This document discusses jaundice, its causes, and approach to postoperative jaundice. It defines jaundice as yellow discoloration from hyperbilirubinemia. Causes of postoperative jaundice include hemolysis, hepatic dysfunction unrelated to surgery, and obstructive causes. The workup involves liver function tests to determine if the jaundice is prehepatic, hepatocellular, or obstructive. Management depends on the identified cause, but generally involves supportive care, discontinuing hepatotoxic drugs, treating sepsis aggressively, and considering surgery for biliary obstruction.
The document summarizes the physiological changes that occur during laparoscopic surgery due to pneumoperitoneum and positioning of the patient. Pneumoperitoneum causes increases in abdominal and thoracic pressure, decreasing cardiac output and lung volume and increasing risk of atelectasis and gas embolism. Positioning such as Trendelenburg can also affect hemodynamics and respiratory function. While healthy patients often tolerate these changes, risks are higher for those with cardiopulmonary or medical issues. Close monitoring is important to detect potential complications involving the cardiovascular, pulmonary, renal and other organ systems.
This document provides an overview of optimizing respiratory care for patients with ALS. It discusses testing and treatment for hypoventilation including non-invasive ventilation. It reviews various modes, settings, and features of non-invasive ventilators. It also covers monitoring downloads, interfaces, desensitization steps, and assessing tidal volume, usage, leaks, minute ventilation, pulse oximetry, and apnea/hypopnea to optimize care. Barriers to compliance like FTD and bulbar onset are addressed. The document provides a comprehensive guide to respiratory management in ALS.
Lection about Histology of the Respiratory System / Лекція на тему "Гістологія дихальної системи" (Author / Автор - Khodorovska Alla / Ходоровська Алла)
This document discusses jaundice, its causes, and approach to postoperative jaundice. It defines jaundice as yellow discoloration from hyperbilirubinemia. Causes of postoperative jaundice include hemolysis, hepatic dysfunction unrelated to surgery, and obstructive causes. The workup involves liver function tests to determine if the jaundice is prehepatic, hepatocellular, or obstructive. Management depends on the identified cause, but generally involves supportive care, discontinuing hepatotoxic drugs, treating sepsis aggressively, and considering surgery for biliary obstruction.
The document summarizes the physiological changes that occur during laparoscopic surgery due to pneumoperitoneum and positioning of the patient. Pneumoperitoneum causes increases in abdominal and thoracic pressure, decreasing cardiac output and lung volume and increasing risk of atelectasis and gas embolism. Positioning such as Trendelenburg can also affect hemodynamics and respiratory function. While healthy patients often tolerate these changes, risks are higher for those with cardiopulmonary or medical issues. Close monitoring is important to detect potential complications involving the cardiovascular, pulmonary, renal and other organ systems.
This document provides an overview of optimizing respiratory care for patients with ALS. It discusses testing and treatment for hypoventilation including non-invasive ventilation. It reviews various modes, settings, and features of non-invasive ventilators. It also covers monitoring downloads, interfaces, desensitization steps, and assessing tidal volume, usage, leaks, minute ventilation, pulse oximetry, and apnea/hypopnea to optimize care. Barriers to compliance like FTD and bulbar onset are addressed. The document provides a comprehensive guide to respiratory management in ALS.
Lection about Histology of the Respiratory System / Лекція на тему "Гістологія дихальної системи" (Author / Автор - Khodorovska Alla / Ходоровська Алла)
This document discusses the anatomy, physiology, and functions of the liver as they relate to anesthesia. It begins with an overview of hepatic anatomy including gross and microscopic structure, blood supply, and drainage. It then covers hepatic blood flow regulation by intrinsic and extrinsic factors and how anesthesia can affect blood flow. The major sections discuss hepatic functions such as metabolism, synthesis, and detoxification. In particular, it notes the liver's roles in glucose regulation, protein and lipid metabolism, coagulation factor production, and bilirubin metabolism.
The document summarizes the anatomy and blood supply of the liver and how anesthetic drugs can affect liver function. It describes the lobes, ligaments, vascularization including the portal triad, and histology of the liver. It then discusses factors that can increase or decrease hepatic blood flow and the effects of various anesthetic drugs on liver function and blood flow, such as halothane potentially causing hepatitis, propofol increasing blood flow, and opioids having little effect if blood flow is maintained.
The document discusses guidelines for managing cardio-circulatory therapy and hemodynamics for cardiac surgery patients, including recommended goals for parameters such as blood pressure, cardiac index, oxygen saturation, and diuresis. It also outlines causes and risks of postoperative hypertension and provides guidance on pharmacological management using intravenous vasodilators, beta blockers, and diuretics to control blood pressure in the postoperative period.
This document presents the case of a 69-year-old male with complaints of increased urinary frequency, dribbling, and incomplete bladder emptying, likely due to benign prostatic hyperplasia. It discusses his medical history, examination findings, and planned treatment of transurethral resection of the prostate (TURP). Key points include the importance of fluid management during TURP to prevent complications like TURP syndrome. TURP syndrome is characterized by central nervous system and cardiovascular system effects due to fluid overload and electrolyte abnormalities. Close monitoring of fluid absorption and electrolytes is needed, along with measures to rapidly correct any hyponatremia that develops during the procedure.
This case report describes a 25-year-old morbidly obese woman with diabetes who experienced bronchospasm during induction for cochlear implant surgery. Initial signs included absent breath sounds, low end-tidal carbon dioxide, and bronchospasm. Treatment included epinephrine, fluids, bronchodilators, and steroids. Further workup ruled out allergic reaction but found previously undiagnosed asthma. Obesity can precipitate rapid desaturation in asthma patients. Uncontrolled asthma is a risk factor for perioperative bronchospasm.
The document discusses the effects of liver disease on anesthesia. It covers topics such as hepatic blood flow regulation, drug metabolism by the liver, and how liver dysfunction impacts the pharmacokinetics and pharmacodynamics of various anesthetic drugs. Liver disease can increase a patient's sensitivity to central nervous system depressants and decrease sensitivity to vasopressors. The duration of action of some drugs may be prolonged due to impaired hepatic clearance and metabolism in patients with liver dysfunction. Induction agents, opioids, muscle relaxants and other drugs are discussed in terms of their safety in liver disease.
Interpretation of pulmonary function tests.a practical guideSoM
This document summarizes a third edition of the book "Interpretation of Pulmonary Function Tests". It provides brief biographies of the authors and acknowledges those who assisted in the publication. It also includes a preface describing some of the additions and updates made for this new edition, as well as a list of common abbreviations used within pulmonary function literature.
A presentation to the ASATT or American Society of Anesthesia Technicians and Technologists at the 2016 ASATT meeting in Chicago, IL was delivered by Kevin Lueders of Bell Medical and Corlius Birkill of Xavant Technologies of South Africa. This power point presentation discusses neuromuscular blocking agents history and usage. It also presented the various methods of monitoring NMBAs with traditional peripheral nerve stimulators and with the new quantitative or objective Train of Four, TOF monitor such as the Stimpod NMS 450 using accelerometry.
This document discusses fluid and electrolyte balance, with an emphasis on surgical patients. It covers topics like total body water, fluid compartments, electrolyte composition and balance, osmotic pressure, factors that can disturb fluid and electrolyte balance like volume deficits or excesses, and management of specific issues like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, and hypocalcemia. Key points emphasized include fluid shifts between compartments, renal regulation of electrolytes, and symptoms and treatment of various electrolyte abnormalities.
A 42-year old female presented with fever, abdominal pain, nausea, vomiting and yellowing of sclera 3-4 days after undergoing a uterine fibroid removal surgery where she was administered halothane anesthesia. Her liver enzymes were elevated and she was diagnosed with halothane-induced hepatitis based on her symptoms, lab results, and history of halothane exposure during surgery. She was treated supportively in the hospital and her condition improved, with normalizing liver enzymes, before being discharged after 2 weeks of treatment and observation.
The document describes urodynamic evaluation (UDE) performed in the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides an introduction to UDE. It then describes the various components of UDE including uroflowmetry, cystometry, pressure flow studies and videourodynamics. It outlines the procedure for setting up and performing UDE, and analyzes storage and voiding phases and parameters measured.
This document discusses the anatomy, physiology, and functions of the liver as they relate to anesthesia. It begins with an overview of hepatic anatomy including gross and microscopic structure, blood supply, and drainage. It then covers hepatic blood flow regulation by intrinsic and extrinsic factors and how anesthesia can affect blood flow. The major sections discuss hepatic functions such as metabolism, synthesis, and detoxification. In particular, it notes the liver's roles in glucose regulation, protein and lipid metabolism, coagulation factor production, and bilirubin metabolism.
The document summarizes the anatomy and blood supply of the liver and how anesthetic drugs can affect liver function. It describes the lobes, ligaments, vascularization including the portal triad, and histology of the liver. It then discusses factors that can increase or decrease hepatic blood flow and the effects of various anesthetic drugs on liver function and blood flow, such as halothane potentially causing hepatitis, propofol increasing blood flow, and opioids having little effect if blood flow is maintained.
The document discusses guidelines for managing cardio-circulatory therapy and hemodynamics for cardiac surgery patients, including recommended goals for parameters such as blood pressure, cardiac index, oxygen saturation, and diuresis. It also outlines causes and risks of postoperative hypertension and provides guidance on pharmacological management using intravenous vasodilators, beta blockers, and diuretics to control blood pressure in the postoperative period.
This document presents the case of a 69-year-old male with complaints of increased urinary frequency, dribbling, and incomplete bladder emptying, likely due to benign prostatic hyperplasia. It discusses his medical history, examination findings, and planned treatment of transurethral resection of the prostate (TURP). Key points include the importance of fluid management during TURP to prevent complications like TURP syndrome. TURP syndrome is characterized by central nervous system and cardiovascular system effects due to fluid overload and electrolyte abnormalities. Close monitoring of fluid absorption and electrolytes is needed, along with measures to rapidly correct any hyponatremia that develops during the procedure.
This case report describes a 25-year-old morbidly obese woman with diabetes who experienced bronchospasm during induction for cochlear implant surgery. Initial signs included absent breath sounds, low end-tidal carbon dioxide, and bronchospasm. Treatment included epinephrine, fluids, bronchodilators, and steroids. Further workup ruled out allergic reaction but found previously undiagnosed asthma. Obesity can precipitate rapid desaturation in asthma patients. Uncontrolled asthma is a risk factor for perioperative bronchospasm.
The document discusses the effects of liver disease on anesthesia. It covers topics such as hepatic blood flow regulation, drug metabolism by the liver, and how liver dysfunction impacts the pharmacokinetics and pharmacodynamics of various anesthetic drugs. Liver disease can increase a patient's sensitivity to central nervous system depressants and decrease sensitivity to vasopressors. The duration of action of some drugs may be prolonged due to impaired hepatic clearance and metabolism in patients with liver dysfunction. Induction agents, opioids, muscle relaxants and other drugs are discussed in terms of their safety in liver disease.
Interpretation of pulmonary function tests.a practical guideSoM
This document summarizes a third edition of the book "Interpretation of Pulmonary Function Tests". It provides brief biographies of the authors and acknowledges those who assisted in the publication. It also includes a preface describing some of the additions and updates made for this new edition, as well as a list of common abbreviations used within pulmonary function literature.
A presentation to the ASATT or American Society of Anesthesia Technicians and Technologists at the 2016 ASATT meeting in Chicago, IL was delivered by Kevin Lueders of Bell Medical and Corlius Birkill of Xavant Technologies of South Africa. This power point presentation discusses neuromuscular blocking agents history and usage. It also presented the various methods of monitoring NMBAs with traditional peripheral nerve stimulators and with the new quantitative or objective Train of Four, TOF monitor such as the Stimpod NMS 450 using accelerometry.
This document discusses fluid and electrolyte balance, with an emphasis on surgical patients. It covers topics like total body water, fluid compartments, electrolyte composition and balance, osmotic pressure, factors that can disturb fluid and electrolyte balance like volume deficits or excesses, and management of specific issues like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, and hypocalcemia. Key points emphasized include fluid shifts between compartments, renal regulation of electrolytes, and symptoms and treatment of various electrolyte abnormalities.
A 42-year old female presented with fever, abdominal pain, nausea, vomiting and yellowing of sclera 3-4 days after undergoing a uterine fibroid removal surgery where she was administered halothane anesthesia. Her liver enzymes were elevated and she was diagnosed with halothane-induced hepatitis based on her symptoms, lab results, and history of halothane exposure during surgery. She was treated supportively in the hospital and her condition improved, with normalizing liver enzymes, before being discharged after 2 weeks of treatment and observation.
The document describes urodynamic evaluation (UDE) performed in the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides an introduction to UDE. It then describes the various components of UDE including uroflowmetry, cystometry, pressure flow studies and videourodynamics. It outlines the procedure for setting up and performing UDE, and analyzes storage and voiding phases and parameters measured.
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The team is currently editing footage from a recent shoot in Sony Vegas, adding titles and new footage while compiling a soundtrack in Garageband. Some footage cannot be used due to poor quality and needs to be re-shot. The editing process involves fast cuts across multiple video and sound layers for titles, footage, diegetic and non-diegetic audio.
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This document lists 10 actors who have portrayed Hamlet in film adaptations between 1948 and 2009. It includes Lawrence Olivier in 1948, Richard Burton in 1964, Derek Jacobi in 1979, Mel Gibson in 1990, Kenneth Branagh in 1996, Ethan Hawke in 2000, David Tennant and Jude Law both in 2009 films, Julio Manrique in 2009, and Blanca Portillo in 2009.
The document provides guidance on designing effective brochures. It notes that while brochures are commonly used, they often contain mistakes that fail to engage customers. The article then outlines best practices for brochure design, including focusing on customer benefits rather than just features, appealing to emotion over logic, and establishing trustworthiness. It emphasizes that the purpose of a brochure is to educate customers about a company rather than directly make a sale.
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James Metcalfe's real estate market update march 2012James Metcalfe
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This article summarizes an interview with Joe Walsh, president of Amherst Securities, about the firm's role in the securitization space and outlook. Key points:
- Amherst is a leading broker-dealer specializing in mortgage-backed securities, serving institutional investors in new issue and secondary markets.
- The firm has expanded into ABS and CMBS, seeing these as natural extensions of its RMBS expertise. It aims to provide better data, analysis and market understanding.
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"Митохондриальная недостаточность и дезорганизация внутриклеточного метаболиз...rnw-aspen
Доклад с XVI Межрегиональной научно-практической конференции "Искусственное питание и инфузионная терапия больных в медицине критических состояний" 21-22 апреля 2016 г.
31 жовтня Сергій Данілов розповів про бессмертних тварин, про причини смерті та старіння, про діагностику смерті мозку й досвід поза тілом, а також чому у вдівців більша вирогідність смерті ніж у вдів.
2. Человеческое тело есть механико-
гидравлическая машина.
Н. Максимович-Амбодик.
«Врачебное веществословие», 1783
3. “In the first place a liking for the procedure is essential.
Without this the status of a resectionist will be about the
same as the status of a musician who dislikes music.”
F. E. B. Foley, 1940
“Очень важно суметь полюбить эту операцию.
Иначе уролог, делающий ТУР, будет похож на
музыканта, который не любит музыку.”
Ф. Ю. Б. Фоли, 1940
5. Для разработки ТУР имели
значение следующие события
•Разработка первого эндоскопа
(lichleiter) немецким врачом Philipp
Bozzini в 1805 году. В качестве
источника света использовалось
пламя свечи
7. •В 1864-1874 гг. И.В. Буяльский и итальянский
хирург Enrico Bottini предложили
гальванокаустическое рассечение
гипертрофированной простатической ткани, что в
определенной степени уменьшало кровотечение
после инцизии простаты раскаленной платиновой
нитью.
10. Первую трансуретральную
резекцию предстательной
железы разработал и произвел
Hugh Hampton Young в 1909
году. Он использовал систему
из двух трубок и специальный
холодно-ножевой перфоратор,
при помощи которого
производилась резекция ткани
простаты. Операция
проводилась вслепую, без
удовлетворительного гемостаза.
13. Первые ТУРы с использованием резектоскопа Штерна-
МакКарти ограничивались удалением незначительной
части простаты. Типичные записи в протоколах операций
того времени – “сделан адекватный канал”, “удалено 5
кусочков ткани ПЖ” или “удалено три сегмента
простаты”. Первые осложнения после ТУР были
опубликованы Dr. J. Alcock в 1933 году и включали
прямокишечно-уретральные свищи, недержание мочи,
кровотечение, сепсис, образование стриктур, разрыв
шейки мочевого пузыря, абсцессы и даже смерть от
поражения электрическим током. Смертность составляла
около 25%.
15. В 1933 г. F. E. B. Foley () описал
резорбцию промывной
жидкости( воды) при интенсивном
венозном кровотечении, которое
возникло при вскрытии вен
простатической капсулы. Он
отметил , что во время операции у
пациента из устьев мочеточников
выделялась кровянистая моча. Он
также выявил высокую концентрацию
свободного гемоглобина в плазме
крови после операции, который
повреждал почки, подобно тому, как
это бывает при переливании
несовместимой крови. Эта концепция
стала первой попыткой объяснить
механизм ОПН у некоторых больных
16. В 1947 году C. D. Creevy () установил, что почти у каждого
больного, перенесшего ТУР, отмечается гемоглобинемия, но у
большинства пациентов это не приводит к выраженным
клиническим проявлениям. Ниже приведен первый клинический
случай “ТУР_синдрома”, описанный в литературе: “Мужчина
68 лет перенес ТУР предстательной железы. В
послеоперационном периоде появились вялость, тошнота,
олигурия, гемоглобинемия, плазма розового цвета. К концу
первых суток развилась желтуха и анемия, не соответствующая
по тяжести операционной кровопотере. Больной умер от
почечной недостаточности. На вскрытии: при микроскопии
тканей почки видны глыбки пигмента, обтурирующие
собирательные трубки. Эпителий извитых канальцев находится
в состоянии дистрофии и некроза. Просветы канальцев
расширены, целостность базальной мембраны канальце
нарушена. Интерстициальная ткань почки инфильтрирована
лимфоцитами и плазмоцитами”
17. Определение
Большинство авторов понимают
под “ТУР-синдромом” все
многообразие изменений
гомеостаза, которое обусловлено
резорбцией большого количества
промывной жидкости. Другое
название “ТУР-синдрома” –
“синдром водной интоксикации”.
20. ЭтиологияЭтиология
При вскрытых венозных синусах
и внутрипузырном давлении > 40
cм водного столба через 12-15 мин
видны отчетливые нефрограммы
Средняя абсорбция
ирригационного раствора 10-30
мл/мин
Описаны случаи абсорбции до 6-8
л жидкости за 75-120 мин операции
21. Таким образом, абсорбция
ирригационного раствора в основном
зависит от
•Повреждения венозных синусов
•Увеличения длительности операции
•Увеличения давления
ирригационной жидкости
22. ТРЕБОВАНИЯ К ИРРИГАЦИОННЫМ РАСТВОРАМ
•Оптическая прозрачность
•Низкая электропроводность
•Изотоничность
•Нетоксичность
•Дешевизна
25. Патогенез ОПН при «ТУР-синдроме»
ТУР
НефротоксиныКровопотеряГемолиз
ГипотензияСвободный
гемоглобин
ГиперренинемияСпазм
почечных
сосудов
Повышение
поступления
натрия в
область
macula densa
Снижение
клубочковой
фильтрации
Повреждение
щеточной каемки
эпителия
канальцев
Ишемия
АНУРИЯ
26. По современным представлениям, существует три
возможных механизма повреждения почек:
•.Механическая блокада почечных канальцев с
отложением пигмента в дистальных участках петли
Генле и в дистальных извитых канальцах
•.Появление нефротоксической гуморальной
субстанции, которая образуется при действии
электрического тока и может повреждать почки.
•.Нарушение кровообращения в почках,
возникающее при наличии в крови свободного
гемоглобина, воздействии нефротоксинов, а также
в результате послеоперационной гипотензии.
27. КЛИНИКА
(симптомы по степени возрастания)
Сердечно-легочные Гематологические и
почечные
Центральная нервная
система
Гипертензия Глицинемия Тошнота/рвота
Брадикардия Гипераммониемия Беспокойство/помрачен
ие сознания
Дисритмия Гипоосмолярность Слепота
Респираторный
дистресс
Гемолиз/анемия Судороги
Цианоз Летаргия/параличи
Гипотензия ОПН Расширенные зрачки
без реакции на свет
Кома Кома Кома
Смерть Смерть Смерть
28. Лечение
Целью патогенетической терапии является ликвидация
гипердратации, дисэлектролитемии, гипоосмолярности
и ацидоза.
1. Коррекция гипонатриемии – введение
гипертонических растворов NaCl (3%, 5%).
Формула расчета для трехпроцентного раствора NaCl
объем(л) = (0,2*масса(кг)*дефицит натрия): 513
Если концентрация натрия в плазме крови не
определена, можно ввести внутривенно 200 мл 5%
раствора NaCl, при отсутствии эффекта (гипотензия,
олигурия) воможно введение еще 100 мл.
29. 2.Устранение гипокальциемии – глюконат
кальция 10% 10 мл внутривенно
3.Коррекция гипоосмолярности – переливание
25% раствора маннитола или 30% раствора
мочевины
4.Устранение избытка жидкости – лазикс 20 –
100 мг под контролем уровня калия в крови
5.Симтоматическое лечение –ликвидация
кровотечения из ложа простаты , нормализация
артериального давления, профилактика и
лечение отека легких и мозга.
30. Профилактика
1. Использование только изоосмолярных (негемолизирующих)
растворов
2. Проведение операции под эпидуральной анестезией, что
облегчает раннюю диагностику “ТУР-синдрома”
3.Технически правильное выполнение операции – адекватный
венозный гемостаз, при наличии перфорации – прекращение
операции и превентивное лечение “ТУР-синдрома”
4.Поддержание постоянно низкого (40-75 см вод. ст)
внутрипузырного давления (цистостома, резектоскопы Iglesias)
5.Интраоперационный контроль ЭКГ, ОЦК, ЦВД, гематокрита,
электролитов крови
6.Ограничение длительности операции одним часом, в случае
необходимости – разбиение операции на два этапа.