Dr Siddhant Kishan Mahato

19/01/2022

20/07/2021

GI EMBRYOLOGY in one sheet.

12/07/2021

Key nerve damages in a sheet

09/07/2021

HEART TUBE FORMATION

Clinical correlations

1. Tetralogy of fallot:
a. Anterior displacement of spiral septum — Pulmonary stenosis
b. Over-riding of aorta
c. Right ventricular hypertrophy
d. Ventricular septal defect

2. Transposition of great arteries:
a. Embryology correlation: spiral septum is not formed
b. Blood from Right ventricle — Aorta
c. Blood from Left ventricle — Pulmonary trunk

09/07/2021

PHARYNGEAL ARCHES MADE EASY

How to remember?
1. ARCH I has much more affinity to the letter “M”
2. ARCH II has much more affinity to the letter “S”
3. Any word with -ta-; -ty- are related to ARCH II
Exception: Stlylopharyngeus muscle

Clinical correlation:

1. Treacher collins syndrome:
a. Arch I fail to differentiate
b. Facial asymmetry
c. Coloboma of lower eyelid
d. External ear anomalies

2. Pierre Robin syndrome:
a. Only mandible not well differentiated
b. Triad:
i. Hypoplastic mandible
ii. Glossoptosis
iii. Cleft palate

1. ARCH: I
a. Cartilage (Meckel’s cartilage)— All Ms
i. Middle ear: Malleus and incus
ii. Ligaments:
1. Anterior ligament of Malleus
2. SphenoMandibular ligament
iii. Sphenoid bone
iv. Maxilla
v. Mandible
vi. ZygoMatic bone
vii. TeMporal bone
b. Nerve: Mandibular Nerve
c. Muscles
i. Muscles of Mastication
1. TeMporal
2. Masseter
3. Medial & lateral pterygoid
ii. Mylohyoid
iii. Tensor muscles: tensor palatine & tensor tyMpani
iv. Anterior belly of digastric
d. Artery: Maxillary artery
2. ARCH: II
a. Cartilage (Richert’s cartilage)— All Ss
i. Middle ear: Stapes
ii. Styloid process
iii. Stylohyoid ligament
iv. Small (lesser) horn of hyoid
v. Superior surface of hyoid
b. Nerve: Facial Nerve (Face 2 Face)
c. Muscles
i. Posterior belly of digastric
ii. Muscles of Face (Face 2 Face)
iii. STYlohyoid
iv. STApedius
v. Auricular muscles
d. Artery: STApedius artery
3. ARCH: III
a. Cartilage
i. Greater horn of hyoid
ii. Inferior surface of hyoid
b. Nerve: Glossopharyngeal Nerve
c. Muscles: STYloPHARyngeus (TY- 2; PHAR- 4; mean will be 3)
d. Artery: Common carotid artery, ICA & ECA
4. ARCH: IV
a. Cartilage: Cartilage of larynx except epiglottis
b. Nerve: Superior laryngeal nerve
c. Muscles: Muscles of pharynx, Palate & Cricothyroid
d. Artery: Right subclavian & Arch of aorta
5. ARCH: VI
a. Cartilage: Cartilage of larynx except epiglottis
b. Nerve: Recurrent laryngeal nerve
c. Muscles: Muscles of larynx except cricothyroid
d. Artery: Pulmonary artery & Ductus arteriosus

06/07/2021

NOTES

Conditions/Drugs and their optimizations pre-operatively

- Hypertension
- All antihypertensive medications should be continued till the day of surgery except
- ACEi & ARBs
- In chronic hypertensive patients the auto-regulation curve shifts to
- Right
- Diabetic Mellitus
- All signs and symptoms of hypoglycemia are masked in GA
- Oral hypoglycemic agents and Insulin in Diabetic patients
- All OHA and insulin stopped before surgery
- Since, they can cause hypoglycemia
- In DM-1 patients, dose of long-acting insulin reduced to
- One-third of the dose
- In DM-2 patients, dose of long-acting insulin reduced to
- Half of the dose
- Target blood glucose level to be maintained
- 200 mg/dl (100-200 mg/dl) by using regular insulin
- Epilepsy
- Provoked by Hypoxia, Hypercarbia, Acidosis
- Decreases the threshold for next seizure
- Can cause status epilepticus
- Status epilepticus is said to occur when a seizure lasts too long or when seizures occur close together and the person doesn't recover between seizures.
- All antiepileptic drugs should be continued till the day of surgery
- Drugs like: Enflurane &Methohexital should be avoided
- Drugs like: Thiopentone sodium, Propofol can be used
- If patient on anti-epileptics
- LFT should be done
- Thyroid Disorders
- Hypothyroidism
- Delayed recovery
- Hyperthyroidism
- Thyroid storm
- All antithyroid/thyroid medications should be continued till the day of surgery.
- Psychiatry Problems
- All antipsychotics continued till the day of surgery
- Older MAO inhibitors stopped
- Continue Mg
- With recent development of short-acting anesthetics
- Atracurium, Cis-atracurium, Mivacurium
- Stoppage of Lithium not advocated
- Old-books: stop for 24-48 hours
- Past history of MI
- All blood thinners increase chances of bleeding in closed cavity spaces during regional anesthetic procedures
- Spinal cord, eye cavity, brain
- Aspirin discontinued 3 days prior to surgery. However, Aspirin continued even on the day of surgery to reduce the chance of Thrombosis, MI, Death in the following
- Prior PCI
- Coronary artery disease
- Stroke

06/07/2021

ASA Grading advantages:
1. Helps to decide mortality and morbidity

ASA Grading disadvantages:
1. Doesn’t tell the anesthetic plan
2. Doesn’t explain the airway assessment

18/06/2021

16/06/2021

Notes on length of ETT: Clinically optimum length is the length at which the air entry is equal on the both sides of chest. This is basically 23 cm in adult males and 21 cm in adult females. The tip of tube should lie 4-5 cm above carina because distance between incisors and carina is 26-28 cm.
For nasal intubation, 3 cm is added to oral length.

15/06/2021

Recommended fasting prior to surgery.

09/06/2021

Class of Antiarrhythmic drugs

08/06/2021

Rule of Sepsis-6

08/06/2021

Dermatomes made easy

04/06/2021

PRIMITIVE REFLEX CHEET-SHEET

27/05/2021

Etiologies of pulmonary infections according to CT-scan patterns.

CMV cytomegalovirus, GM galactomannan, HSV herpes simplex virus, MDS myelodysplastic syndrome, IF immunofluorescence, PCR polymerase in chain reaction, VZV Varicella–Zoster virus