Table Of ContentToma de
decisiones en
anestesiología
Algoritmos de actuación
Cuarta edición
Lois L. Bready, MD
Associate Dean for Graduate Medical Education
Professor and Vice Chair
Department of Anesthesiology
University of Texas Health Sciences Center in San Antonio
San Antonio, Texas
Dawn Dillman, MD
Department of Anesthesiology and Perioperative Medicine
Oregon Health Sciences University
Portland, Oregon
Susan H. Noorily, MD
Clinical Professor
Department of Anesthesiology
University of Texas Health Sciences Center in San Antonio
San Antonio, Texas
COLABORADORES
Stacey Allen, MD Daniel Martin Bitner, MD, MS
Department of Anesthesiology Department of Anesthesiology
University of Texas Health Sciences Center University of Texas Health Sciences Center
in San Antonio, in San Antonio
San Antonio, Texas San Antonio, Texas
D.M. Anderson, MD Mary Blanchette, MD
Department of Anesthesiology Department of Anesthesiology and Perioperative
University of Texas Health Sciences Center Medicine
in San Antonio Oregon Health Sciences University
San Antonio, Texas Portland, Oregon
Franklin L. Anderson, MD Erik A. Boatman, MD
Department of Anesthesiology San Antonio Uniformed Services Health Education
University of Texas Health Sciences Center Consortium
in San Antonio San Antonio, Texas
San Antonio, Texas
Gwendolyn L. Boyd, MD
J. Jeff Andrews, MD Department of Anesthesiology
Department of Anesthesiology University of Alabama at Birmingham School
University of Texas Health Sciences Center of Medicine
in San Antonio Birmingham, Alabama
San Antonio, Texas
Christopher A. Bracken, MD, PhD
William P. Arnold III, MD Department of Anesthesiology
Department of Anesthesia University of Texas Health Sciences Center
University of Virginia in San Antonio
Charlottesville, Virginia San Antonio, Texas
Patrick Bakke, MD Carol R. Bradford, MD
Department of Anesthesiology and Perioperative Department of Otolaryngology
Medicine University of Michigan Medical Center
Oregon Health Sciences University Ann Arbor, Michigan
Portland, Oregon
Kevin M. Brady, MD
Joanne Baust, MD Department of Anesthesiology and Critical Care
Department of Anesthesiology Medicine
University of Texas Health Sciences Center The Johns Hopkins Medical Institutions
in San Antonio Baltimore, Maryland
San Antonio, Texas
Ansgar M. Brambrink, MD, PhD
Jonathan L. Benumof, MD Department of Anesthesiology and Perioperative
Department of Anesthesia Medicine
University of California at San Diego Oregon Health Sciences University
San Diego, California Portland, Oregon
Lauren Berkow, MD Darin Brandt, DO
Department of Anesthesiology and Critical Care Department of Anesthesiology and Perioperative Medicine
Medicine Oregon Health Sciences University
The Johns Hopkins Medical Institutions Portland, Oregon
Baltimore, Maryland
Lois L. Bready, MD
Arnold J. Berry, MD, MPH Department of Anesthesiology
Department of Anesthesiology University of Texas Health Sciences Center
Emory University School of Medicine in San Antonio
Atlanta, Georgia San Antonio, Texas
iii
iv COLABORADORES
Russell C. Brockwell, MD John A. Dilger, MD
Department of Anesthesiology Department of Anesthesiology
University of Alabama at Birmingham Mayo Clinic
Birmingham, Alabama Rochester, Maryland
David M. Broussard, MD Dawn Dillman, MD
Department of Anesthesiology Department of Anesthesiology and Perioperative Medicine
Ochsner Clinical Foundation Oregon Health Sciences University
New Orleans, Louisiana Portland, Oregon
Allan C.D. Brown, MD Stephen Donahue, MD
Department of Anesthesiology Anesthesiologists for Children
University of Michigan Medical Center Dallas, Texas
Ann Arbor, Michigan
Nivine H. Doran, MD
Carol E. Campbell, MD Department of Anesthesiology and Critical Care
Department of Anesthesiology Medicine
University of Texas Health Sciences Center University of New Mexico
in San Antonio Albuquerque, New Mexico
San Antonio, Texas
M. Joanne Douglas, MD
A. Sue Carlisle, MD, PhD Department of Anesthesia
University of British Columbia
Department of Anesthesia and Perioperative Care
Vancouver, British Columbia, Canada
University of California San Francisco and San Francisco
General Hospital
George A. Dumitrascu, MD
San Francisco, California
Ottawa, Ontario, Canada
Bonny Carter, MD
Lynn A. Fenton, MD
Department of Anesthesiology
Department of Anesthesiology and Perioperative Medicine
University of Texas Health Sciences Center
Oregon Health Sciences University
in San Antonio
Portland, Oregon
San Antonio, Texas
Juergen Fleisch, MD
Lydia Cassorla, MD, MBA
Department of Anesthesiology and Perioperative Medicine
Department of Anesthesia and Perioperative Care
Oregon Health Sciences University
University of California San Francisco
Portland, Oregon
San Francisco, California
Judith A. Freeman, MD, CHB
Harold D. Cline, MD
Department of Anesthesiology and Perioperative Medicine
Department of Anesthesiology Oregon Health Sciences University
University of Maryland Medical Center Portland, Oregon
Baltimore, Maryland
Thomas Frietsch, MD
Corey Collins, DO
Department of Anesthesiology and Perioperative Medicine
Medford, Massachusetts Oregon Health Sciences University
Portland, Oregon
Sally Combest, MD
Department of Anesthesiology William R. Furman, MD
University of Texas Health Sciences Center Department of Anesthesiology
in San Antonio University of North Carolina
San Antonio, Texas Chapel Hill, North Carolina
Saundra E. Curry, MD Susan Garwood, MD, ChB, BSc, FRCA
Department of Anesthesiology Department of Anesthesiology
Columbia University College of Physicians and Yale School of Medicine
Surgeons Yale-New Haven Hospital
New York, New York New Haven, Connecticut
Myrdalis Diaz-Ramirez, MD Ethan Gaumond, MD
Department of Anesthesiology and Perioperative Care Department of Anesthesiology and Perioperative Medicine
Oregon Health Sciences University Oregon Health Sciences University
Portland, Oregon Portland, Oregon
COLABORADORES v
Kevin B. Gerold, DO, JD Vivian Hou, MD
Department of Anesthesiology and Critical Care Department of Anesthesiology and Perioperative Medicine
Medicine Oregon Health Sciences University
The Johns Hopkins Medical Institutions Portland, Oregon
Johns Hopkins Bayview Medical Center
Baltimore, Maryland Michael P. Hutchens, MD, MA
Department of Anesthesiology and Perioperative Medicine
James D. Griffin, MD Oregon Health Sciences University
Department of Anesthesiology and Pain Management Portland, Oregon
University of Texas Southwestern Medical Center at
Dallas Per-Olof Jarnberg, MD, PhD
Dallas, Texas Department of Anesthesiology and Perioperative Medicine
Oregon Health Sciences University
Mary Ann Gurkowski, MD Portland, Oregon
Department of Anesthesiology
Wendy B. Kang, MD, JD
University of Texas Health Sciences Center
in San Antonio Department of Anesthesiology
San Antonio, Texas University of Texas Health Sciences Center in San Antonio
San Antonio, Texas
Charles B. Hantler, MD
Suzanne B. Karan, MD
Department of Anesthesiology
Department of Anesthesiology
Washington University
University of Rochester School of Medicine
St. Louis, Missouri
and Dentistry
Rochester, New York
Jinny Kim Hartman, MD
Department of Anesthesiology
Celia I. Kaye, MD, PhD
Dartmouth-Hitchcock Medical Center
Department of Pediatrics
Lebanon, New Hampshire
University of Colorado Health Sciences Center
Denver, Colorado
Joy L. Hawkins, MD
Department of Anesthesia Angela Kendrick, MD
University of Colorado Health Sciences Center
Department of Anesthesiology and Perioperative Medicine
Denver, Colorado
Oregon Health Sciences University
Portland, Oregon
Eugenie Heitmiller, MD
Department of Anesthesiology and Critical Care Jeffrey R. Kirsch, MD
Medicine Department of Anesthesiology and Perioperative Medicine
The Johns Hopkins Medical Institutions Oregon Health Sciences University
Baltimore, Maryland Portland, Oregon
Antonio Hernandez, MD Kevin K. Klein, MD
Department of Anesthesiology Department of Anesthesiology and Pain Management
University of Texas Health Sciences Center University of Texas Southwestern Medical Center at
in San Antonio Dallas
San Antonio, Texas Dallas, Texas
Rosemary Hickey, MD Ines P. Koerner, MD
Department of Anesthesiology Department of Anesthesiology and Perioperative
University of Texas Health Sciences Center Medicine
in San Antonio Oregon Health Sciences University
San Antonio, Texas Portland, Oregon
Joseph R. Holahan, MD Hector LaCassie, MD
South Texas Oncology and Hematology PA Department of Anesthesiology
San Antonio, Texas Duke University Health System
Durham, North Carolina
W. Corbett Holmgreen, MD, DDS
Department of Anesthesiology Kirk Lalwani, MD
University of Texas Health Sciences Center Department of Anesthesiology and Perioperative Medicine
in San Antonio Oregon Health Sciences University
San Antonio, Texas Portland, Oregon
vi COLABORADORES
Marilyn Green Larach, MD, FAAP Kimberly D. Milhoan, MD
Owing Mills, Maryland Department of Anesthesiology
University of Texas Health Sciences Center in San Antonio
Catherine K. Lineberger, MD San Antonio, Texas
Department of Anesthesiology
Duke University Health System Tobias Moeller-Bertram, MD
Durham, North Carolina Department of Anesthesiology
University of California at San Diego
John J. Liszka-Hackzell, MD, PhD
San Diego, California
Department of Anesthesiology
University of Arizona College of Medicine Joseph J. Naples, MD
Tucson, Arizona
Department of Anesthesiology
The Methodist Hospital
Robert Loeb, MD
Houston, Texas
Department of Anesthesiology
University of Arizona College of Medicine
David V. Nelson, PhD
Tucson, Arizona
Department of Psychology and Philosophy
Sam Houston State University
Gaelan B. Luhn, MD
Huntsville, Texas
Department of Anesthesiology
University of Texas Health Sciences Center
Christopher D. Newell, MD
in San Antonio
Department of Anesthesiology and Perioperative Medicine
San Antonio, Texas
Oregon Health Sciences University
Colin F. Mackenzie, MD, ChB, FCCM Portland, Oregon
Department of Anesthesiology
Victor Ng, MD
University of Maryland Medical Center
Baltimore, Maryland Department of Anesthesia and Perioperative Care
University of California San Francisco
T. Philip Malan, Jr., MD, PhD San Francisco, California
Department of Anesthesiology
University of Arizona College of Medicine Dolores B. Njoku, MD
Tucson, Arizona Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions
Vinod Malhotra, MD Baltimore, Maryland
Department of Anesthesiology
Weill Medical College of Cornell University Susan H. Noorily, MD
New York, New York Department of Anesthesiology
University of Texas Health Sciences Center
David C. Mayer, MD
in San Antonio
Department of Anesthesiology San Antonio, Texas
University of North Carolina
Chapel Hill, North Carolina J. Russell Norton, MD
Department of Anesthesiology
Kathryn E. McGoldrick, MD
University of Rochester School of Medicine
Department of Anesthesiology
and Dentistry
New York Medical College
Rochester, New York
Valhalla, New York
Steven C. Onstad
Katherine R. McGuire, MD
Department of Anesthesiology and Perioperative Medicine
Department of Anesthesiology
Oregon Health Sciences University
University of Texas Health Sciences Center in San Antonio
Portland, Oregon
San Antonio, Texas
William T. Merritt, MD, MBA James C. Opton, MD
Department of Anesthesiology and Critical Care Medicine Department of Anesthesiology and Perioperative Medicine
The Johns Hopkins Medical Institutions Oregon Health Sciences University
Baltimore, Maryland Portland, Oregon
Sara M. Metcalf, MD Malcolm D. Orr, MD, PhD
Department of Anesthesiology and Perioperative Medicine Department of Anesthesiology
Oregon Health Sciences University University of Texas Health Sciences Center in San Antonio
Portland, Oregon San Antonio, Texas
COLABORADORES vii
Robert H. Overbaugh, MD Marco S. Robin, DO
Department of Anesthesiology Department of Anesthesiology and Perioperative Medicine
Penn State Milton S. Hershey Medical Center Oregon Health Sciences University
Hershey, Pennsylvania Portland, Oregon
Fred G. Panico, MD Stephen T. Robinson, MD
Seaford, Delaware Department of Anesthesiology and Perioperative Medicine
Oregon Health Sciences University
Cathleen L. Peterson-Layne, MD, PhD
Portland, Oregon
Department of Anesthesiology
Duke University Health System James N. Rogers, MD
Durham, North Carolina Department of Anesthesiology
University of Texas Health Sciences Center
Michael G. Phillips, BHS, PA-C
in San Antonio
University of Alabama at Birmingham San Antonio, Texas
School of Medicine
Birmingham, Alabama Mark A. Rosen, MD
Department of Anesthesia and Perioperative Care
Jorge Pineda, MD
University of California San Francisco
Department of Anesthesiology and Perioperative
San Francisco, California
Medicine
Oregon Health Sciences University Renata Rusa, MD
Portland, Oregon
Department of Anesthesiology and Perioperative Medicine
Oregon Health Sciences University
Anthony S. Poon, MD, DDS, PhD
Portland, Oregon
Department of Oral and Maxillofacial Surgery
University of Texas Health Sciences Center
Andrew S. Rushton, MD
in San Antonio
Department of Anesthesiology and Perioperative
San Antonio, Texas
Medicine
Oregon Health Sciences University
Marcelo Quezado, MD
Portland, Oregon
Department of Anesthesiology and Critical Care
Medicine
Susan M. Ryan, MD
The Johns Hopkins Medical Institutions
Department of Anesthesia and Perioperative Care
Baltimore, Maryland
University of California San Francisco
Rajam S. Ramamurthy, MD San Francisco, California
Department of Anesthesiology
Lauren L. Salgado, MD
University of Texas Health Sciences Center
Department of Anesthesiology
in San Antonio
University of Texas Health Sciences Center in San Antonio
San Antonio, Texas
San Antonio, Texas
Somayaji Ramamurthy, MD
Jamie McElrath Schwartz, MD
Department of Anesthesiology
University of Texas Health Sciences Center Department of Anesthesiology and Critical Care Medicine
in San Antonio The Johns Hopkins Medical Institutions
San Antonio, Texas Baltimore, Maryland
Deborah K. Rasch, MD Jaydeep S. Shah, MD
Department of Anesthesiology Department of Anesthesiology
University of Texas Health Sciences Center University of Texas Health Sciences Center
in San Antonio in San Antonio
San Antonio, Texas San Antonio, Texas
Jeffrey M. Richman, MD David I. Shapiro, MD
Department of Anesthesiology and Critical Care Medicine Department of Anesthesiology
The Johns Hopkins Medical Institutions Erie County Medical Center
Baltimore, Maryland Buffalo, New York
Kerri M. Robertson, MD Aarti Sharma, MD
Department of Anesthesiology Department of Anesthesiology
Duke University Health System Weill Medical College of Cornell University
Durham, North Carolina New York, New York
viii COLABORADORES
Nicholas R. Simmons, MD Michael Verber, MD
Department of Anesthesiology Department of Anesthesiology
Washington University University of Texas Health Sciences Center
St. Louis, Missouri in San Antonio
San Antonio, Texas
Gary D. Skrivanek, MD
Department of Anesthesiology and Pain Management Jennifer F. Vookles, MD
University of Texas Southwestern Medical Center at Department of Anesthesiology and Perioperative
Dallas Medicine
Dallas, Texas Oregon Health Sciences University
Portland, Oregon
Tod B. Sloan, MD, PhD
Department of Anesthesiology David B. Waisel, MD
University of Colorado Health Sciences Center Department of Anesthesiology
Denver, Colorado Boston Children’s Hospital
Boston, Massachusetts
Fred J. Spielman, MD
Department of Anesthesiology Tessa L. Walters, MD
University of North Carolina Burlingame, California
Chapel Hill, North Carolina
Denham S. Ward, MD, PhD
Louis A. Stool, MD Department of Anesthesiology
Department of Anesthesiology and Pain Management University of Rochester School of Medicine and
University of Texas Southwestern Medical Center at Dentistry
Dallas Rochester, New York
Dallas, Texas
Leila G. Welborn, MD
Vijayendra Sudheendra, MD Department of Anesthesiology
Department of Surgery Children’s National Medical Center
Brown University Washington, DC
Providence, Rhode Isaland
Gary Welch, MD
Melba W.G. Swafford, MD Mico, Texas
Department of Anesthesiology
Baylor College of Medicine Lynda T. Wells, MD
Houston, Texas Department of Anesthesiology
University of Virginia Health System
Veronica C. Swanson, MD Charlottesville, Virginia
Department of Anesthesiology and Perioperative Medicine
Oregon Health Sciences University James R. Zaidan, MD, MBA
Portland, Oregon Department of Anesthesiology
Emory University School of Medicine
Jeffrey E. Terrell, MD Atlanta, Georgia
Department of Anesthesiology
University of Michigan Medical Center Angela Zimmerman, MD
Ann Arbor, Michigan Department of Anesthesiology and Perioperative
Medicine
John E. Tetzlaff, MD Oregon Health Sciences University
Division of Anesthesiology Portland, Oregon
Cleveland Clinic
Cleveland, Ohio Marcos A. Zuazu, MD
Department of Anesthesiology
Mohamed Tiouririne, MD University of Texas Health Sciences Center
Department of Anesthesiology in San Antonio
University of Virginia Health System San Antonio, Texas
Charlottesville, Virginia
Irena Vaitkeviciute, MD
Department of Anesthesiology
Yale University School of Medicine
New Haven, Connecticut
PRÓLOGO
El propósito de Toma de decisiones en anestesiología es En el aprendizaje de la práctica de la anestesiología o
presentar el proceso de actuación anestésica en el periope- para revisar un procedimiento con el que no se está fa-
ratorio en forma de árbol de decisiones. Así pues, este tra- miliarizado, es sumamente útil disponer de un acceso in-
bajo no pretende reemplazar los tratados de anestesia clá- mediato a un especialista experimentado que nos pueda
sicos, sino más bien describir cómo se debe emplear la sugerir una estrategia razonable y que nos señale necesi-
información que contienen. Este formato estimula al lector dades quirúrgicas especiales (y peligros potenciales). Esto
a pensar de forma sistemática y a seguir una secuencia de es lo que pretendemos en nuestro trabajo, sugerir una se-
actuación lógica durante todo el proceso de evaluación y rie de esquemas de actuación anestésica razonables que
preparación preoperatoria, en las actuaciones intraopera- sirvan como referencia clínica. Dado que los consejos
torias y en el postoperatorio. Nuestra meta era construir al- aportados por los especialistas experimentados deben in-
goritmos que resultasen fáciles de seguir, en los que se de- dividualizarse para cada paciente en concreto, nuestras
mostrasen claramente los puntos de decisión y que fueran sugerencias deben contemplarse a la vista de las necesi-
sencillos pero no simplistas. Los comentarios vienen es- dades especiales de cada caso. Deseamos que los anes-
quematizados con respecto a los puntos de decisión desig- tesistas y otros especialistas implicados en la asistencia
nados con letras para ampliar la información, que a su vez perioperatoria de los pacientes quirúrgicos puedan en-
está respaldada por referencias bibliográficas. Lo más inte- contrar en esta obra un método de revisión estimulante.
resante ha sido reformular y reorganizar nuestros conoci- La información aportada por los que han utilizado este li-
mientos y experiencia clínica para tratar de construir estos bro ha sido de gran ayuda y los animamos a que nos si-
algoritmos. gan enviando sus sugerencias.
Aunque nos gustaría suponer que nuestras prácticas es- Muchas gracias a los autores, que han compartido ge-
tán basadas en la evidencia, muchas de las decisiones que nerosamente su experiencia clínica y que han acometido
se adoptan en el «mundo real» están influenciadas por las con entusiasmo este formato inusual. Gracias a Natasha
preferencias del paciente, la disponibilidad de equipos y Andjelkovic por su ayuda y apoyo, sin los cuales habría
material, por aspectos medicolegales, así como por las li- sido imposible realizar este libro. Nuestro agradecimiento
mitaciones actuales de la anestesiología. A pesar de estas especial a Katharine Holahan, extraordinaria ayudante
restricciones, nos esforzamos a diario para que nuestras de- editorial, que coordinó el proceso de edición del manus-
cisiones sean precisas y para que el resultado asistencial so- crito y mantuvo una organización perfecta. Y como siem-
bre nuestros pacientes sea óptimo. Hemos intentado ga- pre, nuestra más profunda gratitud al gran número de re-
rantizar que los algoritmos sean precisos y realistas. En sidentes de anestesiología con los que hemos trabajado y
campos controvertidos pueden reflejar las preferencias y el aprendido a lo largo de estos años; nos hacéis sentir or-
modo de actuar de cada uno de los colaboradores. En al- gullosos.
gunos casos puede haber técnicas alternativas válidas que
no están descritas.
Como expertos en educación implicados en progra- Lois L. Bready, MD
mas de formación universitaria, hemos dirigido de forma Dawn Dillman, MD
consciente este trabajo a los rreessiiddeenntteess ddee aanneesstteessiioollooggííaa.. Susan H. Noorily, MD
ix
ÍNDICE DE CONTENIDOS
FUNDAMENTOS DE ANESTESIA 17 RESPUESTA ANTE UNA ALARMA
DE PRESIÓN BAJA 50
1 ANESTESIA GENERAL 2 J. Russell Norton, M.D.,
Dawn Dillman, M.D. y Denham S. Ward, M.D., Ph.D.
2 ANESTESIA REGIONAL (AR) 4 18 RELAJANTES NEUROMUSCULARES 52
Rosemary Hickey, M.D., Sara M. Metcalf, M.D.,
y James N. Rogers, M.D. y Juergen Fleisch, M.D.
3 PREMEDICACIÓN DE LOS ADULTOS 8 19 PACIENTE CON ESTÓMAGO LLENO 56
Katherine R. McGuire, M.D. Joanne Baust, M.D.
4 PREMEDICACIÓN DE LOS NIÑOS 10 20 PACIENTE ANCIANO 58
Joanne Baust, M.D. Robert H. Overbaugh, M.D.
5 SISTEMAS DE RESPIRACIÓN 21 CONSENTIMIENTO INFORMADO
EN ANESTESIA 14 PARA EL ANESTESIÓLOGO 60
Russell C. Brockwell, M.D., David B. Waisel, M.D.
y J. Jeff Andrews, M.D.
22 VOLUNTADES ANTICIPADAS (VA) 62
6 INTUBACIÓN TRAQUEAL (IT) 18 Wendy B. Kang, M.D., J.D.
Dawn Dillman, M.D.
23 ORDEN DE NO REANIMACIÓN
7 VÍA RESPIRATORIA DIFÍCIL: PREVISTA 20
EN EL QUIRÓFANO 64
Tobias Moeller-Bertram, M.D.,
David B. Waisel, M.D.
y Jonathan L. Benumof, M.D.
8 VÍA RESPIRATORIA DIFÍCIL: DEPENDENCIA QUÍMICA
IMPREVISTA, SE PUEDE VENTILAR 24 EN LOS ANESTESIÓLOGOS
Tobias Moeller-Bertram, M.D.,
y Jonathan L. Benumof, M.D. 24 IDENTIFICACIÓN, INTERVENCIÓN
Y TRATAMIENTO 68
9 VÍA RESPIRATORIA DIFÍCIL:
William P. Arnold III, M.D.
IMPREVISTA, NO SE PUEDE
VENTILAR, NO SE PUEDE INTUBAR 28 25 ANESTESIÓLOGOS CON
Tobias Moeller-Bertram, M.D., PROBLEMAS DE DEPENDENCIA:
y Jonathan L. Benumof, M.D. ¿REINCORPORACIÓN LABORAL? 70
William P. Arnold III, M.D.
10 MONITORIZACIÓN EN ANESTESIA 30
D.M. Anderson, M.D. REANIMACIÓN: PARADA CARDÍACA
11 CAPNOGRAFÍA 32
26 ASISTOLIA 74
D.M. Anderson, M.D.
Erik A. Boatman, M.D.
12 PULSIOXIMETRÍA 36
27 FIBRILACIÓN VENTRICULAR (FV)
George A. Dumitrascu, M.D.
Y TAQUICARDIA VENTRICULAR
13 OXIGENACIÓN 38 SIN PULSO (TVSP) 76
David M. Broussard, M.D. Erik A. Boatman, M.D.
14 HIPOXEMIA INTRAOPERATORIA 40 28 ACTIVIDAD ELÉCTRICA SIN
D.M. Anderson, M.D. PULSO (AESP) 78
Erik A. Boatman, M.D.
15 DISMINUCIÓN DE LA CONCENTRACIÓN
INSPIRADA DE OXÍGENO 42 ARRITMIAS POTENCIALMENTE
Robert Loeb, M.D.
MORTALES SIN PARADA CARDÍACA
16 AUMENTO DE LA PRESIÓN MÁXIMA
EN LA VÍA RESPIRATORIA 46 29 BRADICARDIA 82
Robert Loeb, M.D. Stephen T. Robinson, M.D.
xi
