Anesthesia
Inter scalene block
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 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
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
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 →
Remimazolam
Remimazolam Introduction Ultra-short-acting intravenous benzodiazepine Structurally related to midazolam Rapid, predictable metabolism resembles the pharmacokinetic concept of remifentanil Available as remimazolam besylate Water-soluble formulation Trade name: Byfavo Chemistry Imidazobenzodiazepine containing a metabolically labile carboxylic ester linkage Molecular formula: C₂₁H₁₉BrN₄O₂ Molecular weight: approximately 439.3 Da The ester linkage permits rapid hydrolysis to an inactive metabolite Mechanism
Apnoeic Oxygenation
Apnoeic Oxygenation Definition Apnoeic oxygenation is the continuous delivery of oxygen to the airway during apnoea, allowing ongoing alveolar oxygen uptake without spontaneous breathing or positive-pressure ventilation. It delays desaturation and prolongs safe apnoea time during airway management. Important: It maintains oxygenation but does not provide adequate ventilation. Mechanism O₂ continues to diffuse from alveoli
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Neuropathic Pain
NEUROPATHIC PAIN BRIEFThis guide translates Neuropatic pain: Fundamental neurophysiology and pharmacology into structured bedside diagnostic and therapeutic pathways. DEFINITION AND ETIOLOGY Neuropathic pain: Defined by the International Association for the Study of Pain (IASP) as pain caused by a lesion or disease of the somatosensory nervous system . It is critical to recognize that neuropathic
Pediatric airway anatomy and assessment
Paediatric Airway Anatomy and Assessment Introduction Paediatric airway management differs significantly from adult airway management because of unique anatomical and physiological characteristics. A relatively large tongue, cephalad larynx, compliant airway structures, and limited oxygen reserves predispose children to airway obstruction and rapid desaturation. Understanding these differences and performing a systematic airway assessment are essential for
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Nociceptors and Pain Fiber Classification
Nociceptor Classification and Molecular Transduction Clinical Pearls & Key Takeaways • Temporal Distinction: The dichotomy between ‘first’ and ‘second’ pain is purely a function of conduction velocities between fast myelinated Aδ and slow unmyelinated C fibres. • Molecular Transduction: TRPV1 acts as a non-selective gating channel responsive to heat and local acidosis, whereas mechanical noxious
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