pulmonary hypertension and it pathophysiology. pre operative, intraoperative and post operative complications and anesthetic management.
drugs that can be used in anesthetic management of pulmonary hypertensiom
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.
Pulmonary Arterial Hypertension: The Other High Blood Pressure and its association with scleroderma is presented by
Micheal J. Cuttica MD, MS, Assistant Professor of Medicine, Director; Northwestern Pulmonary Hypertension Program, Northwestern University
PowerPoint presentation describing various aspects of Pulmonary Hypertension. Please mail me your feedback on this presentation to following Email ID: tinkujoseph2010@gmail.com.
DIAGNOSIS & MANAGEMENT OF PULMONARY HYPERTENSIONKamal Bharathi
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.
lung transplant for covid patients. selection criteria. challenges in covid 19 patients. short term outcomes for patients operated for covid 19 ards. recommendations in covid 19 lung transplant
anaesthesia for lung transplant. indication and contra indication for lung transplant. intra-op and post op complications of lung transplant,
post op pain relief for lung transplant. patient selection for lung transplant. donor criteria for lung donor
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
anaesthesia Breathing circuits and its classification and functional analysisprateek gupta
anaesthesia breathing circuits. mapleson circuits. classification of circuits. functional analysia of circuits. draw over circuit. advantages and disadvantages of different circuits.
Basic principles of MRI machine. effect of mri on monitoring equipments in anesthesia. modes of anesthesia for MRI procedures.safety measures to be taken for MRI procedures
diagnostic criteria and pathophysiology of hellp syndrome. Its anesthetic management both pre-operatively and post operatively. complication and differential diagnosis of hellp
amniotic fluid embolism and cardiac arrest in pregnancyprateek gupta
obstetric emergency. amniotic fluid embolism-pathophysiology,clinical presentation, diagnosis, treatment, laboratory investigations and prognosis. cardiac arrest in preganacy and ACLS 2015 guidelines for CPR and new updates
colloids with their properties and their benefits and disadvantages . indications for colloids. types of colloids and their effect on volume expansio.various studies done for colloids. body fluid compartments and distribution of total body water.
neuromuscular monitoring. different types of stimulation. patterns in both non- depolarizing and depolarizing blocking agents.various tools to assess the degree of block
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.
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.
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
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
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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!
2. • Pulmonary circulation is a high flow,
low resistance circuit capable of
accommodating the entire right
ventricular output at one-fifth the
pressure of the systemic circulation
3. DEFINITION
• Pulmonary hypertension can be defined by
echocardiography or by cardiac
catheterization.
• Pulmonary hypertension is suspected when
systolic pulmonary arterial pressure is >40
mmHg by echocardiography.
• It is confirmed by cardiac catheterization
when mPAP>25 mmHg at rest or >30
mmHg with exercise
• A mean pulmonary artery pressure of 8 to
20 mmHg at rest is considered normal,.
4. • Pulmonary arterial hypertension
(PAH) is defined as:
1 – Pulmonary hypertension.
2 – Pulmonary capillary wedge
pressure PCWP < 15 mmHg.
3 – Pulmonary vascular resistance
PVR > 3 woods units (240 dynes. sec.
cm-5).
5. CLASSIFICATION
• Pulmonary arterial Hypertension (PAH)
• Pulmonary hypertension owing to left heart
disease
• Pulmonary Hypertension owing to lung
disease
• Chronic thromboembolic pulmonary
hypertension (CTEPH)
• Pulmonary hypertension with unclear
multifactorial mechanisms
19. CXR
• Enlargement of the main, right and left
pulmonary arteries
• Main PA diameter > 29 mm, right PA > 16
mm and left PA > 15 mm
• Tapering of the pulmonary vasculature
(‘peripheral pruning’)
• Heart size - normal or enlarged e.g. right atrial
contour
• Underlying causes, e.g. COPD, cardiac disease
• Loss of aortico-pulmonary window
24. Echo Features of Pulmonary Hypertension
Right ventricular hypertrophy
Significant tricuspid regurgitation - Using TR jet estimated RVSP is 4V2 + RAP
Right atrial enlargement
Right ventricular enlargement/dilatation - D-shaped LVon short axis
Right ventricular dysfunction
Pulmonary regurgitation - Using PR jet estimated PAEDP is 4V2 + RAP
Reduced RV outflow tract velocity, short acceleration time
Dilated IVC not collapsing with respiration (if patient not ventilated)
Patent foramen ovale (bubble contrast used)
Pericardial effusion
Dilated pulmonary arteries
25. Goals of therapy
• Reduce pulmonary artery pressure
• Reduce pulmonary vascular resistance
• Improve RV function
• Improve CI
• BEFORE RV failure becomes irreversible
• Maintain adequate preload
• Maintain SVR
• Avoid acidosis, hypercapnia,
hypothermia, hypoxia
26. Lifestyle modifications
• Na restrictions
• Abstinence from smoking
• Avoid high altitude
• Avoid exertion in settling of free or
frank syncope
29. Medical Therapy for PH
• Treat hypoxia and left heart failure
• Diuretics if right heart failure
• Calcium channel blockers
– Diltiazem if HR > 100 bpm
– Nifedipine if HR < 100 bpm
• Prostacyclin analogs (mortality benefit in
chronic)
– iv epoprostanol, inhaled iloprost, s/c Trepostinil
• Phosphodiesterase (PDE-5) inhibitors
– Sildenafil, Tadalafil
• Endothelin receptor antagonists e.g. Bosentan
• Nitric oxide (inhaled, continuous)
30. ANESTHETIC MANAGEMENT OF PH.
PH is a serious condition perioperative mortality
of 7-24%.
Peri-operative morbidity 14–42% includes:
Respiratory failure
Heart failure, dysrhythmias
Sepsis,
Renal insufficiency,
Myocardial infarction.
31. PRE OPERATIVE EVALUATION
Patient with established PH should be based on a risk
assessment :
Functional state
Severity of the disease
Type of surgery.
32.
33. Prognostication in Group
1 (PAH)
Determinant Low risk (good prognosis) High risk (bad prognosis)
Clinical RV failure NO YES
WHO functional class II/III IV
6 min walk distance > 400m < 300m
CPET results VO2 max > 10.4 ml/kg/min VO2 max < 10.4 ml/kg/min
Echo Minimal RV dysfunction Pericardial effusion
RV enlarged or dysfunction
RA enlarged
Haemodynamics RAP < 10 mmHg
CI > 2.5 L/min/m2
RAP > 20 mmHg
CI < 2.0 L/min/m2
BNP Minimal elevation Significant elevation
McLaughlin VV, McGoon MD. Pulmonary arterial hypertension. Circulation. 2006;114:1417–31.
35. PREOPERATIVE
MANEGMENT
Ideally before surgery, mean PAP should be reduced to a normal of
25 mm Hg.
If substantial RV dysfunction is present, the advisability of surgery
should be reexamined.
Any chronic pulmonary hypertensive therapies that patients
are currently taking should be continued perioperatively to
avoid rebound PH
Short acting anticoagulant like heparin should replace
indirect anticoagulant until the surgical procedure.
Avoid anxiety, pain, and sympathetic stimulation.
Avoid over sedation and hypoventilation.
Antibiotic prophylaxis must be given.
37. • Intraoperative “basic treatment” to
avoid an increase of pulmonary
• arterial pressure:
“Luxury”-oxygenation with inspiratory
FiO2 0.6 – 1.0
Moderate hyperventilation (goal: PaCO2
30-35 mmHg)
Avoidance of metabolic acidosis (pH >
7.4)
Recruitment-manoeuver to avoid
ventilation/perfusion-mismatch.
38. Low-tidal-volume ventilation to avoid
over-inflation of aveoli (goal: ml/kg
ideal body weight)
Temperature management to maintain
body temperature of 36-37°C
“Goal-directed” fluid- and volume-
therapy with hemodynamic
monitoring
39. INTRAOPERATIVE
MANAGEMENT
Optimize RV function and CO with adequate preload, SVR,
and avoid contractility, avoid myocardial depressants
Consider pulmonary vasodilators to decrease RV afterload
Maintain sinus rhythm.
It is good practice to remove air from intravenous syringes
and lines
42. Regional anesthetic techniques:
Not impairing spontaneous breathing
postoperative analgesic therapy
Nearly all patients with pulmonary hypertension receive
continuous anticoagulant therapy;
In severe PH or in diseases affecting the lung, patients
cannot be subjected to remaining in a flat position for
long period of time.
Regional anesthesia combined with careful GA to
ensure adequate oxygenation.
ANESTHETIC TECHNIQUES
43. GENERAL ANESTHESIA
the main advantages are
Safe oxygenation ,
uncomplicated airway management, and
intraoperative selective pulmonary vasodilation can
– if necessary – easily be administered through
the breathing circuit.
44. GENERAL
ANESTHESIA
All standard induction anesthetics can be used in
combination with opioids, as they have no influence on
pulmonary vascular resistance and oxygenation.
Ketamine may PVR due to catecholamine effect. However
patients with RV failure may be catecholamine depeleted.
Histamine-releasing muscle relaxants (atracurium ,
mivacurim) should be avoided for patients with PH,
PVR.
45. Volatile anesthetic agents of concentrations up to
1 MAC can be administered without any negative
effects on pulmonary pressure and resistance.
Nitrous oxide better avoided as it may raise PVR.
So use balanced technique, mixing higher doses of
opioids and low-dose volatile anesthetic agents
,careful with stress response during intubation.
46. • Inhaled nitric oxide (NO): Potent, rapidly
acting and selective pulmonary
vasodilator. it activates the enzyme
guanylate cyclase
• Milrinone/Amrinone (phosphodiesterase
III inhibitor): 50 mcg/kg bolus of
milrinone followed by a perfusion of 0.5-
0.75 mcg/kg/min.
• Dypiridamole: 0.2-0.6 mg/kg
intravenously over 15 min; to be
repeated every 12 hours.
47. • -Inhaled prostacyclin or iloprost: Two
modalities of application
• 1. Intermittent administration: 50
mcg is diluted in 50 ml saline and
nebulized in 15 min, which aerosolizes
a dose between 14 and 17 mcg. This
treatment must be repeated every
hour.
• 2 Continuous administration at a
concentration of 50 ng/kg/min.
48. • Prostaglandin E1 (alprostadyl) and
prostacyclin (PGI2):. They activate
adenylate cyclase to increase camp.
Prostacyclin, 1.5 mg, can be dissolved in
100 ml sterile glycine buffer (final
concentration, 15 mcg/ml);
• administered by means of an inline
nebulizer connected to the inspiratory
line.
• can be infused intravenously at a dose
between 2 and 10 ng/kg/min.
49. • . Epinephrine and norepinephrine31
have been used to treat persistent
systemic hypertension;
norepinephrine has the advantages
of being both a vasoconstrictor and a
positive inotropic agent. This
medication should be titrated
according to the clinical response.
50. • Nitroglycerine
• Dobutamine: is a beta agonist. It stimulates
cyclic adenosine monophosphate (cAMP). It
may induce arrhythmias and increase
oxygen demand.
• Isoproterenol: nonselective beta agonist that
causes pulmonary and peripheral
vasodilatation. It should be gradually
reduced because PVR may return quickly to
elevated baseline levels after discontinuation
51.
52. During Extubation:
Maintaining haemodynamic stability and adequate
ventilation can be difficult.
Deep extubation
May decrease SVR, contractility
Hypoxia and hypercarbia will increase PVR
Awake extubation
Can cause severe pulmonary vasoconstriction
Need tube tolerance without increased sympathetic
tone
Patient may need post-op ventilation with ICU
admission
53. postoperative monitoring until pulmonary pressures
and right-sided heart functions have stabilized at
the preoperative level.
sufficient analgesic therapy in the form of continuous
regional anesthesia
The specific therapy for PH should be resumed
at the preoperative dosage as soon as
possible.
In the postoperative course, it is also advisable to
treat pressure elevations.
Post operative management
54. laparoscopy
• An increase in end tidal carbon dioxide.
Acidosis, arrhythmias ,decrease preload PH
crisis.
• post operative benefits of laparoscopic surgery
must be balanced with intraoperative risk
involved.
• IAP to be maintained at 10-12 mm of Hg.
• CO2 insufflation slow rate to attenuate
abdominal stretch response
• Combined general with epidural anaesthesia
decreasing intraoperative anaesthetic
requirement.