Clinical Anesthesia, 8e: Print + Ebook with Multimedia
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Editura: Lippincott Williams and Wilkins
Limba: Engleza
Nr. pagini: 1808
Coperta: Hardcover
Dimensiuni: 21.6 x 5.7 x 27.9 cm
An aparitie: 25 Jun 2017
Description:
Where experts turn for definitive answers! Clinical Anesthesia covers the full spectrum of clinical issues and options in anesthesiology, providing insightful coverage of pharmacology, physiology, co-existing diseases, and surgical procedures. Unmatched in its clarity and depth of coverage as well as its robust multimedia features, this classic clinical reference brings you the very latest essential knowledge in the field, equipping you to effectively apply today’s standards of care and make optimal clinical decisions on behalf of your patients.
Table of Contents:
Expanded Contents
Multimedia Contents
SECTION 1 Introduction and Overview
Chapter 1 The History of Anesthesia
Anesthesia Before Ether
Physical and Psychological Anesthesia
Early Analgesics and Soporifics
Inhaled Anesthetics
Almost Discovery: Hickman, Clarke, Long, and Wells
Public Demonstration of Ether Anesthesia
Chloroform and Obstetrics
Anesthesia Principles, Equipment, and Standards
Control of the Airway
Tracheal Intubation
Advanced Airway Devices
Early Anesthesia Delivery Systems
Alternative Circuits
Ventilators
Carbon Dioxide Absorption
Flowmeters
Vaporizers
Patient Monitors
Electrocardiography, Pulse Oximetry, and Capnography
Safety Standards
The History of Anesthetic Agents and Adjuvants
Inhaled Anesthetics
Intravenous Anesthetics
Local Anesthetics
Opioids
Muscle Relaxants
Antiemetics
Anesthesia Subspecialties
Regional Anesthesia
Cardiovascular Anesthesia
Neuroanesthesia
Obstetric Anesthesia
Transfusion Medicine
Professionalism and Anesthesia Practice
Organized Anesthesiology
Academic Anesthesia
Establishing a Society
Conclusions
References
Chapter 2 Scope of Practice
Changing Anesthesiology Practice
Bundled Payment Model
Practice Model for Anesthesiologists: The Perioperative Surgical Home
Practice Model Involving Anesthesiologists: The Service Line
Large Group Practices: Anesthesia and Multispecialty
Further Issues
Payment Machinations
Aprn Consensus Model Implications
Administrative Components of Anesthesiology Practice
Operational and Information Resources
Background
The Credentialing Process and Clinical Privileges
Documentation
Maintenance of Certification in Anesthesiology
Professional Staff Participation and Relationships
Establishing Standards of Practice and Understanding the Standard of Care
Leading the Way
Practice Guidelines
Review Implications
Policy and Procedure
Meetings and Case Discussion
Support Staff
Anesthesia Equipment and Equipment Maintenance
Service
Malpractice Insurance
Background
Response to an Adverse Event
Practice Essentials
The “Job Market” for Anesthesia Professionals
Types of Practice
Academic Practice
Private Practice in the Marketplace
Private Practice as an Employee
Billing and Collecting
Classic Methodology
Antitrust Considerations
Legal Implications
Exclusive Service Contracts
Hospital Subsidies
Evolving Practice Arrangements
Prospective Payments
Changing Paradigm
Pay for Performance
Accountable Care Organizations
Management Intricacies
Health Insurance Portability and Accountability Act
Electronic Medical (“Health”) Records
Expansion into Perioperative Medicine and Hospital Care
Operating Room Management
Organization
Contact and Communication
Materials Management
Scheduling Cases
Types of Schedules
Computerization
Preoperative Clinic
Anesthesiology Personnel Issues
Timing
Cost and Quality Issues
Conclusion
References
Chapter 3 Occupational Health
Introduction
Physical Hazards
Waste Anesthetic Gases
Levels of Waste Anesthetic Gases
Health Consequences of Wag Exposure
Chemicals
Allergic Reactions
Radiation
Noise Pollution
Ergonomics/Human Factors
Work Hours, Night Call, and Fatigue
Infectious Hazards
OSHA Standards, Standard Precautions, and Transmission-Based Precautions
Respiratory Viruses
Influenza Viruses
Influenza Pandemics
Avian Influenza A
Human Respiratory Syncytial Virus
Severe Acute Respiratory Syndrome
Enteric Infections
DNA Viruses
Rubella
Measles (Rubeola)
Viral Hepatitis
Pathogenic Human Retroviruses
Risk of Occupational Hiv Infection
Postexposure Treatment and Prophylactic Antiretroviral Therapy
Prion Diseases
Tuberculosis
Viruses in Smoke Plumes
Emotional Considerations
Stress
Impact of Adverse Events
Burnout
Substance Use, Abuse, and Addiction
Impairment and Disability
The Aging Anesthesiologist
Mortality among Anesthesiologists
Suicide
Wellness
Nutrition, Diet, and Fitness
Implementing Lifestyle Interventions for Lifestyle-Related Diseases
Mindfulness
Conclusion
References
Chapter 4 Anesthetic Risk, Quality Improvement, and Liability
Anesthesia Risk
Mortality and Major Morbidity Related to Anesthesia
Risk Management
Conceptual Introduction
Risk Management in Anesthesia
Informed Consent
Record Keeping
What to Do after an Adverse Outcome
Special Circumstances: “Do Not Resuscitate” and Jehovah’s Witnesses
National Practitioner Data Bank
Quality Improvement and Patient Safety in Anesthesia
Structure, Process, and Outcome: The Building Blocks of Quality
Difficulty of Outcome Measurement in Anesthesia
Joint Commission Requirements for Quality Improvement
Alternative Payment Models and Pay for Performance
Professional Liability
The Tort System
Duty
Breach of Duty
Causation
Damages
Standard of Care
Causes of Anesthesia-Related Lawsuits
What to Do When Sued
Acknowledgments
References
Chapter 5 Electrical and Fire Safety
Principles of Electricity
Direct and Alternating Currents
Impedance
Capacitance
Inductance
Electrical Shock Hazards
Alternating and Direct Currents
Source of Shocks
Grounding
Electrical Power: Grounded
Electrical Power: Ungrounded
The Line Isolation Monitor
Ground Fault Circuit Interrupter
Double Insulation
Microshock
Electrosurgery
Conductive Flooring
Environmental Hazards
Electromagnetic Interference
Construction of New Operating Rooms
Fire Safety
References
SECTION 2 Basic Science and Fundamentals
Chapter 6 Genomic Basis of Perioperative Medicine
Scientific Rationale for Perioperative Precision Medicine
Human Genomic Variation
Profiling the Regulatory Genome to Understand Perioperative Biology and Discover Biomarkers of Adverse Outcomes
Epigenetics: The Link Between Environment and Genes
Overview of Genetic Epidemiology and Functional Genomic Methodology
Genomics and Perioperative Risk Profiling
Predictive Biomarkers for Perioperative Adverse Cardiac Events
Perioperative Myocardial Infarction and Ventricular Dysfunction
Perioperative Atrial Fibrillation
Genetic Variants and Postoperative Event-Free Survival
Genetic Susceptibility to Adverse Perioperative Neurologic Outcomes
Genetic Susceptibility to Adverse Perioperative Kidney Outcomes
Genetic Variants and Risk for Postoperative Lung Injury
Pharmacogenomics and Anesthesia
Genetic Variability in Response to Anesthetic Agents
Genetic Variability in Pain Response
Genetic Variability in Response to Other Drugs Used Perioperatively
Conclusions and Future Directions
Acknowledgments
References
Chapter 7 Experimental Design and Statistics
Introduction
Foundations
Data Structure
Descriptive Statistics
Central Location
Spread or Variability
Types of Research Design
Experimental Medicine: Management of Bias
Sampling
Experimental Constraints
Control Groups
Random Allocation of Treatment Groups
Blinding
Experimental Medicine: Statistical Analysis
Hypothesis Formulation
Logic of Proof
Sample Size Calculations
Inferential Statistics
The Fickle P Value
The Bayesian Alternative
Experimental Medicine: Statistical Tests
Interval Data
Confidence Intervals
t Test
Analysis of Variance
Robustness and Nonparametric Tests
Binary Variables
Confidence Intervals on Proportions
Hypothesis Testing
Linear Regression
Epidemiology
Multivariable Linear Regression
Univariable and Multivariable Logistic Regression
Propensity Score Matching and Analysis
Systematic Reviews and Meta-Analyses
Big Data
Conclusions
Interpretation of Results
Statistical Resources
Statistics and Anesthesia
References
Chapter 8 Inflammation, Wound Healing, and Infection
Introduction
Infection Control
Hand Hygiene
Antisepsis
Antibiotic Prophylaxis
Mechanisms of Wound Repair
The Initial Response to Injury
Resistance to Infection
Proliferation
Neovascularization
Collagen and Extracellular Matrix Deposition
Epithelialization
Maturation and Remodeling
Wound Perfusion and Oxygenation
Patient Management
Preoperative Preparation
Intraoperative Management
Volume Management
Postoperative Management
Summary
Areas for Future Research
References
Chapter 9 The Allergic Response
Introduction
Basic Immunologic Principles
Antigens
Thymus-Derived (T-Cell) and Bursa-Derived (B-Cell) Lymphocytes
Antibodies
Effector Cells and Proteins of the Immune Response
Cells
Proteins
Effects of Anesthesia on Immune Function
Hypersensitivity Responses (allergy)
Type I Reactions
Type II Reactions
Type III Reactions (Immune Complex Reactions)
Type IV Reactions (Delayed Hypersensitivity Reactions)
Intraoperative Allergic Reactions
Anaphylactic Reactions
IgE-Mediated Pathophysiology
Chemical Mediators of Anaphylaxis
Peptide Mediators of Anaphylaxis
Arachidonic Acid Metabolites
Kinins
Platelet-Activating Factor
Recognition of Anaphylaxis
Non–IgE-Mediated Reactions
Complement Activation
Nonimmunologic Release of Histamine
Treatment Plan
Initial Therapy
Secondary Treatment
Perioperative Management of the Patient with Allergies
Immunologic Mechanisms of Drug Allergy
Evaluation of Patients with Allergic Reactions
Testing for Allergy
Agents Implicated in Allergic Reactions
Antibiotics
Latex Allergy
Local Anesthetics
Neuromuscular Blocking Agents
Summary
References
Chapter 10 Mechanisms of Anesthesia and Consciousness
What Is Anesthesia?
How Is Anesthesia Measured?
What Is the Chemical Nature of Anesthetic Target Sites?
The Meyer–Overton Rule
Exceptions to the Meyer–Overton Rule
Lipid Versus Protein Targets
Lipid Theories of Anesthesia
Protein Theories of Anesthesia
Evidence for Anesthetic Binding to Proteins
Summary
How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System?
Neuronal Excitability
Synaptic Transmission
Presynaptic Effects
Postsynaptic Effects
Summary
Anesthetic Actions on Ion Channels
Anesthetic Effects on Voltage-Dependent Ion Channels
Summary
Anesthetic Effects on Ligand-Gated Ion Channels
Glutamate-Activated Ion Channels
GABA-Activated Ion Channels
Other Ligand-Activated Ion Channels
Summary
How Are the Molecular Effects of Anesthetics Linked to Anesthesia in the Intact Organism?
Pharmacologic Approaches
Genetic Approaches
Summary
Where in the Central Nervous System Do Anesthetics Work?
Immobility
Autonomic Control
Amnesia
Unconsciousness
Reticular Activating System and Arousal Centers
Thalamus
Cerebral Cortex
Summary
Conclusions
Acknowledgments
References
Chapter 11 Basic Principles of Clinical Pharmacology
Pharmacokinetic Principles
Drug Absorption and Routes of Administration
Transfer of Drugs Across Membranes
Intravenous Administration
Oral Administration
Transcutaneous Administration
Intramuscular and Subcutaneous Administration
Intrathecal, Epidural, and Perineural Injection
Inhalational Administration
Drug Distribution
Redistribution
Drug Elimination
Biotransformation Reactions
Phase I Reactions
Cytochrome P450 Enzymes
Phase II Reactions
Genetic Variations in Drug Metabolism
Chronologic Variations in Drug Metabolism
Renal Drug Clearance
Hepatic Drug Clearance
Pharmacokinetic Models
Physiologic Versus Compartment Models
Pharmacokinetic Concepts
Volume of Distribution
Total Drug (Elimination) Clearance
Elimination Half-Life
Effect of Hepatic or Renal Disease on Pharmacokinetic Parameters
Nonlinear Pharmacokinetics
Compartmental Pharmacokinetic Models
One-Compartment Model
Two-Compartment Model
Three-Compartment Model
Noncompartmental (Stochastic) Pharmacokinetic Models
Pharmacodynamic Principles
Drug–Receptor Interactions
Desensitization and Downregulation of Receptors
Agonists, Partial Agonists, and Antagonists
Dose–Response Relationships
Concentration–Response Relationships
Combined Pharmacokinetic–Pharmacodynamic Models
Population Pharmacokinetic–Pharmacodynamic Models
Therapeutic Thresholds and Therapeutic Window
Drug Interactions
Pharmaceutical (Physiochemical) Interactions
In Vitro Interactions
In Vivo Interactions
Pharmacokinetic Interactions
Absorption (uptake)
Distribution
Metabolism
Pharmacodynamic Interactions
Serotonin Syndrome
Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Rise to Steady-State Concentration
Manual Bolus and Infusion Dosing Schemes
Isoconcentration Nomogram
Context-Sensitive Decrement Times
Soft Pharmacology and Anesthesiology
Target-Controlled Infusions
Time to Maximum Effect Compartment Concentration (Tmax)
Volume of Distribution at Peak Effect (VDPE)
Front-End Pharmacokinetics
Closed-Loop Infusions
Response Surface Models of Drug–Drug Interactions
Conclusion
References
SECTION 3 Core Care Principles
Chapter 12 Cardiac Anatomy and Physiology
Introduction
Gross Anatomy
Architecture
Valve Structure
Coronary Blood Supply
Impulse Conduction
Coronary Physiology
Cardiac Myocyte Anatomy and Function
Ultrastructure
Contractile Apparatus
Calcium–Myofilament Interaction
Myosin–Actin Interaction
Law of Laplace
The Cardiac Cycle
The Pressure–Volume Diagram
Determinants of Systolic Function
Heart Rate
Preload
Afterload
Myocardial Contractility
Determinants of Diastolic Function
Invasive Assessment of LV Relaxation
Invasive Assessment of LV Filling and Compliance
Noninvasive Evaluation of Diastolic Function
Pericardium
Atrial Function
References
Chapter 13 Cardiovascular Pharmacology
Introduction
Cholinergic Drugs
Cholinergic Agonists
Cholinesterase Inhibitors
Muscarinic Antagonists
Muscarinic Antagonist Toxicity
Fundamentals of Catecholamine Pharmacology
Epinephrine
Norepinephrine
Dopamine
Dobutamine
Isoproterenol
Selective β2-Adrenoceptor Agonists
Fenoldopam
Sympathomimetics
Ephedrine
Phenylephrine
α1-Adrenoceptor Antagonists
α2-Adrenoceptor Agonists: Clonidine and Dexmedetomidine
β-Adrenoceptor Antagonists (β-Blockers)
Propranolol
Metoprolol
Atenolol
Esmolol
Labetalol
Carvedilol
Phosphodiesterase Inhibitors
Levosimendan
Digitalis Glycosides
Vasopressin
Nitrovasodilators
Nitroglycerin
Sodium Nitroprusside
Hydralazine
Calcium Channel Blockers
Nifedipine
Nicardipine
Clevidipine
Nimodipine
Diltiazem
Verapamil
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Blockers
References
Chapter 14 Autonomic Nervous System Anatomy and Physiology
Anesthesia and the Autonomic Nervous System
Functional Anatomy
Central Autonomic Organization
Peripheral Autonomic Nervous System Organization
Sympathetic Nervous System
Parasympathetic Nervous System
Autonomic Innervation
Peripheral Circulation
Lungs
Autonomic Nervous System Transmission
Parasympathetic Nervous System Transmission
Sympathetic Nervous System Transmission
Receptors
Cholinergic Receptors
Adrenergic Receptors
α-Adrenergic Receptors
α-Adrenergic Receptors in the Cardiovascular System
α-Adrenergic Receptors in the Central Nervous System
α Receptors in the Kidney
β-Adrenergic Receptors
β Receptors in the Cardiovascular System
β Receptors in the Kidney
Dopaminergic Receptors
Other Receptors
Serotonin
Adrenergic Receptor Numbers and Sensitivity
Autonomic Nervous System Reflexes and Interactions
Baroreceptors
Denervated Heart
Interaction of Autonomic Nervous System Receptors
Interaction with Other Regulatory Systems
Clinical Autonomic Nervous System Pharmacology
Mode of Action
Ganglionic Drugs
Agonists
Antagonists
Cholinergic Drugs
Muscarinic Agonists
Direct Cholinomimetics
Indirect Cholinomimetics
Muscarinic Antagonists
Atropine-Like Drugs
Central Anticholinergic Syndrome
Autonomic Syndromes and Autonomic Regulation
Horner Syndrome
Diabetic Neuropathy
Orthostatic Hypotension
Monoamine Oxidase Inhibitors
Tricyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
References
Chapter 15 Respiratory Function in Anesthesia
Functional Anatomy of the Lungs
Thorax
Muscles of Ventilation
Lung Structures
Conductive Airways
Transitional Airways
Respiratory Airways and the Alveolar–Capillary Membrane
Pulmonary Vascular Systems
Lung Mechanics
Elastic Work
Resistance to Gas Flow
Laminar Flow
Turbulent Flow
Increased Airway Resistance
Physiologic Changes in Respiratory Function Associated with Aging
Control of Ventilation
Terminology
Generation of Ventilatory Pattern
Medullary Centers
Pontine Centers
Higher Respiratory Centers
Reflex Control of Ventilation
Chemical Control of Ventilation
Peripheral Chemoreceptors
Central Chemoreceptors
Ventilatory Response to Altitude
Breath-Holding
Quantitative Aspects of Chemical Control of Breathing
Oxygen and Carbon Dioxide Transport
Bulk Flow of Gas (Convection)
Gas Diffusion
Distribution of Ventilation and Perfusion
Distribution of Blood Flow
Distribution of Ventilation
Ventilation–Perfusion Relationships
Physiologic Dead Space
Assessment of Physiologic Dead Space
Physiologic Shunt
Assessment of Arterial Oxygenation and Physiologic Shunt
Physiologic Shunt Calculation
Pulmonary Function Testing
Lung Volumes and Capacities
Frc Measurement
Pulmonary Function Tests
Forced Vital Capacity
Forced Expiratory Volume
Forced Expiratory Flow
Maximum Voluntary Ventilation
Flow–Volume Loops
Carbon Monoxide Diffusing Capacity
Practical Application of Pulmonary Function Tests
Preoperative Pulmonary Assessment
Anesthesia and Obstructive Pulmonary Disease
Anesthesia and Restrictive Pulmonary Disease
Effects of Cigarette Smoking on Pulmonary Function
Postoperative Pulmonary Function
Postoperative Pulmonary Complications
References
Chapter 16 Fluids, Electrolytes, and Acid–Base Physiology
Acid–Base Interpretation and Treatment
Overview of Acid–Base Equilibrium
Metabolic Alkalosis
Metabolic Acidosis
Respiratory Alkalosis
Respiratory Acidosis
Practical Approach to Acid–Base Interpretation
Examples
Example 1
Example 2
Fluid Management
Physiology
Body Fluid Compartments
Distribution of Infused Fluids
Regulation of Osmolarity and Effective Circulating Volume
Fluid Replacement Therapy
Maintenance Requirements for Water, Sodium, and Potassium
Dextrose
Surgical Fluid Requirements
Water and Electrolyte Composition of Fluid Losses
Influence of Perioperative Fluid Infusion Rates on Clinical Outcomes
Colloids, Crystalloids, and Hypertonic Solutions
Physiology and Pharmacology
Clinical Implications of Choices Between Alternative Fluids
Implications of Crystalloid and Colloid Infusions on Intracranial Pressure
Clinical Implications of Hypertonic Fluid Administration
Fluid Status: Assessment and Monitoring
Conventional Clinical Assessment
Intraoperative Clinical Assessment
Oxygen Delivery as a Goal of Management
Electrolytes
Sodium
Physiologic Role
Hyponatremia
Hypernatremia
Potassium
Physiologic Role
Hypokalemia
Hyperkalemia
Calcium
Physiologic Role
Hypocalcemia
Hypercalcemia
Phosphate
Physiologic Role
Hypophosphatemia
Hyperphosphatemia
Magnesium
Physiologic Role
Hypomagnesemia
Hypermagnesemia
References
Chapter 17 Hemostasis and Transfusion Medicine
Introduction
Hemostasis and Coagulation
Primary Hemostasis
Adherence
Activation
Stabilization
Inhibition
Mechanisms of Antiplatelet Medications
Secondary Hemostasis
Inhibition of Clotting Factors
Fibrinolysis
Inhibition of Fibrinolysis
Laboratory Evaluation of Hemostasis
Laboratory Evaluation of Primary Hemostasis
Laboratory Evaluation of Secondary Hemostasis and Coagulation
Mixing Studies
Viscoelastic Testing
Diagnosis of Thromboembolic Disorders
Congenital Risk Factors for Thrombosis
Acquired Risk Factors for Thrombosis
Monitoring Anticoagulation Therapeutic Agents
Warfarin Anticoagulation
Heparin Anticoagulation Testing
Blood Component Production
Blood Collection
Component Processing and Storage
Plasma Derivatives
Pathogen Inactivation
RBC and Platelet Substitutes
Blood Products and Transfusion Thresholds
Compatibility Testing
Red Blood Cells
Physiologic Compensation for Anemia
Platelets
Plasma Products
Cryoprecipitate
Fibrinogen Concentrate
The Risks of Blood Product Administration
Infectious Risks of Blood Product Administration
Human Immunodeficiency Virus
Hepatitis C Virus
Hepatitis B Virus
Human T-Cell Lymphotropic Virus-1 and Virus-2
Cytomegalovirus
Emerging Infections
Bacterial Contamination
Noninfectious Risks of Blood Product Administration
Immune-Mediated Transfusion Reactions
Transfusion-Related Immunomodulation
Nonimmune-Mediated Transfusion Reactions
Blood Conservation Strategies
Autologous Blood Transfusion
Perioperative Erythropoietin
Perioperative Blood Salvage
Disorders of Hemostasis: Diagnosis and Treatment
Disorders of Primary Hemostasis
Disorders of Secondary Hemostasis
The Hemophilias
Hereditary Hypercoagulability
Acquired Disorders of Hemostasis
Vitamin K Deficiency
Liver Disease
Disseminated Intravascular Coagulopathy (DIC)
Anticoagulation and Pharmacologic Therapy
Anticoagulation Regimens and Associated Anesthetic Concerns
Cyclooxygenase Inhibitors
Phosphodiesterase Inhibitors
ADP Receptor Antagonists
GP IIb/IIIa Receptor Antagonists
Vitamin K Antagonists
New Oral Anticoagulants
Heparin Therapy
Indirect Factor Xa Antagonists
Heparin-Induced Thrombocytopenia
Parenteral Direct Thrombin Inhibitors
Recombinant Activated Factor VII
Prothrombin Complex Concentrates
Desmopressin
Antifibrinolytic Therapy
Lysine Analogues
Conclusions
References
SECTION 4 Anesthetic Drugs and Adjuvants
Chapter 18 Inhaled Anesthetics
Introduction and Overview
Pharmacokinetic Principles
Unique Features of Inhaled Anesthetics
Speed, Gas State, and Route of Administration
Physical Characteristics of Inhaled Anesthetics
Gases in Mixtures
Gases in Solution
Anesthetic Transfer: Machine to Central Nervous System
Uptake and Distribution
FA/FI
Rise in FA in the Absence of Uptake
Rise in FA in the Presence of Uptake
Distribution (Tissue Uptake)
Metabolism
Overpressurization and the Concentration Effect
Second Gas Effect
Ventilation Effects
Perfusion Effects
Ventilation–Perfusion Mismatching
Elimination
Percutaneous and Visceral Loss
Diffusion Between Tissues
Exhalation and Recovery
Diffusion Hypoxia
Clinical Overview of Current Inhaled Anesthetics
Isoflurane
Desflurane
Sevoflurane
Xenon
Nitrous Oxide
Neuropharmacology of Inhaled Anesthetics
Minimum Alveolar Concentration
The Effect of Age on Mac
Other Alterations in Neurophysiology
Cerebral Metabolic Rate and Electroencephalogram
Cerebral Blood Flow, Flow–Metabolism Coupling, and Autoregulation
Intracerebral Pressure
Cerebral Blood Flow Response to Hypercapnia and Hypocapnia
Cerebral Protection
Postoperative Cognitive Dysfunction
Processed Electroencephalograms and Neuromonitoring
Nitrous Oxide
The Circulatory System
Hemodynamics
Myocardial Contractility
Other Circulatory Effects
Coronary Steal, Myocardial Ischemia, and Cardiac Outcome
Cardioprotection from Volatile Anesthetics
Autonomic Nervous System
The Pulmonary System
General Ventilatory Effects
Ventilatory Mechanics
Response to Carbon Dioxide and Hypoxemia
Bronchiolar Smooth Muscle Tone
Mucociliary Function
Pulmonary Vascular Resistance
Hepatic Effects
Neuromuscular System and Malignant Hyperthermia
Genetic Effects, Obstetric Use, and Effects on Fetal Development
Anesthetic Degradation by Carbon Dioxide Absorbers
Compound A
Carbon Monoxide and Heat
Generic Sevoflurane Formulations
Anesthetic Metabolism
Fluoride-Induced Nephrotoxicity
Clinical Utility of Volatile Anesthetics
For Induction of Anesthesia
For Maintenance of Anesthesia
References
Chapter 19 Intravenous Anesthetics
Pharmocokinetics: General Principles for Intravenous Anesthetics
Propofol
Pharmacokinetics
Pharmacodynamics
Central Nervous System Effects
Cardiovascular Effects
Respiratory System Effects
Clinical Uses
Side Effects
Etomidate
Pharmacokinetics
Pharmacodynamics and Clinical Uses
Side Effects
Ketamine
Pharmacokinetics
Pharmacodynamics
Clinical Uses
Anesthesia
Sedation
Analgesia
Chronic Pain
Depression
Side Effects
Central Nervous System
Cardiovascular
Respiratory
Intracranial Pressure/Seizure Issues
Dexmedetomidine
Pharmacokinetics
Pharmacodynamics
Clinical Uses
Side Effects
Benzodiazepines
Pharmacokinetics
Pharmacodynamics and Clinical Uses
Side Effects
Barbiturates
Pharmacokinetics
Pharmacodynamics
Central Nervous System Effects
Cardiovascular Effects
Respiratory System Effects
Clinical Uses
Side Effects
New Intravenous Anesthetics
Remimazolam
Propofol Formulations
Fospropofol
Cyclopropyl-Methoxycarbonyl Metomidate
THRX-918661/AZD-3043
Sedasys
References
Chapter 20 Opioids
Introduction
History
The Endogenous Opioid System
Simultaneous Targeting of Multiple Opioid and Nonopioid Receptors
Opioid Mechanisms
Central Opioid Analgesia
Peripheral Opioid Analgesia
Opioid-Induced Hyperalgesia and Tolerance
Opioid Pharmacokinetics and Pharmacodynamics
Classification of Exogenous Opioids
Opioid Pharmacokinetics
Metabolism: Which Pathways and Metabolites Are Clinically Relevant?
Morphine
Piperidines
Methadone
Naloxone
PKPD Models of Opioid Effect: Which End Point Serves the Clinician Best?
Pharmacodynamics: Pain Relief
Morphine
Fentanyl
Sufentanil
Remifentanil
Pharmacogenetics
Opioid-Induced Respiratory Depression
Mechanisms of Opioid-Induced Respiratory Depression
Incidence and Risk Factors of Opioid-Induced Respiratory Depression
Opioid-Induced Respiratory Depression Versus Opioid Analgesia
Reversal of Opioid-Induced Respiratory Depression
Monitoring
Other Opioid-Related Side Effects
Nausea and Vomiting
Smooth Muscle Effects
Cardiovascular Effects
Remifentanil for Labor Pain
Gender Differences
References
Chapter 21 Neuromuscular Blocking Agents
Physiology and Pharmacology
Morphology of the Neuromuscular Junction
Nerve Stimulation
Presynaptic Events: Mobilization and Release of Acetylcholine
Postsynaptic Events
Receptor Up- and Downregulation
Pharmacologic Characteristics
Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Neuromuscular Effects
Characteristics of Depolarizing Blockade
Pharmacology of Succinylcholine
Side Effects
Clinical Uses
Contraindications
Nondepolarizing Neuromuscular Blocking Agents
Characteristics
Pharmacology
Onset and Duration of Action
Individual Nondepolarizing Agents
Aminosteroid Compounds
Tetrahydroisoquinolinium (“Benzylisoquinolinium”) Derivatives
Drug Interactions
Altered Responses to Neuromuscular Blocking Agents
Monitoring Neuromuscular Blockade
Monitoring and Risk–Benefit Ratio
Stimulator Characteristics
Monitoring Modalities
Testing and Recording the Response
Differential Muscle Sensitivity
Electrode Placement
Monitoring and Clinical Applications
Reversal of Neuromuscular Blockade
Anticholinesterase Agents
Neostigmine
Drug Shortages and Clinical Impact
Edrophonium
Selective Relaxant Binding Agents
Sugammadex
Conclusion
References
Chapter 22 Local Anesthetics
Mechanisms of Action of Local Anesthetics
Anatomy of Nerves
Electrophysiology of Neural Conduction and Voltage-Gated Sodium Channels
Molecular Mechanisms of Local Anesthetics
Mechanism of Nerve Blockade
Pharmacology and Pharmacodynamics
Chemical Properties and Relationship to Activity and Potency
Additives to Increase Local Anesthetic Activity
Epinephrine
Alkalinization of Local Anesthetic Solution
Opioids
β2-Adrenergic Agonists
Steroids
Liposomes
Pharmacokinetics of Local Anesthetics
Systemic Absorption
Distribution
Elimination
Clinical Pharmacokinetics
Clinical Use of Local Anesthetics
Toxicity of Local Anesthetics
Systemic Toxicity of Local Anesthetics
Central Nervous System Toxicity
Cardiovascular Toxicity of Local Anesthetics
Treatment of Systemic Toxicity from Local Anesthetics
Neural Toxicity of Local Anesthetics
Transient Neurologic Symptoms After Spinal Anesthesia
Myotoxicity of Local Anesthetics
Allergic Reactions to Local Anesthetics
Future Therapeutics and Modalities
References
SECTION 5 Preoperative Assessment and Perioperative Monitoring
Chapter 23 Preoperative Patient Assessment and Management
Introduction
Changing Concepts in Preoperative Evaluation
Approach to the Healthy Patient
Screening Patients Using a Systems Approach
Airway
Pulmonary System
Cardiovascular System
Neurologic System
Endocrine System
Evaluation of the Patient with Known Systemic Disease
Cardiovascular Disease
Identifying Patients at Risk for Atherosclerotic Cardiac Disease
Importance of Surgical Procedure
Importance of Exercise Tolerance
Indications for Further Cardiac Testing
Electrocardiogram
Noninvasive Cardiovascular Testing
Assessment of Ventricular and Valvular Function
Coronary Angiography
Perioperative Coronary Interventions
Patients with Coronary Artery Stents
Patients with Cardiovascular Implantable Electronic Devices
Pulmonary Disease
Tobacco Use
Asthma
Obstructive Sleep Apnea
Endocrine Disease
Diabetes Mellitus
Thyroid and Parathyroid Diseases
Adrenal Disorders
Renal Disease
Liver Disease
Other Diseases
Preoperative Laboratory Testing
Defining Normal Values
Risks and Costs Versus Benefits
Clinical Considerations for Laboratory Testing
Summary of the Preoperative Evaluation
Preparation
Smoking Cessation
Continuing Current Medications/Treatment of Coexisting Diseases
β-Blockers
Statins
Prevention of Perioperative Pulmonary Aspiration
ASA Fasting Guidelines
Recommendations for Clear Liquids: At Least 2 Hours
Recommendations for Breast Milk: At Least 4 Hours
Recommendations for Infant Formula, Nonhuman Milk, and Light Meal: At Least 6 Hours
Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration
Psychological Preparation/Premedication
Psychological Preparation
Premedication
Benzodiazepines
Diphenhydramine
Opioids
Anticholinergics
Antibiotic Prophylaxis
Summary of Patient Preparation
References
Chapter 24 Rare Coexisting Diseases
Musculoskeletal Diseases
Muscular Dystrophy and Congenital Myopathy
Duchenne Muscular Dystrophy
Becker Muscular Dystrophy
Emery–Dreifuss Muscular Dystrophy
Limb-Girdle Muscular Dystrophy
Facioscapulohumeral Muscular Dystrophy
Oculopharyngeal Muscular Dystrophy
Congenital Muscular Dystrophy and Myopathy
Management of Anesthesia
Myotonic Dystrophy
Myotonic Dystrophy Type 1
Myotonic Dystrophy Type 2
Management of Anesthesia
Skeletal Muscle Channelopathies
Hyperkalemic Periodic Paralysis
Hypokalemic Periodic Paralysis
Andersen–Tawil Syndrome
Management of Anesthesia
Myasthenia Gravis
Management of Anesthesia
Myasthenic Syndrome (Lambert–Eaton Syndrome)
Management of Anesthesia
Guillain–Barré Syndrome (Polyradiculoneuritis)
Management of Anesthesia
Central Nervous System Diseases
Multiple Sclerosis
Management of Anesthesia
Epilepsy
Management of Anesthesia
Alzheimer Disease
Management of Anesthesia
Parkinson Disease
Management of Anesthesia
Huntington Disease
Management of Anesthesia
Amyotrophic Lateral Sclerosis
Management of Anesthesia
Creutzfeldt–Jakob Disease
Management of Anesthesia
Other Inherited Disorders
Malignant Hyperthermia
Management of the Acute Malignant Hyperthermia Episode
Management of the Malignant Hyperthermia Susceptible Patient
Porphyria
Management of Anesthesia
Cholinesterase Disorders
Management of Anesthesia
Glycogen Storage Diseases
Management of Anesthesia
Mucopolysaccharidoses
Management of Anesthesia
Osteogenesis Imperfecta
Management of Anesthesia
Anemias
Nutritional Deficiency Anemias
Hemolytic Anemias
Hereditary Spherocytosis
Glucose-6-Phosphate Dehydrogenase Deficiency
Pyruvate Kinase Deficiency
Immune Hemolytic Anemias
Hemoglobinopathies
Sickle Cell Disease
Thalassemia
Connective Tissue Diseases
Rheumatoid Arthritis
Management of Anesthesia
Systemic Lupus Erythematosus
Management of Anesthesia
Systemic Sclerosis (Scleroderma)
Management of Anesthesia
Inflammatory Myopathies (Dermatomyositis/Polymyositis)
Management of Anesthesia
Skin Disorders
Epidermolysis Bullosa
Management of Anesthesia
Pemphigus
Management of Anesthesia
References
Chapter 25 The Anesthesia Workstation and Delivery Systems for Inhaled Anesthetics
Anesthesia Workstation Standards and Preuse Procedures
Standards for Anesthesia Machines and Workstations
Failure of Anesthesia Equipment
Safety Features of Newer Anesthesia Workstations
Checkout of the Anesthesia Workstation
Oxygen Analyzer Calibration
Low-Pressure Circuit Leak Test
Oxygen Flush Positive-Pressure Leak Test
Verifying the Integrity of the Gas Supply Lines Between the Flowmeters and the Common Gas Outlet
Evaluation of the Circle System
Workstation Self-Tests
Anesthesia Workstation Pneumatics
The Anatomy of an Anesthesia Workstation
Pipeline Supply Source
Cylinder Supply Source
Nitrous Oxide
Machine Intermediate-Pressure System
Oxygen Supply Pressure Failure Safety Devices
Pneumatic and Electronic Alarm Devices
Oxygen Failure Cutoff (“Fail-Safe”) Valves
Second-Stage Oxygen Pressure Regulator
Flowmeter Assemblies
Operating Principles of Conventional Flowmeters
Components of the Flowmeter Assembly
Problems with Flowmeters
Electronic Flowmeters
Automated Fresh Gas Flow Optimization by Workstation Software
Proportioning Systems
Ge-Datex-Ohmeda Link-25 Proportion-Limiting Control System
Dräger Oxygen Ratio Monitor Controller/Sensitive Oxygen Ratio Controller System
Limitations
Oxygen Flush Valve
Web-Based Anesthesia Software Simulation, the Virtual Anesthesia Machine
Vaporizers
Physics
Vapor Pressure
Latent Heat of Vaporization
Specific Heat
Thermal Conductivity
Ambient Pressure Effects
Variable Bypass Vaporizers
Basic Operating Principles
Factors That Influence Vaporizer Output
Safety Features
Hazards
The Tec 6 and D-Vapor Vaporizers for Desflurane
Unsuitability of Contemporary Variable Bypass Vaporizers for Controlled Vaporization of Desflurane
Operating Principles of the Tec 6 and D-Vapor
Altitude Can Influence Vaporizer Output
Carrier Gas Composition Can Influence Vaporizer Output
Safety Features
The GE-Datex-Ohmeda Aladin Cassette Vaporizer
Maquet FLOW-i Electronic Injector Vaporizer
Anesthesia Breathing Circuits
Mapleson Systems
Bain Circuit
Circle Breathing Systems
The Traditional Circle Breathing System
CO2 Absorbents
The Absorber Canister
Chemistry of Absorbents
Absorptive Capacity
Indicators
Interactions of Inhaled Anesthetics with Absorbents
Anesthesia Ventilators
Classification
Power Source
Drive Mechanism and Circuit Designation
Cycling Mechanism
Bellows Classification
Operating Principles of Ascending Bellows Pneumatically Powered Ventilators
Problems and Hazards
Traditional Circle System Problems
Bellows Assembly Problems
Control Assembly and Power Supply Problems
Anesthesia Workstation Variations
Datex-Ohmeda S/5 ADU and GE Healthcare Aisys Carestation
The Dräger Medical Narkomed 6000 Series, Fabius GS, and Apollo Workstations
Maquet FLOW-i Workstation
Waste Gas Scavenging Systems
Components
Gas-Collecting Assembly
Transfer Means
Scavenging Interface
Gas-Disposal Assembly Conduit
Gas-Disposal Assembly
Hazards
Low-Flow Scavenging Systems
References
Appendix A
FDA 1993 Anesthesia Apparatus Checkout Recommendations
Emergency Ventilation Equipment
Appendix B
Recommendations for Preanesthesia Checkout Procedures (2008)
Subcommittee of ASA Committee on Equipment and Facilities
Guidelines for Preanesthesia Checkout (PAC) Procedures
Background
General Considerations
Personnel Performing the PAC
Objectives for a New PAC
Basic Principles
ASA 2008 Guidelines for Developing Institution-Specific Checkout Procedures Prior to Anesthesia Delivery
Requirements for Safe Delivery of Anesthesia Care
Specific Items
Additional Notes
References to Appendix B
Chapter 26 Commonly Used Monitoring Techniques
Introduction
Monitoring of Inspired Oxygen Concentration
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Arterial Oxygenation by Pulse Oximetry
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Expired Gases
Principles of Operation
Proper Use and Interpretation
Interpretation of Inspired and Expired Carbon Dioxide Concentrations
Interpretation of Inspired and Expired Anesthetic Gas Concentrations
Indications
Contraindications
Common Problems and Limitations
Invasive Monitoring of Systemic Blood Pressure
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Central Venous and Right-Heart Pressures
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Cardiac Output by Arterial Waveform Analysis
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Body Temperature
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Monitoring of Processed EEG Signals
Principles of Operation
Proper Use and Interpretation
Indications
Contraindications
Common Problems and Limitations
Future Trends in Monitoring
References
Chapter 27 Echocardiography
Principles and Technology of Echocardiography
Physics of Sound
Properties of Sound Transmission in Tissue
Instrumentation
Transducers
Beam Shape
Resolution
Signal Processing
Image Display
Spatial Versus Dynamic Image Quality
Two-Dimensional and Three-Dimensional Transesophageal Echocardiography Examination
Probe Insertion
Transesophageal Echocardiography Safety
Contraindication to Transesophageal Echocardiography Probe Placement
Probe Manipulation
Orientation
Goals of the Two-Dimensional Examination
Three-Dimensional Echocardiography
Doppler Echocardiography and Hemodynamics
Spectral Doppler
Pulsed-Wave Doppler
Continuous-Wave Doppler
Color-Flow Doppler
Hemodynamic Assessments
Volumetric Flow Assessments
Valve Area
Pressure Assessment
Echocardiographic Evaluation of Systolic Function
Left Ventricular Walls
Shape
Aneurysms
Texture
Wall Thickness
Segments and Regional Function
Left Ventricular Cavity
Diameters
Global Systolic Function
Percent Fractional Shortening (%fs)
Volumes
Percent Fractional Area Change
Visual Estimation of Fac
Ejection Fraction
Stroke Volume
Associated Findings
Tissue Echocardiography—Myocardial Velocity
Evaluation of Left Ventricular Diastolic Function
Diastolic Physiology
Echocardiographic Assessment of Left Ventricular Diastolic Function
Imaging Views and Techniques
Interpretation of Pulsed-Wave Doppler Velocity Curves
Pericardial Disease: Constrictive Pericarditis and Pericardial Tamponade
Evaluation of Valvular Heart Disease
Aortic Stenosis
Two-Dimensional and M-Mode Echocardiography
Doppler Echocardiography
Mitral Stenosis
Two-Dimensional Echocardiography
Doppler Echocardiography
Associated Findings
Aortic Regurgitation
Two-Dimensional and M-Mode Echocardiography
Doppler Echocardiography
Mitral Regurgitation
Two-Dimensional Echocardiography
Doppler Echocardiography
Tricuspid and Pulmonic Valve Regurgitation
Diseases of the Aorta
Two-Dimensional and Motion-Mode Echocardiography
Cardiac Masses
Congenital Heart Disease
Echocardiography-Assisted Procedures
Ultrasound-Guided Central Vein Cannulation
Epicardial and Epiaortic Echocardiography
Epicardial Echocardiography
Epiaortic Examination
Echocardiography Outside the Operating Room
Focused Transthoracic Cardiac Ultrasound
Focused Exam Views
Focused Assessed Transthoracic Echo
References
SECTION 6 Basic Anesthetic Management
Chapter 28 Airway Management
Perspectives on Airway Management
Review of Airway Anatomy
History of Airway Management
Limitations of Patient History and Physical Examination
Clinical Management of the Airway
Preoxygenation
Support of the Airway with the Induction of Anesthesia
The Anesthesia Facemask
Supraglottic Airways
Tracheal Intubation
Videolaryngoscopy
Npo Status and Rapid-Sequence Induction
Extubation of the Trachea
The Difficult Airway Algorithm
The Airway Approach Algorithm
Awake Airway Management
Clinically Difficult Airway Scenarios
Case 1: Preoperative Endoscopy
Case 2: Flexible Intubation Scope-Aided Intubation
The Flexible Intubation Scope in Airway Management
Elements of the Flexible Intubation Scope
Use of the Flexible Intubation Scope
Case 3: Failed Rapid-Sequence Induction and the SGA
The SGA in the Failed Airway
Case 4: Deviation from the Difficult Airway Algorithm
Other Devices
Airway Bougie
Conclusions
References
Chapter 29 Patient Positioning and Potential Injuries
General Principles
Supine Positions
Variations of Supine Positions
Horizontal
Contoured
Lateral Uterine or Abdominal Mass Displacement
Lithotomy
Complications of Supine Positions
Brachial Plexus Neuropathy
Long Thoracic Nerve Dysfunction
Axillary Trauma from the Humeral Head
Radial Nerve Compression
Median Nerve Dysfunction
Ulnar Neuropathy
Other Supine Position Problems
Lateral Positions
Variations of Lateral Positions
Standard Lateral Position
Semisupine and Semiprone
Flexed Lateral Positions
Complications of Lateral Positions
Eyes and Ears
Neck
Suprascapular Nerve
Prone Positions
Full Prone
Complications of Prone Positions
Eyes and Ears
Neck Problems
Brachial Plexus Injuries
Breast Injuries
Abdominal Compression
Stoma and Genitals
Head-Elevated Positions
Variations of Head-Elevated Positions
Sitting
Supine—Tilted Head Up
Lateral—Tilted Head Up
Complications of Head-Elevated Positions
Postural Hypotension
Air Embolus
Edema of the Face, Tongue, and Neck
Midcervical Tetraplegia
Sciatic Nerve Injury
Head-Down Positions
Complications of Head-Down Positions
Head and Neck Injury
Brachial Plexopathy
Summary
References
Chapter 30 Monitored Anesthesia Care
Terminology
Preoperative Assessment
Techniques of Monitored Anesthesia Care
Pharmacologic Basis of Monitored Anesthesia Care Techniques: Optimizing Drug Administration
Distribution, Elimination, Accumulation, and Duration of Action
Elimination Half-Life
Context-Sensitive Half-Time
How Does the Context-Sensitive Half-Time Relate to the Time to Recovery?
Drug Interactions
Specific Drugs Used for Monitored Anesthesia Care
Propofol
Fospropofol
Benzodiazepines
Opioids
Remifentanil
Ketamine
Dexmedetomidine
Amnesia During Sedation with Dexmedetomidine or Propofol
Patient-Controlled Sedation and Analgesia
Respiratory Function and Sedative–Hypnotic Drugs
Sedation and Upper Airway Patency
Sedation and Protective Airway Reflexes
Sedation and Respiratory Control
Supplemental Oxygen Administration
Head and Neck Fires with the Use of Supplemental Oxygen
Monitoring During Monitored Anesthesia Care
American Society of Anesthesiologists Standards
Communication and Observation
Auscultation
Pulse Oximetry
Capnography
Cardiovascular System
Temperature Monitoring and Management During Monitored Anesthesia Care
Bispectral Index Monitoring During Monitored Anesthesia Care
Preparedness to Recognize and Treat Local Anesthetic Toxicity
Sedation and Analgesia by Nonanesthesiologists
Computer-Assisted Personalized Sedation—SEDASYS
Conclusion
References
Chapter 31 Ambulatory Anesthesia
Place, Procedures, and Patient Selection
Preoperative Screening
Upper Respiratory Tract Infection
Restriction of Food and Liquids Prior to Ambulatory Surgery
Anxiety Reduction
Managing the Anesthetic: Premedication
Benzodiazepines
Opioids and Nonsteroidal Analgesics
Intraoperative Management: Choice of Anesthetic Method
Regional Techniques
Spinal Anesthesia
Children
Adults
Epidural and Caudal Anesthesia
Nerve Blocks
Sedation and Analgesia
General Anesthesia
Induction
Maintenance
Management of Postanesthesia Care
Reversal of Drug Effects
Nausea and Vomiting
Pain
Preparation for Discharging the Patient
Acknowledgments
References
Chapter 32 Office-Based Anesthesia
Brief Historical Perspective of OBA
Advantages and Disadvantages of Office-Based Surgery and Anesthesia
Office Safety
Patient Selection
Surgeon Selection
Office Selection and Requirements
Accreditation
Procedure Selection
Specific Procedures
Liposuction
Aesthetics
Breast
Gastrointestinal Endoscopy
Dentistry and Oral and Maxillofacial Surgery
Orthopedics and Podiatry
Gynecology and Genitourinary
Ophthalmology and Otolaryngology
Pediatrics
Anesthetic Techniques
Anesthetic Agents
Postanesthesia Care Unit
Regulations
Business and Legal Aspects
Conclusions
References
Chapter 33 Nonoperating Room Anesthesia
General Principles
Three-Step Approach to Nonoperating Room Anesthesia
The Patient
The Procedure
The Environment
Anesthesia Equipment and Monitors
Patient Safety in Nonoperating Room Anesthesia
Adverse Events
Preprocedural Checklists
Standards of Care for Nonoperating Room Anesthesia
Patient Transfer
Sedation and Anesthesia
Definition of Sedation and Anesthesia
The Continuum of Anesthesia
Environmental Considerations for Nonoperating Room Anesthesia
X-Rays and Fluoroscopy
Hazards of Ionizing Radiation
Intravenous Contrast Agents
Renal Adverse Reaction
Hypersensitivity Reactions
Specific Nonoperating Room Procedures
Angiography
Interventional Neuroradiology
Procedural and Anesthetic Technique Considerations in Interventional Neuroradiology
Computed Tomography
Radiofrequency Ablation
Transjugular Intrahepatic Portosystemic Shunt
Magnetic Resonance Imaging
Physical Principles
Hazards of MRI
Anesthetic Technique
Pediatric Sedation and Anesthesia for MRI and CT Scans
Sedative Agents
Radiation Therapy
Positron Emission Tomography
Gastroenterology
Upper Gastrointestinal Endoscopy
Endoscopic Retrograde Cholangiopancreatography
Cardiology and Interventional Cardiology
Percutaneous Intervention
Percutaneous Ventricular Assist Devices
Percutaneous Closure of Septal Defects
Alcohol Septal Ablation
Structural Heart Procedures
Electrophysiology
Cardioversions and Diagnostic Tees
Electroconvulsive Therapy
Physiologic Response to Electroconvulsive Therapy
Anesthetic Considerations for ECT
Summary
References
Chapter 34 Anesthesia for the Older Patient
Demographics and Economics of Aging
The Process of Aging
Functional Reserve and the Concept of Frailty
Physiologic Age
The Physiology of Organ Aging
Changes in Body Composition, and Liver and Kidney Aging
Central Nervous System Aging
Drug Pharmacology and Aging
Cardiovascular Aging
Pulmonary Aging
Thermoregulation and Aging
Conduct of Anesthesia
The Preoperative Visit
Intraoperative Management
Postoperative Care
Perioperative Complications
The Future
References
Chapter 35 Neuraxial Anesthesia
Introduction
Indications and Contraindications
Neuraxial Anesthesia and Outcome
Anatomy
Vertebrae
Ligaments
Epidural Space
Meninges
Dura
Arachnoid
Pia
Cerebrospinal Fluid
Spinal Cord
Ultrasound Anatomy of the Spine
Technique
Patient Preparation
Equipment
Positioning
Skin Preparation
Needles
Approach
Technique
Subarachnoid Spinal Anesthesia
Continuous Subarachnoid Spinal Anesthesia
Epidural Anesthesia
Combined Subarachnoid Spinal Epidural
Choice of Technique
Efficiency and Neuraxial Anesthesia
Pharmacology
Subarachnoid Anesthesia
Spread and Duration
Patient Variables
Local Anesthetic Dose
Adjuvants
Epidural Anesthesia
Spread of Block
Onset and Duration
Adjuvants
Test Doses
Physiology
Central Nervous System
Site of Action
Differential Nerve Block
Cardiovascular System
Subarachnoid
Epidural
Prevention and Treatment
Respiratory System
Gastrointestinal System
Temperature Homeostasis
Complications
Backache
Headache
Risk Factors
Diagnosis
Prevention
Treatment/Epidural Blood Patch
Hearing Loss
High Block/Total Subarachnoid Spinal Block
Systemic Toxicity
Neurologic Injury
Needle Trauma
Mass Lesions
Hypoperfusion
Spinal Stenosis
Chemical Injury
References
Chapter 36 Peripheral Nerve Blockade
Introduction
General Principles and Equipment
Preblock Stage
Setup
Monitoring
Premedication and Sedation
Bolus
Documentation
Block Performance Stage
Common Techniques: Nerve Stimulation
Common Techniques: Ultrasound Imaging
Other Related Equipment
Needles
Catheters
Postblock Stage
Block Assessment and Monitoring
Discharge Criteria
Avoiding Complications
Patient Selection
Local Anesthetic Drug Selection, Toxicity, and Doses
Nerve Damage and Other Complications
Clinical Anatomy
Head and Neck
Trigeminal Nerve
Cervical Plexus
Occipital Nerve
Spine
Spinal Nerves
Paravertebral Space
Orientation of the Vertebral Body Processes
Upper Extremity
Brachial Plexus
Trunk
Intercostal Nerves and Articulations
Lumbar Spinal Nerves and Plexus
Inguinal Nerves
Lower Extremity
Sacral Plexus: Formation and Branches
Sciatic, Tibial, and Common Peroneal Nerves
Terminal Nerves of the Lumbar Plexus
Nerves at the Ankle
Specific Techniques
Head and Neck
Trigeminal Nerve Blocks
Cervical Plexus Blocks
Occipital Nerve Blocks
Upper Extremity
Brachial Plexus Block
Terminal Upper Extremity Nerve Blocks
Intravenous Regional Anesthesia (Bier Block)
Trunk Nerve Blocks
Intercostal Nerve Block
Transversus Abdominis Plane Block
Ilioinguinal and Iliohypogastric Nerve Blocks
Penile Block
Lower Extremity
Techniques
Lumbar Plexus Block (Psoas Compartment Block)
Separate Blocks of the Terminal Nerves of the Lumbar Plexus
Sciatic Nerve Block Using Gluteal, Subgluteal, Posterior Popliteal, and Anterior Approaches
Ankle Block
Continuous Catheter Technique
Acknowledgments
References
SECTION 7 Anesthesia Subspeciality Care
Chapter 37 Anesthesia for Neurosurgery
Introduction
Neuroanatomy
Neurophysiology
Pathophysiology
Monitoring
Central Nervous System Function
Influence of Anesthetic Technique on Evoked Potentials
Cerebral Perfusion
Transcranial Doppler Ultrasonography
Laser Doppler Flowmetry
Intracranial Pressure Monitoring
Cerebral Oxygenation and Metabolism Monitors
Cerebral Protection
Ischemic and Reperfusion
Hypothermia
Pharmacologic Therapy for Cerebral Protection
Glucose and Cerebral Ischemia
A Practical Approach
Anesthetic Management
Preoperative Evaluation
Induction of Anesthesia and Airway Management
Maintenance of Anesthesia
Ventilation Management
Fluids and Electrolytes
Transfusion Therapy
Glucose Management
Emergence
Common Surgical Procedures
Surgery for Tumors
Pituitary Surgery
Cerebral Aneurysm Surgery and Endovascular Treatment
Arteriovenous Malformations
Carotid Surgery
Epilepsy Surgery
Awake Craniotomy
Anesthesia and Traumatic Brain Injury
Anesthetic Management
Anesthesia for Spine Trauma and Complex Spine Surgery
Spinal Cord Injury
Comorbid Injuries
Initial Management
Intraoperative Management
Complications of Anesthesia for Spine Surgery
Conclusion
References
Chapter 38 Anesthesia for Thoracic Surgery
Preoperative Evaluation
History
Dyspnea
Cough
Cigarette Smoking
Exercise Tolerance
Risk Factors for Acute Lung Injury
Physical Examination
Respiratory Pattern
Evaluation of the Cardiovascular System
Electrocardiogram
Chest Radiography
Arterial Blood Gas Analysis
Pulmonary Function Testing and Evaluation for Lung Resectability
Effects of Anesthesia and Surgery on Lung Volumes
Spirometry
Flow–Volume Loops
Split-Lung Function Tests
Diffusing Capacity for Carbon Monoxide
Preoperative Preparation
Smoking
Infection
Hydration and Removal of Bronchial Secretions
Wheezing and Bronchodilation
Sympathomimetic Drugs
Phosphodiesterase Inhibitors
Steroids
Cromolyn Sodium
Parasympatholytic Drugs
Pulmonary Rehabilitation
Intraoperative Monitoring
Direct Arterial Catheterization
Central Venous Pressure Monitoring
Pulmonary Artery Catheterization
Transesophageal Echocardiography
Additional Noninvasive Monitoring
Monitoring of Oxygenation and Ventilation
Oxygenation
Ventilation
Physiology of One-Lung Ventilation
One-Lung Ventilation
Absolute Indications for One-Lung Ventilation
Relative Indications for One-Lung Ventilation
Methods of Lung Separation
Double-Lumen Endobronchial Tubes
Lung Separation in the Patient with a Tracheostomy
Lung Separation in the Patient with a Difficult Airway
Single-Lumen Tube Can be Successfully Placed
Use of a Tube Exchanger
Use of Modern Bronchial Blockers
Conclusion of the Surgical Procedure
Management of One-Lung Ventilation
Confirmation of Correct Position of DLT or Endobronchial Blocker
Inspired Oxygen Fraction
Tidal Volume and Respiratory Rate
Positive End-Expiratory Pressure to the Dependent Lung
Continuous Positive Airway Pressure to the Nondependent Lung
Clinical Approach to Management of One-Lung Ventilation
Choice of Anesthesia for Thoracic Surgery
Hypoxic Pulmonary Vasoconstriction
Effects of Anesthetics on Hypoxic Pulmonary Vasoconstriction
Other Determinants of Hypoxic Pulmonary Vasoconstriction
Potentiators of Hypoxic Pulmonary Vasoconstriction
Nitric Oxide and One-Lung Ventilation
Anesthesia for Diagnostic Procedures
Bronchoscopy
Local Anesthesia
General Anesthesia
Rigid Bronchoscopy
Fiberoptic Bronchoscopy
Complications of Bronchoscopy
Diagnostic Procedures for Mediastinal Mass
Mediastinoscopy
Thoracoscopy
Video-Assisted (Minimally Invasive) Thoracoscopic Surgery
Anesthesia Considerations
Postoperative Concerns
Anesthesia for Special Situations
High-Frequency Ventilation
Bronchopleural Fistula and Empyema
Lung Cysts and Bullae
Anesthesia for Resection of the Trachea
Bronchopulmonary Lavage
Myasthenia Gravis
Medical Therapy
Management of General Anesthesia
Postoperative Respiratory Failure
Postoperative Care
Myasthenic Syndrome (Eaton–Lambert Syndrome)
Postoperative Management and Complications
Postoperative Pain Control
Complications Following Thoracic Surgery
Atelectasis
Cardiovascular Complications
Bleeding and Respiratory Complications
Neurologic Complications
References
Chapter 39 Anesthesia for Cardiac Surgery
Introduction
Coronary Artery Disease
Myocardial Oxygen Demand
Myocardial Oxygen Supply
Coronary Blood Flow
Hemodynamic Goals
Monitoring for Ischemia
Selection of Anesthetic
Opioids
Inhalation Anesthetics
Intravenous Sedative Hypnotics
Treatment of Ischemia
Nitrates
Sodium Nitroprusside
Vasoconstrictors
β-Blockers
Calcium Channel Blockers
Valvular Heart Disease
Aortic Stenosis
Pathophysiology
Anesthetic Considerations
Hypertrophic Cardiomyopathy
Pathophysiology
Anesthetic Considerations
Aortic Insufficiency
Pathophysiology
Anesthetic Considerations
Mitral Stenosis
Pathophysiology
Anesthetic Considerations
Mitral Regurgitation
Pathophysiology
Anesthetic Considerations
Aortic Diseases
Aortic Dissection
Anesthetic Considerations
Aortic Aneurysm
Anesthetic Considerations
Cardiopulmonary Bypass
Circuits
Oxygenators
Pumps
Heat Exchanger
Prime
Anticoagulation
Blood Conservation in Cardiac Surgery
Myocardial Protection
Preoperative and Intraoperative Management
Current Drug Therapy
Physical Examination
Premedication
Monitoring
Pulse Oximeter
Electrocardiogram
Temperature
Arterial Blood Pressure
Central Venous Pressure and Pulmonary Artery Catheter
Echocardiography
Central Nervous System Function and Complications
Selection of Anesthetic Drugs
Opioids
Induction Drugs
Neuromuscular Blocking Drugs
Intraoperative Management
Preparation
Preinduction Period
Induction and Intubation
Preincision Period
Incision to Bypass
Cardiopulmonary Bypass
Monitoring and Management During Bypass
Rewarming
Discontinuation of Cardiopulmonary Bypass
Intra-Aortic Balloon Pump
Ventricular Assist Device
Reversal of Anticoagulation
Postbypass Bleeding
Minimally Invasive Cardiac Surgery
Postoperative Considerations
Bring Backs
Tamponade
Pain Management
Anesthesia for Children with Congenital Heart Disease
Preoperative Evaluation
History
Physical Examination
Laboratory Evaluations
Cardiac Evaluations
Premedication
Monitoring
Anesthetic and Intraoperative Management
Tracheal Extubation and Postoperative Ventilation
Hybrid Procedures in Pediatric Cardiac Surgery
References
Chapter 40 Anesthesia for Vascular and Endovascular Surgery
Introduction and Overview
Vascular Disease
Pathophysiology of Atherosclerosis
Concurrent Vascular Disease in Vascular Surgery Patients
Medical Optimization Prior to Vascular Surgery
Preoperative Anesthesia Evaluation for Vascular Surgery
Open Vascular Surgery
Cerebrovascular Disease
Preoperative Evaluation and Preparation
Neurophysiologic Monitoring and Preserving Neurologic Integrity During Carotid Endarterectomy
Anesthetic Considerations for Carotid Endarterectomy
Postoperative Considerations
Aortic Reconstruction
Pathophysiology of Aortic Occlusion and Reperfusion
Renal Hemodynamics and Renal Protection
Spinal Cord Ischemia and Protection
Anesthetic Management of Open Aortic Reconstruction
Peripheral Artery Disease
Anesthetic Management of Lower Extremity Revascularization
Endovascular Surgery
Carotid Artery Stenting
Endovascular Aortic Repair
Evolution of Endovascular Repair for Complex Aneurysms
Anesthetic Management of Endovascular Aneurysm Repair
Complications of Endovascular Aneurysm Repair
Endovascular Management of Peripheral Artery Disease
Conclusion
References
Chapter 41 Obstetric Anesthesia
Physiologic Changes of Pregnancy
Hematologic Alterations
Cardiovascular Changes
Respiratory Changes
Metabolism
Gastrointestinal Changes
Altered Drug Responses
Placental Transfer and Fetal Exposure to Anesthetic Drugs
Placenta
Hemodynamic Factors
Fetus and Newborn
Analgesia for Labor and Vaginal Delivery
Nonpharmacologic Methods of Labor Analgesia
Prepared Childbirth and Psychoprophylaxis
Other Nonpharmacologic Methods
Systemic Medication
Opioids
Ketamine
Regional Analgesia
Epidural Analgesia
Spinal Analgesia
Combined Spinal/Epidural Analgesia
Paracervical Block
Paravertebral Lumbar Sympathetic Block
Pudendal Nerve Block
Inhalation Analgesia and General Anesthesia
Anesthesia for Cesarean Delivery
Neuraxial Anesthesia
Spinal Anesthesia
Lumbar Epidural Anesthesia
Combined Spinal/Epidural Anesthesia
General Anesthesia
Anesthetic Complications
Maternal Mortality
Pulmonary Aspiration
Hypotension
Total Spinal Anesthesia
Local Anesthetic Systemic Toxicity
Postdural Puncture Headache
Nerve Injury
Management of High-Risk Parturients
Hypertensive Disorders of Pregnancy
General Management
Anesthetic Management
Obstetric Hemorrhage
Heart Disease
Congenital Heart Disease
Valvular Heart Disease
Primary Pulmonary Hypertension
Cardiomyopathy of Pregnancy
Coronary Artery Disease and Myocardial Infarction
Sudden Arrhythmic Death Syndrome
Diabetes Mellitus
Obesity
Advanced Maternal Age
Preterm Delivery
Substance Abuse
Tobacco Abuse
Alcohol
Opioids
Marijuana
Cocaine
Amphetamines
Fetal Monitoring
Electronic Fetal Monitoring
Ancillary Tests and Fetal Pulse Oximetry
Newborn Resuscitation in the Delivery Room
Fetal Asphyxia
Neonatal Adaptations at Birth
Resuscitation
Evaluation and Treatment
The APGAR Score
Diagnostic Procedures
Exit Procedure
Anesthesia for Nonobstetric Surgery in the Pregnant Woman
Practical Suggestions
References
Chapter 42 Neonatal Anesthesia
Physiology of the Infant and the Transition Period
The Cardiovascular System
Fetal Circulation
The Pulmonary System
Persistent Pulmonary Hypertension of the Newborn
Meconium Aspiration
The Renal System
Fluid and Electrolyte Therapy in the Neonate
Blood Component Therapy in the Neonate
The Hepatic System
Anatomy of the Neonatal Airway
Anesthetic Drugs in Neonates
Intravenous Agents
Opioids
Neuromuscular Blocking Agents
Nondepolarizing Agents
Intermediate Nondepolarizing Agents
Volatile Agents
Local Anesthetics
Topical Anesthesia
Anesthetic Management of the Neonate
Preoperative Considerations
Preanesthetic Evaluation—History
Preanesthetic Evaluation—Physical Examination
Preanesthetic Evaluation—Laboratory
Preanesthetic Plan
Premedication
Intraoperative Considerations
Monitoring
Anesthetic Systems
Impact of Surgical Requirements on Anesthetic Technique
Uptake and Distribution of Anesthetics in Neonates
Anesthetic Dose Requirements of Neonates
Regional Anesthesia
Spinal Anesthesia
Caudal Block
Epidural Analgesia
Peripheral Nerve Blocks
Postoperative Pain Management
Oral Routes
Rectal Routes
Intravenous Analgesia
Postoperative Ventilation
Special Considerations
Maternal Drug Use During Pregnancy
Temperature Control and Thermogenesis
Respiratory Distress Syndrome
Postoperative Apnea
Retinopathy of Prematurity
Neurodevelopmental Effects of Anesthetic Agents
Surgical Procedures in Neonates
Surgical Procedures in the First Week of Life
Congenital Diaphragmatic Hernia
Omphalocele and Gastroschisis
Tracheoesophageal Fistula
Intestinal Obstruction
Myelomeningocele
Hydrocephalus
Surgical Procedures in the First Month of Life
Necrotizing Enterocolitis
Inguinal Hernia Repair in the Neonate
Pyloric Stenosis
Ligation of A Patent Ductus Arteriosus
Placement of A Central Venous Catheter
Summary
Acknowledgment
References
Chapter 43 Pediatric Anesthesia
Anatomy and Physiology
Airway
Cardiovascular
Central Nervous System
Physiology
Neuroapoptosis
Pharmacology
Developmental Pharmacology
Inhalational Anesthetics
Pharmacokinetics
Pharmacodynamics
Intravenous
Propofol
Ketamine
Etomidate
Neuromuscular Blocking Agents
Opioids
Sedatives
Preoperative Assessment
Fasting Guidelines
Laboratory Testing
Medical Conditions
Upper Respiratory Tract Infection
Asthma
Obstructive Sleep Apnea
Ex-Premature Infants
Malignant Hyperthermia
Myopathies
Sickle Cell Disease
Anterior Mediastinal Mass
Subacute Endocarditis (SBE) Prophylaxis
Obesity
Preoperative History
Allergies
Preoperative Physical Examination
Anesthetic Risks; Consent/Assent
Induction of Anesthesia
Equipment
Monitors
Capnography
Temperature
Depth of Anesthetic Monitoring
Emergency Drugs
Full Stomach and Rapid Sequence Induction
Preoperative Preparation
Anxiolysis
Parental Presence at Induction of Anesthesia
Distraction Techniques
Pharmacologic Sedation
Induction Techniques
Inhalational Induction
IV Induction
IM Induction
Rectal Induction
Problems During Induction of Anesthesia
Hemoglobin Oxygen Desaturation
Laryngospasm
Bradycardia
Maintenance of Anesthesia
Techniques
Fluid Management
General Principles
Elective Surgery
Blood Transfusion Therapy
Prophylaxis for Postoperative Vomiting
Regional Anesthesia and Pain Management
Caudal Blockade
Epidural Block
Spinal Block
Emergence and Recovery from Anesthesia
Transport to PACU
PACU Complications
Laryngospasm, Postoperative Stridor, and Negative Pressure Pulmonary Edema
Oxygen Desaturation
Emergence Delirium
Vomiting
Postoperative Pain
References
SECTION 8 Anesthesia for Selected Surgical Services
Chapter 44 Anesthesia for Laparoscopic and Robotic Surgeries
Introduction
Laparoscopic Surgery
Surgical Approach and Positioning
Ambulatory Laparoscopic Surgery
Robotic Laparoscopic Surgery
Physiologic Impact of Laparoscopy
Cardiovascular System
Respiratory System
Regional Perfusion Effects
Intraoperative Management
Monitoring
Anesthesia Maintenance
Inhaled Anesthetics and Propofol
Nitrous Oxide
Pharmacologic Adjuncts
Neuromuscular Blockade
Mechanical Ventilation
Body Temperature
Fluid Management
Complications Related to Surgery
Intraoperative
Intra-Abdominal Injuries
Cardiopulmonary
Co2 Extravasation
Patient Shifting and Falls
Ocular Injuries
Peripheral Nerve and Brachial Plexus Injuries
Airway Edema
Postoperative Complications
Respiratory Dysfunction
Venous Thrombosis
Postoperative Management
Acute Pain Management
Postoperative Nausea and Vomiting
Conclusion
References
Chapter 45 Anesthesia and Obesity
Definition and Epidemiology
Introduction
Management of Obesity
Medical Therapy
Bariatric Surgery
Pathophysiology
Respiratory System
Cardiovascular and Hematologic Systems
Gastrointestinal System
Renal and Endocrine Systems
Pharmacology
Pharmacologic Principles
Other Perioperative Agents
Preoperative Evaluation
Intraoperative Considerations
Equipment and Monitoring
Airway Management
Induction and Maintenance
Fluid Management
Mechanical Ventilation
Emergence
Monitored Anesthesia Care and Sedation
Regional Anesthesia
Neuraxial Anesthesia
Peripheral Nerve Block
Postoperative Considerations
Ventilatory Evaluation and Management
Postoperative Analgesia
Monitoring
Ambulatory Anesthesia
Critical Care and Resuscitation
Morbidity and Mortality
References
Chapter 46 The Liver: Surgery and Anesthesia
Hepatic Function in Health
Assessment of Hepatic Function
Hepatobiliary Imaging
Liver Biopsy
Hepatic and Hepatobiliary Diseases
Acute Liver Failure
Acute Hepatitis
Alcoholic Hepatitis
Drug-Induced Liver Injury
Pregnancy-Related Liver Diseases
Cirrhosis and Portal Hypertension
Hemostasis
Cardiac Manifestations
Renal Dysfunction
Pulmonary Complications
Hepatic Encephalopathy
Ascites
Varices
Chronic Cholestatic Disease
Chronic Hepatocellular Disease
Hepatocellular Carcinoma
Nonalcoholic Fatty Liver Disease
Preoperative Management
Hepatic Evaluation
Perioperative Risk Associated with Liver Disease
Intraoperative Management
Monitoring and Vascular Access
Selection of Anesthetic Technique
Neuraxial Versus General Anesthesia
Volatile Anesthetics
Nitrous Oxide
Intravenous Anesthetics
Pharmacokinetic and Pharmacodynamic Alterations
Vasopressors
Volume Resuscitation
Transjugular Intrahepatic Portosystemic Shunt Procedure
Hepatic Resection
Postoperative Liver Dysfunction
Conclusions
Acknowledgment
References
Chapter 47 Endocrine Function
Thyroid Gland
Thyroid Metabolism and Function
Tests of Thyroid Function
Serum Thyroxine
Serum Triiodothyronine
Tests for Assessing Thyroid Hormone Binding
Thyroid-Stimulating Hormone
Radioactive Iodine Uptake
Hyperthyroidism
Treatment and Anesthetic Considerations
Anesthesia for Thyroid Surgery
Hypothyroidism
Treatment and Anesthetic Considerations
Parathyroid Glands
Calcium Physiology
Hyperparathyroidism
Treatment and Anesthetic Considerations
Anesthesia for Parathyroid Surgery
Hypoparathyroidism
Clinical Features and Treatment
Adrenal Cortex
Glucocorticoid Physiology
Mineralocorticoid Physiology
Glucocorticoid Excess (Cushing Syndrome)
Anesthetic Management
Mineralocorticoid Excess
Anesthetic Considerations
Adrenal Insufficiency (Addison Disease)
Clinical Presentation
Diagnosis
Treatment and Anesthetic Considerations
Steroid Replacement During the Perioperative Period
Exogenous Glucocorticoid Therapy
Mineralocorticoid Insufficiency
Adrenal Medulla
Pheochromocytoma
Clinical Presentation
Diagnosis
Anesthetic Considerations
Diabetes Mellitus
Classification
Physiology
Diagnosis
Treatment
Anesthetic Management
Preoperative
Intraoperative
Hyperglycemia and Perioperative Outcomes
Perioperative Glycemic Control
Glycemic Goals
Management of Perioperative Hyperglycemia
Type 1 Diabetes
Type 2 Diabetes
Emergencies
Hyperosmolar Nonketotic Coma
Diabetic Ketoacidosis
Hypoglycemia
Pituitary Gland
Anterior Pituitary
Posterior Pituitary
Vasopressin
Diabetes Insipidus
Inappropriate Secretion of Antidiuretic Hormone
Endocrine Response to Surgical Stress
References
Chapter 48 Anesthesia for Otolaryngologic Surgery
Evaluating the Airway
Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Tonsillectomy and Adenoidectomy
Preoperative Evaluation
Sleep-Disordered Breathing and Obstructive Sleep Apnea
Anesthetic Management
Complications
Laryngology
Ear Surgery
Myringotomy and Tube Insertion
Middle Ear and Mastoid
Airway Surgery
Stridor
Bronchoscopy
Pediatric Airway Emergencies
Epiglottitis
Laryngotracheobronchitis
Foreign Body Aspiration
Pediatric and Adult Surgery
Laser Surgery of the Airway
Nasal Surgery
Skull Base Surgery
Upper Airway Infections
Maxillofacial Trauma
Acknowledgments
References
Chapter 49 Anesthesia for Ophthalmologic Surgery
Ocular Anatomy
Ocular Physiology
Formation and Drainage of Aqueous Humor
Maintenance of Intraocular Pressure
Glaucoma
Effects of Anesthesia and Adjuvant Drugs on Intraocular Pressure
Central Nervous System Depressants
Ventilation and Temperature
Adjuvant Drugs
Hypertonic Solutions and Acetazolamide
Neuromuscular Blocking Drugs
Oculocardiac Reflex
Anesthetic Ramifications of Ophthalmic Drugs
Anticholinesterase Agents
Cocaine
Cyclopentolate
Epinephrine
Phenylephrine
Timolol and Betaxolol
Intraocular Perfluorocarbons
Systemic Ophthalmic Drugs
Preoperative Evaluation
Establishing Rapport and Assessing Medical Condition
Anesthesia Options
Side of Anesthesia and Surgery
Anesthesia Techniques
Retrobulbar (Intraconal) and Peribulbar (Extraconal) Blocks
Cannula-Based Techniques
Topical Analgesia
Choice of Local Anesthetics, Block Adjuvants, and Adjuncts
General Principles of Monitored Anesthesia Care
Anesthetic Management in Specific Situations
“Open-Eye, Full-Stomach” Encounters
Intraocular Surgery
Retinal Detachment Surgery
Strabismus Surgery
Principles of Laser Therapy
Postoperative Ocular Complications
Corneal Abrasion
Chemical Injury
Photic Injury
Mild Visual Symptoms
Hemorrhagic Retinopathy
Retinal Ischemia
Ischemic Optic Neuropathy
Anterior Ischemic Optic Neuropathy
Posterior Ischemic Optic Neuropathy
Cortical Blindness
Acute Glaucoma
Postcataract Ptosis
References
Chapter 50 The Renal System and Anesthesia for Urologic Surgery
Introduction and Context
Renal Anatomy and Physiology
Gross Anatomy
Ultrastructure
Correlation of Structure and Function
Glomerular Filtration
Autoregulation of Renal Blood Flow and Glomerular Filtration Rate
Tubular Reabsorption of Sodium and Water
Clinical Assessment of the Kidney
Renal Function Tests
Perioperative Nephrology
Pathophysiology
Electrolyte Disorders
Disorders of Sodium Balance
Disorders of Potassium Balance
Disorders of Calcium, Magnesium, and Phosphorus
Acid–Base Disorders
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Mixed Acid–Base Disorders
Acute Kidney Conditions
Acute Kidney Injury
Nephrotoxins and Perioperative Acute Kidney Injury
Chronic Kidney Disease
Drug Prescribing in Renal Failure
Anesthetic Agents in Renal Failure
Induction Agents and Sedatives
Opioids
Muscle Relaxants
Diuretic Drugs: Effects and Mechanisms
High Renal Risk Surgical Procedures
Cardiac Surgery
Noncardiac Surgery
Anesthetic Considerations for Urologic Procedures
Nephrectomy
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Specific Procedures
Simple and Donor Nephrectomies
Radical Nephrectomy
Radical Nephrectomy With Inferior Vena Cava Tumor Thrombus
Nephron-Sparing Partial Nephrectomy
Laparoscopic and Robotic Nephrectomies
Physiology of Pneumoperitoneum
Cystectomy and Other Major Bladder Surgeries
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Specific Procedures
Partial Cystectomy
Simple and Radical Cystectomy
Ileal Conduit and Other Diversion Procedures
Prostatectomy
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Specific Procedures
Simple Prostatectomy
Radical Prostatectomy
Laparoscopic and Robotic Prostatectomy
Transurethral Surveillance and Resection Procedures
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Specific Procedures
Cystoscopy and Ureteroscopy
Transurethral Bladder Tumor Resection
Transurethral Prostate Resection
Irrigating Solutions and Transurethral Resection Syndrome
Therapies for Urolithiasis
Preoperative Considerations
Intraoperative Considerations
Postoperative Considerations
Specific Procedures
Shock Wave Lithotripsy
Percutaneous Nephrolithotomy
Ureteroscopy for Removal of Stones (URS)
Open and Laparoscopic Pyelolithotomy or Nephrectomy
Urogynecology and Pregnancy-Related Urologic Procedures
Impotence Surgery and Medication
Pediatric Surgical Urologic Disorders
Nephrectomy and Adrenalectomy
Reconstructive Urologic Procedures
Urologic Surgical Emergencies
Testicular Torsion
Fournier Gangrene
Emergency Treatment of Nephrolithiasis
References
Chapter 51 Anesthesia for Orthopedic Surgery
Introduction to Orthopedic Anesthesia
Preoperative Assessment
Selection of Anesthetic Technique
Anesthesia for Spine Surgery
Preoperative Assessment
Positioning for Spine Surgery
Blood Conservation
Spinal Cord Monitoring
Spinal Cord Injury
Scoliosis
Muscular Disorders
Degenerative Vertebral Column Disease
Postoperative Care of the Spine Patient
Complications of Spine Surgery
Upper Extremity Surgery
Surgery to the Shoulder and Upper Arm
Surgical Approach and Positioning
Anesthetic Management
Surgery to the Elbow, Wrist, and Hand
Postoperative Regional Analgesia
Lower Extremity Surgery
Surgery to the Hip and Pelvis
Surgical Approach and Positioning
Anesthesia Technique
Blood Loss and Transfusion
Ambulatory Hip Surgery
Surgery to the Knee
Total Knee Arthroplasty
Positioning and Anesthesia Technique
Analgesia for Total Knee Arthroplasty
Ambulatory Knee Surgery
Surgery to the Foot and Ankle
Pediatric Orthopedic Anesthesia
Special Considerations in Orthopedics
Amputation
Microvascular Surgery
Acute Compartment Syndrome
Tourniquets
Fat Embolus Syndrome/Bone Cement Implantation Syndrome
Venous Thromboembolism and Thromboprophylaxis
References
Chapter 52 Transplant Anesthesia
Anesthetic Management of Organ Donors
Brain-Dead Donors (Donation After Neurologic Death)
Donation After Cardiac Death (Donation After Circulatory Determination of Death)
Living Kidney Donors
Living Liver Donors
Immunosuppressive Agents
Calcineurin Inhibitors
Corticosteroids
Polyclonal and Monoclonal Antibodies
Mammalian Target of Rapamycin Inhibitors
Purine Antagonists
Cell Therapies
Corneal Transplantation
Renal Transplantation
Preoperative Considerations
Intraoperative Procedures
Liver Transplantation
Preoperative Considerations
Intraoperative Procedures
Coagulation
Pediatric Liver Transplantation
Acute Liver Failure
Pancreas and Islet Transplantation
Small Bowel and Multivisceral Transplantation
Composite Tissue Allografts
Lung Transplantation
Recipient Selection
Intraoperative Management
Single-Lung Transplantation
Double-Lung Transplantation
Pediatric Lung Transplantation
Primary Graft Dysfunction (PGD)
Inhaled Nitric Oxide (iNO)
Heart–Lung Transplant (Adult and Pediatric)
Heart Transplantation
Left Ventricular Assist Devices
Recipient Selection
Preanesthetic Considerations
Intraoperative Management
Pediatric Heart Transplantation
Management of the Transplant Patient for Nontransplant Surgery
References
Chapter 53 Trauma and Burns
Initial Evaluation and Resuscitation
Airway Evaluation and Intervention
Airway Obstruction
Full Stomach
Head, Open Eye, and Contained Major Vessel Injuries
Cervical Spine Injury
Direct Airway Injuries
Management of Breathing Abnormalities
Management of Shock
Early Management of Specific Injuries
Head Injury
Diagnosis
Management
Spine and Spinal Cord Injury
Initial Evaluation
Initial Management
Respiratory Complications
Hemodynamic Management
Anesthetic Considerations
Neck Injury
Chest Injury
Chest Wall Injury
Pleural Injury
Pulmonary Contusion
Penetrating Cardiac Injury
Pericardial Tamponade
Blunt Cardiac Injury
Thoracic Aortic Injury
Diaphragmatic Injury
Abdominal and Pelvic Injuries
Fractures of the Pelvis
Extremity Injuries
Burns
Airway Complications
Ventilation and Intensive Care
Carbon Monoxide Toxicity
Cyanide Toxicity
Fluid Replacement
Operative Management
Monitoring
Hemodynamic Monitoring
Urine Output
Oxygenation
Organ Perfusion and Oxygen Utilization
Coagulation
Anesthetic and Adjunct Drugs
Airway Compromise
Hypovolemia
Head and Open Eye Injuries
Cardiac Injury
Burns
Management of Intraoperative Complications
Persistent Hypotension
Hypothermia
Coagulation Abnormalities
Diagnosis
Treatment
Electrolyte and Acid–Base Disturbances
Intraoperative Death
Early Postoperative Considerations
Ventilatory Support
Acute Kidney Injury
Abdominal Compartment Syndrome
Thromboembolism
References
SECTION 9 Postanesthetic Management, Critical Care, and Pain Management
Chapter 54 Postanesthesia Recovery
Postanesthesia Recovery
Standards for Postanesthesia Care
Value and Economics of Postanesthesia Care Unit
Levels of Postoperative/Postanesthesia Care
Postanesthetic Triage
Safety in the Postanesthesia Care Unit
Admission to the Postanesthesia Care Unit
Postoperative Pain Management
Discharge Criteria
Postoperative Evaluation
Cardiovascular Complications
Postoperative Pulmonary Dysfunction
Inadequate Postoperative Ventilation
Inadequate Respiratory Drive
Increased Airway Resistance
Decreased Compliance
Neuromuscular and Skeletal Problems
Increased Deadspace
Increased Carbon Dioxide Production
Inadequate Postoperative Oxygenation
Distribution of Ventilation
Distribution of Perfusion
Inadequate Alveolar PaO2
Reduced Mixed Venous PO2
Obstructive Sleep Apnea
Anemia
Supplemental Oxygen
Perioperative Aspiration
Postoperative Renal Complications
Ability to Void
Renal Tubular Function
Oliguria
Polyuria
Metabolic Complications
Postoperative Acid–Base Disorders
Respiratory Acidemia
Metabolic Acidemia
Respiratory Alkalemia
Metabolic Alkalemia
Glucose Disorders and Control
Hyperglycemia
Hypoglycemia
Electrolyte Disorders
Hyponatremia
Hypokalemia
Hyperkalemia
Calcium and Magnesium
Miscellaneous Complications
Incidental Trauma
Ocular Injuries and Visual Changes
Hearing Impairment
Oral, Pharyngeal, and Laryngeal Injuries
Nerve Injuries
Soft Tissue and Joint Injuries
Skeletal Muscle Pain
Hypothermia and Shivering
Hyperthermia
Persistent Sedation/Delayed Emergence
Altered Mental Status
Emergence Reactions
Delirium and Cognitive Decline
Postoperative Nausea and Vomiting
References
Chapter 55 Acute Pain Management
Acute Pain Defined
Anatomy of Acute Pain
Pain Processing
Chemical Mediators of Transduction and Transmission
The Surgical Stress Response
Preventive Analgesia
Strategies for Acute Pain Management
Assessment of Acute Pain
Opioid Analgesics
Nonopioid Analgesic Adjuncts
Methods of Analgesia
Patient-Controlled Analgesia
Neuraxial Analgesia
Peripheral Nerve Blockade
The Brachial Plexus
The Lumbar Plexus
Sacral Plexus
Truncal Blocks
Wound Infiltration
Continuous Peripheral Nerve Blockade Caveats
Complications from Regional Anesthesia
Perioperative Pain Management of the Opioid-Dependent Patient
Organization of Perioperative Pain Management Services
Special Considerations in the Perioperative Pain Management of Children
Nonparenteral Analgesics
Nonopioid Analgesics
Opioid Analgesics
Patient-Controlled Analgesia
Epidural Neuraxial Analgesia
Peripheral Nerve Blocks in Children
Conclusion
References
Chapter 56 Chronic Pain Management
Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Primary Afferents and Peripheral Stimulation
Neurochemistry of Peripheral Nerve and the Dorsal Root Ganglion
Neurobiology of the Spinal Cord and Spinal Trigeminal Nucleus
Neurobiology of Ascending Pathways
Dorsal Column Tracts
Spinothalamic Tract
Spinohypothalamic, Limbic, and Cortical Connections
Neurobiology of Descending Pathways
Neurobiology of Supraspinal Structures Involved in Higher Cortical Processing
Transition from Acute to Persistent or Chronic Nociception
Management of Common Pain Syndromes
Low Back Pain: Radicular Pain Syndromes
Low Back Pain: Facet Syndrome
Buttock Pain: Sacroiliac Joint Syndrome and Piriformis Syndrome
Piriformis Syndrome
Myofascial Pain Syndrome and Fibromyalgia
Fibromyalgia
Neuropathic Pain Syndromes
Herpes Zoster and Postherpetic Neuralgia
Diabetic Painful Neuropathy
Complex Regional Pain Syndrome
Human Immunodeficiency Virus Neuropathy
Phantom Pain
Cancer Pain
Neurolytic Blocks for Visceral Pain from Cancer
Celiac Plexus Block
Superior Hypogastric Plexus Block
Ganglion Impar Block
Pharmacologic Management of Pain
Opioids
Pharmacologic Treatments of Neuropathic Pain
Antidepressants
Anticonvulsants
Lidocaine Patch, Capsaicin Patch, Mexiletine, and Intravenous Lidocaine
Cannabinoids
Buprenorphine–Naloxone Therapy
Interventional Techniques
Discography
Thermal Annular Procedures
Minimally Invasive Lumbar Decompression Procedure
Vertebroplasty and Kyphoplasty
Spinal Cord Stimulation
Peripheral Nerve Stimulation
Dorsal Root Ganglion Stimulation
Occipital Nerve Stimulation
Intrathecal Drug Delivery
Summary
References
Chapter 57 Critical Care Medicine
Introduction
Anesthesiologists and Critical Care Medicine
Anesthesiology and Critical Care Medicine: The Future
Critical Care Medicine: A Systems and Processes Approach
Processes of Care in the ICU
Staffing
Checklists
Protocols and Care Bundles
Resource Management
Neurologic and Neurosurgical Critical Care
Neuromonitoring
Diagnosis and Clinical Management of the most Common Types of Neurologic Failure
Traumatic Brain Injury
Subarachnoid Hemorrhage
Acute Ischemic Stroke
Anoxic Brain Injury
Cardiovascular and Hemodynamic Aspects of Critical Care
Types of Shock
Cardiogenic Shock
Septic Shock
Monitoring and Resuscitation in Shock States
Hemodynamic Monitoring
Echocardiography
Dynamic Respiratory Indices
Less-Invasive Cardiac Output Monitors
Metabolic Monitoring
Acute Respiratory Failure
Principles of Mechanical Ventilation
Acute Respiratory Distress Syndrome
Acute Kidney Injury
Endocrine Aspects of Critical Care Medicine
Glucose Management in Critical Illness
Adrenal Function in Critical Illness
Thyroid Function in Critical Illness
Somatotropic Function in Critical Illness
Anemia and Transfusion Therapy in Critical Illness
Nutrition in the Critically Ill Patient
Sedation and Analgesia for the Critically Ill Patient
Goals and Assessment
Pharmacologic Management
Delirium and Neurocognitive Complications
Complications in the ICU: Detection, Prevention, and Therapy
Nosocomial Infections
Sinusitis
Ventilator-Associated Pneumonia
Catheter-Related Bloodstream Infections
Urinary Tract Infection
Invasive Fungal Infections
Stress Ulceration and Gastrointestinal Hemorrhage
Venous Thromboembolism
ICU-Acquired Weakness
End-of-Life Care in the ICU
References
Chapter 58 Cardiopulmonary Resuscitation
History
Scope of the Problem
Ethical Issues: Do Not Resuscitate Orders in the Operating Room
Components of Resuscitation
Airway Management
Foreign Body Airway Obstruction
Ventilation
Physiology of Ventilation During Cardiopulmonary Resuscitation
Techniques of Rescue Breathing
Circulation
Physiology of Circulation During Closed-Chest Compression
Cardiac Pump Mechanism
Thoracic Pump Mechanism
Distribution of Blood Flow During Cardiopulmonary Resuscitation
Gas Transport During Cardiopulmonary Resuscitation
Technique of Closed-Chest Compression
Alternative Methods of Circulatory Support
Interposed Abdominal Compression Cardiopulmonary Resuscitation
Mechanical Chest Compression Devices
Active Compression–Decompression Cardiopulmonary Resuscitation
Impedance Threshold Device
Invasive Techniques
Assessing the Adequacy of Circulation During Cardiopulmonary Resuscitation
Pharmacologic Therapy
Routes of Administration
Catecholamines and Vasopressors
Mechanism of Action
Epinephrine
Vasopressin
Amiodarone and Lidocaine
Drugs Not Routinely Given During CPR
Atropine
Sodium Bicarbonate
Calcium
Electrical Therapy
Electrical Pattern and Duration of Ventricular Fibrillation
Defibrillators: Energy, Current, and Voltage
Transthoracic Impedance
Adverse Effects and Energy Requirements
Putting It All Together
Time-Sensitive Model of Ventricular Fibrillation
Bystander CPR and Basic Life Support
Advanced Life Support
Rhythm Analysis and Defibrillation
Pediatric Cardiopulmonary Resuscitation
Postresuscitation Care
Prognosis
References
Chapter 59 Disaster Preparedness
Introduction
Preparation
Family Plan
Government Plan
Health-Care Agency Plans
Role of Anesthesiologist in Managing Mass Casualties
Triage
Decontamination
Emergency Department
Operating Room Management
Chemical
Nerve Agents
Diagnosis
Treatment
Pulmonary Agents
Blood Agents
Biologic
History
Smallpox
Anthrax
Plague
Tularemia
Botulism
Hemorrhagic Fevers
Radiation—Nuclear
Potential Sources of Ionizing Radiation Exposure
Management
Explosives
Conclusion
Appendix A. Disaster Preparedness Planning Guide for Families (from Fema)
References
SECTION 10 Appendices
Appendix 1 Formulas
Appendix 2 Atlas of Electrocardiography
Appendix 3 Pacemaker and Implantable Cardiac Defibrillator Protocols
Appendix 4 American Society of Anesthesiologists Standards, Guidelines, and Statements
Appendix 5 The Airway Approach Algorithm and Difficult Airway Algorithm
Appendix 6 Malignant Hyperthermia Protocol
Appendix 7 Herbal Medications
Appendix 8 Atlas of Ultrasound and Echocardiography
I Perioperative Applications
I.1 FOCUS exam: Focused Transthoracic Cardiac Ultrasound Examination
I.1.a Normal Parasternal Long Axis
I.1.b Normal Parasternal Midpapillary Short Axis
I.1.c Normal Apical Four Chamber
I.1.d Normal Apical Four Chamber
I.1.e Normal Subcostal Inferior Vena Cava
I.2 FAST exam: Focused Assessment with Sonography for Trauma
I.2.a Normal Right Upper Quadrant Coronal
I.2.b Normal Left Upper Quadrant Coronal
I.2.c Normal Male Pelvis Transverse
I.2.d Normal Subcostal Four Chamber
I.3 Thoracic/Pulmonary Ultrasound
I.3.a Normal Lung Sliding
I.3.b No Lung Sliding
I.4 Urinary Bladder Assessment
I.4.a Normal Transverse and Sagittal Bladder
II Perioperative and Intraoperative Applications
II.1 Basic TEE examination
II.1.a Normal Midesophageal Four Chamber
II.1.b Normal Midesophageal Four Chamber, CFD on MV
II.1.c Normal Midesophageal Four Chamber, CFD on TV
II.1.d Normal Midesophageal Two Chamber
II.1.e Normal Midesophageal Long Axis
II.1.f Normal Midesophageal Aortic Valve Long Axis
II.1.g Normal Midesophageal Aortic Valve Long Axis, CFD on AV
II.1.h Normal Midesophageal Aortic Valve Short Axis
II.1.i Normal Midesophageal Right Ventricular Inflow Outflow
II.1.j Normal Midesophageal Right Ventricular Inflow Outflow, CFD on PV
II.1.k Normal Midesophageal Bicaval
II.1.l Normal Transgastric Midpapillary Short Axis
II.1.m Normal Midesophageal Descending Aorta Short Axis
II.1.n Normal Midesophageal Descending Aorta Long Axis
II.2 Additional Views in the Comprehensive TEE Examination
II.2.a Normal Midesophageal Five-chamber
II.2.b Normal Midesophageal Mitral Commissural
II.2.c Normal Midesophageal Ascending Aorta Long Axis
II.2.d Normal Midesophageal Ascending Aorta Short Axis
II.2.e Normal Midesophageal right Pulmonary Vein View
II.2.f Normal Midesophageal Modified Bicaval Tricuspid Valve View
II.2.g Normal Upper Esophageal Right and Left Pulmonary Vein View
II.2.h Normal Midesophageal Left Atrial Appendage Cross Section
II.2.i Normal Transgastric Basal Short Axis
II.2.j Normal Transgastric Apical Short Axis
II.2.k Normal Transgastric Right Ventricular Basal View
II.2.l Normal Transgastric Right Ventricular Inflow-Outflow View
II.2.m Normal Deep Transgastric Five-Chamber View
II.2.n Normal Transgastric Two Chamber
II.2.o Normal Transgastric Right Ventricular Inflow
II.2.p Normal Transgastric Long Axis
II.2.q Normal Upper Esophageal Aortic Arch Long Axis
II.2.r Normal Upper Esophageal Aortic Arch Short Axis
II.3 3-D TEE Examination
II.3.a Normal 3-D Mitral Valve Surgeon’s View
II.3.b Normal 3-D Aortic Valve View
II.4 TEE Assessment of Global LV Systolic Function
II.4.a.i Normal LV Systolic Function: Midesophageal Four Chamber
II.4.a.ii Normal LV Systolic Function: Transgastric Midpapillary Short Axis
II.4.b.i Moderate LV Systolic Dysfunction: Midesophageal Four Chamber
II.4.b.ii Moderate LV Systolic Dysfunction: Transgastric Midpapillary Short Axis
II.4.c.i Severe LV Systolic Dysfunction: Midesophageal Four Chamber
II.4.c.ii Severe LV Systolic Dysfunction: Transgastric Midpapillary Short Axis
II.5 TEE Assessment of Global RV Systolic Function
II.5.a Normal RV Systolic Function: Midesophageal Four Chamber
II.5.b Moderate RV Systolic Dysfunction: Midesophageal Four Chamber
II.6 TEE Detection of Regional LV Systolic Function – Side by Side
II.6.a Normal vs. Abnormal Split Screen
II.6.a.i Normal and Abnormal Wall Motion: Midesophageal Four Chamber
II.6.a.ii Normal and Abnormal Wall Motion: Midesophageal Two Chamber
II.6.a.iii Normal and Abnormal Wall Motion: Midesophageal Long Axis
II.6.a.iv Normal and Abnormal Wall Motion: Transgastric Midpapillary Short Axis
II.7 TEE Assessment in the Severely Hypotensive Patient
II.7.a Hypovolemia
II.7.a.i Hypovolemia: Transgastric LV Short Axis
II.7.a.ii Hypovolemia: Upper Esophageal Superior Vena Cava Short Axis
II.7.a.iii Hypovolemia: Deep Transgastric Five Chamber
II.7.b Systemic Vasoplegia
II.7.b.i Systemic Vasoplegia: Midesophageal Four Chamber
II.7.b.ii Systemic Vasoplegia: Transgastric LV Short Axis
II.7.c Myocardial Ischemia – LV Failure
II.7.c.i Left Ventricular Ischemia/Failure: Midesophageal Four Chamber
II.7.d RV Failure
II.7.d.i Right Ventricular Failure: Midesophageal Four Chamber
II.7.e Tamponade
II.7.e.i Cardiac Tamponade: Midesophageal Four Chamber
II.7.f Cardiac Valvular Dysfunction
II.7.f.i Endocarditis/Severe Aortic Insufficiency: Midesophageal Aortic Valve Long Axis
II.7.f.ii Papillary Muscle Rupture/Severe Mitral Regurgitation: Midesophageal Four Chamber
II.7.g Aortic Dissection
II.7.g.i Type A Aortic Dissection: Midesophageal Aortic Long Axis
II.7.h Ventricular Outflow Obstruction
II.7.h.i Dynamic LV Outflow Tract Obstruction: Midesophageal Four Chamber
II.7.i Pulmonary Embolism
II.7.i.i Pulmonary Embolism: Midesophageal Four Chamber
II.7.j Takotsubo Cardiomyopathy
II.7.j.i Takotsubo Cardiomyopathy: Midesophageal Four Chamber
II.7.j.ii Takotsubo Cardiomyopathy: Midesophageal Two Chamber
II.8 TEE Prompted Changes in Surgical Management
II.8.a Revision of Scheduled Procedure
II.8.a.i Unsuspected Flail Mitral Leaflet: Midesophageal Five Chamber
II.8.a.ii Unsuspected Secundum Atrial Septal Defect: Interatrial Septal View
II.8.b Assessment of Valvular Surgery
II.8.b.i Mitral Valve Replacement
II.8.b.i.1 Post Replacement Paravalvular Leak: Midesophageal Four Chamber View
II.8.b.ii Mitral Valve Repair
II.8.b.ii.1 Post Repair Systolic Anterior Motion/Mitral Regurgitation: Midesophageal Four Chamber
II.8.b.ii.2 Post Repair Mitral Valve Stenosis and Regurgitation: Midesophageal Four Chamber
II.8.b.iii Aortic Valve Replacement
II.8.b.iii.1 Post Repair Aortic Valve Mitral Regurgitation: Midesophageal Four Chamber
II.8.b.iii.2 Post Aortic Valve Replacement/ Paravalvular Leaks: Midesophageal Aortic Short Axis
II.8.c Coronary Revascularization
II.8.c.i Post Coronary Surgery Aortic Dissection: Midesophageal Descending Aortic Short Axis
Index
An aparitie | 25 Jun 2017 |
Autor | Paul G. Barash , Michael K. Cahalan, Bruce F. Cullen |
Dimensiuni | 21.6 x 5.7 x 27.9 cm |
Editura | Lippincott Williams and Wilkins |
Format | Hardcover |
ISBN | 9781496337009 |
Limba | Engleza |
Nr pag | 1808 |
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1,21300 lei 1,05000 lei
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