const pptxgen = require("pptxgenjs"); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.title = "Hydrocephalus & Raised ICP - Anesthesia Management"; pres.author = "MD Anesthesia"; // ── COLOUR PALETTE ────────────────────────────────────────────────────────── const C = { dark: "0D1B2A", // near-black navy (dominant bg) mid: "1B3A5C", // deep blue panel bg accent: "00B4D8", // cyan accent accent2: "F4A261", // warm orange accent red: "E63946", // alert/danger red green: "2DC653", // highlight green white: "FFFFFF", silver: "CAD3E0", light: "EFF6FF", yellow: "FFD166", }; // ── SLIDE HELPERS ──────────────────────────────────────────────────────────── function addTitleBar(slide, title, subtitle = "") { // Full-width header bar slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 1.1, fill: { color: C.mid } }); slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.08, h: 1.1, fill: { color: C.accent } }); slide.addText(title, { x: 0.2, y: 0.1, w: 9.4, h: 0.6, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri Light", margin: 0, }); if (subtitle) { slide.addText(subtitle, { x: 0.2, y: 0.72, w: 9.4, h: 0.32, fontSize: 13, color: C.accent, fontFace: "Calibri", italic: true, margin: 0, }); } } function addFooter(slide, text = "Hydrocephalus & Raised ICP | MD Anesthesia") { slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.42, w: "100%", h: 0.2, fill: { color: C.accent } }); slide.addText(text, { x: 0.15, y: 5.42, w: 9.7, h: 0.2, fontSize: 8, color: C.dark, fontFace: "Calibri", align: "right", margin: 0, }); } function pill(slide, label, x, y, w = 2.2, h = 0.38, bg = C.accent, fg = C.dark) { slide.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: bg }, line: { color: bg }, rectRadius: 0.08 }); slide.addText(label, { x, y, w, h, fontSize: 10, bold: true, color: fg, align: "center", valign: "middle", margin: 0, fontFace: "Calibri" }); } function bulletBox(slide, items, x, y, w, h, bg = C.mid, textColor = C.silver, titleText = "", titleColor = C.accent, fontSize = 11) { slide.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: bg }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 }); if (titleText) { slide.addText(titleText, { x: x + 0.12, y: y + 0.08, w: w - 0.24, h: 0.3, fontSize: 12, bold: true, color: titleColor, fontFace: "Calibri", margin: 0 }); } const textItems = items.map((t, i) => ({ text: t, options: { bullet: { type: "bullet", characterCode: "25B8", color: C.accent }, breakLine: i < items.length - 1, color: textColor, fontSize, fontFace: "Calibri" } })); const ty = titleText ? y + 0.38 : y + 0.12; const th = titleText ? h - 0.45 : h - 0.2; slide.addText(textItems, { x: x + 0.18, y: ty, w: w - 0.28, h: th, valign: "top", margin: 0 }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 1 – TITLE SLIDE // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; // Big accent rectangle left s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.22, h: "100%", fill: { color: C.accent } }); s.addShape(pres.ShapeType.rect, { x: 0.22, y: 0, w: 0.06, h: "100%", fill: { color: C.accent2 } }); s.addText("HYDROCEPHALUS &", { x: 0.5, y: 0.7, w: 9.2, h: 0.9, fontSize: 38, bold: true, color: C.white, fontFace: "Calibri Light", align: "left" }); s.addText("RAISED ICP", { x: 0.5, y: 1.55, w: 9.2, h: 0.9, fontSize: 48, bold: true, color: C.accent, fontFace: "Calibri Light", align: "left" }); s.addText("MANAGEMENT IN ANESTHESIA", { x: 0.5, y: 2.5, w: 9.2, h: 0.5, fontSize: 22, color: C.accent2, fontFace: "Calibri", align: "left" }); // divider s.addShape(pres.ShapeType.rect, { x: 0.5, y: 3.1, w: 5.5, h: 0.04, fill: { color: C.accent } }); s.addText("MD Anesthesia · Neuroanesthesia Module", { x: 0.5, y: 3.25, w: 9, h: 0.35, fontSize: 14, color: C.silver, fontFace: "Calibri", align: "left" }); s.addText("Sources: Miller's Anesthesia 10e · Barash Clinical Anesthesia 9e · Morgan & Mikhail 7e · Robbins Pathology", { x: 0.5, y: 3.65, w: 9, h: 0.28, fontSize: 10, color: C.silver, fontFace: "Calibri", italic: true, align: "left" }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 2 – OUTLINE // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "SESSION OUTLINE"); addFooter(s); const topics = [ ["01", "Intracranial Pressure – Basics & Monroe-Kellie Doctrine"], ["02", "Hydrocephalus – Classification & Pathophysiology"], ["03", "Causes & Clinical Features of Raised ICP"], ["04", "Cerebral Edema – Types & Herniation Syndromes"], ["05", "Cerebral Blood Flow & Autoregulation"], ["06", "Anesthetic Drug Effects on ICP & CBF"], ["07", "Pre-operative Assessment & Optimization"], ["08", "Induction & Airway Management"], ["09", "Intraoperative Management of Raised ICP"], ["10", "Pharmacological ICP Reduction"], ["11", "Surgical Interventions & Shunts – Anaesthesia"], ["12", "Emergence, Extubation & Postoperative Care"], ]; topics.forEach(([num, label], i) => { const col = i < 6 ? 0 : 1; const row = i % 6; const x = col === 0 ? 0.3 : 5.15; const y = 1.25 + row * 0.67; s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.6, h: 0.55, fill: { color: C.mid }, line: { color: C.accent, width: 0.5 }, rectRadius: 0.07 }); s.addText(num, { x: x + 0.06, y, w: 0.5, h: 0.55, fontSize: 14, bold: true, color: C.accent, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); s.addShape(pres.ShapeType.rect, { x: x + 0.56, y: y + 0.12, w: 0.03, h: 0.3, fill: { color: C.accent } }); s.addText(label, { x: x + 0.66, y, w: 3.85, h: 0.55, fontSize: 10.5, color: C.white, valign: "middle", fontFace: "Calibri", margin: 0 }); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 3 – MONROE-KELLIE DOCTRINE / ICP BASICS // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "INTRACRANIAL PRESSURE – BASICS", "Monroe-Kellie Doctrine"); addFooter(s); // Normal ICP box s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.3, w: 4.3, h: 1.1, fill: { color: C.mid }, line: { color: C.green }, rectRadius: 0.1 }); s.addText("Normal ICP", { x: 0.4, y: 1.32, w: 4.1, h: 0.3, fontSize: 12, bold: true, color: C.green, fontFace: "Calibri", margin: 0 }); s.addText([ { text: "Adults: ", options: { bold: true, color: C.yellow } }, { text: "7–15 mmHg\n" }, { text: "Children: ", options: { bold: true, color: C.yellow } }, { text: "3–7 mmHg | Neonates: ", options: { color: C.silver } }, { text: "1.5–6 mmHg" }, ], { x: 0.4, y: 1.62, w: 4.0, h: 0.7, fontSize: 11, color: C.silver, fontFace: "Calibri", margin: 0 }); // Monroe-Kellie s.addShape(pres.ShapeType.roundRect, { x: 4.9, y: 1.3, w: 4.8, h: 1.1, fill: { color: C.mid }, line: { color: C.accent2 }, rectRadius: 0.1 }); s.addText("Monroe-Kellie Doctrine", { x: 5.0, y: 1.32, w: 4.6, h: 0.3, fontSize: 12, bold: true, color: C.accent2, fontFace: "Calibri", margin: 0 }); s.addText("V(Brain) + V(CSF) + V(Blood) = CONSTANT\nIncrease in any → compensated by decrease in others\nOnce compensation exhausted → ICP rises sharply", { x: 5.0, y: 1.62, w: 4.6, h: 0.7, fontSize: 10.5, color: C.silver, fontFace: "Calibri", margin: 0 }); // ICP compartments s.addText("INTRACRANIAL COMPARTMENTS", { x: 0.3, y: 2.6, w: 9.4, h: 0.3, fontSize: 12, bold: true, color: C.accent, fontFace: "Calibri", margin: 0 }); const comps = [ ["Brain Parenchyma", "~80%", C.accent], ["CSF", "~10%", C.accent2], ["Blood", "~10%", C.red], ]; comps.forEach(([name, pct, col], i) => { const x = 0.3 + i * 3.2; s.addShape(pres.ShapeType.roundRect, { x, y: 2.95, w: 3.0, h: 0.7, fill: { color: col + "33" }, line: { color: col }, rectRadius: 0.1 }); s.addText(`${name}\n${pct}`, { x, y: 2.95, w: 3.0, h: 0.7, fontSize: 11, bold: true, color: col, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); }); // ICP grades bulletBox(s, [ "Mild: 20–30 mmHg", "Moderate: 30–40 mmHg", "Severe: > 40 mmHg (cerebral herniation risk)", "CPP = MAP – ICP | Target CPP ≥ 60 mmHg", ], 0.3, 3.8, 9.4, 1.35, C.mid, C.silver, "ICP SEVERITY & CPP", C.red); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 4 – HYDROCEPHALUS CLASSIFICATION // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "HYDROCEPHALUS", "Classification & Pathophysiology"); addFooter(s); s.addText("Accumulation of excessive CSF within the ventricular system due to impaired flow, resorption, or rarely overproduction. ICP rises when compensatory mechanisms are exhausted.", { x: 0.3, y: 1.2, w: 9.4, h: 0.5, fontSize: 11, color: C.silver, fontFace: "Calibri", italic: true, margin: 0, }); // Two columns: Communicating vs Obstructive const leftItems = ["Impaired CSF absorption at arachnoid granulations", "CSF pathways are patent", "Causes: SAH, meningitis, trauma, venous sinus thrombosis, idiopathic (NPH)", "Normal Pressure Hydrocephalus (NPH): triad – gait apraxia, dementia, urinary incontinence"]; const rightItems = ["Blockage within ventricular system", "Obstruction at foramina of Monro, aqueduct of Sylvius, or 4th ventricle outlets", "Causes: Aqueductal stenosis, tumours (posterior fossa), Chiari malformation, intraventricular haemorrhage", "Often presents acutely – surgical emergency"]; bulletBox(s, leftItems, 0.3, 1.82, 4.6, 2.0, C.mid, C.silver, "COMMUNICATING", C.accent); bulletBox(s, rightItems, 5.1, 1.82, 4.6, 2.0, C.mid, C.silver, "NON-COMMUNICATING (OBSTRUCTIVE)", C.red); // Ex Vacuo s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 4.0, w: 9.4, h: 0.75, fill: { color: "1A2A1A" }, line: { color: C.green }, rectRadius: 0.1 }); s.addText([ { text: "EX VACUO HYDROCEPHALUS: ", options: { bold: true, color: C.green } }, { text: "Compensatory ventricular enlargement due to brain parenchymal loss (e.g. Alzheimer's, stroke). ICP is NOT raised. NOT a true hydrocephalus requiring treatment.", options: { color: C.silver } }, ], { x: 0.45, y: 4.0, w: 9.1, h: 0.75, fontSize: 10.5, valign: "middle", fontFace: "Calibri", margin: 0 }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 5 – CAUSES & CLINICAL FEATURES OF RAISED ICP // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "RAISED ICP – CAUSES & CLINICAL FEATURES"); addFooter(s); bulletBox(s, [ "Space-occupying lesions: tumour, abscess, haematoma (EDH, SDH, ICH)", "Cerebral oedema: TBI, stroke, hepatic encephalopathy, hypertensive crisis", "Hydrocephalus (obstructive or communicating)", "Venous sinus thrombosis", "Idiopathic intracranial hypertension (pseudotumour cerebri)", "CO2 retention / hypoxia → cerebral vasodilation", ], 0.3, 1.2, 4.55, 2.6, C.mid, C.silver, "CAUSES", C.accent2); bulletBox(s, [ "Headache (worse on lying down / morning)", "Nausea & vomiting (projectile)", "Papilledema (raised ICP >20 mmHg sustained)", "Altered level of consciousness / GCS decline", "Cushing's triad: Hypertension + Bradycardia + Irregular breathing", "Cranial nerve palsies (CN III, VI)", "Decerebrate / decorticate posturing (severe)", ], 5.1, 1.2, 4.6, 2.6, C.mid, C.silver, "CLINICAL FEATURES", C.red); // Cushing's triad highlight s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 3.95, w: 9.4, h: 0.8, fill: { color: "2A0A0A" }, line: { color: C.red, width: 1.5 }, rectRadius: 0.1 }); s.addText("⚠ CUSHING'S TRIAD = Pre-terminal sign of brainstem herniation\nHypertension (widened pulse pressure) + Bradycardia + Irregular respirations", { x: 0.5, y: 3.95, w: 9.0, h: 0.8, fontSize: 11, bold: true, color: C.red, valign: "middle", fontFace: "Calibri", margin: 0, }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 6 – CEREBRAL OEDEMA & HERNIATION // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "CEREBRAL OEDEMA & HERNIATION", "Pathophysiology"); addFooter(s); // Oedema types bulletBox(s, [ "Blood-brain barrier disruption → fluid into interstitial space", "Occurs around tumours, abscesses, contusions", "White matter predominantly affected", "Responds to STEROIDS (dexamethasone)", ], 0.3, 1.2, 4.55, 1.8, C.mid, C.silver, "VASOGENIC OEDEMA", C.accent); bulletBox(s, [ "Cell membrane injury → intracellular fluid accumulation", "Occurs in ischaemia, hypoxia, metabolic failure", "Grey & white matter both affected", "Does NOT respond to steroids", ], 5.1, 1.2, 4.6, 1.8, C.mid, C.silver, "CYTOTOXIC OEDEMA", C.accent2); // Herniation syndromes s.addText("HERNIATION SYNDROMES", { x: 0.3, y: 3.1, w: 9.4, h: 0.3, fontSize: 12, bold: true, color: C.red, fontFace: "Calibri", margin: 0 }); const hern = [ ["Subfalcine\n(Cingulate)", "Cingulate gyrus under falx cerebri\nContralateral leg weakness", C.accent], ["Uncal\n(Transtentorial)", "CN III palsy (dilated pupil)\nContralateral hemiplegia\nMost common surgical emergency", C.red], ["Central\n(Downward)", "Bilateral Babinski\nDiencephalon / midbrain compression", C.accent2], ["Tonsillar\n(Foramen Magnum)", "Cerebellar tonsils → foramen magnum\nRespiratory arrest – LETHAL", C.yellow], ]; hern.forEach(([name, detail, col], i) => { const x = 0.3 + i * 2.42; s.addShape(pres.ShapeType.roundRect, { x, y: 3.45, w: 2.22, h: 1.65, fill: { color: col + "22" }, line: { color: col }, rectRadius: 0.1 }); s.addText(name, { x: x + 0.06, y: 3.5, w: 2.1, h: 0.4, fontSize: 10.5, bold: true, color: col, align: "center", fontFace: "Calibri", margin: 0 }); s.addText(detail, { x: x + 0.08, y: 3.92, w: 2.06, h: 1.1, fontSize: 9.5, color: C.silver, fontFace: "Calibri", margin: 0 }); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 7 – CBF & AUTOREGULATION // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "CEREBRAL BLOOD FLOW & AUTOREGULATION", "Key Physiological Concepts"); addFooter(s); bulletBox(s, [ "Normal CBF: ~50 mL/100g/min (whole brain ~750 mL/min)", "Ischaemic threshold: <20 mL/100g/min", "Electrical silence: <15 mL/100g/min", "Infarction: <10 mL/100g/min", ], 0.3, 1.25, 4.55, 1.55, C.mid, C.silver, "NORMAL CBF VALUES", C.green); bulletBox(s, [ "Maintained over MAP 50–150 mmHg in healthy brain", "Abolished by: severe TBI, volatile anaesthetics >1 MAC, hypoxia", "Impaired autoregulation → pressure-passive CBF", ], 5.1, 1.25, 4.6, 1.55, C.mid, C.silver, "AUTOREGULATION", C.accent); // CO2 reactivity s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 2.95, w: 9.4, h: 0.9, fill: { color: "0D2040" }, line: { color: C.accent }, rectRadius: 0.1 }); s.addText("CO₂ REACTIVITY (Most powerful physiological regulator)", { x: 0.45, y: 2.97, w: 9.1, h: 0.28, fontSize: 11.5, bold: true, color: C.accent, fontFace: "Calibri", margin: 0 }); s.addText("For every 1 mmHg rise in PaCO₂ → CBF increases ~4% | PaCO₂ ↑ → vasodilation → ↑CBF → ↑ICP\nHyperventilation: PaCO₂ 30–35 mmHg → vasoconstriction → ↓CBF → ↓ICP (temporary – 30–60 mins)", { x: 0.45, y: 3.26, w: 9.1, h: 0.55, fontSize: 10.5, color: C.silver, fontFace: "Calibri", margin: 0 }); // Other factors const factors = [ ["PaO₂ < 50 mmHg", "CBF doubles", C.red], ["Temperature ↓1°C", "CMR ↓7%", C.accent], ["MAP ↑ (impaired AR)", "CBF ↑ → ↑ICP", C.accent2], ["Venous obstruction", "↑CBV → ↑ICP", C.yellow], ]; factors.forEach(([cause, effect, col], i) => { const x = 0.3 + i * 2.42; s.addShape(pres.ShapeType.roundRect, { x, y: 3.98, w: 2.2, h: 0.85, fill: { color: col + "22" }, line: { color: col, width: 0.8 }, rectRadius: 0.08 }); s.addText(cause, { x: x + 0.06, y: 4.0, w: 2.08, h: 0.35, fontSize: 10, bold: true, color: col, fontFace: "Calibri", margin: 0 }); s.addText(effect, { x: x + 0.06, y: 4.38, w: 2.08, h: 0.35, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 8 – ANAESTHETIC DRUG EFFECTS ON ICP // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "ANAESTHETIC DRUG EFFECTS ON ICP & CBF"); addFooter(s); // Table header s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 9.4, h: 0.38, fill: { color: C.accent } }); ["Drug / Agent", "CBF", "CMR", "ICP", "Autoregulation", "Notes"].forEach((h, i) => { const widths = [2.2, 0.9, 0.9, 0.9, 1.7, 2.8]; const xPos = [0.3, 2.5, 3.4, 4.3, 5.2, 6.9]; s.addText(h, { x: xPos[i], y: 1.2, w: widths[i], h: 0.38, fontSize: 10, bold: true, color: C.dark, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); }); const rows = [ ["Propofol", "↓↓", "↓↓", "↓↓", "Preserved", "Drug of choice for TIVA in neuro; neuroprotective", C.green], ["Thiopentone", "↓↓", "↓↓", "↓↓", "Preserved", "Used for rapid ICP reduction; burst suppression", C.green], ["Midazolam / BZD", "↓", "↓", "↓", "Preserved", "Adjunct; avoid large doses", C.silver], ["Ketamine*", "↑↑", "↑", "↑↑", "Preserved", "*Controversial – avoid in raised ICP (traditional); recent data suggests safe with concurrent sedation", C.red], ["Isoflurane (<1MAC)", "↑/−", "↓", "±", "Mild impair.", "Acceptable in balanced technique when ICP controlled", C.yellow], ["Sevoflurane (<1MAC)", "↑/−", "↓", "±", "Mild impair.", "Preferred volatile; better cerebrovascular profile", C.yellow], ["Desflurane", "↑", "↓", "↑", "Impaired", "Avoid in raised ICP – most vasodilatory", C.accent2], ["N₂O", "↑", "↑", "↑", "Preserved", "Avoid in raised ICP; increases CBF; pneumocephalus risk", C.red], ["Opioids (fentanyl)", "↓/−", "↓/−", "↓/−", "Preserved", "Good adjuncts; minimise painful stimuli", C.green], ["Succinylcholine", "↑ (transiently)", "−", "↑ (mild)", "—", "Transient ICP rise; acceptable for RSI", C.yellow], ]; rows.forEach((row, i) => { const bg = i % 2 === 0 ? C.mid : "142236"; s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.58 + i * 0.39, w: 9.4, h: 0.39, fill: { color: bg } }); const widths = [2.2, 0.9, 0.9, 0.9, 1.7, 2.8]; const xPos = [0.3, 2.5, 3.4, 4.3, 5.2, 6.9]; const vals = [row[0], row[1], row[2], row[3], row[4], row[5]]; vals.forEach((v, j) => { const color = j === 0 ? row[6] : (j >= 1 && j <= 3 ? (v.includes("↑") ? C.red : v.includes("↓") ? C.green : C.silver) : C.silver); s.addText(v, { x: xPos[j], y: 1.58 + i * 0.39, w: widths[j], h: 0.39, fontSize: 9, color, align: j === 0 ? "left" : "center", valign: "middle", fontFace: "Calibri", margin: j === 0 ? 4 : 0, bold: j === 0 }); }); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 9 – PRE-OPERATIVE ASSESSMENT // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "PRE-OPERATIVE ASSESSMENT & OPTIMIZATION", "Patient with Raised ICP"); addFooter(s); bulletBox(s, [ "GCS score, focal neurological deficits, cranial nerve examination", "Signs of raised ICP: papilloedema, Cushing's triad", "Airway assessment – full stomach risk (vomiting with raised ICP)", "Functional status & baseline cognitive function", ], 0.3, 1.2, 4.55, 2.0, C.mid, C.silver, "HISTORY & EXAMINATION", C.accent); bulletBox(s, [ "CT head: mass, midline shift, compressed cisterns, ventricle size", "MRI: tumour characterisation, oedema extent", "Angiography if vascular lesion", "Compressed/absent basal cisterns → severely impaired compliance", ], 5.1, 1.2, 4.6, 2.0, C.mid, C.silver, "IMAGING REVIEW", C.accent2); bulletBox(s, [ "FBC, RFT, LFT, coagulation profile, blood glucose", "Electrolytes (Na⁺ – SIADH vs. DI risk), serum osmolality", "ABG if ventilated; ICP monitoring data", "Anticonvulsant levels if on treatment", ], 0.3, 3.3, 4.55, 1.8, C.mid, C.silver, "INVESTIGATIONS", C.green); bulletBox(s, [ "Optimise ICP before induction: head-up 30°, avoid hypercapnia", "Start dexamethasone (4–8 mg 6-hourly) for vasogenic oedema", "Ensure adequate IV access (large bore + CVC ± arterial line)", "Pre-oxygenate fully; plan RSI if raised ICP", "Consent for awake craniotomy / intubation if indicated", ], 5.1, 3.3, 4.6, 1.8, C.mid, C.silver, "OPTIMISATION", C.yellow); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 10 – INDUCTION & AIRWAY MANAGEMENT // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "INDUCTION & AIRWAY MANAGEMENT", "The Critical Period"); addFooter(s); // RSI box s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.2, w: 9.4, h: 0.65, fill: { color: "2A0A0A" }, line: { color: C.red, width: 1.5 }, rectRadius: 0.1 }); s.addText([ { text: "GOAL: ", options: { bold: true, color: C.red } }, { text: "Smooth, rapid induction avoiding haemodynamic surges | Prevent ↑ICP from laryngoscopy | Protect airway from aspiration", options: { color: C.silver } }, ], { x: 0.5, y: 1.2, w: 9.1, h: 0.65, fontSize: 11, valign: "middle", fontFace: "Calibri", margin: 0 }); bulletBox(s, [ "Pre-oxygenation 3–5 min with 100% O₂", "Head-up 20–30° (venous drainage + aspiration prevention)", "Fentanyl 1–3 mcg/kg IV 3 min before laryngoscopy (blunts pressor response)", "Lignocaine 1.5 mg/kg IV (optional, blunts ICP rise to intubation)", "Propofol 1.5–2.5 mg/kg OR Thiopentone 3–5 mg/kg", "RSI: Succinylcholine 1.5 mg/kg OR Rocuronium 1.2 mg/kg (RSI dose)", "Direct laryngoscopy or videolaryngoscopy", "Avoid coughing / bucking – maintain deep anaesthesia", ], 0.3, 1.95, 5.8, 3.15, C.mid, C.silver, "RAPID SEQUENCE INDUCTION STEPS", C.accent); bulletBox(s, [ "Avoid mask ventilation if possible (risk of gastric distension)", "Apnoeic oxygenation during intubation", "Confirm ETCO₂ – target 35–40 mmHg (or 30–35 if acute herniation)", "Post-intubation: NMB maintenance to prevent coughing", "Avoid N₂O (increases CBF, pneumocephalus risk)", "Arterial line before induction in haemodynamically unstable patients", "Obstructive hydrocephalus: EVD or ventriculostomy FIRST under local anaesthesia", ], 6.2, 1.95, 3.5, 3.15, C.mid, C.silver, "KEY PRECAUTIONS", C.yellow); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 11 – INTRAOPERATIVE ICP MANAGEMENT // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "INTRAOPERATIVE MANAGEMENT OF RAISED ICP", "The Four Compartment Approach"); addFooter(s); // Four compartment boxes const comps = [ { label: "1. CELLULAR", color: C.accent, items: ["Surgeon evacuates mass, haematoma, or tumour", "Ask about contralateral lesion if brain still tight after evacuation"], }, { label: "2. CSF", color: C.accent2, items: ["Lumbar CSF drain (if no herniation risk)", "Intraoperative ventricular needle drainage by surgeon", "EVD insertion under LA for obstructive hydrocephalus"], }, { label: "3. FLUID (OEDEMA)", color: C.yellow, items: ["Mannitol 0.25–1 g/kg IV over 15–20 min", "Hypertonic saline 3% or 23.4%", "Dexamethasone (tumour/vasogenic oedema)", "Target serum osmolality 310–320 mOsm/L"], }, { label: "4. BLOOD VOLUME", color: C.red, items: ["Venous: Head 20–30° up, avoid venous obstruction, avoid high PEEP", "Arterial: Controlled hypocapnia PaCO₂ 30–35 mmHg", "IV anaesthesia if volatile causing cerebral vasodilation", "Maintain MAP for adequate CPP"], }, ]; comps.forEach(({ label, color, items }, i) => { const col = i % 2; const row = Math.floor(i / 2); const x = 0.3 + col * 4.85; const y = 1.25 + row * 2.1; s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.6, h: 1.95, fill: { color: color + "18" }, line: { color }, rectRadius: 0.1 }); s.addText(label, { x: x + 0.1, y: y + 0.07, w: 4.4, h: 0.3, fontSize: 12, bold: true, color, fontFace: "Calibri", margin: 0 }); const textItems = items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet", characterCode: "25B8", color }, breakLine: idx < items.length - 1, color: C.silver, fontSize: 10.5, fontFace: "Calibri" }, })); s.addText(textItems, { x: x + 0.18, y: y + 0.4, w: 4.3, h: 1.5, valign: "top", margin: 0 }); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 12 – PHARMACOLOGICAL ICP REDUCTION // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "PHARMACOLOGICAL ICP REDUCTION", "Evidence-Based Agents"); addFooter(s); // Mannitol s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.2, w: 4.55, h: 1.85, fill: { color: C.mid }, line: { color: C.accent }, rectRadius: 0.1 }); s.addText("MANNITOL", { x: 0.4, y: 1.22, w: 4.35, h: 0.3, fontSize: 12, bold: true, color: C.accent, fontFace: "Calibri", margin: 0 }); s.addText([ { text: "Dose: ", options: { bold: true, color: C.yellow } }, { text: "0.25–1 g/kg IV over 15–20 min\n" }, { text: "Onset: ", options: { bold: true, color: C.yellow } }, { text: "20–30 min | Duration: 2–6 hrs\n" }, { text: "Mechanism: ", options: { bold: true, color: C.yellow } }, { text: "Osmotic gradient draws water from brain (intact BBB)\n" }, { text: "⚠ Caution: ", options: { bold: true, color: C.red } }, { text: "Rebound oedema, hypotension, renal failure if osmolality >320 mOsm" }, ], { x: 0.42, y: 1.55, w: 4.3, h: 1.44, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); // Hypertonic Saline s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.2, w: 4.6, h: 1.85, fill: { color: C.mid }, line: { color: C.accent2 }, rectRadius: 0.1 }); s.addText("HYPERTONIC SALINE", { x: 5.2, y: 1.22, w: 4.4, h: 0.3, fontSize: 12, bold: true, color: C.accent2, fontFace: "Calibri", margin: 0 }); s.addText([ { text: "3% NaCl: ", options: { bold: true, color: C.yellow } }, { text: "1–2 mL/kg IV\n" }, { text: "23.4% NaCl: ", options: { bold: true, color: C.yellow } }, { text: "30–60 mL via central line (bolus)\n" }, { text: "Advantages: ", options: { bold: true, color: C.green } }, { text: "No hypotension, maintains intravascular volume\n" }, { text: "⚠ Caution: ", options: { bold: true, color: C.red } }, { text: "Rapid correction of hyponatraemia → central pontine myelinolysis" }, ], { x: 5.22, y: 1.55, w: 4.36, h: 1.44, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); // Steroids s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 3.15, w: 4.55, h: 1.55, fill: { color: C.mid }, line: { color: C.green }, rectRadius: 0.1 }); s.addText("DEXAMETHASONE (STEROIDS)", { x: 0.4, y: 3.17, w: 4.35, h: 0.3, fontSize: 12, bold: true, color: C.green, fontFace: "Calibri", margin: 0 }); s.addText([ { text: "Dose: ", options: { bold: true, color: C.yellow } }, { text: "4–8 mg IV every 6 hrs\n" }, { text: "Indication: ", options: { bold: true, color: C.yellow } }, { text: "Vasogenic oedema (tumours, abscesses)\n" }, { text: "✗ NOT effective: ", options: { bold: true, color: C.red } }, { text: "TBI, stroke, cytotoxic oedema" }, ], { x: 0.42, y: 3.5, w: 4.3, h: 1.14, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); // Furosemide + Barbiturates s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 3.15, w: 4.6, h: 1.55, fill: { color: C.mid }, line: { color: C.yellow }, rectRadius: 0.1 }); s.addText("FUROSEMIDE & BARBITURATES", { x: 5.2, y: 3.17, w: 4.4, h: 0.3, fontSize: 12, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0 }); s.addText([ { text: "Furosemide: ", options: { bold: true, color: C.yellow } }, { text: "0.5 mg/kg IV (synergistic with mannitol)\n" }, { text: "Barbiturate coma: ", options: { bold: true, color: C.yellow } }, { text: "Thiopentone/Pentobarbital infusion\nRefractory ICP unresponsive to other measures\n" }, { text: "⚠ ", options: { color: C.red } }, { text: "Hypotension limits use in haemodynamically unstable" }, ], { x: 5.22, y: 3.5, w: 4.36, h: 1.14, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 13 – VENTILATION & PHYSIOLOGICAL TARGETS // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "VENTILATION & PHYSIOLOGICAL TARGETS", "Intraoperative Goals"); addFooter(s); const targets = [ ["PaCO₂", "35–40 mmHg\n(30–35 if herniation)", "Hyperventilation is temporary bridge only (30–60 min)", C.accent], ["PaO₂", "> 100 mmHg\n(SpO₂ > 98%)", "Hypoxia → cerebral vasodilation → ↑CBF → ↑ICP", C.green], ["MAP", "70–90 mmHg\n(CPP ≥ 60 mmHg)", "Avoid hypotension. Vasopressors if needed. Avoid hypertension (↑CBV)", C.accent2], ["Temperature", "36–37°C\n(Normothermia)", "Hyperthermia ↑CMR → ↑ICP. Therapeutic hypothermia not routine", C.yellow], ["Glucose", "6–10 mmol/L\n(140–180 mg/dL)", "Hyperglycaemia amplifies ischaemic brain injury. Avoid dextrose IVF", C.red], ["Haematocrit", "30–35%\nHb > 10 g/dL", "Anaemia reduces O₂ delivery to brain. Avoid excessive haemodilution", C.silver], ]; targets.forEach(([param, value, rationale, col], i) => { const col_n = i % 3; const row = Math.floor(i / 3); const x = 0.3 + col_n * 3.22; const y = 1.2 + row * 2.05; s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.05, h: 1.9, fill: { color: col + "18" }, line: { color: col }, rectRadius: 0.1 }); s.addText(param, { x: x + 0.1, y: y + 0.08, w: 2.85, h: 0.32, fontSize: 13, bold: true, color: col, fontFace: "Calibri", margin: 0 }); s.addText(value, { x: x + 0.1, y: y + 0.42, w: 2.85, h: 0.58, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri Light", margin: 0 }); s.addText(rationale, { x: x + 0.1, y: y + 1.05, w: 2.85, h: 0.78, fontSize: 9.5, color: C.silver, fontFace: "Calibri", margin: 0 }); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 14 – SURGICAL INTERVENTIONS & SHUNTS // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "SURGICAL INTERVENTIONS & SHUNTS", "Anaesthesia Considerations"); addFooter(s); const procedures = [ { title: "VP SHUNT (Ventriculoperitoneal)", color: C.accent, points: [ "Most common shunt for hydrocephalus", "GA – LMA or ETT depending on position", "Prone/supine or lateral – confirm airway security", "Risk: air embolism on ventricular cannulation", "Post-op: monitor for over-drainage (subdural effusion)", ], }, { title: "VA SHUNT (Ventriculoatrial)", color: C.accent2, points: [ "Used when peritoneum unavailable", "CVP line in right atrium as guide", "Risk: cardiac arrhythmias, bacteraemia, paradoxical embolism", "ECG monitoring during atrial catheter placement", ], }, { title: "ETV (Endoscopic 3rd Ventriculostomy)", color: C.green, points: [ "Bypasses CSF obstruction without shunt", "For aqueductal stenosis / obstructive hydrocephalus", "GA preferred; rigid endoscope in ventricle", "Risks: bradycardia, haemorrhage, hypothalamic injury", "Avoid N₂O – irrigation fluid distends ventricles", ], }, { title: "EXTERNAL VENTRICULAR DRAIN (EVD)", color: C.red, points: [ "Bedside / emergency procedure", "Sedation/LA or GA if uncooperative", "Continuous ICP monitoring + CSF drainage", "Critical in herniation – immediate decompression", ], }, ]; procedures.forEach(({ title, color, points }, i) => { const col = i % 2; const row = Math.floor(i / 2); const x = 0.3 + col * 4.85; const y = 1.2 + row * 2.18; bulletBox(s, points, x, y, 4.6, 2.02, C.mid, C.silver, title, color, 10); }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 15 – EMERGENCE & POSTOPERATIVE CARE // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "EMERGENCE, EXTUBATION & POSTOPERATIVE CARE"); addFooter(s); bulletBox(s, [ "Smooth emergence – avoid coughing/straining (herniation risk through craniotomy site)", "IV lignocaine 1.5 mg/kg or deep extubation technique to suppress cough", "Neostigmine + glycopyrrolate for reversal of NMB", "Extubate awake when GCS adequate, airway reflexes intact, haemodynamically stable", "Delayed awakening: consider opioid overdose, residual volatile, metabolic cause, or new neurological injury", "Direct to CT scanner if neurological status not as expected", ], 0.3, 1.2, 4.55, 3.0, C.mid, C.silver, "EMERGENCE STRATEGIES", C.accent); bulletBox(s, [ "ICU admission for GCS < 15, continued raised ICP, or complex surgery", "Continue ICP monitoring (bolt / EVD)", "Maintain head-up 30°, normocapnia, normothermia, normoglycaemia", "Pain control: paracetamol ± opioids (titrated, avoid over-sedation)", "Anticonvulsants: phenytoin / levetiracetam (post-craniotomy)", "Vigilance for: re-bleed, seizures, CSF leak, meningitis, SIADH", ], 5.1, 1.2, 4.6, 3.0, C.mid, C.silver, "POST-OPERATIVE ICU CARE", C.yellow); // Criteria for extubation s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 4.3, w: 9.4, h: 0.9, fill: { color: "0D2A00" }, line: { color: C.green, width: 1 }, rectRadius: 0.1 }); s.addText("✓ Extubation Criteria Post-Craniotomy", { x: 0.5, y: 4.32, w: 9.1, h: 0.28, fontSize: 11, bold: true, color: C.green, fontFace: "Calibri", margin: 0 }); s.addText("Pre-op GCS | Haemodynamic stability | Adequate ventilation (TV, RR) | Protective airway reflexes | No new neurological deficit | No persistent raised ICP", { x: 0.5, y: 4.6, w: 9.1, h: 0.52, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 16 – SPECIAL SITUATIONS // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "SPECIAL SITUATIONS IN NEUROANESTHESIA"); addFooter(s); bulletBox(s, [ "Obese patients: beware of hypoventilation → ↑PaCO₂", "Maintain end-tidal CO₂ 35–40 mmHg", "Head position crucial – elevation may impair venous return in obesity", "CPAP/NIV post-op to prevent hypercapnic episodes", ], 0.3, 1.2, 4.55, 1.8, C.mid, C.silver, "OBESITY", C.accent); bulletBox(s, [ "Physiological changes alter drug dosing and physiology", "Avoid prolonged hypotension (placenta, brain)", "Positioning: left lateral tilt", "Dexamethasone for vasogenic oedema; mannitol with caution", "Betamethasone for foetal lung maturity if premature delivery anticipated", ], 5.1, 1.2, 4.6, 1.8, C.mid, C.silver, "PREGNANCY", C.accent2); bulletBox(s, [ "Sitting position: venous air embolism (VAE) – most feared complication", "Precordial Doppler + end-tidal N₂ monitoring for VAE", "CVC with multi-orifice catheter in right atrium for air aspiration", "Obstructive hydrocephalus common with posterior fossa masses", "Preoperative EVD or ventriculostomy to decompress before GA", ], 0.3, 3.1, 4.55, 2.05, C.mid, C.silver, "POSTERIOR FOSSA SURGERY", C.red); bulletBox(s, [ "Open fontanelle = natural ICP relief valve", "Inhalational induction acceptable if ICP minimally raised", "Avoid ketamine if ICP concerns (traditional approach)", "Blood loss relative to small volume = proportionally large", "Temperature management critical", ], 5.1, 3.1, 4.6, 2.05, C.mid, C.silver, "PAEDIATRIC HYDROCEPHALUS", C.yellow); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 17 – MONITORING // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "MONITORING IN NEUROANESTHESIA", "Standard & Advanced"); addFooter(s); const standard = ["ECG (5-lead continuous)", "SpO₂ + Waveform capnography (ETCO₂)", "Non-invasive / Invasive BP (arterial line)", "Foley catheter (osmotherapy monitoring)", "Temperature (core – oesophageal/tympanic)", "Neuromuscular blockade (TOF monitor)"]; const advanced = ["ICP monitoring: ICP bolt / EVD / Codman probe", "CPP = MAP – ICP (continuous display)", "Transcranial Doppler (CBF velocity)", "Near-infrared spectroscopy (rSO₂) – cerebral oximetry", "BIS / EEG (depth of anaesthesia, burst suppression)", "SSEP / MEP / BAEP (intraoperative neuromonitoring)"]; bulletBox(s, standard, 0.3, 1.2, 4.55, 3.1, C.mid, C.silver, "STANDARD MONITORING", C.green); bulletBox(s, advanced, 5.1, 1.2, 4.6, 3.1, C.mid, C.silver, "ADVANCED / NEURO-SPECIFIC", C.accent); // ICP waveform s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 4.4, w: 9.4, h: 0.75, fill: { color: C.mid }, line: { color: C.accent2 }, rectRadius: 0.1 }); s.addText([ { text: "ICP WAVEFORM COMPONENTS: ", options: { bold: true, color: C.accent2 } }, { text: "P1 (percussion – arterial pulsation) | P2 (tidal – brain compliance) | P3 (dicrotic – aortic valve closure)\n", options: { color: C.silver } }, { text: "P2 > P1 ", options: { bold: true, color: C.red } }, { text: "= Poor compliance = Impending ICP crisis", options: { color: C.silver } }, ], { x: 0.45, y: 4.4, w: 9.1, h: 0.75, fontSize: 10, valign: "middle", fontFace: "Calibri", margin: 0 }); } // ═══════════════════════════════════════════════════════════════════════════ // SLIDE 18 – QUICK REFERENCE / SUMMARY CARD // ═══════════════════════════════════════════════════════════════════════════ { const s = pres.addSlide(); s.background = { color: C.dark }; addTitleBar(s, "QUICK REFERENCE CARD", "Raised ICP Anaesthesia Management"); addFooter(s); // Emergency ICP reduction algorithm s.addText("ACUTE ICP CRISIS – STEPWISE MANAGEMENT", { x: 0.3, y: 1.18, w: 9.4, h: 0.3, fontSize: 12, bold: true, color: C.red, fontFace: "Calibri", margin: 0 }); const steps = [ ["STEP 1", "Airway/Breathing", "Intubate if GCS ≤ 8 | Target SpO₂ > 98%", C.accent], ["STEP 2", "Hyperventilate", "Temporary: PaCO₂ 30–35 mmHg | Max 30–60 min", C.green], ["STEP 3", "Head-up 30°", "Optimise venous drainage | Avoid neck compression", C.accent2], ["STEP 4", "Osmotherapy", "Mannitol 0.5–1 g/kg IV OR HTS 3% 1–2 mL/kg", C.yellow], ["STEP 5", "Sedation/NMB", "Propofol + fentanyl infusion | NMB to prevent coughing", C.accent], ["STEP 6", "Surgical", "EVD drainage | Decompressive craniectomy", C.red], ]; steps.forEach(([step, title, detail, col], i) => { const row = Math.floor(i / 3); const col_n = i % 3; const x = 0.3 + col_n * 3.22; const y = 1.55 + row * 1.3; s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.05, h: 1.2, fill: { color: col + "22" }, line: { color: col }, rectRadius: 0.1 }); s.addShape(pres.ShapeType.roundRect, { x: x + 0.07, y: y + 0.07, w: 0.75, h: 0.32, fill: { color: col }, line: { color: col }, rectRadius: 0.05 }); s.addText(step, { x: x + 0.07, y: y + 0.07, w: 0.75, h: 0.32, fontSize: 9, bold: true, color: C.dark, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); s.addText(title, { x: x + 0.9, y: y + 0.07, w: 2.1, h: 0.32, fontSize: 11, bold: true, color: col, fontFace: "Calibri", margin: 0 }); s.addText(detail, { x: x + 0.12, y: y + 0.46, w: 2.85, h: 0.66, fontSize: 9.5, color: C.silver, fontFace: "Calibri", margin: 0 }); }); // DO NOT list s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 4.15, w: 9.4, h: 0.85, fill: { color: "2A0505" }, line: { color: C.red }, rectRadius: 0.1 }); s.addText("✗ AVOID IN RAISED ICP: ", { x: 0.45, y: 4.17, w: 2.2, h: 0.3, fontSize: 11, bold: true, color: C.red, fontFace: "Calibri", margin: 0 }); s.addText("N₂O | Ketamine (large doses) | Desflurane | Trendelenburg position | Succinylcholine (relative) | Excessive PEEP | Hypotonic IV fluids | Hyperglycaemia (dextrose IVF) | Hyperthermia | Hypertension/Hypotension swings", { x: 0.45, y: 4.47, w: 9.1, h: 0.5, fontSize: 10, color: C.silver, fontFace: "Calibri", margin: 0 }); } // ── WRITE FILE ─────────────────────────────────────────────────────────────── pres.writeFile({ fileName: "/home/daytona/workspace/hydrocephalus-icp-pptx/Hydrocephalus_Raised_ICP_Anesthesia.pptx" }) .then(() => console.log("DONE: Hydrocephalus_Raised_ICP_Anesthesia.pptx written successfully")) .catch(e => { console.error("ERROR:", e); process.exit(1); });