ASTA NINDANIYA PURUSHA AND ANESTHETIC OUTCOME
*Dr shailendra singh
**Dr DN pande
Acharya charak has described this concept of asta nindaniya purusha viz.atisthoola-atikrisha,atihrshwaatidirgha,aloma-atiloma,atigaura-atikrishna,and has claimed that these patients are associated with bad
therapeutic outcome. This seems to be true not only for medical conditions but anaesthesia as well. here are
some possible explanation of this concept in relation to anaesthesia.
1.ATISTHOOLA(OBESE PTIENTS)-obesity has been challenge for medical field. This has been explained in
ayurveda earlier. Some problems of obese persons which interact with anaesthesia are as followsRELATED PROBLEMS
Cardiovascularcardiomyopathies
hypertension
ischemic heart disease
i.v.canulation
AirwayLarynx interiorly placed
Reduced Oropharyngial space
Preoxygenation
Risk of aspiration
Breathing & RespirationFRC
Lung compliance
Airway resistance
IPPV
Ventilator drive
O2 saturation
PEEP
GastrointestinalIncreased intraabdominal pressure
Prone for GERD
Metabolic & indocrinalFatty liver
Increased BMR
NIDDM
Post opWound healing
infection
2.AITKRISH
ASSOCIATED ANESTHETIC PROBLEMS
Intra operative cardiovascular collapse and mortality.
Difficult because of more subcutaneous fat.
Difficult intubation
-doLess effect
Increased
Decreased
Decreased
Increased
Requires more positive pressure
Decreased
Apnoeic
At least 10 to 15(more than normal)
Increased chance of aspiration
Decreased drug transport & metabolism
Increased energy demand
Autonomic neuropathy-decreased compensatory response.
Delayed
More prone for infections
Ventilator effort
Poor
Infections
Prone for nosocomial infections
Mortality
8 times higher
Less subcutaneous fat
Chance of perioperative hypothermia
Cardiovascular
Chance of fluid overload
hyperthyroidism
Hypertention,tremors
3.ATIHRASHWA- Our experience indicates that the most common problem seen clinically originates from the
high
incidence of spinal and foramen magnum stenosis.These patients present with sleep apnoea andnocturnal
airway obstruction which is probably related to brainstem compression.6"8Patients with sleep apnoea tend to
have apnoeic spells followed by periods of hyperventilation.Therefore,carbondioxide retention has not been a
problem. Most ofthe patients for suboccipital craniectomy wereunder 12 years old and pulmonary function was
notevaluated. Other problems associated with spinalstenosis include chest deformity and upper
cervicalmyelopathy.9'10 Some of the patients have such
severe spinal stenosis that they present with longtract signs and need decompression to preserveperipheral
neurological function.
Hypotonia
Increased response to muscle relaxants
Pituitary insufficiency
Problem in autoregulation
Macroglossia
Difficult intubation
Small chin
Difficult intubation
Micrognethia
Difficult intubation
Crowling of teeth in jaw
Difficulty in extension of neck
Short neck
Difficult intubation
Achondroplesic childs-risk of hydrocephalus
risk of apnoea
Small chest
carefull ventilation
Scoliosis
difficult for spinal & epidural anesthesia
Trouble in joint flexibility & early arthritis
difficulty in intubation and positionong
4.ATIDIRGHAHyperpitutary status
Perioperative instability
Prominent jaw
Difficult intubation
Increased sweating
Heat loss,dehydration
Weakness
Poor post op outcome
hyperglycemia
-do5.ATILOMA-may be because of systemic illness or because of drugsSystemic illnessesDermatomylitis
Contraindication for spinal & epidural anesthesia.
Advanced HIV infection
Imuune compromise,respiratory compromise
Hypothyroidism
Perioperative hypothermia & cardiovascular collapse
Porphyria cutanea tarda
Bleeding tendency
Some CNS disorders
Intraoperative ?
DrugsMinoxidil
Arteriolr dilator-perioperative cardiovascular instability
Phenatoin
Intra operative precipitation of seizures( anesthesia stress induced)
Anabolic steroids
Adrenal shutdown in anesthetic stress condition
HersutismExcessive androgens
?
Adrenal tumour
Hypertensive crisis
OCPs
?
Use of danazole,steroids
Adrenal suppression-perioperative cardiovascular collapse
6.-ALOMASkin diseases
C/I for spinal,epidural & local anesthesia
Hypothyroidism
Hypothermia, hypotension
Stress
Tachycardia,hypertension
Chemotherapy
Drug interaction,low immune status,
Chronic uremia
Post operative renal failure
7.&8.ATIGAURA & ATIKRISHNA-it includes not only complete white or complete blacks but all the diseases which
affect skin color and hence interect with anesthesia also.this can be explained as followsGeneralised palenesssevere anemia
rednessfever
viral infection
sunburn
dermatitis
flushing
yellow skinhyperbilirubinaemia
orange skincarotinaemia
cyanosis(blue skin)abnormal haemoglobin
respiratory diseases
cyanotic heart diseases
hyperpigmentation(dark skin)anti malarials
minocyclin
Perioperative hypoxia, heart failure
Increased intraoperative drug metabolism
Poor post op outcome
C/I for spinal,epidural & local anesthesia
C/I for spinal,epidural & local anesthesia
C/I for spinal,epidural & local anesthesia
Perioperative hepatorenal syndrome
?
Hypoxia
C/I for general anesthesia
C/I for general anesthesia
?
?
brown discolourationhaemosiderin
?
haemochromatosisbronze colour skin with liver, heart, adrenal
Multi organ failure cannot tolerate anaesthesia.
gland, kidney, pituitary, testesfailure ,
pancrease failure-bronze diabetes
dermatomyositis-skin discolouration along with Problem with neuromuscular blocking agent.
inflammation skin and muscle,
muscle weakness,
Difficult reversal
breathing & swallowing problem
More chance for respiratory depression in anesthesia
SLE-butterfly rashes(malar rashes)on skin
along withFever,weight loss,arthritis, seizures,strokes
Precipitation of seizures and stroke perioperativally.
Apart from above descriptionbrown skin persons are more prone for hypertension,diabetes and heart disease , BLACKS are
more prone for allergic reactions(www.brownskin.net).
Summary and conclusion
Thus we find that ashta nindhya purusha explained in ayurveda are very much important in sangyaharan practice.
*anaesthetist Varanasi
**HOD ,de ptt of sangyaharan,bhu, varanasi