Introduction to Regional
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Regional anesthesia involves administering local anesthetics near nerves to block pain signals from specific parts of the body. There are several types including neuraxial blocks like epidurals and spinals that involve the spinal canal, and peripheral nerve blocks that target individual nerves. Regional anesthesia has advantages like reduced blood loss and postoperative complications compared to general anesthesia, though placement can be difficult and side effects like hypotension are possible. Proper technique and monitoring are needed to avoid complications.
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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
Regional anesthesia
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
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
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.
Intravenous induction agents
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
Difficult airway
The document discusses the difficult airway, including its definition, causes, assessment, and management. It defines difficult ventilation and difficult intubation. Causes can be related to the anesthesiologist, equipment, or patient factors like congenital syndromes or acquired conditions. Assessment involves history, physical exam including airway indices like Mallampati score, and radiologic evaluation. Management includes preparing a difficult airway cart and having alternate plans for securing the airway.
Spinal anesthesia (Anatomy and Pharmacology)
This document discusses spinal anesthesia anatomy, pharmacology, and techniques. It covers spinal cord and epidural space anatomy, spinal artery and vein anatomy, and anatomical variations. It discusses the classification, properties, doses, and durations of various local anesthetics used for spinal anesthesia including short, intermediate, and long-acting agents. It also covers spinal anesthetic additives like opioids, and vasoconstrictors and their effects.
Monitoring depth of anaesthesia
This document provides an overview of monitoring depth of anesthesia. It discusses the aims of monitoring to ensure patient safety and prevent awareness during surgery. It reviews the historical background of defining anesthesia stages. Modern concepts view anesthesia as a complex interaction between stimuli, patient responses, and drug-induced effects. Factors like patient characteristics, drug combinations, and surgery duration impact correct drug dosing. Memory is gradually impaired with deeper anesthesia levels before autonomic responses. The document outlines stages of awareness and discusses specific drugs' relationships to anesthesia depth.
Recommended
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
Regional anesthesia
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
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
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.
Intravenous induction agents
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
Difficult airway
The document discusses the difficult airway, including its definition, causes, assessment, and management. It defines difficult ventilation and difficult intubation. Causes can be related to the anesthesiologist, equipment, or patient factors like congenital syndromes or acquired conditions. Assessment involves history, physical exam including airway indices like Mallampati score, and radiologic evaluation. Management includes preparing a difficult airway cart and having alternate plans for securing the airway.
Spinal anesthesia (Anatomy and Pharmacology)
This document discusses spinal anesthesia anatomy, pharmacology, and techniques. It covers spinal cord and epidural space anatomy, spinal artery and vein anatomy, and anatomical variations. It discusses the classification, properties, doses, and durations of various local anesthetics used for spinal anesthesia including short, intermediate, and long-acting agents. It also covers spinal anesthetic additives like opioids, and vasoconstrictors and their effects.
Monitoring depth of anaesthesia
This document provides an overview of monitoring depth of anesthesia. It discusses the aims of monitoring to ensure patient safety and prevent awareness during surgery. It reviews the historical background of defining anesthesia stages. Modern concepts view anesthesia as a complex interaction between stimuli, patient responses, and drug-induced effects. Factors like patient characteristics, drug combinations, and surgery duration impact correct drug dosing. Memory is gradually impaired with deeper anesthesia levels before autonomic responses. The document outlines stages of awareness and discusses specific drugs' relationships to anesthesia depth.
Rapid Sequence Induction & Intubation
Rapid sequence induction and intubation (RSII) is a technique used to minimize the risk of pulmonary aspiration by rapidly inducing unconsciousness and paralysis before intubating the trachea. Key elements of RSII include pre-oxygenating the patient, administering sedative and neuromuscular blocking agents to quickly induce unconsciousness and paralysis, applying cricoid pressure, and promptly intubating the trachea with minimal ventilation. Indications for RSII include patients with full stomachs or gastrointestinal pathology who are at higher risk of aspiration. Contraindications include total airway obstruction or loss of airway landmarks. Potential complications include difficult or failed airway, hypoxia, hypotension,
NON OPERATING ROOM ANAESTHESIA
This document discusses non-operating room anesthesia (NORA). It begins by defining NORA as anesthesia provided outside the operating room, such as in radiology, endoscopy suites, MRI, and dental clinics. It then outlines a three step approach to NORA involving thorough patient assessment, appropriate monitoring and anesthesia care, and post-procedure management. Several ASA guidelines for equipment and facilities in NORA locations are also reviewed. Complications associated with NORA and special considerations for procedures like X-rays, MRIs, and IV contrast administration are discussed. The document emphasizes choosing anesthesia techniques based on patient factors and needs for each specific non-operating room procedure.
Spinal Anaesthesia. by Dr. Shailendra
Spinal anaesthesia involves injecting local anaesthetic into the cerebrospinal fluid surrounding the spinal cord. A brief history was provided including the discovery of cerebrospinal fluid in the 1700s and the first planned spinal anaesthesia on a human in 1891. Key anatomy was discussed including the levels of the spinal cord and vertebrae. Common local anaesthetics used for spinal anaesthesia like bupivacaine and ropivacaine were listed along with typical dosages. Factors affecting the level of spinal block were summarized.
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.
Regional anesthesia
Dr. Suhas presented on regional anesthesia techniques. The presentation covered spinal and epidural anatomy, techniques for administering spinal and epidural blocks, factors affecting the level and duration of blocks, potential complications and their treatment, and applications of regional techniques for different procedures. Key points included identifying spinal landmarks, administration procedures to avoid complications like high blocks, and managing issues like post-dural puncture headache.
Anaesthesia for neurosurgery
This document discusses anesthesia considerations for neurosurgery patients. It covers common neurosurgical procedures, intracranial hypertension, cerebral edema, and the goals of anesthesia which include maintaining stable intracranial pressure and hemodynamics. It then focuses on anesthesia management for patients undergoing craniotomy for mass lesions, including preoperative evaluation and preparation, induction, maintenance with goals of optimal surgical conditions and neurological protection, and controlled emergence.
Spinal anesthesia
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
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.
Obstetric anaesthesia
This document provides an outline and overview of key topics in obstetric anesthesia. It discusses the physiological changes that occur during pregnancy and how they impact anesthesia care. Specific areas covered include analgesia and anesthesia techniques for labor, cesarean delivery, and high-risk obstetric emergencies. Fetal monitoring and considerations for providing anesthesia for non-obstetric surgeries during pregnancy are also summarized. The document aims to educate anesthetists on understanding pregnancy physiology and its implications for safe anesthesia care during labor, delivery, and other procedures.
Anaesthesia machine
The anesthesia machine delivers precise gas mixtures including oxygen and anesthetic gases. Newer machines have advanced ventilators and electronic components compared to older models. An anesthesia workstation integrates components like gas cylinders, flow meters, ventilators into a single unit. Key components include pressure regulators, flow meters, and safety features to prevent gas shortage or hypoxic mixtures from being delivered. Modern machines use digital displays and computer controls for improved monitoring and safety.
Premedication
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
Supraglottic airway device
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
Safety features in anesthesia machine
The 2000 ASTM F1850-00 standard states that anesthesia gas supply devices must be designed so that whenever oxygen supply pressure is reduced below the manufacturer's minimum specification, the delivered oxygen concentration does not decrease below 19% at the common gas outlet. The standard also requires alarms to sound within 5 seconds if oxygen supply pressure falls below approximately 200 kPa. Safety features of anesthesia machines include oxygen/nitrous oxide proportioning systems, oxygen failure safety devices, oxygen supply failure alarms, and vaporizer interlocks.
Anaesthesia for LSCS
Regional anesthesia such as spinal or epidural anesthesia is preferred over general anesthesia for cesarean sections due to lower risks for both mother and baby. Spinal anesthesia provides rapid onset but a finite duration, while epidural anesthesia allows for gradual onset and better control of sensory levels via a catheter. Both techniques require careful management of hypotension through fluid administration and vasopressors. Neuraxial opioids can enhance analgesia without negatively impacting the neonate. The goals are to provide adequate anesthesia and analgesia for surgery and postoperatively while maximizing safety for mother and baby.
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.
Perioperative fluid therapy
This document discusses perioperative fluid therapy. It covers topics such as total body water, fluid compartments, preoperative fluid status evaluation, intravenous fluids including crystalloids like normal saline and lactated ringer's solution and colloids like albumin, gelatin and hydroxyethyl starches. It provides guidelines on calculating fluid requirements including maintenance fluids, deficits, third spacing losses and blood loss replacement. The document emphasizes using crystalloids over colloids for resuscitation and limiting colloid volumes due to lack of evidence for their continued use in acute illness.
Anesthesia awareness
Anesthesia awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and has recall of events. The incidence is 0.1-0.2% but higher for certain procedures like cardiac surgery. Patients at risk include women, those under 60, long surgeries, and prior awareness. Causes include light anesthesia, increased anesthetic requirements, and equipment errors. Patients commonly recall sounds and paralysis. Aftereffects may include PTSD. Prevention strategies include preoperative evaluation, proper equipment use, and intraoperative monitoring like BIS monitoring to maintain anesthesia levels.
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.
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.
Anaesthesia for laparoscopic surgeries
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
5 regional anesthesia
The document discusses the history and current use of spinal, epidural, and caudal anesthesia. It provides details on:
1) The key developments in these techniques from 1885 to present day and their current role in veterinary and human anesthesia.
2) The indications, contraindications, and complications of these regional anesthesia techniques.
3) The local anesthetics, opioids, and other agents used and their mechanisms of action, dosages, durations, and side effects.
4) Techniques for administering spinal, epidural, and caudal anesthesia including needle selection, injection procedures, and postoperative care.
Spinal anesthesia
This document provides information on spinal anesthesia techniques. It begins with a brief history of spinal anesthesia dating back to 1885. It then covers topics such as indications, contraindications, preoperative evaluation, techniques, complications and their management. Specific details are provided on patient positioning, identifying anatomical landmarks, different needle approaches, administering anesthetic solutions and factors affecting spinal block height. The document aims to guide practitioners on safe and effective spinal anesthesia procedures.
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Rapid Sequence Induction & Intubation
Rapid sequence induction and intubation (RSII) is a technique used to minimize the risk of pulmonary aspiration by rapidly inducing unconsciousness and paralysis before intubating the trachea. Key elements of RSII include pre-oxygenating the patient, administering sedative and neuromuscular blocking agents to quickly induce unconsciousness and paralysis, applying cricoid pressure, and promptly intubating the trachea with minimal ventilation. Indications for RSII include patients with full stomachs or gastrointestinal pathology who are at higher risk of aspiration. Contraindications include total airway obstruction or loss of airway landmarks. Potential complications include difficult or failed airway, hypoxia, hypotension,
NON OPERATING ROOM ANAESTHESIA
This document discusses non-operating room anesthesia (NORA). It begins by defining NORA as anesthesia provided outside the operating room, such as in radiology, endoscopy suites, MRI, and dental clinics. It then outlines a three step approach to NORA involving thorough patient assessment, appropriate monitoring and anesthesia care, and post-procedure management. Several ASA guidelines for equipment and facilities in NORA locations are also reviewed. Complications associated with NORA and special considerations for procedures like X-rays, MRIs, and IV contrast administration are discussed. The document emphasizes choosing anesthesia techniques based on patient factors and needs for each specific non-operating room procedure.
Spinal Anaesthesia. by Dr. Shailendra
Spinal anaesthesia involves injecting local anaesthetic into the cerebrospinal fluid surrounding the spinal cord. A brief history was provided including the discovery of cerebrospinal fluid in the 1700s and the first planned spinal anaesthesia on a human in 1891. Key anatomy was discussed including the levels of the spinal cord and vertebrae. Common local anaesthetics used for spinal anaesthesia like bupivacaine and ropivacaine were listed along with typical dosages. Factors affecting the level of spinal block were summarized.
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.
Regional anesthesia
Dr. Suhas presented on regional anesthesia techniques. The presentation covered spinal and epidural anatomy, techniques for administering spinal and epidural blocks, factors affecting the level and duration of blocks, potential complications and their treatment, and applications of regional techniques for different procedures. Key points included identifying spinal landmarks, administration procedures to avoid complications like high blocks, and managing issues like post-dural puncture headache.
Anaesthesia for neurosurgery
This document discusses anesthesia considerations for neurosurgery patients. It covers common neurosurgical procedures, intracranial hypertension, cerebral edema, and the goals of anesthesia which include maintaining stable intracranial pressure and hemodynamics. It then focuses on anesthesia management for patients undergoing craniotomy for mass lesions, including preoperative evaluation and preparation, induction, maintenance with goals of optimal surgical conditions and neurological protection, and controlled emergence.
Spinal anesthesia
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
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.
Obstetric anaesthesia
This document provides an outline and overview of key topics in obstetric anesthesia. It discusses the physiological changes that occur during pregnancy and how they impact anesthesia care. Specific areas covered include analgesia and anesthesia techniques for labor, cesarean delivery, and high-risk obstetric emergencies. Fetal monitoring and considerations for providing anesthesia for non-obstetric surgeries during pregnancy are also summarized. The document aims to educate anesthetists on understanding pregnancy physiology and its implications for safe anesthesia care during labor, delivery, and other procedures.
Anaesthesia machine
The anesthesia machine delivers precise gas mixtures including oxygen and anesthetic gases. Newer machines have advanced ventilators and electronic components compared to older models. An anesthesia workstation integrates components like gas cylinders, flow meters, ventilators into a single unit. Key components include pressure regulators, flow meters, and safety features to prevent gas shortage or hypoxic mixtures from being delivered. Modern machines use digital displays and computer controls for improved monitoring and safety.
Premedication
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
Supraglottic airway device
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
Safety features in anesthesia machine
The 2000 ASTM F1850-00 standard states that anesthesia gas supply devices must be designed so that whenever oxygen supply pressure is reduced below the manufacturer's minimum specification, the delivered oxygen concentration does not decrease below 19% at the common gas outlet. The standard also requires alarms to sound within 5 seconds if oxygen supply pressure falls below approximately 200 kPa. Safety features of anesthesia machines include oxygen/nitrous oxide proportioning systems, oxygen failure safety devices, oxygen supply failure alarms, and vaporizer interlocks.
Anaesthesia for LSCS
Regional anesthesia such as spinal or epidural anesthesia is preferred over general anesthesia for cesarean sections due to lower risks for both mother and baby. Spinal anesthesia provides rapid onset but a finite duration, while epidural anesthesia allows for gradual onset and better control of sensory levels via a catheter. Both techniques require careful management of hypotension through fluid administration and vasopressors. Neuraxial opioids can enhance analgesia without negatively impacting the neonate. The goals are to provide adequate anesthesia and analgesia for surgery and postoperatively while maximizing safety for mother and baby.
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.
Perioperative fluid therapy
This document discusses perioperative fluid therapy. It covers topics such as total body water, fluid compartments, preoperative fluid status evaluation, intravenous fluids including crystalloids like normal saline and lactated ringer's solution and colloids like albumin, gelatin and hydroxyethyl starches. It provides guidelines on calculating fluid requirements including maintenance fluids, deficits, third spacing losses and blood loss replacement. The document emphasizes using crystalloids over colloids for resuscitation and limiting colloid volumes due to lack of evidence for their continued use in acute illness.
Anesthesia awareness
Anesthesia awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and has recall of events. The incidence is 0.1-0.2% but higher for certain procedures like cardiac surgery. Patients at risk include women, those under 60, long surgeries, and prior awareness. Causes include light anesthesia, increased anesthetic requirements, and equipment errors. Patients commonly recall sounds and paralysis. Aftereffects may include PTSD. Prevention strategies include preoperative evaluation, proper equipment use, and intraoperative monitoring like BIS monitoring to maintain anesthesia levels.
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.
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.
Anaesthesia for laparoscopic surgeries
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
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The document discusses the history and current use of spinal, epidural, and caudal anesthesia. It provides details on:
1) The key developments in these techniques from 1885 to present day and their current role in veterinary and human anesthesia.
2) The indications, contraindications, and complications of these regional anesthesia techniques.
3) The local anesthetics, opioids, and other agents used and their mechanisms of action, dosages, durations, and side effects.
4) Techniques for administering spinal, epidural, and caudal anesthesia including needle selection, injection procedures, and postoperative care.
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2. For the femoral nerve block, the femoral nerve is blocked just lateral to the femoral artery in the femoral triangle. For the sciatic nerve block, the nerve can be blocked at various levels including the gluteal region, popliteal fossa, and ankle.
3. Patient positioning and sedation are important considerations for each block. Ultrasound guidance can be used to identify the target nerves and ensure accurate needle placement.
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Ultrasound Guided Regional Anesthesia
1. The document describes ultrasound guided regional anesthesia techniques for the upper and lower extremities. It covers anatomy, pharmacology, physics of ultrasound, and specific nerve block procedures for the arms, legs, and trunk.
2. Upper extremity nerve blocks described include axillary, supraclavicular, interscalene, infraclavicular, mid humeral, elbow/forearm, and wrist blocks. Lower extremity blocks include femoral, sciatic, and obturator nerve blocks.
3. The document provides details on ultrasound guidance, local anesthetic doses and volumes, and needle insertion approaches for each nerve block.
Mc qs in pharmacology
This document contains a collection of questions from various ANZCA exams on the topics of pharmacology and general anaesthetics. The questions cover topics such as pharmacokinetics, drug properties, mechanisms of action, volatile anaesthetic agents, and minimum alveolar concentration. The questions are multiple choice format and cover basic concepts as well as specific drug properties.
Spinal & epidural anaesthesia
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Upper Extremity Regional Anesthesia
A primer on upper extremity regional anesthesia, including interscalene, supraclavicular, infraclavicular, and axillary nerve blocks.
Regional Blocks of the Upper Limb and Thorax RRT
Blocks of the UL and Thorax made easy. Most methods mentioned here are modifications and not classical methods used that maybe be required for examination writing purpose.
Spinal Anesthesia - A Comprehensive Approach
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space to temporarily numb sensation and motor function in the lower body. The anesthesiologist inserts the needle below L2 to access the spinal fluid and avoid the spinal cord. Spinal anesthesia provides excellent surgical conditions for various abdominal, pelvic, and lower extremity procedures. It has been used since the late 1800s and involves carefully positioning the patient and needle to safely access the spinal fluid and distribute the anesthetic in the spinal canal.
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.
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This document discusses regional anesthesia techniques. It defines regional anesthesia as any technique that induces absence of sensation in part of the body. The document then discusses the benefits of regional anesthesia such as low cost, high patient satisfaction, and decreased blood loss. It also notes some risks like hypotension. It describes different types of regional anesthesia including topical, intravenous, peripheral nerve blocks, and neuroaxial blocks. It provides details on procedures like spinal anesthesia and epidural anesthesia. The document discusses factors that influence the spread of local anesthesia and lists some contraindications and complications of regional anesthesia techniques.
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This document discusses the anatomy of the posterior cranial fossa and common pathologies that require surgery in this area. It covers the clinical presentation of posterior fossa diseases and considerations for anesthetic management of posterior fossa surgeries. Key topics include patient positioning, intraoperative monitoring, complications like venous air embolism, and special considerations for pediatric patients. The goal of anesthetic management is to avoid increases in intracranial pressure while maintaining cardiovascular stability during surgery.
Anaesthesia for posterior fossa surgery/NEUROANAESTHESIA
This document discusses the anatomy, contents, clinical presentation, and anesthetic considerations for posterior fossa surgery. The posterior fossa is bounded by bones and contains the cerebellum, brainstem, and cranial nerves. Common tumors present with non-specific symptoms like headache but can also cause neurological deficits depending on the location of the lesion. Anesthetic goals are to facilitate surgery while minimizing brain trauma and maintaining stability. Important considerations include patient positioning, monitoring, induction technique, and maintenance with low-dose inhalational agents and ventilation to reduce intracranial pressure.
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This document outlines the design of an enhanced recovery pathway for hip fracture patients. It reviews evidence that preoperative peripheral nerve blocks provide better pain control and reduce complications. Neuraxial anesthesia like spinal anesthesia is shown to be superior to general anesthesia for hip fractures based on reduced mortality, length of stay, and complications. The pathway emphasizes multimodal analgesia, delirium prevention strategies, and multidisciplinary post-operative care to optimize outcomes for hip fracture patients.
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This document discusses anesthesia considerations for carotid endarterectomy. It begins with an overview of the anatomy and indications for the procedure. Important preoperative evaluations are outlined, including risk assessment, neurological examination, and imaging studies. Intraoperative management focuses on hemodynamic stability, cerebral perfusion monitoring via EEG, TCD, jugular bulb oximetry, and stump pressure. General anesthesia and regional anesthesia techniques are compared. Postoperative concerns like wound hematoma, embolism, and hypertension are also reviewed.
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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.
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The document discusses the anesthetic approach for patients with ischemic heart disease undergoing non-cardiac surgery. It defines ischemic heart disease and risk factors for perioperative cardiac complications. The goals of preoperative evaluation are to characterize the patient's heart disease and determine if additional testing is needed. A stepwise approach involves assessing clinical need for surgery, active cardiac conditions, risk factors, surgery risk, and functional capacity. The anesthetic focuses on maintaining a favorable balance between myocardial oxygen supply and demand to reduce risk of perioperative myocardial ischemia or infarction.
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This document summarizes a presentation on anaesthesia and pain relief given by Dr. Annush Tha. It covers various topics including:
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Anesthesia for laparacopic surgery 2022.
- Laparoscopic surgery utilizes carbon dioxide insufflation to create space in the abdomen for visualization, but this causes various physiological effects.
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This document discusses the evaluation and treatment of vascular injuries associated with orthopedic trauma. It notes that vascular injuries can lead to blood loss, ischemia, compartment syndrome and tissue necrosis if not treated urgently within 6 hours. Physical exam, Doppler ultrasound, angiography and surgical exploration are used for diagnosis. Immediate treatment involves controlling bleeding, volume replacement and splinting injuries. Surgical exploration is indicated for obvious arterial injuries, absent pulses or when the injury site is apparent. The importance of a rapid evaluation and treatment protocol between orthopedic and vascular surgeons is emphasized.
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The document discusses the importance of pre-anesthesia evaluation. It aims to identify patients who may benefit from preoperative optimization, determine if the proposed surgery is appropriate given a patient's condition, and help plan the anesthetic approach. Key aspects of evaluation are reviewing the cardiovascular, pulmonary, neurological, hepatic, renal, endocrine and coagulation systems. Conditions like diabetes, hypertension, coronary artery disease are evaluated in detail. The goals are to ensure patients are optimized and risks are identified to minimize perioperative complications.
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The document discusses the importance of pre-anesthesia evaluation. It aims to identify medical conditions that could impact anesthesia, guide anesthetic planning, obtain consent, and assess surgical risk. Key aspects of evaluation include reviewing the cardiovascular, pulmonary, renal, hepatic, neurological, and respiratory systems. Assessing issues like hypertension, coronary artery disease, diabetes, smoking history helps determine a patient's perioperative risk. The goal is to optimize high-risk patients' conditions before elective surgery and determine if a procedure's risks outweigh its benefits for very sick patients.
Intraoperative management
1. Vascular surgery patients present unique challenges due to multiple comorbidities. Anesthesia aims to provide analgesia, amnesia, and muscle relaxation while minimizing physiologic stress.
2. Regional techniques like epidurals combined with light general anesthesia result in better outcomes for aortic and infrainguinal surgery compared to general anesthesia alone by reducing sympathetic activation.
3. Strict intraoperative monitoring of vital signs, oxygenation, ventilation, and neurologic function is important due to the physiologic perturbations of vascular surgery. Tight glycemic control and maintenance of normothermia and hemostasis also impact outcomes.
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This document provides an overview of spinal anaesthesia. It begins with definitions and history, then covers anatomy including the subarachnoid space and structures pierced during spinal anaesthesia. It describes the mechanism of action of spinal anaesthesia and how local anaesthetics work. Indications, contraindications, preparation, positioning, and complications are discussed. Pharmacology of local anaesthetics for spinal anaesthesia and additives are outlined. Monitoring during the procedure and factors affecting the spread of local anaesthetics are also summarized.
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The document discusses the goals and process of a preanaesthetic evaluation. The anaesthesiologist aims to optimize the patient's medical condition, assess fitness for anaesthesia, and identify any risks. They take a full medical history, examine the patient, and order relevant investigations. For higher risk patients, evaluation may involve multiple specialists and days of preparation. The anaesthesiologist discusses the planned anaesthetic with the patient and obtains consent. Premedication is sometimes used to reduce anxiety, secretions, nausea/vomiting, or enhance the effects of anaesthesia.
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More from Khalid
Introduction to medical ethics
This document discusses the history and principles of bioethics. It begins by explaining how advances in medicine raised new moral issues that ethicists worked to address. Notable cases of unethical human subject research helped establish principles like informed consent and respect for persons. Guidelines like the Nuremberg Code aimed to prevent future abuses. The document then examines key bioethical principles like autonomy, beneficence, nonmaleficence, and justice. It explores how these principles guide issues like informed consent, respecting patient values, avoiding harm, and fair allocation of resources. The challenges of applying principles to complex real-world cases are also discussed.
Physiological Changes In Pregnancy
Physiological changes in pregnancy include changes in the central nervous, respiratory, and cardiovascular systems. The minimum alveolar concentration of anesthetic gases decreases by up to 40% due to hormonal and endogenous changes. Oxygen consumption and minute ventilation increase while functional residual capacity decreases, increasing the risk of desaturation. Blood volume and plasma volume increase substantially, elevating cardiac output and stroke volume and decreasing systemic vascular resistance.
Diabetes Mellitus
The document discusses perioperative management of diabetes mellitus. It covers types of diabetes, complications, preoperative assessment and glycemic control goals. Glycemic control is important to minimize complications from hyperglycemia and hypoglycemia. For major surgery, an intravenous insulin and glucose infusion provides optimal control and prevents fluctuations in blood sugar levels. Frequent monitoring of blood glucose levels is essential in the perioperative period.
Pulmonary Embolism
- Pulmonary embolism affects approximately 500,000 individuals per year in the US, with around 50,000 deaths annually.
- Deep vein thrombosis accounts for over 95% of pulmonary emboli. Risk factors for DVT and thus PE include surgery, trauma, cancer, prolonged immobility, and genetic or acquired hypercoagulable states.
- Diagnosis is suggested by symptoms like dyspnea and chest pain but requires imaging tests like CT pulmonary angiogram, ventilation-perfusion scanning, or echocardiogram to confirm the presence of emboli. Treatment involves anticoagulation with heparin or warfarin.
Shock
Shock is a condition where the cardiovascular system fails to adequately perfuse tissues. It can be caused by an impaired pump (cardiogenic shock), reduced circulating volume (hypovolemic shock), or maldistribution of blood flow (distributive shock). The main effects are cellular hypoxia, impaired metabolism, and organ damage or failure if not treated. Compensatory mechanisms aim to increase perfusion but eventually fail, leading to irreversible cellular damage and death if shock persists.
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The document discusses the role of anesthesiologists in the pre-operative period. It covers the objectives of the pre-operative visit which include obtaining medical history, identifying risk factors, and determining necessary lab tests. The stages of the peri-operative period - pre-operative, intra-operative, and post-operative - are defined. Key aspects of the pre-operative evaluation that are described include assessing patient risk factors, surgical risk stratification, airway evaluation, and guidelines for pre-operative testing based on procedure, disease conditions, and ongoing therapies.
General Anesthesia
1. General anesthesia involves inducing a reversible state of unconsciousness through drugs that provide analgesia, amnesia, and muscle relaxation while maintaining vital life functions.
2. Anesthesiologists are responsible for preoperative evaluation and preparation, intraoperative management including general anesthesia and regional techniques, and postoperative care including pain management.
3. This case report describes a patient who developed arterial oxygen desaturation during percutaneous nephrolithotomy surgery under general anesthesia which was treated with corticosteroids, aminophylline, and a bronchodilator inhaler.
Fluids
1. Perioperative fluid therapy aims to maintain hemodynamic stability and organ perfusion. Fluid requirements depend on maintenance needs, deficits from fasting or drainage, third spacing from surgery, and blood or other losses.
2. Transfusion is considered when hemoglobin levels compromise oxygen delivery, depending on patient tolerance. Blood groups and cross-matching guide compatible transfusions to avoid reactions. Component therapy allows targeted treatment with specific blood products.
3. Careful fluid and transfusion management can prevent complications like hypotension, edema, and transfusion reactions from improper products or volumes. Alternatives like autologous donation or blood substitutes aim to reduce donor dependence.
Emergency Medicine
This document provides an overview of emergency medicine as a specialty. It discusses the top causes of death, the reception process in emergency departments, how cases are triaged from life-threatening to non-urgent, and examples of common illnesses and injuries seen in emergency medicine including chest pain, fractures, seizures, and psychiatric illnesses. It also outlines both the appeals and challenges of working in emergency medicine as well as potential career paths within the specialty.
Patient Monitoring
The document provides an introduction to patient monitoring in anesthesia. It discusses the importance of monitoring to detect potential issues and outlines the key physiological parameters that should be monitored, including circulation, ventilation, oxygenation and temperature. It also describes the various equipment and methods used for monitoring these parameters in both the past and present.
Diagnosis and Management of Shock
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
Patient Monitoring
The document provides an introduction to patient monitoring in anesthesia. It discusses the importance of monitoring to detect potential issues and outlines the key physiological parameters that should be monitored, including circulation, ventilation, oxygenation, and temperature. It also describes the various equipment and methods used for monitoring these parameters in both the past and present.
Blood Transfusion
Blood transfusion practices involve determining a patient's blood type and screening for antibodies to reduce risks of transfusion reactions like hemolytic reactions. Key indications for transfusion include maintaining hemoglobin above 6-8 g/dL and allowing blood loss within established volumes. Complications can be minimized through proper blood type matching, leukoreduction, and following guidelines for transfusion thresholds and volumes.
Airway Evaluation and Management
This document discusses airway evaluation, management of intubation, and complications. It outlines indications for intubation including resuscitation, prevention of lung soiling, and respiratory failure. Successful intubation requires a normal mandible, throat, and cervical spine alignment. Proper equipment and gadgets are also needed. Difficult airways can be predicted by history, examination of the face, jaw, and neck, and tests like Mallampatti. Securing the airway awake is recommended for expected difficult airways. Maintaining oxygenation is the primary goal, and backup plans should be in place in case of unexpected difficult intubation.
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This document summarizes a lecture on medical literature, including the basic purpose of research, common study designs, tools for reviewing studies, and principles of writing research manuscripts. The lecture covers estimating the truth, variability in perceptions of research findings, evolving nature of research, basic study designs like randomized trials and observational studies, analytical aspects like measures of association and issues with numerical approaches, standards for assessing research quality like CONSORT and STROBE, and considerations for writing manuscripts like clinical relevance and brevity. An example randomized controlled trial on spironolactone is presented and discussed.
Airway Evaluation and Management
This document discusses airway evaluation, management of intubation, and complications. It outlines indications for intubation including resuscitation, prevention of lung soiling, and respiratory failure. Successful intubation requires a normal anatomy of the mandible, temporomandibular joint, atlanto-occipital joint, and cervical spine. Proper equipment and gadgets are also needed. Tests like the Mallampatti and Wilson scores can predict difficulty, and a history of previous issues is also informative. Securing the airway awake is recommended for expected difficult airways, and maintenance of oxygenation should be the primary aim with backup plans in place for unexpected difficulties.
CVS PSL and Monitoring
This document provides an overview of cardiovascular physiology and ECG monitoring. It discusses the coronary circulation and conduction system of the heart. It describes the different cardiac cell types and their functions. Topics covered include the action potential, automaticity, conduction speed, the phases of the cardiac cycle, and pressure-volume loops. The document also discusses regulation of the cardiovascular system through neural mechanisms, hormones, and the renin-angiotensin-aldosterone system. Finally, it provides guidance on interpreting ECGs, including identifying rates, durations, abnormalities, and determining the location of myocardial infarction.
Opioids Drugs
The document discusses several key points about opioids:
1. It describes the endogenous opioid systems and receptors in the body, including proenkephalin, prodynorphin, pro-opiomelanocortin, and the mu, kappa, delta, and other receptors.
2. It summarizes the pharmacokinetics and pharmacodynamics of opioids like morphine and meperidine, how they work in the body to produce analgesia and other effects.
3. The main effects of opioids discussed are analgesia, respiratory depression, nausea/vomiting, and other central nervous system effects. Their use in anesthesia is also covered.
Interpretation OF PFT
Pulmonary function tests are used to evaluate respiratory status, quantify pulmonary disability, and manage patients with known pulmonary disease. Acceptable tests require adequate equipment, lack of artifacts, satisfactory start and exhalation, and reproducibility between tests. Obstructive lung disease is identified by reduced FEV1/FVC ratio below normal limits, while restrictive lung disease shows reduced FEV1 and FVC proportionately with normal FEV1/FVC ratio. Upper airway obstruction can be extra-thoracic or intra-thoracic.
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Introduction to Regional
- 2. What is Regional Anesthesia?
- 4. Nerve Sensitivity Autonomic >> Sensory >> Motor
- 6. Neuraxial Spinal Epidural Caudal Peripheral Nerve Block IV Regional ( Bier block )
- 11. Local Anesthetic Physiology Hyperbaric (Dextrose) Isobaric Hypobaric
- 12. Spread of Local Anesthesia • Baricity of Local Anesthetic • Position of Patient • Concentration of Local Anesthetic • Volume Injected • Level of Injection • Speed of Injection
- 13. Advantages • Cheap • High Patient Satisfaction • Well Tolerated in Pulmonary Disease • Maintain Patent Airway • Selective Muscle Relaxation • Decreased Blood Loss • Decreased Incidence of DVT and PE
- 14. Disadvantages • Difficult Placement in Elderly • Hypotension • Patient Can Talk • Patient Anxiety • Not Reliable for Surgery > 2 hours
- 15. Complications • Bleeding • Post-Dural Puncture Headache • Transient Neurological Syndrome • Total Spinal
- 16. Total Spinal • Hypotension • Bradycardia • Arm involvement • Shortness of Breath • Patient Anxiety • Loss of Consciousness
- 17. Contra-Indications • Inadequate equipment for GA • Bleeding Dyscrasia’s • Hypovolemia • Patient Refusal • Sepsis/Bactermia • Anatomic Deformities of the Spine • Neurological Disease • Increased ICP • Fixed Cardiac Output States
- 21. Uses • Hip and Knee Surgery • Lower Extremity Vascular Surgery • Lower Extremity Amputation • Obstetrical – Labor & C/S • Thoracic Surgery – Post-Op Pain Control • Thoracic Trauma • Abdominal Surgery – Post-Op Pain Control
- 22. Advantages •Cheap • High Patient Satisfaction • Well Tolerated in Pulmonary Disease • Maintain Patent Airway • Selective Muscle Relaxation • Decreased Blood Loss • Decreased Incidence of DVT and PE
- 23. Disadvantages •Difficult Placement in Elderly • Hypotension • Patient Can Talk • Patient Anxiety
- 24. Complications • High Epidural • Local Anesthetic Toxicity • Total Spinal • Accidental Dural Puncture
- 25. Contra-Indications • Patient Refusal • Coagulopathy • Localized Skin Infection • Elevated ICP • Hypovolemia • Uncooperative Patient • Pre-Existing Neurological Disease • Spinal Column Abnormalities • Fixed Cardiac Output States
- 26. Peripheral Nerve Blocks
- 27. •Brachial Plexus • Psoas Compartment Block • Femoral Nerve Block • PoplitealFossa Block • Ankle Block
- 32. Intravenous Regional Anesthesia ( Bier block )
- 34. Applications •Distal Arm Surgery • Useful for Short Procedures
- 35. Contra-Indications • Sickle Cell Disease • Crush Injury to the Limb • Very Young may need additional
- 36. Complications • Local Anesthetic Toxicity
- 37. THANK YOU