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Lecture 15

BIMS 201 Lecture Notes - Lecture 15: Aortic Stenosis, Bleeding Diathesis, Anal Fissure


Department
Biomedical Science
Course Code
BIMS 201
Professor
Elizabeth A.Crouch
Lecture
15

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1. Paradoxical Bezold-Jarisch reflex: decresed venous return and
increased sympathetic tone causes forceful contraction of near
empty left ventricle with consequent parasympathetically
mediated arterial vasodilation and bradycardia.
2. Block of cardiac sympathetic fibers.(T1-T4)
Careful positioning, preloading with iv fluids, maintaining normal
circulating volume and use of vasopressors -ephedrine should
counter these effects.
Indications for central neuraxial blockades:
In general lower abdominal, pelvic and lower limb surgeries.
Urology: TURP, TURBT, vesicolithotomy, urthral surgery,
Circumcision etc.
Obstertics: LSCS,manual removal of placenta, cervical tear repair
Gynaecology hysterctomy, fallopian tube ligation, cervical
polypectomy, pelvic floor strengthening etc
Orthopaedic traumatic & non-traumatic curgeries.
Lower limb fractures reduction and fixation
Total hip & knee replacent, knee arthroscopy &
ligament repair etc.
Colorectal: appendicectomy, haemorrhoidectomy, anal fissurectomy
Vascular varicose vein stripping, varicocele ligation.
Contraindications:
Absolute:
Bleeding diathesis.
Patient refusal
Uncooperative patient
Hypovolaemia
Sepsis- local & systemic
Severe stenotic valvular diseases aortic stenosis
Acute neurological diseases and increased intra-cranial
pressure.
Anti-coagulants treatment
Severe spinal deformity
LA drugs allergy.
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