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Fundamentals of Anaesthesia

Third Edition

Cambridge University Press978-0-521-69249-6 - Fundamentals of Anaesthesia: Third EditionEdited by: Tim Smith, Colin Pinnock and Ted LinFrontmatterMore information

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Fundamentalsof Anaesthesia

Third Edition

Edited byTim Smith

Colin PinnockTed Lin

Associate EditorRobert Jones






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First published by Greenwich Medical Media 1999Second edition published 2003Third edition published by Cambridge University Press 2009

Printed in the United Kingdom by Bell and Bain Ltd, Glasgow

A catalogue record for this publication is available from the British Library

Library of Congress Cataloguing in Publication dataFundamentals of anaesthesia / edited by Tim Smith, Colin Pinnock,Ted Lin ; associate editor, Robert Jones. – 3rd ed.

p. ; cm.Includes bibliographical references and index.ISBN 978-0-521-69249-6 (hardback)1. Anesthesia. I. Smith, Tim, 1960– II. Title.[DNLM: 1. Anesthesia. 2. Analgesia. WO 200 F9813 2008]RD81.F78 2008617.9′6 – dc22 2008028629

ISBN 978-0-521-69249-6 Paperback

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Contents

List of contributors page viiiPreface to the first edition xPreface to the second edition xiPreface to the third edition xiiHow to use this book xiiiAcknowledgements xivList of abbreviations xvi

Section 1: Clinical anaesthesia1 Preoperative management 12 Induction of anaesthesia 253 Intraoperative management 444 Postoperative management 575 Special patient circumstances 776 The surgical insult 1057 Regional anaesthesia and analgesia 1158 Principles of resuscitation 1359 Major trauma 156

10 Clinical anatomy 173

Section 2: Physiology1 Cellular physiology 2002 Body fluids 2203 Haematology and immunology 2324 Muscle physiology 2535 Cardiac physiology 2666 Physiology of the circulation 2977 Renal physiology 3258 Respiratory physiology 3589 Physiology of the nervous system 388

10 Physiology of pain 41211 Gastrointestinal physiology 43312 Metabolism and temperature regulation 44813 Endocrinology 466

14 Physiology of pregnancy 48415 Fetal and newborn physiology 499

Section 3: Pharmacology1 Physical chemistry 5042 Pharmacodynamics 5153 Pharmacokinetics 5254 Mechanisms of drug action 5405 Anaesthetic gases and vapours 5576 Hypnotics and intravenous anaesthetic

agents 5697 Analgesic drugs 5848 Neuromuscular blocking agents 6099 Local anaesthetic agents 620

10 Central nervous system pharmacology 63211 Autonomic nervous system pharmacology 64412 Cardiovascular pharmacology 65913 Respiratory pharmacology 67214 Endocrine pharmacology 67815 Gastrointestinal pharmacology 68516 Intravenous fluids 69117 Pharmacology of haemostasis 69618 Antimicrobial therapy 70219 Clinical trials: design and evaluation 714

Section 4: Physics, clinicalmeasurement and statistics1 Applied physics 7192 Clinical measurement 7863 Anaesthetic equipment 8284 Basic statistics 864

Appendix: Primary FRCA syllabus 884Index 897






Contributors

Dr B. L. AppaduConsultant AnaesthetistPeterborough General HospitalPeterborough

Dr I. T. CampbellReader in AnaesthesiaUniversity of Manchester

Dr G. CavillConsultant AnaesthetistWansbeck General HospitalNorthumberland

Dr H. B. J. FischerConsultant AnaesthetistAlexandra HospitalRedditch

Dr S. GrahamConsultant AnaesthetistThe James Cook University HospitalMiddlesbrough

Dr A. K. GuptaDirector of Neurocritical Care and Consultant

AnaesthetistAddenbrooke’s HospitalCambridge

Dr R. M. HadenConsultant AnaesthetistAlexandra HospitalRedditch

Dr C. D. HanningConsultant AnaesthetistLeicester Royal InfirmaryLeicester

Dr S. A. HillConsultant AnaesthetistSouthampton General HospitalSouthampton

Dr J. M. JamesConsultant AnaesthetistBirmingham Heartlands HospitalBirmingham

Dr R. P. JonesAssociate Specialist in AnaesthesiaWithybush HospitalHaverfordwest

Dr K. M. KerrConsultant AnaesthetistAlexandra HospitalRedditch

Dr E. S. LinConsultant AnaesthetistGlenfield HospitalLeicester

Dr D. LiuConsultant AnaesthetistBedford HospitalBedford

Professor C. J. LoteProfessor of Experimental NephrologyUniversity of BirminghamBirmingham

Dr T. J. McLeodConsultant AnaesthetistBirmingham Heartlands HospitalBirmingham






List of contributors ix

Dr M. C. MushambiConsultant AnaesthetistLeicester Royal InfirmaryLeicester

Dr J. R. NeilsonConsultant in HaematologyRussells Hall HospitalDudley

Dr J. P. NolanConsultant AnaesthetistRoyal United HospitalBath

Dr A. OgilvyConsultant AnaesthetistLeicester General HospitalLeicester

Dr M. PaleologosRoyal North Shore HospitalSydneyAustralia

Dr S. M. ParrConsultant AnaesthetistSolihull HospitalSolihull

Dr C. A. PinnockConsultant AnaesthetistAlexandra HospitalRedditch

Professor I. PowerProfessor of Anaesthesia, Critical

Care and Pain MedicineRoyal Infirmary HospitalEdinburgh

Dr A. M. SardesaiConsultant AnaesthetistAddenbrooke’s HospitalCambridge

Dr J. SkoylesConsultant AnaesthetistNottingham City HospitalNottingham

Dr T. C. SmithConsultant AnaesthetistAlexandra HospitalRedditch

Dr J. StoneConsultant MicrobiologistGloucester Royal HospitalGloucester

Dr J. L. C. SwanevelderConsultant AnaesthetistGlenfield HospitalLeicester

Dr A. J. StronachConsultant AnaesthetistAlexandra HospitalRedditch

Dr M. TidmarshConsultant AnaesthetistCity General & Maternity HospitalsCarlisle

Dr L. A. G. VriesConsultant AnaesthetistAlexandra HospitalRedditch

Professor A. R. WolfProfessor of AnaesthesiaBristol Children’s HospitalBristol

Dr J. K. WoodConsultant HaematologistLeicester Royal InfirmaryLeicester






Preface to the first edition

The advent of a syllabus for the FRCA examination, itselfa requirement of the STA, seemed to me to provide anideal opportunity for a dedicated revision textbook. It willtherefore be of no surprise to readers that this volumemirrors closely the syllabus for the primary FRCA in bothstructure and content.

Having enlisted the willing help of my two co-editors,Tim Smith and Ted Lin, we set about recruiting authorsto contribute. Chapter authors have been chosen for theirability and known prowess as teachers and a deliberatepolicy of not inviting ‘usual’ contributions from frequentlyseen names was taken. Having said that, several primaryexaminers appear as contributors and within each chaptercoverage of revision topics has been kept as appropriate tothe examination as possible.

To reduce the variability that is the bane of multi-author texts I have personally edited every chapter toensure consistency of style and it is a reflection of theworkload involved that it has taken three years to completethis project. I am grateful to all contributing authors for

their tolerance and good humour during alteration of theirgolden prose.

Whilst no single book can cover the entire syllabus asa ‘one stop’ aid, the majority of material covered in theexamination is detailed within these pages. Some itemslately included in the syllabus, after completion of themanuscript, will be added in future editions (such as theanatomy pertaining to ankle block). Candidates will, how-ever, be well served if this book is used as a general basisfor revision.

I am extremely grateful to Rob Jones, who has beenresponsible for generating virtually all the artwork withinthis text, the few other diagrams being credited to theirsources.

Thanks are also due to both my co-editors for theirextensive work and dedication. If this volume enables anycandidate to pass the primary examination, who would nothave done so otherwise, then our job will have been welldone.

C. A. PinnockJuly 1999






Preface to the second edition

I am delighted that the success of Fundamentals has enabledus to proceed to an early second edition. It will be apparentto the familiar reader that this edition has undergone rathermore than a simple facelift. A great deal of feedback fromboth examiners and candidates has been used to modifyand shape this current volume. New authors have beenbrought in to Section 1 to revise and modify the clinicalchapters where necessary (incorporating several importantand new areas of emerging knowledge), whilst resuscitationand trauma chapters have been updated by their originalwriters. Anatomy has been extended in scope to reflectsubjects that are currently popular in the Primary FRCA.

In Section 2, there are new chapters on neurology andendocrinology, and an extra chapter on neonatal physiol-ogy has been incorporated to satisfy the demands of theexamination syllabus.

Section 3 has been updated comprehensively with theremoval of some drugs now lapsed and the incorporation

of newer agents that have become available. By populardemand a new chapter on clinical trial design rounds offthe pharmacology section.

It is, however, Section 4 that has undergone the mostradical changes. I am very grateful to Ted Lin for the com-pletely new physics and equipment chapters, which pro-vide excellent core revision in these important areas. Agreater number of diagrams (and many revised graphics)throughout the book and a completely new index completethe modifications over the first edition.

I thus believe that the second edition of Fundamentalsis an even better revision aid to the Primary FRCA exam-ination and will build on the reputation of its forerunner.Once again my thanks go to my three co-editors for theirhard work and determination.

Colin PinnockOctober 2002






Preface to the third edition

I am privileged to have led the creation of the third editionof this popular Primary FRCA text, ably helped by my threeco-editors. Once again, feedback from users of the bookhas helped enormously in developing FoA3. The Royal Col-lege of Anaesthetists’ publication of the Primary syllabuswithin the Competency-based Training Framework has ledus to include that knowledge base, uniquely referenced toFundamentals, in a new Appendix. A number of new con-tributors have enhanced the proportion of current and pastexaminers amongst our writers. The greater use of colourallows the reader to navigate more easily, and changes totechnique boxes make that information easier to assimi-late. This edition contains a number of new chapters inaddition to widespread updates, and has been thoroughlycopy-edited by Hugh Brazier to an unrivalled standard ofconsistency over the previous editions.

Whilst all chapters have been reviewed, there are a num-ber of significant changes.� Section 1 contains a significantly updated chapter in

the growing field of preoperative assessment, and abrand new chapter on resuscitation. The inclusion ofthe DAS algorithms for airway management is aparticular bonus.

� In Section 2 Ted Lin has written an additional chapterspecifically covering the physiology of pain, and ColinPinnock has edited haematology to bring it more inline with the current syllabus.

� Section 3 has a new chapter on analgesic drugs, takingaccount of the substantial developments in this area.The new chapter on mechanisms of drug action putsclear emphasis on the current thinking on themechanism of anaesthesia.

� In Section 4, Ted Lin has put together a clear andconcise statistics chapter, which will make preparationfor this part of the exam straightforward. Theinclusion of aspects of ultrasound and MRI scanninghere and in the clinical section follows itsincorporation into the syllabus.

Despite suggestions to expand Fundamentals to coveranaesthesia to higher levels and in greater depth, we haveadhered to our original aim of providing a textbook specif-ically designed around the RCA Primary Fellowship. In sodoing, we have been better able to adapt to changes in thatexam as well as in anaesthetic core knowledge. The resultis a much more effective exam preparation tool, which inturn is frequently used as a starting point for anaesthetists(and indeed others) of all grades including consultants,some of whom achieved exam success helped by the firstedition. Finally, I am particularly grateful to Colin for hishelp and advice during my turn at leading the editorialprocess.

We were saddened to hear of the death of Dr AndyOgilvy, author of Section 2, Chapter 11, as this edition wasin preparation.

Tim SmithMarch 2008






How to use this book

FoA3 is not just a book. It is a tool to enable the readerto develop both their anaesthetic practice and an under-standing of the scientific principles of anaesthesia.

The book has been structured to correlate closely withthe syllabus of the Primary FRCA. The knowledge sections

of the syllabus are listed in the Appendix, and each sectionof the syllabus is cross-referenced to the relevant page(s)of the text to facilitate revision.






Acknowledgements

A number of organisations have kindly allowed us touse illustrations, tables and other material in these pages.We gratefully acknowledge the help given by the partieslisted below in granting permission to use the materialcited.

Association of Anaesthetists of Great Britain andIrelandSection 1, Chapter 2

Figure IA5: Clinical features of anaphylaxisFigure IA6: First clinical features of anaphylaxisFigure IA7: Management of a patient with suspected

anaphylaxisSection 1, Chapter 3

Figure IN6: Recommendations for standards of moni-toring during anaesthesia and recovery

Section 1, Chapter 4Figure PO1: Criteria to be met before transfer from

recovery room to general wardSection 1, Chapter 5

Figure SC9: Indications for intubation and ventilationfor transfer after brain injury

Figure SC10: Transfer checklist for neurosurgicalpatients

Section 4, Chapter 3Figure EQ41: AAGBI checklist for anaesthetic equip-

ment

British Journal of Anaesthesia (BMJ Publishing Group /Oxford University Press)Section 1, Chapter 4

Figure PO11: DVT risk group classificationSection 4, Chapter 3

Figure EQ20: Mapleson classification system for breath-ing systems

Difficult Airway Society (UK)Section 1, Chapter 2

Figure IA11: Unanticipated difficult intubation duringroutine induction of anaesthesia

Figure IA12: Unanticipated difficult intubation duringrapid sequence induction

Figure IA13: Failed intubation: rescue techniques for the‘can’t intubate, can’t ventilate’ situation

European Resuscitation Council and ResuscitationCouncil (UK)Section 1, Chapter 8

Figure RS1: Causes of airway obstructionFigure RS2: Algorithm for in-hospital resuscitationFigure RS3: Adult basic life support algorithmFigure RS4: Adult choking algorithmFigure RS5: Adult advanced life support algorithmFigure RS7: Bradycardia algorithmFigure RS8: Tachycardia algorithmFigure RS9: Paediatric BLS algorithmFigure RS10: Paediatric foreign-body airway obstruction

algorithmFigure RS11: Paediatric ALS algorithm

European Society of Regional AnaesthesiaSection 1, Chapter 7

Figure RA19: ESRA good practice guidelines for throm-boprophylaxis and CNB

Pharmacokinetics of Anaesthesia, ed. C. Prys-Robertsand C. C. Hug. Oxford: Blackwell, 1984Section 3, Chapter 4

Figure PK9: Mapleson’s water analogue models

Royal College of AnaesthetistsAppendix: Primary FRCA syllabus

The Sourcebook of Medical Illustration, ed. P. Cull.Carnforth: Parthenon Publishing Group, 1989Section 1, Chapter 7

Figure RA7: Patient positions for spinal anaesthesia






Acknowledgements xv

Figure RA22: Patient position for caudal anaesthesiaFigure RA23: Needle angulation for caudal anaes-

thesiaSection 1, Chapter 10

Figure CA1: The mouthFigure CA2: The lateral wall of the left nasal cavityFigure CA3: Coronal section of the nose and maxillary

sinusFigure CA5: Larynx, direct laryngoscopic viewFigure CA6: Larynx, anterior external viewFigure CA7: Larynx, posterior viewFigure CA8: Larynx, lateral viewFigure CA9: Larynx, sectional viewFigure CA11: The bronchi of the respiratory treeFigure CA19: Cervical plexus

Figure CA20: Brachial plexus: relationshipsFigure CA22: Nerves of the lumbar plexusFigure CA23: Nerves of the sacral plexusFigure CA24: Cervical vertebra, superior and lateral

viewsFigure CA25: Thoracic vertebra, superior and lateral

viewsFigure CA26: Lumbar vertebra, superior and lateral

viewsSection 2, Chapter 9

Figure NE19: Structure of the eyeFigure NE23: Distribution of the autonomic nervous

systemSection 2, Chapter 12

Figure MT20: Structure of the liver





Abbreviations

2,3-DPG 2,3-diphosphoglycerate5-HT 5-hydroxytryptamineA adenineA ampereA&E accident and emergencyABC airway, breathing, circulationABV arterial blood volumeAC alternating currentACC anterior cingulate cortexACE angiotensin-converting enzymeACh acetylcholineACT activated clotting timeACTH adrenocorticotropic hormoneACTH-RH adrenocorticotropic hormone-releasing

hormoneADCC antibody-dependent cell-mediated

cytotoxicityADH antidiuretic hormoneADP adenosine diphosphateADR adverse drug reactionADROIT Adverse Drug Reactions Online

Information TrackingAED automated external defibrillatorAER audio evoked responseAF atrial fibrillationAIDS acquired immune deficiency syndromeALS advanced life supportAMD airway management deviceAMP adenosine monophosphateAMPA �-amino 3-hydroxy 5-methyl

4-isoxazolepropionic acidAng I angiotensin IAng II angiotensin IIANOVA analysis of varianceANP atrial natriuretic peptideANS autonomic nervous systemANSI American National Standards InstituteAP action potential (in cardiac physiology)AP anteroposterior

AP anaesthetic proofAPC activated protein CAPC antigen-presenting cellAPCR activated protein C resistanceAPG anaesthetic proof category GAPL adjustable pressure-limitingAPTT activated partial thromboplastin timeAQP aquaporinARDS acute respiratory distress syndromeARR absolute risk reductionASA American Society of AnesthesiologistsASIC acid-sensing ion channelASIS anterior superior iliac spineATLS advanced trauma life supportATP adenosine triphosphateATPS ambient temperature and pressure saturatedAUC area under curveAV atrioventricularAVNRT AV nodal re-entry tachycardiaAVRT AV re-entry tachycardiabd twice a dayBDNF brain-derived neurotrophic factorBLS basic life supportBm B memory cellBMI body mass indexBMR basal metabolic rateBMRO2 basal metabolic rate of oxygen consumptionBNP brain natriuretic peptideBP blood pressureBP boiling pointbpm beats per minuteBSA body surface areaBSER brain-stem evoked responsesBTPS body temperature and pressure saturatedc centiC cytosineCa arterial complianceCAM cell adhesion moleculescAMP cyclic adenosine monophosphate





List of abbreviations xvii

CaO2 alveolar oxygen contentCaO2 arterial oxygen contentCAPD continuous ambulatory peritoneal dialysisCBF cerebral blood flowCBG corticosteroid-binding globulinCBV cerebral blood volumeCCK cholecystokininCcO2 capillary oxygen contentcd candelaCFAM cerebral function analysing monitorCGRP calcitonin gene-related peptideCI cardiac indexCI confidence intervalCK creatinine kinaseCL confidence limitCl clearanceCl lung complianceCMRO2 cerebral metabolic rate of oxygen

consumptionCNB central nerve blockCNS central nervous systemCO cardiac outputCO2 carbon dioxideCoA co-enzyme ACOAD chronic obstructive airways diseaseCOMT catechol-O-methyl transferaseCOP colloid osmotic pressureCOPA cuffed oropharyngeal airwaycos cosineCOSHH control of substances hazardous to healthCOX cyclo-oxygenaseCP creatine phosphateCPAP continuous positive airway pressureCPD-A citrate phosphate dextrose adenineCPK MB creatinine phosphokinase (cardiac

isoenzyme)CPP cerebral perfusion pressureCPP coronary perfusion pressureCPR cardiopulmonary resuscitationCr respiratory system complianceCRPS complex regional pain syndromeCSE combined spinal–epiduralCSF cerebrospinal fluidCSM Committee on Safety of MedicinesCT computerised tomographyCTZ chemoreceptor trigger zoneCV controlled ventilationCvO2 mixed venous oxygen contentCVP central venous pressure

CVS cardiovascular systemCw chest wall complianced deciD dopaminergicda decaDAG diacylglycerolD&C dilatation and curettageDC direct currentDCR dacryocystorhinostomyDDAVP 1-deamino-8-arginine vasopressinDHEA dehydroepiandrosteroneDIC disseminated intravascular coagulationDIT di-iodothyronineDLCO diffusing capacity of the lungs for carbon

monoxideDNA deoxyribonucleic acidDNAR do not attempt resuscitationDNR do not resuscitateDO2 oxygen deliveryDRG dorsal root ganglionDVT deep venous thrombosisEa arterial elastanceEAR expired air respirationEBC effective blood concentrationEC effective concentrationECA electrical control activityECF extracellular fluidECF-A eosinophil chemotactic factor of anaphylaxisECFV extracellular fluid volumeECG electrocardiogramECMO extracorporeal membrane oxygenationECV effective circulating volumeED50 effective dose in 50% of populationED95 effective dose in 95% of populationEDP end-diastolic pointEDPVR end-diastolic pressure–volume relationshipEDRF endothelium-derived relaxing factorEDTA ethylenediaminetetra-acetateEDV end-diastolic volumeEEG electroencephalogramEes ventricular systolic elastanceEF ejection fractionEM electromagneticEMD electromechanical dissociationEMF electromotive forceEMG electromyogramEMLA eutectic mixture of local anaestheticEMS emergency medical serviceENT ear nose and throat





xviii List of abbreviations

EPO erythropoietinEPSP excitatory postsynaptic potentialER endoplasmic reticulumER extraction ratioERC European Resuscitation CouncilERK extracellular signal-regulated kinaseERPC evacuation of retained products of

conceptionERV expiratory reserve volumeESP end-systolic pointESPVR end-systolic pressure–volume relationshipESR erythrocyte sedimentation rateESRA European Society of Regional AnaesthesiaESV end-systolic volumeET endotheliumETC oesophageal–tracheal combitubeETCO2 end-tidal carbon dioxideETT endotracheal tubef femtof frequency of breathsF gas flowF/M feto maternal ratioFA fatty acidFAC fractional area changeFaCO2 fractional alveolar carbon dioxide

concentrationFADH2 flavine adenine dinucleotideFBC full blood countFDC F-decalinFDP fibrin degradation productFe2+ ferrous iron stateFeCO2 fractional mixed expired carbon dioxide

concentrationFEMG frontalis electromyogramFEV% ratio of FEV1 to FVCFEV1 forced expiratory volume in one secondFFA free fatty acidsFFP fresh frozen plasmaFFT fast Fourier transformFG fat groupFGF fresh gas flowFiO2 fractional inspired oxygen concentrationFNHTR febrile non-haemolytic transfusion

reactionsFRC functional residual capacityFSH follicle-stimulating hormoneFTPA F-tripropylamineFVC forced vital capacityG giga

G guanineGABA gamma-aminobutyric acidGCS Glasgow coma scaleGDNF glial cell line-derived neurotrophic factorGDP guanine diphosphateGFR glomerular filtration rateGH growth hormoneGI gastrointestinalGIT gastrointestinal tractGlyR glycine receptorGMP guanosine monophosphateGP glycolytic phosphorylationGPCR G-protein-coupled receptorGTN glyceryl trinitrateGTP guanosine triphosphateh hectoh hourH2 histamine receptor 2HAFOE high airflow oxygen enrichmentHAS human albumin solutionHb haemoglobinHbA adult haemoglobinHbCO carboxyhaemoglobinHbF fetal haemoglobinHBF hepatic blood flowHbmet methaemoglobinHbS sickle haemoglobinHbsulph sulphaemoglobinHCG human chorionic gonadotrophinHCO3

− bicarbonateHct haematocritHD haemodialysisHDL high density lipoproteinHDN haemolytic disease of the newbornHDU high dependency unitHELLP haemolytic anaemia elevated liver enzymes

low plateletsHER hepatic extraction ratioHFJV high-frequency jet ventilationHIV human immunodeficiency virusHME heat and moisturiser exchangerHMWK high molecular weight kininogenHPL human placental lactogenHPV hypoxic pulmonary vasoconstrictionHR heart rateHz hertzI currentI : E inspiratory : expiratory ratioIABP intra-aortic balloon pump





List of abbreviations xix

IC insular cortexICAM intercellular adhesion

moleculeICF intracellular fluidICP intracranial pressureICU intensive care unitIDDM insulin dependent diabetes mellitusIgA immunoglobulin AIgE immunoglobulin EIGF insulin-like growth factorIgG immunoglobulin GiGluR ionotropic glutamine receptorIgM immunoglobulin MIHD ischaemic heart diseaseIL interleukinILCOR International Liaison Committee on

ResuscitationIM intramuscularIML intermediolateralINR international normalised ratioIO intraosseousIOP intra-ocular pressureIP3 inositol triphosphateIPSP inhibitory postsynaptic potentialIR infraredIRV inspiratory reserve volumeISI international sensitivity indexISPTA spatial-peak temporal-average intensityIT implant testedITP idiopathic thrombocytopaenia purpuraIU International unitsIV intravenousIVC inferior vena cavaIVIg intravenous immunoglobulinIVRA intravenous regional anaesthesiaJ jouleJVP jugular venous pressurek kiloK kelvinKCCT kaolin clotting timeKE kinetic energyLAK lymphokine-activated killerLAP left atrial pressureLaser light amplification by stimulated emission of

radiationLBP lipopolysaccharide binding proteinLC locus coeruleusLCNT lateral cutaneous nerve of the thighLD50 lethal dose 50%

LDL low density lipoproteinLED light-emitting diodeLH luteinising hormoneLIS lateral intracellular spaceLMA laryngeal mask airwayLMW low molecular weightLMWH low molecular weight heparinLOH loop of HenleLOR loss of resistanceLOS lower oesophageal sphincterLT leukotrieneLV left ventricleLVEDP left ventricular end-diastolic pressureLVEDV left ventricular end-diastolic volumeLVF left ventricular failureLVH left ventricular hypertrophyLVSW left ventricular stroke workLVSWI left ventricular stroke work indexµ microm metrem milliM megaM muscarinicMAC minimum alveolar concentrationMAO monoamine oxidaseMAOI monoamine oxidase inhibitorMAP mean arterial pressureMCH mean cell haemoglobinMCV mean cell volumeMDP maximum diastolic potentialMEA microwave endometrial

ablationMEFR mid-expiratory flow rateMEPP miniature endplate potentialMEWS modified early warning systemMFR mannosyl–fucosyl receptorMG muscle groupMH malignant hyperthermiaMHC major histocompatabilityMI myocardial infarctionMIA mechanically insensitive afferentMIC minimum inhibitory concentrationMILS manual in line stabilisationMIR minimum infusion rateMIRL membrane inhibitor of reactive lysisMIT mono-iodothyronineMMC migratory motor complexmmHg millimetres of mercury (pressure)MODS multiple organ dysfunction syndrome





xx List of abbreviations

mol moleMONA morphine, oxygen, nitrates, aspirinMPAP mean pulmonary arterial pressuremRNA messenger RNAMSA mechanically sensitive afferentMRSA methicillin-resistant Staphyloccocus aureusMUGA multigated scanMV minute volumeMW molecular weightn nanoN newtonnAChR nicotinic acetylcholine receptorNADH nicotinamide adenine dinucleotideNADPH nicotinamide adenine dinucleotide

phosphateNaHCO3 sodium bicarbonateNANC non-adrenergic non-cholinergicNd-YAG neodymium yttrium aluminium garnetNGF nerve growth factorNIBP non-invasive blood pressureNIST non-interchangeable screw threadNK natural killerNK neurokinin receptorNMDA N-methyl-D-aspartateNMJ neuromuscular junctionNNH number needed to harmNNT number needed to treatNO nitric oxideNREM non-rapid eye movementNRM nucleus raphe magnusNSAID non-steroidal anti-inflammatory drugNTP normal temperature and pressureNTS nucleus tractus solitariusNV nausea and vomitingNWC number of words chosen� ohmO/G oil/gasO/W oil/waterOCI oesophageal contractility indexODC oxyhaemoglobin dissociation curveOP oxidative phosphorylationOPAC oximetric pulmonary artery catheterOR odds ratioOsm osmole� osmotic pressurep picoP probabilityPa pascalPA pulmonary artery

PABA para-aminobenzoic acidPAC pulmonary artery catheterPaCO2 partial pressure of carbon dioxide – alveolarPaCO2 partial pressure of carbon dioxide – arterialPACWP pulmonary artery capillary wedge pressurePADP pulmonary artery diastolic pressurePAF platelet activating factorPAG periaqueductal greyPAH para-aminohippuric acidPaO2 partial pressure of oxygen – alveolarPaO2 partial pressure of oxygen – arterialPARS patient at risk scorePART patient at risk teamPaw airway pressurePBP penicillin-binding proteinPCA patient controlled analgesiaPCC prothrombinase complex concentratesPCEA patient-controlled epidural analgesiaPCO2 partial pressure of carbon

dioxidePCWP pulmonary capillary wedge pressurePD photodiodePDE phosphodiesterase enzymePDGF platelet-derived growth factorPDPH post-dural puncture headachePE potential energyPE pulmonary embolusPeCO2 partial pressure end-tidal carbon dioxidePEA pulseless electrical activityPEEP positive end-expiratory pressurePEFR peak expiratory flow ratePFC perfluorocarbonPGE prostaglandin EPGG prostaglandin GPGH prostaglandin HPGI prostaglandin IPi inorganic phosphatePIH prolactin inhibiting hormonePIP2 phosphatidylinositol bisphosphatePK prekallikreinPLOC provoked lower oesophageal contractionsPMN polymorphonuclear neutrophilsPNMT phenylethanolamine N-methyl transferasePO2 partial pressure of oxygenPONV postoperative nausea and vomitingPPAR peroxisome proliferator-activated receptorPPF plasma protein fractionPPHN persistent pulmonary hypertension of the

newborn





List of abbreviations xxi

ppm parts per millionPPP pentose phosphate pathwayPRI pain rating indexPRST pressure, rate, sweating, tearsPSI pounds per square inchPSVT paroxysmal supraventricular tachycardiaPT prothrombin timePTC post tetanic countPTH parathyroid hormonePTT partial thromboplastin timePTTK partial thromboplastin time with kaolinPV pressure volumePVC poly vinyl chloridePVD peripheral vascular diseasePVG periventricular greyPVR pulmonary vascular resistanceQ flowQ chargeQ cardiac outputQs shunt flowR resistance (electrical)R universal gas constantRAP right atrial pressureRAS reticular activating systemRAST radioallergosorbent testRBC red blood cellRBF renal blood flowRDS respiratory distress syndromeRe Reynolds numberREM rapid eye movementRH relative humidityRIMA reversible inhibitor of monoamine

oxidase ARMP resting membrane potentialRNA ribonucleic acidRNU regional neurosurgical unitROC receptor-operated ion channelRPF renal plasma flowRQ respiratory quotientrRNA ribosomal RNARR relative riskRRR relative risk reductionRS respiratory systemRSI rapid sequence inductionRT3 reverse tri-iodothyronineRV residual volumeRV right ventricleRVM rostral ventromedial medullaRVSWI right ventricular stroke work index

� sum ofs secondS/N signal to noise ratioSA sinoatrialSAGM saline adenine glucose mannitolSaO2 arterial oxygen saturationSARS severe acute respiratory syndromeSD standard deviationSEM standard error of the meanSFH stroma-free haemoglobinSI stroke indexSI Systeme International d’Unites (International

System of Units)SIADH syndrome of inappropriate ADH secretionSIMV synchronised intermittent mandatory

ventilationsin sineSIRS systemic inflammatory response syndromeSL semilunarSLE systemic lupus erythematosusSLOC spontaneous lower oesophageal contractionsSMP sympathetically maintained painSNGFR single-nephron glomerular filtration rateSNP sodium nitroprussideSO2 oxygen saturationSpO2 pulse oximeter oxygen saturationSR sarcoplasmic reticulumSRS-A slow reacting substance of anaphylaxisSSRI selective serotonin reuptake inhibitorSTOP suction termination of pregnancySTT spinothalamic tractSV stroke volumeSVC superior vena cavaSVI systemic vascular indexSvO2 mixed venous oxygen saturationSVP saturated vapour pressureSVR systemic vascular resistanceSVWI stroke volume work indexSW stroke workT absolute temperatureT teraT thyminet1/2 half-lifeT3 tri-iodothyronineT4 thyroxinetan tangentTBPA thyroxine-binding prealbuminTBG thyroxine-binding globulinTBV total blood volume





xxii List of abbreviations

TBW total body waterTc cytotoxic T cellTCA tricyclic antidepressantTCR T-cell receptorTCRE transcervical resection of endometriumTENS transcutaneous electrical nerve stimulationTh T helper cellTHC terahydro-cannabinolTHR total hip replacementTIVA total intravenous anaesthesiaTKR total knee replacementTLC total lung capacityTLV total lung volumeTm tubular maximumTNF tumour necrosis factorTOE transoesophageal echocardiographyTOF train of fourTP threshold potentialt-PA tissue-type plasminogen activatorTPP thiamine pyrophosphateTRALI transfusion-related acute lung injuryTRH thyrotropin-releasing hormonetRNA transfer RNATRP transient receptor potentialTRPV1 transient receptor potential vanilloid 1TSH thyroid-stimulating hormoneTT thrombin timeTTN transient tachypnoea of the newbornTUR transurethral resectionTURBT transurethral resection of bladder tumourTURP transurethral resection of the prostateTXA2 thromboxane A2

U&E urea and electrolytesUBF uterine blood flowUFH unfractionated heparinUK United KingdomUOS upper oesophageal sphincterURT upper respiratory tract

URTI upper respiratory tract infectionUTP uridine triphosphateUV ultra violetv velocityV voltV/Q ventilation/perfusionVA alveolar volumeVbl blood volumeVC vital capacityVCO2 carbon dioxide fluxVD anatomical dead spaceVd volume of distributionVER visual evoked responseVF ventricular fibrillationVIC vaporiser inside circleVIE vacuum-insulated evaporatorVint interstitial fluid volumeVIP vasoactive intestinal peptideVLDL very low density lipoproteinVMA vannilyl mandelic acidVO2 oxygen uptake in the lungsVOC vaporiser outside circleVPC ventricular premature contractionsVpl plasma volumeVPN ventral posterior nucleus of the

thalamusVrbc red blood cell volumeVRE vancomycin-resistant enterococciVRG vessel-rich groupVt tidal volumeVT ventricular tachycardiaVtCO2 volume of carbon dioxide per breathvWF von Willebrand’s factorW wattWBC white blood cellWCC white cell countWHO World Health OrganizationWPW Wolff–Parkinson–White





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Fundamentals of Anaesthesia - Assets - Cambridge