ASRA Guidelines

Jul 31, 2015Download as PPTX, PDF137 likes53,748 views

The document provides guidelines from the American Society of Regional Anesthesia (ASRA) on placing and removing epidural catheters in patients taking anticoagulant and antiplatelet drugs. It lists recommended minimum times to wait after the last dose of various medications before catheter placement and removal, as well as when to restart anticoagulation therapy after removal. The medications are grouped into heparins, low molecular weight heparins, factor Xa and direct thrombin inhibitors, antiplatelet agents, fibrinolytics, and glycoprotein IIb/IIIa inhibitors. For each group, it provides the drug names and recommended waiting times.

ASRA GUIDELINES
GUIDELINES FOR NEURAXIAL ANESTHESIA
AND ANTICOAGULATION
ASRA recommendations for placement & removal of
Epidural Catheter in patient anticoagulant &
Antiplatelet drugs :-

$ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE HEPARIN Catheter can be removed safely, if the last dose is given 6 hrs before IV Unfractionated Heparin Wait till PTT<40 Usual hold time 4 hrs 2 hrs 1-2 hrs SC Unfractionated Heparin No contraindication. The risk of neuraxial bleeding may be reduced by delay of Heparin injection unit , after the block & may be increased in debiliated patients after prolonged therapy. If Heparin given > 4 days, do platelet count prior to catheter removal$

1) The document discusses preoperative considerations and risks for anesthesia in transurethral resection of the prostate (TURP), with a focus on risks in elderly patients. 2) It provides details on TURP syndrome, a cluster of symptoms caused by absorption of irrigating fluid during surgery, and treatments for TURP syndrome and its complications like glycine toxicity, hemolysis, hypothermia, and bleeding. 3) Factors that can minimize risks of TURP syndrome are limiting surgery duration to under 1 hour, maintaining fluid bag height below 60cm, frequent bladder drainage, and careful surgical technique to preserve prostatic capsule integrity. Spinal anesthesia is recommended for its benefits in T

Airway devices and adjuncts Anoop James

Low flow Anaesthesia & Gas MonitoringKalpesh Shah

This document discusses low-flow and minimal-flow anesthesia techniques. It begins by defining low-flow as a fresh gas flow of 1 L/min and minimal-flow as 0.5 L/min. Rebreathing systems allow reuse of exhaled gases after removal of carbon dioxide. Using these techniques can reduce costs by 55-75% and minimize environmental pollution from volatile anesthetic gases. Proper monitoring and maintenance of breathing gas conditions is important for patient safety when using low fresh gas flows.

Defibrillator (ppt)Nitesh Kumar

Ischemic heart disease and anesthetic managementkrishna dhakal

This document discusses ischemic heart disease and its anesthetic management. It begins with defining ischemic heart disease and its causes. It then discusses the perioperative concerns and management for patients undergoing non-cardiac surgery who have ischemic heart disease. This includes preoperative evaluation and testing, intraoperative goals of maintaining a favorable myocardial supply and demand relationship, and anesthetic techniques including general or regional anesthesia to minimize cardiac risk.

Anaesthesia machineimran80

The anesthesia machine delivers precise gas mixtures including oxygen and anesthetic gases. Newer machines have advanced ventilators and electronic components compared to older models. An anesthesia workstation integrates components like gas cylinders, flow meters, ventilators into a single unit. Key components include pressure regulators, flow meters, and safety features to prevent gas shortage or hypoxic mixtures from being delivered. Modern machines use digital displays and computer controls for improved monitoring and safety.

Anesthesia in patients on anti coagulantsNavin Jain‬

This document discusses anesthesia considerations for patients on various anticoagulant medications. It reviews the coagulation cascade and indications for anticoagulation therapy. Common anticoagulants are described including antiplatelet drugs, oral anticoagulants like warfarin, heparins, and newer agents. Guidelines are provided for managing patients on these medications in the perioperative period, including recommendations for stopping medications prior to procedures and resuming them postoperatively. Specific guidance is given for neuraxial anesthesia in anticoagulated patients.

pre op evaluation of cardiac pts for non-cardiac surgeryVkas Subedi

This document discusses the preoperative evaluation of cardiac patients undergoing non-cardiac surgery. It notes that 1-5% of unselected patients experience perioperative cardiac morbidity, and outlines the goals of pre-op evaluation as defining risks, determining if further testing is beneficial, planning anesthesia appropriately, and considering peri-op beta blockade or other therapies. It discusses evaluating patients' history, symptoms, physical exam findings, and using risk indices to stratify cardiac risk. Higher risk factors include recent MI, heart failure, significant arrhythmias or valvular disease. The document provides recommendations for further testing and treatment based on a patient's functional status and cardiac conditions.

Monitored anaesthesia careAnaestHSNZ

The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.

TAP block .pptxAssist. Prof. Radhwan Hazem Alkhashab

This document provides information on transversus abdominis plane (TAP) blocks, including: - TAP blocks are used for lower abdominal surgeries like appendectomies or cesarean sections by blocking nerves between abdominal wall muscles. - The technique involves using ultrasound to guide a needle between the internal oblique and transversus abdominis muscles, then injecting local anesthetic to expand the plane. - Proper needle placement is confirmed by visualizing expansion of the tissue plane under ultrasound. Local anesthetic spreads anesthesia from T8 to the pubic symphysis. - Catheters can be inserted for continuous infusion if prolonged postoperative analgesia is needed.

Context-Sensitive Half-Time in Anaesthetic Practicemonicaajmerajain

The document discusses context-sensitive half-time (CSHT), which is the time required for drug concentrations to decrease by 50% after discontinuing an infusion. CSHT is useful for understanding the duration of drug effects after an infusion stops. It reflects how much drug accumulates in tissues during infusion and then redistributes into the blood. CSHT depends on factors like accumulation, distribution, and excretion rates, which vary between drugs. In anesthetic practice, it is important to understand if a drug has a short, predictable CSHT like remifentanil, or a more prolonged, variable CSHT like fentanyl. While half-life measures elimination rates, CSHT incorporates distribution and depends on infusion duration,

Delayed recovery from anaesthesia.pptShaiq Hameed

Delayed recovery from anesthesia can have multiple contributing factors and causes. It is important to consider potential drug interactions, metabolic abnormalities, and organic causes that may cause prolonged unconsciousness and have serious health implications. Signs and symptoms of metabolic issues may not present normally in an anesthetized patient. The Glasgow Coma Scale provides an objective measure of conscious state regardless of cause.

ASRA Guidelines 4th EditionDr Krunal Bhatt

This document summarizes guidelines from the 4th Edition of the American Society of Regional Anesthesia and Pain Medicine on the anesthetic management of patients receiving various antithrombotic therapies. It outlines recommendations regarding neuraxial blocks and catheter management for patients taking medications such as thrombolytics, unfractionated heparin, low molecular weight heparin, and newer oral anticoagulants. The guidelines provide evidence-based recommendations on timing of blocks and catheter removal in relation to medication dosing and coagulation status monitoring. They emphasize the importance of interdisciplinary communication and individualized clinical decision making to minimize risks while providing optimal pain management.

Interscalene & supraclavicular nerve blocksDavis Kurian

This document provides information on interscalene brachial plexus blocks, including indications, contraindications, anatomy, techniques, complications, and references. It describes Winnie's anterior approach using landmarks to identify the interscalene groove for injection, as well as a posterior approach. Areas of blockade, continuous techniques, and use of nerve stimulation are also summarized. Supraclavicular blockade as an alternative is outlined with similar details.

Total Intravenous AnaesthesiaBrijesh Savidhan

Total intravenous anesthesia (TIVA) involves inducing and maintaining general anesthesia exclusively through intravenous drug administration without volatile agents. It utilizes short-acting hypnotic drugs like propofol and analgesic drugs like fentanyl delivered via target-controlled infusion pumps. TIVA provides advantages like rapid titratability of drugs, faster recovery, reduced pollution and side effects like nausea. Precise computer-controlled infusion pumps along with pharmacokinetic models are used to achieve and maintain targeted drug concentrations in the blood and effect sites. Common drugs utilized in TIVA include propofol, fentanyl and muscle relaxants which are administered individually or in combinations based on the patient and procedure.

Neuromuscular MonitoringMohtasib Madaoo

Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.

Caudal anesthesiaArjun Chhetri

Caudal anesthesia involves needle penetration through the sacral hiatus into the sacral canal. In adults, the sacrum is a triangular bone formed from the fusion of five sacral vertebrae. It differs in neonates and infants due to delayed myelination and fusion of vertebrae. The sacral hiatus is wider in children, allowing easier identification and catheter insertion for caudal anesthesia. Regional techniques require lower approaches in pediatrics due to the lower termination of the spinal cord and dural sac.

Anaesthesia for posterior fossa surgeryDhritiman Chakrabarti

The document discusses the posterior fossa, including its boundaries, contents, blood supply, clinical presentation of lesions, and considerations for anesthesia. The posterior fossa is bounded anteriorly by the clivus and petrous bone, posteriorly by the occipital bone, and laterally by the temporal bone. It contains the cerebellar hemispheres, brainstem, and cranial nerves III-XII. Lesions can cause a variety of signs and symptoms depending on location, including ataxia, nystagmus, limb weakness, and cranial nerve deficits. Anesthesia for posterior fossa surgery requires careful monitoring and positioning to maintain stability while allowing surgical access.

Anaesthesia for renal transplantationSouvik Maitra

This document discusses anesthesia considerations for renal transplantation. It begins by outlining the history of anesthesia used in kidney transplantation, noting the early use of spinal anesthesia and limited monitoring. It then discusses: - Kidney transplantation being the most common transplant procedure worldwide. - Indications and contraindications for transplantation. - Outcomes being greatly improved compared to remaining on dialysis. - Types of donors including living and cadaveric. - Anesthesia goals for living donors focusing on safety. - Evaluation, induction, maintenance and monitoring for recipients. - Positioning, fluid management and hemodynamic goals.

Anaesthesia for neurosurgerySiti Azila

This document discusses anesthesia considerations for neurosurgery patients. It covers common neurosurgical procedures, intracranial hypertension, cerebral edema, and the goals of anesthesia which include maintaining stable intracranial pressure and hemodynamics. It then focuses on anesthesia management for patients undergoing craniotomy for mass lesions, including preoperative evaluation and preparation, induction, maintenance with goals of optimal surgical conditions and neurological protection, and controlled emergence.

Low flow anaesthesiaZIKRULLAH MALLICK

This document discusses low flow anaesthesia. It defines low flow as 500-1000 ml/min of fresh gas flow. The document outlines the technical requirements for safely conducting low flow anaesthesia, including monitors for inspired oxygen, end tidal CO2 and anaesthetic concentrations. It describes the initiation, maintenance and emergence phases of low flow anaesthesia, emphasizing achieving and maintaining an appropriate anaesthetic depth. The document discusses advantages like reduced cost and pollution compared to higher fresh gas flows.

Anaesthesia for cardiac patient undergoing non cardiac surgeryDhritiman Chakrabarti

The document discusses the approach to anesthesia for patients with cardiac disease undergoing non-cardiac surgery. It emphasizes the importance of preoperative evaluation and risk stratification to determine the safest anesthetic plan. During surgery, careful monitoring is recommended to detect any deterioration in cardiac function. The appropriate selection of anesthetic drugs and techniques can help minimize stress on the heart. Overall, the key is choosing an anesthetic that provides stability for the patient's cardiac condition.

Thyroid ppt [autosaved]DR . RAJESH CHOUDHURI

The document discusses thyroid disorders including hyperthyroidism, hypothyroidism, and thyroid storm and their implications for anesthesia such as increased sensitivity to drugs, risks of tachycardia and arrhythmias, and need for careful monitoring of cardiac and respiratory function. It provides guidance on preoperative preparation, intraoperative management, and postoperative care for patients with thyroid disorders undergoing surgery.

DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar

Cerebral physiology and effects of anaesthetic agentsRicha Kumar

The document discusses cerebral physiology and the effects of anesthetic agents. It covers topics such as: - Anatomy of the cerebral circulation including the circle of Willis. - Regulation of cerebral blood flow including chemical, myogenic, and neurogenic factors. - Effects of increased intracranial pressure on cerebral perfusion. - How different anesthetic agents like barbiturates, propofol, etomidate, narcotics, benzodiazepines, ketamine, and volatile anesthetics affect cerebral blood flow and cerebral metabolic rate.

Etomidate a to zdr tushar chokshi

This document provides information about the drug etomidate. It discusses etomidate's history, mechanism of action, effects on body systems, pharmacokinetics, formulations, indications, contraindications, adverse effects, dosing, administration, safety, and relationship to adrenal suppression. The document also outlines cases for discussion and emphasizes that etomidate is the preferred induction agent for hemodynamically unstable patients.

Anaesthesia for spine surgeryAsi-oqua Bassey

Spine surgeries present diverse challenges to anaesthetists. The document outlines considerations for anaesthesia including preoperative evaluation and optimization, induction and intubation while maintaining spine stability, positioning prone or sitting, intraoperative monitoring, maintenance with stable anaesthetic depth and blood pressure, transfusion management for blood loss, emergence and extubation when fully awake, postoperative analgesia, and complications prevention and management. Skillful anaesthetic management is key to optimal patient outcomes for various spine procedures.

Anaesthesia for patient with pacemakerHASSAN RASHID

Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial

asra guidelines.pptxRaj Kumar

1. The guidelines provide recommendations for the timing of regional anesthesia and anticoagulant/antiplatelet medications to reduce the risk of hematoma formation. 2. The recommendations are based on drug half-lives and allow for clearance of 97% of the drug's anticoagulant effect before placement or removal of catheters. For example, it recommends waiting 5 half-lives after discontinuing warfarin. 3. For novel oral anticoagulants like rivaroxaban and apixaban, it recommends waiting 72 hours before catheter placement or removal and considering anti-Factor Xa levels if less time has elapsed. Monitoring and timing recommendations vary based on each drug's pharmacokinetics

More Related Content

What's hot (20)

Monitored anaesthesia careAnaestHSNZ

TAP block .pptxAssist. Prof. Radhwan Hazem Alkhashab

Context-Sensitive Half-Time in Anaesthetic Practicemonicaajmerajain

Delayed recovery from anaesthesia.pptShaiq Hameed

ASRA Guidelines 4th EditionDr Krunal Bhatt

Interscalene & supraclavicular nerve blocksDavis Kurian

Total Intravenous AnaesthesiaBrijesh Savidhan

Neuromuscular MonitoringMohtasib Madaoo

Caudal anesthesiaArjun Chhetri

Anaesthesia for posterior fossa surgeryDhritiman Chakrabarti

Anaesthesia for renal transplantationSouvik Maitra

Anaesthesia for neurosurgerySiti Azila

Low flow anaesthesiaZIKRULLAH MALLICK

Anaesthesia for cardiac patient undergoing non cardiac surgeryDhritiman Chakrabarti

Thyroid ppt [autosaved]DR . RAJESH CHOUDHURI

DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar

Cerebral physiology and effects of anaesthetic agentsRicha Kumar

Etomidate a to zdr tushar chokshi

Anaesthesia for spine surgeryAsi-oqua Bassey

Anaesthesia for patient with pacemakerHASSAN RASHID

Monitored anaesthesia careAnaestHSNZ

TAP block .pptxAssist. Prof. Radhwan Hazem Alkhashab

Context-Sensitive Half-Time in Anaesthetic Practicemonicaajmerajain

Delayed recovery from anaesthesia.pptShaiq Hameed

ASRA Guidelines 4th EditionDr Krunal Bhatt

Interscalene & supraclavicular nerve blocksDavis Kurian

Total Intravenous AnaesthesiaBrijesh Savidhan

Neuromuscular MonitoringMohtasib Madaoo

Caudal anesthesiaArjun Chhetri

Anaesthesia for posterior fossa surgeryDhritiman Chakrabarti

Anaesthesia for renal transplantationSouvik Maitra

Anaesthesia for neurosurgerySiti Azila

Low flow anaesthesiaZIKRULLAH MALLICK

Anaesthesia for cardiac patient undergoing non cardiac surgeryDhritiman Chakrabarti

Thyroid ppt [autosaved]DR . RAJESH CHOUDHURI

DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar

Cerebral physiology and effects of anaesthetic agentsRicha Kumar

Etomidate a to zdr tushar chokshi

Anaesthesia for spine surgeryAsi-oqua Bassey

Anaesthesia for patient with pacemakerHASSAN RASHID

Similar to ASRA Guidelines (20)

Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial

asra guidelines.pptxRaj Kumar

Anticoagulantion and Regional Anesthesiaculionppcrv2022

neuraxial-procedure-v2-3.26.19.pdfolivia9001

This document provides guidelines for the administration of antithrombotic and anticoagulant medications before, during, and after neuraxial procedures based on the medication and dose. It lists specific time periods that should elapse between medications and procedures for various drugs like heparin, enoxaparin, warfarin, and antiplatelet drugs. Thrombolytic agents are contraindicated for neuraxial techniques due to the high risk of spinal hematoma.

Anticoagulantsashishnair22

This document provides guidelines for holding and restarting various anticoagulant and antiplatelet medications before, during, and after procedures involving neuraxial catheters. It lists medications such as heparin, warfarin, low molecular weight heparins, direct thrombin inhibitors, and others along with recommended hold times and when to restart each medication. It also includes each medication's mechanism of action and half-life.

Anticoagulation and Regional AnesthesiaRajnish Gupta

2024-04-07-133011cardiac surgery123.pptxFlyHeyjude

Novel Oral Anticoagulants final (NOAC).pptxkushalranjit

final presentation of anticoagulants.pptxSwastika Swaro

1) Managing patients on anticoagulants who require regional anesthesia or peripheral nerve blocks is challenging due to the risk of bleeding complications like epidural hematomas. 2) Guidelines provide recommendations on interrupting anticoagulants prior to a procedure and resuming them postoperatively based on the drug's half-life, bleeding risk level, and type of block performed. 3) Vigilant monitoring for neurological symptoms is important to allow early diagnosis and treatment of hematomas, which have the best outcome if evacuated within 8-12 hours of onset.

Anticoag transitions 2014Hassan Khraibani

Anticoagulation and Regional Blocks.pptxSivasubramanian795072

Vte prophylaxisBabak Jebelli

This document provides guidelines for venous thromboembolism (VTE) prophylaxis and the use of low molecular weight heparin (LMWH) in pregnancy and postpartum. It outlines risk factors for VTE and bleeding, dosing recommendations for LMWH, and guidelines for the timing of LMWH administration and removal of epidural catheters around C-sections and other surgeries. LMWH is recommended for at least 7 days for those with a VTE risk score of 3 or higher, and dosing depends on weight. Strict timing guidelines aim to reduce the risk of spinal hematoma when combining neuraxial anesthesia and LMWH.

NOAC use - brief handoutPei-shen (James) Wu

This document provides information on the use of novel oral anticoagulants (NOACs) for atrial fibrillation (AFib)-related stroke prevention. It notes that Asians have higher risks of transient ischemic attack (TIA) and cerebrovascular accident (CVA) with AFib than other groups. While aspirin is no better than placebo, NOACs have rapid onset, short half-lives, and fixed dosing without monitoring. The four main NOACs are dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Lixiana). Special considerations include higher renal excretion of P

perioperative management of anticoagulant and antiplatelet agentsShailendraMaharjan1

Anti-coagulantssurgicalperspective11.9.13.pptSharatVijapur1

This document discusses the perioperative management of anticoagulant and antiplatelet medications. It describes procedures as either low or high bleeding risk and recommendations for interrupting or continuing anticoagulation for each. Bridging therapy with low molecular weight heparins or unfractionated heparin is described for high thromboembolic risk patients undergoing procedures. Considerations and guidelines for interrupting and resuming novel oral anticoagulants like dabigatran, rivaroxaban, and apixaban in relation to renal function and procedure bleeding risk are provided. Limited reversal options for the novel anticoagulants in emergency situations are also mentioned.

Anticoagulantaandregionalanesthesia reviewDr.RMLIMS lucknow

This document discusses anticoagulants and their implications for regional anesthesia. It covers the coagulation cascade, classifications of anticoagulants including warfarin, heparin, LMWH, antiplatelets, and newer anticoagulants. Guidelines are provided for timing of regional anesthesia in relation to different anticoagulants. It emphasizes that coagulation defects are the principal risk factor for spinal hematoma from regional anesthesia.

Perioperative management of antithrombotic therapyZaito Hjimae

This document discusses the perioperative management of antithrombotic therapy. The goals are to prevent thromboembolic events like strokes while reducing the risk of major hemorrhage during surgery. It assesses thrombotic risk based on the type of anticoagulation and bleeding risk scores. It provides guidance on bridging anticoagulation during surgery and reversing anticoagulants. It also discusses perioperative management of antiplatelet drugs like aspirin and clopidogrel based on surgery type and risk of cardiovascular events.

Emergency Medical System Network for STEMI ManagementPERKI Pekanbaru

This document discusses the emergency medical system network for managing ST-elevation myocardial infarction (STEMI). It outlines the importance of rapid diagnosis through early electrocardiograms and treatment through reperfusion therapies like primary percutaneous coronary intervention (PCI) or fibrinolysis. The target is first medical contact to reperfusion within 90 minutes for primary PCI or 30 minutes for fibrinolysis. It also discusses long-term secondary prevention therapies.

Endoscopy in patients on antiplatelet or anticoagulant therapy.attiasalman1

This document discusses guidelines for managing anticoagulant and antiplatelet medications before and after gastrointestinal endoscopic procedures. It addresses which procedures require stopping medications, how to classify patient thrombosis risk, when to stop and restart medications, and special considerations for emergent bleeding situations. Key points include classifying endoscopic procedures and patient thrombosis risk as low or high, recommendations to stop or continue various medications before low-risk versus high-risk procedures, and guidance on reversing anticoagulation effects or providing alternate medications for emergency bleeding situations.

Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial

asra guidelines.pptxRaj Kumar

Anticoagulantion and Regional Anesthesiaculionppcrv2022

neuraxial-procedure-v2-3.26.19.pdfolivia9001

Anticoagulantsashishnair22

Anticoagulation and Regional AnesthesiaRajnish Gupta

2024-04-07-133011cardiac surgery123.pptxFlyHeyjude

Novel Oral Anticoagulants final (NOAC).pptxkushalranjit

final presentation of anticoagulants.pptxSwastika Swaro

Anticoag transitions 2014Hassan Khraibani

Anticoagulation and Regional Blocks.pptxSivasubramanian795072

Vte prophylaxisBabak Jebelli

NOAC use - brief handoutPei-shen (James) Wu

perioperative management of anticoagulant and antiplatelet agentsShailendraMaharjan1

Anti-coagulantssurgicalperspective11.9.13.pptSharatVijapur1

Anticoagulantaandregionalanesthesia reviewDr.RMLIMS lucknow

Perioperative management of antithrombotic therapyZaito Hjimae

Emergency Medical System Network for STEMI ManagementPERKI Pekanbaru

Endoscopy in patients on antiplatelet or anticoagulant therapy.attiasalman1

More from KGMU, Lucknow (7)

glycopeptides and lipopeptidesKGMU, Lucknow

This document discusses glycopeptides, lipoglycopeptides, and lipopeptides used to treat gram-positive bacterial infections. It begins with classifications of these drugs and mechanisms of action. Specifically, it focuses on vancomycin as the first glycopeptide antibiotic discovered from soil samples. It describes vancomycin's structure, mechanism of inhibiting cell wall synthesis, and pharmacokinetics. The document also covers the spectrum of activity and clinical uses of vancomycin and risks of resistance.

Stabilization of polytrauma patientKGMU, Lucknow

The document provides guidelines for the stabilization and management of polytrauma patients according to ATLS protocols. It describes the initial assessment of a hypothetical patient involved in a motorbike accident using the ABCDE approach. This includes securing the airway with cervical spine protection, treating breathing issues like tension pneumothorax, controlling hemorrhage, and assessing neurological status. It then outlines the steps for secondary survey, potential indications for emergency procedures, and guidelines for patient transfer to definitive care.

Oxygen and oxygen therapyKGMU, Lucknow

Mapleson systemKGMU, Lucknow

The document discusses various breathing systems used for anesthesia, including the Mapleson A-F systems. It provides details on the history, components, configurations, techniques of use, and functional analysis of each system. The Mapleson A system is described as the original system developed by Evan Magill, with fresh gas entering at the opposite end of the reservoir bag near the patient. Rebreathing occurs more readily with lower fresh gas flows. The Mapleson B and C systems have the fresh gas inlet and adjustable pressure limiting valve located near the patient end.

Electolyte disordersKGMU, Lucknow

This document provides an overview of fluid and electrolyte disorders. It discusses fluid balance, regulation of body water, volume abnormalities including fluid volume deficit and excess. It also covers the basic metabolic panel and common electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. For each disorder it discusses causes, clinical manifestations, evaluation, and treatment approaches. The goal is to recognize these fluid and electrolyte disorders and manage them effectively.

Respiratory physiology h.o.d.KGMU, Lucknow

This document provides an overview of respiratory physiology, including: 1. It describes the functional anatomy of the respiratory system from the nose to the alveoli. 2. It defines and explains various lung volumes and capacities that are measured by spirometry, such as tidal volume, functional residual capacity, and closing capacity. 3. It covers topics related to gas exchange including the roles of surfactant and preoxygenation in increasing oxygen stores in the lungs. 4. It discusses the concepts of ventilation, dead space, and the measurement of physiological dead space using the Bohr equation.

Larynx anatomy of larynx (1)KGMU, Lucknow

The document discusses the anatomy and development of the larynx. It describes the larynx's location and cartilages, including the thyroid, cricoid, epiglottis, and arytenoid cartilages. It also discusses the differences between a child's larynx and an adult larynx. The larynx develops from the foregut and surrounding mesoderm and descends in the neck during early childhood. It has three parts: the supraglottis, glottis, and subglottis, which contain various structures like the true and false vocal cords.

glycopeptides and lipopeptidesKGMU, Lucknow

Stabilization of polytrauma patientKGMU, Lucknow

Oxygen and oxygen therapyKGMU, Lucknow

Mapleson systemKGMU, Lucknow

Electolyte disordersKGMU, Lucknow

Respiratory physiology h.o.d.KGMU, Lucknow

Larynx anatomy of larynx (1)KGMU, Lucknow

Recently uploaded (20)

Biophysics Thermodynamics 1 Chapter NotesPKLI-Institute of Nursing and Allied Health Sciences Lahore , Pakistan.

Biophysics – Unit 01: Thermodynamics This unit introduces the fundamental principles of thermodynamics and their application in biological and physiological systems. It explores how energy is exchanged and transformed in the human body, forming the basis of many critical clinical processes. Key Concepts Covered: System & Surroundings: Open, closed, and isolated systems relevant to physiological environments (e.g., respiratory system as an open system). Zeroth Law: Basis for clinical thermometry and body temperature regulation. First Law of Thermodynamics (Law of Energy Conservation): Application in calorimetry, metabolic rate calculation, and ATP energy balance. Second Law of Thermodynamics: Directionality of biological processes, entropy, and energy efficiency in muscle contraction and enzymatic activity. Third Law: Conceptual relevance in absolute zero and physiological limits. Clinical Applications: Energy transformations during cellular respiration Thermal regulation and homeostasis in patients Bioenergetics in critical care (e.g., post-operative energy needs, fever metabolism) Use of thermodynamic principles in medical devices (ventilators, incubators, dialysis machines)

molecular medicin unit 2 lecturer 1.pptxBolan University of Medical and Health Sciences ,Quetta

Genes are formed by the order of the nitrogenous bases present in the DNA which is crucial for protein synthesis. RNA is another nucleic acid that translates genetic information into proteins from DNA. The nucleotides are linked together for the formation of two long strands. genomics, which encompasses the examination of an organism's entire set of genetic material, including DNA and RNA. by Dr Aliya S.M BUMHS,QTA

SOPHE navigating digital complexity for health education in 21st centiryTina Purnat

This talk invites health education and health promotion professionals to reflect on their evolving role in the age of digital complexity. As digital spaces increasingly shape how people seek, share, and understand health information, educators must expand their impact beyond individuals and communities. We’ll explore how your work also needs to reach upward to senior leaders and policymakers, across to peers in communication, tech, and healthcare, and downward to support and guide newer professionals entering the field. Drawing on SOPHE competencies, this presentation emphasizes relational communication, trust-building, participatory strategies, and systems thinking as essential tools for navigating information ecosystems that are fragmented, commercialized, and emotionally charged. We’ll look at real-world examples—from reproductive health apps and social media self-diagnosis to AI-generated health content—and consider what it takes to build resilience, credibility, and connection in this new environment. Health educators are not just communicators; we are system influencers in a digital world.

Fundus Camera MUCLecture_2024_4344921 (1).pptxshelgohary

Short QT syndrome. Description, Evaluation, ECG changes.SyedFaisalAhmed12

From Established to Emerging Therapies: Expert Perspectives on the Latest Evi...PeerVoice

CHILDBIRTH POSITION DURING LABOR AND DELIVERYpptxdaminipatel37

Incremental Dental Care and Comprehensive Dental CareTeenu Thaikkanath

Bronchial Asthma Diagnosis & Management (2025)Dr AlTokhy

physical examination .pptxKniranda Mayanglambam

Luteal phase support in Assisted Reproducton.pdfAhmed Mowafy

INDIVIDUALIZATION OF INSULIN THERAPY FOR T2D IN INDIAN SCENARIO.pptxGovindRankawat1

Bone mineral density measurements in nuclear medicineMiadAlsulami

Coronary stents: A comprehensive overview of coronary stentsAhmedElBorae1

case presentation paronychia case presentation.pptxalshjrtnsybt

Medical Negligence and Medical Ethics.pptxDr Kadiyali. M. Srivatsa

Negligence & Medical Ethics – The Unspoken Pandemic Presented by Dr. Kadiyali M Srivatsa Every day, patients walk into clinics, trusting someone will care for them. But what if I told you… that medical errors are now the third leading cause of death in the world? Yes—after heart disease and cancer. And the tragedy? Most of these deaths are preventable. 🎬 Scene 2: Medical Negligence – A Global Crisis On Screen: ⚠️ FACT: 2.6 million deaths annually are linked to medical errors – WHO Narration: According to the World Health Organization, over 2.6 million people die every year due to unsafe medical care. In high-income countries, 1 in 10 patients is harmed while receiving hospital care. In low- and middle-income countries… the number is likely even higher, but underreported. This… is a silent pandemic. Act of Commission vs. Omission Negligence isn’t always about what’s done. It’s often about what is not done. Doing what shouldn’t be done. Or… failing to do what must be done. Both destroy lives. Nurses Acting as Doctors Untrained, Unsupervised, Unethical. In some systems, nurses with only 6 months of training diagnose, prescribe, and manage patients without supervision. This is not progress. It’s cost-cutting at the cost of lives. Since 2006, hospitals in the UK began replacing doctors with “Independent Nurse Practitioners and prescriber.” And what happened? Avoidable deaths doubled. Medical litigation rose to £1.5 billion. Hospitals started collapsing under the weight of compensation claims. Real Cases – Real Suffering On Screen: 🚨 True Stories That Shake the Soul Narration: A nurse tells a 23-year-old woman with yellow eyes “It’s just a flu. Take paracetamol.” Two days later, she’s in liver failure. A young man misdiagnosed with shingles actually has septicemia—He collapses in shock. Survives—but just barely. A toddler with pneumonia is sent home. Told to return after the weekend. She nearly dies. These are not accidents. These are acts of negligence. And behind every mistake… is a family left grieving. Why did I create Dr. Maya GPT? Dr. Maya GPT – A Global Guardian for Patient Safety. I could no longer bear to watch patients suffer due to systemic negligence, corporate cost-cutting, and ego-driven medicine. Dr. Maya is not a replacement for doctors. It is a guide. A safety net. An AI-powered guardian that helps people identify when to seek help— and most importantly, whom to trust. The Ethical Compass – Diligence - A Universal Virtue Across Faiths Whether it's the teachings of the Bible, the Quran, the Gita, or the Dhammapada -they all echo one truth: “Act with diligence.” That means effort. Integrity. And doing the right thing—even when no one is watching.

Antibiotics Stewardship:IMA Awareness DriveSMS MEDICAL COLLEGE

Power point presentation on MONKEYPOX.pptxwilliamsundebe1

Public Health-Definition ,concept and development.pdfMUSTAFA MOHAMMED

Chronic Obstructive Pulmonary Disease, NursingAnurag Joseph

Slide 1: Title Slide Title: Understanding COPD: Definition, Diagnosis, Pathophysiology, Management, and Nursing Care Plan Subtitle: A comprehensive guide for nursing students Slide 2: Definition of COPD Definition: COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Main characteristics: Progressive airflow limitation Often associated with smoking Includes emphysema and chronic bronchitis Slide 3: Types of COPD Chronic Bronchitis: Inflammation of bronchial tubes, leading to excess mucus production Symptoms: Chronic cough, sputum production Emphysema: Damage to alveolar walls, leading to air trapping Symptoms: Shortness of breath, barrel chest Slide 4: Diagnosis of COPD Methods of Diagnosis: Pulmonary Function Test (PFT): Measures forced expiratory volume (FEV1) and forced vital capacity (FVC) Arterial Blood Gas (ABG): Measures oxygen and CO2 levels Chest X-ray/CT Scan: Identifies lung damage History and Symptoms: Cough, sputum, and breathlessness history Smoking history Slide 5: Pathophysiology of COPD Airflow Obstruction: Chronic inflammation leading to narrowing of airways Destruction of alveolar walls (emphysema) Increased mucus production (chronic bronchitis) Increased Work of Breathing: Air trapping and limited gas exchange Progressive Hypoxia & Hypercapnia: Reduced oxygen supply and increased carbon dioxide retention Slide 6: Management of COPD Pharmacological Treatment: Bronchodilators (Beta-agonists, Anticholinergics) Corticosteroids (oral or inhaled) Oxygen Therapy Antibiotics (for infections) Non-pharmacological Treatment: Pulmonary Rehabilitation Breathing exercises (e.g., pursed-lip breathing) Lifestyle changes (e.g., smoking cessation) Vaccinations (e.g., flu, pneumonia) Slide 7: Nursing Care Plan for COPD Assessment: Monitor respiratory rate, lung sounds, oxygen saturation Assess for signs of distress (e.g., use of accessory muscles) Record smoking and environmental exposure history Nursing Diagnoses: Impaired Gas Exchange Ineffective Airway Clearance Activity Intolerance Goals: Maintain optimal oxygen levels Enhance airway clearance Increase physical activity tolerance Interventions: Administer bronchodilators and corticosteroids Educate on smoking cessation Promote breathing exercises and positioning Ensure proper nutrition and hydration Educate on recognizing exacerbations

Biophysics Thermodynamics 1 Chapter NotesPKLI-Institute of Nursing and Allied Health Sciences Lahore , Pakistan.

molecular medicin unit 2 lecturer 1.pptxBolan University of Medical and Health Sciences ,Quetta

SOPHE navigating digital complexity for health education in 21st centiryTina Purnat

Fundus Camera MUCLecture_2024_4344921 (1).pptxshelgohary

Short QT syndrome. Description, Evaluation, ECG changes.SyedFaisalAhmed12

From Established to Emerging Therapies: Expert Perspectives on the Latest Evi...PeerVoice

CHILDBIRTH POSITION DURING LABOR AND DELIVERYpptxdaminipatel37

Incremental Dental Care and Comprehensive Dental CareTeenu Thaikkanath

Bronchial Asthma Diagnosis & Management (2025)Dr AlTokhy

physical examination .pptxKniranda Mayanglambam

Luteal phase support in Assisted Reproducton.pdfAhmed Mowafy

INDIVIDUALIZATION OF INSULIN THERAPY FOR T2D IN INDIAN SCENARIO.pptxGovindRankawat1

Bone mineral density measurements in nuclear medicineMiadAlsulami

Coronary stents: A comprehensive overview of coronary stentsAhmedElBorae1

case presentation paronychia case presentation.pptxalshjrtnsybt

Medical Negligence and Medical Ethics.pptxDr Kadiyali. M. Srivatsa

Antibiotics Stewardship:IMA Awareness DriveSMS MEDICAL COLLEGE

Power point presentation on MONKEYPOX.pptxwilliamsundebe1

Public Health-Definition ,concept and development.pdfMUSTAFA MOHAMMED

Chronic Obstructive Pulmonary Disease, NursingAnurag Joseph

ASRA Guidelines

1. ASRA GUIDELINES GUIDELINES FOR NEURAXIAL ANESTHESIA AND ANTICOAGULATION ASRA recommendations for placement & removal of Epidural Catheter in patient anticoagulant & Antiplatelet drugs :-

2. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE HEPARIN Catheter can be removed safely, if the last dose is given 6 hrs before IV Unfractionated Heparin Wait till PTT<40 Usual hold time 4 hrs 2 hrs 1-2 hrs SC Unfractionated Heparin No contraindication. The risk of neuraxial bleeding may be reduced by delay of Heparin injection unit , after the block & may be increased in debiliated patients after prolonged therapy. If Heparin given > 4 days, do platelet count prior to catheter removal

3. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE LMWH (Low molecular weight Heparin) Therapeutic dose 24 hrs 4 hrs Hold time may be longer in patients with renal impairment . Catheter can be removed safely, if the last dose of LMWH is given 12 hrs before. 4-7 hrs Enoxaparin 1mg/kg sc QID or 1.5 mg/kg daily

4. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE LMWH (Low molecular weight Heparin) Therapeutic dose 24 hrs 4 hrs 4-7 hrs Dalteparin: 120 U/Kg BD in 200 Units/Kg daily

5. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONA L INFORMATI ON HALF LIFE FACTOR X-a Inhibition Fondaparinux 72 hrs 12 hrs 17-21 hrs Rivaroxaban 24 hrs 6 hrs(24 hrs for traumatic puncture) Longer hold time in patients with renal impairment 5-9 hrs Apixaban 48 hrs 6-12 hrs

6. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE DIRECT THROMBIN INHIBITORS Argatroban Wait till APTT<40 2 hrs Longer hold time in patients with renal impairment 40-50 mins Lepirudin 1-3 hrs Dabigatran 72 hrs(longer in renal impairment) 6 hrs(24 hrs for traumatic puncture) 8-17 hrs

7. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE ANTIPLATEL ET AGENTS Aspirin No restrictions No restrictions Clopidogrel 7-10 days 2 hrs Dipyridamide 24 hrs Ticlopidine 10-14days

8. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE FIBRINOLYTI CS Streptokinase 10 days 10 days 18-33 mins Alteplase 26-46 mins Tenectoplase 115 mins

9. ASRA GUIDELINES MEDICATION PRIOR TO CATHETER PLACEMENT Minimum time between the last dose of anticoagulant & initial catheter placement AFTER CATHETER REMOVAL When to restart anticoagulation therapy , once catheter has been removed ADDITIONAL INFORMATIO N HALF LIFE GLYCOPROT EIN IIb/IIIa INHIBITORS Abciximab 48 hrs/2 days 2 hrs Eptifibatide 8 hrs Tirofiban

ASRA Guidelines

Recommended

More Related Content

What's hot (20)

Similar to ASRA Guidelines (20)

More from KGMU, Lucknow (7)

Recently uploaded (20)

ASRA Guidelines