Appendix of Management Algorithms For Certain Clinical Conditions

A1. Management of Local Anesthetic Toxicity

Cardiac arrest Respiratory arrest Coma Seizures Unconsciousness Muscular twitching Serum conc Visual and auditory disturbances Light headedness

Tongue numbness

Fig. A.1 Signs of local anesthetic toxicity

Get Help and Code Cart Ready

Maintain ABCs

Airway management—100 % O2 , airway support with possible endotracheal intubation Treatment of seizures—Benzodiazepines (midazolam 2–4 mg), or propofol (avoid if hypotension) 30–100 mg Management of hypotension/cardiac arrhythmias/arrest—ACLS protocol, vasopressors

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Consider Intralipid (20 % lipid emulsion) Indicated for severe toxicity (convulsions, unconsciousness, respiratory or cardiac arrest) – Bolus of 1.5 ml/kg IV over 1 min – Infusion of 0.25 ml/kg/min – May repeat bolus up to 2 more times with an interval of 5 min – May double the infusion rate if hypotension persists – Total intralipid dose not to exceed 10 ml/kg in 30 min

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Refractory cases may need cardiopulmonary bypass Patients with severe toxicity are monitored in the ICU

P.K. Sikka et al. (eds.), Basic Clinical Anesthesia, 675 DOI 10.1007/978-1-4939-1737-2, © Springer Science+Business Media New York 2015 676 Appendix of Management Algorithms For Certain Clinical Conditions

A2. Management of High Spinal Anesthesia

Recognize signs and symptoms Tingling of arms, slurred speech, diffi culty in breathing, drowsiness

↓ Call for help ↓ Maintain ABCs Airway, Breathing, Circulation ↓ 100 % oxygen/airway support Head-up patient position (reverse trendelenburg) as tolerated If bradycardia—administer IV atropine/epinephrine If hypotension—administer IV ephedrine/phenylephrine/epinephrine Maintain hydration ↓ If patient is pregnant—left lateral uterine tilt If baby is compromised—emergency cesarean section Appendix of Management Algorithms For Certain Clinical Conditions 677

A3. Management of Postdural Puncture Headache

• Establish diagnosis. Rule out other causes of headache such as tension headache, migraine, meningitis, subdural hema- toma, subarachnoid hemorrhage, pneumoencephalus, benign intracranial hypertension (a neurological consult may be needed)

PDPH diagnosed Commonly a female less than 40 years Headache worse on sitting and standing (postural) Can be associated with neck pain, nausea, visual disturbances

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Conservative management Bed rest Hydration Caffeinated drinks or IV caffeine infusion Analgesics (Uncommonly used: sumatriptan, gabapentin, occipital nerve block, sphenopalatine ganglion block)

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If no relief in 24 h Consider Epidural blood patch (EBP)

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If headache still persists May administer Cosyntropin 1 mg IV May repeat EBP Reevaluate 678 Appendix of Management Algorithms For Certain Clinical Conditions

A4. Management of Anaphylactic Reaction

Establish diagnosis Airway—swelling, stridor, hoarseness of voice Breathing—tachypnea, wheezing, hypercarbia, low oxygen saturation Circulation—hypotension, pale, drowsy

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Call for help

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Monitor pulse oximetry, ECG, blood pressure Maintain ABCs—Airway, Breathing, Circulation

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Epinephrine IV Adults 50 mcg, Child 1 mcg/kg

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Supportive management IV hydration IV hydrocortisone IV diphenhydramine (antihistaminic) Beta-2 agonist for bronchospasm Appendix of Management Algorithms For Certain Clinical Conditions 679

A5. Management of Intraoperative Bronchospasm

Normal Alveolar plateau Asthmatic

40 CO2, mm Hg

0 Time, ms

Fig. A.2 Capnograph in a normal and asthmatic patient

Diagnosis Increased peak airway pressure Wheezing on auscultation of lungs Decrease in tidal volume

Increased ETCO2 with up-sloping of waveform

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Inform Surgeon

Increase FiO2 to 100 %

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Precipitating causes and management • Light anesthesia—deepen anesthesia by increasing volatile anesthetic concentration and/or administering propofol • Increased secretions—suction secretions, may administer glycopyrrolate • Main stem intubation/kinking of endotracheal tube (ETT)—use fi beroptic bronchoscope to ascertain position of ETT • Anaphylaxis causing bronchospasm—administer IV epinephrine • Pneumothorax—chest tube insertion by surgeon. If tension pneumothorax, then place a 14/16G needle in the second intercostal space in the midclavicular line

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Treatment of bronchospasm

Increase FiO2 to 100 % Beta-2 agonist (albuterol puffs via endotracheal tube) IV epinephrine for severe bronchospasm IV ketamine 0.2–1 mg/kg 680 Appendix of Management Algorithms For Certain Clinical Conditions

A6. Management of Myocardial Ischemia in the PACU

Think MONA: Morphine, Oxygen, Nitroglycerin, Aspirin

• Administer FiO2 of 100 % • Obtain a 12 lead ECG • Call cardiology consult • Administer metoprolol/esmolol to control heart rate • Nitroglycerin patch/infusion for coronary vasodilation • Morphine for pain • Aspirin orally/rectally • Labs: CBC, electrolytes, cardiac enzymes (troponin, CPK), arterial blood gas • If hypotension—administer vasopressor/s • If fl uid overload—administer diuretics (furosemide) Appendix of Management Algorithms For Certain Clinical Conditions 681

A7. Management of Malignant Hyperthermia

• Early Signs—Increased ETCO2 (hypercarbia), tachycardia, masseter muscle rigidity, generalized muscle rigidity, meta- bolic and respiratory acidosis • Late Signs—hyperkalemia, cardiac arrhythmias, hyperthermia, myoglobinuria

Rule out Light anesthesia (tachycardia, hypertension) Hypoventilation (hypercarbia) Malfunction of expiratory valve on anesthesia machine Transfusion reaction Drugs (cocaine, ecstasy) Neuroleptic malignant syndrome (slow onset) Thyroid storm (no muscle rigidity)

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Inform Surgeon Stop surgical procedure If surgical procedure cannot be stopped, then complete procedure ASAP under total intravenous anesthetic

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Treatment of established MH

• FiO2 of 100 % • Increase minute ventilation • Discontinue triggering agents—succinylcholine, volatile inhalational anesthetic agent, avoid calcium channel blockers • Administer Dantrolene IV—Dantrolene is prepared by diluting each 20 mg vial in 60 ml of sterile water. An IV bolus of 2.5 mg/kg is administered (up to 10 mg/kg). Then 1 mg/kg is given every 6 h for 24–48 h • For severe acidosis—sodium bicarbonate 1–2 meq/kg may be given • Hyperkalemia—is treated by administering glucose+insulin, sodium bicarbonate or calcium chloride • Temperature—cool the patient with ice packs or cold saline lavage. Monitor core body temperature • Cardiac arrhythmias—treat as per ACLS protocol • Urine output and color—is measured by inserting a Foley catheter • Monitor labs—ABG, creatine kinase, serum myoglobin, PT, PTT, lactic acid 682 Appendix of Management Algorithms For Certain Clinical Conditions

A8. Management of Anterior Mediastinal Mass

The most common anterior mediastinal mass in adults is a thymoma, whereas in children it is a lymphoma. Patients may present with dyspnea, cough, hoarseness of voice, and superior vena cava (SVC) syndrome (dyspnea, cough, facial swelling, headache). General anesthesia carries the risk of airway and cardiovascular collapse.

• Tracheal diameter should be examined on a CT chest scan • For patients with SVC syndrome, a large bore lower extremity IV/s is placed • A biopsy could be performed under local anesthesia. For resection, general anesthesia is required • If general anesthesia, then secure airway with possible awake fi beroptic bronchoscopy • Maintain spontaneous ventilation • Avoid muscle relaxants • Patient is placed in semi-Fowler’s position (supine with head 30° high), or position of greatest comfort • Ability to change patient position, as needed (lateral/prone) • Rigid bronchoscope should be available • Cardiopulmonary bypass should be available for high-risk patients Appendix of Management Algorithms For Certain Clinical Conditions 683

A9. Management of Foreign Body Aspiration in the Airway

• Diagnosis is made by a careful history and physical examination • Signs include choking and wheezing following a witnessed aspiration, cough, stridor, and unilateral decreased breath sounds • Chest X-ray may be normal, or may show atelectasis or area of hyperinfl ation (obstruction causing distal hyperinfl ation from air trapping) • Dexamethasone is administered to decrease airway edema, and glycopyrrolate as an antisialagogue • Induction of general anesthesia is usually intravenous • However, inhalational induction may be done in an emergency or in a distressed child • Inhalational induction is carried out with 100 % O 2 and sevofl urane • Spontaneous ventilation is safest and is commonly used, as it will not push the foreign body more distally, but there is risk of coughing, laryngospasm, and patient movement • Controlled ventilation provides better control of airway, and no patient movement; however, positive pressure breaths may push the foreign body more distally • Rigid bronchoscopy for removal of foreign body: Surgeon instruments the airway in consultation with the anesthesiologist Index

A Acute Kidney Injury Network (AKIN) , 448 Abbott, E.G. , 3 Acute normovolemic hemodilution (ANH) , 103–104 Abdominal aortic aneurysms (AAA) Acute pain anesthetic management , 356–357 acetaminophen , 270 cross clamping and unclamping , 357 AEDs, ACDs, membrane stabilizers , 271 graft repair , 355–356 analgesic modalities , 269–270 postoperative management , 357–358 benzodiazepines and antispasmodic drugs , 271 symptoms , 356 COX inhibitors/NSAIDs , 270–271 Abdominal compartment syndrome (ACS) , 441, 620 defi nition of , 265 Abdullah, A.R. , 175–183 intravenous local anesthetics , 271 Accreditation Council for Graduate Medical Education (ACGME) , 671 NMDA antagonists , 271 Acetaminophen , 166–167, 270, 541 non-opioid analgesics , 270 Acetazolamide , 170, 171 non-pharmacologic measures , 270 Acetylcholine , 120–121, 151, 152 opioids , 271–275 Acid base balance pain evaluation , 269 classic acid-base theory patient-controlled epidural analgesia , 275 anion gap , 610 preemptive analgesia , 270 arterial blood gas analysis , 610–611 regional anesthesia , 275 Henderson–Hasselbalch equation , 609–610 topical agents , 271 metabolic indices , 610 Acute postoperative hypertension (APH) , 580–581 pH regulation , 611–612 Acute renal failure (ARF) , 561, 594 physicochemical approach Acute respiratory distress syndrome (ARDS) carbonic acid equilibrium , 612–613 causes , 560 chemical interactions affect , 612 management , 560–561

PCO2 , 613 pathophysiology , 560 SID. ( see Strong ion difference (SID)) Adams, M.C. , 489–498 specifi c metabolic abnormalities , 613 Adams, P. , 615–621 total weak acid concentration , 613 Addison’s disease , 468–469 Acquired heart disease Adjustable pressure-limiting (APL) valve , 57, 63 aortic regurgitation , 520 Adrenergic agonists aortic stenosis , 520 alpha-and beta-receptor effects , 178 ischemic heart disease , 519 dobutamine , 179 mitral regurgitation , 520 dopamine , 179 mitral stenosis , 520 ephedrine , 178 peripartum cardiomyopathy , 519–520 epinephrine , 177 primary pulmonary hypertension , 519 norepinephrine , 177–178 valvular heart disease , 520 phenylephrine , 178–179 Acupuncture , 270, 654–655 physiological effects of , 178 Acute kidney injury (AKI) AEDs. See Antiepileptic drugs (AEDs) AKIN criteria , 448 AFE. See Amniotic fl uid embolism (AFE) biomarkers , 450–451 Airway exchange catheter (AEC) , 579 BUN , 450 Airway management characteristics , 448 airway assessment , 23 creatinine , 450 airway blocks intrinsic failure , 449 glossopharyngeal nerve block , 42 parameters , 449 superior laryngeal nerve block , 41 postrenal failure , 449 transtracheal nerve block , 41–42 prerenal failure , 449 diffi cult intubation, prediction of , 26 prevention , 449, 450 diffi cult surgical airway, prediction of , 27 RIFLE criteria , 448 diffi cult videolaryngoscopy, prediction of , 26 risk factors , 449 DMV, prediction of , 25–26 urine output , 450 endotracheal intubation. (see Endotracheal intubation)

P.K. Sikka et al. (eds.), Basic Clinical Anesthesia, 685 DOI 10.1007/978-1-4939-1737-2, © Springer Science+Business Media New York 2015 686 Index

Airway management (cont.) etidocaine , 192 ENT surgery levobupivacaine , 193 airway foreign body , 498 lidocaine , 191 epiglottitis , 496 mepivacaine , 192 laryngospasm , 497–498 prilocaine , 191–192 Ludwig’s angina , 496–497 ropivacaine , 192–193 OSA , 497 Aminocaproic acid , 183 retropharyngeal abscess , 496 Amniotic fl uid embolism (AFE) , 521, 524 supraglottic airways , 497 Amphetamine , 638–639 extubation , 43 Amrinone , 181 history of , 5 Amyotrophic lateral sclerosis (ALS) , 475 LMA insertion, prediction of , 26 Anaphylaxis , 200–201 nonintubation airway management. (see Nonintubation airway Anatomy management) of brachial plexus , 233 otorhinolaryngologic procedures , 497 internal jugular (IJ) vein , 81, 82 PACU , 577–580 kidney and urinary system , 444 patient history , 23, 24 liver , 431, 432 physical examination nerve cell , 185, 186 jaw protrusion test/ULBT , 25 ocular anatomy , 484 LEMON criteria , 23, 24 respiratory system , 363–365 Mallampati score , 23, 25 subclavian (SC) vein , 83, 84 preeclampsia , 514 vertebral column and spinal cord RSII , 42–43 blood supply , 213 tracheal resection , 392–393 cervical and lumbar curvatures , 211 AKI. See Acute kidney injury (AKI) ligaments , 212 Akinesia , 151, 485 meninges , 213 Aladin cassette vaporizer , 62–63 spinal nerves , 212 Alcohol (ethanol) structure , 211, 212 alcohol withdrawal , 637–638 thoracic and sacral curvatures , 211 anesthetic implications , 638 Anderson, P.C. , 603–608 toxicity , 637 Anemia , 105 Aleshi, P. , 211–231, 297–306 causes of , 109–110 Alfentanil , 146 in CKD patients , 452 Allen test , 72 diagnosis of , 108 Allergic reaction. See Hypersensitivity erythropoietin , 103 Alpha1-acid glycoprotein (AAG) , 140 PRBCs , 102 Alpha-2 adrenergic agonists types of , 109 clonidine , 167 Anesthesia dexmedetomidine , 167–168 airway management. (see Airway management) Alvimopan , 147, 274 ambulatory anesthesia. (see Ambulatory anesthesia) Alzheimer’s disease (AD) , 121, 480, 654 arousal pathway , 121 Ambulatory anesthesia basic mechanisms of , 119 advantages , 417 cardiac anesthesia. (see Cardiac anesthesia) anesthesia techniques defi nition of , 119 general anesthesia , 419 epidural anesthesia. (see Epidural anesthesia) MAC , 418 equipment preparation , 20 regional anesthesia , 418–419 general anesthesia. (see General anesthesia (GA)) bariatric surgery , 420 inhalational anesthetics. (see Inhalational anesthetics) discharge criteria , 420 intravenous anesthetics. (see Intravenous anesthetics) facial surgeries , 420 lipid-based theory , 119–120 fast tracking , 421 local anesthetics. (see Local anesthetics) fl uid management , 420 MAC , 119 liposuction , 420 Meyer and Overton correlation , 119–120 pain management , 419–420 neuroanesthesia. (see Neuroanesthesia) patient selection , 417–418 NORA. (see Non-operating room anesthesia (NORA)) PONV prophylaxis , 420 obstetric anesthesia. (see Obstetric anesthesia) preoperative evaluation , 418 pediatric anesthesia. (see Pediatric anesthesia) risks , 417 protein-based theory , 120–121 surgical procedures , 417, 418 regional anesthesia. (see Regional anesthesia (RA)) American Society of Anesthesiologists (ASA) , 424 spinal anesthesia. (see Spinal anesthesia) basic anesthetic monitoring , 70, 71 Thoracic anesthesia. (see thoracic anesthesia) physical status , 14 Anesthesia machine Amide local anesthetics , 189 anesthesia mechanic circuit diagram , 47 allergic reactions , 200 anesthesia workstation , 45, 46 bupivacaine , 192 APL valve , 63 dibucaine , 192 breathing circuits. (see Breathing circuits) Index 687

circuit pressure sensor , 63 Asthma electrical components , 45–46 desfl urane , 376 electrical safety , 64–65 intraoperative bronchospasm , 376 fail-safe safety devices , 50–52 isofl urane , 376 fl owmeters , 52–53 lidocaine , 376 history of , 5 obstetric anesthesia humidifi ers , 64 continuous lumbar epidural analgesia , 517 medical gases. (see Medical gases) effects , 517 newer anesthesia workstations , 66 inhaled beta-adrenergic agonists , 517 operating room scavenging system , 65–66 medical management , 517 pneumatic components , 45 neuraxial anesthesia , 517 spirometers , 63 pregnancy effects , 516 vaporizers. (see Vaporizers) symptoms , 516 ventilators , 63, 64 pathologic features , 374 workstation checkout/guidelines , 67 preoperative evaluation , 9 Ankle surgery , 303 preoperative preparation , 375 Antepartum hemorrhage prevalence , 374 defi nition of , 521 sevofl urane , 376 placental abruption , 521 signs and diagnosis , 374–375 placenta previa , 522, 523 treatment , 375 uterine rupture , 522 Atracurium , 154 vasa previa , 522 Atrial natriuretic peptide (ANP) , 91, 93, 447 Anterior cruciate ligament (ACL) , 300 Atropine , 157 Anticonvulsant drugs (ACDs) Autologous blood donation , 103–104 acute pain , 271 Autonomic hyperrefl exia (AH) , 457, 473, 626 chronic pain , 278 AV P . See Arginine vasopressin (AVP) Antidiuretic hormone (ADH) antagonists , 170, 172 Awareness Antiemetic therapy , 160 anesthesia machine check , 644 anticholinergics , 161 characteristics , 643–644 aprepitant , 606 incidence , 643 corticosteroids , 161 intraoperative approach , 644 dexamethasone , 606 legal consequences , 645 dopamine antagonists , 160–161 monitoring , 644 droperidol , 606 postoperative approach , 644 histamine (H1) blockers , 161 preoperative evaluation , 644

5-HT 3 antagonists , 160, 606 psychological consequences , 645 mechanism , 606 risk factors , 643 neurokinin 1 receptor antagonists , 161–162 Ayre, P. , 5 ondansetron , 605 preoperative medication , 13 prevention , 605, 607 B scopolamine , 606 Backward upward rightward pressure (BURP) , 35 treatment , 605, 607 Badve, M. , 501–526 Antiepileptic drugs (AEDs) Bag-mask ventilation technique acute pain , 271 assessment of , 29 chronic pain , 278 contraindications and complications , 29–30 Antifi brinolytics , 183, 326 face mask, characteristics of , 28 Apfel’s model , 605 one-provider technique , 29, 30 Aprotinin , 183 prerequisites for , 28–29 ARDS. See Acute respiratory distress syndrome (ARDS) two-provider technique , 29, 30 Argalious, M. , 575–584 uses , 28 Arginine vasopressin (AVP) , 182 Bain , 56 Arndt endobronchial blocker , 385, 387 Bain circuit , 56, 57 Arnold–Chiari type II malformation , 540 Bariatric surgery Arterial blood gas analysis FRC and CV , 439

HCO3 , 611 induction , 440 PaCO 2 , 610 maintenance , 440 PaO 2 —hypoxia , 611 monitoring , 440 pH , 610 OSA , 439 Arterial blood pressure monitoring , 69, 70 oxygen consumption and carbon dioxide production , 439 Arterial digital photoplethysmography , 70 patients position , 440 Arterial hypertension , 69 prevalence , 438 Arterial tonometry , 70 routine awake extubation , 440 Arthroscopy , 301 Roux-en-Y gastric bypass , 438 Ascites , 434 Barker, A. , 5 Assessment of Blood Consumption (ABC) score , 618 Bauer, A. , 101–114 688 Index

Beaman, S.T. , 169–172, 671–674 Mapleson systems , 54–57 Becker’s muscular dystrophy (BMD) , 478 requirements , 53–54 Beckwith–Wiedemann syndrome , 539 Breathing control Benumof, J.L. , 615–621 chemical control , 365, 366 Benzocaine , 40, 191 neuronal control , 365 Benzodiazepines (BZDs) , 419 peripheral chemoreceptors , 365–366 acute pain , 271 Bronchial blockers (BB) chronic pain , 279–280 Arndt endobronchial blocker , 385, 387 diazepam , 149 cohen endobronchial blocker , 385 fl umazenil , 149 univent BB tube , 385–387 indications and usage , 147–148 Bupivacaine , 188, 192, 194, 220, 542 lorazepam , 149 Buprenorphine , 146, 281, 638 midazolam , 148–149 Butorphanol , 146, 274, 281, 506 pharmacodynamics , 147 Butterly, A. , 443–458 pharmacokinetics , 147 BZDs. See Benzodiazepines (BZDs) side effects and toxicity cardiovascular effects , 148 paradoxical effect , 148 C respiratory compromise , 148 Caglieri, G. , 5 tolerance, dependence, and withdrawal , 148 Cain, J.G. , 615–621 structure–activity relationships , 147 Calcium channel blockers (CCB) Berry, S. , 483–486 dihydropyridine and non-dihydropyridine , 180 Beta-adrenergic blockers diltiazem , 181 esmolol , 180 nicardipine , 181 labetalol , 180 nifedipine , 180 metoprolol , 180 nimodipine , 181 propranolol , 179 properties of , 181 Bicarbonate , 194 verapamil , 181 Bier, A.K.G. , 5, 299 CAM. See Complementary and alternative medicine (CAM) Bier block , 242, 299 Campbell, L. , 363–394 Bipolar disorder , 483 Campbell, N.F. , 151–157 Bispectral index (BIS) , 18, 80, 132 Cancer pain Bittner, E.A. , 443–458, 489–498 assessment and evaluation of , 294 Blood disorders classifi cation of , 294 anemia , 108–109 defi nition of , 265, 294 coagulation disorders. (see Coagulation disorders) interventional therapies , 295 polycythemia , 110 pharmacologic medications , 294–295 Blood urea nitrogen (BUN) , 450, 503 Capnography , 77–78, 437 Bonica, J. , 5, 265 Carbonic anhydrase inhibitors , 171 Bovet, D. , 5 Cardiac anesthesia Boyle, H. , 5 cardiac implantable electronic devices Boyle’s Law , 46, 48 generic codes , 319 Brachial plexus indications , 320 anatomy of , 233, 235 lidocaine , 320 axillary blockade , 239 monopolar electrocautery , 319 infraclavicular blockade , 238–239 pacemakers and ICD , 318, 319 innervation of upper extremity , 233, 235 sheer devices and programming modes , 319 intercostobrachial and median cutaneous nerve block , 241 cardiac tamponade , 345–346 interscalene blockade , 253–255 cardiac transplantation , 350–351 median nerve blockade , 241 cardiovascular physiology preparation technique , 242–243 afterload , 313, 314 radial nerve blockade , 240 blood pressure ,311, 312 supraclavicular blockade , 255–256 cardiac output , 311 suprascapular blockade , 238 coronary circulation , 313–314 ulnar nerve block , 241 EDV , 312, 313 Brain, A. , 5 heart rate and rhythm , 312 Brainstem auditory evoked potentials (BAEPs) , 80, 81 stroke volume , 312 Braun, H. , 5 CPB Breath Holding Time (BHT) , 598 anesthetic vaporizer , 329 Breathing circuits anticoagulation , 329, 334–335 Bain circuit , 56, 57 bypass machine , 327 circle breathing system , 57 cannulation ,329–330 defi nition of , 53 cardioplegia pump , 329 Jackson-Rees circuit , 56–57 cardiotomy reservoir , 329 Lack system , 56, 57 extracorporeal mechanical circulatory support system , 327 Magill’s circuit , 56, 57 heat exchanger , 329 Index 689

hemoconcentrator , 329 indications , 320 hemodynamic management , 331–332 NBE , 322 initiation , 330–331 preoperative CT scan , 322 line fi lter , 328 probe insertion and manipulation , 321, 322 neurological protection , 332 thoracic aorta oxygenator , 328 anesthetic management , 349 post-CPB bleeding , 335 aortic aneurysms , 348–349 post-CPB hemodynamic management , 334 aortic root and valve , 347 pump , 327 cardiovascular trauma , 349–350 separation , 333–334 carotid/subclavian arteries , 347 termination , 332–333 coronary ostium , 347 venous reservoir , 327 DeBakey classifi cation system , 347, 348 HCM , 345 Ehlers–Danlos syndrome , 347 intraoperative management esmolol , 347 anesthesia maintenance , 325 Marfan syndrome , 347 bleeding prophylaxis , 326 nitroprusside infusion , 347 induction , 325 Stanford classifi cation system , 347 inotrope , 323 valvular heart disease. (see Valvular heart disease) intraoperative monitoring , 324–325 Cardiac index (CI) , 311 premedication , 323–324 Cardiopulmonary bypass (CPB) preventing adverse hemodynamic responses , 323 anesthetic vaporizer , 329 sternotomy and cardiac exposure , 326–327 anticoagulation , 329, 334–335 surgical incision , 325–326 bypass machine , 327 vasoconstrictor , 323 cannulation , 329–330 vasodilator , 323 cardioplegia pump , 329 ischemic heart disease cardiotomy reservoir , 329 CAD , 339 extracorporeal mechanical circulatory support system , 327 coronary perfusion , 338–339 heat exchanger , 329 IABP , 339–340 hemoconcentrator , 329 OPCAB hemodynamic management , 331–332 epicardial stabilization devices , 337 initiation , 330–331 functional safety net , 338 line fi lter , 328 inhaled agent/total intravenous anesthesia , 338 neurological protection , 332 isofl urane , 338 oxygenator , 328 keyhole cardiac surgery , 337 post-CPB bleeding , 335 neuraxial techniques , 338 post-CPB hemodynamic management , 334 operating room setup , 337 pump , 327 physiologic effects , 337 separation , 333–334 prevalence , 337 termination , 332–333 single and double-bypass surgery , 337 venous reservoir , 327 postoperative management Cardiopulmonary resuscitation (CPR) management , 337 adult bradycardia algorithm , 565, 571 patient transport , 335–336 adult cardiac arrest algorithm , 565, 570 postoperative analgesia , 336–337 AV (heart) block , 565, 566, 569 preoperative management breathing, minimum rate , 565 airway disease , 316 cardiac rhythm , 566 antidiabetics , 317–318 cardiovascular status , 570 antihypertensives , 317 defi brillation , 565 chronic anticoagulant therapy , 318 drugs , 565, 569 COPD , 316 nasal/oral airways , 564 coronary artery disease , 316 supraventricular rhythm , 565, 567 diabetes mellitus , 316–317 therapeutic hypothermia , 570 herbals , 318 ventilation , 570 history , 315 ventricular rhythm , 565, 568 laboratory tests , 317 Cardiovascular disease , 182, 258, 593 liver dysfunction , 317 Carotid artery stenosis MET , 315, 316 cardiovascular protection , 360 NYHA functional classifi cation , 315 general anesthesia , 359–360 patient assessment , 314–315 neurologic protection , 360 physical examination , 315–316 normal carotid arteries , 359 renal dysfunction , 317 plaque formation , 359 TEE postoperative management , 360 bite block , 322 regional anesthesia , 358–359 complication rate , 322 symptoms , 358 comprehensive examination , 320–321 CCB. See Calcium channel blockers (CCB) contraindications , 321 CDH. See Congenital diaphragmatic hernia (CDH) 690 Index

Central nervous system (CNS) chronic bronchitis , 376–377 depressants emphysema , 376 alcohol (ethanol) , 637–638 estimation , 376 opioids , 638 GOLD classifi cation , 377 elderly patients , 994 MMRC , 377 etomidate , 135 preoperative evaluation , 9 ketamine , 136 prevalence , 376 preeclampsia , 514 Chronic pain propofol , 131 assessment of , 275–276 stimulants complementary and alternative medicine , 290 amphetamine , 638–639 defi nition of , 265 cocaine , 638–639 imaging and diagnostic testing , 277 tobacco and marijuana , 639–640 interventional pain management thiopental , 133–134 caudal epidural injection , 284 Central venous cannulation (CVC) celiac plexus blocks , 286 complications of , 84 cervical sympathetic block/stellate ganglion block , 286 contraindications for , 81 cryoablation , 285 femoral vein , 84 dorsal column and deep brain stimulation , 289–290 fi lling pressures , 84 ganglion impar block , 287 IJ insertion, technique of , 81–82 hypogastric plexus block , 287 indications for , 81 ilioinguinal nerve block , 288, 289 subclavian vein , 83 imaging , 283 venous puncture, confi rmation of , 82–83 implantable therapies , 289 volume status , 84 indwelling epidural catheters , 289 waveform characteristics , 84–85 intercostal nerve block , 288 Central venous pressure (CVP) , 81, 551 interlaminar epidural steroid injection , 283 Cerebral aneurysm surgery , 412–413 intra-articular facet blocks , 284, 285

Cerebral metabolic rate and oxygen consumption (CMRO2 ) , 125 intrathecal infusion pump implantation , 289 Cerebral physiology kyphoplasty , 289 cerebral protection lateral femoral cutaneous nerve block , 288, 289 anesthetic agents , 404 lumbar sympathetic blocks , 287 corticosteroid therapy , 405 medial branch nerve blocks , 471 hypothermia , 404–405 occipital nerve block , 287 multiple anti-infl ammatory agents , 405 paravertebral nerve block , 287 nimodipine and nicardipine , 405 pharmacology , 282–283 pathophysiology , 403–404 radiofrequency lesioning , 285 inhalational anesthetics , 402–403 sacroiliac joint injections , 284–285 intravenous anesthetics , 402 sympathetic nervous system anatomy , 285–286 vasoactive drugs , 403 transforaminal epidural steroid injection , 283 Cerebrovascular accidents (CVA) trigeminal nerve block , 287 atrial fi brillation , 476 pharmacologic management CHADS2-VASC , 476 AEDs, ACDs, membrane stabilizers , 271 data , 476 antidepressants , 277–278 etiology , 475 benzodiazepines/muscle relaxants , 279–280 mechanisms , 476 COX inhibitors/NSAIDs , 277 perioperative evaluation , 475 NMDA antagonists , 279 Chalifoux, T.M. , 637–640 non-opioid analgesic agents , 277 Charcot-Marie-Tooth (CMT) disease , 475 opioids , 280 Chemoreceptor trigger zone (CTZ) , 159, 161, 605 sodium-channel blocker , 279 Chest X-ray (CXR) , 12, 589, 650 topical medications , 280 Child–Turcotte–Pugh (CPT) system , 433 physical examination , 278 Chloroprocaine , 190, 220 psychological approach , 290 Chronic kidney disease (CKD) rehabilitation , 290 coagulopathy , 452 Circle breathing system defi nition , 451 advantage , 56

encephalopathy , 452 CO2 absorption , 59 kidney dysfunction , 451 components of , 57–58 metabolic acidosis , 451 principle of , 57 myocardial dysfunction and congestive heart failure , 452 Cisatracurium , 19, 154, 435 pericarditis , 452 CKD. See Chronic kidney disease (CKD) physiologic system , 451 Clark, C. , 423–430 preoperative evaluation , 10 Clarke, W.E. , 4 pulmonary edema and pleural effusions , 452 Clonidine , 167, 194 Chronic obstructive pulmonary disease (COPD) , 316, 355 epidural anesthesia , 228 anesthetic considerations , 377–378 spinal anesthesia , 221 BODE index , 377 Closing volume (CV) , 439 Index 691

Clover, J. , 3 Creutzfeldt-Jakob disease (CJD) , 650–651 Clover-respirator bag , 3 Cricoid pressure (CP) , 42–43, 513, 604 CNS. See Central nervous system (CNS) Critical care medicine Coagulation disorders acute myocardial infarction coagulation cascade , 110, 111 causes , 562 coagulation factors , 110, 111 classifi cation , 562–563 DIC , 111 diagnosis , 563–564 hemophilias , 112 management , 564 hemostasis, laboratory tests for , 110, 111 risk factors , 563 medications , 113 acute renal failure , 561 vitamin K defi ciency , 112–113 acute respiratory distress syndrome Cocaine , 5, 190–191, 638–639 causes , 560

CO2 embolism , 438 management , 560–561 Cohen Flextip Endobronchial Blocker , 385 pathophysiology , 560 Cohen, S.R. , 647–651 burns Collins, T. , 24 anesthetic considerations , 572 Colton, G. , 3 classifi cation , 571 Combined spinal–epidural (CSE) technique , 228 physiologic changes , 571–572 Complementary and alternative medicine (CAM) , 290 CPR. ( see Cardiopulmonary resuscitation (CPR)) acupuncture , 654–655 ethical issues , 562 echinacea , 653 mechanical ventilation ephedra , 653 airway protection , 555

garlic , 653 impaired CO2 elimination , 555 ginkgo , 654 impaired oxygenation , 555 ginseng , 654 invasive positive pressure ventilation. (see Invasive positive hypnosis , 1098 pressure ventilation) kava kava , 654 NIPPV , 555 melatonin , 654 weaning patients , 558 music therapy , 655 oxygen hazard non-herbal supplements , 654 absorption atelectasis , 559 saw palmetto (SP) , 654 fi re hazard , 559 St. John’s wort , 654 hypoventilation , 558–559 valerian , 654 pulmonary toxicity , 559 vitamin E , 654 retinopathy of prematurity , 559 Complex regional pain syndrome (CRPS) , 238, 292 parenteral nutrition , 562 Computerized tomography (CT) scans , 277, 426 pulmonary edema , 559–560 Confusion-Assessment Method (CAM-ICU) , 600 pulmonary embolism Congenital diaphragmatic hernia (CDH) , 538–539 blood clots , 564 Congenital myasthenic syndromes (CMS) , 477 clinical signs , 564 Congenital syndromes , 24 diagnosis , 563–564 Conivaptan , 172 management , 564 Cooley, S. , 3 sedation , 559 COPD. See Chronic obstructive pulmonary disease (COPD) sepsis Cormican, D.S. , 169–172 management , 554 Corning, L. , 5 pathophysiology , 554, 555 Coronary steal syndrome , 126 systemic infl ammatory response syndrome , 554 Corticosteroids , 161, 201, 375 shock. ( see Shock) smoke inhalation injury Cosmetic surgery CO poisoning , 561 breast surgery , 658–659 cyanide toxicity , 561–562 facial aesthetic procedures , 658 Crosby, E.T. , 230 intraoperative management Cryoprecipitate , 101, 103, 105 general inhalation anesthesia , 657 Cuff leak test , 579 lidocaine toxicity , 658 Curare , 5 regional anesthesia , 657 Cushing, H. , 304 TIVA , 657 Cushing’s syndrome , 399, 468 liposuction , 658 CVA. See Cerebrovascular accidents (CVA) PONV , 659 CVC. See Central venous cannulation (CVC) preanesthetic evaluation , 657 CVP. See Central venous pressure (CVP) CPB. See Cardiopulmonary bypass (CPB) Cytomegalovirus (CMV) , 107, 648 CPR. See Cardiopulmonary resuscitation (CPR) Craniotomy emergence , 407–408 D induction , 407 Dalby, P.L. , 663–665, 667–669 maintenance , 407 Damian, D. , 119–121 monitoring , 406–407 Datex-Ohmeda machines , 51 patient position , 407 da Vinci robotic surgical system , 627–630 preoperative evaluation , 406 DeChancie, S.M. , 667–670 692 Index

Deep venous thrombosis (DVT) , 305 Droperidol , 160 Delayed cerebral ischemia (DCI) , 411 Drug interactions Depolarizing muscle relaxants , 151–153 anesthetics , 204–206 Desfl urane , 62, 128 pharmaceutical interaction , 203 Dexamethasone , 160, 468, 606, 607 pharmacodynamic interactions , 204 Dexmedetomidine , 167–168 pharmacokinetic interactions , 203 Diabetes insipidus (DI) Duchenne’s muscular dystrophy (DMD) , 478 causes , 468 D V T . See Deep venous thrombosis (DVT) clinical manifestations , 468 diagnosis , 468 treatment , 468 E Diabetes mellitus (DM) Early trauma-induced coagulopathy (ETIC) , 618 endocrine diseases Ear, nose, and throat (ENT) surgery autonomic imbalance , 462 airway fi re , 495 chest radiograph , 461 airway management complications , 461, 462 airway foreign body , 498 electrocardiogram , 461 epiglottitis , 496 history and physical examination , 461 laryngospasm , 497–498 hypoglycemia , 463 Ludwig’s angina , 496–497 insulin time chart , 462 OSA , 497 intraoperative blood glucose management , 463 retropharyngeal abscess , 496–497 ketoacidosis , 462–463 supraglottic airways , 497 laboratory testing , 461 angioedema , 495–496 nonketotic hyperosmolar hyperglycemic coma , 463 fl exible laryngeal (LMA) mask airways , 491 postoperative care , 463 jet ventilation (JV) , 494–495 preoperative evaluation , 461, 462 laser surgery , 493–494 prevalence , 461 Le Fort classifi cation , 493 types , 461, 462 middle ear surgery obstetric anesthesia factors , 489, 490 anesthesia considerations , 519 mastoidectomy , 490 GDM , 518 myringoplasty , 490 glucose tolerance , 518 myringotomy , 489 implications , 518 tympanoplasty , 490 management , 518–519 tympanostomy tube placement , 489 preoperative evaluation , 10, 11 nasal and sinus surgery , 490–491 Diameter index safety system (DISS) , 48 oral RAE tubes , 491 3,4-Diaminopyridine (3,4-DAP) , 477 tracheostomy , 492 Diastolic blood pressure (DBP) , 69, 177, 311, 314 EBV. See Epstein-Barr virus (EBV) Diazepam , 147, 149 ECG. See Electrocardiography (ECG) Dibucaine , 153, 192 Echinacea , 653 Diffi cult mask ventilation (DMV) Edrophonium , 156–157, 478 ASA defi nition of , 25, 589 EEG. See Electroencephalograph (EEG) Han’s Mask Ventilation and Description Scale , 26 Ehlers–Danlos syndrome , 340, 347, 536 “OBESE” , 25 Eisenmenger’s syndrome , 521, 545 preoperative evaluation , 439 Elbow surgery , 299 risk factors for , 25 Elderly patients Diltiazem , 180, 181 cardiovascular system Direct laryngoscopy , 35–38 cardiac autonomic innervation , 593–594 Disseminated intravascular coagulation (DIC) , 113, 455, 618 cardiac conduction system , 593 Diuretics cardiac contraction system , 593 ADH/vasopressin antagonists , 172 vascular system , 594 aldosterone antagonists , 172 central nervous system , 595 carbonic anhydrase inhibitors , 171 gastrointestinal system , 595 loop diuretics , 170–171 hepatobiliary system , 595 nephron , 169, 170 operative risk stratifi cation , 597 osmotic diuretics , 171 perioperative anesthetic considerations potassium-sparing diuretics , 171–172 airway maintenance , 599 thiazides , 169–170 anesthesia induction , 599 DM. See Diabetes mellitus (DM) central neuraxial blockade , 599 DMV. See Diffi cult mask ventilation (DMV) delayed emergence , 600 Dobutamine , 179, 334 functional assessment , 598–599 Dogliotti, A. , 5 intraoperative positioning , 599 Dopamine antagonists , 160–161, 179, 480 maintenance , 599 Double burst stimulation , 156 preoperative evaluation , 598 Down , 24 preoperative sedation , 599 Draeger, H. , 5 venous cannulation , 599 Draeger machines , 5 perioperative pain management , 597–598 Index 693

pharmacodynamics , 597 Endogenous opioids , 139, 665 pharmacokinetics , 595, 597 Endotracheal intubation postoperative care and complications , 600 awake FOB intubation. (see Fiberoptic bronchoscope regional vs . general anesthesia , 598 (FOB)) renal system complications of , 38 glomerular function , 594–595 endotracheal tubes tubular function , 595 placement verifi cation , 38 urinary tract , 595 RAE , 34 respiratory system , 594 size of , 33–34 Electrocardiography (ECG) , 75, 76 indications for , 33 Electroconvulsive therapy (ECT) , 402, 483 laryngoscopic intubation Electroencephalograph (EEG) , 80, 349, 359 direct laryngoscopy , 35–37 Electrolyte abnormalities , 433–434 patient positioning , 35 Electrolytes preoxygenation , 34–35 calcium nasotracheal intubation , 36–38 hypercalcemia , 96–97 videolaryngoscopy , 38 hypocalcemia , 97 Endotracheal tubes (ETT) , 33–34, 556 magnesium Endovascular aortic repair , 358 hypermagnesemia , 98–99 End-stage liver disease (ESLD) , 10 hypomagnesemia , 99 anesthesia induction , 435 phosphate anesthesia maintenance , 435 hyperphosphatemia , 97 ascites , 434 hypophosphatemia , 98 cardiovascular disease , 433 potassium coagulation defects , 434 hyperkalemia , 95 electrolyte abnormalities , 433–434 hypokalemia , 96 endocrine , 434 sodium hepatic encephalopathy , 435 hypernatremia , 94 hepatorenal syndrome , 434 hyponatremia , 95–96 intraoperative monitoring , 435 Electromyography/Nerve Conduction Study (EMG/NCS) , 277 portal hypertension , 434 Emergency abdominal surgery postoperative care , 435 management , 440–441 pulmonary dysfunction , 433 sepsis , 441 End-stage renal disease (ESRD) , 463

trauma , 441 End-tidal carbon dioxide (ETCO2 ) monitoring , 440 End-diastolic volume (EDV) , 312, 343 ENT surgery. See Ear, nose, and throat (ENT) surgery Endocrine diseases Ephedra , 663 Addison’s disease , 468–469 Ephedrine , 178, 203, 663 Cushing’s syndrome , 468 Epidural anesthesia diabetes insipidus catheter placement , 226–227 causes , 467–468 clonidine , 228 clinical manifestations , 467, 468 complications , 229 diagnosis , 468 CSE technique , 228 treatment , 468 epidural blockade, indications for , 223 diabetes mellitus epidural blood patch , 230 autonomic imbalance , 462 epidural needles, tip designs of , 224 chest radiograph , 461 epidural space, identifi cation of , 224–226 complications , 461, 462 local anesthetics , 227 electrocardiogram , 461 mechanism of action , 223 history and physical examination , 461 midline/paramedian approach , 224 hypoglycemia , 463 neostigmine , 221 insulin time chart , 462 opioids , 221 intraoperative blood glucose management , 463 patient positioning and anatomic landmarks , 224 ketoacidosis , 462 preoperative evaluation and consent , laboratory testing , 461 223–224 nonketotic hyperosmolar hyperglycemic coma , 463 preparation , 224 postoperative care , 463 vs . spinal anesthesia , 213–214 preoperative evaluation , 461, 462 test dose and epidural activation , 227 prevalence , 461 troubleshooting , 228 types , 461, 462 vasoconstrictors , 228 parathyroid disorders. (see Parathyroid disorders) Epidural steroid injections , 282, 283 pheochromocytoma , 469–470 Epinephrine (EPI) , 176, 177, 194 SIADH Epstein-Barr virus (EBV) , 647 causes , 467 Erythropoietin , 108, 452 clinical manifestations , 467 Eshraghi, Y. , 101–114 diagnosis , 467 ESLD. See End-stage liver disease (ESLD) treatment , 467 Esmolol , 180, 347 thyroid disorders. (see Thyroid disorders) Esophageal Doppler monitoring (EDM) , 91 694 Index

Ester local anesthetics Furosemide benzocaine , 191 hypercalcemia , 96–97, 466 chloroprocaine , 190 loop diuretics , 170 cocaine , 190–191 renal failure , 358 procaine , 190 SIADH , 467 tetracaine , 190 Estes, J. , 631–636 Etidocaine , 192 G Etomidate , 132, 135, 325, 402, 441 Galway, U.A. , 7–14 Euphoria , 144 Gantacurium , 155, 157 Eutectic mixture of local anesthetic (EMLA) , 192, 198 Gastroesophageal refl ux disorder (GERD) , 588 Extended Mallampati Score (EMS) , 590 Gate control theory , 267, 268 Extracorporeal membrane oxygenation (ECMO) , 539, 543 Gay-Lucca’s Law , 48 Extracorporeal shock wave lithotripsy (ESWL) , 455–456 Gelzinis, T.A. , 69–87 Ex-utero intrapartum treatment (EXIT) , 525 General anesthesia (GA) abdominal aortic aneurysm , 355–356 administration of F airway management , 19 Faces Pain Scale (FPS) , 269 common intraoperative problems , 17, 18 Fail-safe safety devices , 50–52 emergence and extubation , 19 Fat embolism syndrome (FES) goal of , 17 clinical manifestations of , 304 induction of anesthesia , 18, 148 prevention of , 304–305 maintenance , 19 surgical procedures , 305 monitoring , 17–18 Femoral nerve blockade , 244, 259 mortality and morbidity , 17 Fentanyl , 5, 21, 141, 142, 145–146, 507 patient positioning , 19 Ferguson, L. , 623–626 postoperative management , 20 Fiberoptic bronchoscope (FOB) preoperative preparation , 17 contraindications of , 39–40 ambulatory surgeries , 420 diffi cult airway algorithm , 38, 39 aortic cross clamping , 357 equipment , 40 arousal pathway , 121 indications of , 39 carotid artery stenosis , 358 local anesthesia cystectomy , 456 nasotracheal FOB intubation , 40 cystoscopy , 454 orotracheal FOB intubation , 40 defi nition of , 17, 119 oral airways, types of , 40 ECT , 483 sedation and antisialogogues , 40 glaucoma , 485 technique of , 42 heat loss, phases of , 77 Fischer, E. , 4 hip fracture surgery , 301–302 Floppy baby syndrome , 472 hyperparathyroidism , 466 Flowmeters , 52–53 knee arthroscopy , 300 Fluid therapy laparoscopic urology surgery , 457 crystalloid/colloid solutions , 92 mediastinoscopy , 391–392 CVP, PACs, SPV , 91 ophthalmologic surgeries , 485 EDM , 91 peripheral vascular disease , 361 electrolyte concentrations, plasma and intracellular , 89, 90 prostatectomy , 456 electrolytes. (see Electrolytes) fl uid compartments , 89 pulmonary aspiration , 13 goal-directed fl uid therapy , 98 shoulder surgery , 297, 298 hypervolemia , 90 TIVA. ( see Total intravenous anesthesia (TIVA)) hypovolemia , 90 TURP , 455 preoperative oral hydration , 98 Gestational diabetes (GDM) , 518 Flumazenil , 147, 149 Gestational thrombocytopenia , 508 Fluorinated inhalational agents , 3 Gierl, B. , 397–414, 471–483 FOB. See Fiberoptic bronchoscope (FOB) Ginkgo ( Ginkgo biloba ) , 654 Foot surgery , 308 Ginseng , 654 Forced expiratory volume (FEV) , 214, 369, 516 Glasgow Coma Scale (GCS) , 409 Ford, D.J. , 637–640 Global Initiative for Chronic Obstructive Lung Disease Forearm surgery , 299 (GOLD), 377 Forte, P.J. , 131–138 Glomerular fi ltration rate (GFR) , 215, 446, 450, 594 Frailty syndrome , 597 Glycopyrrolate , 13, 157, 380 Frank–Starling law , 313 Goldenhar , 24 Fresh frozen plasma (FFP) , 102, 329, 496 Grable, B. , 69–87 Friedreich’s ataxia , 474 Griffi th, H. , 5 Full Outline of UnResponsiveness (FOUR) , 409 Guedel, A. , 5 Functional pain , 268 Guillain-Barre syndrome (GBS) , 480–481 Functional residual capacity (FRC) , 368, 439, 502, 529, 633 Gyulai, F. , 397–414, 471–483 Index 695

H intraoperative hypertension , 437 Hackett, P. , 89–100 muscle rigidity and proconvulsant activity , 144 Haft, W. , 159–162 pain management , 272 Halaszynski, T. , 233–250, 253–262 PCA , 273 Hall, R. , 5 PCEA , 275 Halothane hepatitis , 126, 661 pediatric anesthesia , 532 Halpern , 230 preoperative medication , 12–13 Halsted, W. , 5 urologic pediatric procedures , 536 Hand surgery , 299 Hydrotherapy , 506 Han’s Mask Ventilation and Description Scale , 26 Hypercalcemia Harika, R. , 587–592 causes of , 96 Head and neck surgery , 492–493 Cushing’s syndrome , 468 Hebl, J.R. , 230 defi nition of , 96 Heidbrink, J. , 5 diabetes insipidus , 467–468 Hemophilias , 112 hydrochlorothiazide , 169 Hensley, J. , 355–362 malignant hyperthermia , 478 Heparin , 104, 113, 182, 329, 334 symptoms and signs , 96, 466 Heparin-induced thrombocytopenia (HIT) , 13 treatment , 97, 466 Hepatic and gastrointestinal diseases.See Liver Hyperkalemia , 436 Hepatic encephalopathy , 435 Addison’s disease , 468–469 Hepatitis B virus (HBV) infection , 107, 662 ARF , 561 Hepatitis C virus (HCV) , 107, 662 CKD , 451 Hepatorenal syndrome , 434, 435 CVA , 404 Herlich, A. , 119–121 defi nition of , 95 Hexobarbital , 7 dysrhythmias/muscle weakness , 172 HHV. See Human herpes viruses (HHV) ECG , 77 High-fl ow nasal cannulas (HFNC) , 28 LMN lesions , 474 Hilmi, I.I. , 661–664 malignant hyperthermia , 479 Hip surgery massive transfusion , 108 arthroscopy , 301 motor neuron diseases , 471–472 hip fractures , 301–302 muscular dystrophies , 478 THA , 302–303 side effects , 172

Histamine (H1 ) blockers , 161 spinal cord injury , 473–474, 625–626 HIT. See Heparin-induced thrombocytopenia (HIT) succinylcholine , 153, 533 Hobbie , 4 symptoms of , 95 Holmes, M. , 5 treatment , 95 Holmes, O.W. , 119 UMN lesions , 472 Horner’s syndrome , 236, 255, 286, 380 Hyperkalemic periodic paralysis (hyperKPP) , 478–479 HPV. See Hypoxic pulmonary constriction (HPV) Hypermagnesemia , 98, 155 Hudson, M.E. , 667 Hypernatremia Human herpes viruses (HHV) causes of , 94 cytomegalovirus , 648 CKD , 451 Epstein-Barr virus , 647–648 defi nition of , 94 HHV-6 , 648 diabetes insipidus , 468 HHV-8 , 648 fl uid resuscitation , 92 HSV-1 , 647 MAC , 125 HSV-2 , 647 management of , 94 varicella zoster virus , 647 osmotic diuretic , 171 Humidifi ers , 64 signs and symptoms of , 94 Hydralazine Hyperphosphatemia , 96, 97, 466 CBF and ICP, impact on , 403 Hypersensitivity chronic mitral regurgitation , 341 anaphylaxis , 200 clinical effects , 176 histamine, nonimmunologic release of , 199 clinical indications , 176 incidence of , 197 mechanism of action , 176 prevention of , 199–200 nasal surgery , 490 type I hypersensitivity , 197 nonimmunologic histamine release , 199 type II hypersensitivity , 199 preeclampsia , 515 type III hypersensitivity , 199 Hydrochlorothiazide (HCTZ) , 169, 468 type IV hypersensitivity , 199 Hydromorphone , 145 Hypertensive disorders abuse , 638 chronic hypertension , 513 in adults , 272 gestational hypertension , 514 characteristics of , 141 preeclampsia chronic kidney disease , 451, 453 airway edema , 514 elimination of , 141 anesthesia considerations , 515–516 equianalgesic dose of , 274 antihypertensive therapy , 515 hypotension and motor blockade , 227 cardiovascular , 514 696 Index

Hypertensive disorders (cont.) HHV central nervous system , 514 cytomegalovirus , 647–648 complications , 514–515 Epstein-Barr virus , 648 eclamptic seizure management , 515 HHV-6 , 648 fl uid management , 515 HHV-8 , 648 HELLP syndrome , 514 HSV-1 , 647 hematologic thrombocytopenia , 514 HSV-2 , 647 hepatic , 514 varicella zoster virus , 647 laboratory workup , 515 infl uenza , 648 postpartum care , 516 nosocomial infections , 649–650 prophylaxis , 515 paramyxovirus , 648 pulmonary edema , 514 prion disease , 651 renal proteinuria and hyperuricemia , 514 Inferior vena cava (IVC) , 91 route and timing of delivery , 515 Infl ammatory pain , 268 seizure prophylaxis , 515 Inhalational anesthetics , 204 Hypertrophic cardiomyopathy (HCM) , 345 alveolar concentration , 123–124 Hypervolemia , 90–91, 412, 502, 531 blood–gas partition coeffi cients of , 123–124 Hypervolemia, hypertension, and hemodilution cardiovascular effects , 125–126 (HHH therapy) , 412 desfl urane , 128 Hypnosis , 506, 654 elimination of , 124 Hypocalcemia , 106 gas–tissue partition coeffi cients of , 124 calcium administration , 333 gastrointestinal effects , 127 CKD patients , 452, 453 halothane , 128 defi nition of , 97 hematologic effects , 127 ethanol, effects of , 637 hepatic effects , 126–127 hypomagnesemic patients , 99 history of , 3–6 massive transfusion , 108 inhalational induction technique , 128–129 neuromuscular blockade , 155, 170–171 inspired concentration , 123 parathyroidectomy , 466 isofl urane, skeletal muscle weakness , 171 MAC of , 124–125 symptoms and signs of , 97, 467 mask inhalation induction techniques, treatment , 97 metabolism , 124 Hypokalemia musculoskeletal effects , 127 beta-2 receptors , 179 neurologic effects , 125 Cushing’s syndrome , 468 nitrous oxide , 127 defi nition of , 96 pharmacokinetics , 123 end-stage liver disease , 434 renal effects , 127 ethanol, effects of , 637 respiratory effects , 126 HypoKPP , 479 sevofl urane , 128 hypomagnesemic patients , 99 xenon , 128 neuromuscular blockade , 155, 169, 170 Injury severity scale (ISS) , 615–616 potassium-sparing diuretics , 171 Internal jugular (IJ) vein , 81–82 skeletal muscle weakness , 170, 171 Interventional radiology (IR) , 424–425 symptoms and signs , 96 Intra-aortic balloon pump (IABP) , 339–340 treatment , 96 Intraoperative bronchospasm , 376 Hypokalemic periodic paralysis (hypoKPP) , 479 Intrapartum assessment Hypomagnesemia , 96, 99, 170 baseline heart rate , 504 Hyponatremia , 94–95, 169, 467 fetal decelerations , 505 Hypophosphatemia , 98, 562, 637 tracing patterns , 505 Hypopnea , 439, 497 variability , 504–505 Hypovolemia , 90, 170, 214 Intrauterine fetal demise (IUFD) , 525–526 Hypoxic pulmonary constriction (HPV) Intravenous anesthetics autoregulatory mechanism , 370 etomidate , 135 defi nition , 370 hexobarbital , 5 factors , 370 ketamine anti-infl ammatory properties , 138 cardiovascular effects , 137 I central nervous system effects , 137 IABP. See Intra-aortic balloon pump (IABP) induction dose of , 136 Idiopathic hypertrophic subaortic stenosis (IHSS) , 345 mechanism of action , 136–137 Infectious diseases nondepolarizing neuromuscular blocking agents , airborne disease , 650 137–138 blood-borne viruses respiratory effects , 137 hepatitis B , 649 pharmacokinetics properties , 132 hepatitis C , 649 phenobarbital , 4 HIV , 648–649 properties of , 136 Index 697

propofol Ketamine cardiovascular effects , 131–132 ambulatory care setting , 419 central nervous system effects , 132–133 anti-infl ammatory properties , 138 dosage and uses , 133 cardiovascular effects , 137 drug distribution , 132 central nervous system effects , 137 mechanism of action , 131 chronic kidney disease , 453 respiratory effects , 132 induction dose of , 136 side effects , 133 IOP , 485 thiopental , 5, 133–134 MAC/TIVA , 21–22 Intravenous regional block (IVRB) , 299 mechanism of action , 136–137 Intubating laryngeal mask airway (ILMA). , 590 nondepolarizing neuromuscular blocking agents , 137 Invasive blood pressure monitoring pain management , 279 indication and contraindications , 71 respiratory effects , 137 normal arterial pulse waveform , 72 septic patient , 441 radial artery pressures , 72 Ketoacidosis Invasive positive pressure ventilation signs and symptoms , 462 airway pressure release ventilation , 558 treatment , 463 assist-control ventilation , 556 Kirstein, A. , 5 continuous mandatory ventilation , 556, 557 Klippel-Feil , 24 ETT , 556 Knee surgery inverse ratio ventilation , 558 ACL repairs , 300

O 2 toxicity , 556 knee arthroscopy , 300 positive end-expiratory pressure , 558 TKA , 300, 301 pressure control ventilation , 557 Koller, C. , 5 pressure support ventilation , 557–558 Kopyeva, T. , 23–44, 575–584 synchronized intermittent mandatory ventilation , 556 Korotkoff, N. , 5 tracheostomy , 556 Krakowski, J.C. , 139–149 types , 556 Kuhn, F. , 5 Irefi n, S. , 23–44 Kwoh , 627 Iron-defi ciency anemia , 109 Ischemic heart disease , 519 CAD , 339 L coronary perfusion , 338–339 Labat , 5 IABP , 339–340 Labetalol , 180, 516 Isofl urane , 3 Lack system , 56 arousal pathway , 121 Lambert-Eaton myasthenic syndrome (LEMS) , asthma , 376 380, 477 blood–gas partition coeffi cients of , 124 Langston, K.D. , 609–614 cardiovascular effects , 125–126 Laparoscopic surgery EEG , 80 anesthetic considerations , 437

gas–tissue partition coeffi cients of , 124 CO 2 embolism , 438 hepatic effects , 126 physiologic changes MAC of , 125 cardiovascular , 436–437 metabolism , 124 renal , 437 mitral regurgitation , 340–342 respiratory , 437 neurological protection , 342 Laryngeal mask airways (LMAs) , 26, 617 neurologic effects , 125 airway control , 19 OPCAB , 338 and aspiration risk , 32 properties of , 60, 127–128 cLMA , 31, 32 renal function , 447–448 insertion technique , 32 respiratory effects , 126 pulmonary aspiration , 603 vaporizers , 60, 62–63 types of , 31 Laryngeal surgery , 493 Left internal mammary artery (LIMA) , 327 J Left-sided DLT Jackson , 54 advantages , 382 Jackson, D.J. , 131–138 algorithm , 383 Jackson-Rees circuit , 55, 56 insertion technique , 383 Janssen, P. , 5 malpositioned tube , 384 Jaw protrusion test , 25 size , 382, 383 Joy, M.A. , 101–114 Lemmon, W. , 5 LEMS. See Lambert-Eaton myasthenic syndrome (LEMS) Levobupivacaine , 193, 194, 508, 512 K Lidocaine , 191, 220 Katz, J.A. , 363–394 Ligda, K.O. , 483–487, 647–651 Kava kava , 654 Li, P. , 623–626 698 Index

Liver neurotoxicity of , 188–189 bariatric surgery opioids , 189 FRC and CV , 439 orotracheal FOB intubation , 40–41 induction , 440 peripheral nerve blockade , 167, 244 maintenance , 440 phenylephrine , 194 monitoring , 440 properties of , 187–188 OSA , 439 spinal anesthesia , 220 oxygen consumption and carbon dioxide production , 439 topical anesthesia , 193 patients position , 440 Local infi ltration analgesia (LIA) , 301 prevalence , 438 Lofgren , 5 routine awake extubation , 438 Lonchena, T. , 643–645 Roux-en-Y gastric bypass , 438 Long, C.W. , 4 CTP system , 433 Loop diuretics emergency abdominal surgery , 440–441 clinical applications/implications in anesthesiology , 170–171 end-stage liver disease mechanism of action , 170 ascites , 434 side effects , 170 cardiovascular disease , 433 Lorazepam , 13, 147, 559 coagulation defects , 434 Loulmet, D. , 627 electrolyte abnormalities , 433–434 Low back pain , 290291 endocrine , 434 Lower extremity nerve blockade hepatic encephalopathy , 435 ankle block , 249 hepatorenal syndrome , 434 femoral nerve block , 244 management , 435 innervation of , 244 portal hypertension , 434 lumbar plexus block , 245, 246 pulmonary dysfunction , 433 popliteal sciatic nerve block , 247 functional anatomy , 431 sciatic nerve block , 246 function tests , 431 Lower motor neurons (LMNs) lesions hepatic lobule , 431, 432 ALS ,475 history and physical examination , 431 cerebrovascular disease , 476–477 indicators , 432 CMT , 475–476 laparoscopic surgery. (see Laparoscopic surgery) Friedreich’s ataxia , 475 MELD score , 433 multiple sclerosis , 475 physiology , 431 signs , 471, 472 transplantation Lumbar plexus blockade , 245–246, 302 anhepatic phase , 435 Lundquist , 5 dissection phase , 435 neohepatic/reperfusion phase , 436 preoperative preparation , 435 M Liver function tests (LFTs) , 12, 433 MAC. See Minimum alveolar concentration (MAC); Monitored LMAs. See Laryngeal mask airways (LMAs) anesthesia care (MAC) Local anesthetics (LA) Macewan, W. , 5 allergic reactions , 189 Macintosh laryngoscopy blades , 35, 37 amide local anesthetics. (see Amide local anesthetics) Macintosh, R. , 5 bicarbonate , 194 Magill, E. , 56 cardiac toxicity , 189 Magill, I. , 5 chemical structure of , 187 Magill’s circuit , 56, 57 classifi cation of , 189 Magnetic resonance imaging (MRI) , 277, 317, 425–426 clonidine , 194 Mallampati airway classifi cation , 25 cocaine , 5 Mangione, M.P. , 89–99 compounding of , 194 Mannitol , 400 cytotoxicity of , 188 clinical applications/implications in anesthesiology , 171 dosages and duration of action , 186 mechanism of action , 134 epidural anesthesia , 228 side effects , 171 epinephrine , 194 TBI , 410, 619 ester local anesthetics , 190 Manrique-Espinel, A.M. , 203–206 history of , 5 MAP. See Mean arterial pressure (MAP) labor epidural analgesia , 508, 509 Mapleson breathing systems , 90–92 mechanism of action , 186 Mapleson, W.W. , 54 methemoglobinemia , 189 Marfan’s syndrome , 536 nasotracheal FOB intubation , 40 Marijuana (Cannabis sativa ) , 639–640 nerve conduction Massive blood transfusion myelinated axon , 185, 186 complications , 108 nerve cell, anatomy of , 185, 186 defi nition , 107 peripheral nerve fi ber types , 185, 187 indications , 107 sodium channel , 185, 186 patient monitoring , 107 sodium–potassium ATPase pump , 185, 186 resuscitation , 107–108 Index 699

Maximum voluntary ventilation (MVV) , 369 CMT , 475–476 McAffee, R. , 159–162 Friedreich’s ataxia , 475 McGill Pain Questionnaire (MPQ) , 269 multiple sclerosis , 475 McHugh, S.M. , 165–168 signs , 472 Mean arterial pressure (MAP) , 69, 131, 311, 357, 398, 400 UMN lesions Medical gases ALS , 475 cylinder supply , 49, 50 cerebrovascular disease , 476–477 heliox , 50 CMT , 475–476 medical air , 50 Friedreich’s ataxia , 475 nitrous oxide , 50 multiple sclerosis , 475 oxygen , 49–50 signs , 472 physics governing gas storage , 46, 48 SMA , 472–473 pipeline supply , 48–49 spinal cord injury , 473–474 xenon , 50 syringomyelia , 474 Megaloblastic anemia , 109 Motor neuron pathway , 471, 472 Melatonin , 654 MND. (see Motor neuron diseases (MND)) Melzack , 267 muscular lesions Memorial Delirium Assessment Scale , 600 malignant hyperthermia , 478–479 Meng, L. , 603–608 muscular dystrophy , 478 Meperidine , 146, 273, 506 myotonia , 478 Mepivacaine , 188, 192 neurological diseases Merskey, H. , 265 Alzheimer’s disease , 480 Messmer, K. , 200 critical illness polyneuropathy/myopathy , 481–482 Metabolic equivalent of task (MET) , 8, 315, 316 GBS , 480–481 Methadone , 145, 280, 532 Parkinsonism , 479–480 Methicillin-resistant Staphylococcus aureus (MRSA) , 649 seizure disorder , 481 Methylnaltrexone , 147, 274 NMJ Methylprednisolone , 161, 282, 475, 561 CMS , 477 Metoclopramide , 161 LEMS , 477 Metoprolol , 180 myasthenia gravis , 477–478 Metro, D.G. , 165–168 MPS. See Myofascial pain syndrome (MPS) Microdialysis catheters (MDCs) , 405 MRI. See Magnetic resonance imaging (MRI) Midazolam , 147–149, 419, 533 Muscle relaxants Miller laryngoscopy blades , 35, 37 chronic pain , 279, 280 Miller, R. , 5 curare , 5 Millikan, G. , 5 depolarizing muscle relaxants , 152–153 Milrinone , 182, 334 neuromuscular transmission, physiology of , 151 Mini Mental-State Examination (MMSE) , 600 nondepolarizing muscle relaxants. (see Nondepolarizing muscle Minimum alveolar concentration (MAC) , 1, 119, 124–125, 643 relaxants) Mivacurium , 154 succinylcholine , 5 MND. See Motor neuron diseases (MND) Mushin, W. , 54 Model for End-Stage Liver Disease (MELD) score , 433 Music therapy , 655 Monitored anesthesia care (MAC) , 418 Myasthenia gravis (MG) , 477–478, 555 airway management , 21 Myocardial infarction (MI) conscious sedation , 21 causes , 562 drugs , 21–22 classifi cation , 562 indications , 20 diagnosis , 563–564 monitoring , 20 management , 564 patient positioning , 19 risk factors , 563 postoperative care/discharge criteria , 22 Myocardial ischemia , 339, 340, 583 preanesthetic examination and evaluation , 20 beta-blockers , 179 Montoya, M.I. , 197–201 ECG , 75, 76 Moon, T.S. , 297–306 EPI , 177 Moore, F. , 89 nicotine , 639 Morphine , 137, 139, 145, 200, 508, 564 nitroglycerin , 175 Morphine-3-glucoronide (M3G) , 145 TEE , 87, 321, 322 Morphine-6-glucoronide (M6G) , 145 Myofascial pain syndrome (MPS) , 290 Morris, L. , 5 Morton, W.T.G. , 3, 119 Motor evoked potentials (MEPs) , 81, 536, 625 N Motor neuron diseases (MND) Naidu, R.K. , 265–295 causes , 471–472 Nalbuphine , 146, 281, 506, 507, 509 denervation , 471 Naloxone , 140, 147, 274, 638 LMN lesions Naltrexone , 146 ALS , 475 Nasopharyngeal airways , 28 cerebrovascular disease , 476–477 National Board of Echocardiography (NBE) , 322 700 Index

National Heart Lung and Blood Institute (NHLBI) , 375, 587 PaCO2 reactivity , 398 National Institute for Occupational Safety and Health (NIOSH) , 65, 661 PaO 2 reactivity , 398 NE. See Norepinephrine (NE) cerebral monitoring Near-infrared spectroscopy (NIRS) , 405 diagnose secondary brain injury , 406 Necrotizing enterocolitis (NEC) , 537 guide therapy , 405 Neostigmine intracranial pressure monitoring , 405 epidural anesthesia , 228 neural pathway monitoring , 406 neuromuscular blockade, reversal of , 156 predict functional recovery , 405 PONV , 582, 605 regional perfusion monitoring , 406 spinal anesthesia , 221 S100B , 405 Nerve injury tissue oxygenation monitoring , 405–406 eye injury , 633 cerebral perfusion ,397 patient position cerebral physiology. (see Cerebral physiology) lateral decubitus position , 634–635 craniotomy , 406–408 lithotomy position , 633–634 intracranial pressure prone position , 634, 635 adequate ventilation , 401 reverse Trendelenburg position , 633 barbiturate coma , 401 sitting position , 634, 635 causes , 399, 401 supine position , 633, 634 clinical signs , 399, 401 Trendelenburg position , 633, 634 cranial vault , 399 peripheral nerve injury CSF circulation , 399 brachial plexus , 631, 632 head elevation , 400 lower extremity nerve injury , 632 hyperosmolar therapy , 400 lumbosacral nerve root , 631, 632 hyperventilation , 400–401 prevention , 632 intracranial elastance , 400 radial and median nerve injuries , 632 Monro–Kellie hypothesis , 399 spinal cord , 631, 632 sedation and analgesia , 401 ulnar nerve injury , 631–632 seizures , 401 Neubert, L. , 123–129 steroid therapy , 401 Neu, M. , 5 surgical interventions , 402 Neuraxial analgesia vasodilation , 399, 401 delayed gastric emptying , 509 neurophysiologic monitoring tests , 397

excessive motor blockade , 510 normal CMRO2 , 397 failed analgesia , 509 psychiatric disorder , 482–483 high/total spinal anesthesia , 510 subarachnoid hemorrhage , 411 hypotension , 509 TBI. (see Traumatic brain injury (TBI)) intravascular injection and systemic toxicity , 510 Neurokinin 1 (NK1) receptor antagonists , 161–162, 659 labor analgesia , 509 Neuroleptic malignant syndrome , 483 nausea and vomiting , 509 Neuromuscular blockade neurological complications , 510 affecting factors , 155 PDPH , 510 depolarizing muscle relaxants , 151 pruritis , 509 neuromuscular transmission, physiology of , 151, 152 respiratory depression , 510 nondepolarizing muscle relaxants. (see Nondepolarizing muscle shivering , 509 relaxants) urinary retention , 509 peripheral nerve stimulator , 155–156 Neuraxial anesthesia reversal agents anticoagulants and , 230–231 atropine , 157 asthma , 516 edrophonium , 156–157 cardiovascular effects , 214 glycopyrrolate , 157 epidural anesthesia. (see Epidural anesthesia) L -cysteine , 157 gastrointestinal effects , 215 neostigmine , 156 labor analgesia , 507 sugammadex , 157 prior spine surgery, patients with , 230 Neuromuscular-blocking drugs (NMBD) , PVD , 360, 361 78, 406, 643 renal and urinary tract , 215 Neuromuscular junction (NMJ) respiratory effects , 214–215 CMS , 477 spinal anesthesia. (see Spinal anesthesia) LEMS , 477 Neuroanesthesia myasthenia gravis , 477–478 AVM , 413 Neuromuscular monitoring , 78–79 cellular physiology , 397 Neuromuscular relaxants. See Muscle relaxants cerebral aneurysm surgery , 412–413 Neuropathic pain , 268, 293, 294 cerebral blood fl ow Neurophysiologic monitoring autonomic innervation , 397–398 BAEPs , 81 cerebral vasculature , 398 bispectral index , 80 circle of Willis , 397–398 electroencephalograph , 80 metabolic-perfusion coupling , 398 MEPs , 81 Index 701

SSEPs , 80–81 interventional neuroradiology , 426–427 visual evoked potentials , 81 IR , 424–425 Nicardipine , 181 MRI , 425–426 Nifedipine , 180 Nonsteroidal anti-infl ammatory drugs (NSAIDs) Nil per oral (NPO) , 13 acetaminophen , 166–167 Nimodipine , 181, 405, 412 acute pain , 271 NIPPV. See Noninvasive positive pressure ventilation (NIPPV) angioedema , 495–496 Nitrates cardiac surgery , 337 hydralazine , 176 chronic pain , 277 nitroglycerin , 175–176 CKD , 454 nitroprusside , 176 clinical uses , 164–165 Nitroglycerin (NTG) , 175–176, 564, 639 COX enzymes , 165

Nitrous oxide (N2 O) , 50 COX-2 inhibitors , 166 history of , 3, 4 side effects , 166 properties of , 127 NORA. See Non-operating room anesthesia (NORA) NMBD. See Neuromuscular-blocking drugs (NMBD) Norepinephrine (NE) , 177–178, 278 NMJ. See Neuromuscular junction (NMJ) Novikov, M. , 101–114 Nociceptive pain , 268 NSAIDs. See Nonsteroidal anti-infl ammatory drugs (NSAIDs) Nondepolarizing muscle relaxants NTG. See Nitroglycerin (NTG) acetylcholine , 151 Numerical Rating Scale (NRS) , 269 atracurium , 154 cisatracurium , 154 gantacurium , 155 O mivacurium , 154 Obesity pancuronium , 154 classifi cation , 587, 588 pharmacologic paralysis , 151 clinical manifestations , 587, 588 rocuronium , 152–154 intraoperative care , 591 vecuronium , 154 obstetric anesthesia Nonintubation airway management anesthesia considerations , 517–518 mask ventilation technique labor and delivery effects , 517 assessment of , 29 physiologic changes , 517 contraindications and complications , 29–30 prevalence , 517 face mask, characteristics of , 28 pathophysiology one-provider technique , 29, 30 cardiovascular system , 587–588 prerequisites for , 28–29 endocrine system , 588–589 two-provider technique , 29, 30 gastrointestinal system , 588 uses , 28 renal system , 589 oxygen delivery systems respiratory system , 588 high-fl ow nasal cannulas , 28 postoperative care , 591–592 nasal cannulas , 27 preoperative assessment nonrebreathing masks , 28 airway evaluation , 589–590 partial rebreathing masks , 27–28 anesthetic plan , 590 simple face masks , 27 aspiration prophylaxis , 590 Venturi masks , 28 cardiovascular system evaluation , 589 pharyngeal airways , 28, 29 equipment , 590 supraglottic airway devices. (see Supraglottic airway devices monitoring , 590 (SADs)) respiratory system evaluation , 589 Noninvasive blood pressure (NIBP) monitoring vascular access , 590 arterial digital photoplethysmography , 70 Obstetric anesthesia arterial tonometry , 70 asthma auscultatory method , 69–71 continuous lumbar epidural analgesia , 517 automated oscillonometer , 71 inhaled beta-adrenergic agonists , 517 complications , 69 medical management , 517 cuff size , 69 neuraxial anesthesia , 517 Noninvasive positive pressure ventilation (NIPPV) , 336, 555–556 pregnancy effects , 516 Non-operating room anesthesia (NORA) symptoms , 516 cardiology procedures cardiac disease cardioversion , 428–429 acquired heart disease. (see Acquired heart disease) coronary angiography , 429 congenital heart disease , 520–521 diagnostic imaging , 429 incidence , 519 endoscopic procedures , 427–429 maternal cardiac arrest , 521 ICU , 429 cesarean section locations , 423 aspiration prophylaxis , 511 patient selection , 423 epidural anesthesia , 512–513 radiation oncology procedures , 428 fasting guidelines , 511 radiologic procedures general anesthesia , 513 CT scan , 426 spinal anesthesia , 511–512 702 Index

Obesity (cont.) prevalence , 374 chloroform , 3 sevofl urane , 376 diabetes mellitus signs and diagnosis , 374–375 anesthesia considerations , 519 treatment , 324–325 GDM , 518 COPD glucose tolerance , 518 anesthetic considerations , 377–378 implications , 518 BODE index , 377 management , 518–519 chronic bronchitis , 376, 377 fetal monitoring emphysema , 376, 377 antepartum assessment , 504 estimation , 377 intrapartum assessment , 504–505 GOLD classifi cation , 377 intrapartum fetal resuscitation , 505 MMRC , 377 hypertensive disorders. (see Hypertensive disorders) prevalence , 376 labor analgesia Obstructive sleep apnea (OSA) adjuvants , 509 bariatric surgery , 438–439 hydrotherapy , 506 body mass index , 379 hypnosis , 506 comorbidity , 379 inhalational analgesia , 506 ENT surgery , 497 intradermal water injection , 506 impaired glucose metabolism , 379 local anesthetic agents , 508, 509 incidence , 379 lumbar epidural block , 508–509 postoperative complications , 379 neuraxial analgesia , 509–510 prevalence , 379 neuraxial anesthesia , 507 regional anesthesia , 379 opioids , 508 O’Connor, J. , 657–659 parenteral opioids , 506–507 Off-pump coronary artery bypass grafting (OPCAB) PCEA , 509 epicardial stabilization devices , 337 remifentanil , 507 functional safety net , 338 spinal epidural block , 508 inhaled agent/total intravenous anesthesia , 338 systemic analgesia , 506 isofl urane , 338 TENS , 506 keyhole cardiac surgery , 337 labor physiology neuraxial techniques , 338 pain effects , 506 operating room setup , 337 stages , 505–506 physiologic effects , 337 maternal hemorrhage prevalence , 337 AFE , 524 single and double-bypass surgery , 337 antepartum hemorrhage , 521–523 Ohmeda Link-25 proportion-limiting control system , 51, 52 fetal surgery , 525 Ondansetron , 160, 606 IUFD , 525–526 OPCAB. See Off-pump coronary artery bypass grafting (OPCAB) nonobstetric surgery , 524–525 Open reduction and internal fi xation (ORIF) , 234, 302 postpartum hemorrhage , 522–524 Operating room (OR) obesity chemical dependency , 664 anesthesia considerations , 517–518 fi re safety , 662–663 labor and delivery effects , 517 HBV infection , 662 physiologic changes , 517 HCV , 662 prevalence , 517 information systems , 668 physiologic changes laser safety , 663 airway changes , 501 latex sensitivity , 662 aortocaval compression , 502 management cardiovascular system , 502 case scheduling , 669 endocrine system , 503 effective operational management , 669 gastrointestinal system , 503 emergent case management , 669 hematologic system , 502–503 operational decisions , 667 musculoskeletal system , 503–504 OR time , 668–669 nervous system , 504 strategic and tactical decisions , 667 placental function and drug transfer , 504 NIOSH safety recommendations , 661, 662 renal system , 503 performance metrics , 668 respiratory system , 501–502 psychological stress , 663–664 uteroplacental blood fl ow , 504 radiation safety , 661–662 Obstructive airway diseases work hours and sleep disturbance , 664 asthma Ophthalmic surgery desfl urane , 376 anesthetic considerations intraoperative bronchospasm , 376 adverse effects , 485, 486 isofl urane , 376 general anesthesia , 485 lidocaine , 376 monitored anesthesia care , 485 pathologic features , 374 ocular injuries , 485–486 preoperative preparation , 375 regional anesthesia , 485 Index 703

intraocular gas expansion surgery , 486 thermoregulation, inhibition of , 144 intraocular pressure tolerance, dependence, and withdrawal , 144–145 anatomy , 483–484 spinal anesthesia , 221 glaucoma , 485 structure–activity relationships , 147 hypoxia and hypercarbia , 485 Optimal external laryngeal manipulation (OELM) , 35 intravenous acetazolamide , 485 Oravitz, T.M. , 175–183 ketamine , 485 Orebaugh, S.L. , 139–149 non-depolarizing muscle relaxants , 485 Oropharyngeal airways , 28 succinylcholine , 485 Orthopedic surgery oculocardiac refl ex , 483, 484 FES , 304–305 retinal detachment surgery , 486 foot and ankle surgery , 303 strabismus surgery , 486 hand and forearm surgery , 299 traumatic open eye injury , 486 hip surgery , 301–303 Opioids , 419, 638 infection prevention , 305 acute pain knee surgery , 300–301 managing side effects , 274 regional anesthesia , 303–304 opioid conversion , 274–275 shoulder surgery PCA , 275 anesthetic considerations , 298 pharmacologic agents , 271, 272 beach chair and lateral decubitus position , 297–298 routes of administration , 272 postoperative pain management , 300–301 analgesia , 142 thromboprophylaxis , 305–306 antagonists , 146 tourniquets , 304 cardiovascular stability , 143 OSA. See Obstructive sleep apnea (OSA) chronic pain , 275–276 Oscillonometer , 70, 71 cough refl ex suppression , 143 Osmotic diuretics , 171 defi nition , 141 Oxygen failure protection device (OFPD) , 51 endogenous opioids , 139 Oxygen ratio monitor controller (ORMC) , 51 epidural anesthesia , 228 fully synthetic opioids , 139 labor analgesia , 508 P miosis , 143 Packed red blood cells (PRBCs) , 102 mixed agonist–antagonists , 146 PACs. See Pulmonary artery catheters (PACs) natural opium alkaloids , 139 PACU. See Postanesthesia care unit (PACU) opioid agonists Pain management alfentanil , 146 acute pain. (see Acute pain) fentanyl , 145–146 cancer pain. (see Cancer pain) hydromorphone , 145 central modulation , 267 meperidine , 146 chronic pain. (see Chronic pain) methadone , 145 CRPS , 292–293 morphine , 145 gate control theory , 267 remifentanil , 146 low back pain , 290–292 sufentanil , 146 myofascial pain , 290 opioid partial agonists , 146 pain, defi nition of , 265 peripheral opioid antagonists , 147 pain pathways pharmacodynamics , 141 ascending pathway , 266 pharmacogenetics , 142 descending pathway , 266–267 pharmacokinetics nociception , 265 elimination , 141 peripheral sensation , 265, 266 lipophilicity , 141 peripheral modulation , 267

p Ka , 141 phantom limb pain , 293 protein binding , 140–141 post-herpetic neuralgia , 293 route of administration , 140 trigeminal neuralgia , 293 receptor subtypes, physiologic effects of , 141 types of , 267–268 respiratory depression , 143 Palonosetron , 160, 605–606 sedation and anxiolysis , 142–143 Pancuronium , 154 semisynthetic opioids , 139 Parathyroid disorders side effects and toxicity hyperparathyroidism cardiovascular effects , 144 bilateral neck exploration , 466 euphoria , 144 complications , 466–467 gastrointestinal and urinary effects , 144 diagnosis , 466 hormonal effects , 144 minimally invasive parathyroidectomy , 466 immune modulation , 144 primary hyperparathyroidism , 466 muscle rigidity and proconvulsant activity , 144 secondary hyperparathyroidism , 466 nausea and vomiting , 144 symptoms and signs , 466 paradoxical response , 144 tertiary hyperparathyroidism , 466 respiratory depression , 143 treatment , 466 sedation and cognitive impairment , 143 hypoparathyroidism , 467 704 Index

Patient-controlled analgesia (PCA) , 598 surgical procedure , 234 acute pain , 272, 273 ultrasound-guided techniques. (see Ultrasound-guided peripheral postoperative pain management , 300–301 nerve blockade) Patient-controlled epidural analgesia (PCEA) , 275, 509 Peripheral nerve stimulator , 155–156 PDIs. See Phosphodiesterase inhibitors (PDIs) Peripheral vascular disease (PVD) PDPH. See Postdural puncture headache (PDPH) endovascular repair , 361 Peak expiratory fl ow (PEF) , 369, 374, 517 general anesthesia , 361 Pediatric anesthesia neuraxial anesthesia , 361 adenotonsillectomy , 535–536 normal and diseased artery , 361 children resuscitation , 542–544 open vascular repair , 361 congenital cardiac disease postoperative management , 361–362 left-sided obstructive lesions , 546 regional anesthesia , 361 left to right shunt lesions , 545 Perlas, A. , 604 right-sided obstructive lesions , 545–546 Perphenazine , 160 Down syndrome/trisomy 21 , 534–535 Pham, T.M. , 265–295 epiglottitis vs . croup , 535 Phantom limb pain , 293 foreign body aspiration , 535 Pharyngeal airways , 28 neonatal emergency Phenobarbital , 4–5, 481 CDH , 538–539 Phenylephrine , 40, 178–179, 194, 360 gastroschisis , 539–540 Pheochromocytoma , 469–470 NEC , 537 Phosphodiesterase inhibitors (PDIs) , 181–182 neural tube defects , 540–541 Pickwickian syndrome , 439 omphalocele , 539–540 Pin Index Safety System (PISS) , 49 pyloric stenosis , 540 Planinsic, R.M. , 627–629 TEF , 537–538 Platelets , 102–103 neonates resuscitation , 543 thrombocytopenia , 111 PACU complications , 536–537 von Willebrand disease , 112 pain management PNB. See Peripheral nerve blockade (PNB) caudal epidural anesthesia , 541–542 Poiseuille’s Law , 617 neuraxial blockade , 541 Polycythemia , 109, 110, 588 peripheral nerve blocks , 542 PONV. See Postoperative nausea and vomiting (PONV) spinal anesthesia , 542 Pope, E. , 4 pediatric scoliosis correction , 536 Popliteal sciatic nerve blockade , 247–248, 261–262 pharmacology Positive end-expiratory pressure (PEEP) , 376, 438, 556, 558, 591 inhalational agents , 532 Postanesthesia care unit (PACU) , 20, 424 intravenous induction agents , 532 airway management non-depolarizing neuromuscular blocking agents , 533 AEC , 579 opioids , 532–533 cuff leak test , 579 succinylcholine , 533 endotracheal extubation , 579 physiology expanding neck hematoma , 579–580 cardiovascular , 529–531 hypoventilation , 578 hematological , 530–531 hypoxemia , 578 pediatric airway , 531 obstruction , 577–578 preterm neonate , 531–532 arrhythmias , 583 renal , 531 bypass/discharge criteria respiratory , 529, 530 delay discharge , 576 temperature regulation , 531 factors , 577 preoperative preparation , 533–534 fast-tracking , 577 tonsillectomy , 535–536 oral intake and voiding , 575 upper respiratory tract infection , 534 regional anesthesia , 576 urological procedures , 536 scoring system , 575 PEEP. See Positive end-expiratory pressure (PEEP) delayed emergence , 582 Peripheral nerve blockade (PNB) delirium , 583–584 benefi ts of , 534 hemodynamic management brachial plexus. (see Brachial plexus) APH , 580 cervical plexus block hypotension and shock , 581 preparation technique , 242–243 hypothermia , 583 side effects , 243 myocardial ischemia , 583 surface anatomy, landmarks, and procedure , 243 nausea and vomiting , 582–583 complications of , 234 oliguria and urinary retention , 583 contraindications , 234 pain , 583 digital and metacarpal nerve block , 242 patient monitoring , 575, 576 intravenous regional anesthesia , 242 perioperative nerve injuries , 583 local anesthetics for , 244 volume responsiveness , 581–582 lower extremity nerve blockade. (see Lower extremity nerve Postdischarge nausea and vomiting (PDNV) , 161, 604–605 blockade) Postdural puncture headache (PDPH) , 222, 510 Index 705

Post-herpetic neuralgia (PHN) , 288, 293 Promethazine , 160 Postoperative nausea and vomiting (PONV) , 582–583 Prophylactic antibiotic , 305 ambulatory anesthesia , 420 Propofol , 5 antiemetics , 161 cardiovascular effects , 131, 132 anticholinergics , 161 central nervous system effects , 132–133 corticosteroids , 161 dosage and uses , 133 dopamine antagonists , 160–161 drug distribution , 132 histamine (H1) blockers , 161 mechanism of action , 131, 132 neurokinin 1 receptor antagonists , 161–162 respiratory effects , 132

serotonin 5HT3 receptors , 160 side effects , 133 cosmetic surgery , 659 Propranolol , 179 defi nition , 659 Protamine , 183, 200, 334–335 electroacupuncture and acupressure , 162 Psychiatric disorders , 482 emetogenic trigger avoidance , 162 Psychogenic pain , 268 etomidate , 135–136 Pulmonary artery catheters (PACs) , 91, 551 foot and ankle surgery , 303 cardiac output , 86–87 IMPACT trial , 608 contraindications , 85 incidence , 604 indications , 85 physiology of , 259 normal cardiac parameters , 86 prophylaxis , 420 pressure tracing , 85 propofol , 133 Pulmonary aspiration risk factors , 159, 605 clinical signs , 603–604 Postoperative visual loss (POVL) , 625 gastric contents, regurgitation of , 13 Postpartum hemorrhage prevention , 14, 604 abnormal placentation , 523 risk factors , 14, 603–604 coagulopathy , 524 treatment , 604 hematomas , 524 Pulmonary dysfunction , 433 lacerations , 524 Pulmonary embolism (PE) , 305 placenta , 524 blood clots , 564 uterine atony , 522 clinical signs , 564 uterine inversion , 524 diagnosis , 564 Potassium-sparing diuretics , 171 management , 564 Preemptive analgesia , 300 Pulmonary function tests (PFTs) , 12, 623 Preoperative evaluation Pulmonary vascular resistance (PVR) , 126, 351 allergies and social habits , 10 Pulse oximetry , 74–75 ASA classifi cations , 14 PVD. See Peripheral vascular disease (PVD) basic preoperative evaluation , 7, 8 cardiac evaluation active cardiac conditions , 7 Q algorithm , 7, 8 Qualitative Sensory Testing (QST) , 277 clinical risk factors , 9 Quick connectors , 48 functional capacity , 8, 9 Quincke, H. , 5 need for surgery , 7 surgical risk , 7–8 chronic kidney disease , 10 R endocrine , 10 RA. See Regional anesthesia (RA) family history , 10 RAAS. See Renin–angiotensin–aldosterone system (RAAS) gastrointestinal , 10 Radial artery catheterization goals of , 7, 8 Allen test , 72 laboratory testing , 11–12 arterial waveform , 74 liver disease , 10 complications , 74 medications , 10–11 insertion site , 73 neurological , 10 natural frequency and damping , 73–74 NPO guidelines , 13 technique of , 72 physical examination , 11 zeroing transducer , 74 pregnancy test , 10 Radiofrequency lesioning (RFL) , 285, 292, 295 premedication , 12–13 Rapid Infusion Catheter (RIC™) , 617 prior anesthetic history , 10 Rapid sequence induction and intubation (RSII) , 42–43 pulmonary aspiration , 13 Rapid sequence intubation (RSI) technique , 19, 458, 604 pulmonary evaluation , 9 Recombinant activated factor VII (RVII) , 103, 105 Pretransfusion testing Rees , 54 type and cross , 101 Referred pain , 268, 290 type and screen , 101 Regional anesthesia (RA) Priestly, J. , 3 acute kidney injury , 453 Prilocaine , 191–193 acute pain , 275 Procaine , 190 Alzheimer’s disease , 480 706 Index

Regional anesthesia (RA) (cont.) propofol , 453 ambulatory surgeries, 418 succinylcholine , 453, 454 asthma , 376 cardiopulmonary bypass surgery , 448 Bier block , 242 CKD , 451–452 cancer pain , 295 genitourinary system , 443, 445 carotid artery stenosis , 358 regional anesthetic techniques , 448 cesarean section , 511 renal physiology COPD , 376–377 ANP , 447 cosmetic surgery , 657 autonomic system , 446–447 elderly patients , 598 autoregulation , 446 endotracheal intubation , 33 feedback mechanisms , 444 epinephrine , 177 GFR , 446 heat loss, phases of , 76 nephron structure and function , 445 history of , 5 prostaglandins , 447 hyperparathyroidism , 466 RAAS , 446 hyperthyroidism , 464 sevofl urane , 447 hypothyroidism , 465 urologic procedures motor neuron diseases , 471 autonomic hyperrefl exia , 457 obesity , 590 cystoscopy , 454 ophthalmic surgery , 485, 486 ESWL , 455–456 orthopedic surgery laparoscopic techniques , 457 advantages , 303 laser lithotripsy , 456 complications , 316 lateral fl exed position , 454 hip fracture surgery , 301–302 lithotomy position , 454 shoulder surgery , 297 radical cystectomy , 456 OSA , 379, 497 radical nephrectomy , 456 pediatric neuraxial anesthesia , 541 radical prostatectomy , 456 peripheral nerve injuries , 631 renal transplantation , 451, 457–458 prilocaine , 191–192 robotic techniques , 457 pulmonary embolism , 564 Trendelenberg position , 454 PVD , 360–361 TURP , 454–455 TURP syndrome , 455 ureteroscopy , 454 ultrasound-assisted peripheral nerve blockade , 253 Renin–angiotensin–aldosterone system (RAAS) , 93, 446 Remifentanil , 146 Residency requirements ambulatory surgical patients, 420 ACGME requirements , 671 bariatric surgery patients , 440 clinical anesthesia (CA) years characteristics of , 141 career pathway , 672 cosmetic surgery , 657 case types , 673 FOB intubation , 40 mandatory rotations residents , 672 labor analgesia , 507 perioperative rotations , 673 MAC/TIVA , 21 surgical subspecialty rotations , 673 MEPs , 81 duty hour requirements , 671–672 PCA , 273 education program , 673 pediatric anesthesia , 532–533 fellowship training , 674 Renal and urinary tract diseases performance evaluations , 673 acute kidney injury scholarly activity , 673–674 AKIN criteria , 448 Respiratory depression , 143, 221 biomarkers , 450–451 Respiratory syncytial virus (RSV) , 648, 662 BUN , 450 Resti, J.P. , 671–674 characteristics , 448 Reticular activating system (RAS) , 119 creatinine , 450 Retinopathy of prematurity (ROP) , 531, 558 intrinsic failure , 448, 449 Right-angle endotracheal tubes (RAE) , 34 parameters , 449 Right atrial pressure (RAP) , 84 prerenal and postrenal failure , 448, 449 Ring, J. , 200 prevention , 449, 450 Robertshaw, F. , 5 RIFLE criteria , 448 Robin, P. , 24 risk factors , 448 Robotic surgery urine output , 450 advantages , 627, 628 anesthetic management carbon dioxide insuffl ation , 628 barbiturates , 453 da Vinci robotic system , 627–628 benzodiazepines , 448, 453 disadvantages , 627, 628 etomidate , 453 emergence and neuromuscular blockade , 628 inhalational agents , 453, 454 history , 627 ketamine , 453 muscle paralysis , 628 muscle relaxants , 453, 454 patient positioning , 628 opioids , 448, 452, 453 robot position , 628 Index 707

Rocuronium , 152–154 neurophysiology , 402 allergic reactions , 199 pediatric anesthesia , 532, 535 cesarean section , 513 properties of , 60, 128 CKD , 454 renal function, effect on , 127, 447–448 drug interactions , 204 tracheal resection , 392 end-stage liver disease , 435 vaporizer , 59–63 pediatric anesthesia , 533–534 Shaffer, E.G. , 653–655 Romeo, R.C. , 631–635 Shires, T. , 89 Ropivacaine , 192–193 Shock ambulatory anesthesia care , 418 bradycardia , 554 cesarean section , 513 classifi cation , 550 dosages and duration of , 186 clinical signs , 550, 552 epidural anesthesia , 228 critical care , 549–551 labor analgesia , 508, 509 excessive sedation , 553 PCEA , 275 management strategy peripheral nerve blockade , 244 blood pressure , 552 popliteal sciatic nerve block , 261 cardiac abnormality/dysfunction , 552–553 spinal anesthesia , 220 fl uid and vasopressors , 552–553 TKA patients , 301 interventions , 553 Ross, F.J. , 661–664 lactic acidosis , 552 Ross, S.M. , 197–201 monitoring Rovenstein , 5 CVP , 551 RSII. See Rapid sequence induction and intubation (RSII) hemodynamic parameters , 552 Rubin, K.P. , 431–441 PAC , 551 pathophysiology , 549–550 stage I progression , 549 S stage II progression , 549–550 SADs. See Supraglottic airway devices (SADs) stage III progression , 550 SAH. See Subarachnoid hemorrhage (SAH) stage IV progression , 550 Sardesai, M. , 311–351 tachycardia , 554 Saw palmetto (SP) , 654 Sickle cell disease (SCD) , 109 Schizophrenia , 483 SID. See Strong ion difference (SID) Sciatic nerve blockade , 246, 247, 259–262 Siggaard-Andersen, O. , 610 Scopolamine , 161 Sikka, P.K. , 3–5, 17–22, 461–470, 549–573 Alzheimer’s disease , 480 Simpson, J.Y. , 3, 4 ambulatory anesthesia care , 420 Singh, A. , 45–67 cardiac anesthesia , 324, 346 Singh, P.M. , 45–67 elderly patients , 559 Single-shot technique , 301, 511 PONV , 161, 420, 606 Sinha, A. , 123–129, 417–421, 593–600 preoperative premedication , 12–13 Sleep apnea , 9 Seizure disorder SMA. See Spinal muscle atrophy (SMA) causes , 481 Smith, K. , 627–630 focal/partial seizures , 481 Smoking , 9, 380–381, 639 generalized tonic-clonic seizure , 481 Snow, J. , 3, 4 petit mal seizures , 481 Sodium nitroprusside (SNP) , 176 Selective serotonin reuptake inhibition (SSRIs) , 278, 482 Somatosensory evoked potentials (SSEPs) , 80, 536, 625 Semisynthetic opioids , 139 Spinal anesthesia , 5 Sensitive oxygen ratio controller (S-ORC) , 51 administration of , 219

Serotonin 5HT3 receptors , 159–160 alpha-2 agonists , 221 Serotonin norepinephrine reuptake inhibitors (SNRIs) , 278 baricity , 219 Serturner , 145 contraindications for , 216 Severe acute respiratory syndrome (SARS) , 650 vs . epidural anesthesia , 213 Sevofl urane failed blocks , 222 ambulatory care setting , 419 hemodynamic collapse , 222 asthma , 376 infection , 222 blood–gas partition coeffi cients of , 124 local anesthetics , 219–220 carbon dioxide absorption , 59 midline and paramedian approach , 218 CKD , 454 neostigmine , 221 elderly patients , 559 neurologic complications , 222 exposure to , 661 opioids , 221 gas–tissue partition coeffi cients of , 124 patient positioning and anatomic landmarks , 217–218 inhalational induction , 18 PDPH , 222 labor analgesia , 506 preoperative evaluation and consent , 216 MAC , 125, 142 progression of blockade , 215–216 metabolism , 124 spinal needles , 217 musculoskeletal effects , 127 vasoconstrictors , 221 myringotomy and tympanostomy tube placement , 489 Spinal muscle atrophy (SMA) , 472–473 708 Index

Spine surgery hyperkalemia , 95 intraoperative care and monitoring , 625 IOP , 485 patient position laryngospasm , 498 Andrews frame , 624 LEMS , 477 complications , 624–625 LMN lesions , 474 Jackson table and Wilson frame , 624 malignant hyperthermia , 479 Mayfi eld pins , 624 metabolism , 153, 203 POVL , 625 motor neuron diseases , 471 preoperative evaluation muscular dystrophies , 478 airway assessment , 623 myasthenia gravis , 477 osteoarthritis , 623–624 neuromuscular blockade , 156 respiratory system , 623 neurophysiology , 402 spinal cord perfusion , 623 pediatric patients , 533 spinal shock , 626 pyloric stenosis , 540 succinylcholine-induced hyperkalemia , 626 renal disease , 454 wake-up test , 625 side effects , 153 Spirometers , 63 spinal cord injury , 473, 625–626 Spironolactone , 170, 172, 564 traumatic open eye injury , 486 Spoerel , 56 UMN lesions , 472 SSEPs. See Somatosensory evoked potentials (SSEPs) Sufentanil Standard bicarbonate concentration (SBC) , 610 characteristics of , 141, 146 Stemland, C. , 529–546 epidural anesthesia , 227 Stewart, P.A. , 612 labor analgesia , 508 Stiff joint syndrome , 519 PCA , 273 St. John’s wort ( Hypericum perforatum ) , 482, 654 pediatric anesthesia , 532 Strong ion difference (SID) spinal anesthesia , 221 free water change Sugammadex , 157 contraction alkalosis , 613–614 Sullivan, E.A. , 203–206 dilutional acidosis , 613 Supine hypotension syndrome , 502 hyperchloremia , 614 Supraglottic airway devices (SADs) hypochloremia , 614 classifi cation of , 31 unidentifi ed anions , 614 complications , 31 Sturgill, E.L. , 151–157 LMA. (see Laryngeal mask airways (LMAs)) Subarachnoid hemorrhage (SAH) uses and advantages , 30 medical management , 411–412 Sword, B. , 5 pathophysiology , 411 Sydenham, T. , 355 prognostic factors , 411 Systemic infl ammatory response syndrome (SIRS) , 441, 554 risk factors , 411 Systemic vascular resistance (SVR) , 126, 311, 345, 502 size and location , 411 Systolic blood pressure (SBP) , 69, 70 Subramaniam, K. , 355–362 Systolic pressure variation (SPV) , 91 Substance abuse acute intoxication , 637 anesthesiologists , 640 T club drugs , 640 Tail, D. , 5 CNS depressant TBI. See Traumatic brain injury (TBI) alcohol , 637–638 TEE. See Transesophageal echocardiography (TEE) characteristics , 638 TEF. See Tracheoesophageal fi stula (TEF) opioids , 638 Temperature monitoring , 77 CNS stimulants Terrell, R. , 3 amphetamine , 638–639 Teter, C. , 5 cocaine , 638–639 Tetracaine tobacco and marijuana , 639–640 ester agents , 189–191 dissociative drugs , 640 orotracheal FOB intubation , 40 emergent consultation , 640 spinal anesthesia , 220, 542 hallucinogens , 640 TAC , 193 history and physical examination , 637 Tetracaine, adrenaline, and cocaine (TAC) , 193 inhalants , 640 Tetralogy of Fallot (TOF) , 520, 545, 546 Succinylcholine , 5 Tetzlaff, J.E. , 185–194 amyotrophic lateral sclerosis , 474 THA. See Total hip arthroplasty (THA) burns , 571, 572 Thiazide diuretics cerebrovascular accident , 476 clinical applications/implications in anesthesiology , 170–171 cesarean section , 513 mechanism of action , 171 chemical structure , 152 side effects , 171 dosage and uses , 153 Thiopental , 5 endotracheal tube, insertion of , 19 cardiovascular effects , 134 end-stage liver disease , 435 central nervous system effects of , 132, 134 Index 709

cesarean section , 513 lungs separation hyperthyroidism , 464 anatomic considerations , 381–382 MAC/TIVA , 21–22 bronchial blockers. (see Bronchial blockers (BB)) mechanism of action , 134 indications , 382 neurophysiology , 402 left-sided DLT. (see Left-sided DLT) pharmacokinetics properties of , 132 right-sided DLT , 384, 387 properties of , 134–135 one-lung ventilation respiratory effects , 134 disadvantage , 389 Thoracic anesthesia iatrogenic right-to-left intrapulmonary shunt , 388, 389 alveolar oxygen tension , 370 lateral decubitus position , 388 anatomy , 363–365 lung mechanics , 389 BPF , 392 management , 390

Co2 transport , 372 postoperative care , 391 CPB , 393 preoperative assessment fl ow-volume loop , 369 arterial blood gas analysis , 380 functions , 365 chest radiography , 380 HPV , 370–371 CT scans and MRI , 380 lung transplantation , 393 non-small cell carcinomas , 380 lung volumes resectability , 381 closing capacity , 369 small cell carcinomas , 380 FEV , 369 smoking cessation , 380–381 forced vital capacity , 369 pulmonary complications , 391 FRC , 368 Thrombocytopenia , 105, 110–113, 181, 434, 514 MVV , 369 Thromboprophylaxis , 305–306 PEF , 369 Thyroid disorders mediastinoscopy , 391–392 hyperthyroidism mixed venous oxygen saturation , 371 anesthetic considerations , 464 obstructive airway diseases. (see Obstructive airway diseases) causes , 464 off-bypass , 393 clinical manifestations , 463 OSA complications , 464–465 body mass index , 379 diagnosis , 464 comorbidity and postoperative complications , 379 thyroid hormone secretion , 464 impaired glucose metabolism , 379 thyroid storm , 465 incidence , 379 treatment , 464 prevalence , 379 hypothyroidism , 465 regional anesthesia , 379–380 Tic douloureux , 293 oxygen transport , 371 Time-weighted average (TWA) , 65 peripheral chemoreceptors , 365, 366 TIVA. See Total intravenous anesthesia (TIVA) physiologic dead space , 369 Tobacco (Nicotiana tabacum L .) , 639–640 pulmonary compliance , 366 Tolvaptan , 172 pulmonary hypertension , 378–379 Tom, M. , 233–250, 253–262 respiratory centers , 365 Topical anesthesia restrictive lung diseases , 378 cocaine , 190 sensors , 365–366 EMLA , 193 thoracic surgery. (see Thoracic surgery) TAC , 193 thoracoscopic surgery , 392 tetracaine , 190 tracheal resection , 392–393 Total body water (TBW) , 89 ventilation-perfusion Total hip arthroplasty (THA) , 302–303 alveolar pressure , 372 Total intravenous anesthesia (TIVA) , 657 high V/Q and dead space , 373–374 defi nition , 21 pulmonary artery , 372, 373 drugs , 21–22 pulmonary venous pressures , 372, 373 indications for , 21 venous admixture , 373 postoperative care/discharge criteria , 22 work of breathing Total knee arthroplasty (TKA) airway resistance , 218 choice of anesthesia , 300 anesthetized COPD patient , 366, 367 postoperative pain management , 300–301 awake patient , 366, 367 Total parenteral nutrition (TPN) , 99

helium-O2 gas mixture , 368 Tourniquets , 110, 304 Reynolds number , 368 Tracheoesophageal fi stula (TEF) , 537–538 Thoracic surgery Train of four (TOF) , 43, 79, 156 anesthesia management Transcutaneous electrical nerve stimulation (TENS) , 270, 291, 506 balanced-drainage system , 388 Transesophageal echocardiography (TEE) , 18 excessive positive pressure , 388 bite block , 322 induction , 386 complication rate , 322 maintenance , 387 comprehensive examination , 320–321 positioning , 387 contraindications , 321, 322 710 Index

Transesophageal echocardiography (TEE) (cont.) head injury , 619 indications , 320 initial examination , 615–616 NBE , 322 ISS calculation , 616 patient monitoring , 87 neck injury , 619 preoperative CT scan , 322 spine injury , 619 probe insertion and manipulation , 320–322 thorax injury , 619–620 Transforaminal epidural steroid injection , 283 Traumatic brain injury (TBI) Transfusion medicine classifi cation , 409 blood disorders. (see Blood disorders) clinical signs , 409 blood substitutes , 114 evaluation , 408 complications FOUR score , 409 acute hemolytic reaction , 105 GCS , 409 allergic reactions , 106 intraoperative management , 409–410 bacterial contamination , 106 pathophysiology , 408 delayed hemolytic reaction , 105 preoperative management , 409 febrile nonhemolytic reactions , 106 treatment , 410 human error , 105 Triamterene , 171 immunosuppression , 265 Tricyclic antidepressants (TCA) , 278, 482 metabolic abnormalities , 106 Trifl uoroethyl vinyl ether , 3 TRALI , 106 Trigeminal neuralgia , 287, 293 cryoprecipitate , 103 Tuberculosis (TB) , 650 erythropoietin , 103 Tuffi er, T. , 5 fresh frozen plasma , 102 Tuohy, E., 5 HIT , 113 Turnbull, J.H. , 211–231 massive blood transfusion , 107–108 Turner , 24 perioperative blood conservation , 103–104 TURP. See Transurethral resection of the prostate (TURP) perioperative transfusion criteria , 104–105 platelet disorders , 110–112 platelets , 102–103 U PRBCs , 102 Ultrasound-guided peripheral nerve blockade pretransfusion testing , 101 axillary blockade , 257 RVII , 103 femoral nerve blockade , 259 Transfusion-related acute lung injury (TRALI) , 106 infraclavicular blockade , 256 Transient ischemic attack (TIA) , 358, 476 interscalene blockade , 233–234 Transient neurological symptoms (TNS) , 188–189, 191 popliteal sciatic nerve blockade , 261–262 Transurethral resection of the prostate (TURP) , 454–455 sciatic nerve blockade , 246–247 Trauma supraclavicular blockade , 255–256 abdomen injury , 620 Upper extremity nerve blockade airway , 616–617 brachial plexus. (see Brachial plexus) AirTraq® laryngoscope , 616 digital and metacarpal nerve block , 242 blind nasal intubation , 616–617 innervation of , 253 Bullard and lighted stylette , 616 intravenous regional anesthesia , 242 coughing and bucking , 616 Upper lip bite test (ULBT) , 25 fi ber-optic intubation , 616 Upper motor neurons (UMNs) lesions Glascow coma scale , 616 ALS , 475 Glidescope® , 616 cerebrovascular disease , 476–477 MAIS and cricoid pressure , 616 CMT , 475–476 11-step examination , 616 Friedreich’s ataxia , 474 supraglottic devices , 617 multiple sclerosis , 475 burn injuries , 620–621 signs , 471, 472 circulation SMA , 472–473 ABC score , 618 spinal cord injury , 473 ETIC , 618 syringomyelia , 474 hypotensive resuscitation , 618 intraosseous (IO) access , 617 isotonic sodium chloride solution , 617 V lethal triad , 618 Valerian , 654 management , 618 Vallejo, M.C. , 501–529 massive transfusion , 618 Valvular heart disease , 520 mortality rates , 617 aortic insuffi ciency , 343 Poiseuille’s Law , 617 aortic stenosis , 343–344 PRBC:plasma:platelet ratio , 618 hemodynamic management , 345 RIC™ , 617 mitral regurgitation Ringer’s lactate solution , 617 anesthetic management , 341 epidemiology , 615 arrhythmias and thrombus formation, 341 extremities injury , 620 bacterial infective endocarditis , 340 Index 711

cardiogenic shock , 340 mitral regurgitation , 340–341 Ehlers–Danlos syndrome , 536 pulmonary hypertension , 376, 519 Frank–Starlin mechanism , 340 PVR , 345 IABP support and placement , 341 restrictive lung diseases , 378 Marfan syndrome , 340 Vecuronium myocardial ischemia/infarction , 340 dosing and administration of , 154 regurgitant fraction , 341 muscle relaxation , 419 rheumatic fever , 340 Venable , 4 vasodilators , 341 Ventilation-perfusion (V/Q) mitral stenosis , 342 alveolar pressure , 372 Vaporizers high V/Q and dead space , 373–374 Aladin cassette vaporizer , 62–63 pulmonary artery , 373, 374 classifi cation of , 60 pulmonary venous pressures , 372, 373 desfl urane vaporizer , 62 venous admixture , 373 heat of vaporization , 59 Venturi masks , 27 saturated vapor pressure , 59 Verapamil , 96, 181 vaporizer output , 60–62 Videolaryngoscopy , 26, 38 working principle of , 63 Visceral edema , 441 Varicella zoster virus (VZV) , 647 Visual Analog Scale (VAS) , 269 Vascular surgery Visual evoked potentials (VEP) , 80, 81 abdominal aortic aneurysm Vitamin E , 11, 111, 654 anesthetic management , 356–357 Vitamin K defi ciency , 112, 434, 532 cross clamping and unclamping , 357 von Mering, J. , 4 graft repair , 355–356 Von Willebrand disease (vWD) , 105, 112, 524 postoperative management , 357–358 symptoms , 356 carotid artery stenosis W cardiovascular protection , 360 Wall , 267 general anesthesia , 359–360 Warner, M.A. , 632 neurologic protection , 360 Warren, J. , 3 normal carotid arteries , 358, 359 Waters, J.H. , 609–614 plaque formation , 358, 359 Waters, R. , 5 postoperative management , 360 Wells, C. , 587–592, 643–645 regional anesthesia , 361 Wells, H. , 3 symptoms , 358 Wernicke–Korsakoff syndrome , 637, 638 carotid artery stenting , 360 Wertheim , 5 endovascular aortic repair , 358 White, S. , 5 peripheral vascular disease , 360–361 Wrist surgery , 299 preoperative evaluation , 355 Vasoconstrictors end-stage liver disease , 435 X epidural anesthesia , 227 Xenon , 50, 128 nasal and sinus surgery , 490 nasotracheal FOB intubation , 40 nasotracheal intubation , 38 Y ropivacaine , 192–193 Yemen, T.A. , 529–546 spinal anesthesia , 220 Vasodilators aortic insuffi ciency , 343 Z Eisenmenger’s syndrome , 521 Zeus robotic surgical system , 627