Tag Archives: anesthesia mnemonics

A TRAVELOGUE: The long journey of Insulin

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Insulin is produced by beta cells of islets of Langerhans.

It is produced from the pro hormone, ‘preproinsulin’ in endoplasmic reticulum. A portion of the structure is cleaved off and the remaining portion is folded with the help of C-peptide to form ‘proinsulin’

The C-peptide portion is then removed to form Insulin

This active Insulin is transported via Golgi apparatus to cytoplasmic granules for exocytosis into plasma

Insulin then binds with its receptor on Insulin sensitive cells

Insulin receptor is a tetramer consisting of 2 alpha & 2 beta units.

Insulin binds to the alpha unit on the cell membrane, while the beta unit, which spans the cell membrane activates tyrosine kinase and the second messenger system

This activates cytoplasmic vesicles containing transport molecules

The vesicles fuse with the cell membrane to incorporate the transport molecules into the cell membrane, which facilitate the transport of glucose into the cell.

MNEMO> MECHANISM OF ACTION: INSULIN Vs GLUCAGON

Insulin binding to the receptor activates an intracellular second-messenger system via tyrosine kinase.
Glucagon binding to its receptor activates a G-protein second-messenger system via adenylyl cyclase.

“Insulin is TricKy”
“Glucagon is ACcurate”

HOW Hb S BECOMES A VILLAIN IN SICKLE CELL DISEASE (SCD) ?

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Inherited as Autosomal Recessive disease (MNEMO> Sickle Cell Disease causes Recession of RBC function)

A single DNA base change ( Beta chain) causes SCD

DNA base change is Adenine for Thymine & the resultant amino acid change is Valine for Glutamic Acid ( MNEMO> Adenine Added; Valine got a Welcome; Glutamine has to Go )

Thus Hb S is produced. As Valine is hydrophobic, the deoxygenated Hb is less water soluble and gets precipitated & polymerized inside the RBC

This polymerization slightly reduces the overall affinity for O2; otherwise the affinity for O2 is same for Hb A and Hb S

These changes also make the RBCs more rigid and contributes to sickling and microvascular occlusion

Regarding hypoxaemia, HbS will precipitate at a PO2 of 5–6 kPa (37-45 mm of Hg). As venous PO2 lies in this range, in case of homozygous individuals having only abnormal Hb will have continuous sickling

Patients with sickle cell trait experience sickling at much lower partial pressures (2.5–4 kPa / 19-30 mm of Hg )

Sickledex test produces a turbidity and becomes positive even with a very small amount of Hb S: so it CAN NOT differentiate between homo & heterozygous states

Reference: Smith T, Pinnock C, Lin T. Fundamentals of Anaesthesia, 3rd edn. Cambridge: Cambridge University Press, 2009; pp. 234–5

Anesthesia Implications in ACHALASIA CARDIA

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MNEMO> First 4 letters of ACHAsia.

A. Acute upper airway obstruction secondary to tracheal compression (by the dilated segment ) can be managed by Sublingual glyceryl nitrate,Passage of a naso-oesophageal tube,Transcutaneous needle puncture,Tracheal intubation etc

C Care against aspiration: The dilated oesophagus must be emptied and decompressed (needs a period of prolonged starvation) Rapid sequence induction ,Tracheal tube removal is performed in the awake patient, Patient should be nursed in the lateral position during recovery.

H History: Respiratory complications, which may be attributed to asthma or chronic bronchitis, are secondary to overspill of undigested material

A Acute problems that can be caused by the dilated segment : Acute thoracic inlet obstruction , difficulty in passing the tracheal tube past the dilated oesophagus, Upper airway obstruction , progressive dilatation of the upper oesophagus may occur in association with air swallowing or IPPV

MNEMO> PENTAZOCINE “HOT DRUG”

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H.Hallucination­ and psychotomimetic­ effects

O.Overt seizures rarely, with iv route

T.Typical Opioid side effects

D.Dose: 0.5 mg/kg i.v. or 30 mg i.v. Q4H. 30 mg iv= 10 mg morphine

R. Respiratory depression, Raised Pulmonary pressures (Pulmo­nary HTN), Raised BP, Raised ICP, Rare disease:Porphyri­a ….are CONTRAINDICATIO­NS

U. Upward CVP, LVEDP,PULMONARY­ PRESSURES

G.Give LESSER doses more FREQUENTLY to reduce side effects

#pharmacology , #opoid ,#pentazocine , #MuscleRelaxants , #mnemonic, #MedicalMnemonics ,#anaesthesia

MNEMO🤓 (anaesthesia implications)>Systemic Lupus Erythematosus

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” SLE – CARD”

1.Cardiac and Renal involvement🔻
2.Anemia🔻
3.Raynaud’s phenomenon: So avoid hypothermia🔻
4.Determine clotting status🔻

🤓Hint Question: “Have you brought your SLE CARD for surgery?”

#SLE, #MedicalMnemonics ,#lupus ,#anaesthesia