anaphylaxis in anesthesia

Clinical manifestations and management of anaphylactic reaction in anaesthesia practice?

positioning in anesthesia

Topic for the day is "what are the different positions given in anesthesia and what are the adverse effects of each?"

Acid-base balance

Biochemistry was one subject which scared me a lot ,all those molecular level breakdown of carbohydrates,fats and protein with ultrastructure of DNA went above my head but i made my own peace with the subject in due course of time  so today i am taking a topic which reminds me of biochemistry and that is Acid-base balance,the question is , Define Base excess?How do kidneys compensate for acid-base balance?

Neuromuscular blockade

In the physiology practicals we did pithing of the frogs and connect their gastrocnemius muscle to graphic display which showed muscle twitch pattern with electrical stimulation,at that point the most important concern for me was  how to hold the frog as I felt it very slimy,much later during my PG times when I struggled with neuromuscular monitoring in operative cases that I used to remember these old times,so lets go on today with a staple question"What are the factors affecting neuromuscular blockage?Discuss various methods to monitor neuromascular blockage?
Potentiation by inhalational agents
 Volatile anaesthetics decrease the requirement of neuromascular blocking drugs by at least 15%,the actual degree of this post synaptic augmentation depends upon both the inhalational drug and the muscle relaxant(desflurane>sevoflurane>isoflurane and enflurane>halothane>N2O/O2/narcotic) and (pancuronium>vecuronium and atracurium)
Temperature
 Hypothermia prolongs the blockade by decreasing the metabolism(mivacurium,atracurium and cisatracurium) and by delaying the excretion (pancuronium and vecuronium ) of the muscle relaxants.
Acid base balance
 Respiratory acidosis potentiates the blockade of most nondepolarising muscle relaxants and antagonises its reversal.
Electrolyte abnormalities
Hypokalaemia and hypocalcemia augment the nondepolarising block while hypermagnesemia potentiates the peripheral nerve blocks.
Age

 Neonates have an increased sensitivity to nondepolarising relaxants because of immature
neuromascular junctions but it does not need dose to be decreased as they have greater volume of

distribution .
Drug interaction
Drugs like dantrolene ,quinidine calcium channel blockers,streptomycin,aminoglycosides,kanamycin,
Neomycin,polymixin,clindamycin are known to potentiate the nondepolarising muscle relaxants.
Concurrent diseases
 Cirrhotic liver disease and chronic renal failur often result in greater volume of distribution and a lower plasma concentration for the given water soluble muscle relaxant drug hence in these patients the initial dose is increased but due to prolonged excretion time the maintenance doses are lowered.

Continuation of adjuncts in anesthesia

In continuation with the topic "adjuncts in anesthesia " today we shall go with antacid
And anti emetics .These drugs attain special significance in emergency surgeries or in
patients with delayed gastric emptying time,yesterday I had a emergency LSCS and I had to administer these drugs before shifting the patient to OT.

Physiology of thermoregulation

First with the foot

Anesthesia thought for the day

Regional anesthesia

Advantages of a subarachnoid block

• Improved analgesia,greater and quicker mobility.
• Decrease stress response
• Decreased thromboembolic complications
• Decrease blood loss and transfusion requirements
• No aspiration pneumonia
• Decreased opiate requirements and its side effects
• No airway manipulation
• Minimal or no effects on foetal and maternal physiology
• Earlier establishment of breast feeding and GI function

The last two are true for obstetric patients,so when studying we have to read as 9 points because that is how it will be asked in exams,keep it simple and to the point.