ANESTHESIA STUDENT

Pre hepatic/ Haemolytic/ Bilirubin overload Massive blood transfusion Transfusion reaction Haemolytic anaemia Surgical trauma with multiple injuries Prosthetic heart valve Cardiopulmonary bypass Hepatocellular injury Exacerbation of preexisting liver disease Hepatic ischemia: hypotension, hypovolemia, cardiac failure Hypoxia Drug-induced - Halothane  Septicaemia Intrahepatic Cholestasis  Viral hepatitis Alcoholic hepatitis Cholestasis in pregnancy  TPN Steroid, OCP Extra hepatic cholestasis Biliary obstruction, stricture, injury, leak Pancreatitis Patients with severe cholestasis may have an elevated prothrombin time, which may respond to vitamin K. Prolonged cholestasis may lead to malabsorption of fats and other fat-soluble vitamins, and thus nutritional evaluation may be required. INR should be monitored until normalization unless another explanation such as coagulopathy or medication is provided.

 Anaesthetic goals: Maintenance of acceptable low heart rate  Immediate treatment to atrial fibrillation and reversion to sinus rhythm  Anaesthetic agents causing cardiac depression have to be avoided  Maintenance of adequate SVR Maintenance of adequate venous return  Avoidance of aortocaval compression  Prevention of hypoxaemia, hypercarbia, hypothermia, acidosis which can precipitate increased pulmonary vascular resistance  Prevention of pain and anaemia  To remember the objectives in sequence: Heart rate and rhythm Preload and afterload Pulmonary vascular resistance 

INTRODUCTION Central Neuraxial block (CNB) is the most popular and most widely practiced technique amongst all anaesthetic techniques.  Report and findings of the 3rd National Audit Project of the Royal College of Anaesthetists showed in a conservative estimate, that CNB is used for at least 8–10% of all operations in the UK. Central Neuraxial block (CNB) techniques can produce highly effective pain relief for a wide variety of indications and may decrease patient morbidity after major surgery. Individual studies and meta-analyses have examined this effect and suggested benefit, [1–2] with even cautious commentators accepting that there is merit in the suggestion. [3] Yeager’s very small study reporting that epidural analgesia markedly reduced complication rates (overall complications, cardiovascular failure, major infections, cortisol rise) in high-risk patients was one of the earlier studies to suggest benefits out with improved analgesia. [4] Rodgers metanalysis [5] reported a r

 Seizure in pregnancy: Causes: Eclampsia - 98% (seizure due to pregnancy) Epilepsy (seizure aggravated by pregnancy) Febrile convulsion  Cerebrovascular -  Intracranial haemorrhage  Cerebral venous sinus thrombosis  Ischemic stroke  Space occupying lesion  Amniotic fluid embolism  Air embolism  Posterior reversible encephalopathy syndrome  Reversible cerebral vasoconstriction syndrome  Thrombotic thrombocytopenic purpura  Metabolic -  Hyperemesis gravidarum  Hyperglycaemia or Hypoglycaemia  Electrolyte abnormality -  Hyponatraemia, Hypernatraemia  Hypocalcaemia, Hypercalcemia Hypomagnesaemia   Pyridoxine deficiency  Acute hepatitis (due to fatty liver in pregnancy, viral hepatitis)  Uraemia  Intermittent porphyria  Infection -  Cerebral Maleria Meningitis Encephalitis Cerebral abscess  Psychogenic non epileptic seizure  Tetany  Drug withdrawal -  Cocaine  Alcohol  Local anaesthetic systemic toxicity 

  The spinal cord i s 45 cm long in the adult , a measurement it shares with the lengths of the femur and the vas deferens and with the distance from the lips to the oesophagogastric junction.  It has an elongated cylindrical shape but is somewhat flattened antero - posteriorly, especially in the lumbar region . The cylinder is not uniform in diameter, but bears cervical and lumbar enlargements that correspond to the origins of the brachial and lumbosacral plexuses. The spinal cord is divided into 31 segments, each emitting a pair of spinal nerves. There are: Eight cervical segments. Twelve thoracic segments. Five lumbar segments. Five sacral segments. One coccygeal segment. With the exception of C1 and C2, the spinal nerves exit the spinal canal through the intervertebral foramina. At the terminal end of the spinal cord: The conus medullaris is the tapered terminal portion of the cord. The cauda equina is the collection of spinal nerves that continue inferiorly in the spinal canal af