This document provides an overview of anesthesia considerations for otolaryngology procedures. It discusses airway management challenges, commonly used airway devices, and special considerations for procedures like tonsillectomy. Complications from laryngospasm, hemorrhage, and postoperative airway obstruction are also reviewed. Proper patient evaluation, device selection, hemostasis, and postoperative monitoring are emphasized to help avoid complications.
This document discusses anesthesia considerations for functional endoscopic sinus surgery (FESS). It notes that general anesthesia is typically used to provide an immobile surgical field and airway protection. Techniques to minimize bleeding include controlled hypotension, use of propofol, positioning, preoperative steroids, local vasoconstrictors, normothermia, and careful extubation using techniques like intravenous lidocaine to reduce coughing. The LMA is an alternative to endotracheal intubation that provides less airway protection but better hemodynamics and recovery.
Surgical procedures of the head and neck require close cooperation between the surgeon and anesthesiologist. The anesthesiologist must understand the anatomy, physiology, and surgical steps. These procedures carry risks like cardiac dysrhythmias from laryngeal manipulation and underestimating blood loss. Nerve damage during surgery can cause postoperative airway issues. Airway management must be tailored to anticipated difficulty and optimize surgical exposure. Vigilance is needed for postoperative airway complications like laryngospasm.
This document discusses anesthetic considerations for various ENT surgeries:
- Special care must be taken when the airway is shared between the anesthetist and surgeon to avoid complications like disconnection, soiling, or damage.
- Tonsillectomies require secure airways and postoperative pain management. Bleeding after tonsillectomy requires resuscitation and securing the airway.
- Other procedures discussed include adenoidectomy, rigid endoscopy, microlaryngoscopy, and tracheostomy. Each requires specific anesthetic techniques tailored to the surgery and potential complications.
The document discusses tracheostomy suctioning and provides information on related anatomy, history, indications, contraindications, hazards, and management of secretions. It details the vagus nerves and their branches, outlines a brief history of suctioning including early studies showing desaturation and cardiac issues, and lists potential hazards like anxiety, increased intracranial pressure, trauma, infection, pneumothorax, hypoxia, and cardiac issues. It emphasizes limiting suction duration and pressure to reduce hypoxia risks.
This document provides information on basic airway management. It discusses airway obstruction as a medical emergency that can be caused by various factors. Methods for recognizing airway obstruction include identifying inspiratory stridor, expiratory wheeze, or paradoxical chest movement. Airway obstruction can be managed with simple techniques like suctioning secretions, head tilt-chin lift maneuver, or inserting an oropharyngeal or nasopharyngeal airway. Oxygen therapy with a non-rebreathing mask at a 10-15 L/min flow rate can also help treat patients with airway obstruction who are still breathing.
Percutaneous tracheostomy by Saja ALdulaijanMaher AlQuaimi
Percutaneous tracheostomy is a minimally invasive procedure that can be performed at the bedside to insert a tracheostomy tube. It involves using dilators of increasing size to gradually widen the incision and insert the tracheostomy tube. The Ciaglia and Griggs techniques are two common methods that use dilators over a guidewire to perform the procedure. Percutaneous tracheostomy has advantages over open surgical tracheostomy as it does not require transferring the patient to the operating room and has lower risks of complications like infection and stenosis. Proper patient positioning, identification of anatomical landmarks, and use of bronchoscopy are important for successful placement of the tracheostomy tube.
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
The document discusses strategies for reducing the cardiac hazard associated with suctioning. It covers the anatomy of related structures like the vagus nerve and how suctioning can stimulate reflexes. It also outlines objectives for staff training on identifying hazards, assessing patients, and reducing risks through techniques like using the minimum safe suction pressure. Several hazards of suctioning are identified, including hypoxia, infection, trauma, and changes to intracranial pressure.
This document discusses anesthesia considerations for functional endoscopic sinus surgery (FESS). It notes that general anesthesia is typically used to provide an immobile surgical field and airway protection. Techniques to minimize bleeding include controlled hypotension, use of propofol, positioning, preoperative steroids, local vasoconstrictors, normothermia, and careful extubation using techniques like intravenous lidocaine to reduce coughing. The LMA is an alternative to endotracheal intubation that provides less airway protection but better hemodynamics and recovery.
Surgical procedures of the head and neck require close cooperation between the surgeon and anesthesiologist. The anesthesiologist must understand the anatomy, physiology, and surgical steps. These procedures carry risks like cardiac dysrhythmias from laryngeal manipulation and underestimating blood loss. Nerve damage during surgery can cause postoperative airway issues. Airway management must be tailored to anticipated difficulty and optimize surgical exposure. Vigilance is needed for postoperative airway complications like laryngospasm.
This document discusses anesthetic considerations for various ENT surgeries:
- Special care must be taken when the airway is shared between the anesthetist and surgeon to avoid complications like disconnection, soiling, or damage.
- Tonsillectomies require secure airways and postoperative pain management. Bleeding after tonsillectomy requires resuscitation and securing the airway.
- Other procedures discussed include adenoidectomy, rigid endoscopy, microlaryngoscopy, and tracheostomy. Each requires specific anesthetic techniques tailored to the surgery and potential complications.
The document discusses tracheostomy suctioning and provides information on related anatomy, history, indications, contraindications, hazards, and management of secretions. It details the vagus nerves and their branches, outlines a brief history of suctioning including early studies showing desaturation and cardiac issues, and lists potential hazards like anxiety, increased intracranial pressure, trauma, infection, pneumothorax, hypoxia, and cardiac issues. It emphasizes limiting suction duration and pressure to reduce hypoxia risks.
This document provides information on basic airway management. It discusses airway obstruction as a medical emergency that can be caused by various factors. Methods for recognizing airway obstruction include identifying inspiratory stridor, expiratory wheeze, or paradoxical chest movement. Airway obstruction can be managed with simple techniques like suctioning secretions, head tilt-chin lift maneuver, or inserting an oropharyngeal or nasopharyngeal airway. Oxygen therapy with a non-rebreathing mask at a 10-15 L/min flow rate can also help treat patients with airway obstruction who are still breathing.
Percutaneous tracheostomy by Saja ALdulaijanMaher AlQuaimi
Percutaneous tracheostomy is a minimally invasive procedure that can be performed at the bedside to insert a tracheostomy tube. It involves using dilators of increasing size to gradually widen the incision and insert the tracheostomy tube. The Ciaglia and Griggs techniques are two common methods that use dilators over a guidewire to perform the procedure. Percutaneous tracheostomy has advantages over open surgical tracheostomy as it does not require transferring the patient to the operating room and has lower risks of complications like infection and stenosis. Proper patient positioning, identification of anatomical landmarks, and use of bronchoscopy are important for successful placement of the tracheostomy tube.
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
The document discusses strategies for reducing the cardiac hazard associated with suctioning. It covers the anatomy of related structures like the vagus nerve and how suctioning can stimulate reflexes. It also outlines objectives for staff training on identifying hazards, assessing patients, and reducing risks through techniques like using the minimum safe suction pressure. Several hazards of suctioning are identified, including hypoxia, infection, trauma, and changes to intracranial pressure.
The document discusses strategies for safe suctioning of patients to avoid potential cardiac hazards. It covers anatomy related to suctioning, a brief history of suctioning techniques, definitions, indications for suctioning, and various hazards associated with suctioning including patient anxiety, changes in intracranial pressure, trauma, infection, pneumothorax, and hypoxia. The objectives are to familiarize nursing staff with safe suctioning techniques and ways to reduce cardiac hazards through both theoretical and practical teaching.
This document provides information on the anesthetic management of three bronchoscopic procedures: rigid bronchoscopy, mediastinoscopy, and endobronchial ultrasound-guided biopsy. Rigid bronchoscopy requires general anesthesia or IV sedation and involves risks of airway obstruction and desaturation that require close monitoring. Mediastinoscopy carries risks of hemorrhage, nerve injury, and pneumothorax that may require emergent intervention. Endobronchial ultrasound-guided biopsy is typically performed with conscious sedation using topical anesthesia and sedatives administered through a bronchoscope.
Rigid bronchoscopy is used to visualize the trachea and bronchi and manage airway obstructions. It has a large diameter that facilitates suctioning and removal of debris or placement of stents. It is commonly used for tumor debulking, foreign body removal, stent placement, and ablative treatments. Contraindications include cardiac issues, pulmonary issues, bleeding risks, and inability to cooperate. Direct intubation through the vocal cords using a rigid telescope is preferred but laryngoscopy can also be used. Intubation through an existing tracheostomy is also possible. Complications include hypoxemia, trauma, and swelling. Careful technique is needed to avoid injuries.
This document discusses complications that can occur with tracheostomies. It notes that most complications can be avoided with meticulous surgery and dedicated postoperative care from a multidisciplinary team, especially nurses in the first 48 hours. Common early complications include hemorrhage, tube obstruction, and tube displacement. Late complications include granuloma formation, tracheo-esophageal fistula, tracheocutaneous fistula, and laryngotracheal stenosis. The document provides details on preventing and managing specific complications like subcutaneous emphysema, pneumothorax, tube displacement, and tracheal necrosis. It emphasizes the importance of proper tube size and position, adequate humidification, infection control, and managing cuff pressure to
World Laparoscopy Hospital provides learning by doing. It provides real-world laparoscopic surgery experience by allowing the trainee to get hands-on directly with whatever surgeons are learning and developing a sense of empowerment. After taking this laparoscopic training course, surgeons and gynecologists can perform laparoscopic surgery them self on their patients with confidence.
The anesthetic problems during minimal access surgery
are related to the cardiopulmonary effects of pneumoperitoneum, carbon dioxide (CO2) absorption, extraperitoneal
gas insufflation, venous embolism, and inadvertent injuries
to intraabdominal organs. Optimal anesthetic care of
patients undergoing laparoscopic surgery is very much
important. Good anesthetic techniques facilitate riskfree surgery and allow early detection and reduction of
complications.
In young patients, fit for diagnostic laparoscopy, general
anesthesia is the preferred method and does not impose
any increased risk. Adequate anesthesia and analgesia
are essential and endotracheal intubation and controlled
ventilation should be considered. The pneumoperitoneum
can be created safely under local anesthesia provided that
the patient is adequately sedated throughout the procedure.
For successful laparoscopy under local anesthesia, intravenous (IV) medication for sedation should be given
The anesthetic problems during minimal access surgery are related to the cardiopulmonary effects of pneumoperitoneum, carbon dioxide (CO2) absorption, extraperitoneal
gas insufflation, venous embolism, and inadvertent injuries to intraabdominal organs.
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
The patient has received an excessive dose of ketamine for her body weight. Ketamine has a long duration of action and she is still experiencing its effects 12 hours later when she should have recovered much sooner. A lower and more appropriate dose of ketamine should have been used.
The document provides an overview of airway anatomy and management techniques. It describes the anatomy starting from the nose down to the trachea. It then discusses factors that can make the airway difficult and techniques for assessing the airway. It explains various airway management techniques including mask ventilation, use of airways, laryngoscopy, intubation, and alternative techniques like LMA and needle cricothyrotomy.
1) Flexible bronchoscopy (FOB) is commonly performed in the ICU for both diagnostic and therapeutic purposes. Some key indications include evaluating pneumonia, hemoptysis, thoracic trauma, and airway inhalation injuries.
2) Performing FOB in critically ill ICU patients presents challenges due to risks of hypoxemia, hypercapnia, and hemodynamic changes from airway obstruction. Careful preparation and monitoring is important.
3) Technical considerations for safe FOB in ventilated patients include using a large ETT, adjusting ventilator settings to minimize changes in tidal volume, and applying suction intermittently to avoid severe desaturation. Proper anesthesia and monitoring of vitals is
This document discusses tracheostomy, including its history, indications, effects, techniques for insertion, care, and cautions. It provides guidance on timing of tracheostomy for prolonged ventilation cases. Key points include:
- Tracheostomy decreases anatomical dead space and work of breathing compared to endotracheal intubation.
- The TracMan study found no difference in mortality between early (1-4 days) and late (10+ days) tracheostomy for prolonged ventilation, though early tracheostomy resulted in less days of sedation.
- Percutaneous tracheostomy is usually performed under bronchoscopic guidance using commercial kits involving guidewire dilation of the tracheal stoma.
- Trache
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
1. The document discusses tracheostomy and anaesthesia considerations for microlaryngeal surgery. It covers the definition, history, steps of the procedure, complications, types of tubes, and techniques for airway management including endotracheal intubation and jet ventilation.
2. Lasers are commonly used in microlaryngeal surgery and ENT procedures. Safety precautions are required due to the risks of burns, fires and smoke inhalation. Special endotracheal tubes coated in metal foil or other fire-resistant materials help protect the airway during laser use.
3. Careful planning is needed for airway management and ventilation during these delicate procedures to provide optimal surgical conditions while protecting the patient's air
Airway management refers to the evaluation, planning and use of medical procedures and devices to maintain or restore ventilation of a patient. The main maneuvers used for opening the airway are head tilt-chin lift and jaw thrust. The correct size of oropharyngeal and nasopharyngeal airways is measured from anatomical landmarks - oropharyngeal airway size is measured from the tip of the mouth to the angle of the mandible, while nasopharyngeal airway size is measured from the tip of the nose to the tragus of the ear.
This document provides information on acquired laryngotracheal stenosis in pediatrics. It discusses pediatric laryngeal anatomy, history taking, physical examination, imaging studies including CT/MRI, endoscopic evaluation using rigid and flexible bronchoscopy, voice evaluation, considerations prior to laryngeal reconstruction such as medical therapy, and tracheotomy placement. The goal of evaluation and treatment is to determine if laryngeal reconstruction can allow for decannulation. Medical therapy aims to reduce inflammation from conditions like gastroesophageal reflux or eosinophilic esophagitis prior to reconstruction.
The document discusses strategies for safe suctioning of patients to avoid potential cardiac hazards. It covers anatomy related to suctioning, a brief history of suctioning techniques, definitions, indications for suctioning, and various hazards associated with suctioning including patient anxiety, changes in intracranial pressure, trauma, infection, pneumothorax, and hypoxia. The objectives are to familiarize nursing staff with safe suctioning techniques and ways to reduce cardiac hazards through both theoretical and practical teaching.
This document provides information on the anesthetic management of three bronchoscopic procedures: rigid bronchoscopy, mediastinoscopy, and endobronchial ultrasound-guided biopsy. Rigid bronchoscopy requires general anesthesia or IV sedation and involves risks of airway obstruction and desaturation that require close monitoring. Mediastinoscopy carries risks of hemorrhage, nerve injury, and pneumothorax that may require emergent intervention. Endobronchial ultrasound-guided biopsy is typically performed with conscious sedation using topical anesthesia and sedatives administered through a bronchoscope.
Rigid bronchoscopy is used to visualize the trachea and bronchi and manage airway obstructions. It has a large diameter that facilitates suctioning and removal of debris or placement of stents. It is commonly used for tumor debulking, foreign body removal, stent placement, and ablative treatments. Contraindications include cardiac issues, pulmonary issues, bleeding risks, and inability to cooperate. Direct intubation through the vocal cords using a rigid telescope is preferred but laryngoscopy can also be used. Intubation through an existing tracheostomy is also possible. Complications include hypoxemia, trauma, and swelling. Careful technique is needed to avoid injuries.
This document discusses complications that can occur with tracheostomies. It notes that most complications can be avoided with meticulous surgery and dedicated postoperative care from a multidisciplinary team, especially nurses in the first 48 hours. Common early complications include hemorrhage, tube obstruction, and tube displacement. Late complications include granuloma formation, tracheo-esophageal fistula, tracheocutaneous fistula, and laryngotracheal stenosis. The document provides details on preventing and managing specific complications like subcutaneous emphysema, pneumothorax, tube displacement, and tracheal necrosis. It emphasizes the importance of proper tube size and position, adequate humidification, infection control, and managing cuff pressure to
World Laparoscopy Hospital provides learning by doing. It provides real-world laparoscopic surgery experience by allowing the trainee to get hands-on directly with whatever surgeons are learning and developing a sense of empowerment. After taking this laparoscopic training course, surgeons and gynecologists can perform laparoscopic surgery them self on their patients with confidence.
The anesthetic problems during minimal access surgery
are related to the cardiopulmonary effects of pneumoperitoneum, carbon dioxide (CO2) absorption, extraperitoneal
gas insufflation, venous embolism, and inadvertent injuries
to intraabdominal organs. Optimal anesthetic care of
patients undergoing laparoscopic surgery is very much
important. Good anesthetic techniques facilitate riskfree surgery and allow early detection and reduction of
complications.
In young patients, fit for diagnostic laparoscopy, general
anesthesia is the preferred method and does not impose
any increased risk. Adequate anesthesia and analgesia
are essential and endotracheal intubation and controlled
ventilation should be considered. The pneumoperitoneum
can be created safely under local anesthesia provided that
the patient is adequately sedated throughout the procedure.
For successful laparoscopy under local anesthesia, intravenous (IV) medication for sedation should be given
The anesthetic problems during minimal access surgery are related to the cardiopulmonary effects of pneumoperitoneum, carbon dioxide (CO2) absorption, extraperitoneal
gas insufflation, venous embolism, and inadvertent injuries to intraabdominal organs.
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
The patient has received an excessive dose of ketamine for her body weight. Ketamine has a long duration of action and she is still experiencing its effects 12 hours later when she should have recovered much sooner. A lower and more appropriate dose of ketamine should have been used.
The document provides an overview of airway anatomy and management techniques. It describes the anatomy starting from the nose down to the trachea. It then discusses factors that can make the airway difficult and techniques for assessing the airway. It explains various airway management techniques including mask ventilation, use of airways, laryngoscopy, intubation, and alternative techniques like LMA and needle cricothyrotomy.
1) Flexible bronchoscopy (FOB) is commonly performed in the ICU for both diagnostic and therapeutic purposes. Some key indications include evaluating pneumonia, hemoptysis, thoracic trauma, and airway inhalation injuries.
2) Performing FOB in critically ill ICU patients presents challenges due to risks of hypoxemia, hypercapnia, and hemodynamic changes from airway obstruction. Careful preparation and monitoring is important.
3) Technical considerations for safe FOB in ventilated patients include using a large ETT, adjusting ventilator settings to minimize changes in tidal volume, and applying suction intermittently to avoid severe desaturation. Proper anesthesia and monitoring of vitals is
This document discusses tracheostomy, including its history, indications, effects, techniques for insertion, care, and cautions. It provides guidance on timing of tracheostomy for prolonged ventilation cases. Key points include:
- Tracheostomy decreases anatomical dead space and work of breathing compared to endotracheal intubation.
- The TracMan study found no difference in mortality between early (1-4 days) and late (10+ days) tracheostomy for prolonged ventilation, though early tracheostomy resulted in less days of sedation.
- Percutaneous tracheostomy is usually performed under bronchoscopic guidance using commercial kits involving guidewire dilation of the tracheal stoma.
- Trache
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
1. The document discusses tracheostomy and anaesthesia considerations for microlaryngeal surgery. It covers the definition, history, steps of the procedure, complications, types of tubes, and techniques for airway management including endotracheal intubation and jet ventilation.
2. Lasers are commonly used in microlaryngeal surgery and ENT procedures. Safety precautions are required due to the risks of burns, fires and smoke inhalation. Special endotracheal tubes coated in metal foil or other fire-resistant materials help protect the airway during laser use.
3. Careful planning is needed for airway management and ventilation during these delicate procedures to provide optimal surgical conditions while protecting the patient's air
Airway management refers to the evaluation, planning and use of medical procedures and devices to maintain or restore ventilation of a patient. The main maneuvers used for opening the airway are head tilt-chin lift and jaw thrust. The correct size of oropharyngeal and nasopharyngeal airways is measured from anatomical landmarks - oropharyngeal airway size is measured from the tip of the mouth to the angle of the mandible, while nasopharyngeal airway size is measured from the tip of the nose to the tragus of the ear.
This document provides information on acquired laryngotracheal stenosis in pediatrics. It discusses pediatric laryngeal anatomy, history taking, physical examination, imaging studies including CT/MRI, endoscopic evaluation using rigid and flexible bronchoscopy, voice evaluation, considerations prior to laryngeal reconstruction such as medical therapy, and tracheotomy placement. The goal of evaluation and treatment is to determine if laryngeal reconstruction can allow for decannulation. Medical therapy aims to reduce inflammation from conditions like gastroesophageal reflux or eosinophilic esophagitis prior to reconstruction.
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
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
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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).
16. 2/24/201616
Surgical procedures involving the eyes, ears, nose,
and throat require a cooperative relationship
between the surgeon and the anesthesiologist.
It is important for the anesthesiologist to
appreciate the anatomy and physiology of the
structures in the operative field.
17.
18.
19. 2/24/201619
Understanding of the surgical procedure is
important.
Patients undergoing surgical procedures on the
head and neck represent a diversity of age groups
from infants to the elderly.
20. 2/24/201620
It is important to appreciate that manipulation of
the larynx, pharynx, and neck may precipitate
cardiac dysrhythmias
Blood loss can be underestimated as a result of
hidden losses within the surgical drapes and blood
swallowed into the stomach.
21. 2/24/201621
• The use of neuromonitoring techniques during
surgery to aid the surgeon in identification of
peripheral nerves in the operative area may
influence the choice and dose of anesthetic and
neuromuscular blocking drugs.
22. 2/24/201622
Damage to nerves that innervate the pharynx,
larynx, and especially the vocal cords (may be
manifested promptly after tracheal extubation) can
occur during head and neck surgery.
The presence of laryngeal and pharyngeal edema
should be considered before tracheal extubation.
23. 2/24/201623
Special Considerations for Head and Neck Surgery
Most patients scheduled for head and neck surgery
will have their airway examined by the surgeon
before surgery.
The anesthesiologist should communicate with the
surgeon about the probability of a difficult airway
and whether nasal or oral tracheal intubation is
indicated for optimal surgical exposure.
24. 2/24/201624
An awake fiberoptic intubation of the trachea or
a tracheostomy under local anesthesia may be
indicated if difficult upper airway management
is anticipated.
Be aware of endotracheal tubes that are
available for head and neck surgery to facilitate
better surgical exposure
26. 2/24/201626
LARYNGOSPASM
Instrumentation or manipulation of the endolarynx
or the presence of blood or a foreign body can
induce laryngospasm.
Laryngospasm is an exaggerated and prolonged
response of the protective glottic closure reflex,
mediated by the superior laryngeal nerve.
27. 2/24/201627
• “With severe Laryngospasm, the false cords and
epiglottic body come together firmly. Airflow is
absent, there is no vocal sound, and the true vocal
cords cannot be seen.
28. 2/24/201628
If laryngospasm persists, arterial hypoxemia and
hypercapnia will decrease postsynaptic action
potentials and brainstem output to the superior
laryngeal nerve, and the intensity of the
laryngospasm will eventually decrease.
29. 2/24/201629
The most common method of overcoming
laryngospasm is continued positive airway pressure
applied by facemask
Intravenous administration of a neuromuscular
blocking drug such as succinylcholine (0.25 to 1
mg/kg). Intubation of the trachca may be warranted
in selected patients.
30. 2/24/201630
Tonsillectomy and Adenoidectomy
Patients who undergo tonsillectomy and
adenoidectomy are usually young and healthy.
Recurrent upper respiratory tract infection remains
a significant indication for surgery
Upper airway obstruction especially during sleep
(obstructive sleep apnea [OSA]),especially in
children younger than 4 years.
31. 2/24/201631
Preoperative evaluation for tonsillectomy or
adenoidectomy, or both, depends on the initial
history and physical examination.
Classic symptoms of severe upper airway
obstruction and adenotonsillar hypertrophy, the
preoperative evaluation rarely requires any special
studies.
32. 2/24/201632
In some patients, if severe airway obstruction is
suspected, an electrocardiogram, echocardiogram,
chest radiograph, and coagulation studies may be
considered
Sedative premedication may be avoided in children
with OSA, intermittent upper airway obstruction, or
very large tonsils.
33. 2/24/201633
OBSTRUCTIVE SLEEP APNEA
OSA syndrome may be associated with
behavior and growth disturbances.
Symptoms include snoring, sleep disturbances
and daytime hypersomnolence, decreased
school performance and personality changes,
recurrent enuresis, hyponasal speech, and
growth disturbances.
34. 2/24/201634
Patients with OSA are often obese
Difficult upper airway management
Short, thick necks, large tongues, and redundant
pharyngeal tissues such that upper airway
obstruction
35. 2/24/201635
Frequent (UAO) and awake tracheal intubation will
be necessary.
Polysomnography to evaluate the severity of OSA
requires hospitalization, is expensive, and is rarely
needed.
38. 2/24/201638
UPPER RESPIRATORY TRACT INFECTIONS
Patients may arrive at the hospital for elective
tonsillectomy and adenoidectomy with an acute
upper respiratory tract infection.
Surgery →→postponed until resolution of the upper
respiratory tract infection, which is typically 7 to 14
days.
Laryngospasm with airway manipulation may be
more likely to occur in the presence of an upper
respiratory tract infection.
39. 2/24/201639
GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux disease (GERD) may be
significant symptom in children with chronic lung
disease or upper airway obstruction (or both)
secondary to increased intrathoracic negative
pressure.
Relevant in neurologically abnormal patients
(hypotonia, developmental delay) because such
patients have a high incidence of GERD even
without upper airway obstruction.
40. 2/24/201640
GERD is a consideration in young children with
significant developmental delay who require
tonsillectomy to treat upper airway obstruction.
41. 2/24/201641
MANAGEMENT OF ANESTHESIA
Management of anesthesia for patients undergoing
tonsillectomy is focused on airway considerations
and bleeding.
Continuous positive airway pressure during
induction of anesthesia may be useful for
alleviating upper airway obstruction.
42. 2/24/201642
Placement of a cuffed endotracheal tube will
decrease the incidence of aspiration of blood.
As with an uncuffed tube, a cuffed endotracheal
tube should be appropriately sized to allow an air
leak around the tube with 20 to 25 cm H20 of peak
airway pressure.
43. 2/24/201643
The tracheal tube cuff is inflated beyond this point
only if high peak airway pressure is needed to
ventilate the lungs adequately or if hemorrhage
suddenly develops.
44. 2/24/201644
When difficult tracheal intubation is anticipated, it
may be helpful to have an otolaryngologist present.
The use of an oral RAE tube for tracheal intubation
may optimize visualization of the surgical field.
45. 2/24/201645
The supraglottic area may be packed with
petroleum gauze to minimize the likelihood of
inhalation of blood from the pharynx.
when gauze packing is used, it is important to
maintain an appropriate leak around the tube
during the application of positive airway pressure.
46. 46
The practice of monitoring young children for 24
hours after surgery is based on Observations of
postoperative airway obstruction occurring in
children younger than 4 years as late as 18 to 24
hours postoperatively.
47. 2/24/201647
In addition to young age, risk factors ssociated
with postoperative airway obstruction after
tonsillectomy may include prematurity and
recent upper respiratory infection.
48. 2/24/201648
Surgeons are meticulous about ensuring a dry
tonsillar bed at the end of surgery
Pack in the posterior of the pharynx to limit
draining of blood into the stomach during the
procedure.
• .
49. 2/24/201649
Inserting an orogastric tube into the stomach
before extubating the trachea while being careful
to not traumatize the adenoidectomy site is a
frequent maneuver to remove any blood that may
have drained into the stomach
50. 2/24/201650
Tracheal extubation is performed when the child is
awake and responding.
In patients with reactive airway disease, including
asthma, tracheal extubation may be performed
while the patient is still anesthetized to decrease
the likelihood of bronchospasm and laryngospasm.
51. 2/24/201651
POSTOPERATIVE CARE AND COMPLICATIONS
Dexamethasone administered intravenously may be
useful for decreasing postoperative pain.
Adding an intraoperative dose of an antiemetic
Removing blood from the stomach may combine to
decrease postoperative emesis.
52. 2/24/201652
Hemorrhage from a bleeding tonsil in the
postoperative period is a recognized complication.
The need for tracheal reintubation may be
complicated by the presence of large amounts of
swallowed blood in the stomach.
53. 2/24/201653
In this regard, care should be taken to not
oversedate these patients.
If the bleeding is not controlled, the patient should
be returned to the operating room for exploration
and surgical hemostasis.
54. 2/24/201654
Acute airway obstruction such as laryngospasm
can lead to negative-pressure pulmonary edema.
This occurs as the patient breathes against a closed
glottis and negative intrathoracic pressure is
created.
55. 2/24/201655
This pressure is transmitted to interstitial tissue,
where the hydrostatic pressure gradient is
increased and enhances fluid movement out of the
pulmonary circulation into the alveoli.
Airway obstruction in the postoperative period
can also be associated with retention of a
pharyngeal pack.
56. 2/24/201656
Postoperative Complications of Tonsillectomy
Emesis (occurs in 30%–65% of patients; mechanism
unknown but may include the presence of irritant
blood in the stomach)
Dehydration
Hemorrhage (75% occurs in first 6 hours after
surgery; if surgical hemostasis is required, a full
stomach and hypovolemia should be considered)
57. 2/24/201657
Pain (minimal after adenoidectomy and severe
after tonsillectomy)
Postobstructive pulmonary edema (rare but
possible if the patient has had a prior acute
upper airway obstruction; treatment may include
supplemental oxygen and administration of
diuretics)
58. 2/24/201658
Early discharge
Examples of patients in whom early discharge
is not advised after tonsillectomy include
Younger than 3 years of age
Abnormal coagulation values
Evidence of obstructive sleep disorder or apnea
59. 2/24/201659
Presence of a peritonsillar abscess
Conditions (distance, weather, social
conditions) that would prevent close
observation or prompt return to the hospital.
60. 2/24/201660
Laser Surgery
Laser surgery provides precision in targeting airway
lesions
Minimal bleeding and edema
Preservation of surrounding structures and rapid
healing.
61. 2/24/201661
The carbon dioxide laser has particular
application in the treatment of laryngeal or
vocal cord papillomas, laryngeal webs,
resection of redundant subglottic tissue, and
coagulation of hemangiomas.
62. 2/24/201662
In most cases laser surgery is preceded by micro
direct laryngoscopy.
The use of small-diameter endotracheal tubes (5.0
or 5.5 mm internal diameter) is necessary for
optimum exposure.
Brief skeletal muscle paralysis as provided by an
infusion of succinylcholine may be useful.
63. 2/24/201663
MANAGEMENT OF ANESTHESIA
Anesthesia during laser surgery may be administered
with or without an endotracheal tube.
However, appropriate laser-resistant endotracheal
tubes should be available.
In this regard, all polyvinyl chloride endotracheal tubes
are flammable and can ignite and vaporize when in
contact with the laser beam.
64. 2/24/201664
Some surgeons may prefer using Marshall
laryngoscope and intermittent ventilation with a
Sanders jet ventilator.
The Sanders jet ventilator delivers oxygen at 50 psi
directly through a port in the laryngoscope.
If Marshall laryngoscope is used, maintenance
anesthesia can be accomplished with an
intravenous anesthetic.
65. 2/24/201665
Use of the Sanders jet ventilator is associated with
a risk for pneumothorax and pneumomediastinum
as a result of rupture of alveolar blebs or a
bronchus.
66. 2/24/201666
Laser surgery produces a plume of smoke and particles
(mean size, 0.31µm) that can be deposited in the alveoli
if aspirated .
This hazard can be minimized if an efficient smoke
evacuator and special masks are used.
A misdirected laser bean can also lead to perforation of
a viscus and transection of blood vessels.Other risks
include venous gas embolism and ocular injury.
68. 2/24/201668
The patient's eyes must be protected by taping
then shut, followed by the application of wet
gauze pads and a metal shield to prevent laser
penetration.
All operating room personnel should wear
special protective glasses.
70. 2/24/201670
Characteristic signs and symptoms of acute epiglottitis
include
(1) a sudden onset of fever, dysphagia, drooling, thick
muffled voice, and preference for the sitting
position with the head extended and leaning
forward
(2) retractions, labored breathing, and cyanosis when
respiratory obstruction is present.
71. Suggestions for drawer labels
Plan A
Initial intubation strategy
OptimiseBougie Alternative
positionlaryngoscope
Remember to move
on if not making
progress
Plan C
Maintain oxygenation
Facemask LMA device
+/- airway adjunct
Postpone surgery
Awaken patient
Plan B
Secondary intubation strategy
LMA deviceFibreoptic intubation
Remember to move
on if not making
progress
Plan D
Can’t intubate, can’t ventilate
Cannula
cricothyroidotomy
Remember to move
on if not making
progress
Plan D
Can’t intubate, can’t ventilate
Surgical
cricothyroidotomy
Remember to move
on if not making
progress
Editor's Notes
Micro Direct laryngoscopy is a procedure to examine the larynx with a microscopy under anesthesia. It is done to examine the larynx fully without problems with gagging, pain, or motion from swallowing or movement of the vocal cords.