Preoperative investigations and significance.
Dr.Moyukh Chowdhury, MBBS
Indoor Medical Officer,
Department of Surgery,
Sylhet Women's Medical College & Hospital,
Bangladesh .
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
anesthesia is a vast area for study . to make it simple for paramedics some important rules of anesthesia are explained in the most simplest way. rules of anesthesia can very as per the type of anesthesia.
Preoperative investigations and significance.
Dr.Moyukh Chowdhury, MBBS
Indoor Medical Officer,
Department of Surgery,
Sylhet Women's Medical College & Hospital,
Bangladesh .
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
anesthesia is a vast area for study . to make it simple for paramedics some important rules of anesthesia are explained in the most simplest way. rules of anesthesia can very as per the type of anesthesia.
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.
This slide presentation covers areas about physiology of respiratory system related to surgery and anaesthesia, definition of postoperative pulmonary complications (PPCs), risk of PPCs, screening for PPC risk and specific management for patients with increased risk.
Hypertensive disorders of pregnancy constitute a leading cause of maternal and perinatal morbidity and mortality worldwide.
Hypertensive crisis is an obstetric emergency that can occur at any time during treatment regardless of history and diagnosis
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
Similar to preoperative evaluation for residents of anesthesia part 2 (20)
Post cardiac arrest brain injury Jan 2023.pptxmansoor masjedi
Post cardiac arrest period is a critical period after return of spontaneous circulation . Optimal care and management is associated with best outcome with least neurological devastating sequella.
Optimal chest compression point , Does one size fit all 0- Dr Masjedi.pptxmansoor masjedi
Cardiopulmonary resuscitation is a life saving process . over years it has undergone changes most prominently in the field of chest compression because high quality chest compression deeply affects outcomes . Chest compression point plays a important role in this regard . Guidelines has changed little in this fundamental part of high quality CPR although ever increasing data denotes its utmost importance .
Challenges in optimal thromboprophylaxis dose in COVID 19 ICU patients.PPTXmansoor masjedi
COVID 19 global epidemy was associated with a lot of unresolved entities amongst them , thromboprophylaxis . This presentation encompasses a brief review of this important aspect of COVID 19 .
Complications & troubleshooting in continuous renal replacement therapymansoor masjedi
Acute kidney injury is a common and important issue in critical care patients . Among different extra corporeal supporting modalities , continuous renal replacement therapy is a common selection especially in unstable conditions . As any other intervention , there are some related complications that should be diagnosed and treated as early as possible .
Diagnostic imaging in COVID 19 pts in intensive care unitsmansoor masjedi
In the era of COVID19 , early diagnosis , ruling out other differential diagnosis , determination of its severity , monitoring the course of the disease , prediction of outcome and response to treatment are so important . CT scan and ultrasound could help physicians in this way . This presentation is part of an international webinar discussing this entity .
Point of critical care Ultrasound play a pivotal role in management of critically ill patients admitted in ICU . Its usage in this regard is ever growing . Here we discus about pearls and pitfalls of POCUS in Intensive care medicine.
A case based approach to the treatment of sepsis in critical caremansoor masjedi
sepsis is the leading cause of death in intensive care units Emergence of multi drug resistance micro organisms should be suspiciously considered early in critically ill patients .
ECMO and its emerging role in trauma ICU 15th ECCC Dubai April 2019mansoor masjedi
Although there are some special considerations & important obstacles , extra-corporeal life support is increasingly used in multiple trauma patients admitted in ICU , with acceptable results.
As a newly emphasized modality to treat infectious complications and also to folloew non-antibiotic regimens against infection, Probiotics has recieved more and more attention now a days.
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
6. Asthma
A chronic inflammatory disease characterized by
obstruction of the airways that is partially or
completely reversible with Rx or spontaneously
Patients with mild, well-controlled asthma have no
greater risk associated with anesthesia and surgery
than normal individuals do
7. Asthma
O2 saturation by pulse oximetry is useful
ABG only in severe acute exacerbation
DDx. of Wheezing
COPD
GERD
Vocal cord dysfunction
Tracheal or bronchial stenosis
Cystic fibrosis
ABPA
Heart failure
8. Asthma
Spirometry is the preferred diagnostic test, but a normal
result does not exclude asthma (strong suspicion →
methacholine challenge test or a trial of bronchodilator
therapy )
PFTs have no perioperative predictive value but in rare
instances may be useful to gauge the severity of disease or
the adequacy of therapy
Preop Chest X-ray is necessary only for evaluation of
infections or pneumothorax
9.
10. COPD
Presence of symptoms on most days for at least 3
months for 2 successive years
oror
recurrent excessive sputum that severely impairs
expiratory airflow
An acute exacerbation is defined as an increase
in symptoms that requires a change in
management
11. COPD
FEV1↓ , FVC↑ , DLCO↓
PFT :not shown to predict periop outcome
C-xray : useful only when infection is suspected
ECG show: RAD , RBBB, or peaked P waves
12. Restrictive pulmonary disorders
Pulmonary : lung resection , pulmonary fibrosis, ILD
Extrapul. : kyphoscoliosis , obesity , AS , Myasth.gravis,
pleural efusion, Pneumothorax
FEV1 and FVC are reduced proportionally, so the ratio
is normal
13. Dyspnea
Chronic dyspnea of unclear etiology ,4 major DDx.:
asthma
COPD
interstitial lung disease
cardiac dysfunction
14. Dyspnea
Hx. & P/E → accurate dx in 2/3 of cases
Initial testing may include:
ECG
Htc (to exclude anemia)
ABG
TFT
C-xray
Spirometry
oximetry at rest and while walking several feet
BNP levels may be useful.
Heart failure : BNP >400 pg/mL
PTE & cor pulmonale :BNP between 100 - 400 pg/mL
16. Prescriptions for antibiotics, bronchodilators, and
steroids, referral to pulmonologists or internists, and
postponing surgery are important in patients at high
risk
17.
18. Pulmonary Hypertension
Persistent Mean PAP> 25 mm Hg with a PAOP <15 mm
Hg
Occult PH is more problematic than fully recognized
disease because symptoms may be attributed to other
diseases and periop decompensation may occur
unexpectedly
Patients with PAH have a high rate of periop morbidity
and mortality
19. Pulmonary Arterial Hypertension
Primary pulmonary hypertension
Sporadic
Familial
Associated with
Collagen vascular disease
Congenital shunts
Portal hypertension
HIV
Drugs/toxins
Persistent pulmonary hypertension of the newborn
Pulmonary Venous Hypertension
Left-sided heart disease
Extrinsic compression of central pulmonary veins
Pulmonary veno-occlusive disease
Pulmonary Hypertension Related to Lung Disease or Hypoxemia
Chronic obstructive pulmonary disease
Interstitial lung disease
Sleep-disordered breathing
Neonatal lung disease
Chronic exposure to high altitude
Pulmonary Hypertension Caused by Chronic Thromboembolic Disease
Pulmonary thrombosis or embolism
Sickle cell disease
Pulmonary Hypertension from Disorders Directly Affecting the Pulmonary
Vasculature
Schistosomiasis
Sarcoidosis
20. Pulmonary Hypertension
Signs and symptoms of disease severity include:
• Dyspnea at rest
• Metabolic acidosis
• Hypoxemia
• Right HF(peripheral edema, hepatomegaly, ↑JVP)
• Hx of syncope
Echo : screening test of choice
ECG: RAD, RBBB, RVH, tall R in V1 & V2,
P pulmonale (leads II, III, aVF, and V1)
21. Smokers and Those Exposed to Second-Hand Smoke
Active and passive smokers
↑ risk of periop resp. complications
Soon after a patient quits smoking
carbon monoxide ↓
Cyanide ↓
Lower nicotine levels improve
vasodilation
many toxic substances that impair
wound healing decrease
Buproprion or clonidine should be started
1 to 2 wks before an attempt at quitting;
nicotine replacement therapy is effective
immediately
24. Diabetes Mellitus
In the United States, 20 million diabetics ,
with 1 million new each year
Females twice as commonly as in males
Diabetic without known CAD or angina = a
nondiabetic with a previous MI for the risk
of myocardial ischemia or cardiac death
Autonomic neuropathy is the best predictor
of silent ischemia
Aggressive management of hyperglycemia
decreases postop complications
25. Diabetes Mellitus
The combination of HTN, diabetes, and age >55 yr accounts
for more than 90% of pts with renal insufficiency
Screening for kidney disease is accepted
Poorly controlled diabetes →risk for the development of stiff
joint syndrome→reduced cervical mobility → Diff. Airway ?
ECG ,electrolytes, BUN, Cr. , and BS is recommended for all
diabetic patients
Target FBS <110 mg/dL in noncritically ill hospitalized patients
29. Renal Disease
Chronic kidney disease (CKD) : GFR <60 mL/min/1.73
m2) for at least 3 months or significant proteinuria
CRF : GFR < 15 mL/min/1.73 m2
ARF: Urine output <0.5 mL/kg/hr
ESRD :loss of renal function ≥ 3 mo
CKD : a significant risk factor for cardiovascular
morbidity and mortality (considered to be equal to
angina, MI, or a history of known CAD)
30. Renal Disease
Valvular heart disease is common in pts undergoing maintenance
dialysis
Pulmonary hypertension and increased cardiac output occur in many
patients with an arteriovenous fistula
Preexisting renal insufficiency + diabetes + contrast medium → risk of
renal failure may be as high as 12% to 50%.
ACEIs and ARBs prevent deterioration in patients with diabetes or renal
insufficiency but may worsen function during hypoperfusion states
LMWHs are cleared by the kidneys and are not removed during dialysis
31. All Forms of Liver Disease
bilirubin >2.5 mg/dL → icterus can be seen in
mucous membranes and sclerae
Reduction of ascites preop→ ↓risk of wound
dehiscence and improve pulmonary function
Na restriction (in diet and IV solutions), diuretics
(esp. spironolactone, which inhibits aldosterone), and
even paracentesis are useful.
32. Coagulopathies
Prolonged PT (without a hx of warfarin)→ the most
common cause is lab. error, liver disease, or
malnutrition
Prolonged aPTT can result from both hypocoagulable
and hypercoagulable cond.
The most common cause of a prolonged aPTT other
than heparin exposure is vWD
33. Thrombocytopenia
Surgery can be performed safely in patients with
platelet >50,000/mm3
Centroneuraxial anesthesia is safe with plt
>100,000/mm3
34. Thrombocytosis
Plt >500,000/mm3 and may be:
physiologic (exercise, pregnancy)
primary (myeloproliferative disorder)
secondary (iron deficiency, neoplasm, surgery, chronic
inflammation)
Plt >1,000,000/mm3 →risk for thrombotic events such as
stroke, MI, pulmonary and mesenteric emboli, and
peripheral arterial and venous clots
35.
36. Neurologic Diseases
Preop evaluation focuses on
the pulmonary system and degree of disability,
especially dysphagia and dyspnea.
Determination of room-air saturation and
orthostatic BP and HR is important
37.
38. URTI & anaesthesia
Mild symptoms - can usually proceed
huge inconvenience to patient if cancelled
Severe symptoms (purulent secretions, productive cough, T > 38°C, or
signs of pulmonary involvement)
Postpone 4 wks
Intermediate severity - ?
? risk of increased bronchial reactivity
Additional risk factors :hx of asthma, need for intubation, surgery on
the airway, smoking hx, and a hx of prematurity in pediatric patients
Dr. Andrew Ferguson
39. Preoperative Evaluation of
Morbidly Obese Patients
Obesity
Present difficult intubation.
Perioperative basal lung collapse leading to
postoperative hypoxia.
History of sleep apnoea may lead to post-operative
airway compromise.
Ideally obese patients should lose weight
preoperatively, and co-existent diabetes and
hypertension stabilised
40. Preoperative Evaluation of Patients with Allergies
Anaphylactic and
anaphylactoid reactions
during anesthesia =1 in 6000
Muscle relaxants :69%
latex (12%) and
Antibiotics (8%)
41.
42.
43.
44.
45.
46.
47. Fasting Guidelines
Time before anaesthesia Food or fluid intake
Up to 8 hours Unrestricted
Up to 6 hours Light meal
Up to 4 hours Breast milk
Up to 2 hours Clear liquids only (no solids, no fat)
2 hours pre-anaesthesia Nothing permitted
Dr. Andrew Ferguson
48.
49. Preoperative Planning for
Postoperative Pain Management
Pain Relief
Method of postoperative analgesia should be in mind.
Allows deep breathing and coughing and
mobilisation.
Prevent secretion retention and lung collapse.
Reduces the incidence of postoperative pneumonia.
Epidurals appear particularly good at this for
abdominal and thoracic surgical procedures.
50.
51.
52.
53.
54.
55.
56. Preoperative consultation
Risk stratification
Risk modification
planning periop pt management
Ideally, the medical consultants who are part of the
periop evaluation should be the same individuals who
provide continuing care for the pt.
57. What is the diagnosis? How was it determined?
Are additional studies required for a more precise
determination?
Is the patient's condition optimized?
Should any specific recommendations be made for
postop management and follow-up?