Additional Information
Book Details
Abstract
Now in a revised and expanded 7th Edition, Kaplan’s Cardiac Anesthesia helps you optimize perioperative outcomes for patients undergoing both cardiac and noncardiac surgery. Dr. Joel L. Kaplan, along with associate editors, Drs. John G. T. Augoustides, David L. Reich, and Gerard R. Manecke, guide you through today’s clinical challenges, including the newest approaches to perioperative assessment and management, state-of-the art diagnostic techniques, and cardiovascular and coronary physiology.
- Complete coverage of echocardiography and current monitoring techniques.
- Guidance from today’s leaders in cardiac anesthesia, helping you avoid complications and ensure maximum patient safety.
- More than 800 full-color illustrations.
- A new section on anesthetic management of the cardiac patient undergoing noncardiac surgery.
- New availability as an eBook download for use the in OR.
- Online-only features, including quarterly updates, an ECG atlas...an increased number of videos, including 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.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| IFC_ExCon page | IFC1 | ||
| Kaplan's Cardiac Anesthesia | i | ||
| Copryright page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | xv | ||
| Foreword | xvii | ||
| A Textbook for All Anesthesiologists | xvii | ||
| Table Of Contents | xix | ||
| Video Contents | xxi | ||
| I Preoperative Assessment and Management | 1 | ||
| 1 Assessment of Cardiac Risk and the Cardiology Consultation | 3 | ||
| Key Points | 3 | ||
| Sources of Perioperative Myocardial Injury in Cardiac Surgery | 3 | ||
| Reperfusion of Ischemic Myocardium | 4 | ||
| Adverse Systemic Effects of Cardiopulmonary Bypass | 4 | ||
| Assessment of Perioperative Myocardial Injury in Cardiac Surgery | 4 | ||
| Assessment of Cardiac Function | 5 | ||
| Electrocardiography Monitoring | 5 | ||
| Serum Biochemical Markers to Detect Myocardial Injury | 6 | ||
| Variability in Diagnosis of Perioperative Myocardial Infarction | 6 | ||
| Cardiac Risk Assessment and Cardiac Risk Stratification Models in Patients Undergoing Cardiac Surgery | 6 | ||
| Predictors of Perioperative and Postoperative Morbidity and Mortality | 6 | ||
| Consistency Among Risk Indices | 9 | ||
| Applicability of Risk Indices to a Given Population | 10 | ||
| Specific Risk Conditions | 12 | ||
| Renal Dysfunction | 12 | ||
| Diabetes | 13 | ||
| Acute Coronary Syndrome | 13 | ||
| Assessment of Cardiac Risk in Patients Undergoing Noncardiac Surgery | 13 | ||
| Stepwise Approach to Cardiac Risk Assessment in Patients Undergoing Noncardiac Surgery | 13 | ||
| Step 1: Determine the Urgency of the Noncardiac Surgery | 13 | ||
| Step 2: Identify Any Unstable Cardiac Condition | 13 | ||
| Step 3: Assess Cardiac Risk of the Noncardiac Surgery | 15 | ||
| Step 4: If the patient Has a Low Cardiac Risk | 15 | ||
| Step 5: If the Patient Has an Elevated Cardiac Risk | 15 | ||
| Step 6: If the Patient Has Poor or Unknown Functional Capacity | 15 | ||
| Step 7: If Testing Is Unlikely to Affect Decision Making or Care | 16 | ||
| Role of Handheld and Pocket Ultrasound | 16 | ||
| Conclusions | 17 | ||
| References | 17 | ||
| 2 Cardiovascular Imaging | 20 | ||
| Key Points | 20 | ||
| Echocardiography | 20 | ||
| Assessment of Left Ventricular Systolic Function | 20 | ||
| Regional Left Ventricular Systolic Function | 21 | ||
| Role of Speckle-Tracking Echocardiography | 22 | ||
| Assessment of Left Ventricular Diastolic Function | 23 | ||
| Right Heart Evaluation | 23 | ||
| Assessment of Valve Lesions | 24 | ||
| Mitral Valve Lesions | 24 | ||
| Aortic Valve Lesions | 26 | ||
| Other Valve Lesions | 28 | ||
| Hemodynamic Assessment | 29 | ||
| Intracardiac Pressures | 29 | ||
| Cardiac Output and Vascular Resistance | 29 | ||
| Pericardial Diseases | 29 | ||
| Diseases of the Aorta | 30 | ||
| Miscellaneous Disorders | 32 | ||
| Stress Echocardiography | 32 | ||
| Myocardial Ischemia | 32 | ||
| Myocardial Viability | 33 | ||
| Valve Lesions | 33 | ||
| Myocardial Nuclear Scintigraphy | 33 | ||
| Cardiac Computed Tomography | 35 | ||
| Cardiovascular Magnetic Resonance Imaging | 37 | ||
| Invasive Coronary Angiography | 41 | ||
| Vascular Imaging | 41 | ||
| Carotid Artery Stenosis | 41 | ||
| Renal Artery Stenosis | 41 | ||
| Peripheral Arterial Disease | 42 | ||
| Peripheral Venous Thrombosis and Venous Insufficiency | 42 | ||
| Summary | 42 | ||
| References | 42 | ||
| 3 Cardiac Catheterization Laboratory | 46 | ||
| Key Points | 46 | ||
| Catheterization Laboratory Facilities: Radiation Safety and Image Acquisition | 47 | ||
| Room Setup, Design, and Equipment | 47 | ||
| Radiation Safety | 48 | ||
| Filmless Imaging and Flat-Panel Technology | 48 | ||
| Facility Caseload | 48 | ||
| Patient Selection for Catheterization | 49 | ||
| Indications for Cardiac Catheterization in the Adult Patient | 49 | ||
| Patient Evaluation Before Cardiac Catheterization | 49 | ||
| Contraindications, High-Risk Patients, and Postcatheterization Care | 50 | ||
| Cardiac Catheterization Procedures | 51 | ||
| Patient Preparation | 51 | ||
| Patient Monitoring and Sedation | 51 | ||
| Left-Sided Heart Catheterization | 51 | ||
| Catheterization Site and Anticoagulation | 51 | ||
| Contrast Agents | 53 | ||
| Right-Sided Heart Catheterization | 54 | ||
| Indications | 54 | ||
| Procedure | 54 | ||
| Shunt Calculations | 54 | ||
| Endomyocardial Biopsy | 55 | ||
| Diagnostic Catheterization Complications | 55 | ||
| Valvular Pathology | 56 | ||
| Stenotic Lesions | 56 | ||
| Aortic Stenosis | 57 | ||
| Mitral Stenosis | 58 | ||
| Regurgitant Lesions | 59 | ||
| Aortic Regurgitation | 59 | ||
| Mitral Regurgitation | 59 | ||
| Prosthetic Valves | 59 | ||
| Angiography | 60 | ||
| Ventriculography | 60 | ||
| Ejection Fraction Determination | 60 | ||
| Abnormalities in Regional Wall Motion | 60 | ||
| Assessment of Mitral Regurgitation | 60 | ||
| Aortography | 61 | ||
| Coronary Arteriography | 61 | ||
| Description of Coronary Anatomy | 61 | ||
| Coronary Anomalies | 61 | ||
| Assessing the Degree of Stenosis | 62 | ||
| Coronary Collaterals | 63 | ||
| Interventional Cardiology: Percutaneous Coronary Intervention | 64 | ||
| General Topics for All Interventional Devices | 64 | ||
| Indications | 64 | ||
| Equipment and Procedure | 65 | ||
| Restenosis | 66 | ||
| Anticoagulation | 67 | ||
| Outcomes: Success and Complications | 69 | ||
| Operating Room Backup | 70 | ||
| General Management for Failed Percutaneous Coronary Intervention | 71 | ||
| Support Devices for High-Risk Angioplasty | 72 | ||
| Controversies in Interventional Cardiology | 75 | ||
| Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease | 75 | ||
| Percutaneous Coronary Intervention Versus Surgical Revascularization in Complex Coronary Artery Disease | 76 | ||
| Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery for Left Main Coronary Artery Disease | 77 | ||
| Specific Interventional Devices | 77 | ||
| Interventional Diagnostic Devices | 77 | ||
| Percutaneous Transluminal Coronary Angioplasty | 77 | ||
| Atherectomy Devices: Directional and Rotational | 78 | ||
| Cutting Balloon | 78 | ||
| Intracoronary Stents | 79 | ||
| Aspiration Thrombectomy Catheters | 80 | ||
| Distal Occlusion Devices | 81 | ||
| Therapy for Chronic Total Occlusions | 81 | ||
| Other Catheter-Based Percutaneous Therapies | 81 | ||
| Percutaneous Valvular Therapy | 81 | ||
| Balloon Valvuloplasty | 81 | ||
| Percutaneous Valve Repair | 83 | ||
| Percutaneous Mitral Valve Repair | 83 | ||
| Anesthetic Management of Percutaneous Mitral Valve Repair | 85 | ||
| Other Catheter-Based Intracardiac Procedures | 88 | ||
| Alcohol Septal Ablation | 88 | ||
| Left Atrial Appendage Occlusion | 88 | ||
| Percutaneous Closure of Patent Foramen Ovale and Septal Defects | 88 | ||
| The Catheterization Laboratory and the Anesthesiologist | 89 | ||
| References | 90 | ||
| 4 Cardiac Electrophysiology | 96 | ||
| Key Points | 96 | ||
| Electrophysiologic Principles | 96 | ||
| Anatomy and Physiology of the Cardiac Pacemaker and Conduction Systems | 96 | ||
| Sinoatrial Node | 96 | ||
| Internodal Conduction | 97 | ||
| Atrioventricular Junction and Intraventricular Conduction System | 97 | ||
| Basic Arrhythmia Mechanisms | 98 | ||
| Diagnostic Evaluation | 99 | ||
| Principles of Electrophysiologic Treatment | 100 | ||
| Specific Arrhythmias | 102 | ||
| Supraventricular Tachyarrhythmias | 102 | ||
| Atrioventricular Reciprocating Tachycardia | 102 | ||
| Catheter-Based Therapy for Accessory Pathways | 104 | ||
| Atrioventricular Nodal Reentrant Tachycardia | 104 | ||
| Catheter-Based Therapy for Atrioventricular Nodal Reentrant Tachycardia | 105 | ||
| Focal Atrial Tachycardia | 105 | ||
| Catheter-Based Therapy for Focal Atrial Tachycardia | 105 | ||
| Inappropriate Sinus Tachycardia | 106 | ||
| Sinus Node Reentrant Tachycardia | 106 | ||
| Atrial Flutter | 106 | ||
| Anesthesia Considerations for Supraventricular Arrhythmia Surgery and Ablation Procedures | 107 | ||
| Atrial Fibrillation | 107 | ||
| Catheter-Based Therapy for Atrial Fibrillation | 108 | ||
| Surgical Therapy for Atrial Fibrillation | 109 | ||
| Anesthesia Considerations | 112 | ||
| Ventricular Arrhythmias | 113 | ||
| Catheter Ablation Therapy for Ventricular Tachycardia | 113 | ||
| Anesthesia Considerations | 113 | ||
| Implantable Cardioverter-Defibrillators | 114 | ||
| Anesthesia Considerations | 114 | ||
| References | 115 | ||
| 5 Cardiac Implantable Electrical Devices | 118 | ||
| Key Points | 118 | ||
| Radiology Imaging Issues | 120 | ||
| Pacemakers | 121 | ||
| Pacemaker Indications | 121 | ||
| Pacemaker Magnets | 121 | ||
| Preanesthetic Evaluation and Pacemaker Reprogramming | 123 | ||
| Intraoperative (or Procedure) Management | 124 | ||
| Pacemaker Failure | 126 | ||
| Temporary Pacemakers | 126 | ||
| Temporary Pacing Generator | 127 | ||
| Indications for Temporary Pacing | 127 | ||
| Transvenous Temporary Pacing | 128 | ||
| Pacing Pulmonary Artery Catheters | 128 | ||
| Transcutaneous Pacing | 128 | ||
| Esophageal Pacing | 129 | ||
| Transthoracic Pacing | 130 | ||
| Postanesthesia Pacemaker Evaluation | 130 | ||
| Implantable Cardioverter-Defibrillators | 131 | ||
| Implantable Cardioverter-Defibrillator Indications | 131 | ||
| Dilated Cardiomyopathy | 132 | ||
| Implantable Cardioverter-Defibrillator Magnets | 132 | ||
| Preanesthetic Evaluation and Implantable Cardioverter-Defibrillator Reprogramming | 132 | ||
| Intraoperative (or Procedure) Management | 132 | ||
| Postanesthesia Implantable Cardioverter-Defibrillator Evaluation | 133 | ||
| Summary | 133 | ||
| Glossary | 133 | ||
| Cautions | 138 | ||
| References | 134 | ||
| II Cardiovascular Physiology, Pharmacology, Molecular Biology, and Genetics | 141 | ||
| 6 Cardiac Physiology | 143 | ||
| Key Points | 143 | ||
| Functional Implications of Gross Anatomy | 143 | ||
| Structure | 143 | ||
| Valves | 145 | ||
| Blood Supply | 146 | ||
| Conduction | 146 | ||
| Cardiac Myocyte Anatomy and Function | 147 | ||
| Ultrastructure | 147 | ||
| Proteins of the Contractile Apparatus | 147 | ||
| Calcium-Myofilament Interaction | 148 | ||
| Biochemistry of Myosin-Actin Interaction | 149 | ||
| Laplace’s Law | 150 | ||
| The Cardiac Cycle | 150 | ||
| Pressure-Volume Diagrams | 152 | ||
| Determinants of Pump Performance | 155 | ||
| Heart Rate | 156 | ||
| Preload | 156 | ||
| Afterload | 158 | ||
| Myocardial Contractility | 160 | ||
| End-Systolic Pressure-Volume Relationships | 160 | ||
| Stroke Work–End-Diastolic Volume Relationships | 162 | ||
| Isovolumic Indices of Contractility | 163 | ||
| Ejection-Phase Indices of Contractility | 164 | ||
| Contractile Indices Based on Ventricular Power | 165 | ||
| Coupling, Energetics, and Efficiency | 165 | ||
| Evaluation of Diastolic Function | 166 | ||
| Invasive Evaluation of Diastolic Function | 167 | ||
| Isovolumic Relaxation | 167 | ||
| Filling | 168 | ||
| Passive Mechanical Behavior | 168 | ||
| Noninvasive Evaluation of Diastolic Function | 169 | ||
| Isovolumic Relaxation | 169 | ||
| Transmitral Blood Flow Velocity | 169 | ||
| Pulmonary Venous Blood Flow Velocity | 171 | ||
| Tissue Doppler Imaging | 172 | ||
| Color M-Mode Propagation Velocity | 172 | ||
| Pericardial Forces | 173 | ||
| Determinants of Atrial Function | 173 | ||
| References | 174 | ||
| 7 Coronary Physiology and Atherosclerosis | 179 | ||
| Key Points | 179 | ||
| Anatomy and Physiology of Blood Vessels | 179 | ||
| Normal Artery Wall | 179 | ||
| Intima | 180 | ||
| Media | 180 | ||
| Adventitia | 180 | ||
| Transmembrane and Transcellular Communication | 180 | ||
| Endothelium | 181 | ||
| Endothelium-Derived Relaxing Factors | 181 | ||
| Endothelium-Derived Contracting Factors | 183 | ||
| Endothelial Inhibition of Platelets | 184 | ||
| Determinants of Coronary Blood Flow | 184 | ||
| Perfusion Pressure and Myocardial Compression | 184 | ||
| Myocardial Metabolism | 185 | ||
| Oxygen | 186 | ||
| Reactive Oxygen Species | 186 | ||
| Carbon Dioxide | 186 | ||
| Adenosine | 186 | ||
| Neural and Humoral Control | 186 | ||
| Neural Control | 186 | ||
| Coronary Innervation | 186 | ||
| Parasympathetic Control | 186 | ||
| β-Adrenergic Coronary Dilation | 187 | ||
| α-Adrenergic Coronary Constriction | 187 | ||
| Classification | 187 | ||
| Presynaptic α-Receptors | 187 | ||
| Cardiac Muscle Cells | 187 | ||
| Coronary Endothelium | 187 | ||
| Coronary Resistance | 187 | ||
| Exercise | 187 | ||
| Myocardial Ischemia | 188 | ||
| Studies in Humans | 188 | ||
| Humoral Control | 188 | ||
| Coronary Pressure-Flow Relations | 188 | ||
| Autoregulation | 188 | ||
| Coronary Reserve | 189 | ||
| Transmural Blood Flow | 190 | ||
| Atherosclerosis | 191 | ||
| Atherogenesis | 192 | ||
| Arterial Wall Inflammation | 192 | ||
| Role of Lipoproteins in Lesion Formation | 192 | ||
| Smooth Muscle Cell Proliferation, Migration, and Arterial Remodeling | 193 | ||
| Pathophysiology of Coronary Blood Flow | 193 | ||
| Coronary Artery Stenoses and Plaque Rupture | 193 | ||
| Hemodynamics | 195 | ||
| Coronary Collaterals | 196 | ||
| Pathogenesis of Myocardial Ischemia | 197 | ||
| Determinants of Ratio of Myocardial Oxygen Supply to Demand | 197 | ||
| Dynamic Stenosis | 198 | ||
| Coronary Steal | 199 | ||
| Intracoronary Evaluation of Atherosclerosis | 199 | ||
| Intravascular Ultrasound | 199 | ||
| Optical Coherence Tomography | 200 | ||
| Fractional Flow Reserve | 200 | ||
| Future Directions | 202 | ||
| References | 202 | ||
| 8 Molecular and Genetic Cardiovascular Medicine | 206 | ||
| Key Points | 206 | ||
| Machinery Behind the Cardiac Rhythm: Ion Channels | 207 | ||
| Patch Clamping | 207 | ||
| Electrical Events Underlying the Cardiac Action Potential | 208 | ||
| Resting Membrane Potential and the Role of the Inwardly Rectifying Potassium Current | 208 | ||
| Phase 0: Rapid Upstroke of the Cardiac Action Potential | 208 | ||
| Phase 1: Early Rapid Repolarization | 209 | ||
| Phases 2 and 3: Plateau Phase and Final Rapid Repolarization | 209 | ||
| Slow Inward Calcium Current | 209 | ||
| Delayed Rectifier Potassium Currents | 209 | ||
| Repolarization in Different Cardiac Tissue Types | 210 | ||
| Phase 4: Diastolic Depolarization and Pacemaker Current | 210 | ||
| Molecular Biology of Ion Channels | 210 | ||
| Molecular Mechanisms | 213 | ||
| Voltage Sensor | 213 | ||
| Ion Channel Pore and Selectivity Filter | 213 | ||
| Channel Inactivation | 213 | ||
| Clinical Correlates | 214 | ||
| Ion Channels and Antiarrhythmic Drugs | 214 | ||
| Ion Channels in Disease | 214 | ||
| Long QT Syndromes | 214 | ||
| Brugada Syndrome | 214 | ||
| Controlling Cardiac Functioning: Receptors | 215 | ||
| Receptor Classes | 215 | ||
| G Proteins | 215 | ||
| Adrenergic Receptors and Signaling Pathways | 216 | ||
| Adrenergic Receptors | 216 | ||
| Regulation of β-Receptor Functioning | 216 | ||
| Muscarinic Receptors and Signaling Pathways | 217 | ||
| Muscarinic Acetylcholine Receptors | 217 | ||
| Regulation of Muscarinic Acetylcholine Receptors | 217 | ||
| Regulation of G-Protein Functioning | 217 | ||
| Other Receptors | 217 | ||
| Clinical Correlates | 217 | ||
| Adenosine Signaling | 217 | ||
| Antiarrhythmic Actions of Adenosine | 218 | ||
| Adenosine and Myocardial Preconditioning | 218 | ||
| Anesthetic Actions | 218 | ||
| Interactions With Channels: Calcium Channels | 219 | ||
| Interactions With Receptors: Muscarinic Receptors | 219 | ||
| Remote Ischemic Conditioning | 220 | ||
| Genetic Cardiovascular Medicine | 220 | ||
| Monogenic Cardiovascular Disorders | 221 | ||
| Methodologies for Identifying Mutations: Linkage Analysis, Sequencing, and Microarrays | 221 | ||
| Clinical Applications | 222 | ||
| Common Complex Multigenic Cardiovascular Disorders | 223 | ||
| State-of-the Art Methodologies for Multigenic Genetic Screening: Whole-Genome Association and Gene Expression Profiling | 223 | ||
| Clinical Application | 224 | ||
| Perioperative Genomics in Cardiac Surgery | 225 | ||
| Gene Therapy | 226 | ||
| MicroRNAs and Antagomir Therapy | 227 | ||
| Cell Therapy | 227 | ||
| Acknowledgments | 228 | ||
| References | 228 | ||
| 9 Systemic Inflammation | 231 | ||
| Key Points | 231 | ||
| Terminology | 231 | ||
| Systemic Inflammation and Cardiac Surgical Procedures | 232 | ||
| Mechanisms of Inflammation-Mediated Injury | 233 | ||
| Physiologic Mediators of Inflammation | 233 | ||
| Cytokines | 233 | ||
| Tumor Necrosis Factor | 233 | ||
| Interleukins | 233 | ||
| Antiinflammatory Cytokines | 234 | ||
| Complement System | 234 | ||
| Endotoxin | 235 | ||
| Endotoxemia | 236 | ||
| Normal Host Defenses Against Endotoxemia | 236 | ||
| Early Tolerance | 236 | ||
| Late Tolerance | 236 | ||
| Criticisms of Endotoxin as a Causative Factor | 237 | ||
| Splanchnic Perfusion | 237 | ||
| Postoperative Complications Attributable to Inflammation | 237 | ||
| Types of Complications | 237 | ||
| Incidence of Complications | 238 | ||
| Potential Therapies for the Prevention of Inflammation-Related Complications | 238 | ||
| Steroid Administration | 238 | ||
| Role of Cardiopulmonary Bypass Technique | 238 | ||
| Complement Inhibition | 241 | ||
| Ultrafiltration | 241 | ||
| Leukocyte Depletion | 241 | ||
| Aprotinin and Other Serine Protease Inhibitors | 241 | ||
| Tumor Necrosis Factor Antagonists | 242 | ||
| E5564 | 242 | ||
| Pentoxifylline | 242 | ||
| Ethyl Pyruvate | 242 | ||
| Statins | 242 | ||
| N-Acetylcysteine | 242 | ||
| Other Potential Antiendotoxin or Antiinflammatory Agents | 242 | ||
| Role of Anesthetic Agents and Vasoactive Agents | 242 | ||
| Selective Digestive Decontamination | 243 | ||
| Summary | 243 | ||
| References | 243 | ||
| 10 Pharmacology of Anesthetic Drugs | 247 | ||
| Key Points | 247 | ||
| Volatile Agents | 248 | ||
| Acute Effects | 248 | ||
| Myocardial Function | 248 | ||
| Cardiac Electrophysiology | 249 | ||
| Coronary Vasoregulation | 249 | ||
| Systemic Regional and Pulmonary Vascular Effects | 250 | ||
| Baroreceptor Reflex | 251 | ||
| Delayed Effects | 251 | ||
| Reversible Myocardial Ischemia | 251 | ||
| Preconditioning and Postconditioning Anesthetic Agents | 254 | ||
| Intravenous Induction Agents | 255 | ||
| Acute Cardiac Effects | 255 | ||
| Myocardial Contractility | 255 | ||
| Molecular Mechanisms: Adrenergic Signaling, Ca2+ Influx, and Ca2+ Sensitivity | 259 | ||
| Integrated Cardiovascular Responses | 260 | ||
| Oxidative Stress | 260 | ||
| Vasculature | 262 | ||
| Systemic Vasoregulation | 264 | ||
| Pulmonary Vasoregulation | 265 | ||
| Endothelial Function | 265 | ||
| Sympathetic and Parasympathetic Nervous System | 266 | ||
| Remodeling and Cell Proliferation | 266 | ||
| Individual Agents | 267 | ||
| Thiopental | 267 | ||
| General Characteristics | 267 | ||
| Cardiovascular Effects | 267 | ||
| Uses in Cardiac Anesthesia | 268 | ||
| Midazolam | 268 | ||
| General Characteristics | 268 | ||
| III Monitoring | 355 | ||
| 12 Electrocardiographic Monitoring | 357 | ||
| Key Points | 357 | ||
| Historical Perspective | 357 | ||
| Basic Electrophysiology and Electrical Anatomy of the Heart | 357 | ||
| Technical Aspects of the Electrocardiogram | 359 | ||
| Signal Acquisition and Power Spectrum of the Electrocardiogram | 359 | ||
| Digital Signal Processing of the Electrocardiogram | 360 | ||
| Formation of a Representative Single-Lead Complex | 360 | ||
| History and Description of the 12-Lead System | 360 | ||
| Technical Aspects of Electrode Placement | 363 | ||
| Intrinsic and Extrinsic Electrocardiographic Artifact | 363 | ||
| Intrinsic Sources | 363 | ||
| Skin Impedance | 363 | ||
| Electrodes | 363 | ||
| Motor Activity | 363 | ||
| Extrinsic Sources | 363 | ||
| Electrical Power-Line Interference | 363 | ||
| Electrocautery | 363 | ||
| Clinical Sources of Artifact | 363 | ||
| Frequency Response of Electrocardiographic Monitors: Monitoring and Diagnostic Modes | 364 | ||
| Electrocardiographic Changes With Myocardial Ischemia | 365 | ||
| Detection of Myocardial Ischemia | 365 | ||
| Anatomic Localization of Ischemia With the Electrocardiogram | 367 | ||
| Clinical Lead Systems for Detecting Ischemia | 367 | ||
| Intraoperative Lead Systems | 368 | ||
| Electrocardiographic Changes With Pacemakers, Respirations, Electrolytes, and Medications | 370 | ||
| Electrocardiographic Changes Resulting From Electrolyte Disorders | 370 | ||
| Hyperkalemia | 370 | ||
| Hypokalemia | 370 | ||
| Hypocalcemia and Hypercalcemia | 370 | ||
| Medications | 370 | ||
| Appendix 12.1 Electrocardiogram Atlas: A Summary of Important Changes on the Electrocardiogram | 373 | ||
| Normal Electrocardiogram: Cardiac Cycle | 374 | ||
| Atrial Fibrillation | 374 | ||
| Atrial Flutter | 374 | ||
| Atrioventricular Block | 375 | ||
| First-Degree | 375 | ||
| Second-Degree: Mobitz Type I/Wenckebach Block | 375 | ||
| Second-Degree: Mobitz Type II Block | 375 | ||
| Third-Degree: Complete Heart Block | 375 | ||
| Atrioventricular Dissociation | 375 | ||
| Bundle Branch Block | 376 | ||
| Left Bundle Branch Block | 376 | ||
| Right Bundle Branch Block | 376 | ||
| Coronary Artery Disease | 377 | ||
| Transmural Myocardial Infarction | 377 | ||
| Subendocardial Myocardial Infarction | 380 | ||
| Myocardial Ischemia | 380 | ||
| Digitalis Effect | 381 | ||
| Electrolyte Disturbances | 381 | ||
| Calcium | 381 | ||
| Potassium | 382 | ||
| Hypokalemia (K+ = 1.9 mEq/L) | 382 | ||
| Hyperkalemia (K+ = 7.9 mEq/L) | 382 | ||
| Hypothermia | 382 | ||
| Multifocal Atrial Tachycardia | 382 | ||
| Paroxysmal Atrial Tachycardia | 383 | ||
| Pericarditis | 383 | ||
| Pericardial Tamponade | 384 | ||
| Pneumothorax | 384 | ||
| Premature Atrial Contraction | 385 | ||
| Premature Ventricular Contraction | 385 | ||
| Pulmonary Embolus | 385 | ||
| Sinus Bradycardia | 385 | ||
| Sinus Arrhythmia | 386 | ||
| Sinus Arrest | 386 | ||
| Sinus Tachycardia | 386 | ||
| Subarachnoid Hemorrhage | 387 | ||
| Torsades de Pointes | 387 | ||
| Ventricular Fibrillation | 388 | ||
| Coarse Ventricular Fibrillation | 388 | ||
| Fine Ventricular Fibrillation | 388 | ||
| Ventricular Tachycardia | 388 | ||
| Wolff-Parkinson-White Syndrome | 388 | ||
| Pacing | 388 | ||
| Atrial Pacing | 388 | ||
| Ventricular Pacing | 388 | ||
| DDD Pacing | 388 | ||
| Acknowledgments | 389 | ||
| Bibliography | 389 | ||
| References | 370 | ||
| 13 Monitoring of the Heart and Vascular System | 390 | ||
| Key Points | 390 | ||
| Hemodynamic Monitoring | 390 | ||
| Arterial Pressure Monitoring | 391 | ||
| General Principles | 391 | ||
| Components of a Pressure Measurement System | 392 | ||
| Characteristics of a Pressure Measurement System | 392 | ||
| Arterial Cannulation Sites | 393 | ||
| Radial and Ulnar Arteries | 393 | ||
| Brachial and Axillary Arteries | 393 | ||
| Femoral Artery | 393 | ||
| Dorsalis Pedis and Posterior Tibial Arteries | 394 | ||
| Indications | 394 | ||
| Contraindications | 394 | ||
| Insertion Techniques | 394 | ||
| Direct Cannulation | 394 | ||
| Ultrasound and Doppler-Assisted Techniques | 394 | ||
| Complications | 396 | ||
| Central Venous Pressure Monitoring | 397 | ||
| Techniques and Insertion Sites | 397 | ||
| Internal Jugular Vein | 397 | ||
| Ultrasound-Guided Internal Jugular Vein Cannulation | 399 | ||
| Clinical Evidence for Ultrasound-Guided Internal Jugular Vein Cannulation | 399 | ||
| Technical Aspects | 399 | ||
| Current Recommendations | 401 | ||
| External Jugular Vein | 401 | ||
| Subclavian Vein | 401 | ||
| Antecubital Veins | 402 | ||
| Femoral Vein | 402 | ||
| Indications | 402 | ||
| Contraindications | 402 | ||
| Complications | 402 | ||
| Pulmonary Arterial Pressure Monitoring | 404 | ||
| Clinical Efficacy and Related Trends in Pulmonary Artery Catheter Usage | 404 | ||
| Noncardiac Surgery Setting | 404 | ||
| Cardiac Surgery Setting | 405 | ||
| Technical Aspects of Pulmonary Artery Catheter Use | 406 | ||
| Indications | 407 | ||
| Contraindications | 408 | ||
| Absolute Contraindications | 408 | ||
| Relative Contraindications | 408 | ||
| Complications | 409 | ||
| Arrhythmias | 409 | ||
| Complete Heart Block | 409 | ||
| Endobronchial Hemorrhage | 409 | ||
| Pulmonary Infarction | 409 | ||
| Catheter Knotting and Entrapment | 409 | ||
| Valvular Damage | 409 | ||
| Thrombocytopenia | 410 | ||
| Thrombus Formation | 410 | ||
| Incorrect Placement | 410 | ||
| Balloon Rupture | 410 | ||
| Ventricular Perforation | 410 | ||
| Artifacts and Erroneous Measurements | 410 | ||
| Special Purpose Pulmonary Artery Catheters | 410 | ||
| Pacing Pulmonary Artery Catheters | 410 | ||
| Electrode Catheters | 410 | ||
| Pacing Wire Catheters | 410 | ||
| Mixed Venous Oxygen Saturation Catheters | 410 | ||
| Cardiac Output Monitoring | 411 | ||
| Fick Method | 411 | ||
| Indicator Dilution | 411 | ||
| Thermodilution | 411 | ||
| Intermittent Thermodilution Cardiac Output | 411 | ||
| Accuracy | 412 | ||
| Precision | 412 | ||
| Continuous Thermodilution Cardiac Output | 413 | ||
| Dye Dilution | 413 | ||
| Alternative Techniques for Assessing Cardiac Output | 413 | ||
| Transpulmonary Thermodilution | 413 | ||
| Cardiac Output Measurements Using Ultrasound Technology | 414 | ||
| Two- and Three-Dimensional Echocardiography | 414 | ||
| Doppler Ultrasound | 414 | ||
| Cardiac Output Derived From Arterial Pulse Wave Analysis | 415 | ||
| Calibrated Pulse Contour Cardiac Output | 415 | ||
| Uncalibrated and Autocalibrated Pulse Contour and Pulse Wave Technology | 415 | ||
| Cardiac Output Derived From Noninvasive Devices | 415 | ||
| Cardiac Output Derived From Volume-Clamp Monitoring Devices | 416 | ||
| Cardiac Output Derived From Bioimpedance and Bioreactance Technology | 416 | ||
| Right Ventricular Ejection Fraction and End-Diastolic Volume | 416 | ||
| Left Atrial Pressure Monitoring | 416 | ||
| Coronary Sinus Catheterization | 416 | ||
| Analysis and Interpretation of Hemodynamic Data | 418 | ||
| Systemic and Pulmonary Vascular Resistances | 418 | ||
| Frank-Starling Relationships | 418 | ||
| End-Systolic Elastance and Pressure-Volume Loops | 419 | ||
| Pulse Oximetry | 419 | ||
| Oxygen Transport Calculations | 420 | ||
| Monitoring Coronary Perfusion | 420 | ||
| Cerebral Oximetry | 420 | ||
| Summary | 420 | ||
| References | 420 | ||
| 14 Basic Intraoperative Transesophageal Echocardiography | 427 | ||
| Key Points | 427 | ||
| Basic Concepts | 427 | ||
| Properties of Ultrasound | 427 | ||
| Ultrasound Beam | 428 | ||
| Attenuation, Reflection, and Scatter | 429 | ||
| Imaging Techniques | 429 | ||
| M Mode | 429 | ||
| B Mode | 429 | ||
| Harmonic Imaging | 430 | ||
| Doppler Techniques | 430 | ||
| Doppler Effect | 431 | ||
| Pulsed-Wave Doppler | 431 | ||
| High-Pulse Repetition Frequency Doppler | 432 | ||
| Continuous-Wave Doppler | 432 | ||
| Color-Flow Doppler | 432 | ||
| Contrast Echocardiography | 433 | ||
| Echocardiographic Scanners | 434 | ||
| Resolution | 434 | ||
| Preprocessing | 434 | ||
| Dynamic Range Manipulation | 434 | ||
| Transmit Power and Overall Gain | 434 | ||
| Time-Gain Compensation | 434 | ||
| Leading-Edge Enhancement | 435 | ||
| Postprocessing | 435 | ||
| Digital Scan Conversion | 435 | ||
| Temporal Processing | 436 | ||
| Gray-Scale Modification | 436 | ||
| Equipment | 437 | ||
| Image Storage | 437 | ||
| Cine Memory | 437 | ||
| Videotape | 437 | ||
| Digital Storage | 437 | ||
| Image Terminology | 438 | ||
| Image Creation | 438 | ||
| Clinical Compression | 438 | ||
| Digital Compression | 438 | ||
| Digital Imaging and Communications in Medicine Standard | 439 | ||
| Image Acquisition, Transmission, Analysis, and Storage | 439 | ||
| Image Acquisition | 439 | ||
| Study Transmission | 439 | ||
| Image Storage: Picture Archiving and Communication System Server | 439 | ||
| Study Distribution and Analysis | 440 | ||
| Dedicated Workstations | 440 | ||
| Off-Site Distribution | 440 | ||
| Complications | 440 | ||
| Safety Guidelines and Contraindications | 441 | ||
| Credentialing | 441 | ||
| Training and Quality Assurance | 441 | ||
| Practice Parameters | 442 | ||
| Technique of Probe Passage | 442 | ||
| Comprehensive Intraoperative Multiplane Transesophageal Echocardiographic Examination | 442 | ||
| Multiplane Transesophageal Echocardiographic Probe Manipulation: Descriptive Terms and Technique | 443 | ||
| Comprehensive Intraoperative Transesophageal Echocardiographic Examination: Imaging Planes and Structural Analysis | 443 | ||
| Left and Right Ventricles | 443 | ||
| Mitral Valve | 448 | ||
| Aortic Valve, Aortic Root, and Left Ventricular Outflow | 449 | ||
| Tricuspid Valve | 454 | ||
| Pulmonic Valve and Pulmonary Artery | 454 | ||
| Left Atrium, Left Atrial Appendage, Pulmonary Veins, and Atrial Septum | 454 | ||
| Right Atrium and Coronary Sinus | 454 | ||
| Thoracic Aorta | 455 | ||
| Anatomic Variants and Artifacts | 455 | ||
| Anatomic Variants | 455 | ||
| Right Atrium | 455 | ||
| Right Ventricle | 456 | ||
| Left Atrium | 457 | ||
| Left Ventricle | 457 | ||
| Aortic Valve | 457 | ||
| Pericardium | 458 | ||
| Imaging Artifacts | 458 | ||
| Clinical Applications | 461 | ||
| Left Ventricular Assessment | 461 | ||
| Assessment of Left Ventricular Size | 461 | ||
| Left Ventricular Preload by End-Diastolic Dimensions | 462 | ||
| Left Ventricular Mass | 464 | ||
| Left Ventricular Systolic Function | 466 | ||
| Left Ventricular Diastolic Function | 466 | ||
| Indices for Evaluation | 467 | ||
| Left Atrial Size | 467 | ||
| Transmitral Doppler Analysis | 467 | ||
| Pulmonary Venous Flow Analysis | 469 | ||
| Color M-Mode Flow Propagation Velocity | 471 | ||
| Tissue Doppler | 471 | ||
| Classification of Diastolic Dysfunction | 472 | ||
| Left Atrial Pressure | 472 | ||
| Right Ventricular Function | 473 | ||
| Right Ventricular Anatomic Assessment | 473 | ||
| Right Ventricular Systolic Function | 474 | ||
| Two Dimensional–Based Methods | 474 | ||
| Doppler-Based Methods | 474 | ||
| Strain-Based Methods | 476 | ||
| Three-Dimensional Methods | 476 | ||
| Hemodynamic Assessment | 477 | ||
| Intravascular Pressures | 477 | ||
| Determination of Intravascular Pressures | 477 | ||
| Cardiac Output | 478 | ||
| Two-Dimensional Echocardiographic Measurement | 478 | ||
| Doppler Measurements | 478 | ||
| Contrast Applications | 480 | ||
| Enhancement of Right-Sided Structures | 480 | ||
| Left Ventricular Opacification | 480 | ||
| Aortic Dissections | 480 | ||
| Doppler Enhancement | 481 | ||
| Myocardial Perfusion | 481 | ||
| Valvular Evaluation | 481 | ||
| Aortic Valve Evaluation | 481 | ||
| Aortic Stenosis | 482 | ||
| Classical Low Flow–Low Gradient, Paradoxic Low Flow–Low Gradient, and Pseudosevere Aortic Stenosis | 485 | ||
| Aortic Regurgitation | 485 | ||
| Mitral Valve Evaluation | 490 | ||
| Mitral Stenosis | 490 | ||
| Doppler Assessment of Mitral Valvular Stenosis | 491 | ||
| Mitral Regurgitation | 491 | ||
| Qualitative Grading Using Color-Flow Doppler | 494 | ||
| Pulmonary Vein Flow Pattern | 495 | ||
| Proximal Isovelocity Surface Area | 495 | ||
| Tricuspid Valve | 497 | ||
| Myocardial Ischemia Monitoring | 498 | ||
| Regional Wall Motion and Systolic Wall Thickness | 498 | ||
| Wall Motion | 499 | ||
| Diagnosis of Ischemia | 499 | ||
| Relation to Other Monitors | 499 | ||
| Limitations | 499 | ||
| Outcome Significance | 500 | ||
| Stress Echocardiography | 500 | ||
| Ischemia-Related Diagnoses | 501 | ||
| References | 501 | ||
| 15 Transesophageal Echocardiography | 505 | ||
| Key Points | 505 | ||
| The Development of a Perioperative Echocardiography Service | 505 | ||
| Training Physicians in Perioperative Echocardiography | 506 | ||
| Echocardiography Equipment | 506 | ||
| Image Storage and Reporting | 506 | ||
| Clinical Areas of Implementation | 506 | ||
| Three-Dimensional Transesophageal Echocardiography | 506 | ||
| Three-Dimensional Reconstruction | 506 | ||
| Historic Overview | 506 | ||
| Limitations of Three-Dimensional Imaging | 506 | ||
| Display of Three-Dimensional Images | 507 | ||
| Narrow Sector (Live Three-Dimensional)–Real Time | 507 | ||
| Wide Sector Focused (Three-Dimensional Zoom)–Real Time | 507 | ||
| Large Sector (Full Volume)–Gated | 507 | ||
| Three-Dimensional Color Doppler–Gated | 507 | ||
| Clinical Applications | 508 | ||
| Right Ventricle | 508 | ||
| Mitral Valve Apparatus | 508 | ||
| Aortic and Tricuspid Valves | 509 | ||
| Congenital and Interventional Procedures | 509 | ||
| Perioperative Echocardiographic Evaluation of Valves | 509 | ||
| General Points Regarding Valve Assessment | 510 | ||
| General Considerations With Prosthetic Valves | 511 | ||
| Types of Prosthetic Valves | 511 | ||
| Doppler Echocardiography for Prosthetic Valves | 513 | ||
| Color-Flow Doppler | 515 | ||
| Mitral Valve | 519 | ||
| Normal Anatomic and Functional Features of the Native Valve | 519 | ||
| Prosthetic or Repaired Mitral Valve | 519 | ||
| The Echocardiographic Examination | 524 | ||
| Mitral Regurgitation | 531 | ||
| Assessing Severity of Regurgitant Flow | 536 | ||
| Surgical Indications | 538 | ||
| Mitral Stenosis | 539 | ||
| Surgical Indications | 544 | ||
| Aortic Valve | 544 | ||
| Normal Anatomic and Functional Features of the Native Valve | 544 | ||
| Prosthetic or Repaired Aortic Valve | 545 | ||
| Echocardiographic Examination | 546 | ||
| Aortic Regurgitation | 548 | ||
| Aortic Valve Regurgitation of the Prosthetic or Repaired Valve | 558 | ||
| Surgical Indications | 559 | ||
| Aortic Stenosis | 559 | ||
| Prosthetic Valve Aortic Stenosis | 561 | ||
| Miscellaneous Issues | 564 | ||
| Surgical or Procedural Intervention | 564 | ||
| Tricuspid Valve | 564 | ||
| Normal Anatomic and Functional Features | 564 | ||
| Prosthetic or Repaired Tricuspid Valve | 564 | ||
| The Echocardiographic Examination | 566 | ||
| Tricuspid Regurgitation | 568 | ||
| Surgical Indications (Fig. 15.89) | 574 | ||
| Tricuspid Stenosis | 575 | ||
| Surgical Indications | 576 | ||
| Pulmonary Valve | 576 | ||
| Normal Anatomic and Functional Features | 576 | ||
| Echocardiographic Examination | 577 | ||
| Pulmonary Valve Insufficiency | 578 | ||
| Pulmonary Valve Stenosis | 580 | ||
| Transesophageal Echocardiography for Interventional Procedures | 583 | ||
| Organizing a Transesophageal Echocardiography Service for the Interventional Suite | 583 | ||
| Role of the Echocardiographer on the Interventional Team | 583 | ||
| Echocardiographic Equipment and Setup | 583 | ||
| Transesophageal Echocardiography Evaluation During Specific Procedures | 584 | ||
| Interatrial Transseptal Puncture | 584 | ||
| Echocardiographic Assessment | 584 | ||
| Patent Foramen Ovale Closure | 585 | ||
| IV Anesthesia for Cardiac Surgical Procedures | 729 | ||
| 20 Anesthesia for Myocardial Revascularization | 731 | ||
| Key Points | 731 | ||
| Epidemiology | 731 | ||
| Pathophysiology of Coronary Artery Disease | 731 | ||
| Anatomy | 731 | ||
| Myocardial Ischemia and Infarction | 733 | ||
| Risk Assessment in Patients Scheduled for Coronary Artery Bypass Grafting | 734 | ||
| Anesthesia for Coronary Artery Bypass Grafting | 736 | ||
| Premedication | 736 | ||
| Anxiolysis, Amnesia, and Analgesia | 736 | ||
| Management of Preoperative Medications | 737 | ||
| β-Blocking Agents | 737 | ||
| Antiplatelet Drugs | 738 | ||
| HMG CoA Reductase Inhibitors | 738 | ||
| Angiotensin-Converting Enzyme Inhibitors | 739 | ||
| Calcium Channel Antagonists | 739 | ||
| Monitoring | 739 | ||
| Electrocardiogram | 739 | ||
| Arterial Pressure Monitoring | 739 | ||
| Central Venous Cannulation | 739 | ||
| Pulmonary Artery Catheterization | 740 | ||
| Transesophageal Echocardiography | 740 | ||
| Neuromonitoring | 742 | ||
| Cerebral Oximetry | 742 | ||
| Processed Electroencephalography Monitoring | 742 | ||
| Induction and Maintenance of General Anesthesia | 742 | ||
| Anesthetic Agents | 742 | ||
| Inhalation Anesthetics and Myocardial Protection | 745 | ||
| Role of Central Neuraxial Blockade | 747 | ||
| Myocardial Ischemia in Patients Undergoing Revascularization Surgery | 749 | ||
| Intraoperative Treatment of Myocardial Ischemia | 749 | ||
| Intravenous Nitroglycerin | 749 | ||
| Calcium Channel Antagonists | 750 | ||
| β-Blockers | 751 | ||
| Weaning Patients From Cardiopulmonary Bypass After Coronary Revascularization | 751 | ||
| The Immediate Postoperative Period | 751 | ||
| Sedation | 751 | ||
| Coronary Artery and Arterial Conduit Spasm | 752 | ||
| Fast-Track Management for Coronary Artery Bypass Grafting | 754 | ||
| Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass | 755 | ||
| Introduction and Surgical Considerations | 755 | ||
| Cardiovascular Effects of Off-Pump Coronary Artery Bypass Grafting | 755 | ||
| Specific Anesthetic Considerations in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting | 756 | ||
| Outcomes for Off-Pump Coronary Artery Bypass Grafting | 758 | ||
| Minimally Invasive Coronary Artery Surgery | 760 | ||
| Conclusions | 761 | ||
| References | 761 | ||
| 21 Valvular Heart Disease | 770 | ||
| Key Points | 770 | ||
| Pathophysiology | 771 | ||
| Pressure-Volume Loops | 771 | ||
| Afterload Stress and Preload Reserve | 771 | ||
| Ventricular Compliance | 772 | ||
| Contractility | 774 | ||
| Aortic Stenosis | 774 | ||
| Clinical Features and Natural History | 774 | ||
| Pathophysiology | 778 | ||
| Difficulty of Low-Gradient, Low-Output Aortic Stenosis | 781 | ||
| Developments in the Hemodynamic Management of Critical Aortic Stenosis Patients | 781 | ||
| Timing of Intervention | 781 | ||
| Anesthesia Considerations | 783 | ||
| Noncardiac Surgery in the Patient With Aortic Stenosis | 785 | ||
| Hypertrophic Cardiomyopathy | 785 | ||
| Hypertrophic Obstructive Cardiomyopathy | 785 | ||
| Clinical Features and Natural History | 786 | ||
| Pathophysiology | 786 | ||
| Anesthesia Considerations | 789 | ||
| Aortic Regurgitation | 790 | ||
| Clinical Features and Natural History | 790 | ||
| Pathophysiology | 790 | ||
| Surgical Decision Making | 792 | ||
| Acute Aortic Regurgitation | 793 | ||
| Anesthesia Considerations | 793 | ||
| Mitral Regurgitation | 794 | ||
| Clinical Features and Natural History | 794 | ||
| Pathophysiology | 794 | ||
| Ischemic Mitral Regurgitation | 795 | ||
| Assessment of Mitral Regurgitation | 796 | ||
| Surgical Decision Making | 796 | ||
| Minimally Invasive Mitral Valve Surgery | 797 | ||
| Anesthesia Considerations | 799 | ||
| Mitral Stenosis | 802 | ||
| Clinical Features and Natural History | 802 | ||
| Pathophysiology | 802 | ||
| Assessment of Mitral Stenosis | 804 | ||
| Surgical Decision Making | 804 | ||
| Anesthesia Considerations | 804 | ||
| Tricuspid Regurgitation | 805 | ||
| Clinical Features and Natural History | 805 | ||
| Surgical Decision Making | 806 | ||
| Anesthesia Considerations | 807 | ||
| Innovations in Valve Repair | 807 | ||
| Aortic Valve Repair | 807 | ||
| Sutureless Valve Replacement | 807 | ||
| New Techniques for Mitral Valve Repair | 808 | ||
| Altering Ventricular Anatomy to Reduce Mitral Regurgitation | 808 | ||
| Percutaneous Valve Replacement | 808 | ||
| Case Study 1: Transapical Aortic Valve Implantation | 809 | ||
| Framing | 809 | ||
| Medical and Surgical History | 809 | ||
| Current Medications | 809 | ||
| Vital Signs | 809 | ||
| Laboratory Results | 809 | ||
| Data Collection and Interpretation | 809 | ||
| Computed Tomography Without Contrast of the Chest, Abdomen, and Pelvis | 809 | ||
| Cardiac Catheterization and Percutaneous Transluminal Coronary Angioplasty Summary | 809 | ||
| Description of Operation | 810 | ||
| Discussion | 810 | ||
| Case Study 2: Robotically Assisted Mitral Valve Repair | 810 | ||
| Framing | 810 | ||
| Data Collection and Interpretation | 810 | ||
| Decision Making and Reassessment | 811 | ||
| Case Study 3: Mitral Valve Repair With Systolic Anterior Motion After Bypass Needing Additional Repair | 811 | ||
| References | 811 | ||
| 22 Congenital Heart Disease in Adults | 818 | ||
| Key Points | 818 | ||
| Noncardiac Surgery in Adults With Congenital Heart Disease | 819 | ||
| General Noncardiac Issues With Longstanding Congenital Heart Disease | 819 | ||
| Pulmonary | 820 | ||
| Hematologic | 820 | ||
| Renal | 821 | ||
| Neurologic | 821 | ||
| Vasculature | 821 | ||
| Pregnancy | 821 | ||
| Psychosocial | 822 | ||
| Cardiac Issues | 822 | ||
| Aortic Stenosis | 823 | ||
| Aortopulmonary Shunts | 823 | ||
| Atrial Septal Defect and Partial Anomalous Pulmonary Venous Return | 824 | ||
| Coarctation of the Aorta | 825 | ||
| Congenitally Corrected Transposition of the Great Vessels (l-Transposition, Ventricular Inversion) | 826 | ||
| Ebstein Anomaly of the Tricuspid Valve | 826 | ||
| Eisenmenger Syndrome | 827 | ||
| Endocardial Cushion Defects (Atrioventricular Canal Defects) | 828 | ||
| Fontan Physiology | 829 | ||
| Complications (Box 22.10) | 829 | ||
| The Modern Fontan Operation | 830 | ||
| Preoperative Assessment | 830 | ||
| Ventilatory Management | 831 | ||
| Pregnancy | 832 | ||
| Fontan Conversion Surgery | 832 | ||
| Patent Ductus Arteriosus | 832 | ||
| Pulmonary Valve Stenosis | 833 | ||
| Single Ventricle | 833 | ||
| Tetralogy of Fallot | 833 | ||
| Transposition of the Great Arteries (d-Transposition) | 834 | ||
| Truncus Arteriosus | 835 | ||
| Ventricular Septal Defects | 835 | ||
| Case Study 1: Atrial Septal Defect | 836 | ||
| Framing | 836 | ||
| Data Collection and Interpretation | 836 | ||
| Decision Making and Interpretation | 836 | ||
| Case Study 2: Anomalous Left Main Coronary Artery | 837 | ||
| Framing | 837 | ||
| Data Collection and Interpretation | 838 | ||
| Decision Making and Interpretation | 838 | ||
| References | 839 | ||
| 23 Thoracic Aorta | 843 | ||
| Key Points | 843 | ||
| Anatomy of the Aorta | 843 | ||
| General Considerations for the Perioperative Care of Aortic Surgical Patients | 845 | ||
| Preanesthetic Assessment | 845 | ||
| Preoperative Medications | 846 | ||
| Anesthetic Management | 846 | ||
| Postoperative Care | 847 | ||
| Thoracic Aortic Aneurysm | 847 | ||
| Diagnostic Imaging for Thoracic Aortic Aneurysms | 848 | ||
| Surgical Considerations for Thoracic Aortic Aneurysms | 848 | ||
| Surgical Repair of Ascending Aortic and Arch Aneurysms | 849 | ||
| Anesthetic Management for Ascending Aorta and Arch Aneurysms | 849 | ||
| Neuroprotection Strategies for Temporary Interruption of Cerebral Blood Flow | 849 | ||
| Deep Hypothermic Circulatory Arrest | 850 | ||
| Retrograde Cerebral Perfusion | 854 | ||
| Selective Antegrade Cerebral Perfusion | 855 | ||
| Pharmacologic Neuroprotection Strategies for Deep Hypothermic Circulatory Arrest | 856 | ||
| Descending Thoracic and Thoracoabdominal Aortic Aneurysms | 856 | ||
| Simple Aortic Cross-Clamp Technique | 857 | ||
| Gott Shunt | 857 | ||
| Partial Left-Heart Bypass | 857 | ||
| Cardiopulmonary Bypass With Deep Hypothermic Circulatory Arrest | 858 | ||
| Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms | 858 | ||
| Anesthetic Management for Thoracoabdominal Aortic Aneurysm Repair | 859 | ||
| Lung Isolation Techniques | 859 | ||
| Paraplegia After Thoracoabdominal Aortic Aneurysm Repair | 860 | ||
| Lumbar Cerebrospinal Fluid Drainage | 861 | ||
| Arterial Pressure Augmentation | 862 | ||
| Intraoperative Neurophysiologic Monitoring | 862 | ||
| Spinal Cord Hypothermia | 863 | ||
| Pharmacologic Protection of the Spinal Cord | 864 | ||
| Renal Protection During Thoracoabdominal Aortic Aneurysm Repair | 864 | ||
| Postoperative Analgesia After Thoracoabdominal Aortic Aneurysm Repair | 864 | ||
| Anesthetic Management for Thoracic Endovascular Aortic Repair | 864 | ||
| Aortic Dissection | 864 | ||
| Type A Aortic Dissection | 865 | ||
| Type B Aortic Dissection | 866 | ||
| Aortic Intramural Hematoma | 866 | ||
| Clinical Diagnosis and Imaging Studies for Aortic Dissection | 867 | ||
| Anesthetic Management for Aortic Dissection | 868 | ||
| Surgical Treatment of Stanford Type A Aortic Dissection | 869 | ||
| Integrated Management of Stanford Type B Aortic Dissection | 869 | ||
| Penetrating Atherosclerotic Ulcer | 869 | ||
| Traumatic Aortic Injury | 870 | ||
| Aortic Atheromatous Disease | 871 | ||
| Takayasu Arteritis | 871 | ||
| Aortic Coarctation | 871 | ||
| Illustrative Transesophageal Echocardiography Cases | 872 | ||
| Case Study 1: Thoracic Aortic Atheroma | 872 | ||
| Framing | 872 | ||
| Questions | 872 | ||
| Data Collection | 872 | ||
| Discussion | 873 | ||
| Case Study 2: Acute Thoracic Aortic Dissection | 873 | ||
| Framing | 873 | ||
| Questions | 874 | ||
| Data Collection | 874 | ||
| Discussion | 874 | ||
| Case Study 3: Thoracic Aortic Transection | 875 | ||
| Framing | 875 | ||
| Clinical Questions | 876 | ||
| Data Collection | 876 | ||
| Discussion | 877 | ||
| Case Study 4: Bicuspid Aortic Valve | 878 | ||
| Framing | 878 | ||
| Questions | 878 | ||
| Data Collection | 878 | ||
| Discussion | 878 | ||
| References | 879 | ||
| 24 Uncommon Cardiac Diseases | 883 | ||
| Key Points | 883 | ||
| Cardiac Tumors | 884 | ||
| Primary Benign Tumors | 885 | ||
| Myxoma | 885 | ||
| Papillary Fibroelastoma | 888 | ||
| Primary Malignant Tumors | 888 | ||
| Metastatic Tumors | 891 | ||
| Anesthetic Considerations | 891 | ||
| Tumors With Systemic Cardiac Manifestations | 894 | ||
| Carcinoid Tumors | 894 | ||
| Anesthetic Considerations | 898 | ||
| Renal Cell Carcinoma | 898 | ||
| Anesthetic Considerations | 899 | ||
| Cardiomyopathy | 901 | ||
| Dilated Cardiomyopathy | 903 | ||
| Anesthetic Considerations | 908 | ||
| Hypertrophic Cardiomyopathy | 909 | ||
| Anesthetic Considerations | 922 | ||
| Restrictive Cardiomyopathy | 924 | ||
| Anesthetic Considerations | 928 | ||
| Arrhythmogenic Right Ventricular Cardiomyopathy | 929 | ||
| Anesthetic Considerations | 931 | ||
| Mitral Valve Prolapse | 932 | ||
| Anesthetic Considerations | 935 | ||
| Case Study 1: Mitral Valve Regurgitation and Septal Hypertrophy | 936 | ||
| Patent Foramen Ovale | 936 | ||
| Anesthesia Considerations | 939 | ||
| Case Study 2: Incidental Patent Foramen Ovale Found During Coronary Artery Bypass Graft Surgery | 939 | ||
| Pulmonary Hemorrhage | 939 | ||
| Pericardial Heart Disease | 941 | ||
| Acute Pericarditis | 941 | ||
| Constrictive Pericarditis | 943 | ||
| Surgical Considerations for Pericardial Disease | 944 | ||
| Anesthetic Considerations | 945 | ||
| Cardiac Tamponade | 945 | ||
| Anesthesia Considerations | 947 | ||
| Case Study 3: Tamponade Case Report | 948 | ||
| Combined Carotid and Coronary Artery Disease | 948 | ||
| Anesthetic Considerations | 951 | ||
| Coronary Arteriovenous Fistula | 951 | ||
| Anesthetic Considerations | 952 | ||
| Case Study 4: Coronary Artery Fistula | 952 | ||
| Cardiac Surgery During Pregnancy | 953 | ||
| Anesthesia Considerations | 954 | ||
| Risks of Human Immunodeficiency Virus Transmission | 955 | ||
| Renal Insufficiency and Cardiac Surgery | 956 | ||
| Anesthesia Considerations | 957 | ||
| Hematologic Problems in Patients Undergoing Cardiac Surgery | 958 | ||
| Hemophilia | 958 | ||
| von Willebrand Disease | 959 | ||
| Antithrombin | 961 | ||
| Cold Agglutinins | 964 | ||
| Sickle Cell Disease | 965 | ||
| Acknowledgments | 967 | ||
| References | 967 | ||
| 25 Anesthesia for Heart, Lung, and Heart-Lung Transplantation | 974 | ||
| Key Points | 974 | ||
| Heart Transplantation | 974 | ||
| Recipient Selection | 974 | ||
| Donor Selection and Graft Harvest | 975 | ||
| Surgical Procedures | 975 | ||
| Orthotopic Heart Transplantation | 975 | ||
| Heterotopic Heart Transplantation | 976 | ||
| Special Situations | 976 | ||
| Pathophysiology Before Transplantation | 977 | ||
| Pathophysiology After Transplantation | 977 | ||
| Anesthetic Management | 977 | ||
| Preoperative Evaluation and Preparation | 977 | ||
| Induction | 978 | ||
| Intraoperative Management | 978 | ||
| Postoperative Management and Complications | 978 | ||
| Pediatric Considerations | 979 | ||
| Lung Transplantation | 980 | ||
| History and Epidemiology | 980 | ||
| Recipient Selection | 981 | ||
| Donor Selection and Graft Harvest | 982 | ||
| Surgical Procedures | 982 | ||
| Single-Lung Transplant | 982 | ||
| Double-Lung Transplant | 982 | ||
| Pathophysiology Before Transplantation | 983 | ||
| Pathophysiology After Lung Transplantation | 984 | ||
| Anesthetic Management | 984 | ||
| Preoperative Evaluation and Preparation | 984 | ||
| Induction of Anesthesia | 985 | ||
| Intraoperative Management | 986 | ||
| Postoperative Management and Complications | 988 | ||
| Living-Related Lung Transplantation | 989 | ||
| Pediatric Considerations | 989 | ||
| Heart-Lung Transplantation | 990 | ||
| History and Epidemiology | 990 | ||
| Recipient Selection | 990 | ||
| Donor Selection and Graft Harvest | 990 | ||
| Surgical Procedures | 990 | ||
| Pathophysiology Before Transplantation | 990 | ||
| Pathophysiology After Transplantation | 990 | ||
| Anesthetic Management | 990 | ||
| Postoperative Management and Complications | 991 | ||
| Pediatric Considerations | 991 | ||
| References | 991 | ||
| 26 Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension | 994 | ||
| Key Points | 994 | ||
| Classification of Pulmonary Hypertension | 994 | ||
| Pathophysiology | 995 | ||
| Clinical Manifestations | 995 | ||
| Diagnostic Evaluation | 997 | ||
| Pulmonary Function Studies | 997 | ||
| Chest Radiography | 997 | ||
| Transthoracic Echocardiography | 998 | ||
| Ventilation/Perfusion Scintigraphy | 998 | ||
| Catheter-Based Pulmonary Angiography | 998 | ||
| Computed Tomography of the Chest | 999 | ||
| Magnetic Resonance Imaging | 1001 | ||
| Evaluation of the Patient With Chronic Thromboembolic Pulmonary Hypertension for Pulmonary Thromboendarterectomy | 1001 | ||
| Operation | 1002 | ||
| Historical Background | 1002 | ||
| Pulmonary Thromboendarterectomy Procedure | 1002 | ||
| Anesthetic Management of Patients Undergoing Pulmonary Thromboendarterectomy | 1006 | ||
| Preoperative Assessment | 1006 | ||
| Hemodynamic Considerations and Anesthetic Induction | 1006 | ||
| Cardiopulmonary Bypass Prime, Cooling and Hypothermic Circulatory Arrest | 1007 | ||
| Rewarming Phase and Separation From Bypass | 1008 | ||
| Management of Airway Bleeding | 1009 | ||
| Management of the Postoperative Patient | 1009 | ||
| Post–Pulmonary Thromboendarterectomy Hemodynamic Management and Persistent Pulmonary Hypertension | 1009 | ||
| Other Pulmonary Considerations and Management of Hypoxemia | 1011 | ||
| Postoperative Thrombosis Prophylaxis and Anticoagulation | 1012 | ||
| Nonsurgical Approach to Chronic Thromboembolic Disease | 1012 | ||
| Pulmonary Hypertension–Targeted Medical Therapy | 1012 | ||
| Percutaneous Balloon Pulmonary Angioplasty | 1014 | ||
| Intraoperative Echocardiography in Patients With Chronic Thromboembolic Pulmonary Hypertension | 1014 | ||
| Pulmonary Thromboendarterectomy in Patients With Sickle Cell Disease | 1018 | ||
| Outcome and Future of Chronic Thromboembolic Pulmonary Hypertension | 1019 | ||
| References | 1019 | ||
| 27 Procedures in the Hybrid Operating Room | 1022 | ||
| Key Points | 1022 | ||
| Technical Considerations | 1022 | ||
| Definition of a Hybrid Operating Room | 1022 | ||
| Equipment and Layout | 1022 | ||
| Imaging Systems | 1023 | ||
| Fluoroscopy | 1023 | ||
| Rotational Angiography | 1023 | ||
| Digital Subtraction Angiography | 1023 | ||
| Echocardiography | 1023 | ||
| Radiation Safety | 1023 | ||
| Procedures | 1023 | ||
| Transcatheter Aortic Valve Replacement | 1023 | ||
| Patient Selection and Indications | 1023 | ||
| Indication for Aortic Valve Replacement: Surgical or Transcatheter | 1024 | ||
| Risk Assessment and Indication for TAVR | 1024 | ||
| Feasibility of the Procedure for Specific Patients and Choice of Access | 1026 | ||
| Selection of Specific Valve Type and Size for the Patient | 1027 | ||
| Logistical Considerations | 1028 | ||
| Multidisciplinary Team | 1028 | ||
| Anesthetic Management | 1029 | ||
| Anesthetic Technique | 1029 | ||
| Procedure-Related Anesthetic Considerations | 1029 | ||
| Monitoring | 1029 | ||
| Equipment | 1029 | ||
| Rapid Ventricular Pacing | 1029 | ||
| Imaging Techniques and Guidance | 1029 | ||
| Transesophageal Echocardiography | 1030 | ||
| Preprocedural Assessments | 1030 | ||
| Intraprocedural Assessments | 1030 | ||
| Postprocedural Assessments | 1031 | ||
| Conventional Angiography | 1031 | ||
| Intraoperative Fluoroscopy | 1031 | ||
| Digital Subtraction Angiography | 1031 | ||
| Multidetector Computed Tomography | 1031 | ||
| Cardiac Magnetic Resonance | 1031 | ||
| Complications | 1031 | ||
| Vascular Injury | 1032 | ||
| Pericardial Hemorrhage | 1032 | ||
| Conduction System Abnormalities and Arrhythmias | 1032 | ||
| Valve Malpositioning | 1032 | ||
| Stroke | 1032 | ||
| Renal Dysfunction | 1033 | ||
| Future Perspectives for TAVR | 1033 | ||
| Transcatheter Mitral Valve Repair: MitraClip | 1033 | ||
| Patient Selection and Indications | 1033 | ||
| Access Routes | 1034 | ||
| Anesthetic Management | 1034 | ||
| Complications | 1034 | ||
| Imaging Techniques and Guidance | 1034 | ||
| Transcatheter Pulmonary Valve Replacement (Melody Valve) | 1036 | ||
| Patient Selection | 1037 | ||
| Access Route | 1037 | ||
| Complications | 1037 | ||
| Anesthetic Management | 1037 | ||
| Miscellaneous Procedures | 1038 | ||
| Hybrid Coronary Artery Revascularization | 1038 | ||
| Hybrid Arrhythmia Procedures | 1038 | ||
| Implantable Pacemaker and Defibrillator Implantations and Lead Extractions | 1038 | ||
| Endovascular Procedures | 1038 | ||
| Anesthetic Management | 1038 | ||
| References | 1038 | ||
| 28 Mechanical Assist Devices for Heart Failure | 1042 | ||
| Key Points | 1042 | ||
| The Current Era of Mechanical Circulatory Support | 1042 | ||
| Mechanical Circulatory Support: Theory and Practice | 1043 | ||
| The Role of the Intraaortic Balloon Pump | 1044 | ||
| Implementation of Mechanical Circulatory Support | 1046 | ||
| Short-Term Support | 1047 | ||
| Possible Outcomes From Short-Term VAD Support | 1048 | ||
| Available Devices for Short-Term Support | 1048 | ||
| CentriMag | 1048 | ||
| Bridge to Immediate Survival: Concepts and Devices | 1049 | ||
| Extracorporeal Membrane Oxygenation | 1049 | ||
| Impella and TandemHeart | 1050 | ||
| Impella | 1051 | ||
| The TandemHeart | 1051 | ||
| Long-Term Support | 1052 | ||
| HeartMate II | 1052 | ||
| HeartWare HVAD | 1052 | ||
| Complications of Mechanical Circulatory Support | 1052 | ||
| Total Artificial Hearts | 1055 | ||
| The SynCardia Temporary Total Artificial Heart | 1056 | ||
| AbioCor Implantable Replacement Heart | 1056 | ||
| Future of the Total Artificial Heart | 1057 | ||
| Perioperative Anesthetic Considerations for VAD Support | 1057 | ||
| Patients Presenting for Elective LVAD Implantation | 1057 | ||
| Issues Related to Outpatient Medications | 1057 | ||
| Preoperative Nutritional Optimization | 1057 | ||
| The Immediate Preoperative Period | 1057 | ||
| Induction and Maintenance | 1057 | ||
| Monitoring | 1058 | ||
| The Postimplantation Period | 1058 | ||
| Potential Effects of LVAD Support on Right Ventricular Function | 1058 | ||
| Intravascular Volume Status | 1059 | ||
| Afterload and Contractility | 1060 | ||
| Bleeding | 1060 | ||
| The Postimplantation Role of Transesophageal Echocardiography | 1061 | ||
| Anesthetic Considerations for SynCardia Total Artificial Heart Implantation | 1061 | ||
| The Role of Transesophageal Echocardiography Before Cardiopulmonary Bypass for Total Artificial Heart Implantation | 1061 | ||
| Conclusion | 1061 | ||
| References | 1061 | ||
| 29 Reoperative Cardiac Surgery | 1064 | ||
| Key Points | 1064 | ||
| Reoperative Cardiac Surgery | 1064 | ||
| Indications for Reoperative Cardiac Surgery | 1064 | ||
| Preoperative Assessment | 1064 | ||
| History | 1064 | ||
| Clinical Examination | 1065 | ||
| Imaging | 1065 | ||
| Before Induction | 1066 | ||
| Days Before Induction | 1066 | ||
| Immediately Before Induction | 1066 | ||
| Anesthesia | 1066 | ||
| Before Incision | 1067 | ||
| Incision | 1067 | ||
| Cannulation | 1067 | ||
| Cardiopulmonary Bypass | 1068 | ||
| Myocardial Protection | 1068 | ||
| Surgical Strategy | 1069 | ||
| Weaning From Bypass | 1069 | ||
| Coagulation Management | 1069 | ||
| Intraoperative Emergency Scenarios | 1069 | ||
| Results of Reoperative Surgery | 1070 | ||
| Emergency Reexploration | 1070 | ||
| Indications | 1070 | ||
| General Considerations | 1070 | ||
| Location of Resternotomy | 1070 | ||
| Performing Emergency Resternotomy | 1071 | ||
| Conclusion | 1071 | ||
| References | 1071 | ||
| 30 Patient Safety in the Cardiac Operating Room | 1072 | ||
| Key Points | 1072 | ||
| The Science of Safety | 1073 | ||
| Evidence-Based Best Practice | 1074 | ||
| Human Error | 1075 | ||
| Theory of Human Error | 1075 | ||
| Taxonomy of Errors | 1077 | ||
| Personal Readiness (Fatigue, Stress) | 1077 | ||
| Vigilance While Performing Transesophageal Echocardiograms | 1081 | ||
| Violations | 1081 | ||
| Teamwork and Communication | 1082 | ||
| Measurement | 1082 | ||
| Disruptions, Distractions, Major and Minor Events | 1083 | ||
| Equipment and Alarms | 1083 | ||
| Teamwork | 1085 | ||
| Communication | 1086 | ||
| Interventions to Improve Patient Safety | 1087 | ||
| Teamwork Training | 1087 | ||
| Checklists and Briefings | 1088 | ||
| Debriefings and Learning From Defects | 1091 | ||
| Structured Communication Protocols (Closed Loop, Handoff Protocols) | 1091 | ||
| Simulation | 1091 | ||
| Medication Safety | 1092 | ||
| Drug Errors | 1092 | ||
| Prevention of Drug Administration Errors | 1095 | ||
| Transfusion Safety | 1096 | ||
| Prevention of Intraoperative Awareness | 1096 | ||
| Reducing System Vulnerability | 1099 | ||
| Single Center Interventions | 1099 | ||
| Multicenter Collaboratives | 1100 | ||
| Culture of Safety | 1100 | ||
| Organizational Culture | 1100 | ||
| Effect of Organizational Culture on Outcome | 1101 | ||
| Improving Organizational Culture | 1102 | ||
| Developing a Just Culture | 1102 | ||
| References | 1102 | ||
| V Extracorporeal Circulation | 1109 | ||
| 31 Cardiopulmonary Bypass Management and Organ Protection | 1111 | ||
| Key Points | 1111 | ||
| Historical Perspective on Cardiopulmonary Bypass | 1111 | ||
| Goals and Mechanics of Cardiopulmonary Bypass | 1112 | ||
| Physiologic Parameters of Cardiopulmonary Bypass | 1112 | ||
| End-Organ Effects of Cardiopulmonary Bypass | 1112 | ||
| Central Nervous System Injury | 1113 | ||
| Incidence and Significance of Injury | 1113 | ||
| Risk Factors for Central Nervous System Injury | 1113 | ||
| Causes of Perioperative Central Nervous System Injury | 1115 | ||
| Cerebral Embolization | 1115 | ||
| Global Cerebral Hypoperfusion | 1115 | ||
| Temperature-Related Factors | 1116 | ||
| Inflammation | 1116 | ||
| Cerebral Edema | 1116 | ||
| Blood-Brain Barrier Dysfunction | 1116 | ||
| Possible Pharmacologic Influences | 1116 | ||
| Genetic Influences | 1116 | ||
| Neuroprotective Strategies | 1117 | ||
| Emboli Reduction | 1117 | ||
| Management of Aortic Atherosclerosis | 1117 | ||
| Pulsatile Perfusion | 1118 | ||
| Acid-Base Management: Alpha-Stat Versus pH-Stat | 1118 | ||
| Temperature and Rewarming Strategies | 1119 | ||
| Mean Arterial Pressure Management During Cardiopulmonary Bypass | 1119 | ||
| Glucose Management | 1120 | ||
| Off-Pump Cardiac Surgery | 1120 | ||
| Pharmacologic Neuroprotection | 1121 | ||
| Thiopental | 1121 | ||
| Propofol | 1122 | ||
| Acadesine | 1122 | ||
| Aprotinin | 1122 | ||
| Nimodipine | 1122 | ||
| GM1 Ganglioside | 1122 | ||
| Dextromethorphan | 1122 | ||
| Remacemide | 1122 | ||
| Lidocaine | 1123 | ||
| β-Blockers | 1123 | ||
| Pegorgotein | 1123 | ||
| C5 Complement Inhibitor: Pexelizumab | 1123 | ||
| Platelet-Activating Factor Antagonist: Lexiphant | 1123 | ||
| Clomethiazole | 1123 | ||
| Steroids | 1123 | ||
| Ketamine | 1123 | ||
| Acute Kidney Injury | 1124 | ||
| Clinical Course, Incidence, and Significance | 1124 | ||
| Risk Factors and Surgery-Related Acute Kidney Injury Pathophysiology | 1125 | ||
| Strategies for Renal Protection | 1127 | ||
| Early Acute Kidney Injury Biomarkers | 1127 | ||
| Cardiopulmonary Bypass Management and the Kidney | 1128 | ||
| Pharmacologic Intervention | 1128 | ||
| Dopamine | 1128 | ||
| Fenoldopam | 1129 | ||
| Diuretic Agents | 1129 | ||
| N-Acetylcysteine | 1129 | ||
| Adrenergic Agonists | 1129 | ||
| Calcium Channel Blockers | 1129 | ||
| Sodium Bicarbonate | 1130 | ||
| Angiotensin-Converting Enzyme Inhibitor and Angiotensin I Receptor Blockers | 1130 | ||
| Insulin-Like Growth Factor | 1130 | ||
| Alternate Perioperative Renoprotective Strategies | 1130 | ||
| Myocardial Injury | 1130 | ||
| Incidence and Significance of Myocardial Dysfunction After Cardiopulmonary Bypass | 1130 | ||
| Risk Factors for Myocardial Injury | 1130 | ||
| Pathophysiology of Myocardial Injury | 1130 | ||
| Myocardial Protection During Cardiac Surgery: Cardioplegia | 1131 | ||
| Composition of Cardioplegia Solutions | 1132 | ||
| Cardioplegia Temperature | 1132 | ||
| Cardioplegia Delivery Routes | 1133 | ||
| Ischemic Preconditioning | 1133 | ||
| Gastrointestinal Complications | 1134 | ||
| Incidence and Significance | 1134 | ||
| Risk Factors | 1134 | ||
| Pathophysiology and Causative Factors | 1134 | ||
| Protecting the Gastrointestinal Tract During Cardiac Surgery | 1135 | ||
| Cardiopulmonary Bypass Management | 1135 | ||
| Emboli Reduction | 1135 | ||
| Drugs | 1135 | ||
| Selective Gastrointestinal Decontamination | 1135 | ||
| Off-Pump Cardiac Surgery | 1135 | ||
| Antiinflammatory Therapies | 1135 | ||
| Lung Injury During Cardiac Surgery | 1135 | ||
| Incidence and Significance | 1135 | ||
| Risk Factors for Pulmonary Dysfunction | 1136 | ||
| Pathophysiology and Causative Factors | 1136 | ||
| Pulmonary Thromboembolism | 1136 | ||
| Pulmonary Protection | 1137 | ||
| Ventilatory Strategies | 1137 | ||
| Pharmacologic Pulmonary Protection | 1137 | ||
| Steroids | 1137 | ||
| Aprotinin | 1137 | ||
| Nitric Oxide | 1137 | ||
| Management of Bypass | 1138 | ||
| The Prebypass Period | 1138 | ||
| Vascular Cannulation | 1138 | ||
| Arterial Cannulation | 1138 | ||
| Venous Cannulation | 1138 | ||
| Other Preparations | 1139 | ||
| Initiation and Discontinuation of Bypass Support: An Overview | 1140 | ||
| Initiation of Cardiopulmonary Bypass | 1140 | ||
| Uncomplicated Initiation | 1140 | ||
| Hypotension With Onset of Bypass | 1140 | ||
| Pump Flow and Pressure During Bypass | 1140 | ||
| Preparation for Separation | 1141 | ||
| Potential for Patient Awareness | 1141 | ||
| Rewarming | 1141 | ||
| Restoration of Systemic Arterial Pressure to Normothermic Value | 1142 | ||
| Removal of Intracardiac Air | 1143 | ||
| Defibrillation | 1143 | ||
| Restoration of Ventilation | 1143 | ||
| Correction of Metabolic Abnormalities and Arterial Oxygen Saturation | 1144 | ||
| Oxygen-Carrying Capacity | 1144 | ||
| Arterial pH | 1144 | ||
| Electrolytes | 1144 | ||
| Other Final Preparations | 1144 | ||
| Separation From Bypass | 1144 | ||
| Perfusion Emergencies | 1144 | ||
| Arterial Cannula Malposition | 1145 | ||
| Aortic or Arterial Dissection | 1145 | ||
| Massive Arterial Gas Embolus | 1146 | ||
| Venous Air Lock | 1146 | ||
| Reversed Cannulation | 1146 | ||
| Special Patient Populations | 1147 | ||
| Care of the Gravid Patient During Bypass | 1147 | ||
| Considerations Before Bypass | 1147 | ||
| Premedication and Patient Positioning | 1147 | ||
| Maternal and Fetal Monitor Information | 1147 | ||
| Conducting the Bypass Procedure | 1148 | ||
| Blood Flow | 1148 | ||
| Blood Pressure | 1148 | ||
| Temperature | 1148 | ||
| Accidental Hypothermia | 1149 | ||
| Patient Selection | 1149 | ||
| Caring for the Accidental Hypothermia Victim | 1149 | ||
| Intracranial Aneurysm Surgery | 1150 | ||
| Minimally Invasive Surgery and Cardiopulmonary Bypass | 1150 | ||
| Port-Access Bypass Circuit | 1150 | ||
| Monitoring for Endovascular Clamp Bypass | 1150 | ||
| Port-Access Cardiac Surgery Outcome Data | 1151 | ||
| References | 1152 | ||
| 32 Extracorporeal Devices and Related Technologies | 1162 | ||
| Key Points | 1162 | ||
| Mechanical Devices | 1163 | ||
| Blood Pumps | 1163 | ||
| Positive Displacement Pumps | 1163 | ||
| Centrifugal Pumps | 1165 | ||
| Safety Mechanisms for Extracorporeal Flow | 1168 | ||
| Electronic Perfusion Records | 1169 | ||
| Extracorporeal Circuitry | 1171 | ||
| Blood Gas Exchange Devices | 1171 | ||
| Venous and Cardiotomy Reservoirs | 1174 | ||
| Miniaturized Cardiopulmonary Bypass | 1174 | ||
| Portable Cardiopulmonary Support Systems | 1175 | ||
| Heat Exchangers | 1176 | ||
| Cooler/Heater Units | 1179 | ||
| Arterial Line Filters | 1179 | ||
| Cannulae and Tubing | 1179 | ||
| Cardioplegia Delivery | 1182 | ||
| Disposable Cardioplegia Circuits | 1183 | ||
| Cardioplegic Delivery Catheters | 1184 | ||
| Antegrade Aortic Root Cardioplegia | 1184 | ||
| Retrograde Coronary Sinus Cardioplegia | 1185 | ||
| Cardioplegia Delivery Systems | 1186 | ||
| The Heart-Lung Machine Priming Solutions | 1186 | ||
| Perioperative Methods of Red Blood Cell Conservation | 1188 | ||
| Preoperative Donation | 1188 | ||
| Plasmapheresis | 1188 | ||
| Autologous Priming Techniques | 1189 | ||
| Perioperative Salvage and Autotransfusion | 1189 | ||
| Cardiotomy Suction | 1189 | ||
| Cell Salvaging Through Centrifugation and Washing Techniques | 1189 | ||
| Postoperative Shed Mediastinal Blood Collection | 1191 | ||
| Ultrafiltration | 1192 | ||
| Modified Ultrafiltration | 1193 | ||
| Coated Circuits | 1194 | ||
| Perfusion Practices | 1195 | ||
| Minimally Invasive Cardiac Surgery | 1195 | ||
| Monitoring During Cardiopulmonary Bypass | 1197 | ||
| Pulsatile Versus Nonpulsatile Flow | 1199 | ||
| Methods of Extracorporeal Circulation | 1200 | ||
| Left-Heart Bypass | 1200 | ||
| Cerebral Protection During Circulatory Arrest | 1201 | ||
| Deep Hypothermic Circulatory Arrest | 1201 | ||
| Retrograde Cerebral Perfusion | 1202 | ||
| Selective Cerebral Perfusion | 1202 | ||
| Communication and Teamwork | 1203 | ||
| Perfusion Simulation | 1205 | ||
| Summary | 1206 | ||
| References | 1207 | ||
| 33 Extracorporeal Membrane Oxygenation | 1214 | ||
| Key Points | 1214 | ||
| History, Evolution, and Current Status of ECMO | 1214 | ||
| ECMO Physiology and Gas Exchange | 1215 | ||
| Management of Venoarterial ECMO | 1217 | ||
| ECMO for Hemodynamic Support | 1217 | ||
| Cannulation for Venoarterial ECMO | 1217 | ||
| Initiation of Venoarterial ECMO | 1218 | ||
| Weaning From Venoarterial ECMO | 1218 | ||
| Management of Venovenous ECMO | 1219 | ||
| Indications for Venovenous ECMO | 1219 | ||
| Contraindications for Venovenous ECMO | 1220 | ||
| Venovenous ECMO Cannulation Strategies | 1220 | ||
| Care of Patients on Venovenous ECMO | 1221 | ||
| Initial Venovenous ECMO Management | 1221 | ||
| Weaning From Venovenous ECMO | 1222 | ||
| Expanded Indications for Venovenous ECMO | 1222 | ||
| ECMO in Thoracic Surgery | 1223 | ||
| Venovenous ECMO in Accidental Hypothermia | 1223 | ||
| Venovenous ECMO in Pulmonary Hypertension | 1223 | ||
| Venovenous ECMO as a Bridge to Lung Transplantation | 1224 | ||
| Awake ECMO | 1224 | ||
| Complications of Venovenous ECMO | 1225 | ||
| Anticoagulation for ECMO | 1225 | ||
| Complications in ECMO | 1225 | ||
| Circuit-Related Complications | 1225 | ||
| Patient-Related Complications | 1226 | ||
| Summary | 1226 | ||
| References | 1226 | ||
| 34 Blood and Fluid Management During Cardiac Surgery | 1229 | ||
| Key Points | 1229 | ||
| Transfusion Guidelines | 1229 | ||
| Rationale for Guidelines | 1229 | ||
| Formulation of Guidelines | 1229 | ||
| Implementation of Guidelines | 1230 | ||
| Blood Groups and Transfusion | 1230 | ||
| ABO Blood Groups | 1230 | ||
| Rhesus Blood Groups | 1231 | ||
| Other Blood Groups | 1231 | ||
| Crossmatching | 1231 | ||
| Complications of Transfusion | 1233 | ||
| Immediate Immune-Mediated Complications | 1233 | ||
| Delayed Immune-Mediated Complications | 1233 | ||
| Nonimmune Complications | 1233 | ||
| Transfusion and Morbidity Outcomes | 1233 | ||
| Morbidity and Mortality | 1233 | ||
| Length of Storage Duration and Morbidity | 1233 | ||
| Genetic Causes of Hemorrhage | 1233 | ||
| Variation in Coagulation Protein Levels | 1234 | ||
| Hemophilias | 1234 | ||
| Von Willebrand Disease | 1235 | ||
| Factor V | 1236 | ||
| Cold Agglutinins | 1236 | ||
| Variation in Platelet Count and Volume | 1237 | ||
| Bleeding After Cardiac Surgery | 1237 | ||
| Reoperation for Bleeding | 1237 | ||
| Ratios in Resuscitation: Implications for Massive Transfusion in Cardiac Surgery | 1237 | ||
| Replacement Therapy | 1239 | ||
| Factor VIIa | 1239 | ||
| Fibrinogen Concentrates | 1239 | ||
| Factor XIII | 1240 | ||
| Prothrombin Complex Concentrates | 1240 | ||
| Volume Replacement: Colloids and Crystalloids | 1240 | ||
| Blood Substitutes | 1242 | ||
| Lowest Hematocrit on Cardiopulmonary Bypass | 1242 | ||
| Conclusions | 1244 | ||
| References | 1244 | ||
| 35 Transfusion Medicine and Coagulation Disorders | 1248 | ||
| Key Points | 1248 | ||
| Overview of Hemostasis | 1248 | ||
| Protein Coagulation Activations | 1250 | ||
| Coagulation Pathways | 1250 | ||
| Contact Activation | 1250 | ||
| Intrinsic System | 1250 | ||
| Extrinsic System | 1250 | ||
| Common Pathway | 1251 | ||
| Vitamin K | 1251 | ||
| Modulators of the Coagulation Pathway | 1251 | ||
| Deficiency States | 1253 | ||
| Contact Activation | 1253 | ||
| Intrinsic System | 1253 | ||
| Extrinsic System | 1254 | ||
| Common Pathway | 1254 | ||
| Liver Disease | 1254 | ||
| Warfarin | 1254 | ||
| Inherited Thrombotic Disorders | 1254 | ||
| Platelet Function | 1254 | ||
| Platelet Adhesion | 1255 | ||
| Platelet Activation and Aggregation | 1255 | ||
| Platelet Disorders | 1255 | ||
| Prostaglandins and Aspirin | 1256 | ||
| Drug-Induced Platelet Abnormalities | 1256 | ||
| Adhesion Inhibitors | 1257 | ||
| Adenosine Diphosphate Receptor Antagonists | 1257 | ||
| Glycoprotein IIb/IIIa Receptor Inhibitors | 1257 | ||
| Vascular Endothelium | 1257 | ||
| Fibrinolysis | 1258 | ||
| Extrinsic Fibrinolysis | 1258 | ||
| Intrinsic Fibrinolysis | 1258 | ||
| Exogenous Activators | 1258 | ||
| Clinical Applications | 1258 | ||
| Heparin | 1258 | ||
| Pharmacology | 1258 | ||
| Chemical Structure | 1258 | ||
| Heparin Versus Heparan | 1259 | ||
| Source and Biologic Role | 1259 | ||
| Potency | 1259 | ||
| Pharmacokinetics and Pharmacodynamics | 1259 | ||
| Actions and Interactions | 1260 | ||
| Bovine Versus Porcine Preparations | 1261 | ||
| Heparin Resistance | 1261 | ||
| Mechanism | 1261 | ||
| Treatment | 1261 | ||
| Heparin Rebound | 1262 | ||
| Incidence and Timing | 1262 | ||
| Treatment and Prevention | 1262 | ||
| Heparin Effects Other Than Anticoagulation | 1262 | ||
| Heparin-Induced Thrombocytopenia | 1263 | ||
| Mechanism | 1263 | ||
| Incidence and Diagnosis | 1264 | ||
| Heparin-Induced Thrombocytopenia With Thrombosis | 1265 | ||
| Treatment and Prevention | 1265 | ||
| Alternative Modes of Anticoagulation | 1265 | ||
| Ancrod | 1265 | ||
| Low-Molecular-Weight Heparins | 1266 | ||
| Heparinoids | 1266 | ||
| Direct Thrombin Inhibitors | 1267 | ||
| New Oral Anticoagulants | 1269 | ||
| Nonthrombogenic Surface | 1269 | ||
| Protamine | 1269 | ||
| Pharmacology | 1269 | ||
| History | 1269 | ||
| Source and Preparation | 1270 | ||
| Uses and Actions | 1270 | ||
| Administration, Distribution, and Fate | 1270 | ||
| Dosage | 1270 | ||
| Adverse Reactions | 1272 | ||
| Rapid Administration | 1272 | ||
| Peripheral Cardiovascular Changes | 1272 | ||
| Effects on Cardiac Inotropy | 1272 | ||
| Left-Sided Injection | 1272 | ||
| Platelet Reactions | 1272 | ||
| Anaphylactoid Reaction | 1272 | ||
| Allergy, Anaphylaxis, and Adverse Responses | 1272 | ||
| Diabetes Mellitus | 1273 | ||
| Prior Exposure to Protamine | 1273 | ||
| Fish Allergy | 1273 | ||
| Vasectomy | 1273 | ||
| Noncardiogenic Pulmonary Edema | 1273 | ||
| Pulmonary Vasoconstriction | 1274 | ||
| Clinical Features | 1274 | ||
| Proposed Mechanism | 1274 | ||
| Treatment and Prevention | 1274 | ||
| Guidelines for Clinical Use | 1274 | ||
| Patients With Diabetes | 1275 | ||
| Vasectomy and Patients With Fish Allergy | 1275 | ||
| Prior Reaction to Protamine | 1275 | ||
| Alternatives to Protamine | 1275 | ||
| Hexadimethrine | 1275 | ||
| Platelet Factor 4 | 1276 | ||
| Interposed Filters | 1276 | ||
| Methylene Blue | 1276 | ||
| Omit Neutralization | 1276 | ||
| Heparinase | 1276 | ||
| Designer Polycations | 1276 | ||
| Bleeding Patient | 1276 | ||
| Patient Factors | 1276 | ||
| Insult of Cardiopulmonary Bypass | 1277 | ||
| Fibrinolysis | 1277 | ||
| Platelet Dysfunction | 1277 | ||
| Clotting Factors | 1277 | ||
| Hypothermia | 1278 | ||
| Prevention of Bleeding | 1278 | ||
| Preoperative Factors | 1278 | ||
| Physical Factors | 1278 | ||
| Pharmacologic Factors | 1278 | ||
| Heparin and Protamine | 1278 | ||
| Desmopressin | 1279 | ||
| Synthetic Antifibrinolytics | 1279 | ||
| Aprotinin | 1280 | ||
| Management of the Bleeding Patient | 1281 | ||
| Risks of Coagulation Products | 1281 | ||
| Determine the Cause | 1282 | ||
| Adjunctive Therapy | 1284 | ||
| Warming | 1284 | ||
| Positive End-Expiratory Pressure | 1284 | ||
| Blood Pressure | 1284 | ||
| References | 1284 | ||
| 36 Discontinuing Cardiopulmonary Bypass | 1291 | ||
| Key Points | 1291 | ||
| General Preparations | 1291 | ||
| Temperature | 1291 | ||
| Laboratory Results | 1292 | ||
| Preparing the Lungs | 1292 | ||
| Preparing the Heart | 1292 | ||
| Management of Intracardiac Air | 1292 | ||
| Heart Rate | 1293 | ||
| Rhythm | 1293 | ||
| Preload | 1294 | ||
| Contractility | 1294 | ||
| Afterload | 1295 | ||
| Final Considerations and Preparations | 1295 | ||
| Routine Weaning From Cardiopulmonary Bypass | 1295 | ||
| Pharmacologic Management of Ventricular Dysfunction | 1297 | ||
| Sympathomimetic Amines | 1297 | ||
| Epinephrine | 1298 | ||
| Dobutamine | 1299 | ||
| Dopamine | 1299 | ||
| Norepinephrine | 1300 | ||
| Isoproterenol | 1300 | ||
| Phosphodiesterase Inhibitors | 1300 | ||
| Calcium Sensitizers | 1301 | ||
| Vasodilators | 1301 | ||
| Vasoplegic Syndrome and Cardiopulmonary Bypass | 1302 | ||
| Vasopressin | 1302 | ||
| Methylene Blue | 1302 | ||
| Additional Pharmacologic Therapy | 1302 | ||
| Controversial Older Treatments | 1303 | ||
| Emerging Intravenous Drugs for Heart Failure and Cardiogenic Shock | 1303 | ||
| Natriuretic Peptide | 1303 | ||
| Istaroxime | 1303 | ||
| Omecamtiv Mecarbil | 1304 | ||
| Pharmacogenetics and Genotyping: the Rational Basis for Individualized Therapy | 1304 | ||
| Intraaortic Balloon Pump Counterpulsation | 1304 | ||
| Indications and Contraindications | 1304 | ||
| Insertion Techniques | 1304 | ||
| Timing and Weaning | 1305 | ||
| Complications | 1306 | ||
| References | 1307 | ||
| VI Postoperative Care | 1311 | ||
| 37 Fast-Track Postoperative Cardiac Recovery and Outcomes | 1313 | ||
| Key Points | 1313 | ||
| Fast-Track Cardiac Surgical Care | 1313 | ||
| Anesthetic Techniques | 1313 | ||
| Evidence Supporting Fast-Track Cardiac Recovery | 1314 | ||
| Post–Cardiac Surgical Recovery Models | 1315 | ||
| Initial Management of Patients in Fast-Track Cardiac Anesthesia: The First 24 Hours | 1315 | ||
| Ventilation Management: Admission to Tracheal Extubation | 1316 | ||
| Optimizing Hemoglobin Concentrations | 1316 | ||
| Management of Bleeding | 1316 | ||
| Electrolyte Management | 1317 | ||
| Glucose Management | 1317 | ||
| Pain Control | 1318 | ||
| Regional Analgesia Techniques | 1318 | ||
| Intrathecal Morphine | 1318 | ||
| Thoracic Epidural Analgesia | 1318 | ||
| Nonsteroidal Antiinflammatory Drugs | 1318 | ||
| Medications for Risk Reduction After Coronary Artery Bypass Graft Procedures | 1319 | ||
| Aspirin | 1319 | ||
| β-Blockers | 1319 | ||
| Statins | 1319 | ||
| Anticoagulation for Valve Operations | 1319 | ||
| Management of Postoperative Complications | 1319 | ||
| Stroke | 1320 | ||
| Delirium | 1320 | ||
| Atrial Fibrillation | 1321 | ||
| Left Ventricular Dysfunction | 1321 | ||
| Right Ventricular Dysfunction | 1322 | ||
| Renal Insufficiency | 1322 | ||
| Postoperative Outcomes | 1322 | ||
| Treatment Options for Coronary Artery Disease | 1322 | ||
| Medical Treatment Versus Surgical Management | 1323 | ||
| Balloon Angioplasty Versus Conventional Coronary Artery Bypass Graft Procedures | 1323 | ||
| Stenting Versus Conventional Coronary Artery Bypass Graft Procedures | 1323 | ||
| Off-Pump Coronary Artery Bypass Versus Coronary Artery Bypass Graft Procedures | 1323 | ||
| References | 1324 | ||
| 38 Postoperative Cardiovascular Management | 1327 | ||
| Key Points | 1327 | ||
| Oxygen Transport | 1327 | ||
| Temperature | 1329 | ||
| Assessment of the Circulation | 1329 | ||
| Physical Examination | 1329 | ||
| Invasive Monitoring | 1329 | ||
| Echocardiography | 1330 | ||
| Postoperative Myocardial Dysfunction | 1330 | ||
| Postoperative Myocardial Ischemia | 1330 | ||
| Therapeutic Interventions | 1331 | ||
| Postoperative Arrhythmias | 1331 | ||
| Preload | 1333 | ||
| Contractility | 1333 | ||
| Afterload | 1334 | ||
| Postoperative Hypertension | 1334 | ||
| Postoperative Vasodilation | 1335 | ||
| Coronary Artery Spasm | 1336 | ||
| Decreased Contractility | 1336 | ||
| Catecholamines | 1336 | ||
| Isoproterenol | 1336 | ||
| Epinephrine | 1337 | ||
| Norepinephrine | 1337 | ||
| Dopamine | 1337 | ||
| Dobutamine | 1337 | ||
| Phosphodiesterase Inhibitors | 1337 | ||
| Effects on Vascular Responses | 1337 | ||
| Combination Therapy: Catecholamines and Phosphodiesterase Inhibitors | 1338 | ||
| Dosage and Administration | 1338 | ||
| Amrinone | 1338 | ||
| Milrinone | 1338 | ||
| Enoximone | 1339 | ||
| Levosimendan | 1339 | ||
| Right-Sided Heart Failure | 1339 | ||
| Diagnosis | 1340 | ||
| Treatment | 1341 | ||
| Effects of Mechanical Ventilation in Heart Failure | 1342 | ||
| Effects of Ventilatory Weaning on Heart Failure | 1342 | ||
| Cardiac Tamponade | 1343 | ||
| Transplanted Heart | 1343 | ||
| Advances in Cardiovascular Surgery and Postoperative Management | 1344 | ||
| Postoperative Management of Complications After Transcatheter Aortic Valve Replacement | 1344 | ||
| Vascular Complications | 1344 | ||
| Stroke | 1345 | ||
| Paravalvular Leak | 1345 | ||
| Cardiac Conduction Abnormalities | 1345 | ||
| Impact of Transcatheter Aortic Valve Replacement on the Cardiac Conduction System | 1345 | ||
| Echocardiography in the Cardiothoracic Intensive Care Unit | 1348 | ||
| Miniaturized Transesophageal Echocardiography Probe | 1348 | ||
| Echocardiography During Postoperative Intensive Care Unit Management of Left Ventricular Assist Devices | 1349 | ||
| Right Ventricular Dysfunction After Left Ventricular Assist Device Placement | 1349 | ||
| Echocardiography to Rule Out Obstructive Shock After Left Ventricular Assist Device Placement | 1350 | ||
| Echocardiography in Patients Requiring Extracorporeal Membrane Oxygenation | 1350 | ||
| Venovenous Extracorporeal Membrane Oxygenation | 1350 | ||
| Venoarterial Extracorporeal Membrane Oxygenation | 1350 | ||
| Using Echocardiography to Troubleshoot Common Complications of Venoarterial Extracorporeal Membrane Oxygenation | 1351 | ||
| Weaning and Discontinuing Venoarterial Extracorporeal Membrane Oxygenation | 1352 | ||
| References | 1353 | ||
| 39 Postoperative Respiratory Care | 1358 | ||
| Key Points | 1358 | ||
| Risk Factors for Respiratory Insufficiency | 1359 | ||
| Assessing Risk Based on Preoperative Status | 1359 | ||
| Operating Room Events | 1359 | ||
| Postoperative Events | 1360 | ||
| Diagnosis of Acute Lung Injury and Acute Respiratory Distress Syndrome | 1361 | ||
| Additional Therapy in Patients With Acute Lung Injury or Acute Respiratory Distress Syndrome | 1361 | ||
| Lung Recruitment | 1362 | ||
| Permissive Hypercapnia | 1362 | ||
| Cardiopulmonary Interactions | 1362 | ||
| Pulmonary Hypertension | 1362 | ||
| Extracorporeal Membrane Oxygenation Support | 1362 | ||
| General Support Issues | 1363 | ||
| Impediments to Weaning and Extubation | 1363 | ||
| Neurologic Complications | 1364 | ||
| Cardiac Complications | 1365 | ||
| Utility of Echocardiography in the Intensive Care Unit Setting | 1365 | ||
| Pleural Effusion | 1365 | ||
| Patent Foramen Ovale | 1366 | ||
| Septic Shock | 1366 | ||
| Assessing Preload for Fluid Management | 1366 | ||
| Pericardial Effusion | 1366 | ||
| Renal Failure and Fluid Overload | 1366 | ||
| Infectious Complications | 1366 | ||
| Gastrointestinal Complications | 1366 | ||
| Nutritional Support and Weaning | 1367 | ||
| Modes of Ventilator Support | 1367 | ||
| Pressure-Controlled Ventilation | 1367 | ||
| Pressure-Support Ventilation | 1368 | ||
| Liberation From Mechanical Support (Weaning) | 1369 | ||
| Objective Measures of Patients’ Strength and Endurance | 1369 | ||
| Weaning: The Process | 1369 | ||
| Specific Impediments to Weaning | 1370 | ||
| Ventilator Dyssynchrony | 1370 | ||
| Muscle Weakness and Critical Illness Polyneuropathy | 1370 | ||
| Tracheostomy | 1370 | ||
| Inability to Wean | 1370 | ||
| Conclusions | 1371 | ||
| References | 1371 | ||
| 40 Central Nervous System Dysfunction After Cardiopulmonary Bypass | 1374 | ||
| Key Points | 1374 | ||
| Categorization of Central Nervous System Injury | 1375 | ||
| Early, Delayed, and Late Stroke | 1375 | ||
| Age-Associated Risk for Central Nervous System Injury | 1376 | ||
| Retrospective Versus Prospective Neurologic Assessment | 1376 | ||
| Delirium | 1377 | ||
| Seizures | 1377 | ||
| Neuropsychologic Dysfunction | 1377 | ||
| Neuropsychological Testing | 1378 | ||
| Preoperative Cognitive Function | 1378 | ||
| Neuropsychological Test Selection | 1378 | ||
| Methodologic Issues in Neurobehavioral Assessment | 1378 | ||
| Mechanisms of Brain Injury | 1379 | ||
| Neuropathologic Studies | 1379 | ||
| Watershed Infarctions | 1380 | ||
| Cerebral Emboli and Outcome | 1381 | ||
| Neurocognitive Dysfunction Unrelated to Cerebral Microgaseous Emboli | 1382 | ||
| Cerebrovascular Disease | 1383 | ||
| Cerebral Perfusion Pressure | 1383 | ||
| Cerebral Venous Obstruction | 1384 | ||
| Hemodynamic Instability During Cardiopulmonary Bypass | 1385 | ||
| Aortic Atherosclerosis | 1385 | ||
| Diabetes Mellitus and Hyperglycemia | 1385 | ||
| Cerebral Blood Flow | 1386 | ||
| pH Management and Cerebral Blood Flow | 1386 | ||
| Cerebral Hyperthermia | 1387 | ||
| Cardiopulmonary Bypass Equipment | 1387 | ||
| Minimally Invasive Extracorporeal Circulation | 1389 | ||
| Cerebroprotective Strategies | 1389 | ||
| Risk Assessment | 1389 | ||
| Carotid Endarterectomy | 1390 | ||
| Transesophageal Echocardiography Versus Epiaortic Scanning | 1391 | ||
| “No-Touch” Technique | 1392 | ||
| CO2 Insufflation During Open-Chamber Procedures | 1393 | ||
| Temperature and Coronary Artery Bypass Grafting | 1393 | ||
| Normothermic Cardiopulmonary Bypass | 1393 | ||
| Procedural Risk | 1394 | ||
| Valve Surgery Versus Coronary Artery Bypass Graft Surgery | 1394 | ||
| Circulatory Arrest | 1394 | ||
| Retrograde and Selective Anterograde Cerebral Perfusion | 1394 | ||
| pH Management During Hypothermic Circulatory Arrest | 1395 | ||
| Minimal Access Surgery and Circulatory Support | 1395 | ||
| Development of Minimal Access Surgical Techniques | 1395 | ||
| Off-Pump Coronary Artery Bypass | 1396 | ||
| Endoscopic, Robot-Assisted Coronary Artery Bypass Graft Procedures | 1396 | ||
| Transcatheter Aortic Valve Implantation | 1396 | ||
| MitraClip | 1397 | ||
| Extracorporeal Membrane Oxygenation and Ventricular Assist Device Procedures and Cerebral Dysfunction | 1397 | ||
| Applied Neuromonitoring | 1398 | ||
| Neuromonitoring During Deep Hypothermic Circulatory Arrest | 1398 | ||
| Pharmacologic Cerebral Protection | 1399 | ||
| References | 1401 | ||
| 41 Long-Term Complications and Management | 1407 | ||
| Key Points | 1407 | ||
| Infections After Cardiac Surgery | 1407 | ||
| Device-Related Infections | 1407 | ||
| Cardiac-Implanted Electronic Devices | 1407 | ||
| Ventricular Assist Devices | 1407 | ||
| Intravascular Devices | 1408 | ||
| Sternal Wound Infections | 1408 | ||
| Prosthetic Valve Endocarditis | 1409 | ||
| Systemic Inflammatory Response Syndrome and Sepsis | 1409 | ||
| Pneumonia | 1410 | ||
| Urinary Tract Infection | 1411 | ||
| Clostridium difficile Colitis | 1411 | ||
| Acute Kidney Injury | 1411 | ||
| Incidence of and Risk Factors for Cardiac Surgery–Associated Acute Kidney Injury | 1411 | ||
| Biomarkers | 1412 | ||
| Etiology and Pathogenesis | 1412 | ||
| Prevention | 1412 | ||
| Treatment | 1412 | ||
| Nutritional Support | 1413 | ||
| Who Should Receive Nutritional Support? | 1413 | ||
| Nutritional Assessment | 1413 | ||
| When Should Nutrition Be Initiated? | 1413 | ||
| Via Which Route Should Nutritional Support Be Given? | 1414 | ||
| What Should Nutritional Support Consist Of? | 1414 | ||
| How Much Should Patients Be Fed, and How Is This Determined? | 1415 | ||
| Complications of Transcatheter Aortic Valve Replacement | 1415 | ||
| Mortality After Transcatheter Aortic Valve Replacement | 1415 | ||
| Stroke After Transcatheter Aortic Valve Replacement | 1415 | ||
| Paravalvular Leak After Transcatheter Aortic Valve Replacement | 1416 | ||
| Vascular and Bleeding Complications After Transcatheter Aortic Valve Replacement | 1416 | ||
| Complications of Minimally Invasive Cardiac Surgery | 1416 | ||
| Minimally Invasive Coronary Artery Bypass Graft | 1416 | ||
| Minimally Invasive Aortic Valve Replacement | 1416 | ||
| Minimally Invasive Mitral Valve Surgery | 1417 | ||
| Complications of Mechanical Assist Devices | 1417 | ||
| Long-Term Complications of Ventricular Assist Device Implantation | 1417 | ||
| Device Infection | 1417 | ||
| Device Thrombosis | 1418 | ||
| Gastrointestinal Bleeding | 1418 | ||
| Neurovascular Events | 1418 | ||
| Device Failure | 1418 | ||
| Long-Term Complications of Extracorporeal Membrane Oxygenation | 1418 | ||
| Patient and Family Support, Palliative Care, and End-of-Life Issues | 1419 | ||
| Prognosticating | 1419 | ||
| Palliative Care | 1420 | ||
| Recommendations for Patient and Family Support | 1420 | ||
| Withdrawal of Life-Sustaining Treatments and Palliative Sedation | 1421 | ||
| References | 1421 | ||
| 42 Postoperative Pain Management for the Cardiac Patient | 1425 | ||
| Key Points | 1425 | ||
| Pain and Cardiac Surgery | 1426 | ||
| Potential Clinical Benefits of Adequate Postoperative Analgesia | 1427 | ||
| Techniques Available for Postoperative Analgesia | 1428 | ||
| Local Anesthetic Infiltration | 1428 | ||
| Nerve Blocks | 1430 | ||
| Opioids | 1431 | ||
| Patient-Controlled Analgesia | 1434 | ||
| Nonsteroidal Antiinflammatory Agents | 1435 | ||
| Alpha2-Adrenergic Agonists | 1438 | ||
| Intrathecal and Epidural Techniques | 1439 | ||
| Intrathecal Techniques | 1440 | ||
| Epidural Techniques | 1444 | ||
| Side Effects of Intrathecal and Epidural Local Anesthetics | 1450 | ||
| Side Effects of Intrathecal and Epidural Opioids | 1451 | ||
| Risk for Hematoma Formation | 1451 | ||
| Multimodal Analgesia | 1452 | ||
| How Important Is Postoperative Pain After Cardiac Surgery? | 1453 | ||
| Conclusions | 1453 | ||
| References | 1454 | ||
| VII The Cardiac Patient for Noncardiac Surgery | 1459 | ||
| 43 Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery | 1461 | ||
| Key Points | 1461 | ||
| Preoperative Cardiac Assessment: Categorizing Risk | 1462 | ||
| Preoperative Cardiac Assessment: Risk Model Calculators | 1462 | ||
| Revised Cardiac Risk Index | 1464 | ||
| ACS-NSQIP Universal Surgical Risk Calculator | 1464 | ||
| Gupta MICA ACS-NSQIP Database Risk Model | 1464 | ||
| Perioperative Cardiac Assessment: Algorithmic Approach | 1464 | ||
| Classification of Recommendations | 1467 | ||
| Screening for Myocardial Ischemia: The Electrocardiogram and Troponins | 1468 | ||
| Management of Cardiac Medications | 1468 | ||
| β-Receptor Antagonists | 1468 | ||
| Angiotensin Blockers | 1468 | ||
| Risk of MACE and α2-Agonists | 1468 | ||
| Aspirin Therapy in Patients Without Coronary Stent Implantation | 1468 | ||
| Dual-Antiplatelet Therapy After Coronary Stent Implantation | 1469 | ||
| Anticoagulants: Vitamin K Antagonists and Novel Oral Anticoagulants | 1469 | ||
| Management of Perioperative Anemia | 1469 | ||
| Pulmonary Vascular Disease and Right Ventricular Dysfunction | 1470 | ||
| Summary | 1470 | ||
| References | 1470 | ||
| 44 The Patient With Coronary Stents Undergoing Noncardiac Surgery | 1472 | ||
| Key Points | 1472 | ||
| Optimal Stenting Technique | 1473 | ||
| Types of Stents | 1473 | ||
| Bare Metal Stents | 1473 | ||
| Drug-Eluting Stents | 1473 | ||
| Stent Platform | 1474 | ||
| Polymer Matrix | 1474 | ||
| Antiproliferative Agents | 1475 | ||
| First Generation Drug-Eluting Stents | 1475 | ||
| Second- and Third-Generation Drug-Eluting Stents | 1475 | ||
| Taxus Ion | 1475 | ||
| Zotarolimus Drug-Eluting Stents | 1475 | ||
| Everolimus Drug-Eluting Stents | 1476 | ||
| Differences Between Drug-Eluting Stents | 1476 | ||
| Biodegradable Coronary Stents | 1476 | ||
| Vascular and Biologic Response to Stent Placement | 1476 | ||
| In-Stent Restenosis | 1476 | ||
| Types of Lesions | 1477 | ||
| Clinical Presentation | 1478 | ||
| Treatment | 1478 | ||
| Stent Thrombosis | 1478 | ||
| Definition | 1478 | ||
| Timing | 1479 | ||
| Risk Factors for Stent Thrombosis | 1480 | ||
| Stent Type | 1480 | ||
| Procedure-Related Factors | 1480 | ||
| Lesion-Related Factors | 1480 | ||
| Treatment-Related Factors | 1480 | ||
| Medical Comorbidities | 1480 | ||
| Management | 1480 | ||
| Outcome | 1480 | ||
| Antiplatelet Therapy | 1480 | ||
| Platelet Physiology | 1480 | ||
| Oral Antiplatelet Agents | 1481 | ||
| Aspirin | 1481 | ||
| Adenosine Receptor Antagonists | 1483 | ||
| Clopidogrel | 1483 | ||
| Prasugrel | 1483 | ||
| Ticagrelor | 1483 | ||
| Protease-Activated Receptor 1 Antagonists | 1483 | ||
| Intravenous Antiplatelet Agents | 1485 | ||
| Glycoprotein IIb/IIIa Inhibitors | 1485 | ||
| Abciximab | 1485 | ||
| Eptifibatide | 1485 | ||
| Tirofiban | 1485 | ||
| Adenosine Diphosphate Antagonists | 1485 | ||
| Cangrelor | 1485 | ||
| Long-Term Antiplatelet Management | 1485 | ||
| Dual Antiplatelet Therapy | 1485 | ||
| Triple Antithrombotic Therapy | 1486 | ||
| Variability in Patient Response to Antiplatelet Therapy | 1486 | ||
| Response to Aspirin | 1486 | ||
| Response to Adenosine Antagonists | 1487 | ||
| Platelet Function Tests | 1487 | ||
| Use of Platelet Function Tests | 1488 | ||
| Noncardiac Surgery and Coronary Stents | 1489 | ||
| Surgery as a Prothrombotic State | 1489 | ||
| Limitations of Current Guidelines and Physician Knowledge | 1490 | ||
| Timing of Surgery | 1490 | ||
| Management of Antiplatelet Therapy | 1491 | ||
| Interruption of Antiplatelet Therapy | 1492 | ||
| Continuation of Antiplatelet Therapy and Risk of Hemorrhage | 1493 | ||
| Bridging Therapy | 1494 | ||
| Patients Undergoing Ambulatory Surgery | 1494 | ||
| An Integrated Approach | 1494 | ||
| References | 1494 | ||
| 45 Ventricular Assist Devices, Cardiac Transplants, and Implanted Electrical Devices in Noncardiac Surgery | 1500 | ||
| Key Points | 1500 | ||
| Ventricular Assist Devices | 1500 | ||
| Complications of Ventricular Assist Devices | 1501 | ||
| Infection | 1501 | ||
| Bleeding | 1501 | ||
| Thrombosis | 1502 | ||
| Right Ventricular Failure | 1502 | ||
| Noncardiac Surgery in Patients With Left Ventricular Assist Devices | 1502 | ||
| Physiologic Changes After Left Ventricular Assist Device Placement | 1502 | ||
| Preoperative Evaluation | 1502 | ||
| Monitoring | 1503 | ||
| Intraoperative Management | 1503 | ||
| Laparoscopic Surgery | 1504 | ||
| Cardiopulmonary Resuscitation | 1504 | ||
| Anesthesia for Noncardiac Surgery After Heart Transplantation | 1504 | ||
| Physiology of the Transplanted Heart | 1505 | ||
| Complications After Transplantation | 1505 | ||
| Rejection | 1505 | ||
| Cardiac Allograft Vasculopathy | 1506 | ||
| Infection | 1506 | ||
| Immunosuppression | 1506 | ||
| Interaction of Immunosuppressants With Anesthetics | 1507 | ||
| Perioperative Management | 1507 | ||
| Cardiovascular Implantable Electronic Device Management in Noncardiac Surgery | 1509 | ||
| Pacemakers | 1509 | ||
| Rate Modulation | 1509 | ||
| Automatic Mode Switching | 1510 | ||
| Electrocardiographic Diagnosis of Myocardial Ischemia in Ventricular Paced Rhythms | 1510 | ||
| Automatic Implantable Cardioverter-Defibrillators | 1510 | ||
| Electromagnetic Interference | 1511 | ||
| Potential Adverse Outcomes | 1512 | ||
| Current Recommendations | 1512 | ||
| References | 1513 | ||
| 46 Echocardiography in Noncardiac Surgery | 1515 | ||
| Key Points | 1515 | ||
| Rescue Echocardiography | 1515 | ||
| Acute Valvular Dysfunction | 1516 | ||
| Acute Aortic Disease | 1516 | ||
| Cardiac Tamponade | 1516 | ||
| Right Ventricular Dysfunction | 1518 | ||
| Pulmonary Embolism | 1518 | ||
| Left Ventricular Hypocontractility | 1519 | ||
| Left Ventricular Hypercontractility and Left Ventricular Outflow Tract Obstruction | 1519 | ||
| Hypovolemia and Low Afterload | 1520 | ||
| Stroke Volume Assessment | 1520 | ||
| Dynamic Indicators of Hypovolemia | 1521 | ||
| Transesophageal Echocardiography as a Monitor in Noncardiac Surgical Procedures | 1522 | ||
| An Argument for Use as a Monitor in Noncardiac Cases | 1522 | ||
| Transesophageal Echocardiography Goal-Directed Therapy | 1522 | ||
| Suggested Method | 1524 | ||
| Transthoracic Echocardiography | 1525 | ||
| Value of Perioperative Transthoracic Echocardiography | 1525 | ||
| How to Perform a Basic Transthoracic Echocardiography Examination | 1526 | ||
| Conclusion | 1527 | ||
| References | 1527 | ||
| 47 Goal-Directed Fluid Therapy, Enhanced Recovery, and the Perioperative Surgical Home for Cardiac Patients in Noncardiac Surgery | 1531 | ||
| Teaching Points | 1531 | ||
| Goal-Directed Fluid Therapy | 1531 | ||
| History, Development, and Outcomes of Goal-Directed Fluid Therapy | 1532 | ||
| Goal-Directed Fluid Therapy and Cost Reduction | 1533 | ||
| Monitoring for Goal-Directed Fluid Therapy | 1534 | ||
| Patient Selection for Goal-Directed Fluid Therapy | 1536 | ||
| Algorithms in Goal-Directed Fluid Therapy | 1536 | ||
| Enhanced Recovery | 1536 | ||
| Perioperative Surgical Home | 1537 | ||
| References | 1538 | ||
| 48 Vascular Surgery | 1540 | ||
| Key Points | 1540 | ||
| General Considerations in Perioperative Management for Vascular Surgery | 1540 | ||
| Preoperative Assessment | 1541 | ||
| Preoperative Medication Management | 1542 | ||
| Premedication for Anxiolysis and Analgesia | 1542 | ||
| Intraoperative Anesthetic Management | 1542 | ||
| Postoperative Management | 1543 | ||
| Carotid Artery and Cerebrovascular Disease | 1543 | ||
| Clinical Features and Natural History | 1543 | ||
| Major Milestones in Carotid Artery Intervention | 1543 | ||
| Symptomatic Carotid Atherosclerotic Disease: Indications for Intervention | 1543 | ||
| Asymptomatic Carotid Atherosclerotic Disease: Indications for Intervention | 1543 | ||
| Carotid Artery Stenting | 1544 | ||
| Additional Factors Influencing Surgical Decision Making | 1544 | ||
| Anesthetic Considerations and Management for Carotid Artery Intervention | 1545 | ||
| Preoperative Evaluation and Preparation | 1545 | ||
| Intraoperative Anesthetic Technique | 1545 | ||
| Local Anesthesia Technique for Carotid Endarterectomy | 1545 | ||
| General Anesthetic Technique for Carotid Endarterectomy | 1545 | ||
| Intraoperative Hemodynamic Monitoring | 1545 | ||
| Anesthesia for Carotid Artery Stenting | 1546 | ||
| Intraoperative Challenges | 1546 | ||
| Postoperative Complications | 1546 | ||
| Abdominal Aortic Disease | 1546 | ||
| Abdominal Aortic Aneurysm | 1547 | ||
| Clinical Features and Natural History | 1547 | ||
| Indications for Abdominal Aortic Aneurysm Intervention | 1547 | ||
| Randomized Trials of Endovascular Versus Open Abdominal Aortic Aneurysm Repair | 1547 | ||
| Additional Factors Influencing Surgical Decision Making | 1548 | ||
| Anesthetic Considerations and Management for Abdominal Aortic Aneurysm Intervention | 1548 | ||
| Preoperative Evaluation and Preparation | 1548 | ||
| Intraoperative Anesthetic Technique | 1548 | ||
| Open Abdominal Aortic Aneurysm Repair | 1548 | ||
| Endovascular Abdominal Aortic Aneurysm Repair | 1549 | ||
| Local and Neuraxial Anesthesia Technique for Endovascular Repair | 1549 | ||
| General Anesthesia Technique for Endovascular Repair | 1549 | ||
| Intraoperative Hemodynamic Monitoring for Endovascular Repair | 1549 | ||
| Intraoperative Neurologic Monitoring for Abdominal Aortic Aneurysm Repair | 1549 | ||
| Intraoperative Challenges | 1550 | ||
| Hemodynamic Management of Aortic Clamping and Unclamping | 1550 | ||
| Hemodynamic Management of Endovascular Stent Deployment | 1551 | ||
| Renal Protection and Function | 1551 | ||
| Postoperative Complications | 1551 | ||
| Unique Complications of Endovascular Intervention | 1554 | ||
| Abdominal Aortic Dissection | 1554 | ||
| Aortoiliac Occlusive Disease | 1555 | ||
| Lower Extremity Arterial Disease | 1557 | ||
| Clinical Features and Natural History | 1557 | ||
| Indications for Lower Extremity Arterial Intervention | 1557 | ||
| Additional Factors Influencing Surgical Decision Making | 1557 | ||
| Anesthetic Considerations and Management for Peripheral Arterial Intervention | 1559 | ||
| Preoperative Evaluation and Preparation | 1559 | ||
| Intraoperative Anesthetic Technique | 1559 | ||
| Open Lower Extremity Arterial Bypass | 1559 | ||
| Endovascular Lower Extremity Peripheral Arterial Repair | 1559 | ||
| Intraoperative Challenges | 1559 | ||
| Postoperative Complications | 1559 | ||
| References | 1560 | ||
| 49 The Cardiac Patient for Thoracic Noncardiac Surgery | 1564 | ||
| Key Points | 1564 | ||
| Anesthetic Management for Pulmonary Resection in the Patient With Cardiac Disease | 1564 | ||
| Coronary Artery Disease | 1564 | ||
| Valvular Heart Disease | 1565 | ||
| Cardiomyopathies | 1566 | ||
| Pulmonary Hypertension | 1566 | ||
| Lung Isolation for Cardiac Patients Having Thoracic Procedures | 1568 | ||
| Double-Lumen Tubes | 1568 | ||
| Advantages of Double-Lumen Tubes | 1568 | ||
| Disadvantages of Double-Lumen Tubes | 1568 | ||
| Endobronchial Blockers for Lung Separation | 1568 | ||
| Lung Separation in Thoracic Aortic Aneurysm Surgery | 1568 | ||
| Management of One-Lung Ventilation | 1568 | ||
| Hypoxemia | 1569 | ||
| Hypoxic Pulmonary Vasoconstriction | 1569 | ||
| Choice of Anesthetic | 1569 | ||
| Cardiac Output | 1570 | ||
| Ventilation Strategies During One-Lung Ventilation | 1570 | ||
| Respiratory Acid-Base Status | 1570 | ||
| Positive End-Expiratory Pressure | 1570 | ||
| Auto-PEEP | 1570 | ||
| Tidal Volume | 1570 | ||
| Volume-Controlled Versus Pressure-Controlled Ventilation | 1571 | ||
| Prediction of Hypoxemia During One-Lung Ventilation | 1571 | ||
| Preoperative Ventilation-Perfusion Scan | 1571 | ||
| Side of Operation | 1571 | ||
| Two-Lung Oxygenation | 1571 | ||
| Preoperative Spirometry | 1571 | ||
| Treatment of Hypoxemia During One-Lung Ventilation | 1571 | ||
| Pharmacologic Manipulations | 1572 | ||
| Intermittent Reinflation of the Nonventilated Lung | 1573 | ||
| Partial Ventilation Methods | 1573 | ||
| Mechanical Restriction of Pulmonary Blood Flow | 1573 | ||
| Hypoxemia Prophylaxis | 1573 | ||
| Bilateral Pulmonary Surgery | 1573 | ||
| Transesophageal Echocardiography for Noncardiac Thoracic Surgery | 1574 | ||
| Airway Surgery | 1574 | ||
| Anesthetic Management for Diagnostic or Therapeutic Airway Procedures | 1574 | ||
| Anesthesia for Tracheal Resection | 1576 | ||
| Pulmonary Hemorrhage | 1576 | ||
| Posttracheostomy Hemorrhage | 1576 | ||
| Mediastinal Masses | 1577 | ||
| Vascular Anomalies With Airway Compression | 1579 | ||
| References | 1580 | ||
| 50 The Pregnant Patient With Cardiac Disease | 1582 | ||
| Key Points | 1582 | ||
| Diagnosis of Heart Disease During Pregnancy | 1583 | ||
| Diagnosis Including Cardiovascular Imaging | 1583 | ||
| Ionizing Radiation Risk to the Fetus | 1584 | ||
| Cardiac Risk Stratification During Pregnancy | 1584 | ||
| Pregnancy and Cardiac Disease | 1585 | ||
| Cardiovascular Physiologic Changes of Pregnancy, Labor, and Delivery | 1585 | ||
| Coronary Artery Disease | 1585 | ||
| Valvular Heart Disease | 1586 | ||
| Pulmonary Hypertension | 1587 | ||
| Congenital Heart Disease | 1587 | ||
| Management of Labor and Delivery in Women With Cardiac Disease | 1588 | ||
| Importance of Multidisciplinary Planning | 1588 | ||
| Mode of Delivery | 1588 | ||
| Anesthetic Options and Monitoring | 1589 | ||
| Noncardiac Surgical Procedures During Pregnancy in Women With Cardiac Disease | 1589 | ||
| Maternal and Fetal Risks | 1590 | ||
| Maternal and Fetal Monitoring | 1590 | ||
| Anesthetic Considerations | 1591 | ||
| Peripartum Cardiomyopathy | 1591 | ||
| Definition | 1591 | ||
| Incidence | 1592 | ||
| Risk Factors | 1592 | ||
| Etiology | 1592 | ||
| Clinical Presentation and Diagnosis | 1592 | ||
| Outcomes and Predictors of Recovery | 1593 | ||
| Management During Pregnancy, Labor and Delivery, and Post Partum | 1593 | ||
| Management During Noncardiac Surgical Procedures | 1594 | ||
| Advanced Cardiac Life Support in the Pregnant Woman | 1594 | ||
| Activation of Cardiac Arrest Alarm | 1594 | ||
| Patient Position | 1596 | ||
| Chest Compressions | 1596 | ||
| Airway | 1596 | ||
| Defibrillation | 1596 | ||
| Medications | 1596 | ||
| Etiology of Cardiac Arrest | 1596 | ||
| Perimortem Cesarean Delivery | 1596 | ||
| References | 1597 | ||
| 51 Critical Care Medicine in the Operating Room | 1600 | ||
| Key Points | 1600 | ||
| Perioperative Triage | 1600 | ||
| Ambulatory Surgery | 1600 | ||
| Critical Care Services | 1601 | ||
| Triaging Patients With Coronary Stents and Noncardiac Surgery | 1601 | ||
| Neurologic System | 1602 | ||
| Perioperative Cerebrovascular Accident | 1602 | ||
| Cardiovascular System | 1602 | ||
| Acute Coronary Syndrome | 1603 | ||
| Heart Failure | 1604 | ||
| Valvular Heart Disease | 1604 | ||
| Aortic Stenosis | 1604 | ||
| Aortic Regurgitation | 1605 | ||
| Mitral Stenosis | 1605 | ||
| Mitral Regurgitation | 1605 | ||
| Arrhythmias | 1605 | ||
| Atrial Fibrillation | 1605 | ||
| Supraventricular Tachyarrhythmia | 1606 | ||
| Ventricular Arrhythmias | 1606 | ||
| Pulmonary System | 1606 | ||
| Respiratory Failure | 1606 | ||
| Type 1: Respiratory Failure—Hypoxemic | 1606 | ||
| Type 2: Respiratory Failure—Hypercarbic With or Without Hypoxemia | 1607 | ||
| Postoperative Respiratory Failure | 1607 | ||
| Respiratory Failure in Circulatory Shock | 1607 | ||
| Pulmonary Edema | 1607 | ||
| Cardiogenic Pulmonary Edema | 1607 | ||
| Noncardiogenic Pulmonary Edema | 1608 | ||
| Negative-Pressure Pulmonary Edema | 1608 | ||
| Acute Respiratory Distress Syndrome | 1608 | ||
| Chronic Obstructive Pulmonary Disease | 1608 | ||
| Hematology | 1609 | ||
| Perioperative Management of Anticoagulation | 1609 | ||
| Warfarin | 1609 | ||
| New Oral Anticoagulants (NOACs) | 1609 | ||
| Direct Thrombin Inhibitors | 1609 | ||
| Factor Xa Inhibitors | 1610 | ||
| Massive Hemorrhage | 1610 | ||
| Venothromboembolism Prophylaxis and Treatment in the Perioperative Setting | 1610 | ||
| Sepsis | 1611 | ||
| References | 1612 | ||
| 52 Perioperative Care to Reduce Major Adverse Cardiac Events and Mortality in Noncardiac Surgical Procedures | 1615 | ||
| Key Points | 1615 | ||
| Perioperative Myocardial Infarction or Injury | 1616 | ||
| Epidemiology of Perioperative Myocardial Infarction | 1616 | ||
| Diagnosis of Myocardial Ischemia and Infarction | 1616 | ||
| Outcome After Perioperative Myocardial Damage | 1616 | ||
| Short-Term Outcome | 1616 | ||
| Long-Term Outcome | 1616 | ||
| Risk Stratification and Prevention | 1617 | ||
| Patient’s Age | 1617 | ||
| Cardiac Risk Indexes | 1617 | ||
| Renal Failure | 1617 | ||
| Anemia and Blood Transfusion | 1617 | ||
| Type of Surgical Procedure | 1618 | ||
| Cardiac Biomarkers | 1618 | ||
| Preoperative Troponin | 1618 | ||
| Postoperative Troponin | 1618 | ||
| B-Type (Brain) Natriuretic Peptides | 1619 | ||
| Perioperative Risk Indices | 1619 | ||
| Postoperative Management | 1620 | ||
| Medications and Percutaneous Interventions to Prevent and Treat Perioperative Major Adverse Cardiac Events | 1620 | ||
| Statins | 1620 | ||
| β-Blockers | 1621 | ||
| Perioperative β-Blocker Strategy | 1621 | ||
| Angiotensin-Converting Enzyme Inhibitors and Aldosterone Antagonists | 1621 | ||
| Nitrates | 1622 | ||
| Antithrombotic Agents | 1622 | ||
| Strategy for Using Antithrombotic Agents While Minimizing the Risk of Bleeding | 1622 | ||
| Percutaneous Coronary Intervention | 1623 | ||
| Treatment of Perioperative Myocardial Infarction | 1623 | ||
| Age and Comorbidity | 1623 | ||
| Patients in Unstable Condition | 1624 | ||
| Patients in Stable Condition | 1624 | ||
| ST-Segment Elevation Myocardial Infarction | 1624 | ||
| Non–ST-Segment Elevation Myocardial Infarction | 1625 | ||
| Myocardial Injury After Noncardiac Surgery | 1626 | ||
| Perioperative Care to Reduce Mortality Rates in Noncardiac Surgical Procedures | 1626 | ||
| “Democracy-Based,” Web-Enabled Approach to Consensus on Perioperative Mortality Reduction | 1626 | ||
| The Five Steps of Consensus Building | 1626 | ||
| Results of the Web-Based Consensus Conference on Perioperative Mortality | 1626 | ||
| Interventions That May Reduce Mortality Rates in Noncardiac Surgical Procedures | 1627 | ||
| Perioperative Hemodynamic Optimization | 1627 | ||
| Noninvasive Ventilation | 1628 | ||
| Neuraxial Anesthesia | 1629 | ||
| Selective Decontamination of the Digestive Tract | 1629 | ||
| Interventions That May Increase Mortality Rates in Noncardiac Surgical Procedures | 1629 | ||
| Perioperative β-Blockers | 1629 | ||
| Further Strategies to Possibly Reduce Mortality Rates in Noncardiac Surgical Procedures: Evidence From Updates and Other Clinical Settings | 1630 | ||
| Statins | 1630 | ||
| Antifibrinolytic Drugs | 1630 | ||
| Liberal Transfusion Strategy | 1630 | ||
| Perioperative Supplemental Oxygen | 1631 | ||
| Levosimendan | 1631 | ||
| Preoperative Intraaortic Balloon Pump Counterpulsation | 1631 | ||
| Volatile Anesthetic Agents | 1631 | ||
| Remote Ischemic Preconditioning | 1631 | ||
| Leukocyte Depletion of Transfused Blood | 1632 | ||
| Insulin for Tight Glycemic Control | 1632 | ||
| Lung-Protective Ventilation | 1632 | ||
| References | 1632 | ||
| Index | 1637 | ||
| A | 1637 | ||
| B | 1640 | ||
| C | 1640 | ||
| D | 1645 | ||
| E | 1646 | ||
| F | 1647 | ||
| G | 1648 | ||
| H | 1648 | ||
| I | 1650 | ||
| J | 1651 | ||
| K | 1651 | ||
| L | 1651 | ||
| M | 1652 | ||
| N | 1654 | ||
| O | 1654 | ||
| P | 1655 | ||
| Q | 1658 | ||
| R | 1658 | ||
| S | 1659 | ||
| T | 1660 | ||
| U | 1662 | ||
| V | 1662 | ||
| W | 1663 | ||
| X | 1663 | ||
| Z | 1663 | ||
| IBC_Clinical Key page | IBC1 |