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  • 11600lei 100.00 lei

    Fluid therapy is one of the most basic interventions spanning across all medical and surgical disciplines. Physicians need to understand the physiology of fluids and electrolytes before they can evaluate the extent to which disease pathophysiology has altered the balance, enabling them to determine the type and quantity of intravenous fluids required for treatment. This new edition is a practical guide to intravenous fluids and their administration to surgical patients. Divided into sixteen sections, the text begins with an overview of normal water balance and distribution of body fluid. The next sections cover the pharmacology of different types of intravenous fluid, followed by discussion on fluid therapy in different medical circumstances, and concluding with a chapter on fluid calculation. The second edition has been fully revised to provide the latest information in the field, and features new topics including fluid choice in the perioperative period and surgery and stress response. Key points Fully revised, new edition presenting latest information on intravenous fluids in surgery Discusses different types of fluid and their application in different circumstances Second edition includes several new topics Previous edition (9789350903957) published in 2013

  • 20000lei 160.00 lei

     Anesteziologia este o specialitate medicala interventionala complexa, in care inducerea farmacodinamica a conditiilor pe baza de analgezice, sedare sau somn si relaxare sunt imbinate cu masurile de reanimare si reechilibrare necesare mentinerii homeostazei.


    Cuprins:

    Cap. I- Introducere
    Cap. II- Anatomo-fiziologie celulara
    Cap. III- Celula nervoasa
    Cap. IV- Farmacocinetica anestezicelor
    Cap. V- Modul de actiune al anestezicelor generale asupra neuronilor si a SNC
    Cap. VI- Schema anatomo-functionala a sistemului nervos
    Cap. VII- Analgezia
    Cap. VIII- Somnul
    Cap. IX- Relaxarea
    Cap. X- Homeostazia
    Cap. XI- Aparatul de anestezie
    Cap. XII- Hemeostazia in chirurgie
    Cap. XIII- Bibliografie

  • Anesthesia Secrets
    La comanda in aproximativ 4 saptamani
    21000lei 190.00 lei

     

    Description:

     

    For more than 30 years, the highly regarded Secrets Series® has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. Anesthesia Secrets, 6th Edition offers practical, up-to-date coverage of the full range of essential topics in the practice of anesthesiology. This bestselling resource features the Secrets’ popular question-and-answer format that also includes lists, tables, pearls, memory aids, and an easy-to-read style – making inquiry, reference, and review quick, easy, and enjoyable.

    The proven Secrets Series® format gives you the most return for your time – succinct, easy to read, engaging, and highly effective.

    Fully revised and updated throughout, including protocols and guidelines that are continuously evolving and that increasingly dictate best practices.

    New chapters on Electrocardiogram Interpretation, Cardiac Physiology, Vasoactive Agents, Volume Assessment, Blood Pressure Disturbances, Mechanical Ventilation Strategies, Perioperative Point-of-Care Ultrasound and Echocardiography, Neuraxial Techniques, Peripheral Nerve and Trunk Blocks, Patient Safety, and Medical Ethics.  

    Top 100 Secrets and Key Points boxes provide a fast overview of the secrets you must know for success in practice and on exams.

    Features bulleted lists, mnemonics, practical tips from leaders in the field – all providing a concise overview of important board-relevant content.

    Portable size makes it easy to carry with you for quick reference or review anywhere, anytime.

     

     

    Table of Contents:

     

    Top 100 Secrets

    1: Fundamentals of Anesthetic Care

    Chapter 1: Introduction to anesthesia

    Chapter 2: Pre-operative evaluation

    Question/Answers

    Chapter 3: Airway management

    Chapter 4: Autonomic nervous system

    Questions/Answers

    Chapter 5: Cardiac physiology

    Chapter 6: Pulmonary physiology

    Chapter 7: Arterial blood gas analysis

    Chapter 8: Volume regulation and fluid replacement

    Chapter 9: Electrolytes

    Questions: Electrolytes

    Chapter 10: Coagulation

    Chapter 11: Transfusion therapy

    Chapter 12: Perioperative patient safety

    Allergic Reactions

    Operating Room Fires

    Patient Positioning

    Ophthalmic Complications

    Venous Air Embolism

    Chapter 13: Perioperative medical ethics

    2: Pharmacology

    Chapter 14: Inhaled anesthetics

    Questions/Answers

    Chapter 15: Intravenous anesthetics

    Chapter 16: Opioids

    Chapter 17: Neuromuscular blocking agents

    Chapter 18: Local anesthetics

    Chapter 19: Vasoactive agents

    3: Patient Monitoring and Procedures

    Chapter 20: Pulse oximetry

    Chapter 21: Capnography

    Chapter 22: Blood pressure monitoring and arterial catheterization

    Chapter 23: Central venous catheterization

    Chapter 24: Perioperative point-of-care ultrasound and echocardiography

    Chapter 25: Volume assessment

    Chapter 26: The anesthesia machine

    Chapter 27: Mechanical ventilation strategies

    Chapter 28: Electrocardiogram

    RBBB

    LBBB

    Frontal Plane

    QRS Morphology in Precordial Leads

    Rhythm

    Chapter 29: Pacemakers and internal cardioverter defibrillators

    4: Perioperative Problems

    Chapter 30: Blood pressure disturbances

    Chapter 31: Pulmonary complications

    Aspiration

    Laryngospasm

    Bronchospasm

    Extubation

    Chapter 32: Awareness during anesthesia

    Chapter 33: Temperature disturbances

    Chapter 34: Post-anesthetic care

    5: Anesthesia and Select Systemic Disease

    Chapter 35: Coronary artery disease and perioperative myocardial infarction

    Chapter 36: Heart failure

    Chapter 37: Valvular heart disease

    Chapter 38: Pulmonary hypertension

    Chapter 39: Obstructive lung disease: asthma and chronic obstructive pulmonary disease

    Chapter 40: Acute respiratory distress syndrome

    Chapter 41: Hepatic dysfunction and liver transplantation

    Chapter 42: Renal function and anesthesia

    Chapter 43: Intracranial and cerebrovascular disease

    Chapter 44: Intracranial hypertension and traumatic brain injury

    Chapter 45: Malignant hyperthermia and other myopathies

    Chapter 46: Degenerative neurological diseases and neuropathies

    Chapter 47: Diabetes mellitus

    Chapter 48: Nondiabetic endocrine disease

    Chapter 49: Obesity and obstructive sleep apnea

    Chapter 50: Alcohol and substance abuse

    6: Anesthesia and Select Patient Populations

    Chapter 51: Neonatal anesthesia

    Chapter 52: Pediatric anesthesia

    Chapter 53: Congenital heart disease

    Chapter 54: Fundamentals of obstetric anesthesia

    Chapter 55: Obstetric analgesia and anesthesia

    Chapter 56: High-risk obstetrics

    Chapter 57: Trauma anesthesia

    Chapter 58: The burned patient

    Chapter 59: Geriatric anesthesia

    7: Anesthesia and Select Surgical Procedures

    Chapter 60: Laparoscopic surgery

    Chapter 61: Major vascular surgery

    Chapter 62: Cardiac surgery: cardiopulmonary bypass

    Chapter 63: Thoracic surgery: lung isolation techniques

    Chapter 64: Spine surgery

    Chapter 65: Craniotomy

    Chapter 66: Shoulder operations

    Chapter 67: Electroconvulsive therapy

    8: Regional Anesthesia and Pain Management

    Chapter 68: Fundamentals of regional anesthesia

    Chapter 69: Peripheral nerve and trunk blocks

    Chapter 70: Nerve blocks for the head and neck

    Chapter 71: Neuraxial anesthesia and analgesia

    Chapter 72: Acute pain management

    Chapter 73: Chronic pain management

    Index

     

  • 22600lei 200.00 lei

    Top of Form

     

    Description:

    For more than 30 years, the highly regarded Secrets Series® has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. Critical Care Secrets, 6th Edition, features the Secrets’ popular question-and-answer format that also includes lists, tables, and an easy-to-read style - making reference and review quick, easy, and enjoyable.

    Table Of Contents:

    I. General ICU Care

    1. Glycemic Control in the ICU

    2. Early Mobility

    3. Sedation, Analgesia, Delirium

    4. Pain Management in the ICU

    5. Ethics and Palliative Care

    6. Fluid Therapy

    7. Nutrition in Critically Ill Patients

    8. Mechanical Ventilation

    9. Noninvasive Respiratory Support

    10. Weaning from Mechanical Ventilation and Extubation

    11. Quality Assurance and Patient Safety in the ICU

    II. Monitoring

    12. Pulse Oximetry, Capnography, and Blood Gas Analysis

    13. Hemodynamic Monitoring

    14. Neuromonitoring

    III. Procedures

    15. Cardiopulmonary resuscitation

    16. Arterial and Central Venous Catheters

    17. Critical Care Ultrasound

    18. Ventricular Assist Device

    19. Percutaneous Assist Devices

    20. Intra-Aortic Balloon Pumps

    21. Extracorporeal Membrane Oxygenation (ECMO)

    22. Tracheal Intubation and Airway Management

    23. Tracheotomy and Upper Airway Obstruction

    24. Chest Tubes and Pneumothorax

    25. Bronchoscopy

    26. Pacemakers and Defibrillators

    IV. Pulmonary

    27. Acute Pneumonia

    28. Asthma

    29. Chronic Obstructive Pulmonary Disease

    30. Acute Respiratory Failure/ARDS

    31. Hemoptysis

    32. Venous Thromboembolism and Fat Embolism

    V. Cardiology

    33. Heart Failure and Valvular Heart Disease

    34. Acute Myocardial Infarction

    35. Cardiac Arrhythmia

    36. Aortic Dissection

    37. Pericardial Disease (Pericardial Tamponade and Pericarditis)

    VI. Infectious Disease

    38. Sepsis and Septic Shock

    39. Endocarditis

    40. Meningitis and Encephalitis in the Intensive Care Unit

    41. Disseminated Fungal Infections

    42. Multidrug-Resistant Bacteria

    43. Skin and Soft Tissue Infections

    44. H1N1/Influenza

    45. Immunocompromised Host

    VII. Renal Disease

    46. Hypertensive Crises

    47. Acute Kidney Injury

    48. Renal Replacement Therapy and Rhabdomyolysis

    49. Hypokalemia and Hyperkalemia

    50. Hyponatremia and Hypernatremia

    VIII. Gastroenterology

    51. Upper and Lower Gastrointestinal Bleeding in the Critically Ill Patient

    52. Acute Pancreatitis

    53. Hepatitis and Cirrhosis

    IX. Endocrinology

    54. Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

    55. Adrenal Insufficiency in the Intensive Care Unit

    56. Thyroid Disease in the ICU

    X. Hematology/Oncology

    57. Blood Products and Coagulation

    58. Thrombocytopenia and Platelets

    59. Disseminated Intravascular Coagulation

    XI. Neurology

    60. Coma

    61. Brain Death

    62. Status Epilepticus

    63. Stroke and Subarachnoid Hemorrhage

    64. Guillain-Barré Syndrome and Myasthenia Gravis

    65. Alcohol Withdrawal

    XII. Surgery and Trauma

    66. Burns and Frostbite

    67. Thoracic Trauma (Flail Chest and Pulmonary & Myocardial Contusion)

    68. Acute Abdomen and Peritonitis

    69. Organ Donation

    XIII. Emergency Medicine

    70. Disaster Medicine, Bioterrorism and Ebola

    71. Allergy and Anaphylaxis

    72. Hypothermia

    73. Heat Stroke

    XIV. Toxicology

    74. General Approach to Poisonings

    75. Analgesics and Antidepressants

    76. Toxic Alcohol Poisoning

    77. Cardiovascular Medications

    78. Neuroleptic Malignant Syndrome

    XV. Unique Patient Populations

    79. Care of the Critically Ill Pregnant Patient

    80. Care of the Obese patient

    81. Oncologic Emergencies

    82. Post-Intensive Care Syndrome & Chronic Critical Illness

    83. ICU Survivors

    XVI. Emerging Therapies

    84. Sepsis: Emerging Therapies

       

    Bottom of Form

     

  • Oxford Handbook of Critical Care
    La comanda in aproximativ 4 saptamani
    200.00 lei

    The fully revised, third edition of this bestselling Handbook describes best practice of critical care in a succinct, concise and clinically-orientated way. Covering the principles of general management, it includes therapeutic and monitoring devices, specific disorders of organ systems, as well as detailed information on drugs and fluids. New material has been added on key areas such as airway maintenance, dressing techniques, infection control, echocardiography, tissue perfusion monitoring, coma and more. With up-to-date references and invaluable clinical advice, there is also plenty of space to add notes or amend sections to suit local protocols.

    Patient-centred and practical, it will serve the consultant, trainee, nurse or other allied health professionals as both a reference and aide memoir. This is the indispensable Oxford Handbook for all those working within critical care.

  • Pocket Anesthesia (Pocket Notebook)
    La comanda in aproximativ 4 saptamani
    25200lei 205.00 lei

     

    Description:

     

    Providing fast access to the most relevant, evidence-based information in all areas of anesthesiology, Pocket Anesthesia, Fourth Edition, is a practical, up-to-date resource for residents, anesthesiologists, CRNAs, and medical students—both on the wards and in the operating room. This concise handbook, now spiral-bound, is designed for portability and quick reference, with information presented in a bulleted, outline format throughout. The Pocket Notebook Series format is ideal for today's fast-paced health care environment. Information is presented in a schematic, outline format, with diagrams and tables for quick, easy reference.

     

     

    Table of Contents:

     

    CONTENTS

    PREOPERATIVE PATIENT EVALUATION

    INTRODUCTION

    PREOPERATIVE PHYSICAL EXAMINATION

    PREOPERATIVE LABORATORY TESTING

    ELECTROCARDIOGRAM (ECG) TESTING

    CARDIAC RISK STRATIFICATION

    INFECTIVE ENDOCARDITIS (IE) ANTIBIOTIC PROPHYLAXIS

    PERIOPERATIVE β-BLOCKER THERAPY

    STATINS

    STENTS & ANTIPLATELET AGENTS

    CONDITIONS WHICH MAY REQUIRE DELAY OF SURGERY FOR OPTIMIZATION

    MEDICATIONS REQUIRING SPECIAL CONSIDERATIONS IN THE PERIOPERATIVE PERIOD

    INHALED ANESTHETICS

    INTRODUCTION

    INHALED ANESTHETIC UPTAKE

    MAJOR FACTORS AFFECTING UPTAKE

    Solubility

    Cardiac Output

    Alveolar–Venous Concentration Gradient

    OTHER FACTORS INFLUENCING UPTAKE

    Factors That Speed Rate of Induction (↑ Fa/Fi)

    ELIMINATION/RECOVERY

    DIFFUSION HYPOXIA

    MINIMUM ALVEOLAR CONCENTRATION (MAC)

    CLINICAL CONSIDERATIONS OF INHALED ANESTHETICS

    SYSTEMIC EFFECTS OF INHALED AGENTS

    INHALATIONAL ANESTHETICS, SPECIFIC COMMENTS

    Nitrous Oxide (N2O)

    Isoflurane

    Desflurane

    Sevoflurane

    Halothane

    Heliox (Helium–Oxygen Combination)

    INTRAVENOUS ANESTHETICS

    INTRODUCTION

    GENERAL PRINCIPLES

    PROPOFOL (DIPRIVAN)

    ETOMIDATE (AMIDATE)

    SODIUM THIOPENTAL (PENTOTHAL)

    METHOHEXITAL (BREVITAL)

    KETAMINE (KETALAR)

    DEXMEDETOMIDINE

    BENZODIAZEPINES (SEE TABLE—PHARMACOLOGY OF COMMONLY ENCOUNTERED BENZODIAZEPINES)

    ANALGESICS

    OPIOIDS (SEE ALSO CHAPTER 13, ACUTE PAIN MANAGEMENT)

    General Comments

    Fentanyl (Sublimaze IV, Fentora Buccal, Actiq Lozenge, Duragesic Transdermal)

    Remifentanil (Ultiva)

    Sufentanil (Sufenta)

    Alfentanil (Alfenta)

    Morphine (Astramorph, Duramorph, MS Contin, Others)

    Hydromorphone (Dilaudid)

    Meperidine (Demerol)

    Methadone (Dolophine)

    Oxycodone

    Codeine

    NMDA RECEPTOR ANTAGONIST & OPIATE AGONISTS

    Ketamine (Ketalar)

    Tramadol (Ultram)

    OPIATE ANTAGONISTS (SEE CHAPTER 2H)

    TRANSDERMAL/TOPICAL MEDICATIONS

    Fentanyl Transdermal (Duragesic)

    Lidocaine Patch, 5% (Lidoderm)

    NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

    NONSELECTIVE COX INHIBITORS

    Acetaminophen (Tylenol, Paracetamol, Ofirmev)

    Propionic Acid Derivatives: Ibuprofen, Naproxen, Ketoprofen, Diclofenac

    Ketorolac (Toradol)

    Aspirin, Acetylsalicylic Acid

    SELECTIVE COX-2 INHIBITORS

    Celecoxib (Celebrex)

    LOCAL ANESTHETICS

    MECHANISM OF ACTION

    STRUCTURE & CLASSIFICATION

    PHARMACODYNAMICS

    SPECIFIC CONSIDERATIONS

    Chloroprocaine

    Lidocaine

    Bupivacaine

    Liposomal Bupivacaine (Exparel®)

    Ropivacaine

    Tetracaine

    Cocaine

    Topical Anesthesia for Minor Procedures (Pediatric IV Placement)

    ADDITIVES TO ENHANCE LOCAL ANESTHETICS

    LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST)

    LA Toxicity Treatment

    Methemoglobinemia (Normal Hemoglobin Oxidized to Methemoglobin)

    NEUROMUSCULAR BLOCKING DRUGS AND REVERSAL AGENTS

    MECHANISM

    Nondepolarizing: Aminosteroids

    Nondepolarizing: Benzylisoquinolines

    Depolarizing: Succinylcholine

    ANTAGONISM OF NONDEPOLARIZING NEUROMUSCULAR BLOCKADE

    Cholinesterase Inhibitors

    Physostigmine

    Sugammadex (Bridion®)

    VASOACTIVE, AUTONOMIC, AND CARDIOVASCULAR DRUGS

    INTRODUCTION

    ADRENERGIC AGONISTS AND VASOPRESSORS

    Dobutamine (Dobutrex)

    Dopamine (Intropin)

    Ephedrine (Generic)

    Epinephrine (Adrenaline)

    Isoproterenol (Isuprel)

    Phenylephrine (Neosynephrine)

    Norepinephrine (Levarterenol, Levophed)

    Vasopressin (Antidiuretic Hormone [ADH], Pitressin)

    Angiotensin II (Giapreza)

    PHOSPHODIESTERASE INHIBITORS

    Amrinone (Inocor, Inamrinone)

    Milrinone (Primacor)

    ADRENERGIC ANTAGONISTS

    α-Blockers

    Phenoxybenzamine (Dibenzyline)

    Phentolamine (Regitine, OraVerse)

    β-Blockers

    Labetalol (Normodyne, Trandate)

    Metoprolol (Lopressor, Toprol XL extended release)

    Esmolol (Brevibloc)

    Propranolol (Inderal)

    α-AGONISTS

    Clonidine (Catapres)

    Methyldopa (Aldomet)

    CALCIUM CHANNEL BLOCKERS (CCB)

    Diltiazem (Cardizem)

    Verapamil (Isoptin, Calan)

    Nicardipine (Cardene)

    Nifedipine (Procardia)

    Clevidipine (Cleviprex)

    VASODILATORS

    Fenoldopam (Corlopam)

    Hydralazine (Apresoline)

    Isosorbide Dinitrate (Isordil)

    Nitroglycerin (Tridil, Glycerol Trinitrate, Nitrostat, Nitrol, Nitro-Bid, Nitrolingual)

    Nitroprusside Sodium (Nipride, Nitropress)

    ANTIARRHYTHMICS

    Adenosine (Adenocard)

    Amiodarone (Cordarone)

    Lidocaine (Xylocaine)

    Procainamide (Pronestyl)

    HEART FAILURE

    Digoxin (Lanoxin)

    Nesiritide (B-Type Natriuretic Peptide, BNP, Natrecor)

    PHARMACOLOGY: ANTIBIOTICS AND HERBAL MEDICINES

    KEY POINTS

    ANTIBIOTICS FOR SURGICAL SITE INFECTION PROPHYLAXIS (PREINCISION DOSING)

    PROCEDURE-SPECIFIC SURGICAL PROPHYLACTIC ANTIBIOTIC RECOMMENDATIONS

    HERBAL MEDICINES AND SIDE EFFECTS

    OTHER DRUGS RELEVANT TO PRACTICE OF ANESTHESIA

    5HT3 ANTAGONISTS (ONDANSETRON, GRANISETRON, DOLASETRON)

    AMISULPRIDE

    ABCIXIMAB (REOPRO)

    ACARBOSE (PRECOSE)

    ACETAZOLAMIDE (DIAMOX)

    ALBUTEROL (PROVENTIL, VENTOLIN)

    ALVIMOPAN (ENTEREG)

    AMINOCAPROIC ACID (AMICAR)

    ANDEXANET ALFA (ANDEXXA; RECOMBINANT FACTOR XA)

    APIXABAN (ELIQUIS)

    ARGATROBAN (ACOVA)

    ATROPINE SULFATE

    BICARBONATE (SODIUM BICARBONATE)

    BICITRA (SODIUM CITRATE/CITRIC ACID)

    BIVALIRUDIN (ANGIOMAX)

    BOSENTAN (TRACLEER)

    BUMETANIDE (BUMEX)

    BUPRENORPHINE + NALOXONE (SUBOXONE)

    CALCIUM CHLORIDE (CaCl2); CALCIUM GLUCONATE (KALCINATE)

    CANAGLIFLOZIN (INVOKANA)

    CARBOPROST TROMETHAMINE (HEMABATE, 15-METHYL PROSTAGLANDIN F2α)

    CLOPIDOGREL (PLAVIX)

    CHLORAL HYDRATE (SOMNOTE)

    CHLOROTHIAZIDE (DIURIL)

    DABIGATRAN (PRADAXA)

    DALTEPARIN (FRAGMIN)

    DANTROLENE (DANTRIUM)

    DESMOPRESSIN ACETATE (DDAVP)

    DEXAMETHASONE (DECADRON)

    DIPHENHYDRAMINE (BENADRYL)

    DOLASETRON (ANZEMET)

    DROPERIDOL (INAPSINE)

    ENOXAPARIN (LOVENOX, LMWH)

    EPINEPHRINE, RACEMIC (VAPONEFRIN)

    EPOPROSTENOL (FLOLAN, PROSTACYCLIN, PROSTAGLANDIN I2 [PGI2])

    EPTIFIBATIDE (INTEGRILIN)

    ETHACRYNIC ACID (EDECRIN)

    EXENATIDE (BYETTA)

    FACTOR VIIA (NOVOSEVEN)

    FAMOTIDINE (PEPCID)

    FLUMAZENIL (MAZICON)

    FUROSEMIDE (LASIX)

    GLIPIZIDE (GLUCOTROL)

    GLUCAGON (GLUCAGEN)

    GLYBURIDE (DIABETA)

    GLYCOPYRROLATE (ROBINUL)

    GRANISETRON (GRANISOL, KYTRIL)

    HALOPERIDOL (HALDOL)

    HEPARIN, UNFRACTIONATED (UFH)

    HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)

    HYDROCHLOROTHIAZIDE (HCTZ, MICROZIDE)

    HYDROCORTISONE (SOLU-CORTEF)

    HYDROXYZINE (VISTARIL, ATARAX)

    IDARUCIZUMAB (PRAXBIND)

    INDIGO CARMINE

    INDOCYANINE GREEN (CARDIO-GREEN)

    INSULIN, REGULAR

    IPRATROPIUM BROMIDE (ATROVENT)

    LEVETIRACETAM (KEPPRA)

    LEVOTHYROXINE (SYNTHROID, T4)

    LIRAGLUTIDE (VICTOZA)

    MAGNESIUM SULFATE (MgSO4)

    MANNITOL (OSMITROL)

    METFORMIN (GLUCOPHAGE)

    METHYLERGONOVINE (METHERGINE)

    METHYLENE BLUE (METHYLTHIONINE CHLORIDE, UROLENE BLUE)

    METHYLPREDNISOLONE (SOLU-MEDROL)

    METHYLNALTREXONE (RELISTOR)

    METOCLOPRAMIDE (REGLAN)

    Naloxone (Narcan)

    NITRIC OXIDE, INHALED (NO, iNO, INOMAX)

    OCTREOTIDE (SANDOSTATIN)

    OMEPRAZOLE (PRILOSEC)

    ONDANSETRON (ZOFRAN)

    ANTIDIABETICS

    OXYTOCIN (PITOCIN)

    PHENYTOIN (DILANTIN)

    PHOSPHORUS (PHOSPHO-SODA, NEUTRA-PHOS)

    PHYSOSTIGMINE (ANTILIRIUM)

    PIOGLITAZONE (ACTOS)

    POTASSIUM CHLORIDE (KCl, KDUR)

    PRASUGREL (EFFIENT)

    PROCHLORPERAZINE (COMPAZINE)

    PROMETHAZINE (PHENERGAN)

    PROSTAGLANDIN E1 (ALPROSTADIL, PROSTIN VR)

    PROTAMINE SULFATE

    RECOMBINANT FACTOR VIIA (NOVOSEVEN)

    REPAGLINIDE (PRANDIN)

    RIVAROXABAN (XARELTO)

    ROSIGLITAZONE (AVANDIA)

    SCOPOLAMINE PATCH (TRANSDERM SCÓP)

    SCOPOLAMINE INJECTION (HYOSCINE)

    SILDENAFIL (VIAGRA, REVATIO)

    SITAGLIPTIN (JANUVIA)

    SPIRONOLACTONE (ALDACTONE)

    THAM

    TISSUE PLASMINOGEN ACTIVATOR (ALTEPLASE, ACTIVASE, TPA)

    TRANEXAMIC ACID/TXA (CYKLOKAPRON)

    TROMETHAMINE (THAM ACETATE)

    VITAMIN K (PHYTONADIONE, AQUAMEPHYTON)

    WARFARIN (COUMADIN)

    ANESTHESIA EQUIPMENT

    GAS SUPPLY

    Oxygen: Path of Hospital Supply to Patient

    ANESTHESIA MACHINE (1SEE APPENDIX B FOR CHECKOUT RECOMMENDATIONS)

    BREATHING CIRCUIT: CONNECTS ANESTHESIA MACHINE TO PATIENT

    Closed-Circuit Anesthesia

    Airway Pressures

    Management of Increased Airway Pressures

    Open Breathing Systems (Historical, Not Typically Used in Modern Medicine)

    Mapleson Breathing Circuits A to E: Five Systems Described in 1950s

    Bain Circuit: Modification of Mapleson D

    ELECTRICAL SAFETY IN THE OR

    Electrosurgery

    Risk of Electrocution

    Ungrounded Power & Protection from Electric Shock

    AIRWAY MANAGEMENT

    INTRODUCTION

    AIRWAY ASSESSMENT

    AIRWAY DEVICES

    AIRWAY MANAGEMENT: OROTRACHEAL INTUBATION

    AIRWAY MANAGEMENT: NASOTRACHEAL INTUBATION

    AIRWAY MANAGEMENT: AWAKE FLEXIBLE FIBEROPTIC INTUBATION

    TRANSTRACHEAL PROCEDURES

    TECHNIQUES OF EXTUBATION

    DIFFICULT AIRWAY ALGORITHM

    ANESTHESIA TECHNIQUES

    INTRODUCTION

    PATIENT INTERVIEW AND EVALUATION

    PREMEDICATION

    ANESTHESIA TECHNIQUES: (GOALS)

    MONITORED ANESTHESIA CARE VS. GENERAL ANESTHESIA: ASA DEFINITIONS

    FLUMAZENIL (FOR ANTAGONISM OF BENZODIAZEPINE EFFECTS)

    INHALATIONAL INDUCTION

    Pediatric Technique

    Adult Inhalational Induction

    INTRAMUSCULAR INDUCTION

    RECTAL INDUCTION

    Characteristics

    Technique

    COMPONENTS OF ANESTHESIA

    “BALANCED ANESTHETIC” TECHNIQUE

    MONITORING OF NEUROMUSCULAR BLOCKADE/PARALYSIS

    Technique

    Train of Four

    Tetanic Stimulation

    Double-Burst Stimulation

    Post-tetanic Count

    Phase II Blockade with Succinylcholine

    AWARENESS

    Frequency of Awareness (from Prospective Study of 11,785 General Anesthetics)

    BRAIN FUNCTION MONITORING, DEPTH OF ANESTHESIA, AND AWARENESS

    BRAIN FUNCTION MONITORING & ANALGESIA

    TOTAL INTRAVENOUS ANESTHESIA (TIVA)

    GUIDELINES FOR USING PROPOFOL

    Induction of General Anesthesia

    Maintenance of General Anesthesia

    Sedation

    EXTUBATION & EMERGENCE

    Deep Extubation

    REGIONAL ANESTHESIA

    PERIPHERAL NERVE BLOCKS

    Introduction

    Preparation and Materials

    Contraindications—Similar to Those for Neuraxial Blockade

    Complications—Common to All Nerve Blocks

    General Considerations for Quality Improvement and Safety without US

    Ultrasound Basics

    Transducer Selection

    Imaging Plane

    Sonographic Appearance of Nerves

    General Considerations for Quality Improvement and Safety

    SUPERFICIAL CERVICAL PLEXUS (SCP) AND DEEP CERVICAL PLEXUS (DCP) BLOCKS

    BRACHIAL PLEXUS BLOCKS

    Interscalene Brachial Plexus Block

    Indications

    Supraclavicular Brachial Plexus Block

    Infraclavicular Brachial Plexus Block

    Axillary Brachial Plexus Block

    Distal Blocks of Peripheral Nerves of Upper Extremity (see Figure 6-2 for anatomy)

    DIGITAL NERVE BLOCK (UPPER EXTREMITY)

    LOWER-EXTREMITY BLOCKS

    Lumbar Plexus Block

    Femoral Nerve Block

    Obturator Nerve Block

    Lateral Femoral Cutaneous Block

    Adductor Canal Block

    Sciatic Nerve Block (Classic, Anterior, Subgluteal)

    Popliteal Block of Sciatic Nerve

    Saphenous Nerve Block

    Ankle Block (Fig. 6-4)

    INTRAVENOUS REGIONAL ANESTHESIA (BIER BLOCK)

    TRUNCAL BLOCKS OF PERIPHERAL NERVES

    Intercostal Nerve Blocks

    Transversus Abdominis Plane Block (TAP Block)

    Thoracic Paravertebral Block (PVB)

    SPINAL/EPIDURAL ANESTHESIA

    Neuraxial Anatomy (also see Figure 6-5)

    Physiologic Effects

    Contraindications to Placing a Neuraxial Block

    Patient Positioning for Block Placement

    SPINAL ANESTHESIA

    Continuous Spinal Anesthesia (CSA)

    EPIDURAL ANESTHESIA

    COMBINED SPINAL–EPIDURAL (CSE) TECHNIQUE

    CAUDAL ANESTHESIA

    POINT-OF-CARE ULTRASOUND (POCUS)

    POINT-OF-CARE ULTRASOUND (POCUS)

    FOCUSED CARDIAC ULTRASOUND

    Parasternal Long Axis (Fig. 7-1)

    Parasternal Short Axis (Fig. 7-2)

    Apical Four Chamber (Fig. 7-3)

    Subcostal Views (2)

    LUNG ULTRASOUND

    Ultrasound Artifact Analysis (and Pathology)

    Interstitial or Alveolar Disease (e.g., Pulmonary Edema, Consolidation, Contusion)

    Pneumothorax

    Pleural Effusion

    FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA (FAST)

    ULTRASOUND-GUIDED VASCULAR ACCESS

    Indications

    Ultrasound Views

    AIRWAY ULTRASOUND (SEE Fig. 7-7)

    PERIOPERATIVE MONITORING

    PULSE OXIMETRY

    Information in Pulse Oximeter Waveform

    NONINVASIVE SPECTROPHOTOMETRIC HEMOGLOBIN MONITORING (e.g., MASIMO® RADICAL-7®)

    NEAR-INFRARED CORTICAL SPECTROPHOTOMETRY (e.g., MEDTRONIC INVOSTM, CASMED FORE-SIGHT ELITE®, MASIMO-O3®)

    NONINVASIVE BLOOD PRESSURE MONITORING (OSCILLOMETRIC SPHYGMOMANOMETRY)

    Causes of Artifacts in NIBP Monitoring

    Complications

    NONINVASIVE CONTINUOUS BLOOD PRESSURE, SV, SVV, SVR, AND CARDIAC OUTPUT MONITORING (EDWARDS CLEARSIGHT™)

    Potential Causes of Artifacts in Noninvasive Continuous Monitoring

    Complications

    TEMPERATURE MONITORING

    Complications of Hyperthermia

    Complications of Hypothermia (below 36°C)

    Artifacts

    Hazards

    Placement

    Malignant Hyperthermia

    ARTERIAL BLOOD PRESSURE (ABP) MONITORING

    SAFELY FLUSHING AN ARTERIAL LINE

    HAZARDS OF ARTERIAL LINE MONITORING

    CENTRAL VENOUS LINES & CENTRAL VENOUS PRESSURE (CVP) MONITORING

    Hazards of Central Line Placement

    Artifacts

    NORMAL CVP & CORRESPONDING ECG WAVEFORM (Fig. 8.2)

    INTRAVASCULAR VOLUME MONITORING BY DYNAMIC RESPONSE OF PULSE PRESSURE VARIATION (PPV): PULSION™ PICCO®; AND STROKE VOLUME VARIATION (SVV): EDWARDS™ VIGILEO®, FLO-TRAC® (USING PERIPHERAL ARTERIAL CATHETER, OPTIONAL CENTRAL VENOUS CATHETER)

    MEASUREMENT OF CARDIAC OUTPUT (ALSO SEE APPENDIX A)

    CONSIDERATIONS FOR PA THERMODILUTION CATHETER INSERTION & MONITORING

    NORMAL PA WAVEFORMS AS CATHETER IS PASSED FROM CVP (RA) TO RV TO PA TO PCWP

    “V” WAVES IN A WEDGE TRACING

    VENTILATION TECHNIQUES

    INTRODUCTION AND OVERVIEW

    Common Ventilation Modes: Continuous Mandatory Ventilation

    MANY ADVANTAGES OF SPONTANEOUS BREATHING VS. POSITIVE-PRESSURE VENTILATION WHILE INTUBATED

    CAPNOGRAPHY

    Hazards of Capnography

    CAPNOGRAPHS (FIG. 9-2)

    FLOW–VOLUME LOOPS (FIG. 9-3)

    MECHANICAL VENTILATION: PROTECTIVE STRATEGIES

    Current Strategies to Prevent Volutrauma, Barotrauma, Atelectrauma, Tracheal Ischemia, & O2 Toxicity

    Specific Settings

    PRONE VENTILATION FOR SEVERE ARDS

    NONINVASIVE VENTILATION (NIV): CPAP VS. BIPAP VS. HIGH-FLOW NASAL CANNULA

    DISCONTINUING MECHANICAL VENTILATION (ALSO CALLED WEANING OR LIBERATING FROM MV)

    SIMV Plus PS is a Common Weaning Mode in Many ICUs

    FLUIDS, ELECTROLYTES, & TRANSFUSION THERAPY

    FLUID MANAGEMENT

    Fluid Compartments

    Assessing Volume Status

    Volume Deficits

    Volume Replacement

    Crystalloids & Colloids

    Notes on Specific Fluids

    APPROACH TO ACID–BASE ANALYSIS

    Strong Ion Difference (Stewart Acid/Base)

    ELECTROLYTES

    Hyponatremia (Na+ <135 mEq/L)

    Hypernatremia (Na+ >145 mEq/L)

    Hypokalemia (K <3.5 mEq/L)

    Hyperkalemia (K+ >5.5 mEq/L)

    Hypocalcemia (Ca2+ <8.4 mg/dL)

    Hypercalcemia (Ca2+ >10.3 mg/dL)

    Hypomagnesemia (Mg2+ <1.3 mEq/L)

    Hypermagnesemia (Mg2+ >2.5 mEq/L)

    Hypophosphatemia (PO43- 2.8 mg/dL)

    Hyperphosphatemia (PO43- >4.5 mg/dL)

    TRANSFUSION THERAPY

    Blood Typing Tests

    Emergency Transfusion

    COMMON BLOOD PRODUCTS

    Red Blood Cells (RBC)

    Packed Red Blood Cells (PRBC)

    Equation for Arterial O2 Content in Blood

    Calculating Allowable Blood Loss

    Whole Blood

    Platelets

    Fresh Frozen Plasma (FFP)

    Cryoprecipitate

    Factor VII (NovoSeven, eptacog alfa)

    DDAVP

    4-Factor Prothrombin Complex Concentrates

    TRANSFUSION COMPLICATIONS

    Infectious Complications

    Coagulopathic Complications

    Transfusion Reactions

    Metabolic Complications

    Immune Complications—Transfusion-Related Immunomodulation (TRIM)

    COAGULATION

    Disorders of Coagulation

    Coagulation Studies

    Platelet Inhibitors

    Bleeding Disorders (Coagulopathies)

    Hyperfibrinolysis

    Heparin-Induced Thrombocytopenia (HIT)

    Disseminated Intravascular Coagulation (DIC)

    Vitamin K Deficiency

    COMMON INTRAOPERATIVE PROBLEMS

    HYPOXIA

    Actions (Fig. 11-1)

    Additional Diagnostic Tests

    BRONCHOSPASM

    Causes

    Investigations

    Management

    HYPOTENSION

    Differential Diagnosis

    Investigations

    Treatment Options

    HYPERTENSION

    Differential Diagnosis

    Investigations/Treatment Options

    HYPERCARBIA

    Differential Diagnosis

    Investigations/Treatment Options

    HYPOCARBIA

    Differential Diagnosis

    Investigations/Treatment Options

    ↑ PEAK AIRWAY PRESSURES

    Differential Diagnosis

    Treatment

    OLIGURIA

    Differential Diagnosis

    Investigations/Treatment Options

    MYOCARDIAL ISCHEMIA/INFARCTION

    Etiology

    Investigations

    Treatment Options

    MALIGNANT HYPERTHERMIA

    BRADYCARDIA

    Differential Diagnosis

    Investigations/Treatment

    TACHYCARDIA

    Differential Diagnosis

    Treatment Options

    DELAYED EMERGENCE

    Differential Diagnosis

    Investigations/Treatment Options

    ANAPHYLAXIS

    Differential Diagnosis

    Clinical Manifestations

    Treatment Options

    Prevention

    LATEX ALLERGY

    Incidence/Risk Factors

    Mechanism

    Preoperative Evaluation

    Equipment/Drug Considerations

    Anesthetic Considerations

    Treatment

    GASTRIC ACID ASPIRATION OR VOMITING UPON INDUCTION OF ANESTHESIA

    Clinical Manifestations

    Management

    COMPLICATIONS OF LARYNGOSCOPY AND INTUBATION

    Causes

    General Complications

    Specific Complications

    PROCEDURES IN ANESTHESIA

    PERIPHERAL VENOUS ACCESS

    Indications

    Technique

    Complications

    RAPID INFUSION CATHETER (RIC LINE)

    Indications

    Technique

    ARTERIAL ACCESS (ALSO SEE CHAPTER 8, ON PERIOPERATIVE MONITORING)

    Indications

    Technique: Radial Artery

    Technique: Brachial Artery

    Technique: Axillary Artery

    Contraindications

    Complications

    CENTRAL VENOUS ACCESS (ALSO SEE CHAPTER 8, ON PERIOPERATIVE MONITORING)

    Indications

    Contraindications

    Technique: Internal Jugular Vein (IJ)

    Technique: Subclavian Vein (SC)

    Technique: Femoral Vein (Fem)

    Complications

    Ultrasound-Guided Central Line Placement

    One-look technique

    Real-Time Visualization of IJ

    Real-Time Visualization of SC

    INSERTION OF A PULMONARY ARTERY CATHETER (PAC) (ALSO SEE CHAPTER 8, ON PERIOPERATIVE MONITORING)

    Indications

    Contraindications

    Technique

    Complication: PA Perforation

    DECOMPRESSION OF A PNEUMOTHORAX (NEEDLE THORACOSTOMY)

    Indication

    Technique (Fig. 12-3)

    Complications

    INSERTION OF A NASOGASTRIC TUBE (NGT)

    Indication

    Contraindications

    Technique

    Complications

    ACUTE PAIN MANAGEMENT

    INTRODUCTION

    DEFINITIONS

    NORMAL PAIN MECHANISMS & PAIN PATHWAYS

    Pain Pathways

    PAIN ASSESSMENT & MEASUREMENT

    History & Physical Exam (see also Fig. 32-1)

    Pain Measurement

    ACUTE PAIN MANAGEMENT

    Treatment

    ANALGESIC DELIVERY SYSTEMS

    PO

    SC/IM

    IV

    Patient-Controlled Analgesia (PCA)

    Neuraxial Analgesia

    Epidural Opioids

    Troubleshooting Epidural Catheter Infusions

    Intrathecal Opioids

    MANAGING SIDE EFFECTS

    ACUTE ON CHRONIC PAIN

    Opioid Receptor Mixed Agonists/Antagonists

    Definitions

    PACU MANAGEMENT AND DISCHARGE

    HYPOTENSION

    Initial Diagnosis & Management

    Management of Specific Conditions

    Bleeding

    HYPERTENSION

    Diagnosis and Management

    RESPIRATORY AND AIRWAY PROBLEMS

    Respiratory Insufficiency: Diagnosis & Management

    Respiratory Insufficiency: Management of Specific Conditions

    NEUROLOGIC PROBLEMS

    Common Problems

    POSTOPERATIVE NAUSEA AND VOMITING (PONV)

    PACU DISCHARGE CRITERIA

    Guidelines for Discharge from Phase 2

    Common Discharge Issues

    COMPLICATIONS OF ANESTHESIA

    INTRODUCTION

    PERIPHERAL NERVE INJURY

    Classification of Peripheral Nerve Lesions

    Anesthesia-related Causes

    Duration of Ischemia

    Other Factors Impacting Peripheral Nerves

    AIRWAY/DENTAL COMPLICATIONS

    Airway Complications

    Dental Injuries

    Burns

    Electrocautery/Electrosurgical Unit

    Magnetic Resonance Imaging

    Perioperative Blindness

    ENHANCED RECOVERY AFTER SURGERY (ERAS)

    TRAUMA, BURN, AND CRITICAL CARE MANAGEMENT

    INTRODUCTION

    AIRWAY MANAGEMENT FOR TRAUMA

    Intubation Indications

    Intubation Considerations

    Induction Considerations

    Acute Spinal Cord Injury (ASCI)

    Intraoperative Trauma Management

    Emergence/Transport

    Fluid Resuscitation

    Nutrition

    Total Parenteral Nutrition (TPN)

    Glycemic Control in ICU Patients

    BURN MANAGEMENT

    Pathophysiology

    INTRAOPERATIVE MANAGEMENT: GENERAL CONSIDERATIONS

    Anesthesia for Burn Surgery

    SEPSIS AND SEPTIC SHOCK

    Screening for Early Sepsis

    Acute Physiology and Chronic Health Evaluation (APACHE) II Score

    Associated Problems in Sepsis

    Early Quantitative Fluid Resuscitation

    Markers of Resuscitation in Sepsis

    MANAGEMENT OF SEPSIS

    An Approach to Sedation of ICU Patients

    Transfusion of Red Blood Cells (RBCs) in the Critically-Ill Patient

    CARDIAC SURGERY

    NORMAL CARDIOVASCULAR PHYSIOLOGY

    Cardiac Cycle: Definitions & Equations

    COMMON DISEASE STATES AFFECTING THE HEART

    Determinants of Myocardial Perfusion

    Hypertension (HTN)

    Valvular Disease

    HEART BLOCKS/ARRHYTHMIAS (SEE CHAPTER 35, ELECTROCARDIOGRAM [ECG] INTERPRETATION)

    Bradyarrhythmias—HR <60 bpm

    Tachyarrhythmias—HR >100 bpm

    Intra-aortic Balloon Pump

    CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE (CIED)

    Anesthetic Considerations for Pacemakers

    Implantable Cardiac Defibrillator (ICD)

    CARDIOPULMONARY BYPASS MACHINE

    Cardiopulmonary Bypass Preanesthetic Management

    Potential Catastrophes During Bypass

    Alpha Stat Vs. pH Stat

    Postop Complications

    TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)

    CARDIAC PHARMACOLOGY (SEE CHAPTER 2F, VASOACTIVE, AUTONOMIC, AND CARDIOVASCULAR DRUGS)

    TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI)/ REPLACEMENT (TAVR)

    THORACIC SURGERY

    PREOPERATIVE EVALUATION FOR THORACIC SURGERY

    COMMON DISEASE STATES OF THE LUNG

    COPD

    Asthma

    Pulmonary Edema

    ARDS (see also Chapter 17, Trauma, Burn, and Critical Care Management)

    Restrictive Lung Disease

    Pulmonary Hypertension Management

    LUNG ISOLATION AND ONE-LUNG VENTILATION (OLV)

    Double-Lumen Tubes (DLTs)

    Bronchial Blockers

    Physiology of 1-Lung Ventilation

    Anesthesia for 1-Lung Ventilation

    Anesthetic Techniques—Specific Surgical Procedures

    GENERAL SURGERY

    INTRODUCTION

    ANESTHETIC CONSIDERATIONS IN ABDOMINAL SURGERY

    Preoperative Evaluation

    Anesthetic Management

    ALCOHOL ABUSE

    Preop Evaluation

    Anesthetic Considerations

    Postop Considerations

    ANESTHETIC MANAGEMENT: LIVER SURGERY

    General Considerations

    Management of Portal Hypertension

    Monitoring

    Anesthetic Technique

    Postop Care

    ANESTHETIC MANAGEMENT: LAPAROSCOPIC SURGERY

    General Considerations

    Anesthetic Technique: Laparoscopic Surgery

    Monitoring

    Postop Care

    LARGE INTESTINAL SURGERY

    Indications

    Preop Evaluation

    Anesthetic Management: Large Intestinal Surgery

    Postop Complications

    SMALL INTESTINAL SURGERY

    Indications

    Carcinoid Tumors/Carcinoid Syndrome

    Monitoring

    Anesthetic Management

    Postop Care

    PANCREATIC SURGERY

    Indications

    Monitoring

    Anesthetic Management

    Postop Care

    SPLENIC SURGERY

    Indications

    Preop Preparation

    Anesthetic Management

    Postop Care

    HEMORRHOIDECTOMY & DRAINAGE OF PERIRECTAL ABSCESS

    Anesthetic Management

    Postop Care

    INGUINAL HERNIORRHAPHY

    Anesthetic Management

    VENTRAL HERNIORRHAPHY

    Preop Considerations

    Monitoring

    Anesthetic Management

    APPENDECTOMY

    Preop Evaluation

    Anesthetic Management

    Postop Care

    CHOLECYSTECTOMY

    Anesthetic Management

    Postop Care

    Anesthesia for Aesthetic Surgery

    Practice Advisory on Liposuction

    BARIATRIC SURGERY

    ANESTHETIC MANAGEMENT: BARIATRIC SURGERY

    Types of Bariatric Surgery

    Preanesthetic Considerations

    Anesthetic Technique

    Airway Management

    Monitoring

    Postop Complications

    VASCULAR SURGERY

    OPEN VASCULAR PROCEDURES

    Abdominal Aortic Aneurysm (AAA) Repair

    Thoracoabdominal Aortic Aneurysm (TAAA) Repair

    Carotid Endarterectomy

    ENDOVASCULAR PROCEDURES

    Endovascular AAA Repair (EVAR)

    Carotid Stent Placement

    Distal Angioplasty/Thrombectomy

    PERIPHERAL VASCULAR SURGERY

    NEUROSURGERY AND ECT

    BASIC PRINCIPLES OF NEUROPHYSIOLOGY

    Cerebral Metabolic Rate (CMR), Cerebral Blood Flow (CBF), and Autoregulation (Fig. 23-1)

    Intracranial Pressure (ICP)

    CRANIOTOMY

    Anesthetic Management

    Awake Craniotomy

    INTRACRANIAL VASCULAR SURGERY: ANEURYSM CLIPPING & RESECTION OF ARTERIOVENOUS MALFORMATIONS (AVMS)

    Preoperative Evaluation

    Induction & Pinning

    Maintenance

    VENTRICULOPERITONEAL SHUNT PLACEMENT/OMMAYA RESERVOIR

    EPIDURAL, SUBDURAL, & INTRACEREBRAL HEMORRHAGE (ICH)

    TRAUMATIC BRAIN INJURY

    ELECTROCONVULSIVE THERAPY (ECT)

    Goals

    Agents

    Management

    INTERVENTIONAL RADIOLOGY

    Central Intra-arterial Thrombolysis/Thrombectomy

    SPECIFIC NEUROLOGIC DISORDERS

    Myasthenia Gravis (MG)

    Multiple Sclerosis

    Guillain–Barré Syndrome

    Parkinson Disease

    OTOLARYNGOLOGY (ENT) AND OPHTHALMOLOGY

    PROCEDURES IN OTOLARYNGOLOGY

    Functional Endoscopic Sinus Surgery (FESS)

    CSF Leak Repair

    Microdirect/Suspension Laryngoscopy (MDL) & Transbronchoscope ENT Procedures

    Medialization Thyroplasty (Vocal Cord Medialization)

    PROCEDURES ON THE INNER EAR AND MASTOID

    Indications

    Special Considerations

    Anesthetic Management

    Stapedectomy

    Myringotomy Tube Placement (Placement of Ear Tubes)

    TONSILLECTOMY/PAROTIDECTOMY/UVULOPALATOPHARYNGOPLASTY

    Tonsillectomy and Adenoidectomy

    Parotidectomy

    Uvulopalatopharyngoplasty (UPPP)

    TRACHEOSTOMY

    Indications

    Special Considerations

    Anesthetic Management

    Management of Existing Tracheostomy

    Management of Mature Tracheostomy (>7 d)

    Management of Fresh Tracheostomy

    PROCEDURES IN OPHTHALMOLOGY

    Special Considerations

    Special Medications in Ophthalmologic Population

    Cataract Surgery: Clear Corneal Phacoemulsification

    Strabismus Surgery

    Other Procedures

    Peribulbar Block (25G–27G, 25-mm needle)

    Retrobulbar Block (25G–27G, 3-cm needle)

    Subtenon’s Block (25G needle)

    RENAL SYSTEM AND UROLOGIC SURGERY

    EVALUATION OF RENAL FUNCTION

    Acute Kidney Injury

    Chronic Renal Failure

    ANESTHESIA FOR PATIENTS WITH RENAL DISEASE

    Effects of Anesthesia on Renal Function

    Indirect Effects of Anesthesia

    Direct Effects of Anesthesia

    MEDICATIONS TO AVOID OR USE WITH CAUTION IN RENAL FAILURE

    UROLOGIC SURGERY

    Cystoscopy/Ureteroscopy/TURBT

    ORTHOPEDIC SURGERY

    GENERAL VS. REGIONAL ANESTHESIA

    POSITIONING

    SPINE SURGERY

    Cervical Spine Surgery

    Thoracic/Lumbar Spine Surgery

    NEUROMONITORING (ALSO SEE CHAPTER 23, NEUROSURGERY AND ECT)

    Types of Monitoring

    Factors Affecting Monitoring

    COMPLICATIONS IN ORTHOPEDIC SURGERY

    ENDOCRINE SURGERY

    THYROID GLAND

    Hyperthyroidism

    Hypothyroidism

    PARATHYROID GLANDS

    Hyperparathyroidism

    Hypoparathyroidism

    Pheochromocytoma

    DIABETES MANAGEMENT

    ADRENAL INSUFFICIENCY

    Anesthesia for Adrenal Insufficiency

    Excess of Corticosteroids (Cushing Syndrome)

    Hyperaldosteronism (Conn Syndrome)

    POSTERIOR PITUITARY GLAND

    Diabetes Insipidus (DI)

    Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion

    OBSTETRIC AND GYNECOLOGIC ANESTHESIA

    INTRODUCTION

    Labor Analgesia and Anesthesia for Cesarean Delivery

    Labor Analgesia

    Anesthetic Considerations in Labor

    Anesthesia for Cesarean Delivery

    APGAR SCORE

    POSTDURAL PUNCTURE HEADACHE (PDPH)

    ANTEPARTUM HEMORRHAGE

    Postpartum Hemorrhage (PPH)

    DRUGS USED ON THE LABOR AND DELIVERY UNIT

    HYPERTENSIVE DISORDERS OF PREGNANCY

    Preeclampsia

    Nonobstetric Surgery in Pregnancy

    ANESTHESIA FOR GYNECOLOGIC SURGERY

    PEDIATRIC ANESTHESIA

    ANATOMY

    Upper Airway

    Vascular Access

    PHYSIOLOGY

    Transition from Fetal to Neonatal Circulation

    Respiratory

    Cardiovascular

    Renal

    Hepatic

    Gastrointestinal

    Hematopoietic

    Neurologic

    Temperature Regulation

    PHARMACOLOGY

    Body Fluid Composition

    Organ System Maturity

    Protein Binding

    Receptors

    PREOPERATIVE EVALUATION

    Psychological Assessment

    Neurotoxicity of Anesthetic Agents

    OR EQUIPMENT AND SETUP

    Intravenous Fluids

    Emergency Drugs

    ANESTHESIA TECHNIQUES

    Induction

    Maintenance

    CLINICAL CONDITIONS

    Respiratory

    Secondary Smoke Exposure

    Cardiac

    Atrial & Ventricular Septal Defects (ASD/VSD)

    Metabolic

    Gastrointestinal

    Pediatric Congenital Syndromes

    NEONATAL & PEDIATRIC RESUSCITATION

    Neonatal Resuscitation Algorithm

    Pediatric Advanced Cardiac Life Support (Also see Chapter 37, Emergency Algorithms)

    POSTOPERATIVE NAUSEA & VOMITING

    OUTSIDE OF THE OPERATING ROOM ANESTHESIA

    GENERAL CONSIDERATIONS AND SAFETY

    CT AND MRI

    CT: General Considerations

    Special Procedures in the CT Suite

    MRI: General Considerations

    INTERVENTIONAL NEURORADIOLOGY

    General Considerations

    ENDOSCOPY AND ERCP

    General Considerations

    CHRONIC PAIN MANAGEMENT

    INTRODUCTION

    LOW BACK PAIN (LBP)

    Strength Testing

    Sensory Testing

    Interventional Pain Treatment

    LUMBAR SPINAL CANAL STENOSIS

    Pathophysiology

    Evaluation

    Treatment

    FAILED BACK SURGERY SYNDROME (FBSS)

    Pathophysiology

    Evaluation

    Treatment

    OSTEOARTHRITIS VS. RHEUMATOID ARTHRITIS

    PERIPHERAL NEUROPATHIC PAIN

    ALGORITHM FOR MANAGEMENT OF NEUROPATHIC PAIN

    Peripheral Neuropathy

    POSTHERPETIC NEURALGIA (PHN)

    Symptoms

    Evaluation

    Treatment

    TRIGEMINAL NEURALGIA

    Incidence

    Etiology

    Symptoms

    Evaluation

    Treatment

    COMPLEX REGIONAL PAIN SYNDROME (CRPS)

    Signs and Symptoms of CRPS

    Treatment

    OCCIPITAL NEURALGIA

    Etiology

    Symptoms

    Evaluation

    Treatment

    HEADACHE

    PHANTOM LIMB PAIN

    Incidence

    Etiology

    Treatment

    VISCERAL PAIN

    Incidence

    Symptoms

    Evaluation

    FIBROMYALGIA

    Incidence

    Etiology

    Symptoms

    Evaluation

    Treatment

    CANCER PAIN

    Treatment

    ORGAN TRANSPLANTATION

    NONLIVING DONORS

    Cadaveric Organ Grafts

    Non–Heart Beating Organ Donors (NHBD) = Donation after Cardiac Death (DCD)

    Organ Preservation Techniques

    Intraoperative Management of Procurement

    LIVING KIDNEY DONOR

    Donor Criteria and Evaluation

    Anesthetic Considerations

    Surgical Procedure

    LIVING LIVER DONOR

    Donor Criteria

    Pediatric Recipients

    Morbidity & Mortality

    Surgical Procedure

    Anesthetic Considerations

    LIVING LUNG DONOR

    Morbidity & Mortality

    Anesthetic Considerations

    Surgical Procedure

    ANESTHESIA FOR KIDNEY TRANSPLANTATION

    Indications

    Preoperative Evaluation

    Intraoperative Management

    Induction & Maintenance

    Surgical Procedure

    Specific Intraoperative Considerations

    Postoperative Management

    ANESTHESIA FOR PANCREAS TRANSPLANTATION

    Indications

    Preoperative Evaluation

    Intraoperative Management

    Induction & Maintenance

    Specific Intraoperative Considerations

    Postoperative Management

    ANESTHESIA FOR LIVER TRANSPLANTATION (ALSO SEE CHAPTER 20, GENERAL SURGERY)

    General

    Preoperative Evaluation

    Intraoperative Management

    Induction and Maintenance

    Postoperative Management

    ANESTHESIA FOR LUNG TRANSPLANTATION

    Indications

    Indications for Heart–Lung Transplantation (HLT)

    Bilateral Sequential Lung Transplantation (BSLT)

    Living Donor Lung Transplantation (LDLT)

    Preoperative Evaluation

    Intraoperative Considerations

    Induction and Maintenance

    Surgical Procedure for Single-Lung Transplantation

    Specific Intraoperative Considerations

    Postoperative Management

    ANESTHESIA FOR HEART TRANSPLANTATION

    General Information

    Most Common Indications

    Preoperative Assessment

    Intraoperative Management

    Surgical Procedure

    Specific Intraoperative Considerations

    GERIATRIC ANESTHESIA

    GENERAL CONCERNS & CONSIDERATIONS

    EFFECTS OF AGING ON PHYSIOLOGY

    Cardiovascular System

    Pulmonary System

    Renal System

    Nervous System

    Assessing Frailty and Low Physiologic Reserve

    PHARMACOLOGY IN THE ELDERLY

    Factors Complicating Drug Administration

    Anesthetic Agent Selection and Administration

    ADDITIONAL PERIOPERATIVE CONSIDERATIONS

    Neuraxial/Regional Blocks

    Elderly Cognitive Assessment

    Postop Delirium (POD) and Periop Neurocognitive Disorder (PND)

    ELECTROCARDIOGRAM (ECG) INTERPRETATION

    ECG LEAD PLACEMENT & UTILITY

    STEPS FOR ECG INTERPRETATION

    ATRIOVENTRICULAR CONDUCTION SYSTEM

    VENTRICULAR ARRHYTHMIAS

    ETHICAL ISSUES & EVENT DISCLOSURE

    END-OF-LIFE ISSUES

    Pediatric/Minor (<18 y) Patients

    JEHOVAH’S WITNESSES (JW)

    DISCLOSURE AND APOLOGY—COMMUNICATING ABOUT UNANTICIPATED EVENTS

    EMERGENCY ALGORITHMS

    ADVANCED CARDIAC LIFE SUPPORT (ACLS)

    C-A-B (Chest compressions, Airway, Breathing)

    Specific Details (Also see Fig. 37-1)

    PEDIATRIC ADVANCED LIFE SUPPORT (PALS) (ALSO SEE CHAPTER 29, PEDIATRIC ANESTHESIA)

    RECOGNIZE THE NEED OF CPR

    Ventricular Fibrillation/Ventricular Tachycardia (Pulseless)

    Asystole and PEA

    Bradycardia with Cardiorespiratory Compromise

    Tachycardia with Cardiorespiratory Compromise

    Acute coronary syndromes: see Figure 37-5

    VASCULAR ACCESS/DRUG ADMINISTRATION

    COMMON MEDICAL PHRASES IN SPANISH

    INTRODUCTION

    APPENDIX

    APPENDIX A: FORMULAE AND QUICK REFERENCE

    CARDIOLOGY

    Fick Cardiac Output

    Shunts

    Valve Area

    Coronary Artery Anatomy (see Fig. A-1)

    PULMONARY

    NEPHROLOGY

    HEMATOLOGY

    OTHER

    SENSITIVITY AND SPECIFICITY CALCULATIONS

    Appendix B: ANESTHESIA MACHINE CHECKOUT & SETTING UP THE OR

    ANESTHESIA MACHINE CHECKOUT

    SETTING UP THE OR FOR A CASE: “SOAP M”

    S: Suction

    O: Oxygen

    A: Airway

    P: Pharmacy

    M: Machine/Monitors

    APPENDIX C: MANAGEMENT OF MALIGNANT HYPERTHERMIA (ALSO SEE CHAPTER 11)

    DIAGNOSIS VS. ASSOCIATED PROBLEMS

    Signs of MH

    Sudden/Unexpected Cardiac Arrest in Young Patients

    Trismus or Masseter Spasm with Succinylcholine

    ACUTE PHASE TREATMENT

    POSTACUTE PHASE

    APPENDIX D: COVID-19† CONSIDERATIONS

    INTRODUCTION

    POOR PROGNOSTIC INDICATORS

    PERIOPERATIVE CONSIDERATIONS

    AIRWAY RECOMMENDATIONS (OR AND OUT-OF-OR)

    INDEX

     

  • 225.00 lei

     

    Description:

    This book describes in concise yet detailed step-by-step instructions on how to perform common procedures, including complex airway management, vascular access, neuraxial blocks, and nuanced anesthetic techniques; it not only covers this breadth of procedures, but presents them in an accessible manner. Chapters follow the format of the indications for a particular procedure, a list of equipment required, step-by-step instructions for performing the procedure, common complications, and troubleshooting techniques. The book is designed intentionally for the busy physician to be able to easily read the essential information, including lists of equipment necessary, numbered steps to perform the procedure, tables of common errors and methods to troubleshoot, indications and contraindications for procedures, detailed photos of equipment setup, and handmade diagrams and images. Anesthesiology Resident Manual of Procedures is comprehensive and written with the physician-in-training in mind, as well as those who are completing their residency or fellowship in the fields of anesthesiology, critical care medicine, and emergency medicine.

     

     

    Table of Contents:

     

    1. Airway Anatomy and Tracheobronchial Tree

    2. Optimizing Intubation Positioning

    3. How to Assemble and Use the Fiberoptic Scope and Tower

    4. Asleep Fiberoptic Intubations

    5. Awake Fiberoptic Intubation

    6. Nasotracheal Intubation

    7. Codes/Out of or Emergency Airway Management

    8. Airway Exchanges

    9. Deep Extubations

    10. Aspiration on Induction

    11. Intubating Without Muscle Relaxant

    12. Jet Ventilation for ENT Surgery

    13. Intubating with a Bougie

    14. Intubating with C-Spine Precautions

    15. Intubating with Video Laryngoscope

    16. Intubating on the Ground

    17. Double-Lumen Endotracheal Tubes

    18. Emergency Cricothyroidotomy

    19. Laryngeal Mask Airways (LMAs)

    20. Troubleshooting Tracheostomies

    21. Ultrasound-Guided Peripheral IVs

    22. Where to Look for Peripheral IV

    23. Subclavian Central Lines without Ultrasound

    24. Internal Jugular Central Line Without Ultrasound

    25. Femoral Lines Without Ultrasound

    26. How to Assemble an Arterial Line Transducer

    27. Radial Arterial Lines

    28. Dorsal Pedal Arterial Lines

    29. Belmont Infuser

    30. Single Shot Spinal

    31. Lumbar Epidurals

    32. Continuous Spinal

    33. Combined Spinal-Epidurals

    34. Thoracic Epidurals

    35. Wet Taps and Epidural Blood Patches

    36. Total Intravenous Anesthetics

    37. Monitored Anesthesia Care

    38. Emergence Without Nitrous Oxide

    39. Craniotomies

    40. Liver Transplants

    Back Matter

     

  • ICU Quick Drug Guide
    La comanda in aproximativ 4 saptamani
    230.00 lei

     

    Description:

    Offering essential, evidence-based practice guidelines specifically for the critical care setting, ICU Quick Drug Guide contains up-to-date information in a quick-access format. This portable handbook provides fast, accurate drug therapy information needed at the point of care, including expert advice throughout to help clinicians determine optimal pharmacological therapy.

    • Offers a quick summary of current clinical guidelines to experienced clinicians while providing a simplified, focused guide to all entry level clinicians.
    • Covers the wide variety of issues seen in the ICU, including sepsis and septic shock, venous thromboembolism, acute heart failure, anaphylaxis, arrhythmias, asthma and COPD, pain, infections, pancreatitis and liver failure, stroke, and many more.
    • Begins each topic with a brief discussion of the disease state followed by drug tables that compare and contrast different treatment regimens, including pharmacokinetics, pharmacodynamics, drug interactions, contraindications, and hepatic/renal dosing.
    • Contains clinical pearls organized by the top disease states seen in the critical/acute care setting.
    • Provides practical and essential drug information from Dr. Jennifer Pai Lee, a clinical pharmacist with expertise in critical care and pharmacokinetics/pharmacodynamics.

     

     

    Table of Contents:

    1.    SECTION 1. CARDIOVASCULAR CRITICAL CARE

    2.    1.  Acute coronary syndromes

    3.    Clinical signs and symptoms of ACS (fig. 1.1)

    4.    Causes of troponin elevations (box 1.1)

    5.    Acute management of ACS

    6.    References

    7.    2.  Acutely decompensated heart failure (ADHF)

    8.    Definitions

    9.    Precipitating factors

    10.  Pharmacologic management

    11.  References

    12.  3.  Adult advanced cardiovascular life support

    13.  Asystole/pulseless electrical activity

    14.  Ventricular fibrillation/pulseless ventricular tachycardia

    15.  Bradycardia with pulse

    16.  Tachycardia with pulse

    17.  Post-cardiac arrest care

    18.  Targeted temperature management (TTM) or therapeutic hypothermia (TH)

    19.  References

    20.  4.  Anticoagulation for atrial fibrillation or atrial flutter

    21.  Anticoagulation to prevent thromboembolism in atrial fibrillation (AF) or atrial flutter

    22.  References

    23.  5.  Hypertensive crisis

    24.  Definitions

    25.  Management

    26.  References

    27.  SECTION 2. ENDOCRINE, GASTROINTESTINAL, AND HEPATIC DISORDERS

    28.  6.  Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)

    29.  Introduction

    30.  Diagnosis criteria (table 6.1)

    31.  Management (table 6.2)

    32.  Insulin preparations (table 6.3)

    33.  References

    34.  7.  Other endocrine emergencies

    35.  Thyroid storm

    36.  Myxedema coma

    37.  Adrenal crisis

    38.  References

    39.  8.  Gastroenterology

    40.  GI fistulas

    41.  Postoperative ileus (POI)

    42.  Postoperative nausea and vomiting (PONV)

    43.  Upper GI bleeding (UGIB)

    44.  References

    45.  9.  Severe acute pancreatitis and liver failure

    46.  Severe acute pancreatitis

    47.  Liver failure

    48.  Hepatic encephalopathy

    49.  References

    50.  SECTION 3. INFECTIOUS DISEASES

    51.  10.  Abdominal infections

    52.  Complicated intra-abdominal infection

    53.  Clostridium difficile infection (CDI)

    54.  References

    55.  11.  Other infections

    56.  Hospital-acquired and ventilator-associated pneumonia

    57.  Community-associated pneumonia

    58.  Influenza

    59.  Intravascular catheter-related infections

    60.  Catheter-associated urinary tract infections (cautis)

    61.  Skin and soft tissue infections (SSTIs)

    62.  Antimicrobial prophylaxis in surgery

    63.  Bacterial meningitis

    64.  References

    65.  12.  Sepsis and septic shock

    66.  Definitions

    67.  Management of sepsis and septic shock

    68.  References

    69.  SECTION 4. NEUROCRITICAL CARE

    70.  13.  Acute ischemic stroke (AIS)

    71.  Definitions

    72.  Classification of stroke types (fig. 13.1)

    73.  National institutes of health stroke scale (table 13.1)

    74.  Management

    75.  References

    76.  14.  Other neurocritical care

    77.  Myasthenia crisis

    78.  Guillain-barre syndrome

    79.  Antithrombotic-induced intracranial hemorrhage

    80.  References

    81.  15.  Status epilepticus

    82.  References

    83.  SECTION 5. PULMONARY DISORDERS

    84.  16.  Asthma and chronic obstructive pulmonary disease (COPD) exacerbation

    85.  Asthma exacerbation

    86.  Chronic obstructive pulmonary disease (COPD) exacerbation

    87.  References

    88.  17.  Pulmonary arterial hypertension (group 1 pulmonary hypertension)

    89.  References

    90.  SECTION 6. MISCELLANEOUS

    91.  18.  Acute alcohol and drug poisoning

    92.  Introduction

    93.  Management after patient stabilization

    94.  References

    95.  19.  Anaphylaxis

    96.  Introduction

    97.  Signs and symptoms (table 19.1)

    98.  Triggers (table 19.2)

    99.  Acute management (table 19.3)

    100.               Prevention

    101.               References

    102.               20.  Drug-induced hyperthermia

    103.               Malignant hyperthermia (MH)

    104.               Neuroleptic malignant syndrome (NMS)

    105.               Serotonin syndrome

    106.               References

    107.               21.  Fluids and electrolyte disorders

    108.               General overview (tables 21.1, 21.2, and 21.3)

    109.               Hypernatremia

    110.               Hyponatremia

    111.               Other electrolyte abnormalities and management (table 21.6)

    112.               References

    113.               22.  Pain, agitation, delirium, and neuromuscular blockade in the intensive care unit (ICU)

    114.               Pain

    115.               Agitation

    116.               Delirium

    117.               Neuromuscular blockade

    118.               References

    119.               23.  Rapid sequence induction

    120.               Introduction

    121.               Pharmacotherapy

    122.               Vasopressors for blood pressure support

    123.               References

    124.               24.  Venous thromboembolism (VTE)

    125.               Introduction

    126.               Risk factors for VTE

    127.               Prevalence of VTE

    128.               Thromboprophylaxis

    129.               Treatment of VTE with anticoagulants

    130.               References

    131.               Appendix

    132.               References

    133.               Index

     

  • 28900lei 265.00 lei

     

    Description:

    Essentials of Equipment in Anaesthesia, Critical Care and Peri-Operative Medicine is a highly practical textbook for trainees in anaesthesia and an invaluable guide for all those who work with anaesthetic equipment, including anaesthetic and intensive care nurses and operating department practitioners.

    The superbly organized and easy-to read format of the book has been retained from previous editions. The text has been comprehensively updated and more focused on the FRCA with the addition of exam tips and new questions. A new chapter addresses the topical and ever expanding field of ‘Point of Care Testing’ in anaesthesia and intensive care. Clear colour photographs and illustrations as well as over 100 interactive self-assessment OSCE questions complete this concise account of anaesthetic equipment and its use in clinical settings.



    Table Of Contents:


    1 Medical gas supply

    2 The anaesthetic machine

    3 Pollution in theatre and scavenging

    4 Breathing systems

    5 Tracheal tubes, tracheostomy tubes and airways

    6 Masks and oxygen delivery devices

    7 Laryngoscopes and tracheal intubation equipment

    8 Ventilators

    9 Humidifaction and filtration

    10 Non-invasive monitoring

    11 Invasive monitoring

    12 Pumps, pain management and regional anaesthesia

    13 Additional equipment used in anaesthesia and intensive care

    14 Point of care testing

    15 Electrical safety

    Appendix A: Safety and standards

    Appendix B: Graphical symbols for use in labelling medical devices

    Appendix C: Decontamination of medical equipment

    Appendix D: Directory of manufacturers

    Glossary

       

     

  • 29500lei 270.00 lei

    Now reflecting a greater focus on today's multidisciplinary approach to care, Critical Care Handbook of the Massachusetts General Hospital, 6th Edition, remains your go-to guide for practical, complete, and current information on medical and surgical critical care. The user-friendly, outline format is designed for rapid reference, providing reliable, hospital-tested protocols that reflect today's most advanced critical care practices. Key Features*Heavily revised to reflect today's need to include all care providers to optimize treatment*New section on Health Care Services, with chapters on handovers and transitions, long-term outcomes of ICU patients, EICU and electronic systems, quality improvement, and more*New chapters on critical care management of Ebola virus disease, ECMO and ventricular assist devices, and critical care of the obstetrical patient*New videos available online*Complete, concise, full-color coverage of this rapidly enlarging field*Convenient pocket size for on-the-go referenceNow with the print edition, enjoy the bundled interactive eBook edition, which can be downloaded to your tablet and smartphone or accessed online and includes features like:*Complete content with enhanced navigation*Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web*Cross-linked pages, references, and more for easy navigation*Highlighting tool for easier reference of key content throughout the text* Ability to take and share notes with friends and colleagues*Quick reference tabbing to save your favorite content for future use

  • 30500lei 275.00 lei

    Apply today's best practices in anesthesiology! Relied on for over 30 years by practicing anesthesiologists and residents as well as nurse anesthetists, Clinical Anesthesia Procedures of the Massachusetts General Hospital offers you current, comprehensive, concise, consistent, and clinically relevant guidelines on all facets of anesthesia, perioperative care, critical care, and pain management from a host of seasoned experts. Key Features *Find the answers you need effortlessly through an easy-to-scan outline format that progresses intuitively from preoperative evaluation through administration of anesthesia to perioperative issues for each subject.*Focus on the clinical fundamentals needed for the safe delivery of anesthesia and perioperative care.*Achieve excellent outcomes using proven procedures from the internationally recognized Department of Anesthesia, Critical Care, and Pain Medicine at the Massachusetts General Hospital.Now with the print edition, enjoy the bundled interactive eBook edition, which can be downloaded to your tablet and smartphone or accessed online and includes features like:*Complete content with enhanced navigation* A powerful search that pulls results from content in the book, your notes, and even the web*Cross-linked pages, references, and more for easy navigation*Highlighting tool for easier reference of key content throughout the text* Ability to take and share notes with friends and colleagues*Quick reference tabbing to save your favorite content for future use

  • 36000lei 310.00 lei

     

    Description:

    The full-color Avoiding Common Anesthesia Errors, significantly updated for this second edition, combines patient safety information and evidence-based guidance for over 300 commonly encountered clinical situations. With a format that suggests conversations between an attending and a trainee, the book helps you identify potential problems and develop a treatment plan to minimize the problem. Brief, easy-to-read chapters cover basic and advanced topics and help you digest information in minutes!

     

     

     

    Table of Contents:

     

    VENTILATION AND AIRWAY

    1 Introduction

    2 Basics of Airway Management (Part I)—Always Keep in Mind Complications That Can Occur With Existing Endotracheal Tubes and Tracheal Extubation

    Inability to Ventilate due to Endotracheal Tube Occlusion

    Avoiding Unexpected Loss of the Airway in Already Intubated Patients

    Anticipate Potential Difficulties and Be Prepared to Treat Airway Failure After Extubation

    Preparing for Safe Tracheal Extubation

    Avoiding Complications of Premature Extubation

    Exchanging a Double-Lumen ETT With a Single-Lumen ETT

    3 Basics of Airway Management—Part II (More Tips and Tidbits to Read on the Train)

    4 Optimize the Airway: Bag–Mask Ventilation

    5 Optimize the Airway: Direct Laryngoscopy

    Basic Principles

    Direct Laryngoscopy Techniques

    Placing the Endotracheal Tube

    6 Oxygen Is a Drug

    Administration

    Volume of Distribution

    Pharmacodynamics

    Circulatory Effects

    Pulmonary Effects

    Medical Use

    Side Effects and Risks

    7 Advantages and Disadvantages of the Laryngeal Mask Airway (LMA)

    Introduction

    8 Avoiding Challenges With Video Laryngoscopy

    When Should I Do an Awake Intubation Instead of VL?

    Should VL Replace DL?

    Overcoming Difficult Tube Placement With VL

    Avoiding Soft Tissue Injury With VL

    9 Do Not Overinflate the Cuff of the Endotracheal Tube

    10 Consider the Use of Lidocaine in the Cuff of the Endotracheal Tube, but Be Aware of the Risks and Alternatives

    Intracuff Lidocaine

    Alternatives

    11 An Easy Intubation Does Not Guarantee an Easy Reintubation—Especially After a Carotid Endarterectomy or Cervical Spine Surgery

    Edema/Hematoma

    Cerebrospinal Fluid Leak

    Recurrent Laryngeal Nerve Injury

    Carotid Body Dysfunction

    Cervical Misalignment

    Surgical Dressings

    12 Plan for an Airway Fire With Every Head and Neck Case

    Introduction

    Fire Triad

    Procedures With Increased Risk for Fire

    Surgical Fire

    Communication and Prevention

    Management of OR Fires

    13 There Are Special Considerations Involved With Both Intubation and Chronic Airway Management of Burn Patients

    Acute Management

    Chronic Management

    14 To PEEP or Not to PEEP—That Is the Question

    Definitions

    Physiologic Effects

    Respiratory

    Cardiac

    Central Nervous System

    Renal

    Hepatic

    Indications

    Prevention of Atelectasis

    ALI/ARDS

    Cardiogenic Pulmonary Edema

    Contraindications

    Treatment of Auto-PEEP

    Ongoing Debate

    15 This Is No Time for Wishful Thinking: Always Troubleshoot an Increase in Peak Airway Pressure

    Consequences of Elevated Ventilatory Pressure

    Airway/Ventilation Equipment Problems

    Patient-Related Problems

    Cough/Light Anesthesia

    Bronchospasm/Wheezing

    Mechanical Airway Obstruction

    Positioning/Surgical Factors

    Decreased Pulmonary and Chest Wall Compliance

    Acute Decreases in Lung Parenchymal Volume

    Auto-PEEP

    Conclusion

    16 The Key to the Smooth and Skilled Placement and Use of Double-Lumen Endotracheal Tubes Is to Take It One Step at a Time

    Introduction

    Sizing of Double-Lumen Endotracheal Tubes

    Placement of Double-Lumen Endotracheal Tubes

    Bronchial Cuff Inflation

    Mechanical Ventilation

    Hypoxia During One-Lung Ventilation

    17 Avoid Common Airway and Ventilation Errors in Morbidly Obese Patients

    Introduction

    Obstructive Sleep Apnea

    Associated Conditions

    Physiologic Alterations

    Establishing the Airway

    Ventilation After the Airway is Established

    Hazards of Tracheal Extubation

    18 Anesthesia for Awake Intubations

    Innervation

    Anesthetization of the Airway

    Nasal Cavity/Nasopharynx

    Oral Cavity/Oropharynx

    Hypopharynx

    Larynx

    Vocal Cords and Trachea

    19 Awake Intubations–Being Able to Do Them Comfortably and Safely for the Patient Is the Benchmark for the Airway Expert

    Indications for Awake Intubation

    Nasal Versus Oral

    Techniques

    Fiber-optic Intubation

    Blind Nasal or Oral Lightwand

    Awake Laryngoscopy

    20 Airway Management in the ICU, Including the Dreaded Leaking Cuff—How to Bring Your Best Game

    Introduction

    General Principles

    Issue: “The Endotracheal Tube Cuff Is Leaking, and I Can’t Ventilate My Patient!”

    Issue: “I Need to Change the ETT or Extubate This Patient, but I’m Concerned About a Difficult Reintubation.”

    Issue: “My Patient’s Tracheostomy Device Is Dislodged.”

    Summary

    21 Ludwig’s Angina

    22 Jet Ventilation—How to Adequately Handle This Exotic Ventilation Technique and Earn the Admiration of Your Spectators

    Accepted Indications for JV

    Insufficient Oxygenation

    Insufficient Carbon Dioxide Elimination

    Increasing Airway Pressure

    JET Gas Conditioning

    23 High-Frequency Jet Ventilation—The View From Philadelphia

    Physical Principles

    Clinical Use and Principles

    CO2 Monitoring

    Other Clinical Considerations

    24 Know How to Perform a Cricothyroidotomy

    25 Don’t Make the Mistake of Thinking That a Tracheostomy Is a Guaranteed Airway

    Tracheal Tube Obstruction

    Foreign Body in Tracheal Tube or Airway

    Loss of Airway With Tracheostomy Tube Removal

    Hemorrhage

    Chronic Complications

    26 Helium for the Compromised Airway—You Have to Understand the Principles and Properties but We’ve Seen Some Amazing Saves

    Physical Properties of Helium

    Heliox

    Physics of Fluid Flow With Heliox

    Administration

    Possible Clinical Applications

    For Upper-Airway Obstruction and Stridor

    For Croup and Bronchiolitis

    For Asthma Exacerbation

    For Severe COPD

    New Avenues in Clinical Helium Use

    Risks of Heliox Use

    LINES AND ACCESS

    27 Introduction

    28 Remember That the IV Start Is Your First Chance to Make a Favorable Impression on the Patient

    29 Never Use an Intravenous Line Without Palpating and Inspecting It Visually

    Perioperative IV Fluid Concerns

    Intraoperative Monitoring

    Consequences

    Treatment Options

    Conclusions

    30 Intraosseous Access

    Needle Types

    Insertion Sites

    Complications of IO Needle Placement

    31 Central Line Placement: Never Neglect the Basics

    32 Avoid Technique-Related Central Venous Catheter Complications by Using Modern Tools

    33 Pulmonary Artery Catheters—Still Relevant and Still Worthy of a Cautious Approach

    How PAC Technology Works

    Placement and Risk

    Errors of Management

    Errors of Interpretation

    Alternative or Supplemental Techniques

    34 Don’t Overflush Lines

    35 Inadvertent Intra-Arterial Injection Can Result in Severe Patient Injury

    Risk Factors for IA Injection

    Signs and Symptoms of Arterial Cannulation

    Pathophysiology

    Treatment Options

    Prevention of IA Injection

    36 Do Not Use the Subclavian Vein for Central Access of Any Type in a Patient Who Is On or Planned for Dialysis

    37 Consult the Surgeons Immediately if Your Patient Loses a Patent Hemodialysis Fistula—This Is a Serious Complication for the Patient

    Hemodialysis Fistulas

    AVF Failure

    Treatment of AVF Thrombosis

    FLUIDS AND RESUSCITATION

    38 Introduction

    39 Crystalloid Fluids: More Than Just a Dash of Salt

    The Evidence

    The Practice

    40 Hypertonic Saline: Still the “Solution” to the Solution Problem?

    41 Synthetic Colloid Solutions Have Distinct Properties and Risk/Benefit Ratios That Require Your Attention!

    42 Do Not Use CVP to Guide Fluid Resuscitation

    TRANSFUSION MEDICINE

    43 Introduction

    44 Know What Screening Tests Are Performed on Volunteer Donor Blood

    Queries and Questionnaire

    Serum Screening

    Platelets

    Blood Type and Antigen Testing

    Understanding and Managing the Patient’s Anxiety

    45 Red Blood Cell Primer

    Washing (Please see Chapter 53 on Washed Products for More Detail)

    Irradiation

    Leukoreduction

    Infectious Complications of pRBCs

    Noninfectious Complications (Other Than Transfusion Reactions)

    46 Type and Screen or Type and Cross-Match?

    Type and Screen

    Cross-Matching

    Optimizing Perioperative Blood Ordering

    47 Special Circumstances: Patients With Antibodies

    48 Plasma—It’s Not Just to Fix an Abnormal INR

    Plasma Use

    Thromboelastography and ROTEM

    Massive Transfusion Protocols

    MTP Controversies and Issues

    Are Guidelines Effective?

    Types of Plasma Products

    Plasma Dosing

    Alternatives to Plasma

    Summary

    49 Plasma Part II: Is This Plasma or Pea Soup?

    50 Remember That the “Universal” Donor Is Different for Red Cell and Plasma Products

    51 Platelets—Often a Mystery!

    52 Cryoprecipitate—The Most Misunderstood Product in the Blood Bank

    Uses of Cryoprecipitate

    Inappropriate Uses of Cryoprecipitate

    Dosing of Cryoprecipitate

    53 Washed Blood Products Are a Source of Confusion—Here’s Some Help

    54 This TEG Tracing Looks Like a Rorschach Blot … Is It Time for a Transfusapalooza?

    Introduction

    TEG Sample Processing

    TEG Parameters

    TEG Tracing Patterns and Weaknesses

    55 Transfusion Reactions

    Treatment of Transfusion Reactions

    56 Transfusion Outcomes

    Varied Practice—Transfusion Triggers pRBC

    Why Decrease Transfusion?

    Risk of Nosocomial Infection

    Cancer Recurrence

    Cardiovascular Effects

    Red Cell Alloimmunization

    Plasma

    Platelets

    All Blood Products

    Increase in Length of Stay

    Increased Costs

    Declining Donor Supply

    57 Directed Donation Is Generally Not a Good Idea

    Blood Safety

    58 Not All Acute Lung Injury After a Transfusion Is Transfusion-Related Acute Lung Injury

    59 Jehovah’s Witnesses and Bloodless Medicine

    Preoperative Strategies for a Bloodless Perioperative Clinical Course

    Intraoperative Strategies for a Bloodless Perioperative Clinical Course

    Anesthesiology Techniques

    Surgical Techniques

    Postoperative Strategies for a Bloodless Perioperative Clinical Course

    60 The Ethics of Jehovah’s Witnesses and Transfusion

    Management Strategies for Jehovah’s Witness Patients—The Basic Three-Part Approach

    MEDICATIONS

    61 Introduction

    62 What Just Happened! What You Need to Know About Medication Errors

    Introduction

    Are Medication Errors a Problem in Anesthesia?

    How Common Are Medication Errors in Anesthesia?

    How Do We Identify Our Drugs?

    What Is the Proper Technique to Draw Up and Administer a Drug?

    What Medication Issues Predispose to Medication Errors?

    What Environmental and Practitioner Issues Predispose to Medication Errors?

    Types of Errors

    ASA Closed Claims

    How Can We Reduce the Incidence of Medication Errors?

    Conclusion

    63 Make Sure You Understand the Complex Medical and Legal Issues Surrounding Off-Label Drug Use

    64 Perioperative Beta-Blocker Therapy for High-Risk Patients Having Noncardiac Surgery—New Data, New Recommendations

    Perioperative Studies

    More Recent Studies

    Task Force Guidelines

    65 Should I Withhold or Continue Angiotensin Receptor Blockers in the Perioperative Period?

    Indications

    Perioperative Guideline

    Should Therapy Be Continued Uninterrupted in the Perioperative Period?

    Timing of Last Dose

    66 Stop Metformin Before Elective Surgery or Intravascular Contrast Dye Study to Decrease the Risk of Lactic Acidosis

    Lactic Acidosis

    Guidelines

    67 Should I Administer Steroids in the Perioperative Period?

    Hyperglycemia

    Wound Healing and Infection

    Steroid Withdrawal

    Other Complications

    68 Beware of the Bowel Prep

    69 What Drugs Require Slow Administration?

    Phenytoin (Dilantin)

    Protamine

    Vancomycin

    Potassium

    Clindamycin

    Thymoglobulin

    Furosemide (Lasix)

    Gentamicin

    Oxytocin (Pitocin)

    Dexamethasone

    Lysine Analogs

    Other Pearls to Avoid Common Errors Involving IV Administration in the Operating Room

    70 Ketamine—Use It Well

    71 TIVA—What You Need to Understand to Do It Well

    Pharmacokinetics

    Time to Peak Effect

    Redistribution

    Elimination

    Pharmacodynamics

    Infusion Systems

    72 Dexmedetomidine: Is There Such a Thing as a Free Lunch?

    What is Dexmedetomidine?

    How Does Dexmedetomidine Work?

    Potential Benefits of Dexmedetomidine

    Complications/Contraindications

    FDA-Approved Uses

    How to Administer Dexmedetomidine

    Clinical Applications of Dexmedetomidine

    Clinical Controversy

    73 Consider Chloroprocaine in Emergency Situations—It Is a Rapid-Onset Local Anesthetic With Low Systemic Toxicity

    Chemical Structure

    Clinical Pharmacology

    Toxicity Controversy

    Clinical Use

    74 Use Bicarbonate as a Buffer to Local Anesthetics—Especially for Skin Infiltration

    Buffering Local Anesthetics to Decrease Onset Time

    Buffering Local Anesthetics to Decrease Pain on Injection

    Stability of Buffered Lidocaine

    How to Prepare Buffered Lidocaine for Skin Infiltration

    75 The Hows, Whys, Ins, and Outs of Succinylcholine or Succinylcholine—Still a Useful Anesthesia Adjunct

    Introduction

    Neuromuscular Blockers Broken Down

    The Neuromuscular Junction and Skeletal Muscle Contraction

    Succinylcholine—Mechanism of Action

    Indications for Succinylcholine

    Cardiovascular Effects of Succinylcholine

    Musculoskeletal Effects of Succinylcholine

    Hyperkalemia and Succinylcholine

    Muscular Dystrophies and Succinylcholine

    Malignant Hyperthermia and Succinylcholine

    Myopathies and Succinylcholine

    76 Don’t Get Burned by Incomplete Reversal of Neuromuscular Blockade

    Introduction

    How Do Nondepolarizing Muscle Relaxants Work?

    How Do We Monitor Neuromuscular Blockade During Surgery?

    How Do We Reverse Neuromuscular Blockade?

    How Do We Define Adequate Recovery From Neuromuscular Blockade?

    What Is the Incidence of Inadequate Reversal?

    What Are the Clinical Implications of Incomplete Reversal?

    Which Groups Have Higher Risk of Incomplete Reversal?

    More About Neuromuscular Monitoring

    What About Clinical Assessment of Neuromuscular Blockade?

    Let’s Talk About Neostigmine—the Old Standard

    A Neostigmine Dosing Strategy

    Let’s Talk About Sugammadex—the New Kid on the Block

    Sugammadex Issues

    A Sugammadex Dosing Strategy

    Putting It All Together—How to Avoid Postoperative Residual Block

    77 Opioid Conversions—It’s Not Only About the Table

    Opioid Conversions in Perioperative Setting

    Making Conversions Easy

    Opioid Conversions From Intravenous to Oral Form

    78 Not All Patients Are Naive—Management of Perioperative Pain in Opioid-Dependent Patients

    Preoperative Evaluation

    Anesthetic Management

    Postoperative Pain Management

    What About Patients on Maintenance Therapy?

    What About Patients Previously Opioid-Dependent or Addicted?

    79 The Basal Infusion Mode in Patient-Controlled Analgesia Is Both Friend and Foe

    80 Keep Discussing the Use of Ketorolac (Toradol) With Your Surgical Team Before the Need Arises and Keep Your Eye on the Literature

    Basic Pharmacology

    Indications and Use

    Postoperative Pain

    Intravascular Regional Anesthesia (Bier Block)

    Periarticular Injection “Cocktail”

    Complications and Issues

    81 Special Topic I: Do Patient With Congenital Insensitivity to Pain Need Anesthetics and Postoperative Opioids?

    Hereditary Sensory and Autonomic Neuropathy

    Classification of Congenital Hyposensitivity to Pain

    Anesthesia and Hereditary Sensory and Autonomic Neuropathy Disorders

    Perioperative Management of Body Temperature

    Perioperative Prevention of Aspiration

    82 Special Topic II: Can Your Patients Eat Their Way Out of Chronic Pain? Some Common Sense Advice

    83 Attacking Acute Perioperative Hypertension— The Cleveland Group Shares Their Battle Plan

    Pharmacologic Acute Hypertension Management Tools—The Sharp End of the Stick

    The Downers (aka Vasodilators)—The Ideal Drug

    Calcium Channel Blockers—But Not Just Any Calcium Channel Blocker

    Calcium Channel Blockers—Dihydropyridine L-type

    Nitrovasodilators (aka Nitric Oxide Donors)

    Beta- and Alpha-Antagonists

    Alpha-2 Agonist

    Oddball IV Antihypertensives

    84 Cardiovascular Vasoactive Drugs That Pump You Up

    Phenylephrine—Straight Up Alpha-1 Agonist

    Ephedrine—Indirect Acting at Beta-1 Receptors Through Release of Norepinephrine

    Dopamine—Dopamine Receptor Agonist and Beyond

    Dobutamine—Beta-1 Receptor Agonist

    Time to Change Gears…

    Norepinephrine (Levophed, aka Leave ‘em Dead) Mixed Alpha-1>>Beta-1 Agonist

    Epinephrine—Mixed Alpha-1 <Beta-1 and -2 Agonist

    Vasopressin (aka Antidiuretic Hormone, Arginine Vasopressin, or Argipressin)

    Methylene Blue (Why Is My Pee GREEN?)

    85 Milrinone—The Not-So-Kidney-Friendly Intraaortic Balloon Pump in a Bottle

    The 30,000 Foot View of Clinical Milrinone Use

    Milrinone: Mechanism of Action

    Milrinone: Indications

    Milrinone: Dosing

    Milrinone: Cautions In Use

    86 Amiodarone and Alternative Antiarrhythmics— Double-Edge Swords for the Treatment of Atrial and Ventricular Fibrillation

    30,000 Foot View of Amiodarone and Alternative Antiarrhythmic Agents

    The Basics of AFIB and Amiodarone

    Drug–Drug Interactions (DDIs) Involving Amiodarone

    Summary

    87 Ondansetron Is a Great Drug, We ALL Use It, But Watch for Headache and QT Prolongation

    Serotonin Pharmacology and the Antiemetic Effect

    Other Indications

    Overall Safety Profile

    Headache

    ECG Effects—QTc Prolongation

    88 A Word About Haloperidol in the Perioperative Period

    Basic Pharmacology and Pharmacokinetics

    Risks and Side Effects

    Pharmacokinetics

    Haloperidol Clinical Pearls for the Anesthesiologist

    89 Remember That Not All Blue-Colored Compounds Are the Same

    Methylene Blue

    Patent Blue

    Isosulfan Blue

    Indigo Carmine

    Indocyanine Green

    FDA Public Health Advisory!

    90 Clonidine Considerations

    Chemical Properties/Pharmacology

    Physiologic Effects

    Dosing/Duration of Action

    Antihypertensive and Cardiovascular Effects

    Sedation/Reduction in Anesthetic Requirements

    Analgesia

    Other Uses

    Side Effects/Contraindications

    91 A Primer on the Psych Syndromes: Serotonin Syndrome Versus Neuroleptic Malignant Syndrome

    Serotonin Syndrome

    Neuroleptic Malignant Syndrome

    Serotonin Syndrome and Other Perioperative Drugs

    Hunter Serotonin Toxicity Criteria

    Neuroleptic Malignant Syndrome in the Perioperative Period

    So—What Is the Exact Mechanism for Neuroleptic Malignant Syndrome and Is It Related to Malignant Hyperthermia in Any Way?

    92 Drug-Drug Interactions Are Now Necessary Knowledge for the Anesthesia Provider and We Can Help

    93 The Six Patterns of Cytochrome P450 Drug-Drug Interactions Relevant to the Perioperative Clinician

    Pattern 1: An Inhibitor Is Added to a Substrate

    Pattern 2: A Substrate Is Added to an Inhibitor

    Pattern 3: An Inducer Is Added to a Substrate

    Pattern 4: A Substrate Is Added to an Inducer

    Pattern 5: Reversal of Inhibition

    Pattern 6: Reversal of Induction

    Remember That These Clinical Effects Are Reversed If the Substrate Is a Prodrug!

    94 Don’t Spend Time Rereading Tom Clancy Novels Until You Have Mastered These Basic Drug-Drug Interactions

    Summary of Cytochrome P450 Metabolism of Intraoperative Drugs

    95 Drug-Drug Interactions and the P-glycoprotein Pump—Be Vigilant With Patients on Digoxin

    Physiology of the Transporter

    Substrates and Inhibitors of the P-glycoprotein Transporter

    Inducers of the P-glycoprotein Transporter

    96 Can You Name Six Perioperative Drug-Drug Interactions That Involve Oral Contraceptives? Okay, You Can Now!

    Oral Contraceptives

    97 Wish We Knew Then What We Know Now— A Case of Serotonin Syndrome in the Operating Room

    Metabolism of Selective Serotonin Reuptake Inhibitor

    Beware of Methylene Blue Pharmacologic Action

    Drug-to-Drug Interaction: Methylene Blue and SSRI

    EQUIPMENT

    98 Introduction

    99 Pulse Oximetry: Perhaps You Need a Refresher?

    Accuracy

    Limitations: Signal Artifacts and Optical Interference

    Clinical Application

    100 The End-Tidal CO2 Monitor Is More Than Just a Device to Tell You That “the Tube in the Airway”

    Review of Capnography

    Capnometry Versus Capnography

    Normal Capnogram

    Factors Influencing Alveolar Dead Space

    Decreased Capnogram

    Increases in ETCO2 Level

    Effect of PEEP

    Bronchospasm

    Negative Arterial–End-Tidal Gradient

    Alterations in Inspiratory CO2

    Other Variations in Waveform

    Monitoring Moderate or Deep Sedation

    101 Noninvasive Blood Pressure Management— It’s Not Just a Piece of Nylon Around the Arm

    Oscillometry

    Proper Use

    Errors of Measurement

    Complications

    102 Avoid Errors in Invasive Blood Pressure Measurement

    103 How, Why, and When to Use Brain Function Monitors

    What Is a “Depth of Anesthesia” Brain Function Monitor?

    What Are the Benefits and Limitations?

    What Do Current Guidelines Say?

    Our Personal Practice

    The Future?

    104 Do Not Improvise Techniques to Warm Patients—Use Warming Devices Only as Per Manufacturers’ Recommendations

    Complications of Hypothermia

    The Pathophysiology and Physics of Hypothermia

    Preventing Hypothermia

    Preventing Patient Injury While Preventing Hypothermia

    105 Transesophageal Echocardiography: Contraindications, Complications, and Misinterpretations

    Probe Placement

    Image Interpretation

    Normal Anatomic Variants

    106 Scavenging Waste Gases Is Perhaps the Only Action We Take That Benefits Us but Not the Patient

    Chronic Exposure to Waste Gases

    Scavenging Systems

    Avoiding Mishaps

    107 Carbon Dioxide Absorbers Save Gas and Moisture but Create the Potential for Mechanical Hazards, Chemical Soup, or a Thermal Disaster

    Basic Management of Absorbers

    Mechanical Complications

    Adverse Chemical Reactions

    108 Infusion Pumps: Get Them Going and Keep Them Going!

    Gravity

    Infusion Pumps

    Syringe Pumps

    Common Principles and Current Considerations

    109 Don’t Bring the Fiberoptic Scope Into the MRI Scanner!

    Metals and MRI

    Anesthesia Equipment

    Airway and Emergency Management

    110 Understanding the Operating Room Circuit and the Line Isolation Monitor—It’s Really Pretty Simple

    Basic Electrical Terminology

    Grounded Power Systems

    Isolated Power Systems

    Conversion of an Isolated Power System to a Grounded System

    Line Isolation Monitor

    111 Cell Phones in the Operating Room—Here Are the Issues

    Mechanisms of Electromagnetic Interference

    Effects of Electromagnetic Interference on Medical Devices

    Risk of Electromagnetic Interference

    Regulation and Standardization

    112 Don’t Let the Tourniquet Cause Extra Pain or Complications

    Muscle

    Nerves

    Cardiovascular Considerations

    Hematologic Complications

    Pharmacokinetics

    PERIOPERATIVE

    113 Introduction

    114 Hurdles of the Electronic Health Record

    115 Hand Hygiene! History, Human Factors, and Helping Your Patients

    Summary

    116 Remember That the Same Simple Mistakes at Induction (and Emergence) Happen Over and Over Again!

    Induction

    Emergence

    117 Smoking Cessation Part I—ANYTIME Is a Good Time to Quit

    Smoking Increases Perioperative Complications

    Any Time Is a Good Time for Stopping Smoking

    How Could Anesthesiologists Help in Smoking Cessation?

    118 Smoking Cessation Part 2—So Good for the Patient as Long as You Understand the Effects on CYP1A2 Drug Metabolism (Especially R-Warfarin)

    119 Flying to the Mayo Clinic for Surgery? The Clot Thickens

    120 Don’t Let Your Understanding of the Utility of Preoperative Stress Testing in Suspected Heart Disease Lapse

    121 A Positive Troponin Does Not Always Mean a Myocardial Infarction—Will the New High-Sensitive Assays Help Sort It Out?

    Troponin Assays

    Renal Failure

    Other Disease States

    Clinical Context—Cardiac Troponin Versus High-Sensitive Cardiac Troponin

    122 Preoperative Anxiolysis: It’s Not Just “Two of Midaz”

    Recent History

    Basic Principles

    Patient Concerns

    Pharmacologic Interventions

    Nonpharmacologic Interventions

    Acupuncture

    Summary

    123 Schizophrenia Is a Devastating Mental and Medical Illness—and These Patients Have Significantly Greater Perioperative Risks Than Age-Matched Controls

    Preoperative Risk Factors and Evaluation

    Intraoperative Management

    Postoperative Risk Factors and Management

    Antipsychotic Drugs

    124 What to Do About the Tattoos and Body Jewelry

    Tattoos

    Piercings and Jewelry

    125 We Now Know That Obstructive Sleep Apnea Is More Common Than We Thought—Manage These Patients Carefully and Conservatively

    Epidemiology

    Risk Factors

    Pathology

    Diagnosis

    Treatment

    Outcome

    Implications for Anesthesia

    Preoperative Evaluation

    Intraoperative Management

    Postoperative Care

    Discharge Criteria

    Outpatient Surgery

    OSA Characteristics for Children

    126 Don’t be Shy About Borrowing ICU Equipment, Medications, and Personnel for the Critically Ill Patient Going to the Operating Room

    Pulmonary Arterial Vasodilators

    Antibiotics and Immunosuppressive Agents

    Temporary Pacemakers

    ICU Ventilator

    ICU Personnel

    Respiratory Therapist

    Ventricular Assist Device Coordinator

    Lung De-recruitment

    127 The Dao of Positioning

    The Problem

    The Lessons

    128 The Supine Position—Complications Can Still Arise!

    General Considerations for Patient Positioning

    Positioning Checklist

    Complications Related to Physiologic Changes

    Respiratory

    Cardiovascular

    Specific Complications

    Peripheral Nerves

    Ulnar Nerve

    Brachial Plexus

    Head

    Skin

    Eyes

    129 Thinking Laterally—How to Safely Position a Patient in the “Sideways” Position for Surgery

    130 Positioning Patients for Spine Surgery

    131 Sit Back and Relax? Implications of the Sitting Position in Shoulder and Brain Surgery

    132 Individuals With Cerebral Palsy and Other Spastic Disorders Need Your Best Positioning Prowess

    133 Use Extra Care in Positioning Patients Who Have Had Amputations

    134 Never, Ever Fire

    Risk Assessment

    Preventative Measures

    Management of the Surgical Fire

    Race to Fire Safety

    Postsurgical Fire Management

    135 Malignant Hyperthermia: If You Get to the Point Where You See an Elevated Temperature, It’s Already Happening

    Treatment of Acute MH

    Treatment of Postacute MH

    What to Stock in the Malignant Hyperthermia Cart

    Drugs

    General Equipment

    Monitoring Equipment

    Nursing Supplies

    Laboratory Testing Supplies

    Forms

    Preparing the Anesthesia Machine for MH-Susceptible Patients

    Contact Information

    136 Good Old-Fashioned Basic Perioperative Blood Pressure Control

    Blood Pressure Control in the 21st Century

    It’s a Big World but Here is BP Management That Should Work for Everyone

    137 Some Additional Thoughts on Blood Pressure Management Techniques—What We Believe, How We Do It, and Where We Think the Science Is Going

    138 Protect the Kidneys, Not the “UOP”

    139 Avoid a 70% Mortality Rate: Do Everything You Can to Prevent Perioperative Renal Failure

    140 Do Not Use Urine Output as an Indicator of Volume Status in Hypothermic Patients

    141 Perioperative Hyperglycemia Is Associated With Poorer Clinical Outcomes so Consider Insulin Therapy for Both Diabetic and Nondiabetic Patients With Elevated Blood Glucose

    142 Seven Ways to Treat Hyperkalemia in the Perioperative Period

    Pathogenesis of Hyperkalemia

    Treatment of Hyperkalemia

    Calcium

    Insulin and Glucose

    Sodium Bicarbonate

    Beta-Adrenergic Agonists

    Loop or Thiazide Diuretics

    Cation-Exchange Resin

    Dialysis

    Blood Products

    143 Laparoscopic Procedures: Managing the Risks and Physiologic Effects During Camera Placement, CO2 Insufflation, and Vertical Positioning

    Cardiovascular Effects

    Intracranial Effects

    Pulmonary Effects

    Soft Tissue Effects

    144 Could This Be Methemoglobinemia, Maybe?

    Methemoglobinemia

    Methemoglobin Formation and Reduction

    Causes of Methemoglobinemia

    Signs and Symptoms

    Diagnosis

    Treatment

    145 The Eye Room—Is It the Easiest of Days? Or the Hardest of Days? Regardless, Vigilance Is Key!

    Managing Expectations

    Types of Anesthesia

    Topical

    Regional Blocks

    General Anesthetics

    Postoperative Course

    Vigilance

    Other Considerations for Eye Surgery

    146 My Eye Hurts! Prevention, Diagnosis, and Treatment of Corneal Injuries After Anesthesia

    Introduction

    Mechanisms of Injury

    Incidence

    Risk Factors

    Prevention of Corneal Injury

    Corneal Lubrication Options

    Do You Really Need an Ophthalmology Consult?

    Diagnosis

    Prognosis and Treatment

    Supportive Care

    Follow-up

    Documentation

    What Can My Center Do to Decrease the Incidence of Corneal Injuries?

    147 Never Forget That Patient Transport Within the Hospital Is One of the Most Dangerous Intervals in the Perioperative Period

    Introduction to Intrahospital Transport (IHT)

    Risks Associated With Intrahospital Transport

    Neurologic Complications

    Pulmonary Complications

    Cardiovascular Complications

    Other Complications

    Avoiding Common Errors: Considerations for Transporting Patients

    148 Seek Out Hypercapnia in the PACU and Remember That an Acceptable Pulse Oximeter Reading Is Not Assurance of Adequate Ventilation

    149 Let’s Go Over It Again: Avoid Residual Neuromuscular Blockade in the PACU!

    How Does Residual Neuromuscular Blockade Manifest and Why Does It Matter?

    How Can the Incidence of Residual Paralysis in the PACU Be Reduced?

    Judicious Use of Neuromuscular Blocking Drugs

    Evaluating for Neuromuscular Blockade

    Clinical Tests

    Neuromuscular Monitors

    Reversal Agents

    Conclusion

    150 Give the Intensivist the Best Handover to Improve Patient Outcomes

    Use Standardized Handover Tools

    Prioritize the Handover Process

    Assemble the Entire Team

    Improve the Handover Process Continually

    Pitfalls to Avoid

    Summary

    151 Don’t Miss Out on Ultrasound—Which ICU Techniques Are Helpful for the Anesthesiologist?

    Introduction

    Focused Lung Ultrasound

    Focused Cardiac Ultrasound

    Ultrasound for Difficult Vascular Access

    Summary

    152 Don’t Overlook the Potential of Perioperative Acupuncture

    Acupuncture Training—Licensed Acupuncturists Versus Medical Acupuncturists

    Efficacy of Acupuncture in the Perioperative Period

    Preoperative Optimization

    Postoperative Pain Control

    Chronic Pain

    Wellness for Providers

    Safety

    153 Consider Acupuncture as an Adjunct for the Prophylaxis and Treatment of Postoperative Nausea and Vomiting

    154 Don’t Warm Up a Cardiac Arrest Patient Unless They Are Dying of Hemorrhage!

    How Does Therapeutic Hypothermia Provide Neuroprotection?

    Potential Complications of Therapeutic Hypothermia

    155 What to Do If You Get a Needlestick Injury

    Common Scenarios Associated With Needlestick Injuries

    Human Immunodeficiency Virus

    Hepatitis B Virus

    Hepatitis C Virus

    REGIONAL ANESTHESIA

    156 Introduction

    157 Complications of Regional Anesthesia: Don’t Touch the Needle Before You Know Them

    Introduction

    Infection

    Bleeding

    Nerve Damage

    Allergic Reactions

    Blockade of Other Nerves

    Intravascular Injection and Local Anesthetic Toxicity

    Supplies and Equipment That Should Be Available When Doing Regional Anesthesia

    158 Make Time for a Timeout Before Placing a Block—the Preprocedure Check

    Suggested Elements of a Preprocedure Block Checklist

    Suggested Script for a Timeout

    What Should Happen When the Worst Happens?

    159 Chlorhexidine: Killing Bacteria … and Allergic Patients?

    Hypersensitivity

    Risk Factors

    Diagnosis

    Management

    160 What Is the Correct Brachial Plexus Block to Perform?

    Anatomy—The Road Map …

    Interscalene Block—Taking the High Road …

    Supraclavicular Block—Always Supra, Often Super as Well

    Infraclavicular Block–Emerging From the Tunnel

    Axillary Block—Taking the Low Road

    Those Darn Unblocked Territories

    Putting It All Together …

    When Should We Avoid or Delay Doing a Block?

    161 Getting the Right Ultrasound Image

    Picking a Transducer

    Ultrasound Controls

    Transducer Maneuvers

    162 Interscalene Blocks—Preventing the Blues!

    Complications

    Phrenic Nerve Block

    163 The Old-Fashioned “Bier” Block Is Still Relevant—The Trick Is to Not Let the Surgeons Get Ahead of You

    Introduction and History

    Advantages and Disadvantages

    Technique

    Agents and Adjuncts

    Cautions

    Getting Back to Our Case …

    164 Remember the Low-Risk/High-Yield Blocks

    Superficial Cervical Plexus Block

    Femoral Nerve Block

    Popliteal Fossa Nerve Block

    Ankle Block

    165 Preparing to Fail: The Dynamics of a Failed Block

    Know Your Anatomy!

    What If It Just Doesn’t Work?

    Blocks for Postoperative Analgesia

    Surgical Blocks

    Know Your Dosing

    A Note on Catheters

    166 Salvage Techniques for Incomplete Upper-Extremity Blocks

    Block Failure

    Salvage Blocks for the Upper Extremity

    Shoulder Surgery

    Forearm/Hand Surgery

    167 Salvage Blocks for Incomplete Lower Extremity Blocks

    Block Failure

    Salvage Blocks for the Lower Extremity

    Hip Surgery

    Knee Surgery

    Lower Leg and Foot Surgery

    168 More Than a Stick and a Burn: Local Anesthetic Systemic Toxicity

    Local Anesthetic Pharmacology

    Properties of Commonly Used Local Anesthetics

    Risk Factors for LAST

    Rate of Systemic Absorption (Fastest to Slowest)

    Clinical Presentation of LAST

    Signs and Symptoms of Local Anesthetic Toxicity

    Prevention of LAST

    Treatment and Management of LAST

    The Management of LAST

    Call for Help and Then Get VOCAL

    169 Lipid Rescue—Where Are We Now?

    Introduction to LAST

    Does This Patient Show Signs of LAST?

    Management of LAST

    History of Lipid Therapy for LAST

    Practical Aspects of Lipid Therapy

    How Does Lipid Rescue Work?

    Side Effects and Complications

    Other Uses for Intralipids

    170 A Patient Who Is Planned for Spinal Anesthesia Asks “Can This Paralyze Me?” What Are the Facts and What Do You Say?

    Introduction

    What Is the Incidence of Injury?

    What Are the Potential Causes of Spinal Cord Injury?

    Direct Trauma

    Compression From Hematoma

    Compression From Abscess

    Neurotoxic Effects of Neuraxial Drug Delivery

    Spinal Cord Ischemia

    Predisposing Conditions

    So, With All This in Mind, How Do You Answer the Patient’s Question?

    171 Spinals in the Lateral Position

    Basic Positioning

    Understanding the Anatomy

    172 Consider the Paramedian Approach for Spinal Anesthesia in the Hip Fracture Patient

    173 When Is a Whisper a Cry for Help? When the Patient Has a High Block

    Inadvertent Intrathecal Injection

    Intravascular Injection

    Ultrasound Guidance and Regional Anesthesia

    Prevention and Treatment

    174 Issues Related to Discharging the Postspinal Patient

    Spinal Anesthesia

    Complications

    Discharge From the PACU

    175 Epidural or Truncal Block? Sorting It Out

    176 Dang It! Wet Tap

    The Differential Diagnosis: Is This a PDPH?

    Why Is a “Simple Headache” so Important?

    What Causes This Type of Headache?

    I Caused a Dural Puncture—Now Who’s Going to Get a Headache?

    What Do I Do After an Unintentional Dural Puncture?

    Oh No! This Is a PDPH. What Do I Do NOW?

    How Do You Perform an Epidural Blood Patch?

    177 Consider Continuous Paravertebral Block as Your Primary Analgesic Technique

    Considerations

    Options

    Anatomy of the Paravertebral Space

    Technique of CPBV

    Multimodal Analgesia: Making the Most of Your Nerve Block

    178 Pneumothorax After Paravertebral, Supraclavicular, or Interscalene Block

    Avoiding Iatrogenic Pneumothorax

    Diagnosing Pneumothorax

    Treatment

    179 Epidural Anesthesia for Mastectomy

    180 What Is the Right Level for Postoperative Epidural Catheter Insertions Based on Type of Surgery?

    Location, Location, Location

    Before Is Likely Better

    Know What You Are Covering—Operative or Postoperative

    Landmarks for Placement and Assessment

    181 Know the Complications of Epidural Corticosteroid Injections

    Neurologic Injury

    Infections

    Systemic Effects

    Arachnoiditis

    182 If You Are New to Neuraxial and Peripheral Nerve Block Infusions—a View From Both Academia and Private Practice

    Why a Continuous Infusion?

    Indications

    Contraindications

    Neuraxial Infusion of What?

    Common Neuraxial Infusion Concentrations

    A Peripheral Nerve Block Infusion of What?

    Do I Make the Solution Myself?

    What Can Go Wrong?

    Troubleshooting Continuous Infusions

    In Summary

    183 What to Do With a Prolonged Block

    Talk to the Patient!

    Review the Chart

    Is It a Nerve Injury?

    What Do I Tell the Patient?

    184 Regional Anesthesia in the ICU—What Should We Use and When Should We Use It?

    Introduction

    Specific Considerations of Regional Anesthesia in the ICU

    Analgesia and Delirium

    Opiates and Cancer

    Regional Anesthesia/Analgesia and Sympathetic Tone

    Regional Anesthesia/Analgesia and Mechanical Ventilation

    Regional Anesthesia/Analgesia in the Septic/Bacteremic Patient

    Regional Anesthesia/Analgesia in the Immunocompromised Patient

    Regional Anesthesia/Analgesia in the Critically Ill Patient With Impaired Homeostasis

    Specific Peripheral Nerve Blocks in the ICU

    PEDIATRIC ANESTHESIA

    185 Introduction

    186 Assent, Consent, and Refusal: Informed Consent and Decision-Making for Adult and Pediatric Patients

    Informed Consent

    Decision-Making Capacity and Competency

    When a Patient Lacks DMC

    The Role of the Surrogate

    The Consent Process for Minors

    Assent, Consent, and Refusal for Pediatric Patients

    Resolution and Assistance

    187 NPO Guidelines Made Easy—Always Maintain a Firm Hold on Current Principles, Best Practices, and Your Own Common Sense

    188 Aspiration and Food Injury—Or When Not to Extubate Deep

    Risk Factors

    Gastric Volume and pH

    Opioids

    Nausea and Vomiting

    Trauma

    Precautions

    Time

    Cricoid Pressure

    Pharmacotherapy

    IV Placement Prior to Induction

    189 Don’t Underestimate the Power of Distraction During Separation and Induction of Anesthesia in Kids

    No Midazolam?

    So …. Back to Basics!

    Introduction to Distraction Techniques

    190 Parental Presence on Induction—It’s Your Call and How to Do It

    191 The Child With a URI

    192 Accept That You Will Have to Meet the Clinical Challenges of Obesity and Obstructive Sleep Apnea in Your Pediatric Patient Cohort

    Definitions and Comorbidities

    BMI

    Coronary Artery Disease (CAD)

    Diabetes Mellitus, Type 2 (DM)

    Mental Health

    Metabolic Syndrome

    Nonalcoholic Fatty Liver Disease (NAFLD)

    Obstructive Sleep Apnea (OSA)

    Orthopedic Comorbidities

    Pseudotumor Cerebri

    A Focus on OSA

    Diagnosis

    Treatment

    Perioperative Concerns for Obese Children With and Without OSA

    Cardiovascular

    Respiratory

    Endocrine

    Preoperative Considerations

    Intraoperative Considerations

    Postoperative Concerns

    193 Neuromuscular Disease in Kids Can Be Very Challenging Because You Don’t Always Have a Definitive Diagnosis—Here’s How to Approach the Clinical Situations

    Muscular Dystrophies

    Myotonic Dystrophy

    Congenital Myopathies

    Mitochondrial Disease

    Malignant Hyperthermia

    194 Pediatric Patients With Epilepsy: Considerations for Patients on a Ketogenic Diet and for Cortical Mapping

    Ketogenic Diet

    Cortical Stimulation Mapping

    195 Neonates Deserve Perioperative Analgesia, Too

    Evaluation of Pain

    Know Your High-Risk Populations

    Planning Postoperative Analgesia

    Drug Therapy for Acute Pain

    Patient-Controlled Analgesia for Children

    Regional Anesthesia for Postoperative Pain

    196 Anesthetic Considerations in Patients With Fontan Physiology Who Present for Noncardiac Surgery

    Introduction

    Physiology

    Evaluation

    Intraoperative Management

    Complications

    197 Anesthesia for Kids and Neurotoxicity: You Are Going to Be Asked, So Don’t Be Surprised and Don’t Act Uninformed

    What Is the Big Deal?

    Experimental Literature

    What About Humans?

    What Now?

    198 Double Down on Pediatric Airway Equipment

    199 Optimizing Bag Mask Ventilation and Direct Laryngoscopy in Children

    Key Anatomic Differences Between Children and Adults

    Optimizing Bag Mask Ventilation and Mask Fit

    Ventilation

    Airway Adjuncts

    Optimizing Direct Laryngoscopy

    Equipment

    Positioning

    Laryngoscopy

    200 Why You Should Expect Hypoxemia During Induction and Emergence of the Pediatric Patient and What to Do About It

    Physiology and Anatomy

    What Can Go Wrong

    How to Avoid These Problems

    What to Do When Hypoxemia Occurs

    201 Why Air Bubbles and Air Emboli Can Be So Serious in Pediatric Patients and How to Safeguard Your Patients

    202 Pediatric Fluid Management

    203 Keeping Babies Warm in the Perioperative Period Is Important, Challenging, and at Times Dangerous!

    204 Pediatric Arterial Access—And the Beat Goes On

    Site Selection

    Complications of Arterial Access in Pediatric Patient

    205 Pediatric Regional Anesthesia—The Karma of Caudals

    Indications

    Contraindications

    Risk-Benefit Ratio and Parental Consent

    Anatomy

    Technique

    Complications

    206 Avoiding the One-Hour Wake Up or How to Save the Sanity of the Parents and Your Own Reputation at the Same Time

    207 When Not to Extubate Deep! And if the Patient Is Already Coughing or Swallowing, It’s Too Late Anyway

    Advantages

    Disadvantages

    How to Successfully Perform a Deep Extubation

    Contraindications to Deep Extubation

    208 Emergence Delirium—Don’t Overcall It, Don’t Undercall It, and Don’t Let It Happen

    Diagnosis

    Causes

    MRI

    Treatment

    Prevention

    209 Too Much, Too Little, Just Right: Avoiding Opioid Withdrawal in Pediatric Patients on Chronic Opioids

    Signs and Symptoms of Withdrawal

    Basics of the Opioid Wean

    Benzodiazepine Dependence

    210 Careful and Conservative Clinical Judgment Is Required Before Discharging a Pediatric Patient to Home

    211 Chronic Pediatric Pain: There’s Always More Than Enough Pain for Everybody Involved and It’s Not About the Blocks!

    Managing Postoperative Pain in Children With Chronic Pain

    Preventing Opioid Withdrawal

    Avoiding Inadequate Postoperative Pain Management

    Avoiding the “Block Is the Cure” Trap

    Pediatric Chronic Pain and Peripheral Nerve Blocks

    Evaluating a Chronic Pain Patient

    Chronic Pain History

    Chronic Pain Examination

    Management of Chronic Pain in Pediatric Patients

    212 “But, It’s Just an Herb!” Avoiding Problems Resulting From Nontraditional Pain Medications in the Pediatric Population

    Chronic Pain and Herbal Therapy

    Chronic Headaches

    Chronic Functional Abdominal Pain

    Musculoskeletal Pain

    A Quick Note on Herbal Contaminants

    Do Herbals Really Cause Adverse Events or Is It All Theoretical?

    What About Neuraxial Blocks and Herbal Medications?

    Common Pitfalls With Herbal Medications

    213 Okay, There Are Herbals, but What About Those “Other Herbals?”

    Anesthetic Considerations of Marijuana

    214 Pitfalls in Pediatric Sedation

    Patient and Procedure

    Risks and Preparation

    Goals and Plan for Procedural Sedation

    Postsedation Discharge Criteria

    215 Pitfalls of Pediatric Anesthesia for International Service Missions

    Pediatric Anesthesia for International Voluntary Services

    Choose Your Adventure Wisely

    Know Your Team Members

    Find the Right Patients

    Equipment Pitfalls

    Don’t Forget the Monitors

    Use Spontaneous Ventilation

    Regional Anesthesia Is Your Friend

    Remember a Postoperative Care Plan

    216 Pediatric Cardiac Arrest Under Anesthesia—Predicting and Preventing the Most Devastating Event of All

    Predictors of Anesthesia-Related Cardiac Arrest in Children

    ASA Physical Status

    Emergency Surgery

    Age

    Cardiac Disease

    Annual Caseload

    Changing Profile of Anesthesia-Related Cardiac Arrest in Children

    Causes of Cardiac Arrest

    Demographics of Cardiac Arrest

    Strategies to Prevent Cardiac Arrest in Anesthetized Children

    Specific Measures

    General Measures

    Conclusion

    NEUROANESTHESIA

    217 Introduction

    218 The Neurophysiology You Learned in Medical School Is Always Relevant—Get a Grip on It and Don’t Let Go

    219 Cerebral Aneurysm Versus “Routine” Craniotomy—The Anesthetic Goals Are Not the Same

    220 Perioperative Visual Loss Is One of the Most Feared and Devastating Complications of Spine Surgery

    221 Being Maximally Prepared for Minimally Invasive Pituitary Surgery

    222 Evoked Potentials: Don’t Approach the Surgeon or Neurophysiologist Until You Know These Principles

    223 Awake Craniotomy

    Introduction

    Preoperative Considerations

    Intraoperative Management

    Intraoperative Complications

    Postoperative Care

    224 Anesthesia for the Pregnant Patient With Neurosurgical Disorder: These Cases Actually Do Happen in Real Life ….. and on the Oral Boards

    Introduction

    Physiologic Changes During Pregnancy

    Timing and Method of Delivery

    Neurosurgical Conditions Requiring Neurosurgical Interventions During Pregnancy

    Traumatic Brain Injury (TBI)

    Intracranial Tumors

    Intracranial Hemorrhage

    Back Surgery

    Anesthetic Considerations of the Pregnant Patient During Neurosurgery

    Preoperative Anesthetic Considerations

    Intraoperative Anesthetic Considerations

    Postoperative Anesthetic Care

    225 Don’t Forget There’s No Such Thing as a Brain Transplant: Preventing Perioperative Stroke

    Recognizing At-Risk Patients

    Preoperative and Intraoperative Management

    General Anesthesia and Regional Techniques

    Hemorrhage and Intraoperative Anemia

    Hyperglycemia

    Intraoperative Hypotension

    Postoperative Assessment and Treatment of Stroke

    226 Anesthesia for Emergent Neurointerventional Procedures: “Neurology Just Called, They Have a Stroke Patient for Thrombectomy Down in Neuroradiology, Start Time is 2 AM”

    Introduction

    General

    General Considerations for All Neurointerventional Procedures

    Emergent Neurointerventional Procedures

    Acute Ischemic Stroke

    Cerebral Aneurysm Coiling Following Subarachnoid Hemorrhage

    Endovascular Management of Cerebral Vasospasm

    Conclusion

    227 Encephalopathy and Intracranial Hypertension in the Acute Liver Failure Patient Are Not the Same Thing!

    West Haven Criteria for Encephalopathy

    Pathophysiology of Raised ICP in ALF

    Intracranial Pressure Monitoring

    General Measures

    Specific Measures

    CARDIAC ANESTHESIA

    228 Introduction

    229 Cardiac Surgical Coagulopathy—You’ll Need the Blood Bank and a Genie in a Bottle

    230 A Is for Aortic, C Is for Cannulation, B Is for … Be Careful!

    Femoral Artery Cannulation

    Axillary Artery Cannulation

    Innominate Artery Cannulation

    Line Placement and Pressure Monitoring

    231 Transesophageal Echocardiography in the Cardiac Surgery Suite—Strategies to Stay Out of Trouble

    232 Myocardial Protection Strategies During Cardiopulmonary Bypass—Do Everything You Can but Realize That Some Ischemic Damage Is Inevitable

    Why Do We Need to Protect the Heart?

    How Do We Protect the Heart? Cardioplegia!

    How Often Is the Cardioplegia Given?

    How Warm or How Cold Is the Cardioplegia Solution?

    Should the Cardioplegia Be Mostly Crystalloid or Blood?

    What Is the Deal With Hyperpolarizing Versus Depolarizing Cardioplegia Solutions?

    Does Transesophageal Echocardiography Play a Role in Cardioplegia Delivery?

    Is There Anything Else We Can Do to Protect the Heart?

    233 The Heartbreak of Left-Sided Valvular Dysfunction

    Need-to-Know Information for Aortic Valve Disease

    Aortic Stenosis

    Hemodynamic Goals for Aortic Stenosis—“Slow, Sinus, and Tight”

    Aortic Insufficiency

    Hemodynamic Goals for Aortic Insufficiency—“Fast, Full, and Forward”

    Need-to-Know Information for Mitral Valve Disease

    Mitral Stenosis

    Hemodynamic Goals for Mitral Stenosis

    Mitral Regurgitation

    Hemodynamic Goals for Mitral Regurgitation

    234 Anesthesia for the Descending Thoracic Aorta—Initiate Damage Control Measures

    Monitoring for DTA Procedures

    DTA Surgery and Organ Ischemia/Protection

    DTA Anatomical Considerations

    DTA Analgesia

    235 Buckle Your Seat Belt: Taking Care of the Patient With Ascending Aortic Dissection

    236 Rolling in the Deep Hypothermic Circulatory Arrest

    Mechanisms of Benefits of DHCA

    Direct Application of Ice to the Head

    Pharmacologic Adjuncts

    Blood Gas Management

    Selective Cerebral Perfusion

    Temperature Management During Rewarming

    Monitoring Cerebral Protection During DHCA

    Additional Monitoring

    237 Anesthesia for Left Ventricular Assist Device Surgery: Essentials to Bear in Mind

    Introduction to Ventricular Assist Devices

    Preoperative Concerns

    Invasive Monitoring

    Careful Induction and Maintenance

    Other Management Issues

    Pre-CPB TEE Evaluation

    During CPB

    Separation From Bypass

    Post-CPB TEE Evaluation

    Right Heart Support

    Extubation Timing

    238 Off-Pump Coronary Artery Grafting Is Like Working on an Engine (While It Is Still Running)

    Background

    Who Best Qualifies for OPCAB?

    OPCAB Is Associated With Outcomes That Are Better or Worse or Equivocal Depending on the Specific Outcome in Question

    Better Outcomes Associated With OPCAB

    Worse Outcomes Associated With OPCAB

    Equivocal Outcomes Associated with OPCAB

    Surgical Technique

    Don’t Lose Sight of the Basics of Anesthetic Management for OPCAB Cases

    Monitoring

    Lines and Access

    Anesthetics

    Anticoagulation

    Hypotension Associated With Retraction and Compression of Heart

    Management of Intraoperative Ischemia

    Extubation

    239 What to Do and What Not to Do for Your Patients With Hypertrophic Obstructive Cardiomyopathy

    240 Cardiac Transplant—Gotta Get This One Right

    Important OHT Patient Preoperative Items

    Immunosuppression for OHT

    Managing the ICD

    Timing OHT Anesthesia Induction

    Monitoring for OHT

    Right Ventricular Failure Risk in OHT

    Coagulopathy in OHT

    Waking Up the OHT Patient

    241 The Right Heart Should Never Play Second Fiddle to the Left Heart—What to Do When the Right Heart Just Really Ain’t Right at All

    Right Heart Anatomy

    Right Heart Dysfunction

    Treating Right Heart Dysfunction

    Tricuspid Valve Regurgitation

    Tricuspid Valve Stenosis

    OBSTETRIC ANESTHESIA

    242 Introduction

    243 Be Prepared for the Presence of a Doula in Both the Labor and Delivery Rooms

    244 Guests on the Labor Deck and in the Delivery Room—How to Manage It and Keep Your Professional Demeanor

    Helpful Hints for Managing Guests

    For the Labor and Delivery Rooms

    For the OR

    In General

    245 Alternatives to Epidural Analgesia for Labor Pain—What to Consider, What You Might Be Asked

    Remifentanil PCA

    Nitrous Oxide

    Acupuncture

    246 Epidural Labor Analgesia: Does It Prolong Labor?

    247 We Were Taught Once a C-section, Always a C-Section … What to Do When Your Hospital Now Wants to Provide Trial of Labor After Cesarean (TOLAC) Services

    248 Should We Place a Spinal for a Version? Anesthesia for External Cephalic Version

    249 Management of an Accidental Dural Puncture in the Laboring Patient “When the Hanging Drop Becomes a Flowing River …”

    250 “We Have an Urgent C-Section!” The Pitfalls of Intrapartum Monitoring of the Fetus

    Introduction

    Basics of Fetal Heart Rate Monitoring

    Baseline

    Variability

    Accelerations

    Decelerations

    Pitfalls With FHR Monitoring

    Inter-observer Variability

    Effects of Treatment on the Fetal Heart Rate

    Conclusion

    251 Stat C-Section—The 30-Minute Rule and Beyond

    252 Postpartum Hemorrhage: Don’t Forget That Having a Baby Is Major Surgery

    Uterine Atony

    Lacerations

    Other Causes of Postpartum Hemorrhage

    General Response to Bleeding

    253 From Glad to Sad (Part 1): Pain Control After Cesarean Section

    IV Opioids

    Nonsteroidal Anti-Inflammatory Drugs

    Acetaminophen

    Postoperative Epidural: Patient-Controlled Epidural Analgesia

    Preservative-Free Morphine (AstraMorph, Duramorph)

    Local Anesthetic Infiltration and TAP Blocks

    Analgesia and Breastfeeding

    254 From Glad to Sad (Part 2): Postpartum Neuropathy of the Lower Extremity

    255 Obstetric Anesthesia/Analgesia Can Work in a Small Hospital: The Key Principles Are Commitment, Flexibility, and Planning

    256 Resuscitation of the Pregnant Cardiopulmonary Arrest Patient: Not Just Standard ACLS

    Immediate Resuscitation Response

    Modifications From BLS/ACLS

    No Modifications

    Emergency Perimortem Cesarean Delivery

    Team Management

    257 The Pregnant Anesthesia Provider (Part 1)—Managing the Occupational Exposures

    Blood-Borne Pathogens

    Inhalational Anesthetic Agents

    Radiation

    Methyl Methacrylate

    Conclusions

    258 The Pregnant Anesthesia Provider (and New Adoptive Parent)—Part 2

    Family Medical Leave Act

    Other Legal Protections

    HUMAN FACTORS

    259 Introduction

    260 Understanding the Human Factor

    Decision Making

    Technology Design and Cognitive Ergonomics

    Communication

    Environmental Design

    Complex Systems

    261 Minimize Errors in Anesthesia: Lessons Learned From Aviation

    Application of Aviation-Adopted Crew Resource Management to Anesthesia Practice

    Communication

    Leadership

    Conflict

    Vigilance

    262 Eliminate Communication Errors by Using a Spelling Alphabet and Spoken Digits

    263 Don’t Ignore Your Intuition

    264 Ethics in Anesthesiology Practice

    Principles

    Ethics and Anesthesiology

    Summary

    265 Know When to Stop—Anesthesia Providers Have Got to Know Their Limitations

    266 Before You Press Play, Let’s Talk About Music in the OR

    267 Never Rush Through a Signout

    268 Don’t Ignore the Folklore—It Can Be a Powerful Ally in Your Clinical Practice

    269 Don’t Underestimate the Role of Spirituality in Patients’ Perceptions of Disease and Healing, and Remember to Uphold the Right to Self-Determination

    Importance to Patients

    The Power of Prayer: Private Versus Intercessory Prayer

    Autonomy, Self-Determination, and Legal Considerations

    What Can We Do?

    270 What’s in a Name?

    271 We Are Not the Only People Who Care About the Patients

    From the Preoperative Evaluation Center Nurse-Practitioners

    From the OR Nurses

    FROM the PACU Nurses

    272 Working in the OR—Sometimes the Staff Gets Sick or Injured, Too

    Workplace Injuries

    Working Sick

    Heads and Hearts

    Syncopal Episodes

    Expect the Unexpected

    Conclusions

    273 The Physician as Patient—What I Learned During the Last Five Times I Went to the OR on the Stretcher Instead of Pushing It

    274 A Primer on Simulation in Anesthesiology— Definitions and Concepts

    275 What Makes a Great Anesthesia Resident?

    The Attending Viewpoint—What Makes a Great Anesthesia Resident?

    The Resident Viewpoint—What Makes a Great Anesthesia Resident?

    LEGAL

    276 Introduction

    277 A Brief on the Legal Process

    Before the Lawsuit

    The “Med Mal” Lawsuit—Who’s Who

    The Lawsuit

    Discovery

    Trial

    Alternatives to Lawsuit

    Mediation

    Arbitration

    278 How “Not” to End Up in a Closed Claims File—Lessons Learned From the ASA Closed Claims Project

    Overview of the ASA Closed Claims Project

    Consent

    Preoperative Evaluation

    Changing of the Guard or “Handoffs” With Poor Communication

    Documentation (or Lack Thereof)

    Altering the Medical Record

    Poor Followup/Communication After an Adverse Outcome

    What to Do

    What Not to Do

    Maligning by Other Healthcare Providers

    279 The Anesthesia Closed Claims Project— What’s Trending Now?

    What’s New in the Database?

    Specific Injuries and Outcomes

    280 A Careful and Complete Anesthesia Record Is the Best Defense Against a Lawsuit

    Components of the Anesthetic Record

    The Anesthesia Record: Friend or Foe

    Potential Pitfalls in Completion of the Anesthesia Record

    Electronic Anesthesia Records

    Additional Uses of the Anesthesia Record

    281 Documentation Disputes in the Medical Record—How to Avoid a Chart War and How to Survive One

    Don’t Start It!

    If You Find Yourself in a Dispute in the Medical Record

    282 Reading in the Operating Room: Is It Worth the Risk?

    283 Going to the Operating Room With a Do-Not-Resuscitate Patient

    Introduction

    The DNR Order

    DNR in the Perioperative Setting

    Alternate Policies for DNR Orders in the OR

    Guidelines Related to DNR Orders in the Perioperative Setting

    Approach to the Perioperative Patient With a DNR Order (“Required Reconsideration”)

    Conclusion

    284 Refusal to Do a Case on Moral or Ethical Grounds: More Practical Navigation Through Choppy Waters

    285 Dental Injuries—Document Carefully and Do Not Overpromise

    286 Apologizing to Patients After an Adverse Event Is the Ethical Thing to Do and Just Might Keep You Out of Court

    What Is a Medical Apology?

    Barriers to Apology

    Advantages of Protecting an Apology

    PROFESSIONAL PRACTICE

    287 Introduction

    288 Marketing 101: Know Your Customers and What They Need!

    Identify Your Customer(s)!

    Ante-Up Qualifications

    Your Group—Initial Job Search, Making Partner, Being a Good Citizen

    Your Hospital or Facility

    Your Surgeons

    Your Patients

    289 Improving OR Throughput: Don’t Say “No”

    First Case On-Time Starts

    Turnover Time

    Parallel Processes

    Reducing Overtime

    290 Cost Analysis: You Always Want to Be at the Table

    Cost Definitions

    Costs Are Not Charges

    Definitions of Costs

    Perspective—Be at the Table

    Cost Analysis: Cost-Minimization Versus Cost-Benefit

    291 Strategic Planning: Failing to Prepare Is Preparing to Fail

    Individual Strategic Objectives

    S–W–O–T Analysis

    Mission Statement

    Vision

    Guiding Principles

    Strategic Planning Process

    292 Business Plan 101: Where You Want to Go and How You Are Going to Get There

    Classical Business Plan Elements

    Executive Summary

    Company Description

    Market Analysis

    Organization and Management

    Financial Projections

    293 Avoid Being Labeled “Simply a Gas-Passer”: An Overview of the Perioperative Surgical Home

    What Is the Perioperative Surgical Home?

    Components of the PSH

    Principles of the PSH

    Why Anesthesiologists?

    Who Benefits From the PSH?

    Implementation Challenges

    294 The Curriculum Vitae: Know Your Audience

    295 Your Career: Interviewing

    Preparing for a New Job: The Network and Your Curriculum Vitae

    Preparing for the Interview

    Interview Day—Your Best Effort

    The Interview

    The Followup

    Final Note

    296 Your Career: Understanding the Basics of Ownership Jobs

    Introduction

    Different Types of Partnership Tracks

    The Buy-In

    Buy-In Example

    Buy-In Negotiations

    Becoming an Equity Partner

    The Buy-Out

    297 Your Career: Employee Jobs

    Single-Specialty and Multispecialty Groups

    Hospital-Owned Practice

    Healthcare Maintenance Organizations

    Anesthesia Practice Management Companies

    Summary

    298 Your Career: Understanding the Basics of Locum Tenens Jobs

    Starting the Process

    299 Your Career—Understanding Solo Practice and the Basics of Medical Practice Finance and Legal Organization

    Case Distribution

    Call Distribution

    Anesthesiologist Relationships

    Control Versus Responsibility

    Finances/Accounting/Legal

    Legal Structure

    300 Your Career: Make Sure You Understand the Compliance Plan

    Billing and Collection Services

    301 Your Career—Know the Risk-Management Strategies of the Practice

    Adaptability to Change

    Liabilities

    Outstanding Litigation

    302 Avoiding Bad Employment Contracts: Due Diligence, Termination, and Restrictive Covenants

    Due Diligence

    Term

    Termination

    Without Cause

    With Cause

    Disability

    Death

    Restrictive Covenants

    303 Avoiding Bad Employment Contracts: Duties, Compensation, and Benefits

    Duties

    Compensation

    Benefits

    304 MACRA—Robbing Peter to Pay Val (ue)

    CONCLUSION

    305 Sage Advice to Close This Book: Anesthesiology and the Aphorisms of B. Franklin, Printer

    Index

     

  • 35200lei 330.00 lei

     

     

    Description:

    Now updated throughout, with new TEE views, new ASE guidelines, new coverage of key topics, and new Expert Consult online access, the TEE Pocket Manual, 2nd Edition, is an indispensable guide to transesophageal echocardiography and its clinical applications. This concise, complete handbook includes everything you need to know when doing TEE and for reporting: normal values, explanations of abnormal findings, schematics and tables, formulas, calculations, pitfalls and artifacts, and more.




    New To This Edition:



    More TEE views - 28 in all - and additional line drawings.

    Updated grading for vascular disease based on ASE Guidelines, specifically aortic stenosis, aortic insufficiency, and mitral stenosis.

    Increased coverage of assessment of right ventral function, including dP/dt, volume overload, and pressure overload.

    Addition of the various transcatheter aortic valves to discussion of prosthetic valves.

    Expanded chapter on 3D TEE to include assessment of left ventricular function and mitral valve anatomy.

    New material on TEE for catheter-based interventions such as transcather aortic valve replacement, left atrial appendage occlusion and MitraClip.

    NEW! Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

    Table Of Contents:

    Glossary of Acronyms
    1. Basic Physics of Ultrasound
    2. Systolic LV Structure/Function
    3. Diastolic Function
    4. Aortic Valve Anatomy
    5. Aortic Valve Stenosis
    6. Aortic Regurgitation
    7. Mitral Valve Anatomy
    8. Mitral Valve Stenosis
    9. Mitral Valve Regurgitation
    10. Pulmonic Valve
    11. Tricuspid Valve
    12. Right Ventricle
    13. Prosthetic Valve Types
    14. Endocarditis
    15. Pericardial Disease
    16. Aortic Athersclerosis Aneurysm Dissection
    17. Adult Congenital Heart Disease
    18. Intracardiac Masses and Objects
    19. Artifacts and Pitfalls
    20. Equations and Calculations
    21. Introperative 3-Dimensional TEE

       

     

  • 40000lei 340.00 lei

     

    Description:

    Guest editor Lena Napolitano has assembled an expert team of authors on the topic of Trauma in the ICU. Articles will focus on: Non-compressible Torso Hemorrhage; Prediction of Massive Transfusion in Trauma; Coagulopathy of Trauma; Viscoelastic testing and Hyperfibrinolysis in Trauma; Tranexamic Update in Trauma; Optimal Reversal of Novel Anticoagulants in Trauma; Optimal Transfusion for Traumatic Hemorrhagic Shock; and more

     

     

    Table of Contents:

     

    Forthcoming Issues

    Preface

    Traumatic Brain Injury Advances

    Key points

    Introduction

    Pharmacologic therapy

    Other pharmacologic therapy

    Nonpharmacologic therapy

    Surgical treatment options

    Intracranial pressure monitoring

    Updated brain trauma foundation guidelines severe TBI

    Treatment complications

    Evaluation of outcome and long-term recommendations

    Summary

    Optimal Fluid Therapy for Traumatic Hemorrhagic Shock

    Key points

    Introduction

    Patient evaluation overview

    Pharmacologic treatment options

    Treatment resistance and complications

    Summary

    Noncompressible Torso Hemorrhage

    Key points

    Introduction

    Definition of noncompressible torso hemorrhage

    Epidemiology of noncompressible torso hemorrhage

    Setting, resource, and institutional considerations

    Investigations in noncompressible torso hemorrhage

    Resuscitation in noncompressible torso hemorrhage

    Hemostasis in noncompressible torso hemorrhage

    Surgical and endovascular access in noncompressible torso hemorrhage

    Organ-specific approaches

    Summary

    Resuscitative Endovascular Balloon Occlusion of the Aorta: Indications, Outcomes, and Training

    Key points

    Introduction

    History

    Resuscitative endovascular balloon occlusion of the aorta procedure

    Indications for resuscitative endovascular balloon occlusion of the aorta use in trauma

    Resuscitative endovascular balloon occlusion of the aorta use in pelvic fracture hemorrhage

    Resuscitative endovascular balloon occlusion of the aorta outcomes in trauma

    Prehospital resuscitative endovascular balloon occlusion of the aorta

    Education and training

    Summary

    Prediction of Massive Transfusion in Trauma

    Key points

    Introduction

    Defining massive transfusion

    Isolated variables predicting transfusion needs

    Clinical gestalt

    Transfusion scores

    Prehospital prediction of massive transfusion

    Turning off massive transfusion

    The use of massive transfusion scores in trauma trials

    Summary

    Tranexamic Acid Update in Trauma

    Key points

    Introduction

    Background

    Patient evaluation overview

    Tranexamic acid use in children

    Pharmacologic treatment options

    Role of viscoelastic testing and massive transfusion protocols

    Treatment complications

    Areas of ongoing research

    Summary

    Coagulopathy of Trauma

    Key points

    Introduction

    Patient evaluation and overview

    Pharmacologic treatment options

    Nonpharmacologic treatment options

    Combination therapies

    Surgical treatment options

    Treatment resistance and complications

    Evaluation of outcome and long-term recommendations

    Summary

    Management of Trauma-Induced Coagulopathy with Thrombelastography

    Key points

    Introduction

    Historical context

    Assay methodology

    Assay interpretation

    Limitations of viscoelastic assays

    Thrombelastography in trauma-induced coagulopathy

    Summary

    Optimal Reversal of Novel Anticoagulants in Trauma

    Key points

    Introduction

    Patient evaluation overview

    Laboratory evaluation overview

    Pharmacologic treatment options

    Nonpharmacologic treatment options

    Complications

    Resuming anticoagulation

    Summary

    Rib Fracture Fixation: Indications and Outcomes

    Key points

    Introduction

    Patient evaluation

    Pharmacologic treatment options

    Nonpharmacologic treatment options

    Surgical treatment options

    Complications related to thoracic trauma and rib fracture fixation

    Treatment resistance

    Evaluation of outcome and long-term recommendations

    Summary

    Postinjury Inflammation and Organ Dysfunction

    Key points

    Historical perspective: evolving concepts on the pathogenesis of multiple organ failure

    Defining multiple organ failure

    Epidemiology and clinical relevance

    The burden of multiple organ failure

    Pathophysiology

    Interventions

    Trauma Quality Improvement

    Key points

    Introduction

    Program structure

    Components

    Adjunct components

    Results

    Summary

    Index

     

  • 340.00 lei

     

    Description:

     

    Each issue of Anesthesia & Analgesia includes thought-provoking case reports that provide real-world insight on a wide variety of clinical scenarios. Now for the first time, this volume brings together 100 recently published case reports, grouped by A&A sections for ease of reference. Framed by A&A editors’ take home messages in each section, these original case reports are valuable reading for anesthesiologists, residents, and nurse anesthetists.

     

     

    Table of Contents:

     

    Introduction

    SECTION 1: Cardiovascular Anesthesiology

    1 Preoperative Assessment of the Impact of Positive Pressure Ventilation With Noninvasive Positive Pressure Ventilation in a Patient With Eisenmenger Syndrome: A Case Study

    CASE DESCRIPTION

    DISCUSSION

    2 Two Cardiac Arrests Because of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography: A Case Report

    CONSENT FOR PUBLICATION

    CASE DESCRIPTION

    DISCUSSION

    CONCLUSIONS

    3 Fatal Intramyocardial Hemorrhage After Pericardiotomy in a Patient With von Willebrand Disease

    CASE DESCRIPTION

    DISCUSSION

    4 Anesthetic Challenges for Posterior Spine Surgery in a Patient With Left Ventricular Assist Device: A Case Report

    DESCRIPTION OF CASE

    DISCUSSION

    Positioning

    Coagulopathy

    CONCLUSIONS

    5 Kounis Syndrome During Anesthesia: Presentation of Indolent Systemic Mastocytosis: A Case Report

    DESCRIPTION OF THE CASE

    DISCUSSION

    6 Intraoperative Acute Multivessel Coronary Vasospasm in Cardiac Allograft: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    7 Left Ventricular Assist Device Insertion in a Patient With Biventricular Noncompaction Cardiomyopathy, Ebstein Anomaly, and a Left Atrial Mass: A Case Report

    CONSENT FOR PUBLICATION

    CASE DESCRIPTION

    DISCUSSION

    8 Mechanical Support With Impella During Malignant Arrhythmia Ablation: A Case Report on the Growing Trend in the Electrophysiology Laboratory

    CASE DESCRIPTION

    DISCUSSION

    Congenitally Corrected Transposition of the Great Arteries Anatomic Considerations

    Associated Anomalies

    Conduction Anomalies

    Pathophysiology of cc-TGA

    9 Elective Venovenous Extracorporeal Membrane Oxygenation for Resection of Endotracheal Tumor: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    10 Normothermic Cardiopulmonary Bypass in Patient with Waldenström’s Macroglobulinemia and Cryoglobulinemia: A Case Report

    DESCRIPTION OF THE CASE

    DISCUSSION

    SECTION 2: Hemostasis

    11 Essential Thrombocytosis and Labor Epidural Placement While on Aspirin: Assessing Hemorrhagic Risks: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    12 Metallosis Identified via Intraoperative Cell Salvage: A Case Report

    WRITTEN CONSENT STATEMENT

    CASE DESCRIPTIONS

    Case 1

    Case 2

    DISCUSSION

    13 Acquired Hemophilia A After Hepatic Yttrium- 90 Radioembolization: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    14 AngioVac Suction Thrombectomy Complicated by Thrombus Fragmentation and Distal Embolization Leading to Hemodynamic Collapse: A Case Report

    CASE REPORT

    DISCUSSION

    CONCLUSIONS

    15 Extreme Plasma Dilution Decreases Heparin and Protamine Cardiopulmonary Bypass Requirements: A Case Report on a Jehovah’s Witness Patient

    CASE DESCRIPTION

    DISCUSSION

    16 Case Report of Severe Antithrombin Deficiency During Extracorporeal Membrane Oxygenation and Therapeutic Plasma Exchange for Double Lung Transplantation

    CASE DESCRIPTION

    DISCUSSION

    SECTION 3: Perioperative Echocardiography and Cardiovascular Education

    17 Lessons Still Being Learned: Acute Pulmonary Tumor Embolus During Renal Cell Carcinoma Resection

    CASE PRESENTATION

    DISCUSSION

    18 Incorrect Diagnosis of Type A Aortic Dissection Attributed to Motion Artifact During Computed Tomographic Angiography: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    19 Excessive Surgical Adhesive Mimicking Aortic Root Abscess: A Case Report

    CASE REPORT

    DISCUSSION

    CONCLUSIONS

    20 Traumatic Ventricular Septal Defect After Stab Wound to the Chest Missed by Transthoracic Echocardiography: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    21 Point- of- Care Ultrasonography to Assess Portal Vein Pulsatility and the Effect of Inhaled Milrinone and Epoprostenol in Severe Right Ventricular Failure: A Report of 2 Cases

    CASE DESCRIPTIONS

    Patient 1

    Patient 2

    DISCUSSION

    22 Profound Obstructive Hypotension From Prone Positioning Documented by Transesophageal Echocardiography in a Patient With Scoliosis: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    23 Intraoperative Transesophageal Echocardiographic Diagnosis of Acute Budd– Chiari Syndrome After Extended Right Hepatectomy

    CASE DESCRIPTION

    DISCUSSION

    SECTION 4: Ambulatory Anesthesia and Perioperative Medicine

    24 Sudden Increase in Etco2 During Upper Endoscopy Under General Endotracheal Anesthesia Suggests the Presence of Tracheoesophageal Fistula: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    25 A Case of Delayed Emergence After Propofol Anesthesia: Genetic Analysis

    CASE DESCRIPTION

    GENETIC ANALYSIS

    DISCUSSION

    26 Case Report: Red Urine After Day Care Strabismus Surgery

    CASE DESCRIPTION

    DISCUSSION

    CONSENT FOR PUBLICATION

    SECTION 5: Anesthetic Clinical Pharmacology

    27 Pheochromocytoma Multisystem Crisis Triggered by Glucocorticoid Administration and Aggravated by Citrate Dialysis

    CASE REPORT

    DISCUSSION

    CONCLUSIONS

    28 Periarticular Morphine- Induced Sphincter of Oddi Spasm Causing Severe Pain and Bradycardia in an Awake Patient Under Spinal Anesthesia: An Important Diagnostic Consideration

    CONSENT FOR PUBLICATION

    CASE DESCRIPTION

    DISCUSSION

    29 Malignant Hyperthermia in a Morbidly Obese Patient Depletes Community Dantrolene Resources: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    30 A Case of Pseudocholinesterase Deficiency Resulting From Malnutrition

    CASE DESCRIPTION

    DISCUSSION

    31 Use of Methohexital and Dexmedetomidine for Maintenance of Anesthesia in a Patient With Mitochondrial Myopathy: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    32 Multiple Anesthetic Drug Sensitization in a Hairdresser With Previous Immediate- Type Hypersensitivity to Penicillin: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    SECTION 6: Technology, Computing, and Simulation

    33 Low SpO2 With Normal SaO2 During General Anesthesia: A Case Report

    DESCRIPTION

    DISCUSSION

    34 Closed- Loop Control of Total Intravenous Anesthesia During Significant Intraoperative Blood Loss: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    SECTION 7: Patient Safety

    35 Intraoperative Tonic- Clonic Seizure Under General Anesthesia Captured by Electroencephalography: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    CONCLUSIONS

    36 Hypertensive Crisis From the Aquamantys Bipolar Sealing System

    CASE DESCRIPTION

    DISCUSSION

    37 Increased Resistance to Flow and Ventilator Failure Secondary to Faulty CO2 Absorbent Insert Not Detected During Automated Anesthesia Machine Check: A Case Report

    DESCRIPTION OF THE CASE

    DISCUSSION

    38 Stepwise Rostrocaudal Brainstem Anesthesia as a Complication of Local Anesthesia: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    39 Brachial Plexus Injury Associated With Subclavian Vein Cannulation: A Case Report

    DESCRIPTION OF CASE

    DISCUSSION

    40 Two Consecutive Preoperative Cardiac Arrests Involving Vancomycin in a Patient Presenting for Hip Disarticulation: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    SECTION 8: Critical Care and Resuscitation

    41 Critical Airway Stenosis in an Adolescent Male With Pompe Disease and Thoracic Lordosis: A Case Report

    DESCRIPTION OF THE CASE

    Liver Biopsy via Transjugular Approach

    Posterior Spinal Fusion

    Return to the Operating Room to Complete the PSF

    DISCUSSION

    42 The First Case Report of Anaphylaxis Caused by the Inclusion Complex of Rocuronium and Sugammadex

    CASE HISTORY

    DISCUSSION

    CONCLUSIONS

    43 Delayed Anaphylaxis to Mammalian Meat Following Tick Exposure and Its Impact on Anesthetic Management for Cardiac Surgery: A Case Report

    CASE 1

    CASE 2

    CASE 3

    DISCUSSION

    44 Massive Subcutaneous Emphysema and Bilateral Tension Pneumothoraces After Supplemental Oxygen Delivery via an Airway Exchange Catheter: A Case Report

    CASE REPORT

    DISCUSSION

    CONCLUSIONS

    45 Hydroxocobalamin for Vasoplegic Syndrome in Liver Transplantation: Restoration of Blood Pressure Without Vasospasm

    CASE DESCRIPTION

    DISCUSSION

    46 Atypical Neuroleptic Malignant Syndrome: Diagnosis and Proposal for an Expanded Treatment Algorithm: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    CONCLUSIONS

    47 Incidental Cerebral Acute Subdural Hematoma After Transforaminal Lumbar Interbody Fusion: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    48 Short- term Vision Loss Following Whipple Surgery: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    49 Optimization of Mechanical Ventilation in a 31- Year- Old Morbidly Obese Man With Refractory Hypoxemia

    CASE REPORT

    DISCUSSION

    CONCLUSIONS

    50 Anesthetic Management of a Patient With Multiple Previous Episodes of Postanesthesia Care Unit Delirium: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    SECTION 9: Trauma

    51 The Extraordinary Case of the Hungry Woman: Large Foreign Body Ingestion With Respiratory Arrest

    DESCRIPTION OF THE CASE

    DISCUSSION

    52 Resuscitative Endovascular Balloon Occlusion of the Aorta and the Anesthesiologist: A Case Report and Literature Review

    DESCRIPTION OF THE CASE: CLINICAL CARE

    Intraoperative Course

    DISCUSSION

    CONCLUSIONS

    SECTION 10: Obstetric Anesthesiology

    53 Anesthetic Considerations for Neuraxial Anesthesia in Pregnant Patients With Pityriasis Rosea With Skin Lesions Covering the Lumbar Spine

    CASE DESCRIPTION

    DISCUSSION

    54 Massive Hemoptysis Through Endotracheal Tube During Emergency Cesarean Delivery: A Case Report and Literature Review

    CASE PRESENTATION

    DISCUSSION

    55 Lateral Position for Cesarean Delivery Because of Severe Aortocaval Compression in a Patient With Marfan Syndrome: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    56 Anesthetic Management for Cesarean Delivery in a Patient With Pulmonary Emboli, Pulmonary Hypertension, and Right Ventricular Failure

    CONSENT FOR PUBLICATION

    CASE DESCRIPTION

    DISCUSSION

    57 Impella™ Left Ventricular Assist Device for Acute Peripartum Cardiomyopathy After Cesarean Delivery

    CASE DESCRIPTION

    DISCUSSION

    58 Chest Pain During Cesarean Delivery in Relation to Anomalous Right Coronary Artery: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    59 Aortoiliac Thrombosis Following Tranexamic Acid Administration During Urgent Cesarean Hysterectomy: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    60 Gas Embolism During Hysteroscopic Surgery? Three Cases and a Literature Review

    CASE DESCRIPTIONS

    Case 1

    Case 2

    Case 3

    DISCUSSION

    SECTION 11: Pediatric Anesthesiology

    61 Unanticipated Compression of the Trachea in a 5- Month- Old Undergoing an MRI for Evaluation of Neurofibromatosis

    CONSENT

    CASE DESCRIPTION

    DISCUSSION

    62 Airway Management of a 3- Year- Old Child With a Penetrating Oropharyngeal Foreign Body Risking Vascular Injury

    CASE

    Preoperative Course

    Induction of Anesthesia

    CT Angiography

    Foreign Body Removal

    Postoperative Course

    DISCUSSION

    Loss of Venous Access

    Lack of Option to Ventilate

    Vascular Proximity

    CONCLUSIONS

    63 Life- Saving Esophageal Intubation in Neonate With Undiagnosed Tracheal Agenesis: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    64 Anesthetic Management for Pediatric Awake Tracheostomy

    CONSENT FOR PUBLICATION

    CASE DESCRIPTION

    DISCUSSION

    65 Anesthetic Management of Conjoined Twins for Computed Tomography Scan

    WRITTEN CONSENT STATEMENT

    CASE DESCRIPTION

    DISCUSSION

    66 Anesthetic Management of Two Pediatric Patients with Concurrent Diagnoses of Mitochondrial Disease and Malignant Hyperthermia Susceptibility: A Case Report

    CASE DESCRIPTION

    Case 1

    Case 2

    DISCUSSION

    67 Continuous Noninvasive Hemodynamic Monitoring in an Infant With Tetra- Amelia

    CASE DESCRIPTION

    DISCUSSION

    68 Two Cases of Duchenne Muscular Dystrophy That Showed Different Reactions to Nerve Stimulation During Peripheral Nerve Block: A Case Report

    CASE DESCRIPTIONS

    Patient 1

    Patient 2

    DISCUSSION

    CONCLUSIONS

    69 Dexmedetomidine as a Supplement to Spinal Anesthesia Block: A Case Report of Three Infants

    CASE DESCRIPTIONS

    DISCUSSION

    70 Case Report of Midazolam Withdrawal– Induced Catatonia in a 9- Year- Old Patient

    CASE DESCRIPTION

    DISCUSSION

    71 Hyperkalemia After Laparoscopic Nephrectomy in Patients With Renal Insufficiency: A Case Report

    CASE REPORT

    Case 1

    Case 2

    DISCUSSION

    CONCLUSIONS

    SECTION 12: Neuroscience and Neuroanesthesiology

    72 Whether to Proceed With Deep Brain Stimulator Battery Change in a Patient With Signs of Potential Sepsis and Parkinson Hyperpyrexia Syndrome: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    73 A Case Report of Onyx Pulmonary Arterial Embolism Contributing to Hypoxemia During Awake Craniotomy for Arteriovenous Malformation Resection

    CONSENT FOR PUBLICATION

    CASE REPORT

    DISCUSSION

    74 Temporary Decompression of Symptomatic Epidural Hematoma via an In Situ Epidural Catheter: A Case Report

    CASE REPORT

    DISCUSSION

    SECTION 13: Respiration and Sleep Medicine

    75 Use of Transnasal Humidified Rapid- Insufflation Ventilatory Exchange for Emergent Surgical Tracheostomy: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    76 Adenotonsillectomy for the Management of Pulmonary Hypertension in a Patient With Complex Congenital Heart Disease: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    77 Intraoperative Autotriggered Pressure Support Ventilation Resistant to Increased Flow Trigger Threshold

    CASE DESCRIPTION

    DISCUSSION

    78 Successful Assessment of Vocal Cord Palsy Before Tracheal Extubation by Laryngeal Ultrasonography in a Patient After Esophageal Surgery: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    SECTION 14: Blood Management

    79 Successful Resuscitation Following Massive Obstetric Hemorrhage in a Patient of the Jehovah’s Witness Faith: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    SECTION 15: Geriatric Anesthesia

    80 The Anesthetic Implications of Aqueous Drainage Devices and Glaucoma: A Report of a Patient Undergoing Urgent Prone Cervical Decompression and Fusion

    CASE

    DISCUSSION

    Aqueous Drainage Devices for Glaucoma

    Implications of Glaucoma and Aqueous Drainage Devices for Anesthetic Care

    CONCLUSIONS

    SECTION 16: Regional Anesthesia and Acute Pain Medicine

    81 A Rare Case of Transverse Sinus Venous Thrombosis Simulating Postdural Puncture Headache After Cervical Epidural Injection

    CASE DESCRIPTION

    DISCUSSION

    82 Continuous Quadratus Lumborum Block for Postoperative Pain in Total Hip Arthroplasty: A Case Report

    CASE REPORT

    DISCUSSION

    SECTION 17: Chronic Pain Medicine

    83 Peripheral Neuromodulation for the Treatment of Postamputation Neuroma Pain: A Case Report

    CASE DESCRIPTION

    DISCUSSION

    84 Successful Treatment of Persistent Pain After Pectus Excavatum Repair Using Paravertebral Nerve Radiofrequency Thermoablation

    CASE REPORT

    DISCUSSION

    SECTION 18: General Case Reports

    85 Case Report of a Massive Retropharyngeal Goiter Resulting in Laryngeal Compression

    CASE

    DISCUSSION

    86 Ventilation and Oxygenation After Emergency Cricothyrotomy: Recommendations for the Management of Suboptimal Invasive Airway Access

    CASE DESCRIPTION

    DISCUSSION

    87 Do Not Burn Your Airway Bridge: A Technique to Safely Exchange a Tracheostomy Tube for a Tracheal Tube

    CASE DESCRIPTION

    DISCUSSION

    CONCLUSIONS

    88 A Rare Case of Hydromorphone- Induced Angioedema Effectively Managed by a Difficult Airway Response Team

    CONSENT FOR PUBLICATION

    CASE DESCRIPTION

    DISCUSSION

    89 Upper Extremity Peripheral