meta-analyses have found regional anaesthesia may reduce the risk of deep vein thrombosis, pulmonary embolism, and blood transfusion requirements compared to general anaesthesia. Regional anaesthesia also provides better immediate postoperative analgesia. However, the choice of anaesthetic depends on each patient's individual factors, medical history, and comorbidities.
It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
1) The document discusses anesthesia considerations for spinal surgery, including pre-operative assessment of airway, respiratory, cardiovascular, and neurological systems, as well as unique challenges like patient positioning and intra-operative monitoring.
2) Key surgical procedures mentioned are laminectomy, discectomy, and instrumentation/fusion, while common spinal conditions requiring surgery include disc lesions, stenosis, tumors, and deformities.
3) Anesthesia techniques aim to maintain a stable depth and avoid sudden changes in anesthetic depth or blood pressure. Intra-operative monitoring discussed includes wake-up tests, SSEP, MEP, and EMGs to evaluate spinal functional integrity.
This document defines complex regional pain syndrome (CRPS) and discusses its epidemiology, types, pathophysiology, stages, diagnostic criteria, investigations, differential diagnosis, and treatment. CRPS is a chronic pain condition that usually affects limbs and is characterized by persistent severe pain, changes in skin color and temperature, and impaired motor function. It is classified into two types and progresses through three stages. The exact mechanisms are unknown but involve both peripheral and central sensitization. Diagnosis is based on clinical criteria and treatment requires a multidisciplinary approach including pharmacotherapy, physical therapy, interventions like sympathetic blocks, and in some cases spinal cord stimulation.
1. Awake craniotomy allows monitoring of brain functions like speech and movement during brain surgery to minimize damage to critical areas. Scalp blocks and sedation are used to keep the patient comfortable but awake.
2. Advantages include mapping of motor and language areas by directly stimulating the brain and observing responses. Risks include seizures, neurological deficits, and other surgical complications if the procedure is not performed carefully.
3. Proper patient selection, psychological preparation, monitoring, anesthesia technique and mapping are essential for successful awake craniotomy outcomes. Careful attention to details improves results more than complex interventions.
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERYDebashish Mondal
This document discusses hip replacement arthroplasty (HRA). It provides information on the types of HRA, indications for surgery, preoperative evaluation and anesthesia considerations. The key points are:
- HRA involves replacing damaged hip joint surfaces with prosthetics to relieve pain and restore function. It can be total or half (hemi) replacement.
- Candidates typically have severe osteoarthritis or other conditions causing irreversible hip damage and unremitting pain.
- Patients require thorough medical evaluation due to common comorbidities in the elderly population undergoing HRA.
- Regional anesthesia like spinal is preferred over general anesthesia for HRA due to benefits like reduced blood loss and better postoperative pain control.
This document provides information about total intravenous anesthesia (TIVA). It begins with a definition of TIVA as a technique of general anesthesia that uses intravenous agents exclusively without inhalational gases.
It then discusses the history of TIVA, types of TIVA, indications, advantages, disadvantages, common drugs used and their properties, drug combinations, and methods of administration including single syringe, manually controlled infusion, target controlled infusion, and closed loop systems. Specific TIVA protocols, dosages, and drug mixtures are also outlined. The document aims to provide an overview of TIVA for educational purposes.
Total intravenous anesthesia (TIVA) involves inducing and maintaining general anesthesia exclusively through intravenous drug administration without volatile agents. It utilizes short-acting hypnotic drugs like propofol and analgesic drugs like fentanyl delivered via target-controlled infusion pumps. TIVA provides advantages like rapid titratability of drugs, faster recovery, reduced pollution and side effects like nausea. Precise computer-controlled infusion pumps along with pharmacokinetic models are used to achieve and maintain targeted drug concentrations in the blood and effect sites. Common drugs utilized in TIVA include propofol, fentanyl and muscle relaxants which are administered individually or in combinations based on the patient and procedure.
Head trauma, also called traumatic brain injury (TBI), occurs in two phases: primary and secondary brain injury. Primary injury involves direct damage to brain tissue from impact. Secondary injury involves downstream effects like edema and ischemia that start minutes after primary injury. Managing TBI focuses on preventing secondary injuries like hypotension, hypoxia, fever and intracranial hypertension that can exacerbate primary damage. Treatment involves intensive monitoring, ventilation, controlling blood pressure/ICP, anticonvulsants and early rehabilitation. The goal is to minimize further brain injury and maximize recovery.
This document discusses the scalp block technique. It begins by describing scalp block as local anesthesia of the scalp nerves. It then discusses the history and development of scalp block, including the original description in 1986 and studies in the 1980s that demonstrated its effectiveness in reducing hemodynamic changes during craniotomy. The document outlines the specific nerves blocked in scalp block and techniques for each, and notes bupivacaine is often used. Advantages include decreased blood pressure and intracranial pressure changes during surgery. Potential complications are also reviewed. Finally, it briefly discusses recent updates to the Glasgow Coma Scale including the addition of a pupil reactivity score in 2018.
The document provides guidelines from the American Society of Regional Anesthesia (ASRA) on placing and removing epidural catheters in patients taking anticoagulant and antiplatelet drugs. It lists recommended minimum times to wait after the last dose of various medications before catheter placement and removal, as well as when to restart anticoagulation therapy after removal. The medications are grouped into heparins, low molecular weight heparins, factor Xa and direct thrombin inhibitors, antiplatelet agents, fibrinolytics, and glycoprotein IIb/IIIa inhibitors. For each group, it provides the drug names and recommended waiting times.
This document discusses endocrine diseases and their implications for anesthesia. It covers both hyperthyroidism and hypothyroidism in detail. For hyperthyroidism, it describes the signs and symptoms, causes, effects on the cardiovascular system, and treatment approaches including antithyroid medications, beta blockers, iodine, and surgery. It provides guidance on preoperative preparation and intraoperative management. For hypothyroidism, it discusses signs and symptoms, effects on the cardiovascular system, diagnosis, and treatment with levothyroxine. It notes risks for anesthesia and importance of rendering patients euthyroid prior to elective surgery.
This document provides information on hyperthyroidism and its implications for anesthesia. It begins with an overview of thyroid gland anatomy and hormone production. The main causes of hyperthyroidism include Graves' disease and toxic multinodular goiter. Clinical features include weight loss, tremors, and tachycardia. Pre-operative evaluation involves assessing for toxic symptoms and complications. Investigations include thyroid function tests and imaging. Patients must be rendered euthyroid before elective surgery to prevent thyroid storm, through anti-thyroid drugs and beta-blockers if needed during emergencies.
Successful management of massive intra-operative pulmonary embolism Apollo Hospitals
Acute Pulmonary Embolism has a high rate of mortality (26%) due to blockade of the pulmonary artery leading to acute increase in right ventricular pressure causing sudden cardiac decompensation. Lack of specific tests for early diagnosis is one of the causes for high rate of mortality but timely diagnosis and active intervention can save the life of the patient.
This document discusses anesthesia considerations for total hip replacement (THR) and total knee replacement (TKR) surgeries. It covers preoperative evaluation and optimization of comorbidities. Regional anesthesia techniques like spinal, epidural and peripheral nerve blocks are preferred due to advantages like less blood loss, better pain control and early mobility. General anesthesia is an option as well. Intraoperative monitoring, fluid management and prevention of complications like venous thromboembolism and cement implantation syndrome are discussed. Early mobilization and multimodal analgesia are emphasized for postoperative care.
This document discusses anesthesia considerations for renal transplantation. It begins by outlining the history of anesthesia used in kidney transplantation, noting the early use of spinal anesthesia and limited monitoring. It then discusses:
- Kidney transplantation being the most common transplant procedure worldwide.
- Indications and contraindications for transplantation.
- Outcomes being greatly improved compared to remaining on dialysis.
- Types of donors including living and cadaveric.
- Anesthesia goals for living donors focusing on safety.
- Evaluation, induction, maintenance and monitoring for recipients.
- Positioning, fluid management and hemodynamic goals.
The document discusses the posterior fossa, including its boundaries, contents, blood supply, clinical presentation of lesions, and considerations for anesthesia. The posterior fossa is bounded anteriorly by the clivus and petrous bone, posteriorly by the occipital bone, and laterally by the temporal bone. It contains the cerebellar hemispheres, brainstem, and cranial nerves III-XII. Lesions can cause a variety of signs and symptoms depending on location, including ataxia, nystagmus, limb weakness, and cranial nerve deficits. Anesthesia for posterior fossa surgery requires careful monitoring and positioning to maintain stability while allowing surgical access.
This document provides information about celiac plexus block (CPB) procedures, including indications, neurolytic agents used, landmarks, insertion technique, complications, success rates, and references. It lists acute or chronic pancreatitis, pancreatic cancer, intra-abdominal metastatic disease, and diagnostic blocks as common indications for CPB. Complications include pneumothorax, nerve injury, and hypotension. Success rates from a referenced study found 89% of patients had adequate or excellent pain relief within the first week and 70-90% continued to have relief at 3 months.
This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
Elderly patients represent the fastest growing population globally. They experience many age-related physiological changes that increase surgical risk. Preoperative evaluation and optimization is important to identify risks like cardiovascular disease and pulmonary issues. Anesthesia in the elderly requires lower doses of induction agents and opioids due to pharmacokinetic changes. Regional anesthesia may provide benefits over general anesthesia. Close postoperative monitoring is needed due to risks of complications like delirium, cognitive dysfunction, hypotension, and hypothermia.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
This document summarizes anesthesia considerations for pneumonectomy. It discusses pre-operative assessment of cardiopulmonary function to determine risk. Intra-operatively, techniques for lung isolation include double lumen tubes, bronchial blockers, or endobronchial tubes. Positioning is lateral, and one-lung ventilation requires strategies to manage hypoxemia. Post-operative monitoring and pain management involve thoracic epidural analgesia, intercostal blocks, and systemic opioids or NSAIDs to prevent complications like respiratory failure, hemorrhage, or pulmonary edema.
A 15-year-old male was brought to the emergency department 19 days after sustaining a chest injury from a tractor steering wheel. He had pain and breathlessness after the injury and was found to have a near complete transaction of the right main bronchus and bronchopleural fistula. He underwent initial treatment including intercostal drainage placement.
On examination, he was conscious but had absent air entry on the right side of the chest and straw colored fluid was found in the right intercostal drainage tube. Imaging showed a right pneumothorax with collapsed lung and absent bronchopulmonary markings. A bronchopleural fistula was diagnosed. Treatment options for bronchopleural fistulas were discussed.
The document discusses the anatomy and nerve supply of the lower limb. It describes the lumbar and sacral plexuses, which provide motor and sensory innervation to the lower extremities. Specifically, it outlines the five major nerves of the lower limb - the femoral, lateral femoral cutaneous, obturator, posterior cutaneous, and sciatic nerves. It also provides details on the lumbar plexus block technique, including landmarks, injection site, and blocked nerves.
This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
The document discusses spinal and spinal cord injuries, including incidence, morbidity and mortality, anatomy, assessment, types of spinal cord injuries, management, and non-traumatic conditions. It provides details on the anatomy of the spine and spinal cord, mechanisms of spinal cord injury, approaches to assessing and managing spinal injuries, and specific spinal cord syndromes. Prevention, immobilization, and avoiding further injury to the spinal cord are the primary goals in managing spinal and spinal cord trauma."
1. Awake craniotomy allows monitoring of brain functions like speech and movement during brain surgery to minimize damage to critical areas. Scalp blocks and sedation are used to keep the patient comfortable but awake.
2. Advantages include mapping of motor and language areas by directly stimulating the brain and observing responses. Risks include seizures, neurological deficits, and other surgical complications if the procedure is not performed carefully.
3. Proper patient selection, psychological preparation, monitoring, anesthesia technique and mapping are essential for successful awake craniotomy outcomes. Careful attention to details improves results more than complex interventions.
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERYDebashish Mondal
This document discusses hip replacement arthroplasty (HRA). It provides information on the types of HRA, indications for surgery, preoperative evaluation and anesthesia considerations. The key points are:
- HRA involves replacing damaged hip joint surfaces with prosthetics to relieve pain and restore function. It can be total or half (hemi) replacement.
- Candidates typically have severe osteoarthritis or other conditions causing irreversible hip damage and unremitting pain.
- Patients require thorough medical evaluation due to common comorbidities in the elderly population undergoing HRA.
- Regional anesthesia like spinal is preferred over general anesthesia for HRA due to benefits like reduced blood loss and better postoperative pain control.
This document provides information about total intravenous anesthesia (TIVA). It begins with a definition of TIVA as a technique of general anesthesia that uses intravenous agents exclusively without inhalational gases.
It then discusses the history of TIVA, types of TIVA, indications, advantages, disadvantages, common drugs used and their properties, drug combinations, and methods of administration including single syringe, manually controlled infusion, target controlled infusion, and closed loop systems. Specific TIVA protocols, dosages, and drug mixtures are also outlined. The document aims to provide an overview of TIVA for educational purposes.
Total intravenous anesthesia (TIVA) involves inducing and maintaining general anesthesia exclusively through intravenous drug administration without volatile agents. It utilizes short-acting hypnotic drugs like propofol and analgesic drugs like fentanyl delivered via target-controlled infusion pumps. TIVA provides advantages like rapid titratability of drugs, faster recovery, reduced pollution and side effects like nausea. Precise computer-controlled infusion pumps along with pharmacokinetic models are used to achieve and maintain targeted drug concentrations in the blood and effect sites. Common drugs utilized in TIVA include propofol, fentanyl and muscle relaxants which are administered individually or in combinations based on the patient and procedure.
Head trauma, also called traumatic brain injury (TBI), occurs in two phases: primary and secondary brain injury. Primary injury involves direct damage to brain tissue from impact. Secondary injury involves downstream effects like edema and ischemia that start minutes after primary injury. Managing TBI focuses on preventing secondary injuries like hypotension, hypoxia, fever and intracranial hypertension that can exacerbate primary damage. Treatment involves intensive monitoring, ventilation, controlling blood pressure/ICP, anticonvulsants and early rehabilitation. The goal is to minimize further brain injury and maximize recovery.
This document discusses the scalp block technique. It begins by describing scalp block as local anesthesia of the scalp nerves. It then discusses the history and development of scalp block, including the original description in 1986 and studies in the 1980s that demonstrated its effectiveness in reducing hemodynamic changes during craniotomy. The document outlines the specific nerves blocked in scalp block and techniques for each, and notes bupivacaine is often used. Advantages include decreased blood pressure and intracranial pressure changes during surgery. Potential complications are also reviewed. Finally, it briefly discusses recent updates to the Glasgow Coma Scale including the addition of a pupil reactivity score in 2018.
The document provides guidelines from the American Society of Regional Anesthesia (ASRA) on placing and removing epidural catheters in patients taking anticoagulant and antiplatelet drugs. It lists recommended minimum times to wait after the last dose of various medications before catheter placement and removal, as well as when to restart anticoagulation therapy after removal. The medications are grouped into heparins, low molecular weight heparins, factor Xa and direct thrombin inhibitors, antiplatelet agents, fibrinolytics, and glycoprotein IIb/IIIa inhibitors. For each group, it provides the drug names and recommended waiting times.
This document discusses endocrine diseases and their implications for anesthesia. It covers both hyperthyroidism and hypothyroidism in detail. For hyperthyroidism, it describes the signs and symptoms, causes, effects on the cardiovascular system, and treatment approaches including antithyroid medications, beta blockers, iodine, and surgery. It provides guidance on preoperative preparation and intraoperative management. For hypothyroidism, it discusses signs and symptoms, effects on the cardiovascular system, diagnosis, and treatment with levothyroxine. It notes risks for anesthesia and importance of rendering patients euthyroid prior to elective surgery.
This document provides information on hyperthyroidism and its implications for anesthesia. It begins with an overview of thyroid gland anatomy and hormone production. The main causes of hyperthyroidism include Graves' disease and toxic multinodular goiter. Clinical features include weight loss, tremors, and tachycardia. Pre-operative evaluation involves assessing for toxic symptoms and complications. Investigations include thyroid function tests and imaging. Patients must be rendered euthyroid before elective surgery to prevent thyroid storm, through anti-thyroid drugs and beta-blockers if needed during emergencies.
Successful management of massive intra-operative pulmonary embolism Apollo Hospitals
Acute Pulmonary Embolism has a high rate of mortality (26%) due to blockade of the pulmonary artery leading to acute increase in right ventricular pressure causing sudden cardiac decompensation. Lack of specific tests for early diagnosis is one of the causes for high rate of mortality but timely diagnosis and active intervention can save the life of the patient.
This document discusses anesthesia considerations for total hip replacement (THR) and total knee replacement (TKR) surgeries. It covers preoperative evaluation and optimization of comorbidities. Regional anesthesia techniques like spinal, epidural and peripheral nerve blocks are preferred due to advantages like less blood loss, better pain control and early mobility. General anesthesia is an option as well. Intraoperative monitoring, fluid management and prevention of complications like venous thromboembolism and cement implantation syndrome are discussed. Early mobilization and multimodal analgesia are emphasized for postoperative care.
This document discusses anesthesia considerations for renal transplantation. It begins by outlining the history of anesthesia used in kidney transplantation, noting the early use of spinal anesthesia and limited monitoring. It then discusses:
- Kidney transplantation being the most common transplant procedure worldwide.
- Indications and contraindications for transplantation.
- Outcomes being greatly improved compared to remaining on dialysis.
- Types of donors including living and cadaveric.
- Anesthesia goals for living donors focusing on safety.
- Evaluation, induction, maintenance and monitoring for recipients.
- Positioning, fluid management and hemodynamic goals.
The document discusses the posterior fossa, including its boundaries, contents, blood supply, clinical presentation of lesions, and considerations for anesthesia. The posterior fossa is bounded anteriorly by the clivus and petrous bone, posteriorly by the occipital bone, and laterally by the temporal bone. It contains the cerebellar hemispheres, brainstem, and cranial nerves III-XII. Lesions can cause a variety of signs and symptoms depending on location, including ataxia, nystagmus, limb weakness, and cranial nerve deficits. Anesthesia for posterior fossa surgery requires careful monitoring and positioning to maintain stability while allowing surgical access.
This document provides information about celiac plexus block (CPB) procedures, including indications, neurolytic agents used, landmarks, insertion technique, complications, success rates, and references. It lists acute or chronic pancreatitis, pancreatic cancer, intra-abdominal metastatic disease, and diagnostic blocks as common indications for CPB. Complications include pneumothorax, nerve injury, and hypotension. Success rates from a referenced study found 89% of patients had adequate or excellent pain relief within the first week and 70-90% continued to have relief at 3 months.
This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
Elderly patients represent the fastest growing population globally. They experience many age-related physiological changes that increase surgical risk. Preoperative evaluation and optimization is important to identify risks like cardiovascular disease and pulmonary issues. Anesthesia in the elderly requires lower doses of induction agents and opioids due to pharmacokinetic changes. Regional anesthesia may provide benefits over general anesthesia. Close postoperative monitoring is needed due to risks of complications like delirium, cognitive dysfunction, hypotension, and hypothermia.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
This document summarizes anesthesia considerations for pneumonectomy. It discusses pre-operative assessment of cardiopulmonary function to determine risk. Intra-operatively, techniques for lung isolation include double lumen tubes, bronchial blockers, or endobronchial tubes. Positioning is lateral, and one-lung ventilation requires strategies to manage hypoxemia. Post-operative monitoring and pain management involve thoracic epidural analgesia, intercostal blocks, and systemic opioids or NSAIDs to prevent complications like respiratory failure, hemorrhage, or pulmonary edema.
A 15-year-old male was brought to the emergency department 19 days after sustaining a chest injury from a tractor steering wheel. He had pain and breathlessness after the injury and was found to have a near complete transaction of the right main bronchus and bronchopleural fistula. He underwent initial treatment including intercostal drainage placement.
On examination, he was conscious but had absent air entry on the right side of the chest and straw colored fluid was found in the right intercostal drainage tube. Imaging showed a right pneumothorax with collapsed lung and absent bronchopulmonary markings. A bronchopleural fistula was diagnosed. Treatment options for bronchopleural fistulas were discussed.
The document discusses the anatomy and nerve supply of the lower limb. It describes the lumbar and sacral plexuses, which provide motor and sensory innervation to the lower extremities. Specifically, it outlines the five major nerves of the lower limb - the femoral, lateral femoral cutaneous, obturator, posterior cutaneous, and sciatic nerves. It also provides details on the lumbar plexus block technique, including landmarks, injection site, and blocked nerves.
This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
The document discusses spinal and spinal cord injuries, including incidence, morbidity and mortality, anatomy, assessment, types of spinal cord injuries, management, and non-traumatic conditions. It provides details on the anatomy of the spine and spinal cord, mechanisms of spinal cord injury, approaches to assessing and managing spinal injuries, and specific spinal cord syndromes. Prevention, immobilization, and avoiding further injury to the spinal cord are the primary goals in managing spinal and spinal cord trauma."
Spinal cord injuries can cause partial or complete loss of motor and sensory function below the site of injury. There are several types of spinal cord injuries including complete and incomplete injuries. Risk factors include men, young adults, seniors, and those active in sports. Causes include trauma, bullet wounds, and falls. Symptoms depend on the injury level but may include paralysis, numbness, loss of bowel/bladder control. Diagnostic tests include imaging like CT, MRI to determine injury level and severity. Complications can include autonomic dysreflexia, pressure sores, loss of sexual function. Treatment involves stabilizing the spine, managing complications, and long-term rehabilitation.
1. Spinal cord injuries are commonly caused by motor vehicle crashes, falls, violence, and sports. The document discusses the anatomy and classification of spinal injuries, including flexible, extension, vertical compression, and other types of injuries.
2. The stability of the spinal injury depends on which vertebral columns are disrupted. Disruption of one column usually results in a stable injury, while disruption of two or more columns can cause instability.
3. Clinical features of a spinal cord injury include neck pain, sensory changes, and abnormal breathing patterns. A full neurological exam evaluates symptoms, medical history, inspection of injuries, and palpation of the spine.
The document discusses spinal cord injuries and intracranial disorders. It causes include motor vehicle accidents, falls, and violence. Manifestations depend on the level and completeness of injury and can include paralysis, loss of sensation, and autonomic dysreflexia. Treatment involves immobilization, monitoring of vital signs, prevention of complications, and rehabilitation.
Traumatic brain injury and Spinal cord injuryJack Frost
1. Traumatic brain injury (TBI) can be either closed or open head injuries and results from head colliding with an object. There are approximately 5.3 million Americans living with TBI.
2. TBIs are classified as mild, moderate, or severe based on loss of consciousness and symptoms. The leading causes of TBI are falls, vehicle accidents, and violence/abuse.
3. Concussions involve temporary neurological dysfunction while contusions are more severe brain bruising that can cause prolonged unconsciousness.
This document discusses spine immobilization and injury. It provides data on the incidence and mechanisms of spine injuries from the Trauma Audit between 2010-2014. It showed the majority of urgent spine surgeries were for the cervical and thoracic regions. The principles of clinical assessment for the cervical and thoracolumbar spine are outlined, including the NEXUS criteria for clearing the cervical spine. Imaging guidelines and classifications systems for cervical (SLIC) and thoracolumbar (TLICS) injuries are summarized. Various immobilization devices for the cervical, thoracic, and lumbar spine like halos, Minerva braces, and TLSO braces are described.
important points regarding ICU psychosis, role of dexmedetomidine in it's treatment, mortality associated with delirium, symptomatic and definitive management
Spine care program at Wockhardt Hospitals makes it a centre for excellence in neurology care with highly skilled clinical expertise
Our Hospitals provide cutting-edge diagnostic and operating facilities such as computerized navigation, imaging and treatment in orthopedics.
- Spinal cord injuries occur most often in males aged 16-30 and result from motor vehicle accidents, violence, falls, or sports.
- Medical management includes immobilizing the spine, administering steroids to reduce swelling, and surgery to decompress the spinal cord if needed.
- Nursing management focuses on respiratory care if needed, skin integrity, bowel and bladder care, pain management, and preventing complications like infection, blood clots, and autonomic dysreflexia.
This document summarizes census data and clinical activity from the Department of Anaesthesia and Critical Care in 2011. It provides statistics on:
- The number of general surgeries, neurosurgeries, and orthopaedic surgeries performed and the most common procedures in each specialty.
- Admissions and outcomes in the Trauma ICU, including demographics, injury patterns, ventilation details, mortality rates, and common procedures.
- Activity in radiology anaesthesia, the peripheral service, and achievements of the department over the past year.
This document outlines meningoencephalitis in pediatric patients. It defines meningitis and encephalitis and discusses the routes by which organisms can reach the central nervous system. It describes the main types of meningitis including acute pyogenic, aseptic, chronic, and others based on organism. It covers the diagnosis, treatment, and complications of meningitis. The diagnosis involves history, physical exam, CSF analysis and imaging tests. Treatment depends on the identified organism and may include antibiotics, antivirals, or antifungals. Complications can include hearing loss, abscesses, hydrocephalus and increased intracranial pressure.
This document provides an overview of assessments used in physiotherapy for patients with spinal cord injuries. It lists the key areas that should be assessed, including pain, range of motion, muscle performance, reflexes, aerobic capacity, cognition, gait, motor function, self-care, ventilation, integument, and community reintegration. For each area, it identifies specific assessment tools and how they are administered to evaluate patients and monitor treatment progress. The goal is to thoroughly examine patients with spinal cord injuries across various physical, neurological, and functional domains.
Dr. M.Manoranjitha kumari discusses spinal anatomy, injuries, and management. She notes that approximately 20,000 new spinal injury cases occur in India each year from mechanisms like MVCs, falls, and blunt trauma. Proper stabilization and immobilization of the spine is important. Surgical intervention may be indicated to decompress the spinal cord or stabilize fractures. The O-arm provides 3D imaging guidance for accurate, minimally invasive spinal fixation procedures.
The spinal cord is a collection of nerves that travels down the back and connects the brain to the rest of the body. Spinal cord injuries occur when the spinal cord is damaged, such as from trauma, loss of blood supply, tumors, or infections. A spinal cord injury can cause paralysis and loss of sensation below the site of injury. Treatment involves corticosteroids, bed rest, traction, rehabilitation, and sometimes surgery to decompress the spinal cord or fuse broken bones. Complications can include urinary and bowel issues, pressure sores, infections, blood clots, spasms, pain, and depression.
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
This document discusses spine injuries, including their definition, epidemiology, anatomy, classification, pathophysiology, diagnosis, management, rehabilitation, complications, prevention, and current trends. Spine injuries refer to damage to the bony or ligamentous structures of the spine, which can occur with or without neurological impairment. They are frequently caused by motor vehicle accidents or falls and require early recognition and treatment to achieve good outcomes. Management involves pre-hospital stabilization and transport, hospital evaluation and stabilization, and may include surgical or non-surgical techniques depending on the injury. Rehabilitation aims to prevent complications and promote recovery, while efforts should also focus on prevention to reduce the incidence of these often devastating injuries.
This document summarizes post-operative care and complications. It discusses the phases of post-operative recovery, monitoring vital signs, wound care, pain management, and common complications like pulmonary issues and infection. The main goals of post-op care are successful recovery, reduced mortality and hospital stay, and lower costs. Care involves monitoring the patient's condition, administering medications, managing drains and nutrition, and watching for complications in order to aid healing and prevent further issues.
MECHANICAL VENTILATION IN NEUROLOGICAL AND NEUROLOGICAL CASES.pptxNeurologyKota
20% of all patients requiring mechanical ventilation suffer from neurological dysfunction.
Major contributor to prolongation of mechanical ventilation in over a third of patients admitted in ICU.
The document discusses a clinical trial that evaluated the effects of treating ARDS patients with the neuromuscular blocking agent (NMBA) cisatracurium for 48 hours. The randomized, double-blind study of 340 ARDS patients found that those receiving cisatracurium had improved oxygenation and a decreased trend in ICU mortality compared to controls. However, the primary outcome of reduced 90-day mortality was not statistically significant between the groups. The authors conclude that NMBAs may provide clinical benefits for ARDS, but further research is still needed.
This document discusses complications of spinal cord injury, including acute complications like pulmonary issues, cardiovascular problems, and pressure ulcers. Chronic complications include heterotopic ossification, gastrointestinal problems, and spasticity. Neurogenic shock, orthostatic hypotension, and autonomic dysreflexia are also covered. Respiratory complications are discussed along with prevention strategies. Bladder dysfunction, urinary tract infections, and thermal regulation challenges are also summarized.
Congenital diaphragmatic hernia is a neonatal emergency that occurs when abdominal organs push into the chest cavity through a defect in the diaphragm. It has traditionally had high mortality rates, but preoperative stabilization techniques including nitric oxide, high frequency ventilation, ECMO, and permissive hypercapnia have reduced mortality to under 75%. The presentation depends on when during fetal development the hernia occurred. Treatment involves preoperative stabilization followed by surgical repair once stabilized, with postoperative care focused on managing pulmonary hypertension and hypoplasia. Prognosis depends on the degree of lung and heart hypoplasia and presence of other defects.
This document provides an overview of respiratory medicine, covering topics such as anatomy and physiology of the lungs, respiratory failure, pleural diseases, asthma, COPD, and more. It defines conditions, lists their typical causes and presentations, and outlines recommended diagnostic tests and treatment approaches. Key areas covered include the mechanics of breathing, definitions of respiratory failure types, common pleural effusions and their management, asthma diagnosis and treatment guidelines, risk factors and management of COPD, and criteria for exacerbation treatment.
1. The document discusses various techniques to assess myocardial viability including echocardiography, single photon emission computed tomography (SPECT), and positron emission tomography.
2. Dobutamine stress echocardiography can identify viable myocardium through contractile reserve but may underestimate viability. SPECT tracers like thallium-201 and sestamibi allow assessment of perfusion and viability through stress-redistribution imaging.
3. Multiple SPECT protocols exist including stress-redistribution, reinjection, and rest redistribution. Tracer uptake correlates to the probability of functional recovery after revascularization. Quantitative myocardial contrast echocardiography also predicts viability through perfusion parameters.
This document discusses donation after brain death. It begins by defining brain death as the irreversible loss of all brain functions, including the brainstem, while the heart is still beating. It then covers the ethical issues surrounding organ donation, the physiological changes that occur after brain death, management of the potential donor, organ retrieval procedures, and contraindications for donation. The goal is to optimize the donor's condition and minimize organ injury to maximize the number of organs that can be transplanted and their viability and function after transplantation.
This document provides an overview of regional anesthesia techniques including spinal anesthesia, epidural anesthesia, and Bier block. Spinal anesthesia involves injecting local anesthetic into the subarachnoid space, while epidural anesthesia involves injection into the epidural space. Bier block, also called intravenous regional anesthesia, involves exsanguinating a limb and injecting local anesthetic near the tourniquet. The document describes anatomy, procedures, indications, advantages, complications, and pharmacology for each technique.
difficult weaning from Mechanical ventilatorDr.Tarek Sabry
1) Difficult weaning refers to patients who fail initial weaning attempts or require up to three spontaneous breathing trials (SBTs) over seven days to be successfully weaned.
2) Causes of difficult weaning include imbalance between respiratory muscle strength and load, cardiac dysfunction, neuromuscular impairment, and metabolic or nutritional deficiencies.
3) Management of difficult weaning involves addressing potentially reversible causes, using ventilator modes like pressure support ventilation (PSV) to aid the weaning process, and considering non-invasive ventilation (NIV) in selected patients.
Anaesthesia management of patient posted for scoliosis correctionNaveen Kumar Ch
This document discusses the anesthetic considerations for scoliosis surgery. It begins with definitions and classifications of scoliosis. It then discusses epidemiology, measurement of severity, pre-anesthetic assessment, anesthesia techniques used, and conclusions. Key points include the need for careful preoperative pulmonary and cardiac evaluation given the risks of respiratory impairment. Intraoperatively, neuromuscular monitoring is important to detect any spinal cord issues, and total intravenous anesthesia is typically used. Postoperatively, close monitoring and respiratory care are essential to address issues like pain management and pulmonary complications.
This document discusses thoracic anesthesia and one lung ventilation. It begins with the aims and goals of thoracic anesthesia, which include minimizing cardiac depression and pulmonary pressures/resistance while ventilating one lung. It then covers topics like the lateral decubitus position, effects of anesthesia/paralysis, techniques for one lung ventilation including double lumen tubes, and the physiological impacts of the lateral position. Hazards of techniques like double lumen tubes are also addressed. The document provides detailed information on evaluating and preparing patients as well as performing thoracic anesthesia.
Seminar on laparoscopic surgery and its anaesthetic considerationdrsauravdas1977
Laparoscopic surgery offers advantages like less tissue trauma, decreased postoperative pain, and shorter hospital stays compared to open surgery. However, pneumoperitoneum (insufflation of carbon dioxide gas) and patient positioning during laparoscopy can impact respiratory, cardiovascular, and renal systems. Anesthesiologists aim to maintain hemodynamic stability, respiratory stability, adequate muscle relaxation, analgesia, and prevent hypothermia and deep vein thrombosis during laparoscopic procedures.
The document describes combined spinal epidural anesthesia (CSEA). It discusses the anatomy related to CSEA, including the spinal cord, subarachnoid space, epidural space, and bony landmarks. It also covers the physiology of regional anesthesia, advantages of CSEA over other techniques, indications for CSEA, prerequisites, contraindications, problems that can occur, and techniques for performing CSEA.
This document discusses skeletal muscle relaxants, also known as neuromuscular blocking drugs. It begins by describing their mechanism of action, either as depolarizing or non-depolarizing agents. It then covers the pharmacology, uses, adverse effects and common examples of both types of drugs. Key points include that depolarizing drugs like succinylcholine cause muscle fasciculations before paralysis, while non-depolarizing drugs like vecuronium and rocuronium provide cardiovascular stability. Reversal agents like neostigmine and the novel sugammadex are also discussed.
Lung volume reduction surgery ghazia tarannum, roll no. 10,bpt 4th yrBPT4thyearJamiaMilli
Lung volume reduction surgery (LVRS) is a procedure that removes severe emphysematous lung tissue to improve lung function in patients with severe pulmonary emphysema. It is performed through open sternotomy, video-assisted thoracoscopic surgery, or thoracotomy. LVRS aims to remove 20-30% of lung volume to relieve breathlessness and improve quality of life. Candidates undergo extensive testing and those with upper lobe emphysema and low exercise capacity have shown improved survival and function. The procedure staples and removes diseased portions of lung. Post-operative pulmonary rehabilitation is important for recovery. Complications can include prolonged air leaks, respiratory failure, and arrhythmias.
The document discusses the role of physiotherapy in the pediatric intensive care unit (PICU). The PICU treats extremely sick pediatric patients with conditions like respiratory, neurological, and cardiovascular disorders. Physiotherapy is important for critically ill PICU patients to prevent long-term muscle weakness, facilitate weaning from ventilation, and promote safe discharge. Key physiotherapy techniques discussed include positioning, percussion and vibrations to clear secretions, breathing exercises like active cycle of breathing, and airway suctioning. The goals are both short-term maintenance of muscle function and long-term rehabilitation and reintegration into society.
Mechanical ventilation in obstructive airway diseasesAnkur Gupta
This document discusses mechanical ventilation for patients with obstructive airway diseases like COPD. Some key points:
- Non-invasive ventilation (NIV) should be considered within 60 minutes of hospital arrival for COPD patients with respiratory acidosis, as NIV can reduce intubation and mortality rates.
- Invasive mechanical ventilation aims to rest respiratory muscles, avoid dynamic hyperinflation, and prevent overventilation. Dynamic hyperinflation can increase work of breathing and compromise cardiac function.
- Ventilation strategies differ between asthma and COPD but generally use small tidal volumes, high inspiratory flows, and respiratory rates to minimize hyperinflation. Sedation and analgesia are also important to control distress and pain
Anesthesia for spinal cord injury and scoliosis030Atef Salama
The potential risk factors for POVL that are listed are:
- Obesity
- Long Prone Cases
- Anemia
- Pressure on the globe
- Hypotension
- Glaucoma
Cataracts is not a risk factor for POVL.
Similar to Intensive fcare for spinal cord injury (20)
About the newer drugs in anaesthesia. What are the problems with the existing drugs? Which all drugs failed commercially? And why? Which are the newer drugs in anaesthesia?
1. An arterial blood gas (ABG) analysis can provide information about oxygenation, ventilation, and acid-base status. It answers questions like how severe hypoxia or hypercarbia is and what acid-base abnormalities may be present.
2. The document provides templates for interpreting ABG results and analyzing acid-base disturbances and their compensation. It also includes several case scenarios where ABG results are used to diagnose conditions like respiratory acidosis from narcotic overdose or metabolic acidosis and hyperventilation from pneumonia.
3. Key steps in ABG interpretation involve checking for hypoxemia and quantifying any shunt fraction, evaluating ventilation and dead space, identifying primary acid-base disturbances and compensation
1) Awake craniotomy is a technique used for brain tumor excision from eloquent areas of the brain to allow for brain mapping during surgery while the patient is awake.
2) The anesthesiologist's role includes extensive preoperative psychological preparation of the patient, administration of sedation and analgesia during surgery to maintain the patient's comfort and cooperation during brain mapping, and careful titration of medications to avoid complications.
3) There are two main anesthetic approaches for awake craniotomy - monitored anesthesia care with sedation or asleep-awake-asleep general anesthesia. Both have benefits and risks depending on factors like surgery duration and patient characteristics. Careful planning and execution of the anesthetic technique
This document discusses the use of target-controlled infusion (TCI) versus manually controlled infusion (MCI) for neuroanesthesia. It outlines the benefits of TCI, including faster achievement of therapeutic drug concentrations, reduced risk of errors, and easier titration of drugs like propofol and remifentanil for hypnosis and analgesia. However, it notes that current TCI models are limited in options and that MCI is still needed in some cases. It provides details on using and optimizing both TCI and MCI for different patient populations and procedures in neuroanesthesia.
This document provides guidance on safely and appropriately administering total intravenous anesthesia (TIVA). It discusses the differences between TIVA and other techniques, and describes the two main methods for TIVA - manual and target-controlled infusion (TCI). For TCI, it emphasizes the importance of using the correct pharmacokinetic model and carefully entering patient information. It provides tips for setup, monitoring, starting and terminating infusions, and highlights vigilance to avoid complications. The overall message is that understanding and applying TIVA requires a thorough knowledge of anesthesiology principles.
This document provides information about arterial blood gas (ABG) analysis, including how to interpret levels of oxygenation, ventilation, and acid-base imbalance from an ABG test. It discusses key measurements like PaO2, PaCO2, oxygen saturation, and bicarbonate levels. It also reviews respiratory physiology concepts like ventilation-perfusion mismatch, shunt fraction, and the oxygen-hemoglobin dissociation curve that are important for understanding ABG results.
The document summarizes several key physiological changes that occur in the central nervous system with aging. It discusses changes in brain morphology like brain atrophy and widening of sulci. There are reductions in neurons, myelinated axons and neurotransmitter function. Cerebral blood flow decreases along with metabolic demand. Calcium regulation is also impaired with aging impacting neurotransmitter release. The hypothalamic-pituitary-adrenal axis shows changes reducing stress response capacity. Overall the aging brain shows structural, metabolic and functional declines impacting cognition, mood and homeostasis.
This document provides information on preparing for and managing obstetric hemorrhage. Some key points:
- Severe bleeding is a leading cause of maternal death worldwide, with rapid blood loss occurring within 24 hours of delivery in many cases.
- Non-pharmacological measures for postpartum hemorrhage include uterine massage, uterine tamponade, compression sutures, and ligation of internal iliac or uterine arteries. Pharmacological options include oxytocin, ergometrine, carboprost, and tranexamic acid.
- For severe hemorrhage, measures such as hysterectomy, arterial embolization, factor VIIa, or cell salvage may be needed. Initial
This document provides information about gas cylinders used in healthcare. It discusses the parts of cylinders including bodies, valves, and pressure relief devices. It explains how gases are measured in psi and other units of pressure. The document outlines safety rules for handling, storing, and using cylinders including proper labeling and preventing damage. Medical gas pipeline systems are described along with components like terminal units, hoses, and testing procedures to ensure safety.
This document discusses the approach to hypo- and hypernatremia in neurosurgical patients in the perioperative period. It covers several key points:
1. Hyponatremia is common in neurosurgical patients and is associated with high mortality. It can be categorized based on extracellular fluid volume status. SIADH and cerebral salt wasting require different treatments.
2. Hypernatremia results from a loss of free water and can cause central nervous system dysfunction. Rapid correction poses risks like cerebral edema. The approach involves assessing volume status based on labs and symptoms.
3. Diabetes insipidus is a potential complication after pituitary or brain surgeries/injuries. It involves excessive
This document discusses anesthesia considerations for procedures performed outside the operating room. It notes that the number and complexity of such procedures has increased, bringing additional responsibilities for anesthesiologists. Special challenges include limited space, equipment, and support staff unfamiliar with patient management. Proper equipment, monitoring, and planning are important when providing anesthesia or sedation in remote locations. The document discusses various locations like radiology suites, specific procedures like ECT, and choices of anesthetic agents and techniques. Patient safety is the top priority for remote location anesthesia.
This document discusses thromboprophylaxis, or the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients. It notes that evidence-based guidelines for venous thromboembolism prophylaxis have been available for over 15 years, but are still underused globally. It provides the rationale for thromboprophylaxis, stating that DVT is prevalent in at-risk patients, often clinically silent, and difficult to predict; complications are also difficult to manage. Thromboprophylaxis, it concludes, is highly effective at preventing DVT and PE, and cost-effective.
This document discusses the field of anesthesiology. It provides information on what anesthesiologists do, including administering medications to alter physiology, being rapid problem solvers, and leading medical teams in complex environments like operating rooms. The document highlights some of the skills involved in the specialty like airway management, pharmacology, resuscitation, and regional anesthesia. It also outlines some of the tools used in anesthesiology like inhaled anesthetics, muscle relaxants, and opioids. The field has advanced greatly in recent decades to improve patient safety during medical procedures.
This document provides an overview of pediatric anesthesia. It discusses:
1) The challenges of understanding and treating children due to their soft organs, immature systems, and sensitivity. Pain management requires careful planning.
2) Various anesthesia induction and maintenance techniques for children including inhaled anesthetics, intravenous agents, opioids, muscle relaxants and their reversal.
3) Airway management considerations like different laryngeal mask sizes for children of varying weights and the challenges of needles and intravenous access for children.
4) Fluid maintenance using Holliday-Segar formula and blood replacement guidelines based on child's age. Reversal and extubation procedures are also outlined.
This document discusses trigeminal neuralgia, a neuropathic pain condition that causes severe, sporadic facial pain. It provides information on:
1) The etiology, including neurovascular compression as a common cause.
2) Symptoms like brief, severe facial pain that may be triggered by light touch.
3) Treatment options like carbamazepine, microvascular decompression surgery, and percutaneous radiofrequency thermocoagulation of the gasserian ganglion.
4) Imaging techniques like MRI that can identify compressive vascular structures.
This document discusses the issue of fatigue among anesthesiologists and its impacts. It notes that fatigue due to lack of adequate sleep can degrade cognitive function and increase medical errors. Studies have found that over 50% of anesthesiologists report making fatigue-related errors. The document calls for more research into tools and strategies to address fatigue, such as scheduling algorithms, light therapy, melatonin, modafinil, and napping. It argues that more must be done to solve the problem of fatigue in anesthesiology in order to improve patient safety.
1. Primary injuries occur at the moment of trauma from physical forces that deform brain tissue, leading to focal injuries like skull fractures and hemorrhages or diffuse injuries like axonal shearing.
2. Specific primary injuries include skull fractures, intracranial hematomas, brain contusions and lacerations caused by compressive, tensile and shear forces on brain tissue.
3. Epidural hematomas are caused by tears to the middle meningeal artery, potentially causing rapid neurologic decline, while intracerebral hemorrhages result from tears to deep cerebral vessels with extensive cortical contusions.
The document discusses the hypothalamus and pituitary gland. It notes that the hypothalamus secretes hormones that regulate the anterior pituitary, while the posterior pituitary is an extension of the hypothalamus and stores hormones. The anterior pituitary develops from Rathke's pouch and the posterior pituitary develops from the infundibulum. The hypothalamus regulates water balance and vasopressin secretion through the posterior pituitary. Diabetes insipidus occurs when there is a deficiency of vasopressin, and can be central or nephrogenic in origin. Post-operative diabetes insipidus is a common complication of pituitary surgery.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
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.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8. Without a left eyelid,she needs
eyedrops to retain her vision
9. Reginald Stephey was convicted on two counts of
intoxicated manslaughter. He completed two
concurrent seven-year prison sentences . On May
20, 2011 Saburido again appeared on the 4th to
last episode of The Oprah Winfrey Show
13. SURGICAL THERAPIES
NEUROLOGIC DETERIORATION ? RADIOLOGY?
CLOSED REDUCTION—SUCCESSFUL?
. SPINAL STABILITY---LOST?
Accepted Indications for Surgery
Progressive neurologic deterioration in an unstable spine,
especially with spinal canal compromise
Failure of closed reduction and stabilization of dislocation with
residual canal narrowing of > 50%
Unstable spine with dislocated bilateral "locked" facets
Unstable spine where nonunion is likely
Uncooperative patient with unstable spine risking further
neurologic injury
Compression of conus medullaris or cauda equina
14. Early Surgical Therapy
Experimental studies…. Go for it!
Clinical studies………..favourable outcome
Must occur <24 hrs, especially in incomplete
injuries
Late (>48hrs) only stabilizes spinal column and
helps rehabilitation
15. SURGICAL APPROACHES
ANTERIOR APPROACH
Your Text here
for removal of disk material, bone, or ligamentous tissue compressing
the spinal cord anteriorly
to treat unstable compression-flexion and distractive-flexion injuries,
often in conjunction with a decompressive corpectomy (removal of
vertebral body) if the cord is compressed
POSTERIOR APPROACH
for significant disruption of the posterior bony or ligamentous structures
of the cervical spine, particularly with minimal or no involvement of the
vertebral body
to treat occipitocervical and atlantoaxial instability and for spinal
instability causing flexion injuries
COMBINED APPROACH [BOTH ANT & POST STRUCTURES]
flexion teardrop fractures, vertical compression burst fractures with
significant posterior ligamentous injury, and bilateral facet dislocation with
disk compression of the spinal cord.
17. CORTICOSTEROIDS
stabilize membranes
• prevent the release of lysosomes and
. excessive Ca2+ ionic fluxes into cells
Improvement in blood flow
• Reduction in tissue edema,
• direct vasodilative effects of steroids
• antioxidant properties
alter ionic-clearing mechanisms
enhance Na+ K+-ATPase activity
inhibit lipid peroxidation formation
19. NASCIS
NASCIS-I No neurologic benefit; ? Inadequate
dose?
NASCIS-II patients treated within 8 hours of
injury showed significant improvement in motor
and sensory function Vs30 mg/kg, followed by 5.4 mg/kg/hr
Treatment 1:methylprednisolone,
placebo…..PRACTICE
for 23 hours
Treatment 2:naloxone, 5.4 mg/kg fol-lowed by 4 mg/kg/hr for 23 hours
Treatment 3:placebo
NASCIS-III MP 30 mg/kg within 824 hours
Treatment 1: Methyprednisolone 5.4 mg/kg/hr for hrs f/b
Treatment 2: Methyprednisolone 5.4 mg/kg/hr for 48 hours
Treatment 3: Tirilizad mesylate 2.5 mg/kg every 6 hours for 48 hours
20. NASCIS-III
Treatment group 2 :especially among patients
whose therapy was initiated 3 to 8 hours after
injury ‘showed’ greater motor recovery at 6 weeks
and 6 months after injury than patients treated with
the same agent for 24 hours. [ post-hoc analysis;
NOT Level 1/Level 2/Level 3 ]
No functional benefit was demonstrated for the use
of steroid therapy in the treatment of penetrating
21. REAL STORY
NASCIS II flaws in study design and statistical
analysis, NASCIS III concerns regarding the
timing of surgery, the process of neurologic
assessment, and the fact that differences in motor
scores and functional outcome were clinically
negligible…no difference in the level of disability
MP-48-hour infusionhigher incidence of
infections
So STEROIDS ARE NOT STANDARD Rx IN A/C
SCI; JUST A TREATMENT OPTION
22. HYPOTHERMIA
Efficacy in mild to moderate traumatic SCI; not in
severe
Circulatory, pulmonary, metabolic, and
immunologic side effects
Only experimental; no clinical evidence
Hence this also is an option; not a standard Rx
23. Hypertension
In patients with hypo-perfusion
MAP above 85 mm Hg for the first 7 days after
injury is recommended to preserve neurologic
function because autoregulation is impaired… [No
definitive data]
more aggressive hypertensive therapy may have
advantages, but risk of hemorrhage and edema.
27. PULMONARY SYSTEM
LEVEL VENT COUGH COMMENTS
FUN 0=no
0=no fun fun
+++= N/L +++=
N/L
ABOVE 0 0 Paralysis of diaphragm and accessory muscles,
C3 resulting in apnea; lifelong ventilator dependence
C3-C5 0 to + 0 Partial to complete diaphragmatic paralysis;
paralysis of accessory muscles-marked reduction in
lung volumes with hypoxemia; recurrent atelectasis
and pneumonia; prolonged mechanical ventilator
dependence; probabl° tracheostomy; most patients
will be weaned from mechanical ventilation
C5-C7 + to ++ +to ++ Paralysis of accessory muscles; marked reduction
in volumes with hypoxemia-recurrent atelectasis
and pneumonia; many patients need mechanical
ventilation; possible tracheostomy
HIGH ++ ++ Partial paralysis of accessory muscles; reduction in
Tx lung volumes with ateiectasis1 increased incidence
of pneumonia; possible need for mechanical
28. Anatomy
»Diaphragm
– Phrenic nerve
– C3-C4-C5
– Contributes to 65% of Vital Capacity
-- injury >C3 = cough tidal breath
-- ↓in all lung volumes except RV in Cx
spine injury improve over next 4-5 ms
29. Anatomy
»Intercostal muscles
– Intercostal nerves
– T1-T11
• Both layers act as inspirators at low
volumes, and expirators at large volumes
• Below C3 ↑ing function of diaphragm;but
cough is extremely limited, since expiratory
assistance of i.c. muscles are not there
30. Lungs get drowned!
Pulmonary complications -- leading causes of
morbidity and early mortality -- seen in as many as
75% of patients.
The reduction of lung volumes and the inability to
generate an effective cough progressive
retention of pulmonary secretions gradual
microatelectasis and lobar atelectasis
incremental hypoxemia and CO2 retention.
31. ↑WOB ALSO TROUBLES
Vital capacity improve in supine position! [↓RV]*
↓ed lung compliance, ↑ed WOB
Gastric atony ↔ pulmonary mechanics
In 2-5 wks , spinal shock state resolves
progressive spasticity of chest wall + abdomen
improve pulmonary function
32. Other pulmonary
complications
Ventilatory failure and aspiration were the earliest
to occur: at 4.5 days [Jackson and Groomes et al]
33. .
Protocol For Reduction of
Pulmonary Complications
in Patients with SCI
34. Aggressive pulmonary
hygiene
.
Frequent nasotracheal suctioning
• to remove secretions
Positional changes every 2 hours [KINETIC Rx- Start early]
• best achieved with rotational or circle beds
• effectively ↓es complications & Ventilator duration- ICU stay
Chest percussion every 4 hours
Assisted coughing exercises every 4 hours rs
Deep breathing exercises every 4 hours
Incentive spirometry every 4 hours
35. PROTOCOL…continued
.
Bronchodilator therapy for assisting secretion clearance and bronchodilator
effects [relative parasympathetic overactivity in tetraplegics-↑secretions]
Early use FOB in cases of lobar atelectasis secondary to retained
secretions
Early institution of mechanical ventilation
• in those with progressive labored breathing,
• increasing respiratory failure (hypoxia or hypercapnia)
• and vital capacities <1000 ml
Close monitoring of respiratory mechanics in patients receiving mechanical
ventilation
• with optimal use PEEP therapy and
• limitation of plateau pressure to <30 cm Hg
36. Anticipation is important
. • significant declines in
first 1 to 3 days pulmonary reserve
• progressive cord edema
first 2 days • Ascending neurologic
injuryso what will happen?
@admission-
diaphragm •VC check Q6H if <2L;
functioning then If <1L &
respiratory failure symptomaticintubate
37. Start seeing through a
binocular into the long term
plans……
cervical SCI below C4 when spinal shock
resolves (2-3 weeks) muscles develop spasticity
improvement in lung volumes and overall
ventilatory ability eventual weaning from
mechanical ventilation
Nearly all patients with complete cervical SCI
above C6 will require a tracheostomy because of
the length of time on the ventilator and the difficulty
38. Suggested settings
ACMV / SIMV
Ventilator settings should be selected that limit the
occurrence of ventilator-associated lung injury
PEEP is added to recruit collapsed alveoli and
prevent further atelectasis
39. Shift gears accordingly…
Chest trauma is associated with SCI
pulmonary contusions, rib fractures,
pneumothorax, hemothorax, and ARDS.
May result in prolonged mechanical ventilation with
difficult weaning and delayed operative spinal
intervention.
40. Fluid plays… Don’t SLIP
Neurogenic Pulmonary oedema : Neurogenic
increases in extravascular water pulmonary
edema [both in head injury and in SCI; ?related to
the initial sympathetic discharge]
Cardiogenic pulmonary edema : reduced
myocardial inotropy [in high SCI] , overzealous
fluid administration.
Because of the hemodynamic alterations observed
in SCI (hypotension, bradycardia), the usual
42. Spinal cord…. Does it belong to CNS or
CVS!!!!
complete cervical SCI has the most pronounced
physiologic effects, consisting of cardiovascular
instability, cardiac dysrhythmias, and ventricular
dysfunction
SCI below T5 results in varying degrees of
hypotension caused by the functional
sympathectomy below the level of injury
DISTINCTLY DIFFERENT MECHANISMS…
43. The Sympathetic BOMB
BLAST
A transient severe increase in blood pressure
caused by an extensive sympathetic discharge at
the time of injury
The systolic blood pressure may be as high as 300
mm Hg, lasting 2 to 5 minutes, with a gradual
decline to values less than baseline
may be responsible for the noncardiogenic
pulmonary edema
44. Aftermath…..
After this HYPOTENSION predominates [ in all
patients with complete cervical SCI ]
Due to vasodilatation 20 to withdrawal of
sympathetic neural outflow
Its a functional sympathetic blockade [sympathetic
receptors lose their normal input and regulation]
Parasympathetic system remains intact since… the
vagus nerve exits from the brainstem.
46. SPINAL SHOCK
seen with physiologic or anatomic transection, or
near transection, of the spinal cord
consists of the loss of somatic motor and sensory
function below the level of injury, loss of voluntary
rectal contraction, and loss of sympathetic
autonomic function
47. SPINAL SHOCK continued
The more severe the functional spinal cord
transection and the higher the level of injury, the
greater the severity and duration of spinal shock.
If the loss lasts longer than 1 hour, pathologic
injuries to the spinal cord, as opposed to a
transient concussive injury are assumed to exist
48. Lack of speed kills….
Beware of the bradycardia in SCI
complete cervical SCI +++; thoracic and lumbar
injuries +/-
interruption of the cardiac accelerator nerves (Tl to T4)
First 2 wks-most dangerous ; resolves over 3- to 5-
weeks
profound degrees of bradycardia, even cardiac arrest,
may occur during turning or tracheal suctioning
sedation, 100% oxygen before suctioning, and limiting
the time allowed for suctioning
Rx: Atropine, Temporary pacemaker
49. What has fallen there…?
SBP < 90 mm of Hg / 30% below baseline
goal : ? MAP > 85 mm of Hg for first 7 days
correction of hypotension is crucial for optimal
preservation of neurologic function and reduction of
20 injury
No autoregulation; so aggressive Rx
Neurogenic shock relative hypovolemia due to
vasodilation so fill, but carefully [pulmonary
edema]
[1]Blood : to maintain Hb>10g
[2]Fluids : isotonic crystalloids / ?HYPERTONIC
50. DON’T ‘PRESS’ TOO MUCH
vasopressor Vs inotropic
agents
potent ά-agonist substantial increases in
afterload impair cardiac O/P can precipitate
LVF inotropic agent is often the drug of choice
for maintaining spinal cord perfusion
Invasive hemodynamic monitoring is
recommended
There is evidence to support improvement in
neurologic outcome in whom hemodynamics are
managed aggressively.
SC edema is maximal at 3 to 6 days after injury,
blood pressure support should continue during this
51. Arrhythmias
Experimental models & clinical reports shown --
Cardiac dysrhythmias [suppressed by atropine]
tachycardia, and ST T wave changes [suppressed
by propranolol]
The initial response to spinal cord compression--
sympathetic discharge elicited a secondary,
compensatory, parasympathetic discharge
autonomic imbalance responsible for the cardiac
dysrhythmias
52. Arrhythmias continued
..
TYPE persistent bradycardia Primary cardiac arrest
severe cervical SCI 31/31 5/31
mild cervical SCI 6/17 -
thoracolumbar SCI 3/23 -
frequency of brady-dysrhythmias was maximal on
day 4 after injury
all abnormalities resolved over a 14-day to 6-week
period
53. GASTROINTESTINAL
SYSTEM
Issues Comments
.
Gastric distention Increased risk of aspiration
Gastric emptying delayed Adversely affect ventilation
Rx : put N-G tube
peptic ulcer disease One cause- high dose steroids
gastritis, Rx: PPI, Sucralfate [continued for 4
hemorrhage weeks] Enteral feeding
Ileus
acalculous cholecystitis
occult acute abdomen patients with SCI may not
demonstrate the usual signs and
symptoms
elevated metabolic rates early nutritional supplementation
57. TEMPERATURE CONTROL
The body temperatures of patients with complete
SCI tend to approach that of the environment
No regulatory mechanisms like vasoconstriction/
sweating
prone to hypothermia
59. DEEP VEIN THROMBOSIS
40-100%
↑ed age, a concomitant lower extremity fracture,
and lack of or delay in thromboprophylaxis ↑es risk
PULMONARY EMBOLISM
In 0.5% to 4.6% of patients
third leading cause of death
moreoften with complete SCI and thoracic
miury
60. Diagnosis and Treatment
Diagnosis
CLINICAL SUSPICION
D-DIMER LEVELS,
VENOGRAPHY,
COLOR FLOW DUPLEX IMAGING
CT ANGIOGRAPHY,
PULMONARY ANGIOGRA-PHY
Treatment
PROPHYLACTIC TREATMENT AS SOON AFTER
INJURY AS IS POSSIBLE (I.E., 72 HOURS)
CONTINUED FOR A MINIMUM OF 3 MONTHS.
EFFECTIVE TREATMENT THE OCCURRENCE OF
DVT DECREASES TO 5%.
63. AUTONOMIC
HYPERREFLEXIA
occurs in 85% of patients with spinal cord
transections above T5
is secondary to autonomic vascular reflexes, which
usually begin to appear about 2 to 3 weeks after
injury
Afferent impulses from bladder or bowel distention,
manipulations of the urinary tract, or surgical
stimulation the pelvic, pudendal, or hypogastric
nerves to the isolated spinal cord a massive
sympathetic response from the adrenal medulla
and sympathetic nervous system, which is no
longer modulated by the normal inhibitory impulses
64. AUTONOMIC
HYPERREFLEXIA
Vasoconstriction occurs below the lesion;
reflex activity of carotid and aortic baroreceptors
produces vasodilation above the lesion
often accompanied by bradycardia, ven-tricular
dysrhythmias, and even heart block.
Sedation or topical anesthesia does not appear to
attenuate the hypertensive response, but deep
general, epidural, or spinal anesthesia is effective
Hypertension Rx
direct-acting vasodilators (e.g., sodium nitroprusside)
beta blocking agents (e.g., esmolol),
combination beta blockers (e.g., labetalol), or
ganglionic blocking agents e.g.,trimethaphan
CCBs (nicardipine),
68. HYPERREFLEXIC SYNDROMES
muscle spasms caused by hyper-active spinal
reflexes without the tempering effect of modulating
cortical, brainstem, and cerebellar influences.
This "mass reflex" may make the management of
the unanesthetized patient difficult.
69. PRESSURE ULCERS
direct pressure effects, reduced tissue perfusion,
and limited mobility.
The use of rotational beds, frequent patient turning,
good skin care, foam padding of bony
prominences, or air floatation beds can help
prevent pressure ulcers.
70. LONG-TERM IMMOBILIZATION
altered calcium metabolism
painful heterotopic ossification
calcification of muscles
joint immobility
osteoporosis with hypercalcemia
nephrocalcinosis and secondary renal failure.
Late mobilization pathologic fractures.
Early institution of active physical therapy is
essential
71. THANK YOU
• LET’S TRY TO MAKE OUR ROLES
MORE AND MORE JUSTIFIABLE IN
THIS WORLD