mkdir -p /home/daytona/workspace/labour-analgesia-ppt && ls /home/daytona/worksp…

~/labour-analgesia-ppt/build.js

const pptxgen = require("pptxgenjs");

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pres.title = "Methods of Labour Analgesia";
pres.author = "Anaesthesia Department";

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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════════
titleSlide(
  "Methods of Labour Analgesia",
  "A Comprehensive Anaesthesia Review"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW / AGENDA
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Agenda",
  [
    "1. Pain Pathways in Labour",
    "2. Goals and Benefits of Labour Analgesia",
    "3. Nonpharmacologic Methods",
    "4. Systemic Opioid Analgesia",
    "5. Inhaled Analgesia (Entonox / Nitrous Oxide)",
    "6. Neuraxial Analgesia — Overview",
    "7. Epidural Analgesia",
    "8. Combined Spinal-Epidural (CSE)",
    "9. Dural Puncture Epidural (DPE)",
    "10. Spinal (Intrathecal) Analgesia",
    "11. Paracervical Block",
    "12. Pudendal Nerve Block",
    "13. Comparison & Selection",
    "14. Impact on Labour Outcome",
    "15. Key Take-Home Points",
  ],
  "Miller's Anesthesia 10e | Barash Clinical Anesthesia 9e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — PAIN PATHWAYS
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Pain Pathways in Labour",
  [
    { text: "First Stage of Labour (Cervical Dilation + Uterine Contractions)", bold: true },
    { text: "Visceral pain via type-C afferent fibres accompanying sympathetic nerves", sub: true },
    { text: "Referred to T10–L1 dermatomes", sub: true },
    { text: "Experienced as diffuse lower abdominal / back pain", sub: true },
    { text: "Late First Stage & Second Stage (Vaginal / Perineal Distension)", bold: true },
    { text: "Somatic pain via pudendal nerve (S2–S4)", sub: true },
    { text: "Well-localised perineal / rectal pressure", sub: true },
    { text: "Factors Affecting Labour Pain Intensity", bold: true },
    { text: "Parity, fetal size/presentation, maternal anxiety, induction of labour", sub: true },
    { text: "Ethnic background, β2-adrenergic gene polymorphisms (Miller's)", sub: true },
    { text: "Labour augmentation, psychological support", sub: true },
  ],
  "Barash 9e p.3486; Miller's 10e p.8840"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — GOALS & BENEFITS
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Goals & Benefits of Labour Analgesia",
  [
    { text: "Maternal Benefits", bold: true },
    { text: "Relief of pain and anxiety during parturition", sub: true },
    { text: "Blunts sympathetic surges → prevents ↑HR, ↑BP, ↓uterine blood flow", sub: true },
    { text: "↓Maternal catecholamines → may convert dysfunctional labour to normal", sub: true },
    { text: "Prevents maternal hyperventilation (↓respiratory alkalosis)", sub: true },
    { text: "Fetal Benefits", bold: true },
    { text: "Prevents maternal hyperventilation → avoids leftward shift of O2-Hgb curve → ↑fetal PaO2", sub: true },
    { text: "Improved uteroplacental blood flow with adequate analgesia", sub: true },
    { text: "Principle (Barash 9e)", bold: true },
    { text: "Labour analgesia may benefit both mother and fetus and should not be withheld if requested", sub: true },
    { text: "Neonatal outcomes are similar with or without pharmacologic analgesia in healthy women", sub: true },
  ],
  "Barash Clinical Anesthesia 9e p.3486"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
sectionDivider("NONPHARMACOLOGIC METHODS");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — NONPHARMACOLOGIC
// ═══════════════════════════════════════════════════════════════════════════════
twoColSlide(
  "Nonpharmacologic Methods",
  "Simple Techniques",
  [
    "Breathing techniques (Lamaze)",
    "Focused attention / relaxation",
    "Position changes",
    "Massage (↓pain 1st stage; Cochrane 10 RCTs)",
    "Aromatherapy & audiotherapy",
    "Heat & cold therapy",
    "Continuous labour support (doula)",
    "Music therapy",
  ],
  "Advanced Techniques",
  [
    "Hydrotherapy (warm water immersion)",
    "Intradermal sterile water injections",
    "TENS (transcutaneous electrical nerve stimulation)",
    "Acupuncture / acupressure",
    "Hypnosis (↓systemic analgesic use; Cochrane 9 RCTs)",
    "Biofeedback",
    "LeBoyer technique",
    "Bradley method",
  ],
  "Miller's 10e p.8841; Barash 9e p.3486"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Evidence for Nonpharmacologic
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Evidence for Nonpharmacologic Methods",
  [
    { text: "Continuous Labour Support (Cochrane; 26 trials, 15,858 women — Miller's 10e)", bold: true },
    { text: "↓Use of pharmacologic analgesia; shorter labour; ↑spontaneous vaginal delivery", sub: true },
    { text: "Acupuncture vs sham (Cochrane; 28 RCTs, n=3960 — Miller's 10e)", bold: true },
    { text: "Minimal reduction in pain; ↑patient satisfaction; ↓pharmacologic analgesia use", sub: true },
    { text: "Acupressure: no significant benefit over sham", sub: true },
    { text: "Massage (Cochrane; 10 RCTs — Miller's 10e)", bold: true },
    { text: "Reduced pain in 1st stage; no benefit in 2nd/3rd stages; ↑sense of control", sub: true },
    { text: "Hypnosis (Cochrane; 9 RCTs, n=2954 — Miller's 10e)", bold: true },
    { text: "↓Use of systemic pharmacologic analgesia; no clear difference in neuraxial use", sub: true },
    { text: "Limitation", bold: true },
    { text: "Most nonpharmacologic studies lack rigorous methodology for comparison with pharmacologic methods", sub: true },
  ],
  "Miller's Anesthesia 10e p.8841–8842"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
sectionDivider("SYSTEMIC OPIOID ANALGESIA");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — SYSTEMIC OPIOIDS
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Systemic Opioid Analgesia",
  [
    { text: "Overview", bold: true },
    { text: "Widely used; provides partial analgesia; does not fully eliminate labour pain", sub: true },
    { text: "Can be given IV (preferred) or IM; PCA gaining popularity", sub: true },
    { text: "Meperidine (Pethidine)", bold: true },
    { text: "Most commonly used IM opioid historically; 25–50 mg IM or 25 mg IV", sub: true },
    { text: "Active metabolite normeperidine — neonatal CNS depression, seizure risk", sub: true },
    { text: "Fentanyl", bold: true },
    { text: "Rapid onset (5 min IV); short duration; preferred for IV/PCA labour analgesia", sub: true },
    { text: "Minimal neonatal respiratory depression at analgesic doses", sub: true },
    { text: "Remifentanil PCA", bold: true },
    { text: "Ultra-short acting; patient-controlled; 0.2–0.8 mcg/kg bolus", sub: true },
    { text: "Requires continuous O2 saturation monitoring and 1:1 nursing", sub: true },
    { text: "Butorphanol & Nalbuphine — mixed agonist-antagonist; less neonatal depression", bold: true },
    { text: "Morphine — prolonged duration; more neonatal depression; less favoured in labour", bold: true },
  ],
  "Barash Clinical Anesthesia 9e; Miller's Anesthesia 10e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
sectionDivider("INHALATION ANALGESIA");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — INHALATION ANALGESIA
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Inhalation Analgesia — Nitrous Oxide (Entonox)",
  [
    { text: "Agent", bold: true },
    { text: "50% N2O + 50% O2 (Entonox) — most widely used inhalation analgesic in obstetrics", sub: true },
    { text: "Self-administered via demand valve at onset of contraction", sub: true },
    { text: "Mechanism", bold: true },
    { text: "NMDA receptor antagonism → analgesic and anxiolytic effects", sub: true },
    { text: "Advantages", bold: true },
    { text: "Non-invasive; rapid onset (30–50 sec); rapidly eliminated", sub: true },
    { text: "No adverse effect on uterine contractions; patient-controlled", sub: true },
    { text: "Provides 50–60% reduction in VAS pain scores", sub: true },
    { text: "Limitations", bold: true },
    { text: "Incomplete analgesia; does not eliminate pain", sub: true },
    { text: "Nausea, dizziness, sedation; requires scavenging system", sub: true },
    { text: "Diffusion hypoxia if O2 concentration not maintained", sub: true },
    { text: "Other inhalational agents (rare use): Methoxyflurane (Penthrox), low-dose isoflurane", bold: true },
  ],
  "Barash Clinical Anesthesia 9e p.3487; Miller's Anesthesia 10e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER
// ═══════════════════════════════════════════════════════════════════════════════
sectionDivider("NEURAXIAL ANALGESIA");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — NEURAXIAL OVERVIEW
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Neuraxial Analgesia — Overview",
  [
    { text: "Gold Standard for Labour Analgesia (Barash 9e)", bold: true },
    { text: "Most effective and widely requested method for labour pain relief", sub: true },
    { text: "Includes: Epidural, CSE, DPE, Spinal (intrathecal)", sub: true },
    { text: "Preprocedural Assessment (Miller's 10e)", bold: true },
    { text: "Review coagulation, platelet count, anatomy, neurological history", sub: true },
    { text: "Informed consent; IV access; baseline BP", sub: true },
    { text: "Contraindications", bold: true },
    { text: "Absolute: Patient refusal, coagulopathy, local infection at site, ↑ICP", sub: true },
    { text: "Relative: Systemic sepsis, hypovolaemia, severe aortic stenosis, patient cooperation", sub: true },
    { text: "Timing", bold: true },
    { text: "Can be initiated at any cervical dilation if requested (ASA/ACOG guidelines)", sub: true },
    { text: "No evidence that early neuraxial analgesia increases cesarean delivery rate", sub: true },
  ],
  "Miller's Anesthesia 10e p.8843; Barash 9e p.3487"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — EPIDURAL ANALGESIA
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Epidural Analgesia",
  [
    { text: "Technique", bold: true },
    { text: "Tuohy needle → epidural space (L2–L3 or L3–L4) → catheter placement", sub: true },
    { text: "Loss-of-resistance technique (saline or air) most common", sub: true },
    { text: "Test dose: 3 ml 1.5% lidocaine + 1:200,000 epi — excludes intrathecal/intravascular placement", sub: true },
    { text: "Drug Regimen — Loading Dose", bold: true },
    { text: "Bupivacaine 0.0625–0.125% + Fentanyl 2 mcg/ml: 10–20 ml in divided doses", sub: true },
    { text: "Ropivacaine 0.1–0.2% + opioid — slightly less motor block than bupivacaine", sub: true },
    { text: "Maintenance Options", bold: true },
    { text: "Continuous epidural infusion (CEI): basal rate 8–12 ml/h", sub: true },
    { text: "PCEA (patient-controlled epidural analgesia): bolus 5 ml q15 min lockout", sub: true },
    { text: "PIEB (programmed intermittent epidural bolus): superior spread vs CEI (Miller's 10e)", sub: true },
    { text: "Advantages: Titratable; catheter allows extension for CS; prolonged analgesia", bold: true },
    { text: "Disadvantages: Motor block; hypotension; urinary retention; PDPH risk ~1%", bold: true },
  ],
  "Miller's Anesthesia 10e p.8844–8848; Barash 9e p.3488–3493"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — CSE
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Combined Spinal-Epidural (CSE) Analgesia",
  [
    { text: "Technique — Needle-through-Needle", bold: true },
    { text: "Epidural space identified → long spinal needle through Tuohy needle into CSF", sub: true },
    { text: "Intrathecal injection → spinal needle removed → epidural catheter placed", sub: true },
    { text: "Intrathecal Drug Dose (Initial)", bold: true },
    { text: "Fentanyl 10–25 mcg ± Sufentanil 1.5–5 mcg ± Bupivacaine 1.25–2.5 mg", sub: true },
    { text: "Provides rapid, dense analgesia within 3–5 minutes", sub: true },
    { text: "Advantages over epidural alone", bold: true },
    { text: "Faster onset of analgesia (immediate spinal component)", sub: true },
    { text: "Less local anaesthetic → minimal motor block ('walking epidural')", sub: true },
    { text: "Epidural catheter available for top-up / conversion to surgical anaesthesia", sub: true },
    { text: "Disadvantages", bold: true },
    { text: "Unverified catheter at time of intrathecal injection", sub: true },
    { text: "Fetal bradycardia (controversial — possibly from ↓maternal epi → uterine hyperstimulation)", sub: true },
    { text: "Higher rate of pruritus (neuraxial opioid)", sub: true },
  ],
  "Miller's Anesthesia 10e p.8849–8852; Barash 9e p.3494–3496"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — DPE
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Dural Puncture Epidural (DPE)",
  [
    { text: "Technique", bold: true },
    { text: "Epidural space identified → small-gauge spinal needle punctures dura (no intrathecal injection)", sub: true },
    { text: "Epidural catheter placed through Tuohy needle as usual", sub: true },
    { text: "Rationale", bold: true },
    { text: "Intentional dural puncture creates micro-hole → enhanced epidural drug diffusion into CSF", sub: true },
    { text: "Produces more reliable bilateral sacral coverage vs standard epidural", sub: true },
    { text: "Advantages over standard epidural", bold: true },
    { text: "Better sacral spread; faster onset; improved quality of analgesia", sub: true },
    { text: "No intrathecal drug injection → avoids risks of CSE (unverified catheter, fetal bradycardia)", sub: true },
    { text: "Compared to CSE", bold: true },
    { text: "Similar quality of analgesia; no difference in onset time", sub: true },
    { text: "Lower incidence of pruritus vs CSE (no intrathecal opioid)", sub: true },
    { text: "Disadvantage: PDPH risk (though small-gauge needle minimises risk)", bold: true },
  ],
  "Miller's Anesthesia 10e p.8852–8854"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — SPINAL ANALGESIA
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Spinal (Intrathecal) Analgesia",
  [
    { text: "Use in Labour", bold: true },
    { text: "Less common as sole technique due to limited duration (~90–120 min)", sub: true },
    { text: "Useful: advanced labour, imminent delivery, inability to place epidural", sub: true },
    { text: "Technique", bold: true },
    { text: "L3–L4 or L4–L5 interspace; pencil-point (Whitacre/Sprotte) needle", sub: true },
    { text: "Drugs for Intrathecal Labour Analgesia", bold: true },
    { text: "Opioid alone: Fentanyl 10–25 mcg OR Sufentanil 5–10 mcg", sub: true },
    { text: "Combined: Fentanyl 10 mcg + Bupivacaine 1–2.5 mg", sub: true },
    { text: "Intrathecal opioid alone: preserves motor function; useful for 'walking analgesia'", sub: true },
    { text: "Advantages", bold: true },
    { text: "Dense, rapid analgesia; reliable; simple technique", sub: true },
    { text: "Disadvantages", bold: true },
    { text: "Single-shot → no catheter for re-dosing; PDPH risk (minimised with pencil-point needle)", sub: true },
    { text: "Hypotension, pruritus, urinary retention", sub: true },
  ],
  "Barash Clinical Anesthesia 9e p.3494; Miller's Anesthesia 10e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — PARACERVICAL BLOCK
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Paracervical Block",
  [
    { text: "Indication", bold: true },
    { text: "Pain relief during first stage of labour (cervical pain T10–L1)", sub: true },
    { text: "Often used by obstetricians when epidural is unavailable", sub: true },
    { text: "Technique", bold: true },
    { text: "LA injected submucosally at 3 and 9 o'clock positions around cervix", sub: true },
    { text: "Blocks uterine/cervical afferents before entering T10–L1 ganglia", sub: true },
    { text: "Drugs: Lignocaine (lidocaine) 1% or Bupivacaine 0.25%; volume 5–10 ml each side", sub: true },
    { text: "Duration: 45–90 min", sub: true },
    { text: "Advantages", bold: true },
    { text: "Simple; no special equipment; effective first-stage pain relief", sub: true },
    { text: "Does NOT require anaesthesiologist", sub: true },
    { text: "Limitations", bold: true },
    { text: "Fetal bradycardia in 2–33% of cases — direct fetal drug absorption / uterine arterial spasm", sub: true },
    { text: "No relief for 2nd stage perineal pain; risk of intravascular injection", sub: true },
    { text: "Less commonly used now due to fetal risks", sub: true },
  ],
  "Barash Clinical Anesthesia 9e p.3497; Miller's Anesthesia 10e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — PUDENDAL NERVE BLOCK
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Pudendal Nerve Block",
  [
    { text: "Indication", bold: true },
    { text: "Second stage perineal pain (S2–S4); episiotomy, instrumental delivery", sub: true },
    { text: "Anatomy", bold: true },
    { text: "Pudendal nerve (S2–S4) passes posterior to ischial spine → lesser sciatic foramen", sub: true },
    { text: "Technique", bold: true },
    { text: "Transvaginal approach: needle guided to ischial spine; 10 ml LA per side", sub: true },
    { text: "Transperineal (external) approach also possible", sub: true },
    { text: "Drugs: Lignocaine 1% or Bupivacaine 0.25–0.5%", sub: true },
    { text: "Onset 3–5 min; Duration 60–90 min", sub: true },
    { text: "Advantages", bold: true },
    { text: "Simple; rapid; effective for 2nd stage and operative vaginal delivery", sub: true },
    { text: "No significant fetal effects", sub: true },
    { text: "Limitations", bold: true },
    { text: "Variable success rate (incomplete block — ischiorectal fossa spread)", sub: true },
    { text: "Risk of intravascular injection, haematoma, infection", sub: true },
    { text: "Does not relieve uterine contraction pain", sub: true },
  ],
  "Barash Clinical Anesthesia 9e p.3498; Miller's Anesthesia 10e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — NEURAXIAL IMPACT ON LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Impact of Neuraxial Analgesia on Labour",
  [
    { text: "Duration of Labour (Miller's 10e)", bold: true },
    { text: "Epidural analgesia may modestly lengthen first and second stages of labour", sub: true },
    { text: "Does NOT increase rate of cesarean delivery — well-established evidence (multiple RCTs)", sub: true },
    { text: "Operative Vaginal Delivery", bold: true },
    { text: "May slightly increase instrumental delivery rate (forceps/vacuum) due to motor block", sub: true },
    { text: "Effect minimised with low-concentration LA + opioid (mobile epidural)", sub: true },
    { text: "Uterine Activity", bold: true },
    { text: "Neuraxial analgesia does not directly suppress uterine contractions", sub: true },
    { text: "↓Maternal catecholamines may actually improve uterine contractility (Barash 9e)", sub: true },
    { text: "Fetal Heart Rate", bold: true },
    { text: "CSE: transient fetal bradycardia possible (within 30 min) — controversial aetiology", sub: true },
    { text: "Standard epidural: minimal direct fetal effect; hypotension must be treated promptly", sub: true },
  ],
  "Miller's Anesthesia 10e p.8855–8858; Barash 9e p.3495"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — COMPARISON TABLE
// ═══════════════════════════════════════════════════════════════════════════════
tableSlide(
  "Comparison of Labour Analgesia Methods",
  ["Method", "Onset", "Efficacy", "Motor Block", "Fetal Effect", "Special Use"],
  [
    ["Non-pharmacologic", "Variable", "+", "None", "None", "All stages, maternal preference"],
    ["Systemic Opioids", "5–15 min", "++", "None", "Mild CNS depression", "IV/IM/PCA; when neuraxial declined"],
    ["Nitrous Oxide", "30–50 sec", "+", "None", "Minimal", "Patient-controlled; non-invasive"],
    ["Epidural", "15–20 min", "++++", "Mild–Mod", "Minimal", "Gold standard; converts to CS"],
    ["CSE", "3–5 min", "++++", "Minimal", "Bradycardia risk", "Fast onset; walking epidural"],
    ["DPE", "10–15 min", "++++", "Minimal", "Minimal", "Better sacral spread vs epidural"],
    ["Intrathecal", "3–5 min", "++++", "Variable", "Minimal", "Advanced labour/imminent delivery"],
    ["Paracervical block", "3–5 min", "++", "None", "Bradycardia 2–33%", "1st stage; obstetrician-performed"],
    ["Pudendal block", "3–5 min", "++", "None", "Minimal", "2nd stage; episiotomy/forceps"],
  ],
  "Barash 9e; Miller's Anesthesia 10e"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — KEY TAKE-HOME POINTS
// ═══════════════════════════════════════════════════════════════════════════════
contentSlide(
  "Key Take-Home Points",
  [
    { text: "Pain in labour arises from uterine contractions (T10–L1) in the 1st stage and perineal distension (S2–S4) in the 2nd stage", bold: false },
    { text: "Neuraxial analgesia (epidural / CSE / DPE) is the gold standard — most effective and does NOT increase cesarean rate", bold: false },
    { text: "Epidural = best for prolonged labour and operative delivery readiness; PIEB > CEI for quality", bold: false },
    { text: "CSE provides fastest onset; DPE provides better sacral spread with fewer CSE risks", bold: false },
    { text: "Systemic remifentanil PCA is the best non-neuraxial pharmacologic option; requires 1:1 monitoring", bold: false },
    { text: "Paracervical block: effective 1st-stage technique but significant fetal bradycardia risk limits use", bold: false },
    { text: "Pudendal block: reliable, simple 2nd-stage analgesia for vaginal / instrumental delivery", bold: false },
    { text: "Non-pharmacologic methods reduce perception of pain and improve satisfaction but lack rigour vs pharmacologic methods", bold: false },
    { text: "All women should receive education and supported choice regarding analgesia — Barash 9e principle", bold: false },
  ],
  "Miller's Anesthesia 10e | Barash Clinical Anesthesia 9e | Creasy & Resnik's MFM"
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 — REFERENCES
// ═══════════════════════════════════════════════════════════════════════════════
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    "2. Barash PG et al. Barash, Cullen & Stoelting's Clinical Anesthesia, 9th Edition. Wolters Kluwer, 2022. pp. 3486–3498.",
    "3. Creasy RK et al. Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice, 9th Edition. Elsevier, 2022.",
    "4. American Society of Anesthesiologists. Practice Guidelines for Obstetric Anesthesia. Anesthesiology, 2016.",
    "5. ACOG Committee Opinion. Approaches to Limit Intervention During Labor and Birth. 2019.",
    "6. Simmons SW et al. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012.",
    "7. Anim-Somuah M et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018.",
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// ═══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/labour-analgesia-ppt/Labour_Analgesia_Methods.pptx" })
  .then(() => console.log("SUCCESS: PPT created"))
  .catch(e => console.error("ERROR:", e));

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

ls -lh /home/daytona/workspace/labour-analgesia-ppt/