By Charles Deakin MA MD MB BChir FRCP FRCA FERC
New version of a winning publication of concise notes on scientific features of the exam for the Fellowship of the Royal collage of Anaethetists. it's been absolutely up to date to mirror adjustments within the exam syllabus. it will be an amazing revision advisor for trainee anaesthetists sitting the FRCA and comparable examinations
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IPPV allows control of O2 and CO2 and enables airway suctioning and may need to be continued postoperatively. Use slow inspiratory flow to allow equilibration of fast and slow alveoli. A long expiratory time reduces air trapping. Avoid PEEP in patients with COPD. If there are high-frequency bullae, avoid N2O and consider double-lumen tube. Spontaneous respiration or jet ventilation (HFJV) may be appropriate with bullae. At the end of surgery, ensure bowel is decompressed and drain any peritoneal air.
Intra-aortic balloon-pump counterpulsation This is used as a mechanical assist device for the failing myocardium. The intraaortic balloon is placed in the aortic arch/early descending thoracic aorta via the femoral artery so that the tip lies distal to left subclavian artery, but is not occluding renal arteries (Fig. 6). 6 Intra-aortic balloon pump showing inflated and deflated position. • Diastolic effects. Expands during diastole, increasing aortic diastolic pressure and therefore coronary perfusion pressure.
East Grinstead reported a mortality rate of 1 in 4128 cases. g. ENT, maxillofacial and plastic surgery • Reduces blood loss • Reduces risk of cerebral aneurysm rupture during clipping. Contraindications • • • • • • • • Hypertension: BP may be extremely labile Ischaemic heart disease: hypotension reduces myocardial perfusion Severe cerebrovascular disease Respiratory disease: vasodilating drugs abolish hypoxic pulmonary vasoconstriction, making shunting worse. Reversible airways obstruction may be made worse by the use of β-blockers or ganglionblocking drugs Diabetes: ganglion blockade impairs stress-induced gluconeogenesis.