Miller’s anesthesia.

Cover......Page 1
Contributors......Page 2
Preface to the Seventh Edition......Page 11
History of Anesthetic Practice......Page 12
Respiration......Page 13
Intravascular Pressures......Page 14
Autonomic Nervous System and Neurohumoral Transmission......Page 16
Surgical Procedures Before 1846......Page 17
Beginning of Inhaled Anesthesia......Page 19
Priority for Discovery......Page 21
Nitrous Oxide......Page 22
Fluorinated Anesthetics......Page 23
Needles and Syringes......Page 24
Crystalloids......Page 25
Early Attempts at Local Anesthesia......Page 26
Regional Blocks......Page 27
Spinal Analgesia (also see Chapter 51)......Page 30
Epidural Analgesia (also see Chapter 51)......Page 31
Intravenous Anesthetics......Page 32
Initial Contact with Arrow Poison......Page 33
Introduction into Clinical Medicine......Page 34
Early Delivery Systems......Page 36
Carbon Dioxide Absorption......Page 37
Stress-Free Anesthesia......Page 38
Masks and Airways......Page 39
Tracheal Tubes......Page 40
Resuscitation (see Chapter 97)......Page 42
Anesthetic Accidents and Complications—Preventive Measures......Page 43
References......Page 45
Changes in Location of Care Delivery......Page 51
Cost of Medical Care......Page 52
Research......Page 53
References......Page 55
The International Scope and Practice of Anesthesia......Page 56
The Middle East (Anis Baraka and Fouad Salim Haddad)......Page 57
The Use of Spongia Somnifera.......Page 58
Russia (Olga N. Afonin)......Page 59
Russia (Olga N. Afonin)......Page 60
China (Yuguang Huang)......Page 61
Raising the Professional Profile of Anesthesia.......Page 62
Recovery Room and Postoperative Intensive Care Units.......Page 63
Pain Management.......Page 64
Southeast Asia (Florian R. Nuevo)......Page 65
South America (Guillermo Lema)......Page 66
Japan (Michiaki Yamakage)......Page 67
Growth of the Specialty.......Page 68
Southeast Asia (Florian R. Nuevo)......Page 69
Europe (Lars I. Eriksson and Peter Simpson)......Page 70
Standardizing the Quality of Patient Care in Anesthesiology and Intensive Care.......Page 71
China (Yuguang Huang)......Page 72
Europe (Lars I. Eriksson and Peter Simpson)......Page 73
Conclusion......Page 74
References......Page 75
Central Processing Unit......Page 76
Memory......Page 77
Communications......Page 78
E-mail......Page 79
Browser......Page 81
Electronic Health Record......Page 82
Decision Support Systems/Artificial Intelligence......Page 84
Telemedicine......Page 85
References......Page 86
Quality Improvement......Page 87
Historical Methods of Quality Assessment......Page 88
Analysis of Quality Improvement Data......Page 89
Voluntary Incident Reporting......Page 90
Comprehensive Unit–Based Safety Program: A Strategy To Learn from Mistakes and Improve Culture......Page 91
Daily Goals Sheet......Page 92
Checklists......Page 93
National Programs in Quality Improvement......Page 94
Pay for Performance......Page 95
The Future: Research, Education, and Ethics......Page 96
References......Page 97
Impact of Human Performance on Patient Safety......Page 99
Nature of the Operational Domain of Anesthesiology......Page 100
Analyzing the Anesthetist’s Domain: The Operational World Versus the Organizational World......Page 101
Normal Accident Theory (NAT)......Page 103
High-Reliability Organization Theory......Page 104
High-Reliability Organization Theory in Anesthesiology......Page 105
Status and Hierarchy Effects......Page 106
Assessing Risk Factors in Anesthesia......Page 107
Errors Per Se Are Not the Cause of Accidents......Page 108
What Should Report Forms Look Like?......Page 109
Human Factors......Page 110
What Exactly Is Crisis Resource Management?......Page 111
Mobilize all available resources (CRM key point 6)......Page 113
Crosscheck and double-check—(never assume anything) (CRM key point 10)......Page 114
How Can CRM Skills Contribute to Patient Safety......Page 115
The ANTS System......Page 116
Ambient Noise and Music in the Operating Room......Page 118
Sleep Debt......Page 119
Microsleep Events......Page 120
Evaluation of Physiologic Sleepiness in Anesthesia Residents......Page 121
European and Australian Regulations......Page 122
Do Anesthesiologists Perceive Fatigue As a Problem?......Page 123
Rest Breaks at Work......Page 124
Light Therapy......Page 125
Illness and Drug Use......Page 126
Why Study Human Performance in Anesthesia?......Page 127
Observation......Page 128
Problem Recognition......Page 130
Taking Action......Page 131
Action Selection and Scheduling......Page 132
Hazardous Attitudes......Page 133
Anesthetic Plan......Page 134
Execution and Adaptation of Plans......Page 135
Model of Event Evolution......Page 136
Empirical Studies of Anesthetists’ Tasks......Page 138
Task Analysis and Action Density......Page 139
Automation......Page 140
Secondary Task Probing......Page 141
Applications of Task Analysis and Workload Methodologies......Page 143
Ability Requirements for Anesthetists......Page 144
Responding to Simulated Critical Incidents......Page 145
Indirect Observation of Anesthetists Involved in Difficult Cases......Page 148
References......Page 149
Patient Simulation......Page 156
Dimension 1: Purpose and Aims of the Simulation Activity......Page 157
Dimension 4: Health Care Domain in Which the Simulation Is Applied......Page 159
Dimension 9: Site of Simulation Participation......Page 160
Reality and Realism of Simulation......Page 161
Setting of the Simulation Exercise......Page 162
Dedicated Simulation Center......Page 163
Advantages and Disadvantages of Different Approaches......Page 164
Debriefing—Heart and Soul of Simulation Trainings......Page 167
Technique of Debriefing......Page 168
Scenario Design......Page 169
Tasks of Instructors......Page 170
Instructor Training......Page 171
Classification of Patient Simulators......Page 172
Components of a Patient Simulator......Page 173
Virtual Reality Simulators......Page 175
Experience with Patient Simulators in Anesthesia......Page 176
Anesthesia Crisis Resource Management......Page 177
Simulation for Training of Anesthesia Residents......Page 179
Continuing Medical Education......Page 180
Use of Patient Simulation for Training Health Care Personnel outside Anesthesia......Page 181
Use of Patient Simulation for Research......Page 182
Effectiveness of Simulation Training......Page 183
How Simulation Can Be More Effective......Page 184
Ecologic Validity of Simulators Compared with the Operating Room......Page 185
Pitfalls of Performance Assessment......Page 186
Can Simulators Be Used for the Evaluation and Testing of Residents or Practitioners?......Page 187
Characteristics of Simulation Centers......Page 188
Costs......Page 190
Proliferation of Simulation Centers......Page 191
Simulation Societies: Society for Simulation in Healthcare and Society in Europe for Simulation Applied to Medicine......Page 192
References......Page 193
Teaching Anesthesia......Page 198
Teaching and Education......Page 199
Teach to Whom?—The Students......Page 200
Why Teach?—The Reasons......Page 201
Who Teaches?—The Teachers......Page 205
The Curriculum—What to Teach?......Page 207
The Methods—How to Teach......Page 208
Acknowledgment......Page 209
References......Page 210
Virtue Ethics, Utilitarianism, and Duty-Driven Ethics......Page 213
Competence or Capacity......Page 214
Jehovah’s Witness Patients......Page 215
Consent for Laboratory Tests: HIV and Pregnancy Testing......Page 216
Advance Directives and Surrogate Decision-Makers......Page 217
Special Issues with Advance Directives—Do-Not-Attempt-Resuscitation Orders in the Operating Room......Page 218
Withdrawal/Withholding of Medical Therapy—Curing versus Caring......Page 219
Donation after Cardiac Death......Page 220
Children As Research Subjects......Page 221
Moral Integrity—Can the Physician Be a Conscientious Objector in Medicine?......Page 222
References......Page 223
Legal Aspects of Anesthesia Care......Page 225
Medical Malpractice......Page 226
Malpractice Defense......Page 227
Apology and Disclosure......Page 228
Decision-Making Capacity......Page 229
Understanding......Page 230
Refusing to Provide Care......Page 231
Advanced Care Planning......Page 232
Physician-Assisted Suicide......Page 233
Law Regarding Pediatric Patients......Page 234
Legal Issues in Pain Management......Page 235
References......Page 236
Neuronal Systems That Regulate Arousal States......Page 239
Passive versus Active Theories of Sleep......Page 240
Physiologic Patterns of Wakefulness and Sleep......Page 241
Wakefulness......Page 242
NREM Sleep......Page 243
REM Sleep......Page 244
Somnogen-Induced Transitions Between Arousal States......Page 245
Effects of Anesthetics on Sleep Circuits......Page 246
Brainstem Sites......Page 247
Memory......Page 248
Distinct Memory Systems Subserve Distinct Types of Memory......Page 249
Types of Memory......Page 250
Memory Consolidation and Different Stages of Memory......Page 251
Anesthetic-Induced Amnesia......Page 252
Effects of Anesthetics on Neural Correlates......Page 254
Information Dissociation and Unconscious States......Page 255
Development and Validation of the BIS Monitor......Page 256
References......Page 257
History and Definitions......Page 262
Sympathetic Nervous System......Page 264
Enteric Nervous System......Page 265
Organization and Integration......Page 267
Overview of the Effects of Sympathetic Mediators......Page 268
Overview of the Effects of Acetylcholine......Page 270
Synthesis of Norepinephrine......Page 271
Release of Norepinephrine......Page 272
Inactivation......Page 273
α-Adrenergic Receptors......Page 274
Dopamine Receptors......Page 276
GTP-Binding Regulatory Proteins (G Proteins)......Page 277
Upregulation and Downregulation......Page 278
Cholinergic Receptors......Page 279
Nonadrenergic, Noncholinergic Neurotransmission in the Autonomic Nervous System......Page 280
Ganglionic Pharmacology......Page 281
Endogenous Catecholamines......Page 282
Epinephrine......Page 283
Dopamine......Page 284
α-Receptor Agonists......Page 285
Isoproterenol.......Page 286
Pharmacology......Page 287
Congestive Heart Failure.......Page 289
Adverse Effects......Page 290
Drugs that Inhibit Synthesis, Storage, or Release of Norepinephrine......Page 291
Drugs Affecting the Renin- Angiotensin System......Page 292
Cholinergic Agonists......Page 293
Muscarinic Antagonists......Page 294
Ganglionic Agonists......Page 295
Plasma Catecholamines......Page 296
Diabetes Mellitus......Page 297
Autonomic Changes in Spinal Cord Transection......Page 298
References......Page 299
Cerebral Physiology and the Effects of Anesthetic Drugs......Page 306
Cerebral Metabolic Rate......Page 307
Anesthetic Drugs.......Page 308
Pao2.......Page 309
Neurogenic Regulation of Cerebral Blood Flow......Page 310
Catecholamine Agonists/Antagonists......Page 311
Age......Page 312
Intravenous Anesthetic Drugs......Page 313
Etomidate......Page 314
Sufentanil.......Page 315
Ketamine......Page 316
Effects on Cerebral Blood Flow.......Page 317
Cerebral Vasodilation by Volatile Anesthetics— Clinical Implications.......Page 319
N2O Administered Alone.......Page 321
Nondepolarizing Relaxants......Page 322
Blood-Brain Barrier......Page 323
Etomidate......Page 324
Critical Cerebral Blood Flow Thresholds......Page 325
Energy Failure and Excitotoxicity......Page 326
Nature of Neuronal Death......Page 327
Considerations Relevant to Focal (Incomplete) Ischemia......Page 328
Propofol.......Page 329
Temperature.......Page 330
Volume/Hematocrit Manipulation.......Page 331
Brain Tumors......Page 332
References......Page 333
Neuromuscular Physiology and Pharmacology......Page 341
Neuromuscular Transmission......Page 342
Morphology......Page 343
Quantal Theory......Page 344
Nerve Action Potential......Page 345
Process of Exocytosis......Page 346
Acetylcholinesterase......Page 347
Postjunctional Acetylcholine Receptors......Page 348
Basic Electrophysiology of Neurotransmission......Page 349
Classic Actions of Depolarizing Muscle Relaxants......Page 350
Nonclassic and Noncompetitive Actions of Neuromuscular Drugs......Page 351
Desensitization Block......Page 352
Postjunctional Conventional Acetylcholine Receptors in Muscle versus Neuronal Acetylcholine Receptors in Muscle......Page 353
Maintenance of Mature Neuromuscular Junctions......Page 355
Prejunctional Acetylcholine Receptors......Page 356
Classes of Drugs Used......Page 357
References......Page 359
Dead Space and Alveolar Ventilation......Page 361
Hyperventilation and Exercise......Page 362
Total Lung Capacity and Subdivisions......Page 363
Respiratory Mechanics......Page 364
Compliance of the Respiratory System......Page 365
Resistance of the Respiratory System......Page 366
Distribution of Inspired Gas: Effect of Compliance, Resistance, and Airway Closure......Page 367
Surface Area.......Page 369
Pressure Gradient.......Page 370
Gravitational Distribution of Blood Flow in the Lung......Page 371
Hypoxic Pulmonary Vasoconstriction......Page 372
Hypoventilation......Page 373
Ventilation-Perfusion Mismatch......Page 374
Impaired Diffusion......Page 375
Right-to-Left Shunt......Page 376
Compliance and Resistance of the Respiratory System......Page 377
Atelectasis......Page 378
Minimizing Gas Resorption.......Page 379
Distribution of Ventilation......Page 381
Hypoxic Pulmonary Vasoconstriction......Page 382
Effects of Anesthetics on Respiratory Drive......Page 383
Spontaneous Breathing......Page 384
Age......Page 385
Lung Function After Cardiac Surgery......Page 386
Respiratory Function During One-Lung Ventilation......Page 387
Physiotherapy......Page 388
References......Page 389
Cardiac Cycle......Page 392
Mechanical Events......Page 393
Preload and Afterload......Page 394
Contractility......Page 395
Heart Rate and Force-Frequency Relationship......Page 396
Cardiac Output......Page 397
Cardiomyocyte Structure and Function......Page 398
Action Potential......Page 399
Contractile Elements......Page 400
Contractile Proteins......Page 401
Myocyte Contraction and Relaxation......Page 402
Neural Regulation of Cardiac Function......Page 403
Hormones Affecting Cardiac Function......Page 404
Baroreceptor Reflex (Carotid Sinus Reflex)......Page 406
References......Page 408
Hepatic Physiology and Pathophysiology......Page 410
Macroscopic Anatomy......Page 411
Physiologic Anatomy......Page 412
The Liver Acinus......Page 415
Hepatic Blood Flow......Page 416
Hepatic Arterial Buffer Response......Page 417
Humoral Control......Page 418
Bile Metabolism and the Enterohepatic Circulation......Page 419
Heme Metabolism......Page 420
Immune and Inflammatory Responses......Page 421
Phase 3 Elimination......Page 422
Clinical Assessment......Page 423
Lactate Dehydrogenase......Page 424
5′-Nucleotidase and γ-Glutamyl Transpeptidase......Page 425
Indicator Dilution Techniques......Page 426
Oxidative Stress and the Glutathione System......Page 427
Drug-Induced Liver Injury......Page 428
Alcohol-Induced Disease......Page 429
Renal Dysfunction......Page 430
Cardiovascular Dysfunction......Page 431
Cholestatic Disease......Page 432
Renal Dysfunction......Page 433
References......Page 434
Renal Physiology......Page 440
The Glomerulus (Renal Corpuscle)......Page 442
The Juxtaglomerular Apparatus......Page 443
Renal Autoregulation......Page 444
Tubular Reabsorption and Secretion......Page 446
Proximal Tubule......Page 447
Oxygen Balance in the Medullary Thick Ascending Loop......Page 448
Urine Output......Page 449
Blood Urea Nitrogen......Page 450
Cystatin C......Page 451
Inulin Clearance......Page 452
Creatinine Clearance......Page 453
Urine-to-Plasma Osmolar Ratio......Page 454
Fractional Excretion of Urea Nitrogen......Page 455
Filtration Fraction......Page 456
Neurohormonal Regulation of Renal Function......Page 457
Renin and Angiotensin......Page 458
Arginine Vasopressin......Page 459
Regulation of AVP Secretion......Page 460
Kinins......Page 461
Natriuretic Peptides......Page 462
Nitric Oxide......Page 463
Nephrotoxic Injury......Page 464
Nephrotoxicity of Volatile Anesthetics......Page 465
Aortic Cross-Clamping......Page 466
Dopaminergic and Diuretic Drugs......Page 467
Aminoglycosides......Page 468
N-Acetylcysteine......Page 469
Sepsis......Page 470
Arginine Vasopressin......Page 471
References......Page 472
Basic Principles of Pharmacology......Page 476
Central Volume of Distribution......Page 477
Peripheral Volumes of Distribution......Page 478
Hepatic Clearance......Page 479
Tissue Clearance......Page 482
Protein Binding......Page 483
Stereochemistry......Page 484
Zero- and First-Order Processes......Page 485
Compartmental Pharmacokinetic Models......Page 486
Bolus Pharmacokinetics.......Page 487
Infusion Pharmacokinetics.......Page 488
Multicompartment Models......Page 489
The Time Course of Drug Effect......Page 491
Definition......Page 492
Receptor Agonists and Antagonists.......Page 493
Receptor States.......Page 495
Receptor Structure......Page 496
Ion Channels......Page 497
Second Messengers......Page 498
Developments in Molecular Pharmacology......Page 499
Concentration-Versus-Response Relationships......Page 500
Effective Dose and Lethal Dose......Page 501
Actions at Different Receptors......Page 503
Pharmacogenetics......Page 504
Genetic Variability in Pharmacokinetics......Page 505
Age......Page 507
Drug-Time Interaction: Increased Receptor Sensitivity......Page 508
Suggested Reading......Page 509
References......Page 510
Inhaled Anesthetics: Mechanisms of Action......Page 511
Unitary, Lipid-Based Theories......Page 512
Evolution from Lipid- to Protein-Centered Mechanisms......Page 513
Immobility......Page 514
Learning and Memory......Page 515
Sedation......Page 516
Integrated Effects on the Cardiovascular and Respiratory Systems......Page 517
From Model Proteins to Receptors......Page 518
Inhibition of Excitatory Acetylcholine and Glutamate Receptors......Page 520
Ca2+ Channels......Page 521
Intracellular Signaling Mechanisms......Page 522
Neuronal Excitability......Page 523
Synaptic Plasticity......Page 524
θ-Rhythms......Page 527
Nonimmobilizers......Page 528
Imaging......Page 529
References......Page 530
The Effect of Ventilation......Page 535
Cardiac Output......Page 536
Tissue Groups......Page 537
Synthesis of Factors Governing the Rise in Fa/Fi Ratio......Page 538
The Second Gas Effect......Page 539
Factors Modifying the Rate of Rise in Fa/Fi......Page 540
The Effect of Changes in Cardiac Output......Page 541
The Effect of Concomitant Changes in Ventilation and Perfusion......Page 542
Ventilation-Perfusion Abnormalities......Page 543
Anesthetic Circuitry......Page 545
The Effect of Rebreathing......Page 546
Closed-Circuit Anesthesia......Page 547
Low-Flow Anesthetic Delivery......Page 549
Differences Between Induction and Recovery......Page 550
Can I Have My Cake and Eat It Too?......Page 552
Diffusion Hypoxia......Page 553
References......Page 554
Pulmonary Pharmacology......Page 556
Volatile Anesthetics......Page 557
Mechanisms of Action......Page 558
Effects of Inhaled Anesthetics on Bronchomotor Tone in Humans......Page 559
Normal Mucociliary Function......Page 562
Effects of Inhaled Anesthetics on Surfactant......Page 563
Determinants of Pulmonary Vascular Tone......Page 565
Inhaled Anesthetics and Hypoxic Pulmonary Vasoconstriction......Page 566
Effects of Inhaled Anesthetics on the Pulmonary Vasculature in Humans......Page 569
Control of Breathing—Central Controllers, Sensors, Effectors......Page 570
General Ventilatory Effects of Anesthetics......Page 572
Lung and Airway Receptors......Page 574
Ventilatory Mechanics and Mechanoreceptors in the Chest Wall......Page 575
Effects of Anesthetics on Ventilatory Response to Chemical Stimuli......Page 578
Carbon Dioxide Response Curves......Page 579
Ventilatory Responses to Hypoxemia......Page 581
Mechanisms of Acute Lung Injury......Page 582
Effects of Inhaled Anesthetics on Acute Lung Injury......Page 583
References......Page 584
Myocardial Contractility......Page 590
Cellular Mechanisms of Myocardial Depression......Page 592
Diastolic Function......Page 593
Left Ventricular Afterload......Page 594
Left Atrial Function......Page 595
Cardiac Conduction......Page 597
Coronary Vascular Effects in Vivo......Page 598
Mechanisms of Volatile Anesthetic–Induced Coronary Vasodilation......Page 599
Acute Preconditioning by Volatile Anesthetics......Page 600
Mitochondrial and Sarcolemmal KATP Channels......Page 602
Protein Kinases......Page 604
Reactive Oxygen Species......Page 607
Delayed Preconditioning by Volatile Anesthetics......Page 610
Postconditioning by Volatile Anesthetics......Page 611
Coronary Vascular Effects of Volatile Anesthetics in Humans......Page 616
Cardioprotection by Volatile Anesthetics in Humans......Page 617
Myocardial Contractility and Left Ventricular Diastolic Function......Page 619
Nitrous Oxide and the Coronary Circulation......Page 620
Summary......Page 621
References......Page 622
Inhaled Anesthetics: Metabolism and Toxicity......Page 628
The Liver and Drug Metabolism......Page 629
Factors Affecting Drug Metabolism......Page 630
Pharmacogenomics of Drug Metabolism......Page 633
Xenon......Page 634
Isoflurane......Page 636
Sevoflurane......Page 637
Stereoselective Metabolism of Inhaled Anesthetics......Page 638
Hepatitis......Page 639
Immune-Mediated Halothane Hepatotoxicity......Page 640
Enflurane, Isoflurane, Desflurane, and Sevoflurane......Page 641
Hydrochlorofluorocarbons......Page 643
Risk Factors for Anesthetic-Induced Hepatitis......Page 644
Methoxyflurane......Page 645
Sevoflurane......Page 646
Sevoflurane and Compound A......Page 647
Carbon Monoxide and Heat......Page 651
Effects on Reproduction and Development......Page 653
General Anesthetics and Neurotoxicity......Page 654
The Greenhouse Effect.......Page 655
Acknowledgment......Page 656
References......Page 657
Inhaled Anesthetic Delivery Systems......Page 662
Anesthesia Workstation Standards and Pre-use Procedures......Page 663
Testing Specific Components of the Anesthesia Delivery System......Page 664
Low-Pressure Circuit Leak Test......Page 665
1993 FDA Negative-Pressure Leak Test......Page 667
Circle System Tests......Page 668
Anatomy of an Anesthesia Workstation......Page 669
Cylinder Supply Source......Page 670
Fail-Safe Valves......Page 671
Flow Meter Assemblies......Page 672
Flow Tubes.......Page 673
Leaks......Page 674
Datex-Ohmeda Link-25 Proportion-Limiting Control System......Page 675
North American Dräger Oxygen Ratio Monitor Controller/Sensitive Oxygen Ratio Controller System......Page 676
Oxygen Flush Valve......Page 677
Vapor Pressure......Page 678
Basic Operating Principles......Page 679
Flow Rate......Page 680
Carrier Gas Composition......Page 681
Underfilling......Page 682
Unsuitability of Contemporary Variable-Bypass Vaporizers for Controlled Vaporization of Desflurane......Page 683
Operating Principles of the Tec 6 and Tec 6 Plus......Page 684
Varied Altitudes......Page 685
The Datex-Ohmeda Aladin Cassette Vaporizer......Page 686
Anesthetic Breathing Circuits......Page 687
Bain Circuit......Page 688
The Traditional Circle Breathing System......Page 689
Chemistry of Absorbents......Page 690
Indicators......Page 691
Anesthesia Ventilators......Page 692
Drive Mechanism and Circuit Designation......Page 693
Bellows Classification......Page 694
Traditional Circle System Problems......Page 695
The Datex-Ohmeda S/5 ADU......Page 697
The Dräger Medical Narkomed 6000 Series and Fabius GS......Page 698
Scavenging Systems......Page 699
Gas-Collecting Assembly......Page 700
Open Interfaces......Page 701
Gas Disposal Assembly Conduit......Page 702
References......Page 703
Breathing System......Page 706
General Considerations......Page 707
Requirements for Safe Delivery of Anesthesia Care......Page 708
Specific Items......Page 709
References......Page 712
Intravenous Anesthetics......Page 714
Physicochemical Characteristics......Page 715
Pharmacokinetics......Page 716
Effects on the Central Nervous System......Page 718
Effects on the Cardiovascular System......Page 719
Induction and Maintenance of Anesthesia......Page 721
Sedation......Page 722
Structure-Activity Relationships......Page 723
Metabolism......Page 724
Mechanism of Action......Page 725
Onset of Central Nervous System Effects......Page 726
Uses......Page 727
Cardiovascular System......Page 728
Physicochemical Characteristics......Page 729
Metabolism......Page 730
Pharmacology......Page 731
Effects on the Central Nervous System......Page 732
Intravenous Sedation......Page 733
Induction and Maintenance of Anesthesia......Page 734
Side Effects and Contraindications......Page 735
Pharmacokinetics......Page 736
History......Page 737
Effects on the Central Nervous System......Page 738
Effects on the Cardiovascular System......Page 740
Sedation......Page 741
History......Page 742
Pharmacokinetics......Page 743
Endocrine Effects......Page 744
Other Effects......Page 745
Metabolism and Pharmacokinetics......Page 746
Sedation......Page 747
Analgesia......Page 748
Effects on the Cardiovascular System......Page 749
Anesthesia......Page 751
History......Page 752
References......Page 753
Classification of Opioid Compounds......Page 764
Opioid Receptors......Page 766
Endogenous Opioid Peptides......Page 767
Intracellular Signal Transduction Mechanism......Page 768
Mechanism of Analgesia......Page 769
Analysis of Knock-out Mice......Page 770
Actions of Opioids on Targets Other Than Opioid Receptors......Page 771
Opiods As Anesthetics......Page 772
Electroencephalography......Page 774
Cerebral Blood Flow and Cerebral Metabolic Rate......Page 775
Muscle Rigidity......Page 776
Respiratory Effects of Opioids......Page 777
Nontherapeutic Effects......Page 778
Neurologic Mechanisms......Page 779
Ischemia......Page 780
Vascular Mechanisms......Page 781
Opiate Tolerance and Addiction......Page 782
Renal and Urodynamic Effects of Opioids......Page 783
Obstetrics......Page 784
Immune Effects......Page 785
Common Pharmacokinetic Features of Opioids......Page 786
Morphine......Page 787
Sufentanil......Page 788
Remifentanil......Page 789
Renal Failure......Page 790
Cardiopulmonary Bypass......Page 792
Analgesia......Page 793
Fentanyl......Page 795
Sufentanil......Page 796
Total Intravenous Anesthesia......Page 797
Alfentanil......Page 798
Transdermal Therapeutic System......Page 799
Iontophoresis......Page 800
Transmucosal Drug Delivery......Page 801
Other Opioid Agonists......Page 802
Butorphanol......Page 803
Nalbuphine......Page 804
Reversal of Respiratory Depression by Naloxone......Page 805
Methylnaltrexone......Page 806
Sedative-Hypnotics......Page 807
Muscle Relaxants......Page 808
Miscellaneous......Page 809
References......Page 810
Intravenous Drug Delivery Systems......Page 820
Pharmacokinetic Considerations......Page 821
The Biophase......Page 825
Indirect-Effect Models......Page 826
Drug Potency......Page 827
Pharmacodynamic Drug Interactions......Page 828
Bolus Dose Calculations......Page 831
Maintenance Infusion Rate......Page 833
Recovery from Anesthesia......Page 834
Terms and Definitions......Page 839
Devices......Page 840
Optimization of Target-Controlled Drug Delivery......Page 842
Outcome......Page 847
Closed-Loop Drug Delivery Systems......Page 848
Summary......Page 849
References......Page 851
History and Clinical Use......Page 854
Postjunctional Effects......Page 855
Monitoring Neuromuscular Function......Page 856
Pharmacokinetics and Pharmacodynamics......Page 857
Dibucaine Number and Atypical Butyrylcholinesterase Activity......Page 858
Ventricular Dysrhythmias.......Page 859
Increased Intraocular Pressure......Page 860
Clinical Uses......Page 861
Nondepolarizing Neuromuscular Blockers......Page 862
Benzylisoquinolinium Compounds......Page 863
Steroidal Neuromuscular Blockers......Page 864
Diallyl Derivative of Toxiferine......Page 865
Potency of Nondepolarizing Neuromuscular Blockers......Page 866
Pharmacokinetics and Pharmacodynamics......Page 867
Initial and Maintenance Dosage......Page 869
Neuromuscular Blockers and Tracheal Intubation......Page 870
Rapid Tracheal Intubation......Page 872
Low-Dose Relaxants for Tracheal Intubation......Page 873
Intermediate-Acting Neuromuscular Blockers.......Page 874
Short-Acting Neuromuscular Blockers.......Page 875
Autonomic Effects......Page 876
Tachycardia.......Page 877
Respiratory Effects......Page 878
Interactions Among Nondepolarizing Neuromuscular Blockers......Page 879
Interactions with Antibiotics......Page 880
Interactions with Local Anesthetic and Antidysrhythmic Drugs......Page 881
Recovery From Neuromuscular Blockade......Page 882
Antagonism of Residual Neuromuscular Blockade......Page 883
The Anticholinesterase Administered......Page 884
Rate of Spontaneous Recovery from the Neuromuscular Blocker......Page 885
Cardiovascular Effects......Page 886
Sugammadex......Page 887
Pharmacokinetics.......Page 888
Cysteine......Page 889
Pediatric Patients......Page 890
Severe Renal Disease......Page 892
Hepatobiliary Disease......Page 893
Neuromuscular Blockers and Weakness Syndromes in the Critically Ill......Page 895
Critical Illness Myopathy......Page 896
Should Nondepolarizing Neuromuscular Blockers Be Used in ICU Patients?......Page 897
References......Page 898
References......Page 0
Nitric Oxide and Inhaled Pulmonary Vasodilators......Page 934
Inhaled Nitric Oxide......Page 935
Enhancement of Ventilation-Perfusion Matching by Inhalation of Nitric Oxide......Page 936
Nitric Oxide Is an Important Regulatory Molecule in the Perinatal Lung.......Page 937
Inhaled Nitric Oxide Increases Systemic Oxygenation in Hypoxemic Newborns with Pulmonary Hypertension.......Page 938
Treatment of Cardiogenic Shock Caused by Right Ventricular Myocardial Infarction.......Page 939
Valvular Heart Disease.......Page 940
Inhaled Nitric Oxide and Platelet Function......Page 941
Inhaled Nitric Oxide and Ischemia-Reperfusion Injury of Extrapulmonary Organs......Page 942
Safety Issues and Method of Administration......Page 943
Other Inhaled Pulmonary Vasodilators......Page 944
References......Page 945
Herbal Medicines......Page 949
Echinacea......Page 950
Garlic......Page 952
Saw Palmetto......Page 953
Summary......Page 954
Acupuncture for Postoperative Nausea and Vomiting......Page 955
References......Page 956
Risk of Anesthesia......Page 959
Framework of Perioperative Risk......Page 960
Types of Studies......Page 961
Problems Inherent in Studying Anesthesia-Related Risk......Page 962
Early Studies of Anesthesia- Related Mortality......Page 963
Anesthesia-Related Mortality Studies after 1980......Page 965
Analysis of Intraoperative Cardiac Arrest......Page 968
Perioperative Mortality and Morbidity in Outpatient Surgery......Page 969
Use of Anesthesia Information Management Systems......Page 971
Other Approaches to Discern the Root Cause of Morbidity and Mortality......Page 972
Issues Associated with Anesthesia- Related Mortality......Page 973
Risks Related to the Patient......Page 974
Obstetrics......Page 976
Pediatrics......Page 979
Geriatrics......Page 980
Risks Directly Related to the Anesthetic Drug......Page 981
Risks Related to the Location of Surgery and Postoperative Monitoring......Page 982
Risks Related to the Anesthesia Provider......Page 983
Risks to the Anesthesiologist......Page 984
Summary......Page 985
References......Page 986
Preoperative Evaluation......Page 990
Preoperative Risk Assessment......Page 991
Detecting Disease in Preoperative Evaluation......Page 992
Components of the Preoperative Medical History......Page 993
The Preoperative Physical Examination......Page 994
Hypertension......Page 997
Ischemic Heart Disease......Page 998
Heart Failure......Page 1002
Murmurs and Valvular Abnormalities......Page 1003
Mitral Stenosis......Page 1004
Prosthetic Heart Valves......Page 1005
Rhythm Disturbances and Electrocardiographic Abnormalities......Page 1006
Peripheral Vascular Disease......Page 1007
Restrictive Pulmonary Disorders......Page 1008
Pulmonary Hypertension......Page 1009
Smokers and Those Exposed to Second-Hand Smoke......Page 1010
Diabetes Mellitus......Page 1011
Hypothalamic-Pituitary-Adrenal Disorders......Page 1012
Renal Disease......Page 1013
Remote History of “Hepatitis”......Page 1015
All Forms of Liver Disease......Page 1016
Glucose-6-Phosphate Dehydrogenase Deficiency......Page 1017
Thrombocytopenia......Page 1018
Risk of Thromboembolism or Pulmonary Emboli......Page 1019
Multiple Sclerosis......Page 1020
Neuromuscular Junction Disorders......Page 1021
Central Nervous System Tumors......Page 1022
Rheumatoid Arthritis......Page 1023
Systemic Lupus Erythematosus......Page 1024
Kyphoscoliosis......Page 1025
Cancer Patients......Page 1026
Preoperative Evaluation of Patients with a Transplanted Organ......Page 1027
Preoperative Evaluation of Patients with Allergies......Page 1028
Preoperative Evaluation of Patients with Obstructive Sleep Apnea......Page 1029
Evaluation of Patients with a History of Substance Abuse......Page 1030
Preoperative Nutritional Evaluation......Page 1031
Patients with Do-Not-Resuscitate Orders......Page 1032
Meeting Regulatory and Reporting Requirements......Page 1033
Preoperative Medical-Legal Issues......Page 1034
Information Technology and Decision Support Systems in Preoperative Evaluation......Page 1035
Infective Endocarditis Prophylaxis......Page 1036
Preoperative Use of Alternative and Complementary Therapies......Page 1037
Preoperative Laboratory and Diagnostic Studies......Page 1039
The Preoperative Evaluation Clinic......Page 1041
Collaboration, Commitment, and Teamwork......Page 1042
Financial Concerns in Developing a Preoperative Clinic......Page 1043
Preoperative Standardization and Accuracy of Documentation......Page 1044
Information Management and Centralization......Page 1046
Structure and Activities of the Preoperative Evaluation Clinic......Page 1047
Enhanced Operating Room Efficiency and Outcomes......Page 1048
Patient Education and Patient Satisfaction......Page 1049
Role of the Medical Consultant in Preoperative Evaluation......Page 1051
References......Page 1052
Anesthetic Implications of Concurrent Diseases......Page 1056
Role of the Primary Care Physician or Consultant......Page 1057
Preoperative and Preprocedure Diabetes Mellitus......Page 1058
Glucotoxicity......Page 1061
“Tight Control” Regimen 1......Page 1062
Other Conditions Associated with Diabetes......Page 1063
Hyperlipoproteinemia, Hyperlipidemia, and Hypolipidemia......Page 1065
Hyperalimentation (Total Parenteral or Enteral Nutrition)......Page 1066
Androgens......Page 1067
Glucocorticoid Excess......Page 1068
Mineralocorticoid Deficiency......Page 1070
Perioperative Stress and the Need for Corticoid Supplementation......Page 1071
Adrenal Cortex Function in the Elderly......Page 1072
Adrenal Medullary Sympathetic Hormone Excess: Pheochromocytoma......Page 1073
Hypofunction or Aberration in Function of the Sympathetic Nervous System (Dysautonomia)......Page 1074
Thyroid Dysfunction......Page 1075
Hyperthyroidism......Page 1076
Hypothyroidism......Page 1077
Hyperparathyroidism and Hypercalcemia......Page 1078
Hypocalcemia......Page 1080
Anterior Pituitary Hypofunction......Page 1081
Posterior Pituitary Hormone Excess and Deficiency......Page 1082
Recommendations......Page 1083
Role of Coronary Artery Bypass Graft or Percutaneous Coronary Interventions before Noncardiac Surgery......Page 1084
Summary of Preoperative and Intraoperative Factors That Correlate with Perioperative Morbidity......Page 1086
Preoperative and Preprocedure Therapy......Page 1087
Cardiac Valve Prostheses and Anticoagulant Therapy and Prophylaxis for Deep Venous Thrombosis......Page 1088
Cardiac Conduction Disturbances: Cardiac Arrhythmias......Page 1091
General Preoperative and Preprocedure Considerations......Page 1092
Pulmonary Vascular Diseases......Page 1097
Chronic Diseases of the Lung......Page 1098
Minimizing Risks Preoperatively......Page 1099
Diseases of the Central Nervous System, Neuromuscular Diseases, and Psychiatric Disorders......Page 1100
Infectious Diseases of the Central Nervous System, Degenerative Disorders of the Central Nervous System, and Headache......Page 1101
Metabolic Diseases......Page 1103
Neuromuscular Disorders......Page 1104
Preoperative Prediction of Increased Intracranial Pressure during Neurosurgery......Page 1105
Causes and Systemic Effects of Renal Disorders......Page 1106
Patients with Insufficient but Functioning Kidneys......Page 1107
Patients Undergoing Dialysis......Page 1108
Infectious Disease......Page 1109
Hyponatremia and Hypernatremia......Page 1110
Hypokalemia and Hyperkalemia......Page 1111
Ulcerative Colitis and Carcinoid Tumors as Examples of Gastrointestinal Disease Affecting Other Systems......Page 1113
Anemia and Polycythemia......Page 1115
Sickle Cell Anemia and Related Hemoglobinopathies......Page 1116
Cytoskeletal Anemias (Hereditary Spherocytosis and Elliptocytosis), Enzyme-Deficient Anemias, and Autoimmune Hemolytic Anemias......Page 1117
Platelet Disorders......Page 1118
Hemophilia and Related Clotting Disorders......Page 1120
Oncologic Disease......Page 1121
Antihypertensive Drugs......Page 1122
Mood-Altering Drugs......Page 1125
Other Drugs......Page 1126
Magnesium, Cimetidine, and Oral Contraceptives......Page 1127
Interrupting a Drug Regimen before Surgery......Page 1129
References......Page 1130
Cardiovascular Concerns......Page 1139
Associated Arm Position......Page 1140
Variations of the Supine Position......Page 1141
Lithotomy......Page 1143
Lateral Decubitus......Page 1146
Prone......Page 1148
Sitting......Page 1150
Peripheral Nerve Injury......Page 1152
Ulnar Nerve......Page 1153
Brachial Plexus......Page 1154
Perioperative Eye Injury and Visual Loss......Page 1155
Evaluation and Treatment of Perioperative Neuropathies......Page 1156
References......Page 1157
Neuromuscular Disorders and Malignant Hyperthermia......Page 1159
Anesthetic Considerations.......Page 1160
Duchenne’s Muscular Dystrophy and Becker’s Muscular Dystrophy......Page 1161
Anesthetic Considerations.......Page 1163
Myotonic Dystrophy......Page 1164
Anesthetic Considerations.......Page 1165
Anesthetic Considerations.......Page 1166
Induction and Maintenance of Anesthesia.......Page 1167
Eaton-Lambert Myasthenic Syndrome......Page 1168
Malignant Hyperthermia......Page 1169
Physiology and Pathophysiology of Excitation-Contraction Coupling and Malignant Hyperthermia......Page 1170
Malignant Hyperthermia Is the Result of Abnormal Function of Muscle Calcium Release Units......Page 1171
Genetics......Page 1172
Distribution of RYR1 Mutations......Page 1173
Anesthetic Triggering......Page 1174
Diagnosis in the Operating Room and Postanesthesia Care Unit......Page 1176
Anesthesia for Susceptible Patients......Page 1177
References......Page 1178
Nature of Physics and Measurement......Page 1184
Measurement of Mass......Page 1185
Measurement of Energy......Page 1186
Data Processing......Page 1187
Errors in Signal Analysis......Page 1188
Principles of Pressure Measurement......Page 1190
Dynamic Pressure Measurement (Transducer)......Page 1191
Principles of Sound......Page 1193
Active Sound Examination (Percussion, Echo, Doppler)......Page 1194
Direct Current......Page 1196
Alternating Current......Page 1197
Passive Electric Examination (Electrocardiograph, Electroencephalograph)......Page 1198
Active Electric Examination (Neuromuscular Block Monitor, Somatosensory Evoked Potentials)......Page 1199
Simple Absorbance Monitors (Capnometer, Anesthetic Analyzer)......Page 1200
Processed Absorbance Monitors (Pulse Oximeter)......Page 1201
Basic Design of Pulse Oximeters......Page 1202
Principles of Temperature......Page 1203
Mass and Volume Flow Meters (Urometer, Volumeter)......Page 1204
Velocity and Pressure Flow Meters (Venturi, Pitot)......Page 1205
Summary of Flow Measurement......Page 1207
References......Page 1208
Monitoring the Depth of Anesthesia......Page 1215
Definitions of Anesthetic Depth......Page 1216
What is Anesthesia?......Page 1217
Pharmacologic View of the Anesthetic State......Page 1218
Experimental Characterization of the Anesthetic State......Page 1220
Fundamental Relationships That Characterize the Anesthetic State......Page 1222
Measuring the Incidence of Awareness......Page 1223
Studies of the Incidence of Awareness......Page 1224
Normal Requirement—Low Delivery......Page 1225
Reducing Intraoperative Risk......Page 1226
Unconscious Memory Formation During Anesthesia......Page 1227
Movement Response and the MAC Concept......Page 1228
Other Clinical Responses......Page 1230
Assessing Depth During Maintenance of Anesthesia......Page 1231
Opioids as Complete Anesthetics......Page 1232
Clinical Signs of Inadequate Anesthesia and Plasma Concentration of Opioids......Page 1233
Spontaneous Electroencephalogram......Page 1235
Electroencephalographic Signal Processing......Page 1236
The Bispectral Index......Page 1237
Entropy......Page 1238
Patient State Index......Page 1239
Narcotrend......Page 1240
Clinical Interpretation and Effects of Drugs on Electrophysiologic Monitors......Page 1241
Hypnotics......Page 1242
Nitrous Oxide......Page 1243
Response to Noxious Stimulation......Page 1244
Outcome......Page 1245
References......Page 1246
Cardiovascular Monitoring......Page 1252
Stethoscopy......Page 1253
Heart Rate Monitoring......Page 1254
Manual Intermittent Techniques......Page 1255
Automated Intermittent Techniques......Page 1256
Direct Measurement of Arterial Blood Pressure......Page 1257
Alternative Arterial Pressure Monitoring Sites......Page 1258
Natural Frequency, Damping Coefficient, and Dynamic Response of Pressure Monitoring Systems......Page 1259
Components of Pressure Monitoring Systems......Page 1261
Transducer Setup: Zeroing and Leveling......Page 1262
Normal Arterial Pressure Waveforms......Page 1263
Arterial Blood Pressure Gradients......Page 1265
Abnormal Arterial Pressure Waveforms......Page 1266
Arterial Pressure Monitoring for Prediction of Volume Responsiveness......Page 1268
Choosing the Catheter, Site, and Method of Central Venous Cannulation......Page 1270
Right Internal Jugular Vein Cannulation......Page 1271
External Jugular Vein......Page 1273
Ultrasound-Guided Central Venous Cannulation......Page 1274
Mechanical Complications of Central Venous Catheterization......Page 1275
Thromboembolic Complications of Central Venous Catheterization......Page 1276
Physiologic Considerations for Central Venous Pressure Monitoring: Diastolic Pressure-Volume Relationships and Transmural Pressure......Page 1277
Normal Central Venous Pressure Waveforms......Page 1278
Abnormal Central Venous Pressure Waveforms......Page 1280
Pulmonary Artery Catheterization......Page 1282
Additional Guidelines for Placement of Pulmonary Artery Catheters......Page 1283
Complications of Pulmonary Artery Catheter Monitoring......Page 1284
Physiologic Considerations for Pulmonary Artery Catheter Monitoring: Prediction of Left Ventricular Filling Pressure......Page 1286
Normal Pulmonary Artery and Wedge Pressure Waveforms......Page 1287
Left Atrial Pressure, Pulmonary Artery Wedge Pressure, and Pulmonary Capillary Pressure......Page 1288
Abnormal Pulmonary Artery and Wedge Pressure Waveforms......Page 1289
Use of Central Vascular Pressures to Estimate Left Ventricular Preload......Page 1294
PAC Underestimation of Left Ventricular End-Diastolic Pressure......Page 1295
PAC Overestimation of Left Ventricular End-Diastolic Pressure......Page 1296
Additional Features of Pulmonary Artery Catheters......Page 1297
Indications for Pulmonary Artery Catheterization......Page 1298
Sources of Error in Thermodilution Cardiac Output Monitoring......Page 1299
Continuous Thermodilution Cardiac Output Monitoring......Page 1300
Mixed Venous Oximetry Pulmonary Artery Catheter......Page 1301
Pulmonary Artery Catheter–Derived Hemodynamic Variables......Page 1302
Suprasternal Doppler Cardiac Output Monitoring......Page 1303
Bioimpedance Cardiac Output Monitoring......Page 1304
Pulse Contour Cardiac Output Monitoring......Page 1305
References......Page 1306
History......Page 1314
Practice Guidelines for Transesophageal Echocardiography......Page 1315
Properties of Ultrasound......Page 1316
Transducer Frequency, Image Resolution, and Depth of Penetration......Page 1317
Basic Principles of Image Optimization: Gain, Depth, and Focus......Page 1319
Integration of Flow and Structure......Page 1320
Tissue Doppler......Page 1322
Equipment Design and Operation......Page 1323
Basic Transesophageal Examination......Page 1324
Comprehensive Transesophageal Examination......Page 1326
Basic Transthoracic Examination......Page 1328
Evaluation of Ventricular Filling......Page 1330
Estimation of Cardiac Output......Page 1331
Assessment of Ventricular Diastolic Function......Page 1332
Transesophageal Echocardiography During Life-Threatening Hypotension......Page 1333
Aortic Diseases......Page 1334
Valvular Diseases......Page 1335
Coronary Disease......Page 1337
Congenital Heart Surgery......Page 1338
Certification......Page 1339
References......Page 1340
Standard Electrocardiographic Recordings......Page 1342
Myocardial Activation—The QRS Complex......Page 1343
Ventricular Hypertrophy and Enlargement......Page 1344
Myocardial Infarction......Page 1346
Magnesium.......Page 1347
Five-Electrode Electrocardiographic Monitoring......Page 1348
Ten-Electrode, Twelve-Lead Electrocardiographic Monitoring......Page 1349
Diagnosis of Arrhythmias......Page 1350
Sinus Tachycardia......Page 1351
Paroxysmal Supraventricular Tachycardia......Page 1352
Atrial Flutter......Page 1354
Atrial Fibrillation......Page 1355
Ventricular Tachycardia......Page 1356
Ventricular Fibrillation......Page 1357
Conduction Defects......Page 1358
Left Bundle Branch Block.......Page 1359
ST Depression–Type Ischemia......Page 1360
ST Elevation–Type Ischemia......Page 1361
Real-Time Myocardial Ischemia Monitoring......Page 1362
Electrocardiographic Lead Sensitivity for Detecting Perioperative Myocardial Ischemia......Page 1363
Example 2.......Page 1364
Example 3.......Page 1367
References......Page 1370
Postoperatively......Page 1372
Pacemakers......Page 1373
Pacemaker Codes......Page 1377
Pacemaker Magnets......Page 1378
Preanesthetic Evaluation and Pacemaker Reprogramming......Page 1380
Intraoperative (or Procedure) Management of Pacemakers......Page 1382
Pacemaker Failure......Page 1385
Implantable Cardioverter-Defibrillators......Page 1387
ICD Magnets......Page 1388
Intraoperative (or Procedure) Management of ICDs......Page 1389
Glossary......Page 1390
References......Page 1392
Alveolar Gases......Page 1395
Arterial Gases......Page 1396
Shunt......Page 1397
Calculating Shunt Fraction and Dead Space......Page 1398
Temperature Correction......Page 1399
Artifactual Changes in Arterial Blood Gas Values......Page 1400
In-Line Blood Gas Monitoring......Page 1402
Pulse Oximetry......Page 1403
Multiwavelength Pulse Oximeters.......Page 1404
Critically Ill.......Page 1405
New and Future Applications......Page 1406
Tissue Oxygenation......Page 1407
Mass Spectrometry......Page 1408
Mainstream versus Sidestream......Page 1409
Mainstream.......Page 1410
Time.......Page 1411
Volume.......Page 1412
Static Curve......Page 1413
Analysis of Lung Recruitment......Page 1415
Inspiratory Pressure Monitoring......Page 1416
Closed-Loop Analysis......Page 1417
Apnea Monitoring......Page 1418
Monitoring High-Frequency Ventilation......Page 1419
Monitoring the Respiratory System in Transport......Page 1421
References......Page 1422
Renal Function Monitoring......Page 1426
Renal Physiology......Page 1428
Normal Function......Page 1429
The Pathophysiology of Ischemic Acute Kidney Injury......Page 1431
Anesthesia, Surgery, and Normal Renal Function......Page 1432
Effects of Regional Anesthesia......Page 1433
Effects of Inhaled Anesthetics......Page 1434
Other Perioperative Perturbations and Renal Function......Page 1435
Monitors of Renal Function......Page 1436
Oxygen Delivery: Blood Gas, Acid-Base Balance, and Hematocrit......Page 1437
Intravascular Volume Status: Central Venous Pressure, Pulmonary Capillary Wedge Pressure, Left Atrial Pressure, and Left Ventricular End-Diastolic Area......Page 1438
Autoregulation and Distribution of Cardiac Output to the Kidneys......Page 1439
Urine Volume......Page 1440
Serum Creatinine Concentration......Page 1441
Urinary Sodium Concentration......Page 1442
Creatinine Clearance......Page 1443
Renal Blood Flow......Page 1445
Novel (Early) Biomarkers of Acute Kidney Injury......Page 1447
New Filtration-Based Markers of Renal Dysfunction......Page 1448
Biomarkers Reflecting Renal Tubular Cell Damage (Tubular Enzymuria)......Page 1449
Biomarkers Reflecting the Renal Tubular Cell Response to Stress......Page 1450
Preoperative Evaluation of Renal Function......Page 1451
References......Page 1452
Neurologic Monitoring......Page 1459
Jugular Bulb Venous Oxygen Saturation.......Page 1460
Cerebral Oximetry.......Page 1461
Thermal Diffusion Cerebral Blood Flow Monitoring.......Page 1462
Monitors of Nervous System Function......Page 1463
Abnormal Electroencephalogram.......Page 1464
Processed Electroencephalogram Concepts.......Page 1465
Sensory Evoked Responses.......Page 1466
Somatosensory Evoked Potentials.......Page 1469
Brainstem Auditory Evoked Potentials.......Page 1470
Transcranial Motor Evoked Potentials.......Page 1471
Electromyography.......Page 1472
Electroencephalogram.......Page 1473
Cerebral Oximetry (Near-Infrared Spectroscopy).......Page 1474
Seizure Focus Localization Surgery......Page 1475
Other Posterior Fossa Neoplasms......Page 1476
Spinal Column and Spinal Cord Surgery (Monitors: SSEPs, MEPs, EMG)......Page 1477
Transcranial Doppler.......Page 1479
Cerebral Ischemia......Page 1480
Barbiturates, Propofol, and Etomidate.......Page 1481
Opioids.......Page 1483
Volatile Anesthetics......Page 1484
Intravenous Agents......Page 1486
Hypotension......Page 1488
Hypercarbia and Hypocarbia......Page 1489
Physiologic Factors Influencing Sensory Evoked Responses......Page 1490
References......Page 1491
Types of Peripheral Nerve Stimulation......Page 1497
Train-of-Four Stimulation......Page 1498
Tetanic Stimulation......Page 1499
Post-Tetanic Count Stimulation......Page 1500
Double-Burst Stimulation......Page 1501
Sites of Nerve Stimulation and Different Muscle Responses......Page 1502
Mechanomyography......Page 1503
Acceleromyography......Page 1504
Phonomyography......Page 1506
Recovery......Page 1507
Depolarizing Neuromuscular Blockade (Phase I and II Blocks)......Page 1508
Use of a Peripheral Nerve Stimulator During Induction of Anesthesia......Page 1509
When to Use a Peripheral Nerve Stimulator......Page 1510
References......Page 1511
Afferent Input......Page 1514
Efferent Responses......Page 1515
Response Thresholds......Page 1516
Gain and Maximum Response Intensity......Page 1517
Heat Transfer......Page 1518
Patterns of Intraoperative Hypothermia......Page 1519
Thermoregulation......Page 1520
Heat Balance......Page 1521
Shivering......Page 1522
Complications......Page 1523
Postanesthetic Shivering......Page 1524
Preventing Redistribution Hypothermia......Page 1526
Cutaneous Warming......Page 1527
Deliberate Severe Intraoperative Hypothermia......Page 1528
Hyperthermia and Fever......Page 1529
Fever......Page 1530
Temperature-Monitoring Sites......Page 1531
Temperature-Monitoring and Thermal Management Guidelines......Page 1532
References......Page 1533
Physical Chemistry of Water......Page 1538
Determinants of Acidity or Alkalinity of a Solution......Page 1539
Carbon Dioxide......Page 1540
Metabolic Acid-Base Disturbances......Page 1541
Regulation of Acid-Base Balance......Page 1543
Base Deficit/Excess (Copenhagen) Approach......Page 1544
Anion Gap Approach......Page 1545
Stewart-Fencl Approach......Page 1546
Acid-Base Disturbances in the Emergency Setting......Page 1547
Perioperative Acid-Base Disturbances......Page 1549
Acid-Base Disturbances in Critical Illness......Page 1551
References......Page 1552
Airway Management in the Adult......Page 1554
Anatomy......Page 1555
Airway Assessment......Page 1556
Oxygenation and Preoxygenation......Page 1558
Intravenous Anesthesia with Narcotics......Page 1559
Facemask Airway......Page 1560
Technique......Page 1562
Role of the Laryngeal Mask Airway......Page 1564
Protection against Pulmonary Aspiration......Page 1565
Tracheal Intubation......Page 1566
Nasotracheal Intubation......Page 1567
Macintosh Laryngoscope and Technique of Orotracheal Intubation......Page 1568
Tracheal Tube Passage with Successful Macintosh Laryngoscopy......Page 1569
Blind Endotracheal Intubation with the Macintosh Laryngoscope......Page 1570
Straight Laryngoscope......Page 1571
Flexible Fiberoptic Laryngoscope......Page 1572
Technique......Page 1573
Contraindications and Complications......Page 1575
Optical Stylets......Page 1576
Tracheal Intubation through the Laryngeal Mask Airway......Page 1577
C-Trach......Page 1578
Lighted Stylet (Light-Guided Intubation)......Page 1579
Physiologic Response to Tracheal Intubation......Page 1580
Care During Surgery......Page 1581
Position......Page 1582
Airway Exchange Catheters......Page 1583
Seldinger Cricothyrotomy......Page 1584
Follow-up After Difficulty with Airway Management......Page 1585
Risk of Pulmonary Aspiration......Page 1586
“Cannot Intubate, Cannot Ventilate” Situation......Page 1587
Summary......Page 1588
References......Page 1589
Spinal, Epidural, and Caudal Anesthesia*......Page 1592
Indications and Contraindications......Page 1593
Anatomy......Page 1594
Cardiovascular Effects......Page 1597
Technique......Page 1599
Position......Page 1600
Projection and Puncture......Page 1601
Useful Drugs......Page 1604
Hypobaric and Isobaric Spinal Anesthesia......Page 1605
Factors Affecting Block Height......Page 1606
Complications......Page 1607
Clinical Pearls......Page 1608
Position......Page 1609
Projection and Puncture......Page 1610
Caudal Technique......Page 1611
Useful Drugs......Page 1612
Intravascular Injection......Page 1613
Neurologic Injury......Page 1614
Clinical Controversies and Neuraxial Blocks......Page 1615
References......Page 1616
Techniques for Localizing Neural Structures......Page 1620
Technique......Page 1621
Side Effects and Complications......Page 1623
Technique......Page 1624
Side Effects and Complications......Page 1625
Method of Needle Localization......Page 1626
Side Effects and Complications......Page 1627
Technique at the Wrist......Page 1628
Intravenous Regional Blocks......Page 1629
Psoas Compartment Block (Posterior Approach to the Lumbar Plexus)......Page 1630
Side Effects and Complications......Page 1631
Femoral Block......Page 1633
Lateral Femoral Cutaneous Nerve Block......Page 1634
Technique......Page 1636
Classic (Posterior) Approach of Labat......Page 1637
Anterior Approach......Page 1638
Techniques to Improve Success Rates......Page 1639
Nerve Blocks at the Ankle......Page 1640
Deep Peroneal, Superficial Peroneal, and Saphenous Nerves......Page 1641
Blocks of the Head and Neck......Page 1642
Mental Nerve......Page 1643
Deep Cervical Plexus......Page 1645
Translaryngeal Block......Page 1646
Clinical Applications......Page 1647
Intercostal Nerve Block and Interpleural Catheter Placement......Page 1648
Intercostal Block......Page 1649
Thoracic Paravertebral Block......Page 1650
Continuous Catheter Techniques......Page 1651
Neurologic Complications......Page 1652
References......Page 1653
Principles of Ultrasound Imaging......Page 1656
The Doppler Shift......Page 1657
Ultrasound Transducers and Manipulation......Page 1659
Nerve Imaging with Ultrasound......Page 1660
Block Needles for Ultrasound-Guided Procedures......Page 1661
Anatomic Variation......Page 1665
Passthrough Brachial Plexus......Page 1666
Cervical Ribs......Page 1667
Infraclavicular Block......Page 1668
Axillary Block......Page 1670
Musculocutaneous–Median Nerve Fusion (Low-Lying Lateral Cord in the Axillary Region)......Page 1671
Ilioinguinal Block......Page 1672
Femoral Block......Page 1673
Phantom Training and Safety......Page 1679
References......Page 1684
Water Physiology......Page 1686
Sodium Physiology......Page 1687
Hyponatremia......Page 1688
Hypernatremia......Page 1689
Potassium Physiology......Page 1690
Hyperkalemia......Page 1691
Calcium Physiology......Page 1692
Magnesium Physiology......Page 1693
Hypermagnesemia......Page 1694
Phosphate Physiology......Page 1695
Hypophosphatemia......Page 1696
Pathology......Page 1697
Management and Evaluation of Diabetes Mellitus......Page 1698
Anesthetic Considerations......Page 1699
Hypoglycemia......Page 1701
Metabolic Acidosis from Low Cardiac Output......Page 1702
Acute Hyperventilation and Hypotension......Page 1703
Shock......Page 1704
Hypertonic Salt Solutions......Page 1706
Colloid Solutions and Blood Substitutes......Page 1707
Perfluorochemical Emulsions and Hemoglobin-Based Oxygen Carriers......Page 1708
Compensatory Intravascular Volume Expansion......Page 1709
Redistribution......Page 1710
Postoperative Patient with Bowel Obstruction......Page 1711
Patient with Liver Failure......Page 1712
Patient with Anuric Renal Failure Undergoing Nontransplantation Surgery......Page 1713
Acutely Burned Patient......Page 1714
Intravascular Volume Resuscitation of Patient in Hemorrhagic Shock......Page 1715
References......Page 1716
Allogeneic (Homologous) Blood......Page 1719
Autologous Blood......Page 1721
Crossmatching......Page 1722
Maximal Surgical Blood Order Schedule......Page 1723
Specific Recommended Protocol......Page 1724
Changes in Oxygen Transport......Page 1725
Dilutional Thrombocytopenia......Page 1726
Disseminated Intravascular Coagulation-like Syndrome (DIC)......Page 1728
Diagnosis and Treatment of a Hemorrhagic Diathesis after Whole Blood Transfusions......Page 1729
Citrate Intoxication and Hyperkalemia......Page 1730
Temperature......Page 1731
Hemolytic Transfusion Reaction......Page 1732
Treatment......Page 1733
Nonhemolytic Transfusion Reactions......Page 1734
Hepatitis C......Page 1735
Cytomegalovirus......Page 1736
Transfusion-Related Immunomodulation......Page 1737
Platelet Concentrates......Page 1738
Fresh Frozen Plasma......Page 1740
Single-Donor Plasma......Page 1741
Synthetic Hydroxyethyl Starch......Page 1742
Other Than Human Red Blood Cells (Blood)......Page 1743
References......Page 1744
Vascular Endothelial Role in Hemostasis......Page 1747
Extrinsic Pathway of Coagulation......Page 1748
Common Pathway of Coagulation......Page 1749
Evaluation of Bleeding Disorders......Page 1750
Acquired Bleeding Disorders......Page 1751
Common Inherited Thrombotic Disorders......Page 1753
Heparin-Induced Thrombocytopenia......Page 1754
Platelet Count and Bleeding Time......Page 1755
Heparin Concentration Measurement......Page 1756
Platelet Function Monitors......Page 1757
References......Page 1758
Autologous Transfusion, Recombinant Factor VIIa, and Bloodless Medicine......Page 1760
Patient Selection......Page 1761
Preoperative Collection of Components......Page 1762
Conserved Red Blood Cell Mass......Page 1763
Clinical Studies......Page 1764
Intraoperative Blood Collection......Page 1765
Clinical Studies......Page 1766
Complex Surgery and Traumas Resulting in Profuse Bleeding......Page 1767
Patients with Hemorrhagic Stroke......Page 1768
Bloodless Medicine......Page 1769
Summary......Page 1770
References......Page 1771
Excitatory Mechanisms......Page 1773
Inhibitory Mechanisms......Page 1774
Definitions......Page 1775
Interdisciplinary Management of Chronic Pain......Page 1776
Occupational Therapy......Page 1777
Opioids......Page 1778
Antiepileptic Drugs......Page 1781
Topical Analgesics......Page 1782
Development of Novel Analgesics......Page 1783
Cancer Pain......Page 1784
Cancer Pain......Page 1785
Characteristics of Chronic Pain Patients in the Perioperative Period......Page 1786
Chronic Use of Analgesics and Adjuvant Drugs......Page 1787
Perioperative Management......Page 1788
Acknowledgment......Page 1789
References......Page 1790
Anesthesia for Thoracic Surgery......Page 1795
Respiratory Mechanics......Page 1796
Ventilation-Perfusion Scintigraphy......Page 1797
Ischemia......Page 1798
Chronic Obstructive Pulmonary Disease......Page 1799
Nocturnal Hypoxemia......Page 1800
Flow Limitation......Page 1801
Smoking......Page 1802
Small Cell Lung Cancer......Page 1803
Assessment of the Patient with Lung Cancer......Page 1804
Difficult Endobronchial Intubation......Page 1805
Assessment for Repeat Thoracic Surgery......Page 1806
Capnometry......Page 1807
Transesophageal Echocardiography......Page 1808
Size Selection......Page 1809
Methods of Insertion......Page 1811
Right-Sided Double-Lumen Endobronchial Tubes......Page 1812
Positioning of Double-Lumen Tubes......Page 1813
Bronchial Blockers......Page 1814
The Wire-Guided Endobronchial Blocker (Arndt Blocker)......Page 1815
Difficult Airways and One-Lung Ventilation......Page 1816
Position Change......Page 1817
Neurovascular Complications......Page 1819
Anesthetic Management......Page 1820
Temperature......Page 1821
Hypoxemia......Page 1822
Hypoxic Pulmonary Vasoconstriction......Page 1823
Cardiac Output......Page 1824
Tidal Volume......Page 1825
Preoperative Spirometry......Page 1826
Treatment of Hypoxemia......Page 1827
Partial Ventilation Methods......Page 1828
Rigid Bronchoscopy......Page 1829
Mediastinoscopy......Page 1831
Video-assisted Thoracoscopic Surgery......Page 1833
Pneumonectomy......Page 1834
Limited Pulmonary Resections: Segmentectomy and Wedge Resection......Page 1836
Transthoracic Approach......Page 1837
Benign Esophageal Stricture......Page 1838
Zenker’s Diverticulum......Page 1839
Tracheal Resection......Page 1840
Bronchiectasis/Lung Abscess/Empyema......Page 1841
Bronchopleural Fistula......Page 1842
Bullae......Page 1843
Pneumatoceles......Page 1844
Lung Transplantation......Page 1845
Pulmonary Hemorrhage......Page 1846
Post-tracheostomy Hemorrhage......Page 1847
Pulmonary Thromboendarterectomy......Page 1848
Bronchopulmonary Lavage......Page 1849
Mediastinal Masses......Page 1850
Thymectomy for Myasthenia Gravis......Page 1852
Postoperative Analgesia (See Chapter 87)......Page 1853
Other Techniques......Page 1854
Epidural Analgesia......Page 1855
Paravertebral Block......Page 1856
Shoulder Pain......Page 1857
References......Page 1858
The “Graying” of America......Page 1864
Genetic Influences on Cardiac Disease......Page 1865
Pulmonary Artery Catheterization......Page 1866
CNS Monitoring......Page 1867
Transcranial Doppler......Page 1869
Glucose Control......Page 1870
Hormone Replacement Therapy......Page 1871
Monitoring of Anticoagulation......Page 1873
Heparin-Induced Thrombocytopenia......Page 1874
Protamine Reactions......Page 1877
Hypercoagulable States......Page 1878
Premedication......Page 1879
The Pre–Cardiopulmonary Bypass Period......Page 1880
Onset of Cardiopulmonary Bypass......Page 1881
Preparations for Weaning from Cardiopulmonary Bypass: The “CVP” Mnemonic......Page 1882
Awareness......Page 1883
Bleeding and Coagulopathy......Page 1884
Metabolic Disturbances......Page 1885
Venous Reservoirs......Page 1886
Heat Exchanger......Page 1887
Anticoagulation......Page 1888
Cannulation......Page 1889
Initiation and Maintenance of CPB......Page 1890
Myocardial Protection......Page 1891
Temperature......Page 1892
The α-Stat Hypothesis......Page 1893
Inflammatory Response to Cardiopulmonary Bypass......Page 1894
Deep Hypothermic Circulatory Arrest......Page 1895
Left Heart Bypass......Page 1896
Cardiopulmonary Support and Extracorporeal Membrane Oxygenation Circuits......Page 1897
Coronary Anatomy......Page 1898
Surgical Considerations......Page 1899
Surgical Considerations......Page 1900
Surgical Considerations......Page 1901
Pathophysiology......Page 1902
Mitral Regurgitation......Page 1904
Anesthetic Management......Page 1905
Hypertrophic Obstructive Cardiomyopathy and the Mitral Valve......Page 1906
Pathophysiology......Page 1907
Acute Aortic Regurgitation......Page 1908
Tricuspid Regurgitation......Page 1909
Minimally Invasive Aortic Valve Surgery......Page 1910
Heart Failure......Page 1911
Heart Transplantation......Page 1912
Ventricular Assist Devices......Page 1914
Passive Ventricular Reshaping......Page 1918
Preoperative Anesthetic Considerations......Page 1919
Principle 1: The Presence or Absence of Cyanosis......Page 1920
Principle 2: The Presence or Absence of Intracardiac or Extracardiac Shunts......Page 1921
Cox-Maze Procedure......Page 1922
Pericardial Tamponade......Page 1923
Echocardiographic Features of Pericardial Tamponade......Page 1924
Anesthetic Management of Pericardial Tamponade......Page 1925
Traumatic Aortic Injury......Page 1926
Ischemic Emergencies......Page 1927
Radiocontrast Media......Page 1928
Biventricular Pacing......Page 1929
Low Cardiac Output Syndrome......Page 1930
Hypertension......Page 1931
Renal Insufficiency......Page 1932
Postoperative Management of Central Nervous System Injury or Dysfunction......Page 1933
Respiratory Insufficiency......Page 1934
Correcting Existing Coagulopathies......Page 1935
Pharmacologic Attenuation of Bleeding......Page 1936
Pain......Page 1937
References......Page 1939
Historical Perspectives......Page 1951
Cardiac Arrhythmias......Page 1952
Permanent Pacing......Page 1953
Preoperative Evaluation......Page 1954
Monitored Anesthesia Care......Page 1955
Anesthetic Considerations......Page 1956
References......Page 1957
Anesthesia for Vascular Surgery......Page 1959
Atherosclerosis......Page 1960
Perioperative and Long-Term Cardiac Outcomes......Page 1961
Guideline-Based Approach......Page 1962
Previous Coronary Artery Bypass Surgery......Page 1963
Cardiac Catheterization and Prophylactic Revascularization......Page 1964
Assessment of Renal Function......Page 1966
Monitoring for Myocardial Ischemia......Page 1967
Hemodynamic Monitoring......Page 1968
Abdominal Aortic Aneurysm......Page 1969
Hemodynamic and Metabolic Changes......Page 1970
Renal Function and Protection......Page 1974
Aortic Unclamping......Page 1975
Intraoperative Monitoring......Page 1976
Autologous Blood Procurement......Page 1977
Anesthetic Drugs and Techniques......Page 1978
Etiology and Classification......Page 1980
Preoperative Preparation and Monitoring......Page 1982
Simple Aortic Cross-Clamping......Page 1983
Left Heart Bypass......Page 1984
Spinal Cord Ischemia and Protection......Page 1985
Renal Ischemia and Protection......Page 1987
Coagulation and Metabolic Management......Page 1988
Endovascular Technique......Page 1989
Anesthetic Management......Page 1990
Morbidity and Mortality......Page 1991
EVAR-2 Trial......Page 1992
Acute Arterial Occlusion......Page 1993
Chronic Arterial Occlusion......Page 1994
Regional versus General Anesthesia......Page 1995
Anesthetic Management......Page 1999
Carotid Endarterectomy......Page 2000
Perioperative Morbidity and Mortality......Page 2001
Anesthetic Management......Page 2002
Regional and Local Anesthesia......Page 2003
Carbon Dioxide and Glucose Management......Page 2004
Somatosensory Evoked Potentials......Page 2005
Postoperative Considerations......Page 2006
Postoperative Management of Vascular Surgery Patients......Page 2007
References......Page 2008
Recurrent Issues in Neuroanesthesia......Page 2019
Control of Intracranial Pressure and Brain Relaxation......Page 2020
Selection of Anesthetics......Page 2022
Normal Brain.......Page 2023
Management of Arterial Blood Pressure......Page 2024
Diuretics......Page 2025
Prone......Page 2026
Achieving the Sitting Position.......Page 2027
Pneumocephalus......Page 2028
Venous Air Embolism......Page 2029
Which Vein Should Be Used for Right Heart Access.......Page 2030
Paradoxical Air Embolism......Page 2031
Nitrous Oxide.......Page 2032
Intravenous Fluid Management......Page 2033
Hypothermia......Page 2034
Emergence from Anesthesia......Page 2035
Aneurysms and Arteriovenous Malformations......Page 2036
Vasospasm.......Page 2037
Anesthetic Selection.......Page 2038
Lumbar Cerebrospinal Fluid Drainage.......Page 2039
Neurophysiologic Monitoring......Page 2040
Anesthetic Technique......Page 2041
Cervical Spine......Page 2042
Monitoring.......Page 2043
Blood Pressure Management.......Page 2044
Brain Tissue Po2 Monitoring......Page 2045
Brainstem Stimulation......Page 2046
Monitoring......Page 2047
Anesthetic Technique......Page 2048
Anesthetic Technique......Page 2049
Stereotactic Procedures......Page 2050
Tumors and Arteriovenous Malformations.......Page 2051
Cerebrospinal Fluid Shunting Procedures......Page 2052
Acknowledgment......Page 2053
References......Page 2055
Obesity As a Disease......Page 2062
Metabolic Syndrome......Page 2063
Obstructive Sleep Apnea/Hypopnea Syndrome......Page 2065
Behavioral Modification and Interventions......Page 2066
Surgical Management of Obesity......Page 2067
Malabsorptive Procedures......Page 2068
Preoperative Evaluation......Page 2069
Airway Management (also see Chapter 50)......Page 2070
Anesthetic Drugs and Dosing......Page 2072
Postoperative Management......Page 2073
Management of Complications......Page 2074
References......Page 2075
Anesthesia and the Renal and Genitourinary Systems......Page 2078
Kidney and Abdominal Ureter......Page 2079
Penis and Scrotum......Page 2080
Glomerular Filtration Rate......Page 2081
Creatinine and Creatinine Clearance......Page 2082
Protein......Page 2083
Acidemia......Page 2084
Effects of Drugs in Patients with Reduced Renal Function......Page 2085
Inhaled Anesthetics......Page 2086
Muscle Relaxants and Their Antagonists......Page 2087
Acute Renal Failure......Page 2089
Hemodialysis......Page 2090
Preservation of Renal Function......Page 2091
Anesthetic Techniques......Page 2092
Morbidity and Mortality after Transurethral Resection of the Prostate......Page 2093
Glycine Toxicity......Page 2094
Treatment of Transurethral Resection of the Prostate Syndrome......Page 2095
Laparoscopic Surgery in Urology......Page 2096
Biomechanical Effects of Shock Wave Therapy......Page 2097
Anesthetic Choices for Lithotripsy......Page 2098
Radical Nephrectomy for Renal Cell Carcinoma......Page 2099
Comparison of Anesthetic Techniques for Radical Prostatectomy......Page 2100
Inflammatory Renal Diseases......Page 2101
Prostatic Pain......Page 2102
General Considerations......Page 2103
References......Page 2104
Effect of Anesthetics on Hepatic Function......Page 2108
Volatile Anesthetics......Page 2109
Effect of Hepatic Dysfunction and Hepatobiliary Disease on Anesthetic Drug Pharmacokinetics......Page 2111
Neuromuscular Blocking Drugs......Page 2112
Asymptomatic Preoperative Liver Enzyme Test Abnormalities......Page 2113
Acute Hepatitis......Page 2114
Steatosis and Steatohepatitis......Page 2115
Cirrhosis as a Perioperative Risk Factor......Page 2116
Surgical Procedures That Increase the Risk of Postoperative Liver Failure......Page 2117
Postoperative Jaundice......Page 2118
Perioperative Management of Patients with Asymptomatic or Chronic Liver Dysfunction......Page 2120
Transjugular Intrahepatic Portosystemic Shunt Procedure......Page 2121
Acknowledgment......Page 2122
References......Page 2123
Anesthesia for Abdominal  Organ Transplantation......Page 2127
Intraoperative Management......Page 2128
Donation after Cardiac Death......Page 2129
Care of Living Organ Donors......Page 2130
Living Liver Donor......Page 2131
Pathophysiology of End-Stage Renal Disease......Page 2133
Preoperative Considerations......Page 2134
Intraoperative Management......Page 2136
Postoperative Care......Page 2137
Pathophysiology of Pancreatic Insufficiency......Page 2138
Preoperative Considerations......Page 2139
Anesthesia for Patients after Pancreas Transplantation......Page 2140
Organ Matching and Allocation......Page 2141
Pathophysiology of End-Stage Liver Disease......Page 2142
Preoperative Considerations......Page 2143
Intraoperative Management......Page 2144
Anesthesia for Patients after Liver Transplantation......Page 2148
Immunosuppression......Page 2149
References......Page 2151
Anesthesia for Laparoscopic Surgery......Page 2157
Increase in the Partial Pressure of Arterial Carbon Dioxide......Page 2158
Pneumothorax, Pneumomediastinum, Pneumopericardium......Page 2159
Gas Embolism......Page 2160
Hemodynamic Repercussions of Pneumoperitoneum in Healthy Patients......Page 2161
Cardiac Arrhythmias During Laparoscopy......Page 2163
Stress Response......Page 2164
Laparoscopy During Pregnancy and in Children......Page 2165
Preoperative Evaluation of the Patient and Premedication......Page 2166
General Anesthesia......Page 2167
Summary......Page 2168
References......Page 2169
Anesthesia for Obstetrics......Page 2175
Cardiovascular System......Page 2176
Hematologic System......Page 2177
Renal System......Page 2178
Uterine Blood Flow......Page 2179
Evaluation of the Fetus......Page 2181
Normal Progress of Labor......Page 2182
Transcutaneous Electrical Nerve Stimulation......Page 2183
Fentanyl......Page 2184
Remifentanil......Page 2185
Inhaled Analgesia......Page 2186
Epidural Test Dose......Page 2187
Combined Spinal-Epidural Analgesia......Page 2188
Paracervical and Pudendal Blocks......Page 2189
2-Chloroprocaine......Page 2190
Spinal Anesthesia......Page 2191
Combined Spinal-Epidural Technique......Page 2192
Failed Endotracheal Intubation......Page 2193
Hypotension......Page 2194
Post–Dural Puncture Headache......Page 2196
Spinal and Epidural Hematoma......Page 2197
Clinical Features......Page 2198
HELLP Syndrome......Page 2199
Anesthetic Considerations......Page 2200
Placental Abruption......Page 2202
Placenta Accreta......Page 2203
Postpartum Hemorrhage......Page 2204
Anesthesia for Nonobstetric Surgery During Pregnancy......Page 2205
Trauma (also see Chapter 72)......Page 2206
Fetal Surgery......Page 2207
References......Page 2208
Geriatric Orthopedic Patients......Page 2213
Neurologic Complications.......Page 2214
Fat Embolism Syndrome......Page 2215
Osteoarthritis......Page 2216
Rheumatoid Arthritis......Page 2217
Achondroplasia......Page 2218
Osteogenesis Imperfecta......Page 2219
Thromboprophylaxis in Orthopedic Surgery......Page 2220
Arthroscopy......Page 2221
Pelvic Fractures......Page 2222
Hip and Knee Arthroplasties......Page 2223
Foot and Ankle Surgeries......Page 2224
Upper Extremity Surgeries......Page 2225
Spinal Surgeries......Page 2226
References......Page 2229
Core Concepts in the Anesthetic Management of Elderly Patients......Page 2232
Nervous System......Page 2233
Respiratory System......Page 2234
Consent, Surrogate Decision Makers, and Advance Directives......Page 2235
Functional Status and Assessment of Functional Reserve......Page 2236
Delirium......Page 2237
Chronic Pain......Page 2239
Preoperative Evaluation......Page 2240
Intravenous Anesthetics and Benzodiazepines......Page 2241
Regional versus General Anesthesia......Page 2242
Postoperative Cognitive Dysfunction......Page 2243
References......Page 2244
Anesthesia for Trauma......Page 2248
Prioritizing Trauma Care......Page 2250
Anesthesia in War and Austere Conditions......Page 2252
Emergency Airway Management......Page 2253
Prophylaxis Against Aspiration of Gastric Contents......Page 2254
Anesthetics and Induction of Anesthesia......Page 2255
Adjuncts to Endotracheal Intubation......Page 2256
Pathophysiology of Hemorrhagic Shock......Page 2257
Early Resuscitation......Page 2259
Resuscitation Fluids......Page 2261
Resuscitation Equipment......Page 2263
Late Resuscitation......Page 2264
Trauma to the Central Nervous System......Page 2266
Spinal Cord Injury......Page 2270
Specific Conditions......Page 2271
Soft Tissue Trauma......Page 2273
Chest Injuries—Pulmonary......Page 2274
Chest Injuries—Cardiac Injury......Page 2275
Trauma and Pregnancy......Page 2276
Acute Pain Management......Page 2277
References......Page 2278
Anesthesia and Prehospital Emergency and Trauma Care......Page 2283
Basic Life Support......Page 2284
Helicopter EMS......Page 2285
Vital Signs......Page 2286
Prehospital Blood Tests......Page 2287
Sedation, Anesthesia, and Pain Control in the Prehospital Setting......Page 2288
Prehospital Trauma Care......Page 2289
Patient Evaluation on the Scene and Initial Management......Page 2290
Bronchospasm: COPD and Asthma......Page 2291
Acute Coronary Syndrome......Page 2292
Pulmonary Embolism......Page 2293
Altered Level of Consciousness......Page 2294
Prehospital Management......Page 2295
Patient Evaluation......Page 2296
Prehospital Mass Casualty Incident Management and Disaster Medicine......Page 2297
The Optimal Level of Prehospital Care: BLS Versus ALS or “Scoop-and-Run” Versus “Stay-and-Play”......Page 2298
References......Page 2299
Chemical and Biological Warfare Agents: The Role of the Anesthesiologist......Page 2303
Classic Definitions of Chemical and Biological Agents......Page 2304
NBC Classification......Page 2305
Iran-Iraq War......Page 2306
Biological Warfare Agent Release......Page 2307
Actions of Nerve Agents......Page 2308
Clinical Experience with Intoxications from Organophosphates.......Page 2309
Atropine.......Page 2310
Pyridostigmine Pretreatment.......Page 2311
Cellular Action of Mustard Agent......Page 2312
Lung-Damaging Agents......Page 2313
Use of Steroids.......Page 2314
Treatment......Page 2315
Ricin......Page 2316
General Considerations......Page 2318
Pathogenesis.......Page 2319
Management of the Incident......Page 2321
Early Patient Management after Chemical and Biological Warfare Release......Page 2322
Management of Mixed Toxic and Physical Injury......Page 2323
References......Page 2324
Airway Safety and Maintenance......Page 2327
Vocal Cord Palsy......Page 2328
Laryngospasm......Page 2329
Airway Trauma......Page 2330
General Anesthesia......Page 2334
Nitrous Oxide......Page 2335
Types of Nasal Surgery......Page 2336
Nasal Vasoconstrictors......Page 2337
Postoperative Considerations......Page 2338
Nonsteroidal Anti-inflammatory Drugs......Page 2339
Bleeding Tonsil......Page 2340
Anesthetic Techniques for Endoscopy......Page 2341
Open System......Page 2342
Jet Ventilation Techniques......Page 2343
Inhaled Foreign Bodies......Page 2344
General Considerations......Page 2345
Abscess and Ludwig’s Angina......Page 2346
Glottic Lesions......Page 2347
Ocular Anatomy......Page 2348
Ophthalmologic Drugs......Page 2349
Laboratory Studies......Page 2350
Anticoagulation......Page 2351
Sub-Tenon’s Block......Page 2352
Tarsorrhaphy......Page 2353
Pterygium Excision.......Page 2354
Anesthesia-Related Eye Injuries......Page 2355
References......Page 2356
History......Page 2359
Robotic Systems......Page 2360
Anesthetic Considerations......Page 2364
Mitral Valve Surgery and Anesthetic Implications......Page 2365
Internal Mammary Artery Harvest......Page 2366
Atrial Fibrillation Surgery......Page 2367
Neurosurgery......Page 2369
Gynecologic Surgery......Page 2370
Summary......Page 2371
References......Page 2372
Physics of Laser Light......Page 2374
Laser System Hardware......Page 2377
Clinical Applications......Page 2378
Risks of Laser Use: Standards and Regulations......Page 2379
Embolism......Page 2380
Relative Flammability: Effect of Tube Composition......Page 2381
Protection of the Endotracheal Tube......Page 2382
Jet Ventilation......Page 2384
Summary......Page 2385
References......Page 2386
Ambulatory (Outpatient) Anesthesia......Page 2388
Facility Design and Safety......Page 2389
Selection of Procedures......Page 2390
Patient Characteristics......Page 2391
Preoperative Evaluation......Page 2392
Pharmacologic Preparation......Page 2393
Benzodiazepines......Page 2394
Prevention of Nausea and Vomiting......Page 2395
Neurokinin-1 Antagonists......Page 2396
Basic Anesthetic Techniques......Page 2397
General Anesthesia......Page 2398
Benzodiazepines......Page 2399
Inhaled Anesthetics......Page 2400
Opioid Analgesics......Page 2402
Antagonist (Reversal) Drugs......Page 2403
Spinal and Epidural Anesthetic Techniques......Page 2404
Peripheral Nerve Blocks......Page 2405
Monitored Anesthesia Care......Page 2406
Cerebral Monitoring......Page 2408
Optimal Anesthetic Techniques......Page 2409
Multimodal Approaches to Minimizing Side Effects......Page 2410
Office-Based Anesthesia......Page 2412
Anesthesia for Procedures outside the Operating Room......Page 2413
Electroconvulsive Therapy......Page 2414
Discharge after Regional Anesthesia......Page 2415
Outcome Measures......Page 2416
Future Perspectives......Page 2418
References......Page 2419
Monitoring......Page 2429
Personnel and Staffing......Page 2430
General Considerations......Page 2431
Anesthesia in the Radiology Suite......Page 2432
Computed Tomography......Page 2433
Principles of MRI......Page 2434
Limitations and Hazards of MRI......Page 2435
Anesthetic Management for MRI......Page 2436
Anesthesia for Interventional Neuroradiology......Page 2437
Anesthetic Management......Page 2438
Coronary Angiography and Percutaneous Coronary Intervention......Page 2439
Cardiac Catheterization......Page 2441
Pediatric Cardiac Catheterization......Page 2442
Interventions During Cardiac Catheterization......Page 2443
Elective Cardioversion......Page 2444
Anesthetic Management of Electroconvulsive Therapy......Page 2445
External Beam Radiotherapy for Cancer in Children......Page 2447
References......Page 2449
Clinical Care in Extreme Environments: At High and Low Pressure and in Space......Page 2453
Increased Barometric Pressure......Page 2454
Increased Inert Gas Partial Pressure......Page 2456
Carbon Monoxide Poisoning......Page 2458
Gas Embolism and Decompression Sickness......Page 2459
Maintenance of Oxygen Transport in Severe Anemia......Page 2460
Therapeutic Systems......Page 2461
Hyperbaric Treatment Schedules......Page 2462
Oxygen Toxicity......Page 2463
Patient Monitoring......Page 2465
Blood Gas Assessment and Ventilator Management......Page 2466
Fire Hazards......Page 2467
Nitrous Oxide......Page 2468
Regional Anesthesia......Page 2469
Physiologic Changes......Page 2470
Infants Born at Altitude......Page 2471
High-Altitude Pulmonary Edema......Page 2472
General Principles......Page 2473
General Anesthesia......Page 2474
Prediction of Oxygenation during Commercial Flight......Page 2475
Physiologic and Medical Issues During Space Flight......Page 2476
Summary......Page 2477
References......Page 2478
Development of Flexures of the Spine......Page 2484
Local Fixation......Page 2486
Absorption from the Epidural Space.......Page 2487
Distribution Volume.......Page 2488
Opioids......Page 2489
Psychological Factors......Page 2490
Nonanalgesic Indications......Page 2491
Absolute Contraindications to Peripheral Nerve Block Procedures......Page 2492
Epidemiology......Page 2493
Equipment and Techniques Used to Identify Anatomic Spaces and Nerve Trunks......Page 2494
Sedation and General Anesthesia......Page 2495
Postoperative Monitoring in the Recovery Room......Page 2496
Anatomy of the Sacral Hiatus......Page 2497
Technique......Page 2498
Lumbar Epidural Anesthesia......Page 2499
Sacral Epidural Anesthesia......Page 2500
Adverse Effects and Complications......Page 2501
Axillary Blocks......Page 2502
Thoracic Infraclavicular Blocks......Page 2503
Posterior Approach......Page 2504
Transthecal Blocks......Page 2505
Complications......Page 2506
Femoral Nerve Block......Page 2507
Saphenous Nerve Block......Page 2508
Proximal Sciatic Nerve Blocks......Page 2509
Lateral Approach......Page 2510
Thoracic Paravertebral Space Block......Page 2511
Block of the Ilioinguinal, Iliohypogastric, and External Spermatic Nerves......Page 2512
Pudendal Nerve Block......Page 2513
Other Blocks of Nerves of the Trunk......Page 2514
Block of the Infraorbital Nerve......Page 2515
Surface Anesthesia......Page 2516
References......Page 2517
Pediatric Anesthesia......Page 2523
The Cardiovascular System......Page 2524
The Pulmonary System......Page 2525
The Liver......Page 2527
Developmental Pharmacology......Page 2528
Sevoflurane......Page 2529
Isoflurane......Page 2531
Thiopental......Page 2532
Dexmedetomidine......Page 2533
Remifentanil......Page 2534
Nondepolarizing Muscle Relaxants......Page 2536
Preoperative Preparation......Page 2537
Fasting......Page 2538
The Child with an Upper Respiratory Tract Infection......Page 2539
Parents in the Operating Room......Page 2540
Endotracheal Tubes......Page 2541
The Child with a Full Stomach......Page 2542
The Difficult Airway......Page 2543
The Child with Stridor......Page 2545
Intravenous Fluids......Page 2546
Packed Red Blood Cells......Page 2547
Blood Warmers......Page 2548
Routine Monitoring and Safety Issues......Page 2549
Invasive Monitoring......Page 2550
Anesthesia Circuits......Page 2551
Apoptosis......Page 2552
Omphalocele and Gastroschisis......Page 2553
Diaphragmatic Hernia......Page 2554
The Former Preterm Infant......Page 2555
Children with Repaired Heart Disease......Page 2556
Regional Anesthesia and Analgesia......Page 2557
References......Page 2558
Anesthesia for Pediatric Cardiac Surgery......Page 2562
Unique Features of Pediatric Cardiac Anesthesia......Page 2563
Physiologic Considerations and Maturational Features of the Pediatric Patient......Page 2564
Physiologic Approach to Congenital Heart Disease......Page 2566
Shunt Lesions......Page 2567
Regurgitant Valves......Page 2568
Chronic Consequences of Congenital Heart Disease......Page 2569
Surgical Procedures and Special Techniques......Page 2570
Concurrent Medications and Drug Interactions......Page 2573
Physiologic Monitoring......Page 2575
Intraoperative Echocardiography......Page 2576
Specialized Central Nervous System Monitoring......Page 2577
Induction and Maintenance of Anesthesia......Page 2578
Priming Volume......Page 2581
Temperature......Page 2582
Blood Gas Management......Page 2583
Initiation of Cardiopulmonary Bypass......Page 2584
Regional Cerebral Perfusion......Page 2585
Renal Effects......Page 2586
Discontinuation of Cardiopulmonary Bypass......Page 2587
Ultrafiltration......Page 2588
Left Ventricular Dysfunction......Page 2590
Right Ventricular Dysfunction......Page 2591
Pulmonary Artery Hypertension......Page 2592
Anticoagulation, Hemostasis, and Blood Conservation......Page 2593
Postoperative Management......Page 2595
Mechanical Assist Devices......Page 2596
Anesthesia for Heart and Lung Transplantation......Page 2598
Anesthesia for Closed-Heart Operations......Page 2600
Anesthesia for Interventional or Diagnostic Cardiac Procedures......Page 2601
Angioplasty of Branch Pulmonary Artery Stenosis......Page 2603
Coil Embolization......Page 2604
Cardiac Event Monitoring......Page 2605
Implantation of Pacemakers and Defibrillators......Page 2606
Magnetic Resonance Imaging of the Heart......Page 2607
Offsite Anesthesia in Cardiac Surgery Patients......Page 2608
References......Page 2609
Organization of the Pediatric Intensive Care Unit......Page 2616
Development of Autonomic Control of the Circulation......Page 2617
Congenital Heart Disease......Page 2618
Acute Circulatory Failure in Children......Page 2619
Dopamine......Page 2620
Bicarbonate Therapy......Page 2621
Hypertension......Page 2622
Kawasaki Disease......Page 2623
Pulmonary Circulation......Page 2624
Resistive Forces......Page 2625
Respiratory Failure......Page 2626
Obstructive Airway Disease......Page 2627
Treatment of Respiratory Failure......Page 2628
Ventilatory Therapy......Page 2629
Status Asthmaticus......Page 2632
Sleep Apnea......Page 2633
Functional Postnatal Neurologic Development......Page 2634
Increased Intracranial Pressure......Page 2635
Sedation......Page 2636
Brain Death......Page 2637
Renal Failure......Page 2638
Hemolytic-Uremic Syndrome......Page 2639
Syndrome of Inappropriate Secretion of Antidiuretic Hormone......Page 2640
Structural and Functional Development of the Intestine......Page 2641
Necrotizing Enterocolitis......Page 2642
Nutritional Support in Critically Ill Children......Page 2643
Peripheral versus Central Alimentation: Energy Considerations......Page 2644
Congenital Disorders......Page 2645
Complications of Transfusion Therapy......Page 2646
Respiratory Distress and Mediastinal Mass......Page 2647
The Older Child: Sepsis and Septic Shock......Page 2648
Human Immunodeficiency Virus......Page 2650
Child Abuse......Page 2651
Sudden Infant Death Syndrome......Page 2652
Gastrointestinal System......Page 2653
Respiratory Effort......Page 2654
Pulmonary Resuscitation......Page 2655
Administration of Surfactant......Page 2656
Detection of Hypovolemia......Page 2657
Resuscitation Drugs......Page 2658
Resuscitation of Children......Page 2659
References......Page 2661
The Postanesthesia Care Unit......Page 2667
Early Postoperative Physiologic Changes......Page 2668
Transport to the PACU......Page 2669
Residual Neuromuscular Blockade......Page 2670
Management of Upper Airway Obstruction......Page 2671
Decreased Pao2......Page 2672
Transfusion-Related Lung Injury......Page 2673
Postoperative Nausea and Vomiting......Page 2674
Supplemental Oxygen......Page 2675
Hemodynamic Instability......Page 2676
Hypovolemic (Decreased Preload)......Page 2677
Cardiac Monitoring......Page 2678
Renal Dysfunction......Page 2679
Rhabdomyolysis......Page 2680
Delirium......Page 2681
Emergence Excitement......Page 2682
Postanesthesia Scoring Systems......Page 2683
Infection Control......Page 2684
Outpatient Procedures......Page 2685
References......Page 2686
Postoperative Nausea and Vomiting......Page 2689
Absorbed Toxins and Drugs......Page 2690
Stimulation of the Vestibular System......Page 2691
History of PONV, Motion Sickness, or Migraine......Page 2693
Propofol and Inhaled Anesthetics......Page 2696
Duration of Anesthesia......Page 2697
Risk Assessment......Page 2698
Measurement of Nausea and Vomiting/Retching......Page 2699
Relative Risk Reduction and Risk Ratio......Page 2701
Generalizability of Study Results......Page 2702
Meta-analyses......Page 2703
Dopamine Antagonists......Page 2704
Serotonin Antagonists......Page 2706
Neurokinin-Antagonists......Page 2707
Combinations and Multimodal Therapy......Page 2708
Rescue Treatment......Page 2709
Patients in Whom Significant Preventive Measures Should Be Undertaken......Page 2710
References......Page 2711
Fundamental Considerations......Page 2716
Acute Effects......Page 2717
Preventive Analgesia......Page 2718
Advantages and Characteristics......Page 2719
Intravenous Patient-Controlled Analgesia......Page 2720
Nonsteroidal Anti-inflammatory Agents......Page 2721
Tramadol......Page 2723
Single-Dose Neuraxial Opioids......Page 2724
Continuous Epidural Analgesia......Page 2725
Location of Catheter Insertion......Page 2726
Pruritus.......Page 2727
Patient-Controlled Epidural Analgesia......Page 2728
Risks with Epidural Analgesia......Page 2729
Peripheral Regional Analgesia......Page 2730
Ambulatory Surgical Patients......Page 2731
Elderly Patients......Page 2732
Opioid-Tolerant Patients......Page 2733
Pediatric Patients......Page 2734
Postoperative Pain Services......Page 2735
References......Page 2736
Total Body Water and Fluid Compartments......Page 2741
Composition of Body Fluids and Distribution of Fluid......Page 2742
Sympathetic Nervous System......Page 2743
Pressure Natriuresis......Page 2744
Hypovolemia......Page 2745
Renal Volume or Na+ Loss......Page 2746
Cardiac and Extracardiac Pathology......Page 2747
Assessment of the Fluid Balance......Page 2748
Cardiac Output Measurement......Page 2749
Volumetric Preload Parameters......Page 2750
Transesophageal Echocardiography......Page 2751
Microcirculation and Regional Blood Flow......Page 2752
Arterial Blood Gas Analysis......Page 2753
Maintenance Fluid Therapy......Page 2754
Liberal Intravascular Fluid Therapy......Page 2755
Crystalloids......Page 2756
Hydroxyethyl Starches......Page 2757
Dextrans......Page 2758
Treatment of Hypervolemia......Page 2759
References......Page 2760
Cognitive Dysfunction and Other Long-Term Complications of Surgery and Anesthesia......Page 2762
Analysis......Page 2763
Subjective Cognition and Proxy Ratings of Cognitive Change......Page 2764
Temperature......Page 2765
Pharmacologic Techniques to Protect the Brain in Cardiac Surgery......Page 2766
Incidence and Risk Factors for Postoperative Cognitive Dysfunction after Noncardiac Surgery......Page 2767
Risk Factors for POCD after Noncardiac Surgery......Page 2768
Drugs......Page 2769
Inflammatory Mediators......Page 2771
Genetic Aspects......Page 2772
References......Page 2773
Postoperative Visual Loss......Page 2777
Mechanisms of Retinal Ischemia......Page 2778
Central Retinal Artery Occlusion......Page 2779
Treatment......Page 2781
Mechanism......Page 2782
Patient Characteristics......Page 2783
Retrospective Case Series......Page 2784
Trauma (see also Chapter 72)......Page 2785
Control of Blood Flow......Page 2786
Current Knowledge and Controversies......Page 2787
Prognosis, Treatment, and Prevention......Page 2790
Cortical Blindness......Page 2791
Prognosis, Treatment, and Prevention......Page 2792
Visual Loss after Vitrectomy and Vitreal Gas Bubble Tamponade......Page 2793
References......Page 2794
Role of the Medical Director......Page 2798
Rapid-Response Teams......Page 2799
Structure: Open versus Closed Intensive Care Units......Page 2800
Quality of Evidence......Page 2801
Simplified Acute Physiology Score......Page 2802
Multiple Organ Dysfunction Score......Page 2804
Cortisol Replacement......Page 2805
“Tight” Glycemic Control......Page 2806
Acute Respiratory Failure......Page 2807
Lung Recruitment Maneuvers......Page 2809
Prone Positioning......Page 2810
Inhaled Nitric Oxide......Page 2811
Fluid Management and Monitoring......Page 2812
General Supportive Measures......Page 2813
General Supportive Measures......Page 2814
Subglottic Aspiration of Secretions......Page 2815
Duration......Page 2816
References......Page 2817
Critical Care Protocols......Page 2821
Rationale for Protocol Development......Page 2822
Protocol Design......Page 2823
Glycemic Control......Page 2825
Transfusion......Page 2826
Conclusion......Page 2827
References......Page 2828
Respiratory Care......Page 2830
Total Ventilator-Controlled Ventilatory Support (Controlled Mechanical Ventilation)......Page 2831
Pressure Support Ventilation......Page 2832
Effects on Gas Exchange......Page 2833
PEEP/CPAP Effects on Hemodynamics......Page 2834
High-Frequency Oscillation......Page 2835
Monitoring Controlled Mechanical Ventilation......Page 2836
Role of Chest Wall Mechanics......Page 2838
Ventilatory Requirement/Gas Delivery Asynchrony......Page 2839
Elastic Properties of Nonhomogeneous Lung and Ventilator-Induced Lung Injury......Page 2840
Expiratory Flow Limitation and Intrinsic PEEP (PEEPi)-AUTOPEEP......Page 2841
PEEPi without Flow Limitation......Page 2842
Acute Respiratory Distress Syndrome......Page 2844
Acute Cardiogenic Pulmonary Edema......Page 2845
References......Page 2846
Neurocritical Care......Page 2849
Intracranial Physiology and Cerebral Autoregulation......Page 2850
Fluids and Electrolytes......Page 2852
Fever and Infection......Page 2853
Cerebral Blood Flow......Page 2854
Jugular Bulb Oximetry......Page 2855
Brain Tissue Oxygen Tension (Pbo2)......Page 2856
Radiologic Imaging......Page 2857
Head Injury......Page 2858
Subarachnoid Hemorrhage......Page 2860
Cardiac Dysfunction......Page 2861
Ischemic Stroke......Page 2862
Postoperative Neurosurgical Care......Page 2863
Status Epilepticus......Page 2864
Spinal Cord Injury......Page 2865
Encephalitis......Page 2866
Summary......Page 2867
References......Page 2868
Metabolic Control Systems and the Response to Surgical Stress......Page 2872
Growth Hormone......Page 2873
Sympathoadrenergic System......Page 2874
Glucagon and Insulin......Page 2876
Thyroid Hormones......Page 2877
Endothelial Cells......Page 2878
The Immunologic/Coagulation Connection......Page 2880
Fasting and Malnutrition......Page 2881
Carbohydrate Metabolism......Page 2882
Protein Metabolism......Page 2883
Energy Expenditure......Page 2886
The Metabolic Responses to Sepsis......Page 2887
The Preoperative Stress Response......Page 2888
Neuraxial Anesthesia......Page 2889
Thermoregulation......Page 2890
The Postoperative Period......Page 2891
The Perioperative Period......Page 2892
Indications for Nutritional Support......Page 2893
Parenteral versus Enteral Nutrition......Page 2894
Lipids......Page 2895
Complications......Page 2896
Refeeding......Page 2898
Gastrointestinal System Complications......Page 2899
Renal Dysfunction......Page 2900
Conclusion......Page 2901
References......Page 2902
Epidemiology of Acute Kidney Injury......Page 2906
History of Renal Replacement Therapy......Page 2907
Techniques and Modalities......Page 2908
Dose and Prescriptions for Renal Replacement Therapies......Page 2909
Does Receipt of More Dialysis Improve Patient Outcomes?......Page 2910
Continuous Versus Intermittent CRRT......Page 2911
Sepsis and Multiple Organ Dysfunction Syndrome......Page 2912
Congestive Heart Failure......Page 2913
Nomenclature......Page 2914
Citrate......Page 2915
References......Page 2916
Cardiopulmonary Resuscitation: Basic and Advanced Life Support......Page 2919
Physiologic Considerations......Page 2920
Monitoring Performance of Cardiopulmonary Resuscitation......Page 2922
Airway Control and Ventilation......Page 2924
Automated External Defibrillators and Manual Defibrillation......Page 2925
Advanced Cardiac Life Support......Page 2926
Supraventricular Tachyarrhythmia......Page 2927
Ventricular Bradyarrhythmia......Page 2929
Ventricular Tachyarrhythmia......Page 2930
Pulseless Ventricular Tachycardia or Ventricular Fibrillation......Page 2933
Outcome after In-Hospital Resuscitation......Page 2936
Pediatric Resuscitation (also see Chapters 82, 83, and 84)......Page 2937
Basic Life Support......Page 2938
Supraventricular Tachyarrhythmia......Page 2939
Ventricular Tachyarrhythmia......Page 2941
Management of Cardiac Arrest......Page 2942
Pulseless Ventricular Tachycardia or Ventricular Fibrillation......Page 2943
Educational Initiatives......Page 2944
References......Page 2945
Brain Death......Page 2950
Traditional Concept of Death of an Organism......Page 2951
The Concept of Brain Death......Page 2954
Consciousness and the Electroencephalogram......Page 2955
Regulation of Body Temperature......Page 2956
Hypothalamic-Pituitary Endocrine Functions......Page 2957
Apnea Test......Page 2958
Cerebral Death: Persistent Vegetative State......Page 2959
Considerations Regarding Children......Page 2960
Confirmatory Tests for Brain Death......Page 2961
Evoked Responses......Page 2962
Transcranial Doppler Ultrasonography......Page 2963
References......Page 2964
History......Page 2967
Medical Management in the Operating Room......Page 2968
Scheduling......Page 2970
Turnovers......Page 2972
OR of the Future......Page 2973
The Daily Schedule......Page 2974
Operating Room Utilization......Page 2975
Anesthesia Service Management......Page 2977
Cost Accounting in the Operating Room......Page 2978
Summary......Page 2980
References......Page 2981
Electrical Safety in the Operating Room......Page 2985
Electrical Ground......Page 2987
Isolation of Electric Power from Ground......Page 2988
Capacitive Coupling......Page 2990
Macroshock......Page 2991
Electrosurgery......Page 2992
Unipolar Electrosurgery......Page 2993
Safe Practice......Page 2994
References......Page 2995
Environmental Safety Including Chemical Dependency......Page 2996
Health Risks......Page 2997
Radiation (also see Chapter 79)......Page 2998
Nonionizing Radiation: Lasers......Page 2999
Hepatitis B......Page 3000
Hepatitis C......Page 3001
AIDS and Health Care Workers......Page 3002
Tuberculosis......Page 3004
Transmission......Page 3005
Transmission-Based Precautions......Page 3006
Fatigue and Clinical Performance......Page 3007
Additional Stressors......Page 3008
Prevalence......Page 3009
Intervention......Page 3010
Intervention......Page 3011
Prognosis......Page 3012
References......Page 3013
Statistical Methods in Anesthesia......Page 3017
Normal Distribution......Page 3018
Caution......Page 3019
Univariate Versus Multivariate Regression......Page 3020
Confidence Intervals......Page 3021
Study Design......Page 3022
Paired Versus Unpaired Data......Page 3023
Bayesian Approach to Probability......Page 3024
Summary......Page 3025
Selected Introductory Statistics Texts......Page 3026
A......Page 3027
B......Page 3036
C......Page 3040
D......Page 3051
E......Page 3054
F......Page 3058
G......Page 3060
H......Page 3062
I......Page 3067
K......Page 3071
L......Page 3072
M......Page 3076
N......Page 3081
O......Page 3085
P......Page 3088
R......Page 3097
S......Page 3101
T......Page 3107
U......Page 3111
V......Page 3112
Z......Page 3115