mkdir -p /home/daytona/workspace/perioperative-care-ppt && ls /home/daytona/work…

~/perioperative-care-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
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pres.author = 'Bailey and Love 28th Edition';
pres.title = 'Perioperative Care';

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// ─────────────────────────────────────────────────────────────────────────────
// HELPER FUNCTIONS
// ─────────────────────────────────────────────────────────────────────────────

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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1: TITLE
// ─────────────────────────────────────────────────────────────────────────────
titleSlide("Perioperative Care", "Comprehensive Overview for the Surgical Team");

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2: OUTLINE
// ─────────────────────────────────────────────────────────────────────────────
contentSlide("Outline", [
  { heading:"1. Introduction & Multidisciplinary Team" },
  { text:"Definition, team composition, aims" },
  { heading:"2. Preoperative Assessment" },
  { text:"History, examination, risk stratification" },
  { heading:"3. Prehabilitation & Patient Optimisation" },
  { text:"Fitness, smoking, anaemia, glycaemic control" },
  { heading:"4. Anaesthesia — Types & Preparation" },
  { text:"GA, regional, local; monitoring" },
  { heading:"5. Intraoperative Care" },
  { text:"Ventilation, fluid management, safety checklists" },
  { heading:"6. Postoperative Care & Monitoring" },
  { text:"NEWS, PACU, common complications" },
  { heading:"7. Enhanced Recovery (ERAS)" },
  { text:"Core elements, early mobilisation, discharge" },
], { fontSize:14 });

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 1
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(1, "Introduction &\nMultidisciplinary Team", "What is Perioperative Care?");

contentSlide("Perioperative Care — Definition", [
  "Perioperative care is integrated care delivered to the patient by a multidisciplinary team before, during and after surgery",
  "Aims to improve patient outcome and reduce healthcare-related costs",
  "The MDT brings together the patient and care team in the perioperative period",
  "Input varies depending on medical condition and complexity of surgery",
  "Risk assessment: simple blood tests → sophisticated CPET for fitness assessment",
  "WHO Surgical Safety Checklist routinely used to prevent surgical errors",
  "Anaesthetists are extending their care into pre- and postoperative phases",
]);

contentSlide("The Perioperative MDT (Table 21.12)", [
  { heading:"Clinical Team" },
  { sub:"Ward, theatre and specialist nursing staff" },
  { sub:"Anaesthetic and surgical teams" },
  { sub:"Acute medicine, cardiology, care of the elderly" },
  { heading:"Allied Health Professionals" },
  { sub:"Physiotherapists and occupational therapists" },
  { sub:"Rehabilitation and social care workers" },
  { heading:"Support Services" },
  { sub:"Radiology and pathology teams" },
  { sub:"Administration and scheduling team" },
  { sub:"Specific personnel, e.g. cardiac devices team" },
]);

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 2
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(2, "Preoperative Assessment", "Know before you operate");

contentSlide("History Taking — Key Domains", [
  { heading:"Cardiovascular" },
  { sub:"Chest pain, palpitations, syncope, hypertension, heart failure" },
  { heading:"Respiratory" },
  { sub:"Dyspnoea, wheeze, cough, asthma, COPD, sleep apnoea" },
  { heading:"Haematological" },
  { sub:"Bleeding disorders, DVT/PE history, sickle cell, objection to blood products" },
  { heading:"Infection" },
  { sub:"HIV/hepatitis/tuberculosis, MRSA, COVID-19, drug-resistant organisms" },
  { heading:"Previous Surgery & Anaesthesia" },
  { sub:"Difficult Airway Society Alert, suxamethonium apnoea, malignant hyperpyrexia" },
]);

tableSlide("Medical Examination (Table 21.2)",
  ["System", "What to Assess"],
  [
    ["General",        "Anaemia, jaundice, cyanosis, frailty, nutritional status, BMI"],
    ["Cardiovascular", "Pulse rate/rhythm, BP, heart sounds, JVP, peripheral oedema, exercise tolerance"],
    ["Respiratory",    "Rate & effort, chest expansion, percussion, breath sounds, SpO2, PEFR"],
    ["Gastrointestinal","Abdominal masses, ascites, bowel sounds, hernia"],
    ["Neurological",   "Consciousness, cognitive function, power, tone, reflexes"],
    ["Airway",         "Mouth opening, neck extension, Mallampati, thyromental distance, dentition"],
  ],
  [3.2, 9.8]
);

contentSlide("Preoperative Assessment for Emergency Surgery", [
  "Same principles as elective surgery — but time is limited",
  "NCEPOD classification: Immediate (minutes) → Urgent (hours) → Expedited (days) → Elective",
  "Medical assessment starts even if surgery is time-critical",
  "Optimisation may continue in critical care preoperatively",
  "Some risks will persist — discuss with patient during consent",
  "Early identification of need for postoperative critical care",
  "Safety checklists ensure nothing is forgotten under pressure",
  "Risk assessments guide best strategy selection",
]);

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 3
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(3, "Prehabilitation &\nOptimisation", "Improving reserve before the knife");

contentSlide("Prehabilitation — Core Concept", [
  "Prehabilitation: improving functional capacity of patients prior to major surgery",
  "Goal: improve postoperative outcomes in patients with poor functional reserve",
  "The window between decision to operate and surgery date is used effectively",
  { heading:"Specific Optimisation Steps" },
  { sub:"Stop smoking — reduces pulmonary complications significantly" },
  { sub:"Reduce alcohol intake" },
  { sub:"Lose weight (high BMI increases risk)" },
  { sub:"Treat pre-existing anaemia" },
  { sub:"Control blood sugar in diabetic patients" },
  { sub:"Review and modify existing medications" },
]);

contentSlide("Cardiopulmonary Exercise Testing (CPET)", [
  "CPET: sophisticated test to objectively assess patient's level of fitness",
  "Identifies occult cardiorespiratory limitation not apparent from history alone",
  "Key measures: VO2 max, anaerobic threshold (AT)",
  "AT < 11 mL/kg/min associated with increased perioperative mortality",
  "Guides decision-making for high-risk surgery and ICU bed planning",
  "Helps in counselling patients and obtaining informed consent",
  "Combined with subjective functional assessment (METs)",
  "Part of the risk stratification pathway before major elective surgery",
]);

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 4
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(4, "Anaesthesia", "Types, Preparation & Monitoring");

contentSlide("Preparation for Anaesthesia", [
  "Surgeon and anaesthetist cooperate for thorough preoperative assessment",
  "Recognise medical and anaesthetic risk factors, facilitate optimisation",
  "Careful preassessment + MDT approach + standardised care pathway = Enhanced Recovery",
  { heading:"General Anaesthetic Triad (Summary Box 23.2)" },
  { sub:"Amnesia: loss of awareness" },
  { sub:"Analgesia: pain relief" },
  { sub:"Muscle relaxation" },
]);

tableSlide("IV Anaesthetic Agents — Key Features",
  ["Agent", "Class", "Key Properties"],
  [
    ["Propofol",    "Di-isopropyl phenol",  "Smooth induction, haemodynamic stability, use as infusion (TIVA), antiemetic"],
    ["Thiopentone", "Barbiturate",           "Rapid induction, myocardial depression, lowers ICP (neurosurgery)"],
    ["Etomidate",   "Steroid derivative",    "Good haemodynamic stability, brief action; risk of adrenocortical depression"],
    ["Ketamine",    "Phencyclidine",         "Dissociative; maintains airway reflexes; useful in haemodynamic compromise"],
    ["Sevoflurane", "Inhalational (vapour)", "Non-pungent; useful for inhalational induction in children/difficult airway"],
  ],
  [3.0, 3.0, 7.0]
);

contentSlide("Types of Anaesthesia", [
  { heading:"General Anaesthesia (GA)" },
  { sub:"IV induction (propofol most common), maintained by inhalational or TIVA" },
  { sub:"Airway: facemask, LMA or endotracheal tube depending on procedure" },
  { heading:"Regional / Neuraxial" },
  { sub:"Spinal: single-shot intrathecal LA; rapid dense block; used for lower limb/obstetric/pelvic surgery" },
  { sub:"Epidural: catheter in epidural space; slower onset; excellent for post-op analgesia" },
  { sub:"Peripheral nerve blocks: TAP, erector spinae, femoral, brachial plexus etc." },
  { heading:"Local Anaesthesia" },
  { sub:"Topical, infiltration, or Bier's block (IVRA) for limb surgery" },
  { sub:"Prilocaine used for Bier's; bupivacaine NEVER used (cardiac toxicity risk)" },
]);

contentSlide("Ventilation During Anaesthesia", [
  "Mechanical ventilation required when spontaneous ventilation is inadequate",
  { heading:"Volume Control Ventilation" },
  { sub:"Preset tidal volume delivered regardless of airway pressure" },
  { sub:"Risk: barotrauma (pneumothorax) in obese, laparoscopic, Trendelenburg patients" },
  { heading:"Pressure Control Ventilation" },
  { sub:"Flow generated until preset pressure reached" },
  { sub:"Tidal volume varies with airway resistance and intra-abdominal pressure" },
  { heading:"PEEP (Positive End-Expiratory Pressure)" },
  { sub:"Maintains functional residual capacity, opens collapsed alveoli" },
  { sub:"Reduces vascular shunting, improves gas exchange" },
]);

contentSlide("Intraoperative Monitoring (Minimum Standard)", [
  { heading:"Cardiovascular" },
  { sub:"ECG (continuous cardiac monitoring)" },
  { sub:"Non-invasive blood pressure (NIBP)" },
  { heading:"Ventilation & Oxygenation" },
  { sub:"Inspired oxygen concentration" },
  { sub:"SpO2 by pulse oximetry" },
  { sub:"End-tidal CO2 (capnography)" },
  { heading:"For Major Surgery (Additional)" },
  { sub:"Temperature monitoring" },
  { sub:"Urine output (hourly via catheter)" },
  { sub:"Central venous pressure (CVP)" },
  { sub:"Delivery of anaesthetic agents (volatile monitoring)" },
]);

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 5
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(5, "Intraoperative Care", "Fluid Management, Safety & Positioning");

contentSlide("Perioperative Fluid Management", [
  "Goal: maintain euvolaemia — avoid both under- and over-hydration",
  { heading:"Crystalloids" },
  { sub:"Normal saline: risk of hyperchloraemic acidosis with large volumes" },
  { sub:"Balanced solutions (Hartmann's/Ringer's lactate) preferred for most cases" },
  { heading:"Colloids" },
  { sub:"HES (hydroxyethyl starch): associated with AKI and coagulopathy — avoid in sepsis" },
  { sub:"Albumin: considered in liver failure / hypoalbuminaemia" },
  { heading:"Goal-Directed Fluid Therapy (GDFT)" },
  { sub:"Uses stroke volume, cardiac output monitoring (e.g. oesophageal Doppler)" },
  { sub:"Targets optimal tissue perfusion with minimal fluid loading" },
]);

contentSlide("WHO Surgical Safety Checklist", [
  { heading:"Sign In (before induction of anaesthesia)" },
  { sub:"Patient identity, site, procedure confirmed" },
  { sub:"Consent verified; anaesthesia equipment checked; allergies reviewed" },
  { heading:"Time Out (before skin incision)" },
  { sub:"All team members introduced; surgeon confirms procedure and critical steps" },
  { sub:"Antibiotic prophylaxis given; imaging displayed" },
  { heading:"Sign Out (before patient leaves theatre)" },
  { sub:"Procedure name confirmed; instrument, swab and needle count correct" },
  { sub:"Specimens labelled; equipment issues addressed" },
  { sub:"Surgeon, anaesthetist and nurse verbally confirm postoperative care plan" },
]);

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 6
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(6, "Postoperative Care", "Monitoring, Complications & Recovery");

contentSlide("Postoperative Settings — Levels of Care", [
  "Routine ward: for low-risk patients recovering from straightforward procedures",
  "Post-Anaesthesia Care Unit (PACU): 24-48 h intensive monitoring post major surgery",
  "Overnight Intensive Recovery (OIR): intermediate care for moderate-risk patients",
  "High Dependency Unit (HDU): single organ support, close monitoring",
  "Intensive Care Unit (ICU): multi-organ support; ventilation; vasopressors",
  "Level of care determined by procedure complexity and patient comorbidities",
  "Good communication between hospital and community facilitates safe discharge",
]);

contentSlide("National Early Warning Score (NEWS)", [
  "NEWS: aggregate scoring system to detect clinical deterioration early",
  { heading:"Physiological Parameters Scored" },
  { sub:"Respiratory rate (≥25 = score 3; ≤8 = score 3)" },
  { sub:"SpO2 (≤91 = high score; target ≥96)" },
  { sub:"Heart rate, blood pressure, temperature" },
  { sub:"Level of consciousness (AVPU)" },
  { sub:"Supplemental oxygen use adds to score" },
  { heading:"Action Thresholds" },
  { sub:"Score 0-4: routine monitoring" },
  { sub:"Score 5-6: urgent review by clinician" },
  { sub:"Score ≥7: emergency response — consider ICU" },
]);

contentSlide("Common Postoperative Complications", [
  { heading:"Respiratory" },
  { sub:"Atelectasis, pneumonia — Rx: chest physio, adequate analgesia, avoid fluid overload" },
  { sub:"Respiratory failure — may require HDU/ICU support" },
  { heading:"Cardiovascular" },
  { sub:"Atrial fibrillation (15-20% post oesophagectomy) — treat with antiarrhythmics" },
  { sub:"Perioperative myocardial infarction — watch for ECG changes, troponin rise" },
  { heading:"Renal" },
  { sub:"Acute kidney injury (AKI) — monitor urine output, avoid nephrotoxins" },
  { heading:"Surgical Site" },
  { sub:"Wound infection, dehiscence, anastomotic leak" },
  { sub:"DVT/PE — early mobilisation, prophylaxis essential" },
]);

contentSlide("Pain Management — Multimodal Analgesia", [
  "Postoperative pain delays recovery, increases chest complications and risk of chronic pain",
  { heading:"WHO Analgesic Ladder" },
  { sub:"Step 1: Paracetamol + NSAIDs (regular dosing)" },
  { sub:"Step 2: Weak opioids (codeine, tramadol)" },
  { sub:"Step 3: Strong opioids (morphine, oxycodone) — titrate carefully" },
  { heading:"Multimodal Approach (ERAS-aligned)" },
  { sub:"Regular paracetamol + NSAID as baseline" },
  { sub:"Regional blocks (epidural, TAP, nerve blocks) — opioid-sparing" },
  { sub:"PCA (Patient-Controlled Analgesia) for IV opioid delivery" },
  { sub:"Avoid long-acting IV opioids in day surgery (delay discharge)" },
]);

// ─────────────────────────────────────────────────────────────────────────────
// SECTION 7
// ─────────────────────────────────────────────────────────────────────────────
sectionDivider(7, "Enhanced Recovery\nAfter Surgery (ERAS)", "Faster, safer, smarter recovery");

contentSlide("ERAS — Core Concept", [
  "ERAS: global perioperative quality improvement initiative",
  "Based on attenuation of the stress response to surgical injury",
  "Designed to speed clinical recovery and reduce length of stay and cost",
  "Achieved by optimising health before surgery (prehabilitation) + evidence-based perioperative care",
  "The gastrointestinal system is central to many core ERAS elements",
  "Employing ERAS practices leads to improved clinical outcomes",
]);

contentSlide("ERAS — Key Preoperative Elements", [
  "Patient education and counselling before admission",
  "No prolonged preoperative fasting (clear fluids up to 2h, solids up to 6h)",
  "Carbohydrate loading: oral carbohydrate drink 2-3 hours before induction",
  "Avoidance of mechanical bowel preparation (unless rectal surgery)",
  "Prehabilitation: exercise programme, smoking cessation, alcohol reduction",
  "Optimise anaemia, glycaemic control, cardiac/pulmonary status",
  "VTE risk assessment and prophylaxis planning",
  "Antibiotic prophylaxis: given 30-60 minutes before incision",
]);

contentSlide("ERAS — Intraoperative Elements", [
  "Short-acting anaesthetic agents to enable rapid recovery",
  "Multimodal opioid-sparing analgesia (regional blocks + NSAIDs + paracetamol)",
  "Goal-directed fluid therapy to maintain euvolaemia",
  "Maintenance of normothermia (forced-air warming, warmed fluids)",
  "Laparoscopic / minimally invasive approach where possible",
  "Avoidance of nasogastric tubes and routine drains",
  "Maintain normovolaemia: avoid excessive IV fluids (impairs gut motility)",
  "Short-acting neuromuscular blocking agents — full reversal before extubation",
]);

contentSlide("ERAS — Postoperative Elements", [
  { heading:"Early Oral Intake" },
  { sub:"Early oral hydration and nourishment — promotes gut recovery" },
  { sub:"Avoid nasogastric intubation post-surgery" },
  { heading:"Mobilisation" },
  { sub:"Early planned physiotherapy and mobilisation from Day 1" },
  { sub:"Reduces DVT, urinary retention, atelectasis, pressure sores, faecal impaction" },
  { heading:"Analgesia" },
  { sub:"Opioid-sparing regimen: regular NSAIDs + paracetamol + regional blocks" },
  { heading:"Discharge Planning" },
  { sub:"Started before admission — involves stoma nurses, physio, community carers" },
  { sub:"Telephone follow-up ensures patient recovery is on track" },
]);

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE: DAY SURGERY DISCHARGE CRITERIA
// ─────────────────────────────────────────────────────────────────────────────
contentSlide("Discharge Criteria (Table 22.5)", [
  "Vital signs stable for at least 1 hour",
  "Pain controlled with oral analgesia (VAS ≤ 3/10)",
  "Minimal nausea and vomiting",
  "Able to tolerate oral fluids",
  "Able to walk (or at baseline mobility)",
  "Minimal wound bleeding",
  "Patient understands wound care and follow-up plan",
  "Responsible adult escort arranged for journey home",
  "Written and verbal discharge instructions provided",
  "No time restriction — except specific procedures (e.g. 6h after tonsillectomy)",
], { fontSize:13 });

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE: SPECIAL POPULATIONS
// ─────────────────────────────────────────────────────────────────────────────
twoColSlide("Special Considerations in Perioperative Care",
  [
    "Children: prioritise on list to avoid prolonged starvation",
    "Insulin-dependent diabetes: first on elective list",
    "Elderly/frail patients: comprehensive geriatric assessment",
    "Obese patients (high BMI): pressure control ventilation preferred",
    "Morbidly obese: Trendelenburg raises airway pressure risk",
    "Cardiac device patients: involve cardiac devices team",
  ],
  [
    "Hepatic impairment: coagulopathy, altered drug metabolism",
    "Renal impairment: avoid nephrotoxins, adjust drug doses",
    "Airway concerns: Difficult Airway Society alert in records",
    "Malignant hyperpyrexia history: family history screening",
    "Previous anaesthesia problems: suxamethonium apnoea",
    "Patients refusing blood: Jehovah's Witnesses — early planning",
  ],
  "High-Risk Groups",
  "Special Precautions"
);

// ─────────────────────────────────────────────────────────────────────────────
// FINAL SLIDE
// ─────────────────────────────────────────────────────────────────────────────
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  fontFace:"Calibri", valign:"top", margin:8,
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finalSlide.addText("Source: Bailey and Love's Short Practice of Surgery, 28th Edition", {
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// ─────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName:"/home/daytona/workspace/perioperative-care-ppt/Perioperative_Care_BaileyLove28.pptx" })
  .then(() => console.log("DONE: Perioperative_Care_BaileyLove28.pptx created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/perioperative-care-ppt && node create_ppt.js

ls -lh /home/daytona/workspace/perioperative-care-ppt/Perioperative_Care_BaileyL…

~/perioperative-care-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE';
pres.author = 'Bailey and Love 28th Edition';
pres.title = 'Perioperative Care';

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// =============================================================================
// SLIDE 1 — TITLE
// =============================================================================
titleSlide("Perioperative Care", "Comprehensive Overview for the Surgical Team");

// =============================================================================
// SLIDE 2 — OUTLINE
// =============================================================================
contentSlide("Outline", [
  { head:"1.  Introduction & Multidisciplinary Team",   items:["Definition, team composition, aims"] },
  { head:"2.  Preoperative Assessment",                  items:["History, examination, risk stratification, NCEPOD"] },
  { head:"3.  Prehabilitation & Patient Optimisation",   items:["Fitness, smoking, anaemia, glycaemic control, CPET"] },
  { head:"4.  Anaesthesia — Types & Preparation",        items:["GA, regional, local; monitoring intraoperatively"] },
  { head:"5.  Intraoperative Care",                      items:["Ventilation, fluid management, WHO Safety Checklist"] },
  { head:"6.  Postoperative Care & Monitoring",          items:["NEWS, PACU, complications, analgesia"] },
  { head:"7.  Enhanced Recovery After Surgery (ERAS)",   items:["Core elements, early mobilisation, discharge criteria"] },
]);

// =============================================================================
// SECTION 1 — INTRODUCTION
// =============================================================================
sectionDivider(1, "Introduction &\nMultidisciplinary Team", "What is Perioperative Care?");

contentSlide("Perioperative Care — Definition", [
  "Integrated care delivered to the patient by an MDT before, during and after surgery",
  "Aims: improve patient outcome and reduce healthcare-related costs",
  "MDT brings together the patient and care team throughout the perioperative period",
  "Input varies depending on medical condition and complexity of surgery",
  "Risk assessment: simple blood tests through to sophisticated CPET for fitness",
  "WHO Surgical Safety Checklist routinely used to prevent surgical errors",
  "Anaesthetists now extending care into pre- and postoperative phases",
]);

contentSlide("The Perioperative MDT (Table 21.12)", [
  { head:"Clinical Team", items:[
    "Ward, theatre and specialist nursing staff",
    "Anaesthetic and surgical teams",
    "Acute medicine, cardiology, care of the elderly"
  ]},
  { head:"Allied Health Professionals", items:[
    "Physiotherapists and occupational therapists",
    "Rehabilitation and social care workers"
  ]},
  { head:"Support Services", items:[
    "Radiology and pathology teams",
    "Administration and scheduling team",
    "Specific personnel, e.g. cardiac devices team"
  ]},
]);

// =============================================================================
// SECTION 2 — PREOPERATIVE ASSESSMENT
// =============================================================================
sectionDivider(2, "Preoperative Assessment", "Know before you operate");

contentSlide("History Taking — Key Domains", [
  { head:"Cardiovascular", items:[
    "Chest pain, palpitations, syncope, hypertension, heart failure"
  ]},
  { head:"Respiratory", items:[
    "Dyspnoea, wheeze, asthma, COPD, sleep apnoea"
  ]},
  { head:"Haematological", items:[
    "Bleeding disorders, DVT/PE history, sickle cell, objection to blood products"
  ]},
  { head:"Infection", items:[
    "HIV/hepatitis/TB, MRSA, COVID-19, drug-resistant organisms"
  ]},
  { head:"Previous Surgery & Anaesthesia", items:[
    "Difficult Airway Society Alert, suxamethonium apnoea",
    "Family history of malignant hyperpyrexia"
  ]},
]);

tableSlide("Medical Examination (Table 21.2)",
  ["System", "Key Assessment Points"],
  [
    ["General",         "Anaemia, jaundice, cyanosis, frailty, nutritional status, BMI"],
    ["Cardiovascular",  "Pulse rate/rhythm, BP, heart sounds, JVP, peripheral oedema, exercise tolerance"],
    ["Respiratory",     "Rate & effort, chest expansion, percussion, breath sounds, SpO2, PEFR"],
    ["Gastrointestinal","Abdominal masses, ascites, bowel sounds, hernia"],
    ["Neurological",    "Consciousness, cognitive function, power, tone, reflexes"],
    ["Airway",          "Mouth opening, neck extension, Mallampati, thyromental distance, dentition"],
  ],
  [3.2, 9.8]
);

contentSlide("Emergency Surgery — NCEPOD Classification", [
  "Same preoperative assessment principles as elective — but time-limited",
  { head:"NCEPOD Urgency Classification", items:[
    "Immediate — within minutes (life-/limb-threatening)",
    "Urgent — within hours",
    "Expedited — within days",
    "Elective — timing to suit patient, hospital and staff"
  ]},
  { head:"Key Principles", items:[
    "Medical assessment starts even if unable to complete before incision",
    "Some risks persist — discuss with patient during consent",
    "Optimisation may continue in a critical care environment preoperatively",
    "Identify need for postoperative critical care early; liaise with duty ICU physician"
  ]},
]);

// =============================================================================
// SECTION 3 — PREHABILITATION
// =============================================================================
sectionDivider(3, "Prehabilitation &\nOptimisation", "Improving reserve before surgery");

contentSlide("Prehabilitation — Core Concept", [
  "Improving functional capacity of patients prior to major surgery",
  "Goal: improve postoperative outcomes, especially in patients with poor functional reserve",
  "Window between decision to operate and surgery date used effectively",
  { head:"Specific Optimisation Steps", items:[
    "Stop smoking — reduces pulmonary complications significantly",
    "Reduce alcohol intake",
    "Weight loss where high BMI present",
    "Treat pre-existing anaemia (iron infusion, EPO if needed)",
    "Optimise blood sugar control in diabetic patients",
    "Review and modify existing medications",
  ]},
]);

contentSlide("Cardiopulmonary Exercise Testing (CPET)", [
  "Objective assessment of patient fitness — identifies occult cardiorespiratory limitation",
  { head:"Key Metrics", items:[
    "VO2 max — maximum oxygen consumption",
    "Anaerobic threshold (AT) — AT < 11 mL/kg/min associated with increased perioperative mortality",
  ]},
  { head:"Clinical Uses", items:[
    "Guides surgical decision-making and risk stratification",
    "Assists in planning postoperative ICU/HDU bed requirements",
    "Informs patient counselling and informed consent",
    "Combined with subjective functional assessment (METs)",
  ]},
]);

// =============================================================================
// SECTION 4 — ANAESTHESIA
// =============================================================================
sectionDivider(4, "Anaesthesia", "Types, Preparation & Monitoring");

contentSlide("Preparation for Anaesthesia", [
  "Surgeon and anaesthetist cooperate for thorough preoperative assessment",
  "Recognise medical and anaesthetic risk factors; facilitate patient optimisation",
  "MDT approach + standardised care pathway = cornerstone of Enhanced Recovery",
  { head:"General Anaesthetic Triad (Summary Box 23.2)", items:[
    "Amnesia — loss of awareness",
    "Analgesia — pain relief",
    "Muscle relaxation",
  ]},
]);

tableSlide("IV Anaesthetic Agents — Key Features",
  ["Agent", "Class", "Key Properties"],
  [
    ["Propofol",    "Di-isopropyl phenol", "Smooth induction, haemodynamic stability, suitable for TIVA, antiemetic"],
    ["Thiopentone", "Barbiturate",         "Rapid induction, myocardial depression, lowers ICP (neurosurgery use)"],
    ["Etomidate",   "Steroid derivative",  "Good haemodynamic stability, brief action; risk of adrenocortical depression"],
    ["Ketamine",    "Phencyclidine",       "Dissociative; maintains airway reflexes; useful in haemodynamic compromise"],
    ["Sevoflurane", "Inhalational vapour", "Non-pungent; inhalational induction in children and difficult airway cases"],
  ],
  [2.8, 3.0, 7.2]
);

contentSlide("Types of Anaesthesia", [
  { head:"General Anaesthesia (GA)", items:[
    "IV induction (propofol most common) — maintained by inhalational agent or TIVA",
    "Airway: facemask, LMA or endotracheal tube depending on procedure",
  ]},
  { head:"Neuraxial / Regional", items:[
    "Spinal: single-shot intrathecal LA; rapid dense block; lower limb / obstetric / pelvic surgery",
    "Epidural: catheter technique; slower onset; excellent prolonged post-op analgesia",
    "Peripheral nerve blocks: TAP, erector spinae, femoral, brachial plexus, etc.",
  ]},
  { head:"Local Anaesthesia", items:[
    "Topical, infiltration, or Bier's block (IVRA) for upper limb surgery",
    "Prilocaine used for Bier's block — bupivacaine NEVER used (cardiac toxicity)",
  ]},
]);

contentSlide("Ventilation During Anaesthesia", [
  "Mechanical ventilation required when spontaneous ventilation is inadequate",
  { head:"Volume Control Ventilation", items:[
    "Preset tidal volume delivered regardless of airway pressure",
    "Risk: barotrauma (pneumothorax) in obese, Trendelenburg, laparoscopic cases",
  ]},
  { head:"Pressure Control Ventilation", items:[
    "Flow generated until preset pressure reached",
    "Tidal volume varies with airway resistance and intra-abdominal pressure",
  ]},
  { head:"PEEP (Positive End-Expiratory Pressure)", items:[
    "Maintains functional residual capacity; opens collapsed alveoli",
    "Reduces vascular shunting and improves gas exchange",
  ]},
]);

contentSlide("Intraoperative Monitoring (Minimum Standard)", [
  { head:"Cardiovascular", items:[
    "ECG — continuous cardiac monitoring",
    "Non-invasive blood pressure (NIBP)",
  ]},
  { head:"Ventilation & Oxygenation", items:[
    "Inspired oxygen concentration",
    "SpO2 by pulse oximetry",
    "End-tidal CO2 (capnography)",
  ]},
  { head:"Additional Monitoring for Major Surgery", items:[
    "Temperature monitoring",
    "Urine output (hourly via catheter)",
    "Central venous pressure (CVP)",
    "Volatile anaesthetic agent delivery monitoring",
  ]},
]);

// =============================================================================
// SECTION 5 — INTRAOPERATIVE CARE
// =============================================================================
sectionDivider(5, "Intraoperative Care", "Fluids, Safety & Positioning");

contentSlide("Perioperative Fluid Management", [
  "Goal: maintain euvolaemia — avoid both under- and over-hydration",
  { head:"Crystalloids", items:[
    "Normal saline: risk of hyperchloraemic acidosis with large volumes",
    "Balanced solutions (Hartmann's / Ringer's lactate) preferred for most cases",
  ]},
  { head:"Colloids", items:[
    "HES (hydroxyethyl starch): associated with AKI and coagulopathy — avoid in sepsis",
    "Albumin: considered in liver failure or significant hypoalbuminaemia",
  ]},
  { head:"Goal-Directed Fluid Therapy (GDFT)", items:[
    "Uses stroke volume / cardiac output monitoring (e.g. oesophageal Doppler)",
    "Targets optimal tissue perfusion with minimal fluid loading",
  ]},
]);

contentSlide("WHO Surgical Safety Checklist", [
  { head:"Sign In — Before Induction of Anaesthesia", items:[
    "Patient identity, site and procedure confirmed",
    "Consent verified; anaesthesia equipment and drugs checked; allergies reviewed",
  ]},
  { head:"Time Out — Before Skin Incision", items:[
    "All team members introduced by name and role",
    "Surgeon confirms procedure, critical steps and anticipated blood loss",
    "Antibiotic prophylaxis confirmed; relevant imaging displayed",
  ]},
  { head:"Sign Out — Before Patient Leaves Theatre", items:[
    "Procedure name confirmed; instrument, swab and needle count correct",
    "Specimens labelled; equipment issues addressed",
    "Surgeon, anaesthetist and nurse confirm key postoperative care plan",
  ]},
]);

// =============================================================================
// SECTION 6 — POSTOPERATIVE CARE
// =============================================================================
sectionDivider(6, "Postoperative Care", "Monitoring, Complications & Recovery");

contentSlide("Postoperative Settings — Levels of Care", [
  "Routine ward: low-risk patients after straightforward procedures",
  "Post-Anaesthesia Care Unit (PACU): 24-48h intensive monitoring post-major surgery",
  "Overnight Intensive Recovery (OIR): intermediate care, moderate-risk patients",
  "High Dependency Unit (HDU): single organ support with close monitoring",
  "Intensive Care Unit (ICU): multi-organ support, ventilation, vasopressors",
  "Level of care driven by procedure complexity and patient comorbidities",
  "Good community communication facilitates safe, timely discharge",
]);

contentSlide("National Early Warning Score (NEWS)", [
  "Aggregate scoring system for early detection of clinical deterioration",
  { head:"Physiological Parameters Scored", items:[
    "Respiratory rate  (score 3 if >= 25 or <= 8)",
    "SpO2  (score increases as saturation falls below 96%)",
    "Heart rate, blood pressure, temperature",
    "Level of consciousness (AVPU scale)",
    "Supplemental oxygen use adds to total score",
  ]},
  { head:"Response Thresholds", items:[
    "Score 0-4: routine ward monitoring",
    "Score 5-6: urgent review by ward clinician",
    "Score >= 7: emergency response — consider ICU/HDU escalation",
  ]},
]);

contentSlide("Common Postoperative Complications", [
  { head:"Respiratory", items:[
    "Atelectasis, pneumonia — Rx: chest physio, adequate analgesia, avoid fluid overload",
    "Respiratory failure — may require HDU/ICU ventilatory support",
  ]},
  { head:"Cardiovascular", items:[
    "Atrial fibrillation (15-20% after oesophagectomy) — treat with antiarrhythmics",
    "Perioperative MI — watch for ECG changes and troponin rise",
  ]},
  { head:"Renal", items:[
    "Acute kidney injury — monitor urine output, avoid nephrotoxins",
  ]},
  { head:"Surgical Site & Systemic", items:[
    "Wound infection, dehiscence, anastomotic leak",
    "DVT / PE — early mobilisation and pharmacological prophylaxis essential",
  ]},
]);

contentSlide("Pain Management — Multimodal Analgesia", [
  "Postoperative pain delays recovery and increases risk of chest complications and chronic pain",
  { head:"WHO Analgesic Ladder", items:[
    "Step 1: Regular paracetamol + NSAIDs",
    "Step 2: Weak opioids — codeine, tramadol",
    "Step 3: Strong opioids — morphine, oxycodone (titrate carefully)",
  ]},
  { head:"Multimodal / ERAS-Aligned Approach", items:[
    "Regional blocks (epidural, TAP, peripheral nerve blocks) — opioid-sparing",
    "PCA (Patient-Controlled Analgesia) for IV opioid self-administration",
    "Avoid long-acting IV opioids in day surgery (delay discharge and cause nausea)",
  ]},
]);

// =============================================================================
// SECTION 7 — ERAS
// =============================================================================
sectionDivider(7, "Enhanced Recovery\nAfter Surgery (ERAS)", "Faster, safer, smarter recovery");

contentSlide("ERAS — Core Concept", [
  "ERAS: global perioperative quality improvement initiative",
  "Based on attenuation of the surgical stress response",
  "Goal: speed clinical recovery and reduce length of stay and costs",
  "Achieved through prehabilitation + evidence-based perioperative care",
  "The GI system is central: carbohydrate loading, early feeding, avoid NG tubes",
  "Employing ERAS practices leads to improved clinical outcomes",
]);

contentSlide("ERAS — Preoperative Elements", [
  "Patient education and counselling before admission",
  "No prolonged fasting — clear fluids up to 2 h, solids up to 6 h before surgery",
  "Carbohydrate loading: oral carbohydrate drink 2-3 h before induction",
  "Avoid mechanical bowel preparation (unless rectal surgery)",
  "Prehabilitation: exercise programme, smoking cessation, alcohol reduction",
  "Optimise anaemia, glycaemic control, cardiac and pulmonary status",
  "VTE risk assessment and prophylaxis planning",
  "Antibiotic prophylaxis given 30-60 minutes before skin incision",
]);

contentSlide("ERAS — Intraoperative Elements", [
  "Short-acting anaesthetic agents to enable rapid recovery",
  "Multimodal opioid-sparing analgesia: regional blocks + NSAIDs + paracetamol",
  "Goal-directed fluid therapy to maintain euvolaemia",
  "Maintain normothermia: forced-air warming blanket, warmed IV fluids",
  "Minimally invasive (laparoscopic) approach where possible",
  "Avoid routine nasogastric tubes and prophylactic drains",
  "Avoid excessive IV fluids — impairs gut motility and wound healing",
  "Full reversal of neuromuscular blockade confirmed before extubation",
]);

contentSlide("ERAS — Postoperative Elements", [
  { head:"Early Oral Intake", items:[
    "Early oral hydration and nourishment — promotes gut recovery",
    "Avoid nasogastric tubes post-operatively",
  ]},
  { head:"Early Mobilisation", items:[
    "Planned physiotherapy and mobilisation from Day 1",
    "Reduces DVT, urinary retention, atelectasis, pressure sores, faecal impaction",
  ]},
  { head:"Opioid-Sparing Analgesia", items:[
    "Regular NSAIDs + paracetamol as baseline",
    "Regional blocks to minimise opioid requirement",
  ]},
  { head:"Discharge Planning", items:[
    "Started before admission — involves stoma nurses, physio, community carers",
    "Telephone follow-up to ensure recovery is on track",
  ]},
]);

contentSlide("Discharge Criteria (Table 22.5)", [
  "Vital signs stable for at least 1 hour",
  "Pain controlled with oral analgesia (acceptable VAS score)",
  "Minimal nausea and vomiting",
  "Able to tolerate oral fluids",
  "Able to mobilise (or at baseline mobility)",
  "Minimal wound bleeding",
  "Patient understands wound care and follow-up plan",
  "Responsible adult escort arranged for journey home",
  "Written and verbal discharge instructions provided",
  "Note: no fixed time restriction except specific procedures (e.g. 6 h after tonsillectomy)",
]);

// =============================================================================
// SPECIAL CONSIDERATIONS
// =============================================================================
twoColSlide("Special Considerations in Perioperative Care",
  "High-Risk Patient Groups",
  [
    "Children — prioritise on list to avoid prolonged starvation",
    "Insulin-dependent diabetes — schedule first on elective list",
    "Elderly/frail — comprehensive geriatric assessment needed",
    "High BMI — pressure-control ventilation preferred",
    "Cardiac device patients — involve cardiac devices team",
    "Patients refusing blood — Jehovah's Witnesses: early planning",
  ],
  "Special Precautions",
  [
    "Hepatic impairment — coagulopathy, altered drug metabolism",
    "Renal impairment — avoid nephrotoxins, adjust drug doses",
    "Airway concerns — Difficult Airway Society alert in records",
    "Malignant hyperpyrexia — family history screening essential",
    "Suxamethonium apnoea — document and alert team",
    "MRSA / COVID-19 — isolate and use appropriate PPE",
  ]
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// =============================================================================
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// =============================================================================
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  "Perioperative care is an integrated MDT effort spanning pre-, intra- and postoperative phases",
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  "Prehabilitation optimises the patient's functional reserve before surgery",
  "Anaesthesia choice impacts recovery speed — short-acting agents favoured in ERAS",
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// =============================================================================
// WRITE
// =============================================================================
pres.writeFile({ fileName:"/home/daytona/workspace/perioperative-care-ppt/Perioperative_Care_BaileyLove28.pptx" })
  .then(() => console.log("DONE"))
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rm /home/daytona/workspace/perioperative-care-ppt/create_ppt.js

~/perioperative-care-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");

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// =============================================================================
// SLIDE 1 — TITLE
// =============================================================================
titleSlide("Perioperative Care", "Comprehensive Overview for the Surgical Team");

// =============================================================================
// SLIDE 2 — OUTLINE
// =============================================================================
contentSlide("Outline", [
  { head:"1.  Introduction & Multidisciplinary Team",   items:["Definition, team composition, aims"] },
  { head:"2.  Preoperative Assessment",                  items:["History, examination, risk stratification, NCEPOD"] },
  { head:"3.  Prehabilitation & Patient Optimisation",   items:["Fitness, smoking, anaemia, glycaemic control, CPET"] },
  { head:"4.  Anaesthesia — Types & Preparation",        items:["GA, regional, local; monitoring intraoperatively"] },
  { head:"5.  Intraoperative Care",                      items:["Ventilation, fluid management, WHO Safety Checklist"] },
  { head:"6.  Postoperative Care & Monitoring",          items:["NEWS, PACU, complications, analgesia"] },
  { head:"7.  Enhanced Recovery After Surgery (ERAS)",   items:["Core elements, early mobilisation, discharge criteria"] },
]);

// =============================================================================
// SECTION 1
// =============================================================================
sectionDivider(1, "Introduction &\nMultidisciplinary Team", "What is Perioperative Care?");

contentSlide("Perioperative Care — Definition", [
  "Integrated care delivered to the patient by an MDT before, during and after surgery",
  "Aims to improve patient outcome and reduce healthcare-related costs",
  "MDT brings together the patient and care team throughout the perioperative period",
  "Input varies depending on medical condition and complexity of surgery",
  "Risk assessment: from simple blood tests to sophisticated CPET for fitness",
  "WHO Surgical Safety Checklist routinely used to prevent surgical errors",
  "Anaesthetists now extending care into pre- and postoperative phases",
]);

contentSlide("The Perioperative MDT (Table 21.12)", [
  { head:"Clinical Team", items:[
    "Ward, theatre and specialist nursing staff",
    "Anaesthetic and surgical teams",
    "Acute medicine, cardiology, care of the elderly",
  ]},
  { head:"Allied Health Professionals", items:[
    "Physiotherapists and occupational therapists",
    "Rehabilitation and social care workers",
  ]},
  { head:"Support Services", items:[
    "Radiology and pathology teams",
    "Administration and scheduling team",
    "Specific personnel per case, e.g. cardiac devices team",
  ]},
]);

// =============================================================================
// SECTION 2
// =============================================================================
sectionDivider(2, "Preoperative Assessment", "Know before you operate");

contentSlide("History Taking — Key Domains", [
  { head:"Cardiovascular", items:[
    "Chest pain, palpitations, syncope, hypertension, heart failure",
  ]},
  { head:"Respiratory", items:[
    "Dyspnoea, wheeze, asthma, COPD, sleep apnoea",
  ]},
  { head:"Haematological", items:[
    "Bleeding disorders, DVT/PE history, sickle cell, objection to blood products",
  ]},
  { head:"Infection", items:[
    "HIV / hepatitis / TB, MRSA, COVID-19, drug-resistant organisms",
  ]},
  { head:"Previous Surgery & Anaesthesia", items:[
    "Difficult Airway Society Alert, suxamethonium apnoea",
    "Family history of malignant hyperpyrexia",
  ]},
]);

tableSlide("Medical Examination (Table 21.2)",
  ["System", "Key Assessment Points"],
  [
    ["General",          "Anaemia, jaundice, cyanosis, frailty, nutritional status, BMI"],
    ["Cardiovascular",   "Pulse rate/rhythm, BP, heart sounds, JVP, peripheral oedema, exercise tolerance"],
    ["Respiratory",      "Rate & effort, chest expansion, percussion, breath sounds, SpO2, PEFR"],
    ["Gastrointestinal", "Abdominal masses, ascites, bowel sounds, hernia"],
    ["Neurological",     "Consciousness, cognitive function, power, tone, reflexes"],
    ["Airway",           "Mouth opening, neck extension, Mallampati, thyromental distance, dentition"],
  ],
  [3.2, 9.8]
);

contentSlide("Emergency Surgery — NCEPOD Classification", [
  "Same preoperative assessment principles as elective — but time-limited",
  { head:"NCEPOD Urgency Classification", items:[
    "Immediate — within minutes (life- or limb-threatening)",
    "Urgent — within hours",
    "Expedited — within days",
    "Elective — timing to suit patient, hospital and staff",
  ]},
  { head:"Key Principles", items:[
    "Medical assessment starts even if unable to complete before incision",
    "Some risks persist — discuss openly with patient during consent",
    "Optimisation may continue in a critical care environment preoperatively",
    "Identify need for postoperative critical care early; liaise with duty ICU physician",
  ]},
]);

// =============================================================================
// SECTION 3
// =============================================================================
sectionDivider(3, "Prehabilitation &\nOptimisation", "Improving reserve before surgery");

contentSlide("Prehabilitation — Core Concept", [
  "Improving functional capacity of patients prior to major surgery",
  "Goal: improve postoperative outcomes, especially with poor functional reserve",
  "Window between decision to operate and surgery date used effectively",
  { head:"Specific Optimisation Steps", items:[
    "Stop smoking — reduces pulmonary complications significantly",
    "Reduce alcohol intake",
    "Weight loss where high BMI is present",
    "Treat pre-existing anaemia (iron infusion, EPO if required)",
    "Optimise blood sugar control in diabetic patients",
    "Review and modify existing medications",
  ]},
]);

contentSlide("Cardiopulmonary Exercise Testing (CPET)", [
  "Objective assessment of patient fitness — identifies occult cardiorespiratory limitation",
  { head:"Key Metrics", items:[
    "VO2 max — maximum oxygen consumption during exercise",
    "Anaerobic threshold (AT) — AT below 11 mL/kg/min linked to higher perioperative mortality",
  ]},
  { head:"Clinical Uses", items:[
    "Guides surgical decision-making and risk stratification",
    "Assists in planning postoperative ICU / HDU bed requirements",
    "Informs patient counselling and informed consent discussion",
    "Combined with subjective functional capacity assessment (METs)",
  ]},
]);

// =============================================================================
// SECTION 4
// =============================================================================
sectionDivider(4, "Anaesthesia", "Types, Preparation & Monitoring");

contentSlide("Preparation for Anaesthesia", [
  "Surgeon and anaesthetist cooperate for thorough preoperative assessment",
  "Recognise medical and anaesthetic risk factors; facilitate patient optimisation",
  "MDT approach + standardised care pathway = cornerstone of Enhanced Recovery",
  { head:"General Anaesthetic Triad (Summary Box 23.2)", items:[
    "Amnesia — loss of awareness",
    "Analgesia — pain relief",
    "Muscle relaxation",
  ]},
]);

tableSlide("IV Anaesthetic Agents — Key Features",
  ["Agent", "Class", "Key Properties"],
  [
    ["Propofol",    "Di-isopropyl phenol", "Smooth induction, haemodynamic stability, suitable for TIVA, antiemetic"],
    ["Thiopentone", "Barbiturate",         "Rapid induction, myocardial depression, lowers ICP — neurosurgery use"],
    ["Etomidate",   "Steroid derivative",  "Good haemodynamic stability, brief action; risk of adrenocortical depression"],
    ["Ketamine",    "Phencyclidine",       "Dissociative; maintains airway reflexes; useful in haemodynamic compromise"],
    ["Sevoflurane", "Inhalational vapour", "Non-pungent; inhalational induction in children and difficult airway cases"],
  ],
  [2.8, 3.0, 7.2]
);

contentSlide("Types of Anaesthesia", [
  { head:"General Anaesthesia (GA)", items:[
    "IV induction (propofol most common) — maintained by inhalational agent or TIVA",
    "Airway: facemask, LMA or endotracheal tube depending on procedure",
  ]},
  { head:"Neuraxial / Regional", items:[
    "Spinal: single-shot intrathecal LA; rapid dense block; lower limb / obstetric / pelvic surgery",
    "Epidural: catheter technique; slower onset; excellent prolonged post-op analgesia",
    "Peripheral nerve blocks: TAP, erector spinae, femoral, brachial plexus, etc.",
  ]},
  { head:"Local Anaesthesia", items:[
    "Topical, infiltration, or Bier's block (IVRA) for upper limb surgery",
    "Prilocaine used for Bier's block — bupivacaine NEVER used (cardiac toxicity risk)",
  ]},
]);

contentSlide("Ventilation During Anaesthesia", [
  "Mechanical ventilation required when spontaneous ventilation is inadequate",
  { head:"Volume Control Ventilation", items:[
    "Preset tidal volume delivered regardless of airway pressure",
    "Risk: barotrauma (pneumothorax) in obese, Trendelenburg or laparoscopic cases",
  ]},
  { head:"Pressure Control Ventilation", items:[
    "Flow generated until preset pressure reached",
    "Tidal volume varies with airway resistance and intra-abdominal pressure",
  ]},
  { head:"PEEP (Positive End-Expiratory Pressure)", items:[
    "Maintains functional residual capacity; opens collapsed alveoli",
    "Reduces vascular shunting and improves gas exchange",
  ]},
]);

contentSlide("Intraoperative Monitoring (Minimum Standard)", [
  { head:"Cardiovascular", items:[
    "ECG — continuous cardiac monitoring",
    "Non-invasive blood pressure (NIBP)",
  ]},
  { head:"Ventilation & Oxygenation", items:[
    "Inspired oxygen concentration",
    "SpO2 by pulse oximetry",
    "End-tidal CO2 (capnography)",
  ]},
  { head:"Additional Monitoring for Major Surgery", items:[
    "Temperature monitoring",
    "Urine output (hourly via catheter)",
    "Central venous pressure (CVP)",
    "Volatile anaesthetic agent delivery monitoring",
  ]},
]);

// =============================================================================
// SECTION 5
// =============================================================================
sectionDivider(5, "Intraoperative Care", "Fluids, Safety & Positioning");

contentSlide("Perioperative Fluid Management", [
  "Goal: maintain euvolaemia — avoid both under- and over-hydration",
  { head:"Crystalloids", items:[
    "Normal saline: risk of hyperchloraemic acidosis with large volumes",
    "Balanced solutions (Hartmann's / Ringer's lactate) preferred for most cases",
  ]},
  { head:"Colloids", items:[
    "HES (hydroxyethyl starch): associated with AKI and coagulopathy — avoid in sepsis",
    "Albumin: considered in liver failure or significant hypoalbuminaemia",
  ]},
  { head:"Goal-Directed Fluid Therapy (GDFT)", items:[
    "Uses stroke volume / cardiac output monitoring (e.g. oesophageal Doppler)",
    "Targets optimal tissue perfusion with minimal fluid loading",
  ]},
]);

contentSlide("WHO Surgical Safety Checklist", [
  { head:"Sign In — Before Induction of Anaesthesia", items:[
    "Patient identity, site and procedure confirmed",
    "Consent verified; anaesthesia equipment and drugs checked; allergies reviewed",
  ]},
  { head:"Time Out — Before Skin Incision", items:[
    "All team members introduced by name and role",
    "Surgeon confirms procedure, critical steps and anticipated blood loss",
    "Antibiotic prophylaxis confirmed; relevant imaging displayed",
  ]},
  { head:"Sign Out — Before Patient Leaves Theatre", items:[
    "Procedure name confirmed; instrument, swab and needle count correct",
    "Specimens labelled; equipment issues addressed",
    "Surgeon, anaesthetist and nurse confirm key postoperative care plan",
  ]},
]);

// =============================================================================
// SECTION 6
// =============================================================================
sectionDivider(6, "Postoperative Care", "Monitoring, Complications & Recovery");

contentSlide("Postoperative Settings — Levels of Care", [
  "Routine ward: low-risk patients after straightforward procedures",
  "Post-Anaesthesia Care Unit (PACU): 24-48h intensive monitoring post-major surgery",
  "Overnight Intensive Recovery (OIR): intermediate care, moderate-risk patients",
  "High Dependency Unit (HDU): single organ support with close monitoring",
  "Intensive Care Unit (ICU): multi-organ support, ventilation, vasopressors",
  "Level of care driven by procedure complexity and patient comorbidities",
  "Good community communication facilitates safe, timely discharge",
]);

contentSlide("National Early Warning Score (NEWS)", [
  "Aggregate scoring system for early detection of clinical deterioration",
  { head:"Physiological Parameters Scored", items:[
    "Respiratory rate  (score 3 if >= 25 or <= 8 breaths/min)",
    "SpO2  (score increases as saturation falls below 96%)",
    "Heart rate, blood pressure, temperature",
    "Level of consciousness (AVPU scale)",
    "Supplemental oxygen use adds to total score",
  ]},
  { head:"Response Thresholds", items:[
    "Score 0-4: routine ward monitoring",
    "Score 5-6: urgent review by ward clinician",
    "Score >= 7: emergency response — consider ICU / HDU escalation",
  ]},
]);

contentSlide("Common Postoperative Complications", [
  { head:"Respiratory", items:[
    "Atelectasis, pneumonia — Rx: chest physio, adequate analgesia, avoid fluid overload",
    "Respiratory failure — may require HDU / ICU ventilatory support",
  ]},
  { head:"Cardiovascular", items:[
    "Atrial fibrillation (15-20% after oesophagectomy) — treat with antiarrhythmics",
    "Perioperative MI — watch for ECG changes and troponin rise",
  ]},
  { head:"Renal", items:[
    "Acute kidney injury — monitor urine output hourly, avoid nephrotoxins",
  ]},
  { head:"Surgical Site & Systemic", items:[
    "Wound infection, dehiscence, anastomotic leak",
    "DVT / PE — early mobilisation and pharmacological prophylaxis essential",
  ]},
]);

contentSlide("Pain Management — Multimodal Analgesia", [
  "Postoperative pain delays recovery and increases risk of chest complications and chronic pain",
  { head:"WHO Analgesic Ladder", items:[
    "Step 1: Regular paracetamol + NSAIDs",
    "Step 2: Weak opioids — codeine, tramadol",
    "Step 3: Strong opioids — morphine, oxycodone (titrate carefully)",
  ]},
  { head:"Multimodal / ERAS-Aligned Approach", items:[
    "Regional blocks (epidural, TAP, peripheral nerve blocks) — opioid-sparing",
    "PCA (Patient-Controlled Analgesia) for IV opioid self-administration",
    "Avoid long-acting IV opioids in day surgery (delay discharge and cause nausea)",
  ]},
]);

// =============================================================================
// SECTION 7 — ERAS
// =============================================================================
sectionDivider(7, "Enhanced Recovery\nAfter Surgery (ERAS)", "Faster, safer, smarter recovery");

contentSlide("ERAS — Core Concept", [
  "ERAS: global perioperative quality improvement initiative",
  "Based on attenuation of the surgical stress response",
  "Goal: speed clinical recovery and reduce length of stay and costs",
  "Achieved through prehabilitation + evidence-based perioperative care",
  "The GI system is central: carbohydrate loading, early feeding, avoid NG tubes",
  "Employing ERAS practices leads to measurably improved clinical outcomes",
]);

contentSlide("ERAS — Preoperative Elements", [
  "Patient education and counselling before admission",
  "No prolonged fasting — clear fluids up to 2 h, solids up to 6 h before surgery",
  "Carbohydrate loading: oral carbohydrate drink 2-3 h before induction",
  "Avoid mechanical bowel preparation (unless rectal surgery)",
  "Prehabilitation: exercise programme, smoking cessation, alcohol reduction",
  "Optimise anaemia, glycaemic control, cardiac and pulmonary status",
  "VTE risk assessment and prophylaxis planning",
  "Antibiotic prophylaxis given 30-60 minutes before skin incision",
]);

contentSlide("ERAS — Intraoperative Elements", [
  "Short-acting anaesthetic agents to enable rapid recovery",
  "Multimodal opioid-sparing analgesia: regional blocks + NSAIDs + paracetamol",
  "Goal-directed fluid therapy to maintain euvolaemia",
  "Maintain normothermia: forced-air warming blanket and warmed IV fluids",
  "Minimally invasive (laparoscopic) approach where possible",
  "Avoid routine nasogastric tubes and prophylactic drains",
  "Avoid excessive IV fluids — impairs gut motility and wound healing",
  "Full reversal of neuromuscular blockade confirmed before extubation",
]);

contentSlide("ERAS — Postoperative Elements", [
  { head:"Early Oral Intake", items:[
    "Early oral hydration and nourishment — promotes gut recovery",
    "Avoid nasogastric tubes post-operatively",
  ]},
  { head:"Early Mobilisation", items:[
    "Planned physiotherapy and mobilisation from Day 1",
    "Reduces DVT, urinary retention, atelectasis, pressure sores, faecal impaction",
  ]},
  { head:"Opioid-Sparing Analgesia", items:[
    "Regular NSAIDs + paracetamol as baseline",
    "Regional blocks to minimise opioid requirement",
  ]},
  { head:"Discharge Planning", items:[
    "Started before admission — involves stoma nurses, physio, community carers",
    "Telephone follow-up to confirm recovery is on track",
  ]},
]);

contentSlide("Discharge Criteria (Table 22.5)", [
  "Vital signs stable for at least 1 hour",
  "Pain controlled with oral analgesia",
  "Minimal nausea and vomiting",
  "Able to tolerate oral fluids",
  "Able to mobilise (or at pre-operative baseline)",
  "Minimal wound bleeding",
  "Patient understands wound care and follow-up plan",
  "Responsible adult escort arranged for journey home",
  "Written and verbal discharge instructions provided",
  "Note: no fixed time restriction except specific procedures (e.g. 6 h post-tonsillectomy)",
]);

// =============================================================================
// SPECIAL CONSIDERATIONS
// =============================================================================
twoColSlide("Special Considerations in Perioperative Care",
  "High-Risk Patient Groups",
  [
    "Children — prioritise on list to avoid prolonged starvation",
    "Insulin-dependent diabetes — schedule first on elective list",
    "Elderly / frail — comprehensive geriatric assessment needed",
    "High BMI — pressure-control ventilation preferred",
    "Cardiac device patients — involve cardiac devices team",
    "Patients refusing blood products — early planning essential",
  ],
  "Special Precautions",
  [
    "Hepatic impairment — coagulopathy, altered drug metabolism",
    "Renal impairment — avoid nephrotoxins, adjust drug doses",
    "Airway concerns — Difficult Airway Society alert in records",
    "Malignant hyperpyrexia — family history screening essential",
    "Suxamethonium apnoea — document clearly and alert team",
    "MRSA / COVID-19 — isolate and use appropriate PPE",
  ]
);

// =============================================================================
// FINAL SLIDE
// =============================================================================
var finalSlide = pres.addSlide();
finalSlide.addShape(pres.ShapeType.rect, { x:0, y:0, w:'100%', h:'100%', fill:{color:COL.navy} });
finalSlide.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:'100%', fill:{color:COL.gold} });
finalSlide.addShape(pres.ShapeType.rect, { x:0.18, y:3.1, w:13.12, h:0.07, fill:{color:COL.teal} });
finalSlide.addText("Key Takeaways", {
  x:0.5, y:0.5, w:12.3, h:0.9,
  fontSize:34, bold:true, color:COL.gold, fontFace:"Calibri", align:"center", valign:"middle", margin:0
});

var takeaways = [
  "Perioperative care is an integrated MDT effort spanning pre-, intra- and postoperative phases",
  "Thorough preoperative assessment and risk stratification prevents avoidable complications",
  "Prehabilitation optimises the patient's functional reserve before surgery",
  "Anaesthesia choice impacts recovery speed — short-acting agents favoured in ERAS",
  "WHO Surgical Safety Checklist is mandatory to prevent surgical errors",
  "NEWS score enables early detection of postoperative deterioration",
  "ERAS: avoid prolonged fasting, carbohydrate loading, early feeding and mobilisation",
];
var ty = 1.55;
takeaways.forEach(function(t, i) {
  finalSlide.addText(t, {
    x:0.5, y:ty, w:12.3, h:0.38,
    fontSize:13.5,
    color: i === takeaways.length - 1 ? COL.gold : COL.white,
    bold:  i === takeaways.length - 1,
    fontFace:"Calibri", bullet:true, valign:"middle", margin:0
  });
  ty += 0.40;
});

finalSlide.addText("Source: Bailey and Love's Short Practice of Surgery, 28th Edition", {
  x:0.5, y:6.9, w:12.3, h:0.35,
  fontSize:11, color:COL.midGray, fontFace:"Calibri", align:"center", italic:true, margin:0
});

// =============================================================================
// WRITE FILE
// =============================================================================
pres.writeFile({ fileName:"/home/daytona/workspace/perioperative-care-ppt/Perioperative_Care_BaileyLove28.pptx" })
  .then(function() { console.log("DONE"); })
  .catch(function(e) { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/perioperative-care-ppt && node create_ppt.js && ls -l…