This document summarizes the training process for anesthesiologists in the United States. It outlines the educational requirements including undergraduate studies, medical school, residency training, and licensing exams. Residency training typically lasts 4 years and involves rotations in different specialties like pediatrics, cardiac, and neurosurgery. The training emphasizes patient safety, duty hour limits, and developing skills in perioperative care, acute and chronic pain management, and crisis situations. Overall, the training produces physicians skilled in integrated medical management and efficient, cost-effective surgical care for patients.
This document summarizes the training process for anesthesiologists in the United States. It outlines the educational requirements including undergraduate studies, medical school, residency training, and licensing exams. Residency training typically lasts 4 years and involves rotations in different specialties like pediatrics, cardiac, and neurosurgery. The training emphasizes patient safety, duty hour limits, and developing skills in perioperative care, acute and chronic pain management, and crisis situations. Overall, the training produces physicians skilled in integrated medical management and efficient, cost-effective surgical care for patients.
NGHIÊN CỨU HIỆU QUẢ CỦA GÂY TÊ KHOANG CƠ VUÔNG THẮT LƯNG BẰNG LEVOBUPIVACAIN ...jackjohn45
NGHIÊN CỨU HIỆU QUẢ CỦA GÂY TÊ KHOANG CƠ VUÔNG THẮT LƯNG BẰNG LEVOBUPIVACAIN 0,25% DƯỚI HƯỚNG DẪN SIÊU ÂM TRONG GIẢM ĐAU ĐA MÔ THỨC SAU PHẪU THUẬT LẤY THAI.pdf
ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ CO THẮT TÂM VỊ BẰNG PHẪU THUẬT HELLER KẾT HỢP TẠO VAN CHỐNG TRÀO NGƯỢC QUA NỘI SOI Ổ BỤNG
Phí tải 20.000đ Liên hệ quangthuboss@gmail.com
This document summarizes changes to general anesthesia techniques for Caesarean sections over recent decades. It discusses replacing the old "thiopentone-suxamethonium" rapid sequence induction with newer options like ketamine-propofol or rocuronium paired with sugammadex reversal. Modifications have been made to pre-oxygenation, induction agents, neuromuscular blockade, inhalational agents, adjuncts, and emphasis on meticulous timing. The "Gatt Rule of 100s" proposes a standardized induction sequence with rocuronium reversal by sugammadex within 100 seconds of delivery. Overall, it examines how the traditional general anesthesia Caesarean section technique evolved due to
NGHIÊN CỨU HIỆU QUẢ CỦA GÂY TÊ KHOANG CƠ VUÔNG THẮT LƯNG BẰNG LEVOBUPIVACAIN ...jackjohn45
NGHIÊN CỨU HIỆU QUẢ CỦA GÂY TÊ KHOANG CƠ VUÔNG THẮT LƯNG BẰNG LEVOBUPIVACAIN 0,25% DƯỚI HƯỚNG DẪN SIÊU ÂM TRONG GIẢM ĐAU ĐA MÔ THỨC SAU PHẪU THUẬT LẤY THAI.pdf
ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ CO THẮT TÂM VỊ BẰNG PHẪU THUẬT HELLER KẾT HỢP TẠO VAN CHỐNG TRÀO NGƯỢC QUA NỘI SOI Ổ BỤNG
Phí tải 20.000đ Liên hệ quangthuboss@gmail.com
This document summarizes changes to general anesthesia techniques for Caesarean sections over recent decades. It discusses replacing the old "thiopentone-suxamethonium" rapid sequence induction with newer options like ketamine-propofol or rocuronium paired with sugammadex reversal. Modifications have been made to pre-oxygenation, induction agents, neuromuscular blockade, inhalational agents, adjuncts, and emphasis on meticulous timing. The "Gatt Rule of 100s" proposes a standardized induction sequence with rocuronium reversal by sugammadex within 100 seconds of delivery. Overall, it examines how the traditional general anesthesia Caesarean section technique evolved due to
This document discusses diabetes and pregnancy, focusing on gestational diabetes (GDM). It provides information on:
1) The pathophysiology and risk factors of GDM, noting that it is characterized by increased insulin resistance and inadequate insulin secretion as pregnancy progresses.
2) Findings from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study that showed associations between higher maternal glucose levels and increased risk of adverse pregnancy outcomes.
3) International recommendations and criteria for screening and diagnosing GDM, which vary between organizations like ADA, IADPSG, and WHO. Regular screening is recommended between 24-28 weeks gestation.
This document discusses peripartum seizures and provides several case studies. It outlines an algorithmic approach for evaluating and managing peripartum seizures. Causes can include preeclampsia, eclampsia, epilepsy, or other neurological conditions. Initial treatment involves magnesium sulfate, controlling blood pressure and monitoring. Atypical presentations require further investigation like imaging to rule out conditions like cerebral venous sinus thrombosis. MRI is generally preferred over CT for imaging during pregnancy due to risks of radiation and better detection of conditions like posterior reversible encephalopathy syndrome. Management after delivery includes continued magnesium sulfate, antihypertensives, anticonvulsants and thromboprophylaxis as needed.
This document discusses anesthesia considerations for obstetric hemorrhage. It provides statistics on causes of maternal mortality, including that obstetric hemorrhage accounts for 67.4% of maternal deaths in Vietnam. Common causes of obstetric hemorrhage are uterine atony, retained placenta, abnormal placentation. Risk factors include previous cesarean sections, placenta previa, and placenta accreta. Treatment involves medical uterotonics, blood transfusion, and in severe cases, hysterectomy. Anesthesia management includes anticipating blood loss and having blood products available.
This document discusses the management of high risk parturients, or pregnant women with medical complications or risk factors. It defines high risk parturients and outlines common medical conditions and obstetric risks that classify women as high risk. The document discusses strategies for assessing risk, creating individualized obstetric and anesthesia plans, and ensuring appropriate care for high risk women during labor, delivery and emergencies. It emphasizes the importance of a multidisciplinary team approach, systems to facilitate safe handovers of care, and the need for regional high risk obstetric databases and audits to continually improve care for this patient population.
The document discusses regional anesthesia techniques for caesarean section. It recommends using hyperbaric bupivacaine with fentanyl for spinal anesthesia. It suggests crystalloid cohydration for intravenous fluids and using phenylephrine instead of ephedrine as the vasopressor. The document also recommends combined spinal-epidural anesthesia to reduce spinal doses and improve hemodynamic stability. It provides guidance on epidural top-ups or converting to spinal anesthesia if the epidural fails. The key points emphasize optimal drug choices, fluid management, hemodynamic control and contingency plans for regional anesthesia during caesarean sections.
A 34-year-old Vietnamese woman presented with pulmonary thromboembolism following a cesarean delivery. She experienced cardiac arrest and was resuscitated, but later died from a pulmonary embolism. Pregnancy increases the risks of deep vein thrombosis and pulmonary embolism due to venous stasis, a hypercoagulable state, and vascular injury during delivery. Cesarean delivery further increases these risks compared to vaginal birth. While low molecular weight heparin can effectively prevent and treat thrombosis, early recognition and treatment are needed to reduce the high mortality rates associated with pulmonary embolism during pregnancy.
This document discusses maternal mortality and complications related to obstetric anesthesia. It summarizes that a study of over 257,000 births found serious anesthesia complications in 85 patients (1 in 3,000), with high neuraxial block, respiratory arrest, and unrecognized spinal catheter being the most common. It also provides background information on maternal mortality rates in the Philippines.
Ropivacaine is a new local anesthetic with less cardiovascular and neurological toxicity compared to bupivacaine. This study evaluated the effectiveness of spinal anesthesia using 14 mg of ropivacaine with 30 μg of fentanyl for total abdominal hysterectomies. Results showed that ropivacaine provided effective sensory blockade and muscle relaxation for surgery. Side effects like hypotension and nausea were mild and managed easily. Ropivacaine is concluded to be suitable for short gynecological surgeries allowing for early patient recovery and mobilization.
This study aimed to compare the accuracy of cardiac index measurements between USCOM (ultrasound cardiac output monitor), a non-invasive method, and PICCO (Pulse contour cardiac output), an invasive method, in patients with septic shock. The study found a strong positive linear correlation between the two methods (r=0.8, p<0.001). Bland-Altman analysis showed that 95% of cardiac index measurements from the two methods fell within the limits of agreement. The study concluded that USCOM can accurately measure cardiac index as a non-invasive replacement for the invasive PICCO method in critically ill septic patients.
20. Mổ đẻ tê tủy sống phiên (n=30)
Bupivacaine tỷ trọng cao 12 mg
• FENTANYL: ít đau trong mổ
• FENTANYL: ít buồn nôn trong mổ
Manullang et al. Anesth Analg 2000;90:1162-6.
IV Ondansetron
4 mg
IT Fentanyl
15 μg
Thêm một opioid cải thiện sự thoải mái của
bệnh nhân
21. Morphine
• 100 - 200 μg
• Không chất bảo
quản
• Giảm đau sau mổ
Morpheus
37. AA LL PP HH AA AA GG OO NN II SS TT SS
Tại sao dùng phenylephrine?
• Phenylephrine hiệu quả hơn
• Ephedrine gây toan máu thai nhi
Phenylephrine
38. Ephedrine giảm pH và BE thai nhi
Figure 1. Meta-analysis of trials - effect on umbilical arterial pH
Favours ephedrine Favours phenylephrine
Alahuhta
Hall
LaPorta
Moran
Pierce
Thomas
Overall effect
-0.10 -0.05 0.00 0.05 0.10
Weighted mean difference (umbilical cord arterial blood pH)
Lee A, Ngan Kee WD, Gin T. Anesth Analg 2002;94 920-6.
39.
40. 2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0
TM Rốn : ĐM Mẹ
1.13
(Median values)
* P < 0.0001
0.17 *
Ephedrine Phenylephrine
Ngan Kee WD Anesthesiology 2009; 111:506-12
Ephedrine crosses the placenta more
43. Thời điểm....
Phòng so với Điều trị
Điều trị Hiệu quả Nhất:
•Bắt đầu dùng ngay sau khi tê tủy sống
44. Cách dùng....
Truyền so với Boluses
• Cả hai hiệu quả
• Tiêm cách quãng đơn giản
• Truyền thuận tiện
45. Khuyến cáo:
Kỹ thuật Bolus :
• Liều Bolus : 50-100 μg (0.5-1ml)
• Bắt đầu ngay sau khi tê tủy sống
•Đo HA mỗi 1 phút
• Boluses thêm khi HA bắt đầu giảm
46. Khuyến cao:
Kỹ thuật truyền:
• Bơm tiêm điện
• Bắt đầu ~50 μg/min ngay sau khi khởi tê
• Đo HA mỗi 1 phút
• Tăng tốc độ nếu HA giảm
• Giảm/ngừng nếu HA tăng
47. Khuyến cáo:
Mạch chậm thì sao?
• Associated with ¯cardiac output
• Tolerate to ~ 50-60 bpm
• BP high/normal: stop and wait!
• BP low: IVF, ephedrine,
atropine/glycopyrrolate*
* Thận trọng tăng huyết áp với chất
kháng cholinergics!
48. Khuyến cáo:
Những ca nguy cơ cao thì sao?
• Tiền sản giật
• Fetal compromise
• Ít nghiên cứu
• ít thuốc vận mạc cần thiết
• Dùng liều ít tích cực
59. Epidural Topup….
….or De Novo Spinal?
Đánh giá tê NMC:
• Kiểm soát đau thế nào?
• Mức độ phong bế?
• Bao nhiêu thuốc tê?
• Can thiệp thường xuyên thế nào?
62. Emergency
TOPUPS
SỰ XEM XÉT
• Thường cho dưới áp lực về thời gian
• Liều lớn, tiêm nhanh
• Tốc độ tác dụng
• Sự an toàn
63. • If the quality of epidural block is paramount, then
0.75% ropivacaine is suggested.
• If the speed of onset is important, then a lidocaine
and epinephrine solution, with or without fentanyl,
appears optimal
64. Các biên chứng của gây tê NMC kéo
Các biên chứng của gây tê NMC kéo
dài
dài
8
14
6
2
1
12
Regan KL, O'Sullivan G. Anaesthesia 2008;63:136-42
71. Gây tê vùng cho mổ lấy thai
K E Y P O I N T S
Gây tê TS
• Thuốc tê tỷ trọng cao
• + Fentanyl / Sufentanil
• ± Morphine
72. Gây tê vùng cho mổ lấy thai
K E Y P O I N T S
Dịch truyền
• Dịch tinh thể trong tê
• Dịch keo trước hoặc trong tê
• Không cần trì hoãn truyền dịch
73. Gây tê vùng cho mổ lấy thai
K E Y P O I N T S
Thuốc tăng huyết áp
• Tránh liều cao ephedrine trước lấy thai
• Phenylephrine được ưa thích hơn
• Bolus hoặc truyền
• Mạch chậm: tạm dừng và đợi.
74. Gây tê vùng cho mổ lấy thai
K E Y P O I N T S
K ết hợp tê TS và NMC (CSE)
• Tốt để giảm liều
• Ổ định huyết động tốt hơn
• Tốt cho phẫu thuật kéo dài
75. Gây tê vùng cho mổ lấy thai
K E Y P O I N T S
Epidural Topup for C-Section
• 2% Lidocaine + Adrenaline ± Bicarbonate
• 0.75% Ropivacaine
• TS sau NMA: giảm liều
76. Gây tê vùng cho mổ lấy thai
Warwick D. Ngan Kee
Dept of Anaesthesia & Intensive Care
The Chinese University of Hong Kong