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Communication Skills Stations
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Explain the procedure. This should be done while referring to the diagram. Performed under general anaesthetic, it usually takes 90 minutes. While referring to the diagram, explain the position of the horizontal cut in the neck that will leave a thin scar.
General Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Anatomically general anesthetic causes an alteration in the ongoing activities of nervous system at myriad levels involving the peripheral sensory neurons, spinal cord, brainstem, and the cerebral cortex. In response to surgical procedure, an inhalational anesthetic exerts actions of spinal cord and therefore causes the state of immobilization. The GABA analogs such as pentobarbital and propofol produce sedative actions through GABAA receptors in the tuberomammillary nucleus whereas dexmedetomidine a α2 adrenergic-receptor agonist exerts sedative effects via locus ceruleus. An inhalational anesthetic causes loss of consciousness by depressing the excitability of thalamic neurons and inhibition of thalamocortical communication. Both intravenous and inhalational anesthetic produce amnesic effect through depression of hippocampal neurotransmission (Koblin et al., 1994).
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Shock waves are short bursts of energy pulses of about 5 microseconds (μs) duration. These are sometimes called compressive and tensile phases. In a liquid they affect the density, pressure and particle velocity. The wave begins with an immediate jump to a peak positive pressure of about 40 MegaPascals (MPa). This is referred to as a ‘shock’. The transition is faster than can be measured and is less than 5 nanoseconds in duration. The pressure then falls to zero about 1 μs later. Following that, a region of negative pressure that lasts around 3 μs and has a peak negative pressure around –10 MPa. The amplitude of the negative pressure is less than the peak positive pressure, and the negative phase of the waveform generally does not have a shock in it – that is, there is no abrupt transition. Together the 5 μs pulse is generally referred to as a shock wave, shock pulse or pressure pulse; technically, however, it is only the sharp leading transition (positive pressure) that is a shock. The principle of this positive and negative wave, which may affect how effective the wave is, relates to the time between positive and negative peaks. If the rate is too quick and the second positive peak is occurring at the same time as the previous wave’s negative pressure – they will cancel some of their respective destructive effect. If, however, the rate is too slow, treatment is less than ideal as the patient may remain under a general anaesthetic for longer than was necessary. This also has an effect on theatre turnaround time, which is an important financial consideration [61].
Implementation of perioperative music in day care surgery
Published in Acta Chirurgica Belgica, 2023
Muriël Reudink, Victor X. Fu, Kwint T. R. Mackenbach, Johannes Jeekel, Gerrit D. Slooter, Esther M. Dias
Although several systematic reviews and meta-analyses have previously described the positive role of music on pain and analgesia needs [1,3,15], no statistically significant beneficial effects on postoperative pain and opioid requirement were observed in the current study. Several reasons seem apparent for the lack of results. No sample size calculation was performed, given that the primary outcome measure was implementation adherence. Therefore, this study was not adequately powered to evaluate a significant clinical effect. Furthermore, implementation was performed in day care surgery, as this was considered to involve straightforward surgical procedures minimizing logistical planning issues in the hospitals’ infrastructure. Postoperative pain levels and opioid requirement are usually low, making it hard to find a clinically relevant, beneficial effect in the first place. However, it should be noted that a trend towards less patients needing postoperative opioids when listening to perioperative music was observed. Previous research revealed that regional anesthesia, compared to general anesthetic techniques, decreases postoperative pain. This could also possibly explain the finding that more patients in the control group required more postoperative opioids since a higher proportion of patients in the control group received general anaesthesia [16]. Especially in light of the current opioid epidemic [17], music could be an attractive non-pharmacological additive to opioid-free analgesia, which is unfortunately limited studied [18].
Preventing pediatric chronic postsurgical pain: Time for increased rigor
Published in Canadian Journal of Pain, 2022
Christine B. Sieberg, Keerthana Deepti Karunakaran, Barry Kussman, David Borsook
During surgery, general anesthetics produce a state of drug-induced unconsciousness but not analgesia. The exception is ketamine, which produces dose-related unconsciousness and analgesia. Analgesics are administered according to weight-based dosing in response to clinical (patient movement) and autonomic (blood pressure, heart rate, respiratory rate, sweating) activity, rather than with a objective marker of nociception directly from the central nervous system. The mechanism and intensity of analgesia will vary with the class of drug, dosage, and route of administration. With respect to pain perception, a preclinical fMRI study in macaques found that noxious stimuli resulted in activation of the secondary somatosensory cortex and insula under propofol or pentobarbital anesthesia, whereas no activation was observed with isoflurane anesthesia.40 In humans, ongoing nociceptive processing has been shown to occur in adolescent patients under balanced general anesthesia.41
Neuroprotective effect of miR-212-5p on isoflurane-induced cognitive dysfunction by inhibiting neuroinflammation
Published in Toxicology Mechanisms and Methods, 2021
Jiguo Si, Yanwu Jin, Min Cui, Qun Yao, Ruijun Li, Xingwei Li
General anesthetics have been widely used for hundreds of years in the clinic for surgical operations (Xie and Xu 2013). Among various anesthetics, isoflurane is one of the most commonly used inhalation anesthetics in blocking the peripheral nerve and pain management (Franks 2006). Previously, it was reported that isoflurane could permeate through the placental barrier and cause toxicity to the central nervous system, which in turn affects the development of the central nervous system and induce cognitive dysfunction (Wang et al. 2009; Lemkuil et al. 2011). Moreover, isoflurane could induce cell apoptosis and inhibits cell differentiation (Zhang et al. 2015). There are a variety of factors that are related to the neurotoxicity of isoflurane, such as the activation of caspase, neuroinflammation, and oxidative stress (Xie et al. 2008; Wu et al. 2012; Li et al. 2017). Therefore, it is of great significance to develop effective neuroprotective strategies against isoflurane-induced neurotoxicity.