Anesthesia

                                                          ANESTHESIA

Anesthesia, or anaesthesia (from Greek ἀν-, an-, "without"; and αἴσθησις, aisthēsis, "sensation", see spelling differences) is a temporary state consisting of unconsciousness, loss of memory, lack of pain, and muscle relaxation.

Anesthesia is a unique medical intervention which does not itself offer any particular medical benefit and instead enables the performance of other medical interventions. The best anesthetic is therefore one with the lowest risk to the patient that still achieves the end points required to complete the other intervention. There are many different needs and goals of anesthesia. The goals (end points) are traditionally described as unconsciousness and amnesia, analgesia, and muscle relaxation. To reach multiple end points one or more drugs are commonly used (such as general anesthetics, hypnotics, sedatives,paralytics, narcotics, and analgesics), each of which serves a specific purpose in creating a safe anesthetic.

The types of anesthesia are broadly classified into general anesthesia, sedation and regional anesthesia. General anesthesia refers to the suppression of activity in the central nervous system, resulting in unconsciousness and total lack of sensation. Sedation (or dissociative anesthesia) uses agents that inhibit transmission of nerve impulses between higher and lower centers of the brain inhibiting anxiety and the creation of long-term memories. Regional anesthesia renders a larger area of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord. It is divided into peripheral and central blockades. Peripheral blockade inhibits sensory perception within a specific location on the body, such as when a tooth is "numbed" or when a nerve block is given to stop sensation from an entire limb. Central blockades place the local anesthetic around the spinal cord (such as with spinal and epidural anesthesia) removing sensation to any area below the level of the block.

There are both major and minor risks of anesthesia. Examples of major risks include death, heart attack and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and readmission to hospital. The likelihood of a complication occurring is proportional to the relative risk of a variety of factors related to the patient's health, the complexity of the surgery being performed and the type of anesthetic. Of these factors, the person's health prior to surgery (stratified by the ASA physical status classification system) has the greatest bearing on the probability of a complication occurring. Patients typically wake within minutes of an anesthetic being terminated and regain their senses within hours. One exception is a condition called long-term post-operative cognitive dysfunction, characterized by persistent confusion lasting weeks or months, which is more common in those undergoing cardiac surgery and in the elderly.

The first public demonstration of general anesthesia was in 1846 by a Boston dentist named William T.G. Morton at the Massachusetts General Hospital. Dr. Morton gave an ether anesthetic for the removal of a neck tumor by surgeon John Collins Warren (the first editor of the New England Journal of Medicine and dean of Harvard Medical School). About a decade later, cocaine was introduced as the first viable local anesthetic. It wasn't until the 1930s that Dr. Harvey Cushing tied the stress response to higher mortality rates and began using local anesthetic for hernia repairs in addition to general anesthesia.

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Video source: Nucleus Media.

NEPALI TEEJ SONG: 

Teej (Nepali: तीज) is a festival celebrated in Nepal and northern India. Traditionally observed by women for the wellness of their husband, this festival these day symbolizes a forum for women's freedom of expressions.
Literally, "teej" means "third". Therefore Teej falls on the third day after the moonless night (Amavasya) and the third day after the full moon night of every month. However, the third day after the new moon or Amavasya of Shraavana (श्रावण) month is the most important Teej. As Shraavana (or Saawan) month falls during monsoon or rainy season when the surroundings become green, the Shraavana Teej is also called Hariyali Teej (Green Teej).
Teej is celebrated in Nepal It falls on the third day after the new moon of the Shraawana or Sraawan month of Hindu calendar in late July to early August. Dedicated to the Goddess Parvati, commemorating her union with Lord Shiva, the festival is celebrated for sexual bliss, well-being of spouse and children and purification of own body and soul. The festival is a three-day-long celebration that combines sumptuous feasts as well as rigid fasting.

Observance in Nepal

Nepalese Women dancing in Teej

The first day of Teej is called Dar Khane Din. On this day the women,married and unmarried, mainly Khas Gorkha of Nepalis ethnicity mainly Bahun and Chhetri cast, assemble at one place, in their finest attire and start dancing and singing devotional songs. Amidst all this, the grand feast takes place. What is unusual about this day is that the feast is hosted by gentlemen. Women, who work hard throughout the year, do not have to do anything that day. That is the day for them to embellish themselves in sorha singaar meaning dressing up and make up to the full extent, indulge in good food, and dance. Often times, because women are invited by multiple brothers for the feast, they try to dance off some food before they are ready to eat more. The food served that day is supposed to be rich and abundant. This is probably the only day in a year that allows women full freedom of expression. Consequently, women have traditionally used this occasion to express their pains and pang in the lyrics of songs they sing while dancing. With the advancement of communication and awareness, women these days use this occasion to voice their concerns about social issues and discrimination against women. The jollity often goes on till midnight, after which the 24 hour fast starts.
The second day is the fasting day. Some women live without a morsel of food and drops of water while others take liquid and fruit. The fasting is observed by both married and unmarried women. Married women abstain strictly from food and drinks with a believe that their devotion to the god will be blessed with longevity, peace and prosperity of their husband and family. Whereas, unmarried women observe the fasting with a hope of being blessed with good husband in future. On this day, they gaily dress and visit a nearby Shiva temple singing and dancing on the way. The Pashupatinath Temple gets the highest number of devotees. At the Shiva temple, women circumambulate the Shiva Lingam, which symbolizes Lord Shiva, offers the praying with flowers, sweets and coins. The main puja (religious ceremony) takes place with offerings of flowers, fruits, etc., made to Shiva and his wife goddess Parvati, beseeching them to grant their blessing upon the husband and family. The important part of the puja is the oil lamp which should be alight throughout the night. It is believed that by the lightening of oil lamp all night long will bring peace and prosperity to the husband and entire family.
The third day of the festival is Rishi Panchami. After the completion of the previous day's poooja, women pay homage to seven saints or sages and offer praying to various deities and bathe with red mud found on the roots of the sacred datiwan bush, along with its leaves. This act of purification is the final ritual of Teej, after which women are considered absolved from all their sins. The recent years have witnessed an alteration in the rituals, especially concerning the severity, but its essence remains the same.
Teej is celebrated just before the first day of Ganesh Chaturthi. Women do 24-hour nirjala fasting (without water or fruit) for the wellness of their spouse and their married life and unmarried would be praying to get a nice husband.
 
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Electrical conduction system of human heart.

  THE CARDIAC CONDUCTION OF HUMAN HEART:

The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the cardiac muscle (myocardium). The myocardium contracts after stimulation. It is the ordered stimulation of the myocardium that allows efficient contraction of the heart, thereby allowing blood to be pumped throughout the body.
Signals arising in the SA node stimulate the atria to contract and travel to the AV node. After a delay, the stimulus is conducted through the bundle of His to the Purkinje fibers and the endocardium at the apex of the heart, then finally to the ventricular epicardium.
On the microscopic level, the wave of depolarization propagates to adjacent cells via gap junctions located on the intercalated disk. The heart is a functional syncytium (not to be confused with a true "syncytium" in which all the cells are fused together, sharing the same plasma membrane as in skeletal muscle). In a functional syncytium, electrical impulses propagate freely between cells in every direction, so that the myocardium functions as a single contractile unit. This property allows rapid, synchronous depolarization of the myocardium. While advantageous under normal circumstances, this property can be detrimental, as it has potential to allow the propagation of incorrect electrical signals. These gap junctions can close to isolate damaged or dying tissue, as in a myocardial infarction.

VALVES CONTRACTING AND RELAXATION DUE TO THE ELECTRICAL CONDUCTION

VIDEO:

 

Images:

Requirements for effective pumping:

In order to maximize efficiency of contraction and cardiac output, the conduction system of the heart has:

• Substantial atrial to ventricular delay. This will allow the atria to completely empty their contents into the ventricles; simultaneous contraction would cause inefficient filling and backflow. The atria are electrically isolated from the ventricles, connected only via the AV node which briefly delays the signal.
• Coordinated contraction of ventricular cells. The ventricles must maximize systolic pressure to force blood through the circulation, so all the ventricular cells must work together.
  • Ventricular contraction begins at the apex of the heart, progressing upwards to eject blood into the great arteries. Contraction that squeezes blood towards the exit is more efficient than a simple squeeze from all directions. Although the ventricular stimulus originates from the AV node in the wall separating the atria and ventricles, the Bundle of His conducts the signal to the apex.
  • Depolarization propagates through cardiac muscle very rapidly. Cells of the ventricles contract nearly simultaneously.
  • The action potentials of cardiac muscle are unusually sustained. This prevents premature relaxation, maintaining initial contraction until the entire myocardium has had time to depolarize and contract.
• Absence of tetany. After contracting, the heart must relax to fill up again. Sustained contraction of the heart without relaxation would be fatal, and this is prevented by a temporary inactivation of certain ion channels.
• Cardiac muscle has some similarities to neurons and skeletal muscle, as well as important unique properties. Like a neuron, a given myocardial cell has a negative membrane potential when at rest. Stimulation above a threshold value induces the opening of voltage-gated ion channels and a flood of cations into the cell. The positively charged ions entering the cell cause the depolarization characteristic of an action potential. Like skeletal muscle, depolarization causes the opening of voltage-gated calcium channels and release of Ca²⁺ from the t-tubules. This influx of calcium causes calcium-induced calcium release from the sarcoplasmic reticulum, and free Ca²⁺ causes muscle contraction. After a delay, Potassium channels reopen and the resulting flow of K⁺ out of the cell causes repolarization to the resting state.
  Note that there are important physiological differences between nodal cells and ventricular cells; the specific differences in ion channels and mechanisms of polarization give rise to unique properties of SA node cells, most important, the spontaneous depolarizations necessary for the SA node's pacemaker activity.
                                          
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SWEET NEPALI POEM

LUKAMARI KHELDAI: ( A sweet Nepali poem )

Song by Prekshya Lamshal:

 

This poem was sang on SHIKARANI XANDA : a sanskrit way of singing. Thousands of poems are written in this way in mainly Nepal. The tips to write poem in this way is ( ISS SSS III IIS SII IS). You should learn Nepali language to write beautifully. 
                                                        
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MOTHER'S SACRIFICE

Mother’s Sacrifice

My mom only had one eye. I hated her… she was such an embarrassment. My mom ran a small shop at a flea market. She collected little weeds and such to sell… anything for the money we needed she was such an embarrassment. There was this one day during elementary school.

I remember that it was field day, and my mom came. I was so embarrassed. How could she do this to me? I threw her a hateful look and ran out. The next day at school… “Your mom only has one eye?!” and they taunted me.

I wished that my mom would just disappear from this world so I said to my mom, “Mom, why don’t you have the other eye?! You’re only going to make me a laughingstock. Why don’t you just die?” My mom did not respond. I guess I felt a little bad, but at the same time, it felt good to think that I had said what I’d wanted to say all this time. Maybe it was because my mom hadn’t punished me, but I didn’t think that I had hurt her feelings very badly.

That night… I woke up, and went to the kitchen to get a glass of water. My mom was crying there, so quietly, as if she was afraid that she might wake me. I took a look at her, and then turned away. Because of the thing I had said to her earlier, there was something pinching at me in the corner of my heart. Even so, I hated my mother who was crying out of her one eye. So I told myself that I would grow up and become successful, because I hated my one-eyed mom and our desperate poverty.

Then I studied really hard. I left my mother and came to Seoul and studied, and got accepted in the Seoul University with all the confidence I had. Then, I got married. I bought a house of my own. Then I had kids, too. Now I’m living happily as a successful man. I like it here because it’s a place that doesn’t remind me of my mom.

This happiness was getting bigger and bigger, when someone unexpected came to see me “What?! Who’s this?!” It was my mother… Still with her one eye. It felt as if the whole sky was falling apart on me. My little girl ran away, scared of my mom’s eye.

And I asked her, “Who are you? I don’t know you!!” as if I tried to make that real. I screamed at her “How dare you come to my house and scare my daughter! Get out of here now!!” And to this, my mother quietly answered, “oh, I’m so sorry. I may have gotten the wrong address,” and she disappeared. Thank goodness… she doesn’t recognize me. I was quite relieved. I told myself that I wasn’t going to care, or think about this for the rest of my life.

Then a wave of relief came upon me… one day, a letter regarding a school reunion came to my house. I lied to my wife saying that I was going on a business trip. After the reunion, I went down to the old shack, that I used to call a house…just out of curiosity there, I found my mother fallen on the cold ground. But I did not shed a single tear. She had a piece of paper in her hand…. it was a letter to me.

She wrote:

My son, I think my life has been long enough now. And… I won’t visit Seoul anymore… but would it be too much to ask if I wanted you to come visit me once in a while? I miss you so much. And I was so glad when I heard you were coming for the reunion. But I decided not to go to the school…. For you… I’m sorry that I only have one eye, and I was an embarrassment for you. You see, when you were very little, you got into an accident, and lost your eye. As a mother, I couldn’t stand watching you having to grow up with only one eye… so I gave you mine… I was so proud of my son that was seeing a whole new world for me, in my place, with that eye. I was never upset at you for anything you did. The couple times that you were angry with me. I thought to myself, ‘it’s because he loves me.’ I miss the times when you were still young around me. I miss you so much. I love you. You mean the world to me.

My World Shattered.  I hated the person who only lived for me .   I cried for My Mother, I didn’t know of any way that will make up for my worst deeds…

Moral: 

Never Ever hate anyone for their disabilities.  Never disrespect your parents, don’t ignore and under estimate their sacrifices.  They give us life, they raise us better than they had been, they give and keep trying to give better than they ever had.  They never wish unwell for their kids even in their wildest dreams.  They always try showing right path and being motivator.  Parents give up all for kids, forgive all mistakes made by kids.  There is no way to repay what they done for kids, all we can do is try giving what they need and it is just time, love and respect.

STORY: Who is Happy? The Peacock and The Crow

Who is Happy? The Peacock and The Crow

A crow lived in the forest and was absolutely satisfied in life. But one day he saw a swan. “This swan is so white,” he thought, “and I am so black. This swan must be the happiest bird in the world.”

He expressed his thoughts to the swan. “Actually,” the swan replied, “I was feeling that I was the happiest bird around until I saw a parrot, which has two colors. I now think the parrot is the happiest bird in creation.” The crow then approached the parrot. The parrot explained, “I lived a very happy life until I saw a peacock. I have only two colors, but the peacock has multiple colors.”

The crow then visited a peacock in the zoo and saw that hundreds of people had gathered to see him. After the people had left, the crow approached the peacock. “Dear peacock,” the crow said, “you are so beautiful. Every day thousands of people come to see you. When people see me, they immediately shoo me away. I think you are the happiest bird on the planet.”

The peacock replied, “I always thought that I was the most beautiful and happy bird on the planet. But because of my beauty, I am entrapped in this zoo. I have examined the zoo very carefully, and I have realized that the crow is the only bird not kept in a cage. So for past few days I have been thinking that if I were a crow, I could happily roam everywhere.” 

 MORAL:

That’s our problem too. We make unnecessary comparison with others and become sad. We don’t value what God has given us.  This all leads to the vicious cycle of unhappiness.  Learn to be happy in what you have instead of looking at what you don’t have.   There will always be someone who will have more or less than you have.  Person who is satisfied with what he/she has, is the happiest person in the world. 

CORONARY ARTERY BYPASS SURGERY.

Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic  narrowing and improve the blood supply to the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery.

Video can be illustrated as:

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                                                    Operation Threatre

                                                             Heart Opening

                                                                  Grafting

                                                 Hole Construction

                             
                                                 Bypass Artery Grafting at Leg

                                              Bypass Artery Grafting at Leg

                                                 O          Operating.

                                                               

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