Additional Information
Book Details
Abstract
Optimize perioperative outcomes with Kaplan’s Cardiac Anesthesia! Dr. Joel L. Kaplan and a host of other authorities help you make the best use of the latest techniques and navigate your toughest clinical challenges. Whether you are administering anesthesia to cardiac surgery patients or to cardiac patients undergoing non-cardiac surgery, you’ll have the guidance you need to avoid complications and ensure maximum patient safety.
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Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.
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Update your understanding of cardiovascular and coronary physiology, and the latest advances in molecular biology and inflammatory response mechanisms.
- Master the newest approaches to perioperative assessment and management, including state-of-the art diagnostic techniques.
- Tap into the latest knowledge about 2D and 3D transesophageal echocardiography, anesthesia delivery for minimally invasive/robotic cardiac surgery, assist devices and artificial hearts, cardiac pacing, cardiac resynchronization therapy, ablation techniques, and more.
- Access the complete contents online at Expert Consult, plus additional online-only features including an ECG atlas...videos that demonstrate 2-D and 3-D TEE techniques in real time...and an Annual Year End Highlight from the Journal of Cardiovascular Anesthesia that’s posted each February.
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Clearly visualize techniques with over 800 full-color illustrations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Kaplan’s Cardiac Anesthesia: The Echo Era | i | ||
| Copyright | ii | ||
| Dedication | iii | ||
| Contributors | iv | ||
| Foreword | x | ||
| Preface | xi | ||
| Contents | xiii | ||
| Section I: Preoperative Assessmentand Management | 1 | ||
| Chapter 1: Assessment of Cardiac Risk and the Cardiology Consultation | 2 | ||
| Sources of Perioperative Myocardial Injury in Cardiac Surgery | 2 | ||
| Assessment of Perioperative Myocardial Injury in Cardiac Surgery | 3 | ||
| Cardiac Risk Assessment and Cardiac Risk Stratification Models | 5 | ||
| Specific Risk Conditions | 12 | ||
| Cardiovascular Testing | 13 | ||
| Conclusions | 13 | ||
| References | 14 | ||
| Chapter 2: Cardiovascular Imaging | 16 | ||
| Basic Principles and Instrumentation | 16 | ||
| Evaluation of Cardiac Function | 17 | ||
| Evaluation of Myocardial Perfusion | 19 | ||
| Evaluation of Myocardial Metabolism | 22 | ||
| Valvular Heart Disease | 24 | ||
| Vascular Disease | 27 | ||
| Summary | 30 | ||
| References | 30 | ||
| Chapter 3: Cardiac Catheterization Laboratory: Diagnostic and Therapeutic Procedures in the Adult Patient | 33 | ||
| Catheterization Laboratory Facilities: Radiation Safety, Image Acquisition, And Physician Credentialing | 34 | ||
| Patient Selection for Catheterization | 36 | ||
| Cardiac Catheterization Procedure | 38 | ||
| Valvular Pathology | 43 | ||
| Angiography | 46 | ||
| Catheterization Report | 50 | ||
| Interventional Cardiology: Percutaneous Coronary Intervention | 51 | ||
| Specific Interventional Devices | 61 | ||
| Other Catheter-Based Percutaneous Therapies | 67 | ||
| Other Catheter-Based Intracardiac Procedures | 68 | ||
| The Catheterization Laboratory and the Anesthesiologist | 69 | ||
| References | 69 | ||
| Chapter 4: Cardiac Electrophysiology: Diagnosis and Treatment | 74 | ||
| Basic Electrophysiologic Principles | 75 | ||
| Specific Arrhythmias | 80 | ||
| Ventricular Arrhythmias | 91 | ||
| Implantable Cardioverter-Defibrillator | 92 | ||
| References | 93 | ||
| Chapter 5: Cardiac Physiology | 98 | ||
| Functional Implications Of Gross Anatomy | 98 | ||
| Cardiac Myocyte Anatomy And Function | 102 | ||
| Laplace’s Law | 105 | ||
| Cardiac Cycle | 105 | ||
| Pressure-Volume Diagrams | 107 | ||
| Determinants of Pump Performance | 111 | ||
| Coupling, Energetics, And Efficiency | 119 | ||
| Evaluation Of Diastolic Function | 120 | ||
| Pericardial Forces | 126 | ||
| Determinants of Atrial Function | 127 | ||
| References | 128 | ||
| Section II: Cardiovascular Physiology,Pharmacology, MolecularBiology, and Genetics | 97 | ||
| Chapter 6: Coronary Physiology and Atherosclerosis | 132 | ||
| Anatomy And Physiology Of Blood Vessels | 132 | ||
| Determinants Of Coronary Blood Flow | 137 | ||
| Coronary Pressure-Flow Relations | 141 | ||
| Atherosclerosis | 144 | ||
| Pathophysiology of Coronary Blood Flow | 147 | ||
| Future Directions | 152 | ||
| References | 153 | ||
| Chapter 7: Molecular and Genetic Cardiovascular Medicine | 157 | ||
| The Machinery Behind the Cardiac Rhythm: Ion Channels | 158 | ||
| Controlling Cardiac Functioning: Receptors | 165 | ||
| Anesthetic Actions | 169 | ||
| Acknowledgments | 176 | ||
| References | 176 | ||
| Chapter 8: Systemic Inflammation | 178 | ||
| Terminology | 178 | ||
| Systemic Inflammation and Cardiac Surgery | 179 | ||
| Endotoxemia | 182 | ||
| Splanchnic Perfusion | 184 | ||
| Postoperative Complications Attributable to Inflammation | 185 | ||
| References | 189 | ||
| Chapter 9: Pharmacology of Anesthetic Drugs | 193 | ||
| Volatile Agents | 194 | ||
| Intravenous Induction Agents | 201 | ||
| Individual Agents | 208 | ||
| Opioids In Cardiac Anesthesia | 215 | ||
| Effects Of Cardiopulmonary Bypass On Pharmacokinetics And Pharmacodynamics | 224 | ||
| Acknowledgments | 228 | ||
| References | 228 | ||
| Chapter 10: Cardiovascular Pharmacology | 235 | ||
| Anti-Ischemic Drug Therapy | 235 | ||
| Pharmacotherapy for Acute and Chronic Heart Failure | 257 | ||
| Pharmacotherapy for Cardiac Arrhythmias | 274 | ||
| References | 286 | ||
| Section III: Monitoring | 297 | ||
| Chapter 11: Evolution of Perioperative Echocardiography | 298 | ||
| Early Developments Leading To The Medical Use Of Ultrasound | 298 | ||
| Early Medical Use of Ultrasound | 298 | ||
| Early History of Clinical Echocardiography | 299 | ||
| Transesophageal Echocardiography | 302 | ||
| Other Developments | 306 | ||
| Recent Developments | 307 | ||
| Organizations, Training, Guidelines, And Examinations | 310 | ||
| A Cautionary Note | 311 | ||
| Acknowledgments | 312 | ||
| References | 312 | ||
| Chapter 12: Intraoperative Transesophageal Echocardiography | 315 | ||
| Basic Concepts | 316 | ||
| Imaging Techniques | 317 | ||
| Echocardiographic Scanners | 326 | ||
| Equipment | 331 | ||
| Complications | 332 | ||
| Credentialing | 333 | ||
| Training/Quality Assurance | 333 | ||
| Practice Parameters | 333 | ||
| Technique of Probe Passage | 333 | ||
| Anatomy and Tee Views | 334 | ||
| Clinical Applications | 347 | ||
| Future Technologies | 378 | ||
| References | 378 | ||
| Chapter 13: Decision Making and Perioperative Transesophageal Echocardiography | 383 | ||
| Case Study: Stenosis Without Stenosis | 385 | ||
| Case Study: The Regurgitant Carpenter | 386 | ||
| Intraoperative Transesophageal Echocardiography: Indications | 386 | ||
| Intraoperative Transesophageal Echocardiography: Performance of the Intraoperative Examination | 387 | ||
| Case Study: “What Incision Do I Need to Make? Hurry Please, the Patient is Dying!” | 410 | ||
| References | 413 | ||
| Chapter 14: Monitoring of the Heart and Vascular System | 416 | ||
| Hemodynamic Monitoring | 416 | ||
| Arterial Pressure Monitoring | 416 | ||
| Central Venous Pressure Monitoring | 424 | ||
| Pulmonary Arterial Pressure Monitoring | 431 | ||
| Special-Purpose Pulmonary Artery Catheters | 437 | ||
| Cardiac Output Monitoring | 438 | ||
| Alternative Techniques For Assessing Cardiac Output | 440 | ||
| Left Atrial Pressure Monitoring | 442 | ||
| Analysis And Interpretation Of Hemodynamic Data | 443 | ||
| Pulse Oximetry | 444 | ||
| Oxygen Transport Calculations | 445 | ||
| Summary | 445 | ||
| References | 445 | ||
| Chapter 15: Electrocardiographic Monitoring | 452 | ||
| Historical Perspective | 452 | ||
| Basic Electrophysiology And Electrical Anatomy Of The Heart | 452 | ||
| Technical Aspects of the Electrocardiogram | 454 | ||
| Electrocardiographic Changes With Myocardial Ischemia | 460 | ||
| Electrocardiographic Changes With Medications, Electrolytes, And Pacemakers | 464 | ||
| References | 464 | ||
| Chapter 16: Central Nervous System Monitoring | 466 | ||
| Electroencephalography | 466 | ||
| Auditory-Evoked Potentials | 475 | ||
| Transcranial Doppler Ultrasound | 480 | ||
| Jugular Bulb Oximetry | 484 | ||
| Cerebral Oximetry | 485 | ||
| Summary | 490 | ||
| Disclosure | 490 | ||
| Acknowledgment | 490 | ||
| References | 492 | ||
| Chapter 17: Coagulation Monitoring | 496 | ||
| Hemostasis | 496 | ||
| Monitoring Heparin Effect | 497 | ||
| Heparin Neutralization | 503 | ||
| Tests of Coagulation | 505 | ||
| Monitoring Fibrinolysis | 506 | ||
| Monitoring the Thrombin Inhibitors | 506 | ||
| Evaluation of a Prolonged Activated Partial Thromboplastin Time | 507 | ||
| Monitoring Platelet Function | 507 | ||
| Bedside Platelet Function Testing | 511 | ||
| Summary | 516 | ||
| References | 517 | ||
| Section IV: Anesthesia and Transesophageal Echocardiography for Cardiac Surgery | 521 | ||
| Chapter 18: Anesthesia for Myocardial Revascularization | 522 | ||
| Epidemiology | 522 | ||
| Pathophysiology Of Coronary Artery Disease | 522 | ||
| Risk Assessment in Patients Scheduled for Coronary Artery Bypass Grafting Surgery | 526 | ||
| Anesthesia For Coronary Artery Bypass Grafting | 530 | ||
| Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass | 553 | ||
| Minimally Invasive Coronary Artery Surgery | 558 | ||
| Conclusions | 559 | ||
| References | 561 | ||
| Chapter 19: Valvular Heart Disease | 570 | ||
| Pathophysiology | 571 | ||
| Aortic Stenosis | 574 | ||
| Hypertrophic Cardiomyopathy | 584 | ||
| Aortic Regurgitation | 589 | ||
| Mitral Regurgitation | 593 | ||
| Mitral Stenosis | 600 | ||
| Tricuspid Regurgitation | 603 | ||
| Innovations In Valve Repair | 604 | ||
| References | 609 | ||
| Chapter 20: Congenital Heart Disease in Adults | 615 | ||
| General Noncardiac Issues With Longstanding Congenital Heart Disease | 616 | ||
| Cardiac Issues | 619 | ||
| References | 634 | ||
| Chapter 21: Thoracic Aorta | 637 | ||
| Anatomy Of The Aorta | 637 | ||
| General Considerations For The Perioperative Care of Aortic Surgical Patients | 639 | ||
| Thoracic Aortic Aneurysm | 641 | ||
| Aortic Dissection | 657 | ||
| Penetrating Atherosclerotic Ulcer | 662 | ||
| Traumatic Aortic Injury | 662 | ||
| Aortic Atheromatous Disease | 662 | ||
| Takayasu Arteritis | 663 | ||
| Aortic Coarctation | 663 | ||
| Illustrative Transesophageal Echocardiography Cases | 664 | ||
| References | 672 | ||
| Chapter 22: Uncommon Cardiac Diseases | 675 | ||
| Cardiac Tumors | 675 | ||
| Cardiomyopathy | 682 | ||
| Mitral Valve Prolapse | 698 | ||
| Patent Foramen Ovale | 701 | ||
| Pulmonary Hemorrhage | 704 | ||
| Pericardial Heart Disease | 706 | ||
| Combined Carotid and Coronary Artery Disease | 713 | ||
| Coronary Arteriovenous Fistula | 716 | ||
| Cardiac Surgery During Pregnancy | 718 | ||
| Risks of Human Immunodeficiency Virus Transmission | 719 | ||
| Renal Insufficiency and Cardiac Surgery | 721 | ||
| Hematologic Problems in Patients Undergoing Cardiac Surgery | 723 | ||
| Hemophilia | 723 | ||
| Acknowledgments | 731 | ||
| References | 732 | ||
| Chapter 23: Anesthesia for Heart, Lung, and Heart-Lung Transplantation | 737 | ||
| Heart Transplantation | 737 | ||
| Lung Transplantation | 742 | ||
| Heart-Lung Transplantation | 750 | ||
| References | 752 | ||
| Chapter 24: Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension | 755 | ||
| Epidemiology And Pathophysiology | 756 | ||
| Clinical Manifestations | 756 | ||
| Diagnostic Evaluation | 757 | ||
| Operability | 759 | ||
| Medical Treatment Of Chronic Thromboembolic Pulmonary Hypertension | 759 | ||
| Operation | 760 | ||
| Anesthetic Management for Patients Undergoing Pulmonary Thromboendarterectomy | 763 | ||
| Acute Pulmonary Embolism | 769 | ||
| Massive Pulmonary Embolism | 772 | ||
| Pulmonary Arterial Hypertension | 776 | ||
| References | 786 | ||
| Chapter 25: Cardiac Pacing and Defibrillation | 790 | ||
| Pacemakers | 791 | ||
| Implantable Cardioverter-Defibrillators | 799 | ||
| Summary | 801 | ||
| Glossary | 801 | ||
| References | 804 | ||
| Chapter 26: Procedures in the Hybrid Operating Room | 807 | ||
| Rationale | 807 | ||
| Hybrid Cardiovascular Procedures | 807 | ||
| Planning | 809 | ||
| Equipment | 810 | ||
| Hybrid Training | 812 | ||
| Summary | 812 | ||
| References | 813 | ||
| Chapter 27: New Approaches to the Surgical Treatment of End-Stage Heart Failure | 814 | ||
| Epidemiology, Pathophysiology, And Limitations Of Current Management | 814 | ||
| Surgical Options For Heart Failure | 815 | ||
| Mechanical Circulatory Support | 818 | ||
| Cardiac Transplantation | 829 | ||
| New Therapies | 829 | ||
| Anesthetic Considerations In The Patient With Severely Impaired Cardiac Function | 829 | ||
| Conclusions | 833 | ||
| References | 833 | ||
| Section V: Extracorporeal Circulation | 837 | ||
| Chapter 28: Cardiopulmonary Bypass Management and Organ Protection | 838 | ||
| Historic Perspective On Cardiopulmonary Bypass | 838 | ||
| Goals And Mechanics Of Cardiopulmonary Bypass | 839 | ||
| Physiologic Parameters Of Cardiopulmonary Bypass | 840 | ||
| End-Organ Effects Of Cardiopulmonary Bypass | 840 | ||
| Central Nervous System Injury | 840 | ||
| Acute Renal Injury | 851 | ||
| Myocardial Injury | 857 | ||
| Gastrointestinal Complications | 860 | ||
| Lung Injury During Cardiac Surgery | 862 | ||
| Management Of Bypass: An Overview | 864 | ||
| Initiation And Discontinuation Of Bypass Support | 866 | ||
| Perfusion Emergencies | 871 | ||
| Special Patient Populations | 873 | ||
| Minimally Invasive Surgery And Cardiopulmonary Bypass | 876 | ||
| References | 879 | ||
| Chapter 29: Extracorporeal Devices and Related Technologies | 888 | ||
| Mechanical Devices | 889 | ||
| Extracorporeal Circuitry | 894 | ||
| Cardioplegia Delivery Systems | 904 | ||
| Priming Solutions and Controversies | 907 | ||
| Computers in Perfusion | 908 | ||
| Perioperative Methods of Red Blood Cell Conservation | 909 | ||
| Autologous Priming Techniques | 910 | ||
| Coated Circuits | 915 | ||
| Perfusion Practices | 917 | ||
| Methods of Extracorporeal Circulation | 921 | ||
| Summary | 926 | ||
| References | 926 | ||
| Chapter 30: Blood and Fluid Management during Cardiac Surgery | 933 | ||
| Transfusion Guidelines | 933 | ||
| Blood Groups And Transfusion | 934 | ||
| Genetic Causes of Hemorrhage | 937 | ||
| Bleeding After Cardiac Surgery | 940 | ||
| Replacement Therapy | 942 | ||
| Lowest Hematocrit On Cardiopulmonary Bypass | 944 | ||
| Conclusion | 946 | ||
| References | 946 | ||
| Chapter 31: Transfusion Medicine and Coagulation Disorders | 949 | ||
| Overview of Hemostasis | 949 | ||
| Heparin | 959 | ||
| Protamine | 970 | ||
| Bleeding Patient | 977 | ||
| Conclusions | 984 | ||
| References | 985 | ||
| Chapter 32: Discontinuing Cardiopulmonary Bypass | 992 | ||
| General Preparations | 992 | ||
| Preparing The Lungs | 993 | ||
| Preparing The Heart | 993 | ||
| Final Preparations | 994 | ||
| Routine Weaning From Cardiopulmonary Bypass | 995 | ||
| Pharmacologic Management Of Ventricular Dysfunction | 996 | ||
| Intra-Aortic Balloon Pump Counterpulsation | 1002 | ||
| Decision Making With Transesophageal Echocardiography While Discontinuing Cardiopulmonary Bypass | 1005 | ||
| References | 1007 | ||
| Section VI: Postoperative Care | 1009 | ||
| Chapter 33: Postoperative Cardiac Recovery and Outcomes | 1010 | ||
| Fast-Track Cardiac Surgery Care | 1010 | ||
| Initial Management of Fast-Track Cardiac Anesthesia Patients: The First 24 Hours | 1012 | ||
| Management of Complications | 1016 | ||
| Echocardiography Cases | 1020 | ||
| References | 1022 | ||
| Chapter 34: Postoperative Cardiovascular Management | 1025 | ||
| Oxygen Transport | 1025 | ||
| Temperature | 1027 | ||
| Assessment Of The Circulation | 1027 | ||
| Postoperative Myocardial Dysfunction | 1028 | ||
| Postoperative Myocardial Ischemia | 1028 | ||
| Therapeutic Interventions | 1029 | ||
| Postoperative Hypertension | 1032 | ||
| Postoperative Vasodilation | 1033 | ||
| Coronary Artery Spasm | 1034 | ||
| Decreased Contractility | 1034 | ||
| Right-Heart Failure | 1037 | ||
| Cardiac Tamponade | 1041 | ||
| Transplanted Heart | 1041 | ||
| References | 1042 | ||
| Chapter 35: Postoperative Respiratory Care | 1046 | ||
| Risk Factors For Respiratory Insufficiency | 1047 | ||
| Diagnosis of Acute Lung Injury and Acute Respiratory Distress Syndrome | 1049 | ||
| Therapy With Acute Lung Injury/Acute Respiratory Distress Syndrome | 1050 | ||
| Impediments to Weaning and Extubation | 1051 | ||
| Modes of Ventilator Support | 1054 | ||
| Liberation from Mechanical Support (Weaning) | 1056 | ||
| Conclusions | 1058 | ||
| References | 1058 | ||
| Chapter 36: Central Nervous System Dysfunction after Cardiopulmonary Bypass | 1061 | ||
| Age-Associated Risk for Central Nervous System Injury | 1061 | ||
| Central Nervous System Injury | 1062 | ||
| Neuropsychological Dysfunction | 1067 | ||
| Mechanisms of Brain Injury | 1069 | ||
| Neuropathologic Studies | 1069 | ||
| Cerebral Blood Flow | 1074 | ||
| Cerebroprotective Strategies | 1077 | ||
| References | 1081 | ||
| Chapter 37: Long-Term Complications and Management | 1086 | ||
| Sedation in the Intensive Care Unit | 1086 | ||
| Infections In Patients In The Intensive Care Unit | 1089 | ||
| Acute Renal Failure | 1096 | ||
| Nutrition Support | 1097 | ||
| References | 1104 | ||
| Chapter 38: Postoperative Pain Management for the Cardiac Patient | 1107 | ||
| Pain and Cardiac Surgery | 1108 | ||
| Potential Clinical Benefits of Adequate Postoperative Analgesia | 1109 | ||
| Techniques Available for Postoperative Analgesia | 1110 | ||
| Local Anesthetic Infiltration | 1110 | ||
| Nerve Blocks | 1112 | ||
| Opioids | 1113 | ||
| Patient-Controlled Analgesia | 1115 | ||
| Nonsteroidal Anti-Inflammatory Agents | 1117 | ||
| α2-Adrenergic Agonists | 1120 | ||
| Intrathecal and Epidural Techniques | 1121 | ||
| Multimodal Analgesia | 1133 | ||
| How Important Is Postoperative Pain After Cardiac Surgery? | 1133 | ||
| Conclusions | 1133 | ||
| References | 1134 | ||
| Section VII: Education in Cardiac Anesthesia | 1139 | ||
| Chapter 39: Reducing Errors in Cardiac Anesthesiology | 1140 | ||
| Errors Involving the Placement of Central Catheters | 1141 | ||
| Preventing Intraoperative Awareness | 1147 | ||
| Drug Errors | 1148 | ||
| Fatigue and Error in Cardiac Anesthesia | 1152 | ||
| American Society of Anesthesiologists Closed Claims Project Results for Cardiac Anesthesia | 1153 | ||
| References | 1154 | ||
| Chapter 40: Cardiac Anesthesia | 1156 | ||
| Formalized Education Of Cardiothoracic Anesthesiologists | 1158 | ||
| Qualifications Of Cardiothoracic Anesthesiologists | 1159 | ||
| Teaching And Learning Cardiac Anesthesiology | 1160 | ||
| Teaching Process And Content Resources | 1162 | ||
| Evaluation | 1163 | ||
| Lifelong Learning, Continuing Medical Education, And Maintenance Of Certification | 1164 | ||
| Summary | 1164 | ||
| References | 1171 | ||
| Selected Readings | 1172 | ||
| Chapter 41: Transesophageal Echocardiography | 1173 | ||
| Definitions | 1173 | ||
| Perioperative Transesophageal Echocardiography Training | 1176 | ||
| History Of The Development Of The Certification Process | 1179 | ||
| Clinical Competence Versus Certification | 1181 | ||
| Acknowledgment | 1181 | ||
| References | 1182 | ||
| Index | 1183 | ||
| Electrocardiogram Atlas: A Summary ofImportant Changes on the Electrocardiogram | 1203 |