Additional Information
Book Details
Abstract
Anesthesia Secrets, 4th Edition by James Duke, MD has the quick answers you need for practice and review. It uses the popular question-and-answer format of the Secrets Series® to make essential guidance easy to reference and study. A list of the Top 100 Secrets in anesthesiology lets you review the most frequently encountered board review questions at a glance; and an informal tone, user-friendly format, and pocket size make the book both convenient and portable.
- A section on the Top 100 Secrets in anesthesiology provides you with a high-yield overview of essential material for study or self assessment.
- A question-and-answer format, Key Points boxes, bulleted lists, mnemonics, and a two-color page layout make information remarkably easy to reference and review.
- Practical tips from the authors provide valuable insights into best practices.
- The book's portable size lets you carry it comfortably in your lab coat pocket.
- Thorough updates throughout equip you with the most up-to-date information on all areas of anesthesia, including the most current standards of care.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover\r | Cover | ||
| Anesthesia Secrets\r | iii | ||
| Copyright Page\r | iv | ||
| Dedication | v | ||
| Contents | vii | ||
| Contributors | xiii | ||
| Preface | xvii | ||
| Top 100 Secrets | 1 | ||
| Section I: Basics of Patient Management\r | 9 | ||
| Chapter 1: Autonomic Nervous System\r | 9 | ||
| 1. Describe the autonomic nervous system.\r | 9 | ||
| 2. Review the anatomy of the sympathetic nervous system\r | 10 | ||
| 3. Elaborate on the location and names of the sympathetic ganglia. Practically speaking, what is the importance of knowing the name and location of theseganglia?\r | 10 | ||
| 4. Describe the postganglionic adrenergic receptors of the sympathetic nervous system and the effects of stimulating these receptors.\r | 11 | ||
| 5. Review the anatomy and function of the parasympathetic nervous system.\r | 11 | ||
| 6. What are catecholamines? Which catecholamines occur naturally? Which are synthetic?\r | 11 | ||
| 7. Review the synthesis of dopamine, norepinephrine, and epinephrine.\r | 11 | ||
| 8. How is norepinephrine metabolized?\r | 12 | ||
| 9. Describe the synthesis and degradation of acetylcholine.\r | 12 | ||
| 10. What are sympathomimetics?\r | 12 | ||
| 11. Review the sympathomimetics commonly used in the perioperative environment.\r | 12 | ||
| 12. Discuss the effects of phenylephrine and review common doses of this medication.\r | 14 | ||
| 13. Discuss the effects of ephedrine and review common doses of this medication. Give some examples of medications that contraindicate the use of ephedrineand why.\r | 14 | ||
| 14. What are the indications for using β-adrenergic antagonists?\r | 14 | ||
| 15. Review the mechanism of action for β1-antagonists and side effects.\r | 14 | ||
| 16. Review the effects of β2-antagonism.\r | 14 | ||
| 17. How might complications of β-blockade be treated intraoperatively?\r | 15 | ||
| 18. Describe the pharmacology of α-adrenergic antagonists.\r | 15 | ||
| 19. Review α2-agonists and their role in anesthesia.\r | 15 | ||
| 20. Discuss muscarinic antagonists and their properties.\r | 15 | ||
| 21. What is the significance of autonomic dysfunction? How might you tell if a patient has autonomic dysfunction?\r | 15 | ||
| 22. What is a pheochromocytoma, and what are its associated symptoms? How is pheochromocytoma diagnosed?\r | 15 | ||
| 23. Review the preanesthetic and intraoperative management of pheochromocytoma patients.\r | 16 | ||
| Suggested Reading\r | 16 | ||
| Chapter 2: Respiratory and Pulmonary Physiology\r | 17 | ||
| 1. What is the functional residual capacity? What factors affect it?\r | 17 | ||
| 2. What is closing capacity? What factors affect the closing capacity? What is the relationship between closing capacity and functional residual capacity?\r | 17 | ||
| 3. What muscles are responsible for inspiration and expiration?\r | 17 | ||
| 4. What is the physiologic work of breathing?\r | 17 | ||
| 5. Discuss the factors that affect the resistance to gas flow. What is laminar and turbulent gas flow?\r | 18 | ||
| 6. Suppose a patient has an indwelling 7-mm endotracheal tube and cannot be weaned because of the increased work of breathing. What would be of greaterbenefit, cutting off 4 cm of endotracheal tube or replacing the tube with one ofgreater internal diamete\r | 18 | ||
| 7. Why might helium be of benefit to a stridorous patient?\r | 18 | ||
| 8. Discuss dynamic and static compliance.\r | 18 | ||
| 9. How does surface tension affect the forces in the small airways and alveoli?\r | 18 | ||
| 10. Review the different zones (of West) in the lung with regard to perfusion and ventilation.\r | 19 | ||
| 11. What are the alveolar gas equation and the normal alveolar pressure at sea level on room air?\r | 19 | ||
| 12. What is the A-a gradient and what is a normal value for this gradient?\r | 19 | ||
| 13. What is the practical significance of estimating A-a gradient?\r | 19 | ||
| 14. What are the causes of hypoxemia?\r | 19 | ||
| 15. What are the A-a gradients for the different causes of hypoxemia:\r | 20 | ||
| 16. Discuss V/Q mismatch. How can general anesthesia worsen V/Q mismatch?\r | 20 | ||
| 17. Define anatomic, alveolar, and physiologic dead space.\r | 21 | ||
| 18. How is Vd/Vt calculated?\r | 21 | ||
| 19. Define absolute shunt. How is the shunt fraction calculated?\r | 21 | ||
| 20. What is hypoxic pulmonary vasoconstriction?\r | 21 | ||
| 21. Calculate arterial and venous oxygen content (CaO2 and CvO2).\r | 21 | ||
| 22. How is CO2 transported in the blood?\r | 21 | ||
| 23. How is PCO2 related to alveolar ventilation?\r | 22 | ||
| 24. What factors alter oxygen consumption?\r | 22 | ||
| 25. Where is the respiration center located in the brain?\r | 22 | ||
| 26. How do carbon dioxide and oxygen act to stimulate and repress breathing?\r | 22 | ||
| 27. What are the causes of hypercarbia?\r | 22 | ||
| 28. What are the signs and symptoms of hypercarbia?\r | 23 | ||
| Suggested Readings\r | 23 | ||
| Chapter 3: Blood Gas and Acid-Base Analysis\r | 24 | ||
| 1. What are the normal arterial blood gas values in a healthy patient breathing room air at sea level?\r | 24 | ||
| 2. What information does arterial blood gas provide about the patient? | 24 | ||
| 3. How is the regulation of acid-base balance traditionally described? | 24 | ||
| 4. What is the physiochemical approach (Stewart model) for the analysis of acid-base balance? | 25 | ||
| 5. What are the common acid-base disorders and their compensation? | 25 | ||
| 6. How do you calculate the degree of compensation? | 26 | ||
| 7. What are the common causes of respiratory acid-base disorders? | 26 | ||
| 8. What are the major buffering systems of the body? | 26 | ||
| 9. What organs play a major role in acid-base balance? | 26 | ||
| 10. What is meant by pH? | 27 | ||
| 11. Why is pH important? | 27 | ||
| 12. List the major consequences of acidemia. | 27 | ||
| 13. List the major consequences of alkalemia. | 27 | ||
| 14. Is the HCO3 value on the arterial blood gas the same as the CO2 value on the chemistry panel? | 28 | ||
| 15. What is the base deficit? How is it determined? | 28 | ||
| 16. What is the anion gap? | 28 | ||
| 17. List the common causes of a metabolic alkalosis. | 29 | ||
| 18. List the common causes of elevated and nonelevated anion gap metabolic acidosis. | 29 | ||
| 19. Describe a stepwise approach to acid-base interpretation. | 29 | ||
| Suggested Readings\r | 30 | ||
| Chapter 4: Fluids, Volume Regulation, and Volume Disturbances\r | 31 | ||
| 1. Describe the functionally distinct compartments of body water, using a 70-kg patient for illustration.\r | 31 | ||
| 2. Describe the dynamics of fluid distribution between the intravascular and interstitial compartments.\r | 31 | ||
| 3. How are body water and tonicity regulated?\r | 31 | ||
| 4. Discuss the synthesis of antidiuretic hormone.\r | 32 | ||
| 5. List conditions that stimulate and inhibit release of antidiuretic hormone.\r | 32 | ||
| 6. What is diabetes insipidus?\r | 32 | ||
| 7. List causes of diabetes insipidus.\r | 33 | ||
| 8. Discuss alternative treatments for diabetes insipidus.\r | 33 | ||
| 9. Define the syndrome of inappropriate antidiuretic hormone release. What is the primary therapy?\r | 34 | ||
| 10. What disorders are associated with SIADH?\r | 34 | ||
| 11. What is aldosterone? What stimulates its release? What are its actions?\r | 34 | ||
| 12. Discuss issues associated with estimating volume status in outpatients.\r | 34 | ||
| 13. Discuss estimating volume status in acutely ill patients.\r | 34 | ||
| 14. Are there distinct advantages to using colloids to resuscitate a patient?\r | 34 | ||
| 15. Review the composition of crystalloid solutions.\r | 35 | ||
| 16. Review the colloidal solutions that are available.\r | 35 | ||
| 17. What is the normal range for serum osmolality?\r | 36 | ||
| 18. What situations might be appropriate for the use of hypertonic saline?\r | 36 | ||
| 19. How do you estimate fluid loss during a surgical procedure?\r | 36 | ||
| 20. What is meant by third-space losses? What are the effects of such losses?\r | 36 | ||
| 21. How much fluid is appropriate to administer during a surgical procedure?\r | 37 | ||
| 22. Is blood pressure a good sign of hypovolemia?\r | 37 | ||
| 23. What clinical findings support a diagnosis of hypervolemia?\r | 37 | ||
| Suggested Readings\r | 37 | ||
| Chapter 5: Electrolytes\r | 38 | ||
| 1. What is a normal sodium concentration? What degree of hyponatremia is acceptable to continue with a planned elective procedure?\r | 38 | ||
| 2. How is hyponatremia classified? | 38 | ||
| 3. How should acute hyponatremia be treated? | 38 | ||
| 4. Is there a subset of patients who may tend to have residual neurologic sequelae from a hyponatremic episode?\r | 39 | ||
| 5. What may cause acute hyponatremia in the operating room?\r | 39 | ||
| 6. Discuss hypernatremia and its causes. | 39 | ||
| 7. What problems does hypernatremia pose for the anesthesiologist? | 39 | ||
| 8. Review hypokalemia and its causes. | 39 | ||
| 9. What are the risks of hypokalemia? | 40 | ||
| 10. A patient takes diuretics and is found to have a potassium level of 3 mEq/L. Why not give the patient enough potassium to restore the serum level to normal?\r | 40 | ||
| 11. If potassium is administered, how much should be administered and how fast should it be administered? | 40 | ||
| 12. Define hyperkalemia and review its symptoms. | 40 | ||
| 13. What are some causes of hyperkalemia? | 40 | ||
| 14. Describe the patterns of hyperkalemia observed after the administration of succinylcholine. | 41 | ||
| 15. A patient with chronic renal failure requires an arteriovenous fistula for hemodialysis. Potassium is measured as 7 mEq/L. What are the risks of generalanesthesia?\r | 41 | ||
| 16. How is hyperkalemia treated? | 41 | ||
| 17. What are the major causes and manifestations of hypocalcemia? | 41 | ||
| 18. How is hypocalcemia treated? | 42 | ||
| 19. Does hypomagnesemia pose a problem for the anesthesiologist? | 42 | ||
| 20. Hyperchloremia has been increasingly recognized after administration of what standard resuscitation fluid?\r | 42 | ||
| Suggested Reading | 42 | ||
| Chapter 6: Transfusion Therapy\r | 43 | ||
| 1. How would knowledge of oxygen delivery impact the decision to transfuse?\r | 43 | ||
| 2. At what point is DO2crit reached? What are our surrogate measures for DO2crit?\r | 43 | ||
| 3. What are the physiologic adaptations to acute normovolemic anemia?\r | 43 | ||
| 4. Historically, a hemoglobin level of 10 g/dl (hematocrit of 30) was used as a transfusion trigger. Why is this is no longer an accepted Practice?\r | 44 | ||
| 5. What are the risks of transfusion?\r | 44 | ||
| 6. What infectious diseases can be contracted from a transfusion and how significant is that risk?\r | 44 | ||
| 7. Review the major transfusion-related reactions.\r | 44 | ||
| 8. What are the current standards for the length of storage of blood? What is a blood storage lesion?\r | 46 | ||
| 9. Is there convincing evidence that the effect of a transfusion on immune function is harmful?\r | 46 | ||
| 10. Review the features of transfusion-related acute lung injury.\r | 46 | ||
| 11. What conditions may predispose a patient to transfusion-related acute lung injury?\r | 47 | ||
| 12. Discuss the criteria for diagnosis of transfusion-related acute lung injury.\r | 47 | ||
| 13. What treatments are available for transfusion-related acute lung injury?\r | 47 | ||
| 14. Review the ABO and Rh blood genotypes and the associated antibody patterns.\r | 47 | ||
| 15. What is the difference between a type and screen and a crossmatch?\r | 48 | ||
| 16. What type of blood should be used in an emergency situation?\r | 48 | ||
| 17. What are some of the complications of massive blood transfusion?\r | 48 | ||
| 18. If suspected, how should a major transfusion reaction be managed?\r | 49 | ||
| 19. What alternatives are there to transfusion of donor blood?\r | 49 | ||
| 20. What are the limitations, advantages, and disadvantages of alternative hemoglobin solutions?\r | 49 | ||
| Suggested Readings | 50 | ||
| Chapter 7: Coagulation\r | 51 | ||
| 1. How can you identify a patient at risk for bleeding?\r | 51 | ||
| 2. What processes form the normal hemostatic mechanism?\r | 51 | ||
| 3. Describe primary hemostasis.\r | 51 | ||
| 4. Review secondary hemostasis.\r | 51 | ||
| 5. What are the intrinsic and extrinsic coagulation pathways?\r | 51 | ||
| 6. Explain fibrinolysis.\r | 52 | ||
| 7. Why doesn't blood coagulate in normal tissues?\r | 52 | ||
| 8. What is an acceptable preoperative platelet count?\r | 53 | ||
| 9. List the causes of platelet abnormalities.\r | 53 | ||
| 10. How does aspirin act as an anticoagulant?\r | 53 | ||
| 11. Review the properties of factor VIII.\r | 53 | ||
| 12. How does vitamin K deficiency affect coagulation?\r | 54 | ||
| 13. How does heparin act as an anticoagulant?\r | 54 | ||
| 14. Give a general description of the different coagulation tests.\r | 54 | ||
| 15. What does the partial thromboplastin time measure?\r | 54 | ||
| 16. Describe the activated partial thromboplastin time.\r | 54 | ||
| 17. How is the activated clotting time measured?\r | 55 | ||
| 18. What is the prothrombin time?\r | 55 | ||
| 19. Explain the international normalized ratio.\r | 55 | ||
| 20. What are the indications for administering fresh frozen plasma?\r | 55 | ||
| 21. What is cryoprecipitate? When should it be administered?\r | 55 | ||
| 22. What is disseminated intravascular coagulation?\r | 55 | ||
| 23. What tests are used for the diagnosis of disseminated intravascular coagulation?\r | 55 | ||
| 24. Describe the treatment of disseminated intravascular coagulation\r | 56 | ||
| 25. What is recombinant factor VIIa (NovoSeven)?\r | 56 | ||
| 26. Discuss the basic principles of thrombelastography.\r | 56 | ||
| 27. Discuss the parameters measured by thromboelastography.\r | 57 | ||
| Suggested Readings | 57 | ||
| Chapter 8: Airway Management\r | 58 | ||
| 1. List several indications for endotracheal intubation. | 58 | ||
| 2. Review objective measures suggesting the need to perform endotracheal intubation. | 58 | ||
| 3. What historical information might be useful in assessing a patient's airway? | 58 | ||
| 4. Describe the physical examination of the oral cavity. | 58 | ||
| 5. Review the Mallampati classification. | 59 | ||
| 6. What is the next step after examination of the oral cavity? | 59 | ||
| 7. Describe the examination of the neck. | 59 | ||
| 8. Discuss the anatomy of the larynx. | 60 | ||
| 9. Describe the innervation and blood supply to the larynx. | 60 | ||
| 10. Summarize the various instruments available to facilitate oxygenation. | 60 | ||
| 11. What are the benefits of oral and nasal airways? | 61 | ||
| 12. How are laryngoscopes used? | 61 | ||
| 13. What structures must be aligned to accomplish visualization of the larynx? | 61 | ||
| 14. What is a GlideScope? | 61 | ||
| 15. What endotracheal tubes are available? | 61 | ||
| 16. What are laryngeal mask airways? | 63 | ||
| 17. What other airway management devices are available? | 63 | ||
| 18. Describe the indications for an awake intubation. | 63 | ||
| 19. How is the patient prepared for awake intubation? | 63 | ||
| 20. How is awake intubation performed? | 63 | ||
| 21. What nerve blocks are useful when awake intubation is planned? | 64 | ||
| 22. What are predictors of difficult mask ventilation? Why is this important? | 64 | ||
| 23. The patient has been anesthetized and paralyzed, but the airway is difficult to intubate. Is there an organized approach to handling this problem?\r | 65 | ||
| 24. Describe the technique of transtracheal ventilation and its limitations. | 65 | ||
| 25. What are criteria for extubation? | 65 | ||
| 26. What is rapid-sequence induction? Which patients are best managed in this fashion? | 65 | ||
| 27. How is RSI performed? | 66 | ||
| 28. What is the purpose of preoxygenation before the induction of anesthesia? | 67 | ||
| 29. Anesthesiologists routinely deliver 100% oxygen for a few minutes before extubation. What is the logic behind this action and why might an FiO2 of 80%be better?\r | 67 | ||
| Suggested Readings | 67 | ||
| Chapter 9: Pulmonary Function Testing\r | 68 | ||
| 1. What are pulmonary function tests and how are they used? | 68 | ||
| 2. What is the benefit of obtaining pulmonary function tests? | 68 | ||
| 3. Besides abnormal pulmonary function tests, what are recognized risk factors for postoperative pulmonary complications?\r | 68 | ||
| 4. What factors should be taken into consideration when interpreting pulmonary function tests? | 68 | ||
| 5. Describe standard lung volumes. | 68 | ||
| 6. What are the lung capacities? | 68 | ||
| 7. What techniques are used to determine functional residual capacity? | 69 | ||
| 8. What information is obtained from spirometry? | 69 | ||
| 9. What is the diffusing capacity for the single-breath diffusion capacity (DLCO)? | 69 | ||
| 10. What disease states cause a decrease in DLCO? | 69 | ||
| 11. What disease states cause an increase in DLCO? | 70 | ||
| 12. Review obstructive airway diseases and their pulmonary function test abnormalities. | 70 | ||
| 13. Review restrictive lung disorders and their associated pulmonary function test abnormalities. | 70 | ||
| 14. What is a flow-volume loop and what information does it provide? | 71 | ||
| 15. What are the characteristic patterns of the flow-volume loop in a fixed airway obstruction, variable extrathoracic obstruction, and intrathoracic obstruction?\r | 71 | ||
| 16. What is the value of measuring flow-volume loops in a patient with an anterior mediastinal mass? | 71 | ||
| 17. What are the effects of surgery and anesthesia on pulmonary function? | 73 | ||
| 18. What pulmonary function test values predict increased perioperative pulmonary complications after abdominal or thoracic surgery?\r | 73 | ||
| 19. Are there absolute values of specific pulmonary function tests below which the risk of surgery is prohibitive?\r | 74 | ||
| Suggested Reading | 74 | ||
| Section II: Pharmacology\r | 75 | ||
| Chapter 10: Volatile Anesthetics\r | 75 | ||
| 1. What are the properties of an ideal anesthetic gas?\r | 75 | ||
| 2. What are the chemical structures of the more common anesthetic gases? Why do we no longer use the older ones?\r | 75 | ||
| 3. How are the potencies of anesthetic gases compared?\r | 75 | ||
| 4. What factors may influence MAC?\r | 76 | ||
| 5. Define partition coefficient. Which partition coefficients are important?\r | 76 | ||
| 6. Review the evolution in hypothesis as to how volatile anesthetics work.\r | 76 | ||
| 7. What factors influence speed of induction?\r | 77 | ||
| 8. What is the second gas effect? Explain diffusion hypoxia.\r | 77 | ||
| 9. Should nitrous oxide be administered to patients with pneumothorax? Are there other conditions in which nitrous oxide should be avoided?\r | 78 | ||
| 10. Describe the ventilatory effects of the volatile anesthetics.\r | 78 | ||
| 11. What effects do volatile anesthetics have on hypoxic pulmonary vasoconstriction, airway caliber, and mucociliary function?\r | 78 | ||
| 12. What effects do volatile anesthetics have on circulation?\r | 79 | ||
| 13. Which anesthetic agent is most associated with cardiac dysrhythmias?\r | 79 | ||
| 14. Discuss the biotransformation of volatile anesthetics and the toxicity of metabolic products.\r | 79 | ||
| 15. Review the effects of CO2 absorbants on volatile anesthetic by-products.\r | 80 | ||
| 16. Which anesthetic agent has been shown to be teratogenic in animals? Is nitrous oxide toxic to humans?\r | 81 | ||
| Suggested Readings | 81 | ||
| Chapter 11: Opioids\r | 82 | ||
| 1. What is an opiate? An opioid? A narcotic? | 82 | ||
| 2. What are endogenous opioids? | 82 | ||
| 3. Differentiate opioid tolerance, dependence, and abuse. | 82 | ||
| 4. Name the opioids commonly used in the perioperative setting, their trade names, equivalent morphine doses, half-lives, and chemical classes.\r | 82 | ||
| 5. Describe the various opioid receptors and their effects. | 82 | ||
| 6. What is an opioid agonist-antagonist? | 82 | ||
| 7. Explain the mechanism of action, duration, and side effects of the opioid antagonist naloxone. | 82 | ||
| 8. Describe the various routes of administration of opioids. | 83 | ||
| 9. What are the typical side effects of opioids? | 83 | ||
| 10. Which opioids are associated with histamine release? | 84 | ||
| 11. Describe the mechanism of opioid-induced nausea. | 84 | ||
| 12. What is methylnaltrexone and what potential role does it have in opioid therapy? | 84 | ||
| 13. Describe the cardiovascular effects of opioids. | 85 | ||
| 14. Describe the typical respiratory pattern and ventilatory response to carbon dioxide in the presence of opioids.\r | 85 | ||
| 15. Describe the analgesic onset, peak effect, and duration of intravenous fentanyl, morphine, and hydromorphone.\r | 85 | ||
| 16. Explain how fentanyl can have a shorter duration of action but a longer elimination half-life than morphine.\r | 85 | ||
| 17. Explain the concept of context-sensitive half-time and its relevance to opioids. | 86 | ||
| 18. Explain why morphine may cause prolonged ventilatory depression in patients with renal failure. | 86 | ||
| 19. Which opioids may be associated with seizure activity in patients with renal failure? | 86 | ||
| 20. What is remifentanil and how does it differ from other opioids? | 87 | ||
| 21. Describe the metabolism of codeine. | 87 | ||
| 22. What are some particular concerns with methadone dosing? | 87 | ||
| 23. What is tramadol? | 88 | ||
| 24. What are some of the unique characteristics of meperidine? | 88 | ||
| 25. Describe the site and mechanism of action of neuraxial opioids. | 88 | ||
| 26. Discuss the effect of lipid solubility on neuraxial opioid action. | 88 | ||
| 27. Are opioid receptors exclusively in the central nervous system? | 88 | ||
| 28. Describe the advantages of combining local anesthetics and opioids in neuraxial analgesia. | 88 | ||
| 29. What is DepoDur and how is it different from other neuraxial opioids? | 88 | ||
| Suggested Readings | 89 | ||
| Chapter 12: Intravenous Anesthetics And Benzodiazepines\r | 90 | ||
| 1. What qualities would the ideal intravenous induction agent possess? | 90 | ||
| 2. List the commonly used induction agents and their properties. Compare their cardiovascular effects. | 90 | ||
| 3. Instead of injecting pentothal intravenously, you have inadvertently administered it into the patient's intra-arterial line. What is the impact on thepatient and how should potential problems be addressed?\r | 90 | ||
| 4. What are contraindications to STP use? | 90 | ||
| 5. How do induction agents affect respiratory drive? | 91 | ||
| 6. How does ketamine differ from other induction agents? | 92 | ||
| 7. Discuss the concerns for the use of etomidate in the critically ill patient. | 92 | ||
| 8. Describe propofol infusion syndrome. | 92 | ||
| 9. What are some contraindications to the use of propofol? | 93 | ||
| 10. What would be an appropriate induction agent for a 47-year-old healthy male with a parietal lobe tumor scheduled for craniotomy and tumor excision?\r | 93 | ||
| 11. Describe the mechanism of action of benzodiazepines. | 93 | ||
| 12. What benzodiazepines are commonly administered intravenously? | 93 | ||
| 13. How should oversedation induced by benzodiazepines be managed? | 93 | ||
| 14. What do you tell the nurses who will monitor this patient about possible side effects of flumazenil? | 94 | ||
| Suggested Readings | 94 | ||
| Chapter 13: Muscle Relaxants and Monitoring of Relaxant Activity\r | 95 | ||
| 1. Describe the anatomy of the neuromuscular junction.\r | 95 | ||
| 2. What is the structure of the acetylcholine receptor?\r | 95 | ||
| 3. With regard to neuromuscular transmission, list all locations for acetylcholine receptors.\r | 96 | ||
| 4. Review the steps involved in normal neuromuscular transmission.\r | 96 | ||
| 5. What are the benefits and risks of using muscle relaxants?\r | 96 | ||
| 6. How are muscle relaxants classified?\r | 96 | ||
| 7. What are the indications for using succinylcholine?\r | 96 | ||
| 8. If succinylcholine works so rapidly and predictably, why not use it all the time?\r | 97 | ||
| 9. How do mature and immature acetylcholine receptors differ?\r | 97 | ||
| 10. Differentiate between qualitative and quantitative deficiencies in pseudocholinesterase.\r | 97 | ||
| 11. Review the properties of nondepolarizing muscle relaxants.\r | 98 | ||
| 12. Review the metabolism of nondepolarizing neuromuscular blockers.\r | 98 | ||
| 13. Describe common side effects of nondepolarizing neuromuscular blockers.\r | 99 | ||
| 14. Review medications that potentiate the actions of muscle relaxants.\r | 99 | ||
| 15. What clinical conditions potentiate the actions of neuromuscular blockers?\r | 99 | ||
| 16. Discuss important characteristics of a nerve stimulator.\r | 99 | ||
| 17. List the different patterns of stimulation.\r | 99 | ||
| 18. Which is the simplest mode of stimulation?\r | 99 | ||
| 19. Which mode is most commonly used to assess degree of blockade? How is it done?\r | 100 | ||
| 20. What is tetanic stimulation?\r | 100 | ||
| 21. Explain posttetanic facilitation and posttetanic count.\r | 100 | ||
| 22. What is double-burst stimulation?\r | 100 | ||
| 23. What is acceleromyography?\r | 101 | ||
| 24. Which nerves can be chosen for stimulation?\r | 101 | ||
| 25. What are the characteristic responses to the various patterns of stimulation produced by nondepolarizing agents?\r | 101 | ||
| 26. Summarize the characteristic responses to the various patterns of stimulation produced by depolarizing relaxants (succinylcholine).\r | 101 | ||
| 27. For surgical purposes, based on nerve stimulation, what is adequate muscular relaxation?\r | 101 | ||
| 28. How might relaxant activity be terminated?\r | 102 | ||
| 29. Review the properties of sugammadex.\r | 102 | ||
| 30. How might sugammadex alter anesthetic practice?\r | 102 | ||
| 31. Discuss the appropriate time to reverse neuromuscular blockade based on nerve stimulation.\r | 102 | ||
| 32. Review the acetylcholinesterase inhibitors commonly used to antagonize nondepolarizing blockade.\r | 102 | ||
| 33. Review important side effects of acetylcholinesterase administration.\r | 102 | ||
| 34. Should all patients who receive nondepolarizing relaxants be reversed?\r | 103 | ||
| 35. Review the clinical signs associated with return of adequate strength.\r | 103 | ||
| 36. A patient appears weak after pharmacologic reversal of neuromuscular blockade. What factors should be considered?\r | 103 | ||
| Suggested Readings\r | 104 | ||
| Chapter 14: Local Anesthetics\r | 105 | ||
| 1. What role do local anesthetics play in the practice of anesthesiology?\r | 105 | ||
| 2. How are local anesthetics classified?\r | 105 | ||
| 3. How are local anesthetics metabolized?\r | 105 | ||
| 4. How are impulses conducted in nerve cells?\r | 105 | ||
| 5. What is the mechanism of action of local anesthetics?\r | 106 | ||
| 6. Your patient states that he was told he is allergic to Novocain, which he received for a tooth extraction. Should you avoid using local anesthetics in this patient?\r | 106 | ||
| 7. What determines local anesthetic potency?\r | 106 | ||
| 8. What factors influence the duration of action of local anesthetics?\r | 107 | ||
| 9. What determines local anesthetic onset time?\r | 107 | ||
| 10. How does the onset of anesthesia proceed in a peripheral nerve block?\r | 107 | ||
| 11. What are the maximum safe doses of various local anesthetics?\r | 107 | ||
| 12. Which regional anesthetic blocks are associated with the greatest degree of systemic vascular absorption of local anesthetic?\r | 108 | ||
| 13. Why are epinephrine and phenylephrine often added to local anesthetics? What cautions are advisable regarding the use of these drugs?\r | 108 | ||
| 14. How does a patient become toxic from local anesthetics? What are the clinical manifestations of local anesthetic toxicity?\r | 108 | ||
| 15. Is the risk of cardiotoxicity the same with various local anesthetics?\r | 108 | ||
| 16. How will you prevent and treat systemic toxicity?\r | 109 | ||
| 17. What is the risk of neurotoxicity with local anesthetics?\r | 109 | ||
| 18. Which local anesthetic is associated with the risk of methemoglobinemia?\r | 110 | ||
| 19. Describe the role of lipid infusion in the treatment of local anesthetic toxicity.\r | 110 | ||
| 20. What are some of the newer local anesthetics and what are their potential applications?\r | 110 | ||
| Suggested Readings\r | 111 | ||
| Chapter 15: Inotropes and Vasodilator Drugs\r | 112 | ||
| 1. What are the benefits of cardiovascular drugs? | 112 | ||
| 2. Discuss the limitations of drugs that alter vascular tone. | 112 | ||
| 3. What are the general goals of inotropic support and the characteristics of the ideal inotrope? | 112 | ||
| 4. Discuss the hemodynamic profile of the phosphodiesterase III inhibitors amrinone and milrinone. | 112 | ||
| 5. What untoward effects can result from use of phosphodiesterase inhibitors? How are these minimized? | 112 | ||
| 6. What are other advantages of the phosphodiesterase inhibitors? | 113 | ||
| 7. What intracellular intermediary is involved in the actions of phosphodiesterase III inhibitors and sympathomimetic amines? | 113 | ||
| 8. How does increased intracellular cAMP affect the cardiac myocyte? What are the corresponding effects on myocardial function?\r | 113 | ||
| 9. Describe the hemodynamic profiles of epinephrine, norepinephrine, and dopamine. | 113 | ||
| 10. Describe the hemodynamic profiles of isoproterenol and dobutamine. | 113 | ||
| 11. Which characteristics of -adrenergic agonists limit their effectiveness? | 114 | ||
| 12. How may the side effects and limitations of -adrenergic agonists be minimized? | 114 | ||
| 13. Is digitalis useful as an inotrope intraoperatively? | 114 | ||
| 14. What are the mechanism and sites of action of nitrovasodilators? | 114 | ||
| 15. Describe the antianginal effects of nitrates. | 114 | ||
| 16. Describe the etiology of tachyphylaxis with nitrovasodilators. | 115 | ||
| 17. Discuss the types and mechanisms of action of selective vasodilating agents available for clinical use. | 115 | ||
| 18. Describe the mechanism of action of vasopressin. | 116 | ||
| 19. How may vasopressin aid in the management of cardiogenic or septic shock? | 116 | ||
| 20. How may -type natriuretic peptide aid in the management of end-stage congestive heart failure? | 116 | ||
| 21. What is diastolic heart failure and what management options are available? | 116 | ||
| 22. What are the clinical indications and current evidence for using dopamine? | 116 | ||
| 23. Describe the new inotropic agent levosimendan, including mechanism of action and place in clinical therapy.\r | 117 | ||
| 24. What mechanism of action accounts for the inotropic effect of thyroid hormone? | 117 | ||
| Suggested Readings\r | 117 | ||
| Chapter 16: Preoperative Medication\r | 118 | ||
| 1. List the major goals of premedication. | 118 | ||
| 2. List the most commonly used preoperative medications with the appropriate dose. | 118 | ||
| 3. What factors should be considered in selecting premedication for a patient? | 118 | ||
| 4. What factors limit the ability to give depressant medications preoperatively? | 118 | ||
| 5. What is meant by psychologic premedication? | 118 | ||
| 6. Discuss the role of benzodiazepines in premedication. | 118 | ||
| 7. List the most common side effects when opioids are used as a premedication. | 119 | ||
| 8. Describe the reasons to include an anticholinergic agent in premedication. | 119 | ||
| 9. Summarize the effects of commonly used anticholinergic agents. | 120 | ||
| 10. List the common side effects of anticholinergic medications. | 120 | ||
| 11. A patient in the preoperative holding area is delirious after receiving only 0.4mg of scopolamine as a premedication. What is the cause of the delirium?How is it managed?\r | 120 | ||
| 12. How does the concern for aspiration pneumonitis influence the choice of premedication? | 120 | ||
| 13. Is it safe to allow patients to drink some water to swallow preoperative medications? | 121 | ||
| 14. What are the differences between premedication of pediatric vs. adult patients? | 121 | ||
| 15. How does the age of pediatric patients influence premedication? | 121 | ||
| 16. Describe the preoperative management of a morbidly obese patient with a difficult airway. Assume that the patient is otherwise healthy.\r | 122 | ||
| Suggested Readings\r | 122 | ||
| Section III: Preparing for Anesthesia\r | 123 | ||
| Chapter 17: Preoperative Evaluation\r | 123 | ||
| 1. What are the goals of the preoperative evaluation?\r | 123 | ||
| 2. Discuss the important features of the preoperative evaluation.\r | 123 | ||
| 3. How often does the preoperative evaluation alter care plans?\r | 123 | ||
| 4. What are the features of informed consent?\r | 123 | ||
| 5. What is the physical status classification of the ASA?\r | 123 | ||
| 6. How long should a patient fast before surgery?\r | 124 | ||
| 7. What are the appropriate preoperative laboratory tests? Which patients should have an electrocardiogram? Chest radiography?\r | 124 | ||
| 8. What is the generally accepted minimum hematocrit for elective surgery?\r | 124 | ||
| 9. Are there ways of predicting which patients will have pulmonary complications?\r | 125 | ||
| 10. When are preoperative consultations with other specialists indicated?\r | 125 | ||
| 11. What benefits and risks are associated with preoperative cigarette cessation?\r | 126 | ||
| 12. How long before surgery must a patient quit smoking to realize any health benefits?\r | 126 | ||
| 13. What are current guidelines for perioperative cardiac evaluation of patients scheduled for noncardiac surgery?\r | 127 | ||
| 14. What are active cardiac conditions?\r | 127 | ||
| 15. What are the clinical risk factors for a major perioperative cardiac event?\r | 127 | ||
| 16. What constitutes the basic laboratory evaluation of coagulation status?\r | 127 | ||
| 17. Are there special anesthetic considerations for surgical patients on warfarin?\r | 127 | ||
| 18. What are considerations for patients with coronary stents?\r | 128 | ||
| 19. A 3-year-old child presents for an elective tonsillectomy. His mother reports that for the past 3 days he has had a runny nose and postnasal drip. Shouldyou postpone surgery?\r | 128 | ||
| Suggested Readings\r | 129 | ||
| Chapter 18: The Anesthesia Machine and Vaporizers\r | 130 | ||
| 1. What is an anesthesia machine? | 130 | ||
| 2. Describe the plumbing of an anesthesia machine to create an overview of its essential interconnections. | 130 | ||
| 3. What gases are ordinarily available on all anesthesia machines and what are their sources? | 130 | ||
| 4. Since the flow rates of N2O and O2 are controlled independently, can the machine be set to deliver a hypoxic mixture to the patient?\r | 130 | ||
| 5. What is a regulator? How does it control the flow of gas? | 130 | ||
| 6. How does the hospital piped gas supply compare to the use of tank gas? | 131 | ||
| 7. The hospital supply of oxygen is lost. The gauge on the O2 tank reads 1000 psi. How long will you be able to deliver oxygen before the tanks are empty?\r | 131 | ||
| 8. A new tank of N2O is installed, and the pressure gauge reads only about 750 psig. Why is the pressure in the N2O tank different from the pressures of othergases?\r | 131 | ||
| 9. List the uses of O2 in an anesthesia machine. | 131 | ||
| 10. Describe the safety systems used to prevent incorrect gas connections at the wall and cylinders. | 132 | ||
| 11. In addition to the distinctions described previously, what other ways are gases distinguished to help prevent human error?\r | 132 | ||
| 12. There are two flowmeters for each gas on an anesthesia machine. Couldn't you safely get away with only one?\r | 132 | ||
| 13. Why are the flowmeters for air, O2, and N2O arranged in a specific order? | 132 | ||
| 14. What is meant by a fail-safe valve? | 132 | ||
| 15. Would it be safer to leave the tank O2 supply on your machine turned on so, if the pipeline O2 failed, the machine would automatically switch immediately tothe backup tank supply?\r | 132 | ||
| 16. How long can you continue to deliver O2 when the wall supply fails? | 133 | ||
| 17. What physical principles are involved in the process of vaporization? | 133 | ||
| 18. What does it mean when it is said that a vaporizer has variable bypass? What is the effect of having such a vaporizer turned on its side?\r | 133 | ||
| 19. What does temperature compensation mean? | 134 | ||
| 20. What is the pumping effect? | 134 | ||
| 21. How does altitude affect modern vaporizers? | 134 | ||
| 22. What happens if you put the wrong agent in a vaporizer calibrated for another agent? | 134 | ||
| 23. What is different about the desflurane vaporizer? | 134 | ||
| 24. What prevents turning on two vaporizers simultaneously? | 135 | ||
| 25. At an altitude of 7000 feet, you have to set the vaporizer to deliver more desflurane than you would expect given the published minimum alveolarconcentration of that agent. Explain why this does not happen with vaporizersfor other anesthetic agents.\r | 135 | ||
| 26. A patient with malignant hyperthermia needs to be anesthetized. Should the vaporizers be removed from the anesthesia machine?\r | 135 | ||
| 27. What is a scavenger? | 136 | ||
| Suggested Readings\r | 136 | ||
| Chapter 19: Anesthesia Circuits and Ventilators\r | 137 | ||
| 1. What are the different types of anesthesia breathing circuits?\r | 137 | ||
| 2. Give an example of an open circuit.\r | 137 | ||
| 3. Give an example of a semiopen circuit.\r | 137 | ||
| 4. Give an example of a semiclosed circuit.\r | 138 | ||
| 5. Give an example of a closed circuit\r | 138 | ||
| 6. Rank the Mapleson circuits in order of efficiency for controlled and spontaneous ventilation\r | 138 | ||
| 7. What circuit is most commonly used in anesthesia delivery systems today?\r | 138 | ||
| 8. How is a breathing circuit disconnection detected during delivery of an anesthetic?\r | 138 | ||
| 9. How is CO2 eliminated from a circle system?\r | 139 | ||
| 10. How much CO2 can the absorbent neutralize? What factors affect its efficiency?\r | 139 | ||
| 11. How do you know when the absorbent has been exhausted? What adverse reactions can occur between volatile anesthetic and CO2 absorbants?\r | 139 | ||
| 12. How can you check the competency of a circle system?\r | 139 | ||
| 13. How do anesthesia ventilators differ from intensive care unit ventilators?\r | 139 | ||
| 14. What gas is used to drive the bellows in an anesthesia ventilator?\r | 139 | ||
| 15. What is the status of the scavenger system when the bellows is below the top of its excursion?\r | 140 | ||
| 16. What is the effect of the extra pressure required to open the exhaust valve on the patient?\r | 140 | ||
| 17. What parameters can be adjusted on an anesthesia ventilator?\r | 140 | ||
| 18. Why have descending bellows been abandoned in favor of ascending bellows?\r | 140 | ||
| 19. What would be the cause when the bellows fails to rise completely between each breath?\r | 140 | ||
| 20. How does fresh gas flow rate contribute to tidal volume?\r | 141 | ||
| 21. How and where is tidal volume measured? Why are different measures frequently not equal?\r | 141 | ||
| 22. When using very low flows of fresh gas, why is there sometimes a discrepancy between inspired oxygen concentration and fresh gas concentration?\r | 141 | ||
| Suggested Readings\r | 141 | ||
| Chapter 20: Patient Positioning\r | 142 | ||
| 1. What is the goal of positioning a patient for surgery? | 142 | ||
| 2. Review the most common positions used in the operating room. | 142 | ||
| 3. What physiologic effects are related to change in body position? | 142 | ||
| 4. Describe the lithotomy position and its common complications. | 142 | ||
| 5. What nerves may be affected from lithotomy positioning? | 144 | ||
| 6. What are the special concerns for a patient positioned in the lateral decubitus position? | 144 | ||
| 7. What are the physiologic effects and risks associated with the Trendelenburg position? | 144 | ||
| 8. What specific concerns are associated with the prone position? | 144 | ||
| 9. What is the beach chair position? | 145 | ||
| 10. When is a sitting position used? | 145 | ||
| 11. What are the advantages of the sitting position? | 145 | ||
| 12. List the disadvantages of the sitting position. | 145 | ||
| 13. How does venous air embolism occur? What are the sequelae? | 145 | ||
| 14. Review the sensitivity and limitations of monitors for detecting venous air embolism. | 145 | ||
| 15. What are the concerns for positioning a pregnant patient? | 146 | ||
| 16. What peripheral neuropathies are associated with cardiac surgery? | 146 | ||
| 17. What is the most common perianesthetic neuropathy? | 146 | ||
| 18. Review the incidence of brachial plexus injuries. | 146 | ||
| 19. How might upper extremity neuropathies be prevented through careful positioning? | 146 | ||
| 20. What injuries may occur to the eye? | 147 | ||
| 21. Review the procedures that have been associated with postoperative visual loss. | 147 | ||
| 22. What factors may predispose a patient having spine surgery to postoperative visual loss? | 147 | ||
| 23. What patterns of blindness are noted? | 148 | ||
| 24. How does the head position affect the position of the endotracheal tube with respect to the carina? | 148 | ||
| Suggested Readings\r | 148 | ||
| Chapter 21: Mechanical Ventilation in Critical Illness\r | 149 | ||
| 1. Why might a patient require mechanical ventilation?\r | 149 | ||
| 2. Which is the most common mode of ventilation, volume or pressure control?\r | 149 | ||
| 3. What are the most commonly used modes of positive-pressure ventilation?\r | 149 | ||
| 4. Does PC-CMV permit the patient to interact with the ventilator?\r | 149 | ||
| 5. How does VC-A-C mode work?\r | 150 | ||
| 6. Do VC-A-C and VC-SIMV differ?\r | 150 | ||
| 7. When initiating mechanical ventilation, how do you decide on VC-A-C over VC-SIMV?\r | 150 | ||
| 8. What other variables are associated with conventional modes of MV?\r | 150 | ||
| 9. What is pressure support ventilation?\r | 150 | ||
| 10. How does pressure control ventilation differ from pressure support ventilation?\r | 150 | ||
| 11. What are trigger variables?\r | 151 | ||
| 12. What are the goals of mechanical ventilation in patients with acute respiratory failure?\r | 151 | ||
| 13. What are the initial ventilator settings in acute respiratory failure?\r | 152 | ||
| 14. What is the role of positive end-expiratory pressure?\r | 152 | ||
| 15. How is optimal positive end-expiratory pressure identified?\r | 152 | ||
| 16. What is intrinsic or auto-positive end-expiratory pressure?\r | 152 | ||
| 17. What are the side effects of PEEPe and PEEPi?\r | 153 | ||
| 18. What is a ventilator bundle?\r | 153 | ||
| 19. What is controlled hypoventilation with permissive hypercapnia?\r | 153 | ||
| 20. What is compliance? How is it determined?\r | 154 | ||
| 21. How is peak pressure measured?\r | 154 | ||
| 22. How is static pressure measured?\r | 154 | ||
| 23. How is compliance calculated?\r | 154 | ||
| 24. Is ventilation in the prone position an option for patients who are difficult to oxygenate?\r | 154 | ||
| 25. What are the indications for prone ventilation?\r | 155 | ||
| 26. How is the patient who is fighting the ventilator approached?\r | 155 | ||
| 27. Should neuromuscular blockade be used to facilitate mechanical ventilation?\r | 155 | ||
| 28. Is split-lung ventilation ever useful?\r | 156 | ||
| Suggested Readings\r | 156 | ||
| Section IV: Patient Monitoring and Procedures\r | 157 | ||
| Chapter 22: Electrocardiography\r | 157 | ||
| 1. Are all abnormal ECGs indicative of heart disease?\r | 157 | ||
| 2. What is the differential diagnosis for low voltage?\r | 157 | ||
| 3. Is electrocardiography sensitive or insensitive for detecting chamber enlargement and hypertrophy?\r | 157 | ||
| 4. Which clues suggest that a patient may have left ventricular hypertrophy?\r | 157 | ||
| 5. An adult has a large R wave in V1. What is the differential diagnosis?\r | 157 | ||
| 6. What leads are most helpful when looking for a bundle-branch block?\r | 158 | ||
| 7. What are the characteristics of a right bundle-branch block?\r | 158 | ||
| 8. What is an intraventricular conduction delay? When is it seen?\r | 158 | ||
| 9. What are the characteristics of a left bundle-branch block?\r | 158 | ||
| 10. What is a hemiblock?\r | 159 | ||
| 11. You are attempting to pass a Swan-Ganz catheter into the pulmonary artery in a patient with LBBB. When the hemodynamic tracing suggests that the cathetertip is in the right ventricle, the patient suddenly becomes bradycardic, with aheart rate of 25. What happened?\r | 159 | ||
| 12. Does a normal ECG exclude the possibility of severe coronary artery disease?\r | 159 | ||
| 13. How are patients with myocardial infarction subdivided on the basis of ECG changes during infarction?\r | 159 | ||
| 14. Does ST-segment elevation always indicate a myocardial infarction?\r | 161 | ||
| 15. For patients with ST-segment elevation myocardial infarction, how is the location identified?\r | 161 | ||
| 16. A patient has evidence on ECG of an acute inferior myocardial infarction. What associated findings should you look for?\r | 162 | ||
| 17. What is reciprocal change? Why is it important?\r | 162 | ||
| 18. What ECG findings suggest hypothyroidism?\r | 162 | ||
| 19. An elderly patient presents with fatigue, confusion, and atrial fibrillation with a slow ventricular response (heart rate = 40). The ECG demonstrates STdepression that is concave upward. The family states that the patient is on anunknown medication that is locked in his apartment. What laboratory test should you order to confirm your suspicion?\r | 163 | ||
| 20. An ECG recorded when the operating room nurse is scrubbing the patient's chest demonstrates wide complex electrical activity. The patient isasymptomatic. What do you suspect? How can you prove that you are correctwhen you analyze the ECG tracing? | 163 | ||
| 21. What ECG findings suggest hyperkalemia?\r | 163 | ||
| 22. What ECG findings suggest hypokalemia?\r | 163 | ||
| 23. What ECG findings suggest hypocalcemia?\r | 165 | ||
| 24. What ECG changes suggest hypercalcemia?\r | 165 | ||
| 25. What are some of the common causes of a prolonged QT interval?\r | 166 | ||
| 26. A patient has a right bundle-branch block that is new compared to the ECG from 2 years ago. How should I proceed?\r | 166 | ||
| 27. A patient has a left bundle-branch block that is new compared to the ECG from 2 years ago. How should I proceed?\r | 167 | ||
| Suggested Readings\r | 167 | ||
| Chapter 23: Pulse Oximetry\r | 168 | ||
| 1. What is pulse oximetry?\r | 168 | ||
| 2. How important is pulse oximetry?\r | 168 | ||
| 3. What are transmission pulse oximetry and reflection pulse oximetry?\r | 168 | ||
| 4. How does a pulse oximeter work?\r | 168 | ||
| 5. How is oxygen saturation determined from the amount of red and infrared light received and absorbed?\r | 168 | ||
| 6. How does the pulse oximeter determine the degree of arterial hemoglobin saturation?\r | 169 | ||
| 7. What is the normalization procedure?\r | 169 | ||
| 8. How does the R/IR ratio relate to the oxygen saturation?\r | 169 | ||
| 9. What is the oxyhemoglobin dissociation curve?\r | 170 | ||
| 10. Why might the pulse oximeter give a false reading? Part 1-not R/IR related\r | 171 | ||
| 11. Why might the pulse oximeter give a false reading? Part 2-R/IR related.\r | 172 | ||
| 12. The saturation plummets after injection of methylene blue. Is the patient desaturating?\r | 172 | ||
| 13. Explain the difference between functional hemoglobin and fractional hemoglobin saturation.\r | 173 | ||
| 14. Do pulse oximeters measure functional hemoglobin saturation or fractional hemoglobin saturation?\r | 173 | ||
| 15. Since the patient is oxygenated before anesthetic induction, if the pulse oximeter reaches 100%, does this indicate complete denitrogenation?\r | 173 | ||
| 16. Is the pulse oximeter a good indicator of ventilation?\r | 173 | ||
| 17. Are there complications associated with the use of pulse oximetry probes?\r | 173 | ||
| Suggested Readings\r | 174 | ||
| Chapter 24: Capnography\r | 175 | ||
| 1. What is the difference between capnometry and capnography? Which is better?\r | 175 | ||
| 2. Describe the most common method of gas sampling and the associated problems.\r | 175 | ||
| 3. What is the importance of measuring CO2?\r | 175 | ||
| 4. Describe the capnographic waveform.\r | 175 | ||
| 5. What may cause elevation of the baseline of the capnogram?\r | 176 | ||
| 6. Does ETCO2 correlate with PaCO2?\r | 176 | ||
| 7. Is it possible to see exhaled CO2 after accidental intubation of the esophagus?\r | 176 | ||
| 8. What might result in sudden loss of capnographic waveform?\r | 176 | ||
| 9. What process might lead to decreases in ETCO2?\r | 177 | ||
| 10. What processes may increase ETCO2?\r | 177 | ||
| 11. What processes can change the usual configuration of the waveform?\r | 178 | ||
| Suggested Readings\r | 179 | ||
| Chapter 25: Central Venous Catheterization And Pressure Monitoring\r | 180 | ||
| 1. Define central venous catheterization.\r | 180 | ||
| 2. What are the perioperative indications for placement of a central venous catheter? | 180 | ||
| 3. What are the nonoperative indications for placement of a central venous catheter? | 180 | ||
| 4. What is the best approach to central venous cannulation? | 180 | ||
| 5. Describe the subclavian vein approach. | 180 | ||
| 6. Describe the internal jugular vein approach. | 181 | ||
| 7. Describe the external jugular vein approach. | 181 | ||
| 8. When is the femoral vein approach used? | 181 | ||
| 9. Review the different types of central venous catheters. | 181 | ||
| 10. How is a catheter introduced into the central venous circulation? | 181 | ||
| 11. In attempting a central venous puncture, dark blood returns. Does this satisfy you that you are indeed within a vein?\r | 182 | ||
| 12. How is central venous pressure measured? | 182 | ||
| 13. At what point on the body should central venous pressure be measured? | 182 | ||
| 14. Where should the distal orifice of the catheter be positioned? | 183 | ||
| 15. How can you judge the correct positioning of the distal orifice of the catheter? | 183 | ||
| 16. Describe the normal central venous pressure waveform and relate its pattern to the cardiac cycle. | 183 | ||
| 17. What influences central venous pressure? | 184 | ||
| 18. Is central venous pressure an indicator of cardiac output? | 184 | ||
| 19. How does central venous pressure relate to right ventricular preload? | 184 | ||
| 20. Does central venous pressure relate to left ventricular preload? | 185 | ||
| 21. Is there a single normal central venous pressure reading? | 185 | ||
| 22. Are there noninvasive alternatives to central venous pressure that better indicate volume status? | 186 | ||
| 23. How can an abnormal central venous pressure waveform be used to diagnose abnormal cardiac events? | 186 | ||
| 24. Can you use the central venous catheter for blood transfusions? | 186 | ||
| 25. Describe complications associated with placement of the central venous catheter. | 186 | ||
| 26. Are any special precautions needed when removing a central venous catheter? | 187 | ||
| Suggested Readings\r | 187 | ||
| Chapter 26: Pulmonary Artery Catheterization\r | 188 | ||
| 1. What pressures are measured by pulmonary artery catheters? | 188 | ||
| 2. What are normal values for central venous, pulmonary artery, and pulmonary artery occlusion pressures? | 188 | ||
| 3. What other hemodynamic variables can be measured or calculated from the pulmonary artery catheter? What are their normal values?\r | 188 | ||
| 4. In what surgical procedures are pulmonary artery catheters most likely to be placed? What medical problems might influence a clinician’s likelihood toinsert a pulmonary artery catheter before surgery?\r | 188 | ||
| 5. Do pulmonary artery catheters improve patient outcomes? | 189 | ||
| 6. What complications are associated with pulmonary artery catheterization? | 189 | ||
| 7. Summarize the usual presentation, major risk factors, and management of pulmonary artery rupture. | 189 | ||
| 8. How might kinking of the pulmonary artery catheter be avoided? | 189 | ||
| 9. What is the phlebostatic axis? | 190 | ||
| 10. Describe the features of the central venous waveform. | 190 | ||
| 11. Describe the features of the right ventricle waveform. | 190 | ||
| 12. Describe the pulmonary artery waveform. | 190 | ||
| 13. Review the pulmonary artery occlusion pressure waveform. | 191 | ||
| 14. Contrast spontaneous breathing and positive-pressure mechanical ventilation and their effect on pulmonary artery occlusion pressure waveforms.\r | 191 | ||
| 15. Pulmonary artery catheter pressures are surrogate measures for what important physiologic variables? What assumptions are made about the variables obtained throughpulmonary artery catheterization?\r | 192 | ||
| 16. In the presence of a large pulmonary artery occlusion pressure v wave, how should pulmonary artery occlusion pressure be estimated?\r | 193 | ||
| 17. How might catheter position within the lung lead to errors in interpreting left atrial pressure catheter data?\r | 193 | ||
| Acknowledgment\r | 193 | ||
| Suggested Readings\r | 193 | ||
| Chapter 27: Arterial Catheterization and Pressure Monitoring\r | 194 | ||
| 1. Why is arterial blood pressure monitored? | 194 | ||
| 2. How do noninvasive blood pressure devices work? | 194 | ||
| 3. What are the indications for intra-arterial blood pressure monitoring? | 194 | ||
| 4. What are the complications of invasive arterial monitoring? | 195 | ||
| 5. How is radial artery catheterization performed? | 195 | ||
| 6. Describe the normal blood supply to the hand. | 195 | ||
| 7. Describe Allen's test. Explain its purpose. | 195 | ||
| 8. Is Allen's test an adequate predictor of ischemic sequelae? | 196 | ||
| 9. What alternative cannulation sites are available? | 196 | ||
| 10. How does a central waveform differ from a peripheral waveform? | 196 | ||
| 11. What information can be obtained from an arterial waveform? | 197 | ||
| 12. How is the arterial waveform reproduced? | 197 | ||
| 13. Define damping coefficient and natural frequency. | 197 | ||
| 14. What are the characteristics of overdamped and underdamped monitoring systems? | 198 | ||
| 15. How can the incidence of artifacts in arterial monitoring systems be reduced? | 198 | ||
| 16. What is distal pulse amplification? | 198 | ||
| 17. What are the risks and benefits of having heparin in the fluid of a transduction system? | 199 | ||
| 18. Are any risks associated with flushing the catheter system? | 199 | ||
| Suggested Readings\r | 199 | ||
| Section V: Perioperative problems\r | 201 | ||
| Chapter 28: Blood Pressure Disturbances\r | 201 | ||
| 1. What is the significance of hypertension to the general patient population?\r | 201 | ||
| 2. What blood pressure value is considered hypertensive?\r | 201 | ||
| 3. What causes hypertension?\r | 201 | ||
| 4. What are some of the physiologic processes that occur as a patient becomes hypertensive?\r | 201 | ||
| 5. Identify current drug therapies for hypertensive patients.\r | 201 | ||
| 6. What are the consequences of sustained hypertension?\r | 202 | ||
| 7. Why should antihypertensives be taken up until the time of surgery?\r | 202 | ||
| 8. Which antihypertensives should be held the day of surgery?\r | 203 | ||
| 9. Is regional anesthesia a viable option for hypertensive patients?\r | 203 | ||
| 10. Provide a differential diagnosis for intraoperative hypertension.\r | 203 | ||
| 11. How should intraoperative and postoperative hypertension be managed?\r | 203 | ||
| 12. Are hypertensive patients undergoing general anesthesia at increased risk for perioperative cardiac morbidity?\r | 204 | ||
| 13. Broadly categorize the causes of perioperative hypotension.\r | 204 | ||
| 14. What is joint cement and how does it cause hypotension?\r | 204 | ||
| 15. Why does administration of renin-angiotensin system antagonists result in hypotension in the peri-induction period? How might the hypotension betreated?\r | 205 | ||
| 16. How does regional anesthesia create hypotension?\r | 205 | ||
| 17. How is intraoperative hypotension evaluated and treated?\r | 205 | ||
| 18. Review the standard adrenergic agonists used to manage hypotension during anesthesia.\r | 205 | ||
| 19. How should hypotension caused by cardiac ischemia be treated?\r | 205 | ||
| Suggested Readings\r | 206 | ||
| Chapter 29: Awareness During Anesthesia\r | 207 | ||
| 1. Review the classifications of memory and awareness.\r | 207 | ||
| 2. What is the incidence of awareness?\r | 207 | ||
| 3. Are certain techniques and clinical situations more likely to result in awareness?\r | 207 | ||
| 4. Describe clinical signs and symptoms of light anesthesia.\r | 207 | ||
| 5. What are the ramifications of awareness?\r | 208 | ||
| 6. How should a patient who may have been aware during a recent anesthetic be approached?\r | 208 | ||
| 7. What are methods to avoid awareness?\r | 208 | ||
| 8. Are monitors available to assess the depth of anesthesia?\r | 209 | ||
| Suggested Readings\r | 209 | ||
| Chapter 30: Cardiac Dysrhythmias\r | 210 | ||
| 1. Name some of the causes of sinus bradycardia. | 210 | ||
| 2. A postoperative patient develops light-headedness with sinus bradycardia and a heart rate of 36. Systolic blood pressure is 83 mm Hg. What treatmentshould be undertaken?\r | 210 | ||
| 3. How is first-degree atrioventricular block identified? | 210 | ||
| 4. Describe the types of second-degree atrioventricular block. | 210 | ||
| 5. What is third-degree atrioventricular block? | 210 | ||
| 6. In addition to complete heart block, what are some other causes of atrioventricular dissociation? | 211 | ||
| 7. What are some of the causes of atrioventricular block? | 211 | ||
| 8. Your patient exhibits transient evidence of both sinoatrial node and atrioventricular node dysfunction with simultaneous slowing of the sinusrate and second-degree atrioventricular block, type I. What is going on?\r | 211 | ||
| 9. Which antihypertensive agents are to be avoided in patients with significant bradycardia or heart block? | 211 | ||
| 10. Name some of the arrhythmias seen with digoxin toxicity. | 211 | ||
| 11. Is it always appropriate to treat sinus tachycardia with -blockers? | 211 | ||
| 12. What is meant by the term paroxysmal supraventricular tachycardia? | 212 | ||
| 13. What is multifocal atrial tachycardia? When is it seen? | 212 | ||
| 14. What is the main contraindication to adenosine? | 212 | ||
| 15. A patient suddenly develops an irregular rhythm with heart rate of 170. A 12-lead electrocardiogram shows no P waves. What is the likely rhythm?How should it be managed?\r | 212 | ||
| 16. Is adenosine useful for the treatment of atrial fibrillation? | 212 | ||
| 17. What should be done to reduce the risk of stroke in a patient with chronic or paroxysmal atrial fibrillation?\r | 213 | ||
| 18. What is a wide-complex tachycardia? What is in the differential diagnosis? | 213 | ||
| 19. A 60-year-old man with a history of prior anterior myocardial infarction develops a monomorphic wide complex tachycardia after noncardiac surgery.What is the most likely diagnosis, and which treatments would be appropriateor inappropriate?\r | 213 | ||
| 20. What characteristics of a wide-complex tachycardia suggest ventricular tachycardia rather than supraventricular tachycardia with aberrancy?\r | 213 | ||
| 21. Why is it important to distinguish between polymorphic and monomorphic ventricular tachycardia? | 214 | ||
| 22. How is torsades de pointes treated? | 214 | ||
| 23. How are patients with congenital long QT syndrome and syncope treated? | 214 | ||
| 24. Are implantable cardioverter-defibrillators curative for ventricular arrhythmias? | 214 | ||
| 25. Do all patients with an accessory pathway have a delta wave (WPW pattern) on their baseline electrocardiogram?\r | 214 | ||
| 26. A 25-year-old patient presenting with palpitations is noted to have a wide-complex, irregular tachycardia at a rate of 260. The upstroke of the QRS isslurred. The blood pressure is normal, and the patient appears well. What is themost likely diagnosis? What treatments are indicated? What treatments are potentially harmful?\r | 215 | ||
| 27. Why is it important to save electrocardiogram tracings that document an arrhythmia? | 215 | ||
| Suggested Readings\r | 216 | ||
| Chapter 31: Temperature Disturbances\r | 217 | ||
| 1. Describe the processes that contribute to thermoregulation.\r | 217 | ||
| 2. Which patients are at risk for hypothermia?\r | 217 | ||
| 3. Does hypothermia have an impact on patient outcome?\r | 217 | ||
| 4. Characterize the different stages of hypothermia.\r | 217 | ||
| 5. Which perioperative events predispose a patient to hypothermia?\r | 218 | ||
| 6. Which physical processes contribute to a patient's heat loss in the operating room?\r | 219 | ||
| 7. As a practical matter, what is done to a patient in the operating room that increases heat loss?\r | 219 | ||
| 8. Should all patients receive temperature monitoring within the operating room? What are acceptable sites for temperature monitoring?\r | 219 | ||
| 9. Review shivering and nonshivering thermogenesis.\r | 219 | ||
| 10. Describe the electrocardiographic manifestations of hypothermia.\r | 219 | ||
| 11. How does hypothermia affect the actions and metabolism of drugs used in the operative environment?\r | 220 | ||
| 12. Discuss methods of rewarming.\r | 220 | ||
| 13. Define hyperthermia.\r | 220 | ||
| 14. Describe the manifestations of hyperthermia.\r | 220 | ||
| 15. What conditions are associated with hyperthermia?\r | 221 | ||
| 16. What drugs increase the risk of hyperthermia?\r | 221 | ||
| 17. What are the pharmacologic effects of hyperthermia?\r | 221 | ||
| 18. What is the treatment for the hyperthermic patient in the operating room?\r | 221 | ||
| Suggested Readings\r | 221 | ||
| Chapter 32: Postanesthetic Care\r | 222 | ||
| 1. Which patients should be cared for in the postanesthetic care unit? | 222 | ||
| 2. Review important considerations as the patient is about to be moved from the operating room to the postanesthetic care unit.\r | 222 | ||
| 3. Describe the process for postanesthetic care unit admission. | 222 | ||
| 4. What monitors should be used routinely in the postanesthetic care unit? | 222 | ||
| 5. What problems should be resolved during postanesthetic care? | 223 | ||
| 6. How is ventilation adversely affected by anesthesia? | 223 | ||
| 7. Describe the appearance of residual neuromuscular blockade. | 223 | ||
| 8. How do opioids and residual volatile anesthetics affect breathing? | 224 | ||
| 9. How should these causes of hypoventilation be treated? | 224 | ||
| 10. The patient has been delivered to the postanesthetic care unit. Oxygen saturations are noted to be in the upper 80s, and chest wall movement isinadequate. How should the patient be managed?\r | 225 | ||
| 11. The patient develops stridorous breath sounds. Describe the likely cause and the appropriate management. | 225 | ||
| 12. How is laryngospasm treated? | 225 | ||
| 13. The laryngospasm resolves. Chest auscultation reveals bilateral rales. What is the most likely cause? | 225 | ||
| 14. How is negative-pressure pulmonary edema treated? | 226 | ||
| 15. Describe an approach to the evaluation of postoperative hypertension and tachycardia. | 226 | ||
| 16. What might cause hypotension in the postoperative phase? | 226 | ||
| 17. How should hypotension be treated? | 226 | ||
| 18. Under what circumstances is a patient slow to awaken? | 226 | ||
| 19. Discuss the issues surrounding postoperative nausea and vomiting. | 227 | ||
| 20. Should ambulatory patients be treated differently in the postanesthetic care unit? | 227 | ||
| 21. Should patients be required to tolerate oral intake before postanesthetic care unit discharge? | 227 | ||
| 22. A patient has undergone a general anesthetic for an outpatient procedure. Recovery has been uneventful, yet the patient has no ride home. How shouldthis be handled?\r | 227 | ||
| 23. In designing a postanesthetic care unit for a new outpatient surgical center, the board of directors states that all patients should be kept in the postanestheticcare unit for at least 1 hour for recovery. Is this minimal postanesthetic careunit stay reasonable?\r | 227 | ||
| Suggested Readings\r | 228 | ||
| Section VI: Anesthesia And Systemic Disease\r | 229 | ||
| Chapter 33: Ischemic Heart Disease\r | 229 | ||
| 1. Name the known risk factors for the development of ischemic heart disease.\r | 229 | ||
| 2. Describe the normal coronary blood flow.\r | 229 | ||
| 3. Describe the coronary anatomy.\r | 229 | ||
| 4. Explain the determinants of myocardial oxygen demand and delivery.\r | 229 | ||
| 5. What is the clinical manifestation of myocardial ischemia?\r | 230 | ||
| 6. How is angina graded?\r | 230 | ||
| 7. Describe the pathogenesis of a perioperative myocardial infarction.\r | 230 | ||
| 8. What clinical factors increase the risk of a perioperative myocardial infarction following noncardiac surgery?\r | 230 | ||
| 9. What is the definition of recent and prior myocardial infarction?\r | 231 | ||
| 10. How does the type of surgery influence the risk stratification for perioperative ischemia?\r | 231 | ||
| 11. How can cardiac function be assessed by history and physical examination?\r | 231 | ||
| 12. When would you consider noninvasive stress testing before noncardiac surgery?\r | 231 | ||
| 13. What tests performed by medical consultants can help further evaluate patients with known or suspected ischemic heart disease?\r | 231 | ||
| 14. What are the main indications for coronary revascularization before noncardiac surgery?\r | 232 | ||
| 15. A patient after percutaneous coronary intervention is scheduled for surgery. What is your concern?\r | 232 | ||
| 16. Why do patients with drug-eluting stents need significantly longer time than those with bare metal stents?\r | 233 | ||
| 17. Should all cardiac medications be continued throughout the perioperative period?\r | 233 | ||
| 18. How would you give β-blockers to high-risk patients?\r | 233 | ||
| 19. Would you give prophylactic intraoperative nitroglycerin infusion?\r | 233 | ||
| 20. What electrocardiogram findings support the diagnosis of ischemic heart disease?\r | 233 | ||
| 21. When is a resting 12-lead ECG recommended?\r | 233 | ||
| 22. How long should a patient with a recent myocardial infarction wait before undergoing elective noncardiac surgery?\r | 234 | ||
| 23. Outline the hemodynamic goals of induction and maintenance of general anesthesia in patients with IHD.\r | 234 | ||
| 24. What monitors are useful for detecting ischemia intraoperatively?\r | 234 | ||
| 25. Would you use transesophageal echocardiography routinely in patients with high cardiac risk undergoing noncardiac surgery?\r | 234 | ||
| 26. Is a pulmonary artery catheter reasonable to use routinely for optimization of high-risk patients? What is its potential benefit?\r | 234 | ||
| Suggested Readings\r | 235 | ||
| Chapter 34: Heart Failure\r | 236 | ||
| 1. What is heart failure? | 236 | ||
| 2. Name the causes of heart failure. | 236 | ||
| 3. Describe the classification of heart failure. | 237 | ||
| 4. How is the severity of heart failure classified? | 237 | ||
| 5. What major alterations in the heart occur in patients with heart failure? | 237 | ||
| 6. What is the Frank-Starling law? | 238 | ||
| 7. How is cardiac output calculated? What is a normal cardiac output and index? | 238 | ||
| 8. What is the connection between exercise and cardiac output? | 238 | ||
| 9. What is systolic dysfunction? | 238 | ||
| 10. What is diastolic dysfunction? | 238 | ||
| 11. Do the neurohumoral responses in heart failure have therapeutic significance? | 239 | ||
| 12. What are the presenting symptoms of heart failure? | 240 | ||
| 13. What physical signs suggest heart failure? | 240 | ||
| 14. What laboratory studies are useful in evaluating the patient with heart failure? | 240 | ||
| 15. What treatment strategies are used in the different stages of heart failure? | 241 | ||
| 16. What should be considered in preparing to conduct an anesthetic on patients with heart failure? | 242 | ||
| 17. How would you manage a patient with decompensated heart failure? | 242 | ||
| 18. Which anesthetic agents can be used in decompensated heart failure? | 242 | ||
| 19. Is regional anesthesia contraindicated in patients with heart failure? | 242 | ||
| 20. How would you support the heart in decompensated heart failure during anesthesia? | 242 | ||
| Suggested Readings\r | 243 | ||
| Chapter 35: Valvular Heart Disease\r | 244 | ||
| 1. Discuss the basic pathophysiology of valvular heart diseases. | 244 | ||
| 2. Describe common findings of the history and physical examination in patients with valvular heart disease. | 244 | ||
| 3. Which tests are useful in the evaluation of valvular heart disease? | 244 | ||
| 4. How is echocardiography helpful in anesthesia management? | 244 | ||
| 5. Which other monitors aid the anesthesiologist in the perioperative period? | 245 | ||
| 6. What is a pressure-volume loop? | 245 | ||
| 7. How does a normal pressure-volume loop appear? | 245 | ||
| 8. Discuss the pathophysiology of aortic stenosis. | 245 | ||
| 9. How can be the severity of aortic stenosis characterized by echocardiography? | 246 | ||
| 10. What is the indication for aortic valve replacement in aortic stenosis? | 246 | ||
| 11. How are the compensatory changes in the left ventricle represented by a pressure-volume loop? | 246 | ||
| 12. What are the hemodynamic goals in the anesthetic management of patients with aortic stenosis? | 247 | ||
| 13. Discuss the management of the patients with aortic stenosis after aortic valve replacement. | 247 | ||
| 14. Discuss the pathophysiology of aortic insufficiency. | 247 | ||
| 15. What parameters can be used in echocardiography to characterize the severity of aortic insufficiency? | 248 | ||
| 16. What is the indication for aortic valve replacement in aortic stenosis? | 248 | ||
| 17. What does the pressure-volume loop look like in acute and chronic aortic insufficiency? | 248 | ||
| 18. What are the hemodynamic goals in the anesthetic management of patients with aortic insufficiency? | 249 | ||
| 19. Discuss the hemodynamic changes in patients with aortic insufficiency after aortic valve replacement. | 249 | ||
| 20. What is the pathophysiology of mitral stenosis? | 249 | ||
| 21. What parameters can be used in echocardiography to characterize the severity of mitral stenosis? | 249 | ||
| 22. What is the indication for mitral valve replacement in mitral stenosis? | 249 | ||
| 23. How is the pressure-volume loop changed from normal in mitral stenosis? | 250 | ||
| 24. What are the anesthetic considerations in mitral stenosis? | 250 | ||
| 25. Discuss the postoperative management of patients with mitral stenosis after mitral valve replacement. | 250 | ||
| 26. Describe the pathophysiology of mitral regurgitation. | 250 | ||
| 27. What parameters can be used in echocardiography to characterize the severity of mitral regurgitation? | 251 | ||
| 28. What is the indication for mitral valve replacement in mitral regurgitation? | 251 | ||
| 29. How is the pressure-volume loop in mitral regurgitation changed from normal? | 251 | ||
| 30. What are the hemodynamic goals in anesthetic management of mitral regurgitation? | 252 | ||
| 31. Discuss the hemodynamic management after mitral valve repair or replacement in patient with mitral regurgitation.\r | 253 | ||
| Suggested Readings\r | 253 | ||
| Chapter 36: Aorto-Occlusive Disease\r | 254 | ||
| 1. Define aortic vascular disease. | 254 | ||
| 2. What risk factors and coexisting diseases are common in these patients? | 254 | ||
| 3. What is the natural progression of aortic vascular disease? | 254 | ||
| 4. Describe preoperative preparation of such patients in the presence of concurrent disease. | 254 | ||
| 5. List the appropriate intraoperative monitors for aortic surgery. | 255 | ||
| 6. Discuss the physiologic implications of aortic clamping and unclamping. | 255 | ||
| 7. Review the anesthetic goals for these surgical patients. | 255 | ||
| 8. What can be done intraoperatively to preserve renal function? | 256 | ||
| 9. What are the potential advantages to postoperative epidural analgesia? | 256 | ||
| 10. What specific concerns exist for endovascular repair of the aorta? | 256 | ||
| 11. Describe the primary aspects of management when a patient presents with an acute abdominal aortic rupture.\r | 257 | ||
| 12. Discuss the important elements of postoperative care. | 257 | ||
| Suggested Readings | 258 | ||
| Chapter 37: Intracranial and Cerebrovascular Disease\r | 259 | ||
| 1. What is cerebrovascular insufficiency?\r | 259 | ||
| 2. Compare global ischemia with focal ischemia.\r | 259 | ||
| 3. How does cerebrovascular insufficiency manifest itself?\r | 259 | ||
| 4. What is the etiology of cerebrovascular accidents and transient ischemic attacks?\r | 259 | ||
| 5. Are other factors involved in neurologic outcome following an episode of cerebrovascular insufficiency?\r | 259 | ||
| 6. List the risk factors for cerebral ischemic events.\r | 260 | ||
| 7. Who is a candidate for carotid endarterectomy?\r | 260 | ||
| 8. Define cerebral autoregulation. How is it affected in cerebrovascular disease and what are the anesthetic implications?\r | 260 | ||
| 9. How are the cerebral responses to hypercapnia and hypocapnia altered in cerebrovascular disease? What are the anesthetic i implications?\r | 260 | ||
| 10. What is normal cerebral blood flow? At what level is cerebral blood flow considered ischemic?\r | 260 | ||
| 11. How do inhalational anesthetics affect cerebral perfusion and cerebral metabolic rate?\r | 261 | ||
| 12. How should patients having carotid endarterectomy be monitored?\r | 261 | ||
| 13. Is regional or general anesthesia preferred for the endarterectomy patient?\r | 261 | ||
| 14. What are the advantages of regional anesthesia for carotid endarterectomy?\r | 261 | ||
| 15. What are the advantages and disadvantages of general anesthesia for patients undergoing carotid endarterectomy?\r | 261 | ||
| 16. What methods of monitoring cerebral perfusion during general anesthesia are available?\r | 261 | ||
| 17. Do stump pressures provide reliable cerebral perfusion information?\r | 261 | ||
| 18. Does intraoperative electroencephalogram provide clinically useful information during carotid endarterectomy?\r | 262 | ||
| 19. What are the common postoperative complications of carotid endarterectomy?\r | 262 | ||
| 20. What are the major causes and presentations of spontaneous subarachnoid hemorrhage?\r | 262 | ||
| 21. List the Hunt-Hess classification of neurologic status following spontaneous subarachnoid hemorrhage.\r | 262 | ||
| 22. Describe the management of intracranial aneurysms following spontaneous subarachnoid hemorrhage.\r | 263 | ||
| 23. Why is early surgical clipping so critical in the management of spontaneous subarachnoid hemorrhage resulting from aneurysm rupture?\r | 263 | ||
| 24. How is vasospasm diagnosed? Who is at risk?\r | 263 | ||
| 25. Describe the treatment options if vasospasm is suspected following an spontaneous subarachnoid hemorrhage....\r | 263 | ||
| 26. How can surgical exposure be improved and the brain be protected during aneurysm surgery?\r | 264 | ||
| 27. What is a cerebral arteriovenous malformation?\r | 265 | ||
| 28. How do arteriovenous malformations typically present?\r | 265 | ||
| 29. What are the common treatment modalities for arteriovenous malformations?\r | 265 | ||
| 30. Describe the anesthetic management for surgical excision of an arteriovenous malformation.\r | 265 | ||
| 31. What is normal perfusion pressure breakthrough?\r | 265 | ||
| Suggested Readings\r | 266 | ||
| Chapter 38: Reactive Airway Disease\r | 267 | ||
| 1. Define reactive airway disease, in particular, asthma.\r | 267 | ||
| 2. What are the different types of asthma?\r | 267 | ||
| 3. What diseases mimic asthma?\r | 267 | ||
| 4. What are the important historical features of an asthmatic patient?\r | 267 | ||
| 5. What physical findings are associated with asthma?\r | 268 | ||
| 6. What preoperative tests should be ordered?\r | 268 | ||
| 7. Describe the mainstay of therapy in asthma.\r | 268 | ||
| 8. What other medications and routes of delivery are used in asthma?\r | 268 | ||
| 9. What is the best approach to preoperative management of the patient with reactive airway disease?\r | 270 | ||
| 10. Review the pros and cons of induction agents in asthmatic patients.\r | 270 | ||
| 11. What agents may be used for maintenance anesthesia?\r | 270 | ||
| 12. What are the complications of intubation and mechanical ventilation in asthmatic patients?\r | 271 | ||
| 13. What are the causes of intraoperative wheezing and the correct responses to asthmatic patients with acute bronchospasm?\r | 271 | ||
| 14. Describe the emergence techniques for asthmatic patients under general endotracheal anesthesia.\r | 272 | ||
| 15. What new therapies are available to anesthesiologists treating asthmatic patients in bronchospasm?\r | 272 | ||
| Suggested Readings\r | 273 | ||
| Chapter 39: Aspiration\r | 274 | ||
| 1. What is aspiration and what differentiates aspiration pneumonitis from aspiration pneumonia? | 274 | ||
| 2. How often does aspiration occur and what is the morbidity and mortality rate? | 274 | ||
| 3. What are risk factors for aspiration? | 274 | ||
| 4. What precautions before anesthetic induction are required to prevent aspiration or mollify its sequelae? | 274 | ||
| 5. How might a patient with a difficult airway and at risk for aspiration be managed? | 275 | ||
| 6. Describe the different clinical pictures caused by the three broad types of aspirate: acidic fluid, nonacidic fluid, and particulate matter.\r | 275 | ||
| 7. Review the clinical signs and symptoms after aspiration. | 276 | ||
| 8. When is a patient suspected of aspiration believed to be out of danger? | 276 | ||
| 9. Describe the treatment for aspiration. | 276 | ||
| Suggested Readings\r | 277 | ||
| Chapter 40: Chronic Obstructive Pulmonary Disease\r | 278 | ||
| 1. Define chronic obstructive pulmonary disease. | 278 | ||
| 2. What are the features of asthma and asthmatic bronchitis? | 278 | ||
| 3. Describe chronic bronchitis and emphysema. | 278 | ||
| 4. List contributory factors associated with the development of chronic obstructive pulmonary disease. | 278 | ||
| 5. What historical information should be obtained before surgery? | 279 | ||
| 6. What features distinguish pink puffers from blue bloaters? | 279 | ||
| 7. List abnormal physical findings in patients with chronic obstructive pulmonary disease. | 279 | ||
| 8. What laboratory examinations are useful? | 279 | ||
| 9. How does a chronically elevated arterial carbon dioxide partial pressure affect the respiratory drive in a person with chronic obstructive pulmonarydisease?\r | 279 | ||
| 10. What are the deleterious effects of oxygen administration in these patients? | 280 | ||
| 11. How do general anesthesia and surgery affect pulmonary mechanics? | 280 | ||
| 12. What factors are associated with an increased perioperative morbidity or mortality? | 280 | ||
| 13. List the common pharmacologic agents used to treat COPD and their mechanisms of action. | 281 | ||
| 14. What therapies are available to reduce perioperative pulmonary risk? | 281 | ||
| 15. Do advantages exist with regional anesthesia techniques in patients with chronic obstructive pulmonary disease?\r | 282 | ||
| 16. What agents can be used for induction and maintenance of general anesthesia? | 282 | ||
| 17. Discuss the particular concerns regarding muscle relaxation (and reversal) in patients with chronic obstructive pulmonary disease.\r | 282 | ||
| 18. Discuss the choice of opioids in these patients. | 282 | ||
| 19. Define auto-PEEP. | 283 | ||
| 20. Form a differential diagnosis for intraoperative wheezing. | 283 | ||
| 21. How would you treat intraoperative bronchospasm? | 283 | ||
| 22. What factors may determine the need for postoperative mechanical ventilation? | 284 | ||
| 23. Should H2-receptor antagonists be avoided in patients with chronic obstructive pulmonary disease? | 284 | ||
| 24. At the conclusion of surgery, should a patient with chronic obstructive pulmonary disease be extubated deep or awake?\r | 284 | ||
| Suggested Readings\r | 284 | ||
| Chapter 41: Acute Respiratory Distress Syndrome (ARDS)\r | 285 | ||
| 1. What is the difference between acute lung injury and acute respiratory distress syndrome?\r | 285 | ||
| 2. How would you define acute respiratory distress syndrome?\r | 285 | ||
| 3. What are the risk factors for acute respiratory distress syndrome?\r | 286 | ||
| 4. What is the most common cause and mortality rate for acute respiratory distress syndrome?\r | 287 | ||
| 5. Describe the pathogenesis of acute respiratory distress syndrome.\r | 287 | ||
| 6. Describe the stages of acute respiratory distress syndrome.\r | 288 | ||
| 7. How do patients who develop acute respiratory distress syndrome typically present?\r | 288 | ||
| 8. Do any pulmonary diseases mimic acute respiratory distress syndrome?\r | 289 | ||
| 9. Are any drug therapies available to treat acute respiratory distress syndrome?\r | 289 | ||
| 10. Does that mean that none of these agents has a role in patients with refractory acute respiratory distress syndrome?\r | 289 | ||
| 11. Is there an optimal fluid strategy in acute respiratory distress syndrome?\r | 289 | ||
| 12. Can mechanical ventilation exacerbate or delay healing from acute respiratory distress syndrome?\r | 290 | ||
| 13. How should patients with acute respiratory distress syndrome be ventilated?\r | 290 | ||
| 14. Define lung recruitment maneuver and the different techniques for performing it.\r | 290 | ||
| 15. How does prone ventilation improve oxygenation?\r | 290 | ||
| 16. Does prone ventilation offer a survival benefit in acute respiratory distress syndrome patients?\r | 291 | ||
| Suggested Readings\r | 292 | ||
| Chapter 42: Pulmonary Hypertension\r | 293 | ||
| 1. Define pulmonary hypertension.\r | 293 | ||
| 2. List conditions that produce pulmonary hypertension.\r | 293 | ||
| 3. Discuss the pathophysiology and natural history of pulmonary hypertension.\r | 293 | ||
| 4. What is the blood supply to the right ventricle?\r | 294 | ||
| 5. How is pulmonary vascular resistance calculated and what are normal values?\r | 294 | ||
| 6. What are some electrocardiographic and radiologic features of the disease?\r | 294 | ||
| 7. What signs and symptoms suggest pulmonary hypertension?\r | 294 | ||
| 8. Discuss the observed abnormalities on pulmonary function testing.\r | 294 | ||
| 9. What additional diagnostic tests are available for evaluating pulmonary hypertension? What results may be expected?\r | 295 | ||
| 10. Discuss standard therapies for patients suffering from pulmonary hypertension.\r | 295 | ||
| 11. What medications are available to treat increased pulmonary artery pressures?\r | 295 | ||
| 12. A patient with a history of pulmonary hypertension presents for a surgical procedure. How should this patient be monitored intraoperatively?\r | 296 | ||
| 13. What intraoperative measures may decrease PH?\r | 296 | ||
| 14. Discuss the effect of volatile anesthetics and nitrous (not nitric) oxide on the pulmonary circulation.\r | 296 | ||
| 15. What are the effects of intravenous anesthetics on pulmonary artery pressure and hypoxic pulmonary vasoconstriction?\r | 297 | ||
| 16. Are regional anesthetics an option?\r | 297 | ||
| 17. Discuss the advantages and disadvantages of the intravenous nitrovasodilators.\r | 297 | ||
| 18. Discuss the properties of nitric oxide (NO).\r | 297 | ||
| 19. Discuss the therapeutic usefulness and limitations of nitric oxide in pulmonary hypertension.\r | 298 | ||
| 20. What are prostanoids and their therapeutic counterparts?\r | 298 | ||
| 21. What is the value of adenosine?\r | 299 | ||
| 22. What are phosphodiesterase-5 inhibitors?\r | 299 | ||
| Suggested Readings\r | 299 | ||
| Chapter 43: Perioperative Hepatic Dysfunction\r | 300 | ||
| 1. What is the normal physiologic function of the liver? | 300 | ||
| 2. What is the most common cause of acute parenchymal liver disease? | 300 | ||
| 3. What is cirrhosis? | 300 | ||
| 4. Describe the neurologic derangements in patients with cirrhosis. | 300 | ||
| 5. What pulmonary changes occur in a patient with cirrhosis? | 301 | ||
| 6. Describe the changes in the cardiovascular system in patients with cirrhosis. | 301 | ||
| 7. What is hepatorenal syndrome? How does it differ from acute renal failure in patients with end-stage liver disease?\r | 301 | ||
| 8. Describe volume assessment and fluid management in patients with hepatorenal syndrome. | 301 | ||
| 9. What are the gastrointestinal and hematologic derangements that occur with cirrhosis? | 301 | ||
| 10. Which liver function tests are used to detect hepatic cell damage? | 302 | ||
| 11. Describe the laboratory tests used to assess hepatic synthetic function and their limitations. | 302 | ||
| 12. What laboratory tests are used to diagnosis cholestatic liver disease? | 302 | ||
| 13. How can laboratory results be used to stratify perioperative risk in patients with cirrhosis? | 302 | ||
| 14. What risk factors for liver disease can be identified by history and physical examination? | 303 | ||
| 15. What is jaundice? | 303 | ||
| 16. Distinguish between unconjugated and conjugated hyperbilirubinemia. | 303 | ||
| 17. List the common causes of unconjugated and conjugated hyperbilirubinemia. | 304 | ||
| 18. What are the main causes of hepatocyte injury? | 304 | ||
| 19. How do inhalational anesthetic gases produce hepatic dysfunction? | 304 | ||
| 20. How do inhalational agents alter hepatic blood flow? | 305 | ||
| 21. What are the preoperative management goals in a patient with liver disease? | 306 | ||
| 22. What are the intraoperative management goals in a patient with liver disease? | 306 | ||
| 23. What adjustment in anesthetic medications should be made in a patient with liver disease? | 306 | ||
| Suggested Readings\r | 307 | ||
| Chapter 44: Renal Function and Anesthesia\r | 308 | ||
| 1. Describe the anatomy of the kidney. | 308 | ||
| 2. List the major functions of the kidney. | 309 | ||
| 3. Discuss glomerular and tubular function. | 309 | ||
| 4. Review the site of action and significant effects of commonly used diuretics. | 309 | ||
| 5. Describe the unique aspects of renal blood flow and control. | 309 | ||
| 6. Describe the sequence of events associated with decreased renal blood flow. | 310 | ||
| 7. What preoperative risk factors are associated with postoperative renal failure? | 311 | ||
| 8. Discuss the major causes of perioperative acute renal failure. | 311 | ||
| 9. What laboratory abnormalities are observed in renal failure? | 311 | ||
| 10. Comment on various laboratory tests and their use in detecting acute renal dysfunction. | 311 | ||
| 11. What are measures of tubular function? | 313 | ||
| 12. At what point is renal reserve lost and do patients develop laboratory evidence of renal insufficiency? | 314 | ||
| 13. Discuss the usefulness of urine output in assessing renal function. | 314 | ||
| 14. What is the best way to protect the kidneys during surgery? | 314 | ||
| 15. Does dopamine have a role in renal preservation? | 314 | ||
| 16. Describe the effects of volatile anesthetics on renal function. | 314 | ||
| 17. What is the best relaxant for patients with renal insufficiency? | 315 | ||
| 18. How are patients with renal insufficiency managed perioperatively? | 315 | ||
| 19. What is accomplished during hemodialysis? | 316 | ||
| Suggested Readings\r | 316 | ||
| Chapter 45: Increased Intracranial Pressure and Traumatic Brain Injury\r | 317 | ||
| 1. Define elevated intracranial pressure.\r | 317 | ||
| 2. What are the determinants of intracranial pressure?\r | 317 | ||
| 3. How is intracranial pressure measured?\r | 317 | ||
| 4. Summarize the conditions that commonly cause elevated intracranial pressure.\r | 317 | ||
| 5. Describe the symptoms of increased intracranial pressure.\r | 317 | ||
| 5. Describe the symptoms of increased intracranial pressure.\r | 318 | ||
| 7. What are the determinants of cerebral perfusion pressure?\r | 318 | ||
| 8. What is intracranial elastance? Why is it clinically significant?\r | 318 | ||
| 9. How is cerebral blood flow regulated?\r | 318 | ||
| 10. What is the goal of anesthetic care for patients with elevated intracranial pressure?\r | 319 | ||
| 11. Can this goal be aided by preoperative interventions?\r | 319 | ||
| 12. How is the goal of reduced intracranial volume achieved at induction of anesthesia?\r | 320 | ||
| 13. How is intracranial pressure moderated during maintenance of anesthesia?\r | 320 | ||
| 14. Is hyperventilation a reasonable strategy for long-term intracranial pressure management?\r | 320 | ||
| 15. Which intravenous fluids are used during surgery to minimize intracranial pressure?\r | 320 | ||
| 16. What are the effects of volatile anesthetics on cerebral blood flow?\r | 321 | ||
| 17. How do neuromuscular blocking agents affect intracranial pressure?\r | 321 | ||
| 18. Discuss strategies for controlling intracranial pressure at emergence from anesthesia.\r | 321 | ||
| 19. If the previously mentioned measures fail to control intracranial pressure, what other measures are available?\r | 322 | ||
| 20. What are the mechanisms behind traumatic brain injury?\r | 322 | ||
| 21. What are the anesthetic goals in a patient with traumatic brain injury?\r | 322 | ||
| 22. In a patient with traumatic head injury, how should fluid resuscitation be prioritized and what fluids are beneficial?\r | 322 | ||
| Suggested Readings\r | 323 | ||
| Chapter 46: Malignant Hyperthermia and Other Motor Diseases\r | 324 | ||
| 1. What is malignant hyperthermia and its underlying defect? | 324 | ||
| 2. What are the inheritance pattern and triggering agents for malignant hyperthermia? | 324 | ||
| 3. Describe the cellular events, presentation, and metabolic abnormalities associated with malignant hyperthermia.\r | 324 | ||
| 4. How is malignant hyperthermia treated? | 324 | ||
| 5. How does dantrolene work? How is dantrolene prepared? | 325 | ||
| 6. How is malignant hyperthermia susceptibility assessed in an individual with a positive family history or prior suggestive event?\r | 325 | ||
| 7. What are the indications for muscle biopsy and halothane-caffeine contracture testing? | 325 | ||
| 8. What is masseter muscle rigidity and what is its relation to malignant hypothermia? | 325 | ||
| 9. Describe the preparation of an anesthetic machine and anesthetic for a patient with known malignant hypothermia susceptibility.\r | 326 | ||
| 10. Should malignant hypothermia-susceptible patients be pretreated with dantrolene? | 326 | ||
| 11. What patients are at risk for redeveloping symptoms of malignant hypothermia after treatment with dantrolene?\r | 326 | ||
| 12. What drugs commonly administered intraoperatively are safe to use in malignant hyperthermia-susceptible patients.\r | 326 | ||
| 13. Compare neuroleptic malignant syndrome with malignant hypothermia. | 326 | ||
| 14. What are the muscular dystrophies and their underlying defect? | 327 | ||
| 15. What are the most common muscular dystrophies and their clinical history? | 327 | ||
| 16. Briefly review of forms of muscular dystrophy. | 327 | ||
| 17. How do patients with muscular dystrophy respond to muscle relaxants and volatile anesthetics? | 327 | ||
| 18. Are patients with muscular dystrophy at risk for malignant hyperthermia? | 327 | ||
| 19. What is myotonic dystrophy? | 328 | ||
| 20. How does myotonic dystrophy affect the cardiopulmonary system? | 328 | ||
| 21. What are the important muscle relaxant considerations in patients with myotonic dystrophy? | 328 | ||
| 22. What is myasthenia gravis? | 328 | ||
| 23. Describe the clinical presentation of myasthenia gravis. | 328 | ||
| 24. How is myasthenia gravis treated? What can lead to an exacerbation of symptoms? | 328 | ||
| 25. What are some of the principal anesthetic concerns in the management of a myasthenic patient for any operative procedure? | 328 | ||
| 26. Describe the altered responsiveness of myasthenic patients to muscle relaxants. | 328 | ||
| 27. What is Lambert-Eaton myasthenic syndrome? Describe its symptoms, associations, and treatment. | 329 | ||
| 28. Review the anesthetic concerns for a patient with Lambert-Eaton syndrome. | 329 | ||
| Suggested Readings\r | 330 | ||
| Chapter 47: Degenerative Neurologic Diseases and Neuropathies\r | 331 | ||
| 1. What is amyotrophic lateral sclerosis and its anesthetic considerations?\r | 331 | ||
| 2. Review the clinical manifestations of Guillain-Barré syndrome.\r | 331 | ||
| 3. How is the autonomic nervous system affected in Guillain-Barré syndrome?\r | 331 | ||
| 4. What are the major anesthetic considerations for patients with Guillain-Barré syndrome?\r | 331 | ||
| 5. Review the pathophysiologic features of Parkinson's disease.\r | 332 | ||
| 6. Describe the clinical manifestations of Parkinson's disease.\r | 332 | ||
| 7. What are the effects of levodopa therapy, particularly on intravascular volume status?\r | 332 | ||
| 8. Review the anesthetic considerations for a patient with Parkinson's disease.\r | 332 | ||
| 9. What are the clinical signs and symptoms of Alzheimer's disease?\r | 332 | ||
| 10. What is the most significant anesthetic problem associated with Alzheimer's disease?\r | 332 | ||
| 11. What are the hallmark features of multiple sclerosis?\r | 333 | ||
| 12. Do steroids have a role in the treatment of multiple sclerosis?\r | 333 | ||
| 13. What factors have been associated with an exacerbation of multiple sclerosis?\r | 333 | ||
| 14. Review some perioperative concerns for patients with multiple sclerosis. Are medications used for most general anesthetic safe?\r | 333 | ||
| 15. Are local anesthetics especially toxic for patients with multiple sclerosis?\r | 333 | ||
| 16. Are epidural and spinal anesthesias safe for patients with multiple sclerosis?\r | 333 | ||
| 17. Are muscle relaxants safe in patients with multiple sclerosis?\r | 334 | ||
| 18. Describe postpoliomyelitis syndrome.\r | 334 | ||
| 19. What are the anesthetic considerations for patients with postpolio syndrome?\r | 334 | ||
| 20. Review critical illness polyneuropathy and the patient subsets prone to developing it.\r | 334 | ||
| 21. Describe the clinical features of critical illness polyneuropathy.\r | 334 | ||
| 22. Review the anesthetic concerns in patients with critical illness polyneuropathy.\r | 334 | ||
| Suggested Readings\r | 335 | ||
| Chapter 48: Alcohol and Substance Abuse\r | 336 | ||
| 1. How is alcohol absorbed and metabolized? | 336 | ||
| 2. What are the acute and chronic effects of alcohol on the nervous system? | 336 | ||
| 3. What are the effects of alcohol on the cardiovascular system? | 336 | ||
| 4. How does alcohol affect the respiratory system? | 336 | ||
| 5. How does alcohol affect the gastrointestinal and hepatobiliary systems? | 337 | ||
| 6. Which nutritional deficiencies are seen in chronic alcohol users? | 337 | ||
| 7. What are the effects of alcohol on inhalational anesthetics? | 337 | ||
| 8. How does alcohol affect muscle relaxants? | 337 | ||
| 9. Describe special considerations in the perioperative assessment of alcohol-abusing patients. | 337 | ||
| 10. How should sober chronic alcohol abusers be anesthetized? | 337 | ||
| 11. What are the signs and symptoms of alcohol withdrawal? | 338 | ||
| 12. Review the differences between addiction, dependence, pseudoaddiction, and tolerance. | 338 | ||
| 13. List complications of chronic opioid abuse. | 338 | ||
| 14. Discuss perioperative problems associated with the chronic opioid abuser. | 339 | ||
| 15. Describe the time frame and stages of opioid withdrawal. | 339 | ||
| 16. What medications are used to stabilize and detoxify the withdrawing opioid patient? | 339 | ||
| 17. To what arrhythmias are methadone-treated patients prone? | 339 | ||
| 18. What are the various forms of cocaine and routes of administration? | 339 | ||
| 19. How is cocaine metabolized and excreted? | 339 | ||
| 20. What are the mechanism of action and physiologic effects of cocaine? | 339 | ||
| 21. List the common signs and symptoms of acute cocaine intoxication. | 340 | ||
| 22. What is the most life-threatening toxic side effect and its treatment? | 340 | ||
| 23. List the signs and symptoms of cocaine withdrawal. | 340 | ||
| 24. What are the anesthetic concerns in the acutely intoxicated cocaine user? | 340 | ||
| 25. Can the nonacutely intoxicated patient who has used cocaine be safely anesthetized? | 340 | ||
| 26. What is crystal methamphetamine and what are its properties? | 341 | ||
| 27. What are the signs of symptoms of methamphetamine intoxication and withdrawal? | 341 | ||
| 28. What is ecstasy and what are its mechanism of action and route of administration? | 341 | ||
| 29. What are the cognitive, physical, and psychologic effects of ecstasy? | 341 | ||
| 30. What is phencyclidine and what is its mechanism of action? | 341 | ||
| 31. Discuss the physical and psychologic effects of phencyclidine. | 341 | ||
| 32. How do you increase clearance of phencyclidine? | 342 | ||
| Suggested Readings\r | 342 | ||
| Chapter 49: Diabetes Mellitus\r | 343 | ||
| 1. Describe the principal types of diabetes mellitus.\r | 343 | ||
| 2. What is considered ideal (target) glucose control?\r | 343 | ||
| 3. What comorbidities are frequently observed in patients with diabetes mellitus and to what significance?\r | 343 | ||
| 4. What oral medications are currently used in type 2 diabetes?\r | 343 | ||
| 5. What insulins are in current use?\r | 344 | ||
| 6. Is there an advantage to the use of insulins that are in solution as opposed to insulin that is in a suspension?\r | 345 | ||
| 7. Describe the role of insulin on glucose metabolism and the impact of stress.\r | 345 | ||
| 8. Is there evidence that tight glucose control is beneficial in critically ill patients?\r | 345 | ||
| 9. What are the complications of hyperglycemia in the perioperative setting?\r | 345 | ||
| 10. What considerations are important during the preoperative evaluation?\r | 345 | ||
| 11. What is the significance of autonomic neuropathy? How can it be assessed?\r | 345 | ||
| 12. What preoperative laboratory tests are appropriate for the patient with diabetes?\r | 346 | ||
| 13. Are there any signs that oral intubation may be difficult?\r | 346 | ||
| 14. How should the patient with diabetes be prepared before surgery? Should all patients with diabetes receive insulin intraoperatively?\r | 346 | ||
| 15. How do you make an insulin and glucose infusion?\r | 347 | ||
| 16. How fast can the blood glucose be lowered in a markedly hyperglycemic patient?\r | 347 | ||
| 17. Describe the postoperative management of the patient with diabetes.\r | 347 | ||
| 18. How do you manage patients using subcutaneous insulin pumps?\r | 347 | ||
| 19. What insulins are preferred for pump use?\r | 348 | ||
| 20. Describe the management of patients with diabetes requiring urgent surgery.\r | 348 | ||
| 21. Are regional anesthetics helpful in patients with insulin-dependent diabetes? Can epinephrine be added to local anesthetic solutions?\r | 348 | ||
| 22. Is it possible to achieve continuous monitoring of glucose levels in the operating room and in the perioperative period?\r | 349 | ||
| Suggested Readings\r | 349 | ||
| Chapter 50: Nondiabetic Endocrine Disease\r | 351 | ||
| 1. Describe four steps involved in thyroid hormone synthesis.\r | 351 | ||
| 2. How much tri-iodothyronine and thyroxine are produced? What regulates their production?\r | 351 | ||
| 3. List the common thyroid function tests and their use in assessment of thyroid disorders.\r | 351 | ||
| 4. List common signs, symptoms, and causes of hypothyroidism.\r | 352 | ||
| 5. Of the numerous manifestations of hypothyroidism, which are most important in relation to anesthesia?\r | 352 | ||
| 6. How does hypothyroidism affect minimum alveolar concentration of anesthetic agents?\r | 352 | ||
| 7. How is hypothyroidism treated?\r | 352 | ||
| 8. Under what circumstances should elective surgery be delayed for a hypothyroid patient?\r | 353 | ||
| 9. List common signs, symptoms, and causes of hyperthyroidism.\r | 353 | ||
| 10. How is hyperthyroidism treated?\r | 353 | ||
| 11. Which effects of hyperthyroidism are the most important with regard to anesthesia?\r | 353 | ||
| 12. How is minimum alveolar concentration affected by hyperthyroidism?\r | 353 | ||
| 13. Define thyrotoxicosis.\r | 354 | ||
| 14. How is thyrotoxicosis treated?\r | 354 | ||
| 15. What complications may occur after a surgical procedure involving the thyroid gland?\r | 354 | ||
| 16. Describe the functions and regulation of the adrenal gland.\r | 354 | ||
| 17. What is a pheochromocytoma?\r | 354 | ||
| 18. How much cortisol is produced by the adrenal cortex?\r | 355 | ||
| 19. What is the most common cause of hypothalamic-pituitary-adrenal axis disruption?\r | 355 | ||
| 20. What is an addisonian crisis?\r | 355 | ||
| 21. How is an addisonian crisis treated?\r | 355 | ||
| 22. How do exogenous steroids compare to cortisol?\r | 355 | ||
| 23. Is perioperative stress steroid supplementation for patients on steroid therapy necessary?\r | 356 | ||
| 24. If supplemental corticosteroids are to be administered perioperatively, how much should be given?\r | 356 | ||
| 25. Review calcium homeostasis.\r | 357 | ||
| Suggested Readings | 357 | ||
| Chapter 51: Obesity and Sleep Apnea\r | 358 | ||
| 1. Define obesity. | 358 | ||
| 2. Discuss the cardiovascular considerations in the obese patient. | 358 | ||
| 3. Review some pulmonary and respiratory considerations in the obese patient. | 358 | ||
| 4. What are the gastrointestinal and hepatic changes seen in obese patients? | 358 | ||
| 5. Discuss the pharmacokinetic changes found in the obese patient. | 359 | ||
| 6. Discuss the appropriate preoperative assessment of this population. | 359 | ||
| 7. What are the advantages or disadvantages of offering regional anesthesia to the obese patient? | 360 | ||
| 8. Review the challenges in monitoring these patients. | 360 | ||
| 9. Discuss positioning the obese patient. | 360 | ||
| 10. What extubation criteria would you use for the obese patient? | 361 | ||
| 11. Review special concerns for pregnant women and children with obesity. | 361 | ||
| 12. What is obstructive sleep apnea? | 361 | ||
| 13. Is obstructive sleep apnea common? | 361 | ||
| 14. Which techniques can be used to identify patients with obstructive sleep apnea? | 361 | ||
| 15. What procedures are performed to aid in weight loss? | 362 | ||
| 16. Is bariatric surgery used in the pediatric population? | 362 | ||
| Suggested Readings\r | 363 | ||
| Chapter 52: Allergic Reactions\r | 364 | ||
| 1. Review the four types of immune-mediated allergic reactions and their mechanisms. | 364 | ||
| 2. What is meant by anaphylaxis? | 364 | ||
| 3. What is an anaphylactoid reaction? | 364 | ||
| 4. What are the common causes of anaphylaxis in the operating room? | 364 | ||
| 5. Review the issues concerning allergic reactions to muscle relaxants. | 365 | ||
| 6. Should a penicillin-allergic patient receive cephalosporins? | 365 | ||
| 7. What is latex? | 365 | ||
| 8. What demographic groups are at risk for latex allergy? | 366 | ||
| 9. Has the incidence of latex allergy increased? | 366 | ||
| 10. How is a latex allergy developed? | 366 | ||
| 11. How should an operating room be prepared for a latex-allergic patient? | 366 | ||
| 12. How should any allergic reaction be treated? | 366 | ||
| 13. Should patients with a prior history of allergic reaction be pretreated with histamine blockers or corticosteroids?\r | 367 | ||
| 14. What tests are available to diagnose and characterize a prior allergic reaction? Should patients having a prior anaphylactic reaction be tested?\r | 367 | ||
| 15. What are the implications of occupational latex exposure? | 367 | ||
| Suggested Readings\r | 368 | ||
| Chapter 53: Herbal supplements\r | 369 | ||
| 1. How does the Federal Food and Drug Administration regulate herbal medications?\r | 369 | ||
| 2. What is the incidence of herbal medicine use in the surgical patient population? What are commonly used herbal medicines?\r | 369 | ||
| 3. How can commonly used herbal medicines adversely affect the surgical patient?\r | 369 | ||
| 4. What are the risks involved in consuming ephedra?\r | 369 | ||
| 5. Review the effects of vitamin E.\r | 370 | ||
| 6. What are the reported benefits and adverse effects of fish oil?\r | 370 | ||
| 7. What are the beneficial properties and side effects of kava and valerian?\r | 370 | ||
| 8. Review the alleged benefits and risks of ginkgo.\r | 370 | ||
| 9. What are the alleged benefits and risks of ginseng?\r | 370 | ||
| 10. Review the alleged benefits and risks of garlic.\r | 371 | ||
| 11. What about ginger?\r | 371 | ||
| 12. Review the properties and effects of feverfew.\r | 371 | ||
| 13. Review the effects of St. John's wort.\r | 371 | ||
| 14. Since these medications appear to impair coagulation, how can their effect be evaluated clinically?\r | 371 | ||
| 15. What are current recommendations regarding discontinuing use of herbal medications before surgery?\r | 372 | ||
| Suggested Readings\r | 372 | ||
| Section VII: Special Anesthetic Considerations\r | 373 | ||
| Chapter 54: Trauma\r | 373 | ||
| 1. Review conditions that predispose trauma patients to increased anesthetic risk.\r | 373 | ||
| 2. Outline the initial management of an unconscious, hypotensive patient.\r | 373 | ||
| 3. What is the significance of Glasgow Coma Scale (GCS) score of 8?\r | 373 | ||
| 4. Describe the changes in vital signs associated with progressive blood loss.\r | 374 | ||
| 5. What is the initial therapy for hypovolemic shock?\r | 374 | ||
| 6. Why is rapid-sequence induction preferred for airway management in trauma patients?\r | 374 | ||
| 7. How does an uncleared cervical spine modify the approach to the airway?\r | 374 | ||
| 8. Which induction agents are best for trauma patients?\r | 375 | ||
| 9. Why are trauma patients hypothermic?\r | 375 | ||
| 10. What is meant by damage control surgery?\r | 375 | ||
| 11. How have damage control concepts been applied in orthopedic injuries?\r | 375 | ||
| 12. What is the universal theory of the compartment syndrome?\r | 376 | ||
| 13. How does cardiac tamponade present? What is Beck's triad? How should anesthesia be managed in a patient with tamponade?\r | 376 | ||
| 14. What is the significance, clinical presentation, and treatment of a tension pneumothorax?\r | 376 | ||
| 15. What is the abdominal compartment syndrome?\r | 376 | ||
| 16. What challenges do spinal cord-injured patients pose?\r | 377 | ||
| 17. Should succinylcholine be used in patients with spinal cord injury?\r | 377 | ||
| 18. Describe the presentation of a myocardial contusion.\r | 377 | ||
| 19. Describe the management of a pregnant trauma patient.\r | 378 | ||
| 20. Review concerns for the elderly trauma patient.\r | 378 | ||
| 21. How might a bronchial or tracheal tear present? What are alternatives for managing ventilation during operative repair?\r | 378 | ||
| 22. How is air embolism diagnosed and managed?\r | 379 | ||
| Suggested Readings\r | 379 | ||
| Chapter 55: The Burned Patient\r | 380 | ||
| 1. Who gets burned? | 380 | ||
| 2. What are the three main factors that correlate with increased mortality with burn injury? | 380 | ||
| 3. What are the consequences of skin damage? | 380 | ||
| 4. How are burns classified? | 380 | ||
| 5. What systems are affected by burns? | 380 | ||
| 6. How is the cardiovascular system affected? | 381 | ||
| 7. How is the respiratory system affected? | 381 | ||
| 8. What is inhalation injury? | 381 | ||
| 9. What is the best way to treat inhalation injury? | 381 | ||
| 10. What are the features of carbon monoxide poisoning? | 381 | ||
| 11. How do burns affect the gastrointestinal tract? | 382 | ||
| 12. How is renal function affected? | 382 | ||
| 13. How is myoglobinuria treated? | 382 | ||
| 14. How is hepatic function affected? | 382 | ||
| 15. Are drug responses altered? | 382 | ||
| 16. What is the endocrine response to a burn? | 382 | ||
| 17. What are the hematologic complications that occur with burns? | 383 | ||
| 18. What are the immunologic complications that occur with burns? | 383 | ||
| 19. How are patients with burns resuscitated? | 383 | ||
| 20. How do you calculate the percent of total body surface burned? | 384 | ||
| 21. Early surgical burn wound intervention has recently been shown to be one of the major reasons for the improved outcome in burn patients. What are the fourcategories of operations that are common for the burn-injured patient?\r | 384 | ||
| 22. What is important in the preoperative history? | 384 | ||
| 23. What should the anesthesiologist look for on the preoperative physical examination? | 384 | ||
| 24. What preoperative tests are required before induction? | 385 | ||
| 25. What monitors are needed to give a safe anesthetic? | 385 | ||
| 26. How must the use of muscle relaxants be modified for a burned patient? | 385 | ||
| 27. What techniques have been used to markedly reduce blood loss in excisional burn surgery? | 385 | ||
| 28. What induction drugs are good for burn patients? | 385 | ||
| 29. Describe specific features of electrical burns. | 386 | ||
| Suggested Readings\r | 386 | ||
| Chapter 56: Neonatal Anesthesia\r | 387 | ||
| 1. Why are neonates and preterm infants at increased anesthetic risk?\r | 387 | ||
| 2. Do neonates have normal renal function?\r | 387 | ||
| 3. Why is it important to provide infants with exogenous glucose?\r | 387 | ||
| 4. What are the differences in the gastrointestinal or hepatic function of neonates?\r | 387 | ||
| 5. What is retinopathy of prematurity?\r | 388 | ||
| 6. How is volume status assessed in neonates?\r | 388 | ||
| 7. What problems are common in premature infants?\r | 388 | ||
| 8. What special preparations are needed before anesthetizing a neonate?\r | 389 | ||
| 9. What intraoperative problems are common in small infants?\r | 389 | ||
| 10. What are the most common neonatal emergencies?\r | 390 | ||
| 11. Discuss the incidence and anesthetic implications of congenital diaphragmatic hernia.\r | 390 | ||
| 12. Which congenital anomalies are associated with tracheoesophageal fistula?\r | 390 | ||
| 13. How should patients with tracheoesophageal fistula be managed?\r | 391 | ||
| 14. What are the differences between omphalocele and gastroschisis?\r | 391 | ||
| 15. How are patients with omphalocele or gastroschisis managed in the perioperative period?\r | 391 | ||
| 16. How does pyloric stenosis present?\r | 392 | ||
| 17. Discuss the perioperative management of patients with pyloric stenosis.\r | 392 | ||
| 18. Are there any benefits to specific ventilator strategies in neonates?\r | 392 | ||
| 19. At what age should the former premature infant be allowed to go home after surgery?\r | 392 | ||
| 20. Does regional anesthesia protect the patient from developing postoperative anesthesia?\r | 393 | ||
| Suggested Readings\r | 393 | ||
| Chapter 57: Pediatric Anesthesia\r | 394 | ||
| 1. What are the differences between the adult and pediatric airways? | 394 | ||
| 2. Are there any differences in the adult and pediatric pulmonary systems? | 394 | ||
| 3. How does the cardiovascular system differ in a child? | 394 | ||
| 4. What are normal vital signs in children? | 395 | ||
| 5. When should a child be premedicated? Which drugs are commonly used? | 395 | ||
| 6. Should parents be allowed to accompany their children to the operating room? | 395 | ||
| 7. What medications are available for premedication? | 396 | ||
| 8. Describe the commonly used induction techniques in children. | 396 | ||
| 9. How does the presence of a left-to-right shunt affect inhalational induction and intravenous induction? | 397 | ||
| 10. How about a right-to-left shunt? | 397 | ||
| 11. What other special precautions need to be taken in a child with heart disease? | 397 | ||
| 12. How is an endotracheal tube of appropriate size chosen? | 398 | ||
| 13. Can cuffed endotracheal tubes be used in children and laryngeal mask airways? | 398 | ||
| 14. How is an appropriate-size laryngeal mask airway chosen? | 399 | ||
| 15. How does the pharmacology of commonly used anesthetic drugs differ in children? | 399 | ||
| 16. How is perioperative fluid managed in children? | 399 | ||
| 17. What is the most common replacement fluid used in children? Why? | 399 | ||
| 18. What is the estimated blood volume in children? | 400 | ||
| 19. How is acceptable blood loss calculated? | 400 | ||
| 20. How do the manifestations of hypovolemia differ in children? | 400 | ||
| 21. What are the systemic responses to blood loss? | 400 | ||
| 22. What is the most common type of regional anesthesia performed in children? Which local anesthetic is used and what dose is appropriate?\r | 400 | ||
| 23. Describe the common postoperative complications. | 401 | ||
| 24. What is the significance of masseter muscle rigidity? | 402 | ||
| 25. Should children with upper respiratory infection receive general anesthesia? | 402 | ||
| 26. What are the implications of sleep-disordered breathing in children? | 403 | ||
| Suggested Readings\r | 403 | ||
| Chapter 58: Congenital Heart Disease\r | 404 | ||
| 1. What is the incidence of congenital heart disease? | 404 | ||
| 2. What causes pulmonary hypertension in association with congenital heart disease? | 404 | ||
| 3. Describe the pulmonary vascular effects of left-to-right shunts. | 404 | ||
| 4. How do left-to-right shunts affect the heart? | 404 | ||
| 5. What is a pulmonary hypertensive crisis? How is it treated? | 405 | ||
| 6. How does PAH affect perioperative risk? | 405 | ||
| 7. How are shunts calculated? | 405 | ||
| 8. How are pulmonary vascular resistance and systemic vascular resistance calculated? | 405 | ||
| 9. Do anesthetic drugs affect pulmonary vascular resistance? | 406 | ||
| 10. What causes cyanosis in congenital heart disease? | 406 | ||
| 11. Describe the clinical problems associated with cyanotic congenital heart disease. | 406 | ||
| 12. What is tetralogy of Fallot? What are tet spells? | 406 | ||
| 13. How are tet spells treated? | 407 | ||
| 14. What effects do anesthetic agents have on shunting in patients with cyanotic congenital heart disease? | 407 | ||
| 15. What is the main problem associated with ventricular obstructive lesions? | 408 | ||
| 16. What is a ductal-dependent lesion? | 408 | ||
| 17. Why can oxygen be dangerous in patients with single ventricle physiology? | 408 | ||
| 18. What is the best anesthetic technique for patients with congenital heart disease? | 409 | ||
| 19. How soon does cardiac function return to normal after surgical repair? | 409 | ||
| 20. What is subacute bacterial endocarditis and how can it be prevented? | 409 | ||
| Suggested Readings\r | 410 | ||
| Chapter 59: Fundamentals of Obstetric Anesthesia\r | 411 | ||
| 1. What are the cardiovascular adaptations to pregnancy?\r | 411 | ||
| 2. What hematologic changes accompany pregnancy?\r | 411 | ||
| 3. What pulmonary and respiratory changes occur with pregnancy?\r | 412 | ||
| 4. What is a normal arterial blood gas in a pregnant patient?\r | 413 | ||
| 5. What gastrointestinal changes occur during pregnancy?\r | 413 | ||
| 6. What renal changes are associated with pregnancy?\r | 413 | ||
| 7. What changes occur in the central nervous system of pregnant patients?\r | 413 | ||
| 8. What hepatic alterations occur with pregnancy?\r | 413 | ||
| 9. What pregnancy-related changes occur to plasma proteins?\r | 413 | ||
| 10. What is the uterine blood flow at term?\r | 414 | ||
| 11. What is aortocaval compression syndrome? How is it treated?\r | 414 | ||
| 12. What are the most important physiologic changes during labor?\r | 414 | ||
| 13. How quickly do the physiologic alterations of pregnancy return to normal after delivery?\r | 414 | ||
| 14. Discuss the pathways involved in labor pain.\r | 414 | ||
| 15. What are the three stages of labor?\r | 414 | ||
| 16. Describe the anatomy of the placenta and umbilical cord.\r | 415 | ||
| 17. What factors influence uteroplacental perfusion?\r | 415 | ||
| 18. How should hypotension associated with spinal anesthesia be treated in a cesarean section or laboring patient?\r | 415 | ||
| 19. What is the role of intravenous fluid preloading before regional anesthesia for cesarean delivery?\r | 415 | ||
| 20. How are drugs and other substances transported across the placenta?\r | 415 | ||
| 21. What methods are used to evaluate fetal well-being during labor?\r | 416 | ||
| 22. What is the significance of fetal heart rate decelerations?\r | 416 | ||
| 23. What is the Apgar score?\r | 417 | ||
| 24. Describe the management of the pregnant patient undergoing nonobstetric surgery.\r | 417 | ||
| Suggested Readings\r | 418 | ||
| Chapter 60: Obstetric Analgesia and Anesthesia\r | 419 | ||
| 1. What are the most commonly used parenteral opioids for labor analgesia? Which side effects are of special concern to the parturient?\r | 419 | ||
| 2. What advantages does PCA offer over conventional intermittent bolus dosing?\r | 419 | ||
| 3. Discuss the benefits of epidural analgesia for labor and delivery.\r | 420 | ||
| 4. What are the indications and contraindications for epidural analgesia during labor and delivery?\r | 420 | ||
| 5. Discuss the importance of a test dose and suggest an epidural test dose regimen. When and why is this regimen used?\r | 420 | ||
| 6. What are the characteristics of the ideal local anesthetic for use in labor? Discuss the three most common local anesthetics used in obstetric anesthesia.How does epinephrine affect the action of local anesthetics?\r | 420 | ||
| 7. Describe the properties and benefits of ropivacaine in obstetric anesthesia.\r | 421 | ||
| 8. Name three methods for administering epidural analgesia. State the concerns associated with each.\r | 421 | ||
| 9. Discuss the complications of epidural anesthesia and their treatments.\r | 421 | ||
| 10. Explain the mechanism of action of intrathecal and epidural opioids. What effect do they have on pain perception, sympathetic tone, sensation, andmovement?\r | 422 | ||
| 11. What opioids are used to provide spinal and epidural analgesia during labor? Name their most common side effects. Do they provide adequate analgesia forlabor and delivery when used alone?\r | 422 | ||
| 12. Is there a cause-and-effect relationship between epidural anesthesia and prolonged labor or operative delivery?\r | 423 | ||
| 13. Relate the advantages and disadvantages of spinal anesthesia for cesarean section. Which drugs are frequently used in the technique?\r | 423 | ||
| 14. What are the advantages and disadvantages of cesarean section with epidural anesthesia vs. spinal anesthesia? What are the most commonly used localanesthetics?\r | 423 | ||
| 15. How is combined spinal/epidural anesthesia performed? What are its advantages?\r | 424 | ||
| 16. List the indications for general anesthesia for cesarean section.\r | 424 | ||
| 17. What concerns the practitioner when administering general anesthesia for cesarean section? How is it performed?\r | 425 | ||
| Suggested Readings\r | 425 | ||
| Chapter 61: High-Risk Obstetrics\r | 426 | ||
| 1. What is a high-risk pregnancy? | 426 | ||
| 2. Describe the hypertensive disorders of pregnancy. | 426 | ||
| 3. What causes preeclampsia? | 426 | ||
| 4. What clinical findings are present in preeclampsia? | 426 | ||
| 5. What conditions contribute to maternal and perinatal mortality in preeclampsia? | 427 | ||
| 6. What is HELLP syndrome? | 427 | ||
| 7. How is preeclampsia managed? | 427 | ||
| 8. What are the indications for invasive monitoring? | 428 | ||
| 9. What potential problems may occur in patients receiving magnesium sulfate? | 428 | ||
| 10. What are the anesthetic considerations in patients with preeclampsia? | 428 | ||
| 11. What is eclampsia? | 428 | ||
| 12. How are eclamptic seizures treated? | 428 | ||
| 13. Discuss preterm labor. | 429 | ||
| 14. What is the treatment of preterm labor? | 429 | ||
| 15. Discuss antepartum hemorrhage. | 429 | ||
| 16. What is placenta previa? | 429 | ||
| 17. What is postpartum uterine atony? How is it managed? | 429 | ||
| 18. Discuss diabetes and its anesthetic considerations. | 430 | ||
| 19. What causes disseminated intravascular coagulation in obstetric patients? | 430 | ||
| 20. What types of renal diseases are most frequently seen in obstetric patients? | 430 | ||
| 21. How is anesthetic management affected in patients with renal disease? | 430 | ||
| 22. Which cardiac disease most commonly complicates pregnancy? | 430 | ||
| 23. How is congenital heart disease managed during pregnancy? | 430 | ||
| Suggested Readings\r | 431 | ||
| Chapter 62: Geriatric Anesthesia\r | 432 | ||
| 1. What is geriatric anesthesia and why is it important? | 432 | ||
| 2. What are the overriding characteristics and principles governing age-related physiologic changes as they relate to anesthesia in geriatrics?\r | 432 | ||
| 3. Review age-related changes to the cardiovascular system. | 432 | ||
| 4. Describe age-related changes to the pulmonary system. | 432 | ||
| 5. Discuss age-related changes to the nervous system. | 433 | ||
| 6. How is baseline renal function impaired in the elderly? | 433 | ||
| 7. How does serum creatinine change with aging? | 433 | ||
| 8. How do changes in renal function affect anesthetic management? | 433 | ||
| 9. How is liver function affected by aging? What are some anesthetic implications? | 433 | ||
| 10. In what ways does body composition change with aging? | 433 | ||
| 11. How do these changes in body composition affect anesthetic management? | 433 | ||
| 12. Why are these patients prone to hypothermia? | 434 | ||
| 13. What is the affect of aging on anesthetic requirements? | 434 | ||
| 14. How are the pharmacokinetics and quality of spinal anesthesia affected by age? | 434 | ||
| 15. Review the dynamics of epidural anesthesia change with age. | 434 | ||
| 16. Do all elderly patients need extensive preoperative testing? | 434 | ||
| 17. Is there a difference in outcome when performing regional vs. general anesthesia in the elderly? | 434 | ||
| 18. What are the most common postoperative complications in elderly patients? | 434 | ||
| 19. What is postoperative cognitive dysfunction and what are its risk factors? | 435 | ||
| 20. What are the implications of postoperative cognitive dysfunction on patient mortality? | 435 | ||
| 21. What can anesthesiologists do to limit postoperative cognitive dysfunction in at-risk patients? | 435 | ||
| 22. Is age itself a predictor of perioperative mortality in the elderly? | 435 | ||
| Suggested Readings\r | 436 | ||
| Chapter 63: Sedation and Anesthesia Outside the Operating Room\r | 437 | ||
| 1. What procedures outside the operating room require sedation or general anesthesia?\r | 437 | ||
| 2. What equipment and standards are necessary for safely conducting an anesthetic outside the operating room?\r | 437 | ||
| 3. What monitoring is necessary for administration of any anesthetic, regardless of whether it is in the operating room or elsewhere?\r | 438 | ||
| 4. How might anesthesiologists be involved in establishing standards for sedation and analgesia conducted by nonanesthesiologists?\r | 438 | ||
| 5. Explain conscious sedation and the continuum of depth of anesthesia.\r | 438 | ||
| 6. What are some of the requirements for the administration of moderate sedation by nonanesthesiologists?\r | 439 | ||
| 7. Is it advisable to have nonanesthesiogists administer deep sedation?\r | 440 | ||
| 8. What is dexmedetomidine and what role does it serve in moderate sedation?\r | 440 | ||
| 9. Why is soluble contrast media important to anesthesiologists?\r | 440 | ||
| 10. Besides anaphylaxis, what is a major risk with regard to contrast media?\r | 440 | ||
| 11. Are there specific steps that can be taken to avoid and treat contrast media reactions?\r | 440 | ||
| 12. What are some of the more common manifestations of the reactions to soluble contrast media?\r | 441 | ||
| 13. How is radiation exposure measured?\r | 441 | ||
| 14. How can anesthesiologists protect themselves from radiation exposure?\r | 442 | ||
| 15. Define the unique problems associated with providing an anesthetic in the magnetic resonance imaging suite.\r | 442 | ||
| 16. What modifications in the anesthesia machine, ventilator, and monitoring equipment must be made to provide an anesthetic in the magnetic resonanceimaging suite?\r | 443 | ||
| Suggested Readings\r | 444 | ||
| Chapter 64: Pacemakers and Internal Cardioverter Defibrillators\r | 445 | ||
| 1. Explain the letters in the NBG coding system for pacemakers.\r | 445 | ||
| 2. What does AOO, VOO, or DOO mode mean?\r | 445 | ||
| 3. What is the result of VVI pacing?\r | 445 | ||
| 4. What is the result of DDI pacing?\r | 445 | ||
| 5. What does DDD pacing mean?\r | 446 | ||
| 6. Describe the difference between a unipolar and bipolar pacemaker.\r | 446 | ||
| 7. What is an implantable cardioverter defibrillator?\r | 446 | ||
| 8. What are common indications for permanent pacing?\r | 446 | ||
| 9. What are some common indications for implantable cardioverter defibrillator implantation?\r | 446 | ||
| 10. What is the effect of placing a magnet over a device?\r | 446 | ||
| 11. Do patients with devices need to avoid microwave ovens or other hospital electronics?\r | 447 | ||
| 12. Are there other responses to electromagnetic interference by devices?\r | 447 | ||
| 13. Can device leads be dislodged?\r | 447 | ||
| 14. Can device leads be damaged with intravascular access?\r | 447 | ||
| 15. Do typical anesthetics and intraoperative medications affect the ability of implantable cardioverter defibrillators to defibrillate patients?\r | 447 | ||
| 16. Can changes in the patient's clinical status affect pacemaker function?\r | 447 | ||
| 17. Can programming patients to a different mode lead to hemodynamic compromise?\r | 448 | ||
| 18. Should patients with pacemakers or defibrillators be evaluated before and after surgery?\r | 448 | ||
| 19. Are there any precautions that can decrease the effect of electrocautery on devices?\r | 448 | ||
| 20. If no underlying rhythm is seen when a pacemaker rate is rapidly decreased, does that mean that the patient is pacemaker dependent?\r | 448 | ||
| 21. No pacer spikes are seen on the monitoring system with your patient with a pacemaker. Does this mean that the pacemaker is not functioningproperly?\r | 448 | ||
| 22. Does failure of a pacemaker stimulus to capture the heart necessarily imply pacemaker malfunction?\r | 448 | ||
| 23. If a pacemaker stimulus is superimposed on a native complex, is the pacemaker necessarily malfunctioning?\r | 449 | ||
| Suggested Readings\r | 450 | ||
| Section VIII: Regional Anesthesia\r | 451 | ||
| Chapter 65: Spinal Anesthesia\r | 451 | ||
| 1. What are the advantages of spinal anesthesia over general anesthesia?\r | 451 | ||
| 2. What are the usual doses of common local anesthetics used in spinal anesthesia and the duration of effect?\r | 451 | ||
| 3. Where are the principal sites of effect of spinal local anesthetics?\r | 451 | ||
| 4. What factors determine the termination of effect?\r | 451 | ||
| 5. Describe the factors involved in distribution (and extent) of conduction blockade.\r | 452 | ||
| 6. At what lumbar levels should a spinal anesthetic be administered? What structures are crossed when performing a spinal block?\r | 452 | ||
| 7. What are the most common complications of spinal anesthesia?\r | 452 | ||
| 8. What are the physiologic changes and risk factors found with subarachnoid block-associated hypotension?\r | 452 | ||
| 9. What are the etiology and risk factors for subarachnoid block-associated bradycardia?\r | 453 | ||
| 10. Why are patients who have received spinal anesthetics especially sensitive to sedative medications? What is deafferentation?\r | 453 | ||
| 11. Review the clinical features of total spinal anesthesia.\r | 453 | ||
| 12. If a patient has a cardiac arrest while having a subarachnoid block, how should resuscitative measures differ from standard advanced cardiac life supportprotocols?\r | 453 | ||
| 13. What are the clinical features of a postdural puncture headache and the treatment?\r | 453 | ||
| 14. What is the risk of neurologic injury after spinal anesthesia?\r | 454 | ||
| 15. What is the effect of spinal anesthesia on temperature regulation?\r | 454 | ||
| 16. What are contraindications to spinal anesthesia?\r | 454 | ||
| 17. Review the current recommendations for administering regional anesthesia to patients with altered coagulation caused by medications.\r | 454 | ||
| 18. Should spinal (or epidural) anesthesia be performed when unfractionated heparin is administered?\r | 454 | ||
| 19. Should spinal (or epidural) anesthesia be performed when low-molecular-weight heparin is administered?\r | 455 | ||
| 20. What are the sites of action, benefits, and side effects of intrathecal opioids?\r | 455 | ||
| 21. What is transient neurologic syndrome and its cause?\r | 455 | ||
| 22. Since lidocaine is associated with TNS, what would be an appropriate local anesthetic selection for an ambulatory procedure?\r | 456 | ||
| 23. Can continuous spinal anesthesia be performed?\r | 456 | ||
| Suggested Readings\r | 457 | ||
| Chapter 66: Epidural Analgesia and Anesthesia\r | 458 | ||
| 1. Where is the epidural space? Describe the relevant anatomy. | 458 | ||
| 2. Differentiate between a spinal and an epidural anesthetic. | 458 | ||
| 3. How is caudal anesthesia related to epidural anesthesia? When is it used? | 458 | ||
| 4. What are the advantages of using epidural anesthesia vs. general anesthesia? | 459 | ||
| 5. What are the disadvantages of epidural compared with general anesthesia? | 459 | ||
| 6. What are the advantages of epidural anesthesia over spinal anesthesia? | 459 | ||
| 7. What are the disadvantages of epidural compared with spinal anesthesia? | 459 | ||
| 8. What factors should the anesthesiologist address in the preoperative assessment before performing an epidural anesthetic? | 459 | ||
| 9. Describe the technique for performing a lumbar epidural anesthetic. | 460 | ||
| 10. Are there any contraindications to epidural anesthesia? | 460 | ||
| 11. What are the potential complications of epidural anesthesia? Can they be anticipated or prevented? | 461 | ||
| 12. What physiologic changes should be expected after successful initiation of an epidural anesthetic? | 462 | ||
| 13. How does one choose which local anesthetic to use? | 462 | ||
| 14. Why is epinephrine sometimes combined with the local anesthetic? Should it be included in all cases? | 463 | ||
| 15. When should opioids be included in the epidural anesthetic? | 463 | ||
| 16. Why can some patients with epidural blocks move around and even walk, whereas others have a dense motor block?\r | 463 | ||
| 17. When is analgesia preferable to anesthesia? | 464 | ||
| 18. How do you determine the level of anesthesia needed for different types of surgeries? What is a segmental block? When is it used?\r | 464 | ||
| 19. How do you determine the amount of local anesthetic solution used for different procedures? What factors affect spread in the epidural space?\r | 464 | ||
| 20. What is a combined spinal-epidural anesthetic? Why use both? | 464 | ||
| 21. What is a combined epidural-general anesthetic? Why give the patient two anesthetics? | 464 | ||
| 22. What should the anesthesiologist ask the patient postoperatively after an epidural anesthetic? | 465 | ||
| Suggested Readings\r | 465 | ||
| Chapter 67: Peripheral Nerve Blocks\r | 466 | ||
| 1. What are the advantages of peripheral nerve blocks? | 466 | ||
| 2. What basic principles should be followed to ensure a safe and successful peripheral nerve block? | 466 | ||
| 3. What are the risks of performing a peripheral nerve block? | 466 | ||
| 4. How can the risks from a peripheral nerve block be minimized? | 466 | ||
| 5. Describe a good technique for advancing the needle and injecting the local anesthetic solution. | 467 | ||
| 6. How are peripheral nerves localized? | 467 | ||
| 7. Is one technique to localize nerves better or safer than any other? | 467 | ||
| 8. When using ultrasound guidance, what is the difference between an in-plane and an out of-plane approach? | 467 | ||
| 9. Review upper-extremity nerve blocks, including their indications, limitations, and complications. | 467 | ||
| 10. What is the Bier block and how is it performed? | 467 | ||
| 11. How is local anesthetic toxicity avoided when performing a Bier block? | 468 | ||
| 12. What peripheral nerve block can be performed for surgery of the lower extremity? | 469 | ||
| 13. What peripheral nerve block can be used to provide anesthesia or analgesia to the chest wall? | 471 | ||
| 14. What peripheral nerve block can be used to provide anesthesia or analgesia to the anterior abdominal wall?\r | 471 | ||
| Suggested Readings\r | 471 | ||
| Section IX: Anesthetic Considerations in Selected Surgical Procedures\r | 473 | ||
| Chapter 68: Heart Transplantation\r | 473 | ||
| 1. What are the common diagnoses indicating heart transplantation in adults?\r | 473 | ||
| 2. What is the bridge-to-transplant management of patients with heart failure?\r | 473 | ||
| 3. What are the criteria for the selection of transplant recipients?\r | 473 | ||
| 4. What are the priority criteria for the selection of the recipients?\r | 473 | ||
| 5. What is the significance of peak VO2 measurement?\r | 474 | ||
| 6. What is the role of peak VO2 in the decision-making process of heart transplantation?\r | 474 | ||
| 7. What are the absolute contraindications for the selection of the recipients?\r | 474 | ||
| 8. What are the criteria for donor selection?\r | 474 | ||
| 9. How is anesthesia managed for organ harvesting?\r | 474 | ||
| 10. How is the heart harvested and preserved for transplantation?\r | 475 | ||
| 11. In order of increasing acuity, review the physical status of patients awaiting heart transplantation.\r | 475 | ||
| 12. What are the hemodynamic characteristics of the heart of the recipients?\r | 475 | ||
| 13. Describe an appropriate anesthetic induction for patients with heart failure.\r | 475 | ||
| 14. How is anesthesia maintained for heart transplantation?\r | 475 | ||
| 15. What monitors should be used for heart transplantation?\r | 476 | ||
| 16. Are there specific preparations for cardiopulmonary bypass?\r | 476 | ||
| 17. Describe the etiology of coagulation disorders in these patients.\r | 476 | ||
| 18. What antifibrinolytic agents can be used to decrease bleeding?\r | 476 | ||
| 19. What preparation should be made before termination of cardiopulmonary bypass?\r | 477 | ||
| 20. What is the implication of autonomic denervation of the transplanted heart?\r | 477 | ||
| 21. What is the cause of the immediate left ventricular dysfunction after cardiopulmonary bypass?\r | 477 | ||
| 22. What is the cause of right ventricular failure after cardiopulmonary bypass?\r | 477 | ||
| 23. How can right ventricular function be evaluated during the surgery?\r | 478 | ||
| 24. What are the treatment options for right ventricular failure?\r | 478 | ||
| 25. What is the advantage of nitric oxide in the management of heart transplantation?\r | 478 | ||
| 26. What are the side effects of administration of nitric oxide?\r | 478 | ||
| 27. What are the concerns in anesthetic management of post-heart transplant patients for noncardiac surgery?\r | 478 | ||
| Suggested Readings\r | 479 | ||
| Chapter 69: Liver Transplantation\r | 480 | ||
| 1. What is the Model for End-stage Liver Disease MELD? | 480 | ||
| 2. Describe some indications and contraindications for liver transplantation. | 480 | ||
| 3. How does the cardiovascular physiology of a patient with end-stage liver disease differ from that of a normal patient?\r | 480 | ||
| 4. What are some preanesthetic considerations in a liver transplant patient? | 480 | ||
| 5. What is the significance of portal pulmonary hypertension? How are these patients managed in the pretransplant period?\r | 482 | ||
| 6. What are the concerns before anesthetic induction in the patient with end-stage liver disease? | 482 | ||
| 7. Describe the three stages of liver transplantation. | 483 | ||
| 8. What is the role of venovenous bypass? Are there any alternatives? | 483 | ||
| 9. List some of the anesthetic concerns during the preanhepatic (dissection) phase. | 483 | ||
| 10. What are some anesthetic concerns that arise during stage 2, the anhepatic phase? | 484 | ||
| 11. Define reperfusion syndrome. What are its clinical implications? | 484 | ||
| 12. Describe some of the major anesthetic management issues during the reperfusion stage (stage 3). | 485 | ||
| 13. What are indicators of graft function during stage 3? | 486 | ||
| Suggested Readings\r | 486 | ||
| Chapter 70: Cardiopulmonary Bypass\r | 487 | ||
| 1. What are the main functions of a cardiopulmonary bypass circuit?\r | 487 | ||
| 2. What are the basic components of the cardiopulmonary bypass circuit?\r | 487 | ||
| 3. Define the levels of hypothermia. What are adverse effects of hypothermia?\r | 487 | ||
| 4. Why is hypothermia used on cardiopulmonary bypass?\r | 487 | ||
| 5. Discuss the common cannulation sites for bypass.\r | 487 | ||
| 6. What are the basic anesthetic techniques used in cardiopulmonary bypass cases?\r | 488 | ||
| 7. List the two basic types of oxygenators.\r | 488 | ||
| 8. What is meant by pump prime? What is the usual hemodynamic response to initiating bypass?\r | 488 | ||
| 9. Why is systemic anticoagulation necessary?\r | 488 | ||
| 10. How is the adequacy of anticoagulation measured before and during bypass?\r | 488 | ||
| 11. What must be ascertained before placing the patient on cardiopulmonary bypass?\r | 489 | ||
| 12. Why is a left ventricular vent used?\r | 489 | ||
| 13. What are the characteristics of cardioplegia?\r | 489 | ||
| 14. Discuss myocardial protection during cardiopulmonary bypass. What elements should be in place to optimize myocardial protection?\r | 489 | ||
| 15. What is the function of an aortic cross-clamp?\r | 489 | ||
| 16. Review the physiologic responses to cardiopulmonary bypass.\r | 490 | ||
| 17. What are the pH-stat and -stat methods of blood gas measurement?\r | 490 | ||
| 18. Develop an appropriate checklist for discontinuing bypass.\r | 490 | ||
| 19. How is the heparin effect reversed? What are potential complications?\r | 490 | ||
| 20. Why is cardiac pacing frequently useful after bypass?\r | 490 | ||
| 21. What are some therapies for the patient with impaired cardiac performance or difficulty weaning from cardiopulmonary bypass?\r | 491 | ||
| 22. Review the central nervous system complications of cardiopulmonary bypass.\r | 491 | ||
| 23. What might be done to decrease the incidence of such complications?\r | 491 | ||
| Suggested Readings\r | 492 | ||
| Chapter 71: Lung Isolation Techniques\r | 493 | ||
| 1. What are the indications for lung isolation?\r | 493 | ||
| 2. How can lung isolation be achieved while maintaining one-lung ventilation?\r | 493 | ||
| 3. How do you choose the appropriate size double-lumen endotracheal tube?\r | 493 | ||
| 4. How is the right main stem bronchus different from the left and how does this affect right-sided double-lumen endotracheal tube design?\r | 494 | ||
| 5. Describe the placement and positioning of double-lumen endotracheal tubes.\r | 495 | ||
| 6. What complications may be caused by double-lumen endotracheal tubes?\r | 495 | ||
| 7. Name three methods of bronchial blockade.\r | 495 | ||
| 8. Describe the Univent tube.\r | 495 | ||
| 9. What are the advantages of using a Univent tube?\r | 495 | ||
| 10. What are the advantages of a double-lumen endotracheal tube?\r | 496 | ||
| 11. Describe the placement and positioning of a Univent tube.\r | 496 | ||
| 12. What complications can occur with the Univent tube?\r | 496 | ||
| 13. Describe the wire-guided endobronchial blocker.\r | 496 | ||
| 14. What are the advantages of the wire-guided endobronchial blocker?\r | 496 | ||
| 15. How can the Fogarty embolectomy catheter be used as a bronchial blocker?\r | 496 | ||
| 16. What tubes or bronchial blockers would you select for single-lung ventilation in children and adults?\r | 497 | ||
| 17. What are the standard ventilator settings for one-lung ventilation?\r | 497 | ||
| 18. Which volatile anesthetic agent would you use for single-lung ventilation?\r | 498 | ||
| 19. What pulmonary changes occur with one-lung ventilation?\r | 498 | ||
| 20. How should you manage hypoxia during one-lung ventilation?\r | 498 | ||
| Suggested Readings\r | 499 | ||
| Chapter 72: Somatosensory-Evoked Potentials and Spinal Surgery\r | 500 | ||
| 1. What are somatosensory-evoked potentials? | 500 | ||
| 2. How are somatosensory-evoked potentials generated? | 500 | ||
| 3. What major peripheral nerves are most commonly stimulated? | 500 | ||
| 4. Trace the neurosensory pathway from the peripheral nerves to the cerebral cortex. | 500 | ||
| 5. At what points along the neurosensory pathway are somatosensory-evoked potentials most commonly recorded? | 500 | ||
| 6. Describe the characteristics of the somatosensory-evoked potential waveform. | 500 | ||
| 7. Name several characteristic peaks important for the evaluation of somatosensory-evoked potentials. | 501 | ||
| 8. What is the central somatosensory conduction time? | 501 | ||
| 9. What are the indications for intraoperative use of somatosensory-evoked potential monitoring? | 502 | ||
| 10. What constitutes a significant change in the somatosensory-evoked potential? | 502 | ||
| 11. Summarize the effects of anesthetic agents on the amplitude and latency of somatosensory-evoked potentials.\r | 502 | ||
| 12. What is the take-home message of the effects of anesthetic agents on somatosensory-evoked potentials? | 503 | ||
| 13. What other physiologic variables can alter somatosensory-evoked potentials? | 503 | ||
| 14. If somatosensory-evoked potentials change significantly, what can the anesthesiologist and surgeon do to decrease the insult to the monitorednerves?\r | 504 | ||
| 15. Despite normal somatosensory-evoked potentials, can patients awaken with neurologic deficits? | 504 | ||
| Suggested Readings\r | 504 | ||
| Chapter 73: Anesthesia for Craniotomy\r | 505 | ||
| 1. Are there particular anesthetic problems associated with intracranial surgery?\r | 505 | ||
| 2. How is the anesthetic requirement different in the brain and related structures?\r | 505 | ||
| 3. Should monitoring be different during a craniotomy?\r | 505 | ||
| 4. Discuss the considerations for fluid administration during craniotomy.\r | 506 | ||
| 5. When are measures for brain protection required?\r | 506 | ||
| 6. How can the brain be protected?\r | 506 | ||
| 7. How is the choice of anesthetic agent made?\r | 507 | ||
| 8. What are the concerns for patient positioning during a craniotomy?\r | 507 | ||
| 9. Why do some patients awaken slowly after a craniotomy?\r | 508 | ||
| 10. What anesthesia problems are unique to surgery on the intracranial blood vessels?\r | 508 | ||
| 11. Are there special anesthetic problems associated with brain tumors?\r | 509 | ||
| 12. Are there other anesthetic concerns during craniotomies?\r | 509 | ||
| Suggested Readings\r | 510 | ||
| Chapter 74: Minimally Invasive Surgery\r | 511 | ||
| 1. What are the origins of modern laparoscopic surgery?\r | 511 | ||
| 2. What are some currently practiced laparoscopic, thoracoscopic, or endoscopic procedures?\r | 511 | ||
| 3. Are there any contraindications for laparoscopic procedures?\r | 511 | ||
| 4. What are the benefits of laparoscopy when compared with open procedures?\r | 512 | ||
| 5. Why has carbon dioxide become the insufflation gas of choice during laparoscopy?\r | 512 | ||
| 6. How does carbon dioxide insufflation affect PaCO2?\r | 513 | ||
| 7. How does patient positioning affect hemodynamics and pulmonary function during laparoscopy?\r | 513 | ||
| 8. What is considered a safe increase in intra-abdominal pressure?\r | 513 | ||
| 9. Describe pulmonary changes associated with pneumoperitoneum.\r | 514 | ||
| 10. What effect does the intra-abdominal pressure increase have on perfusion of intra-abdominal organs?\r | 514 | ||
| 11. What are the neurohumoral responses associated with laparoscopy?\r | 515 | ||
| 12. Should nitrous oxide be used as an anesthetic adjuvant during laparoscopy?\r | 515 | ||
| 13. What anesthetic techniques can be used for minimally invasive surgery?\r | 515 | ||
| 14. Can laparoscopy be performed on children or pregnant women?\r | 516 | ||
| 15. What complications are associated with laparoscopic surgery and carbon dioxide pneumoperitoneum?\r | 516 | ||
| Suggested Readings\r | 517 | ||
| Chapter 75: Laser Surgery and Operating Room Fires\r | 518 | ||
| 1. What is a laser? | 518 | ||
| 2. What makes lasers behave differently from each other? | 518 | ||
| 3. What are the hazards of lasers? | 519 | ||
| 4. What are some unique airway considerations for the patient having laser surgery of the airway? | 519 | ||
| 5. Describe ventilation techniques commonly encountered during airway laser surgery | 519 | ||
| 6. What are the three essential components necessary to create an operating room fire? | 520 | ||
| 7. What are high-risk procedures for operating room fires? | 520 | ||
| 8. What strategies can reduce the incidence of airway fires? | 520 | ||
| 9. What are signs that a fire has occurred? | 520 | ||
| 10. Should an airway fire occur, what are the recommended practices for its management? | 520 | ||
| 11. Are there additional recommendations for a fire not involving the airway? | 521 | ||
| Suggested Readings\r | 521 | ||
| Chapter 76: Electroconvulsive Therapy\r | 522 | ||
| 1. What are the major indications for electroconvulsive therapy treatment? | 522 | ||
| 2. What are the downsides of antidepressant medication? | 522 | ||
| 3. What are the proposed mechanisms by which electroconvulsive therapy is effective? | 522 | ||
| 4. Has electroconvulsive therapy always been considered a good treatment for depression? | 522 | ||
| 5. How safe is electroconvulsive therapy? | 522 | ||
| 6. What is the physiologic response to electroconvulsive therapy? | 522 | ||
| 7. What patients are at increased risk for complications after electroconvulsive therapy? | 523 | ||
| 8. What type of preoperative evaluation is necessary before electroconvulsive therapy treatment? | 523 | ||
| 9. Describe the technique of electroconvulsive therapy, including appropriate monitors and medications. | 523 | ||
| 10. What additional medications are used to address hypertension and tachycardia? | 524 | ||
| 11. What is an optimal seizure duration? | 524 | ||
| 12. What can be done to prolong a seizure of inadequate duration or terminate a prolonged seizure? | 525 | ||
| 13. How many electroconvulsive therapy treatments are usually necessary? | 525 | ||
| 14. What are some of the adverse effects of electroconvulsive therapy? | 525 | ||
| 15. Is electroconvulsive therapy curative? | 525 | ||
| Suggested Readings\r | 526 | ||
| Section X: Pain Management\r | 527 | ||
| Chapter 77: Acute Pain Management\r | 527 | ||
| 1. Define acute pain.\r | 527 | ||
| 2. Why has acute pain been undertreated?\r | 527 | ||
| 3. How is pain assessed?\r | 527 | ||
| 4. What medications are useful in treating acute pain?\r | 528 | ||
| 5. Do all types of pain respond equally to medication containing opioids?\r | 529 | ||
| 6. What is the risk of addiction with opioids?\r | 529 | ||
| 7. How should opioids be given? Are some opioids better than others?\r | 529 | ||
| 8. When treating acute pain in a chronic pain patient, how should the approach differ?\r | 530 | ||
| 9. How should a patient-controlled analgesia pump be set?\r | 530 | ||
| 10. What are common side effects of opioids? How are they treated?\r | 531 | ||
| 11. How do neuraxial opioids work?\r | 531 | ||
| 12. How do agonist-antagonists differ from opioids such as morphine?\r | 531 | ||
| 13. How should patients with continuous infusions for analgesia or patient-controlled analgesia pumps be monitored?\r | 532 | ||
| 14. How is an oral agent chosen for a patient who previously received intravenous opioids?\r | 532 | ||
| 15. Which nonsteroidal antiinflammatory drug should be used?\r | 533 | ||
| 16. Are cyclooxygenase-2 agents any better for pain than cyclooxygenase-1 agents?\r | 533 | ||
| 17. What other techniques can be used for acute pain management?\r | 533 | ||
| 18. How does good acute pain management make a difference?\r | 533 | ||
| Suggested Readings\r | 534 | ||
| Chapter 78: Chronic Pain Management\r | 535 | ||
| 1. What is the definition of pain?\r | 535 | ||
| 2. How does normal pain perception occur?\r | 535 | ||
| 3. What is the classification of pain based on neurophysiologic mechanisms?\r | 535 | ||
| 4. Name the most commonly used groups of medications for the treatment of chronic pain.\r | 535 | ||
| 5. How are nerve blocks helpful in the treatment of chronic pain?\r | 537 | ||
| 6. Are psychosocial factors important in the diagnosis and treatment of pain?\r | 537 | ||
| 7. How is pain of malignant origin treated?\r | 537 | ||
| 8. Define CRPS I and II. What nerve blocks are commonly used to treat these conditions?\r | 537 | ||
| 9. How is neuropathic pain treated?\r | 537 | ||
| 10. Define myofascial pain syndrome.\r | 538 | ||
| 11. Define fibromyalgia.\r | 538 | ||
| 12. How is fibromyalgia managed?\r | 538 | ||
| 13. List possible etiologies of low back pain.\r | 538 | ||
| 14. What is the rationale behind the use of epidural steroids in the treatment of radicular symptoms associated with a herniated disk?\r | 538 | ||
| 15. Explain the gate theory of pain.\r | 539 | ||
| 16. Name some indications for the use of spinal cord stimulators.\r | 539 | ||
| 17. What are the most common medications used for intrathecal delivery via implantable delivery systems?\r | 539 | ||
| Suggested Readings\r | 540 | ||
| Index\r | 541 |