BOOK
Anesthesia E-Book
Ronald D. Miller | Lars I. Eriksson | Lee A Fleisher | Jeanine P. Wiener-Kronish | William L. Young
(2009)
Additional Information
Book Details
Abstract
From fundamental principles to advanced subspecialty procedures, Miller’s Anesthesia covers the full scope of contemporary anesthesia practice. It is the go-to reference for masterful guidance on the technical, scientific, and clinical challenges you face. Now new chapters, new authors, meticulous updates, an increased international presence, and a new full-color design ensure that the 7th edition continues the tradition of excellence that you depend on.
- Covers the full scope of contemporary anesthesia practice.
- Offers step-by-step instructions for patient management and an in-depth analysis of ancillary responsibilities and problems.
- Incorporates ‘Key Points’ boxes in every chapter that highlight important concepts.
- Extends the breadth of international coverage with contributions from prominent anesthesiologists from all over the world, including China, India, and Sweden.
- Features 30 new authors and 13 new chapters such as Sleep, Memory and Consciousness; Perioperative Cognitive Dysfunction; Ultrasound Guidance for Regional Anesthesia; Anesthesia for Correction of Cardiac Arrhythmias; Anesthesia for Bariatric Surgery; Prehospital Emergency and Trauma Care; Critical Care Protocols; Neurocritical Care; and Renal Replacement Therapy.
- Dedicates an entire section to pediatric anesthesia, to help you address the unique needs of pediatric patients.
- Presents a new full-color design -- complete with more than 1,500 full-color illustrations -- for enhanced visual guidance.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| e9780443069598v1.pdf | 1 | ||
| Front cover | 1 | ||
| Half title page | 2 | ||
| Title page | 4 | ||
| Copyright page | 5 | ||
| Contributors | 6 | ||
| Preface to the Seventh Edition | 16 | ||
| Table of contents | 18 | ||
| Part I: Introduction | 24 | ||
| Chapter 1: History of Anesthetic Practice | 26 | ||
| Key Points | 26 | ||
| Cardiopulmonary Physiology | 27 | ||
| Autonomic Nervous System and Neurohumoral Transmission | 30 | ||
| Historical Development of Theories of Pain | 31 | ||
| Surgical Procedures Before 1846 | 31 | ||
| Introduction of General Anesthesia | 33 | ||
| Development of Inhaled Anesthetics | 36 | ||
| Needles and Syringes | 38 | ||
| Intravenous Fluid Therapy | 39 | ||
| Introduction of Regional Anesthesia | 40 | ||
| Neuraxial Block and Acute Pain Service | 44 | ||
| Intravenous Anesthetics | 46 | ||
| Muscle Relaxants | 47 | ||
| Anesthesia Apparatus | 50 | ||
| Stress-Free Anesthesia | 52 | ||
| Airway Management and Resuscitation | 53 | ||
| Anesthetic Accidents and Complications—Preventive Measures | 57 | ||
| References | 59 | ||
| Chapter 2: Scope of Modern Anesthetic Practice | 66 | ||
| Key Points | 66 | ||
| Forces That Will Change Anesthetic Practice | 66 | ||
| Process Assessment and Quality Metrics | 68 | ||
| Changes in Personnel | 68 | ||
| Research | 68 | ||
| References | 70 | ||
| Chapter 3: The International Scope and Practice of Anesthesia | 72 | ||
| Outline | 72 | ||
| The Early History of International Anesthesia | 73 | ||
| The Cross-Pollination Period: Approximately 1920-1980 | 76 | ||
| The Modern Period: The Essentials of Modern Anesthesia Around the World | 79 | ||
| Conclusion | 90 | ||
| References | 91 | ||
| Chapter 4: Medical Informatics | 92 | ||
| Key Points | 92 | ||
| Computer Hardware | 92 | ||
| Computer Software | 95 | ||
| Computers and Computing in Medicine | 98 | ||
| References | 102 | ||
| Chapter 5: Quality Improvement | 104 | ||
| Key Points | 104 | ||
| What Is Quality? | 105 | ||
| Historical Methods of Quality Assessment | 105 | ||
| Measures of Quality Improvement | 106 | ||
| Examples of Quality Improvement Programs and Tools | 107 | ||
| Sources of Quality Improvement Information | 111 | ||
| The Future: Research, Education, and Ethics | 113 | ||
| Summary | 114 | ||
| References | 114 | ||
| Chapter 6: Human Performance and Patient Safety | 116 | ||
| Key Points | 116 | ||
| Impact of Human Performance on Patient Safety | 116 | ||
| Nature of the Operational Domain of Anesthesiology | 117 | ||
| Safety Culture of the Operating Room and Intensive Care Environment (See Chapters 99-101) | 118 | ||
| Characteristics of Successful Incident Reporting Systems | 125 | ||
| Human Factors | 127 | ||
| How Can CRM Skills Be Learned and Trained | 132 | ||
| The Study of Human Performance | 144 | ||
| Cognitive Process Model of the Anesthetist | 145 | ||
| The Anesthetist’s Tasks | 151 | ||
| Other Studies of “Vigilance” and Decision-Making by Anesthetists | 162 | ||
| References | 166 | ||
| Chapter 7: Patient Simulation | 174 | ||
| Key Points | 174 | ||
| Simulation in Aviation | 175 | ||
| Uses of Simulators | 175 | ||
| Twelve Dimensions of Simulation | 175 | ||
| Conceptual Issues about Patient Simulation | 179 | ||
| Site of Simulation | 181 | ||
| Team Training, Single Discipline, and Crews | 185 | ||
| Debriefing for Simulation Training | 185 | ||
| Scenario Design | 187 | ||
| Instructor Qualification | 188 | ||
| Classification of Patient Simulators | 190 | ||
| Development of Patient Simulators | 194 | ||
| Screen-Based Simulators (Microsimulators) | 194 | ||
| Experience with Patient Simulators in Anesthesia | 194 | ||
| Use of Patient Simulation for Training Health Care Personnel outside Anesthesia | 199 | ||
| Use of Patient Simulation for Research | 200 | ||
| Use of Patient Simulation in Support of Biomedical Industries | 201 | ||
| Other Uses of Simulators | 201 | ||
| Effectiveness of Simulation Training | 201 | ||
| Ecologic Validity of Simulators Compared with the Operating Room | 203 | ||
| Evaluation of Clinical Performance during Simulation Scenarios | 204 | ||
| Pitfalls of Performance Assessment | 204 | ||
| Can Simulators Be Used for the Evaluation and Testing of Residents or Practitioners? | 205 | ||
| Characteristics of Simulation Centers | 206 | ||
| Costs | 208 | ||
| Proliferation of Simulation Centers | 209 | ||
| Simulation Societies: Society for Simulation in Healthcare and Society in Europe for Simulation Applied to Medicine | 210 | ||
| Future of Patient Simulation in Anesthesia | 211 | ||
| References | 211 | ||
| Chapter 8: Teaching Anesthesia | 216 | ||
| Key Points | 216 | ||
| Teaching and Education | 217 | ||
| Teach to Whom?—The Students | 218 | ||
| Why Teach?—The Reasons | 219 | ||
| Who Teaches?—The Teachers | 223 | ||
| The Curriculum—What to Teach? | 225 | ||
| The Methods—How to Teach | 226 | ||
| Summary | 227 | ||
| Acknowledgment | 227 | ||
| Suggested Readings | 228 | ||
| References | 228 | ||
| Chapter 9: Ethical Aspects of Anesthesia Care | 232 | ||
| Key Points | 232 | ||
| History of Ethics in Medicine and Ethical Theory | 232 | ||
| Clinical Ethics | 233 | ||
| Research Ethics | 240 | ||
| Physician Participation in Executions | 241 | ||
| Moral Integrity—Can the Physician Be a Conscientious Objector in Medicine? | 241 | ||
| Summary | 242 | ||
| Suggested Reading | 242 | ||
| References | 242 | ||
| Chapter 10: Legal Aspects of Anesthesia Care | 244 | ||
| Key Points | 244 | ||
| Professional Liability | 245 | ||
| Legal Aspects of Informed Consent | 248 | ||
| Legal Aspects of End-of-Life Care | 251 | ||
| Other Legal Aspects of Anesthesiology | 253 | ||
| References | 255 | ||
| Part II: Anesthetic\rPhysiology | 258 | ||
| Chapter 11: Sleep, Memory, and Consciousness | 260 | ||
| Key Points | 260 | ||
| Neuronal Systems That Regulate Arousal States | 260 | ||
| Memory | 269 | ||
| Consciousness | 275 | ||
| Conclusion | 278 | ||
| References | 278 | ||
| Chapter 12: The Autonomic Nervous System | 284 | ||
| Key Points | 284 | ||
| History and Definitions | 284 | ||
| Functional Anatomy | 286 | ||
| Function | 289 | ||
| Pharmacology | 293 | ||
| Drugs and the Autonomic Nervous System | 304 | ||
| Autonomic Dysfunction | 318 | ||
| New Concepts in Autonomic Activity | 321 | ||
| References | 321 | ||
| Chapter 13: Cerebral Physiology and the Effects of Anesthetic Drugs | 328 | ||
| Key Points | 328 | ||
| Regulation of Cerebral Blood Flow | 329 | ||
| Effects of Anesthetics on Cerebral Blood Flow and Cerebral Metabolic Rate | 335 | ||
| Other Effects of Anesthetics on Cerebral Physiology | 345 | ||
| Cerebral Physiology in Pathologic States | 347 | ||
| References | 355 | ||
| Chapter 14: Neuromuscular Physiology and Pharmacology | 364 | ||
| Key Points | 364 | ||
| Neuromuscular Transmission | 365 | ||
| The Neuromuscular Junction | 368 | ||
| Drug Effects on Postjunctional Receptors | 373 | ||
| Biology of Prejunctional and Postjunctional Nicotinic Acetylcholine Receptors | 376 | ||
| Antagonism of Neuromuscular Blockade | 380 | ||
| References | 382 | ||
| Chapter 15: Respiratory Physiology | 384 | ||
| Key Points | 384 | ||
| Respiratory Function in Waking Subjects | 384 | ||
| Respiratory Function During Anesthesia | 400 | ||
| References | 412 | ||
| Chapter 16: Cardiac Physiology | 416 | ||
| Key Points | 416 | ||
| Physiology of the Intact Heart | 416 | ||
| Cellular Cardiac Physiology | 422 | ||
| Control of Cardiac Function | 427 | ||
| References | 432 | ||
| Chapter 17: Hepatic Physiology and Pathophysiology | 434 | ||
| Key Points | 434 | ||
| Overview | 435 | ||
| Hepatic Anatomy | 435 | ||
| Splanchnic Circulation and Hepatic Blood Flow | 440 | ||
| Biochemical and Physiologic Functions of the Liver | 443 | ||
| Evaluation of the Liver | 447 | ||
| Hepatic Pathophysiology | 451 | ||
| References | 458 | ||
| Chapter 18: Renal Physiology | 464 | ||
| Key Points | 464 | ||
| Anatomy and Physiology | 466 | ||
| Evaluation of Renal Function | 473 | ||
| Neurohormonal Regulation of Renal Function | 481 | ||
| Perioperative Ischemic and Nephrotoxic Injury | 488 | ||
| References | 496 | ||
| Part III: Anesthetic\rPharmacology | 500 | ||
| Chapter 19: Basic Principles of Pharmacology | 502 | ||
| Key Points | 502 | ||
| Pharmacokinetics | 503 | ||
| Pharmacodynamics | 518 | ||
| Variability in Drug Response | 530 | ||
| Summary | 535 | ||
| Suggested Reading | 535 | ||
| References | 536 | ||
| Chapter 20: Inhaled Anesthetics: Mechanisms of Action | 538 | ||
| Key Points | 538 | ||
| History | 539 | ||
| Integrated Effects on Central Nervous System Function | 541 | ||
| Identification of Molecular Sites of Anesthetic Action | 545 | ||
| Molecular Targets of Inhaled Anesthetics | 547 | ||
| Cellular Mechanisms | 550 | ||
| Simple Circuits and Complex Networks | 551 | ||
| Research Strategies for the Future | 555 | ||
| Summary | 557 | ||
| References | 557 | ||
| Chapter 21: Inhaled Anesthetics: Uptake and Distribution | 562 | ||
| Key Points | 562 | ||
| The Inspired-to-Alveolar Anesthetic Relationship | 562 | ||
| Factors Modifying the Rate of Rise in Fa/Fi | 567 | ||
| The Effect of Nitrous Oxide on Closed Gas Spaces | 572 | ||
| Anesthetic Circuitry | 572 | ||
| Low-Flow or Closed-Circuit Delivery of Anesthesia | 574 | ||
| Recovery from Anesthesia | 577 | ||
| References | 581 | ||
| Chapter 22: Pulmonary Pharmacology | 584 | ||
| Key Points | 584 | ||
| Bronchomotor Tone | 585 | ||
| Mucociliary Function and Surfactant | 590 | ||
| Pulmonary Vascular Resistance | 593 | ||
| Control of Ventilation | 598 | ||
| Acute Lung Injury | 610 | ||
| Summary | 612 | ||
| References | 612 | ||
| Chapter 23: Cardiovascular Pharmacology | 618 | ||
| Key Points | 618 | ||
| Volatile Anesthetics and Cardiovascular Function | 618 | ||
| Volatile Anesthetics and Cardiac Electrophysiology | 625 | ||
| Volatile Anesthetics and the Coronary Circulation | 626 | ||
| Volatile Anesthetics and Neural Control of the Circulation | 647 | ||
| Nitrous Oxide and Cardiovascular Function | 647 | ||
| Nitrous Oxide and Cardiac Electrophysiology | 648 | ||
| Nitrous Oxide and the Coronary Circulation | 648 | ||
| Nitrous Oxide and Neural Control of the Circulation | 649 | ||
| Xenon | 649 | ||
| Summary | 649 | ||
| References | 650 | ||
| Chapter 24: Inhaled Anesthetics: Metabolism and Toxicity | 656 | ||
| Key Points | 656 | ||
| Drug Metabolism and Biotransformation | 657 | ||
| Metabolism of Inhaled Anesthetics | 662 | ||
| Toxicity of Inhaled Anesthetics | 667 | ||
| Summary | 684 | ||
| Acknowledgment | 684 | ||
| References | 685 | ||
| Chapter 25: Inhaled Anesthetic Delivery Systems | 690 | ||
| Key Points | 690 | ||
| Anesthesia Workstation Standards and Pre-use Procedures | 691 | ||
| Anesthesia Workstation Pneumatics | 697 | ||
| Vaporizers | 706 | ||
| Anesthetic Breathing Circuits | 715 | ||
| Carbon Dioxide Absorbents | 718 | ||
| Anesthesia Ventilators | 720 | ||
| Anesthesia Workstation Variations | 725 | ||
| Scavenging Systems | 727 | ||
| Summary | 731 | ||
| References | 731 | ||
| Anesthesia Apparatus Checkout Recommendations, 1993 | 734 | ||
| Emergency Ventilation Equipment | 734 | ||
| High-Pressure System | 734 | ||
| Low-Pressure System | 734 | ||
| Scavenging System | 734 | ||
| Breathing System | 734 | ||
| Manual and Automatic Ventilation Systems | 735 | ||
| Monitors | 735 | ||
| Final Position | 735 | ||
| 2007 Guidelines for Preanesthesia Checkout Procedures | 735 | ||
| Background | 735 | ||
| General Considerations | 735 | ||
| Personnel Performing the Preanesthesia Checkout | 736 | ||
| Objectives for a New Preanesthesia Checkout | 736 | ||
| Guidelines for Developing Institution-Specific Checkout Procedures before Anesthesia Delivery | 736 | ||
| References | 740 | ||
| Supplement: Additional Notes on Preanesthesia Checkout | 740 | ||
| Chapter 26: Intravenous Anesthetics | 742 | ||
| Key Points | 742 | ||
| Propofol | 743 | ||
| Barbiturates | 751 | ||
| Benzodiazepines | 757 | ||
| Flumazenil | 764 | ||
| Phencyclidines (Ketamine) | 765 | ||
| Etomidate | 770 | ||
| α-Adrenergic Agonists: Dexmedetomidine | 774 | ||
| Droperidol | 780 | ||
| Summary | 781 | ||
| References | 781 | ||
| Chapter 27: Opioids | 792 | ||
| Key Points | 792 | ||
| Pharmacology of Opioids | 792 | ||
| Neurophysiologic Effects of Opioids | 800 | ||
| Respiratory Effects of Opioids | 805 | ||
| Cardiovascular Effects of Opioids | 807 | ||
| Endocrinologic Effects of Opioids | 810 | ||
| Opiate Tolerance and Addiction | 810 | ||
| Renal and Urodynamic Effects of Opioids | 811 | ||
| Gastrointestinal Effects of Opioids | 812 | ||
| Other Opioid Effects | 812 | ||
| Pharmacokinetics and Pharmacodynamics of Opioids | 814 | ||
| Anesthetic Techniques Using Opioids | 821 | ||
| Other Opioid Agonists | 830 | ||
| Agonist-Antagonist Opioid Compounds | 831 | ||
| Opioid Antagonists | 833 | ||
| Drug Interactions with Opioids | 835 | ||
| References | 838 | ||
| Chapter 28: Intravenous Drug Delivery Systems | 848 | ||
| Key Points | 848 | ||
| Pharmacokinetic Considerations | 849 | ||
| Pharmacodynamic Considerations | 853 | ||
| Designing Dosing Regimens | 859 | ||
| Infusion Devices | 867 | ||
| Summary | 877 | ||
| References | 879 | ||
| Chapter 29: Pharmacology of Muscle Relaxants and Their Antagonists | 882 | ||
| Key Points | 882 | ||
| History and Clinical Use | 882 | ||
| Principles of Action of Neuromuscular Blockers at the Neuromuscular Junction | 883 | ||
| Monitoring Neuromuscular Function | 884 | ||
| Pharmacology of Succinylcholine | 885 | ||
| Nondepolarizing Neuromuscular Blockers | 890 | ||
| Drug Interactions and Other Factors Affecting Response to Neuromuscular Blockers | 907 | ||
| Recovery From Neuromuscular Blockade | 910 | ||
| Special Populations | 918 | ||
| References | 926 | ||
| Chapter 30: Local Anesthetics | 936 | ||
| Key Points | 936 | ||
| Basic Pharmacology | 937 | ||
| Anatomy of the Peripheral Nerve | 939 | ||
| Mechanism of Action of Local Anesthetics (Pharmacodynamics) | 943 | ||
| Clinical Pharmacology | 946 | ||
| Choice of Local Anesthetic for Various Regional Anesthetic Procedures | 949 | ||
| Pharmacokinetics | 954 | ||
| Toxicity | 955 | ||
| References | 960 | ||
| Chapter 31: Nitric Oxide and Inhaled Pulmonary Vasodilators | 964 | ||
| Key Points | 964 | ||
| Inhaled Nitric Oxide | 965 | ||
| Other Inhaled Pulmonary Vasodilators | 974 | ||
| Conclusion | 975 | ||
| References | 975 | ||
| Chapter 32: Complementary and Alternative Therapies | 980 | ||
| Key Points | 980 | ||
| Herbal Medicines | 980 | ||
| Nonherbal Dietary Supplements | 986 | ||
| Acupuncture | 986 | ||
| Music Therapy | 987 | ||
| Conclusion | 987 | ||
| References | 987 | ||
| Part IV: Anesthesia\rManagement | 990 | ||
| Chapter 33: Risk of Anesthesia | 992 | ||
| Key Points | 992 | ||
| Framework of Perioperative Risk | 993 | ||
| Issues Related to Study Design | 994 | ||
| Risks Related to the Patient | 1007 | ||
| Special Patient Groups | 1009 | ||
| Risks Directly Related to the Anesthetic Drug | 1014 | ||
| Risks Related to Surgery | 1015 | ||
| Risks Related to the Location of Surgery and Postoperative Monitoring | 1015 | ||
| Risks Related to the Anesthesia Provider | 1016 | ||
| Improving Anesthesia Safety | 1018 | ||
| Future Directions in Perioperative Risk | 1018 | ||
| Summary | 1018 | ||
| References | 1019 | ||
| Chapter 34: Preoperative Evaluation | 1024 | ||
| Key Points | 1024 | ||
| The Evolution in Preoperative Evaluation | 1025 | ||
| Preoperative Risk Assessment | 1025 | ||
| Detecting Disease in Preoperative Evaluation | 1026 | ||
| Preoperative Evaluation of Patients with Coexisting Disease | 1031 | ||
| Special Issues in Preoperative Evaluation | 1061 | ||
| Residency Training in Preoperative Evaluation | 1067 | ||
| Meeting Regulatory and Reporting Requirements | 1067 | ||
| Preoperative Medical-Legal Issues | 1068 | ||
| Information Technology and Decision Support Systems in Preoperative Evaluation | 1069 | ||
| Preoperative Involvement in Prevention of Surgical Site Infections | 1070 | ||
| Preoperative Planning for Postoperative Pain Management | 1071 | ||
| Preoperative Use of Alternative and Complementary Therapies | 1071 | ||
| Preoperative Laboratory and Diagnostic Studies | 1073 | ||
| The Preoperative Evaluation Clinic | 1075 | ||
| Patient Education and Patient Satisfaction | 1083 | ||
| Preoperative Fasting Status | 1085 | ||
| Role of the Medical Consultant in Preoperative Evaluation | 1085 | ||
| Role of the Preoperative Clinic in Guiding Intraoperative Management Choices | 1086 | ||
| Summary | 1086 | ||
| References | 1086 | ||
| Chapter 35: Anesthetic Implications of Concurrent Diseases | 1090 | ||
| Key Points | 1090 | ||
| Role of the Primary Care Physician or Consultant | 1091 | ||
| Diseases Involving the Endocrine System and Disorders of Nutrition | 1092 | ||
| Diseases Involving the Cardiovascular System | 1117 | ||
| Disorders of the Respiratory and Immune Systems | 1126 | ||
| Diseases of the Central Nervous System, Neuromuscular Diseases, and Psychiatric Disorders | 1134 | ||
| Renal Disease, Infectious Diseases, and Electrolyte Disorders | 1140 | ||
| Gastrointestinal and Liver Diseases | 1147 | ||
| Hematologic Disorders and Oncologic Disease | 1149 | ||
| Patients Given Drug Therapy for Chronic and Acute Medical Conditions | 1156 | ||
| Interrupting a Drug Regimen before Surgery | 1163 | ||
| References | 1164 | ||
| Chapter 36: Patient Positioning and Anesthesia | 1174 | ||
| Key Points | 1174 | ||
| Cardiovascular Concerns | 1174 | ||
| Pulmonary Concerns | 1175 | ||
| Specific Positions | 1175 | ||
| Peripheral Nerve Injury | 1187 | ||
| Perioperative Eye Injury and Visual Loss | 1190 | ||
| Evaluation and Treatment of Perioperative Neuropathies | 1191 | ||
| Anesthesia outside the Operating Room | 1192 | ||
| Summary | 1192 | ||
| References | 1192 | ||
| Chapter 37: Neuromuscular Disorders and Malignant Hyperthermia | 1194 | ||
| Key Points | 1194 | ||
| Multiple Sclerosis | 1195 | ||
| Motor Neuron Disorders | 1195 | ||
| Guillain-Barré Syndrome | 1196 | ||
| Hereditary Motor-Sensory Neuropathies, including Charcot-Marie-Tooth Disease | 1196 | ||
| Duchenne’s Muscular Dystrophy and Becker’s Muscular Dystrophy | 1196 | ||
| Limb-Girdle Muscular Dystrophy | 1199 | ||
| Myotonic Dystrophy | 1199 | ||
| Myotonia Congenita | 1200 | ||
| Myotubular Myopathy | 1200 | ||
| Metabolic Myopathies | 1201 | ||
| Mitochondrial Myopathies | 1202 | ||
| Myasthenia Gravis | 1203 | ||
| Eaton-Lambert Myasthenic Syndrome | 1203 | ||
| Periodic Paralysis (Hyperkalemic and Hypokalemic) | 1204 | ||
| Malignant Hyperthermia | 1204 | ||
| References | 1213 | ||
| Chapter 38: Fundamental Principles of Monitoring Instrumentation | 1220 | ||
| Key Points | 1220 | ||
| Why Fundamental Principles Are Important | 1220 | ||
| Basic Principles | 1220 | ||
| Pressure Measurement | 1226 | ||
| Measurements Using Sound Energy (Longitudinal Pressure Wave) | 1229 | ||
| Measurements Using Electric Energy (Transverse Wave) (see also Chapter 100) | 1232 | ||
| Measurement Using Light Energy | 1236 | ||
| Measurement of Temperature | 1239 | ||
| Measurement of Flow | 1240 | ||
| Conclusion | 1244 | ||
| References | 1244 | ||
| Chapter 39: Monitoring the Depth of Anesthesia | 1252 | ||
| Key Points | 1252 | ||
| Definitions of Anesthetic Depth | 1253 | ||
| Awareness and Memory | 1260 | ||
| Hypnotics, Analgesics, and Anesthetic Depth | 1265 | ||
| Electrophysiologic Monitoring (see also Chapter 46) | 1272 | ||
| Conclusions | 1283 | ||
| References | 1283 | ||
| Chapter 40: Cardiovascular Monitoring | 1290 | ||
| Key Points | 1290 | ||
| Introduction to Cardiovascular Monitoring: Focused Physical Examination | 1291 | ||
| Arterial Blood Pressure Monitoring | 1293 | ||
| Central Venous Pressure Monitoring | 1308 | ||
| Pulmonary Artery Catheter Monitoring | 1320 | ||
| Cardiac Output Monitoring | 1337 | ||
| Mixed Venous Oximetry Pulmonary Artery Catheter | 1339 | ||
| Right Ventricular Ejection Fraction Pulmonary Artery Catheters | 1340 | ||
| Pulmonary Artery Catheter–Derived Hemodynamic Variables | 1340 | ||
| Other Methods for Monitoring Cardiac Output and Perfusion | 1341 | ||
| References | 1344 | ||
| Chapter 41: Transesophageal Echocardiography | 1352 | ||
| Key Points | 1352 | ||
| History | 1352 | ||
| Practice Guidelines for Transesophageal Echocardiography | 1353 | ||
| Properties of Ultrasound | 1354 | ||
| Equipment Design and Operation | 1361 | ||
| Basic Transesophageal Examination | 1362 | ||
| Comprehensive Transesophageal Examination | 1364 | ||
| Basic Transthoracic Examination | 1366 | ||
| Assessment of Hemodynamics | 1368 | ||
| Detection of Myocardial Ischemia | 1372 | ||
| Transesophageal Echocardiography in Cardiac Surgery | 1372 | ||
| Transesophageal Echocardiography in Noncardiac Surgery and Critical Care | 1377 | ||
| Data Storage, Documentation, and Quality Assurance | 1377 | ||
| Certification | 1377 | ||
| References | 1378 | ||
| Chapter 42: Electrocardiography | 1380 | ||
| Key Points | 1380 | ||
| Electrocardiographic Lead Systems | 1380 | ||
| Normal Electrical Activity | 1381 | ||
| The Abnormal Electrocardiogram | 1382 | ||
| Electrocardiographic Monitoring Systems | 1386 | ||
| Interpretation and Management of Arrhythmias | 1388 | ||
| Electrocardiographic Criteria for Acute Myocardial Ischemia | 1398 | ||
| Real-Time Myocardial Ischemia Monitoring | 1400 | ||
| References | 1408 | ||
| Chapter 43: Implantable Cardiac Pulse Generators: Pacemakers and Cardioverter-Defibrillators | 1410 | ||
| Key Points | 1410 | ||
| Pacemakers | 1411 | ||
| Implantable Cardioverter-Defibrillators | 1425 | ||
| Summary | 1428 | ||
| Glossary | 1428 | ||
| References | 1430 | ||
| Chapter 44: Respiratory Monitoring | 1434 | ||
| Key Points | 1434 | ||
| Gas Exchange | 1434 | ||
| Blood Gas Analysis | 1438 | ||
| Oxygen Saturation | 1442 | ||
| Mixed Venous Monitoring | 1446 | ||
| Tissue Oxygenation | 1446 | ||
| Expired Gas Analysis | 1447 | ||
| Waveform Analysis of Expired Respiratory Gases | 1448 | ||
| Pulmonary and Chest Wall Monitoring | 1452 | ||
| Apnea Monitoring | 1457 | ||
| Lung Water Analysis | 1458 | ||
| Monitoring High-Frequency Ventilation | 1458 | ||
| Monitoring the Respiratory System in Transport | 1460 | ||
| References | 1461 | ||
| Chapter 45: Renal Function Monitoring | 1466 | ||
| Key Points | 1466 | ||
| Renal Physiology | 1468 | ||
| The Pathophysiology of Ischemic Acute Kidney Injury | 1471 | ||
| Anesthesia, Surgery, and Normal Renal Function | 1472 | ||
| Perioperative Hemodynamic Instability and Renal Function | 1475 | ||
| Other Perioperative Perturbations and Renal Function | 1475 | ||
| Monitors of Renal Function | 1476 | ||
| Indirect Markers of Optimal Renal Perfusion and Function | 1477 | ||
| Autoregulation and Distribution of Cardiac Output to the Kidneys | 1479 | ||
| Laboratory Tests of Serum and Urine as Markers of Renal Function | 1480 | ||
| Preoperative Evaluation of Renal Function | 1491 | ||
| Summary | 1492 | ||
| References | 1492 | ||
| Chapter 46: Neurologic Monitoring | 1500 | ||
| Key Points | 1500 | ||
| Monitoring Modalities | 1501 | ||
| Clinical Applications of Neurologic Monitoring | 1514 | ||
| Nonsurgical Factors Influencing Monitoring Results | 1522 | ||
| Summary | 1532 | ||
| References | 1532 | ||
| Chapter 47: Neuromuscular Monitoring | 1538 | ||
| Key Points | 1538 | ||
| Types of Peripheral Nerve Stimulation | 1538 | ||
| Principles of Peripheral Nerve Stimulation | 1539 | ||
| Patterns of Nerve Stimulation | 1539 | ||
| The Nerve Stimulator | 1543 | ||
| The Stimulating Electrodes | 1543 | ||
| Sites of Nerve Stimulation and Different Muscle Responses | 1543 | ||
| Recording of Evoked Responses | 1544 | ||
| Evaluation of Recorded Evoked Responses | 1548 | ||
| Use of Nerve Stimulators Without Recording Equipment | 1550 | ||
| When to Use a Peripheral Nerve Stimulator | 1551 | ||
| References | 1552 | ||
| Chapter 48: Temperature Regulation and Monitoring | 1556 | ||
| Key Points | 1556 | ||
| Normal Thermoregulation | 1556 | ||
| Thermoregulation During General Anesthesia | 1558 | ||
| Development of Hypothermia During General Anesthesia | 1560 | ||
| Neuraxial Anesthesia | 1562 | ||
| Consequences of Mild Intraoperative Hypothermia | 1565 | ||
| Perioperative Thermal Manipulations | 1568 | ||
| Deliberate Severe Intraoperative Hypothermia | 1570 | ||
| Hyperthermia and Fever | 1571 | ||
| Temperature Monitoring | 1573 | ||
| Summary | 1575 | ||
| References | 1575 | ||
| e9780443069598v2 | 1580 | ||
| Front cover | 1580 | ||
| Half title page | 1581 | ||
| Title page | 1583 | ||
| Copyright page | 1584 | ||
| Contributors | 1585 | ||
| Preface to the Seventh Edition | 1595 | ||
| Table of contents | 1597 | ||
| Chapter 49: Perioperative Acid-Base Balance | 1603 | ||
| Key Points | 1603 | ||
| Physical Chemistry of Water | 1603 | ||
| Acid-Base Abnormalities | 1606 | ||
| Regulation of Acid-Base Balance | 1608 | ||
| Conclusion | 1617 | ||
| References | 1617 | ||
| Chapter 50: Airway Management in the Adult | 1619 | ||
| Key Points | 1619 | ||
| Anatomy | 1620 | ||
| Airway Assessment | 1621 | ||
| Physiology and Pathophysiology of the Upper Airway | 1623 | ||
| Pharmacology of Airway Management | 1624 | ||
| Facemask Airway | 1625 | ||
| Supraglottic Airway Devices | 1627 | ||
| Tracheal Tubes | 1631 | ||
| Tracheal Intubation | 1631 | ||
| Percutaneous Airway | 1649 | ||
| Complications of Airway Management | 1650 | ||
| Follow-up After Difficulty with Airway Management | 1650 | ||
| Cleaning and Disinfection of Airway Equipment | 1651 | ||
| Challenging Airway Management Scenarios | 1651 | ||
| Summary | 1653 | ||
| Caveats | 1654 | ||
| Statement of Interest | 1654 | ||
| Acknowledgments | 1654 | ||
| References | 1654 | ||
| Chapter 51: Spinal, Epidural, and Caudal Anesthesia* | 1657 | ||
| Key Points | 1657 | ||
| Indications and Contraindications | 1658 | ||
| Anatomy | 1659 | ||
| Physiologic Effects | 1662 | ||
| Spinal Anesthesia | 1664 | ||
| Epidural and Caudal Anesthesia | 1674 | ||
| Clinical Controversies and Neuraxial Blocks | 1680 | ||
| References | 1681 | ||
| Chapter 52: Nerve Blocks | 1685 | ||
| Key Points | 1685 | ||
| Techniques for Localizing Neural Structures | 1685 | ||
| Upper Extremity Blocks | 1686 | ||
| Lower Extremity Blocks | 1695 | ||
| Blocks of the Head and Neck | 1707 | ||
| Blocks of the Thorax and Abdomen | 1713 | ||
| Continuous Catheter Techniques | 1716 | ||
| Choice of Local Anesthetic | 1717 | ||
| Neurologic Complications | 1717 | ||
| Summary | 1718 | ||
| References | 1718 | ||
| Chapter 53: Ultrasound Guidance for Regional Anesthesia | 1721 | ||
| Key Points | 1721 | ||
| Principles of Ultrasound Imaging | 1721 | ||
| Limits of Ultrasound Resolution | 1722 | ||
| Spatial Compound Imaging | 1722 | ||
| The Doppler Shift | 1722 | ||
| Ultrasound Transducers and Manipulation | 1724 | ||
| Nerve Imaging with Ultrasound | 1725 | ||
| Block Needles for Ultrasound-Guided Procedures | 1726 | ||
| Ultrasound Artifacts in Regional Anesthesia | 1730 | ||
| Anatomic Variation | 1730 | ||
| Supraclavicular and Interscalene Blocks | 1731 | ||
| Infraclavicular Block | 1733 | ||
| Axillary Block | 1735 | ||
| Ilioinguinal Block | 1737 | ||
| Femoral Block | 1738 | ||
| Sciatic Block | 1744 | ||
| Phantom Training and Safety | 1744 | ||
| References | 1749 | ||
| Chapter 54: Intravascular Fluid and Electrolyte Physiology | 1751 | ||
| Key Points | 1751 | ||
| Water Physiology | 1751 | ||
| Sodium Physiology | 1752 | ||
| Potassium Physiology | 1755 | ||
| Calcium Physiology | 1757 | ||
| Magnesium Physiology | 1758 | ||
| Phosphate Physiology | 1760 | ||
| Chloride Physiology | 1762 | ||
| Glucose Physiology and Fluid Implications | 1762 | ||
| Diabetes Mellitus | 1762 | ||
| Acid-Base Factors | 1767 | ||
| Clinical Acid-Base Balance Disturbances | 1767 | ||
| Fluid Balance and Fluid Replacement Solutions | 1769 | ||
| Surgical Fluid Balance and Shock | 1769 | ||
| Colloid Solutions and Blood Substitutes | 1772 | ||
| Fluid Management of Specific Clinical Conditions | 1774 | ||
| Deficits | 1775 | ||
| Losses | 1775 | ||
| Acknowledgments | 1781 | ||
| References | 1781 | ||
| Chapter 55: Transfusion Therapy | 1785 | ||
| Key Points | 1785 | ||
| Blood Therapy | 1785 | ||
| Indications for Transfusion | 1785 | ||
| Compatibility Testing | 1788 | ||
| Approaches Requiring Less Than a Complete Crossmatch | 1789 | ||
| Emergency Transfusion | 1790 | ||
| Storage of Blood | 1791 | ||
| Complications | 1791 | ||
| Transfusion Reactions | 1798 | ||
| Infectivity of Blood | 1801 | ||
| Leukoreduction of Red Blood Cell Transfusions | 1804 | ||
| Blood Component Therapy | 1804 | ||
| Packed Red Blood Cells | 1804 | ||
| Platelet Concentrates | 1804 | ||
| Fresh Frozen Plasma | 1806 | ||
| Cryoprecipitate | 1807 | ||
| Prothrombin Complex | 1807 | ||
| Single-Donor Plasma | 1807 | ||
| Other Options to Reduce Infectivity | 1808 | ||
| Albumin and Plasma Protein Preparations | 1808 | ||
| Synthetic Colloid Solution Therapy | 1808 | ||
| Synthetic Hydroxyethyl Starch | 1808 | ||
| Dextrans | 1809 | ||
| Hypertonic Saline, Possibly with Dextran | 1809 | ||
| Synthetic Oxygen-Carrying Substances | 1809 | ||
| Informed Consent | 1810 | ||
| References | 1810 | ||
| Chapter 56: Coagulation | 1813 | ||
| Key Points | 1813 | ||
| Normal Hemostasis | 1813 | ||
| Disorders of Hemostasis | 1816 | ||
| Prothrombotic States | 1819 | ||
| Monitoring Coagulation | 1821 | ||
| References | 1824 | ||
| Chapter 57: Autologous Transfusion, Recombinant Factor VIIa, and Bloodless Medicine | 1827 | ||
| Key Points | 1827 | ||
| Preoperative Blood Donation | 1828 | ||
| Intraoperative Blood Collection | 1832 | ||
| Postoperative Blood Collection | 1833 | ||
| Fibrin Glue | 1834 | ||
| Recombinant Factor VIIA | 1834 | ||
| Bloodless Medicine | 1836 | ||
| Summary | 1837 | ||
| References | 1838 | ||
| Part V: Adult\rSubspecialty\rManagement | 1841 | ||
| Chapter 58: Anesthesia and Treatment of Chronic Pain | 1843 | ||
| Key Points | 1843 | ||
| Physiologic Changes in Patients with Persistent Pain | 1843 | ||
| Clinical Definitions, Prevalence, and Classification of Chronic Pain | 1845 | ||
| Interdisciplinary Management of Chronic Pain | 1846 | ||
| Drugs Used for Chronic Pain | 1848 | ||
| Interventional Methods Used for Chronic Pain | 1854 | ||
| Perioperative Management of Patients with Chronic Pain | 1856 | ||
| Acknowledgment | 1859 | ||
| References | 1860 | ||
| Chapter 59: Anesthesia for Thoracic Surgery | 1865 | ||
| Key Points | 1865 | ||
| Preoperative Evaluation of the Thoracic Surgery Patient | 1866 | ||
| Intraoperative Monitoring | 1877 | ||
| Lung-Isolation Techniques | 1879 | ||
| Positioning | 1887 | ||
| Anesthetic Management | 1890 | ||
| Management of One-Lung Ventilation | 1892 | ||
| Anesthetic Management for Common Surgical Procedures | 1899 | ||
| Anesthetic Management for Specific Surgical Procedures | 1907 | ||
| Postoperative Management | 1923 | ||
| References | 1928 | ||
| Chapter 60: Anesthesia for Cardiac Surgical Procedures | 1935 | ||
| Key Points | 1935 | ||
| Cardiovascular Disease in the 21st Century | 1935 | ||
| Approach to Anesthesia for Adult Cardiac Patients | 1937 | ||
| Cardiopulmonary Bypass | 1957 | ||
| Specific Cardiovascular Disease States | 1969 | ||
| Procedures in the Cardiac Catheterization Laboratory and the Hybrid Operating Room | 1999 | ||
| Problems in the Postoperative Period | 2001 | ||
| Acknowledgments | 2010 | ||
| References | 2010 | ||
| Chapter 61: Anesthesia for Correction of Cardiac Arrhythmias | 2023 | ||
| Key Points | 2023 | ||
| Historical Perspectives | 2023 | ||
| Scope of Cardiac Arrhythmias | 2024 | ||
| Normal Cardiac Rhythm | 2024 | ||
| Cardiac Arrhythmias | 2024 | ||
| Indications for Correction of Cardiac Arrhythmias | 2025 | ||
| Permanent Pacing | 2025 | ||
| Resynchronization Therapy | 2026 | ||
| Implantable Cardioverter-Defibrillator | 2027 | ||
| Correction of Cardiac Arrhythmias with Ablation Therapy | 2028 | ||
| Future Trends | 2029 | ||
| References | 2029 | ||
| Chapter 62: Anesthesia for Vascular Surgery | 2031 | ||
| Key Points | 2031 | ||
| Atherosclerosis | 2032 | ||
| Preoperative Evaluation | 2033 | ||
| Perioperative Myocardial Ischemia | 2039 | ||
| Perioperative β-Blocker Therapy | 2040 | ||
| Hemodynamic Monitoring | 2040 | ||
| Abdominal Aortic Reconstruction | 2041 | ||
| Thoracoabdominal Aortic Surgery | 2052 | ||
| Endovascular Aortic Repair | 2061 | ||
| Lower Extremity Revascularization | 2065 | ||
| Carotid Endarterectomy | 2072 | ||
| Postoperative Management of Vascular Surgery Patients | 2079 | ||
| References | 2080 | ||
| Chapter 63: Neurosurgical Anesthesia | 2091 | ||
| Key Points | 2091 | ||
| Recurrent Issues in Neuroanesthesia | 2091 | ||
| Specific Procedures | 2108 | ||
| Acknowledgment | 2125 | ||
| References | 2127 | ||
| Chapter 64: Anesthesia for Bariatric Surgery | 2135 | ||
| Key Points | 2135 | ||
| Obesity As a Disease | 2135 | ||
| Nonsurgical Management of Obesity | 2139 | ||
| Surgical Management of Obesity | 2140 | ||
| Anesthetic Management of Bariatric Surgical Patients | 2142 | ||
| Considerations for Management of Obese Patients Undergoing Nonbariatric Surgery | 2148 | ||
| References | 2148 | ||
| Chapter 65: Anesthesia and the Renal and Genitourinary Systems | 2151 | ||
| Key Points | 2151 | ||
| Innervation of the Genitourinary System | 2152 | ||
| Anesthesia for Patients with Renal Disease | 2154 | ||
| Renal and Genitourinary Procedures | 2165 | ||
| Urogenital Pain Syndromes | 2174 | ||
| Acknowledgment | 2177 | ||
| References | 2177 | ||
| Chapter 66: Anesthesia and the Hepatobiliary System | 2181 | ||
| Key Points | 2181 | ||
| Effect of Anesthetics on Hepatic Function | 2181 | ||
| Effect of Hepatic Dysfunction and Hepatobiliary Disease on Anesthetic Drug Pharmacokinetics | 2184 | ||
| Risk Factors for Postoperative Hepatobiliary Complications | 2186 | ||
| Postoperative Jaundice | 2191 | ||
| Perioperative Management of Patients with Asymptomatic or Chronic Liver Dysfunction | 2193 | ||
| Anesthetic Considerations for Procedures Involving the Liver and Biliary System | 2194 | ||
| Acknowledgment | 2195 | ||
| References | 2196 | ||
| Chapter 67: Anesthesia for Abdominal\rOrgan Transplantation | 2201 | ||
| Anesthesia for Abdominal Organ Transplantation | 2201 | ||
| Care of Organ Donors after Neurologic Determination of Death | 2202 | ||
| Care of Living Organ Donors | 2204 | ||
| Contraindications to Solid Organ Transplantation | 2207 | ||
| Kidney Transplantation | 2207 | ||
| Pancreas and Kidney-Pancreas Transplantation | 2212 | ||
| Liver Transplantation | 2215 | ||
| Intestine Transplantation | 2223 | ||
| Infection after Abdominal Solid Organ Transplantation | 2223 | ||
| Immunosuppression | 2223 | ||
| References | 2225 | ||
| Chapter 68: Anesthesia for Laparoscopic Surgery | 2231 | ||
| Key Points | 2231 | ||
| Ventilatory and Respiratory Changes During Laparoscopy | 2232 | ||
| Hemodynamic Problems During Laparoscopy | 2235 | ||
| Problems Related to Patient Position | 2238 | ||
| Postoperative Benefits and Consequences of Laparoscopy | 2238 | ||
| Alternatives to CO2 Pneumoperitoneum | 2239 | ||
| Laparoscopy During Pregnancy and in Children | 2239 | ||
| Complications of Laparoscopy | 2240 | ||
| Anesthesia for Laparoscopy | 2240 | ||
| Summary | 2242 | ||
| References | 2243 | ||
| Chapter 69: Anesthesia for Obstetrics | 2249 | ||
| Key Points | 2249 | ||
| Physiologic Changes of Pregnancy | 2250 | ||
| The Fetus | 2253 | ||
| Uterine Blood Flow | 2253 | ||
| Placental Transfer of Anesthetic Drugs | 2255 | ||
| Evaluation of the Fetus | 2255 | ||
| Role of Intrauterine Resuscitation | 2256 | ||
| Normal Progress of Labor | 2256 | ||
| Anesthesia for Spontaneous Vaginal Delivery | 2257 | ||
| Analgesia for Labor and Vaginal Delivery | 2257 | ||
| Anesthesia for Cesarean Section | 2265 | ||
| Complications of Regional Anesthesia | 2268 | ||
| Complicated Obstetric Conditions | 2272 | ||
| Anesthesia for Nonobstetric Surgery During Pregnancy | 2279 | ||
| Analgesia for External Cephalic Version | 2281 | ||
| Fetal Surgery | 2281 | ||
| References | 2282 | ||
| Chapter 70: Anesthesia for Orthopedic Surgery | 2287 | ||
| Key Points | 2287 | ||
| Preoperative Evaluation | 2287 | ||
| Regional Versus General Anesthesia | 2294 | ||
| Perioperative Management of Orthopedic Patients | 2294 | ||
| References | 2303 | ||
| Chapter 71: Geriatric Anesthesia | 2307 | ||
| Key Points | 2307 | ||
| Core Concepts in the Anesthetic Management of Elderly Patients | 2307 | ||
| Preventable Hazards and Special Perioperative Considerations for Elderly Patients | 2310 | ||
| Functional Status and Assessment of Functional Reserve | 2311 | ||
| Expected Outcomes | 2315 | ||
| Disposition and Posthospital Care | 2315 | ||
| Risk Assessment | 2315 | ||
| Preoperative Evaluation | 2315 | ||
| Anesthetic Management | 2316 | ||
| Future Directions | 2319 | ||
| References | 2319 | ||
| Chapter 72: Anesthesia for Trauma | 2323 | ||
| Key Points | 2323 | ||
| Prioritizing Trauma Care | 2325 | ||
| Anesthesia in War and Austere Conditions | 2327 | ||
| Emergency Airway Management | 2328 | ||
| Resuscitation from Hemorrhagic Shock | 2332 | ||
| Trauma to the Central Nervous System | 2341 | ||
| Orthopedic and Soft Tissue Trauma | 2346 | ||
| Other Traumatic Injuries | 2349 | ||
| Selected Patient Populations | 2351 | ||
| Postoperative Care | 2352 | ||
| Summary | 2353 | ||
| References | 2353 | ||
| Chapter 73: Anesthesia and Prehospital Emergency and Trauma Care | 2359 | ||
| Key Points | 2359 | ||
| Organizational Models of Prehospital Emergency Care | 2360 | ||
| Communication | 2362 | ||
| Basic Techniques and Skills | 2362 | ||
| Prehospital Trauma Care | 2365 | ||
| Adult Medical Emergencies | 2367 | ||
| Pediatric Emergencies | 2371 | ||
| Prehospital Mass Casualty Incident Management and Disaster Medicine | 2373 | ||
| Controversies in Prehospital Emergency and Trauma Care | 2374 | ||
| References | 2375 | ||
| Chapter 74: Chemical and Biological Warfare Agents: The Role of the Anesthesiologist | 2379 | ||
| Key Points | 2379 | ||
| Nature of Chemical and Biological Warfare Hazards | 2380 | ||
| Role of the Anesthesiologist in the Clinical Management of Hazards and Threats from Chemical and Biological Warfare Agents | 2384 | ||
| Involvement of the Anesthesiologist in the Management of Casualties from Chemical and Biological Warfare Agents | 2397 | ||
| Effects of Chemical and Biological Warfare Agents on Anesthetic Practice | 2399 | ||
| References | 2400 | ||
| Chapter 75: Anesthesia for Eye, Ear, Nose, and Throat Surgery | 2403 | ||
| Key Points | 2403 | ||
| General Principles of Ear, Nose, and Throat Surgery | 2403 | ||
| Ear Surgery | 2410 | ||
| Nasal Surgery | 2412 | ||
| Throat and Head and Neck Surgery | 2415 | ||
| Intraoral Surgery | 2415 | ||
| Laryngeal Procedures | 2417 | ||
| Head and Neck Surgery | 2421 | ||
| Anesthesia for Eye Surgery | 2424 | ||
| References | 2432 | ||
| Chapter 76: Anesthesia for Robotic Surgery | 2435 | ||
| Key Points | 2435 | ||
| History | 2435 | ||
| Robotic Systems | 2436 | ||
| General Surgery | 2440 | ||
| Summary | 2447 | ||
| References | 2448 | ||
| Chapter 77: Anesthesia for Laser Surgery | 2451 | ||
| Key Points | 2451 | ||
| Physics of Laser Light | 2451 | ||
| Laser System Hardware | 2454 | ||
| Clinical Applications | 2455 | ||
| Biologic Effects of Laser Light | 2456 | ||
| Risks of Laser Use: Standards and Regulations | 2456 | ||
| Laser Hazards | 2457 | ||
| Eye Protection | 2458 | ||
| Endotracheal Tube Fires | 2458 | ||
| Airway Fire Protocol | 2462 | ||
| Summary | 2462 | ||
| References | 2463 | ||
| Chapter 78: Ambulatory (Outpatient) Anesthesia | 2465 | ||
| Key Points | 2465 | ||
| Rationale for Ambulatory Surgery | 2466 | ||
| Facility Design and Safety | 2466 | ||
| Patient Selection Criteria | 2467 | ||
| Preoperative Assessment | 2469 | ||
| Basic Anesthetic Techniques | 2474 | ||
| Facilitating the Recovery Process | 2485 | ||
| Special Considerations | 2489 | ||
| Discharge Criteria | 2492 | ||
| Outcome Measures | 2493 | ||
| Future Perspectives | 2495 | ||
| References | 2496 | ||
| Chapter 79: Anesthesia at Remote Locations | 2507 | ||
| Key Points | 2507 | ||
| Monitoring | 2507 | ||
| Facilities and Equipment | 2508 | ||
| Personnel and Staffing | 2508 | ||
| Medications | 2509 | ||
| Recovery Care | 2509 | ||
| Radiology Suite | 2509 | ||
| Magnetic Resonance Imaging | 2512 | ||
| Anesthesia for Interventional Neuroradiology | 2515 | ||
| Interventional Cardiology | 2517 | ||
| Electroconvulsive Therapy | 2523 | ||
| Therapeutic Radiation | 2525 | ||
| References | 2527 | ||
| Chapter 80: Clinical Care in Extreme Environments: At High and Low Pressure and in Space | 2531 | ||
| Key Points | 2531 | ||
| Physiologic Effects of Increased Gas Pressure | 2532 | ||
| Rationale for the Treatment of Selected Specific Syndromes | 2536 | ||
| Therapeutic Systems | 2539 | ||
| Hyperbaric Treatment Schedules | 2540 | ||
| Side Effects of HBO Therapy | 2541 | ||
| Practical Aspects of Hyperbaric Therapy | 2543 | ||
| Effects of Altitude | 2548 | ||
| Medical Care in Space | 2554 | ||
| Summary | 2555 | ||
| References | 2556 | ||
| Part VI: Pediatric\rAnesthesia | 2563 | ||
| Chapter 81: Regional Anesthesia in Children | 2565 | ||
| Relevant Differences between Children and Adults | 2565 | ||
| Indications, Contraindications, and Complications | 2572 | ||
| Selection of Materials, Techniques, and Agents | 2575 | ||
| Safety Precautions and Discharge Criteria | 2576 | ||
| Neuraxial Blocks | 2578 | ||
| Upper Extremity Conduction Blocks | 2583 | ||
| Lower Extremity Conduction Blocks | 2587 | ||
| Blocks of Nerves Supplying the Trunk | 2592 | ||
| Block of Nerves Supplying the Head and Neck | 2596 | ||
| Other Procedures | 2597 | ||
| Conclusion | 2598 | ||
| References | 2598 | ||
| Chapter 82: Pediatric Anesthesia | 2605 | ||
| Key Points | 2605 | ||
| Developmental Considerations | 2606 | ||
| Pharmacology and Pharmacodynamics | 2610 | ||
| Anesthetic Considerations | 2619 | ||
| Considerations for Neonatal Anesthesia | 2634 | ||
| Specific Neonatal and Surgical Procedures | 2635 | ||
| Regional Anesthesia and Analgesia | 2639 | ||
| References | 2640 | ||
| Chapter 83: Anesthesia for Pediatric Cardiac Surgery | 2645 | ||
| Key Points | 2645 | ||
| Unique Features of Pediatric Cardiac Anesthesia | 2646 | ||
| Anesthetic Management | 2656 | ||
| Intraoperative Management | 2658 | ||
| Cardiopulmonary Bypass | 2664 | ||
| Anticoagulation, Hemostasis, and Blood Conservation | 2676 | ||
| Postoperative Management | 2678 | ||
| Anesthesia for Heart and Lung Transplantation | 2681 | ||
| Anesthesia for Closed-Heart Operations | 2683 | ||
| Anesthesia for Interventional or Diagnostic Cardiac Procedures | 2684 | ||
| Pediatric Cardiac Electrophysiology | 2688 | ||
| Advances in Resynchronization Therapy | 2690 | ||
| Anesthesia for Noncardiac Surgery | 2690 | ||
| Offsite Anesthesia in Cardiac Surgery Patients | 2691 | ||
| References | 2692 | ||
| Chapter 84: Pediatric and Neonatal\rIntensive Care | 2699 | ||
| Pediatric and Neonatal Intensive Care | 2699 | ||
| Organization of the Pediatric Intensive Care Unit | 2699 | ||
| Cardiovascular System | 2700 | ||
| Respiratory System | 2707 | ||
| Central Nervous System | 2717 | ||
| Renal System | 2721 | ||
| Endocrine System | 2723 | ||
| Gastrointestinal System | 2724 | ||
| Hematology | 2728 | ||
| Oncology | 2730 | ||
| Infectious Disease: Life-Threatening Infections in Infants and Children | 2731 | ||
| Pediatric Trauma | 2734 | ||
| Sudden Infant Death Syndrome | 2735 | ||
| The Asphyxiated Child | 2736 | ||
| Cardiopulmonary Resuscitation | 2737 | ||
| Parent/Family Support | 2744 | ||
| Acknowledgment | 2744 | ||
| References | 2744 | ||
| Part VII: Postoperative Care | 2751 | ||
| Chapter 85: The Postanesthesia Care Unit | 2753 | ||
| Key Points | 2753 | ||
| Admission to the PACU | 2754 | ||
| The Standards for Postanesthesia Care | 2754 | ||
| Early Postoperative Physiologic Changes | 2754 | ||
| Transport to the PACU | 2755 | ||
| Upper Airway Obstruction | 2756 | ||
| Management of Upper Airway Obstruction | 2757 | ||
| Differential Diagnosis of Arterial Hypoxemia in the PACU | 2758 | ||
| Pulmonary Edema | 2759 | ||
| Monitoring and Treatment of Hypoxemia | 2760 | ||
| Optimal Perioperative Oxygenation | 2760 | ||
| Oxygen Delivery Systems | 2761 | ||
| Hemodynamic Instability | 2762 | ||
| Myocardial Ischemia: Evaluation and Treatment | 2764 | ||
| Cardiac Dysrhythmias | 2765 | ||
| Renal Dysfunction | 2765 | ||
| Body Temperature and Shivering | 2767 | ||
| Postoperative Nausea and Vomiting | 2767 | ||
| Delirium | 2767 | ||
| Emergence Excitement | 2768 | ||
| Delayed Awakening | 2769 | ||
| Discharge Criteria | 2769 | ||
| Infection Control | 2770 | ||
| Future Considerations | 2771 | ||
| Summary | 2772 | ||
| References | 2772 | ||
| Chapter 86: Postoperative Nausea and Vomiting | 2775 | ||
| Key Points | 2775 | ||
| Etiology: Pathways for Nausea and Vomiting | 2776 | ||
| Risk Factors and Independent Predictors | 2779 | ||
| Prophylactic Antiemetic Strategies | 2785 | ||
| Antiemetics (Table 86-2) | 2790 | ||
| Special Settings | 2795 | ||
| A Rational Guideline for the Management of PONV | 2796 | ||
| References | 2797 | ||
| Chapter 87: Acute Postoperative Pain | 2803 | ||
| Key Points | 2803 | ||
| Fundamental Considerations | 2803 | ||
| Treatment Methods | 2806 | ||
| Systemic Analgesic Techniques | 2806 | ||
| Postoperative Analgesia in Special Populations | 2818 | ||
| Acknowledgment | 2823 | ||
| References | 2823 | ||
| Chapter 88: Postoperative Intravascular Fluid Therapy | 2829 | ||
| Key Points | 2829 | ||
| Basic Physiology of Fluid Balance | 2829 | ||
| Fluid Balance in the Postoperative Period | 2833 | ||
| Assessment of the Fluid Balance | 2836 | ||
| Therapy for Alterations in Fluid Balance | 2842 | ||
| References | 2848 | ||
| Chapter 89: Cognitive Dysfunction and Other Long-Term Complications of Surgery and Anesthesia | 2851 | ||
| Key Points | 2851 | ||
| Detection of Postoperative Cognitive Dysfunction | 2852 | ||
| Incidence and Risk Factors for Postoperative Cognitive Dysfunction after Cardiac Surgery | 2854 | ||
| Incidence and Risk Factors for Postoperative Cognitive Dysfunction after Noncardiac Surgery | 2856 | ||
| Etiologic Considerations | 2858 | ||
| Clinical Significance of POCD | 2862 | ||
| Acknowledgment | 2862 | ||
| References | 2862 | ||
| Chapter 90: Postoperative Visual Loss | 2867 | ||
| Key Points | 2867 | ||
| Retinal Ischemia: Branch and Central Retinal Artery Occlusion | 2868 | ||
| Ischemic Optic Neuropathy | 2872 | ||
| Cortical Blindness | 2881 | ||
| Acute Glaucoma | 2883 | ||
| Visual Changes after Transurethral Resection of the Prostate | 2883 | ||
| Visual Loss after Vitrectomy and Vitreal Gas Bubble Tamponade | 2883 | ||
| Conclusion | 2884 | ||
| Acknowledgment | 2884 | ||
| References | 2884 | ||
| Part VIII: Critical Care\rMedicine | 2889 | ||
| Chapter 91: Overview of Anesthesiology and Critical Care Medicine | 2891 | ||
| Key Points | 2891 | ||
| Intensive Care Unit Organization | 2891 | ||
| Quality Measurement in Critical Care | 2894 | ||
| Management of Critically Ill Patients | 2898 | ||
| Complications of Intensive Care Unit Management | 2908 | ||
| Conclusion | 2910 | ||
| References | 2910 | ||
| Chapter 92: Critical Care Protocols | 2915 | ||
| Key Points | 2915 | ||
| Rationale for Protocol Development | 2916 | ||
| Protocol Design | 2917 | ||
| Protocol Implementation | 2919 | ||
| ICU Protocols | 2919 | ||
| The Future of Protocolized Medicine | 2921 | ||
| Conclusion | 2921 | ||
| References | 2922 | ||
| Chapter 93: Respiratory Care | 2925 | ||
| Key Points | 2925 | ||
| Definitions | 2926 | ||
| Modes of Mechanical Ventilation | 2926 | ||
| Clinical Problems Associated with Mechanical Ventilation | 2935 | ||
| Mechanical Ventilation for Specific Clinical Entities | 2939 | ||
| References | 2941 | ||
| Chapter 94: Neurocritical Care | 2945 | ||
| Key Points | 2945 | ||
| Intracranial Physiology and Cerebral Autoregulation | 2946 | ||
| General Cardiopulmonary Considerations | 2948 | ||
| Fluids and Electrolytes | 2948 | ||
| Fever and Infection | 2949 | ||
| Monitoring | 2950 | ||
| Common Diseases in the Neurocritical Care Unit | 2954 | ||
| Ethical Considerations | 2963 | ||
| Summary | 2963 | ||
| References | 2964 | ||
| Chapter 95: Nutrition and Metabolic Control | 2969 | ||
| Key Points | 2969 | ||
| Metabolic Control Systems and the Response to Surgical Stress | 2969 | ||
| Fasting and Malnutrition | 2978 | ||
| Eating | 2979 | ||
| The Metabolic Responses to Surgical and Traumatic Injury | 2979 | ||
| The Metabolic Responses to Sepsis | 2984 | ||
| Modulation of the Stress Response | 2985 | ||
| Nutritional Support | 2989 | ||
| Special Considerations | 2997 | ||
| Conclusion | 2998 | ||
| References | 2999 | ||
| Chapter 96: Renal Replacement Therapies | 3003 | ||
| Key Points | 3003 | ||
| Epidemiology of Acute Kidney Injury | 3003 | ||
| History of Renal Replacement Therapy | 3004 | ||
| Indications to Start and Stop Renal Replacement Therapies | 3005 | ||
| Techniques and Modalities | 3005 | ||
| The Role of Renal Replacement Therapies in Different Clinical Conditions | 3009 | ||
| Technical Notes | 3011 | ||
| Summary | 3013 | ||
| References | 3013 | ||
| Chapter 97: Cardiopulmonary Resuscitation: Basic and Advanced Life Support | 3017 | ||
| Key Points | 3017 | ||
| Basic Life Support | 3018 | ||
| Advanced Cardiac Life Support | 3024 | ||
| Pediatric Resuscitation (also see Chapters 82, 83, and 84) | 3035 | ||
| Educational Initiatives | 3042 | ||
| Acknowledgment | 3043 | ||
| References | 3043 | ||
| Chapter 98: Brain Death | 3049 | ||
| Key Points | 3049 | ||
| History | 3050 | ||
| Traditional Concept of Death of an Organism | 3050 | ||
| The Concept of Brain Death | 3053 | ||
| Mechanism of Brain Death | 3054 | ||
| Neurophysiologic Basis of Brain Death | 3054 | ||
| Criteria and Tests for Determining Brain Death | 3057 | ||
| Prerequisites for Diagnosing Brain Death | 3058 | ||
| Clinical Diagnosis of Brain Death | 3058 | ||
| Special Considerations | 3058 | ||
| Central Integrator Theory of the Brain | 3060 | ||
| Variability in Policies and Practices for Determining Brain Death | 3060 | ||
| Confirmatory Tests for Brain Death | 3060 | ||
| Anesthesiologists in Organ Donation | 3063 | ||
| References | 3063 | ||
| Part IX: Ancillary\rResponsibilities\rand Problems | 3067 | ||
| Chapter 99: Operating Room Management | 3069 | ||
| Key Points | 3069 | ||
| History | 3069 | ||
| Medical Management in the Operating Room | 3070 | ||
| Efficiency of Operation | 3072 | ||
| The Daily Schedule | 3076 | ||
| Anesthesia Service Management | 3079 | ||
| Operating Room Information Systems | 3080 | ||
| Cost Accounting in the Operating Room | 3080 | ||
| Regulatory Issues | 3082 | ||
| Summary | 3082 | ||
| References | 3083 | ||
| Chapter 100: Electrical Safety in the Operating Room | 3087 | ||
| Key Points | 3087 | ||
| Electrical Ground | 3089 | ||
| Isolation of Electric Power from Ground | 3090 | ||
| Capacitive Coupling | 3092 | ||
| Electrical Shock | 3093 | ||
| Electrosurgery | 3094 | ||
| Safe Practice | 3096 | ||
| References | 3097 | ||
| Chapter 101: Environmental Safety Including Chemical Dependency | 3099 | ||
| Key Points | 3099 | ||
| Waste Gases | 3100 | ||
| Radiation (also see Chapter 79) | 3101 | ||
| Infection | 3103 | ||
| SARS | 3108 | ||
| OSHA Standards | 3109 | ||
| Chemical Dependence | 3112 | ||
| Summary | 3116 | ||
| References | 3116 | ||
| Chapter 102: Statistical Methods in Anesthesia | 3121 | ||
| Key Points | 3121 | ||
| Statistical Approaches | 3122 | ||
| Study Design | 3126 | ||
| Evidence-Based Medicine | 3129 | ||
| Summary | 3129 | ||
| Bibliography | 3130 | ||
| Index | 3131 |