mahmood badyah

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The P50 value on the O2 Hemoglobin Dissociation Curve..

PaO2 at SPO2 of 90%..

Anesthesia

The Dr Roc Trauma Anesthetic Record Chart Is Now Complete! It can be tailored into a brilliant audit and research tool. I Sincerely Regret the backlog of sending The Standard Anesthetic Chart, I will within the next hour catchup on the backlog! My Email mjoosab@gmail.com I will send you the editable excel version and PDF versions of both Standard and Trauma Charts Please send me feedback on how to improve the Chart Enjoy Easter and The Long Weekend Drive Safe! Take Care Ơ̴̴͡.̮Ơ̴̴̴͡ Anesthesia

Venous Blood Oxygen.

PaO2 In A Neonate!

Hypoxemia

Anesthesia

Carbonic Anhydrase Inhibitor.

The Hemoglobin : Oxygen Dissociation Curve, DrSunita

Took This Pic Whilst In The Labour Ward Assessing A Patient For C-Section.. WHAT ARE THESE⁉️ Ơ̴̴͡.̮Ơ̴̴̴͡ Anesthesia

Bronchodilators.

Primary Indication For Use Of Double Lumen Endotracheal Tube.

Good Pic..

Local Anesthetic With Vasoconstrictor Effect.

Local Anesthetic With Cardiotoxic Side Effects.

Local anesthetic that can result in the side effect of Methemoglobinemia.

20% INTRALIPID This is used to manage Systemic Bupivicaine Cardiotoxicity, What is it's Mechanism Of Action⁉️

Local Anesthetic Implicated In Causing TNS(Transient Neurological Symptoms) After Spinal Anesthesia.

Anion Gap In Critically iLl

Causes of Metabolic Acidosis.

THE SITTING POSITION A.INDICATIONS The sitting position is used for surgery at the back of the head, such as • posterior fossa craniotomy, • cervical and upper thoracic spine surgery, such as cervical laminectomy. II. RISKS 1. Air Embolism The sitting position for cranial surgery is associated with a high incidence of AIR EMBOLISM (25%–45%). This occurs because of noncollapsible venous channels, such as diploic and emissary veins which can be torn during craniotomy. The sitting position leads to air entrainment because of the negative pressure gradient between the surgical site and the heart. 2. Hypotension A. More with abrupt instead of gradually attaining position. In fact, orthostatic blood pressure decreases are common (76%) in the first 60 minutes after induction of anesthesia. Hence, direct arterial pressure must be followed closely on attaining the sitting position, with the transducer leveled at the head. B. Hydration Status Inadequate hydration is more likely to cause hypotension. Hypotension seemed to be particularly an issue in patients who are classified as ASA III or IV. 3. Low Cardiac Output Cardiac output decreases because of a reduction in venous return and the inability for cardiovascular reflexes to compensate. Peripheral and pulmonary vascular resistance increases but only incompletely compensates for the decrease in cardiac output, and cerebral perfusion pressure decreases as a consequence. Cardiovascular instability can also occur during tumor dissection. 3. MIDCERVICAL QUADRIPLEGIA (This is thought to be attributable to a combination of preexisting cervical spine disease and low perfusion pressure); 4. SOFT TISSUE SWELLING The airway, tongue, and facial swelling (exacerbated by place- ment of oral airways for lengthy surgery); Airway obstructing supraglottic edema has also been reported after prolonged posterior fossa surgery conducted with the head in forced flexion.. 5. OBSTRUCTION OF THE TRACHEAL TUBE Obstruction of the endotracheal tube is usually the result of overzealous flexion in the absence of a bite-block. 6. NERVE INJURIES These such as brachial plexus stretch injuries can be caused by inadequate arm support. 7. PNEUMOCEPHALUS. 8. OTHER To date, experts are aware of at least 20 cases of paraplegia after acoustic neuroma resection in the sitting position. III ADVANTAGES Despite its potential problems, the sitting position was not associated with increased morbidity in large series. In fact, sitting patients were less likely to bleed and had fewer cranial nerve deficits than nonsitting cases . Surgical preference for the sitting position is grounded in familiarity with it, the advantages of a clear field (blood readily drains away) and better exposure requiring less aggressive retraction. Dural venous pressure is indeed 5 to 10 cm lower in the sitting versus the supine position . Cerebral blood flow may not decrease on achieving the sit- ting position in anesthetized neurosurgical patients. Other advantages of the sitting position include • improved ventilation (less chest wall compression compared with the prone position), • improved access to the face (eg, for cranial nerve monitoring, ETT check) and extremities (eg, for monitoring neuromuscular blockade, checking vascular access). IV. CONTRAINDICATIONS A. Cardiovascular instability, B. Cardiac Dysfunction especially those known with intracardiac or other right-to-left shunts. C. ORTHODEOXIA (evidence of intra- pulmonary vascular malformation), D. SEVERE CERVICAL SPINE DISEASE E. ADVANCED AGE V. PROCEDURE FOR ATTAINING THE SITTING POSITION • The goal should be to achieve a semi recumbent position with legs elevated to near the level of the heart rather than a ‘‘bolt-upright’’ seated position. • This position assists in keeping central venous pressure (CVP) positive, which, in turn, reduces the atmospheric pressure gradient favoring venous air embolism (VAE). • Before upright positioning, the transesophageal echocardiography (TEE) probe and head-pin holder are placed. • A colloid fluid bolus of approx- imately 10 mL/kg is administered to compensate for venous pooling.This maneuver has been shown to increase CVP and improve systemic blood pressure. • Appropriate positioning technique for the sitting position ensures support of arms and shoulders through the use of special armboards that are placed so that the arms are not pulling the shoulders downward. • Excessive neck flexion is avoided, and a distance of two finger-breadths is maintained between the chin and the sternum . • In addition, the inspired pressure is checked, such that kinking of the ETT can be detected at an early stage. Some advocate the routine use of armored tubes, • When attaining the sitting position, the lower extremities are elevated with the ‘‘kidney rest’’ adjustment of the operating table, to which pillows and folded blankets are added. • Venous return from the lower extremities is further enhanced by compression stockings. • To avoid abdominal compression and sciatic nerve stretch injury the buttocks should be padded and excessive hip flexion avoided. • The seated position should not be achieved at the expense of the ability to lower the head rapidly with respect to the heart (ie, the ability to put the table in the Trendelenburg position). With the overall plane of the OR table in a slight Trendelenburg position, the back is elevated to achieve a 60 to 90degre head-up posture. • Once the final position has been achieved, the head is fixed to the frame, the arterial pressure transducer is zeroed at the level of the foramen magnum to assess cerebral perfusion pressure better, • Precordial Doppler instrumentation is positioned and tested for VAE detection. AN ARTERIAL LINE is Mandatory and must have the Transducer placed at the External Auditory Meatus As This Best Reflects Cerebral Perfusion. Ơ̴̴͡.̮Ơ̴̴̴͡ Anesthesia

Local Anesthetic Also Classified As An Anti-arrhythmic Drug.

A Case Of Improvisation! Today we ran out of Adult Sized South RAE tubes. So we resorted to using an Armored Tube Instead For This Adult Tonsillectomy. Ơ̴̴͡.̮Ơ̴̴̴͡ Anesthesia

Sent from Dr.Manjunath.S.T MVJMC&RH Bangalore

Inhalational Anesthetic Agent Causing Post Operative Nausea & Vomiting

Intractable Opioid Side Effect.

STOPBANG Mnemonic for Assessment of Which Condition?

STOPBANG This Mnemonic is for screening of patients with OSA (obstructive sleep apnea) have recurrent upper airway obstruction during sleep. Patients with obstructive sleep apnea are at risk for development of • left ventricular hypertrophy, • pulmonary hypertension, • myocardial infarction as well as DAYTIME SOMNOLENCE The greatest risk factor for development of OSA is ---> OBESITY Initial screening is via the STOP-BANG questionnaire. Patients with three or more criteria are considered high risk: • Snore: Does the patient snore at night? • Tired: Is the patient tired during the day? • Observe: Has the patient been observed not breathing at night? • Pressure: Is the patient being treated for high blood pressure? • BMI > 35. • Age >50. • Neck circumference > 40 cm. • Gender: Male. POLYSOMNOGRAPHY Confirmatory diagnosis is made from Polysomnography. This will report • The apnea hypopnea index, or • The total number of apneic or hypopneic events per hour: Whereby the disease is categorized as A. MILD • 5 to 15 events/hour B. MODERATE • 15-30 events/hour: moderate disease. C. SEVERE • 30 or more events per hour TREATMENT • DIET & EXERCISE Weight loss should be encouraged, as even a 10% decrease in weight can greatly improve symptoms. • CPAP (Continuos Positive Airway Pressure) Patients with moderate to severe disease should also be treated with CPAP. While it is unclear if CPAP reverses the cardiac risk factors, studies have shown that it decreases daytime somnolence. • MANDIBULAR DEVICE • SURGICAL Though definitive the Uvulopalatopharyngoplasty is not a 100% cure for all cases. Ref Morgan: Clinical Anesthesiology, ed 4, p 814 Miller: Anesthesia, ed 7, p 2092-3 Ơ̴̴͡.̮Ơ̴̴̴͡ Anesthesia