This document summarizes the physiological changes in pregnancy and their implications for anesthesia. It discusses how pregnancy causes increased blood volume, cardiac output, oxygen consumption and acidity levels. These changes can cause issues like supine hypotension syndrome when the mother lies on her back. The document also covers respiratory, coagulation, gastrointestinal and central nervous system changes in pregnancy and how they impact drug dosages and anesthesia techniques. Special considerations are discussed for intubation, regional anesthesia and placental drug transport.
Anesthetic consideration in smokers,alcoholics and addictsAftab Hussain
Anaesthetic consideration in smokers alcoholic and drug addicts. As an anaesthesiologist we must be aware with the problems associated with their management and interaction with anaesthetics.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
Anesthetic consideration in smokers,alcoholics and addictsAftab Hussain
Anaesthetic consideration in smokers alcoholic and drug addicts. As an anaesthesiologist we must be aware with the problems associated with their management and interaction with anaesthetics.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
obstetric and gyneacology; Changes in pregnancy, cardiovascular changes, respiratory changes, endocrine changes, gastrointestinal changes, related organ changes in pregnancy. hormonal changes during pregnancy.
Detailed account of the various changes that occur in maternal anatomy, physiology, and metabolism of pregnant women. These physiological changes are often very precise, and deviations of physiological responses can be a prelude to possible disease/infectious states. In this second part of Labor, we will examine the various systems of the human body,its altered states during pregnancy, and how those changes affect the woman preparing for delivery. Special care is imperative in properly determining the needs of an expecting mother, so developing an intimate, trusting relationship between the mother and fully understanding her physiological output will lead to the best chances of a successful delivery.
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...Md Rabiul Alam
Surgical and Anaesthetic management of a patient with diseased heart is always challenging. Specially it sweats more when the issue is PREGNANCY. It demands skillful and sophisticated handling of the patient. Moreover, when the finding is incidental, a single break of concentration can be fatal.
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Similar to Physiological Changes in Pregnancy and Its Anaesthetic Implications. (20)
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Physiological Changes in Pregnancy and Its Anaesthetic Implications.
1. PHYSIOLOGICAL CHANGES IN
PREGNANCY AND ITS
ANAESTHETIC IMPLICATIONS
DR. MOHTASIB MADAOO
DEPARTMENT OF ANAESTHESIOLOGY,
SAIFEE HOSPITAL.
2. PHYSIOLOGICAL CHANGES IN
PREGNANCY
• Pregnancy produces profound physiological changes that
alter the usual responses to Anesthesia .
• Unique challenges - two patients are cared for
simultaneously .
• Failure to take care can be disastrous for one or both of
them.
3. CARDIOVASCULAR CHANGES
Parameter Change
Blood Volume Increases by 30%
Plasma Volume Increases by 45%
Cardiac Output Increases by 30-50%
Stroke Volume Increases by 25%
Heart Rate Increases by 15-25%
Peripheral Vascular Resistance Decreases by15-20%
CVP Unchanged
4. ANAESTHETIC IMPLICATIONS
AortoCaval Compression
• Enlarged uterus compresses IVC and Lower Aorta when the
patient lies supine Obstruction of IVC Decreases Venous
Return leads to Decrease in Cardiac Output
• When awake most women are capable of compensating for the
decrease in stroke volume by increasing Sytemic Vascular
Resistance and Heart rate. There are also alternative venous
pathways : the paravertebral and azygos systems.
• During Anaesthesia compensatory mechanisms are reduced or
abolished.
• Obstruction of lower aorta causes reduced blood flow to
kidneys, uteroplacental unit and lower extremities.
5. SUPINE HYPOTENSION SYNDROME
8 to 15% of pregnant women have Overt Caval
Compression (supine hypotension syndrome)
• Hypotension
• Sweating
• Bradycardia
• Pallor
• Nausea
• Vomiting
Prevention of SHS: Uterus should be displaced by placing a
rigid wedge under the right hip and tilting the table left side
down.
Regional anaethesia – Profound Hypotension
The patient can be turned to full left lateral position.
6. RESPIRATORY CHANGES
Parameter Change
Oxygen consumption Increases by 20 to 50%
Minute ventilation Increases by 50%
Tidal volume Increases by 40%
Respiratory rate Unchanged/Slightly Increases
PaO2 Increases by 10%
PaCO2 Decreases by 15%
HCO3 Decreases by 15%
FRC Decreases by 20%
7. ANAESTHETIC IMPLICATIONS
• Decreased FRC and Increased oxygen consumption
promotes rapid oxygen desaturation during periods of
apnea. This is more marked in obese patients.
• The reduced FRC causes airway closure in 50% of
parturients at term in the supine position making pre-oxygenation
less effective.
• Regional block further diminishes FRC which leads to
rapid development of Hypoxemia.
• Preoxygenation prior to induction of general anesthesia is
therefore mandatory to avoid hypoxemia in pregnant
patients.
8. Factors affecting Smooth Intubation
• There is capillary engorgement and edema of the upper
airway down to the pharynx, false cords, glottis and
arytenoids.
• The increase in chest diameter and enlarged breasts can
make laryngoscopy difficult.
Failure to intubate the trachea is 7 times more common in the
term parturient compared to non pregnant patients.
A smaller diameter endotracheal tube may be required for
intubation especially in cases of pre eclampsia.
Blood flow to the nasal mucosa is increased so
Oropharyngeal intubation is preferred over Nasal intubation.
9. COAGULATION CHANGES
Parameter Changes
Fibrinogen Increased from 2.5g/l to 5g/l
Factor 2 Slightly Increased
Factor 5 Slightly Increased
Factor 7 Increased 10 folds
Factor 8 Increased 2 folds
Factor 9 and 10 Increased
Factor 11 Decreased by 70%
Factor 12 Increased by 40%
Factor 13 Decreased by 40%
Bleeding time, PT, PTT is unchanged.
Pregnancy is a hypercoagulable state.
There is increased risk of thromboembolic episode.
10. GIT CHANGES
The parturient should be considered a full stomach patient
during most of gestation because
• Upward & anterior displacement of the stomach by the uterus
leads to increase in intragastric pressure and decrease in
gastroesophageal angle.
• Reduction of lower esophageal sphincter pressure due to
increased progesterone levels.
Risk of Regurgitation and aspiration of gastric contents.
Increased placental gastrin secretion which worsens gastric
acidity.
11. ANAESTHETIC IMPLICATIONS
• Prophylaxis in the form of H2 blocking drug and Prokinetic
drugs to all pregnant patients for surgery from 2nd
trimester onwards is a must.
• During GA airway protection by means of cuffed ETT is
mandatory; So is rapid sequence induction from 2nd
trimester of pregnancy till 48hrs post partum.
• Extubation should be done when the patient is awake and
on their side to reduce the risk of aspiration.
• The danger of aspiration is almost eliminated when
regional anaethesia is used.
12. CNS CHANGES & ITS IMPLICATIONS
Decrease in minimum alveolar concentrations secondary to
increased levels of progesterone and β- endorphin levels.
• Rapid induction with inhalation agents – The increased
minute ventilation combined with decreased FRC and
decreased MAC.
13. CNS CHANGES & ITS IMPLICATIONS
The amount of local anaesthetic drug required in a pregnant
woman is less compared to the non pregnant state. (Approx
two-thirds of the normal dose is adequate)
• Exaggerated lumbar lordosis contribute to cephalad
spread of the local anaesthetic.
• Engorged epidural plexus of veins will decrease the
volume of the epidural and subarachnoid space.
• The CSF pressure is increased due to compression from
the epidural veins in the epidural space.
• Increased sensitivity to opiods, sedatives, and local
anaesthetics when used for neuraxial anaesthesia.
14. RENAL CHANGES
• Renal vasodilatation increases renal blood flow early
during pregnancy.
• Increased Cardiac output leads to Increased GFR &
Increased renal plasma flow by 50% which increases
clearance of urea, uric acid and Creatinine.
• Increased Renin & Aldosterone level promotes Na+
retention leading to volume overload.
• Decreased Renal tubular threshold for glucose & amino
acids → mild glycosuria & proteinuria (< 300mg/d).
• Progesterone mediated ueretetic smooth muscle
relaxation can lead to urinary stasis making pregnant
women prone to urinary tract infections.
There is increase in the volume of distribution for drugs and
may have to be given in higher than normal dosages.
15. HEPATIC CHANGES
• Hepatic function and blood flow are unchanged.
• A mild decrease in serum albumin is due to an expanded
plasma volume. Thus, the free fraction of albumin-bound
medications is increased.
• A 25—30% decrease in serum pseudocholinesterase
activity is also present at term,but it rarely produces
significant prolongation of SCh action.
• Increased cholesterol gall stone formation(progesterone).
16. PLACENTAL TRANSPORT
MECHANISMS
• Simple diffusion – 02 and CO2 transport occurs due to the
difference between partial pressures on both sides. Ffatty
acids are also transported by means of simple diffusion.
• Secondary active transport – amino acids are transferred
mostly as linked carriers.
• Pinocytosis – Placenta is Impermeable to proteins, only
IgG is transported.
• Bulk transport – Water and electrolytes moves across bulk
flow.
17. FACTORS AFFECTING PLACENTAL
TRANSFER OF DRUGS
• Lipid solubility – The placental membrane is freely
permeable to lipid soluble substances, which undergo
flow dependent transfer. Higher the lipid solubility , higher
the transfer of drugs.
• Molecular weight – Drugs with smaller molecular weight
diffuse easily (<600da)
• Degree of ionization – Ionized form will not cross the
barrier easily. The degree of ionization of acidic drugs is
greater on the maternal side and lower on the fetal side.
• Protein binding – protein bound drugs will not diffuse
easily, only free drug would cross the placental barrier
easily. Acidosis reduces the protein binding of local
anaesthetic. Reduced albumin concentration increases
the proportion of unbound drug
18. ANAESTHETIC DRUGS
Opioids – All opioids cross the placenta in significant
amounts. They are weak bases, bound to α-glycoprotein.
Pethidine – Longer half life is due to its active metabolite
norpethidine, which may lead to respiratory depression in the
neonate.
Morphine – It is poorly lipid soluble but readily crosses the
placenta due to low protein binding.
Fentanyl – It is highly lipid soluble and albumin bound, so
crosses the placental barrier easily.
IV Induction agents – Sodium thiopentone is highly lipid
soluble, weakly acidic, 75% protein bound and less than 50%
ionized at physiological pH. It crosses the placenta easily.
Propofol – It is highly protein bound and lipophilic.
19. Inhalational Agents – These agents are highly soluble with low
molecular weights.
Muscle relaxants – These are quaternary ammonium compounds
and fully ionized. These drugs are fully ionized as well as have
low lipid solubility, hence they do not cross the placenta.
Local Anaesthetics – These drugs have low molecular weights
and also are lipid soluble. Different drugs have different protein
binding.