BOOK
Stoelting's Anesthesia and Co-Existing Disease E-Book
Katherine Marschall | Roberta L. Hines
(2017)
Additional Information
Book Details
Abstract
A classic since its first publication nearly 25 years ago, Stoelting's Anesthesia and Co-Existing Disease, 7th Edition, by Drs. Roberta L. Hines and Katherine E. Marschall, remains your go-to reference for concise, thorough coverage of pathophysiology of the most common diseases and their medical management relevant to anesthesia. To provide the guidance you need to successfully manage or avoid complications stemming from pre-existing conditions there are detailed discussions of each disease, the latest practice guidelines, easy-to-follow treatment algorithms, and more.
- Presents detailed discussions of common diseases, as well as highlights of more rare diseases and their unique features that could be of importance in the perioperative period.
- Examines specific anesthesia considerations for special patient populations—including pediatric, obstetric and elderly patients.
- Features abundant figures, tables, diagrams, and photos to provide fast access to the most pertinent aspects of every condition and to clarify critical points about management of these medical illnesses.
- Ideal for anesthesiologists in practice and for anesthesia residents in training and preparing for boards.
- Includes brand new chapters on sleep-disordered breathing, critical care medicine and diseases of aging as well as major updates of nearly all other chapters.
- Covers respiratory disease in greater detail with newly separated chapters on Sleep Disordered Breathing; Obstructive Lung Disease; Restrictive Lung Disease; and Respiratory Failure.
- Provides the latest practice guidelines, now integrated into each chapter for quick reference.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Stoelting’s ANESTHESIA AND CO-EXISTING DISEASE | i | ||
| Stoelting’s ANESTHESIA AND CO-EXISTING DISEASE | iii | ||
| Copyright | iv | ||
| Preface | v | ||
| Contributors | vii | ||
| Contents | xi | ||
| 1 - Sleep-Related Breathing Disorders | 1 | ||
| PHYSIOLOGY OF SLEEP | 2 | ||
| Sleep Stages | 2 | ||
| Physiologic Differences Between NREM and REM Sleep | 2 | ||
| Respiratory Control During Wakefulness and Sleep | 2 | ||
| Effects of Aging and Disease on Sleep | 2 | ||
| Cardiovascular System Physiology During NREM and REM Sleep | 3 | ||
| Cerebral Blood Flow, Spinal Cord Blood Flow, and Epileptogenicity During NREM and REM Sleep | 3 | ||
| Effects of Sleep on Energy Balance and Metabolism | 3 | ||
| Effects of Drugs on Sleep | 3 | ||
| SPECIFIC SLEEP DISORDERS | 3 | ||
| PATHOGENESIS OF SLEEP-RELATED BREATHING DISORDERS | 4 | ||
| Pathogenesis of Obstructive Sleep Apnea | 4 | ||
| Narrowing of the Upper Airway | 4 | ||
| Obesity | 5 | ||
| Genetic Factors | 5 | ||
| Pathogenesis of Central Sleep Apnea | 5 | ||
| Primary/Idiopathic Central Sleep Apnea | 5 | ||
| Secondary Central Sleep Apnea | 5 | ||
| Central Sleep Apnea With Cheyne-Stokes Breathing | 5 | ||
| Pathogenesis of Sleep-Related Hypoventilation Disorders | 5 | ||
| Pathogenesis of Sleep-Related Hypoxemia Disorder | 6 | ||
| PATHOPHYSIOLOGIC CONSEQUENCES OF SLEEP-RELATED BREATHING DISORDERS | 6 | ||
| Pathophysiologic Consequences of Obstructive Sleep Apnea | 6 | ||
| Cardiovascular Consequences (Table 1.2) | 6 | ||
| Neurologic Consequences | 7 | ||
| Metabolic Consequences | 7 | ||
| Pathophysiologic Consequences of Central Sleep Apnea | 7 | ||
| Pathophysiologic Consequences of Sleep-Related Hypoventilation Disorders | 7 | ||
| PREVALENCE OF SLEEP-RELATED BREATHING DISORDERS | 7 | ||
| Prevalence of Obstructive Sleep Apnea | 7 | ||
| Prevalence of Central Sleep Apnea | 7 | ||
| Prevalence of Obesity Hypoventilation Syndrome | 7 | ||
| DIAGNOSIS OF SLEEP-RELATED BREATHING DISORDERS | 7 | ||
| Polysomnography | 8 | ||
| Morphometric Models | 8 | ||
| Questionnaires | 8 | ||
| Criteria for the Diagnosis of Obstructive Sleep Apnea in Adults | 9 | ||
| Criteria for the Diagnosis of Central Sleep Apnea | 9 | ||
| Criteria for the Diagnosis of Sleep-Related Hypoventilation Disorders | 9 | ||
| Criterion for the Diagnosis of Sleep-Related Hypoxemia Disorder | 9 | ||
| TREATMENT OF SLEEP-RELATED BREATHING DISORDERS | 9 | ||
| Treatment of Obstructive Sleep Apnea | 9 | ||
| Positive Airway Pressure Therapy | 9 | ||
| Oral Appliance Therapy | 10 | ||
| Surgical Therapy | 11 | ||
| Medical Therapy | 11 | ||
| Treatment of Central Sleep Apnea | 11 | ||
| Treatment of Sleep-Related Hypoventilation Disorders | 11 | ||
| PERIOPERATIVE CONSIDERATIONS IN PATIENTS WITH SLEEP-RELATED BREATHING DISORDERS | 11 | ||
| PRACTICE GUIDELINES FOR PERIOPERATIVE MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA | 11 | ||
| PERIOPERATIVE OPIOID-INDUCED RESPIRATORY DEPRESSION | 12 | ||
| KEY POINTS | 12 | ||
| THE ESS | 14.e1 | ||
| INTERPRETING ESS SCORES | 14.e1 | ||
| CATEGORY 1. SNORING AND APNEA | 14.e2 | ||
| CATEGORY 2. DAYTIME SLEEPINESS | 14.e2 | ||
| CATEGORY 3. RISK FACTORS | 14.e2 | ||
| HIGH RISK FOR OBSTRUCTIVE SLEEP APNEA CHARACTERISTICS | 14.e3 | ||
| LOW RISK FOR OBSTRUCTIVE SLEEP APNEA CHARACTERISTICS | 14.e3 | ||
| CATEGORY 2: HISTORY OF APPPARENT AIRWAY OBSTRUCTION DURING SLEEP | 14.e4 | ||
| CATEGORY 3: SOMNOLENCE | 14.e4 | ||
| SCORING | 14.e4 | ||
| STOP-BANG SCORING MODEL (8 YES-OR-NO QUESTIONS) | 14.e5 | ||
| 2 - Obstructive Respiratory Diseases | 15 | ||
| ACUTE UPPER RESPIRATORY TRACT INFECTION | 15 | ||
| Signs and Symptoms | 15 | ||
| Diagnosis | 15 | ||
| Management of Anesthesia | 15 | ||
| ASTHMA | 16 | ||
| Signs and Symptoms | 16 | ||
| Diagnosis | 16 | ||
| Pulmonary Function Testing | 17 | ||
| Arterial Blood Gas Analysis | 18 | ||
| Chest Radiography and Electrocardiography | 18 | ||
| Treatment | 19 | ||
| Status Asthmaticus | 19 | ||
| Management of Anesthesia | 20 | ||
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 22 | ||
| Signs and Symptoms | 22 | ||
| Diagnosis | 23 | ||
| Pulmonary Function Tests | 23 | ||
| Chest Radiography | 23 | ||
| Computed Tomography | 23 | ||
| Arterial Blood Gases | 23 | ||
| Treatment | 24 | ||
| Lung Volume Reduction Surgery | 24 | ||
| Management of Anesthesia | 24 | ||
| Risk Reduction Strategies | 25 | ||
| Smoking Cessation | 25 | ||
| Effects of Smoking Cessation. The adverse effects of carbon monoxide on oxygen-carrying capacity and of nicotine on the cardiova... | 26 | ||
| Intermediate to Long-Term Effects. Cigarette smoking causes mucus hypersecretion, impairment of mucociliary transport, and narro... | 26 | ||
| Nutritional Status | 27 | ||
| Regional Anesthesia | 27 | ||
| General Anesthesia | 27 | ||
| Postoperative | 28 | ||
| Lung Expansion Maneuvers | 28 | ||
| LESS COMMON CAUSES OF EXPIRATORY AIRFLOW OBSTRUCTION | 29 | ||
| Bronchiectasis | 29 | ||
| Pathophysiology | 29 | ||
| Diagnosis | 29 | ||
| Treatment | 29 | ||
| Management of Anesthesia | 29 | ||
| Cystic Fibrosis | 30 | ||
| Pathophysiology | 30 | ||
| Diagnosis | 30 | ||
| Treatment | 30 | ||
| Clearance of Airway Secretions | 30 | ||
| Bronchodilator Therapy | 30 | ||
| Reduction in Viscoelasticity of Sputum | 30 | ||
| Antibiotic Therapy | 30 | ||
| Management of Anesthesia | 30 | ||
| Primary Ciliary Dyskinesia | 31 | ||
| Bronchiolitis Obliterans | 31 | ||
| Tracheal Stenosis | 31 | ||
| Diagnosis | 31 | ||
| Management of Anesthesia | 31 | ||
| KEY POINTS | 31 | ||
| 3 - Restrictive Respiratory Diseases and Lung Transplantation | 33 | ||
| ACUTE INTRINSIC RESTRICTIVE LUNG DISEASE (ALVEOLAR AND INTERSTITIAL PULMONARY EDEMA) | 34 | ||
| Pulmonary Edema | 34 | ||
| Aspiration | 34 | ||
| Neurogenic Pulmonary Edema | 35 | ||
| Drug-Induced Pulmonary Edema | 35 | ||
| High-Altitude Pulmonary Edema | 35 | ||
| Reexpansion Pulmonary Edema | 36 | ||
| Negative Pressure Pulmonary Edema | 36 | ||
| Management of Anesthesia in Patients With Pulmonary Edema | 36 | ||
| ACUTE RESPIRATORY FAILURE | 36 | ||
| Overview | 36 | ||
| Mechanical Support of Ventilation | 37 | ||
| Volume-Cycled Ventilation | 37 | ||
| Assist-Control Ventilation | 37 | ||
| Synchronized Intermittent Mandatory Ventilation | 37 | ||
| Pressure-Cycled Ventilation | 37 | ||
| Management of Patients Receiving Mechanical Support of Ventilation | 38 | ||
| Sedation | 38 | ||
| Muscle Relaxants | 38 | ||
| Complications of Mechanical Ventilation | 38 | ||
| Infection | 38 | ||
| Barotrauma | 38 | ||
| Atelectasis | 38 | ||
| Monitoring of Treatment | 38 | ||
| Mixed Venous Partial Pressure of Oxygen | 39 | ||
| Arterial pH | 39 | ||
| Intrapulmonary Shunt | 39 | ||
| Weaning From the Ventilator | 40 | ||
| Tracheal Extubation | 40 | ||
| Oxygen Supplementation | 40 | ||
| ACUTE RESPIRATORY DISTRESS SYNDROME | 40 | ||
| Diagnosis | 40 | ||
| Clinical Management | 41 | ||
| CHRONIC INTRINSIC RESTRICTIVE LUNG DISEASE (INTERSTITIAL LUNG DISEASE) | 42 | ||
| Pulmonary Fibrosis | 42 | ||
| Sarcoidosis | 42 | ||
| Hypersensitivity Pneumonitis | 42 | ||
| Eosinophilic Granuloma | 42 | ||
| Alveolar Proteinosis | 42 | ||
| Lymphangioleiomyomatosis | 43 | ||
| Management of Anesthesia in Patients With Chronic Interstitial Lung Disease | 43 | ||
| CHRONIC EXTRINSIC RESTRICTIVE LUNG DISEASE | 43 | ||
| Thoracic Extrapulmonary Causes | 43 | ||
| Extrathoracic Causes | 46 | ||
| ANESTHETIC MANAGEMENT OF PATIENTS WITH RESTRICTIVE LUNG DISEASE | 49 | ||
| DIAGNOSTIC PROCEDURES IN PATIENTS WITH LUNG DISEASE | 49 | ||
| LUNG TRANSPLANTATION | 49 | ||
| Overview | 49 | ||
| Management of Anesthesia for Primary Lung Transplantation Surgery | 49 | ||
| Management of Anesthesia for Patients With Prior Lung Transplantation | 50 | ||
| Physiologic Effects of Lung Transplantation | 51 | ||
| KEY POINTS | 52 | ||
| RESOURCES | 52 | ||
| 4 - Critical Illness | 53 | ||
| PATHOPHYSIOLOGY OF THE CRITICALLY ILL PATIENT UNDERGOING SURGERY | 53 | ||
| Shock: Disordered Perfusion | 53 | ||
| Hypodynamic Shock | 54 | ||
| Hypovolemic Shock | 54 | ||
| Cardiogenic Shock | 54 | ||
| Obstructive Shock | 54 | ||
| Hyperdynamic Shock | 54 | ||
| Septic Shock | 54 | ||
| Traumatic Shock | 54 | ||
| Inflammation: Sepsis and the Systemic Response to Trauma | 54 | ||
| Commonalities of Systemic Inflammation | 54 | ||
| Primary Goals: Surviving Sepsis | 54 | ||
| General Resuscitative Measures | 55 | ||
| Diagnosis of Septic Source | 55 | ||
| Empirical Antibiotic Therapy and Infection Source Control | 55 | ||
| Fluid Resuscitation | 55 | ||
| Vasopressor and Inotropic Medications | 55 | ||
| Steroid Management | 55 | ||
| Hemoglobin Target | 55 | ||
| Ventilator Measures for Sepsis-Induced Acute Respiratory Distress Syndrome | 55 | ||
| General Critical Care Management | 55 | ||
| A Genomic and Molecular Perspective | 56 | ||
| Systemic Inflammatory Response Syndrome | 56 | ||
| Compensatory Antiinflammatory Response Syndrome | 56 | ||
| Persistent Inflammation, Immunosuppression, and Catabolism Syndrome | 56 | ||
| Hemorrhage: The Exsanguinating Patient | 56 | ||
| Classification of Hemorrhage | 56 | ||
| Coagulopathy Associated With Massive Hemorrhage and Injury | 57 | ||
| Damage Control Resuscitation | 57 | ||
| Overview and General Principles | 57 | ||
| Limitation of Crystalloid Use. Rapid and large-volume crystalloid infusion in exsanguinating patients can worsen bleeding by clo... | 57 | ||
| Optimal Transfusion Practice. Patients who require massive transfusion, defined as transfusion of 10 units of packed red blood c... | 57 | ||
| Role of Procoagulants in the Exsanguinating Patient | 57 | ||
| Clotting Factors | 57 | ||
| Antifibrinolytic Agents | 58 | ||
| The Anticoagulated Patient | 58 | ||
| Platelet Dysfunction and Thrombocytopenia | 58 | ||
| Acute Cardiopulmonary Instability | 59 | ||
| Hemodynamic Compromise and Circulatory Collapse | 59 | ||
| Cardiac Etiologies | 59 | ||
| Peripheral Etiologies | 61 | ||
| Acute Exacerbation of Respiratory Failure | 61 | ||
| Anatomic Mechanical Etiologies | 61 | ||
| Airway Circuit Mechanical Etiologies | 62 | ||
| Primary Pulmonary Etiologies | 62 | ||
| Metabolic Derangements | 63 | ||
| Malnutrition | 63 | ||
| Overfeeding | 63 | ||
| Refeeding Syndrome | 63 | ||
| Hyperglycemia | 63 | ||
| Paradigm Shifts. Until the beginning of this millennium, blood glucose levels of up to 220 mg/dL were routinely tolerated in cri... | 64 | ||
| Sick Euthyroid Syndrome | 64 | ||
| Low T3 State | 64 | ||
| Low T4 State | 64 | ||
| Recovery State | 64 | ||
| Treatment | 64 | ||
| Utility of Thyroid Function Tests in the Critically Ill Patient | 64 | ||
| Relative Adrenal Insufficiency | 64 | ||
| Acute Renal Dysfunction | 65 | ||
| RIFLE Criteria | 65 | ||
| AKIN Criteria | 65 | ||
| KDIGO Criteria | 65 | ||
| Cirrhosis | 65 | ||
| Fulminant Hepatic Failure | 66 | ||
| Neurologic Disorders | 66 | ||
| Pain, Agitation, and Delirium | 66 | ||
| Pain and Analgesia | 66 | ||
| Agitation and Sedation | 66 | ||
| Delirium | 67 | ||
| Metabolic Encephalopathy | 67 | ||
| Critical Illness Polyneuropathy | 68 | ||
| Acute Quadriplegic Myopathy | 68 | ||
| Prolonged Effects of Neuromuscular Blockade | 68 | ||
| GENERAL PRINCIPLES OF PERIOPERATIVE MANAGEMENT IN THE CRITICALLY ILL PATIENT | 68 | ||
| Intravenous Fluid Management | 68 | ||
| Parenteral Solutions | 68 | ||
| Maintenance Fluid Therapy | 69 | ||
| Resuscitative Fluid Therapy: Crystalloid Versus Colloid | 69 | ||
| Interruption of Enteral Nutrition Preoperatively | 70 | ||
| Administration of Blood Products | 70 | ||
| Process for Availability of Blood Products Intraoperatively | 70 | ||
| Emergency Transfusion | 70 | ||
| Reconstitution of PRBCs | 71 | ||
| Mitigation of Surgical Site Infections | 71 | ||
| Risk Factors | 71 | ||
| Preventive Measures | 71 | ||
| General Principles of Prophylactic Perioperative Antibiotic Administration | 71 | ||
| Ongoing Antimicrobial Management of Established Infections in the OR | 71 | ||
| Venous Thromboembolism Prophylaxis | 72 | ||
| Critically Ill Nonsurgical Patients | 72 | ||
| Critically Ill Surgical Patients | 72 | ||
| Nonorthopedic Surgical Patients | 72 | ||
| Orthopedic Surgical Patients | 72 | ||
| Glycemic Management | 73 | ||
| Perioperative Impact of Diabetes Mellitus | 73 | ||
| Perioperative and Intraoperative Glycemic Control Regimens | 73 | ||
| Steroid Management | 73 | ||
| Indications for Administration of Stress Steroid Dosing | 73 | ||
| Risks Associated With Stress Steroid Dosing | 73 | ||
| Thermal Regulation | 74 | ||
| Hypothermia | 74 | ||
| Hyperthermia | 74 | ||
| Malignant Hyperthermia | 74 | ||
| SPECIAL SCENARIOS IN THE MANAGEMENT OF THE CRITICALLY ILL SURGICAL PATIENT | 74 | ||
| Transporting the Critically Ill Patient to and From the Operating Room | 74 | ||
| General Principles | 74 | ||
| Maintenance of Therapies | 75 | ||
| Contraindications to Transport | 75 | ||
| Specific Operations in Critically Ill Patients | 75 | ||
| Abdominal Compartment Syndrome | 75 | ||
| Definitions | 75 | ||
| Significance: Progressive Organ Failure | 75 | ||
| Treatment | 76 | ||
| Damage Control in the Trauma Patient | 76 | ||
| The Initial Operation: A Band-Aid for Anatomy to Facilitate Repair of Physiology | 76 | ||
| The SICU Resuscitation: Abrogation of the Lethal Triad | 76 | ||
| The Definitive Operation: Restoration of Anatomy | 76 | ||
| After Damage Control: Subsequent Operative Interventions | 76 | ||
| Common Operations to Facilitate Management of the Critically Ill Patient | 76 | ||
| Tracheostomy | 76 | ||
| Enteral Feeding Access | 76 | ||
| KEY POINTS | 77 | ||
| RESOURCES | 78 | ||
| 5 - Ischemic Heart Disease | 79 | ||
| STABLE ANGINA PECTORIS | 79 | ||
| Diagnosis | 80 | ||
| Electrocardiography | 81 | ||
| Nuclear Cardiology Techniques | 81 | ||
| Echocardiography | 81 | ||
| Stress Cardiac MRI | 81 | ||
| Electron Beam Computed Tomography | 81 | ||
| CT Angiography | 82 | ||
| Coronary Angiography | 82 | ||
| Treatment | 82 | ||
| Treatment of Associated Diseases | 82 | ||
| Reduction of Risk Factors and Lifestyle Modification | 82 | ||
| Medical Treatment of Myocardial Ischemia | 82 | ||
| Revascularization | 84 | ||
| ACUTE CORONARY SYNDROME | 84 | ||
| ST-Segment Elevation Myocardial Infarction | 84 | ||
| Pathophysiology | 85 | ||
| Diagnosis | 85 | ||
| Laboratory Studies | 85 | ||
| Imaging Studies | 86 | ||
| Treatment | 86 | ||
| Reperfusion Therapy | 86 | ||
| Percutaneous Coronary Intervention | 87 | ||
| Coronary Artery Bypass Graft Surgery | 87 | ||
| Adjunctive Medical Therapy | 87 | ||
| Unstable Angina/Non–ST-Segment Elevation Myocardial Infarction | 87 | ||
| Diagnosis | 87 | ||
| Treatment | 88 | ||
| COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION | 88 | ||
| Postinfarction Ischemia | 88 | ||
| Cardiac Dysrhythmias | 88 | ||
| Pericarditis | 88 | ||
| Mitral Regurgitation | 89 | ||
| Ventricular Septal Rupture | 89 | ||
| Myocardial Dysfunction | 89 | ||
| Cardiogenic Shock | 89 | ||
| Myocardial Rupture | 89 | ||
| Right Ventricular Infarction | 89 | ||
| Mural Thrombus and Stroke | 90 | ||
| PERIOPERATIVE IMPLICATIONS OF PERCUTANEOUS CORONARY INTERVENTION | 90 | ||
| Percutaneous Coronary Intervention and Thrombosis | 90 | ||
| Surgery and Risk of Stent Thrombosis | 91 | ||
| Surgery and Bare-Metal Stents | 91 | ||
| Surgery and Drug-Eluting Stents | 91 | ||
| Risk of Bleeding Related to Antiplatelet Drugs | 91 | ||
| Bleeding Versus Stent Thrombosis in the Perioperative Period | 91 | ||
| Perioperative Management of Patients With Stents | 91 | ||
| PCI-to-Surgery Interval | 91 | ||
| Continuation of Dual Antiplatelet Therapy | 92 | ||
| Perioperative Monitoring Strategies | 92 | ||
| Anesthetic Technique | 92 | ||
| Immediate Availability of an Interventional Cardiologist | 92 | ||
| PERIOPERATIVE MYOCARDIAL INFARCTION | 92 | ||
| Pathophysiology | 92 | ||
| Diagnosis | 93 | ||
| PREOPERATIVE ASSESSMENT OF PATIENTS WITH KNOWN OR SUSPECTED ISCHEMIC HEART DISEASE | 93 | ||
| History | 93 | ||
| Physical Examination | 95 | ||
| Specialized Preoperative Testing | 95 | ||
| Exercise Electrocardiography | 95 | ||
| Stress Echocardiography and Stress Nuclear Imaging | 95 | ||
| Computed Tomography and Magnetic Resonance Imaging | 95 | ||
| MANAGEMENT OF ANESTHESIA IN PATIENTS WITH KNOWN OR SUSPECTED ISCHEMIC HEART DISEASE UNDERGOING NONCARDIAC SURGERY | 95 | ||
| Risk Stratification | 96 | ||
| Management After Risk Stratification | 98 | ||
| Coronary Artery Bypass Grafting | 98 | ||
| Percutaneous Coronary Intervention | 98 | ||
| Pharmacologic Management | 98 | ||
| Intraoperative Management | 99 | ||
| Monitoring | 101 | ||
| Intraoperative Management of Myocardial Ischemia | 101 | ||
| Postoperative Management | 102 | ||
| CARDIAC TRANSPLANTATION | 103 | ||
| Management of Anesthesia | 103 | ||
| Postoperative Complications | 103 | ||
| Anesthetic Considerations in Heart Transplant Recipients | 104 | ||
| Response to Drugs | 104 | ||
| Preoperative Evaluation | 104 | ||
| Management of Anesthesia | 104 | ||
| KEY POINTS | 105 | ||
| RESOURCES | 106 | ||
| 6 - Valvular Heart Disease | 107 | ||
| PREOPERATIVE EVALUATION | 108 | ||
| History and Physical Examination | 108 | ||
| Drug Therapy | 108 | ||
| Laboratory Data | 108 | ||
| Presence of Prosthetic Heart Valves | 109 | ||
| Assessment of Prosthetic Heart Valve Function | 109 | ||
| Complications Associated With Prosthetic Heart Valves | 109 | ||
| Management of Anticoagulation in Patients With Prosthetic Heart Valves | 110 | ||
| Prevention of Bacterial Endocarditis | 110 | ||
| MITRAL STENOSIS | 110 | ||
| Pathophysiology | 111 | ||
| Diagnosis | 111 | ||
| Treatment | 111 | ||
| Management of Anesthesia | 112 | ||
| Monitoring | 112 | ||
| Postoperative Management | 113 | ||
| MITRAL REGURGITATION | 113 | ||
| Pathophysiology | 113 | ||
| Diagnosis | 113 | ||
| Treatment | 114 | ||
| Management of Anesthesia | 114 | ||
| Monitoring | 115 | ||
| MITRAL VALVE PROLAPSE | 115 | ||
| Diagnosis | 115 | ||
| Management of Anesthesia | 115 | ||
| Preoperative Evaluation | 115 | ||
| Monitoring | 116 | ||
| AORTIC STENOSIS | 116 | ||
| Pathophysiology | 117 | ||
| Diagnosis | 118 | ||
| Treatment | 119 | ||
| Management of Anesthesia | 121 | ||
| Monitoring | 121 | ||
| AORTIC REGURGITATION | 122 | ||
| Pathophysiology | 122 | ||
| Diagnosis | 122 | ||
| Treatment | 123 | ||
| Management of Anesthesia | 123 | ||
| Monitoring | 123 | ||
| TRICUSPID REGURGITATION | 123 | ||
| Pathophysiology | 124 | ||
| Management of Anesthesia | 124 | ||
| TRICUSPID STENOSIS | 124 | ||
| PULMONIC VALVE REGURGITATION | 124 | ||
| PULMONIC STENOSIS | 124 | ||
| PERCUTANEOUS TREATMENT OF VALVULAR HEART DISEASE | 124 | ||
| Aortic Valve Procedures | 124 | ||
| Mitral Valve Procedures | 125 | ||
| Pulmonic Valve Procedures | 125 | ||
| Left Atrial Appendage Closure | 126 | ||
| KEY POINTS | 126 | ||
| 7 - Congenital Heart Disease | 129 | ||
| CONGENITAL HEART LESIONS | 130 | ||
| Acyanotic Congenital Heart Disease | 130 | ||
| Shunting Lesions | 130 | ||
| Atrial Septal Defect | 130 | ||
| Signs and Symptoms. Patients can present with increasing dyspnea on exertion, decreased exercise tolerance, fatigue, heart failu... | 131 | ||
| Management of Anesthesia. For general management strategies and anesthetic management, please see “Balancing Pulmonary and Vascu... | 132 | ||
| Ventricular Septal Defect | 132 | ||
| Signs and Symptoms. The severity of signs and symptoms depends on the size of the defect, the pressure difference between the ve... | 133 | ||
| Management of Anesthesia. The most conservative summary would probably be to treat a patient with a VSD of unknown severity like... | 133 | ||
| Patent Ductus Arteriosus (PDA) | 133 | ||
| Signs and Symptoms. Most patients with a PDA have only mild to moderate shunting and remain asymptomatic. It is not uncommon for... | 133 | ||
| Management of Anesthesia. Most patients in whom the ductus fails to close spontaneously will be operated on during the neonatal ... | 134 | ||
| Obstructive Lesions | 134 | ||
| Aortic Stenosis | 134 | ||
| Signs and Symptoms. Most patients with bicuspid aortic valves remain asymptomatic until adulthood. Infants with severe (more lik... | 134 | ||
| Management of Anesthesia. See Chapter 6, “Valvular Heart Disease,” and the section about aortic stenosis for details on anesthet... | 135 | ||
| Pulmonic Stenosis | 135 | ||
| Signs and Symptoms. Symptoms depend on the severity and associated defects (e.g., cyanosis in severe cases with an associated VS... | 135 | ||
| Management of Anesthesia. Pulmonary stenosis can be treated with open surgery that requires cardiopulmonary bypass or percutaneo... | 135 | ||
| Coarctation of the Aorta | 135 | ||
| Signs and Symptoms. All forms of aortic coarctation share the common adverse outcomes of systolic hypertension, CHF, aortic diss... | 135 | ||
| Management of Anesthesia. Coarctation ideally should be repaired in infancy or early childhood before patients develop systemic ... | 135 | ||
| Ebstein Anomaly | 136 | ||
| Signs and Symptoms. Severity of symptoms is proportional to the degree of tricuspid valve displacement and function. Symptoms ca... | 136 | ||
| Management of Anesthesia. Symptomatic treatment includes pharmacologic therapy for heart failure and dysrhythmias, as well as ca... | 136 | ||
| Cyanotic Congenital Heart Disease | 136 | ||
| Tetralogy of Fallot | 136 | ||
| Signs and Symptoms | 137 | ||
| Management of Anesthesia | 137 | ||
| Eisenmenger Syndrome | 138 | ||
| Signs and Symptoms | 138 | ||
| Management of Anesthesia | 138 | ||
| Tricuspid Atresia | 139 | ||
| Signs and Symptoms | 139 | ||
| Management of Anesthesia | 139 | ||
| Transposition of the Great Arteries | 139 | ||
| Signs and Symptoms | 140 | ||
| Management of Anesthesia | 140 | ||
| Truncus Arteriosus | 140 | ||
| 8 - Abnormalities of Cardiac Conduction and Cardiac Rhythm | 151 | ||
| HISTORICAL ROOTS OF DYSRHYTHMIA DETECTION | 151 | ||
| THE ECG AS A MONITOR | 152 | ||
| CONDUCTION SYSTEM OF THE HEART | 152 | ||
| CARDIAC CONDUCTION DISTURBANCES | 154 | ||
| First-Degree Atrioventricular Heart Block | 154 | ||
| Second-Degree Atrioventricular Heart Block | 154 | ||
| Bundle Branch Blocks | 155 | ||
| Right Bundle Branch Block | 155 | ||
| Left Bundle Branch Block | 155 | ||
| Third-Degree Atrioventricular Heart Block | 156 | ||
| CARDIAC DYSRHYTHMIA OVERVIEW | 156 | ||
| MECHANISMS OF TACHYDYSRHYTHMIAS | 156 | ||
| Increased Automaticity | 157 | ||
| Reentry Pathways | 157 | ||
| Triggering by Afterdepolarizations | 157 | ||
| SUPRAVENTRICULAR DYSRHYTHMIAS | 157 | ||
| Sinus Tachycardia | 157 | ||
| Premature Atrial Beats | 158 | ||
| Paroxysmal Supraventricular Tachycardia | 158 | ||
| Wolff-Parkinson-White Syndrome | 160 | ||
| Multifocal Atrial Tachycardia | 160 | ||
| Atrial Fibrillation | 161 | ||
| Atrial Flutter | 163 | ||
| VENTRICULAR DYSRHYTHMIAS | 163 | ||
| Ventricular Ectopy (Premature Ventricular Beats) | 163 | ||
| Ventricular Tachycardia | 164 | ||
| Ventricular Fibrillation | 165 | ||
| Prolonged QT Syndromes | 165 | ||
| MECHANISMS OF BRADYDYSRHYTHMIAS | 167 | ||
| Sinus Bradycardia | 168 | ||
| Junctional Rhythm | 168 | ||
| TREATMENT OF CARDIAC DYSRHYTHMIAS | 169 | ||
| Antidysrhythmic Drugs | 169 | ||
| Adenosine | 170 | ||
| Atropine | 170 | ||
| Amiodarone | 170 | ||
| β-Adrenergic Blockers | 170 | ||
| Calcium Channel Blockers | 170 | ||
| Digoxin | 171 | ||
| Dopamine | 171 | ||
| Epinephrine | 171 | ||
| Isoproterenol | 171 | ||
| Lidocaine | 172 | ||
| Magnesium | 172 | ||
| Procainamide | 172 | ||
| Sotalol | 172 | ||
| Vasopressin | 172 | ||
| Twenty-Percent Lipid Emulsion | 172 | ||
| Transcutaneous Pacing | 172 | ||
| Electrical Cardioversion | 173 | ||
| Defibrillation | 173 | ||
| Radiofrequency Catheter Ablation | 173 | ||
| CARDIAC IMPLANTED ELECTRONIC DEVICES | 173 | ||
| Permanently Implanted Cardiac Pacemakers | 174 | ||
| Pacing Modes | 174 | ||
| Asynchronous Pacing | 174 | ||
| Single-Chamber Pacing | 174 | ||
| Dual-Chamber Pacing | 175 | ||
| DDD Pacing. Dual-chamber pacemakers have two leads, one placed in the right atrium and one located in the right ventricle. DDD p... | 175 | ||
| DDI Pacing. In the DDI pacing mode, there is sensing in both the atrium and ventricle, but the only response to a sensed event i... | 175 | ||
| Rate-Adaptive Pacemakers | 175 | ||
| Anesthesia for Cardiac Pacemaker Insertion | 175 | ||
| Permanently Implanted Cardioverter-Defibrillators | 176 | ||
| Anesthesia for Insertion of Implantable Cardioverter-Defibrillators | 177 | ||
| Cardiac Resynchronization Devices | 177 | ||
| SURGERY IN PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES | 177 | ||
| Preoperative Evaluation | 177 | ||
| Management of Anesthesia | 178 | ||
| KEY POINTS | 180 | ||
| RESOURCES | 180 | ||
| 9 - Systemic and Pulmonary Arterial Hypertension | 183 | ||
| SYSTEMIC HYPERTENSION | 183 | ||
| Public Health Implications | 183 | ||
| Pathophysiology | 183 | ||
| Current Treatment of Hypertension | 186 | ||
| Lifestyle Modification | 186 | ||
| Pharmacologic Therapy | 186 | ||
| Treatment of Secondary Hypertension | 187 | ||
| Perioperative Implications of Hypertension | 188 | ||
| Preoperative Evaluation | 188 | ||
| Intraoperative Considerations | 188 | ||
| Induction of Anesthesia and Monitoring | 189 | ||
| Maintenance of Anesthesia | 189 | ||
| Hypertensive Crises | 190 | ||
| Acute Postoperative Hypertension | 190 | ||
| PULMONARY ARTERIAL HYPERTENSION | 191 | ||
| Definitions and Classification | 191 | ||
| Definition | 191 | ||
| Hemodynamic Classification | 192 | ||
| WHO Clinical Classification | 192 | ||
| Pathophysiology and Pharmacologic Treatment | 193 | ||
| Prostanoids | 193 | ||
| Endothelin Receptor Antagonists | 193 | ||
| Nitric Oxide/Guanylate Cyclase | 193 | ||
| Perioperative Considerations | 193 | ||
| Preoperative Evaluation | 193 | ||
| Assessing Risk Factors | 194 | ||
| Outcome Studies | 194 | ||
| Perioperative Physiology | 194 | ||
| Right Ventricular Afterload | 194 | ||
| Right Ventricular Inotropy | 194 | ||
| Myocardial Supply and Demand | 195 | ||
| Interventricular Dependence | 195 | ||
| Procedural Considerations | 196 | ||
| Orthopedics | 196 | ||
| Laparoscopy | 196 | ||
| Thoracic Surgery | 196 | ||
| KEY POINTS | 196 | ||
| RESOURCES | 197 | ||
| 10 - Heart Failure and Cardiomyopathies | 199 | ||
| HEART FAILURE | 199 | ||
| Definition | 199 | ||
| Epidemiology and Costs | 199 | ||
| Etiology | 200 | ||
| FORMS OF VENTRICULAR DYSFUNCTION | 200 | ||
| Systolic and Diastolic Heart Failure | 200 | ||
| Systolic Heart Failure | 200 | ||
| Diastolic Heart Failure | 200 | ||
| Acute and Chronic Heart Failure | 200 | ||
| Left-Sided and Right-Sided Heart Failure | 201 | ||
| Low-Output and High-Output Heart Failure | 201 | ||
| PATHOPHYSIOLOGY OF HEART FAILURE | 202 | ||
| Frank-Starling Relationship | 202 | ||
| Activation of the Sympathetic Nervous System | 202 | ||
| Alterations in Inotropy, Heart Rate, and Afterload | 202 | ||
| Humorally Mediated Responses and Biochemical Pathways | 203 | ||
| Myocardial Remodeling | 203 | ||
| SYMPTOMS AND SIGNS OF HEART FAILURE | 203 | ||
| Symptoms | 203 | ||
| Signs | 204 | ||
| DIAGNOSIS OF HEART FAILURE | 204 | ||
| Laboratory Tests | 205 | ||
| Electrocardiography | 205 | ||
| Chest Radiography | 205 | ||
| Echocardiography | 205 | ||
| CLASSIFICATION OF HEART FAILURE | 205 | ||
| MANAGEMENT OF HEART FAILURE | 206 | ||
| Management of Chronic Heart Failure | 206 | ||
| Management of Systolic Heart Failure | 207 | ||
| Inhibitors of the Renin-Angiotensin-Aldosterone System | 207 | ||
| Angiotensin-Converting Enzyme Inhibitors | 207 | ||
| Angiotensin II Receptor Blockers | 207 | ||
| Aldosterone Antagonists | 208 | ||
| β-Blockers | 208 | ||
| Statins | 208 | ||
| Diuretics | 208 | ||
| Vasodilators | 208 | ||
| Novel Therapies | 208 | ||
| Management of Diastolic Heart Failure | 208 | ||
| Surgical Management of Heart Failure | 209 | ||
| Anesthetic Considerations for Patients With Implantable Nonpulsatile Ventricular Assist Devices | 210 | ||
| Management of Acute Heart Failure | 211 | ||
| Diuretics and Vasodilators | 211 | ||
| Inotropic Support | 211 | ||
| Calcium Sensitizers | 211 | ||
| Exogenous B-Type Natriuretic Peptide | 212 | ||
| Nitric Oxide Synthase Inhibitors | 212 | ||
| Mechanical Devices | 212 | ||
| Prognosis | 213 | ||
| MANAGEMENT OF ANESTHESIA | 213 | ||
| Preoperative Evaluation and Management | 213 | ||
| Intraoperative Management | 214 | ||
| Postoperative Management | 214 | ||
| CARDIOMYOPATHIES | 214 | ||
| Hypertrophic Cardiomyopathy | 215 | ||
| Signs and Symptoms | 216 | ||
| Diagnosis | 216 | ||
| Treatment | 216 | ||
| Medical Therapy | 217 | ||
| Surgical Therapy | 217 | ||
| Prognosis | 217 | ||
| Management of Anesthesia | 218 | ||
| Preoperative Evaluation and Management | 218 | ||
| Intraoperative Management | 218 | ||
| Parturient Patients. Pregnancy is usually well tolerated in patients with HCM despite the pregnancy-induced decrease in systemic... | 218 | ||
| Postoperative Management | 219 | ||
| Dilated Cardiomyopathy | 219 | ||
| Signs and Symptoms | 219 | ||
| Diagnosis | 219 | ||
| Treatment | 219 | ||
| 11 - Pericardial Disease and Cardiac Trauma | 225 | ||
| PERICARDIAL ANATOMY AND FUNCTION | 225 | ||
| ACUTE PERICARDITIS | 225 | ||
| Diagnosis | 225 | ||
| Treatment | 226 | ||
| Relapsing Pericarditis | 226 | ||
| Pericarditis After Cardiac Surgery | 226 | ||
| PERICARDIAL EFFUSION AND CARDIAC TAMPONADE | 226 | ||
| Signs and Symptoms | 227 | ||
| Cardiac Tamponade | 227 | ||
| Loculated Pericardial Effusions | 228 | ||
| Diagnosis | 228 | ||
| Treatment | 230 | ||
| Management of Anesthesia | 230 | ||
| CONSTRICTIVE PERICARDITIS | 231 | ||
| Signs and Symptoms | 231 | ||
| Diagnosis | 232 | ||
| Treatment | 233 | ||
| Management of Anesthesia | 233 | ||
| PERICARDIAL AND CARDIAC TRAUMA | 234 | ||
| 12 - Vascular Disease | 237 | ||
| DISEASES OF THE THORACIC AND ABDOMINAL AORTA | 237 | ||
| ANEURYSMS AND DISSECTIONS OF THE THORACIC AND ABDOMINAL AORTA | 238 | ||
| Incidence | 238 | ||
| Etiology | 239 | ||
| Classification | 240 | ||
| Signs and Symptoms | 240 | ||
| Diagnosis | 241 | ||
| Medical Management of Aortic Aneurysms | 242 | ||
| Preoperative Evaluation | 243 | ||
| Indications for Surgery | 243 | ||
| Rupture of Abdominal Aortic Aneurysm | 243 | ||
| Aortic Dissections | 243 | ||
| Type A Dissection | 243 | ||
| Ascending Aorta. All patients with acute dissection involving the ascending aorta should be considered candidates for surgery. T... | 244 | ||
| Aortic Arch. In patients with acute aortic arch dissection, resection of the aortic arch (i.e., the segment of aorta that extend... | 244 | ||
| Descending Thoracic Aorta. Patients with an acute but uncomplicated type B aortic dissection who have normal hemodynamics, no pe... | 244 | ||
| Unique Risks of Surgery | 244 | ||
| Surgical Approach | 244 | ||
| Anterior Spinal Artery Syndrome. Cross-clamping the thoracic aorta can result in ischemic damage to the spinal cord (see Fig. 12... | 244 | ||
| Spinal Cord Blood Supply. The spinal cord is supplied by one anterior spinal artery and two posterior spinal arteries (Fig. 12.6... | 244 | ||
| Risk Factors. The risk of paraplegia during thoracic aortic surgery is determined by the interaction of four factors: (1) the de... | 245 | ||
| Hemodynamic Responses to Aortic Cross-Clamping. Thoracic aortic cross-clamping and unclamping are associated with severe hemodyn... | 245 | ||
| Hemodynamic Responses to Aortic Unclamping. Unclamping of the thoracic aorta is associated with substantial decreases in systemi... | 246 | ||
| Management of Anesthesia | 246 | ||
| Monitoring Blood Pressure | 246 | ||
| Monitoring Neurologic Function | 246 | ||
| Monitoring Cardiac Function | 247 | ||
| Monitoring Intravascular Volume and Renal Function | 247 | ||
| Induction and Maintenance of Anesthesia | 247 | ||
| Postoperative Management | 248 | ||
| ENDOVASCULAR AORTIC ANEURYSM REPAIR | 248 | ||
| Complications | 250 | ||
| Anesthetic Management | 250 | ||
| Postoperative Management | 250 | ||
| CAROTID ARTERY DISEASE AND STROKE | 250 | ||
| Epidemiology and Risk Factors | 250 | ||
| Cerebrovascular Anatomy | 251 | ||
| Diagnostic Tests | 251 | ||
| Treatment of Stroke | 251 | ||
| Carotid Endarterectomy | 252 | ||
| Preoperative Evaluation | 252 | ||
| Management of Anesthesia | 252 | ||
| Postoperative Management and Complications | 253 | ||
| Endovascular Treatment of Carotid Disease | 253 | ||
| PERIPHERAL ARTERIAL DISEASE | 254 | ||
| Chronic Arterial Insufficiency | 254 | ||
| Risk Factors | 254 | ||
| Signs and Symptoms | 254 | ||
| Diagnosis | 254 | ||
| Treatment | 255 | ||
| Management of Anesthesia | 255 | ||
| Postoperative Management | 256 | ||
| Subclavian Steal Syndrome | 256 | ||
| Coronary-Subclavian Steal Syndrome | 257 | ||
| Acute Arterial Occlusion | 257 | ||
| Signs and Symptoms | 257 | ||
| Diagnosis | 257 | ||
| Treatment | 257 | ||
| Management of Anesthesia | 257 | ||
| Raynaud Phenomenon | 257 | ||
| Diagnosis | 258 | ||
| Treatment | 258 | ||
| Management of Anesthesia | 258 | ||
| PERIPHERAL VENOUS DISEASE | 258 | ||
| Superficial Thrombophlebitis and Deep Vein Thrombosis | 258 | ||
| Prevention of Venous Thromboembolism | 259 | ||
| Clinical Risk Factors | 259 | ||
| Regional Anesthesia | 259 | ||
| Treatment of Deep Vein Thrombosis | 259 | ||
| Complications of Anticoagulation | 260 | ||
| SYSTEMIC VASCULITIS | 261 | ||
| Temporal (Giant Cell) Arteritis | 261 | ||
| Thromboangiitis Obliterans (Buerger Disease) | 261 | ||
| Signs and Symptoms | 261 | ||
| Treatment | 261 | ||
| Management of Anesthesia | 261 | ||
| Polyarteritis Nodosa | 262 | ||
| Lower Extremity Chronic Venous Disease | 262 | ||
| KEY POINTS | 262 | ||
| RESOURCES | 263 | ||
| 13 - Diseases Affecting the Brain | 265 | ||
| CEREBRAL BLOOD FLOW, BLOOD VOLUME, AND METABOLISM | 265 | ||
| Arterial Carbon Dioxide Partial Pressure | 266 | ||
| Arterial Oxygen Partial Pressure | 266 | ||
| Cerebral Perfusion Pressure and Cerebral Autoregulation | 266 | ||
| Venous Blood Pressure | 267 | ||
| Anesthetic Drugs | 267 | ||
| INCREASED INTRACRANIAL PRESSURE | 268 | ||
| Methods to Decrease Intracranial Pressure | 270 | ||
| Specific Causes of Increased Intracranial Pressure | 271 | ||
| Aqueductal Stenosis | 271 | ||
| Benign Intracranial Hypertension | 271 | ||
| Normal Pressure Hydrocephalus | 272 | ||
| INTRACRANIAL TUMORS | 272 | ||
| Tumor Types | 272 | ||
| Astrocytoma | 272 | ||
| Oligodendroglioma | 272 | ||
| Ependymoma | 272 | ||
| Primitive Neuroectodermal Tumor | 272 | ||
| Meningioma | 273 | ||
| Pituitary Tumor | 273 | ||
| Acoustic Neuroma | 273 | ||
| Central Nervous System Lymphoma | 273 | ||
| Metastatic Tumor | 273 | ||
| Management of Anesthesia | 273 | ||
| Preoperative Management | 274 | ||
| Induction of Anesthesia | 274 | ||
| Maintenance of Anesthesia | 274 | ||
| Fluid Therapy | 275 | ||
| Monitoring | 275 | ||
| Postoperative Management | 275 | ||
| Sitting Position and Venous Air Embolism | 276 | ||
| DISORDERS RELATED TO VEGETATIVE BRAIN FUNCTION | 277 | ||
| Coma | 277 | ||
| Management of Anesthesia | 279 | ||
| Brain Death and Organ Donation | 279 | ||
| Management of Anesthesia | 280 | ||
| CEREBROVASCULAR DISEASE | 280 | ||
| Cerebrovascular Anatomy | 280 | ||
| Acute Ischemic Stroke | 281 | ||
| Management of Acute Ischemic Stroke | 282 | ||
| Perioperative and Periprocedural Stroke | 283 | ||
| Acute Hemorrhagic Stroke | 283 | ||
| Intraparenchymal Hemorrhage | 284 | ||
| Epidural Hematoma | 284 | ||
| Subdural Hematoma | 284 | ||
| Subarachnoid Hemorrhage and Intracranial Aneurysms | 284 | ||
| Management of Anesthesia | 286 | ||
| Arteriovenous Malformation | 287 | ||
| Venous Angioma | 288 | ||
| Cavernous Angioma | 288 | ||
| Capillary Telangiectasia | 288 | ||
| Arteriovenous Fistula | 288 | ||
| Management of Anesthesia | 288 | ||
| Moyamoya Disease | 289 | ||
| 14 - Spinal Cord Disorders | 305 | ||
| ACUTE SPINAL CORD INJURY | 305 | ||
| Management of Anesthesia | 306 | ||
| CHRONIC SPINAL CORD INJURY | 307 | ||
| Management of Anesthesia | 308 | ||
| AUTONOMIC HYPERREFLEXIA | 308 | ||
| SPINAL CORD TUMORS | 309 | ||
| Management of Anesthesia | 309 | ||
| INTERVERTEBRAL DISK DISEASE | 310 | ||
| Cervical Disk Disease | 310 | ||
| Management of Anesthesia | 310 | ||
| Lumbar Disk Disease | 311 | ||
| CONGENITAL AND DEGENERATIVE DISEASES OF THE VERTEBRAL COLUMN AND SPINAL CORD | 311 | ||
| Spina Bifida Occulta | 311 | ||
| Meningocele and Myelomeningocele | 311 | ||
| Tethered Spinal Cord Syndrome | 311 | ||
| Syringomyelia | 312 | ||
| Spondylosis and Spondylolisthesis | 312 | ||
| Amyotrophic Lateral Sclerosis | 312 | ||
| Friedreich’s Ataxia | 313 | ||
| KEY POINTS | 313 | ||
| RESOURCES | 313 | ||
| 15 - Diseases of the Autonomic and Peripheral Nervous Systems | 315 | ||
| AUTONOMIC DISORDERS | 315 | ||
| Multiple System Atrophy | 315 | ||
| Management of Anesthesia | 315 | ||
| Orthostatic Intolerance Syndrome | 316 | ||
| Management of Anesthesia | 316 | ||
| Paraganglioma | 316 | ||
| 16 - Diseases of Aging | 327 | ||
| INTRODUCTION | 327 | ||
| BIOLOGY OF AGING | 327 | ||
| PHYSIOLOGIC EFFECTS OF AGING | 329 | ||
| Central Nervous System | 329 | ||
| Cardiovascular System | 329 | ||
| Respiratory System | 332 | ||
| Renal System, Fluids, and Electrolytes | 333 | ||
| Gastrointestinal System | 333 | ||
| Immune System | 333 | ||
| Endocrine Function Changes | 333 | ||
| Sarcopenia and Body Composition | 333 | ||
| FRAILTY | 334 | ||
| GERIATRIC SYNDROMES | 334 | ||
| Dementia | 334 | ||
| Falls and Balance Disorders | 334 | ||
| PHARMACOKINETIC AND PHARMACODYNAMIC CHANGES WITH AGING | 335 | ||
| Management of Anesthesia | 335 | ||
| Inhalational Anesthetics | 335 | ||
| Propofol | 335 | ||
| Etomidate | 335 | ||
| Thiopental | 335 | ||
| Midazolam | 335 | ||
| Opioids | 336 | ||
| Fentanyl | 336 | ||
| Remifentanil | 336 | ||
| Meperidine | 337 | ||
| Neuromuscular Blocking Drugs | 337 | ||
| PERIOPERATIVE OUTCOMES AFTER CARDIAC AND NONCARDIAC SURGERY | 337 | ||
| PERIOPERATIVE CARE OF ELDERLY PATIENTS | 337 | ||
| Preoperative Assessment | 337 | ||
| Nutrition and Anorexia | 339 | ||
| Functional Status | 339 | ||
| Cognition | 340 | ||
| Medication Review | 340 | ||
| Goals of Care | 340 | ||
| Preoperative Assessment of Patients Undergoing Urgent or Emergent Surgery | 340 | ||
| Intraoperative Management | 340 | ||
| Monitoring | 340 | ||
| Anesthetic Management | 340 | ||
| Fluid Therapy/Blood Transfusion | 341 | ||
| Postoperative Management | 341 | ||
| Postoperative Delirium and Cognitive Dysfunction | 341 | ||
| Postoperative Pain Control | 341 | ||
| Care of the Elderly in the ICU | 342 | ||
| KEY POINTS | 342 | ||
| RESOURCES | 343 | ||
| 17 - Diseases of the Liver and Biliary Tract | 345 | ||
| EPIDEMIOLOGY OF LIVER DISEASE | 345 | ||
| FUNCTION OF THE LIVER | 345 | ||
| Liver Anatomy and Physiology | 346 | ||
| Assessment of Liver Function | 347 | ||
| DISEASES OF THE BILIARY TRACT | 348 | ||
| Biliary Tract Anatomy | 348 | ||
| Cholelithiasis | 348 | ||
| Choledocholithiasis | 348 | ||
| HYPERBILIRUBINEMIA | 348 | ||
| Gilbert Syndrome | 348 | ||
| Crigler-Najjar Syndrome | 349 | ||
| Benign Postoperative Intrahepatic Cholestasis | 349 | ||
| HEPATITIDES | 349 | ||
| Viral Hepatitis | 349 | ||
| Nonalcoholic Fatty Liver Disease | 350 | ||
| Alcoholic Liver Disease | 350 | ||
| Inborn Errors of Metabolism | 351 | ||
| Wilson Disease | 351 | ||
| α1-Antitrypsin Deficiency | 351 | ||
| Hemochromatosis | 351 | ||
| Autoimmune Hepatitis | 351 | ||
| Primary Biliary Cirrhosis | 352 | ||
| Primary Sclerosing Cholangitis | 352 | ||
| Drug/Toxin-Induced Liver Disease | 352 | ||
| Cardiac Causes of Liver Disease | 352 | ||
| ACUTE LIVER FAILURE | 353 | ||
| CIRRHOSIS | 353 | ||
| Portal Hypertension | 354 | ||
| Ascites and Spontaneous Bacterial Peritonitis | 354 | ||
| Varices | 354 | ||
| Hepatic Encephalopathy | 354 | ||
| Hepatorenal Syndrome | 355 | ||
| Hepatopulmonary Syndrome | 355 | ||
| Portopulmonary Hypertension | 356 | ||
| ANESTHESIA FOR PATIENTS WITH LIVER DISEASE | 356 | ||
| PROCEDURES AND OPERATIONS FOR LIVER DISEASE | 356 | ||
| Transjugular Intrahepatic Portosystemic Shunt | 356 | ||
| Partial Hepatectomy | 357 | ||
| Liver Transplantation | 357 | ||
| KEY POINTS | 357 | ||
| RESOURCES | 358 | ||
| 18 - Diseases of the Gastrointestinal System | 359 | ||
| PROCEDURES TO EVALUATE AND TREAT DISEASES OF THE GASTROINTESTINAL SYSTEM | 359 | ||
| Upper Gastrointestinal Endoscopy | 359 | ||
| Colonoscopy | 360 | ||
| Other Diagnostic Tools | 360 | ||
| DISEASES OF THE ESOPHAGUS | 360 | ||
| Symptoms of Esophageal Disease | 360 | ||
| Esophageal Motility Disorders | 361 | ||
| The Chicago Classification | 361 | ||
| Achalasia | 361 | ||
| Treatment | 361 | ||
| Anesthetic Concerns | 362 | ||
| Distal Esophageal Spasm | 362 | ||
| Esophageal Structural Disorders | 362 | ||
| Esophageal Diverticula | 362 | ||
| Hiatal Hernia | 363 | ||
| Esophageal Tumors | 363 | ||
| Esophagectomy | 363 | ||
| Morbidity and Mortality. The morbidity and mortality of esophagectomy are quite high. Morbidity rates are almost 50% in speciali... | 363 | ||
| Anesthetic Implications. Patients are often malnourished (protein-calorie malnutrition) before esophagectomy and for many months... | 363 | ||
| Gastroesophageal Reflux Disease | 363 | ||
| Pathophysiology of GERD | 364 | ||
| Complications of GERD | 364 | ||
| Treatment | 364 | ||
| Perioperative Management and Anesthetic Considerations | 364 | ||
| PEPTIC ULCER DISEASE | 364 | ||
| Complications | 365 | ||
| Bleeding | 365 | ||
| Perforation | 365 | ||
| Obstruction | 365 | ||
| Gastric Ulcer | 365 | ||
| Stress Gastritis | 365 | ||
| Treatment | 365 | ||
| Antacids | 365 | ||
| H2-Receptor Antagonists | 366 | ||
| Proton Pump Inhibitors | 366 | ||
| Prostaglandin Analogues | 366 | ||
| Cytoprotective Agents | 366 | ||
| Miscellaneous Drugs | 366 | ||
| Treatment of Helicobacter pylori Infection | 366 | ||
| Surgical Treatment | 366 | ||
| ZOLLINGER-ELLISON SYNDROME | 367 | ||
| Pathophysiology | 367 | ||
| Treatment | 367 | ||
| Management of Anesthesia | 367 | ||
| POSTGASTRECTOMY SYNDROMES | 367 | ||
| Dumping | 367 | ||
| Alkaline Reflux Gastritis | 368 | ||
| INFLAMMATORY BOWEL DISEASE | 368 | ||
| Ulcerative Colitis | 368 | ||
| Complications | 368 | ||
| Crohn’s Disease | 368 | ||
| Treatment of Inflammatory Bowel Disease | 369 | ||
| Surgical Treatment | 369 | ||
| Medical Treatment | 369 | ||
| CARCINOID TUMORS | 370 | ||
| Carcinoid Tumors Without Carcinoid Syndrome | 370 | ||
| Carcinoid Tumors With Systemic Symptoms Due to Secreted Products | 370 | ||
| Carcinoid Syndrome | 371 | ||
| Treatment | 371 | ||
| Management of Anesthesia | 371 | ||
| ACUTE PANCREATITIS | 372 | ||
| Pathogenesis | 372 | ||
| Complications | 372 | ||
| Treatment | 373 | ||
| Chronic Pancreatitis | 373 | ||
| GASTROINTESTINAL BLEEDING | 373 | ||
| Upper Gastrointestinal Tract Bleeding | 373 | ||
| Lower Gastrointestinal Tract Bleeding | 374 | ||
| ADYNAMIC ILEUS | 374 | ||
| KEY POINTS | 374 | ||
| RESOURCES | 375 | ||
| 19 - Inborn Errors of Metabolism | 377 | ||
| PORPHYRIAS | 377 | ||
| Classification | 377 | ||
| Acute Porphyrias | 377 | ||
| Acute Intermittent Porphyria | 378 | ||
| Variegate Porphyria | 379 | ||
| Hereditary Coproporphyria | 379 | ||
| ALA Dehydratase Porphyria | 379 | ||
| Nonacute Porphyrias | 379 | ||
| Porphyria Cutanea Tarda | 379 | ||
| Congenital Erythropoietic Protoporphyria | 379 | ||
| Erythropoietic Protoporphyria | 379 | ||
| X-Linked Protoporphyria | 379 | ||
| Acute Attacks of Porphyria | 379 | ||
| Triggering Drugs | 380 | ||
| Management of Anesthesia | 380 | ||
| Regional Anesthesia | 380 | ||
| General Anesthesia | 381 | ||
| Treatment of a Porphyric Crisis | 382 | ||
| DISORDERS OF PURINE METABOLISM | 382 | ||
| Gout | 382 | ||
| Treatment | 382 | ||
| Management of Anesthesia | 382 | ||
| Lesch-Nyhan Syndrome | 383 | ||
| DISORDERS OF CARBOHYDRATE METABOLISM | 383 | ||
| HEMOCHROMATOSIS | 383 | ||
| WILSON DISEASE | 383 | ||
| KEY POINTS | 384 | ||
| RESOURCES | 384 | ||
| 20 - Nutritional Diseases: Obesity and Malnutrition | 385 | ||
| OBESITY | 385 | ||
| Definition | 385 | ||
| Epidemiology | 385 | ||
| Pathophysiology | 386 | ||
| Fat Storage | 386 | ||
| Cellular Disturbances | 386 | ||
| Genetic Factors | 387 | ||
| Environmental Factors | 387 | ||
| Psychological and Socioeconomic Factors | 387 | ||
| Diseases Associated With Obesity | 388 | ||
| Endocrine Disorders | 388 | ||
| Glucose Intolerance and Diabetes Mellitus Type 2 | 388 | ||
| Endocrinopathies Causing Obesity | 388 | ||
| Cardiovascular Disorders | 388 | ||
| Systemic Hypertension | 388 | ||
| Cardiac Disease | 389 | ||
| Coronary Artery Disease. Obesity seems to be an independent risk factor for the development of ischemic heart disease, and this ... | 389 | ||
| Heart Failure. Obesity is an independent risk factor for heart failure. In its staging of heart failure, the American College of... | 389 | ||
| Respiratory Disorders | 389 | ||
| Lung Volumes | 389 | ||
| Gas Exchange and Work of Breathing | 390 | ||
| Lung Compliance and Airway Resistance | 390 | ||
| Obstructive Sleep Apnea | 391 | ||
| Obesity Hypoventilation Syndrome | 391 | ||
| Gastrointestinal Disorders | 391 | ||
| Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis | 391 | ||
| Gallbladder Disease | 391 | ||
| Gastric Emptying and Gastroesophageal Reflux Disease | 391 | ||
| Inflammatory Syndrome of Obesity | 391 | ||
| Cancer | 392 | ||
| Thromboembolic Disorders | 392 | ||
| Musculoskeletal Disorders | 392 | ||
| Degenerative Joint Disease | 392 | ||
| Nervous System | 392 | ||
| Treatment of Obesity | 392 | ||
| Nonpharmacologic Therapy | 392 | ||
| Medical Therapy | 393 | ||
| Surgical Therapy | 393 | ||
| Types of Bariatric Surgery | 393 | ||
| Restrictive Bariatric Procedures. Laparoscopic adjustable gastric banding, sleeve gastrectomy, and vertical banded gastroplasty ... | 393 | ||
| Malabsorptive Bariatric Procedures. Malabsorptive procedures include distal gastric or jejunoileal bypass, biliopancreatic diver... | 393 | ||
| Combined Bariatric Procedure. The combined bariatric procedure called Roux-en-Y gastric bypass (RYGB) includes both gastric rest... | 395 | ||
| Surgical Complications | 396 | ||
| Protein-Calorie Malnutrition. Severe malnutrition is the most serious metabolic complication of bariatric surgery. Red meat is p... | 396 | ||
| Fat Malabsorption. Fat-soluble vitamin malabsorption and fat malabsorption (evidenced by steatorrhea) are common with RYGB and B... | 396 | ||
| Consideration of Bariatric Surgery in Pediatric and Adolescent Patients | 396 | ||
| Management of Anesthesia in Obese Patients | 396 | ||
| Preoperative Evaluation | 396 | ||
| Physical Examination and Airway Examination | 397 | ||
| Preoperative Diagnostic Tests | 397 | ||
| Home Medications | 398 | ||
| Intraoperative Management | 398 | ||
| Positioning | 398 | ||
| Laparoscopic Surgery | 398 | ||
| Choice of Anesthesia | 399 | ||
| Regional Anesthesia. Regional anesthesia—spinal anesthesia, epidural anesthesia, and peripheral nerve block—may be technically d... | 399 | ||
| General Anesthesia. Induction of general anesthesia in the obese patient is not without risks. The anesthetic plan, including al... | 399 | ||
| Airway Management | 399 | ||
| Management of Ventilation | 399 | ||
| Induction and Maintenance of Anesthesia | 400 | ||
| Pharmacokinetics of Anesthetic Drugs | 400 | ||
| Monitoring | 401 | ||
| Fluid Management | 401 | ||
| Emergence | 401 | ||
| Postoperative Management | 401 | ||
| Transport | 402 | ||
| Postoperative Analgesia | 402 | ||
| Respiratory and Cardiovascular Monitoring and Management | 402 | ||
| Discharge to an Unmonitored Setting | 402 | ||
| Postoperative Complications | 402 | ||
| MALNUTRITION AND VITAMIN DEFICIENCIES | 403 | ||
| Malnutrition | 403 | ||
| Enteral Nutrition | 403 | ||
| Parenteral Nutrition | 403 | ||
| Vitamin Deficiencies | 403 | ||
| KEY POINTS | 404 | ||
| RESOURCES | 405 | ||
| 21 - Fluid, Electrolyte, and Acid-Base Disorders | 407 | ||
| ABNORMALITIES OF WATER, OSMOLALITY, AND ELECTROLYTES | 407 | ||
| Water and Osmolal Homeostasis | 407 | ||
| DISORDERS OF SODIUM | 408 | ||
| Hyponatremia | 409 | ||
| Signs and Symptoms | 409 | ||
| Diagnosis | 409 | ||
| Treatment | 410 | ||
| Management of Anesthesia | 411 | ||
| Transurethral Resection of the Prostate (TURP) Syndrome | 411 | ||
| Hypernatremia | 412 | ||
| Signs and Symptoms | 412 | ||
| Diagnosis | 412 | ||
| Treatment | 412 | ||
| Management of Anesthesia | 413 | ||
| DISORDERS OF POTASSIUM | 413 | ||
| Hypokalemia | 414 | ||
| Signs and Symptoms | 414 | ||
| Diagnosis | 414 | ||
| Treatment | 414 | ||
| Management of Anesthesia | 414 | ||
| Hyperkalemia | 415 | ||
| Signs and Symptoms | 415 | ||
| Diagnosis | 415 | ||
| Treatment | 416 | ||
| Management of Anesthesia | 416 | ||
| DISORDERS OF CALCIUM | 416 | ||
| Hypocalcemia | 416 | ||
| Signs and Symptoms | 416 | ||
| Diagnosis | 417 | ||
| Treatment | 417 | ||
| Management of Anesthesia | 417 | ||
| Hypercalcemia | 417 | ||
| Signs and Symptoms | 417 | ||
| 22 - Renal Disease | 425 | ||
| CLINICAL ASSESSMENT OF RENAL FUNCTION | 426 | ||
| Glomerular Filtration Rate | 426 | ||
| Creatinine Clearance | 427 | ||
| Serum Creatinine | 427 | ||
| Blood Urea Nitrogen | 427 | ||
| Renal Tubular Function and Integrity | 427 | ||
| Urine Concentrating Ability | 428 | ||
| Proteinuria | 428 | ||
| Fractional Excretion of Sodium | 428 | ||
| Urinalysis | 428 | ||
| Other Biomarkers of Renal Function | 428 | ||
| ACUTE KIDNEY INJURY | 428 | ||
| Etiology | 428 | ||
| Prerenal Azotemia | 429 | ||
| Renal Azotemia | 429 | ||
| Postrenal Azotemia | 429 | ||
| Risk Factors | 430 | ||
| Diagnosis | 430 | ||
| Complications | 430 | ||
| Treatment | 431 | ||
| Prognosis | 431 | ||
| Drug Dosing in Patients With Renal Impairment | 432 | ||
| Management of Anesthesia | 432 | ||
| CHRONIC KIDNEY DISEASE | 432 | ||
| Diagnosis | 433 | ||
| Progression of Chronic Kidney Disease | 433 | ||
| Adaptation to Chronic Kidney Disease | 434 | ||
| Complications | 434 | ||
| Uremic Syndrome | 434 | ||
| Renal Osteodystrophy | 434 | ||
| Anemia | 434 | ||
| Uremic Bleeding | 435 | ||
| Neurologic Changes | 435 | ||
| Cardiovascular Changes | 435 | ||
| Treatment | 435 | ||
| Blood Pressure | 436 | ||
| Nutrition | 436 | ||
| Anemia | 436 | ||
| Renal Replacement Therapy | 436 | ||
| Hemodialysis and Associated Clinical Challenges | 436 | ||
| Vascular Access. A surgically created vascular access site is necessary for effective hemodialysis (Fig. 22.3). Native arteriove... | 436 | ||
| Nutrition and Fluid Balance. During progressive renal failure, catabolism and anorexia lead to loss of lean body mass, but conco... | 438 | ||
| Infection. Infection is the second leading cause of death in patients with ESRD. Contributing factors include impaired phagocyto... | 438 | ||
| Peritoneal Dialysis | 438 | ||
| Drug Clearance in Patients Undergoing Dialysis | 438 | ||
| Perioperative Hemodialysis | 438 | ||
| Management of Anesthesia | 439 | ||
| Preoperative Evaluation | 439 | ||
| Induction of Anesthesia | 439 | ||
| Maintenance of Anesthesia | 440 | ||
| Fluid Management and Urine Output | 440 | ||
| Monitoring | 440 | ||
| Associated Concerns | 441 | ||
| Regional Anesthesia | 441 | ||
| Postoperative Management | 441 | ||
| RENAL TRANSPLANTATION | 441 | ||
| Management of Anesthesia | 441 | ||
| General Anesthesia | 441 | ||
| Regional Anesthesia | 442 | ||
| Postoperative Complications | 442 | ||
| Anesthetic Considerations in Renal Transplant Recipients Undergoing Surgery | 442 | ||
| PRIMARY DISEASES OF THE KIDNEYS | 442 | ||
| Glomerulonephritis | 443 | ||
| Nephrotic Syndrome | 443 | ||
| Pathophysiology | 443 | ||
| Thromboembolic Complications | 443 | ||
| Infection | 443 | ||
| Protein Binding | 443 | ||
| Nephrotic Edema | 443 | ||
| Goodpasture Syndrome | 443 | ||
| Acute Interstitial Nephritis | 444 | ||
| Hereditary Nephritis | 444 | ||
| Polycystic Kidney Disease | 444 | ||
| Renal Tubular Acidosis | 444 | ||
| Fanconi Syndrome | 444 | ||
| Bartter and Gitelman Syndromes | 444 | ||
| Nephrolithiasis | 444 | ||
| Treatment | 445 | ||
| Renal Hypertension | 445 | ||
| Uric Acid Nephropathy | 445 | ||
| Hepatorenal Syndrome | 445 | ||
| Benign Prostatic Hyperplasia | 446 | ||
| Medical Therapy | 446 | ||
| Invasive Treatments | 446 | ||
| Transurethral Resection of the Prostate (TURP) Syndrome | 446 | ||
| Intravascular Volume Expansion. Rapid intravascular fluid volume expansion from systemic absorption of irrigating fluids (absorp... | 447 | ||
| Intravascular Volume Loss. Perioperative hypotension during TURP is sometimes preceded by systemic hypertension. It is conceivab... | 447 | ||
| Hyponatremia. Acute hyponatremia due to intravascular absorption of sodium-free irrigating fluids may cause confusion, agitation... | 447 | ||
| Hypoosmolality. Hypoosmolality rather than hyponatremia may be the crucial physiologic derangement leading to CNS dysfunction in... | 447 | ||
| Hyperammonemia. Hyperammonemia is a result of the use of glycine-containing irrigation solutions, with subsequent systemic absor... | 447 | ||
| Hyperglycinemia. Glycine is an inhibitory neurotransmitter similar to γ-aminobutyric acid in the spinal cord and brain. The use ... | 447 | ||
| KEY POINTS | 447 | ||
| RESOURCES | 448 | ||
| 23 - Endocrine Disease | 449 | ||
| DIABETES MELLITUS | 449 | ||
| Signs and Symptoms | 450 | ||
| Type 1 Diabetes | 450 | ||
| Type 2 Diabetes | 450 | ||
| Diagnosis | 451 | ||
| Treatment | 451 | ||
| Oral Antidiabetic Drugs | 451 | ||
| Insulin | 452 | ||
| Complications | 455 | ||
| Diabetic Ketoacidosis | 455 | ||
| Hyperglycemic Hyperosmolar Syndrome | 455 | ||
| Microvascular Complications | 455 | ||
| Nephropathy | 455 | ||
| Peripheral Neuropathy | 456 | ||
| Retinopathy | 456 | ||
| Autonomic Neuropathy | 456 | ||
| Macrovascular Complications | 456 | ||
| Management of Anesthesia | 456 | ||
| Preoperative Evaluation | 456 | ||
| Intraoperative Management | 457 | ||
| Postoperative Care | 458 | ||
| INSULINOMA | 458 | ||
| THYROID DISEASE | 458 | ||
| Diagnosis | 459 | ||
| Hyperthyroidism | 459 | ||
| Signs and Symptoms | 459 | ||
| Treatment | 460 | ||
| Management of Anesthesia | 460 | ||
| Thyroid Storm | 461 | ||
| Hypothyroidism | 461 | ||
| Signs and Symptoms | 461 | ||
| Treatment | 462 | ||
| Management of Anesthesia | 462 | ||
| Myxedema Coma | 463 | ||
| Goiter and Thyroid Tumors | 463 | ||
| Complications of Thyroid Surgery | 463 | ||
| PHEOCHROMOCYTOMA | 464 | ||
| Signs and Symptoms | 464 | ||
| Diagnosis | 465 | ||
| Management of Anesthesia | 465 | ||
| Preoperative Management | 465 | ||
| Intraoperative Management | 466 | ||
| Postoperative Management | 467 | ||
| ADRENAL GLAND DYSFUNCTION | 467 | ||
| Hypercortisolism (Cushing Syndrome) | 467 | ||
| Primary Hyperaldosteronism (Conn Syndrome) | 468 | ||
| Hypoaldosteronism | 468 | ||
| Adrenal Insufficiency | 468 | ||
| Signs and Symptoms | 468 | ||
| Diagnosis | 469 | ||
| Treatment | 469 | ||
| Management of Anesthesia | 469 | ||
| PARATHYROID GLAND DYSFUNCTION | 470 | ||
| Hyperparathyroidism | 470 | ||
| Hypoparathyroidism | 471 | ||
| PITUITARY GLAND DYSFUNCTION | 472 | ||
| Acromegaly | 472 | ||
| Signs and Symptoms | 472 | ||
| Treatment | 473 | ||
| Management of Anesthesia | 473 | ||
| Diabetes Insipidus | 473 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) | 474 | ||
| KEY POINTS | 474 | ||
| RESOURCES | 475 | ||
| 24 - Hematologic Disorders | 477 | ||
| PHYSIOLOGY OF ANEMIA | 477 | ||
| The Transfusion Trigger | 478 | ||
| Management of Anesthesia: General Concepts for Anemia | 478 | ||
| EVALUATION AND CLASSIFICATION OF ANEMIA | 479 | ||
| Microcytic Anemias | 479 | ||
| Iron Deficiency Anemia | 479 | ||
| Diagnosis | 479 | ||
| Treatment | 479 | ||
| Thalassemia | 479 | ||
| Thalassemia Minor | 479 | ||
| Thalassemia Intermedia | 479 | ||
| Thalassemia Major | 480 | ||
| Management of Anesthesia | 480 | ||
| Normocytic Anemias | 480 | ||
| Hemolytic Anemias | 480 | ||
| Disorders of Red Cell Structure | 480 | ||
| Hereditary Spherocytosis. Abnormalities in membrane protein composition can result in lifelong hemolytic anemia. Hereditary sphe... | 480 | ||
| Management of Anesthesia. Anesthetic risk in these patients is dictated by the severity of the anemia and whether the hemolysis ... | 481 | ||
| Hereditary Elliptocytosis. Hereditary elliptocytosis is caused by an abnormality in one of the membrane proteins, spectrin or gl... | 481 | ||
| Acanthocytosis. Acanthocytosis is another defect in membrane structure found in patients with a congenital lack of β-lipoprotein... | 481 | ||
| Paroxysmal Nocturnal Hemoglobinuria. Paroxysmal nocturnal hemoglobinuria (PNH) is a stem cell disorder that may arise in hematop... | 481 | ||
| Treatment of PNH. In the past, the life expectancy of patients with PNH was 8–10 years after diagnosis. In 2007 the US Food and ... | 481 | ||
| Management of Anesthesia. The nocturnal manifestation of hemolysis is thought to result from carbon dioxide retention and the su... | 481 | ||
| Disorders of Red Cell Metabolism | 481 | ||
| Embden-Meyerhof Pathway. The Embden-Meyerhof pathway (nonoxidative or anaerobic pathway) is responsible for generation of the AT... | 481 | ||
| Phosphogluconate Pathway. The phosphogluconate pathway couples oxidative metabolism with nicotinamide adenine dinucleotide phosp... | 481 | ||
| Glucose-6-Phosphate Dehydrogenase Deficiency. G6PD deficiency is an X-linked genetic disease and is the most common enzymatic di... | 482 | ||
| Pyruvate Kinase Deficiency. Pyruvate kinase deficiency, an autosomal recessive disorder, is the most common erythrocyte enzyme d... | 482 | ||
| Methemoglobin Reductase Pathway. The methemoglobin reductase pathway uses the pyridine nucleotide–reduced nicotinamide adenine d... | 482 | ||
| Luebering-Rapoport Pathway. The Luebering-Rapoport pathway is responsible for production of 2,3-DPG. A single enzyme—2,3 bisphos... | 482 | ||
| Disorders of Hemoglobin | 483 | ||
| Sickle S Hemoglobin. Sickle cell disease is a disorder caused by the substitution of valine for glutamic acid in the β-globin su... | 483 | ||
| Management of Anesthesia. Sickle cell trait does not cause an increase in perioperative morbidity or mortality. However, sickle ... | 483 | ||
| Sickle C Hemoglobin. The prevalence of HbC is about one-fourth that of HbS. HbC causes the erythrocyte to lose water via enhance... | 483 | ||
| Management of Anesthesia. The anesthetic risks of HbSC disease have not been as well studied as those of HbSS disease. However, ... | 484 | ||
| Sickle Hemoglobin–β-Thalassemia. Among African Americans, the frequency of the β-thalassemia gene is only one-tenth that of the ... | 484 | ||
| Unstable Hemoglobins. Hbs are made unstable by structural changes that reduce their solubility or render them more susceptible t... | 484 | ||
| Management of Anesthesia. Anesthetic management of patients with unstable Hbs is largely dictated by the degree of hemolysis. Tr... | 484 | ||
| Autoimmune Hemolytic Anemias | 484 | ||
| Anemia of Chronic Disease | 484 | ||
| Treatment | 484 | ||
| Anemia of Chronic Kidney Disease | 484 | ||
| Aplastic Anemia | 485 | ||
| Management of Anesthesia | 485 | ||
| Macrocytic/Megaloblastic Anemias | 485 | ||
| Folate and Vitamin B12 Deficiency Anemia | 485 | ||
| OTHER HEMOGLOBIN-RELATED DISORDERS | 486 | ||
| Hemoglobins With Increased Oxygen Affinity | 486 | ||
| 25 - Skin and Musculoskeletal Diseases | 507 | ||
| SKIN DISEASES | 508 | ||
| Acanthosis Nigricans | 508 | ||
| Atopic Dermatitis | 508 | ||
| Epidermolysis Bullosa | 508 | ||
| Signs and Symptoms | 508 | ||
| 26 - Infectious Diseases | 539 | ||
| INFECTION PREVENTION OVERVIEW | 540 | ||
| Antibiotic Resistance | 540 | ||
| Surgical Site Infections | 540 | ||
| Risk Factors for Surgical Site Infections | 541 | ||
| Signs and Symptoms | 541 | ||
| Diagnosis | 541 | ||
| Management of Anesthesia | 541 | ||
| Preoperative | 541 | ||
| Prophylactic Antibiotics. It was recognized many years ago that prophylactic administration of antimicrobial agents prevents pos... | 541 | ||
| Physical and Physiologic Preventive Measures. Several simple physical measures have been studied to determine their effects on t... | 542 | ||
| Oxygen. An easy method of improving oxygen tension is to increase the concentration of inspired oxygen. Studies of patients unde... | 542 | ||
| Analgesia. Superior treatment of surgical pain is associated with increased postoperative subcutaneous oxygen partial pressures ... | 542 | ||
| Carbon Dioxide. Hypocapnia occurs frequently during anesthesia and can be deleterious for many reasons, particularly because of ... | 543 | ||
| Glucose. The results of studies to date suggest that in the perioperative period, the ideal blood glucose goal should be in the ... | 543 | ||
| Wound-Probing Protocols. Current studies suggest that infection of contaminated wounds can be decreased by following wound-probi... | 543 | ||
| BLOODBORNE INFECTIONS | 543 | ||
| Bloodstream Infections | 543 | ||
| Signs and Symptoms | 543 | ||
| Diagnosis | 543 | ||
| Treatment | 543 | ||
| Management of Anesthesia | 543 | ||
| Preoperative | 543 | ||
| Intraoperative | 544 | ||
| Postoperative | 544 | ||
| Sepsis | 544 | ||
| Signs and Symptoms | 545 | ||
| Diagnosis | 545 | ||
| Treatment | 545 | ||
| Prognosis | 545 | ||
| Management of Anesthesia | 545 | ||
| Preoperative | 545 | ||
| Intraoperative | 545 | ||
| Postoperative | 545 | ||
| GASTROINTESTINAL INFECTIONS | 547 | ||
| Clostridium Difficile Infection | 547 | ||
| Signs and Symptoms | 547 | ||
| Diagnosis | 547 | ||
| Treatment | 547 | ||
| Prognosis | 547 | ||
| Management of Anesthesia | 547 | ||
| Preoperative | 547 | ||
| 27 - Diseases Related to Immune System Dysfunction | 567 | ||
| INADEQUATE INNATE IMMUNITY | 568 | ||
| Neutropenia | 568 | ||
| Neutropenia in Pediatric Patients | 568 | ||
| Neutropenia in Adults | 569 | ||
| Abnormalities of Phagocytosis | 569 | ||
| Management of Patients With Neutropenia or Abnormalities of Phagocytosis | 570 | ||
| Deficiencies in Components of the Complement System | 570 | ||
| Hyposplenism | 570 | ||
| EXCESSIVE INNATE IMMUNITY | 570 | ||
| Neutrophilia | 570 | ||
| Monocytosis | 572 | ||
| Asthma | 572 | ||
| MISDIRECTED INNATE IMMUNITY | 572 | ||
| Angioedema | 572 | ||
| Management of Anesthesia | 572 | ||
| INADEQUATE ADAPTIVE IMMUNITY | 573 | ||
| Defects of Antibody Production | 573 | ||
| Defects of T Lymphocytes | 573 | ||
| Combined Immune System Defects | 574 | ||
| EXCESSIVE ADAPTIVE IMMUNITY | 574 | ||
| Allergic Reactions | 574 | ||
| Anaphylaxis | 575 | ||
| Diagnosis | 575 | ||
| Treatment | 575 | ||
| Drug Allergy | 576 | ||
| Epidemiology | 576 | ||
| Allergic Drug Reactions During the Perioperative Period | 577 | ||
| Muscle Relaxants | 577 | ||
| Antibiotics | 577 | ||
| Latex | 578 | ||
| Hypnotics | 578 | ||
| Opioids | 579 | ||
| Local Anesthetics | 579 | ||
| Volatile Anesthetics | 579 | ||
| Aspirin and Other NSAIDs | 579 | ||
| Radiocontrast Media | 579 | ||
| Dyes | 580 | ||
| Chlorhexidine | 580 | ||
| Protamine | 580 | ||
| Blood and Blood Products | 580 | ||
| Synthetic Volume Expanders | 580 | ||
| Other Drugs | 580 | ||
| Eosinophilia | 580 | ||
| MISDIRECTED ADAPTIVE IMMUNITY | 581 | ||
| Autoimmune Disorders | 581 | ||
| ANESTHESIA AND IMMUNOCOMPETENCE | 582 | ||
| Transfusion-Related Immunomodulation | 582 | ||
| Neuroendocrine Stress Response | 582 | ||
| Effects of Anesthetics on Immune Response | 582 | ||
| KEY POINTS | 583 | ||
| RESOURCES | 584 | ||
| 28 - Cancer | 585 | ||
| MECHANISM | 586 | ||
| DIAGNOSIS | 586 | ||
| TREATMENT | 586 | ||
| Traditional Chemotherapy | 587 | ||
| Targeted Chemotherapy | 587 | ||
| Radiation Therapy | 587 | ||
| Ablation Therapy | 587 | ||
| Adverse Effects of Cancer Treatment | 588 | ||
| Cardiovascular System | 588 | ||
| Respiratory System | 589 | ||
| Renal System | 589 | ||
| Hepatic System | 590 | ||
| Airway and Oral Cavity | 590 | ||
| Gastrointestinal System | 590 | ||
| Endocrine System | 590 | ||
| Hematologic System | 590 | ||
| Nervous System | 591 | ||
| Tumor Lysis Syndrome | 591 | ||
| CANCER IMMUNOLOGY | 591 | ||
| Diagnosis | 591 | ||
| Immunomodulators | 591 | ||
| Cancer Vaccines | 591 | ||
| PARANEOPLASTIC SYNDROMES | 592 | ||
| Fever and Cachexia | 592 | ||
| Neurologic Abnormalities | 592 | ||
| Endocrine Abnormalities | 592 | ||
| SIADH | 592 | ||
| Hypercalcemia | 593 | ||
| Cushing Syndrome | 593 | ||
| Hypoglycemia | 593 | ||
| Renal Abnormalities | 593 | ||
| Dermatologic and Rheumatologic Abnormalities | 593 | ||
| Hematologic Abnormalities | 593 | ||
| LOCAL EFFECTS OF CANCER AND METASTASES | 593 | ||
| Superior Vena Cava Syndrome/Superior Mediastinal Syndrome | 593 | ||
| Spinal Cord Compression | 594 | ||
| Increased Intracranial Pressure | 594 | ||
| CANCER PAIN | 594 | ||
| Pathophysiology | 594 | ||
| Drug Therapy | 594 | ||
| Neuraxial Analgesia | 594 | ||
| Neurolytic Procedures | 595 | ||
| MANAGEMENT OF ANESTHESIA | 595 | ||
| COMMON CANCERS ENCOUNTERED IN CLINICAL PRACTICE | 596 | ||
| Lung Cancer | 597 | ||
| Etiology | 597 | ||
| Signs and Symptoms | 597 | ||
| Histologic Subtypes | 597 | ||
| Diagnosis | 597 | ||
| Treatment | 597 | ||
| Management of Anesthesia | 598 | ||
| Colorectal Cancer | 598 | ||
| Etiology | 598 | ||
| Diagnosis | 598 | ||
| Signs and Symptoms | 598 | ||
| 29 - Psychiatric Disease, Substance Abuse, and Drug Overdose | 611 | ||
| MOOD DISORDERS | 611 | ||
| Depression | 611 | ||
| Diagnosis | 611 | ||
| Treatment | 612 | ||
| Selective Serotonin Reuptake Inhibitors | 613 | ||
| Serotonin Syndrome. Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur with therapeutic d... | 613 | ||
| Monoamine Oxidase Inhibitors | 614 | ||
| Management of Anesthesia. Anesthesia can be safely conducted in patients being treated with MAOIs despite earlier recommendation... | 614 | ||
| Postoperative Care. Provision of analgesia during the postoperative period is influenced by the potential adverse interactions b... | 615 | ||
| Nonpharmacologic Treatments of Depression | 615 | ||
| Management of Anesthesia. Anesthesia for ECT must be brief, provide the ability to monitor and limit the physiologic effects of ... | 616 | ||
| Bipolar Disorder | 617 | ||
| Treatment | 617 | ||
| Lithium | 617 | ||
| Management of Anesthesia. Evidence of lithium toxicity is an important consideration during the preoperative evaluation. The mos... | 618 | ||
| SCHIZOPHRENIA | 618 | ||
| Treatment | 618 | ||
| Management of Anesthesia | 618 | ||
| Neuroleptic Malignant Syndrome | 618 | ||
| ANXIETY DISORDERS | 619 | ||
| EATING DISORDERS | 619 | ||
| Anorexia Nervosa | 619 | ||
| Signs and Symptoms | 619 | ||
| 30 - Pediatric Diseases | 635 | ||
| UNIQUE CONSIDERATIONS IN PEDIATRIC PATIENTS | 636 | ||
| Anesthesia-Induced Developmental Neurotoxicity | 636 | ||
| Anxiety | 636 | ||
| Anatomy and Physiology | 636 | ||
| Body Size and Thermoregulation | 636 | ||
| Central Nervous System | 636 | ||
| Airway | 636 | ||
| Respiratory System | 636 | ||
| Cardiovascular System | 637 | ||
| Fluids and Renal Physiology | 637 | ||
| Hepatic System | 637 | ||
| Hematologic System | 637 | ||
| Pharmacology | 638 | ||
| Anesthetic Requirements | 638 | ||
| Pharmacokinetics | 638 | ||
| Pediatric Cardiac Arrest During Anesthesia | 639 | ||
| Causes of Cardiac Arrest | 639 | ||
| Management | 639 | ||
| THE PRETERM NEWBORN | 639 | ||
| Definition | 639 | ||
| Respiratory Distress Syndrome | 640 | ||
| 31 - Pregnancy-Associated Diseases | 671 | ||
| PHYSIOLOGIC CHANGES ASSOCIATED WITH PREGNANCY | 671 | ||
| Cardiovascular System | 671 | ||
| Respiratory System | 672 | ||
| Hematologic System | 672 | ||
| Gastrointestinal System | 672 | ||
| Endocrine System | 673 | ||
| Other Changes | 673 | ||
| ANESTHETIC CONSIDERATIONS | 673 | ||
| Nonobstetric Surgery | 673 | ||
| Obstetric Anesthesia Care | 675 | ||
| Regional Analgesic Techniques | 675 | ||
| Lumbar Epidural Analgesia | 675 | ||
| Combined Spinal-Epidural Analgesia | 675 | ||
| Anesthesia for Cesarean Delivery | 675 | ||
| HYPERTENSIVE DISORDERS OF PREGNANCY | 676 | ||
| Gestational Hypertension | 676 | ||
| Preeclampsia | 676 | ||
| Pathophysiology | 677 | ||
| Treatment | 677 | ||
| Management of Anesthesia | 678 | ||
| Labor Analgesia | 678 | ||
| Spinal Anesthesia. Spinal anesthesia is the anesthetic of choice for patients with preeclampsia, unless it is contraindicated be... | 678 | ||
| General Anesthesia. Not only are patients with preeclampsia subject to the common risks of general anesthesia during pregnancy, ... | 678 | ||
| HELLP Syndrome | 678 | ||
| Signs and Symptoms | 678 | ||
| Treatment | 679 | ||
| Index | 695 | ||
| A | 695 | ||
| B | 698 | ||
| C | 699 | ||
| D | 702 | ||
| E | 703 | ||
| F | 705 | ||
| G | 705 | ||
| H | 706 | ||
| I | 709 | ||
| J | 710 | ||
| K | 710 | ||
| L | 710 | ||
| M | 711 | ||
| N | 712 | ||
| O | 713 | ||
| P | 714 | ||
| Q | 718 | ||
| R | 718 | ||
| S | 719 | ||
| T | 721 | ||
| U | 722 | ||
| V | 723 | ||
| W | 723 | ||
| X | 724 | ||
| Z | 724 | ||
| IBC | ES2 |