Table Of ContentPOX~ ESTH ES I A
I
CONTENTS
ContributingAuthors ix
Pre/iKe xiii
pREOpERATIVE pATIENT EVA! UATION 1_1
{esseM.Ehrenfeld
PHARMACOLOGY'INHALATIONAL
AMESIHFTICS 2A_l
DavidLParrisandSamuelC.Seiden
PHARMACOLOGY'INTRAVENOUS
ANESTHETICSANDANALGESICS 2B.5
WOOl/el( Seiden
pHARMACOIcay·IDCAI ANESTHETICS K _la
Jenna HonsenandSamuelC.Seiden
PHARMACOLOGY'NEUROMUSCULAR
BLOCKING DRUGSAND REVERSALAGENTS 20.22
JennaHansenandSamuelC.Seiden
PHARMACOLOGY:VASOACTIVE.AUTONOMIC
AND CARDIOVASClJI Aft DRLlGS 2E_2S
SqmuelC Seiden
I!HARMACOJ.O~=QMMONL,(
ENCOUNTERED DRUGS INANESTHESIA 2E_38
SamuelC.Seiden andStephen Fink
PHARMACalcay·ANTIBIOTICSAND
HERBALMEllli:lNES lG:.l2
RichardD.UrmanandJesseM.Ehrenfeld
ANESTHESIA EQUIPMENT 3-1
(enniferBartlett
A1RWAY....MA~GfMENT 4.1
TQwnBhgNg
ANESTHESIATECHNIQUES 5-1
BenjaminUnger
REGIONAl ANESTHESIA 6-1
I'ereLIIm
PERIOPERATIVE MONITORING 7.1
Fronds X Djllon
8.1
FrondSX Djllon
FLUIDS,ELECTROLYTES,&TRANSFUSION
IHERAPY 9.'
AranvaBagchi
COMMON INTRAOPERATive PROBLEMS 10.'
RandyFayne
ANESIHESI~O~ED!JRES l1.1h.'l
Ka;Mouhes
AcUTe PAIN MANAGEMENT 12.'
No'in;VadiveluandChristianWhitney
I'AClL.MANAc:;EMEI'U.AND....lll~CIlARGE 13-1
PiyushMathur
COMPliCATIONS OFANESTHESIA 14-1
MichaelWSanfordandDavidA.Nakata
TRAUMA,BURN,AND CRITICALCARE
MANAGEMENT 15_1
DanielWJohnson
ANESTHESIA FOR CARDIAC SURGERY 16.'
AmandaRheeandUndaShore-Lesserson
ANES.IH.ESIAEO.R.IHO..RAc.u:...s.uRGERY 17.'
'GnochonM.Anagnostou
ANESTHESIA FOR GENERALAND
ABDOMINAl SURGERY 18_1
MogedArgolious
ANESTHESIA FORVASClII AB SURGERY 19.'
ANESTHESIA FOR NEUROLOC:;IC SURC:;ERY,
NEURORADIOLOC:;Y, AND ECT 20-1
'oshunH.Atkins
ANESTHESIA FOR DIDI dRYNGO! ooy
(ENT)AND OPHTHALMOLOGY 21-1
'oshunH.Atkins
&EN.A.! SYSTEM AND..ANESIHESIA....EOR
URO! OGIC SURGERY 22-1
Christinefiner
ANESTHESIA FOR ORTHOPEDIC SURGERY 23.1
RobertHsiungandPeterWu
ANESTHESIA FOR ENDOCRINE SURGERY 24-1
Matvey&bylev
ANESTHESIA FOR OBSTETRICAND
GXNE~OLQGl~URGERY1 --225~
PalomaToledo
PEDIATRICANESTHESIA 26_1
Thamas M RomaoeW
AMBULATORYAIIIESIHESIA 2{,..1
UrsulaGalway
ANESTHESiA FORAESTHETiC SURGERY &
SURGERYOUTSIDE OFTHE OpERATING
ROOM 28.1
RuchirGuptaandPadmoSurampudi
MANAGEMENTOF CHRONIC PAIN 29_1
NaliniVadiveluandChristianWhitney
ORGANTRANSPLANTATION 30.1
AmooclnRheeoodMarkAhel
ANESTHESIA FORTHE ELDERLy 31.1
RaymondC.Roy
ECG INTERPRETATION 32_1
Amanda RheeandLinda Shore-Lesserson
ETHICAl ISSUES INANESTHESIA 33.1
JesseM.EhrenfeldandRichardD.Ull71an
EMERGENCYAI GORITHMS 34·1
TracyPalumboDavich
COMMON MEDICAl PHRASES IN SPANISH 35_1
SolomonMaya
NORMAL LABORATORYVALUES 36.1
MarkA.Hoeft
AppENDIX A.1
A:FormulaeandQuickReference
B.:An.e.stb.esia....MachioeORChedmutRe.ClllIlm..e.Qdotioas
C:SettingUpTheORForAnAnesthesiaCase
or
D:Mana!?ement MalignantHYPerlhermia
AcquisitionsEditor:liscMeAliSler
ManagingEditor:Mal!eT.Demoski
ProjectManager:BridgettDaugherty
SeniorManufacturingManager:BenjaminRivera
SeniorMarketingManager:AngelaPanetta
C"'ativeDirector:DougSm""k
ProductionServ",e:ApUlrl,Inc.
©2009byLippincottWiIliams&Wilkins,aWoltersKluwerbusiness
BOWalnutStreet
Philad"lphia,PA19106USA
LWW.com
Allrightsr"'e.....ed.Tnisbookisprotectedbycopyright.No partofthisbookmaybe
reproduced inanyform byanymeans.includingpnotocopying.or utilizedbyanyinfor
mationstorageandretrievalsy5temwithoutwritten permissionfromtnecopyright
owner.exceptforbriefquotationsembodiedincriticalarticlesandreviews.Materials
appearingintni.bookprepared byindr.idualsasp.rt01theirofficialdutie'asU.S.gov
ernmentemployee,are notcoveredbytheabove-mentionedcopyright.
PrimedinChina
LibraryofCongressCataloging-in-PublicationData
PocketanesthesiaI [editedby]RichardD.Urman,Jesse M.Ehrenfeld.
p.; cm.
Includesbibliographicalreferencesandindex.
ISBN·1l: 978·0-7817·9584-5(alk.paper)
ISBN·10,0·7817-9584-2(alk.paper)
1.Anennesiology---Handbooks,manuals.etc. 2.Anenhe,O>--Handbooks,m"nual"etc.
I.Urman,RichardQ II,Ehrenfeld.JesseM
[DNLM: 1. Anenhe,ia- l-'hndbooks.1 Anesthet"'s-Handbooks. WO231P719
2009]
RD82.2.P6252009
617.9'6--dc22
2009008498
Careh"sbeentakentoconfirmthe.ccur"eroftheinformauoopresented"ndtode·
scribegenerally"cceptedpractices.How"""r,theauthors,editors,"nd publis~erare
notresponsibleforerrorsor omissionsorforanyconsequencesfromapplicationof
theioformationinthisbookandmakenowatT:Imy.expre"edor implied,withre'pect
to the currency,completeness.oraccuracyofthecontents01the publication.Applica·
nonoftheinformationinaparticularsituation remainstheprofessionalresponSibility
ofthepractitioner.
Theauthors,editors,"I'dpublls~erh:r;eexerted everyefforttoensureth"tdrug
selectionanddcsagesetlorthinthistextareinaccordanceWithcurrentrecommen
dationsandpracticeatthetime01publication.However,inviewofongOingresearch,
ch"ng."ingov"rnmentr"gubtion.,"I'dthecon<t:lntflowofinformationrelating[0
drugtherapyanddrugr"actions,theread"risurg"d tocheckthe pacbgeins"rtfor
eachdrugforanyeh"ngeinindicationsanddosage andforaddedwarningsandprecau·
tions.Thisisparticularlyimport3ntwhentherecommendedagentisan"worinfre·
quenllyemploy"ddrug.
Som" drugsandmMicald.....ic". pres"ntedinthepublicationhav"FoodandDrug
Adrrunistrauon(FDA)clearanceforlimiteduseinrestrictedresearchsettings.Itisthe
re,ponsibilltyofthe h""lth ca",provid"rtoascertainth"FDAstatUIofeachdrugor
device pl.nnedloruseintheirclinicalpractice.
TopurchaseadditionalcopiesofthISbook.callourcusecmerservicedepartmentat
(800)638·3030or faxordersto (301)223·2J20.lnternationalcu.tomersshouldcall
(301)223·2300.
VisitLippincottWilliams&Wilkin.onthe InterneeatLIN'N.com.LippincottWilli"ms&
Wilkinscustomerservicerepre'entatr.esareavailablefrom8,30amto6pm,EST.
109876H·321
Copy'oghedm r
I
CONTRIBUTING AUTHORS
MarkAbel,M.D.
AssociateProfessor,DeparonentofAnesthesiology
MontefioreMedicalCenter
AlbertEinSleinCollegeofMedicine
Jonathan M.Anagnostou,M.D.
AssociateProfessorof ClinicalAnesthesia
MedicalDirectorofRespintoryCare
lndianaUniversityHospital
HagedArgalious,M.D.
AssisuntProfessorofAnesthesiology
ClevelandClinicLerner CollegeofMedicine
JoshuaH.Atkins.M.D.,Ph.D.
Assistant ProfessorofAnesthesiologyand CriticalCue
UniversityofPennsylvaniaSchoolofMedicine
Aranya Sagehi,M.D.
ClinicalFellowinAnesthesia,Masuchusetts GeneralHospital
HarvardMedicalSchool
JenniferBartlett,M.D.
AnesthesiaResident,DepartmentofAnesthesia
IndianaUniversityMedicalCenter
Tarun Shalla,M.D.
ChiefResident,DepartmentofAnesthesiology
NorthwesternUniversity,FeinbergSchoolofMedicine
MatveyBobylev,M_D.
StaffAnesthesiologist,DepartmentofGenen.1Anesthesiology
The Cleveland ClinicFoundation
Francis X.Dillon,M.D.
AssistantAnesthetist,MassachusettsEyeandEarInfinnary
InstructorinAnesthesia,HarvardMedicalSchool
Tracy Palumbo Dovich,M.D.
StaffAnesthesiologist,ClevelandClinic
Jesse M.Ehrenfeld,M.D.
Assistant inAnesthesia,MassachusettsGeneralHospital
InstructorinAnesthesia,HarvardMedicalSchool
RandyFayne,D.O.
StaffAnesthesiologist,WilliamBeaumontHospital
SouthOaklandAnesthesiaAssociates
Christine Finer,M.D.
ClinicalFellowinAnesthesia,Massachusetts GeneralHospital
Ha-vard MedicalSchool
Stephen Fink,M.D.
AnesthesiaResident,DepartmentofAnesthesia
StanfordUniversityMedicalCenter
RuchirGupta,M.D.
Anesthesia Resident,DepartmentofAnesthesia
St.VincentCatholic MedicalCenter
UrsulaA.GalwayM.D.
StaffAnesthesiologist.DepartmentofAnesthesiology
TheClevelandClinicFoundation
Jenna Hansen,M.D.,MS.
ResidentPhysician.DepartmentofAnesthesia
Stanford UniversityMedicalCenter
MarkA.Hoeft,M.D.
ClinicalFellowinAnesthesia.Massachusetts General Hospital
HarvardMedicalSchool
RobertHsiung,M.D.
StaffAnesthesiologist
VirginiaMasonMedicalCenter
DanielW.Johnson,M.D.
ClinicalFellowinAnesthesia,Massachusetts GeneralHospital
Harvard MedicalSchool
DavidA.Nakata,M.D.,M.B.A.
Vice-Chair ResidencyDevelopment&AnesthesiaProgramDirector
DepartmentofAnesthesia
IndianaUniversityMedicalCenter
Piyush Mathur,M.D.
StaffAnestheslclogist/lntensivist
AnesthesiaInstitute.ClevelandClinic
Kai Matthes,M.D.,Ph.D.
MiltonH.AlperFellow,PediatricAnesthesiology
Children's HospitalBoston
Harvard MedicalSchool
Salomon M.Maya,M.D.
ClinicalFellowinAnesthesia.Massachusetts GeneralHospital
Harvard MedicalSchool
David L. Parris,M.D.
ResidentPhysician.DepartmentofAnesthesia
Stanford University MedicalCenter
AmandaJ.Rhee,M.D.
Anesthesia Resident.MontefioreMedicalCenter
AlbertEinsteinCollegeofMedicine
c '.
I
PREFACE
Writtenbyresidents.fellows.andattendingstaff,PocketAnesthesiapro
videsa practical,concise,up-to-datesourceofinformationformanage
mentofthemostcommonper-operativeconditionsfacingtcday'sanes
thesiaprovider.Ourgoalinwritingthispocket guide wasto provide a
useful,evidence-based referencewhichproviderscanrefer to,inorder
toquicklyfindthe most relevant informationthey need.
We are gratefulfor the supportofallourcontributorsfrom many
differentinstitutions,aswellasthe hcusestafffellows,andattendingsat
both the Massachusetts GeneralandBrighamandWomen'sHospitals.
Asphysicians.wefeelprivileged toworkwith anincrediblegroup ofin
dividualswho support our clinicalactivitieseach day.This includes our
surgicalcolleagues.nursingandsupportstaff.
We are especiallyindebted to a number of individuals,whose un
endingsupportandencouragementmade thisworkpossible.These in
clude Drs.Jeaninewlener-Krcotsh,CharlesVacanti,WarrenZapol,War
renSandbergandBeverlyPhilip.We wouldlike to thankthe Lippincott
Williams &Wilkins staff,including Nicole Dernoski,Brian Brown.and
LisaMcAllister.
We wouldalsoliketo thankDrs.vanessaHenkeandSamuelSeiden
fortheiroutstandingeditorialcontributionsandclinicalinsight.Finally.a
veryspecialthanksto our parents andfamiliesfor their continued en
couragement.loveandsupport.
We hopethatyoufindPocketAnesthesia avaluableresource.
JESSEM.EHRENFELD.M.D.
RICHARDD.URMAN.M.D.
Boston.Massachusetts
c '.
PREOPERATIVE PATIENT
EVALUATION
JESSEM.EHRENFELD
_SAPhy$icIlS.tfjsCI;,.ssificati().n EXample
No...organic/physi()l()gic/psychiatricproblems Healthypa~iE!l'lt .>
Controlledmedicalconditionswithmildsystemic ControlledHTN/
E!ffects,no....Ii/llitati0l'lsinfunctionalability sill0ker(ob.E!si~y
III Medicalconditionswithseveresystemiceffects, ControlledCHF/stable
limitationsinfunctionalability angina/morbid
obesity/COPD/chronic
renalinsuff.
IV Poorlycontrolled medicalconditionsassociated Unstableangina/
withsignificantimpairmentinfunctionalabilitythatis symptomaticCOPD
p()~E!I'l~.i.ClI..~h.~eCl~...to.....lifE! orCHF
V Criticalcondition,littlechanceofsurvivalwithout RupturedAAA
slJ~gicaJpr()cedure
VI ~rClin~eCld,.u.nderg()ing()rgan~()nation
E Emergency,trauma Gunshotwound,(;1perf.
I~Q~~~••i¥~ilnt:irYiiw
Cur:rerltiss.~~ln~icClti()nJ()r~urgE!rY.
ftCl~~I1'1~dical...~.istory P~E!~E!I'l~e~SE!YE!ri~y()fll1E!dicClL£()Il1()r~i~i~Ies
ROS Fo~us()1'lgE!nerClIJlJl'lcti()I'lCllcClpa~ity
CV Angina,SOB,exercisetolerance,activitylevel,limitingfactors
Pulmonary SOB,dyspneaonexertion,smoking,inhaleruse,baseline02use
Neurologic TIA,stroke,pain,depression,anxiety
GI GERDsymptoms,NPOstatus
Renai/GU Possibilityofpregnancy
Heme Easybruising,easybleeding,hxofanemia,clottingd/o
Musculoskeletal <::E!ryifCllrCll'lgE!()f/ll()~i()l'.l
.~~r:giC:ClI.....hi.~~Qr:Y e~E!yi()lJ~.slJrgE!~iE!~,il'l~llJcjil'lg.c()ll1pIIcClti()l'ls/()u~~()Il1E!~
Anesthetichistory Examineoldrecordsforhxofdifficultairwaymanagement,
eQNY:ClI'lYsfCl/lliJyb)(~lJggE!s,~iYE!.()f.ll1aligI'lClnt.hYPE!r~hE!~/llia
.~Qc:iClI...~i~~Qr:Y T()~Cl~~()LClI~()b()lliJli~i~~~uglJsE! ' .
Allergies Drugallergies(anaphylaxis,airwayswelling,hives,pulmonary
reacti()ns)vs:sJ~E!effE!cts/il'ltolE!rClI'l~E!,JCltE!)(Cllle~gy
Medications Especiallycardiovascularrneds,insulin,anticoagulationmeds
PREOPERATIVEPHYSICALEXAMINATION
• Vital signs:Restingheartrate,BP,Sp02height,weight,body massindex
• CV&pulm:Heart&lungsounds,JVD,pulm/periphedema,carotidbruits
• Airwayexam:
1.Mallampatiscore(seebelow)
2.Thyromentaldistance:Haveptextendneck&measurespacebetweenmental
prominenceandthyroidcartilage;<6emmayindicatedifficultintubation
3.Cervicalspineflexion/extension:Examinepatientfor,j,rangeofmotionthatmight
limitheadmovementintosniffingpositionduringintubation
4.Miscellaneous:Oralopening,sizeofmandible (micrognathia)&tongue(rnacroglos
sia),dentition(loose,missing,prostheses)
