Barash, Cullen, and Stoelting’s Clinical Anesthesia

 

Description:

Covering the full spectrum of clinical issues and options in anesthesiology, Barash, Cullen, and Stoelting’s Clinical Anesthesia, Ninth Edition, edited by Drs. Bruce F. Cullen, M. Christine Stock, Rafael Ortega, Sam R. Sharar, Natalie F. Holt, Christopher W. Connor, and Naveen Nathan, provides insightful coverage of pharmacology, physiology, co-existing diseases, and surgical procedures. This award-winning text delivers state-of-the-art content unparalleled in clarity and depth of coverage, as well robust multimedia features that equip you to effectively apply today’s standards of care and make optimal clinical decisions on behalf of your patients.

 

Table of Contents:

 

Multimedia Contents

Section 1: Introduction and Overview

1. The History of Anesthesia

Anesthesia Before Ether

Physical and Psychological Anesthesia

Early Analgesics and Soporifics

Inhaled Anesthetics

Almost Discovery: Hickman, Clarke, Long, and Wells

Public Demonstration of Ether Anesthesia

Chloroform and Obstetrics

Anesthesia Principles, Equipment, and Standards

Control of the Airway

Tracheal Intubation

Advanced Airway Devices

Early Anesthesia Delivery Systems

Alternative Circuits

Ventilators

Carbon Dioxide Absorption

Flowmeters

Vaporizers

Patient Monitors

Electrocardiography, Pulse Oximetry, and Capnography

Safety Standards

The History of Anesthetic Agents and Adjuvants

Inhaled Anesthetics

Intravenous Anesthetics

Local Anesthetics

Opioids

Muscle Relaxants

Antiemetics

Anesthesia Subspecialties

Regional Anesthesia

Cardiovascular Anesthesia

Pediatric Anesthesia

Neuroanesthesia

Obstetric Anesthesia

Transfusion Medicine

Professionalism and Anesthesia Practice

Organized Anesthesiology

Academic Anesthesiology

Establishing a Society

Conclusions

2. The Practice of Anesthesiology

Introduction

The Practice of Anesthesiology

The Value of Anesthesiologists

Perioperative Surgical Home

Enhanced Recovery after Surgery

Practice Parameters: Standards, Guidelines, and Advisories

Operating Room Management

Physician Executive Roles and Additional Training

Advocacy/Participation

Accreditation, Training, and Certification

Initial Certification

Maintenance of Certification

Financial Aspects of Anesthesia Practice

Introduction

Basics of Anesthesia Billing and Reimbursement

Coding

Billing

Medical Direction and the Anesthesia Care Team Model

What are Medical Direction and Medical Supervision?

Who are “Qualified Individuals”?

Payment for Anesthesia Care

How Does Medical Direction or Supervision Affect Reimbursement?

Government versus Commercial Insurance Payments

Balance Billing and the No Surprises Act

Summary and Future Directions

Quality and Safety

Regulatory

Center for Medicare and Medicaid Services

The Joint Commission

Health Insurance Portability and Accountability Act

State Regulations

Conclusion

Support

Employment Markets

Choosing a Practice

Life Outside of Clinical Practice

Wellness and Burnout

Financial Wellness

Debt Burden and Debt Repayment

Savings, Budgeting, and Retirement Planning

Protecting Assets: Insurance

The Future

Global and Public Health

Green or “Clean” Anesthesia

Artificial Intelligence and the Future of Anesthesia Care

Conclusion

3. Occupational Health and Well-Being

Introduction

Physical Hazards

Ergonomics

Inhalation Anesthetics

Levels of Waste Anesthetic Gases

Health Consequences of WAG Exposure

Surgical Smoke

Radiation

Noise

Interpersonal Issues

Night Call, Sleepiness, and Fatigue

Substance Use Disorders

Infectious Hazards

Standard and Transmission-Based Precautions

Respiratory Viruses

Influenza Viruses

Avian Influenza A

Human Respiratory Syncytial Virus

Severe Acute Respiratory Syndrome

Enteric Infections

DNA Viruses

Rubella

Measles (Rubeola)

Viral Hepatitis

Pathogenic Human Retroviruses

Risk of Occupational HIV Infection

Postexposure Treatment and Prophylactic Antiretroviral Therapy

Prion Diseases

Tuberculosis

Impairment and Disability

The Aging Anesthesiologist

Mortality Among Anesthesiologists

Suicide

Psychological Considerations

Stress

Impact of Adverse Events

Well-Being, Burnout, and Workplace Culture

Burnout

Well-Being

Nutrition, Diet, and Fitness

Mindfulness

Creating a Culture of Support

Conclusion

4. Anesthetic Risk, Quality Improvement, and Liability

Anesthesia Risk

Mortality and Major Morbidity Related to Anesthesia

Risk Management

Conceptual Introduction

Risk Management in Anesthesia

Informed Consent

Record Keeping

What to Do After an Adverse Outcome

Special Circumstances: “Do Not Resuscitate”

National Practitioner Data Bank

Quality Improvement and Patient Safety in Anesthesia

Structure, Process, and Outcome: The Building Blocks of Quality

Continuous Quality Improvement

Tracking Adverse Events for Anesthesia CQI Programs

Joint Commission Requirements for Quality Improvement

Alternative Payment Models and Pay for Performance

Clinical Outcomes Registries in Anesthesiology

Professional Liability

The Tort System

Duty

Breach of Duty

Causation

Damages

Standard of Care

Causes of Anesthesia-Related Lawsuits

What to Do When Sued

Acknowledgments

5. Electrical Safety and Fires in the Operating Room

Fundamental Principles of Electricity

Electrical Circuits with Oscillating Voltages

Electrical Shock

Causes of Electric Shock

Grounded Electrical Power

Common Safety Features of a Grounded Electrical Power System

Power Receptacles

Ground-Isolated Electrical Power

The Line Isolation Monitor

Microshock

Safety Features within Monitors

Electrosurgery

Electromagnetic Interference

Emergency Backup Power

Regulations and Building Codes

Operating Room Fires

American Society of Anesthesiologists Fire Prevention Practice Advisory

Fire Triangle/Tetrahedron

Flammability, Oxygen Concentration, Gas Density, and Nitrous Oxide

Assessing Fire Risk during the Presurgical Timeout

OR Fires and Lessons from Closed Claims and Review Findings

Why Is 2 L/min O2 via Nasal Cannula or Face Mask Not Safe for High–Fire-Risk Cases?

On-Patient versus In-Patient Fires

Airway Fires

Laser-Related Airway Fires

Tracheostomy Fires

Tonsillectomy Fires

Eye Surgery Fires

Abdominal Surgery/Colonoscopy Fires

Thoracic Surgery Fires

Electrical Equipment Fire

Fire Prevention

Fire Response

Section 2: Basic Science and Fundamentals

6. Genomic Basis of Perioperative Precision Medicine

Scientific Rationale for Perioperative Precision Medicine

Human Genomic Variation

Profiling the Regulatory Genome to Understand Perioperative Biology and Discover Biomarkers of Organ Injury and Adverse Outcomes

Epigenetics: The Link between Environment and Genes

Overview of Genetic Epidemiology and Functional Genomic Methodology

Genomics and Perioperative Risk Profiling

Predictive Biomarkers for Perioperative Adverse Cardiac Events

Perioperative Myocardial Infarction and Ventricular Dysfunction

Perioperative Atrial Fibrillation

Genetic Variants and Postoperative Event-Free Survival

Genetic Susceptibility to Adverse Perioperative Neurologic Outcomes

Genetic Susceptibility to Adverse Perioperative Kidney Outcomes

Genetic Variants and Risk for Postoperative Acute Lung Injury

Pharmacogenomics and Anesthesia

Genetic Variability in Response to Anesthetic Agents

Genetic Variability in Pain Response

Genetic Variability in Response to Other Drugs Used Perioperatively

Conclusions and Future Directions

7. Experimental Design and Statistics

Introduction

Foundations

Data Structure

Descriptive Statistics

Central Location

Spread or Variability

Types of Research Design

Experimental Medicine: Management of Bias

Sampling

Experimental Constraints

Control Groups

Random Allocation of Treatment Groups

Blinding

Experimental Medicine: Data Analysis

Null Significance Hypothesis Test Formulation

Logic of Proof

Sample Size Calculations

Sample Test Statistics

The Fickle P Value

The Bayesian Alternative

Experimental Medicine: Statistical Tests

Interval Data

Confidence Intervals

t-Test

Analysis of Variance

Robustness and Nonparametric Tests

Binary Variables

Confidence Intervals on Proportions

Hypothesis Testing

Linear Regression

Epidemiology

Multivariable Linear Regression

Univariable and Multivariable Logistic Regression

Propensity Score Matching and Analysis

Systematic Reviews and Meta-Analyses

Big Data

Conclusions

Interpretation of Results

Statistical Resources

Statistics and Anesthesia

8. Inflammation, Wound Healing, and Infection

Introduction

Infection Control

Hand Hygiene

Antisepsis

Role of Single-Use Disposables in Infection Control

Antibiotic Prophylaxis

Mechanisms of Wound Repair

The Initial Response to Injury

Resistance to Infection

Proliferation

Neovascularization

Collagen and Extracellular Matrix Deposition

Epithelialization

Maturation and Remodeling

Wound Perfusion and Oxygenation

Patient Management

Preoperative Preparation

Intraoperative Management

Volume Management

Postoperative Management

Summary

9. The Allergic Response

Introduction

Basic Immunologic Principles

Antigens

Thymus-Derived (T-cell) and Bursa-Derived (B-cell) Lymphocytes

Antibodies

Effector Cells and Proteins of the Immune Response

Cells

Proteins

Effects of Anesthesia on Immune Function

Hypersensitivity Responses (Allergy)

Type I Reactions

Type II Reactions

Type III Reactions (Immune Complex Reactions)

Type IV Reactions (Delayed Hypersensitivity Reactions)

Intraoperative Allergic Reactions

Anaphylactic Reactions

IgE-Mediated Pathophysiology

Molecular Mediators of Anaphylaxis

Peptide Mediators of Anaphylaxis

Arachidonic Acid Metabolites

Kinins

Platelet-Activating Factor

Recognition of Anaphylaxis

Non–IgE-Mediated Reactions

Complement Activation

Nonimmunologic Release of Histamine

Treatment Plan

Initial Therapy

Secondary Treatment

Perioperative Management of the Patient with Allergies

Immunologic Mechanisms of Drug Allergy

Evaluation of Patients with Allergic Reactions

Testing for Allergy

Agents Implicated in Allergic Reactions

Antibiotics

Latex Allergy

Local Anesthetics

Neuromuscular Blocking and Reversal Agents

Summary

10. Mechanisms of Anesthesia and Consciousness

What Is Anesthesia?

How Is Anesthesia Measured?

What Is the Chemical Nature of Anesthetic Target Sites?

The Meyer–Overton Rule

Exceptions to the Meyer–Overton Rule

Lipid versus Protein Targets

Lipid Theories of Anesthesia

Protein Theories of Anesthesia

Evidence for Anesthetic Binding to Proteins

Summary

How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System?

Neuronal Excitability

Synaptic Transmission

Presynaptic Effects

Postsynaptic Effects

Summary

Potential Anesthetic Targets

GABA-Activated Ion Channels

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels

Two-Pore Potassium Channels

Sodium Channels

T-Type Calcium Channels

Shaker Potassium Channels

NMDA-Subtype Glutamate-Activated Ion Channels

Mitochondrial Complex I

Synaptic Vesicle Release Machinery

Summary

How and Where in the Central Nervous System Do Anesthetics Work?

Spinal Cord—Immobility

Brainstem—Autonomic Control

Mechanisms of Anesthesia—Lessons from Sleep

Subcortical and Cortical Structures—Unconsciousness

Subcortical Structures—Regulation of Arousal and Sleep

Thalamus and Cerebral Cortex—Arousal and Content of Consciousness

Hippocampus, Amygdala, and Cerebral Cortex—Amnesia

Summary

Conclusions

Acknowledgments

11. Basic Principles of Clinical Pharmacology

Pharmacokinetic Principles

Drug Absorption and Routes of Administration

Transfer of Drugs across Membranes

Intravenous Administration

Oral Administration

Transcutaneous Administration

Intramuscular and Subcutaneous Administration

Intrathecal, Epidural, and Perineural Injection

Inhalational Administration

Drug Distribution

Redistribution

Drug Elimination

Biotransformation Reactions

Phase I Reactions

Cytochrome P450 Enzymes

Phase II Reactions

Genetic Variations in Drug Metabolism

Chronologic Variations in Drug Metabolism

Renal Drug Clearance

Hepatic Drug Clearance

Pharmacokinetic Models

Physiologic versus Compartment Models

Pharmacokinetic Concepts

Volume of Distribution

Total Drug (Elimination) Clearance

Elimination Half-Life

Effect of Hepatic or Renal Disease on Pharmacokinetic Parameters

Nonlinear Pharmacokinetics

Compartmental Pharmacokinetic Models

One-Compartment Model

Two-Compartment Model

Three-Compartment Model

Noncompartmental (Stochastic) Pharmacokinetic Models

Neural Networks and Artificial Intelligence

Pharmacodynamic Principles

Drug–Receptor Interactions

Desensitization and Downregulation of Receptors

Agonists, Partial Agonists, and Antagonists

Dose–Response Relationships

Concentration–Response Relationships

Combined Pharmacokinetic–Pharmacodynamic Models

Population Pharmacokinetic–Pharmacodynamic Models

Therapeutic Thresholds and Therapeutic Window

Drug Interactions

Pharmaceutical (Physiochemical) Interactions

In Vitro Interactions

In Vivo Interactions

Pharmacokinetic Interactions

Absorption (Uptake)

Distribution

Metabolism

Pharmacodynamic Interactions

Serotonin Syndrome

Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics

Rise to Steady-State Concentration

Manual Bolus and Infusion Dosing Schemes

Pharmacokinetic Simulation Software

Context-Sensitive Decrement Time

Context-Sensitive Time to Recovery

Soft Pharmacology and Anesthesiology

Target-Controlled Infusions

Time to Maximum Effect Compartment Concentration (Tmax)

Volume of Distribution at Peak Effect (VDPE)

Front-End Pharmacokinetics

Closed-Loop Infusions

Response Surface Models of Drug–Drug Interactions

Conclusion

Section 3: Core Principles

12. Cardiac Anatomy and Physiology

Introduction

Gross Anatomy

Valves

Conduction System

Coronary Anatomy

Coronary Physiology

Cardiac Myocyte Anatomy and Function

Ultrastructure

Contractile Apparatus Proteins

Ca2+-Myofilament Interaction

Myosin–Actin Interaction

Laplace’s Law

The Cardiac Cycle

Pressure–Volume Diagrams

Determinants of Cardiac Performance

Heart Rate

Preload

Afterload

Myocardial Contractility

Evaluation of Diastolic Function

Relaxation

LV Filling

Compliance

Pericardial Restraint

Determinants of Atrial Function

Pathophysiology of Heart Failure

Presentation

Diagnosis

Functional Characteristics

13. Autonomic and Cardiovascular Pharmacology

Introduction

Cholinergic Drugs

Cholinergic Agonists

Cholinesterase Inhibitors

Muscarinic Antagonists

Muscarinic Antagonist Toxicity

Fundamentals of Catecholamine Pharmacology

Epinephrine

Norepinephrine

Dopamine

Dobutamine

Isoproterenol

Selective Beta2-Adrenoceptor Agonists

Fenoldopam

Sympathomimetics

Ephedrine

Phenylephrine

Alpha1-adrenoceptor Antagonists

Alpha2-adrenoceptor Agonists: Clonidine and Dexmedetomidine

Beta-Adrenoceptor Antagonists (Beta-Blockers)

Propranolol

Metoprolol

Atenolol

Esmolol

Labetalol

Carvedilol

Phosphodiesterase Inhibitors

Levosimendan

Digitalis Glycosides

Vasopressin

Nitrovasodilators

Nitroglycerin

Sodium Nitroprusside

Hydralazine

Calcium Channel Blockers

Nifedipine

Nicardipine

Clevidipine

Nimodipine

Diltiazem

Verapamil

Angiotensin Converting Enzyme Inhibitors

Angiotensin Receptor Blockers

Acknowledgments

14. Autonomic Nervous System Anatomy and Physiology

Anesthesia and the Autonomic Nervous System

Functional Anatomy

Central Autonomic Organization

Peripheral Autonomic Nervous System Organization

Sympathetic Nervous System

Parasympathetic Nervous System

Autonomic Innervation

Peripheral Circulation

Lungs

Autonomic Nervous System Transmission

Parasympathetic Nervous System Transmission

Sympathetic Nervous System Transmission

Receptors

Cholinergic Receptors

Adrenergic Receptors

α-Adrenergic Receptors

α-Adrenergic Receptors in the Cardiovascular System

α-Adrenergic Receptors in the Central Nervous System

α Receptors in the Kidney

β-Adrenergic Receptors

β Receptors in the Cardiovascular System

β Receptors in the Kidney

Dopaminergic Receptors

Other Receptors

Serotonin

Adrenergic Receptor Numbers and Sensitivity

Autonomic Nervous System Reflexes and Interactions

Baroreceptors

Denervated Heart

Interaction of Autonomic Nervous System Receptors

Interaction with Other Regulatory Systems

Clinical Autonomic Nervous System Pharmacology

Mode of Action

Ganglionic Drugs

Agonists

Antagonists

Cholinergic Drugs

Muscarinic Agonists

Direct Cholinomimetics

Indirect Cholinomimetics

Muscarinic Antagonists

Atropine-Like Drugs

Central Anticholinergic Syndrome45

Autonomic Syndromes and Autonomic Regulation

Horner Syndrome

Diabetic Neuropathy

Orthostatic Hypotension

Monoamine Oxidase Inhibitors

Tricyclic Antidepressants

Selective Serotonin Reuptake Inhibitors

15. Respiratory Function in Anesthesia

Introduction

Respiratory Mechanics

Equation of Motion

Work and Power of Breathing

Elastic Forces

Measuring Elastic Forces during Anesthesia

Driving Pressure

Esophageal Pressure and Chest Wall Compliance

Changes in Elastic Forces under Anesthesia

Resistive Forces

Anatomy of the Airways

Airway Resistance

Tissue Resistance

Measurement of Resistance

Changes in Resistance during Anesthesia

Intrinsic PEEP

Gas Exchange

Impairments in Gas Exchange during Anesthesia

Oxygen

Carbon Dioxide

Control of Breathing

Chemical Feedback of Breathing

Reflexive Control of Breathing

CO2 Exchange under Anesthesia

Lung Volumes and Capacities

Pulmonary Function Tests

Forced Vital Capacity

Forced Expiratory Volume

Forced Expiratory Flow

Flow–Volume Loops

Carbon Monoxide Diffusing Capacity

Practical Application of Pulmonary Function Tests

Summary

16. Acid–Base, Fluids, and Electrolytes

Acid–Base Equilibrium

Acid–Base Interpretation and Treatment

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Alkalosis

Respiratory Acidosis

Diagnosis of Acid–Base Disorders and Interpretation of Arterial Blood Gas

Examples

Fluid Management

Physiology

Body Fluid Compartments

Distribution of Infused Fluids

Regulation of Osmolarity and Circulating Volume

Fluid Replacement Therapy

Maintenance Requirements for Water, Sodium, and Potassium

Dextrose

Surgical Fluid Requirements

Water and Electrolyte Composition of Fluid Losses

Influences of Perioperative and Intraoperative Fluid Infusion Rates on Clinical Outcomes

Colloids, Crystalloids, and Hypertonic Solutions

Physiology and Pharmacology

Clinical Implications of Choice between Alternative Fluids

Implications of Crystalloid and Colloid Infusions on Intracranial Pressure

Buffered versus Nonbuffered Crystalloid

Clinical Implications of Hypertonic Fluid  Administration

Fluid Status: Assessment and Monitoring

Conventional Clinical Assessment

Intraoperative Clinical Assessment

Electrolytes

Sodium

Physiologic Role

Hyponatremia

Hypernatremia

Potassium

Physiologic Role

Hypokalemia

Hyperkalemia

Calcium

Physiologic Role

Hypocalcemia

Hypercalcemia

Magnesium

Physiologic Role

Hypomagnesemia

Hypermagnesemia

Phosphorus

Physiologic Role

Hypophosphatemia

Hyperphosphatemia

17. Hemostasis and Transfusion Medicine

Introduction

Hemostasis and Coagulation

Primary Hemostasis

Adherence

Activation

Stabilization

Inhibition

Mechanisms of Antiplatelet Medications

Secondary Hemostasis

Inhibition of Clotting Factors

Fibrinolysis

Inhibition of Fibrinolysis

Laboratory Evaluation of Hemostasis

Laboratory Evaluation of Primary Hemostasis

Laboratory Evaluation of Secondary Hemostasis and Coagulation

Mixing Studies

Viscoelastic Testing

Diagnosis of Thromboembolic Disorders

Congenital Risk Factors for Thrombosis

Acquired Risk Factors for Thrombosis

Monitoring Anticoagulation Therapeutic Agents

Warfarin Anticoagulation

Heparin Anticoagulation Testing

Blood Component Production

Blood Collection

Component Processing and Storage

Plasma Derivatives

RBC and Platelet Substitutes

Blood Products and Transfusion Practice

Compatibility Testing

Red Blood Cells

Physiologic Compensation for Anemia

Platelets

Plasma Products

Cryoprecipitate

Fibrinogen Concentrate

Emerging Blood Products

The Risks of Blood Product Administration

Infectious Risks of Blood Product Administration

Human Immunodeficiency Virus

Hepatitis C Virus

Hepatitis B Virus

Human T-Cell Lymphotropic Virus-1 and Virus-2

Cytomegalovirus

Emerging Infections

Bacterial Contamination

Noninfectious Risks of Blood Product Administration

Immune-Mediated Transfusion Reactions

Transfusion-Related Immunomodulation

Nonimmune-Mediated Transfusion Reactions

Patient Blood Management

Preoperative Anemia Management

Perioperative Iron Supplementation

Perioperative Erythropoietin

Autologous Blood Transfusion

Perioperative Blood Salvage

Disorders of Hemostasis: Diagnosis and Treatment

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

The Hemophilias

Hereditary Hypercoagulability

Acquired Disorders of Hemostasis

Vitamin K Deficiency

Liver Disease

Disseminated Intravascular Coagulation (DIC)

Anticoagulation and Pharmacologic Therapy

Anticoagulation Regimens and Associated Anesthetic Concerns

Cyclooxygenase Inhibitors

Phosphodiesterase Inhibitors

ADP Receptor Antagonists

GP IIb/IIIa Receptor Antagonists

Protease-Activated Receptor (PAR)-1 Antagonist

Vitamin K Antagonists

New Oral Anticoagulants

Heparin Therapy

Indirect Factor Xa Antagonists

Heparin-Induced Thrombocytopenia

Parenteral Direct Thrombin Inhibitors

Recombinant Activated Factor VII

Prothrombin Complex Concentrates

Desmopressin

Antifibrinolytic Therapy

Lysine Analog

Conclusions

Section 4: Anesthetic Drugs and Adjuvants

18. Inhaled Anesthetics

Introduction

Pharmacokinetic Principles

Unique Features of Inhaled Anesthetics

Speed, Gas State, and Route of Administration

Physical Characteristics of Inhaled Anesthetics

Gases in Mixtures

Gases in Solution

Anesthetic Transfer: Machine to Central Nervous System

Uptake and Distribution

FA/FI

Rise in FA in the Absence of Uptake

Rise in FA in the Presence of Uptake

Distribution (Tissue Uptake)

Metabolism

Overpressurization and the Concentration Effect

Second Gas Effect

Ventilation Effects

Perfusion Effects

Ventilation–Perfusion Mismatching

Elimination

Percutaneous and Visceral Loss

Diffusion between Tissues

Exhalation and Recovery

Diffusion Hypoxia

Clinical Overview of Current Inhaled Anesthetics

Isoflurane

Desflurane

Sevoflurane

Xenon

Nitrous Oxide

Neuropharmacology of Inhaled Anesthetics

Minimum Alveolar Concentration

The Effect of Age on MAC

Other Alterations in Neurophysiology

Cerebral Metabolic Rate and Electroencephalogram

Cerebral Blood Flow, Flow–Metabolism Coupling, and Autoregulation

Intracerebral Pressure

Cerebral Blood Flow Response to Hypercapnia and Hypocapnia

Cerebral Protection

Postoperative Cognitive Dysfunction

Processed Electroencephalograms and Neuromonitoring

Nitrous Oxide

The Circulatory System

Hemodynamics

Myocardial Contractility

Other Circulatory Effects

Coronary Steal, Myocardial Ischemia, and Cardiac Outcome

Cardioprotection from Volatile Anesthetics

Autonomic Nervous System

The Pulmonary System

General Ventilatory Effects

Ventilatory Mechanics

Response to Carbon Dioxide and Hypoxemia

Bronchiolar Smooth Muscle Tone

Mucociliary Function

Pulmonary Vascular Resistance

Hepatic Effects

Neuromuscular System and Malignant Hyperthermia

Uterine Tone, Genetic Markers, Fetal Development, and Neonatal Neurobehavioral Outcomes

Anesthetic Degradation by Carbon Dioxide Absorbers

Compound A

Carbon Monoxide and Heat

Anesthetic Metabolism

Fluoride-Induced Nephrotoxicity

Environmental Effects of Volatile Anesthetics

Clinical Utility of Volatile Anesthetics

For Induction of Anesthesia

For Maintenance of Anesthesia

Acknowledgments

19. Intravenous Anesthetics

Pharmacokinetics: General Principles for Intravenous Anesthetics

Propofol

Introduction

Pharmacokinetics

Pharmacodynamics

Central Nervous System Effects

Cardiovascular Effects

Respiratory System Effects

Clinical Uses

Side Effects

Etomidate

Introduction

Pharmacokinetics

Pharmacodynamics and Clinical Uses

Side Effects

Ketamine

Introduction

Pharmacokinetics

Pharmacodynamics

Clinical Uses

Anesthesia

Sedation

Analgesia

Chronic Pain

Depression

Side Effects

Dexmedetomidine

Introduction

Pharmacokinetics

Pharmacodynamics

Clinical Uses

Side Effects

Benzodiazepines

Introduction

Pharmacokinetics

Pharmacodynamics and Clinical Uses

Side Effects

Barbiturates

Introduction

Pharmacokinetics

Pharmacodynamics

Central Nervous System Effects

Cardiovascular Effects

Respiratory System Effects

Clinical Uses

Side Effects

New Intravenous Anesthetics

Propofol Formulations

20. Opioids

Introduction

History

The Endogenous Opioid System

Multifunctional Opioids

Nociception and Pain

Opioids and Opioid Mechanisms

Classification of Exogenous Opioids

Central Opioid Analgesia

Peripheral Opioid Analgesia

Opioid-Induced Hyperalgesia and Opioid Tolerance

Opioid Tolerance to Respiratory Depression

Opioid Pharmacokinetics and Pharmacodynamics

Opioid Pharmacokinetics

Metabolism: Which Pathways and Metabolites Are Clinically Relevant?

Morphine

Piperidines

Methadone

Naloxone

Pharmacodynamics: Which End Point Serves the Clinician Best?

Pharmacodynamics: Pain Relief

Morphine

Fentanyl

Sufentanil

Remifentanil

Buprenorphine

Oliceridine

Pharmacogenetics

Opioid-Induced Respiratory Depression

Mechanisms of Opioid-Induced Respiratory Depression

Incidence and Risk Factors of Opioid-Induced Respiratory Depression

Opioid-Induced Respiratory Depression versus Opioid Analgesia

Combining Opioids and Central Depressants

Reversal of Opioid-Induced Respiratory Depression

Monitoring

Monitoring of Nociception during Anesthesia and Surgery

Monitoring on the Ward

Other Opioid-Related Side Effects

Nausea and Vomiting

Smooth Muscle Effects

Cardiovascular Effects

21. Neuromuscular Blocking Drugs

Introduction

Physiology

Nerve Propagation and Nerve Terminal

Presynaptic Events

Neuromuscular Junction

Post Synaptic Events

Receptor Up- and Downregulation

Pharmacology

Characterization of Neuromuscular Blocking Drugs

Interpatient Variation

Depolarizing Neuromuscular Blocking NMB Drug: Succinylcholine

Depolarizing Blockade Characteristics

Pharmacology of Succinylcholine

Succinylcholine Side Effects

Succinylcholine Clinical Uses

Succinylcholine Contraindications

Nondepolarizing Neuromuscular Blocking Drugs

Characteristics of Nondepolarizing Neuromuscular Blocking Drugs

Drug Classification of Nondepolarizing Neuromuscular Blocking Drugs

Onset of Action of Nondepolarizing Neuromuscular Blocking Drugs

Duration of Action of Nondepolarizing Neuromuscular Blocking Drugs

Aminosteroids

Benzylisoquinolinium Drugs

Adverse Effects of Nondepolarizing Neuromuscular Blocking Drugs

Nondepolarizing Neuromuscular Blocking Drug Interactions

Nondepolarizing Neuromuscular Blocking Drug Altered Responses

Monitoring Neuromuscular Blockade

History and Clinical Significance of Monitoring Neuromuscular Blockade

Time and Clinical Assessment of Neuromuscular Blockade

Peripheral Nerve Stimulators

Quantitative Monitoring

Differential Muscle Sensitivity to Neuromuscular Blockade

Receptor Occupancy to Stimulation Response Relationship

Adoption of Quantitative Monitoring into Clinical Practice

Reversal of Neuromuscular Blockade

Depth of Block Definitions

Anticholinesterase Drugs

Factors Affecting Neostigmine Reversal

Neostigmine Dosing

Other Effects of Neostigmine

Neostigmine Weakness

Neostigmine Cost Variation Over Time

Edrophonium

Selective Relaxant Binding Drugs: Sugammadex

Selective Relaxant Binding Drugs: Future Drugs

22. Local Anesthetics

Mechanisms of Action of Local Anesthetics

Anatomy of Nerves

Electrophysiology of Neural Conduction and Voltage-Gated Sodium Channels

Molecular Mechanisms of Local Anesthetics

Mechanism of Nerve Blockade

Pharmacology and Pharmacodynamics

Chemical Properties and Relationship to Activity and Potency

Additives to Increase Local Anesthetic Activity

Epinephrine

Alkalinization of Local Anesthetic Solution

Opioids

α2-Adrenergic Agonists

Steroids

Liposomes

Pharmacokinetics of Local Anesthetics

Systemic Absorption

Distribution

Elimination

Clinical Pharmacokinetics

Clinical Use of Local Anesthetics

Toxicity of Local Anesthetics

Local Anesthetic Systemic Toxicity (LAST)

Central Nervous System Toxicity

Cardiovascular Toxicity

Clinical Presentation of LAST

Incidence of LAST

Prevention and Treatment of LAST

Treatment of Systemic Toxicity from Local Anesthetics

Neural Toxicity of Local Anesthetics

Transient Neurologic Symptoms after Spinal Anesthesia

Myotoxicity of Local Anesthetics

Allergic Reactions to Local Anesthetics

Future Therapeutics and Modalities

Section 5: Preoperative Assessment and Perioperative Monitoring

23. Preoperative Patient Assessment and Management

Introduction

Changing Concepts in Preoperative Evaluation

Approach to the Healthy Patient

Patient Identification, Diagnosis, and Planned Procedure

Response to Previous Anesthetics

Medications/Allergies

Screening Patients Using a Systems Approach

Airway

Pulmonary System

Cardiovascular System

Neurologic System

Endocrine System

Evaluation of the Patient With Known Systemic Disease

Cardiovascular Disease

Identifying Clinical Risk Factors

Identifying Patients at Risk for Atherosclerotic Cardiac Disease

Importance of Surgical Procedure

Calculation of Risk to Predict Perioperative Morbidity

Preoperative Cardiac Testing

Special Patient Populations

Pulmonary Disease

Smoking

Asthma

Obstructive Sleep Apnea (OSA)

Endocrine Disease

Diabetes Mellitus

Thyroid and Parathyroid Diseases

Adrenal Disorders

Renal Disease

Liver Disease

Infectious Disease

Other Diseases

Preoperative Laboratory Testing

Defining Normal Values

Risks and Costs versus Benefits

Clinical Considerations for Laboratory Testing

Summary of the Preoperative Evaluation

Preparation

Smoking Cessation

Continuing Current Medications/Treatment of Coexisting Diseases

β-Blockers

Anticoagulation

Aspirin

Statins

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers

Prevention of Perioperative Pulmonary Aspiration

ASA Fasting Guidelines

Recommendations for Clear Liquids: At Least 2 Hours

Recommendations for Breast Milk: At Least 4 Hours

Recommendations for Infant Formula, Nonhuman Milk, and Light Meal: At Least 6 Hours

Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration

Psychological Preparation/Premedication

Psychological Preparation

Premedication

Benzodiazepines

Diphenhydramine

Opioids

Dexmedetomidine

Anticholinergics

Antibiotic Prophylaxis

Summary of Patient Preparation

24. Rare Coexisting Diseases

Musculoskeletal Diseases

Muscular Dystrophy and Congenital Myopathy

Duchenne Muscular Dystrophy

Becker Muscular Dystrophy

Emery–Dreifuss Muscular Dystrophy

Limb-Girdle Muscular Dystrophy

Facioscapulohumeral Muscular Dystrophy

Oculopharyngeal Muscular Dystrophy

Congenital Muscular Dystrophy and Myopathy

Management of Anesthesia

Myotonic Dystrophy

Myotonic Dystrophy Type 1

Myotonic Dystrophy Type 2

Management of Anesthesia

Skeletal Muscle Channelopathies

Hyperkalemic Periodic Paralysis

Hypokalemic Periodic Paralysis

Andersen–Tawil Syndrome

Management of Anesthesia

Myasthenia Gravis

Management of Anesthesia

Myasthenic Syndrome

Guillain–Barré Syndrome

Management of Anesthesia

Central Nervous System Disease

Multiple Sclerosis

Management of Anesthesia

Epilepsy

Classification

Treatment

Management of Anesthesia

Alzheimer Disease

Management of Anesthesia

Parkinson Disease

Management of Anesthesia

Huntington Disease

Management of Anesthesia

Amyotrophic Lateral Sclerosis

Management of Anesthesia

Creutzfeldt–Jakob Disease

Management of Anesthesia

Other Inherited Disorders

Malignant Hyperthermia

Management of the Acute Malignant Hyperthermia Episode

Management of the Malignant Hyperthermia Susceptible Patient

Porphyrias

Management of Anesthesia

Cholinesterase Disorders

Management of Anesthesia

Glycogen Storage Diseases

Management of Anesthesia

Mucopolysaccharidoses

Management of Anesthesia

Osteogenesis Imperfecta

Treatment

Management of Anesthesia

Anemias

Nutritional Deficiency Anemias

Iron Deficiency Anemia

Folate and Vitamin B12 Deficiency Anemia

Anemia of Chronic Disease

Hemolytic Anemias

Hereditary Spherocytosis

Glucose-6-Phosphate Dehydrogenase Deficiency

Pyruvate Kinase Deficiency

Immune Hemolytic Anemias

Hemoglobinopathies

Sickle Cell Disease

Thalassemia

Connective Tissue Diseases

Rheumatoid Arthritis

Management of Anesthesia

Systemic Lupus Erythematosus

Management of Anesthesia

Systemic Sclerosis (Scleroderma)

Management of Anesthesia

Inflammatory Myopathies

Management of Anesthesia

Skin Disorders

Epidermolysis Bullosa

Management of Anesthesia

Pemphigus

Management of Anesthesia

25. The Anesthesia Workstation and Delivery Systems for Inhaled Anesthetics

The Anatomy of an Anesthesia Workstation

Pipeline Supply Source

Wall Outlets

Cylinder Supply Source

Nitrous Oxide

Machine Intermediate-Pressure System

Oxygen Supply Pressure Failure Safety Devices

Pneumatic and Electronic Alarm Devices

Oxygen Failure Cutoff (“Fail-Safe”) Valves

Second-Stage Oxygen Pressure Regulator

Flowmeter Assemblies

Operating Principles of Conventional Flowmeters

Components of the Flowmeter Assembly

Problems with Flowmeters

Electronic Gas Flow Control

Automated Fresh Gas Flow Optimization

Proportioning Systems

GE-Datex-Ohmeda Link-25 Proportion-Limiting Control System

Dräger Sensitive Oxygen Ratio Controller System

Limitations

Oxygen Flush Valve

Vaporizers

Physics

Vapor Pressure

Latent Heat of Vaporization

Specific Heat

Thermal Conductivity

Ambient Pressure Effects

Variable Bypass Vaporizers

Basic Operating Principles

Factors that Influence Vaporizer Output

Safety Features

Hazards

Vaporizers for Desflurane

Unsuitability of Contemporary Variable Bypass Vaporizers for Controlled Vaporization of Desflurane

Operating Principles of the Tec 6 and D-Vapor

Altitude Can Influence Vaporizer Output

Carrier Gas Composition Can Influence Vaporizer Output

Safety Features

The GE-Datex-Ohmeda Aladin Cassette Vaporizer

Electronic Injector Vaporizers

Anesthesia Breathing Systems

The Circle System

The Traditional Circle Breathing System

Hazards of the Circle System

Variations in Design: Coaxial

CO2 Absorbents: Canister, Chemistry, Interactions, Indicators

The Absorber Canister

The Chemistry of Absorbents

Absorptive Capacity

Indicators

Interactions of Inhaled Anesthetics with Absorbents

Mapleson Circuits

The Bain Circuit

The Jackson-Rees (Mapleson F) Circuit

The Self-Inflating Resuscitation Bag

Anesthesia Ventilators

Pneumatically Driven Bellows Ventilators

Electric Piston Pump Ventilators

Problems and Hazards with Piston Ventilators

Electric Turbine Ventilators

Volume Reflectors

Problems and Hazards

Bellows Assembly Problems

Control Assembly and Power Supply Problems

Future Technologies

Waste Gas Scavenging Systems

Components

Gas-Collecting Assembly

Transfer Means

Scavenging Interface

Gas-Disposal Assembly Conduit

Gas-Disposal Assembly

Problems and Hazards

Low-Flow Scavenging Systems

Failure of Anesthesia Equipment

Safety Features of Newer Anesthesia Workstations

Checkout of the Anesthesia Workstation

Oxygen Analyzer Calibration

Low-Pressure Circuit Leak Test

Oxygen Flush Positive-Pressure Leak Test

Verifying the Integrity of the Gas Supply Lines between the Flowmeters and the Common Gas Outlet

Evaluation of the Circle System

Workstation Self-Tests

Appendix A

FDA 1993 Anesthesia Apparatus Checkout Recommendations

Emergency Ventilation Equipment

Appendix B

Recommendations for Preanesthesia Checkout Procedures

Background

General Considerations

Personnel Performing the PAC

Objectives for a New PAC

Basic Principles

Guidelines for Developing Institution-Specific Checkout Procedures Prior to Anesthesia Delivery

Requirements for Safe Delivery of Anesthesia Care

Specific Items

Additional Notes

26. Commonly Used Monitoring Techniques

Introduction

Monitoring of Inspired Oxygen Concentration

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Arterial Oxygenation by Pulse Oximetry

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Expired Gases

Principles of Operation

Proper Use and Interpretation

Interpretation of Inspired and Expired Carbon Dioxide Concentrations

Interpretation of Inspired and Expired Anesthetic Gas Concentrations

Indications

Contraindications

Common Problems and Limitations

Invasive Monitoring of Systemic Blood Pressure

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Intermittent Noninvasive Monitoring of Systemic Blood Pressure

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Central Venous and Right-Heart Pressures

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Cardiac Output by Pulmonary Arterial Catheter

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Cardiac Output by Arterial Waveform Analysis

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Body Temperature

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring of Processed EEG Signals

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Monitoring Neuromuscular Blockade

Principles of Operation

Proper Use and Interpretation

Indications

Contraindications

Common Problems and Limitations

Future Trends in Monitoring

27. Echocardiography and Point-of-Care Ultrasound

Introduction

Physics of Sound

Characteristics of Sound Waves

Reflection

Resolution and Image Optimization

Temporal Resolution

Spatial Resolution

Common Artifacts

Doppler Echocardiography

The Doppler Principle

Doppler Imaging Modes

Pulsed Wave Doppler

Color Doppler Imaging

Tissue Doppler Imaging

Continuous Wave Doppler Imaging

Hemodynamic Assessment

Velocity

Gradient

Stroke Distance, Stroke Volume, and Cardiac Output

The Continuity Equation

Perioperative Echocardiography Imaging

Indications

Transesophageal Echocardiography

Complications and Contraindications

Probe Insertion and Manipulation

Image Orientation

Principal TEE Imaging Planes

Focused Transthoracic Echocardiography: Basic and Advanced Views

Three-Dimensional Echocardiography

Clinical Echocardiography

Left Ventricle

Normal Anatomy and Echocardiographic Appearance of the Left Ventricle

Global Systolic Function

Regional Systolic Function

Strain

Left Ventricular Diastolic Function

Left Ventricular Pathology

Dilation

Ventricular Aneurysms and Pseudoaneurysms

Hypertrophy

Right Ventricle

Diameters and Wall Thickness

RV Systolic Function

Valvular Heart Disease

Aortic Valve

Aortic Stenosis

Aortic Regurgitation

Mitral Valve

Mitral Stenosis

Mitral Regurgitation

Tricuspid Regurgitation

Other Pathology

Diseases of the Aorta

Pericardial Disease

Cardiac Masses

Congenital Heart Disease

Point-of-Care Ultrasound

Focused Cardiac Ultrasound

Lung Ultrasound

Abdominal Ultrasound

Other Uses of Ultrasound

Ultrasound-Guided Vascular Cannulation

Epicardial and Epiaortic Ultrasound

Out-of-OR Echocardiography

Training and Certification

Training in Perioperative Echocardiography

Certification in Perioperative Echocardiography

Future Trends in Echocardiography

Conclusions

Acknowledgment

Section 6: Basic Anesthetic Management

28. Airway Management

Perspectives on Airway Management

Review of Airway Anatomy

History of Airway Management

Limitations of Patient History and Physical Examination

Clinical Management of the Airway

Preoxygenation

Support of the Airway with the Induction of Anesthesia

The Anesthesia Facemask

Supraglottic Airways

Tracheal Intubation

Videolaryngoscopy

NPO Status and Rapid-Sequence Induction (Video 28-15)

Extubation of the Trachea

The Difficult Airway Algorithm and Infographics

Awake Airway Management

Clinically Difficult Airway Scenarios

Case 1: Preoperative Endoscopy

Preoperative Endoscopic Airway Evaluation (PEAE)

Case 2: Flexible Intubation Scope-aided Intubation

The Flexible Intubation Scope in Airway Management

Elements of the Flexible Intubation Scope

Use of the Flexible Intubation Scope

Case 3: Failed Rapid-sequence Induction and the SGA

The SGA in the Failed Airway

Case 4: Flexibility and Back-up Planning in Difficult Airway Management

Other Devices

Esophageal Tubes with Laryngeal Openings

Airway Introducers

Transcricothyroid Membrane Procedures

Retrograde Wire-Aided Tracheal Intubation

Cricothyrotomy

Conclusions

29. Patient Positioning and Potential Injuries

General Principles

Supine Positions

Variations of Supine Positions

Horizontal

Contoured

Lateral Uterine or Abdominal Mass Displacement

Lithotomy

Complications of Supine Positions

Brachial Plexus Neuropathy

Long Thoracic Nerve Dysfunction

Axillary Trauma from the Humeral Head

Radial Nerve Compression

Median Nerve Dysfunction

Ulnar Neuropathy

Other Supine Position Problems

Lateral Positions

Variations of Lateral Positions

Standard Lateral Position

Semisupine and Semiprone

Flexed Lateral Positions

Complications of Lateral Positions

Eyes and Ears

Neck

Suprascapular Nerve

Prone Positions

Full Prone

Complications of Prone Positions

Eyes and Ears

Neck Problems

Brachial Plexus Injuries

Breast Injuries

Abdominal Compression

Stoma and Genitals

Head-Elevated Positions

Variations of Head-Elevated Positions

Sitting

Supine—Tilted Head Up

Lateral—Tilted Head Up

Complications of Head-Elevated Positions

Postural Hypotension

Air Embolus

Edema of the Face, Tongue, and Neck

Midcervical Quadriplegia

Sciatic Nerve Injury

Head-Down Positions

Complications of Head-Down Positions

Head and Neck Injury

Brachial Plexopathy

Summary

30. Monitored Anesthesia Care

Terminology

Preoperative Assessment

Medical Status

Airway

Monitored Anesthesia Care Candidacy

Patient Factors

Case Factors

Conversion of Monitored Anesthesia Care to General Anesthesia

Patient Expectations

Monitoring during Monitored Anesthesia Care

American Society of Anesthesiologists Standards

Communication and Observation

Pulse Oximetry

Capnography

Cardiovascular System

Temperature

Monitoring Depth of Sedation

ASA Definitions of Sedation

Ramsay Sedation Scale/Modified Ramsay Sedation Scale

Richmond Agitation Sedation Score

Modified Observer’s Assessment of Alertness/Sedation Scale

Processed Electroencephalography

Supplemental Oxygen Administration

Head and Neck Fires with the Use of Supplemental Oxygen

Techniques of Monitored Anesthesia Care

Pharmacologic Basis of Monitored Anesthesia Care Techniques

Distribution, Elimination, Accumulation, and Duration of Action

Elimination Half-Life

Context-Sensitive Half-Time

How Does the Context-Sensitive Half-Time Relate to the Time to Recovery?

Drug Interactions

Specific Drugs Used for Monitored Anesthesia Care

Propofol

Benzodiazepines

Remimazolam

Opioids

Remifentanil

Ketamine

“Ketofol”

Dexmedetomidine

Complications during Monitored Anesthesia Care

Respiratory Depression

Aspiration

Laryngospasm

Cardiovascular Complications

Preparedness to Recognize and Treat Local Anesthetic Systemic Toxicity

Closed Claims with Monitored Anesthesia Care

Sedation and Analgesia by Nonanesthesiologists

Future Directions

Patient-Controlled Sedation and Analgesia

Target-Controlled Infusions

Closed Loop Anesthesia Delivery Systems

Conclusion

Acknowledgments

31. Ambulatory Anesthesia

The Place

Procedures

Patient Selection

Preoperative Screening

Upper Respiratory Tract Infection

Restriction of Food and Liquids Prior to Ambulatory Surgery

Managing the Anesthetic: Premedication

Anxiety Reduction and Benzodiazepines

Opioids and Nonsteroidal Analgesics

Intraoperative Management: Choice of Anesthetic

Regional Techniques

Spinal Anesthesia

Children

Adults

Epidural and Caudal Anesthesia

Peripheral Nerve Blocks

Sedation and Analgesia

General Anesthesia

Induction

Maintenance

Management of Postanesthesia Care

Nausea and Vomiting

Pain

Preparation for Discharge

Acknowledgments

32. Office-Based Anesthesia

Brief Historical Perspective of OBA

The Advantages and Disadvantages of Office-Based Surgery and Anesthesia

Office Safety

Patient Selection

Surgeon Selection

Office Selection and Requirements

Accreditation

Procedure Selection

Specific Procedures

Liposuction

Aesthetics

Breast

Gastrointestinal Endoscopy

Dentistry/Oral and Maxillofacial Surgery

Orthopedics/Podiatry

Gynecology/Genitourinary

Ophthalmology/Otolaryngology

Pediatrics

Anesthetic Techniques

Anesthetic Agents

Postanesthesia Care Unit

Regulations

Business and Legal Aspects

Conclusions

33. Nonoperating Room Anesthesia

General Principles

Three-Step Approach to Nonoperating Room Anesthesia

The Patient

The Procedure

The Environment

Anesthesia Equipment and Monitors

Patient Safety in Nonoperating Room Anesthesia

Adverse Events

Preprocedural Checklists

Standards of Care for Nonoperating Room Anesthesia

Patient Transfer

Sedation and Anesthesia

Definition of Sedation and Anesthesia

The Continuum of Anesthesia

Environmental Considerations for Nonoperating Room Anesthesia

X-Rays and Fluoroscopy

Hazards of Ionizing Radiation

Intravenous Contrast Agents

Renal Adverse Reaction

Hypersensitivity Reactions

Specific Nonoperating Room Procedures

Angiography

Interventional Neuroradiology

Procedural and Anesthetic Technique Considerations in Interventional Neuroradiology

Computed Tomography

Radiofrequency Ablation

Transjugular Intrahepatic Portosystemic Shunt

Magnetic Resonance Imaging

Physical Principles

Hazards of MRI

Anesthetic Technique

Pediatric Sedation and Anesthesia for MRI and CT Scans

Sedative Agents

Radiation Therapy

Positron Emission Tomography

Gastroenterology

Upper Gastrointestinal Endoscopy

Endoscopic Retrograde Cholangiopancreatography

Cardiology and Interventional Cardiology

Percutaneous Intervention

Percutaneous Ventricular Assist Devices

Percutaneous Closure of Septal Defects

Alcohol Septal Ablation

Structural Heart Procedures

Electrophysiology

Cardioversions and Diagnostic TEEs

Electroconvulsive Therapy

Physiologic Response to Electroconvulsive Therapy

Anesthetic Considerations for ECT

Summary

Acknowledgments

34. Anesthesia for the Older Patient

Demographics and Economics of Aging

The Process of Aging

Functional Reserve and the Concept of Frailty

The Physiology of Organ Aging

Changes in Body Composition, and Liver and Kidney Aging

Central Nervous System Aging

Drug Pharmacology and Aging

Cardiovascular Aging

Pulmonary Aging

Thermoregulation and Aging

Perioperative Management of the Aging Patient

Evaluation and Care of the Older Surgical Patient in Preparation for Surgery

Immediate Preoperative and Intraoperative Management

Postoperative Care

Perioperative Complications

The Future

35. Neuraxial Anesthesia

Introduction

Indications and Contraindications

Neuraxial Anesthesia and Outcome

Anatomy

Vertebrae

Ligaments

Epidural Space

Meninges

Dura

Arachnoid

Pia

Cerebrospinal Fluid

Spinal Cord

Ultrasound Anatomy of the Spine

Technique

Patient Preparation

Equipment

Positioning

Skin Preparation

Needles

Approach

Technique

Subarachnoid Spinal Anesthesia

Continuous Subarachnoid Spinal Anesthesia

Epidural Anesthesia

Combined Subarachnoid Spinal Epidural

Choice of Technique

Efficiency and Neuraxial Anesthesia

Pharmacology

Subarachnoid Anesthesia

Spread and Duration

Patient Variables

Local Anesthetic Dose

Adjuvants

Epidural Anesthesia

Spread of Block

Onset and Duration

Adjuvants

Test Doses

Physiology

Central Nervous System

Site of Action

Differential Nerve Block

Cardiovascular System

Subarachnoid

Epidural

Prevention and Treatment

Respiratory System

Gastrointestinal System

Temperature Homeostasis

Complications

Backache

Headache

Risk Factors

Diagnosis

Prevention

Treatment/Epidural Blood Patch

Hearing Loss

High Block/Total Subarachnoid Spinal Block

Systemic Toxicity

Neurologic Injury

Needle Trauma

Mass Lesions

Hypoperfusion

Spinal Stenosis

Chemical Injury

36. Peripheral Nerve Blockade

Introduction

General Principles and Equipment

Preblock Stage

Setup

Monitoring

Premedication and Sedation

Documentation

Block Performance Stage

Common Techniques: Nerve Stimulation

Common Techniques: Ultrasound Imaging

Other Related Equipment

Needles

Catheters

Postblock Stage

Block Assessment and Monitoring

Discharge Criteria

Avoiding Complications

Patient Selection

Local Anesthetic Drug Selection, Toxicity, and Doses

Nerve Damage and Other Complications

Clinical Anatomy

Head and Neck

Trigeminal Nerve (Video 36-1)

Cervical Plexus

Occipital Nerve

Spine

Spinal Nerves

Paravertebral Space

Orientation of the Vertebral Body Processes

Upper Extremity

Brachial Plexus

Trunk

Intercostal Nerves and Articulations

Lumbar Spinal Nerves and Plexus

Inguinal Nerves

Lumbosacral Plexus: Formation and Branches

Lower Extremity

Terminal Nerves of the Lumbar Plexus

Sciatic, Tibial, and Common Peroneal Nerves

Nerves at the Ankle

Specific Techniques

Head and Neck

Trigeminal Nerve Blocks

Cervical Plexus Blocks

Occipital Nerve Blocks

Upper Extremity

Brachial Plexus Block

Terminal Upper Extremity Nerve Blocks

Intravenous Regional Anesthesia (Bier Block)

Trunk: Interfascial Plane and Nerve Blocks

A New Era of Interfascial Plane Blocks

Erector Spinae Plane Block

Paravertebral Block

Intercostal Nerve Block

Serratus Anterior Plane Block

Interpectoral [Pectoralis (PECS) 1] and Pectoserratus [Pectoralis (PECS) 2] Plane Blocks

Rectus Sheath Block

Transversus Abdominis Plane Block

Quadratus Lumborum Block

Ilioinguinal and Iliohypogastric Nerve Blocks

Penile Block

Lower Extremity

Techniques

Lumbar Plexus Block (Psoas Compartment Block)

Separate Blocks of the Terminal Nerves of the Lumbar Plexus

Sciatic Nerve Block Using Gluteal, Subgluteal, Posterior Popliteal, and Anterior Approaches

Ankle Block

Continuous Catheter Technique

Acknowledgments

Section 7: Anesthesia Subspeciality Care

37. Anesthesia for Neurosurgery

Introduction

Neuroanatomy

Neurophysiology

Pathophysiology

Monitoring

Central Nervous System Function

Influence of Anesthetic Technique on Evoked Potentials

Cerebral Perfusion

Transcranial Doppler Ultrasonography

Laser Doppler Flowmetry

Intracranial Pressure Monitoring

Cerebral Oxygenation and Metabolism Monitors

Cerebral Protection

Ischemia and Reperfusion

Hypothermia

Pharmacologic Therapy for Cerebral Protection

Glucose and Cerebral Ischemia

A Practical Approach

Anesthetic Management

Preoperative Evaluation

Induction of Anesthesia and Airway Management

Maintenance of Anesthesia

Ventilation Management

Fluids and Electrolytes

Transfusion Therapy

Glucose Management

Emergence

Common Surgical Procedures

Surgery for Tumors

Pituitary Surgery

Cerebral Aneurysm Surgery and Endovascular Treatment

Arteriovenous Malformations

Carotid Surgery

Epilepsy Surgery

Awake Craniotomy

Anesthesia and Traumatic Brain Injury

Anesthetic Management

Anesthesia for Spine Trauma and Complex Spine Surgery

Spinal Cord Injury

Initial Management

Intraoperative Management

Complications of Anesthesia for Spine Surgery

Conclusion

38. Anesthesia for Thoracic Surgery

Introduction

Lung Cancer

Preoperative Evaluation

History

Dyspnea

Cough

Cigarette Smoking

Chronic Obstructive Pulmonary Disease

Exercise Tolerance

Risk Factors for Acute Lung Injury

Physical Examination

Respiratory Pattern

Evaluation of the Cardiovascular System

Electrocardiogram

Chest Radiography

Arterial Blood Gas Analysis

Pulmonary Function Testing and Evaluation for Lung Resectability

Effects of Anesthesia and Surgery on Lung Volumes

Spirometry

Flow–Volume Loops

Split-Lung Function Tests

Diffusing Capacity for Carbon Monoxide

Maximal Oxygen Consumption

Preoperative Preparation

Smoking

Nutrition

Infection

Hydration and Removal of Bronchial Secretions

Wheezing and Bronchodilation

Sympathomimetic Drugs

Phosphodiesterase Inhibitors

Steroids

Cromolyn Sodium

Parasympatholytic Drugs

Pulmonary Rehabilitation

Intraoperative Monitoring

Direct Arterial Catheterization

Central Venous Pressure Monitoring

Pulmonary Artery Catheterization

Transesophageal Echocardiography

Additional Noninvasive Monitoring

Monitoring of Oxygenation and Ventilation

Oxygenation

Ventilation

Physiology of One-Lung Ventilation

One-Lung Ventilation

Lung Isolation

Lung Separation

Methods of Lung Separation

Double-Lumen Endobronchial Tubes35

Selection of DLT Size: Formulas, CT Scans, and Ultrasound

Chest Imaging as a Guide for DLT Selection

Placement of Double-Lumen Tubes

Problems of Malposition of the Double-Lumen Tube

Lung Separation in the Patient with a Tracheostomy

Lung Separation in the Patient with a Difficult Airway

If a Single-Lumen Tube Can Be Successfully Placed

Use of a Tube Exchanger

Use of Modern Bronchial Blockers

Double-Lumen Tube or Bronchial Blocker?

Management of One-Lung Ventilation

Confirmation of Correct Position of the DLT or Bronchial Blocker

Inspired Oxygen Fraction

Continuous Positive Airway Pressure to the Nondependent Lung

Tidal Volume

Positive End-Expiratory Pressure

Continuous Positive Airway Pressure

Recruitment Maneuvers

Driving Pressure

Mechanical Power

Therapeutic Hypercarbia

Clinical Approach to the Management of One-Lung Ventilation

Conclusion of the Surgical Procedure

Choice of Anesthesia for Thoracic Surgery

Tubeless Thoracic Surgery

Robotic Thoracic Surgery

Anesthesia for Diagnostic Procedures

Bronchoscopy

Local Anesthesia

General Anesthesia

Rigid Bronchoscopy

Fiberoptic Bronchoscopy

Complications of Bronchoscopy

Diagnostic Procedures for Mediastinal Mass

Mediastinoscopy

Thoracoscopy

Video-Assisted (Minimally Invasive) Thoracoscopic Surgery

Anesthesia Considerations

Postoperative Concerns

Anesthesia for Special Situations

High-Frequency Ventilation

Bronchopleural Fistula and Empyema

Lung Cysts and Bullae

Anesthesia for Resection of the Trachea

Bronchopulmonary Lavage

Myasthenia Gravis

Medical Therapy

Management of General Anesthesia

Postoperative Respiratory Failure

Postoperative Care

Myasthenic Syndrome (Eaton–Lambert Syndrome)

Postoperative Management and Complications

Postoperative Pain Control

Complications Following Thoracic Surgery

Atelectasis

Cardiovascular Complications

Bleeding and Respiratory Complications

Neurologic Complications

39. Anesthesia for Cardiac Surgery

Introduction

Coronary Artery Disease

Myocardial Oxygen Demand

Myocardial Oxygen Supply

Coronary Blood Flow

Hemodynamic Goals

Selection of Anesthetic

Opioids

Inhalation Anesthetics

Intravenous Sedative Hypnotics

Treatment of Ischemia

Nitrates

Sodium Nitroprusside

Vasoconstrictors

β-Blockers

Valvular Heart Disease

Mitral Stenosis

Pathophysiology

Anesthetic Considerations

Mitral Regurgitation

Pathophysiology

Anesthetic Considerations

Tricuspid Stenosis

Tricuspid Regurgitation

Hypertrophic Cardiomyopathy

Pathophysiology

Anesthetic Considerations

Aortic Valve Stenosis

Pathophysiology

Anesthetic Considerations of Aortic Stenosis

Aortic Insufficiency

Pathophysiology

Anesthetic Considerations

Aortic Diseases

Aortic Dissection

Anesthetic Considerations

Aortic Aneurysm

Anesthetic Considerations

Heart Failure

Definition, Classification, and Staging of Heart Failure

Pathophysiology of Chronic Heart Failure

Cardiogenic Shock

Mechanical Circulatory Support (MCS) in Cardiogenic Shock: When and Why?

Long-Term or Durable Left Ventricular Assist Devices

Cardiopulmonary Bypass

Venous Cannulae and Cannulation Strategies

Venous Reservoir

Mechanical Pumps

Oxygenators

Heat Exchangers

Arterial Cannulae and Cannulation Strategies

Arterial Line Filter and Pressure Monitor

Ancillary Components

Pump Prime

Anticoagulation

Blood Conservation in Cardiac Surgery

Myocardial Protection

Preoperative and Intraoperative Management

Preoperative Considerations

Premedication and Anxiolysis

Monitoring

Electrocardiogram

Temperature

Arterial Blood Pressure

Central Venous Pressure and Pulmonary Artery Catheter

Echocardiography

Neurologic Monitoring

Selection of Anesthetic Drugs

Intraoperative Management

Preparation

Preinduction Period

Induction and Intubation

Preincision Period

Incision to Bypass

Cardiopulmonary Bypass

Monitoring and Management during Bypass

Rewarming, De-Airing, and Removal of Aortic Cross Clamp

Discontinuation of Cardiopulmonary Bypass

Postcardiopulmonary Bypass

Minimally Invasive Cardiac Surgery (MICS) for Myocardial Revascularization

Minimally Invasive and Robotic Valvular Surgery

Percutaneous Approaches to Valvular Disease

Postoperative Considerations

Indications for Re-Exploration

Children with Congenital Heart Disease

Introduction

Preoperative Evaluation

History

Physical Examination

Laboratory Evaluations

Cardiac Evaluations

Premedication

Monitoring

Intraoperative Management

Tracheal Extubation and Postoperative Ventilation

Postoperative Monitoring

Low Cardiac Output Syndrome (LCOS)

Pulmonary Hypertension Crisis

Adults with Congenital Heart Disease

40. Anesthesia for Vascular and Endovascular Surgery

Introduction

Vascular Disease

Pathophysiology of Atherosclerosis

Concurrent Vascular Disease in Vascular Surgery Patients

Medical Optimization Prior to Vascular Surgery

Preoperative Anesthesia Evaluation for Vascular Surgery

Open Vascular Surgery

Cerebrovascular Disease

Preoperative Evaluation and Preparation

Neurophysiologic Monitoring and Preserving Neurologic Integrity During Carotid Endarterectomy

Anesthetic Considerations for Carotid Endarterectomy

Postoperative Considerations

Aortic Reconstruction

Pathophysiology of Aortic Occlusion and Reperfusion

Renal Hemodynamics and Renal Protection

Spinal Cord Ischemia and Protection

Anesthetic Management of Open Aortic Reconstruction

Peripheral Artery Disease

Anesthetic Management of Lower Extremity Revascularization

Endovascular Surgery

Carotid Artery Stenting

Endovascular Aortic Repair

Evolution of Endovascular Repair for Complex Aneurysms

Anesthetic Management of Endovascular Aneurysm Repair

Complications of Endovascular Aneurysm Repair

Endovascular Management of Peripheral Artery Disease

Conclusion

41. Obstetric Anesthesia

Anatomic and Physiologic Changes of Pregnancy

Airway and Pulmonary Changes

Cardiovascular Changes

Hematology and Coagulation

Gastrointestinal System

Renal System

Hepatic System

Endocrine System

Placental Transfer and Fetal Exposure to Anesthetic Drugs

Placental Drug Transfer

Uteroplacental Blood Flow

Fetus and Newborn

Analgesia for Labor and Vaginal Delivery

Nonpharmacologic Methods of Labor Analgesia

Prepared Childbirth and Psychoprophylaxis

Other Nonpharmacologic Methods

Systemic Medication

Opioids

Ketamine

Neuraxial Analgesia

Epidural Analgesia

Combined Spinal–Epidural Analgesia

Dural-Puncture Epidural Analgesia

Spinal Analgesia

Impact of Neuraxial Analgesia on Labor

Alternative Regional Anesthetic Techniques

Inhalation Analgesia and General Anesthesia

Anesthesia for Cesarean Delivery

Preoperative Preparation, Monitoring, and Positioning

Neuraxial Anesthesia

Spinal Anesthesia

Epidural Anesthesia

Combined Spinal–Epidural Anesthesia

General Anesthesia

Postoperative Analgesia

Anesthetic Complications

Pulmonary Aspiration

Hypotension

Total Spinal Anesthesia

Local Anesthetic Systemic Toxicity

Postdural Puncture Headache

Neurologic Injury

Maternal Mortality

Management of High-Risk Parturients

Hypertensive Disorders of Pregnancy

Pathophysiology

Systemic Effects

General Management

Anesthetic Management

Obstetric Hemorrhage

Antepartum Hemorrhage

Postpartum Hemorrhage

Anesthetic Management

Heart Disease

Congenital Heart Disease

Valvular Heart Disease

Pulmonary Hypertension

Cardiomyopathy

Ischemic Heart Disease

Arrhythmias

Aortic Disease

Diabetes Mellitus

Obesity

Advanced Maternal Age

Anticoagulation

Maternal Cardiac Arrest

Preterm Delivery

Substance Use Disorder

Tobacco

Alcohol

Opioids

Marijuana

Cocaine

Amphetamines

Fetal Monitoring

Electronic Fetal Monitoring

Fetal Heart Rate Interpretation

Newborn Resuscitation in the Delivery Room

Fetal Asphyxia

Neonatal Adaptations at Birth

Resuscitation

Evaluation and Treatment

The Apgar Score

Exit Procedure

Anesthesia for Nonobstetric Surgery in the Pregnant Woman

Teratogenicity

Anesthetic Implications of Pregnancy Physiology

Anesthetic Management for Nonobstetric Surgery

Practical Suggestions

42. Neonatal Anesthesia

Physiology of the Infant and the Transition Period

The Cardiovascular System

Fetal Circulation

The Pulmonary System

Persistent Pulmonary Hypertension of the Newborn

Meconium Aspiration

The Renal System

Fluid and Electrolyte Therapy in the Neonate

Blood Component Therapy in the Neonate

The Hepatic System

Anatomy of the Neonatal Airway

Anesthetic Drugs in Neonates

Intravenous Agents

Opioids

Neuromuscular Blocking Agents

Nondepolarizing Agents

Intermediate Nondepolarizing Agents

Volatile Agents

Local Anesthetics

Topical Anesthesia

Anesthetic Management of the Neonate

Preoperative Considerations

Preanesthetic Evaluation—History

Preanesthetic Evaluation—Physical Examination

Preanesthetic Evaluation—Laboratory

Preanesthetic Plan

Premedication

Intraoperative Considerations

Monitoring

Anesthetic Systems

Impact of Surgical Requirements on Anesthetic Technique

Uptake and Distribution of Anesthetics in Neonates

Anesthetic Dose Requirements of Neonates

Regional Anesthesia

Spinal Anesthesia

Caudal Block

Epidural Analgesia

Peripheral Nerve Blocks

Postoperative Pain Management

Oral Routes

Rectal Routes

Intravenous Analgesia

Postoperative Ventilation

Special Considerations

Maternal Drug Use during Pregnancy

Temperature Control and Thermogenesis

Respiratory Distress Syndrome

Postoperative Apnea

Retinopathy of Prematurity

Neurodevelopmental Effects of Anesthetic Agents

Surgical Procedures in Neonates

Surgical Procedures in the First Week of Life

Congenital Diaphragmatic Hernia

Omphalocele and Gastroschisis

Tracheoesophageal Fistula

Intestinal Obstruction

Myelomeningocele

Hydrocephalus

Surgical Procedures in the First Month of Life

Necrotizing Enterocolitis

Inguinal Hernia Repair in the Neonate

Pyloric Stenosis

Ligation of a Patent Ductus Arteriosus

Placement of a Central Venous Catheter

Summary

Acknowledgment

43. Pediatric Anesthesia

Anatomy and Physiology

Airway

Cardiovascular

Central Nervous System

Physiology

Neuroapoptosis

Pharmacology

Developmental Pharmacology

Inhalational Anesthetics

Pharmacokinetics

Pharmacodynamics

Respiration

Cardiovascular

Central Nervous System

Renal

Hepatic

In Vitro Metabolism

Intravenous

Induction Agents

Neuromuscular Blocking Agents

Opioids and Analgesics

Sedatives

Resuscitation Medications

Preoperative Assessment and Preparation

Informed Consent, Assent, and Parental Permission

Fasting Guidelines

Laboratory Testing

Upper Respiratory Tract Infection (URI)

Asthma

Obstructive Sleep Apnea (OSA)

Prematurity

Malignant Hyperthermia (MH)

Myopathies

Mitochondrial Disease

Sickle Cell Disease

Other Hematologic Disorders

Anterior Mediastinal Mass

Subacute Bacterial Endocarditis Prophylaxis

Obesity

Diabetes Mellitus

Autism

Preoperative History

Allergies

Preoperative Physical Examination

Preoperative Preparation

Anxiolysis

Induction of Anesthesia

Equipment

Airway Management Supplies

Laryngeal Mask Airways

Endotracheal Tubes

Ventilation Strategies

Monitors

Capnography

Temperature

Depth of Anesthetic Monitoring

Other Monitors

Emergency Drugs

Airway Management—Special Considerations

Full Stomach and Rapid Sequence Induction

Difficult Airway

Lung Isolation

Anesthesia for Airway Surgery

Induction Techniques

Intravenous Induction

Establishing IV Access

Problems during Induction of Anesthesia

Hemoglobin Oxygen Desaturation

Laryngospasm

Bradycardia

Maintenance of Anesthesia

Techniques

Fluid Management

Blood Transfusion Therapy

Prophylaxis for Postoperative Vomiting

Regional Anesthesia

Medical Decision Making

Pharmacology and Dosing

Safety and Complications

Regional Techniques—Neuraxial

Spinal Block

Epidurals (Caudal, Lumbar, and Thoracic)

Regional Techniques—Peripheral

Emergence and Recovery from Anesthesia

Tracheal Extubation

LMA Removal

Delayed Emergence

Transport to PACU

PACU Complications

Respiratory Complications

Perioperative Respiratory Adverse Events (PRAEs)

Postoperative Apnea

Postoperative Stridor

Negative Pressure Pulmonary Edema

Emergence Delirium

Vomiting

Pain

Section 8: Anesthesia for Selected Surgical Services

44. Anesthesia for Laparoscopic and Robotic Surgeries

Introduction

Laparoscopic Surgery

Surgical Approach and Positioning

Ambulatory Laparoscopic Surgery

Robotic Laparoscopic Surgery

Physiologic Impact of Laparoscopy

Cardiovascular System

Respiratory System

Regional Perfusion Effects

Intraoperative Management

Monitoring

Anesthesia Maintenance

Inhaled Anesthetics and Propofol

Nitrous Oxide

Pharmacologic Adjuncts

Neuromuscular Blockade

Mechanical Ventilation

Body Temperature

Fluid Management

Complications Related to Surgery

Intraoperative

Intra-abdominal Injuries

Cardiopulmonary

CO2 Extravasation

Patient Shifting and Falls

Peripheral Nerve and Brachial Plexus Injuries

Ocular Injuries

Airway Edema

Postoperative Complications

Respiratory Dysfunction

Venous Thrombosis

Postoperative Management

Acute Pain Management

Postoperative Nausea and Vomiting

Conclusion

45. Anesthesia and Obesity

Definition and Epidemiology

Introduction

Management of Obesity

Medical Therapy

Bariatric Surgery

Pathophysiology

Respiratory System

Cardiovascular and Hematologic Systems

Gastrointestinal System

Renal and Endocrine Systems

Pharmacology

Pharmacologic Principles

Other Perioperative Agents

Preoperative Evaluation

Intraoperative Considerations

Equipment and Monitoring

Airway Management

Induction and Maintenance

Fluid Management

Mechanical Ventilation

Emergence

Monitored Anesthesia Care and Sedation

Regional Anesthesia and Analgesia

Neuraxial Anesthesia

Peripheral Nerve Block

Postoperative Considerations

Ventilatory Evaluation and Management

Postoperative Analgesia

Monitoring

Ambulatory Anesthesia

Critical Care and Resuscitation

Morbidity and Mortality

46. The Liver: Surgery and Anesthesia

Hepatic Function in Health

Assessment of Hepatic Function

Hepatobiliary Imaging

Liver Biopsy

Hepatic and Hepatobiliary Diseases

Acute Liver Failure

Acute Hepatitis

Alcoholic Hepatitis

Drug-Induced Liver Injury

Pregnancy-Related Liver Diseases

Chronic Hepatocellular Disease

Cirrhosis and Portal Hypertension

Hemostasis

Cardiac Manifestations

Renal Dysfunction

Pulmonary Complications

Hepatic Encephalopathy

Ascites

Varices

Hepatocellular Carcinoma

Nonalcoholic Fatty Liver Disease

Chronic Cholestatic Disease

Preoperative Management

Hepatic Evaluation

Perioperative Risk Associated with Liver Disease

Intraoperative Management

Monitoring and Vascular Access

Selection of Anesthetic Technique

Neuraxial versus General Anesthesia

Volatile Anesthetics

Nitrous Oxide

Intravenous Anesthetics

Pharmacokinetic and Pharmacodynamic Alterations

Vasopressors

Volume Resuscitation

Transjugular Intrahepatic Portosystemic Shunt Procedure

Hepatic Resection

Postoperative Liver Dysfunction

Conclusions

Acknowledgments

47. Endocrine Function

Thyroid Gland

Thyroid Metabolism and Function

Tests of Thyroid Function

Thyroid-Stimulating Hormone

Serum Thyroxine

Serum Triiodothyronine

Tests for Assessing Thyroid Hormone Binding

Radioactive Iodine Uptake

Hyperthyroidism

Treatment and Anesthetic Considerations

Anesthesia for Thyroid Surgery

Hypothyroidism

Treatment and Anesthetic Considerations

Parathyroid Glands

Calcium Physiology

Hyperparathyroidism

Treatment and Anesthetic Considerations

Anesthesia for Parathyroid Surgery

Hypoparathyroidism

Clinical Features and Treatment

Adrenal Cortex

Glucocorticoid Physiology

Mineralocorticoid Physiology

Glucocorticoid Excess (Cushing Syndrome)

Anesthetic Management

Mineralocorticoid Excess

Anesthetic Considerations

Adrenal Insufficiency (Addison Disease)

Clinical Presentation

Diagnosis

Treatment and Anesthetic Considerations

Steroid Replacement during the Perioperative Period

Exogenous Glucocorticoid Therapy

Mineralocorticoid Insufficiency

Adrenal Medulla

Pheochromocytoma

Clinical Presentation

Diagnosis

Anesthetic Considerations

Diabetes Mellitus

Classification

Physiology

Diagnosis

Treatment

Anesthetic Management

Preoperative

Intraoperative

Hyperglycemia and Perioperative Outcomes

Perioperative Glycemic Control

Glycemic Goals

Management of Perioperative Hyperglycemia

Type 1 Diabetes

Type 2 Diabetes

Emergencies

Hyperglycemic Hyperosmolar State

Diabetic Ketoacidosis

Hypoglycemia

Pituitary Gland

Anterior Pituitary

Posterior Pituitary

Vasopressin (ADH)

Diabetes Insipidus

Inappropriate Secretion of Antidiuretic Hormone

Endocrine Response to Surgical Stress

48. Anesthesia for Otolaryngologic Surgery

Evaluating the Airway

Anesthesia for Pediatric Ear, Nose, and Throat Surgery

Tonsillectomy and Adenoidectomy

Preoperative Evaluation

Sleep-Disordered Breathing and Obstructive Sleep Apnea

Anesthetic Management

Complications

Laryngology

Ear Surgery

Myringotomy and Tube Insertion

Middle Ear and Mastoid

Airway Surgery

Stridor

Bronchoscopy

Pediatric Airway Emergencies

Epiglottitis

Laryngotracheobronchitis

Foreign-Body Aspiration

Pediatric and Adult Surgery

Laser Surgery of the Airway

Nasal Surgery

Skull Base Surgery

Upper Airway Infections

Maxillofacial Trauma

Acknowledgments

49. Anesthesia for Ophthalmologic Surgery

Anatomy of the Eye

Physiology of Intraocular Pressure

Formation and Drainage of Aqueous Humor

Intraocular Pressure Regulation

Intraocular Pressure Dysregulation: Glaucoma

Factors Influencing Intraocular Pressure

Ventilation and Temperature

Airway Management

Anesthetic Agents

Other Medications

Hypertonic Solutions

Acetazolamide

Neuromuscular Blocking Drugs

Oculocardiac Reflex

Anesthetic Implications of Ophthalmologic Medications

Parasympathomimetic Agents

Cocaine

Cyclopentolate

Phenylephrine

Beta-adrenergic Antagonists

Alpha-adrenergic Agonists

Intraocular Perfluorocarbons

Systemic Ophthalmic Drugs

Anesthesia Management

Preoperative Evaluation

Anesthesia Options

Side of Anesthesia and Surgery

Anesthesia Techniques

Retrobulbar (Intraconal) and Peribulbar (Extraconal) Blocks

Cannula-based Techniques

Topical Analgesia

Choice of Local Anesthetics, Block Adjuvants, and Adjuncts

General Principles of Monitored Anesthesia Care

Anesthetic Management in Specific Situations

“Open-Eye, Full-Stomach” Encounters

Intraocular Surgery

Retinal Detachment Surgery

Strabismus Surgery

Principles of Laser Therapy

Postoperative Ocular Complications

Surface Injuries

Corneal Abrasion

Chemical Injury

Photic Injury

Postoperative Vision Loss

Postsurgical Acute Glaucoma

Hemorrhagic Retinopathy

Retinal Ischemia

Postoperative Ischemic Optic Neuropathy

Cortical Blindness

Other Complications

Postcataract Ptosis

Acknowledgments

50. The Renal System and Anesthesia for Urologic Surgery

Kidney Anatomy and Physiology

Gross Anatomy

Ultrastructure

Correlation of Structure and Function

Glomerular Filtration

Autoregulation of Kidney Blood Flow and Glomerular Filtration Rate

Tubular Reabsorption of Sodium and Water

Clinical Assessment of the Kidney

Kidney Function Tests

Perioperative Nephrology

Pathophysiology

Electrolyte Disorders

Disorders of Sodium Balance

Disorders of Potassium Balance

Disorders of Calcium, Magnesium, and Phosphorus

Acid–Base Disorders

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Acidosis

Respiratory Alkalosis

Mixed Acid–Base Disorders

Acute Kidney Conditions

Acute Kidney Injury

Nephrotoxins and Perioperative Acute Kidney Injury

Chronic Kidney Disease

Drug Prescribing in Renal Failure

Anesthetic Agents in Renal Failure

Induction Agents and Sedatives

Opioids

Muscle Relaxants

Diuretic Drugs: Effects and Mechanisms

High Renal-Risk Surgical Procedures

Cardiac Surgery

Noncardiac Surgery

Anesthetic Considerations for Urologic Procedures

Nephrectomy

Preoperative Considerations

Intraoperative Considerations

Postoperative Considerations

Specific Procedures

Simple and Donor Nephrectomies

Radical Nephrectomy

Radical Nephrectomy with Inferior Vena Cava Tumor Thrombus

“Nephron-Sparing” Partial Nephrectomy

Laparoscopic and Robotic Nephrectomies

Physiology of Pneumoperitoneum

Cystectomy and Other Major Bladder Surgeries

Preoperative Considerations

Intraoperative Considerations

Postoperative Considerations

Specific Procedures

Partial Cystectomy

Simple and Radical Cystectomy

Ileal Conduit and Other Diversion Procedures

Prostatectomy

Preoperative Considerations

Intraoperative Considerations

Postoperative Considerations

Specific Procedures

Simple Prostatectomy

Radical Prostatectomy

Laparoscopic and Robotic Prostatectomy

Transurethral Surveillance and Resection Procedures

Preoperative Considerations

Intraoperative Considerations

Postoperative Considerations

Specific Procedures

Cystoscopy and Ureteroscopy

Transurethral Bladder Tumor Resection

Transurethral Prostate Resection (TURP)

Irrigating Solutions and Transurethral Resection Syndrome

Therapies for Urolithiasis

Preoperative Considerations

Intraoperative Considerations

Postoperative Considerations

Specific Procedures

Shock Wave Lithotripsy

Percutaneous Nephrolithotomy

Ureteroscopy for Removal of Stones

Open and Laparoscopic Pyelolithotomy or Nephrectomy

Urogynecology, Pregnancy-Related and other Miscellaneous Urologic Procedures

Impotence Surgery and Medication

Pediatric Surgical Urologic Disorders

Nephrectomy and Adrenalectomy

Reconstructive Urologic Procedures

Urologic Surgical Emergencies

Testicular Torsion

Fournier Gangrene

Emergency Treatment of Nephrolithiasis

51. Anesthesia for Orthopedic Surgery

Introduction

Preoperative Assessment

Selection of Anesthetic Technique

Anesthesia for Spine Surgery

Preoperative Assessment

Positioning for Spine Surgery

Blood Conservation

Spinal Cord Monitoring

Spinal Cord Injury

Scoliosis

Muscular Disorders

Degenerative Vertebral Column Disease

Postoperative Care of the Spine Patient

Complications of Spine Surgery

Upper Extremity Surgery

Surgery to the Shoulder and Upper Arm

Surgical Approach and Positioning

Anesthetic Management

Surgery to the Elbow, Wrist, and Hand

Postoperative Regional Analgesia

Lower Extremity Surgery

Surgery to the Hip and Pelvis

Surgical Approach and Positioning

Anesthesia Technique

Blood Loss and Transfusion

Ambulatory Hip Surgery

Surgery to the Knee

Total Knee Arthroplasty

Positioning and Blood Loss

Analgesia for Total Knee Arthroplasty

Ambulatory Knee Surgery

Surgery to the Foot and Ankle

Pediatric Orthopedic Anesthesia

Special Considerations in Orthopedics

Amputation

Microvascular Surgery

Acute Compartment Syndrome

Tourniquets

Fat Embolus Syndrome/Bone Cement Implantation Syndrome

Venous Thromboembolism and Thromboprophylaxis

52. Transplant Anesthesia

Anesthetic Management of Organ Donors

Brain-Dead Donors (Donation after Neurologic Determination of Death)

Donation after Cardiac Death (Donation after Circulatory Determination of Death)

Living Kidney Donors

Living Liver Donors

Corneal Transplantation

Renal Transplantation

Preoperative Considerations

Intraoperative Procedures

Liver Transplantation

Preoperative Considerations

Intraoperative Procedures

Coagulation

Pediatric Liver Transplantation

Acute Liver Failure

Pancreas and Islet Transplantation

Small Bowel and Multivisceral Transplantation

Composite Tissue Allografts

Lung Transplantation

Recipient Selection

Intraoperative Management

Single-Lung Transplantation

Double-Lung Transplantation

Pediatric Lung Transplantation

Primary Graft Dysfunction

Inhaled Nitric Oxide

Heart–Lung Transplant (Adult and Pediatric)

Heart Transplantation

Short-, Intermediate-, and Long-Term Mechanical Circulatory Support Systems

Recipient Selection

Preanesthetic Considerations

Intraoperative Management

Pediatric Heart Transplantation

Cardiac Transplantation from Donation after Circulatory Determination of Death

Management of the Transplant Patient for Nontransplant Surgery

Acknowledgment

53. Anesthesia for Trauma and Burns

What Is Trauma Anesthesia?

Airway

Video Laryngoscopy

Supraglottic Airways

Cricothyroidotomy

Pulmonary

Cardiovascular

Hypotensive Resuscitation

Neurologic

Resuscitation

Transfusion

Whole Blood Resuscitation

Adjuncts

Steroids

Crystalloid Therapy

Bicarbonate

Renal

Measures of Resuscitation

Viscoelastic Testing

Point-of-Care Ultrasound

Future

Immunotherapy

Special Populations

Pediatrics

Burns

Section 9: Postanesthetic Management, Critical Care, and Pain Management

54. Postanesthesia Recovery

Postanesthesia Recovery

Standards for Postanesthesia Care

Value and Economics of Postanesthesia Care Unit

Levels of Postoperative/Postanesthesia Care

Postanesthetic Triage

Safety in the Postanesthesia Care Unit

Admission to the Postanesthesia Care Unit

Postoperative Pain Management

Discharge Criteria

Postoperative Evaluation

Cardiovascular Complications

Postoperative Pulmonary Dysfunction

Inadequate Postoperative Ventilation

Inadequate Respiratory Drive

Increased Airway Resistance

Decreased Compliance

Neuromuscular and Skeletal Problems

Increased Dead Space

Increased Carbon Dioxide Production

Inadequate Postoperative Oxygenation

Distribution of Ventilation

Distribution of Perfusion

Inadequate Alveolar PAO2

Reduced Mixed Venous PO2

Obstructive Sleep Apnea

Anemia

Supplemental Oxygen

Perioperative Aspiration

Postoperative Renal Complications

Ability to Void

Renal Tubular Function

Oliguria

Polyuria

Metabolic Complications

Postoperative Acid–Base Disorders

Respiratory Acidemia

Metabolic Acidemia

Respiratory Alkalemia

Metabolic Alkalemia

Glucose Disorders and Control

Hyperglycemia

Hypoglycemia

Electrolyte Disorders

Hyponatremia

Hypokalemia

Hyperkalemia

Calcium and Magnesium

Miscellaneous Complications

Incidental Trauma

Ocular Injuries and Visual Changes

Hearing Impairment

Oral, Pharyngeal, and Laryngeal Injuries

Nerve Injuries

Soft-Tissue and Joint Injuries

Skeletal Muscle Pain

Hypothermia and Shivering

Hyperthermia

Persistent Sedation

Altered Mental Status

Emergence Reactions

Delirium and Cognitive Decline

Postoperative Nausea and Vomiting

55. Acute Pain Management

Acute Pain Defined

Anatomy of Acute Pain

Pain Processing

Chemical Mediators of Transduction and Transmission

The Surgical Stress Response

Preventive Analgesia

Strategies for Acute Pain Management

Assessment of Acute Pain

Opioid Analgesics

Biased Opioid Ligands

Nonopioid Analgesic Adjuncts

Methods of Analgesia

Patient-Controlled Analgesia

Neuraxial Analgesia

The Opioid-Dependent Patient

Definitions

The Transitional Pain Service

Management of the Opioid-Dependent Patient

Special Populations

Organization of Perioperative Pain Management Services

Conclusion

56. Chronic Pain Management

Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing

Primary Afferents and Peripheral Stimulation

Neurochemistry of Peripheral Nerve and the Dorsal Root Ganglion

Neurobiology of the Spinal Cord and Spinal Trigeminal Nucleus

Neurobiology of Ascending Pathways

Dorsal Column Tracts

Spinothalamic Tract

Spinohypothalamic, Limbic, and Cortical Connections

Neurobiology of Descending Pathways

Neurobiology of Supraspinal Structures Involved in Higher Cortical Processing

Transition from Acute to Persistent or Chronic Nociception

Management of Common Pain Syndromes

Spine Pain: Radicular Pain Syndromes

Low Back Pain: Facet Syndrome

Buttock Pain: Sacroiliac Joint Syndrome and Piriformis Syndrome

Piriformis Syndrome

Myofascial Pain Syndrome and Fibromyalgia

Fibromyalgia

Neuropathic Pain Syndromes

Herpes Zoster and Postherpetic Neuralgia

Diabetic Painful Neuropathy

Human Immunodeficiency Virus Neuropathy

Phantom Pain

Complex Regional Pain Syndrome

Cancer Pain

Neurolytic Blocks for Visceral Pain from Cancer

Celiac Plexus Block

Superior Hypogastric Plexus Block

Ganglion Impar Block

Pharmacologic Management of Pain

Opioids

Pharmacologic Treatment of Neuropathic Pain

Antiepileptics

Antidepressants

Lidocaine Patch, Capsaicin Patch, Mexiletine, and Cannabinoids

Cannabinoids

Buprenorphine–Naloxone Therapy

Interventional Techniques

Use of Contrast for Interventional Pain Procedures

Thermal Annular Procedures

Minimally Invasive Lumbar Decompression Procedure

Vertebroplasty and Kyphoplasty

Spinal Cord Stimulation

Peripheral Nerve Stimulation

Dorsal Root Ganglion Stimulation

Intrathecal Drug Delivery

Summary

57. Critical Care Medicine

Introduction

Anesthesiologists and Critical Care Medicine

Anesthesiology and Critical Care Medicine: The Future

Critical Care Medicine: A Systems and Processes Approach

Processes of Care in the ICU

Staffing

Checklists

Protocols and Care Bundles

Resource Management

Neurologic and Neurosurgical Critical Care

Neuromonitoring

Diagnosis and Clinical Management of the Most Common Types of Neurologic Failure

Traumatic Brain Injury

Subarachnoid Hemorrhage

Acute Ischemic Stroke

Anoxic Brain Injury

Cardiovascular and Hemodynamic Aspects of Critical Care

Types of Shock

Cardiogenic Shock

Septic Shock

Monitoring and Resuscitation in Shock States

Hemodynamic Monitoring

Echocardiography

Dynamic Respiratory Indices

Less-Invasive Cardiac Output Monitors

Metabolic Monitoring

Acute Respiratory Failure

Principles of Mechanical Ventilation

Acute Respiratory Distress Syndrome

Acute Kidney Injury

Endocrine Aspects of Critical Care Medicine

Glucose Management in Critical Illness

Adrenal Function in Critical Illness

Thyroid Function in Critical Illness

Somatotropic Function in Critical Illness

Anemia and Transfusion Therapy in Critical Illness

Nutrition in the Critically Ill Patient

Sedation and Analgesia for the Critically Ill Patient

Goals and Assessment

Pharmacologic Management

Delirium and Neurocognitive Complications

Complications in the ICU: Detection, Prevention, and Therapy

Nosocomial Infections

Sinusitis

Ventilator-Associated Pneumonia

Catheter-Related Bloodstream Infections

Urinary Tract Infection

Invasive Fungal Infections

Stress Ulceration and Gastrointestinal Hemorrhage

Venous Thromboembolism

ICU-Acquired Weakness

End-of-Life Care in the ICU

58. Cardiopulmonary Resuscitation

History

Scope of the Problem

Components of Resuscitation

Airway Management

Foreign-Body Airway Obstruction

Ventilation

Physiology of Ventilation during Cardiopulmonary Resuscitation

Techniques of Rescue Breathing

Circulation

Physiology of Circulation during Closed-Chest Compression

Cardiac Pump Mechanism

Thoracic Pump Mechanism

Distribution of Blood Flow during Cardiopulmonary Resuscitation

Gas Transport during Cardiopulmonary Resuscitation

Technique of Closed-Chest Compression

Alternative Methods of Circulatory Support

Mechanical Chest Compression Devices

Impedance Threshold Device

Invasive Techniques

Assessing the Adequacy of Circulation during Cardiopulmonary Resuscitation

Pharmacologic Therapy

Routes of Administration

Catecholamines and Vasopressors

Mechanism of Action

Epinephrine

Vasopressin

Amiodarone and Lidocaine

Drugs Not Routinely Given during CPR

Atropine

Sodium Bicarbonate

Calcium

Electrical Therapy

Electrical Pattern and Duration of Ventricular Fibrillation

Defibrillators: Energy, Current, and Voltage

Transthoracic Impedance

Adverse Effects and Energy Requirements

Putting It All Together

Time-Sensitive Model of Ventricular Fibrillation

Bystander CPR and Basic Life Support

Advanced Life Support

Rhythm Analysis and Defibrillation

Pediatric Cardiopulmonary Resuscitation

Postresuscitation Care

Prognosis

Resuscitation in the Operating Room

Unique Features and Special Circumstances

Crisis Resource Management, Teamwork, and Communication

Ethical Issues: Do-Not-Resuscitate Orders in the Operating Room

59. Disaster Preparedness

Introduction

Preparation

Family Plan

Government Plan

Healthcare Agency Plans

Role of Anesthesiologist in Managing Mass Casualties

Triage

Decontamination

Emergency Department

Operating Room Management

Chemical

Nerve Agents

Diagnosis

Treatment

Pulmonary Agents

Blood Agents

Biologic

History

Smallpox

Anthrax

Plague

Tularemia

Botulism

Hemorrhagic Fevers

Radiation—Nuclear

Potential Sources of Ionizing Radiation Exposure

Management

Explosives

Leadership

Conclusion

Section 10: Appendices

1. Formulas

Lung Volumes and Capacities

Lung Volumes and Capacities

2. Atlas of Electrocardiography

Coronary Artery Disease

Acknowledgments

3. Pacemaker and Implantable Cardiac Defibrillator Protocols

Pacemakers

Implantable Cardiac Defibrillators

Potential Intraoperative Problems with CIEDs

General Principles of Perioperative Management of Patients with CIEDs

Recommendations for Postoperative Follow-Up of Patients with CIEDs (Tables A3-7 to A3-9)

Acknowledgment

4. American Society of Anesthesiologists Standards, Guidelines, and Statements

Standards for Basic Anesthetic Monitoring

Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia12

Basic Standards for Preanesthesia Care

Standards for Postanesthesia Care

Practice Advisory for the Prevention and Management of Operating Room Fires (Fig. A4-1)

APSF Fire Safety Algorithm (Fig. A4-2)

Position on Monitored Anesthesia Care

Distinguishing Monitored Anesthesia Care (MAC) from Moderate Sedation/Analgesia (Conscious Sedation)

Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders or Other Directives that Limit Treatment

Practice Guidelines for Preoperative Fasting and Use of Pharmacologic Agents to Reduce Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures

5. The American Society of Anesthesiologists Difficult Airway Algorithms

ASA Difficult Airway Algorithm: Adult Patients (Figure A5-1)

ASA Difficult Airway Algorithm: Pediatric Patients (Figure A5-2)

6. Herbal Medications

7. Atlas of Ultrasound and Echocardiography (eBook/online only)

Index

 

An aparitie	26 oct 2023
Autor	Bruce F. Cullen MD, M. Christine Stock MD, Rafael Ortega MD, Sam R. Sharar MD, Natalie F. Holt, Christopher W. Connor M.D., Ph.D., Naveen Nathan
Dimensiuni	213 x 276 mm
Editura	LWW
Format	Hardcover
ISBN	9781975199074
Limba	Engleza
Nr pag	1728
Versiune digitala	DA