recovery phases general anaesthesia adult paediatric PACU stages emergence

mkdir -p /home/daytona/workspace/recovery-anaesthesia-ppt && ls /home/daytona/workspace/recovery-anaesthesia-ppt

~/recovery-anaesthesia-ppt/build.js

mkdir -p /home/daytona/workspace/recovery-anaesthesia-ppt && echo "dir ready"

cat > /home/daytona/workspace/recovery-anaesthesia-ppt/build.js << 'ENDOFSCRIPT' const pptxgen = require("pptxgenjs"); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.author = "MD Anaesthesia"; pres.title = "Recovery Phases from General Anaesthesia"; const C = { navy: "0B1F3A", mid: "112D4E", teal: "00B4D8", sky: "90E0EF", white: "F0F4F8", gold: "FFD166", green: "06D6A0", red: "EF476F", grey: "1E3A5F", lgrey: "2A4A72", }; function addHeader(slide, title, subtitle) { slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.85, fill:{color:C.teal} }); slide.addText(title, { x:0.25, y:0, w:9.5, h:0.85, fontSize:22, bold:true, color:C.navy, valign:"middle", fontFace:"Calibri", margin:0 }); if (subtitle) { slide.addShape(pres.ShapeType.rect, { x:0, y:0.85, w:10, h:0.32, fill:{color:C.navy} }); slide.addText(subtitle, { x:0.25, y:0.85, w:9.5, h:0.32, fontSize:11, color:C.sky, italic:true, valign:"middle", fontFace:"Calibri", margin:0 }); } } function addFooter(slide, page) { slide.addShape(pres.ShapeType.rect, { x:0, y:5.35, w:10, h:0.28, fill:{color:C.grey} }); slide.addText("MD Anaesthesia | Recovery from General Anaesthesia | 2026", { x:0.3, y:5.35, w:7.5, h:0.28, fontSize:9, color:C.sky, fontFace:"Calibri", valign:"middle", margin:0 }); slide.addText(String(page), { x:9.2, y:5.35, w:0.6, h:0.28, fontSize:9, color:C.gold, fontFace:"Calibri", valign:"middle", align:"right", margin:0 }); } function addBulletBox(slide, x, y, w, h, title, items, titleColor, fontSize) { titleColor = titleColor || C.gold; fontSize = fontSize || 12; slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill:{color:C.grey}, line:{color:C.lgrey, width:1} }); slide.addText(title, { x:x+0.12, y:y+0.08, w:w-0.2, h:0.3, fontSize:13, bold:true, color:titleColor, fontFace:"Calibri", margin:0 }); var bullets = items.map(function(t, i) { return { text:t, options:{ bullet:true, fontSize:fontSize, color:C.white, fontFace:"Calibri", breakLine: i < items.length-1 } }; }); slide.addText(bullets, { x:x+0.12, y:y+0.42, w:w-0.2, h:h-0.5, valign:"top" }); } function addCard(slide, x, y, w, h, heading, body, headColor) { headColor = headColor || C.teal; slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill:{color:C.grey}, line:{color:C.lgrey, width:1.2} }); slide.addShape(pres.ShapeType.rect, { x, y, w, h:0.3, fill:{color:headColor} }); slide.addText(heading, { x:x+0.08, y, w:w-0.1, h:0.3, fontSize:11.5, bold:true, color:C.navy, valign:"middle", fontFace:"Calibri", margin:0 }); slide.addText(body, { x:x+0.08, y:y+0.33, w:w-0.14, h:h-0.38, fontSize:11, color:C.white, fontFace:"Calibri", valign:"top", wrap:true, margin:0 }); } // ── SLIDE 1: TITLE ────────────────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.22, h:5.63, fill:{color:C.teal} }); s.addShape(pres.ShapeType.rect, { x:0.22, y:0, w:0.08, h:5.63, fill:{color:C.gold} }); s.addText("Recovery Phases from\nGeneral Anaesthesia", { x:0.55, y:0.7, w:9.1, h:2.3, fontSize:40, bold:true, color:C.white, fontFace:"Calibri", align:"left", valign:"middle", lineSpacingMultiple:1.2 }); s.addText("Adult & Paediatric Perspectives | MD Anaesthesia", { x:0.55, y:2.98, w:8.5, h:0.48, fontSize:22, color:C.teal, fontFace:"Calibri" }); s.addShape(pres.ShapeType.line, { x:0.55, y:3.5, w:8, h:0, line:{color:C.gold, width:2} }); s.addText("Department of Anaesthesiology", { x:0.55, y:3.65, w:7, h:0.36, fontSize:14, color:C.sky, fontFace:"Calibri" }); s.addText("Source: Miller's Anaesthesia 10e • Barash Clinical Anaesthesia 9e", { x:0.55, y:5.05, w:8.5, h:0.28, fontSize:9.5, color:C.lgrey, fontFace:"Calibri" }); })(); // ── SLIDE 2: OUTLINE ──────────────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Presentation Outline"); addFooter(s, 2); var topics = [ ["01","Guedel's Stages of Anaesthesia","Historical framework & depth of anaesthesia"], ["02","Three Phases of PACU Recovery","Phase I, II & III — definitions & goals"], ["03","Transport to PACU","Safe transfer, monitoring, SBAR handover"], ["04","Phase I Recovery — Adult","Airway, ventilation, CVS, thermoregulation, pain"], ["05","Complications in Adult PACU","Airway obstruction, PONV, delirium, hypothermia"], ["06","Adult Discharge Criteria","Modified Aldrete Score & ASA 2019 standards"], ["07","Paediatric Physiology","Age-specific vulnerabilities & monitoring needs"], ["08","Paediatric PACU Management","Airway, PONV, emergence agitation, pain scales"], ["09","Paediatric Discharge Criteria","Modified Aldrete, caregiver education, special groups"], ["10","Fast-Tracking / Phase I Bypass","White criteria, eligibility, benefits"], ]; topics.forEach(function(item, i) { var col = i < 5 ? 0 : 1; var row = i < 5 ? i : i - 5; var x = col === 0 ? 0.3 : 5.2; var y = 1.1 + row * 0.84; s.addShape(pres.ShapeType.rect, { x, y, w:4.6, h:0.73, fill:{color:C.grey}, line:{color:C.lgrey, width:1} }); s.addShape(pres.ShapeType.rect, { x, y, w:0.44, h:0.73, fill:{color:C.teal} }); s.addText(item[0], { x, y, w:0.44, h:0.73, fontSize:13, bold:true, color:C.navy, align:"center", valign:"middle", fontFace:"Calibri", margin:0 }); s.addText(item[1], { x:x+0.52, y:y+0.05, w:4, h:0.34, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", margin:0 }); s.addText(item[2], { x:x+0.52, y:y+0.39, w:4, h:0.26, fontSize:9.5, color:C.sky, italic:true, fontFace:"Calibri", margin:0 }); }); })(); // ── SLIDE 3: GUEDEL'S STAGES ──────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Guedel's Classification of Anaesthetic Stages (1937)", "Foundation for understanding induction and recovery — recovery reverses Stages III → II → I"); addFooter(s, 3); var stages = [ ["Stage I","Analgesia / Induction",C.green,"Conscious, drowsy; pain relief beginning; possible amnesia\nBreathing & reflexes intact; patient cooperative; no LOC"], ["Stage II","Excitement / Delirium",C.red,"Loss of consciousness; uninhibited cortical activity\nBreath-holding, vomiting, laryngospasm risk\n⚠ Most DANGEROUS stage — keep brief; avoid stimulation"], ["Stage III","Surgical Anaesthesia",C.teal,"4 planes: Regular breathing → progressive apnoea\nProgressive EOM fixation, pupil dilation, reflex loss\nTarget plane for operative surgery"], ["Stage IV","Medullary Depression",C.red,"Respiratory & cardiovascular collapse\nAnaesthetic overdose — immediately life-threatening"], ]; stages.forEach(function(st, i) { var y = 1.25 + i * 1.0; s.addShape(pres.ShapeType.rect, { x:0.25, y, w:9.5, h:0.88, fill:{color:C.grey}, line:{color:st[2], width:2} }); s.addShape(pres.ShapeType.rect, { x:0.25, y, w:1.52, h:0.88, fill:{color:st[2]} }); s.addText(st[0], { x:0.25, y:y, w:1.52, h:0.46, fontSize:14, bold:true, color:C.navy, align:"center", valign:"bottom", fontFace:"Calibri", margin:0 }); s.addText(st[1], { x:0.25, y:y+0.46, w:1.52, h:0.38, fontSize:9.5, bold:true, color:C.navy, align:"center", valign:"top", fontFace:"Calibri", margin:0 }); s.addText(st[3], { x:1.9, y:y+0.07, w:7.7, h:0.76, fontSize:11.5, color:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); s.addText("Modern agents (propofol, remifentanil) allow rapid progression & recovery, often bypassing Stage II entirely", { x:0.25, y:5.1, w:9.5, h:0.25, fontSize:10.5, color:C.gold, italic:true, fontFace:"Calibri" }); })(); // ── SLIDE 4: THREE PHASES ──────────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Three Phases of Postanaesthetic Recovery", "ASA Standards for Postanesthesia Care — last amended October 2019"); addFooter(s, 4); var phases = [ { num:"Phase I", label:"Immediate\nPostanaesthetic", color:C.teal, time:"OR → PACU (hours to 24 h)", x:0.3, pts:["Transition directly from OR to PACU","Close haemodynamic & SpO₂ monitoring","Ensure patent airway & adequate ventilation","Titrate IV analgesia & antiemetics","Assess & treat hypothermia / shivering","Prepare for Phase II transfer or ICU"] }, { num:"Phase II", label:"Discharge\nPreparation", color:C.gold, time:"PACU → Home / Ward", x:3.45, pts:["For ambulatory / day-care patients","Ambulation, oral intake, voiding assessed","Pain on oral medications (NRS ≤ 3)","PONV resolved; patient alert & oriented","Responsible adult escort confirmed","Written discharge instructions provided"] }, { num:"Phase III", label:"Extended\nConvalescence", color:C.green, time:"Home / Rehabilitation", x:6.6, pts:["Recovery continues at home","Wound care & activity restriction education","Oral analgesia; ice / elevation PRN","Phone follow-up at 24 hours","Outpatient review as scheduled","Cognitive & functional restoration"] }, ]; phases.forEach(function(ph) { s.addShape(pres.ShapeType.rect, { x:ph.x, y:1.02, w:3.05, h:0.62, fill:{color:ph.color} }); s.addText(ph.num, { x:ph.x, y:1.02, w:3.05, h:0.3, fontSize:16, bold:true, color:C.navy, align:"center", valign:"middle", fontFace:"Calibri", margin:0 }); s.addText(ph.label, { x:ph.x, y:1.32, w:3.05, h:0.3, fontSize:10.5, color:C.navy, align:"center", fontFace:"Calibri", margin:0 }); s.addShape(pres.ShapeType.rect, { x:ph.x, y:1.72, w:3.05, h:3.55, fill:{color:C.grey}, line:{color:C.lgrey, width:1} }); s.addText(ph.time, { x:ph.x+0.1, y:1.75, w:2.88, h:0.28, fontSize:9.5, color:ph.color, italic:true, fontFace:"Calibri", valign:"middle", margin:0 }); var bullets = ph.pts.map(function(t,i){ return { text:t, options:{bullet:true, fontSize:11, color:C.white, fontFace:"Calibri", breakLine:i<ph.pts.length-1} }; }); s.addText(bullets, { x:ph.x+0.1, y:2.07, w:2.88, h:3.13, valign:"top" }); }); })(); // ── SLIDE 5: TRANSPORT TO PACU ────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Transport to PACU & Initial Assessment", "Overall PACU complication rate ~23.7% — Miller's Anaesthesia 10e"); addFooter(s, 5); addBulletBox(s, 0.28, 1.08, 4.55, 2.05, "Pre-Transport Checklist", [ "Airway secured / patent; SpO₂ > 95%","Haemodynamics stable (BP, HR within normal)","NMB adequately reversed — TOF ratio ≥ 0.9","Reversal given: neostigmine+glyco / sugammadex","Pain & PONV prophylaxis administered","Surgeon informed; dressings/drains secured" ], C.teal, 11.5); addBulletBox(s, 0.28, 3.18, 4.55, 2.1, "During Transport", [ "Supplemental O₂ via mask or nasal prongs","Continuous SpO₂ ± ECG portable monitoring","Anaesthesiologist / trained nurse escorts","Emergency drugs & airway kit available","Verbal stimulation to maintain consciousness","Lateral position if airway at risk" ], C.gold, 11.5); addBulletBox(s, 5.05, 1.08, 4.67, 2.05, "SBAR Handover to PACU Nurse", [ "Situation: Patient ID, procedure, surgeon","Background: PMH, allergies, chronic meds","Assessment: Anaesthetic technique, airway used","Response: Fluids, blood loss, urine output, drugs","Pain score on arrival, last analgesic dose" ], C.teal, 11.5); addBulletBox(s, 5.05, 3.18, 4.67, 2.1, "Immediate PACU Assessment", [ "Airway patency & respiratory rate","SpO₂, BP, HR, temperature, pain NRS 0–10","Level of consciousness (AVPU / Ramsay)","Surgical site — drains, dressings, bleeding","IV access, urine output, warmth" ], C.gold, 11.5); })(); // ── SLIDE 6: ADULT PHASE I — AIRWAY & RESP ────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Phase I Recovery — Adult: Airway & Respiratory", "Most frequent cause of morbidity & mortality in PACU — Barash 9e"); addFooter(s, 6); addCard(s, 0.28, 1.1, 4.55, 2.1, "Causes of Airway Obstruction", "• Posterior tongue displacement / soft-tissue collapse\n• Laryngospasm — secretions, blood, extubation\n• Laryngeal oedema — post-intubation / anaphylaxis\n• Neck haematoma (thyroid / carotid surgery)\n• Rx: Chin-lift, jaw-thrust, OPA/NPA, lateral position\n• Laryngospasm: CPAP → succinylcholine 0.1 mg/kg IV", C.red); addCard(s, 5.06, 1.1, 4.64, 2.1, "Hypoventilation", "• Residual volatile anaesthetic / propofol\n• Opioid-induced respiratory depression\n• Residual NMB — most common reversible cause\n• Obesity, OSA, pain/splinting\n• Rx: Arousal → naloxone 20–40 µg IV titration\n• Flumazenil 0.1 mg for benzodiazepines", C.red); addCard(s, 0.28, 3.26, 4.55, 1.98, "Hypoxaemia", "• SpO₂ < 93% common in PACU on room air\n• V/Q mismatch, atelectasis, pulmonary oedema\n• Aspiration, pneumothorax, PE\n• Rx: Supplemental O₂, CPAP/NIV, treat cause\n• Children 0–3 yr — MUCH faster desaturation", C.gold); addCard(s, 5.06, 3.26, 4.64, 1.98, "Respiratory Monitoring", "• Continuous SpO₂ — mandatory for all patients\n• ETCO₂ if intubated or high risk (OSA, obesity)\n• Respiratory rate every 5 min initially\n• O₂ supplementation ≥ 30 min post-GA\n• OSA: SpO₂ until ≥ 90% on room air while asleep\n• ABG if PaCO₂ or acid-base status uncertain", C.teal); })(); // ── SLIDE 7: ADULT PHASE I — CVS & THERMOREGULATION ───────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Phase I Recovery — Adult: Cardiovascular & Thermoregulation"); addFooter(s, 7); addBulletBox(s, 0.28, 1.08, 4.55, 1.78, "Hypertension", [ "Pain, anxiety, hypoxia, hypercarbia","Bladder distension, emergence agitation","Pre-existing hypertension, drug rebound (clonidine, β-blocker)","Rx: Analgesia first → labetalol / hydralazine / GTN infusion" ], C.red, 11.5); addBulletBox(s, 5.06, 1.08, 4.64, 1.78, "Hypotension", [ "Hypovolaemia: haemorrhage, 3rd space, inadequate replacement","Residual anaesthetic / spinal vasodilation","Cardiogenic — LV failure, PE, tension pneumothorax","Rx: IV fluid bolus 500 mL → vasopressors → ECHO if needed" ], C.red, 11.5); addBulletBox(s, 0.28, 2.93, 4.55, 1.78, "Arrhythmias", [ "Sinus tachycardia — pain, hypovolaemia, fever, anaemia","Bradycardia — neostigmine, β-blockers, vagal, opioids","SVT / AF — electrolyte imbalance, pain, hypoxia","Rx: Treat underlying cause; antiarrhythmics if haemodynamically significant" ], C.gold, 11.5); addBulletBox(s, 5.06, 2.93, 4.64, 1.78, "Hypothermia & Shivering", [ "Core temp < 36°C — very common post-GA","↑ PACU stay by 40–90 min; ↑ O₂ consumption 200% (shivering)","Coagulopathy, ↑ wound infection, myocardial ischaemia risk","Rx: Forced-air warming blanket, warm IV fluids, meperidine 25 mg IV" ], C.teal, 11.5); s.addShape(pres.ShapeType.rect, { x:0.28, y:4.77, w:9.42, h:0.5, fill:{color:C.grey}, line:{color:C.gold, width:1.5} }); s.addText("⚠ CMS/TJC Surgical Care Improvement Project: Temperature ≥ 36°C must be documented within 15 min of PACU admission — quality indicator", { x:0.45, y:4.79, w:9, h:0.44, fontSize:11, color:C.gold, fontFace:"Calibri", valign:"middle" }); })(); // ── SLIDE 8: ADULT PAIN, PONV, NEURO ──────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Phase I Recovery — Adult: Pain, PONV & Neurological Assessment"); addFooter(s, 8); addBulletBox(s, 0.28, 1.08, 4.55, 2.05, "Pain Management", [ "Assess NRS 0–10 every 15 min; document","Multimodal: paracetamol + NSAID + opioid + regional","Short-acting IV opioids for titration (fentanyl, morphine)","Epidural / peripheral nerve catheters — post-thoracic/abdominal","⚠ Tachycardia + low/normal BP + pain → fluid status first before opioids","Inadequate analgesia → ↑ HTN, tachycardia, sympathetic surge" ], C.gold, 11.5); addBulletBox(s, 5.06, 1.08, 4.64, 2.05, "PONV", [ "Major cause of dissatisfaction & prolonged PACU stay","Apfel score: female, PONV hx, non-smoker, postop opioids (1 pt each)","Prophylaxis: ondansetron 4 mg IV + dexamethasone 4–8 mg","Rescue: cyclizine, promethazine, droperidol 0.625 mg IV","Aspiration risk — lateral position if vomiting","Oral fluids only after nausea resolved" ], C.gold, 11.5); addBulletBox(s, 0.28, 3.18, 4.55, 2.1, "Emergence Agitation & Delirium", [ "Incidence 5–50% elderly; younger patients 15% POCD","Differential: pain, hypoxia, hypercarbia, hypoglycaemia, urinary retention","Agitation + hypoxia → exclude respiratory cause FIRST","Treatment: verbal reassurance; most resolves in 10–15 min","IV sedation if safety risk (midazolam / propofol titrated)","Hypoactive delirium easily missed — periodic orientation checks" ], C.red, 11.5); addBulletBox(s, 5.06, 3.18, 4.64, 2.1, "Neurological Monitoring", [ "Level of consciousness: AVPU or Ramsay Scale","NMB reversal adequacy — TOF ratio, head-lift 5 sec","Cognitive orientation: person, place, time","POCD risk: elderly, cardiac surgery, prolonged anaesthesia","Pupillary response — opioid vs neurological injury","Stroke protocol if new focal motor / speech deficit" ], C.teal, 11.5); })(); // ── SLIDE 9: ADULT DISCHARGE CRITERIA ─────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Discharge Criteria from Phase I PACU — Adult", "Modified Aldrete Score — minimum score 9/10 required"); addFooter(s, 9); var tableData = [ ["Parameter","Score 2","Score 1","Score 0"], ["Activity","Moves all 4 limbs voluntarily / on command","Moves 2 limbs","Moves no limbs"], ["Respiration","Breathes deeply & coughs freely","Dyspnoea / limited breathing","Apnoeic"], ["Circulation","BP within ±20% pre-op baseline","BP within ±21–49% baseline","BP >±50% baseline"], ["Consciousness","Fully awake","Arousable on calling","Not responding"], ["SpO₂",">92% on room air","Needs O₂ to maintain >90%","<90% on supplemental O₂"], ]; var colW = [1.9, 2.42, 2.42, 2.42]; var colX = [0.28, 2.18, 4.6, 7.02]; var rowH = 0.56; tableData.forEach(function(row, ri) { row.forEach(function(cell, ci) { var isH = ri === 0; var bg = isH ? C.teal : ri%2===0 ? C.grey : C.mid; s.addShape(pres.ShapeType.rect, { x:colX[ci], y:1.08+ri*rowH, w:colW[ci], h:rowH, fill:{color:bg}, line:{color:C.lgrey, width:0.5} }); s.addText(cell, { x:colX[ci]+0.06, y:1.08+ri*rowH, w:colW[ci]-0.1, h:rowH, fontSize:isH?11.5:10.5, bold:isH, color:isH?C.navy:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); }); s.addShape(pres.ShapeType.rect, { x:0.28, y:4.52, w:9.42, h:0.76, fill:{color:C.grey}, line:{color:C.green, width:1.5} }); s.addText("Additional ASA 2019 Requirements:", { x:0.42, y:4.54, w:4.5, h:0.26, fontSize:11, bold:true, color:C.green, fontFace:"Calibri" }); s.addText("• Pain NRS ≤ 3 • PONV controlled • Temperature ≥ 36°C • Urine output ≥ 0.5 mL/kg/h • Responsible adult escort (ambulatory) • Written discharge instructions", { x:0.42, y:4.78, w:9.1, h:0.44, fontSize:10.5, color:C.white, fontFace:"Calibri" }); })(); // ── SLIDE 10: PAEDIATRIC PHYSIOLOGY ───────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Paediatric Recovery — Unique Physiological Considerations", "Age-specific vulnerabilities require modified protocols — Barash 9e & Miller 10e"); addFooter(s, 10); var cols = [ { title:"Respiratory", color:C.teal, x:0.28, items:["O₂ consumption 6–8 mL/kg/min (adult 3–4)","Small FRC → rapid O₂ desaturation","Neonates / infants: SpO₂ falls within minutes of apnoea","Obligate nasal breathers < 3 months of age","Narrowest airway at cricoid (not glottis)","URI within 2 wks ↑ laryngospasm / desaturation risk"] }, { title:"Cardiovascular", color:C.gold, x:3.45, items:["Cardiac output is HR-dependent","Bradycardia → immediate ↓ BP (limited SV reserve)","Normal HR: neonate 120–160; toddler 90–130; child 70–110","Atropine 0.02 mg/kg IV for vagal bradycardia","Limited vasoconstrictive reserve","Immature baroreceptor response"] }, { title:"Thermoregulation", color:C.sky, x:6.62, items:["Large surface area : body mass ratio","Neonates: brown fat thermogenesis","Rapid heat loss during transfer","Warm PACU environment (26–28°C for neonates)","Target core temp ≥ 36.5°C for neonates","Warm blankets, hat, warm IV fluids"] }, ]; cols.forEach(function(col) { s.addShape(pres.ShapeType.rect, { x:col.x, y:1.08, w:3.1, h:4.22, fill:{color:C.grey}, line:{color:col.color, width:1.5} }); s.addShape(pres.ShapeType.rect, { x:col.x, y:1.08, w:3.1, h:0.36, fill:{color:col.color} }); s.addText(col.title, { x:col.x+0.08, y:1.08, w:2.94, h:0.36, fontSize:13, bold:true, color:C.navy, valign:"middle", fontFace:"Calibri", margin:0 }); var bullets = col.items.map(function(t,i){ return { text:t, options:{bullet:true, fontSize:11, color:C.white, fontFace:"Calibri", breakLine:i<col.items.length-1} }; }); s.addText(bullets, { x:col.x+0.1, y:1.5, w:2.9, h:3.72, valign:"top" }); }); })(); // ── SLIDE 11: PAEDIATRIC PHASE I & II ─────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Paediatric Phase I & II Recovery Management", "Airway, PONV, Emergence Agitation & Pain Assessment"); addFooter(s, 11); addBulletBox(s, 0.28, 1.08, 4.55, 2.08, "Airway — Paediatric Priorities", [ "Lateral / 'sniffing' position to prevent obstruction","Post-intubation croup: nebulised adrenaline 0.5 mL/kg (1:1000)","Laryngospasm: CPAP 10 cmH₂O; succinylcholine 2 mg/kg IV if refractory","URI within 2 wks → cancel elective intubation if possible","SpO₂ monitor on every paediatric PACU patient","Avoid stimulation during Stage II emergence" ], C.teal, 11.5); addBulletBox(s, 5.06, 1.08, 4.64, 2.08, "Paediatric PONV", [ "Incidence > 25% in children > 3 yr","High risk: strabismus, tonsillectomy, long procedures","Ondansetron 0.1 mg/kg IV (max 4 mg)","Dexamethasone 0.15 mg/kg IV intraoperatively","Avoid oral fluids until child is alert & asking to drink","Rectal paracetamol for small children if oral not possible" ], C.gold, 11.5); addBulletBox(s, 0.28, 3.22, 4.55, 2.05, "Emergence Agitation (EA) — Paediatric", [ "Peak incidence 2–6 years; sevoflurane / desflurane","PAED Scale: score ≥ 10 = significant EA","EA vs pain — critical differential diagnosis","Rx: fentanyl 1–2 µg/kg IV or dexmedetomidine 0.5 µg/kg","Parental presence in PACU markedly reduces EA","Propofol for LMA removal reduces EA incidence" ], C.red, 11.5); addBulletBox(s, 5.06, 3.22, 4.64, 2.05, "Paediatric Pain Assessment Scales", [ "Neonates / infants: NIPS, CRIES scale","Toddlers 1–3 yr: FLACC (Face, Legs, Activity, Cry, Consolability)","Children 3–7 yr: Faces Pain Scale (FPS-R)","Children ≥ 7 yr: NRS 0–10","Multimodal: paracetamol + ibuprofen (> 3 months) + opioids","Caudal / peripheral blocks — reduce systemic opioid requirement" ], C.teal, 11.5); })(); // ── SLIDE 12: PAEDIATRIC DISCHARGE ────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Paediatric Discharge Criteria & Special Groups", "Modified Aldrete + Caregiver Education"); addFooter(s, 12); addBulletBox(s, 0.28, 1.08, 4.55, 2.2, "Modified Aldrete Score — Paediatric", [ "Activity: Purposeful movement of all limbs","Respiration: Crying / coughing normally; SpO₂ ≥ 93%","Circulation: BP & HR within 20% of pre-op baseline","Consciousness: Awake / easily arousable; EA resolved","Colour: Pink; SpO₂ ≥ 93% on room air","Score ≥ 9/10 required before PACU discharge" ], C.teal, 11.5); addBulletBox(s, 5.06, 1.08, 4.64, 2.2, "Additional Paediatric Requirements", [ "Pain FLACC ≤ 3 or NRS ≤ 3","PONV controlled; tolerating oral fluids","Temperature ≥ 36°C (36.5°C neonates)","Day-care: void or infant with expected wet nappy","Parent / guardian present at bedside","Written discharge & danger sign instructions" ], C.gold, 11.5); addBulletBox(s, 0.28, 3.35, 4.55, 1.92, "Caregiver Discharge Education", [ "No hot food or drinks for 2 h (throat numbness)","Drowsiness may persist up to 24 hours","Paracetamol dosing schedule explained","Return if: fever, persistent vomiting, bleeding, stridor","24-hour telephone access to surgical team" ], C.sky, 11.5); addBulletBox(s, 5.06, 3.35, 4.64, 1.92, "Special Paediatric Groups", [ "Ex-premature < 60 weeks PCA: apnoea monitoring 12–24 h","Down syndrome: atlantoaxial instability precautions","Sickle cell: maintain hydration & O₂ in PACU","Neonates & infants < 6 months: overnight admission","Tonsillectomy < 3 yr or severe OSA: extended PACU monitoring" ], C.red, 11.5); })(); // ── SLIDE 13: FAST-TRACKING ────────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Fast-Tracking & Bypass of Phase I PACU", "White Fast-Track Criteria for Ambulatory Surgery"); addFooter(s, 13); addBulletBox(s, 0.28, 1.08, 4.55, 2.52, "Eligibility for Phase I Bypass", [ "Short procedure < 90 min; ASA I–II","TIVA with propofol / remifentanil preferred","BIS or depth of anaesthesia monitoring used","LMA used (not ETT)","Adequate pre-operative & intraoperative analgesia","Apfel score ≤ 1 (low PONV risk)","No major haemorrhage, no ICU admission" ], C.teal, 11.5); addBulletBox(s, 5.06, 1.08, 4.64, 2.52, "White Fast-Track Score (Target ≥ 12/14)", [ "Level of consciousness: awake & oriented = 2","Physical activity: steady gait, no dizziness = 2","Haemodynamic stability: BP ±20% baseline = 2","Respiratory stability: SpO₂ > 90% on RA = 2","Pain assessment: minimal or none = 2","Nausea / vomiting: minimal or none = 2","Bleeding: minimal = 2" ], C.gold, 11.5); s.addShape(pres.ShapeType.rect, { x:0.28, y:3.66, w:9.42, h:1.62, fill:{color:C.grey}, line:{color:C.green, width:1.5} }); s.addText("Benefits of Fast-Tracking", { x:0.42, y:3.68, w:4.5, h:0.3, fontSize:12, bold:true, color:C.green, fontFace:"Calibri" }); s.addText("Contraindications to Phase I Bypass", { x:5.1, y:3.68, w:4.3, h:0.3, fontSize:12, bold:true, color:C.red, fontFace:"Calibri" }); s.addText("• Reduced PACU costs & nurse staffing requirements\n• Higher patient satisfaction & faster home discharge\n• Lower incidence of PONV & pain on Phase II arrival", { x:0.42, y:3.98, w:4.35, h:1.24, fontSize:11, color:C.white, fontFace:"Calibri" }); s.addText("• Severe OSA, morbid obesity, ASA ≥ III\n• Major surgery, significant haemorrhage\n• Neuraxial blockade with motor block\n• Uncontrolled pain or persistent agitation", { x:5.1, y:3.98, w:4.35, h:1.24, fontSize:11, color:C.white, fontFace:"Calibri" }); })(); // ── SLIDE 14: COMPARISON TABLE ─────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Adult vs Paediatric Recovery — Key Differences at a Glance"); addFooter(s, 14); var rows = [ ["Parameter","Adult","Paediatric"], ["Airway risk","Tongue/soft-tissue, residual NMB","Subglottic oedema, laryngospasm, obligate nasal breathing"], ["O₂ reserve","Adequate FRC; slower desaturation","Low FRC → rapid SpO₂ fall within minutes in neonates"], ["PONV incidence","20–30%; Apfel score guided","≥25% children >3 yr; tonsillectomy/strabismus high risk"], ["Pain assessment","NRS 0–10; verbal self-report","FLACC, CRIES, Faces scale; behavioural cues dominate"], ["Emergence agitation","5–50% elderly; delirium / confusion","Peak 2–6 yr; PAED scale; EA ≠ pain — important distinction"], ["Hypothermia risk","Moderate; ↑ PACU stay 40–90 min","High; large SA:mass ratio; neonates extremely vulnerable"], ["Discharge","Aldrete ≥ 9; NRS ≤ 3; void optional","Modified Aldrete ≥ 9; parent present; ex-premature: admit"], ["Drug dosing","Weight or standard adult doses","Strict mg/kg; narrow therapeutic index; hepatic immaturity"], ]; var colW = [2.38, 3.38, 3.6]; var colX = [0.3, 2.68, 6.06]; var rowH = 0.5; rows.forEach(function(row, ri) { row.forEach(function(cell, ci) { var isH = ri===0; var bg = isH ? C.teal : ci===0 ? C.lgrey : ri%2===0 ? C.grey : C.mid; s.addShape(pres.ShapeType.rect, { x:colX[ci], y:1.08+ri*rowH, w:colW[ci], h:rowH, fill:{color:bg}, line:{color:C.lgrey, width:0.5} }); s.addText(cell, { x:colX[ci]+0.06, y:1.08+ri*rowH, w:colW[ci]-0.1, h:rowH, fontSize:isH?12:10.5, bold:isH||ci===0, color:isH?C.navy:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); }); })(); // ── SLIDE 15: SUMMARY ──────────────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "Summary & Key Takeaways"); addFooter(s, 15); var pts = [ [C.teal, "Recovery reverses Guedel's Stages III→II→I; modern agents (propofol/remifentanil) allow rapid, smooth recovery often bypassing Stage II"], [C.gold, "Three phases: Phase I (PACU, close monitoring), Phase II (discharge preparation), Phase III (home convalescence)"], [C.teal, "PACU overall complication rate ~23.7%; airway obstruction, hypoventilation & hypotension are the most critical events"], [C.gold, "Multimodal analgesia + PONV prophylaxis are cornerstones of Phase I care in both adult & paediatric patients"], [C.green, "Paediatric patients: lower O₂ reserve, faster desaturation, higher EA incidence, weight-based drugs → age-specific protocols essential"], [C.gold, "Modified Aldrete Score ≥ 9/10 + ASA 2019 criteria required before Phase I PACU discharge in all patients"], [C.green, "White Fast-Track Score ≥ 12/14 allows safe Phase I bypass for appropriate short ambulatory procedures"], [C.red, "Ex-premature (<60 wks PCA), neonates, infants with OSA or sickle cell disease → mandatory extended monitoring / overnight admission"], ]; pts.forEach(function(item, i) { var y = 1.1 + i * 0.54; s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.42, h:0.47, fill:{color:C.grey}, line:{color:C.lgrey, width:0.5} }); s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.2, h:0.47, fill:{color:item[0]} }); s.addText(item[1], { x:0.6, y, w:9.0, h:0.47, fontSize:11.5, color:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); })(); // ── SLIDE 16: REFERENCES ───────────────────────────────────────── (function(){ var s = pres.addSlide(); s.background = {color:C.navy}; addHeader(s, "References"); addFooter(s, 16); var refs = [ "1. Miller RD et al. Miller's Anaesthesia, 10th Edition. Elsevier, 2023. Chapter: Postanesthesia Care Unit.", "2. Barash PG, Cullen BF, Stoelting RK et al. Clinical Anaesthesia, 9th Edition. Wolters Kluwer, 2023. Chapter 54: Postanesthesia Recovery.", "3. American Society of Anesthesiologists. Standards for Postanesthesia Care. Amended October 23, 2019.", "4. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.", "5. White PF, Song D. New criteria for fast-tracking after outpatient anesthesia. Anesth Analg. 1999;88:1069–1072.", "6. Guedel AE. Inhalation Anesthesia: A Fundamental Guide. 2nd ed. New York: Macmillan; 1951.", "7. Benumof JL, Dagg R, Benumof R. Critical hemoglobin desaturation before return to unparalyzed state after succinylcholine. Anesthesiology. 1997;87:979.", "8. Xue FS et al. Comparative study of early postoperative hypoxemia in infants, children, and adults. Anesth Analg. 1996;83:709.", "9. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85:808.", ]; refs.forEach(function(ref, i) { var y = 1.12 + i * 0.5; s.addText(ref, { x:0.35, y, w:9.35, h:0.44, fontSize:10.8, color:i===0?C.sky:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); })(); pres.writeFile({ fileName: "/home/daytona/workspace/recovery-anaesthesia-ppt/Recovery_Phases_GA_MD_Anaesthesia.pptx" }) .then(function(){ console.log("SUCCESS"); }) .catch(function(e){ console.error("ERROR:", e); }); ENDOFSCRIPT echo "Script written"

cd /home/daytona/workspace/recovery-anaesthesia-ppt && node build.js

ls -lh /home/daytona/workspace/recovery-anaesthesia-ppt/

ERAS protocol anaesthesia 2024 components preoperative intraoperative postoperative elements

mkdir -p /home/daytona/workspace/eras-ppt && cat > /home/daytona/workspace/eras-ppt/build.js << 'ENDOFSCRIPT' const pptxgen = require("pptxgenjs"); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.author = "MD Anaesthesia"; pres.title = "ERAS Protocol in Anaesthesia"; // ── COLOUR PALETTE ────────────────────────────────────────────── const C = { dark: "0D1B2A", // dominant bg panel: "1A2D42", // card/box bg teal: "00C9A7", // primary accent blue: "0096C7", // secondary accent gold: "FFD166", // highlight amber: "F4A261", // intraop rose: "EF476F", // warning/post sky: "90E0EF", // sub text white: "EFF6FF", // body text lgrey: "243B55", // dividers green: "06D6A0", // positive/outcomes pre: "48CAE4", // preadmission intra: "F4A261", // intraop post: "A8DADC", // postop }; // ── HELPERS ───────────────────────────────────────────────────── function addHeader(s, title, sub) { s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.78, fill:{color:C.teal} }); s.addText(title, { x:0.22, y:0, w:9.6, h:0.78, fontSize:21, bold:true, color:C.dark, valign:"middle", fontFace:"Calibri", margin:0 }); if (sub) { s.addShape(pres.ShapeType.rect, { x:0, y:0.78, w:10, h:0.3, fill:{color:C.panel} }); s.addText(sub, { x:0.22, y:0.78, w:9.6, h:0.3, fontSize:10.5, color:C.sky, italic:true, valign:"middle", fontFace:"Calibri", margin:0 }); } } function addFooter(s, n) { s.addShape(pres.ShapeType.rect, { x:0, y:5.33, w:10, h:0.3, fill:{color:C.lgrey} }); s.addText("MD Anaesthesia | ERAS Protocol | 2026", { x:0.3, y:5.33, w:7.5, h:0.3, fontSize:9, color:C.sky, fontFace:"Calibri", valign:"middle", margin:0 }); s.addText(String(n), { x:9.2, y:5.33, w:0.6, h:0.3, fontSize:9, color:C.gold, fontFace:"Calibri", valign:"middle", align:"right", margin:0 }); } function bBox(s, x, y, w, h, title, items, tc, fs) { tc = tc||C.gold; fs = fs||11.5; s.addShape(pres.ShapeType.rect, { x, y, w, h, fill:{color:C.panel}, line:{color:C.lgrey, width:1} }); s.addText(title, { x:x+0.1, y:y+0.07, w:w-0.18, h:0.3, fontSize:12.5, bold:true, color:tc, fontFace:"Calibri", margin:0 }); var bl = items.map(function(t,i){ return { text:t, options:{bullet:true, fontSize:fs, color:C.white, fontFace:"Calibri", breakLine:i<items.length-1} }; }); s.addText(bl, { x:x+0.1, y:y+0.4, w:w-0.18, h:h-0.48, valign:"top" }); } function card(s, x, y, w, h, title, body, tc) { tc = tc||C.teal; s.addShape(pres.ShapeType.rect, { x, y, w, h, fill:{color:C.panel}, line:{color:C.lgrey, width:1} }); s.addShape(pres.ShapeType.rect, { x, y, w, h:0.3, fill:{color:tc} }); s.addText(title, { x:x+0.08, y, w:w-0.14, h:0.3, fontSize:11.5, bold:true, color:C.dark, valign:"middle", fontFace:"Calibri", margin:0 }); s.addText(body, { x:x+0.08, y:y+0.33, w:w-0.14, h:h-0.38, fontSize:11, color:C.white, fontFace:"Calibri", valign:"top", wrap:true, margin:0 }); } // ════════════════════════════════════════════════════════════════ // SLIDE 1 — TITLE // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; // Left accent bar s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:5.63, fill:{color:C.teal} }); s.addShape(pres.ShapeType.rect, { x:0.25, y:0, w:0.1, h:5.63, fill:{color:C.gold} }); // Title s.addText("ERAS Protocol", { x:0.6, y:0.55, w:9, h:1.5, fontSize:52, bold:true, color:C.white, fontFace:"Calibri", valign:"middle" }); s.addText("Enhanced Recovery After Surgery", { x:0.6, y:2.0, w:9, h:0.55, fontSize:24, color:C.teal, fontFace:"Calibri" }); s.addText("Perioperative Anaesthesia Perspective", { x:0.6, y:2.53, w:9, h:0.4, fontSize:18, color:C.gold, fontFace:"Calibri" }); s.addShape(pres.ShapeType.line, { x:0.6, y:3.0, w:8.2, h:0, line:{color:C.gold, width:2} }); s.addText("MD Anaesthesia | Department of Anaesthesiology", { x:0.6, y:3.1, w:8, h:0.36, fontSize:14, color:C.sky, fontFace:"Calibri" }); s.addText("References: Miller's Anaesthesia 10e • Barash Clinical Anaesthesia 9e • Sabiston Textbook of Surgery • ERAS Society Guidelines", { x:0.6, y:5.2, w:9.2, h:0.25, fontSize:8.5, color:C.lgrey, fontFace:"Calibri" }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 2 — OUTLINE // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Presentation Outline"); addFooter(s, 2); var items = [ ["01","History & Evolution of ERAS","From Kehlet's Fast Track to ERAS Society"], ["02","Rationale & Goals","Surgical stress response, outcomes, evidence"], ["03","ERAS Team & Multidisciplinary Approach","Roles, audit, compliance tracking"], ["04","Pre-Admission Elements","Counselling, prehabilitation, nutritional optimisation"], ["05","Preoperative Elements","Fasting, carbohydrate loading, bowel prep, premedication"], ["06","Intraoperative Elements","Anaesthesia, GODT, PONV, thermoregulation, minimal opioids"], ["07","Postoperative Elements","Early feeding, mobilisation, analgesia, drain/catheter removal"], ["08","ERAS in Specific Surgical Specialties","Colorectal, cardiac, obstetric, urology, bariatric"], ["09","Outcomes & Evidence Base","LOS reduction, complications, survival benefit"], ["10","Barriers & Implementation Framework","Compliance audit, ERAS in India, challenges"], ]; items.forEach(function(item, i) { var col = i<5 ? 0 : 1; var row = i<5 ? i : i-5; var x = col===0 ? 0.28 : 5.18; var y = 1.15+row*0.84; s.addShape(pres.ShapeType.rect, { x, y, w:4.65, h:0.73, fill:{color:C.panel}, line:{color:C.lgrey, width:1} }); s.addShape(pres.ShapeType.rect, { x, y, w:0.46, h:0.73, fill:{color:C.teal} }); s.addText(item[0], { x, y, w:0.46, h:0.73, fontSize:13, bold:true, color:C.dark, align:"center", valign:"middle", fontFace:"Calibri", margin:0 }); s.addText(item[1], { x:x+0.54, y:y+0.05, w:4.04, h:0.34, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", margin:0 }); s.addText(item[2], { x:x+0.54, y:y+0.39, w:4.04, h:0.26, fontSize:9.5, color:C.sky, italic:true, fontFace:"Calibri", margin:0 }); }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 3 — HISTORY & DEFINITION // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "History & Definition of ERAS", "\"Enhanced Recovery After Surgery\" — Fearon, Ljungqvist & Kehlet, 2001"); addFooter(s, 3); // Timeline var tl = [ {yr:"1990s", col:C.pre, txt:"Henrik Kehlet (Denmark) — Fast Track surgery for colorectal patients. 8 elderly patients discharged 2 days post-colectomy (vs 2-week average)"}, {yr:"2001", col:C.blue, txt:"ERAS Group founded: Fearon (UK), Ljungqvist (Sweden), Kehlet (Denmark), de Jong (NL). Name shifted from 'Fast Track' to 'Enhanced Recovery'"}, {yr:"2005", col:C.teal, txt:"First evidence-based ERAS consensus guideline published for colonic resection (Fearon et al. Clin Nutr 2005)"}, {yr:"2010", col:C.green, txt:"ERAS Society formally established. Specialty-specific guidelines begin. Netherlands: 30+ hospitals show 30–50% LOS reduction in <1 year"}, {yr:"2024", col:C.gold, txt:"ERAS Society publishes 30+ specialty guidelines. ERAS adopted globally — colorectal, cardiac, obstetric, bariatric, urology, orthopaedics and more"}, ]; tl.forEach(function(item, i) { var y = 1.15+i*0.83; s.addShape(pres.ShapeType.rect, { x:0.28, y, w:9.44, h:0.72, fill:{color:C.panel}, line:{color:item.col, width:2} }); s.addShape(pres.ShapeType.rect, { x:0.28, y, w:0.88, h:0.72, fill:{color:item.col} }); s.addText(item.yr, { x:0.28, y, w:0.88, h:0.72, fontSize:13, bold:true, color:C.dark, align:"center", valign:"middle", fontFace:"Calibri", margin:0 }); s.addText(item.txt, { x:1.28, y:y+0.1, w:8.3, h:0.55, fontSize:11.5, color:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); s.addText("ERAS = evidence-based, multimodal, multidisciplinary perioperative care pathway designed to attenuate surgical stress & accelerate recovery", { x:0.28, y:5.07, w:9.44, h:0.24, fontSize:10, color:C.gold, italic:true, fontFace:"Calibri" }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 4 — RATIONALE & SURGICAL STRESS RESPONSE // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Rationale — Surgical Stress Response & ERAS Goals", "ERAS modifies the neuroendocrine-metabolic response to surgery"); addFooter(s, 4); bBox(s, 0.28, 1.1, 4.62, 2.5, "Surgical Stress Response (Traditional)", [ "HPA axis activation: ↑ cortisol, ACTH, catecholamines", "Catabolic state: protein breakdown, hyperglycaemia", "Immunosuppression: ↓ NK cells, impaired phagocytosis", "Coagulation activation: DVT, PE risk", "Gut hypoperfusion: bacterial translocation, ileus", "Increased sympathetic tone: HTN, tachycardia", "Prolonged fasting → insulin resistance & muscle wasting", ], C.rose, 11.5); bBox(s, 5.06, 1.1, 4.66, 2.5, "ERAS Interventions Targeting Stress", [ "Carbohydrate loading → attenuates insulin resistance", "Minimally invasive surgery → ↓ tissue trauma", "Thoracic epidural analgesia → blocks HPA activation", "Opioid minimisation → ↓ ileus, earlier feeding", "Goal-directed fluid therapy → organ perfusion", "Normothermia maintenance → ↓ wound infection", "Early enteral feeding → gut mucosal integrity", ], C.teal, 11.5); // Goals bar s.addShape(pres.ShapeType.rect, { x:0.28, y:3.66, w:9.44, h:1.6, fill:{color:C.panel}, line:{color:C.gold, width:1.5} }); s.addText("ERAS Goals — Evidence from Miller's Anaesthesia 10e & Sabiston Surgery", { x:0.42, y:3.68, w:9, h:0.3, fontSize:12, bold:true, color:C.gold, fontFace:"Calibri" }); var goals = [ ["30–50%\nLOS reduction","Complication\nrate ↓ by 50%","Opioid use\nmarkedly ↓","Same-day discharge\nrate ↑ (7%→58%)","5-yr survival\nimproved with compliance"], ]; goals[0].forEach(function(g, i) { var gx = 0.42+i*1.88; s.addShape(pres.ShapeType.rect, { x:gx, y:4.02, w:1.78, h:1.15, fill:{color:C.teal}, line:{color:C.teal, width:1} }); s.addText(g, { x:gx, y:4.02, w:1.78, h:1.15, fontSize:12, bold:true, color:C.dark, align:"center", valign:"middle", fontFace:"Calibri", lineSpacingMultiple:1.2 }); }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 5 — ERAS TEAM & FRAMEWORK // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "ERAS Team — Multidisciplinary Approach & Implementation", "Success depends on ALL providers across ALL perioperative phases — Miller's 10e"); addFooter(s, 5); var members = [ {role:"Anaesthesiologist", color:C.teal, x:0.28, y:1.1, w:3.0, pts:["Preop assessment & optimisation","Anaesthetic technique (regional preference)","Goal-directed fluid therapy (GDFT)","PONV prophylaxis & multimodal analgesia","Normothermia, BIS monitoring","Postop pain management & PACU care"]}, {role:"Surgeon", color:C.blue, x:3.42, y:1.1, w:3.0, pts:["Minimally invasive surgical technique","Optimal incision choice","Drain & NG tube avoidance","Early catheter / drain removal","Bowel prep decision-making","Discharge criteria review"]}, {role:"Nursing & AHP", color:C.gold, x:6.56, y:1.1, w:3.16, pts:["Patient counselling & education","Preop carbohydrate loading protocol","Early mobilisation programme","Nutrition & dietetics input","Physiotherapy — respiratory & mobility","Social work — discharge planning"]}, ]; members.forEach(function(m) { s.addShape(pres.ShapeType.rect, { x:m.x, y:m.y, w:m.w, h:3.92, fill:{color:C.panel}, line:{color:m.color, width:1.5} }); s.addShape(pres.ShapeType.rect, { x:m.x, y:m.y, w:m.w, h:0.35, fill:{color:m.color} }); s.addText(m.role, { x:m.x+0.08, y:m.y, w:m.w-0.14, h:0.35, fontSize:13, bold:true, color:C.dark, valign:"middle", fontFace:"Calibri", margin:0 }); var bl = m.pts.map(function(t,i){ return {text:t, options:{bullet:true, fontSize:11.5, color:C.white, fontFace:"Calibri", breakLine:i<m.pts.length-1}}; }); s.addText(bl, { x:m.x+0.1, y:m.y+0.42, w:m.w-0.18, h:3.42, valign:"top" }); }); s.addShape(pres.ShapeType.rect, { x:0.28, y:5.08, w:9.44, h:0.24, fill:{color:C.panel}, line:{color:C.teal, width:1} }); s.addText("⚑ Continuous audit of ERAS compliance is mandatory — outcomes improve linearly with protocol adherence (Gustafsson et al.)", { x:0.38, y:5.08, w:9.24, h:0.24, fontSize:10, color:C.teal, fontFace:"Calibri", valign:"middle" }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 6 — PRE-ADMISSION ELEMENTS // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Pre-Admission ERAS Elements", "Prehabilitation, optimisation & education — begins weeks before surgery"); addFooter(s, 6); bBox(s, 0.28, 1.1, 4.62, 2.15, "Patient Education & Counselling", [ "Detailed explanation of surgical pathway & expectations","Set realistic recovery goals (early ambulation, oral feeding)","Written + verbal information provided","Reduce anxiety → ↓ preoperative sedation need","Family/caregiver involvement in planning","Telemedicine / phone-call follow-up pathway explained", ], C.pre, 11.5); bBox(s, 5.06, 1.1, 4.66, 2.15, "Prehabilitation", [ "Exercise programme 4–8 weeks before surgery","↑ Cardiorespiratory reserve, ↑ functional capacity","Protein-rich diet + oral nutritional supplements","Respiratory physiotherapy (incentive spirometry)","Smoking cessation ≥ 4 weeks before surgery","Alcohol reduction ≥ 4 weeks before surgery", ], C.pre, 11.5); bBox(s, 0.28, 3.3, 4.62, 2.0, "Nutritional Assessment & Optimisation", [ "Malnutrition screening: NRS-2002 or MUST score","Preop oral nutritional supplements if NRS ≥ 3","Preoperative enteral feeding 7–14 days if severely malnourished","Correct anaemia (iron supplementation / EPO)","Haemoglobin target ≥ 10 g/dL before elective surgery", ], C.gold, 11.5); bBox(s, 5.06, 3.3, 4.66, 2.0, "Medical Optimisation", [ "Blood glucose control: HbA1c < 8% target","Antihypertensive optimisation — avoid interruption","Cardiac risk assessment (RCRI, functional capacity)","Anaemia workup: iron studies, B12, folate","DVT / PE risk assessment — LMWH prophylaxis plan","Review and rationalise chronic opioid use", ], C.gold, 11.5); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 7 — PREOPERATIVE ELEMENTS (DAY OF SURGERY) // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Preoperative ERAS Elements — Day of Surgery", "Avoiding prolonged fasting & metabolic stress — ERAS Society Guidelines"); addFooter(s, 7); card(s, 0.28, 1.08, 3.0, 2.05, "Fasting Guidelines", "Clear fluids: allowed until 2h pre-op\nSolids: NPO 6h pre-op\nBreast milk: 4h; formula: 6h (paeds)\nAvoid prolonged fasting → ↑ insulin resistance\nNO routine overnight fasting", C.pre); card(s, 3.44, 1.08, 3.0, 2.05, "Carbohydrate (CHO) Loading", "200 mL complex CHO drink (maltodextrin 12.5%)\n800 mL evening before surgery\n400 mL 2–3h before induction\n↓ Insulin resistance by 50%\n↓ Nausea, anxiety, hunger\nContraindicated: diabetics (assess individually)", C.pre); card(s, 6.6, 1.08, 3.12, 2.05, "Bowel Preparation", "Routine mechanical bowel prep ABANDONED\nEvidence: ↑ dehydration, electrolyte imbalance\nSelective use for left colon / rectal surgery\nOral antibiotics ± mechanical prep for colorectal (2019 update)\nNo bowel prep for upper GI, hepatic, urological", C.gold); card(s, 0.28, 3.2, 3.0, 2.08, "Premedication", "Anxiolytics: use minimally / avoid\nLong-acting benzodiazepines AVOIDED\n(↓ early mobilisation, POCD risk)\nGabapentin / pregabalin: preop multimodal analgesia\nCOX-2 inhibitor / paracetamol: analgesic preload\nAntacids if aspiration risk", C.blue); card(s, 3.44, 3.2, 3.0, 2.08, "Thromboprophylaxis", "LMWH: enoxaparin 40 mg SC — night before\nCompression stockings + pneumatic devices\nEarly mobilisation as key mechanical prophylaxis\nExtended thromboprophylaxis 4 wks for cancer sx\nBridge with LMWH for high-risk patients on warfarin", C.blue); card(s, 6.6, 3.2, 3.12, 2.08, "Antimicrobial Prophylaxis", "IV antibiotics 60 min before incision\nCefazolin 1–3 g based on weight\nRedosing if prolonged surgery (> 4h) or >1500 mL blood loss\nSkin antisepsis: chlorhexidine-alcohol prep\nAvoid routine postop antibiotics", C.blue); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 8 — INTRAOPERATIVE ELEMENTS — ANAESTHESIA // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Intraoperative ERAS Elements — Anaesthesia Techniques", "Minimise opioids, control stress response, maintain homeostasis"); addFooter(s, 8); bBox(s, 0.28, 1.08, 4.6, 2.1, "Anaesthetic Technique", [ "TIVA with propofol/remifentanil preferred over volatile agents","Short-acting anaesthetics → rapid, smooth emergence","Regional anaesthesia preferred: epidural / spinal / peripheral blocks","Thoracic epidural (T8–T10): gold standard for open abdominal sx","BIS monitoring (40–60) → prevents awareness & over-sedation","Neuromuscular monitoring (TOF) → guided reversal", ], C.intra, 11.5); bBox(s, 5.06, 1.08, 4.66, 2.1, "Opioid-Sparing Multimodal Analgesia", [ "Pre-emptive: paracetamol + COX-2 inhibitor + gabapentinoid","Intraop IV adjuncts: ketamine 0.1–0.3 mg/kg, magnesium 50 mg/kg","Lidocaine infusion 1.5 mg/kg/h → opioid sparing, gut motility","Dexmedetomidine: sympatholysis, opioid reduction","Local infiltration / TAP / rectus sheath / wound infiltration","Target: ZERO intraop opioid or minimal fentanyl", ], C.intra, 11.5); bBox(s, 0.28, 3.24, 4.6, 2.05, "Goal-Directed Fluid Therapy (GDFT)", [ "Monitor: oesophageal Doppler / FloTrac / LiDCO / PICCO","Target: stroke volume variation (SVV) < 10–13%","Restrict crystalloid; avoid salt & water overload","Maintain euvolaemia — avoid hypo- AND hypervolaemia","Vasopressors (noradrenaline) to correct vasodilation","Transfusion trigger: Hb < 7–8 g/dL (restrictive strategy)", ], C.blue, 11.5); bBox(s, 5.06, 3.24, 4.66, 2.05, "PONV Prophylaxis & Other Intraop Elements", [ "Apfel score: ≥ 2 → dual prophylaxis mandatory","Ondansetron 4 mg + dexamethasone 4–8 mg IV","Avoid N₂O — emetogenic, bowel distension","Normothermia: forced-air warming, warm IV fluids (target 36–37°C)","Avoid routine NG tubes — insert only if needed intraop, remove early","Minimally invasive surgery (laparoscopic) preferred", ], C.blue, 11.5); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 9 — POSTOPERATIVE ELEMENTS // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Postoperative ERAS Elements", "Early feeding, mobilisation, analgesia & removal of lines"); addFooter(s, 9); bBox(s, 0.28, 1.08, 4.6, 2.12, "Postoperative Analgesia — Multimodal", [ "Continue epidural infusion 48–72h (open abdominal sx)","Bupivacaine 0.1–0.25% ± fentanyl 2 µg/mL @ 4–10 mL/h","Regular paracetamol 1 g QID + NSAIDs if no contraindication","Avoid routine systemic opioids; PRN morphine as rescue only","Gabapentinoids — reduce opioid requirement","PCA morphine if epidural not feasible; limit duration", ], C.post, 11.5); bBox(s, 5.06, 1.08, 4.66, 2.12, "Early Enteral Nutrition & Oral Fluids", [ "Clear fluids within 2–4h of surgery","Solid diet by 6–8h postoperatively (abdominal sx)","Early feeding: ↓ ileus, ↓ infection, ↓ LOS","Remove NG tube before end of surgery (or within 24h)","Oral nutritional supplements for 4–6 weeks post-discharge","High-protein diet (1.2–1.5 g/kg/day) during recovery", ], C.post, 11.5); bBox(s, 0.28, 3.26, 4.6, 2.0, "Early Mobilisation", [ "Sit out of bed POD 0 (same day) if stable","Walk in corridor by POD 1 — structured physiotherapy","Mobilisation target chart displayed at bedside","↓ DVT risk, ↓ pneumonia, ↓ muscle wasting","Early mobilisation requires: adequate pain control, no IV lines","Physiotherapy twice daily from POD 1", ], C.green, 11.5); bBox(s, 5.06, 3.26, 4.66, 2.0, "Early Removal of Tubes, Lines & Catheters", [ "Urinary catheter: remove POD 1 (unless pelvic surgery)","IV cannula: convert to oral medications ASAP","Drains: avoid routine use; remove by POD 2 if used","NG tube: NO routine use postoperatively","Epidural: consider removal POD 2–3 if oral analgesia adequate","Monitor urine output without catheter (voiding trial)", ], C.green, 11.5); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 10 — ERAS IN SPECIFIC SPECIALTIES // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "ERAS in Specific Surgical Specialties", "ERAS Society publishes 30+ specialty-specific guidelines — Table 22.1 (Sabiston Surgery)"); addFooter(s, 10); var specs = [ {title:"Colorectal Surgery", col:C.teal, x:0.28, y:1.08, w:3.08, pts:["First ERAS guideline (2005, 2019 update)","TEA standard for open surgery","Laparoscopic preferred where possible","Selective mechanical bowel prep + oral antibiotics","LOS: 2 days vs 7–10 days conventional"]}, {title:"Cardiac Surgery", col:C.blue, x:3.5, y:1.08, w:3.08, pts:["Fast-track extubation within 4–8h","Multimodal analgesia: dexmedetomidine + paracetamol","Ketamine infusion — reduces ICU delirium","Early enteral feeding via NG/NJ if needed","Glycaemic control: target 140–180 mg/dL in ICU"]}, {title:"Obstetrics / LSCS", col:C.gold, x:6.72, y:1.08, w:3.0, pts:["Spinal anaesthesia — standard","Carbetocin preferred over oxytocin infusion","Early PO clear fluids 2–4h post-LSCS","Transversus abdominis plane (TAP) block","Early ambulation: 6–12h post-LSCS","Urinary catheter out within 12–24h"]}, {title:"Bariatric Surgery", col:C.amber, x:0.28, y:3.52, w:3.08, pts:["Short-acting TIVA preferred","RSI / awake FOI for difficult airway","Opioid minimisation critical (OSA risk)","TEP / TAP block or wound infiltration","Early VTE prophylaxis; continue post-discharge","LOS 1–2 days (vs 3–5 days conventional)"]}, {title:"Urology (RC / RP)", col:C.rose, x:3.5, y:3.52, w:3.08, pts:["ERAS for radical cystectomy (2013 guideline)","TEA ± liposomal bupivacaine","Early removal of ureteric stents & drains","Oral feeding within 24h post-cystectomy","Alvimopan (peripherally acting µ-antagonist) for ileus"]}, {title:"Orthopaedics (TKR/THR)", col:C.green, x:6.72, y:3.52, w:3.0, pts:["Spinal/regional ± sedation preferred","Tranexamic acid — blood loss minimisation","Multimodal analgesia: NJB, adductor canal block","No routine drains in TKR/THR","Same-day discharge protocols in low-risk patients"]}, ]; specs.forEach(function(sp) { s.addShape(pres.ShapeType.rect, { x:sp.x, y:sp.y, w:sp.w, h:1.9, fill:{color:C.panel}, line:{color:sp.col, width:1.5} }); s.addShape(pres.ShapeType.rect, { x:sp.x, y:sp.y, w:sp.w, h:0.3, fill:{color:sp.col} }); s.addText(sp.title, { x:sp.x+0.08, y:sp.y, w:sp.w-0.14, h:0.3, fontSize:11.5, bold:true, color:C.dark, valign:"middle", fontFace:"Calibri", margin:0 }); var bl = sp.pts.map(function(t,i){ return {text:t, options:{bullet:true, fontSize:10.5, color:C.white, fontFace:"Calibri", breakLine:i<sp.pts.length-1}}; }); s.addText(bl, { x:sp.x+0.1, y:sp.y+0.34, w:sp.w-0.18, h:1.5, valign:"top" }); }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 11 — OUTCOMES & EVIDENCE BASE // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "ERAS Outcomes & Evidence Base", "Miller's Anaesthesia 10e • Sabiston Surgery • ERAS Society Meta-analyses"); addFooter(s, 11); var outcomes = [ {label:"Hospital LOS\nReduced", val:"30–50%", col:C.teal, sub:"Netherlands study\n>30 hospitals"}, {label:"Complications\nDecreased", val:"~50%", col:C.green, sub:"Lobo et al.\nColorectal ERAS"}, {label:"Opioid\nConsumption ↓", val:"Significant", col:C.gold, sub:"Ambulatory ERAS\ncenter study"}, {label:"Same-Day\nDischarge ↑", val:"7%→58%", col:C.blue, sub:"Breast cancer\nERAS center"}, {label:"5-Year\nSurvival ↑", val:"Improved", col:C.amber, sub:"Gustafsson et al.\nCompliance link"}, ]; outcomes.forEach(function(o, i) { var x = 0.28+i*1.9; s.addShape(pres.ShapeType.rect, { x, y:1.08, w:1.8, h:1.5, fill:{color:o.col} }); s.addText(o.val, { x, y:1.08, w:1.8, h:0.7, fontSize:26, bold:true, color:C.dark, align:"center", valign:"middle", fontFace:"Calibri", margin:0 }); s.addText(o.label, { x, y:1.78, w:1.8, h:0.5, fontSize:11, bold:true, color:C.dark, align:"center", fontFace:"Calibri", margin:0 }); s.addShape(pres.ShapeType.rect, { x, y:2.62, w:1.8, h:0.48, fill:{color:C.panel} }); s.addText(o.sub, { x, y:2.62, w:1.8, h:0.48, fontSize:9.5, color:C.sky, align:"center", fontFace:"Calibri", valign:"middle" }); }); bBox(s, 0.28, 3.16, 9.44, 2.1, "Key Trial Evidence", [ "Gustafsson et al.: Compliance with ERAS → linear reduction in complications & 30-day mortality in colorectal surgery. Higher compliance = better outcomes", "ERAS vs RCT (appendectomy): ERAS mean discharge 9.7h vs 23.2h conventional; equal readmission rates (Miller's 10e, p.10042)", "POWER Study (JAMA Surg 2019): ERAS protocol use associated with significantly ↓ postoperative complications in colorectal surgery", "Breast cancer center: Same-day discharge 7.2% → 58.6%; LOS reduced 1.6 → 1.2 days after ERAS implementation (Miller's 10e)", ], C.gold, 11); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 12 — BARRIERS & COMPLIANCE AUDIT // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Barriers to ERAS Implementation & Compliance Audit", "Critical insight: teams are often wrong about their own compliance — Sabiston Surgery"); addFooter(s, 12); bBox(s, 0.28, 1.08, 4.6, 2.1, "Common Barriers to ERAS", [ "Lack of multidisciplinary team coordination","Resistance from surgeons / nursing staff to change practice","Complex protocols → risk of missed elements (16 elements in colorectal ERAS)","Resource constraints: staffing, monitoring equipment","Patient non-compliance with early ambulation or feeding","Inadequate preoperative education infrastructure", ], C.rose, 11.5); bBox(s, 5.06, 1.08, 4.66, 2.1, "Compliance Audit — ERAS Programme", [ "Prospective database: capture ALL ERAS elements per patient","Regular audit cycle: monthly team review of compliance data","Teams consistently overestimate their own compliance","Target: > 70% overall compliance for outcome benefits","ERAS Interactive Audit System (EIAS) — errassociety.org","Feedback loop: data → practice change → re-audit", ], C.teal, 11.5); bBox(s, 0.28, 3.24, 4.6, 2.05, "ERAS in India — Challenges", [ "Variable surgical volume & infrastructure","Staff training & turnover issues","Cost of GDFT monitoring equipment","Cultural barriers: patients expect prolonged bed rest","High patient load → protocol adherence difficult","Emerging ERAS centres in tertiary hospitals (AIIMS, CMC)", ], C.gold, 11.5); bBox(s, 5.06, 3.24, 4.66, 2.05, "Implementation Framework (WHO Surgical Safety)", [ "Phase 1: Steering committee + pilot team formation","Phase 2: Baseline audit — identify gaps in current practice","Phase 3: Protocol development + staff training","Phase 4: Roll-out with real-time data collection","Phase 5: Monthly audit-feedback-revision cycle","Phase 6: Publication & regional scale-up", ], C.teal, 11.5); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 13 — ERAS PATHWAY OVERVIEW (VISUAL SUMMARY TABLE) // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "ERAS Protocol — Complete Pathway at a Glance", "Based on ERAS Society Colorectal Guidelines (Fearon 2005, Gustafsson 2019) — Extended to All Specialties"); addFooter(s, 13); var phases = [ {label:"PREADMISSION", col:C.pre, x:0.28, items:[ "Patient counselling & education","Prehabilitation (exercise, physiotherapy)","Nutritional screening (NRS-2002)","Correct anaemia (iron / EPO)","HbA1c < 8%; BP optimisation","Smoking / alcohol cessation", ]}, {label:"PREOPERATIVE", col:C.blue, x:2.68, items:[ "CHO loading (800 mL evening; 400 mL 2h pre)","Fasting: clear fluids until 2h before","NO routine bowel prep (selective)","Prophylactic antibiotics 60 min pre-incision","LMWH + TED stockings","Minimal / no premedication (avoid BDZ)", ]}, {label:"INTRAOPERATIVE", col:C.intra, x:5.08, items:[ "TIVA / short-acting agents / regional preferred","GDFT (Doppler / FloTrac — SVV < 13%)","Opioid-sparing analgesia (ketamine, Mg, lidocaine)","PONV prophylaxis (2-drug: 5HT3 + dex)","Normothermia (forced-air warming)","MIS — laparoscopic / robotic", ]}, {label:"POSTOPERATIVE", col:C.post, x:7.48, items:[ "Oral fluids 2–4h; diet by 6–8h postop","Regular paracetamol + NSAID","Epidural infusion 48–72h (open cases)","Early mobilisation: sit POD 0; walk POD 1","Remove catheter POD 1; IV line ASAP","Discharge audit + 30-day follow-up", ]}, ]; phases.forEach(function(ph) { s.addShape(pres.ShapeType.rect, { x:ph.x, y:1.08, w:2.26, h:4.2, fill:{color:C.panel}, line:{color:ph.col, width:2} }); s.addShape(pres.ShapeType.rect, { x:ph.x, y:1.08, w:2.26, h:0.38, fill:{color:ph.col} }); s.addText(ph.label, { x:ph.x+0.06, y:1.08, w:2.14, h:0.38, fontSize:11, bold:true, color:C.dark, align:"center", valign:"middle", fontFace:"Calibri", margin:0 }); var bl = ph.items.map(function(t,i){ return {text:t, options:{bullet:true, fontSize:10.8, color:C.white, fontFace:"Calibri", breakLine:i<ph.items.length-1}}; }); s.addText(bl, { x:ph.x+0.1, y:1.5, w:2.1, h:3.68, valign:"top" }); }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 14 — SUMMARY & KEY TAKEAWAYS // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "Summary & Key Takeaways"); addFooter(s, 14); var pts = [ [C.teal, "ERAS is an evidence-based, multidisciplinary perioperative care programme designed to attenuate surgical stress & accelerate recovery (Kehlet 1990s → ERAS Society 2010)"], [C.gold, "Four phases: Pre-admission (prehabilitation), Preoperative (CHO loading, antibiotics), Intraoperative (GDFT, opioid-sparing, normothermia), Postoperative (early feeding, mobilisation)"], [C.teal, "ERAS reduces LOS by 30–50%, complications by ~50%, and with higher compliance, improves 5-year survival in colorectal cancer surgery (Gustafsson et al.)"], [C.gold, "Anaesthesiologist's role is central: regional anaesthesia, GDFT, PONV prophylaxis, opioid-minimisation, BIS monitoring and early PACU extubation"], [C.green, "Thoracic epidural analgesia (T8–T10) remains gold standard for open abdominal surgery within ERAS; TIVA with propofol/remifentanil preferred over volatile agents"], [C.gold, "Carbohydrate loading (800 mL evening + 400 mL 2h pre-op) reduces insulin resistance by 50%; routine overnight fasting is ABANDONED in ERAS"], [C.green, "ERAS Society guidelines now cover 30+ surgical specialties — tailored protocols essential for colorectal, cardiac, obstetric, bariatric, urology & orthopaedic patients"], [C.rose, "Compliance audit is mandatory — teams overestimate adherence. Target > 70% compliance. Outcomes improve linearly with better protocol adherence"], ]; pts.forEach(function(item, i) { var y = 1.08+i*0.53; s.addShape(pres.ShapeType.rect, { x:0.28, y, w:9.44, h:0.47, fill:{color:C.panel}, line:{color:C.lgrey, width:0.5} }); s.addShape(pres.ShapeType.rect, { x:0.28, y, w:0.2, h:0.47, fill:{color:item[0]} }); s.addText(item[1], { x:0.58, y, w:9.1, h:0.47, fontSize:11, color:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); })(); // ════════════════════════════════════════════════════════════════ // SLIDE 15 — REFERENCES // ════════════════════════════════════════════════════════════════ (function(){ var s = pres.addSlide(); s.background = {color:C.dark}; addHeader(s, "References"); addFooter(s, 15); var refs = [ "1. Miller RD et al. Miller's Anaesthesia, 10th Edition. Elsevier, 2023. Chapter 27: Ambulatory Anaesthesia — ERAS (p.10041–10043); Chapter 3: Perioperative Management (p.352–354).", "2. Barash PG et al. Barash Clinical Anaesthesia, 9th Edition. Wolters Kluwer, 2023. Enhanced Recovery After Surgery.", "3. Townsend CM et al. Sabiston Textbook of Surgery, 21st Edition. Elsevier, 2022. Chapter 22: Enhanced Recovery After Surgery (p.368–393).", "4. Fearon KC, Ljungqvist O, Von Meyenfeldt M et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466–477.", "5. Gustafsson UO et al. Adherence to the Enhanced Recovery After Surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146(5):571–577.", "6. ERAS Society Guidelines 2019 (Colorectal Surgery update): Gustafsson UO et al. World J Surg. 2019;43:659–695.", "7. Scott MJ et al. ERAS Society Recommendations for Anesthesia for Gastrointestinal Surgery Part 1. Acta Anaesthesiol Scand. 2015;59:1212–1231.", "8. POWER Study: Association between ERAS protocol use and postoperative complications in colorectal surgery. JAMA Surg. 2019;154(8):725–736.", ]; refs.forEach(function(ref, i) { s.addText(ref, { x:0.35, y:1.1+i*0.52, w:9.35, h:0.46, fontSize:10.8, color:i===0?C.sky:C.white, fontFace:"Calibri", valign:"middle", wrap:true, margin:0 }); }); })(); // ── SAVE ──────────────────────────────────────────────────────── pres.writeFile({ fileName: "/home/daytona/workspace/eras-ppt/ERAS_Protocol_MD_Anaesthesia.pptx" }) .then(function(){ console.log("SUCCESS"); }) .catch(function(e){ console.error("ERROR:", e); }); ENDOFSCRIPT echo "Script written OK"

cd /home/daytona/workspace/eras-ppt && node build.js && ls -lh *.pptx