Essential Clinical Anesthesia

1191 Pages·2011·22.7 MB·English

by  Charles A. Vacanti

Essential Clinical Anesthesia
Theclinicalpracticeofanesthesiahasundergonemanyadvancesinthepastfewyears,making
thistheperfecttimeforanewstate-of-the-artanesthesiatextbookforpractitionersand
trainees.ThegoalofEssentialClinicalAnesthesiaistoprovideamodern,clinicallyfocused
textbookgivingrapidaccesstocomprehensive,succinctknowledgefromexpertsinthefield.
Allclinicaltopicsofrelevancetoanesthesiologyareorganizedinto29sectionsconsistingof
184chapters.Theprintversioncontains167chaptersthatcoveralltheessentialclinicaltopics,
whereasanadditional17chaptersandappendixonsubjectsofinteresttothemoreadvanced
practitionercanbefreelyaccessedatwww.cambridge.org/vacanti.Newertechniques,suchas
ultrasoundnerveblocks,roboticsurgery,andtransesophagealechocardiography,areincluded,
andnumerousillustrationsandtablesassistthereaderinrapidlyassimilatingkeyinformation.
Thisauthoritativetextiseditedbydistinguishedfaculty,withcontributorsfrommanyofthe
leadingacademicanesthesiologydepartmentsintheUnitedStates,andincludesan
introductionfromDr.S.RaoMallampati.
EssentialClinicalAnesthesiaisyouressentialcompanionwhenpreparingforboardreview
andrecertificationexams,andinyourdailyclinicalpractice.
CharlesA.Vacanti,M.D.,istheVandam/CovinoProfessorofAnaesthesiaatHarvardMedicalSchooland
Anesthesiologist-in-ChiefoftheDepartmentofAnesthesiology,Perioperative,andPainMedicineatthe
BrighamandWomen’sHospital.Hehaspublishedmorethan200originalarticles,reviews,book
chapters,andabstracts,andheholdsmorethan20patents.Inaddition,heservesastheDirectorofthe
LaboratoriesforTissueEngineeringandRegenerativeMedicineattheBrighamandWomen’sHospital.
HeisthefoundingeditorofthejournalTissueEngineeringandfoundingpresidentoftheTissue
EngineeringSocietyInternational.Heiscurrentlyamember,andwaspreviouslypresident,ofthe
GoverningCounciloftheSocietyofAcademicAnesthesiologyAssociations(SAAA).
PankajK.Sikka,M.D.,Ph.D.,isastaffanesthesiologistattheEmersonHospitalinMassachusetts.He
completedananesthesiaresidencyatYaleNewHavenHospital,acardiothoracicanesthesiafellowshipat
theClevelandClinicFoundation,andadoctoralprograminpharmacologyatLouisianaStateUniversity
MedicalCenter.Hewasoneofthefirsttocultureratkidneycellsinvitro,makingiteasyandinexpensive
toperformexperiments.HeisamemberofataskforceoftheAmericanSocietyofAnesthesiologists
Self-EducationandEvaluationprogram.
RichardD.Urman,M.D.,M.B.A.,isAssistantProfessorofAnaesthesiaatHarvardMedicalSchoolanda
staffanesthesiologistatBrighamandWomen’sHospital.Hespecializesinambulatoryanesthesia,
co-directstheCenterforPerioperativeManagementandMedicalInformatics,andisthedirectorof
proceduralsedationmanagementandeducationforthehospital.Heisalsoco-founderoftheInstitutefor
SafetyinOffice-BasedSurgery.Hisacademicinterestsincludepatientsafety,novelanestheticdrugs,and
operatingroomefficiency.
MarkDershwitz,M.D.,Ph.D.,isProfessorandViceChairofAnesthesiologyandProfessorof
BiochemistryandMolecularPharmacologyattheUniversityofMassachusettsMedicalSchool.Heis
editor-in-chiefoftheWebsiteAccessAnesthesiologyandco-authorofTheMcGraw-HillSpecialtyBoard
Review:Anesthesiology.Hisresearchhasfocusedonintravenousanesthetics,antiemetics,
andintraoperativebrainfunctionmonitoring.
B.ScottSegal,M.D.,M.H.C.M.,isProfessorofAnesthesiologyatTuftsUniversitySchoolofMedicineand
ChairmanoftheDepartmentofAnesthesiologyatTuftsMedicalCenter.Heisasenioreditorofthe
AmericanBoardofAnesthesiologywrittenexaminationandanoralexaminerfortheboard.Heisalso
co-founderoftheanswerpage.com,aneducationalWebsiteservingthousandsofphysiciansworldwide.

Essential Clinical Anesthesia
Editedby
CharlesA.Vacanti,M.D.
HarvardMedicalSchoolandBrighamandWomen’sHospital
PankajK.Sikka,M.D.,Ph.D.
EmersonHospital
RichardD.Urman,M.D.,M.B.A.
HarvardMedicalSchoolandBrighamandWomen’sHospital
MarkDershwitz,M.D.,Ph.D.
UniversityofMassachusettsMedicalSchool
B.ScottSegal,M.D.,M.H.C.M.
TuftsUniversitySchoolofMedicineandTuftsMedicalCenter
cambridgeuniversitypress
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CambridgeUniversityPress
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Informationonthistitle:www.cambridge.org/9780521720205
(cid:1)C CambridgeUniversityPress2011
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithoutthewritten
permissionofCambridgeUniversityPress.
Firstpublished2011
PrintedintheUnitedStatesofAmerica
AcatalogrecordforthispublicationisavailablefromtheBritishLibrary.
LibraryofCongressCataloginginPublicationdata
Essentialclinicalanesthesia/editedbyCharlesVacanti...[etal.].
p. ; cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-521-72020-5(pbk.)
1.Anesthesiology. 2.Anesthesia. I.Vacanti,Charles. II.Title.
[DNLM:1.Anesthesia–methods. 2.Anesthesiology–methods.
3.Anesthetics–administration&dosage. WO200]
RD81.E856 2011
617.9(cid:2)6–dc22 2010028650
ISBN978-0-521-72020-5Paperback
Additionalresourcesforthispublicationat
www.cambridge.org/vacanti
CambridgeUniversityPresshasnoresponsibilityforthepersistenceor
accuracyofURLsforexternalorthird-partyInternetWebsites
referredtointhispublicationanddoesnotguaranteethatanycontent
onsuchWebsitesis,orwillremain,accurateorappropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurate
andup-to-dateinformationthatisinaccordwithacceptedstandards
andpracticeatthetimeofpublication.Althoughcasehistoriesare
drawnfromactualcases,everyefforthasbeenmadetodisguisethe
identitiesoftheindividualsinvolved.Nevertheless,theauthors,
editors,andpublisherscanmakenowarrantiesthattheinformation
containedhereinistotallyfreefromerror,notleastbecauseclinical
standardsareconstantlychangingthroughresearchandregulation.
Theauthors,editors,andpublishersthereforedisclaimallliabilityfor
directorconsequentialdamagesresultingfromtheuseofmaterial
containedinthisbook.Readersarestronglyadvisedtopaycareful
attentiontoinformationprovidedbythemanufacturerofanydrugsor
equipmentthattheyplantouse.
Contents
SectionEditors xiii
Contributors xv
Preface xxix
Foreword xxxi
S.RaoMallampati
1 Historyofanesthesia 1 14 Substanceabuseandanesthesia 88
RafaelA.OrtegaandChristineMai ThomasJ.GraetzandLisaR.Leffert
Part1–PreoperativeCareandEvaluation Part2–AirwayManagement
B.ScottSegalandAngelaM.Bader,editors WilliamH.Rosenblatt,editor
2 Preoperativeanestheticassessment 7 15 Anatomyofthehumanairway 95
SohailK.MahboobiandSheilaR.Barnett SarahH.Wiser
3 Obstructiveandrestrictivelungdisease 16 16 Airwayassessment 98
ShannonS.McKenna RahulKokaandB.ScottSegal
4 Anestheticgoalsinpatientswithmyocardial 17 Perioperativeairwaymanagement 102
ischemiaandheartfailure 23 SibinkaBajicandSarahH.Wiser
SuganthaSundar,JasonM.Erlich,andEswarSundar
18 Managementofthedifficultairway 112
5 Anestheticgoalsinpatientswithvalvularheart EssiM.VulliandWariyaSukhupragarn
disease 28
SuganthaSundar,DeviMahendran,andEswarSundar Part3–AnesthesiaEquipment
6 Obesity 37 YasodanandaKumarAreti,editor
LiemC.NguyenandStephanieB.Jones
19 Medicalgassupply,vacuum,andscavenging 121
7 Chronicrenalfailure 43 JesseM.EhrenfeldandYasodanandaKumarAreti
EdwardA.Bittner
20 Anesthesiamachine 129
8 Liverdisease 49 YasodanandaKumarAreti
JasonC.BrookmanandWarrenS.Sandberg
21 Anesthesiaventilators 138
9 Diabetesmellitusandperioperativeglucose YasodanandaKumarAretiandEdwardR.Garcia
control 56
22 Anesthesiabreathingapparatuses 144
RumaR.BoseandBalachundharSubramaniam
JingpingWangandCharlesA.Vacanti
10 Commonblooddisorders 62
23 Electricalsafety 149
JonathanD.BloomandEdwardA.Bittner
JesseM.Ehrenfeld,SeetharamanHariharan,and
11 Theelderlypatient 70 StephenB.Corn
RumaR.BoseandSheilaR.Barnett
12 Neurologicdiseasesandanesthesia 77 Part4–PatientMonitoring
SpiroG.Spanakis,JohnLin,andPankajK.Sikka BhavaniS.Kodali,editor
13 Anestheticconsiderationsinpsychiatric 24 Hemodynamicpatientmonitoring 155
diseases 83
AmitAsopa,TheodoreE.Dushane,and
HoumanAmirfarzanandPankajK.Sikka SwaminathanKarthik
Contents
25 Theelectrocardiogramandapproachto 41 Perioperativeantiemetictherapies 263
diagnosisofcommonabnormalities 173 JohnP.BroadnaxandB.ScottSegal
UshaB.Tedrow
42 COXinhibitorsand(cid:1) -adrenoceptoragonists 268
2
26 Pulseoximetryandcapnography 186 BenjaminParishandMarkDershwitz
ZhilingXiongandBhavaniS.Kodali
43 Diuretics 271
27 Monitoringofneuromuscularblockade 191 EdwardR.Garcia
KaiMatthesandNeelakantanSunder
44 Druginteractions 274
28 Thermoregulationandtemperaturemonitoring 198 MarthaCordoba-AmorochoandJieZhou
MatthiasStopfkuchen-Evans,ElliottS.Farber,and
45 Allergicreactions 278
FrancisX.Vacanti
KaranMadanandDavidL.Hepner
29 Neurophysiologicmonitoring 203
KaiMatthesandMaryEllenMcCann
Part7–PharmacologyofLocalAnesthetics
30 Intraoperativeawareness 209
PradeepDinakarandGaryR.Strichartz,editors
ScottD.Kelley
46 Mechanismofactionandpharmacokinetics 283
PeterGernerandPradeepDinakar
Part5–InhalationAnesthetics
47 Clinicalapplicationsoflocalanesthetics 288
JamesH.Philip,editor
PradeepDinakarandPeterGerner
31 Inhalationanesthetics 213
MatthiasStopfkuchen-Evans,LinaM.
Part8–AnesthesiaTechniques
Bolanos-Diaz,AlimoradG.Djalali,andBeverlyK.Philip
SaschaS.Beutler,editor
32 Pharmacokineticsofinhalationalagents 218
JamesH.Philip 48 Administrationofgeneralanesthesia 295
FrancisX.DillonandRanaBadr
33 Pharmacodynamicsofinhalationalagents 224
JanBoublikandRichardD.Urman 49 Totalintravenousanesthesia(TIVA) 305
AmitGuptaandJ.LanceLichtor
50 Monitoredanesthesiacare 309
Part6–IntravenousAnestheticsand
ShubjeetKaur
AdjunctDrugs
51 Patientpositioningandcommonnerveinjuries 313
MarkDershwitz,editor
ChristianD.Gonzalez
34 Intravenousinductionagents 227
AakashAgarwalaandMarkDershwitz
Part9–ManagingtheTransitionfrom
35 Mechanismsofanestheticactions 233 Anesthesia
KenSoltandDouglasE.Raines
RobertM.Knapp,editor
36 Pharmacokineticsofintravenousagents 236
52 Emergencefromanesthesia 317
LisbethLopezPappasandMarkDershwitz
MichaelP.StoreyandRichardD.Urman
37 Opioids 242
53 PostoperativecomplicationsinthePACU 321
DarinJ.CorrellandCarlE.Rosow
AlaNozariandEdwardA.Bittner
38 Musclerelaxants 251
54 Managementofpostoperativenauseaand
TorinD.ShearandJ.A.JeevendraMartyn
vomiting 326
39 Reversalofneuromuscularblockade 257 RobertM.Knapp
ThorC.MillandandNeelakantanSunder
55 Cognitivechangesaftersurgeryandanesthesia 330
40 Perioperativepulmonaryaspiration JoshuaC.Vacanti,GregoryJ.Crosby,and
prophylaxis 261 DeborahJ.Culley
JohnP.BroadnaxandB.ScottSegal
vi
Contents
Part10–RegionalAnesthesia Part13–CardiacAnesthesia
MercedesA.ConcepcionandMarkDershwitz,editors StantonK.Shernan,editor
56 Anatomyofthevertebralcolumnandspinal 70 Cardiacphysiology 427
cord 335 NelsonL.ThaemertandRenaBeckerly
AssiaValovska
71 Cardiovascularpharmacology 438
57 Spinalanesthesia 340 ArtiOriandDouglasC.Shook
IvanT.ValovskiandAssiaValovska
72 Adjunctcardiovasculardrugs 447
58 Epiduralanesthesia 349 AlexanderC.GerhartandBalachundhar
RichardS.FieldandB.ScottSegal Subramaniam
59 Principlesofultrasound-guidednerveblocks 356 73 Coronaryarterybypassgraftingutilizing
TanjaS.FreyandAdamB.Collins cardiopulmonarybypass 451
TheresaS.ChangandJohnA.Fox
60 Upperextremitynerveblocks 361
EddyM.Feliz,TanjaS.Frey,AdamB.Collins,and 74 Off-pumpcoronaryarterybypass 461
Abdel-KaderMehio TheresaS.ChangandJohnA.Fox
61 Lowerextremitynerveblocks 370 75 Transesophagealechocardiography 464
MoˆnicaM.Sa´ReˆgoandAdamB.Collins KarinneJervisandBalachundharSubramaniam
76 Pacemakersandautomatedimplantable
cardioverter–defibrillators 473
Part11–FluidandElectrolyteBalance
SuganthaSundarandEswarSundar
SelwynO.RogersJr.,editor
77 Ventricularassistdevices 479
62 Fluidreplacement 383
AmandaA.FoxandJohnA.Fox
SilviaPiviandLorenzoBerra
78 Anestheticconsiderationsforsurgicalrepairof
63 Acid–basebalanceinanesthesiaandintensive thethoracicaorta 485
caremedicine 388
BrianJ.GelfandandAmandaA.Fox
GeorgeP.Topulos
79 Cardiactransplantationintheadult 492
64 Ionbalance 396
MartinaNowak,PremS.Shekar,and
TommasoMauriandLorenzoBerra MichaelN.D’Ambra
65 Totalparenteralnutrition 402 80 Persistentpostoperativebleedingincardiac
MalloryWilliamsandGyorgyFrendl surgicalpatients 497
WalterBethune,MichaelG.Fitzsimons,and
EdwinG.AveryIV
Part12–TransfusionMedicine
RichardM.Kaufman,editor
Part14–VascularAnesthesia
66 Bloodproducts 407
SimonGelmanandStanleyLeeson,editors
EdwardR.Garcia
67 Bloodtransfusion 411 81 Carotidendarterectomy 503
BrianJ.GelfandandStanleyLeeson
JonathanE.Charnin
68 Massivetransfusion 417 82 Abdominalaorticaneurysm 509
FredCobey,SimonGelman,andJonathanD.Gates
AmyJ.OrtmanandSusanVassallo
69 Normovolemichemodilution,perioperative 83 Endovascularabdominalaorticaneurysmrepair 516
bloodsalvage,andautologousblood K.AnnetteMizuguchi
donation 422
84 Peripheralvasculardisease 519
ThomasJ.Graetz
LauraH.LeducandJamesL.Helstrom
vii
Contents
Part15–ThoracicAnesthesia Part18–AnesthesiaforGeneralSurgical
ShannonS.McKenna,editor Procedures
85 Respiratoryphysiology 523 WarrenS.Sandberg,editor
ShannonS.McKenna
100Anesthesiaforintra-abdominalsurgery 631
86 Oxygenandcarbondioxidetransport 530 KhaldounFarisandFarazSyed
SwaminathanKarthikandJ.TaylorReed
101Laparoscopicsurgery 636
87 Lungisolationtechniques 536 KaiMatthesandBhavaniS.Kodali
ShineSunandSarahH.Wiser
102Anesthesiaforesophagealand
88 Anestheticmanagementforpulmonary gastricsurgery 640
resection 546 AmyL.KimandWarrenS.Sandberg
SarahH.WiserandPhilipM.Hartigan
103Anesthesiaforgynecologicand
89 Lungtransplantation 557 breastsurgery 647
VladimirFormanek BronwynCooper
90 Bronchoscopyandmediastinoscopy 563 104Anesthesiaforlivertransplantation 651
SharonL.WetherallandPhilipM.Hartigan JasonC.BrookmanandWarrenS.Sandberg
91 Managementofmediastinalmass 568
Ju-MeiNg Part19–AnesthesiaforEndocrineDiseases
BalachundharSubramaniam,editor
Part16–Neuroanesthesia
105Thyroiddisorders 661
LindaS.Aglio,editor EmilyA.SingerandPankajK.Sikka
92 Principlesofneurophysiology 575 106Parathyroiddisorders 666
DennisJ.McNichollandLeeA.KearseJr. DavidR.Moss
93 Cerebralprotection 585 107Pheochromocytoma 669
GraceY.Kim DeborahS.Pederson
94 Craniotomy 591 108SIADH,diabetesinsipidus,andtranssphenoidal
ElizabethM.RickersonandLisaJ.Crossley pituitarysurgery 673
JohnSummersandBalachundharSubramaniam
95 Cerebrovasculardiseases 597
GraceY.Kim 109Disordersoftheadrenalcortex 676
JohnSummersandBalachundharSubramaniam
96 Anesthesiaforelectroconvulsivetherapy 611
LambertusDrop
Part20–AnesthesiaforNeuromuscular
Part17–AnesthesiaforRenaland andCollagenDiseases
UrinaryTractDiseases PaulD.Allen,editor
PaulD.Allen,editor 110Malignanthyperthermia 681
MatthewC.MartinezandJohnD.Mitchell
97 Renalphysiology 617
EdwardR.Garcia 111Myastheniagravis 685
TomasCvrk
98 Urology 621
NaveenNathanandTarunBhalla 112Musculardystrophyandmyotonicdystrophy 690
JasonM.ErlichandSuganthaSundar
99 Kidneyandpancreastransplantation 628
ThomasEdrichandSayeedMalek
viii
Contents
Part21–AnesthesiaforOcular,Ear,and Part24–PediatricAnesthesia
ThroatDiseases LucindaL.Everett,editor
D.JohnDoyle,editor 127Basicconsiderationsfor
pediatricanesthesia 777
113Ophthalmicprocedures 695
AlinaLazarandPatriciaR.Bachiller
J.VictorRyckmanandD.JohnDoyle
128Preoperativeevaluationofthepediatric
114Commonotolaryngologyprocedures 701
patientandcoexistingdiseases 787
NailaMoghulandD.JohnDoyle
ScottA.LeGrandandThomasM.Romanelli
115Lasers,airwaysurgery,andoperatingroomfires 708
129Anestheticconsiderationsforcommon
AlvaroA.Macias,NailaMoghul,andD.JohnDoyle
proceduresinchildren 795
TonyaL.K.Miller,NoahE.Gordon,and
Part22–AnesthesiaforOrthopedicand MaryEllenMcCann
TraumaSurgery 130Neonatalsurgicalemergencies 804
NoahE.GordonandMaryEllenMcCann
Abdel-KaderMehioandKamenV.Vlassakov,editors
131Congenitalheartdisease 813
116Anesthesiaforcommonorthopedic
DeniseM.ChanandAnnetteY.Schure
procedures 713
PatricioLeyton,GianPaoloVolpato,andKamenV. 132Managementofpostoperativepain
Vlassakov inchildren 824
RahulKokaandNavilF.Sethna
117Rheumatoidarthritisandscoliosis 721
KenjiButterfield,Abdel-KaderMehio,and 133Neonatalresuscitation:clinicalandpractical
JohnD.Mitchell considerations 833
DeniseM.Chan,ThomasJ.Mancuso,and
118Anestheticmanagementinspinesurgery 726
McCallumR.Hoyt
Abdel-KaderMehioandSwapneelK.Shah
119Anesthesiafortrauma 732
Part25–AmbulatoryandRemote
BishrHaydar
LocationAnesthesia
Part23–ObstetricAnesthesia BeverlyK.Philip,editor
WilliamR.Camann,editor 134Introductiontoambulatoryanesthesia 837
McCallumR.HoytandNailaMoghul
120Physiologicchangesduringpregnancy 739
CarloPancaroandWilliamR.Camann 135Anesthesiaoutsidetheoperatingroom 841
WendyL.GrossandRamonMartin
121Analgesiaforlabor 744
ArvindPalanisamyandB.ScottSegal 136Office-basedanesthesia 846
FredE.Shapiro
122Anesthesiaforcesareandelivery 751
LawrenceC.Tsen
Part26–ManagementAspectsof
123Obstetrichemorrhage 757
AnesthesiaPractice
CosminGauranandLisaR.Leffert
RossJ.Musumeci,editor
124Preeclampsia 761
AmyJ.OrtmanandLisaR.Leffert 137Patientsafety,qualityassurance,andrisk
management 851
125Pregnantpatientswithcomorbiddiseases 766
MiriamHarnettandJeffreyB.Cooper
AnasuyaVasudevanandStephenD.Pratt
138Operatingroommanagement:coreprinciples 855
126Anesthesiaforfetalintervention 772
RichardD.UrmanandSunilEappen
RolandBrusseauandLindaA.Bulich
ix