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Postgraduate Topics in Anaesthesia
V Mahadevan, Anil Kumar Asokan
1:
Oxygen—Haemoglobin Dissociation Curve
SHIFTS IN ODC
CAUSES
FACTORS AFFECTING THE POSITION OF THE OXY-Hb DISSOCIATION CURVE
Temperature
Hydrogen Ions
CO2
Organic Phosphates-2,3 DPG and ATP
Congenital Abnormalities of ODC
ODC and Environmental Factors
Carbon Monoxide
ODC and Chronic Disease States
ODC in Acute Disease State
Acute Myocardial Ischaemia
Blood Storage and Transfusion
ODC and Anaesthesiologist
ODC and Cardiopulmonary Bypass
Therapeutic Manipulation of ODC
2:
Bohr Effect
3:
Gate Control Theory of Pain
4:
Opiate Receptors
MECHANISM OF OPIOID ACTION
5:
Extracellular Fluid
INTRODUCTION
RELATIVE SIZES OF BODY FLUID COMPARTMENTS
CONTENTS OF THE ECF
DETERMINATION OF IVF
DETERMINATION OF INTERSTITIAL AND INTRACELLULAR SPACE
PRINCIPLES OF FLUID REPLACEMENT
Non-ionic Solutions
Ionic Solutions
Blood Products and Colloids
COMPLICATIONS OF OVEREXPANSION OF THE INTERSTITIAL SPACE
6:
Effect of Hypothermia on Cardiorespiratory Physiology
7:
Regulation of Cerebral Blood Flow
INTRODUCTION
CHEMICAL REGULATION OF CBF
Cerebral Metabolic Rate
PaCO2
PaO2
MYOGENIC REGULATION (AUTOREGULATION)
Definition
Mechanism
NEUROGENIC REGULATION
BLOOD VISCOSITY
EFFECTS OF ANAESTHETIC DRUGS ON CBF AND CMR
8:
Cerebral Steal
9:
Microcirculation in Shock
CLASSIFICATION OF SHOCK
THE STAGES OF SHOCK
MICROCIRCULATION
Structure
MICROVASCULATURE IN SHOCK
10:
Supine Hypotensive Syndrome
CLINICAL FEATURES
EFFECTS ON FOETUS
PREVENTION
11:
Nitroglycerine
INTRODUCTION
Chemical Structure
Pharmacokinetics
Pharmacodynamics
Mechanism of Action
Therapeutic Uses
Disadvantages/Demerits
12:
Beta-blockers and Anaesthetic Implications
INTRODUCTION
CLASSIFICATION
BETA BLOCKING DRUGS
PHARMACODYNAMICS
PHARMACOKINETICS
INDICATIONS FOR BETA-BLOCKERS
Cardiovascular
In Hypertension BP is Reduced by
Anti-arrhythmic Effect due to
In Hypertrophic Obstructive Cardiomyopathy
Angina
Cyanotic Spells
ANAESTHETIC INDICATIONS
NEUROPSYCHIATRIC INDICATION
GLAUCOMA
CONTRAINDICATIONS TO BETA-BLOCKER THERAPY
Adequate Beta-blocker Therapy
ANAESTHETIC CONSIDERATIONS IN PATIENTS ON BETA-BLOCKER THERAPY
DRUG INTERACTIONS
Reversal of Beta-Blockade
Treatment of Anaesthetic Induced Hypertension
Labetalol
Esmolol
Uses
13:
Calcium Channel Blockers
ROLE OF CALCIUM IN CARDIAC CELL ACTIVITY
GODFRANID CLASSIFICATION OF CA CHANNEL BLOCKERS
Mechanism of Action
PHARMACOKINETICS
INDICATIONS
Advantage over Beta-blockers
ANAESTHESIA AND CALCIUM CHANNEL BLOCKERS
Treatment of Ca++ Blocker Toxicity
14:
Propofol (Diprivan)
CHEMICAL CHARACTERISTICS
METABOLISM
PHARMACOKINETICS
PHARMACOLOGY
RESPIRATORY SYSTEM
Action is Similar to Barbiturates
Maintenance Infusion
CVS
Other Effects
Uses
SIDE EFFECTS
15:
Midazolam
PHARMACOKINETICS
EFFECTS ON ORGAN SYSTEMS
CLINICAL USES
Drug Interactions
Adverse Reactions
TREATMENT
16:
Flumazenil
STRUCTURE
PHYSIOCHEMICAL CHARACTERISTICS
MECHANISM OF ACTION
PHARMACOKINETICS
PHARMACOLOGY
Uses and Doses
Side Effects and Contraindications
17:
Narcotic Antagonists
HISTORY
Antagonist
CLINICALLY USEFUL OPIOID ANTAGONISTS
Uses of Narcotic Antagonists: General
NALOXONE
Uses of Naloxone
Other Uses of Naloxone
Special Features
Absorption, Fate and Excretion
Side Effects and Toxicity
NALTREXONE HYDROCHLORIDE (TREXAN)
Side Effects
NALMEFENE
Side Effects
18:
Magnesium Sulfate
INTRODUCTION
MECHANISM OF ACTION
DOSAGE
SIDE EFFECTS OF MAGNESIUM THERAPY
MONITORING DURING MAGNESIUM THERAPY
19:
Steroids in Anaesthetic Practice
ANAESTHETIC CONSIDERATIONS
MINERALOCORTICOID DEFICIENCY
SIDE EFFECTS OF STEROIDS
CONTRAINDICATIONS
20:
Neuroleptanalgesia
USES OF NEUROLEPTANALGESIA
DOSAGE
SIDE EFFECTS
CONTRAINDICATIONS
21:
Acute Barbiturate Poisoning
CLINICAL FEATURES
TEMPERATURE
DIAGNOSIS
MANAGEMENT
SPECIFIC THERAPY
MONITORING
22:
Rationale for Premedication
CONSIDERATIONS FOR PHARMACOLOGIC PREMEDICATION
SELECTED GOALS OF PREMEDICATION
DETERMINANTS OF DRUG CHOICE AND DOSE
DEPRESSANT PHARMACOLOGIC PREMEDICATION
23:
Placental Transfer of Drugs
DETERMINANTS OF PLACENTAL TRANSFER
Maternal Factors
Placental Factors (Fig. 23.1)
Foetal Factors (Fig. 23.2)
Foetal Uptake of Drugs
Foetal Distribution of Drugs
Foetal Metabolism and Excretion of Drugs
PLACENTAL TRANSFER OF INDIVIDUAL DRUGS
Inhalational Anaesthetics
Barbiturates
Tranquilizers
Local Anaesthetics
Neuromuscular Blocking Drugs
Atropine and Neostigmine
24:
Anaphylactic Reactions during Anaesthesia
DEFINITION
INCIDENCE
PATHOPHYSIOLOGY OF ANAPHYLACTIC REACTION
CLINICAL MANIFESTATIONS
CVS Manifestations
Respiratory System Manifestations
Cutaneous Manifestations
DIFFERENTIAL DIAGNOSIS IN ANAESTHETISED PATIENT
MANAGEMENT OF ANAPHYLAXIS
Initial Therapy
Secondary Treatment
IMMUNODIAGNOSTIC TEST
SPECIFIC ALLERGIC REACTIONS SEEN BY ANAESTHESIOLOGIST
Narcotics
Barbiturates
Local Anaesthetics
Radio-contrast Media
Protamine
Streptokinase
Mannitol
Methyl Methacrylate
25:
Assessment of Blood Loss during Surgery
ASSESSMENT OF BLOOD LOSS DURING SURGERY
METHODS TO MEASURE BLOOD LOSS
26:
Massive Blood Transfusion
APPARATUS
INDICATIONS
COMPLICATIONS
Rate Dependent Complications
Volume Dependent Complications
27:
Blood Component Therapy
PACKED RED BLOOD CELLS
ADVANTAGES OF USING PACKED CELLS
PLATELET CONCENTRATES
FRESH FROZEN PLASMA
Indications for FFP
CRYOPRECIPITATE
Use
PROTHROMBIN COMPLEX
Indication
SINGLE DONOR PLASMA
ALBUMIN AND PLASMA PROTEIN PREPARATIONS
Indication
GRANULOCYTE CONCENTRATE
Indications
28:
Autologous Blood Transfusion
DEFINITION
HISTORY
TYPES OF AUTOLOGOUS TRANSFUSION
Preoperative Phlebotomy (POP)
Uses
Complications
Cross-over Usage
Intraoperative Blood Salvage
Characteristics of Salvaged Blood
Indications
Contraindications
Complications
Postoperative Blood Salvage
Post-traumatic Salvage
29:
Acute Normovolaemic Haemodilution
DEFINITION
PHYSIOLOGICAL EFFECTS
PATIENT SELECTION
Technique
Complications
Contraindications
30:
Regional Anaesthesia in Children
BLOCK OF DORSAL NERVE OF PENIS
Principle
Technique
NERVE BLOCK FOR HERNIA REPAIR
Technique
SUBARACHNOID BLOCK
IVRA
Procedure
BRACHIAL PLEXUS BLOCK
31:
Trigeminal Neuralgia (Tic Douloureux)
TREATMENT
Medical
Thermocoagulation
Trigeminal Nerve Block
Gasserian Ganglion Block
Maxillary Nerve
Mandibular Nerve
Other Surgical Approaches
Neurolytic Blockade: Considerations
32:
Coeliac Plexus Block
ANATOMY
PHYSIOLOGY OF COELIAC PLEXUS BLOCK
Blockade of Afferent Nociceptive Fibres
Blockade of Sympathetic Fibres to GIT
Blockade of Sympathetic Fibres to Splanchnic Vessels
DRUGS USED FOR CoELIAC PLEXUS BLOCKADE
Alcohol
Phenol
INDICATIONS
TECHNIQUE
PROCEDURE
COMPLICATIONS
33:
Patient Controlled Analgesia
INTRODUCTION
PRINCIPLE
PCA DEVICES
PCA MODES
BASIC VARIABLES IN PCA
ADVANTAGES OF PCA
DISADVANTAGES OF PCA
34:
Noninvasive Methods to Assess Ventricular Function
CARDIAC RHYTHM
MECHANICAL FUNCTION OF THE VENTRICLES AND PERIPHERAL VASCULAR SYSTEM
Heart Sounds
Arterial Pressure
CVP
CARDIAC OUTPUT
ECHOCARDIOGRAPHIC ESTIMATION OF LEFT VENTRICULAR SIZE, FUNCTION AND REGIONAL WALL MOTION
FLOW PATTERN USING COLOUR DOPPLER
RADIONUCLEIDE IMAGING
MYOCARDIAL METABOLIC STATE
35:
Advanced Life Support
DRUGS AND FLUIDS
Drugs Used
Adrenaline
Sodium Bicarbonate
Vasopressin
Calcium
Other Drugs
ECG Monitoring
Ventricular Fibrillation
Asystole
Treatment
Electromechanical Dissociation
Pulseless Ventricular Tachycardia
Fibrillation Treatment
36:
Pulmonary Capillary Wedge Pressure
CONDITIONS WHERE PCWP DOES NOT REFLECT LVEDP
Indications for Measurement
Measurement
37:
Intra-Aortic Balloon Pump
ADVANTAGES OF IABP
CRITERIA FOR MECHANICAL SUPPORT OF CIRCULATION
INDICATIONS FOR IABP
PHYSIOLOGICAL CHANGES WITH IABP
APPLICATIONS
COMPLICATIONS
LIMITATIONS OF IABP
CONTRAINDICATIONS
38:
Cardiopulmonary Cerebral Resuscitation Controversies
CARDIAC PUMP VERSUS THORACIC PUMP
Site of Compression
CAB or ABC?
The Demise of Polypharmacy
COLLOID VERSUS CRYSTALLOID
Defibrillation
Early Intubation
Role of Laymen
Cerebral Protection
39:
Aetiology and Management of Intraoperative Cardiac Arrhythmias
INDIVIDUAL ARRHYTHMIAS
Supraventricular Arrhythmias
VENTRICULAR ARRHYTHMIAS
Heart Block
Sinus Tachycardia
Sinus Bradycardia
Premature Complexes: Atrial vs Ventricular
ATRIAL FLUTTER
ATRIAL FIBRILLATION (AF)
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION (VF)
Ventricular Fibrillation is Cardiac Arrest
Management of VF
Management of Electromechanical Dissociation
Ventricular Asystoles
General Points
Significance of the WPW Syndrome
40:
Air Embolism
VENOUS AIR EMBOLISM
MONITORING
Occurrence of Air Embolism during Cardiopulmonary Bypass
41:
Oxygen Toxicity
PULMONARY TOXICITY
Hypoventilation
Retrolental Fibroplasia
CNS TOXICITY
PROPOSED MECHANISMS OF O2 TOXICITY
Absorption Collapse
Lung Surfactant
Metabolic Upset
Myocardial Failure
Role of Endocrine System
42:
Flail Chest
DEFINITION
DIAGNOSIS
MANAGEMENT
Aims
MONITORING
TREATMENT
43:
Acid Aspiration Syndrome
HISTORY
INCIDENCE
Mortality
Morbidity
PATHOPHYSIOLOGY
ASPIRATION DUE TO VOMITING OCCURS
FACTORS WHICH CAN DELAY GASTRIC EMPTYING TIME
FACTORS CONTRIBUTING INCOMPETENCE TO GASTROESOPHAGEAL SPHINCTER
Types of Pulmonary Aspirate
FACTORS DETERMINING THE EXTENT OF PULMONARY INJURY
CLINICAL PICTURE
DIAGNOSIS
MANAGEMENT
PREVENTION OF ACID ASPIRATION SYNDROME
44:
Tension Pneumothorax
INTRODUCTION
OPEN PNEUMOTHORAX
CLOSED PNEUMOTHORAX
TENSION (VALVULAR) PNEUMOTHORAX
Causes
Pathophysiology
Clinical Features
Cardinal Signs of Tension Pneumothorax
Radiographic Evidence
ANAESTHETIC AND PERIOPERATIVE CONSIDERATIONS
45:
Hyperbaric Oxygen Therapy
LIST OF CONDITIONS FOR WHICH HBO IS USED
PHYSIOLOGIC EFFECTS OF INCREASED GAS PRESSURE
RATIONALE FOR TREATMENT OF SPECIFIC SYNDROMES
Carbon Monoxide Poisoning
Gas Embolism
Acute Infection
Support of Arterial Oxygenation During Anaesthesia
Maintenance of Oxygen Transport in Severe Anaemia
THERAPEUTIC SYSTEMS
Multiple Chambers
Monoplace Chamber
TREATMENT MODE
46:
Adult Respiratory Distress Syndrome
DEFINITION
PREDISPOSING FACTORS
AETIOLOGY AND PATHOPHYSIOLOGY
MULTIPLE ORGAN FAILURE
MANAGEMENT
PREVENTION
TREATMENT
MONITORING
47:
Hyperkalaemia
CAUSES
SIGNS AND SYMPTOMS
ECG CHANGES
TREATMENT
48:
Aetiology and Management of Intraoperative Bronchospasm
DEFINITION
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS OF INTRAOPERATIVE BRONCHOSPASM
MANAGEMENT OF INTRAOPERATIVE BRONCHOSPASM
Beta Adrenergic Agents
Anticholinergics
Other Measures
49:
American Society of Anaesthesiologists Grading
AMERICAN SOCIETY OF ANAESTHESIOLOGISTS PHYSICAL STATUS
50:
Post-dural Puncture Headache
INCIDENCE
AETIOLOGY
DIAGNOSIS
PREVENTION
TREATMENT
51:
Role of Anaesthesiologist in Eclampsia
INTRODUCTION
DEFINITIONS
TARGET ORGAN CHANGES IN SEVERE PET/ECLAMPSIA
Coagulation Abnormalities
Anaesthetic Considerations and Management of Severe PET/Eclampsia
THE AIMS OF THERAPY IN SEVERE PET/ECLAMPSIA
TREATMENT OF PET
DRUGS USED TO TREAT HYPERTENSION
GENERAL ANAESTHESIA
52:
Myxoedema and Anaesthetic Indications
AETIOLOGY OF HYPOTHYROIDISM
DIAGNOSIS
SIGNS AND SYMPTOMS
Physical Examination
Cardiovascular System
Endocrine System
TREATMENT
MANAGEMENT OF ANAESTHESIA
Premedication
Preinduction Monitoring
INDUCTION OF ANAESTHESIA
MAINTENANCE OF ANAESTHESIA
Precautions
REGIONAL ANAESTHESIA
MYXOEDEMA COMA
53:
Anaesthetic Considerations in Ophthalmic Surgery
LOCAL ANAESTHESIA
Advantages
Disadvantages
GENERAL ANAESTHESIA
Anaesthetic Considerations
Anaesthetic Management of Ophthalmic Surgery
54:
Transurethral Prostatectomy Syndrome
CLINICAL FEATURES
Symptoms
Signs
TREATMENT
55:
Sickle Cell Anaemia and its Anaesthetic Implications
PATHOPHYSIOLOGY
Factors Promoting Formation of Sickle Cells
CLINICAL MANIFESTATIONS
Infarctive Crisis
TREATMENT
MANAGEMENT OF ANAESTHESIA
Preanaesthetic Transfusion
Preoperative Assessment and Preparation
Premedication
Intraoperative and Postoperative Precautions
Postoperative Period
Role of Regional Anaesthesia
56:
Anaesthetic Technique and Problems in Total Hip Replacement
ANAESTHETIC MANAGEMENT
Monitoring
BLOOD LOSS
POSITIONING
CHECKLIST
INTRAOPERATIVE HYPOTENSION
To Minimise these Complications
POSTOPERATIVE MANAGEMENT
57:
Positioning in Anaesthesia
SUPINE POSITION
Complications
PRONE POSITION
Indications
POSITIONING
Effect on the CVS
Effect on Respiratory System
Neurologic Injuries
Other Injuries
HEAD ELEVATED POSITIONS
The Sitting Positions
Physiologic Effects
The Trendelenburg Position
The Lateral Decubitus Position
LITHOTOMY POSITION
Complications
Anaesthesiologic Considerations
58:
Malignant Hyperthermia
DEFINITION
INCIDENCE
PATHOGENESIS
Abnormalities
SKELETAL MUSCLE
MYOCARDIUM
CENTRAL NERVOUS SYSTEM
SYMPATHETIC NERVOUS SYSTEM
BLOOD
THEORIES OF MALIGNANT HYPERTHERMIA
CLINICAL PRESENTATION
Incidence of Various Clinical Signs
CRUCIAL SIGNS
LAB FINDINGS OF ACUTE MH
DIFFERENTIAL DIAGNOSIS
MH TRIGGERING FACTORS
Anaesthetic Agents
Safe
Unsafe
Genetics
Associated Disorders
Coincidental Association
TREATMENT
Specific
Supportive Therapy
PREANAESTHETIC DIAGNOSIS
ANAESTHESIA IN MH PATIENTS
Avoidance of Triggering Agents
Precautions
59:
Awareness During Anaesthesia
60:
Monitoring of Intracranial Pressure
THE INTRACRANIAL PRESSURE/VOLUME CURVE
INDICATIONS FOR ICP MONITORING
USES OF ICP MONITORING
TECHNIQUES OF ICP MONITORING
Intraventricular Catheter
Advantages
Disadvantages
Fluid Filled Surface Monitoring Devices
Balloon Devices
Hollow Screw Devices
Cup Catheter
Nonfluid Coupled Devices for Surface Monitoring of ICP
Mechanical (ICP Pressure Switch)
Optical (Ladd ICP Monitor)
Electronic Devices
Implantable Devices
Disadvantages
Epidural Sensors
61:
Brain Preservation: Recent Trends
INTRODUCTION
CEREBRAL PROTECTION MODALITIES
CALCIUM CHANNEL ANTAGONISTS
EXCITATORY AMINO ACID ANTAGONISTS
PROSTAGLANDIN INHIBITORS
CORTICOSTEROIDS
62:
Sensory Evoked Potential
DEFINITION
CLASSIFICATION OF SENSORY EVOKED POTENTIALS
Depending upon Distance between Neural Generator and Recording Electrode
Sensory Evoked Potentials
Poststimulus Latencies
RECORDING OF SENSORY EVOKED POTENTIALS
Somatosensory Evoked Potentials
Clinical Uses
Factors Affecting SSEP
Auditory Evoked Potentials
TECHNIQUES
Brainstem Evoked Potentials
Uses
Electrocochleography
Auditory Nerve Action Potentials (ANAP)
Visual Evoked Potentials
Visual Evoked Potential are Used in the Following Procedures
63:
Pulse Oximetry
INTRODUCTION
PRINCIPLE
BASIC DESIGN
INTERPRETATION
ADVANTAGES AND USES
Main Uses
Limitations and Errors
Biological Errors
Disadvantages
64:
End Tidal Capnography
PRINCIPLE
EQUIPMENT
ANALYSER
SIDE STREAM ANALYSER
MAINSTREAM ANALYSER
NORMAL CAPNOGRAM
Systematic Examination of Capnogram
Presence of Exhaled Gas
Analysis of Phases of Capnogram
END TIDAL CO2
CLINICAL APPLICATIONS
65:
Humidifiers
DEFINITIONS
Absolute Humidity
Humidity at Saturation
Relative Humidity
IMPORTANCE OF HUMIDIFICATION
CLASSIFICATION OF HUMIDIFIERS
HUMIDIFICATION METHODS
Direct Instillation of Saline
Simple Bottle Humidifier (Fig. 65.2)
The Heat and Moisture Exchanger (HME) or Artificial Nose (Fig. 65.3)
Advantages
Disadvantages
NEBULISER (FIG. 65.4)
Ultrasonic Nebuliser Droplets (Fig. 65.5)
Advantage
Disadvantages
66:
Mapleson Circuits
MAPLESON A SYSTEM (FIG. 66.1)
Technique of Use
Functional Analysis and FGF Recommendations
During Spontaneous Ventilation
During Controlled Ventilation
THE LACK CIRCUIT (FIG. 66.4)
Equipment
Technique of Use
Functional Analysis and FGF Requirements
Comparison with other Circuits
MAPLESON B SYSTEM (FIG. 66.5)
Equipment
Technique of Use
MAPLESON C SYSTEM (FIG. 66.6)
Equipment
MAPLESON D SYSTEM (FIG. 66.7)
BAIN'S CIRCUIT (FIG. 66.8)
Equipment
Technique of Use
Functional Analysis
During Spontaneous Ventilation
FGF during Controlled Ventilation
Hazards of the Bain Circuit
Testing of Brain and Penlon Coaxial Circuits
Sterilisation of Bain Circuit
Advantages of Bain Circuit
MAPLESON E SYSTEM (THE T PIECE)
Description of the Equipment
Modifications
Harrisons Classification of the Modifications of T Piece
Techniques of Use
Functional Analysis (Fig. 66.12)
Hazards of the T Piece System
JACKSON REES MODIFICATION OF T PIECE (MAPLESON F) (FIG. 66.13)
Description of the Equipment
Techniques of Use
Functional Analysis
Advantages
Disadvantages
67:
Positive End Expiratory Pressure
GRAVITY DEPENDENT DEVICES
Under Water Column
Water Weighted Diaphragm
NON-GRAVITY DEPENDENT DEVICES
Venturi PEEP Valve
Spring Loaded Disk Valve
Pressurised Exhalation Balloon Valve
Magnetic PEEP Valve
Fixed or Adjustable Orifice
MEASUREMENT
INDICATIONS
EFFECTS
Pulmonary
Cardiovascular and Haemodynamic Effects
Optimal PEEP
Auto PEEP/Inadvertent PEEP/Intrinsic PEEP
Monitoring
68:
Intermittent Mandatory Ventilation
DEFINITION
APPARATUS
SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION (FIG. 68.3)
CLINICAL APPLICATIONS OF IMV
69:
Pressure Support Ventilation
PSV MAX
70:
Weaning Modes of Ventilation
DEFINITION
CRITERIA FOR WEANING
CLINICAL CRITERIA
WEANING METHODS
T Piece Weaning
IMV Weaning (Flow chart 70.1)
IMV/SIMV-Pressure Support Ventilation
CPAP and Weaning
Airway Pressure Release Ventilation (Fig. 70.2)
71:
High Frequency Positive Pressure Ventilation
INTRODUCTION AND HISTORICAL PERSPECTIVE
DEFINITION
CHARACTERISTICS
THEORIES
FEATURES
USES AND INDICATIONS
72:
Sterilisation of Anaesthetic Equipments
INTRODUCTION
Decontamination
Disinfection
Sterilisation
AUTOCLAVING
GAMMA IRRADIATION
ETHYLENE OXIDE OR PROPYLENE OXIDE GAS
RECOMMENDATIONS FOR STERILISATION OF ANAESTHETIC EQUIPMENTS
Anaesthetic Machine
Circle Absorbers
Ventilators
Face Masks
Endotracheal Tube and Airway
Laryngoscope Blade and Other Metal Accessaries
Special Precautions for Infected Cases
Storage of Sterile Objects
73:
Electrical Hazards in Operation Theatres
FROM NORMAL ELECTRIC CURRENTS
Static Electricity
Diathermy
PREVENTION OF HAZARDS DUE TO DIATHERMY
The Other Normal Electric Currents
FAULTY ELECTRIC CURRENTS
Prevention
74:
Brain Death
THE ESTABLISHMENT OF CESSATION OF ALL BRAIN FUNCTIONS
Clinical Neurological Examination
Paraclinical/Laboratory Confirmatory Tests
DEMONSTRATION OF IRREVERSIBILITY IS ESTABLISHED BY:
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