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Showing posts from February, 2021

Estimating intraoperative blood loss

 Abstract Background: Estimating intraoperative blood loss can be a difficult task, especially when blood is mostly absorbed by gauze. In this study, we haveprovidedanimprovedmethodforestimatingbloodthatwasabsorbedbygauze. Objectives: To developaguidethatmedicalstaffcanusetoestimatebloodlossthatwasabsorbedbysurgicalgauze. Materials and Methods: Aclinical experiment was conducted using expired blood and commonsizes of surgical gauze to create a realistic stain of absorbed blood inthegauze. Differentpercentagesof stainingwerephotographedtocreateananalogueforthe amountof bloodabsorbedbythegauze. Results: A visual analogue was created to aid the estimation of blood absorbed by the gauze. The absorptive capacity of different gauzesizeswasdeterminedwhenthegauzewasdrippingwithblood. Theamountof reductioninabsorptionwasalsodetermined whenthegauzewaswettedwithnormalsalinebeforeuse. Conclusions: Theuseofavisualanaloguewillincreasetheaccuracyofbloodlossestimationanddecreasetheconsequencesrelated

The Airway

 The Airway "An opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again and the heart becomes strong." Vesalius 1555 The anaesthetist is responsible for maintenance of the airway and gas exchange. 28% of deaths due to anaesthesia are due to inability to intubate or ventilate (ASA). Normal airway patency is maintained by tension in the muscles connecting the larynx to the sternum, skull and mandible. Contraction of the pharyngeal dilator and tongue muscles opens the airway in a phasic manner during inspiration. Loss of muscle tension due to deep sleep, alcohol, sedation or disease may lead to pharyngeal obstruction, specially in the presence of anatomical abnormalities. The oropharynx is most prone to obstruction (posterior border of the tongue). As it is also part of the gastro-intestinal tract the protective airway reflexes are essential to prevent aspiration. Manage

Regional Anaesthesia

 Regional Anaesthesia Neuraxial Blockade Neuraxial (central) block with subarachnoid (SAB) or epidural (EDB) injection of local anaesthetic (LA) can provide excellent peri-operative anaesthesia and analgesia with many advantages over general anaesthesia. ADVANTAGES Comparative advantages over general anaesthesia • Stress response and the hypercoagulable state due to surgery are minimized. • Pre-emptive, intra, and post operative analgesia • Reduced bleeding • Muscle relaxation with spontaneous respiration • Thrombo embolism is reduced in the high risk patient. • Safer recovery, early mobilization and feeding, and better respiratory outcome • Minimal equipment and drugs which reduces cost A voids disadvantages of general anaesthesia • Unconsciousness, loss of protective reflexes, difficult airway • Awareness, PONY, sore throat, hangover • Gaseous pollution • Equipment hazards • High cost CONTRAINDICATIONS TO CENTRAL BLOCKADE Absolute • Patient refusal of technique • Sepsis at the site o