Core Topics in Cardiac Anesthesia, Second Edition

518 Pages·2013·7.67 MB·English

Core Topics in Cardiac
Anesthesia, Second Edition

Core Topics in Cardiac
Anesthesia, Second Edition
Edited by
Jonathan H. Mackay
FRCP FRCA
ConsultantAnaesthetist
PapworthHospital
Cambridge,UK
Joseph E. Arrowsmith
MD FRCP FRCA FFICM
ConsultantAnaesthetist
PapworthHospital
Cambridge,UK
Examiner,RoyalCollegeofAnaesthetists
CAMBRIDGE UNIVERSITY PRESS
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Informationonthistitle:www.cambridge.org/9780521196857
©CambridgeUniversityPress2012
Thispublicationisincopyright.Subjecttostatutoryexception
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noreproductionofanypartmaytakeplacewithout
thewrittenpermissionofCambridgeUniversityPress.
Firstpublished2012
PrintedintheUnitedKingdomattheUniversityPress,Cambridge
Acataloguerecordforthispublicationisavailablefromthe
BritishLibrary
LibraryofCongressCataloging-in-PublicationData
Coretopicsincardiacanaesthesia/editedbyJonathanH.Mackay,
JosephE.Arrowsmith.–2nded.
p. cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-521-19685-7(Hardback)
1. Anesthesiaincardiology. 2. Heart–Surgery.
I. Mackay,JonathanH. II. Arrowsmith,JosephE. III. Title.
RD87.3.H43C672012
617.9067412–dc23
2011033949
ISBN978-0-521-19685-7Hardback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceor
accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto
inthispublication,anddoesnotguaranteethatanycontentonsuch
websitesis,orwillremain,accurateorappropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovide
accurateandup-to-dateinformationwhichisinaccordwith
acceptedstandardsandpracticeatthetimeofpublication.Although
casehistoriesaredrawnfromactualcases,everyefforthasbeenmade
todisguisetheidentitiesoftheindividualsinvolved.Nevertheless,
theauthors,editorsandpublisherscanmakenowarrantiesthat
theinformationcontainedhereinistotallyfreefromerror,notleast
becauseclinicalstandardsareconstantlychangingthroughresearch
andregulation.Theauthors,editorsandpublishersthereforedis-
claimallliabilityfordirectorconsequentialdamagesresultingfrom
theuseofmaterialcontainedinthisbook.Readersarestrongly
advisedtopaycarefulattentiontoinformationprovidedbythe
manufacturerofanydrugsorequipmentthattheyplantouse.
“Mother stuns medics as she suffers heart failure, gives birth and has
life-saving surgery ... all in one day”
Mail Online, 17 April 2009
April2009NinaWhear(38)andhertwins,[left]Evie(birthweight3lb
11oz/1673g)and[right]Alfie(birthweight4lb10oz/2098g).InJanuary2009,
whileinlatepregnancy,Ninapresentedtoherlocalhospitalwithacutetype
Aaorticdissection.ShewastransferredtoPapworthHospital,whereshe
underwentemergencyCesareansectionfollowedbyreplacementofher
ascendingaortaunderthecareofJohnKneeshaw(Chapter36)andSam
Nashef(Chapters17and18).NinawasthefirstmotheroftwinsintheUK,
andoneofonlyahandfulworldwide,tosurvivesurgeryforthislethal
complicationofpregnancywithoutfetalloss.Photograph:Albanpix
Ltd/RexFeatures,withpermission.WiththanksandbestwishestoNina,
AlfieandEvie.

Contents
List of contributors x
Reviewsof the first edition xiv
Preface xv
Preface to thefirstedition xvi
Forewordtothe second edition xvii
Forewordtothe first edition xviii
List of abbreviations xix
Section 1 – Anatomy and physiology 12 Effectsof CPB ondrugpharmacokinetics 71
Jens Fassl and Berend Mets
1 Cardiac embryology and anatomy 1
Doris M. Rassl and Martin J. Goddard –
Section 3 Diagnosis of cardiac
2 Cardiac electrophysiology 8
disease
Stefan G. DeHert
3 Cardiac excitation–contraction 13 Symptoms and signs of cardiac disease 75
coupling 13 Joseph E. Arrowsmith
M. L. Srikanth andKenneth H. McKinlay 14 Non-invasive diagnostic tests 81
4 Ventricularperformance 18 J. M. Tom Pierceand Sarah Marstin
Fabio Guarracino and Rubia Baldassarri 15 Cardiac radiological imaging 87
5 Coronaryphysiology 22 Catherine V. Koffel and Maximilien J. Gourdin
MichaelHaney 16 Invasive diagnosistechniques 95
6 Cardiovascular control mechanisms 28 Herve Schlotterbeck andStephaneNoble
Patrick Wouters
–
7 Anesthesia andthe cardiovascular Section 4 Cardiac surgery for
system 33 anesthesiologists
Ben W. Howes and Alan M. Cohen
17 Patientselectionand riskstratification 103
– SamerA. M.Nashef
Section 2 Cardiac pharmacology
18 Basic principles ofcardiac surgery 108
8 Cardiac receptors 39 SamerA. M.Nashef
Todd Kiefer and Mihai V. Podgoreanu
19 Myocardial protection 113
9 Inotropes andvasoactive drugs 48 Betsy Evans and David P. Jenkins
Mark Dougherty and Stephen T.Webb
20 Myocardial stunning, hibernation and
10 Anti-dysrhythmic drugs 57 preconditioning 119
Alan Ashworth andKamen P. Valchanov Stefan G. DeHert
11 Anticoagulantsand procoagulants 64 21 Prosthetic heart valves 124 vii
Alan F. Merry Yasir Abu-Omar and John J. Dunning
Contents
Section 5 – Monitoring 36 Aortic dissection 223
Andrew C.Knowles and John D. Kneeshaw
22 Routine clinicalmonitoring 133
37 Aortic arch surgery 228
JörnKarhausenand Jonathan B.Mark
Andrew C.Knowles and Coralie Carle
23 Invasive hemodynamicmonitoring 141
38 Descendingthoracic aorta surgery 232
Matthew E. Atkins and Jonathan B.Mark
David Riddington andHarjotSingh
24 Transesophageal echocardiography 147
39 Permanent pacemakers and implantable
Roger M. O.Hall
defibrillators 241
25 Intraoperativeassessment ofventricular Maros Elsik and Simon P. Fynn
function 154
40 Anesthesia and electrophysiological
Yeewei W. Teo and Andrew Roscoe
disorders 249
26 Neurologic monitoring 160 Andrew J. Richardson and J. M. Tom Pierce
Joseph E. Arrowsmith
41 Acutemyocardialischemiaandinfarction 257
Andrew Neitzel and Bevan Hughes
–
Section 6 Routine coronary heart
42 Miscellaneous catheterlaboratory
surgery procedures 261
Tom Rawlingsand Jean-Pierre van Besouw
27 Premedication, induction and
maintenance 169 43 Cardiomyopathies andconstrictive
pericarditis 268
Paul H. M. Sadleir andAndrew I. Gardner
Florian Falter andJonathanH. Mackay
28 Routine conduct of cardiopulmonary
bypass 175 44 Cardiac transplantation 275
Barbora Parizkovaand StephenJ.Gray Clive J. Lewis
29 Routine early postoperative care 181 45 Pulmonary vascular disease 282
Maura Screaton Cameron Graydonand Roger M. O.Hall
30 Off-pump coronary surgery 186 46 Cardiac tumors 288
Jonathan H. Mackayand Joseph E. Arrowsmith Nigel Farnumand Joseph E. Arrowsmith
47 Cardiothoracic trauma 293
Section 7 – Anesthetic management of Betsy Evans and John J. Dunning
specific conditions 48 Cardiac surgery during pregnancy 299
Sarah Conollyand Khalid Khan
31 Aortic valve disease 193
Jonathan H. Mackayand Joseph E. Arrowsmith
–
Section 8 Pediatric cardiac
32 Mitral valve disease 200
anesthesia
Jonathan H. Mackayand Francis C.Wells
33 Tricuspidand pulmonaryvalvedisease 208 49 General principles 303
Ving Yuen SeeTho Isabeau A. Walker and JonH. Smith
34 Minimally invasive cardiac surgery 215 50 Conduct of anesthesia 307
Andrew C.Knowles and Jose Coddens JonH. Smith andIsabeau A. Walker
viii 35 Redo surgery 220 51 Common congenital heartlesions 313
JonGraham David J.Barronand Kevin P. Morris
Contents
52 Common congenital heart operations 329 Section 10 – Cardiac intensive care
David J. Barron andKevinP. Morris
65 CardiovascularproblemsinthecardiacICU 409
53 Postoperative care 335
Trevor W. R.Lee andJonathanH. Mackay
Fiona E. Reynolds and Kevin P. Morris
66 Resuscitation after adult cardiac surgery 413
54 Adult congenital heart disease 339
Jonathan H. Mackay
Craig R.Bailey andHelenM. Daly
67 Respiratory complications 420
– Florian Falter
Section 9 Cardiopulmonary
68 Gastrointestinal complications 424
bypass
Britta MillhoffandPaul Quinton
55 Cardiopulmonary bypass equipment 345 69 Renal complications 430
John Whitbread and Stephen J. Gray ShitalkumarShah and William T.McBride
56 Failuretoweanfrom bypass 355 70 Neurologic complications 438
Simon Colah and StephenJ. Gray Rabi Panigrahi and Charles W. Hogue
57 Advanced mechanicalsupport 359
StephenJ.Gray andSimon Colah Section 11 – Miscellaneous topics
58 Coagulopathy andblood conservation 366
71 Infection 447
David Cardone and Andrew A. Klein
MargaretI.Gillham and Juliet E. Foweraker
59 The systemic inflammatory response to
cardiopulmonary bypass 374 72 Regional anesthesia 453
Trevor W. R.Lee
R.Clive Landisand Ravi J. DeSilva
60 Temperature control,hypothermia and 73 Pain management aftercardiac surgery 458
rewarming 382 Siân I. Jaggar and Amod Manocha
Charles Willmott 74 Hematological problems 465
61 Deep hypothermiccirculatory arrest 387 Joseph E. Arrowsmith andJonathanH. Mackay
Charles W. Hogue and Joseph E. Arrowsmith 75 Cardiovascular disease andnon-cardiac
62 Cardiopulmonary bypass emergencies 395 surgery 469
Hans-Joachim Priebe
David J. Daly
63 Controversies in cardiopulmonary
bypass 400
Christiana C.Burt and FlorianFalter Appendix 1 479
64 Non-cardiac applications of cardiopulmonary Appendix 2 480
bypass 406 Appendix 3 481
Joseph E. Arrowsmith andJonathanH. Mackay Index 482
ix
Contributors
Yasir Abu-Omar AlanM. Cohen
Registrar in Cardiothoracic Surgery, Papworth Consultant Anaesthetist, Bristol Royal Infirmary,
Hospital, Cambridge, UK Bristol, UK
Matthew E. Atkins Simon Colah
Fellow in Anesthesia, Duke University Medical Senior Clinical Perfusion Scientist, Cambridge
Center, Durham, NC, USA Perfusion Services, Cambridge, UK
Joseph E. Arrowsmith Sarah Conolly
Consultant Anaesthetist, Papworth Hospital, Consultant Anaesthetist, James Cook University
Cambridge, UK Hospital, Middlesborough, UK
AlanAshworth DavidJ. Daly
Consultant Anaesthetist, Wythenshawe Hospital, Consultant Anaesthetist, The Alfred Hospital,
Manchester, UK Melbourne, Australia
Rubia Baldassarri Helen M. Daly
Cardiothoracic Department, University Hospital Consultant Paediatric Anaesthetist, Evelina Hospital,
of Pisa, Pisa, Italy London, UK
Craig R. Bailey Stefan G.De Hert
ConsultantPaediatricAnaesthetist,EvelinaChildren’s Professor of Anesthesiology, University of
Hospital, London, UK Amsterdam,Amsterdam,TheNetherlandsandGhent
University Hospital, Ghent, Belgium
DavidJ. Barron
Consultant Surgeon, Birmingham Children’s RaviJ. De Silva
Hospital, Birmingham, UK Consultant Cardiac Surgeon (LT), The Oxford Heart
Centre, Oxford, UK
ChristianaC. Burt
Consultant Cardiothoracic Anaesthetist (LT), Mark Dougherty
The Heart Hospital, London, UK Consultant Cardiothoracic Anaesthetist, Royal
Victoria Hospital, Belfast, Northern Ireland, UK
DavidCardone
Consultant Anaesthetist, Royal Adelaide Hospital, John J. Dunning
Adelaide, South Australia ConsultantSurgeon,PapworthHospital,Cambridge,UK
Coralie Carle Maros Elsik
Anaesthetic Specialty Registrar, Lancashire Cardiac FellowinCardiology,PapworthHospital,Cambridge,UK
Centre, Blackpool, UK
Betsy Evans
JoseCoddens Specialty Registrar in Cardiothoracic Surgery,
x Onze Lieve Vrouw Clinic, Aalst, Belgium Papworth Hospital, Cambridge, UK