Decode Medicine from OPD to ICU rounds
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 →
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 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 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