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Clinical Anesthesia
Mechanisms of Anesthesia and Consciousness
Table of Contents
Free Topics
A Burning ET Tube with a High Concentration of O2 or O2/N2O Will Exhibit a “blowtorch” Effect
A Capacitor Consists of Two Parallel Conductors Separated by an Insulator
A Safety Feature of the Isolated Power System is Illustrated
Flowchart - Adult Bradycardia (With Pulse) Algorithm - Flowchart
Flowchart - Adult Tachycardia (With Pulse) Algorithm - Flowchart
Inside a Fuse Box with the Circuit Breakers Removed
John Snow's Inhaler (1847)
Maintenance of Certification in Anesthesiology
Modern Electrical Outlet in Which the Ground Wire is Present
Morton's Ether Inhaler (1846)
Prevention of Occupationally Acquired Infections
The Capacitance that Exists in Alternating Current (AC) Power Lines and AC-Operated Equipment Results in Small “leakage Currents” that Partially Degrade the Isolated Power System
The Current Standard for Patient Lead Wires (Top) Requires a Female Connector
The Most Common Injuries Leading to Anesthesia Malpractice Claims in the Year 2000 or Later
The Rabbit Head-Drop Assay
When a Faulty Piece of Equipment Without an Equipment Ground Wire is Plugged into an Electrical Outlet Not Containing a Ground Wire, the Case of the Instrument Will Become Hot
1: Introduction and Overview
1. The History of Anesthesia
1. The History of Anesthesia
Academic Anesthesia - Professionalism and Anesthesia Practice
Advanced Airway Devices - Anesthesia Principles, Equipment, and Standards
Almost Discovery: Hickman, Clarke, Long, and Wells - Anesthesia Before Ether
Alternative Circuits - Anesthesia Principles, Equipment, and Standards
Anesthesia Before Ether
Anesthesia Principles, Equipment, and Standards
Anesthesia Subspecialties
Carbon Dioxide Absorption - Anesthesia Principles, Equipment, and Standards
Cardiovascular Anesthesia - Anesthesia Subspecialties
Chloroform and Obstetrics - Anesthesia Before Ether
Conclusions
Control of the Airway - Anesthesia Principles, Equipment, and Standards
Early Analgesics and Soporifics - Anesthesia Before Ether
Early Anesthesia Delivery Systems - Anesthesia Principles, Equipment, and Standards
Electrocardiography, Pulse Oximetry, and Capnography - Anesthesia Principles, Equipment, and Standards
Establishing a Society - Professionalism and Anesthesia Practice
F - 1. Morton's Ether Inhaler (1846)
F - 2. The âdunked Dog.â
F - 3. John Snow's Inhaler (1847)
F - 4. Waters' Carbon Dioxide Absorbance Canister
F - 5. The Rabbit Head-Drop Assay
Flowmeters - Anesthesia Principles, Equipment, and Standards
Inhaled Anesthetics - Anesthesia Before Ether
Neuroanesthesia - Anesthesia Subspecialties
Obstetric Anesthesia - Anesthesia Subspecialties
Organized Anesthesiology - Professionalism and Anesthesia Practice
Patient Monitors - Anesthesia Principles, Equipment, and Standards
Physical and Psychological Anesthesia - Anesthesia Before Ether
Professionalism and Anesthesia Practice
Public Demonstration of Ether Anesthesia - Anesthesia Before Ether
References
Regional Anesthesia - Anesthesia Subspecialties
Safety Standards - Anesthesia Principles, Equipment, and Standards
T - 1. Events in the Development of Muscle Relaxants
The History of Anesthetic Agents and Adjuvants
The History of Anesthetic Agents and Adjuvants - Antiemetics
The History of Anesthetic Agents and Adjuvants - Inhaled Anesthetics
The History of Anesthetic Agents and Adjuvants - Intravenous Anesthetics
The History of Anesthetic Agents and Adjuvants - Local Anesthetics
The History of Anesthetic Agents and Adjuvants - Muscle Relaxants
The History of Anesthetic Agents and Adjuvants - Opioids
Tracheal Intubation - Anesthesia Principles, Equipment, and Standards
Transfusion Medicine - Anesthesia Subspecialties
Vaporizers - Anesthesia Principles, Equipment, and Standards
Ventilators - Anesthesia Principles, Equipment, and Standards
2. Scope of Practice
2. Scope of Practice
Accountable Care Organizations - Practice Essentials
Administrative Components of Anesthesiology Practice
Anesthesia Equipment and Equipment Maintenance - Administrative Components of Anesthesiology Practice
Anesthesiology Personnel Issues - Operating Room Management
Antitrust Considerations - Practice Essentials
Billing and Collecting - Practice Essentials
Bundled Payment Model - Changing Anesthesiology Practice
Changing Anesthesiology Practice
Conclusion
Cost and Quality Issues
Electronic Medical (âHealthâ) Records - Practice Essentials
Establishing Standards of Practice and Understanding the Standard of Care - Administrative Components of Anesthesiology Practice
Evolving Practice Arrangements - Practice Essentials
Exclusive Service Contracts - Practice Essentials
Expansion into Perioperative Medicine and Hospital Care - Practice Essentials
F - 1. Elements of the Perioperative Surgical Home Model
Further Issues - Changing Anesthesiology Practice
Health Insurance Portability and Accountability Act - Practice Essentials
Hospital Subsidies - Practice Essentials
Large Group Practices: Anesthesia and Multispecialty - Changing Anesthesiology Practice
Maintenance of Certification in Anesthesiology - Administrative Components of Anesthesiology Practice
Malpractice Insurance - Administrative Components of Anesthesiology Practice
Management Intricacies - Practice Essentials
Meetings and Case Discussion - Administrative Components of Anesthesiology Practice
Operating Room Management
Operational and Information Resources - Administrative Components of Anesthesiology Practice
Organization - Operating Room Management
Policy and Procedure - Administrative Components of Anesthesiology Practice
Practice Essentials
Practice Model for Anesthesiologists: The Perioperative Surgical Home - Changing Anesthesiology Practice
Practice Model Involving Anesthesiologists: The Service Line - Changing Anesthesiology Practice
Professional Staff Participation and Relationships - Administrative Components of Anesthesiology Practice
References
Response to an Adverse Event - Administrative Components of Anesthesiology Practice
Scheduling Cases - Operating Room Management
Support Staff - Administrative Components of Anesthesiology Practice
T - 1. Types of Data an Anesthesiology Group Should Track and Maintain Concerning Its Own Practice
The âJob Marketâ for Anesthesia Professionals - Practice Essentials
The Credentialing Process and Clinical Privileges - Administrative Components of Anesthesiology Practice
Types of Practice - Practice Essentials
3. Occupational Health
3. Occupational Health
Allergic Reactions - Physical Hazards
Burnout - Emotional Considerations
Chemicals - Physical Hazards
Conclusion
DNA Viruses - Infectious Hazards
Emotional Considerations
Enteric Infections - Infectious Hazards
Ergonomics/Human Factors - Physical Hazards
F - 1. Clinical Course and Serologic Profiles of Acute and Chronic Hepatitis B
F - 2. Demonstration of a Similar Reduction in All-Cause Mortality from Longer Periods of Moderate Physical Activity When Compared to Shorter Periods of Vigorous Activity
Impact of Adverse Events - Emotional Considerations
Impairment and Disability - Emotional Considerations
Implementing Lifestyle Interventions for Lifestyle-Related Diseases - Wellness
Infectious Hazards
Measles (Rubeola) - Infectious Hazards
Mindfulness - Wellness
Mortality among Anesthesiologists - Emotional Considerations
Noise Pollution - Physical Hazards
Nutrition, Diet, and Fitness - Wellness
OSHA Standards, Standard Precautions, and Transmission-based Precautions - Infectious Hazards
Pathogenic Human Retroviruses - Infectious Hazards
Physical Hazards
Prion Diseases - Infectious Hazards
Radiation - Physical Hazards
References
Respiratory Viruses - Infectious Hazards
Rubella - Infectious Hazards
Stress - Emotional Considerations
Substance Use, Abuse, and Addiction - Emotional Considerations
Suicide - Emotional Considerations
T - 1. Sources of Operating Room Contamination
T - 2. Types of Reactions to Latex Gloves
T - 3. Comparative Noise Levels
T - 4. Standard Precautions
T - 5. Ebola Precautions
T - 6. Prevention of Occupationally Acquired Infections
T - 7. Risk of Occupational Infection with Blood-Borne Pathogens
T - 8. Signs of Substance Abuse and Dependence
The Aging Anesthesiologist - Emotional Considerations
Tuberculosis - Infectious Hazards
Viral Hepatitis - Infectious Hazards
Viruses in Smoke Plumes - Infectious Hazards
Waste Anesthetic Gases - Physical Hazards
Wellness
Work Hours, Night Call, and Fatigue - Physical Hazards
4. Anesthetic Risk, Quality Improvement, and Liability
4. Anesthetic Risk, Quality Improvement, and Liability
Acknowledgments
Alternative Payment Models and Pay for Performance - Quality Improvement and Patient Safety in Anesthesia
Anesthesia Risk
Causes of Anesthesia-related Lawsuits - Professional Liability
Difficulty of Outcome Measurement in Anesthesia - Quality Improvement and Patient Safety in Anesthesia
F - 1. Types of Anesthesia Care in Malpractice Claims in the Year 2000 or Later
F - 2. The Most Common Injuries Leading to Anesthesia Malpractice Claims in the Year 2000 or Later
Joint Commission Requirements for Quality Improvement - Quality Improvement and Patient Safety in Anesthesia
Mortality and Major Morbidity Related to Anesthesia - Anesthesia Risk
National Practitioner Data Bank - Anesthesia Risk
Professional Liability
Quality Improvement and Patient Safety in Anesthesia
References
Risk Management - Anesthesia Risk
Structure, Process, and Outcome: The Building Blocks of Quality - Quality Improvement and Patient Safety in Anesthesia
T - 1. Estimates of Anesthesia-related Death
T - 2. Rates of Selected Anesthesia Complications
T - 3. World Health Organization Surgical Safety Checklist Elements
The Tort System - Professional Liability
What to Do When Sued - Professional Liability
5. Electrical and Fire Safety
5. Electrical and Fire Safety
Alternating and Direct Currents - Electrical Shock Hazards
Capacitance - Principles of Electricity
Conductive Flooring - Electrosurgery
Construction of New Operating Rooms
Direct and Alternating Currents - Principles of Electricity
Double Insulation
Electrical Power: Grounded
Electrical Power: Ungrounded
Electrical Shock Hazards
Electromagnetic Interference
Electrosurgery
Environmental Hazards
F - 1. A Capacitor Consists of Two Parallel Conductors Separated by an Insulator
F - 10. Modern Electrical Cable in Which a Third, or Ground Wire Has Been Added
F - 11. Modern Electrical Outlet in Which the Ground Wire is Present
F - 12. Detail of Modern Electrical Power Receptacle
F - 13. The Ground Wires (Bare Wires) from the Power Outlet are Run to the Neutral Bus Bar, Where They are Connected with the Neutral Wires (White Wires) (Arrowheads)
F - 14. Diagram of a House with Older Style Wiring that Does Not Contain a Ground Wire
F - 15. Diagram of a House with Modern Wiring in Which the Third, or Ground, Wire Has Been Added
F - 16. A Simple Light Bulb Circuit in Which the Hot (Black) and Neutral (White) Wires are Connected with the Corresponding Wires from the Light Bulb Fixture
F - 17. When a Faulty Piece of Equipment Without an Equipment Ground Wire is Plugged into an Electrical Outlet Not Containing a Ground Wire, the Case of the Instrument Will Become Hot
F - 18. When a Faulty Piece of Equipment Containing an Equipment Ground Wire is Properly Connected to an Electrical Outlet with a Grounding Connection, the Current (Dashed Line) Will Preferentially Flow Down the Low-Resistance Ground Wire
F - 19. Right: a âcheater Plugâ that Converts a Three-Prong Power Cord to a Two-Prong Cord.Left: The Wire Attached to the Cheater Plug is Rarely Connected to the Screw in the Middle of the Outlet
F - 2. Sine Wave Flow of Electrons in a 60-Hz AC
F - 20. Isolated Power Panel Showing Circuit Breakers, LIM, and Isolation Transformer (Arrow).B: Detail of an Isolation Transformer with the Attached Warning Lights
F - 21. In the OR, the Isolation Transformer Converts the Grounded Power on the Primary Side to an Ungrounded Power System on the Secondary Side of the Transformer
F - 22. Detail of the Inside of a Circuit Breaker Box in an Isolated Power System
F - 23. A Safety Feature of the Isolated Power System is Illustrated
F - 24. A Faulty Piece of Equipment Plugged into the Isolated Power System Does Not Present a Shock Hazard
F - 25. The Capacitance that Exists in Alternating Current (AC) Power Lines and AC-Operated Equipment Results in Small âleakage Currentsâ that Partially Degrade the Isolated Power System
F - 26. The Meter of the LIM is Calibrated in Milliamperes
F - 27. When a Faulty Piece of Equipment is Plugged into the Isolated Power System, It Will Markedly Decrease the Impedance from Line 1 or Line 2 to Ground
F - 28. A GFCI Electrical Outlet with Integrated Test (Black) and Reset (Red) Buttons
F - 29. Special GFCI Circuit Breaker
F - 3. A Typical AC Circuit Where There is a Potential Difference of 120 V Between the Hot and Neutral Sides of the Circuit
F - 30. The Electrically Susceptible Patient is Protected from Microshock by the Presence of an Intact Equipment Ground Wire
F - 31. A Broken Equipment Ground Wire Results in a Significant Hazard to the Electrically Susceptible Patient
F - 32. A Hospital-Grade Plug that Can Be Visually Inspected
F - 33. A Properly Applied Electrosurgical Unit (ESU) Return Plate
F - 34. An Improperly Applied Electrosurgical Unit (ESU) Return Plate
F - 35. The Current Standard for Patient Lead Wires (Top) Requires a Female Connector
F - 36. The Fire Triangle
F - 37. A Burning ET Tube with a High Concentration of O2 or O2/N2O Will Exhibit a âblowtorchâ Effect
F - 38. Laserflex Laser Resistant ET Tube
F - 39. Lasertubus Laser Resistant ET Tube
F - 4. An Individual Can Complete an Electric Circuit and Receive a Shock by Coming in Contact with the Hot Side of the Circuit (Point A)
F - 40. A Nasal Cannula Connected to the Alternate Fresh Gas Outlet (Arrow) on a GE-Datex-Ohmeda Aestiva Anesthesia Machine
F - 41. Simulation of Fire Caused by ESU Electrode During Surgery
F - 42. A Demonstration of the Intense Heat and Flame that is Present in an Alcohol Fire
F - 43. The Figure Shows the CO (2) Fire Protection Device
F - 44. The CO (2) Fire Protection Device with White Smoke Exiting the Device (Simulating Carbon Dioxide Flow) and Surrounding the ESU Pencil Tip
F - 5. A 60-W Light Bulb Has an Internal Resistance of 240 ohms and Draws 0.5 A of Current
F - 6. In a Neutral Grounded Power System, the Electric Company Supplies Two Lines to the Typical Home
F - 7. Inside a Fuse Box with the Circuit Breakers Removed
F - 8. The Arrowhead Indicates the Ground Wire from the Circuit Breaker Box Attached to a Cold-Water Pipe
F - 9. An Older Style Electrical Outlet Consisting of Just Two Wires (a Hot and a Neutral)
Fire Safety
Ground Fault Circuit Interrupter
Grounding - Electrical Shock Hazards
Impedance - Principles of Electricity
Inductance - Principles of Electricity
Microshock
Principles of Electricity
References
Source of Shocks - Electrical Shock Hazards
T - 1. Effects of 60-Hz Current on an Average Human for a 1-Second Contact
T - 2. Differences Between Power and Equipment Grounding in the Home and the Operating Room
T - 3. Recommendations for The Prevention and Management of Operating Room Fires
T - 4. Fuel Sources Commonly Found in the Operating Room
The Line Isolation Monitor
2: Basic Science and Fundamentals
10. Mechanisms of Anesthesia and Consciousness
10. Mechanisms of Anesthesia and Consciousness
Acknowledgments
Amnesia - Where in the Central Nervous System Do Anesthetics Work?
Anesthetic Actions on Ion Channels
Anesthetic Effects on Ligand-gated Ion Channels - Anesthetic Actions on Ion Channels
Anesthetic Effects on Voltage-dependent Ion Channels - Anesthetic Actions on Ion Channels
Autonomic Control - Where in the Central Nervous System Do Anesthetics Work?
Conclusions
Evidence for Anesthetic Binding to Proteins - What is the Chemical Nature of Anesthetic Target Sites?
Exceptions to the Meyer-Overton Rule - What is the Chemical Nature of Anesthetic Target Sites?
F - 1. The Meyer-overton Rule
F - 2. Enflurane Potentiates the Ability of GABA (-Aminobutyric Acid) to Activate a Chloride Current in Cultured Rat Hippocampal Cells
F - 3. Volatile Anesthetics Activate Background K[+] Channels
F - 4. Nitrous Oxide Inhibits NMDA-Elicited, but Not GABA-Elicited Currents in Rat Hippocampal Neurons
F - 5. The Effects of Halothane (Hal), Enflurane (Enf), and Fluorothyl (HFE) on GABA-Activated Chloride Currents in Dissociated Rat CNS Neurons
F - 6. Mutations in the [Ã](2) and [Ã](3) Subunits of the GABA (A) Receptor Reduce Sensitivity to Etomidate and Propofol
F - 7. Diagram of Subcortical Arousal Circuitry Implicated in Anesthetic-Induced Unconsciousness
F - 8. A Multisite Model for Anesthesia
Genetic Approaches - How are the Molecular Effects of Anesthetics Linked to Anesthesia in the Intact Organism?
How are the Molecular Effects of Anesthetics Linked to Anesthesia in the Intact Organism?
How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System?
How is Anesthesia Measured?
Immobility - Where in the Central Nervous System Do Anesthetics Work?
Lipid Theories of Anesthesia - What is the Chemical Nature of Anesthetic Target Sites?
Lipid versus Protein Targets - What is the Chemical Nature of Anesthetic Target Sites?
Neuronal Excitability - How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System?
Pharmacologic Approaches - How are the Molecular Effects of Anesthetics Linked to Anesthesia in the Intact Organism?
Protein Theories of Anesthesia - What is the Chemical Nature of Anesthetic Target Sites?
References
Summary - Anesthetic Actions on Ion Channels
Summary - Anesthetic Actions on Ion Channels
Summary - How are the Molecular Effects of Anesthetics Linked to Anesthesia in the Intact Organism?
Summary - How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System?
Summary - What is the Chemical Nature of Anesthetic Target Sites?
Summary - Where in the Central Nervous System Do Anesthetics Work?
Synaptic Transmission - How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System?
T - 1. Mouse Genetics of Anesthesia
The Meyer-Overton Rule - What is the Chemical Nature of Anesthetic Target Sites?
Unconsciousness - Where in the Central Nervous System Do Anesthetics Work?
What is Anesthesia?
What is the Chemical Nature of Anesthetic Target Sites?
Where in the Central Nervous System Do Anesthetics Work?
11. Basic Principles of Clinical Pharmacology
11. Basic Principles of Clinical Pharmacology
Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Closed-loop Infusions - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Compartmental Pharmacokinetic Models - Pharmacokinetic Models
Concentration-Response Relationships - Pharmacodynamic Principles
Conclusion
Context-sensitive Decrement Times - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Dose-Response Relationships - Pharmacodynamic Principles
Drug Absorption and Routes of Administration - Pharmacokinetic Principles
Drug Distribution - Pharmacokinetic Principles
Drug Elimination - Pharmacokinetic Principles
Drug Interactions
Drug-Receptor Interactions - Pharmacodynamic Principles
F - 1. The Relationship Between Hepatic Extraction Ratio (E, Right Y-Axis), Intrinsic Clearance (Cl (i), x-Axis), and Hepatic Clearance (Cl(H), Left Y-Axis) at the Normal Hepatic Blood Flow (Q) of 1.5 L/min
F - 10. Schematic Pharmacodynamic Curves, with Dose or Concentration on the x-Axis and Effect or Receptor Occupancy on the Y-Axis, that Illustrate Agonism, Partial Agonism, and Antagonism
F - 11. The Changes in Plasma Drug Concentration and Pharmacologic Effect During and after an Intravenous Infusion
F - 12. A Schematic of a Three-Compartment Pharmacokinetic Model with the Effect Site Linked to the Central Compartment
F - 13. The Effect Site Concentration Versus Time Profiles after a Small Intravenous Bolus (Solid Black Line) and a Larger Intravenous Bolus (Solid Blue Line) of Fentanyl
F - 14. A Computer Simulation of the Plasma Propofol Concentration Profile During and after the Administration of a Single Bolus and Infusion Scheme Calculated Using the Steady-State, One-Compartment Pharmacokinetic Parameters (Red Line) and the Bet Scheme from Table 11-7 (Blue Line) to Achieve a Plasma Concentration of 5 g/mL
F - 15. Isoconcentration Nomogram for Determining Propofol Infusion Rates Designed to Maintain a Desired Plasma Propofol Concentration
F - 16. Simulated Plasma Propofol Concentration History Resulting from the Information in the Isoconcentration Nomogram in Figure 11-15 and Extending the Times to Switch the Infusion to the Next Lower Increment to the Midpoint of the Subsequent Time Segment (I.e., the Switch from 250 to 225 g/kg/min Was at 5 Minutes, Rather Than at 4.5 Minutes)
F - 17. The Context-Sensitive Plasma Half-Time for Fentanyl, Alfentanil, Sufentanil, and Remifentanil
F - 18. The Context-Sensitive 25%, 50%, and 75% Plasma Decrement Times for Fentanyl, Alfentanil, Sufentanil, and Remifentanil
F - 19. The Effect Site Context-Sensitive Half-Times (CSHTs) for the Classic Anesthetic Drugs and Their Analogous Soft Drugs
F - 2. The Relationship Between Liver Blood Flow (Q, x-Axis) and Hepatic Clearance (Cl (H), Y-Axis) for Different Values of Intrinsic Clearance (Cl(i))
F - 20. This is a Simulation of a Target-Controlled Infusion (TCI) in Which the Plasma Concentration is Targeted at 5 g/mL
F - 21. This is a Simulation of a Target-Controlled Infusion (TCI) in Which the Effect Site Concentration (C (e)) is Targeted at 5 g/mL
F - 22. The Influence of the Misspecification of Each of the Components of the Traditional Three Compartment Pharmacokinetic Models on the Prolonged Discrepancy (Overshoot) Between Predicted and Targeted Concentrations with Target-Controlled Infusions
F - 23. The Misestimation of the Central Distribution Volume (Vc) by a Traditional Compartmental PK-PD Model Results in More Interindividual Variability in Pharmacodynamic Estimates Than Pharmacodynamic Estimates from a High-Resolution, Recirculatory PK-PD Model
F - 24. The Effects of Cardiac Output on the Blood-effect Site Equilibration Rate (k (e0)) When the PK-PD Model is a High-Resolution ârecirculatoryâ Model (Black Circles) Versus a Traditional Compartmental Model (Triangles)
F - 25. The Effect of Adding Remifentanil on the Concentration-effect Curve for Sevoflurane Induced Analgesia (No Hemodynamic Response to a 5 Second, 50 mA Tetanic Stimulation in Volunteers)
F - 26. Remifentanil-sevoflurane Interaction for Sedation (Green Line) and Analgesia to Electrical Tetanic Stimulation (Red Line) for Volunteers
F - 27. Isoboles to Demonstrate Additive (Blue Line), Synergistic (Green Line), and Antagonistic (Red Line) Interactions Between Drug A and Drug B
F - 28. A Response Surface Model Characterizing the Remifentanil-sevoflurane Interaction for Analgesia to Electrical Tetanic Stimulation
F - 29. The Optimal Target Concentration Pairs of Remifentanil and Sevoflurane to Maintain Adequate Analgesia (95% Isobole for Analgesia to Electrical Tetanic Stimulation) and Result in the Most Rapid Emergence for Anesthetics of Various Durations
F - 3. The Relationship Between Liver Blood Flow (Q, x-Axis) and Hepatic Extraction Ratio (E, Y-Axis) for Different Values of Intrinsic Clearance (Cl (i))
F - 4. The Plasma Concentration (Y-Axis) Versus Time (x-Axis) Curve for Two Drugs Which Only Differ in Their Elimination Clearance
F - 5. The Plasma Concentration Versus Time Profile Plotted on Both Linear (Blue Line, Left Y-Axis) and Logarithmic (Red Line, Right Y-Axis) Scales for a Hypothetical Drug Exhibiting One-Compartment, First-Order Pharmacokinetics
F - 6. The Logarithmic Plasma Concentration Versus Time Profile for a Hypothetical Drug Exhibiting Two-Compartment, First-Order Pharmacokinetics
F - 7. A Schematic of a Two-Compartment Pharmacokinetic Model
F - 8. A Schematic of a Three-Compartment Pharmacokinetic Model
F - 9. A Schematic Curve of the Effect of a Drug Plotted Against Dose
Front-end Pharmacokinetics - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Isoconcentration Nomogram - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Manual Bolus and Infusion Dosing Schemes - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Noncompartmental (Stochastic) Pharmacokinetic Models - Pharmacokinetic Models
Pharmaceutical (Physiochemical) Interactions - Drug Interactions
Pharmacodynamic Interactions - Drug Interactions
Pharmacodynamic Principles
Pharmacokinetic Concepts - Pharmacokinetic Models
Pharmacokinetic Interactions - Drug Interactions
Pharmacokinetic Models
Pharmacokinetic Principles
Physiologic versus Compartment Models - Pharmacokinetic Models
References
Response Surface Models of Drug-Drug Interactions - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Rise to Steady-state Concentration - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Soft Pharmacology and Anesthesiology - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
T - 1. Substrates for CYP Isoenzymes Encountered in Anesthesiology
T - 2. Drugs with Significant Renal Excretion Encountered in Anesthesiology
T - 3. Classification of Drugs Encountered in Anesthesiology According to Hepatic Extraction Ratios
T - 4. Half-lives and Corresponding Percentage of Drug Removed
T - 5. Inducers and Inhibitors of Hepatic Drug Metabolism
T - 6. Serotonergic Psychiatric Drugs Implicated in the Cases of Serotonin Syndrome with Methylene Blue
T - 7. The Bolus-Elimination-Infusion (BET) Scheme to Achieve a Propofol Plasma Concentration of 5 g/mL for 120 Minutes
T - 8. The Optimal Target Concentration Pairs of Sevoflurane and Remifentanil for Anesthetics 30 to 900 Minutes in Duration
Target-controlled Infusions - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Time to Maximum Effect Compartment Concentration (T(max)) - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
Volume of Distribution at Peak Effect (V(DPE)) - Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics
6. Genomic Basis of Perioperative Medicine
6. Genomic Basis of Perioperative Medicine
Acknowledgments
Conclusions and Future Directions
Epigenetics: The Link between Environment and Genes - Scientific Rationale for Perioperative Precision Medicine
F - 1. The Perioperative Period Represents a Unique and Extreme Example of Gene-environment Interactions
F - 2. Multiple Opportunities Exist for Implementation of a Set of Actionable, Accessible, and Sustainable Clinical Decision Support Tools to Provide Pharmacogenomics (PGx)-Guided Drug Prescription Along the Continuum of Perioperative Care, Under a New Clinical Paradigm to Reduce Hospital Length of Stay and Cost
F - 3. Categories of Common Human Genetic Variation
F - 4. Increasing Complexity of the Central Dogma of Molecular Biology
F - 5. Pharmacogenomic Determinants of Individual Drug Response Operate by Pharmacokinetic and Pharmacodynamic Mechanisms
Genetic Susceptibility to Adverse Perioperative Kidney Outcomes - Genomics and Perioperative Risk Profiling
Genetic Susceptibility to Adverse Perioperative Neurologic Outcomes - Genomics and Perioperative Risk Profiling
Genetic Variability in Pain Response - Pharmacogenomics and Anesthesia
Genetic Variability in Response to Anesthetic Agents - Pharmacogenomics and Anesthesia
Genetic Variability in Response to Other Drugs Used Perioperatively - Pharmacogenomics and Anesthesia
Genetic Variants and Postoperative Event-free Survival - Genomics and Perioperative Risk Profiling
Genetic Variants and Risk for Postoperative Lung Injury - Genomics and Perioperative Risk Profiling
Genomics and Perioperative Risk Profiling
Human Genomic Variation - Scientific Rationale for Perioperative Precision Medicine
Overview of Genetic Epidemiology and Functional Genomic Methodology - Scientific Rationale for Perioperative Precision Medicine
Pharmacogenomics and Anesthesia
Predictive Biomarkers for Perioperative Adverse Cardiac Events - Genomics and Perioperative Risk Profiling
Profiling the Regulatory Genome to Understand Perioperative Biology and Discover Biomarkers of Adverse Outcomes - Scientific Rationale for Perioperative Precision Medicine
References
Scientific Rationale for Perioperative Precision Medicine
T - 1. Categories of Perioperative Phenotypes
T - 2. Summary of Gene Expression Studies with Implications for Perioperative Cardiovascular Outcomes
T - 3. Representative Genetic Polymorphisms Associated with Altered Susceptibility to Adverse Perioperative Cardiovascular Events
T - 4. Representative Genetic Polymorphisms Associated with Altered Susceptibility to Adverse Perioperative Neurologic Events
T - 5. Representative Genetic Polymorphisms Associated with Other Adverse Perioperative Outcomes
T - 6. Examples of Genetic Polymorphisms Involved in Variable Responses to Drugs Used in the Perioperative Period
7. Experimental Design and Statistics
7. Experimental Design and Statistics
Big Data - Experimental Medicine: Statistical Tests
Binary Variables - Experimental Medicine: Statistical Tests
Blinding - Experimental Medicine: Management of Bias
Conclusions
Control Groups - Experimental Medicine: Management of Bias
Epidemiology - Experimental Medicine: Statistical Tests
Experimental Constraints - Experimental Medicine: Management of Bias
Experimental Medicine: Management of Bias
Experimental Medicine: Statistical Analysis
Experimental Medicine: Statistical Tests
F - 1. Probable Cause
F - 2. Four Scatter Plots from the Anscombe Data Sets
F - 3. Graphical Representation of 45 Baseline Covariates Before and after Propensity Score Matching Using Data from Wijeysundera et al
F - 4. A Forest Plot Illustrates the Relative Strength of Treatment Effect Across Multiple Studies
Foundations
Foundations - Central Location
Foundations - Data Structure
Foundations - Descriptive Statistics
Foundations - Spread or Variability
Foundations - Types of Research Design
Hypothesis Formulation - Experimental Medicine: Statistical Analysis
Inferential Statistics - Experimental Medicine: Statistical Analysis
Interpretation of Results - Conclusions
Interval Data - Experimental Medicine: Statistical Tests
Linear Regression - Experimental Medicine: Statistical Tests
Logic of Proof - Experimental Medicine: Statistical Analysis
Multivariable Linear Regression - Experimental Medicine: Statistical Tests
Propensity Score Matching and Analysis - Experimental Medicine: Statistical Tests
Random Allocation of Treatment Groups - Experimental Medicine: Management of Bias
References
Sample Size Calculations - Experimental Medicine: Statistical Analysis
Sampling - Experimental Medicine: Management of Bias
Statistical Resources - Conclusions
Statistics and Anesthesia - Conclusions
Systematic Reviews and Meta-analyses - Experimental Medicine: Statistical Tests
T - 1. Data Types
T - 2. Classification of Clinical Research Reports
T - 3. Algebraic Statement of Statistical Hypotheses
T - 4. Errors in Hypothesis Testing: The Two-Way Truth Table
T - 5. When to Use What
The Bayesian Alternative - Experimental Medicine: Statistical Analysis
The Fickle P Value - Experimental Medicine: Statistical Analysis
Univariable and Multivariable Logistic Regression - Experimental Medicine: Statistical Tests
8. Inflammation, Wound Healing, and Infection
8. Inflammation, Wound Healing, and Infection
Antibiotic Prophylaxis - Infection Control
Antisepsis - Infection Control
Areas for Future Research - Summary
F - 1. Thomas et al
F - 2. World Health Organization Schematic of the 5 Moments for Hand Hygiene
F - 3. The Effect of Oxygen and/or Antibiotics on Lesion Diameter after Intradermal Injection of Bacteria into Guinea Pigs
F - 4. The Figure Demonstrates Rates of Surgical Wound Infection Corresponding to the Temporal Relation Between Antibiotic Administration and the Start of Surgery
F - 5. Schematic of the Processes of Wound Healing
F - 6. The Varying Oxygen Tension in the Wound Module
F - 7. Schematic of Superoxide and Other Oxidant Production Within the Phagosome
Hand Hygiene - Infection Control
Infection Control
Intraoperative Management - Patient Management
Maturation and Remodeling - Mechanisms of Wound Repair
Mechanisms of Wound Repair
Patient Management
Postoperative Management - Patient Management
Preoperative Preparation - Patient Management
Proliferation - Mechanisms of Wound Repair
References
Resistance to Infection - Mechanisms of Wound Repair
Summary
T - 1. Criteria for Defining a Surgical Site Infection (SSI)
T - 2. Indications for Hand Hygiene
T - 3. Hand Hygiene Technique
T - 4. Skin Care
T - 5. General Recommendations for Antibiotic Prophylaxis
T - 6. Preoperative Checklist
T - 7. Intraoperative Management
T - 8. Standard Volume Management Guidelines for Surgical Patients
T - 9. Postoperative Management
The Initial Response to Injury - Mechanisms of Wound Repair
Wound Perfusion and Oxygenation
9. The Allergic Response
9. The Allergic Response
Agents Implicated in Allergic Reactions - Perioperative Management of the Patient with Allergies
Anaphylactic Reactions
Basic Immunologic Principles
Basic Immunologic Principles - Antibodies
Basic Immunologic Principles - Antigens
Basic Immunologic Principles - Effector Cells and Proteins of the Immune Response
Basic Immunologic Principles - Effects of Anesthesia on Immune Function
Basic Immunologic Principles - Thymus-Derived (T-Cell) and Bursa-Derived (B-Cell) Lymphocytes
Evaluation of Patients with Allergic Reactions - Perioperative Management of the Patient with Allergies
F - 1. Basic Structural Configuration of the Antibody Molecule Representing Human Immunoglobulin G (IgG)
F - 10. Electron Micrograph of Human Cutaneous Mast Cell after Injection of Dynorphin, a -Opioid Agonist
F - 11. Different Mechanisms of Mediator Release from Human Cutaneous Mast Cells Stimulated Immunologically by Anti-IgE and by Nonimmunologic Stimuli with Substance P
F - 2. Diagram of Complement Activation
F - 3. Type I Immediate Hypersensitivity Reactions (Anaphylaxis) Involve IgE Antibodies Binding to Mast Cells or Basophils by Way of Their Fc Receptors
F - 4. Type II or Cytotoxic Reactions
F - 5. Type III Immune Complex Reactions
F - 6. Type IV Immune Complex Reactions (Delayed Hypersensitivity or Cell-Mediated Immunity)
F - 7. During Anaphylaxis (Type I Immediate Hypersensitivity Reaction), (1) Antigen Enters a Patient During Anesthesia through a Parenteral Route
F - 8. Sequence of Events Producing Granulocyte Aggregation, Pulmonary Leukostasis, and Cardiopulmonary Dysfunction
F - 9. Example of an Anaphylactic Reaction after Rapid Vancomycin Administration in a Patient
Hypersensitivity Responses (Allergy)
IgE-mediated Pathophysiology - Anaphylactic Reactions
Immunologic Mechanisms of Drug Allergy - Perioperative Management of the Patient with Allergies
Intraoperative Allergic Reactions - Hypersensitivity Responses (Allergy)
Non-IgE-mediated Reactions - Anaphylactic Reactions
Perioperative Management of the Patient with Allergies
References
Summary
T - 1. Agents Administered during Anesthesia that Act as Antigens
T - 2. Biologic Characteristics of Immunoglobulins
T - 3. Recognition of Anaphylaxis during Regional and General Anesthesia
T - 4. Biologic Effects of Anaphylatoxins
T - 5. Drugs Capable of Nonimmunologic Histamine Release
T - 6. Management of Anaphylaxis during General Anesthesia
T - 7. Agents Implicated in Allergic Reactions During Anesthesia
Treatment Plan - Anaphylactic Reactions
Type I Reactions - Hypersensitivity Responses (Allergy)
Type II Reactions - Hypersensitivity Responses (Allergy)
Type III Reactions (Immune Complex Reactions) - Hypersensitivity Responses (Allergy)
Type IV Reactions (Delayed Hypersensitivity Reactions) - Hypersensitivity Responses (Allergy)
3: Core Care Principles
12. Cardiac Anatomy and Physiology
12. Cardiac Anatomy and Physiology
Afterload - Determinants of Systolic Function
Architecture - Gross Anatomy
Atrial Function - Determinants of Diastolic Function
Calcium-Myofilament Interaction - Cardiac Myocyte Anatomy and Function
Cardiac Myocyte Anatomy and Function
Contractile Apparatus - Cardiac Myocyte Anatomy and Function
Coronary Blood Supply - Gross Anatomy
Coronary Physiology
Determinants of Diastolic Function
Determinants of Systolic Function
F - 1. Illustration Depicting the Components of the Myocardium
F - 10. Mechanical and Electrical Events of the Cardiac Cycle Showing Also the LV Volume Curve and the Heart Sounds
F - 11. This Illustration Depicts the Steady-State LV Pressure-volume Diagram
F - 12. These Schematic Illustrations Demonstrate Alterations in the Steady-State LV Pressure-volume Diagram Produced by a Reduction in Myocardial Contractility As Indicated by a Decrease in the Slope of the End-Systolic Pressure-volume Relation (ESPVR; Left Panel) and a Decrease in LV Compliance As Indicated by an Increase in the Position of the End-Diastolic Pressure-volume Relation (EDPVR; Right Panel)
F - 13. This Illustration Depicts the Major Factors that Determine LV Diastolic (Left) and Systolic (Right) Function
F - 14. This Schematic Diagram Depicts Factors that Influence Experimental and Clinical Estimates of Sarcomere Length As a Pure Index of the Preload of the Contracting LV Myocyte
F - 15. This Schematic Diagram Illustrates the LV End-Systolic Pressure-volume and Aortic End-Systolic Pressure-Stroke Volume Relations (ESPVR and A (o)P(es)-SVR, Respectively) Used to Determine LV-Arterial Coupling As the Ratio of End-Systolic Elastance (E(es); the Slope of ESPVR) and Effective Arterial Elastance (E(a); the Slope of A(o)P(es)-SVR)
F - 16. LV Pressure- and Volume-Overload Produce Compensatory Responses Based on the Nature of the Inciting Stress
F - 17. This Illustration Depicts the Method Used to Derive the LV End-Systolic Pressure-volume Relation (ESPVR) from a Series of Differentially Loaded LV Pressure-volume Diagrams Generated by Abrupt Occlusion of the Inferior Vena Cava in a Canine Heart in Vivo
F - 18. Calculation of Fractional Area Change from LV Midpapillary Short Axis Images Obtained at End-Diastole (Left Panel) and End-Systole (Right Panel)
F - 19. This Illustration Depicts the Simultaneous Relationships Between LA and LV Pressures (P (LA) and P(LV), Respectively; Top Panels), LV Filling Rate During Early Filling (E) and Atrial Systole (A; Middle Panels), and Early Mitral Annular Velocity (e; Bottom Panels) Under Normal Conditions and During Evolving Diastolic Dysfunction (Impaired Relaxation, Pseudonormal, and Restrictive)
F - 2. Illustration Depicting the Contraction Characteristics and Modes of Emptying of the RV and LV
F - 20. Transmitral Blood Flow Velocity Waveforms Obtained Using Pulse Wave Doppler Echocardiography Under Normal Conditions (Left) and During Delayed Relaxation (Right)
F - 21. Pulmonary Venous Blood Flow Velocity Waveforms Obtained Using Pulse Wave Doppler Echocardiography Under Normal Conditions (Left Panel) and in the Presence of Increased LA Pressure (Right Panel)
F - 22. Pressure-volume Relation of the Pericardium (Blue Line) Compared with the LV End-Diastolic Pressure-volume Relation (EDPVR; Red Line)
F - 3. An Anterior View of the Heart (Left) Shows Right Coronary and Left Anterior Descending Coronary Arteries
F - 4. Schematic Representation of Blood Flow in the Left and Right Coronary Arteries During Phases of the Cardiac Cycle
F - 5. Diagram of the Arterial-to-Arterial and Venous-to-Venous Anastomoses of the Coronary Arterial System, Which Allow Diversion of Flow if One Distribution Becomes Blocked.B: Diagram of the Epicardial Coronary Vessels Lying on the Cardiac Muscle Surface, the Penetrating Deep Vessels, and the Subendocardial Arterial Plexus Connecting the Deep Vessels
F - 6. Schematic Illustration of the Myosin Molecule Demonstrating Double Helix Tail, Globular Heads that Form Cross Bridges with Actin During Contraction, Two Pairs of Light Chains, and âhingesâ (Cleavage Sites of Proteolytic Enzymes) that Divide the Molecule into Meromyosin Fragments (See Text)
F - 7. Cross-Sectional Schematic Illustration Demonstrating the Structural Relationship Between the Troponin-tropomyosin Complex and Actin Under Resting Conditions (Left Panel) and after Ca[2+] Binding to Troponin C (Right Panel, See Text)
F - 8. Schematic Illustration of the Actin Filaments and its Individual Monomers and Active Myosin-Binding Sites (M; Left Panel)
F - 9. This Schematic Diagram Depicts the Opposing Forces Within a Theoretical LV Sphere that Determine the Law of Laplace
Gross Anatomy
Heart Rate - Determinants of Systolic Function
Impulse Conduction - Gross Anatomy
Invasive Assessment of LV Filling and Compliance - Determinants of Diastolic Function
Invasive Assessment of LV Relaxation - Determinants of Diastolic Function
Law of Laplace
Myocardial Contractility - Determinants of Systolic Function
Myosin-Actin Interaction - Cardiac Myocyte Anatomy and Function
Noninvasive Evaluation of Diastolic Function - Determinants of Diastolic Function
Pericardium - Determinants of Diastolic Function
Preload - Determinants of Systolic Function
References
T - 1. Determinants of Left Ventricular Diastolic Function
T - 2. Common Causes of Left Ventricular Diastolic Dysfunction
The Cardiac Cycle
The Pressure-Volume Diagram
Ultrastructure - Cardiac Myocyte Anatomy and Function
Valve Structure - Gross Anatomy
13. Cardiovascular Pharmacology
(1)-Adrenoceptor Antagonists
(2)-Adrenoceptor Agonists: Clonidine and Dexmedetomidine
13. Cardiovascular Pharmacology
-Adrenoceptor Antagonists (-Blockers)
Angiotensin Receptor Blockers
Angiotensin-converting Enzyme Inhibitors
Atenolol - -Adrenoceptor Antagonists (-Blockers)
Calcium Channel Blockers
Carvedilol - -Adrenoceptor Antagonists (-Blockers)
Cholinergic Agonists
Cholinergic Drugs
Cholinesterase Inhibitors
Clevidipine - Calcium Channel Blockers
Digitalis Glycosides
Diltiazem - Calcium Channel Blockers
Dobutamine
Dopamine
Ephedrine - Sympathomimetics
Epinephrine
Esmolol - -Adrenoceptor Antagonists (-Blockers)
F - 1. Chemical Structures of Direct Acting Cholinergic-Mimetic Esters and Alkaloids
F - 2. Chemical Structures of Clinical Anticholinesterases
F - 3. Chemical Structures of Inhaled Muscarinic Antagonists
F - 4. Schematic Illustration of [Ã]-Adrenoceptor Agonist Mechanism of Action
F - 5. Schematic Illustration of [α]-Adrenoceptor Agonist Mechanism of Action
F - 6. Schematic Illustration of Potential Mechanism by Which [Ã]-Blockers Produce Vasodilation; Abbreviations: VGCC, Voltage-Gated Ca[2+] Channel; AC, Adenylyl Cyclase; NO, Nitric Oxide; sGC, Soluble Guanylyl Cyclase; ROS, Reactive Oxygen Species; LDL, Low-Density Lipoprotein
F - 7. Schematic Illustration of Inhibitors of the Renin-angiotensin System; Abbreviations: DRI, Direct Renin Inhibitor; ACE, Angiotensin-Converting Enzyme; ACE I, Angiotensin-Converting Enzyme Inhibitor; ARB, Angiotensin Receptor Blocker; AT (1), Angiotensin Subtype 1 Receptor
Fenoldopam
Fundamentals of Catecholamine Pharmacology
Hydralazine
Isoproterenol
LaÃlol - -Adrenoceptor Antagonists (-Blockers)
Levosimendan
Metoprolol - -Adrenoceptor Antagonists (-Blockers)
Muscarinic Antagonist Toxicity
Muscarinic Antagonists
Nicardipine - Calcium Channel Blockers
Nifedipine - Calcium Channel Blockers
Nimodipine - Calcium Channel Blockers
Nitroglycerin - Nitrovasodilators
Nitrovasodilators
Norepinephrine
Phenylephrine - Sympathomimetics
Phosphodiesterase Inhibitors
Propranolol - -Adrenoceptor Antagonists (-Blockers)
References
Selective b(2)-Adrenoceptor Agonists
Sodium Nitroprusside - Nitrovasodilators
Sympathomimetics
T - 1. Comparative Muscarinic Actions of Direct Cholinomimetic Agents
T - 2. Comparative Effects of Muscarinic Antagonists
T - 3. Atropine Toxicity
T - 4. Antimuscarinic Compounds Associated with Central Anticholinergic Syndrome
T - 5. Comparative Effects of Endogenous and Synthetic Catecholamines
T - 6. Comparative Effects of -blockers
T - 7. Comparative Effects of Milrinone, Levosimendan, and Vasopressin
T - 8. Comparative Effects of Ca2+ Channel Blockers
Vasopressin
Verapamil - Calcium Channel Blockers
14. Autonomic Nervous System Anatomy and Physiology
14. Autonomic Nervous System Anatomy and Physiology
Adrenergic Receptors - Receptors
Anesthesia and the Autonomic Nervous System
Autonomic Nervous System Reflexes and Interactions
Autonomic Syndromes and Autonomic Regulation
Baroreceptors - Autonomic Nervous System Reflexes and Interactions
Cholinergic Drugs - Clinical Autonomic Nervous System Pharmacology
Cholinergic Receptors - Receptors
Clinical Autonomic Nervous System Pharmacology
Denervated Heart - Autonomic Nervous System Reflexes and Interactions
Diabetic Neuropathy - Autonomic Syndromes and Autonomic Regulation
F - 1. Schematic Distribution of the Craniosacral (Parasympathetic) and Thoracolumbar (Sympathetic) Nervous Systems
F - 10. Location of Several Known Adrenergic Receptors
F - 11. The Normal Blood Pressure Response to the Valsalva Maneuver is Demonstrated
F - 12. The Interactions of the Renin-angiotensin and SNS in Regulating Homeostasis are Shown Schematically Along with the Physiologic Variables that Modulate Their Function
F - 13. Chemical Structures of Direct-Acting Cholinomimetic Esters and Alkaloids
F - 14. Structural Formulas of Clinically Useful Reversible Anticholinesterase Drugs
F - 15. Structural Formulas of the Clinically Useful Antimuscarinic Drugs
F - 16. Horner Syndrome (Left Eye)
F - 2. Schematic Diagram of the Efferent ANS
F - 3. The Spinal Reflex Arc of the Somatic Nerves is Shown on the Left
F - 4. The Anatomy and Physiology of the Terminal Postganglionic Sympathetic and Parasympathetic Fibers are Similar
F - 5. Synthesis and Metabolism of Acetylcholine
F - 6. The Chemical Configurations of Three Endogenous Catecholamines are Compared with Those of Three Synthetic Catecholamines
F - 7. Schematic of the Synthesis of Catecholamines
F - 8. Schematic of the Synthesis and Disposition of NE in Adrenergic Neurotransmission
F - 9. This Schematic Demonstrates Just a Few of the Presynaptic Adrenergic Receptors Thought to Exist
Functional Anatomy
Functional Anatomy - Central Autonomic Organization
Functional Anatomy - Peripheral Autonomic Nervous System Organization
Ganglionic Drugs - Clinical Autonomic Nervous System Pharmacology
Horner Syndrome - Autonomic Syndromes and Autonomic Regulation
Interaction of Autonomic Nervous System Receptors - Autonomic Nervous System Reflexes and Interactions
Interaction with Other Regulatory Systems - Autonomic Nervous System Reflexes and Interactions
Mode of Action - Clinical Autonomic Nervous System Pharmacology
Monoamine Oxidase Inhibitors - Autonomic Syndromes and Autonomic Regulation
Orthostatic Hypotension - Autonomic Syndromes and Autonomic Regulation
Receptors
References
Selective Serotonin Reuptake Inhibitors - Autonomic Syndromes and Autonomic Regulation
T - 1. Homeostatic Balance between Adrenergic and Cholinergic Effects
T - 2. Classification of Nerve Fibers
T - 3. Adrenergic Receptors: Order of Potency of Agonists and Antagonists
T - 4. Adrenergic Receptors
T - 5. Comparative Muscarinic Actions of Direct Cholinomimetic Agents
T - 6. Comparison of Antimuscarinic Drugs
T - 7. Antimuscarinic Compounds Associated with Central Anticholinergic Syndrome
Tricyclic Antidepressants - Autonomic Syndromes and Autonomic Regulation
15. Respiratory Function in Anesthesia
15. Respiratory Function in Anesthesia
Anesthesia and Obstructive Pulmonary Disease
Anesthesia and Restrictive Pulmonary Disease
Assessment of Arterial Oxygenation and Physiologic Shunt - Oxygen and Carbon Dioxide Transport
Assessment of Physiologic Dead Space - Oxygen and Carbon Dioxide Transport
Bulk Flow of Gas (Convection) - Oxygen and Carbon Dioxide Transport
Chemical Control of Ventilation - Control of Ventilation
Control of Ventilation
Distribution of Ventilation and Perfusion - Oxygen and Carbon Dioxide Transport
Effects of Cigarette Smoking on Pulmonary Function
Elastic Work - Lung Mechanics
F - 1. Dynamic Pressure-volume Loop of Resting Tidal Volume
F - 10. Flow-volume Loop
F - 2. Pulmonary Pressure-volume Relationships at Different Values of Total Lung Capacity (TLC), Ignoring Hysteresis
F - 3. Classic Central Nervous System (CNS) Respiratory Centers
F - 4. Carbon Dioxide-ventilatory Response Curve
F - 5. Distribution of Blood Flow in the Isolated Lung
F - 6. Distribution of Ventilation, Blood Flow, and Ventilation-perfusion Ratio in the Normal, Upright Lung
F - 7. Continuum of Ventilation-perfusion Relationships
F - 8. Lung Volumes and Capacities
F - 9. FEF (25%-75%)
Functional Anatomy of the Lungs
Functional Anatomy of the Lungs - Lung Structures
Functional Anatomy of the Lungs - Muscles of Ventilation
Functional Anatomy of the Lungs - Pulmonary Vascular Systems
Functional Anatomy of the Lungs - Thorax
Gas Diffusion - Oxygen and Carbon Dioxide Transport
Generation of Ventilatory Pattern - Control of Ventilation
Higher Respiratory Centers - Control of Ventilation
Lung Mechanics
Lung Volumes and Capacities - Pulmonary Function Testing
Medullary Centers - Control of Ventilation
Oxygen and Carbon Dioxide Transport
Physiologic Dead Space - Oxygen and Carbon Dioxide Transport
Physiologic Shunt - Oxygen and Carbon Dioxide Transport
Physiologic Shunt Calculation - Oxygen and Carbon Dioxide Transport
Pontine Centers - Control of Ventilation
Postoperative Pulmonary Complications - Postoperative Pulmonary Function
Postoperative Pulmonary Function
Practical Application of Pulmonary Function Tests - Pulmonary Function Testing
Pulmonary Function Testing
Pulmonary Function Tests - Pulmonary Function Testing
References
Reflex Control of Ventilation - Control of Ventilation
Resistance to Gas Flow - Lung Mechanics
T - 1. Major Divisions of the Lung
T - 2. Functional Airway Divisions
T - 3. Definition of Respiratory Pattern Terminology
T - 4. Pulmonary Function Tests in Restrictive and Obstructive Lung Disease
Terminology - Control of Ventilation
16. Fluids, Electrolytes, and Acid-Base Physiology
16. Fluids, Electrolytes, and Acid-Base Physiology
Acid-Base Interpretation and Treatment
Calcium - Electrolytes
Electrolytes
Examples - Practical Approach to Acid-Base Interpretation
F - 1. Blood Hemoglobin (Mean ± SEM) Sampled at Three Baseline Periods During a 30-Minute Catecholamine Infusion and for 3 Hours after Starting a 20-Minute 0.9% NaCl Bolus of 24 mL/kg
F - 10. A Diagnostic Flow Chart for Hypokalemia with a High Rate of K[+] Excretion
F - 11. Electrocardiographic (ECG) Manifestations of Hyperkalemia
F - 12. Algorithmic Management of Hyperkalemia
F - 13. Schematic Representation of the Regulatory System Maintaining Ca[2+] Homeostasis
F - 2. Renal Filtration, Reabsorption, and Excretion of Water
F - 3. Left: The Sigmoid Relationship Between Plasma Vasopressin (VP) and Urinary Osmolality
F - 4. Top: Mean Postoperative Verbal Analogue Scale (VAS) Nausea Scores in Each Group over the First 72 Postoperative Hours
F - 5. Solid and Liquid Phase Gastric Emptying Times (T (50)) after 4 Days of Standard or Restricted Intravenous Postoperative Fluid Therapy
F - 6. Algorithm by Which Hyponatremia Can Be Evaluated
F - 7. Hyponatremia is Treated According to the Etiology of the Disturbance, the Level of Serum Osmolality, and a Clinical Estimation of Total Body Sodium
F - 8. Rapid Correction of Either Hypernatremia or Hyponatremia Can Cause Severe Brain Injury
F - 9. Severe Hypernatremia is Evaluated by First Separating Patients into Hypovolemic, Euvolemic, and Hypervolemic Groups Based on Assessment of Extracellular Volume (ECV)
Fluid Management
Fluid Management - Colloids, Crystalloids, and Hypertonic Solutions
Fluid Management - Fluid Replacement Therapy
Fluid Management - Fluid Status: Assessment and Monitoring
Fluid Management - Physiology
Fluid Management - Surgical Fluid Requirements
Magnesium - Electrolytes
Metabolic Acidosis - Acid-Base Interpretation and Treatment
Metabolic Alkalosis - Acid-Base Interpretation and Treatment
Overview of Acid-Base Equilibrium - Acid-Base Interpretation and Treatment
Phosphate - Electrolytes
Potassium - Electrolytes
Practical Approach to Acid-Base Interpretation
References
Respiratory Acidosis - Acid-Base Interpretation and Treatment
Respiratory Alkalosis - Acid-Base Interpretation and Treatment
Sodium - Electrolytes
T - 1. Generation of Metabolic Alkalosis
T - 10. Hourly and Daily Maintenance Water Requirements
T - 11. Claimed Advantages and Disadvantages of Colloid Versus Crystalloid Intravenous Fluids
T - 12. Hypertonic Resuscitation Fluids: Advantages and Disadvantages
T - 13. Regulation of Total Body Electrolyte Mass and Plasma Concentrations
T - 14. Common Associations with the Syndrome of Inappropriate Antidiuretic Hormone Secretion
T - 15. Diagnostic Criteria for Syndrome of Inappropriate Antidiuretic Hormone Secretion
T - 16. Hypernatremia: Acute Treatment
T - 17. Causes of Renal Potassium Loss
T - 18. Hypokalemia: Treatment
T - 19. Severe Hyperkalemia Treatment
T - 2. Factors that Maintain Metabolic Alkalosis
T - 20. Hypocalcemia: Clinical Manifestations
T - 21. Hypocalcemia: Acute Treatment
T - 22. Hypophosphatemia: Acute Treatment
T - 23. Manifestations of Altered Serum Magnesium Concentrations
T - 24. Hypomagnesemia: Acute Treatment
T - 3. Respiratory Compensation in Response to Metabolic Alkalosis and Metabolic Acidosis
T - 4. Differential Diagnosis of Metabolic Acidosis
T - 5. Failure to Maintain Appropriate Ventilatory Compensation for Metabolic Acidosis
T - 6. Changes of [HCO3-] and pH in Response to Acute and Chronic Changes in PaCO2
T - 7. Sequential Approach to Acid-Base Interpretation
T - 8. Hyperchloremic Metabolic Acidosis during Prolonged Surgery
T - 9. Metabolic Alkalosis Secondary to Nausea and Vomiting with Subsequent Lactic Acidosis Secondary to Hypovolemia
17. Hemostasis and Transfusion Medicine
17. Hemostasis and Transfusion Medicine
Acquired Disorders of Hemostasis - Disorders of Hemostasis: Diagnosis and Treatment
Anticoagulation and Pharmacologic Therapy
Anticoagulation Regimens and Associated Anesthetic Concerns - Anticoagulation and Pharmacologic Therapy
Antifibrinolytic Therapy - Anticoagulation and Pharmacologic Therapy
Blood Component Production
Blood Component Production - Blood Collection
Blood Component Production - Component Processing and Storage
Blood Component Production - Pathogen Inactivation
Blood Component Production - Plasma Derivatives
Blood Component Production - RBC and Platelet Substitutes
Blood Conservation Strategies
Blood Conservation Strategies - Autologous Blood Transfusion
Blood Products and Transfusion Thresholds
Blood Products and Transfusion Thresholds - Compatibility Testing
Blood Products and Transfusion Thresholds - Cryoprecipitate
Blood Products and Transfusion Thresholds - Fibrinogen Concentrate
Blood Products and Transfusion Thresholds - Plasma Products
Blood Products and Transfusion Thresholds - Platelets
Blood Products and Transfusion Thresholds - Red Blood Cells
Conclusions
Desmopressin - Anticoagulation and Pharmacologic Therapy
Diagnosis of Thromboembolic Disorders - Laboratory Evaluation of Hemostasis
Disorders of Hemostasis: Diagnosis and Treatment
Disorders of Primary Hemostasis - Disorders of Hemostasis: Diagnosis and Treatment
Disorders of Secondary Hemostasis - Disorders of Hemostasis: Diagnosis and Treatment
F - 1. Overview of Platelet Pathways for Adherence, Activation, Stabilization, and Physiologic Inhibition
F - 2. Schematic Diagram of the Coagulation Cascade of Clotting Factors, with Extrinsic, Intrinsic, and Common Pathways
F - 3. Schematic Diagram of Inhibitory Control of the Coagulation Cascade
F - 4. Fibrinolysis and Antifibrinolysis Pathways
Fibrinolysis - Hemostasis and Coagulation
Hemostasis and Coagulation
Hereditary Hypercoagulability - Disorders of Hemostasis: Diagnosis and Treatment
Laboratory Evaluation of Hemostasis
Laboratory Evaluation of Primary Hemostasis - Laboratory Evaluation of Hemostasis
Laboratory Evaluation of Secondary Hemostasis and Coagulation - Laboratory Evaluation of Hemostasis
Monitoring Anticoagulation Therapeutic Agents - Laboratory Evaluation of Hemostasis
Primary Hemostasis - Hemostasis and Coagulation
Prothrombin Complex Concentrates - Anticoagulation and Pharmacologic Therapy
Recombinant Activated Factor VII - Anticoagulation and Pharmacologic Therapy
References
Secondary Hemostasis - Hemostasis and Coagulation
T - 1. Blood Components
T - 10. Noninfectious Transfusion Reactions
T - 11. Perioperative Blood Conservation Strategies
T - 12. Classification of Inherited von Willebrand Disease
T - 13. Common Disorders Associated with Disseminated Intravascular Coagulation
T - 14. Scoring Algorithm for the Diagnosis of Disseminated Intravascular Coagulation
T - 15. Oral Anticoagulation Medications
T - 2. International Society Transfusion Guidelines
T - 3. Equations for Tissue Oxygenation
T - 4. Clinical Indications of Tissue Hypoxia
T - 5. Indications for Platelet Transfusion
T - 6. Causes of Acquired Platelet Dysfunction
T - 7. Indications for the Use of Plasma Products
T - 8. Indications for Fibrinogen Replacement
T - 9. Residual Risk of Transfusion-transmitted Infections
The Risks of Blood Product Administration
The Risks of Blood Product Administration - Infectious Risks of Blood Product Administration
The Risks of Blood Product Administration - Noninfectious Risks of Blood Product Administration
Viscoelastic Testing - Laboratory Evaluation of Hemostasis
4: Anesthetic Drugs and Adjuvants
18. Inhaled Anesthetics
18. Inhaled Anesthetics
Anesthetic Degradation by Carbon Dioxide Absorbers
Anesthetic Metabolism
Anesthetic Transfer: Machine to Central Nervous System - Pharmacokinetic Principles
Carbon Monoxide and Heat - Anesthetic Degradation by Carbon Dioxide Absorbers
Clinical Overview of Current Inhaled Anesthetics
Clinical Utility of Volatile Anesthetics
Compound A - Anesthetic Degradation by Carbon Dioxide Absorbers
Desflurane - Clinical Overview of Current Inhaled Anesthetics
Distribution (Tissue Uptake) - Pharmacokinetic Principles
Elimination - Pharmacokinetic Principles
F - 1. Chemical Structure of Inhaled Anesthetics
F - 10. Effect of Age on Minimum Alveolar Concentration (MAC) is Plotted
F - 11. Cerebral Blood Flow (and Velocity) Measured in the Presence of Normocapnia and in the Absence of Surgical Stimulation in Volunteers Receiving Halothane or Isoflurane.[,]
F - 12. Heart Rate and Blood Pressure Changes (from Awake Baseline) in Volunteers Receiving General Anesthesia with Isoflurane (I), Desflurane (D), or Sevoflurane (S)
F - 13. Cardiac Index, Central Venous Pressure (or Right Atrial Pressure), and Systemic Vascular Resistance Changes (from Awake Baseline) in Volunteers Receiving General Anesthesia with Isoflurane (I), Desflurane (D), or Sevoflurane (S).[,]
F - 14. Myocardial Contractility Indices from Chronically Instrumented Dogs.[,]
F - 15. The Dose of Epinephrine Associated with Cardiac Arrhythmias in Animal and Human Models Was Least with Halothane
F - 16. Mean QTc Intervals in Children, Age 1 to 14 Years, after Inhalation of 2% Sevoflurane or 6% Desflurane, Both in 66% N (2)O/O(2)
F - 17. Consecutive Measurements of Sympathetic Nerve Activity (SNA; Mean ± SE) from Human Volunteers During Induction of Anesthesia with Propofol and the Subsequent Mask Administration of Sevoflurane or Desflurane for a 10-Minute Period
F - 18. Stress Hormone Responses to a Rapid Increase in Anesthetic Concentration, from 4% to 12% Inspired
F - 19. Comparison of Mean Changes in Resting PaCO (2), Tidal Volume, Respiratory Rate, and Minute Ventilation in Patients Anesthetized with Isoflurane, Sevoflurane, Desflurane, or N(2)O(N)
F - 2. The Rise in Alveolar (F (A)) Anesthetic Concentration Toward the Inspired (F(I)) Concentration is Most Rapid with the Least Soluble Anesthetics, N(2)O (Nitrous Oxide), Desflurane, and Sevoflurane
F - 20. All Inhaled Anesthetics Produce Similar Dose-Dependent Decreases in the Ventilatory Response to Carbon Dioxide (CO (2))
F - 21. Influence of 0.1 Minimum Alveolar Concentration (MAC) of Four Volatile Anesthetic Agents on the Ventilatory Response to a Step Decrease in End-Tidal Oxygen Concentration
F - 22. Changes in Respiratory System Resistance Expressed As a Percentage of the Baseline Recorded after Tracheal Intubation but Prior to Administration of Sevoflurane or Desflurane to the Inspired Gas Mixture
F - 23. Shunt Fraction (Top Panel) and the Alveolar-arterial Oxygen Gradient (Bottom) Immediately Before, During, and after One-Lung Ventilation (OLV) in Patients Anesthetized with Desflurane or Isoflurane
F - 24. Compound A Levels Produced from Three Non-Dessicated Carbon Dioxide Absorbents During 1 Minimum Alveolar Concentration Sevoflurane Anesthesia Delivered to Volunteers at 1 L/min Fresh Gas Flow (Mean ± SE)
F - 3. The Second Gas Effect is Demonstrated in the Graphs
F - 4. A Graphic and Relative Equation to Demonstrate the Second Gas Effect
F - 5. The F (A)/F(I) Ratio Rises More Rapidly if Ventilation and the Anesthetic Concentration are Increased
F - 6. When No Ventilation/Perfusion Abnormalities Exist, the Alveolar (P (A)) and Arterial (P(a)) Anesthetic Partial Pressures Rise Together (Dotted Blue Lines) Toward the Inspired Partial Pressure (P(I))
F - 7. Elimination of Anesthetic Gases is Defined As the Ratio of End-Tidal Anesthetic Concentration (F (A)) to the Last F(A) During Administration and Immediately Before the Beginning of Elimination (F(A0))
F - 8. The Recovery Times to Orientation after Anesthesia of Varying Durations
F - 9. The Effects of Isoflurane on Cerebral Metabolic Rate of Oxygen Consumption (CMRO (2)) As a Percentage of Control (âawakeâ)
Fluoride-induced Nephrotoxicity - Anesthetic Metabolism
For Induction of Anesthesia - Clinical Utility of Volatile Anesthetics
For Maintenance of Anesthesia - Clinical Utility of Volatile Anesthetics
Gases in Mixtures - Pharmacokinetic Principles
Gases in Solution - Pharmacokinetic Principles
Generic Sevoflurane Formulations - Anesthetic Degradation by Carbon Dioxide Absorbers
Genetic Effects, Obstetric Use, and Effects on Fetal Development
Hepatic Effects
Introduction and Overview
Isoflurane - Clinical Overview of Current Inhaled Anesthetics
Metabolism - Pharmacokinetic Principles
Minimum Alveolar Concentration - Neuropharmacology of Inhaled Anesthetics
Neuromuscular System and Malignant Hyperthermia
Neuropharmacology of Inhaled Anesthetics
Nitrous Oxide - Clinical Overview of Current Inhaled Anesthetics
Other Alterations in Neurophysiology - Neuropharmacology of Inhaled Anesthetics
Overpressurization and the Concentration Effect - Pharmacokinetic Principles
Perfusion Effects - Pharmacokinetic Principles
Pharmacokinetic Principles
Physical Characteristics of Inhaled Anesthetics - Pharmacokinetic Principles
References
Second Gas Effect - Pharmacokinetic Principles
Sevoflurane - Clinical Overview of Current Inhaled Anesthetics
T - 1. Physiochemical Properties of Volatile Anesthetics
T - 2. Distribution of Cardiac Output by Tissue Group
T - 3. Factors that Increase Minimum Alveolar Concentration
T - 4. Factors that Decrease Minimum Alveolar Concentration
The Circulatory System
The Circulatory System - Autonomic Nervous System
The Circulatory System - Cardioprotection from Volatile Anesthetics
The Circulatory System - Coronary Steal, Myocardial Ischemia, and Cardiac Outcome
The Circulatory System - Hemodynamics
The Circulatory System - Myocardial Contractility
The Circulatory System - Other Circulatory Effects
The Pulmonary System
The Pulmonary System - Bronchiolar Smooth Muscle Tone
The Pulmonary System - General Ventilatory Effects
The Pulmonary System - Mucociliary Function
The Pulmonary System - Pulmonary Vascular Resistance
The Pulmonary System - Response to Carbon Dioxide and Hypoxemia
The Pulmonary System - Ventilatory Mechanics
Unique Features of Inhaled Anesthetics - Pharmacokinetic Principles
Uptake and Distribution - Pharmacokinetic Principles
Ventilation Effects - Pharmacokinetic Principles
Ventilation-Perfusion Mismatching - Pharmacokinetic Principles
Xenon - Clinical Overview of Current Inhaled Anesthetics
19. Intravenous Anesthetics
19. Intravenous Anesthetics
Barbiturates
Barbiturates - Clinical Uses
Barbiturates - Pharmacodynamics
Barbiturates - Pharmacokinetics
Barbiturates - Side Effects
Benzodiazepines
Benzodiazepines - Pharmacodynamics and Clinical Uses
Benzodiazepines - Pharmacokinetics
Benzodiazepines - Side Effects
Clinical Uses - Dexmedetomidine
Clinical Uses - Ketamine
Clinical Uses - Propofol
Cyclopropyl-methoxycarbonyl Metomidate - New Intravenous Anesthetics
Dexmedetomidine
Etomidate
F - 1. Plasma Concentration after Bolus Injection of an Intravenous Anesthetic
F - 10. Dexmedetomidine
F - 11. Dexmedetomidine's Mechanism of Action in the Central Nervous System
F - 12. Midazolam
F - 13. Thiopental: (RS)-[5-Ethyl-4,6-Dioxo-5-(Pentan-2-Yl)-1,4,5,6-Tetrahydropyrimidin-2-Yl]sulfanide Sodium
F - 14. Structural Comparison Between Midazolam and Remimazolam
F - 15. Etomidate, Cyclopropyl-Methoxycarbonyl Metomidate (CPMM), and Their Metabolites
F - 2. Hydraulic Depiction of a Three-Compartment Model
F - 3. Context-Sensitive Half-Time of Intravenous Anesthetics
F - 4. A Simulation of the Time Necessary to Achieve a 50% Decrease in Drug Concentration in the Blood after Variable Length Intravenous Infusions of Remifentanil, Fentanyl, Alfentanil and Sufentanil
F - 5. Propofol
F - 6. Propofol's Proposed Mechanism of Action in the Central Nervous System
F - 7. Etomidate
F - 8. Ketamine
F - 9. Ketamine's Mechanism of Action in the Central Nervous System
Fospropofol - New Intravenous Anesthetics
Ketamine
New Intravenous Anesthetics
Pharmacodynamics - Dexmedetomidine
Pharmacodynamics - Ketamine
Pharmacodynamics - Propofol
Pharmacodynamics and Clinical Uses - Etomidate
Pharmacokinetics - Dexmedetomidine
Pharmacokinetics - Etomidate
Pharmacokinetics - Ketamine
Pharmacokinetics - Propofol
Pharmocokinetics: General Principles for Intravenous Anesthetics
Propofol
Propofol Formulations - New Intravenous Anesthetics
References
Remimazolam - New Intravenous Anesthetics
Sedasys - New Intravenous Anesthetics
Side Effects - Dexmedetomidine
Side Effects - Etomidate
Side Effects - Ketamine
Side Effects - Propofol
T - 1. Properties of the Ideal Intravenous Anesthetic Agent
T - 10. Midazolam Dosing by Clinical Use
T - 11. Barbiturates
T - 2. Propofol
T - 3. Etomidate
T - 4. Etomidate Pharmacokinetics
T - 5. Ketamine
T - 6. Dexmedetomidine
T - 7. Benzodiazepines
T - 8. Benzodiazepine Metabolism and Clearance
T - 9. Benzodiazepine Pharmacokinetics
20. Opioids
20. Opioids
Cardiovascular Effects - Other Opioid-related Side Effects
Central Opioid Analgesia - Opioid Mechanisms
Classification of Exogenous Opioids - Opioid Pharmacokinetics and Pharmacodynamics
F - 1. Chemical Structure of Commonly Used Opioids
F - 10. Analgesic Response to Morphine-6-Glucuronide in Volunteers with Loss of Functional Mutations in the Melanocortin-1-Receptor Gene (Red Line) Compared to Volunteers with an Intact Gene and Blond or Dark Hair (Blue)
F - 11. Effect of Supplemental Oxygen on Pulse Oximeter Values in a Postoperative Patient on PCA Morphine
F - 12. Effect of the Administration of 50 g Remifentanil on Ventilation in One Subject During Air Breathing (A, C, and E) and During Inhalation of 50% Oxygen (B, D, and F)
F - 13. Safety or Utility Functions
F - 14. Influence of the BK (Ca)-Channel Blocker GAL021 on Opioid-Induced Respiratory Depression
F - 15. Oxygen Saturation Tracings of 16 Patients Following Noncardiac Surgery
F - 16. Episodic Breathing Pattern in a Hypothetical Patient with Recurrent Obstructive Apneic Events As Might Occur During Sleep
F - 2. Simplified Diagram of Activated Descending Inhibitory Pathways (Green Lines) in Response to Afferent Nociceptive Input (Red Lines)
F - 3. Schematic Diagram Illustrating the Role of Opioids in Analgesia of Peripheral Inflammation
F - 4. Context-Sensitive Half-Times, or the Time to a 50% Drop in Plasma Concentration (Cp) Versus Infusion Duration for Remifentanil, Fentanyl, and Sufentanil
F - 5. Morphine Metabolism in the Liver and Transport of its Metabolites into the Bloodstream and Bile System
F - 6. The Ability to Reliably Translate a Randomly Applied Nociceptive Stimulus into a Numerical Pain Score (Between Pain Threshold and Pain Tolerance) is Shown in Healthy Individuals and Chronic Pain Patients, to Demonstrate the Effects of Opioid Treatment
F - 7. Simulated Effect of Multiple Bolus Doses of Fentanyl (100 to 150 g) During Anesthesia, and Morphine During and Following Anesthesia, on the Analgesic and Hemodynamic State of the Patient
F - 8. Effect of a Short Remifentanil Infusion on Breathing
F - 9. Propofol-remifentanil Interaction on âtime to Wake Upâ Following Anesthesia
Gender Differences
Incidence and Risk Factors of Opioid-induced Respiratory Depression - Opioid-induced Respiratory Depression
Mechanisms of Opioid-induced Respiratory Depression - Opioid-induced Respiratory Depression
Metabolism: Which Pathways and Metabolites are Clinically Relevant? - Opioid Pharmacokinetics and Pharmacodynamics
Monitoring - Opioid-induced Respiratory Depression
Nausea and Vomiting - Other Opioid-related Side Effects
Opioid Mechanisms
Opioid Pharmacokinetics - Opioid Pharmacokinetics and Pharmacodynamics
Opioid Pharmacokinetics and Pharmacodynamics
Opioid-induced Hyperalgesia and Tolerance - Opioid Mechanisms
Opioid-induced Respiratory Depression
Opioid-induced Respiratory Depression versus Opioid Analgesia - Opioid-induced Respiratory Depression
Other Opioid-related Side Effects
Peripheral Opioid Analgesia - Opioid Mechanisms
Pharmacodynamics: Pain Relief - Opioid Pharmacokinetics and Pharmacodynamics
Pharmacogenetics - Opioid Pharmacokinetics and Pharmacodynamics
PKPD Models of Opioid Effect: Which End Point Serves the Clinician Best? - Opioid Pharmacokinetics and Pharmacodynamics
References
Remifentanil for Labor Pain
Reversal of Opioid-induced Respiratory Depression - Opioid-induced Respiratory Depression
Smooth Muscle Effects - Other Opioid-related Side Effects
T - 1. Inhibitors and Inducers of CYP3A and Inhibitors of CYP2D6
T - 2. Estimates of Analgesic tchr(189)ke0 for Clinically Relevant End Points of Pain Relief and Respiratory Depression
21. Neuromuscular Blocking Agents
21. Neuromuscular Blocking Agents
Altered Responses to Neuromuscular Blocking Agents
Anticholinesterase Agents - Reversal of Neuromuscular Blockade
Characteristics - Nondepolarizing Neuromuscular Blocking Agents
Characteristics of Depolarizing Blockade - Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Clinical Uses - Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Conclusion
Contraindications - Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Differential Muscle Sensitivity - Monitoring Neuromuscular Blockade
Drug Interactions
Drug Shortages and Clinical Impact - Reversal of Neuromuscular Blockade
Electrode Placement - Monitoring Neuromuscular Blockade
F - 1. Schematic Representation of the Neuromuscular Junction (Not Drawn to Scale)
F - 10. Peripheral Nerve Stimulator-Ministim (Life-Tech, Now Kimberly-Clark, Irving, TX).B: Acceleromyographic Neuromuscular Monitor-Stimpod (Xavant Technologies, Pretoria, South Africa).C: Acceleromyographic Neuromuscular Monitor-TOF-Watch S (Organon Ltd, Swords, Co
F - 11. Single Twitch (ST) Stimulation
F - 12. Approximate Time Course of Twitch Height after Rocuronium, 0.6 mg/kg, at Different Muscles
F - 13. Upper Esophageal Resting Tone in Volunteers Given Vecuronium
F - 14. Time from Injection of Rocuronium Until Recovery to Train of-Four (TOF) Ratio of 0.9 in Adults
F - 15. Neuromuscular Blocking Agent Recovery Curve and Recommendations for Pharmacologic (Neostigmine) Reversal of Neuromuscular Block
F - 16. Duration of Action of Neuromuscular Blockade with Succinylcholine 1 mg/kg (Sux), and Rocuronium 1.2 mg/kg Followed 3 Minutes Later by Sugammadex 16 mg/kg (Roc-Sug)
F - 17. Calabadion 2 (A), the Second-Generation Cucurbituril Receptor, Features a Cavity with Naphthalene Walls and Binds with High Affinity to Steroidal (B; Ka = 0.53-3.4 Ã 109 M-1) and Benzylisoquinoline (Ka = 4.8 Ã 106 M-1) Neuromuscular-Blocking Agents
F - 2. Nicotinic Acetylcholine Receptors (nAChRs) Termed âfetalâ (Due to Their Expression Early in Development) Consist of Five Subunits: Two [α] Subunits, As Well As One [Ã], One , and One Subunit (Denoted As [α](2)[Ã])
F - 3. Nicotinic Acetylcholine Receptors (nAChRs) Termed âadultâ (Due to Their Expression Later in Development) Consist of Five Subunits: Two [α] Subunits, As Well As One [Ã], One , and One Subunit (Denoted As [α](2)[Ã])
F - 4. Example of a Dose-Response Relationship
F - 5. Characteristics of Depolarizing Block
F - 6. Characteristics of Nondepolarizing Block
F - 7. Mean Increase in Intraocular Pressure (IOP) from Baseline in Response to Various Procedures and Maneuvers
F - 8. Neuromuscular Blocking Agents Provide Better Intubating Conditions Than High Doses of Opioids, Without Hypotension
F - 9. Neuromuscular Blockade As a Function of Time for Four Neuromuscular Blocking Agents
Individual Nondepolarizing Agents - Nondepolarizing Neuromuscular Blocking Agents
Monitoring and Clinical Applications - Monitoring Neuromuscular Blockade
Monitoring and Risk-Benefit Ratio - Monitoring Neuromuscular Blockade
Monitoring Modalities - Monitoring Neuromuscular Blockade
Monitoring Neuromuscular Blockade
Morphology of the Neuromuscular Junction - Physiology and Pharmacology
Nerve Stimulation - Physiology and Pharmacology
Neuromuscular Effects - Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Nondepolarizing Neuromuscular Blocking Agents
Onset and Duration of Action - Nondepolarizing Neuromuscular Blocking Agents
Pharmacologic Characteristics
Pharmacology - Nondepolarizing Neuromuscular Blocking Agents
Pharmacology of Succinylcholine - Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Physiology and Pharmacology
Postsynaptic Events - Physiology and Pharmacology
Presynaptic Events: Mobilization and Release of Acetylcholine - Physiology and Pharmacology
Receptor Up- and Downregulation - Physiology and Pharmacology
References
Reversal of Neuromuscular Blockade
Selective Relaxant Binding Agents - Reversal of Neuromuscular Blockade
Side Effects - Depolarizing Neuromuscular Blocking Drugs: Succinylcholine
Stimulator Characteristics - Monitoring Neuromuscular Blockade
T - 1. Pharmacokinetic and Pharmacodynamic Properties of the Depolarizing Neuromuscular Blocking Agent Succinylcholine
T - 10. Relationship between Various Clinical Signs and Peak Inspiratory Force in Healthy Awake Volunteers during Partial Neuromuscular Block
T - 11. Suggested Management of Neuromuscular Blockade According to Monitoring
T - 12. Classification of Depth of Nondepolarizing Neuromuscular Block Based on Subjective and Objective Criteria
T - 13. Summary of Randomized Trials Investigating the Relationship between Depth of Neuromuscular Block, Pneumoperitoneal (Intra-abdominal) Pressure and Outcome
T - 2. Pharmacokinetic and Pharmacodynamic Properties of Aminosteroid Nondepolarizing Neuromuscular Blocking Agents
T - 3. Pharmacokinetic and Pharmacodynamic Properties of Benzylisoquinolinium Nondepolarizing Neuromuscular Blocking Agents
T - 4. Sensitivity of Patients with Neuromuscular Disease to Neuromuscular Blocking Agents and Association with Malignant Hyperthermia
T - 5. Characteristics of Various Patterns of Neurostimulation
T - 6. Relationship between % Receptor Occupancy and Train-of-Four Ratio during Nondepolarizing Block
T - 7. Consistency of the Train-of-Four Ratio in Response to Neurostimulation at Varying Current Intensity at Three Depths of Neuromuscular Block
T - 8. Reliability in Correctly Identifying Presence of Fade in Response to Train-of-Four and Double-Burst Stimulation using Subjective (Visual or Tactile) Methods during Minimal Neuromuscular Block (TOF Ratio = 0.40-0.70).
T - 9. Selected Reports of Postoperative Residual Paralysi, 1979-2016
Testing and Recording the Response - Monitoring Neuromuscular Blockade
22. Local Anesthetics
22. Local Anesthetics
Additives to Increase Local Anesthetic Activity - Pharmacology and Pharmacodynamics
Anatomy of Nerves - Mechanisms of Action of Local Anesthetics
Chemical Properties and Relationship to Activity and Potency - Pharmacology and Pharmacodynamics
Clinical Pharmacokinetics - Pharmacokinetics of Local Anesthetics
Clinical Use of Local Anesthetics
Distribution - Pharmacokinetics of Local Anesthetics
Electrophysiology of Neural Conduction and Voltage-gated Sodium Channels - Mechanisms of Action of Local Anesthetics
Elimination - Pharmacokinetics of Local Anesthetics
F - 1. Schematic Cross-Section of a Typical Peripheral Nerve
F - 10. Fraction of Dose Absorbed into the Systemic Circulation over Time from Epidural Injection of Lidocaine or Bupivacaine
F - 11. Lack of Correlation Between Patient Weight and Peak Plasma Concentration after Epidural Administration of 150 mg of Bupivacaine
F - 12. Success of Resuscitation of Dogs after Cardiovascular Collapse from Intravenous Infusions of Lidocaine, Bupivacaine, Levobupivacaine (L-Bupiv), and Ropivacaine
F - 13. Serum Concentrations in Sheep at Each Toxic Manifestation for Bupivacaine, Levo (L)-Bupivacaine, and Ropivacaine
F - 14. Mild Prolongation in QRS Interval and Change in Cardiac Output after Intravenous Infusions of Bupivacaine (103 mg), Levobupivacaine (L-Bupiv; 37 mg), and Ropivacaine (115 mg) in Healthy Volunteers
F - 15. Diagram Illustrating the Relationship Between Cardiac Action Potential (Top), Sodium Channel State (Middle), and Block of Sodium Channels by Bupivacaine (Bottom)
F - 16. Heart Rate-dependent Effects of Lidocaine and Bupivacaine on Velocity of the Cardiac Action Potential (V.(Max))
F - 17. Plasma Concentrations Required to Induce Myocardial Depression in Dogs Administered Bupivacaine, Levobupivacaine (L-Bupiv), Ropivacaine, and Lidocaine
F - 18. Skeletal Muscle Cross-Section with Characteristic Histologic Changes after Continuous Exposure to Bupivacaine for 6 Hours
F - 19. Comparison of the Duration of Nociceptive (Blue Closed Diamonds) and Motor (Blue Open Diamonds) Blockade Produced by Triple Application of 1% Lidocaine/Capsaicin/Qx-314 (Red Diamonds) or 2% Lidocaine/Capsaicin/Qx-314 (Orange Open Diamonds)
F - 2. Diagram of Node of Ranvier Displaying Mitochondria (M), Tight Junctions in Paranodal Area (P), and Schwann Cell (S) Surrounding Node
F - 3. Schwann Cells Form Myelin around One Myelinated Axon or Encompass Several Unmyelinated Axons
F - 4. Illustration of Dominant Form of Sodium Channel During Generation of an Action Potential
F - 5. Diagram of the Bilayer Lipid Membrane of Conductive Tissue with the Sodium Channel Spanning the Membrane
F - 6. Diagram of the Local Anesthetic Binding Site, Depicting a Hydrophobic Pocket Within the Sodium Channel Pore
F - 7. Diagram Illustrating the Principle of Decremental Conduction Block by Local Anesthetic at a Myelinated Axon
F - 8. Addition of Dexamethasone to Either Ropivacaine or Bupivacaine Increases the Duration of Analgesia after Interscalene Brachial Plexus Block
F - 9. Increasing Doses of Ropivacaine Used for Wound Infiltration Result in Linearly Increasing Maximal Plasma Concentrations (C (Max))
Future Therapeutics and Modalities
Mechanism of Nerve Blockade - Mechanisms of Action of Local Anesthetics
Mechanisms of Action of Local Anesthetics
Molecular Mechanisms of Local Anesthetics - Mechanisms of Action of Local Anesthetics
Pharmacokinetics of Local Anesthetics
Pharmacology and Pharmacodynamics
References
Systemic Absorption - Pharmacokinetics of Local Anesthetics
T - 1. Classification of Nerve Fibers
T - 10. Effects of Cardiac, Hepatic, and Renal Disease on Lidocaine Pharmacokinetics
T - 11. Dose-Dependent Systemic Effects of Lidocaine
T - 12. Practice Advisory on Treatment of Local Anesthetic Systemic Toxicity
T - 13. The Incidence of Transient Neurologic Symptoms (TNSs) Varies with Type of Spinal Local Anesthetic and Surgery
T - 2. Voltage-Gated Sodium Channels
T - 3. Physicochemical Properties of Clinically Used Local Anesthetics
T - 4. Relative Potency of Local Anesthetics for Different Clinical Applications
T - 5. Effects of Addition of Epinephrine to Local Anesthetics
T - 6. Typical Cmax after Regional Anesthesia with Commonly Used Local Anesthetics
T - 7. Pharmacokinetic Parameters of Clinically Used Local Anesthetics
T - 8. Relative Potency for Systemic Central Nervous System Toxicity by Local Anesthetics and Ratio of Dosage Needed for Cardiovascular System: Central Nervous System (CVS:CNS) Toxicity
T - 9. Clinical Profile of Local Anesthetics
Toxicity of Local Anesthetics
Toxicity of Local Anesthetics - Allergic Reactions to Local Anesthetics
Toxicity of Local Anesthetics - Neural Toxicity of Local Anesthetics
Toxicity of Local Anesthetics - Systemic Toxicity of Local Anesthetics
Toxicity of Local Anesthetics - Transient Neurologic Symptoms after Spinal Anesthesia
Toxicity of Local Anesthetics - Treatment of Systemic Toxicity from Local Anesthetics
5: Preoperative Assessment and Perioperative Monitoring
23. Preoperative Patient Assessment and Management
23. Preoperative Patient Assessment and Management
Antibiotic Prophylaxis
Approach to the Healthy Patient
Cardiovascular Disease - Evaluation of the Patient with Known Systemic Disease
Changing Concepts in Preoperative Evaluation
Continuing Current Medications/Treatment of Coexisting Diseases - Preparation
Defining Normal Values - Preoperative Laboratory Testing
Endocrine Disease - Evaluation of the Patient with Known Systemic Disease
Evaluation of the Patient with Known Systemic Disease
F - 1. Cardiac Risk (Percent of Patients Expected to Have Major Cardiac Complications) by Revised Cardiac Risk Index (RCRI) Class and Type of Surgical Procedure
F - 2. Approach to Perioperative Cardiac Assessment for Patients with Coronary Artery Disease (CAD)
F - 3. Approach to Perioperative Cardiac Assessment for Patients with Coronary Artery Stent
F - 4. Percentage of Patients Exhibiting Anxiety from Baseline to Time after Oral Midazolam
F - 5. Percentage of Patients in Each Group Failing to Recall Specific Events of the Operative Day
Liver Disease - Evaluation of the Patient with Known Systemic Disease
Other Diseases - Evaluation of the Patient with Known Systemic Disease
Premedication - Psychological Preparation/Premedication
Preoperative Laboratory Testing
Preparation
Prevention of Perioperative Pulmonary Aspiration - Preparation
Psychological Preparation - Psychological Preparation/Premedication
Psychological Preparation/Premedication
Pulmonary Disease - Evaluation of the Patient with Known Systemic Disease
References
Renal Disease - Evaluation of the Patient with Known Systemic Disease
Risks and Costs versus Benefits - Preoperative Laboratory Testing
Screening Patients Using a Systems Approach - Approach to the Healthy Patient
Smoking Cessation - Preparation
Summary of Patient Preparation
Summary of the Preoperative Evaluation
T - 1. Preanesthetic Evaluation Screen
T - 10. Preoperative Risk Factors for Postoperative Reintubation
T - 11. Clinical Manifestations of Thyroid and Parathyroid Diseases
T - 12. Top 10 Factors Predisposing to Aspiration
T - 13. Summary of Fasting Recommendations for All Ages to Reduce the Risk of Pulmonary Aspiration
T - 14. Comparison of Preoperative Visit to Pentobarbital Premedication (% of patients)
T - 15. Common Preoperative Medications, Doses, and Administration Routes
T - 16. Comparison of Pharmacologic Variables of Benzodiazepines
T - 17. Comparison of Effects of Three Anticholinergic Drugs
T - 2. Classification of Urgency of Surgical Procedures
T - 3. Risk Factors for PONV in Adults
T - 4. Herbal/Dietary Supplements and Drug Interactions
T - 5. Modified Mallampati Airway Classification System
T - 6. Components of the Airway Examination that Suggest Difficult Tracheal Intubation
T - 7. American Society of Anesthesiologists (ASA) Physical Status (PS) Classification
T - 8. Revised Cardiac Risk Index (RCRI)
T - 9. Estimated Energy Requirement for Various Activities
24. Rare Coexisting Diseases
24. Rare Coexisting Diseases
Alzheimer Disease - Central Nervous System Diseases
Amyotrophic Lateral Sclerosis - Central Nervous System Diseases
Andersen-Tawil Syndrome - Skeletal Muscle Channelopathies
Anemias
Central Nervous System Diseases
Cholinesterase Disorders - Other Inherited Disorders
Connective Tissue Diseases
Creutzfeldt-Jakob Disease - Central Nervous System Diseases
Epidermolysis Bullosa - Skin Disorders
Epilepsy - Central Nervous System Diseases
F - 1. Muscle Cell Cytoskeleton
F - 2. Distribution of Predominant Muscle Weakness in Different Types of Muscular Dystrophy
F - 3. Dose-response for Vecuronium in Normal Patients and Patients with Myasthenia Gravis
F - 4. Excitation-contraction Coupling and Malignant Hyperthermia
F - 5. Simplified Pathway of Glycogen Synthesis and Degradation
F - 6. Magnetic Resonance Imaging of a Cervical Spine in a Patient with Rheumatoid Arthritis
F - 7. The Ultrastructure of the Zones of the Skin
F - 8. Epidermolysis Bullosa
Glycogen Storage Diseases - Other Inherited Disorders
Guillain-Barré Syndrome (Polyradiculoneuritis) - Skeletal Muscle Channelopathies
Hemoglobinopathies - Anemias
Hemolytic Anemias - Anemias
Huntington Disease - Central Nervous System Diseases
Hyperkalemic Periodic Paralysis - Skeletal Muscle Channelopathies
Hypokalemic Periodic Paralysis - Skeletal Muscle Channelopathies
Inflammatory Myopathies (Dermatomyositis/Polymyositis) - Connective Tissue Diseases
Malignant Hyperthermia - Other Inherited Disorders
Mucopolysaccharidoses - Other Inherited Disorders
Multiple Sclerosis - Central Nervous System Diseases
Muscular Dystrophy and Congenital Myopathy - Musculoskeletal Diseases
Musculoskeletal Diseases
Myasthenia Gravis - Skeletal Muscle Channelopathies
Myasthenic Syndrome (Lambert-Eaton Syndrome) - Skeletal Muscle Channelopathies
Myotonic Dystrophy - Musculoskeletal Diseases
Nutritional Deficiency Anemias - Anemias
Osteogenesis Imperfecta - Other Inherited Disorders
Other Inherited Disorders
Parkinson Disease - Central Nervous System Diseases
Pemphigus - Skin Disorders
Porphyria - Other Inherited Disorders
References
Rheumatoid Arthritis - Connective Tissue Diseases
Skeletal Muscle Channelopathies
Skin Disorders
Systemic Lupus Erythematosus - Connective Tissue Diseases
Systemic Sclerosis (Scleroderma) - Connective Tissue Diseases
T - 1. Types of Muscular Dystrophy and Congenital Myopathies
T - 10. Treatment of an Acute Episode of Malignant Hyperthermia
T - 11. Safe versus Unsafe Drugs in Malignant Hyperthermia
T - 12. Types of Porphyria
T - 13. Drugs Known to Precipitate Acute Porphyria
T - 14. Classic Cholinesterase Genotypes
T - 15. Classification of Glycogen Storage Diseases
T - 16. Mucopolysaccharidoses
T - 17. Anesthetic Considerations in Osteogenesis Imperfecta
T - 18. Types of Anemia
T - 19. Compensatory Mechanisms to Increase Oxygen Delivery with Chronic Anemia
T - 2. Classification of Myotonic Dystrophy
T - 20. Drugs that Can Produce Hemolysis in Patients with Glucose-6-Phosphate Dehydrogenase Deficiency
T - 21. Hemoglobin Variants
T - 22. Mechanisms of Cellular and Tissue Injury in Sickle Cell Disease
T - 23. Complications of Sickle Cell Disease
T - 24. Extra-articular Manifestations of Rheumatoid Arthritis
T - 25. Adverse Effects of Drugs Used to Treat Connective Tissue Diseases
T - 3. Skeletal Muscle Channelopathies
T - 4. Clinical Features of Familial Periodic Paralysis
T - 5. Clinical Presentations of Myasthenia Gravis
T - 6. Osserman Staging System for Myasthenia Gravis
T - 7. Comparison of Myasthenic Syndrome and Myasthenia Gravis
T - 8. Antiepileptic Drugs Classified by Mechanism of Action
T - 9. Malignant Hyperthermia Clinical Grading Scale
25. The Anesthesia Workstation and Delivery Systems for Inhaled Anesthetics
25. The Anesthesia Workstation and Delivery Systems for Inhaled Anesthetics
Absorptive Capacity - CO(2) Absorbents
Additional Notes
Anesthesia Breathing Circuits
Anesthesia Ventilators
Anesthesia Workstation Pneumatics - Checkout of the Anesthesia Workstation
Anesthesia Workstation Standards and Preuse Procedures
Anesthesia Workstation Variations
Appendix A
Appendix B
ASA 2008 Guidelines for Developing Institution-Specific Checkout Procedures Prior to Anesthesia Delivery - Appendix B
Checkout of the Anesthesia Workstation
Chemistry of Absorbents - CO(2) Absorbents
Circle Breathing Systems - Anesthesia Breathing Circuits
Classification - Anesthesia Ventilators
CO(2) Absorbents
Components - Waste Gas Scavenging Systems
Cylinder Supply Source - Checkout of the Anesthesia Workstation
Datex-Ohmeda S/5 ADU and GE Healthcare Aisys Carestation - Anesthesia Workstation Variations
Electronic Flowmeters - Checkout of the Anesthesia Workstation
Evaluation of the Circle System - Checkout of the Anesthesia Workstation
F - 1. Dräger Apollo Workstation.B: Dräger Perseus A500 Workstation
F - 10. Apollo Manual Checklist Screen
F - 11. Apollo Automated Self-Test Screen
F - 12. 3,000 Psig E-Cylinder with Linde Integrated Valve, Liv (A)
F - 13. 3,000 Psig E-Cylinder Valve Showing 50 Psig DISS Connection (Arrow) (A) that Could Be Connected to the Machine Oxygen Hose if Wall Oxygen Supply Fails (B)
F - 14. DISS Connector.B: PISS Connector
F - 15. Pressure-Sensor Shutoff Valve
F - 16. Oxygen Failure Protection Device/Sensitive Oxygen Ratio Controller (OFPD/S-ORC), Which Responds Proportionally to Changes in Oxygen Supply Pressure
F - 17. Failure of Fail-Safe Valve to Prevent a Hypoxic Mixture
F - 18. Oxygen Flowmeter Assembly
F - 19. The Annular Space
F - 2. Dräger Fabius GS Workstation.B: Mindray A7 Workstation
F - 20. Flow Tube Constriction
F - 21. Flowmeter Sequence-a Potential Cause of Hypoxia
F - 22. Oxygen Flow Tube Leak
F - 23. Datex S5/ADU
F - 24. Dräger Fabius GS
F - 25. Low Flow Wizard of the Drager Apollo Workstation
F - 26. Schematic (A) and Photo (B) of Ohmeda Link-25 Proportion-Limiting Control System
F - 27. Dräger Oxygen Ratio Monitor Controller/Sensitive Oxygen Ratio Controller
F - 28. The Virtual Anesthesia Machine (VAM) Simulator, an Interactive Model of an Anesthesia Machine
F - 29. Saturated Vapor Pressure Versus Temperature Curves for Desflurane, Isoflurane, Halothane, Enflurane, and Sevoflurane
F - 3. GE Aisys CS2 Workstation.B: GE Aestiva Workstation
F - 30. Generic Variable Bypass Vaporizer
F - 31. Simplified Schematic of the GE-Ohmeda Tec Type Vaporizer
F - 32. Simplified Schematic of the Dräger Vapor 19.1 Vaporizer
F - 33. Influence of Gas Composition on Delivered Anesthetic Concentration
F - 34. Simplified Schematic of the Tec 6 Desflurane Vaporizer
F - 35. Performance of Tec Type Vaporizer Versus the Tec 6 Desflurane Vaporizer at Varying Ambient Atmospheric Pressures (1 atm = 760 mmHg)
F - 36. Tec 6 Desflurane Vaporizer Alarm Indicators.B: Dräger D-Vapor Desflurane Alarm Indicators
F - 37. Aladin Vaporizer Sevoflurane Cassette (Courtesy of GE Healthcare)
F - 38. Aladin Cassette Vaporizers (Arrows) on a GE Datex-Ohmeda Aisys Carestation
F - 39. Simplified Schematic of GE-Datex-Ohmeda Aladin Cassette Vaporizer
F - 4. Spacelabs Healthcare ARKON Workstation (Courtesy Spacelabs Healthcare, Snoqualmie, Washington).B: Maquet FLOW-i C30 Workstation
F - 40. Mapleson Breathing Systems (A-f)
F - 41. The Bain Circuit (Coaxial Version of Mapleson D)
F - 42. Dräger Fabius GS Ventilator
F - 43. Inspiratory (A) and Expiratory (B) Phases of Gas Flow in a Traditional Circle System with an Ascending Bellows Ventilator
F - 44. Threshold Pressure Alarm Limit
F - 45. The GE Datex-Ohmeda AS/3 ADU Workstation.B: D-Lite Sensor
F - 46. Dräger Fabius GS Fresh Gas Decoupled (FDG) Breathing System During Inspiratory Phase of Mechanical Ventilation
F - 47. Maquet FLOW-i Breathing and Ventilator Circuit During Positive-Pressure Inspiration
F - 48. Maquet FLOW-i Volume Reflector
F - 49. Components of a Scavenging System
F - 5. Self-Inflating Resuscitation Bag (SIRB)
F - 50. A, B: Two Open Reservoir Scavenging Interfaces
F - 51. Closed Scavenging Interfaces
F - 52. Dynamic Gas Scavenging System (DGSS)
F - 6. Diagram of a Generic Two-Gas Anesthesia Machine
F - 7. Inappropriate Use of the Oxygen Flush Valve to Check the Low-Pressure Circuit of a Datex-Ohmeda Machine Equipped with a Check Valve
F - 8. FDA Negative-Pressure Leak Test
F - 9. Components of the Circle Breathing System
Failure of Anesthesia Equipment
FDA 1993 Anesthesia Apparatus Checkout Recommendations - Appendix A
Flowmeter Assemblies - Checkout of the Anesthesia Workstation
Hazards - Waste Gas Scavenging Systems
Indicators - CO(2) Absorbents
Interactions of Inhaled Anesthetics with Absorbents - CO(2) Absorbents
Low-Pressure Circuit Leak Test - Checkout of the Anesthesia Workstation
Machine Intermediate-Pressure System - Checkout of the Anesthesia Workstation
Mapleson Systems - Anesthesia Breathing Circuits
Maquet FLOW-i Electronic Injector Vaporizer - Vaporizers
Maquet FLOW-i Workstation - Anesthesia Workstation Variations
Nitrous Oxide - Checkout of the Anesthesia Workstation
Operating Principles of Ascending Bellows Pneumatically Powered Ventilators - Anesthesia Ventilators
Oxygen Analyzer Calibration - Checkout of the Anesthesia Workstation
Oxygen Flush Valve - Checkout of the Anesthesia Workstation
Oxygen Supply Pressure Failure Safety Devices - Checkout of the Anesthesia Workstation
Physics - Vaporizers
Pipeline Supply Source - Checkout of the Anesthesia Workstation
Problems and Hazards - Anesthesia Ventilators
Proportioning Systems - Checkout of the Anesthesia Workstation
Recommendations for Preanesthesia Checkout Procedures (2008)Subcommittee of ASA Committee on Equipment and FacilitiesGuidelines for Preanesthesia Checkout (PAC) Procedures - Appendix B
References
Safety Features of Newer Anesthesia Workstations
Standards for Anesthesia Machines and Workstations
T - 1. Comparison of Anesthesia Workstation Functions
T - 2. Physical Properties of Potent Inhaled Volatile Anesthetic Agents
T - 3. Fresh Gas Flow Rate versus Working Pressure
T - 4. Dial Setting versus Flow through Restrictor R2
T - 5. Performance of OLDER Tec Type Vaporizers versus the Tec 6 Desflurane Vaporizer at Varying Ambient Pressures
T - 6. Vaporizer Models and Characteristics
T - 7. Absorbent Comparisons
T - 8. NIOSH Recommendations for Maximum Levels for Exposure of Personnel to Trace Anesthesia Gases and Vapors
The Absorber Canister - CO(2) Absorbents
The Dräger Medical Narkomed 6000 Series, Fabius GS, and Apollo Workstations - Anesthesia Workstation Variations
The GE-Datex-Ohmeda Aladin Cassette Vaporizer - Vaporizers
The Tec 6 and D-Vapor Vaporizers for Desflurane - Vaporizers
Vaporizers
Variable Bypass Vaporizers - Vaporizers
Waste Gas Scavenging Systems
Web-based Anesthesia Software Simulation, the Virtual Anesthesia Machine
Workstation Self-tests - Checkout of the Anesthesia Workstation
26. Commonly Used Monitoring Techniques
26. Commonly Used Monitoring Techniques
Common Problems and Limitations - Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Common Problems and Limitations - Invasive Monitoring of Systemic Blood Pressure
Common Problems and Limitations - Monitoring of Arterial Oxygenation by Pulse Oximetry
Common Problems and Limitations - Monitoring of Body Temperature
Common Problems and Limitations - Monitoring of Cardiac Output by Arterial Waveform Analysis
Common Problems and Limitations - Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Common Problems and Limitations - Monitoring of Central Venous and Right-Heart Pressures
Common Problems and Limitations - Monitoring of Expired Gases
Common Problems and Limitations - Monitoring of Inspired Oxygen Concentration
Common Problems and Limitations - Monitoring of Processed EEG Signals
Contraindications - Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Contraindications - Invasive Monitoring of Systemic Blood Pressure
Contraindications - Monitoring of Arterial Oxygenation by Pulse Oximetry
Contraindications - Monitoring of Body Temperature
Contraindications - Monitoring of Cardiac Output by Arterial Waveform Analysis
Contraindications - Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Contraindications - Monitoring of Central Venous and Right-Heart Pressures
Contraindications - Monitoring of Expired Gases
Contraindications - Monitoring of Inspired Oxygen Concentration
Contraindications - Monitoring of Processed EEG Signals
F - 1. The Oxyhemoglobin Dissociation Curve
F - 10. A Graphical Depiction of the Components of the Arterial Waveform Used by the Windkessel-Based Area Under the Curve Method
F - 11. Representative Data from a Single Human Volunteer Demonstrating Changes in EEG with Increasing Serum Concentrations of Propofol
F - 2. Gaseous-Phase Infrared Transmission Spectrum for Carbon Dioxide and Nitrous Oxide
F - 3. The Normal Capnogram
F - 4. The Relationship Between the Frequency of Fluid-Filled Transducing Systems and Damping
F - 5. Sequence of Oscillometric Blood Pressure Determination
F - 6. The Progression of Intracardiac Pressures from Central Venous Pressure to End-Diastolic Left Ventricular Pressure
F - 7. The Normal Central Venous Pressure (CVP) Trace
F - 8. Pressure Tracing Observed During the Flotation of a Pulmonary Artery Catheter
F - 9. Depiction of Blood Flow into and Out of a Prototypical âwindkessel Artery
Future Trends in Monitoring
Indications - Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Indications - Invasive Monitoring of Systemic Blood Pressure
Indications - Monitoring of Arterial Oxygenation by Pulse Oximetry
Indications - Monitoring of Body Temperature
Indications - Monitoring of Cardiac Output by Arterial Waveform Analysis
Indications - Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Indications - Monitoring of Central Venous and Right-Heart Pressures
Indications - Monitoring of Expired Gases
Indications - Monitoring of Inspired Oxygen Concentration
Indications - Monitoring of Processed EEG Signals
Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Invasive Monitoring of Systemic Blood Pressure
Monitoring of Arterial Oxygenation by Pulse Oximetry
Monitoring of Body Temperature
Monitoring of Cardiac Output by Arterial Waveform Analysis
Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Monitoring of Central Venous and Right-Heart Pressures
Monitoring of Expired Gases
Monitoring of Inspired Oxygen Concentration
Monitoring of Processed EEG Signals
Principles of Operation - Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Principles of Operation - Invasive Monitoring of Systemic Blood Pressure
Principles of Operation - Monitoring of Arterial Oxygenation by Pulse Oximetry
Principles of Operation - Monitoring of Body Temperature
Principles of Operation - Monitoring of Cardiac Output by Arterial Waveform Analysis
Principles of Operation - Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Principles of Operation - Monitoring of Central Venous and Right-Heart Pressures
Principles of Operation - Monitoring of Expired Gases
Principles of Operation - Monitoring of Inspired Oxygen Concentration
Principles of Operation - Monitoring of Processed EEG Signals
Proper Use and Interpretation - Intermittent Noninvasive Monitoring of Systemic Blood Pressure
Proper Use and Interpretation - Invasive Monitoring of Systemic Blood Pressure
Proper Use and Interpretation - Monitoring of Arterial Oxygenation by Pulse Oximetry
Proper Use and Interpretation - Monitoring of Body Temperature
Proper Use and Interpretation - Monitoring of Cardiac Output by Arterial Waveform Analysis
Proper Use and Interpretation - Monitoring of Cardiac Output by Pulmonary Arterial Catheter
Proper Use and Interpretation - Monitoring of Central Venous and Right-Heart Pressures
Proper Use and Interpretation - Monitoring of Expired Gases
Proper Use and Interpretation - Monitoring of Inspired Oxygen Concentration
Proper Use and Interpretation - Monitoring of Processed EEG Signals
References
T - 1. Detection of Critical Events by Implementing Gas Analysis
T - 2. Factors that May Change End-Tidal CO2 (ETCO2) during Anesthesia
T - 3. Arterial Cannulation and Direct Blood Pressure Monitoring
T - 4. Adverse Effects Associated with Pulmonary Artery Monitoring
27. Echocardiography
27. Echocardiography
Aortic Regurgitation - Evaluation of Valvular Heart Disease
Aortic Stenosis - Evaluation of Valvular Heart Disease
Cardiac Masses
Color-flow Doppler - Doppler Echocardiography and Hemodynamics
Congenital Heart Disease
Diastolic Physiology - Evaluation of Left Ventricular Diastolic Function
Diseases of the Aorta
Doppler Echocardiography and Hemodynamics
Echocardiographic Assessment of Left Ventricular Diastolic Function - Evaluation of Left Ventricular Diastolic Function
Echocardiographic Evaluation of Systolic Function
Echocardiography Outside the Operating Room
Echocardiography-assisted Procedures
Epiaortic Examination - Epicardial and Epiaortic Echocardiography
Epicardial and Epiaortic Echocardiography
Epicardial Echocardiography - Epicardial and Epiaortic Echocardiography
Evaluation of Left Ventricular Diastolic Function
Evaluation of Valvular Heart Disease
F - 1. Sound Wave
F - 10. Midesophageal Long-Axis View
F - 11. Midesophageal Ascending Aortic Long-Axis View
F - 12. Midesophageal Ascending Aortic Short-Axis View
F - 13. Midesophageal Aortic Valve Short-Axis View
F - 14. Midesophageal Right Ventricular Inflow-outflow View
F - 15. Midesophageal Bicaval View
F - 16. Transgastric Short-Axis View
F - 17. Descending Aortic Short-Axis View
F - 18. Descending Aortic Long-Axis View
F - 19. Three-Dimensional Transesophageal Echocardiographic Imaging of the Base of the Heart with the Atria Removed, in Systole and Diastole
F - 2. Three-Dimensional Beam
F - 20. Three-Dimensional Imaging of Prolapsing Middle Scallop of the Posterior Mitral Valve Leaflet (Asterisk)
F - 21. Calculating Blood Flow Velocity
F - 22. Doppler Echocardiography in Aortic Insufficiency
F - 23. Evaluation of Aortic Insufficiency (AI)
F - 24. Doppler Evaluation of Mitral Regurgitation (Mr; Midesophageal Five-Chamber View)
F - 25. Determination of Stroke Volume
F - 26. Stroke Volume Calculation
F - 27. Evaluation of Aortic Stenosis
F - 28. Left Ventricular (LV) Walls
F - 29. Two-Dimensional Evaluation of Left Ventricular (LV) Global and Regional Functions
F - 3. Method-Mode (M-Mode) Echocardiography of a Normal Aortic Valve
F - 30. Quantitation of Left Ventricular (LV) Systolic Function
F - 31. Tissue Doppler Imaging
F - 32. Diastolic Phase of the Cardiac Cycle
F - 33. The Impact of Progressive Left Ventricular (LV) Diastolic Dysfunction on Transmitral Mitral Flow (E, A) and Mitral Annular Velocities (E, A)
F - 34. Algorithm for Diagnosis of Left Ventricular Diastolic Dysfunction
F - 35. Echocardiographic Findings in Pericardial Effusion
F - 36. Two-Dimensional Echocardiographic Findings in Mitral Stenosis
F - 37. Doppler Echocardiography Findings in Mitral Stenosis
F - 38. Mitral Regurgitation
F - 39. Aortic Atheromas Imaged in Descending Thoracic Aorta Short-Axis (A and C) and Long-Axis (B and D) Views
F - 4. Scan Lines
F - 40. Aortic Disease
F - 41. Aortic Dissection
F - 42. Cardiac Masses
F - 43. Atrial Septal Defect (ASD)
F - 44. Internal Jugular Vein (IJV) and Carotid Artery (CA) and Their Anatomic Relationship
F - 45. Top: Ultrasound Confirmation of Guide Wire Position
F - 46. Parasternal Long-Axis View of a Patient with Aortic Stenosis Detected on Preoperative Echo
F - 47. Subcostal Four-Chamber View of a Patient with Cardiac Tamponade
F - 48. Standard Transthoracic Echo (TTE) Images Obtained During a FoCUS Exam; Each Panel Shows the Ultrasound Probe Positioning and Corresponding Echo Images
F - 5. Linear Scanners Image a Rectangular Section of the Anatomy Compared with the Arced Sector Imaged with Phased Array Scanners
F - 6. Orientation of the Hand, As Described in the Text, for an Imaging Plane of 0 Degrees
F - 7. Orientation of the Hand, As Described in the Text, for an Imaging Plane of 90 Degrees
F - 8. Midesophageal Four-Chamber View
F - 9. Midesophageal Two-Chamber View
Focused Transthoracic Cardiac Ultrasound
Focused Transthoracic Cardiac Ultrasound - Focused Assessed Transthoracic Echo
Focused Transthoracic Cardiac Ultrasound - Focused Exam Views
Hemodynamic Assessments - Doppler Echocardiography and Hemodynamics
Image Display - Principles and Technology of Echocardiography
Instrumentation - Principles and Technology of Echocardiography
Left Ventricular Cavity - Echocardiographic Evaluation of Systolic Function
Left Ventricular Walls - Echocardiographic Evaluation of Systolic Function
Mitral Regurgitation - Evaluation of Valvular Heart Disease
Mitral Stenosis - Evaluation of Valvular Heart Disease
Pericardial Disease: Constrictive Pericarditis and Pericardial Tamponade - Evaluation of Left Ventricular Diastolic Function
Physics of Sound - Principles and Technology of Echocardiography
Principles and Technology of Echocardiography
Properties of Sound Transmission in Tissue - Principles and Technology of Echocardiography
References
Signal Processing - Principles and Technology of Echocardiography
Spatial versus Dynamic Image Quality - Principles and Technology of Echocardiography
Spectral Doppler - Doppler Echocardiography and Hemodynamics
T - 1. Calculation of Cardiopulmonary Pressures
T - 10. Common Clinical Conditions and Associated Focus Targets
T - 2. Grading of Wall Function
T - 3. Grading of Aortic Stenosis
T - 4. Grading of Mitral Stenosis
T - 5. Grading of Aortic Insufficiency (AI)
T - 6. Carpentier Classification of Mitral Regurgitation (MR)
T - 7. Grading of Mitral Regurgitation
T - 8. Grading of Tricuspid Regurgitation
T - 9. Grading of Pulmonary Regurgitation
Tricuspid and Pulmonic Valve Regurgitation - Evaluation of Valvular Heart Disease
Two-dimensional and Motion-mode Echocardiography - Diseases of the Aorta
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Contraindication to Transesophageal Echocardiography Probe Placement
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Goals of the Two-dimensional Examination
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Orientation
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Probe Insertion
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Probe Manipulation
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Three-dimensional Echocardiography
Two-dimensional and Three-dimensional Transesophageal Echocardiography Examination - Transesophageal Echocardiography Safety
Ultrasound-guided Central Vein Cannulation - Echocardiography-assisted Procedures
6: Basic Anesthetic Management
28. Airway Management
28. Airway Management
Clinical Management of the Airway
Conclusions
F - 1. The Major Landmarks of the Airway Mechanism
F - 10. When a Curved Laryngoscope Blade is Used, the Tip of the Blade is Placed in the Vallecula, the Space Between the Base of the Tongue and the Pharyngeal Surface of the Epiglottis.B: The Tip of a Straight Blade is Advanced Beneath the Epiglottis
F - 11. The Cormack-lehane Laryngeal View Scoring System: Grade 1 (A), Grade 2 (B), Grade 3 (C), and Grade 4 (D)
F - 12. The Bonfils (Karl Storz, Tuttlingen, Germany)
F - 13. The Shikani Seeing Optical Stylet (Clarus Medical, LLC, Minneapolis, MN).B: The Levitan Fps
F - 14. The Clarus Video System (Clarus Medical, LLC, Minneapolis, MN)
F - 15. (A) Mcgrath Mac and (B) Mcgrath Series 5 (Medtronic, Dublin, Ireland), (C) Glidescope Multiuse Blade and (D) Glidescope Cobalt Single-Use Blade (Verathon, Bothell, Wa), and (E) Gliderite Rigid Stylet (Verathon, Bothell, Wa)
F - 16. Passage of a Tracheal Tube through the Right Palatoglossal Arch Due to a Blind Spot Created with Videolaryngoscopy
F - 17. The Storz C-MAC
F - 18. (A) The Pentax Airway Scope (Hoya-Pentax, Tokyo, Japan).(B) The Airtraq Laryngoscope (Prodol Meditec S.a., Vizcaya, Spain)
F - 19. Markings of an Airway Exchange Catheter (AEC) are Aligned with the Markings on the in Situ Tracheal Tube
F - 2. Ultrasound Image of the Cricothyroid Membrane (CTM, Midline Sagittal)
F - 20. The American Society of Anesthesiologists Difficult Airway Algorithm
F - 21. The Airway Approach Algorithm: a Decision Tree Approach to Entry into the American Society of Anesthesiologists Difficult Airway Algorithm
F - 22. The Vortex Approach
F - 23. Airway Innervation
F - 24. The Palatoglossal Arch (Arrow) is a Soft Tissue Fold that is a Continuation of the Posterior Edge of the Soft Palate to the Base of the Tongue
F - 25. The Flexible Intubation Scope May Be Useful for Diagnosis and Therapy below the Level of the Vocal Ligaments, Including Examination of Bronchial Segments and Pulmonary Toilet
F - 26. The Ambu aScope 3 Single-Use Flexible Intubation Scope
F - 27. Size Discrepancy Between an Airway Exchange Catheter or Flexible Intubation Scope and a Tracheal Tube Can Create Clefts that Can Trap Tissues and Hinder Intubation
F - 28. Intubating Oral Airways: (A) Ovassapian, (B) Berman and (C) Williams Intubating Oral Airways
F - 29. The Esophageal Tracheal Combitube
F - 3. Holding the Anesthesia Mask on the Face
F - 30. System for Regulation of a High-Pressure Oxygen Source for Transtracheal Jet Ventilation
F - 31. (A) Ventrain.(B) Cook Transtracheal Catheter.(C) Enk Flow Modulator.(D) Ravussin Needle
F - 4. The Family of Laryngeal Mask Airways (from Top): (A) Unique, (B) Flexible, (C) Supreme, (D) Fastrach
F - 5. Insertion of the Laryngeal Mask Airway (LMA)
F - 6. (A) The King Lt, (B) I-Gel, (C) Air-Q, and (D) Aura-I
F - 7. With the Patient Supine, the Oral and Pharyngeal Axes Do Not Overlap.B: Extension at the Atlanto-Occipital Joint Maximally Overlaps the Oral and Pharyngeal Axes
F - 8. Mallampati/Samsoon-young Classification of the Oropharyngeal View
F - 9. Lingual Tonsil Hyperplasia
History of Airway Management - Perspectives on Airway Management
Limitations of Patient History and Physical Examination - Perspectives on Airway Management
Perspectives on Airway Management
Preoxygenation - Clinical Management of the Airway
References
Review of Airway Anatomy - Perspectives on Airway Management
Support of the Airway with the Induction of Anesthesia - Clinical Management of the Airway
T - 1. Anatomic Differences between Infant and Adult Larynxes
T - 10. Features of the LMA ProSeal
T - 11. Size and Length of Pediatric Tracheal Tubes Relative to Airway Anatomy
T - 12. Mouth Opening Needed for Commonly Used Indirect Laryngoscopes
T - 13. Pulmonary Aspiration: Patients at Risk for Aspiration, Methods to Reduce Aspiration Risk, and ASA Recommended Fasting Guidelines
T - 14. Complications of Tracheal Extubation
T - 15. Criteria for Routine âAwakeâ Postsurgical Extubation
T - 16. Clinical Situations Presenting Increased Risk for Complications at Time of Extubation
T - 17. Regional Anesthesia (RA) for Patients with Likely Difficult Airways
T - 18. The Vortex Approach: Maneuvers and Alterations between Noninvasive Airway Attempts
T - 19. Contraindications to Flexible Scope Intubation
T - 2. Physical Exam Features with Airway Management Implications
T - 20. Common Reasons for Failure of Flexible Scope Intubation
T - 21. Flexible Scope-aided Intubation Techniques
T - 22. Criteria for Performing Emergent Invasive Airway Management
T - 23. Equipment for Retrograde Wire Intubation
T - 3. Conditions with Airway Management Implications
T - 4. Syndromes Associated with Difficult Airway Management
T - 5. Techniques of Common Airway Indexes Measurement
T - 6. Summary of Pooled Sensitivity and Specificity of Commonly Used Methods of Airway Evaluation
T - 7. Simplified Risk Score for Difficult Intubation
T - 8. Assessment and Predictability of Difficult Mask Ventilation
T - 9. Advantages of the Laryngeal Mask Airway in Supraglottic Surgery
The Difficult Airway Algorithm
The Difficult Airway Algorithm - Awake Airway Management
The Difficult Airway Algorithm - Clinically Difficult Airway Scenarios
The Difficult Airway Algorithm - The Airway Approach Algorithm
The Flexible Intubation Scope in Airway Management
The Flexible Intubation Scope in Airway Management - Elements of the Flexible Intubation Scope
The Flexible Intubation Scope in Airway Management - Use of the Flexible Intubation Scope
The SGA in the Failed Airway
The SGA in the Failed Airway - Case 4: Deviation from the Difficult Airway Algorithm
The SGA in the Failed Airway - Other Devices
29. Patient Positioning and Potential Injuries
29. Patient Positioning and Potential Injuries
Complications of Head-Down Positions - Head-Down Positions
Complications of Head-Elevated Positions - Head-Elevated Positions
Complications of Lateral Positions - Lateral Positions
Complications of Prone Positions - Prone Positions
Complications of Supine Positions - Supine Positions
F - 1. Supine Adult with Minimal Gradients in the Horizontal Vascular Axis
F - 10. The Standard Lateral Decubitus Position
F - 11. The Semisupine Position with Dorsal Pads Supporting the Torso, the Extended Arm Padded at the Elbow, and the Elevated Arm Restrained on a Well-Cushioned, Adjustable Overhead Bar (A)
F - 12. The Lateral Jackknife Position, Intended to Open Intercostal Spaces
F - 13. The Flexed Lateral (Kidney) Position
F - 14. Circumduction of the Arm Displacing the Scapula and Stretching the Suprascapular Nerve Between its Anchoring Points at the Cervical Spine and the Suprascapular Notch
F - 15. The Classic Prone Position
F - 16. Sources of Potential Injury to the Brachial Plexus and its Peripheral Components When the Patient is in the Prone Position
F - 17. Conventional Neurosurgical Sitting Position
F - 18. Head-Elevated Positions Often Used for Operations About the Ventral and Ventrolateral Aspects of the Head, Face, Neck, and Cervical Spine
F - 19. The Lawn Chair Position for Surgery around the Shoulder Joint.B: The Upper Torso is Rotated Toward the Nonsurgical Shoulder and Supported with a Firm Roll or Pad
F - 2. Establishment of the Contoured Supine (Lawn Chair) Position
F - 20. Head-Down Tilt
F - 3. Standard Lithotomy Position with âcandy Caneâ Extremity Support
F - 4. Low Lithotomy Position for Perineal Access, Transurethral Instrumentation, or Combined Abdominoperineal Procedures
F - 5. High Lithotomy Position
F - 6. The Exaggerated Lithotomy Position
F - 7. Scapular Winging
F - 8. Medial-to-Lateral View of Right Elbow
F - 9. Arm Restraint, if Excessively Tight, Can Compress the Anterior Interosseous Nerve and Vessel Against the Interosseous Membrane in the Volar Forearm to Produce an Ischemic Neuropathy
Full Prone - Prone Positions
General Principles
Head-Down Positions
Head-Elevated Positions
Lateral Positions
Prone Positions
References
Summary
Supine Positions
Variations of Head-Elevated Positions - Head-Elevated Positions
Variations of Lateral Positions - Lateral Positions
Variations of Supine Positions - Supine Positions
30. Monitored Anesthesia Care
30. Monitored Anesthesia Care
American Society of Anesthesiologists Standards - Monitoring during Monitored Anesthesia Care
Amnesia during Sedation with Dexmedetomidine or Propofol - Specific Drugs Used for Monitored Anesthesia Care
Auscultation - Monitoring during Monitored Anesthesia Care
Benzodiazepines - Specific Drugs Used for Monitored Anesthesia Care
Bispectral Index Monitoring during Monitored Anesthesia Care - Monitoring during Monitored Anesthesia Care
Capnography - Monitoring during Monitored Anesthesia Care
Cardiovascular System - Monitoring during Monitored Anesthesia Care
Communication and Observation - Monitoring during Monitored Anesthesia Care
Computer-assisted Personalized Sedation-SEDASYS - Monitoring during Monitored Anesthesia Care
Conclusion
Context-sensitive Half-time - Distribution, Elimination, Accumulation, and Duration of Action
Dexmedetomidine - Specific Drugs Used for Monitored Anesthesia Care
Distribution, Elimination, Accumulation, and Duration of Action
Drug Interactions
Elimination Half-life - Distribution, Elimination, Accumulation, and Duration of Action
F - 1. The Changes in Drug Concentration During Differing Administration Techniques
F - 2. Context-Sensitive Half-Time As a Function of Infusion Duration
F - 3. The Context-Sensitive Half-Time is Not the Sole Determinant of the Time It Takes for the Patient to Awaken
F - 4. Midazolam Cp50 (the Concentration at Which 50% of Subjects Will Fail to Respond to a Verbal Command) As a Function of Age
Fospropofol - Specific Drugs Used for Monitored Anesthesia Care
Head and Neck Fires with the Use of Supplemental Oxygen - Supplemental Oxygen Administration
Ketamine - Specific Drugs Used for Monitored Anesthesia Care
Monitoring during Monitored Anesthesia Care
Opioids - Specific Drugs Used for Monitored Anesthesia Care
Patient-controlled Sedation and Analgesia - Specific Drugs Used for Monitored Anesthesia Care
Pharmacologic Basis of Monitored Anesthesia Care Techniques: Optimizing Drug Administration
Preoperative Assessment
Preparedness to Recognize and Treat Local Anesthetic Toxicity - Monitoring during Monitored Anesthesia Care
Propofol - Specific Drugs Used for Monitored Anesthesia Care
Pulse Oximetry - Monitoring during Monitored Anesthesia Care
References
Remifentanil - Specific Drugs Used for Monitored Anesthesia Care
Respiratory Function and Sedative-Hypnotic Drugs
Sedation and Analgesia by Nonanesthesiologists - Monitoring during Monitored Anesthesia Care
Sedation and Protective Airway Reflexes - Respiratory Function and Sedative-Hypnotic Drugs
Sedation and Respiratory Control - Respiratory Function and Sedative-Hypnotic Drugs
Sedation and Upper Airway Patency - Respiratory Function and Sedative-Hypnotic Drugs
Specific Drugs Used for Monitored Anesthesia Care
Supplemental Oxygen Administration
T - 1. American Society of Anesthesiologists Statements, Guidelines, and Practice Advisories Related to Monitored Anesthesia Care and Sedation/Analgesia.
T - 2. Published Strategies for Reducing the Pain on Intravenous Injection of Propofol
T - 3. Comparison of the Important Properties of Midazolam and Diazepam
T - 4. Recommended Regimen for the Use of Flumazenil to Antagonize Benzodiazepine Effects
T - 5. Typical Dose Ranges of Sedative, Hypnotic, and Analgesic Drugs
T - 6. A Comparison of Some Important Properties of Propofol and Dexmedetomidine
T - 7. Recommendations to Prevent Burn Injuries during MAC
T - 8. Observer's Assessment of Alertness/Sedation Scale
T - 9. Continuum of Depth of Sedation
Techniques of Monitored Anesthesia Care
Temperature Monitoring and Management during Monitored Anesthesia Care - Monitoring during Monitored Anesthesia Care
Terminology
31. Ambulatory Anesthesia
31. Ambulatory Anesthesia
Acknowledgments
Anxiety Reduction - Preoperative Screening
Benzodiazepines - Managing the Anesthetic: Premedication
Epidural and Caudal Anesthesia - Intraoperative Management: Choice of Anesthetic Method
F - 1. Admission Rates after Ambulatory Surgery Among 635 California Outpatient Surgery Facilities, Studied Between 2005 and 2015
F - 2. Apnea after Regional and General Anesthesia in Infants
F - 3. Overweight or Obese Patients Had Higher Health-Care Charges, When Adjusted for Presence of Medical Comorbidity
F - 4. The Very Smallest Dose (0.25 mg/kg) of Oral Midazolam Syrup Was Equally As Effective As the Two Higher Doses When Commercially Prepared Oral Midazolam Syrup Was Used
F - 5. When a Continuous Femoral Perineural Infusion, Spinal Anesthesia, and Multimodal Analgesia, are Used Together, Pain Scores are Less, When Compared with the Same Spinal Anesthetic Technique and Multimodal Analgesia Plan Coupled with a Placebo Femoral Nerve Catheter
F - 6. Number of Patients with a Continuous Peripheral Nerve Block (CPNB) Per Year by Discharge Status (Inpatient vs
F - 7. Mean Differences in Daily Nausea Scores Between High-Pain and Low-Pain Groups, with 95% Confidence Intervals from Day of Surgery (Dos) to Postoperative Day 7
F - 8. As the Dose of Neuromuscular Blocking Agent (Intraoperative Dose of Atracurium, Cisatracurium, Rocuronium, or Vecuronium) Increases, the Likelihood of Respiratory Complications Increases
General Anesthesia - Intraoperative Management: Choice of Anesthetic Method
Intraoperative Management: Choice of Anesthetic Method
Management of Postanesthesia Care
Managing the Anesthetic: Premedication
Nausea and Vomiting - Management of Postanesthesia Care
Nerve Blocks - Intraoperative Management: Choice of Anesthetic Method
Opioids and Nonsteroidal Analgesics - Managing the Anesthetic: Premedication
Pain - Management of Postanesthesia Care
Place, Procedures, and Patient Selection
Preoperative Screening
Preparation for Discharging the Patient - Management of Postanesthesia Care
References
Regional Techniques - Intraoperative Management: Choice of Anesthetic Method
Restriction of Food and Liquids Prior to Ambulatory Surgery - Preoperative Screening
Reversal of Drug Effects - Management of Postanesthesia Care
Sedation and Analgesia - Intraoperative Management: Choice of Anesthetic Method
Spinal Anesthesia - Intraoperative Management: Choice of Anesthetic Method
T - 1. Guide to Determine Length of Stay for Infants after Surgery
T - 2. An Example of a Scoring System that Can Be Used to Determine Whether a Patient is at Increased Risk for Complications due to OSA
T - 3. Fasting Guidelines before Surgery
T - 4. A Guide to Medications Appropriate to Take Prior to Surgery
T - 5. A Guide to Premedication
T - 6. Status of Drugs Used for the Neuraxial or Perineural Human Research
T - 7. Techniques to Decrease Postoperative Nausea and Vomiting Risk
Upper Respiratory Tract Infection - Preoperative Screening
32. Office-based Anesthesia
32. Office-based Anesthesia
Accreditation - Office Selection and Requirements
Advantages and Disadvantages of Office-based Surgery and Anesthesia
Anesthetic Agents - Anesthetic Techniques
Anesthetic Techniques
Brief Historical Perspective of OBA
Business and Legal Aspects - Regulations
Conclusions
Office Safety
Office Selection and Requirements
Patient Selection
Postanesthesia Care Unit
Procedure Selection
References
Regulations
Specific Procedures - Procedure Selection
Surgeon Selection
T - 1. States that have Regulations Regarding Office-based Surgery and Anesthesia
T - 10. Factors Considered in Accrediting an Office for Surgical Procedures
T - 11. Considerations for the Pediatric Perioperative Anesthesia Environment
T - 12. Definitions of Levels of Sedation/Analgesia by the American Society of Anesthesiology
T - 13. Distribution of Types of Patient Injury during MAC Recorded in ASA Closed Claims Project Database during 1990s
T - 2. Causes of Injury in the Office-based Practice
T - 3. Unsuitable Candidates for an Office-Based Procedure
T - 4. Risk Factors for the Development of Deep Vein Thrombosis (DVT)
T - 5. Recommended Treatment for Prevention of Deep Vein Thrombosis in Patients, Stratified by Risk
T - 6. Sentinel Events that Should Trigger a Case Review and Be Presented at a Performance Improvement/Quality Assurance Meeting
T - 7. Equipment Required for Safe Delivery of Office-based Anesthesia
T - 8. Emergencies that Require Contingency Plans
T - 9. American Society of Anesthesiology Classification of Surgical Procedures
33. Nonoperating Room Anesthesia
33. Nonoperating Room Anesthesia
Adverse Events - Patient Safety in Nonoperating Room Anesthesia
Angiography - Specific Nonoperating Room Procedures
Cardiology and Interventional Cardiology - Specific Nonoperating Room Procedures
Computed Tomography - Specific Nonoperating Room Procedures
Definition of Sedation and Anesthesia - Sedation and Anesthesia
Electroconvulsive Therapy - Specific Nonoperating Room Procedures
Environmental Considerations for Nonoperating Room Anesthesia
F - 1. A Three-Step Paradigm for Nonoperating Room Anesthesia
F - 2. A Radiology Suite Showing a C-Arm and the High Density of Equipment that May Separate the Anesthesiologist from the Patient
F - 3. Three Dimensional En Face View of Mitral Valve
F - 4. Three Dimensional En Face View of Mitral Valve after Two Mitraclips Deployed
Gastroenterology - Specific Nonoperating Room Procedures
General Principles
Interventional Neuroradiology - Specific Nonoperating Room Procedures
Intravenous Contrast Agents - Environmental Considerations for Nonoperating Room Anesthesia
Magnetic Resonance Imaging - Specific Nonoperating Room Procedures
Patient Safety in Nonoperating Room Anesthesia
Pediatric Sedation and Anesthesia for MRI and CT Scans - Specific Nonoperating Room Procedures
Positron Emission Tomography - Specific Nonoperating Room Procedures
Preprocedural Checklists - Patient Safety in Nonoperating Room Anesthesia
Radiation Therapy - Specific Nonoperating Room Procedures
Radiofrequency Ablation - Specific Nonoperating Room Procedures
References
Sedation and Anesthesia
Specific Nonoperating Room Procedures
Standards of Care for Nonoperating Room Anesthesia - Patient Safety in Nonoperating Room Anesthesia
Summary
T - 1. Patient Factors Requiring Sedation or Anesthesia for Nonoperating Room Procedures
T - 10. Arrhythmia Classification
T - 11. Anesthetic Consideration for Electroconvulsive Therapy
T - 2. Common Nonoperating Room Anesthesia Procedures
T - 3. American Society of Anesthesiology Standards for Nonoperating Room Anesthetizing Locations
T - 4. Complications of Nonoperating Room Anesthesia
T - 5. Definition of General Anesthesia and Levels of Sedation/Analgesia
T - 6. Common Terms Used in Radiation Exposure
T - 7. Clinical Manifestations of Immediate and Nonimmediate Hypersensitivity Reactions to Radiocontrast Agents
T - 8. Considerations in Patients Presenting for the Transjugular Intrahepatic Portosystemic Shunt Procedure
T - 9. Common Radiosensitive Tumors in Children
The Continuum of Anesthesia - Sedation and Anesthesia
Three-step Approach to Nonoperating Room Anesthesia
Three-step Approach to Nonoperating Room Anesthesia - The Environment
Three-step Approach to Nonoperating Room Anesthesia - The Patient
Three-step Approach to Nonoperating Room Anesthesia - The Procedure
Transjugular Intrahepatic Portosystemic Shunt - Specific Nonoperating Room Procedures
X-rays and Fluoroscopy - Environmental Considerations for Nonoperating Room Anesthesia
34. Anesthesia for the Older Patient
34. Anesthesia for the Older Patient
Conduct of Anesthesia
Demographics and Economics of Aging
F - 1. The Actual and Estimated US Population from 1940 to 2040 is Shown Broken Down by Age Range
F - 2. Overlap of Frailty with Disability and Comorbidity
F - 3. Age-Related Changes in Body Composition are Gender-Specific
F - 4. The Effect of Age on the Volume of Distribution at Steady State (Vd (ss)) for Pentothal in Women
F - 5. The Effect of Age on the Elimination Half-Life of Diazepam
F - 6. Young and Elderly Adults are Subjected to a Passive Tilt Test in Their Euvolemic State and after an Approximate 2 kg of Water and 100 Meq of Sodium Loss
F - 7. Effect of Aging on Lung Volumes
F - 8. The Response to Total Sympathectomy from Spinal Anesthesia As Illustrated in Older Men with Cardiac Disease
F - 9. The Interaction Between Age and Comorbid Disease
Intraoperative Management - Conduct of Anesthesia
Perioperative Complications - Conduct of Anesthesia
Postoperative Care - Conduct of Anesthesia
References
T - 1. Effect of Age on Drug Dosing
T - 2. Effect of Age on Selected Perioperative Complications and Associated Mortality
The Future
The Physiology of Organ Aging
The Physiology of Organ Aging - Cardiovascular Aging
The Physiology of Organ Aging - Central Nervous System Aging
The Physiology of Organ Aging - Changes in Body Composition, and Liver and Kidney Aging
The Physiology of Organ Aging - Drug Pharmacology and Aging
The Physiology of Organ Aging - Pulmonary Aging
The Physiology of Organ Aging - Thermoregulation and Aging
The Preoperative Visit - Conduct of Anesthesia
The Process of Aging
The Process of Aging - Functional Reserve and the Concept of Frailty
The Process of Aging - Physiologic Age
35. Neuraxial Anesthesia
35. Neuraxial Anesthesia
Anatomy
Backache - Complications
Cardiovascular System - Physiology
Central Nervous System - Physiology
Cerebrospinal Fluid - Anatomy
Complications
Epidural Anesthesia - Pharmacology
Epidural Space - Anatomy
F - 1. The Vertebral Body
F - 10. Scanning in the Paramedian Longitudinal Plane.B: Probe Oriented Parallel to the Axis of Spine Model.C: Ultrasound Image with a Typical Saw-Tooth Sign: Hyperechoic Flat Band on the Right Represents Sacrum, Saw-Teeth Indicate Lamina, and the Two Parallel Bands Between Saw-Teeth Correspond to the Interspace Containing the Ligamentum Flavum-dorsal Dura Unit (Upper) and the Ventral Dura Posterior Longitudinal Ligament-vertebral Body Complex (Lower)
F - 11. Scanning in the Transverse Plane.B: Probe Oriented Perpendicular to the Axis of Spine Model.C: Typical Sonogram of a Lumbar Interspace: Midline Hyperechoic Structures Represent the Ligamentum Flavum-dorsal Dura Unit (Upper) and the Ventral Dura Posterior Longitudinal Ligament-vertebral Body Complex (Lower); Bilateral Symmetrical Hyperechoic Structures Indicate Articular and Transverse Processes with Their Acoustic Shadows
F - 12. Marking Skin Insertion Point in the Transverse Plane
F - 13. Sitting Position for Neuraxial Block
F - 14. Tilting the Operating Table Can Encourage the Patient to Flex Her Hips and Lumbar Spine
F - 15. Lateral Position for Neuraxial Block
F - 16. Some Spinal and Epidural Needles
F - 17. Combined Spinal Epidural Using Standard Needles
F - 18. Vertebral Anatomy of the Lumbar Midline and Paramedian Approaches
F - 19. Troubleshooting Contact with Bones
F - 2. Three-Dimensional Reconstruction of Human Lumbar Ligamentum Flavum (LF)
F - 20. Thoracic Epidural Insertion: Use the Lamina As a Depth Marker and âwalkâ the Needle into the Epidural Space
F - 21. Using an Introducer Needle
F - 22. Hand Positions for Intermittently Advancing a Needle Toward the Epidural Space Using a Winged Needle
F - 23. The Bromage Technique for Identifying the Epidural Space
F - 24. The Doughty Technique: the Nondominant (Left) Hand Braces the Needle Against the Patient's Back
F - 25. Hand Positions for (A) the Original Doughty Technique and (B), (C), and (D) Various âson-of-Doughtyâ Techniques
F - 26. Hand Position for Stabilizing CSE Needles
F - 27. Different Positions of Epidural and Spinal Needles with the Needle-through-Needle CSE Technique
F - 28. Spread of Sensory Block with CSE
F - 29. In the Supine Position, Hyperbaric Local Anesthetics Injected at the Apex of the Lumbar Lordosis (Circle) Flow with Gravity and Pool in the Sacrum and Thoracic Kyphosis
F - 3. The Compartments of the Epidural Space (Grey) are Discontinuous
F - 30. Range of Sensory Block after Intrathecal Injection of Two Different Solutions of 0.5% Tetracaine
F - 31. Mean Radiographic Spread after Epidural Injection of 5 mL Iotrolan, 240 mg I/mL, in 90 Patients
F - 32. Spread of Sensory Block after Intrathecal (IT) or Epidural (EP) Injection of 30 or 45 mg Lidocaine
F - 33. Mean Differences in Cardiac Output (A) and Systemic Vascular Resistance (B) in Term Parturients after Intrathecal Injection of 7 (B7) or 10 (B10) mg Isobaric Bupivacaine
F - 34. Percentage Changes from Prevasopressor Values in Cardiac Output (CO), Heart Rate (HR), and Mean Arterial Pressure (MAP) after the Administration of Phenylephrine or Ephedrine.B: Percentage Changes from Prevasopressor Values, in Stroke Volume (Sv), and Systemic Vascular Resistance (SVR) after the Administration of Phenylephrine or Ephedrine
F - 35. Transmission Electron Micrograph of the Acellular Dura Mater (Collagen Bundles in the Top One-Third of the Micrograph) and the Cellular Arachnoid Mater (Bottom Two-Thirds of the Micrograph)
F - 36. Midline or Paramedian Approaches (Needles A and B) May Directly Traumatize the Spinal Cord, Whereas Unintentional Lateral Deviation of the Needle (C) May Contact the Spinal Nerve or the Anterior or Posterior Primary Ramus Outside the Foramen
F - 37. Extradural Mass Lesions
F - 38. Approach to Perioperative Nerve Injury
F - 4. The Spinal Meninges of a Dog, Showing the Pia Mater (PM) in Apposition to the Spinal Cord, the Subarachnoid Space (SS), the Arachnoid Mater (AM) with Trabeculae Stretching from the Arachnoid Mater to the Pia Mater, and the Dura Mater (DM)
F - 5. Scanning Electron Microscopic Image of a Radial Longitudinal Section of Human Dura Mater
F - 6. Human Spinal Dural Sac
F - 7. Dura-arachnoid Interface Model
F - 8. Fenestrations in the Pial Cellular Layer at the Level of the Spinal Cord
F - 9. Human Sensory Dermatomes
Gastrointestinal System - Physiology
Headache - Complications
Hearing Loss - Complications
High Block/Total Subarachnoid Spinal Block - Complications
Indications and Contraindications
Ligaments - Anatomy
Meninges - Anatomy
Neuraxial Anesthesia and Outcome
Neurologic Injury - Complications
Pharmacology
Physiology
References
Respiratory System - Physiology
Spinal Cord - Anatomy
Subarachnoid Anesthesia - Pharmacology
Systemic Toxicity - Complications
T - 1. Suggested Contents for an Epidural Cart
T - 2. Some Common Surgical Procedures That Can Be Done with Subarachnoid Spinal Anesthesia
T - 3. Recommendations for Epidural Anesthesia
T - 4. Local Anesthetics Used for Surgical Epidural Block
T - 5. Complications of Unintended Intrathecal Injection of 45 mg of Lidocaine in Parturients
Technique
Technique - Approach
Technique - Choice of Technique
Technique - Efficiency and Neuraxial Anesthesia
Technique - Needles
Technique - Patient Preparation
Technique - Technique
Temperature Homeostasis - Physiology
Ultrasound Anatomy of the Spine - Anatomy
Vertebrae - Anatomy
36. Peripheral Nerve Blockade
36. Peripheral Nerve Blockade
Acknowledgments
Avoiding Complications - General Principles and Equipment
Block Performance Stage - General Principles and Equipment
Clinical Anatomy
Continuous Catheter Technique - Specific Techniques
F - 1. Designated Regional Block Room with Labeled Storage Cart
F - 10. Schematic Diagram of the Brachial Plexus
F - 11. Courses of the Terminal Nerves of the Upper Extremity
F - 12. Cutaneous Innervation of the Upper Extremity
F - 13. Schematic Diagrams of the Lumbar (Left; L1-L4) and Sacral (Right; L4-s4) Plexuses
F - 14. Cutaneous Innervation of the Lower Extremity by Terminal Nerves
F - 15. Illustration of the Anterior Pelvic Area Showing Courses of Major Branches of the Lumbar Plexus
F - 16. Ultrasound Scanning of the Supraorbital, Infraorbital, and Mental Foramina
F - 17. Lateral View of a Computed Tomography-Scanned Skull Showing the Bony Landmarks and Final Needle Insertion Angles for the Maxillary (Red Needle) and Mandibular (Blue Needle) Nerves
F - 18. Lateral View of the Head and Neck, Showing Block Needle Insertion Angles Needed to Perform Superficial Cervical Plexus Block
F - 19. Arrangement of Relevant Anatomy for Ultrasound-Guided Interscalene Brachial Plexus Block
F - 2. Current Density is Localized to the Needle Tip When Using Nonconducting Solutions (e.g., D5W), Thereby Maintaining the Motor Response to the Threshold Current Level During Nerve Stimulation
F - 20. Arrangement of Relevant Anatomy for Ultrasound-Guided Supraclavicular Brachial Plexus Block
F - 21. Arrangement of Relevant Anatomy for Ultrasound-Guided Infraclavicular Brachial Plexus Block
F - 22. Arrangement of Relevant Anatomy for Ultrasound-Guided Axillary Brachial Plexus Block
F - 23. Arrangement of Relevant Anatomy for Ultrasound-Guided Radial Nerve Block
F - 24. Illustration of the Anterior Forearm Showing the Courses of the Median and Ulnar Nerves
F - 25. Arrangement of Relevant Anatomy for Ultrasound-Guided Median and Ulnar Nerve Block
F - 26. Arrangement of Relevant Anatomy for Ultrasound-Guided Intercostal Nerve Block
F - 27. Landmarks for Paravertebral Block at the Thoracic Spine
F - 28. Arrangement of Relevant Anatomy and Transverse Probe Placement for Thoracic Paravertebral Block
F - 29. Arrangement of Relevant Anatomy for Ultrasound-Guided TAP Block
F - 3. Probe Sterility Using the Full Cover of a Sterile Sleeve (A) and a Sterile Transparent Dressing (e.g., Tegaderm; 3M Health Care, St Paul, MN) (B)
F - 30. Variations of Abdominal Field Blocks
F - 31. Arrangement of Relevant Anatomy for Ultrasound-Guided Rectus Sheath Block
F - 32. Arrangement of Relevant Anatomy for Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block
F - 33. Surface Landmarking for the Lumbar Plexus (Psoas Compartment) Block
F - 34. Arrangement of Relevant Anatomy for Ultrasound-Assisted Lumbar Plexus Block
F - 35. Arrangement of Relevant Anatomy for Ultrasound-Guided Femoral Nerve Block
F - 36. Arrangement of Relevant Anatomy for Ultrasound-Guided Obturator Nerve Block (Anterior and Posterior Branches) in the Proximal Thigh Using an Oop Approach
F - 37. Arrangement of Relevant Anatomy for Ultrasound-Guided Saphenous Nerve Block Using a Transsartorius Perifemoral Approach
F - 38. Landmarks for Sciatic Nerve Block Using a Posterior Gluteal (Labat) Approach When Using Nerve Stimulation Procedure
F - 39. Arrangement of Relevant Anatomy for Ultrasound-Guided Sciatic Nerve Block Using a Posterior Gluteal (Labat) Approach
F - 4. Compressed Air Injection Technique (CAIT) Used to Avoid High Injection Pressure; 50% Compression of Air Volume Within the Syringe Corresponds to an Injection Pressure of 760 mmHg
F - 40. Arrangement of Relevant Anatomy for Ultrasound-Guided Sciatic Nerve Block with a Subgluteal Approach
F - 41. Arrangement of Relevant Anatomy for Ultrasound-Guided Sciatic Nerve Block with a Popliteal Approach
F - 42. Arrangement of Relevant Anatomy for Ultrasound-Guided Sciatic Block Using an Anterior Approach
F - 43. Arrangement of Relevant Anatomy for Ultrasound-Guided Posterior Tibial Nerve Block at the Ankle Using an Ip Approach
F - 44. Arrangement of Relevant Anatomy for Ultrasound-Guided Deep Peroneal Nerve Block at the Anterior Ankle
F - 5. Major Branches of the Trigeminal Nerve
F - 6. Schematic Diagram of the Cervical Plexus, Which Arises from the Anterior Primary Rami of C2-c4
F - 7. The Cervical, Thoracic, Lumbar, and Sacral Dermatomes of the Body
F - 8. Needle Insertion Points and Angles for Deep Cervical Plexus Block
F - 9. Greater and Lesser Occipital Nerve Anatomy, Supply (Green, Greater Occipital Nerve; Pink, Lesser Occipital Nerve), and Block Needle Insertion Sites (X)
General Principles and Equipment
Head and Neck - Clinical Anatomy
Head and Neck - Specific Techniques
Lower Extremity - Clinical Anatomy
Lower Extremity - Specific Techniques
Other Related Equipment - General Principles and Equipment
Penile Block - Specific Techniques
Postblock Stage - General Principles and Equipment
Preblock Stage - General Principles and Equipment
Premedication and Sedation - General Principles and Equipment
References
Specific Techniques
Spine - Clinical Anatomy
T - 1. Useful Anatomic Landmarks for Localizing Nerves during Common Ultrasound-guided Peripheral Nerve Blocks
Techniques - Specific Techniques
Trunk - Clinical Anatomy
Trunk Nerve Blocks - Specific Techniques
Upper Extremity - Clinical Anatomy
Upper Extremity - Specific Techniques
7: Anesthesia Subspeciality Care
37. Anesthesia for Neurosurgery
37. Anesthesia for Neurosurgery
A Practical Approach - Cerebral Protection
Anesthesia and Traumatic Brain Injury
Anesthesia for Spine Trauma and Complex Spine Surgery
Anesthetic Management
Anesthetic Management - Anesthesia and Traumatic Brain Injury
Arteriovenous Malformations - Common Surgical Procedures
Awake Craniotomy - Common Surgical Procedures
Carotid Surgery - Common Surgical Procedures
Central Nervous System Function - Monitoring
Cerebral Aneurysm Surgery and Endovascular Treatment - Common Surgical Procedures
Cerebral Oxygenation and Metabolism Monitors - Cerebral Perfusion
Cerebral Perfusion
Cerebral Protection
Common Surgical Procedures
Comorbid Injuries - Anesthesia for Spine Trauma and Complex Spine Surgery
Complications of Anesthesia for Spine Surgery - Anesthesia for Spine Trauma and Complex Spine Surgery
Conclusion
Emergence - Anesthetic Management
Epilepsy Surgery - Common Surgical Procedures
F - 1. Gross Anatomy of the Brain
F - 10. Lundberg A, B, and C Wave Morphologies
F - 2. The Circle of Willis, Demonstrating the Anterior and Posterior Blood Supply to the Brain
F - 3. Gross Anatomy of the Venous Drainage System of the Brain, Including the Major Venous Sinuses
F - 4. Cerebrospinal Fluid Compartments Within and around the Brain
F - 5. Major Ascending and Descending Spinal Cord Tracts (Cross-Section)
F - 6. The Spinal Cord Blood Supply
F - 7. Autoregulation in the Central Nervous System: Cerebral Blood Flow (CBF) Remains Constant Between Mean Arterial Pressures (MAP) of Approximately 60 to 160 mmHg (Blue)
F - 8. Intracranial Elastance Curve
F - 9. Representative Brainstem Auditory Evoked Potential (BAEP), Somatosensory Evoked Potential (SSEP), and Motor Evoked Potential (MEP) Tracings
Fluids and Electrolytes - Anesthetic Management
Glucose and Cerebral Ischemia - Cerebral Protection
Glucose Management - Anesthetic Management
Hypothermia - Cerebral Protection
Induction of Anesthesia and Airway Management - Anesthetic Management
Influence of Anesthetic Technique on Evoked Potentials - Monitoring
Initial Management - Anesthesia for Spine Trauma and Complex Spine Surgery
Intracranial Pressure Monitoring - Cerebral Perfusion
Intraoperative Management - Anesthesia for Spine Trauma and Complex Spine Surgery
Ischemic and Reperfusion - Cerebral Protection
Laser Doppler Flowmetry - Cerebral Perfusion
Maintenance of Anesthesia - Anesthetic Management
Monitoring
Neuroanatomy
Neurophysiology
Pathophysiology
Pharmacologic Therapy for Cerebral Protection - Cerebral Protection
Pituitary Surgery - Common Surgical Procedures
Preoperative Evaluation - Anesthetic Management
References
Spinal Cord Injury - Anesthesia for Spine Trauma and Complex Spine Surgery
Surgery for Tumors - Common Surgical Procedures
T - 1. Functionality of CNS Structures
T - 2. Hunt and Hess Grading System
T - 3. World Federation of Neurological Surgeons (WFNS) Grading Scale
T - 4. Fisher Grade System
T - 5. Spetzler-Martin Grading System
T - 6. American Spinal Cord Association (ASIA) Impairment Scale
Transcranial Doppler Ultrasonography - Cerebral Perfusion
Transfusion Therapy - Anesthetic Management
Ventilation Management - Anesthetic Management
38. Anesthesia for Thoracic Surgery
38. Anesthesia for Thoracic Surgery
Absolute Indications for One-lung Ventilation - One-lung Ventilation
Anesthesia for Diagnostic Procedures
Anesthesia for Resection of the Trachea - Anesthesia for Special Situations
Anesthesia for Special Situations
Bronchopleural Fistula and Empyema - Anesthesia for Special Situations
Bronchopulmonary Lavage - Anesthesia for Special Situations
Bronchoscopy - Anesthesia for Diagnostic Procedures
Central Venous Pressure Monitoring - Intraoperative Monitoring
Choice of Anesthesia for Thoracic Surgery
Clinical Approach to Management of One-lung Ventilation - Management of One-lung Ventilation
Complications Following Thoracic Surgery - Postoperative Management and Complications
Confirmation of Correct Position of DLT or Endobronchial Blocker - Management of One-lung Ventilation
Continuous Positive Airway Pressure to the Nondependent Lung - Management of One-lung Ventilation
Diagnostic Procedures for Mediastinal Mass
Direct Arterial Catheterization - Intraoperative Monitoring
Effects of Anesthetics on Hypoxic Pulmonary Vasoconstriction - Hypoxic Pulmonary Vasoconstriction
Evaluation of the Cardiovascular System - Preoperative Evaluation
F - 1. Estimated 2011 Deaths from Cancer in the United States
F - 10. Schematic Representation of Two-Lung Ventilation Versus One-Lung Ventilation (OLV)
F - 11. Left Main Stem Endobronchial Intubation Using a Carlens Tube
F - 12. Fiberoptic Bronchoscopic View of the Main Carina (A), the âleft Bronchial Carinaâ (B), and the Right Bronchus (C)
F - 13. Malposition of the Left Bronchial Limb of the Double-Lumen Tube (DLT)
F - 14. Bronchoscopic View Showing Laceration in Left Mainstem Bronchus
F - 15. Lung Separation in the Patient with a difficult Airway
F - 16. The Univent Tube Also Allows Lung Separation Using a Single-Lumen Endotracheal Tube.B: The Univent Bronchial Blocker Positioned in Left Main Stem Bronchus
F - 17. Arndt Blocker.B: Cohen Blocker.C: Uniblocker.D: Ez Blocker
F - 18. Conclusion of the Surgical Procedure
F - 19. Effect of 10 Cm H (2)O Positive End-Expiratory Pressure (PEEP) on Functional Residual Capacity (FRC)
F - 2. Flow-volume Loop in a Normal Subject
F - 20. Role of Hypoxic Pulmonary Vasoconstriction (HPV) in Preserving Pao (2) (in Dogs)
F - 21. Flow Chart Describing the Preoperative Evaluation of the Patient with an Anterior Mediastinal Mass
F - 22. Anatomic Relationships During Mediastinoscopy
F - 3. Flow-volume Loops Relative to Lung Volumes in a Normal Subject, in a Patient with COPD, in a Patient with Fixed Obstruction (Tracheal Stenosis), and in a Patient with Pulmonary Fibrosis (Restrictive Defect)
F - 4. The Order of Tests to Determine the Cardiopulmonary Status of the Patient and the Extent of Lung Resection that Would Be Tolerated
F - 5. Schematic Representation of the Effects of Gravity on the Distribution of Pulmonary Blood Flow in the Lateral Decubitus Position
F - 6. Schematic Representation of Mediastinal Shift in the Spontaneously Breathing, Open-Chested Patient in the Lateral Decubitus Position
F - 7. Schematic Representation of Paradoxical Respiration in the Spontaneously Breathing, Open-Chested Patient in the Lateral Decubitus Position
F - 8. The Left Side of the Schematic Shows the Distribution of Ventilation in the Awake Patient (Closed Chest) in the Lateral Decubitus Position, and the Right Side Shows the Distribution of Ventilation in the Anesthetized Patient (Closed Chest) in the Lateral Decubitus Position
F - 9. This Schematic of a Patient in the Lateral Decubitus Position Compares the Closed-Chested Anesthetized Condition with the Open-Chested Anesthetized and Paralyzed Condition
High-Frequency Ventilation - Anesthesia for Special Situations
History - Preoperative Evaluation
Hydration and Removal of Bronchial Secretions - Preoperative Preparation
Hypoxic Pulmonary Vasoconstriction
Infection - Preoperative Preparation
Inspired Oxygen Fraction - Management of One-lung Ventilation
Intraoperative Monitoring
Lung Cysts and Bullae - Anesthesia for Special Situations
Lung Separation in the Patient with a Difficult Airway - One-lung Ventilation
Lung Separation in the Patient with a Tracheostomy - One-lung Ventilation
Management of One-lung Ventilation
Mediastinoscopy - Diagnostic Procedures for Mediastinal Mass
Methods of Lung Separation - One-lung Ventilation
Monitoring of Oxygenation and Ventilation - Intraoperative Monitoring
Myasthenia Gravis - Anesthesia for Special Situations
Myasthenic Syndrome (Eaton-Lambert Syndrome) - Anesthesia for Special Situations
Nitric Oxide and One-lung Ventilation - Hypoxic Pulmonary Vasoconstriction
One-lung Ventilation
Other Determinants of Hypoxic Pulmonary Vasoconstriction - Hypoxic Pulmonary Vasoconstriction
Physical Examination - Preoperative Evaluation
Positive End-expiratory Pressure to the Dependent Lung - Management of One-lung Ventilation
Postoperative Management and Complications
Postoperative Pain Control - Postoperative Management and Complications
Potentiators of Hypoxic Pulmonary Vasoconstriction - Hypoxic Pulmonary Vasoconstriction
Preoperative Evaluation
Preoperative Preparation
Pulmonary Artery Catheterization - Intraoperative Monitoring
Pulmonary Function Testing and Evaluation for Lung Resectability - Preoperative Evaluation
Pulmonary Rehabilitation - Preoperative Preparation
References
Relative Indications for One-lung Ventilation - One-lung Ventilation
Smoking - Preoperative Preparation
T - 1. Indications for One-lung Ventilation
T - 2. Indications for the Use of Endobronchial Blockers
T - 3. Comparison of Bronchial Blockers (BBs)
T - 4. Clinical Approach to One-lung Ventilation (OLV) Management
T - 5. Indications for Bronchoscopy
T - 6. Instruments of Choice for Bronchoscopy
T - 7. Clinical Classification of Myasthenia Gravis (MG)
T - 8. Anticholinesterase Drugs Used to Treat Myasthenia Gravis
T - 9. Disorders Associated with Myasthenia Gravis
Thoracoscopy - Diagnostic Procedures for Mediastinal Mass
Tidal Volume and Respiratory Rate - Management of One-lung Ventilation
Transesophageal Echocardiography - Intraoperative Monitoring
Video-assisted (Minimally Invasive) Thoracoscopic Surgery - Diagnostic Procedures for Mediastinal Mass
Wheezing and Bronchodilation - Preoperative Preparation
39. Anesthesia for Cardiac Surgery
39. Anesthesia for Cardiac Surgery
Anesthesia for Children with Congenital Heart Disease
Anesthetic and Intraoperative Management - Anesthesia for Children with Congenital Heart Disease
Anticoagulation - Cardiopulmonary Bypass
Aortic Aneurysm - Aortic Diseases
Aortic Diseases
Aortic Dissection - Aortic Diseases
Aortic Insufficiency - Valvular Heart Disease
Aortic Stenosis - Valvular Heart Disease
Blood Conservation in Cardiac Surgery - Cardiopulmonary Bypass
Bring Backs - Postoperative Considerations
Cardiopulmonary Bypass
Circuits - Cardiopulmonary Bypass
Coronary Artery Disease
Coronary Blood Flow - Coronary Artery Disease
Current Drug Therapy - Preoperative and Intraoperative Management
F - 1. Determinants of Myocardial Oxygen Balance
F - 10. General Approach to Termination of Cardiopulmonary Bypass (CPB)
F - 11. Hemodynamic Abnormalities on Termination of Cardiopulmonary Bypass
F - 12. Algorithm for the Diagnosis and Treatment of Hemodynamic Abnormalities on Termination of Cardiopulmonary Bypass
F - 13. The Physiologic Effects of Intra-Aortic Balloon Pump (IABP) Counterpulsation
F - 2. The Pressure Relationships Between the Aorta (1) and the Left Ventricle (2) Determine Coronary Perfusion Pressure
F - 3. Pathophysiology of Aortic Stenosis
F - 4. Pathophysiology of Primary Left Ventricular (LV) Hypertrophy in Hypertrophic Cardiomyopathy
F - 5. Pathophysiology of Aortic Insufficiency
F - 6. Pathophysiology of Mitral Stenosis
F - 7. Pathophysiology of Mitral Regurgitation
F - 8. The Basic Circuit for Cardiopulmonary Bypass
F - 9. Weaning from Cardiopulmonary Bypass
Heat Exchanger - Cardiopulmonary Bypass
Hemodynamic Goals - Coronary Artery Disease
Hybrid Procedures in Pediatric Cardiac Surgery - Anesthesia for Children with Congenital Heart Disease
Hypertrophic Cardiomyopathy - Valvular Heart Disease
Inhalation Anesthetics - Coronary Artery Disease
Intraoperative Management - Preoperative and Intraoperative Management
Intravenous Sedative Hypnotics - Coronary Artery Disease
Minimally Invasive Cardiac Surgery
Mitral Regurgitation - Valvular Heart Disease
Mitral Stenosis - Valvular Heart Disease
Monitoring - Anesthesia for Children with Congenital Heart Disease
Monitoring - Preoperative and Intraoperative Management
Monitoring for Ischemia - Coronary Artery Disease
Myocardial Oxygen Demand - Coronary Artery Disease
Myocardial Oxygen Supply - Coronary Artery Disease
Myocardial Protection - Cardiopulmonary Bypass
Opioids - Coronary Artery Disease
Oxygenators - Cardiopulmonary Bypass
Pain Management - Postoperative Considerations
Physical Examination - Preoperative and Intraoperative Management
Postoperative Considerations
Premedication - Anesthesia for Children with Congenital Heart Disease
Premedication - Preoperative and Intraoperative Management
Preoperative and Intraoperative Management
Preoperative Evaluation - Anesthesia for Children with Congenital Heart Disease
Prime - Cardiopulmonary Bypass
Pumps - Cardiopulmonary Bypass
References
Selection of Anesthetic - Coronary Artery Disease
Selection of Anesthetic Drugs - Preoperative and Intraoperative Management
T - 1. Coronary Artery Disease: Hemodynamic Goals
T - 10. Preoperative Findings Suggestive of Ventricular Dysfunction
T - 11. Preoperative Physical Examination
T - 12. Anesthetic Preparation for Cardiac Surgery
T - 13. Checklist before Initiating Cardiopulmonary Bypass
T - 14. Checklist during Cardiopulmonary Bypass
T - 15. Checklist before Separation from Cardiopulmonary Bypass
T - 16. Etiology of Right or Left Ventricular Dysfunction after Cardiopulmonary Bypass
T - 17. Steps for Improving Systemic Flow
T - 18. Medications Given by Continuous Infusion
T - 19. Right Ventricular Failure
T - 2. Treatment of Intraoperative Ischemia
T - 20. Intra-aortic Balloon Pump Indications and Contraindications
T - 21. Physiologic Effects of Congenital Cardiac Lesions
T - 22. Classification of Cardiac Murmurs
T - 3. Aortic Stenosis: Hemodynamic Goals
T - 4. Hypertrophic Cardiomyopathy: Hemodynamic Goals
T - 5. Aortic Insufficiency: Hemodynamic Goals
T - 6. Mitral Stenosis: Hemodynamic Goals
T - 7. Mechanisms of Mitral Regurgitation
T - 8. Mitral Regurgitation: Hemodynamic Goals
T - 9. Acute Aortic Dissection: Hemodynamic Goals
Tamponade - Postoperative Considerations
Tracheal Extubation and Postoperative Ventilation - Anesthesia for Children with Congenital Heart Disease
Treatment of Ischemia - Coronary Artery Disease
Valvular Heart Disease
40. Anesthesia for Vascular and Endovascular Surgery
40. Anesthesia for Vascular and Endovascular Surgery
Aortic Reconstruction - Open Vascular Surgery
Carotid Artery Stenting - Endovascular Surgery
Cerebrovascular Disease - Open Vascular Surgery
Conclusion
Concurrent Vascular Disease in Vascular Surgery Patients - Vascular Disease
Endovascular Aortic Repair - Endovascular Surgery
Endovascular Management of Peripheral Artery Disease - Endovascular Surgery
Endovascular Surgery
F - 1. Rate of Cardiovascular Death, Myocardial Infarction, or Major Adverse Cardiac Event by Presence, Severity, and Extent of Coronary Artery Disease (CAD)
F - 10. Odds Ratio for Outcome of (A) Stroke or Death, or (B) Death for Carotid Endarterectomy Performed Under General Versus Local Anesthesia
F - 11. Cumulative Incidence of Abdominal Aortic Aneurysm Rupture, According to Aneurysm Diameter at Diagnosis
F - 12. Systemic Hemodynamic Response to Aortic Cross-Clamping (AoX)
F - 13. Blood Volume Redistribution Following Aortic Cross-Clamp (AoX) Placement
F - 14. Hemodynamic Response to Aortic Cross-Clamp (AoX) Release
F - 15. Vascular Supply to the Spinal Cord
F - 16. Snorkel and Periscope Stents
F - 17. Types of Endoleaks
F - 2. Typical Overlap of Atherosclerotic Cardiovascular Disease by Vascular Bed
F - 3. ST Segment Changes with Heart Rate (HR) During an Ischemic Episode
F - 4. Temporal Trends in [Ã]-Blockade Initiation Within 30 Days of Surgery from 2003 to 2012
F - 5. Cumulative Survival and Freedom from Major Adverse Cardiac Event for Routine Versus Selective Coronary Angiography Prior to Major Vascular Surgery in Intermediate- to High-Risk Patients
F - 6. Univariate Kaplan-meier (K-M) Survival Curves, Stratified According to Postoperative Myocardial Ischemia, for Different Major Vascular Surgical Procedures
F - 7. Proposed Algorithm for Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery
F - 8. Intact and Hypoplastic Circle of Willis
F - 9. Characteristic Electroencephalogram (EEG) Changes with Reduction in Cerebral Blood Flow
Introduction and Overview
Medical Optimization Prior to Vascular Surgery - Vascular Disease
Open Vascular Surgery
Pathophysiology of Atherosclerosis - Vascular Disease
Peripheral Artery Disease - Open Vascular Surgery
Preoperative Anesthesia Evaluation for Vascular Surgery - Vascular Disease
References
T - 1. Coronary Artery Disease (CAD) Severity for Vascular Surgery Patients Who Underwent Routine or Selective Coronary Angiography
T - 2. Effect of Level of Aortic Occlusion on Changes in Cardiovascular Variables
T - 3. Risk Scores for 30-day Mortality for EVAR Patients
Vascular Disease
41. Obstetric Anesthesia
41. Obstetric Anesthesia
Advanced Maternal Age - Management of High-risk Parturients
Alcohol - Substance Abuse
Altered Drug Responses - Physiologic Changes of Pregnancy
Amphetamines - Substance Abuse
Analgesia for Labor and Vaginal Delivery
Anesthesia for Cesarean Delivery
Anesthesia for Nonobstetric Surgery in the Pregnant Woman
Anesthetic Complications
Cardiovascular Changes - Physiologic Changes of Pregnancy
Cocaine - Substance Abuse
Diabetes Mellitus - Management of High-risk Parturients
Diagnostic Procedures - Newborn Resuscitation in the Delivery Room
F - 1. Diagram of the Circulation in the Mature Fetal Lamb
F - 10. American Heart Association Neonatal Resuscitation Algorithm
F - 11. Recommendations for Management of Parturients and Surgical Procedures
F - 2. Management of the difficult Airway in Pregnancy with Special Reference to the Presence or Absence of Fetal Distress
F - 3. Proposed Scheme of Pathophysiologic Changes in Toxemia of Pregnancy
F - 4. Comparison of the Balance in the Biologic Actions of Prostacyclin and Thromboxane in Normal Pregnancy with the Imbalance of Increased Thromboxane and Decreased Prostacyclin in Preeclamptic Pregnancy
F - 5. Initial Central Venous Pressure Measurements (Three or More Recordings of Maternal Diastolic Pressure) and Intravenous Volume Replacement Required to Attain the Range of 6 to 8 Cm H (2)O in Five Groups of Women with Preeclampsia Classified According to the Severity of the Disease (by Diastolic Blood Pressure)
F - 6. Mean Platelet Count in Women with HELLP Syndrome Without Steroids, and Before and after Standard Steroid (24 mg/Day) and High Steroid (24 mg/Day) Therapy
F - 7. Mean and SE of Mean Arterial Pressure (MAP), Mean Pulmonary Artery Pressure (PAP), and Pulmonary Wedge Pressure (PWP) in Patients with Severe Preeclampsia Receiving Thiopental and Nitrous Oxide (40%) with 0.5% Halothane Anesthesia for Cesarean Section
F - 8. Classification and Mechanism of Fetal Heart Rate Patterns
F - 9. Three-Tiered Fetal Heart Rate Interpretation System
Fetal Asphyxia - Newborn Resuscitation in the Delivery Room
Fetal Monitoring
Fetal Monitoring - Ancillary Tests and Fetal Pulse Oximetry
Fetal Monitoring - Electronic Fetal Monitoring
Fetus and Newborn - Placental Transfer and Fetal Exposure to Anesthetic Drugs
Gastrointestinal Changes - Physiologic Changes of Pregnancy
General Anesthesia - Anesthesia for Cesarean Delivery
Heart Disease - Management of High-risk Parturients
Hematologic Alterations - Physiologic Changes of Pregnancy
Hemodynamic Factors - Placental Transfer and Fetal Exposure to Anesthetic Drugs
Hypertensive Disorders of Pregnancy - Management of High-risk Parturients
Hypotension - Anesthetic Complications
Local Anesthetic Systemic Toxicity - Anesthetic Complications
Management of High-risk Parturients
Marijuana - Substance Abuse
Maternal Mortality - Anesthetic Complications
Metabolism - Physiologic Changes of Pregnancy
Neonatal Adaptations at Birth - Newborn Resuscitation in the Delivery Room
Nerve Injury - Anesthetic Complications
Neuraxial Anesthesia - Anesthesia for Cesarean Delivery
Newborn Resuscitation in the Delivery Room
Nonpharmacologic Methods of Labor Analgesia - Analgesia for Labor and Vaginal Delivery
Obesity - Management of High-risk Parturients
Obstetric Hemorrhage - Management of High-risk Parturients
Opioids - Substance Abuse
Physiologic Changes of Pregnancy
Placenta - Placental Transfer and Fetal Exposure to Anesthetic Drugs
Placental Transfer and Fetal Exposure to Anesthetic Drugs
Postdural Puncture Headache - Anesthetic Complications
Practical Suggestions - Anesthesia for Nonobstetric Surgery in the Pregnant Woman
Preterm Delivery
Pulmonary Aspiration - Anesthetic Complications
References
Regional Analgesia - Analgesia for Labor and Vaginal Delivery
Respiratory Changes - Physiologic Changes of Pregnancy
Resuscitation - Newborn Resuscitation in the Delivery Room
Substance Abuse
Systemic Medication - Analgesia for Labor and Vaginal Delivery
T - 1. Summary of Physiologic Changes of Pregnancy at Term
T - 2. Uterotonic Therapy
T - 3. Hemodynamic Goals with Valvular Lesions
T - 4. Anesthetic Considerations Associated with Cocaine and/or Amphetamine Abuse
T - 5. Resuscitation Equipment in the Delivery Room
T - 6. Therapeutic Guidelines for Neonatal Resuscitation
T - 7. Apgar Scores
The Apgar Score - Newborn Resuscitation in the Delivery Room
Tobacco Abuse - Substance Abuse
Total Spinal Anesthesia - Anesthetic Complications
42. Neonatal Anesthesia
42. Neonatal Anesthesia
Acknowledgment
Anatomy of the Neonatal Airway - Physiology of the Infant and the Transition Period
Anesthetic Dose Requirements of Neonates - Anesthetic Management of the Neonate
Anesthetic Drugs in Neonates - Physiology of the Infant and the Transition Period
Anesthetic Management of the Neonate
Blood Component Therapy in the Neonate - Physiology of the Infant and the Transition Period
F - 1. Schematic Representation of the Fetal Circulation
F - 10. Effect of Age on Minimum Alveolar Concentration (MAC) of Anesthetic Gases
F - 11. Ilioinguinal Nerve Block
F - 12. Caudal Block
F - 13. TAP (Transversus Abdominis Plane) Block Using a Linear Ultrasound Probe with a Small Footprint (25 mm), the Abdominal Wall is Scanned from Medial to Lateral, the Three Layers of the Abdominal Muscles are Recognized, a Needle is Inserted into the Space Between the Internal Oblique and the Transversus Abdominis Muscle While Hydro-Dissecting to Find the Plane, 0.5 mL/kg of 0.125% Bupivacaine is Injected into Each Side to Provide Analgesia for the Abdominal Wall
F - 14. Schematic Drawings Illustrating the Development of the Diaphragm
F - 15. Infant with Left-Sided Congenital Diaphragmatic Hernia
F - 16. Another Infant with Congenital Diaphragmatic Hernia
F - 17. Omphalocele on Day 1 of Life
F - 18. Gastroschisis
F - 19. Silo Placement on Neonate with Gastroschisis
F - 2. Schema of Reduced Cardiac Reserve in Fetal and Newborn Animal Hearts Compared with Adult Hearts
F - 20. Diagrams of the Five Most Commonly Encountered Forms of Esophageal Atresia and Tracheoesophageal Fistula, Shown in Order of Frequency
F - 21. Jejunal Atresia
F - 22. Laparascopic Repair of Pyloric Stenosis
F - 3. Static Lung Volumes of Infants and Adults
F - 4. Correlation of Mean Pulmonary Arterial Pressure with Age in 85 Normal-Term Infants Studied During the First 3 Days of Life
F - 5. Diagram of Muscle Extension Along Pulmonary Arterial Branches (Shaded Bars)
F - 6. Complicating Anatomic Factors in Infants
F - 7. Configuration of the Adult (A) Versus the Infant (B) Larynx
F - 8. Insertion of Miller Blade Down the Right Side of the Tongue
F - 9. Cricoid Pressure Applied with Little Finger
Fluid and Electrolyte Therapy in the Neonate - Physiology of the Infant and the Transition Period
Impact of Surgical Requirements on Anesthetic Technique - Anesthetic Management of the Neonate
Intraoperative Considerations - Anesthetic Management of the Neonate
Maternal Drug Use during Pregnancy - Special Considerations
Neurodevelopmental Effects of Anesthetic Agents - Special Considerations
Physiology of the Infant and the Transition Period
Postoperative Apnea - Special Considerations
Postoperative Pain Management - Anesthetic Management of the Neonate
Postoperative Ventilation - Anesthetic Management of the Neonate
Preoperative Considerations - Anesthetic Management of the Neonate
References
Regional Anesthesia - Anesthetic Management of the Neonate
Respiratory Distress Syndrome - Special Considerations
Retinopathy of Prematurity - Special Considerations
Special Considerations
Summary
Surgical Procedures in Neonates
Surgical Procedures in the First Month of Life - Surgical Procedures in Neonates
Surgical Procedures in the First Week of Life - Surgical Procedures in Neonates
T - 1. Normal Blood Gas Values in the Neonate
T - 2. Comparison of Normal Respiratory Values in Infants and Adults
T - 3. Abnormalities Associated with the Preterm Infant: Common Anesthetic Concerns
T - 4. Common Ventilator Strategies in Neonates
T - 5. Advantages of Particular Ventilator Strategies in Neonates
T - 6. Regional Anesthesia Techniques Useful in Neonates
T - 7. Postoperative Pain Control for Neonates and Infants
Temperature Control and Thermogenesis - Special Considerations
The Cardiovascular System - Physiology of the Infant and the Transition Period
The Hepatic System - Physiology of the Infant and the Transition Period
The Pulmonary System - Physiology of the Infant and the Transition Period
The Renal System - Physiology of the Infant and the Transition Period
Uptake and Distribution of Anesthetics in Neonates - Anesthetic Management of the Neonate
43. Pediatric Anesthesia
43. Pediatric Anesthesia
Airway - Anatomy and Physiology
Allergies - Preoperative Assessment
Anatomy and Physiology
Anesthetic Risks; Consent/Assent - Preoperative Assessment
Anxiolysis - Preoperative Preparation
Bradycardia - Problems during Induction of Anesthesia
Cardiovascular - Anatomy and Physiology
Central Nervous System - Anatomy and Physiology
Developmental Pharmacology - Pharmacology
Emergence and Recovery from Anesthesia
Emergence Delirium - PACU Complications
Emergency Drugs - Induction of Anesthesia
Equipment - Induction of Anesthesia
F - 1. Developmental Changes in Common Cytochromes of Interest in Pediatric Anesthesia
F - 2. The More Rapid Washin of Halothane in Children Compared with Adults
F - 3. Age and the MAC of Isoflurane from Premature Infants to Adults
F - 4. Pharmacokinetics of Dantrolene in Children 2 to 7 Years of Age
F - 5. for the Child Who Fears the Face Mask, the Mask is Removed and the Elbow of the Breathing Circuit is Inserted Between Interlaced Fingers in the Hand
F - 6. Algorithm to Diagnose and Manage Laryngospasm in Children
F - 7. Position of the Child after Tracheal Extubation in Preparation for Transfer to PACU and the Pediatric ICU
Fasting Guidelines - Preoperative Assessment
Fluid Management - Maintenance of Anesthesia
Full Stomach and Rapid Sequence Induction - Induction of Anesthesia
Hemoglobin Oxygen Desaturation - Problems during Induction of Anesthesia
Induction of Anesthesia
Induction Techniques - Preoperative Preparation
Inhalational Anesthetics - Pharmacology
Intravenous - Pharmacology
Laboratory Testing - Preoperative Assessment
Laryngospasm - Problems during Induction of Anesthesia
Laryngospasm, Postoperative Stridor, and Negative Pressure Pulmonary Edema - PACU Complications
Maintenance of Anesthesia
Medical Conditions - Preoperative Assessment
Monitors - Induction of Anesthesia
Oxygen Desaturation - PACU Complications
PACU Complications
Pharmacology
Postoperative Pain - PACU Complications
Preoperative Assessment
Preoperative History - Preoperative Assessment
Preoperative Physical Examination - Preoperative Assessment
Preoperative Preparation
Problems during Induction of Anesthesia
Prophylaxis for Postoperative Vomiting - Maintenance of Anesthesia
References
Regional Anesthesia and Pain Management - Maintenance of Anesthesia
T - 1. Anatomic Features of the Upper Airway in Infants Compared with Adults
T - 10. Subacute Bacterial Endocarditis Prophylaxis Recommendations by American Heart Association
T - 11. Drug Dosing for Obese Children
T - 12. Factors Associated with Laryngospasm
T - 13. Causes of Bradycardia in Infants and Children
T - 14. Causes of Delayed Emergence from Anesthesia in Children
T - 2. Normal Range of Resting Heart Rates and Blood Pressure in Children
T - 3. Pharmacology of Inhaled Anesthetics
T - 4. Determinants of the Washin and Washout of Inhalational Anesthetics
T - 5. Factors That Explain the More Rapid Washin of Inhalational Anesthetics in Children Compared with Adults
T - 6. Pseudocholinesterase Variants
T - 7. Fasting Guidelines for Children Requiring Elective Anesthesia
T - 8. Criteria to Cancel Anesthesia with an Upper Respiratory Tract Infection
T - 9. Washout Times for Inhalational Anesthetics from Current Anesthesia Workstations
Techniques - Maintenance of Anesthesia
Transport to PACU
Vomiting - PACU Complications
8: Anesthesia for Selected Surgical Services
44. Anesthesia for Laparoscopic and Robotic Surgeries
44. Anesthesia for Laparoscopic and Robotic Surgeries
Acute Pain Management - Postoperative Management
Airway Edema - Complications Related to Surgery
Ambulatory Laparoscopic Surgery - Laparoscopic Surgery
Anesthesia Maintenance - Intraoperative Management
Body Temperature - Intraoperative Management
Cardiovascular System - Physiologic Impact of Laparoscopy
Complications Related to Surgery
Conclusion
F - 1. Robotic Surgery Room Setup
F - 2. Venous Air Embolism of the Right Atrium Visible with Transesophageal Echocardiographic Monitoring
Fluid Management - Intraoperative Management
Intraoperative - Complications Related to Surgery
Intraoperative Management
Laparoscopic Surgery
Mechanical Ventilation - Intraoperative Management
Monitoring - Intraoperative Management
Ocular Injuries - Complications Related to Surgery
Patient Shifting and Falls - Complications Related to Surgery
Peripheral Nerve and Brachial Plexus Injuries - Complications Related to Surgery
Physiologic Impact of Laparoscopy
Postoperative Complications
Postoperative Management
Postoperative Nausea and Vomiting - Postoperative Management
References
Regional Perfusion Effects - Physiologic Impact of Laparoscopy
Respiratory Dysfunction - Postoperative Complications
Respiratory System - Physiologic Impact of Laparoscopy
Robotic Laparoscopic Surgery - Laparoscopic Surgery
Surgical Approach and Positioning - Laparoscopic Surgery
T - 1. Benefits of Laparoscopic Surgery
T - 2. Disadvantages of Laparoscopy Surgery
T - 3. Examples of Robotic-assisted Laparoscopic Surgery
T - 4. Causes of Hemodynamic Changes during Laparoscopy
T - 5. Causes of Pulmonary Changes during Laparoscopy
T - 6. Causes of Severe Hypercarbia during Laparoscopy
T - 7. Causes of Hypoxia during Laparoscopy
T - 8. Causes of Regional Perfusion Changes during Laparoscopy
Venous Thrombosis - Postoperative Complications
45. Anesthesia and Obesity
45. Anesthesia and Obesity
Airway Management - Intraoperative Considerations
Ambulatory Anesthesia
Cardiovascular and Hematologic Systems - Pathophysiology
Critical Care and Resuscitation
Definition and Epidemiology
Emergence - Intraoperative Considerations
Equipment and Monitoring - Intraoperative Considerations
F - 1. Effects of Obesity, Positioning, and Anesthesia on Lung Volumes
F - 2. Interrelationship of Cardiovascular and Pulmonary Sequelae of Obesity
F - 3. Adaptation of the Heart to Obesity and Hypertension
F - 4. Body Composition in Extremely Obese and Weight-Reduced States Compared with Reference Female Values
F - 5. Ramped Position with âstackingâ of Towels and Blankets
F - 6. Illustration of the Walter Henderson Maneuver
Fluid Management - Intraoperative Considerations
Gastrointestinal System - Pathophysiology
Induction and Maintenance - Intraoperative Considerations
Intraoperative Considerations
Introduction - Definition and Epidemiology
Management of Obesity - Definition and Epidemiology
Mechanical Ventilation - Intraoperative Considerations
Monitored Anesthesia Care and Sedation - Intraoperative Considerations
Monitoring - Postoperative Considerations
Morbidity and Mortality
Other Perioperative Agents - Pharmacology
Pathophysiology
Pharmacologic Principles - Pharmacology
Pharmacology
Postoperative Analgesia - Postoperative Considerations
Postoperative Considerations
Preoperative Evaluation
References
Regional Anesthesia - Intraoperative Considerations
Renal and Endocrine Systems - Pathophysiology
Respiratory System - Pathophysiology
T - 1. Classification of Obesity, and Systemic Disease Risk According to Waist Circumference
T - 2. Implications of Medical Consequences of Obesity
T - 3. Intravenous Drug Dosing in Obesity
T - 4. Summary of Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea (OSA): A Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea
Ventilatory Evaluation and Management - Postoperative Considerations
46. The Liver: Surgery and Anesthesia
46. The Liver: Surgery and Anesthesia
Acknowledgment
Acute Hepatitis - Hepatic and Hepatobiliary Diseases
Acute Liver Failure - Hepatic and Hepatobiliary Diseases
Alcoholic Hepatitis - Hepatic and Hepatobiliary Diseases
Ascites - Cirrhosis and Portal Hypertension
Assessment of Hepatic Function
Cardiac Manifestations - Cirrhosis and Portal Hypertension
Chronic Cholestatic Disease
Chronic Hepatocellular Disease
Cirrhosis and Portal Hypertension
Conclusions
Drug-induced Liver Injury - Hepatic and Hepatobiliary Diseases
F - 1. A Magnified Cross-Section of a Liver Lobule (Right) with its Component Cells and Structures is Juxtaposed to a 90-Degree Rotated View of a Portion of This Cross-Section (Left) Showing the Mixing of Hepatic Portal and Arterial Blood in the Hepatic Sinusoids
F - 2. Transjugular Intrahepatic Portosystemic Shunt Procedure
F - 3. Schematic Depiction of Couinaud Segmental Liver Anatomy and the Normal Portal Venous Structures
Hemostasis - Cirrhosis and Portal Hypertension
Hepatic and Hepatobiliary Diseases
Hepatic Encephalopathy - Cirrhosis and Portal Hypertension
Hepatic Evaluation - Preoperative Management
Hepatic Function in Health
Hepatic Resection - Intraoperative Management
Hepatobiliary Imaging
Hepatocellular Carcinoma
Intraoperative Management
Liver Biopsy
Monitoring and Vascular Access - Intraoperative Management
Nonalcoholic Fatty Liver Disease
Perioperative Risk Associated with Liver Disease - Preoperative Management
Pharmacokinetic and Pharmacodynamic Alterations - Intraoperative Management
Postoperative Liver Dysfunction
Pregnancy-related Liver Diseases - Hepatic and Hepatobiliary Diseases
Preoperative Management
Pulmonary Complications - Cirrhosis and Portal Hypertension
References
Renal Dysfunction - Cirrhosis and Portal Hypertension
Selection of Anesthetic Technique - Intraoperative Management
T - 1. Blood Tests and the Differential Diagnosis of Hepatic Dysfunction
T - 10. Proposed Nomenclature of Hepatic Encephalopathy
T - 11. Precipitating Factors in Hepatic Encephalopathy
T - 12. Modified Child-Pugh Score
T - 13. Causes of Postoperative Liver Dysfunction
T - 14. Causes of Hyperbilirubinemia
T - 2. Initial Laboratory Analysis of Suspected Acute Liver Failure
T - 3. Grades of Encephalopathy
T - 4. ICP Management Protocol
T - 5. King's College Selection Criteria for Liver Transplantation According to the Etiology of Acute Liver Failure
T - 6. Clinical Chemistry Criteria for Drug-Induced Liver Injury (DILI)
T - 7. Distinguishing Features of Intrahepatic Cholestasis of Pregnancy (ICP), the HELLP Syndrome, and Fatty Liver of Pregnancy (AFLP)
T - 8. Staging of the Hepatopulmonary Syndrome
T - 9. West Haven Criteria for Semiquantitative Grading of Mental State
Transjugular Intrahepatic Portosystemic Shunt Procedure - Intraoperative Management
Varices - Cirrhosis and Portal Hypertension
Vasopressors - Intraoperative Management
Volume Resuscitation - Intraoperative Management
47. Endocrine Function
47. Endocrine Function
Adrenal Cortex
Adrenal Insufficiency (Addison Disease) - Adrenal Cortex
Adrenal Medulla
Anesthetic Management - Diabetes Mellitus
Anterior Pituitary - Pituitary Gland
Calcium Physiology - Parathyroid Glands
Classification - Diabetes Mellitus
Diabetes Mellitus
Diagnosis - Diabetes Mellitus
Emergencies - Diabetes Mellitus
Endocrine Response to Surgical Stress
Exogenous Glucocorticoid Therapy - Adrenal Cortex
F - 1. Thyroid Hormone Biosynthesis Consists of Four Stages: (1) Organification, (2) Binding, (3) Coupling, and (4) Release
F - 10. Time Course for Postoperative Insulin Resistance in Patients Undergoing Open Cholecystectomy
F - 2. Parathyroid Hormone (PTH) and Vitamin D Metabolism and Action
F - 3. Interrelationship of the Volume and Potassium Feedback Loops on Aldosterone Secretion
F - 4. Plasma Cortisol Concentrations (Mean ± SEM) Were Measured in Three Groups of Patients Undergoing Elective Surgery
F - 5. Synthesis and Metabolism of Endogenous Catecholamines
F - 6. Catabolism of Norepinephrine and Epinephrine
F - 7. Correlation of Hemoglobin A1c with Average Glucose
F - 8. Relation Among Perioperative Injury, Hyperglycemia, and Outcomes
F - 9. Modulators of Perioperative Hyperglycemia
Glucocorticoid Excess (Cushing Syndrome) - Adrenal Cortex
Glucocorticoid Physiology - Adrenal Cortex
Glycemic Goals - Diabetes Mellitus
Hyperglycemia and Perioperative Outcomes - Diabetes Mellitus
Hyperparathyroidism - Parathyroid Glands
Hypoparathyroidism - Parathyroid Glands
Management of Perioperative Hyperglycemia - Diabetes Mellitus
Mineralocorticoid Excess - Adrenal Cortex
Mineralocorticoid Insufficiency - Adrenal Cortex
Mineralocorticoid Physiology - Adrenal Cortex
Parathyroid Glands
Perioperative Glycemic Control - Diabetes Mellitus
Pheochromocytoma - Adrenal Medulla
Physiology - Diabetes Mellitus
Pituitary Gland
Posterior Pituitary - Pituitary Gland
References
T - 1. Tests of Thyroid Gland Function
T - 10. Criteria for the Diagnosis of Diabetes
T - 11. Properties of Selected Glucose-lowering Drugs
T - 12. Properties of Common Insulin Preparations
T - 13. Current Recommendations for Glycemic Control in Critically Ill Patients
T - 14. Management of Diabetic Ketoacidosis
T - 2. Causes of Hyperthyroidism
T - 3. Management of Thyroid Storm
T - 4. Causes of Hypothyroidism
T - 5. Management of Myxedema
T - 6. Management of Acute Adrenal Insufficiency
T - 7. Management Options for Steroid Replacement in the Perioperative Period
T - 8. Glucocorticoid Preparations
T - 9. Drugs Used in the Management of Pheochromocytoma
Thyroid Gland
Thyroid Gland - Hyperthyroidism
Thyroid Gland - Hypothyroidism
Thyroid Gland - Tests of Thyroid Function
Thyroid Gland - Thyroid Metabolism and Function
Treatment - Diabetes Mellitus
48. Anesthesia for Otolaryngologic Surgery
48. Anesthesia for Otolaryngologic Surgery
Acknowledgments
Airway Surgery - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Anesthetic Management - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Complications - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Ear Surgery - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Epiglottitis - Pediatric Airway Emergencies
Evaluating the Airway
F - 1. Events Leading to Cor Pulmonale
F - 2. Classification of Tonsil Size, Including Percentage of Oropharyngeal Area Occupied by Hypertrophied Tonsils
F - 3. Patient with a Peritonsillar Abscess on the Left Side
F - 4. Neck Radiograph of a Patient with a Peritonsillar Abscess (Arrow)
F - 5. Computed Tomography Scan of a Patient with a Peritonsillar Abscess (Arrow)
F - 6. Illustration of Facial Nerve and Monitoring Electrodes
F - 7. Aspirated Foreign Body in the Right Main Stem Bronchus
F - 8. The Surgical Laryngoscope and the Jet Ventilator Needle.B: The Surgical View of the Laryngoscope Positioned in the Patient's Pharynx and Connected to a Continuous Flow of Oxygen through the Jet Ventilator Needle.C: View of the Anesthetized, Spontaneously Breathing Patient.D: Laser-Aided Resection of Vocal Cord Lesion
Foreign Body Aspiration - Pediatric Airway Emergencies
Laryngology - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Laryngotracheobronchitis - Pediatric Airway Emergencies
Laser Surgery of the Airway - Pediatric and Adult Surgery
Maxillofacial Trauma - Pediatric and Adult Surgery
Nasal Surgery - Pediatric and Adult Surgery
Pediatric Airway Emergencies
Pediatric and Adult Surgery
Preoperative Evaluation - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
References
Skull Base Surgery - Pediatric and Adult Surgery
Sleep-disordered Breathing and Obstructive Sleep Apnea - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
T - 1. Tonsillectomy and Adenoidectomy Inpatient Guidelines: Recommendation of the American Academy of Otolaryngology-Head and Neck Surgery
T - 2. Causes of Stridor
T - 3. Clinical Component of the Evaluation of Patients with Stridor
T - 4. Comparison of External Diameter of Standard Endotracheal Tubes versus Rigid Bronchoscope
T - 5. Comparison of Standard Plastic versus Metal Endotracheal Tubes
Tonsillectomy and Adenoidectomy - Anesthesia for Pediatric Ear, Nose, and Throat Surgery
Upper Airway Infections - Pediatric and Adult Surgery
49. Anesthesia for Ophthalmologic Surgery
âOpen-Eye, Full-Stomachâ Encounters - Anesthetic Management in Specific Situations
49. Anesthesia for Ophthalmologic Surgery
Acute Glaucoma - Postoperative Ocular Complications
Adjuvant Drugs - Effects of Anesthesia and Adjuvant Drugs on Intraocular Pressure
Anesthesia Options - Preoperative Evaluation
Anesthesia Techniques - Preoperative Evaluation
Anesthetic Management in Specific Situations
Anesthetic Ramifications of Ophthalmic Drugs
Anticholinesterase Agents - Anesthetic Ramifications of Ophthalmic Drugs
Central Nervous System Depressants - Effects of Anesthesia and Adjuvant Drugs on Intraocular Pressure
Chemical Injury - Postoperative Ocular Complications
Cocaine - Anesthetic Ramifications of Ophthalmic Drugs
Corneal Abrasion - Postoperative Ocular Complications
Cortical Blindness - Postoperative Ocular Complications
Cyclopentolate - Anesthetic Ramifications of Ophthalmic Drugs
Effects of Anesthesia and Adjuvant Drugs on Intraocular Pressure
Epinephrine - Anesthetic Ramifications of Ophthalmic Drugs
Establishing Rapport and Assessing Medical Condition - Preoperative Evaluation
F - 1. Diagram of Ocular Anatomy
F - 10. Sub-Tenon (Episcleral) Block with Blunt Cannula
F - 2. Ocular Anatomy Concerned with Control of Intraocular Pressure
F - 3. Mean Intraocular Pressure after Administration of Thiopental, 3 to 4 mg/kg, and Pancuronium, 0.08 mg/kg at 0
F - 4. Intraconal (Retrobulbar) Block and Schematic Representation of the Intraorbital Muscle Cone
F - 5. Needle Placement for Intraconal (Retrobulbar) Block
F - 6. Extraconal (Peribulbar) Block and Schematic Representation of the Intraorbital Muscle Cone
F - 7. Needle Placement for Extraconal (Peribulbar) Block
F - 8. Ultrasound-Guided Block with Overlay
F - 9. Base of the Brain and the Path that Local Anesthetic Agents Might Follow if Inadvertently Injected into the Subarachnoid Space
Formation and Drainage of Aqueous Humor - Ocular Physiology
Glaucoma - Ocular Physiology
Hemorrhagic Retinopathy - Postoperative Ocular Complications
Intraocular Perfluorocarbons - Anesthetic Ramifications of Ophthalmic Drugs
Intraocular Surgery - Anesthetic Management in Specific Situations
Ischemic Optic Neuropathy - Postoperative Ocular Complications
Maintenance of Intraocular Pressure - Ocular Physiology
Mild Visual Symptoms - Postoperative Ocular Complications
Ocular Anatomy
Ocular Physiology
Oculocardiac Reflex
Phenylephrine - Anesthetic Ramifications of Ophthalmic Drugs
Photic Injury - Postoperative Ocular Complications
Postcataract Ptosis - Postoperative Ocular Complications
Postoperative Ocular Complications
Preoperative Evaluation
Principles of Laser Therapy - Anesthetic Management in Specific Situations
References
Retinal Detachment Surgery - Anesthetic Management in Specific Situations
Retinal Ischemia - Postoperative Ocular Complications
Side of Anesthesia and Surgery - Preoperative Evaluation
Strabismus Surgery - Anesthetic Management in Specific Situations
Systemic Ophthalmic Drugs - Anesthetic Ramifications of Ophthalmic Drugs
T - 1. Requirements of Ophthalmic Surgery
T - 2. Effects of Succinylcholine on Intraocular Pressure: Double-Blind d-Tubocurarine or Gallamine Pretreatment
T - 3. Differential Solubilities of Gases
T - 4. Complications of Needle-based Ophthalmic Anesthesia
T - 5. Concerns with Various Ocular Procedures
Timolol and Betaxolol - Anesthetic Ramifications of Ophthalmic Drugs
Ventilation and Temperature - Effects of Anesthesia and Adjuvant Drugs on Intraocular Pressure
50. The Renal System and Anesthesia for Urologic Surgery
50. The Renal System and Anesthesia for Urologic Surgery
Acid-Base Disorders - Perioperative Nephrology
Acute Kidney Conditions - Perioperative Nephrology
Chronic Kidney Disease - Perioperative Nephrology
Clinical Assessment of the Kidney - Renal Anatomy and Physiology
Cystectomy and Other Major Bladder Surgeries
Electrolyte Disorders - Perioperative Nephrology
Emergency Treatment of Nephrolithiasis - Urologic Surgical Emergencies
F - 1. The Gross Anatomy and Internal Structure of the Genitourinary System and Kidney.B: Internal Organization of the Kidney Includes Cortex and Medulla Regions and the Vasculature.C: The Nephron is the Functional Unit of the Kidney.D: Plasma Filtration Occurs in the Glomerulus; 20% of Plasma that Enters the Glomerulus Passes through the Specialized Capillary Wall into the Bowman Capsule and Enters the Tubule to Be Processed and Generate Urine
F - 10. Images from a Robotic Radical Prostatectomy Procedure Highlight the Significant Difficulty in Accessing Patients after the Robot is Docked (A), the Remote Location of the Surgeon (B), the Utility of a Carefully Placed Mayo Stand to Protect the Patient's Face and Endotracheal Tube (C), and the Value of Shoulder Support Padding to Avoid Pressure Injuries (D)
F - 11. Intervention Choices for Urinary Tract Stones
F - 12. Nitric Oxide-mediated Vascular Smooth Muscle Relaxation, Including the Inhibiting Effects of Sildenafil on Cyclic GMP-Specific Phosphodiesterase Type 5 (PDE5)
F - 2. Renal Blood Flow (RBF) Autoregulation Maintains RBF and Glomerular Filtration Rate (GFR) Relatively Constant with Changes in Systolic Blood Pressure from About 80 to 200 mmHg
F - 3. The Nonlinear Relationship Between Changes in Renal Filtration and Serum Creatinine Level Means that a Large Reduction (e.g., 75%, 120 to 30 mL/min) in Glomerular Filtration Rate (GFR) May Be Associated with a Modest Rise in Serum Creatinine
F - 4. Acid-base Map
F - 5. Site of Action of Commonly Available Diuretics
F - 6. Clinical Risk Factors that Predict Perioperative Acute Kidney Injury and Renal Dysfunction
F - 7. Common Positioning Options for Urologic Surgery Include Right Lateral Decubitus with Waist Extension (A), Lithotomy (B), Supine with Steep (30 to 45 Degrees) Trendelenburg (C), and Exaggerated Lithotomy (D)
F - 8. Radical Nephrectomy with Inferior Vena Cava Thrombus Removal for Renal Cell Carcinoma is a Major Operative Procedure
F - 9. Crude Incidence Rates for Prostate Cancer, by Race/Ethnicity
Fournier Gangrene - Urologic Surgical Emergencies
Glomerular Filtration - Renal Anatomy and Physiology
Gross Anatomy - Renal Anatomy and Physiology
High Renal Risk Surgical Procedures - Perioperative Nephrology
Impotence Surgery and Medication - Urogynecology and Pregnancy-related Urologic Procedures
Intraoperative Considerations - Cystectomy and Other Major Bladder Surgeries
Intraoperative Considerations - Nephrectomy
Intraoperative Considerations - Prostatectomy
Introduction and Context
Nephrectomy
Nephrectomy and Adrenalectomy - Urogynecology and Pregnancy-related Urologic Procedures
Pathophysiology - Perioperative Nephrology
Pediatric Surgical Urologic Disorders - Urogynecology and Pregnancy-related Urologic Procedures
Perioperative Nephrology
Postoperative Considerations - Cystectomy and Other Major Bladder Surgeries
Postoperative Considerations - Nephrectomy
Postoperative Considerations - Prostatectomy
Preoperative Considerations - Cystectomy and Other Major Bladder Surgeries
Preoperative Considerations - Nephrectomy
Preoperative Considerations - Prostatectomy
Prostatectomy
Reconstructive Urologic Procedures - Urogynecology and Pregnancy-related Urologic Procedures
References
Renal Anatomy and Physiology
Specific Procedures - Cystectomy and Other Major Bladder Surgeries
Specific Procedures - Nephrectomy
Specific Procedures - Prostatectomy
T - 1. Nephrotoxins Commonly Found in the Hospital Setting
T - 10. Contraindications to Shock Wave Lithotripsy
T - 2. Factors Contributing to Hyperkalemia in Chronic Renal Failure
T - 3. The Uremic Syndrome
T - 4. Nondepolarizing Muscle Relaxants in Renal Failure
T - 5. Physiology of CO2 Pneumoperitoneum in the Trendelenburg Position
T - 6. Properties of Commonly Used Irrigating Solutions for Transurethral Resection Procedures
T - 7. Signs and Symptoms of Acute Hyponatremia
T - 8. Treatment of the Transurethral Resection Syndrome
T - 9. Spectrum of Kidney Stones Types: Composition, Frequency, and Causes
Testicular Torsion - Urologic Surgical Emergencies
Therapies for Urolithiasis
Therapies for Urolithiasis - Intraoperative Considerations
Therapies for Urolithiasis - Postoperative Considerations
Therapies for Urolithiasis - Preoperative Considerations
Therapies for Urolithiasis - Specific Procedures
Transurethral Surveillance and Resection Procedures
Transurethral Surveillance and Resection Procedures - Intraoperative Considerations
Transurethral Surveillance and Resection Procedures - Postoperative Considerations
Transurethral Surveillance and Resection Procedures - Preoperative Considerations
Transurethral Surveillance and Resection Procedures - Specific Procedures
Urogynecology and Pregnancy-related Urologic Procedures
Urologic Surgical Emergencies
51. Anesthesia for Orthopedic Surgery
51. Anesthesia for Orthopedic Surgery
Acute Compartment Syndrome - Special Considerations in Orthopedics
Amputation - Special Considerations in Orthopedics
Anesthesia for Spine Surgery
Anesthetic Management - Upper Extremity Surgery
Blood Conservation - Anesthesia for Spine Surgery
Complications of Spine Surgery - Anesthesia for Spine Surgery
Degenerative Vertebral Column Disease - Anesthesia for Spine Surgery
F - 1. Positioning for Spine Surgery
F - 2. Positioning for Upper Extremity Surgery: Beach Chair Position
F - 3. Positioning for Hip Surgery
Fat Embolus Syndrome/Bone Cement Implantation Syndrome - Special Considerations in Orthopedics
Introduction to Orthopedic Anesthesia
Lower Extremity Surgery
Microvascular Surgery - Special Considerations in Orthopedics
Muscular Disorders - Anesthesia for Spine Surgery
Pediatric Orthopedic Anesthesia
Positioning for Spine Surgery - Anesthesia for Spine Surgery
Postoperative Care of the Spine Patient - Anesthesia for Spine Surgery
Postoperative Regional Analgesia - Upper Extremity Surgery
Preoperative Assessment
Preoperative Assessment - Anesthesia for Spine Surgery
References
Scoliosis - Anesthesia for Spine Surgery
Selection of Anesthetic Technique
Special Considerations in Orthopedics
Spinal Cord Injury - Anesthesia for Spine Surgery
Spinal Cord Monitoring - Anesthesia for Spine Surgery
Surgery to the Elbow, Wrist, and Hand - Upper Extremity Surgery
Surgery to the Foot and Ankle - Lower Extremity Surgery
Surgery to the Hip and Pelvis - Lower Extremity Surgery
Surgery to the Knee - Lower Extremity Surgery
Surgery to the Shoulder and Upper Arm - Upper Extremity Surgery
Surgical Approach and Positioning - Upper Extremity Surgery
T - 1. Multimodal Analgesia for Orthopedic Surgery
T - 2. Regional Techniques for Upper Extremity Surgery
T - 3. Summary of ASRA Practice Advisory Guidelines for Neuraxial Anesthesia and Antithrombotics
T - 4. Anesthetic Techniques and Nerve Blocks for Lower Extremity Surgery
T - 5. Criteria for Fat Embolism Syndrome
Tourniquets - Special Considerations in Orthopedics
Upper Extremity Surgery
Venous Thromboembolism and Thromboprophylaxis - Special Considerations in Orthopedics
52. Transplant Anesthesia
52. Transplant Anesthesia
Acute Liver Failure - Liver Transplantation
Anesthetic Management of Organ Donors
Brain-dead Donors (Donation after Neurologic Death) - Anesthetic Management of Organ Donors
Calcineurin Inhibitors - Immunosuppressive Agents
Cell Therapies - Immunosuppressive Agents
Composite Tissue Allografts
Corneal Transplantation
Corticosteroids - Immunosuppressive Agents
Donation after Cardiac Death (Donation after Circulatory Determination of Death) - Anesthetic Management of Organ Donors
F - 1. Left Lateral Segment (Segments II and III) Living Donor Transplantation
F - 2. Right Lobe (Segments V to VIII) Living Donor Transplantation
F - 3. Implanted Heartmate XVE, an Intracorporeal Left Ventricular Assist Device
F - 4. Tandemheart Percutaneous Ventricular Assist Device
F - 5. Anatomy of Bicaval Orthotopic Heart Transplant
Heart Transplantation
Heart-lung Transplant (Adult and Pediatric)
Immunosuppressive Agents
Inhaled Nitric Oxide (iNO) - Lung Transplantation
Intraoperative Management - Heart Transplantation
Intraoperative Management - Lung Transplantation
Intraoperative Procedures - Liver Transplantation
Intraoperative Procedures - Renal Transplantation
Left Ventricular Assist Devices - Heart Transplantation
Liver Transplantation
Living Kidney Donors - Anesthetic Management of Organ Donors
Living Liver Donors - Anesthetic Management of Organ Donors
Lung Transplantation
Mammalian Target of Rapamycin Inhibitors - Immunosuppressive Agents
Management of the Transplant Patient for Nontransplant Surgery
Pancreas and Islet Transplantation
Pediatric Heart Transplantation - Heart Transplantation
Pediatric Liver Transplantation - Liver Transplantation
Polyclonal and Monoclonal Antibodies - Immunosuppressive Agents
Preanesthetic Considerations - Heart Transplantation
Preoperative Considerations - Liver Transplantation
Preoperative Considerations - Renal Transplantation
Primary Graft Dysfunction (PGD) - Lung Transplantation
Purine Antagonists - Immunosuppressive Agents
Recipient Selection - Heart Transplantation
Recipient Selection - Lung Transplantation
References
Renal Transplantation
Small Bowel and Multivisceral Transplantation
T - 1. Anesthesiology Setup for Organ Procurement
T - 2. Ideal Deceased Lung Donor Characteristics
T - 3. UNOS Consensus Committee Criteria for Prediction of Dcd Death within 60 Minutes of Withdrawal of Life-sustaining Treatment
T - 4. Complications of Chronic Immune Suppression
T - 5. Diagnoses of Patients on Adult Renal Transplant Waiting List
T - 6. Multisystem Complications of End-stage Liver Disease
T - 7. Diagnoses Leading to Liver Transplantation in Adults
T - 8. Lung Recipient Selection Guidelines
T - 9. Effect of Denervation on Cardiac Pharmacology
53. Trauma and Burns
53. Trauma and Burns
Abdominal and Pelvic Injuries - Early Management of Specific Injuries
Abdominal Compartment Syndrome - Early Postoperative Considerations
Acute Kidney Injury - Early Postoperative Considerations
Airway Evaluation and Intervention - Initial Evaluation and Resuscitation
Anesthetic and Adjunct Drugs - Operative Management
Burns - Early Management of Specific Injuries
Chest Injury - Early Management of Specific Injuries
Early Management of Specific Injuries
Early Postoperative Considerations
Extremity Injuries - Early Management of Specific Injuries
F - 1. Clinical Sequence for Initial Management of the Major Trauma Patient
F - 10. Rotation Thromboelastometry Graph Depicting Each Clotting Parameter
F - 11. Calculated Dose Reduction of Various Anesthetics Administered As Bolus or Infusion in Moderate Hemorrhagic Shock
F - 12. Physiologic Effects of Abdominal Compartment Syndrome
F - 13. Prophylaxis Model Based on Combination of Eastern Association for Surgery of Trauma (EAST) Recommendations and the Data from Baldwin et al
F - 2. Canadian Cervical Spine Rule Designed to Diagnose Cervical Spine Injury in Conscious Patients and Identify Patients Who Require Further Radiographic (Computed Tomography [CT]) Evaluation
F - 3. Relationship Between Emergency Department Systolic Blood Pressure, Base Deficit, and Overall Mortality Rate of Trauma Patients; Head Injury Patients are Not Included
F - 4. Schematic Representation of Bloody Vicious Cycle or Lethal Triad
F - 5. Effect of Semi-Fowler's Position on Ventilation in Quadriplegic Patients
F - 6. Algorithm for Management of Various Clinical Scenarios Produced by Severe Blunt Cardiac Injury
F - 7. Typical Transesophageal Echocardiographic Appearances of Three Grades of Traumatic Aortic Injury
F - 8. Transthoracic Echocardiographic Windows Used in Trauma Patients and Images Obtained through Each Window
F - 9. Thrombelastogram
Head Injury - Early Management of Specific Injuries
Initial Evaluation and Resuscitation
Management of Breathing Abnormalities - Initial Evaluation and Resuscitation
Management of Intraoperative Complications - Operative Management
Management of Shock - Initial Evaluation and Resuscitation
Monitoring - Operative Management
Neck Injury - Early Management of Specific Injuries
Operative Management
References
Spine and Spinal Cord Injury - Early Management of Specific Injuries
T - 1. Classification of Laryngeal Injuries
T - 10. Diagnostic Tools in Abdominal Trauma: Strengths and Weaknesses
T - 11. Pathophysiologic Changes in the Early (First 2 Days) and Late Phases of the Burn Injury
T - 12. Lund-Browder Body Surface Area Calculation Table Used during Admission of the Patient to Determine Percent Burn Size, Location, and Estimated Burn Depth
T - 13. Symptoms of Carbon Monoxide Toxicity as a Function of the Blood Cohb Level
T - 14. Guidelines for Initial Fluid Resuscitation after Thermal Injury
T - 15. Transthoracic Echocardiographic Examination in the Trauma Setting
T - 16. Clinical Features Associated with Intraoperative Mortality
T - 17. Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE) Classification for Acute Kidney Injury
T - 2. Advanced Trauma Life Support Classification of Hemorrhagic Shock
T - 3. Available Plasma Preparations and Their Features
T - 4. Massive Transfusion Protocol Used in Grady Memorial Hospital in Atlanta
T - 5. Effects on Outcome of Secondary Insults on the Brain Occurring from Time of Injury Through Resuscitation
T - 6. Two-Level Initial Evaluation of Consciousness
T - 7. 6-Month Outcomes for Patients with Brain Injury In Various Studies
T - 8. Common Clinical, Radiographic, and Ultrasound Features of Thoracic Aortic Injuries
T - 9. Change in the Management of Blunt Thoracic Aortic Injuries from 1997 to 2007
Thromboembolism - Early Postoperative Considerations
Ventilatory Support - Early Postoperative Considerations
9: Postanesthetic Management, Critical Care, and Pain Management
54. Postanesthesia Recovery
54. Postanesthesia Recovery
Ability to Void - Postoperative Renal Complications
Admission to the Postanesthesia Care Unit
Altered Mental Status - Miscellaneous Complications
Anemia - Postoperative Pulmonary Dysfunction
Cardiovascular Complications
Decreased Compliance - Postoperative Pulmonary Dysfunction
Discharge Criteria
Distribution of Perfusion - Postoperative Pulmonary Dysfunction
Distribution of Ventilation - Postoperative Pulmonary Dysfunction
Electrolyte Disorders - Metabolic Complications
F - 1. Percentage of Patients Experiencing Severe Pain in the Postanesthesia Care Unit (PACU), the Ambulatory Surgery Unit (ASU), and During Phone Call Follow-Up at 24 Hours
F - 2. Rate of Spo (2) Decline after Onset of Apnea
F - 3. Spo (2) Versus Postanesthesia Care Unit Time in Patients Spontaneously Ventilating in Room Air after General Anesthesia (Group 1, 0 to 1 Year of Age; Group 2, 1 to 3 Years; Group 3, 3 to 14 Years; Group 4, 14 to 58 Years)
Glucose Disorders and Control - Metabolic Complications
Hyperthermia - Miscellaneous Complications
Hypothermia and Shivering - Miscellaneous Complications
Inadequate Alveolar Pao(2) - Postoperative Pulmonary Dysfunction
Inadequate Postoperative Oxygenation - Postoperative Pulmonary Dysfunction
Inadequate Postoperative Ventilation - Postoperative Pulmonary Dysfunction
Inadequate Respiratory Drive - Postoperative Pulmonary Dysfunction
Incidental Trauma - Miscellaneous Complications
Increased Airway Resistance - Postoperative Pulmonary Dysfunction
Increased Carbon Dioxide Production - Postoperative Pulmonary Dysfunction
Increased Deadspace - Postoperative Pulmonary Dysfunction
Levels of Postoperative/Postanesthesia Care
Metabolic Complications
Miscellaneous Complications
Neuromuscular and Skeletal Problems - Postoperative Pulmonary Dysfunction
Obstructive Sleep Apnea - Postoperative Pulmonary Dysfunction
Oliguria - Postoperative Renal Complications
Perioperative Aspiration - Postoperative Pulmonary Dysfunction
Persistent Sedation/Delayed Emergence - Miscellaneous Complications
Polyuria - Postoperative Renal Complications
Postanesthesia Recovery
Postanesthetic Triage
Postoperative Acid-Base Disorders - Metabolic Complications
Postoperative Evaluation
Postoperative Nausea and Vomiting - Miscellaneous Complications
Postoperative Pain Management
Postoperative Pulmonary Dysfunction
Postoperative Renal Complications
Reduced Mixed Venous Po(2) - Postoperative Pulmonary Dysfunction
References
Renal Tubular Function - Postoperative Renal Complications
Safety in the Postanesthesia Care Unit
Skeletal Muscle Pain - Miscellaneous Complications
Standards for Postanesthesia Care - Postanesthesia Recovery
Supplemental Oxygen - Postoperative Pulmonary Dysfunction
T - 1. Components of a Postanesthesia Care Unit Admission Report
T - 2. Two Most Commonly Used Postanesthesia Care Unit Discharge Criteria Systems
T - 3. Common Oxygen Delivery Systems with Correlating O2 Flow Rates to Delivered Fio2 Ranges
T - 4. Causes of Acidemia
Value and Economics of Postanesthesia Care Unit
55. Acute Pain Management
55. Acute Pain Management
Acute Pain Defined
Anatomy of Acute Pain
Assessment of Acute Pain
Chemical Mediators of Transduction and Transmission
Complications from Regional Anesthesia
Conclusion
Epidural Neuraxial Analgesia - Special Considerations in the Perioperative Pain Management of Children
F - 1. Afferent Nociceptive Pathway
F - 10. Oxycodone Metabolism
F - 11. Codeine Metabolism Pathway in an Individual with Cytochrome P450 2D6 (CYP2D6) Extensive Metabolism
F - 12. Linear Verbal Analogue Score and âfacesâ Pain Assessment Tool
F - 13. Paracetamol Inhibits Prostanoid Synthesis
F - 14. Hypothesized Mechanisms of Action of Gabapentin
F - 15. Dermatome Guide for Placement of Epidural Catheters
F - 16. Ultrasound-Guided Supraclavicular Nerve Block
F - 17. Ultrasound-Guided Infraclavicular Nerve Block
F - 18. Ultrasound-Guided Femoral Nerve Blockade: Short Axis Ultrasound Image of the Infrainguinal Structures
F - 19. Probe and Needle Position and Diagram of Dissected Iliac Fossa Showing Anatomy for the Suprainguinal Fascia Iliaca Block
F - 2. Efferent Pathways Involved in Nociceptive Regulation
F - 20. Sonograms During Hydro-Dissection (Left Image) and Towards Conclusion of Block (Right Image) Showing the Collection of Local Anaesthetic (LA) Beneath the Fascia Iliaca (Black Arrows) with the Needle Advanced through It
F - 21. Sequence of Transverse Sonograms (Distal to Proximal) Demonstrating the Spread of the Local Anesthetic in Both the Subepimyseal and Subparaneural Compartments after an Ultrasound-Guided Popliteal Sciatic Nerve Block above its Bifurcation
F - 22. Ultrasound-Guided Thoracic Paravertebral Block
F - 23. Graphic Representing Probe Position and Ultrasound Image Obtained During a Pecs I Block (Left), Pecs II Block (Middle) or a Serratus Plane Block (Right)
F - 24. The Bilateral Dual (BD) TAP Block
F - 25. Photograph and Ultrasonographic Images Demonstrating Siting of the TAP Block
F - 3. Schematic on the Right Showing the Rexed Lamination and the Approximate Organization of the Approach of the Afferent to the Spinal Cord As They Enter at the Dorsal Root Entry Zone and Then Penetrate into the Dorsal Horn to Terminate in Laminae I and II (A/C) or Penetrate More Deeply to Loop Upward to Terminate As High As the Dorsum of Lamina III (A[Ã])
F - 4. Schematic Summarizing the Organization of Dorsal Horn Systems that Contribute to the Processing of Nociceptive Information
F - 5. Pain Sensitization
F - 6. The Four Elements of Pain Processing: Transduction, Transmission, Modulation, and Perception
F - 7. Schematic of the Neurochemistry of Somatosensory Processing at Peripheral Sensory Nerve Endings
F - 8. Schematic Representation of Peripheral and Spinal Mechanism Involved in Neuroplasticity
F - 9. Primary Nociceptive Transmission in the Spinal Cord
Methods of Analgesia
Neuraxial Analgesia - Methods of Analgesia
Nonopioid Analgesic Adjuncts
Nonparenteral Analgesics - Special Considerations in the Perioperative Pain Management of Children
Opioid Analgesics
Opioid Analgesics - Special Considerations in the Perioperative Pain Management of Children
Organization of Perioperative Pain Management Services
Pain Processing - Anatomy of Acute Pain
Patient-controlled Analgesia - Methods of Analgesia
Patient-controlled Analgesia - Special Considerations in the Perioperative Pain Management of Children
Perioperative Pain Management of the Opioid-dependent Patient
Peripheral Nerve Blockade - Methods of Analgesia
Peripheral Nerve Blocks in Children - Special Considerations in the Perioperative Pain Management of Children
Preventive Analgesia
References
Special Considerations in the Perioperative Pain Management of Children
Strategies for Acute Pain Management
T - 1. Primary Afferent Nerves
T - 10. Assignment of Likely Codeine Metabolism Phenotypes Based on Cytochrome P450 2D6 (Cyp2d6) Diplotypes
T - 11. Conversion Ratios from Morphine to Methadone,
T - 12. Methadone Drug Interactions
T - 13. Nonopioid Analgesics (Adult Dosing Guidelines)
T - 14. Dexmedetomidine Dosing Guidelines
T - 15. Usual Intravenous Opioid Patient-controlled Analgesia Regimens in the Opioid-naive Adult Patient
T - 16. Relative Risk Factors Associated with the Use of Patient-controlled Analgesia
T - 17. Guidelines for Adult Epidural Catheter Dosing Regimen
T - 18. Intrathecal Analgesia Dosing Guidelines
T - 19. Intrathecal Analgesia: Other Dosing Guidelines
T - 2. Algogenic Substances
T - 20. Brachial Plexus Blockade
T - 21. Lumbar and Sacral Plexus Blockade
T - 22. Truncal Blocks
T - 23. Recommended Dosing Regimen of Local Anesthetics for Continuous Peripheral Nerve Blockade
T - 24. Risk Factors for Nerve Injury during the Performance of Regional Anesthesia
T - 25. Advantages of Ultrasound-guided Regional Anesthesia
T - 26. Ultrasound-guided Regional Anesthesia (UGRA) and Patient Safety
T - 27. Suggested Guidelines for Perioperative Pain Management in the Opioid-tolerant Patient
T - 3. Consequences of Poorly Managed Acute Pain
T - 4. Options for Components of Multimodal Therapy for Commonly Performed Surgeries
T - 5. Three Classes of Acute Pain
T - 6. Features of Pain Commonly Addressed during Assessment
T - 7. Opioid Analgesic Pharmacokinetics
T - 8. Opioid Equianalgesic Dosing,
T - 9. Patients at Risk for Opioid-induced Sedation and Respiratory Depression
The Surgical Stress Response
56. Chronic Pain Management
56. Chronic Pain Management
Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Buttock Pain: Sacroiliac Joint Syndrome and Piriformis Syndrome - Management of Common Pain Syndromes
Cancer Pain
Complex Regional Pain Syndrome - Neuropathic Pain Syndromes
Diabetic Painful Neuropathy - Neuropathic Pain Syndromes
Discography - Interventional Techniques
Dorsal Root Ganglion Stimulation - Interventional Techniques
F - 1. Histologic Sections and Schematic Diagrams of the Spinal Dorsal Horn
F - 10. Placement of the Intrathecal Needle Under Fluoroscopy
F - 11. Connection of the Intrathecal Catheter to the Programmable Pump and Confirmation of Cerebrospinal Fluid Prior to Placement in the Pocket
F - 2. Right L5 Transforaminal Epidural Injection
F - 3. Typical Microscopic Appearances of Methylprednisolone, 80 mg/mL and 40 mg/mL, and Triamcinolone 40 mg/mL
F - 4. Left L4 to L5 Facet Joint Injection
F - 5. Sacroiliac Joint Injection
F - 6. Target Points (A) and Expected Lesions (B) from Water-Cooled Radiofrequency Denervation at the Right L5 Medial Branch and the S1, S2, and S3 Lateral Branches
F - 7. Retrocrural Versus Anterocrural Approaches to Neurolysis of the Celiac Plexus
F - 8. Vertebroplasty at T10 Vertebral Level
F - 9. Placement of the Epidural Needle and the Spinal Cord Electrodes at the Thoracic (A) and Cervical (B) Levels
Herpes Zoster and Postherpetic Neuralgia - Neuropathic Pain Syndromes
Human Immunodeficiency Virus Neuropathy - Neuropathic Pain Syndromes
Interventional Techniques
Intrathecal Drug Delivery - Interventional Techniques
Low Back Pain: Facet Syndrome - Management of Common Pain Syndromes
Low Back Pain: Radicular Pain Syndromes - Management of Common Pain Syndromes
Management of Common Pain Syndromes
Minimally Invasive Lumbar Decompression Procedure - Interventional Techniques
Myofascial Pain Syndrome and Fibromyalgia - Management of Common Pain Syndromes
Neurobiology of Ascending Pathways - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Neurobiology of Descending Pathways - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Neurobiology of Supraspinal Structures Involved in Higher Cortical Processing - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Neurobiology of the Spinal Cord and Spinal Trigeminal Nucleus - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Neurochemistry of Peripheral Nerve and the Dorsal Root Ganglion - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Neurolytic Blocks for Visceral Pain from Cancer - Cancer Pain
Neuropathic Pain Syndromes
Occipital Nerve Stimulation - Interventional Techniques
Opioids - Pharmacologic Management of Pain
Peripheral Nerve Stimulation - Interventional Techniques
Phantom Pain - Neuropathic Pain Syndromes
Pharmacologic Management of Pain
Pharmacologic Treatments of Neuropathic Pain - Pharmacologic Management of Pain
Primary Afferents and Peripheral Stimulation - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
References
Spinal Cord Stimulation - Interventional Techniques
Summary
T - 1. Primary Afferent Fibers and Their Function
T - 2. Dosages (mg/day) of the Commonly Used Antidepressants and Anticonvulsants
T - 3. Recommended Drugs for Chronic Pain Syndromes
Thermal Annular Procedures - Interventional Techniques
Transition from Acute to Persistent or Chronic Nociception - Anatomy, Physiology, and Neurochemistry of Somatosensory Pain Processing
Vertebroplasty and Kyphoplasty - Interventional Techniques
57. Critical Care Medicine
57. Critical Care Medicine
Acute Kidney Injury
Acute Respiratory Distress Syndrome - Acute Respiratory Failure
Acute Respiratory Failure
Adrenal Function in Critical Illness - Endocrine Aspects of Critical Care Medicine
Anemia and Transfusion Therapy in Critical Illness
Cardiovascular and Hemodynamic Aspects of Critical Care
Checklists - Processes of Care in the ICU
Complications in the ICU: Detection, Prevention, and Therapy
Delirium and Neurocognitive Complications - Sedation and Analgesia for the Critically Ill Patient
Diagnosis and Clinical Management of the Most Common Types of Neurologic Failure - Neurologic and Neurosurgical Critical Care
Endocrine Aspects of Critical Care Medicine
End-of-Life Care in the ICU
Glucose Management in Critical Illness - Endocrine Aspects of Critical Care Medicine
Goals and Assessment - Sedation and Analgesia for the Critically Ill Patient
ICU-acquired Weakness - Complications in the ICU: Detection, Prevention, and Therapy
Monitoring and Resuscitation in Shock States - Cardiovascular and Hemodynamic Aspects of Critical Care
Neurologic and Neurosurgical Critical Care
Neuromonitoring - Neurologic and Neurosurgical Critical Care
Nosocomial Infections - Complications in the ICU: Detection, Prevention, and Therapy
Nutrition in the Critically Ill Patient
Pharmacologic Management - Sedation and Analgesia for the Critically Ill Patient
Principles of Mechanical Ventilation - Acute Respiratory Failure
Processes of Care in the ICU
Protocols and Care Bundles - Processes of Care in the ICU
References
Resource Management - Processes of Care in the ICU
Sedation and Analgesia for the Critically Ill Patient
Somatotropic Function in Critical Illness - Endocrine Aspects of Critical Care Medicine
Staffing - Processes of Care in the ICU
Stress Ulceration and Gastrointestinal Hemorrhage - Complications in the ICU: Detection, Prevention, and Therapy
T - 1. Suggested Daily Intensive Care Unit Checklist
T - 2. ICU Management of Patients with Severe Traumatic Brain Injury
T - 3. Definitions of Sepsis and Organ Failure
T - 4. Management of Severe Sepsis and Septic Shock
T - 5. Kidney Disease: Improving Global Outcomes (KDIGO) Classification of Acute Kidney Injury
T - 6. Suggested Empiric Antibiotic Regimens for Common Intensive Care Unit Infections
T - 7. Caprini Venous Thromboembolism Risk Assessment Model
Thyroid Function in Critical Illness - Endocrine Aspects of Critical Care Medicine
Types of Shock - Cardiovascular and Hemodynamic Aspects of Critical Care
Venous Thromboembolism - Complications in the ICU: Detection, Prevention, and Therapy
58. Cardiopulmonary Resuscitation
58. Cardiopulmonary Resuscitation
Advanced Life Support - Putting It All Together
Adverse Effects and Energy Requirements - Electrical Therapy
Airway Management
Alternative Methods of Circulatory Support - Circulation
Amiodarone and Lidocaine - Pharmacologic Therapy
Assessing the Adequacy of Circulation during Cardiopulmonary Resuscitation - Circulation
Bystander CPR and Basic Life Support - Putting It All Together
Catecholamines and Vasopressors - Pharmacologic Therapy
Circulation
Components of Resuscitation
Defibrillators: Energy, Current, and Voltage - Electrical Therapy
Drugs Not Routinely Given during CPR - Pharmacologic Therapy
Electrical Pattern and Duration of Ventricular Fibrillation - Electrical Therapy
Electrical Therapy
Ethical Issues: Do Not Resuscitate Orders in the Operating Room
F - 1. Advanced Cardiac Life Support Cardiac Arrest Circular Algorithm
F - 2. Adult Bradycardia (with Pulse) Algorithm
F - 3. Adult Tachycardia (with Pulse) Algorithm
F - 4. Pediatric Advanced Life Support Cardiac Arrest Algorithm
F - 5. Pediatric Advanced Life Support Bradycardia (with Pulse and Poor Perfusion) Algorithm
F - 6. Pediatric Advanced Life Support Tachycardia (with Pulse and Poor Perfusion) Algorithm
F - 7. Postcardiac Arrest Care Algorithm
Foreign Body Airway Obstruction - Airway Management
History
Pediatric Cardiopulmonary Resuscitation
Pharmacologic Therapy
Physiology of Circulation during Closed-chest Compression - Circulation
Physiology of Ventilation during Cardiopulmonary Resuscitation - Ventilation
Postresuscitation Care
Prognosis - Postresuscitation Care
Putting It All Together
References
Rhythm Analysis and Defibrillation - Putting It All Together
Routes of Administration - Pharmacologic Therapy
Scope of the Problem
T - 1. Critical Variables Associated with Successful Resuscitation
T - 2. Adult Advanced Cardiac Life Support Drugs and Doses (Intravenous)
T - 3. Medications for Pediatric Resuscitation
Technique of Closed-chest Compression - Circulation
Techniques of Rescue Breathing - Ventilation
Time-Sensitive Model of Ventricular Fibrillation - Putting It All Together
Transthoracic Impedance - Electrical Therapy
Ventilation
59. Disaster Preparedness
59. Disaster Preparedness
Biologic
Biologic - Anthrax
Biologic - Botulism
Biologic - Hemorrhagic Fevers
Biologic - History
Biologic - Plague
Biologic - Smallpox
Biologic - Tularemia
Blood Agents - Chemical
Chemical
Conclusion
Decontamination - Role of Anesthesiologist in Managing Mass Casualties
Emergency Department - Role of Anesthesiologist in Managing Mass Casualties
Explosives
F - 1. Diagrammatic Descriptions of Definitions
F - 2. Surge Capacity: How Hospitals Can Deal with Increased Number of Patients Arriving at Their Emergency Departments Following a Mass Casualty Event
Family Plan - Preparation
Government Plan - Preparation
Health-Care Agency Plans - Preparation
Management - Radiation-Nuclear
Nerve Agents - Chemical
Operating Room Management - Role of Anesthesiologist in Managing Mass Casualties
Potential Sources of Ionizing Radiation Exposure - Radiation-Nuclear
Preparation
Pulmonary Agents - Chemical
Radiation-Nuclear
References
Role of Anesthesiologist in Managing Mass Casualties
T - 1. Types of Disasters According to the Joint Commission on Accreditation of Health-Care Organizations
T - 2. Issues for Which FEMA Must Prepare and Agencies with Which It Must Coordinate
T - 3. Operating Room Procedures for Mass Casualty: Management Step by Step
T - 4. Biologic Agents Used for Warfare
T - 5. Radiation Exposure Terms
Triage - Role of Anesthesiologist in Managing Mass Casualties
10: Appendices
Appendix 1: Formulas
Appendix 2: Atlas of Electrocardiography
Appendix 3: Pacemaker and Implantable Cardiac Defibrillator Protocols
Appendix 3: Pacemaker and Implantable Cardiac Defibrillator Protocols
Appendix 4: American Society of Anesthesiologists Standards, Guidelines, and Statements
Appendix 5: The Airway Approach Algorithm and Difficult Airway Algorithm
Appendix 6: Malignant Hyperthermia Protocol
Appendix 7: Herbal Medications
Appendix 8: Atlas of Ultrasound and Echocardiography
T - 1. Abbreviation Table
T - 2. Generic Pacemaker Code: NASPE/BPEG Revised (2002)
T - 3. Generic Defibrillator Code (NBG): NASPE/BPEG
T - 4. Essential Elements of the Information Given to the CIED Physician
T - 5. Essential Elements of the Preoperative CIED Evaluation to Be Provided to the Operative Team
T - 6. Example of a Stepwise Approach to the Perioperative Management of the Patient with a CIED
T - 7. Specific Procedures and Writing Committee Recommendations on Postoperative CIED Evaluation
T - 8. Indications for the Interrogation of CIEDs prior to Patient Discharge or Transfer from a Cardiac Telemetry Environment
T - 9. Treatment of Pacemaker Failure
Front Matter
Contributing Authors
Preface
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