triad of anaesthesia
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Invasive blood pressure_monitoring
This document provides an overview of arterial blood pressure monitoring. It discusses the history and development of non-invasive blood pressure measurement techniques. It then focuses on the components, principles, and technical aspects of invasive arterial blood pressure monitoring using an intra-arterial catheter connected to a transducer system. Key points covered include the components of the measuring system, optimizing the system's natural frequency and damping, and the importance of zeroing and leveling the transducer.
Intravenous induction agents
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
Bier block (intravenous regional anesthesia)
This presentation details the indications, mechanism, procedure, complications and drugs used for bier block anesthesia.
Capnography
1) Capnography refers to the measurement of carbon dioxide in exhaled gas and can be used to monitor ventilation status.
2) It was first introduced in 1943 but the early devices were large and impractical.
3) Capnography is now widely used in healthcare to monitor patients during procedures like intubation, sedation, mechanical ventilation and general anesthesia by providing information on respiratory and perfusion status.
Spinal anaesthesia basics
This document provides an overview of spinal anaesthesia. It begins with definitions and history, then covers anatomy including the subarachnoid space and structures pierced during spinal anaesthesia. It describes the mechanism of action of spinal anaesthesia and how local anaesthetics work. Indications, contraindications, preparation, positioning, and complications are discussed. Pharmacology of local anaesthetics for spinal anaesthesia and additives are outlined. Monitoring during the procedure and factors affecting the spread of local anaesthetics are also summarized.
Basic mechanical ventilation settings
modes of mechanical ventilation, indication, goals of mechanical ventilation, termination of mechanical ventilation, types of mechanical ventilation, basic ventilator parameters, PEEP, pressure support, CMV, ACM, CPAP, SIMV
Anesthesia workstation
The key points of the document are:
1) The most important part of pre-use checks on an anesthesia workstation is verifying the presence of a self-inflating resuscitation bag in case of issues with ventilation or oxygenation.
2) An ideal vaporizer would maintain a constant output concentration regardless of changes in gas flow, temperature, pressure, or carrier gas composition, but real vaporizers are affected by these factors.
3) Modern vaporizers use various techniques like temperature compensation and automatic controls to minimize fluctuations in vapor concentration due to changes in ambient conditions.
Bed side pulmonary function tests 7
The document describes various bedside pulmonary function tests that can be used to assess lung function and predict postoperative risk. Some of the tests described include the breath holding test to measure cardiopulmonary reserve, single breath count to measure vital capacity, match blowing test to measure maximum breathing capacity, cough test to evaluate cough strength, and tests using a respirometer or whistle to measure parameters like peak expiratory flow rate. The tests provide information on lung volumes, flows, and ability that can help identify patients at risk for pulmonary complications during or after surgery.
Recommended
Invasive blood pressure_monitoring
This document provides an overview of arterial blood pressure monitoring. It discusses the history and development of non-invasive blood pressure measurement techniques. It then focuses on the components, principles, and technical aspects of invasive arterial blood pressure monitoring using an intra-arterial catheter connected to a transducer system. Key points covered include the components of the measuring system, optimizing the system's natural frequency and damping, and the importance of zeroing and leveling the transducer.
Intravenous induction agents
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
Bier block (intravenous regional anesthesia)
This presentation details the indications, mechanism, procedure, complications and drugs used for bier block anesthesia.
Capnography
1) Capnography refers to the measurement of carbon dioxide in exhaled gas and can be used to monitor ventilation status.
2) It was first introduced in 1943 but the early devices were large and impractical.
3) Capnography is now widely used in healthcare to monitor patients during procedures like intubation, sedation, mechanical ventilation and general anesthesia by providing information on respiratory and perfusion status.
Spinal anaesthesia basics
This document provides an overview of spinal anaesthesia. It begins with definitions and history, then covers anatomy including the subarachnoid space and structures pierced during spinal anaesthesia. It describes the mechanism of action of spinal anaesthesia and how local anaesthetics work. Indications, contraindications, preparation, positioning, and complications are discussed. Pharmacology of local anaesthetics for spinal anaesthesia and additives are outlined. Monitoring during the procedure and factors affecting the spread of local anaesthetics are also summarized.
Basic mechanical ventilation settings
modes of mechanical ventilation, indication, goals of mechanical ventilation, termination of mechanical ventilation, types of mechanical ventilation, basic ventilator parameters, PEEP, pressure support, CMV, ACM, CPAP, SIMV
Anesthesia workstation
The key points of the document are:
1) The most important part of pre-use checks on an anesthesia workstation is verifying the presence of a self-inflating resuscitation bag in case of issues with ventilation or oxygenation.
2) An ideal vaporizer would maintain a constant output concentration regardless of changes in gas flow, temperature, pressure, or carrier gas composition, but real vaporizers are affected by these factors.
3) Modern vaporizers use various techniques like temperature compensation and automatic controls to minimize fluctuations in vapor concentration due to changes in ambient conditions.
Bed side pulmonary function tests 7
The document describes various bedside pulmonary function tests that can be used to assess lung function and predict postoperative risk. Some of the tests described include the breath holding test to measure cardiopulmonary reserve, single breath count to measure vital capacity, match blowing test to measure maximum breathing capacity, cough test to evaluate cough strength, and tests using a respirometer or whistle to measure parameters like peak expiratory flow rate. The tests provide information on lung volumes, flows, and ability that can help identify patients at risk for pulmonary complications during or after surgery.
Spinal anesthesia
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
Capnography
This document provides an overview of capnography including:
1) The objectives of describing ventilation, perfusion, and their relationship as assessed by capnography.
2) A description of the normal capnogram waveform and factors that can cause abnormal waveforms related to airway, breathing, and circulation problems.
3) Clinical applications of capnography including confirming endotracheal tube placement, assessing ventilation status, and predicting outcomes of cardiac arrest resuscitation.
Supraglottic airway device
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
Intermediate & low pressure system
This document provides information on the design and components of intermediate and low pressure anaesthesia systems. It discusses the history of anaesthesia machines and describes the key parts of the high, intermediate and low pressure systems. These include oxygen cylinders, pressure regulators, pipelines, flow meters, vaporizers and the common gas outlet. Safety features like oxygen failure devices and their purpose are also explained.
Gas laws in anaesthesia
The document discusses various gas laws and their applications in anesthesia and respiratory physiology. It begins by using Boyle's law to calculate the volume of oxygen remaining in a cylinder at a pressure of 15 psig. It then explains Charles, Gay-Lussac's, Avogadro's, Dalton's laws and their relevance. Further sections cover Hagen-Poiseuille's law, Reynolds number, Graham's law, Bernoulli's principle, Venturi effect, Coanda effect, critical temperature, Poynting effect, adiabatic changes, and other gas laws and their importance in areas like gas delivery, flow dynamics, and equipment function.
Intro to Hypoxic pulmonary vasoconstriction
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Epidural anesthesia
Epidural anesthesia blocks pain in a specific region of the body by administering local anesthetics into the epidural space surrounding the spinal cord. This results in decreased sensation in the lower half of the body. Epidural anesthesia can be performed at different spinal levels and provides pain relief rather than total lack of sensation. It allows for selective nerve blockade and is commonly used for operations below the diaphragm when general anesthesia is contraindicated or for post-operative pain relief.
Difficult airway
The document discusses the management of difficult airways. It defines difficult mask ventilation and difficult laryngoscopy/intubation. It describes various tests that can be used to assess a difficult airway, such as the Mallampati test, thyromental distance, sternomental distance, and neck mobility tests. Radiographic predictors of a difficult airway are also discussed, along with causes of difficult intubation related to patient anatomy and various medical conditions.
Neuromuscular Monitoring
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Basic modes of mechanical ventilation
This document discusses various modes of mechanical ventilation. It begins by describing the basic components and functions of a ventilator. The document then explains the key parameters that ventilators can control including tidal volume, frequency, pressure, and time settings. Several common ventilation modes are described including controlled mandatory ventilation (CMV), assist-control ventilation, intermittent mandatory ventilation (IMV), and synchronized intermittent mandatory ventilation (SIMV). Each mode is defined by how the ventilator delivers breaths in terms of being time-triggered or patient-triggered and how breaths are cycled. The advantages and disadvantages of different modes are also briefly discussed.
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Regional anesthesia
Dr. Suhas presented on regional anesthesia techniques. The presentation covered spinal and epidural anatomy, techniques for administering spinal and epidural blocks, factors affecting the level and duration of blocks, potential complications and their treatment, and applications of regional techniques for different procedures. Key points included identifying spinal landmarks, administration procedures to avoid complications like high blocks, and managing issues like post-dural puncture headache.
Extubation problems and its management
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
supraglottic airway devices
This document provides an overview of supraglottic airway devices. It discusses their history, classifications, indications, contraindications, complications and techniques. It describes some of the major devices including the Classic LMA, LMA Unique, Flexible LMA, LMA Fastrach, Air-Q, and LMA CTrach. Supraglottic devices are used to maintain airway patency and provide ventilation above the vocal cords. They have advantages over face masks and endotracheal tubes in certain situations but also have potential complications if not properly placed.
Monitoring depth of anesthesia
This document discusses various methods for monitoring the depth of anesthesia. It describes clinical techniques such as assessing autonomic responses and muscle movement. It also discusses pharmacological principles like minimum alveolar concentration for different anesthetic responses. Methods for monitoring brain electrical activity are outlined, including spontaneous EEG, compressed spectral analysis, bispectral index, and entropy monitors. Brain electrical activity monitors provide quantitative measures of anesthetic effect but can be influenced by other physiological factors. Overall, the document provides an overview of traditional and advanced techniques for assessing depth of anesthesia.
Day Care Anaesthesia.pptx
This document discusses day care anaesthesia, which involves providing anaesthetic care for elective outpatient surgical procedures and discharging patients on the same day. Key benefits include reduced hospital bed usage, lower costs, and fewer hospital-acquired infections. Patients must meet selection criteria like being ASA physical status I-III with controlled medical conditions, over 6 weeks old, able to recover at home, and having a low-risk procedure under 90 minutes. Contraindications include procedures with major fluid shifts or blood loss, significant postoperative pain or nausea/vomiting, uncontrolled medical issues, or substance abuse.
Double Lumen Endobronchial Tubes ppt
Double lumen tubes were developed in the 1950s-60s to enable lung isolation during thoracic surgery. The Carlens and Bryce-Smith tubes were some of the earliest designs, featuring curves and cuffs to isolate the left or right mainstem bronchus. Modern tubes like the Robertshaw are widely used and come in varying sizes from 26-41 French. Placement requires careful advancement and confirmation via auscultation, cuff inflation, and bronchoscopy to avoid malposition and injury. Double lumen tubes allow selective ventilation and treatment of each lung but require replacement with a single tube after surgery.
post operative cognitive dysfunction
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
Laryngeal mask-airway
The document discusses the history and use of laryngeal mask airways (LMA). It describes how Dr. Brain developed the first LMA prototype in 1981 as a supraglottic device that sits outside the trachea but provides an airway. Over time, different types of LMAs were developed including the classic LMA, ProSeal LMA, reinforced LMA, LMA-Unique, and Supreme LMA. The document outlines the features and proper insertion technique for each LMA and discusses their advantages, such as being less invasive than endotracheal tubes, as well as potential complications if not properly placed.
Perioperative hypoxia
This document discusses perioperative hypoxia. It begins by defining different types of hypoxia and the organs most sensitive to hypoxia. It then discusses the body's defenses against hypoxia like increased ventilation and circulation. Potential causes of preoperative, intraoperative, and postoperative hypoxia are outlined. These include patient factors like underlying lung disease as well as issues with oxygen delivery systems. Methods for diagnosing hypoxia like pulse oximetry and blood gas analysis are also covered. The document concludes by noting management involves addressing the underlying cause of low oxygen levels and optimizing oxygen delivery.
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Spinal anesthesia
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
Capnography
This document provides an overview of capnography including:
1) The objectives of describing ventilation, perfusion, and their relationship as assessed by capnography.
2) A description of the normal capnogram waveform and factors that can cause abnormal waveforms related to airway, breathing, and circulation problems.
3) Clinical applications of capnography including confirming endotracheal tube placement, assessing ventilation status, and predicting outcomes of cardiac arrest resuscitation.
Supraglottic airway device
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
Intermediate & low pressure system
This document provides information on the design and components of intermediate and low pressure anaesthesia systems. It discusses the history of anaesthesia machines and describes the key parts of the high, intermediate and low pressure systems. These include oxygen cylinders, pressure regulators, pipelines, flow meters, vaporizers and the common gas outlet. Safety features like oxygen failure devices and their purpose are also explained.
Gas laws in anaesthesia
The document discusses various gas laws and their applications in anesthesia and respiratory physiology. It begins by using Boyle's law to calculate the volume of oxygen remaining in a cylinder at a pressure of 15 psig. It then explains Charles, Gay-Lussac's, Avogadro's, Dalton's laws and their relevance. Further sections cover Hagen-Poiseuille's law, Reynolds number, Graham's law, Bernoulli's principle, Venturi effect, Coanda effect, critical temperature, Poynting effect, adiabatic changes, and other gas laws and their importance in areas like gas delivery, flow dynamics, and equipment function.
Intro to Hypoxic pulmonary vasoconstriction
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Epidural anesthesia
Epidural anesthesia blocks pain in a specific region of the body by administering local anesthetics into the epidural space surrounding the spinal cord. This results in decreased sensation in the lower half of the body. Epidural anesthesia can be performed at different spinal levels and provides pain relief rather than total lack of sensation. It allows for selective nerve blockade and is commonly used for operations below the diaphragm when general anesthesia is contraindicated or for post-operative pain relief.
Difficult airway
The document discusses the management of difficult airways. It defines difficult mask ventilation and difficult laryngoscopy/intubation. It describes various tests that can be used to assess a difficult airway, such as the Mallampati test, thyromental distance, sternomental distance, and neck mobility tests. Radiographic predictors of a difficult airway are also discussed, along with causes of difficult intubation related to patient anatomy and various medical conditions.
Neuromuscular Monitoring
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Basic modes of mechanical ventilation
This document discusses various modes of mechanical ventilation. It begins by describing the basic components and functions of a ventilator. The document then explains the key parameters that ventilators can control including tidal volume, frequency, pressure, and time settings. Several common ventilation modes are described including controlled mandatory ventilation (CMV), assist-control ventilation, intermittent mandatory ventilation (IMV), and synchronized intermittent mandatory ventilation (SIMV). Each mode is defined by how the ventilator delivers breaths in terms of being time-triggered or patient-triggered and how breaths are cycled. The advantages and disadvantages of different modes are also briefly discussed.
Etomidate a to z
This document provides information about the drug etomidate. It discusses etomidate's history, mechanism of action, effects on body systems, pharmacokinetics, formulations, indications, contraindications, adverse effects, dosing, administration, safety, and relationship to adrenal suppression. The document also outlines cases for discussion and emphasizes that etomidate is the preferred induction agent for hemodynamically unstable patients.
Regional anesthesia
Dr. Suhas presented on regional anesthesia techniques. The presentation covered spinal and epidural anatomy, techniques for administering spinal and epidural blocks, factors affecting the level and duration of blocks, potential complications and their treatment, and applications of regional techniques for different procedures. Key points included identifying spinal landmarks, administration procedures to avoid complications like high blocks, and managing issues like post-dural puncture headache.
Extubation problems and its management
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
supraglottic airway devices
This document provides an overview of supraglottic airway devices. It discusses their history, classifications, indications, contraindications, complications and techniques. It describes some of the major devices including the Classic LMA, LMA Unique, Flexible LMA, LMA Fastrach, Air-Q, and LMA CTrach. Supraglottic devices are used to maintain airway patency and provide ventilation above the vocal cords. They have advantages over face masks and endotracheal tubes in certain situations but also have potential complications if not properly placed.
Monitoring depth of anesthesia
This document discusses various methods for monitoring the depth of anesthesia. It describes clinical techniques such as assessing autonomic responses and muscle movement. It also discusses pharmacological principles like minimum alveolar concentration for different anesthetic responses. Methods for monitoring brain electrical activity are outlined, including spontaneous EEG, compressed spectral analysis, bispectral index, and entropy monitors. Brain electrical activity monitors provide quantitative measures of anesthetic effect but can be influenced by other physiological factors. Overall, the document provides an overview of traditional and advanced techniques for assessing depth of anesthesia.
Day Care Anaesthesia.pptx
This document discusses day care anaesthesia, which involves providing anaesthetic care for elective outpatient surgical procedures and discharging patients on the same day. Key benefits include reduced hospital bed usage, lower costs, and fewer hospital-acquired infections. Patients must meet selection criteria like being ASA physical status I-III with controlled medical conditions, over 6 weeks old, able to recover at home, and having a low-risk procedure under 90 minutes. Contraindications include procedures with major fluid shifts or blood loss, significant postoperative pain or nausea/vomiting, uncontrolled medical issues, or substance abuse.
Double Lumen Endobronchial Tubes ppt
Double lumen tubes were developed in the 1950s-60s to enable lung isolation during thoracic surgery. The Carlens and Bryce-Smith tubes were some of the earliest designs, featuring curves and cuffs to isolate the left or right mainstem bronchus. Modern tubes like the Robertshaw are widely used and come in varying sizes from 26-41 French. Placement requires careful advancement and confirmation via auscultation, cuff inflation, and bronchoscopy to avoid malposition and injury. Double lumen tubes allow selective ventilation and treatment of each lung but require replacement with a single tube after surgery.
post operative cognitive dysfunction
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
Laryngeal mask-airway
The document discusses the history and use of laryngeal mask airways (LMA). It describes how Dr. Brain developed the first LMA prototype in 1981 as a supraglottic device that sits outside the trachea but provides an airway. Over time, different types of LMAs were developed including the classic LMA, ProSeal LMA, reinforced LMA, LMA-Unique, and Supreme LMA. The document outlines the features and proper insertion technique for each LMA and discusses their advantages, such as being less invasive than endotracheal tubes, as well as potential complications if not properly placed.
Perioperative hypoxia
This document discusses perioperative hypoxia. It begins by defining different types of hypoxia and the organs most sensitive to hypoxia. It then discusses the body's defenses against hypoxia like increased ventilation and circulation. Potential causes of preoperative, intraoperative, and postoperative hypoxia are outlined. These include patient factors like underlying lung disease as well as issues with oxygen delivery systems. Methods for diagnosing hypoxia like pulse oximetry and blood gas analysis are also covered. The document concludes by noting management involves addressing the underlying cause of low oxygen levels and optimizing oxygen delivery.