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DOC_ACADEMIA: ANAESTHESIA STUDENT

Anesthesia notes, Anesthesia pharmacology, Clinical Anesthesia , Physiology in Anesthesia, Comorbidity disease in Anesthesia, Anesthesia complications, Regional Anesthesia, Paediatric Anesthesia, Anesthesia machine, Physics in Anesthesia, Anesthetic considerations

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Paediatric blood pressure

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By Anaesthesia student - February 07, 2023

Lower limit of paediatric systolic blood pressure according to age: 0 - 1 month: > 60 mmHg 1 month - 1 yr: > 70 mmHg 1 yr - 10 yr: > 70 + (2 x age in yrs) > 10 yrs: > 90 mmHg

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Paediatric blood pressure

By Anaesthesia student - February 07, 2023

Lower limit of paediatric systolic blood pressure according to age: 0 - 1 month: > 60 mmHg 1 month - 1 yr: > 70 mmHg 1 yr - 10 yr: > 70 + (2 x age in yrs) > 10 yrs: > 90 mmHg

Basic physiology of Neuromuscular junction

By Salahuddin - July 09, 2022

Macro-anatomy of neuron ⍺ Motor neuron is surrounded by myelin sheath which is formed by the Swann cell. Speed of conduction in ⍺ neuron is faster (50 - 100 m/s) due to myelin insulation and node of Ranvier. In the node of Ranvier, there is a high concentration of voltage-gated sodium channel causing depolarisation and saltatory movement to the next node. The neuromuscular junction commences at the nonmyelinated nerve ending. Extraocular, laryngeal and some facial muscles are innervated by slow conducting Ɣ neuron with multiple innervations. Motor endplate The axon terminal surrounded by Schwann cell cytoplasm contains mitochondria and vesicles. The synaptic vesicles are synthesised in the anterior horn cell of the spinal cord and transported to the motor nerve terminal via the micro-tubular system. The synaptic gap is 50 nm wide and contains a basement lamina of 20 nm consisting of mucopolysaccharides. Ach receptor...

Clinical effects of Sevoflurane

By Salahuddin - January 05, 2023

Due to the preferable pharmacodynamics, Sevoflurane is the most favoured drug for the induction and maintenance of anaesthesia. Its low blood-gas partition coefficient helps to rapid alteration of the level of anaesthesia. CVS effects: → Mild ↓ cardiac contractility (dose-dependent, equal to isoflurane) → Mild ↓ SVR (dose-dependent, equal to Halothane) → Mild ↓ BP (dose-dependent, most least compared to others) → Minimal effect on HR → May cause prolongation of the QT interval → Not associated with coronary steal → Doesn't sensitize the myocardium → No effect on splanchnic blood flow Respiratory effects: → Non-irritant → Dose-dependent Tidal volume depression (less than Isoflurane, equal to Halothane) → ↑ RR (equal to Isoflurane, more than Halothane) → ↓ MV causing ↑ PaCO2 → Depression of hypoxic and hypercapnic ventilatory drive → Inhibition of hypoxic pulmonary vasoconstriction → Bronchial smooth muscle r...

Blood Gas Partition Coefficient

By Salahuddin - January 05, 2023

It is the ratio of the amount of anaesthetic agents present in the blood compared to gas when two phases are of equal volume and pressure and in equilibrium at 37 degrees Celsius. ⇒ Also called as Ostwald coefficient of blood gas. ⇒ It expresses the solubility of the agent in blood. ⇒ The higher the blood/gas partition coefficient, the more the agent is soluble. It will take longer to raise the agent's partial pressure in the blood. Anaesthesia is related to the partial pressure of the anaesthetic agent at the effect site. ↑ B/G partition coefficient: ↑ Duration Onset time of anaesthesia ↑ Duration of Offset time of anaesthesia ↓ B/G partition coefficient: ↓ Duration of Onset time ↓ Duration of Offset time The blood gas partition coefficient of the volatile agents: Halothane: 2.4 Isoflurane: 1.4 Sevoflurane: 0.6 Desflurane: 0.4 Halothane is present in the blood 2.4 times more than that present in t...

Regulation of Hepatic blood flow

By Salahuddin - May 27, 2022

Blood supply of liver 25% of cardiac output, 1.5 L/ min Blood supply by hepatic artery (1/3 supply, 98% O2 saturation) and hepatic portal vein (2/3 supply, 70 - 85% O2 saturation) The hepatic triad is formed by the branches of the hepatic artery, hepatic portal vein and bile canaliculus which run together Portal venue and hepatic arteriole join together to form hepatic sinusoid (specialised capillary system) which optimises exchange with hepatocyte Venous drainage to IVC via right and left hepatic vein Regulation of hepatic blood flow Hepatic artery - extrinsic and intrinsic regulation mechanism Portal vein - extrinsic regulation mechanism Intrinsic mechanism: Myogenic autoregulation 👉🏻 if drop-in hepatic arterial pressure ➡️ flow is maintained by a decrease in hepatic arterial resistance Hepatic arterial buffer response 👉🏻 if reduction of flow in portal vein ➡️ compensatory decrease in resistance of hepatic artery t...

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