The document discusses thyroid surgery under local anesthesia in selected patients. It notes that historically thyroid surgery was often performed under local anesthesia. The advantages of local anesthesia include avoiding side effects of general anesthesia, providing postoperative analgesia, and facilitating day surgery cases. Thyroid surgery can be safely performed under local anesthesia in properly selected patients, with benefits including reduced costs, operating time, and burden on anesthesia resources compared to general anesthesia. Complications were low when local anesthesia was used.
Supplemental corticosteroids for dental patients with adrenal insufficiency R...DrKamini Dadsena
Primary Adrenal Insufficiency:
It is caused by a progressive destruction of the adrenal cortex, usually of an idiopathic nature (most commonly autoimmune), but also results from hemorrhage, sepsis, infectious diseases (such as tuberculosis, human immunodeficiency virus, cytomegalovirus and fungal infection), malignancy, adrenalectomy, amyloidosis or drugs.
Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical.
Approach to an HIV positive surgical patientusifoh itaman
A discussion on the clinical evaluation and management of an HIV positive surgical patient. Also gives insight on the problems of the HIV patient and management of needle stick injury.
Supplemental corticosteroids for dental patients with adrenal insufficiency R...DrKamini Dadsena
Primary Adrenal Insufficiency:
It is caused by a progressive destruction of the adrenal cortex, usually of an idiopathic nature (most commonly autoimmune), but also results from hemorrhage, sepsis, infectious diseases (such as tuberculosis, human immunodeficiency virus, cytomegalovirus and fungal infection), malignancy, adrenalectomy, amyloidosis or drugs.
Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical.
Approach to an HIV positive surgical patientusifoh itaman
A discussion on the clinical evaluation and management of an HIV positive surgical patient. Also gives insight on the problems of the HIV patient and management of needle stick injury.
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...KETAN VAGHOLKAR
Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for
treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the
open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open
cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological
investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively.
Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group
A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60
years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not
develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B.
The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of
postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the
patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The
commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean
hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy
is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic
requirement, early commencement of oral feeds, and shorter duration of hospitalization
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
Fast Track surgery from the orthopedic point of view
How to apply FTS in orthopedics specially in Arthroplasty surgery. Evidence based practice in orthopedics
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...KETAN VAGHOLKAR
Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for
treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the
open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open
cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological
investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively.
Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group
A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60
years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not
develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B.
The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of
postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the
patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The
commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean
hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy
is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic
requirement, early commencement of oral feeds, and shorter duration of hospitalization
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
Fast Track surgery from the orthopedic point of view
How to apply FTS in orthopedics specially in Arthroplasty surgery. Evidence based practice in orthopedics
Adhesions are an important yet often neglected cause of impaired fertility
The use of adhesion prevention agents should be considered in laparoscopic surgeries as well as Open Surgeries, where adhesion formation is expected
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Thyroid surgery under local anesthesia in selected group of patient
1. THYROID SURGERY UNDER LOCAL
ANESTHESIA IN SELECTED GROUP
OF PATIENT
DR. MD. SAFIULLAH
Associate Professor (Otolaryngology & Head-Neck surgery)
Malek Ukil Medical College
Bangladesh
2. THYROID SURGERY UNDER LOCALANESTHESIA
• In our practice we do thyroid operation under local anesthesia, In
selected group of patients.
• Usually preferred under general anesthesia in current surgical practice.
• Since Koller introduced local anesthesia. Historically thyroid surgery has
been preferred under local anesthesia for many years ago.
• as early as 1907 TP Dunhill reported several conjugative thyroidectomy
under local anesthesia. 1932 GW-Criles has preferred more than 20000
thyroidectomy
• under local anesthesia. Last two decades many surgeons are doing
thyroid operation in a number of cases under local anesthesia .
3. THYROID SURGERY UNDER LOCALANESTHESIA
ADVANTAGE
• Avoidance of side effect of general anesthesia.
• Nausea. vomiting, post operative disorientation.
• Local anesthesia also provide analgesia during post operative period.
• Local anesthesia also modified the stress response of surgery.
• Finally Local anesthesia facilities day cases of thyroid surgery.
• Usefully set up limited anesthesia time an also helps in work load of the hospital.
• Cost & manpower (Anesthesiologist) is also a important factor in country like
Bangladesh.
4. Classification of Goiter
The WHO has classified goiters according to clinical appearance into three grades:
• Grade 0: no palpable or visible abnormality of the thyroid.
• Grade 1: Palpable thyroid mass that is not visualized with the neck in neutral position.
• Grade 2: a visual apparent mass within the neck in neutral position.
Classification of Goiter
• Epidemiology (sporadic, endemic and familial)
• Etiology (iodine deficiency, thyroiditis, malignant, drug-induced and genetic)
• Morphology (multinodular or diffuse)
• Functional (non-toxic and toxic)
THYROID SURGERY UNDER LOCALANESTHESIA
5. Surgical Anatomy
• Weight 20-25 gm
• functional unit- lobule (20-40 follicle, lined by cuboidal epithelium)
• Follicle-contains colloid in which thyroglobulin is stored.
Vascular Supply
• Superior thyroid artery and vein.
• Inferior thyroid artery and vein.
• Anastomosis occurs between main thyroid arteries and tracheal and esophageal arteries.
extensive lymphatic network is there within the gland
THYROID SURGERY UNDER LOCALANESTHESIA
11. PREMEDICATION
• (.5 mg) alprazolam orally at bed time before surgery patient was sedated in pre
operative room by use I/m pethidine I/v Phenergan acceding to body wt.
• Infiltration anesthesia (.5%) lidocaine with (1:100000) adrenaline injected with gouge
niddle in the incision line under skin flap.
• Surgery was performed constant monitor after operation patient was monitor in the
recovery room.
• I/v ceftriaxone (1gm I/v) as prophylactic antibiotics. I/m tramadol was used for post
operative anesthesia none of the patient develop hypocalcemia hypoparathyroidism.
• Feeding start evening. Drain tube removed next morning.
THYROID SURGERY UNDER LOCALANESTHESIA
22. OPERATIVE DATA
• Defined from entry into room to recovery room time was 45 minutes (range from
35-50min) in local anesthesia group and 75 minutes (range from 65-90 min) in
general anesthesia group this are statistically significant. No specific operative
difficulties in local anesthesia group.
• There was drain was inserted in strap muscle. During the recovery room after
surgery was monitoring. To see the sign of respiratory obstruction bleeding &
pain. Less analgesic in post-operative period.
Thyroid surgery under local anesthesia
23. Local Anesthesia
(n=42)
General Anesthesia
(n=42)
Gender
* Male
* Female
7
35
11
31
Pathology
* Benign
* Malignant
35
7
32
11
Lession Size 5.1 cm 6.3 cm
Operation Type
* Lobectomy
* Subtotal thyroidectomy
* Total thyroidectomy
20
18
4
15
18
9
Mean Operating Time 45 mins 70 mins
Mean Cost 400 USD 1000 USD
Comparison clinical features between general and local anesthesia
THYROID SURGERY UNDER LOCALANESTHESIA
24. * Male
* Female
Pathology
* Benign
* Malignant
Lession Size
Operation Type
* Lobectomy
* Subtotal
thyroidectomy
* Total thyroidectomy
Mean Operating Time
Mean Cost
Local Anesthesia
(n=42)
25. THYROID SURGERY UNDER LOCALANESTHESIA
COMPLICATION
• Injury and bleeding
• Respiratory obstruction
• Hypoparathyroidism
• Vocal cord paralysis
• Haematoma
• Seroma
• Infection and conservation of general anesthesia.
• Transient Nausea and vomiting which .
26. THYROID SURGERY UNDER LOCAL
ANESTHESIA
COMPLICATION OF THYROID SURGERY
0%
1%
2%
3%
4%
5%
6%
Hypocalcemia Hematoma Recurrent laryngeal nerve injury Wound infection
Series 1 Column1 Column2
5%
2%
0.8%
5%
27. THYROID SURGERY UNDER LOCALANESTHESIA
CONTRA INDICATION OF LOCAL
ANESTHESIA
• When General anesthesia has its limitations and may not be appropriate in patient
with cardiac complication. Exclusion criteria for local anesthesia were substernal
goiter.
• allergy to local anesthesia.
• obese short neck reoperation.
• Concomitant procedures and neck dissections.
28. THYROID SURGERY UNDER LOCALANESTHESIA
COST OF OPERATION
• Patient from admission to discharge mean cost was 400 USD local
anesthesia group but general anesthesia group cost of the
operation 1000 USD. But 95% confidence interval for the cost
incurred by patient who under do surgery local anesthesia. This is
the difference of both the group which was statistically significant.
29. THYROID SURGERY UNDER LOCALANESTHESIA
DURATION OF STAY IN THE HOSPITAL
• Duration of stay in the Hospital after operation and all the patient started
talking oral in the evening of operation. Among 42 patient 13 patient (26%)
with local anesthesia group discharged with 24 Hours of admission.
• Mean length of stay in the local anesthesia group 39 Hours to 71 Hours but
General anesthesia group stay the Hospital 72 Hours. Which was statistically
significant and general anesthesia group was 65 to 75 (p≤0.05) measure
differences in both group which was statistically significant.
30. THYROID SURGERY UNDER LOCALANESTHESIA
CONCLUSION
• Basic objective of our study was to review experience local anesthesia concerning
the safe and outcome in this approach. The reasons usual quoted for the failure of
this technique are fear of a neurologic complications’. Quick postoperative recovery
and discharge from the Hospital thus cut down the cost incurred by the patient. This
particularly important in a country where vast majority of the patient poor and can’t
even afford the basic necessities of life. Due to limitation number of trained
anesthesia people and increase the burden of the patient. Economically feasible
local anesthesia have carried out such analysis and found that was much less patient
on general anesthesia.
• Our study highlights that thyroid surgery under local anesthesia safe efficacious and
cost effective and thus improve the quality of the life of the patient.
