This document provides an introduction to obstetric anesthesia. It discusses how the anesthetist is responsible for maintaining the physiology of both the mother and fetus during childbirth. The anesthetist must understand and account for alterations in the mother's physiology, anatomy, and pharmacology that occur during pregnancy and delivery. This includes changes to organ function, muscle tone, circulation, respiration and more. Providing anesthesia for childbirth also carries certain risks that the anesthetist must be prepared for, such as potential complications related to the dual physiology of mother and fetus. Effective communication with obstetricians is important to achieve the best outcomes.
General anesthesia & obstetrics- c-section part ISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
General anesthesia & obstetrics- c-section part ISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Anesthesia
What are the risks and complications of anesthesia?
Stages of anesthesia
types of Anesthesia :
General ,local and Regional Anesthesia
Drugs for Anesthesia
BUPIVACAINE epidural effectiveness has a clearly scientific evidence for perioperative analgesia
Bupivacaine epidural still safe in a wide range dose to cause systemic toxicity
We always reduce the risk of LA toxicity by our usually practice procedures
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. INTRODUCTION
During obstetric anesthesia the
anesthetist controls the following
Maternal
– Gas exchange, perfusion of vital organs and metabolism
– Pain perception and reflexes
– Skeletal muscle tone
– Consciousness or unconsciousness
Fetal
– Gas exchange, perfusion of vital organs, metabolism
Uterine
– Myometrial tone
AND IS RESPONSIBLE FOR …..
3. the maintenance of
Maternal
– Physiology
– Safety
– Comfort
Fetal
– Physiology
Surgical
– Surgical conditions
This is the aim of the obstetric anesthetist
4. ASA '96 162
Risks involved
Physician Insurers Association of America
(PIAA)
– Malpractice claims against anesthetists
– Most frequent conditions for which claims were made
–Pregnancy and birth
American Society of Anesthetists
(ASA)
– Obstetric vs. non-O malpractice claims
– C/S risk double that of any other procedure
6. ASA 2005, 402
“ It will be necessary to ascertain
anesthesia’s precise effect, both upon the
action of the uterus and on the assistant
abdominal muscles; its influence, if any,
upon the child; whether it has a tendency
to hemorrhage or other complications.”
Scottish obstetrician James Simpson after administering
ether to a woman to treat the pain of childbirth
1847
7. “If we could induce local anesthesia without
the absence of consciousness, which occurs
in general anesthesia, many would see it as
a still greater improvement.”
Sir James Young after the first maternal
death due to anesthesia in England
1848
8. WHAT’S DIFFERENT?
Why the increased risk?
TWO IN ONE
INTRA-OPERATIVE AWARENESS
PHYSIOLOGY / PHARMACOLOGY !
ECG CHANGES
ASSOCIATED PATHOLOGY
PRE-ECLAMPSIA – ECLAMPSIA
HELLP – SYNDROME
ANTEPARTUM HEMORRHAGE
RHEUMATIC HEART DISEASE
9. Q VADIS
What does the anesthetist need, firstly himself to survive,
and secondly have mother and child survive too
– NORMAL VS ALTERED PHYSIOLOGY
– NORMAL VS ALTERED PHARMACOLOGY
– VASCULAR ACCESS
– AIRWAY MANAGEMENT
– REGIONAL ANESTHESIA
– RESUSCITATION
• KNOWLEDGEKNOWLEDGE
•• SKILLSSKILLS
i.e. A COMPETENT CLINICIAN!
11. 1 Hematological
Obstetric blood loss
Normal PV delivery
– 600ml
Normal PV delivery of twins
– 1000ml
Caesarian section
– 1000ml
Substantial blood loss is to be
expected in the obstetric patient!
22. Predicted mortality rates (%) after aspiration. Each shaded area
represents the mortality rate interval predicted for a specific
pH and volume of solution aspirated.
23. Prevention of aspiration
AVOID GENERAL
ANESTHESIA
NPO
PRO-KINETICS
ANTI-ACIDS
SELLICK MANEUVRE
→ SPINAL / EPIDURAL
→ FLUID
→ METOCLOPRAMIDE
→ NON PARTICULATE
Na CITRATE, PNEUCID
→ CRICOID PRESSURE
24. Prevention of aspiration
- Sellick maneuver or cricoid pressure -
All(!) patients from 12 weeks gestation.
25. Altered pharmacology
↓ MAC for inhalational agents
– From 8-12 weeks gestation
– Due to ↑ progesterone levels
↓ dose of LA
– Epidural venous engorgement
– ↑ sensitivity of nerves, ? progesterone
26. Regression lines for dose of epidural solution and age in
nonpregnant women at term. The gravida obviously requires
much less drug.
27. ASA 2005 402
WHAT’S ON OFFER?
a. STANDBY (“no interference”)
b. O2, N2O, OPIATES
c. GENERAL ANESTHETICS
– USA; babies of 23% of pregnant women delivered by C/S (2005)
d. REGIONAL ANESTHETICS
– EPIDURAL (CAUDAL)
– SPINAL
– COMBINED SPINAL-EPIDURAL
– CONTINUOUS SPINAL
– PATIENT CONTROLLED EPIDURAL ANALGESIA
28. c. General anesthetics
↓↓ incidence / popularity
Risks involved
– Failure to intubate
– Aspiration
Experience of childbirth
– Bonding
– Presence of father
34. II. Anatomy
Early labor
– T11 - T12
Progressing cervical dilatation
– T10 - L1
Second stage
– S2 – 4
– distention of vaginal vault and perineum
35.
36.
37.
38.
39.
40. International Headache Society ASA '05 103
PDPH
Bilateral; frontal, occipital or both
– May involve neck and upper shoulders
Develops < 7days following LP
– Generally < 48hours
– > 3days in 25% of cases
Disappears < 14days following LP
Worsens < 15min assuming upright position
Improves < 30min assuming recumbent position
41. PDPH
Proposed mechanisms
Traction on pain sensitive intracranial structures
– 150ml CSF: 75ml spinally / 75ml supra –
– Volunteers: removal of 10% of CSF = headache
Cerebral venous dilatation
– “compensatory” intracranial hyperaemia
– More evidence than first mechanism
42. PDPH
Greatest influence on the incidence
1. Technique
a. Direction of bevel (Quincke type needle)
Parallel with longitudinal fibers of dura
2. Choice of needle
a. Size (smaller is safer)
Not larger than 26G
b. Design
Pencil-point tip, i.e. not to cut fibers
44. SUMMARY
Role of anesthetist during C/S
Attending primarily to the mother,
and by doing so, assuring the best
possible outcome for the baby
- in a cramped space shared by at least seven demanding people -
45. SUMMARY
REALISE AND RECOGNISE ALTERED
– PHYSIOLOGY
– ANATOMY
– PHARMACOLOGY
COMMUNICATE WITH OBSTETRICIAN
CAN BE REWARDING!