Decode Medicine from OPD to ICU rounds
Supraclavicular brachial plexus block History First introduced by Kulemkempff and Percy in 1911 for mid humerus level to hand surgeries. Relevant anatomy Targets the trunks of brachial plexus formed by C5 -T1 when they form divisions at the level of clavicle. Subclavian artery lies on top of fist rib along with brachial plexus lying […]
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DIFFICULT PEDIATRIC AIRWAY Definition A difficult paediatric airway is a clinical situation in which a conventionally trained anaesthesiologist experiences difficulty with one or more of the following: Face mask ventilation Supraglottic airway placement Tracheal intubation Extubation Front-of-neck access (FONA) Children desaturate much faster than adults because of: Higher oxygen consumption (6–8 mL/kg/min) Lower functional residual
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PEDIATRIC AIRWAY MANAGEMENT Introduction Paediatric airway management is one of the most important and challenging aspects of paediatric anaesthesia. Children are not small adults; they possess unique anatomical and physiological characteristics that predispose them to airway obstruction, difficult ventilation, rapid desaturation, and airway-related complications. The primary goals of paediatric airway management are: • Maintain airway
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Preoperative Cardiac Risk Assessment Introduction The aim of preoperative cardiac risk assessment is to identify patients at increased risk of perioperative cardiovascular complications. To detect any active or unstable cardiovascular disease requiring evaluation or treatment prior to surgery. Used to estimate the risk of major adverse cardiovascular events (MACE). Used to assess the functional capacity.
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Preoperative Investigations Guidelines Preoperative investigations should not be ordered as a routine battery of tests for every patient. The decision should be based on the patient’s clinical condition, comorbidities, medications, age, and the type and extent of surgery. Two commonly referenced guidelines are: Indian Society of Anaesthesiologists (ISA) Practice Guidelines for Preoperative Investigations — Indian
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AIRWAY ASSESMENT Objectives of airway assessment Identify a potentially difficult airway. Anticipate the type of difficulty likely to occur. Prepare appropriate equipment and personnel. Develop a primary and alternative airway plan. Maintain oxygenation throughout airway management. Reduce airway trauma and complications. Anticipate difficulty with extubation and reintubation. No single airway examination test can reliably predict
Inter scalene block Brief history: First brachial plexus block was performed by William Steward Halsted in 1889 → by exposing the brachial plexus and using cocaine for blockade. Inter-scalene block was first described by Winnie in 1970. It often spares the lower branches of the plexus the C8 and T1 fibres innervating ulnar border of
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Physiological Changes in Pregnancy and Their Anaesthetic Implications Physiological adaptation in pregnancy occurs due to three broad mechanisms (Miller’s Anesthesia, 10th ed.): (1) Hormonal changes – oestrogen, progesterone, relaxin, prostaglandins, human placental lactogen, renin–angiotensin–aldosterone activation. (2) Mechanical effects of the enlarging gravid uterus (aortocaval compression, diaphragmatic splinting, altered spinal curvature). (3) Increased maternal metabolic
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AWAKE CRANIOTOMY Dr. Surya Tej PV INTRODUCTION: Specialised Neurosurgical technique Permits intraoperative neurological assessment and functional brain mapping during tumour resection. (1) Depends on appropriate patient selection and preparation+ effective regional analgesia+ titrated sedation Why Awake Craniotomy? Allows real time functional mapping of the brain’s eloquent areas during tumour resection Allows preservation of eloquent areas
Esketamine (S-Ketamine) Introduction S(+) enantiomer of racemic ketamine Non-barbiturate, non-opioid dissociative anaesthetic Produces hypnosis, profound somatic analgesia, amnesia, dissociation 2 times more potent than racemic ketamine 3 times more potent than R-ketamine Available as: IV/IM injection anaesthetic use Intranasal spray for depression Trade names: Ketanest-S, Spravato Mechanism of action Anaesthetic and analgesic action Esketamine →