Control of respiration.Ankle block.Blood transfusion (preservatives, massive, indications and complications).Local anesthetics (types, mode of action and toxicity).Anti-coagulants (oral, heparin and LMWH).VaporizersPhysiological changes associated with pregnancy . . . anesthesia for C.S. with bronchial asthma . . . suppose this patient under GA desaturates, what’s your management?Management of Head trauma.Patient with Mitral stenosis is scheduled for DHS, management. Management of patient with myasthenia gravis for laparoscopic surgery.Complex regional pain syndromeStatistics (forgot the question). # # # # #PorphyriasFemoral nerve anatomy.Appendectomy in cardiac transplant patient.HypoxiaHypothyroidismLaparoscopic surgery in cardiac patientAirway fireFluid management in burnsOxygen cascadeObstetric physiologyPost-operative nausea and vomitingPhysiologic shuntBrachial plexus blocksIdeal anesthetic gasDC shock # # # # # # #

Station IAlveolar-Arterial O2 difference : (causes that increase, what happens during induction of anesthesia and alveolar gas equation)Drugs: =Amiodarone = Adenosine = Clonidine = Atrial natruretic peptide Anaphylactoid reactionsNerves of the femoral triangleStation II 2 Induction agents: pharmacology, pharmacodynamics and pharmacokinetics Body response to hypovolemia and estimation of blood loss in Pediatrics.

Compare sevoflurane with TIVANon-respiratory functions of the lungs.Station IIIA 4-year old child was involved in RTA presented to ER awake then his consciousness deteriorated (GCS 4/15). What is your management.Cerebral blood flow and brain protection.Tension pneumothoraxTreatment of pulmonary edemaTreatment of hyperkalemiaAnesthetic Management of vaginal delivery for placenta previa patient.Station IV:A 58 y old male patient with known DM and CABG done 2 years ago presented with lower limb weakness, perineal numbness due to acute L4-5 disc prolapse . . .anesthetic management.WPW syndrome (diagnosis and treatment)Pancreatic cancer pain reliefNon-invasive ventilationPost-spinal surgery complications.

# # # # #- Trigeminal block

- Modes of ventilation

- Myasthenia gravis in preeclampsia

- Morbid obese ( awake intubation)

- Blunt chest trauma

- Colloid

- x ray >>> cvp to inf vena cava

- Diabetes, preoperative assessment,

- Heart failure

- Pulse oximetry or Capnogragh

- Receptors (agonists / antagonists)

- Septic shock

- Prolonged QT syndrome

- Pain assessment

- ARDS

- Spirometry

- Lung compliance

- Ventricular pressure-volume loops

- Tamponade, Tension pneumothorax

- Anaesthesia of recent MI for TURP

# # # # #

Zizo’sImportant to know by heart

( CVS and Respiratory physiology – general pharmacology – ARDS and Septic shock in ICU- all anesthesia drugs (IV, inhalational, MR, LA)

Drawings and graphs All blocks. ECG : be systematic (confirm patient ID, calibration, axis) X-ray: be systematic, “pulmonary artery cath with pneumothorax on the same side”

Parkinsonism.Brachial plexus blocks.Prolonged QT syndromeHow to calculate loading and maintenance doses.Drug receptors.Ideal muscle relaxant.O2 dissociation curve . . . compare to CO2 dissociation curve.Bier’s block.CapnographyClark’s electrode.Anesthetic gas monitoring.Osmolality.Starling forces and edema formation.Glucose homeostasis.Blood flow to the liver.Volume of distribution.T1/2 and elimination.History taking.Arterial wave form.Pulse oximeter.Anesthesia for renal transplantation.TURP syndrome.Hyperkalemia.PIH.Morbid obesity.OSA.

Case: patient with bronchial asthma who presents with acute neurological deficit requiring surgery. He is on 3 drugs for asthma (he doesn’t remember the names) . . . “they went into PFT and Pressure volume loops”Case: 30 y old female admitted to ICU following 2 days of fever, cough and no response to penicillin. Ex: lower left lung fields show bronchial breathing.

*Remember : goal directed therapy . . .

1) you can admit critically ill patient to ICU for a few hours preoperatively to improve condition and optimize tissue O2 delivery 2) in treatment of patients with septic shock

# # # # #

Zurich:

Effects of gas exchange on pressure-volume loop of the chest? ? and discuss oxygenation.Ankle blockMagnesiumAmiodaroneClassification of anti-arrhythmic drugsChoose a drug of induction and show changes in concentration after induction.Context-sensitive half lifePlasma expandersNear drowningPhysiological changes after bleedingAnesthesia for eye surgeryAnesthesia for non-cardiac surgery in a cardiac patientRheumatoid PLUS: X-ray and ECG # # # # # #

ISTANBUL 2014

Day I

Session I:

Head Q: What do you understand by “respiratory insufficiency”. Which pulmonary function tests would help in assessment ? How does anesthesia affect respiratory functions?

During discussion the following questions were asked:

Pulmonary function tests and how to tell obstructive vs restrictive (clinical…blood… then spirometry and so on ….).

O2 cascade, alveolar gas equation and shunt equation, O2 content, DO2, ….

The other 12.5 minutes:

Blood supply to the brain: the circle of Willis, Draw, explain why it’s a circle then went into CEA and how to avoid brain ischemia (monitoring, the use of shunt, . . . ) which type of anesthesia . . . stellate ganglion block . . . its complications . . . complications of Local Anesthetics.

Physiological changes in pregnancy and how you manage a young lady with advanced pregnancy who collapses inside hospital.

Anticoagulants and precautions with blocks

A patient underwent 60% hepatectomy: what is the investigation you would do immediately postop and what are the likely electrolyte disturbance? What about his renal function?

Session II:

Draw a diagram representing drug concentration of a short acting induction agent. Show half time marks. What’s clearance, volume of distribution and how can you use this knowledge in drug infusion of anesthetics.

Context sensitive half life.

Factors affecting MAC and how to speed induction.

Metabolism of muscle relaxants.

The other 12.5 min

Visceral pain(define, criteria, . . )

ECG : wide complex tachycardia (can you calculate axis?)

Session III:

A 66 y old male patient, smoker for 20 year (30 pack/ year) and stopped 3 years ago, underwent radical cystectomy for cancer bladder. The procedure was lengthy because of adhesions. The patient was shifted to ICU postoperativel where he was extubated successfully but then developed dyspnea.

Discussion of the case involved assessment, investigations and causes of his dyspnea.

Which anesthetics you can/can’t use in surgery for cancer. (recent studies showed that patients with cancer anesthetized with GA+ regional technique had less recurrence than when opiods were used)

X-ray: left-sided diaphragmatic hernia.

A patient undergoing laparoscopic fundoplication develops intraoperative hypoxia (diagnosis and management)

Management of status asthmaticus.

Session IV:

A 35 Y old, 34 week pregnant female with repeated attacks of severe headache undergoes a brain CT which shows a big frontal meningioma leading to increased ICP and midline shift. Her blood pressure is 170/110.

During case discussion I was asked the following (what’s your plan, what is causing her hypertension, how would you manage her hypertension and how to prevent acute increases in ICP with intubation)

TEF (tracheoesophageal fistula): management and suppose fistula is at carina what will you do?

Polythiacemia rubra vera: define, is there any bleeding tendency and what are the measures to prevent peri-operative venous thrombosis and PE.

Anesthetic management of patient with untreated hypertension.

ICP (intracranial pressure): monitoring, normal value and how to decrease, neuraxial with increased ICP?

DAY II:

Station I:

Pulmonary function tests.

Stellate ganglion block(anatomy, indications and complications)

Hypo- and hypercalcemia (causes, treatment and ECG changes)

Station II:

Measurements that can be obtained from pulmonary artery catheter

Anti-coagulants (peri-operative management)

Perioperative use of B-blockers.

Perioperative oral hypoglycemic.

Diuretics (perioperatively).

Station III

A 27 y old male patient was found unconscious in a closed space during a burn accident. There were burns to his face with soot around mouth. (Discussion went through management of inhalational burn, complications and anesthesia for such patients.)

Pulmonary embolism (management)

X-ray: intubated patient with fracture rib and pneumothorax and lung contusion on the right side.

Station IV

65 y old male patient, 179 cm height and 105 kg weight, was operated for right hemicolectomy was admitted to ICU 5 weeks post-op for heart failure and sepsis. During his stay he developed bed sores and he’s scheduled for grafting of the bed sores. (discussion went into causes for this, how to evaluate preoperatively and investigations needed then anesthetic management of such patient)

Phantom limb pain.

Multiple sclerosis

Airway assessment for a patient with goiter and hypothyroidism

ECG: 1st degree heart block with septal infarction.

Compare ropivacaine to bupivacaine.

EDAIC Vienna 2014(1ST DAY):Physiology:-Difference in systemic PaCO2 and PaO2 in normal and supine one lung ventilation, explanation with curves..- pulmonary functions- differences between pediatrics and adults with stress on the airway anatomy and physiology.Pharmacolgy:- a stat dose of 200 mg of propofol given to a 70 kg patient.How to estimate plasma concentration and What you will need to know to do that.-Single and multi compartment models. Difference between propofol and thiopental.

-toxic effects of inhalational anesthetics-drugs acting on the uterusCase:--63 years old with cancer colon and received chemotherapy but stopped 6 months ago due to cardiac and renal toxicity, coming for liver resection due to single metastasis , splenic injury intra operative but manged to save the spleen. Nurse calling you in the recovery for low urine output..--options for anesthesia in old age coming for cataract, advantages and disadvantages of each option.--intra operative bradycardia and hypotension in a patient with a pacemaker..-chest X ray of rt lower lobe collapseCase:-asthmatic patient on 3 (unknown)medications for emergency lumbar vertebral decompression

with acute lower limb paralysis.How would you proceed.-How to assess pain. Pain scales, effects of pain on the postoperative period.-ECG of Heart block.-prolonged QT syndrome. Causes, complications and management.

EDIAC Vienna (second day) 2014How to calculate the loading dose of propofolWhat is the factors affecting drug distributionIonization and solubilitypKa, pH, Hassel pack equationLocal anaesthetics: mechanism of action, chemical formula, factors affects potency and solubilityCompare between ropivacaine and bubivacainePulmonary function test: normal, obstructive, restrictive, changes under anaesthesiaPulmonary shunt, V/Q mismatch, lung zonesCa homeostasis and role of it in the body and haemodialysis in CRF patients with coagulopathyCase 1: case of CABG complicated with bleeding and shifted to the ICU, management, complications (they like to hear MI in the differential diagnosis of any oliguria)CXR: ICU patient with lung opacity (note the tubes like ICT, ECG, ETT, CVP)Case 2: case with history of stable angina, HTN and for aortic aneurysm repair (pre-intra –post)Acute pancreatitis, VF (torsade de point)NB: cardiac physiology and assessment manly asked in the clinical