BOOK
Smith and Aitkenhead's Textbook of Anaesthesia E-Book
Alan R. Aitkenhead | Jonathan Thompson | David J. Rowbotham | Iain Moppett
(2013)
Additional Information
Book Details
Abstract
Textbook of Anaesthesia has become the book of choice for trainee anaesthetists beginning their career in the specialty. It is highly suitable for part 1 of the Fellowship of the Royal College of Anaesthetists and similar examinations. It is also a practical guide for all anaesthetists and other health care professionals involved in the perioperative period.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Smith and Aitkenhead’s Textbook of Anaesthesia | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Preface | ix | ||
| List of Contributors | xi | ||
| Chapter 1: General principles of pharmacology | 1 | ||
| HOW DO DRUGS ACT? | 1 | ||
| Physicochemical Properties | 1 | ||
| Action on Receptors | 1 | ||
| Action on Enzymes | 2 | ||
| THE BLOOD–BRAIN BARRIER AND PLACENTA | 2 | ||
| PLASMA PROTEIN BINDING | 3 | ||
| METABOLISM | 4 | ||
| Enzyme Induction and Inhibition | 4 | ||
| DRUG EXCRETION | 4 | ||
| PHARMACOKINETIC PRINCIPLES | 5 | ||
| Volume of Distribution | 5 | ||
| Clearance | 5 | ||
| Elimination Half-Life | 6 | ||
| Calculating t1/2, V and Clearance | 6 | ||
| Two-Compartment Models | 7 | ||
| Context-Sensitive Half-Life | 8 | ||
| PHARMACOGENETICS | 8 | ||
| METHODS OF DRUG ADMINISTRATION | 8 | ||
| Oral | 8 | ||
| Gastric Emptying | 9 | ||
| First-Pass Effect | 9 | ||
| Bioavailability | 9 | ||
| Lingual and Buccal | 9 | ||
| Intramuscular | 9 | ||
| Subcutaneous | 9 | ||
| Intravenous | 9 | ||
| Bolus | 9 | ||
| Infusion | 10 | ||
| Patient-Controlled Analgesia (PCA) | 10 | ||
| Rectal | 10 | ||
| Transdermal | 10 | ||
| Inhalation | 11 | ||
| Epidural | 11 | ||
| Spinal (Subarachnoid) | 11 | ||
| DRUG INTERACTIONS | 11 | ||
| Pharmaceutical | 11 | ||
| Pharmacokinetic | 11 | ||
| Pharmacodynamic | 12 | ||
| VOLATILE ANAESTHETIC AGENTS | 12 | ||
| Mechanism of Action | 12 | ||
| Potency | 12 | ||
| Onset of Action | 12 | ||
| FURTHER READING | 13 | ||
| Chapter 2: Inhalational anaesthetic agents | 14 | ||
| PROPERTIES OF THE IDEAL INHALATIONAL ANAESTHETIC AGENT | 14 | ||
| Minimum Alveolar Concentration (MAC) | 14 | ||
| Factors Which Lead to a Reduction in MAC | 15 | ||
| Factors Which Increase MAC | 15 | ||
| Mechanisms of Action | 15 | ||
| Individual Anaesthetic Agents | 15 | ||
| AGENTS IN COMMON CLINICAL USE | 15 | ||
| Isoflurane | 16 | ||
| Physical Properties | 16 | ||
| Uptake and Distribution | 16 | ||
| Metabolism | 16 | ||
| Respiratory System | 17 | ||
| Cardiovascular System | 17 | ||
| Uterus | 18 | ||
| Central Nervous System | 18 | ||
| Muscle Relaxation | 19 | ||
| Desflurane | 19 | ||
| Physical Properties | 20 | ||
| Uptake and Distribution | 20 | ||
| Metabolism | 20 | ||
| Respiratory System | 20 | ||
| Cardiovascular Effects | 21 | ||
| Central Nervous System | 21 | ||
| Musculoskeletal System | 21 | ||
| Sevoflurane | 22 | ||
| Physical Properties | 22 | ||
| Uptake and Distribution | 22 | ||
| Metabolism | 22 | ||
| Respiratory System | 22 | ||
| Cardiovascular System | 22 | ||
| Central Nervous System | 22 | ||
| Renal System | 23 | ||
| Musculoskeletal System | 23 | ||
| Obstetric Use | 23 | ||
| Interaction with Carbon Dioxide Absorbers | 23 | ||
| Halothane | 23 | ||
| Uptake and Distribution | 23 | ||
| Metabolism | 24 | ||
| Respiratory System | 24 | ||
| Cardiovascular System | 24 | ||
| Central Nervous System | 25 | ||
| Gastrointestinal Tract | 25 | ||
| Uterus | 25 | ||
| Skeletal Muscle | 25 | ||
| Halothane-Associated Hepatic Dysfunction | 25 | ||
| Comparison of Isoflurane, Desflurane, Sevoflurane and Halothane | 26 | ||
| Pharmacokinetics | 26 | ||
| Respiratory System | 26 | ||
| Cardiovascular System | 26 | ||
| Central Nervous System | 26 | ||
| Neuromuscular Junction | 26 | ||
| Uterus | 27 | ||
| Metabolism | 27 | ||
| Carbon Dioxide Absorbers | 27 | ||
| AGENTS IN OCCASIONAL USE | 28 | ||
| Enflurane | 28 | ||
| Physical Properties | 28 | ||
| Uptake and Distribution | 28 | ||
| Metabolism | 28 | ||
| Respiratory System | 28 | ||
| Cardiovascular System | 28 | ||
| Uterus | 28 | ||
| Central Nervous System | 28 | ||
| Muscle Relaxation | 28 | ||
| Hepatotoxicity | 28 | ||
| Diethyl Ether | 29 | ||
| Uptake and Distribution | 29 | ||
| Central Nervous System | 29 | ||
| Respiratory System | 29 | ||
| Cardiovascular System | 29 | ||
| Alimentary System | 29 | ||
| Skeletal Muscle | 29 | ||
| Uterus and Placenta | 29 | ||
| Metabolism | 29 | ||
| Clinical Use of Ether | 29 | ||
| ANAESTHETIC GASES | 30 | ||
| Nitrous Oxide (N2O) | 30 | ||
| Manufacture | 30 | ||
| Storage | 30 | ||
| Physical Properties | 30 | ||
| Pharmacology | 30 | ||
| The Concentration Effect | 31 | ||
| The Second Gas Effect | 31 | ||
| Systemic Effects | 31 | ||
| Respiratory System | 31 | ||
| Cardiovascular System | 31 | ||
| Central Nervous System | 32 | ||
| Neuromuscular Junction | 32 | ||
| Side-Effects of Nitrous Oxide | 32 | ||
| Postoperative Nausea and Vomiting | 32 | ||
| Diffusion Hypoxia | 32 | ||
| Effect on Closed Gas Spaces | 32 | ||
| Effects on Blood and the Nervous System | 32 | ||
| Teratogenic Changes | 33 | ||
| Environment | 33 | ||
| Other Gases Used During Anaesthesia | 33 | ||
| Oxygen | 33 | ||
| Manufacture | 33 | ||
| Oxygen Concentrators | 33 | ||
| Adverse Effects of Oxygen. | 33 | ||
| Fire | 33 | ||
| Cardiovascular depression | 33 | ||
| Absorption atelectasis | 33 | ||
| Pulmonary oxygen toxicity | 34 | ||
| Central nervous system oxygen toxicity | 34 | ||
| Retrolental fibroplasia | 34 | ||
| Depressed haemopoiesis | 34 | ||
| Carbon Dioxide | 34 | ||
| Physiological Data | 34 | ||
| Uses of Carbon Dioxide in anaesthesia | 34 | ||
| Medical Air | 35 | ||
| Uses of Medical Air. | 35 | ||
| Advantages of Air. | 35 | ||
| Xenon | 35 | ||
| Physical Properties | 35 | ||
| Systemic Effects | 35 | ||
| Helium | 35 | ||
| FURTHER READING | 36 | ||
| Chapter 3: Intravenous anaesthetic agents | 37 | ||
| Properties of the Ideal Intravenous Anaesthetic Agent | 37 | ||
| Mechanism of Action of Intravenous Anaesthetic Drugs | 37 | ||
| Pharmacokinetics of Intravenous Anaesthetic Drugs | 39 | ||
| Distribution to Other Tissues | 39 | ||
| BARBITURATES | 40 | ||
| Thiopental Sodium | 41 | ||
| Chemical Structure | 41 | ||
| Physical Properties and Presentation | 41 | ||
| Central Nervous System | 41 | ||
| Cardiovascular System | 41 | ||
| Respiratory System | 41 | ||
| Skeletal Muscle | 42 | ||
| Uterus and Placenta | 42 | ||
| Eye | 42 | ||
| Hepatorenal Function | 42 | ||
| Pharmacokinetics | 42 | ||
| Dosage and Administration | 42 | ||
| Adverse Effects | 43 | ||
| Indications | 43 | ||
| Absolute Contraindications | 43 | ||
| Precautions | 43 | ||
| Methohexital Sodium | 44 | ||
| Chemical Structure | 44 | ||
| Physical Properties and Presentation | 44 | ||
| Pharmacology | 45 | ||
| Central Nervous System | 45 | ||
| Cardiovascular System | 45 | ||
| Respiratory System | 45 | ||
| Pharmacokinetics | 45 | ||
| Dosage and Administration | 45 | ||
| Adverse Effects | 45 | ||
| Indications | 45 | ||
| Absolute Contraindications | 45 | ||
| Precautions | 45 | ||
| NON-BARBITURATE INTRAVENOUS ANAESTHETIC AGENTS | 45 | ||
| Propofol | 45 | ||
| Chemical Structure | 45 | ||
| Physical Properties and Presentation | 45 | ||
| Pharmacology | 46 | ||
| Central Nervous System | 46 | ||
| Cardiovascular System | 46 | ||
| Respiratory System | 46 | ||
| Skeletal Muscle | 46 | ||
| Gastrointestinal System | 46 | ||
| Uterus and Placenta | 47 | ||
| Hepatorenal | 47 | ||
| Endocrine | 47 | ||
| Pharmacokinetics | 47 | ||
| Dosage and Administration | 47 | ||
| Adverse Effects | 47 | ||
| Indications | 48 | ||
| Absolute Contraindications | 48 | ||
| Precautions | 48 | ||
| Etomidate | 48 | ||
| Chemical Structure | 48 | ||
| Physical Characteristics and Presentation | 48 | ||
| Pharmacology | 48 | ||
| Pharmacokinetics | 49 | ||
| Dosage and Administration | 49 | ||
| Adverse Effects | 49 | ||
| Indications | 49 | ||
| Absolute Contraindications | 49 | ||
| Precautions | 49 | ||
| Ketamine Hydrochloride | 49 | ||
| Chemical Structure | 49 | ||
| Physical Characteristics and Presentation | 49 | ||
| Pharmacology | 50 | ||
| Central Nervous System | 50 | ||
| Cardiovascular System | 50 | ||
| Respiratory System | 50 | ||
| Skeletal Muscle | 50 | ||
| Gastrointestinal System | 50 | ||
| Uterus and Placenta | 50 | ||
| The Eye | 50 | ||
| Pharmacokinetics | 50 | ||
| Dosage and Administration | 50 | ||
| Adverse Effects | 50 | ||
| Indications | 51 | ||
| Absolute Contraindications | 51 | ||
| Precautions | 51 | ||
| Other Drugs | 51 | ||
| INTRAVENOUS MAINTENANCE OF ANAESTHESIA | 51 | ||
| Indications for Intravenous Maintenance of Anaesthesia | 51 | ||
| Principles of IVA | 52 | ||
| Techniques of Administration | 52 | ||
| Intermittent Injection | 52 | ||
| Manual Infusion Techniques | 52 | ||
| Target-Controlled Infusion (TCI) Techniques | 53 | ||
| Closed-Loop Systems | 54 | ||
| Adverse Reactions to Intravenous Anaesthetic Agents | 54 | ||
| Clinical Features | 54 | ||
| Predisposing Factors | 54 | ||
| Incidence | 54 | ||
| Treatment | 54 | ||
| FURTHER READING | 55 | ||
| Chapter 4: Local anaesthetic agents | 56 | ||
| MECHANISM OF ACTION OF LOCAL ANAESTHETICS | 56 | ||
| Mechanism of Local Anaesthetic Inhibition of the Voltage-Activated Na+ Channel | 57 | ||
| THE VOLTAGE-ACTIVATED Na+ CHANNEL | 58 | ||
| PAIN FIBRES | 59 | ||
| LOCAL ANAESTHETIC STRUCTURE | 61 | ||
| PHARMACOLOGICAL PROPERTIES OF LOCAL ANAESTHETICS | 61 | ||
| DIFFERENTIAL SENSORY AND MOTOR BLOCKADE | 62 | ||
| PHARMACOKINETICS | 62 | ||
| Absorption | 62 | ||
| Distribution | 62 | ||
| Metabolism | 62 | ||
| Clearance | 63 | ||
| Placental Transfer | 63 | ||
| CLINICAL PREPARATION OF LOCAL ANAESTHETICS | 63 | ||
| ENANTIOMER PHARMACOLOGY | 63 | ||
| INDIVIDUAL LOCAL ANAESTHETIC PHARMACOLOGY | 63 | ||
| Bupivacaine | 63 | ||
| Levobupivacaine | 63 | ||
| Ropivacaine | 63 | ||
| Lidocaine | 64 | ||
| Prilocaine | 64 | ||
| LOCAL ANAESTHETIC TOXICITY | 64 | ||
| Early Clinical Reports | 64 | ||
| Scientific Investigations | 64 | ||
| Human Volunteer Studies | 64 | ||
| Systemic Toxicity | 64 | ||
| Mechanisms of Systemic Toxicity | 65 | ||
| MANAGEMENT OF SEVERE LOCAL ANAESTHETIC TOXICITY | 65 | ||
| Prevention of Severe Local Anaesthetic Toxicity | 65 | ||
| EMERGING LOCAL ANAESTHETIC APPROACHES | 67 | ||
| Imaging and Local Anaesthesia | 67 | ||
| TRP Channels and Pain | 67 | ||
| FURTHER READING | 67 | ||
| Chapter 5: Analgesic drugs | 69 | ||
| OPIOIDS | 69 | ||
| Mechanism of Action | 69 | ||
| Pharmacodynamic Effects of Opioids | 70 | ||
| Analgesic Action | 71 | ||
| Central Nervous System | 71 | ||
| Respiratory | 72 | ||
| Gastrointestinal | 72 | ||
| Cardiovascular | 72 | ||
| Other Effects | 72 | ||
| Opioid Structure | 72 | ||
| Pharmacokinetics and Physicochemical Properties | 73 | ||
| Routes of Administration | 76 | ||
| MOP Agonists | 76 | ||
| Morphine | 76 | ||
| Diamorphine | 77 | ||
| Papaveretum | 77 | ||
| Hydromorphone | 77 | ||
| Meperidine (Pethidine) | 77 | ||
| Fentanyl | 78 | ||
| Alfentanil | 78 | ||
| Sufentanil | 78 | ||
| Remifentanil | 78 | ||
| Oxycodone | 79 | ||
| Methadone | 79 | ||
| Codeine | 79 | ||
| Dihydrocodeine | 79 | ||
| Tramadol | 79 | ||
| Mixed Agonist–Antagonist Opioids | 80 | ||
| Partial Agonists | 80 | ||
| Buprenorphine | 80 | ||
| Opioid Antagonists | 80 | ||
| New Developments in Opioid Pharmacology | 80 | ||
| PARACETAMOL | 80 | ||
| Mechanism of Action | 81 | ||
| Pharmacokinetics | 81 | ||
| Pharmacodynamics | 82 | ||
| Overdose and Hepatic Toxicity | 82 | ||
| NON-STEROIDAL ANTI-INFLAMMATORY DRUGS | 82 | ||
| Mechanism of Action | 82 | ||
| Pharmacokinetics | 83 | ||
| Pharmacodynamics | 84 | ||
| Analgesia | 84 | ||
| Gastrointestinal System | 84 | ||
| Platelet Function | 84 | ||
| Renal Function | 84 | ||
| Aspirin-Induced Asthma | 84 | ||
| Contraindications | 84 | ||
| COX-2-SPECIFIC INHIBITORS | 84 | ||
| Mechanism of Action | 84 | ||
| Pharmacodynamics | 85 | ||
| Analgesia | 85 | ||
| Gastrointestinal | 85 | ||
| Haematological | 85 | ||
| Cardiovascular | 85 | ||
| Renal | 85 | ||
| KETAMINE | 85 | ||
| Mechanism of Action | 86 | ||
| Pharmacokinetics | 86 | ||
| Pharmacodynamics | 86 | ||
| FURTHER READING | 86 | ||
| Chapter 6: Muscle function and neuromuscular blockade | 87 | ||
| PHYSIOLOGY OF NEUROMUSCULAR TRANSMISSION | 87 | ||
| PHARMACOLOGY OF NEUROMUSCULAR TRANSMISSION | 90 | ||
| Depolarizing Neuromuscular Blocking Agents | 90 | ||
| Succinylcholine Chloride (Suxamethonium) | 90 | ||
| Inherited Factors | 91 | ||
| Acquired Factors | 92 | ||
| Side-Effects of Succinylcholine | 92 | ||
| Muscle Pains | 92 | ||
| Increased Intraocular Pressure | 92 | ||
| Increased Intragastric Pressure | 92 | ||
| Hyperkalaemia | 92 | ||
| Cardiovascular Effects | 93 | ||
| Anaphylactic Reactions | 93 | ||
| Characteristics of Depolarizing Neuromuscular Block | 93 | ||
| Decamethonium | 94 | ||
| Non-Depolarizing Neuromuscular Blocking Agents | 94 | ||
| Benzylisoquinolinium Compounds | 94 | ||
| Tubocurarine Chloride | 94 | ||
| Alcuronium Chloride | 94 | ||
| Gallamine Triethiodide | 95 | ||
| Atracurium Besylate | 95 | ||
| Cisatracurium | 96 | ||
| Doxacurium Chloride | 96 | ||
| Mivacurium Chloride | 96 | ||
| Aminosteroid Compounds | 96 | ||
| Pancuronium Bromide | 97 | ||
| Vecuronium Bromide | 97 | ||
| Pipecuronium Bromide | 97 | ||
| Rocuronium Bromide | 97 | ||
| Rapacuronium Bromide | 97 | ||
| Factors Affecting Duration of Non-Depolarizing ŁNeuromuscular Block | 98 | ||
| Characteristics of Non-Depolarizing Neuromuscular Block | 98 | ||
| REVERSAL AGENTS | 98 | ||
| Anticholinesterases | 98 | ||
| Neostigmine | 99 | ||
| Edrophonium | 99 | ||
| Pyridostigmine | 99 | ||
| Physostigmine | 99 | ||
| Organophosphorus Compounds | 100 | ||
| Cyclodextrins | 100 | ||
| Sugammadex | 100 | ||
| NEUROMUSCULAR MONITORING | 100 | ||
| Mechanomyography | 101 | ||
| Electromyography | 101 | ||
| Accelerography | 101 | ||
| Modes of Stimulation | 102 | ||
| Twitch | 102 | ||
| Train-of-Four (TOF) Twitch Response | 102 | ||
| Tetanic Stimulation | 102 | ||
| Post-Tetanic Potentiation or Facilitation | 103 | ||
| Double-Burst Stimulation (DBS) | 103 | ||
| Indications for Neuromuscular Monitoring | 104 | ||
| REFERENCE | 104 | ||
| FURTHER READING | 104 | ||
| Chapter 7: Sedative and anxiolytic drugs | 105 | ||
| INDICATIONS FOR THE USE OF SEDATIVE DRUGS | 106 | ||
| Procedural Sedation | 106 | ||
| Premedication | 106 | ||
| Supplementation of General or Regional Anaesthesia | 106 | ||
| Awake Fibreoptic Tracheal Intubation | 107 | ||
| Critical Care | 107 | ||
| Administration Techniques | 107 | ||
| Sedative Drugs | 107 | ||
| BENZODIAZEPINES | 108 | ||
| Pharmacology | 108 | ||
| Physical Properties | 108 | ||
| Systemic Effects | 108 | ||
| CNS Effects | 108 | ||
| Muscle Relaxation | 110 | ||
| Respiratory Effects | 110 | ||
| Cardiovascular Effects | 110 | ||
| Pharmacokinetics | 110 | ||
| Diazepam | 110 | ||
| Chapter 8: Drugs acting on the cardiovascular system | 116 | ||
| THE AUTONOMIC NERVOUS SYSTEM | 116 | ||
| The Sympathetic Nervous System | 116 | ||
| Sympathetic Neurotransmitters | 118 | ||
| Adrenergic Receptor Pharmacology | 119 | ||
| Structure of Adrenergic Receptors | 120 | ||
| Second and Third Messenger Systems | 120 | ||
| The Parasympathetic Nervous System | 120 | ||
| Parasympathetic Neurotransmitters | 121 | ||
| Parasympathetic Receptor Pharmacology | 121 | ||
| DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM | 122 | ||
| Sympathomimetic Drugs | 122 | ||
| Catecholamines | 123 | ||
| Endogenous Catecholamines | 123 | ||
| Adrenaline | 123 | ||
| Noradrenaline | 124 | ||
| Dopamine | 124 | ||
| Synthetic Catecholamines | 124 | ||
| Isoprenaline | 124 | ||
| Dobutamine | 125 | ||
| Dopexamine | 125 | ||
| Non-Catecholamine Sympathomimetics | 125 | ||
| Ephedrine | 126 | ||
| Phenylephrine | 126 | ||
| Methoxamine | 126 | ||
| Metaraminol | 126 | ||
| Vasopressin | 126 | ||
| Phosphodiesterase Inhibitors | 126 | ||
| Glucagon | 127 | ||
| Calcium | 127 | ||
| Calcium Sensitizers | 127 | ||
| Selective β2 -Agonists | 128 | ||
| Salbutamol | 128 | ||
| Sympatholytic Drugs | 128 | ||
| Centrally Acting Sympatholytic Drugs | 128 | ||
| Peripherally Acting Sympatholytic Drugs | 129 | ||
| Ganglion Blocking Drugs | 129 | ||
| Adrenergic Neurone Blocking Drugs | 129 | ||
| α-Adrenergic Receptor Antagonists | 129 | ||
| α1-Selective Antagonists | 130 | ||
| α2-Selective Antagonists | 130 | ||
| Non-Selective a -Antagonists | 130 | ||
| β-Adrenergic Receptor Antagonists | 130 | ||
| β1- or β2-Adrenergic Receptor Affinity | 130 | ||
| Partial Agonist Activity | 130 | ||
| Membrane-Stabilizing Effect | 131 | ||
| Ancillary Effects | 131 | ||
| Pharmacological Properties of β-Blockers | 131 | ||
| Indications for β-Blockade | 131 | ||
| Adverse Reactions to β-Blockers | 134 | ||
| Reactions Resulting from β-Blockade | 134 | ||
| Cardiovascular effects. | 134 | ||
| Induction of bronchospasm. | 135 | ||
| Raynaud’s phenomenon. | 135 | ||
| Diabetes mellitus. | 135 | ||
| Other. | 135 | ||
| Idiosyncratic Reactions | 135 | ||
| Newer β-Blockers | 135 | ||
| DRUGS ACTING ON THE PARASYMPATHETIC NERVOUS SYSTEM | 136 | ||
| Parasympathetic Antagonists | 136 | ||
| Atropine | 136 | ||
| Hyoscine | 136 | ||
| Glycopyrronium Bromide (Glycopyrrolate) | 136 | ||
| Antimuscarinic Drugs in Premedication | 136 | ||
| Parasympathetic Agonists | 136 | ||
| Anticholinesterase Drugs | 137 | ||
| VASODILATORS | 137 | ||
| Nitrates | 137 | ||
| Sodium Nitroprusside | 137 | ||
| Potassium Channel Activators | 138 | ||
| Nicorandil | 138 | ||
| CALCIUM CHANNEL BLOCKERS | 138 | ||
| Mechanism of Action | 138 | ||
| Clinical Effects | 139 | ||
| Classification | 139 | ||
| First-Generation Calcium Channel Blockers | 139 | ||
| Second- and Third-Generation CCBs | 141 | ||
| Anaesthesia and Calcium Channel Blockers | 141 | ||
| DRUGS ACTING VIA THE RENIN–ANGIOTENSIN–ALDOSTERONE SYSTEM | 141 | ||
| Drugs Acting on the Renin–Angiotensin System | 143 | ||
| ACE Inhibitors | 143 | ||
| Clinical Applications of ACE Inhibitors | 143 | ||
| Angiotensin-II Receptor Blockers | 145 | ||
| ANTIARRHYTHMIC DRUGS | 145 | ||
| The Cardiac Action Potential | 146 | ||
| Mechanisms of Arrhythmias | 146 | ||
| Arrhythmias and Anaesthesia | 147 | ||
| Mechanisms of Action of Antiarrhythmic Drugs | 147 | ||
| Class 1 Antiarrhythmics | 149 | ||
| Class 1a | 149 | ||
| Class 1b | 149 | ||
| Class 1c | 149 | ||
| Class 2 Antiarrhythmic Drugs | 151 | ||
| Class 3 Antiarrhythmic Drugs | 151 | ||
| Class 4 Antiarrhythmic Drugs | 153 | ||
| Other Antiarrhythmics | 153 | ||
| Cardiac Glycosides | 153 | ||
| FURTHER READING | 154 | ||
| Chapter 9: Drugs acting on the respiratory system | 155 | ||
| DRUGS AFFECTING AIRWAY CALIBRE | 155 | ||
| Bronchodilators | 156 | ||
| β-Adrenergic Agonists | 156 | ||
| Chapter 10: Drugs used in renal disease | 168 | ||
| DRUG CONSIDERATIONS IN PATIENTS WITH RENAL DYSFUNCTION | 168 | ||
| Influence of Renal Disease on Pharmacokinetics | 168 | ||
| Influence of Drugs on Renal Function | 168 | ||
| VASOACTIVE DRUGS USED IN RENAL DYSFUNCTION | 169 | ||
| Dopamine | 169 | ||
| Mechanism of Action | 169 | ||
| Clinical Uses | 170 | ||
| Side-Effects | 170 | ||
| Dopexamine | 170 | ||
| Fenoldopam | 170 | ||
| Adenosine | 170 | ||
| Calcium Channel Blockers | 171 | ||
| Angiotensin-Converting Enzyme (ACE) Inhibitors | 171 | ||
| Noradrenaline/Adrenaline/Phenylephrine | 171 | ||
| Antidiuretic Hormone (Vasopressin) and Desmopressin (DDAVP) | 172 | ||
| DIURETICS | 172 | ||
| Carbonic Anhydrase Inhibitors | 173 | ||
| Acetazolamide | 173 | ||
| Osmotic Diuretics | 174 | ||
| Mannitol | 174 | ||
| Loop Diuretics | 174 | ||
| Furosemide | 174 | ||
| Bumetanide | 175 | ||
| Thiazide Diuretics | 175 | ||
| Potassium-Sparing Diuretics | 176 | ||
| Amiloride and Triamterene | 176 | ||
| Spironolactone | 176 | ||
| ACUTE RENAL FAILURE, SEPSIS AND THE INTENSIVE CARE UNIT | 177 | ||
| ACUTE KIDNEY INJURY AFTER CARDIAC OR MAJOR VASCULAR SURGERY | 177 | ||
| DRUGS AND RENAL TRANSPLANTATION | 178 | ||
| Erythropoietin | 178 | ||
| Immunosuppression | 178 | ||
| Prednisolone and Azathioprine | 178 | ||
| Ciclosporin A and Ciclosporin-Neoral | 178 | ||
| Rapamycin | 178 | ||
| Tacrolimus | 179 | ||
| Mycophenolate Mofetil | 179 | ||
| FURTHER READING | 179 | ||
| Chapter 11: Metabolism, the stress response to surgery and perioperative thermoregulation | 180 | ||
| METABOLISM | 180 | ||
| CARBOHYDRATE METABOLISM | 180 | ||
| Aerobic Glycolysis | 180 | ||
| Anaerobic Glycolysis | 181 | ||
| Gluconeogenesis | 182 | ||
| PROTEIN METABOLISM | 182 | ||
| LIPID METABOLISM | 185 | ||
| Cholesterol | 186 | ||
| Ketones | 187 | ||
| Measuring Metabolic Rate | 187 | ||
| THE STRESS RESPONSE TO SURGERY | 187 | ||
| Consequences of the Neuroendocrine Element of the Stress Response | 188 | ||
| Protein Catabolism | 188 | ||
| Carbohydrate Mobilization | 189 | ||
| Fat Metabolism | 189 | ||
| Cardiovascular Effects | 189 | ||
| Respiratory Effects | 189 | ||
| Gastrointestinal Effects | 189 | ||
| Immunological System Effects | 190 | ||
| Afferent Neural Stimuli | 190 | ||
| Local Factors and the Immunological (Cytokine) Response | 190 | ||
| Effect of General Anaesthesia on the Stress Response | 190 | ||
| Effect of Epidural Anaesthesia and Analgesia on the Stress Response | 191 | ||
| Neuroendocrine Element | 191 | ||
| Cytokine Element | 191 | ||
| Benefits of Modifying the Stress Response | 191 | ||
| THERMOREGULATION AND ANAESTHESIA | 191 | ||
| Physiology | 191 | ||
| Heat Balance | 191 | ||
| Thermogenesis | 191 | ||
| Heat Loss | 192 | ||
| Thermoregulation | 192 | ||
| Thermoreceptors | 192 | ||
| Central Control | 193 | ||
| Effector Mechanisms | 193 | ||
| Measurement of Temperature | 193 | ||
| Effect of General Anaesthesia on Thermoregulation | 193 | ||
| Widening of the Interthreshold Range | 193 | ||
| Stages of Hypothermia | 194 | ||
| Phase 1 (Redistribution Stage) | 194 | ||
| Phase 2 (Heat Loss> Heat Production) | 196 | ||
| Phase 3 (Plateau Phase) | 196 | ||
| Effect of Regional Anaesthesia on Thermoregulation | 196 | ||
| Consequences of Perioperative Hypothermia | 196 | ||
| Physical, Active and Passive Strategies for Avoiding Perioperative Hypothermia | 196 | ||
| Postanaesthetic Shivering | 197 | ||
| FURTHER READING | 198 | ||
| Chapter 12: Fluid, electrolyte and acid–base balance | 199 | ||
| BASIC DEFINITIONS | 199 | ||
| COMPARTMENTAL DISTRIBUTION OF TOTAL BODY WATER | 200 | ||
| SOLUTE COMPOSITION OF BODY FLUID COMPARTMENTS | 200 | ||
| Extracellular Fluid | 200 | ||
| Intracellular Fluid | 201 | ||
| WATER HOMEOSTASIS | 201 | ||
| PRACTICAL FLUID BALANCE | 201 | ||
| Rule 1 | 201 | ||
| Rule 2 | 202 | ||
| Normal Maintenance Needs | 202 | ||
| Abnormal Losses | 202 | ||
| Existing Deficits | 203 | ||
| Assessment of Dehydration | 203 | ||
| Laboratory Assessment | 203 | ||
| Perioperative Fluid Therapy | 203 | ||
| SODIUM AND POTASSIUM | 204 | ||
| Sodium Balance | 204 | ||
| Disorders of Sodium/Water Balance | 204 | ||
| Hypernatraemia | 204 | ||
| Consequences of Hypernatraemia | 205 | ||
| Treatment of Hypernatraemia | 205 | ||
| Hyponatraemia | 206 | ||
| Consequences of Hyponatraemia | 207 | ||
| Treatment of Hyponatraemia | 208 | ||
| Potassium Balance | 208 | ||
| Hypokalaemia | 208 | ||
| Hyperkalaemia | 208 | ||
| ACID–BASE BALANCE | 209 | ||
| Basic Definitions | 210 | ||
| Acid–Base Disorders | 211 | ||
| Metabolic Acidosis | 212 | ||
| Clinical Effects and Treatment | 212 | ||
| Metabolic Alkalosis | 213 | ||
| Respiratory Acidosis | 214 | ||
| Respiratory Alkalosis | 214 | ||
| Stewart’s Physicochemical Theory of Acid–Base Balance | 215 | ||
| FURTHER READING | 215 | ||
| Chapter 13: Haematological disorders and blood transfusion | 216 | ||
| THE PHYSIOLOGY OF BLOOD | 216 | ||
| Blood Cells and Plasma | 216 | ||
| Blood Coagulation | 217 | ||
| HAEMATOLOGICAL DISORDERS AND THEIR IMPACT ON ANAESTHESIA | 219 | ||
| Anaemia | 219 | ||
| Haemoglobinopathies | 219 | ||
| Sickle-Cell Disease | 219 | ||
| Thalassaemia | 221 | ||
| Neutropaenia | 222 | ||
| Inherited and Other Coagulopathies | 222 | ||
| Coagulopathy of Trauma | 222 | ||
| Disseminated Intravascular Coagulation (DIC) | 225 | ||
| Drug-Induced Coagulopathies | 225 | ||
| Thrombocytopaenia | 227 | ||
| INTERVENTIONAL PROCEDURES AND REGIONAL ANAESTHESIA IN COAGULOPATHIC PATIENTS | 228 | ||
| THROMBOSIS AND ACUTE ISCHAEMIC EVENTS | 228 | ||
| PATIENTS WITH HAEMATOLOGICAL MALIGNANCY | 229 | ||
| BLOOD PRODUCTS AND BLOOD TRANSFUSION | 229 | ||
| Red Cell Storage Lesion | 230 | ||
| MAJOR HAEMORRHAGE | 234 | ||
| Predictable Blood Loss | 234 | ||
| Jehovah’s Witnesses | 235 | ||
| FURTHER READING | 235 | ||
| Chapter 14: Basic physics for the anaesthetist | 236 | ||
| BASIC DEFINITIONS | 236 | ||
| FLUIDS | 237 | ||
| Behaviour of Gases | 238 | ||
| The Gas Laws | 238 | ||
| Avogadro’s Hypothesis | 238 | ||
| Critical Temperature | 239 | ||
| Clinical Application of the Gas Laws | 239 | ||
| Filling Ratio | 239 | ||
| Entonox | 239 | ||
| Pressure Notation in Anaesthesia | 240 | ||
| GAS REGULATORS | 241 | ||
| Pressure Relief Valves | 241 | ||
| Pressure-Reducing Valves (Pressure Regulators) | 241 | ||
| Pressure Demand Regulators | 242 | ||
| Flow of Fluids | 243 | ||
| Laminar Flow | 243 | ||
| Turbulent Flow: Flow of Fluids Through Orifices | 243 | ||
| Applications of Turbulence in Anaesthetic Practice | 244 | ||
| THE VENTURI, THE INJECTOR AND BERNOULLI | 244 | ||
| The Coanda Effect | 246 | ||
| HEAT | 246 | ||
| Temperature and its Measurement | 246 | ||
| Specific Heat Capacity | 247 | ||
| VAPORIZATION AND VAPORIZERS | 247 | ||
| Vaporizers | 248 | ||
| Temperature Compensation | 249 | ||
| Back Pressure (Pumping Effect) | 249 | ||
| HUMIDITY AND HUMIDIFICATION | 250 | ||
| Absolute and Relative Humidity | 250 | ||
| Humidification of the Respiratory Tract | 250 | ||
| SOLUBILITY OF GASES | 250 | ||
| Solubility Coefficients | 251 | ||
| Diffusion | 251 | ||
| Osmosis | 251 | ||
| ELECTRICITY | 252 | ||
| Basic Quantities and Units | 252 | ||
| Electrical Safety | 253 | ||
| Isolation Circuits | 254 | ||
| Microshock | 254 | ||
| Safety Testing | 254 | ||
| The Defibrillator | 254 | ||
| Diathermy | 255 | ||
| ISOTOPES AND RADIATION | 255 | ||
| X-Rays | 255 | ||
| Radiation Safety | 255 | ||
| MAGNETIC RESONANCE IMAGING | 256 | ||
| Physical Principles of MRI | 257 | ||
| ULTRASOUND | 257 | ||
| LASERS | 258 | ||
| Physical Principles of Lasers | 259 | ||
| OPTICAL FIBRES | 260 | ||
| FIRES AND EXPLOSIONS | 260 | ||
| Fuels | 260 | ||
| Support of Combustion | 261 | ||
| Sources of Ignition | 261 | ||
| Static Electricity | 261 | ||
| Diathermy | 261 | ||
| Other Sources of Ignition | 261 | ||
| Prevention of Static Charges | 261 | ||
| FURTHER READING | 261 | ||
| Chapter 15: Anaesthetic apparatus | 262 | ||
| GAS SUPPLIES | 262 | ||
| Bulk Supply of Anaesthetic Gases | 262 | ||
| Bulk Store | 262 | ||
| Oxygen | 262 | ||
| Oxygen Concentrators | 263 | ||
| Nitrous Oxide | 263 | ||
| Medical Compressed Air | 263 | ||
| Piped Medical Vacuum | 263 | ||
| Terminal Outlets | 264 | ||
| Gas Supplies | 264 | ||
| CYLINDERS | 264 | ||
| THE ANAESTHETIC MACHINE | 266 | ||
| Supply of Gases | 266 | ||
| Pressure Gauges | 266 | ||
| Pressure Regulators | 266 | ||
| Flow Restrictors | 266 | ||
| Pressure Relief Valves on Regulators | 266 | ||
| Flowmeters | 267 | ||
| Problems with Flowmeters | 267 | ||
| Quantiflex | 267 | ||
| Linked Flowmeters | 268 | ||
| Vaporizers | 268 | ||
| SAFETY FEATURES OF MODERN ANAESTHETIC MACHINES | 271 | ||
| BREATHING SYSTEMS | 273 | ||
| Adjustable Pressure-Limiting Valve | 273 | ||
| Classification of Breathing Systems | 274 | ||
| Mapleson A Systems | 275 | ||
| Mapleson B and C Systems | 276 | ||
| Mapleson D System | 276 | ||
| Mapleson E and F Systems | 278 | ||
| Mapleson ADE System | 279 | ||
| Drawover Systems | 280 | ||
| Rebreathing Systems | 280 | ||
| Soda Lime | 280 | ||
| Baralyme | 281 | ||
| ‘To-and-Fro’ (Waters’) System | 281 | ||
| Circle System | 281 | ||
| Manual Resuscitation Breathing Systems | 284 | ||
| VENTILATORS | 285 | ||
| Inspiration | 286 | ||
| Constant Pressure Generator | 286 | ||
| Constant Flow Generator | 287 | ||
| Change from Inspiration to Expiration | 288 | ||
| Expiration | 288 | ||
| Change from Expiration to Inspiration | 288 | ||
| Delivery of Anaesthetic Gas | 288 | ||
| Transport Ventilators | 290 | ||
| High-Frequency Ventilation | 290 | ||
| Venturi Injector Device | 290 | ||
| SCAVENGING | 291 | ||
| Scavenging Apparatus | 292 | ||
| Active Systems | 292 | ||
| Semi-Active Systems | 292 | ||
| Passive Systems | 292 | ||
| RESERVOIR BAGS | 294 | ||
| LARYNGOSCOPES | 294 | ||
| Curved Blade | 295 | ||
| Straight Blade | 295 | ||
| Light Source | 296 | ||
| Laryngoscope Handle | 296 | ||
| Video Laryngoscopes | 296 | ||
| Fibreoptic Laryngo/Bronchoscope | 297 | ||
| TRACHEAL TUBES | 299 | ||
| Tube Size | 300 | ||
| Plain Tubes | 300 | ||
| Cuffed Tubes | 300 | ||
| Cuff Volume | 300 | ||
| Shape of Tube | 301 | ||
| Specialized Tubes | 301 | ||
| Tracheostomy Tubes | 302 | ||
| Cricothyroidotomy Devices | 303 | ||
| Connections | 303 | ||
| Catheter Mount | 303 | ||
| Tracheal Tube Connectors | 304 | ||
| Angle Pieces | 304 | ||
| PROTECTING THE BREATHING SYSTEM IN ANAESTHESIA | 304 | ||
| SUPRAGLOTTIC AIRWAY DEVICES (SADs) | 305 | ||
| The Classic Lma (cLMA) | 305 | ||
| Second Generation SADs | 305 | ||
| The Intubating LMA | 307 | ||
| OTHER APPARATUS | 307 | ||
| Face Masks | 307 | ||
| Intubating Forceps | 308 | ||
| Laryngeal Spray | 308 | ||
| Mouth Gag | 308 | ||
| Bougie | 309 | ||
| Stilettes | 309 | ||
| The Aintree Intubating Catheter (AIC) | 309 | ||
| Airways | 309 | ||
| Suction Apparatus | 310 | ||
| Head-Elevating Laryngoscopy Position Devices | 310 | ||
| DECONTAMINATION OF ANAESTHETIC EQUIPMENT | 310 | ||
| FURTHER READING | 311 | ||
| Chapter 16: Clinical measurement and monitoring | 312 | ||
| PROCESS OF CLINICAL MEASUREMENT | 314 | ||
| Stages of Clinical Measurement | 314 | ||
| The Microprocessor Revolution | 314 | ||
| Essential Requirements for Clinical Measurement | 314 | ||
| The Importance of Repeated Measurements | 315 | ||
| Measurement of Continuous Signals Over Time | 315 | ||
| Zero Stability | 315 | ||
| Gain Stability | 315 | ||
| Amplitude Linearity | 315 | ||
| Hysteresis | 315 | ||
| Frequency Response | 315 | ||
| Signal-to-Noise Ratio | 316 | ||
| Analogue and Digital Processing | 316 | ||
| Mechanical Measuring Instruments | 316 | ||
| Analogue Computers | 316 | ||
| Microcomputers and Digital Signal Processing | 316 | ||
| Analogue-to-Digital Conversion | 316 | ||
| Data Display | 317 | ||
| Analogue Displays | 317 | ||
| Microprocessor-Controlled Displays | 317 | ||
| BIOLOGICAL ELECTRICAL SIGNALS | 318 | ||
| Amplification | 318 | ||
| Input Impedance and Common Mode Rejection | 318 | ||
| Frequency Response | 319 | ||
| Noise and Interference | 319 | ||
| Noise Originating from the Patient | 319 | ||
| Noise Originating from the Patient–Electrode Interface | 319 | ||
| Noise Originating Outside the Patient | 319 | ||
| BIOLOGICAL MECHANICAL SIGNALS | 320 | ||
| Electromechanical Transducers | 320 | ||
| THE CARDIOVASCULAR SYSTEM | 321 | ||
| Electrocardiography | 321 | ||
| Arterial Pressure | 322 | ||
| Indirect Methods | 322 | ||
| Oscillometric Measurement of Arterial Pressure | 322 | ||
| Other Techniques | 323 | ||
| Direct Measurement | 323 | ||
| Resonant Frequency and Damping | 324 | ||
| Determination of the Resonant Frequency and Damping | 324 | ||
| Optimal Damping | 325 | ||
| Accuracy of Arterial Pressure Measurements | 325 | ||
| Central Venous Pressure | 326 | ||
| Pulmonary Artery Pressure | 326 | ||
| Cardiac Output | 328 | ||
| The Fick Principle | 328 | ||
| Indicator Dilution | 329 | ||
| Chemical Indicator Dilution | 329 | ||
| Thermal Indicator Dilution | 329 | ||
| Pulse Contour Analysis | 330 | ||
| Doppler Ultrasonography | 330 | ||
| Generation and Detection of Ultrasound | 331 | ||
| Properties of Ultrasound | 331 | ||
| Detection of Motion by the Doppler Effect: Cardiac Output | 331 | ||
| Transoesophageal Echocardiography | 332 | ||
| Thoracic Electrical Bioimpedance | 332 | ||
| THE RESPIRATORY SYSTEM | 332 | ||
| Clinical | 332 | ||
| Oesophageal Stethoscope | 333 | ||
| Respiratory Rate | 333 | ||
| Airway Pressure | 333 | ||
| Measurement of Gas Flow and Volume | 333 | ||
| Measuring Volume | 334 | ||
| Spirometers | 334 | ||
| Gas Meters | 334 | ||
| The Dräger Volumeter | 334 | ||
| The Wright Respirometer | 334 | ||
| Integration of the Flow Signal | 334 | ||
| Indirect Methods of Measuring Tidal Volume | 335 | ||
| Pneumography | 335 | ||
| Respiratory Inductance Plethysmography | 335 | ||
| Measuring Gas Flow | 335 | ||
| Volume–Time Methods | 335 | ||
| Variable Orifice (Constant Pressure Change) Flowmeters | 335 | ||
| Rotameter | 336 | ||
| The Peak Flowmeter | 336 | ||
| Variable Pressure Change (Fixed Orifice) Flowmeters | 336 | ||
| Bourdon Gauge Flowmeter | 336 | ||
| Pneumotachograph | 336 | ||
| Other Devices for Measuring Gas Flow | 337 | ||
| Hot-Wire Flowmeters | 337 | ||
| Ultrasonic Flowmeters | 337 | ||
| GAS AND VAPOUR ANALYSIS | 337 | ||
| Chemical Methods | 337 | ||
| Physical Methods | 337 | ||
| Non-Specific Methods | 338 | ||
| Thermal Conductivity | 338 | ||
| Refractive Index: Interference Refractometers | 338 | ||
| Specific Methods | 338 | ||
| Oxygen | 338 | ||
| Carbon Dioxide and Anaesthetic Gases | 339 | ||
| Absorption of Radiation | 339 | ||
| Mass Spectrometry | 340 | ||
| Gas–Liquid Chromatography | 340 | ||
| Raman Scattering | 341 | ||
| BLOOD GAS ANALYSIS | 341 | ||
| The Glass pH Electrode | 341 | ||
| The CO2 Electrode | 341 | ||
| Oxygenation | 341 | ||
| Oxygen Tension | 342 | ||
| Oxygen Electrode: the Polarographic Method | 342 | ||
| Galvanic or Fuel Cell | 342 | ||
| Transcutaneous Electrodes | 343 | ||
| Oxygen Content | 343 | ||
| Oximetry: Measurement of Oxygen Saturation | 343 | ||
| In Vitro Oximetry | 343 | ||
| Pulse Oximetry | 344 | ||
| THE NERVOUS SYSTEM | 345 | ||
| Depth of Anaesthesia | 346 | ||
| The Isolated Forearm Technique | 346 | ||
| The electroencephalogram and evoked potentials | 346 | ||
| Auditory Evoked Potentials | 347 | ||
| Other Techniques | 347 | ||
| Intracranial Pressure | 347 | ||
| Brain Oxygenation | 347 | ||
| TEMPERATURE | 349 | ||
| Direct Reading Non-Electrical Thermometers | 349 | ||
| Liquid Expansion Thermometers | 349 | ||
| Chemical Thermometers | 349 | ||
| Infrared Thermometers | 349 | ||
| Remote Reading Instruments | 349 | ||
| Resistance-Wire Thermometers | 349 | ||
| Thermistor Thermometers | 349 | ||
| Thermocouple Thermometers | 350 | ||
| Equipment Temperature | 350 | ||
| Dial Thermometers | 350 | ||
| Bimetallic Strip Thermometers | 350 | ||
| BLOOD LOSS AND TRANSFUSION | 350 | ||
| Red Cell Loss | 350 | ||
| Blood Clotting | 350 | ||
| Near-Patient Testing | 351 | ||
| MONITORING STANDARDS | 351 | ||
| ALARMS | 351 | ||
| Oxygen Supply | 352 | ||
| Breathing Systems | 352 | ||
| Vapour Analyser | 353 | ||
| Cardiovascular | 353 | ||
| Infusion Devices | 353 | ||
| GENERAL GUIDELINES FOR MONITORING DURING ANAESTHESIA | 353 | ||
| Additional Monitoring | 354 | ||
| Monitoring During Transfer | 354 | ||
| ANAESTHETIC RECORD-KEEPING | 355 | ||
| Automated Records | 355 | ||
| FURTHER READING | 356 | ||
| Chapter 17: Preoperative assessment and premedication | 357 | ||
| THE PROCESS OF PREOPERATIVE ASSESSMENT | 357 | ||
| Who, When and Where? | 357 | ||
| History | 358 | ||
| Presenting Condition and Concurrent Medical History | 358 | ||
| Anaesthetic History | 358 | ||
| Family History | 359 | ||
| Drug History | 359 | ||
| History of Allergy | 361 | ||
| Smoking | 361 | ||
| Alcohol | 362 | ||
| Obstructive Sleep Apnoea | 362 | ||
| Physical Examination | 362 | ||
| Special Investigations | 363 | ||
| Urine Analysis | 363 | ||
| Full Blood Count | 363 | ||
| Blood Chemistry | 364 | ||
| Coagulation Tests | 364 | ||
| Chest X-Ray | 364 | ||
| Other X-rays | 365 | ||
| Cardiac Investigation | 365 | ||
| ECG | 365 | ||
| Echocardiography | 365 | ||
| Pulmonary Function Tests | 365 | ||
| Cardiopulmonary Exercise Testing | 365 | ||
| PREDICTION OF PERIOPERATIVE MORBIDITY OR MORTALITY | 367 | ||
| Prediction of Non-Specific Adverse Outcome | 367 | ||
| ASA (American Society of Anesthesiologists) Grading | 368 | ||
| POSSUM | 369 | ||
| Prediction of Specific Adverse Events | 369 | ||
| The Difficult Airway | 369 | ||
| Adverse Cardiac Events | 369 | ||
| Respiratory Complications | 370 | ||
| PREOPERATIVE PREPARATION | 370 | ||
| Postponing Surgery for Clinical Reasons | 370 | ||
| Acute Upper Respiratory Tract Infection | 370 | ||
| Coexisting Medical Disease and Drug Therapy | 371 | ||
| Emergency Surgery for Which the Patient has not been Resuscitated Adequately | 371 | ||
| Recent Ingestion of Food | 371 | ||
| Failure to Obtain Consent | 371 | ||
| Preoperative Fasting | 371 | ||
| Providing Information to the Patient and Obtaining Consent | 371 | ||
| Blood Transfusion Requests | 372 | ||
| Preoperative Organization of the Operating Theatre and the Postoperative Period | 372 | ||
| PREMEDICATION AND OTHER PROPHYLACTIC MEASURES | 373 | ||
| Relief from Anxiety | 373 | ||
| Sedation | 373 | ||
| Postoperative Antiemesis | 373 | ||
| Analgesia | 373 | ||
| Paracetamol | 373 | ||
| Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) | 373 | ||
| Opioid Analgesics | 373 | ||
| Reduction in Secretions | 373 | ||
| Reduction in Gastric Volume and Elevation of Gastric pH | 374 | ||
| Reduction in Vagal Reflexes | 374 | ||
| Limitation of Sympathoadrenal Responses | 374 | ||
| Drugs Used for Premedication | 374 | ||
| Benzodiazepines | 374 | ||
| Anticholinergic Agents | 374 | ||
| β-Blockers | 375 | ||
| Clonidine and Dexmedetomidine | 376 | ||
| Other Prophylactic Measures | 376 | ||
| FURTHER READING | 376 | ||
| Chapter 18: Intercurrent disease and anaesthesia | 377 | ||
| Physiological Reserve | 377 | ||
| Extent of Surgery | 377 | ||
| Specific Disease Processes | 378 | ||
| CARDIOVASCULAR DISEASE | 378 | ||
| Ischaemic Heart Disease | 378 | ||
| Preoperative Assessment | 378 | ||
| History | 379 | ||
| Examination | 379 | ||
| Risk Stratification | 379 | ||
| Investigations | 380 | ||
| Preoperative Therapy | 382 | ||
| Pre-Existing Cardiovascular Disease | 382 | ||
| Treatment and Additional Interventions | 383 | ||
| Premedication | 384 | ||
| Anaesthesia: General Principles | 385 | ||
| Anaesthetic Agents | 386 | ||
| Arrhythmias | 386 | ||
| Intraoperative Arrhythmias | 386 | ||
| Management | 387 | ||
| Intraoperative Bradyarrhythmias | 387 | ||
| Intraoperative Tachyarrhythmias | 387 | ||
| Permanent Pacemakers | 388 | ||
| Specific Issues in Anaesthetic Management | 388 | ||
| Implantable Cardioverter Defibrillators (ICDs) | 389 | ||
| Valvular Heart Disease | 389 | ||
| General Principles | 389 | ||
| Aortic Stenosis | 389 | ||
| Mitral Stenosis | 390 | ||
| Aortic Regurgitation | 390 | ||
| Mitral Regurgitation | 390 | ||
| Infective Endocarditis | 390 | ||
| Hypertrophic Cardiomyopathy | 390 | ||
| RESPIRATORY DISEASE | 391 | ||
| Assessment | 391 | ||
| History | 391 | ||
| Examination | 391 | ||
| Investigations | 391 | ||
| Chest X-ray | 391 | ||
| ECG | 391 | ||
| Haematology | 391 | ||
| Sputum Culture | 391 | ||
| Pulmonary Function Tests | 391 | ||
| Blood Gas Measurement | 392 | ||
| Effects of Anaesthesia and Surgery | 392 | ||
| Regional Anaesthesia | 392 | ||
| Laparoscopic Surgery | 392 | ||
| Obstructive Pulmonary Disease | 393 | ||
| Chronic Obstructive Pulmonary Disease | 393 | ||
| ASTHMA | 393 | ||
| Preoperative Management | 393 | ||
| Treatment of Airways Obstruction | 393 | ||
| Treatment of Active Infection | 394 | ||
| Treatment of Cardiac Failure | 394 | ||
| Weight Reduction | 394 | ||
| Smoking | 394 | ||
| Premedication | 394 | ||
| Anaesthesia | 394 | ||
| An Approach with Minimal Intervention | 394 | ||
| Elective Mechanical Ventilation | 394 | ||
| Regional Anaesthesia | 394 | ||
| Anaesthetic Agents | 394 | ||
| Postoperative Care | 395 | ||
| Oxygen and Respiratory Care | 395 | ||
| Analgesia | 395 | ||
| Bronchiectasis | 395 | ||
| Restrictive Lung Disease | 395 | ||
| Bronchial Carcinoma | 396 | ||
| Tuberculosis | 396 | ||
| GASTROINTESTINAL DISEASE | 396 | ||
| Malnutrition | 396 | ||
| Fluid and Electrolyte Depletion | 396 | ||
| Gastrointestinal Reflux | 396 | ||
| LIVER DISEASE | 397 | ||
| Preoperative Assessment | 397 | ||
| Initial Management Issues | 398 | ||
| Conduct of Anaesthesia | 398 | ||
| RENAL DISEASE | 399 | ||
| Pre-Anaesthetic Assessment | 399 | ||
| Fluid Balance | 399 | ||
| Electrolyte Disturbances | 399 | ||
| Sodium | 399 | ||
| Potassium | 400 | ||
| Calcium | 400 | ||
| Cardiovascular Effects | 400 | ||
| Neurological Effects | 400 | ||
| Haematological Effects | 400 | ||
| Other Factors | 401 | ||
| Drug Treatment | 401 | ||
| Anaesthesia | 401 | ||
| Postoperative Renal Failure | 402 | ||
| DIABETES MELLITUS | 402 | ||
| Preoperative Assessment | 403 | ||
| Control of Blood Glucose | 403 | ||
| Treatment Regimens | 403 | ||
| Complications of Diabetes Mellitus | 404 | ||
| Concurrent Drug Therapy | 404 | ||
| Perioperative Diabetic Management | 404 | ||
| Emergency Surgery and Diabetic Ketoacidosis | 405 | ||
| OTHER ENDOCRINE DISORDERS | 405 | ||
| Pituitary Disease | 405 | ||
| Acromegaly | 405 | ||
| Cushing’s Disease | 406 | ||
| Hypopituitarism (Simmonds’ Disease) | 406 | ||
| Diabetes Insipidus | 406 | ||
| Thyroid Disease | 406 | ||
| Goitre | 406 | ||
| Thyrotoxicosis | 406 | ||
| Preparation for Thyroidectomy | 407 | ||
| Hypothyroidism | 407 | ||
| Disease of the Adrenal Cortex | 407 | ||
| Hypersecretion of Cortisol (Cushing’s Syndrome) | 407 | ||
| Primary Hypersecretion of Aldosterone (Conn’s Syndrome) | 407 | ||
| Adrenocortical Hypofunction | 408 | ||
| Congenital Adrenal Hyperplasia (Adrenogenital Syndrome) | 408 | ||
| Steroid Therapy | 408 | ||
| Steroid Cover for Anaesthesia and Surgery | 408 | ||
| Disease of the Adrenal Medulla | 409 | ||
| Phaeochromocytoma | 409 | ||
| NEUROLOGICAL DISEASE | 409 | ||
| General Considerations | 409 | ||
| Assessment | 409 | ||
| Respiratory Impairment | 409 | ||
| Altered Innervation of Muscle and Hyperkalaemia | 409 | ||
| Autonomic Disturbances | 410 | ||
| Conscious Level | 410 | ||
| Increased Intracranial Pressure | 410 | ||
| Medicolegal | 410 | ||
| Epilepsy | 410 | ||
| Anaesthesia | 410 | ||
| Status Epilepticus | 410 | ||
| Parkinson’s Disease | 411 | ||
| Anaesthetic Management | 411 | ||
| Multiple Sclerosis | 412 | ||
| Peripheral Neuropathies | 412 | ||
| Acute Demyelinating Polyneuropathy (Guillain–Barré Syndrome) | 412 | ||
| Motor Neurone Disease (Progressive Muscular Atrophy, Amyotrophic Lateral Sclerosis, Progressive Bulbar Palsy) | 412 | ||
| Hereditary Ataxias | 412 | ||
| Spinal Cord Lesions with Paraplegia | 413 | ||
| Huntington’s Chorea | 413 | ||
| Myasthenia Gravis | 413 | ||
| Familial Periodic Paralysis | 413 | ||
| Progressive Muscular Dystrophy | 413 | ||
| Dystrophia Myotonica | 414 | ||
| PSYCHIATRIC DISEASE | 414 | ||
| Electroconvulsive Therapy | 414 | ||
| Anaesthesia | 414 | ||
| Preoperative assessment | 414 | ||
| Anaesthetic Management | 414 | ||
| Drug Interactions | 415 | ||
| Tricyclic Antidepressants | 415 | ||
| Monoamine Oxidase Inhibitors | 415 | ||
| Selective Serotonin Reuptake Inhibitors | 415 | ||
| Phenothiazines | 415 | ||
| Lithium | 415 | ||
| CONNECTIVE TISSUE DISORDERS | 415 | ||
| Rheumatoid Arthritis | 416 | ||
| Airway Problems | 416 | ||
| Respiratory Function | 416 | ||
| Cardiovascular System | 416 | ||
| Anaemia | 416 | ||
| Renal Function | 416 | ||
| Steroid Therapy and Immunosuppression | 416 | ||
| Routine Preoperative Investigation | 416 | ||
| Conduct of Anaesthesia | 416 | ||
| Other Connective Tissue Diseases | 416 | ||
| Scleroderma | 416 | ||
| Systemic Lupus Erythematosus | 417 | ||
| Ankylosing Spondylitis | 417 | ||
| Marfan’s Syndrome | 417 | ||
| NUTRITIONAL PROBLEMS | 417 | ||
| Obesity | 417 | ||
| Cardiovascular Function | 417 | ||
| Respiratory Function | 417 | ||
| Other Factors | 417 | ||
| Pickwickian Syndrome | 417 | ||
| Malnutrition | 417 | ||
| ANAESTHETIC CONSIDERATIONS IN THE ELDERLY | 418 | ||
| Organ System Changes | 418 | ||
| Central Nervous System | 418 | ||
| Cardiovascular | 418 | ||
| Respiratory System | 418 | ||
| Renal | 418 | ||
| ANAESTHETIC CONSIDERATIONS | 418 | ||
| HUMAN IMMUNODEFICIENCY VIRUS | 419 | ||
| MYELOMA | 419 | ||
| PORPHYRIA | 420 | ||
| FURTHER READING | 421 | ||
| Chapter 19: Consent and information for patients | 422 | ||
| TYPES OF CONSENT | 422 | ||
| CONSENT AS AN ACTIVE PROCESS | 423 | ||
| Voluntariness | 423 | ||
| Information | 423 | ||
| Quantity | 423 | ||
| Methods of Information Provision | 424 | ||
| Communicating Risk | 425 | ||
| Capacity | 426 | ||
| Consent in Special Circumstances | 426 | ||
| Emergency | 426 | ||
| Children | 426 | ||
| Pregnancy | 427 | ||
| SUMMARY | 427 | ||
| FURTHER READING | 427 | ||
| Chapter 20: The operating theatre environment | 428 | ||
| THE OPERATING THEATRE SUITE | 428 | ||
| Transfer of Patient | 429 | ||
| Anaesthetic Room | 429 | ||
| Operating Room | 430 | ||
| Temperature, Humidity and Ventilation | 430 | ||
| Light | 431 | ||
| Safety in the Operating Theatre | 431 | ||
| Electrical Safety | 431 | ||
| Explosions | 431 | ||
| Atmospheric Pollution | 432 | ||
| Infection | 433 | ||
| Prevention of Hospital-Acquired Infection | 434 | ||
| Noise | 434 | ||
| Equipment Checks | 435 | ||
| Alternative Means of Ventilation | 435 | ||
| Perform Manufacturer’s Machine Check | 435 | ||
| Power Supply | 435 | ||
| Gas Supplies and Suction | 437 | ||
| Suction | 437 | ||
| Medical Gas Supplies | 437 | ||
| Breathing System and Vaporizers | 438 | ||
| Manual Leak Test of Vaporizer | 438 | ||
| Carbon Dioxide Absorber | 438 | ||
| Alternative Breathing Systems | 438 | ||
| Correct Gas Outlet | 438 | ||
| Ventilator | 438 | ||
| Two-Bag Test | 439 | ||
| Scavenging | 439 | ||
| Monitoring Equipment | 439 | ||
| Airway Equipment | 439 | ||
| Single-Use Devices | 439 | ||
| Total Intravenous Anaesthesia (TIVA) | 439 | ||
| Ancillary and Resuscitation Equipment | 439 | ||
| Machine Failure | 440 | ||
| ‘Shared Responsibility’ Equipment | 440 | ||
| Recording and Audit | 440 | ||
| Recovery | 440 | ||
| Emergencies | 440 | ||
| Recovery Room/Post-Anaesthesia Care Unit | 440 | ||
| High-Dependency Unit | 441 | ||
| Procedure Rooms | 441 | ||
| Other Accommodation | 441 | ||
| Other Anaesthetizing Locations | 441 | ||
| Ancillary Staff | 442 | ||
| Physicians’ Assistants (Anaesthesia) | 442 | ||
| FURTHER READING | 443 | ||
| Chapter 21: The practical conduct of anaesthesia | 444 | ||
| PREPARATION FOR ANAESTHESIA | 444 | ||
| INDUCTION OF ANAESTHESIA | 444 | ||
| Inhalational Induction | 444 | ||
| Complications and Difficulties | 445 | ||
| Intravenous Induction | 445 | ||
| Complications and Difficulties | 446 | ||
| POSITION OF PATIENT FOR SURGERY | 446 | ||
| MAINTENANCE OF ANAESTHESIA | 447 | ||
| Inhalational Anaesthesia with Spontaneous Ventilation | 448 | ||
| Conduct | 448 | ||
| Minimum Alveolar Concentration | 448 | ||
| Signs of Anaesthesia | 448 | ||
| Complications and Difficulties | 449 | ||
| Delivery of Inhalational Agents – Airway Maintenance | 450 | ||
| Use of the Face Mask | 450 | ||
| Use of the Laryngeal Mask Airway and Other Supraglottic Airway Devices | 450 | ||
| indications | 450 | ||
| contraindications | 450 | ||
| Tracheal Intubation | 451 | ||
| Indications | 451 | ||
| Preparation | 451 | ||
| Choice of Equipment | 451 | ||
| Laryngoscopes | 451 | ||
| Tracheal Tubes | 451 | ||
| Anaesthesia for Tracheal Intubation | 452 | ||
| Inhalational Technique for Intubation | 452 | ||
| Relaxant Anaesthesia for Intubation | 452 | ||
| Conduct of Laryngoscopy | 453 | ||
| Conduct of Intubation | 453 | ||
| Nasal Intubation | 454 | ||
| Difficult Intubation | 454 | ||
| Aetiology | 454 | ||
| Management | 455 | ||
| Inhalational Induction | 457 | ||
| Awake Intubation | 458 | ||
| Complications of Tracheal Intubation | 458 | ||
| Early Complications | 458 | ||
| Late Complications | 458 | ||
| Anaesthesia Using Neuromuscular Blocking Drugs | 458 | ||
| Indications | 458 | ||
| Conduct of Relaxant Anaesthesia | 458 | ||
| Assessment of Relaxant Anaesthesia | 458 | ||
| Reversal of Relaxation | 459 | ||
| OTHER TECHNIQUES | 459 | ||
| Total Intravenous Anaesthesia | 459 | ||
| Opioid Infusions | 460 | ||
| CONDUCT OF EXTUBATION | 460 | ||
| Complications of Tracheal Extubation | 461 | ||
| Laryngeal Spasm | 461 | ||
| Regurgitation/Inhalation | 461 | ||
| EMERGENCE AND RECOVERY | 461 | ||
| REFERENCES AND FURTHER READING | 461 | ||
| Chapter 22: Management of the difficult airway | 462 | ||
| BEFORE MANAGING THE DIFFICULT AIRWAY | 463 | ||
| Preparedness | 463 | ||
| Organizational Preparedness | 463 | ||
| Guidelines | 463 | ||
| Equipment | 463 | ||
| Communication and Training | 463 | ||
| Personal Preparedness | 465 | ||
| Assessment and Planning a Strategy | 465 | ||
| MANAGEMENT OF THE DIFFICULT AIRWAY | 466 | ||
| Training, Teamwork and Human Factors | 466 | ||
| Before Approaching the Difficult Airway | 466 | ||
| Securing the Airway Awake | 466 | ||
| Administration of Muscle Relaxants in the Patient with a Difficult Airway | 467 | ||
| Selecting an Appropriate Size of Tracheal Tube | 467 | ||
| DIFFICULT AIRWAYS AND THEIR MANAGEMENT | 468 | ||
| The ASA and DAS Guidelines | 468 | ||
| Difficult Mask Ventilation | 468 | ||
| Difficulties with Mask Ventilation can be due to: | 468 | ||
| MANAGEMENT OF UNPREDICTED DIFFICULT INTUBATION | 474 | ||
| Plan A: Primary Intubation Attempt | 474 | ||
| Plan B: Secondary Intubation Attempt | 474 | ||
| Intubation Via a SAD | 475 | ||
| Intubation Via an ILMA | 475 | ||
| Plan C: Failed Intubation, Oxygenation and Waking | 477 | ||
| Management of Unanticipated Difficult Intubation During RSI | 477 | ||
| Plan D: Management of the CICV Situation | 479 | ||
| Give 100% Oxygen and Call for Help | 480 | ||
| Perform Optimal Face Mask Ventilation | 480 | ||
| Insert an Appropriate SAD | 480 | ||
| Wake the Patient if this is Feasible | 480 | ||
| If Waking is not Feasible and CICV Persists, Administer a Neuromuscular Blocking Drug if not Already Administered | 480 | ||
| If the Situation is not Resolved, Secure the Airway with Direct Tracheal Access | 481 | ||
| Decision making in CICV | 481 | ||
| EMERGENCY SURGICAL AIRWAY TECHNIQUES | 481 | ||
| Devices | 481 | ||
| Narrow-Bore Cannula with High Pressure SourceVentilation | 481 | ||
| Wide-Bore Cannula (≥4 mm) | 482 | ||
| Surgical Airway | 482 | ||
| Ventilation and Expiration Via Cricothyroidotomy Devices | 483 | ||
| Narrow-Bore Cannula | 483 | ||
| Wide-Bore Cannula and Surgical Techniques | 484 | ||
| MANAGEMENT OF THE PREDICTED DIFFICULT AIRWAY | 484 | ||
| MANAGEMENT OF THE OBSTRUCTED AIRWAY | 485 | ||
| Upper Airway Obstruction | 486 | ||
| Mid-Tracheal Obstruction | 487 | ||
| Lower Tracheal or Bronchial Obstruction | 487 | ||
| Specific Techniques | 488 | ||
| Supraglottic Airway Devices for Airway Rescue | 488 | ||
| SADs as Conduits for Intubation | 488 | ||
| ‘Videolaryngoscopes’, Rigid Indirect Laryngoscopes, Optical Stilettes and Advanced Intubation Aids: (see also Chapter 15) | 488 | ||
| EXTUBATION AND RECOVERY | 490 | ||
| Guidelines on Management of Extubation | 491 | ||
| THE DIFFICULT AIRWAY IN OTHER LOCATIONS | 492 | ||
| MANAGEMENT OF THE DIFFICULT AIRWAY IN CHILDREN | 493 | ||
| Management of the Child with an Inhaled Foreign Body | 494 | ||
| AFTER DIFFICULT AIRWAY MANAGEMENT | 496 | ||
| Immediate Management | 496 | ||
| Long-Term Management | 496 | ||
| FURTHER READING | 496 | ||
| Chapter 23: Management of the high-risk surgical patient | 497 | ||
| WHAT MAKES AN OPERATION HIGH-RISK? | 497 | ||
| IDENTIFYING THE HIGH-RISK SURGICAL PATIENT | 498 | ||
| RISK PREDICTION SCORING SYSTEMS | 498 | ||
| ASA Score | 498 | ||
| Shoemaker’s Criteria | 498 | ||
| Possum Score | 498 | ||
| Revised Cardiac Risk Index | 499 | ||
| POSTOPERATIVE PULMONARY COMPLICATION RISK PREDICTORS | 499 | ||
| LABORATORY INVESTIGATIONS FOR RISK ASSESSMENT | 499 | ||
| Routine Investigations | 499 | ||
| Plasma Biomarkers | 499 | ||
| Resting Echocardiography | 500 | ||
| Stress Echocardiography | 500 | ||
| Assessment of Functional Capacity | 500 | ||
| Simple Exercise Testing | 500 | ||
| Cardiopulmonary Exercise Testing (CPET) | 500 | ||
| Anaerobic Threshold | 501 | ||
| Ventilatory Efficiency | 501 | ||
| Identification of Myocardial Dysfunction | 502 | ||
| REDUCING RISK BEFORE SURGERY | 502 | ||
| ALTERNATIVES TO MAJOR SURGERY | 503 | ||
| PREOPERATIVE INTERVENTIONS TO REDUCE RISK | 504 | ||
| β-Blockade | 504 | ||
| Statin Therapy | 504 | ||
| Coronary Revascularization | 504 | ||
| Smoking Cessation | 504 | ||
| Chest Physiotherapy | 504 | ||
| Correction of Anaemia | 505 | ||
| IDENTIFYING PATIENTS IN NEED OF POSTOPERATIVE CRITICAL CARE | 505 | ||
| PERIOPERATIVE MANAGEMENT OF THE HIGH-RISK PATIENT | 506 | ||
| Choice of Anaesthetic Technique | 506 | ||
| Haemodynamic Monitoring, Fluid Therapy, and Optimization of Oxygen Delivery | 506 | ||
| Oxygen Delivery | 506 | ||
| Oxygen Consumption | 506 | ||
| Stroke Volume | 506 | ||
| Preoperative Optimization of Oxygen Delivery | 507 | ||
| Intraoperative Stroke Volume Optimization | 508 | ||
| Preload Responsiveness to Guide Fluid Therapy | 509 | ||
| Choice of Fluid | 510 | ||
| Fluid Restriction Regimens | 510 | ||
| POSTOPERATIVE MANAGEMENT | 511 | ||
| Monitoring on the General Ward | 511 | ||
| Monitoring in the Critical Care Unit | 511 | ||
| Central Venous Catheter | 511 | ||
| Arterial Cannula | 512 | ||
| INOTROPIC SUPPORT FOR THE HIGH-RISK SURGICAL PATIENT | 512 | ||
| FURTHER READING | 513 | ||
| Chapter 24: Local anaesthetic techniques | 514 | ||
| FEATURES OF LOCAL ANAESTHESIA | 514 | ||
| COMPLICATIONS OF LOCAL ANAESTHESIA | 515 | ||
| Local Anaesthetic Toxicity | 515 | ||
| Clinical Features and Treatment | 515 | ||
| Prevention | 515 | ||
| Test Dose | 515 | ||
| Hypotension | 515 | ||
| Sympathetic Blockade | 515 | ||
| Total Spinal Blockade | 516 | ||
| Vasovagal Attack | 516 | ||
| Anaphylactoid Reaction | 516 | ||
| Local Anaesthetic Toxicity | 516 | ||
| Motor Blockade | 516 | ||
| Pneumothorax | 516 | ||
| Urinary Retention | 516 | ||
| Neurological Complications | 516 | ||
| Equipment Problems | 516 | ||
| GENERAL MANAGEMENT | 516 | ||
| Patient Assessment and Selection | 516 | ||
| Selection of Technique | 517 | ||
| Premedication | 517 | ||
| Timing | 518 | ||
| Resuscitation Equipment | 518 | ||
| Regional Block Equipment | 518 | ||
| Needles | 518 | ||
| Immobile Needle Technique | 519 | ||
| Catheters | 519 | ||
| Nerve Stimulators | 519 | ||
| Ultrasound | 520 | ||
| Asepsis | 520 | ||
| Monitoring | 520 | ||
| Supplementary Techniques | 520 | ||
| After-Care | 521 | ||
| INTRAVENOUS REGIONAL ANAESTHESIA | 521 | ||
| Indications | 521 | ||
| Method | 521 | ||
| Tourniquet Pain | 522 | ||
| Choice of Drug | 522 | ||
| Lower Limb | 522 | ||
| CENTRAL NERVE BLOCKS | 522 | ||
| Physiological Effects of Subarachnoid Block | 522 | ||
| Differential Nerve Blockade | 522 | ||
| Respiratory System | 522 | ||
| Cardiovascular System | 522 | ||
| Prevention of Hypotension | 523 | ||
| Gastrointestinal System | 523 | ||
| Physiological Effects of Epidural Block | 523 | ||
| Indications for Subarachnoid Block | 523 | ||
| Types of Surgery | 523 | ||
| Urology | 523 | ||
| Gynaecology | 524 | ||
| Obstetrics | 524 | ||
| Any Surgical Procedure on the Lower Limbs or Perineum | 524 | ||
| Indications for Epidural Blockade | 524 | ||
| Contraindications to Subarachnoid Block and Epidural Anaesthesia | 524 | ||
| Performance of Subarachnoid Block | 524 | ||
| Intravenous Access | 524 | ||
| Positioning the Patient | 525 | ||
| Technique of Lumbar Puncture | 525 | ||
| Factors Affecting Spread | 526 | ||
| Factors Affecting Duration | 526 | ||
| Agents | 528 | ||
| Complications | 528 | ||
| Acute | 528 | ||
| Postoperative | 529 | ||
| Other complications. | 529 | ||
| Continuous Spinal Anaesthesia | 529 | ||
| Performance of Epidural Block | 529 | ||
| Equipment | 529 | ||
| Technique | 530 | ||
| Single-Dose Technique | 531 | ||
| Catheter Insertion | 531 | ||
| Factors Affecting Spread | 531 | ||
| Factors Affecting Onset | 531 | ||
| Factors Affecting Duration | 532 | ||
| Agents | 532 | ||
| Lidocaine | 532 | ||
| Bupivacaine | 532 | ||
| Levobupivacaine | 532 | ||
| Ropivacaine | 532 | ||
| Complications | 532 | ||
| Intraoperative | 532 | ||
| Total Spinal Anaesthesia | 532 | ||
| Massive Epidural Block and Subdural Block | 532 | ||
| Postoperative | 533 | ||
| Anticoagulants and Subarachnoid Block or Epidural Anaesthesia | 533 | ||
| Oral Anticoagulants | 533 | ||
| Platelets | 533 | ||
| Antiplatelet Agents | 533 | ||
| Heparin | 533 | ||
| Intraoperative Heparinization | 534 | ||
| Caudal Anaesthesia | 534 | ||
| Indications | 534 | ||
| Method | 534 | ||
| Complications | 534 | ||
| PERIPHERAL BLOCKS | 535 | ||
| Head and Neck Blocks | 535 | ||
| Awake Intubation | 535 | ||
| Upper Limb Blocks | 535 | ||
| Anatomy of the Brachial Plexus | 536 | ||
| Ultrasound-Guidance | 536 | ||
| Axillary Block | 536 | ||
| Positioning | 536 | ||
| Method | 537 | ||
| Disadvantages | 539 | ||
| Infraclavicular Block | 540 | ||
| Chapter 25: Anaesthesia for the bariatric patient | 550 | ||
| INTRODUCTION | 550 | ||
| MEASURING OBESITY | 550 | ||
| OBESITY PATHOPHYSIOLOGY, ŁCOMORBIDITY AND THE METABOLIC SYNDROME | 550 | ||
| The Adipose Organ | 551 | ||
| COMORBIDITY AND ANAESTHETIC MANAGEMENT | 551 | ||
| Airway | 551 | ||
| Anatomy | 551 | ||
| Airway Adjuncts | 552 | ||
| Respiratory Pathophysiology | 552 | ||
| Anatomy | 552 | ||
| Pathophysiology | 553 | ||
| CLINICAL RESPIRATORY COMORBIDITY | 554 | ||
| Asthma | 554 | ||
| Sleep-Disordered Breathing | 554 | ||
| ANAESTHETIC MANAGEMENT POINTS | 554 | ||
| CARDIOVASCULAR PATHOPHYSIOLOGY | 554 | ||
| Oxygen Demand and Delivery | 555 | ||
| Cardiac Pathophysiology | 555 | ||
| Electrophysiology | 555 | ||
| Right Ventricular Pathophysiology | 555 | ||
| VASCULAR DISEASE | 555 | ||
| LIVER | 556 | ||
| Gastro-Oesophageal Reflux | 557 | ||
| PHARMACOLOGY | 557 | ||
| Intravenous Induction Agents | 557 | ||
| Inhalational Agents | 557 | ||
| Muscle Relaxants | 557 | ||
| Suxamethonium | 557 | ||
| Non-Depolarizing Agents | 558 | ||
| Reversal Agents | 558 | ||
| Sugammadex | 558 | ||
| BARIATRIC OPERATIONS | 558 | ||
| Gastric Banding | 558 | ||
| Sleeve Gastrectomy | 558 | ||
| Malabsorbtive Procedures | 558 | ||
| POSTOPERATIVE CARE OF THE OBESITY SURGERY PATIENT | 559 | ||
| Weight Loss and Malnutrition | 559 | ||
| FURTHER READING | 559 | ||
| Chapter 26: Day-case anaesthesia | 560 | ||
| PATIENT SELECTION | 560 | ||
| ORGANIZATION OF THE DAY-CASE UNIT | 562 | ||
| Types Of Unit | 562 | ||
| Facilities Available | 563 | ||
| Admission | 563 | ||
| ANAESTHESIA | 563 | ||
| Premedication | 563 | ||
| Benzodiazepines | 563 | ||
| Antiemetics | 564 | ||
| Antacids | 564 | ||
| Analgesics | 564 | ||
| General and Regional Anaesthesia | 564 | ||
| General Anaesthesia | 564 | ||
| Regional Anaesthesia | 565 | ||
| POSTOPERATIVE CARE | 566 | ||
| REFERENCE | 567 | ||
| FURTHER READING | 567 | ||
| Chapter 27: Anaesthesia for gynaecological and genitourinary surgery | 568 | ||
| GENERAL CONSIDERATIONS | 568 | ||
| Positioning | 568 | ||
| Laparoscopic Procedures | 569 | ||
| Other Endoscopic Surgery | 570 | ||
| TRANSURETHRAL RESECTION (TUR) SYNDROME | 570 | ||
| REGIONAL ANAESTHESIA | 571 | ||
| PERIOPERATIVE INFECTIONS | 572 | ||
| OTHER CONSIDERATIONS | 572 | ||
| ANAESTHETIC IMPLICATIONS OF SPECIFIC SURGICAL TECHNIQUES | 573 | ||
| Pelvic Surgery | 573 | ||
| Nephrectomy and Renal Surgery | 574 | ||
| Prostate Surgery | 574 | ||
| Intrauterine and Transurethral Bladder Surgery | 575 | ||
| Perineal, Penile and Testicular Surgery | 576 | ||
| Continence Surgery | 576 | ||
| Surgery for Renal Tract Stones | 577 | ||
| FURTHER READING | 577 | ||
| Chapter 28: Anaesthesia for orthopaedic surgery | 578 | ||
| THE PATIENT POPULATION | 578 | ||
| Comorbidities | 578 | ||
| Rheumatoid Arthritis | 578 | ||
| Osteoarthritis | 579 | ||
| Ankylosing Spondylitis | 579 | ||
| Concurrent Drug Therapy | 579 | ||
| Non-Steroidal Anti-Inflammatory Drugs | 579 | ||
| Opioid Analgesics | 579 | ||
| Corticosteroids | 580 | ||
| Immunosuppressant Drugs | 580 | ||
| Other Drugs | 580 | ||
| TECHNIQUES OF ANAESTHESIA | 580 | ||
| General Anaesthesia | 580 | ||
| Regional Anaesthesia | 580 | ||
| POSTOPERATIVE ANALGESIA | 581 | ||
| Oral and Intravenous Agents | 581 | ||
| Central Neuraxial Drugs | 582 | ||
| Peripheral Nerve Blocks | 582 | ||
| SURGICAL CONSIDERATIONS | 583 | ||
| Positioning | 583 | ||
| Prophylaxis Against Infection | 583 | ||
| Prophylaxis Against Hypothermia | 583 | ||
| Prophylaxis Against Thromboembolism | 584 | ||
| Arterial Tourniquets | 584 | ||
| Blood Conservation | 585 | ||
| Avoidance of Red Cell Loss | 585 | ||
| Cell Salvage | 585 | ||
| Modified Transfusion Triggers | 586 | ||
| Hypotensive Anaesthesia | 586 | ||
| SPECIFIC SURGICAL PROCEDURES | 586 | ||
| Primary Hip Arthroplasty | 586 | ||
| Hip Resurfacing Arthroplasty | 587 | ||
| Revision of Hip Replacement | 587 | ||
| Dislocation of a Prosthetic Hip | 587 | ||
| Knee Replacement | 587 | ||
| Shoulder Replacement | 588 | ||
| Spinal Surgery | 588 | ||
| Peripheral Surgery | 589 | ||
| FURTHER READING | 589 | ||
| Chapter 29: Anaesthesia for ENT, maxillofacial and dental surgery | 590 | ||
| ENT SURGERY | 590 | ||
| The Shared Airway | 590 | ||
| Tonsillectomy | 590 | ||
| Adenoidectomy | 591 | ||
| Rigid Endoscopy and Microlaryngoscopy | 591 | ||
| Thyroid Surgery | 592 | ||
| Tracheostomy | 592 | ||
| Nasal and Sinus Surgery | 593 | ||
| Ear Surgery | 593 | ||
| ENT Emergencies | 594 | ||
| Bleeding Tonsil | 594 | ||
| Epistaxis | 594 | ||
| Epiglottitis and Stridor | 595 | ||
| ORAL AND MAXILLOFACIAL SURGERY | 595 | ||
| Oral Surgery | 595 | ||
| Orthognathic Surgery | 596 | ||
| Facial Trauma and Fractures | 596 | ||
| ANAESTHESIA FOR HEAD & NECK CANCER SURGERY | 597 | ||
| Laryngectomy | 597 | ||
| Excision of Salivary Glands | 598 | ||
| Neck Dissection | 598 | ||
| Surgery for Oral, Nasal and Oropharyngeal Cancer | 598 | ||
| DENTAL ANAESTHESIA | 599 | ||
| General Anaesthesia | 599 | ||
| Sedation | 599 | ||
| FURTHER READING | 600 | ||
| Chapter 30: Ophthalmic anaesthesia | 601 | ||
| PHYSIOLOGY OF THE EYE | 601 | ||
| Control of Intraocular Pressure | 601 | ||
| External Pressure | 603 | ||
| Venous Pressure | 603 | ||
| Arterial Blood Gas Tensions | 603 | ||
| Arterial Pressure | 603 | ||
| Aqueous and Vitreous Volumes | 604 | ||
| Sodium Hyaluronate | 604 | ||
| OCULAR BLOOD FLOW | 604 | ||
| OCULOCARDIAC REFLEX | 604 | ||
| CONDITIONS FOR INTRAOCULAR SURGERY | 604 | ||
| Expulsive Haemorrhage | 604 | ||
| Effect of Anaesthetic Drugs on Intraocular Pressure | 604 | ||
| Premedication | 604 | ||
| Induction Agents | 605 | ||
| Muscle Relaxants | 605 | ||
| Volatile Anaesthetic Agents | 605 | ||
| Opioids | 605 | ||
| CHOICE OF ANAESTHESIA | 605 | ||
| General Anaesthesia | 605 | ||
| Indications for General Anaesthesia | 605 | ||
| Contraindications to General Anaesthesia | 606 | ||
| Assessment and Preparation | 606 | ||
| Induction of Anaesthesia | 606 | ||
| Airway Management | 606 | ||
| Maintenance of Anaesthesia | 607 | ||
| Local Anaesthesia for Eye Surgery | 607 | ||
| NOMENCLATURE OF BLOCKS | 608 | ||
| Relevant Anatomy | 608 | ||
| Selection of Patients and Blocks | 610 | ||
| OPHTHALMIC REGIONAL BLOCKS | 611 | ||
| Needle-Based Blocks | 611 | ||
| Modern Retrobulbar Block | 611 | ||
| Inferotemporal Peribulbar Block | 611 | ||
| Medial Peribulbar Block | 611 | ||
| Sub-Tenon’s Block | 612 | ||
| Local Anaesthetic Agents and Adjuncts | 612 | ||
| Complications of Ophthalmic Regional Blocks | 613 | ||
| Orbital Haemorrhage | 613 | ||
| Prevention of Haemorrhage | 614 | ||
| Central Spread of Local Anaesthetic Agent | 614 | ||
| Mechanism | 614 | ||
| Signs and Symptoms of Central Spread | 614 | ||
| Treatment of Central Spread | 614 | ||
| Prevention of Central Spread | 614 | ||
| Damage to the Globe | 615 | ||
| Optic Nerve Damage | 616 | ||
| Extraocular Muscle Malfunction | 616 | ||
| OPHTHALMIC DRUGS RELEVANT TO THE ANAESTHETIST | 616 | ||
| ANAESTHESIA FOR SPECIFIC OPHTHALMIC PROCEDURES REQUIRING GENERAL ANAESTHESIA | 616 | ||
| Penetrating Eye Injury | 616 | ||
| Cataract Surgery | 617 | ||
| Vitreoretinal (VR) Surgery | 617 | ||
| Strabismus Surgery | 618 | ||
| Glaucoma Surgery | 618 | ||
| Dacrocystorhinostomy | 618 | ||
| Other Oculoplastic Procedures | 618 | ||
| Paediatric Procedures | 618 | ||
| Sedation and Ophthalmic Blocks | 619 | ||
| CONCLUSION | 619 | ||
| FURTHER READING | 619 | ||
| Chapter 31: Anaesthesia for vascular, endocrine and plastic surgery | 620 | ||
| MAJOR VASCULAR SURGERY | 620 | ||
| General Considerations | 620 | ||
| Preoperative Medical Therapy in Vascular Surgical Patients | 621 | ||
| Abdominal Aortic Aneurysm | 621 | ||
| Elective Open AAA Repair | 622 | ||
| The Postoperative Period | 623 | ||
| Emergency Open Repair | 624 | ||
| Endovascular Aortic Aneurysm Repair | 624 | ||
| Surgery for Occlusive Peripheral Vascular Disease | 625 | ||
| Bypass of Aorto-Iliac Occlusion | 625 | ||
| Peripheral Arterial Reconstruction | 625 | ||
| Carotid Artery Surgery | 626 | ||
| Chapter 32: Neurosurgical anaesthesia | 640 | ||
| APPLIED ANATOMY AND PHYSIOLOGY | 640 | ||
| Anatomy | 640 | ||
| Brain | 640 | ||
| Spinal Cord | 640 | ||
| Cerebrospinal Fluid | 641 | ||
| Meninges | 641 | ||
| Vascular Supply | 642 | ||
| Autonomic Nervous System | 642 | ||
| Intracranial Pressure | 642 | ||
| Cerebral Blood Flow | 642 | ||
| Cerebral Metabolism | 643 | ||
| Effects of Oxygen and Carbon Dioxide on Cerebral Blood Flow | 644 | ||
| GENERAL PRINCIPLES OF NEUROSURGICAL ANAESTHESIA | 644 | ||
| Induction of Anaesthesia | 644 | ||
| Positioning | 645 | ||
| Heat Loss | 645 | ||
| Maintenance of Anaesthesia | 646 | ||
| Fluid Replacement Therapy | 646 | ||
| Supplementary Drug Therapy | 646 | ||
| Monitoring During Neurosurgical Anaesthesia | 647 | ||
| Mechanisms for Reducing Intracranial Pressure | 647 | ||
| Elective Hypotension | 647 | ||
| Recovery from Anaesthesia | 647 | ||
| POSTOPERATIVE CARE | 648 | ||
| ANAESTHESIA FOR ELECTIVE INTRACRANIAL SURGERY | 648 | ||
| Intracranial Tumours | 648 | ||
| Cerebrovascular Lesions | 649 | ||
| Anaesthesia for Interventional Neuroradiology | 650 | ||
| Pituitary Surgery (Hypophysectomy) | 650 | ||
| CSF Shunt Insertion and Revision | 650 | ||
| Functional Surgery | 651 | ||
| Treatment of Trigeminal Neuralgia | 651 | ||
| Posterior Fossa Craniotomy | 651 | ||
| Detection and Treatment of Air Embolism | 652 | ||
| ANAESTHESIA FOR SURGERY OF THE SPINE AND SPINAL CORD | 652 | ||
| Anaesthesia for Cervical Spine Surgery | 652 | ||
| Anterior Cervical Decompression | 653 | ||
| Posterior Cervical Laminectomy | 653 | ||
| Anaesthesia for Thoracic and Lumbar Decompression | 653 | ||
| ANAESTHESIA FOR EMERGENCY INTRACRANIAL SURGERY | 653 | ||
| MANAGEMENT OF THE HEAD-INJURED PATIENT | 654 | ||
| INTENSIVE CARE MANAGEMENT OF HEAD-INJURED PATIENTS | 655 | ||
| Sedation | 655 | ||
| Ventilation | 655 | ||
| Detailed Neurological Assessment | 655 | ||
| ICP Monitoring | 655 | ||
| Adequate Fluid Therapy and Nutrition | 655 | ||
| High-Dependency Nursing Care | 656 | ||
| ANAESTHESIA FOR CT AND MRI SCANNING | 656 | ||
| FURTHER READING | 656 | ||
| Chapter 33: Anaesthesia for thoracic surgery | 657 | ||
| PREOPERATIVE ASSESSMENT | 657 | ||
| History and Examination | 657 | ||
| Differential Diagnosis | 658 | ||
| Investigations | 658 | ||
| Whole-Lung Testing | 658 | ||
| Regional Lung Function | 659 | ||
| Invasive Assessment | 659 | ||
| Treatment | 659 | ||
| ANATOMY | 660 | ||
| Radiographic Surface Markings | 661 | ||
| INDUCTION AND MAINTENANCE OF ANAESTHESIA | 661 | ||
| Lateral Thoracotomy | 661 | ||
| The Lateral Position | 662 | ||
| One-Lung Anaesthesia | 662 | ||
| Positioning Double-Lumen Bronchial Tubes | 663 | ||
| Clinical Assessment | 664 | ||
| Using the Fibreoptic Intubating Laryngoscope | 664 | ||
| Mode of Ventilation | 666 | ||
| Physiological Changes | 667 | ||
| ANAESTHESIA FOR THORACIC SURGERY PROCEDURES | 667 | ||
| Rigid Bronchoscopy | 667 | ||
| Rigid Oesophagoscopy | 668 | ||
| Cervical Mediastinoscopy and Anterior Mediastinotomy | 669 | ||
| Video-Assisted Thoracoscopic Surgery | 669 | ||
| Pulmonary Lobectomy | 669 | ||
| Pneumonectomy | 670 | ||
| Pleurectomy and Pleurodesis | 670 | ||
| Empyema | 670 | ||
| Lung Cysts and Bullae | 670 | ||
| Bronchopleural Fistula | 670 | ||
| Tracheal Surgery | 670 | ||
| Tracheostomy | 671 | ||
| Oesophageal Surgery | 671 | ||
| POSTOPERATIVE CARE | 671 | ||
| OUTCOME | 672 | ||
| FURTHER READING | 672 | ||
| Chapter 34: Anaesthesia for cardiac surgery | 674 | ||
| TRENDS IN SURGICAL PRACTICE | 674 | ||
| Ischaemic Heart Disease | 674 | ||
| Valve Disease | 675 | ||
| Congenital Heart Disease | 676 | ||
| Cardiopulmonary Bypass | 676 | ||
| Venous Reservoir | 676 | ||
| Pumps | 677 | ||
| Oxygenator | 677 | ||
| Connecting Tubes, Filters, Manometer, Suction | 677 | ||
| Fluid Prime | 677 | ||
| PREOPERATIVE ASSESSMENT | 677 | ||
| Exercise Electrocardiography | 677 | ||
| Cardiac Catheterization | 677 | ||
| Echocardiography | 678 | ||
| Radionuclide Imaging | 678 | ||
| Computed Tomography/Magnetic Resonance Imaging | 679 | ||
| Additional Investigations | 679 | ||
| Preoperative Drug Therapy | 679 | ||
| Investigations | 679 | ||
| RISK ASSESSMENT | 680 | ||
| MONITORING | 681 | ||
| Electrocardiograph | 681 | ||
| Systemic Arterial Pressure | 681 | ||
| Central Venous Pressure | 681 | ||
| Cardiac Output | 681 | ||
| Echocardiography | 681 | ||
| Cerebral Monitoring | 681 | ||
| Temperature | 681 | ||
| Biochemistry and Haematology | 682 | ||
| Display | 682 | ||
| PATHOPHYSIOLOGY | 682 | ||
| ANAESTHETIC TECHNIQUE | 683 | ||
| Premedication | 683 | ||
| Induction of Anaesthesia | 683 | ||
| Anaesthesia Pre-CPB | 684 | ||
| Cardiopulmonary Bypass | 684 | ||
| Myocardial Preservation | 685 | ||
| Perfusion on Bypass | 685 | ||
| Coagulation Control | 685 | ||
| Oxygen Delivery | 685 | ||
| Acid–Base Balance | 685 | ||
| Serum Potassium Concentration | 685 | ||
| Weaning from CPB | 686 | ||
| Low Cardiac Output State | 686 | ||
| Intra-Aortic Balloon Pump | 686 | ||
| Bleeding | 687 | ||
| HAEMODYNAMICS AFTER CPB | 687 | ||
| Other Aspects | 687 | ||
| Temperature | 687 | ||
| Biochemical Monitoring | 687 | ||
| Cardiac Rhythm | 687 | ||
| Heart Block | 687 | ||
| Supraventricular Arrhythmias | 688 | ||
| Ventricular Arrhythmias | 688 | ||
| Transfer to Postoperative Care Unit | 688 | ||
| POSTOPERATIVE CARE | 688 | ||
| Bleeding | 688 | ||
| Criteria for Tracheal Extubation | 688 | ||
| Pain Relief | 689 | ||
| FURTHER READING | 689 | ||
| Chapter 35: Obstetric anaesthesia and analgesia | 690 | ||
| ANATOMY AND PHYSIOLOGY OF PREGNANCY | 690 | ||
| Progesterone | 691 | ||
| Haemodynamic Changes | 691 | ||
| Aortocaval Compression | 692 | ||
| Regional Blood Flow | 693 | ||
| Respiratory Changes | 693 | ||
| Renal Changes | 694 | ||
| Gastrointestinal Changes | 695 | ||
| Haematological Changes | 695 | ||
| Coagulation | 695 | ||
| The Epidural And Subarachnoid Spaces | 696 | ||
| Anatomy of the Epidural Space | 696 | ||
| Pain Pathways in Labour and Caesarean Section | 697 | ||
| The Placenta | 698 | ||
| Functions of the Placenta | 698 | ||
| Transport of Respiratory Gases | 698 | ||
| Hormone Production | 698 | ||
| Immunological | 698 | ||
| Placental Transfer of Drugs | 698 | ||
| Factors Determining Placental Transfer | 698 | ||
| Materno-Fetal Concentration Gradient | 698 | ||
| Molecular Weight and Lipid Solubility | 699 | ||
| Protein Binding | 699 | ||
| Degree of Ionization | 699 | ||
| Maternal and Fetal ph | 699 | ||
| Placental Factors and Uteroplacental Blood Flow | 699 | ||
| Effects of Drugs on the Fetus | 699 | ||
| Effects of Drugs on the Neonate | 699 | ||
| Lactation and Drugs in Obstetric Anaesthesia | 700 | ||
| PHARMACOLOGY OF RELEVANT DRUGS | 701 | ||
| Uterotonic Drugs | 701 | ||
| Syntocinon (Oxytocin) | 701 | ||
| Carbetocin | 702 | ||
| Ergometrine | 702 | ||
| Syntometrine | 702 | ||
| Prostaglandins | 702 | ||
| Carboprost | 702 | ||
| Misoprostol | 702 | ||
| Dinoprostone | 702 | ||
| Mifepristone (RU486) | 702 | ||
| Tocolytic Drugs | 702 | ||
| β2-Adrenergic Receptor Agonists (Terbutaline, Salbutamol, Ritodrine) | 702 | ||
| Oxytocin Antagonists (Atosiban) | 702 | ||
| Glyceryl Trinitrate (GTN) | 702 | ||
| Indomethacin | 703 | ||
| BASIC OBSTETRICS | 703 | ||
| Normal Labour | 703 | ||
| The First Stage of Labour | 703 | ||
| The Second Stage of Labour | 703 | ||
| The Third Stage of Labour | 703 | ||
| Fetal Monitoring | 705 | ||
| Urgency of Caesarean Section | 706 | ||
| Umbilical Cord Blood Analysis | 706 | ||
| FEEDING AND ANTACID PROPHYLAXIS IN LABOUR | 706 | ||
| PAIN AND PAIN RELIEF IN LABOUR | 707 | ||
| The Effect of Pain and Analgesia on the Mother and Fetus | 707 | ||
| The Ideal Analgesic | 707 | ||
| Analgesia During Labour | 708 | ||
| Non-Pharmacological Analgesia | 708 | ||
| Birth Preparation Classes | 708 | ||
| Environment and the Management of Labour | 708 | ||
| Transcutaneous Electrical Nerve Stimulation | 708 | ||
| Complementary Therapies | 708 | ||
| Parenteral (Systemic) Analgesia | 708 | ||
| Inhalational Analgesia | 709 | ||
| Regional Analgesia for Labour | 709 | ||
| EPIDURAL AND SUBARACHNOID ANALGESIA | 709 | ||
| Indications for Epidural Analgesia | 709 | ||
| Contraindications to Epidural Analgesia in Labour | 709 | ||
| Maternal Refusal | 709 | ||
| Bleeding Disorders | 710 | ||
| Sepsis in the Lumbar Area and Systemic Sepsis | 710 | ||
| Technique of Regional Analgesia | 710 | ||
| Preparation | 710 | ||
| Normal Labour | 711 | ||
| Conduct of the Epidural | 711 | ||
| Test Dose | 712 | ||
| Combined Spinal-Epidural for Labour and the ‘Walking’ Epidural | 712 | ||
| Technique | 712 | ||
| Assessment | 713 | ||
| Management of the Labouring Woman with Epidural Analgesia | 713 | ||
| Posture | 713 | ||
| Monitoring of Mother and Baby | 713 | ||
| Maintenance of Analgesia | 713 | ||
| Repeated Bolus Administration | 713 | ||
| Continuous Infusion by Syringe Pump | 713 | ||
| Patient-Controlled Epidural Analgesia (PCEA) | 714 | ||
| Problems Maintaining Epidural Analgesia | 714 | ||
| REGIONAL ANAESTHESIA FOR THE PARTURIENT | 714 | ||
| Elective Caesarean Section | 714 | ||
| Spinal Anaesthesia | 714 | ||
| Epidural Anaesthesia | 715 | ||
| Combined Spinal-Epidural Anaesthesia | 716 | ||
| Emergency Caesarean Section | 716 | ||
| Topping up an Existing Epidural | 716 | ||
| Spinal Anaesthesia for an Emergency | 716 | ||
| Chapter 36: Paediatric anaesthesia | 731 | ||
| PHYSIOLOGY IN THE NEONATE | 731 | ||
| Respiration | 731 | ||
| Cardiovascular System | 732 | ||
| Blood Volume | 733 | ||
| Haemoglobin | 733 | ||
| Renal Function and Fluid Balance | 733 | ||
| Fluid Therapy | 734 | ||
| Temperature Regulation and Maintenance | 735 | ||
| Monitoring | 736 | ||
| PHARMACOLOGY IN THE NEONATE | 736 | ||
| Developmental Pharmacology | 736 | ||
| Specific Drugs in Paediatric Anaesthesia | 737 | ||
| Inhalational Agents | 737 | ||
| Nitrous Oxide | 737 | ||
| Halothane | 737 | ||
| Isoflurane | 738 | ||
| Sevoflurane | 738 | ||
| Desflurane | 738 | ||
| Intravenous Agents | 738 | ||
| Barbiturates | 738 | ||
| Propofol | 738 | ||
| Ketamine | 738 | ||
| Opioids | 739 | ||
| Neuromuscular Blocking Drugs and their Antagonists | 739 | ||
| Succinylcholine | 739 | ||
| Non-Depolarizing Agents | 740 | ||
| ANAESTHETIC MANAGEMENT | 740 | ||
| Preoperative Preparation | 740 | ||
| Preoperative Fasting | 740 | ||
| Premedication | 741 | ||
| Induction | 742 | ||
| Airway Management | 742 | ||
| Monitoring | 744 | ||
| Day Surgery | 744 | ||
| Paediatric Regional Anaesthesia | 745 | ||
| SPECIFIC OPERATIONS IN THE NEONATE | 747 | ||
| Inguinal Hernia Repair | 747 | ||
| Pyloromyotomy | 747 | ||
| Tracheo-Oesophageal Fistula and Oesophageal Atresia | 747 | ||
| Diaphragmatic Hernia | 748 | ||
| Exomphalos and Gastroschisis | 748 | ||
| Postoperative Care | 748 | ||
| FURTHER READING | 750 | ||
| Chapter 37: Emergency anaesthesia | 751 | ||
| PREOPERATIVE ASSESSMENT | 751 | ||
| Assessment of Circulating Volume | 753 | ||
| Intravascular Volume Deficit | 753 | ||
| Extracellular Volume Deficit | 754 | ||
| THE FULL STOMACH | 755 | ||
| The Lower Oesophageal Sphincter | 756 | ||
| Gastric Emptying | 756 | ||
| TECHNIQUES OF ANAESTHESIA | 757 | ||
| Phase I – Preparation | 757 | ||
| Phase II – Induction | 757 | ||
| Rapid-Sequence Induction | 757 | ||
| Inhalational Induction | 759 | ||
| Awake Intubation | 760 | ||
| Regional Anaesthesia | 760 | ||
| Phase III – Maintenance of Anaesthesia | 760 | ||
| Fluid Management | 761 | ||
| Phase IV – Reversal and Emergence | 761 | ||
| Tracheal Extubation | 761 | ||
| Phase V – Postoperative Management | 762 | ||
| Prophylactic Postoperative IPPV | 762 | ||
| Emergency Laparotomy in the Older Patient | 762 | ||
| THE ANAESTHETIST AND MAJOR TRAUMA | 763 | ||
| Primary Survey/Damage Control Resuscitation | 763 | ||
| Airway/Breathing | 763 | ||
| Damage Control Resuscitation | 764 | ||
| Circulation | 764 | ||
| Pump Function | 765 | ||
| Damage Control Surgery | 765 | ||
| Massive Transfusion | 767 | ||
| ACKNOWLEDGEMENT | 768 | ||
| FURTHER READING | 768 | ||
| Chapter 38: Anaesthesia outside the operating theatre | 769 | ||
| ANAESTHESIA IN REMOTE HOSPITAL LOCATIONS | 769 | ||
| General Considerations and Principles | 769 | ||
| Anaesthesia in the Radiology Department | 770 | ||
| Computed Tomography | 771 | ||
| General Principles | 771 | ||
| Anaesthetic Management | 771 | ||
| Magnetic Resonance Imaging | 772 | ||
| General Principles | 772 | ||
| Anaesthetic Management | 773 | ||
| staff safety | 773 | ||
| patient safety | 773 | ||
| Equipment | 773 | ||
| conduct of anaesthesia | 774 | ||
| Diagnostic and Interventional Angiography | 775 | ||
| General Principles | 775 | ||
| Anaesthetic Management | 775 | ||
| Complications of Angiography | 775 | ||
| Interventional Neuroradiology | 775 | ||
| Cardiac Catheterization | 776 | ||
| Pacemaker and Cardioverter/Defibrillator Implant-ation | 776 | ||
| TIPS Procedures | 776 | ||
| Anaesthesia for Radiotherapy | 776 | ||
| Anaesthetic Management | 777 | ||
| Anaesthesia for Electroconvulsive Therapy | 777 | ||
| Anaesthesia | 778 | ||
| Anaesthesia in the Accident and Emergency Department | 778 | ||
| ANAESTHESIA IN THE PRE-HOSPITAL ENVIRONMENT | 779 | ||
| Personal Preparation for Working in the Pre-Hospital Environment | 779 | ||
| Training in Pre-Hospital Care | 779 | ||
| Team Working | 780 | ||
| Working at the Scene | 780 | ||
| Logistical Considerations | 780 | ||
| Clinical Considerations | 780 | ||
| Airway | 780 | ||
| Cervical Spine Control | 781 | ||
| Breathing | 781 | ||
| Circulation | 781 | ||
| Deficit | 781 | ||
| Extremity | 781 | ||
| Anaesthetic and Analgesic Techniques | 781 | ||
| Local/Regional Anaesthesia | 781 | ||
| Intravenous Analgesia | 781 | ||
| Inhalational Analgesia | 781 | ||
| Intravenous Anaesthesia | 781 | ||
| Transfer to Hospital | 782 | ||
| FURTHER READING | 783 | ||
| Chapter 39: Anaesthesia for the patient with a transplanted organ | 784 | ||
| INTRODUCTION | 784 | ||
| GENERAL CONSIDERATIONS | 784 | ||
| Immunosuppression | 784 | ||
| Residual Comorbidity | 785 | ||
| ANAESTHETIC CONSIDERATIONS | 785 | ||
| Preoperative | 785 | ||
| Immunosuppressive Regimens | 785 | ||
| Transplanted Organ Status | 785 | ||
| Presence of Infection | 786 | ||
| Function of Other Organ Systems | 787 | ||
| Intraoperative | 787 | ||
| Avoidance of Surgical Stress | 787 | ||
| Reduce Injury to Transplanted Organ | 787 | ||
| Infection | 787 | ||
| Postoperative | 788 | ||
| SPECIFIC ISSUES | 788 | ||
| Renal | 788 | ||
| Indications for Renal Transplantation | 788 | ||
| Preoperative Status | 788 | ||
| Surgical Presentation | 788 | ||
| Anaesthetic Considerations | 788 | ||
| Liver | 789 | ||
| Indications for Transplantation | 789 | ||
| Preoperative Status | 789 | ||
| Surgical Presentation | 789 | ||
| Anaesthesia | 790 | ||
| Cardiac | 790 | ||
| Indication for Transplantation | 790 | ||
| Preoperative Status | 790 | ||
| Surgical Presentation | 790 | ||
| Chapter 40: Postoperative care | 794 | ||
| THE EARLY RECOVERY PERIOD | 794 | ||
| Systems Affected | 794 | ||
| Central Nervous System | 794 | ||
| Cardiovascular System | 794 | ||
| Respiratory System | 795 | ||
| Gastrointestinal System | 795 | ||
| Staff, Equipment and Monitoring | 795 | ||
| CENTRAL NERVOUS SYSTEM | 797 | ||
| Conscious Level | 797 | ||
| Hypoglycaemia | 797 | ||
| Hyperglycaemia | 797 | ||
| Cerebral Pathology | 797 | ||
| Other Causes | 797 | ||
| Confusion and Agitation | 798 | ||
| Pain | 798 | ||
| RESPIRATORY SYSTEM | 798 | ||
| Hypoventilation | 798 | ||
| Airway Obstruction | 798 | ||
| Laryngeal Spasm | 800 | ||
| Laryngeal Oedema | 800 | ||
| Bronchospasm | 800 | ||
| Ventilatory Drive | 800 | ||
| Peripheral Factors | 801 | ||
| Treatment | 802 | ||
| Hypoxaemia | 802 | ||
| Ventilation–Perfusion Abnormalities | 802 | ||
| Shunt | 803 | ||
| Hypoventilation | 803 | ||
| Diffusion Defects | 803 | ||
| Diffusion Hypoxia | 803 | ||
| Reduced Venous Oxygen Content | 803 | ||
| Tissue Hypoxia | 803 | ||
| Pulmonary Changes after Abdominal Surgery | 803 | ||
| Predisposing Factors | 805 | ||
| Clinical Findings | 805 | ||
| Collapse of Lung Units | 805 | ||
| Pneumonia | 805 | ||
| Treatment | 806 | ||
| Reducing Pulmonary Complications | 806 | ||
| Preoperative | 806 | ||
| Intraoperative | 806 | ||
| Postoperative | 806 | ||
| Oxygen Therapy | 806 | ||
| Oxygen Therapy Devices | 807 | ||
| Fixed-Performance Devices | 807 | ||
| Variable-Performance Devices | 808 | ||
| Oxygen Therapy in the Recovery Ward | 808 | ||
| Controlled Oxygen Therapy | 809 | ||
| CARDIOVASCULAR SYSTEM | 810 | ||
| Hypotension | 810 | ||
| Residual Effects of Anaesthetic Drugs | 810 | ||
| Hypovolaemia | 810 | ||
| Arrhythmias | 810 | ||
| Ventricular Failure | 811 | ||
| Sepsis with Shock | 811 | ||
| Hypertension | 811 | ||
| Arrhythmias | 811 | ||
| Conduction Defects | 812 | ||
| Myocardial Ischaemia | 812 | ||
| Acute Coronary Syndrome | 812 | ||
| Reduction of Risk | 813 | ||
| Diagnosis | 813 | ||
| OTHER MAJOR POSTOPERATIVE COMPLICATIONS | 813 | ||
| Deep Venous Thrombosis | 813 | ||
| Risk Factors | 813 | ||
| Diagnosis | 814 | ||
| Investigations | 814 | ||
| Ultrasonography | 814 | ||
| CT/ MR Venography | 814 | ||
| D-Dimers | 814 | ||
| Prophylaxis | 814 | ||
| Elimination of Stasis | 814 | ||
| Alteration of Blood Coagulability | 814 | ||
| Platelet Aggregation | 814 | ||
| The Coagulation Mechanism | 815 | ||
| Pulmonary Embolism | 815 | ||
| Diagnosis | 815 | ||
| Presenting features | 815 | ||
| Physical Signs | 815 | ||
| Investigations | 815 | ||
| Treatment | 816 | ||
| Deep Venous Thrombosis | 816 | ||
| Pulmonary Embolism | 816 | ||
| Postoperative Renal Dysfunction | 816 | ||
| Effects of Anaesthesia | 817 | ||
| Postoperative Hepatic Dysfunction | 817 | ||
| Halothane | 817 | ||
| OTHER COMPLICATIONS | 818 | ||
| Nausea and Vomiting | 819 | ||
| Prevention and Treatment | 819 | ||
| Headache | 819 | ||
| Sore Throat | 819 | ||
| Hoarseness | 819 | ||
| Laryngeal Granulomata | 819 | ||
| Dental Trauma | 820 | ||
| Ocular Complications | 820 | ||
| Muscles | 820 | ||
| Shivering | 820 | ||
| Succinylcholine Pains | 820 | ||
| Surgical Considerations | 821 | ||
| FURTHER READING | 821 | ||
| Chapter 41: Postoperative pain | 822 | ||
| PHYSIOLOGY | 823 | ||
| Nociceptors | 823 | ||
| Primary Afferent Fibres | 823 | ||
| Dorsal Horn Neurones | 824 | ||
| Allodynia and Hyperalgesia | 824 | ||
| Ascending Tracts and Supraspinal Systems | 824 | ||
| Descending Systems | 825 | ||
| Visceral Pain | 825 | ||
| Neuropathic Pain | 825 | ||
| Referred Pain | 825 | ||
| EFFECTS OF NOXIOUS SURGICAL STIMULATION | 825 | ||
| INPATIENT PAIN TEAMS | 825 | ||
| CAUSES OF VARIATION IN ANALGESIC REQUIREMENTS | 826 | ||
| Site and Type of Surgery | 826 | ||
| Age, Gender and Body Weight | 827 | ||
| Psychological Factors | 827 | ||
| Pharmacokinetic Variability | 827 | ||
| Pharmacodynamic Variability | 828 | ||
| MEASUREMENT OF PAIN | 828 | ||
| TREATMENT OF POSTOPERATIVE PAIN | 829 | ||
| METHODS OF TREATING POSTOPERATIVE PAIN | 829 | ||
| Traditional Administration of Opioids | 829 | ||
| Subcutaneous Administration of Opioids | 830 | ||
| Algorithms for Opioid Administration | 830 | ||
| Sites of Action and Properties of Morphine and Morphine-Like Drugs | 832 | ||
| Parenteral Routes of Opioid Administration | 832 | ||
| Bolus I.V. Administration | 832 | ||
| Continuous I.V. Infusion | 832 | ||
| Patient-Controlled Analgesia | 833 | ||
| Non-Parenteral Opioid Administration | 834 | ||
| Sublingual Opioids | 834 | ||
| Oral Route | 834 | ||
| Transmucosal | 834 | ||
| The Rectal Route | 835 | ||
| Inhaled/Intranasal | 835 | ||
| Transdermal | 835 | ||
| Intra-Articular and Intraperitoneal | 835 | ||
| REGIONAL ANAESTHESIA AND PAIN MANAGEMENT | 835 | ||
| Local Anaesthetic Techniques | 835 | ||
| Spinal Nerve Block | 836 | ||
| Epidural Block | 836 | ||
| Potential Advantages of Epidural Analgesia | 837 | ||
| Potential Complications of Epidural Analgesia | 837 | ||
| Haematoma and Abscess after Epidural Analgesia | 837 | ||
| Caudal Block | 838 | ||
| Other Regional Blocks Used for Postoperative Analgesia | 838 | ||
| Spinal and Epidural Opioids | 839 | ||
| Subarachnoid Opioids | 839 | ||
| Epidural Opioids | 839 | ||
| Side Effects of Epidural Opioids | 839 | ||
| Inhalation of Volatile or Gaseous Anaesthetics | 839 | ||
| Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Selective Cox-2 Inhibitors | 840 | ||
| Paracetamol | 840 | ||
| NMDA Antagonists | 840 | ||
| Other Drugs | 841 | ||
| Non-Pharmacological Methods | 841 | ||
| Cryotherapy | 841 | ||
| Transcutaneous Electrical Stimulation | 841 | ||
| Acupuncture | 841 | ||
| PRE-EMPTIVE ANALGESIA | 841 | ||
| BALANCED (MULTIMODAL) ANALGESIA | 841 | ||
| NEUROPATHIC PAIN IN THE POSTOPERATIVE PERIOD | 842 | ||
| Pre-Anaesthetic Assessment Clinics | 842 | ||
| FURTHER READING | 842 | ||
| Chapter 42: Postoperative nausea and vomiting | 843 | ||
| DEFINITIONS | 843 | ||
| MECHANISMS OF NAUSEA AND VOMITING | 843 | ||
| Vomiting Centre | 843 | ||
| Chemoreceptor Trigger Zone (CTZ) | 844 | ||
| Stimulation of the Vomiting Centre | 844 | ||
| Gastrointestinal Tract | 844 | ||
| Vestibular System | 845 | ||
| Cardiovascular System | 845 | ||
| Cortical Inputs | 845 | ||
| Gag Reflex | 845 | ||
| Neural and Muscular Co-ordination During Vomiting | 845 | ||
| Pre-Ejection Phase | 845 | ||
| Ejection Phase | 845 | ||
| Post-Ejection Phase | 845 | ||
| ADVERSE EFFECTS | 845 | ||
| IDENTIFYING PATIENTS AT RISK | 846 | ||
| Patient Factors | 846 | ||
| Anaesthetic Factors | 846 | ||
| Surgical Factors | 847 | ||
| Risk Stratification | 847 | ||
| Post-Discharge Nausea and Vomiting (PDNV) | 848 | ||
| MANAGEMENT | 848 | ||
| Prevention | 848 | ||
| Treatment | 848 | ||
| PHARMACOLOGY | 848 | ||
| Dopamine D2 Receptor Antagonists | 850 | ||
| Butyrophenones | 850 | ||
| Phenothiazines | 850 | ||
| Benzamides | 851 | ||
| Histamine H1 Receptor Antagonists | 851 | ||
| Cholinergic M1 Receptor Antagonists | 851 | ||
| Serotonin 5-HT3 Receptor Antagonists | 851 | ||
| Corticosteroids | 851 | ||
| Substance P (NK1) Antagonists | 851 | ||
| Cannabinoids | 852 | ||
| Other Techniques | 852 | ||
| FURTHER READING | 852 | ||
| Chapter 43: Complications during anaesthesia | 853 | ||
| CAUSES OF COMPLICATIONS | 853 | ||
| Human Error | 853 | ||
| Communication Failure | 853 | ||
| Equipment Failure | 853 | ||
| Coexisting Disease | 854 | ||
| Inevitable Complications | 854 | ||
| AVOIDANCE OF COMPLICATIONS | 854 | ||
| Experience | 854 | ||
| Record-Keeping | 854 | ||
| Redundant Systems | 854 | ||
| Monitoring | 854 | ||
| MANAGEMENT OF COMPLICATIONS | 855 | ||
| Generic Management of Complications | 855 | ||
| The Evolving Problem | 855 | ||
| Record-Keeping | 855 | ||
| MEDICOLEGAL ASPECTS OF COMPLICATIONS | 856 | ||
| Management of the Medicolegal Aspects of Complications | 856 | ||
| COMPLICATIONS | 856 | ||
| Respiratory System | 856 | ||
| Respiratory Obstruction | 856 | ||
| Management | 857 | ||
| Laryngospasm | 858 | ||
| Chapter 44: Quality and safety in anaesthesia | 887 | ||
| QUALITY | 887 | ||
| CULTURE OF QUALITY AND SAFETY | 887 | ||
| Understanding Generation of Errors: Systems Approach | 887 | ||
| Focus on Safety Behaviour and Non-Technical Skills | 889 | ||
| Communication and Teamwork | 891 | ||
| Situational Awareness | 891 | ||
| Anticipation and Preparedness | 892 | ||
| Decision-Making | 892 | ||
| MEASURING SAFETY AND QUALITY | 893 | ||
| Safety Culture | 893 | ||
| Measuring Quality | 893 | ||
| Clinical Outcomes: Real or Surrogate | 894 | ||
| Selecting a Good Quality Indicator | 895 | ||
| Quality Indicators at Individual Patient Level | 895 | ||
| Quality Assessment at Departmental Level | 895 | ||
| Quality Improvement Tools | 895 | ||
| Requirements for Quality Improvement | 895 | ||
| Checklists | 896 | ||
| WHO Checklist | 897 | ||
| DESIGNING PROBLEMS OUT OF THE SYSTEM | 899 | ||
| Safety by Design | 899 | ||
| Organizational Design | 899 | ||
| Making it Easy to do the Right Thing | 899 | ||
| Understanding Workarounds | 899 | ||
| Learning from Incidents | 899 | ||
| Acknowledging and Recording that they Happen | 899 | ||
| Appropriate Analysis of Incidents | 899 | ||
| Feedback to Relevant Staff | 900 | ||
| Organizational Memory | 900 | ||
| Models for Implementing Quality Improvement Programmes | 900 | ||
| Plan-Do-Study-Act (PDSA) | 900 | ||
| Six Sigma | 900 | ||
| Lean Production System | 900 | ||
| Root Cause Analysis | 901 | ||
| Failure Modes and Effects Analysis | 901 | ||
| SUMMARY | 901 | ||
| FURTHER READING | 901 | ||
| Chapter 45: The intensive care unit | 902 | ||
| STAFFING AN INTENSIVE CARE UNIT | 902 | ||
| The ICU Consultant | 903 | ||
| The ICU Resident | 903 | ||
| Nursing Staff | 903 | ||
| Physiotherapists | 904 | ||
| Pharmacists | 904 | ||
| Dieticians | 904 | ||
| The Microbiologist | 904 | ||
| OUTREACH/FOLLOW-UP | 904 | ||
| ADMISSION TO THE INTENSIVE CARE UNIT | 905 | ||
| Assessment of Patients | 905 | ||
| History | 906 | ||
| Examination | 906 | ||
| Airway and Respiratory System | 906 | ||
| Cardiovascular System | 906 | ||
| Gastointestinal Tract | 906 | ||
| Renal System | 906 | ||
| Central Nervous System | 906 | ||
| Limbs/Skin and Wounds | 906 | ||
| Lines and Sepsis | 906 | ||
| Investigations/Planned Interventions | 907 | ||
| Formulating a Plan | 907 | ||
| Transfers | 907 | ||
| MONITORING IN ICU | 907 | ||
| Basic Non-Invasive Monitoring | 907 | ||
| Invasive Monitoring | 907 | ||
| Arterial Pressure | 907 | ||
| Central Venous Pressure | 908 | ||
| Pulmonary Artery Catheter | 908 | ||
| Pulse Contour Analysis | 908 | ||
| Oesophageal Doppler | 908 | ||
| Other Technologies | 908 | ||
| Echocardiography | 908 | ||
| Ultrasound Imaging | 908 | ||
| ICP/Jugular Venous Saturation/Compressed Spectral Array/BIS | 908 | ||
| INSTITUTION OF INTENSIVE CARE | 909 | ||
| The Respiratory System | 909 | ||
| Type 1 Respiratory Failure – PaO2 <8 kPa with Normal/Low PaCO2 | 909 | ||
| Type 2 Respiratory Failure – PaO2 <8 kPa and PaCO2 > <8 kPa | 909 | ||
| Assessment of the Patient with Respiratory Failure | 909 | ||
| Management of Respiratory Failure | 910 | ||
| Continuous Positive Airway Pressure (CPAP) | 910 | ||
| Non-Invasive Positive Pressure Ventilation (NIPPV or NIV) | 910 | ||
| Mechanical Ventilation | 911 | ||
| Tracheal Intubation | 911 | ||
| Sedation and Analgesia | 911 | ||
| An Overview of Modes of Ventilation | 912 | ||
| Volume Controlled Ventilation | 912 | ||
| Pressure Controlled Ventilation | 912 | ||
| Synchronized Intermittent Mandatory Ventilation (SIMV) | 912 | ||
| Pressure Support Ventilation (PSV)/Assisted Spontaneous Breathing (ASB) | 913 | ||
| Positive End Expiratory Pressure (PEEP) | 913 | ||
| Problems Associated with Mechanical Ventilation | 913 | ||
| Problem Solving in Ventilated Patients | 913 | ||
| Ventilation Strategies | 913 | ||
| Other Aspects of Ventilation | 914 | ||
| High-Frequency Oscillation | 914 | ||
| Prone Positioning | 914 | ||
| Nitric Oxide | 914 | ||
| Extracorporeal Membrane Oxygenation | 914 | ||
| Weaning from Mechanical Ventilation | 915 | ||
| Outcomes from Lung Injury Requiring Prolonged IPPV | 915 | ||
| Cardiovascular System | 915 | ||
| Shock | 915 | ||
| Basic Applied Cardiovascular Physiology | 916 | ||
| Optimization of the Cardiovascular Status | 917 | ||
| Outcome from Shock States | 917 | ||
| Gastrointestinal System | 918 | ||
| Manifestations of Gastrointestinal Tract Failure | 918 | ||
| Nutrition | 918 | ||
| Parenteral Feeding | 919 | ||
| Refeeding Syndrome | 919 | ||
| Stress Ulcer Prophylaxis | 919 | ||
| Blood Glucose | 919 | ||
| Outcomes of Gastrointestinal Failure | 919 | ||
| Fluid Balance | 919 | ||
| Renal Dysfunction | 920 | ||
| Renal Replacement Therapy (RRT) | 921 | ||
| Continuous Venovenous Haemofiltration (CVVHF) | 921 | ||
| Continuous Venovenous Haemodialysis (CVVHD) | 921 | ||
| Continuous Venovenous Haemodiafiltration (CVVHDF) | 922 | ||
| Vascular Access for Renal Replacement Therapy | 922 | ||
| Outcomes After Kidney Injury | 922 | ||
| Neurological System | 923 | ||
| Outcomes | 924 | ||
| OTHER ASPECTS OF INTENSIVE CARE | 924 | ||
| Venous Thromboembolism Prophylaxis | 924 | ||
| ICU-Acquired Muscle Weakness | 924 | ||
| Healthcare-Associated Infection (HAI) | 925 | ||
| Catheter-Related Bloodstream Infection (CRBSI) | 925 | ||
| Antibiotic Therapy | 925 | ||
| Ventilator-Associated Pneumonia (VAP) | 925 | ||
| Psychological Problems on the Intensive Care Unit | 926 | ||
| Delirium in ICU | 926 | ||
| Care Bundles | 926 | ||
| ETHICAL ISSUES IN ICU | 927 | ||
| OUTCOME AFTER INTENSIVE CARE | 927 | ||
| DEATH IN THE ICU | 928 | ||
| Futility and withdrawal | 928 | ||
| Brainstem Death | 929 | ||
| ORGAN DONATION | 929 | ||
| DISCHARGE FROM INTENSIVE CARE | 930 | ||
| Follow-Up Clinics | 930 | ||
| FUTURE DEVELOPMENTS | 930 | ||
| FURTHER READING | 931 | ||
| Chapter 46: Management of chronic pain | 932 | ||
| DEFINITIONS OF PAIN AND RELATED TERMS | 932 | ||
| THE PARADIGM OF PAIN | 933 | ||
| EPIDEMIOLOGY OF CHRONIC PAIN | 933 | ||
| CLASSIFICATION OF PAIN | 934 | ||
| Nociceptive Pain | 934 | ||
| Somatic Pain | 934 | ||
| Visceral Pain | 934 | ||
| Neuropathic Pain | 934 | ||
| Sympathetically Maintained Pain | 934 | ||
| MANAGEMENT OF CHRONIC PAIN | 935 | ||
| Assessment | 935 | ||
| Pain History | 936 | ||
| Physical Examination | 936 | ||
| Investigations | 936 | ||
| Explanation | 936 | ||
| Treatment | 936 | ||
| Medication | 937 | ||
| Cancer Pain | 937 | ||
| Paracetamol | 938 | ||
| Non-Steroidal Anti-Inflammatory Drugs | 938 | ||
| Opioid Analgesics | 938 | ||
| Non-Cancer Pain | 938 | ||
| Opioid Drugs | 938 | ||
| Alternative Opioids and Alternative Routes of Administration | 939 | ||
| Transdermal Drug Delivery | 939 | ||
| Subcutaneous Administration | 940 | ||
| Spinal Administration | 940 | ||
| Co-Analgesics | 940 | ||
| Anticonvulsants | 940 | ||
| Tricyclic and SNRI Antidepressants | 941 | ||
| Antiarrhythmic Drugs | 941 | ||
| Ketamine | 941 | ||
| Capsaicin | 941 | ||
| Cannabinoids | 941 | ||
| Oral Corticosteroids | 941 | ||
| Interventional Pain Therapies | 941 | ||
| Agents | 942 | ||
| Local Anaesthetics | 942 | ||
| Corticosteroids | 942 | ||
| Botulinum Toxin | 943 | ||
| Neurolytic Techniques | 943 | ||
| Chemical Neurolysis | 943 | ||
| Radiofrequency Lesions | 943 | ||
| Epidural Steroids | 944 | ||
| Spinal Endoscopy | 944 | ||
| Nerve Root Injection | 944 | ||
| Medial Branch Block of the Dorsal Ramus (Lumbar and Cervical Facet Nerve Blocks) | 944 | ||
| Sympathetic Nerve Blocks | 944 | ||
| Intravenous Regional Sympathetic Block with Guanethidine | 945 | ||
| Stimulation-Induced Analgesia | 945 | ||
| Transcutaneous Electrical Nerve Stimulation | 945 | ||
| Spinal Cord Stimulation | 945 | ||
| Acupuncture | 946 | ||
| Psychological Techniques | 946 | ||
| Pain Management Programme | 946 | ||
| EVIDENCE-BASED PRACTICE | 946 | ||
| COSTS OF PAIN MANAGEMENT SERVICES | 946 | ||
| FURTHER READING | 947 | ||
| Chapter 47: Resuscitation | 948 | ||
| INTRODUCTION | 948 | ||
| SCIENCE AND GUIDELINES | 948 | ||
| EPIDEMIOLOGY | 948 | ||
| PREVENTION | 949 | ||
| Guidelines for Prevention of In-Hospital Cardiac Arrest (Resuscitation Council (UK)) | 949 | ||
| CARDIOPULMONARY RESUSCITATION | 950 | ||
| Diagnosis of Cardiac Arrest | 950 | ||
| High-Quality CPR | 950 | ||
| Starting CPR in Hospital | 951 | ||
| ADVANCED LIFE SUPPORT | 951 | ||
| Shockable Rhythms (VF/VT) | 951 | ||
| Sequence of Actions | 953 | ||
| Precordial Thump | 953 | ||
| Defibrillation Strategy | 953 | ||
| Pads Versus Paddles | 953 | ||
| Safe Use of Oxygen | 953 | ||
| Single Versus Three-Shock Strategy | 953 | ||
| Defibrillation Energy | 954 | ||
| Non-Shockable Rhythms (PEA and Asystole) | 954 | ||
| Sequence of Actions for PEA | 954 | ||
| Sequence of Actions for Asystole | 954 | ||
| During CPR | 954 | ||
| Potentially Reversible Causes | 955 | ||
| Use of Ultrasound Imaging During Advanced Life Support | 955 | ||
| Resuscitation in the Operating Room | 955 | ||
| Cardiac Arrest in the Prone Position | 956 | ||
| Cardiac Arrest Caused by Local Anaesthetic | 956 | ||
| Airway Management and Ventilation | 956 | ||
| Assisting the Circulation | 957 | ||
| Intravascular Access | 957 | ||
| Drugs | 957 | ||
| Adrenaline | 957 | ||
| Atropine | 957 | ||
| Anti-Arrhythmic Drugs | 957 | ||
| Bicarbonate | 957 | ||
| Calcium | 958 | ||
| Mechanical CPR | 958 | ||
| Impedance Threshold Device (ITD) | 958 | ||
| Lund University Cardiac Arrest System (LUCAS) CPR | 958 | ||
| Load-Distributing Band CPR (AutoPulse) | 958 | ||
| PERI-ARREST ARRHYTHMIAS | 958 | ||
| Tachycardias | 958 | ||
| Bradycardia | 961 | ||
| POST-RESUSCITATION CARE | 961 | ||
| The Post-Cardiac-Arrest Syndrome | 961 | ||
| Airway and Breathing | 962 | ||
| Circulation | 962 | ||
| Disability (Optimizing Neurological Recovery) | 962 | ||
| Control of Seizures | 962 | ||
| Glucose Control | 962 | ||
| Temperature Control | 962 | ||
| Treatment of Hyperpyrexia | 962 | ||
| Therapeutic Hypothermia | 962 | ||
| Prognostication | 963 | ||
| Clinical Examination | 963 | ||
| Biochemical Markers | 963 | ||
| Neurophysiological Studies | 963 | ||
| Imaging Studies | 963 | ||
| Impact of Therapeutic Hypothermia on Prognostication | 964 | ||
| Organ Donation | 964 | ||
| DECISIONS RELATING TO CARDIOPULMONARY RESUSCITATION | 964 | ||
| DNAR Decisions in the Perioperative Period | 964 | ||
| NATIONAL CARDIAC ARREST AUDIT | 965 | ||
| ACKNOWLEDGEMENT | 965 | ||
| FURTHER READING | 965 | ||
| Appendix A: Training and assessment in anaesthesia | 966 | ||
| INTRODUCTION | 966 | ||
| BASIC PRINCIPLES | 966 | ||
| Spiral Learning | 966 | ||
| Experiential Learning | 967 | ||
| Phases of Training | 967 | ||
| Introduction to Anaesthetic Practice | 967 | ||
| Modular Training | 967 | ||
| Subspeciality Training | 969 | ||
| Less Than Full-Time (‘Part-Time’) Training | 969 | ||
| Training in Pain Medicine and Intensive Care Medicine | 969 | ||
| ASSESSMENT TOOLS | 970 | ||
| Examinations | 970 | ||
| Multiple-Choice Questions (MCQs) | 971 | ||
| Objective Structured Clinical Examination (OSCE) | 971 | ||
| Short Answer Questions (SAQ) | 971 | ||
| Structured Oral Examinations (SOE) | 972 | ||
| Learning Resources | 972 | ||
| LIFE-LONG LEARNING AND CPD | 973 | ||
| FURTHER READING | 973 | ||
| Appendix B: Data, statistics and clinical trials | 974 | ||
| TYPES OF DATA | 974 | ||
| SUMMARIZING DATA | 975 | ||
| SAMPLING | 975 | ||
| PROBABILITY | 976 | ||
| DATA DISTRIBUTIONS | 976 | ||
| Uniform Distributions | 976 | ||
| Non-Uniform Distributions | 976 | ||
| Chi-Square Distribution | 977 | ||
| Inferring Information from a Sample | 977 | ||
| BIAS | 977 | ||
| Selection Bias | 978 | ||
| Topic Selection | 978 | ||
| Population Selection | 978 | ||
| Inclusion/Exclusion Bias | 978 | ||
| Methodological Bias | 978 | ||
| Outcome Bias | 978 | ||
| Detection Bias | 978 | ||
| Missing Outcomes | 978 | ||
| Reporting Bias | 978 | ||
| TESTING | 979 | ||
| Chi-Squared Test | 980 | ||
| Rank Tests | 982 | ||
| t-Tests | 983 | ||
| Multiple Testing | 983 | ||
| Relationship Testing | 983 | ||
| Comparison of Techniques | 984 | ||
| PREDICTIVE TESTING AND SCORING SYSTEMS | 985 | ||
| Test Accuracy | 985 | ||
| Risk Scoring | 986 | ||
| Survival Analysis | 988 | ||
| TYPES OF ERROR | 988 | ||
| Other Categories of Error | 989 | ||
| CLINICAL TRIALS | 990 | ||
| Observational Studies | 990 | ||
| Case Control Studies | 990 | ||
| Cross-Sectional Studies | 990 | ||
| Interventional Studies | 990 | ||
| Framing the Question | 991 | ||
| Evidence | 991 | ||
| Population | 991 | ||
| Intervention | 991 | ||
| Comparison | 991 | ||
| Outcome | 991 | ||
| Timeliness | 991 | ||
| Regulatory Approvals | 991 | ||
| Ethical Review | 991 | ||
| Sponsorship | 992 | ||
| Local Approvals | 992 | ||
| National Approvals | 992 | ||
| Trial Registration | 992 | ||
| Specific Aspects of Trial Conduct | 992 | ||
| Informed consent | 992 | ||
| Randomization | 992 | ||
| Blinding | 993 | ||
| Completeness of Follow-Up | 993 | ||
| Stages of Drug Trials | 993 | ||
| Publication | 993 | ||
| Publication Checklists | 993 | ||
| Presentation of Results | 994 | ||
| Absolute Risk (AR) | 994 | ||
| Relative Risk (RR) | 994 | ||
| Absolute Risk Reduction (ARR) | 994 | ||
| Relative Risk Reduction (RRR) | 995 | ||
| Number Needed to Treat (NNT) | 995 | ||
| Number Needed to Harm (NNH) | 995 | ||
| Odds Ratio | 995 | ||
| FURTHER READING | 995 | ||
| Appendix C: Clinical data | 996 | ||
| APPENDIX C (IA): ABBREVIATIONS USED IN TEXT AND APPENDICES | 996 | ||
| APPENDIX C (IB): SI SYSTEM | 1002 | ||
| VOLUME | 1002 | ||
| TEMPERATURE | 1003 | ||
| PRESSURE MEASUREMENTS – CONVERSION FACTORS | 1003 | ||
| MOLES | 1003 | ||
| MOLES/OSMOLES | 1003 | ||
| APPENDIX C (II): INHALATIONAL ANAESTHETIC AGENTS – PHYSICAL PROPERTIES | 1004 | ||
| APPENDIX C (III): CARDIOVASCULAR SYSTEM | 1005 | ||
| APPENDIX C (IVA): CHEMICAL PATHOLOGY – BIOCHEMICAL VALUES | 1007 | ||
| APPENDIX C (IVB): CONVERSION CHART – HYDROGEN ION CONCENTRATION TO pH | 1009 | ||
| APPENDIX C (V): HAEMATOLOGY | 1009 | ||
| APPENDIX C (VI): FLUID BALANCE | 1011 | ||
| APPENDIX C (VII): RENAL FUNCTION TESTS | 1014 | ||
| APPENDIX C (VIII): PULMONARY FUNCTION TESTS | 1015 | ||
| APPENDIX C (IX): PAEDIATRICS | 1016 | ||
| APPENDIX C (X): GAS FLOWS IN ANAESTHETIC BREATHING SYSTEMS | 1018 | ||
| Index | 1019 |