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Book Details
Abstract
- Provides guidance on the anesthetic diagnosis and management of the full range of cardiac lesions, helping minimize adverse outcomes and reduce complications for patients with common, complex, or uncommon cardiac conditions.
- Includes complete coverage of echocardiography and current monitoring techniques needed for thorough perioperative assessment – all from the anesthesiologist’s perspective.
- Discusses safe and effective perioperative anesthetic management of patients presenting with advanced levels of cardiac care such as drug-eluting stents, multiple antiplatelet drugs, ventricular assist devices, multiple drugs for end-stage heart failure, and implanted electrical devices that produce cardiac resynchronization therapy, as well as patients with complicated obstetric problems or other significant cardiovascular issues.
- Features a concise, easy-to-navigate format and Key Points boxes in each chapter that help you find answers quickly.
- Provides guidance on the anesthetic diagnosis and management of the full range of cardiac lesions, helping minimize adverse outcomes and reduce complications for patients with common, complex, or uncommon cardiac conditions.
- Includes complete coverage of echocardiography and current monitoring techniques needed for thorough perioperative assessment – all from the anesthesiologist’s perspective.
- Discusses safe and effective perioperative anesthetic management of patients presenting with advanced levels of cardiac care such as drug-eluting stents, multiple antiplatelet drugs, ventricular assist devices, multiple drugs for end-stage heart failure, and implanted electrical devices that produce cardiac resynchronization therapy, as well as patients with complicated obstetric problems or other significant cardiovascular issues.
- Features a concise, easy-to-navigate format and Key Points boxes in each chapter that help you find answers quickly.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Essentials of Cardiac Anesthesia for Noncardiac Surgery | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xi | ||
| Table Of Contents | xiii | ||
| I Perioperative Medicine | 1 | ||
| 1 Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery | 2 | ||
| Keywords | 2.e1 | ||
| Key Points | 2 | ||
| Preoperative Cardiac Assessment: Categorizing Risk | 3 | ||
| Preoperative Cardiac Assessment Using Risk Modeling Calculators | 4 | ||
| Revised Cardiac Risk Index | 7 | ||
| ACS-NSQIP Universal Surgical Risk Calculator | 7 | ||
| Algorithmic Approach to Perioperative Cardiac Assessment | 7 | ||
| Classification of Recommendations | 8 | ||
| Principles of Management and Cardiac Medications | 11 | ||
| Electrocardiograms | 11 | ||
| Cardiac Enzymes | 11 | ||
| β-Receptor Antagonists | 11 | ||
| Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers | 12 | ||
| Aspirin Therapy in Patients Without Coronary Stent Implantation | 12 | ||
| Dual Antiplatelet Therapy After Coronary Stent Implantation | 12 | ||
| Anticoagulants: Vitamin K Antagonists and New Oral Anticoagulants | 13 | ||
| Perioperative Anemia Management | 14 | ||
| Pulmonary Vascular Disease and Right Ventricular Dysfunction | 14 | ||
| Suggested Reading | 15 | ||
| 2 Perioperative Approach to the High-Risk Cardiac Patient | 16 | ||
| Keywords | 16.e1 | ||
| Key Points | 16 | ||
| Perioperative Triage | 17 | ||
| Ambulatory Surgery | 17 | ||
| Critical Care Services | 17 | ||
| Triaging Patients With Coronary Stents for Noncardiac Surgery | 18 | ||
| Cardiovascular System | 19 | ||
| Coronary Artery Disease | 19 | ||
| Hypertension | 21 | ||
| Heart Failure | 23 | ||
| Takotsubo Cardiomyopathy | 23 | ||
| Valvular Heart Disease | 25 | ||
| Aortic Stenosis | 25 | ||
| Aortic Regurgitation | 26 | ||
| Mitral Stenosis | 26 | ||
| Mitral Regurgitation | 27 | ||
| Arrhythmias | 27 | ||
| Atrial Fibrillation | 27 | ||
| Supraventricular Tachyarrhythmia | 28 | ||
| Ventricular Arrhythmias | 28 | ||
| Perioperative Management of Anticoagulation | 29 | ||
| Warfarin | 29 | ||
| New Oral Anticoagulants | 30 | ||
| Direct Thrombin Inhibitors | 30 | ||
| Factor Xa Inhibitors | 31 | ||
| Suggested Reading | 31 | ||
| 3 Care of the Patient With Coronary Stents Undergoing Noncardiac Surgery | 33 | ||
| Keywords | 33.e1 | ||
| Key Points | 33 | ||
| Types of Stents | 34 | ||
| Bare Metal Stents | 36 | ||
| Drug-Eluting Stents | 36 | ||
| First-Generation Drug-Eluting Stents | 37 | ||
| Second- and Third-Generation Drug-Eluting Stents | 37 | ||
| Differences Among Drug-Eluting Stents | 37 | ||
| Biodegradable Coronary Stents | 37 | ||
| Responses to Stent Placement | 38 | ||
| Stent-Related Complications | 38 | ||
| In-Stent Restenosis | 38 | ||
| Clinical Presentation | 39 | ||
| Treatment | 39 | ||
| Stent Thrombosis | 39 | ||
| Definition | 39 | ||
| Timing | 40 | ||
| Risk Factors for Stent Thrombosis | 41 | ||
| Stent Type | 41 | ||
| Procedure-Related Factors | 41 | ||
| Lesion-Related Factors | 42 | ||
| Treatment-Related Factors | 42 | ||
| Medical Comorbidities | 42 | ||
| Management | 42 | ||
| Outcome | 42 | ||
| Antiplatelet Therapy | 43 | ||
| Oral Antiplatelet Agents | 43 | ||
| Aspirin | 43 | ||
| Adenosine Receptor Antagonists | 44 | ||
| Clopidogrel | 47 | ||
| Prasugrel | 47 | ||
| Ticagrelor | 48 | ||
| Protease-Activated Receptor-1 Receptor Antagonists | 48 | ||
| Intravenous Antiplatelet Agents | 48 | ||
| Glycoprotein IIb/IIIa Receptor Inhibitors | 48 | ||
| Abciximab | 48 | ||
| Eptifibatide | 49 | ||
| Tirofiban | 49 | ||
| Adenosine Diphosphate Antagonists | 49 | ||
| Cangrelor | 49 | ||
| Long-Term Antiplatelet Management | 49 | ||
| Dual Antiplatelet Therapy | 49 | ||
| Triple Antithrombotic Therapy | 51 | ||
| Variability in Patients’ Response to Antiplatelet Therapy | 52 | ||
| Response to Aspirin | 52 | ||
| Response to Adenosine Antagonists | 53 | ||
| Platelet Function Tests | 53 | ||
| Use of Platelet Function Tests | 55 | ||
| Noncardiac Surgery and Coronary Stents | 57 | ||
| Surgery as a Prothrombotic State | 57 | ||
| Limitations of Current Guidelines and Physician Knowledge | 57 | ||
| Timing of Surgery | 60 | ||
| Management of Antiplatelet Therapy | 62 | ||
| Interruption of Antiplatelet Therapy | 64 | ||
| Continuation of Antiplatelet Therapy and Risk of Hemorrhage | 66 | ||
| Bridging Therapy | 67 | ||
| Patients Undergoing Ambulatory Surgery | 68 | ||
| An Integrated Approach | 68 | ||
| Suggested Reading | 68 | ||
| 4 Cardiovascular Implantable Electronic Device Management in Noncardiac Surgery | 70 | ||
| Keywords | 70.e1 | ||
| Key Points | 70 | ||
| Pacemaker Basics | 71 | ||
| Pacemaker Indications | 72 | ||
| Pacemaker Leads | 72 | ||
| Rate Modulation | 73 | ||
| Multisite Pacing | 75 | ||
| Mode Switching | 76 | ||
| Pacemaker Failure | 77 | ||
| Leadless Transcatheter-Deployed Intracardiac Pacemakers | 77 | ||
| Automatic Implantable Cardioverter-Defibrillator Basics | 78 | ||
| Automatic Implantable Cardioverter-Defibrillator Indications | 81 | ||
| Magnet Application | 81 | ||
| Subcutaneous Implantable Cardioverter-Defibrillators | 85 | ||
| Preoperative Preparation for A Patient With A Cardiac Implantable Electrical Device | 86 | ||
| Electromagnetic Interference | 90 | ||
| Preoperative Evaluation: Summary | 92 | ||
| Current Recommendations | 92 | ||
| Intraoperative Management of A Patient With A Cardiac Implantable Electrical Device | 94 | ||
| Special Situations | 96 | ||
| Imaging Patients With Cardiac Implantable Electrical Devices | 96 | ||
| Lithotripsy | 96 | ||
| Antibiotic Prophylaxis | 96 | ||
| Potential Adverse Outcomes | 97 | ||
| Postoperative Management of A Patient With A Cardiac Implantable Electrical Device | 98 | ||
| Suggested Reading | 98 | ||
| 5 Left Ventricular Assist Device–Supported Patient Presenting for Noncardiac Surgery | 100 | ||
| Keywords | 100.e1 | ||
| Key Points | 100 | ||
| Role of Ventricular Assist Devices in the Management of Heart Failure | 100 | ||
| INTERMACS | 102 | ||
| Specific Devices in Current Use | 103 | ||
| HeartMate II | 103 | ||
| HeartWare HVAD | 104 | ||
| HeartMate 3 | 104 | ||
| Perioperative Management | 104 | ||
| Overview of the Preoperative Assessment | 104 | ||
| Planning Appropriate Perioperative Anticoagulation | 108 | ||
| Management of a Cardiac Implantable Electronic Device | 109 | ||
| Baseline Parameters of Ventricular Assist Device Function | 111 | ||
| Appropriate Staffing of the Case | 111 | ||
| Intraoperative Anesthetic Management | 111 | ||
| Key Points of Physiology | 112 | ||
| Ventricular Interdependence | 112 | ||
| Series Circulatory Effects | 112 | ||
| Ventriculoarterial Coupling | 112 | ||
| Frank-Starling Mechanism | 113 | ||
| Anrep Effect | 113 | ||
| Bowditch Effect | 113 | ||
| Specific Intraoperative Actions | 113 | ||
| Plug It In! | 114 | ||
| Appropriate Antibiotic Coverage | 114 | ||
| Anticoagulation | 115 | ||
| Anesthetic Agents and Techniques | 115 | ||
| Monitoring | 115 | ||
| Putting It All Together: Optimization During the Intraoperative Period | 116 | ||
| Postoperative Considerations | 117 | ||
| Suggested Reading | 118 | ||
| Heart Failure and VAD Statistics | 118 | ||
| Devices | 118 | ||
| VAD Physiology | 119 | ||
| 6 Anesthesia for Noncardiac Surgery After Heart Transplant | 120 | ||
| Keywords | 120.e1 | ||
| Key Points | 120 | ||
| Physiologic Attributes of the Transplanted Heart | 122 | ||
| The Transplanted Heart and the Cardiovascular System | 122 | ||
| Anatomic Correlates | 122 | ||
| Reinnervation | 123 | ||
| Filling Patterns | 123 | ||
| Exercise Response | 124 | ||
| Receptors and Drug Response | 125 | ||
| Complications After Transplantation | 125 | ||
| Rejection | 125 | ||
| Cardiac Allograft Vasculopathy | 126 | ||
| Infection | 128 | ||
| Immunosuppressive Medications and Their Perioperative Management | 128 | ||
| Immunosuppression | 128 | ||
| Induction Therapy | 129 | ||
| Maintenance Therapy | 130 | ||
| Rejection | 130 | ||
| Interactions of Immunosuppressant Medications and Anesthetic Drugs | 130 | ||
| Preoperative Assessment and Optimization | 132 | ||
| Preoperative Evaluation and Testing | 132 | ||
| Perioperative Immunosuppressant Management | 134 | ||
| Perioperative Monitoring and Management | 134 | ||
| Monitoring | 134 | ||
| Anesthetic Technique | 135 | ||
| Intraoperative Management | 135 | ||
| Postoperative Management | 136 | ||
| Conclusion | 136 | ||
| Suggested Reading | 137 | ||
| 7 Pulmonary Hypertension in Noncardiac Surgical Patients | 138 | ||
| Keywords | 138.e1 | ||
| Key Points | 138 | ||
| Classification of Pulmonary Hypertension | 139 | ||
| Idiopathic Pulmonary Arterial Hypertension | 139 | ||
| Pathogenesis | 140 | ||
| Clinical Manifestations | 141 | ||
| Right Ventricular Pathophysiology: Effect of Pulmonary Hypertension on the Right Ventricle | 143 | ||
| Diagnostic Evaluation | 145 | ||
| Right Ventricular Volume Overload | 147 | ||
| Right Ventricular Pressure Overload | 148 | ||
| Treatment Options for Pulmonary Hypertension | 149 | ||
| Anesthetic Management | 154 | ||
| Preoperative Evaluation | 154 | ||
| Choice of Anesthetic Technique | 155 | ||
| Intraoperative Monitoring | 155 | ||
| Hemodynamic Goals | 156 | ||
| Intraoperative Pharmacologic Management | 159 | ||
| Postoperative Considerations | 162 | ||
| Conclusion | 163 | ||
| Suggested Reading | 163 | ||
| 8 Adult Congenital Heart Disease in Noncardiac Surgery | 165 | ||
| Keywords | 165.e1 | ||
| Key Points | 165 | ||
| Noncardiac Surgery in Adults With Congenital Heart Disease | 166 | ||
| General Noncardiac Issues With Long-Standing Congenital Heart Disease | 166 | ||
| Pulmonary | 168 | ||
| Hematologic | 168 | ||
| Renal | 169 | ||
| Neurologic | 169 | ||
| Vasculature | 170 | ||
| Pregnancy | 170 | ||
| Psychosocial | 172 | ||
| Cardiac Issues | 172 | ||
| Aortic Stenosis | 174 | ||
| Aortopulmonary Shunts | 174 | ||
| Atrial Septal Defect and Partial Anomalous Pulmonary Venous Return | 175 | ||
| Coarctation of the Aorta | 177 | ||
| Congenitally Corrected Transposition of the Great Vessels (L-Transposition, Ventricular Inversion) | 178 | ||
| Ebstein Anomaly of the Tricuspid Valve | 179 | ||
| Eisenmenger Syndrome | 180 | ||
| Endocardial Cushion Defects (Atrioventricular Canal Defects) | 183 | ||
| Fontan Physiology | 183 | ||
| Complications (Box 8.7) | 185 | ||
| Modern Fontan Operation | 186 | ||
| Preoperative Assessment | 186 | ||
| Ventilatory Management | 188 | ||
| Pregnancy | 189 | ||
| Patient Ductus Arteriosus | 190 | ||
| Pulmonary Valve Stenosis | 190 | ||
| Tetralogy of Fallot | 191 | ||
| Transposition of the Great Arteries (D-Transposition) | 192 | ||
| Ventricular Septal Defects | 194 | ||
| Conclusion | 194 | ||
| Suggested Reading | 194 | ||
| II Anesthesia for Noncardiac Surgery | 197 | ||
| 9 Cardiovascular Monitoring in Noncardiac Surgery | 198 | ||
| Keywords | 198.e1 | ||
| Key Points | 198 | ||
| Standard American Society of Anesthesiologists Monitors | 199 | ||
| Electrocardiogram | 199 | ||
| Arterial Blood Pressure Monitoring | 201 | ||
| Pulse Oximetry | 205 | ||
| Expired Carbon Dioxide | 206 | ||
| Urine Output, pH, Base Deficit, and Lactate | 206 | ||
| Invasive Monitoring | 207 | ||
| Central Venous Catheterization | 207 | ||
| Pulmonary Artery Catheterization | 208 | ||
| Minimally Invasive and Noninvasive Hemodynamic Monitoring | 210 | ||
| Arterial Pulse Wave | 210 | ||
| Esophageal Doppler | 210 | ||
| Bioimpedance and Cardiac Velocitometry | 212 | ||
| Near-Infrared Spectroscopy | 212 | ||
| Conclusion | 212 | ||
| Suggested Reading | 212 | ||
| 10 Echocardiography in Noncardiac Surgery | 214 | ||
| Keywords | 214.e1 | ||
| Key Points | 214 | ||
| Rescue Echocardiography | 215 | ||
| Acute Valvular Dysfunction | 216 | ||
| Acute Aortic Disease | 218 | ||
| Cardiac Tamponade | 219 | ||
| Right Ventricular Dysfunction | 222 | ||
| Pulmonary Embolism | 224 | ||
| Left Ventricular Hypocontractility | 225 | ||
| Left Ventricular Hypercontractility and Left Ventricular Outflow Tract Obstruction | 226 | ||
| Hypovolemia and Low Afterload | 228 | ||
| Stroke Volume Assessment | 229 | ||
| Dynamic Indicators of Hypovolemia | 231 | ||
| Transesophageal Echocardiography as a Monitor in Noncardiac Surgical Procedures | 232 | ||
| Argument for Use as a Monitor in Noncardiac Cases | 232 | ||
| Transesophageal Echocardiography Goal-Directed Therapy | 233 | ||
| Suggested Method | 236 | ||
| Transthoracic Echocardiography | 238 | ||
| Value of Perioperative Transthoracic Echocardiography | 239 | ||
| How to Perform a Basic Transthoracic Echocardiography Examination | 240 | ||
| Conclusion | 245 | ||
| Suggested Reading | 245 | ||
| 11 Cardiovascular Pharmacology in Noncardiac Surgery | 247 | ||
| Keywords | 247.e1 | ||
| Key Points | 247 | ||
| Vasoactive Agents Used in the Perioperative Period (Boxes 11.1 to 11.3) | 248 | ||
| Vasopressors | 248 | ||
| Phenylephrine | 248 | ||
| Ephedrine | 251 | ||
| Vasopressin | 252 | ||
| Methylene Blue | 252 | ||
| Inotropes | 253 | ||
| Sympathomimetic Amines | 253 | ||
| Epinephrine | 253 | ||
| Dobutamine | 256 | ||
| Isoproterenol | 256 | ||
| Dopamine | 256 | ||
| Norepinephrine | 257 | ||
| Phosphodiesterase III Inhibitors | 257 | ||
| Milrinone | 257 | ||
| Levosimendan | 258 | ||
| Vasodilators | 258 | ||
| Nitroglycerin | 259 | ||
| Nitroprusside | 259 | ||
| Clevidipine | 262 | ||
| Nicardipine | 263 | ||
| β-Adrenergic Blockers | 263 | ||
| Propranolol | 264 | ||
| Metoprolol | 264 | ||
| Esmolol | 265 | ||
| Labetalol | 266 | ||
| Vasoactive Drug Administration Using Infusion Pumps | 266 | ||
| Antiarrhythmic Drugs Used in the Perioperative Period (Boxes 11.4 and 11.5) | 268 | ||
| Class I Antiarrhythmic Drugs: Sodium Channel Blockers (Membrane Stabilizers) | 271 | ||
| Procainamide (Class IA) | 271 | ||
| Lidocaine (Class IB) | 271 | ||
| Class II Drugs: β-Adrenergic Receptor Antagonists | 272 | ||
| Metoprolol | 272 | ||
| Esmolol | 272 | ||
| Class III Drugs: Potassium Channel Blockers and Agents That Prolong Repolarization | 273 | ||
| Amiodarone | 273 | ||
| Class IV Drugs: Calcium Channel Blockers | 274 | ||
| Verapamil and Diltiazem | 274 | ||
| Other Antiarrhythmic Agents | 275 | ||
| Adenosine | 275 | ||
| Potassium | 275 | ||
| Magnesium | 276 | ||
| Pharmacologic Management of Chronic Heart Failure | 277 | ||
| Renin-Angiotensin Blockers | 277 | ||
| Angiotensin-Converting Enzyme Inhibitors | 277 | ||
| Angiotensin Receptor Blockers | 278 | ||
| Recent Advancements in the Treatment of Heart Failure | 278 | ||
| Angiotensin Receptor–Neprilysin Inhibitors | 278 | ||
| Ivabradine | 278 | ||
| Pharmacologic Management of Pulmonary Hypertension (Box 11.6) | 280 | ||
| Inhaled Nitric Oxide | 281 | ||
| Prostacyclin and Analogs | 281 | ||
| Phosphodiesterase Inhibitors | 285 | ||
| Endothelin Receptor Antagonists | 286 | ||
| Riociguat (Adempas) | 287 | ||
| Suggested Reading | 287 | ||
| 12 General, Regional, or Monitored Anesthesia Care for the Cardiac Patient Undergoing Noncardiac Surgery | 289 | ||
| Keywords | 289.e1 | ||
| Key Points | 289 | ||
| Monitored Anesthesia Care | 290 | ||
| Monitoring During Monitored Anesthesia Care | 291 | ||
| Sedation | 291 | ||
| Propofol | 294 | ||
| Fentanyl | 295 | ||
| Remifentanil | 295 | ||
| Dexmedetomidine | 295 | ||
| Midazolam | 296 | ||
| Local Anesthesia | 296 | ||
| Local Anesthetic Systemic Toxicity | 298 | ||
| Special Considerations | 300 | ||
| Conclusion | 301 | ||
| Regional and Neuraxial Anesthesia | 301 | ||
| Neuraxial Anesthesia | 301 | ||
| Anticoagulation and Neuraxial Anesthesia | 302 | ||
| Reversal of Anticoagulation | 303 | ||
| Peripheral Nerve Block | 305 | ||
| General Anesthesia | 306 | ||
| Anesthetic Agents | 307 | ||
| Volatile Anesthetics | 307 | ||
| Nitrous Oxide | 308 | ||
| Etomidate | 308 | ||
| Ketamine | 309 | ||
| Maintenance of General Anesthesia | 309 | ||
| Special Situations | 310 | ||
| Eye Surgery | 310 | ||
| Ambulatory Surgery | 310 | ||
| Suggested Reading | 311 | ||
| 13 Vascular Surgery | 313 | ||
| Keywords | 313.e1 | ||
| Key Points | 313 | ||
| General Considerations for Perioperative Management for Vascular Surgery | 314 | ||
| Preoperative Assessment and Management | 314 | ||
| Intraoperative Anesthetic Management | 316 | ||
| Postoperative Management | 319 | ||
| Carotid Artery and Cerebrovascular Disease | 319 | ||
| Considerations for Intervention | 319 | ||
| Intraoperative Anesthetic Considerations and Management | 321 | ||
| Local Anesthesia Technique for Carotid Endarterectomy | 321 | ||
| General Anesthetic Technique for Carotid Endarterectomy | 322 | ||
| Additional Intraoperative Monitoring | 322 | ||
| Anesthesia for Carotid Artery Stenting | 323 | ||
| Perioperative Challenges | 323 | ||
| Abdominal Aortic Disease | 324 | ||
| Considerations for Intervention | 324 | ||
| Intraoperative Anesthetic Considerations and Management | 325 | ||
| Open Abdominal Aortic Aneurysm Repair | 325 | ||
| Endovascular Abdominal Aortic Aneurysm Repair | 326 | ||
| Perioperative Challenges | 327 | ||
| Hemodynamic Management of Aortic Clamping and Unclamping | 327 | ||
| Renal Protection and Function | 332 | ||
| Respiratory Challenges | 333 | ||
| Unique Complications of Endovascular Intervention | 333 | ||
| Abdominal Aortic Dissection | 334 | ||
| Aortoiliac Occlusive Disease | 335 | ||
| Lower Extremity Arterial Disease | 335 | ||
| Considerations for Intervention | 337 | ||
| Intraoperative Anesthetic Considerations and Management | 337 | ||
| Open Lower Extremity Arterial Bypass | 337 | ||
| Endovascular Lower Extremity Peripheral Arterial Repair | 338 | ||
| Perioperative Challenges | 338 | ||
| Suggested Reading | 339 | ||
| 14 The Cardiac Patient for Thoracic Noncardiac Surgery | 340 | ||
| Keywords | 340.e1 | ||
| Key Points | 340 | ||
| Anesthetic Management for Pulmonary Resection in Patients With Cardiac Disease | 341 | ||
| Coronary Artery Disease | 341 | ||
| Valvular Heart Disease | 343 | ||
| Cardiomyopathies | 344 | ||
| Pulmonary Hypertension | 344 | ||
| Lung Isolation for Cardiac Patients Having Thoracic Procedures | 348 | ||
| Double-Lumen Tubes | 349 | ||
| Advantages | 349 | ||
| Disadvantages | 349 | ||
| Difficult Intubation | 349 | ||
| Airway Injuries | 350 | ||
| Endobronchial Blockers for Lung Separation | 350 | ||
| Lung Separation in Thoracic Aortic Aneurysm Surgery | 351 | ||
| Lung Separation for Esophageal Surgery | 351 | ||
| Management of One-Lung Ventilation | 352 | ||
| Hypoxemia | 352 | ||
| Hypoxic Pulmonary Vasoconstriction | 353 | ||
| Choice of Anesthetic | 353 | ||
| Cardiac Output | 354 | ||
| Ventilation Strategies During One-Lung Ventilation | 354 | ||
| Respiratory Acid-Base Status | 355 | ||
| Positive End-Expiratory Pressure | 355 | ||
| Auto-PEEP | 355 | ||
| Tidal Volume | 355 | ||
| Volume-Controlled Versus Pressure-Controlled Ventilation | 356 | ||
| Prediction of Hypoxemia During One-Lung Ventilation | 357 | ||
| Preoperative Ventilation/Perfusion Scan | 358 | ||
| Side of Operation | 358 | ||
| Two-Lung Oxygenation | 358 | ||
| Preoperative Spirometry | 358 | ||
| Treatment of Hypoxemia During One-Lung Ventilation | 358 | ||
| Pharmacologic Manipulations | 361 | ||
| Intermittent Reinflation of the Nonventilated Lung | 361 | ||
| Partial Ventilation Methods | 361 | ||
| Hypoxemia Prophylaxis | 363 | ||
| Bilateral Pulmonary Surgery | 363 | ||
| Transesophageal Echocardiography for Noncardiac Thoracic Surgery | 363 | ||
| Airway Surgery | 365 | ||
| Anesthetic Management for Diagnostic or Therapeutic Airway Procedures | 365 | ||
| Anesthesia for Tracheal Resection | 368 | ||
| Pulmonary Hemorrhage | 370 | ||
| Pulmonary Artery Catheter–Induced Hemorrhage | 370 | ||
| During Weaning From Cardiopulmonary Bypass | 370 | ||
| Posttracheostomy Hemorrhage | 372 | ||
| Mediastinal Masses | 372 | ||
| Vascular Anomalies With Airway Compression | 374 | ||
| Suggested Reading | 378 | ||
| 15 Anesthesia for Cardioversion and Electrophysiologic Procedures | 379 | ||
| Keywords | 379.e1 | ||
| Key Points | 379 | ||
| Overview of Electrophysiology Procedures | 380 | ||
| Electrophysiology Laboratory | 380 | ||
| Catheter Placement and Generation of Intracardiac Electrograms | 381 | ||
| Catheter Mapping System | 382 | ||
| Mechanisms of Cardiac Arrhythmias | 382 | ||
| Bradyarrhythmias | 382 | ||
| Tachyarrhythmias | 383 | ||
| Anesthetic Agents and Cardiac Conduction | 384 | ||
| Propofol | 384 | ||
| Antiarrhythmic Qualities | 387 | ||
| Proarrhythmic Qualities | 387 | ||
| Etomidate | 387 | ||
| Opioids | 387 | ||
| Fentanyl | 387 | ||
| Morphine | 388 | ||
| Remifentanil | 388 | ||
| Benzodiazepines | 388 | ||
| Dexmedetomidine | 388 | ||
| Antiarrhythmic Qualities | 389 | ||
| Proarrhythmic Qualities | 389 | ||
| Volatile Anesthetics | 389 | ||
| Cardioversion | 390 | ||
| Anesthetic Considerations | 391 | ||
| Cardiac Implantable Electronic Devices | 392 | ||
| Anesthetic Considerations | 393 | ||
| Catheter Ablations | 393 | ||
| Paroxysmal Supraventricular Tachycardia | 393 | ||
| Atrioventricular Nodal Reentrant Tachycardia | 394 | ||
| Atrioventricular Reciprocating Tachycardia | 394 | ||
| Atrial Tachycardia | 394 | ||
| Atrial Flutter | 395 | ||
| Atrial Fibrillation and Left Atrial Ablations | 395 | ||
| Ventricular Tachycardia and Premature Ventricular Contraction Ablation | 396 | ||
| Anesthetic Considerations | 397 | ||
| Left Atrial Appendage Closure | 398 | ||
| Endovascularly Delivered Closure | 398 | ||
| Watchman | 399 | ||
| Amplatzer | 399 | ||
| Percutaneous Closure | 399 | ||
| Lariat | 399 | ||
| Anesthetic Considerations | 399 | ||
| Complications | 400 | ||
| Vascular Complications | 400 | ||
| Thromboembolism | 400 | ||
| Iatrogenic Cardiac Arrhythmias | 400 | ||
| Pericardial Effusion | 400 | ||
| Air Embolism | 401 | ||
| Pulmonary Vein Stenosis | 401 | ||
| Atrioesophageal Fistula | 401 | ||
| Phrenic Nerve Injury | 402 | ||
| Death | 402 | ||
| Conclusion | 402 | ||
| Suggested Reading | 402 | ||
| 16 Cardiac Patients Requiring Emergent Noncardiac Surgery | 404 | ||
| Keywords | 404.e1 | ||
| Key Points | 404 | ||
| Anesthesia for Cardiac Patients Undergoing Emergent Abdominal Surgery | 405 | ||
| Preoperative Concerns | 406 | ||
| Intraoperative Concerns | 408 | ||
| Postoperative Period | 409 | ||
| Emergent Trauma Surgery in Cardiac Patients | 409 | ||
| Recognition of Preexisting Cardiac Disease in Trauma Patients | 410 | ||
| Preparation for Trauma Patients With Cardiac Disease | 410 | ||
| Vasoactive Drugs for Emergent Trauma Preparation | 411 | ||
| Trauma Care in Older Patients With Established Cardiac Disease | 412 | ||
| Overview of Aging Effects on Cardiac Function | 412 | ||
| Management of Trauma Patients With Cardiac Disease | 413 | ||
| Procoagulant Agent Use During Trauma: Impact on Patients With Coronary Artery Disease | 413 | ||
| Trauma Care in Adults With Congenital Heart Disease | 414 | ||
| Preoperative Preparation for Adult Trauma Patients With Congenital Heart Disease | 414 | ||
| Intraoperative Care of Trauma Patients With Congenital Heart Disease | 415 | ||
| Emergent Neurologic Surgery in Patients With Cardiac Disease | 415 | ||
| Introduction | 415 | ||
| Preoperative Evaluation | 416 | ||
| Goals in the Anesthetic Management of Neurologic Emergencies in Patients With Head Injury | 418 | ||
| Prevention of Hypoxia | 419 | ||
| Blood Pressure Management | 419 | ||
| Hypotension | 419 | ||
| Hypertension | 420 | ||
| Blood Glucose Control | 420 | ||
| Hyperthermia | 420 | ||
| Intracranial Hypertension | 421 | ||
| Goals in Anesthetic Management of Patients With Spinal Cord Emergencies | 421 | ||
| Anesthetic Management of Patients With Cerebral Aneurysm Surgery | 422 | ||
| Anesthetic Management of Patients With Emergencies in Interventional Neuroradiology | 423 | ||
| Intracranial Aneurysm Ablation | 423 | ||
| Thrombolysis and Thrombectomy of Acute Thromboembolic Stroke | 423 | ||
| Special Considerations in Anesthetic Management | 424 | ||
| Patients With Ischemic Heart Disease | 424 | ||
| Heart Rate | 424 | ||
| Blood Pressure | 424 | ||
| Fluid Status | 424 | ||
| Arterial Oxygen Content | 424 | ||
| Temperature | 425 | ||
| Patients With Valvular Heart Disease | 425 | ||
| Aortic Stenosis | 425 | ||
| III Critical Care Medicine | 509 | ||
| 20 Management in the Postanesthesia Care Unit of Complications in Cardiac Patients | 510 | ||
| Key Points | 510 | ||
| Surgery, Anesthesia, and the Heart | 512 | ||
| Postanesthesia Cardiac Complications in Cardiac Patients | 513 | ||
| Acute Coronary Syndrome | 513 | ||
| Unstable Angina/Non–ST Segment Elevation Myocardial Infarction | 513 | ||
| ST-Segment Elevation Myocardial Infarction | 514 | ||
| Acute Decompensated Heart Failure | 516 | ||
| Arrhythmias | 517 | ||
| Respiratory Complications After Noncardiac Surgery | 519 | ||
| Effects of Anesthesia on Respiratory Function | 519 | ||
| Respiratory Monitoring, Diagnosis, and Treatment in the Postanesthesia Care Unit | 519 | ||
| Hypoxemia | 519 | ||
| Hypercarbia and Hypoventilation | 520 | ||
| Bleeding in Cardiac Patients After Noncardiac Surgery | 521 | ||
| Vitamin K Antagonists | 521 | ||
| Direct Oral Anticoagulants | 522 | ||
| Antiplatelet Agents | 523 | ||
| Diagnosis and Management of Postoperative Bleeding | 523 | ||
| Suggested Reading | 525 | ||
| 21 Postoperative Care of the Critically Ill | 526 | ||
| Keywords | 526.e1 | ||
| Key Points | 526 | ||
| Neurologic System | 526 | ||
| Perioperative Cerebrovascular Accident | 526 | ||
| Pulmonary System | 528 | ||
| Respiratory Failure | 528 | ||
| Type 1 Respiratory Failure: Hypoxemic | 528 | ||
| Type 2 Respiratory Failure: Hypercarbic With or Without Hypoxemia | 529 | ||
| Postoperative Respiratory Failure | 529 | ||
| Respiratory Failure in Circulatory Shock | 530 | ||
| Pulmonary Edema | 530 | ||
| Cardiogenic Pulmonary Edema | 530 | ||
| Noncardiogenic Pulmonary Edema | 531 | ||
| Negative-Pressure Pulmonary Edema | 531 | ||
| Acute Respiratory Distress Syndrome | 531 | ||
| Chronic Obstructive Pulmonary Disease | 532 | ||
| Hematology | 533 | ||
| Massive Hemorrhage | 533 | ||
| Complications of Massive Transfusion | 533 | ||
| Venous Thromboembolism Prophylaxis and Treatment in the Perioperative Setting | 534 | ||
| Sepsis | 535 | ||
| Suggested Reading | 536 | ||
| 22 Reducing Major Adverse Cardiac Events and All-Cause Mortality in Noncardiac Surgery | 538 | ||
| Keywords | 538.e1 | ||
| Key Points | 538 | ||
| Perioperative Myocardial Infarction or Injury | 539 | ||
| Epidemiology of Perioperative Myocardial Infarction | 540 | ||
| Diagnosis of Myocardial Ischemia and Infarction | 540 | ||
| Risk Stratification and Prevention | 541 | ||
| Patient’s Age | 541 | ||
| Cardiac Risk Indexes | 541 | ||
| Kidney Disease | 542 | ||
| Anemia and Blood Transfusion | 542 | ||
| Type of Surgical Procedure | 543 | ||
| Altered Preoperative Coagulation | 544 | ||
| Cardiac Biomarkers | 544 | ||
| Preoperative Troponin | 544 | ||
| Postoperative Troponin | 545 | ||
| B-Type (Brain) Natriuretic Peptides | 546 | ||
| Perioperative Risk Indices | 547 | ||
| Postoperative Management | 548 | ||
| Medications and Percutaneous Interventions to Prevent and Treat Perioperative Major Adverse Cardiac Events | 549 | ||
| Statins | 549 | ||
| β-Blockers | 550 | ||
| Perioperative β-Blocker Strategy | 550 | ||
| Ivabradine | 551 | ||
| Angiotensin-Converting Enzyme Inhibitors and Aldosterone Antagonists | 551 | ||
| Nitrates | 552 | ||
| Antithrombotic Agents | 552 | ||
| Antiplatelet Drugs Discontinuation and Bridging | 553 | ||
| Strategy for Using Antithrombotic Agents While Minimizing the Risk of Bleeding | 554 | ||
| Percutaneous Coronary Intervention | 554 | ||
| Treatment of Perioperative Myocardial Infarction | 555 | ||
| Age and Comorbidity | 555 | ||
| Patients in Unstable Condition | 555 | ||
| Patients in Stable Condition | 557 | ||
| ST-Segment Elevation Myocardial Infarction | 559 | ||
| Non–ST Segment Elevation Myocardial Infarction | 561 | ||
| Myocardial Injury After Noncardiac Surgery | 562 | ||
| Outcome After Perioperative Myocardial Damage | 562 | ||
| Short-Term Outcome | 562 | ||
| Long-Term Outcome | 563 | ||
| Perioperative Care to Reduce Mortality Rates in Noncardiac Surgical Procedures | 563 | ||
| “Democracy-Based,” Web-Enabled Approach to Consensus on Perioperative Mortality Rate Reduction | 564 | ||
| Results of the Updated Web-Based Consensus Conference on Perioperative Mortality | 565 | ||
| Interventions That May Reduce Mortality Rates in Noncardiac Surgical Procedures | 566 | ||
| Perioperative Hemodynamic Optimization | 566 | ||
| Noninvasive Ventilation | 567 | ||
| Neuraxial Anesthesia | 568 | ||
| Selective Decontamination of the Digestive Tract | 569 | ||
| Tranexamic Acid | 570 | ||
| Interventions That May Increase Mortality Rates in Noncardiac Surgical Procedures | 570 | ||
| Perioperative β-Blockers | 570 | ||
| Further Strategies to Possibly Reduce Mortality Rates in Noncardiac Surgical Procedures: Evidence From Other Clinical Settings | 572 | ||
| Volatile Anesthetic Agents | 572 | ||
| Leukocyte Depletion of Transfused Blood | 572 | ||
| Insulin for Tight Glycemic Control | 573 | ||
| Lung-Protective Ventilation | 573 | ||
| Preoperative Intraaortic Balloon Pump Counterpulsation | 573 | ||
| Vacuum-Assisted Closure | 573 | ||
| Levosimendan | 574 | ||
| Remote Ischemic Preconditioning | 574 | ||
| Future Perspectives | 574 | ||
| Nutritional Support and Supplementation | 575 | ||
| Synthetic Colloids | 575 | ||
| Sedation | 575 | ||
| Inspired Oxygen Fraction | 576 | ||
| High-Flow Nasal Cannula Oxygen | 576 | ||
| Suggested Reading | 576 | ||
| Index | 579 | ||
| A | 579 | ||
| B | 582 | ||
| C | 582 | ||
| D | 585 | ||
| E | 586 | ||
| F | 587 | ||
| G | 587 | ||
| H | 588 | ||
| I | 589 | ||
| J | 590 | ||
| K | 591 | ||
| L | 591 | ||
| M | 592 | ||
| N | 593 | ||
| O | 594 | ||
| P | 595 | ||
| Q | 599 | ||
| R | 599 | ||
| S | 600 | ||
| T | 601 | ||
| U | 602 | ||
| V | 603 | ||
| W | 604 | ||
| Z | 604 | ||
| Inside Back Cover | ibc1 |