Spinal anesthesia involves injecting local anesthetic into the subarachnoid space to reversibly block sensory and motor function below the injection site. It has several advantages over general anesthesia for certain surgeries, providing anesthesia without airway manipulation. Common complications include hypotension from sympathetic blockade and post-dural puncture headache from a cerebrospinal fluid leak at the injection site. Proper patient positioning, choice of needle and drug, and fluid management can help reduce complications of this technique for lower abdominal, urogenital and lower extremity surgeries.
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurrent episodes of upper airway collapse during sleep, which can fragment sleep and cause daytime sleepiness. Risk factors include obesity, large neck size, and anatomical features that narrow the airway. Polysomnography is the gold standard test to diagnose OSA by measuring breathing patterns, oxygen levels, and brain waves during sleep. Left untreated, OSA is associated with increased risks of hypertension, heart disease, and stroke. Treatment involves lifestyle changes and devices like CPAP that maintain airway pressure during sleep.
This document provides information on obstructive sleep apnea (OSA), including its physiology, risk factors, symptoms, diagnosis, and treatment. OSA involves pauses in breathing during sleep due to upper airway collapse. It is diagnosed through an overnight sleep study that measures breathing, oxygen levels, and brain waves. A high number of breathing pauses or dips in oxygen (apnea-hypopnea index over 5) indicates OSA. Common symptoms include loud snoring, witnessed breathing pauses, and daytime sleepiness. Risk factors include obesity, large neck size, and family history. Treatment typically involves a CPAP machine to keep the airway open during sleep.
This document provides an overview of neurologic and neurosurgical emergencies that may present in the intensive care unit (ICU). It discusses altered consciousness, increased intracranial pressure, neurogenic respiratory failure, status epilepticus, acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, head trauma, and spinal cord injury. For each topic, it describes evaluations, potential causes, and management strategies.
Obstructive sleep apnea is a sleep disorder where breathing is disrupted during sleep due to the upper airway collapsing or narrowing. It involves cessation (apnea) or reduction (hypopnea) of breathing for 10 seconds or more. The condition is caused by a combination of anatomical narrowing of the airway and loss of muscle tone in the throat during sleep. Polysomnography is used to diagnose by measuring breathing, oxygen levels, and sleep stages. Treatment options include lifestyle changes, oral devices, surgery, and continuous positive airway pressure (CPAP).
Anesthesia for spinal cord injury and scoliosis030Atef Salama
The potential risk factors for POVL that are listed are:
- Obesity
- Long Prone Cases
- Anemia
- Pressure on the globe
- Hypotension
- Glaucoma
Cataracts is not a risk factor for POVL.
This document summarizes the post-operative course of a 16-year-old male who was admitted following a motor vehicle accident with multiple injuries including a head injury. On post-operative day 1, the patient was stable with no pain and normal vital signs. On post-operative day 2, the patient remained stable and comfortable with slightly dilated pupils on the right side. Potential differential diagnoses discussed include local anesthetic systemic toxicity, total spinal anesthesia, and brachial plexus injury resulting in Horner's syndrome.
3. Intra Cranial Pressure and nursing interventions.pptxHayatALAKOUM
ICP is the pressure inside the cranial vault comprised of brain tissue, CSF, and blood volume. Increased ICP occurs when the volume-pressure relationship becomes unbalanced. Signs of increased ICP include changes in level of consciousness, vital signs, pupillary changes, extraocular movements, and other neurological changes. Treatment focuses on decreasing ICP through interventions like hyperventilation, osmotic diuretics, corticosteroids, maintaining fluids and electrolytes, treating fever, and avoiding stimuli that increase ICP.
intracranial pressure nursing care processHayatALAKOUM
1) Intracranial pressure (ICP) is the pressure inside the skull and is comprised of brain tissue, cerebrospinal fluid, and blood volume. Increased ICP is defined as pressure over 15 mm Hg.
2) Signs of increased ICP include changes in level of consciousness, vital signs, pupillary changes, and extraocular movements.
3) Nursing interventions to decrease ICP include managing fluids and electrolytes, administering medications to reduce swelling such as mannitol and steroids, treating fever, maintaining proper positioning, and minimizing stimuli that increase pressure.
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurrent episodes of upper airway collapse during sleep, which can fragment sleep and cause daytime sleepiness. Risk factors include obesity, large neck size, and anatomical features that narrow the airway. Polysomnography is the gold standard test to diagnose OSA by measuring breathing patterns, oxygen levels, and brain waves during sleep. Left untreated, OSA is associated with increased risks of hypertension, heart disease, and stroke. Treatment involves lifestyle changes and devices like CPAP that maintain airway pressure during sleep.
This document provides information on obstructive sleep apnea (OSA), including its physiology, risk factors, symptoms, diagnosis, and treatment. OSA involves pauses in breathing during sleep due to upper airway collapse. It is diagnosed through an overnight sleep study that measures breathing, oxygen levels, and brain waves. A high number of breathing pauses or dips in oxygen (apnea-hypopnea index over 5) indicates OSA. Common symptoms include loud snoring, witnessed breathing pauses, and daytime sleepiness. Risk factors include obesity, large neck size, and family history. Treatment typically involves a CPAP machine to keep the airway open during sleep.
This document provides an overview of neurologic and neurosurgical emergencies that may present in the intensive care unit (ICU). It discusses altered consciousness, increased intracranial pressure, neurogenic respiratory failure, status epilepticus, acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, head trauma, and spinal cord injury. For each topic, it describes evaluations, potential causes, and management strategies.
Obstructive sleep apnea is a sleep disorder where breathing is disrupted during sleep due to the upper airway collapsing or narrowing. It involves cessation (apnea) or reduction (hypopnea) of breathing for 10 seconds or more. The condition is caused by a combination of anatomical narrowing of the airway and loss of muscle tone in the throat during sleep. Polysomnography is used to diagnose by measuring breathing, oxygen levels, and sleep stages. Treatment options include lifestyle changes, oral devices, surgery, and continuous positive airway pressure (CPAP).
Anesthesia for spinal cord injury and scoliosis030Atef Salama
The potential risk factors for POVL that are listed are:
- Obesity
- Long Prone Cases
- Anemia
- Pressure on the globe
- Hypotension
- Glaucoma
Cataracts is not a risk factor for POVL.
This document summarizes the post-operative course of a 16-year-old male who was admitted following a motor vehicle accident with multiple injuries including a head injury. On post-operative day 1, the patient was stable with no pain and normal vital signs. On post-operative day 2, the patient remained stable and comfortable with slightly dilated pupils on the right side. Potential differential diagnoses discussed include local anesthetic systemic toxicity, total spinal anesthesia, and brachial plexus injury resulting in Horner's syndrome.
3. Intra Cranial Pressure and nursing interventions.pptxHayatALAKOUM
ICP is the pressure inside the cranial vault comprised of brain tissue, CSF, and blood volume. Increased ICP occurs when the volume-pressure relationship becomes unbalanced. Signs of increased ICP include changes in level of consciousness, vital signs, pupillary changes, extraocular movements, and other neurological changes. Treatment focuses on decreasing ICP through interventions like hyperventilation, osmotic diuretics, corticosteroids, maintaining fluids and electrolytes, treating fever, and avoiding stimuli that increase ICP.
intracranial pressure nursing care processHayatALAKOUM
1) Intracranial pressure (ICP) is the pressure inside the skull and is comprised of brain tissue, cerebrospinal fluid, and blood volume. Increased ICP is defined as pressure over 15 mm Hg.
2) Signs of increased ICP include changes in level of consciousness, vital signs, pupillary changes, and extraocular movements.
3) Nursing interventions to decrease ICP include managing fluids and electrolytes, administering medications to reduce swelling such as mannitol and steroids, treating fever, maintaining proper positioning, and minimizing stimuli that increase pressure.
Spinal anesthesia involves injecting local anesthetic into the fluid-filled space surrounding the spinal cord. This blocks pain and other sensations below the injection site. The document discusses the anatomy of spinal anesthesia, commonly used local anesthetics, indications, contraindications, proper administration technique, and potential complications and their treatments. It provides a comprehensive overview of spinal anesthesia.
This document provides an overview of spinal and epidural anaesthesia. It discusses the history, anatomy, techniques, medications used, complications and advantages/disadvantages. Key points include: the first spinal anaesthesia in humans was performed in 1898 using cocaine; epidural anaesthesia was first described in 1921; techniques involve identifying the epidural space using loss of resistance or hanging drop methods; common local anaesthetics include bupivacaine and ropivacaine; potential complications include post-dural puncture headache and neurological issues; advantages are reduced cardiovascular and respiratory effects compared to general anaesthesia.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
This document provides an overview of general anesthesia. It discusses the basic principles, including the four main stages and physiological effects. It covers the mechanisms of action of different anesthetic agents, including inhalational agents like halothane, isoflurane, sevoflurane and intravenous agents like propofol, etomidate, ketamine. It also discusses pre-anesthetic medications, depth of anesthesia monitoring, analgesic adjuncts and newly approved agent remimazolam. The document is intended as an educational seminar on general anesthesia.
Sleep disordered breathing and cardiovascular diseasesdinanathkumar
Sleep apnea is associated with several cardiovascular diseases. It is seen in up to 50% of hypertensive patients and 30% of heart failure patients. Studies show a dose-response relationship between the severity of sleep apnea and hypertension risk over time. The high prevalence of undiagnosed sleep apnea in patients with drug-resistant hypertension supports its role in causing treatment-resistant high blood pressure. Sleep apnea also predisposes patients to heart failure through mechanisms like increased sympathetic activity and blood pressure elevation, and can worsen existing heart failure. Around 40% of patients with sleep apnea have diabetes as well, and studies demonstrate a relationship between the severity of sleep apnea and insulin resistance even after accounting for body
Sleep disordered breathing and cardiovascular diseasesdinanathkumar
This document discusses sleep disordered breathing and its relationship to cardiovascular diseases. It begins by defining different types of sleep and terms related to sleep apnea. Sleep apnea is associated with increased risks of cardiovascular diseases like hypertension, diabetes, and heart failure. Obstructive sleep apnea is more common in men and people who are overweight, and involves collapse of the upper airway during sleep. Central sleep apnea involves instability of breathing control and is seen more in heart failure patients. Polysomnography is the gold standard for diagnosing sleep apnea but home sleep tests are also used. Treating sleep apnea may help reduce cardiovascular risks.
This document discusses various induction agents used in general anesthesia. It begins by defining general anesthesia and its key features. It then covers general principles of pharmacology relevant to induction agents, including their action on receptors, plasma protein binding, crossing the blood-brain barrier, and distribution to other tissues. The document classifies common intravenous induction agents and discusses in detail the properties, mechanisms, uses, and adverse effects of thiopental sodium, propofol, and etomidate.
This document provides information about epidural anaesthesia. It discusses the history and development of epidural techniques. It then describes the anatomy of the spinal cord, meninges, epidural space and sacral canal. It explains the mechanism of action of epidural anaesthesia and factors affecting drug distribution and elimination. Finally, it outlines the physiological effects of epidural anaesthesia on the cardiovascular, respiratory, gastrointestinal, genitourinary and neuroendocrine systems.
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin GaikwadSachin Gaikwad
This document provides information on central neuroaxial blockade including spinal and epidural anesthesia. It discusses:
1) Applied anatomy of the vertebral column and spinal cord levels.
2) Contents and landmarks of the epidural space.
3) Advantages of neuroaxial blockade over general anesthesia.
4) Physiological effects including cardiovascular, respiratory, and thermoregulatory changes.
5) Procedures, drugs, and complications of spinal and epidural anesthesia.
This document provides an introduction to general anaesthesia. It discusses the stages of anaesthesia according to the Guedel classification system and describes various drugs used in anaesthesia including intravenous agents like thiopentone, propofol, and benzodiazepines. It also discusses inhalational agents such as nitrous oxide, ether, halothane, isoflurane, and sevoflurane. Finally, it covers muscle relaxants, distinguishing between depolarizing agents like suxamethonium and non-depolarizing agents. The document provides an overview of the pharmacodynamics and uses of these different drug classes for anaesthesia.
Dysautonomia refers to a malfunction of the autonomic nervous system that controls involuntary body functions like heart rate, blood pressure, digestion, and sweating. The document discusses the anatomy and functions of the autonomic nervous system and its divisions. It then defines dysautonomia and lists various causes like diabetes, multiple sclerosis, and injuries. Common symptoms involve fatigue, dizziness, digestive issues, urinary problems, and temperature regulation difficulties. Tests of autonomic function are described that measure responses like heart rate and blood pressure during maneuvers to identify autonomic dysfunction.
1) Regional anesthesia in pediatrics requires special considerations due to anatomical and physiological differences compared to adults. Key differences include lower spinal cord termination, delayed myelination, and decreased plasma protein content.
2) Common regional anesthesia techniques in children include caudal epidural blocks, peripheral nerve blocks, and spinals. Caudal blocks are often used for infraumbilical surgery while peripheral nerve blocks are used for procedures on the extremities.
3) Proper technique and monitoring are important to avoid potential complications such as local toxicity, dural puncture, and hemodynamic issues. Ultrasound guidance can improve success and safety.
Ephaptic transmission of impulses between neighbouring neurons (i.e. coupling of adjacent nerve fibres due to local exchange of ions or local electric fields) leading to excessive or abnormal firing.
Spinal anaesthesia involves injecting local anaesthetic into the cerebrospinal fluid surrounding the spinal cord. A brief history was provided including the discovery of cerebrospinal fluid in the 1700s and the first planned spinal anaesthesia on a human in 1891. Key anatomy was discussed including the levels of the spinal cord and vertebrae. Common local anaesthetics used for spinal anaesthesia like bupivacaine and ropivacaine were listed along with typical dosages. Factors affecting the level of spinal block were summarized.
Local anesthetics can have systemic effects at high levels. They primarily act by depressing the central nervous system and lowering seizure thresholds. Preconvulsive signs may include numbness, shivering, or twitching. Convulsions last less than a minute and increase blood flow and metabolism. Local anesthetics have direct effects on the cardiovascular and respiratory systems by relaxing muscles and decreasing heart rate and blood pressure. Toxicity is caused by rapid intravenous injection, absorption from vascular sites, or overdose. Factors reducing toxicity include using the minimum effective dose and concentration and slowly injecting while aspirating.
1. Supratentorial surgeries require careful anesthetic management to maintain adequate cerebral perfusion and oxygenation while optimizing conditions for tumor resection.
2. Key goals include preventing increases in intracranial pressure through careful induction, positioning, ventilation, and emergence from anesthesia.
3. Emergence should be smooth to avoid straining or bucking which can abruptly increase intracranial pressure and risk hemorrhage or herniation.
This document discusses the history and techniques of neuroaxial anesthesia. It begins by outlining some of the pioneers who contributed to the development of spinal and epidural anesthesia. It then provides details on spinal anatomy and the spread of local anesthetics. Various techniques are described, including spinal, epidural, and caudal approaches. Factors influencing the level of blockade are discussed. Common local anesthetics and adjuncts used for neuroaxial anesthesia are listed, along with their dosing and onset/duration of action. Potential complications are also summarized.
This document provides information on spinal anesthesia. It begins by defining spinal anesthesia as a single injection of local anesthetic into the subarachnoid space, usually at the lumbar level of L3-L4. It then lists several advantages of spinal anesthesia including reduced costs, increased patient satisfaction, and benefits for patients with respiratory disease, diabetes, or who are elderly. Potential complications are also outlined such as bradycardia, nausea and vomiting, and hypotension. Proper patient positioning and administration technique are emphasized to perform the block safely and effectively.
Local anesthetics work by reversibly blocking sodium channels in nerve fibers, inhibiting pain signal conduction. They can provide local anesthesia through infiltration of tissues or regional anesthesia through epidural administration. The two main types are esters and amides, with amides being safer and more commonly used. Potential adverse effects include allergy, toxicity from high doses, and methemoglobinemia. Proper administration techniques and monitoring can help prevent complications.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Spinal anesthesia involves injecting local anesthetic into the fluid-filled space surrounding the spinal cord. This blocks pain and other sensations below the injection site. The document discusses the anatomy of spinal anesthesia, commonly used local anesthetics, indications, contraindications, proper administration technique, and potential complications and their treatments. It provides a comprehensive overview of spinal anesthesia.
This document provides an overview of spinal and epidural anaesthesia. It discusses the history, anatomy, techniques, medications used, complications and advantages/disadvantages. Key points include: the first spinal anaesthesia in humans was performed in 1898 using cocaine; epidural anaesthesia was first described in 1921; techniques involve identifying the epidural space using loss of resistance or hanging drop methods; common local anaesthetics include bupivacaine and ropivacaine; potential complications include post-dural puncture headache and neurological issues; advantages are reduced cardiovascular and respiratory effects compared to general anaesthesia.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
This document provides an overview of general anesthesia. It discusses the basic principles, including the four main stages and physiological effects. It covers the mechanisms of action of different anesthetic agents, including inhalational agents like halothane, isoflurane, sevoflurane and intravenous agents like propofol, etomidate, ketamine. It also discusses pre-anesthetic medications, depth of anesthesia monitoring, analgesic adjuncts and newly approved agent remimazolam. The document is intended as an educational seminar on general anesthesia.
Sleep disordered breathing and cardiovascular diseasesdinanathkumar
Sleep apnea is associated with several cardiovascular diseases. It is seen in up to 50% of hypertensive patients and 30% of heart failure patients. Studies show a dose-response relationship between the severity of sleep apnea and hypertension risk over time. The high prevalence of undiagnosed sleep apnea in patients with drug-resistant hypertension supports its role in causing treatment-resistant high blood pressure. Sleep apnea also predisposes patients to heart failure through mechanisms like increased sympathetic activity and blood pressure elevation, and can worsen existing heart failure. Around 40% of patients with sleep apnea have diabetes as well, and studies demonstrate a relationship between the severity of sleep apnea and insulin resistance even after accounting for body
Sleep disordered breathing and cardiovascular diseasesdinanathkumar
This document discusses sleep disordered breathing and its relationship to cardiovascular diseases. It begins by defining different types of sleep and terms related to sleep apnea. Sleep apnea is associated with increased risks of cardiovascular diseases like hypertension, diabetes, and heart failure. Obstructive sleep apnea is more common in men and people who are overweight, and involves collapse of the upper airway during sleep. Central sleep apnea involves instability of breathing control and is seen more in heart failure patients. Polysomnography is the gold standard for diagnosing sleep apnea but home sleep tests are also used. Treating sleep apnea may help reduce cardiovascular risks.
This document discusses various induction agents used in general anesthesia. It begins by defining general anesthesia and its key features. It then covers general principles of pharmacology relevant to induction agents, including their action on receptors, plasma protein binding, crossing the blood-brain barrier, and distribution to other tissues. The document classifies common intravenous induction agents and discusses in detail the properties, mechanisms, uses, and adverse effects of thiopental sodium, propofol, and etomidate.
This document provides information about epidural anaesthesia. It discusses the history and development of epidural techniques. It then describes the anatomy of the spinal cord, meninges, epidural space and sacral canal. It explains the mechanism of action of epidural anaesthesia and factors affecting drug distribution and elimination. Finally, it outlines the physiological effects of epidural anaesthesia on the cardiovascular, respiratory, gastrointestinal, genitourinary and neuroendocrine systems.
Central Neuroxial blockage ( Spinal and Epidural block ) By Dr Sachin GaikwadSachin Gaikwad
This document provides information on central neuroaxial blockade including spinal and epidural anesthesia. It discusses:
1) Applied anatomy of the vertebral column and spinal cord levels.
2) Contents and landmarks of the epidural space.
3) Advantages of neuroaxial blockade over general anesthesia.
4) Physiological effects including cardiovascular, respiratory, and thermoregulatory changes.
5) Procedures, drugs, and complications of spinal and epidural anesthesia.
This document provides an introduction to general anaesthesia. It discusses the stages of anaesthesia according to the Guedel classification system and describes various drugs used in anaesthesia including intravenous agents like thiopentone, propofol, and benzodiazepines. It also discusses inhalational agents such as nitrous oxide, ether, halothane, isoflurane, and sevoflurane. Finally, it covers muscle relaxants, distinguishing between depolarizing agents like suxamethonium and non-depolarizing agents. The document provides an overview of the pharmacodynamics and uses of these different drug classes for anaesthesia.
Dysautonomia refers to a malfunction of the autonomic nervous system that controls involuntary body functions like heart rate, blood pressure, digestion, and sweating. The document discusses the anatomy and functions of the autonomic nervous system and its divisions. It then defines dysautonomia and lists various causes like diabetes, multiple sclerosis, and injuries. Common symptoms involve fatigue, dizziness, digestive issues, urinary problems, and temperature regulation difficulties. Tests of autonomic function are described that measure responses like heart rate and blood pressure during maneuvers to identify autonomic dysfunction.
1) Regional anesthesia in pediatrics requires special considerations due to anatomical and physiological differences compared to adults. Key differences include lower spinal cord termination, delayed myelination, and decreased plasma protein content.
2) Common regional anesthesia techniques in children include caudal epidural blocks, peripheral nerve blocks, and spinals. Caudal blocks are often used for infraumbilical surgery while peripheral nerve blocks are used for procedures on the extremities.
3) Proper technique and monitoring are important to avoid potential complications such as local toxicity, dural puncture, and hemodynamic issues. Ultrasound guidance can improve success and safety.
Ephaptic transmission of impulses between neighbouring neurons (i.e. coupling of adjacent nerve fibres due to local exchange of ions or local electric fields) leading to excessive or abnormal firing.
Spinal anaesthesia involves injecting local anaesthetic into the cerebrospinal fluid surrounding the spinal cord. A brief history was provided including the discovery of cerebrospinal fluid in the 1700s and the first planned spinal anaesthesia on a human in 1891. Key anatomy was discussed including the levels of the spinal cord and vertebrae. Common local anaesthetics used for spinal anaesthesia like bupivacaine and ropivacaine were listed along with typical dosages. Factors affecting the level of spinal block were summarized.
Local anesthetics can have systemic effects at high levels. They primarily act by depressing the central nervous system and lowering seizure thresholds. Preconvulsive signs may include numbness, shivering, or twitching. Convulsions last less than a minute and increase blood flow and metabolism. Local anesthetics have direct effects on the cardiovascular and respiratory systems by relaxing muscles and decreasing heart rate and blood pressure. Toxicity is caused by rapid intravenous injection, absorption from vascular sites, or overdose. Factors reducing toxicity include using the minimum effective dose and concentration and slowly injecting while aspirating.
1. Supratentorial surgeries require careful anesthetic management to maintain adequate cerebral perfusion and oxygenation while optimizing conditions for tumor resection.
2. Key goals include preventing increases in intracranial pressure through careful induction, positioning, ventilation, and emergence from anesthesia.
3. Emergence should be smooth to avoid straining or bucking which can abruptly increase intracranial pressure and risk hemorrhage or herniation.
This document discusses the history and techniques of neuroaxial anesthesia. It begins by outlining some of the pioneers who contributed to the development of spinal and epidural anesthesia. It then provides details on spinal anatomy and the spread of local anesthetics. Various techniques are described, including spinal, epidural, and caudal approaches. Factors influencing the level of blockade are discussed. Common local anesthetics and adjuncts used for neuroaxial anesthesia are listed, along with their dosing and onset/duration of action. Potential complications are also summarized.
This document provides information on spinal anesthesia. It begins by defining spinal anesthesia as a single injection of local anesthetic into the subarachnoid space, usually at the lumbar level of L3-L4. It then lists several advantages of spinal anesthesia including reduced costs, increased patient satisfaction, and benefits for patients with respiratory disease, diabetes, or who are elderly. Potential complications are also outlined such as bradycardia, nausea and vomiting, and hypotension. Proper patient positioning and administration technique are emphasized to perform the block safely and effectively.
Local anesthetics work by reversibly blocking sodium channels in nerve fibers, inhibiting pain signal conduction. They can provide local anesthesia through infiltration of tissues or regional anesthesia through epidural administration. The two main types are esters and amides, with amides being safer and more commonly used. Potential adverse effects include allergy, toxicity from high doses, and methemoglobinemia. Proper administration techniques and monitoring can help prevent complications.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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2. INTRODUCTION
Spinal anesthesia involves the
use of small amounts of local
anesthetic injected into the
subarachnoid space to
produce a reversible loss of
sensory and motor function
3. ANATOMY
VERTEBRAL COLUMN CONSISTS OF
7 CERVICAL VERTEBRAE
12 THORACIC VERTEBRAE
5 LUMBAR VERTEBRAE
5 SACRAL VERTEBRAE
4 COCCYGEAL VERTEBRAE
The spinal cord is enclosed in the vertebral
column, It extends from the foramen magnum
where it is continuous with the medulla to the level
of the L1 in adults and around levels L3 in infants
5 The spinal cord terminates in a tapering cone
shaped structure called as conus medullaris
4. CAUDA EQUINA
Cauda equina refers to the bundle of
nerve roots located at the lower end
of the spinal cord, which extend
beyond the termination of the spinal
cord at the first lumbar vertebra.
The cauda equina exists within
the lumbar cistern, a gap between
the arachnoid membrane and the pia
mater of the spinal cord, called
the subarachnoid space
5. Therefore, performing a lumbar
(subarachnoid) puncture below L1 in
an adult (L3 in a child) usually avoids
potential needle trauma to the cord
And damage to the cauda equina is
unlikely, as these nerve roots float in
the dural sac below L1 and tend to be
pushed away (rather than pierced) by
an advancing needle
6. LAYERS OF SPINAL CORD
SKIN
SUBCUTANEOUS TISSUE
SUPRA SPINOUS LIGAMENT
INTERSPINOUS LIGAMENT
LIGAMENTUM FLAVUM
EDPIDURAL SPACE
DURA MATER
ARACHNOID MATER
SUBARACHNOID SPACE
PIA MATER
7.
8. DERMATOMES
A DERMATOME IS A AREA OF SKIN INNERVATED BY
SENSORY FIBRES FROM A SINGLE SPINAL NERVE
•Cervical nerves. There are eight pairs of these
Cervical nerves, numbered C1 through C8. They
originate from your neck.
•Thoracic nerves. You have 12 pairs of thoracic
nerves that are numbered T1 through T12
•Lumbar nerves. There are five pairs of lumbar spinal
nerves, designated L1 through L5.
•Sacral nerves. Like the lumbar spinal nerves, you
also have five pairs of sacral spinal nerves.
•Coccygeal nerves. You only have a single pair of
coccygeal spinal nerves.
15. APPROACHES OF SPINAL
ANESTHESIA
1)Midline Approach - The most common approach, the
needle or introducer is placed midline, perpendicular to
spinous processes, aiming slightly cephalad .
2)Paramedian Approach - Indicated in patients who can
not adequately flex because of pain or whose ligaments
are ossified, the spinal needle is placed 1.5 cm laterally
and slightly caudad to the center of the selected
interspace.
16. MIDLINE APPROACH
The most common
approach, the needle or
introducer is placed
midline, perpendicular
to spinous processes,
aiming slightly cephalad
17. PARAMEDIAN
APPROACH
Indicated in patients who
can not adequately flex
because of pain or whose
ligaments are ossified, the
spinal needle is placed 1.5
cm laterally and slightly
caudad to the center of
the selected interspace.
18. DRUGS USED IN SPINAL ANESTHESIA
LIDOCAINE
Onset of action occurs in 3 to 5 minutes
with a duration of anesthesia that lasts for
1 to 1.5 hours
Rapid onset of action , intermediate
duration and low toxicity
Disadvantages — Transient neurological
symptoms
19. BUPIVACAINE
One of the most widely
used local anesthetics
Onset of action is
within 5 to 8 minutes,
with a duration of
anesthesia that lasts
from 90 to 150 minutes
20. OTHER DRUGS USED IN
SPINAL ANESTHESIA
•Tetracaine 0.5%
•Mepivacaine 2%
•Ropivacaine 0.75%
•Levobupivacaine 0.5%
•Chloroprocaine 3%
21. ADJUVANTS USED IN SPINAL ANESTHESIA
Produce intense visceral analgesia and prolong only sensory blockade
1)Opioids - Lipophilic agents such as fentanyl and sufentanil have a much more localized effect
,rapid onset of action and an effective duration greater than 6 hours.
2)CLONIDINE-alpha 2 agonist (150ug)
Onset -same
Duration-prolonged
3)Epinephrine- vasoconstrictor action delays absorption of local anesthetic
4)Phenylephrine-1:1,000 concentration
22. MECHANISM OF ACTION
I. Interacts with the receptor situated within the
voltage sensitive sodium channel and raises
the threshold of channel opening
II. Decreases the entry of sodium ions during
upstroke of action potential
III. Local depolarization fails to reach the
threshold potential and conduction block is
acheived
27. AUTONOMIC BLOCKADE
The sympathetic nervous system (SNS) is described as
thoracolumbar since sympathetic fibers exit the spinal cord
from Tl to L2.
The parasympathetic nervous system (PNS) has been described
as cranio sacral since parasympathetic fibers exit in the cranial
and sacral regions of the CNS.
The end result of neuraxial blockade is a decreased sympathetic
tone with an unopposed parasympathetic tone. This imbalance
will result in many of the expected alterations of normal
homeostasis noted with the administration of spinal anesthesia.
28. CARDIO VASCULAR EFFECTS
Spinal blockade can impact the
cardiovascular system by causing the
following changes:
1)Decrease in blood pressure (33%
incidence of hypotension in non-obstetric
populations)
2)Decrease in heart rate (13% incidence
of bradycardia in non-obstetric
populations)
29. RESPIRATORY EFFECTS
Spinal blockade plays a very minor role in altering pulmonary
function.
Even with high thoracic levels of blockade, tidal volume is
unchanged.
There is a slight decrease in vital capacity. This is the result of
relaxation of the abdominal muscles during exhalation.
The phrenic nerve is innervated by C3-C5 and is responsible for
the autonomic movement of diaphragm.
The phrenic nerve is extremely hard to block, even with a high
spinal, apnea associated with a high spinal is thought to be
related to brainstem hypoperfusion and not blockade of the
phrenic nerve. This is based on the fact that spontaneous
respiration resumes after hemodynamic resuscitation has occurred
30. RENAL EFFECTS
Neuraxial blockade effectively blocks spinal control of the bladder at the lumbar
and sacral levels
Urinary retention can occur due to the loss of autonomic bladder control.
Detrusor function of the bladder is blocked by local anesthetics. Normal function
does not return until sensory function returns to S3
31. MANAGEMENT OF COMMON COMPLICATIONS
OF SA
• HYPOTENSION
• Increase the rate of administration of IV
fluids
• Oxygen supplementation until BP restores
back to optimal levels
• Vasopressors
• Ephedrine sulphate
• Mephenteramine
• Phenylephrine
• Epinephrine
• Norepinephrine
• BRADYCARDIA - Administer Atropine
• Respiratory impairment or Total
Spinal - Intubate and ventilate the
patient with 100% Oxygen
32. POST DURAL PUNCTURE HEADACHE
Post dural puncture headache
is a common potential
complication of a lumbar
puncture, with symptoms
caused by traction on pain-
sensitive structures from low
cerebrospinal fluid pressure
(intracranial hypotension)
following a leak of
cerebrospinal fluid at the
puncture site
33. PDPH
Incidence -10% to 40% of LP procedures, but can be as low
as 2% when small gauge (less than or equal to 24 gauge)
non-cutting needles are used
It is postural and it is often fronto-occipital associated with
stiff neck , nausea, vomiting , dizziness and photophobia.
Pathophysiology-Loss of CSF at a faster rate than it can be
produced causing traction on the structures supporting
brain, particularly dura
It is aggravated by sitting or standing and decreased or
relieved by lying down Flat.
34. MANAGEMENT
o CONSERVATIVE MANAGEMENT - BED REST , HYDRATION , ANALGESICS , ANTI EMETICS
AGGRESSIVE MEDICAL MANAGEMENT - THEOPHYLLINE, CAFFEINE ,OCCIPITAL NERVE BLOCK
EPIDURAL BLOOD PATCH
RECONSIDER DIAGNOSIS , FIBRE GLUE SURGERY
35. ADVANTAGES OF SPINAL ANESTHESIA
1. 1)Cost - The costs associated with SPA are minimal.
2. 2)Respiratory disease - Spinal anesthesia produces few
adverse effects on the respiratory system as long as
unduly high blocks are avoided.
3. 3)Patent airway - As control of the airway is not
compromised, there is a reduced risk of airway
obstruction or the aspiration of gastric contents
4. 4)Diabetic patients-There is little risk of unrecognized
hypoglycemia in an awake patient.
36. REFERENCES
MORGAN AND MIKHAIL CLINICAL ANESTHESIOLOGY - 6TH EDITION
MILLERS ANESTHESIA - 9TH EDITION
NYSORA
BJA
COLLINS REGIONAL ANESTHESIA