Objective ANAESTHESIA Review A Comprehensive Textbook for the Examinees by Atul P Kulkarni. JV Divatia , Vijaya P Patil

Objective ANAESTHESIA Review A Comprehensive Textbook for the Examinees by Atul P Kulkarni. JV Divatia , Vijaya P Patil olor Plates i-xiii 1. Mitral Stenosis with Pulmonary Hypertension 3 M Shetmahajan, V P atil 2. ...

Objective ANAESTHESIA Review A Comprehensive Textbook for the Examinees by Atul P Kulkarni. JV Divatia , Vijaya P Patil olor Plates i-xiii 1. Mitral Stenosis with Pulmonary Hypertension 3 M Shetmahajan, V P atil 2. Ischemic Heart Disease 15 J D ivatia, J Doctor, A Chatterjee 3. Hypertension 29 V P atil, M Shetmahajan 4. Tetralogy of Fallot 37 V A garwal, R Ambulkar, M Desai 5. Patent Ductus Arteriosus 43 R A mbulkar, V Agarwal, M Joshi 6. Permanent Pacemaker 49 S Bakshi, V P atil, S Myatra 7. Peripheral Vascular Disease 59 P Jain, A K ulkarni, S Bhosale 8. Pneumonectomy 63 P R anganathan, B Trivedi 9. Bronchiectasis with Lung Abscess 73 P R anganathan, A Kothekar 10. Chronic Obstructive Pulmonary Disease 77 A K ulkarni, M Desai, A Chatterjee 11. Intercostal Drain 85 P R anganathan, B Trivedi 12. Hypertensive Disorders in Pregnancy 88 S Bakshi, R A mbulkar, S Bhosale 13. Pregnancy: Physiological Changes and Anemia 102 R A mbulkar, S Bakshi, M Desai 14. Emergency Lower Segment Cesarean Section (LSCS) 113 S Bakshi, R A mbulkar, J Doctor 15. Non-obstetric Surgery in a Pregnant Patient 120 S Bakshi, R A mbulkar, M Joshi 16. Amniotic Fluid Embolism 123 R A mbulkar, S Bakshi, A Kothekar 17. Obstetric Hemorrhage 126 R A mbulkar, S Bakshi, A Chatterjee 18. Hydrocephalus 132 S M yatra, S Bakshi, S Bhosale 19. Meningomyelocele 141 S Bakshi, S M yatra 20. Traumatic Brain Injury 146 A K ulkarni, M Joshi 21. Managing Difficult Airway 154 V P atil, J Doctor 22. Burns 165 N A min, V Patil, B Trivedi 23. Cleft Lip and Cleft Palate 181 V A garwal, A Chatterjee 24. Geriatric Patient 188 R G ehdoo, A Kothekar 25. Transurethral Resection of Prostate 197 J D ivatia, R Gehdoo, S Bhosale 26. Proximal Fracture Femur 205 R G ehdoo, J Divatia, B Trivedi 27. Cataract 211 S Bakshi, R G ehdoo 28. Morbid Obesity 216 V P atil, M Joshi 29. Cirrhosis with Portal Hypertension 228 A K ulkarni, J Divatia 30. Laparoscopic Cholecystectomy 243 P R anganathan 31. Colles’ Fracture 249 P Jain, A Chatt erjee 32. Kyphoscoliosis 254 P Jain, A K ulkarni 33. Large Thyroid Mass 260 M Shetmahajan xii Objective Anesthesia Review: A Comprehensive Textbook for the Examinees 34. Diabetes Mellitus 270 M Shetmahajan 35. Chronic Renal Failure and Renal Transplant 286 V Agarwal 36. Tonsillectomy 298 S Myatra, S Bakshi, J Doctor 37. Circumcision 303 P Jain 38. Acute Postoperative Pain 305 P Jain, M Joshi, K Sharma 39. Pharmacokinetic Principles in Anesthesia 311 V Agarwal, A Kulkarni Section Two: Anaesthesia Equipment and Table Viva 40. Arterial Blood Gas Analysis 321 V Patil, J Doctor 41. Mechanical Ventilation 331 A Kulkarni, R Sareen, J Divatia 42. Pulmonary Function Tests 341 V Patil, M Desai 43. Anesthesia Machine 352 N Amin, V Agarwal 44. Vaporizers 377 P Ranganathan, M Shetmahajan 45. Anesthesia Breathing Systems 395 S Myatra, P Jain 46. Endotracheal Tubes, Double Lumen Tubes and Combitube 406 A Kulkarni, A Chatterjee 47. Cardiopulmonary Resuscitation 416 S Myatra, B Trivedi, A Kothekar 48. Airways, Connectors, Laryngoscopes and Non-rebreathing Valves 426 N Amin 49. Electrocardiography 438 R Ambulkar 50. Interpretation of X-rays 448 A Kulkarni, R Sareen, A Chatterjee 51. Supraglottic Airway Devices 457 V Agarwal, A Kulkarni 52. Regional Anesthesia Instruments 470 P Jain, A Kulkarni 53. Nerve Locator and Peripheral Nerve Stimulator 475 N Amin 54. Oxygen Therapy Devices and Manual Resuscitator 487 N Amin, V Patil 55. Videolaryngoscopes 501 A Kulkarni, M Desai, S Bhosale Index 511 ¾¾ Mitral Stenosis with Pulmonary Hypertension ¾¾ Ischemic Heart Disease ¾¾ Hypertension ¾¾ Tetralogy of Fallot ¾¾ Patent Ductus Arteriosus ¾¾ Permanent Pacemaker ¾¾ Peripheral Vascular Disease ¾¾ Pneumonectomy ¾¾ Bronchiectasis with Lung Abscess ¾¾ Chronic Obstructive Pulmonary Disease ¾¾ Intercostal Drain ¾¾ Hypertensive Disorders in Pregnancy ¾¾ Pregnancy: Physiological Changes and Anemia ¾¾ Emergency LSCS ¾¾ Non-obstetric Surgery in a Pregnant Patient ¾¾ Amniotic Fluid Embolism ¾¾ Obstetric Hemorrhage ¾¾ Hydrocephalus ¾¾ Meningomyelocele ¾¾ Traumatic Brain Injury ¾¾ Managing Difficult Airway ¾¾ Burns ¾¾ Cleft Lip and Cleft Palate ¾¾ Geriatric Patient ¾¾ Transurethral Resection of Prostate ¾¾ Proximal Fracture Femur ¾¾ Cataract ¾¾ Morbid Obesity ¾¾ Cirrhosis with Portal Hypertension ¾¾ Laparoscopic Cholecystectomy ¾¾ Colles Fracture ¾¾ Kyphoscoliosis ¾¾ Large Thyroid Mass ¾¾ Diabetes Mellitus ¾¾ Chronic Renal Failure and Renal Transplant ¾¾ Tonsillectomy ¾¾ Circumcision ¾¾ Acute Postoperative Pain ¾¾ Pharmacokinetic Principles in Anesthesia Case Discussion S e c t i o n One 1 Mitral Stenosis with Pulmonary Hypertension M Shetmahajan, V Patil What are the causes of mitral stenosis (MS)? Mitral stenosis refers to decrease in mitral valve area. Most common cause of MS is rheumatic heart disease, although more than 50% of these patients do not give a history suggestive of rheumatic fever in past. Rheumatic fever leads to cardiac inflammation causing pancarditis which heals with scarring, affecting valves. In the acute phase, rheumatic fever may cause mitral regurgitation. Mitral stenosis develops few years later and symptoms develop after many more years when mitral valve area reduces significantly. The stenosis is characterized by fusion, fibrosis, thickening, and calcification of the leaflets, and thickening, fusion and shortening of the chordae tendineae. Other causes of MS include congenital mitral stenosis, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), malignant carcinoid, mucopolysaccharidoses (of the Hunter-Hurler phenotype), Fabry disease, Whipple disease, and methysergide therapy. Describe the pathophysiology of mitral stenosis The normal mitral valve area is 4 to 6 cm2. In very early diastole, there is a small pressure gradient between left atrium (LA) and left ventricle (LV), which rapidly equilibrates in the phase of diastasis followed by phase of atrial contraction. As the mitral orifice narrows in MS, it obstructs free flow of blood from left atrium to left ventricle during diastole, leading to the development of a pressure gradient between two chambers and an increase in LA and pulmonary venous 42-year-old lady, with a history of rheumatic mitral stenosis presents with large pelvic mass suspected to be ovarian cyst. She is scheduled for excision of mass. She gives history of balloon mitral valvotomy 13-year ago. She also gives a history of normal pregnancy 15-year ago. She can climb 2 flights of stairs without difficulty but feels breathless beyond this.pressure. This gradient is increased by increases in the heart rate (reducing diastolic time) or cardiac output (increasing flow of blood across mitral valve). As obstruction becomes more and more severe, time required for left ventricular filling increases and left atrial contraction (kick) becomes necessary to fill ventricle. As mitral valve area goes below 1 cm2, left atrial pressure increases to about 25 mmHg (normal LA pressure is about 5 mmHg). Since there are no valves between pulmonary circulation and left atrium, increased left atrial pressure is transmitted to pulmonary circulation causing pulmonary hypertension. Also this constant pressure overload of the left atrium leads to the increase in left atrial size, which then becomes more prone to develop atrial fibrillation and atrial thrombus formation. As stenosis worsens, flow restriction also limits left ventricular filling and thus LV preload. In addition, there is increased afterload due to reflex vasoconstriction in response to low cardiac output. Both these factors result in decreased LV function, leading to further reduction in cardiac output and thus may mimic left ventricular failure. In its early stage, the pulmonary hypertension is often described as “passive” and reversible, as elevation of Pulmonary Arterial Pressure is caused solely by passive backward transmission of the elevated left atrial pressure. Over period of time, this leads to pulmonary artery and arteriole vasoconstriction called as reactive pulmonary hypertension. Over longer period, the muscular layer of pulmonary arterioles hypertrophies in response to elevated