Dr. Ankita Patil and Dr. Neharica Seth discuss the goals and process of pre-anesthetic evaluation, which includes assessing a patient's medical history and physical health to ensure they can safely undergo anesthesia and mitigate perioperative risks. The evaluation involves examining all major organ systems and functions, as well as ordering relevant tests and developing a plan for managing any issues. The overall aim is to optimize patient safety and outcomes through informed risk assessment and treatment prior to surgery.
Preanesthetic evaluation of patients in oral and maxillofacial surgeryPunam Nagargoje
The word is derived from the Greek words an, which means “without” and aithesia which means “feeling”
The use of medical anesthesia was first reported in 1846
The development of anesthesia has made today’s modern surgical techniques possible
• Basic Principles of Anesthesia
• “Triad of General Anesthesia”
need for unconsciousness
need for analgesia
need for muscle relaxation and loss of reflexes
• Preoperative Evaluation
• The preanesthetic evaluation has specific objectives including:
- Establishing a doctor-patient relationship,
- Becoming familiar with the surgical illness and
- coexisting medical conditions,
- Anticipating potential complication
Developing a management strategy for perioperative anesthetic care,
- Obtaining informed consent for the anesthetic plan.
The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.
• Pre-operative
This applied both in evaluation & investigations
• General
This include the following:
1-General condition of the patient.
2-Psychological condition. ( Specially in major operations).
• Specific
This include the following:
1-Related to anaesthesia.
2-Related to the surgery.
• Medical History
1. Review the chart
2. Review previous records
3. Interview the patient
• Demographic Data
Height / weight
Vital signs
Diagnosis
History and Physical Exam
Note any abnormalities
Don’t assume that all problems are listed
• Steps of the preoperative visit :
• Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.
• Pre-op Testing Schema Example
• Preoperative Laboratory Testing:
• only if indicated from the preoperative history and physical examination.
• "Routine or standing" pre operative tests should be discouraged
• -CBC anticipated significant blood loss, suspected hematological disorder (eg.anemia, thalassemia, SCD), or recent chemotherapy.
• -Electrolytes diuretics, chemotherapy, renal or adrenal disorders
• -ECG age >50 yrs ,history of cardiac disease, hypertension, peripheral vascular disease, DM, renal, thyroid or metabolic disease.
• -Chest X-rays prior cardiothoracic procedures ,COPD, asthma, a change in respiratory symptoms in the past six months.
• -Urine analysis DM, renal disease or recent UTI.
• -tests for different systems according to history and examination
• Disease-based indications
Alcohol abuse
CBC, ECG, lytes, LFTs, PT
Anemia
CBC
Bleeding disorder
CBC, LFTs, PT, PTT
Cardiovascular
CBC, creatinine, CXR, ECG, lytes
• Disease-based indications
Cerebrovascular disease
Creatinine, glucose, ECG
Diabetes
Creatinine, electrolytes, glucose, ECG
Hepatic disease
CBC, creatinine, lytes, LFTs, PT
• Disease-based indications
Pregnancy (controversial)
Serum B-hCG- 7 days, Upreg 3 days
Pulmonary disease
CBC, ECG, CXR
Renal disease
CBC, Cr, lytes, ECG
RA
CBC, ECG, CX
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
Preanesthetic evaluation of patients in oral and maxillofacial surgeryPunam Nagargoje
The word is derived from the Greek words an, which means “without” and aithesia which means “feeling”
The use of medical anesthesia was first reported in 1846
The development of anesthesia has made today’s modern surgical techniques possible
• Basic Principles of Anesthesia
• “Triad of General Anesthesia”
need for unconsciousness
need for analgesia
need for muscle relaxation and loss of reflexes
• Preoperative Evaluation
• The preanesthetic evaluation has specific objectives including:
- Establishing a doctor-patient relationship,
- Becoming familiar with the surgical illness and
- coexisting medical conditions,
- Anticipating potential complication
Developing a management strategy for perioperative anesthetic care,
- Obtaining informed consent for the anesthetic plan.
The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.
• Pre-operative
This applied both in evaluation & investigations
• General
This include the following:
1-General condition of the patient.
2-Psychological condition. ( Specially in major operations).
• Specific
This include the following:
1-Related to anaesthesia.
2-Related to the surgery.
• Medical History
1. Review the chart
2. Review previous records
3. Interview the patient
• Demographic Data
Height / weight
Vital signs
Diagnosis
History and Physical Exam
Note any abnormalities
Don’t assume that all problems are listed
• Steps of the preoperative visit :
• Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.
• Pre-op Testing Schema Example
• Preoperative Laboratory Testing:
• only if indicated from the preoperative history and physical examination.
• "Routine or standing" pre operative tests should be discouraged
• -CBC anticipated significant blood loss, suspected hematological disorder (eg.anemia, thalassemia, SCD), or recent chemotherapy.
• -Electrolytes diuretics, chemotherapy, renal or adrenal disorders
• -ECG age >50 yrs ,history of cardiac disease, hypertension, peripheral vascular disease, DM, renal, thyroid or metabolic disease.
• -Chest X-rays prior cardiothoracic procedures ,COPD, asthma, a change in respiratory symptoms in the past six months.
• -Urine analysis DM, renal disease or recent UTI.
• -tests for different systems according to history and examination
• Disease-based indications
Alcohol abuse
CBC, ECG, lytes, LFTs, PT
Anemia
CBC
Bleeding disorder
CBC, LFTs, PT, PTT
Cardiovascular
CBC, creatinine, CXR, ECG, lytes
• Disease-based indications
Cerebrovascular disease
Creatinine, glucose, ECG
Diabetes
Creatinine, electrolytes, glucose, ECG
Hepatic disease
CBC, creatinine, lytes, LFTs, PT
• Disease-based indications
Pregnancy (controversial)
Serum B-hCG- 7 days, Upreg 3 days
Pulmonary disease
CBC, ECG, CXR
Renal disease
CBC, Cr, lytes, ECG
RA
CBC, ECG, CX
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
2. Pre Anaesthetic Evaluation
• Defnition
The process of clinical assessment that precedes the delivery of
anesthesia care for surgery and for non-surgical procedures.
• Preoperative evaluation is an integral component of the
anesthesiologists’ role as perioperative physicians who are involved in
integrated medical care before, during, and after surgery
3. Goals and Benefits of PAC
• To ensure that the patient can safely tolerate anesthesia for the planned surgery.
• Mitigate perioperative risks
• Better document comorbid illness
• Reduce the patient’s (and family’s) anxiety through education
• Optimize preexisting medical conditions
• Order specialized investigations
• Initiate interventions intended to decrease risk
• To discuss aspects of perioperative care (e.g.anticipated risks, fasting guidelines),
• To arrange appropriate levels of postoperative care
• To predict the difficulty during intubation
• To obtain informed consent
4. Clinical examination
1. Medical History
2. Physical examination
Medical history
Planned surgery and its indication
Current known medical problems and past medical issues
Diseases or symptoms their associated severity, stability, associated
activity limitations, exacerbations (current or recent), prior treatments, and planned
interventions
Previous surgeries, anesthesia types, and anesthesia-related complications
Prescription and over-the-counter medications should be documented, along with
their dosages and schedules
5. any allergies to medications and other substances
Addictions-tobacco,alcohol,drugs consumption
smoking history
Pack year :No. cigarettes smoked per day x years smoked /20
20 pack years is considered as a significant factor for developing COPD
Family history: personal or family history of pseudocholinesterase deficiency and
malignant hyperthermia (including a suggestive history such as hyperthermia or
rigidity during anesthesia) must be clearly documented to facilitate appropriate planning
before the day of surgery. Information from previous anesthetic records may clarify an
uncertain history
Menstrual history: LMP
6. ASSESSMENT OF FUNCTIONAL CAPACITY
• Assessment of the patient’s cardiopulmonary fitness or functional capacity is an
integral component of the preoperative clinical examination
• Functional capacity is typically quantified in using the metabolic equivalent of task
(MET)
• One metabolic equivalent of task (MET) is the amount of oxygen consumed while
sitting at rest, and is equivalent to an oxygen consumption of 3.5 mL/min/kg body
weight.
• Value :- 1 – 12
(Light – Moderate – Vigorous)
7.
8. Dukes activity status index
• 1-4 METS ( eating,dressing ,walking around the house,dish washing)
• 5-9METS ( Climb a flight of stairs ,walk one or 2 blocks on level ground,run a short
distance,moderate activites like golf,dancing )
• >10 METS ( sternous sports (swimming ,bicycle,tennis),heavy professional
domestic work
9. PHYSICAL EXAMINATION
GPE – Weight,Height, BMI
Higher mental function
Built
Nutritional Status
Nails :Cyanosis, Clubbing
Conjunctiva
Sclera ( Jaundice)
Back & Spine
Edema
Gait
Vital Signs – BP
Pulse
RR
Temperature
10. Airway examination
Pt is asked about:-
• Artificial Dentures
If yes it must be either removed / protected during the course of anesthesia
• Teeth ( Loose, Cracked, Chipped, Capped)
• Mouth opening
• Jaw Joint ( if it clicks, pops or hurts)
Maybe TM joint syndrome accompanied by chronic pain / repeated dislocation of
jaw.
• Snoring (Predictor of difficult intubation)
• Day time sleep (Somnolence) ( Sleep Apnea)
11.
12. MALLAMPATI CLASSIFICATION
• Class I: soft palate, tonsillar fauces,
tonsillar pillars, and tip of uvula
visualized
• Class II: soft palate, tonsillar fauces,
and uvula visualized
• Class III: soft palate and base of uvula
visualized
• Class IV: only hard palate visualized
Class III and IV→ Difficult to
Intubate
13. DIFFICULT MASK VENTILATION
Predictors
• Age more than 55 years,
• BMI more than 26 kg/m2
• Absence of teeth
• Presence of a beard
• History of snoring
Others
• increased neck circumference
• face and neck deformities (i.e., prior surgery, prior radiation, prior trauma, congenital abnormalities)
• Rheumatoid arthritis-cervical spine is often affected-atlanto axial instability
• Trisomy 21 (Down syndrome)-microstomia,macroglossia,atlanto axial instability and sublaxation
• scleroderma -autoimmune condition causing fibrosis of skin-contractures may be
seen,microstomia,mandibular bone resorption -difficult intubation and difficul vascular assess
• cervical spine disease, or previous cervical spine surgery
16. Cardiovascular system
• We need to check that the pt is having any the
following conditions or not : CHF
HTN
IHD
Cardiomyopathy
Valvular / Subvalvular ds
Arrhythmias
Atherosclerosis
• To assess CVS: the pt is asked about
-- Shortness of breath(at rest,sleep)
-- chest pain, chest tightness
-- Pedal edema
-- Previous Heart / Lung surgery
-- medication
17. Hypertension
• Blood pressure > 140/90 mmHg
• Measurement should be >2 times on different occasion
• Should be taken in both arms
• The goals of preoperative evaluation are to identify any secondary causes of
hypertension, presence of other cardiovascular risk factors (e.g., smoking,
diabetes mellitus), and evidence of end-organ damage.
• The physical examination should focus on vital signs, thyroid gland, peripheral
pulses, and cardiovascular system (including bruits and signs of intravascular
volume overload).
• Cancellation/ postpone case if BP > 180/110 mmHg
• Stop ACE inhibitor and ARBs and continue beta blocker and clonidine
18. NYHA CLASSIFICATION
• NYHA class I: no limitation of physical activity; ordinary activity not a
cause of fatigue, palpitations, or syncope
• NYHA class II: slight limitation of physical activity; ordinary activity
resulting in fatigue, palpitations, or syncope
• NYHA class III: marked limitation of physical activity; less than ordinary
activity resulting in fatigue, palpita_x0002_tions, or syncope; comfort at
rest
• NYHA class IV: inability to do any physical activity without discomfort;
symptoms at rest
19. Renal system
• The preoperative evaluation of patients with CKD should emphasize the cardiovascular
system, cerebrovascular system, intravascular volume status, and electrolyte status.
• The early stages of CKD typically cause no symptoms.
• The anesthesiologist should inquire about the cardiovascular systems (i.e., chest pain,
orthopnea, paroxysmal nocturnal dyspnea), urine output, associated comorbidities,
medications, dialysis schedules, and any hemodialysis catheter problems (e.g., infection,
thrombosis).
20. Hepatic system
• Most of the patients with liver disease will be asymptomatic
• Some may complain Fatigue, weight loss, dark urine, pale stools, pruritus, right
upper quadrant pain, bloating, and jaundice
• Physical Examination : jaundice, bruising, ascites, pleural effusions, peripheral
edema, hepatomegaly, splenomegaly, and altered mental status
• Past history of liver disease should be asked
21. ENDOCRINE SYSTEM
Endocrine disturbances & end organ effects of -
DM
Thyroid/Parathyroid
Pituitary
Adrenals
Can increase perioperative risk substantially.
* Pt is asked about
--waking up at night freq to urinate (DM)
--increased thirst (DM)
--increased perspiration than others (Pheochromocytoma)
--Headache (Pheochromocytoma)
--Feeling more cold/warm (hypo/hyperthyroid)
--Muscle cramps/spasm in legs >3 times a year (Thyroid)
22. • Diabetes
• Blood Sugar
– Normal :-
Fasting :- 70-100 mg %
PP :- less than 126 mg %
– Diagnostic Criteria :-
Fasting :- > 125 mg % or
Glucose tolerance test > 200 mg % (2 hr.)
Random :- 200 mg % or more with symptoms ( polyurea, polydypsia, unexplained
wt.loss)
• usual glycemic control, history of hypoglycemic episodes, current therapy, and the
severity of any end-organ complications should be documented
• physical examination
– evaluation of pulses
– skin breakdown
– joint (especially cervical spine) mobility
23. NEUROLOGICAL SYSTEM
Pt is asked about
-- h/o seizure / convulsion / stroke/fall/
head injury/head surgery
-- pin & needle sensation in arms & legs
-- Migraine
24. MUSCULOSKELETAL SYSTEM
Pt is asked about
-- h/o arthritis
-- low back pain
-- taking pain pills/pain shots in last 6 months
Examination of Back & spine:
-- Done to evaluate any congenital deformity/ kyphoscoliosis etc.
-- to assess whether spines are fused or not.
25. HEMATOLOGICAL SYSTEM
Pt is asked about
-- problem with blood clotting if any after minor cuts / bruise
-- H/O spontaneous bleeding
-- H/O blood transfusion
26. INVESTIGATION
• COMPLETE BLOOD COUNT, HEMOGLOBIN, AND HEMATOCRIT
• Typical clinical indications include
– history of increased bleeding
– hematologic disorders
– CKD
– chronic liver disease,
– recent chemotherapy or radiation treatment
– corticosteroid therapy
– anticoagulant therapy
– poor nutritional status
27. Renal function test
• clinical indications include
– diabetes mellitus
– hypertension
– cardiac disease
– potential dehydration (e.g., vomiting, diarrhea)
– anorexia
– bulimia
– fluid overload states (e.g., heart rate, ascites)
– known renal disease, liver disease
– relevant recent chemotherapy (e.g., cisplatin, carboplatin)
– renal transplantation
28. LIVER FUNCTION TESTING
• clinical indications include
– a history of hepatitis (viral, alcohol, drug-induced, autoimmune)
– jaundice
– cirrhosis
– portal hypertension
– biliary disease
– gallbladder disease
– hepatotoxic drug exposure
– tumor involvement of the liver
– bleeding disorders
32. Special Consideration For Thyroid
• indirect laryngoscopy
• ENT check up for vocal cords
• Recent TFT
• Possibility of difficult intubation
• Pre op tracheostomy consent for possible tracheomalacia
35. Conclusion
• Pre anaesthetic evaluation is the clinical foundation for guiding perioperative
patient management and it has the potential to reduce perioperative morbidity and
enhance patient outcome.
• The fundamental purpose of preoperative evaluation is to obtain pertinent
information regard_x0002_ing the patient’s medical history, formulate an
assessment of the patient’s perioperative risk, and develop a plan for any requisite
clinical optimization.
• The anesthesiologist is the perioperative medical specialist and thus is uniquely
positioned to evaluate the risks associated with anesthesia or surgery, discuss these
risks with the patient, and manage them perioperatively in collaboration with the
surgical team, referring physician, and other medical specialists