Anatomy of brachial plexus , subarachanoid space and epidural space . Make a ppt of 30 slides for anaesthesia PG students .
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Searching Images
brachial plexus anatomy diagram roots trunks divisions cords
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subarachnoid space epidural space spinal cord cross section anatomy
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regional anesthesia brachial plexus nerve block interscalene axillary
Running Command
ls /home/daytona/workspace/ 2>/dev/null && mkdir -p /home/daytona/workspace/anae…
Writing File
~/anaesthesia-anatomy-ppt/build_ppt.js
const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");
// ─── Colour palette ────────────────────────────────────────────────────────
const C = {
navy: "0D2137", // dominant background
darkBg: "091929", // alternate darker
teal: "00B8D9", // accent headings
amber: "FFB347", // highlight / bullets
white: "F0F4F8",
light: "B0C4D8",
green: "4CAF82",
red: "E05A5A",
midBg: "122840", // card backgrounds
};
// ─── Image URLs ─────────────────────────────────────────────────────────────
const IMG = {
bpDiagram: "https://cdn.orris.care/cdss_images/HARRISON_1763034978151_dcfec64f-4894-46b6-94bd-ba17fd6a8314.png",
bpMRI: "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_84a54033dbc8ecad8a5f6bc966a49c2e9eb53fa9ac67b2835fa0f5cdb82d3651.jpg",
bpCadaver: "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_9f3cd2a0d555feaacb1f044acbbe90c4b722b0701b0110de7144f429a6b62ab8.jpg",
bpUltrasound:"https://cdn.orris.care/cdss_images/pmc_clinical_VQA_edc5d6a45712e894ff7082d361cf0781ce12e4e76f0600bba7d9580ec4dcf326.jpg",
bpInfraclav: "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_1b3f4a0ae6311464eaa0a5f60d83c36ae8ddadfb6b7ab79e4f4f6c2b7891a306.jpg",
bpSupraclav: "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_ea2191a916822debc57a4c8c357dff69201329ca63ba3b7155402ec7fd8a980d.jpg",
spinalMRI: "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_b976a62c5ccd49c7f0defd8b3e72c0bb630789f5ab6efb976849718fbb984eaf.jpg",
spinalMRI2: "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e721b23638e92195e7534d9cc8c6db83410e32ec47c3c60a9c5cce3875a38b96.jpg",
epiduralFig: "https://cdn.orris.care/cdss_images/16b155e915375ee13a1ca44ba4cb83217d78f06b48fc25dbd4d561bf2cde5743.png",
ligFlavum: "https://cdn.orris.care/cdss_images/21d0b52019b115ac8896f2660fc2a3b660dfb86f0be44e9e547bbc63d08ba535.png",
meningesFig: "https://cdn.orris.care/cdss_images/309b849fc80e813a21de7330fe1b70450e2dc5eb3e084f54f5c6ee18cd844761.png",
};
// Pre-fetch all images as base64
console.log("Fetching images...");
let imageData = {};
const urls = Object.values(IMG);
try {
const result = execSync(
`node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`,
{ maxBuffer: 50 * 1024 * 1024, timeout: 60000 }
).toString();
const arr = JSON.parse(result);
arr.forEach((item, i) => {
const key = Object.keys(IMG)[i];
if (!item.error) imageData[key] = item.base64;
else console.log(`Image failed: ${key} - ${item.error}`);
});
} catch(e) {
console.log("Image fetch error:", e.message);
}
console.log(`Loaded ${Object.keys(imageData).length} images`);
// ─── Helper functions ───────────────────────────────────────────────────────
function makePres() {
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Anatomy for Anaesthesia – Brachial Plexus, Subarachnoid & Epidural Space";
pres.author = "Anaesthesia PG Department";
return pres;
}
function addBg(slide, color) {
slide.addShape("rect", { x: 0, y: 0, w: 10, h: 5.625, fill: { color: color || C.navy } });
}
function addTitle(slide, text, opts = {}) {
slide.addText(text, {
x: 0.4, y: 0.2, w: 9.2, h: 0.65,
fontSize: opts.size || 24, bold: true,
color: opts.color || C.teal, fontFace: "Calibri",
align: "left", margin: 0, ...opts
});
}
function addDivider(slide, y) {
slide.addShape("line", { x: 0.4, y: y || 0.95, w: 9.2, h: 0, line: { color: C.teal, width: 1.5 } });
}
function addSubtitle(slide, text, y) {
slide.addText(text, {
x: 0.4, y: y || 1.0, w: 9.2, h: 0.35,
fontSize: 13, bold: true, color: C.amber, fontFace: "Calibri", margin: 0
});
}
function addBullets(slide, items, opts = {}) {
const textArr = items.map((item, i) => ({
text: item,
options: {
bullet: opts.noBullet ? false : { indent: 10 },
breakLine: i < items.length - 1,
color: opts.color || C.white,
fontSize: opts.size || 15,
fontFace: "Calibri",
}
}));
slide.addText(textArr, {
x: opts.x || 0.4, y: opts.y || 1.45,
w: opts.w || 9.2, h: opts.h || 3.7,
valign: "top", margin: [2, 0, 2, 8],
lineSpacingMultiple: 1.15,
});
}
function addCard(slide, x, y, w, h, title, items, titleColor) {
slide.addShape("rect", { x, y, w, h, fill: { color: C.midBg }, line: { color: C.teal, width: 1 } });
slide.addText(title, { x: x + 0.1, y: y + 0.05, w: w - 0.2, h: 0.3, fontSize: 11, bold: true, color: titleColor || C.amber, fontFace: "Calibri", margin: 0 });
const textArr = items.map((item, i) => ({
text: item,
options: { bullet: { indent: 8 }, breakLine: i < items.length - 1, color: C.white, fontSize: 11, fontFace: "Calibri" }
}));
slide.addText(textArr, { x: x + 0.1, y: y + 0.38, w: w - 0.2, h: h - 0.45, valign: "top", margin: [1, 0, 1, 5], lineSpacingMultiple: 1.1 });
}
function sectionBanner(slide, label, subtitle) {
// Full-slide section divider with big centered text
slide.addShape("rect", { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkBg } });
slide.addShape("rect", { x: 0, y: 2.0, w: 10, h: 1.625, fill: { color: C.midBg } });
slide.addShape("line", { x: 1, y: 2.0, w: 8, h: 0, line: { color: C.teal, width: 2 } });
slide.addShape("line", { x: 1, y: 3.625, w: 8, h: 0, line: { color: C.teal, width: 2 } });
slide.addText(label, { x: 0.5, y: 2.1, w: 9, h: 1.1, fontSize: 36, bold: true, color: C.teal, fontFace: "Calibri", align: "center", valign: "middle" });
if (subtitle) slide.addText(subtitle, { x: 0.5, y: 3.7, w: 9, h: 0.6, fontSize: 16, color: C.light, fontFace: "Calibri", align: "center", italic: true });
slide.addText("ANATOMY FOR ANAESTHESIA", { x: 0.5, y: 0.5, w: 9, h: 0.4, fontSize: 12, color: C.light, fontFace: "Calibri", align: "center", charSpacing: 4 });
slide.addText("For PG Anaesthesia Students", { x: 0.5, y: 5.0, w: 9, h: 0.35, fontSize: 11, color: C.amber, fontFace: "Calibri", align: "center" });
}
// ─── BUILD PRESENTATION ─────────────────────────────────────────────────────
const pres = makePres();
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s, C.darkBg);
s.addShape("rect", { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.teal } });
s.addShape("rect", { x: 0, y: 4.8, w: 10, h: 0.825, fill: { color: C.midBg } });
s.addText("ANATOMY FOR ANAESTHESIA", { x: 0.5, y: 0.55, w: 9.2, h: 0.5, fontSize: 14, color: C.teal, fontFace: "Calibri", charSpacing: 5, bold: false, align: "left" });
s.addText([
{ text: "Brachial Plexus", options: { breakLine: true, color: C.white, fontSize: 30, bold: true } },
{ text: "Subarachnoid Space", options: { breakLine: true, color: C.white, fontSize: 30, bold: true } },
{ text: "Epidural Space", options: { breakLine: false, color: C.amber, fontSize: 30, bold: true } },
], { x: 0.5, y: 1.2, w: 9.2, h: 2.4, fontFace: "Calibri", valign: "top" });
s.addShape("line", { x: 0.5, y: 3.75, w: 5, h: 0, line: { color: C.teal, width: 2 } });
s.addText("Regional & Neuraxial Anatomy for Anaesthesia PG Students", { x: 0.5, y: 3.85, w: 9, h: 0.4, fontSize: 14, color: C.light, fontFace: "Calibri", italic: true });
s.addText("Department of Anaesthesiology | Postgraduate Teaching Series", { x: 0.5, y: 4.9, w: 9, h: 0.35, fontSize: 11, color: C.light, fontFace: "Calibri", align: "center" });
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 2 – CONTENTS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Table of Contents");
addDivider(s);
const sections = [
["PART 1", "Brachial Plexus", "Slides 3 – 12"],
["PART 2", "Subarachnoid Space", "Slides 13 – 21"],
["PART 3", "Epidural Space", "Slides 22 – 28"],
["PART 4", "Clinical Correlations & Summary", "Slides 29 – 30"],
];
sections.forEach(([part, title, pages], i) => {
const y = 1.15 + i * 1.0;
s.addShape("rect", { x: 0.4, y, w: 9.2, h: 0.82, fill: { color: C.midBg }, line: { color: C.teal, width: 0.75 } });
s.addText(part, { x: 0.55, y: y + 0.08, w: 1.1, h: 0.3, fontSize: 10, bold: true, color: C.amber, fontFace: "Calibri", margin: 0 });
s.addText(title, { x: 1.7, y: y + 0.08, w: 5.5, h: 0.3, fontSize: 16, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
s.addText(pages, { x: 7.4, y: y + 0.08, w: 2.0, h: 0.3, fontSize: 11, color: C.teal, fontFace: "Calibri", align: "right", margin: 0 });
s.addShape("line", { x: 0.55, y: y + 0.42, w: 9.0, h: 0, line: { color: C.teal, width: 0.5, dash: "dash" } });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 3 – BRACHIAL PLEXUS SECTION BANNER
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
sectionBanner(s, "BRACHIAL PLEXUS", "Formation, Anatomy & Anaesthetic Relevance");
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 4 – OVERVIEW OF BRACHIAL PLEXUS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Brachial Plexus: Overview");
addDivider(s);
addBullets(s, [
"Formed from anterior primary rami of C5, C6, C7, C8, T1 nerve roots",
"Organisation: 5 Roots → 3 Trunks → 6 Divisions → 3 Cords → 5 Terminal Nerves",
"Enclosed within fibrous fascial sheaths (interscalene fascial sheath proximally; axillary sheath distally)",
"Clinically important landmark: emerges between anterior and middle scalene muscles",
"Lies posterior to vertebral artery and above 2nd part of subclavian artery",
"Provides complete motor and sensory innervation to the upper limb",
], { y: 1.1, size: 15, h: 3.5 });
if (imageData.bpMRI) {
s.addImage({ data: imageData.bpMRI, x: 6.8, y: 1.1, w: 3.0, h: 4.1 });
s.addText("MRI anatomy — Brachial Plexus roots, trunks, cords", {
x: 6.8, y: 5.15, w: 3.0, h: 0.3, fontSize: 8, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 5 – ROOTS AND TRUNKS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Roots & Trunks of the Brachial Plexus");
addDivider(s);
addCard(s, 0.3, 1.05, 4.5, 4.2, "ROOTS (5 roots: C5–T1)", [
"C5–T1 emerge from intervertebral foramina",
"Travel in grooves between anterior & posterior tubercles of transverse processes",
"Emerge between scalene muscles above subclavian artery",
"Pre-fixed plexus: C4–C8; Post-fixed: C6–T2",
"Phrenic nerve (C3,4,5): anterior to scalenus anterior muscle",
], C.teal);
addCard(s, 5.0, 1.05, 4.5, 4.2, "TRUNKS (3 trunks)", [
"UPPER (Superior): C5 + C6 unite",
"MIDDLE: C7 alone continues",
"LOWER (Inferior): C8 + T1 converge",
"Cross base of posterior triangle of neck",
"Upper & middle trunks pass above subclavian artery",
"Lower trunk: behind or below the artery",
"Branch from upper trunk: Suprascapular nerve, nerve to subclavius",
], C.amber);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 6 – DIVISIONS AND CORDS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Divisions & Cords of the Brachial Plexus");
addDivider(s);
addSubtitle(s, "Divisions: at lateral border of 1st rib, each trunk divides into Anterior and Posterior");
addCard(s, 0.3, 1.55, 9.4, 1.4, "THREE CORDS — formed ~level of pectoralis minor muscle", [
"LATERAL cord: Anterior divisions of Upper + Middle trunks (C5–C7) | MEDIAL cord: Anterior division of Lower trunk (C8, T1) | POSTERIOR cord: Posterior divisions of all 3 trunks (C5–T1)",
], C.teal);
s.addText("Cord positions relative to axillary artery (2nd part):", { x: 0.3, y: 3.05, w: 9.4, h: 0.3, fontSize: 12, bold: true, color: C.amber, fontFace: "Calibri" });
const positions = [["LATERAL cord", "Superior / Lateral to artery", C.teal], ["POSTERIOR cord", "Posterior to artery", C.light], ["MEDIAL cord", "Inferior / Medial to artery", C.amber]];
positions.forEach(([name, pos, col], i) => {
const x = 0.3 + i * 3.2;
s.addShape("rect", { x, y: 3.4, w: 3.0, h: 1.8, fill: { color: C.midBg }, line: { color: col, width: 1.5 } });
s.addText(name, { x: x + 0.1, y: 3.45, w: 2.8, h: 0.35, fontSize: 12, bold: true, color: col, fontFace: "Calibri", align: "center", margin: 0 });
s.addText(pos, { x: x + 0.1, y: 3.85, w: 2.8, h: 0.9, fontSize: 12, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 7 – TERMINAL BRANCHES
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Terminal Branches of the Brachial Plexus");
addDivider(s);
if (imageData.bpDiagram) {
s.addImage({ data: imageData.bpDiagram, x: 5.8, y: 0.95, w: 3.9, h: 4.4 });
}
const branches = [
["Musculocutaneous N.", "C5, C6, C7", "Lateral cord", "Biceps, brachialis, coracobrachialis"],
["Median N.", "C5–T1", "Lateral + Medial cords", "Forearm flexors, thenar muscles"],
["Ulnar N.", "C8, T1", "Medial cord", "Intrinsics, hypothenar, flexor carpi ulnaris"],
["Radial N.", "C5–T1", "Posterior cord", "Extensors of arm and forearm"],
["Axillary N.", "C5, C6", "Posterior cord", "Deltoid, teres minor"],
];
s.addText(["Nerve", "Root", "From", "Motor function"].join(" "), {
x: 0.3, y: 1.1, w: 5.3, h: 0.3, fontSize: 10, bold: true, color: C.amber, fontFace: "Calibri", margin: 0
});
branches.forEach(([nerve, root, cord, motor], i) => {
const y = 1.45 + i * 0.75;
const bg = i % 2 === 0 ? C.midBg : C.navy;
s.addShape("rect", { x: 0.3, y, w: 5.3, h: 0.68, fill: { color: bg } });
s.addText([
{ text: nerve, options: { bold: true, color: C.teal, breakLine: true, fontSize: 11 } },
{ text: `Root: ${root} | From: ${cord}`, options: { color: C.light, fontSize: 9 } },
], { x: 0.35, y: y + 0.04, w: 5.2, h: 0.6, fontFace: "Calibri", margin: 0 });
});
s.addText("Schematic diagram of the brachial plexus\n(from Harrison's, showing roots → terminal nerves)", {
x: 5.8, y: 5.25, w: 3.9, h: 0.35, fontSize: 8, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 8 – BRACHIAL PLEXUS DIAGRAM WITH CADAVER
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Brachial Plexus: Cadaveric & Schematic Anatomy");
addDivider(s);
if (imageData.bpCadaver) {
s.addImage({ data: imageData.bpCadaver, x: 0.3, y: 1.05, w: 9.4, h: 4.3 });
}
s.addText("Cadaveric dissection & schematic: C5–T1 roots → trunks → divisions → cords → terminal branches. AS = Anterior scalene, MS = Middle scalene, SCA = Subclavian artery, IJV = Internal jugular vein", {
x: 0.3, y: 5.3, w: 9.4, h: 0.25, fontSize: 8, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 9 – FASCIAL SHEATHS & ANAESTHETIC SPACES
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Fascial Sheaths — Key Concept for Nerve Blocks");
addDivider(s);
addBullets(s, [
"Brachial plexus is ensheathed in a continuous fascial tunnel (prevertebral fascia derivative)",
"INTERSCALENE SHEATH: surrounds roots/trunks between scalene muscles — target for interscalene block",
"AXILLARY SHEATH: envelops cords and terminal nerves in the axilla — target for axillary block",
"Volume of LA injected spreads within this sheath → determines extent of block",
"Gaps in the sheath mean musculocutaneous nerve (exits sheath early) may need separate injection",
"Relationship to phrenic nerve: lies anterior to anterior scalene; interscalene blocks cause ~100% ipsilateral phrenic palsy",
"C8/T1 roots (lower trunk) may escape interscalene injection — inadequate ulnar coverage",
], { size: 14, y: 1.1, h: 4.0 });
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 10 – BRACHIAL PLEXUS BLOCK APPROACHES
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Approaches to Brachial Plexus Block");
addDivider(s);
const blocks = [
["INTERSCALENE", "C5–C7 (upper trunk)", "Shoulder & upper arm surgery; inadequate for hand", "Phrenic palsy, vertebral artery, epidural/intrathecal"],
["SUPRACLAVICULAR", "C5–T1", "'Spinal of arm'; upper extremity distal to shoulder", "Pneumothorax, phrenic palsy"],
["INFRACLAVICULAR", "C5–T1 (cords)", "Elbow, forearm, hand", "Less risk of pneumothorax"],
["AXILLARY", "Terminal branches", "Elbow to hand, forearm surgery", "Musculocutaneous needs separate injection"],
];
const headers = ["Approach", "Root coverage", "Indications", "Key complications"];
headers.forEach((h, i) => {
const widths = [2.0, 1.8, 3.0, 2.8];
const xs = [0.3, 2.35, 4.2, 7.25];
s.addText(h, { x: xs[i], y: 1.05, w: widths[i], h: 0.3, fontSize: 10, bold: true, color: C.amber, fontFace: "Calibri", margin: 0 });
});
blocks.forEach(([name, roots, ind, comp], i) => {
const y = 1.4 + i * 0.95;
const bg = i % 2 === 0 ? C.midBg : C.navy;
s.addShape("rect", { x: 0.3, y, w: 9.4, h: 0.88, fill: { color: bg } });
s.addText(name, { x: 0.35, y: y + 0.05, w: 1.9, h: 0.75, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri", valign: "middle", margin: 0 });
s.addText(roots, { x: 2.35, y: y + 0.05, w: 1.75, h: 0.75, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
s.addText(ind, { x: 4.2, y: y + 0.05, w: 2.95, h: 0.75, fontSize: 11, color: C.light, fontFace: "Calibri", valign: "middle", margin: 0 });
s.addText(comp, { x: 7.25, y: y + 0.05, w: 2.4, h: 0.75, fontSize: 11, color: C.red, fontFace: "Calibri", valign: "middle", margin: 0 });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 11 – ULTRASOUND OF BRACHIAL PLEXUS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Ultrasound Anatomy of the Brachial Plexus");
addDivider(s);
if (imageData.bpUltrasound) {
s.addImage({ data: imageData.bpUltrasound, x: 0.2, y: 1.05, w: 5.7, h: 4.3 });
}
s.addText("US-guided blocks: Interscalene & Serratus Plane", { x: 0.2, y: 5.3, w: 5.7, h: 0.25, fontSize: 8, color: C.light, fontFace: "Calibri", align: "center", italic: true });
addCard(s, 6.2, 1.05, 3.6, 2.0, "INTERSCALENE SONOANATOMY", [
"Hypoechoic oval structures (roots) between ASM and MSM",
"Probe: transverse on lateral neck at C6 level",
"In-plane needle: lateral-to-medial trajectory",
"C5, C6, C7 roots visualised as 'traffic light' sign",
], C.teal);
addCard(s, 6.2, 3.2, 3.6, 2.1, "SUPRACLAVICULAR SONOANATOMY", [
"Trunks: honeycomb cluster lateral to subclavian artery",
"Probe: coronal oblique above clavicle",
"Target: 'corner pocket' (junction of 1st rib & SCA)",
"Pleura lies deep — monitor for pneumothorax",
], C.amber);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 12 – INFRACLAVICULAR BLOCK ULTRASOUND
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Infraclavicular Block — Cords & Ultrasound");
addDivider(s);
if (imageData.bpInfraclav) {
s.addImage({ data: imageData.bpInfraclav, x: 0.2, y: 1.05, w: 5.5, h: 4.2 });
s.addText("Infraclavicular block: axillary artery (AA), lateral (LC), medial (MC), posterior (PC) cords", {
x: 0.2, y: 5.25, w: 5.5, h: 0.3, fontSize: 8, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
addCard(s, 5.9, 1.05, 3.9, 4.2, "INFRACLAVICULAR ANATOMY", [
"Target: 3 cords around 2nd part of axillary artery",
"Lateral cord: superior/lateral to AA",
"Medial cord: medial/inferior to AA",
"Posterior cord: posterior to AA",
"ADVANTAGES: catheter well-secured; no arm movement needed; less phrenic involvement",
"Probe: sagittal below clavicle near coracoid",
"Covers elbow, forearm, wrist, hand",
"Avoid: pneumothorax if probe too medial",
], C.teal);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 13 – SUBARACHNOID SPACE SECTION BANNER
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
sectionBanner(s, "SUBARACHNOID SPACE", "Anatomy, CSF Physiology & Clinical Significance");
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 14 – SPINAL MENINGES OVERVIEW
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Spinal Meninges: The Three Layers");
addDivider(s);
if (imageData.meningesFig) {
s.addImage({ data: imageData.meningesFig, x: 6.8, y: 1.0, w: 2.9, h: 4.4 });
s.addText("Spinal meninges: DM=dura, AM=arachnoid, SS=subarachnoid space, PM=pia\n(Barash's Clinical Anesthesia)", {
x: 6.8, y: 5.3, w: 2.9, h: 0.28, fontSize: 7.5, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
addCard(s, 0.3, 1.05, 6.3, 1.35, "DURA MATER (outer)", [
"Thickest layer: 270–280 μm; ~80 lamellar collagen layers",
"Extends from foramen magnum → S2 (fuses with filum terminale)",
"Potential subdural space: between dura and arachnoid",
], C.amber);
addCard(s, 0.3, 2.5, 6.3, 1.35, "ARACHNOID MATER (middle)", [
"True permeability barrier (NOT dura): tight junctions between cells",
"Trabecular web-like portion extends to pia mater",
"Arachnoid granulations: CSF exits CNS here via herniations through dura",
], C.teal);
addCard(s, 0.3, 3.95, 6.3, 1.35, "PIA MATER (inner)", [
"Innermost layer: flat overlapping cells coat the spinal cord",
"Contains fenestrations (esp. lumbar cord & nerve roots)",
"Spaces of Virchow–Robin: pial extensions into cord parenchyma",
], C.green);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 15 – SUBARACHNOID SPACE ANATOMY
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Subarachnoid Space (SAS): Anatomical Boundaries");
addDivider(s);
addBullets(s, [
"Located BETWEEN the arachnoid mater (outer) and pia mater (inner)",
"Extends from foramen magnum → S2 (dural sac terminus); laterally follows nerve roots to intervertebral foramina",
"Contains cerebrospinal fluid (CSF), blood vessels, trabeculae, and nerve roots",
"Widest at the lumbar cistern (L1/L2 to S2): contains the cauda equina — site of lumbar puncture",
"Communicates cranially with the cranial subarachnoid space (basal cisterns)",
"Spaces of Virchow–Robin: extensions of SAS along penetrating vessels into cord substance",
"Clinical key: Lumbar puncture is performed below L1 in adults (below L3 in children) to avoid cord injury",
], { size: 14.5, y: 1.05, h: 4.2 });
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 16 – SPINAL CORD ANATOMY
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Spinal Cord: Level, Segments & Conus");
addDivider(s);
if (imageData.spinalMRI) {
s.addImage({ data: imageData.spinalMRI, x: 6.5, y: 1.0, w: 3.3, h: 4.4 });
s.addText("T2 MRI sagittal & axial: SC, DM, ES, NR — cervical, thoracic, lumbar regions", {
x: 6.5, y: 5.3, w: 3.3, h: 0.28, fontSize: 7.5, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
addBullets(s, [
"Fetus: spinal cord reaches sacrum",
"Neonate: cord ends at L3",
"Adults: conus medullaris at ~L1 (range: T12 – L3 in 10% adults)",
"31 pairs of spinal nerves: anterior (motor) + posterior (sensory) roots",
"Nerve roots named for foramina of exit — cervical: named for lower vertebra; below cervical: upper vertebra",
"Cauda equina: lumbar and sacral roots below conus, surrounded only by pia mater — safety of LP here",
"Lumbar cistern (thecal sac): L1/L2 → S2; ideal LP target: L3–L4 or L4–L5 interspace",
], { size: 14, y: 1.05, w: 6.2, h: 4.2 });
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 17 – CSF: PHYSIOLOGY & PROPERTIES
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Cerebrospinal Fluid: Properties & Physiology");
addDivider(s);
addCard(s, 0.3, 1.05, 4.5, 4.3, "CSF PROPERTIES", [
"Volume: 100–160 mL total (adult)",
"Spinal volume: ~25–35 mL",
"99% water; contains protein, glucose, electrolytes, neurotransmitters",
"Normal pressure (lateral decubitus): 10–20 cmH₂O",
"Density (baricity reference): 1.003–1.008 g/mL at 37°C",
"pH: 7.33; Protein: 15–45 mg/dL",
"Glucose: 2.5–4.5 mmol/L (60–70% plasma glucose)",
], C.teal);
addCard(s, 5.0, 1.05, 4.5, 4.3, "CSF DYNAMICS (updated view)", [
"NOT solely produced by choroid plexus — parenchymal capillaries of brain & cord also contribute",
"NOT solely absorbed by arachnoid granulations — lymphatic system absorbs significant amount",
"Flow: non-unidirectional; cardiac oscillations produce local mixing",
"Slow diffusion of solutes; reabsorption across capillary membranes",
"Relevance: determines spread of intrathecal drugs",
"Baricity of LA vs. CSF determines hyperbaric/hypobaric/isobaric spread",
], C.amber);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 18 – SPINAL ANESTHESIA: DRUG SPREAD IN SAS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Drug Spread in the Subarachnoid Space");
addDivider(s);
addBullets(s, [
"Nerves in the SAS are easily anesthetised — highly accessible; small doses sufficient",
"LA diffuses through pia mater → Virchow–Robin spaces → spinal cord & dorsal root ganglia",
"Differential block order (most sensitive → least): B fibres > C fibres > Aδ fibres > Aβ fibres > Aα fibres",
"Differential block heights: sympathetic (cold) > pinprick > touch (each ~ 1–2 segments higher)",
"Baricity governs rostral/caudal spread: hyperbaric → dependent position; hypobaric → non-dependent",
"Factors: baricity, patient position, dose, volume, speed of injection, lumbosacral curvature",
], { size: 14.5, y: 1.05, h: 3.4 });
s.addText("Nerve Fibre Sensitivity to Local Anaesthetics", { x: 0.3, y: 4.55, w: 9.4, h: 0.3, fontSize: 12, bold: true, color: C.amber, fontFace: "Calibri", margin: 0 });
const fibres = [["B fibres", "1–3 μm", "Pre-ganglionic sympathetic", "MOST sensitive"], ["C fibres", "0.3–1 μm", "Cold / pain (unmyelinated)", "2nd"], ["Aδ fibres", "1–4 μm", "Pinprick / cold (myelinated)", "3rd"], ["Aβ fibres", "5–12 μm", "Touch / pressure", "4th"], ["Aα fibres", "12–20 μm", "Motor", "LEAST sensitive"]];
fibres.forEach(([name, size, fn, sens], i) => {
const x = 0.3 + i * 1.88;
const col = i === 0 ? C.teal : i === 4 ? C.red : C.light;
s.addShape("rect", { x, y: 4.9, w: 1.78, h: 0.65, fill: { color: C.midBg }, line: { color: col, width: 1 } });
s.addText([{ text: name, options: { bold: true, color: col, breakLine: true, fontSize: 10 } }, { text: size, options: { color: C.light, breakLine: true, fontSize: 9 } }, { text: sens, options: { color: C.amber, fontSize: 9 } }], { x: x + 0.05, y: 4.9, w: 1.7, h: 0.65, fontFace: "Calibri", valign: "middle", align: "center", margin: 0 });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 19 – MRI ANATOMY OF SAS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "MRI Anatomy: Subarachnoid Space & Spinal Canal");
addDivider(s);
if (imageData.spinalMRI2) {
s.addImage({ data: imageData.spinalMRI2, x: 0.3, y: 1.05, w: 5.8, h: 4.3 });
s.addText("MRI axial T2 & sagittal T1: intramedullary (green), intradural/SAS (yellow), dorsal epidural (purple); PLL = posterior longitudinal lig., LF = ligamentum flavum", {
x: 0.3, y: 5.3, w: 5.8, h: 0.28, fontSize: 7.5, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
addCard(s, 6.3, 1.05, 3.5, 4.3, "KEY MRI LANDMARKS", [
"T2 MRI: CSF appears bright (high signal) — excellent for demarcating SAS",
"Spinal cord: intermediate signal intensity",
"Epidural fat: bright on T1",
"Ligamentum flavum: posterior boundary of epidural space",
"Dura mater: dark linear boundary on T2",
"Cauda equina roots: fine linear structures within SAS on lumbar MRI",
"Conus level: visible on sagittal T2 — critical before LP",
], C.teal);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 20 – LUMBAR PUNCTURE ANATOMY
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Lumbar Puncture — Anatomical Pathway");
addDivider(s);
addSubtitle(s, "Structures traversed by spinal needle (midline approach, L3–L4 or L4–L5)", 1.02);
const layers = [
["1", "Skin & subcutaneous tissue", C.light, "Variable depth"],
["2", "Supraspinous ligament", C.amber, "Connects spinous process tips"],
["3", "Interspinous ligament", C.amber, "Soft; between spinous processes"],
["4", "Ligamentum flavum", C.teal, "Dense elastic; 'give' felt on entry"],
["5", "Epidural space", C.green, "Contains fat, veins — 'first pop'"],
["6", "Dura mater", C.amber, "Thin fibrous layer — 'second pop'"],
["7", "Subdural space", C.light, "Potential space (usually not entered)"],
["8", "Arachnoid mater", C.teal, "True barrier; penetrated next"],
["9", "Subarachnoid space", C.teal, "CSF flows → confirm correct placement"],
];
layers.forEach(([num, name, col, note], i) => {
const x = i < 5 ? 0.3 : 5.15;
const y = i < 5 ? 1.4 + i * 0.77 : 1.4 + (i - 5) * 0.77;
s.addShape("rect", { x, y, w: 4.7, h: 0.7, fill: { color: C.midBg }, line: { color: col, width: 1.5 } });
s.addText(num, { x: x + 0.05, y: y + 0.05, w: 0.3, h: 0.6, fontSize: 14, bold: true, color: col, fontFace: "Calibri", valign: "middle", align: "center", margin: 0 });
s.addText([{ text: name, options: { bold: true, color: C.white, breakLine: true, fontSize: 12 } }, { text: note, options: { color: C.light, fontSize: 10 } }], { x: x + 0.4, y: y + 0.04, w: 4.2, h: 0.62, fontFace: "Calibri", valign: "middle", margin: 0 });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 21 – SPINAL ANAESTHESIA CLINICAL POINTS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Spinal (Subarachnoid) Anaesthesia — Clinical Keys");
addDivider(s);
addCard(s, 0.3, 1.05, 4.6, 2.05, "ADVANTAGES", [
"Dense block with small drug dose",
"Rapid onset; defined dermatomal level",
"Avoids systemic LA toxicity",
"CSF confirmation of correct placement",
"Useful: LSCS, lower limb, urological surgery",
], C.green);
addCard(s, 5.1, 1.05, 4.6, 2.05, "COMPLICATIONS", [
"Hypotension (sympathetic block)",
"PDPH (post-dural puncture headache)",
"High / total spinal",
"Urinary retention; backache",
"Cauda equina syndrome (rare, neurotoxicity)",
], C.red);
addCard(s, 0.3, 3.2, 9.4, 2.1, "DETERMINANTS OF BLOCK LEVEL", [
"Baricity of LA: hyperbaric (bupivacaine + dextrose) → gravitational spread; hypobaric → ascends",
"Patient position: sitting vs. lateral vs. supine after injection",
"Drug dose & volume; speed of injection; lumbosacral anatomy; patient height/weight (limited role)",
"Addition of opioids (fentanyl, morphine) extends duration; clonidine/dexmedetomidine as adjuvants",
], C.teal);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 22 – EPIDURAL SPACE SECTION BANNER
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
sectionBanner(s, "EPIDURAL SPACE", "Anatomy, Contents & Anaesthetic Implications");
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 23 – EPIDURAL SPACE BOUNDARIES
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Epidural Space: Boundaries & Extent");
addDivider(s);
if (imageData.epiduralFig) {
s.addImage({ data: imageData.epiduralFig, x: 6.5, y: 1.0, w: 3.3, h: 4.4 });
s.addText("Schematic: compartments of epidural space (grey) showing discontinuous fat pockets\n(Barash's Clinical Anesthesia / Hogan 1991)", {
x: 6.5, y: 5.3, w: 3.3, h: 0.28, fontSize: 7.5, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
addBullets(s, [
"Location: within vertebral canal but OUTSIDE the dural sac",
"Extent: Foramen magnum (superior) → S2 (inferior, end of dural sac)",
"Anterior boundary: Posterior longitudinal ligament (PLL)",
"Posterior boundary: Laminae + Ligamentum flavum",
"Lateral boundaries: Pedicles — communicates with paravertebral space via intervertebral foramina",
"The epidural space is NOT a continuous open space — dura intermittently abuts bony/ligamentous structures",
"CERVICAL level: essentially no epidural fat",
"LUMBAR level: fat in anterior & posterior aspects forms discrete metameric pockets",
], { size: 14.5, y: 1.05, w: 6.2, h: 4.3 });
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 24 – CONTENTS OF EPIDURAL SPACE
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Contents of the Epidural Space");
addDivider(s);
const items = [
["EPIDURAL FAT", "Mostly posterior & lateral; absent in cervical; important pharmacokinetic reservoir for lipophilic drugs (e.g., fentanyl)", C.amber],
["EPIDURAL VEINS (Batson's plexus)", "Predominantly in ANTERIOR epidural space; valveless — connect to vertebral & pelvic veins; engorge in pregnancy → venous cannulation risk", C.red],
["SPINAL NERVE ROOTS", "Travel through epidural space in dural sleeves before exiting via foramina; covered only by thin dura here", C.teal],
["SPINAL ARTERIES", "Small radicular arteries run with nerve roots; artery of Adamkiewicz (T9–T12 left) — relevant to spinal cord ischaemia risk", C.green],
["LYMPHATICS", "Drain CSF and epidural space contents", C.light],
];
items.forEach(([title, desc, col], i) => {
const y = 1.1 + i * 0.87;
s.addShape("rect", { x: 0.3, y, w: 9.4, h: 0.8, fill: { color: C.midBg }, line: { color: col, width: 1.5 } });
s.addText(title, { x: 0.4, y: y + 0.06, w: 3.0, h: 0.65, fontSize: 11, bold: true, color: col, fontFace: "Calibri", valign: "middle", margin: 0 });
s.addShape("line", { x: 3.5, y: y + 0.1, w: 0, h: 0.6, line: { color: col, width: 0.75 } });
s.addText(desc, { x: 3.6, y: y + 0.06, w: 6.0, h: 0.68, fontSize: 12, color: C.light, fontFace: "Calibri", valign: "middle", margin: 0 });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 25 – LIGAMENTUM FLAVUM
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Ligamentum Flavum — The Gateway to Epidural Space");
addDivider(s);
if (imageData.ligFlavum) {
s.addImage({ data: imageData.ligFlavum, x: 0.3, y: 1.05, w: 4.5, h: 4.2 });
s.addText("3D reconstruction of lumbar ligamentum flavum showing posterior-lateral (A) and posterior (B) views; note midline gap (arrow)\n(Reina et al., Anesth Analg 2016)", {
x: 0.3, y: 5.3, w: 4.5, h: 0.28, fontSize: 7.5, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
addCard(s, 5.1, 1.05, 4.6, 4.2, "LIGAMENTUM FLAVUM — ANATOMY", [
"Paired ligaments: 2 halves, one from each side",
"Midline gap (esp. at thoracic level) — important: loss of resistance may be felt unevenly",
"Composed mainly of elastin fibres (80%) → gives 'yellow' colour and elasticity",
"THICKNESS: Cervical 1.5–3 mm; Thoracic 3–5 mm; Lumbar 5–6 mm (thickest)",
"Loss of resistance (LOR) technique relies on recognising LF resistance",
"Combined with needle 'give' → confirms epidural entry",
"Thickens with age and degeneration — denser LOR in elderly",
"Cervical LF may be absent in midline (Lirk et al.)",
], C.teal);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 26 – MECHANISMS OF EPIDURAL ANESTHESIA
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Mechanisms of Epidural Drug Action");
addDivider(s);
addBullets(s, [
"Primary targets: spinal nerve roots in epidural space (extradural) AND subarachnoid nerve roots",
"Nerve roots in epidural space: covered by thin dura → relatively accessible to LA",
"Spinal cord: direct diffusion through dura/arachnoid; Virchow-Robin spaces; vasculature",
"Dorsal root ganglia: considered most important site; DRG lies in epidural space near foramina",
"S1 and L5 posterior roots are LARGEST and most resistant to epidural block",
"Differential block: same fibre sensitivity order as spinal — sympathetic blocked highest",
"Regression order: motor function returns first, then touch, pinprick, cold sensation last",
], { size: 14.5, y: 1.05, h: 3.4 });
s.addText("Drug spread within epidural space is NON-UNIFORM (Hogan's cadaveric cryomicrotome studies) — explains clinical unpredictability", {
x: 0.3, y: 4.55, w: 9.4, h: 0.5, fontSize: 13, color: C.amber, fontFace: "Calibri", bold: true,
fill: { color: C.midBg }, margin: [6, 6, 6, 10], shape: "rect"
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 27 – EPIDURAL APPROACH AND LOSS OF RESISTANCE
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Epidural Techniques — Approach & Loss of Resistance");
addDivider(s);
addCard(s, 0.3, 1.05, 4.5, 4.3, "MIDLINE vs. PARAMEDIAN", [
"MIDLINE: supraspinous lig. → interspinous lig. → LF → epidural space",
"PARAMEDIAN: bypasses supraspinous + interspinous ligaments → pierces LF",
"Paramedian preferred: thoracic (steep spinous process angle), elderly, obese, limited flexion",
"LOSS OF RESISTANCE (LOR): to saline (preferred) or air",
"Hanging drop technique: negative epidural pressure draws drop into needle",
"Depth: lumbar ~4–6 cm from skin; thoracic ~4–5 cm; cervical ~3–4 cm",
], C.teal);
addCard(s, 5.0, 1.05, 4.7, 4.3, "NEEDLE CHARACTERISTICS", [
"Tuohy needle (16–18G most common): curved Huber tip to guide catheter",
"Sprotte / Whitacre: pencil-point (spinal) — NOT used for epidural",
"Epidural catheter: advanced 3–5 cm beyond needle tip",
"Epidural test dose: 3 mL 1.5% lidocaine + epinephrine 1:200,000 (15 mcg)",
"HR increase >20 bpm → intravascular; high block → intrathecal",
"Top-up doses titrated; continuous infusion technique possible",
"Combined Spinal-Epidural (CSE): spinal for onset + epidural for duration",
], C.amber);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 28 – FACTORS AFFECTING EPIDURAL SPREAD
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Factors Affecting Epidural Drug Spread");
addDivider(s);
addSubtitle(s, "Unlike spinal, baricity does not govern spread — anatomy and volume are primary determinants");
const factors = [
["Volume of Injectate", "Most important: larger volume → wider spread", C.teal],
["Age", "Elderly: reduced epidural fat & narrower foramina → easier spread; dose reduction needed", C.amber],
["Pregnancy", "Engorgement of epidural veins (increased intra-abdominal pressure) → reduced volume, faster spread", C.red],
["Obesity", "Increased intra-abdominal pressure → engorged veins → reduced epidural volume", C.red],
["Level of injection", "Lumbar: more predictable than thoracic or cervical", C.teal],
["Speed of injection", "Faster injection → slightly wider spread (controversial)", C.light],
["Drug concentration", "Affects quality/density of block more than spread", C.amber],
["Patient position", "Less impact than spinal; some evidence for sitting: dependent spread", C.light],
];
factors.forEach(([factor, desc, col], i) => {
const col2 = i < 4 ? 0.3 : 5.1;
const y = i < 4 ? 1.45 + i * 0.95 : 1.45 + (i - 4) * 0.95;
s.addShape("rect", { x: col2, y, w: 4.5, h: 0.88, fill: { color: C.midBg }, line: { color: col, width: 1 } });
s.addText(factor, { x: col2 + 0.1, y: y + 0.05, w: 4.3, h: 0.3, fontSize: 11, bold: true, color: col, fontFace: "Calibri", margin: 0 });
s.addText(desc, { x: col2 + 0.1, y: y + 0.36, w: 4.3, h: 0.46, fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0 });
});
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 29 – CLINICAL CORRELATIONS SUMMARY
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s);
addTitle(s, "Clinical Correlations — Putting It All Together");
addDivider(s);
addCard(s, 0.3, 1.05, 3.0, 4.3, "BRACHIAL PLEXUS", [
"Interscalene: shoulder (C5–C7) — 100% phrenic palsy",
"Supraclavicular: 'spinal of arm' — pneumothorax risk",
"Infraclavicular: cords — safe; catheter friendly",
"Axillary: terminal branches — forearm/hand; no pneumo",
"US guidance: reduces complications; confirms spread",
"LAST: local anesthetic systemic toxicity — treat with lipid emulsion",
], C.teal);
addCard(s, 3.55, 1.05, 3.0, 4.3, "SUBARACHNOID SPACE", [
"LP level: L3–L4 / L4–L5 in adults",
"Hyperbaric bupivacaine: most common intrathecal LA",
"CSF baricity (1.003–1.008) governs spread",
"PDPH: due to CSF leak through dural hole — atraumatic needle reduces risk",
"Cauda equina syndrome: neurotoxic LA in high concentration / microcatheters",
"Total spinal: emergency — airway + vasopressors",
], C.amber);
addCard(s, 6.8, 1.05, 2.9, 4.3, "EPIDURAL SPACE", [
"Catheter placed 3–5 cm beyond needle tip",
"Test dose: excludes intravascular/intrathecal",
"Segmental block — most predictable at lumbar level",
"Epidural veins engorged in pregnancy",
"Epidural haematoma: stop anticoagulants per ASRA guidelines",
"Epidural abscess: rare; back pain + fever + neuro deficit",
"CSE: combines benefits of both techniques",
], C.green);
}
// ────────────────────────────────────────────────────────────────────────────
// SLIDE 30 – SUMMARY & KEY TAKEAWAYS
// ────────────────────────────────────────────────────────────────────────────
{
const s = pres.addSlide();
addBg(s, C.darkBg);
s.addShape("rect", { x: 0, y: 0, w: 10, h: 0.5, fill: { color: C.teal } });
s.addText("SUMMARY", { x: 0.4, y: 0.07, w: 9.2, h: 0.38, fontSize: 16, bold: true, color: C.navy, fontFace: "Calibri", charSpacing: 4 });
const summItems = [
["BRACHIAL PLEXUS", "C5–T1 → Roots → Trunks (upper/middle/lower) → Divisions → Cords (lateral/posterior/medial) → 5 terminal nerves. Fascial sheath is the anatomical basis for nerve blocks. Block approach dictates coverage and complication profile.", C.teal],
["SUBARACHNOID SPACE", "Between arachnoid and pia mater; contains CSF + cauda equina. Lumbar cistern (L1–S2) is the LP target. Drug spread governed by baricity + position. Differential block follows fibre size sensitivity.", C.amber],
["EPIDURAL SPACE", "Outside dural sac; foramen magnum to S2. Not a continuous cavity — discontinuous fat pockets. Boundaries: PLL (anterior), LF (posterior). Contents: fat, Batson's veins, nerve roots. LOR technique identifies it. Volume and age drive spread.", C.green],
];
summItems.forEach(([title, text, col], i) => {
const y = 0.6 + i * 1.6;
s.addShape("rect", { x: 0.3, y, w: 9.4, h: 1.5, fill: { color: C.midBg }, line: { color: col, width: 2 } });
s.addShape("rect", { x: 0.3, y, w: 0.18, h: 1.5, fill: { color: col } });
s.addText(title, { x: 0.6, y: y + 0.08, w: 8.8, h: 0.35, fontSize: 13, bold: true, color: col, fontFace: "Calibri", margin: 0 });
s.addText(text, { x: 0.6, y: y + 0.46, w: 8.8, h: 0.96, fontSize: 12.5, color: C.white, fontFace: "Calibri", margin: 0, lineSpacingMultiple: 1.15 });
});
s.addText("Source: Barash's Clinical Anesthesia 9e | Miller's Anesthesia 10e | Gray's Anatomy for Students | Harrison's Principles 22e", {
x: 0.3, y: 5.35, w: 9.4, h: 0.26, fontSize: 8, color: C.light, fontFace: "Calibri", align: "center", italic: true
});
}
// ─── WRITE FILE ──────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/anaesthesia-anatomy-ppt/Anaesthesia_PG_Anatomy_Brachial_Subarachnoid_Epidural.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
console.log("PPT saved to: " + outPath);
}).catch(e => {
console.error("Error saving PPT:", e);
process.exit(1);
});
Running Command
cd /home/daytona/workspace/anaesthesia-anatomy-ppt && node build_ppt.js 2>&1
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Retry
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