Intravenous regional anesthesia (ivra)
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Total Intravenous Anesthesia(TIVA), recent updates
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.
Patient positioning and anaesthetic consideration
This document discusses various surgical body positions and their physiological effects. It describes positions like supine, lithotomy, lateral, and prone. For each position, it details how positioning impacts cardiovascular and pulmonary function, as well as nerves that may be at risk of injury. Complications from prolonged use of each position are also reviewed. The document emphasizes the importance of careful patient positioning to balance surgical access needs with physiological stability and risk of pressure injuries.
Lower limb blocks
1) Lower limb nerve blocks provide post-operative pain relief and are safer than complete sympathectomy, though they are technically more difficult than upper limb blocks or central neuraxial blocks.
2) The lumbar and sacral plexuses give rise to various nerves that can be blocked individually or as combinations to anesthetize the lower limb, including the femoral, lateral femoral cutaneous, and obturator nerves.
3) The 3-in-1 block anesthetizes the femoral, obturator, and lateral femoral cutaneous nerves via a single injection into the femoral sheath above the inguinal ligament.
Total Intravenous Anaesthesia
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.
Breathing circuit's
The document discusses various paediatric breathing circuits used in anaesthesia. It describes the key components and classifications of breathing circuits. The most commonly used circuits include the Mapleson A (Magill) system, which is best for spontaneous breathing but requires high fresh gas flows. The Mapleson D and Bain circuits are efferent reservoir systems that work efficiently for controlled ventilation. The Ayre's T-piece is a simple no-valve circuit designed for paediatric use. The document provides details on the construction, functioning and advantages of these different breathing circuit designs.
Spinal & epidural needle
This document discusses the history and types of spinal and epidural needles. It begins by introducing regional anesthesia and the importance of needles. It then describes the development of spinal needles over time from Quincke's original design to modern pencil-point needles. Key spinal needle types including Quincke, Whitacre, and Sprotte are outlined. Epidural needles including Touhy and Crawford designs are also summarized. Complications related to needle placement are briefly mentioned. The document emphasizes that needle design modifications have improved techniques like spinal and epidural anesthesia.
Brachial plexus block
The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It provides innervation to the upper limb. The document describes the anatomy and formation of the brachial plexus in detail. It also discusses various techniques for brachial plexus block, including interscalene, supraclavicular, infraclavicular, and axillary approaches. Ultrasound guidance is recommended to visualize the relevant anatomy and spread of local anesthetic.
supraglottic airway devices
This document provides an overview of supraglottic airway devices. It discusses their history, classifications, indications, contraindications, complications and techniques. It describes some of the major devices including the Classic LMA, LMA Unique, Flexible LMA, LMA Fastrach, Air-Q, and LMA CTrach. Supraglottic devices are used to maintain airway patency and provide ventilation above the vocal cords. They have advantages over face masks and endotracheal tubes in certain situations but also have potential complications if not properly placed.
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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.
Patient positioning and anaesthetic consideration
This document discusses various surgical body positions and their physiological effects. It describes positions like supine, lithotomy, lateral, and prone. For each position, it details how positioning impacts cardiovascular and pulmonary function, as well as nerves that may be at risk of injury. Complications from prolonged use of each position are also reviewed. The document emphasizes the importance of careful patient positioning to balance surgical access needs with physiological stability and risk of pressure injuries.
Lower limb blocks
1) Lower limb nerve blocks provide post-operative pain relief and are safer than complete sympathectomy, though they are technically more difficult than upper limb blocks or central neuraxial blocks.
2) The lumbar and sacral plexuses give rise to various nerves that can be blocked individually or as combinations to anesthetize the lower limb, including the femoral, lateral femoral cutaneous, and obturator nerves.
3) The 3-in-1 block anesthetizes the femoral, obturator, and lateral femoral cutaneous nerves via a single injection into the femoral sheath above the inguinal ligament.
Total Intravenous Anaesthesia
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.
Breathing circuit's
The document discusses various paediatric breathing circuits used in anaesthesia. It describes the key components and classifications of breathing circuits. The most commonly used circuits include the Mapleson A (Magill) system, which is best for spontaneous breathing but requires high fresh gas flows. The Mapleson D and Bain circuits are efferent reservoir systems that work efficiently for controlled ventilation. The Ayre's T-piece is a simple no-valve circuit designed for paediatric use. The document provides details on the construction, functioning and advantages of these different breathing circuit designs.
Spinal & epidural needle
This document discusses the history and types of spinal and epidural needles. It begins by introducing regional anesthesia and the importance of needles. It then describes the development of spinal needles over time from Quincke's original design to modern pencil-point needles. Key spinal needle types including Quincke, Whitacre, and Sprotte are outlined. Epidural needles including Touhy and Crawford designs are also summarized. Complications related to needle placement are briefly mentioned. The document emphasizes that needle design modifications have improved techniques like spinal and epidural anesthesia.
Brachial plexus block
The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It provides innervation to the upper limb. The document describes the anatomy and formation of the brachial plexus in detail. It also discusses various techniques for brachial plexus block, including interscalene, supraclavicular, infraclavicular, and axillary approaches. Ultrasound guidance is recommended to visualize the relevant anatomy and spread of local anesthetic.
supraglottic airway devices
This document provides an overview of supraglottic airway devices. It discusses their history, classifications, indications, contraindications, complications and techniques. It describes some of the major devices including the Classic LMA, LMA Unique, Flexible LMA, LMA Fastrach, Air-Q, and LMA CTrach. Supraglottic devices are used to maintain airway patency and provide ventilation above the vocal cords. They have advantages over face masks and endotracheal tubes in certain situations but also have potential complications if not properly placed.
Truncal blocks.pptx
The seminar covered truncal blocks including abdominal wall blocks like transversus abdominis plane (TAP) block, rectus sheath block, and ilioinguinal/iliohypogastric nerve blocks as well as chest wall blocks such as serratus plane block, pectoral nerve blocks, thoracic paravertebral block, and intercostal blocks. Techniques like ultrasound-guided quadratus lumborum block and erector spinae block were also described along with relevant anatomy, indications, and potential complications of truncal blocks.
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One lung ventilation
One-lung ventilation (OLV) is used for thoracic surgeries to isolate one lung from the other. It requires skill to place lung isolation equipment like double-lumen endotracheal tubes (DLT) and prevent hypoxemia. DLTs have two lumens allowing independent ventilation of each lung. Placement is checked by auscultation and bronchoscopy to ensure proper position before surgery. Complications can include airway damage if the tube is malpositioned or overinflated. Careful technique and monitoring are needed for safe OLV.
Pre-oxygenation
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
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The document discusses different types of breathing systems used in anesthesia, including their components, principles of function, and classifications based on gas flow patterns and carbon dioxide elimination methods. Key systems described include the Mapleson A, B, C, and D circuits as well as the Bain system.
Low flow anaesthesia
This document discusses low flow anaesthesia. It defines low flow as 500-1000 ml/min of fresh gas flow. The document outlines the technical requirements for safely conducting low flow anaesthesia, including monitors for inspired oxygen, end tidal CO2 and anaesthetic concentrations. It describes the initiation, maintenance and emergence phases of low flow anaesthesia, emphasizing achieving and maintaining an appropriate anaesthetic depth. The document discusses advantages like reduced cost and pollution compared to higher fresh gas flows.
Caudal anesthesia
Caudal anesthesia involves needle penetration through the sacral hiatus into the sacral canal. In adults, the sacrum is a triangular bone formed from the fusion of five sacral vertebrae. It differs in neonates and infants due to delayed myelination and fusion of vertebrae. The sacral hiatus is wider in children, allowing easier identification and catheter insertion for caudal anesthesia. Regional techniques require lower approaches in pediatrics due to the lower termination of the spinal cord and dural sac.
Monitored anaesthesia care
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
Delayed recovery from anaesthesia.ppt
Delayed recovery from anesthesia can have multiple contributing factors and causes. It is important to consider potential drug interactions, metabolic abnormalities, and organic causes that may cause prolonged unconsciousness and have serious health implications. Signs and symptoms of metabolic issues may not present normally in an anesthetized patient. The Glasgow Coma Scale provides an objective measure of conscious state regardless of cause.
Monitoring depth of anesthesia
This document discusses various methods for monitoring the depth of anesthesia. It describes clinical techniques such as assessing autonomic responses and muscle movement. It also discusses pharmacological principles like minimum alveolar concentration for different anesthetic responses. Methods for monitoring brain electrical activity are outlined, including spontaneous EEG, compressed spectral analysis, bispectral index, and entropy monitors. Brain electrical activity monitors provide quantitative measures of anesthetic effect but can be influenced by other physiological factors. Overall, the document provides an overview of traditional and advanced techniques for assessing depth of anesthesia.
Gas laws in anaesthesia
The document discusses various gas laws and their applications in anesthesia and respiratory physiology. It begins by using Boyle's law to calculate the volume of oxygen remaining in a cylinder at a pressure of 15 psig. It then explains Charles, Gay-Lussac's, Avogadro's, Dalton's laws and their relevance. Further sections cover Hagen-Poiseuille's law, Reynolds number, Graham's law, Bernoulli's principle, Venturi effect, Coanda effect, critical temperature, Poynting effect, adiabatic changes, and other gas laws and their importance in areas like gas delivery, flow dynamics, and equipment function.
Central neuroaxial blockade
Neuraxial anesthesia involves injecting anesthetic medication into the epidural space surrounding the spinal cord or into the cerebrospinal fluid surrounding the spinal cord. This numbs the patient from the abdomen to the toes and can eliminate the need for general anesthesia. There are several types of neuraxial anesthesia including spinal, epidural and caudal blocks. Neuraxial anesthesia provides analgesia with less risk of respiratory depression compared to general anesthesia and limits surgical stress responses. Potential complications include hypotension, neurological issues, and post-dural puncture headache. Careful patient positioning and drug selection can affect the level and density of the resulting nerve block.
Neuraxial block
The document provides information on moderators and presenters for a discussion on neuraxial blocks. It then summarizes the history and types of neuraxial blocks including spinal and epidural anesthesia. Key details are provided on the anatomy related to neuraxial blocks including vertebrae, spinal cord, meninges, blood supply and cerebrospinal fluid. Advantages and disadvantages of regional anesthesia over general anesthesia are highlighted. Levels of blocks required for different surgeries and surface anatomy landmarks are outlined.
Baska mask
The document describes the Baska Mask, a new supraglottic airway device that aims to address limitations of existing laryngeal masks by having a smaller opening to reduce risk of aspiration, a tab to aid in placement, dual gastric channels for ventilation and suctioning, and a cuffless design that inflates with ventilation rather than requiring separate cuff inflation. Standard placement and removal techniques for the Baska Mask are provided.
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epidural anesthesia
This document discusses epidural anesthesia. Some key points:
- Epidural anesthesia allows for placement of a continuous catheter, which is useful for cases of unpredictable duration, prolonged postoperative analgesia, chronic pain control, and obstetric analgesia/anesthesia.
- Local anesthetics injected into the epidural space spread horizontally to nearby dermatomes and vertically in a preferentially cephalad direction.
- Factors affecting the level and spread of an epidural block include injection site, dose, volume, concentration, position, age, and speed of injection. Increasing dose and volume increases spread, while concentration mostly affects density.
- Onset is usually within 5 minutes, and peak
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This document provides an overview of the PEC I, PEC II, and serratus plane blocks. It describes the neural anatomy of the chest wall and how each block works. The PEC I blocks the lateral and medial pectoral nerves. The PEC II extends the block to also cover the T2-4 spinal nerves and long thoracic nerve. The serratus plane block covers the thoracodorsal and intercostal nerves laterally. Proper ultrasound identification of muscle planes and appropriate local anesthetic deposition are described for each block. Indications for each block depend on the extent of breast or chest wall surgery.
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This document summarizes the oxygen cascade from the atmosphere to tissues. It describes how oxygen partial pressure decreases stepwise from the lungs to mitochondria. Key points include how partial pressures, diffusion, hemoglobin binding, and the oxyhemoglobin dissociation curve influence oxygen delivery. Physiologic and pathologic factors that can shift the curve right or left, improving or impairing oxygen release, are also reviewed.
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Truncal blocks.pptx
The seminar covered truncal blocks including abdominal wall blocks like transversus abdominis plane (TAP) block, rectus sheath block, and ilioinguinal/iliohypogastric nerve blocks as well as chest wall blocks such as serratus plane block, pectoral nerve blocks, thoracic paravertebral block, and intercostal blocks. Techniques like ultrasound-guided quadratus lumborum block and erector spinae block were also described along with relevant anatomy, indications, and potential complications of truncal blocks.
Understanding Anesthesia Vaporizers
This document discusses various types of vaporizers used to deliver anesthetic gases. It begins with an overview of vaporizers, their classification, and the physics principles underlying their function. It then examines specific vaporizers in more detail, including the Goldman, Boyle's bottle, copper kettle, TEC, and EMO models. For each vaporizer, the document outlines their design, method of vaporization, temperature compensation, advantages and limitations. It focuses on key aspects such as safety, accuracy, and how various design features impact anesthetic delivery.
One lung ventilation
One-lung ventilation (OLV) is used for thoracic surgeries to isolate one lung from the other. It requires skill to place lung isolation equipment like double-lumen endotracheal tubes (DLT) and prevent hypoxemia. DLTs have two lumens allowing independent ventilation of each lung. Placement is checked by auscultation and bronchoscopy to ensure proper position before surgery. Complications can include airway damage if the tube is malpositioned or overinflated. Careful technique and monitoring are needed for safe OLV.
Pre-oxygenation
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
Anaesthesia breathing systems
The document discusses different types of breathing systems used in anesthesia, including their components, principles of function, and classifications based on gas flow patterns and carbon dioxide elimination methods. Key systems described include the Mapleson A, B, C, and D circuits as well as the Bain system.
Low flow anaesthesia
This document discusses low flow anaesthesia. It defines low flow as 500-1000 ml/min of fresh gas flow. The document outlines the technical requirements for safely conducting low flow anaesthesia, including monitors for inspired oxygen, end tidal CO2 and anaesthetic concentrations. It describes the initiation, maintenance and emergence phases of low flow anaesthesia, emphasizing achieving and maintaining an appropriate anaesthetic depth. The document discusses advantages like reduced cost and pollution compared to higher fresh gas flows.
Caudal anesthesia
Caudal anesthesia involves needle penetration through the sacral hiatus into the sacral canal. In adults, the sacrum is a triangular bone formed from the fusion of five sacral vertebrae. It differs in neonates and infants due to delayed myelination and fusion of vertebrae. The sacral hiatus is wider in children, allowing easier identification and catheter insertion for caudal anesthesia. Regional techniques require lower approaches in pediatrics due to the lower termination of the spinal cord and dural sac.
Monitored anaesthesia care
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
Delayed recovery from anaesthesia.ppt
Delayed recovery from anesthesia can have multiple contributing factors and causes. It is important to consider potential drug interactions, metabolic abnormalities, and organic causes that may cause prolonged unconsciousness and have serious health implications. Signs and symptoms of metabolic issues may not present normally in an anesthetized patient. The Glasgow Coma Scale provides an objective measure of conscious state regardless of cause.
Monitoring depth of anesthesia
This document discusses various methods for monitoring the depth of anesthesia. It describes clinical techniques such as assessing autonomic responses and muscle movement. It also discusses pharmacological principles like minimum alveolar concentration for different anesthetic responses. Methods for monitoring brain electrical activity are outlined, including spontaneous EEG, compressed spectral analysis, bispectral index, and entropy monitors. Brain electrical activity monitors provide quantitative measures of anesthetic effect but can be influenced by other physiological factors. Overall, the document provides an overview of traditional and advanced techniques for assessing depth of anesthesia.
Gas laws in anaesthesia
The document discusses various gas laws and their applications in anesthesia and respiratory physiology. It begins by using Boyle's law to calculate the volume of oxygen remaining in a cylinder at a pressure of 15 psig. It then explains Charles, Gay-Lussac's, Avogadro's, Dalton's laws and their relevance. Further sections cover Hagen-Poiseuille's law, Reynolds number, Graham's law, Bernoulli's principle, Venturi effect, Coanda effect, critical temperature, Poynting effect, adiabatic changes, and other gas laws and their importance in areas like gas delivery, flow dynamics, and equipment function.
Central neuroaxial blockade
Neuraxial anesthesia involves injecting anesthetic medication into the epidural space surrounding the spinal cord or into the cerebrospinal fluid surrounding the spinal cord. This numbs the patient from the abdomen to the toes and can eliminate the need for general anesthesia. There are several types of neuraxial anesthesia including spinal, epidural and caudal blocks. Neuraxial anesthesia provides analgesia with less risk of respiratory depression compared to general anesthesia and limits surgical stress responses. Potential complications include hypotension, neurological issues, and post-dural puncture headache. Careful patient positioning and drug selection can affect the level and density of the resulting nerve block.
Neuraxial block
The document provides information on moderators and presenters for a discussion on neuraxial blocks. It then summarizes the history and types of neuraxial blocks including spinal and epidural anesthesia. Key details are provided on the anatomy related to neuraxial blocks including vertebrae, spinal cord, meninges, blood supply and cerebrospinal fluid. Advantages and disadvantages of regional anesthesia over general anesthesia are highlighted. Levels of blocks required for different surgeries and surface anatomy landmarks are outlined.
Baska mask
The document describes the Baska Mask, a new supraglottic airway device that aims to address limitations of existing laryngeal masks by having a smaller opening to reduce risk of aspiration, a tab to aid in placement, dual gastric channels for ventilation and suctioning, and a cuffless design that inflates with ventilation rather than requiring separate cuff inflation. Standard placement and removal techniques for the Baska Mask are provided.
Management of Bronchospasm during General Anaesthesia
This was presented in the journal club at JNMC, Belagavi. This is based on an article by Alex Looseley.
epidural anesthesia
This document discusses epidural anesthesia. Some key points:
- Epidural anesthesia allows for placement of a continuous catheter, which is useful for cases of unpredictable duration, prolonged postoperative analgesia, chronic pain control, and obstetric analgesia/anesthesia.
- Local anesthetics injected into the epidural space spread horizontally to nearby dermatomes and vertically in a preferentially cephalad direction.
- Factors affecting the level and spread of an epidural block include injection site, dose, volume, concentration, position, age, and speed of injection. Increasing dose and volume increases spread, while concentration mostly affects density.
- Onset is usually within 5 minutes, and peak
Pec I and PECS II, serratus anterior block
This document provides an overview of the PEC I, PEC II, and serratus plane blocks. It describes the neural anatomy of the chest wall and how each block works. The PEC I blocks the lateral and medial pectoral nerves. The PEC II extends the block to also cover the T2-4 spinal nerves and long thoracic nerve. The serratus plane block covers the thoracodorsal and intercostal nerves laterally. Proper ultrasound identification of muscle planes and appropriate local anesthetic deposition are described for each block. Indications for each block depend on the extent of breast or chest wall surgery.
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O2 cascade flux n odc
This document summarizes the oxygen cascade from the atmosphere to tissues. It describes how oxygen partial pressure decreases stepwise from the lungs to mitochondria. Key points include how partial pressures, diffusion, hemoglobin binding, and the oxyhemoglobin dissociation curve influence oxygen delivery. Physiologic and pathologic factors that can shift the curve right or left, improving or impairing oxygen release, are also reviewed.
anaesthesia Breathing circuits and its classification and functional analysis
anaesthesia breathing circuits. mapleson circuits. classification of circuits. functional analysia of circuits. draw over circuit. advantages and disadvantages of different circuits.
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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.
Regional anesthesia
Regional anesthesia can be divided into neuraxial blocks and peripheral nerve blocks. Neuraxial blocks include subarachnoid, epidural and caudal anesthesia. Neuraxial blocks have specific anatomy, indications, contraindications, safety precautions, equipment, and techniques that must be followed. The document outlines the key anatomical structures involved in neuraxial blocks, when they are indicated, potential risks, how to prepare the patient, types of needles used, and proper positioning and aseptic techniques.
Regional Anesthesia
Regional anesthesia is a technique that induces loss of sensation in part of the body using local anesthetics. It has benefits like lower costs, high patient satisfaction, and decreased risks of DVT and PE compared to general anesthesia. However, it requires skills and may cause issues like hypotension. The main types are topical, intravenous, peripheral nerve blocks, plexus blocks, and neuro-axial blocks. Regional anesthesia can provide anesthesia for surgery, post-op analgesia, or chronic pain treatment. Factors like the anesthetic used, patient position, and injection speed affect its spread. Spinal and epidural blocks involve injecting anesthetic into the subarachnoid or epidural space and have risks like anaphyl
Adjuncts to local anesthetics
This document discusses common adjuncts and additives used with local anesthetics for nerve blocks and spinal anesthesia. It describes how epinephrine prolongs the duration and intensity of nerve blocks by causing vasoconstriction. Alkalinization can increase the effectiveness of local anesthetics but risks of precipitation limit its usefulness. Opioids and alpha-2 adrenergic agonists provide analgesic effects when added to local anesthetics by binding to receptors in the spinal cord. Fentanyl and morphine are commonly used opioid adjuncts. Dexamethasone may also prolong the duration of local anesthetic nerve blocks when used, though the mechanism is unknown.
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Xenon is a gaseous anesthetic agent with several potential advantages over traditional inhaled anesthetics. It has minimal environmental impact, provides cardiovascular stability, and may have neuroprotective and renoprotective effects. Studies in animal models and some human trials suggest xenon can reduce neuronal injury from ischemia and hypoxia. It also appears to reduce delayed graft function in renal transplant patients. However, xenon is very expensive compared to other agents. Further research is still needed to fully evaluate its clinical benefits and cost-effectiveness.
Diagnosis and treatment of carcinoma of larynx by nitesh Kr.
The document discusses the diagnosis and clinical features of laryngeal cancer. It outlines the various steps involved in diagnosis which include collecting a history, physical examination, laryngoscopy, endoscopy, biopsy, radiological imaging and staging. Specific symptoms associated with glottic, supraglottic and subglottic cancers are provided. Treatment options discussed include radiotherapy, conservative and total laryngectomy surgery, and combined therapy. Complications, disabilities after total laryngectomy and vocal rehabilitation methods are also summarized.
Preemptive analgesia
Preemptive analgesia is an antinociceptive treatment that prevents the establishment of altered processing of afferent input which amplifies postoperative pain. It was first formulated by Crile who advocated regional blocks in addition to general anesthesia to prevent intraoperative nociception and formation of painful scars. There are three definitions of preemptive analgesia: treatment starting before surgery to prevent central sensitization caused by incisional injury; treatment preventing central sensitization caused by incisional and inflammatory injuries; and treatment covering the period of surgery and initial postoperative period. While some studies found no difference between preincisional and postincisional treatment, others reported modest benefits with preincisional analgesia.
Peripheral nerve blocks
Peripheral nerve blocks are gaining popularity for pain management due to advantages like less nausea, hemodynamic stability, and ability to perform surgery in patients with cardiovascular or bleeding risks. Specific nerve blocks include interscalene, supraclavicular, infraclavicular, axillary, and others. Ultrasound is often used to identify nerves and nearby structures before injection of local anesthetic, allowing effective pain relief with fewer side effects compared to general or epidural anesthesia. Proper technique and understanding of anatomy are required to perform safe and effective peripheral nerve blocks.
Forearm fractures
The document discusses the anatomy and classification of forearm fractures. It describes the radius and ulna bones of the forearm and their articulations. Forearm fractures can be classified as proximal, middle, or distal, and can affect one or both bones. Common types include radial shaft fractures, Galeazzi fractures, and Monteggia's fractures. Assessment involves neurovascular and range of motion exams. Treatment depends on the fracture type but may include immobilization, closed reduction, open reduction and internal fixation, or external fixation.
ANAESTHETIC CONSIDERATIONS IN AIDS PATIENTS
1) HIV/AIDS patients present special challenges for anesthesia due to the virus' effects on multiple body systems and interactions with antiretroviral drugs.
2) Evaluation of patients should assess organ involvement and potential for drug interactions. Anesthetic plans must be tailored to individual patients while minimizing interruptions to antiretroviral therapy.
3) Strict universal precautions including protective equipment, careful handling of sharps and contaminated materials, and safety equipment help minimize risk of infection to hospital staff from needle sticks or exposure to bodily fluids.
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Diagnosis and treatment of carcinoma of larynx by nitesh Kr.
Diagnosis and treatment of carcinoma of larynx by nitesh Kr.
More from Dr. Shaheer Haider
Perioperative EKG in Cardiothoracic Anesthesia
1. The document discusses various abnormalities that can be seen on preoperative electrocardiograms (EKGs), including chamber hypertrophies, conduction defects, arrhythmias, and signs of ischemia/infarction.
2. Chamber hypertrophies covered include left and right atrial and ventricular hypertrophies, each with characteristic EKG patterns.
3. Conduction defects discussed are right and left bundle branch blocks, along with their typical EKG presentations and common causes.
Enteral nutrition finall
The document provides information on calculating calorie requirements, indications for tube feeding, types of enteral formulas, methods of enteral feeding administration, and potential complications. It discusses formulas for different clinical conditions including renal, hepatic, diabetic and pulmonary. Continuous and bolus feeding methods are described. Common gastrointestinal complications like diarrhea, constipation and nausea are outlined along with potential causes and treatments. Electrolyte imbalances from enteral feeding and their management are also summarized.
Anaesthetic plan
This document outlines an anesthetic plan with sections discussing the case scenario, anesthetic concerns, preoperative management, monitoring standards, choice of anesthesia, drugs and dosages, intraoperative fluids, airway management, maintenance, postanesthesia plan, and postop pain management. However, most of the document consists of blank fields to be filled in, so it does not provide much contextual information on its own.
Thyroid disease in pregnancy
This document summarizes thyroid disease in pregnancy. It discusses how thyroid function changes normally during pregnancy, with relative iodine deficiency and increased levels of thyroid binding globulin and T4 in early gestation. It notes that hyperthyroidism in pregnancy is usually caused by Graves' disease. Left untreated, it can lead to risks for both mother and fetus, including heart failure, thyroid storm, growth restriction and preterm labor. Management involves achieving an euthyroid state through medications like thionamides or propranolol, with close monitoring of thyroid function tests during pregnancy and treatment of any thyroid storm that may occur during labor and delivery.
Pv loops
The document discusses three key determinants of cardiac output: preload, afterload, and contractility. Preload refers to the presystolic stretch of the heart and is reflected by the end-diastolic pressure and volume. Afterload is the pressure the left ventricle must overcome during systole and is often represented by systolic pressure. Contractility determines the strength of the heart's contraction and can be measured by the left ventricular ejection fraction.
Postop carotid endarterectomy
The document provides guidelines for postoperative care after carotid endarterectomy, noting that patients should be closely monitored for complications like hypertension, hypotension, hematoma, and cardiac issues in the first 48 hours after surgery. It also discusses potential complications like hyperperfusion syndrome, intracerebral hemorrhage, and seizures that require strict blood pressure control. The guidelines emphasize vigilant monitoring and management of hemodynamics and neurological symptoms in the postoperative period to optimize outcomes and prevent complications.
Evidence Based Medicine (Anesthesiology)
1. The document provides guidelines from the American Society of Anesthesiologists for managing difficult airways. It defines different types of difficult airways and levels of evidence for various airway management techniques.
2. Key recommendations include conducting an airway evaluation, preparing basic airway equipment, having a pre-planned intubation strategy with non-invasive options, considering awake versus induced intubation, and careful planning for extubation with criteria for awake versus induced extubation.
3. The guidelines provide evidence-based recommendations for each step of difficult airway management - evaluation, preparation, intubation strategy, extubation strategy, and follow-up care - to assist anesthesiologists in decision-making.
Recognition And Management Of Difficult Airway
This document discusses recognition and management of difficult airways. It defines difficult airway as difficulty with mask ventilation or tracheal intubation. It discusses incidence, risk factors, assessment techniques like Mallampati classification and thyromental distance, and management strategies including awake intubation, use of airway adjuncts like LMA, and the ASA difficult airway algorithm which provides a structured approach. The key points are assessing risk factors, having proper equipment and backup plans, and pursuing oxygenation throughout management of a difficult airway.
B R A I N D E A T H
The document discusses brain death, its diagnosis and pathophysiology. It defines brain death as the complete and irreversible loss of brain function. The diagnosis involves meeting strict clinical criteria demonstrating the absence of brainstem reflexes as well as confirmatory tests like EEG. Brain death results in no prospect of survival without life support or recovery of brain function. Proper diagnosis is important for organ donation where brain death constitutes legal death.
Anti Coagulation In Pregnancy
1) The patient requires careful management of anticoagulation for her mechanical heart valve during pregnancy and delivery. She should receive adjusted-dose low molecular weight heparin throughout pregnancy.
2) A regional anesthetic technique could be used for her planned c-section, but her coagulation status and platelet count must be checked closely both before and after the procedure due to her anticoagulation.
3) After delivery, she will need to resume anticoagulation while monitoring closely for any signs of spinal hematoma due to her recent regional block and anticoagulated state.
S C O L I O S I S
Scoliosis can cause restrictive lung defects, ventilation-perfusion mismatch, and hypoxemia due to thoracic deformity. It can also involve the cardiovascular system by raising right heart pressures or causing mitral valve prolapse. Careful pre-anesthetic evaluation should assess the respiratory, cardiovascular, and neurological systems. Intraoperatively, temperature, fluids, positioning, spinal cord monitoring, and blood conservation are important considerations, as is post-operative respiratory therapy and pain management.
Patient Ventilator Synchrony & Successful Weaning講義
This document discusses patient-ventilator synchrony and successful weaning. It defines weaning as the gradual decrease of ventilatory support to prepare for extubation. Optimal synchrony depends on factors like trigger sensitivity, ventilator response time, appropriate tidal volume, and complete expiration to minimize work of breathing. Various ventilator modes and settings can be adjusted to improve synchrony and reduce the risk of reintubation during weaning and extubation.
Optimal Patient Vent Synchrony
This document discusses obtaining optimal patient-ventilator synchrony. It describes three phases of patient-ventilator interaction: triggering, breath delivery, and cycling. Trigger asynchrony can occur if the ventilator does not respond quickly enough to the patient's effort. Breath delivery asynchrony may happen if the ventilator does not provide enough flow. Cycling asynchrony can result if the neural inspiration time does not match the mechanical inspiration time. The document provides tips for recognizing and addressing asynchrony issues, such as adjusting ventilator settings and modes. The overall goal is to minimize patient discomfort and optimize lung protection and recovery.
Interpretation Of Arterial Blood Gas
This document provides information about interpreting arterial blood gases, including:
1. It discusses acid-base balance and how the respiratory and renal systems work to maintain pH.
2. It describes the four main acid-base disorders: respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis.
3. It explains how to interpret the components of an arterial blood gas like pH, PaCO2, PaO2, and bicarbonate levels.
Sepsis Guidelines 2007
Early recognition and treatment of sepsis is important to improve outcomes. The guidelines recommend initially evaluating airway, breathing, and circulation. Goals of early resuscitation include restoring central venous pressure, blood pressure, urine output, and central venous oxygen saturation through aggressive fluid administration and vasopressors if needed within 6 hours of recognition. Intravenous antibiotics should also be administered within 1 hour, and cultures obtained, to treat the underlying infection.
Obesity
This document provides clinical guidelines for the identification, evaluation, and treatment of overweight and obesity in adults. An expert panel was convened by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases to develop the guidelines based on a thorough review of scientific evidence. The guidelines examine the health risks of overweight and obesity and various treatment strategies, providing recommendations to help practitioners effectively assess and treat overweight and obese patients.
P R E G N A N C Y I N D U C E D H Y P E R T E N S I O N
Pregnancy-induced hypertension (PIH) is defined as new hypertension developing after 20 weeks of gestation. It affects 5-8% of pregnancies and can range from mild to severe, including pre-eclampsia and eclampsia. The exact cause is unknown but may involve immunological and endothelial dysfunction factors. Treatment aims to prevent complications and involves bed rest, magnesium sulfate, antihypertensive drugs, and delivery if gestation reaches term or the mother/baby's condition deteriorates.
P O N V
An anxious 52-year-old man is presenting for revision of a previous tympano-mastoidectomy surgery. He has a history of postoperative nausea and vomiting after prior procedures. Monitored anesthesia care with sedation may be suitable for this patient's surgery given his anxiety. General anesthetic techniques that minimize postoperative nausea and vomiting risks include the use of antiemetics like ondansetron and dexamethasone. Regional anesthesia may further reduce postoperative nausea and vomiting risks compared to general anesthesia. Control of blood loss is important during middle ear surgery to maintain a bloodless surgical field. Long-acting neuromuscular blocking agents should be avoided due to the delicate nature of middle ear surgery.
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Patient Ventilator Synchrony & Successful Weaning講義
Patient Ventilator Synchrony & Successful Weaning講義
P R E G N A N C Y I N D U C E D H Y P E R T E N S I O N
P R E G N A N C Y I N D U C E D H Y P E R T E N S I O N