Showing posts with label Anesthesia. Show all posts
Showing posts with label Anesthesia. Show all posts

Sunday, May 16, 2021

Fact of the day - halothane hepatotoxicity


A patient with biliary stones who's undergone laparoscopic cholecystectomy may develop signs of hepatotoxicity between 2 days - three weeks post-op. due to halothane. The mechanism is this anesthetic's biotransformation to reactive metabolites through P450.

At risk category of patients are females more than 40 years of age.
Labs show elevated AST and ALT.
Hepatitis is relatively rare.

Other effects:

- Cardiac arrhythmias

- malignant hyperthermia

- hypertension

That's all

- Jaskunwar Singh

Wednesday, October 30, 2019

Post-LP Headache

Hey guys! 

Here's all you need to you know about that nasty headache some patients get, after a lumbar puncture (LP).

How common?
Up to one-thirds of all cases.

What are the risk factors?
None. Despite years of anecdotal advice to the contrary, none of the following has ever been scientifically shown to be a risk factor: position during or after the procedure; hydration status before, during or after; amount of CSF removed; immediate activity or rest post-LP.

When does it happen?
Within 24 hours of LP.

How does it present?
Let's SOCRATES the pain here.

Site: Frontal > Occipital
Onset: Acute
Character: Dull aching
Radiation: None
Association: Mild neck stiffness, nausea
Time Course: Lasts for 2 days to 2 weeks
Exacerbating factor: Sitting upright or standing, and so the relieving factor is lying down
Severity: Varies 

What is the pathology?
Thought to be continued leakage of CSF from the puncture site and intracranial hypotension. Other neuro-vascular mechanisms may be involved.

How do I prevent it?
Using the smallest practical needle and keeping the bevel facing up. Before withdrawing the needle, reinserting the stilette.

How do I treat it?
It's self limiting. Can use analgesia, as per WHO Pain Ladder. In extreme cases, can also involve an anaesthetist for an epidural 'blood patch'.

Know something you'd like to add? Let me know.

Thank you for reading. Have a nice rest of the day, you.

- Ashish Singh

Monday, May 13, 2019

Caudal anaesthesia

Hello Awesomites!

Caudal anesthesia is a type of epidural anesthesia. 

The indications for single shot CA are abdominal,urologic or orthopedic surgical procedures located in the sub-umbilical abdominal, pelvic and genital areas, or the lower limbs, where postoperative pain does not require prolonged strong analgesia. Examples include inguinal or umbilical herniorrhaphy, orchidopexy, hypospadias and club foot surgery.

Anatomical landmarks (Figure)
The sacrum is roughly the shape of an equilateral triangle,with its base identified by feeling the two
posterosuperior iliac processes and a caudal summit corresponding to the sacral hiatus.The sacral hiatus is located at the caudal end of the median crest and is created by failure of the S5 laminae
to fuse (Figure). The hiatus is surrounded by the sacral cornu.

Obtain consent for the procedure either from the patient or, if appropriate, from the parents. After induction of general anaesthesia and airway control, the patient is positioned laterally (or ventrally),
with their hips flexed to 90°. Skin disinfection should be performed carefully, because of the proximity to the anus.
After defining the bony landmarks of the sacral triangle, the two sacral cornuae are identified by moving your fingertips from side to side.The gluteal cleft is not a reliable mark of the midline. The puncture is performed between the two sacral cornuae. The needle is oriented 60° in relation to back plane, 90° to skin surface. The needle bevel is oriented ventrally, or parallel to the fibers of the sacro-coccygeal ligament.
After verifying absence of spontaneous reflux of blood or cerebrospinal fluid (more sensitive than an aspiration test), injection of LA should be possible be without resistance. Inject slowly (over about one minute).

-Upasana Y. :) 

Saturday, April 27, 2019

Propofol infusion syndrome

Hello friends!

It is the triad of metabolic acidosis, skeletal myopathy and acute cardiomyopathy.

It is seen in children on prolonged infusion.

It occurs due to failure of metabolism of free fatty acids.



Hi friends!

Propofol is a non-barbiturate intravenous anesthetic agent.
Colour : milky white liquid.
Chemical name : 2,6-diisopropylphenol.
Composition: soyabean oil, glycerol and lecithin.
Metabolism:70% in liver, 30% in lungs and kidneys.

Propofol is associated with quick recovery. So it is the drug of choice for day care surgeries.

Systemic effects:
CVS : It decreases systemic vascular resistance leading to fall in blood pressure causing tachycardia. But it actually causes bradycardia. The reason being blunting of carotid body receptor response (which we have studied in our physiology)
RS : It causes maximum depression of upper airway reflexes. So it is the drug of choice for insertion of laryngeal mask airway.
CNS :  It causes cerebral vasoconstriction leading to fall in intracranial pressure. It is an antiemetic, antipruritic and antioxidant.
It is an anticonvulsant but may cause involuntary movements.

Thanks for reading!

Tuesday, January 1, 2019

In short: Dexmedetomidine and bradycardia

If a patient who is intubated and sedated develops bradycardia, go through the sedatives list - it might give you a hint on what is causing the bradycardia.

Dexmedetomidine (Precedex) is notorious for causing bradycardia. Another sedative associated with bradycardia is propofol.

That's all!

Will update this post at a later date. What you can do if you are free: Read up on it, write a small post on it and email it to us so we can post it and learn from you :)


Friday, December 29, 2017

Nasotracheal intubation


This post is about the indications and contraindications of nasotracheal intubation.

1) Oral surgery
2) Fracture mandible
3) Inadequate mouth opening
4) Tube to be kept for longer time
5) Awake fibre-optic intubation

1) Fracture of base of skull (may directly enter inside skull)
2) CSF rhinorrhea (increases infection - meningitis)
3) Nasal mass (do not allow tube to pass)
4) Adenoids
5) Coagulopathy
6) Decreased movement of endotracheal tube
7) Nasal mucosal damage.

Thanks for reading.

Madhuri Reddy

Malignant hyperthermia

Malignant hyperthermia is a syndrome of rapidly rising temperature.

It occurs due to abnormality of Ryanodine receptors which cause release of large amount of calcium from sarcoplasm reticulum leading to sustained muscular contraction.

It is triggered by:
1) Succinylcholine (50%) - most common
2) ether
3) methoxyflurane
4) halothane
5) enflurane
6) isoflurane
7) Desflurane
8) sevoflurane

Clinical features:
1) Masseter muscle spasm - most initial sign
2) Rise in end tidal CO2
3) Tachycardia
4) Respiratory/ metabolic acidosis
5) Hyperkalemia
6) Pulmonary edema
7) Cerebral edema
8) Myoglobinuria
9) Renal failure
10) Rise in temperature - late sign

1) Stop all anesthetic agents (because one of it is a triggering factor).
2) Hyperventilate with 100% O2.
3) Inj.Dantrolene - 2 mg/kg  intravenously every 5 minutes to a maximum dose of 10 mg/kg.
Dantrolene can be continued for next 48 hours.
4) Sodabicarb to correct metabolic acidosis.
5) Cooling of body.
6) Other symptomatic treatment.

To detect malignant hyperthermia:
BEST DIAGNOSTIC TEST -> Halothane Caffeine muscle contraction test.
BEST SCREENING TEST -> Creatinine kinase test.

Thanks for reading.

Madhuri Reddy

Sunday, October 29, 2017

Neonatal Resuscitation Tray

Hello :D

The tray consist of the following :-
1.Long cuff surgical gloves.
3.Mucous extractor/ suction apparatus - (yankauer suction tube)
4.Suction catheter (6,8,10 Fr= French)
5. Facemask  size 0 and 1
6. Self inflating bag with reservoir , flow inflating bag or T-peice device
7. Laryngoscope with STRAIGHT BLADE (0 and 1 size)  (keep spare bulb and batteries)
8. Endotracheal tube (2,2.5,3,3.5,4 mm ID=internal diameter)
9. Stylet
10. Nasogastric tube (6,8 Fr= French)
11. Disposable syringes ( 1,2 and 10 ml)
12. IV cannula
13. Adhesive tapes and scissors
14. Umblical vessel catheters
15. Pediatric reflex Hammer
16. Drugs (Rarely indicated)
 -Adrenaline (1:10,000)
-Sodium bicarbonate
-Calcium gluconate (not a routine resuscitation drug)
-Potassium chloride (I have seen in my tray!)

So What is in your tray ? :P
Go and find out it in your NICU.
Do share it below in the comment section.

-Upasana Y. :)

Tuesday, August 22, 2017

Image Based MCQ on Instruments

Hello awesomites!
Yesterday we posted an Image based MCQ on Instruments and here is the answer to the question.
Q. What is the inner diameter of the device shown in the picture if it is to be used in adults?

A. 2-3 mm
B. 8-9 mm
C. 12-15 mm
D. 21-23 mm
The correct answer is B. 8-9 mm. The image given shows an Endotracheal tube that is available in different sizes for different age groups.
Internal diameter 3mm - 6mm is used for Paediatric cases.
Typically, an 8.0 or 8.5 mm for adult men and 7.5 to 8.0 mm for adult women is an ideal choice.
Thanks for your active participation in the question.
MD Mobarak Hussain (Maahii)

Wednesday, June 14, 2017

Dibucaine Number.

Hello !
Let's see what this Dibucaine number is.

So Dibucaine is a local anesthetic.

Dibucaine inhibits 80% of the normal Pseudocholinesterase enzyme and 20% of the Atypical enzyme.

The number is determined by measuring the percentage of Pseudocholinesterase enzyme that remains unchanged in the blood of individuals administered a standard dose of Dibucaine intravenously.

Normal Dibucaine number is 70-80% i.e 70-80%of normal enzyme is inhibited by Dibucaine.
If there is a point mutation in the enzyme making it a Atypical Pseudocholinesterase then Dibucaine will not be able to inhibit it and the number will decrease.

This number is used to measure the activity of Atypical Pseudocholinesterase,and to assess the likely hood of prolonged apnea after succinylcholine administration.

Sodium Fluoride can also be used in place of Dibucaine.

If you know more on it Add to this information.

Let's learn Together!