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Miller's Anesthesia E-Book

Miller's Anesthesia E-Book

Ronald D. Miller | Lars I. Eriksson | Lee A Fleisher | Jeanine P. Wiener-Kronish | Neal H Cohen | William L. Young

(2014)

Additional Information

Book Details

Abstract

From fundamental principles to advanced subspecialty procedures, Miller’s Anesthesia covers the full scope of contemporary anesthesia practice. This go-to medical reference book offers masterful guidance on the technical, scientific, and clinical challenges you face each day, in addition to providing the most up-to-date information available for effective board preparation.

  • Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
  • Address the unique needs of pediatric patients with guidance from an entire section on pediatric anesthesia.
  • View more than 1,500 full-color illustrations for enhanced visual clarity.
  • Access step-by-step instructions for patient management, as well as an in-depth analysis of ancillary responsibilities and problems.
  • Quickly reference important concepts with ‘Key Points’ boxes integrated into every chapter.
  • Stay current on today's most recent anesthetic drugs and guidelines/protocols for anesthetic practice and patient safety, and access expanded coverage on new techniques such as TEE and other monitoring procedures.
  • Take advantage of the unique, international perspectives of prominent anesthesiologists from all over the world, including the UK, Australia, India, Brazil, and Germany.
  • Remain at the forefront of new developments in anesthesia with coverage of hot topics including Non-OR Anesthesia; Role of the Anesthesiologist in Disasters; Sleep Medicine in Anesthesia; Perioperative and Anesthesia-related Neurotoxicity; Anesthetic Implications of Complementary and Alternative Medicine; and Robotics.
  • Study brand-new chapters on Perioperative Fluid Management; Extracorporeal Support Therapies; Anesthesia for Organ Donation/Procurement; and Malignant Hyperthermia and other Genetic Disorders.

Table of Contents

Section Title Page Action Price
Front\rCover Cover
IFC IFC
Miller’s Anesthesia iii
Copyright iv
Dedication v
Contributors vi
Preface xxi
Remembrance xxiii
Contents xxv
Video Contents xxx
PART\rI - Introduction 1
Chapter 1 - Scope of Modern Anesthetic Practice 2
SCOPE OF ANESTHESIA AND PERIOPERATIVE CARE IN HEALTH CARE AND FORCES THAT WILL CHANGE PRACTICES (FIG. 1-1) 3
PROCESS ASSESSMENT AND QUALITY METRICS 6
CHANGES IN PERSONNEL 7
RESEARCH 7
References 8
References 9.e1
Chapter\r2 - International Scope, Practice, and Legal Aspects of Anesthesia 10
EARLY HISTORY OF INTERNATIONAL ANESTHESIA 12
THE CROSS-POLLINATION PERIOD: 1920-1980 16
THE MODERN PERIOD: THE ESSENTIALS OF MODERN ANESTHESIA AROUND THE WORLD 21
CONCLUSION 46
References 46
References 47.e1
Chapter\r3 - Perioperative Management 48
PERIOPERATIVE MANAGEMENT 50
CONCLUSION 54
References 55
References 55.e1
Chapter\r4 - Operating Room Management 56
HISTORY 56
STRUCTURE FOR OPERATING ROOM MANAGEMENT 57
OPERATING ROOM FUNCTION GOALS 59
DAILY SCHEDULE MANAGEMENT 65
ANESTHESIA SERVICE 67
OPERATING ROOM QUALITY AND PATIENT SAFETY (ALSO SEE CHAPTERS 6 AND 7) 68
COST ACCOUNTING IN THE OPERATING ROOM 69
SUMMARY 70
References 71
References 72.e1
Chapter\r5 - Medical Informatics 73
COMPUTER HARDWARE 74
COMPUTER SOFTWARE 76
COMPUTERS AND COMPUTING IN MEDICINE 80
References 85
References 86.e1
Chapter\r6 - Quality Improvement and Patient Safety 87
WHAT IS QUALITY? 88
METHODS OF QUALITY ASSESSMENT 89
QUALITY IMPROVEMENT MEASURES AND TOOLS 92
SOURCES OF QUALITY IMPROVEMENT INFORMATION 96
EXAMPLES OF QUALITY IMPROVEMENT PROGRAMS 101
THE FUTURE: RESEARCH, EDUCATION AND ETHICS 103
SUMMARY 104
References 104
Reference 105.e1
Chapter\r7 - Human Performance and Patient Safety 106
IMPACT OF HUMAN PERFORMANCE ON PATIENT SAFETY 106
NATURE OF THE OPERATIONAL DOMAIN OF ANESTHESIOLOGY 107
SAFETY CULTURE OF THE OPERATING ROOM AND INTENSIVE CARE ENVIRONMENT 108
CHARACTERISTICS OF SUCCESSFUL INCIDENT REPORTING SYSTEMS 115
HUMAN FACTORS 119
HOW CAN CRISIS RESOURCE MANAGEMENT SKILLS BE LEARNED AND TRAINED? 124
THE STUDY OF HUMAN PERFORMANCE 137
COGNITIVE PROCESS MODEL OF THE ANESTHESIA PROFESSIONAL 138
THE ANESTHESIA PROFESSIONAL’S TASKS 144
OTHER STUDIES OF “VIGILANCE” AND DECISION MAKING BY ANESTHESIA PROFESSIONALS 155
References 160
References 166.e1
Chapter\r8 - Patient Simulation 167
SIMULATION IN AVIATION 168
USES OF SIMULATORS 168
TWELVE DIMENSIONS OF SIMULATION 168
CONCEPTUAL ISSUES ABOUT PATIENT SIMULATION 172
SITE OF SIMULATION 175
TEAM TRAINING, SINGLE DISCIPLINE, AND CREWS 178
DEBRIEFING FOR SIMULATION TRAINING 178
SCENARIO DESIGN 181
INSTRUCTOR QUALIFICATION 181
CLASSIFICATION OF PATIENT SIMULATORS 184
DEVELOPMENT OF PATIENT SIMULATORS 188
SCREEN-BASED SIMULATORS (MICROSIMULATORS) 188
EXPERIENCE WITH PATIENT SIMULATORS IN ANESTHESIA 188
USE OF PATIENT SIMULATION FOR TRAINING HEALTH CARE PERSONNEL OUTSIDE ANESTHESIA 193
USE OF PATIENT SIMULATION FOR RESEARCH 194
USE OF PATIENT SIMULATION IN SUPPORT OF BIOMEDICAL INDUSTRIES 196
OTHER USES OF SIMULATORS 196
EFFECTIVENESS OF SIMULATION TRAINING 196
ECOLOGIC VALIDITY OF SIMULATORS COMPARED WITH THE OPERATING ROOM 198
EVALUATION OF CLINICAL PERFORMANCE DURING SIMULATION SCENARIOS 198
PITFALLS OF PERFORMANCE ASSESSMENT 199
USE OF SIMULATORS FOR THE EVALUATION AND TESTING OF ANESTHESIA PROFESSIONALS 200
COSTS 203
PROLIFERATION OF SIMULATION CENTERS 203
SIMULATION SOCIETIES: SOCIETY FOR SIMULATION IN HEALTH CARE AND SOCIETY IN EUROPE FOR SIMULATION APPLIED TO MEDICINE 205
FUTURE OF PATIENT SIMULATION IN ANESTHESIA 205
References 206
References 209.e1
Chapter\r9 - Teaching Anesthesia 210
BACKGROUND AND HISTORY OF ANESTHESIA EDUCATION (ALSO SEE CHAPTER 1) 211
ANESTHESIA LEARNERS 213
RESIDENT AND FELLOW EDUCATION 215
ANESTHESIA TEACHING METHODS 223
THE FUTURE OF ANESTHESIA EDUCATION 227
References 228
References 231.e1
Chapter\r10 - Ethical Aspects of Anesthesia Care 232
ETHICAL THEORY 235
CLINICAL ETHICS 236
RESEARCH ETHICS 246
PHYSICIAN PARTICIPATION IN EXECUTIONS 248
MORAL INTEGRITY—CAN THE PHYSICIAN BE A CONSCIENTIOUS OBJECTOR IN MEDICINE? 248
SUMMARY 249
References 249
References 250.e1
Chapter\r11 - Legal Aspects of Anesthesia Care in America 251
PROFESSIONAL LIABILITY 252
LEGAL ASPECTS OF INFORMED CONSENT 257
LEGAL ASPECTS OF END-OF-LIFE CARE 260
OTHER LEGAL ASPECTS OF ANESTHESIOLOGY 263
References 266
References 267.e1
Chapter\r12 - Anesthesia Business Models 268
PRACTICE MODELS 269
STAFFING MODELS 271
ESSENTIAL BUSINESS PRACTICES 274
References 278
References 280.e1
PART\rII - Anesthetic Physiology 281
Chapter\r13 - Consciousness, Memory, and Anesthesia 282
SCIENTIFIC AND CLINICAL IMPORTANCE 282
CONSCIOUSNESS 282
MEMORY 289
CONCLUSION 300
References 300
References 302.e1
Chapter\r14 - Sleep Medicine 303
DEFINITION OF SLEEP 303
HOW TO ASSESS SLEEP 304
PHYSIOLOGY 308
SLEEP AND BREATHING 312
SLEEP AND ANESTHESIA: TWO UNEQUAL TWINS INFLUENCING PERIOPERATIVE MEDICINE 319
References 326
References 328.e1
Chapter\r15 - Perioperative and Anesthesia Neurotoxicity 329
DEVELOPMENTAL NEUROTOXICITY 329
NEUROTOXICITY IN THE ELDERLY 337
SUMMARY AND CONCLUSIONS 343
References 344
References 345.e1
Chapter\r16 - The Autonomic Nervous System 346
HISTORY AND DEFINITIONS 346
FUNCTIONAL ANATOMY 347
FUNCTION 351
PHARMACOLOGY 355
DRUGS AND THE AUTONOMIC NERVOUS SYSTEM 365
AUTONOMIC DYSFUNCTION 379
NEW CONCEPTS IN AUTONOMIC ACTIVITY 383
References 383
References 386.e1
Chapter\r17 - Cerebral Physiology and the Effects of Anesthetic Drugs 387
ANATOMY OF THE CEREBRAL CIRCULATION 388
EFFECTS OF ANESTHETICS ON CEREBRAL BLOOD FLOW AND CEREBRAL METABOLIC RATE 396
OTHER EFFECTS OF ANESTHETICS ON CEREBRAL PHYSIOLOGY 408
CEREBRAL PHYSIOLOGY IN PATHOLOGIC STATES 410
References 419
References 422.e1
Chapter\r18 - Neuromuscular Physiology and Pharmacology 423
NEUROMUSCULAR TRANSMISSION 425
NEUROMUSCULAR JUNCTION 428
DRUG EFFECTS ON POSTJUNCTIONAL RECEPTORS 433
BIOLOGY OF PREJUNCTIONAL AND POSTJUNCTIONAL NICOTINIC ACETYLCHOLINE RECEPTORS 437
NEUROMUSCULAR JUNCTION AT EXTREMES OF AGE 442
References 443
References 443.e1
Chapter\r19 - Respiratory Physiology and Pathophysiology 444
RESPIRATORY PHYSIOLOGY IS CENTRAL TO THE PRACTICE OF ANESTHESIA 444
PULMONARY PHYSIOLOGY IN HEALTH 444
VENTILATION 446
STATIC LUNG VOLUMES—FUNCTIONAL RESIDUAL CAPACITY 447
RESPIRATORY MECHANICS 447
DISTRIBUTION OF INSPIRED GAS 451
PERFUSION 453
CLINICAL ASSESSMENT OF LUNG FUNCTION 455
INTRAOPERATIVE RESPIRATORY EVENTS 456
VENTILATION-PERFUSION MATCHING DURING ANESTHESIA 462
FACTORS THAT INFLUENCE RESPIRATORY FUNCTION DURING ANESTHESIA 464
LUNG FUNCTION AFTER CARDIAC SURGERY 470
POSTOPERATIVE PHYSIOTHERAPY 471
EFFECT OF SLEEP ON RESPIRATION 471
References 471
References 472.e1
Chapter\r20 - Cardiac Physiology 473
PHYSIOLOGY OF THE INTACT HEART 473
CELLULAR CARDIAC PHYSIOLOGY 479
CONTROL OF CARDIAC FUNCTION 485
References 490
References 491.e1
Chapter\r21 - Gastrointestinal Physiology and Pathophysiology 492
REGULATION OF GASTROINTESTINAL FUNCTION 493
INTESTINAL MUCOSAL IMMUNOLOGY 493
NEUROCRINE REGULATION OF MOTILITY 494
TRAVEL AND MIXING OF FOOD IN THE GASTROINTESTINAL TRACT 495
SECRETION 500
DIGESTION AND ABSORPTION 505
GASTROINTESTINAL BLOOD FLOW 509
SPLANCHNIC BLOOD VOLUME 511
References 518
References 519.e1
Chapter\r22 - Hepatic Physiology and Pathophysiology 520
OVERVIEW 521
HEPATIC ANATOMY 521
FUNCTIONS OF THE LIVER 525
EVALUATION OF THE LIVER 531
HEPATIC PATHOPHYSIOLOGY 535
References 542
References 544.e1
Chapter\r23 - Renal Physiology, Pathophysiology, and Pharmacology 545
THE GLOMERULUS (RENAL CORPUSCLE) 547
THE TUBULE 550
REGULATORY MECHANISMS IN SALT AND WATER REABSORPTION 555
EVALUATION OF RENAL FUNCTION 556
ASSESSMENT OF GLOMERULAR FILTRATION RATE 558
TUBULAR FUNCTION TESTS 561
RENAL HEMODYNAMICS 564
NEUROHORMONAL REGULATION OF RENAL FUNCTION 566
SYSTEMS PROMOTING VASOCONSTRICTION AND SALT RETENTION 566
Systems Promoting Vasodilation and Salt Excretion 570
PROSTAGLANDINS AND KININS 570
PERIOPERATIVE ISCHEMIC AND NEPHROTOXIC INJURY 574
ANESTHETIC DRUGS 574
MECHANICAL VENTILATION 576
INDUCED HYPOTENSION 576
AORTIC CROSS-CLAMPING 576
CARDIAC SURGERY AND CARDIOPULMONARY BYPASS 577
NEPHROTOXIC INSULTS 580
SEPSIS 582
RENAL CROSSTALK 585
References 585
References 588.e1
PART III -\rAnesthetic Pharmacology 589
Chapter\r24 - Basic Principles of Pharmacology 590
PHARMACOKINETICS PRINCIPLES 591
PHARMACODYNAMIC PRINCIPLES 600
SPECIAL POPULATIONS 605
SUMMARY 612
References 612
References 613.e1
Chapter 25\r- Inhaled Anesthetics: Mechanisms of Action 614
HISTORY 615
INTEGRATED EFFECTS ON CENTRAL NERVOUS SYSTEM FUNCTION 618
IDENTIFICATION OF MOLECULAR SITES OF ANESTHETIC ACTION 623
CELLULAR MECHANISMS 629
SIMPLE CIRCUITS AND COMPLEX NETWORKS 631
RESEARCH STRATEGIES FOR THE FUTURE 633
SUMMARY 635
References 635
References 637.e1
Chapter\r26 - Inhaled Anesthetic Pharmacokinetics: Uptake, Distribution, Metabolism, and Toxicity 638
INTRODUCTION 639
UPTAKE AND DISTRIBUTION OF INHALED ANESTHETICS 639
SYNTHESIS OF THE MODEL AND INHALED ANESTHETIC INDUCTION: PK/PD 650
METABOLISM AND TOXICITY OF INHALED ANESTHETICS 656
References 667
References 669.e1
Chapter\r27 - Inhaled Anesthetics: Pulmonary Pharmacology 670
INTRODUCTION 671
INHALED ANESTHETICS 671
CONTROL OF RESPIRATION 687
ACUTE LUNG INJURY 698
NITROUS OXIDE 702
XENON 702
SUMMARY 702
References 703
References 705.e1
Chapter\r28 - Inhaled Anesthetics: Cardiovascular Pharmacology 706
INTRODUCTION 706
VOLATILE ANESTHETICS 706
NITROUS OXIDE AND CARDIOVASCULAR FUNCTION 742
XENON 744
SUMMARY 748
References 749
References 751.e1
Chapter\r29 - Inhaled Anesthetics: Delivery Systems 752
STANDARDS AND GUIDELINES FOR ANESTHESIA WORKSTATIONS 754
FUNCTIONAL ANATOMY OF THE ANESTHESIA WORKSTATION 755
CHECKING YOUR ANESTHESIA WORKSTATION 804
References 817
References 820.e1
Chapter\r30 - Intravenous Anesthetics 821
PROPOFOL 822
BARBITURATES 832
BENZODIAZEPINES 837
FLUMAZENIL 843
PHENCYCLIDINES (KETAMINE) 845
ETOMIDATE 850
DEXMEDETOMIDINE 854
DROPERIDOL 859
SUMMARY 860
References 860
Refernces 863.e1
Chapter\r31 - Opioid Analgesics 864
PHARMACOLOGY OF OPIOIDS 864
NEUROPHYSIOLOGIC EFFECTS OF OPIOIDS 873
RESPIRATORY EFFECTS OF OPIOIDS 877
CARDIOVASCULAR EFFECTS OF OPIOIDS 879
ENDOCRINOLOGIC EFFECTS OF OPIOIDS 881
OPIOID TOLERANCE AND OPIOID-INDUCED HYPERALGESIA 882
RENAL AND URODYNAMIC EFFECTS OF OPIOIDS 883
GASTROINTESTINAL EFFECTS OF OPIOIDS 884
OTHER OPIOID EFFECTS 885
PHARMACOKINETICS AND PHARMACODYNAMICS OF OPIOIDS 886
ANESTHETIC TECHNIQUES USING OPIOIDS 894
OTHER OPIOID AGONISTS 901
AGONIST-ANTAGONIST OPIOID COMPOUNDS 903
OPIOID ANTAGONISTS 906
DRUG INTERACTONS WITH OPIOIDS 907
References 910
References 914.e1
Chapter\r32 - Nonopioid Pain Medications 915
INTRODUCTION 915
CALCIUM CHANNEL BLOCKERS 915
SODIUM CHANNEL BLOCKERS 917
References 918
References 918.e1
Chapter 33 - Intravenous Drug Delivery Systems 919
INTRODUCTION 920
PHARMACOKINETIC CONSIDERATIONS 921
PHARMACODYNAMIC CONSIDERATIONS 925
DESIGNING DOSING REGIMENS 934
INTRAVENOUS INFUSION DEVICES AND TECHNOLOGIES 942
References 956
References 957.e1
Chapter\r34 - Pharmacology of Neuromuscular Blocking Drugs 958
HISTORY AND CLINICAL USE 959
PRINCIPLES OF ACTION OF NEUROMUSCULAR BLOCKERS AT THE NEUROMUSCULAR JUNCTION 959
PHARMACOLOGY OF SUCCINYLCHOLINE 960
NONDEPOLARIZING NEUROMUSCULAR BLOCKERS 965
SPECIAL POPULATIONS 983
References 992
References 994.e1
Chapter\r35 - Reversal (Antagonism) of Neuromuscular Blockade 995
HISTORY 996
ANTAGONISM OF NEUROMUSCULAR BLOCKADE: CURRENT MANAGEMENT PRACTICES 996
DRUGS USED TO ANTAGONIZE (REVERSE) NEUROMUSCULAR BLOCKADE 1004
References 1025
References 1027.e1
Chapter\r36 - Local Anesthetics 1028
BASIC PHARMACOLOGY 1029
ANATOMY OF THE PERIPHERAL NERVE 1031
MECHANISM OF ACTION OF LOCAL ANESTHETICS (PHARMACODYNAMICS) 1035
CLINICAL PHARMACOLOGY 1038
CHOICE OF LOCAL ANESTHETIC FOR VARIOUS REGIONAL ANESTHETIC PROCEDURES 1041
PHARMACOKINETICS 1046
TOXICITY 1047
DEVELOPMENT OF PROLONGED-DURATION AND SENSORY- OR NOCICEPTIVE-SELECTIVE LOCAL ANESTHETICS 1051
BIOLOGIC MECHANISMS OF LOCAL ANESTHETIC FAILURE: INFLAMMATION, HYPERALGESIA, TACHYPHYLAXIS, AND GENETIC VARIANTS 1051
References 1052
References 1054.e1
PART IV -\rAnesthesia Management 1055
Chapter\r37 - Risk of Anesthesia 1056
INTRODUCTION 1056
FRAMEWORK OF PERIOPERATIVE RISK 1057
ISSUES RELATED TO STUDY DESIGN 1058
RISKS RELATED TO PATIENT CHARACTERISTICS 1070
SPECIAL PATIENT GROUPS 1073
RISKS DIRECTLY RELATED TO THE ANESTHETIC DRUG 1077
RISKS RELATED TO SURGERY 1078
RISKS RELATED TO THE LOCATION OF SURGERY AND POSTOPERATIVE MONITORING 1078
RISKS RELATED TO THE ANESTHESIA PROVIDER 1079
RISKS TO THE ANESTHESIOLOGIST 1080
IMPROVING ANESTHESIA SAFETY 1081
SUMMARY 1082
References 1082
References 1084.e1
Chapter\r38 - Preoperative Evaluation 1085
EVOLUTION OF PREANESTHESIA EVALUATION 1086
GOALS AND BENEFITS OF PREANESTHESIA EVALUATION 1086
ROLE OF THE MEDICAL CONSULTANT IN PREOPERATIVE EVALUATION 1087
DETECTING DISEASE IN PREOPERATIVE EVALUATION 1088
PREOPERATIVE EVALUATION OF PATIENTS WITH COEXISTING DISEASE 1092
SPECIAL ISSUES IN PREOPERATIVE EVALUATION 1135
PREOPERATIVE LABORATORY AND DIAGNOSTIC STUDIES 1141
PREOPERATIVE RISK ASSESSMENT 1144
PREOPERATIVE MEDICATION MANAGEMENT 1146
PLANNING FOR ANESTHESIA 1147
REGULATORY ISSUES 1149
PREOPERATIVE EVALUATION CLINIC 1149
CONCLUSION 1152
References 1153
References 1155.e1
Chapter\r39 - Anesthetic Implications of Concurrent Diseases 1156
ROLE OF THE PRIMARY CARE PHYSICIAN OR CONSULTANT 1157
DISEASES INVOLVING THE ENDOCRINE SYSTEM AND DISORDERS OF NUTRITION 1158
DISEASES INVOLVING THE CARDIOVASCULAR SYSTEM 1181
DISORDERS OF THE RESPIRATORY AND IMMUNE SYSTEMS 1190
DISEASES OF THE CENTRAL NERVOUS SYSTEM, NEUROMUSCULAR DISEASES, AND PSYCHIATRIC DISORDERS 1196
RENAL DISEASE AND ELECTROLYTE DISORDERS 1202
GASTROINTESTINAL AND LIVER DISEASES 1208
HEMATOLOGIC DISORDERS AND ONCOLOGIC DISEASE 1211
PATIENTS GIVEN DRUG THERAPY FOR CHRONIC AND ACUTE MEDICAL CONDITIONS 1217
References 1222
References 1225.e1
Chapter\r40 - Anesthetic Implications of Complementary and Alternative Medications 1226
HERBAL MEDICINES 1227
SUMMARY 1235
ACUPUNCTURE 1235
DEEP BREATHING 1236
MUSIC THERAPY 1236
CONCLUSION 1237
References 1237
References 1239.e1
Chapter\r41 - Patient Positioning and Associated Risks 1240
INTRODUCTION 1240
CARDIOVASCULAR CONCERNS 1241
PULMONARY CONCERNS 1241
SPECIFIC POSITIONS 1242
PERIPHERAL NERVE INJURY 1256
SPECIFIC NEUROPATHIES 1258
PERIOPERATIVE EYE INJURY AND VISUAL LOSS 1261
EVALUATION AND TREATMENT OF PERIOPERATIVE NEUROPATHIES 1262
ANESTHESIA OUTSIDE THE OPERATING ROOM 1263
CONCLUSION 1264
References 1264
References 1265.e1
Chapter\r42 - Neuromuscular Disorders and Other Genetic Disorders 1266
ACQUIRED AND HEREDITARY NEUROPATHIES 1267
GUILLAIN-BARRÉ SYNDROME OR ACUTE INFLAMMATORY DEMYELINATING POLYRADICULOPATHY 1269
CRITICAL ILLNESS POLYNEUROPATHY AND CRITICAL ILLNESS MYOPATHY 1269
MYASTHENIA GRAVIS 1270
LAMBERT-EATON-MYASTHENIC SYNDROME 1271
MULTIPLE SCLEROSIS 1271
AMYOTROPHIC LATERAL SCLEROSIS 1272
DUCHENNE MUSCULAR DYSTROPHY 1273
BECKER MUSCULAR DYSTROPHY 1275
LIMB-GIRDLE MUSCULAR DYSTROPHY 1275
MYOTONIC DYSTROPHIES 1276
MYOTUBULAR OR CENTRONUCLEAR MYOPATHY 1276
DISORDERS OF MUSCLE ENERGY METABOLISM 1277
MITOCHONDRIAL MYOPATHIES 1278
PERIODIC PARALYSES 1279
HYPOKALEMIC PERIODIC PARALYSIS 1280
GENETICS OF MENDELIAN, MITOCHONDRIAL, AND COMPLEX DISEASES 1281
MITOCHONDRIAL DISEASES 1281
IMPLICATIONS FOR CLINICAL TRANSLATION 1283
IMPLICATION FOR ANESTHESIOLOGISTS 1283
References 1284
References 1286.e1
Chapter\r43 - Malignant Hyperthermia and Muscle-Related Disorders 1287
MALIGNANT HYPERTHERMIA 1288
MALIGNANT HYPERTHERMIA IS THE RESULT OF ABNORMAL FUNCTION OF MUSCLE CALCIUM RELEASE UNITS 1290
DANTROLENE 1291
GENETICS 1292
FULMINANT MALIGNANT HYPERTHERMIA 1294
ANESTHETIC TRIGGERING 1294
NONANESTHETIC MALIGNANT HYPERTHERMIA 1295
MALIGNANT HYPERTHERMIA–ASSOCIATED SYNDROMES 1296
DIAGNOSIS IN THE SURGICAL AND POSTANESTHESIA CARE UNITS 1297
TREATMENT 1298
ANESTHESIA FOR SUSCEPTIBLE PATIENTS 1299
EVALUATION OF SUSCEPTIBILITY 1299
MULTIPLE SCLEROSIS 1300
MOTOR NEURON DISORDERS 1300
GUILLAIN-BARRÉ SYNDROME 1301
HEREDITARY MOTOR-SENSORY NEUROPATHIES, INCLUDING CHARCOT-MARIE-TOOTH DISEASE 1301
DUCHENNE MUSCULAR DYSTROPHY AND BECKER MUSCULAR DYSTROPHY 1302
LIMB-GIRDLE MUSCULAR DYSTROPHY 1305
MYOTONIC DYSTROPHY 1305
MYOTONIA CONGENITA 1306
MYOTUBULAR MYOPATHY 1306
METABOLIC MYOPATHIES 1306
MITOCHONDRIAL MYOPATHIES 1308
MYASTHENIA GRAVIS 1309
EATON-LAMBERT MYASTHENIC SYNDROME 1310
PERIODIC PARALYSIS (HYPERKALEMIC, HYPOKALEMIC, AND NORMOKALEMIC) 1310
SUMMARY 1311
References 1311
References 1314.e1
Chapter\r44 - Fundamental Principles of Monitoring Instrumentation 1315
WHY FUNDAMENTAL PRINCIPLES ARE IMPORTANT 1315
BASIC PRINCIPLES 1315
MEASUREMENT USING LIGHT ENERGY 1331
SIGNAL ARTIFACT MANAGEMENT 1334
MEASUREMENT OF TEMPERATURE 1335
MEASUREMENT OF FLOW 1336
References 1339
References 1344.e1
Chapter\r45 - Cardiovascular Monitoring 1345
INTRODUCTION TO CARDIOVASCULAR MONITORING: FOCUSED PHYSICAL EXAMINATION 1346
ARTERIAL BLOOD PRESSURE MONITORING 1347
CENTRAL VENOUS PRESSURE MONITORING 1361
PULMONARY ARTERY CATHETER MONITORING 1370
CARDIAC OUTPUT MONITORING 1387
OTHER METHODS FOR MONITORING CARDIAC OUTPUT AND PERFUSION 1389
References 1392
References 1395.e1
Chapter\r46 - Perioperative Echocardiography 1396
INTRODUCTION 1396
HISTORY 1396
TRANSESOPHAGEAL ECHOCARDIOGRAPHY PRACTICE GUIDELINES 1397
PROPERTIES OF ULTRASOUND 1398
EQUIPMENT DESIGN AND OPERATION 1405
BASIC TRANSESOPHAGEAL ECHOCARDIOGRAPHIC EXAMINATION 1410
COMPREHENSIVE TRANSESOPHAGEAL EXAMINATION 1412
BASIC TRANSTHORACIC EXAMINATION 1414
ASSESSMENT OF VENTRICULAR FILLING 1416
DETECTION OF MYOCARDIAL ISCHEMIA 1420
TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CARDIAC SURGERY 1421
TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN NONCARDIAC SURGERY AND CRITICAL CARE 1427
DATA STORAGE, DOCUMENTATION, AND QUALITY ASSURANCE 1427
CERTIFICATION 1427
References 1428
References 1428.e1
Chapter\r47 - Electrocardiography, Perioperative Ischemia, and Myocardial Infarction 1429
ELECTROCARDIOGRAPHIC LEAD SYSTEMS 1430
NORMAL ELECTRICAL ACTIVITY 1430
THE ABNORMAL ELECTROCARDIOGRAM 1431
ELECTROCARDIOGRAPHIC MONITORING SYSTEMS 1434
ARRHYTHMIA INTERPRETATION AND MANAGEMENT 1437
REAL-TIME MYOCARDIAL ISCHEMIA MONITORING 1449
ELECTROCARDIOGRAPHIC CRITERIA FOR ACUTE MYOCARDIAL ISCHEMIA 1450
ELECTROCARDIOGRAPHIC LEAD SENSITIVITY FOR DETECTING PERIOPERATIVE MYOCARDIAL ISCHEMIA 1451
PERIOPERATIVE MYOCARDIAL ISCHEMIA AND INFARCTION 1451
References 1459
References 1459.e1
Chapter\r48 - Implantable Cardiac Pulse Generators: Pacemakers and Cardioverter-Defibrillators 1460
PACEMAKERS 1464
IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS 1476
SPECIAL SITUATIONS: VENTRICULAR ASSIST DEVICES AND TEMPORARY PACING 1482
SUMMARY 1483
References 1485
References 1486.e1
Chapter\r49 - Neurologic Monitoring 1487
MONITORING MODALITIES 1488
CLINICAL APPLICATIONS OF NEUROLOGIC MONITORING 1501
NONSURGICAL FACTORS INFLUENCING MONITORING RESULTS 1511
SUMMARY 1521
References 1521
References 1523.e1
Chapter\r50 - Monitoring Brain State During General Anesthesia and Sedation 1524
INDUCTION OF GENERAL ANESTHESIA 1525
MAINTENANCE OF GENERAL ANESTHESIA: PHYSIOLOGIC SIGNS AND THE NOCICEPTIVE-MEDULLARY-AUTONOMIC PATHWAY 1525
MAINTENANCE OF GENERAL ANESTHESIA: ELECTROENCEPHALOGRAM-BASED INDICES OF LEVEL OF CONSCIOUSNESS 1527
EMERGENCE FROM GENERAL ANESTHESIA 1531
EMERGING STRATEGIES FOR MONITORING THE BRAIN STATES OF GENERAL ANESTHESIA AND SEDATION 1533
References 1539
References 1540.e1
Chapter\r51 - Respiratory Monitoring 1541
OVERVIEW OF RESPIRATORY MONITORING 1542
AMERICAN SOCIETY OF ANESTHESIOLOGISTS STANDARDS 1543
PHYSICAL EXAMINATION 1543
PULSE OXIMETRY 1544
MIXED VENOUS OXYGEN SATURATION 1548
TISSUE OXYGENATION 1549
CAPNOMETRY AND CAPNOGRAPHY 1551
BLOOD GAS ANALYSIS 1553
MONITORING LUNG FLOWS, VOLUMES, AND PRESSURES 1559
PLETHYSMOGRAPHIC MONITORING 1566
RESPIRATORY RATE MONITORING: APNEA MONITORING 1567
IMAGING FOR RESPIRATORY MONITORING 1568
POINT-OF-CARE TESTS 1571
RESPIRATORY MONITORING IN SPECIAL CONDITIONS 1572
AUTOMATED DATA SYSTEMS 1573
ADDITIONAL MONITORED VARIABLES 1574
References 1576
References 1579.e1
Chapter\r52 - Renal Function Monitoring 1580
RENAL PHYSIOLOGIC FUNCTION 1581
PATHOPHYSIOLOGIC PROCESSES OF ISCHEMIC ACUTE KIDNEY INJURY 1585
ANESTHESIA, SURGERY, AND NORMAL RENAL FUNCTION 1587
PERIOPERATIVE HEMODYNAMIC INSTABILITY AND RENAL FUNCTION 1589
OTHER PERIOPERATIVE PERTURBATIONS AND RENAL FUNCTION 1589
MONITORS OF RENAL FUNCTION 1591
INDIRECT MARKERS OF OPTIMAL RENAL PERFUSION AND FUNCTION 1591
AUTOREGULATION AND DISTRIBUTION OF CARDIAC OUTPUT TO THE KIDNEYS 1593
EXCESSIVE INTRAVASCULAR VOLUME AND THE ABDOMINAL COMPARTMENT SYNDROME 1594
LABORATORY TESTS OF SERUM AND URINE AS MARKERS OF RENAL FUNCTION 1594
NOVEL (EARLY) BIOMARKERS OF ACUTE KIDNEY INJURY 1599
PREOPERATIVE EVALUATION OF RENAL FUNCTION 1601
SUMMARY 1601
References 1601
References 1603.e1
Chapter\r53 - Neuromuscular Monitoring 1604
TYPES OF PERIPHERAL NERVE STIMULATION 1605
PRINCIPLES OF PERIPHERAL NERVE STIMULATION 1605
PATTERNS OF NERVE STIMULATION 1605
THE NERVE STIMULATOR 1609
STIMULATING ELECTRODES 1609
SITES OF NERVE STIMULATION AND DIFFERENT MUSCLE RESPONSES 1610
RECORDING OF EVOKED RESPONSES 1611
EVALUATION OF RECORDED EVOKED RESPONSES 1614
USE OF NERVE STIMULATORS IN DAILY CLINICAL PRACTICE 1617
WHEN TO USE A PERIPHERAL NERVE STIMULATOR 1619
References 1621
References 1621.e1
Chapter\r54 - Temperature Regulation and Monitoring 1622
NORMAL THERMOREGULATION 1622
THERMOREGULATION DURING GENERAL ANESTHESIA 1624
DEVELOPMENT OF HYPOTHERMIA DURING GENERAL ANESTHESIA 1627
NEURAXIAL ANESTHESIA 1628
CONSEQUENCES OF MILD INTRAOPERATIVE HYPOTHERMIA 1631
PERIOPERATIVE THERMAL MANIPULATIONS 1636
DELIBERATE SEVERE INTRAOPERATIVE HYPOTHERMIA 1639
HYPERTHERMIA AND FEVER 1640
TEMPERATURE MONITORING 1642
TEMPERATURE MONITORING SITES 1643
SUMMARY 1644
References 1645
References 1646.e1
Chapter\r55 - Airway Management in the Adult 1647
INTRODUCTION 1648
FUNCTIONAL AIRWAY ANATOMY 1648
AIRWAY ASSESSMENT 1651
PHYSIOLOGIC CONCEPTS FOR AIRWAY MANAGEMENT 1653
ANESTHESIA FOR AIRWAY MANAGEMENT 1654
VENTILATION VIA A MASK 1659
SUPRAGLOTTIC AIRWAY 1661
ENDOTRACHEAL INTUBATION 1665
PERCUTANEOUS AIRWAYS 1678
EXTUBATION OF THE TRACHEA 1680
SUMMARY 1681
References 1681
References 1683.e1
Chapter\r56 - Spinal, Epidural, and Caudal Anesthesia 1684
PRINCIPLES 1684
PRACTICE 1684
HISTORICAL PERSPECTIVES 1685
ANATOMY 1685
ANATOMIC VARIATIONS 1687
MECHANISM OF ACTION 1688
PHYSIOLOGIC EFFECTS 1689
INDICATIONS 1691
CONTRAINDICATIONS 1691
SPINAL ANESTHESIA 1693
EPIDURAL ANESTHESIA 1703
COMBINED SPINAL-EPIDURAL 1709
CAUDAL ANESTHESIA 1710
COMPLICATIONS 1711
OUTCOMES 1716
RECENT ADVANCES 1716
References 1717
References 1720.e1
Chapter\r57 - Peripheral Nerve Blocks 1721
TECHNIQUES FOR LOCALIZING NEURAL STRUCTURES 1722
UPPER EXTREMITY BLOCKS 1724
BLOCKS OF THE THORAX AND ABDOMEN 1732
LOWER EXTREMITY BLOCKS 1736
CONTINUOUS CATHETER TECHNIQUES 1748
CHOICE OF LOCAL ANESTHETIC 1749
COMPLICATIONS 1749
SUMMARY 1750
References 1751
References 1751.e1
Chapter\r58 - Ultrasound Guidance for Regional Anesthesia 1752
INTRODUCTION 1752
FUNDAMENTAL ASSUMPTIONS AND ARTIFACTS IN ULTRASOUND IMAGING 1752
TRANSDUCER SELECTION, MANIPULATION, AND MODES OF IMAGING 1753
NEEDLE TIP VISIBILITY 1756
APPROACHES TO REGIONAL BLOCK WITH ULTRASOUND 1757
EXAMPLES OF COMMON REGIONAL BLOCKS 1759
TRAINING AND SAFETY 1764
CONCLUSIONS 1765
References 1766
References 1766.e1
Chapter\r59 - Perioperative Fluid and Electrolyte Therapy 1767
PHYSIOLOGY 1768
References 1808
References 1810.e1
Chapter\r60 - Perioperative Acid-Base Balance 1811
WHY IS ACID-BASE BALANCE IMPORTANT? 1811
WHAT ARE ACIDS AND BASES? 1811
ACID-BASE ABNORMALITIES 1814
REGULATION OF ACID-BASE BALANCE 1816
ANALYTIC TOOLS USED IN ACID-BASE CHEMISTRY 1817
ACID-BASE PROBLEMS IN DIFFERENT CLINICAL SETTINGS 1823
TREATING ACID-BASE DISTURBANCES 1828
SUMMARY 1829
References 1829
References 1829.e1
Chapter 61\r- Patient Blood Management: Transfusion Therapy 1830
EVOLUTION AND RECENT HISTORY OF BLOOD TRANSFUSION THERAPY 1830
1990 TO 2005 1831
INDICATIONS FOR TRANSFUSION 1831
CHANGES DURING STORAGE OF BLOOD 1835
COMPATIBILITY TESTING 1837
APPROACHES REQUIRING LESS THAN A COMPLETE CROSSMATCH 1839
EMERGENCY TRANSFUSION 1840
COMPLICATIONS 1842
TRANSFUSION RATIOS 1848
BLOOD TRANSFUSIONS, PHARMACOLOGY, AND HEMOSTASIS 1849
CITRATE INTOXICATION AND HYPERKALEMIA 1850
TEMPERATURE 1850
ACID-BASE ABNORMALITIES 1851
TRANSFUSION REACTIONS 1851
OTHER NONINFECTIOUS RISKS OF BLOOD TRANSFUSIONS 1854
OTHER ADVERSE EFFECTS OF BLOOD TRANSFUSION 1858
LEUKOREDUCTION AND IRRADIATION OF BLOOD TRANSFUSIONS 1858
BLOOD COMPONENT THERAPY 1859
ALBUMIN AND PLASMA PROTEIN PREPARATIONS 1862
SYNTHETIC COLLOID SOLUTION THERAPY 1863
SYNTHETIC OXYGEN-CARRYING SUBSTANCES 1864
INFORMED CONSENT 1865
References 1865
References 1867.e1
Chapter 62 - Patient Blood Management: Coagulation 1868
NORMAL HEMOSTASIS 1868
DISORDERS OF HEMOSTASIS 1871
PROTHROMBOTIC STATES 1874
MONITORING COAGULATION 1876
References 1880
References 1880.e1
Chapter\r63 - Patient Blood Management: Autologous Blood Procurement, Recombinant Factor VIIa Therapy, and Blood Utilization 1881
AUTOLOGOUS BLOOD PROCUREMENT 1882
RECOMBINANT FACTOR VIIA 1888
BLOOD UTILIZATION 1890
BLOODLESS MEDICINE 1894
CONCLUSION 1895
References 1895
References 1896.e1
Index i1
IBC IBC
Front\rCover Cover
IFC IFC
Miller’s Anesthesia iii
Copyright iv
Dedication v
Contributors vi
Preface xxi
Remembrance xxiii
Contents xxv
Video Contents xxx
PART V - Adult Subspecialty\rManagement 1897
Chapter\r64 - Anesthesia and Treatment of Chronic Pain 1898
PHYSIOLOGIC CHANGES IN PERSISTENT PAIN 1898
CLINICAL DEFINITIONS, PREVALENCE, AND CLASSIFICATION OF CHRONIC PAIN 1901
INTERDISCIPLINARY MANAGEMENT OF CHRONIC PAIN 1902
DRUGS USED FOR CHRONIC PAIN 1903
INTERVENTIONAL METHODS USED FOR CHRONIC PAIN 1910
PERIOPERATIVE MANAGEMENT OF PATIENTS WITH CHRONIC PAIN 1912
References 1917
References 1918.e1
Chapter\r65 - Palliative Medicine 1919
WHAT IS PALLIATIVE MEDICINE? 1919
WHERE IS PALLIATIVE CARE DELIVERED? 1921
DIFFERENCES BETWEEN HOSPICE CARE AND PALLIATIVE CARE 1923
COMMUNICATION 1925
PROGNOSIS 1928
DYING PROCESS 1932
ANESTHETIC CONCERNS IN THE PATIENT RECEIVING PALLIATIVE CARE 1938
References 1940
References 1941.e1
Chapter\r66 - Anesthesia for Thoracic Surgery 1942
PREOPERATIVE EVALUATION OF THE THORACIC SURGERY PATIENT 1943
CONCOMITANT MEDICAL CONDITIONS 1945
ASSESSMENT OF THE PATIENT WITH LUNG CANCER (SEE CHAPTER 38) 1951
DIFFICULT ENDOBRONCHIAL INTUBATION 1952
PREDICTION OF DESATURATION DURING ONE-LUNG VENTILATION 1953
ASSESSMENT FOR REPEAT THORACIC SURGERY 1953
INTRAOPERATIVE MONITORING (SEE CHAPTERS 44 AND 51) 1953
INVASIVE HEMODYNAMIC MONITORING (SEE CHAPTER 45) 1954
OTHER NEW MONITORING TECHNOLOGY 1955
LUNG ISOLATION 1955
DIFFICULT AIRWAYS AND ONE-LUNG VENTILATION 1962
LUNG ISOLATION TECHNIQUES IN PATIENTS WITH A TRACHEOSTOMY IN PLACE 1963
ANESTHETIC MANAGEMENT 1967
MANAGEMENT OF ONE-LUNG VENTILATION 1967
HYPOXIC PULMONARY VASOCONSTRICTION 1969
VENTILATION STRATEGIES DURING ONE-LUNG VENTILATION 1970
PREDICTION OF HYPOXEMIA DURING ONE-LUNG VENTILATION 1972
TREATMENT OF HYPOXEMIA DURING ONE-LUNG VENTILATION 1973
ANESTHETIC MANAGEMENT FOR COMMON SURGICAL PROCEDURES 1976
PULMONARY SURGERY 1980
LOBECTOMY 1981
PNEUMONECTOMY 1982
LIMITED PULMONARY RESECTIONS: SEGMENTECTOMY AND WEDGE RESECTION 1984
ANESTHETIC MANAGEMENT FOR SPECIFIC SURGICAL PROCEDURES 1984
ANESTHESIA FOR TRACHEAL RESECTION 1987
BLEBS, BULLAE, CYSTS, AND PNEUMATOCELES 1991
LUNG TRANSPLANTATION 1992
PULMONARY HEMORRHAGE 1994
PULMONARY THROMBOENDARTERECTOMY 1996
BRONCHOPULMONARY LAVAGE 1996
MEDIASTINAL MASSES 1997
THYMECTOMY FOR MYASTHENIA GRAVIS 1998
POSTOPERATIVE MANAGEMENT 1999
POSTOPERATIVE ANALGESIA (SEE CHAPTER 98) 2000
References 2004
References 2006.e1
Chapter\r67 - Anesthesia for Cardiac Surgical Procedures 2007
CARDIOVASCULAR DISEASE IN THE TWENTY-FIRST CENTURY 2008
APPROACH TO ANESTHESIA FOR THE ADULT CARDIAC PATIENT 2009
CARDIOPULMONARY BYPASS 2032
SPECIFIC CARDIOVASCULAR DISEASE STATES 2045
PROCEDURES IN THE CARDIAC CATHETERIZATION LABORATORY AND THE HYBRID OPERATING ROOM 2077
PROBLEMS IN THE POSTOPERATIVE PERIOD 2079
References 2091
References 2095.e1
Chapter\r68 - Anesthesia for Correction of Cardiac Arrhythmias 2096
HISTORICAL PERSPECTIVES 2096
SCOPE OF CARDIAC ARRHYTHMIAS 2097
NORMAL CARDIAC RHYTHM 2097
CARDIAC ARRHYTHMIAS 2098
PERMANENT PACING 2100
RESYNCHRONIZATION THERAPY 2101
IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR 2102
CORRECTION OF CARDIAC ARRHYTHMIAS WITH ABLATION THERAPY 2103
FUTURE TRENDS 2104
References 2105
References 2105.e1
Chapter 69 - Anesthesia for Vascular Surgery 2106
ATHEROSCLEROSIS 2107
PREOPERATIVE EVALUATION 2108
PERIOPERATIVE MYOCARDIAL ISCHEMIA 2114
PERIOPERATIVE Β-ADRENERGIC BLOCKER THERAPY 2115
PERIOPERATIVE STATIN THERAPY 2115
HEMODYNAMIC MONITORING 2116
ABDOMINAL AORTIC RECONSTRUCTION 2116
THORACOABDOMINAL AORTIC SURGERY 2127
ENDOVASCULAR AORTIC REPAIR SURGERY 2136
LOWER EXTREMITY REVASCULARIZATION 2140
CAROTID ENDARTERECTOMY 2147
POSTOPERATIVE MANAGEMENT OF VASCULAR SURGERY PATIENTS 2155
References 2156
References 2157.e1
Chapter\r70 - Anesthesia for Neurologic Surgery 2158
RECURRENT ISSUES IN NEUROANESTHESIA 2159
SPECIFIC PROCEDURES 2176
References 2196
References 2199.e1
Chapter\r71 - Anesthesia for Bariatric Surgery 2200
OBESITY AS A DISEASE 2200
NONSURGICAL MANAGEMENT OF OBESITY 2204
SURGICAL MANAGEMENT OF OBESITY 2206
ANESTHETIC MANAGEMENT OF THE BARIATRIC SURGICAL PATIENT 2208
CONSIDERATIONS FOR MANAGEMENT OF THE OBESE PATIENT PRESENTING FOR NONBARIATRIC SURGERY 2215
References 2215
References 2216.e1
Chapter\r72 - Anesthesia and the Renal and Genitourinary Systems 2217
INNERVATION OF THE GENITOURINARY SYSTEM 2218
ANESTHESIA FOR PATIENTS WITH RENAL DISEASE 2220
RENAL AND GENITOURINARY PROCEDURES 2229
UROGENITAL PAIN SYNDROMES 2239
References 2242
References 2243.e1
Chapter\r73 - Anesthesia and the Hepatobiliary System 2244
EFFECT OF ANESTHETICS ON HEPATIC FUNCTION 2245
EFFECT OF HEPATIC DYSFUNCTION AND HEPATOBILIARY DISEASE ON ANESTHETIC DRUG PHARMACOKINETICS 2248
RISK FACTORS FOR POSTOPERATIVE HEPATOBILIARY COMPLICATIONS 2250
POSTOPERATIVE JAUNDICE 2255
PERIOPERATIVE MANAGEMENT OF PATIENTS WITH ASYMPTOMATIC OR CHRONIC LIVER DYSFUNCTION 2257
ANESTHETIC CONSIDERATIONS FOR PROCEDURES INVOLVING THE LIVER AND BILIARY SYSTEM 2259
References 2260
References 2261.e1
Chapter\x0B74 - Anesthesia for Abdominal Organ Transplantation 2262
ABDOMINAL ORGAN TRANSPLANTATION 2262
KIDNEY TRANSPLANTATION 2263
PANCREAS TRANSPLANTATION 2270
LIVER TRANSPLANTATION 2274
CONCLUSIONS 2289
References 2289
References 2291.e1
Chapter\r75 - Anesthesia for Organ Procurement 2292
INTRODUCTION 2292
MANAGEMENT OF ORGAN DONORS AFTER DECLARATION OF BRAIN (NEUROLOGIC) DEATH 2293
DIAGNOSIS AND DETERMINATION OF BRAIN DEATH 2294
DONATION AFTER CARDIAC (CIRCULATORY) DEATH 2295
ISCHEMIA-REPERFUSION INJURY AND ORGAN PRESERVATION 2297
EXTENDED CRITERIA DONOR 2298
MANAGEMENT OF ORGAN DONORS BEFORE PROCUREMENT 2298
MANAGEMENT OF DONORS AFTER CARDIAC DEATH 2300
MANAGEMENT OF ORGAN DONOR DURING PROCUREMENT SURGERY 2301
MANAGEMENT OF LIVING ORGAN DONORS 2301
References 2305
References 2306.e1
Chapter\r76 - Brain Death 2307
INTRODUCTION 2308
HISTORY 2308
TRADITIONAL CONCEPT OF DEATH OF AN ORGANISM 2311
THE CONCEPT OF BRAIN DEATH 2312
MECHANISM OF BRAIN DEATH 2313
NEUROPHYSIOLOGIC BASIS OF BRAIN DEATH 2313
CRITERIA AND TESTS FOR DETERMINING BRAIN DEATH 2317
PREREQUISITES FOR DIAGNOSING BRAIN DEATH 2317
CLINICAL DIAGNOSIS OF BRAIN DEATH 2318
SPECIAL CONSIDERATIONS 2318
VARIABILITY IN POLICIES AND PRACTICES FOR DETERMINING BRAIN DEATH 2319
ANCILLARY TESTS FOR BRAIN DEATH 2320
ORGAN DONATION 2324
References 2326
References 2327.e1
Chapter\r77 - Anesthesia for Obstetrics 2328
PHYSIOLOGIC CHANGES DURING PREGNANCY AND DELIVERY 2329
UTEROPLACENTAL PHYSIOLOGY 2334
LABOR PROGRESS 2335
LABOR AND FETAL MONITORING 2337
LABOR ANALGESIA 2339
ANESTHESIA CONSIDERATIONS FOR OPERATIVE DELIVERY 2343
ANESTHESIA FOR CESAREAN DELIVERY 2343
SPINAL ANESTHESIA 2344
MATERNAL COMORBIDITIES 2348
ANESTHESIA FOR ABNORMAL PRESENTATIONS 2350
OBSTETRIC EMERGENCIES 2350
NONOBSTETRIC SURGERY DURING PREGNANCY 2353
References 2356
References 2358.e1
Chapter\r78 - Anesthesia for Fetal Surgery and Other Fetal Therapies 2359
INDICATIONS, PROCEDURES, AND OUTCOMES 2362
OBSTRUCTIVE UROPATHY 2364
PREOPERATIVE ASSESSMENT AND COUNSELING 2374
INTRAOPERATIVE MANAGEMENT AND CONSIDERATIONS 2375
POSTOPERATIVE MANAGEMENT AND CONSIDERATIONS 2380
MANAGEMENT OF EX UTERO INTRAPARTUM TREATMENT PROCEDURE 2381
CONCLUSIONS AND FUTURE CONSIDERATIONS 2383
References 2383
References 2385.e1
Chapter\r79 - Anesthesia for Orthopedic Surgery 2386
PREOPERATIVE EVALUATION 2386
REGIONAL VERSUS GENERAL ANESTHESIA 2394
PERIOPERATIVE MANAGEMENT OF ORTHOPEDIC PATIENTS 2394
References 2405
References 2406.e1
Chapter\r80 - Geriatric Anesthesia 2407
CORE CONCEPTS IN THE ANESTHETIC MANAGEMENT OF THE OLDER PATIENT 2408
COGNITIVE ISSUES IN OLDER ADULTS 2412
CONSENT, SURROGATE DECISION MAKERS, AND ADVANCE DIRECTIVES 2415
RISK ASSESSMENT AND PREOPERATIVE EVALUATION 2415
SPECIAL PERIOPERATIVE CONSIDERATIONS FOR THE OLDER PATIENT 2417
ANESTHETIC MANAGEMENT 2417
OUTCOMES 2420
References 2420
References 2422.e1
Chapter\r81 - Anesthesia for Trauma 2423
PRIORITIZING TRAUMA CARE 2425
ANESTHESIA IN WAR AND AUSTERE CONDITIONS 2427
EMERGENCY AIRWAY MANAGEMENT 2429
RESUSCITATION FROM HEMORRHAGIC SHOCK 2433
RESUSCITATION FLUIDS 2440
TRAUMA TO THE CENTRAL NERVOUS SYSTEM 2443
ORTHOPEDIC AND SOFT TISSUE TRAUMA 2450
OTHER TRAUMATIC INJURIES 2452
SELECTED PATIENT POPULATIONS 2455
POSTOPERATIVE CARE 2456
SUMMARY 2457
References 2457
References 2459.e1
Chapter\r82 - Anesthesia and Prehospital Emergency and Trauma Care 2460
INTRODUCTION AND HISTORICAL BACKGROUND 2460
ORGANIZATIONAL MODELS OF PREHOSPITAL EMERGENCY CARE 2461
BASIC TECHNIQUES AND SKILLS 2463
ADULT MEDICAL EMERGENCIES 2468
PEDIATRIC EMERGENCIES 2472
PREHOSPITAL MASS CASUALTY INCIDENT MANAGEMENT AND DISASTER MEDICINE 2475
References 2477
References for online 2478.e1
CHAPTER\r83 - THE ROLE OF THE ANESTHESIA PROVIDER IN NATURAL AND HUMAN-INDUCED DISASTERS* 2480
CLASSIFICATION 2480
RESPONDING TO NATURAL DISASTER 2480
THE IMPACT OF NATURAL DISASTER ON THE WORK OF THE ANESTHESIA PROVIDER 2480
RESPONDING TO A NATURAL DISASTER: PRACTICAL CONSIDERATIONS 2481
PREHOSPITAL ON-SITE EMERGENCY CARE 2481
EARTHQUAKES: A SPECIAL DISASTER SITUATION 2481
FIELD ANESTHESIA 2483
ANESTHETIC TECHNIQUES FOR USE IN NATURAL DISASTERS 2485
INTRODUCTION 2487
APPROACHES TO THE LITERATURE 2488
DEFINITIONS 2488
ESSENTIAL PROPERTIES OF CHEMICAL AND BIOLOGIC WARFARE AGENTS 2489
TOXICITY AND ITS MODIFICATIONS 2489
AGENTS OF CHEMICAL AND BIOLOGIC WARFARE: BACKGROUND AND DEVELOPMENT 2490
HAZARDS AND THREATS 2492
MODES OF RELEASE OF CHEMICAL AND BIOLOGICAL WARFARE AGENTS 2492
AGENTS 2493
INVOLVEMENT OF THE ANESTHESIA PROVIDER IN THE MANAGEMENT OF CASUALTIES FROM EXPOSURE TO CHEMICAL AND BIOLOGIC WARFARE AGENTS 2506
EFFECTS OF CHEMICAL AND BIOLOGIC WARFARE AGENTS ON ANESTHETIC PRACTICE 2509
References 2510
References 2511.e1
Chapter\r84 - Anesthesia for Eye Surgery 2512
OCULAR ANATOMY 2512
OCULOCARDIAC REFLEX 2513
INTRAOCULAR PRESSURE 2513
OPHTHALMOLOGIC DRUGS 2514
PREOPERATIVE EVALUATION (SEE CHAPTER 38) 2514
ANESTHETIC TECHNIQUES 2516
OPHTHALMOLOGIC PROCEDURES 2518
References 2521
References 2522.e1
Chapter 85 - Anesthesia for Ear, Nose, and Throat Surgery 2523
SYNOPSIS OF EAR, NOSE, AND THROAT ANATOMY 2524
PREOPERATIVE EVALUATION FOR EAR, NOSE, AND THROAT SURGERY 2526
AIRWAY MANAGEMENT IN OTOLARYNGOLOGY 2527
AIRWAY DISORDERS IN OTOLARYNGOLOGY 2528
ANESTHESIA FOR PANENDOSCOPY 2530
OTOLARYNGOLOGIC TRAUMA 2534
NASAL SURGERY 2535
TONSILLECTOMY AND ADENOIDECTOMY 2536
ENDOSCOPIC SINUS SURGERY 2537
THYROID AND PARATHYROID SURGERY 2537
AIRWAY FIRES 2538
EAR SURGERY 2538
PAROTID AND OTHER SALIVARY GLAND SURGERY 2540
SLEEP APNEA SURGERY 2540
ZENKER DIVERTICULUM 2541
ANESTHESIA FOR SURGICAL AIRWAYS: CRICOTHYROTOMY AND TRACHEOSTOMY 2542
NECK DISSECTION AND LARYNGECTOMY 2542
MAXILLARY, MANDIBULAR, AND TEMPOROMANDIBULAR JOINT SURGERY 2543
EAR, NOSE, AND THROAT LASER SURGERY 2543
PHONOSURGERY 2545
HEAD AND NECK FLAP RECONSTRUCTIVE SURGERY 2545
STRIDOR AND HELIOX 2546
ANESTHESIA FOR FACE TRANSPLANTATION 2546
References 2547
References 2549.e1
Chapter 86 - Administration of Anesthesia by Robots 2550
WHAT IS A ROBOT? 2550
DECISION SUPPORT SYSTEMS FOR INTRAOPERATIVE USE IN ANESTHESIA 2551
CLOSED-LOOP SYSTEMS 2557
VARVEL PARAMETERS IN CONTROLLER PERFORMANCE EVALUATION 2559
THE CLOSED-LOOP ANESTHESIA DELIVERY SYSTEM: PURI’S RESEARCH GROUP 2563
THE WORK OF THE ITAG RESEARCH GROUP 2568
REGULATORY ISSUES: WHY ARE CLOSED-LOOP SYSTEMS NOT YET COMMERCIALLY AVAILABLE? 2575
MANUAL ROBOTS 2577
References 2579
References 2580.e1
Chapter\r87 - Anesthesia for Robotically Conducted Surgery 2581
HISTORY 2582
ROBOTIC SYSTEMS 2583
CARDIAC SURGERY (ALSO SEE CHAPTER 67) 2586
ROBOTIC-ASSISTED THORACOSCOPIC SURGERY 2592
UROLOGIC SURGERY 2593
GENERAL SURGERY 2594
ANESTHETIC CONSIDERATIONS 2594
GYNECOLOGIC SURGERY 2594
NEUROSURGERY 2595
ORTHOPEDIC SURGERY 2595
SUMMARY 2596
References 2596
References 2597.e1
Chapter\r88 - Anesthesia for Laser Surgery 2598
PHYSICS OF LASER 2598
TYPES OF LASERS 2599
LASER MODES AND SETTINGS 2600
BIOLOGIC EFFECT 2600
COMMON LASER OPERATIONS 2601
RISKS OF LASER USE: STANDARDS AND REGULATIONS 2601
SPECIFIC LASER HAZARDS 2603
OPERATING ROOM FIRE 2605
OTHER CONSIDERATIONS 2610
AIRWAY AND OTHER FIRES ON THE SURFACE OF THE PATIENT 2610
References 2610
References 2611.e1
Chapter\r89 - Ambulatory (Outpatient) Anesthesia 2612
DEFINITIONS 2613
BENEFITS OF AMBULATORY SURGERY 2613
FACILITIES FOR AMBULATORY SURGERY 2613
PATIENT SELECTION CRITERIA 2614
PREOPERATIVE ASSESSMENT 2617
PATIENT PREPARATION 2619
ANESTHETIC TECHNIQUES 2621
MONITORING DEPTH OF ANESTHESIA 2631
RECOVERY FROM AMBULATORY ANESTHESIA 2631
POSTOPERATIVE PAIN 2633
POSTOPERATIVE NAUSEA AND VOMITING 2634
SPECIAL AREAS 2637
HOME READINESS AND BEYOND 2639
References 2641
References 2645.e1
Chapter\r90 - Non–Operating Room Anesthesia 2646
OVERVIEW: DEFINING NON–OPERATING ROOM ANESTHESIA—WHAT IT IS AND HOW WE GOT HERE 2646
FINANCIAL AND OPERATIONAL CONSTRAINTS 2648
TRANSITIONAL PRIORITIES FOR ANESTHESIOLOGISTS OUTSIDE OF THE OPERATING ROOM 2650
GASTROINTESTINAL PROCEDURES IN THE ENDOSCOPY SUITE 2653
INTERVENTIONAL PULMONARY PROCEDURES 2655
NOVEL ANESTHETIC CONCERNS 2655
ANESTHESIOLOGY FOR IMAGE-GUIDED INTERVENTIONS: EVOLUTION OF A NEW INTERFACE 2655
PROCEDURES GUIDED BY COMPUTED TOMOGRAPHY, POSITRON EMISSION TOMOGRAPHY, AND MAGNETIC RESONANCE IMAGING 2659
IMAGE-GUIDED PROCEDURES FOR SPECIALTY AREAS: NEURORADIOLOGY AND INTERVENTIONAL CARDIOLOGY 2661
PROCEDURES IN THE NEURORADIOLOGY SUITE 2661
INTERVENTIONAL CARDIOLOGY PROCEDURES: GENERAL CONSIDERATIONS FOR CATHERIZATION LABORATORY AND ELECTROPHYSIOLOGY LABORATORY 2662
ANESTHESIOLOGISTS IN THE ELECTROPHYSIOLOGY LABORATORY 2663
ANESTHESIOLOGISTS IN THE CATHERIZATION LABORATORY 2665
INTERVENTIONAL ECHOCARDIOGRAPHY ANESTHESIOLOGISTS AS CO-PROCEDURALISTS—THE ROAD AHEAD 2670
THE ROAD AHEAD: TOWARD A COMPREHENSIVE STRATEGY 2670
References 2672
References 2673.e1
Chapter\r91 - Clinical Care in Extreme Environments: At High and Low Pressure and in Space 2674
PHYSIOLOGIC EFFECTS OF INCREASED GAS PRESSURE 2676
RATIONALE FOR THE TREATMENT OF SELECTED SPECIFIC SYNDROMES 2679
FUTURE DIRECTIONS 2682
THERAPEUTIC SYSTEMS 2682
HYPERBARIC TREATMENT SCHEDULES 2684
SIDE EFFECTS OF HYPERBARIC THERAPY 2685
PRACTICAL ASPECTS OF HYPERBARIC THERAPY 2687
EFFECTS OF ALTITUDE 2692
MEDICAL CARE IN SPACE 2699
SUMMARY 2701
References 2701
References 2704.e1
PART VI -\rPediatric Anesthesia 2705
Chapter\r92 - Regional Anesthesia in Children 2706
RELEVANT DIFFERENCES BETWEEN CHILDREN AND ADULTS 2706
INDICATIONS, CONTRAINDICATIONS, AND COMPLICATIONS 2713
SELECTION OF MATERIALS AND ANESTHETIC SOLUTION 2717
ANATOMIC IDENTIFICATION IN REGIONAL ANESTHESIA 2719
SAFETY, PRECAUTIONS AND DISCHARGE CRITERIA 2720
NEURAXIAL BLOCKS 2722
UPPER EXTREMITY CONDUCTION BLOCKS 2728
LOWER EXTREMITY CONDUCTION BLOCKS 2736
BLOCKS OF NERVES SUPPLYING THE TRUNK 2743
FACE, HEAD, AND NECK NERVE BLOCKS 2748
OTHER PROCEDURES 2753
References 2754
References 2756.e1
Chapter\r93 - Pediatric Anesthesia 2757
DEVELOPMENTAL CONSIDERATIONS 2758
PHARMACOLOGIC AND PHARMACODYNAMIC RESPONSES 2763
ANESTHETIC CONSIDERATIONS 2773
CONSIDERATIONS FOR NEONATAL ANESTHESIA 2789
SPECIFIC NEONATAL AND SURGICAL PROCEDURES 2791
REGIONAL ANESTHESIA AND ANALGESIA 2796
References 2796
References 2798.e1
Chapter\r94 - Anesthesia for Pediatric Cardiac Surgery 2799
UNIQUE FEATURES OF PEDIATRIC CARDIAC ANESTHESIA 2800
ANESTHETIC MANAGEMENT 2810
CARDIOPULMONARY BYPASS 2819
ANTICOAGULATION, HEMOSTASIS, AND BLOOD CONSERVATION 2832
POSTOPERATIVE MANAGEMENT 2834
ANESTHESIA FOR HEART AND LUNG TRANSPLANTATION 2837
ANESTHESIA FOR CLOSED-HEART OPERATIONS 2840
ANESTHESIA FOR INTERVENTIONAL OR DIAGNOSTIC CARDIAC PROCEDURES 2841
ADULT CONGENITAL HEART DISEASE 2845
PEDIATRIC CARDIAC ELECTROPHYSIOLOGY 2847
ADVANCES IN RESYNCHRONIZATION THERAPY 2848
ANESTHESIA FOR NONCARDIAC SURGERY 2849
OFFSITE ANESTHESIA IN CARDIAC SURGERY PATIENTS 2850
References 2851
References 2853.e1
Chapter\r95 - Pediatric and Neonatal Intensive Care 2854
RELATIONSHIP BETWEEN THE INTENSIVE CARE UNIT AND THE OPERATING ROOM 2854
FAMILY PARTNERED CARE IN THE PEDIATRIC INTENSIVE CARE UNIT 2855
DISCLOSURE OF MEDICAL ERRORS 2855
ORGANIZATION OF THE PEDIATRIC INTENSIVE CARE UNIT 2856
CARDIOVASCULAR SYSTEM (SEE ALSO CHAPTERS 93 AND 94) 2856
COMMON CARDIOVASCULAR DISEASE STATES 2857
CARDIOVASCULAR PHARMACOLOGY 2861
NEONATAL RESUSCITATION 2865
PHASES OF RESUSCITATION 2869
INTERVENTIONS DURING THE CARDIAC ARREST (NO-FLOW) AND CPR (LOW-FLOW) 2871
POSTRESUSCITATION MYOCARDIAL DYSFUNCTION 2875
VENTRICULAR FIBRILLATION AND VENTRICULAR TACHYCARDIA IN CHILDREN 2876
RESPIRATORY SYSTEM 2877
CENTRAL NERVOUS SYSTEM 2895
ENDOCRINE SYSTEM 2905
GASTROINTESTINAL SYSTEM 2906
IMMUNITY AND INFECTION 2913
PEDIATRIC TRAUMA 2915
TRANSPORT OF THE CRITICALLY ILL CHILD 2917
References 2917
References for online only 2922.e1
PART VII\r- Postoperative Care 2923
Chapter\r96 - The Postanesthesia Care Unit 2924
ADMISSION TO THE PACU 2925
STANDARDS FOR POSTANESTHESIA CARE 2925
EARLY POSTOPERATIVE PHYSIOLOGIC CHANGES 2926
TRANSPORT TO THE PACU 2927
UPPER AIRWAY OBSTRUCTION 2927
MANAGEMENT OF UPPER AIRWAY OBSTRUCTION 2929
DIFFERENTIAL DIAGNOSIS OF ARTERIAL HYPOXEMIA IN THE PACU 2930
PULMONARY EDEMA 2931
MONITORING AND TREATMENT OF HYPOXEMIA 2932
OPTIMAL PERIOPERATIVE OXYGENATION 2932
OXYGEN DELIVERY SYSTEMS 2933
HEMODYNAMIC INSTABILITY 2935
MYOCARDIAL ISCHEMIA: EVALUATION AND TREATMENT 2936
CARDIAC DYSRHYTHMIAS 2937
RENAL DYSFUNCTION 2938
BODY TEMPERATURE AND SHIVERING 2939
POSTOPERATIVE NAUSEA AND VOMITING 2940
DELIRIUM 2940
EMERGENCE EXCITEMENT 2941
DELAYED AWAKENING 2941
DISCHARGE CRITERIA 2942
INFECTION CONTROL 2943
FUTURE CONSIDERATIONS 2943
SUMMARY 2944
References 2945
References 2946.e1
Chapter\r97 - Postoperative Nausea and Vomiting 2947
ETIOLOGY: PATHWAYS FOR NAUSEA AND VOMITING 2948
RISK FACTORS AND INDEPENDENT PREDICTORS 2949
PROPHYLACTIC ANTIEMETIC STRATEGIES 2958
ANTIEMETICS 2963
SPECIAL SETTINGS 2969
A RATIONAL GUIDELINE FOR THE MANAGEMENT OF POSTOPERATIVE NAUSEA AND VOMITING 2970
References 2972
References 2973.e1
Chapter\r98 - Acute Postoperative Pain 2974
FUNDAMENTAL CONSIDERATIONS 2975
TREATMENT METHODS 2978
SYSTEMIC ANALGESIC TECHNIQUES 2978
POSTOPERATIVE ANALGESIA IN SPECIAL POPULATIONS 2991
References 2996
References 2998.e1
Chapter\r99 - Cognitive Dysfunction and Other Long-term Complications of Surgery and Anesthesia 2999
DETECTION OF POSTOPERATIVE COGNITIVE DYSFUNCTION 3000
INCIDENCE AND RISK FACTORS FOR POSTOPERATIVE COGNITIVE DYSFUNCTION AFTER CARDIAC SURGERY 3002
INCIDENCE AND RISK FACTORS FOR POSTOPERATIVE COGNITIVE DYSFUNCTION AFTER NONCARDIAC SURGERY 3003
ETIOLOGIC CONSIDERATIONS 3007
CLINICAL SIGNIFICANCE AND LONG-TERM CONSEQUENCES OF POSTOPERATIVE COGNITIVE DYSFUNCTION 3009
References 3009
References 3010.e1
Chapter\r100 - Postoperative Visual Loss 3011
RETINAL ISCHEMIA: BRANCH AND CENTRAL RETINAL ARTERY OCCLUSION 3012
ISCHEMIC OPTIC NEUROPATHY 3016
CORTICAL BLINDNESS 3026
ACUTE GLAUCOMA 3028
VISUAL CHANGES AFTER TRANSURETHRAL RESECTION OF THE PROSTATE 3028
VISUAL LOSS AFTER VITRECTOMY AND VITREAL GAS BUBBLE TAMPONADE 3029
CONCLUSION 3029
References 3029
References 3032.e1
PART VIII -\rCritical Care Medicine 3033
Chapter\r101 - Critical Care Anesthesiology 3034
INTENSIVE CARE UNIT ORGANIZATION 3034
QUALITY MEASUREMENT IN CRITICAL CARE 3037
MANAGEMENT OF CRITICALLY ILL PATIENTS 3038
COMPLICATIONS OF INTENSIVE CARE UNIT MANAGEMENT 3048
CONCLUSION 3051
References 3051
References 3053.e1
Chapter\r102 - Critical Care Protocols and Decision Support 3054
RATIONALE FOR PROTOCOL DEVELOPMENT 3055
PROTOCOL DESIGN 3056
PROTOCOL IMPLEMENTATION 3058
INTENSIVE CARE UNIT PROTOCOLS 3058
THE FUTURE OF MEDICINE BASED ON PROTOCOLS 3060
CONCLUSION 3061
References 3061
References 3062.e1
Chapter\r103 - Respiratory Care 3063
SETTINGS OF MECHANICAL VENTILATION 3064
PRINCIPLES OF RESPIRATORY PHYSIOLOGY APPLICABLE TO THE CLINICAL SCENARIO 3074
MECHANICAL VENTILATION IN THE CLINICAL SCENARIO 3078
References 3082
References 3083.e1
Chapter\r104 - Nitric Oxide and Other Inhaled Pulmonary Vasodilators 3084
INTRODUCTION 3085
INHALED NITRIC OXIDE 3085
OTHER INHALED PULMONARY VASODILATORS 3095
CONCLUSIONS 3096
References 3096
References 3097.e1
Chapter\r105 - Neurocritical Care 3098
INTRACRANIAL PHYSIOLOGY AND CEREBRAL AUTOREGULATION 3099
GENERAL CARDIOPULMONARY CONSIDERATIONS 3101
FLUIDS AND ELECTROLYTES 3102
FEVER AND INFECTION 3103
MONITORING 3103
COMMON DISEASES IN THE NEUROCRITICAL CARE UNIT 3108
ETHICAL CONSIDERATIONS 3118
CONCLUSION 3118
References 3118
References 3120.e1
Chapter\r106 - Nutrition and Metabolomics 3121
SYSTEMS BIOLOGY AND METABOLOMICS 3121
METABOLIC CONTROL SYSTEMS AND THE RESPONSE TO SURGICAL STRESS 3122
FASTING AND MALNUTRITION 3132
EATING 3133
METABOLIC RESPONSES TO SURGICAL AND TRAUMATIC INJURY 3133
METABOLIC RESPONSES TO SEPSIS 3138
MODULATING THE STRESS RESPONSE 3139
NUTRITIONAL SUPPORT 3144
SPECIAL CONSIDERATIONS 3153
CONCLUSIONS 3154
References 3154
References 3157.e1
Chapter\r107 - Extracorporeal Support Therapies 3158
INTRODUCTION TO EXTRACORPOREAL SUPPORT THERAPIES: MULTIORGAN SUPPORT FOR THE PATIENT WHO IS CRITICALLY ILL 3158
HISTORICAL NOTES 3159
TECHNICAL ASPECTS AND MODES OF EXTRACORPOREAL SUPPORT 3161
CLINICAL APPLICATIONS 3173
ALTERNATIVE EXTRACORPOREAL SUPPORT TECHNIQUES 3178
CONCLUSIONS 3180
References 3180
References 3181.e1
Chapter\r108 - Cardiopulmonary Resuscitation: Basic and Advanced Life Support 3182
SUDDEN CARDIAC ARREST AND CARDIOPULMONARY RESUSCITATION 3183
MANAGEMENT OF CARDIAC ARREST 3200
POSTRESUSCITATION INTERVENTIONS 3203
PEDIATRIC RESUSCITATION 3206
FUTURE OF RESUSCITATION SCIENCE AND CARE 3213
References 3214
References 3216.e1
PART IX -\rAncillary Issues andResponsibilities 3217
Chapter\r109 - Electrical Safety in the Operating Room 3218
ELECTRICAL GROUND 3220
ISOLATION OF ELECTRIC POWER FROM THE GROUND 3221
CAPACITIVE COUPLING 3224
ELECTRICAL SHOCK 3226
ELECTROSURGERY 3227
SAFE PRACTICE 3229
References 3230
References 3230.e1
Chapter\r110 - Environmental Safety and Chemical Dependency 3231
ANESTHESIA GASES 3232
RADIATION 3234
INFECTIONS 3235
FATIGUE 3239
SUBSTANCE ABUSE 3240
TREATMENT 3243
References 3245
References 3246.e1
Chapter\r111 - Statistical Methods in Anesthesia 3247
STATISTICAL APPROACHES 3248
STUDY DESIGN 3252
EVIDENCE-BASED MEDICINE 3256
SUMMARY 3256
Bibliography 3256
Chapter 112 - Evaluation and Classification of Evidence for the ASA Clinical Practice Guidelines 3257
COLLECTION AND ORGANIZATIONOF LITERATURE 3257
LITERATURE EVALUATIONAND MITIGATION OF BIAS 3257
AGGREGATION AND CLASSIFICATIONOF LITERATURE-BASED EVIDENCE 3264
EVALUATION OF OPINION-BASEDEVIDENCE 3264
PROTOCOL FOR ORGANIZING ANDINTEGRATING AGGREGATED EVIDENCE 3268
SUMMARY AND CONCLUSIONS 3269
References 3270
References 3270.e1
Index i1
IBC IBC