Today we will discuss one of the most critical devices utilised by anesthetists and throughout the anesthetic communities—the oxygen delivery devices. From anesthesia circuits, nasal prongs, and basic face masks to ventilators in the ICU environment, these devices are integral to guaranteeing optimal oxygen delivery. It is important to understand these devices in determining the oxygen flow, the needed fraction of inspired oxygen (FiO2), and categorizing these devices according to patient requirements.
Significance of Oxygen Therapy
Oxygen is crucial to life, and its administration becomes important in the management of hypoxemia, which may occur because of hypoventilation, ventilation-perfusion (V/Q) mismatch, atelectasis, or anesthetic-induced respiratory depression. Oxygen therapy is important for:
The management of hypoxemia and enhancement of tissue oxygenation
Carbon monoxide poisoning
Maintaining survival during low atmospheric pressure environments, e.g., mountaineering
Aiding patients undergoing anesthesia who cannot breathe on their own
The World Health Organization (WHO) has indicated that an FiO2 of 80% is acceptable, though in the majority of ICU environments, 50-60% FiO2 is usually acceptable. Oxygen delivery can be administered via simple face masks, nasal cannulas, or invasive ventilatory assistance based on a patient’s ventilatory needs.
Classification of Oxygen Delivery Systems
Oxygen delivery systems can be classified into two general categories:
Normobaric Oxygen Therapy – Oxygen is delivered at atmospheric pressure.
Hyperbaric Oxygen Therapy – Oxygen is administered at greater-than-atmospheric pressures.
Additional Classification Based on Patient Dependency
Low Dependency Systems:Supplemental oxygen alone is adequate to correct hypoxemia in spontaneously breathing patients.
Medium Dependency Systems: Patients need further assistance like Continuous Positive Airway Pressure (CPAP) or High-Flow Nasal Cannula (HFNC).
High Dependency Systems: Patients need mechanical ventilation or Non-Invasive Positive Pressure Ventilation (NIPPV).
Low Dependency Oxygen Delivery Systems
Low dependency systems are subdivided into:
Low Flow Devices:
Nasal Cannula: Supplies variable oxygen concentration (FiO2 varies with respiratory rate and tidal volume).
Simple Face Mask: Supplies more FiO2 than a nasal cannula but less accurately.
Reservoir Masks:
Partial Rebreather Mask: Permits some rebreathing of exhaled gases, which raises FiO2.
Non-Rebreather Mask: Fitted with one-way valves to avoid rebreathing, providing increased FiO2 levels.
High Flow Devices:
Venturi Mask: Offers a constant and reliable FiO2 irrespective of patient effort.
High-Flow Nasal Cannula (HFNC): Provides warm, humid oxygen at high flow rates (max. 60 L/min), facilitating improved oxygenation and comfort.
Determinants of Delivered FiO2
Several factors affect the actual FiO2 that a patient inhales:
Equipment Factors: Oxygen flow rate, mask volume, quality of fit, and effectiveness of mask seal.
Other Factors: Whether or not humidification is present, patient compliance, and external air entrainment.
Conclusion:
Knowledge of oxygen delivery devices is essential to maximize patient care, especially in ICU and anesthesia environments. Selecting the appropriate oxygen therapy modality according to patient requirements and levels of dependency ensures proper oxygenation, reduces complications, and improves overall treatment outcomes.
Stay updated, stay ready, and keep moving forward in the specialty of anesthesiology and critical care!
Anesthesia residency is challenging, and keeping books, apps, and study timetables in sync is daunting. The Conceptual Anesthesia App has been developed to guide you along the way, providing a learning pathway from first-year residency through final exams and super speciality preparation.
Book Suggestions for Every Year of Residency
First-Year Residency
For first-year residents, a good starting point is Lee’s Synopsis of Anesthesia, a short and easy-to-read book that helps with answering OT questions but is not sufficient for exams.
This book provides a basic understanding of anesthesia.
Second-Year Residency
Miller’s Anesthesia: This is also called the bible of Anesthesia, It is a standard reference book, but it is complex and difficult to memorize.
To make it more manageable, starting with systemic topics like neuro, respiratory, and cardiac anesthesia can be helpful.
Morgan and Mikhail’s Clinical Anesthesiology:This is an alternative to Miller’s Anesthesia, it is simpler than Miller’s but more detailed than Lee’s.
This book presents information in a more understandable format and is useful for exam preparation.
Important Tips:
Miller’s Anesthesia was useful for systemic topics like transplant, cardiac, neuro, and respiratory anesthesia but was not used directly for theory answers.
Referencing Miller’s Anesthesia in exams (MD, DNB, DA) impresses examiners.
A strategic study approach is to read Morgan and Mikhail’s for six months and make notes. Instead of writing extensive handwritten notes, highlighting key points, bookmarking, or using sticky notes can make revision easier.
Objective Anesthesia Review (ARC Book): This book Includes case presentations, explanations, instruments, and machines.
Yao and Artusio’s Anesthesiology: Comprehensive case presentation guide. Extra points from this book can be added to the ARC book.
Stoelting’s Anesthesia and Co-Existing Disease: Helpful for extra case-related questions.
For Anesthesia Equipment:
Dorsch’s Anesthesia Equipment is detailed but difficult to remember.
Understanding Anesthestic Equipment & Procedure a Practical Approach by Dr. Baheti and Dr. Laheri: It is simpler and sufficient for exams.
Note: If you are too loaded with your training, thesis and studies the ARC book is the ultimate solution, it also covers equipment, but only enough to pass, not to excel.
For Anesthesia Pharmacology:
Stoelting’s Pharmacology and Physiology in Anesthetic Practice covers all anesthetic and related drugs comprehensively.
Subject-specific books for super speciality preparation or deeper understanding:
These are books not only for people who want to take NEET SS but also for those who want to understand the subject in a better way.
Neuroanesthesia: Cottrell and Patel’s Neuroanesthesia (comprehensive), if you don’t have the time you can for the shorter version of this book or Handbook of Neuroanesthesia (shorter).
Cardiac Anesthesia: Kaplan’s Cardiac Anesthesia, is well written, in detail yet easy to understand.
Pediatric Anesthesia: Gregory’s Textbook of Pediatric Anesthesia or Principles and Practice of Pediatric Anesthesia by Dr. Snehalatha and Dr. Nandini Dawe (simpler, Indian perspective).
Regional Anesthesia:
Hadzic’s Textbook of Regional Anesthesia and Acute Pain Management– Well-structured with anatomy, sonoanatomy, block procedures, and key takeaways. Ideal for exam answers.
Herman Sehmbi’s (MCQs in Regional Anesthesia and Pain Therapy) – Essential for practising MCQs, especially for the regional anesthesia fellowship entrance exam at Ganga Hospital, Coimbatore.
Ganga Hospital Handbook – Summarized, well-organized, and useful for specific blocks. Covers:
Instagram Channel for the latest updates and information.
Anesthesia residency can be tricky to balance with books, apps, and study schedules, but strategic learning and wise resources make it simple. Streamline your preparation with the Conceptual Anesthesia App, guided book suggestions, and online resources and ace your exams!
Click here to visit the Conceptual Anesthesia website to learn more about the platform and how it can help you during your residency.
Anesthesia is a field that requires accuracy, in-depth knowledge, and a deep understanding of both theoretical and practical principles. Most of the resources available in the market either they are either unreliable or do not provide a methodical approach tailored to postgraduate students and working anesthesiologists.
Conceptual Anesthesia books fill this gap with meticulously designed content that caters to MD, DNB, and DA students while also serving as a comprehensive reference for experienced practitioners. In this blog, we explore why these books stand out from the available study materials and why every anesthesiology student should purchase them.
1. Handbook of Drugs Used in Anesthesia & Allied Specialties(for MD/DNB/DA Theory & Practical Exam Preparation)
What Makes This Book Unique?
Offers a comprehensive categorization of anesthetic medications by the mechanism of action, pharmacokinetics, pharmacodynamics, and side effects.
This textbook concentrates exclusively on anesthesiology and critical care for focused learning.
Organized in a clear manner that simplifies drug knowledge and its application to medical practice.
Necessary for postgraduate students require detailed information for examinations and practitioners require an accessible, instant reference.
How Does it Stand Compared to Other Market Resources?
Focused more on anesthesia-specific medications than general pharmacology texts.
Has a clear and organized structure compared to most drug books in which drugs are given without proper description.
Made for ease of practical use, as opposed to theory-oriented resources.
2. Handbook of Instruments & Machine in Anesthesia (for MD/DNB/DA Theory & Practical Exam Preparation)
What Makes This Book Unique?
Provides a comprehensive review of all major anesthetic instruments, such as endotracheal tubes, LMAs, laryngoscopes, and regional anesthesia equipment.
Well-illustrated with high-quality photographs and diagrams, facilitating visual learning and identification.
It breaks down complex ideas into simple terms and uses clear pictures to show how everything works.
Gives step-by-step instructions on the application and working of each instrument, which is hardly discussed in such detail in other anesthesia books.
How Does it Stand Compared to Other Market Resources?
In contrast to books on general surgical instruments, this one is exclusively devoted to machines and tools of anaesthesia-related devices.
While most resources mention instruments very little, this one has thorough explanations with a clinical perspective.
A necessity for exam prep as well as everyday knowledge.
7. DNB Master Solutions in Anesthesiology (2021-19) with Recent Advances Vol. 2
Why This Book Is a Must For DNB/MD Students?
Supplements Volume 1, covers DNB last year’s paper from 2019 to 2022, with detailed explanations.
Emerging trends and the latest developments in anesthesiology so that students remain abreast of the times.
Fills the gap between theoretical concepts and practical application in clinical practice.
How does It compare to Other Market Resources?
In contrast to old resources that fail to account for recent developments, this book makes students aware of the most up-to-date guidelines and methods.
A worthy supplement for anyone seeking to deepen their knowledge of modern anesthesia practice.
The books are not available from bookstores or online websites. They are exclusive and are available only with a premium subscription to Conceptual Anesthesia. A combined learning package integrating structured books, expert online lectures, and interactive case discussions. This specially curated collection offers detailed insights, case-based education, and systematic approaches that are essential for anesthesia residents and practitioners.
Subscribe to Conceptual Anesthesia Now!! And get access to these precious resources and revolutionize your anesthesia residency.
Conclusion
Conceptual Anesthesia books revolutionize learning anesthesiology by providing well-organized, exam-focused, and clinically applicable content. Contrary to textbooks that are vague, unstructured, or irrelevant to practice, Conceptual Anesthesia books deliver an effortless and effective learning process.
Whether you’re studying for theory, practicals, or super speciality entrance exams, Conceptual Anesthesia books will grant you an unparalleled edge. Spend in the finest study aids and start heading down the success road with Conceptual Anesthesia books!
The decision between DNB (Diplomate of National Board) and MD (Doctor of Medicine) for a career in Anesthesia usually pops into the mind of many medical aspirants. Both provide highly excellent career prospects, however, with different advantages and challenges. In this blog, we will try to compare both of them and help you make an informed choice.
Understanding DNB and MD in Anesthesia
MD in Anesthesia
MD in Anesthesia is a postgraduate degree offered by medical colleges associated with universities and is regulated by the Medical Council of India (MCI) (now under the National Medical Commission – NMC). Admission to MD programs is through the NEET PG examination.
DNB in Anesthesia
The DNB examination is conducted by the National Board of Examinations (NBE). DNB courses are available in accredited hospitals all over India, and admission is also based on the NEET PG examination.
Differences Between DNB and MD in Anesthesia
1. Training and Exposure
MD Residency: Training is conducted in medical colleges with a structured academic curriculum, regular case discussions, and a strong focus on theoretical knowledge.
DNB Residency: The practice is done in private hospitals and some government institutions. The hands-on clinical exposures may be highly rewarding, but formal academics may not always receive a top priority.
2. Examination Structure
MD Exam Preparation: The MD exam is conducted by the university and includes internal assessments, theory papers, and practicals.
DNB Exam Preparation: The DNB examination is considered more challenging as it has a national-level standardized exam, with stringent practicals and evaluations.
3. Recognition and Job Opportunities
MD in Anesthesia is widely recognized in both government and private hospitals, making it easier to secure academic positions.
DNB in Anesthesia is equally valued, but some hospitals and state governments may prefer MD candidates for academic roles.
TheMS residency is not relevant to Anesthesia because it is a non-surgical speciality.
4. Private Practice and Academics
MDs are likely to get more opportunities for teaching jobs in medical colleges.
DNBs require extra effort to settle down in academia, but they can shine well in private and corporate hospitals.
How Conceptual Anesthesia Can Help in Anesthesia Residency?
Conceptual Anesthesia offers structured resources and expert-led sessions for aspiring anesthesiologists. With our Premium Membership, you get unlimited access to the following:
Clinical Examination and Demonstration
Theory Notes & Discussions
DNB OSCE Sessions
Conceptual Anesthesia Books (Hardcopy)
Live Sessions by Legendary Faculties on Important & Rare Cases
Solved Question Papers
Live MCQ Discussions for SS Exams
Question Bank to practice MCQs for SS Exams
Pearls to Revise Important & High Yield Points
… and many more worthy resources to facilitate your preparation and clinical skills.
Which One Do You Choose?
Your choice must be guided by your career expectations:
If you want a well-structured academic environment and find it easier to get into teaching positions, the MD is more suitable.
If you want immense clinical exposure and are okay with self-learning, DNB will be the most suitable for you.
No matter what the way is, preparation for DNB exams, MD exams, and NEET PG is a must to get admission in a reputed institution.
Conclusion
Both DNB and MD in Anesthesia provide excellent career opportunities. Although MD has a traditional edge in academics, DNB provides solid clinical training. As regulations are changing, DNB is now widely accepted and recognized. Your focus should be on choosing a good institute, working hard, and ensuring quality MD residency or DNB residency training for a successful career in Anesthesia.
If you’re preparing for NEET PG, DNB examination, or MS exam preparation, stay dedicated and choose the path that aligns with your career goals!
Anesthesia residency is an exciting journey that demands adaptability, continuous learning, and a commitment to excellence. Each year of residency offers unique challenges and opportunities. Here’s a structured guide to navigating the do’s and don’ts for your first, second, and third years of anesthesia residency, ensuring a successful and fulfilling experience.
First Year of Residency: Building a Strong Foundation
Do’s:
Prioritize Punctuality: Aim to arrive at least 15 minutes before the Operating Theatre (OT) sessions, typically starting around 8 to 8:30 AM. Early arrival allows you to prepare necessary equipment and medications, demonstrating professionalism and ensuring active participation in procedures.
Establish a Consistent Routine: Set regular wake-up times aligned with your responsibilities. Allocate specific periods for study, recreation, and rest to maintain a healthy work-life balance.
Engage in Continuous Learning: Utilize educational resources like the Conceptual Anesthesiaapp, which offers over 400 recorded lectures covering essential anesthesia topics. Participate actively in live sessions and practical demonstrations to reinforce your knowledge.
Master the Basics: Familiarize yourself with the dosages of commonly used drugs and the necessary equipment for various procedures. This foundational knowledge builds confidence and competence in clinical settings.
Show Honesty and Responsible Behavior: A diligent and proactive student creates an excellent impression with consultants and seniors, which, in turn, fetches greater responsibilities and learning experiences for the next years.
Don’ts:
Do not Neglect Self-Developing Projects: Don’t skip meals or compromise on rest. Keep healthy snacks at hand for crucial changes in schedules and understand that work hours would vary, adaptability is the key.
Overlook early thesis planning. You should agree on a topic for your thesis with your guide by the end of your first year, formulate the protocol, and apply for ethics clearance. This will allow you to begin collecting data during your second year.
Second Year of Residency: Expanding Competence and Responsibility
Do’s:
Deepen Your Knowledge: Start reading about essential topics from available material such as “Morgan and Mikhail’s Clinical Anesthesiology.” Progress to heavier texts such as “Miller’s Anesthesia” only when the prior knowledge is consolidated.
Take on More Responsibilities: Consultants may delegate independence in managing cases. Accept the challenges to broaden your decision-making capabilities and clinical competencies.
Balance Work and Study: Even in relatively easy periods, keep doing academic work like reading articles, making notes, and preparing for exams.
Innovative Practices: Look for new techniques or procedures being implemented in your institution. Team up with consultants who are interested in new methods, and volunteer to help after proper preparation.
Don’ts:
Avoid Taking Responsibility in the OT: Senior anesthesiologists appreciate when junior residents demonstrate responsibility, allowing seniors to take short breaks. Always ensure a responsible individual is present in the OT before considering stepping out. Stay attentive: avoid using mobile phones and monitor the patient vigilantly.
Building a Supportive Study Group: Get a few study buddies to work through cases and share your notes with one another. This group can make studying and even residency life easier.
Third Year of Residency: Preparing for Independent Practice
Do’s
Define Your Career Path: Based on the intent after completion of residency, identify which examination is necessary and which procedures need to be followed in each case.
Refine Clinical Skills: Continue refining your clinical skills, preparing yourself for independent practice.
Build a Professional Network: Connect with peers, mentors, and senior anesthesiologists. Networking can lead to job opportunities and mentorship even after your training
Review Certification Requirements: Ensure you’ve met all the requirements for board certification or licensure in your region.
Dont’s:
Ignore Revision Preparation: Take the first two and a half years to consolidate your knowledge. In the last three months, revised intensively from consistent sources.
Neglect Professional Conduct: Maintain amicable relations with colleagues; do not argue over duties or procedures. Respect authority figures, as they are involved in your training and assessment.
Ignore Personal Well-being: Refrain from practising unhealthy habits like smoking, excessive alcohol, or drug use. Take care of your health to support a lengthy and productive career.
Neglect Commitment to Responsibilities: Report to all tasks; do not take undue absence which puts a responsibility on colleagues and hampers your professionalism.
Conclusion:
Embarking on an anesthesia residency is a transformative journey that demands adaptability, continuous learning, and a commitment to excellence. By adhering to the outlined do’s and don’ts throughout each year of your residency, you’ll be well-prepared to transition into a competent and confident anesthesiologist, ready to make meaningful contributions to patient care and the medical community.
Remember, the habits and knowledge you cultivate during this period will serve as the foundation for your future practice. Embrace each challenge as a learning opportunity, and remain steadfast in your dedication to both personal and professional growth.
In the medical field, anesthesia is a very specialized and fulfilling job path. Anesthesia residents are extremely important to guarantee the patient’s safety and comfort throughout surgeries and other medical procedures.
Here in this blog, you will see how to become the bestanesthesia resident, the necessary courses, job profiles, salary expectations, and opportunities in the field:
Who is an Anesthesiologist?
Anesthesia resident who focuses on controlling the patient’s vital signs and delivering anesthesia during and after surgical procedures is an anesthesia resident. They ensure the effectiveness of pain management and give patients critical care both during and after procedures.
How to be the best Anesthesia Resident?
Education path
Pursue MBBS degree
Complete your MBBS program within 5 years with the internship.
Clear PG Entrance Exam
Enroll in a reputable medical college by passing competitive entrance exams such as NEET-PG in India.
Postgraduate Specialization in Anesthesia
Pursue the MD or Diploma in Anesthesiology after completing your MBBS by completing the postgraduate entrance exams, NEET-PG in India.
Alternatively, you may choose to pursue a DNB course in Anesthesiology.
Licensing
Obtain a license to practice from the medical council in your country.
Courses for Anesthesia
MD (Anesthesiology): It is a 3-year master’s degree that focuses on anesthesia practices.
Diploma in Anesthesiology: shorter duration compared to an MD, typically 2 years.
DNB (Anesthesiology): It is a 3-year course and it is equivalent to MD.
Job Profiles in Anesthesia
Clinical Roles
Anesthesiologist
Administer anesthesia, monitor vital signs, and oversee patient recovery after surgery.
Intensive Care Expert
Work in ICUs to manage critically ill patients.
Pediatric/Obstetric Anesthesiologist
Specialize in anesthesia for pediatric patients or women during childbirth.
Academic Roles
Teaching and research roles in medical colleges and universities.
Non-Medical Roles
You can work in medical consulting, healthcare administration, or pharmaceutical work.
Salary of an Anesthesiologist
Private sector positions typically offer higher salaries than government roles.
The salary of an anesthesiologist may depend on location, experience, specialization, and type of healthcare institution.
In India: Experienced anesthesiologists earn between₹8–20 LPA and fresh graduates typically earn between₹5–6 LPA.
In USA: The anesthesiologist in USA gets paid somewhere around between $250,000–$400,000 per year.
Salary may be different depending upon the country.
Scope of Anesthesiologist Growing Demand
Increased surgical procedures and advancements in medical technology are driving the global demand for anesthesiologists. Wide Opportunities
Anesthesia residents are in high demand, and they can also expect to earn high salaries in countries like the USA, Canada, Australia, and the Middle East. Subspecialization
Emerging fields such as pain medicine, neuro-anesthesia, and regional anesthesia present significant opportunities for growth. Research and Development
You can grab opportunities in clinical trials, drug development, and academic research.
Skills to Pursue a Career in Anesthesiology 1)Robust understanding of pharmacology and physiology. 2)Capacity to maintain composure under pressure. 3)Meticulousness and focus on detail. 4)Effective communication and collaboration skills.
What is the Function of Conceptual Anesthesiology During Your Residency?
Conceptual Anesthesia is an excellent learning platform for anesthesia residents. It inspires the anesthesia residents to concentrate on understanding the basic ideas and concepts that underlie anesthesia practice rather than just learning procedures and protocols. For anesthesia residents, this approach is highly advantageous as it improves their capacity for critical thinking and adaptability to complex clinical situations and ultimately leads to better patient care.
Conclusion
It demands a stable base within the scientific subjects, years of precise schooling, and a committed dedication to affected person protection and care. The anesthesia residents develop with surgical techniques, essential care, and ache control.
Aspiring anesthesiologists have to be equipped for a lengthy yet gratifying career, beginning with an MBBS degree and advancing through postgraduate specialization and, optionally, subspecialty training. This career presents diverse opportunities in clinical practice, academia, research, and healthcare management.
The subject’s competitive salary, high job satisfaction, and innovation potential make it an excellent choice for those passionate about medicine and technology. As the need for personalized and specialized patient care grows, the scope for anesthesiologists is anticipated to expand significantly in the future.
To sum it up, you can take help from conceptual anesthesia to become an anesthesiologist, which merges the challenge of mastering critical medical skills with the reward of making a significant difference in patients’ lives.
So this is one of the very basic topics which each one of you would get either in a viva or in the basic science of anesthesiology as a long note or to describe any of the circuits which I’m going to discuss today and on the 16th for a short note as well. In viva you can be asked about the functional analysis of every circuit that you are reading and the functions of each part or what are the specifications for each part of these anesthesia circuits can be asked in any viva question which you are going to face and it will be a lifelong lesson for every one of you to know about these anesthesia circuits.
So basically what is the anesthesia circuit it is an assembly of components which connects the patient’s airway to the anesthesia machine and it is from this the artificial atmosphere and into which the patient will breathe throughout the anesthesia that you are administering. So this breathing circuits you have to know the history of how these breathing circuits evolved before we jump into the actual breathing systems.
So somewhere it will be given as 1917 when Sir Ivan Magill devised the Magill circuit which is now present as Mapleson A circuit and somewhere in anesthesia museum, it will be given as in 1928 Sir Ivan Magill devised the Mapleson A circuit.
And in 1927 the Ralph M Walters, and Ralph Milton Walters devised this to-and-fro system of carbon dioxide canister. This has become very popular now because this canister can be autoclaved and it has a carbon dioxide absorber as well. So those patients who have got a respiratory infection such as tuberculosis they were using this machine in particular to autoclave it and then use it so that they can prevent the infection which can occur from patient to patient if they are using the anesthesia circuits.
And in 1937 Philips Ayer was the one who devised these specifications for pediatric systems as the ISTPs. Before then there were no gross circuits which were available for pediatric population. There was Mapleson A, B and C but there was no pediatric population could be served through the circuits because it would drag the endotracheal tube and lots of effort for spontaneous ventilation as well as controlled ventilation was there with all the Mapleson systems which were available back then.
And if you have to read about Ayre he is a very peculiar person who has got a cleft lip cleft palate himself and I think he got operated also. He is a very great person and he has suffered so much of personal losses yet he beautifully made these ISTPs to help people to help the pediatric population who would get anesthetized. And the revolutionary discovery was by Brain Sword with whom he devised a closed system closed circuit and this closed circuit is being modified and used nowadays with the carbon dioxide observer and this person is the person behind it.
One should not forget about the Mapleson system which was devised in 1954 William Mapleson gave actually five systems A, B, C, D and E. E’s modification became Jacksonry’s modified circuit E to make it as Jacksonry’s circuit which is F circuit. This was a milestone article which was published in the British Journal of Anesthesia. If anyone would be interested to know about how Mapleson classified all these systems we can go through this landmark article in BJA and this is another landmark article which was given by Dr. Bain and Sporell who they both devised the Bain circuit which we are using now which is again a modification of Mapleson D circuit and this circuit was long enough and this enabled the scavenging system for actively scavenging the anesthesia gases which are there in the which we are using day in and day out and William Sporell as well as Bain showed that as you can see in this picture they showed that scavenging also is possible through the suction system and they also anesthetized patients with cleft lip and cleft palate with Bain circuit and proved that without effective rebreeding patients can be anesthetized using Bain circuit which is again a modification of Mapleson D. And based on these anesthesia circuits these anesthesia circuits have a requirement which they should meet before using it up to a particular patient.
There are essential requirements and desirable requirements. The essential requirement is the one which has to be met for anaesthetizing the patient. So the primary requirement will be it should deliver the anesthetic gases as well as the fresh gas flow at the same concentration in the shortest time possible to the patient and these circuits should eliminate the carbon dioxide that the patient is producing as and when possible without a possibility of inhaling the carbon dioxide which the patient is expiring and the apparatus should have a minimal dead space apparatus dead space as possible and these systems should have a very low resistance.
So these are the essential requirements for the anesthesia breathing circuits and the desirable requirements are it should actually consume less fresh gas flow it should have conservation of heat and humidification of inspired air is one desired quality of breathing circuit and should be lightweight and inexpensive and it should be convenient for your usage like you should not hang hold the mask have a tight-fitting mask and the circuit should not drag you down or drag the endotracheal duct down because of its weight.
So it should be convenient during usage whether it is spontaneous or controlled it should be efficient for both and it can be it should be useful for both adults and paediatrics there should be an effective scavenging system like as you can attach through veins a suction cannula or a suction apparatus at the APL well to vent the anesthetic gases so that will minimize the data pollution and you should prevent the patient from barotrauma and as I said it should be inexpensive and these breathing circuits are classified as two ways one is drips and another is the convoy and the convoy is a modified convoy so drips modified I mean devised these breathing systems based on the volume of the reservoir and the amount of rebreathing that is allowed within the circuit. So this system is not used nowadays because of the obvious disadvantages where he classified the systems into open semi-open, semi-closed and closed so in the open system there is no reservoir and no rebreathing in a semi-open there is a good reservoir but there is no rebreathing and in an an semi-closed there is a good reservoir and a partial rebreathing and in closed there is a reservoir and there is a complete rebreathing.
So what are the examples of these are drips gave it as the open method is open circuit is the one which is the ether by ether drop method which is a Schimelbusch method but do we really see a circuit in Schimmelbusch mask no it is just the mask which is held and a cloth which is put and then the ether is given as an open drop method there is no circuit which is involved in a Schimelbusch mask so this is again the first thing itself became an absolute one. He classified say Mapleson A to E as semi-open but some of them came with the notion that how can it be a open system when the APL valve is partially closed and you are allowing a partial rebreathing so and that again led to a controversy and there is another system called as a semi-closed system so what drips did was he said partial open APL valve in a closed circuit or in a complete circle system is a semi-open semi-closed circuit and a completely closed APL valve belongs to a closed circuit is what drips told so the obvious disadvantages are the Mapleson system itself can act as a semi-closed one as well as semi-open one and there is no clear cut data which says this system belongs to this and there is no circuit which is involved in the open drop method so then came the modified convoy there are so many methods of classifying so these two will be enough for us to know and modified convoy is the one where he classified the breathing systems into two without carbon dioxide absorption and with carbon dioxide absorption so based on the flow if there are any flow control valves or unidirectional flow is aided by a valve whether it be a Ruben valve or an unidirectional flow valve so if there is an unidirectional flow valve then it is an unidirectional system if there are no valves and the fresh gas flow as well as is flowing bidirectionally then it becomes a bidirectional flow so with carbon dioxide absorption the unidirectional system is the circle system and the bidirectional flow system is the waters to and fro canister and in breathing systems without carbon dioxide absorption the unidirectional flow is the non-repeating system and in bidirectional flow we have got the maplesons a b c lag system and the miller circuit and the humphreys ade system so this is the bidirectional flow.
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As Anesthesia residency comes to an end, residents struggle with the thought of what is next now. As you stand at this crossroads in your career, you need to carefully make up your mind. There are two alternative paths a fellowship or scholarship. These both have their respective boons, so you should choose carefully.
Let’s take a look at each to make a better decision.
Pursuing a Fellowship
Fellowship Provides very specialized training in certain areas of anesthesia, such as:
Pain management: Focusing itself on the diagnosis and treatment of chronic pain with nerve blocks and spinal injection tools.
Critical care medicine: This will prepare you to manage critically ill patients in an ICU setting.
Cardiac anesthesia: A subspecialty that is driven by anesthesiologists providing anesthesia for patients undergoing cardiovascular surgery.
Pediatric anesthesia: Training and specializing in providing anesthesia care to neonates, infants, and children.
Regional anesthesia and acute pain medicine: Focusing on nerve block anesthesia and managing post-surgical pain.
Benefits of a Fellowship
Career development: One becomes a subject-matter expert after finishing a fellowship, which opens opportunities in academia or leading hospitals.
A higher pay: In addition to being specialty certified, specialization also may increase looking at an increase in income.
Job satisfaction: You will more likely be excited to work in a niche area in anesthesia if it affords you the satisfaction that practices into your near and long-term goals.
Choose Fellowship If:
You have a strong interest in one subspecialty of anesthesia.
You aspire to further enhance your skills while enhancing your chances at career opportunities.
You plan to work in an academic medicine or research-oriented position.
Pursuing for Scholarship (Research and Academia)
A scholarship route focuses on academic contribution, research, and teaching in the field of anesthesia. Scholars contribute to the advancement of medical knowledge while often working in academic institutions or an R&D organization.
The benefits of a scholarship route:
Contribution to Science: Help in new and ground-breaking research, from results to publications that can shape and change the future of anesthesia.
Teaching Role: Teaching and training future generations of anesthesiologists.
Flexible Career Track: Academic positions typically maintain a more reasonable work-life structure than clinical positions.
Consider a Scholarship If
You are passionate about research and innovation.
You enjoy teaching and contributing to academic development.
You want to become involved in global health initiatives or policymaking.
How to Decide Between a Fellowship and Scholarship?
The choice of paths ultimately depends on your priorities and long-term goals. Below are a few pointers for consideration:
Passion and Interest: Think about what exactly you are interested in. Are you interested in a certain clinical field or more geared towards research and teaching?
Finances: Fellowship training might pay a higher diagnostic salary, whereas in a scholarship, there might be a somewhat more stable income by being engaged in academic activities.
Work-Life Balance: Academic roles would often come with greater structure in terms of working hours, while fellowship-trained specialists tend to have lifestyles with on-call duties that are often heavy going.
Mentoring and Mentorship: Ask for advice from mentors and colleagues who have taken one of these paths.
Job Market: Research the demand for either subspecialists or academic positions in your area or area of interest.
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This is how Conceptual Anesthesia would fit you better through your residency:
1. Clinical Examination and Demonstration
Mastering clinical skills is vital for everyanesthesia resident. Conceptual Anesthesia provides detailed clinical examination guides and demonstrations to help you excel in practical scenarios. These sessions prepare you for real-world challenges faced by anesthesia residents.
2. Notes and Discussion on Theory
Conceptual Anesthesia is well crafted by expert faculty. These resources target the anesthesia residency programs and make even the most difficult concepts smoothly assimilate.
3. DNB OSCE Classes
If you’re preparing for DNB exams, our OSCE sessions are a game-changer. Designed by experts, these sessions provide practical insights and tips to excel in objective structured clinical examinations, a crucial component of top anesthesiology residency programs.
4. Conceptual Anesthesia Books-Hard Copy
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You will learn from the legends of anesthesiology! Our live sessions cover important and rare cases, giving you an edge in understanding these pivotal cases in any discussions occurring in anesthesia residency programs.
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Ace your residency exams with the help of solved question papers and an exhaustive question bank for SS exams. These resources are perfect for anesthesia residents aiming for top scores in competitive exams.
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MCQ discussion engages you in a very interactive way, sharpens your mind, and pinpoints weak areas. Sessions are held specifically to the needs of anesthesia residency programs for effective medical practice in preparation for SS exams.
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Conclusion:
Conceptual Anesthesia bridges the gap between learning and practice, making it the perfect partner for every anesthesia resident aiming to excel in their field.
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Okay, good evening everybody. We will be having a case discussion today on anesthesia management in a pregnant patient with mitral stenosis who’s posted for cesarean section. So Dr. Vignesh will be presenting the case and then we will be discussing, so for the initial 15 to 20 minutes we will be talking on the pathophysiology of MS and basically the medicine part and the remaining 15-20 minutes we’ll talk about the anesthesia management.
So I think we can start. Okay, Dr. Vignesh you can start the case. Yes ma’am.
So my patient like Mrs. Swati, 33 year old female. Vignesh you can switch on your video. Okay ma’am.
Vignesh. Yes, now you can start. So my patient, slides are not moving.
My patient, 33 year old female with education qualification till 12th standard, like a resident of Jahangir, Puri. She is a gravida 3, para 2, live 1, abortion 1, currently with 9 months of amenorrhea, that is 36 weeks plus 5 days, weeks of gestation and with complaints of licking for the past 2 hours and has been admitted for safe confinement. And she had presented 4 months ago with the complaints of breathing and cough for 1 week.
And her current pregnancy was a spontaneous conception and booked at nearby PHC and there was no excessive vomiting, no bleeding TB, no burning maturation and no fever with rash. And she felt quickening at 18 weeks and she is able to do all her daily activities and no issue of any headache, blurring of vision and abdominal pain and she pursues normal fetal movements. And 4 months ago she developed breathlessness over 1 week which was insidious and onset and gradually progressive in nature and initially she had breathlessness only during exertion that is during climbing stairs and during strenuous activities and later it got progressing to even at rest she was having breathlessness.
And breathlessness got aggravated while lying down and got relieved in sitting position. And she also had a cough for 1 week that time and not associated with any fever or sputum production and it got aggravated while lying down and relieved by sitting position. That time she had a history of breathlessness on lying down flat so she used 2 pillows while lying down and there was a history of swelling of both the lower limbs and extending up to the ankles which was relieved by rest, which was reduced by rest.
And no issue of any chest pain, palpitations, loss of consciousness at that time and no issue of abdominal pain or loss of appetite and no issue of cough or blood in sputum and no issue of bluish discoloration of fingers or toes and no issue of any frequent hospitalization for respiratory illnesses. And coming to the presenting illness, she was evaluated, that time she was evaluated in the cardiology, diagnosed to have a severe heart disease at that time and she underwent a procedure in the cath lab. Her symptoms resolved over a period of 2 days and there was no issue of any ICU stay or mechanical ventilation and she got discharged after 2 days.
And in the past, like 7 years before also, she had a similar episode, like that time she had palpitations and syncope and was taken to emergency and that time itself she was diagnosed with a heart disease and she underwent a procedure in the cath lab following which her symptoms got resolved over 3 days and that time also she was not admitted on any ICU and no issue of any mechanical ventilation and she was prescribed cardiac medications and injections once every 3 weeks that time itself. And she doesn’t have any other co-morbidities and no issue of any fever or joint pain or swelling in the childhood and no issue of any recurrent sore throat in the childhood. And past surgical history, there is no issue of any major surgeries in the past and post-op static history, she had a normal regenerative delivery 5 years ago and no issue of any symptoms suggestive of cardiac illnesses during that pregnancy and the issue of spontaneous abortion in first trimester 3 years ago.
And coming to treatment history, currently the patient is on Metaprolol 25mg OD and Torzimide 10mg OD and she is on Acitrom 2mg OD and it was stopped. She got admitted for a safe confinement one week before in ward. So, the Acitrom was stopped 4 days before and she was switched to injection low molecular weight heparin 40mg subcutaneous PD and she is taking tablet Ecosprin 75mg and injection penicillin 1.2 million units once in every 3 weeks and there is no known drug allergy.
And menstrual history, she had menarche at 12 years and she was having regular cycles and the LMB was at 12-12-20-23 and personal history, she was housewife, studied till 12th standard and no issue of any addictions, consumes mixed diet and has normal bowel and bladder habits and no issue of any heart diseases in the rest of the family members. So, my professional diagnosis is Gravida 3 Para 2, live one, abortion one, pregnant lady at 36 plus 5, 36 weeks plus 5 days of gestation. A known case of Rheumatic Valvular Disease with no signs of heart to heart failure has been admitted for a safe confinement.
Okay, so far from the history, what are your positive findings? Ma’am, she is a known case of rheumatic heart disease and had an episode of breathlessness and cough that time and she underwent a balloon valve mitral valve autoimmune and currently she is not having any cardiac symptoms and has been admitted for safe confinement. Okay, consider that this patient does not have any history papers, she does not have any papers related to her previous admission and she is not that educated and she cannot actually tell you that what procedure she underwent. So, let’s forget for a moment that she has rheumatic heart disease, she is a known case.
So, just based on the history, what do you think that what are her positive symptoms? Ma’am, cough with breathlessness, breathlessness, it is due to exertion the patient had, ma’am. She also has cough, right? Yes, ma’am. So, based on only these two symptoms, breathlessness and cough, it could be either a cardiac or a respiratory cause.
We do not know what it is. Anything specific that is pointing towards cardiac in this positive history of this patient? This patient also had, it was not associated with any sputum production or any other this thing, ma’am. Yeah, okay.
So, Vignesh, my question was that is there any positive history in this patient which is pointing towards the diagnosis of a cardiac disease? A patient doesn’t have any other sputum production or any other thing, so which might be a fever with sputum production which suggests pneumonia or any other respiratory cause? And the patient had a history of lower limb swelling, ma’am? No, the lower limb swelling can be a sign of pregnancy also, right? So, the most important finding in this patient which points towards cardiac is orthopnea. Yeah, orthopnea and PND. Right, right.
Yeah, yeah, yeah. So, it’s okay. So, orthopnea, can you tell me why it happens? Ma’am, orthopnea, basically it happens like all these, like, if one wants, like orthopnea is basically the patient develops breathlessness while lying supine and it is because of increased venous return, like leading to pulmonary congestion.
The pulmonary vasculature is already non-compliant because of chronic increased pulmonary blood flow or increased pulmonary venous congestion. So, like, these patients develop this thing. Right, right.
So, it could be mainly because of, probably because of LV failure, something which has caused an increase in the LV pressures leading to the transmission of the, increased backward transmission of the pressures to the left atrium and then finally to the pulmonary vasculature leading to orthopnea. So, orthopnea is a very, it’s a positive factor in this patient. What about PND? This patient doesn’t have PND, but what do you mean by PND? Ma’am, PND usually, it happens in the night, like when the patient lies, when the patient goes for sleep, like the patient will be sleeping.
It can happen in the daytime also, it depends upon, yeah, yeah, yeah, right. Okay, ma’am. So, like, when the patient lies, when the patient sleeps for, like, two to three hours, like the sympathetic discharge will be reduced and then, like, again, like increased venous return will also be there.
