Complications in Anesthesia, Second Edition

1020 Pages·2006·18.4 MB·English

by  John L. Atlee MD

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Section Editors
JOHN L. ATLEE, MD TERRI G. MONK, MD
Professor of Anesthesiology Professor
Department of Anesthesiology Department of Anesthesiology
Medical College of Wisconsin Duke University Medical Center
Milwaukee, Wisconsin Durham, North Carolina
BRENDA A. BUCKLIN, MD TIMOTHY E. MOREY, MD
Associate Professor of Anesthesiology Associate Professor of Anesthesiology
Department of Anesthesiology Department of Anesthesiology
University of Colorado Health Sciences Center University of Florida College of Medicine
Denver, Colorado Gainesville, Florida
MARK A. CHANEY, MD MICHAEL J. MURRAY, MD, PHD
Associate Professor of Anesthesiology Professor of Anesthesiology and Chair
Department of Anesthesia and Critical Care Department of Anesthesiology
University of Chicago Pritzker School of Medicine Mayo Clinic College of Medicine
Chicago, Illinois Jacksonville, Florida
DONN M. DENNIS, MD, FAHA NADER D. NADER, MD
Joachim S. Gravenstein, MD, Professor of Anesthesiology Associate Professor of Anesthesiology, Surgery and
Department of Anesthesiology Pathology
University of Florida College of Medicine State University of New York at Buffalo School of
Gainesville, Florida Medicine
Vice President-Pharmacology, ARYx Therapeutics, Inc. Buffalo, New York
Santa Clara, California
MICHAEL F. O’CONNOR, MD
JOHN ELLIS, MD
Associate Professor
Professor of Anesthesiology
Department of Anesthesia and Critical Care
Department of Anesthesia and Critical Care
University of Chicago Pritzker School of Medicine
University of Chicago Pritzker School of Medicine
Chicago, Illinois
Chicago, Illinois
KERRI M. ROBERTSON, MD
JOEL M. GUNTER, MD
Associate Clinical Professor of Anesthesiology
Professor of Clinical Anesthesia and Pediatrics
Chief, General, Vascular, High-Risk Transplant and Surgical
Department of Anesthesia
Critical Care Medicine Division
University of Cincinnati School of Medicine
Chief, Transplant Services
Attending Anesthesiologist
Duke University School of Medicine
Department of Anesthesia
Department of Anesthesiology
Children’s Hospital Medical Center
Durham, North Carolina
Cincinnati, Ohio
SCOTT R. SPRINGMAN, MD
ROSEMARY HICKEY, MD
Professor
Professor and Program Director
Departments of Anesthesiology and Surgery
Department of Anesthesiology
University of Wisconsin Medical School
University of Texas Health Science Center at San Antonio
Madison, Wisconsin
San Antonio, Texas
BRIAN M. ILFELD, MD KEVIN K. TREMPER, MD
Associate Professor Professor and Chairman
Department of Anesthesia Department of Anesthesiology
University of California, San Diego University of Michigan Medical Center
San Diego, California Ann Arbor, Michigan
DONALD A. KROLL, MD, PHD B. CRAIG WELDON, MD
Staff Anesthesiologist Associate Professor
Department of Surgery Department of Anesthesiology and Pediatrics
Veterans Affairs Medical Center Duke University School of Medicine
Biloxi, Mississippi Durham, North Carolina
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1600 John F.Kennedy Blvd.
Ste 1800
Philadelphia,PA 19103-2899
COMPLICATIONS IN ANESTHESIA,2nd edition ISBN-13:978-1-4160-2215-2
ISBN-10:1-4160-2215-5
Copyright © 2007,1999 by Saunders,an imprint ofElsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing.As new research and experience broaden
our knowledge,changes in practice,treatment,and drug therapy may become necessary or appropriate.
Readers are advised to check the most current information provided (i) on procedures featured or (ii) by
the manufacturer ofeach product to be administered,to verify the recommended dose or formula,the
method and duration ofadministration,and contraindications.It is the responsibility ofthe practitioner,
relying on his or her own experience and knowledge ofthe patient,to make diagnoses,to determine
dosages and the best treatment for each individual patient,and to take all appropriate safety precautions.
To the fullest extent ofthe law,neither the Publisher nor the Editors assumes any liability for any injury
and/or damage to persons or property arising out ofor related to any use ofthe material contained in this
book.
The Publisher
Library ofCongress Cataloging-in-Publication Data
Complications in anesthesia / [edited by] John L.Atlee.-- 2nd ed.
p.;cm.
Includes bibliographical references and index.
ISBN 1-4160-2215-5
1. Anesthesia--Complications. I. Atlee,John L.
[DNLM: 1. Anesthesia--adverse effects. 2. Anesthetics--adverse effects. WO 245 C7369 2007]
RD82.5.C63 2007
617.9′6041--dc22 2006040549
Executive Publisher: Natasha Andjelkovic
Developmental Editor:Jean Nevius
Publishing Services Manager:Tina Rebane
Project Manager:Amy Norwitz
Marketing Manager:Dana Butler
Printed in the United States ofAmerica
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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To all who have contributed to this work,and to the patients we serve.

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Preface
An ounce ofprevention is worth a pound ofcure.
–ANONYMOUS
The second edition of Complications in Anesthesia, like its using the same headings.Schematics,figures,and tables are
first edition,is intended to provide all practitioners ofanes- used liberallyto illustrate key points or to summarize impor-
thesia and critical care medicine with a comprehensive source tant information.Key references are listed at the end ofeach
of information for most complications that might be faced chapter under “Further Reading,” avoiding in-text citations
that might distract the reader.Some chapters contain foot-
in clinical practice. Topics are addressed in ten sections:
notes that provide further explanations. In this way, the
Pharmacology;General Anesthesia;Regional Anesthesia and
reader can gain useful insight into a topic of interest in the
Pain Management; Cardiothoracic and Vascular Surgery;
minimal amount oftime and with maximal retention.Also,
Physiologic Imbalance and Coexisting Disease; Equipment
thumb indexing and liberal cross-referencing are intended to
and Monitoring;Pediatrics and Neonatology;Neurosurgery, reduce the need for time-consuming index searches.Finally,
Ophthalmology, and ENT; Other Surgical Subspecialties under Further Reading,in text,or in footnotes,there are ref-
(subdivided into Obstetrics and Gynecology,General Surgery, erences to Web sites for more or updated information.In that
Urologic Surgery, and Orthopedic Surgery); and Special way,the readercan keep abreast ofnew developments.
Topics (subdivided into Postanesthesia Care Unit,Diagnostic I hope this unconventional treatment ofcomplications in
or Therapeutic Intervention, and Medicolegal Aspects). anesthesia and critical care will serve several purposes: first,
Section Editors were selected based on their special expertise to permit quick location and researching of topics of interest
and knowledge ofthe topics addressed in each section. to busy practitioners in the least amount of time;second,to
Each chapter is presented in a highly structured format organize the thought processes involved in medical decision-
(in accordance with problem-based learning) under the fol- making in an attractive format—i.e.,akin to Sherlock Holmes’
lowing headings and subheadings: Case Synopsis, Problem “who done it?”; and third and most importantly, to reduce
Analysis (divided into Definition, Recognition, Risk
the risk to our patients for unexpected and untoward events.
Assessment,Implications),Management,and Prevention;in
chapters with more than one topic,each topic is addressed
John L.Atlee,MD
vii

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Contributors
Mark Abel, MD Lori A. Aronson, MD, FAAP
Clinical Assistant Professor, Department of Anesthesiology, Assistant Professor of Clinical Anesthesia and Pediatrics,
Mount Sinai Medical Center, New York, New York Department of Anesthesia, University of Cincinnati College
Vaporizers of Medicine; Assistant Professor, Clinical Anesthesia and
Pediatrics, Department of Anesthesia, Cincinnati Children’s
Gaury S. Adhikary, MD, FRCA Hospital Medical Center, Cincinnati, Ohio
Assistant Professor, Department of Anesthesiology, Hypoxemia
University of Michigan Hospitals, Ann Arbor, Michigan
John L. Atlee, MD
Carbon Dioxide Absorbers
Professor of Anesthesiology, Department of Anesthesiology,
Medical College of Wisconsin, Milwaukee, Wisconsin
Maurice S. Albin, MD, MSc (Anes)
Adenosine; Disorders ofPotassium Balance; Nonbarbiturate
Professor of Anesthesiology, Department of Anesthesiology,
Anesthetics; Chemotherapeutic Agents; Cardiac Risk
University of Alabama School of Medicine, Birmingham,
Assessment; Postobstruction Pulmonary Edema; Perioperative
Alabama
Tachyarrhythmias; Tachyarrhythmias with Ventricular
Venous Air Embolism
Preexcitation; Long QT Syndromes and Ventricular
Arrhythmias; Patients with Cardiac Rhythm Management
Stacey L. Allen, MD Devices; Disorders ofWater Homeostasis: Hyponatremia and
Assistant Professor of Anesthesiology, Department of Hypernatremia
Anesthesiology, University of Texas Health Science Center at
San Antonio, San Antonio, Texas Michael S. Avidan, MD
Corneal Injury; Open Globe Injury Associate Professor of Anesthesiology and Surgery; Division
Chief, CT Anesthesiology and CT Intensive Care,
Steven J. Allen, MD Washington University School of Medicine, St. Louis,
Professor of Anesthesiology, Ohio State University College Missouri
of Medicine; Chief Executive Officer, Columbus Children’s HIV Infection and AIDS
Hospital, Columbus, Ohio
Autonomic Hyperreflexia Isaac Azar, MD
Professor of Anesthesiology, Albert Einstein College of
Medicine; Consultant, Department of Anesthesiology,
Jonathan M. Anagnostou, MD
Beth Israel Medical Center, New York, New York
Associate Professor of Clinical Anesthesia, Department
Scavenging Systems
of Anesthesia, Indiana University School of Medicine;
Staff Anesthesiologist, Medical Director of Respiratory Care,
James E. Baker, MD, FRCPC
Department of Anesthesia, Respiratory Care, Indiana
Assistant Professor and Anesthesiologist, Department of
University Hospital, Indianapolis, Indiana
Anesthesia and Perioperative Care, University of California,
Blood and Blood Products: Hepatitis and HIV
San Francisco, San Francisco, California
Postoperative Pulmonary Hypertension
Maged Argalious, MD
Staff Anesthesiologist, Departments of General Narayan Baliga, MD
Anesthesiology and Critical Care Medicine, Cleveland Clinic
Staff Anesthesiologist, Kenosha Hospital and Medical
Foundation, Cleveland, Ohio
Center, Kenosha, Wisconsin
Complications ofTrauma Surgery
Difficult Airway: Opiate-Induced Muscle Rigidity
George A. Arndt, MD Shahar Bar-Yosef, MD
Professor (CHS), Department of Anesthesiology, Assistant Professor, Department of Anesthesiology and
University of Wisconsin Medical School, Madison, Critical Care, Duke University School of Medicine, Durham,
Wisconsin North Carolina
Difficult Airway: Cannot Ventilate,Cannot Intubate Complications ofLaparoscopic Surgery
ix