Case-Based Anesthesia: Clinical Learning Guides

251 Pages·2009·3.4 MB·English

by  George Shorten MD

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C L I N I C A L L E A R N I N G G U I D E S
CASE-BASED ANESTHESIA
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C L I N I C A L L E A R N I N G G U I D E S
CASE-BASED ANESTHESIA
GEORGE SHORTEN
Professor of Anaesthesia and Intensive Care Medicine
Department of Anaesthesia
University College of Cork
Consultant Anaesthetist
Department of Anaesthesia
Cork University Hospital
Cork, Ireland
STEPHEN F. DIERDORF, MD
Professor and Vice Chairman
Department of Anesthesia
Indiana University School of Medicine
Indianapolis, Indiana
GABRIELLA IOHOM, MD, PhD
Consultant Anaesthetist/Senior Lecturer
Cork University Hospital
University College Cork
Cork, Ireland
CHRISTOPHER J. O’CONNOR, MD
Professor of Anesthesiology
Rush University Medical Center
Chicago, Illinois
CHARLES W. HOGUE, JR., MD
Associate Professor
Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions and The Johns Hopkins Hospital
Baltimore, Maryland
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Library of Congress Cataloging-in-Publication Data
Case-based anesthesia : clinical learning guides / [edited by] George Shorten.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-7817-8955-4
1. Anesthesia—Case studies. I. Shorten, George.
[DNLM: 1. Anesthesia—Case Reports. 2. Anesthesia—Problems and Exercises. 3. Anesthesiology—
methods—Case Reports. 4. Anesthesiology—methods—Problems and Exercises. 5. Anesthetics—Case Reports.
6. Anesthetics—Problems and Exercises. 7. Perioperative Care—methods—Case Reports. 8. Perioperative
Care—methods—Problems and Exercises.
WO 218.2 C337 2009]
RD82.45.C37 2009
617.9’6—dc22
2008052575
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any conse-
quences from application of the information in this book and make no warranty, expressed or implied, with respect
to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a
particular situation remains the professional responsibility of the practitioner; the clinical treatments described and
recommended may not be considered absolute and universal recommendations.
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forth in this text are in accordance with the current recommendations and practice at the time of publication.
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recommended agent is a new or infrequently employed drug.
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Dedicated to the memory of Gerard McDonnell.
Dr. Shorten wishes to thank Ms. Renee Mooney
for her incomparable efficiency and hard work.
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F O R E W O R D
The discovery and application of anesthesia is the most im- So in this setting, where does Case-Based Anesthesia: Clinical
portant contribution of American medicine to mankind. Its Learning Guidesedited by Drs. Shorten, Dierdorf, O’Connor,
impact exceeds even the elucidation of the human genome. Iohom, and Hogue fit in? In other words, do we need yet an-
Without visionary discoveries by pioneers in anesthesiology, other anesthesiology text? The answer, in this case, is a re-
the explosive growth in type, complexity, and safety of surgi- sounding yes! Why? First starting with the title, Clinical
cal procedures would not have occurred. More importantly, Learning Guides, the editors have chosen to emphasize learn-
anesthesiology is considered to be the lead specialty in patient ing in the broader sense, not just Board exam preparation and
safety. re-certification, but acquisition of knowledge as part of the
The core principle that drives these advances is training process of responsibility and accountability for one’s education
and continuing education. It is interesting to note that, in the and lifelong learning. By viewing education through this lens,
19th century, anesthesiology was considered a “technique” the practioner can apply information gained from this text
with little scientific merit. It was not until 100 years later into a variety of clinical and examination settings. The Editors
that the specialty developed a rigorous scientific foundation accomplish their goal through the innovative approach of
with postgraduate training programs. Even more astound- using two formats for case-based learning: “Step-by Step” or
ing is the fact that, into the late 20th century, there was a “Reflection.” This is a unique approach for a textbook.
paucity of books authored by North Americans. Textbooks Importantly, it recognizes different learning styles to help re-
supporting resident education, preparation for board exam- inforce important clinical concepts. This is the first time such
inations, and reference for clinical care were predominantly diverse information has been organized on these educationally
British in origin. sound principles in a clinical textbook. The editors have cou-
In the 1980s the educational scene changed dramatically. pled this with the use of “hot topics” where new evidence can
Residents and fellows were recruited from the upper tier of be applied to clinical conundrums as well as to responses to ex-
medical school graduates. In addition to publication of core amination questions. This is accomplished by a list of all-star
and specialty textbooks and journals, application of electronic contributors, each an authority in his/her own area of expert-
media, such as the Internet, has revolutionized the specialty ise. It is as if the reader is being taken through a clinically chal-
of anesthesiology. The American Board of Anesthesiology lenge case with an expert at their side.
has stated, “The ability to independently acquire and process As Thomas L. Friedman implies in his best-selling book
information in a timely manner is central to assure individual The World is Flat(Picador 2007), anesthesiologists worldwide
responsibility for all aspects of patient care.” Although use of are truly interconnected, as globalization brings us into wide-
the Internet and other electronic media assist in rapidly an- reaching contact with our peers and new opportunities arise.
swering questions related to patient care, most residents, fel- Thus, Case-Based Anesthesia: Clinical Learning Guides is tar-
lows, and experienced clinicians still use the printed word to geted at an international array of inquisitive trainees and clini-
comprehensively learn about a new topic, prepare for board cians whose basic goal is safe and unsurpassed clinical care of
examination and recertification, and even organize a clinical our patients.
management plan for the patient with a complex array of co-
existing diseases. Paul G. Barash, MD
Professor, Department of Anesthesiology
Yale University School of Medicine
Attending Anesthesiologist
Yale-New Haven Hospital
New Haven, Connecticut
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C O N T R I B U T O R S
Hassan M. Ahmad, MD John Dowling, BDS, MB, BCh, BAO(Hons),
The Johns Hopkins School of Medicine BMedSc(NUI)
The Johns Hopkins Hospital Specialist Registrar in Anaesthesia
Baltimore, Maryland Cork University Hospital
Cork, Ireland
Ioanna Apostolidou, MD
Associate Professor of Anesthesiology Craig Dunlop, MBBS, FCARCSI
School of Medicine Specialist Registrar in Anaesthesia
University of Minnesota Cork University Hospital
Minneapolis, Minnesota Cork, Ireland
Ashit Bardhan, MBBS, FCARCSI Amanda A. Fox
Specialist Registrar Staff Anesthesiologist
Cork University Hospital Brigham & Women’s Hospital
Cork, Ireland Harvard Medical School
Boston, Massachusetts
Dorothy Breen, FCARCSI, FJFICM
Specialist Registrar in Anaesthesia Kelly Grogan, MD
Cork University Hospital Assistant Professor of Anesthesiology and Critical Care Medicine
Cork, Ireland The Johns Hopkins School of Medicine
The Johns Hopkins Hospital
Siun Burke, FCARCSI Baltimore, Maryland
Research Fellow
Cork University Hospital Anthony Hennessy, FCARCSI
Cork, Ireland Specialist Registrar in Anaesthesia
Cork University Hospital
Asokumar Buvanendran, MD Cork, Ireland
Associate Professor of Anesthesiology
Rush University Medical Center Charles W. Hogue, Jr., MD
Chicago, Illinois Associate Professor
Department of Anesthesiology and Critical Care Medicine
Charles D. Collard The Johns Hopkins Medical Institutions and The Johns Hopkins Hospital
Professor and Vice-Chairman Baltimore, Maryland
Department of Anesthesiology
Baylor College of Medicine Michelle Isac, MD
Houston, Texas Assistant Clinical Professor of Anesthesia
McMaster University
W. Christopher Croley, MD, FCCP Hamilton, Ontario, Canada
Assistant Professor of Anesthesiology and Critical Care Medicine
Rush University Medical Center Jason S. Johnson, MD
Chicago, Illinois Associate Professor of Anesthesiology
School of Medicine
Stephen F. Dierdorf, MD University of Minnesota
Professor and Vice Chairman Minneapolis, Minnesota
Department of Anesthesia
Indiana University School of Medicine
Indianapolis, Indiana
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x CONTRIBUTORS
Roy Kan, MBBS(Singapore), MMed (Anesth) James O’Driscoll, FCARCSI
Department of Anesthesiology and Critical Care Medicine Specialist Registrar in Anaesthesia
The Johns Hopkins School of Medicine Cork University Hospital
The Johns Hopkins Hospital Cork, Ireland
Baltimore, Maryland
Owen O’Sullivan, MB, BCh, BAO
Justin Lane, FCARCSI Specialist Registrar in Anaesthesia
Specialist Registrar in Anaesthesia Cork University Hospital
Cork University Hospital Cork, Ireland
Cork, Ireland
Richard J. Pollard, MD
Peter John Lee, MB, BCh, BAO, FCARCSI Southeast Anesthesia Consultants
Specialist Registrar in Anaesthesia Charlotte, North Carolina
Cork University Hospital
Cork, Ireland David M. Rothenberg, MD, FCCM
The Max S. Sadove, MD Professor of Anesthesiology
Audrey R. Leverich, MD Associate Dean, Academic Affiliations
Fellow in Cardiothoracic Anesthesiology Rush University Medical Center
Department of Anesthesiology Chicago, Illinois
Weill Cornell Medical College
New York-Presbyterian Hospital Leon Serfontein, MBChB, FANZCA
New York, New York
Consultant Anaesthetist
Cork University Hospital
Jay K. Levin, MD Cork, Ireland
Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins School of Medicine Mansoor A. Siddiqui, MBBS, FCPS, FCARCSI
The Johns Hopkins Hospital
Specialist Registrar in Anaesthesia
Baltimore, Maryland
Cork University Hospital
Cork, Ireland
Bryan V. May, MD
Southeast Anesthesiology Consultants Nikolaos J. Skubas, MD
Charlotte, North Carolina
Associate Professor of Anesthesiology
Weill Cornell Medical College
Nanhi Mitter, MD Department of Anesthesiology
Assistant Professor New York, New York
Department of Anesthesiology
Rush University Medical Center Joshua D. Stearns, MD
Chicago, Illinois
Assistant Professor of Anesthesiology and Critical Care Medicine
The Johns Hopkins School of Medicine
Laurel E. Moore, M.D. The Johns Hopkins Hospital
Department of Anesthesiology Baltimore, Maryland
The University of Michigan
Ann Arbor, Michigan Jason Van der Velde, BAA, MBChB, EMDM-A
Trauma Research Registrar
Mohan Mugawar, FCARCSI Cork University Hospital
Specialist Registrar in Anaesthesia Cork, Ireland
Department of Anaesthesia
Cork University Hospital John Vullo, MD
Cork, Ireland
Southeast Anesthesiology Consultants
Charlotte, North Carolina
Christopher J. O’Connor, MD
Professor of Anesthesiology Adrienne Wells, MD
Rush University Medical Center
Assistant Professor of Anesthesiology
Chicago, Illinois
Rush University Medical Center
Chicago, Illinois
Brian D. O’Donnell, MB, FCARCSI, MSc
Clinical Lecturer in Anaesthesia
Cork University Hospital
Cork, Ireland