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Combined Spinal Epidural Anesthesia By Capt Bilal Baig Graded Anesthetist Supervised by Col Manzoor Ahmed Faridi Classified Anesthetist
CASE REPORT ,[object Object],[object Object],[object Object],[object Object]
Presenting complaints ,[object Object]
Past history ,[object Object],[object Object]
[object Object],[object Object],[object Object]
Obstetrical history ,[object Object],[object Object],[object Object],[object Object]
Genral Physical Examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Pre-Anesthesia Assesment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-Anesthesia Assesment(contd) ,[object Object],[object Object],[object Object],[object Object]
Anesthetic management  ,[object Object],[object Object],[object Object]
Anesthetic management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anesthetic management ,[object Object],[object Object]
Anesthetic management
Anesthetic management ,[object Object],[object Object]
Anesthetic management ,[object Object],[object Object]
Anesthetic management ,[object Object]
Anesthetic management ,[object Object]
Anesthetic management ,[object Object],[object Object]
Anesthetic management ,[object Object],[object Object],[object Object],[object Object]
Anesthetic management ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
DISCUSSION
Background  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy of CSE
Anatomy ,[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiology of Regional Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Organ system effects of regional anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Organ system effects of regional anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Organ system effects of regional anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Organ system effects of regional anesthesia ,[object Object],[object Object],[object Object]
Organ system effects of regional anesthesia ,[object Object],[object Object]
Advantages of regional anesthesia over general anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Advantages of epidural over spinal ,[object Object],[object Object],[object Object],[object Object]
Disadvantages of epidural compared to spinal ,[object Object],[object Object],[object Object]
The twin theory  ,[object Object],[object Object],[object Object],[object Object]
Advantages of CSEA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Techniques  ,[object Object]
Techniques (cont) ,[object Object],[object Object]
Techniques (cont) ,[object Object],[object Object]
Techniques (cont) ,[object Object]
Technique (cont) ,[object Object],[object Object],[object Object],[object Object]
Indications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-requisites ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contraindications  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Problems  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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