Basics of Anesthesia

Cover
Title Page
Copyright
Contributors
Foreword
Preface to Seventh Edition
Section I: Introduction
	Chapter 1: Scope of Anesthesia Practice
		Definition of Anesthesiology as a Specialty
		Evolution of Anesthesia as a Multidisciplinary Medical Specialty
			Pain Management
			Critical Care Medicine
			Pediatric Anesthesia
			Cardiac Anesthesia
			Obstetric Anesthesia
			Other Surgical Areas of Anesthesia
		Perioperative Patient Care
			Preoperative Evaluation
			Operating Room Theaters
			Postanesthesia Care Unit
		Training and Certification in Anesthesiology
			Postgraduate (Residency) Training in Anesthesiology
			American Board of Anesthesiology
			Credentialing and Privileging
		Other Anesthetic Providers
			Certified Registered Nurse Anesthetists
			Anesthesiologist Assistants
		Quality of Care and Safety in Anesthesia
			Continuous Quality Improvement
		Organizations with Emphasis on Anesthesia Quality and Safety
			Anesthesia Patient Safety Foundation
			Anesthesia Quality Institute
			American Society of Anesthesiologists Closed Claims Project and Its Registries
			Foundation for Anesthesia Education and Research
		Professional Liability
			Adverse Events
		Risks of Anesthesia
		Hazards of Working in the Operating Room
		Summary and Future Outlook
		Questions of the Day
		References
	Chapter 2: Learning Anesthesia
		Competencies and Milestones
		Structured Approach to Anesthesia Care
			Preoperative Evaluation
			Creating the Anesthesia Plan
			Preparing the Operating Room
			Managing the Intraoperative Anesthetic
			Patient Follow-up
		Learning Strategies
			Learning Orientation Versus Performance Orientation
		Teaching Anesthesia
		Questions of the Day
		References
	Chapter 3: Anesthesia and Health Information Technology
		History of Anesthesia Documentation and Aims
		The Demand for Data
		Professional Performance Data Reporting with Health It
		Features of the Electronic Health Record in Anesthesia and Perioperative Care
		Health Care Information Privacy and Security
		Selected Key Topics for Health IT
			Interoperability
			System Design, User Interface, and Usability
			Clinical Decision Support
			Transitioning to Health IT: From Paper Records to an AIMS, and Beyond
			Legal Issues and Responsibilities of the AIMS User
		Conclusion and the Future
		Questions of the Day
		References
Section II: Pharmacology and Physiology
	Chapter 4: Basic Pharmacologic Principles
		Pharmacokinetic Principles
		Pharmacodynamic Principles
			Potency and Efficacy
			Anesthetic Drug Interactions
		Special Populations
			Influence of Obesity on Anesthetic Drugs
			Influence of Increasing Age on Anesthetic Drug Pharmacology
		Summary
		Questions of the Day
		References
	Chapter 5: Clinical Cardiac and Pulmonary Physiology
		Hemodynamics
			Arterial Blood Pressure
			Physiologic Approach to Hypotension
		Cardiac Reflexes
			Autonomic Nervous System
			Baroreceptors
		Coronary Blood Flow
		Pulmonary Circulation
			Pulmonary Artery Pressure
			Pulmonary Vascular Resistance
			Zones of the Lung
			Pulmonary Edema
		Pulmonary Gas Exchange
			Oxygen
			Carbon Dioxide
		Pulmonary Mechanics
			Static Properties
			Dynamic Properties and Airway Resistance
		Control of Breathing
			Central Integration and Rhythm Generation
			Central Chemoreceptors
			Peripheral Chemoreceptors
			Hypercapnic Ventilatory Response
			Hypoxic Ventilatory Response
			Effects of Anesthesia
			Disorders of Ventilatory Control
		Integration of the Heart and Lungs
			Oxygen Delivery
			Oxygen Extraction
		Questions of the Day
		References
	Chapter 6: Autonomic Nervous System
		Anatomy of the Autonomic Nervous System
			The Sympathetic Nervous System
			The Parasympathetic Nervous System
		Adrenergic Pharmacology
			Endogenous Catecholamines
			Synthetic Catecholamines
			Noncatecholamine Sympathomimetic Amines
		Selective α-adrenergic Receptor Agonists
			α1-Adrenergic Agonists
			α2-Adrenergic Agonists
		β2-adrenergic Receptor Agonists
			ADRENERGIC RECEPTOR AGONISTS
			ADRENERGIC RECEPTOR ANTAGONISTS
		α-adrenergic Receptor Antagonists
			Phenoxybenzamine
			Prazosin
			Yohimbine
		β-adrenergic Antagonists
			Adverse Effects of β-adrenergic blockade
			Specific β-Adrenergic Blockers
		Cholinergic Pharmacology
			Muscarinic Antagonists
			Cholinesterase Inhibitors
		Questions of the Day
		References
	Chapter 7: Inhaled Anesthetics
		History
		The First Inhaled Anesthetics
			Nitrous Oxide
			Diethyl Ether
			Chloroform
		Inhaled Anesthetics Between 1920 and 1940
		Fluorine Chemistry and Modern Inhaled Anesthetics
			Halothane
			Methoxyflurane
			Enflurane
			Isoflurane
			Sevoflurane and Desflurane
		Mechanism of Action
			Measurable Characteristics
		Physical Properties
			Molecular Structure
			Vapor Pressure and Delivery
			Economic and Environmental Considerations
			Stability
		Relative Potency of Inhaled Anesthetics
		Pharmacokinetics of Inhaled Anesthetics
			Factors That Determine the Alveolar Partial Pressure
			Recovery From Anesthesia
			Feasibility of Inhaled Anesthetic Use for Sedation in ICU
		Effects on Organ Systems
			Circulatory Effects
			Ventilation Effects
			Central Nervous System Effects
			Neuromuscular Effects
			Malignant Hyperthermia
			Hepatic Effects
			Renal Effects
		Questions of the Day
		References
	Chapter 8: Intravenous Anesthetics
		Propofol
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Clinical Uses
		Fospropofol
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Clinical Uses
		Barbiturates
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Side Effects
			Clinical Uses
		Benzodiazepines
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Side Effects
			Clinical Uses
		Ketamine
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Clinical Uses
		Etomidate
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Clinical Uses
		Dexmedetomidine
			Physicochemical Characteristics
			Pharmacokinetics
			Pharmacodynamics
			Clinical Uses
		Questions of the Day
		References
	Chapter 9: Opioids
		Basic Pharmacology
			Structure-Activity
			Mechanism
			Metabolism
		Clinical Pharmacology
			Pharmacokinetics
			Pharmacodynamics
			Drug Interactions
			Special Populations
			Unique Features of Individual Opioids
			Opioid Agonist-Antagonists and Pure Antagonists
		Clinical Application
			Common Clinical Indications
			Rational Drug Selection and Administration
		Emerging Developments
			Opioids and Cancer Recurrence
			Opioid Abuse Epidemic
		Questions of the Day
		References
	Chapter 10: Local Anesthetics
		History
		Nerve Conduction
		Local Anesthetic Actions on Sodium Channels
			pH, Net Charge, and Lipid Solubility
		Differential Local Anesthetic Blockade
		Spread of Local Anesthesia After Injection
		Pharmacokinetics
			Local Anesthetic Vasoactivity
			Metabolism
			Additives
		Adverse Effects
			Systemic Toxicity
			Lipid Resuscitation
			Local Tissue Toxicity
			Allergic Reactions
		Specific Local Anesthetics
			Amino Esters
			Amino Amides
			Single Enantiomers
			Topical Local Anesthetics
			Tumescent Local Anesthesia
			Systemic Local Anesthetics for Acute and Chronic Pain
		When Local Anesthesia Fails
		Future Local Anesthetics
		Conclusions
		Questions of the Day
		References
	Chapter 11: Neuromuscular Blocking Drugs
		Clinical Uses
			Choice of Neuromuscular Blocking Drug
			Hypersensitivity Reactions
		Neuromuscular Junction
			Prejunctional Receptors and Release of Acetylcholine
			Postjunctional Receptors
			Extrajunctional Receptors
		Structure-Activity Relationships
		Depolarizing Neuromuscular Blocking Drugs
			Characteristics of Blockade
			Metabolism
			Adverse Side Effects
		Nondepolarizing Neuromuscular Blocking Drugs
			Pharmacokinetics
			Pharmacodynamic Responses
			Cardiovascular Effects
			Critical Care Medicine and Critical Illness Myopathy and Polyneuropathy
		Long-Acting Nondepolarizing Neuromuscular Blocking Drug
			Pancuronium
		Intermediate-Acting Nondepolarizing Neuromuscular Blocking Drugs
			Vecuronium
			Rocuronium
			Atracurium
			Cisatracurium
		Short-Acting Nondepolarizing Neuromuscular Blocking Drug
			Mivacurium
		Monitoring the Effects of Nondepolarizing Neuromuscular Blocking Drugs
			Patterns of Stimulation
		Antagonism of Nondepolarizing Neuromuscular Blocking Drugs
		Adverse Outcomes From Inadequate Antagonism of Neuromuscular Blockade
			Anticholinesterase Drugs (Neostigmine)
			Factors Influencing the Success of Antagonism of Neuromuscular Blocking Drugs
			Evaluation of the Adequacy of Antagonism
			A New Antagonist of Neuromuscular Blocking Drugs
		Summary
		Questions of the Day
		References
	Chapter 12: Anesthetic Neurotoxicity
		Anesthetic Drugs as a Cause for Neurodegeneration and Long-Term Neurocognitive Deficits
			Basic Science of Anesthetic-Induced Developmental Neurotoxicity
			Age-Dependent Vulnerability of Anesthetic
			Characterization of AIDN
			Relevant Anesthetic Durations and Concentrations
			Anesthetic and Sedative Drugs
			Alleviation of AIDN
		Clinical Evidence for Neurotoxicity
		Intraoperative Course and Neurocognitive Outcomes
			Arterial Blood Pressure
			Hypocapnia and the Brain
			Oxygen Management
			Temperature
		Conclusion
		Questions of the Day
		References
Section III: Preoperative Preparation and Intraoperative Management
	Chapter 13: Preoperative Evaluation and Medication
		Preoperative Assessment: Overview
			History and Physical Examination
			Investigations and Testing
			Consultations
		Anesthetic Implications of Common Comorbid Conditions
			Hypertension
			Coronary Artery Disease
			Heart Failure
			Valvular Disease
			Cardiac Implantable Electronic Devices
			Pulmonary Disease
			Obstructive Sleep Apnea
			Obesity
			Diabetes Mellitus
			Renal Disease
			Anemia
			Elderly Patients
		Formulation of an Anesthetic Plan
			Risk Assessment and Informed Consent
			Medications
			Fasting Guidelines
		Conclusion
		Questions of the Day
		References
	Chapter 14: Choice of Anesthetic Technique
		Types of Anesthesia
		Choosing an Appropriate Anesthetic Technique
		Practical Aspects of Anesthesia Choice
			General Anesthesia
			Regional Anesthesia
			Monitored Anesthesia Care
		Environmental Impact
		Questions of the Day
		References
	Chapter 15: Anesthesia Delivery Systems
		Anesthesia Workstation
			Fail-Safe Valve
			Compressed Gases
			Flowmeters
		Vaporizers
			Physics of Vaporization
			Vaporizer Classification and Design
		Anesthetic Breathing Systems
			Mapleson Breathing Systems
			Mapleson F (Jackson-Rees) System
			Bain System
			Circle System
			Closed Anesthetic Breathing System
		Anesthesia Machine Ventilators
			Bellows
			Humidity and Heat Exchange in the Breathing Circuit
			Humidification
		Pollution of the Atmosphere with Anesthetic Gases
			Scavenging Systems
			Periodic Preventive Maintenance of Anesthesia Equipment
			Anesthetic Technique
			Adequate Room Ventilation
		Elimination of Carbon Dioxide
			Carbon Dioxide Absorbents
			Efficiency of Carbon Dioxide Neutralization
			Degradation of Inhaled Anesthetics
		Checking Anesthesia Machine and Circle System Function
			ASA 2008 Recommendations for Preanesthesia Checkout Procedures
		Questions of the Day
		References
	Chapter 16: Airway Management
		Anatomy and Physiology of the Upper Airway
			Nose
			Mouth and Pharynx
			Larynx
			Trachea
		Airway Assessment
			History and Anatomic Examination
		Airway Management Techniques
			Ventilation Via a Face Mask
		Supraglottic Airway Devices
			Laryngeal Mask Airway
			Air-Q Masked Laryngeal Airways
			I-Gel
			Esophageal Tracheal Combitube and King Laryngeal Tube
		Endotracheal Intubation
			Difficult Airway Management
			Direct Laryngoscopy
			Choice of Direct Laryngoscope Blade
			Video Laryngoscopes
			Endotracheal Tube Stylets, Introducers, and Airway Exchange Catheters
			Flexible Fiberoptic Endotracheal Intubation
			Awake Fiberoptic Endotracheal Intubation
			Blind Nasotracheal Intubation
			Endotracheal Tube Sizes
			Confirmation of Endotracheal Intubation
			Rapid Sequence Induction of Anesthesia With Cricoid Pressure
		Transtracheal Techniques
			Cricothyrotomy
			Transtracheal Jet Ventilation
			Retrograde Endotracheal Intubation
			Endotracheal Extubation
		Complications
			Complications During Laryngoscopy and Endotracheal Intubation
			Complications While the Endotracheal Tube Is in Place
			Complications After Endotracheal Extubation
		Airway Management in Infants and Children
			Airway Management Differences Between Infants and Adults
			Managing the Normal Airway in Infants and Children
			Preanesthetic Medication and Parental Presence During Induction of Anesthesia
			Induction of Anesthesia
			Direct Laryngoscopy and Endotracheal Intubation
			Managing the Difficult Airway in Infants and Children
			Tracheal Extubation in Infants and Children
		Questions of the Day
		References
	Chapter 17: Spinal, Epidural, and Caudal Anesthesia
		Principles
		Practice
		Anatomy
			Spinal Nerves
			Blood Supply
			Anatomic Variations
		Mechanism of Action
			Drug Uptake and Distribution
			Drug Elimination
		Physiologic Effects
			Cardiovascular
			Central Nervous System
			Respiratory
			Gastrointestinal
			Renal
		Indications
			Neuraxial Anesthesia
			Neuraxial Analgesia
		Contraindications
			Absolute
			Relative
		Spinal Anesthesia
			Factors Affecting Block Height
			Duration of the Block
			Pharmacology
			Technique
			Monitoring of the Block
		Epidural Anesthesia
			Factors Affecting Epidural Block Height
			Pharmacology
			Technique
		Combined Spinal-Epidural Anesthesia
			Technique
		Caudal Anesthesia
			Pharmacology
			Technique
		Complications
			Neurologic
			Cardiovascular
			Respiratory
			Infection
			Backache
			Nausea and Vomiting
			Urinary Retention
			Pruritus
			Shivering
			Complications Unique to Epidural Anesthesia
		Recent Advances in Ultrasonography
		Questions of the Day
		References
	Chapter 18: Peripheral Nerve Blocks
		Introduction
			The Role of Regional Anesthesia
			Preparation to Perform a Regional Nerve Block
		Ultrasound Basics
			Basic Ultrasound Physics
			Echogenic Properties of Nerves and Tissue
			Ergonomics and Transducer Manipulation
			Regional Block Technique
			Peripheral Nerve Catheters
		Cervical Plexus Block
		Upper Extremity Blocks
			Brachial Plexus
			Intercostobrachial Nerve Block
		Lower Extremity Blocks
			Femoral Nerve
			Sciatic Nerve
			Ankle Block
		Chest and Abdomen Blocks
			Intercostal Nerve Block
			Transversus Abdominis Plane Block
		Intravenous Regional Anesthesia (Bier Block)
			Selection of Local Anesthetic
			Characteristics of the Block
			Risks
		Questions of the Day
		References
	Chapter 19: Patient Positioning and Associated Risks
		Physiologic Aspects of Positioning
		General Positioning
			Supine
			Lithotomy
			Lateral Decubitus
			Prone
			Sitting
		Positioning for Robotic Surgery
		Pressure Injuries
		Bite Injuries
		Peripheral Nerve Injuries
			Ulnar Nerve
			Brachial Plexus
			Other Upper Extremity Nerves
			Lower Extremity Nerves
		Evaluation and Treatment of Perioperative Neuropathies
		Perioperative Eye Injury and Visual Loss
		Anesthesia Outside the Operating Room
		Conclusion
		Questions of the Day
		References
	Chapter 20: Anesthetic Monitoring
		Introduction
			Overview
		Respiratory System
			Oxygenation
			Ventilation
		Circulatory System
			Measurement of the Electrocardiogram
			Blood Pressure and Flow
			Measures of Intravascular Volume Responsiveness
			Central Venous Monitoring
		Central Nervous System
			Processed Electroencephalograph Monitoring
			Minimum Alveolar Concentration Alert Monitoring
			Intracranial Pressure Monitoring
			Cerebral Oximetry
		Peripheral Nervous System
			Neuromuscular Monitoring
		Temperature
		Magnetic Resonance Imaging and Adverse Conditions
		Monitors and Alarms
		Questions of the Day
		References
	Chapter 21: Acid-Base Balance and Blood Gas Analysis
		Definitions
			Acids and Bases
			Acidemia and Acidosis
			Base Excess
		Regulation of the Hydrogen Ion Concentration
			Buffer Systems
			Ventilatory Response
			Renal Response
		Analysis of Arterial Blood Gases
			Blood Gas and pH Electrodes
			Sampling
			Temperature Correction
			Oxygenation
		Differential Diagnosis of Acid-Base Disturbances
			Adverse Responses to Acidemia and Alkalemia
			Respiratory Acidosis
			Respiratory Alkalosis
			Metabolic Acidosis
			Metabolic Alkalosis
			Diagnosis
		Other Information Provided by Analysis of Arterial Blood Gases and pH
			Ventilation
			Oxygenation
			Cardiac Output Estimates
		Questions of the Day
		References
	Chapter 22: Hemostasis
		Primary Hemostasis
		Secondary Hemostasis
			Clotting Cascade and Propagation of the Clot
			Control and Termination of Coagulation
			Fibrinolysis
		Diseases Associated with Bleeding
			Inherited Coagulation Factor Deficiencies
			Acquired Coagulation Factor Disorders
			Treatment of Clotting Factor Deficiencies
			Platelet Disorders
		Diseases Associated with Thrombosis
			Hereditary Hypercoagulable States
			Acquired Hypercoagulable States
			Treatment of Hypercoagulable States
		Laboratory Evaluation of Hemostasis
			Tests of Coagulation
			Tests of Fibrinolysis
			Tests of Platelet Function
		Antithrombotics and Procoagulants
			Antiplatelet Drugs
			Anticoagulants
			Procoagulants
		Perioperative Management of Anticoagulation
		Questions of the Day
		References
	Chapter 23: Fluid Management
		Background
		Overview of Fluid and Electrolyte Physiology
		Perioperative Fluid Balance
		Fluid Replacement Solutions
			Crystalloids
			Colloids
			Crystalloids Versus Colloids
		Perioperative Fluid Strategies
			Intraoperative Fluids
			Monitoring Adequacy of Fluid Replacement
		Questions of the Day
		References
	Chapter 24: Blood Therapy
		Blood Therapy Procedures
			Crossmatch
			Emergency Transfusion
			Type and Screen
			Blood Storage
		Decision to Transfuse
			Patient Blood Management
			Monitoring for Blood Loss
			Monitoring for Inadequate Perfusion and Oxygenation of Vital Organs
			Monitoring for Transfusion Indicators (Especially Hemoglobin Concentration)
		Blood Components
			Packed Red Blood Cells
			Platelets
			Fresh Frozen Plasma
			Cryoprecipitate
		Complications of Blood Therapy
			Transmission of Infectious Diseases
			Noninfectious Hazards of Transfusion
			Metabolic Abnormalities
			Hypothermia
			Coagulation
			Transfusion Reactions
		Autologous Blood Transfusions
			Predeposited Autologous Donation
			Intraoperative and Postoperative Blood Salvage
			Normovolemic Hemodilution
		Conclusions and Future Directions
		Questions of the Day
		References
Section IV: Special Anesthetic Considerations
	Chapter 25: Cardiovascular Disease
		Coronary Artery Disease
			Patient History
			Electrocardiogram
			Risk Stratification Versus Risk Reduction
			Perioperative Cardiac Risk Reduction Therapy
			Management of Anesthesia
			Postoperative Care
		Valvular Heart Disease
			Mitral Stenosis
			Mitral Regurgitation
			Aortic Stenosis
			Aortic Regurgitation
			Mitral Valve Prolapse
		Disturbances of Cardiac Conduction and Rhythm
			Heart Block
			Sick Sinus Syndrome
			Ventricular Premature Beats
			Ventricular Tachycardia
			Preexcitation Syndromes
			Prolonged QT Interval Syndrome
		Artificial Cardiac Pacemakers
		Essential Hypertension
			Management of Anesthesia
			Preoperative Evaluation
			Induction of Anesthesia
			Maintenance of Anesthesia
			Postoperative Management
		Congestive Heart Failure
			Management of Anesthesia
		Hypertrophic Cardiomyopathy
			Management of Anesthesia
		Pulmonary Hypertension and Cor Pulmonale
			Management of Anesthesia
		Cardiac Tamponade
			Management of Anesthesia
		Aneurysms of the Aorta
			Management of Anesthesia
		Cardiopulmonary Bypass
			Components of the Cardiopulmonary Bypass Circuit
			Monitoring During Cardiopulmonary Bypass
			Myocardial Preservation
			Management of Anesthesia
			Discontinuation of Cardiopulmonary Bypass
			Off-Pump Coronary Artery Bypass Graft Surgery
		Questions of the Day
		References
	Chapter 26: Congenital Heart Disease
		Fundamental Pathophysiology in Congenital Heart Disease
			Left-to-Right Shunts
			Right-to-Left Shunts
			Mixing Lesions
			Eisenmenger Syndrome
			Obstructive Lesions
		Perioperative Management
			History and Physical Examination
			Preparation for Surgery
			Induction of Anesthesia
			Maintenance of Anesthesia
			Cardiopulmonary Bypass
		Postoperative Care
		Questions of the Day
		References
	Chapter 27: Chronic Pulmonary Disease and Thoracic Anesthesia
		Introduction
			History
			Physical Examination
			Laboratory Examination
		Asthma
			Clinical Presentation
			Management of Anesthesia
		Chronic Obstructive Pulmonary Disease
			Clinical Presentation
			Perioperative Management
		Interstitial Lung Disease
		Cystic Fibrosis
		Obstructive Sleep Apnea
			Clinical Presentation
			Treatment of Obstructive Sleep Apnea
			Preoperative Evaluation of Patients With Obstructive Sleep Apnea
			Perioperative Management
			Postoperative Management
			Obesity Hypoventilation Syndrome
		Pulmonary Hypertension
			Pathophysiology
			Preoperative Evaluation
			Management of Anesthesia
		Anesthesia for Lung Resection
			Preoperative Assessment for Pulmonary Resection
			Smoking Cessation
			Assessment of the Patient With Lung Cancer
			Indications for Lung Isolation
			Options for Lung Isolation
			Airway Anatomy
			Sizing a Double-Lumen Endobronchial Tube
			Methods of Insertion of a Left-Sided DoubleLumen Tube
			Positioning a Left-Sided Double-Lumen Tube
			Right-Sided Double-Lumen Tube Indications
			Positioning a Bronchial Blocker
			Physiologic Considerations of One-Lung Ventilation in the Lateral Position
			Conduct of Anesthesia
			Approach to Intravenous Fluid Management
			Approach to One-Lung Ventilation
			Prediction of Intraoperative Hypoxia
			Management of Hypoxia During One-Lung Ventilation
			Conclusion of Surgery
			Pain Management
		Mediastinoscopy
		Mediastinal Masses
		Questions of the Day
		References
	Chapter 28: Renal, Liver, and Biliary Tract Disease
		Renal Disease
			Renal Blood Flow
			Glomerular Filtration Rate
			Humoral Mediators of Renal Function
			Drug Clearance
			Renal Function Tests
			Pharmacology of Diuretics
			Pathophysiology of End-Stage Renal Disease
			Management of Anesthesia in Patients With End-Stage Renal Disease
			Differential Diagnosis and Management of Perioperative Oliguria
		Liver Disease
			Hepatic Blood Flow
			Intrinsic Determinants of Hepatic Blood Flow
			Extrinsic Determinants of Hepatic Blood Flow
			Glucose Homeostasis
			Coagulation
			Drug Metabolism
			Heme Metabolism
			Cholesterol and Lipid Metabolism
			Protein Metabolism
			Pathophysiology of End-Stage Liver Disease
			Effects of Anesthesia and Surgery on the Liver
			Management of Anesthesia in Patients With End-Stage Liver Disease
			Induction and Maintenance of Anesthesia
			Management of Coagulopathy
			Postoperative Jaundice
			Management of Anesthesia in Intoxicated Patients
			Alcohol Withdrawal Syndrome
		Diseases of the Biliary Tract
			Management of Anesthesia
		Questions of the Day
		References
	Chapter 29: Nutritional, Gastrointestinal, and Endocrine Disease
		Nutritional Disorders
			Morbid Obesity
			Malnutrition
		Gastrointestinal Disease
			Inflammatory Bowel Disease
			Gastroesophageal Reflux Disease
		Endocrine Disorders
			Diabetes Mellitus
			Hyperthyroidism and Thyroid Storm
			Hypothyroidism
			Thyroid Surgery
			Pheochromocytoma and Paraganglioma
			Multiple Endocrine Neoplasia and Neuroendocrine Tumors
			Adrenal Insufficiency and Steroid Replacement
			Pituitary Apoplexy
			Cushing Syndrome
		Questions of the Day
		References
	Chapter 30: Central Nervous System Disease
		Neuroanatomy
		Neurophysiology
			Regulation of Cerebral Blood Flow
			Cerebral Metabolic Rate and Neurovascular Coupling
			Cerebral Perfusion Pressure and Cerebral Autoregulation
			Cerebrovascular Paco2 and Pao2 Reactivity
			Effects of Anesthetics on Cerebral Blood Flow
		Intracranial Pressure
			Determinants of ICP and the Compensation for an Increased ICP
			Effect of Anesthetics on Intracranial Pressure
		Neuroprotection
		Neurophysiologic Monitoring
		Anesthesia for Neurosurgery
			Preoperative Assessment
			Monitoring
			Induction of Anesthesia
			Positioning
			Maintenance of Anesthesia
			Intracranial Pressure Reduction and Brain Relaxation
			Ventilation Adjustment
			Intravascular Fluid Management
			Postoperative Care
			Venous Air Embolism
		Common Clinical Cases
			Intracranial Mass Lesions
			Intracranial Aneurysms
			Arteriovenous Malformations
			Carotid Disease
		Questions of the Day
		References
	Chapter 31: Ophthalmology and Otolaryngology
		Ophthalmology
			Intraocular Pressure
			Ophthalmic Medications
			Oculocardiac Reflex
			Preoperative Assessment
			Anesthetic Options
			Anesthesia Management of Specific Ophthalmic Procedures
			Postoperative Eye Issues
		Otolaryngology
			Special Considerations for Head and Neck Surgery
			Anesthesia Management of Specific Otolaryngology Procedures
		Questions of the Day
		References
	Chapter 32: Orthopedic Surgery
		Rheumatologic Disorders
			Rheumatoid Arthritis
			Ankylosing Spondylitis
		Spine Surgery
			Anesthetic Technique
			Awareness
			Blood Conservation During Spine Surgery
			Positioning
			Intraoperative Spinal Cord Monitoring
			Vision Loss
		Surgery in the Sitting Position
		Fractured Hip
			Anesthetic Technique
		Total Joint Replacement
			Total Hip Replacement
			Total Knee Replacements and Tourniquets
			Deep Venous Thrombosis and Thromboembolism Prophylaxis
		Questions of the Day
		References
	Chapter 33: Obstetrics
		Physiologic Changes in Pregnant Women
			Cardiovascular System Changes
			Pulmonary System Changes
			Gastrointestinal Changes
			Nervous System Changes
			Renal Changes
			Hepatic Changes
		Physiology of the Uteroplacental Circulation
			Uterine Blood Flow
			Placental Exchange
		Stages of Labor
		Anatomy of Labor Pain
		Methods of Labor Analgesia
			Nonpharmacologic Techniques
			Systemic Medications
			Neuraxial (Regional) Analgesia
		Neuraxial Techniques
			Preoperative Assessment
			Timing and Placement of Epidural
			Epidural Technique
			Combined Spinal-Epidural Technique
			Epidural and Combined Spinal-Epidural Dosing and Delivery Techniques
			Spinal Labor Analgesia
		Contraindications of Neuraxial Anesthesia
		Complications of Regional Anesthesia
			Systemic Toxicity and Excessive Blockade
			Hypotension
			Increased Core Temperature
		Other Nerve Blocks for Labor
			Paracervical Block
			Pudendal Block
		Anesthesia for Cesarean Delivery
			Spinal Anesthesia
			Epidural Anesthesia
			Combined Spinal-Epidural Anesthesia
			General Anesthesia
		Abnormal Presentations and Multiple Births
			Multiple Gestations
			Abnormal Presentations
		Hypertensive Disorders of Pregnancy
			Preeclampsia
		Hemorrhage in Pregnant Women
			Placenta Previa
			Massive Hemorrhage
			Abruptio Placentae
			Uterine Rupture
			Retained Placenta
			Uterine Atony
			Placenta Accreta
		Amniotic Fluid Embolism
		Anesthesia for Nonobstetric Surgery During Pregnancy
			Avoidance of Teratogenic Drugs
			Avoidance of Intrauterine Fetal Hypoxia and Acidosis
			Prevention of Preterm Labor
			Management of Anesthesia
			Laparoscopic Surgery
		Diagnosis and Management of Fetal Distress
			Key Evaluation Components
			Fetal Heart Rate Categories
		Evaluation of the Neonate and Neonatal Resuscitation
			Cardiopulmonary Resuscitation
		Questions of the Day
		References
	Chapter 34: Pediatrics
		Developmental Physiology
			Respiratory System
			Cardiovascular System
			The Renal System
			The Hematologic System
		Pharmacologic Differences
			Pharmacokinetics
			Hepatic Metabolism
			Renal Excretion
			Pharmacology of Inhaled Anesthetics
		Fluids and Electrolytes
			Intraoperative Fluid Administration
			Glucose Administration
		Transfusion Therapy
			Maximum Allowable Blood Loss
			Transfusion of Blood Products
			Antifibrinolytics
			Recombinant Factor VIIa
		Pediatric Airway
			Airway Assessment
			Airway Management Techniques
			Difficult Pediatric Airway
		Anesthetic Considerations
			Preoperative Evaluation and Preparation
			Perioperative Considerations
			The Postanesthesia Care Unit
		Medical and Surgical Diseases Affecting the Neonate
			Necrotizing Enterocolitis
			Abdominal Wall Defects: Gastroschisis and Omphalocele
			Tracheoesophageal Fistula
			Congenital Diaphragmatic Hernia
			Patent Ductus Arteriosus
			Retinopathy of Prematurity
			Myelomeningocele
			Pyloric Stenosis
		Special Anesthetic Considerations
			Anesthesia for the Former Premature Infant
			Anesthesia for Remote Locations
			Ex-Utero Intrapartum Therapy Procedure and Fetal Surgery
			Anesthetic Neurotoxicity and Neuroprotection in the Developing Brain
		Questions of the Day
		References
	Chapter 35: Elderly Patients
		Why Geriatric Anesthesiology Is Important
		Morbidity and Mortality Rates
		Age-Related Physiologic Changes
			Cardiovascular Changes
			Pulmonary Changes
			Metabolic and Renal Changes
			Changes in Basal Metabolic Rate
			Central Nervous System Changes
		Perioperative Care in the Elderly
			Medications
			Intraoperative Monitoring
			Choice of Anesthesia
			General Anesthesia
			Monitored Anesthesia Care
			Neuraxial Anesthesia
		Postoperative Care
			Pain
			Postoperative Neurologic Events
		Reduction of Perioperative Risk
		Medications to Avoid in the Geriatric Population
		Summary
		Questions of the Day
		References
	Chapter 36: Organ Transplantation
		Considerations for Organ Transplantation
		Kidney Transplantation
			Preoperative Assessment
			Intraoperative Management
			Postoperative Management
		Liver Transplantation
			Preoperative Assessment
			Intraoperative Management
			Postoperative Management
		Heart Transplantation
			Preoperative Evaluation
			Intraoperative Management
			Postoperative Management
		Lung Transplantation
			Preoperative Evaluation
			Intraoperative Management
			Postoperative Management
		Pancreas Transplantation
		Conclusions
		Questions of the Day
		References
	Chapter 37: Outpatient Anesthesia
		Introduction
		Outpatient Anesthesia Is Different
		Outpatient Anesthesia Is Patient-Centered
		Defining the Value of Ambulatory Care
		Selection
			Patient
			Practitioner
			Procedure
			Place (Surgical Facility)
		The Perioperative Journey of an Ambulatory Surgical Patient
			An Itinerary for Success
			Preoperative Phase: Days to Weeks Before Surgery
			Preoperative Phase: Day(s) Before Surgery
			Preoperative Phase: Day of Surgery
			Intraoperative Phase: Anesthesia Techniques
			Postoperative Phase: Beginning of Recovery
			Postoperative Phase: Discharging Patients Home
			Postoperative Phase: Postdischarge Issues
			Outcomes
		Conclusion
		Questions of the Day
			Special Mention
		References
	Chapter 38: Anesthesia for Procedures in Non–Operating Room Locations
		Characteristics of Nora Locations
			Importance of Communication
			Standard of Care and Equipment
		Safety and Concerns in Radiology Suites
			Radiation Safety Practices
			Monitoring the Radiation Dose
			Adverse Reactions to Contrast Materials
		Magnetic Resonance Imaging
			MRI Safety Considerations
			Monitoring Issues in MRI Suites
			Compatible Equipment
		Anesthesia for Noninvasive Imaging Procedures
			Physiologic Monitoring
			Oxygen Administration
			Pharmacologically Induced Sedation
			Management of Anesthesia for Computed Tomography
			Management of Anesthesia for MRI
		Interventional Radiology
			Interventional Neuroradiology
			Body Interventional Radiology
		Endoscopy and Endoscopic Retrograde Cholangiopancreatography
			Anesthesia Evaluation and Management
			Challenges and Complications
		Catheter-Based Cardiology Procedures
			Adult Cardiac Catheterization
			Electrophysiology Studies
			Structural Heart Disease Intervention
			Pediatric Studies
			Challenges and Complications
		Electroconvulsive Therapy
			Electrically Induced Seizures
			Anesthesia Evaluation
			Psychotropic Medications
			Induction of Anesthesia and Seizure
			Physiologic Responses to Seizure and Treatment
		Questions of the Day
		References
Section V: The Recovery Period
	Chapter 39: Postanesthesia Recovery
		Admission to the Postanesthesia Care Unit
		Early Postoperative Physiologic Disorders
		Upper Airway Obstruction
			Loss of Pharyngeal Muscle Tone
			Residual Neuromuscular Blockade
			Laryngospasm
			Airway Edema
			Obstructive Sleep Apnea
			Management of Airway Obstruction
			Monitoring Airway Patency During Transport
		Hypoxemia in the Postanesthesia Care Unit
			Alveolar Hypoventilation
			Decreased Alveolar Partial Pressure of Oxygen
			Ventilation-to-Perfusion Mismatch and Shunt
			Increased Venous Admixture
			Decreased Diffusion Capacity
		Pulmonary Edema in the Postanesthesia Care Unit
			Postobstructive Pulmonary Edema
			Transfusion-Related Acute Lung Injury
		Oxygen Supplementation
			Oxygen Delivery
			Continuous Positive Airway Pressure and Noninvasive Positive-Pressure Ventilation
		Hemodynamic Instability
			Systemic Hypertension
			Systemic Hypotension
			Myocardial Ischemia
			Cardiac Dysrhythmias
		Delirium
			Risk Factors
			Management
			Emergence Agitation
		Renal Dysfunction
			Oliguria
			Intra-Abdominal Hypertension
			Rhabdomyolysis
			Contrast Nephropathy
		Body Temperature and Shivering
			Mechanism
			Treatment
		Postoperative Nausea and Vomiting
			High-Risk Patients
			Prevention and Treatment
		Delayed Awakening
			Treatment
		Discharge Criteria
		Questions of the Day
		References
	Chapter 40: Perioperative Pain Management
		Common Terminology
			Pain Services
		Neurobiology of Pain
			Nociception
			Modulation of Nociception
			Preemptive and Preventive Analgesia
			Opioid-Induced Hyperalgesia
			Multimodal Approach to Perioperative Recovery
		Analgesic Delivery Systems
			Patient-Controlled Analgesia
		Systemic Therapy
			Oral Administration
			Intravenous Administration
			Subcutaneous Administration
			Transdermal/Iontophoretic Administration
			Transmucosal Administration
		Neuraxial Analgesia
			Intrathecal Administration
			Epidural Administration
			Side Effects of Neuraxial Analgesic Drugs
		Surgical Site (Incision) Infiltration
		Intra-Articular Administration
		Intrapleural Analgesia
		Peripheral Nerve Block
			Techniques
			Adjuvant Drugs
		Regional Analgesia
			Catheter Versus Single-Shot Techniques
		Paravertebral Blocks
		Transversus Abdominis Plane Block
		Questions of the Day
		References
Section VI: Consultant Anesthetic Practice
	Chapter 41: Critical Care Medicine
		Respiratory Failure
			Mechanical Ventilation
			Noninvasive Positive-Pressure Ventilation
			Weaning From Mechanical Ventilation and Tracheal Extubation
			Acute Respiratory Distress Syndrome
			Tracheostomies
		Shock
			Hypovolemic Shock
			Cardiogenic Shock
			Vasodilatory Shock
			Hemodynamic Monitoring
			Sepsis
		Acute Renal Failure
			Epidemiology
			Diagnosis
			Treatment
			Dialysis
		Pain and Sedation
			Analgesia
			Sedation
			Sedation Interruption
		Other Topics in Critical Care
			Delirium
			Nutrition
			Glucose Control
			Prophylaxis
			Hospital-Acquired Infections
			ICU Staffing and Organization
		Questions of the Day
		References
	Chapter 42: Anesthesia for Trauma
		Introduction
			Background
			Physiology in Trauma
		Initial Management
			Prearrival Preparation
			Trauma Bay
			Adjuncts and Investigations
			Definitive Care and Transport
			Decision Making in Trauma
		Intraoperative Management
			Phase 1: Uncontrolled Hemorrhage
			Phase 2: Controlled Hemorrhage
			Phase 3: Restoration of Physiology
		Special Groups
			Traumatic Brain Injury
			Spinal Cord Injury
			Burns
			Extremes of Age
			Trauma in Pregnancy
			Care for Trauma Patients in Non-OR Settings
		Questions of the Day
		References
	Chapter 43: Human-Induced and Natural Disasters
		Disaster Types and Nomenclature
		Epidemiology
		Disaster Preparation and Response
			Phases of a Disaster
		Mass Casualty Events
			Role of the Anesthesia Provider
			Triage of Victims
			Prehospital Care
			Hospital Care
		Nuclear Exposure
		Chemical and Biologic Terrorism
			Decontamination
			Personal Protective Equipment
		Infectious Disease Disasters and Pandemics
		Cyber Attacks and High Altitude Electromagnetic Pulse Events
		Postdisaster Syndromes Surveillance
		Recovery
		Questions of the Day
		References
	Chapter 44: Chronic Pain Management
		Classification of Chronic Pain
		Multidisciplinary Pain Management
		Common Pain Syndromes
			Low Back Pain
			Neuropathic Pain
			Musculoskeletal Pain
			Cancer-Related Pain
		Pharmacologic Management of Chronic Pain
			Acetaminophen and Nonsteroidal Antiinflammatory Drugs
			Antidepressants
			Anticonvulsants
			Opioids
		Interventional Pain Therapies
			Epidural Injection of Steroids
			Facet Blocks and Radiofrequency Treatment
			Sympathetic Blocks
			Spinal Cord Stimulation
			Intrathecal Drug Delivery
		Summary
		Questions of the Day
		References
	Chapter 45: Cardiopulmonary Resuscitation
		Basic Life Support
			Recognition
			Early Cardiopulmonary Resuscitation
			Early Defibrillation
			Ancillary Devices and Alternative Techniques
		Adult Advanced Cardiac Life Support
			Monitoring Cardiopulmonary Resuscitation
			Airway Management
			Algorithms
			Medications
		Pediatric Advanced Cardiovascular Life Support
			Circulation
			Airway
			Defibrillation
			Drugs
		Postresuscitation Care
			Acute Coronary Syndrome
			Hemodynamic Goals
			Neurologic Monitoring
			Targeted Temperature Management
			Blood Glucose Control
			Prognosis
		Special Perioperative Considerations
			Anaphylaxis
			Gas Embolism
			Local Anesthetic Systemic Toxicity
			Cardiovascular Collapse From Neuraxial Anesthesia
		Systems of Care
		Questions of the Day
		References
	Chapter 46: Operating Room Management
		Perioperative Leadership
		Anesthesiology Staffing
		Operating Room Efficiency
			Operating Room Utilization
			Operating Room Throughput and Turnover Time
		Questions of the Day
		References
		Additional Resources
		E-only Material
	Chapter 47: Awareness Under Anesthesia
		Incidence
		Etiology and Risk Factors for Intraoperative Awareness
		Psychological Sequelae
		Prevention of Awareness
			Brain Function Monitoring
		Asa Practice Advisory on Intraoperative Awareness and Brain Function Monitors
		Medicolegal Sequelae of Awareness
			Data From the Anesthesia Closed Claims Project
		Summary
		Questions of the Day
		References
	Chapter 48: Quality and Patient Safety in Anesthesia Care
		Definitions: Quality Versus Safety
		Specific Approaches to Anesthesia Safety
			Learning From Experience
			Adoption of Specialty-Wide Standards
			Patient Safety–Focused Programs
		From Safety to Quality: Making Anesthesia Both Safer and Better
			Process Measures
			Structural Measures
			Outcome Measures
		Tools for Improving Local Outcomes
			Structured Quality Improvement Programs: FADE, PDSA, and DMAIC
			Multidisciplinary Process Improvement: Root Cause Analysis, “Never Events,” and Failure Mode Effects Analysis
		Summary
		Questions of the Day
		References
	Chapter 49: Palliative Care
		Introduction
			What Is Hospice?
			Hospice and Palliative Medicine Subspecialty
			Anesthesiologists’ Contribution to Palliative Care
		What Do Palliative Care Teams Do?
			Palliative Care in the Intensive Care Unit
			Withdrawal of Life Support
			Spirituality in Serious Illness
		Palliative Care and Pain
			Use of Opioids at the End of Life
			Cancer Pain
			Noncancer Pain
		Challenges in the Palliative Care Patient
			Identifying Palliative Care and Hospice Patients
			Prognosis
			Communication
		Perioperative Management of the Palliative Care Patient
			Advance Directives
			Decision-Making Capacity
			Surrogate Decision Makers
			How to Approach Perioperative DNR Conversations
		Conclusion
		Questions of the Day
		References
	Chapter 50: Sleep Medicine and Anesthesia
		Introduction
			Human Sleep
			General Anesthesia
			Other Arousal States
			Sleep and Anesthesia: How Different Are They?
		Functional Neuroanatomy of Sleep and Arousal Pathways
		Sleep-disordered Breathing or Sleep-Related Breathing Disorders
		Obstructive Sleep Apnea (OSA)
			Pathophysiology of Upper Airway Collapse in OSA
			Clinical Diagnostic Criteria
			Polysomnography and Portable Devices
			Prevalence of OSA in the General and Surgical Population
			OSA and Comorbid Conditions
			Surgery and OSA Severity
			OSA and Postoperative Complications
			Clinical Pathways and Principles of Perioperative Management
		Conclusion
		Questions of the Day
		References
	Chapter 51: New Models of Anesthesia Care: Perioperative Medicine, the Perioperative Surgical Home, and Population Health
		Growth and Expansion of Anesthesia Practice
		Changing Health Care Landscape
			Workforce Changes Affecting the Models of Anesthesia Care
			New Payment Models
			Transitions From Anesthesiology to Perioperative Medicine
		Implications of New Models of Care on Anesthesia Training Programs
		Conclusion
		Questions of the Day
		References