Anesthesia Secrets, 4th Edition

A......Page 2
Copyright......Page 4
Dedication......Page 5
Contributors......Page 6
Preface......Page 10
Top 100 Secrets......Page 11
Describe the autonomic nervous system.......Page 19
Elaborate on the location and names of the sympathetic ganglia. Practically speaking, what is the importance of knowing th......Page 20
Review the synthesis of dopamine, norepinephrine, and epinephrine.......Page 21
Review the sympathomimetics commonly used in the perioperative environment.......Page 22
Review the effects of 2-antagonism.......Page 24
What is a pheochromocytoma, and what are its associated symptoms? How is pheochromocytoma diagnosed?......Page 25
Suggested Reading......Page 26
What is the functional residual capacity? What factors affect it?......Page 27
What advantages does PCA offer over conventional intermittent bolus dosing?......Page 345
Why is it important to provide infants with exogenous glucose?......Page 318
Explain the determinants of myocardial oxygen demand and delivery.......Page 238
Suppose a patient has an indwelling 7-mm endotracheal tube and cannot be weaned because of the increased work of breathing......Page 28
List causes of diabetes insipidus.......Page 43
Should an airway fire occur, what are the recommended practices for its management?......Page 528
Review upper-extremity nerve blocks, including their indications, limitations, and complications.......Page 35
What are measures of tubular function?......Page 29
What is obstructive sleep apnea?......Page 44
Discuss V/Q mismatch. How can general anesthesia worsen V/Q mismatch?......Page 30
What is a ductal-dependent lesion?......Page 31
What are the standard ventilator settings for one-lung ventilation?......Page 505
In a patient with traumatic head injury, how should fluid resuscitation be prioritized and what fluids are beneficial?.........Page 32
Suggested Readings......Page 33
Describe the mainstay of therapy in asthma.......Page 34
What major alterations in the heart occur in patients with heart failure?......Page 122
What organs play a major role in acid-base balance?......Page 36
What effects do volatile anesthetics have on hypoxic pulmonary vasoconstriction, airway caliber, and mucociliary function......Page 88
What are the complications of intubation and mechanical ventilation in asthmatic patients?......Page 280
How is intraoperative hypotension evaluated and treated?......Page 37
How is awake intubation performed?......Page 38
Describe a stepwise approach to acid-base interpretation.......Page 39
Suggested Readings......Page 40
Describe the dynamics of fluid distribution between the intravascular and interstitial compartments.......Page 41
Are there any contraindications for laparoscopic procedures?......Page 190
List conditions that stimulate and inhibit release of antidiuretic hormone.......Page 42
What are the criteria for donor selection?......Page 134
At what points along the neurosensory pathway are somatosensory-evoked potentials most commonly recorded?......Page 346
Why can some patients with epidural blocks move around and even walk, whereas others have a dense motor block?.........Page 45
What is meant by third-space losses? What are the effects of such losses?......Page 46
How is congenital heart disease managed during pregnancy?......Page 439
Is blood pressure a good sign of hypovolemia?......Page 47
Suggested Readings......Page 158
Suggested Readings......Page 402
What are the effects of alcohol on the cardiovascular system?......Page 48
How does a pulse oximeter work?......Page 49
What is meant by pump prime? What is the usual hemodynamic response to initiating bypass?......Page 228
What are the alleged benefits and risks of ginseng?......Page 379
Comment on various laboratory tests and their use in detecting acute renal dysfunction.......Page 50
How should an operating room be prepared for a latex-allergic patient?......Page 375
What is eclampsia?......Page 304
How is hyperkalemia treated?......Page 51
What complications are associated with laparoscopic surgery and carbon dioxide pneumoperitoneum?......Page 58
How does central venous pressure relate to right ventricular preload?......Page 52
What equipment and standards are necessary for safely conducting an anesthetic outside the operating room?.........Page 53
What hematologic changes accompany pregnancy?......Page 352
What monitors should be used routinely in the postanesthetic care unit?......Page 54
What pregnancy-related changes occur to plasma proteins?......Page 56
What is a flow-volume loop and what information does it provide?......Page 57
Describe the postoperative management of the patient with diabetes.......Page 150
What are the main causes of hepatocyte injury?......Page 59
What is the implication of autonomic denervation of the transplanted heart?......Page 271
Suggested Readings......Page 60
What processes form the normal hemostatic mechanism?......Page 61
What causes preeclampsia?......Page 435
Describe the neurologic derangements in patients with cirrhosis.......Page 309
What preoperative tests should be ordered?......Page 277
Discuss the role of benzodiazepines in premedication.......Page 86
Describe the examination of the neck.......Page 62
Review shivering and nonshivering thermogenesis.......Page 63
Why are the flowmeters for air, O2, and N2O arranged in a specific order?......Page 142
Is electroconvulsive therapy curative?......Page 64
Are there any signs that oral intubation may be difficult?......Page 355
Is adenosine useful for the treatment of atrial fibrillation?......Page 221
What tests are used for the diagnosis of disseminated intravascular coagulation?......Page 65
Can the nonacutely intoxicated patient who has used cocaine be safely anesthetized?......Page 66
Suggested Readings......Page 67
Review objective measures suggesting the need to perform endotracheal intubation.......Page 68
Describe the symptoms of increased intracranial pressure.......Page 326
Are other factors involved in neurologic outcome following an episode of cerebrovascular insufficiency?......Page 69
Should parents be allowed to accompany their children to the operating room?......Page 284
Describe the innervation and blood supply to the larynx.......Page 70
Review the effects of St. John's wort.......Page 380
List complications of chronic opioid abuse.......Page 71
Despite normal somatosensory-evoked potentials, can patients awaken with neurologic deficits?......Page 512
How is the patient prepared for awake intubation?......Page 73
Does failure of a pacemaker stimulus to capture the heart necessarily imply pacemaker malfunction?......Page 74
What is rapid-sequence induction? Which patients are best managed in this fashion?......Page 75
How is RSI performed?......Page 76
Anesthesiologists routinely deliver 100% oxygen for a few minutes before extubation. What is the logic behind this acti........Page 77
Suggested Readings......Page 434
What are the concerns before anesthetic induction in the patient with end-stage liver disease?......Page 78
How does an uncleared cervical spine modify the approach to the airway?......Page 264
What techniques are used to determine functional residual capacity?......Page 79
Describe the treatment for aspiration.......Page 285
What are the potential advantages to postoperative epidural analgesia?......Page 135
What other special precautions need to be taken in a child with heart disease?......Page 406
Should nitrous oxide be used as an anesthetic adjuvant during laparoscopy?......Page 80
What other physiologic variables can alter somatosensory-evoked potentials?......Page 511
How can the Fogarty embolectomy catheter be used as a bronchial blocker?......Page 81
How are drugs and other substances transported across the placenta?......Page 424
What is a combined spinal-epidural anesthetic? Why use both?......Page 473
Which anesthetic agents can be used in decompensated heart failure?......Page 251
Suggested Reading......Page 84
What are risk factors for aspiration?......Page 85
Describe some of the major anesthetic management issues during the reperfusion stage (stage 3).......Page 493
Which effects of hyperthyroidism are the most important with regard to anesthesia?......Page 124
What are the advantages of the wire-guided endobronchial blocker?......Page 89
Review the effects of CO2 absorbants on volatile anesthetic by-products.......Page 90
Which anesthetic agent has been shown to be teratogenic in animals? Is nitrous oxide toxic to humans?......Page 91
Suggested Readings......Page 189
How should opioids be given? Are some opioids better than others?......Page 92
What is the initial therapy for hypovolemic shock?......Page 383
When should a child be premedicated? Which drugs are commonly used?......Page 160
What are the etiology and risk factors for subarachnoid block-associated bradycardia?......Page 233
What effect does the intra-abdominal pressure increase have on perfusion of intra-abdominal organs?......Page 522
Do the neurohumoral responses in heart failure have therapeutic significance?......Page 94
If a patient has a cardiac arrest while having a subarachnoid block, how should resuscitative measures differ from standa......Page 423
What are the causes of intraoperative wheezing and the correct responses to asthmatic patients with acute bronchospasm?........Page 95
What therapies are available to reduce perioperative pulmonary risk?......Page 235
What is placenta previa?......Page 183
Are patients with muscular dystrophy at risk for malignant hyperthermia?......Page 96
What are some of the newer local anesthetics and what are their potential applications?......Page 120
Review the anesthetic concerns in patients with critical illness polyneuropathy.......Page 343
What are some particular concerns with methadone dosing?......Page 97
How is compliance calculated?......Page 98
Suggested Readings......Page 99
Instead of injecting pentothal intravenously, you have inadvertently administered it into the patient's intra-arterial lin......Page 100
Discuss the common cannulation sites for bypass.......Page 495
How do induction agents affect respiratory drive?......Page 101
Describe the characteristics of the somatosensory-evoked potential waveform.......Page 102
How have damage control concepts been applied in orthopedic injuries?......Page 103
How does one choose which local anesthetic to use?......Page 471
How is anesthesia maintained for heart transplantation?......Page 104
What is the structure of the acetylcholine receptor?......Page 105
What are the benefits and risks of using muscle relaxants?......Page 106
What laboratory examinations are useful?......Page 107
Review the properties of nondepolarizing muscle relaxants.......Page 108
List the disadvantages of the sitting position.......Page 155
Which is the simplest mode of stimulation?......Page 109
Review the current recommendations for administering regional anesthesia to patients with altered coagulation caused by m......Page 119
What is tetanic stimulation?......Page 110
What is the significance of fetal heart rate decelerations?......Page 425
Summarize the characteristic responses to the various patterns of stimulation produced by depolarizing relaxants (succiny......Page 111
Suggested Readings......Page 146
Review important side effects of acetylcholinesterase administration.......Page 112
A patient appears weak after pharmacologic reversal of neuromuscular blockade. What factors should be considered?.........Page 113
Suggested Readings......Page 114
What is the result of VVI pacing?......Page 115
Your patient states that he was told he is allergic to Novocain, which he received for a tooth extraction. Should you avoi......Page 116
What is diastolic dysfunction?......Page 117
List possible etiologies of low back pain.......Page 118
Suggested Readings......Page 121
How can commonly used herbal medicines adversely affect the surgical patient?......Page 295
List some of the anesthetic concerns during the preanhepatic (dissection) phase.......Page 123
What are the differences between premedication of pediatric vs. adult patients?......Page 131
What is postpartum uterine atony? How is it managed?......Page 125
What are the anesthetic goals in a patient with traumatic brain injury?......Page 126
What are the implications of postoperative cognitive dysfunction on patient mortality?......Page 314
If supplemental corticosteroids are to be administered perioperatively, how much should be given?......Page 127
Suggested Readings......Page 209
Do neonates have normal renal function?......Page 128
How does the cardiovascular system differ in a child?......Page 403
What are normal vital signs in children?......Page 404
What is a regulator? How does it control the flow of gas?......Page 140
List the most common side effects when opioids are used as a premedication.......Page 129
Define CRPS I and II. What nerve blocks are commonly used to treat these conditions?......Page 220
A patient in the preoperative holding area is delirious after receiving only 0.4mg of scopolamine as a premedication. Wha......Page 130
What are the physiologic changes and risk factors found with subarachnoid block-associated hypotension?......Page 437
Which congenital anomalies are associated with tracheoesophageal fistula?......Page 399
Are drug responses altered?......Page 250
What are the most common postoperative complications in elderly patients?......Page 443
Describe the pathogenesis of acute respiratory distress syndrome.......Page 133
What clinical findings are present in preeclampsia?......Page 378
What is latex?......Page 327
Describe special considerations in the perioperative assessment of alcohol-abusing patients.......Page 200
Which intravenous fluids are used during surgery to minimize intracranial pressure?......Page 137
What are considerations for patients with coronary stents?......Page 138
Suggested Readings......Page 139
Name the most commonly used groups of medications for the treatment of chronic pain.......Page 198
How is hypothyroidism treated?......Page 141
Describe the technique of electroconvulsive therapy, including appropriate monitors and medications.......Page 354
How is an oral agent chosen for a patient who previously received intravenous opioids?......Page 540
What does it mean when it is said that a vaporizer has variable bypass? What is the effect of having such a vaporizer tur......Page 143
What is different about the desflurane vaporizer?......Page 144
List the signs and symptoms of cocaine withdrawal.......Page 349
Would you use transesophageal echocardiography routinely in patients with high cardiac risk undergoing noncardiac surgery......Page 145
Describe the cellular events, presentation, and metabolic abnormalities associated with malignant hyperthermia..........Page 147
What is masseter muscle rigidity and what is its relation to malignant hypothermia?......Page 148
Are there other anesthetic concerns during craniotomies?......Page 149
Are there specific steps that can be taken to avoid and treat contrast media reactions?......Page 229
Define the unique problems associated with providing an anesthetic in the magnetic resonance imaging suite..........Page 451
Suggested Readings......Page 151
How does alcohol affect the respiratory system?......Page 152
How are shunts calculated?......Page 154
What is the physiologic response to electroconvulsive therapy?......Page 303
What are the clinical features of a postdural puncture headache and the treatment?......Page 416
Discuss the pathways involved in labor pain.......Page 201
To what arrhythmias are methadone-treated patients prone?......Page 156
How are patients with burns resuscitated?......Page 392
What factors may predispose a patient having spine surgery to postoperative visual loss?......Page 157
What are some preanesthetic considerations in a liver transplant patient?......Page 159
What are trigger variables?......Page 161
What peripheral nerve block can be performed for surgery of the lower extremity?......Page 478
Can cuffed endotracheal tubes be used in children and laryngeal mask airways?......Page 162
What is jaundice?......Page 270
What is controlled hypoventilation with permissive hypercapnia?......Page 163
How is the heparin effect reversed? What are potential complications?......Page 306
Is ventilation in the prone position an option for patients who are difficult to oxygenate?......Page 164
How is the patient who is fighting the ventilator approached?......Page 165
What is normal perfusion pressure breakthrough?......Page 274
Is split-lung ventilation ever useful?......Page 166
Suggested Readings......Page 225
What diseases mimic asthma?......Page 167
What are the differences in the gastrointestinal or hepatic function of neonates?......Page 205
What are the characteristics of a right bundle-branch block?......Page 168
Does a normal ECG exclude the possibility of severe coronary artery disease?......Page 169
What are the differences between omphalocele and gastroschisis?......Page 400
For patients with ST-segment elevation myocardial infarction, how is the location identified?......Page 171
What is reciprocal change? Why is it important?......Page 172
What are the sites of action, benefits, and side effects of intrathecal opioids?......Page 242
Define auto-PEEP.......Page 173
What is important in the preoperative history?......Page 393
What ECG changes suggest hypercalcemia?......Page 175
What are some of the common causes of a prolonged QT interval?......Page 176
Describe the pathophysiology of mitral regurgitation.......Page 259
Suggested Readings......Page 177
Which perioperative events predispose a patient to hypothermia?......Page 178
What clinical factors increase the risk of a perioperative myocardial infarction following noncardiac surgery?.........Page 179
How do patients who develop acute respiratory distress syndrome typically present?......Page 297
What is an optimal seizure duration?......Page 532
Why might the pulse oximeter give a false reading? Part 2-R/IR related.......Page 182
Suggested Readings......Page 184
Should monitoring be different during a craniotomy?......Page 185
What are the criteria for the selection of transplant recipients?......Page 246
Does ETCO2 correlate with PaCO2?......Page 186
What hepatic alterations occur with pregnancy?......Page 422
What processes may increase ETCO2?......Page 187
Are there additional recommendations for a fire not involving the airway?......Page 188
Discuss the pathophysiology of aortic stenosis.......Page 191
At what point on the body should central venous pressure be measured?......Page 192
Is hyperventilation a reasonable strategy for long-term intracranial pressure management?......Page 193
What are the implications of occupational latex exposure?......Page 342
Is central venous pressure an indicator of cardiac output?......Page 194
What are the mechanism of action and physiologic effects of cocaine?......Page 195
Can you use the central venous catheter for blood transfusions?......Page 196
What induction drugs are good for burn patients?......Page 394
Suggested Readings......Page 197
Discuss the pathophysiology and natural history of pulmonary hypertension.......Page 302
What complications are associated with pulmonary artery catheterization?......Page 199
Describe the pathogenesis of a perioperative myocardial infarction.......Page 239
What are signs that a fire has occurred?......Page 240
Which techniques can be used to identify patients with obstructive sleep apnea?......Page 370
Pulmonary artery catheter pressures are surrogate measures for what important physiologic variables? What assumptions are......Page 202
How might catheter position within the lung lead to errors in interpreting left atrial pressure catheter data?.........Page 203
Suggested Readings......Page 316
How do noninvasive blood pressure devices work?......Page 204
What is the effect of placing a magnet over a device?......Page 206
Do patients with devices need to avoid microwave ovens or other hospital electronics?......Page 207
What is distal pulse amplification?......Page 208
How is malignant hyperthermia treated?......Page 210
Why should antihypertensives be taken up until the time of surgery?......Page 211
Provide a differential diagnosis for intraoperative hypertension.......Page 212
Are hypertensive patients undergoing general anesthesia at increased risk for perioperative cardiac morbidity?.........Page 213
What factors are associated with an increased perioperative morbidity or mortality?......Page 289
How should hypotension caused by cardiac ischemia be treated?......Page 214
What are the systemic responses to blood loss?......Page 409
Suggested Readings......Page 215
Describe clinical signs and symptoms of light anesthesia.......Page 216
How safe is electroconvulsive therapy?......Page 217
Suggested Readings......Page 218
Review the site of action and significant effects of commonly used diuretics.......Page 219
What is considered a safe increase in intra-abdominal pressure?......Page 455
What drugs commonly administered intraoperatively are safe to use in malignant hyperthermia-susceptible patients..........Page 335
What is the most common replacement fluid used in children? Why?......Page 222
Describe the altered responsiveness of myasthenic patients to muscle relaxants.......Page 337
Do all patients with an accessory pathway have a delta wave (WPW pattern) on their baseline electrocardiogram?.........Page 223
Why is it important to save electrocardiogram tracings that document an arrhythmia?......Page 224
Review some pulmonary and respiratory considerations in the obese patient.......Page 226
Review the clinical features of total spinal anesthesia.......Page 462
Suggested Readings......Page 230
Describe the process for postanesthetic care unit admission.......Page 231
What is meant by anaphylaxis?......Page 373
How is ventilation adversely affected by anesthesia?......Page 232
The patient develops stridorous breath sounds. Describe the likely cause and the appropriate management.......Page 234
What is the endocrine response to a burn?......Page 356
A patient has undergone a general anesthetic for an outpatient procedure. Recovery has been uneventful, yet the patient h......Page 236
Suggested Readings......Page 237
How do you choose the appropriate size double-lumen endotracheal tube?......Page 501
What is the rationale behind the use of epidural steroids in the treatment of radicular symptoms associated with a hernia......Page 299
Is a pulmonary artery catheter reasonable to use routinely for optimization of high-risk patients? What is its potential......Page 243
Suggested Readings......Page 244
Name the causes of heart failure.......Page 245
How is cardiac output calculated? What is a normal cardiac output and index?......Page 247
What laboratory studies are useful in evaluating the patient with heart failure?......Page 249
At what age should the former premature infant be allowed to go home after surgery?......Page 401
What are the mechanisms behind traumatic brain injury?......Page 331
Suggested Readings......Page 252
Describe common findings of the history and physical examination in patients with valvular heart disease.......Page 253
How does a normal pressure-volume loop appear?......Page 254
How are the compensatory changes in the left ventricle represented by a pressure-volume loop?......Page 255
Discuss the pathophysiology of aortic insufficiency.......Page 256
What parameters can be used in echocardiography to characterize the severity of aortic insufficiency?......Page 257
Describe the presentation of a myocardial contusion.......Page 386
No pacer spikes are seen on the monitoring system with your patient with a pacemaker. Does this mean that the pacemaker i......Page 258
How is the pressure-volume loop in mitral regurgitation changed from normal?......Page 260
What are the hemodynamic goals in anesthetic management of mitral regurgitation?......Page 261
Suggested Readings......Page 262
What is the result of DDI pacing?......Page 263
What is the Bier block and how is it performed?......Page 265
Describe the primary aspects of management when a patient presents with an acute abdominal aortic rupture..........Page 266
Suggested Readings......Page 267
How does cerebrovascular insufficiency manifest itself?......Page 268
What are the important historical features of an asthmatic patient?......Page 276
Define cerebral autoregulation. How is it affected in cerebrovascular disease and what are the anesthetic implications?.........Page 269
Why is cardiac pacing frequently useful after bypass?......Page 498
Describe the treatment options if vasospasm is suspected following an spontaneous subarachnoid hemorrhage..........Page 272
Suggested Readings......Page 308
How can surgical exposure be improved and the brain be protected during aneurysm surgery?......Page 273
Suggested Readings......Page 275
When treating acute pain in a chronic pain patient, how should the approach differ?......Page 491
What agents may be used for maintenance anesthesia?......Page 279
What new therapies are available to anesthesiologists treating asthmatic patients in bronchospasm?......Page 281
Suggested Readings......Page 282
How often does aspiration occur and what is the morbidity and mortality rate?......Page 283
Suggested Readings......Page 286
Describe chronic bronchitis and emphysema.......Page 287
Describe the Univent tube.......Page 288
List the common pharmacologic agents used to treat COPD and their mechanisms of action.......Page 290
Discuss the choice of opioids in these patients.......Page 291
How would you treat intraoperative bronchospasm?......Page 292
At the conclusion of surgery, should a patient with chronic obstructive pulmonary disease be extubated deep or awake?.........Page 293
Suggested Readings......Page 395
How would you define acute respiratory distress syndrome?......Page 294
Why has carbon dioxide become the insufflation gas of choice during laparoscopy?......Page 520
Are any drug therapies available to treat acute respiratory distress syndrome?......Page 298
List the indications for general anesthesia for cesarean section.......Page 300
Suggested Readings......Page 301
Discuss the effect of volatile anesthetics and nitrous (not nitric) oxide on the pulmonary circulation.......Page 305
Are regional anesthetics helpful in patients with insulin-dependent diabetes? Can epinephrine be added to local anestheti......Page 307
If a pacemaker stimulus is superimposed on a native complex, is the pacemaker necessarily malfunctioning?.........Page 315
What are the proposed mechanisms by which electroconvulsive therapy is effective?......Page 460
What are the absolute contraindications for the selection of the recipients?......Page 310
How is minimum alveolar concentration affected by hyperthyroidism?......Page 311
What are the advantages and disadvantages of cesarean section with epidural anesthesia vs. spinal anesthesia? What are th......Page 432
Distinguish between unconjugated and conjugated hyperbilirubinemia.......Page 312
How do inhalational anesthetic gases produce hepatic dysfunction?......Page 313
Describe the anatomy of the kidney.......Page 317
Discuss the major causes of perioperative acute renal failure.......Page 320
Is bariatric surgery used in the pediatric population?......Page 323
How are patients with renal insufficiency managed perioperatively?......Page 324
Suggested Readings......Page 325
Discuss the incidence and anesthetic implications of congenital diaphragmatic hernia.......Page 328
How is intracranial pressure moderated during maintenance of anesthesia?......Page 329
Discuss strategies for controlling intracranial pressure at emergence from anesthesia.......Page 330
Suggested Readings......Page 332
What are the inheritance pattern and triggering agents for malignant hyperthermia?......Page 333
How is malignant hyperthermia susceptibility assessed in an individual with a positive family history or prior suggestive......Page 334
How is neuropathic pain treated?......Page 545
How do patients with muscular dystrophy respond to muscle relaxants and volatile anesthetics?......Page 336
Review the anesthetic concerns for a patient with Lambert-Eaton syndrome.......Page 338
Suggested Readings......Page 339
Review the clinical manifestations of Guillain-Barré syndrome.......Page 340
What is the most significant anesthetic problem associated with Alzheimer's disease?......Page 341
How can the risks from a peripheral nerve block be minimized?......Page 468
Suggested Readings......Page 344
Review the differences between addiction, dependence, pseudoaddiction, and tolerance.......Page 347
Review concerns for the elderly trauma patient.......Page 348
Discuss the physical and psychologic effects of phencyclidine.......Page 350
Suggested Readings......Page 351
Explain conscious sedation and the continuum of depth of anesthesia.......Page 447
What insulins are in current use?......Page 353
Describe the management of patients with diabetes requiring urgent surgery.......Page 357
Suggested Readings......Page 358
List the common thyroid function tests and their use in assessment of thyroid disorders.......Page 360
Of the numerous manifestations of hypothyroidism, which are most important in relation to anesthesia?......Page 361
List common signs, symptoms, and causes of hyperthyroidism.......Page 362
What complications may occur after a surgical procedure involving the thyroid gland?......Page 363
What is a combined epidural-general anesthetic? Why give the patient two anesthetics?......Page 364
Is perioperative stress steroid supplementation for patients on steroid therapy necessary?......Page 365
Review calcium homeostasis.......Page 366
Discuss the cardiovascular considerations in the obese patient.......Page 367
Discuss the appropriate preoperative assessment of this population.......Page 368
What are the advantages or disadvantages of offering regional anesthesia to the obese patient?......Page 369
What procedures are performed to aid in weight loss?......Page 371
Suggested Readings......Page 372
How is pain assessed?......Page 488
Should a penicillin-allergic patient receive cephalosporins?......Page 374
Can changes in the patient's clinical status affect pacemaker function?......Page 456
What tests are available to diagnose and characterize a prior allergic reaction? Should patients having a prior anaphylac......Page 376
Suggested Readings......Page 377
What are current recommendations regarding discontinuing use of herbal medications before surgery?......Page 381
What is the significance of Glasgow Coma Scale (GCS) score of 8?......Page 382
What is meant by damage control surgery?......Page 384
How does cardiac tamponade present? What is Beck's triad? How should anesthesia be managed in a patient with tamponade?........Page 385
What anesthetic techniques can be used for minimally invasive surgery?......Page 391
How might a bronchial or tracheal tear present? What are alternatives for managing ventilation during operative repair?........Page 387
Suggested Readings......Page 388
What are the three main factors that correlate with increased mortality with burn injury?......Page 389
When are measures for brain protection required?......Page 514
What are the features of carbon monoxide poisoning?......Page 390
Describe the common postoperative complications.......Page 410
Why are neonates and preterm infants at increased anesthetic risk?......Page 396
What problems are common in premature infants?......Page 397
What intraoperative problems are common in small infants?......Page 398
What medications are available for premedication?......Page 405
How is an endotracheal tube of appropriate size chosen?......Page 407
How does the pharmacology of commonly used anesthetic drugs differ in children?......Page 408
Should children with upper respiratory infection receive general anesthesia?......Page 411
Suggested Readings......Page 412
Describe the pulmonary vascular effects of left-to-right shunts.......Page 413
Has electroconvulsive therapy always been considered a good treatment for depression?......Page 481
How are pulmonary vascular resistance and systemic vascular resistance calculated?......Page 414
Why is systemic anticoagulation necessary?......Page 415
Why can oxygen be dangerous in patients with single ventricle physiology?......Page 417
How soon does cardiac function return to normal after surgical repair?......Page 418
Suggested Readings......Page 419
What are the cardiovascular adaptations to pregnancy?......Page 420
Describe the management of the pregnant patient undergoing nonobstetric surgery.......Page 426
Suggested Readings......Page 427
What are the most commonly used parenteral opioids for labor analgesia? Which side effects are of special concern to the p......Page 428
What are the characteristics of the ideal local anesthetic for use in labor? Discuss the three most common local anestheti......Page 429
Name three methods for administering epidural analgesia. State the concerns associated with each.......Page 430
How is combined spinal/epidural anesthesia performed? What are its advantages?......Page 433
How is preeclampsia managed?......Page 436
Discuss antepartum hemorrhage.......Page 438
Review age-related changes to the cardiovascular system.......Page 441
How is liver function affected by aging? What are some anesthetic implications?......Page 442
Discuss myocardial protection during cardiopulmonary bypass. What elements should be in place to optimize myocardial prot......Page 497
What is postoperative cognitive dysfunction and what are its risk factors?......Page 444
What is the cause of right ventricular failure after cardiopulmonary bypass?......Page 485
Can continuous spinal anesthesia be performed?......Page 465
Suggested Readings......Page 445
What procedures outside the operating room require sedation or general anesthesia?......Page 446
What are some of the requirements for the administration of moderate sedation by nonanesthesiologists?......Page 448
Besides anaphylaxis, what is a major risk with regard to contrast media?......Page 449
How is radiation exposure measured?......Page 450
What modifications in the anesthesia machine, ventilator, and monitoring equipment must be made to provide an anesthetic......Page 452
What does AOO, VOO, or DOO mode mean?......Page 454
If no underlying rhythm is seen when a pacemaker rate is rapidly decreased, does that mean that the patient is pacemaker......Page 457
At what lumbar levels should a spinal anesthetic be administered? What structures are crossed when performing a spinal blo......Page 461
Should spinal (or epidural) anesthesia be performed when unfractionated heparin is administered?......Page 463
What is transient neurologic syndrome and its cause?......Page 464
Suggested Readings......Page 466
Differentiate between a spinal and an epidural anesthetic.......Page 467
Describe the technique for performing a lumbar epidural anesthetic.......Page 469
What are some anesthetic concerns that arise during stage 2, the anhepatic phase?......Page 492
What are the potential complications of epidural anesthesia? Can they be anticipated or prevented?......Page 470
When should opioids be included in the epidural anesthetic?......Page 472
What should the anesthesiologist ask the patient postoperatively after an epidural anesthetic?......Page 474
What basic principles should be followed to ensure a safe and successful peripheral nerve block?......Page 475
Is one technique to localize nerves better or safer than any other?......Page 476
What is the central somatosensory conduction time?......Page 509
What peripheral nerve block can be used to provide anesthesia or analgesia to the anterior abdominal wall?.........Page 480
How is anesthesia managed for organ harvesting?......Page 482
In order of increasing acuity, review the physical status of patients awaiting heart transplantation.......Page 483
What antifibrinolytic agents can be used to decrease bleeding?......Page 484
What are the concerns in anesthetic management of post-heart transplant patients for noncardiac surgery?......Page 486
Suggested Readings......Page 487
What is the significance of portal pulmonary hypertension? How are these patients managed in the pretransplant period?.........Page 490
Suggested Readings......Page 494
How is the adequacy of anticoagulation measured before and during bypass?......Page 496
What might be done to decrease the incidence of such complications?......Page 499
Suggested Readings......Page 500
What are the downsides of antidepressant medication?......Page 530
How is the right main stem bronchus different from the left and how does this affect right-sided double-lumen endotracheal......Page 502
What are the advantages of using a Univent tube?......Page 503
Describe the wire-guided endobronchial blocker.......Page 504
How should you manage hypoxia during one-lung ventilation?......Page 506
Suggested Readings......Page 507
Trace the neurosensory pathway from the peripheral nerves to the cerebral cortex.......Page 508
Summarize the effects of anesthetic agents on the amplitude and latency of somatosensory-evoked potentials..........Page 510
How is the anesthetic requirement different in the brain and related structures?......Page 513
What are the concerns for patient positioning during a craniotomy?......Page 515
Why do some patients awaken slowly after a craniotomy?......Page 516
Are there special anesthetic problems associated with brain tumors?......Page 517
Suggested Readings......Page 518
What are some currently practiced laparoscopic, thoracoscopic, or endoscopic procedures?......Page 519
How does patient positioning affect hemodynamics and pulmonary function during laparoscopy?......Page 521
What are the neurohumoral responses associated with laparoscopy?......Page 523
Can laparoscopy be performed on children or pregnant women?......Page 524
Suggested Readings......Page 525
What makes lasers behave differently from each other?......Page 526
Describe ventilation techniques commonly encountered during airway laser surgery......Page 527
What type of preoperative evaluation is necessary before electroconvulsive therapy treatment?......Page 531
What are some of the adverse effects of electroconvulsive therapy?......Page 533
Suggested Readings......Page 534
Why has acute pain been undertreated?......Page 535
What medications are useful in treating acute pain?......Page 536
What is the risk of addiction with opioids?......Page 537
How do agonist-antagonists differ from opioids such as morphine?......Page 539
How does good acute pain management make a difference?......Page 541
Suggested Readings......Page 542
What is the classification of pain based on neurophysiologic mechanisms?......Page 543
How is fibromyalgia managed?......Page 546
What are the most common medications used for intrathecal delivery via implantable delivery systems?......Page 547
Suggested Readings......Page 548
A......Page 549
B......Page 553
C......Page 554
D......Page 558
E......Page 559
F......Page 560
G......Page 561
H......Page 562
I......Page 565
L......Page 567
M......Page 569
N......Page 571
O......Page 572
P......Page 573
R......Page 576
S......Page 578
T......Page 580
V......Page 581
Z......Page 582