from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from io import BytesIO

# ── Colour palette ─────────────────────────────────────────────────────────────
DARK_TEAL   = RGBColor(0x00, 0x5F, 0x73)   # header bars
MID_TEAL    = RGBColor(0x0A, 0x91, 0x96)   # accents / sub-headers
LIGHT_AQUA  = RGBColor(0xE0, 0xF7, 0xFA)   # content bg
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
DARK_TEXT   = RGBColor(0x1A, 0x1A, 0x2E)
GOLD        = RGBColor(0xE9, 0xC4, 0x6A)   # highlight
ORANGE      = RGBColor(0xF4, 0xA2, 0x61)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ── Helper functions ────────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, color):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = color
    shape.line.fill.background()
    return shape

def add_tb(slide, text, x, y, w, h, size, bold=False, color=WHITE,
           align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb

def add_bullet_box(slide, items, x, y, w, h, title=None, title_size=16,
                   bullet_size=14, bg_color=LIGHT_AQUA, title_color=DARK_TEAL,
                   bullet_color=DARK_TEXT, symbol="•"):
    """Draw a coloured box with optional title and bullet list."""
    box = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    box.fill.solid()
    box.fill.fore_color.rgb = bg_color
    box.line.color.rgb = MID_TEAL
    box.line.width = Pt(1)

    tb = slide.shapes.add_textbox(Inches(x+0.12), Inches(y+0.08), Inches(w-0.24), Inches(h-0.16))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(4)
    tf.margin_top = Pt(2)

    if title:
        p = tf.paragraphs[0]
        p.alignment = PP_ALIGN.LEFT
        run = p.add_run()
        run.text = title
        run.font.size = Pt(title_size)
        run.font.bold = True
        run.font.color.rgb = title_color
        run.font.name = "Calibri"

    for item in items:
        p = tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        run = p.add_run()
        run.text = f"{symbol}  {item}"
        run.font.size = Pt(bullet_size)
        run.font.color.rgb = bullet_color
        run.font.name = "Calibri"
        p.space_before = Pt(3)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 – TITLE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)

# Background gradient-like layers
add_rect(slide, 0, 0, 13.333, 7.5, DARK_TEAL)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0x00, 0x3D, 0x4F))

# Decorative top stripe
add_rect(slide, 0, 0, 13.333, 0.35, GOLD)

# White card
add_rect(slide, 1.1, 0.8, 11.1, 5.2, WHITE)

# Title
add_tb(slide, "Anesthetic Management of Thyroid Surgery",
       1.3, 1.1, 10.7, 1.8, 34, bold=True, color=DARK_TEAL, align=PP_ALIGN.CENTER)

# Horizontal rule
add_rect(slide, 2.5, 2.95, 8.3, 0.04, GOLD)

# Subtitle
add_tb(slide, "A Comprehensive Perioperative Approach",
       1.3, 3.1, 10.7, 0.7, 20, bold=False, color=MID_TEAL, align=PP_ALIGN.CENTER, italic=True)

# Moderator
add_tb(slide, "Moderator:",
       3.5, 3.95, 6, 0.45, 15, bold=True, color=DARK_TEXT, align=PP_ALIGN.CENTER)
add_tb(slide, "Dr. Mukesh Patir",
       3.5, 4.35, 6, 0.5, 18, bold=True, color=DARK_TEAL, align=PP_ALIGN.CENTER)
add_tb(slide, "Assistant Professor, Department of Anaesthesiology",
       2.0, 4.8, 9.3, 0.45, 13, color=DARK_TEXT, align=PP_ALIGN.CENTER)
add_tb(slide, "Assam Medical College and Hospital, Dibrugarh",
       2.0, 5.2, 9.3, 0.45, 13, bold=True, color=DARK_TEXT, align=PP_ALIGN.CENTER)

# Bottom stripe
add_rect(slide, 0, 7.1, 13.333, 0.4, MID_TEAL)
add_tb(slide, "Department of Anaesthesiology  |  AMCH Dibrugarh",
       0, 7.12, 13.333, 0.35, 11, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 – OVERVIEW / CONTENTS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Overview", 0.3, 0.15, 12.7, 0.8, 30, bold=True, color=WHITE)

contents = [
    "1.  Surgical Indications for Thyroidectomy",
    "2.  Surgical Anatomy Relevant to Anaesthesia",
    "3.  Pre-operative Assessment",
    "4.  Preoperative Optimization – Hyperthyroidism & Hypothyroidism",
    "5.  Airway Assessment & Management",
    "6.  Anaesthetic Technique – Induction, Maintenance & Monitoring",
    "7.  Intraoperative Considerations",
    "8.  Nerve Integrity Monitor (NIM) ETT",
    "9.  Positioning & Surgical Setup",
    "10. Postoperative Care & Complications",
    "11. Thyroid Storm – Recognition & Treatment",
    "12. Special Scenarios & Summary",
]
add_bullet_box(slide, contents, 0.5, 1.3, 12.3, 5.9, bullet_size=15,
               bg_color=WHITE, symbol="►", bullet_color=DARK_TEXT)

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 – SURGICAL INDICATIONS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Surgical Indications for Thyroidectomy", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

left_items = [
    "Thyroid cancer (papillary, follicular, medullary, anaplastic)",
    "Failed medical therapy for hyperthyroidism",
    "Large symptomatic goiter with compressive symptoms",
    "Suspicious thyroid nodule (indeterminate cytology)",
    "Toxic multinodular goiter",
    "Graves' disease – definitive surgical treatment",
]
right_items = [
    "Substernal / retrosternal goiter",
    "Cosmetically unacceptable goiter",
    "Patient preference / intolerance to radioiodine",
    "Pregnancy with uncontrolled hyperthyroidism",
    "Minimally invasive procedures increasingly performed:",
    "  – Robot-assisted transaxillary thyroidectomy",
    "  – Transoral thyroidectomy (requires nasal intubation)",
]

add_bullet_box(slide, left_items, 0.4, 1.3, 6.0, 4.6, title="Common Indications",
               bullet_size=13.5, bg_color=LIGHT_AQUA)
add_bullet_box(slide, right_items, 6.7, 1.3, 6.2, 4.6, title="Additional / Emerging",
               bullet_size=13.5, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 – SURGICAL ANATOMY RELEVANT TO ANAESTHESIA
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Surgical Anatomy Relevant to Anaesthesia", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

left_items = [
    "Thyroid gland: two lobes + isthmus at C5–T1",
    "Closely related to trachea and larynx",
    "Recurrent Laryngeal Nerve (RLN):",
    "  – Runs in tracheoesophageal groove",
    "  – Motor supply to all intrinsic laryngeal muscles (except cricothyroid)",
    "  – At risk during thyroidectomy",
    "Superior Laryngeal Nerve (SLN):",
    "  – External branch: cricothyroid muscle",
    "  – Internal branch: sensory to supraglottis",
]
right_items = [
    "Parathyroid glands (usually 4) lie posterior to thyroid",
    "Inadvertent removal → hypoparathyroidism → hypocalcaemia",
    "Superior thyroid artery (branch of external carotid)",
    "Inferior thyroid artery (branch of thyrocervical trunk)",
    "Thyroidea ima (in ~10%) from brachiocephalic / aorta",
    "Large substernal goiters may behave as anterior mediastinal mass",
    "CT/MRI review essential before surgery for retrosternal extension",
]
add_bullet_box(slide, left_items, 0.4, 1.3, 6.0, 5.4, title="Key Structures",
               bullet_size=12.5, bg_color=LIGHT_AQUA)
add_bullet_box(slide, right_items, 6.7, 1.3, 6.2, 5.4, title="Anaesthetic Relevance",
               bullet_size=12.5, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 – PRE-OPERATIVE ASSESSMENT
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Pre-operative Assessment", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

col1 = [
    "Thyroid function tests: TSH, free T3, free T4",
    "Serum calcium & phosphate",
    "Full blood count, coagulation profile",
    "ECG – check for AF, tachyarrhythmia",
    "Indirect laryngoscopy – vocal cord assessment",
    "Review current medications (antithyroid, beta-blockers, steroids)",
]
col2 = [
    "Airway assessment: Mallampati, thyromental distance, neck mobility",
    "Review CT/MRI for tracheal deviation, compression, substernal extension",
    "Assess tracheal compression degree (Maran grading)",
    "Endoscopic airway evaluation for large / compressive goiters",
    "Cardiovascular status: echo if AF, cardiac failure suspected",
    "Pulmonary function tests if significant tracheal compression",
]
col3 = [
    "Thyroid cancer ↑ risk of difficult intubation",
    "Goiter size alone is NOT predictive of difficult intubation",
    "Incidence of difficult intubation in goiter surgery: 5–8%",
    "Awake intubation if: large goiter + airway obstruction + tracheal deviation",
    "Substernal goiter: risk of intrathoracic airway obstruction after GA induction",
    "Discuss plan with surgeon before induction",
]

add_bullet_box(slide, col1, 0.3, 1.3, 4.1, 5.4, title="Investigations", bullet_size=12, bg_color=LIGHT_AQUA)
add_bullet_box(slide, col2, 4.65, 1.3, 4.1, 5.4, title="Airway & Imaging", bullet_size=12, bg_color=RGBColor(0xFD, 0xF6, 0xEC))
add_bullet_box(slide, col3, 9.0, 1.3, 4.0, 5.4, title="Key Concerns", bullet_size=12, bg_color=RGBColor(0xFF, 0xF0, 0xF0))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 – PREOPERATIVE OPTIMIZATION – HYPERTHYROIDISM
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Preoperative Optimization – Hyperthyroidism", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

# Goal statement
add_rect(slide, 0.4, 1.25, 12.5, 0.6, DARK_TEAL)
add_tb(slide, "Goal: Achieve euthyroid state before elective surgery to prevent thyroid storm",
       0.5, 1.28, 12.3, 0.55, 14, bold=True, color=GOLD, align=PP_ALIGN.CENTER)

medical = [
    "Antithyroid drugs (thionamides):",
    "  – Carbimazole / Methimazole: 10–40 mg/day",
    "  – Propylthiouracil (PTU): 100–600 mg/day",
    "  – PTU also inhibits peripheral T4 → T3 conversion",
    "Beta-blockers (Propranolol 40–160 mg/day):",
    "  – Control tachycardia, tremor, anxiety",
    "  – Continue until day of surgery",
    "Iodine (Lugol's iodine) 5–7 days before surgery:",
    "  – Reduces thyroid vascularity (Wolff-Chaikoff effect)",
    "  – Decreases intraoperative blood loss",
    "Target: Heart rate < 80 bpm; euthyroid status confirmed",
]
signs = [
    "Sinus tachycardia / Atrial fibrillation",
    "Myocardial ischemia",
    "Congestive heart failure",
    "Nervousness, tremulousness, insomnia",
    "Heat intolerance, weight loss",
    "Goiter, exophthalmos (Graves' disease)",
    "Operating on acutely hyperthyroid gland",
    "  → may provoke thyroid storm",
    "Do NOT induce GA in uncontrolled hyperthyroid state",
]
add_bullet_box(slide, medical, 0.4, 1.95, 7.0, 5.0, title="Medical Optimization",
               bullet_size=12.5, bg_color=LIGHT_AQUA)
add_bullet_box(slide, signs, 7.65, 1.95, 5.3, 5.0, title="Clinical Signs & Risks",
               bullet_size=12.5, bg_color=RGBColor(0xFF, 0xF0, 0xF0))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 – PREOPERATIVE OPTIMIZATION – HYPOTHYROIDISM
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Preoperative Optimization – Hypothyroidism", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

features = [
    "Bradycardia, decreased cardiac output",
    "Increased peripheral vascular resistance",
    "Low voltage ECG (pericardial effusion)",
    "Depressed ventilatory response to hypoxia/hypercapnia",
    "Lethargy, cold intolerance, slow mentation",
    "Anemia, coagulopathy, hypothermia",
    "Enhanced sensitivity to anesthetic agents, opioids & sedatives",
    "Delayed drug metabolism → prolonged drug action",
    "Risk of postoperative ventilatory failure if severe",
]
management = [
    "Elective surgery: optimize thyroid status first",
    "Levothyroxine (T4) replacement: 1.6 mcg/kg/day",
    "Allow 4–6 weeks for full optimization",
    "Mild-moderate hypothyroidism: surgery generally safe",
    "Severe hypothyroidism / myxedema coma: postpone elective surgery",
    "Emergency surgery: IV levothyroxine + hydrocortisone",
    "Intraoperatively: expect slow metabolism of drugs",
    "Avoid hypothermia; active warming measures",
    "Monitor for hypoglycaemia and hyponatraemia",
]
add_bullet_box(slide, features, 0.4, 1.3, 6.0, 5.6, title="Features Relevant to Anaesthesia",
               bullet_size=13, bg_color=LIGHT_AQUA)
add_bullet_box(slide, management, 6.7, 1.3, 6.2, 5.6, title="Perioperative Management",
               bullet_size=13, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 – AIRWAY ASSESSMENT & MANAGEMENT
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Airway Assessment & Management", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

assessment = [
    "Mallampati class, mouth opening, neck mobility",
    "Thyromental distance (< 6 cm = difficult)",
    "Tracheal deviation (clinical exam + CXR/CT)",
    "Degree of airway obstruction (stridor, orthopnea)",
    "Indirect/direct laryngoscopy – pre-op vocal cord assessment",
    "CT/MRI: tracheal narrowing, substernal extension",
    "Flow-volume loop: intrathoracic vs. extrathoracic obstruction",
]
techniques = [
    "Standard RSI / modified RSI for most elective cases",
    "Video laryngoscopy preferred for anticipated difficult airway",
    "Awake fibreoptic intubation (AFOI) for:",
    "  – Large goiter + significant tracheal compression",
    "  – Stridor at rest or with exertion",
    "  – Tracheal deviation with compression",
    "  – Previous difficult airway history",
    "LMA: increasingly used; allows spontaneous ventilation",
    "  – Enables real-time vocal cord monitoring",
    "Nasal intubation required for transoral thyroidectomy",
    "Armoured (reinforced) ETT: reduces kinking in neck position",
    "NIM-ETT if intraoperative neural monitoring planned",
]
substernal = [
    "Behave like anterior mediastinal masses",
    "Risk of intrathoracic airway obstruction post-induction",
    "Avoid paralysis until airway secured",
    "Consider AFOI or inhalational induction (Sevoflurane)",
    "Have surgical team ready for emergency sternotomy",
    "Standby for rigid bronchoscopy",
]
add_bullet_box(slide, assessment, 0.3, 1.25, 4.1, 5.6, title="Airway Assessment",
               bullet_size=12, bg_color=LIGHT_AQUA)
add_bullet_box(slide, techniques, 4.65, 1.25, 4.7, 5.6, title="Intubation Strategy",
               bullet_size=12, bg_color=RGBColor(0xFD, 0xF6, 0xEC))
add_bullet_box(slide, substernal, 9.55, 1.25, 3.5, 5.6, title="Substernal Goiter",
               bullet_size=12, bg_color=RGBColor(0xFF, 0xF0, 0xF0))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 – ANAESTHETIC TECHNIQUE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Anaesthetic Technique", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

premedication = [
    "Anxiolytic: Midazolam 1–2 mg IV (with caution in hypothyroid)",
    "Continue beta-blockers until day of surgery",
    "Continue antithyroid drugs",
    "Antisialagogue: Glycopyrrolate 0.2 mg IM/IV",
    "H2 antagonist: Ranitidine if risk of regurgitation",
    "Antiemetic premedication (PONV risk is high in thyroid surgery)",
]
induction = [
    "Standard: IV induction with Propofol (1.5–2.5 mg/kg)",
    "Fentanyl 1–2 mcg/kg for analgesia",
    "Muscle relaxant:",
    "  – Succinylcholine 1.5 mg/kg for RSI",
    "  – Rocuronium 0.6 mg/kg (if NIM not used)",
    "  – If NIM-ETT: Succinylcholine only for intubation",
    "    (no further NMB post-intubation)",
    "Inhalational induction (Sevoflurane) for:",
    "  – Anticipated difficult airway / substernal goiter",
    "  – Paediatric patients",
]
maintenance = [
    "Inhalational: Isoflurane / Sevoflurane in O2/Air",
    "TIVA: Propofol infusion + Remifentanil (good haemodynamic control)",
    "Avoid high-dose volatile agents in hyperthyroid patients",
    "Muscle relaxation: Avoid if NIM monitoring used",
    "If NMB used: sugammadex for reversal",
    "Monitoring:",
    "  – Standard: NIBP, ECG, SpO2, EtCO2, temperature",
    "  – Consider: IBP (unstable hyperthyroid, cardiac disease)",
    "  – NIM-ETT waveform monitoring",
    "  – Depth of anaesthesia (BIS) for TIVA",
]
add_bullet_box(slide, premedication, 0.3, 1.25, 3.9, 5.6, title="Premedication",
               bullet_size=11.5, bg_color=LIGHT_AQUA)
add_bullet_box(slide, induction, 4.42, 1.25, 4.3, 5.6, title="Induction",
               bullet_size=11.5, bg_color=RGBColor(0xFD, 0xF6, 0xEC))
add_bullet_box(slide, maintenance, 8.95, 1.25, 4.1, 5.6, title="Maintenance & Monitoring",
               bullet_size=11.5, bg_color=RGBColor(0xF0, 0xF8, 0xF0))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 – NIM-ETT & INTRAOPERATIVE NEURAL MONITORING
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Nerve Integrity Monitor (NIM) ETT &\nIntraoperative Neural Monitoring (IONM)", 0.3, 0.1, 12.7, 0.92, 24, bold=True, color=WHITE)

nim = [
    "NIM-ETT: Specialised ETT with surface electrodes near vocal cords",
    "Electrodes record EMG activity from vocalis muscles",
    "Surgeon stimulates structures suspected to be RLN",
    "Positive signal: EMG waveform + audible tone → confirms RLN",
    "Helps preserve recurrent laryngeal nerve function",
    "Also allows post-dissection mapping before nerve section",
    "Requires correct positioning: electrodes at 15–20 mm from cords",
    "Verify position after head/neck repositioning for surgical exposure",
]
drug = [
    "Succinylcholine or small dose Rocuronium acceptable for intubation",
    "After intubation: NO further neuromuscular blocking drugs",
    "Residual NMB will abolish EMG signals → false negatives",
    "Use train-of-four (TOF) monitoring to confirm full recovery",
    "Spontaneous ventilation assists EMG quality during IONM",
    "Avoid deep volatile anaesthesia: may suppress EMG",
    "Remifentanil infusion useful for haemodynamic stability without NMB",
]
limitations = [
    "False positives: ETT movement, electrical interference",
    "False negatives: residual NMB, incorrect ETT position",
    "Does not prevent RLN injury – only monitors it",
    "Laryngeal LMA as alternative: allows real-time vocal cord visualisation",
    "Bilateral RLN injury: rare but mandates immediate reintubation",
]
add_bullet_box(slide, nim, 0.3, 1.25, 5.8, 5.6, title="NIM-ETT – Principle & Use",
               bullet_size=12.5, bg_color=LIGHT_AQUA)
add_bullet_box(slide, drug, 6.35, 1.25, 3.8, 5.6, title="Drug Considerations",
               bullet_size=12.5, bg_color=RGBColor(0xFD, 0xF6, 0xEC))
add_bullet_box(slide, limitations, 10.35, 1.25, 2.7, 5.6, title="Limitations",
               bullet_size=11.5, bg_color=RGBColor(0xFF, 0xF0, 0xF0))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 – POSITIONING & INTRAOPERATIVE CONSIDERATIONS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Positioning & Intraoperative Considerations", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

positioning = [
    "Supine with neck extended (shoulder roll)",
    "Table tilt: 15–20° reverse Trendelenburg",
    "  – Reduces venous congestion in neck",
    "  – Reduces bleeding",
    "Arm board: arms tucked by side",
    "Eye protection: taping mandatory",
    "Risk of venous air embolism (VAE):",
    "  – Head elevated + venous channels open",
    "  – Monitor with EtCO2 + capnography",
    "  – Have left lateral position + aspiration ready",
]
intraop = [
    "Haemostasis: controlled normotension preferred",
    "Avoid hypertension (risk of venous bleeding/hematoma)",
    "Antibiotic prophylaxis: Cefazolin 1g IV before incision",
    "Temperature monitoring: maintain normothermia",
    "Fluid management: restrict crystalloids in neck surgery",
    "Dexamethasone 8 mg IV: reduces oedema + PONV",
    "Blood loss: usually minimal (<100 mL) but can be significant in large goiters",
    "Surgeon may use Lugol's iodine soaked packs (warn team)",
    "Avoid high airway pressures: may mask surgical complications",
]
add_bullet_box(slide, positioning, 0.4, 1.3, 6.0, 5.5, title="Patient Positioning",
               bullet_size=13, bg_color=LIGHT_AQUA)
add_bullet_box(slide, intraop, 6.7, 1.3, 6.2, 5.5, title="Intraoperative Management",
               bullet_size=13, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 12 – EXTUBATION & POSTOPERATIVE CARE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Extubation & Postoperative Care", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

extubation = [
    "Optimal conditions essential for safe extubation",
    "Smooth emergence – avoid coughing/bucking:",
    "  – Remifentanil infusion 0.01–0.05 mcg/kg/min at extubation",
    "  – IV Lidocaine 1–1.5 mg/kg before suctioning",
    "  – Dexmedetomidine infusion",
    "Deep extubation: avoids straining but risk of airway obstruction",
    "Before extubation: check for vocal cord movement",
    "  – Ask patient to say 'E' sound (awake extubation)",
    "  – Evaluate by laryngoscopy / fibreoptic check",
    "Cuff leak test: may identify subglottic oedema",
    "Reintubation equipment MUST be immediately available",
]
complications = [
    "HAEMATOMA FORMATION (most dangerous early complication):",
    "  – Can cause rapid airway compromise",
    "  – Open wound at bedside if stridor/distress",
    "  – Immediate surgical re-exploration",
    "RECURRENT LARYNGEAL NERVE INJURY:",
    "  – Unilateral: hoarseness, weak voice",
    "  – Bilateral: stridor, aphonia → emergency reintubation",
    "TRACHEOMALACIA:",
    "  – Post-decompression collapse after substernal goiter removal",
    "  – May need immediate reintubation / tracheostomy",
    "HYPOCALCAEMIA (hypoparathyroidism):",
    "  – Onset 24–96 hours post-op",
    "  – Circumoral numbness, carpopedal spasm, Chvostek's sign",
    "  – Laryngeal stridor → laryngospasm (early sign!)",
    "  – Treat: IV calcium gluconate / calcium chloride",
    "PNEUMOTHORAX: after substernal goiter excision",
]
add_bullet_box(slide, extubation, 0.3, 1.25, 5.5, 5.7, title="Extubation Strategy",
               bullet_size=11.5, bg_color=LIGHT_AQUA)
add_bullet_box(slide, complications, 6.1, 1.25, 6.9, 5.7, title="Postoperative Complications",
               bullet_size=11, bg_color=RGBColor(0xFF, 0xF0, 0xF0))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 13 – THYROID STORM
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, RGBColor(0x8B, 0x00, 0x00))
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Thyroid Storm (Thyrotoxic Crisis) – Recognition & Management", 0.3, 0.15, 12.7, 0.8, 24, bold=True, color=WHITE)

# Alert banner
add_rect(slide, 0.4, 1.2, 12.5, 0.55, RGBColor(0xFF, 0xCC, 0x00))
add_tb(slide, "⚠  MEDICAL EMERGENCY – Life-threatening exacerbation of hyperthyroidism; most common in undiagnosed or undertreated patients",
       0.5, 1.22, 12.3, 0.5, 12.5, bold=True, color=DARK_TEXT, align=PP_ALIGN.CENTER)

features = [
    "HYPERTHERMIA (fever > 38.5°C, often > 40°C)",
    "Tachycardia / Tachyarrhythmia (HR > 140/min)",
    "Atrial fibrillation / dysrhythmias",
    "Myocardial ischemia / congestive heart failure",
    "Agitation, confusion, delirium, coma",
    "Nausea, vomiting, diarrhoea, abdominal pain",
    "Profuse diaphoresis",
    "Triggers: surgery, trauma, infection, iodine load",
    "No single diagnostic lab test – clinical diagnosis",
    "Burch-Wartofsky Point Scale (BWPS) used for scoring",
]
treatment = [
    "REMOVE / TREAT PRECIPITATING CAUSE",
    "Step 1 – Beta-blocker (FIRST drug):",
    "  Propranolol 1–2 mg IV bolus every 10–15 min",
    "  Or Esmolol infusion (rate control)",
    "Step 2 – Thionamide (1 hour after beta-blocker):",
    "  PTU 200 mg PO/NG q4h (also blocks T4→T3 conversion)",
    "  Or Methimazole 20–40 mg q4–6h",
    "Step 3 – Iodine (at least 1 hour after thionamide):",
    "  Lugol's iodine 10 drops TID or SSKI",
    "Step 4 – Glucocorticoid:",
    "  Dexamethasone 2 mg IV q6h (blocks T4→T3 conversion)",
    "Supportive: cooling blankets, paracetamol (NOT aspirin)",
    "IV fluids + electrolyte correction",
    "Differentiate from: MH, phaeochromocytoma, NMS, light anaesthesia",
]
add_bullet_box(slide, features, 0.3, 1.9, 5.5, 5.0, title="Clinical Features",
               bullet_size=12, bg_color=RGBColor(0xFF, 0xF0, 0xF0))
add_bullet_box(slide, treatment, 6.1, 1.9, 6.9, 5.0, title="Treatment – Sequential Steps",
               bullet_size=11.5, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, RGBColor(0x8B, 0x00, 0x00))
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 14 – REGIONAL ANAESTHESIA / SPECIAL TECHNIQUES
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Regional Anaesthesia & Special Considerations", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

regional = [
    "Bilateral superficial cervical plexus block (BSCPB):",
    "  – Limited / minimally invasive thyroidectomy",
    "  – Landmark or ultrasound guided",
    "  – LA: Bupivacaine 0.25% + Lignocaine 1%",
    "  – Covers C2–C4 dermatomes",
    "  – May require sedation (Dexmedetomidine / Midazolam)",
    "Deep cervical plexus block: higher risk (VA, PN block)",
    "BSCPB advantages: reduces opioid requirement, early discharge",
    "LMA with spontaneous ventilation:",
    "  – Increasingly used for standard thyroidectomy",
    "  – Enables real-time vocal cord function assessment",
]
special = [
    "PAEDIATRIC THYROIDECTOMY:",
    "  – Inhalational induction (Sevoflurane)",
    "  – Weight-based drug dosing",
    "  – Smaller ETT; risk of subglottic oedema",
    "PREGNANCY:",
    "  – Thyroid surgery preferably 2nd trimester",
    "  – Avoid teratogenic drugs (first trimester)",
    "  – Fetal heart rate monitoring intraoperatively",
    "EMERGENCY THYROIDECTOMY / THYROID CANCER:",
    "  – Higher risk of difficult airway",
    "  – Plan for awake fibreoptic intubation",
    "  – Multidisciplinary team approach",
    "MINIMALLY INVASIVE / ROBOTIC THYROIDECTOMY:",
    "  – Transaxillary: standard ETT",
    "  – Transoral: nasal intubation mandatory",
    "  – CO2 insufflation: monitor EtCO2 carefully",
]
add_bullet_box(slide, regional, 0.3, 1.3, 6.0, 5.6, title="Regional Techniques",
               bullet_size=12, bg_color=LIGHT_AQUA)
add_bullet_box(slide, special, 6.6, 1.3, 6.4, 5.6, title="Special Patient Groups",
               bullet_size=12, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 15 – ANALGESIA & PONV MANAGEMENT
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Postoperative Analgesia & PONV Management", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

analgesia = [
    "Thyroid surgery: mild-moderate postoperative pain",
    "Multimodal analgesia preferred:",
    "  – Paracetamol 1g IV q6h (regular)",
    "  – NSAIDs: Diclofenac / Ketorolac (if no contraindication)",
    "  – Tramadol 50–100 mg IV q6h PRN",
    "  – Morphine 2–4 mg IV PRN (use cautiously – opioid-sparing preferable)",
    "Bilateral superficial cervical plexus block:",
    "  – Reduces postop opioid consumption significantly",
    "Dexamethasone 8 mg IV: analgesic + antiemetic + reduces oedema",
    "IV Lignocaine infusion: opioid-sparing, reduces PONV",
    "Avoid excess opioids: risk of respiratory depression",
    "Wound infiltration: local anaesthetic by surgeon",
]
ponv = [
    "Thyroid surgery = HIGH PONV risk procedure",
    "Risk factors: Female sex, non-smoker, history of PONV/motion sickness",
    "Opioid use adds further risk",
    "Apfel score ≥ 2: multimodal prophylaxis",
    "Prophylaxis regimen:",
    "  – Dexamethasone 8 mg IV at induction",
    "  – Ondansetron 4 mg IV at end of surgery",
    "  – Consider Droperidol 0.625–1.25 mg IV",
    "  – Scopolamine patch (transdermal) if high risk",
    "TIVA with Propofol: reduces baseline PONV vs. volatile agents",
    "Adequate hydration reduces PONV",
    "Treat with: Ondansetron, Metoclopramide, Promethazine",
]
add_bullet_box(slide, analgesia, 0.3, 1.3, 6.3, 5.6, title="Postoperative Analgesia",
               bullet_size=12, bg_color=LIGHT_AQUA)
add_bullet_box(slide, ponv, 6.85, 1.3, 6.1, 5.6, title="PONV Prophylaxis & Treatment",
               bullet_size=12, bg_color=RGBColor(0xFD, 0xF6, 0xEC))

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 16 – SUMMARY FLOWCHART
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "Perioperative Management – Summary Checklist", 0.3, 0.15, 12.7, 0.8, 26, bold=True, color=WHITE)

steps = [
    ("1. PRE-OPERATIVE", [
        "TFTs, Ca, ECG, vocal cord assessment",
        "Airway assessment + CT/MRI review",
        "Optimize thyroid status (euthyroid before elective surgery)",
        "Beta-blockers + antithyroid drugs until day of surgery",
        "Plan airway strategy (routine vs. difficult vs. AFOI)",
    ], DARK_TEAL),
    ("2. INDUCTION", [
        "Appropriate ETT (standard / NIM / armoured / nasal)",
        "Video laryngoscope on standby",
        "AFOI if large goiter + significant airway compromise",
        "Succinylcholine for RSI; no NMB post-intubation if IONM",
        "Smooth induction – minimise sympathetic response",
    ], MID_TEAL),
    ("3. MAINTENANCE", [
        "Controlled normotension; reverse Trendelenburg",
        "IONM – NIM-ETT signal monitoring",
        "Temperature monitoring; active warming",
        "Dexamethasone 8mg; consider BSCPB for analgesia",
        "Gentle haemostasis; minimal airway pressures",
    ], RGBColor(0x2A, 0x9D, 0x8F)),
    ("4. EMERGENCE & POST-OP", [
        "Smooth extubation – remifentanil / IV lignocaine",
        "Vocal cord assessment before / after extubation",
        "Watch for: haematoma, RLN injury, hypocalcaemia",
        "Multimodal analgesia; PONV prophylaxis",
        "Serial Ca monitoring 24–96 h post total thyroidectomy",
    ], RGBColor(0x26, 0x4F, 0x78)),
]

for i, (title, items, color) in enumerate(steps):
    col_x = 0.3 + i * 3.22
    add_rect(slide, col_x, 1.25, 3.0, 0.45, color)
    add_tb(slide, title, col_x+0.05, 1.27, 2.9, 0.42, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_bullet_box(slide, items, col_x, 1.72, 3.0, 5.12,
                   bullet_size=11.5, bg_color=LIGHT_AQUA, symbol="✓")

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 17 – REFERENCES
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, RGBColor(0xF5, 0xF9, 0xFA))
add_rect(slide, 0, 0, 13.333, 1.05, DARK_TEAL)
add_rect(slide, 0, 1.05, 13.333, 0.06, GOLD)
add_tb(slide, "References", 0.3, 0.15, 12.7, 0.8, 30, bold=True, color=WHITE)

refs = [
    "1.  Barash PG, Cullen BF, Stoelting RK, et al. Barash, Cullen & Stoelting's Clinical Anesthesia, 9th ed. Wolters Kluwer; 2022. Chapter 47: Anesthesia for Thyroid Surgery, pp. 3995–3996.",
    "2.  Miller RD, et al. Miller's Anesthesia, 2-Volume Set, 10th ed. Elsevier; 2023. Chapter 66: Thyroid and Parathyroid Surgery, pp. 9813–9814.",
    "3.  Morgan GE, Mikhail MS. Clinical Anesthesiology, 7th ed. McGraw-Hill; 2022. Chapter: Thyroid Disease and Thyroid Surgery.",
    "4.  Haugen BRM, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.",
    "5.  Burch HB, Wartofsky L. Life-threatening thyrotoxicosis: Thyroid storm. Endocrinol Metab Clin North Am. 1993;22(2):263–277.",
    "6.  Dralle H, Sekulla C, Lorenz K, et al. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32(7):1358–1366.",
    "7.  Cernea CR, et al. Surgical techniques for avoiding the external branch of the superior laryngeal nerve injury during thyroidectomy. Head Neck. 2009;31(12):1742.",
    "8.  ASA Difficult Airway Algorithm – Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31–81.",
    "9.  Goldman-Cecil Medicine, International Edition. Elsevier; 2020. Section: Thyroid Storm / Thyrotoxic Crisis, pp. 3074.",
    "10. Rosen's Emergency Medicine: Concepts and Clinical Practice, 9th ed. Elsevier; 2018. Chapter 117: Management of Thyrotoxicosis.",
]

tb = slide.shapes.add_textbox(Inches(0.5), Inches(1.3), Inches(12.3), Inches(5.7))
tf = tb.text_frame
tf.word_wrap = True
tf.margin_left = Pt(4)
for i, ref in enumerate(refs):
    p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
    p.space_before = Pt(3)
    run = p.add_run()
    run.text = ref
    run.font.size = Pt(11.5)
    run.font.color.rgb = DARK_TEXT
    run.font.name = "Calibri"

add_rect(slide, 0, 7.1, 13.333, 0.4, DARK_TEAL)
add_tb(slide, "Anesthetic Management of Thyroid Surgery  |  AMCH Dibrugarh", 0, 7.12, 13.333, 0.35, 10, color=WHITE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 18 – THANK YOU
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_TEAL)
add_rect(slide, 0, 0, 13.333, 0.4, GOLD)
add_rect(slide, 0, 7.1, 13.333, 0.4, GOLD)

add_rect(slide, 1.5, 1.5, 10.3, 4.5, WHITE)
add_tb(slide, "Thank You", 1.5, 1.8, 10.3, 1.5, 52, bold=True, color=DARK_TEAL, align=PP_ALIGN.CENTER)
add_rect(slide, 3.5, 3.3, 6.3, 0.05, GOLD)
add_tb(slide, "Dr. Mukesh Patir", 1.5, 3.5, 10.3, 0.6, 22, bold=True, color=DARK_TEAL, align=PP_ALIGN.CENTER)
add_tb(slide, "Assistant Professor, Department of Anaesthesiology", 1.5, 4.1, 10.3, 0.45, 15, color=DARK_TEXT, align=PP_ALIGN.CENTER)
add_tb(slide, "Assam Medical College and Hospital, Dibrugarh", 1.5, 4.55, 10.3, 0.45, 15, bold=True, color=DARK_TEXT, align=PP_ALIGN.CENTER)
add_tb(slide, "Questions & Discussion Welcome", 1.5, 5.15, 10.3, 0.5, 14, italic=True, color=MID_TEAL, align=PP_ALIGN.CENTER)

# ── Save ────────────────────────────────────────────────────────────────────
out = "/tmp/workspace/thyroid-anesthesia-ppt/Anesthetic_Management_Thyroid_Surgery_AMCH.pptx"
from io import BytesIO
buf = BytesIO()
prs.save(buf)
with open(out, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {out}")