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Yao & Artusio's Anesthesiology: Problem-Oriented Patient Management
PEEP
Table of Contents
Free Topics
2. Bronchoscopy, Mediastinoscopy, and Thoracoscopy
Acknowledgments
Contributors
F - 1.1. Lung Volumes and Lung Capacities
F - 1.3. Closing Volume (CV) Measurement by Single-Breath Nitrogen Test
F - 3.2. Nitrogen (N2) Content of Inspired Air Prevents Alveolar Collapse
F - 3.6. Lung Recruitment in ARDS with Progressive Increase in Peep
F - 5.2. Echocardiographic Evaluation of the Left Ventricle (LV)
F - 5.4. Hemodynamic Consequences of Myocardial Ischemia
Figure - Closing Volume (CV) Measurement by Single-Breath Nitrogen Test
Figure - Lung Volumes and Lung Capacities
Flowchart - A Systematic Approach to Emergence and Extubation - Flowchart
Flowchart - Pathogenesis of Postoperative Respiratory Failure - Flowchart
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Respiratory Failure
Preface
Preoperative Evaluation and Preparation
T - 3.1 Differential Diagnosis of Postoperative Respiratory Failure
T - 3.5 Clinical Screening Criteria for Extubation Readiness
T - 5.2 Different Hypothermic Acid-Base Regulatory Strategies
Table - Clinical Screening Criteria for Extubation Readiness
Table - Differential Diagnosis of Postoperative Respiratory Failure
Section 1. The Respiratory System
1. Asthma and Chronic Obstructive Pulmonary Disease
1. Asthma and Chronic Obstructive Pulmonary Disease
F - 1.1. Lung Volumes and Lung Capacities
F - 1.2. Flow-Volume Loops in a Healthy Person (A), a Patient with Obstructive Lung Disease (B), a Patient with Restrictive Lung Disease (C), a Patient with a Fixed Obstruction (D), a Patient with a Variable Extrathoracic Obstruction (E), and a Patient with a Variable Intrathoracic Obstruction (F)
F - 1.3. Closing Volume (CV) Measurement by Single-Breath Nitrogen Test
F - 1.4. Cyclic Adenosine Monophosphate (cAMP) Pathways Involved in Bronchodilator Action
F - 1.5. A Systematic Approach to Emergence and Extubation
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 1.1 Differences Between Obstructive and Restrictive Lung Diseases
2. Bronchoscopy, Mediastinoscopy, and Thoracoscopy
2. Bronchoscopy, Mediastinoscopy, and Thoracoscopy
F - 2.1. Representative Bronchoscopic Images of a Bronchial Blocker and DLT Placement
F - 2.2. Changes in Blood Perfusion with the Lateral Decubitus Position
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 2.1 Minimal Pulmonary Function Test Criteria for Various-Sized Pulmonary Resections
T - 2.2 Indications for Single-Lung Ventilation
T - 2.3 Advantages and Disadvantages of Bronchial Blockers
3. Aspiration and Postoperative Respiratory Failure
3. Aspiration and Postoperative Respiratory Failure
Adjunctive Management of Respiratory Failure
Aspiration
F - 3.1. Pathogenesis of Postoperative Respiratory Failure
F - 3.2. Nitrogen (N2) Content of Inspired Air Prevents Alveolar Collapse
F - 3.3. Possible Indications for Emergency Endotracheal Intubation
F - 3.4. Definition of the Acute Respiratory Distress Syndrome (ARDS)
F - 3.5. The Pathogenesis of ARDS
F - 3.6. Lung Recruitment in ARDS with Progressive Increase in Peep
F - 3.7. Ventricular Failure and Pulmonary Edema Precipitated by Spontaneous Ventilation
Indications for Ventilator Support
Liberation of the Patient from Mechanical Ventilation
Management of Mechanical Ventilation
Management of Refractory Respiratory Failure
Postoperative Respiratory Failure
T - 3.1 Differential Diagnosis of Postoperative Respiratory Failure
T - 3.2 Pulmonary Ultrasound Findings
T - 3.3 Use of Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure
T - 3.4 Low-Stretch Lung Protective Ventilator Strategy for Acute Respiratory Distress Syndrome
T - 3.5 Clinical Screening Criteria for Extubation Readiness
The Acute Respiratory Distress Syndrome
4. Lung Transplantation
4. Lung Transplantation
F - 4.1. Representative Tracings of Flow-Volume Loops from a Healthy Individual, a Patient with Parenchymal Obstructive Disease, a Patient with Tracheal Stenosis, and a Patient with Restrictive Disease from Parenchymal Fibrosis
F - 4.2. Tracings of Femoral Arterial Blood Pressure, along with Pulmonary Artery (PA) and Central Venous (CV) Pressures, Before and after Occlusion of the Left PA (A) and during Implantation of a Left Lung Graft (B)
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 4.1 Lung Transplants Categorized by Disease
Section 2. The Cardiovascular System
10. Abdominal Aortic Aneurysm Repair
10. Abdominal Aortic Aneurysm Repair
F - 10.1. Treatment Algorithm for Timing of Elective Noncardiac Surgery in Patients with Coronary Stents
F - 10.2. Stepwise Algorithm for Preoperative Assessment for Patients with Coronary Artery Disease (CAD) Undergoing Noncardiac Surgery
F - 10.3. Diagram to Show Components of the Anterior Spinal Artery
F - 10.4. Typical Ssep Trace
F - 10.5. Ssep Response to Aortic Cross-Clamping (AXC)
F - 10.6. Types of Endovascular Leaks
F - 10.7. Systemic Hemodynamic Response to Aortic Cross-Clamping (AoX)
F - 10.8. Systemic Hemodynamic Response to Aortic Unclamping
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 10.1 Typical Respiratory Parameters Used to Determine Suitability for Extubation
T - 10.2 Epidural Opioid/Bupivacaine Combinations Administered by Continuous Infusion
11. Hypertension
11. Hypertension
F - 11.1. Change in Amplitude and Contour of the Upper Limb (A) and Ascending Aortic (B) Pressure Wave with Age, as Recorded in Three Female Members of a Family: at Age 18 (Left), at Age 48 (Center), and at Age 97 Years (Right)
F - 11.2. The Renin-Angiotensin System and the Mechanism of Action of Antihypertensive Drugs
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 11.1 Categories of Blood Pressure in Adults
T - 11.2 Categories of Blood Pressure in Pediatrics
T - 11.3 Classification of Hypertension
T - 11.4 Cardiovascular Effects of Calcium Channel Blockers
T - 11.5 Intraoperative Control of Hypertension
12. Cardiac Tamponade
12. Cardiac Tamponade
F - 12.1. Acute Versus Delayed Tamponade
F - 12.10. Intraoperative Hemodynamics Before and after Pericardial Decompression
F - 12.2. Acute Regional Pericardial Effusion, Right Atrial Compression
F - 12.3. Acute Regional Pericardial Effusion, Left Atrial Compression
F - 12.4. Parallel Ventricular Interdependence
F - 12.5. Central Venous Pressure (Cvp) Waveform Abnormalities in Tamponade
F - 12.6. Predicted Response to Volume Challenge in Tamponade Versus Right Ventricular (RV) Dysfunction
F - 12.7. Right Atrium (RA) Collapse from Early Tamponade
F - 12.8. Exaggerated Ventricular Interdependence
F - 12.9. ROTEM[r] Assay Data
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 12.1 Differential Diagnoses of a Low Cardiac Output
T - 12.2 Three Phases of Cardiac Tamponade
T - 12.3 Causes of Cardiac Tamponade
T - 12.4 Signs and Symptoms of Cardiac Tamponade
T - 12.5 Measured and Calculated Hemodynamic Parameters
T - 12.6 Approaches to Pericardiocentesis
T - 12.7 Rotational Thromboelastometry Numerical Parameters
T - 12.8 Rotational Thromboelastometry Data for Section B.9
13. Heart Transplantation and Subsequent Noncardiac Surgery
13. Heart Transplantation and Subsequent Noncardiac Surgery
F - 13.1. International Society for Heart and Lung Transplantation: Adult Heart Transplant Diagnosis for Transplants Performed Between January 1, 2009, and June 30, 2017
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Management
Subsequent Noncardiac Surgery
14. Ischemic Heart Disease and Noncardiac Surgery
14. Ischemic Heart Disease and Noncardiac Surgery
F - 14.1. Treatment Algorithm for Timing of Elective Noncardiac Surgery in Patients with Coronary Stents
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
5. Ischemic Heart Disease and Coronary Artery Bypass Grafting
5. Ischemic Heart Disease and Coronary Artery Bypass Grafting
F - 5.1. Branches of the Coronary Arteries
F - 5.10. Plasma Thromboxane B2 Concentrations Before and after Administration of Protamine Infused over 3 Seconds, 30 Seconds, 300 Seconds, and 30 Minutes
F - 5.11. Pulmonary Hemodynamics Before and after Administration of Protamine Infused over 3 Seconds, 30 Seconds, 300 Seconds, and 30 Minutes
F - 5.12. The Function of the Intra-Aortic Balloon Pump (IABP)
F - 5.2. Echocardiographic Evaluation of the Left Ventricle (LV)
F - 5.3. Echocardiographic Evaluation of the Systolic Function of the LV
F - 5.4. Hemodynamic Consequences of Myocardial Ischemia
F - 5.5. Color Doppler Echocardiography
F - 5.6. Doppler Mode
F - 5.7. Atheromatous Aortic Disease
F - 5.8. Pressure Tracings of Right Atrium (RA), Right Ventricle (RV), Pulmonary Artery (PA), and Pulmonary Artery Occlusion Pressure (PAOP)
F - 5.9. Hemodynamic Management during Weaning from Cpb
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 5.1 Cardiac Anesthesia Intravenous Medications
T - 5.2 Different Hypothermic Acid-Base Regulatory Strategies
6. Mechanical Circulatory Support
6. Mechanical Circulatory Support
F - 6.1. One Complete Cardiac Cycle and the Corresponding Waveform of the IABP during the Inflation and Deflation
F - 6.2. A.waveform Characteristics: Inflation of IABP Before Dicrotic Notch; Diastolic Augmentation Encroaches onto Systole, May Be Unable to Distinguish
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
7. Valvular Heart Disease
7. Valvular Heart Disease
Alternative Treatments
F - 7.1. Normal P-V Loop and Valve Positions
F - 7.10. Pressure Curves for the LV, Left Atrium, Pulmonary Artery, and Aorta in Patients with Ms
F - 7.11. Pressure Curves for the LV, Left Atrium, Pulmonary Artery, and Aorta in Patients with MR
F - 7.12. The Process of Producing the B-Mode and M-Mode Images
F - 7.13. Wall Segments of the LV
F - 7.14. Continuous-Wave Doppler Across the Av in the Deep Transgastric Apical View from a Patient with Severe As
F - 7.15. Pressure Gradients in Severe As are Measured during Systole as the Difference Between Aortic and Left Ventricular Pressures Displayed Using a Scale of 0 to 20 Mmhg
F - 7.16. Transesophageal Echocardiographic Findings of Moderate As (Midesophageal Av Short-Axis View [left] and Long-Axis View [right])
F - 7.17. Transesophageal Echocardiographic Findings of Moderate Aortic Regurgitation (Midesophageal Av Long-Axis View; Color Flow Doppler)
F - 7.18. Transesophageal Echocardiographic Findings of Severe Ms with 2d View (Left) and 3D View (Right)
F - 7.19. Transesophageal Echocardiographic Findings of Moderate MR (Color Flow Doppler) with 3D View (Top) and 2d View (Bottom)
F - 7.2. Contractility
F - 7.3. P-V Loop of As
F - 7.4. P-V Loops of Acute and Chronic Aortic Insufficiency (AI)
F - 7.5. P-V Loops of Ms
F - 7.6. P-V Loop of Acute and Chronic Mitral Regurgitation (MR)
F - 7.7. Pressure Curves for the LV, Left Atrium, Pulmonary Artery, and Aorta in a Healthy Individual
F - 7.8. Pressure Curves for the LV, Left Atrium (LA), Pulmonary Artery, and Aorta in Patients with As
F - 7.9. Pressure Curves for the LV, Left Atrium, Pulmonary Artery, and Aorta in Patients with Aortic Regurgitation
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 7.1 Transesophageal Echocardiography Severity Scales of Valvular Lesions
T - 7.2 The Signs and Symptoms for the Various Valvular Lesions
T - 7.3 Hemodynamic Goals for the Various Valvular Lesions
8. Pacemakers, Implantable Cardioverter-Defibrillators, and Cardiac Resynchronization Therapy Devices
8. Pacemakers, Implantable Cardioverter-Defibrillators, and Cardiac Resynchronization Therapy Devices
F - 8.1. Atrioventricular Heart Block
F - 8.2. The Subcutaneous ICD
F - 8.3. Chest x-Ray of Implanted Subcutaneous ICD
F - 8.4. Micra Leadless Pacemaker
F - 8.5. Chest x-Ray of Micra Leadless Pacemaker Implanted in the Right Ventricle (Blue Arrows) in Anterior-Posterior and Lateral Views
F - 8.6. Anteroposterior Placement of Defibrillating Electrodes
F - 8.7. Placement of Defibrillating Electrodes
F - 8.8. Rhythm Strip of Pacemaker-Mediated Tachycardia (PMT)
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 8.1 NASPE/BPEG Generic Pacemaker Identification Code
T - 8.2 NASPE/BPEG Generic Defibrillator Code
9. Thoracic and Thoracoabdominal Aortic Aneurysms
9. Thoracic and Thoracoabdominal Aortic Aneurysms
F - 9.1. Midesophageal Av Long-Axis View on TEE Demonstrating Moderate Central AI Secondary to Aortic Root and Ascending Aortic Dilatation in a Young Woman with Turner Syndrome
F - 9.10. Surgical Options for Taas and Thoracic Aortic Dissections
F - 9.11. Elephant Trunk Procedure
F - 9.12. Three-Dimensional (3D) CT Reconstruction Demonstrating Endovascular Exclusion of the Descending Thoracic Aorta Aneurysm after Abdominal and Arch Debranching
F - 9.13. Three-Dimensional (3D) CT Reconstruction after Abdominal Debranching
F - 9.14. Lhb is Utilized for Distal Perfusion during TAAA Repair
F - 9.15. Surgical Strategies for Aortic Arch Debranching and Tevar for Aortic Arch Aneurysms
F - 9.16. Illustration Demonstrating a Hybrid Aortic Arch Repair, Where an Endograft is Placed in the Aortic Arch and the Proximal Descending Aorta to Facilitate Aortic Remodeling and Create the Landing Zone for Future Reinterventions
F - 9.2. Three-Dimensional (3D) CT Reconstruction Demonstrating a Thoracoabdominal Aneurysm that Begins in the Descending Thoracic Aorta and Extends to the Infrarenal Aorta, above the Bifurcation into the Iliac Arteries
F - 9.3. A.midesophageal Av Long-Axis View on TEE Demonstrating Av Annulus, Sinus, and Sinotubular Junction Dimensions at Mid-Systole.b.ascending Aorta in Short Axis Demonstrating Aneurysmal Enlargement with a Diameter of 5.3 Cm in a Young Woman with Turner Syndrome
F - 9.4. The Modified Crawford Classification of Taaas
F - 9.5. A.midesophageal Av Short-Axis View on TEE Showing a Bicuspid Valve, with Fusion of the Left and Right Coronary Cusps.b.midesophageal Av Long-Axis View on TEE Demonstrating the Characteristic Doming of a Stenotic Bicuspid Av and Blunting of the Sinotubular Junction Due to Aortic Root (Ascending Aortic) Dilatation
F - 9.6. Midesophageal Av Short-Axis View on TEE Demonstrating an Aad (Arrow) that Extends Proximally to the Av in a Young Patient with Mfs
F - 9.7. Transgastric Midpapillary View on TEE Demonstrating Accumulation of Blood in the Posterior Pericardial Space (Arrow) after Aad
F - 9.8. The Stanford and Debakey Classifications of Aortic Dissections
F - 9.9. Spinal Cord Blood Supply
Intraoperative Management
Pathophysiology and Differential Diagnosis
Postoperative Anesthetic Management
Preoperative Evaluation and Preparation
T - 9.1 Annual Rate of Rupture for Thoracic Aortic Aneurysms
T - 9.2 Guidelines for Elective Intervention in Patients with Ascending or Descending Thoracic Aortic Aneurysms
T - 9.3 Types of Thoracic Ascending Aorta Aneurysm Repairs
Section 3. The Gastrointestinal System
15. Intestinal Obstruction and Enhanced Recovery after Surgery
15. Intestinal Obstruction and Enhanced Recovery after Surgery
F - 15.1. Pathophysiologic Changes of Intestinal Obstruction
F - 15.2. Gi Fluids
F - 15.3. Sample GDFT Algorithm
F - 15.4. Poqi Risk Stratification for Monitoring in Enhanced Recovery Protocol
F - 15.5. Conceptual Framework of Mechanisms of the Surgical Stress Response
F - 15.6. Flow Chart for Management of PONV in the Context of Enhanced Recovery
F - 15.7. Myocardial Dysfunction in Sepsis
F - 15.8. Proposed Mechanism for Poi
F - 15.9. Rescue Plan for Suboptimal Analgesia
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 15.1 Acute Abdomen Differential
T - 15.2 Transcellular Fluid Composition
T - 15.3 Factors that Increase Intragastric Volume and Pressure
T - 15.4 Treatment Algorithm for Achieving Optimal Analgesia after Colorectal Surgery
T - 15.5 Physiologic Challenges to Homeostasis
T - 15.6 Choices of Antiemetic Agents in Adults: Dosage and Timing
T - 15.7 Pathophysiology of Aspiration
16. Liver Transplantation
16. Liver Transplantation
Acknowledgment
F - 16.1. Comparison of Waitlist Mortality and Transplantation Rate Between Model for End-Stage Liver Disease (Meld) and Meld-Sodium (Na) Scores in Patients with Cirrhotic Liver Disease
F - 16.2. Changes of the Coagulation and Fibrinolytic System in Esld
F - 16.3. Schematic Diagram of Venovenous Bypass Circuit during Liver Transplantation
F - 16.4. Three Different Techniques to Reconstruct the Hepatovenous Outflow
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 16.1 Adverse Effects of Immunosuppressant Medications
Section 4. The Nervous System
17. Brain Tumor and Craniotomy
17. Brain Tumor and Craniotomy
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 17.1 Classification of Intracranial Tumors
T - 17.2 Genetic Conditions Associated with Intracranial Tumors
T - 17.3 Specific Anesthetic Considerations in Posterior Fossa Craniotomy
T - 17.4 Anesthetic Effects on Intraoperative Neuromonitoring
T - 17.5 Physiologic Effects on Intraoperative Neuromonitoring
T - 17.6 The Effects of Anesthetic Agents on Cerebral Blood Flow, Metabolism, and Intracranial Pressure
T - 17.7 The Osmolarity and Composition of Commonly Used Crystalloid Solutions
T - 17.8 Rapid Assessment of Persistent Coma Immediately Postcraniotomy
18. Carotid Artery Disease
18. Carotid Artery Disease
F - 18.1. Arterial Circle of Willis
F - 18.2. Cerebral Autoregulatory Curves in Normotensive and Chronic Hypertensive Patients
F - 18.3. An Example of Density Spectral Array (A) and Compressed Spectral Array (B) during a Period of Marked Hypotension during Initiation of Bypass
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
19. Awake Craniotomy for Mapping and Surgery in the Eloquent Cortex
19. Awake Craniotomy for Mapping and Surgery in the Eloquent Cortex
Acknowledgments
F - 19.1. A.a 30-Year-Old Male with a Known Glioblastoma Presents with Increasing Seizure Frequency and Tumor Progression on Follow-Up Studies
F - 19.2. Idealized Icp Volume Curve
F - 19.3. Pressure-Cbf Relationships
F - 19.4. Autoregulatory Curve of the Cerebral Vasculature in the Normotensive Adult, the Hypertensive Adult, and the Newborn
F - 19.5. MRI Scan of a 29-Year-Old Female with a 2-Week History of Word-Finding Difficulty and No Other Symptoms
F - 19.6. CT Scan of a 73-Year-Old Man Who Underwent an Uneventful Left Awake Craniotomy with Motor and Language Area Mapping
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 19.1 Commonly Used Drugs in Seizure Control
T - 19.2 Osmotic Values of Common Intravenous Fluids
20. Head Injury
20. Head Injury
F - 20.1. Initial Head CT Scan (basal): Bilateral Tsah
F - 20.2. Initial Head CT Scan (Vertex): Bilateral Tsah
F - 20.3. Follow-Up Head CT Scan: Contusions with Malignant Cerebral Edema
F - 20.4. Follow-Up Head CT Scan: Contusions with Brain Swelling and Effacement of Sulci and basal Cisterns
Intraoperative Management
Pathophysiology and Differential Diagnosis
Postoperative Neurointensive Care Management
Preoperative Evaluation and Preparation
T - 20.1 Glasgow Coma Scale
21. Cerebral Aneurysm
21. Cerebral Aneurysm
F - 21.1. Change in Cbf as a Function of Paco2 and Pao2 Tension
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 21.1 Modified Hunt and Hess Clinical Grades
T - 21.2 World Federation of Neurological Surgeons (WFNS) Grading Scale
Section 5. The Endocrine System
22. Pheochromocytoma
22. Pheochromocytoma
F - 22.1. Synthesis and Metabolism of Endogenous Catecholamine
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 22.1 Syndromes Associated with Pheochromocytoma
T - 22.2 Biochemical Tests for Diagnosis of Pheochromocytoma
T - 22.3 Suggested Drugs to Avoid in Patients with Pheochromocytoma
T - 22.4 Intravenous Drugs to Control Intraoperative Hypertension
23. Diabetes Mellitus
23. Diabetes Mellitus
F - 23.1. Onset and Duration of Action Graphic for Common Subcutaneous Insulin Preparations
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 23.1 American Diabetes Association Diagnostic Criteria for Diabetes Mellitus
T - 23.2 Common Therapies for Type 2 Diabetes
Section 6. The Genitourinary System
24. Transurethral Resection of the Prostate and Geriatric Anesthesia
24. Transurethral Resection of the Prostate and Geriatric Anesthesia
Comparing M-TURP, B-TURP, and L-TURP
F - 24.1. The Decrease in Body Temperature during TURP is Related to the Temperature of the Irrigating Solution and to the Duration of Surgery
F - 24.2. The Blood Pressure, Heart Rate, and Absorption Rate of Radioactively Tagged Irrigation Solution during TURP
F - 24.3. Mean Changes in Thoracic Impedance, Cardiac Output, Alveolar-Arterial Oxygen Tension Difference, and Serum Sodium Level during TURP
F - 24.4. Metabolic Pathways of Glycine
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 24.1 Common Medications in the Perioperative Period with Potential Neurological Effects
25. Kidney Transplant
25. Kidney Transplant
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 25.1 Drug Treatment for Hyperkalemia
T - 25.2 Pharmacokinetics of Neuromuscular Blocking Agents in Normal Versus Anephric Patients
26. Robotic-Assisted Laparoscopic Surgery
26. Robotic-Assisted Laparoscopic Surgery
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 26.1 Influence of Physical Properties on the Diffusion of Gas through a Gas-Liquid Interface
T - 26.2 Differences Between Air and Carbon Dioxide Emboli
Section 7. The Reproductive System
27. Placenta Previa/Placenta Accreta Spectrum
27. Placenta Previa/Placenta Accreta Spectrum
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
28. Hypertensive Disorders of Pregnancy
28. Hypertensive Disorders of Pregnancy
F - 28.1. Endothelial Cell Dysfunction in Response to Unknown Factors May Cause a Hormonal Imbalance in Women with Pregnancy-Induced Hypertension
F - 28.2. The Loss of 5-Ht1 Receptors Prevents Stimulation of Angiotensin II Release
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 28.1 Changes that Imply Hypercoagulation in Preeclampsia
29. Breech Presentation, Fetal Distress, and Mitral Stenosis
29. Breech Presentation, Fetal Distress, and Mitral Stenosis
F - 29.1. Two-Dimensional Echocardiography of the Mitral Valve Showing Severe Mitral Stenosis with the Typical 'hockey-Stick' Appearance
F - 29.2. Fetal Heart Rate (FHR) Decelerations in Relation to the Time of Onset of Uterine Contractions (UCs)
F - 29.3. Checklist for Treatment of Last
F - 29.4. Algorithms for Management of Failed Tracheal Intubation in Obstetric Patients
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 29.1 World Health Organization (WHO) Risk Classification for Cardiovascular Disease in Pregnancy
T - 29.2 Revised Jones Criteria
T - 29.3 Apgar Scoring System
30. Appendectomy for a Pregnant Patient
30. Appendectomy for a Pregnant Patient
F - 30.1. Changes in Position and Direction of the Appendix during Pregnancy
F - 30.2. The Pregnant Uterus Compressing the Aorta and the Inferior Vena Cava (Aortocaval Compression) in Supine Position
F - 30.3. Pulmonary Volumes and Capacities during Pregnancy
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
Section 8. The Hematologic System
31. Hemophilia and Disorders of Coagulation
31. Hemophilia and Disorders of Coagulation
Acknowledgment
F - 31.1. Tracings of Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM)
F - 31.2. Schematic Diagram of the Procoagulant Phase of Coagulation Depicting the Cascade Sequence in Three Steps, Designated as the Intrinsic, Extrinsic, and Common Coagulation Pathways
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 31.1 Specific Factors Assessed by Different Coagulation Tests
T - 31.2 Interpretation of Thromboelastography (TEG)/Rotational Thromboelastometry (ROTEM) Parameters
T - 31.3 Von Willebrand Disease: Diagnosis, Classification, and Response to Desmopressin D-Arginine Vasopressin (DDAVP)
T - 31.4 The Prevalence of Hereditary Defects of the Hemostatic System
T - 31.5 Factor VIII Replacement Products
T - 31.6 Levels of Factor VIII Necessary for Hemostasis
32. Sickle Cell Disease
32. Sickle Cell Disease
F - 32.1. Pathogenesis of Sickle Cell Damage
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 32.1 Clinical Manifestations of Sickle Cell Disease
T - 32.2 Types of Sickle Cell Crises
Section 9. Eye, Ear, Nose, and Throat
33. Airway Trauma
33. Airway Trauma
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 33.1 Glasgow Coma Scores
34. Open-Eye Injury and Cataract Surgery
34. Open-Eye Injury and Cataract Surgery
Anesthesia for Cataract Surgery
F - 34.1. Sites of Formation, Circulation, and Drainage of Aqueous Humor
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
35. Laser Treatment for Laryngeal Lesions
35. Laser Treatment for Laryngeal Lesions
F - 35.1. Laryngoscopic View of Multiple Papillomata Surrounding the Vocal Cords and Obstructing the Airway
F - 35.2. Example of Laser Resistant Endotracheal Tubes (Etts)
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
Section 10. Pediatrics
36. Tracheoesophageal Fistula
36. Tracheoesophageal Fistula
F - 36.1. Gross Classification of Ea and Tef
Intraoperative Management
Pathophysiology and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
37. Congenital Diaphragmatic Hernia
37. Congenital Diaphragmatic Hernia
F - 37.1. Chest Radiograph of a Neonate with a Left Diaphragmatic Hernia
F - 37.2. Cdh Internal Abdominal View
F - 37.3. Potential Sites of Cdh
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
38. Tetralogy of Fallot
38. Tetralogy of Fallot
F - 38.1. A.uncorrected Tetralogy of Fallot with Pulmonary Stenosis (TOF/PS) Demonstrating Malalignment Ventricular Septal Defect (VSD) with Aortic Override, Valvular and Subvalvular (Dynamic) PS
F - 38.2. Illustration of TOF with Pulmonary Atresia Group 1 with Short Segment Pulmonary Artery (PA), Good-Sized Pas in Continuity Supplied by a Right-Sided Patent Ductus Arteriosus, and One Major Aortopulmonary Collateral Artery from the Left Subclavian Artery
F - 38.3. Illustration of TOF with Pulmonary Atresia Group 3 with No Main Pulmonary Artery (PA), Small Branch Pas in Continuity Supplied by Major Aortopulmonary Collateral Arteries (MAPCAs)
F - 38.4. Chamber Oxygen Saturations and Relative Flows for a Patient with Uncorrected Tetralogy of Fallot with Pulmonary Stenosis (TOF/PS)
F - 38.5. A.palliative Modified Blalock-Taussig Shunt (MBTS) for Tetralogy of Fallot with Pulmonary Stenosis (TOF/PS)
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
39. Transposition of the Great Arteries
39. Transposition of the Great Arteries
F - 39.1. Depiction of Saturations, Pressures, and Blood Flows in Complete Transposition of the Great Vessels with Intercirculatory Mixing at the Atrial Level and a Small Lvot Gradient
F - 39.2. Depiction of the Most Common Coronary Artery Patterns in Transposition of the Great Vessels
F - 39.3. The Differential Diagnosis of Transposition of the Great Arteries
F - 39.4. Details of the Arterial Switch Procedure
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 39.1 Clinical Subsets of Transposition of Great Arteries
T - 39.2 Major Differences Between Adult and Pediatric Cardiopulmonary Bypass
T - 39.3 Recommended Full Flow Rates for Pediatric Cardiopulmonary Bypass
40. Pyloric Stenosis
40. Pyloric Stenosis
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 40.1 Metabolic Findings in the Newborn Secondary to Pyloric Stenosis
T - 40.2 Estimation of the Degree of Dehydration in a Newborn
T - 40.3 Fluid Requirement to Replace Intraoperative Fluid Losses (Except Blood Loss) in the Newborn
T - 40.4 Innocent Murmurs of Childhood
T - 40.5 Comparative Anatomy of the Larynx and Trachea in the Newborn and the Adult
T - 40.6 Endotracheal Tube Size for Pediatric Patient
41. Inflammatory Airway Disease in Childhood: Laryngotracheobronchitis
41. Inflammatory Airway Disease in Childhood: Laryngotracheobronchitis
F - 41.1. An Emergency Cricothyrotomy May Be Performed by Passing a 14-Gauge Intravenous Catheter through the Cricothyroid Membrane into the Trachea
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 41.1 The Westley Croup Score
T - 41.2 Characteristics of Croup and Epiglottitis
42. Cleft Palate
42. Cleft Palate
F - 42.1. Various Degrees of Cleft Palate and Lip
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 42.1 Minimum Fasting Period (Hours) for Pediatric Patients
T - 42.2 Opioid Analgesics for Pediatric Patients
T - 42.3 Nonopioid Analgesics for Pediatric Patients
43. Congenital Heart Disease with a Cervical Mass in Infancy
43. Congenital Heart Disease with a Cervical Mass in Infancy
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
44. Patent Ductus Arteriosus and Prematurity
44. Patent Ductus Arteriosus and Prematurity
F - 44.1. A.anatomically, Atypical Patent Ductus Arteriosus (PDA) Arising Proximal to the Left Subclavian Artery (Sa).b.large Patent Ductus Arteriosus Sweeping into the Descending Aorta and Appearing to Be the Arch
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 44.1 Classification of Prematurity
T - 44.2 Neutral and Critical Temperature
T - 44.3 Normal Values of Arterial Blood Gases and pH in Pediatric Patients
T - 44.4 Normal Blood Pressure of Infants Weighing Between 1,000 and 4,000 G
45. Post-tonsillectomy Hemorrhage
45. Post-tonsillectomy Hemorrhage
F - 45.1. Blood Supply to the Lateral Oropharynx
F - 45.2. Stages of Tonsillectomy Healing
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 45.1 Pacu Discharge Criteria for the Pediatric (Under 13 Years of Age) Patient
Section 11. Pain Management and Neuraxial Blocks
46. Brachial Plexus Block
46. Brachial Plexus Block
F - 46.1. The Brachial Plexus
F - 46.2. Ultrasound Image of Interscalene Groove
F - 46.3. Ultrasound-Guided Interscalene Block
F - 46.4. Ultrasound-Guided Interscalene Block
F - 46.5. Ultrasound Image of the Supraclavicular Fossa
F - 46.6. Ultrasound-Guided Supraclavicular Block
F - 46.7. Ultrasound Image of the Infraclavicular Region Using a High-Frequency Linear Probe
F - 46.8. Ultrasound Image of the Axilla
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
47. Nerve Blocks of the Lower Extremity
47. Nerve Blocks of the Lower Extremity
F - 47.1. Lumbar Plexus
F - 47.10. Saphenous Nerve Block: View of the Lower Adductor Canal
F - 47.11. Sciatic Nerve Block, the Labat Approach
F - 47.12. Popliteal Fossa Block Showing Local Anesthetic Surrounding Nerves Distal to Nerve Bifurcation
F - 47.13. Popliteal Fossa Block Just Proximal to Bifurcation
F - 47.14. Ipack Blockscanning at the Level of the Femoral Condyles
F - 47.15. Ipack Injectionlocation of Ipack Injection Between the Popliteal Artery and the Femur, Proximal to the Femoral Condyles
F - 47.2. Sacral Plexus
F - 47.3. The Posterior Tibial Nerve Block
F - 47.4. The Deep Peroneal Nerve Block
F - 47.5. The Femoral Nerve Block, Lateral Femoral Cutaneous Nerve Block, and Obturator Nerve Block
F - 47.6. Perineural Femoral Nerve Block
F - 47.7. Fascia Iliacainfrainguinal Fascia Iliaca Block, Transverse Approach
F - 47.8. Suprainguinal Fascia Iliaca Block, Sagittal Approach
F - 47.9. Post-Periarterial Saphenous Nerve Injection in the Adductor Canal
Intraoperative Management
Postoperative Pain Management
Preoperative Evaluation
Preoperative Preparation
48. Complex Regional Pain Syndromes
48. Complex Regional Pain Syndromes
Complications
Medical Disease and Differential Diagnosis
Pain Management
T - 48.1 Physiochemical Properties of Commonly Used Local Anesthetics
T - 48.2 Cardiovascular Effects of Lidocaine
49. Cancer Pain
49. Cancer Pain
F - 49.1. World Health Organization-Advocated Stepladder Approach to Management of Cancer Pain
Invasive Therapy
Medical Disease and Differential Diagnosis
Nonpharmacologic Management
Pharmacologic Treatment of Pain
T - 49.1 Routes of Opioid Administration
T - 49.2 Opioids Used Orally or Parenterally to Treat Cancer Pain
50. Low Back Pain and Sciatica
50. Low Back Pain and Sciatica
F - 50.1. Transforaminal Epidural Steroid Injection at L5 and S1 Levels, Oblique View at 25 Degrees
F - 50.2. Transforaminal Epidural Steroid Injection at L5 and S1 Levels, Lateral View
F - 50.3. Transforaminal Epidural Steroid Injection at L5 and S1 Levels, Anterior-Posterior View (after Digital Subtraction Image Checking)
F - 50.4. Charite Disc
F - 50.5. Charite Disc Replacement at L4-L5
F - 50.6. L5-S1 ADR, Lateral Fluoroscopic View
F - 50.7. Anteroposterior Fluoroscopic View of Ard
F - 50.8. Interspinous Process Decompression System (X STOP)
F - 50.9. Interspinous Process Decompression System (X STOP)
Management of Low Back Pain and Sciatica
Medical Disease and Differential Diagnosis
T - 50.1 Differentiating Spinal Shock, Upper Motor Neuron Lesions, and Lower Motor Neuron Lesions
T - 50.2 Nerve Root Signs
51. Perioperative Pain Management
51. Perioperative Pain Management
Chronic Opioid Therapy and Perioperative Pain Management
F - 51.1. Epidural Analgesia Order Sheet
F - 51.2. PCA Adult Order Sheet
Perioperative Pain Management for Ambulatory Surgery
Perioperative Pain Management for Thoracotomy
T - 51.1 Consequences of Inadequate Pain Management after Ambulatory Surgery
The Role of an Acute Pain Service (APS)
52. Acupuncture
52. Acupuncture
Acupuncture as a Complementary Medical Therapy
Acupuncture for the Treatment of Chronic Conditions
Complications
F - 52.1. Auricular Acupuncture
F - 52.2. Li4 (He Gu,) Acupuncture Point is on the Dorsum of the Hand, Between the First and Second Metacarpal Bones, Radial to the Midpoint of the Second Metacarpal Bone
F - 52.3. The Pc6 (Nei Guan,) Acupuncture Point is Located 2 Cun (Tsun), Approximately 2.6 in., above the Transverse Crease of the Wrist, Between the Tendons of the Muscle Palmaris Longus and Muscle Flexor Capri Radialis
Section 12. Miscellaneous
53. Myasthenia Gravis
53. Myasthenia Gravis
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 53.1 Anticholinesterase Drugs Used to Treat Myasthenia Gravis (Dose in mg)
54. Malignant Hyperthermia
54. Malignant Hyperthermia
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
Suggested Resources
T - 54.1 Associated Musculoskeletal Disorders/Signs in Patients Susceptible to Malignant Hyperthermia
T - 54.2 The Laboratory Findings of Acute Malignant Hyperthermia
55. Postoperative Residual Neuromuscular Weakness and Prolonged Apnea
55. Postoperative Residual Neuromuscular Weakness and Prolonged Apnea
F - 55.1. Structure of Sugammadex, a Synthetic -Cyclodextrin
F - 55.2. X-Ray Crystal Structure of Sugammadex (Green) and Rocuronium (Blue) with Encapsulation of a Rocuronium Molecule by a Sugammadex Molecule at 1:1 Ratio
Intraoperative Management
Medical Diseases and Differential Diagnosis
Postoperative Management
T - 55.1 Relation Between Dibucaine Number and Duration of Succinylcholine Neuromuscular Blockade
T - 55.2 Characteristics of Commonly Used Muscle Relaxants
56. Burns
56. Burns
F - 56.1. The Rule of Nines for Determining the Percentage of Body Surface Area Burned in Adults
F - 56.2. Diagram and Table for Determining the Percentage of Body Surface Area Burned in Children
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 56.1 Classification of Burn Depth
T - 56.2 Fluid Resuscitation for Adults with Major Burns
T - 56.3 The Metabolism, Elimination, and Histamine Release of Muscle Relaxants
57. Trauma
57. Trauma
F - 57.1. Basic ROTEM[r] Image
F - 57.10. A Guideline for Transfusion Based on TEG Results
F - 57.2. ROTEM[r] in a Patient with Normal Coagulation Parameters
F - 57.3. ROTEM[r] in a Patient with a Platelet Deficiency
F - 57.4. ROTEM[r] in a Patient with a Fibrinogen Deficiency
F - 57.5. ROTEM[r] in a Patient with Hyperfibrinolysis
F - 57.6. ROTEM[r] in a Patient with Heparin Influence
F - 57.7. Guide to Therapy Based on ROTEM[r] Results
F - 57.8. Basic TEG Image
F - 57.9. Effects of Different Coagulation States on TEG Results
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 57.1 Thromboelastography (TEG) Values Compared to Their Rotation Thromboelastometry (ROTEM®) Equivalents
58. Scoliosis
58. Scoliosis
F - 58.1. In Addition to Producing a Lateral Deformity of the Spine, Scoliosis also Results in Rotation of the Vertebral Bodies and Significant Rib Cage Deformity
F - 58.10. Proper Arm Position and Improper Arm Position during Scoliosis Surgery
F - 58.11. Proper and Improper Positioning on the Four-Poster Frame during Spine Surgery
F - 58.12. Example of Tea-Colored Urine Secondary to Rhabdomyolysis
F - 58.2. A Computed Tomography Scan of the Thorax Demonstrating Significant Loss of Lung Volume Resulting from the Rib Cage Deformity
F - 58.3. Measurement of the Curve in Scoliosis Using Cobb Angle
F - 58.4. Relation Between Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1), and Size of the Curve in 20 Patients with Thoracic Scoliosis
F - 58.5. Example of a Positioning Used on a Traction Table for Full Body Casting of Infantile Scoliosis
F - 58.6. Outline of Pathways Involved in Somatosensory Evoked Potential (Ssep) and Motor Evoked Potential (Mep) Monitoring
F - 58.7. Typical Ssep Trace
F - 58.8. This Horseshoe-Type Headrest Has Been Associated with Unilateral Eye Blindness Resulting from Pressure on the Eye during Surgery
F - 58.9. Foam Face Rest with Mirror
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
59. Hypoxia and Equipment Failure
59. Hypoxia and Equipment Failure
F - 59.1. Phases of the Normal Capnogram
F - 59.2. Abnormal Capnograms
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 59.1 Preanesthesia Equipment Checkout Procedures
T - 59.2 Differential Diagnosis of Low Spo2 Reading
T - 59.3 Differential Diagnosis of Pulmonary Edema
T - 59.4 Diagnostic Criteria for Acute Respiratory Distress Syndrome
60. Electroconvulsive Therapy
60. Electroconvulsive Therapy
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 60.1 Mechanism of Action of Electroconvulsive Therapyphysiologic Theories
T - 60.2 The Most Common Side Effects and Anesthetic Interactions of Psychiatric Medications
61. Ambulatory Surgery
61. Ambulatory Surgery
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
62. Magnetic Resonance Imaging
62. Magnetic Resonance Imaging
F - 62.1. The MRI Suite Should Be Separated into Four Zones
F - 62.2. The Anesthesiologist is Watching the Patient (in Zone IV) and Anesthesia Monitors in Zone III Control Room during MRI Scan
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
63. Morbid Obesity, Obstructive Sleep Apnea, and Bariatric Anesthesia
63. Morbid Obesity, Obstructive Sleep Apnea, and Bariatric Anesthesia
Intraoperative Management
Medical Disease and Differential Diagnosis
Postoperative Management
Preoperative Evaluation and Preparation
T - 63.1 Weight-Based Dosing Scalar Recommendation for Commonly Used Intravenous Anesthetics
Front Matter
Acknowledgments
Contributors
Preface
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