Clinical Anesthesia, 8e: Print + Ebook with Multimedia
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Clinical Anesthesia, 8e: Print + Ebook with Multimedia

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Cod produs/ISBN: 9781496337009

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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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