const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Guedel's Stages of Anaesthesia";
pres.author = "MD Anaesthesia";

// ─── Colour Palette ───────────────────────────────────────────────
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// ─── Helper: add a slide background ──────────────────────────────
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// ─── Helper: header bar ──────────────────────────────────────────
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}

// ─── Helper: footer ──────────────────────────────────────────────
function footer(slide, text = "Guedel's Stages of Anaesthesia  |  MD Anaesthesia") {
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}

// ─── Helper: bullet list ─────────────────────────────────────────
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}

// ─── Helper: coloured card ───────────────────────────────────────
function card(slide, x, y, w, h, bgColor, title, lines, titleSize = 13, lineSize = 11) {
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// ══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);

  // Large accent top bar
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    fill: { color: "0D2137" }, line: { color: C.teal, width: 2 }, rectRadius: 0.18
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  s.addText("GUEDEL'S STAGES OF ANAESTHESIA", {
    x: 1, y: 1.05, w: 8, h: 0.85,
    fontSize: 30, bold: true, color: C.gold, fontFace: "Calibri",
    align: "center", charSpacing: 2
  });

  s.addShape(pres.ShapeType.rect, { x: 2.5, y: 1.9, w: 5, h: 0.05, fill: { color: C.tealLt } });

  s.addText("A Comprehensive Review for MD Anaesthesia", {
    x: 1, y: 2.05, w: 8, h: 0.5,
    fontSize: 16, color: C.tealLt, fontFace: "Calibri", align: "center", italic: true
  });

  s.addText([
    { text: "Based on:  ", options: { bold: false, color: C.gray, fontSize: 11 } },
    { text: "Katzung's Basic & Clinical Pharmacology  •  Morgan & Mikhail's Clinical Anaesthesiology  •  Miller's Anaesthesia", options: { bold: false, color: C.offWhite, fontSize: 11 } }
  ], { x: 1, y: 2.68, w: 8, h: 0.45, fontFace: "Calibri", align: "center" });

  s.addText("Arthur Ernest Guedel (1883–1956)  |  Classification published 1937", {
    x: 1, y: 3.15, w: 8, h: 0.35,
    fontSize: 11, color: C.gray, fontFace: "Calibri", align: "center", italic: true
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  s.addText("MD Anaesthesia  |  Prepared for academic use", {
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    fontSize: 9, color: C.gray, fontFace: "Calibri", valign: "middle", align: "center"
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 — HISTORICAL BACKGROUND & BASIS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Historical Background", "Origins of the classification");
  footer(s);

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    fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri"
  });

  bulletList(s, [
    "Published 1937 — one of first safety systems in anaesthesiology",
    "Developed for DIETHYL ETHER as the sole inhalational agent",
    "Patients premedicated with morphine + atropine",
    "IV anaesthetics not yet in common use",
    "Neuromuscular blocking drugs not yet available",
    "Observations based on: respiration, eye signs, muscle tone & reflexes",
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  });

  bulletList(s, [
    "Ether phased out (USA by 1980s); replaced by fluorinated hydrocarbons",
    "'Balanced anaesthesia' uses multiple agents — classical signs may be masked",
    "NMBDs abolish respiratory muscle signs rendering traditional monitoring unreliable",
    "Still taught because: conceptual framework for depth of anaesthesia",
    "BIS / EEG-based monitors now supplement/replace clinical signs",
    "Useful in resource-limited settings & inhalational induction (paediatrics)",
  ], 5.2, 1.73, 4.3, 3.2, { fontSize: 11.5, color: C.offWhite });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 — OVERVIEW: 4 STAGES
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Overview: The Four Stages", "Progressive CNS depression from analgesia to medullary paralysis");
  footer(s);

  const stages = [
    {
      num: "I", name: "Analgesia", col: C.green, col2: "1A5C40",
      span: "Induction → Loss of Consciousness",
      points: [
        "Analgesia without amnesia (early)",
        "Analgesia + amnesia (late)",
        "Patient conscious, responds to commands",
        "Protective reflexes intact",
        "Suitable: minor procedures (e.g. N₂O)"
      ]
    },
    {
      num: "II", name: "Excitement / Delirium", col: "E67E22", col2: "6B3800",
      span: "LOC → Onset of Automatic Breathing",
      points: [
        "Delirium, vocalization, amnesia",
        "Respiration: rapid, irregular, breath-holding",
        "↑ HR, ↑ BP — sympathetic surge",
        "Risk: vomiting, laryngospasm",
        "Eyelash reflex disappears, others intact",
        "Shorten by rapid ↑ in agent concentration"
      ]
    },
    {
      num: "III", name: "Surgical Anaesthesia", col: C.teal, col2: "07484B",
      span: "Automatic Respiration → Respiratory Paralysis",
      points: [
        "4 planes based on ocular & respiratory signs",
        "Progressive muscle relaxation",
        "Plane I–IV (see next slides)",
        "Target: Planes II–III for most surgery",
        "Plane III was target before NMBDs"
      ]
    },
    {
      num: "IV", name: "Medullary Depression", col: C.red, col2: "5C1010",
      span: "Respiratory Arrest → Death",
      points: [
        "Medullary paralysis — overdose",
        "Respiratory arrest (apnea)",
        "Vasomotor collapse → cardiac arrest",
        "Maximally dilated, fixed pupils",
        "Complete muscle relaxation",
        "AVOID — immediately reduce agent"
      ]
    }
  ];

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  const w = 2.2;

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      x, y: 1.65, w, h: 3.5,
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      fill: { color: C.gold }, line: { color: C.gold, width: 0 }
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 — STAGE I & II DETAIL
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Stage I & Stage II — Detail", "Analgesia  →  Excitement");
  footer(s);

  // Stage I
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  });

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    fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });

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    ["Consciousness", "Present; responds to commands"],
    ["Analgesia", "Present (amnesia added late in stage)"],
    ["Respiration", "Normal, regular"],
    ["Pupils", "Normal size, reactive to light"],
    ["Reflexes", "All intact"],
    ["Eyelash reflex", "Present"],
    ["BP / HR", "Normal"],
    ["Clinical use", "N₂O sedation, minor procedures"],
  ];

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    const yy = 1.73 + i * 0.36;
    s.addText(`${label}:`, { x: 0.3, y: yy, w: 1.6, h: 0.32, fontSize: 11, bold: true, color: C.tealLt, fontFace: "Calibri" });
    s.addText(val, { x: 1.95, y: yy, w: 2.7, h: 0.32, fontSize: 11, color: C.offWhite, fontFace: "Calibri" });
  });

  // Stage II
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  });

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    x: 5.2, y: 1.15, w: 4.6, h: 0.5,
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    ["Behaviour", "Delirium, vocalization, struggling"],
    ["Respiration", "Rapid, irregular; breath-holding possible"],
    ["Pupils", "Dilated, reactive"],
    ["Eyelash reflex", "Disappears in this stage"],
    ["Other reflexes", "Intact — coughing, vomiting, swallowing"],
    ["BP / HR", "Increased (sympathetic surge)"],
    ["Hazard", "Vomiting, laryngospasm, aspiration"],
    ["Management", "Rapid ↑ in agent conc.; short duration"],
  ];

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    s.addText(val, { x: 6.95, y: yy, w: 2.7, h: 0.3, fontSize: 11, color: C.offWhite, fontFace: "Calibri" });
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}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 — STAGE III OVERVIEW
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Stage III — Surgical Anaesthesia", "The most important stage, divided into four planes");
  footer(s);

  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.18, w: 9.6, h: 0.72,
    fill: { color: "07484B" }, line: { color: C.teal, width: 1 }, rectRadius: 0.1
  });
  s.addText([
    { text: "Definition: ", options: { bold: true, color: C.gold, fontSize: 13 } },
    { text: "Onset of automatic (regular) respiration  →  Complete cessation of spontaneous respiration (apnea)  |  Divided into FOUR PLANES.", options: { bold: false, color: C.offWhite, fontSize: 13 } }
  ], { x: 0.35, y: 1.22, w: 9.3, h: 0.62, fontFace: "Calibri", valign: "middle" });

  // Column headers
  const cols = ["Sign / Feature", "PLANE I", "PLANE II", "PLANE III", "PLANE IV"];
  const cw = [2.0, 1.9, 1.9, 1.9, 1.9];
  const cx = [0.2, 2.2, 4.1, 6.0, 7.9];
  const hdrColors = ["0D2137", C.plane1, C.plane2, C.plane3, C.plane4];

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      fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
    });
  });

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    ["Eyeball movement", "Present (oscillating)", "Ceases — fixed central", "Fixed", "Fixed"],
    ["Eyelid reflex", "LOST", "LOST", "LOST", "LOST"],
    ["Conjunctival reflex", "Lost at base of plane", "Lost", "Lost", "Lost"],
    ["Corneal reflex", "Present", "LOST", "Lost", "Lost"],
    ["Lacrimation", "Present", "↑ (sign of light plane)", "Absent", "Absent"],
    ["Pupil size", "Normal / mild dilat.", "Moderate dilatation", "Dilated widely", "Max. dilated"],
    ["Light reflex", "Present", "Diminishing", "ABOLISHED", "Absent"],
    ["Laryngeal reflex", "Present", "LOST", "Lost*", "Lost"],
    ["Respiration", "Regular, automatic", "Regular, automatic", "Diaphragmatic only", "Apnea"],
    ["Intercostal muscles", "Active", "Beginning paralysis", "Progressive → complete", "Complete paralysis"],
    ["Response to skin stimulation", "Present", "LOST", "Lost", "Lost"],
  ];

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    const bgC = rowColors[ri % 2];
    row.forEach((cell, ci) => {
      const isWarn = cell === "LOST" || cell === "ABOLISHED" || cell === "Apnea" || cell === "Max. dilated";
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        fontSize: 9.5,
        color: ci === 0 ? C.gray : isWarn ? C.red : C.offWhite,
        bold: ci === 0 || isWarn,
        fontFace: "Calibri", valign: "middle", align: ci === 0 ? "left" : "center"
      });
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  s.addText("* Laryngeal reflex in Plane III can still be provoked by painful stimuli (anal / cervical dilatation)  |  Key entry sign: eyeball oscillation = Plane I onset", {
    x: 0.2, y: 5.25, w: 9.6, h: 0.2,
    fontSize: 8.5, color: C.gray, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 — STAGE III: PLANES I & II
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Stage III — Plane I & Plane II", "From automatic breathing to intercostal paralysis onset");
  footer(s);

  // Plane I card
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.15, w: 4.6, h: 4.1,
    fill: { color: "082C25" }, line: { color: C.plane1, width: 2 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.15, w: 4.6, h: 0.5, fill: { color: C.plane1 } });
  s.addText("PLANE I", {
    x: 0.2, y: 1.15, w: 4.6, h: 0.5,
    fontSize: 18, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle"
  });

  s.addText("Onset of automatic respiration → Cessation of eyeball movements", {
    x: 0.3, y: 1.7, w: 4.4, h: 0.5,
    fontSize: 10.5, color: C.tealLt, fontFace: "Calibri", italic: true, align: "center"
  });

  bulletList(s, [
    "ENTRY SIGN: Onset of regular, automatic breathing",
    "Eyeballs: oscillating / roving movements present",
    "Eyelid reflex: LOST",
    "Swallowing reflex: disappears",
    "Conjunctival reflex: lost at bottom of this plane",
    "Corneal reflex: still present",
    "Pupils: normal size, light reflex present",
    "Lacrimation: present",
    "Respiration: automatic, regular, tidal vol. adequate",
    "Intercostal muscles: active, full breathing",
    "Response to skin stimulation: present",
    "Eyeball oscillation = SAFE zone; patient can be operated on",
  ], 0.3, 2.23, 4.4, 3.0, { fontSize: 11 });

  // Plane II card
  s.addShape(pres.ShapeType.roundRect, {
    x: 5.2, y: 1.15, w: 4.6, h: 4.1,
    fill: { color: "08233C" }, line: { color: C.plane2, width: 2 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.15, w: 4.6, h: 0.5, fill: { color: C.plane2 } });
  s.addText("PLANE II", {
    x: 5.2, y: 1.15, w: 4.6, h: 0.5,
    fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });

  s.addText("Cessation of eyeball movements → Beginning of intercostal paralysis", {
    x: 5.3, y: 1.7, w: 4.4, h: 0.5,
    fontSize: 10.5, color: C.tealLt, fontFace: "Calibri", italic: true, align: "center"
  });

  bulletList(s, [
    "Eyeballs: FIXED, central (no movement)",
    "Corneal reflex: LOST",
    "Laryngeal reflex: LOST (caution: upper airway infection ↑ irritability)",
    "Lacrimation: INCREASES — useful sign of light anaesthesia",
    "Pupils: moderate dilatation, light reflex diminishing",
    "Respiration: automatic, regular, good tidal volume",
    "Intercostal muscles: beginning of paralysis",
    "Movement response to skin stimulation: GONE",
    "Deep breathing response to stimulation: GONE",
    "Swallowing reflex: absent",
    "Most routine/minor-to-moderate surgery performed at this plane",
    "WARNING: Adequate depth — do not deepen without reason",
  ], 5.3, 2.23, 4.4, 3.0, { fontSize: 11 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 — STAGE III: PLANES III & IV
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Stage III — Plane III & Plane IV", "Deep anaesthesia — approach with caution");
  footer(s);

  // Plane III card
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.15, w: 4.6, h: 4.1,
    fill: { color: "3B2000" }, line: { color: C.plane3, width: 2 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.15, w: 4.6, h: 0.5, fill: { color: C.plane3 } });
  s.addText("PLANE III", {
    x: 0.2, y: 1.15, w: 4.6, h: 0.5,
    fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });

  s.addText("Beginning → Completion of intercostal muscle paralysis", {
    x: 0.3, y: 1.7, w: 4.4, h: 0.5,
    fontSize: 10.5, color: C.gold, fontFace: "Calibri", italic: true, align: "center"
  });

  bulletList(s, [
    "Respiration: DIAPHRAGMATIC ONLY (intercostal paralysis progressing)",
    "Thoracic cage: moves inward on inspiration (paradoxical breathing)",
    "Tidal volume progressively falls",
    "Pupils: WIDELY dilated",
    "Light reflex: ABOLISHED",
    "Laryngeal reflex: lost, BUT can be provoked by:",
    "   → Painful cervical dilatation",
    "   → Painful anal dilatation",
    "Eyeballs: fixed, central",
    "Intercostal muscles: progressive → complete paralysis",
    "Historical significance: preferred plane for major abdominal surgery",
    "   (adequate muscle relaxation without NMBDs)",
    "WARNING: Approaching dangerous depth",
  ], 0.3, 2.22, 4.4, 3.05, { fontSize: 10.5 });

  // Plane IV card
  s.addShape(pres.ShapeType.roundRect, {
    x: 5.2, y: 1.15, w: 4.6, h: 4.1,
    fill: { color: "2E0000" }, line: { color: C.plane4, width: 2 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 1.15, w: 4.6, h: 0.5, fill: { color: C.plane4 } });
  s.addText("PLANE IV  ⚠", {
    x: 5.2, y: 1.15, w: 4.6, h: 0.5,
    fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });

  s.addText("Complete intercostal paralysis → Diaphragmatic paralysis (APNEA)", {
    x: 5.3, y: 1.7, w: 4.4, h: 0.5,
    fontSize: 10.5, color: C.red, fontFace: "Calibri", italic: true, align: "center"
  });

  bulletList(s, [
    "Diaphragm: progressively paralysed → APNEA",
    "Respiration: ceases completely",
    "Pupils: MAXIMALLY DILATED, fixed (no light reflex)",
    "Eyes: widely open, fixed, glazed appearance",
    "All reflexes: completely absent",
    "Muscle tone: complete flaccidity",
    "HR: falls, BP collapses",
    "Merges imperceptibly into Stage IV (medullary depression)",
    "IMMEDIATELY REDUCE ANAESTHETIC AGENT",
    "Initiate IPPV if apnea occurs",
    "This plane should NEVER be intentionally reached",
    "Monitor: SpO₂, BP, ETCO₂, BIS continuously",
  ], 5.3, 2.22, 4.4, 3.05, { fontSize: 10.5, color: C.offWhite });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 — STAGE IV & KEY CLINICAL SIGNS SUMMARY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Stage IV & Clinical Signs Summary", "Medullary depression  •  Key monitoring parameters");
  footer(s);

  // Stage IV
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.18, w: 3.8, h: 4.0,
    fill: { color: "1A0000" }, line: { color: C.red, width: 2 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.18, w: 3.8, h: 0.48, fill: { color: C.red } });
  s.addText("STAGE IV — OVERDOSE", {
    x: 0.2, y: 1.18, w: 3.8, h: 0.48,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });

  bulletList(s, [
    "Span: Respiratory arrest → Death",
    "Medullary paralysis",
    "Respiratory arrest (apnea)",
    "Vasomotor collapse",
    "Cardiac arrest",
    "Maximally dilated, fixed pupils",
    "Complete muscle relaxation",
    "No reflexes whatsoever",
    "⚠ AVOID AT ALL COSTS",
    "Immediately: stop agent, ventilate, vasopressors",
  ], 0.3, 1.7, 3.6, 3.4, { fontSize: 11, color: C.offWhite });

  // Key signs box
  s.addShape(pres.ShapeType.roundRect, {
    x: 4.2, y: 1.18, w: 5.6, h: 4.0,
    fill: { color: "07253A" }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 4.2, y: 1.18, w: 5.6, h: 0.48, fill: { color: "07484B" } });
  s.addText("MOST IMPORTANT CLINICAL SIGNS", {
    x: 4.2, y: 1.18, w: 5.6, h: 0.48,
    fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle"
  });

  const keyRows = [
    ["Sign", "Significance", "Color"],
    ["Eyeball oscillation", "Entry into Stage III Plane I — SAFE zone", C.plane1],
    ["Eyeball fixation", "Deeper anaesthesia — Plane II or beyond", C.plane2],
    ["↑ Lacrimation", "Light anaesthesia (Plane II) — may need deeper", C.tealLt],
    ["Corneal reflex loss", "Reached Plane II", C.plane2],
    ["Pupil dilatation + absent light reflex", "Plane III — dangerously deep", C.plane3],
    ["Intercostal paralysis (diaphragm only)", "Plane III — major hazard", C.plane3],
    ["Maximal pupil dilatation + apnea", "Plane IV / Stage IV — emergency", C.plane4],
    ["Increased BP/HR during surgery", "Light anaesthesia — deepen or give analgesic", C.gold],
    ["Decreasing BP + bradycardia", "Too deep — reduce agent", C.red],
  ];

  keyRows.forEach((row, ri) => {
    if (ri === 0) return; // skip header
    const yy = 1.72 + (ri - 1) * 0.35;
    s.addShape(pres.ShapeType.rect, { x: 4.2, y: yy, w: 0.08, h: 0.3, fill: { color: row[2] } });
    s.addText(row[0] + ":", {
      x: 4.32, y: yy, w: 2.2, h: 0.3,
      fontSize: 10.5, bold: true, color: row[2], fontFace: "Calibri", valign: "middle"
    });
    s.addText(row[1], {
      x: 6.55, y: yy, w: 3.1, h: 0.3,
      fontSize: 10.5, color: C.offWhite, fontFace: "Calibri", valign: "middle"
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 — EYE SIGNS IN DETAIL
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Eye Signs — The Cornerstone of Guedel's Classification", "Guedel's key contribution: systematic eye sign monitoring");
  footer(s);

  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.15, w: 9.6, h: 0.6,
    fill: { color: "07484B" }, line: { color: C.teal, width: 1 }, rectRadius: 0.1
  });
  s.addText("Guedel's original contribution was to add systematic EYE SIGNS to the existing four-stage framework, allowing safe staging of surgical anaesthesia.", {
    x: 0.35, y: 1.18, w: 9.3, h: 0.52,
    fontSize: 12, color: C.offWhite, fontFace: "Calibri", valign: "middle", italic: true
  });

  const eyeSigns = [
    { title: "Eyeball Oscillation", stage: "Stage III — Plane I", color: C.plane1,
      points: ["Roving, rolling, pendular movements of eyeballs", "FIRST sign of entry into Stage III", "Indicates: adequate but not excessive depth", "Safe for surgical stimulation to begin", "As oscillation STOPS → entering Plane II"] },
    { title: "Eyeball Fixation", stage: "Stage III — Plane II+", color: C.plane2,
      points: ["Eyeballs become fixed in central position", "Marks transition from Plane I to Plane II", "More controlled surgical anaesthesia", "No voluntary or reflex eye movements", "Corneal reflex already absent at this point"] },
    { title: "Corneal Reflex", stage: "Stage III — Plane I→II", color: C.tealLt,
      points: ["Test: gentle touch of cornea with cotton wisp", "Present: Plane I of Stage III", "LOST: marks entry into Plane II", "Reliable indicator of anaesthetic depth", "Do not confuse with conjunctival reflex (lost earlier)"] },
    { title: "Pupil Size & Light Reflex", stage: "Stage III — Planes III–IV", color: C.plane3,
      points: ["Normal/small: Planes I–II", "Moderate dilatation: Plane II", "WIDE dilatation + abolished light reflex: Plane III", "MAXIMAL dilatation: Plane IV / Stage IV", "Parasympathetic depression → unopposed sympathetic"] },
    { title: "Lacrimation", stage: "Stage III — Plane II (clinically useful)", color: C.gold,
      points: ["Increases in Plane II — sign of light anaesthesia", "Useful practical sign: tears forming in anesthetised patient", "Should prompt: check depth, add analgesic if needed", "Absent in Plane III and beyond", "Historical: easily observed, no equipment needed"] },
  ];

  const cardW = 1.88;
  const cardX = [0.2, 2.1, 4.0, 5.9, 7.8];

  eyeSigns.forEach((item, i) => {
    const x = cardX[i];
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 1.85, w: cardW, h: 3.3,
      fill: { color: "0A1E30" }, line: { color: item.color, width: 1.5 }, rectRadius: 0.1
    });
    s.addShape(pres.ShapeType.rect, { x, y: 1.85, w: cardW, h: 0.45, fill: { color: item.color } });
    s.addText(item.title, {
      x: x + 0.05, y: 1.85, w: cardW - 0.1, h: 0.45,
      fontSize: 10.5, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle"
    });
    s.addText(item.stage, {
      x: x + 0.05, y: 2.33, w: cardW - 0.1, h: 0.32,
      fontSize: 9, color: item.color, fontFace: "Calibri", italic: true, align: "center"
    });
    const bullItems = item.points.map((p, pi) => ({
      text: p,
      options: { bullet: { code: "25B8" }, color: C.offWhite, fontSize: 9.5, breakLine: pi < item.points.length - 1 }
    }));
    s.addText(bullItems, {
      x: x + 0.06, y: 2.67, w: cardW - 0.12, h: 2.4,
      fontFace: "Calibri", valign: "top"
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 — RESPIRATORY SIGNS IN DETAIL
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Respiratory Signs Across Stages", "Breathing patterns as depth indicators");
  footer(s);

  const respData = [
    {
      stage: "Stage I", col: C.green,
      pattern: "Normal",
      rate: "Normal 12-20/min",
      depth: "Normal tidal volume",
      quality: "Regular",
      muscles: "All respiratory muscles active",
      note: "No change from baseline"
    },
    {
      stage: "Stage II", col: "E67E22",
      pattern: "Irregular",
      rate: "Rapid / irregular",
      depth: "Variable — may hold breath",
      quality: "Irregular, jerky",
      muscles: "May have breath-holding or rapid shallow breathing",
      note: "Unpredictable; risky stage"
    },
    {
      stage: "Stage III Pl. I", col: C.plane1,
      pattern: "Automatic",
      rate: "Regular 12-16/min",
      depth: "Good tidal volume",
      quality: "Smooth, regular",
      muscles: "Full thoraco-abdominal movement",
      note: "Safe — automated breathing resumes"
    },
    {
      stage: "Stage III Pl. II", col: C.plane2,
      pattern: "Automatic",
      rate: "Regular, slightly slower",
      depth: "Adequate tidal volume",
      quality: "Smooth",
      muscles: "Intercostals beginning to weaken",
      note: "Still adequate spontaneous ventilation"
    },
    {
      stage: "Stage III Pl. III", col: C.plane3,
      pattern: "Diaphragmatic",
      rate: "Slower, shallow",
      depth: "Reduced — intercostal loss",
      quality: "Abdominal / paradoxical",
      muscles: "Intercostals paralysed; diaphragm only",
      note: "Chest may move inward on inspiration"
    },
    {
      stage: "Stage III Pl. IV", col: C.plane4,
      pattern: "Agonal / Apnea",
      rate: "Very slow → 0",
      depth: "Minimal → none",
      quality: "Gasping or absent",
      muscles: "Diaphragm also failing",
      note: "Immediate IPPV required"
    },
    {
      stage: "Stage IV", col: C.red,
      pattern: "APNEA",
      rate: "0 — no breathing",
      depth: "None",
      quality: "None",
      muscles: "All paralysed",
      note: "Emergency — medullary depression"
    },
  ];

  const headers = ["Stage", "Pattern", "Rate", "Depth", "Quality", "Muscles / Note"];
  const colW = [1.5, 1.2, 1.5, 1.3, 1.2, 2.8];
  const colX = [0.1];
  for (let i = 0; i < colW.length - 1; i++) colX.push(colX[i] + colW[i] + 0.02);

  // Header row
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: colX[i], y: 1.18, w: colW[i], h: 0.36, fill: { color: C.teal } });
    s.addText(h, {
      x: colX[i], y: 1.18, w: colW[i], h: 0.36,
      fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
    });
  });

  respData.forEach((row, ri) => {
    const yy = 1.58 + ri * 0.54;
    const cells = [row.stage, row.pattern, row.rate, row.depth, row.quality, `${row.muscles}  ${row.note}`];
    cells.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, {
        x: colX[ci], y: yy, w: colW[ci], h: 0.5,
        fill: { color: ci === 0 ? row.col : ri % 2 === 0 ? "0C1F30" : "0D2640" }
      });
      s.addText(cell, {
        x: colX[ci] + 0.04, y: yy, w: colW[ci] - 0.08, h: 0.5,
        fontSize: ci === 5 ? 9.5 : 10,
        color: ci === 0 ? C.navy : C.offWhite,
        bold: ci === 0,
        fontFace: "Calibri", valign: "middle", align: ci === 0 ? "center" : "left"
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 — REFLEXES CHART
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Reflex Changes Across Stages", "Progressive loss of protective reflexes with increasing depth");
  footer(s);

  const reflexes = [
    "Eyelash reflex",
    "Swallowing reflex",
    "Eyelid reflex",
    "Conjunctival reflex",
    "Corneal reflex",
    "Lacrimation (↑ = light)",
    "Laryngeal reflex",
    "Light reflex (pupillary)",
    "Cough reflex",
    "Gag reflex",
    "Skin (somatic) response",
  ];

  // Status: P = Present, L = Lost, A = Abolished, ↑ = Increased, D = Diminished
  const statusGrid = [
    // StI, StII, SIII-PI, SIII-PII, SIII-PIII, SIII-PIV, StIV
    ["P", "L",  "L",  "L",  "L",  "L",  "L"],  // Eyelash
    ["P", "P",  "L",  "L",  "L",  "L",  "L"],  // Swallowing
    ["P", "P",  "L",  "L",  "L",  "L",  "L"],  // Eyelid
    ["P", "P",  "L*", "L",  "L",  "L",  "L"],  // Conjunctival
    ["P", "P",  "P",  "L",  "L",  "L",  "L"],  // Corneal
    ["N", "N",  "N",  "↑",  "A",  "A",  "A"],  // Lacrimation
    ["P", "P",  "P",  "L",  "L†","L",  "L"],  // Laryngeal
    ["P", "P",  "P",  "D",  "A",  "A",  "A"],  // Light reflex
    ["P", "P",  "P",  "L",  "L",  "L",  "L"],  // Cough
    ["P", "P",  "P",  "L",  "L",  "L",  "L"],  // Gag
    ["P", "P",  "P",  "L",  "L",  "L",  "L"],  // Skin resp
  ];

  const stageLabels = ["Stage I", "Stage II", "Plane I", "Plane II", "Plane III", "Plane IV", "Stage IV"];
  const stageCols =   [C.green,  "E67E22",  C.plane1, C.plane2, C.plane3, C.plane4, C.red];
  const colW = 1.22;
  const firstColW = 1.95;

  // Headers
  s.addShape(pres.ShapeType.rect, { x: 0.1, y: 1.18, w: firstColW, h: 0.42, fill: { color: "0D2137" } });
  s.addText("REFLEX", { x: 0.1, y: 1.18, w: firstColW, h: 0.42, fontSize: 11, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle" });

  stageLabels.forEach((label, i) => {
    const cx = 0.1 + firstColW + i * colW + i * 0.02;
    s.addShape(pres.ShapeType.rect, { x: cx, y: 1.18, w: colW, h: 0.42, fill: { color: stageCols[i] } });
    s.addText(label, { x: cx, y: 1.18, w: colW, h: 0.42, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  const colorMap = { "P": C.green, "L": C.red, "L*": C.red, "L†": C.red, "A": C.red, "↑": C.gold, "D": "E67E22", "N": C.gray };

  reflexes.forEach((ref, ri) => {
    const yy = 1.63 + ri * 0.36;
    const bgC = ri % 2 === 0 ? "0C1F30" : "0A1828";
    s.addShape(pres.ShapeType.rect, { x: 0.1, y: yy, w: firstColW, h: 0.33, fill: { color: "0A1E30" } });
    s.addText(ref, { x: 0.14, y: yy, w: firstColW - 0.08, h: 0.33, fontSize: 10.5, color: C.gray, bold: false, fontFace: "Calibri", valign: "middle" });

    statusGrid[ri].forEach((val, si) => {
      const cx = 0.1 + firstColW + si * colW + si * 0.02;
      s.addShape(pres.ShapeType.rect, { x: cx, y: yy, w: colW, h: 0.33, fill: { color: bgC } });
      s.addText(val, {
        x: cx, y: yy, w: colW, h: 0.33,
        fontSize: 11, bold: true, color: colorMap[val] || C.offWhite,
        fontFace: "Calibri", align: "center", valign: "middle"
      });
    });
  });

  s.addText("P = Present  |  L = Lost  |  A = Abolished  |  D = Diminishing  |  ↑ = Increased  |  N = Normal  |  * Lost at base of Plane I  |  † Can be provoked by cervical/anal stimulation", {
    x: 0.1, y: 5.25, w: 9.8, h: 0.2,
    fontSize: 8, color: C.gray, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 12 — MODERN ANAESTHESIA vs GUEDEL
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "Guedel's Classification in Modern Context", "Limitations, current relevance, and modern depth monitoring");
  footer(s);

  // Left: Limitations
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.18, w: 4.55, h: 4.1,
    fill: { color: "220A0A" }, line: { color: C.red, width: 1.5 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.18, w: 4.55, h: 0.45, fill: { color: C.red } });
  s.addText("Limitations of Guedel's Classification", {
    x: 0.2, y: 1.18, w: 4.55, h: 0.45,
    fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle"
  });
  bulletList(s, [
    "Designed for ETHER — not applicable as described with modern agents",
    "NMBDs eliminate respiratory muscle signs (most important signs masked)",
    "IV agents (propofol, ketamine) cause rapid stage progression — stages blur",
    "'Balanced anaesthesia': IV induction + inhalational maintenance + NMBDs + analgesics",
    "Premedication with morphine + atropine no longer standard",
    "Rapid-sequence induction bypasses Stages I & II entirely",
    "Modern agents (sevoflurane, desflurane) have minimal excitatory Stage II",
    "Concurrent monitoring (BIS, SpO₂, ETCO₂, IBP) supersedes clinical signs",
  ], 0.3, 1.7, 4.35, 3.5, { fontSize: 11 });

  // Right: Relevance + Modern monitoring
  s.addShape(pres.ShapeType.roundRect, {
    x: 5.0, y: 1.18, w: 4.8, h: 1.95,
    fill: { color: "082815" }, line: { color: C.green, width: 1.5 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.18, w: 4.8, h: 0.45, fill: { color: C.green } });
  s.addText("Remaining Relevance", {
    x: 5.0, y: 1.18, w: 4.8, h: 0.45,
    fontSize: 12.5, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle"
  });
  bulletList(s, [
    "Conceptual framework — taught in all anaesthesia training",
    "Inhalational inductions in children (sevoflurane)",
    "Resource-limited settings where monitoring is basic",
    "Gas induction in uncooperative/special needs patients",
    "Understanding depth: still relevant conceptually",
  ], 5.1, 1.68, 4.6, 1.4, { fontSize: 11 });

  s.addShape(pres.ShapeType.roundRect, {
    x: 5.0, y: 3.2, w: 4.8, h: 2.08,
    fill: { color: "061830" }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.14
  });
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 3.2, w: 4.8, h: 0.45, fill: { color: "07484B" } });
  s.addText("Modern Depth of Anaesthesia Monitoring", {
    x: 5.0, y: 3.2, w: 4.8, h: 0.45,
    fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle"
  });
  bulletList(s, [
    "BIS (Bispectral Index): 40-60 = adequate surgical anaesthesia",
    "Entropy (State & Response Entropy)",
    "Narcotrend Index",
    "Auditory evoked potentials (AEP)",
    "End-tidal agent concentration (ETAC): ~0.7-1.3 MAC",
    "PRST score (Pressure, Rate, Sweating, Tears)",
  ], 5.1, 3.72, 4.6, 1.5, { fontSize: 11 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 13 — EXAM HIGH-YIELD MNEMONICS & SUMMARY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  headerBar(s, "High-Yield Points for MD Exam", "Key facts, mnemonics and exam favourites");
  footer(s);

  // Top band
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.2, y: 1.18, w: 9.6, h: 0.65,
    fill: { color: "07484B" }, line: { color: C.teal, width: 1 }, rectRadius: 0.1
  });
  s.addText("Stage III is the most important stage — subdivided into 4 planes based on EYE SIGNS + RESPIRATORY MUSCLE SIGNS", {
    x: 0.3, y: 1.22, w: 9.4, h: 0.55,
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    "Stage III entry: onset of automatic breathing + eyeball oscillation",
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    "Stage III → IV: apnea (diaphragmatic paralysis)",
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    "Classification based on = DIETHYL ETHER",
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// ══════════════════════════════════════════════════════════════════
// SLIDE 14 — REFERENCES
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  const refs = [
    "1.  Katzung BG et al. Basic and Clinical Pharmacology, 16th Edition. McGraw-Hill; 2021. Chapter: Inhalational Anaesthetics — Guedel's Signs, p.701.",
    "2.  Morgan GE, Mikhail MS. Morgan & Mikhail's Clinical Anesthesiology, 7th Edition. McGraw-Hill; 2022.",
    "3.  Miller RD et al. Miller's Anesthesia, 10th Edition. Elsevier; 2023. Chapter: Monitoring Depth of Anaesthesia.",
    "4.  Barash PG, Cullen BF, Stoelting RK et al. Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition. Wolters Kluwer; 2022.",
    "5.  Guedel AE. Inhalation Anesthesia: A Fundamental Guide. New York: Macmillan; 1937.",
    "6.  Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's Clinical Anesthesiology. 6th Ed.",
    "7.  StatPearls: Anesthesia Stages. NCBI Bookshelf, NBK557596. National Library of Medicine, 2023.",
    "8.  Wikipedia. Guedel's Classification. Accessed May 2026.",
  ];

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