Doc - Academia

21/07/2026

🩺 Regional Anaesthesia Challenge of the Week
🎯 What would be your block of choice?

A 68-year-old obese patient is scheduled for shoulder/proximal humerus surgery.

📋 Medical history:

✅ COPD
✅ Severe obesity
✅ Obstructive sleep apnoea (OSA)
✅ Pre-existing hemidiaphragmatic paralysis
✅ Poor respiratory reserve

🚫 Goal: Provide excellent surgical anaesthesia and postoperative analgesia while avoiding phrenic nerve palsy and respiratory deterioration.

❓Which regional anaesthesia technique would you choose?

👍 A. Interscalene block (ISB)
👍 B. Superior Trunk Block (STB)
👍 C. Combined Suprascapular + Axillary Nerve Block (Shoulder Block)
👍 D. Costoclavicular Block
👍 E. ESP Block
👍 F. High Thoracic Paravertebral Block
👍 G. Other (please specify)

💬 Tell us your preferred technique and explain your rationale.

27/04/2026

Pathophysiology of Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic, progressive, autoimmune, and inflammatory disease of the Central Nervous System (CNS), which encompasses the brain and the spinal cord. It does not affect the peripheral nervous system.

The Demyelinating Process: The primary target of the disease is the myelin sheath—the protective, fatty insulating layer that surrounds nerve fibers (axons) and is produced by oligodendrocytes in the CNS.
• In a healthy nervous system, myelin allows for the rapid, efficient transmission of electrical impulses via "saltatory conduction" (where the signal jumps between the Nodes of Ranvier).
• In MS, autoreactive T-cells and B-cells cross the blood-brain barrier and mount an inflammatory attack against the myelin sheaths and the oligodendrocytes.
• This destruction of myelin (demyelination) strips the axons of their insulation, causing electrical signals to slow down significantly, leak out, or be blocked entirely.

Plaque Formation and Progression: As the body attempts to repair the damage, astrocytes proliferate to form scar tissue (gliosis) over the demyelinated areas. These hardened scars are known as plaques or scleroses, giving the disease its name. Over time, the underlying axons themselves become damaged and sever, leading to irreversible neurological deficits.

From regional anaesthesia perspective, there are strict considerations.

26/04/2026

Anaesthetic drug interaction in Parkinson's disease:

Both anesthetics and carbidopa/levodopa heavily influence vascular tone.

The Interaction: General anesthetics (propofol, volatile gases like sevoflurane) predictably cause vasodilation and cardiac depression. Levodopa therapy can cause central depletion of norepinephrine and autonomic dysfunction, frequently leading to profound orthostatic hypotension and reduced vascular resistance.

Clinical Consequence: The combination can lead to severe intraoperative hypotension. Mean arterial pressures (MAP) can rapidly drop to dangerous levels.

Anaesthesiologists must be prepared to support blood pressure with direct-acting vasopressors (like phenylephrine) rather than indirect-acting ones (like ephedrine), as catecholamine stores may be depleted in PD patients.

26/04/2026

Laparoscopic surgery has become a standard of care, but it presents unique physiological challenges for high-risk patients. In this episode, our panel of experts discusses the critical effects of pneumoperitoneum on the cardiovascular, neurological, and respiratory systems, incorporating the latest clinical guidelines (2024–2026).

Key Discussion Topics:
✅ Hemodynamic stability in cardiac patients
✅ Managing Intracranial Pressure (ICP) and Cerebral Perfusion
✅ Anesthesia for Geriatric and Frail patients
✅ Lung Protective Ventilation strategies
✅ Managing Myasthenia Gravis and COPD in Laparoscopy

Laparoscopic Surgery in High-Risk Patients: Cardiovascular, Neurological, and Respiratory Management

23/04/2026

part 1 tips:

Preoperative assessment specific to Neuromuscular Disease for Laparoscopy

→ FVC and maximal inspiratory pressure (MIP) are the critical respiratory parameters. �

→ If FVC < 50% predicted, plan for postoperative NIV/CPAP. �

→ If FVC < 30% or MIP < 30 cmH₂O, the patient is at very high risk of postoperative respiratory failure and may require ICU admission. �

→ Echocardiography is mandatory in Duchenne (100% prevalence of dilated cardiomyopathy by age 18) and Becker (70% by age 40). �

→ Scoliosis affects positioning and may worsen the restrictive ventilatory pattern — discuss positioning with the surgical team preoperatively.

14/04/2026

https://youtu.be/1KNeUgt75b8

FCPS part 2 clinical discussion

Timeline[00:00] Introduction and Podcast Overview[02:41] Exam Strategies: How to Structure High-Scoring Answers[06:49] Preparation Timeline: How Long Does It...

26/02/2026

Rising or Narrowing of Pulse Pressure....
What Pulse Pressure Reveals About the Heart?

25/02/2026

Not All Sympathomimetics Are Equal — They Shape Pulse Pressure Differently!

11/02/2026

Mastering Cyanide Poisoning: High-Yield Review for EDAIC & FCPS Part 1

Welcome to Doc Academia!

Cyanide poisoning is a critical, "must-know" topic for any anaesthesia trainee. Whether you are appearing for the EDAIC Part 1 or FCPS Part 1 exams, understanding the cellular mechanism of histotoxic hypoxia and the specific antidote protocols is essential for success.

In this comprehensive lesson, we break down the complex pathophysiology of cyanide poisoning into easy-to-digest concepts, focusing on exactly what you need to know for the exam and clinical practice.

📌 What you will learn in this video:

→ The Cellular Mechanism: How cyanide inhibits Cytochrome c Oxidase and halts ATP production.
→ Clinical Recognition: Identifying the "Bitter Almond" odor and the "Cherry-Red" skin paradox.
→ Etiology: Why Sodium Nitroprusside infusion and smoke inhalation are high-risk scenarios.
→ Management Protocols: A step-by-step guide to resuscitation and provider safety.
→ Antidote Pharmacology: In-depth review of Hydroxocobalamin, Sodium Thiosulfate, and the "decoy" strategy of Nitrites.

🧨 Exam Tips Included:

→ Why pulse oximetry can be deceptively normal.
→ The dangers of using Nitrites in fire victims.
→ Metabolic markers (Lactate trends) to watch for.

Don't forget to like, subscribe, and hit the notification bell to stay updated with more high-yield medical education content designed for anaesthesia residents and specialists.