Additional Information
Book Details
Abstract
- Trusted authorities deliver the key cardiac anesthesia knowledge you need to know.
- A concise, user-friendly format and key points boxes in each chapter help you quickly locate crucial information.
- Annotated references guide you to the most practical additional resources.
- A portable size and clinical emphasis facilitates and enhances bedside patient care.
- Designed as a companion to Kaplan’s Cardiac Anesthesia.
- Includes new topics vital to the current practice of cardiac anesthesiologists, such as transesophageal echocardiography; percutaneous valve procedures; new pacemakers and automatic internal defibrillators used for cardiac resynchronization therapy; left ventricular assist devices and extracorporeal membrane oxygenation therapy of heart failure; and patient safety issues.
- Focuses on today’s most current and relevant therapies, including New Cardiac Drugs, and Heart Mate, Heart Ware, and Impella LVADs.
- Describes care of the cardiac patient in Hybrid Operating Rooms, Catheterization Laboratories, and Electrophysiology Laboratories, as well as the Cardiac Operating Rooms.
- Perfectly suited for residents, fellows, nurse anesthetists and anesthesiologists in practice.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Kaplan's Essentials of Cardiac Anesthesia | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xvii | ||
| Table Of Contents | xix | ||
| I Preoperative Assessment and Management | 1 | ||
| 1 Cardiac Risk, Imaging, and the Cardiology Consultation | 2 | ||
| Key Points | 2 | ||
| Cardiac Risk Assessment and Cardiac Risk Stratification Models in Patients Undergoing Cardiac Surgery | 3 | ||
| Predictors of Perioperative and Postoperative Morbidity and Mortality | 3 | ||
| Consistency Among Risk Indices | 7 | ||
| Sources of Perioperative Myocardial Injury in Cardiac Surgery | 8 | ||
| Reperfusion of Ischemic Myocardium | 8 | ||
| Adverse Systemic Effects of Cardiopulmonary Bypass | 9 | ||
| Assessment of Perioperative Myocardial Injury in Cardiac Surgery | 9 | ||
| Cardiovascular Imaging | 11 | ||
| Echocardiography | 11 | ||
| Assessment of Left Ventricular Systolic Function | 11 | ||
| Regional Left Ventricular Systolic Function | 12 | ||
| Assessment of Left Ventricular Diastolic Function | 12 | ||
| Right Heart Evaluation | 13 | ||
| Assessment of Valve Lesions | 13 | ||
| Stress Echocardiography | 14 | ||
| Myocardial Ischemia | 14 | ||
| Myocardial Nuclear Scintigraphy | 14 | ||
| Cardiac Computed Tomography | 15 | ||
| Cardiovascular Magnetic Resonance Imaging | 16 | ||
| Suggested Readings | 16 | ||
| 2 Cardiac Catheterization Laboratory | 18 | ||
| Key Points | 18 | ||
| Patient Selection for Catheterization | 19 | ||
| Indications for Cardiac Catheterization in the Adult Patient | 19 | ||
| Patient Evaluation Before Cardiac Catheterization | 21 | ||
| Cardiac Catheterization Procedures | 21 | ||
| Patient Monitoring and Sedation | 22 | ||
| Left-Sided Heart Catheterization | 22 | ||
| Catheterization Site and Anticoagulation | 22 | ||
| Right-Sided Heart Catheterization | 22 | ||
| Indications | 22 | ||
| Diagnostic Catheterization Complications | 23 | ||
| Valvular Pathology | 23 | ||
| Angiography | 23 | ||
| Ventriculography | 23 | ||
| Ejection Fraction Determination | 23 | ||
| Abnormalities in Regional Wall Motion | 25 | ||
| Assessment of Mitral Regurgitation | 25 | ||
| Aortography | 26 | ||
| Coronary Arteriography | 26 | ||
| Description of Coronary Anatomy | 26 | ||
| Assessing the Degree of Stenosis | 27 | ||
| Interventional Cardiology: Percutaneous Coronary Intervention | 27 | ||
| General Topics for All Interventional Devices | 28 | ||
| Indications | 28 | ||
| Equipment and Procedure | 28 | ||
| Restenosis | 30 | ||
| Anticoagulation | 30 | ||
| Operating Room Backup | 32 | ||
| Support Devices for High-Risk Angioplasty | 35 | ||
| Controversies in Interventional Cardiology | 35 | ||
| Percutaneous Coronary Intervention Versus Surgical Revascularization in Complex Coronary Artery Disease | 35 | ||
| Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery for Left Main Coronary Artery Disease | 37 | ||
| Specific Interventional Devices | 38 | ||
| Intracoronary Stents | 38 | ||
| Suggested Readings | 39 | ||
| 3 Cardiac Electrophysiology | 40 | ||
| Key Points | 40 | ||
| Electrophysiologic Principles | 41 | ||
| Anatomy and Physiology of the Cardiac Pacemaker and Conduction Systems | 41 | ||
| Sinoatrial Node | 41 | ||
| Internodal Conduction | 41 | ||
| Atrioventricular Junction and Intraventricular Conduction System | 43 | ||
| Basic Arrhythmia Mechanisms | 43 | ||
| Diagnostic Evaluation | 43 | ||
| Anesthesia Considerations for Supraventricular Arrhythmia Surgery and Ablation Procedures | 44 | ||
| Ventricular Arrhythmias | 45 | ||
| Anesthesia Considerations | 45 | ||
| Cardiac Implantable Electrical Devices | 47 | ||
| Pacemakers | 47 | ||
| Pacemaker Indications | 48 | ||
| Pacemaker Magnets | 48 | ||
| Preanesthetic Evaluation and Pacemaker Reprogramming | 52 | ||
| Intraoperative (or Procedure) Management | 54 | ||
| Temporary Pacemakers | 54 | ||
| Indications for Temporary Pacing | 55 | ||
| Transvenous Temporary Pacing | 55 | ||
| Pacing Pulmonary Artery Catheters | 56 | ||
| Transcutaneous Pacing | 56 | ||
| Postanesthesia Pacemaker Evaluation | 57 | ||
| Implantable Cardioverter-Defibrillators | 57 | ||
| Implantable Cardioverter-Defibrillator Indications | 58 | ||
| Implantable Cardioverter-Defibrillator and Magnets | 58 | ||
| Preanesthetic Evaluation and Implantable Cardioverter-Defibrillator Reprogramming | 59 | ||
| Intraoperative (or Procedure) Management | 59 | ||
| Postanesthesia Implantable Cardioverter-Defibrillator Evaluation | 59 | ||
| Suggested Readings | 59 | ||
| II Cardiovascular Physiology, Pharmacology, Molecular Biology, and Genetics | 61 | ||
| 4 Cardiac Physiology | 62 | ||
| Key Points | 62 | ||
| Functional Implications of Gross Anatomy | 63 | ||
| Structure | 63 | ||
| Valves | 63 | ||
| Blood Supply | 63 | ||
| Conduction | 64 | ||
| Cardiac Myocyte Anatomy and Function | 65 | ||
| Ultrastructure | 65 | ||
| Proteins of the Contractile Apparatus | 66 | ||
| Calcium-Myofilament Interaction | 66 | ||
| The Cardiac Cycle | 67 | ||
| Pressure-Volume Diagrams | 68 | ||
| Determinants of Pump Performance | 70 | ||
| Preload | 70 | ||
| Afterload | 71 | ||
| Myocardial Contractility | 72 | ||
| End-Systolic Pressure-Volume Relationships | 72 | ||
| Stroke Work–End-Diastolic Volume Relationships | 74 | ||
| Isovolumic Indices of Contractility | 74 | ||
| Ejection-Phase Indices of Contractility | 74 | ||
| Evaluation of Diastolic Function | 75 | ||
| Pericardial Forces | 77 | ||
| Suggested Readings | 78 | ||
| 5 Coronary Physiology and Atherosclerosis | 80 | ||
| Key Points | 80 | ||
| Anatomy and Physiology of Blood Vessels | 80 | ||
| Normal Artery Wall | 81 | ||
| Endothelium | 81 | ||
| Endothelium-Derived Relaxing Factors | 81 | ||
| Endothelium-Derived Contracting Factors | 81 | ||
| Endothelial Inhibition of Platelets | 82 | ||
| Determinants of Coronary Blood Flow | 83 | ||
| Perfusion Pressure and Myocardial Compression | 83 | ||
| Myocardial Metabolism | 85 | ||
| Neural and Humoral Control | 85 | ||
| Coronary Innervation | 85 | ||
| Parasympathetic Control | 85 | ||
| β-Adrenergic Coronary Dilation | 86 | ||
| α-Adrenergic Coronary Constriction | 86 | ||
| Coronary Pressure-Flow Relations | 86 | ||
| Autoregulation | 86 | ||
| Coronary Reserve | 86 | ||
| Transmural Blood Flow | 86 | ||
| Atherosclerosis | 87 | ||
| Arterial Wall Inflammation | 88 | ||
| Role of Lipoproteins in Lesion Formation | 88 | ||
| Pathophysiology of Coronary Blood Flow | 89 | ||
| Coronary Artery Stenoses and Plaque Rupture | 89 | ||
| Hemodynamics | 90 | ||
| Coronary Collaterals | 90 | ||
| Pathogenesis of Myocardial Ischemia | 91 | ||
| Determinants of Ratio of Myocardial Oxygen Supply to Demand | 91 | ||
| Dynamic Stenosis | 92 | ||
| Coronary Steal | 92 | ||
| Suggested Readings | 93 | ||
| 6 Molecular and Genetic Cardiovascular Medicine and Systemic Inflammation | 94 | ||
| Key Points | 94 | ||
| Machinery Behind the Cardiac Rhythm: Ion Channels | 95 | ||
| Phase 0: Rapid Upstroke of the Cardiac Action Potential | 96 | ||
| Phase 1: Early Rapid Repolarization | 96 | ||
| Phases 2 and 3: Plateau Phase and Final Rapid Repolarization | 96 | ||
| Phase 4: Diastolic Depolarization and Pacemaker Current | 97 | ||
| Molecular Biology of Ion Channels | 97 | ||
| Ion Channel Pore and Selectivity Filter | 97 | ||
| Clinical Correlates | 97 | ||
| Ion Channels and Antiarrhythmic Drugs | 97 | ||
| Ion Channels in Disease | 97 | ||
| Controlling Cardiac Functioning: Receptors | 98 | ||
| Receptor Classes | 99 | ||
| Adrenergic Receptors and Signaling Pathways | 99 | ||
| Adrenergic Receptors | 99 | ||
| Regulation of β-Receptor Functioning | 101 | ||
| Muscarinic Receptors and Signaling Pathways | 101 | ||
| Muscarinic Acetylcholine Receptors | 101 | ||
| Clinical Correlates | 101 | ||
| Adenosine Signaling | 102 | ||
| Antiarrhythmic Actions of Adenosine | 102 | ||
| Anesthetic Actions | 102 | ||
| Interactions With Channels: Calcium Channels | 102 | ||
| Genetic Cardiovascular Medicine | 102 | ||
| Clinical Applications | 103 | ||
| Common Complex Multigenic Cardiovascular Disorders | 103 | ||
| Clinical Applications | 104 | ||
| Perioperative Genomics in Cardiac Surgery | 105 | ||
| Gene Therapy | 105 | ||
| Systemic Inflammation | 106 | ||
| Systemic Inflammation and Cardiac Surgical Procedures | 106 | ||
| Mechanisms of Inflammation-Mediated Injury | 106 | ||
| Physiologic Mediators of Inflammation | 107 | ||
| Cytokines | 107 | ||
| Complement System | 108 | ||
| Postoperative Complications Attributable to Inflammation | 110 | ||
| Types of Complications | 110 | ||
| Potential Therapies for the Prevention of Inflammation-Related Complications | 110 | ||
| Suggested Readings | 110 | ||
| 7 Pharmacology of Anesthetic Drugs | 112 | ||
| Key Points | 112 | ||
| Volatile Agents | 113 | ||
| Acute Effects | 113 | ||
| Myocardial Function | 113 | ||
| Cardiac Electrophysiology | 113 | ||
| Coronary Vasoregulation | 113 | ||
| Systemic Vascular Effects | 114 | ||
| Baroreceptor Reflex | 114 | ||
| Delayed Effects | 114 | ||
| Reversible Myocardial Ischemia | 114 | ||
| Anesthetic Preconditioning | 115 | ||
| Intravenous Induction Agents | 116 | ||
| Acute Cardiac Effects | 116 | ||
| Myocardial Contractility | 116 | ||
| Vasculature | 117 | ||
| Individual Agents | 118 | ||
| Thiopental | 118 | ||
| General Characteristics | 118 | ||
| Cardiovascular Effects | 118 | ||
| Uses in Cardiac Anesthesia | 121 | ||
| Midazolam | 121 | ||
| General Characteristics | 121 | ||
| Cardiovascular Effects | 121 | ||
| III Monitoring | 167 | ||
| 9 Electrocardiographic Monitoring | 168 | ||
| Key Points | 168 | ||
| The 12-Lead System | 168 | ||
| Electrocardiographic Artifact | 170 | ||
| Electrical Power–Line Interference | 170 | ||
| Electrocautery | 170 | ||
| Clinical Sources of Artifact | 170 | ||
| Electrocardiographic Changes With Myocardial Ischemia | 171 | ||
| Detection of Myocardial Ischemia | 171 | ||
| Anatomic Localization of Ischemia With the Electrocardiogram | 173 | ||
| Clinical Lead Systems for Detecting Ischemia | 174 | ||
| Intraoperative Lead Systems | 174 | ||
| Electrocardiographic Changes With Pacemakers, Respirations, Electrolytes, and Medications | 175 | ||
| Electrocardiographic Changes Resulting From Electrolyte Disorders | 176 | ||
| Hyperkalemia | 176 | ||
| Hypokalemia | 176 | ||
| Hypocalcemia and Hypercalcemia | 176 | ||
| Medications | 177 | ||
| Appendix 9.1 Electrocardiogram Atlas: A Summary of Important Changes on the Electrocardiogram | 178 | ||
| Normal Electrocardiogram: Cardiac Cycle | 180 | ||
| Atrial Fibrillation | 180 | ||
| Atrial Flutter | 181 | ||
| Atrioventricular Block | 181 | ||
| First-Degree | 181 | ||
| Second-Degree: Mobitz Type I/Wenckebach Block | 182 | ||
| Second-Degree: Mobitz Type II Block | 182 | ||
| Third-Degree: Complete Heart Block | 182 | ||
| Atrioventricular Dissociation | 183 | ||
| Bundle Branch Block | 183 | ||
| Left Bundle Branch Block | 183 | ||
| Right Bundle Branch Block | 184 | ||
| Coronary Artery Disease | 185 | ||
| Transmural Myocardial Infarction | 185 | ||
| Subendocardial Myocardial Infarction | 189 | ||
| Myocardial Ischemia | 190 | ||
| Digitalis Effect | 190 | ||
| Electrolyte Disturbances | 191 | ||
| Calcium | 192 | ||
| Potassium | 192 | ||
| Hypokalemia (K+ = 1.9 mEq/L) | 192 | ||
| Hyperkalemia (K+ = 7.9 mEq/L) | 192 | ||
| Hypothermia | 192 | ||
| Multifocal Atrial Tachycardia | 193 | ||
| Paroxysmal Atrial Tachycardia | 193 | ||
| Pericarditis | 194 | ||
| Pericardial Tamponade | 194 | ||
| Pneumothorax | 195 | ||
| Premature Atrial Contraction | 196 | ||
| Premature Ventricular Contraction | 196 | ||
| Pulmonary Embolus | 196 | ||
| Sinus Bradycardia | 197 | ||
| Sinus Arrhythmia | 197 | ||
| Sinus Arrest | 198 | ||
| Sinus Tachycardia | 198 | ||
| Subarachnoid Hemorrhage | 199 | ||
| Torsades De Pointes | 199 | ||
| Ventricular Fibrillation | 200 | ||
| Coarse Ventricular Fibrillation | 200 | ||
| Fine Ventricular Fibrillation | 200 | ||
| Ventricular Tachycardia | 200 | ||
| Wolff-Parkinson-White Syndrome | 201 | ||
| Pacing | 201 | ||
| Atrial Pacing | 201 | ||
| Ventricular Pacing | 201 | ||
| DDD Pacing | 202 | ||
| Acknowledgments | 202 | ||
| Bibliography | 202 | ||
| Suggested Readings | 177 | ||
| 10 Monitoring of the Heart and Vascular System | 203 | ||
| Key Points | 203 | ||
| Hemodynamic Monitoring | 203 | ||
| Arterial Pressure Monitoring | 205 | ||
| Arterial Cannulation Sites | 205 | ||
| Insertion Techniques | 206 | ||
| Direct Cannulation | 206 | ||
| Ultrasound and Doppler-Assisted Techniques | 207 | ||
| Central Venous Pressure Monitoring | 208 | ||
| Internal Jugular Vein | 210 | ||
| Ultrasound-Guided Internal Jugular Vein Cannulation | 212 | ||
| Pulmonary Arterial Pressure Monitoring | 214 | ||
| Technical Aspects of Pulmonary Artery Catheter Use | 215 | ||
| Complications | 218 | ||
| Arrhythmias | 218 | ||
| Complete Heart Block | 219 | ||
| Endobronchial Hemorrhage | 220 | ||
| Pulmonary Infarction | 221 | ||
| Catheter Knotting and Entrapment | 221 | ||
| Valvular Damage | 221 | ||
| Pacing Pulmonary Artery Catheters | 221 | ||
| Mixed Venous Oxygen Saturation Catheters | 222 | ||
| Cardiac Output Monitoring | 222 | ||
| Thermodilution | 222 | ||
| Intermittent Thermodilution Cardiac Output | 222 | ||
| Continuous Thermodilution Cardiac Output | 223 | ||
| Coronary Sinus Catheterization | 224 | ||
| Suggested Readings | 224 | ||
| 11 Basic Intraoperative Transesophageal Echocardiography | 226 | ||
| Key Points | 226 | ||
| Basic Concepts | 227 | ||
| Properties of Ultrasound | 227 | ||
| Imaging Techniques | 228 | ||
| M Mode | 228 | ||
| Two-Dimensional Mode | 228 | ||
| Doppler Techniques | 229 | ||
| Color-Flow Doppler | 229 | ||
| Equipment | 229 | ||
| Complications | 230 | ||
| Safety Guidelines and Contraindications | 231 | ||
| Technique of Probe Passage | 231 | ||
| Comprehensive Intraoperative Multiplane Transesophageal Echocardiographic Examination | 232 | ||
| Probe Manipulation: Descriptive Terms and Technique | 232 | ||
| Comprehensive Intraoperative Transesophageal Echocardiographic Examination: Imaging Planes and Structural Analysis | 239 | ||
| Left and Right Ventricles | 239 | ||
| Mitral Valve | 240 | ||
| Aortic Valve, Aortic Root, and Left Ventricular Outflow | 247 | ||
| Tricuspid Valve | 247 | ||
| Pulmonic Valve and Pulmonary Artery | 248 | ||
| Left Atrium, Left Atrial Appendage, Pulmonary Veins, and Atrial Septum | 248 | ||
| Right Atrium and Coronary Sinus | 248 | ||
| Thoracic Aorta | 249 | ||
| Clinical Applications | 250 | ||
| Left Ventricular Assessment | 250 | ||
| Assessment of Left Ventricular Size | 250 | ||
| Left Ventricular Preload by End-Diastolic Dimensions | 250 | ||
| Left Ventricular Systolic Function | 250 | ||
| Myocardial Ischemia Monitoring | 251 | ||
| Regional Wall Motion | 251 | ||
| Wall Motion | 251 | ||
| Diagnosis of Ischemia | 251 | ||
| Limitations | 252 | ||
| Outcome Significance | 253 | ||
| Right Ventricular Function | 253 | ||
| Hemodynamic Assessment | 254 | ||
| Intravascular Pressures | 254 | ||
| Determination of Intravascular Pressures | 254 | ||
| Cardiac Output | 255 | ||
| Doppler Measurements | 255 | ||
| Contrast Applications | 255 | ||
| Valvular Evaluation | 256 | ||
| Aortic Valve Evaluation | 256 | ||
| Aortic Stenosis | 256 | ||
| Aortic Regurgitation | 258 | ||
| Mitral Valve Evaluation | 259 | ||
| Mitral Stenosis | 259 | ||
| Mitral Regurgitation | 259 | ||
| Qualitative Grading Using Color-Flow Doppler | 260 | ||
| Tricuspid Valve | 261 | ||
| Intraoperative Transesophageal Echocardiography: Indications | 261 | ||
| Case Studies of Intraoperative Transesophageal Echocardiography | 263 | ||
| Suggested Readings | 276 | ||
| 12 Central Nervous System Monitoring | 277 | ||
| Key Points | 277 | ||
| Electroencephalography | 278 | ||
| Physiologic Basis of Electroencephalography | 278 | ||
| Practical Considerations of Electroencephalographic Recording and Signal Processing | 279 | ||
| Display of Electroencephalographic Information | 280 | ||
| Time-Domain Analysis | 280 | ||
| Frequency-Domain Analysis | 282 | ||
| Auditory-Evoked Potentials | 286 | ||
| Somatosensory-Evoked Potentials | 286 | ||
| Motor-Evoked Potentials | 287 | ||
| Transcranial Doppler Ultrasound | 288 | ||
| Ultrasound Technology | 288 | ||
| Pulsed-Wave Spectral Display | 290 | ||
| Power M-Mode Doppler Display | 290 | ||
| Embolus Detection | 292 | ||
| Intervention Threshold | 292 | ||
| Jugular Bulb Oximetry | 292 | ||
| Cerebral Oximetry | 293 | ||
| Near-Infrared Technology | 293 | ||
| Validation | 294 | ||
| Multimodality Neuromonitoring | 294 | ||
| Surgery on the Aorta | 294 | ||
| Circulatory Arrest | 294 | ||
| Antegrade Cerebral Perfusion | 296 | ||
| Descending Aorta Surgery | 296 | ||
| Routine Coronary Artery Bypass Graft and Valve Procedures | 296 | ||
| Extracorporeal Membrane Oxygenation | 297 | ||
| Depth of Anesthesia | 297 | ||
| Summary | 297 | ||
| Suggested Readings | 297 | ||
| 13 Coagulation Monitoring | 299 | ||
| Key Points | 299 | ||
| Monitoring Heparin Effect | 299 | ||
| Activated Coagulation Time | 300 | ||
| Heparin Resistance | 302 | ||
| Measurement of Heparin Sensitivity | 302 | ||
| Heparin Concentration | 304 | ||
| Heparin Neutralization | 304 | ||
| Protamine Effects on Coagulation Monitoring | 304 | ||
| Monitoring for Heparin Rebound | 304 | ||
| Heparin Neutralization Monitors | 305 | ||
| Tests of Coagulation | 306 | ||
| Bedside Tests of Coagulation | 307 | ||
| Fibrinogen Level | 307 | ||
| Monitoring the Thrombin Inhibitors | 307 | ||
| Bivalirudin | 308 | ||
| Monitoring Platelet Function | 308 | ||
| Platelet Count | 308 | ||
| Bedside Coagulation and Platelet Function Testing | 309 | ||
| Viscoelastic Tests | 309 | ||
| Thromboelastography | 309 | ||
| Thromboelastography Modifications | 313 | ||
| ROTEM (Rotational Thrombelastometry) | 314 | ||
| Point-of-Care Tests of Platelet Response to Agonists | 316 | ||
| VerifyNow | 316 | ||
| Platelet Function Analyzer | 316 | ||
| Suggested Readings | 318 | ||
| IV Anesthesia for Cardiac Surgical Procedures | 321 | ||
| 14 Anesthesia for Myocardial Revascularization | 322 | ||
| Key Points | 322 | ||
| Epidemiology | 323 | ||
| Pathophysiology of Coronary Artery Disease | 324 | ||
| Anatomy | 324 | ||
| Myocardial Ischemia and Infarction | 327 | ||
| Anesthesia for Coronary Artery Bypass Grafting | 327 | ||
| Premedication | 328 | ||
| Anxiolysis, Amnesia, and Analgesia | 328 | ||
| Management of Preoperative Medications | 328 | ||
| β-Blocking Agents | 328 | ||
| Antiplatelet Drugs | 330 | ||
| HMG CoA Reductase Inhibitors | 330 | ||
| Angiotensin-Converting Enzyme Inhibitors | 331 | ||
| Monitoring | 331 | ||
| Electrocardiogram | 331 | ||
| Arterial Pressure Monitoring | 332 | ||
| Central Venous Cannulation | 332 | ||
| Pulmonary Artery Catheterization | 332 | ||
| Transesophageal Echocardiography | 332 | ||
| Neuromonitoring | 333 | ||
| Induction and Maintenance of General Anesthesia | 333 | ||
| Anesthetic Agents | 334 | ||
| Inhalation Anesthetics and Myocardial Protection | 335 | ||
| Role of Central Neuraxial Blockade | 336 | ||
| Myocardial Ischemia in Patients Undergoing Revascularization Surgery | 336 | ||
| Intraoperative Treatment of Myocardial Ischemia | 337 | ||
| Intravenous Nitroglycerin | 337 | ||
| Calcium Channel Antagonists | 339 | ||
| β-Blockers | 339 | ||
| The Immediate Postoperative Period | 340 | ||
| Sedation | 340 | ||
| Coronary Artery and Arterial Conduit Spasm | 341 | ||
| Fast-Track Management for Coronary Artery Bypass Grafting | 341 | ||
| Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass | 343 | ||
| Cardiovascular Effects of Off-Pump Coronary Artery Bypass Grafting | 343 | ||
| Specific Anesthetic Considerations in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting | 345 | ||
| Outcomes for Off-Pump Coronary Artery Bypass Grafting | 347 | ||
| Minimally Invasive Coronary Artery Surgery | 348 | ||
| Suggested Readings | 350 | ||
| 15 Valvular Heart Disease | 352 | ||
| Key Points | 352 | ||
| Aortic Stenosis | 353 | ||
| Clinical Features and Natural History | 353 | ||
| Pathophysiology | 354 | ||
| Difficulty of Low-Gradient, Low-Output Aortic Stenosis | 356 | ||
| Timing of Intervention | 357 | ||
| Anesthesia Considerations | 357 | ||
| Hypertrophic Cardiomyopathy | 359 | ||
| Hypertrophic Obstructive Cardiomyopathy | 359 | ||
| Clinical Features and Natural History | 359 | ||
| Pathophysiology | 360 | ||
| Anesthesia Considerations | 362 | ||
| Aortic Regurgitation | 364 | ||
| Clinical Features and Natural History | 364 | ||
| Pathophysiology | 364 | ||
| Surgical Decision Making | 366 | ||
| Acute Aortic Regurgitation | 366 | ||
| Anesthesia Considerations | 367 | ||
| Mitral Stenosis | 368 | ||
| Clinical Features and Natural History | 368 | ||
| Pathophysiology | 370 | ||
| Surgical Decision Making | 370 | ||
| Mitral Regurgitation | 372 | ||
| Clinical Features and Natural History | 372 | ||
| Pathophysiology | 372 | ||
| Ischemic Mitral Regurgitation | 373 | ||
| Surgical Decision Making | 374 | ||
| Minimally Invasive Mitral Valve Surgery | 374 | ||
| Anesthesia Considerations | 376 | ||
| Anesthesia Considerations | 378 | ||
| Tricuspid Regurgitation | 379 | ||
| Clinical Features and Natural History | 379 | ||
| Surgical Decision Making | 380 | ||
| Anesthesia Considerations | 381 | ||
| Innovations in Valve Repair | 382 | ||
| Aortic Valve Repair | 382 | ||
| Sutureless Valve Replacement | 382 | ||
| New Techniques for Mitral Valve Repair | 383 | ||
| Altering Ventricular Anatomy to Reduce Mitral Regurgitation | 383 | ||
| Suggested Readings | 383 | ||
| 16 Congenital Heart Disease in Adults | 385 | ||
| Key Points | 385 | ||
| General Noncardiac Issues With Longstanding Congenital Heart Disease | 386 | ||
| Cardiac Issues | 386 | ||
| Aortic Stenosis | 388 | ||
| Aortopulmonary Shunts | 389 | ||
| Atrial Septal Defect and Partial Anomalous Pulmonary Venous Return | 390 | ||
| Coarctation of the Aorta | 391 | ||
| Eisenmenger Syndrome | 393 | ||
| Fontan Physiology | 395 | ||
| The Modern Fontan Operation | 395 | ||
| Preoperative Assessment | 396 | ||
| Ventilatory Management | 397 | ||
| Tetralogy of Fallot | 398 | ||
| Transposition of the Great Arteries (d-Transposition) | 399 | ||
| Suggested Readings | 400 | ||
| 17 Thoracic Aorta | 402 | ||
| Key Points | 402 | ||
| General Considerations for the Perioperative Care of Aortic Surgical Patients | 404 | ||
| Preanesthetic Assessment | 404 | ||
| Anesthetic Management | 405 | ||
| Postoperative Care | 407 | ||
| Thoracic Aortic Aneurysm | 407 | ||
| Surgical Considerations for Thoracic Aortic Aneurysms | 408 | ||
| Surgical Repair of Ascending Aortic and Arch Aneurysms | 409 | ||
| Anesthetic Management for Ascending Aorta and Arch Aneurysms | 410 | ||
| Neuroprotection Strategies for Temporary Interruption of Cerebral Blood Flow | 410 | ||
| Deep Hypothermic Circulatory Arrest | 411 | ||
| Retrograde Cerebral Perfusion | 411 | ||
| Selective Antegrade Cerebral Perfusion | 412 | ||
| Pharmacologic Neuroprotection Strategies for Deep Hypothermic Circulatory Arrest | 412 | ||
| Descending Thoracic and Thoracoabdominal Aortic Aneurysms | 412 | ||
| Simple Aortic Cross-Clamp Technique | 413 | ||
| Gott Shunt | 414 | ||
| Partial Left-Heart Bypass | 414 | ||
| Cardiopulmonary Bypass With Deep Hypothermic Circulatory Arrest | 415 | ||
| Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms | 416 | ||
| Anesthetic Management for Thoracoabdominal Aortic Aneurysm Repair | 416 | ||
| Lung Isolation Techniques | 416 | ||
| Paraplegia After Thoracoabdominal Aortic Aneurysm Repair | 417 | ||
| Lumbar Cerebrospinal Fluid Drainage | 418 | ||
| Arterial Pressure Augmentation | 419 | ||
| Intraoperative Neurophysiologic Monitoring | 420 | ||
| Spinal Cord Hypothermia | 420 | ||
| Pharmacologic Protection of the Spinal Cord | 420 | ||
| Postoperative Analgesia After Thoracoabdominal Aortic Aneurysm Repair | 420 | ||
| Anesthetic Management for Thoracic Endovascular Aortic Repair | 421 | ||
| Aortic Dissection | 421 | ||
| Type A Aortic Dissection | 421 | ||
| Type B Aortic Dissection | 422 | ||
| Anesthetic Management for Aortic Dissection | 422 | ||
| Surgical Treatment of Stanford Type A Aortic Dissection | 423 | ||
| Integrated Management of Stanford Type B Aortic Dissection | 424 | ||
| Traumatic Aortic Injury | 424 | ||
| Suggested Readings | 424 | ||
| 18 Uncommon Cardiac Diseases | 426 | ||
| Key Points | 426 | ||
| Cardiac Tumors | 427 | ||
| Primary Benign Tumors | 428 | ||
| Myxoma | 428 | ||
| Papillary Fibroelastoma | 430 | ||
| Primary Malignant Tumors | 430 | ||
| Metastatic Tumors | 431 | ||
| Anesthetic Considerations | 431 | ||
| Tumors With Systemic Cardiac Manifestations | 432 | ||
| Carcinoid Tumors | 432 | ||
| Anesthetic Considerations | 433 | ||
| Renal Cell Carcinoma | 433 | ||
| Anesthetic Considerations | 434 | ||
| Cardiomyopathy | 434 | ||
| Dilated Cardiomyopathy | 438 | ||
| Anesthetic Considerations | 443 | ||
| Hypertrophic Cardiomyopathy | 443 | ||
| V Extracorporeal Circulation | 607 | ||
| 25 Cardiopulmonary Bypass Management and Organ Protection | 608 | ||
| Key Points | 608 | ||
| Goals and Mechanics of Cardiopulmonary Bypass | 609 | ||
| Physiologic Parameters of Cardiopulmonary Bypass | 609 | ||
| End-Organ Effects of Cardiopulmonary Bypass | 610 | ||
| Central Nervous System Injury | 611 | ||
| Incidence and Significance of Injury | 611 | ||
| Risk Factors for Central Nervous System Injury | 611 | ||
| Causes of Perioperative Central Nervous System Injury | 614 | ||
| Cerebral Embolization | 614 | ||
| Global Cerebral Hypoperfusion | 615 | ||
| Temperature-Related Factors | 616 | ||
| Inflammation | 616 | ||
| Cerebral Edema | 616 | ||
| Blood-Brain Barrier Dysfunction | 616 | ||
| Neuroprotective Strategies | 617 | ||
| Emboli Reduction | 617 | ||
| Management of Aortic Atherosclerosis | 618 | ||
| Pulsatile Perfusion | 618 | ||
| Acid-Base Management: Alpha-Stat Versus pH-Stat | 619 | ||
| Temperature and Rewarming Strategies | 619 | ||
| Mean Arterial Pressure Management During Cardiopulmonary Bypass | 619 | ||
| Glucose Management | 620 | ||
| Off-Pump Cardiac Surgery | 621 | ||
| Pharmacologic Neuroprotection | 621 | ||
| Thiopental | 621 | ||
| Propofol | 622 | ||
| Aprotinin | 622 | ||
| Nimodipine | 622 | ||
| Lidocaine | 622 | ||
| β-Blockers | 622 | ||
| Steroids | 623 | ||
| Ketamine | 623 | ||
| Acute Kidney Injury | 623 | ||
| Clinical Course, Incidence, and Significance | 624 | ||
| Risk Factors and Surgery-Related Acute Kidney Injury Pathophysiology | 624 | ||
| Strategies for Renal Protection | 626 | ||
| Early Acute Kidney Injury Biomarkers | 626 | ||
| Cardiopulmonary Bypass Management and the Kidney | 627 | ||
| Pharmacologic Intervention | 627 | ||
| Dopamine | 628 | ||
| Fenoldopam | 628 | ||
| Diuretic Agents | 628 | ||
| N-Acetylcysteine | 628 | ||
| Adrenergic Agonists | 629 | ||
| Calcium Channel Blockers | 629 | ||
| Sodium Bicarbonate | 629 | ||
| Angiotensin-Converting Enzyme Inhibitor and Angiotensin I Receptor Blockers | 629 | ||
| Myocardial Injury | 629 | ||
| Incidence and Significance of Myocardial Dysfunction After Cardiopulmonary Bypass | 630 | ||
| Risk Factors for Myocardial Injury | 630 | ||
| Pathophysiology of Myocardial Injury | 630 | ||
| Myocardial Protection During Cardiac Surgery: Cardioplegia | 631 | ||
| Composition of Cardioplegia Solutions | 631 | ||
| Cardioplegia Temperature | 632 | ||
| Cardioplegia Delivery Routes | 633 | ||
| Gastrointestinal Complications | 634 | ||
| Incidence and Significance | 634 | ||
| Risk Factors | 634 | ||
| Pathophysiology and Causative Factors | 634 | ||
| Protecting the Gastrointestinal Tract During Cardiac Surgery | 635 | ||
| Cardiopulmonary Bypass Management | 635 | ||
| Emboli Reduction | 635 | ||
| Drugs | 635 | ||
| Off-Pump Cardiac Surgery | 636 | ||
| Lung Injury During Cardiac Surgery | 636 | ||
| Incidence and Significance | 636 | ||
| Pathophysiology and Causative Factors | 637 | ||
| Pulmonary Thromboembolism | 637 | ||
| Pulmonary Protection | 638 | ||
| Ventilatory Strategies | 638 | ||
| Pharmacologic Pulmonary Protection | 638 | ||
| Steroids | 638 | ||
| Management of Bypass | 638 | ||
| The Prebypass Period | 638 | ||
| Vascular Cannulation | 639 | ||
| Arterial Cannulation | 639 | ||
| Venous Cannulation | 640 | ||
| Other Preparations | 641 | ||
| Initiation and Discontinuation of Bypass Support: an Overview | 642 | ||
| Initiation of Cardiopulmonary Bypass | 642 | ||
| Uncomplicated Initiation | 642 | ||
| Hypotension With Onset of Bypass | 643 | ||
| Pump Flow and Pressure During Bypass | 644 | ||
| Preparation for Separation | 645 | ||
| Potential for Patient Awareness | 645 | ||
| Rewarming | 646 | ||
| Restoration of Systemic Arterial Pressure to Normothermic Value | 647 | ||
| Removal of Intracardiac Air | 647 | ||
| Defibrillation | 648 | ||
| Restoration of Ventilation | 649 | ||
| Correction of Metabolic Abnormalities and Arterial Oxygen Saturation | 649 | ||
| Oxygen-Carrying Capacity | 649 | ||
| Arterial pH | 649 | ||
| Electrolytes | 650 | ||
| Other Final Preparations | 650 | ||
| Separation From Bypass | 651 | ||
| Perfusion Emergencies | 651 | ||
| Arterial Cannula Malposition | 651 | ||
| Aortic or Arterial Dissection | 652 | ||
| Massive Arterial Gas Embolus | 653 | ||
| Venous Air Lock | 654 | ||
| Reversed Cannulation | 654 | ||
| Special Patient Populations | 655 | ||
| Care of the Gravid Patient During Bypass | 655 | ||
| Considerations Before Bypass | 655 | ||
| Premedication and Patient Positioning | 655 | ||
| Maternal and Fetal Monitor Information | 655 | ||
| Conducting the Bypass Procedure | 656 | ||
| Blood Flow | 657 | ||
| Blood Pressure | 657 | ||
| Temperature | 658 | ||
| Accidental Hypothermia | 658 | ||
| Patient Selection | 658 | ||
| Caring for the Accidental Hypothermia Victim | 658 | ||
| Intracranial Aneurysm Surgery | 659 | ||
| Minimally Invasive Surgery and Cardiopulmonary Bypass | 659 | ||
| Port-Access Bypass Circuit | 659 | ||
| Monitoring for Endovascular Clamp Bypass | 661 | ||
| Port-Access Cardiac Surgery Outcome Data | 661 | ||
| Suggested Readings | 662 | ||
| 26 Extracorporeal Devices Including Extracorporeal Membrane Oxygenation | 664 | ||
| Key Points | 664 | ||
| Mechanical Devices | 665 | ||
| Blood Pumps | 665 | ||
| Positive Displacement Pumps | 665 | ||
| Centrifugal Pumps | 666 | ||
| Safety Mechanisms for Extracorporeal Flow | 667 | ||
| Extracorporeal Circuitry | 669 | ||
| Blood Gas Exchange Devices | 669 | ||
| Venous and Cardiotomy Reservoirs | 670 | ||
| Heat Exchangers | 671 | ||
| Arterial Line Filters | 671 | ||
| Cannulae and Tubing | 672 | ||
| Cardioplegia Delivery | 673 | ||
| The Heart-Lung Machine Priming Solutions | 674 | ||
| Perioperative Salvage and Autotransfusion | 674 | ||
| Cardiotomy Suction | 674 | ||
| Cell Salvaging Through Centrifugation and Washing Techniques | 675 | ||
| Monitoring During Cardiopulmonary Bypass | 675 | ||
| History, Evolution, and Current Status of Extracorporeal Membrane Oxygenation | 677 | ||
| Extracorporeal Membrane Oxygenation Physiology and Gas Exchange | 678 | ||
| Management of Venoarterial Extracorporeal Membrane Oxygenation | 679 | ||
| Extracorporeal Membrane Oxygenation for Hemodynamic Support | 679 | ||
| Initiation of Venoarterial Extracorporeal Membrane Oxygenation | 679 | ||
| Weaning From Venoarterial Extracorporeal Membrane Oxygenation | 680 | ||
| Management of Venovenous Extracorporeal Membrane Oxygenation | 681 | ||
| Indications for Venovenous Extracorporeal Membrane Oxygenation | 681 | ||
| Care of Patients on Venovenous Extracorporeal Membrane Oxygenation | 682 | ||
| Initial Venovenous Extracorporeal Membrane Oxygenation Management | 682 | ||
| Weaning From Venovenous Extracorporeal Membrane Oxygenation | 682 | ||
| Complications of Venovenous Extracorporeal Membrane Oxygenation | 683 | ||
| Suggested Readings | 683 | ||
| 27 Transfusion Medicine and Coagulation Disorders | 685 | ||
| Key Points | 685 | ||
| Overview of Hemostasis | 686 | ||
| Protein Coagulation Activations | 687 | ||
| Coagulation Pathways | 687 | ||
| Contact Activation | 687 | ||
| Intrinsic System | 688 | ||
| Extrinsic System | 688 | ||
| Common Pathway | 689 | ||
| Vitamin K | 689 | ||
| Modulators of the Coagulation Pathway | 689 | ||
| Platelet Function | 692 | ||
| Platelet Adhesion | 692 | ||
| Platelet Activation and Aggregation | 692 | ||
| Prostaglandins and Aspirin | 693 | ||
| Drug-Induced Platelet Abnormalities | 693 | ||
| Adenosine Diphosphate Receptor Antagonists | 693 | ||
| Glycoprotein Iib/Iiia Receptor Inhibitors | 695 | ||
| Fibrinolysis | 695 | ||
| Extrinsic Fibrinolysis | 695 | ||
| Intrinsic Fibrinolysis | 695 | ||
| Exogenous Activators | 695 | ||
| Clinical Applications | 696 | ||
| Heparin | 696 | ||
| Pharmacokinetics and Pharmacodynamics | 697 | ||
| Actions and Interactions | 697 | ||
| Heparin Resistance | 698 | ||
| Heparin Rebound | 699 | ||
| Heparin-Induced Thrombocytopenia | 699 | ||
| Mechanism | 700 | ||
| Incidence and Diagnosis | 701 | ||
| Treatment and Prevention | 702 | ||
| Alternative Modes of Anticoagulation | 703 | ||
| Direct Thrombin Inhibitors | 703 | ||
| New Oral Anticoagulants | 706 | ||
| Protamine | 707 | ||
| Adverse Reactions | 708 | ||
| Bleeding Patient | 708 | ||
| Insult of Cardiopulmonary Bypass | 708 | ||
| Synthetic Antifibrinolytics | 708 | ||
| Management of the Bleeding Patient | 709 | ||
| Coagulation Products | 709 | ||
| Replacement Therapy | 710 | ||
| Factor VIIa | 710 | ||
| Fibrinogen Concentrates | 711 | ||
| Prothrombin Complex Concentrates | 711 | ||
| Suggested Readings | 714 | ||
| 28 Discontinuing Cardiopulmonary Bypass | 715 | ||
| Key Points | 715 | ||
| General Preparations | 716 | ||
| Temperature | 716 | ||
| Laboratory Results | 717 | ||
| Preparing the Lungs | 717 | ||
| Preparing the Heart | 718 | ||
| Management of Intracardiac Air | 718 | ||
| Heart Rate | 719 | ||
| Rhythm | 720 | ||
| Preload | 721 | ||
| Contractility | 721 | ||
| Afterload | 723 | ||
| Final Considerations and Preparations | 723 | ||
| Routine Weaning from Cardiopulmonary Bypass | 724 | ||
| Pharmacologic Management of Ventricular Dysfunction | 727 | ||
| Sympathomimetic Amines | 728 | ||
| Epinephrine | 731 | ||
| Dobutamine | 731 | ||
| Dopamine | 732 | ||
| Norepinephrine | 732 | ||
| Isoproterenol | 732 | ||
| Phosphodiesterase Inhibitors | 733 | ||
| Calcium Sensitizers | 734 | ||
| Vasodilators | 734 | ||
| Vasoplegic Syndrome and Cardiopulmonary Bypass | 736 | ||
| Vasopressin | 736 | ||
| Methylene Blue | 736 | ||
| Intraaortic Balloon Pump Counterpulsation | 736 | ||
| Indications and Contraindications | 737 | ||
| Timing and Weaning | 738 | ||
| Complications | 739 | ||
| Suggested Readings | 739 | ||
| VI Postoperative Care | 741 | ||
| 29 Postoperative Respiratory Care | 742 | ||
| Key Points | 742 | ||
| Fast-Track Cardiac Surgical Care | 743 | ||
| Anesthetic Techniques | 743 | ||
| Evidence Supporting Fast-Track Cardiac Recovery | 744 | ||
| Initial Management of Patients in Fast-Track Cardiac Anesthesia: The First 24 Hours | 745 | ||
| Ventilation Management: Admission to Tracheal Extubation | 746 | ||
| Management of Bleeding | 747 | ||
| Electrolyte Management | 747 | ||
| Pain Control | 748 | ||
| Management of Postoperative Complications | 749 | ||
| Risk Factors for Respiratory Insufficiency | 750 | ||
| Assessing Risk Based on Preoperative Status | 751 | ||
| Operating Room Events | 751 | ||
| Postoperative Events | 751 | ||
| Diagnosis of Acute Lung Injury and Acute Respiratory Distress Syndrome | 752 | ||
| Additional Therapy in Patients With Acute Lung Injury or Acute Respiratory Distress Syndrome | 753 | ||
| Impediments to Weaning and Extubation | 753 | ||
| Modes of Ventilator Support | 753 | ||
| Pressure-Support Ventilation | 755 | ||
| Liberation From Mechanical Support (Weaning) | 755 | ||
| Weaning: the Process | 755 | ||
| Specific Impediments to Weaning | 756 | ||
| Tracheostomy | 756 | ||
| Inability to Wean | 756 | ||
| Suggested Readings | 757 | ||
| 30 Postoperative Cardiovascular Management | 758 | ||
| Key Points | 758 | ||
| Oxygen Transport | 759 | ||
| Temperature | 760 | ||
| Assessment of the Circulation | 761 | ||
| Postoperative Myocardial Dysfunction | 762 | ||
| Postoperative Myocardial Ischemia | 762 | ||
| Therapeutic Interventions | 763 | ||
| Postoperative Arrhythmias | 763 | ||
| Preload | 764 | ||
| Contractility | 766 | ||
| Afterload | 766 | ||
| Postoperative Hypertension | 766 | ||
| Postoperative Vasodilation | 768 | ||
| Coronary Artery Spasm | 768 | ||
| Decreased Contractility | 769 | ||
| Catecholamines | 769 | ||
| Isoproterenol | 770 | ||
| Epinephrine | 770 | ||
| Norepinephrine | 770 | ||
| Dopamine | 771 | ||
| Dobutamine | 771 | ||
| Phosphodiesterase Inhibitors | 771 | ||
| Levosimendan | 772 | ||
| Right-Sided Heart Failure | 772 | ||
| Diagnosis | 773 | ||
| Treatment | 774 | ||
| Effects of Mechanical Ventilation in Heart Failure | 776 | ||
| Effects of Ventilatory Weaning on Heart Failure | 777 | ||
| Cardiac Tamponade | 777 | ||
| Transplanted Heart | 779 | ||
| Advances in Cardiovascular Surgery and Postoperative Management | 779 | ||
| Postoperative Management of Complications After Transcatheter Aortic Valve Replacement | 779 | ||
| Vascular Complications | 780 | ||
| Stroke | 780 | ||
| Paravalvular Leak | 780 | ||
| Cardiac Conduction Abnormalities | 781 | ||
| Echocardiography in the Cardiothoracic Intensive Care Unit | 781 | ||
| Miniaturized Transesophageal Echocardiography Probe | 782 | ||
| Echocardiography During Postoperative Intensive Care Unit Management of Left Ventricular Assist Devices | 782 | ||
| Right Ventricular Dysfunction After Left Ventricular Assist Device Placement | 782 | ||
| Echocardiography to Rule Out Obstructive Shock After Left Ventricular Assist Device Placement | 782 | ||
| Echocardiography in Patients Requiring Extracorporeal Membrane Oxygenation | 783 | ||
| Using Echocardiography to Troubleshoot Common Complications of Venoarterial Extracorporeal Membrane Oxygenation | 784 | ||
| Weaning and Discontinuing Venoarterial Extracorporeal Membrane Oxygenation | 784 | ||
| Suggested Readings | 785 | ||
| 31 Central Nervous System Dysfunction After Cardiopulmonary Bypass | 786 | ||
| Key Points | 786 | ||
| Categorization of Central Nervous System Injury | 787 | ||
| Early, Delayed, and Late Stroke | 788 | ||
| Age-Associated Risk for Central Nervous System Injury | 788 | ||
| Retrospective Versus Prospective Neurologic Assessment | 789 | ||
| Neuropsychologic Dysfunction | 789 | ||
| Mechanisms of Brain Injury | 790 | ||
| Watershed Infarctions | 791 | ||
| Cerebral Emboli and Outcome | 791 | ||
| Cerebral Perfusion Pressure | 792 | ||
| Cerebral Venous Obstruction | 793 | ||
| Hemodynamic Instability During Cardiopulmonary Bypass | 793 | ||
| Aortic Atherosclerosis | 793 | ||
| Diabetes Mellitus and Hyperglycemia | 794 | ||
| Cerebral Blood Flow | 794 | ||
| pH Management and Cerebral Blood Flow | 794 | ||
| Cerebral Hyperthermia | 795 | ||
| Cardiopulmonary Bypass Equipment | 795 | ||
| Minimally Invasive Extracorporeal Circulation | 796 | ||
| Cerebroprotective Strategies | 796 | ||
| Risk Assessment | 796 | ||
| Carotid Endarterectomy | 796 | ||
| Transesophageal Echocardiography Versus Epiaortic Scanning | 797 | ||
| “No-Touch” Technique | 798 | ||
| Carbon Dioxide Insufflation During Open-Chamber Procedures | 798 | ||
| Temperature and Coronary Artery Bypass Grafting | 799 | ||
| Applied Neuromonitoring | 799 | ||
| Neuromonitoring During Deep Hypothermic Circulatory Arrest | 799 | ||
| Pharmacologic Cerebral Protection | 801 | ||
| Suggested Readings | 802 | ||
| 32 Long-Term Complications and Management | 804 | ||
| Key Points | 804 | ||
| Infections After Cardiac Surgery | 805 | ||
| Device-Related Infections | 805 | ||
| Cardiac-Implanted Electronic Devices | 805 | ||
| Ventricular Assist Devices | 805 | ||
| Intravascular Devices | 806 | ||
| Sternal Wound Infections | 806 | ||
| Prosthetic Valve Endocarditis | 807 | ||
| Systemic Inflammatory Response Syndrome and Sepsis | 808 | ||
| Pneumonia | 808 | ||
| Urinary Tract Infection | 810 | ||
| Acute Kidney Injury | 810 | ||
| Treatment | 811 | ||
| Complications of Transcatheter Aortic Valve Replacement | 812 | ||
| Complications of Mechanical Assist Devices | 813 | ||
| Long-Term Complications of Ventricular Assist Device Implantation | 813 | ||
| Device Infection | 813 | ||
| Device Thrombosis | 814 | ||
| Gastrointestinal Bleeding | 814 | ||
| Neurovascular Events | 814 | ||
| Device Failure | 815 | ||
| Long-Term Complications of Extracorporeal Membrane Oxygenation | 815 | ||
| Patient and Family Support, Palliative Care, and End-of-Life Issues | 816 | ||
| Prognosticating | 817 | ||
| Palliative Care | 818 | ||
| Recommendations for Patient and Family Support | 818 | ||
| Withdrawal of Life-Sustaining Treatments and Palliative Sedation | 819 | ||
| Suggested Readings | 819 | ||
| 33 Postoperative Pain Management for the Cardiac Patient | 821 | ||
| Key Points | 821 | ||
| Pain and Cardiac Surgery | 823 | ||
| Potential Clinical Benefits of Adequate Postoperative Analgesia | 824 | ||
| Local Anesthetic Infiltration | 824 | ||
| Nerve Blocks | 826 | ||
| Opioids | 827 | ||
| Patient-Controlled Analgesia | 830 | ||
| Nonsteroidal Antiinflammatory Agents | 830 | ||
| Alpha2-Adrenergic Agonists | 831 | ||
| Intrathecal and Epidural Techniques | 832 | ||
| Intrathecal Techniques | 833 | ||
| Epidural Techniques | 833 | ||
| Risk for Hematoma Formation | 834 | ||
| Multimodal Analgesia | 835 | ||
| Suggested Readings | 835 | ||
| Index | 837 | ||
| A | 837 | ||
| B | 840 | ||
| C | 841 | ||
| D | 846 | ||
| E | 847 | ||
| F | 849 | ||
| G | 849 | ||
| H | 849 | ||
| I | 851 | ||
| J | 852 | ||
| K | 853 | ||
| L | 853 | ||
| M | 853 | ||
| N | 855 | ||
| O | 856 | ||
| P | 856 | ||
| Q | 859 | ||
| R | 859 | ||
| S | 861 | ||
| T | 862 | ||
| U | 864 | ||
| V | 864 | ||
| W | 866 | ||
| X | 866 | ||
| Z | 866 | ||
| Inside Back Cover | ibc1 |