ls /home/daytona/workspace/ 2>/dev/null && echo "---" && ls /home/daytona/skills…

mkdir -p /home/daytona/workspace/vaporizers-ppt

~/vaporizers-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Vaporizers in Anaesthesia";
pres.author = "MD Anaesthesia";

// ─── Palette ───────────────────────────────────────────────────────────────
const C = {
  navy:    "0D2B4E",  // deep navy – dominant background
  teal:    "1A6B7C",  // supporting teal accent
  cyan:    "27B5C8",  // bright cyan highlight
  gold:    "E8A820",  // gold accent for callouts
  white:   "FFFFFF",
  offWhite:"EFF4F7",
  light:   "B8D4DE",
  midgray: "6E8EA0",
  dark:    "091B30",
};

// ─── Helpers ───────────────────────────────────────────────────────────────
function titleBar(slide, text, sub) {
  // dark left accent bar
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.cyan }, line: { color: C.cyan } });
  slide.addText(text, {
    x: 0.25, y: 0.18, w: 9.5, h: 0.6,
    fontSize: 26, bold: true, color: C.white,
    fontFace: "Calibri", margin: 0
  });
  if (sub) {
    slide.addText(sub, {
      x: 0.25, y: 0.78, w: 9.5, h: 0.32,
      fontSize: 13, color: C.light, fontFace: "Calibri", italic: true, margin: 0
    });
  }
  // thin rule under title
  slide.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 1.12, w: 9.5, h: 0.03, fill: { color: C.teal }, line: { color: C.teal } });
}

function card(slide, x, y, w, h, fillColor) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x, y, w, h,
    fill: { color: fillColor || C.teal },
    line: { color: "FFFFFF", pt: 0 },
    shadow: { type: "outer", color: "000000", blur: 8, offset: 3, angle: 135, opacity: 0.18 }
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };

  // full-width teal band bottom
  card(s, 0, 4.5, 10, 1.125, C.dark);

  // Vertical cyan stripe left
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.45, h: 5.625, fill: { color: C.cyan }, line: { color: C.cyan } });

  // Circle decoration top-right
  s.addShape(pres.shapes.OVAL, { x: 8.2, y: -0.9, w: 3.2, h: 3.2, fill: { color: C.teal, transparency: 70 }, line: { color: C.teal, transparency: 70 } });
  s.addShape(pres.shapes.OVAL, { x: 8.8, y: -0.4, w: 2, h: 2, fill: { color: C.cyan, transparency: 55 }, line: { color: C.cyan, transparency: 55 } });

  s.addText("VAPORIZERS IN", {
    x: 0.7, y: 1.2, w: 9, h: 0.85,
    fontSize: 44, bold: true, color: C.white, fontFace: "Calibri",
    charSpacing: 5
  });
  s.addText("ANAESTHESIA", {
    x: 0.7, y: 1.9, w: 9, h: 1.1,
    fontSize: 58, bold: true, color: C.cyan, fontFace: "Calibri",
    charSpacing: 3
  });

  s.addText("Principles · Classification · Clinical Applications · Hazards", {
    x: 0.7, y: 3.2, w: 8, h: 0.45,
    fontSize: 15, color: C.light, fontFace: "Calibri", italic: true
  });

  // Bottom bar text
  s.addText("MD Anaesthesia  ·  Miller's 10e  ·  Barash 9e", {
    x: 0.5, y: 4.6, w: 9, h: 0.4,
    fontSize: 12, color: C.midgray, fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW / CONTENTS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Overview");

  const topics = [
    ["01", "Definition & Purpose"],
    ["02", "Relevant Physics (SVP, Latent Heat)"],
    ["03", "Classification of Vaporizers"],
    ["04", "Variable Bypass Vaporizer"],
    ["05", "Desflurane Vaporizer (Tec 6)"],
    ["06", "Cassette Vaporizer (Aladin)"],
    ["07", "Factors Affecting Vaporizer Output"],
    ["08", "Vaporizer Mount & Interlock"],
    ["09", "Hazards & Special Situations"],
  ];

  const cols = [[0, 3], [4, 8]]; // x-positions for two columns
  const colItems = [topics.slice(0, 5), topics.slice(5)];

  colItems.forEach((col, ci) => {
    const xBase = ci === 0 ? 0.3 : 5.15;
    col.forEach((item, i) => {
      const y = 1.35 + i * 0.78;
      // number badge
      s.addShape(pres.shapes.RECTANGLE, { x: xBase, y: y, w: 0.45, h: 0.45, fill: { color: C.cyan }, line: { color: C.cyan } });
      s.addText(item[0], { x: xBase, y: y + 0.03, w: 0.45, h: 0.38, fontSize: 13, bold: true, color: C.dark, fontFace: "Calibri", align: "center", margin: 0 });
      s.addText(item[1], { x: xBase + 0.55, y: y + 0.06, w: 4.2, h: 0.35, fontSize: 14, color: C.white, fontFace: "Calibri", margin: 0 });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – DEFINITION & PURPOSE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Definition & Purpose");

  // Main definition box
  card(s, 0.3, 1.3, 9.4, 1.2, C.teal);
  s.addText("A vaporizer converts liquid volatile anaesthetic into vapour and adds a precise, clinically safe concentration to the fresh gas flow (FGF).", {
    x: 0.5, y: 1.38, w: 9, h: 1.02,
    fontSize: 15.5, color: C.white, fontFace: "Calibri", italic: false
  });

  // Three cards: SVP problem, Solution, Historical
  const boxes = [
    { x: 0.3, color: C.dark, head: "The Problem", body: "SVP of volatile agents far exceeds clinically useful concentrations\nSevoflurane SVP = 160 mmHg = 21% at 20°C\nClinical use: only 1–3%" },
    { x: 3.55, color: C.dark, head: "The Solution", body: "Vaporizer dilutes saturated vapour with bypass gas to achieve safe, accurate output concentration at the desired vol%" },
    { x: 6.8, color: C.dark, head: "Historical Note", body: "Morton's ether inhaler (1846) – first public anaesthetic\nHad NO temperature compensation or output regulation" },
  ];
  boxes.forEach((b) => {
    card(s, b.x, 2.7, 3.1, 2.65, b.color);
    s.addShape(pres.shapes.RECTANGLE, { x: b.x, y: 2.7, w: 3.1, h: 0.42, fill: { color: C.cyan }, line: { color: C.cyan } });
    s.addText(b.head, { x: b.x + 0.1, y: 2.72, w: 2.9, h: 0.38, fontSize: 13, bold: true, color: C.dark, fontFace: "Calibri", margin: 0 });
    s.addText(b.body, { x: b.x + 0.12, y: 3.18, w: 2.86, h: 2.1, fontSize: 12.5, color: C.light, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – PHYSICS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Relevant Physics", "Saturated Vapour Pressure · Latent Heat · Boiling Point");

  // SVP table
  s.addText("SVP of Common Agents at 20°C", {
    x: 0.3, y: 1.25, w: 4.8, h: 0.35,
    fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0
  });

  const tableRows = [
    [{ text: "Agent", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
     { text: "SVP (mmHg)", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
     { text: "Boiling Point", options: { bold: true, color: C.dark, fill: { color: C.cyan } } }],
    ["Desflurane", "~669", "23.5°C"],
    ["Halothane", "243", "50.2°C"],
    ["Isoflurane", "238", "48.5°C"],
    ["Sevoflurane", "160", "58.6°C"],
  ];

  const rowFills = ["", C.dark, "132E48", C.dark, "132E48"];
  const tableData = tableRows.map((row, ri) => {
    if (ri === 0) return row;
    return row.map(cell => ({ text: cell, options: { color: C.white, fill: { color: rowFills[ri] } } }));
  });

  s.addTable(tableData, {
    x: 0.3, y: 1.65, w: 4.6,
    border: { pt: 1, color: C.teal },
    fontSize: 13, fontFace: "Calibri",
    colW: [1.9, 1.5, 1.2]
  });

  // Right-side explanations
  const concepts = [
    { title: "Saturated Vapour Pressure (SVP)", body: "Pressure exerted by vapour above liquid at equilibrium. Temperature-dependent: ↑ temp → ↑ SVP → ↑ vapour concentration. Determines maximum concentration achievable." },
    { title: "Latent Heat of Vaporization", body: "Energy needed to convert liquid → vapour is absorbed from surroundings. Without compensation, liquid cools → SVP falls → output drops. Vaporizers compensate with wicks/baffles + temp-compensating valves." },
    { title: "Boiling Point", body: "Temperature at which SVP = atmospheric pressure. Inversely related to volatility. Desflurane (BP 23.5°C) boils at room temperature → needs special Tec 6 vaporizer." },
  ];

  concepts.forEach((c, i) => {
    const y = 1.25 + i * 1.38;
    s.addShape(pres.shapes.RECTANGLE, { x: 5.25, y, w: 4.5, h: 1.28, fill: { color: C.dark }, line: { color: C.teal, pt: 1 } });
    s.addShape(pres.shapes.RECTANGLE, { x: 5.25, y, w: 0.06, h: 1.28, fill: { color: C.gold }, line: { color: C.gold } });
    s.addText(c.title, { x: 5.4, y: y + 0.05, w: 4.2, h: 0.32, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
    s.addText(c.body, { x: 5.4, y: y + 0.38, w: 4.2, h: 0.85, fontSize: 11.5, color: C.light, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Classification of Vaporizers");

  // Two classification axes
  // Axis 1: Circuit position
  s.addText("By Circuit Position", { x: 0.3, y: 1.25, w: 4.5, h: 0.35, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const posBoxes = [
    { label: "OUT-OF-CIRCUIT\n(Plenum)", sub: "Modern standard\nOutput via fresh gas line\nOperates under positive pressure", x: 0.3, col: C.teal },
    { label: "IN-CIRCUIT\n(Draw-over)", sub: "Patient's breathing draws gas through\nResource-limited settings\nHistorical significance", x: 2.7, col: "1A4A5A" },
  ];
  posBoxes.forEach(b => {
    card(s, b.x, 1.65, 2.25, 2.1, b.col);
    s.addText(b.label, { x: b.x + 0.12, y: 1.72, w: 2.0, h: 0.7, fontSize: 13, bold: true, color: C.cyan, fontFace: "Calibri" });
    s.addText(b.sub, { x: b.x + 0.12, y: 2.42, w: 2.0, h: 1.25, fontSize: 11.5, color: C.light, fontFace: "Calibri" });
  });

  // Divider
  s.addShape(pres.shapes.RECTANGLE, { x: 5.1, y: 1.2, w: 0.04, h: 4.1, fill: { color: C.teal }, line: { color: C.teal } });

  // Axis 2: By design
  s.addText("By Design/Mechanism", { x: 5.25, y: 1.25, w: 4.5, h: 0.35, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const typeBoxes = [
    { num: "1", name: "Variable Bypass", eg: "GE Tec 5/7, Dräger Vapor 2000", y: 1.65 },
    { num: "2", name: "Dual-circuit (Heated)", eg: "Tec 6 / Tec 6 Plus – desflurane only", y: 2.48 },
    { num: "3", name: "Cassette Vaporizer", eg: "GE Aladin – multiple agents", y: 3.31 },
    { num: "4", name: "Injection-type", eg: "Electronic injection of liquid agent", y: 4.14 },
  ];
  typeBoxes.forEach(t => {
    card(s, 5.25, t.y, 4.45, 0.72, C.dark);
    s.addShape(pres.shapes.RECTANGLE, { x: 5.25, y: t.y, w: 0.4, h: 0.72, fill: { color: C.cyan }, line: { color: C.cyan } });
    s.addText(t.num, { x: 5.25, y: t.y + 0.18, w: 0.4, h: 0.36, fontSize: 15, bold: true, color: C.dark, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(t.name, { x: 5.75, y: t.y + 0.06, w: 3.8, h: 0.32, fontSize: 13.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    s.addText(t.eg, { x: 5.75, y: t.y + 0.38, w: 3.8, h: 0.28, fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0, italic: true });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – VARIABLE BYPASS VAPORIZER
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Variable Bypass Vaporizer", "Most common type · Agent-specific · Passive (no electricity)");

  // Components list (left)
  s.addText("Key Components", { x: 0.3, y: 1.25, w: 4.5, h: 0.35, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const comps = [
    "Inlet / outlet ports",
    "Concentration control dial",
    "Bypass chamber",
    "Vaporizing chamber (wicks + baffles)",
    "Temperature-compensating valve",
    "Agent-specific filling assembly",
  ];
  s.addText(comps.map(c => ({ text: c, options: { bullet: { code: "25BA" }, breakLine: true, color: C.white } })).concat([{ text: "" }]),
    { x: 0.3, y: 1.65, w: 4.6, h: 2.0, fontSize: 13, fontFace: "Calibri" }
  );

  // Principle arrow diagram (simple)
  s.addText("PRINCIPLE: FLOW SPLITTING", { x: 0.3, y: 3.72, w: 4.6, h: 0.3, fontSize: 11, bold: true, color: C.cyan, fontFace: "Calibri", charSpacing: 2, margin: 0 });
  // FGF arrow
  card(s, 0.3, 4.1, 1.1, 0.38, C.teal);
  s.addText("FGF IN", { x: 0.3, y: 4.12, w: 1.1, h: 0.34, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  // bypass
  card(s, 1.55, 3.82, 1.6, 0.38, "1A4A5A");
  s.addText("BYPASS", { x: 1.55, y: 3.84, w: 1.6, h: 0.34, fontSize: 11, color: C.light, fontFace: "Calibri", align: "center", margin: 0 });
  // vap chamber
  card(s, 1.55, 4.32, 1.6, 0.38, C.teal);
  s.addText("VAP CHAMBER", { x: 1.55, y: 4.34, w: 1.6, h: 0.34, fontSize: 10, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  // outlet
  card(s, 3.3, 4.1, 1.1, 0.38, C.cyan);
  s.addText("OUTPUT", { x: 3.3, y: 4.12, w: 1.1, h: 0.34, fontSize: 11, bold: true, color: C.dark, fontFace: "Calibri", align: "center", margin: 0 });
  // arrows
  s.addShape(pres.shapes.RECTANGLE, { x: 1.42, y: 4.27, w: 0.12, h: 0.04, fill: { color: C.light }, line: { color: C.light } });
  s.addShape(pres.shapes.RECTANGLE, { x: 1.42, y: 3.97, w: 0.12, h: 0.04, fill: { color: C.light }, line: { color: C.light } });
  s.addShape(pres.shapes.RECTANGLE, { x: 3.16, y: 3.97, w: 0.14, h: 0.04, fill: { color: C.cyan }, line: { color: C.cyan } });
  s.addShape(pres.shapes.RECTANGLE, { x: 3.16, y: 4.27, w: 0.14, h: 0.04, fill: { color: C.cyan }, line: { color: C.cyan } });

  // Right column: splitting ratio example + temperature compensation
  s.addText("Splitting Ratio Example (Sevoflurane, 20°C)", { x: 5.1, y: 1.25, w: 4.6, h: 0.35, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const calcData = [
    [{ text: "Parameter", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
     { text: "Value", options: { bold: true, color: C.dark, fill: { color: C.cyan } } }],
    ["SVP sevoflurane @ 20°C", "160 mmHg = 21%"],
    ["Vap chamber outflow", "100 mL/min (21 mL sevo)"],
    ["For 1% output → bypass", "2,000 mL/min"],
    ["Bypass : vap ratio", "20 : 1"],
    ["For 2% output → bypass", "950 mL/min"],
    ["Bypass : vap ratio", "9.5 : 1"],
  ];
  const calcFills = ["", C.dark, "132E48", C.dark, "132E48", C.dark, "132E48"];
  const calcFormatted = calcData.map((row, ri) => {
    if (ri === 0) return row;
    return row.map(cell => ({ text: cell, options: { color: C.white, fill: { color: calcFills[ri] } } }));
  });
  s.addTable(calcFormatted, {
    x: 5.1, y: 1.65, w: 4.6, border: { pt: 1, color: C.teal },
    fontSize: 12, fontFace: "Calibri", colW: [2.7, 1.9]
  });

  // Temp compensation
  s.addShape(pres.shapes.RECTANGLE, { x: 5.1, y: 3.62, w: 4.6, h: 1.7, fill: { color: C.dark }, line: { color: C.teal, pt: 1 } });
  s.addShape(pres.shapes.RECTANGLE, { x: 5.1, y: 3.62, w: 0.06, h: 1.7, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("Temperature Compensation", { x: 5.25, y: 3.68, w: 4.3, h: 0.3, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  s.addText(
    "↑ Temp → ↑ SVP → ↑ vapour output (without correction)\nBimetallic strip or expansion rod deflects:\n→ opens bypass more, restricts vaporizing chamber outflow\n→ maintains constant output concentration\nAgent-specific calibration essential",
    { x: 5.25, y: 4.0, w: 4.3, h: 1.25, fontSize: 12, color: C.light, fontFace: "Calibri" }
  );
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – DESFLURANE VAPORIZER (Tec 6)
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Desflurane Vaporizer – Tec 6 / Tec 6 Plus", "Unique physics demand a unique device");

  // Why special?
  card(s, 0.3, 1.28, 9.4, 0.88, "8B1A1A");
  s.addText("⚠  WHY DESFLURANE NEEDS A SPECIAL VAPORIZER", { x: 0.45, y: 1.32, w: 9.0, h: 0.32, fontSize: 13, bold: true, color: "#FFD700", fontFace: "Calibri", margin: 0 });
  s.addText("SVP ≈ 669 mmHg at 20°C  ·  Boiling point = 23.5°C  →  Boils at room temperature  →  Unpredictable output in standard vaporizer", {
    x: 0.45, y: 1.62, w: 9.0, h: 0.48,
    fontSize: 12.5, color: C.white, fontFace: "Calibri", margin: 0
  });

  // Left: How it works
  s.addText("How Tec 6 Works", { x: 0.3, y: 2.28, w: 4.6, h: 0.32, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const steps = [
    "Electrically heated sump maintains desflurane at 39°C (~1550 mmHg ≈ 2 atm)",
    "All agent is fully vaporized in the sump",
    "Pure desflurane vapour is metered as a gas",
    "Metered vapour blended into fresh gas flow",
    "More accurately a gas BLENDER than a vaporizer",
    "Requires electrical power to operate (alarmed if power fails)",
  ];
  s.addText(
    steps.map((t, i) => ({ text: `${i + 1}.  ${t}`, options: { bullet: false, breakLine: true, color: i === 4 ? C.cyan : C.white } })),
    { x: 0.3, y: 2.65, w: 4.7, h: 2.75, fontSize: 12.5, fontFace: "Calibri" }
  );

  // Right: Altitude effect
  s.addText("Altitude Effect – Critical Difference", { x: 5.25, y: 2.28, w: 4.5, h: 0.32, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const altData = [
    [{ text: "", options: { fill: { color: C.cyan } } },
     { text: "Variable Bypass\n(Tec 5/7)", options: { bold: true, color: C.dark, fill: { color: C.cyan }, align: "center" } },
     { text: "Tec 6\n(Desflurane)", options: { bold: true, color: C.dark, fill: { color: C.cyan }, align: "center" } }],
    [{ text: "Output", options: { bold: true, color: C.light, fill: { color: "132E48" } } },
     { text: "Constant partial pressure", options: { color: C.white, fill: { color: "132E48" } } },
     { text: "Constant vol%", options: { color: C.white, fill: { color: "132E48" } } }],
    [{ text: "High altitude", options: { bold: true, color: C.light, fill: { color: C.dark } } },
     { text: "Near compensated (ambient pressure)", options: { color: C.white, fill: { color: C.dark } } },
     { text: "↓ Partial pressure (vol% same)", options: { color: "#FFD700", fill: { color: C.dark } } }],
    [{ text: "Action needed", options: { bold: true, color: C.light, fill: { color: "132E48" } } },
     { text: "Minimal", options: { color: C.white, fill: { color: "132E48" } } },
     { text: "↑ dial setting", options: { color: "#FF8C8C", fill: { color: "132E48" }, bold: true } }],
  ];
  s.addTable(altData, {
    x: 5.25, y: 2.65, w: 4.5, border: { pt: 1, color: C.teal },
    fontSize: 11.5, fontFace: "Calibri", colW: [1.1, 1.7, 1.7]
  });

  // Formula
  card(s, 5.25, 4.15, 4.5, 1.15, C.dark);
  s.addShape(pres.shapes.RECTANGLE, { x: 5.25, y: 4.15, w: 0.06, h: 1.15, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText("Altitude Correction Formula (Tec 6):", { x: 5.4, y: 4.22, w: 4.2, h: 0.3, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  s.addText("Required dial = Normal dial × (760 mmHg ÷ Ambient pressure mmHg)", {
    x: 5.4, y: 4.54, w: 4.2, h: 0.65,
    fontSize: 12.5, color: C.cyan, fontFace: "Calibri", bold: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – ALADIN CASSETTE VAPORIZER
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Aladin Cassette Vaporizer – GE Aisys / Avance", "CPU-controlled · Multi-agent · Electronic");

  // Image placeholder (Aladin cassette image)
  const imgUrl = "https://cdn.orris.care/cdss_images/98228e78e640bdd462546ea584c46891b2812e9e182be2b3ee5bc82d3b7c5cfa.png";
  const images = JSON.parse(require("child_process").execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js "${imgUrl}"`
  ).toString());
  if (images[0] && images[0].base64) {
    s.addImage({ data: images[0].base64, x: 0.3, y: 1.28, w: 3.2, h: 2.4 });
    s.addText("Aladin SEV Cassette (GE Carestation)", {
      x: 0.3, y: 3.72, w: 3.2, h: 0.3, fontSize: 10, color: C.midgray, fontFace: "Calibri", italic: true, align: "center"
    });
  }

  // How it works
  s.addText("Design & Operation", { x: 3.75, y: 1.25, w: 5.9, h: 0.32, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const points = [
    "Single permanent vaporizer unit inside the workstation",
    "Accepts interchangeable agent-specific Aladin cassettes",
    "Agents: halothane, isoflurane, enflurane, sevoflurane, desflurane",
    "Cassettes are colour-coded AND magnetically coded (auto-identified by CPU)",
    "Fixed restrictor in bypass chamber",
    "Electronically controlled flow valve at vaporizing chamber outlet",
    "CPU inputs: dial setting, pressure, temperature, bypass flow, vaporizing chamber flow, carrier gas composition",
    "No recalibration needed on cassette swap ('CALIBRATION NOT REQUIRED')",
  ];
  s.addText(
    points.map(p => ({ text: p, options: { bullet: { code: "25BA" }, breakLine: true, color: C.white } })).concat([{ text: "" }]),
    { x: 3.75, y: 1.62, w: 5.9, h: 2.95, fontSize: 12, fontFace: "Calibri" }
  );

  // Advantage/disadvantage boxes
  const adv = [
    { label: "✔  ADVANTAGES", items: ["One unit handles all agents", "Fast cassette swap", "No cassette tipping risk", "Electronic precision"], col: "0D4A2E" },
    { label: "✘  LIMITATIONS", items: ["Requires electricity", "CPU/sensor failure modes", "Agent-coded – no mixing", "Higher cost"], col: "4A0D0D" },
  ];
  adv.forEach((a, i) => {
    const x = 0.3 + i * 4.7;
    card(s, x, 4.2, 4.5, 1.2, a.col);
    s.addText(a.label, { x: x + 0.12, y: 4.24, w: 4.2, h: 0.3, fontSize: 12, bold: true, color: i === 0 ? "#6FE88F" : "#FF8C8C", fontFace: "Calibri", margin: 0 });
    s.addText(a.items.join("  ·  "), { x: x + 0.12, y: 4.56, w: 4.2, h: 0.75, fontSize: 11.5, color: C.light, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – FACTORS AFFECTING VAPORIZER OUTPUT
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Factors Affecting Vaporizer Output");

  const factors = [
    { title: "Temperature", icon: "🌡", body: "↑ Temperature → ↑ SVP → ↑ output if uncompensated\nModern vaporizers: bimetallic strip compensates\nOutput remains accurate over typical OR range (18–25°C)" },
    { title: "Fresh Gas Flow Rate", icon: "💨", body: "At very high flow rates: insufficient saturation time → ↓ output\nAt very low flow rates: back-diffusion effects\nAccurate over calibrated range (typically 0.2–15 L/min)" },
    { title: "Carrier Gas Composition", icon: "⚗", body: "O₂ vs N₂O vs air differ in solubility in liquid agent\nSwitching from O₂ to N₂O: transient ↑ output then ↓\nSwitching from N₂O to O₂: transient ↓ then return to normal" },
    { title: "Altitude / Barometric Pressure", icon: "🏔", body: "Variable bypass: near constant partial pressure output\nTec 6: constant vol%, but ↓ partial pressure at altitude\nDose adjustment required for Tec 6 at high altitude" },
    { title: "Backpressure (Pumping Effect)", icon: "🔁", body: "Positive-pressure ventilation → intermittent backpressure into vaporizer\nTransiently ↑ output (gas pushed into vaporizing chamber)\nCheck valves (outlet check valve) minimise this effect" },
    { title: "Liquid Level", icon: "💧", body: "Very low agent level → ↓ output\nOverfilling or tipping → agent enters bypass → ↑↑ output\nSide-fill vaporizers prevent most overfilling" },
  ];

  const positions = [
    { x: 0.25, y: 1.28 }, { x: 3.45, y: 1.28 }, { x: 6.65, y: 1.28 },
    { x: 0.25, y: 3.2  }, { x: 3.45, y: 3.2  }, { x: 6.65, y: 3.2  },
  ];

  factors.forEach((f, i) => {
    const { x, y } = positions[i];
    card(s, x, y, 3.0, 1.82, C.dark);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.0, h: 0.42, fill: { color: C.teal }, line: { color: C.teal } });
    s.addText(`${f.icon}  ${f.title}`, { x: x + 0.1, y: y + 0.06, w: 2.8, h: 0.3, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    s.addText(f.body, { x: x + 0.1, y: y + 0.48, w: 2.8, h: 1.28, fontSize: 11, color: C.light, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – VAPORIZER MOUNT & INTERLOCK
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Vaporizer Mount & Interlock System");

  const pts = [
    { head: "Removable Mounts", body: "Allow rapid vaporizer exchange\nFewer vaporizer positions required\nEssential if malignant hyperthermia suspected – remove vaporizer\nDetachable mounts: risk of low-pressure leaks or FGF obstruction on connection failure" },
    { head: "Post-mounting Checks", body: "Confirm vaporizer is seated and locked before use\nPerform manufacturer-required leak test\nCheck for audible gas leak / spillage" },
    { head: "Interlock Requirement (MANDATORY)", body: "All anaesthesia machines MUST prevent FGF passing through more than one vaporizer simultaneously\nInterlock device designs vary significantly across manufacturers\nInterlock failures have been reported → potential for anaesthetic overdose" },
    { head: "Outlet Check Valve", body: "Located between vaporizer and common gas outlet (e.g., GE Aestiva)\nPrevents backflow into vaporizer during positive-pressure ventilation\nReduces pumping effect (↑ output artefact)\nInfluences which leak test method is appropriate" },
  ];

  pts.forEach((p, i) => {
    const x = i < 2 ? 0.3 : 5.2;
    const y = i % 2 === 0 ? 1.28 : 3.28;
    card(s, x, y, 4.65, 1.88, C.dark);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.65, h: 0.42, fill: { color: i === 2 ? "8B1A1A" : C.teal }, line: { color: i === 2 ? "8B1A1A" : C.teal } });
    s.addText(p.head, { x: x + 0.12, y: y + 0.07, w: 4.4, h: 0.3, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    s.addText(p.body, { x: x + 0.12, y: y + 0.5, w: 4.4, h: 1.28, fontSize: 12, color: C.light, fontFace: "Calibri" });
  });

  // Key rule
  s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 5.18, w: 9.4, h: 0.3, fill: { color: "8B1A1A" }, line: { color: "8B1A1A" } });
  s.addText("⚠  Never use two vaporizers simultaneously. Interlock failure has caused anaesthetic overdose.", {
    x: 0.4, y: 5.19, w: 9.2, h: 0.28, fontSize: 11.5, bold: true, color: "#FFD700", fontFace: "Calibri", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – HAZARDS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Hazards & Special Situations");

  const hazards = [
    { title: "Misfilling", color: "6B1A1A", icon: "⚗", body: "Wrong agent → overdose or underdose\nDesflurane in isoflurane vaporizer → massive overdose (much higher SVP)\nAgent-specific fillers reduce (not eliminate) misfilling\nGas analysis is the key safety check" },
    { title: "Tipping", color: "5A2A0A", icon: "↗", body: "Liquid agent enters bypass chamber\nExtremely high vapour output when turned on\nFlush at high flows before returning to use\nSome vaporizers: 'T' (transport) dial setting isolates chambers" },
    { title: "Overfilling", color: "1A4A1A", icon: "💧", body: "Liquid enters bypass → dangerous concentration\nSide-fill design prevents overfilling at normal position\nRisk: rocking/tipping while filling, or filling vaporizer in 'ON' position" },
    { title: "Leaks", color: "1A2A5A", icon: "💨", body: "Sources: filler cap, drain valve, vaporizer-machine interface, internal failure\nPresentation: awareness, low inhaled agent conc, odour of agent\nLeak test after every vaporizer mount/change" },
    { title: "Contamination", color: "3A1A4A", icon: "🦠", body: "Rare but reported\nWater in sevoflurane vaporizer → bacterial growth (S. epidermidis)\nBacteria metabolise agent → volatile toxic compounds" },
    { title: "Carrier Gas Effect", color: "1A3A4A", icon: "⚙", body: "Changing from O₂ to N₂O (or vice versa):\nTransient fluctuation in output\nAllow stabilisation time\nUse circuit gas analyser to confirm final concentration" },
  ];

  const positions = [
    { x: 0.25, y: 1.28 }, { x: 3.45, y: 1.28 }, { x: 6.65, y: 1.28 },
    { x: 0.25, y: 3.22 }, { x: 3.45, y: 3.22 }, { x: 6.65, y: 3.22 },
  ];

  hazards.forEach((h, i) => {
    const { x, y } = positions[i];
    card(s, x, y, 3.0, 1.88, h.color);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.0, h: 0.42, fill: { color: h.color }, line: { color: h.color } });
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.0, h: 0.42, fill: { color: "00000040" }, line: { color: "FFFFFF", pt: 1 } });
    s.addText(`${h.icon}  ${h.title}`, { x: x + 0.1, y: y + 0.07, w: 2.8, h: 0.3, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
    s.addText(h.body, { x: x + 0.1, y: y + 0.5, w: 2.8, h: 1.3, fontSize: 11, color: C.light, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 – COMPARISON TABLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Comparison: Vaporizer Types at a Glance");

  const headers = ["Feature", "Variable Bypass\n(Tec 5/7, Vapor 2000)", "Desflurane\n(Tec 6)", "Aladin Cassette\n(GE)"];
  const rows = [
    ["Mechanism", "Passive flow splitting", "Heated sump + gas blending", "CPU-controlled flow valve"],
    ["Temperature comp.", "Bimetallic/mechanical", "Electrical heating", "Electronic/CPU"],
    ["Agent-specific?", "Yes – one agent per vaporizer", "Desflurane ONLY", "One unit, multiple cassettes"],
    ["Requires electricity?", "No", "Yes (alarmed)", "Yes"],
    ["Altitude (vol%)", "Slight ↑ at altitude", "Constant vol%", "Electronically compensated"],
    ["Altitude (partial P)", "Near constant", "↓ proportionally", "Compensated"],
    ["Tipping risk?", "High – flush before use", "N/A", "N/A"],
    ["Agent consumption\n(approx.)", "3 × FGF × vol% = mL/hr", "Higher consumption", "3 × FGF × vol% = mL/hr"],
  ];

  const allRows = [
    headers.map((h, i) => ({ text: h, options: { bold: true, color: C.dark, fill: { color: C.cyan }, align: "center" } })),
    ...rows.map((row, ri) => row.map((cell, ci) => ({
      text: cell,
      options: { color: ci === 0 ? C.gold : C.white, fill: { color: ri % 2 === 0 ? C.dark : "132E48" }, bold: ci === 0 }
    })))
  ];

  s.addTable(allRows, {
    x: 0.2, y: 1.28, w: 9.6,
    border: { pt: 1, color: C.teal },
    fontSize: 11, fontFace: "Calibri",
    colW: [1.9, 2.5, 2.3, 2.9]
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 – KEY FORMULAS & QUICK REFERENCE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  titleBar(s, "Key Formulas & Quick Reference");

  const formulas = [
    { label: "Saturated vapour concentration (SVC)", formula: "SVC (%) = SVP ÷ Atmospheric pressure × 100" },
    { label: "Liquid agent consumption", formula: "3 × FGF (L/min) × vol% = mL liquid agent / hour" },
    { label: "Tec 6 altitude correction", formula: "Dial setting = Normal dial × (760 ÷ Ambient P mmHg)" },
    { label: "Splitting ratio (vol% output)", formula: "vol% = Vap chamber vapour flow ÷ Total outflow × 100" },
  ];

  formulas.forEach((f, i) => {
    const y = 1.3 + i * 1.02;
    card(s, 0.3, y, 9.4, 0.92, C.dark);
    s.addShape(pres.shapes.RECTANGLE, { x: 0.3, y, w: 0.06, h: 0.92, fill: { color: C.gold }, line: { color: C.gold } });
    s.addText(f.label, { x: 0.48, y: y + 0.06, w: 4.5, h: 0.3, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
    s.addText(f.formula, { x: 4.8, y: y + 0.22, w: 4.8, h: 0.52, fontSize: 14, bold: true, color: C.cyan, fontFace: "Courier New", margin: 0 });
  });

  // Quick recall box
  card(s, 0.3, 5.15, 9.4, 0.35, C.teal);
  s.addText(
    "Remember: Variable bypass = agent-specific, passive, prone to tipping.  Tec 6 = heated, for desflurane only, increase dial at altitude.  Aladin = CPU, multi-agent cassette.",
    { x: 0.45, y: 5.18, w: 9.0, h: 0.29, fontSize: 11, color: C.dark, bold: true, fontFace: "Calibri", margin: 0 }
  );
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 – CLOSING
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };

  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.45, h: 5.625, fill: { color: C.cyan }, line: { color: C.cyan } });
  s.addShape(pres.shapes.OVAL, { x: 7.5, y: 3.5, w: 4, h: 4, fill: { color: C.teal, transparency: 75 }, line: { color: C.teal, transparency: 75 } });

  s.addText("SUMMARY", {
    x: 0.7, y: 1.0, w: 9, h: 0.6,
    fontSize: 38, bold: true, color: C.cyan, fontFace: "Calibri", charSpacing: 8
  });

  const summaryPts = [
    "Vaporizers precisely dilute volatile anaesthetic vapour to clinically safe concentrations",
    "Variable bypass vaporizers: passive, temperature-compensated, agent-specific",
    "Desflurane (Tec 6): heated sump gas blender – increase dial at high altitude",
    "Aladin cassette: CPU-controlled, multi-agent, requires electricity",
    "Key hazards: misfilling, tipping, overfilling, leaks – gas analyser is the safety net",
    "Interlock system ensures only one vaporizer operates at a time",
  ];

  s.addText(
    summaryPts.map(p => ({ text: p, options: { bullet: { code: "25CF" }, breakLine: true, color: C.white } })).concat([{ text: "" }]),
    { x: 0.7, y: 1.75, w: 8.8, h: 3.2, fontSize: 13.5, fontFace: "Calibri" }
  );

  s.addText("Sources: Miller's Anesthesia 10e (Ch. 20)  ·  Barash's Clinical Anesthesia 9e (Ch. 25)", {
    x: 0.7, y: 5.1, w: 9, h: 0.35,
    fontSize: 11, color: C.midgray, fontFace: "Calibri", italic: true
  });
}

// ─── Write file ────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/vaporizers-ppt/Vaporizers_in_Anaesthesia.pptx" })
  .then(() => console.log("Done: /home/daytona/workspace/vaporizers-ppt/Vaporizers_in_Anaesthesia.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/vaporizers-ppt && node build.js 2>&1

mkdir -p /home/daytona/workspace/laparoscopy-ppt && ls /home/daytona/workspace/l…

~/laparoscopy-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Laparoscopic Surgeries – Anaesthesia";
pres.author = "MD Anaesthesia";

// ── Palette ────────────────────────────────────────────────────────────────
const C = {
  bg:      "0A1F2E",   // deep dark blue – dominant background
  panel:   "0D2E42",   // slightly lighter panel
  teal:    "0E7C7B",   // teal accent
  cyan:    "1BBFBD",   // bright cyan highlight
  orange:  "E07B39",   // warm orange for warnings / callouts
  gold:    "F0B429",   // gold for headers / emphasis
  green:   "27A96C",   // green for normal / safe
  red:     "C0392B",   // red for danger
  white:   "FFFFFF",
  light:   "B5CDD8",
  midgray: "6E8EA0",
  dark:    "061523",
};

// ── Helpers ────────────────────────────────────────────────────────────────
function titleBar(slide, text, sub) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.14, h: 5.625, fill: { color: C.cyan }, line: { color: C.cyan } });
  slide.addText(text, { x: 0.28, y: 0.17, w: 9.5, h: 0.62, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
  if (sub) slide.addText(sub, { x: 0.28, y: 0.78, w: 9.5, h: 0.3, fontSize: 13, color: C.light, fontFace: "Calibri", italic: true, margin: 0 });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0.28, y: 1.12, w: 9.5, h: 0.03, fill: { color: C.teal }, line: { color: C.teal } });
}

function card(slide, x, y, w, h, fill, lineColor) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x, y, w, h, fill: { color: fill || C.panel },
    line: { color: lineColor || "FFFFFF", pt: lineColor ? 1 : 0 },
    shadow: { type: "outer", color: "000000", blur: 7, offset: 3, angle: 135, opacity: 0.2 }
  });
}

function headerStrip(slide, x, y, w, h, fill, text, textColor) {
  slide.addShape(pres.shapes.RECTANGLE, { x, y, w, h, fill: { color: fill }, line: { color: fill } });
  slide.addText(text, { x: x + 0.1, y: y + 0.05, w: w - 0.15, h: h - 0.08, fontSize: 12.5, bold: true, color: textColor || C.dark, fontFace: "Calibri", margin: 0 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };

  // decorative circles
  s.addShape(pres.shapes.OVAL, { x: 7.8, y: -1.0, w: 4.0, h: 4.0, fill: { color: C.teal, transparency: 78 }, line: { color: C.teal, transparency: 78 } });
  s.addShape(pres.shapes.OVAL, { x: 8.6, y: -0.3, w: 2.2, h: 2.2, fill: { color: C.cyan, transparency: 62 }, line: { color: C.cyan, transparency: 62 } });
  // bottom bar
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 4.8, w: 10, h: 0.825, fill: { color: C.dark }, line: { color: C.dark } });
  // left accent
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.5, h: 5.625, fill: { color: C.cyan }, line: { color: C.cyan } });

  s.addText("LAPAROSCOPIC", { x: 0.75, y: 1.0, w: 9, h: 0.8, fontSize: 46, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 4 });
  s.addText("SURGERIES", { x: 0.75, y: 1.75, w: 9, h: 0.9, fontSize: 56, bold: true, color: C.cyan, fontFace: "Calibri", charSpacing: 3 });
  s.addText("Anaesthetic Principles & Management", { x: 0.75, y: 2.8, w: 8.5, h: 0.45, fontSize: 18, color: C.gold, fontFace: "Calibri", italic: true });
  s.addText("Pneumoperitoneum · Positioning · Complications · Special Populations", { x: 0.75, y: 3.3, w: 8.5, h: 0.35, fontSize: 13.5, color: C.light, fontFace: "Calibri" });

  s.addText("MD Anaesthesia  ·  Miller's 10e  ·  Barash 9e", { x: 0.6, y: 4.9, w: 8.5, h: 0.35, fontSize: 12, color: C.midgray, fontFace: "Calibri" });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – CONTENTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Contents");

  const topics = [
    ["01", "Introduction & Why CO2"],
    ["02", "Physiology of Pneumoperitoneum"],
    ["03", "Cardiovascular Effects"],
    ["04", "Respiratory Effects"],
    ["05", "CNS, Renal & Other Effects"],
    ["06", "Positioning Effects"],
    ["07", "Anaesthetic Management"],
    ["08", "Ventilation Strategy & NMB"],
    ["09", "Complications"],
    ["10", "Venous Gas Embolism"],
    ["11", "Specific Procedures"],
    ["12", "Special Patient Populations"],
    ["13", "Monitoring"],
    ["14", "Summary"],
  ];

  const half = Math.ceil(topics.length / 2);
  [topics.slice(0, half), topics.slice(half)].forEach((col, ci) => {
    const xBase = ci === 0 ? 0.28 : 5.15;
    col.forEach((item, i) => {
      const y = 1.3 + i * 0.6;
      s.addShape(pres.shapes.RECTANGLE, { x: xBase, y, w: 0.42, h: 0.38, fill: { color: C.cyan }, line: { color: C.cyan } });
      s.addText(item[0], { x: xBase, y: y + 0.02, w: 0.42, h: 0.34, fontSize: 12, bold: true, color: C.dark, fontFace: "Calibri", align: "center", margin: 0 });
      s.addText(item[1], { x: xBase + 0.52, y: y + 0.06, w: 4.3, h: 0.28, fontSize: 13, color: C.white, fontFace: "Calibri", margin: 0 });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – INTRODUCTION & WHY CO2
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Introduction", "Laparoscopy: minimal access surgery with a unique set of anaesthetic challenges");

  // Definition box
  card(s, 0.28, 1.28, 9.44, 0.88, C.teal, null);
  s.addText("Laparoscopic surgery involves CO2 insufflation into a body cavity (pneumoperitoneum) and camera visualization through small trocar ports. Challenges arise from: (1) physiological effects of CO2 pneumoperitoneum, (2) patient positioning, and (3) limited access to the patient intraoperatively.", {
    x: 0.44, y: 1.35, w: 9.1, h: 0.75, fontSize: 13.5, color: C.white, fontFace: "Calibri"
  });

  // Why CO2 - 4 cards
  s.addText("Why CO2 for Insufflation?", { x: 0.28, y: 2.28, w: 5, h: 0.32, fontSize: 13.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const co2 = [
    { icon: "💨", label: "High diffusion coefficient", body: "Rapidly absorbed & excreted via lungs" },
    { icon: "🫧", label: "Lowest embolism risk", body: "Highly soluble – safer than air or O2 if gas embolism occurs" },
    { icon: "🔥", label: "Non-combustible", body: "Safe with electrosurgery / laser" },
    { icon: "💰", label: "Cheap & available", body: "Widely available, easy to store" },
  ];
  co2.forEach((c, i) => {
    const x = 0.28 + i * 2.38;
    card(s, x, 2.65, 2.22, 1.55, C.panel, C.teal);
    s.addText(c.icon, { x: x + 0.08, y: 2.7, w: 0.5, h: 0.5, fontSize: 20, fontFace: "Calibri" });
    s.addText(c.label, { x: x + 0.08, y: 3.22, w: 2.06, h: 0.32, fontSize: 12, bold: true, color: C.cyan, fontFace: "Calibri", margin: 0 });
    s.addText(c.body, { x: x + 0.08, y: 3.55, w: 2.06, h: 0.58, fontSize: 11.5, color: C.light, fontFace: "Calibri" });
  });

  // Three challenge pillars
  s.addText("The Three Anaesthetic Challenges", { x: 0.28, y: 4.32, w: 5, h: 0.3, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const challenges = ["CO2 Pneumoperitoneum\nPhysiology", "Patient Positioning\nTrendelenburg / Lateral", "Limited Patient Access\nOnce trocar / robot docked"];
  challenges.forEach((c, i) => {
    const x = 0.28 + i * 3.18;
    card(s, x, 4.68, 2.98, 0.72, C.dark, C.cyan);
    s.addShape(pres.shapes.RECTANGLE, { x, y: 4.68, w: 0.38, h: 0.72, fill: { color: C.cyan }, line: { color: C.cyan } });
    s.addText(`${i + 1}`, { x, y: 4.86, w: 0.38, h: 0.36, fontSize: 14, bold: true, color: C.dark, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(c, { x: x + 0.48, y: 4.72, w: 2.42, h: 0.62, fontSize: 12, color: C.white, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – CARDIOVASCULAR EFFECTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Cardiovascular Effects of Pneumoperitoneum");

  // Table
  const tData = [
    [
      { text: "Parameter", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
      { text: "Effect", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
      { text: "Mechanism", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
    ],
    [
      { text: "Cardiac Output", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "↓ ~30% at institution", options: { color: "#FF8C8C", fill: { color: C.dark } } },
      { text: "↓ Venous return (lower body compression)", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "SVR", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "↑ Significantly", options: { color: "#FF8C8C", fill: { color: C.panel } } },
      { text: "Mechanical compression + renin-angiotensin activation", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "MAP", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "→ or ↑ up to 16%", options: { color: "#6FE88F", fill: { color: C.dark } } },
      { text: "↑ SVR offsets ↓ CO", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Heart Rate", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Variable", options: { color: C.light, fill: { color: C.panel } } },
      { text: "Vagal stimulation initially, then tachycardia from hypercarbia", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Myocardial O2 demand", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "↑", options: { color: "#FF8C8C", fill: { color: C.dark } } },
      { text: "↑ Afterload", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Renal/splanchnic flow", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "↓", options: { color: "#FF8C8C", fill: { color: C.panel } } },
      { text: "Vessel compression + ↓ CO", options: { color: C.light, fill: { color: C.panel } } },
    ],
  ];

  s.addTable(tData, {
    x: 0.28, y: 1.28, w: 9.44,
    border: { pt: 1, color: C.teal },
    fontSize: 12.5, fontFace: "Calibri",
    colW: [2.1, 2.2, 5.14]
  });

  // Key callouts
  const callouts = [
    { color: C.orange, text: "⏱  SVR & CO return toward normal within 10 min of institution (compensatory adaptation)" },
    { color: "8B1A1A", text: "⚠  If IAP > 20 mmHg: CO drops further as venous return collapses AND MAP begins to fall" },
    { color: "1A3A1A", text: "✔  Preoperative fluid loading + preinduction colloid boluses ↑ stroke volume and urine output" },
  ];
  callouts.forEach((c, i) => {
    card(s, 0.28, 4.35 + i * 0.38, 9.44, 0.34, c.color, null);
    s.addText(c.text, { x: 0.42, y: 4.36 + i * 0.38, w: 9.1, h: 0.3, fontSize: 11.5, color: C.white, bold: i === 1, fontFace: "Calibri", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – RESPIRATORY EFFECTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Respiratory Effects of Pneumoperitoneum");

  // Left column: effect table
  const rData = [
    [
      { text: "Parameter", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
      { text: "Change", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
    ],
    [{ text: "FRC", options: { bold: true, color: C.gold, fill: { color: C.dark } } }, { text: "↓", options: { color: "#FF8C8C", fill: { color: C.dark } } }],
    [{ text: "Vital Capacity", options: { bold: true, color: C.gold, fill: { color: C.panel } } }, { text: "↓", options: { color: "#FF8C8C", fill: { color: C.panel } } }],
    [{ text: "Pulmonary Compliance", options: { bold: true, color: C.gold, fill: { color: C.dark } } }, { text: "↓", options: { color: "#FF8C8C", fill: { color: C.dark } } }],
    [{ text: "Peak Airway Pressure", options: { bold: true, color: C.gold, fill: { color: C.panel } } }, { text: "↑", options: { color: "#FF8C8C", fill: { color: C.panel } } }],
    [{ text: "V/Q Mismatch", options: { bold: true, color: C.gold, fill: { color: C.dark } } }, { text: "↑ (worsened)", options: { color: "#FF8C8C", fill: { color: C.dark } } }],
    [{ text: "Intrapulm. Shunt", options: { bold: true, color: C.gold, fill: { color: C.panel } } }, { text: "↓ (paradox)", options: { color: "#6FE88F", fill: { color: C.panel } } }],
    [{ text: "PaO2", options: { bold: true, color: C.gold, fill: { color: C.dark } } }, { text: "Mostly maintained", options: { color: "#6FE88F", fill: { color: C.dark } } }],
    [{ text: "EtCO2 / PaCO2", options: { bold: true, color: C.gold, fill: { color: C.panel } } }, { text: "↑ (CO2 absorption)", options: { color: "#FF8C8C", fill: { color: C.panel } } }],
  ];
  s.addTable(rData, {
    x: 0.28, y: 1.28, w: 4.5,
    border: { pt: 1, color: C.teal },
    fontSize: 12.5, fontFace: "Calibri",
    colW: [2.8, 1.7]
  });

  // Right column: mechanisms
  const mechs = [
    { title: "Cephalad Diaphragm Shift", body: "Raised IAP pushes abdominal contents upward\n→ Compression atelectasis, ↓ FRC & VC\n→ ↑ Airway pressures, ↓ compliance" },
    { title: "CO2 Absorption", body: "CO2 absorbed via lymphatic + venous plexuses\n→ ↑ PaCO2 requiring ↑ minute ventilation\n→ Typically 10–25% ↑ MV needed to maintain normocarbia" },
    { title: "The Shunt Paradox", body: "More atelectasis but LESS shunt:\nCO2 potentiates hypoxic pulmonary vasoconstriction (HPV)\n→ Blood redirected away from collapsed lung regions\n→ Better V/Q matching than expected; oxygenation often preserved" },
    { title: "Hypercarbia → Acidosis", body: "Respiratory acidosis if ventilation inadequate\nCO2 augments anaesthetic effect\nPaCO2 >80 mmHg → depressed consciousness" },
  ];
  mechs.forEach((m, i) => {
    const y = 1.28 + i * 1.06;
    card(s, 5.0, y, 4.72, 0.98, C.dark, C.teal);
    s.addShape(pres.shapes.RECTANGLE, { x: 5.0, y, w: 0.07, h: 0.98, fill: { color: C.orange }, line: { color: C.orange } });
    s.addText(m.title, { x: 5.16, y: y + 0.05, w: 4.44, h: 0.28, fontSize: 12.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
    s.addText(m.body, { x: 5.16, y: y + 0.35, w: 4.44, h: 0.58, fontSize: 11.5, color: C.light, fontFace: "Calibri" });
  });

  // Bottom note
  card(s, 0.28, 5.22, 9.44, 0.3, "8B1A1A", null);
  s.addText("⚠  Obese patients: 22% higher RR, 8% lower TV, 38% higher peak inspiratory pressures vs non-obese – expect and plan for higher airway pressures", {
    x: 0.42, y: 5.24, w: 9.1, h: 0.26, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – CNS, RENAL & OTHER EFFECTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "CNS, Renal & Other Systemic Effects");

  const blocks = [
    {
      title: "🧠  CNS / Intracranial", color: "1A2E5A", hdr: C.cyan,
      items: [
        "↑ ICP: CO2 → cerebral vasodilation → ↑ CBF → ↑ ICP",
        "↑ IOP: increases with Trendelenburg depth and duration",
        "Optic nerve sheath diameter (ONSD) ↑ – non-invasive ICP surrogate",
        "Prolonged steep Trendelenburg → facial, periorbital, and occasional laryngeal oedema",
        "Catecholamine release (neurohumoral response)",
      ]
    },
    {
      title: "🫘  Renal", color: "1A3A2E", hdr: C.green,
      items: [
        "↓ Renal blood flow: ↓ CO + direct compression + renin-angiotensin activation",
        "IAP >15 mmHg → ↑ risk of postoperative AKI",
        "Target IAP <12 mmHg for renal protection",
        "Post-laparoscopic nephrectomy oliguria: usually self-limited",
        "Furosemide, mannitol, 'renal-dose' dopamine: NO proven benefit",
      ]
    },
    {
      title: "⚡  Endocrine / Other", color: "2E1A3A", hdr: C.gold,
      items: [
        "Renin-angiotensin system activation",
        "Gastro-oesophageal reflux risk (raised IAP)",
        "↑ DVT risk (venous stasis + lithotomy position)",
        "Trocar placement trauma: ~0.5% visceral/vascular injury",
        "Brachial plexus neuropraxia (arm positioning in Trendelenburg)",
        "ETT displacement (cephalad carina shift with IAP ↑)",
      ]
    },
  ];

  blocks.forEach((b, i) => {
    const y = 1.28 + i * 1.42;
    card(s, 0.28, y, 9.44, 1.32, b.color, null);
    headerStrip(s, 0.28, y, 9.44, 0.38, b.hdr, b.title, C.dark);
    const bullets = b.items.map(it => ({ text: it, options: { bullet: { code: "25BA" }, breakLine: true, color: C.light } }));
    bullets.push({ text: "" });
    s.addText(bullets, { x: 0.42, y: y + 0.44, w: 9.1, h: 0.82, fontSize: 11.5, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – POSITIONING EFFECTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Positioning Effects", "Position type determines physiological perturbations and complications");

  const positions = [
    {
      name: "TRENDELENBURG\n(Head-Down)", use: "Gynaecological, urological laparoscopy\nRobotic prostatectomy / hysterectomy",
      effects: [
        "↑ Preload (blood funnelled from LE → RA)",
        "↑ ICP and ↑ IOP",
        "Cephalad diaphragm shift → ↓ FRC, ↑ airway pressures",
        "Risk of mainstem intubation (carina shifts cephalad)",
        "Protects against VGE (↑ CVP reduces CO2 entrainment)",
        "Facial / periorbital / laryngeal oedema (prolonged)",
      ],
      col: "0D2E42", hdr: C.cyan
    },
    {
      name: "REVERSE TRENDELENBURG\n(Head-Up)", use: "Cholecystectomy, upper GI laparoscopy\nBariatric surgery",
      effects: [
        "↓ Preload → ↓ CO (volume load before surgery)",
        "Better pulmonary compliance (bowel falls away from diaphragm)",
        "Risk of patient sliding caudally – secure anti-skid padding",
        "Lower intraocular pressure",
      ],
      col: "0D2E1A", hdr: C.green
    },
    {
      name: "LATERAL DECUBITUS", use: "Laparoscopic nephrectomy\nAdrenal surgery",
      effects: [
        "Pad pressure points meticulously",
        "Maintain neutral spine alignment",
        "Table flexion adds to positional nerve stress",
        "Similar CV/respiratory concerns as other laparoscopic positions",
      ],
      col: "2A1A0D", hdr: C.gold
    },
  ];

  positions.forEach((p, i) => {
    const y = 1.28 + i * 1.43;
    card(s, 0.28, y, 9.44, 1.33, p.col, null);
    headerStrip(s, 0.28, y, 9.44, 0.38, p.hdr, p.name + "   |   Use: " + p.use, C.dark);
    const bullets = p.effects.map(e => ({ text: e, options: { bullet: { code: "25BA" }, breakLine: true, color: C.light } }));
    bullets.push({ text: "" });
    s.addText(bullets, { x: 0.42, y: y + 0.44, w: 9.1, h: 0.82, fontSize: 11.5, fontFace: "Calibri" });
  });

  // Bottom warning
  card(s, 0.28, 5.57, 9.44, 0.3, "4A2000", null);
  s.addText("⚠  Check ETT position AFTER insufflation AND after every position change – mainstem intubation risk is real", {
    x: 0.4, y: 5.58, w: 9.1, h: 0.28, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – ANAESTHETIC MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Anaesthetic Management", "Preoperative · Airway · Ventilation · Haemodynamics · Analgesia");

  const cols = [
    {
      title: "Preoperative",
      hdr: C.cyan,
      items: [
        "Cardiopulmonary reserve is KEY",
        "Obese: ↑ atelectasis risk, ↑ airway pressures, ↑ GORD",
        "Cardiac disease: consider arterial line, TEE",
        "Pulmonary hypertension: high risk",
        "Raised ICP: cerebral oximetry, avoid steep Trendel",
        "COPD: widen EtCO2–PaCO2 gap expected",
      ]
    },
    {
      title: "Airway",
      hdr: C.gold,
      items: [
        "GA with ETT: standard for all major laparoscopic cases",
        "LMA: only for short, head-neutral procedures (diagnostic lap in selected patients)",
        "NOT LMA in Trendelenburg / long cases / obesity",
        "ETT cuff just beyond vocal cords (prevent mainstem)",
        "OGT / NGT: decompresses stomach, improves view",
        "RSI if peritonitis, bowel obstruction, or aspiration risk",
      ]
    },
    {
      title: "Haemodynamics",
      hdr: C.green,
      items: [
        "Pre-induction fluid optimisation (colloid if high risk)",
        "Maintain IAP <12–15 mmHg",
        "Vasopressors (phenylephrine/noradrenaline) for refractory ↓ BP",
        "Target MAP ≥65 mmHg",
        "For CKD: IAP <12 mmHg to protect renal perfusion",
        "Restrict fluids before urethral anastomosis (prostatectomy)",
      ]
    },
  ];

  cols.forEach((col, ci) => {
    const x = 0.28 + ci * 3.22;
    card(s, x, 1.28, 3.08, 3.85, C.dark, col.hdr);
    headerStrip(s, x, 1.28, 3.08, 0.38, col.hdr, col.title, C.dark);
    const bullets = col.items.map(it => ({ text: it, options: { bullet: { code: "25BA" }, breakLine: true, color: C.white } }));
    bullets.push({ text: "" });
    s.addText(bullets, { x: x + 0.12, y: 1.72, w: 2.84, h: 3.35, fontSize: 11.5, fontFace: "Calibri" });
  });

  // Analgesia section (full width below)
  card(s, 0.28, 5.2, 9.44, 0.28, C.panel, C.orange);
  s.addText("PAIN MANAGEMENT: Multimodal (paracetamol + opioid) | Epidural: rarely needed for laparoscopic | Port-site infiltration | Rectus sheath catheter | AVOID NSAIDs in urological cases", {
    x: 0.42, y: 5.22, w: 9.1, h: 0.24, fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – VENTILATION STRATEGY & NMB
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Ventilation Strategy & Neuromuscular Blockade");

  // Left: ventilation
  s.addText("Ventilation Strategy", { x: 0.28, y: 1.28, w: 4.7, h: 0.35, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const ventItems = [
    { hdr: "↑ Minute ventilation", body: "Increase MV by 10–25% from baseline to compensate for CO2 absorption. Monitor EtCO2 continuously." },
    { hdr: "Mode: Pressure Control (PCV)", body: "Recommended over volume control in steep Trendelenburg. ↓ Peak airway pressures, ↑ compliance." },
    { hdr: "Lung-protective settings", body: "TV 6–8 mL/kg IBW · PEEP 5–10 cmH2O · Keep Pplat <30 cmH2O · Driving pressure <15 cmH2O" },
    { hdr: "PEEP titration", body: "Balance oxygenation vs haemodynamic compromise. Higher PEEP → ↑ airway pressure but not equivalent ↑ in transpulmonary pressure (chest wall compliance also affected)." },
    { hdr: "Recruitment manoeuvres", body: "Prevent and reverse atelectasis intraoperatively. Periodic sustained inflations (e.g., 30 cmH2O × 30 s)." },
    { hdr: "Permissive hypercapnia", body: "Acceptable in some but AVOID in: CKD (hyperkalemia from acidosis), ↑ ICP, severe pulm HTN." },
  ];

  ventItems.forEach((v, i) => {
    const y = 1.68 + i * 0.64;
    card(s, 0.28, y, 4.7, 0.58, i % 2 === 0 ? C.dark : C.panel, C.teal);
    s.addText(v.hdr, { x: 0.38, y: y + 0.05, w: 4.5, h: 0.24, fontSize: 12, bold: true, color: C.cyan, fontFace: "Calibri", margin: 0 });
    s.addText(v.body, { x: 0.38, y: y + 0.3, w: 4.5, h: 0.24, fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0 });
  });

  // Right: NMB
  s.addText("Neuromuscular Blockade (NMB)", { x: 5.28, y: 1.28, w: 4.44, h: 0.35, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  card(s, 5.28, 1.68, 4.44, 3.6, C.dark, C.orange);
  s.addText([
    { text: "Deep NMB is strongly recommended for laparoscopic surgery:\n\n", options: { bold: true, color: C.orange, breakLine: false } },
    { text: "✔  Allows lower IAP (12 vs 15 mmHg) for equivalent surgical exposure\n", options: { color: C.light } },
    { text: "✔  Lower IAP → less cardiovascular & renal compromise\n", options: { color: C.light } },
    { text: "✔  Improved surgical conditions\n", options: { color: C.light } },
    { text: "✔  Essential in robotic cases – patient movement with fixed arms = internal tissue tearing\n\n", options: { color: C.light } },
    { text: "Monitoring:\n", options: { bold: true, color: C.cyan } },
    { text: "Continuous TOF monitoring intraoperatively\nSugammadex for reversal (faster, more complete than neostigmine)\nConfirm TOF ratio >0.9 before extubation\n\n", options: { color: C.light } },
    { text: "Key principle:\n", options: { bold: true, color: C.cyan } },
    { text: "NMB not only improves surgical conditions but directly reduces physiological stress of pneumoperitoneum by enabling lower insufflation pressures", options: { color: C.light } },
  ], { x: 5.4, y: 1.76, w: 4.2, h: 3.45, fontSize: 12, fontFace: "Calibri" });

  // Bottom strip
  card(s, 0.28, 5.33, 9.44, 0.3, "3A1A00", null);
  s.addText("TIVA vs Volatile: Both acceptable. TIVA (propofol): ↓ PONV (important – laparoscopy has high PONV rate), may ↓ ICP in steep Trendelenburg (inconclusive data)", {
    x: 0.42, y: 5.35, w: 9.1, h: 0.26, fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – VENOUS GAS EMBOLISM
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Venous CO2 Gas Embolism (VGE)", "Most catastrophic complication of laparoscopy");

  // Red alert bar
  card(s, 0.28, 1.28, 9.44, 0.52, "7A0000", null);
  s.addText("VGE = CO2 enters venous system → right heart → ↑ pulmonary arterial pressure → ↓ LV preload → ↓ CO → cardiovascular collapse. Subclinical emboli in ~20% of laparoscopic prostatectomies, ~100% of laparoscopic hysterectomies (by TEE).", {
    x: 0.42, y: 1.32, w: 9.1, h: 0.44, fontSize: 12.5, color: C.white, fontFace: "Calibri"
  });

  // 3 columns: cause / diagnosis / treatment
  const sections = [
    {
      title: "CAUSES / ENTRY POINTS", hdr: C.orange,
      items: [
        "Direct Veress needle insertion into vein/organ",
        "Injured/transected vessels during dissection",
        "Round ligament transection (hysterectomy)",
        "Deep dorsal venous complex (prostatectomy)",
        "Trendelenburg ↑ CVP → protective (less entrainment)",
      ]
    },
    {
      title: "DIAGNOSIS", hdr: C.gold,
      items: [
        "Acute tachycardia, arrhythmias",
        "QRS widening",
        "Hypotension, hypoxia",
        "Sudden ↓ EtCO2 (obstruction of pulmonary flow)",
        "Cyanosis",
        "\"Mill wheel\" murmur on auscultation",
        "TEE: most sensitive – near white-out of RV chambers = RV air lock",
      ]
    },
    {
      title: "TREATMENT", hdr: C.green,
      items: [
        "IMMEDIATE cessation of CO2 insufflation",
        "Abdominal decompression",
        "100% O2 + hyperventilation (↑ CO2 elimination)",
        "Left lateral decubitus + Trendelenburg\n(Durant's manoeuvre – minimises RV air lock)",
        "Rapid IV fluid for hypotension",
        "ACLS if cardiac arrest",
      ]
    },
  ];

  sections.forEach((sec, i) => {
    const x = 0.28 + i * 3.22;
    card(s, x, 1.9, 3.08, 3.5, C.dark, sec.hdr);
    headerStrip(s, x, 1.9, 3.08, 0.38, sec.hdr, sec.title, C.dark);
    const bullets = sec.items.map(it => ({ text: it, options: { bullet: { code: "25BA" }, breakLine: true, color: C.light } }));
    bullets.push({ text: "" });
    s.addText(bullets, { x: x + 0.12, y: 2.34, w: 2.84, h: 3.0, fontSize: 11.5, fontFace: "Calibri" });
  });

  // Durant manoeuvre note
  card(s, 0.28, 5.46, 9.44, 0.3, C.teal, null);
  s.addText("Durant's Manoeuvre: Left lateral decubitus + Trendelenburg → floats air lock to RV apex → may restore forward flow while aspiration/resuscitation is initiated", {
    x: 0.42, y: 5.48, w: 9.1, h: 0.26, fontSize: 11, color: C.dark, bold: true, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – OTHER COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Other Complications of Laparoscopic Surgery");

  const comps = [
    {
      title: "Subcutaneous Emphysema", hdr: C.orange,
      body: "CO2 tracks along fascial planes\nSigns: crepitus on palpation, sudden ↑ EtCO2\nManagement: check needle placement, ↓ IAP, ↑ MV"
    },
    {
      title: "Capnothorax / Pneumothorax", hdr: C.orange,
      body: "CO2 enters pleural space (diaphragm defect / fascial tracking)\nSudden ↓ SpO2, ↑ airway pressures\nManagement: decompress, chest drain if severe"
    },
    {
      title: "Endobronchial Intubation", hdr: C.gold,
      body: "Cephalad carina shift with ↑ IAP\nETT tip advances into right main bronchus\nPrevention: cuff just below vocal cords; auscultate after insufflation"
    },
    {
      title: "Vagal Bradycardia / Asystole", hdr: C.gold,
      body: "Peritoneal stretch → vagal reflex during insufflation\nManagement: stop insufflation, IV atropine 0.6 mg\nRarely progresses to asystole"
    },
    {
      title: "Trocar / Veress Complications", hdr: "FF8C8C",
      body: "~0.5% visceral or major vascular injury at insertion\nLarge vessel injury (aorta, IVC) = surgical emergency\nConversion to laparotomy; haemostasis priority"
    },
    {
      title: "Positioning Complications", hdr: C.green,
      body: "Brachial plexus neuropraxia (arm position)\nCompartment syndrome (prolonged lithotomy)\nFacial / corneal injury (robotic arms)\nPatient sliding / fall from OR table (extreme Trendelenburg)"
    },
  ];

  const positions_g = [
    { x: 0.28, y: 1.28 }, { x: 3.45, y: 1.28 }, { x: 6.62, y: 1.28 },
    { x: 0.28, y: 3.35 }, { x: 3.45, y: 3.35 }, { x: 6.62, y: 3.35 },
  ];

  comps.forEach((c, i) => {
    const { x, y } = positions_g[i];
    card(s, x, y, 3.02, 1.96, C.dark, C.panel);
    headerStrip(s, x, y, 3.02, 0.38, c.hdr === "FF8C8C" ? C.red : c.hdr, c.title, C.dark);
    s.addText(c.body, { x: x + 0.12, y: y + 0.45, w: 2.78, h: 1.44, fontSize: 11.5, color: C.light, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12 – SPECIFIC PROCEDURES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Specific Procedures – Anaesthetic Considerations");

  const tData = [
    [
      { text: "Procedure", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
      { text: "Position", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
      { text: "Key Anaesthetic Points", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
    ],
    [
      { text: "Lap. Cholecystectomy", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Reverse Trendelenburg", options: { color: C.light, fill: { color: C.dark } } },
      { text: "Most common procedure; ↓ preload; short – LMA possible in selected cases; PONV common", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Lap. Appendicectomy", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Trendelenburg / Supine", options: { color: C.light, fill: { color: C.panel } } },
      { text: "RSI if peritonitis or GORD risk; ETT required; antibiotics pre-op", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Lap. Hysterectomy", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Steep Trendelenburg + lithotomy", options: { color: C.light, fill: { color: C.dark } } },
      { text: "~100% subclinical VGE; ↑ ICP/IOP; deep NMB; TIVA preferred (PONV); restrictive fluids", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Robotic Prostatectomy", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Steep Trendelenburg", options: { color: C.light, fill: { color: C.panel } } },
      { text: "Limited access once docked; deep NMB mandatory; fluid restriction near urethral anastomosis; ↑ ICP", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Lap. Nephrectomy", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Lateral decubitus", options: { color: C.light, fill: { color: C.dark } } },
      { text: "Pad pressure points; neutral spine; postop oliguria (self-limited); avoid NSAIDs; no 'renal-dose' dopamine benefit", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Bariatric Laparoscopy", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Reverse Trendelenburg", options: { color: C.light, fill: { color: C.panel } } },
      { text: "Obese: RSI essential; high PEEP; lung-protective ventilation; ↑ airway pressures; GORD risk; DVT prophylaxis", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Diagnostic Laparoscopy", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Trendelenburg", options: { color: C.light, fill: { color: C.dark } } },
      { text: "Short procedure; LMA sometimes acceptable; PONV prophylaxis; ensure full NMB reversal before extubation", options: { color: C.light, fill: { color: C.dark } } },
    ],
  ];

  s.addTable(tData, {
    x: 0.28, y: 1.28, w: 9.44,
    border: { pt: 1, color: C.teal },
    fontSize: 11.5, fontFace: "Calibri",
    colW: [2.0, 1.8, 5.64]
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 13 – SPECIAL POPULATIONS + MONITORING
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Special Populations & Monitoring");

  // Left: special populations
  s.addText("High-Risk Populations", { x: 0.28, y: 1.28, w: 4.7, h: 0.33, fontSize: 13.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const pops = [
    { label: "Obesity", body: "↑ Atelectasis, ↑ airway P, ↓ FRC\nRSI; high PEEP; lung-protective\nExpect higher peak pressures\nGORD → aspiration risk" },
    { label: "Cardiac Disease (CCF, IHD)", body: "30% ↓ CO + ↑ SVR poorly tolerated\nArterial line ± TEE\nIAP <12 mmHg; no permissive hypercapnia\nWatch for ischaemia (↑ myocardial O2 demand)" },
    { label: "Raised ICP / Cerebrovascular Disease", body: "Transcranial Doppler or cerebral oximetry\nAvoid steep Trendelenburg if possible\nMaintain normocarbia strictly\nMonitor ONSD (non-invasive ICP surrogate)" },
    { label: "CKD / Renal Impairment", body: "IAP <12 mmHg mandatory\nPermissive hypercapnia CONTRAINDICATED\n(acidosis → hyperkalaemia)\nAvoid NSAIDs; monitor UO" },
    { label: "Pulmonary Hypertension", body: "Hypercarbia → ↑ PVR → RV failure\nPrevent hypoxia, acidosis, high airway P\nConsider inhaled NO or prostacyclins\nAvoid N2O" },
  ];

  pops.forEach((p, i) => {
    const y = 1.67 + i * 0.78;
    card(s, 0.28, y, 4.7, 0.72, C.dark, C.teal);
    s.addShape(pres.shapes.RECTANGLE, { x: 0.28, y, w: 0.07, h: 0.72, fill: { color: C.cyan }, line: { color: C.cyan } });
    s.addText(p.label, { x: 0.42, y: y + 0.05, w: 4.44, h: 0.26, fontSize: 12, bold: true, color: C.cyan, fontFace: "Calibri", margin: 0 });
    s.addText(p.body, { x: 0.42, y: y + 0.34, w: 4.44, h: 0.32, fontSize: 10.5, color: C.light, fontFace: "Calibri", margin: 0 });
  });

  // Right: monitoring table
  s.addText("Monitoring", { x: 5.2, y: 1.28, w: 4.52, h: 0.33, fontSize: 13.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const monData = [
    [
      { text: "Monitor", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
      { text: "Indication", options: { bold: true, color: C.dark, fill: { color: C.cyan } } },
    ],
    ["ECG, SpO2, NIBP, EtCO2", "ALL cases – mandatory"],
    ["EtCO2 continuous", "Monitor CO2 absorption – all cases"],
    ["Invasive arterial line", "Prolonged, obese, cardiac disease"],
    ["CVP / CVC", "Major cases, instability"],
    ["Urine output", "Renal protection; IAP monitoring"],
    ["TOF monitoring", "All cases requiring NMB"],
    ["TEE", "Cardiac disease, suspected VGE"],
    ["Cerebral oximetry / TCD", "Cerebrovascular disease"],
    ["ONSD (ultrasound)", "Non-invasive ICP – robotic/Trendelenburg"],
  ];

  const monFormatted = monData.map((row, ri) => {
    if (ri === 0) return row;
    return row.map(cell => ({ text: cell, options: { color: ri % 2 === 0 ? C.white : C.light, fill: { color: ri % 2 === 0 ? C.panel : C.dark } } }));
  });
  s.addTable(monFormatted, {
    x: 5.2, y: 1.67, w: 4.52,
    border: { pt: 1, color: C.teal },
    fontSize: 11.5, fontFace: "Calibri",
    colW: [2.4, 2.12]
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 14 – CONTRAINDICATIONS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };
  titleBar(s, "Contraindications to Laparoscopy");

  const ciData = [
    [
      { text: "Contraindication", options: { bold: true, color: C.dark, fill: { color: C.red } } },
      { text: "Type", options: { bold: true, color: C.dark, fill: { color: C.red } } },
      { text: "Reason", options: { bold: true, color: C.dark, fill: { color: C.red } } },
    ],
    [
      { text: "Uncorrected coagulopathy", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Absolute", options: { color: "#FF8C8C", bold: true, fill: { color: C.dark } } },
      { text: "Uncontrollable trocar haemorrhage", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Severe haemodynamic instability", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Absolute", options: { color: "#FF8C8C", bold: true, fill: { color: C.panel } } },
      { text: "Cannot tolerate ↓ CO from pneumoperitoneum", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Uncorrected ↑ ICP", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Absolute", options: { color: "#FF8C8C", bold: true, fill: { color: C.dark } } },
      { text: "Hypercarbia + Trendelenburg = further ↑ ICP → herniation", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Severe pulmonary hypertension", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Absolute", options: { color: "#FF8C8C", bold: true, fill: { color: C.panel } } },
      { text: "Hypercarbia + ↑ PAP → RV failure", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Intestinal obstruction", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Relative", options: { color: C.orange, bold: true, fill: { color: C.dark } } },
      { text: "Bowel distension ↓ visibility; ↑ aspiration risk; bowel injury risk", options: { color: C.light, fill: { color: C.dark } } },
    ],
    [
      { text: "Previous multiple laparotomies", options: { bold: true, color: C.gold, fill: { color: C.panel } } },
      { text: "Relative", options: { color: C.orange, bold: true, fill: { color: C.panel } } },
      { text: "Dense adhesions → ↑ trocar injury; consider open entry", options: { color: C.light, fill: { color: C.panel } } },
    ],
    [
      { text: "Morbid obesity / very high BMI", options: { bold: true, color: C.gold, fill: { color: C.dark } } },
      { text: "Relative", options: { color: C.orange, bold: true, fill: { color: C.dark } } },
      { text: "↑ IAP at baseline, ↑ airway pressures, ↑ aspiration risk – manage carefully", options: { color: C.light, fill: { color: C.dark } } },
    ],
  ];

  s.addTable(ciData, {
    x: 0.28, y: 1.28, w: 9.44,
    border: { pt: 1, color: C.teal },
    fontSize: 12.5, fontFace: "Calibri",
    colW: [3.0, 1.3, 5.14]
  });

  card(s, 0.28, 5.45, 9.44, 0.3, C.teal, null);
  s.addText("Decision to proceed must weigh surgical benefit vs physiological risk on a case-by-case basis with anaesthesiologist-surgeon shared decision-making", {
    x: 0.42, y: 5.47, w: 9.1, h: 0.26, fontSize: 11.5, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 15 – SUMMARY
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.bg };

  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.5, h: 5.625, fill: { color: C.cyan }, line: { color: C.cyan } });
  s.addShape(pres.shapes.OVAL, { x: 7.5, y: 3.2, w: 4.5, h: 4.5, fill: { color: C.teal, transparency: 80 }, line: { color: C.teal, transparency: 80 } });

  s.addText("SUMMARY", { x: 0.75, y: 0.7, w: 9, h: 0.65, fontSize: 40, bold: true, color: C.cyan, fontFace: "Calibri", charSpacing: 8 });

  const summaryPts = [
    "CO2 pneumoperitoneum: ↓ CO (~30%), ↑ SVR, ↑ MAP, ↑ airway pressures, ↑ CO2 absorption, ↑ ICP",
    "Trendelenburg: ↑ ICP/IOP, cephalad diaphragm, mainstem intubation risk – check ETT after insufflation",
    "Increase MV by 10–25% to compensate CO2 absorption; use PCV in steep Trendelenburg; lung-protective settings",
    "Deep NMB allows lower IAP → less haemodynamic & renal compromise; mandatory for robotic cases",
    "VGE: cease insufflation → 100% O2 → Durant's position → hyperventilation → ACLS if arrest",
    "High-risk patients (cardiac, obesity, CKD, pulm HTN): additional monitoring, strict IAP limits",
    "PONV prophylaxis essential; multimodal analgesia; TIVA preferred for PONV-prone procedures",
  ];

  s.addText(
    summaryPts.map(p => ({ text: p, options: { bullet: { code: "25CF" }, breakLine: true, color: C.white } })).concat([{ text: "" }]),
    { x: 0.75, y: 1.48, w: 8.8, h: 3.8, fontSize: 13.5, fontFace: "Calibri" }
  );

  s.addText("Sources: Miller's Anesthesia 10e (Ch. 12, 27, 67)  ·  Barash's Clinical Anesthesia 9e (Ch. 44, 50)", {
    x: 0.75, y: 5.2, w: 9, h: 0.35, fontSize: 11, color: C.midgray, fontFace: "Calibri", italic: true
  });
}

// ── Write ──────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/laparoscopy-ppt/Laparoscopic_Anaesthesia.pptx" })
  .then(() => console.log("Done: /home/daytona/workspace/laparoscopy-ppt/Laparoscopic_Anaesthesia.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/laparoscopy-ppt && node build.js 2>&1