Indirect IA (Inferior Alveolar) nerve block on a model

University of The Pacific Arthur A. Dugoni School of Dentistry present a video illustrating the technique of Inferior Alveolar Nerve Block on a model by Dr. Anders Nattestad, Professor and Director, Department of Oral and Maxillofacial Surgery.

Causes of poor bilateral breath sounds after intubation

Think about DOPE

Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation

1. Displaced (usually right mainstem, pyreform fossa, etc.)
2. Obstruction (kinked or bitten tube, mucuous plug, etc.)
3. Pneumothorax (collapsed lung)
4. Esophagus

Umbilical vein catheterization technique

Umbilical vein catheterization may be a life-saving procedure in neonates who require vascular access and resuscitation. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth.
Umbilical vein catheters (UVC), are used for exchange transfusions, monitoring of central venous pressure, and infusion of fluids (when passed through the ductus venosus and near the right atrium); and for emergency vascular access for infusions of fluid, blood products or medications.
Usually in the emergency department peripheral access is preferred for critically ill newborns and if this is impossible, umbilical vein catheterization may be attempted.

Technique :

# The umbilical cord stump and surrounding abdomen should be sterilized with a bactericidal solution. Sterile drapes should be placed.
# A purse-string suture or umbilical tape is tied around the base of the stump to provide hemostasis and to anchor the line after the procedure.

# Using the scalpel, the cord is cut horizontally, approximately 1.5-2 cm from the abdominal wall. Two thick-walled small arteries and one thin-walled larger vein should be identified. The umbilical vein may continue to ooze blood.
# Hemostasis is achieved through tightening the umbilical tape or suture. The arteries do not usually bleed secondary to vasospasm.
# Forceps are then used to clear any thrombi and dilate the vein.
# A 3.5F catheter is used for preterm newborns, and a 5F catheter is used for full-term newborns.

5F umbilical catheter. Note proximal attachment for stopcock

# The catheter should be flushed with pre-heparinized solution and attached to a closed stopcock.
# The catheter is then grasped 1 cm from its distal tip with the iris forceps and gently inserted, aiming the tip toward the right shoulder. Advance the catheter only 1-2 cm beyond the point at which good blood return is obtained. This is approximately 4-5 cm in a full-term neonate. If resistance is initially met, loosen the umbilical tape or suture and manipulate the angle of approach.

Insertion of umbilical vein catheter

# Do not force the advancement.
# Secure the catheter with a suture through the cord, marker tape, and a tape bridge.
# The position of the catheter must be confirmed radiographically. A properly placed umbilical vein catheter appears to travel cephalad until it passes through the ductus venosus.
# Standardized graphs estimate the length of catheter insertion based on shoulder-to-umbilicus length. Alternatively, the shoulder-to-umbilicus length may be multiplied by 0.6 to determine a length that leaves the tip of the catheter above the diaphragm but below the right atrium.
# In an emergency resuscitation, the catheter is best advanced only 1-2 cm beyond the point at which good blood return is obtained.

No anesthesia is typically required for the procedure.

Extraglottis Devices

How to perform Combined Spinal-Epidural Obstetric Anesthesia

Femoral Nerve Block at the level of the inguinal skin crease

Femoral nerve block is commonly performed by insertion of the block needle 1-2 cm lateral to the femoral artery just below the inguinal ligament as seen in the picture which requires multiple attempts at ..............

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Pocket Anesthesia (Pocket Notebook Series)

Designed for easy transport and quick reference, this new addition to the Pocket Notebook Series presents essential information that residents, anesthesiologists, CRNAs, and medical students need on the wards and in the operating room. Edited by anesthesia faculty at Harvard Medical School, Pocket Anesthesia is ideally suited for today’s fast-paced anesthesia environment—it is concise, easy to read, and evidence-based. Essential information is presented in a well-organized schematic outline format with many tables, algorithms, and diagrams. The book is filled with must-know facts about drugs, frequent intraoperative problems, differential diagnosis, common disease states, patient evaluation, and anesthetic considerations for each subspecialty.

Agents for Spinal anesthesia

"Little Boys Prefer Toys":

• Lidocaine
• Bupivicaine
• Procaine
• Tetracaine

NOTES :
1-Lidocaine provides a short duration of anesthesia and is primarily useful for surgical and obstetrical procedures lasting less than one hour.

2-Tetracaine Vs Bupivacaine:Tetracaine and bupivacaine are used for procedures lasting 2 to 5 hours. Tetracaine appears to provide a somewhat longer duration of anesthesia and a more profound degree of motor block than does bupivacaine. On the other hand, compared with tetracaine, bupivacaine has been demonstrated to be associated with a decreased incidence of hypotension.
In addition, bupivacaine may be better than tetracaine for use in orthopedic surgical procedures since it appears to be associated with a lower incidence of tourniquet pain.

3-Vasoconstrictors can prolong the duration of spinal anesthesia of all three agents. However, the greatest duration is seen when vasoconstrictors are added to tetracaine solutions.

Ultrasound-Guided Femoral Nerve Block

Extraglottis Devices

Principles of EndotracheaI Intubation During General Anaesthesia

Anesthesia Oral Board Review: Knocking Out the Boards

The accreditation process for anesthesia in the United States is considered one of the most difficult in all medical specialties, with residents required to pass both an oral and written exam to gain certification. This book is specially designed for the American Board of Anesthesiology Oral Examination. The evidence-based approach is presented in a concise outline-oriented format, with an emphasis on test results and visual images. The Knockout Treatment Plan demonstrates the correct method of managing the case to the satisfaction of the examiners, while the Technical Knockout sections give additional tips for successfully passing the examination. The straightforward format of this book makes it suitable not only as an oral review book but also as an introduction to anesthesia rotations formedical students, medical interns, and nurse anesthetist students; furthermore, the book can be used as a technical study guide for anesthesia residents. More than 100 topics in this book have already been board-review tested by residents.

A Practice of Anesthesia for Infants and Children

Extensively revised and updated, and in full-color throughout, the new edition of this popular text delivers practical advice on the safe, effective administration of general and regional anesthesia to infants and children. More than 50 internationally renowned experts-and a brand-new editor-discuss standard techniques as well as the very latest advances in pediatric anesthesiology, keeping you on the cusp of today’s best practices. Chapter after chapter, you’ll find authoritative guidance on everything from preoperative evaluation through neonatal emergencies to the PACU, as well as more than 1,000 illustrations that clarify concepts. And, as an Expert Consult title, this thoroughly updated 4th edition comes with access to the complete fully searchable contents online as well as video clips of pediatric anesthesia procedures, pediatric drug dosage calculators, extended references, and downloadable images for use in electronic presentations.


* Reviews underlying scientific information and addresses preoperative assessment and anesthesia management in detail to help you make better informed decisions.
* Provides guidelines for postoperative care, emergencies, and special procedures in one single source for your reference convenience.
* Includes access to the complete fully searchable contents online as well as video clips of pediatric anesthesia procedures, pediatric drug dosage calculators, extended references, and downloadable images.
* Discusses the full range of pediatric anesthesiology from preoperative evaluation through neonatal emergencies to the PACU to prepare you for any situation you encounter.
* Incorporates sweeping revisions and updates throughout, including new chapters on congenital heart disease, conscious sedation, and anesthesia in developing countries that keep you apprised of the latest techniques and procedures.
* Features a new editor, Dr. Jerrold Lerman, who contributes a wealth of experience in pediatric anesthesiology.
* Provides new insights from neonatologists and neonatal pharmacologists who give you a clear, up-to-date picture of the pharmacologic responses of neonates.
* Incorporates numerous figures and tables throughout for easy retention of information.
* Presents a new full-color format and hundreds of new color illustrations that clarify complex principles of techniques.

For Download :

CLICK

Mallampati test

To try to identify patients who will prove difficult to intubate.The patient sits in front of the anaesthetist and opens the mouth wide.
The patient is assigned a grade according to the best view obtained.

View obtained during Mallampati test:
1. Faucial pillars, soft palate and .........

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Local anaesthesia technique for Middle ear and Mastoid

Modified ASA Grade for assessment of fitness for anaesthesia and surgery

ASA or American Society of Anesthesiologists grade is the most commonly used grading system to accurately predict morbidity and mortality.
Medical co-morbidity increases the risk associated with anaesthesia and surgery,50% of patients presenting for elective surgery are ASA grade 1.

Corresponding grade in each classification for ASA and revised assessments

A Practice of Anesthesia for Infants and Children

Extensively revised and updated, and in full-color throughout, the new edition of this popular text delivers practical advice on the safe, effective administration of general and regional anesthesia to infants and children. More than 50 internationally renowned experts-and a brand-new editor-discuss standard techniques as well as the very latest advances in pediatric anesthesiology, keeping you on the cusp of today’s best practices. Chapter after chapter, you’ll find authoritative guidance on everything from preoperative evaluation through neonatal emergencies to the PACU, as well as more than 1,000 illustrations that clarify concepts. And, as an Expert Consult title, this thoroughly updated 4th edition comes with access to the complete fully searchable contents online as well as video clips of pediatric anesthesia procedures, pediatric drug dosage calculators, extended references, and downloadable images for use in electronic presentations.

* Reviews underlying scientific information and addresses preoperative assessment and anesthesia management in detail to help you make better informed decisions.
* Provides guidelines for postoperative care, emergencies, and special procedures in one single source for your reference convenience.
* Includes access to the complete fully searchable contents online as well as video clips of pediatric anesthesia procedures, pediatric drug dosage calculators, extended references, and downloadable images.
* Discusses the full range of pediatric anesthesiology from preoperative evaluation through neonatal emergencies to the PACU to prepare you for any situation you encounter.
* Incorporates sweeping revisions and updates throughout, including new chapters on congenital heart disease, conscious sedation, and anesthesia in developing countries that keep you apprised of the latest techniques and procedures.
* Features a new editor, Dr. Jerrold Lerman, who contributes a wealth of experience in pediatric anesthesiology.
* Provides new insights from neonatologists and neonatal pharmacologists who give you a clear, up-to-date picture of the pharmacologic responses of neonates.
* Incorporates numerous figures and tables throughout for easy retention of information.
* Presents a new full-color format and hundreds of new color illustrations that clarify complex principles of techniques.

For Download :

CLICK HERE

Common Nerve Blocks Used by Ophthalmologists

ADMINISTERING LOCAL NERVE BLOCKS

Diagram 1: Common Periorbital Nerve Blocks


Diagram 2: Common Facial Nerve Blocks ..........    

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Digital Local Anaesthesia

Clinical Ambulatory Anesthesia (Cambridge Clinical Guides) - 2010 Edition

Ambulatory care can be a challenging setting in which to provide anesthesia – not all patients are suitable for rapid discharge post-operatively and opinions differ as to which types of surgery should be performed as day cases. This comprehensive guide delivers up-to-date, evidence-based advice on how to provide optimal anesthesia care for ambulatory surgery. Written by a leading clinical anesthesiologist, it provides clear guidance about how to handle particular patients in particular situations. The evidence and scientific knowledge for each issue are presented with reference to major studies and review papers, followed by practical advice based on the author’s continuous clinical and scientific experience over 30 years. Topics include planning, equipping and staffing ambulatory units, pharmacology, basic concepts of ambulatory care, pre- and post-operative issues and current controversies. Clinical Ambulatory Anesthesia is essential reading for the clinical, postgraduate anesthesiologist as well as nurse anesthetists involved with ambulatory care.

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