downloaded from www.medicalbr.com Get more medical books and resources at www.medicalbr.com downloaded from www.medicalbr.com downloaded from www.medicalbr.com Copyright © 2018 by McGraw-Hill Education All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-1-25-983443-1 MHID: 1-25-983443-3 The material in this eBook also appears in the print version of this title: ISBN: 978-1-25-983442-4, MHID: 1-25-983442-5 eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this 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to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise downloaded from www.medicalbr.com Contents Chapter Authors Contributors Research and Review Foreword Preface The Practice of Anesthesiology SECTION I Anesthetic Equipment & Monitors The Operating Room Environment Charles E Cowles, Jr., MD, MBA, FASA Breathing Systems The Anesthesia Workstation Cardiovascular Monitoring Noncardiovascular Monitoring SECTION downloaded from www.medicalbr.com II Clinical Pharmacology Pharmacological Principles Inhalation Anesthetics Intravenous Anesthetics 10 Analgesic Agents 11 Neuromuscular Blocking Agents 12 Cholinesterase Inhibitors & Other Pharmacological Antagonists to Neuromuscular Blocking Agents 13 Anticholinergic Drugs 14 Adrenergic Agonists & Antagonists 15 Hypotensive Agents 16 Local Anesthetics 17 Adjuncts to Anesthesia SECTION III Anesthetic Management downloaded from www.medicalbr.com 18 Preoperative Assessment, Premedication, & Perioperative Documentation 19 Airway Management 20 Cardiovascular Physiology & Anesthesia 21 Anesthesia for Patients with Cardiovascular Disease 22 Anesthesia for Cardiovascular Surgery 23 Respiratory Physiology & Anesthesia 24 Anesthesia for Patients with Respiratory Disease 25 Anesthesia for Thoracic Surgery 26 Neurophysiology & Anesthesia 27 Anesthesia for Neurosurgery 28 Anesthesia for Patients with Neurological & Psychiatric Diseases 29 Anesthesia for Patients with Neuromuscular Disease 30 Kidney Physiology & Anesthesia 31 Anesthesia for Patients with Kidney Disease 32 Anesthesia for Genitourinary Surgery downloaded from www.medicalbr.com 33 Hepatic Physiology & Anesthesia Michael Ramsay, MD, FRCA 34 Anesthesia for Patients with Liver Disease Michael Ramsay, MD, FRCA 35 Anesthesia for Patients with Endocrine Disease 36 Anesthesia for Ophthalmic Surgery 37 Anesthesia for Otolaryngology–Head & Neck Surgery 38 Anesthesia for Orthopedic Surgery Edward R Mariano, MD, MAS 39 Anesthesia for Trauma & Emergency Surgery Brian P McGlinch, MD 40 Maternal & Fetal Physiology & Anesthesia Michael A Frölich, MD, MS 41 Obstetric Anesthesia Michael A Frölich, MD, MS 42 Pediatric Anesthesia 43 Geriatric Anesthesia 44 Ambulatory & Non–Operating Room Anesthesia SECTION Regional Anesthesia & Pain downloaded from www.medicalbr.com intravenous regional anesthesia, 1022 median nerve block, 1016–1017 musculocutaneous nerve block, 1018–1019 radial nerve block, 1018 ulnar nerve block, 1017–1018 Testicular tumors, 706–707 Tetany, 204 Tetracaine, 265t, 269t Tetralogy of Fallot, 431 Therapeutic window, 147 Thermodilution, 101–106 Thermodilution curve, 101, 102f, 104f Thermoregulation, 1214–1215 Thiamylal, 172f Thiazide diuretics, 390t Thiazide/thiazide-like diuretics, 668–669 edematous disorders (sodium overload), 668 hypercalciuria, 668 hypertension, 668 intravenous dosages, 668 nephrogenic diabetes insipidus, 668 side effects, 669 Thiocyanate, 256 Thiopental, 172f, 174t, 1220, 1249 Third-degree burns, 834 “Third-space” loss, 916 Thoracic bioimpedance, 107 Thoracic epidural blocks, 982 Thoracic paravertebral nerve block, 1091 Thoracic surgery, 553–582 See also specific surgeries bronchoscopy for, 573–575 case discussion on, 580–581 diagnostic thoracic procedures, 573–577 esophageal surgery, 578–579 lung resection, 563–573 See also Lung resection lung transplantation, 577–578 downloaded from www.medicalbr.com mediastinoscopy, 575–576 one-lung ventilation in, 556–563 anatomic considerations in, 559 double-lumen bronchial tubes in complications of, 562 description of, 558–562 placement of, 559–562 single-lumen tracheal tubes with bronchial blocker in, 562–563 physiologic considerations in anesthesia for, 554–557 lateral decubitus position in, 554f, 554–555, 555f open pneumothorax in, 555–556 tracheal resection, 573 See also Tracheal resection video-assisted thoracoscopic surgery (VATS), 573 Thoracic sympathetic chain block, 1097 Three-limb lead placement, rearranged, 90, 91f Thrombocytopenia, 867 Thromboelastography (TEG), 451, 725, 827, 828f Thromboembolism, 948 Thrombomodulin (TM), 824 Thromboxane A2 (TXA2), 883 Thyroid disorders hyperthyroidism, 759–760 hypothyroidism, 760–761 physiology, 758–759 Thyroid hormone, 759 Thyroid storm, 760 Thyroidectomy, 760 Thyromental distance, 311 Thyrotoxicosis, 647, 760 Thyrotropin-releasing hormone (TRH), 758 Thyroxine (T4), 722, 758 Tibial nerve, 1039f Tibial/common peroneal nerve courses, 1039f Tidal volume, 1268 Time-cycled ventilators, 68 downloaded from www.medicalbr.com cycle, 1339 Time-weighted average (TWA), 16 Timolol, 777 Tissue Doppler, 362f Tissue group composition, 140t Tissue hypoperfusion, 825f Tissue plasminogen activator (tPA), 615–616 Tonometry, for arterial blood pressuring monitoring, 84 Topiramate, 1078t Torsades des pointes, 409 Total hip arthroplasty illustration of, 812f uncemented, 808f Total intravenous anesthesia (TIVA) technique, 171, 180, 461, 605, 948 Total knee replacement intraoperative management, 813–814 preoperative considerations, 813 Total lung capacity (TLC), 538 Total parenteral nutrition (TPN), 1225–1226 infusions, 1227 Tourniquets, 822 Toxic shock syndrome, 1322t Toyota Production System (TPS), 28–29 Tracheal lumen, 561f Tracheal resection, 573, 575f, 576f anesthetic considerations, 573 preoperative considerations, 573 Tracheal tube (TT) description of, 325f, 1260, 1264 disadvantages of wrapping, 790t Tracheobronchial tree, 559f Tracheostomy, 793 Tracheotomy, 1266 Train-of-four stimulation, 134, 204 Tramadol, 1081 Tranexamic acid, 825, 826f downloaded from www.medicalbr.com Transcardiopulmonary thermodilution, 105f Transcranial Doppler (TCD), 459 Transcutaneous cardiac pacing (TCP), 1272 Transcutaneous electrical nerve stimulation (TENS), 1072, 1104–1105 Transdermal fentanyl, 1084 Transesophageal echocardiography (TEE), 96, 96f, 108–109, 357, 404–406, 442, 452f–456f, 607, 708, 741 probes, 1240 Transfusion See also Blood transfusion blood bank practices, 1199 blood groups, 1197–1198 ABO system, 1197 red blood cell antigen systems, 1198 Rh system, 1198 compatibility testing ABO–Rh testing, 1198 antibody screen, 1198 crossmatch, 1198 crossmatching, 1198 emergency, 1198–1199 intraoperative, 1199–1200 fresh frozen plasma (FFP), 1199–1200 granulocyte transfusions, 1200 packed red blood cells, 1199 platelet transfusions, 1200 procoagulant transfusions, 1200 Transfusion-associated circulatory overload (TACO), 827, 1202 Transfusion-associated hyperkalemia, 1156 Transfusion-related acute lung injury (TRALI), 827, 1202 Transient ischemic attacks (TIAs), 488, 621 Transient neurological symptoms (TNS), 994 Transient receptor potential vanilloid 1 (TRPV1), 264 Transjugular intrahepatic portosystemic shunt (TIPS), 739, 955 Transmittance oximetry, 120 Transplanted heart anesthetic management, 432–434 downloaded from www.medicalbr.com patient with, 432–434 preoperative considerations, 432–433 Transpulmonary pressure, 501 Transpulmonary thermodilution, 102–103 Trans-sacral nerve block anatomy, 1093 complications, 1095 indications, 1093 technique, 1094 Transthoracic echocardiography (TTE), 108–109, 357, 404 Transtracheal jet ventilation, 1265 Transurethral bladder resection, 705–706 Transurethral resection of the prostate (TURP) absorption of irrigation fluid, 699 bladder perforation, 700 intraoperative considerations, 698–701 anesthesia, choice of, 700 bladder perforation, 700 coagulopathy, 700 hypothermia, 700 monitoring, 700–701 septicemia, 700 TURP syndrome, 698–700 manifestations of, 699t preoperative considerations, 698 surgical complications, 699t Transversus abdominis plane (TAP), 916 Transversus abdominis plane (TAP) block, 1044, 1045f, 1075, 1105 Trauma anesthesia, 820 Trauma/emergency surgery airway, 820–821 breathing, 821–822 case discussion on, 839–841 circulation, 822 definitive trauma interventions anesthetic induction/maintenance, 829–830 downloaded from www.medicalbr.com damage control surgery, 830 in elderly, 838 head See Head trauma injury assessment, 823 mass casualty incidents, 838 neurological function, 823 resuscitation hemorrhage, 823–824 hemostatic resuscitation, 826–827 massive transfusion protocols, 827–828 trauma-induced coagulopathy, 824–826 Trauma-induced coagulopathy, 825f Traumatic brain injury (TBI), 830–833 diffuse neuronal injury, 831 Glasgow Coma Scale for, 610t intracranial pressure, 831 intraparenchymal injuries, 831 primary brain injuries, 831 secondary brain injuries, 831 Trazodone, 1077t Trendelenburg positions, 696–697 Triamcinolone, 1080t Tricuspid atresia, 431–432 Tricuspid regurgitation, 424–425 anesthetic management choice of agents, 425 monitoring, 425 objectives, 425 pathophysiology, 425 preoperative considerations, 424–425 treatment, 425 Trifluoroacetic acid, 164 Trigeminal nerve block anatomy, 1085 complications, 1088 gasserian ganglion block, 1085, 1086f downloaded from www.medicalbr.com illustration of, 1086f indications, 1085 mandibular nerve, 1087f, 1087–1088 maxillary nerve, 1085–1087, 1087f ophthalmic nerve, 1085 Triiodothyronine (T3), 722, 758 Triple response of Lewis, 1059 Trismus See Masseter muscle rigidity Tromethamine, 447, 1178, 1181 Troponin, 348 Trousseau sign, 763, 1160 True negatives, 300t True positives, 300t Truncus arteriosus, 432 Trunk, peripheral nerve blocks intercostal block, 1040–1041 paravertebral block, 1041–1043 Pecs block, 1043–1044, 1044f superficial cervical plexus block, 1040 transversus abdominis plane (TAP) block, 1044 ultrasound image of, 1045f Tubeless lithotripsy unit, 701f Tubuloglomerular balance, 1149 Tubuloglomerular feedback, 662 Tuffier’s line, 972 Tumor lysis syndrome, 1160 Tumors, 1070 Tuohy needle, 1042 Two-compartment model, 144, 144f Tympanoplasty, 798 U Ulnar artery, blood pressure monitoring via, 87 Ulnar nerve course, 1018f downloaded from www.medicalbr.com stimulation, 134 Ulnar nerve block, 1017–1018 at elbow, 1019f at wrist, 1019f Ultrafiltration, 445–446 Ultrasonic flow sensors, 63 Ultrasound-guided interscalene block, 1008f Ultrasound-guided procedures, 1085 Unanticipated hospital admission, following ambulatory surgery, 952 Unidirectional valves, 42–43, 43f Unstable angina, 395 Upper extremity axillary block, 1012–1015 brachial plexus anatomy, 1004 infraclavicular block, 1010–1012 interscalene block, 1005–1008 intravenous regional anesthesia, 1022 peripheral nerve blocks, 1004–1022 supraclavicular block, 1008–1010 surgery of distal upper extremity surgery, 815–816 shoulder surgery, 815 terminal nerves, blocks, 1015–1022 Upper gastrointestinal bleeding, 1325 Upper respiratory tract infection (URI), 909 Urinary diversion, 706 Urinary output clinical considerations, 133 indications and contraindications, 133 in noncardiovascular monitoring, 133 techniques and complications, 133 U.S Food and Drug Administration (FDA), 77, 285 Use-dependent block, 264 Uterine activity, 853–854 Uterine atony, 854 Uterine muscle, 853 downloaded from www.medicalbr.com Uteroplacental circulation, 847, 848f anesthetic agents, placental transfer of, 850–851 placental function, 848–849 physiological anatomy, 848 placental exchange, 849 respiratory gas exchange, 849–850 uterine blood flow, 847–848 uteroplacental blood flow, anesthetic agents effect, 851 V Vacuum system, in medical gas systems, 13 Vaginal birth after cesarean (VBAC), 867, 881 Vaginal delivery, general anesthesia for, 873t Vagus nerve, 500, 794f Valproic acid, 1078t Valvular aortic stenosis, 421 Valvular heart disease, 414–427, 415–427 anticoagulation, 426–427 aortic regurgitation, 423–424 aortic stenosis, 421–423 endocarditis prophylaxis, 425–426 general evaluation of patients, 414–415 history of, 414 laboratory evaluation, 415 mitral regurgitation, 417–420 mitral stenosis, 415–417 mitral valve prolapse, 420–421 physical examination, 414–415 special studies, 415 tricuspid regurgitation, 424–425 Vancomycin, 1251 Vaporization, 55 Vaporizers, 55–59 copper kettle, 55–56 electronic, 57, 59 modern conventional, 56–57 downloaded from www.medicalbr.com Vaporizing chamber, 57 Vapor-phase humidifier, 66 Vascular surgery, 483–490 anesthetic management of, 485–488 kidney failure, 487 paraplegia, 486–487 postoperative considerations, 488 surgery involving aortic arch, 485–486 surgery involving descending thoracic aorta, 486–487 surgery on abdominal aorta, 487–488 surgery on ascending aorta, 485 aorta/aortic lesions, 484–485 aneurysms in, 484 coarctation of, 485 dissection of, 484 occlusive disease of, 484–485 trauma in, 485 carotid artery surgery, 488–490 general anesthesia, 489 monitoring cerebral function, 489–490 preoperative anesthetic evaluation and management, 488–489 preoperative considerations, 488 regional anesthesia, 490 Vasoconstriction, 1299 Vasodepressor, 363 Vasodilators, 391t, 472t, 593 Vasopressin, 739, 1275t Vasopressors, 421, 471t, 593, 1324 Vecuronium, 217–218, 683 characteristics of, 211t, 212t chemical structure of, 206f dosage, 218 metabolism and excretion, 217–218 physical structure, 217 side effects and clinical considerations cardiovascular, 218 downloaded from www.medicalbr.com liver failure, 218 Venlafaxine, 1077t Venous air embolism, 606–608 central venous catheterization, 607 monitoring for, 607–608 treatment of, 608 Ventilation, 512–514, 513t distribution of, 513f, 513–514 mechanical See Mechanical ventilation in operating rooms, 16 spontaneous See Spontaneous ventilation time constants of, 514 Ventilation-perfusion (V/Q) scintigraphy, 564 Ventilators, 66–75 alarms, 72 anesthesia ventilators, problems associated with, 74–75 circuit design, 69–72 double-circuit system ventilators, 69–71, 71f piston ventilators, 71 spill valve, 72 expiratory phase, 68–69 function, 67 inspiratory phase, 67–68 mechanics of, 1344–1345 overview, 67–69 pressure and volume monitoring, 72 transition phase from expiration to inspiration, 68 transition phase from inspiration to expiration, 68 ventilator alarms, 72 ventilator circuit design, 69–72 double-circuit system ventilators, 69–71 piston ventilators, 71 spill valve, 72 Ventricular arrhythmias, 409, 410t–411t Ventricular compliance, 355f Ventricular function curves, 357, 357f downloaded from www.medicalbr.com Ventricular hypertrophy, 371 Ventricular pressure-volume diagrams, 358F Ventricular pressure–volume relationships, 369f Ventricular septal defect (VSD), 430 Ventricular systolic function, 353 Ventricular tachycardia (VT), 399, 1270 Verapamil, 376t, 378t, 1276t Vernakalant, 378t Vertebra prominens, 972 Vertebrae, 962 Vertebral column, 963f Vertebroplasty, 1107 Vessel-rich group, 140 Video laryngoscopes, 321–324 Video-assisted thoracoscopic surgery (VATS), 564, 573 Viral DNA, 1253 Vitamin D, 762, 764, 1159 Vitamin D receptors, 762 Vitamin K, 720, 722 Volatile anesthetics, 55, 159, 540, 590 See also Desflurane; Halothane; Isoflurane; Sevoflurane cerebral autoregulation, dose-dependent depression of, 590f cerebral blood flow and volume affected by, 589–590 cerebral metabolic rate affected by, 589 cerebral metabolic rate and blood flow, altered coupling of, 590 cerebrospinal fluid dynamics affected by, 590 intracranial pressure affected by, 590 Volume-controlled ventilation (VCV), 1339 Volume-cycled ventilators, 68, 1339 Volume–pressure loop, 125f von Willebrand factor (vWF), 734 W Waste anesthetic gas disposal (WAGD), 13, 16 Waste-gas scavengers, 75–77 Weak base, 1170 downloaded from www.medicalbr.com Wenger chestpiece See Precordial stethoscope West zones, 515 Wick humidifier, 66 Wide dynamic range (WDR) neurons, 1054 Widened pulse pressures, 253 Widespread Pain Index (WPI), 1066 Wind-up, 1055 Withdrawal of treatment, 1326 Wolff–Parkinson–White (WPW) syndrome, 373–374, 408 Wong-Baker FACES rating scale, 1063 Wood’s metal, 11 World Health Organization (WHO), 10 Wound-related sepsis, 1322 Wright respirometer, 61, 64f X Xenon advantages and disadvantages of, 161t anti-apoptotic effect of, 158 clinical pharmacology of, 169 Y Y-connection, 63 Y-connector, 61 Z Ziconotide, 1075 Zollinger–Ellison syndrome, 278 Zygapophyseal joints, 1070 downloaded from www.medicalbr.com downloaded from www.medicalbr.com downloaded from www.medicalbr.com ...Get more medical books and resources at www.medicalbr.com downloaded from www.medicalbr.com downloaded from www.medicalbr.com Copyright © 2018 by McGraw-Hill Education All rights reserved Except as... A major change in editors and authors occurred with the 5th edition and it is clear that they stayed true to the ideals of the original editors Now in 2018, the 6th edition is presented to us The text continues to be simple, concise, and... have multiple years of graduate medical education and perhaps certification in other medical specialties TABLE 1–1 Aspects of the practice of medicine that are included within the scope of anesthesiology. 1 downloaded from