Postgraduate topics in anaesthesia

280 Pages·2011·3.65 MB·English

by  Asokan

Postgraduate Topics in
ANAESTHESIA

Postgraduate Topics in
ANAESTHESIA
Author
V Mahadevan
Formerly
Director and Professor
Department of Anaesthesiology
Medical College
Thiruvananthapuram, Kerala, India
Presently
Head of Department
Anaesthesiology and Critical Care
Ananthapuri Hospitals and Research Institute
Thiruvananthapuram, Kerala, India
Co-author
Anil Kumar Asokan
Seniour Consultant in Anaesthesiology and Critical Care
Ananthapuri Hospitals and Research Institute
Thiruvananthapuram, Kerala, India
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Postgraduate Topics in Anaesthesia
© 2011, V Mahadevan
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or
by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the
authors and the publisher.
This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure
accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error (s). In
case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2011
ISBN 978-93-5025-156-0
Typeset at JPBMP typesetting unit
Printed at
Preface
A book of short notes! That too when you have umpteen numbers of textbooks and CME notes.
The present examination system is entirely different from the past. The long hours of essay writing
are replaced by precise short answer questions. You cannot write volumes on a particular topic. The
answers have to be precise.
The students of anaesthesia are confronted with many avenues of learning which include
textbooks, journals, lectures, refresher courses and their own clinical experience. The book represents
a set of short answers from the selected questions asked for postgraduate examinations in standard
institutions in the last five years. This is not intended to replace the textbooks, but to augment them.
The book is meant to help the postgraduates in preparing for the examination and to give them an
insight into the art of short note writing and say serve as a quick reference book before the examination.
V Mahadevan

Acknowledgements
I acknowledge with gratitude the supports provided by my teachers, colleagues, postgraduate
students.
I sincerely thank Dr Anil Kumar Asokan (co-author), Dr Jose Chacko, Dr Sajith Philip and
Dr Saneesh for the help they rendered in preparing and editing the text.
I can never forget the psychological support given by my wife Mrs Lalitha Mahadevan and my
daughter Miss Preethi Mahadevan during the preparation of this book.
I also like to put on record my appreciation for Mr PM Sebastian (Jose) (Branch Manager, Kochi
Branch) and Mr Arun Kumar, M/s Jaypee Brothers Medical Publishers (P) Ltd for the sincere support
they had given in publishing this manuscript.

Contents
1. Oxygen–Haemoglobin Dissociation Curve......................................................1
Shifts in ODC....................................................................................................................2
Causes..............................................................................................................................3
Factors affecting the position of the Oxy-Hb dissociation curve .........................................3
Therapeutic manipulation of ODC....................................................................................5
2. Bohr Effect.................................................................................................... 7
3. Gate Control Theory of Pain .......................................................................... 8
4. Opiate Receptors......................................................................................... 10
Mechanism of opioid action............................................................................................10
5. Extracellular Fluid....................................................................................... 12
Introduction....................................................................................................................12
Relative sizes of body fluid compartments.......................................................................12
Contents of the ECF .......................................................................................................12
Determination of IVF......................................................................................................13
Determination of interstitial and intracellular space .........................................................13
Principles of fluid replacement ........................................................................................14
Complications of overexpansion of the interstitial space..................................................15
6. Effect of Hypothermia on Cardiorespiratory Physiology................................16
Changes in the cardiovascular system.............................................................................16
Changes in peripheral circulation....................................................................................17
7. Regulation of Cerebral Blood Flow .............................................................. 18
Introduction....................................................................................................................18
Chemical regulation of CBF............................................................................................18
Myogenic regulation (autoregulation)..............................................................................19
Neurogenic regulation.....................................................................................................20
Blood viscosity................................................................................................................21
Effects of anaesthetic drugs on CBF and CMR................................................................21
8. Cerebral Steal ............................................................................................. 22
9. Microcirculation in Shock ........................................................................... 24
Classification of shock.....................................................................................................24
The stages of shock.........................................................................................................24
Microcirculation..............................................................................................................25
Microvasculature in shock...............................................................................................26