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Clinical Anesthesia Procedures of the Massachusetts General Hospital Handbook
Non-operating room anesthesia (NORA)
Table of Contents
Free Topics
[beta]-Adrenergic antagonists
Abdominal Aortic Repair
About
Acetaminophen
Adult Resuscitation
Anatomy and Physiology
Anesthesia for Ophthalmic Surgery
Anesthesia for Otorhinolaryngologic Procedures
Anticoagulation and Neuraxial Blockade
Body Temperature Changes
Calculator - MELD Score
Calculator - Modified Child-Pugh Score
Commonly Used Drugs
Complications of Blood Transfusion Therapy
Day of Surgery Premedication
Flowchart - American Society of Anesthesiologists (ASA) difficult Airway Algorithm
Flowchart - Stepwise Approach to Perioperative Cardiac Assessment for CAD from the Latest ACC/AHA Guidelines
General Assessment
Hemodynamic and Cardiovascular Complications
Hyperthermia
Induction
Laboratory Studies
Major Burn Injuries
Neonatal Resuscitation
Neuromuscular Blockade
Patient Discussion
Pediatric Resuscitation
Perioperative Coagulopathy
Pharmacotherapy
Preanesthetic Considerations
Preoperative Assessment and Management
Preoperative Cardiovascular Evaluation for Noncardiac Surgery
Preoperative Medical Optimization
Principles of Pain Management
Pulmonary Resection
Regional Anesthesia of the Lower Extremity
Spinal Anesthesia
Treatment of Acute Pain in the Perioperative Setting
Vasodilators
Part I. Evaluating the Patient Before Anesthesia
1. Evaluating the Patient Before Anesthesia
Anesthetic Assessment and Plan
Day of Surgery Premedication
Delaying Surgical Procedures
Ethical Considerations in Patient Care
History
Informed Consent
Introduction
Laboratory Studies
Patient Discussion
Preoperative Medical Optimization
Review of Systems
Suggested Readings
The Physical Examination
2. Basics of Echocardiography
Conclusion
Echocardiographic Assessment
Hemodynamic Measurements and Fluid Responsiveness
Introduction
Suggested Readings
Transesophageal Image Acquisition
Transthoracic Image Acquisition
3. Specific Considerations With Cardiac Disease
Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators
Cardiac Transplant Patient
Congenital Heart Disease
Congestive Heart Failure
Coronary Anatomy
General Considerations
Hypertrophic Cardiomyopathy
Ischemic Heart Disease
Preanesthetic Considerations
Preoperative Cardiovascular Evaluation for Noncardiac Surgery
Suggested Readings
Valvular Heart Disease
4. Specific Considerations With Pulmonary Disease
Acute Respiratory Distress Syndrome
Asthma
Chronic Obstructive Pulmonary Disease
Obesity
Overview
Pulmonary Function
Suggested Readings
5. Specific Considerations With Renal Disease
Anesthetic Management
Future Considerations for Identification of Patients at Risk of Perioperative AKI
General Considerations
Pharmacology and Renal Failure
Pharmacology and the Kidney
Physiology
Renal Failure
Suggested Readings
6. Specific Considerations With Liver Disease
Anesthesia in Patients With Liver Disease
Hepatic Anatomy
Hepatic Function
Liver Disease
Metabolism of Anesthetics
Postoperative Liver Dysfunction
Suggested Readings
Surgical Risk in Patients With Liver Disease
7. Specific Considerations With Endocrine Disease
Adrenal Cortical Disease
Adrenal Medullary Disease
Calcium Metabolism and Parathyroid Disease
Carcinoid
Diabetes Mellitus
Hypoglycemia
Pituitary Disease
Suggested Readings
Thyroid Disease
8. Infectious Diseases and Infection Control in Anesthesia
Immunocompromised Patients
Infection Control in the OR
Introduction
Occupational Exposure to Infectious Disease
Pathogenic Organisms of Anesthetic Concern
Perioperative Antibiotics
Suggested Readings
Part II. Administration of Anesthesia
10. The Anesthesia Machine
Anesthesia Machine Checkout Recommendations
Anesthesia Ventilators
Breathing Systems
Emergency Equipment
Gas Analysis
Overview
Safety Features
Scavenging
Suggested Readings
The Gas Delivery System
11. Administration of General Anesthesia
Airway Management
Emergence and Extubation
Indications
Induction of Anesthesia
Intraoperative Adverse Effects Related to General Anesthesia and Management
Introduction
Maintenance of Anesthesia
Postoperative Adverse Effects Related to General Anesthesia
Pre-op Evaluation and Planning
Suggested Readings
Transport and Disposition
12. Intravenous and Inhalation Anesthetics
Pharmacology of Inhalation Anesthetics
Pharmacology of Intravenous Anesthetics
Suggested Readings
13. Airway Evaluation and Management
Applied Anatomy
Endotracheal Intubation
Evaluation
Laryngeal Mask Airway
Mask Airway
Special Considerations
Suggested Readings
The Difficult Airway and Emergency Airway Techniques
14. Neuromuscular Blockade
Disorders That Influence the Response to NMBDs
Effects of NMB
General Pharmacology
Introduction
Monitoring of Neuromuscular Function
Neuromuscular Blockade
Neuromuscular Junction
Reversal of NMB
Suggested Readings
15. Monitoring
Cardiovascular System
CVP and Cardiac Output
Respiratory System
Standard Monitoring
Suggested Readings
Temperature Monitoring
16. Monitoring Anesthetic Brain States
Age-Related Changes in Anesthetic-Induced EEG Signatures
Clinical Monitoring of Anesthetic States
Conclusion
Effects of Different Anesthetics on the Brain
Electroencephalogram-Based Indices of Level of Consciousness
End-Tidal Anesthetic Concentration
General Considerations
Suggested Readings
The Spectral Analysis of the EEG
17. Intra-anesthetic Problems
Abnormal Urine Output
Anaphylactic and Anaphylactoid Reactions
Aspiration
Bronchospasm
Cardiac Tamponade
Diaphoresis (Sweating)
Dysrhythmias
Equipment Malfunctions
Fire and Electrical Hazards in the Operating Room
Hypercarbia
Hypertension
Hyperthermia
Hypotension
Hypothermia
Hypoxemia
Laryngospasm
Malignant Hyperthermia
Myocardial Ischemia
Pneumothorax
Pulmonary Embolism
Suggested Readings
18. Perioperative Hemodynamic Control
Adrenergic Agonists
Adrenergic Receptor Physiology
Autoregulation
Beta-Adrenergic Antagonists
Blood Pressure
Controlled Hypotension
Drug Dosage Calculations
Nonadrenergic Agents
Suggested Readings
Vasodilators
19. Local Anesthetics
Clinical Uses of Local Anesthetics
General Principles
Novel Developments
Suggested Readings
Toxicity
20. Spinal, Epidural, and Caudal Anesthesia
Anticoagulation and Neuraxial Blockade
Caudal Anesthesia
Combined Spinal-Epidural Anesthesia
Contraindications to Neuraxial Anesthesia
Epidural Anesthesia
General Considerations
Segmental Level Required for Surgery
Spinal Anesthesia
Suggested Readings
21. Regional Anesthesia
Abbreviations
Acknowledgments
Complications Common to All Nerve Blocks
Equipment
General Considerations
General Contraindications
Nerve Localization Techniques
Regional Anesthesia of the Lower Extremity
Regional Anesthesia of the Neck
Regional Anesthesia of the Trunk
Regional Anesthesia of the Upper Extremity
Suggested Readings
22. Anesthesia for Orthopedic Surgery
Anesthesia for Elbow, Arm, and Hand Surgery
Anesthesia for Foot and Ankle Surgery
Anesthesia for Orthopedic Oncology
Anesthesia for Orthopedic Trauma
Anesthesia for Shoulder Surgery
Anesthesia for Spine Surgery
Anesthesia for Total Hip and Knee Arthroplasty
General Consideration
Suggested Readings
23. Anesthesia for Neurosurgery
Electrophysiologic Monitoring
Intraoperative Management
Pharmacology
Physiology
Preoperative Considerations for Neurosurgical Procedures
Specific Neurosurgical Procedures
Suggested Readings
Surgery on the Spine and Spinal Cord
24. Anesthesia for Spine Surgery
Blood Loss
Disposition
Introduction
Postoperative Pain Management
Spinal Cord Perfusion
Suggested Readings
25. Anesthesia for Transplant Surgery
Anesthesia for Kidney Transplantation
Anesthesia for Liver Transplantation
Anesthesia for Organ Procurement
Anesthesia for Pancreas Transplantation
History and Ethical Considerations
Suggested Readings
26. Anesthesia for Abdominal Surgery
Anesthetic Considerations for Specific Abdominal Procedures
Anesthetic Techniques
Management of Anesthesia
Preanesthetic Considerations
Suggested Readings
27. Anesthesia for Thoracic Surgery
Bronchopleural Fistula
Endoscopic Procedures
Esophageal Surgery
Intrapulmonary Hemorrhage
Mediastinal Operations
Monitoring
Preoperative Evaluation
Preoperative Preparation
Pulmonary Resection
Suggested Readings
Tracheal Resection and Reconstruction
28. Anesthesia for Vascular Surgery
Abdominal Aortic Repair
Amputations
Carotid Revascularization
Peripheral Arterial Surgery
Preoperative Assessment and Management
Suggested Readings
Thoracoabdominal Aortic Aneurysm Repair
29. Anesthesia for Cardiac Surgery
Anesthesia for Off-Site Cardiac Procedures
Anesthetic Management
Cardiopulmonary Bypass
Induction
Other Cardiac Procedures
Pediatric Cardiac Anesthesia
Postoperative Care
Preoperative Assessment for Cardiac Surgery
Suggested Readings
30. Anesthesia for Head and Neck Surgery
Anesthesia for Dentistry and Oral and Maxillofacial Surgery
Anesthesia for Ophthalmic Surgery
Anesthesia for Otorhinolaryngologic Procedures
Anesthesia for Procedures of the Neck
Suggested Readings
31. Anesthesia for Urologic Surgery
Anesthesia for Specific Urologic Procedures
Lithotripsy
Patients With Spinal Cord Pathology
Suggested Readings
32. Anesthesia for Obstetrics and Gynecology
Amniotic Fluid Embolism
Analgesia for Labor and Vaginal Delivery
Anesthesia for Cesarean Delivery
Anesthesia for Gynecologic Surgery
Anesthesia for Nonobstetric Surgery During Pregnancy
Anesthesia for Oocyte Retrieval
CPR During Pregnancy
Labor and Delivery
Maternal Physiology in Pregnancy
Medications Commonly Used for Labor and Delivery
Peripartum Hemorrhage
Placental Transfer of Drugs
Preeclampsia
Suggested Readings
33. Anesthesia for Pediatric Surgery and Care of the Neonate
Analgesia
Anatomy and Physiology
Common Neonatal Problems Pertinent to Anesthesia
Development
Emergence and Post-anesthesia Care
Endotracheal Intubation
Fluid Management
General Assessment
Induction Techniques
Periprocedural Considerations and Fasting Guidelines
Pharmacotherapy
Preparation of the OR
Specific Pediatric Anesthesia Problems
Suggested Readings
The Preanesthetic Visit
34. Non-Operating Room Anesthesia
Anesthesia for CT-Guided Thermal Ablations
Anesthesia for Diagnostic Radiology
Anesthesia for Electroconvulsive Therapy
Anesthesia for Gastrointestinal Procedures
Anesthesia for Gastrointestinal/Genitourinary and Vascular Radiology Procedures
Anesthesia for Neurointerventions
Anesthesia for Proton Beam Therapy and Radiation Therapy
Anesthesia Techniques
Contrast Media
General Considerations
Suggested Readings
35. Anesthesia for Trauma and Burns
Initial Evaluation of the Trauma Patient
Major Burn Injuries
Specific Injuries
Suggested Readings
The Pediatric Trauma Patient
The Pregnant Trauma Patient
36. Transfusion Therapy
Acknowledgment
Blood Component Therapy
Blood Typing and Cross-Matching
Coagulation Studies
Complications of Blood Transfusion Therapy
Conservation and Salvage Techniques
Perioperative Coagulopathy
Pharmacologic Therapy
Plasma Substitutes
Special Considerations
Suggested Readings
The Decision to Transfuse
9. Safety in Anesthesia
General Safety Strategies
Overview of Safety in Anesthesia
Quality Assurance and Safety Improvement Programs
Standards for Safe Anesthesia Care
Suggested Readings
Types of Errors
Part III. Perioperative Issues
37. The Post-anesthesia Care Unit
Admission to the PACU
Body Temperature Changes
Considerations for Pediatric Recovery
Criteria for Discharge
Critical Care in the Post-anesthesia Recovery Unit
Effects of Anesthetics and Sedatives
Enhanced Recovery After Surgery
General Complications
General Considerations
Hemodynamic and Cardiovascular Complications
Monitoring
Neurologic Complications
Postoperative Nausea and Vomiting
Principles of Pain Management
Recovery From Regional and Neuraxial Anesthesia
Renal Complications
Respiratory and Airway Complications
Suggested Readings
38. Pain Management
Complementary and Alternative Medicine in Pain Management
Definition and Terminology
Suggested Readings
Treatment of Acute Pain in the Perioperative Setting
39. Adult, Pediatric, and Newborn Resuscitation
Adult Resuscitation
Cardiac Arrest
Neonatal Resuscitation
Overview
Pediatric Resuscitation
Suggested Readings
40. Vascular Access
Applied Vascular Anatomy
Common Issues and Troubleshooting
Overview
Principles of Image-Guided Vascular Access
Suggested Readings
Vascular Access Devices
Appendices
I. Drugs With Narrow Therapeutic Ranges and Potential for Harm
II. Commonly Used Drugs
III. Common Intravenous Antibiotics
Front Matter
Preface
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