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Get quick answers to the most important clinical questions with Duke’s Anesthesia Secrets, 5th Edition! Authors James Duke, MD and Brian M. Keech, MD present this easy-to-read, bestselling resource that uses the popular and trusted Secrets Series® Q&A format. It provides rapid access to the practical, "in-the-trenches" know-how you need to succeed – both in practice and on board and recertification exams.

  • Zero in on key information with bulleted lists, tables, mnemonics, illustrations, practical tips from the authors, and "Key Points" boxes that provide a concise overview of important board-relevant content.
  • Review essential material efficiently with the "Top 100 Secrets in Anesthesiology" – perfect for last-minute study or self-assessment.
  • Get the evidence-based guidance you need to provide optimal care for your patients – ideal for medical students, residents, fellows, and practitioners.
  • Apply all the latest advances in techniques, technology, and pharmacology, and explore effective solutions to a full range of clinical issues in anesthesiology.

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Published 29 January 2015
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Duke's Anesthesia
FIFTH EDITION
†JAMES C. DUKE, MD, MBA
Associate Professor of Anesthesiology
University of Colorado Health Sciences Center
Aurora, Colorado
Associate Director [Retired]
Department of Anesthesiology
Denver Health Medical Center
Denver, Colorado
†Deceased
BRIAN M. KEECH, MD, FAAP
Assistant Professor of Anesthesiology
University of Colorado Health Sciences Center
Aurora, Colorado
Staff Anesthesiologist
Department of Anesthesiology
Denver Health Medical Center
Denver, ColoradoTable of Contents
Cover image
Title Page
Copyright
Dedication
Contributors
Preface
Top 100 Secrets
Section 1 Basics of Patient Management
Chapter 1 Autonomic Nervous System
Suggested Readings
Chapter 2 Respiratory and Pulmonary Physiology
Suggested Readings
Chapter 3 Blood Gas and Acid-Base Analysis
Suggested Readings
Chapter 4 Volume Regulation, Volume Disturbances, and Fluid Replacement
Suggested Readings
Chapter 5 Electrolytes
Suggested ReadingsChapter 6 Transfusion Therapy
Website
Suggested Readings
Chapter 7 Coagulation
Website
Suggested Readings
Chapter 8 Airway Management
Website
Suggested Readings
Chapter 9 Pulmonary Function Testing
Suggested Readings
Section 2 Pharmacology
Chapter 10 Volatile Anesthetics
Suggested Readings
Chapter 11 Opioids
Suggested Readings
Chapter 12 Intravenous Anesthetics and Benzodiazepines
Suggested Readings
Chapter 13 Muscle Relaxants and Monitoring of Relaxant Activity
Suggested Readings
Chapter 14 Local Anesthetics
Website
Suggested Readings
Chapter 15 Inotropes and Vasodilator Drugs
Suggested ReadingsChapter 16 Preoperative Medication
Suggested Readings
Section 3 Preparing for Anesthesia
Chapter 17 Preoperative Evaluation
Suggested Readings
Chapter 18 The Anesthesia Machine and Vaporizers, and Anesthesia Circuits and
Ventilators
Suggested Readings
Chapter 19 Patient Positioning
Website
Suggested Readings
Chapter 20 Mechanical Ventilation in Critical Illness
Website
Suggested Readings
Section 4 Patient Monitoring and Procedures
Chapter 21 Pulse Oximetry
Website
Suggested Readings
Chapter 22 Capnography
Website
Suggested Readings
Chapter 23 Central Venous Catheterization and Pressure Monitoring
Suggested Readings
Chapter 24 Flow-Directed Therapy
WebsitesSuggested Readings
Section 5 Perioperative Problems
Chapter 25 Blood Pressure Disturbances, Arterial Catheterization, and Blood Pressure
Monitoring
Suggested Readings
Chapter 26 Awareness During Anesthesia
Website
Suggested Readings
Chapter 27 Temperature Disturbances
Website
Suggested Readings
Chapter 28 Postanesthetic Care
Website
Suggested Readings
Section 6 Anesthesia and Systemic Disease
Chapter 29 Ischemic Heart Disease and Myocardial Infarction
Suggested Readings
Chapter 30 Heart Failure
Website
Suggested Readings
Chapter 31 Valvular Heart Disease
Website
Suggested Readings
Chapter 32 Aorto-Occlusive Diseases
Suggested ReadingsChapter 33 Intracranial and Cerebrovascular Disease
Suggested Readings
Chapter 34 Reactive Airway Disease
Websites
Suggested Readings
Chapter 35 Aspiration
Suggested Readings
Chapter 36 Chronic Obstructive Pulmonary Disease
Suggested Readings
Chapter 37 Acute Respiratory Distress Syndrome (ARDS)
Suggested Readings
Chapter 38 Pulmonary Hypertension
References
Chapter 39 Perioperative Hepatic Dysfunction and Liver Transplantation
Website
Suggested Readings
Chapter 40 Renal Function and Anesthesia
Suggested Readings
Chapter 41 Increased Intracranial Pressure and Traumatic Brain Injury
Website
Suggested Readings
Chapter 42 Malignant Hyperthermia and Other Motor Diseases
Websites
Suggested Readings
Chapter 43 Degenerative Neurologic Diseases and NeuropathiesSuggested Readings
Chapter 44 Alcohol and Substance Abuse
Websites
Suggested Readings
Chapter 45 Diabetes Mellitus
Websites
Selected Readings
Chapter 46 Nondiabetic Endocrine Disease
Suggested Readings
Chapter 47 Obesity and Sleep Apnea
Websites
Suggested Readings
Chapter 48 Allergic Reactions
Suggested Readings
Chapter 49 Herbal Supplements
Suggested Readings
Section 7 Special Anesthetic Considerations
Chapter 50 Trauma
Suggested Readings
Chapter 51 The Burned Patient, Laser Surgery and Operating Room Fires
The Burned Patient
Laser Surgery and Operating Room Fires
Websites
Suggested Readings
Chapter 52 Neonatal AnesthesiaSuggested Readings
Chapter 53 Pediatric Anesthesia
Suggested Readings
Chapter 54 Congenital Heart Disease
Suggested Readings
Chapter 55 Fundamentals of Obstetric Anesthesia
Websites
Suggested Readings
Chapter 56 Obstetric Analgesia and Anesthesia
Websites
Suggested Readings
Chapter 57 High-Risk Obstetrics
Website
Suggested Readings
Chapter 58 Geriatric Anesthesia
Suggested Readings
Chapter 59 Sedation and Anesthesia Outside the Operating Room
Websites
Suggested Readings
Chapter 60 Pacemakers and Internal Cardioverter Defibrillators
Suggested Readings
Section 8 Regional Anesthesia
Chapter 61 Spinal Anesthesia
Website
Suggested ReadingsChapter 62 Epidural Analgesia and Anesthesia
Websites
Suggested Readings
Chapter 63 Peripheral Nerve Blocks
Website
Suggested Readings
Section 9 Anesthetic Considerations in Selected Surgical Procedures
Chapter 64 Principles of Anesthesia in Heart Transplantation
Websites
Suggested Readings
Chapter 65 Cardiopulmonary Bypass
Suggested Readings
Chapter 66 Lung Isolation Techniques
Websites
Suggested Readings
Chapter 67 Somatosensory-Evoked Potentials and Spinal Surgery
Suggested Readings
Chapter 68 Anesthesia for Craniotomy
Suggested Readings
Chapter 69 Minimally Invasive Surgery
Websites
Suggested Readings
Chapter 70 Electroconvulsive Therapy
Suggested Readings
Section 10 Pain ManagementChapter 71 Acute Pain Management
Suggested Readings
Chapter 72 Chronic Pain Management
Website
Suggested Readings
IndexCopyright
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ANESTHESIA SECRETS, FIFTH EDITION ISBN: 978-0-323249775
Copyright © 1996 by Hanley & Belfus
Copyright © 2011, 2006, 2000 by Mosby, Inc., an affiliate of Elsevier Inc.
Copyright © 2016 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in
any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in
writing from the publisher. Details on how to seek permission, further information
about the Publisher's permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be
found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods,
professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should
be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety
precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors,
or editors, assume any liability for any injury and/or damage to persons or propertyas a matter of products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas contained in the material
herein.
Library of Congress Cataloging-in-Publication Data
Anesthesia secrets / [edited by] James C. Duke.—Fifth edition.
   p. ; cm.
 Includes bibliographical references and index.
 ISBN 978-0-323-24977-5 (pbk.)
 I. Duke, James, 1957- , editor.
 [DNLM: 1. Anesthesia—Examination Questions. 2. Anesthesiology—methods
—Examination Questions. 3. Anesthetics—Examination Questions. WO 218.2]
 RD82.3
 617.9'6—dc23
2014027621
Content Strategist: James Merritt
Content Development Specialists: Kelly McGowan/Lucia Gunzel
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Umarani Natarajan
Designer: Steven Stave
Illustrations Manager: Emily Costantino
Marketing Manager: Melissa Darling
Printed in the USA
Last digit is the print number: 9 8 7 6 5 4 3 2 1Dedication
Dedicated to Renee, My Wonderful Wife and Companion, to Dr. Philip Mehler, and
to the Many Contributors to Anesthesia Secrets.
James C. Duke
To my wife Molly, thank you for all your love and support, and to my Mom, Dad and
brother for always being there for me.
Brian M. Keech
Dedication to Dr. Duke, MD, MBA
This dedication is for Dr. James Duke, co-editor of this fifth edition of Anesthesia
Secrets and also editor of the previous four editions of this text. Sadly, Dr. Duke
recently passed after a two-year struggle with a brain tumor.
Dr. Duke, or Jim as he was known at Denver Health, was a superbly talented
anesthesiologist both for complicated elective cases as well as for those critically
injured trauma patients seen at Denver Health, where Dr. Duke worked the last 20
years of his almost three-decade career. In addition, while at Denver Health, he
quickly distinguished himself as someone who was passionate about quality of care,
process improvement and patient safety. Soon after joining Denver Health, he was
appointed Associate Director of the Anesthesia Department, a position he admirably
held until his medical retirement in 2013.
Moreover, his leadership skills earned him an appointment to the Denver Health
Medical Executive Committee, for which he held the role of Secretary of the Medical
Staff, and ultimately was appointed President of the Medical Staff, which he held
until his retirement.
Dr. Duke was a superb educator, beloved and respected by the hundreds of students
and residents with whom he interacted during his career. His assiduous dedication to
the Anesthesia Secrets text is a testament to his commitment to medical education.
Dr. Duke was a true “renaissance” man. He was an affable person, with impeccable
tastes in clothing, food, motorcycles, and gardening. His subtle southern drawl was a
perfect complement to his overall persona.
Jim will be sorely missed. His contribution to Denver Health and its anesthesia
department, to the next generation of medical professionals, and to humanity are
unassailable and indeed most impressive. The legacy he has formally established with
the Anesthesia Secrets text will continue to be impactful for many generations to comeand will keep him in our collective memories for many years forthwith.
Philip S. Mehler MD, FACP, FAED
Glassman Professor of Medicine
University of Colorado
Denver Health Medical Center and
The University of Colorado
Denver, COContributors
Rita Agarwal MD
Professor of Anesthesiology, Director of Pediatric Education, Department of
Anesthesiology, University of Colorado, Aurora, CO
Pediatric Anesthesiology Program Director, Anesthesiology, Children's Hospital
Colorado, Aurora, CO
Benjamin Atwood MD
Anesthesia Resident, Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA
Clinical Fellow in Anesthesia, Harvard Medical School, Boston, MA
Daniel R. Beck MD, MS, Assistant Professor, Cardiothoracic Anesthesiologist,
Department of Anesthesiology, University of Colorado, Veterans Affairs Medical
Center, Denver, CO
Bethany Benish MD
Assistant Professor of Anesthesiology, Department of Anesthesiology, University of
Colorado, Aurora, CO
Attending Anesthesiologist, Department of Anesthesiology, Denver Health Medical
Center, Denver, CO
Mark Chandler MD
Assistant Professor, University of Colorado Health Sciences Center, Aurora, CO
Anesthesiologist, Department of Anesthesiology, Denver Health Medical Center,
Denver, CO
Christopher Ciarallo MD, FAAP
Assistant Professor, Department of Anesthesiology, University of Colorado School of
Medicine, Aurora, CO
Director of Pediatric Anesthesiology, Department of Anesthesiology, Denver Health
Medical Center, Denver, CO
Pediatric Anesthesiologist, Anesthesiology, Children's Hospital Colorado, Aurora,
CO
Rachel D. Clopton MD, Fellowship, Pediatric Anesthesia, Children's Hospital
Colorado, University of Colorado Hospital, Aurora, CO
Mary DiMiceli MD, OB Anesthesiology Fellow, Obstetric Anesthesia, Vanderbilt
University Hospital, Nashville, TN
James C. Duke MD, MBA (Deceased), Associate Director, Retired, Anesthesiology,
Denver Health Medical Center, Denver, CO
Matthew J. Fiegel BA, MD, Associate Professor, Anesthesiology, University of
Colorado Hospital, Aurora, CO
Jacob Friedman MDAssistant Professor, Department of Anesthesiology, University of Colorado Health
Sciences Center, Aurora, CO
Staff Anesthesiologist, Department of Anesthesiology, Denver Veteran's Affairs
Hospital, Denver, CO
Robert Friesen MD
Professor, Anesthesiology, Children's Hospital Colorado, Aurora, CO
Professor, Department of Anesthesiology, University of Colorado School of Medicine,
Denver, CO
Andrea J. Fuller MD, Assistant Professor of Anesthesiology, University of Colorado
Health Sciences Center, Aurora, CO
James B. Haenel RRT, Surgical Critical Care Specialist, Surgery, Denver Health
Medical Center, Denver, CO
Michelle Dianne Herren MD
Pediatric Anesthesiologist, Department of Anesthesiology, University of Colorado
Hospital, Aurora, CO
Pediatric Anesthesiologist, Denver Health Medical Center, Denver, CO
Pediatric Anesthesiologist, Children's Hospital Colorado, Aurora, CO
Daniel J. Janik MD
Associate Professor, Department of Anesthesiology, University of Colorado School of
Medicine, Aurora, CO
Co-director Intraoperative Neuromonitoring, Anesthesiology, University of Colorado
Hospital, Aurora, CO
Gillian E. Johnson MD, Anesthesiologist, Pikes Peak Anesthesia, Colorado Springs,
CO
Jeffrey L. Johnson MD
Assistant Professor of Surgery, University of Colorado Health Sciences Center,
Aurora, CO
Director, Surgical Intensive Care, Denver Health Medical Center, Denver, CO
Alma N. Juels MD
Assistant Professor, Department of Anesthesiology, University of Colorado, Aurora,
CO
Attending Physician, Department of Anesthesiology, Denver Health Medical Center,
Denver, CO
Rachel M. Kacmar MD, Assistant Professor, Department of Anesthesiology,
University of Colorado, Aurora, CO
Brian M. Keech MD, FAAP
Staff Anesthesiologist, Denver Health Medical Center, Denver, CO
Assistant Professor of Anesthesiology, University of Colorado School of Medicine,
Denver, CO
Michael Kim BA, DO, Anesthesia Resident, Anesthesiology, University of
Colorado Health Sciences Center, Aurora, CO
Renee Kolte-Edwards MD, Anesthesiologist, Anesthesiology, Altru Health System,
Grand Forks, ND
Jason P. Krutsch MD, Associate Professor, Pain Medicine Fellowship Site Director,
Department of Anesthesiology, University of Colorado, Denver, COSunil Kumar MD, FFARCS
Assistant Professor, Department of Anesthesiology, University of Colorado Health
Sciences Center, Aurora, CO
Anesthesiologist, Department of Anesthesiology, Denver Health Medical Center,
Denver, CO
Philip R. Levin MD, Clinical Professor, Department of Anesthesiology, David
Geffen School of Medicine at UCLA, Los Angeles, CA
Ana M. Lobo MD, MPH, Assistant Professor of Anesthesiology, Department of
Anesthesiology, Yale New Haven Hospital, New Haven, CT
Christopher M. Lowry MD
Assistant Professor of Medicine, Department of Cardiology, University of Colorado,
Aurora, CO
Director of Cardiac Electrophysiology, Department of Cardiology, Denver Health
Medical Center, Denver, CO
Staff Electrophysiologist, Department of Cardiology, University of Colorado Hospital,
Aurora, CO
Howard Miller MD
Associate Director, Anesthesiology, Denver Health Medical Center, Denver, CO
Associate Professor, Department of Anesthesiology, University of Colorado School of
Medicine, Aurora, CO
Aaron Murray MD
Assistant Professor, Department of Anesthesiology, University of Colorado Health
Sciences Center, Aurora, CO
Anesthesiologist, Department of Anesthesiology, Denver Health Medical Center,
Denver, CO
Malcolm Packer MD
Associate Professor of Anesthesiology, Department of Anesthesiology, University of
Colorado Denver, CO
Attending Anesthesiologist, Department of Anesthesiology, Denver Health and
Hospitals Authority; Children's Hospital Colorado, Aurora, CO
Gurdev S. Rai MD
Chief, Anesthesia, Eastern Colorado Health Care System/Denver Veterans Affairs
Medical Center, Denver, CO
Assistant Professor, Department of Anesthesia, University of Colorado, Aurora, CO
Prairie N. Robinson MD, Anesthesiology Resident, University of Colorado Health
Sciences Center, Aurora, CO
Olivia Romano MD, Assistant Professor, Department of Anesthesiology,
University of Colorado Anschutz Medical Campus, Aurora, CO
Michael M. Sawyer MD, Assistant Professor of Anesthesiology, Department of
Anesthesiology, University of Colorado Health Hospital Association, Denver, CO
Lawrence I. Schwartz MD, Associate Professor, Department of Anesthesiology,
Children's Hospital Colorado, University of Colorado, Aurora, CO
Tamas Seres MD, Associate Professor, Department of Anesthesiology, University
of Colorado, Aurora, CO
Robert Slover MD, Director of Pediatrics, The Barbara Davis Center for Diabetes,University of Colorado, Aurora, CO
Robin Slover MD
Associate Professor, Department of Anesthesiology, University of Colorado, Aurora,
CO
Medical Director, Pain Consultation Services, Anesthesiology, Children's Hospital
Colorado, Aurora, CO
Laurie M. Steward MD, Pediatric Anesthesiologist and Senior Instructor,
Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO
Mark Twite MA, MB, BChir, FRCP, Director of Pediatric Cardiac Anesthesia,
Department of Anesthesiology, Children's Hospital and University of Colorado,
Aurora, CO
Ronald Valdivieso MD, Associate Professor, Department of Anesthesiology,
University of Colorado, Aurora, CO
Nathaen Weitzel MD, Associate Professor, Department of Anesthesiology,
University of Colorado, Aurora, CO
Barbara Wilkey MD, Assistant Professor, Department of Anesthesiology,
University of Colorado, Aurora, CO
Jennifer Zieg MD, Senior Instructor, Anesthesiology, Children's Hospital Colorado,
University of Colorado Hospital, Aurora, COP r e f a c e
I n this fifth edition of Anesthesia Secrets, the goal continues to be concise presentation
of a wide range of topics important to anyone interested in anesthesiology. My goal
has always been not to merely offer a few words suitable for the sake of familiarity,
but to provide appropriate depth to allow readers to integrate the concerns of this
field into their wider knowledge of medicine in general. I t is my hope for medical
students that both rotating through the anesthesia clinical services elective and
reviewing A nesthesia S ecrets contributes to their decision to enter this esteemed
profession.
I am humbled by the reception Anesthesia Secrets has received since the first edition
was published in 1996. I take it as an affirmation that my contributors and I have a
good idea of the important concepts in the field, as much as they can be described in
a text of this size. I thank my contributors for this edition and all previous editions.
Over the years my contributors have gone on to successful careers across the country,
yet their imprint remains throughout. A lthough they may no longer be listed as
authors, they nonetheless have my thanks.
A nd to you, the reader, thank you for making Anesthesia Secrets a part of your
educational program.
James C. Duke MD, MBA
I t has been an honor for me to work with D r. J im D uke and the contributors of the
now rightly named, Duke's Anesthesia Secrets, FI FTH ED I TI ON . From using this series
as a medical student, resident, fellow and now a. ending anesthesiologist, I can a. est
to its excellence. Whether used as a quick reference for the most salient topics in
anesthesiology, or as a starting point for more in-depth study, its quality is
unmatched.
Thank you for choosing D uke's Anesthesia Secrets, FI FTH ED I TI ON as your study
aid. I hope you enjoy using it as much as we have enjoyed preparing it for you.
Brian M. Keech MD, FAAPTop 100 Secrets
T hese secrets are 100 of the top board alerts. T hey summarize the concepts,
principles, and most salient details of anesthesiology.
1. A preoperative visit by an informative and reassuring anesthesiologist
provides useful psychological preparation and calms the patient's fears and
anxiety before anesthesia. The choice of premedication depends on the physical
and mental status of the patient, whether the patient is an inpatient or
outpatient, whether the surgery is elective or emergent, and whether the patient
has a history of postoperative nausea and vomiting.
2. “All that wheezes is not asthma.” Also consider mechanical airway
obstruction, congestive heart failure, allergic reaction, pulmonary embolus,
pneumothorax, aspiration, and endobronchial intubation.
3. Under most circumstances, peri-induction hypotension responds best to
intravenous fluid. Estimating volume status requires gathering as much clinical
information as possible because any single variable may be misleading. Always
look for supporting information. Replace intraoperative fluid losses with isotonic
fluids.
4. Thorough airway examination and identification of the patient with a
potentially difficult airway are of paramount importance. The
“difficult-toventilate, difficult-to-intubate” scenario must be avoided if possible.
5. For the elective case, fasting guidelines include:
Clear liquids (water, clear juices) 2 hours
Nonclear liquids (Jello, breast milk) 4 hours
Light meal or snack (crackers, toast, liquid) 6 hours
Full meal (fat containing, meat) 8 hours
6. Increasing the delivered concentration of anesthetic, increasing the fresh gas
flow, increasing alveolar ventilation, and using nonlipid-soluble anesthetics
increase speed of onset of volatile anesthetics.
7. Obese patients may be difficult to ventilate and difficult to intubate. Backup
strategies should always be considered and readily available before airway
management begins.
8. Infants may be difficult to intubate because they have a more anterior larynx,relatively large tongues, and a floppy epiglottis. The narrowest part of the larynx
is below the vocal cords at the cricoid cartilage.
9. The semiclosed circuit using a circle system is the most commonly used
anesthesia circuit. Components include an inspiratory limb, expiratory limb,
unidirectional valves, a CO absorber, a gas reservoir bag, and a pop-off valve on2
the expiratory limb.
10. Advantages of a circle system include conservation of heat and moisture, the
ability to use low flows of fresh gas, and the ability to scavenge waste gases.
Disadvantages include multiple sites for disconnection and high compliance.
11. Local anesthetic agents are either aminoesters or aminoamides. The two
classes of agents differ in their allergic potential and method of
biotransformation.
12. Termination of effect of intravenous anesthetics is through redistribution, not
biotransformation and breakdown. Benzodiazepines and opioids have
synergistic effects with intravenous induction agents, requiring adjustment in
dosing.
13. Neuropathic pain is usually less responsive to opioids than pain originating
from nociceptors.
14. The most common complications from epidural analgesia are hypotension,
inadequate analgesia requiring replacement or manipulation, pruritus,
nausea/vomiting, and shivering, with less common but potentially detrimental
complications being post–dural puncture headache (PDPH), high/total spinal,
intrathecal (IT) or intravenous (IV) catheter placement, systemic toxicity and
nerve injury.
15. Definitive treatment of preeclampsia is immediate delivery, but mainstay of
management is blood pressure control and seizure prophylaxis with β blocker or
vasodilators and magnesium sulfate, respectively.
16. Anesthesiologists should be aware of patients at high risk for postpartum
hemorrhage or uterine atony and prepare accordingly—type and cross and have
blood to transfuse readily available.
17. Most elective thoracic surgical procedures in adults using one-lung
ventilation (OLV) can be achieved using a left double-lumen endotracheal tube
(DLT). Right DLTs and bronchial blockers are more difficult to place and more
likely to move during surgery, requiring repositioning with a fiber-optic
bronchoscope (FOB). The initiation of OLV stops all ventilation to one lung,
which would create a 50% right-to-left shunt and relative hypoxemia if perfusion
were unchanged.
18. When somatosensory-evoked potentials (SSEPs) are monitored during spine
surgery, avoid exceeding 1 minimal alveolar concentration (MAC) of volatile
anesthetic to maximize the effectiveness of signal acquisition.19. During prolonged spine surgery in the prone position, use a combination of
colloid and crystalloid for fluid replacement to help avoid ischemic optic
neuropathy.
20. Patients on β blockers should take them on the day of surgery and continue
them perioperatively. Because the receptors are upregulated, withdrawal may
precipitate hypertension, tachycardia, and myocardial ischemia. Rarely are β
blockers initiated the day of surgery. Clonidine should be continued.
21. Even mild hypothermia has a negative influence on patient outcome,
increasing rates of wound infection, delaying healing, increasing blood loss, and
increasing cardiac morbidity threefold.
22. O-negative blood is the universal donor for packed red blood cells; for plasma
it is AB positive.
23. Not all elderly patients need an extensive preoperative workup; tailor it to
their underlying illnesses and invasiveness of the surgery. Patients with
Alzheimer disease may become more confused and disoriented with
preoperative sedation.
24. Basal function of most organ systems is relatively unchanged by the aging
process per se, but the functional reserve and ability to compensate for
physiologic stress are reduced. In general, anesthetic requirements are decreased
in geriatric patients. There is an increased potential for a wide variety of
postoperative complications in the elderly, and postoperative cognitive
dysfunction is arguably the most common.
25. Pregnant patients can pose airway management problems because of airway
edema, large breasts that make laryngoscopy difficult, full stomachs rendering
them prone to aspiration, and rapid oxygen desaturation caused by decreased
functional residual capacity.
26. Normal saline, when administered in large quantities, produces a
hyperchloremic metabolic acidosis; the associated base deficit may lead the
provider to conclude incorrectly that the patient continues to be hypovolemic.
27. There is no set hemoglobin/hematocrit level at which transfusion is required.
The decision should be individualized to the clinical situation, taking into
consideration the patient's health status. If blood is needed in an emergency,
type O–packed cells (best is O-negative) and/or type-specific blood may be used.
28. The most common intraoperative bleeding diathesis is dilutional
thrombocytopenia. In general, this is not seen until significant blood loss has
occurred and has been replaced with IV crystalloid and blood products that do
not contain platelets.
29. Thromboelastography (TEG) is a dynamic point of care test of clotting that
can help distinguish between surgical and non-surgical bleeding. It can identify
specific deficiencies of coagulation factors, fibrinogen and platelets, and candetect plasmin dysregulation and abnormal clot breakdown.
30. The primary treatment for disseminated intravascular coagulation (DIC) is to
treat the underlying medical condition.
31. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV ), the1
FEV /FVC ratio, and the flow between 25% and 75% of the FVC (mean maximal1
flow [MMF] ) are the most clinically helpful indices obtained from25-75
spirometry. No single pulmonary function test result absolutely contraindicates
surgery.
32. Common opioid side effects include nausea, pruritus, bradycardia, urinary
retention, and respiratory depression.
33. Appropriate dosing of intravenous anesthetics requires considering
intravascular volume status, comorbidities, age, and chronic medications.
34. Ketamine is the best induction agent for patients with hypovolemic trauma
as long as there is no risk for increased intracranial pressure (ICP). It is also a
good agent for patients with active bronchospastic disease.
35. Propofol is the least likely of all induction agents to result in nausea and
vomiting. Termination of the effects of intravenous anesthetics is by
redistribution, not biotransformation and breakdown.
36. Metabolism of relaxants is more important than pharmacologic reversal for
termination of relaxant effect. Train-of-four assessment is highly subjective and
has been demonstrated repeatedly to underestimate residual neuromuscular
blockade. It may be a best practice to administer reversal agents to all patients
receiving nondepolarizing relaxants. Leave clinically weak patients intubated
and support respirations until the patient can demonstrate return of strength.
37. Lipid solubility, pK , and protein binding of the local anesthetics determinea
their potency, onset, and duration of action, respectively.
38. Vasopressin has a role in blood pressure maintenance in septic shock,
cardiogenic shock, and other shock states.
39. Low-dose dopamine is ineffective for prevention and treatment of acute
renal failure and for protection of the gut. Dopamine is not an effective
treatment for septic shock. The best way to maintain renal function during
surgery is to ensure an adequate intravascular volume, maintain cardiac output,
and avoid drugs known to decrease renal perfusion.
40. The risk of clinically significant aspiration pneumonitis in healthy patients
having elective surgery is very low. Many patients require little or no
premedication. Routine use of pharmacologic agents to alter the volume or pH
of gastric contents is unnecessary.
41. American College of Cardiology/American Heart Association guidelines forcardiac testing are the current gold standard for preoperative cardiac
assessment. However, the most important component of the preanesthetic
evaluation is a thorough, accurate and focused history and physical
examination.
42. The four active cardiac conditions that will likely result in surgical
cancellation to assess cardiac evaluation and treatment are unstable coronary
syndrome, decompensated heart failure, significant cardiac arrhythmias, and
severe valvular disease.
43. Postoperative blindness is increasing in frequency, but it is unclear exactly
which patients are at risk. Although not a guarantee to prevent this complication,
during lengthy spine procedures in the prone position, intravascular volume,
hematocrit, and perfusion pressure should be maintained.
44. The most common postoperative nerve injury is ulnar neuropathy. It is most
commonly found in men older than 50 years, is delayed in presentation, is not
invariably prevented by padding, and is multifactorial in origin.
45. Oxygenation and ventilation are separate processes, and pulse oximetry does
not assess adequacy of ventilation. Treat the patient, not the symptom!
46. Trends in central venous pressures (CVPs) are more valuable than isolated
values and should always be evaluated in the context of the patient's scenario.
47. The systolic blood pressure in the radial artery may be as much as 20 to
50  mm  Hg higher than the pressure in the central aorta.
48. Awareness is most likely in cases where minimal anesthetic is administered,
such as in cardiopulmonary bypass, hemodynamic instability, trauma, and fetal
delivery.
49. Symptoms of awareness can be nonspecific, and the use of neuromuscular
blockade increases the risk of unrecognized awareness.
50. Even mild hypothermia has a negative influence on patient outcome,
increasing wound infection rates, increasing nitrogen loss, delaying healing,
increasing blood loss, and increasing hospitalization as well as cardiac morbidity.
Hypothermia is dissatisfying in postoperative patients. The best method to treat
hypothermia is use of forced-air warming blankets. Warm all fluids and blood
products. Cover all body surfaces possible, including the head, to further reduce
heat loss.
51. Patients with suspected sleep apnea should be managed in the same way
patients with diagnosed sleep apnea are managed. Supplemental oxygen,
regular checks, and oxygen saturations are the best standards for treatment.
52. Patients with excellent exercise capacity, even in the presence of ischemic
heart disease, will be able to tolerate the stresses of noncardiac surgery. The
ability to climb two or three flights of stairs without significant symptoms(angina, dyspnea) is usually an indication of adequate cardiac reserve.
53. β-Blocker therapy significantly decreases the postoperative mortality rate of
patients with high cardiac risk after noncardiac surgery so it should be
established whenever it is indicated, as well as before surgery.
54. Diastolic dysfunction can cause primarily heart failure in the presence of
normal ejection fraction (EF) or it can be secondary in systolic heart failure with
low EF with increased left atrial (LA) pressure. Different types of diastolic
dysfunction need different types of fluid and hemodynamic management.
55. The most common cause of perioperative mortality is cardiac disease.
Postoperative renal failure also has an important impact on outcome.
56. In the normal brain, cerebral blood flow varies directly with the cerebral
metabolic rate. Inhalational agents are said to uncouple this relationship in that
they decrease the cerebral metabolic rate while concurrently dilating cerebral
blood vessels and increasing cerebral blood flow.
57. The key to subarachnoid hemorrhage (SAH) management is early diagnosis
and surgical treatment within 72 hours. Vasospasm should be treated with
hypertensive, hypervolemic, hemodilution (HHH) therapy. None of the
methods of monitoring cerebral blood flow during carotid endarterectomy
(CEA) has been demonstrated to improve outcome, and none has gained
widespread acceptance as the monitor of choice.
58. Patients for planned pulmonary resections absolutely require pulmonary
function tests to ensure that more lung is not resected than is compatible with
life. Injudicious resections may create a ventilator-dependent patient.
59. Mechanical ventilation settings for patients with acute respiratory disease
syndrome (ARDS) or acute lung injury (ALI) include tidal volume at 6 to 8  ml/kg
of ideal body weight and limiting plateau pressures to O. PEEP should be2
adjusted to prevent end-expiratory collapse.
60. Hypoxia, hypercarbia, and acidosis worsen pulmonary artery pressure (PAP).
Vasopressin increases systemic vascular resistance (SVR) without increasing
PAP. Norepinephrine increases SVR to a greater extent than it increases
pulmonary vascular resistance (PVR), so it is also useful in pulmonary artery
hypertension (PAH).
61. Patients with liver disease commonly have an increased volume of
distribution, necessitating an increase in initial dose requirements.
62. Although the portal vein supplies up to 75% of total hepatic blood flow, only
45% to 55% of the oxygen requirements are provided by this part of the
circulation. Because of the large hepatic reserve, significant impairment of
physiologic function must occur before clinical signs and symptoms of hepatic
failure become evident.63. Patients undergoing cardiac or aortic surgery are particularly at risk for
developing postoperative renal insufficiency.
64. Preoperative renal risk factors (increased creatinine and a history of renal
dysfunction), left ventricular dysfunction, advanced age, jaundice, and diabetes
mellitus are predictive of postoperative renal dysfunction.
65. The majority of renal function tests are neither sensitive nor specific in
predicting perioperative renal dysfunction and are affected by many variables
common to the perioperative environment. The best way to maintain renal
function during surgery is to ensure an adequate intravascular volume, maintain
cardiac output, and avoid drugs known to decrease renal perfusion.
66. Malignant hyperthermia (MH) is a hypermetabolic disorder that presents in
the perioperative period after exposure to inhalational agents or succinylcholine.
The sine qua non of MH is an unexplained rise in end-tidal carbon dioxide in a
patient with unexplained tachycardia. A temperature rise is a late feature.
Patients with a history of, or susceptibility to, MH must receive anesthesia with a
nontriggering agent. The anesthesiologist must have a heightened awareness of
MH, have prepared the anesthetic machine, and have the MH cart in the room.
67. Chronic alcoholics may have cardiomyopathy and dysrhythmias, may be
predisposed to aspiration, and may have diminished pulmonary function. They
may have impaired synthetic liver function (important screening tests are
albumin and prothrombin time). Alcohol withdrawal may cause seizures.
68. Cocaine sensitizes the cardiovascular system to the effects of endogenous
catecholamines. Ketamine and pancuronium potentiate the cardiovascular
toxicity of cocaine and should be avoided.
69. Patients with diabetes have a high incidence of coronary artery disease with
an atypical or silent presentation. Maintaining perfusion pressure, controlling
heart rate, conducting continuous ECG observation, and maintaining a high
index of suspicion during periods of refractory hypotension are key
considerations. The goal for insulin management during surgery is to maintain
glucose between 120 and 200  mg/dl.
70. Perioperatively mild to moderate hypothyroidism is of little concern even for
elective surgery. Patients with severe, symptomatic hypothyroidism should be
treated before surgery. MAC of volatile anesthetics is unchanged in both
hypothyroid and hyperthyroid states. Thyroid storm may mimic malignant
hyperthermia.
71. Chronic exogenous glucocorticoid therapy should not be discontinued
abruptly. Doing so may precipitate acute adrenocortical insufficiency.
72. Morbidly obese patients have numerous systemic disorders and physiologic
challenges, including restrictive lung disease, obstructive sleep apnea, coronary
artery disease, diabetes, hypertension, cardiomegaly, pulmonary hypertension,
and delayed gastric emptying. Safe anesthetic practice requires preparation fordiagnosis, monitoring, and emergent treatment of any of these conditions.
73. Obese patients often have obstructive sleep apnea (OSA), requiring
appropriate diagnosis and care, especially in the postoperative period.
74. The major causes of anaphylactic reactions in the operating room are muscle
relaxants and latex allergy. Concerning latex allergy, proper preparation of the
operating room environment is critical. Schedule at-risk patients as the first
surgical cases of the day. Latex- and nonlatex-containing supplies should be
clearly identified and the former avoided. Powdered gloves should be avoided.
Health care workers are at increased risk for latex hypersensitivity. Avoid the use
of powdered gloves whenever possible and be alert for the development of
symptoms that might signify latex allergy.
75. The initial management of a trauma patient requires attention to the ABCs:
airway, breathing, and circulation. Ensuring numerous large-gauge intravenous
sites for resuscitation is a priority.
76. Precipitous cardiovascular collapse may be caused by unrecognized sources
of bleeding, cardiac tamponade, tension pneumothorax, or air embolism.
Unstable, hemorrhaging patients should receive O-negative, type-specific, or
crossmatched blood if still unstable after resuscitation with 2 liters of balanced
crystalloid solution.
77. Massive transfusion protocols now mandate aggressive administration of
plasma and platelets as well as red blood cells, usual in a 1 : 1 : 1 ratio. The triad of
hypothermia, acidosis, and coagulopathy is highly lethal; in this scenario,
damage-control surgical principles should be considered and long operative
periods avoided.
78. The initial goal of resuscitation in burn patients is to correct hypovolemia.
Burns cause a generalized increase in capillary permeability with loss of
significant fluid and protein into interstitial tissue. There should be a low
threshold for electiv e intubation in burn patients suspected of having inhalation
injury.
79. Infants may be difficult to intubate because they have a more anterior larynx,
relatively large tongues, and a floppy epiglottis. The narrowest part of the larynx
has been found to be below the vocal cords at the cricoid cartilage. Children
desaturate more rapidly than do adults because of increased metabolic rate,
increased dead space, inefficient chest wall mechanics, and, in neonates,
immature alveoli.
80. Physiologic alterations in patients during pregnancy include increases in
cardiac output, heart rate, plasma volume, minute ventilation, and oxygen
consumption; decreases in SVR; dilutional anemia; loss of functional residual
capacity (FRC); and a hypercoagulable state.
81. Uterine atony is the most common cause of postpartum hemorrhage and
often results in substantial blood loss.82. Obesity and diabetes mellitus increase the parturients' risk for development
of preeclampsia, preterm labor and delivery, painful labor, fetal macrosomia,
and operative delivery, for which a well-functioning, early placed epidural will
increase success for safe delivery and avoid risks for potential general anesthesia.
83. Basal function of most organ systems is relatively unchanged by the aging
process, but the functional reserve and ability to compensate for physiologic
stress are reduced.
84. There is increased potential for a wide variety of postoperative complications
in the elderly; postoperative cognitive dysfunction (POCD) is arguably the most
common.
85. Administering anesthesia to a patient undergoing magnetic resonance
imaging (MRI) poses unique challenges. Any ferromagnetic object can become a
projectile and all equipment, including gas cylinders, must be nonferrous.
86. In the pacemaker coding system, the first letter refers to the chamber paced,
the second letter to the chamber in which sensing occurs, the third letter to the
responses to sensing in chambers, and the fourth letter to rate responsiveness.
87. Loss of afferent sensory and motor stimulation renders a patient sensitive to
sedative medications secondary to deafferentation. For the same reason
neuraxial anesthesia decreases the MAC of volatile anesthetics.
88. The correct use of peripheral nerve block (PNB) can decrease the incidence of
perioperative complications such as pain, nausea, vomiting, and other opioid
side effects caused by the decreased use of such drugs.
89. Methods to improve oxygenation during OLV include increasing FiO ,2
checking DLT and bronchial blocker placement, applying PEEP to the ventilated
lung and continuous positive airway pressure (CPAP) to the nonventilated lung,
asking the surgeon to restrict pulmonary blood flow to the nonventilated lung,
and returning to two-lung ventilation.
90. If ICP is high, as evidenced by profound changes in mental status or
radiologic evidence of cerebral swelling, avoid volatile anesthetics and opt
instead for a total intravenous anesthetic technique.
91. Measures to acutely decrease ICP include elevation of the head of the bed;
hyperventilation (PaCO 25 to 30  mm  Hg); diuresis (mannitol and/or2
furosemide); and minimized intravenous fluid. In the setting of elevated ICP,
avoid ketamine and nitrous oxide.
92. Chronic pain is best treated using multiple therapeutic modalities. These
include physical therapy, psychological support, pharmacologic management,
and the rational use of more invasive procedures such as nerve blocks and
implantable technologies.
93. Preexisting cerebral vasospasm may be worsened by systemic hypotensionduring surgery.
94. Pulmonary catheterization has not been shown to improve outcome in all
patient subsets.
95. Malignant hyperthermia is an inherited disorder that presents in the
perioperative period after exposure to inhalational agents and/or
succinylcholine. Dantrolene is a mainstay of therapy. Discontinue volatile
anesthetic and ask for HELP!
96. Perioperative glucocorticoid supplementation should be considered for
patients receiving exogenous steroids.
97. During OLV, protective ventilation strategies include low-tidal volume
ventilation (6  ml/kg), PEEP 5  cm H 0, limited peak airway pressures, and2
permissive hypercapnia.
98. Patients with diabetes have a high incidence of coronary artery disease with
an atypical or silent presentation.
99. From about 24 hours after injury until the burn has healed, succinylcholine
may cause hyperkalemia because of proliferation of extrajunctional
neuromuscular receptors. Hyperkalemia is a contraindication.
100. Patients with liver disease commonly have an increased volume of
distribution, necessitating an increase in initial dose requirements. However,
because the drug metabolism may be reduced, smaller doses are subsequently
administered at longer intervals.I n d e x
Page numbers followed by “f” indicate figures, “t” indicate tables, and “b” indicate
boxes.
A
ABCs (airway, breathing, circulation), of unconscious, hypotensive patient
management, 324
Abdominal aortic rupture, acute, primary management of, 216–217
Abdominal surgery, perioperative mortality/morbidity associated with, 236t
ABO blood genotypes, 41–42, 42t
Abscess
after epidural anesthesia, 409
formation of, spinal anesthesia-related, 400
Acceleromyography, 92
Acetaminophen, as acute pain treatment, 460
Acetylcholine (ACh), synthesis and degradation of, 12
Acetylcholine (ACh) receptors
locations for, 87
mature versus immature, 89
structure of, 87
Acetylcholinesterase, side effects of, 94
Acetylcholinesterase inhibitors, 94
Acid-base analysis, 22–26
stepwise approach to, 26
Acid-base balance
organs involved in, 23–24
regulation of, 22
Acid-base disorders
causes of, 22
compensatory mechanisms in, 23t
Acid-base status, ABG assessment of, 22
Acidemia, consequences of, 24Acidosis
lactic, as blood transfusion indicator, 38
metabolic
anion gap, causes of, 22b, 25
non-anion gap, causes of, 25b
respiratory, 22
Activated clotting time (ACT), 48
in cardiopulmonary bypass patients, 429–430
Activated partial thromboplastin time (aPTT), 48
Acute kidney injury (AKI), liver disease and, 258
Acute noninfectious lung diseases, causes of, 243b
Acute parenchymal liver disease, cause of, 257
Acute renal dysfunction, laboratory tests in, 271–272
Acute respiratory distress syndrome (ARDS), 240–246, 246b
cause of, 240–242
definitions of, 240, 241b
drug therapies for, 243
inciting events associated with, 242t
lung compliance/resistance and, 17
mortality rate for, 240–242
pathogenesis of, 242
risk factors for, 240
stages of, 242–243
Acute tubular necrosis, 271
Addiction, 295
opiates-related, 461–462
Addisonian crisis, 308
Adenomas, parathyroid, 307
Adenosine monophosphate, cyclic (cAMP), 103
Adhesive arachnoiditis, spinal anesthesia-related, 400
Adrenal gland, anatomy and physiology of, 307
Adrenal insufficiency
in burned patients, 332
perioperative, 308–309
α-Adrenergic agonists, as hypotension treatment, 169
β-Adrenergic agonists, 382tas asthma treatment, 226
as chronic obstructive pulmonary disease treatment, 237t
effectiveness of, 104
side effects and limitations of, 104
α-Adrenergic antagonists. See α blockers
β-Adrenergic antagonists. See Beta blockers
β-Adrenergic blockers, interaction with muscle relaxants, 91
Adrenergic receptors, of SNS, postganglionic, 10
end-organ effects of, 11t
Adrenocortical insufficiency, acute, 308
Adrenocorticotropic hormone (ACTH), 307
Adverse drug reactions see also names of specific drugs
in geriatric patients, 387
Age, in anesthetic solution amount, 412
Agglutinins, 41–42, 42t
Agglutinogens, 41–42, 42t
Agitation, emergent, in pediatric patients, 354
α agonists, role in anesthesia, 142
Air, as laparoscopic insufflation gas, 452t
Air embolism, 329
central venous catheterization-related, 159
venous, 130
Airway
difficult, 57–58
algorithm of, 57–58, 58f
as aspiration risk factor, 232
fire, 337–338, 338b
inhalation injury-related edema of, 331
injuries to, 329
laryngeal mask, 54–56, 350–351, 351t
laser surgery of, 337
considerations for, 337
as fire cause, 337–338, 338b
nasal, 54
oral, 54
pediatric, comparison with adult airway, 348tsurface tension in, 17–18
Airway disease, obstructive, 62, 63t
Airway management, 51–60, 54b
in cervical spine injury patients, 324–325
devices, 56
emergent, with uncleared cervical spine, 324–325
historical information in, 51
in obese patients, 312–313, 313b–314b
in postanesthetic care unit patients, 183
in spinal cord injury patients, 327
in trauma patients, 324
Airway obstruction
burn-related, 331
carotid endarterectomy-related, 221
flow-volume loops in, 63
in neonates, 340
patient position-related, 129–130
Alanine aminotransferase (ALT), hepatic cell damage and, 259
Albumin
as buffering system, 23
in fluid resuscitation, 31, 31t
hepatic synthetic function and, 259
for volume replacement, 31
Albuterol
as allergic reaction treatment, 317
as asthma treatment, 226, 227t
as chronic obstructive pulmonary disease treatment, 237t
Alcohol
absorption and metabolism of, 293–298
considerations for, 294
Alcohol abuse, 294
concerns in, 295b
Alcohol withdrawal, 294
Aldosterone, 30, 307
Aldrete Score, for postanesthesia patient evaluation, 181, 182t
Alkalemia, consequences of, 24Alkaline phosphatase (ALP), biliary tract function and, 259
Alkalosis
metabolic, causes of, 25
respiratory, 22
Allen test, 170–171
Allergic reactions, 315–319, 318b
asthmatic, 225
immune-mediated, types of, 315–318
to local anesthetics, 96–97
treatment of, 317
Altitude, effect on vaporizer, 122
Alveolar gas equation, 18
Alveolar pressure, 18
Alveolar ventilation, relationship with partial pressure of CO (PCO ), 212 2
Alveoli
in pediatric patients, 348t
surface tension in, 17–18
Alzheimer disease, 290
anesthetic problems in, 290
Ambulatory patients, in postanesthesia care unit, 185
American College of Cardiology/American Heart Association, guidelines for
preoperative evaluation before electroconvulsive therapy (ECT) treatment, 456
American Society of Anesthesiologists (ASA)
anesthesia monitoring standards of, 206, 389–390
obstructive sleep apnea checklist of, 313
physical status classification of, 113
Task Force on Sedation and Analgesia, 390
Aminoamides, 96, 97f
ε-Aminocaproic acid, use in heart transplantation patients, 423
Aminoesters, 96, 97f
Aminophylline, as chronic obstructive pulmonary disease treatment, 237t
Amitriptyline, as chronic pain treatment, 468t
Amnesia, anterograde, electroconvulsive therapy-related, 458
Amphetamines, as hyperthermia risk factor, 180
Amrinone, hemodynamic profile of, 102–103
Amyotrophic lateral sclerosis (ALS), 289–292Analgesia
versus anesthesia, 412
epidural
in aortic surgery patients, 216
in obstetric patients, 371, 373–375
neuraxial, 80
preventive/multimodal, 465, 465t
Anaphylactic reactions, 317
to blood transfusion, 39, 40t
Anaphylactoid reaction, 315
Anaphylaxis
causes of, in operating room, 315–316
definition of, 315
incidence of, 317
Anemia
acute normovolemic, 38
in burned patients, 332
cirrhosis-related, 259
dilutional, of pregnancy, 366
Anesthesia
age-related changes on, 63
versus analgesia, 412
awareness during, 174–176
depth of
assessment of, 175
continuum of, 390
geriatric, 385–388, 387b
goals for surgical patients, 215
insufficient, clinical signs and symptoms of, 174
light, 174
neuraxial
versus general anesthesia, 406
in pulmonary hypertension, 254
obstetric analgesia and, 371–377, 376b
outside the operating room, 389–391, 391b
equipment and standards, 389pediatric, 347–355, 354b
Anesthesia bellows ventilator
classification of, 127
failure to rise of, 127
Anesthesia delivery systems. See Anesthesia machines
Anesthesia gases, available on anesthesia machines, 118
Anesthesia machines, 118–127
breathing circuits on, 123, 124f, 126b
closed, 124
disconnection of, 125
Mapleson, 124
open, 123
semiclosed, 124, 125f
semiopen, 124
Datex-Ohmeda, 118, 123
definition of, 118–127
Diameter Index Safety System, 119
Drager, 118, 123
fail-safe valve of, 120, 120f
flowmeters of, 120
gas regulators on, 118–119
gas supply for, 119
interconnections of, 118
for malignant hyperthermia patients, 123
preparation for malignant hypothermia patients, 284–285
safety systems of, 119–120
scavenger systems of, 118, 123
vaporizers of, 123b
Anesthesiologists
cardiac, in pediatric patients, 360–361
role in sedation and analgesia standard establishments, 390
Aneurysm
aortic, 214–217
intracranial, 221–222
rebleeding of, 448
rupture, as spontaneous subarachnoid hemorrhage cause, 222Aneurysm clipping, 221–222
Aneurysm surgery, brain protection during, 223
Angina
grading of, 188
myocardial ischemia-related, 188
pulmonary hypertension and, 248
valvular heart disease-related, 205
Angiography, coronary, for ischemic heart disease evaluation, 190
Angioplasty, balloon, 190
Angiotensin-converting enzyme inhibitors (ACEIs)
as heart failure treatment, 201
as hypertension treatment, 167t
Angiotensin receptor antagonists, as hypertension treatment, 167t
Anhepatic stage, in liver transplantation, anesthetic concerns during, 265
Anion gap, 25
Anorexia, as symptom of heart failure, 200–201
Antacids, preoperative administration of, 111
use in morbidly obese patients, 112
β antagonism, effects of, 142
β antagonists, action mechanism and side effects of, 141
Antibiotic prophylaxis
in burned patients, 333
in pediatric heart disease patients, 350
Antibiotics
allergic reactions to, 315
interaction with muscle relaxants, 91
Anticholinergics, 14–15
as asthma treatment, 226, 227t
as chronic obstructive pulmonary disease treatment, 237t
preoperative administration of, 110
in pediatric patients, 111b
side effects of, 110, 111t
use in electroconvulsive therapy, 456–457
Anticholinergic syndrome, central, 111
Anticholinesterases, for patients with COPD, 238
Anticoagulantsconcomitant use of fish oils and, 321
oral, regional anesthesia and, 400
preoperative discontinuation of, 117
Anticoagulation
cardiopulmonary bypass-related, 429–430
for pulmonary hypertension, 249–250
Anticonvulsants, as chronic pain treatment, 468t
Antidepressants. See also Tricyclic antidepressants
in elderly, 455
preoperative administration of, 109
Antidiuretic hormone (ADH), 332
release of, 27, 28t
synthesis of, 27
Antiemetics, preoperative administration of, 111
Antifibrinolytic agents, use in heart transplantation patients, 423
Antihistamines
as allergic reaction treatment, 317
as hyperthermia risk factor, 180
Antihypertensive agents, 166, 167t
perioperative use of, 168t
use during pregnancy, 380
Antileukotrienes, as chronic obstructive pulmonary disease treatment, 237t
Antithrombin deficiency, in burned patients, 332
Antithrombin III, 46
Antithyroid drugs, 306
Anxiety
awareness during anesthesia-related, 174
blood-loss related, 325t
in parents of pediatric patients, 347
preoperative, 109
in pediatric patients, 112
preoperative, in pediatric patients, 347
AOO modes, in pacemakers, 392
Aortic clamping and unclamping, 215
Aortic cross-clamp, 430–432
Aortic dissection, as aortic stenosis cause, 208–209Aortic insufficiency (AI), 208–209, 209f
hemodynamic goals in anesthetic management of, 210
Aortic stenosis (AS), 206–207
Aortic surgery, 215
Aortic valve replacement, 207, 209
Aortic vascular disease, 214
Aorto-occlusive diseases, 214–217, 217b
definition of, 214–217
Aortocaval compression syndrome, 366
Apgar score, 368, 369t
Apnea, postoperative, in premature infants, 345
Aprotinin, allergic reactions to, 315
ARDS. See Acute respiratory distress syndrome (ARDS)
Arginine vasopressin (AVP). See Vasopressin
Arndt blocker™, 437
Arrhythmias
as active cardiac condition, 115
digoxin-related, 249–250
methadone-related, 296
Arterial blood gas (ABG) analysis, 22
in asthmatic patients, 226
for chronic obstructive pulmonary disease, 235
in evaluating patients with heart failure, 201
during pregnancy, 363–365, 365t
values at sea level, 23t
Arterial hypoxemia, in cirrhosis patients, 258
Arterial monitoring, invasive, complications of, 170
Arteriovenous malformations, cerebral, 223
presentation of, 223
surgical excision of, 223
treatment modalities for, 223
Aspartate aminotransferase (AST), hepatic cell damage and, 259
Aspiration, 231–233, 233b
of acidic fluid, 232
in alcohol abusers, 293
clinical signs and symptoms after, 232definition of, 231–233
in morbidly obese patients, 112
of nonacidic fluid, 232
of particulate food matter, 232
as pneumonitis cause, 111
prevention of, 231–232
risk factors for, 231
treatment for, 232–233
Aspirin, as anticoagulant, 47
Associated pulmonary arterial hypertension (APAH), 247
Asthma
clinical features of, 234
definition of, 225–230
diseases which mimic, 225
important historical features of, 225
mainstay of therapy in, 226
preoperative management in, 227–228
pulmonary function test abnormalities in, 63t
symptoms and physical findings associated with, 225–226
types of, 225
Asynchronous modes, of pacemakers, 392
Atelectasis, in obese patients, 312
Atracurium
allergic reactions to, 315–316
duration of, in liver disease, 262
loading dose of, 311t
for patients with COPD, 238
Atrial fibrillation
central venous pressure waveform, 158
valvular heart disease-related, 205
Atrial septostomy, for pulmonary hypertension, 251
Atropine
for bradycardia, 399
as chronic obstructive pulmonary disease treatment, 237t
side effects of, 111t
use in pediatric patients, 112Attenuated sensorium, during postanesthetic care, 181
Auto-positive-end expiratory pressure (auto-PEEP), 137, 138f
Autoimmune disease, fish oil treatment of, 321
Autonomic denervation, of transplanted heart, 424
Autonomic dysfunction, significance of, 15
Autonomic hyperreflexia, 327
Autonomic nervous system, 9–15, 9b
in Guillain-Barré syndrome, 289
Autoregulation, cerebral, 219
Autoregulation breakthrough, 224
Awake intubation
indications for, 56
medications for, 57t
nerve blocks in, 56–57
patient preparation for, 56
performing, 56
Awakening, from anesthesia, slow, 185
after craniotomy, 448
Awareness
during anesthesia, 174–176, 175b
classification of, 174–175
techniques and clinical situations in, 174
Awareness with recall (AWR)
ramifications of, 174
strategies to decrease the incidence of, 175
Axillary artery
as arterial pressure monitoring cannulation site, 171
as cardiopulmonary bypass cannulation site, 426–427
B
Baclofen, as chronic pain treatment, 468t
Bacteria, antibiotic-resistant, 333
Bacterial infections, contracted from blood transfusion, 39
Balloon-tipped bronchial blockers, in lung isolation, 435t
Barbiturate coma, for intracranial pressure reduction, 280b, 281
Bariatric surgery, as obesity treatment, 312–313Baricity, 397
Baroreceptor reflex, in pediatric patients, 347
Barotrauma, positive-end expiratory pressure-related, 137
Base deficit (BD), 25
Beach chair position, 130
Beck triad, 326–327
Beer-Lambert law, 142–146
Benzocaine, as methemoglobinemia cause, 100
Benzodiazepines, 83–86, 85b
action mechanism of, 85–86
as chronic pain treatment, 468t
duration of, in liver disease, 262
oversedation with, 86
in premedication, 109
used in morbidly obese patients, 112
Benzyl-isoquinoline relaxants, duration of, in liver disease, 262
Beta blockers
as chronic pain treatment, 468t
as hypertension treatment, 166, 167t
indications for, 14
as ischemic heart disease treatment, 191
perioperative use of, 9b
Bezold-Jarisch reflex, 399
Bicarbonate
arterial blood gas value of, 24–25
as buffering system, 23
Bier block, 416
Biliary obstruction, causes of, 261t
Bilirubin
jaundice and, 261
in neonates, 340
Bipolar pacemakers, 392–393
Bispectral index (BIS), 175
Biventricular pacemakers, 394
Bleeding. See Hemorrhage
Blindness. See also Visual losspatterns of, 133
β Blockade, complications of, treatment of, 14
α blockers
as hypertension treatment, 167t
pharmacology of, 14
Blood
arterial, 154
oxygen content of, calculation of, 20
screening of, 42
storage, length of, 39–40
Blood crossmatch, 42, 42t
Blood flow
cerebral
autoregulation, 219
effect of volatile anesthetics on, 280
factors affecting, 281b
ischemic, 219
normal, 219
regulation of, 278–279, 279f
coronary, normal, 187
renal
aspects of, 270
in burn patients, 332
decreased, 271
uterine, during pregnancy, 365–366
Blood gas analysis, 22–26
pH-stat and α-stat methods of, 431
Blood loss. See also Hemorrhage
acceptable, 352
in excisional burn surgery, 335
during liver transplantation, 265
in pediatric patients, 353t
progressive, changes in vital signs with, 325t
Blood pressure
diastolic, in pediatric patients, 348t
disturbances of, 166–173, 172b. See also Hypertension; Hypotensionhypovolemia and, 32
systolic
changes in, with progressive blood loss, 325t
in pediatric patients, 348t
value of, 166–173
Blood pressure monitoring, 166–173, 172b
intraarterial, indications for, 169–170
in obese patients, 312
Blood storage lesion, 39–40
Blood transfusions
autologous, 43
central venous catheterization for, 158
hemoglobin level as indicator for, 116b
infectious diseases contracted from, 39
massive, complications of, 42–43
risks of, 38
Blood types, 41–42, 42t
Blood urea nitrogen (BUN), as test of renal function, 273t
Blood volume
estimated, in pediatric patients, 352t
in obese patients, 310
Blue bloaters, 235
Body composition, age-related changes to, 386
Body mass index (BMI), 310–313, 311t
Body temperature. See also Thermoregulation
monitoring standards for, 390
Body water
compartments of, 27–32, 28f
regulation of, 27
Brachial artery, as arterial pressure monitoring cannulation site, 171
Brachial plexus
anesthesia related injuries, 131
injuries to, 131
positioning-related injury, 131
as somatosensory-evoked potential recording site, 440
surgical exploration of, 441Brachial plexus blocks, local anesthetic systemic vascular absorption in, 98–99
Bradycardia
after epidural anesthetic initiation, 408
fetal, 367
in infants, 342t
opioids-related, 77
in pediatric patients, 347
reflex, prevention of, 110
spinal anesthesia-related, 399
Brain
anesthetic requirements in, 446
electrical activity monitoring in, 175
Brain protection, 223, 447
Brain tumors, 449
Breathing
effect of carbon dioxide and oxygen on, 21
work of
in obese patients, 310
in pediatric patients, 350–351
positive-end expiratory pressure-related increase in, 137
Breathing circuits, on anesthesia machines. See Anesthesia machines, breathing
circuits on
Bronchial blocker, 329
Bronchial tear, 329
Bronchitis
asthmatic, 234
chronic, 234
pulmonary function test abnormalities in, 63t
Bronchospasm, 331
asthma-related, 225
intraoperative, 229, 238–239
Bronchus, width estimation of, 436
Brooke formula, modified, 333
Buffering systems, of body, 23
Bupivacaine, 402
cardiotoxicity of, 99motor block from, 411
potency of, 98t
use in, pediatric patients, 353
use in obstetric patients, 372–373, 373t
Buprenorphine, equianalgesic doses of, 462t
Burned patients, 330–339, 335b
operations for, 333
Burns
classification of, 330
factors of increase mortality in, 330
systems affected by, 330
Butorphanol, as intravenous analgesic for labor, 372t
C
Caffeine-halothane contracture test (CHCT), for malignant hyperthermia, 284
indications for, 284
Calcium, serum levels of, 307
Calcium channel blockers (CCBs), 382t
as hypertension treatment, 167t
interaction with muscle relaxants, 91
for pulmonary artery hypertension, 251
as spontaneous subarachnoid hemorrhage treatment, 222
“Calcium drug”, 107
Cancer, as pain cause, 471b
Cannulation, central venous, contraindications to, 152
Capillary refill rate, changes in, with progressive blood loss, 325t
Capnogram, elevation of baseline of, 148
Capnographic waveform, 148, 149f
processes that can change the usual configuration of, 151, 151f
sudden loss of, 149–150, 149f
Capnography, 148–151, 150b
Capnometry, differentiated from capnography, 148–151
Carbamazepine, as chronic pain treatment, 468t
Carbon dioxide. See also End-tidal carbon dioxide (ETCO )2
absorbent neutralization of, 125
blood transport of, 21effect on breathing, 21
elimination from circle system, 125
importance of measuring, 148
as insufflation gas, 451, 452t
partial pressure, correlation with end-tidal carbon dioxide, 149
Carbon dioxide absorbents, effect on volatile anesthetic by-products, 72
Carbon monoxide poisoning, 331–332, 334
Carbonic anhydrase inhibitors, as diuretic, 270t
Carboxyhemoglobin, effect on pulse oximeter reading, 145
Cardiac arrest, during spinal anesthesia, 400
Cardiac conditions, active, 115
Cardiac disease, during pregnancy, 383
Cardiac evaluation, perioperative, 116
Cardiac filling pressure, incorrect interpretation of, 137
Cardiac function, evaluation of, 189
Cardiac index (CI), 196
Cardiac output
in burned patients, 331
central venous pressure as indicator of, 156–157
exercise and, 196–197
in hypertension, 166
in neonates, 340
in obese patients, 310
in patient evaluation, 196
in pediatric patients, 347
Cardiac output monitors, new minimally invasive, principles of, 164
Cardiac pacing, after bypass, 431
Cardiac remodeling, 195–196
Cardiac risk, perioperative, 114–117, 115b
Cardiac surgery
minimally invasive, 451
peripheral neuropathies associated with, 131
Cardiomyopathy, dilated, as heart failure cause, 194
Cardioplegia, 430
Cardiopulmonary bypass (CPB), 254–255, 426–433, 432b–433b
appropriate checklist for discontinuing, 431basic anesthetic techniques used in, 427–428
complications of, 432
difficulty weaning from, 432
in heart transplantation patients, 422–423
left ventricular (LV) dysfunction after, 424
myocardial protection during, 430
physiologic responses to, 431
specific preparations for, 423
termination of, 424
Cardiopulmonary bypass (CPB) circuit, 426–432
basic components of, 426
priming solutions for, 429
Cardiovascular collapse, local anesthetics-related, 100
Cardiovascular drugs see also names of specific drugs
benefits of, 102–107
use during perioperative period, 191
Cardiovascular system
age-related changes to, 385
effect of alcohol on, 293
effect of burns on, 331
effect of hypothermia on, 178t
effect of local anesthetics on, 99
effect of myotonic dystrophy on, 286
effect of patient positioning on, 128
pediatric
versus child, 347
neonatal, 340
Cardioverter defibrillators, implantable, 393, 396b
Carotid artery, central venous catheterization-related injury to, 158
Cataracts, electrical burns-related, 335
Catecholamines, 11
effect on uteroplacental perfusion, 366
synthetic pathway of, 13f
Catheterization
arterial, for blood pressure measurement, 166–173, 172b
damping coefficient in, 172, 173fflushing of, 173
cardiac
for pulmonary hypertension diagnosis, 249
for valvular heart disease evaluation, 205
central venous, 152–159
catheter placement in, 154, 158–159
catheter removal in, 159
complications of, 158–159
definition of, 152–159, 153f
nonoperative indications for placement of, 152
in obese patients, 312
perioperative indications for placement of, 152
types of catheters used in, 154
pulmonary artery
in ischemic heart disease patients, 192
for pulmonary hypertension monitoring, 252
in valvular heart disease patients, 206
Cauda equina syndrome, 100
spinal anesthesia-related, 399
Caudal anesthesia, 404
Caudal epidural block, in pediatric patients, 353, 353t
Caudal nerve blocks, 98–99
Celebrex, as preventive analgesia, 465t
Central anticholinergic syndrome, 111
Central nervous system. See also Brain
effect of alcohol abuse on, 293
effect of hypothermia on, 178t
effect of local anesthetics on, 99
pregnancy-related changes in, 365
Central somatosensory conduction time, 441
Central venous circulation, catheter introduced into, 152
Central venous pressure (CVP)
as cardiac output indicator, 156–157
influences on, 156
measurement of, 155, 155f
normal values for, 158relationship to right ventricular preload, 157, 157b, 157f
as volume status indicator, 158
waveforms of, 156, 156f, 158
Central waveform, versus peripheral waveform, 171, 171f
Cephalosporins, use in penicillin-allergic patients, 316
Cerebral blood flow (CBF)
factors affecting, 281b
regulation of, 279f
Cerebral cortex, peripheral nerves to, neurosensory pathway, 440
Cerebral perfusion
effect of inhalational anesthetics on, 219
monitoring, 220
Cerebral perfusion pressure (CPP)
in craniotomy patients, 449b–450b
determinants of, 278
Cerebrospinal fluid, as intracranial pressure determinant, 277
Cerebrovascular accidents (CVAs), 218
ephedra-related, 320
etiology of, 218
Cerebrovascular disease, 218–224, 222b–223b. See also Stroke
in aorto-occlusive disease patients, 215
preoperative risk assessment of, 116–117
Cerebrovascular insufficiency, 218–224
Cervical spine injuries, airway management of, 324–325
Cesarean section, anesthesia for
epidural, 375
general, 376
as hypotension cause, 367
regional, 367
spinal, 375, 375t
Cetacaine spray, use in awake intubation, 57t
Chamomile, 320
Chemical burns, 330–335
Chest radiographs, 139–140
in heart failure, 201
in inhalation injury, 331preoperative, 113, 114t
in obese patients, 311
in pulmonary hypertension, 248
for valvular heart disease evaluation, 205
Child-Turcotte-Pugh Score, 259–260, 260t
Chloroprocaine
maximum safe dose of, 98t
potency of, 98t
use in obstetric patients, 372–373, 373t
Cholinergic receptor stimulation, end-organ effects of, 11t
Chondroitin 4-sulfate, 320
Chronic obstructive pulmonary disease (COPD), 234–239, 238b
abnormal physical findings in patients with, 235
with aorto-occlusive disease, 214
blue bloaters, 235
deeply anesthetized or emerging, 239
definition of, 234–239
historical information obtained before surgery in, 234–235
pink puffers, 235
as postoperative pulmonary complication risk factor, 115–116, 116t
treatment of, 237t
Chronic postoperative pain syndrome, 464
Circle system, competency of, 126
Circulatory arrest
considerations associated with, 429
utilized, 428–429
Cirrhosis, 257
laboratory results used to stratify perioperative risk in, 259–260
Cisatracurium, duration of, in liver disease, 262
Citrate, accumulation during liver transplantation, 265
Clevidipine, 105
Clonidine
perioperative use of, 14
as preventive analgesia, 465t
Closing capacity, 16
Coagulation, 45–50, 47bimpaired, secondary to herbal medications, 322
laboratory evaluation of, 117
Coagulation abnormalities, in heart transplantation, 423
Coagulation factors, during pregnancy, 362
Coagulation pathways, intrinsic and extrinsic, 45, 46f
Coagulation studies, preoperative, 114t
Coagulation system, cardiopulmonary bypass-related activation of, 429
Coagulation tests, in pregnant patients, 380
Coagulopathies
in burned patients, 332
cirrhosis-related, 259
massive blood transfusion-related, 42
Cocaine, 296–297, 297b
acute intoxication
anesthetic concerns in, 297
signs and symptoms of, 296
cardiac ischemia in, 296
as hyperthermia risk factor, 180
metabolism of, 296
physiologic effects of, 296
use in awake intubation, 57t
Cocaine withdrawal, 296–297
Codeine
equianalgesic doses of, 462t
metabolism of, 79
Cognitive dysfunction, postoperative, in geriatric patients, 387–388
Cohen blocker™, 437
Colloid solutions, 30–31, 31t
allergic reactions to, 315
use in burned patients, 333
Coma
cardiopulmonary bypass-related, 432
myxedema, 305
Compartment syndromes
abdominal, 326
concept of, 326Complex regional pain syndrome I (CRPS I), 469
Complex regional pain syndrome II (CRPS II), 469
Compliance, pulmonary
dynamic and static, 17
in mechanical ventilation, 138–139
Compound A, 72
Concentric hypertrophy, 206
Conduction, as heat loss mechanism, 178
Conduction blockade, factors involved in, 397
Congenital heart disease, 356–361
adults with, 359
complications related to, 359
cyanotic, 359–360, 360b
incidence of, 356–361
in pregnant patients, 383
surgery for, 359
types of, 356, 357t
Congestive heart failure, 194–203
diastolic, 106
end-stage, β-type natriuretic peptide for, 106
pediatric patients, 349
preoperative risk assessment of, 116–117
signs and symptoms of, 189
Consultations, preoperative, 114
Continuous positive airway pressure (CPAP), use in lung isolation, 434
Contusion, myocardial, 328
Convection, as heat loss mechanism, 178
Cor pulmonale, 247
Corneal abrasion, patient positioning-related, 132
Coronary arteries, anatomy of, 187
Coronary artery bypass grafting, prior to noncardiac surgery, 190
Coronary artery disease (CAD)
in aorto-occlusive disease patients, 214
cirrhosis-related, 258
diabetes mellitus-related, 299
as heart failure cause, 194obesity-related, 310
Coronary syndromes, unstable, as active cardiac condition, 115
Corticosteroids
as asthma treatment, 226, 227t
as chronic obstructive pulmonary disease treatment, 237t
for intracranial pressure reduction, 280b
perioperative, 309
as pretreatment to allergic reaction, 317
as treatment to allergic reaction, 317
Corticotropin-releasing hormone, 307
Cortisol
as chronic obstructive pulmonary disease treatment, 237t
potency of, 308t
production of, 307
Cortisone, potency of, 308t
Cough
asthma-related, 225–226
bronchitis-related, 234
chronic obstructive pulmonary disease-related, 234–235
emphysema-related, 234
as heart failure symptom, 200–201
Craniotomy
anesthesia for, 446–450, 449b–450b
in pediatric patients, 449
sitting-position, 447–448
Creatinine, 271–272
Creatinine clearance rate, 271–272, 273t
Critical illness, mechanical ventilation in, 134–141, 140b
Critical oxygen delivery (DO ), 38–432crit
Cromolyn sodium, 227
as chronic obstructive pulmonary disease treatment, 237t
Cryoprecipitate, 49
Crystalloid solutions
composition of, 30, 30t
effect on intracranial pressure, 280
use in patients undergoing cesarean section, 367Cushing reflex, 449
Cyanosis
asthma-related, 225–226
congenital heart disease-related, 359–360, 360b
Cyclo-oxygenase inhibitors, 382t
Cyclobenzaprine, as chronic pain treatment, 468t
D
Damage control surgery, 326
Damping coefficient, 172, 173f
Dantrolene, 284
effect on skeletal muscle, 91
as malignant hyperthermia treatment, 284
as malignant hypothermia treatment, 285
DDD pacing, of pacemakers, 392
DDI pacing, of pacemakers, 392
Dead space
anatomic, alveolar, physiologic, definition of, 19
positive-end expiratory pressure-related increase in, 137
Death, ephedra-related, 320
Delirium
central anticholinergic syndrome-related, 111
in geriatric patients, 387
Dependence, definition of, 295
Depolarization, 96
Depression
awareness during anesthesia-related, 174
electroconvulsive therapy for, 455
Dermatitis, contact, 315
Desflurane
chemical structure of, 68f
metabolic products of, 72
physical properties of, 68t
and production of carbon monoxide, 72
somatosensory-evoked potential effects of, 442t
vaporizer, 122delivery of, 122–123
Device leads, intravascular access and, 394
Dexamethasone
as chronic obstructive pulmonary disease treatment, 237t
potency of, 308t
as preventive analgesia, 465t
Dexmedetomidine
use in awake intubation, 57t
use in pediatric patients, 349t
Dextrans, use in resuscitation, 31, 31t
Diabetes insipidus (DI), 27–28
causes of, 29t
treatments for, 28–29
Diabetes mellitus, 299–304, 304b
in aorto-occlusive disease patients, 215
glucose control in, 299
laboratory tests for, 302
oral medications used in, 299, 300t
postoperative management in, 303
in pregnant patients, 383
preoperative evaluation in, 301
types of, 299–304
urgent surgery in, 303
Diaphragm
displacement of, patient positioning-related, 130
dysfunction of, carbon dioxide insufflation-related, 451–452
Diarrhea, bloody, 332
Diastolic dysfunction, 166, 197
diagnosis of, 197–199
different types of, 199–200
evolution of, 200f
Diazepam
as chronic pain treatment, 468t
intravenous administration of, 86
as preoperative sedation, 110t
somatosensory-evoked potential effects of, 442tuse in pediatric patients, 349t
Diffuse axonal injury (DAI), 281
Diffusion capacity, single-breath (DLCO), 62
Diffusion defects, as hypoxemia cause, 19
Digitalis, as intraoperative inotrope, 104
Digoxin, for pulmonary hypertension, 249–250
Dilution, lithium, 165
Diplopia, spinal anesthesia-related, 400
Dipyridamole thallium imaging, 190
Disseminated intravascular coagulation (DIC), 49
diagnosis of, 49
in pregnant patients, 383
treatment of, 49
Distal orifice, position of, 155
Diuretics
as hypertension treatment, 167, 167t
loop, 270t
osmotic, 270t
potassium-sparing, 270t
for pulmonary hypertension, 249–250
site of action of, 270, 270t
Dobutamine, hemodynamic profiles of, 104
DOO modes, in pacemakers, 392
Dopamine, 216
clinical indications/current evidence for using, 106–107
hemodynamic profiles of, 104
renal effects of, 274
synthesis of, 12, 13f
Dorsalis pedis artery, as arterial pressure monitoring cannulation site, 171
Droperidol, 442t
Drug-induced liver injury (DILI), 257
Drug metabolism
in burned patients, 332
effect of hypothermia on, 179
in neonates, 340
Drugsas hyperthermia risk factor, 180
as perioperative hypotension risk factor, 168
Duchenne muscular dystrophy, 285–286
“Ductal-dependent” lesions, 358
Duloxetine, as preventive analgesia, 465t
Dynamic compliance, of lung, 17
Dysautonomia, 15
Dyshemoglobinemias, effect on pulse oximeter reading, 145
Dyspnea
asthma-related, 225–230
chronic obstructive pulmonary disease-related, 234–239
as heart failure symptom, 200–201
pulmonary hypertension and, 248
Dysrhythmias, ephedra-related, 320
Dystrophin, 285
E
Echinacea angustifolia, 320
Echocardiography
in anesthesia management, 205
with Doppler technology, for valvular heart disease evaluation, 205
for heart failure evaluation, 201
for ischemic heart disease evaluation, 190
for pulmonary hypertension evaluation, 249
stress, for ischemic heart disease evaluation, 190
transesophageal, 197–199
complications to, 160
contraindications of, 160, 162t
during conventional cannulation, 428
in high-risk cardiac surgical patients, 192
images obtained, 160
indications for, 160, 162b
for perioperative ischemia monitoring, 160
for pulmonary hypertension monitoring, 252
role of, 160–164, 161f
during valvular heart disease surgery, 205Eclampsia, 381
Ecstasy (3, 4-methylenedioxymethamphetamine), 298, 298b
Edema
on the airway, 331
cerebral, 224
in hyperglycemic patients, 303
in liver transplant patients, 264
pulmonary, 331
cardiogenic, lung compliance/resistance and, 17
heart failure-related, 200
negative-pressure, 184
Edrophonium, 238
Eisenmenger syndrome, 247, 349
Elderly patients. See also Geriatric anesthesia
trauma in, 328–329
Elective surgery, in hypothyroid patients, 305–306
Electrical bioimpedance, 165
Electrical burns, 330–335
Electrocardiography (ECG)
during anesthesia, 390
in chronic obstructive pulmonary disease, 235
exercise, 190
in heart failure, 201
in hypothermia, 179
for obese patients, 311
preoperative, 114t
in pulmonary hypertension, 248
QRS complex, magnesium sulfate-related widening of, 380
12-lead, in ischemic heart disease, 191
Electrocautery, pacing devices and, 395
Electroconvulsive therapy, 455–459, 458b
adverse effects of, 458
complications after, 456
effectiveness of, 455
indications for, 455–458
number of treatments, 458safety of, 455
Electroencephalography (EEG)
for brain protection assessment, 447
during carotid endarterectomy, 220
processed, 175
Electrolytes, 33–37, 37b
for chronic obstructive pulmonary disease, 235
Electromagnetic interference (EMI), pacing devices and, 394
Elevated anion gap (AG) metabolic acidosis, 25
EMLA cream, use in pediatric patients, 349
Emphysema, 234
pulmonary function test abnormalities in, 62, 63t
Encephalopathy, hepatic, 257
End-stage liver disease (ESLD), 257
End-tidal anesthetic concentration (ETAC), 175
End-tidal carbon dioxide (ETCO )2
correlation with partial pressure of carbon dioxide, 149
decrease, 150, 150f
definition of, 148
importance of, 148
increase, 150–151, 150f
Endarterectomy, carotid, 219–220
Endocarditis
bacterial, subacute, 360, 360b
infective, as aortic stenosis cause, 208–209
Endocrine disease, nondiabetic, 305–309, 308b
Endocrine system, effect of burns on, 332
Endothelin receptor antagonists, 251
for pulmonary artery hypertension, 250
Endotracheal anesthesia, general, 229
Endotracheal intubation
awake, 56, 57t
blind, 56
head position during, 55f, 133
indications for, 51–60
in laser surgery of the airway, 337objective measures in, 51
Endotracheal tubes
cuffed, for pediatric patients, 350–351
double-lumen, 434, 436f
complications of, 436–437
in lung isolation, 435t
placement and positioning of, 436
right-sided, 436
single-lumen, 435, 435t
size of, for pediatric patients, 350, 350t
types of, 54
Endovascular repair, of the aorta, 216
Enflurane
in implantable cardioverter defibrillators, 394
somatosensory-evoked potential effects of, 442t
Environmental exposure, as chronic obstructive pulmonary disease cause, 234
Ephedra, 320
Ephedrine
for bradycardia, 399
effects and doses of, 12–14
as hypotension treatment, 367
Epidural analgesia, 404–413, 411b
in aortic surgery patients, 216
combined with spinal anesthesia, 375–376
in obstetric patients, 371–374
Epidural anesthesia, 404–413, 411b
caudal, in pediatric patients, 353, 353t, 404
combined with
general anesthesia, 412
spinal anesthesia, 405–406
comparison with
general anesthesia, 406
spinal anesthesia, 405
complications of, 408–409
contraindications to, 407–408
differentiated from spinal anesthesia, 404disadvantages of, 405
in geriatric patients, 387
with heparin administration, 401
local anesthetics used in, 410t
lumbar, 407
neurotoxicity of, 100
physiologic changes after initiation of, 408
postoperative questions for patients after, 412–413
preoperative assessment before performing, 406–407
use in
multiple sclerosis patients, 291
pulmonary hypertension patients, 254
Epidural nerve block, local anesthetic systemic vascular absorption in, 98–99
Epidural placement, paramedian technique for, 407
Epidural space, anatomy of, 404–413
Epidural steroids, as radiculopathic pain treatment, 470
Epinephrine
added to local anesthetics, 99
as allergic reaction treatment, 317
as asthma treatment, 226, 227t
as chronic obstructive pulmonary disease treatment, 237t
hemodynamic profiles of, 104
with local anesthetic, 411
synthesis of, 12, 13f
use in pediatric patients, 351
Epoprostenol, 251
for portal pulmonary hypertension, 258
Erb point, 440
Erythropoietin, 43
Esmolol, 168t
Esophageal Doppler monitor, 161–162, 162f
assumptions and limitations of, 164
for goal-directed fluid therapy, 162–163, 164f
information obtained from, 162, 163f, 163t
intraoperative, 163–164
for other types of surgery, 164use of, 163
Esophageal surgery, lung isolation, 434
Esophagus, accidental intubation of, 149
Ester local anesthetics, allergic reactions to, 414
Estimated fluid deficit (EFD), in pediatric patients, 352
Etidocaine, potency of, 97
Etomidate, 83
cardiovascular effects of, 84t
cirrhosis and, 262
dosing guidelines for, 84t
intracranial pressure effects of, 279
somatosensory-evoked potential effects of, 442t
use in
burned patients, 332
critically ill patients, 84–85
Evaporation, as heat loss mechanism, 178
Evoked response monitoring, for anesthesia depth assessment, 175
Exercise, cardiac output and, 196–197
Exercise intolerance, heart failure-related, 194–203
Exercise tolerance
as cardiac function indicator, 189
decreased, valvular heart disease-related, 205
Expiratory reserve volume, 61, 62f
Extracellular fluid, as intracranial pressure determinant, 277
Extracorporeal membrane oxygenation (ECMO), for pulmonary hypertension, 251
Extubation
criteria for, 59
in obese patients, 312, 312t
100% oxygen administration prior to, 59–60
Eye injury, patient positioning-related, 132
F
Factor VIIa, recombinant, 49
Factor VIII, 47, 259
Familial factors, as chronic obstructive pulmonary disease cause, 234
Famotidine, 231–232Fasting, pediatric, 113, 114t
Fast-track recovery, 181–186
Fatigue
heart failure-related, 200–201
pulmonary hypertension and, 248
Febrile reactions, to blood transfusion, 39
Femoral artery
as arterial pressure monitoring cannulation site, 171
as cardiopulmonary bypass cannulation site, 426–427
Femoral nerve, effect of lithotomy positioning on, 129
Femoral nerve blocks, 98–99
Femoral vein, as central venous catheter insertion site, 154
Femur, fractures of, 326
Fenoldopam, 105, 216
Fenoterol, as chronic obstructive pulmonary disease treatment, 237t
Fentanyl, 75t
as acute pain treatment, 462–463
duration of action of, 78t
elimination half-life of, 78
in epidural anesthetic, 411
equianalgesic doses of, 462t
in implantable cardioverter defibrillators, 394
as intravenous analgesic for labor, 372t
as liver disease treatment, 262
loading dose of, 311t
onset of action of, 78t
peak effect of, 78t
somatosensory-evoked potential effects of, 442t
transdermal, equianalgesic doses of, 462t
use in
awake intubation, 57t
pediatric patients, 349t
Fetal heart rate
decelerations of, 368, 369f
monitoring of, 367, 368t
Feverfew, 320properties and effects of, 322
Fiberoptic endoscopy, 56
Fibrin degradation products, 45–46
Fibrinolysis, 45–46
Fibrinolytic therapy, regional anesthesia and, 400
Fibromyalgia, 469
Fick principle, 165
FiO . See Fractional concentration of oxygen in inspired gas (FiO )2 2
Fires
as burn cause, 330–335
in operating room, 330–339, 338b
components, 337
high-risk procedures for, 337
signs for occurring, 338
triad, 337
Fish oil, 320–321
Fistulas, tracheoesophageal, 343
Flow directed therapy, 160–165, 165b
Flow-volume loop, 63, 64f–65f
Fludrocortisone, potency of, 308t
Fluid distribution, intravascular and interstitial, dynamics of, 27
Fluid management
in acute respiratory distress syndrome, 244
in burned patients, 333
during craniotomy, 446–447
in hepatorenal syndrome patients, 258–259
in pediatric patients, 352
Fluid replacement, 27–32
Fluid resuscitation
colloid solutions use in, 30–31
in intraabdominal surgery, outcomes of, 30
Fluid retention, heart failure-related, 194–203
Fluid status, central venous pressure as indicator of, 157f
Flumazenil, side effects of, 86
Fluoride, as anesthetic metabolic product, 72
Fluoxetine, as chronic pain treatment, 468tFluphenazine, as chronic pain treatment, 468t
Food and Drug Administration (FDA), on herbal medications, 320–323
Foramen ovale, in craniotomy patients, 447–448
Forced expiratory and inspiratory flow at 50% of forced vital capacity (FEF /FIF ),50 50
63, 64f
Forced expiratory volume in one second (FEV ), 62f1
in obstructive lung disease, 63t
Fractional concentration of oxygen in inspired gas (FiO )2
low, as hypoxemia cause, 18
during organ harvesting, 422
oxygen therapy-related increase in, 183, 183t
prior to extubation, 59–60
Fractional of excretion of sodium (FENa), as test of renal function, 273t
Frank-Starling law, 196
Frank-Starling principle, 102–107, 103f
Fresh frozen plasma (FFP), indications for, 48
Fulminant liver failure, 257
Functional residual capacity (FRC), 16
Furosemide, 216
for intracranial pressure reduction, 280b
G
Gabapentin
as chronic pain treatment, 468t
as preventive analgesia, 465t
Garlic, 320
benefits and risks of, 321
Gas flow, pulmonary resistance to, 17
Gas rebreathing, 165
Gas sampling, method of, 148
Gases
available on anesthesia machines, 118
for insufflation, 451, 452t
Gastric acid secretion blockers, preoperative administration of, 110t, 111
Gastric emptying, in neonates, 340
Gastroesophageal refluxin neonates, 340
in obese patients, 310
Gastrointestinal system
acid-base balance in, 24
effect of alcohol on, 293–294
effect of burns on, 332
pregnancy-related changes in, 365
Gastrokinetic agents, preoperative administration of, 110t, 111
Gastroschisis, 343–344
differentiated from omphalocele, 343–344
Gate theory, of pain, 470
General anesthesia
affect pulmonary mechanics, 235–236
for cesarean section, 376
combined with epidural anesthetic, 412
definition of, 391t
effect on renal function, 274
in geriatric patients, 387
heat loss during, 178
in hypertensive patients, 167
in ischemic heart disease patients, 191–192
for minimally invasive surgery, 453
patient discharge following, 185–186
for patients undergoing carotid endarterectomy, 220
in pediatric patients, 354
procedures require, 389–390
ventilation-perfusion (V/Q) mismatch and, 19
General surgery, minimally invasive, 451
Genetic factors, as chronic obstructive pulmonary disease cause, 234
Genetic testing, for malignant hypothermia, 284
Geriatric anesthesia, 385–388, 387b
Gestational diabetes, 299
Ginger, 320–322
Ginkgo, 320–321
Ginseng, 320–321
Glasgow Coma Scale (GCS), 324, 325tGlial cells, as intracranial pressure determinant, 277
GlideScope, 54
Glomerular filtration, 268–269
Glomerular filtration rate, age-related changes in, 386
Glucocorticoids
as hypothalamic-pituitary-adrenal axis disruption cause, 307
use in cardiopulmonary bypass patients, 423
Gluconeogenesis, in neonates, 340
Glucosamine, 320
Glucose
neonates' need for, 340
perioperative monitoring of, 303–304
Glucose control
in critically ill diabetic patients, 301
ideal, 299
Glucose infusion, in diabetic patients, 302
Glucose metabolism, role of insulin on, 301
γ-Glutamyltransferase (GGT), biliary tract function and, 259
Glycopyrrolate
as chronic obstructive pulmonary disease treatment, 237t
as preoperative sedation, 110t
side effects of, 111t
use in awake intubation, 56, 57t
used in morbidly obese patients, 112
Gold salts, as asthma treatment, 227
Goodpasture syndrome, 315
Graft function, in liver transplantation, 266
Graves disease, 305
Gravity, in lung perfusion, 245
Guillain-Barré syndrome, 289
Gum elastic bougies, 56
Gynecologic procedures, minimally invasive, 451
H
Hagen-Poiseuille relationship, 17
Half-time, context-sensitive, 78, 79fHaloperidol, as chronic pain treatment, 468t
Halothane
as cardiac dysrhythmia cause, 71
chemical structure of, 68f
hepatic dysfunction from, 261–262
physical properties of, 68t
somatosensory-evoked potential effects of, 442t
Hand, blood supply to, 170
Head positioning
during endotracheal intubation, 55f, 133
Health care workers, latex allergy in, 318, 318b
Heart disease, congenital, 356–361
Heart failure (HF), 194–204, 203b–204b. See also Congestive heart failure
alterations in heart, 195–196
anesthetic management of, 202
bridge-to-transplant management of patients with, 420
causes of, 194, 195b
classification of severity of, 194
decompensated, 202–203
as active cardiac condition, 115
definition of, 194–203
diastolic, 106
end-stage, β-type natriuretic peptide for, 106
evaluating patient with, 201
long-term treatment of, 203
obesity-related, 310
physical signs of, 201
regional anesthesia contraindicated in patients with, 203
right-sided, 235
staging of, 194
treatment strategies used in different stages of, 201–202
Heart-lung transplantation, for pulmonary hypertension, 251
Heart murmurs
diastolic, 205
during pregnancy, 362
systolic, 205valvular heart disease-related, 205
Heart rate
changes in, with progressive blood loss, 325t
fetal, monitoring of, 367, 368t
in pediatric patients, 348t
Heart sounds, during pregnancy, 362
Heart transplantation, 420–425, 425b
absolute contraindications for, 421
advantage of NO, 424
anesthesia management of patients after, 425
cardiopulmonary bypass, 422–423
common diagnoses indicating, 420–425
criteria for donor selection, 422
indications and contraindications for, 420–421
maintaining anesthesia for, 423
monitors used for, 423
priority criteria for, recipients, 421
retrieved and preserved for, 422
role of peak VO in decision-making process of, 4212
side effects of NO, 425
Heat exhaustion, 180
Heat loss, in the operating room, 178
Heat stroke, 180
Height, in anesthetic solution amount, 412
Heliox, as asthma-related bronchospasm treatment, 229
Helium, 17
as laparoscopic insufflation gas, 452t
HELLP syndrome, 378–379
Hematocrit
in chronic obstructive pulmonary disease, 235
preoperative
measurement of, 113
minimum acceptable, 114
Hematologic system
effect of burns on, 332
effect of hypothermia on, 178tpregnancy-related changes in, 362, 363t
Hematoma
after epidural anesthesia, 409
cervical, 306–307
spinal anesthesia-related, 400
Hemodialysis, 275–276
Hemodilution
cardiopulmonary bypass-related, 431
isovolemic, 43, 443
Hemodynamics
changes in, during laparoscopy, 452, 453t
of heart transplant recipients, 422
stability, during postanesthetic care, 181
Hemofiltration, during cardiopulmonary bypass, 423
Hemoglobin
as blood transfusion indicator, 116b
minimum acceptable, 114
preoperative measurement of, 113, 114t
as transfusion trigger, 38
Hemoglobin saturation, arterial, 142, 143f
Hemoglobin solutions, 43
Hemolytic transfusion reactions, 39, 41–42
Hemorrhage
antepartum, 381
gastrointestinal, 332
retinal, diabetes mellitus-related, 299
risk for, 45–50
subarachnoid, 446–449
spontaneous, 221
warfarin-related, 117
Hemostasis, 45
primary, 45
secondary, 45
Hemothorax, 158
Henderson-Hasselbalch equation, 24–25
Heparinallergic reactions to, 315
as anticoagulant, 48
effect reversed, 431
perioperative administration of, 117
spinal/epidural anesthesia with, 401
use in arterial transducer systems, 172–173
Heparin-induced thrombocytopenia (HIT) antibodies, 429–430
Hepatic encephalopathy, 257
Hepatic function. See Liver function
Hepatic system, effect of hypothermia on, 178t
Hepatitis, viral, as acute parenchymal liver disease cause, 257
Hepatobiliary system, effect of alcohol on, 293–294
Hepatocyte injury, causes of, 262t
Hepatopulmonary syndrome (HPS), 258
Hepatorenal syndrome (HRS), 258
Herbal supplements, 320–323, 322b
Hernia
congenital diaphragmatic, 343
hiatal, in obesity, 310
Herniated disk, as radiculopathy cause, 470
Hip, dislocation of, 128
Hip replacement surgery, pulmonary hypertension after, 255
Histamine, release of, opioids associated with, 76
Histamine blockers, as allergic reaction pretreatment, 317
Histamine receptor antagonists
preoperative administration of, 111
use in morbidly obese patients, 112
use in chronic obstructive pulmonary disease patients, 239
Human immunodeficiency virus (HIV) infection, contracted from blood transfusion,
39
Hunt-Hess classification, of neurologic status following spontaneous subarachnoid
hemorrhage, 221
Hydralazine, 105, 167t
Hydrocephalus, as cause of intracranial pressure increase, 278t
Hydrocodone, equianalgesic doses of, 462t
Hydromorphone, 75t
as acute pain treatment, 460, 462–463duration of action of, 78t
equianalgesic doses of, 462t
onset of action of, 78t
peak effect of, 78t
as seizure risk factor, 79
Hydroxyethyl starch, 31, 31t
Hyperbilirubinemia, conjugated, 261
Hypercapnia, in cerebrovascular disease, 219
Hypercarbia, effect on uteroplacental perfusion, 366
Hyperchloremia, 37
Hypercoagulable state, during pregnancy, 362
Hypercyanotic spells, 358, 358t
Hyperdynamic circulatory state, of liver disease, 258
Hyperglycemia
blood glucose lowering in, 303
complications of, 301
in diabetic patients, 299
Hyperkalemia, 35, 36f, 89
in liver transplant patients, 264
Hyperlipidemia, fish oil treatment of, 321
Hypernatremia, 34, 34t
Hyperparathyroid function, 307
Hyperparathyroidectomy, complications of, 307
Hyperperfusion, cerebral, carotid endarterectomy-related, 221
Hypertension
antihypertensive agent treatment of, 166–167, 167t
carotid endarterectomy-related, 220
causes of, 166
as cerebral ischemic event risk factors, 218
consequences of, 166
definition and classification of, 166–173
diabetes mellitus-related, 299
diastolic, 166–173
electroconvulsive therapy-related, 455–456
ephedra-related, 320
fish oil treatment of, 321general anesthesia use in, 167
intraoperative, 167, 168t, 169
malignant, 166–173
medications for, 457
obesity-related, 310
perioperative, 168
joint cement-related, 168–169
physiologic processes in, 166
portal pulmonary, 258
postoperative, 167, 184
pulmonary, 247–256, 255b
congenital heart disease-related, 356–357
considerations for, preoperative, 253
as crisis, 357
intraoperative measures for, 253
pathophysiology and natural history of, 248
signs of, 248
symptoms of, 248
transesophageal echo signs of, 249
treatment of, 357t
regional anesthesia use in, 169
systemic, 166–173
untreated, 166
Hypertensive disorders, pregnancy-associated, 378, 379t
Hyperthermia
conditions associated with, 180
definition of, 180
malignant, 180, 283–288, 288b
cellular events, presentation, and metabolic abnormalities in, 283
inheritance pattern of, 283
manifestations of, 180
treatment of, 180
Hyperthyroidism
anesthetic effects on, 306
diagnosis of, 306t
signs and symptoms of, 306Hyperventilation
effect on intracranial pressure, 280, 280b
for intracranial pressure reduction, 280b
Hypervolemia, 222
central venous pressure in, 157f
for intracranial pressure reduction, 280b
Hypnotic agents, used in craniotomy patients, 447
Hypocalcemia
after hyperparathyroidectomy, 307
causes and manifestations of, 36–37
treatment of, 37
Hypocapnia, in cerebrovascular disease, 219
Hypocarbia
effect on uteroplacental perfusion, 366
as physiologic variables alter in somatosensory-evoked potentials, 443
Hypokalemia
causes of, 34–35
in liver transplant patients, 264
risks of, 35, 35f
Hypomagnesemia, 37
Hyponatremia
acute, causes of, 33–34
causes of, 34t
classification of, 33
in liver transplant patients, 264
residual neurologic sequelae in, 33
Hypoplastic left heart syndrome, 358
Hypotension
after epidural anesthesia, 408
aortic unclamping-related, 215
as blood transfusion indicator, 38
as cerebral ischemic event risk factors, 218
hypocalcemia-related, 36–37
hypomagnesemia-related, 37
in infants, 342t
orthostatic, after surgery, 9bpatient positioning-related, 130
peri-induction, 9b
as physiologic variables alter in somatosensory-evoked potentials, 443
postoperative, 185
spinal anesthesia-related, 367
subarachnoid block-associated, 399
systemic, pulmonary artery catheter in, 252
thyrotoxicosis-related, 306
treatment for, 185
in unconscious patients, 324
Hypothalamic-pituitary-adrenal (HPA) axis, 307
Hypothermia, 179b
during cardiopulmonary bypass, 423
definition of, 177
effect on drug action and metabolism, 179
effect on organ systems, 178t
electrocardiographic manifestations of, 179
in geriatric patients, 386
in infants, 342t
as intraoperative brain protection, 447
levels of, 426
malignant
drugs administered intraoperatively for, 285
muscular dystrophy and, 286
versus neuroleptic malignant syndrome, 285
susceptibility assessment of, 284
treatment of, 283–284
massive blood transfusion-related, 43
risk for, 177
spinal anesthesia-related, 400
stages of, 177
in trauma patients, 326
used on cardiopulmonary bypass, 426
Hypothyroidism
anesthetic consideration in, 305
causes of, 305primary, diagnosis of, 306t
secondary, diagnosis of, 306t
signs and symptoms of, 305
Hypoventilation
controlled, with permissive hypercapnia, 138
as hypoxemia cause, 18–19
opioids-related, 182
during postanesthetic care, 181
Hypovolemia
on burn patients, 331–332
central venous pressure in, 157f
diagnosis of, 32
in pediatric patients, 352
as perioperative hypotension cause, 168
renal function in, 272
Hypoxemia
in acute respiratory distress syndrome patients, 243
causes of, 18–19, 19b
during OLV, 438–439
Hypoxia
alveolar, 438
diffusion, 69
in infants, 342t
maternal, effect on uteroplacental perfusion, 366
in obese patients, 312
as physiologic variables alter in somatosensory-evoked potentials, 443
postoperative management of, 183
I
Ibuprofen, as chronic pain treatment, 468t
Idiopathic pulmonary arterial hypertension (IPAH), 247
Ileus, 332
Immune-complex formation, 315
Immune function, effect of blood transfusion on, 40
Immune system, effect of burns on, 333
Implantable delivery systems, of drug, 470In-plane approach, using ultrasound guidance, 415–416, 415f
Induction, of anesthesia
in chronic obstructive pulmonary disease, 237–238
in pediatric patients, 347–349
preoxygenation before, 59
rapid inhalational, in pediatric patients, 349
rapid-sequence, 59
in trauma patients, 324
speed of, factors affecting, 69
steal, in pediatric patients, 349
Induction agents see also specific induction agents
for asthmatic patients, 228
for burn patients, 335
cardiovascular effects of, 84t
commonly used, 83
effect on respiratory drive, 84
intravenous, 83–86
somatosensory-evoked potential effects of, 442t
for trauma patients, 325–326
Infants. See also Neonates
cardiovascular system of, 347
intraoperative problems in, 342t
perioperative fluid management in, 352
premature
anesthetic risk in, 340–345
common health problems in, 341t
postoperative apnea in, 345
retinopathy in, 341
Infections
central venous catheterization-related, 159
occult, diabetes mellitus-related, 299
Infectious diseases, contracted from blood transfusion, 39
Informed consent, 113
Inhalational agents. See Inhalational anesthetics
Inhalational anesthetics, 67–73, 70b
biotransformation of, 72