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Faust's Anesthesiology Review E-Book

Faust's Anesthesiology Review E-Book

Michael J. Murray | Steven H. Rose | Denise J. Wedel | C. Thomas Wass | Barry A Harrison | Jeff T Mueller | Terence L Trentman

(2014)

Additional Information

Book Details

Abstract

Quickly expand your knowledge base and master your residency with Faust's Anesthesiology Review, the world’s best-selling review book in anesthesiology. Combining comprehensive coverage with an easy-to-use format, this newly updated medical reference book is designed to efficiently equip you with the latest advances, procedures, guidelines, and protocols. It’s the perfect refresher on every major aspect of anesthesia.

  • Take advantage of concise coverage of a broad variety of timely topics in anesthesia.
  • Focus your study time on the most important topics, including anesthetic management for cardiopulmonary bypass, off-pump coronary bypass, and automatic internal cardiac defibrillator procedures; arrhythmias; anesthesia for magnetic resonance imaging; occupational transmission of blood-borne pathogens; preoperative evaluation of the patient with cardiac disease; and much more.
  • Search the entire contents online at Expert Consult.com.

Table of Contents

Section Title Page Action Price
Front cover Cover
Inside front cover IFC
Front matter i
Faust’s anesthesiology review i
Copyright iv
Dedication v
Contributors vii
Preface xv
Table of contents xvii
I Operating room 1
1 Medical gas supply 1
Suggested readings 2
2 Electrical supply 3
Electrical safety in the operating room 3
Power systems 3
Grounded power systems 3
Isolated power systems 3
Line isolation monitors 3
Electrical requirements in the operating room 4
Suggested readings 4
Suggested readings 5
Prevention 6
Preparation 6
Management of an operating room fire 6
Suggested readings 6
5 Operating room management 8
Operating room governance 8
Operating room efficiency 8
Operating room utilization 8
Cost management 9
Conclusion 9
Suggested readings 9
II Equipment 11
6 Vaporizers 11
Concentration-calibrated vaporizers 11
Vaporization methods 12
Flow over 12
Bubble through 12
Injection 12
Temperature compensation 12
Thermostatic compensation 12
Computer controlled 12
Supplied heat 12
Suggested readings 12
Physical principles 13
Pressure change across the constriction 13
Physical properties of the gas 13
Effects of temperature and pressure 13
Types of indicators 13
Arrangement of flowmeters 14
Problems 14
Inaccuracy 14
Back pressure 14
Improper alignment 14
Improper sequence 14
Static electricity 14
Hidden floats 14
Erratic movement of the float 15
Suggested readings 15
Benefits 16
Degradation of inhaled anesthetic agents 16
Thermal injuries and CO production 16
New absorbents 16
Suggested readings 16
9 Carbon dioxide retention and capnography 17
CO2 retention 17
Capnography 17
Terminology 17
Sidestream versus mainstream sampling 17
CO2 measurement methods 18
Capnograms 18
Suggested readings 19
10 Tracheal tubes 20
Supraglottic airways 22
Facemasks 23
Pharyngeal airways 23
Suggested readings 24
Esophageal intubation 25
Bronchial intubation 25
Tracheal or bronchial rupture 25
Complications that occur with the tracheal tube in place 25
Excessive leak or resistance 25
Obstruction 25
Migration 25
Mucosal ulceration or necrosis 25
Ignition 25
Dehydration/hypothermia 25
Nasal alar necrosis 25
Sinusitis 25
III Monitoring 31
14 Pulse oximetry 31
Technology 31
Accuracy 31
Response time 31
Low-amplitude states 31
Dyshemoglobins 32
Dyes and pigments 32
Ambient light 32
Skin pigment 32
Electrocautery 32
Motion artifact 32
Fingernail polish 32
Other useful data 32
Complications of pulse oximetry 32
Suggested readings 32
15 The pulmonary artery catheter 33
Indications for the use of pulmonary artery catheter 33
Insertion and complications of pulmonary artery catheter 33
Data and interpretation 33
The cardiac output 33
The pulmonary artery occlusion pressure 34
The mixed venous oxygen saturation 34
Right ventricular function 34
The pulmonary artery catheter controversy 34
Suggested readings 34
16 The arterial waveform 35
Equipment and cannulation 35
Waveform interpretation 35
Dynamic indexes of fluid responsiveness 35
Cardiac output derived from the arterial pressure waveform 36
Suggested readings 36
17 Intermittent noninvasive blood pressure monitoring 37
Methods of obtaining blood pressure 37
Palpation 37
Auscultation 37
Doppler 37
Finger plethysmography 37
Tonometry 37
Oscillometry 37
Equipment for oscillometric blood pressure monitoring 37
Oscillometry operation and function 37
Factors affecting the accuracy of oscillometric blood pressure monitoring 38
Relationship between the size of the cuff and the size of the arm  38
Site of monitoring  38
Arm positioning  38
Arrhythmias  38
Potential adverse events during oscillometric blood pressure monitoring 38
Suggested readings 38
Incidence of intraoperative awareness 39
Risk factors for intraoperative awareness 39
Prevention of awareness 39
Brain-function monitoring 39
Summary 40
Suggested readings 40
19 Monitoring integrity of the neuromuscular junction 41
Neuromuscular transmissions 41
Clinical indicators of neuromuscular blockade 41
Neuromuscular monitoring 41
Nerve stimulators 41
Sites for monitoring 41
Modes of stimulation 42
Single twitch 42
Train of four 42
Tetanus 43
Posttetanic facilitation 43
Double-burst stimulation 43
Techniques to monitor muscular response 43
Electromyography 43
Mechanomyography 43
Acceleromyography 43
Phonomyography 43
Suggested readings 43
20 Evoked potential monitoring 44
The evoked potential waveform 44
Brainstem auditory evoked responses 44
Somatosensory evoked potentials 45
Motor evoked potentials 45
Visual evoked potentials 46
Intraoperative changes in evoked potential signals 46
Suggested readings 46
IV Physiology 47
21 Oxygen transport 47
The oxyhemoglobin dissociation curve 47
Suggested readings 48
CO2 dissociation curve 49
Suggested readings 49
23 Interpretation of arterial blood gases 50
Acid-base disturbances 50
Ventilation 50
Oxygenation 50
Case examples 51
Acute respiratory acidosis—buffering 51
V Anatomy 117
51 Anatomy of the larynx 117
Description 117
Laryngeal skeleton 117
Joints, ligaments, and membranes of the larynx 117
Interior of the larynx 117
Innervation 118
Muscles 118
Blood supply 118
Considerations with the infant larynx 118
Suggested readings 118
52 Coronary circulation and the myocardial conduction system 119
Coronary circulation 119
Myocardial conduction system 119
Suggested readings 122
Standard views 123
Thoracic aorta 124
Suggested readings 124
Clinical perioperative applications 125
Assessment of left ventricular and right ventricular function 125
Detection of myocardial ischemia 126
Preload assessment 126
Cardiac operations 126
Thoracic aortic surgery 126
Atherosclerotic disease of the aorta 126
Transplant surgery 126
Neurosurgery 126
Use in the emergency department and intensive care unit 127
Suggested readings 127
Clinical considerations 128
Suggested readings 128
56 Anatomy of the posterior fossa 129
Boundaries 129
Structures 129
Veins 129
Arteries 129
Suggested readings 132
57 Spinal cord anatomy and blood supply 133
Anatomy 133
Ligaments 133
Epidural space 133
Meninges 133
Blood supply 134
Suggested readings 134
58 Brachial plexus anatomy 135
Simplifying brachial plexus anatomy 135
Non-neural brachial plexus anatomy 136
Suggested readings 136
Reducing the morbidity and mortality rates associated with central venous cannulation 137
Suggested readings 137
VI Pharmacology 139
60 Molecular and cellular mechanisms of anesthesia 139
Lipid-based hypotheses 139
Protein-based hypotheses 139
Cellular effects 140
Central nervous system effects 141
Suggested readings 141
Cardiac output 142
Ventilation 142
Second-gas effect 142
Suggested readings 143
62 Minimum alveolar concentration 144
Important concepts related to minimum alveolar concentration 144
Alveolar concentration 144
Steady state 144
Ambient pressure 144
Stimulus 144
Response 144
Determination of minimum alveolar concentration 144
Dose-response relationship 145
Factors affecting minimum alveolar concentration 145
Anesthetic requirement to blunt responses to various stimuli 145
Clinical relevance 146
Suggested readings 146
Left-to-right shunt 147
Mixed shunt (right-to-left and left-to-right) 147
Suggested readings 147
64 Inhalation anesthetic agents 148
Pharmacokinetics 148
Uptake 148
Excretion 148
Distribution 148
Minimum alveolar concentration 148
Blood-gas partition coefficient 148
Concentration effect and second-gas effect 149
Shunts 149
Alveolar—mixed venous partial pressure difference 149
The effect of co on uptake and emergence 150
Suggested readings 150
Hematologic and immune toxicity 151
Occupational exposure 151
Neurologic toxicity 151
Myocardial effects 151
N2O and closed air spaces 151
Compliant spaces increase volume 151
Noncompliant spaces increase pressure 151
Examples 151
Bowel gas and bowel obstruction 151
Pneumothorax and communicating blebs 151
Venous air emboli 151
Balloon-tipped catheters 151
Tracheal tube cuffs 152
Middle ear 152
Intraocular pressure 152
Dural closure 152
Suggested readings 152
Sensitivity to epinephrine 153
Coronary vasodilation 154
Anesthetic effect on diastolic dysfunction 154
Right ventricular function 154
Suggested readings 154
Nitrous oxide 155
Cerebral metabolic rate and cerebral blood flow 155
Electroencephalogram 155
Evoked potentials 155
Pneumocephalus 155
Isoflurane 156
VII Colloids and blood products 229
100 Albumin, hetastarch, and pentastarch 229
The colloid controversy 229
Albumin 229
Hetastarch and pentastarch 229
Pharmacokinetics and pharmacodynamics of hetastarch and pentastarch 229
Adverse effects of hetastarch and pentastarch 230
Clinical usefulness of colloids 230
Contraindications to the use of colloid solutions 230
Acknowledgment 230
Suggested readings 230
Screen 231
Crossmatch 231
Incompatibility risk and emergency transfusion 231
Suggested readings 231
102 Red blood cell and platelet transfusion 232
Red blood cells 232
Collection, storage, and administration 232
Autologous blood transfusion and directed transfusion 232
Synthetic hemoglobins 232
Red blood cell transfusion 232
Indications for transfusion of red blood cells 232
Platelet transfusions 233
Platelet preparation and storage 233
Platelet matching 233
Indications for platelet transfusion 233
Risks of platelet transfusion 233
Platelet alloimmunization and platelet refractoriness 233
Other risks of platelet transfusion 234
Suggested readings 234
Postoperative complications 235
Treatment of coagulopathy 236
Suggested readings 236
Pathophysiology 237
Signs and symptoms 237
Complications 237
Prevention 238
Treatment 238
Suggested readings 238
105 Nonhemolytic transfusion reactions 239
Febrile reactions 239
Mild allergic reactions 239
Anaphylactic reactions 239
Transfusion-related acute lung injury 239
Immunomodulation 240
Suggested readings 240
VIII Preoperative and postoperative issues 241
106 Preoperative evaluation of the patient with cardiac disease for noncardiac operations 241
Defining comorbid conditions 241
Assessing surgical risk 241
Evaluating functional status 242
Applying the revised american college of cardiology/american heart association guidelines 242
Perioperative β-adrenergic receptor blockade 242
Patients with prior percutaneous coronary interventions 243
Patients with cardiac-rhythm management devices 244
Suggested readings 244
Cardiovascular outcomes 245
Respiratory outcomes 245
Wound-healing and bone-healing outcomes 245
Surgery represents an excellent opportunity for smoking cessation 245
Helping patients quit smoking 245
Summary 246
Suggested readings 246
Obstructive sleep apnea, obesity, cardiovascular risk, and metabolic syndrome 248
Anesthetic management of patients with obstructive sleep apnea 248
Summary 251
Suggested readings 251
109 Postoperative nausea and vomiting 252
Physiology 252
Risk factors 252
Treatment 252
Conclusion 253
Suggested readings 253
110 Anesthesia for drug abusers 254
Suggested readings 254
111 Acute and chronic alcoholism and anesthesia 258
Metabolism 258
Acute central nervous system effects 258
Chronic alcoholism 258
Anesthetic management of patients with alcohol use disorders 258
Delirium tremens 259
Alcoholic abstinence 259
Disulfiram 259
Acamprosate 259
Naltrexone 259
Suggested readings 260
Risk factors for latex allergy 261
Treatment of latex allergy 261
Prevention of latex allergy 261
Suggested readings 261
113 The evaluation and management of prolonged emergence from anesthesia 262
Pharmacologic causes of delayed emergence 262
Anesthetic agents 262
Neuromuscular blockade 263
Pharmacokinetic and pharmacodynamic factors 263
Metabolic disturbances of delayed emergence 263
Acid-base disorders 263
Endocrine disorders 263
Electrolyte abnormalities 263
Neurologic causes of delayed emergence 263
Suggested readings 264
Diagnosis 265
Prevention 265
Treatment 265
Outcomes and long-term consequences 266
Suggested readings 266
IX Specialty anesthesia 267
A Regional anesthesia 267
115 Local anesthetic agents: Mechanism of action 267
Anatomy of A nerve cell 267
Nerve cell membrane and depolarization 267
Structure of local anesthetic agents 267
Action of local anesthetic agents 267
Suggested readings 267
116 Local anesthetic agents: Pharmacology 269
Physiochemical properties 269
Physiologic disposition 269
Esters 270
Amides 270
Clinical use of local anesthetic agents 271
Esters 271
Benzocaine 271
Procaine 271
Chloroprocaine 271
Tetracaine 271
Amides 271
Prilocaine 271
Lidocaine 271
Mepivacaine 271
Etidocaine 271
Bupivacaine 271
Pure isomeric agents 271
Levobupivacaine  271
Ropivacaine  271
Suggested readings 271
117 Toxicity of local anesthetic agents 272
Factors influencing blood levels of local anesthetic agents 272
Site of injection 272
Choice of local anesthetic agent 272
Dose of local anesthetic agent 272
Coadministration of vasoconstrictors 272
Metabolism 272
Systemic toxicity 272
Central nervous system toxicity 272
Cardiovascular system toxicity 273
Allergy to local anesthetic agents 273
Neural toxicity 273
Methemoglobinemia 273
Diagnosis, prevention, and treatment of toxic reactions 273
Cauda equina syndrome 273
Transient neurologic symptoms 273
Special populations 273
Liposuction 273
Suggested readings 273
118 Preservatives in local anesthetic solutions 274
Sulfites 274
Disodium ethylenediaminetetraacetate 274
Parabens 274
Substitution of preservative-containing solutions for preservative-free solutions 274
Suggested readings 274
119 Cocaine pharmacology 275
Pharmacology 275
Actions 275
Local anesthetic actions 275
Sympathomimetic actions 275
Central nervous system actions 275
Cardiovascular actions 275
Anesthetic uses and considerations 275
Management of toxic side effects 276
Suggested readings 276
Acetaminophen 277
Steroids 277
Regional anesthesia 277
α2-receptor agonists 277
Ketamine 277
Opioids 277
α2δ ligands 277
Suggested readings 277
121 Needle blocks of the eye 278
Anatomy 278
Terminology 278
Local anesthetic agents 278
Types of eye blocks 278
Intraconal block 278
Extraconal block 278
Sub-tenon block 278
Contraindications 278
Complications 278
Retrobulbar hemorrhage 278
Oculocardiac reflex 280
Diplopia 280
Central retinal artery occlusion 280
Puncture of posterior globe 280
Penetration of the optic nerve 280
Inadvertent brainstem anesthesia 280
Epinephrine toxicity 281
Suggested readings 281
Other factors affecting the level of blockade 282
Spinal anesthetic agents 282
Cardiovascular effects 282
Pulmonary effects 282
Gastrointestinal effects 282
Genitourinary effects 282
Cerebral blood flow 282
Contraindications to spinal anesthesia 282
Suggested readings 283
Selection and dose of local anesthetic agent 284
Complications 285
Suggested readings 286
Advantages 287
Disadvantages 287
Equipment and technique 287
Epidural test doses 287
Complications 288
Suggested readings 288
Low-molecular-weight heparin 289
Oral anticoagulants 290
Antiplatelet medications 290
Conclusion 290
Suggested readings 291
Anatomic technique 292
Position 292
Landmarks 292
Block performance 292
Nerve stimulation technique 292
Ultrasound guidance 293
Choice of local anesthetic agent 293
Complications 293
Suggested readings 293
Technique 294
Side effects and complications 295
Supraclavicular block 295
Technique 295
Side effects and complications 296
Axillary block 296
Technique 296
Side effects and complications 297
Suggested readings 297
128 Lower extremity block: Psoas compartment block 298
Clinical applications 298
Relevant anatomy 298
Technique 298
Patient position 298
Needle insertion site 298
Needle redirection cues 299
Ultrasound-guided posterior lumbar plexus block 299
Side effects and complications 299
Suggested readings 299
Clinical applications 301
Technique 301
X Pain medicine 495
210 Preemptive analgesia and postoperative pain: The transition from an acute to a chronic state 495
Persistent pain states 495
Underlying mechanisms 495
Prevention of the facilitated state 496
Role of regional anesthesia 497
Acknowledgment 497
Suggested readings 497
Choice of opioids 499
Initial setup 499
Adverse effects and outcomes 499
Conclusion 500
Suggested readings 500
Suggested readings 501
213 Complex regional pain syndrome 502
Terminology 502
Etiology 502
Diagnosis 502
Treatment 502
Occupational therapy 502
Psychiatric therapy 503
Pharmacologic therapy 503
Procedural techniques 503
Suggested readings 503
214 Postoperative headache 504
Postdural puncture headache 504
Prevention 504
Treatment 504
Other postoperative headaches 504
Suggested readings 505
Interventional therapy 506
Neuraxially administered analgesia 507
Nerve blocks and ablative procedures 507
Surgical procedures 507
Other approaches 507
Suggested readings 508
216 Postherpetic neuralgia 509
Description of the syndrome 509
Pathophysiology 509
Treatment 509
Pharmacotherapy 509
Nerve blocks 510
Surgical procedures 510
Suggested readings 510
Site of injection 511
Technique 511
Medications used 511
Contraindications and adverse effects 511
Conclusion 511
Suggested readings 511
Suggested readings 513
219 Lumbar sympathetic blockade 514
Relevant anatomy 514
Indications 514
Technique 514
Brown single-needle technique 514
Lateral approach first described by reid 514
Mandl technique 515
Adverse events 516
Suggested readings 516
Expected side effects 518
Adverse effects 518
Suggested readings 518
Outcome studies 519
Complications 520
Future directions 520
Suggested readings 520
XI Critical care medicine 523
222 Advanced cardiac life support 521
Suggested readings 523
Mode of mechanical ventilation 524
Volume control mechanical ventilation 524
Pressure control mechanical ventilation 524
Intraoperative mechanical ventilation: Which mode should we use? 525
Transpulmonary pressure in volume or pressure control mechanical ventilation 525
Inspiratory time, respiratory rate, and i:e ratio 525
Exhalation 525
Clinical application of intraoperative mechanical ventilation 526
Mechanical ventilation in patients with airway obstruction 526
Mechanical ventilation in patients with decreased respiratory compliance 527
Intraoperative mechanical ventilation and acute lung injury 527
Summary 528
Suggested readings 528
Central nervous system effects 529
Cardiovascular effects 529
Effects on air-containing cavities 529
Effects on blood sugar 530
Anesthetic management in an HBOT chamber 530
Suggested readings 530
225 Nutrition support in the hospitalized patient 531
Feeding the critically ill: The when and how 531
Nutrition goals 531
Protein 531
Branched-chain amino acids 531
Arginine 532
Glutamine 532
Carbohydrate 532
Lipids 532
Specific critical illness 532
Conclusions 532
Suggested readings 532
226 Perioperative management of blood glucose 533
Preoperative management of glycemic control 533
Intraoperative management of glycemic control 534
Postoperative management of glycemic control 534
Blood glucose measurement 534
Treatment protocols 534
Summary 535
Suggested readings 535
Treatment 536
Diuresis 536
Recruitment maneuvers 536
Permissive hypercapnia 537
Tracheal gas insufflation 537
Inhaled nitric oxide and prostaglandin E1 538
Prone positioning 539
High-frequency oscillatory ventilation 539
Extracorporeal membrane oxygenation 539
Other therapeutic interventions 539
Mortality and morbidity 539
Suggested readings 539
Treatment 541
Pharmacologic treatment 541
Anesthetic management of the patient with pulmonary arterial hypertension 541
Preoperative evaluation 541
Intraoperative management 541
Postoperative management 542
Conclusion 542
Suggested readings 542
Anesthetic management 543
Preoperative evaluation 543
Intraoperative monitoring 543
Postoperative management 543
Suggested readings 543
230 Carbon monoxide poisoning 544
Pathophysiology 544
Signs and symptoms 544
Treatment 544
Carbon monoxide production from CO2 absorbers 544
Suggested readings 544
231 Acute renal failure 545
Incidence and signs and symptoms 545
Risk factors 545
Laboratory analysis 545
Causes and treatment 545
Prerenal acute renal failure 545
Intrinsic renal failure 545
Postrenal azotemia 545
Management 545
Complications 546
Suggested readings 546
Initial resuscitation 547
Diagnosis 548
Antibiotic therapy and source control 548
Vasopressors and inotropes 548
Corticosteroids 550
Recombinant human activated protein C 550
Supportive therapy 550
Suggested readings 550
233 Anesthesia for burn-injured patients 551
Acute injury 551
General burn care 551
Excision and grafting 551
Preoperative evaluation of the patient with burns 551
Airway 551
Pulmonary care 552
Circulation 552
Neurologic care 552
Vascular access 552
Nutrition 552
Parenteral infusions 552
Care in the operating room 552
Setup 552
Patient care 552
Postoperative care 552
Care outside of the operating room 553
Electrical injuries 553
Nonthermal skin diseases 553
Conclusion 553
Suggested readings 553
234 Perioperative corticosteroids 554
The role of corticosteroids in attenuating stress response 554
Treatment of adrenal suppression 555
Treatment of airway edema 555
Timing of administration of the dose of corticosteroids 555
Treatment of postoperative nausea and vomiting 555
The use of corticosteroids for antiinflammatory properties 555
Adverse effects associated with the use of corticosteroids 556
Suggested readings 557
XII Risk management 559
235 Medical ethics 559
Principles of medical ethics 559
Autonomy 559
Beneficence 559
Nonmaleficence 559
Justice 559
A method of resolving an ethical dilemma 559
Ethical dilemmas encountered in anesthesia practice 559
Suggested readings 560
The informed-consent process 561
Obtaining informed consent when treating the incompetent or minor patient 561
Obtaining informed consent in emergent circumstances 561
Suggested reading 561
237 Medicolegal principles: Medical negligence 562
Elements of malpractice actions 562
Types of claims against anesthesia personnel 562
Lack of informed consent 562
The process 562
Managing legal risk 562
Acknowledgment 563
Suggested readings 563
Trends in injury 564
Respiratory monitoring 564
Difficult intubation 564
Obstetric anesthesia 564
Lessons learned from the ASA closed claims project 565
Suggested readings 565
Medication errors, assessment, and prevention 566
Programs to improve outcome 566
Disclosure of errors to patients 566
Suggested readings 566
240 Management of the difficult airway 567
Preoperative evaluation 567
Tongue versus pharyngeal size 567
Atlanto-occipital extension 567
Anterior mandibular space 567
Defining the difficult airway 567
Management of the difficult airway 567
Suggested readings 568
241 Perioperative pulmonary aspiration 570
Importance of pulmonary aspiration 570
Pulmonary aspiration in children 570
Use of medications and preoperative fasting 570
Occurrence of aspiration in the perioperative period 570
Management of perioperative pulmonary aspiration 571
Conclusion 571
Suggested readings 571
242 Eye and dental complications 572
Eye injury 572
Corneal injury 572
Postoperative visual loss 572
Reducing the risk of postoperative visual loss 573
Blood pressure management  573
Management of intraoperative fluids  573
Management of anemia  573
Use of vasopressors  573
Patient positioning  573
Recognizing and treating postoperative visual loss 573
Dental injury 573
Etiology 573
Patient factors 573
Anesthetic factors 573
Prevention 573
Treatment and management of dental injury 574
Suggested readings 574
243 Intraoperative patient positioning 575
Commonly used positions 575
Complications resulting from incorrect positioning 575
Problems related to the trendelenburg position 576
Problems related to the sitting position 576
Problems related to head positioning 576
Correct positioning 577
Upper extremity positioning 577
Lower extremity positioning 577
Suggested readings 577
Timing of symptoms 578
Impact of elbow flexion 578
Anatomy and elbow flexion 578
Forearm supination and ulnar neuropathy 578
Outcomes of ulnar neuropathy 578
Brachial plexopathies 578
Brachial plexus entrapment 578
Prone positioning 578
Anatomy of shoulder abduction 578
Inflammatory plexopathy 579
Lower-extremity neuropathies 579
Impact of hip abduction on the obturator nerve 579
Impact of hip flexion on the lateral femoral cutaneous nerve 579
Practical considerations for perioperative peripheral neuropathies 580
Prevention 580
Follow-up care 580
Unique positioning problems with catastrophic results 580
Spinal cord ischemia 580
Thoracic outlet obstruction 580
Steep trendelenburg position 580
Postoperative visual loss 580
Suggested readings 581
Clinical presentation 582
Mechanism 582
Treatment of malignant hyperthermia crisis 582
Anesthesia for patients with malignant hyperthermia susceptibility 582
Evaluation of the patient with malignant hyperthermia susceptibility 583
Source for further assistance 583
Suggested readings 583
246 Anaphylactic and anaphylactoid reactions 584
Pathophysiology 584
Clinical presentation 584
Diagnosis 584
Substances commonly implicated in anaphylactic and anaphylactoid reactions 585
Neuromuscular blocking agents 585
Latex 585
Antibiotics 585
Other substances 585
Treatment 585
Suggested readings 585
XIII Practice management 587
247 Licensure, credentialing, and privileging 587
How health care organizations credential and privilege providers 587
License renewal, reappointment, and continuation of clinical privileges 588
Delegated credentialing 588
Suggested readings 588
248 Board certification and maintenance of certification 589
Primary certification 589
Continuum of education in anesthesiology 589
Subspecialty certification 590
Maintenance of certification 590
Summary 590
Suggested readings 590
249 Principles of medical professional liability insurance 591
Scope of coverage—what is covered? 591
Exclusions—what is not covered? 591
Limits of liability—how much is covered? 591
Occurrence versus claims-made coverage 591
Consent-to-settle clauses 592
Suggested readings 592
250 Medicolegal principles: The anesthesia record 592
Suggested readings 593
251 Anesthesia information management systems 593
Architecture and configuration 593
Prevalence and utilization 593
Benefits 594
Summary 594
Suggested readings 594
252 Medical coding and payment systems 595
Medical diagnosis and procedure codes 595
CPT code development and valuation process 595
Anesthesia coding 596
Payment methodology illustrations—anesthesia 596
Illustration 1 596
Illustration 2 596
Payment methodology illustrations—resource-based relative value system 596
Illustration 3 597
Conclusion 597
Suggested readings 597
Suggested readings 598
254 Chemical dependency in anesthesia personnel 599
Recognizing impairment in a colleague 599
Intervention 599
Risk of relapse 600
Suggested readings 600
Index 601
A 601
B 603
C 604
D 606
E 607
F 608
G 609
H 609
I 610
J 611
K 611
L 611
M 612
N 614
O 615
P 616
Q 618
R 618
S 619
T 621
U 622
V 622
W 623
X 623
Z 623
Inside back cover IBC