Lecture Notes: Clinical Anaesthesia

199 Pages·2012·11.13 MB·English

by  Carl L. Gwinnutt

CLINICAL ANAESTHESIA
Lecture Notes 4th Edition
Review of the previous edition
CLINICAL ANAESTHESIA
“Lecture Notes Clinical Anesthesia offers a comprehensive review of general anesthesiology principles G
and practices in a quick and easy-to-read style. I recommend it as an excellent first-step for students w
and other medical professionals who are interested in the field of anesthesiology.” in
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Mohanad Shukry, MD, Anesthesiology, June 2009 u Lecture Notes
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Perfect for medical students, junior doctors, anaesthetic nurses and allied health professionals,
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Lecture Notes Clinical Anaesthesia provides a thorough introduction to the modern principles and t
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practices of clinical anaesthesia. r
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Full-colour diagrams, photographs and key fact boxes support easy understanding of the theory of o
anaesthetics allowing confident transfer of information into clinical practice. t
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This fourth edition has been fully revised and updated to reflect recent developments within the
L Carl Gwinnutt
anaesthetics specialty and is fully supported by a wide-range of self-assessments for study and revision
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purposes together with a range of ‘tips for anaesthesia attachments’ that start each chapter. N Matthew Gwinnutt
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Whether you need to develop your knowledge for clinical practice, or refresh that knowledge in the run-up A
to examinations, Lecture Notes Clinical Anaesthesia will help foster a systematic approach to the clinical L 4th Edition
situation for all medical students and hospital doctors.
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For information on all the titles in the Lecture Notes series, please visit: www.lecturenoteseries.com
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ISBN 978-0-470-65892-5
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BASQ 06/27/2012 15:32:7 Page170
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Clinical Anaesthesia
Lecture Notes
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Toawonderfulwifeandmarvellous,uncomplainingmother.
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Clinical Anaesthesia
Lecture Notes
Carl Gwinnutt
MBBSMRCSLRCPFRCA
FormerlyConsultantAnaesthetist
SalfordRoyalHospitalNHSFoundationTrust
HonoraryClinicalLecturerinAnaesthesia
UniversityofManchester,UK
Matthew Gwinnutt
MBChB(Hons)
CoreTraineeinAnaesthesia
MerseyDeanery
Liverpool,UK
FourthEdition
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LibraryofCongressCataloging-in-PublicationData
Lecturenotes.Clinicalanaesthesia/CarlGwinnutt,MatthewGwinnutt.–4thed.
p.;cm.
Clinicalanaesthesia
Includesbibliographicalreferencesandindex.
ISBN978-0-470-65892-5(pbk.:alk.paper)
I.Gwinnutt,Matthew. II.Title. III.Title:Clinicalanaesthesia.
[DNLM: 1. Anesthesia. 2. Anesthetics. WO200]
617.906–dc23
2012007478
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1 2012
FTOC 06/27/2012 15:46:47 Page5
Contents
Listofcontributors,vi
Preface,vii
Acknowledgements,viii
Listofabbreviations,ix
1 Anaestheticassessmentandpreparationforsurgery,1
2 Anaestheticequipmentandmonitoring,18
3 Drugsandfluidsusedduringanaesthesia,39
4 Thepracticeofgeneralanaesthesia,58
5 Localandregionalanaesthesia,79
6 Specialcircumstances,88
7 Post-anaesthesiacare,100
8 Theacutelyilladultpatientontheward,121
Section1:Recognitionandassessment,121
Section2:Managementofcommonemergencies,131
Answerstoshort-answerquestions,159
Answerstotrue/falsequestions,171
Index,177
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Contributor
AnthonyMcCluskey
ConsultantinAnaesthesiaandCriticalCare
StockportNHSFoundationTrust
SteppingHillHospital
Stockport,UK
FPREF 06/27/2012 15:57:26 Page7
Preface
Itisnowover15yearssinceIembarkeduponthe Also included is a small chapter covering some
first edition of this book, and with each subse- of the specialist branches of anaesthesia that
quent edition I have tried to respond to the students may encounter; it has not been possi-
demands of the readers and the changes within ble to cover every one and I hope those whose
thespecialtyofanaesthesiaitself.Inrecentyears specialties are not included will understand.
theanaesthetist’srolehasexpandeddramatically Trainees from many specialties now work as
from simply ‘providing the conditions under part of the ‘Hospital at Night’ team, and one of
whichsurgerycanbeperformedsafely’andnow theirrolesistorespondtorequestsforhelpwith
involves contact with the majority of patients acutelyillpatientsthattheymaynotbefamiliar
admitted to hospital. This includes playing a with.Followingonfromthesuccessofthechap-
majorroleinpreoperativeassessmentandpost- terinthepreviouseditionontherecognitionand
operativecare,acute and chronic pain manage- management of the acutely ill patient on the
ment, as well as the recognition, resuscitation ward,thishasnowbeenexpandedintotwosec-
andmanagementofthecriticallyill.Thisedition tions;thefirstonrecognitionandassessmentof
seesmanychangestoreflectthis. thesechallengingpatients,followedbyadviceon
The first major change to this edition is the howinitiallytomanagecommonlyencountered
lossofthechaptergivinganoverviewofcritical problems.
care. During my career in anaesthesia I have Butperhapsthegreatestchangeforthisedition
been privileged to see this specialty grow from isthatInowwelcomemyson,asheembarksona
theeffortsofgroupsof enthusiaststoitsrecent careerinanaesthesia,asco-author.Hehaspro-
formalrecognitionandtheformationoftheFac- videdafreshinsightintothespecialtyasseenby
ultyofIntensiveCareMedicinewithintheRoyal ananaesthetistintraining,andismoreawareof
CollegeofAnaesthestists.Consequently,Iwould whatmedicalstudentsneedtoknow,ratherthan
encourage students to turn to the many excel- whatIthinktheyoughttoknow.Hehasworked
lenttextsavailableonthisfascinatingandevolv- tirelessly on the manuscript and provided new
ingspecialty. photographic illustrations; for that I owe him
The next change in this edition is a reorgan- enormously–thankyou!
ization of the way anaesthesia is presented. IclosebyreiteratingwhatIsaidattheendof
Firstly, information on equipment, monitoring theprefaceofthepreviousedition,butthistime
and the drugs and fluids you will see anaesthe- themessagecomesfrombothofus;wehopeyou
tists use in their everyday practice. This is enjoythisbook,butevenmorewehopeithelps
followed by an overview of ‘giving an anaes- you care for your patients. If it has, tell your
thetic’, which describes the processes and pro- friends; if it hasn’t, tell us why and we’ll try to
cedures used to ensure the patient’s safety. ensurethatthenexteditionisevenbetter!
FACKNOW 06/27/2012 15:50:36 Page8
Acknowledgments
IwouldliketothankIntersurgicalforFigures2.3 his help and advice with transversus abdominis
and 2.5, Aircraft Medical for Figure 2.7(d), and planeblocksandFigure5.2.
Tanya Lachlan, Deltex Medical for Figures 2.18 ThanksareduetotheDifficultAirwaySociety
and2.19.Figure2.10isfromMcGuireandYounger, for Figure 6.3 and the National Tracheostomy
2010(seeusefulinformationsectioninChapter2), SafetyProjectforFigures8.1and8.2.
with permission of Oxford University Press on I would also like to express my sincere grati-
behalfoftheBritishJournalofAnaesthesia. tudetoDrRichardMorgan,ProfessorGarySmith
Figures 8.6, 8.7, 8.8 and 8.9 are reproduced andDrJasSoarfortheircontributionstothepre-
withkindpermissionfromMichaelScottandthe vious edition, some of which by necessity have
ResuscitationCouncil(UK). beenincludedinthisedition.
Figure 4.12 is reproduced with permission of
Dr.P.RossandIamgratefultoDrJ.Corcoranfor