Table Of ContentA Glossary of
Anesthesia and
Related Terminology
Second Edition
Sanford L. Klein
A Glossary of
Anesthesia and
Related Terminology
Second Edition
With 228 Illustrations
Springer-Verlag
New York Berlin Heidelberg London Paris
Tokyo Hong Kong Barcelona Budapest
Sanford L. Klein, DDS, MD
Professor and Chairman
Department of Anesthesia
University of Medicine and Dentistry of New Jersey
Robert Wood Johnson Medical School
New Brunswick, NJ 08903-0019 USA
The first edition was published by Medical Examination Publishing Co., Inc.
Library of Congress Cataloging-in-Publication Data
Klein, Sanford L.
A glossary of anesthesia and related terminology / Sanford L. Klein-2nd ed.
p. cm.
Includes bibliographical references.
ISBN-13: 978-0-387-97831-4 e-ISBN-13: 978-1-4613-9238-5
DOl: 10.1007/978-1-4613-9238-5
I. Anesthesia-Dictionaries. 2. Anesthesia-Terminology. I. Title.
[DNLM: I. Anesthesia-terminology. WO 213 K64q]
RD78.5.K54 1992
617.9'6'03-dc20
DNLM/DLC
for Library of Congress 92-2223
Printed on acid-free paper.
©1993 by Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1s t edition 1993
All rights reserved. This work may not be translated or copied in whole or in part without the written permission
of the publisher (Springer-Verlag, 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in
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retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or
hereafter developed is forbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not
especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and
Merchandise Marks Act, may accordingly be used freely by anyone.
While the advice and information in this book are believed to be true and accurate at the date of going to press,
neither the authors nor the editors nor the publishers can accept any legal responsibility for any errors or omissions
that may be made. The publisher makes no warranty, express or implied, with respect to the material contained
herein.
Production managed by Christin R. Ciresi; manufacturing supervised by Jacqui Ashri.
Typeset by Princeton Editorial Associates, Princeton, NJ.
987654321
This book is dedicated in all humility to Dr. William F. Harrigan, my first chief, who not only
rescued me from polishing Pontiacs in Passaic, but who also set an example for achievement
that I continue to admire. This book is also dedicated to Dr. Harry Wollman, without whose
many kindnesses and, in some instances, deliberate lapses of attention, I could not be where I
am today.
The author and the publisher of this book have made every effort to ensure that all therapeutic
modalities that are recommended are in accordance with accepted standards at the time of
publication.
The drugs specified within this book may not have specific approval by the Food and Drug
Administration in regard to the indications and dosages that are recommended by the author. The
manufacturer's package insert is the best source of current prescribing information.
Preface to the Second Edition
The second edition of this text catches the specialty of anesthesia at what will probably prove
to be the apex of its influence and recognition amongst the specialties of medicine. The
scientific basis of the specialty is becoming increasingly well delineated. Anesthesiologists
have established themselves in local, regional, and national forums as spokespersons not only
for the specialty, but also for medicine in general. And the specialty at last may be emerging
from the stereotype of a faceless, inarticulate, shy and retiring figure, whose outstanding
characteristic was the cloying odor of diethel ether!
Technology has moved into the specialty on seven league boots. Just as an example, the
basic design of the anesthesia machine was stable between the early 1950s and certainly the
late 1970s. Suddenly, in the blink of an eye, our anesthesia machines are becoming intelligent,
are utilizing heads-up displays, and are becoming more and more capable of writing the
anesthesia record. Monitoring standards for anesthesia have burgeoned to the point that almost
every aspect of the specialty is impinged upon by some rule and some "thou will or thou will
not." The importation and creation of terminology is exploding. In fact, one of the problems in
updating this book was deciding when to stop.
The author hopes that the goal of creating a snapshot in time through definitions of
commonly used words and phrases has been achieved. Furthermore, I hope this book will be
very helpful to new and old practitioners of the specialty by meeting its primary goal of
providing a common language and a common understanding of language in the specialty
without which clear discourse is impossible.
In conclusion, I would like to thank Ms. Lenore Stewart, who was of immense help with
her perseverance, her artistry, and her editing and assembling skills in making this new edition
a real living and breathing entity, and the other members of my department, from the residents
to the senior staff, who contributed their time and efforts in reviewing and critiquing the
various elements of this text.
vii
A
AAA:
See Anesthesia Administrative Assembly.
AANA:
See American Association of Nurse Anesthetists.
AAPD:
See Association of Anesthesiology Program Directors.
ABA:
See American Board of Anesthesiology.
Abandonment:
Refusal, in a medicolegal context, on the part of a physician or dentist to continue caring for
a patient without the patient's consent.
Abdominal Electrocardiography:
Obstetric technique for determining the fetal electrocardiogram by the application of
electrodes to the mother's abdominal wall. Difficulty is encountered owing to electrical
interference from the maternal electrocardiogram and abdominal wall musculature and
gross interference from fetal movement.
Abdominal Nerve Syndrome:
See Abdominal wall pain.
Abdominal Wall Pain, Abdominal Nerve Syndrome:
Little understood cause of chronic abdominal pain, this syndrome is due to entrapment of
the intercostal nerves as they emerge through the rectus sheath. The pain is characterized as
sharp or burning and can persist for a long time.
Abducens:
Sixth cranial nerve and the most likely to be affected by a drop in cerebrospinal fluid
pressure after a spinal anesthetic. Paralysis of the abducens causes diplopia. See Cranial
nerves.
1
Ablation
Ablation:
Process of removing material from the surface of an object, usually by vaporization or
decomposition. Ablation may also mean complete mechanical destruction; cryosurgery is
used for total ablation of a tumor. Ablation-type heat shielding is used on the nose cones of
rockets returning to earth.
Abort:
Abrupt termination of an ongoing event.
ABS Plastic:
Class of plastics that is identified as belonging to the acrylonitrile-butadiene-styrene group.
They are usually of good rigidity, high impact strength, and fair hardness over a wide
temperature range. ABS is a typical plastic used in helmets, luggage, and machine parts,
where abrasion resistance is not a prerequisite.
Absolute Zero:
Temperature that, according to theory, is the lowest physically possible. This temperature
has been closely approached but never reached in practice. In units it is zero Kelvin CK),
minus 273.15 degrees Celsius CC), and minus 459.67 degrees Fahrenheit CF).
Absorbent Channeling:
Phenomenon occurring in poorly packed absorbent canisters that can severely affect the
proper absorption of CO The cross-sectional area of absorbent to which the gas stream is
2•
exposed is reduced dramatically by small passageways, or channels that course through the
absorbent from one end to the other, bypassing the bulk of active absorbent. It can lead to a
relatively rapid yet insidious buildup of CO in the gas mixture the patient breathes.
2
Absorber:
See Carbon dioxide absorption.
Absorber Bypass:
Fitting that allows exhaled gases to be routed around the CO absorber material in the circle
2
system. Dangerous if not understood (allows for CO2 rebreathing). See Circle system.
Absorption:
Process by which a substance becomes available to the circulating fluids of the body. The
rate of absorption depends on the physical characteristics of the substances being absorbed
and the nature of the barriers and membranes between the site of initial deposit and the
circulation.
Absorption Atelectasis:
Phenomenon that occurs when the air passageway to the alveolus is blocked. If the patient
has been breathing air, it can be assumed that at the instant of blockage the PA0 is
2
approximately 100 mm Hg, PAC0 is approximately 40 mm Hg, alveolar pressure of
2
2
Accuracy
nitrogen is 573 nun Hg, and partial pressure of water vapor is 47 nun Hg. In capillary blood
flowing past the alveolus, the partial pressure of nitrogen and water vapor are the same;
however, P02 is about 40 nun Hg and PC02 is about 45 nun Hg. On balance, this gives a
net positive pressure to the alveolus, which loses gas to the pulmonary blood and gradually
collapses. This gradual collapse is splinted by nitrogen which shifts slowly to the alveolus
from the blood flowing past it, tending to keep the alveolus open. In any situation where
alveolar O2 has been augmented to take the place of alveolar nitrogen, absorption atelecta
sis occurs more quickly because the partial pressure difference between alveolar O2 and
capillary 02is much greater. In fact, when a healthy individual breathes 100% O2, the PA02
approaches 668 nun Hg, PAC02 is 45 nun Hg, and water vapor is 47 nun Hg. See
Atelectasis.
Absorption Indicator:
Any of a number of chemicals added to CO2 absorption granules to demonstrate progres
sive diminution of absorptive capacity. A commonly used indicator is the chemical ethyl
violet. As absorption capacity decreases, this indicator changes from white to purple. The
deeper the purple, the less absorption capacity is available. Ethyl violet has a critical pH
(the pH at which the color changes) of 10.3. Absorption indicators are only qualitatively
accurate; a purple granule may tum white again when exposed to air owing to the limited
regeneration capacity of some absorbents. Any absorption chamber that is color-tinged
should be refilled. See Carbon dioxide absorption.
Abusive Legal Process (Barratry):
Use of the courts to harass an individual. Along with defamation, it is grounds for a
countersuit in patient-initiated malpractice action.
Accelerations:
See Fetal monitor.
Accumulation:
Phenomenon resulting from repeated drug administrations that are spaced so closely
together that neither metabolism nor excretion is fast enough to prevent the drug from
increasing in concentration in the body. For example, succinylcholine is a drug that
undergoes rapid metabolism in the plasma. However, a fast-running intravenous infusion of
succinylcholine can actually cause the plasma concentration of succinylcholine to rise
continuously until the infusion is stopped or a plateau is reached (based on an equilibrium
between administration and metabolism).
Accumulator:
Mildly obsolescent alternative to 'reservoir tank,' 'reservoir,' or 'storage container.'
Accuracy:
Measurement or, when applied to laboratory equipment, specification of the freedom from
error of a device. Most often it is expressed as a percentage over a particular range. For
3
AGO
example, a 2% error on a scale of 100, in whole numbers, means that '98' may be registered
on the machine as 96, 97, 98, 99, or 100, and the machine is still operating within design
limits. See Precision.
ACO:
See Acid citrate dextrose, Blood storage, Blood types, CPD blood preservation.
Acebutolol:
Cardio-selective beta-blocker that has intrinsic sympathomimetic effect and membrane
stabilizing effect. See Intrinsic sympathomimetic activity; Membrane stabilizing activity.
Acetaminophen (Tylenol):
Effective alternate drug to the salicylates when analgesic and antipyretic actions are
needed. Acetaminophen is a breakdown product of phenacetin. It is well tolerated by the
gastrointestinal tract, but overdosage may cause severe hepatic or renal damage or death.
Acetazolamide (Oiamox):
Drug that inhibits the enzyme carbonic anhydrase. By inhibiting this enzyme, acetazolam
ide prevents the combination of H0 and CO from forming carbonic acid, which then
2 2
dissociates into hydrogen ion and bicarbonate. It functions as a diuretic and mild antihyper
tensive agent. The drug at times has found controversial use as a preanesthetic agent for
open eye injuries, as it is known to decrease intraocular pressure. Acetazolamide interferes
with the CO transport mechanism and may, at least transiently, give rise to increased CO
2 2
tension in the peripheral tissues and decreased CO tension in the pulmonary alveoli.
2
Acetylation:
Form of drug metabolism in which an acetyl group, COCH is added to a drug or other
3,
pharmacologically active compound to change its reactivity.
AcetylchOline (ACh):
Neurotransmitter substance released at autonomic nerve endings by cholinergic neurons.
Synthesis of ACh is controlled by the enzyme choline acetyltransferase, which mediates
transfer of an acetyl group from acetyl coenzyme A to choline. Following release at
cholinergic nerve endings, ACh is rapidly hydrolyzed and inactivated by the enzyme
acetylcholinesterase. Acetylcholine produces peripheral vasodilation (flushing of the face,
increased skin temperature); stimulates secretion from exocrine glands (sweating, saliva
tion, tearing); causes bronchoconstriction, decreased heart rate, and pupillary constriction;
and stimulates gastrointestinal smooth muscle (peristalsis), defecation, and urination. See
Neuromuscular blocking agent, Succinylcholine.
o
II
(CH3hN+-CHrCH~-CH3
Acetylcholine (ACh).
4
