Ketamine produces dissociative anesthesia and has hypnotic, analgesic, and amnesic effects. It works by binding to NMDA receptors and other sites like opioid receptors. Ketamine has a rapid onset after IV or IM administration, with effects seen within 1-5 minutes. It causes increased blood pressure and heart rate by stimulating the sympathetic nervous system. Ketamine can also increase respiratory rate and salivation, dilate pupils, and has short-term side effects like confusion and out of body experiences. It has various indications like analgesia, anesthesia induction, and improving psychiatric disorders.
Intravenous Anaesthetics are a group of fast-acting
compounds that are used to induce a state of impaired
awareness of complete sedation.
These are drugs that, when given intravenously in an
appropriate dose, cause a rapid loss of consciousness.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
Ketamine is a unique IV anesthetic with analgesic-like properities that has been used for both induction and maintenance if anesthesia, as well as an analgesic adjunctive during local anesthesia.
Adjunctive use of small dose keamine (0.1 – 0.2 mg/kg IV) appear to be associated with opioid-sparing effects and a less frequent incidence of adverse events and greater patient and physician acceptance.
Intravenous Anaesthetics are a group of fast-acting
compounds that are used to induce a state of impaired
awareness of complete sedation.
These are drugs that, when given intravenously in an
appropriate dose, cause a rapid loss of consciousness.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
Ketamine is a unique IV anesthetic with analgesic-like properities that has been used for both induction and maintenance if anesthesia, as well as an analgesic adjunctive during local anesthesia.
Adjunctive use of small dose keamine (0.1 – 0.2 mg/kg IV) appear to be associated with opioid-sparing effects and a less frequent incidence of adverse events and greater patient and physician acceptance.
A General Anaesthetic is a drug that produces a reversible state of unconscious with absence of pain sensation over the entire body; such agents have been described as drugs that remove the most precious human attributes ---- Conscious.
Ketamine
Brand name: KETALAR
Phencyclidine derivative
Shorting acting
Mainly used in children and elderly adults for short procedures such as burns dressing.
ABUSIVE DRUG
Is a dissociative anaesthetic as it produces a cataleptic state in which the patient appears to be awake but is detached from the environment and is unresponsive to pain.
Please also refer to other reference books for clarity.
complete and detail study on the topic of general anesthetics by the collaboration of teacher and students for the student , teachers and other health care professionals to learn more on the topics
Hello friends. In this PPT I am talking about general anaesthetics and skeletal muscle relaxants. If you like it, please do let me know in the comments section. A single word of appreciation from you will encourage me to make more of such videos. Thanks. Enjoy and welcome to the beautiful world of pharmacology where pharmacology comes to life. This video is intended for MBBS, BDS, paramedical and any person who wishes to have a basic understanding of the subject in the simplest way.
status epilepticus is medical emergency ,it can be convulsive or non convulsive
febrile convulsions are the most common provoked seizures in children of age 6 to 60 months
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Introduction :
• Ketamine is a phencyclidine derivative that produces dissociative
anesthesia characterised by evidence on the EEG of dissociation
between the thalamocortical and limbic system.
• Ketamine is frequently described as a "unique drug" because it has
hypnotic, analgesic and amnesic effects - no other drug used in clinical
practice combines these three important features.
• It was first used clinically in 1970, and because of these combined
effects it was thought that it might be the perfect anesthetic agent.
• Ketamine has advantages over propofol & etomidate in not requiring a
lipid emulsion vehicle.
3. • Ketamine is water soluble molecule that structurally
resembles phencyclidine.
Mechanism of Action :-
• The mechanism of action of ketamine induced
analgesia & dissociative anesthesia is unknown.
• It interacts with multiple CNS receptors.
• Ketamine binds non-competetively to the
phencyclidine recognision site on N-methyl-D-
aspartate(NMDA) receptors.
• In addition ketamine exerts effect at other sites
including opioid receptor & muscarinic receptors &
nicotinic acetylcholine receptors.
4. Pharmacokinetics
• Rapid onset of action, relatively short duration
of action & high lipid solubility.
• Peak plasma concentrations of ketamine occur
within 1 min after IV administration & within 5
mins after IM injection.
• Initially ketamine is distributed to highly
perfused tissues such as brain & extreme lipid
solubility ensures its rapid transfer across the
BBB.
• Ketamine has high hepatic clearance rate(1
L/min).
5. Actions of Ketamine on the Body:
Central Nervous System (CNS):
After an i/v injection the effects of ketamine on the CNS begin
slowly than other anaesthetic induction agents (1-5 minutes for
ketamine compared with 30 -60 seconds for Thiopentone).
• The anesthetic state produced is frequently called "dissociative
anesthesia" which implies that the patient is detached from the
environment and self.
• The patient's eyes often remain open and constantly move from
side to side.
6. • The duration of action depends on the route of administration.
• In contrast to the smooth induction of anaesthesia, the patient
may be agitated on recovery from ketamine.
• This is often called "emergence delirium", during which the
patient may be disorientated, restless, and crying.
• Patients may continue to experience unpleasant dreams up to
24 hours after the drug has been given.
• Ketamine is potent cerebral vasodilator & capable of
increasing cerebral blood flow by 60% in normal indivisual &
causes a rise in intracranial pressure and should not be used
in patients who have sustained a recent head injury
7. Cardiovascular System (CVS):
• Ketamine causes mild stimulation of the CVS.
• The systolic blood pressure rises about 20 to 40 mmhg & small
increase in diastolic. The heart rate is increased by about 20% - the
overall effect is therefore to increase the workload of the heart.
• In the majority of patients the blood pressure rises steadily over 3-5
minutes and then returns to normal 10-20 minutes after injection.
• There is wide individual variation in cardiovascular responses.
• These increases do not seem to be dose-related when more than 1
mg/kg is given and larger doses do not necessarily cause a greater
increase in pressure.
• There is no evidence to suggest that patients with a high
preoperative blood pressure are at greater risk of developing a rise
in blood pressure following ketamine administration when
compared with normotensive patients.
8. Premedication with midazolam may reduces this rise in
blood pressure.
As the cardiovascular stimulation following ketamine is
mediated through the sympathetic nervous system it would
seem appropriate to give alpha or beta blockers to patients
who develop excessively high blood pressures.
However, the effects of these drugs are unpredictable, and
they are probably best avoided in otherwise normal
patients as there is no evidence of damage occurring from
these short episodes of elevated blood pressure.
9. Respiratory system:
• If Ketamine is administered rapidly by intravenous injection
it often causes the patient to stop breathing for a short
time (up to one minute).
• After a slow intravenous induction, breathing is well
maintained and may even increase slightly.
• The airway is usually well maintained during Ketamine
anesthesia and there is some preservation of pharyngeal
and laryngeal reflexes in comparison with other
intravenous agents.
• However this cannot be guaranteed, and normal airway
care must be maintained to prevent obstruction or
aspiration
10. • Recent research using a pulse oximeter has shown that
following an intravenous induction with ketamine (2
mg/kg) the oxygen saturation falls
• A simple oxygen mask or nasal prongs may be used.
• Ketamine produces some bronchodilation making it a
useful anaesthetic drug for patients with asthma
11. Skeletal muscle
Muscle tone is often increased.
Spontaneous movements may occur during
anesthesia but reflex response to surgery is
uncommon if the patient is adequately
anaesthetised.
Placenta
Ketamine crosses the placenta easily .
Secretions
Salivation is increased.
12. The Eyes
• The intra-ocular pressure rises for a short time
following administration.
• Eye movements may continue throughout
surgery.
• It is not suitable for use in patients with a
perforated eye injury or for ophthalmic
surgery where a still eye is required.
• Pupils are moderately dilated.
13. Routes of Administration:
• Ketamine can be given by either the intravenous
route 1-2 mg/kg or intramuscular route 4-8 mg/kg
to provide anesthesia.
14. Indications for Use:
• Analgesia :
- Intense analgesia can be achieved with sub-
anesthetic doses of 0.2 – 0.5 mg/kg IV.
- Analgesia is thought to be greater for somatic
than
for visceral pain
- Analgesia can be produced during labor without
associated depression of the neonate.
- Ketamine is useful as an analgesic adjuvant in
patients with pre-existing chronic pain syndromes
who require surgery
15. Induction of Anesthesia :
• Induction of anesthesia is produced by administration of
ketamine 1-2 mg/kg or intramuscular 4-8 mg/kg to provide
anesthesia.
• Consciousness is lost in 30-60 seconds after IV administration
& 2-4 mins after IM administration.
• Return of consciousness usually occurs in 10-20 mins after an
injected induction dose of ketamine but return of full
orientation may require additional 60-90 mins.
• Amnesia persists for about 60-90 mins after recovery of
consciousness.
• Because of its rapid onset of action ketamine has been used
as an IM induction drug in children and been used extensively
for burn patients, debridement & skin grafting procedures.
• Induction of anesthesia in acute hypovolemic patients is often
accomplished with ketamine.
16. Reversal of Opioid Tolerance :
• Administration of sub-anesthetic doses of ketamine i.e. 0.3
mg/kg/hr improves analgesia and may reduce the likelihood of
opioid tolerance.
Improvement of Psychiatric Disorders :
• Ketamine in small doses improves the post-operative
depressive state in patients with mental depression.
• Intermittent treatment with low dose ketamine also results in
long-term suppression of obsessions & compulsions in patients
with obsessive compulsive disorder.
17. Short term side effects of Ketamine are:
• Increase in heart rate
• Slurred speech
• Confusion, disorientation
• Out-of-body experience
• Shifts in perception of
reality
• Nausea
• Sedation
• Hypertension
• Euphoria
• Distortion or loss of
sensory perceptions
(common)
• Open- and closed-eye
visuals (common)
• Dissociation of mind from
body
• Numbness
• Ataxia (loss of motor
coordination)
• Significant change in
perception of time
• Double-vision