const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ── Fetch images ──────────────────────────────────────────────────────────────
const imgUrls = [
  "https://cdn.orris.care/cdss_images/6144a365e5722ef6ef1b077504d7222862dbb439596517a9bdf0dd05e8fcb214.png", // integrated regulation / autoregulation curve
  "https://cdn.orris.care/cdss_images/519df37e2f3e66d05bfc289edcf8162de33b25e9acdfb81b53b6a07dab6a793e.png", // volatile agents CBF vs MAC
  "https://cdn.orris.care/cdss_images/7629cd61007d1b2842ba3d047f4bb9c165a7828a7828cabdffcb5cec74d9ba18.png", // integrated regulatory processes diagram
];

const imgs = JSON.parse(
  execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`
  ).toString()
);

// ── Palette ───────────────────────────────────────────────────────────────────
const C = {
  navy:    "0A1628",   // dominant bg
  slate:   "142035",   // section bg
  teal:    "00B4C5",   // accent headings
  gold:    "F0A500",   // accent 2 / highlights
  white:   "FFFFFF",
  light:   "D6E4F0",
  muted:   "8BA3BD",
  red:     "E84545",
  green:   "27AE60",
  orange:  "E67E22",
};

// ── Helper: standard slide background ────────────────────────────────────────
function addBg(slide, color = C.navy) {
  slide.background = { color };
}

// ── Helper: header bar ────────────────────────────────────────────────────────
function addHeader(slide, title, subtitle = "") {
  // Top accent strip
  slide.addShape("rect", { x: 0, y: 0, w: 10, h: 0.08, fill: { color: C.teal }, line: { color: C.teal } });
  slide.addText(title, {
    x: 0.35, y: 0.14, w: 9.3, h: 0.55,
    fontSize: 22, bold: true, color: C.teal, fontFace: "Calibri",
    margin: 0,
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.35, y: 0.65, w: 9.3, h: 0.32,
      fontSize: 11, color: C.muted, fontFace: "Calibri", italic: true, margin: 0,
    });
  }
  // Divider line
  slide.addShape("line", { x: 0.35, y: 0.95, w: 9.3, h: 0, line: { color: C.teal, width: 1 } });
}

// ── Helper: bottom source bar ─────────────────────────────────────────────────
function addSource(slide, text) {
  slide.addShape("rect", { x: 0, y: 5.35, w: 10, h: 0.28, fill: { color: C.slate }, line: { color: C.slate } });
  slide.addText(text, {
    x: 0.3, y: 5.37, w: 9.4, h: 0.22,
    fontSize: 7.5, color: C.muted, fontFace: "Calibri", margin: 0,
  });
}

// ── Helper: pill badge ────────────────────────────────────────────────────────
function addPill(slide, label, x, y, w = 1.5, bg = C.teal) {
  slide.addShape("roundRect", { x, y, w, h: 0.32, fill: { color: bg }, line: { color: bg }, rectRadius: 0.08 });
  slide.addText(label, { x, y: y + 0.03, w, h: 0.26, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
}

// ── Helper: bullet text block ─────────────────────────────────────────────────
function bulletBlock(slide, items, x, y, w, h, opts = {}) {
  const rows = items.map((item, i) => ({
    text: item,
    options: { bullet: { code: "2022" }, breakLine: i < items.length - 1, fontSize: opts.fontSize || 13, color: opts.color || C.white, fontFace: "Calibri", paraSpaceAfter: opts.paraSpaceAfter || 4 }
  }));
  slide.addText(rows, { x, y, w, h, valign: "top" });
}

// ── Helper: data card ─────────────────────────────────────────────────────────
function dataCard(slide, label, value, unit, x, y, w = 2.1, bg = C.slate) {
  slide.addShape("roundRect", { x, y, w, h: 0.9, fill: { color: bg }, line: { color: C.teal, width: 1 }, rectRadius: 0.1 });
  slide.addText(label, { x: x + 0.08, y: y + 0.04, w: w - 0.16, h: 0.22, fontSize: 9, color: C.muted, fontFace: "Calibri", margin: 0 });
  slide.addText(value, { x: x + 0.08, y: y + 0.26, w: w - 0.16, h: 0.36, fontSize: 20, bold: true, color: C.teal, fontFace: "Calibri", margin: 0 });
  slide.addText(unit, { x: x + 0.08, y: y + 0.62, w: w - 0.16, h: 0.22, fontSize: 8.5, color: C.muted, fontFace: "Calibri", margin: 0 });
}

// ═════════════════════════════════════════════════════════════════════════════
// BUILD PRESENTATION
// ═════════════════════════════════════════════════════════════════════════════
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical";
pres.title = "Cerebral Autoregulation & Anesthetic Effects on CBF";

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 — Title Slide
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  // Left accent column
  sl.addShape("rect", { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.teal }, line: { color: C.teal } });
  sl.addShape("rect", { x: 0.18, y: 0, w: 0.06, h: 5.625, fill: { color: C.gold }, line: { color: C.gold } });

  sl.addText("Cerebral Autoregulation", {
    x: 0.5, y: 1.1, w: 9, h: 0.82,
    fontSize: 36, bold: true, color: C.teal, fontFace: "Calibri", margin: 0,
  });
  sl.addText("& Anesthetic Effects on Cerebral Blood Flow", {
    x: 0.5, y: 1.88, w: 9, h: 0.55,
    fontSize: 22, color: C.gold, fontFace: "Calibri", margin: 0,
  });
  sl.addShape("line", { x: 0.5, y: 2.52, w: 5.5, h: 0, line: { color: C.muted, width: 0.75 } });
  sl.addText("MD Anesthesia  |  Neurosurgical Anesthesia", {
    x: 0.5, y: 2.62, w: 9, h: 0.32,
    fontSize: 13, color: C.muted, fontFace: "Calibri", italic: true, margin: 0,
  });

  // Sub-topics as small tags
  const tags = ["Physiology of CBF", "Autoregulation", "CO₂ & O₂ Reactivity", "Volatile Agents", "IV Agents", "ICP", "CPP"];
  tags.forEach((t, i) => {
    addPill(sl, t, 0.5 + i * 1.35, 3.3, 1.28, i % 2 === 0 ? C.teal : "1A4060");
  });

  sl.addText("Sources: Miller's Anesthesia 10e · Barash Clinical Anesthesia 9e · Morgan & Mikhail 7e", {
    x: 0.5, y: 5.1, w: 9, h: 0.22,
    fontSize: 8, color: C.muted, fontFace: "Calibri", italic: true, margin: 0,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 — Normal CBF: Physiology & Key Values
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Normal Cerebral Blood Flow — Key Values", "Miller's Anesthesia 10e, Ch. 10");

  // Data cards
  const cards = [
    ["Mean CBF", "50", "mL/100 g/min  (PaCO₂ 40 mmHg)"],
    ["Gray Matter", "80", "mL/100 g/min"],
    ["White Matter", "20", "mL/100 g/min"],
    ["Total CBF", "750", "mL/min  (15–20% CO)"],
    ["CMRO₂", "3–4", "mL O₂/100 g/min"],
    ["Normal ICP", "<15", "mmHg"],
  ];
  cards.forEach(([label, value, unit], i) => {
    const row = Math.floor(i / 3);
    const col = i % 3;
    dataCard(sl, label, value, unit, 0.35 + col * 3.12, 1.1 + row * 1.1, 2.9);
  });

  // Thresholds section
  sl.addText("CBF Thresholds & Brain Function", {
    x: 0.35, y: 3.35, w: 9.3, h: 0.3,
    fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0,
  });

  const thresholds = [
    { label: "EEG Slowing", value: "< 20–25", bg: C.orange },
    { label: "Isoelectric EEG", value: "< 20", bg: "#B7410E" },
    { label: "Irreversible Damage", value: "< 10", bg: C.red },
    { label: "MCA TCD Normal", value: "~55", bg: C.green },
    { label: "Vasospasm (TCD)", value: "> 120", bg: C.red },
  ];
  thresholds.forEach((t, i) => {
    sl.addShape("roundRect", { x: 0.35 + i * 1.88, y: 3.75, w: 1.75, h: 0.9, fill: { color: t.bg }, line: { color: t.bg }, rectRadius: 0.1 });
    sl.addText(t.value + "\nmL/100 g/min", { x: 0.35 + i * 1.88, y: 3.77, w: 1.75, h: 0.46, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    sl.addText(t.label, { x: 0.35 + i * 1.88, y: 4.23, w: 1.75, h: 0.38, fontSize: 9, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  });

  addSource(sl, "Miller's Anesthesia 10e, p. 931  |  Morgan & Mikhail Clinical Anesthesiology 7e, p. 1075");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 — Cerebral Autoregulation: Classic Concept
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Cerebral Autoregulation — Classic (Lassen) Concept", "Miller's Anesthesia 10e, p. 934–936");

  // Left: text
  sl.addText("Definition", { x: 0.35, y: 1.08, w: 4.5, h: 0.28, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  sl.addText(
    "The intrinsic ability of the cerebral vasculature to maintain a relatively constant CBF (≈50 mL/100 g/min) despite changes in mean arterial pressure (MAP).",
    { x: 0.35, y: 1.36, w: 4.6, h: 0.72, fontSize: 11.5, color: C.white, fontFace: "Calibri", margin: 0 }
  );

  // Classic curve illustration (simple shapes)
  // LLA / ULA labels
  sl.addText("Classic Autoregulation Curve", { x: 0.35, y: 2.1, w: 4.5, h: 0.28, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const pts = [
    { label: "Lower Limit of Autoregulation (LLA)", val: "MAP ~50–70 mmHg", col: C.orange },
    { label: "Autoregulatory Plateau", val: "MAP 50–150 mmHg  |  CBF ≈ constant", col: C.green },
    { label: "Upper Limit of Autoregulation (ULA)", val: "MAP ~150 mmHg", col: C.red },
    { label: "Pressure-Passive Flow", val: "Below LLA or above ULA — CBF ∝ MAP", col: C.muted },
  ];
  pts.forEach((p, i) => {
    sl.addShape("roundRect", { x: 0.35, y: 2.45 + i * 0.62, w: 0.2, h: 0.4, fill: { color: p.col }, line: { color: p.col }, rectRadius: 0.04 });
    sl.addText(p.label, { x: 0.62, y: 2.46 + i * 0.62, w: 4.3, h: 0.22, fontSize: 10.5, bold: true, color: p.col, fontFace: "Calibri", margin: 0 });
    sl.addText(p.val, { x: 0.62, y: 2.67 + i * 0.62, w: 4.3, h: 0.2, fontSize: 10, color: C.light, fontFace: "Calibri", margin: 0 });
  });

  // Right: image
  if (imgs[0] && imgs[0].base64) {
    sl.addImage({ data: imgs[0].base64, x: 5.15, y: 1.05, w: 4.6, h: 4.15 });
  }

  addSource(sl, "Miller's Anesthesia 10e, p. 934–937  |  Lassen NA, Acta Neurol Scand, 1959");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 — Mechanisms of Autoregulation
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Mechanisms Regulating Cerebral Blood Flow", "Miller's Anesthesia 10e, Table 10.1");

  const mechanisms = [
    {
      title: "Myogenic (Pressure)",
      color: C.teal,
      points: ["Vascular smooth muscle contracts in response to↑ transmural pressure", "Bayliss effect — intrinsic property of vessel wall", "Primary mechanism of static autoregulation", "Operates over MAP 50–150 mmHg"],
    },
    {
      title: "Chemical / Metabolic",
      color: C.gold,
      points: ["CO₂ is the most potent vasodilator", "PaCO₂ ↑ → vasodilation → ↑CBF (4% per mmHg)", "PaO₂ < 50 mmHg → marked vasodilation", "Hypoxia and hypercarbia both IMPAIR autoregulation"],
    },
    {
      title: "Neurogenic",
      color: C.orange,
      points: ["Adrenergic: sympathetic activation → vasoconstriction (shifts ULA rightward)", "Cholinergic, serotonergic, VIPergic pathways modulate tone", "Limits CBF surge in acute hypertension", "Reduced capacity for vasodilation during hypotension"],
    },
    {
      title: "Neurovascular Coupling",
      color: C.green,
      points: ["Regional CBF closely matches local metabolic demand", "Mediators: NO, K⁺, adenosine, CO₂, EETs", "Gray matter CBF 4× white matter", "Basis for functional MRI (BOLD signal)"],
    },
  ];

  mechanisms.forEach((m, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.35 + col * 4.82;
    const y = 1.1 + row * 2.2;
    sl.addShape("roundRect", { x, y, w: 4.55, h: 2.08, fill: { color: C.slate }, line: { color: m.color, width: 1.5 }, rectRadius: 0.12 });
    sl.addShape("roundRect", { x, y, w: 4.55, h: 0.4, fill: { color: m.color }, line: { color: m.color }, rectRadius: 0.12 });
    sl.addShape("rect", { x, y: y + 0.25, w: 4.55, h: 0.15, fill: { color: m.color }, line: { color: m.color } });
    sl.addText(m.title, { x: x + 0.15, y: y + 0.06, w: 4.25, h: 0.3, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    const bulletItems = m.points.map((p, pi) => ({ text: p, options: { bullet: { code: "25B8" }, breakLine: pi < m.points.length - 1, fontSize: 10.5, color: C.white, fontFace: "Calibri", paraSpaceAfter: 3 } }));
    sl.addText(bulletItems, { x: x + 0.12, y: y + 0.46, w: 4.3, h: 1.55, valign: "top" });
  });

  addSource(sl, "Miller's Anesthesia 10e, p. 932–938  |  Barash Clinical Anesthesia 9e, p. 1413–1415");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 — CO₂ and O₂ Reactivity
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "CO₂ and O₂ Reactivity of Cerebral Vessels", "Miller's Anesthesia 10e, p. 940–944");

  // CO2 section
  sl.addShape("roundRect", { x: 0.35, y: 1.08, w: 4.55, h: 4.15, fill: { color: C.slate }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.12 });
  sl.addText("CO₂ Reactivity", { x: 0.45, y: 1.14, w: 4.35, h: 0.34, fontSize: 14, bold: true, color: C.teal, fontFace: "Calibri", margin: 0 });

  const co2Items = [
    ["Most potent physiologic modulator", C.white],
    ["~4% change in CBF per 1 mmHg PaCO₂", C.teal],
    ["Linear between PaCO₂ 20–80 mmHg", C.white],
    ["Mechanism: CO₂ → H⁺ → vasodilation via NO and prostaglandins", C.white],
    ["Hyperventilation (PaCO₂ ↓) → vasoconstriction → ↓CBF & ↓ICP", C.gold],
    ["Hypocarbia effect lasts ~4–6 hours (CSF pH equilibration)", C.white],
    ["PaCO₂ < 20 mmHg → risk of cerebral ischemia (not routinely used)", C.red],
    ["Anesthetic agents preserve CO₂ reactivity (unlike autoregulation)", C.green],
  ];
  co2Items.forEach(([text, color], i) => {
    sl.addText([{ text, options: { bullet: { code: "2022" }, fontSize: 10.5, color, fontFace: "Calibri" } }], {
      x: 0.45, y: 1.56 + i * 0.44, w: 4.35, h: 0.42, valign: "top",
    });
  });

  // O2 section
  sl.addShape("roundRect", { x: 5.12, y: 1.08, w: 4.55, h: 4.15, fill: { color: C.slate }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.12 });
  sl.addText("O₂ Reactivity", { x: 5.22, y: 1.14, w: 4.35, h: 0.34, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const o2Items = [
    ["Normal PaO₂: minimal effect on CBF", C.white],
    ["PaO₂ < 50–60 mmHg → steep ↑ in CBF", C.orange],
    ["Hypoxic vasodilation mediated by: adenosine, NO, K⁺ ATP channels", C.white],
    ["Hyperoxia (PaO₂ >300 mmHg) → mild vasoconstriction (10–15%)", C.white],
    ["Hypoxia IMPAIRS cerebral autoregulation", C.red],
    ["Brain tissue O₂ tension (PbtO₂): normal 20–50 mmHg", C.teal],
    ["PbtO₂ < 20 mmHg → intervention warranted", C.orange],
    ["PbtO₂ < 10 mmHg → cerebral ischemia", C.red],
  ];
  o2Items.forEach(([text, color], i) => {
    sl.addText([{ text, options: { bullet: { code: "2022" }, fontSize: 10.5, color, fontFace: "Calibri" } }], {
      x: 5.22, y: 1.56 + i * 0.44, w: 4.35, h: 0.42, valign: "top",
    });
  });

  addSource(sl, "Miller's Anesthesia 10e, p. 940–944  |  Morgan & Mikhail 7e, p. 1076");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 — Integrated Regulation Diagram (image slide)
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Integrated Regulation of CBF — Contemporary View", "Miller's Anesthesia 10e, Fig. 10.10, p. 966–968");

  if (imgs[2] && imgs[2].base64) {
    sl.addImage({ data: imgs[2].base64, x: 0.35, y: 1.05, w: 5.5, h: 4.2 });
  }

  // Key callouts on right
  sl.addText("Key Takeaways", { x: 6.05, y: 1.05, w: 3.65, h: 0.32, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const takeaways = [
    { text: "Autoregulation is dynamic, not static", color: C.teal },
    { text: "Multiple pathways act simultaneously on cerebral resistance vessels", color: C.white },
    { text: "Anesthetics affect CBF at MULTIPLE levels", color: C.gold },
    { text: "↓Metabolism → indirect vasoconstriction", color: C.green },
    { text: "Direct vasodilation → ↑CBF (volatile agents)", color: C.orange },
    { text: "↓Sympathetic tone → impaired ULA protection", color: C.white },
    { text: "↓Cardiac output → ↓cerebral perfusion", color: C.red },
    { text: "Plateau width varies significantly between individuals", color: C.muted },
  ];
  takeaways.forEach((t, i) => {
    sl.addShape("roundRect", { x: 6.05, y: 1.46 + i * 0.45, w: 0.18, h: 0.28, fill: { color: t.color }, line: { color: t.color }, rectRadius: 0.04 });
    sl.addText(t.text, { x: 6.28, y: 1.47 + i * 0.45, w: 3.35, h: 0.28, fontSize: 10.5, color: t.color, fontFace: "Calibri", margin: 0 });
  });

  addSource(sl, "Miller's Anesthesia 10e, Fig. 10.10, p. 966–968");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 — Volatile Anesthetic Agents & CBF
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Volatile Anesthetic Agents — Effects on CBF & Autoregulation", "Barash Clinical Anesthesia 9e, p. 1413–1415");

  // Image on left
  if (imgs[1] && imgs[1].base64) {
    sl.addImage({ data: imgs[1].base64, x: 0.3, y: 1.05, w: 5.1, h: 3.5 });
  }
  sl.addText("CBF vs MAC — volatile agents (normocapnia)", {
    x: 0.3, y: 4.55, w: 5.1, h: 0.28,
    fontSize: 9, italic: true, color: C.muted, fontFace: "Calibri", align: "center", margin: 0,
  });

  // Table right
  const agents = [
    { name: "Halothane", cbf: "↑↑↑ dose-dep.", cmro2: "↓↓", ar: "Abolished", icp: "↑↑", col: C.red },
    { name: "Isoflurane", cbf: "↑ at >1 MAC", cmro2: "↓↓↓", ar: "Impaired ↑dose", icp: "↑ (mild)", col: C.orange },
    { name: "Sevoflurane", cbf: "Minimal <1 MAC", cmro2: "↓↓↓", ar: "Preserved ≤1 MAC", icp: "↑ minimal", col: C.green },
    { name: "Desflurane", cbf: "Minimal <1 MAC", cmro2: "↓↓", ar: "Impaired ↑dose", icp: "↑ mild", col: C.teal },
    { name: "N₂O", cbf: "↑ (sympathetic)", cmro2: "↑ (metabolic)", ar: "Some impairment", icp: "↑", col: C.muted },
  ];

  // Header row
  const hdrs = ["Agent", "CBF", "CMRO₂", "Autoregulation", "ICP"];
  const colW = [1.35, 0.9, 0.9, 1.35, 0.72];
  const startX = 5.55;
  hdrs.forEach((h, i) => {
    const xPos = startX + colW.slice(0, i).reduce((a, b) => a + b, 0);
    sl.addShape("rect", { x: xPos, y: 1.05, w: colW[i], h: 0.38, fill: { color: C.teal }, line: { color: C.teal } });
    sl.addText(h, { x: xPos + 0.04, y: 1.07, w: colW[i] - 0.08, h: 0.3, fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  });

  agents.forEach((ag, ri) => {
    const rowY = 1.48 + ri * 0.7;
    const rowBg = ri % 2 === 0 ? C.slate : C.navy;
    sl.addShape("rect", { x: startX, y: rowY, w: 4.22, h: 0.64, fill: { color: rowBg }, line: { color: rowBg } });
    // Left color stripe
    sl.addShape("rect", { x: startX, y: rowY, w: 0.06, h: 0.64, fill: { color: ag.col }, line: { color: ag.col } });
    const vals = [ag.name, ag.cbf, ag.cmro2, ag.ar, ag.icp];
    vals.forEach((v, ci) => {
      const xPos = startX + colW.slice(0, ci).reduce((a, b) => a + b, 0);
      sl.addText(v, {
        x: xPos + (ci === 0 ? 0.1 : 0.04), y: rowY + 0.1, w: colW[ci] - 0.08, h: 0.44,
        fontSize: 9.5, color: ci === 0 ? ag.col : C.white, bold: ci === 0, fontFace: "Calibri", align: ci === 0 ? "left" : "center", valign: "middle", margin: 0,
      });
    });
  });

  sl.addText("All volatile agents: direct cerebral vasodilators + impair autoregulation dose-dependently", {
    x: 5.55, y: 5.05, w: 4.22, h: 0.24,
    fontSize: 9, color: C.gold, fontFace: "Calibri", italic: true, align: "center", margin: 0,
  });

  addSource(sl, "Barash Clinical Anesthesia 9e, Fig. 18-10, p. 1413  |  Miller's Anesthesia 10e, p. 946–950");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 — Intravenous Anesthetic Agents
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Intravenous Anesthetic Agents — Effects on CBF", "Miller's Anesthesia 10e, p. 950–960");

  const agents = [
    {
      name: "Propofol", color: C.teal,
      points: ["↓CBF and ↓CMRO₂ (coupled)", "Preserves autoregulation and CO₂ reactivity", "Preferred for neuroanesthesia TIVA", "↓ICP — favoured in raised ICP management", "Risk: hypotension → ↓CPP if MAP falls"],
    },
    {
      name: "Barbiturates\n(Thiopental)", color: C.gold,
      points: ["↓↓CBF and ↓↓CMRO₂ (maximum at EEG silence)", "Preserves autoregulation", "Max CMRO₂ reduction = dose causing isoelectric EEG", "No further ↓CMRO₂ beyond EEG silence", "Barbiturate coma used for ICP rescue"],
    },
    {
      name: "Ketamine", color: C.red,
      points: ["↑CBF and ↑CMRO₂ — cerebral vasodilator", "IMPAIRS autoregulation", "↑ICP — traditionally avoided in neurosurgery", "Recent evidence: safe with controlled ventilation", "Preserves CO₂ reactivity"],
    },
    {
      name: "Etomidate", color: C.orange,
      points: ["↓CBF and ↓CMRO₂", "Preserves autoregulation and CO₂ reactivity", "Cardiovascular stability — useful for induction", "Adrenocortical suppression limits infusion use", "Increases epileptiform EEG activity"],
    },
    {
      name: "Dexmedetomidine", color: C.green,
      points: ["↓CBF modestly (sympatholytic)", "CMRO₂ reduction minimal", "Preserves autoregulation and CO₂ reactivity", "Enhances glymphatic clearance (vs. volatile agents)", "Useful for awake craniotomy sedation"],
    },
    {
      name: "Benzodiazepines\n(Midazolam)", color: C.muted,
      points: ["↓CBF and ↓CMRO₂ (mild-moderate)", "Preserves autoregulation", "Plateau effect on CMRO₂ reduction", "Does not cause EEG silence alone", "↓ICP proportional to baseline ICP"],
    },
  ];

  agents.forEach((ag, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.35 + col * 3.2;
    const y = 1.08 + row * 2.18;
    sl.addShape("roundRect", { x, y, w: 3.05, h: 2.05, fill: { color: C.slate }, line: { color: ag.color, width: 1.5 }, rectRadius: 0.1 });
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    sl.addShape("rect", { x, y: y + 0.24, w: 3.05, h: 0.14, fill: { color: ag.color }, line: { color: ag.color } });
    sl.addText(ag.name, { x: x + 0.1, y: y + 0.05, w: 2.85, h: 0.3, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    const bulletItems = ag.points.map((p, pi) => ({
      text: p,
      options: { bullet: { code: "25B8" }, breakLine: pi < ag.points.length - 1, fontSize: 9.5, color: C.white, fontFace: "Calibri", paraSpaceAfter: 2 }
    }));
    sl.addText(bulletItems, { x: x + 0.08, y: y + 0.44, w: 2.9, h: 1.55, valign: "top" });
  });

  addSource(sl, "Miller's Anesthesia 10e, p. 950–960  |  Barash Clinical Anesthesia 9e, Ch. 18");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 — ICP, CPP and Monro-Kellie Doctrine
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "ICP, CPP & the Monro-Kellie Doctrine", "Miller's Anesthesia 10e, p. 929–930");

  // Monro-Kellie box
  sl.addShape("roundRect", { x: 0.35, y: 1.1, w: 9.3, h: 0.85, fill: { color: C.slate }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.1 });
  sl.addText("Monro-Kellie Doctrine:", { x: 0.55, y: 1.18, w: 2.2, h: 0.3, fontSize: 11.5, bold: true, color: C.teal, fontFace: "Calibri", margin: 0 });
  sl.addText(
    "The cranium is a rigid, non-expandable box. Its contents — brain parenchyma (~80%), CSF (~10%), and blood (~10%) — are constant in volume. An increase in any component must be compensated by a decrease in another, or ICP rises.",
    { x: 2.75, y: 1.15, w: 6.7, h: 0.72, fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0 }
  );

  // Left: ICP and CPP
  sl.addText("Intracranial Pressure", { x: 0.35, y: 2.08, w: 4.4, h: 0.3, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const icpItems = [
    "Normal ICP: < 15 mmHg",
    "Raised ICP: > 20 mmHg (requires intervention)",
    "Severe ICP: > 40 mmHg",
    "CPP = MAP − ICP   (target > 60–70 mmHg)",
    "Low CPP → ischaemia; High CPP → hyperaemia + edema",
    "Cushing's reflex: severe ICP → hypertension + bradycardia",
  ];
  bulletBlock(sl, icpItems, 0.35, 2.42, 4.45, 2.6, { fontSize: 11 });

  // Right: factors and management
  sl.addText("Anesthetic Management of ↑ICP", { x: 5.2, y: 2.08, w: 4.5, h: 0.3, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const mgmt = [
    { label: "AVOID", items: ["Ketamine, high-dose volatile agents", "Coughing, straining, Trendelenburg", "Hypercarbia, hypoxia, hyperthermia", "Suxamethonium (mild ↑ICP)"], color: C.red },
    { label: "USE", items: ["Propofol TIVA or low-dose sevoflurane ≤1 MAC", "Hyperventilation: PaCO₂ 30–35 mmHg", "Head up 15–30°, avoid neck compression", "Mannitol 0.25–1 g/kg, hypertonic saline"], color: C.green },
  ];
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    }));
    sl.addText(bItems, { x: 5.3, y: y + 0.36, w: 4.25, h: 0.88, valign: "top" });
  });

  addSource(sl, "Miller's Anesthesia 10e, p. 929–930, 961–965  |  Barash Clinical Anesthesia 9e, p. 1413");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 — Clinical Scenarios Summary
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "High-Yield Clinical Scenarios for Anesthesia Practice", "Miller's Anesthesia 10e · Morgan & Mikhail 7e");

  const scenarios = [
    {
      scenario: "Carotid Endarterectomy",
      concern: "ICA cross-clamp → ↓CBF to ipsilateral hemisphere",
      strategy: "Maintain MAP at/above awake baseline; TCD/EEG monitoring; use shunt if needed. Avoid hypotension.",
      color: C.teal,
    },
    {
      scenario: "Craniotomy for Tumor",
      concern: "↑ICP, brain relaxation, herniation risk",
      strategy: "TIVA (propofol) preferred. Maintain PaCO₂ 30–35 mmHg. Mannitol/hypertonic saline. Avoid N₂O.",
      color: C.gold,
    },
    {
      scenario: "Head Injury (TBI)",
      concern: "Impaired autoregulation, pressure-passive CBF",
      strategy: "CPP > 60 mmHg; target ICP < 20 mmHg. Avoid hypoxia, hypercarbia, hyperthermia. Barbiturate coma for refractory ICP.",
      color: C.red,
    },
    {
      scenario: "Sitting Position Surgery",
      concern: "↓Venous return → ↓MAP → ↓CPP; air embolism",
      strategy: "Maintain MAP ≥ 60 mmHg at brain level. PEEP cautiously. Precordial Doppler + end-tidal CO₂ monitoring.",
      color: C.orange,
    },
    {
      scenario: "Subarachnoid Hemorrhage",
      concern: "Vasospasm; impaired autoregulation",
      strategy: "TCD monitoring for vasospasm (MCA velocity > 120 cm/s = Lindegaard ratio > 3). Triple-H therapy. Nimodipine.",
      color: C.green,
    },
    {
      scenario: "Controlled Hypotension",
      concern: "Below LLA → pressure-passive CBF; ischaemia",
      strategy: "Keep MAP ≥ 50–60 mmHg. NB: LLA shifts rightward in chronic hypertension. Monitor EEG/NIRS.",
      color: C.muted,
    },
  ];

  scenarios.forEach((sc, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
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    const y = 1.1 + row * 1.48;
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    sl.addText("→ " + sc.strategy, { x: x + 0.1, y: y + 0.68, w: 4.4, h: 0.64, fontSize: 9.5, color: C.white, fontFace: "Calibri", margin: 0 });
  });

  addSource(sl, "Miller's Anesthesia 10e  |  Morgan & Mikhail 7e, p. 1075–1078  |  Barash Clinical Anesthesia 9e");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 — Summary Comparison Table
// ─────────────────────────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  addBg(sl);
  addHeader(sl, "Summary: Anesthetic Effects on Cerebral Physiology", "Quick Reference for MD Anesthesia Exam");

  const headers = ["Agent", "CBF", "CMRO₂", "Autoregulation", "CO₂ React.", "ICP", "Best Use"];
  const colWidths = [1.55, 0.85, 0.85, 1.25, 0.9, 0.75, 1.4];
  const rows = [
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    ["Thiopental",    "↓↓",    "↓↓↓",  "Preserved",     "Preserved", "↓↓",  "ICP rescue",       C.gold],
    ["Isoflurane",    "↑>1MAC","↓↓",   "Impaired dose", "Preserved", "↑",   "General anesthesia",C.orange],
    ["Sevoflurane",   "Min",   "↓↓",   "≤1MAC OK",      "Preserved", "↑min","Neuro (low dose)",  C.green],
    ["Desflurane",    "Min",   "↓",    "Impaired",      "Preserved", "↑",   "General",          C.teal],
    ["Ketamine",      "↑↑",    "↑",    "Impaired",      "Preserved", "↑↑",  "Avoid in ↑ICP",    C.red],
    ["Dexmedetomidine","↓mod", "Min",  "Preserved",     "Preserved", "↓",   "Awake craniotomy", C.green],
    ["N₂O",           "↑",    "↑",    "Some impair.",  "Preserved", "↑",   "Avoid neuro",      C.muted],
  ];

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  });

  rows.forEach((row, ri) => {
    const color = row[8] || C.teal;
    const rowY = 1.48 + ri * 0.46;
    const rowBg = ri % 2 === 0 ? C.slate : C.navy;
    sl.addShape("rect", { x: 0.25, y: rowY, w: 9.55, h: 0.42, fill: { color: rowBg }, line: { color: rowBg } });
    sl.addShape("rect", { x: 0.25, y: rowY, w: 0.06, h: 0.42, fill: { color: color }, line: { color: color } });
    let xC = 0.25;
    row.slice(0, 7).forEach((cell, ci) => {
      const cellColor = ci === 0 ? color : (
        cell.includes("↑↑") ? C.red : cell.includes("↑") ? C.orange :
        cell.includes("↓↓") ? C.green : cell.includes("↓") ? "#4FC3F7" :
        cell === "Preserved" ? C.green : cell.includes("Impaired") ? C.orange :
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        align: ci === 0 ? "left" : "center", valign: "middle", margin: 0,
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      xC += colWidths[ci];
    });
  });

  sl.addText("Green = favourable for neurosurgery  |  Orange = use with caution  |  Red = generally avoid in raised ICP", {
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    fontSize: 8.5, color: C.muted, fontFace: "Calibri", italic: true, align: "center", margin: 0,
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  addSource(sl, "Miller's Anesthesia 10e  |  Barash Clinical Anesthesia 9e  |  Morgan & Mikhail Clinical Anesthesiology 7e");
}

// ─────────────────────────────────────────────────────────────────────────────
// Write file
// ─────────────────────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/dm-anaesthesia/cerebral-autoregulation/Cerebral_Autoregulation_Anesthesia.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("✓ Saved:", outPath);
}).catch(err => {
  console.error("Error:", err);
  process.exit(1);
});