<<

Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

A a2-adrenoceptor agonists abciximab 261 local anaesthesia spinal adjuncts 229 abdominal obesity 171 stress response to surgery 175

abnormal placentation, postpartum haemorrhage a2-adrenoceptor blockers, cardiac output 233 (PPH) 383 b-adrenoceptors 239 abnormal respiration 113 adrenaline 179 abnormal waveforms, 292 b-adrenoceptor blockers 237, 238–41 ABO blood group, see blood groups cardiac output 232 absolute humidity 332 cocaine overdose management 254 absolute 318 intraocular pressure 152

absorption atelectasis 136 b2-adrenoceptor blockers 267 acarbose 277 adrenocortical suppression, etomidate 201 acceleromyography 156 AEP, see auditory evoked potentials ACE inhibitors 242 afferents, autonomic nervous system 23 acetylcholine 23 age/ageing 172–4 muscle action potentials 154 subarachnoid (spinal) anaesthesia 83 postjunctional nicotinic receptors 154 air embolism N-acetylcysteine, paracetamol overdose 252 ultrasound 338 acidosis venous cannulation 18 hypercapnic 121 air-filled spaces, 206 lactic 111 airway(s) acquired immune response, see immune response awareness 284 activated protein C, sepsis management 399 goitre effects 187 active scavenging systems 312 irritation 203–4 acute haemolytic reactions 372 thyroid disease 187 acute lung disease, compliance 120 upper, see upper airways acute normovolaemic haemodilution 371 acute phase proteins, sepsis 399 neonates/infants 165 acute respiratory distress syndrome (ARDS) 122–3 nose 28 acyanotic congenital heart disease, see congenital albumin 185 heart disease alcohol Addisonian crisis 176 overdose 253, 255 additives, nutritional support 190 withdrawal, clonidine 234 adenosine 237 alcohol thermometers 328 adenylyl cyclase, inotropes 246 alfentanil, patient-controlled analgesia (PCA) 215 adjuvant drugs, subarachnoid (spinal) anaesthesia 83 alkalinization, see local anaesthesia adrenaline 178–80, 247 allergic reactions hypotension management 246 blood transfusion 372 local anaesthesia 223 local anaesthesia 222 a-adrenoceptors, adrenaline 179, 180 thiopental 201 a-adrenoceptor blockers, systemic vascular see also anaphylaxis

resistance (SVR) 231 a1-acid glycoprotein, local anaesthetic binding 221

405

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

altitude effect, vaporizers 303 anterior cardiac vein 48 ambient light interference, pulse oximetry anterior radicular artery of Adamkiewicz 62 289 anterior spinal artery 61, 62 amethocaine 220 anti-arrhythmic drugs 235–8 aminergic neurotransmitters 181 ‘Sicilian Gambit’ classification 237 amiodarone 220 Vaughan–Williams classification 236–7 AMPA receptors, 361 see also specific drugs amphetamines, abuse of 256 antibiotics, sepsis management 399 amplification, biological potentials 350 antibodies 400 Amsorb 310 anticholinesterases 230 anaemic , hyperbaric 133 anticoagulant drugs 258–62 anaesthesia intra-arterial 80 breathing effects 116 antidepressant drugs 251 depth of, see depth of anaesthesia antidiuretic hormone (ADH) 351 heat loss mechanisms 329 antidopaminergic drugs 250 during magnetic resonance imaging 336 anti-hypertensive drugs 241–3 336 anti-inflammatory effects, non-steroidal pneumothorax 101, 102 anti-inflammatory drugs 263 postoperative nausea and vomiting 168, antimuscarinic drugs 250 249 antineoplastic effects, non-steroidal anaesthetic breathing systems 304–9 anti-inflammatory drugs 264 296–8 antiplatelet drugs 261 analgesia/analgesics 393 antipyretic action, non-steroidal anti-inflammatory complex regional pain syndromes 388 drugs 263 foot 95 antiserotoninergic drugs 250 magnesium sulphate 265 antisialogogue effect, clonidine 234 nitrous oxide 206 antithrombotic effects, non-steroidal non-steroidal anti-inflammatory drugs anti-inflammatory drugs 263 263 anxiolysis, clonidine 234 analysis of variance (ANOVA), statistics 354 aorta anaphylactoid reactions 397 lumbar region 99 see also allergic reactions surgery, spinal cord injury 62 anaphylaxis aortic incompetence 379–80 adrenaline 178 aortic stenosis 378–9 management 364 aortic valve disease 378–80 suxamethonium 212 see also aortic incompetence; aortic stenosis see also allergic reactions aortocaval compression, see pregnancy anatomy 7–8, 13–99 apnoea 112, 116–18 aneroid pressure gauges 318 testing, brain stem death 366 angina pectoris 50–1 apnoeic oxygenation 116 b-adrenoceptor blockers 239 appearance 2–3 stellate ganglion block 45 aqueous humour 98 angiotensin antagonists 242 intraocular pressure 151 angiotensin-converting enzyme (ACE) inhibitors arachnoid mater 81 242 argon lasers 334 ankle block 96 arrhythmias, see cardiac arrhythmias antecubital fossa 76–8 arterial pressure, cerebral blood flow 150 anterior approach arterial pulmonary hypertension 141 sciatic 94 arterial supply, cerebral circulation 13–14 stellate ganglion block 46 arterial tourniquet 400–3

406

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

arytenoid cartilage 35, 36 beta-blockers, see b-adrenoceptor blockers aspirin 261 Bezold–Jarisch reflex 243 asthma 123–5 bicarbonate magnesium sulphate 265 diabetic ketoacidosis management 390 atelectrauma 121 local anaesthesia alkalinization 223 atenolol, cardiac output 232 biguanides 276 atracurium 209 bile synthesis 59 metabolism 210 bilirubin formation 362 atrial fibrillation (AF) 238, 345 binding effects, local anaesthesia 221 atrial septal defect (ASD) 161 bioavailability 277–80 attenuation, ultrasound 338 biological potentials 349–50 auditory evoked potentials (AEP) 288 biotrauma 121 depth of anaesthesia measurement 285 bipolar surgical diathermy 348 auriculotemporal nerve block 31 birth, uterine activity 269 autologous blood donation 371 bispectral analysis, depth of anaesthesia 286 autonomic nervous system 21–4 (BIS), depth of anaesthesia ageing 172 286 denervation, cardiac transplants 49 bleeding, see blood loss myocardial innervation 50 blinding, clinical trials 281 stress response to surgery 174 blood, fluid therapy 109 autonomic neuropathy 22 blood– partition coefficient 203 autonomic regulation failure, complex blood groups 369–73 regional pain syndromes (CRPS) blood loss 386 compensatory responses 110–12 Avogadro’s law 314 fluid therapy 108 relevance 315 percutaneous tracheostomy 44 awake patient, pneumothorax 102 subarachnoid 14 awareness 283–4 blood solubility, inhalational anesthetics 203 ‘a’ wave, central venous pressure (CVP) 103 blood supply, nose 27 axillary 70 blood , massive blood transfusion 372 B blood transfusion 369–71 back bar, anaesthetic machine 298 complications 371–3 baclofen 230 massive transfusion 372 trigeminal neuralgia 25 sepsis management 400 Baralyme (barium lime) 310 blood volume barbotage, subarachnoid (spinal) anaesthesia 83 children 167 bariatric surgery 170 neonates/infants 167 barium lime (Baralyme) 310 B lymphocytes 396 barotrauma, protection from 298 body fluid compartments 107 basal metabolic rate (BMR), neonates/infants body mass index (BMI), obesity 170 165 body temperature 327–9 basilic vein 77 cerebral blood flow 148, 149 basophils 396 changes, arterial tourniquet 402 Battle’s sign 29 children 166 behaviour 3 Bohr effect 131 benzodiazepines 241 boiling point 316 antidepressant overdose management 251 bone marrow toxicity, nitrous oxide 207 overdose 252 Boyle’s law 313 stress response to surgery 175 relevance 314

407

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

brachial plexus 67–71 capnography 291, 292 cross-section 98 capsaicin, complex regional pain syndromes (CRPS) brachial plexus block 68–70 388 brain stem death 365–7 carbamazepine, trigeminal neuralgia 25 evoked potentials 367 carbohydrate metabolism exclusions 365 insulin 276 eye signs 367 liver 58 methods 365 carbonation, local anaesthesia alkalinization 224 see also specific methods carbon dioxide absorption 310 preconditions 365 carbon dioxide lasers 334 pupillary signs 367 carbon dioxide measurement 290–3 breathing 112–16 carbon monoxide heat loss mechanisms 329, 331 poisoning 132 Brewer–Luckhardt reflex 24 production 310 bronchi 38–42 carboxyhaemoglobin 131 bronchoconstriction, asthma 124 carboxyhaemoglobinaemia 290 bronchodilatation, adrenaline 178 carcinoid syndrome 181 bronchomotor tone 123–5 cardiac action potential 235, 236 bronchopulmonary segments 41 cardiac arrhythmias left lung 41 adrenaline 180 right lung 40 b-adrenoceptor blockers 239 , awareness 284 halothane 202 buffering, plasma proteins 186 local anaesthesia 220 bupivacaine 220, 225–8 magnesium sulphate 265 chirality 193 venous cannulation 18 structure 219, 226 see also anti-arrhythmic drugs toxicity 227 cardiac disease ‘buzz words’ 10–12 adrenaline 180 reduction 243 C cardiac function Caesarean section 385 body temperature 327 calcium channel blockers 237, 241 hypothermia 330 tocolytic effects 268 ultrasound 338 calcium modifying drugs, complex regional pain cardiac function, preoperative assessment syndromes (CRPS) 388 125–7 calibration cardiac output

pulse oximetry 289 a2-adrenoceptor blockers 233 vaporizers 302 b-adrenoceptor blockers 232 calorie sources 190 blood loss 111 canal of Schlemm 98 children 166 cannabinoids clonidine 233 cannabis 250 drugs affecting 232 anaesthesia implications 256 esmolol 232 overdose 255 hypoxic pulmonary vasoconstriction 143 cannulation 104–7 measurement 129, 323–7 antecubital fossa 78 myocardial blood supply 48 insertion complications 106 neonates/infants 166 venous, see venous cannulation oxygen flux 129 capacitance, defibrillation 346 propranolol 232 capillary fluid flux, pulmonary oedema 139 cardiac rate, mitral stenosis, see mitral stenosis

408

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

cardiac resuscitation, adrenaline 178 ketamine 198 cardiac rhythm, mitral stenosis, see mitral stenosis local anaesthesia 222 cardiac transplants 49–51 magnesium sulphate 266 Cardiff Aldasorber 312 neonates/infants 167 cardio-oesophageal sphincter, diaphragm 56 oxygen toxicity 135 cardiopulmonary exercise (CPX) testing 127 pregnancy 157 cardiovascular information, capnography 291 propofol 196 cardiovascular system 47 thiopental 200 adrenaline 179 central , anticoagulant drugs 261 ageing 172 central tendon, diaphragm 55 arterial tourniquet 402 central venous cannulation, ultrasound 338 children 166–7 central venous pressure (CVP) 16, 104–7 desflurane 203 intraocular pressure 152 enflurane 202 right ventricular function 16, 102 etomidate 200 cephalic vein, antecubital fossa 77 5-hydroxytryptamine 182 cerebral blood flow 143–50 inhalational anaesthetics 202 cerebral circulation 13–15 isoflurane 203 arterial supply 13–14, 17 ketamine 199 venous drainage 14, 17 local anaesthesia 222 cerebral function analysing monitor (CFAM) 286 magnesium sulphate 266 cerebral function monitor (CFM) 286 neonates/infants 166–7 cerebral herniation, raised intracranial pressure 144

nitric oxide effects 184 cerebral metabolic rate (CMRO2) 149 nitrous oxide 207 cerebral vasospasm 15 non-steroidal anti-inflammatory drug 264 cerebrospinal fluid (CSF) 81, 146 obesity 171 lumbar region 99 pregnancy 156 cervical plexus 31–3 propofol 197 see also carotid endarterectomy (CEA) thiopental 201 cervical spinal cord injury 394 carotid arteries 13 Charles’s law 313 neck surface anatomy 43 chemoreceptor trigger zone (CTZ), venous cannulation 18 postoperative nausea and vomiting carotid endarterectomy (CEA) 31–2 (PONV) 169, 250 carotid sheath, cross-section 98 chemoreceptors, peripheral 114 cascade humidifier, humidification 333 chest drains, pneumothorax 103 caudal (sacral extradural) anaesthesia 86–9 chest X-ray 55 cauda equina, lumbar region 99 Cheyne–Stokes respiration 113 central chemoreceptors, breathing 114 children 165–7 central gas supply 295 brain stem death testing 365 central herniation, raised intracranial pressure 144 chirality 193–5 central nervous system (CNS) chlorpropamide 276 adrenaline 180 cholestasis, jaundice 363 ageing 172 cholinesterase, pregnancy 158 desflurane 203 choroid 97 enflurane 203 blood volume 151 etomidate 200 chronaxy, nerve stimulators 341 5-hydroxytryptamine 182 ciliary body 98 hypothermia 330 cingulate herniation 144 inhalational anaesthetics 203 circle of Willis 15 isoflurane 203 circle system, see anaesthetic breathing systems

409

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

circulating volume cold water bath, humidification 333 mitral incompetence 377 collection system, scavenging 311 mitral stenosis 376 colloid oncotic pressure, decreased 140 circulation, changes at birth 161–4 colloids, see fluid therapy fetal circulation 162 colorimetric carbon dioxide measurement 292 pulmonary vascular resistance 163 colour coding, gas cylinders 294 circulatory support, adrenaline 178 colour Doppler ultrasound 339 cisatracurium 209 combined gas laws 314 metabolism 210 common earth 344 Clark electrode 293 common gas outlet 298 clathrate theory, general anaesthesia 360 common-mode rejection ratio (CMRR) 350 claw hand, ulnar nerve 72 compensatory responses, see blood loss clearance, target-controlled infusion (TCI) complement 397 272 complex regional pain syndromes (CRPS) 385–8 clinical measurement and equipment 8–9 compliance 118–20 clinical significance, clinical trials 282, 357 neonates/infants 166 clinical signs, depth of anaesthesia 285 compound A, sevoflurane 310 clinical trials 280–2 compressed spectral array (CSA), depth of clinical significance 282, 357 anaesthesia 285 statistical significance 282, 357 concordant congenital heart disease 161 type I errors 281, 356 conduction, heat loss mechanisms 329, 331 type II errors 281, 356 confidence limits, statistics 354 clonidine 233–5 congenital heart disease 161–4 caudal anaesthesia 88 conscious 273–4 local anaesthesia spinal adjuncts 229 constant-flow ventilators, compliance 120 clopidogrel 261 constant-pressure ventilators, compliance 120 close marking system 1–2 constipation, magnesium sulphate 265 closed circle circuit anaesthetic breathing context-sensitive half-time (CSHT) systems 305 propofol 196 closing capacity, neonates/infants 166 target-controlled infusion 271, 272 coagulation continuous positive airways pressure (CPAP) arterial tourniquet 402 137 body temperature 327 contractility hypothermia 330 aortic stenosis 379 massive blood transfusion 372 mitral incompetence 377 pathways 260 mitral stenosis 376 vitamin K 260 contralateral cortex, pain pathways 392 problems, haemofiltration 369 controlled ventilation, Mapleson A anaesthetic see also anticoagulant drugs breathing systems 307 coagulopathy convection, heat loss mechanisms 329, 331 jaundice 361 conventional ventilation 121 postpartum haemorrhage 383 Cormack and Lehane classification, pre-eclampsia 385 34 cocaine corniculate cartilage 35 anaesthesia implications 256 coronary angiography, cardiac function 127 overdose 254 cortical afferents, postoperative nausea and codeine phosphate, patient-controlled analgesia vomiting (PONV) 169 (PCA) 216 cortical vein thrombosis 15 coeliac plexus 59–61 corticosteroids coeliac plexus block 59–61 postdural puncture headache 85

410

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

postoperative nausea and vomiting management delayed-type hypersensitivity reactions 397 250 delayed wound healing, hyperbaric oxygen 132 sepsis management 400 d-subtype opioid receptors 213 side effects 250 depolarizing neuromuscular blocks 154, 209 spinal cord injury management 394 depth of anaesthesia 283–7 cortisol desflurane output 177 airways irritation 204 production 176 blood–gas partition coefficient 203 surgical response 175 chirality 195 costal diaphragm 55 MAC50 203 cranial nerves 365–6 metabolism 204 cranial nerves reflexes, see brain stem death testing permitted maxima 312 cricoid cartilage 35, 36, 98 side effects 203 neck surface anatomy 43 stability 205 cricoid pressure, pregnancy 158 vaporizers 303 cricothyroid membrane 43 dexmedetomidine 235 critical care, ultrasound 338 local anaesthesia spinal adjuncts 229 critical pressure 315 dextrans, fluid therapy 109 critical temperature 315 diabetes insipidus 351 cross-sections 97–9 diabetes mellitus 275–7 crystalloids, see fluid therapy diabetic ketoacidosis 388–91 Cushing’s reflex, raised intracranial pressure 144 diagnostic coeliac plexus block 60 cutaneous innervation, median nerve block 75 diagnostic sympathetic blocks, complex regional ‘c’ wave, central venous pressure (CVP) 103 pain syndromes (CRPS) 387 cyanotic congenital heart disease, see congenital dial thermometers 328 heart disease diamorphine, patient-controlled analgesia (PCA) 215 cyclo-oxygenase-2 (COX-2) inhibitors 264 diaphragm 53–6 cyclo-oxygenase (COX) enzymes 262–4 diaphragm pressure gauges 318 cytochrome P450 373–5 diastolic blood pressure, aortic stenosis 379 cytokines, sepsis 399 diathermy, see surgical diathermy cytotoxic hypersensitivity reactions 397 diazoxide, tocolytic effects 268 cytotoxic T lymphocytes 396 digital nerve blocks 71 digoxin 248 D bioavailability 278 Dalton’s law of partial 313, 314 mechanism of action 237 dantrolene, MDMA (ecstasy) overdose 255 dihydropyridines 241 data collection, clinical trials 281 diminished biliary secretion, jaundice 363 D configuration 194 2,3-diphosphoglycerate (2,3-DPG) 130, 131 decompressive sickness 132 Diploma of Anaesthesia 6 decreased colloid oncotic pressure, pulmonary direct cannulation 322 oedema 140 direct connection (resistive coupling) 343 decreased interstitial pressure, pulmonary oedema 140 direct intra-arterial monitoring 78 decreased lymphatic clearance, pulmonary oedema direct vasodilators 232 140 discordant congenital heart disease 161 decreased reflection coefficient, pulmonary oedema disease factors, postoperative nausea and vomiting 140 (PONV) 168, 249 deep peroneal nerve block 96 disposal system, scavenging 311

defective bilirubin binding, jaundice 362 dissolved oxygen, oxygen flux (O2 flux) 129 defibrillation 345–7 diuretics 241 dehydration, fluid therapy 108 anaesthetic implications 241

411

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

dobutamine 247 Eisenmenger syndrome 142, 163 stress echocardiography 127 electrical safety 342–5 dopamine 248 electricity dopamine receptors 207 definition 343 dopexamine 247 effects of 342 Doppler ultrasonography 339 (ECG) 126 colour Doppler 339 electroconvulsive therapy (ECT) 380–2 organ blood flow measurement 322 electrocution 342 dorsal column stimulation, complex regional pain electroencephalogram (EEG) 286 syndromes (CRPS) 387 electromagnetic flowmeters 323 dorsal respiratory neurons, respiratory centre 113 electromyography 156 double burst stimulation (DBS) 155 , ketamine 199 double-lumen endobronchial tubes 41–2, 138 emergency oxygen flush, anaesthetic machine 297 positioning 138 emesis, nitrous oxide 207 2,3-DPG 130, 131 enantiomers 194 driving pressure, myocardial blood supply 48 endobronchial tubes, double-lumen, see double- drug(s) lumen endobronchial tubes adverse reactions 396 endocrine system investigations 398 obesity 171 baricity 82 stress response to surgery, see stress responses, bronchomotor tone 124 surgery doses endoneurium, local anaesthesia 218 caudal (sacral extradural) anaesthesia 87 endothelial nitric oxide synthase (eNOS) 183 subarachnoid (spinal) anaesthesia 82 energy metabolism, neonates/infants 167 elimination, jaundice 362 energy requirements, see nutritional requirements heart rate reduction 243 enflurane hypoxic pulmonary vasoconstriction 143 airways irritation 204 overdoses 251–3 blood–gas partition coefficient 203 postoperative nausea and vomiting 169 chirality 195 pregnancy 158 MAC50 203 drug-induced pulmonary hypertension 141 metabolism 204 drugs of abuse 253–6 permitted maxima 312 dry bulb hygrometer 333 side effects dural sheath 83 cardiovascular system 202 dura mater 81 CNS effects 203 dynamic compliance 119 toxicity 204 dypyridamole–thallium scintigraphy scanning 127 enoximone 248 dyspepsia, magnesium sulphate 265 enteral nutrition 191 dysphoria, ketamine 199 entonox 295, 296 eosinophils 396 E ephedrine 249 early goal-directed therapy (EGDT) 128 hypotension management 244 sepsis management 399 epidural anaesthesia 83–6 earth leakage circuit breakers (ELCB) 344 epidural catheters, anticoagulant drugs 262 Eaton–Lambert syndrome 153 epidural space, lumbar region 99 echocardiography, cardiac function 126 epilepsy, magnesium sulphate 265 eclampsia, magnesium sulphate 265 epineurium, local anaesthesia 218 ecstasy (MDMA), overdose 254 ergometrine 269 ectopic pacemaker activity 238 ergot alkaloids 269 effective refractory period 236 erythropoiesis, liver 59

412

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

esmolol , see cardiac output 232 fast channels, cardiac tissue 222 hypertension therapy 241 fat metabolism, insulin 276 ethanol felypressin 180 tocolytic effects 268 femoral artery 89 see also alcohol femoral nerve 89, 90, 91 ethics committee 280 anatomy 92 etidocaine 219 femoral nerve block 90, 93 etomidate 199–201 fascia iliaca block 92 chirality 195 technique 93 intraocular pressure 152 indications 92 stress response to surgery 175 3-in-1 block 92 evaporation, heat loss mechanisms 329, 331 efficacy 92 evoked potentials (EPs) 287–8 technique 93 brain stem death testing 367 femoral triangle 89–90 depth of anaesthesia measurement 285 femoral vein 89 examiners’ knowledge 3 fentanyl, patient-controlled analgesia (PCA) excimer lasers 335 215 exophthalmos 189 fetal circulation 162 extracellular fluid (ECF) 107 fetal haemoglobin 131 extradural (epidural) space 83–6 oxygen–haemoglobin dissociation curve 130 extraocular muscles 20 fibreoptic bronchoscopy 39 intraocular pressure 152 trachea 39–40 extrinsic compression, intraocular pressure (IOP) fibrinogen 186 152 , organ blood flow measurement eye 97 322 anaesthesia 19–20, 150 field block technique, inguinal hernia repair, see laryngoscopy 151 inguinal hernia repair suxamethonium 151 filling ratio, gas cylinders 295

brain stem death testing 367 FiO2, PaO2 prediction 133 cross-sections 97 fixed output state, aortic stenosis 379 exophthalmos 189 flow 300 intraocular pressure, see intraocular pressure flow control valves 297 (IOP) flowmeters 298–300 oxygen toxicity 135 anaesthetic machine 297 penetrating injuries 150 flow rate, vaporizers 302 peribulbar block 19 flow restrictors, anaesthetic machine 297 retrobulbar block 19 fluid balance sub-Tenon’s block 20 children 165 eye, anatomy 19–21 neonates/infants 165 globe 20, 98 pre-eclampsia 385 outer layers 97 fluid flow 300 choroid 97 fluid requirements 190 retina 97 fluid therapy 107–10 sclera 97 children 165 eyesight, lasers 335 diabetic ketoacidosis management 389 neonates/infants 165 F flumazenil facial sensory nerves 29–31 benzodiazepine overdose management 252 failing lungs 120 overdose 274

413

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

foot ageing 173 analgesia 95 etomidate 201 ankle block 96 5-hydroxytryptamine 182 deep peroneal nerve block 96 ketamine 199 local anaesthetic techniques 95 neonates/infants 167 posterior tibial nerve block 96 non-steroidal anti-inflammatory drugs saphenous nerve block 96 264 sensory innervation 95–6 obesity 171 superficial peroneal nerve block 96 pregnancy, see pregnancy sural nerve block 96 propofol 197 foramina gate control, pain pathways 392 diaphragm 55 gauge pressure 318 eye 21 Gay–Lussac’s law 313 foreign bodies, magnetic resonance imaging gelatins, fluid therapy 109 problems 336 gender, subarachnoid (spinal) anaesthesia 83 framework, nose 27 general anaesthesia free radical scavengers 387 carotid endarterectomy, see carotid frequency dependence, local anaesthesia 220, endarterectomy (CEA) 228 mechanisms of action 359–61 frequency effects, ultrasound 338 genitofemoral nerve 66 fresh frozen plasma (FFP) 261 frontalis (scalp) electromyogram 287 5-hydroxytryptamine 182 fuel cell 293–4 trauma, postpartum haemorrhage 383 functional residual capacity (FRC) glibenclamide 276 obesity 171 glipizide 276 pregnancy 157 Glisson’s 57 glitazones 277 G globe, see eye, anatomy

GABAA receptors globulins 185 agonists 230 glomerular filtration rate, ageing 173 general anaesthesia 360 glossopharyngeal nerve, larynx 38 nitrous oxide 207 glucagon 248 gabapentin, trigeminal neuralgia 25 glucocorticoids, complex regional pain syndromes gain, biological potentials 350 (CRPS) 388 c-globulins 186 glucocorticoids, response to surgery 176–8 ganglion blockers, systemic vascular resistance gluconeogenesis 58, 390 (SVR) 232 glucose 5% 108 gas, turbulent flow 300 a-glucosidase inhibitors 277 gas cylinders, see gas supply glutamate receptors 360 315–16 glycaemic control 400 permitted maxima 312 glyceryl trinitrate (GTN) 184 gas laws 312–15 systemic vascular resistance 231 gas pipelines, anaesthetic machine 296 tocolytic effects 268 gas supply 294–6 glycine intoxication (TUR) syndrome with anaesthetic machine 297 hyponatraemia 351 nitrous oxide 295, 296, 316 glycine receptors 360 oxygen 295, 316 glycogenesis 58 gastric bypass surgery 170 glycogenolysis 59 gastrointestinal system goal-directed therapy (GDT) 128 adrenaline 180 goitres 187

414

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

Goldman index, cardiac function 126 heat loss mechanisms 329–31 graft-versus-host disease, blood transfusion 373 height, subarachnoid (spinal) anaesthesia 83 grand mal convulsions HELLP syndrome 384 electroconvulsive therapy 381 Henderson–Hasselbalch equation 218 local anaesthesia toxicity 221 Henry’s law 313 great cardiac vein, myocardial blood supply 48 hyperbaric oxygen 133 greater auricular nerve block 31 relevance 314 greenhouse effect, nitrous oxide 207 heparins 260 hepatic artery 57 H hernia, diaphragm 56 haematological system, pregnancy, see pregnancy hiatus hernia 56 haematoma, subdural 15 high (total spinal) block 86 haemofiltration 367–9 high frequency ventilation, acute respiratory distress haemoglobin–oxygen dissociation curve, see syndrome (ARDS) 122

oxygen–haemoglobin dissociation curve high/rising end-tidal CO2, capnography 292 haemoglobins high thoracic spinal cord injury 394 abnormal 131 history of anaesthesia 6–7 concentration 129 Diploma of Anaesthesia 6 fetal 131 FFARCS 6 saturation 133 HME (heat and moisture exchange) filter, haemorrhage, see blood loss humidification 332 haemostasis 259 Horner’s syndrome 33, 45 fresh frozen plasma 261 5-HT receptors 182–3 hair hygrometer 333 human albumin , fluid therapy 109 Haldane effect 131 humidification (of inspired gases) 332–4 halothane humidity airways irritation 203 absolute 332 blood–gas partition coefficient 203 measurement 333–4 chirality 195 relative 332 MAC50 203 Humphrey ADE system 309 metabolism 204 hydralazine, systemic vascular resistance permitted maxima 312 (SVR) 232 side effects hydrocortisone, replacement regimens 177 arrhythmias 202 hydromorphone, patient-controlled analgesia toxicity 204 (PCA) 216 stability 205 hydrophilic molecules, placental drug transfer 160 hand, arterial supply 78–80 hydrostatic pulmonary oedema 140 hapten formation 396 5-hydroxytryptamine (serotonin) 180–3 Harris–Benedict equation 189 general anaesthesia 360 Hartmann’s solution 108 hyoid bone, surface anatomy 43 head-up position, raised intracranial pressure hypothalamo–pituitary–adrenal responses, blood 146 loss 111 heart hyperbaric oxygen 132–4 heart rate hypercapnic acidosis 121 aortic incompetence 380 hyperkalaemia aortic stenosis 379 sinus bradycardia 238 mitral incompetence 377 suxamethonium 212 reduction, hypotension, see hypotension hyperosmolar states 351 heart rhythm, aortic stenosis 379 hyperpyrexia, malignant, see malignant hyperpyrexia heart transplants, see cardiac transplants hypersensitivity reactions 396–7

415

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

hypertension immune response 395–8 b-adrenoceptor blockers 239, 241 liver 59 benign intracranial 145 immunoglobulins (IgA) 186 esmolol therapy 241 immunomodulation, blood transfusion 373 venous pulmonary 141 impaired drainage, raised intracranial pressure 145 hyperthyroidism 187, 188 impedance hypertrophic cardiomyopathy, b-adrenoceptor defibrillation 347 blockers 240 definition 343 hyperventilation 113 implants, magnetic resonance imaging problems 336 hypoglycaemia, b-adrenoceptor blockers 240 impulse propagation, normal action potentials 217 hypoglycaemic agents, oral 276–7 inadvertent subdural block 86 hypokalaemia, sinus tachycardia 238 increased bilirubin production, jaundice 362 hypomagnesaemia, magnesium sulphate increased capillary hydrostatic pressure, pulmonary 265 oedema 139 hypotension 243–6 indicator dilution methods, organ blood flow induced, see induced hypotension measurement 323 management 244–6 indirect connection (capacitive coupling) 343 spinal cord injury 62 induced hypotension 230–3 stroke volume reduction 244 see also systemic vascular resistance (SVR) systemic vascular resistance reduction 244 inducible nitric oxide synthase (iNOS) 183 hypotensive anaesthesia, clonidine 234 infants, see neonates/infants hypothalamic–pituitary–adrenal axis infections stress response to surgery 175 blood transfusion 373 surgery 176 hyperbaric oxygen 132 hypothermia 329, 330 venous cannulation 19 hypothyroidism 187, 188 infective bacterial endocarditis (IBE) hypoventilation 112, 116–18, 123 aortic stenosis 379 oxygen adverse effects 136 mitral incompetence 377

PaCO2 118 infective hepatitis, jaundice 362 hypovolaemia 37–8 inferior orbital fissure 21 hypoxia inferior vena cava, lumbar region 99 anaemic 133 inflammatory response 396 breathing effects 116 inotropes 247 heart rate reduction 243 local anaesthesia 224 one-lung anaesthesia, see one-lung anaesthesia sepsis, see sepsis protection from 298 stress response to surgery 175 sinus bradycardia 238 inflation effects, arterial tourniquet 402 hypoxic pulmonary vasoconstriction (HPV) 141, information 10–12 142, 143 hierarchy of 11 one-lung anaesthesia 137 purpose 10 hysteresis, compliance 119 infraorbital nerve block 31 infrared, body temperature measurement 328 I infrared absorption ideal weight 170 carbon dioxide measurement 292 iliohypogastric nerve 66 pulse oximetry 289 ilioinguinal nerve 66 infratrochlear nerve block 31 immediate hypersensitivity reactions 397 infusion pumps, magnetic resonance imaging immediate transfusion reaction, see blood problems 336 transfusion inguinal hernia repair 65–7 immune complex hypersensitivity reactions 397 inguinal region innervation 65–7

416

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

inhalational anaesthesia/anaesthetics 202–5 permitted maxima 312 scavenging 312 side effects sedation 274 cardiovascular system 203 inhaled nitric oxide 184 CNS effects 203 injection site, local anaesthesia toxicity 221 isolated (floating) electrical circuits 344 injection speed and direction, subarachnoid (spinal) isolated forearm technique, depth of anaesthesia anaesthesia 83 286 innate immune response, see immune response isoprenaline 248 inotropes 246–9 insulin 275–6 J diabetic ketoacidosis management 389 jaundice 361–3 stress response to surgery 175 liver 59 intercostal nerve(s) 51–3 jugular venous bulb oxygen saturation (SjVO2) 326, 52, 53 327 intermediate zone, liver 58 internal jugular vein 15–19 K interscalene block, see brachial plexus block kainate receptors 361 interstitial pressure, pulmonary oedema j, Starling equation 139 140 j-subtype opioid receptors 213 intra-arterial blood pressure measurement ketamine 197–9 319–21 chirality 195, 199 intra-arterial injection 79–80 conscious sedation 274 intracellular water (ICW) 107 ketone metabolism 390 intracranial pressure (ICP) 147 Kety–Schmidt method cerebral blood flow 149 cerebral blood flow measurement 149 measurement 146 organ blood flow measurement 323 normal readings 144, 145 kidney 99 intracranial pressure (ICP), raised 143–6 Kussmaul respiration 113 intragastric balloon surgery 170 intraocular pressure (IOP) 150–2, 317 L intrapleural intercostal nerve block 52 labetalol intrapleural venous cannulation 18 cardiac output 232 intrapulmonary alveolar rupture 103 hypertension therapy 241 intravascular pressure 317 labyrinth, postoperative nausea and vomiting intravenous induction agents 149 (PONV) 249 intravenous sedation, see conscious sedation lactic acidosis, blood loss 111 invasive blood pressure 317 laminae, lumbar region 99 inverse ratio ventilation, acute respiratory distress laminar flow 300–1 syndrome (ARDS) 123 laparoscopic gastric banding 170 inverse steal, cerebral blood flow 150 Laplace’s law 317 iris 98 laryngoscopy 34 irreversible monoamine oxidase inhibitors (MAOIs) Cormack and Lehane classification 34 257 eye anaesthesia 151 ischaemic necrosis, adrenaline 180 intraocular pressure 151, 152 isoflurane larynx 33–8 airways irritation 204 neck surface anatomy 43 blood–gas partition coefficient 203 lasers 334–5 chirality 195 latent heat of 302 MAC50 203 latent heat, definition 316 metabolism 204 lateral approach 95

417

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

latex allergy 363–4 periportal zone 58 radioallergoabsorbent tests 364–78 perivenous zone 58 L configuration 194 protein synthesis 58 left bronchopulmonary segments 41 Rappaport’s acinus 58 left coronary artery 47 storage 59 left main bronchus 40 local anaesthesia 216–20 left ventricular function, central venous pressure adjuncts 225 (CVP) 106, 107 adrenaline 223 lens 98 alkalinization 223–5 lethal electrical currents 343 chemistry of 217 leucocytes 396 barriers to drug passage 218 level of injection, subarachnoid (spinal) carotid endarterectomy, see carotid anaesthesia 82 endarterectomy (CEA) levels of evidence, statistics 355 choice of 225 levobupivacaine, caudal (sacral extradural) conscious sedation 274 anaesthesia 87 definition 216 (lignocaine) 225–8 frequency dependence 220, 228 chirality 193 Henderson–Hasselbalch equation 218 nebulized 37 inflammatory response 224 ligamenta flava, extradural (epidural) space 84 lipid solubility 219, 225 ligaments, larynx 35 mechanisms of action 217 lignocaine, see lidocaine (lignocaine) metabolism 228 lipid metabolism nasotracheal intubation 29 diabetic ketoacidosis 390 onset time 226 liver 59 physicochemical differences 226 lipophilicity pK a 218 local anaesthesia 219, 225 clinical implications 218 placental drug transfer 160 tissue penetration 218 manometry 318 potency 226 lithium 256 preparations 225 adverse effects 257 protein binding 220, 225, 226 anaesthesia implications 257 sensory–motor dissociation 227 lithium dilution cardiac output (LiDCO) 325 spinal adjuncts 228–30 liver 56 structure 217, 226 bile synthesis 59 structure–activity relationships 219 blood supply 57 toxicity 220–3 hepatic artery 57 vasoactivity 227 portal vein 57 locked-in syndrome 366

carbohydrate metabolism 58 low/falling end-tidal CO2, capnography 291 drug biotransformation 58 low molecular weight heparins (LMWH) 260 P450 mono-oxygenase system 58 lumbar plexus 65 erythropoiesis 59 lumbar plexus block 65 Glisson’s capsule 57 technique 65 immunological functions 59 lumbar region 99 intermediate zone 58 lumbar sympathectomy 63–4 jaundice 59 lumbar sympathetic chain 63–5 lipid metabolism 59 lung-protective ventilation 121

microscopic architecture 57 lung volume, PaO2 117 portal area 57 lymphatic clearance, pulmonary oedema 140 portal triads 58 lymphocytes 396

418

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

M metabolism MAC50 203 adrenaline 180 macrophages 396 arterial tourniquet 402 magnesium sulphate 265–6, 267 heart rate reduction 243 local anaesthesia spinal adjuncts 229 hypothermia 330 magnetic resonance imaging (MRI) 335–7 metaraminol, hypotension management major surgery outcomes, nitrous oxide 206 245 malignant hyperpyrexia metformin 276 inhalational anaesthetics 203 methaemoglobin 131 nitrous oxide 208 methaemoglobinaemia 227 suxamethonium 212 pulse oximetry 290 mandibular division, trigeminal nerve (fifth cranial methionine, paracetamol overdose 252 nerve) 26 methysergide 182 mandibular nerve 30 Meyer–Overton hypothesis 359 Mann–Whitney U test, statistics 354 microencapsulated haemoglobin 110 Mapleson breathing systems, see anaesthetic microshock, electrical safety 344 breathing systems midazolam 230 marking system, see clinical science viva intravenous sedation 274 massive transfusions, see blood transfusion overdose, flumazenil therapy 274 mass lesions, raised intracranial pressure 144 middle cardiac vein 48 mass spectrometry middle cerebral artery 15 carbon dioxide measurement 292 mid-humeral level nerve blocks humidity measurement 334 median nerve block 75 oxygen measurement 294 radial nerve block 74 maxillary division, trigeminal nerve (fifth cranial ulnar nerve block 72 nerve) 26 mild perioperative hypothermia 329 maxillary nerve 30 milrinone 248 MDMA (ecstasy), overdose 254 mitral incompetence 377 mechanical pressure effects, arterial tourniquet mitral stenosis 376–7 401 mitral valve disease 375–8 mechanomyography 156 see also mitral incompetence; mitral mechanoreceptors, control of breathing 114 stenosis median cubital vein 77 mivacurium 209 median frequency, depth of anaesthesia metabolism 210 measurement 285 modified Allen test 79 median nerve 74–6 modulation, pain pathways 392 median nerve block 75 monitoring medical air 295 awareness 284 meglitinides 277 vaporizers 303 Meier’s brachial plexus block 69 monoamine oxidase inhibitors (MAOIs) membrane stabilizers, complex regional pain 257–8 syndromes (CRPS) 387 monoamine uptake inhibitors 230 meningeal layers 80 monoclonal antibodies 400 mental nerve block 31 monocytes 396 mercury thermometers 328 mood-affecting drugs 256–8 meta-analysis 355 see also specific drugs metabolic equivalent level (MET) 126 morbidity, diabetes mellitus 275 metabolic rate morphine, patient-controlled analgesia ageing 172 (PCA) 215 neonates/infants 165 mortality, obesity 171

419

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

motor nerve supply saphenous nerve block 96 diaphragm 55 superficial peroneal nerve block 96 eye 20 supraorbital nerve block 30 ulnar nerve 71 supratrochlear nerve block 30 movement artefacts, pulse oximetry 289 sural nerve block 96 multiple sclerosis, hyperbaric oxygen 133 sympathetic blocks 22 l-subtype opioid receptors 213 see also specific blocks muscle action potentials 154 nerve stimulators, neuromuscular block assessment acetylcholine 154 155 muscles, larynx, see larynx neuraxial block adjuvants 228–30 musculoskeletal system neurogenic shock, spinal cord injury 394 electroconvulsive therapy 381 neurology, evoked potentials (EPs) 288 pregnancy 158 neurolytic drugs, coeliac plexus block 61 myalgia, suxamethonium 212 neuromuscular blocks/blocking agents 154–5, 209–11 myasthenia gravis 153 assessment myocardial blood supply 46–9 acceleromyography 156 myocardial innervation 49–51 electromyography 156 myocardium, jaundice 361 mechanomyography 156 myotoxicity, local anaesthesia toxicity 222 suxamethonium 213 myxoedema 187, 188 classification 209 see also specific classes N depolarizing blocks 154, 209 þ þ Na /K pump, normal action potentials 217 diaphragm 56 naloxone established agents 209 opiate overdose management 254 metabolism 210 tramadol overdose management 253 non-depolarizing blocks 154, 209 nasotracheal intubation 29 phase II blocks 154 nateglinide 277 structure 154 natural killer (NK) cells 396 see also specific drugs Nd:YAG lasers 334 neuromuscular junction 153–6 nebulized lignocaine 37 neuronal nicotinic acetylcholine receptors 360 , humidification 333 neuronal nitric oxide synthase (nNOS) 183 neck neuropathic pain cricoid cartilage 98 clonidine 234 cross-sections 98 stellate ganglion block 45 surface anatomy 42–4 neuropathy autonomic 22 negative predictive value, statistical tests 357 neurosurgery, anticoagulant drugs 259 neonates/infants 164–8 neurotoxicity, nitrous oxide toxicity 207 neostigmine 230 neurotransmitters 23, 392 nerve blocks aminergic 181 ankle block 96 parasympathetic 23 auriculotemporal nerve 31 sympathetic 23 cervical plexus 33 New York Heart Association (NYHA) deep peroneal nerve block 96 functional classification, cardiac function digital nerve blocks 71 126 inadvertent subdural block 86 nicotinamide (vitamin B2) deficiency 181 infraorbital nerve block 31 nitrates, tocolytic effects 268 infratrochlear nerve block 31 nitric oxide (NO) 183–5 mental nerve block 31 acute respiratory distress syndrome 123 posterior tibial nerve block 96 hypoxic pulmonary vasoconstriction 142

420

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

nitric oxide synthases (NOS) 183 noradrenaline 23, 247 inhibitors, sepsis management 400 hypotension management 245 nitrogen balance assessment 190 normal action potentials 217 nitrous oxide 63–4 normal pressure waveform, see central venous advantages 206 pressure (CVP) anaesthetic effect 207 normal saline 108 analgesia 206, 207 nose 26–9 blood–gas partition coefficient 203 null hypothesis, statistical tests 356 disadvantages 206 nutrition 189–91 cardiovascular system 207 nutritional requirements 189 emesis 207 fluids 190 greenhouse effect 207 protein 190 malignant hyperpyrexia 208 nutritional support respiratory depression 207 additives 190 207 indications 189 gas cylinders 295, 296, 316 supplements 190 intraocular pressure 152 MAC50 203 O metabolism 204 obesity 170–2 permitted maxima 312 obstetrics, oxygen adverse effects 135 stability 205 obstructed apnoea 116 toxicity 204, 207, 208 obstructive sleep apnoea 113 NMDA receptor(s) oesophageal contractility, depth of anaesthesia general anaesthesia 360 measurement 287 nitrous oxide 207 oesophageal Doppler monitor (ODM) NMDA receptor antagonists 324 complex regional pain syndromes 388 oesophagus, cross-section 98 local anaesthesia spinal adjuncts 229 Ohm’s law 343 nociceptors, pain pathways, see pain pathways olfaction 27 non-adrenergic non-cholinergic (NANC) nerves 124 oncotic pressure non-anaesthetic drugs 9 definition 139, 352 see also specific drugs measurement 353 non-depolarizing neuromuscular blockers 154, 209 Ondine’s curse 113 non-haemolytic reactions, blood transfusion 372 one-lung anaesthesia 136–8 non-immune transfusion-related acute lung injury, onset time, local anaesthesia 226 blood transfusion 372 ophthalmic division, trigeminal nerve (fifth cranial non-invasive blood pressure 317 nerve) 25 non-malignant pain, coeliac plexus block 60 ophthalmic nerve 30 non-obstetric surgery, see pregnancy opiates/opioids 213–16

non-obstructed apnoea, PaO2 117 abuse of, anaesthesia implications 256 non-parametric data 353 breathing effects 116 non-parametric tests, see statistics cerebral blood flow 150 non-selective monoamine oxidase inhibitors complex regional pain syndromes 388 (MAOIs) 257 local anaesthesia spinal adjuncts 228 non-specific immune response, see immune overdose 254 response stress response to surgery 175 non-steroidal anti-inflammatory drugs (NSAIDs) opioid receptors 213, 229 262–4 optical activity, chirality 194 as anticoagulants 261 optic canal 21 local anaesthesia spinal adjuncts 230 oral hypoglycaemic agents 276–7

421

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

oral questions 3–5 pancuronium 209 type of 6 metabolism 210

orbit 20 PaO2 116–17 organ blood flow measurement 322–5 cerebral blood flow 148

organ retrieval 367 prediction from FiO2 133 osmolality 352 ventilation response curve 115 osmolarity 352 para-amino hippuric acid (PAH) clearance 323 osmosis 351–3 paracetamol, overdose 252 osmotic pressure 352 paramagnetic analyser 293 overfilling, vaporizers 302 parametric data 353 oxycodone, patient-controlled analgesia (PCA) 216 parametric tests, see statistics oxygen parasympathetic nervous system 23 adverse effects bronchomotor tone 123 absorption atelectasis 136 denervation, cardiac transplants 49 at atmospheric pressure 134 electroconvulsive therapy 381 see also oxygen toxicity myocardial innervation 50 hyperbaric conditions, see oxygen toxicity paratracheal approach, stellate ganglion block 46 hypoventilation 136 paravertebral block 51 obstetrics 135 parenteral nutrition 190 paediatrics 136 parietal pleura damage, pneumothorax 103 gas cylinders 295, 316 passive systems, scavenging 312 hypoxic pulmonary vasoconstriction 143 patient-controlled analgesia (PCA) 214–16 measurement 293–4 patient factors, postoperative nausea and vomiting utilization 128 (PONV) 168, 249 oxygenation peak expiratory flow rate (PEFR) measurement 124 apnoeic 116 pedicles, lumbar region 99

PaCO2 117 percutaneous tracheostomy 43–4 oxygen concentrators 295 haemorrhage 44

oxygen consumption, PaO2 117 subglottic stenosis 44 oxygen delivery 127–9 perfluorocarbons, fluid therapy 110 determining factors 128 periaqueductal grey matter, pain pathways 392 oxygen desaturation rate 117 peribulbar block, eye 19 oxygen failure and interlock devices 297 perineurium, local anaesthesia 218

oxygen flux (O2 flux) 129 perioperative autologous blood recovery 371 oxygen–haemoglobin dissociation curve 129–32 perioperative fluid losses 108 oxygen reserves 117 perioperative glucose control 275 oxygen saturation 129 perioperative ischaemia, b-adrenoceptor blockers oxygen toxicity 134–6 239 oxytocin antagonists 268 Perioperative Ischaemia Evaluation (POISE) trial 240 oxytocics 269 peripheral chemoreceptors 114 peripheral nerve location, nerve stimulators 340–2 P peripheral nervous system, magnesium sulphate P450 mono-oxygenase system 58 effects 266 pacemakers peripheral vascular ischaemia 240 magnetic resonance imaging problems 336 peripheral vasodilators, systemic vascular resistance surgical diathermy 348 (SVR) 231 PaCO2 117–18, 148 periportal zone, liver 58 ventilation response curve 114, 115 perivenous zone, liver 58 paediatrics, oxygen adverse effects 136 permissive hypercapnia 121 pain pathways 391–3 pethidine, patient-controlled analgesia (PCA) 215

422

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

pharmacokinetic model, target-controlled infusion postdural puncture headache (PDPH) 85 (TCI) 271 posterior approach, sciatic nerve block 94 pharmacokinetics, ageing 173 posterior approach of Labat, sciatic nerve pharmacology 8–9, 193–282 block 94 see also specific drugs posterior arteries 61 phentolamine, systemic vascular resistance (SVR) posterior tibial nerve block 96 231 post-junctional nicotinic receptors, acetylcholine 154 phenylalkylamines 241 postoperative analgesia 214 phenylephrine, hypotension management 245 postoperative cognitive dysfunction (POCD) 173 phenytoin postoperative jaundice 362 grand mal convulsion management 221 postoperative nausea and vomiting (PONV) 168–70, trigeminal neuralgia 25 249–50, 375 phosphate, diabetic ketoacidosis management 389 risk factors 168 phrenic nerve 54–5 anaesthetic factors 168, 249 palsy 54 disease factors 168, 249 physiology 8–9, 101–91 patient factors 168, 249 pia mater 81 surgical factors 168, 249 ‘Pickwickian syndrome,’ 171 375 pioglitazone 277 postpartum haemorrhage (PPH) 269, 382–3

pcap, Starling equation 139 non-uterine causes 269, 382

pis, Starling equation 139 risk factors 269 pKa, local anaesthesia, see local anaesthesia uterine causes 268, 382 placental drug transfer, see pregnancy post-tetanic count (PTC), neuromuscular block placentation, abnormal 383 assessment 155 plasma 185 practical anatomy 7 plasma proteins 185–6 precipitants, diabetic ketoacidosis management pneumothorax 101–4 389 venous cannulation 18 predisposing factors, local anaesthesia toxicity definition 102 221 diagnosis pre-eclampsia 383–5 anaesthetized patient 102 pregnancy 156–60 awake patient 102 subarachnoid anaesthesia 83 management 103 preload, aortic incompetence 380 traumatic 101 pressor responses, clonidine 234 Poiseuille–Hagen equation 300 pressure(s) 317–18 polycythaemia, cyanotic congenital heart disease pressure-controlled ventilation 122 164 pressure regulators, anaesthetic machine 297 popliteal fossa block, sciatic nerve block 95 pressure reversal, general anaesthesia 360 portal area, liver 57 ‘pressurizing’ effect, vaporizers 303 portal triads, liver 58 pretracheal fascia, cross-section 98 portal vein 57 prilocaine 225–8 positive end-expiratory pressure (PPEP) chirality 193 ventilation structure 226 hypoxia management 138 toxicity 223, 227 pulmonary oedema management 140 primary afferents, pain pathways 392 ventilation 121, 122 procedures 8 positive predictive value, statistical tests 357 procoagulant–anticoagulant balance, sepsis 399 positron emission tomography (PET) prolonged actions, suxamethonium 212 cerebral blood flow measurement 149 prone ventilation, acute respiratory distress organ blood flow measurement 323 syndrome (ARDS) 123

423

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

propivacaine 226 Q propofol 195–7 qualitative data, statistics 354 intravenous sedation 274 postoperative nausea and vomiting management R 250 radial artery 79 target-controlled infusion 271, 274 radial nerve 73–4 propranolol radial nerve block 73, 74 adverse effects 240 radiation 329, 330 cardiac output 232 radicularis magna 62 proptosis 188 radioallergoabsorbent tests (RAST) 364–78 prostaglandins, uterine activity 270 radiofrequency ablation 26 protein binding, local anaesthesia 220, 225, 226 raised intracranial pressure, see intracranial pressure protein metabolism, insulin 276 (ICP), raised protein requirements, see nutritional requirements Raman effect 292 protein synthesis, liver 58 randomization 281 prothrombin complex concentrate (PCC), rapid sequence induction, pregnancy 158 haemostasis 261 Rappaport’s acinus 58 pseudocritical temperature 316 R designation 194 psoas compartment block 65 receiving scavenging system 311 psoas major muscle 99 recreational drugs 253–6 psychotherapy, complex regional pain syndromes see also specific drugs (CRPS) 388 recurrent laryngeal nerve 38 Pulmonary Artery Catheters in Patient Management red cell agglutinins 370 (PACMAN) study 325 re-entry tachycardia 238 pulmonary artery flotation catheters reflection coefficient, pulmonary oedema 140 (PAC) 324 reflex response, spinal cord injury 395 pulmonary aspiration of gastric contents 39 regional anaesthesia pregnancy 157 clonidine 234 pulmonary hypertension (hypoxic pulmonary stress response to surgery 176 vasoconstriction) 141–3 ultrasound 338 acyanotic congenital heart disease 163 regional nerve blockade, ultrasound 339 pulmonary oedema 138–40 Regnault’s hygrometer 333 pulmonary sequestration, local anaesthesia toxicity regurgitation 379 222 relative humidity 332 pulmonary toxicity, oxygen 135 remifentanil pulmonary vascular resistance (PVR) patient-controlled analgesia 216 acyanotic congenital heart disease 163 target-controlled infusion 271 mitral stenosis 376 renal replacement therapy, sepsis management 400 neonates 163 renal system pulmonary hypertension 142 ageing, see age/ageing pulsatile component loss, pulse oximetry 289 jaundice 361 pulse contour analysis 324 magnesium sulphate effects 266 pulse contour CO (PiCCO) 325 neonates/infants 167 pulse oximetry 288–90 non-steroidal anti-inflammatory drugs 264 ‘pumping’ effect, vaporizers 302 repaglinide 277 pupillary signs repeated infusion, target-controlled infusion (TCI) 273 brain stem death testing 367 resistance 343 raised intracranial pressure 144 resistance thermometer 328 pure dehydration, fluid therapy 108 respiratory alkalosis, pregnancy 157 P–V curves, compliance 119 respiratory centre, see breathing

424

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

respiratory effects sacrum 86 adrenaline 180 sample size 281 arterial tourniquet 402 saphenous nerve block 96 magnesium sulphate 266 saturated vapour pressure (SVP) nitrous oxide 207 definition 315 non-steroidal anti-inflammatory drugs 264 vaporizers 302 respiratory failure treatment, asthma 124 scalene muscles 98 respiratory sinus arrhythmia 286 scavenging 311–12 respiratory stimulants 116 sciatic nerve 93–5 respiratory system sciatic nerve block 93–5 ageing, see age/ageing scintillography 149 capnography 291 sclera 97 etomidate 201 S designation 194 5-hydroxytryptamine 182 secondary afferents, pain pathways 392 ketamine 199 second gas effect, nitrous oxide 207 obesity, see obesity sedation, clonidine 234 pregnancy, see pregnancy see beck effect 328 propofol 197 Seldinger technique 17 thiopental 201 selective monoamine oxidase-A inhibitors 257 see also breathing selective monoamine oxidase-B inhibitors 258 respiratory tetraplegia 55 selective serotonin re-uptake inhibitors (SSRIs) 251, resting potential 349 258 retina 97 selenium, sepsis management 400 retrobulbar block, eye 19 semi-open anaesthetic breathing systems 306 revision 12 sensation, nose 28 Reynolds number 301 sensitivity, statistical tests 357 rheology, cerebral blood flow 149 sensory–motor dissociation, local anaesthesia 227 rheumatic fever, mitral stenosis 376 sensory nerve supply

qcap, Starling equation 139 diaphragm 55

qis, Starling equation 139 eye 21 right coronary artery 47 foot 95–6 right lung 40 sepsis 398–400 right main bronchus 40 septic shock 398 right ventricular function 16, 104 Serious Hazards of Transfusion (SHOT) report 371 rocuronium 210 serotonin, see 5-hydroxytryptamine (serotonin) metabolism 210 serotonin syndrome 251, 253 side effects 211 severe sepsis 398 ropivacaine 225–8 sevoflurane chirality 193 blood–gas partition coefficient 203 structure 219 chirality 195 toxicity 227 compound A production 310 rosiglitazone 277 MAC50 203 R–R interval variation, depth of anaesthesia metabolism 204 measurement 286 permitted maxima 312 side effects S airways irritation 203 sacral extradural anaesthesia, see caudal (sacral cardiovascular system 203 extradural) anaesthesia CNS effects 203 sacral hiatus, see caudal (sacral extradural) stability 205 anaesthesia toxicity 204

425

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

shivering, clonidine 234 ‘spray as you go’ anaesthetic 37 ‘Sicilian Gambit’ classification, anti-arrhythmic staff health issues, scavenging 311 drugs 237 standard deviation (SD) 354 R, Starling equation 139 standard error of the mean (SEM) 354 single photon emission computed tomography starches, fluid therapy 109 (SPECT) Starling equation 139 cerebral blood flow measurement 149 j 121

organ blood flow measurement 323 pcap 139

single twitch, neuromuscular block assessment 155 pis 139

sinoatrial node (SAN) 222 qcap 139

sinus bradycardia 237 qis 139 hyperkalaemia 238 R 139 hypoxia 238 Starling mechanism 50 sinus tachycardia 238 starvation 189 hypokalaemia 238 static compliance 119 skull 144 statistical significance, clinical trials 282, 357 slow channels, cardiac tissue 222 statistics 10, 353–5 small cardiac vein 48 clinical trials 281 smoking, postoperative nausea and vomiting tests 356–7 (PONV) 375 steal, cerebral blood flow 150 soda lime 309–11 stellate ganglion block 44–6 sodium nitroprusside (SNP) 184 sympathetic nerves 45 systemic vascular resistance 231 techniques 46 sodium/potassium pump, normal action potentials sternal part, diaphragm 55 217 stress responses, clonidine 234 soft tissue injuries, hyperbaric oxygen 133 stress responses, surgery 174–6 somatic pain, myocardial innervation 50 catabolism 174 somatosensory evoked potential monitoring 63 definition 174 specific compliance 119 endocrine response 174–5 specific immune response, see immune response stroke volume, hypotension 244 specificity, statistical tests 357 stroma-free haemoglobin 110 spectral edge, depth of anaesthesia measurement 285 Student’s t-test 354 spinal adjuncts, local anaesthesia, see local subarachnoid (spinal) anaesthesia 80–3 anaesthesia subarachnoid haemorrhage 14 , heart rate reduction 243 magnesium sulphate 265 spinal cord blood supply 61–3 subarachnoid space 80, 81 spinal cord injury 393–5 subclavian perivesicular block 70 causes 62 subclavian veins 18 respiratory tetraplegia 55 subdural haematoma 15 risk minimization 63 subglottic stenosis 44 pharmacological methods 63 subject selection 281 somatosensory evoked potential monitoring 63 sub-Tenon’s block, eye 20 spinal processes, lumbar region 99 suggamadex 210 spinal surgery, evoked potentials (EPs) 287 sulphonylureas 276 spinothalamic pain, myocardial innervation 51 superficial peroneal nerve block 96 splitting ratio, vaporizers 302 superior laryngeal nerve 38

SpO2 monitoring, jaundice 362 superior orbital fissure 21 spontaneous abortion 160 supplements, nutritional support 190 spontaneous respiration, Mapleson A anaesthetic supraclavicular block 69–70 breathing systems 306 supraorbital nerve block 30

426

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

suprasternal notch, neck surface anatomy 43 aortic incompetence 380 supratrochlear nerve block 30 direct vasodilators 232 sural nerve block 96 ganglion blockers 232 surface area/mass ratio maintenance, aortic stenosis 379 children 166 mitral incompetence 377 neonates/infants 166 mitral stenosis 376 surface landmarks, subarachnoid (spinal) reduction, hypotension 244 anaesthesia 82 systole, myocardial blood supply 48 surgery mortality, ageing 173 T outcome target-controlled infusion (TCI) 270–3 body temperature 327 temperature, see body temperature hypothermia 330 teratogenicity 159, 160 postoperative nausea and vomiting 168, 249 nitrous oxide 208 surgical decompression, trigeminal neuralgia 26 terfenadine surgical diathermy 347–9 cytochrome P450 inhibition 375 surgical gastroplasty 170 torsades de pointes 375 suxamethonium 154, 211–13 tetanic stimulation, neuromuscular block eye anaesthesia 151 assessment 155 intraocular pressure 152 tetanus, magnesium sulphate 265 metabolism 210, 213 tetracyclic antidepressants 258 spinal cord injury management 394 tetralogy tetrad of Fallot 161, 164 ‘swoosh’ tests, caudal (sacral extradural) tetrastarches, fluid therapy 109 anaesthesia 88 thalamus, pain pathways 392 sympathetically maintained pain 24, 386 thalassaemia 131 sympathetic blocks, autonomic nervous system 22 theca, lumbar region 99 sympathetic chain, cross-section 98 T helper lymphocytes 396 sympathetic division, autonomic nervous system theoretical anatomy 7 22–3 therapeutic coeliac plexus block 59 sympathetic mediation, complex regional pain therapeutic sympathetic blocks, complex regional syndromes (CRPS) 386 pain syndromes (CRPS) 387 sympathetic nervous system thermal injury, surgical diathermy 347 bronchomotor tone 123 thermistors 328 denervation, cardiac transplants 49 thermocouples 328 electroconvulsive therapy 381 thiopental 199–201 stellate ganglion block 45 thoracic duct injury, venous cannulation 18 stimulation, depth of anaesthesia measurement thoracic electrical bioimpedance 325 285 3-in-1 block, see femoral nerve block supply, myocardial innervation 50 thrombotic pulmonary hypertension 141 sympathetic neurotransmitters 23 thyroid 186–9 sympathetic trunk, lumbar region 99 cross-section 98 sympathoadrenal response, surgery 176 thyroid cartilage 35 syndrome of inappropriate ADH secretion thyroid disease, b-adrenoceptor blockers 240 (SIADH) 351 thyroid hormones 187 syntocinon 269 thyroid-stimulating hormone (TSH) 187 syntometrine 270 thyroid storm 188 systemic inflammatory response syndrome (SIRS) thyrotoxic crisis 188 398 thyrotoxicosis 187

systemic vascular resistance (SVR) 231 thyroxine (T4) 187 acyanotic congenital heart disease 163 thyroxine-binding globulin (TBG) 187

427

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

trilene (trichloroethylene) reaction 311 turbinate bones 27 T lymphocytes 396 turbulent flow 300–1 tocolytics 266–8 two-dimensional images, ultrasound 339 magnesium sulphate 265 tympanic membrane thermometers 328 see also specific drugs tolbutamide 276 U tonicity 353 ulnar artery 79 topical anaesthesia ulnar nerve 71–2 airway 37 ulnar nerve block 71, 72 eye 19 ultrasound 337–40 top-up solutions, local anaesthesia alkalinization field block technique 67 223 venous cannulation guidance 18 torsades de pointes, terfenadine 375 uncal herniation, raised intracranial pressure total body water (TBW) 107 144 total intravenous anaesthesia (TIVA) 195 understanding 10–12 total parenteral nutrition (TPN) 190 underwater seal drain, pneumothorax 103 tourniquet, arterial, see arterial tourniquet unipolar surgical diathermy 348 tourniquet pain 402 universal gas law 313 ‘tourniquet syndrome,’ 401 upper airways trachea 38–42 adrenaline 178 cross-section 98 lasers 335 neck surface anatomy 43 uterine-stimulating drugs 268–70 , intraocular pressure (IOP) uterus 152 activity, birth 269 tracheostomy, percutaneous, see percutaneous atony, postpartum haemorrhage 382 tracheostomy inhalational anaesthetics 203 train-of-four (TOF), neuromuscular block magnesium sulphate effects 266, 267 assessment 155 tramadol V chirality 195 vagal reflexes 24 overdose 252 vagal stimulation, heart rate reduction 243 patient-controlled analgesia 216 van’t Hoff equation 352 transcranial Doppler ultrasonography 149 vaporizer inside circle (VIC) 303 transcutaneous nerve stimulation (TENS) 387 vaporizer outside circle (VOC) 303 transducers, humidity measurement 333 vaporizers 301–4 transfer scavenging system 311 anaesthetic machine 298 transfusion-related acute lung injury (TRALI), vapours 315–16 blood transfusion 371 vasoactivity, local anaesthesia 227 transmitter-gated ion channels 360 vasoconstrictors transoesophageal echocardiography (TOE) 339 adrenaline 178 cardiac output measurement 324 local anaesthesia spinal adjuncts 229 transverse processes, lumbar region 99 local anaesthesia toxicity 221 traumatic pneumothorax 101 subarachnoid anaesthesia 83 tricyclic antidepressants (TCAs) 251, 258 vasodilatation, nitric oxide 184, 185 trigeminal nerve (fifth cranial nerve) 24–6, 30 vasodilators, direct 232 brain stem death testing 366 vasopressin, sepsis management 400

tri-iodothyronine (T3) 187 vasopressors, pre-eclampsia 385 trimetaphan 232 Vaughan–Williams classification, see anti- ‘triple-H therapy’, cerebral vasospasm 15 arrhythmic drugs TUR syndrome 351 vecuronium 210

428

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-72644-3 - The Anaesthesia Science Viva Book, Second Edition Simon Bricker Index More information

Index

velocity, ultrasound 339 vocal cords 35 venepuncture, antecubital fossa 77 volatile anaesthetics venous cannulation 17–18 cerebral blood flow 150 venous drainage, cerebral circulation 14, 17 nitric oxide interactions 184 þ see also specific vessels voltage-dependent K channels 217 venous pressure, cerebral blood flow 150 voltage-gated ion channels, general anaesthesia 360 venous pulmonary hypertension 141 volume of distribution (Vd), target-controlled venous thromboembolism 262 infusion (TCI) 272 pregnancy 158 volutrauma 121 prevention 262 vomiting centre (VC) 169, 250 risk factors 262 ‘v’ wave, central venous pressure (CVP) 105 ventilation 139 acute respiratory distress syndrome 122, 123 W conventional 121 warfarin high frequency 122 case study 259 lung-protective 121 cessation of 259 permissive hypercapnia 121 mechanism of action 260 positive end-expiratory pressure 121, 122 warm water bath, humidification 333 pressure-controlled 122 water intoxication 351 prone 123 waveforms, defibrillation 347 sepsis management 399 weight, subarachnoid (spinal) anaesthesia 83 ventilator-associated lung injury (VALI) 121 wet bulb hygrometer, humidity measurement 333 ventricular fibrillation 345 Wheatstone bridge 320 management 346 wheeze 125 ventricular premature beats 238 ‘whoosh’ tests, caudal (sacral extradural) ventricular septal defect (VSD) 161 anaesthesia 88 Venturi principle 317 Wilcoxon signed rank test 354 vertebral arteries 13–88 Winnie’s brachial plexus block 69 cross-section 98 wrist vertebral body, lumbar region 99 median nerve block 75 vertebral canal, lumbar region 99 radial nerve block 74 vertebral part, diaphragm 55 ulnar nerve block 72 vertical infraclavicular block 70 vestibular afferents, postoperative nausea and X vomiting (PONV) 169 ‘x’ descent, central venous pressure (CVP) 105 vestibular nuclei, postoperative nausea and xenon 205 vomiting (PONV) 249 blood–gas partition coefficient 203 VIC (vaporizer inside circle) 303 cardiovascular side effects 203 visceral afferents, postoperative nausea and MAC50 203 vomiting (PONV) 169, 250 metabolism 204 visceral pleura damage, pneumothorax 103 visual evoked responses 288 Y vitamin B2 deficiency 181 ‘y’ descent, central venous pressure (CVP) 105 vitamin K, coagulation pathways 260 vitreous humour 98 Z VOC (vaporizer outside circle) 303 zygomatic nerve block 31

429

© Cambridge University Press www.cambridge.org