Essential Anesthesia From Science to Practice 2nd Edition by TY Euliano, JS Gravenstein, N Gravenstein, D Gravenstein ISBN 9780521149457 0521149452

Section 1: Clinical management

Chapter 1: Pre-operative evaluation

History

Medications

Allergies

Habits

Physical examination

Laboratory evaluations and studies

NPO status

Planned procedure

Anesthetic choice

Common disorders

Trauma emergency

Diabetes

Coronary artery disease

Pacemaker/AICD

Chronic hypertension

Congestive heart failure

Pulmonary disease

Asthma

Chronic renal failure

Pre-operative medication management

Peri-operative beta-blockade

Antihypertensives

Anticoagulants

Monoamine oxidase inhibitors (MAOIs)

Herbal remedies

Informed consent

Notes

Chapter 2: Airway management

Examination of the airway

Airway management techniques

Mask–ventilation

Laryngeal mask airway

Endotracheal intubation

Oral intubation by direct laryngoscopy

“Can’t intubate” situations

Awake fiberoptic intubation

Airway management plan

Notes

Chapter 3: Vascular access and fluid management

Vascular access

Peripheral venous cannulation

Central venous catheterization

Internal jugular (IJ) catheter placement technique

Pulmonary artery catheterization

Fluid management

Fluid types

Fluid requirements

Evolving fluid replacement strategy

Blood loss

Blood replacement

Risks

Notes

Chapter 4: Regional anesthesia

Neuraxial anesthesia

Hemodynamic effects

Pulmonary effects

Complications

Technique

Indications

Peripheral nerve blocks

Indications

Intravenous regional anesthesia (IVRA)

Local anesthetic toxicity

Notes

Chapter 5: General anesthesia

Pre-operative holding

Induction, maintenance, and emergence

Pre-oxygenation

Induction

The rapid sequence induction

Positioning

Depth of anesthesia and monitoring

Emergence

Problems

Notes

Chapter 6: Post-operative care

Early post-operative care

Early post-operative pain

Complications

Desaturation

Differential diagnosis

Management

Hypotension

Differential diagnosis

Management

Hypertension

Differential diagnosis

Management

PACU discharge

Outpatients

Continued post-operative care

Pain management

Chronic pain

Note

Chapter 7: Monitoring

Introduction

Focused monitoring

Inspection

Spontaneous ventilation

The eyes

Head lift test

Auscultation

Palpation

Instruments that supplement clinical monitoring

Non-invasive instruments

Blood pressure

Pulse and cerebral oximetry

The electrocardiogram

Monitoring respired gases

Capnography

Oxygen

Anesthetic gases

Temperature

Neuromuscular function

Doppler and ultrasound

The electroencephalogram and evoked responses

Invasive monitors

Arterial catheter

Central venous catheter

Pulmonary artery (PA) catheter

Notes

Chapter 8: The anesthesia machine

Systems without gas storage

Single-valve system with gas storage

Multi-valve system with gas storage

Systems with carbon dioxide absorption

Note

Section 2: Applied physiology and pharmacology

Chapter 9: Anesthesia and the cardiovascular system

Blood pressure and its determinants

Blood pressure control

Baroreceptor

Atrial stretch receptors

Chemoreceptors

Long-term control

Anesthesia in the patient with cardiovascular disease

Hypertension

Ischemic heart disease

Pacemaker/AICD

Congestive heart failure

Cardiovascular problems during anesthesia

Hypotension

Arrhythmias

Hypertension

Notes

Chapter 10: Anesthesia and the lung

Basic pulmonary physiology

Purpose of breathing

Control of breathing

Mechanics of ventilation

The work of breathing

Matching of ventilation and perfusion

Tissue oxygenation

Oxyhemoglobin dissociation curve

Alveolar air equation

Clinical relevance of the oxyhemoglobin dissociation curve

The hypoxemic patient

Conscious sedation

Studies of pulmonary function

Spirometry

Arterial blood gas analysis

Oxygen

Carbon dioxide

Bicarbonate

Anion gap

Buffers

ABG interpretation

Two clinical examples

Providing supplemental oxygen

Pre-oxygenation/denitrogenation

Mechanical ventilation

Anesthesia in the patient with pulmonary disease

Asthma

Obstructive sleep apnea

Pulmonary problems during anesthesia

Notes

Chapter 11: Anesthesia and other systems

The brain

The stomach

The liver

Liver enzymes

Liver function studies

Halothane hepatitis

The kidneys

The blood

Volume

Oxygen-carrying capacity

Clotting

Platelets

Calcium

Congenital hemorrhagic diseases

Heparin

Warfarin-type agents

Coagulation studies

Prothrombin time (PT)

Activated partial thromboplastin time (aPTT, normally 25–40 s)

Activated clotting time (ACT, normally <120 s)

The thromboelastogram (TEG)

Notes

Chapter 12: A brief pharmacology related to anesthesia

Approaching the anesthesia task with drugs

The basic approach

Drug interaction

Theories of anesthesia

Pharmacologic preparation for anesthesia

Reduce the risk of aspiration (Table 12.1)

Reduce anxiety (Table 12.2)

Benzodiazepines

Dexmedetomidine (Precedex®)

Prevent nausea and vomiting (Table 12.3)

Droperidol (Inapsine®)

Serotonin receptor blockers

Intravenous anesthetics (Table 12.4)

Barbiturates

Propofol (Diprivan®)

Etomidate (Amidate®)

Ketamine (Ketalar®)

Inhalation anesthetics (Table 12.5)

Uptake and distribution of inhaled anesthetics

The gases

Nitrous oxide

The concentration and second gas effects

Diffusion hypoxia

Xenon

The anesthetic vapors

Ethers

Halogenated aliphatic compounds

Halothane hepatitis

Comparing effects on heart, lung, and brain

Inhalation induction

Cardiovascular effects

Respiratory effects

Central nervous system effects

The opioids (Table 12.7)

Morphine

Hydromorphone (Dilaudid ®)

Meperidine (pethidine, Demerol®, Dolantin®, Pethadol®)

Fentanyls

Opioid receptor antagonism: naloxone (Narcan®)

Non-opioid analgesics in anesthesia

Clinical perspectives on the use of analgesics

Neuromuscular blockers and their antagonists (Table 12.11)

Depolarizing muscle relaxants

Non-depolarizing muscle relaxants

Muscle relaxant reversal

Dantrolene

The local anesthetics (Table 12.13)

Additives

Bicarbonate

Epinephrine

Clonidine (Catapres®)

Opioids

Bronchodilators

Cardiovascular drugs

The anticholinergic drugs

Drugs to raise blood pressure (Table 12.14)

Ephedrine

Epinephrine/norepinephrine

Dopamine

Dobutamine (Dobutrex®)

Isoproterenol (Isuprel®)

Phenylephrine (Neosynephrine®)

Vasopressin (Pitressin®)

Drugs to lower blood pressure (Table 12.15)

Beta-blockers

Direct vasodilators

Nitroglycerin

Sodium nitroprusside (Nipride®)

Clonidine (Catapres®)

Nitric oxide (INOmax®)

Antiarrhythmic drugs (Table 12.16)

Advanced cardiac life support

Notes

Section 3: Clinical cases

1 Breast lumpectomy under conscious sedation

2 Carpal tunnel release under Bier block

Note

3 Cataract removal under MAC

Note

4 Cesarean section under regional anesthesia

Note

5 Gastric bypass under general anesthesia

6 AV shunt placement under peripheral nerve block

7 Open repair of an abdominal aortic aneurysm in a patient with coronary artery disease

8 Trauma patient under general anesthesia

9 Liver resection under general anesthesia

10 Back surgery in a patient with chronic pain and an AICD

11 Pediatric inguinal hernia repair under general anesthesia

Index