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INDEX
Page numbers in boldface type indicate complete chapters. Page numbers followed by t indicate tables; f, figures.
A
ABCs (airway, breathing, circulation), of trauma
management, 373Abdominal surgeryperioperative morbidity and mortality associated
with, 280tpulmonary function testing prior to, 73, 73t
Abdominal wall, peripheral nerve block anesthesia
for, 471ABO blood genotype, 47–48, 48tAbortion, spontaneous, inhalational anesthesia-
related, 81Acceleromyography, 101Acetaminophen, as acute pain treatment, 528–529Acetazolamide, 310t
Acetylcholine, 95synthesis and degradation of, 12
Acetylcholine receptors, 95, 96, 97Acetylcholinesterase, side effects of, 102–103Acetylcholinesterase inhibitors, 102Acid-base analysis
physiological approach (Stewart model) for, 25stepwise approach in, 29
Acid-base balanceorgans involved n, 26–27regulation of, 24–25
Acid-base disorders, compensation mechanisms in,25, 25t, 26, 26t
Acid-base status, 24Acidemia, 27, 29Acidosislactic, as blood transfusion indicator, 43metabolic, 25t, 26tanion gap, 24b, 29
in liver transplantation patients, 484non-anion gap, 29brenal failure-related, 311saline solutions-related, 33
respiratory, 25t, 26, 26tin trauma patients, 378
Activated clotting time (ACT), 55
in cardiopulmonary bypass patients, 488–489Activated partial thromboplastin time (aPTT), 54Acute respiratory distress syndrome (ARDS),
285–292in burn patients, 381
Acute respiratory distress syndrome (ARDS)(Continued)
definition of, 285–286refractory, 289
Addictiondefinition of, 338opioids-related, 529
Addisonian crisis, 355
Adenosinecontraindications to, 212pulmonary circulation effects of, 299as pulmonary hypertension treatment, 295
Adenosine monophosphate, cyclic (cAMP), 113Adrenal gland, functions and regulation of, 354Adrenal insufficiency
in burned patients, 382perioperative, 356
b-Adrenergic agonistsas asthma treatment, 268, 269tas chronic obstructive pulmonary disease
treatment, 281t
side effects and limitations of, 114Adrenergic agonists, as hypotension treatment, 205a-Adrenergic antagonists. See Alpha blockersb-Adrenergic antagonists. See Beta blockersAdrenergic receptors, 11end-organ effects of, 11t
Adrenocortical insufficiency, 355, 356
Adrenocorticotropic hormone (ACTH), 354Adult respiratory distress syndrome. See Acute
respiratory distress syndrome (ARDS)Adverse drug reactions. See also names of
specific drugsin geriatric patients, 434–435
Afentanil, 83tAfterload, epidural anesthesia-related reduction
in, 462Agglutinins, 47–48, 47tAgglutinogens, 47–48, 47tAgitation, emergent, in pediatric patients, 402Air, as laparoscopic insufflation gas, 512t
Air embolism, 378, 379cardiopulmonary bypass-related, 491central venous catheterization-related, 185, 186pulmonary artery catheterization-related, 189venous, 145–146
541
542 INDEX
Airwaydifficult, 59, 61, 65, 66fas aspiration risk factor, 275
inhalation injury-related edema of, 381
injuries to, 378endotracheal intubation-related, 495
laryngeal mask, 63, 66f, 399, 399t, 403laser surgery of, 519as fire cause, 520–521, 521b
nasal, 61oral, 61
pediatric, comparison with adult airway, 394, 394tsurface tension in, 18
Airway disease, obstructive, 70Airway management, 58–67airway assessment in, 58in cervical spine injury patients, 374–375
in eclampsia patients, 428–429emergent, with uncleared cervical spine, 374–375in obese patients, 360, 362in postanesthetic care unit patients, 225in spinal cord injury patients, 377in trauma patients, 374
Airway obstruction
asthma-related, 278burn-related, 381carotid endarterectomy-related, 262flow-volume loops in, 71, 73fin neonates, 387patient position-related, 144, 145
Alanine aminotransferase, as hepatocellular damageindicator, 302
Albuminbuffering function of, 26hepatic synthesis of, 302use in fluid resuscitation, 33t, 35
Albuterol
as allergic reaction treatment, 367as asthma treatment, 268, 269tas chronic obstructive pulmonary disease
treatment, 281tAlcohol, absorption and metabolism of, 336Alcohol abuse
adverse physical effects of, 304t, 336, 337as liver disease risk factor, 304t
Alcohol dehydrogenase, 336Alcoholic patients, perioperative assessment of, 337Alcohol withdrawal, 338Aldosterone, 34, 354
Aldrete Score, for postanesthesia patient evaluation,222, 223t
Alkalemia, 29consequences of, 27–28
Alkaline phosphatase, as biliary tract functionindicator, 302
Alkalosis
metabolic, 25t, 26t, 29respiratory, 25t, 26, 26t
Allen’s test, 195–196
Allergic reactions, 364–368asthmatic, 267to local anesthetics, 106, 466treatment of, 366–367
Alpha2-agonists, role in anesthesia, 15Alpha blockersas hypertension treatment, 202tpharmacology of, 15as pulmonary hypertension treatment, 295
Altitude, effect on vaporizer function, 134, 135Alveolar-arterial oxygen gradient (A-a gradient)
Alveolar gas equation, 19Alveolar pressure, 19Alveolar ventilation, relationship with partial pressure
of carbon dioxide (PCO2), 22Alveoliin pediatric patients, 395t
surface tension in, 18Alzheimer’s disease, 332–333Ambulatory patients, in postanesthesia care
units, 227Ambulatory procedures, local anesthetics for, 456American College of Cardiologists/American Heart
Association
aortic valve replacement guidelines of, 248cardiac risk assessment guidelines of, 126, 127mitral valve replacement guidelines of, 249–250,
251American Society of Anesthesiologistsanesthesia monitoring standards of, 245, 438
obstructive sleep apnea checklist of, 361–362physical status classification scale of, 123–124Task Force on Sedation and Analgesia, 438
Aminoamides, 105, 105f, 109e-Aminocaproic aid, use in heart transplantation
patients, 476–477Aminoesters, 105, 105f, 109
Aminophylline, as chronic obstructive pulmonarydisease treatment, 281t
Amitriptyline, as chronic pain treatment, 536tAmnesic drugs, 208use in cardiopulmonary bypass patients, 488
Amphetamines, as hyperthermia risk factor,
221Amrinone, hemodynamic profile of, 112Amyotropic lateral sclerosis (ALS), 331Analgesiaversus anesthesia, 464epidural
in aortic surgery patients, 256in obstetric patients, 420, 421
neuraxial, 88Anaphylactic reactions, 367to blood transfusion, 44, 45t
Anaphylactoid reaction, 364Anaphylaxis
contrast media-related, 440definition of, 364in the operating room, 364
INDEX 543
Anemiaacute normovolemic, 43in burned patients, 383cirrhosis-related, 302
dilutional, of pregnancy, 414Anesthesiaversus analgesia, 464awareness during, 207–209depth ofassessment of, 209continuum of, 438
light, 207–208outside the operating room, 437–444pediatric, 394–403
Anesthesia delivery systems. See Anesthesiamachines
Anesthesia gases. See also Inhalational anesthetics
available on anesthesia machines, 130Anesthesia machines, 130–136, 137–141breathing circuits on, 137–139, 137f,
138f, 140bdisconnection of, 138–139Mapleson, 137–138, 137f
Datex-Ohmeda, 130, 135
definition of, 130Diameter-Index-Safety-System (DISS), 132Drager, 130, 135flowmeters of, 132gas regulators on, 130–131gas supply for, 130, 131
for magnetic resonance imaging suites, 443–444preparation for malignant hyperthermia patients,
135–136, 326safety and fail-safe systems of, 132, 133fscavenger systems of, 130, 136vaporizers of, 133–134, 135–136
Anesthesiologists
radiation exposure protection in, 442role in sedation and analgesia standards
establishment, 438Aneurysmaortic, 254–255abdominal, rupture of, 257
surgical repair of, 256intracranial, rebleeding of, 263, 508as intracranial pressure increase cause, 318trupture of, as subarachnoid hemorrhage
cause, 263subarachnoid hemorrhage-related, 263–264
Aneurysm clipping, 263Aneurysm surgery, brain protection during, 264–265Anginagrading of, 230myocardial ischemia-related, 230pulmonary hypertension-related, 294valvular heart disease-related, 244
Angioedema, anaphylaxis-related, 364Angiography, coronary, for ischemic heart disease
evaluation, 232
Angioplasty, balloon, 233Angiotensin, laparoscopy-related increase in, 515Angiotensin-converting enzyme inhibitors (ACEIs)as heart failure treatment, 239, 241
as hypertension treatment, 201, 202tas pulmonary hypertension treatment, 295
Angiotensin receptor blockersas heart failure treatment, 241as hypertension treatment, 202t
Anion gap, 24b, 28–29Ankle nerve block, 470t
Antacids, preoperative administration of, 120–121in morbidly obese patients, 122
Antibiotic prophylaxisin burned patients, 383in pediatric heart disease patients, 397
Antibiotics
allergic reactions to, 364as chronic bronchitis treatment, 283interaction with neuromuscular blocking
agents, 99Anticholinergicsas asthma treatment, 268, 269tas chronic obstructive pulmonary disease
treatment, 281t, 282as hyperthermia risk factor, 221preoperative administration of, 119–120, 120tin pediatric patients, 121
side effects of, 120tuse in electroconvulsive therapy, 523
Anticholinergic syndrome, central, 120Anticholinesterases, use in chronic obstructive
pulmonary disease patients, 282Anticoagulants
as atrial fibrillation treatment, 213interaction with fish oil, 370preoperative termination of, 126
as pulmonary hypertension treatment, 296–297use in cardiopulmonary bypass patients, 488–489
Anticonvulsants, as pain treatment, 536tAntidepressants. See also Tricyclic antidepressantspreoperative administration of, 118use in geriatric patients, 522
Antidiuretic hormone, 382. See also Vasopressinrelease of, 31–32, 32tsynthesis of, 32
Antiemetics, preoperative administration of, 120–121Antifibrinolytic agents, use in heart transplantation
patients, 476–477
Antihistaminesas allergic reaction treatment, 367as hyperthermia risk factor, 221
Antihypertensive agents, 201, 202tperioperative use of, 202, 203, 204tuse during pregnancy, 427
Antileukotrienes, as chronic obstructive pulmonary
disease treatment, 281tAntithrombin III, 52–53Antithyroid drugs, 353
544 INDEX
Anxietyawareness during anesthesia-related, 208blood loss-related, 374thyperthyroidism-related, 353
in parents of pediatric patients, 395–396preoperative, 118in pediatric patients, 121, 395
as respiratory alkalosis cause, 26Aortic cross-clamping and unclamping, 255, 256, 489Aortic dissection, as aortic stenosis cause, 247–248Aortic insufficiency, 246f, 247–248, 248t, 249, 252
Aortic stenosis, 245–246, 247, 252Aortic surgery, 254–258as renal insufficiency risk factor, 316
Aortic valve replacement, 246, 247, 248, 249Aortic vascular disease. See Aorto-occlusive diseaseAortocaval compression syndrome, 414, 415
Aorto-occlusive disease, 254–258Apgar score, 417, 417tApneapostoperative, in premature infants, 392–393in premature infants, 388t
Aprotinin, allergic reactions to, 365Arginine vasopressin. See Vasopressin
Arrhythmias, 210–216as active cardiac condition, 126, 127digoxin toxicity-related, 211electrical burns-related, 386electrocardiographic findings in, 163halothane-related, 79
methadone-related, 339succinylcholine-related, 97
Arterial blood gas (ABG) analysis. See also Blood gasanalysis
in asthmatic patients, 268in chronic obstructive pulmonary disease patients,
279
in congestive heart failure patients, 241normal values at sea level, 24, 24tduring pregnancy, 413, 413t
Arteriovenous malformations, cerebral, 265Aspartate aminotransferase, as hepatocellular
damage indicator, 302
Aspiration, 274–277of acidic fluid, 275definition of, 274of gastric contents, 64as acute respiratory distress syndrome risk
factor, 287t
in alcohol abusers, 336as wheezing cause, 283
in morbidly obese patients, 122of nonacidic fluid, 275of particulate food matter, 275as pneumonitis cause, 120–121pulmonary, in liver transplantation patients,
483risk factors for, 511–512treatment for, 276–277
Aspirinanticoagulant activity of, 53use in cardiopulmonary bypass patients, 492
Asthma
clinical features of, 278definition of, 267diseases which mimic, 267preoperative management in, 270pulmonary function test abnormalities in, 70, 71tas respiratory acidosis cause, 26treatment of, 268–269, 269t, 270
types of, 267Atelectasis, in obese patients, 360Atherosclerosis, as aorto-occlusive disease cause, 254Atopy, as latex allergy risk factor, 366Atracuriumallergic reactions to, 364–365
loading dose of, 359tas nondepolarizing neuromuscular blocking
agent, 98tuse in chronic obstructive pulmonary disease
patients, 282use in renal insufficiency patients, 315
Atrial fibrillation, 212
digoxin-related, 163hyperthyroidism-related, 353paroxysmal, 213pulmonary hypertension-related, 294with rapid ventricular response, 212valvular heart disease-related, 244
Atrial kick, 294Atrioventricular dissociation, 210–211, 213Atrioventricular heart block, 211second-degree, 210third-degree (complete), 210–211
Atrioventricular node dysfunction, 211Atropine
as chronic obstructive pulmonary diseasetreatment, 281t
side effects of, 120, 120tas sinus bradycardia treatment, 210use in pediatric patients, 121
Autoimmune disease, as liver disease risk factor, 304t
Autonomic denervation, of transplanted hearts, 477Autonomic dysfunction, 15Autonomic hyperreflexia, 377Autonomic nervous systemanatomy and function of, 9–16in Guillain-Barre syndrome, 331
Auto-positive-end expiratory pressure (auto-PEEP),152, 153, 153f, 155
Autoregulation, of cerebral blood flow, 260Autoregulation breakthrough, 265Avian influenza, blood transfusion-related
transmission of, 44Awakening, from anesthesia, 223
intracranial pressure control during, 321slow, 226–227after craniotomy, 508
INDEX 545
Awareness, during anesthesiaduring anesthesia, 207–209in cardiopulmonary bypass patients, 488classification of, 207
Axillary arteryas arterial pressure monitoring cannulation site,
196, 196fas cardiopulmonary bypass cannulation site,
487–488Axillary nerve block, 469t
B
Back pain, epidural anesthesia-related, 465Baclofen, as chronic pain treatment, 536tBacteria, antibiotic-resistant, 383Bacterial infections, blood transfusion-related
transmission of, 44
Barbiturate coma, 322Bariatric surgery, 362–363Baricity, 452Baroreceptor reflex, in pediatric patients, 394Barotrauma, positive-end expiratory pressure-related,
153Base deficit, 28
"Beach chair" position, 145Beck’s triad, 376Benzocaine, as methemoglobinemia cause, 110Benzodiazepinesaction mechanism of, 93as chronic pain treatment, 536t
intravenous administration of, 93oversedation with, 93–94as preoperative sedation, 118–119use inliver disease patients, 306morbidly obese patients, 122
Beta blockers
as chronic pain treatment, 536tcontraindications to, 211as heart failure treatment, 239, 241as hypertension treatment, 201, 202tindications for, 14interaction with neuromuscular blocking
agents, 99as ischemic heart disease treatment, 233perioperative use of, 9as pulmonary hypertension treatment, 295side effects of, intraoperative treatment of, 15as sinus tachycardia treatment, 211
Beta1-blockers, action mechanism and side effectsof, 14
Beta2-blockers, side effects of, 14Bicarbonatearterial blood gas analysis value of, 28buffering function of, 26
Bier blocks, 467–469
Biliary tractobstruction of, 305tsurgical reconstruction of, 485
Bilirubinin neonates, 387–388unconjugated, 304t
Bispectral index (BI), 209
Bladder, epidural anesthesia-related distentionof, 462
Blindness. See also Vision losspostoperative, 147–148
Bloodarterial, color of, 182donated
alternatives to, 49screening of, 44storage of, 46
oxygen content of, calculation of, 21, 22Blood-borne transmission, of Infectious disease, 44Blood circulation. See Blood flow
Blood cross-matching, 48, 48tBlood flowcerebralautoregulation of, 260effect of inhalational anesthetics on, 321factors affecting, 321bischemic, 260
normal, 260regulation of, 318–319, 319f
coronarydeterminants of, 230normal, 229
hepatic, effect of inhalational anesthetics on,
305–306pulmonary, 293effect of adenosine on, 299effect of inhalational agents on, 296–297
renal, 309–311in burned patients, 382
uterine, during pregnancy, 411t, 414
Blood gas analysis, 24–30pH-stat and a-stat methods of, 490
Blood loss. See also Hemorrhageacceptable (ABL), in pediatric patients, 400effect on vital signs, 374tin excisional burn surgery, 385
in liver transplantation patients, 484in pediatric patients, 400, 401t
Blood pressure. See also Hypertension; Hypotensiondiastolic, in pediatric patients, 394disturbances of, 201–206. See also Hypertension;
Hypotension
as hypovolemia indicator, 37systoliceffect of blood loss on, 374tin pediatric patients, 394
Blood pressure monitoringintra-arterial, 194–200in obese patients, 360
Blood screening, 48Blood transfusions, 43–50adverse reactions to, 44–45, 45t, 49, 50
546 INDEX
Blood transfusions (Continued)autologous, 49central venous catheterization for, 186in emergency situations, 48, 50
hemoglobin level as indicator for, 126infectious disease transmission in, 44massive, complications of, 48–49, 53, 287tphysiologic indicators for, 43, 44
Blood types/typing, 47–48, 47tBlood typing, 48Blood urea nitrogen (BUN), 311–312, 312t, 313–314
Blood volumeestimated, in pediatric patients, 399, 400, 400tin obese patients, 358during pregnancy, 412t
"Blue bloaters," 279Body composition, aging-related changes in, 433–434
Body temperature. See also Thermoregulationdisturbances in, 217–221monitoring of, 97, 438
Body watercompartments and distribution of, 31, 31fregulation of, 31–32
Brachial artery, as arterial pressure monitoring
cannulation site, 196, 196fBrachial plexusinjuries toanesthetic technique-related, 146patient position-related, 144–145, 146
patient position-related injury to, 144–145, 146
as somatosensory-evoked potential recording site,500
surgical exploration of, 502Brachial plexus blocksas acute pain treatment, 533local anesthestic vascular absorption in, 107
Bradycardia
antihypertensive agents contraindicated in, 211causes of, 210bfetal, 416hypothyroidism-related, 380intraoperative treatment of, 15opioids-related, 90
in pediatric patients, 394in infants, 389tin premature infants, 388t
reflex, 120sinus, 210digoxin toxicity-related, 211
spinal anesthesia-related, 452, 453Brainanesthetic requirements in, 505electrical activity monitoring in, 209respiration center of, 22
Brain protection, 264–265, 506–507Brain tumors, 93, 509
Breathing. See also Ventilationeffect of carbon dioxide and oxygen on, 22physiologic work of, 17, 18
Breathing (Continued)work ofin obese patients, 358in pediatric patients, 398
positive-end expiratory pressure-relatedincrease in, 153
Breathing circuits, on anesthesia machines.See Anesthesia machines, breathing circuits on
Bronchial blockade, 378, 493, 495, 496–497, 497tBronchiolitis, 70Bronchitis
asthmatic, 278chronic, 278, 283pulmonary function test abnormalities in, 70
Bronchoconstriction, histamine receptor stimulation-related, 284
Bronchodilator therapy, preoperative, 272
Bronchospasmanaphylaxis-related, 364asthma-related, 267, 271–273inhalation injury-related, 381intraoperative, 271–273, 283
Bronchusright and left main stem, 494
tears of, 378width estimation of, 493, 494t
Brooke formula, modified, 383–384Buffer systems, of the body, 26Bundle-branch blocks, 158left, 157, 158, 158f, 167
right, 157, 158, 158f, 166–167pulmonary artery catheterization-related, 189
Bupivacainecardiotoxicity of, 108, 109as epidural anesthetic, 462tpotency of, 107tas spinal anesthesia, 451t, 456
use inin cesarean sections, 423tobstetric patients, 420–421, 423tpediatric patients, 401
Buprenorphine, 82equianalgesic doses of, 532t
Burger’s disease, 533Burned patients, 380–386Burnsclassification of, 380on the neck, 59thoracic, 17
Butorphanol, 82equianalgesic doses of, 532tuse in obstetric patients, 419t
C
Caffeine-halothane contracture test, 325Calcium, homeostasis of, 357
Calcium channel blockersas hypertension treatment, 201, 202tinteraction with neuromuscular blocking agents, 99
INDEX 547
Calcium channel blockers (Continued)nondihydropyridine, contraindication to, 211as pulmonary hypertension treatment, 295
Calcium sensitizers, 117
Cancer. See also specific types of canceras pain cause, 537
Capillary refill rate, effect of blood loss on, 374tCapnography, 175–179Capnometry, differentiated from capnography, 175Carbamazepine, as chronic pain treatment, 536tCarbon dioxide. See also End-tidal carbon dioxide
(ETCO2)blood transport of, 21as chemistry panel value, 28correlation with partial pressure of carbon dioxide,
176effect on breathing, 22
elimination from anesthesia circuits, 139exhaled, capnographic measurement of, 175–179increase of, as hypercarbia cause, 22, 23as insufflation gas, 512, 512t, 513, 516–517
Carbon dioxide absorbents, effect of inhalationalanesthetic by-products, 80–81
Carbon monoxide poisoning, 78, 80, 381–382, 385
Carboxyhemoglobin, effect on pulse oximetryaccuracy, 172
Cardiac arrest, during spinal anesthesia, 453Cardiac conditions, active, 126, 127Cardiac filling pressure, incorrect interpretation
of, 153
Cardiac functionevaluation of, 126, 127, 231in pediatric cardiac surgery patients, 409
Cardiac index, 238pulmonary artery catheterization measurement
of, 188Cardiac output
in burn patients, 381calculation of, 238central venous pressure as indicator of,
184exercise-related increase in, 238hypercarbia-related increase in, 23
in hypertension, 201in obese patients, 358passage through shunts, 21in pediatric patients, 394in neonates, 387
postpartum, 411t
during pregnancy, 411tpulmonary artery catheterization measurement
of, 188Cardiac pacing, postbypass, 490Cardiac risk, perioperative, assessment guidelines
for, 127, 128tCardiac surgery
lung isolation use in, 493minimally-invasive, 511as renal insufficiency risk factor, 316
Cardiac surgery patients, peripheral neuropathyin, 146
Cardiomyopathy, dilated, 236, 236tCardioplegia, 489
Cardiopulmonary bypass, 487–492as acute respiratory distress syndrome
risk factor, 287tcomplications of, 491–492difficulty in weaning from, 491in heart transplantation patients, 476–477left ventricular dysfunction after, 477
myocardial protection during, 489, 491patient preparation for, 476right left ventricular dysfunction after, 477termination of, 477
Cardiopulmonary bypass circuits, 487priming solutions for, 488
Cardiovascular collapse, 376, 378local anesthetics-related, 108–109
Cardiovascular diseasealcohol abuse-related, 336, 337congenital, 404–410in pediatric patients, 397–398, 404–410in pregnant patients, 430–431
Cardiovascular drugs. See also names ofspecific drugs
benefits of, 112use during perioperative period, 233
Cardiovascular systemaging-related changes to, 432
effect of alcohol on, 336effect of burns on, 381effect of cirrhosis on, 301effect of hypothermia on, 218teffect of local anesthetics on, 108–109effect of myotonic dystrophy on, 328effect of opioids on, 85
effect of patient positioning on, 142pediatriccomparison with adult, 394neonatal, 387
Cardioversion, chemical, 212Cardioverter-defibrillators, implantable, 214
Carotid arteriescentral venous catheterization-related injury to, 186pulmonary artery catheterization-related injury to, 189
Cataracts, electrical burns-related, 386Catecholamines, 11effect on uteroplacental perfusion, 415
synthetic pathway of, 13fCatheterizationarterial, for blood pressure measurement, 194–200damping coefficients in, 196, 197, 198flushing of, 199in valvular heart disease patients, 245
cardiac, for pulmonary hypertension evaluation, 295
central venous, 180–187catheter placement in, 180, 180f, 181–182,
183, 186
548 INDEX
Catheterization (Continued)catheter removal in, 187complications of, 185f, 186in obese patients, 360
types of catheters used in, 181epidural, in pregnant patients, 361Foley embolectomy, 495, 496–497pulmonary artery, 188–193catheter kinking during, 189–190effect on patient outcomes, 189in ischemic heart disease patients, 234
in valvular heart disease patients, 245waveforms of, 190, 191–192, 191f, 192f
Cauda equina syndrome, 109, 452Caudal anesthesia, 458in pediatric patients, 400–401, 401t
Caudal nerve blocks, 107
Central anticholinergic syndrome, 120Central nervous system. See also Braineffect of alcohol abuse on, 336effect of hypothermia on, 218teffect of local anesthetics on, 108, 109pregnancy-related changes in, 413
Central somatosensory conduction time, 501
Central venous pressure (CVP)as cardiac output indicator, 184influences on, 184measurement of, 182normal values for, 185, 188during pregnancy, 411t
pulmonary artery catheterization measurementof, 188
relationship to right ventricular preload, 184–185as volume status indicator, 185f, 186waveforms of, 183–184, 183f, 186, 190, 190f
Cephalosporins, use in penicillin-allergic patients, 365Cerebral cortex, peripheral neural neurosensory
pathway to, 500Cerebral perfusion, effect of inhalational anesthesia
on, 261Cerebral perfusion pressurein craniotomy patients, 508determinants of, 318
intraoperative monitoring of, 261Cerebral perfusion pressure breakthrough, 265Cerebrospinal fluidas intracranial pressure determinant, 317local anesthetic injected into, 452lumbosacral volume of, 452
spinal anesthesia resorption from, 451Cerebrovascular disease, 259–266. See also Strokein aorto-occlusive disease patients, 255preoperative risk assessment of, 128
Cerebrovascular insufficiency, 259Cervical spine injuries, airway management in,
374–375
Cesarean section, anesthesia forepidural, 423–424general, 424, 425
Cesarean section, anesthesia for (Continued)as hypotension cause, 415regional, 415spinal, 423–424, 423t
Cetacaine, use in awake intubation, 64tChagas’ disease, 44Chamomile, 369Chemical burns, 380Chest wall, peripheral nerve block anesthesia for, 471Child-Turcotte-Pugh Score, 302–303, 303t, 306Chloroprocaine
maximum safe doses of, 107tpotency of, 107tuse as epidural anesthetic, 462t, 464use in obstetric patients, 420, 421
Cholecystitis, acalculous, 382Cholinergic receptors, end-organ effects of, 12t
Chondroitin 4-sulfate, 369Chronic obstructive pulmonary disease (COPD),
278–284in aorto-occlusive disease patients, 254"blue bloaters" in, 279definition of, 278"pink puffers" in, 279
as postoperative pulmonary complication riskfactor, 125, 125t
pulmonary elastic recoil in, 17Cirrhosis, 301–302alcoholic, 337cardiovascular physiology in, 480
central nervous system dysfunction associatedwith, 300
definition of, 300Hepatopulmonary syndrome of, 301hepatorenal syndrome of, 301as hyponatremia cause, 38tpreoperative risk assessment in, 302–303
pulmonary hypertension associated with, 301Cisatracurium, as nondepolarizing neuromuscular
blocking agent, 98tCitrate, accumulation during in liver transplantation,
484Clevidipine
action mechanisms and action sites of, 115hemodynamic profile of, 115
Clonidine, perioperative use of, 9Closing capacity, 17Coagulation, 51–57Coagulation factors. See also specific coagulation
factorsas liver function indicators, 302during pregnancy, 411–412pregnancy-related increase in, 412t
Coagulation pathways, intrinsic and extrinsic, 51–52Coagulation system, cardiopulmonary bypass-related
activation of, 488, 490
Coagulation tests, 54in pregnant patients, 428preoperative, 125t, 127
INDEX 549
Coagulopathiesin burned patients, 385cirrhosis-related, 302cyanotic heart disease-related, 406
in heart transplantation patients, 476herbal supplement-related, 371–372, 520in liver transplantation patients, 483, 484, 485massive blood transfusion-related, 48medication-related, 454in trauma patients, 378
Cocaine, 339, 340–341, 340b
as hyperthermia risk factor, 221use in awake intubation, 64t
Cocaine withdrawal, 340Codeine, 83tequianalgesic doses of, 532tmetabolism of, 87
Cognitive dysfunction, postoperativecardiopulmonary bypass-related, 491in geriatric patients, 434–435
Colloid solutions, 34–35allergic reactions to, 364use in burned patients, 383–384
Coma
acidemia-related, 27barbiturate, 322cardiopulmonary bypass-related, 491myxedema, 352
Compartment syndromesabdominal, 376
universal theory of, 376Complex regional pain syndrome I (CRPS I), 537Complex regional pain syndrome II (CRPS II), 537Compliance, pulmonaryin acute respiratory distress syndrome, 288dynamic and static, 18in mechanical ventilation, 154
Conduction, as heat loss mechanism, 219Conduction block, 452Confusion, acidemia-related, 27Congenital heart disease, 404–410cyanotic, 406, 406b, 407–408, 407tin pediatric patients, 397–398
in pregnant patients, 430–431Congestive heart failure, 236diastolic, 115, 116as hyponatremia cause, 38tleft-to-right shunt-related, 397signs and symptoms of, 231
treatment of, 117Connective tissue disease, as pulmonary hypertension
risk factor, 293Constipation, hypothyroidism-related, 380Consultations, preoperative, 125–126Continuous positive airway pressure (CPAP), use in
lung isolation, 497
Contrast media, soluble, 440–441, 441tContusionsmyocardial, 377–378pulmonary, 287t
Convection, as heat loss mechanism, 219Cornea, patient positioning-related injury to, 147Coronary arteries, anatomy of, 229Coronary artery bypass grafting, prior to
noncardiac surgery, 232Coronary artery diseasein aorto-occlusive disease patients, 254diabetes-related, 343electrocardiographic findings in, 159, 159fas heart failure cause, 236, 236thypothyroidism treatment in, 352–353
in liver disease patients, 480in liver transplant patients, 480
Coronary syndromes, unstable, 126, 127Corticosteroidsas allergic reaction prophylaxis, 367as asthma treatment, 268, 269t, 271
as chronic obstructive pulmonary diseasetreatment, 281t
for intracranial pressure reduction, 319perioperative supplemental, 356use in spinal cord injury patients, 377
Corticotropin-releasing hormone, 354Cortisol
as chronic obstructive pulmonary diseasetreatment, 281t
comparison with exogenous steroids, 355–356,355t
laparoscopy-related increase in, 515synthesis and function of, 354
Cortisone, potency of, 355tCoughasthma-related, 267bronchitis-related, 278chronic obstructive pulmonary disease-related, 279emphysema-related, 278heart failure-related, 240
Craniotomyanesthesia for, 505–510in pediatric patients, 510
Creatinine, 311–312, 312t, 313–314, 433Creatinine clearance rate, 310, 312tCreutzfeldt-Jakob disease, 44
Critically-ill patients, mechanical ventilation in,149–156
Cromolyn sodium, 269, 281tCryoprecipitates, 51Crystalloid solutionscomposition of, 35, 35t
effect on intracranial pressure, 320–321use in patients undergoing cesarean section, 415
Crystal methamphetamine, 341Cushing reflex, 317, 509–510Cyanosisasthma-related, 268congenital heart disease-related, 406, 406b,
407–408, 407tpulmonary hypertension-related, 294
Cyclobenzaprine, as chronic pain treatment, 536tCyclooxygenase-1 (COX-1) agents, 533
550 INDEX
Cyclooxygenase-2 (COX-2) agents, 533Cystic fibrosis, pulmonary function test abnormalities
in, 70Cytomegalovirus infection, as hepatocellular injury
cause, 305t
D
Damage control surgery, 375–376, 378Damping coefficient, 197, 198, 198fDantroleneeffect on skeletal muscle, 99
as malignant hyperthermia prophylaxis, 326as malignant hyperthermia treatment, 324, 325, 326
Dead spacealveolar, anatomic, and physiologic, 21positive-end expiratory pressure-related increase
in, 153
during pregnancy, 412tDeliriumcentral anticholinergic syndrome-related, 120in geriatric patients, 434–435
Dependence, definition of, 338DepoDur, 88Depression. See also Antidepressants
awareness during anesthesia-related, 208electroconvulsive therapy for, 522–526
Dermatitis, contact, 364Desfluraneas carbon monoxide poisoning cause, 80chemical structure of, 75, 75f
metabolic products of, 79–80physical properties of, 76tsomatosensory-evoked potential effects of, 502tvaporizer delivery of, 134, 135
Dexamethasoneas chronic obstructive pulmonary disease
treatment, 281t
potency of, 355tDexmedetomidine (Precedex), 440, 444Dextrans, use in resuscitation, 35, 36tDiabetes insipidus, 32–34, 33tDiabetes mellitus, 343–350in aorto-occlusive disease surgical patients,
255, 256glucose control in, 345oral hypoglycemic agent therapy for, 344postoperative management in, 347in pregnant patients, 430preoperative evaluation in, 345
types of, 343urgent surgery in, 348
Diacetylmorphine, 83tDiaphragmcarbon dioxide insufflation-related dysfunction
of, 513patient positioning-related displacement of,
144–145respiratory function of, 17
Diarrhea, bloody, 382
Diastolic dysfunction, 201, 238–239, 239fDiazepamas chronic pain treatment, 536tintravenous administration of, 93
as preoperative sedation, 119tsomatosensory-evoked potential effects of, 502tuse in pediatric patients, 396t
Dietary Supplement Health and EducationAct (1994), 369
Diffusion, impaired, as hypoxemia cause, 20Diffusion capacity, single-breath (DLCO), 69–70, 71t
Digitalis, as intraoperative inotrope, 114Digoxin, as arrhythmia cause, 163, 2111,25-Dihydroxyvitamin D, 357Diltiazem, contraindication to, 211Dipyridamole thallium imaging, 232Disseminated intravascular coagulation, 53, 55, 56
in pregnant patients, 430treatment of, 54
Distal pulse amplification, 198–199Diureticsaction sites of, 309, 310tas hypertension treatment, 201, 202tas hyponatremia cause, 38t, 482
loop, 310tosmotic, 310tpotassium-sparing, 310tas hyperkalemia cause, 482
as pulmonary hypertension treatment,296–297
side effects of, 309, 310tthiazide, 310t
Dobutamine, hemodynamic profiles of, 113–114Dopamine, 11hemodynamic profiles of, 113laparoscopy-related increase in, 515limitations of, 115, 116–117
renal effects of, 314synthesis of, 11–12
Dorsalis pedis artery, as arterial pressure monitoringcannulation site, 196, 196f
Doxacurium, as nondepolarizing neuromuscularblocking agent, 98t
Droperidol, 502tDrug abusers, nitrous oxide toxicity in, 78Drug delivery systems, implantable, 539Drug metabolismin burned patients, 382effect of hypothermia on, 220, 221
effect of liver disease on, 483in neonates, 387
Drugs. See also names of specific drugshepatotoxicity of, 304tas hyperthermia risk factor, 221as perioperative hypotension risk factor, 204
Duchenne muscular dystrophy, 327
Ductal-dependent lesions, 408Dynamic compliance, 18Dysplasia, bronchopulmonary, 388t
INDEX 551
Dyspneaacute respiratory distress syndrome-related, 288asthma-related, 267chronic obstructive pulmonary disease-related, 279
heart failure-related, 236, 240pulmonary hypertension-related, 294
Dystrophin, 327
E
Echinacea, 369Echocardiography
for aortic insufficiency evaluation, 248, 248tfor aortic stenosis evaluation, 246, 246tfor congestive heart failure evaluation, 240–241for ischemic heart disease evaluation, 232for mitral stenosis evaluation, 249, 249tfor pulmonary hypertension evaluation, 295
stress, for ischemic heart disease evaluation, 232transesophagealin high-risk cardiac surgical patients, 234during valvular heart disease surgery, 244–245
for valvular heart disease evaluation, 244–245Eclampsia, 428–429Ecstasy (3,4-methylenedioxymethamphetamine), 341
Edemaof the airway, 381cerebral, 265, 347pulmonary, 17burn-related, 381heart failure-related, 236
negative-pressure, 225–226Edrophonium, 102, 282Eisenmenger’s syndrome, 397, 404Elderly patients. See also Geriatric anesthesiaantidepressant therapy in, 522trauma in, 378
Elective surgery, in hypothyroid patients, 353, 356
Electrical burns, 380, 386Electrocardiography (ECG), 157–167during anesthesia, 438in arrhythmias, 163, 215–216in bundle-branch blocks, 157, 158, 158f,
159, 166–167
in congestive heart failure, 240in coronary artery disease, 159, 159fdelta wave pattern on, 214–215exercise, 231in hypercalcemia, 165–166, 165fin hyperkalemia, 163, 163f
in hypocalcemia, 165, 165fin hypokalemia, 163–164, 164fin hypothermia, 219–220in hypothyroidism, 162large R wave in V1 on, 157, 166bin myocardial infarction, 159–160, 160f, 161,
161f, 162, 162f
preoperative, 124, 125tin geriatric patients, 434in obese patients, 359
Electrocardiography (ECG) (Continued)prolonged QT interval on, 166in pulmonary hypertension, 294P waves, in ventricular tachycardia, 213, 214
QRS complexmagnesium sulfate-related widening of, 428in ventricular tachycardia, 213
QT interval, prolonged, 214ST-segment on, 159–160, 160f, 161, 161t, 162,
162f, 16312-lead, in ischemic heart disease, 233–234
in valvular heart disease, 244Electroconvulsive therapy (ECT), 522–526Electroencephalography (EEG)for brain protection assessment, 506during carotid endarterectomy, 262processed, 209
Electrolyte disturbances, 38–42in liver transplantation patients, 482
Embolism. See also Air embolismfat, 287tas valvular heart disease cause, 244
EMLA cream, use in pediatric patients, 396Emphysema
clinical features of, 278pulmonary function test abnormalities in,
70, 71tas respiratory acidosis cause, 26
Encephalopathyhepatic, 300
Wernicke’s, 336, 337Endarterectomy, carotid, 260, 261, 262Endocarditis, infectiveas aortic stenosis cause, 247–248subacute, 409–410
Endocrine disordersas metabolic alkalosis cause, 29
nondiabetic, 351–357Endocrine system, effect of burns on, 382Endoscope, development of, 515Endotracheal intubationawake, 63–64, 64tblind, 63
in diabetic patients, 346difficulty in weaning from, 18head position during, 62f, 148indications for, 58in laser surgery of the airway patients, 520in pediatric patients, 402
Endotracheal tubescuffed, for pediatric patients, 398double-lumen, 493, 494, 494t, 495, 496,
497, 497tleakage of, in pediatric patients, 394tfor lung isolation, 494f, 495for pediatric patients, 394t, 398–399, 398t
Robertshaw, 494fsize of, for pediatric patients, 398, 398ttypes of, 61–63
552 INDEX
Endovascular repair, of the aorta, 256–257End-tidal carbon dioxide (ETCO2)correlation with partial pressure of carbon dioxide,
176
decrease, 177definition of, 175–176importance of, 175increase, 177–178
Enfluranechemical structure of, 75fsomatosensory-evoked potential effects of, 502t
Enterocolitis, necrotizing, 388tEnvironmental exposure, as chronic obstructive
pulmonary disease cause, 278Enzyme deficiencies, as unconjugated bilirubin
cause, 304tEphedrine
effects and doses of, 14as hypotension treatment, 415perioperative use of, 12–14
Ephredra, 369–370Epidural analgesiain aortic surgery patients, 256in obstetric patients, 420, 421
Epidural anesthesia, 458–465caudal, in pediatric patients, 400–401, 401tcombined with general anesthesia, 464–465combined with spinal anesthesia, 424, 464comparison withgeneral anesthesia, 459
spinal anesthesia, 459complications of, 461, 465contraindications to, 460–461differentiated from spinal anesthesia, 43epidural, 108in geriatric patients, 434with heparin use, 454–455
lumbar, 460motor blocks associated with, 463–464neurotoxicity of, 109–110preoperative evaluation prior to, 459–460segmental, 464use in
multiple sclerosis patients, 333obstetric patients, 421–422pulmonary hypertension patients, 297
Epidural nerve block, local anesthetic vascularabsorption in, 107
Epidural space, anatomy of, 458
Epidural steroids, as radiculopathic pain treatment,538–539
Epinephrine, 11as allergic reaction treatment, 367as asthma treatment, 269tas chronic obstructive pulmonary disease
treatment, 281t
coadministration with local anesthetics, 108, 463hemodynamic profiles of, 113laparoscopy-related increase in, 515synthesis of, 11–12
Epinephrine (Continued)use in cesarean sections, 423tuse in pediatric patients, 399
Epoprostenol, 299
Epstein-Barr virus infection, 305tErb’s point, 500Erythropoietin, 49Esmolol, 204t, 211Esophageal surgery, lung isolation use in, 493Esophagus, accidental intubation of, 176Estimated fluid deficits (EFD), in pediatric patients,
399Etidocaine, potency of, 106, 107tEtomidatecardiovascular effects of, 90as induction agent, 91tintracranial pressure effects of, 320
as sedative, 91tsomatosensory-evoked potential effects of, 502tuse inburned patients, 382critically ill patients, 92
Evaporation, as heat loss mechanism, 219Evoked response monitoring, for anesthesia depth
assessment, 209Exercise, effect on cardiac output, 238Exercise intolerancechronic obstructive pulmonary disease-related, 279heart failure-related, 236valvular heart disease-related, 244
Exercise tolerance, as cardiac function indicator, 231Expiration, muscles responsible for, 17Extubationin chronic obstructive pulmonary disease patients,
284criteria for, 65, 361tin obese patients, 361, 361t
100% oxygen administration prior to, 67Eye injuryin hyperthyroid patients, 353patient positioning-related, 147
F
Factor II, 337Factor V, 337Factor Va, 487Factor VII, 337, 412t, 488Factor VIIa, 487recombinant, 56
Factor VIII, 53–54, 302, 412tFactor VIIIa, 487Factor IX, 412tFactor X, 337, 412tFactor XII, 412tFasting, preoperative, 124, 124t, 274–275Fast tracking, 222, 488
Fat embolism syndrome, 287tFatigueheart failure-related, 236, 240hyperthyroidism-related, 353
INDEX 553
Fatigue (Continued)hypothyroidism-related, 380pulmonary hypertension-related, 294
Febrile reactions, to blood transfusion, 45
Femoral arteryas arterial pressure monitoring cannulation site,
196, 196fas cardiopulmonary bypass cannulation site,
487–488Femoral nerve, effect of patient positioning on, 144Femoral nerve blocks, 107, 470t
Femoral vein, as central venous catheter insertionsite, 181
Femur, fractures of, 375–376Fenoldopam, 115–116Fenoterol, 268, 281tFentanyl, 83t, 455
as acute pain treatment, 530, 533in awake intubation, 64tcomparison with morphine, 85duration of action of, 85, 86teffect on pulmonary vascular resistance, 406elimination half-life of, 85equianalgesic doses of, 532t
loading dose of, 359tonset of action of, 85, 86tpeak effect of, 85, 86tsomatosensory-evoked potential effects of, 502ttransdermal, equianalgesic doses of, 532tuse in
liver transplantation patients, 483obstetric patients, 419t, 422tpediatric patients, 396t
Fentanylx, use in obstetric patients, 423tFetal heart rate monitoring, 416, 416fFetus, nitrous oxide toxicity in, 78Feverfew, 369, 371
Fibrin degradation products, 55Fibrinogen, pregnancy-related increase in, 412tFibrinolysis, 52pregnancy-related increase in, 412t
Fibromyalgia, 538Fibrosis, pulmonary, 17
FiO2. See Fractional concentration of oxygen ininspired gas (FiO2)
Firesas burn cause, 380in operating rooms, 520–521, 521b
Fish oil, 369, 370
Fistulas, tracheoesophageal, 390, 391Flashbacks, awareness during anesthesia-related, 208Flow-volume loops, 71–72, 72f, 73fFludrocortisone, potency of, 355tFluid loss, intraoperative, 36–37Fluid management, 31–37in acute respiratory distress syndrome, 289–290
in burned patients, 383–384during craniotomy, 506in hepatorenal syndrome patients, 301for hyponatremia control, 38–39
Fluid management (Continued)for intracranial pressure control, 319, 320–321intraoperative, 36–37in pediatric patients, 399–400
of traumatic brain injury patients, 322–323Fluid retention, heart failure-related, 236Fluid status, central venous pressure as indicator
of, 185fFlumazenil, side effects of, 94Fluorideas anesthetic metabolic product, 80
nephrotoxicity of, 314Fluoxetine, as chronic pain treatment, 536tFluphenazine, as chronic pain treatment, 536tFood and Drug Administration (FDA), 369Forced expiratory flow at 50% of forced vital capacity/
forced inspiratory flow at 50% of forced vital
capacity (FEF50/FIF50), 71Forced expiratory volume in one second (FEV1), 70f
in obstructive airway diseases, 70during pregnancy, 412t
Forced expiratory volume in one second (FEV1)/forcedvital capacity (FVC) ratio, 74
in obstructive airway diseases, 70, 71t
in restrictive airway diseases, 71tForced vital capacity (FVC), 74Fractional concentration of oxygen in inspired gas (FiO2)
low, as hypoxemia cause, 19, 20during organ harvesting, 474–475oxygen therapy-related increase in, 224, 224t
prior to extubation, 67Fractional excretion of sodium (FENa), 312tFrank-Starling law, 238Fresh frozen plasma, indications for use of, 55Functional residual capacity (FRC), 69f, 70fdefinition of, 17determination of, 69
during pregnancy, 412trelationship to closing capacity, 17
G
Gabapentin, as pain treatment, 536tGallamine, use in renal insufficiency patients, 315t
Ganglia, sympathetic, 10, 10fGarlic, 369, 371Gasesavailable on anesthesia machines, 130for insufflation, 512, 512t
Gas flow, pulmonary resistance to, 17, 18
Gastric acid secretion blockers, preoperativeadministration of, 119t, 120–121
Gastric emptying, in neonates, 387–388Gastroesophageal refluxin neonates, 387–388in obese patients, 358–359
Gastrointestinal system
acid-base balance function of, 27effect of alcohol on, 337effect of burns on, 382pregnancy-related changes in, 413
554 INDEX
Gastrokinetic agents, preoperative administration of,119t, 120–121, 274–275
Gastroschisis, 390, 391–392differentiated from omphalocele, 391
Gate theory, of pain, 539General anesthesiain carotid endarterectomy patients, 261for cesarean sections, 424, 425in chronic obstructive pulmonary disease patients,
282, 283combined with epidural anesthesia, 464–465
comparison with epidural anesthesia, 459definition of, 439teffect on renal function, 314in geriatric patients, 434heat loss during, 218in hypertensive patients, 204
in ischemic heart disease patients, 234for laparoscopic procedures, 516patient discharge following, 227in pediatric patients, 402–403pulmonary function effects of, 280ventilation-perfusion mismatch-exacerbating
effect of, 20
Geriatric anesthesia, 432–436Ginger, 369, 371Ginkgo, 369, 370Ginseng, 369, 370Glasgow Coma Scale (GCS), 373tGlideScope, 61
Glomerular filtration, 309Glomerular filtration rate, 312aging-related decrease in, 433
Glomerulonephropathy, during pregnancy, 430Glossopharyngeal nerve block, 64Glucocorticoidsas hypothalamic-pituitary-adrenal axis disruption
cause, 355use in cardiopulmonary bypass patients, 476
Gluconeogenesis, in neonates, 387Glucosamine, 369Glucoseneonates’ need for, 387
perioperative monitoring of, 349Glucose-containing intravenous fluids, 399–400contraindication to, 320–321, 322
Glucose control, in diabetes patients, 345Glucose infusion, in diabetic patients, 347Glucose metabolism, effect of insulin therapy
on, 345g-Glutamyltransferase, as biliary tract function
indicator, 302Glycopyrrolateas chronic obstructive pulmonary disease
treatment, 281tas preoperative sedation, 119t
side effects of, 120tuse in awake intubation, 64tuse in morbidly obese patients, 122
Glycosides, cardiac, as pulmonary hypertensiontreatment, 296–297
Goiter, 353Gold salts, as asthma treatment, 269
Goodpasture’s syndrome, 364Graves’ disease, 352, 353Guillain-Barre syndrome, 331–332Gynecologic procedures, minimally-invasive, 511
H
Hagen-Poiseuille relationship, 18
Half-time, context-sensitive, 86, 87fHaloflurane, physical properties of, 76tHaloperidol, as chronic pain treatment, 536tHalothaneas cardiac arrhythmia cause, 79as hypercyanotic spell cause, 407–408
somatosensory-evoked potential effectsof, 502t
Hand, blood supply to, 195Headachescontrast media-related, 441tpheochromocytoma-related, 15–16postdural puncture, 452, 453, 461, 465
Head and neck, examination of, 59–60Head positioning, during endotracheal intubation,
62f, 148Healthcare workers, latex allergy in, 366, 367–368Heart, effect of hypothermia on, 218tHeart block
atrioventricular, 211second-degree, 210third-degree, 210–211
intraoperative treatment of, 15pulmonary artery catheterization-related, 189
Heart failure, 236–243. See also Congestive heartfailure
anesthetic induction in, 475decompensated, 126, 127, 240, 242–243definition of, 236diastolic, 115, 116obesity-related, 358refractory, end-stage, 241
right-sided, 279treatment for, 241–242
Heart-lung transplantation, 296–297Heart murmursdiastolic, 244heart failure-related, 240
during pregnancy, 411systolic, 244valvular heart disease-related, 244
Heart rateeffect of blood loss on, 374tepidural anesthesia-related decrease in, 462fetal, monitoring of, 416, 416f
in pediatric patients, 394during pregnancy, 411ttherapeutic reduction in, 212
INDEX 555
Heart sounds, during pregnancy, 411Heart transplantation, 241, 473–479cardiopulmonary bypass in, 476–477as retransplantation, 473
Heat exhaustion, 220Heat intolerance, hyperthyroidism-related, 353Heat loss. See also Hypothermiain the operating room, 218, 219, 220
Heat stroke, 220Heliox, as asthma-related bronchospasm
treatment, 272
Heliumas laparoscopic insufflation gas, 512tuse in stridorous patients, 18
HELLP syndrome, 427Hematocritas blood transfusion indicator, 50
in chronic obstructive pulmonary disease, 279preoperativemeasurement of, 124, 125tminimum acceptable, 124
Hematologic systemcirrhosis-related disorders of, 302effect of burns on, 383
effect of hypothermia on, 218tpregnancy-related changes in, 411–412, 411t, 412t
Hematomacervical, 354epidural, 318t, 461reabsorption of, 304t
Hemodialysis, 316Hemodilutioncardiopulmonary bypass-related, 490isovolemic, 503normovolemic, 43
Hemodynamicseffect of patient positioning on, 513
of heart transplant recipients, 475laparoscopy-related changes in, 513, 514t, 515postanesthesia, 223
Hemofiltration, during cardiopulmonary bypass, 476Hemoglobinas blood transfusion indicator, 43, 44, 50, 126
pregnancy-related decrease in, 412tpreoperative measurement of, 124, 125t
Hemoglobin saturationarterial, 169functional compared with fractional, 173
Hemoglobin solutions, 49–50
Hemolysis, as unconjugated bilirubin cause, 304tHemolytic transfusion reactions, 44, 45, 45t, 47Hemorrhageantepartum, 429gastrointestinal, 300, 382in heart transplant recipients, 476–477intracerebral, as intracranial pressure increase
cause, 318tintraventricular, in premature infants, 388tpulmonary, 189
Hemorrhage (Continued)risk assessment for, 51, 54subarachnoid, 505, 508, 509spontaneous, 262–263
warfarin-related, 127Hemostasis, 51Hemothorax, 185, 186, 189Henderson-Hasselbalch equation, 28Heparinallergic reactions to, 365anticoagulant activity of, 54
low-molecular-weight, 455perioperative administration of, 127reversal of, 490unfractionated, 454–455use in arterial transducer systems, 199
Hepatic function. See Liver function
Hepatitisas hepatocellular injury cause, 305tviral, as liver disease risk factor, 304t
Hepatobiliary system, effect of alcohol on, 337Hepatocellular injury, 304, 305tassessment of, 302
Hepatopulmonary syndrome, 301, 482
Hepatorenal syndrome, 301Herbal supplements, 369–372Herniacongenital diaphragmatic, 390hiatal, 358–359
Herniated disks, as radiculopathy cause, 538–539
Hetastarch (hydroxyethyl starch), 35, 36tHip, dislocation of, 143Histamine, opioids-related release of, 84Histamine receptor antagonistsas allergic reaction prophylaxis, 367preoperative administration of, 120–121in morbidly obese patients, 122
use in chronic obstructive pulmonary diseasepatients, 284
Hoarseness. See also Stridorhypothyroidism-related, 380
Human immunodeficiency virus (HIV) infectionblood transfusion-related transmission of, 44
as pulmonary hypertension risk factor, 293Hunt-Hess classification, of post-subarachnoid
hemorrhage neurologic status, 262–263Hydralazine, 115, 204tHydrocephalus, as intracranial pressure increase
cause, 318t
Hydrocodone, 83tequianalgesic doses of, 532t
Hydromorphone, 83tas acute pain treatment, 528–529, 530duration of action of, 85, 86tequianalgesic doses of, 532tonset of action of, 85, 86t
peak effect of, 85, 86tas seizure risk factor, 86
Hydroxyethyl starch (Hetastarch), 35, 36t
556 INDEX
Hyperbilirubinemiaconjugated, 303, 304unconjugated, 303, 304, 304t
Hypercalcemia, electrocardiographic findings in,
165–166, 165fHypercapniacerebrovascular disease-related, 260minute ventilation during, 22
Hypercarbiacauses of, 22–23effect on pulmonary arterial pressure, 296
maternal, effect on uteroplacental perfusion, 415signs and symptoms of, 23
Hyperchloremia, 42Hypercoagulable states, during pregnancy,
411–412, 418Hypercyanotic spells, 407–408, 407t
Hyperglycemiablood glucose reduction in, 347complications of, 345in diabetic patients, 345effect on intracranial pressure, 320–321
Hyperkalemia, 40–41acidemia-related, 27
electrocardiographic findings in, 163, 163fin liver transplantation patients, 482, 484succinylcholine-related, 97
Hyperlipidemia, fish oil treatment of, 370Hypernatremia, 39, 40tHyperperfusion, cerebral, carotid endarterectomy-
related, 262Hypertensionalcohol abuse-related, 336antihypertensive agent treatment of, 201, 202,
202t, 203carotid endarterectomy-related, 262causes of, 201
as cerebrovascular ischemic event risk factor, 260definition and classification of, 201diabetes-related, 343diastolic, 201electroconvulsive therapy-related, 522–523, 524ephedra-related, 369–370
general anesthesia use in, 204intraoperative, 203, 203tmalignant, 201as intracranial pressure increase cause, 318t
obesity-related, 358pheochromocytoma-related, 15–16
physiologic processes in, 201postoperative, 203, 226pregnancy-associated, 426, 426t, 427, 428, 428t,
430, 431prevalence and significance of, 201pulmonary, 293–299cirrhosis-related, 482
congenital heart disease-related, 404as crisis, 405definition of, 293
Hypertension (Continued)effect on perioperative risk, 405intraoperative management of, 296portal, 301–302, 482
treatment of, 295, 405tregional anesthesia use in, 203systemic, 201untreated, 202
Hyperthermia, 220, 221definition of, 220intraoperative treatment of, 221
malignant, 97, 221, 324–326, 329bcomparison with neuroleptic malignant
syndrome, 326relationship to muscular dystrophy, 327
Hyperthyroidism, 353–354diagnosis of, 351t
Hyperventilationacidemia-related, 27effect on intracranial pressure, 320
Hypervolemiacentral venous pressure in, 185fsplanchnic, cirrhosis-related, 484
Hypnotic agents. See also
use in craniotomy patients, 507Hypocalcemia, 41–42, 357alkalemia-related, 28electrocardiographic findings in, 165, 165fin liver transplantation patients, 484renal failure-related, 311
Hypocapniacerebrovascular disease-related, 260
Hypocarbiaeffect on somatosensory-evoked potentials, 503maternal, effect on uteroplacental perfusion, 415
Hypoglycemic agents, oral, 344Hypokalemia, 39, 40
alkalemia-related, 28electrocardiographic findings in, 163–164, 164fin liver transplantation patients, 482
Hypomagnesemia, 41, 42alkalemia-related, 28
Hyponatremia, 38–39, 38t
in liver transplantation patients, 482, 484Hypoparathyroidism, functional, 357Hypophosphatemia, alkalemia-related, 28Hypoplastic left heart syndrome, 408, 409fHypotensionanaphylaxis-related, 364
aortic unclamping-related, 255as blood transfusion indicator, 43carotid endarterectomy-related, 262effect on somatosensory-evoked potentials, 503effect on uteroplacental perfusion, 415epidural anesthesia-related, 461hypocalcemia-related, 41
hypomagnesemia, 41hypovolemia-related, 33in infants, 389t
INDEX 557
Hypotension (Continued)in liver transplantation patients, 484, 485orthostatic, postoperative, 9patient positioning-related, 145
peri-induction, 9perioperative, 204–206joint cement-related, 204–205
postoperative, 226spinal anesthesia-related, 415, 452thyrotoxicosis-related, 354in unconscious patients, 373
Hypothalamic-pituitary-adrenal axis, 354glucocorticoid-related disruption of, 355
Hypothermia, 217, 219–220, 220bduring cardiopulmonary bypass, 476definition of, 217–218effect on drug action and metabolism, 220
effect on organ systems, 218tin geriatric patients, 434hypothyroidism-related, 380in infants, 389, 389tas intraoperative brain protection, 506levels of, 487massive blood transfusion-related, 49
in pulmonary hypertension patients, 296rewarming treatment of, 220stages of, 217–218in trauma patients, 375, 378use in cardiopulmonary bypass, 487
Hypothyroidism, 245, 352, 353
electrocardiographic findings in, 162as hyponatremia cause, 38tprimary, diagnosis of, 351tsecondary, diagnosis of, 351t
Hypoventilationcontrolled, with permissive hypercapnia, 153–154as hypercarbia cause, 22
as hypoxemia cause, 20opioids-related, 224postanesthesia, 223
Hypovolemiablood pressure as indicator of, 37in burned patients, 385
in burn patients, 381central venous pressure in, 185fdiagnosis of, 37hypernatremia-related, 39in pediatric patients, 400as perioperative hypotension cause, 204
renal function in, 314Hypoxemiaacute lung injury-related, 285talveolar-arterial oxygen gradient incauses of, 19–20, 20bas hepatocellular injury cause, 305tpartial pressure of carbon dioxide oxygen in arterial
blood inpartial pressure of oxygen in arterial blood inas respiratory alkalosis cause, 26
Hypoxiadiffusion, 77–78effect on pulmonary arterial pressure, 296effect on somatosensory-evoked potentials, 503
in infants, 389tmaternal, effect on uteroplacental perfusion, 415minute ventilation during, 22in obese patients, 360during one-lung ventilation, 498postoperative management of, 225
I
Ibuprofen, as pain treatment, 536tIleus, 382Immune-complex formation, 364Immune systemeffect of blood transfusions on, 46
effect of burns on, 383Implantable drug delivery systems, 539Induction, of anesthesiain chronic obstructive pulmonary disease
patients, 282in end-stage liver disease patients, 482–483in heart failure patients, 475, 477
in pediatric patients, 395–396, 397preoxygenation before, 67rapid-sequence, 65–67in pediatric patients, 396in trauma patients, 374
speed of, factors affecting, 77, 78
steal, in pediatric patients, 396use inpediatric patients, 396trauma patients, 374
Induction agents. See also specific induction agentsfor asthmatic patients, 270for burned patients, 385–386
intravenous, 90for liver disease patients, 306respiratory effects of, 91somatosensory-evoked potential effects of, 502tfor trauma patients, 375
Infants. See also Neonates
airway of, 394tcardiovascular system of, 394estimated blood volume in, 400tintraoperative problems in, 389, 389tintubation in, 402perioperative fluid management in, 399
prematureanesthetic risk in, 387common health problems in, 388, 388tpostoperative apnea in, 392–393retinopathy in, 388, 388t
Infectionsin burned patients, 385
central venous catheterization-related,185, 186
pulmonary artery catheterization-related, 189
558 INDEX
Infectious disease, blood transfusion-relatedtransmission of, 44
Inflammatory bowel disease, 304tInfluenza, avian, 44
Informed consent, 123Inhalational anesthetics, 75–81. See also specific
inhalational anestheticsbiotransformation of, 79–80cardiovascular effects of, 79, 80tcerebral blood flow effects of, 321cerebral perfusion and metabolic rate effects
of, 261chemical structures of, 75, 75fcirculatory effects of, 80tflammability of, 75hepatic blood flow effects of, 305–306ideal, 75
interaction withcarbon dioxide absorbents, 139neuromuscular blocking agents, 99
physical properties of, 76tpotencies of, 75pulmonary circulation effects of, 296–297renal function effects of, 314
side effects/toxicity of, 75, 79–80liver dysfunction, 304–305respiratory depression, 224teratogenicity, 81
for single-lung ventilation, 498somatosensory-evoked potential effects of,
502t, 503use inalcoholic or alcohol-intoxicated patients, 337burned patients, 382cardiopulmonary bypass patients, 488craniotomy patients, 507muscular dystrophy patients, 327
neonates, 387pediatric patients, 396
ventilatory effects of, 78–79Inhalation injury, 381of burned patients, 385
Inotropes, 112–117as right ventricular failure treatment, 296
Inspiration, muscles responsible for, 17Insufflationcomplications of, 516–517gases for, 512, 512t
Insulin infusion, 347
Insulin pumps, subcutaneous, 347–348Insulin resistance, acidemia-related, 27Insulin therapy, 344, 345, 348teffect on glucose metabolism, 345intraoperative, 346–347
Intensive care units (ICUs)aortic surgery patients in, 257
ventilator use in, 139, 150"fighting the,", 155trigger variables in, 151
Intercostal muscles, respiratory function of, 17Intercostal nerve blocks, 107, 471, 533International Association for the Study of Pain, 535International normalized ratio (INR), 55, 302
Interscalene nerve blocks, 469tIntestines, epidural anesthesia-related contraction
of, 462Intra-abdominal pressurecarbon dioxide insufflation-related increase in, 513effect of patient positioning on, 142effect on organ perfusion, 514–515
in obesity, 358–359safe increase in, 513–514
Intraclavicular nerve blocks, 469tIntracranial disease, 259–266Intracranial elastance, 318, 318f, 319Intracranial pressure, elevated
succinylcholine-related, 97Trendelenburg position-related, 144
Intracranial pressure (ICP)during anesthesia, 319, 320–321determinants of, 317elevated, 317–323in craniotomy patients, 508, 509–510
definition of, 317electroconvulsive therapy-related, 522–523positive-end expiratory pressure-related, 153symptoms and consequences of, 317–318
Intracranial surgery, anesthesia for, 505–510Intragastric pressure, in obesity, 358–359
Intrathecal delivery. See also Spinal anesthesiaof drugs, 539
Intravenous access, in obese patients, 360Intravenous analgesia, use during labor and
delivery, 419, 419tIntravenous anestheticsideal, 90
loading dose of, in obese patients, 359, 359tuse in pulmonary hypertension patients, 297
Intravenous drug abuse, as valvular heart diseasecause, 244
Intravenous induction agents, use in pediatricpatients, 396, 397
Intraventricular conduction delays, 158Intubation. See also Endotracheal intubationaccidental esophageal, 176in asthmatic patients, 271
Iodide, in thyroid hormone synthesis, 351Iodine, radioactive, as hyperthyroidism
treatment, 353Ipratropium, 281tIschemiacardiacas hypotension cause, 205–206myocardial. See Myocardial ischemia
cerebral, 260
global compared with focal, 259end-organ, cyanotic heart disease-related, 406as hepatocellular injury cause, 305t
INDEX 559
Ischemia (Continued)radial artery thrombosis-related, 195–196subendocardial, 408
Ischemic heart disease, 229–235preoperative risk assessment of, 128
Isofluranechemical structure of, 10, 75fas hypercyanotic spell cause, 407–408metabolic products of, 79–80physical properties of, 76tsomatosensory-evoked potential effects of, 502t
Isoproterenol, hemodynamic profiles of, 113–114
J
Jaundice, definition of, 241–242"Jaws of steel." See Masseter muscle rigidity (MMR)Jet ventilation, in laser surgery of the airway, 519Joint cement, as hypotension cause, 204–205Jugular veinsas central venous catheter insertion site, 181
distention ofchronic obstructive pulmonary disease-related,
279heart failure-related, 240pulmonary hypertension-related, 294valvular heart disease-related, 244
K
Kava, 369, 370
Kernicterus, in neonates, 387–388Ketaminecardiovascular effects of, 90contraindication in brain tumor patients, 93contraindication to, 234, 320, 322effect on pulmonary vascular resistance, 406as induction agent, 91t
as preoperative sedation, 91t, 119tside effects of, 92somatosensory-evoked potential effects of, 502tuse inburned patients, 382electroconvulsive therapy, 524
pediatric patients, 396, 396tKetorolac, as acute pain treatment, 533Kidneyin acid-base balance regulation, 26anatomy of, 308–309effect of hypothermia on, 218tfunctions of, 309
intraoperative protection for, 314Korsakoff’s psychosis, 336
L
Labetalol, perioperative use of, 204tLabor and deliveryanalgesia use during, 419, 419tepidural analgesia use during, 420epidural anesthesia use during, 419t, 422–423
local anesthetics use during, 420–421pain associated with, 414physiologic changes during, 414
Labor and delivery (Continued)preterm, 429stages of, 414–415
Laboratory testing, preoperative, 124, 125t, 126
of asthmatic patients, 268of burned patients, 385of diabetic patients, 346of geriatric patients, 434of obese patients, 360
Lambert-Eaton myasthenic syndrome, 329–330Laminar gas flow, 18, 22
Laminectomy, pain associated with, 539Laparoscopic surgery, 511–517contraindications to, 511–512in obese patients, 360
Laplace’s law, 18, 237Laryngeal mask airway (LMAs), 63, 66f, 399, 399t, 403
Laryngoscopes, 58, 61Laryngoscopy, difficulties in, 58, 59Laryngospasm, 225in pediatric patients, 402
Larynxanatomy of, 60blood supply and innervation of, 60
visualization of, 61Lasers, definition of, 518Laser surgery, 518–521Lateral decubitus position, 143f, 144, 498Lateral femoral cutaneous nerve, patient
positioning-related injury to, 144
Latexdefinition of, 365occupational exposure to, 367–368
Latex allergy, 365, 366, 367–368"Lawnchair-recumbent" position, 143fLeft atrial pressure (LAP), measurement of, 192, 193Left ventricle, cardiopulmonary bypass-related
distention of, 489Left ventricular dysfunctionafter cardiopulmonary bypass, 477heart failure-related, 237
Left ventricular ejection fraction, in heart failure,238–239, 240, 241
Left ventricular end-diastolic pressure (LVEDP)in aortic insufficiency, 249in aortic stenosis, 246, 246f, 247measurement of, 192
Left ventricular end-diastolic volume (LVEDV),measurement of, 192
Left ventricular hypertrophydefinition of, 244electrocardiographic findings in, 157heart failure-related, 240hypertension-related, 201
Left-ventricular pressure-volume loops, 239fLeft ventricular systolic dysfunction, 250–251
Left ventricular vents, 489Left ventricular volume, in heart failure, 238–239, 239fLeft ventricular volume overload, 247–248, 247f
560 INDEX
Leukotriene inhibitors, as asthma treatment, 269Levobupivacaine, 110, 451tLevodopa, 332Levorphanol, equianalgesic doses of, 532t
Levosimendan, 115, 117Levothyroxine, 352–353Lidocaineas epidural anesthetic, 462t, 464maximum safe doses of, 107tpotency of, 107tas spinal anesthesia, 451t
as transient neurologic syndrome cause, 456use inawake intubation, 64tcesarean sections, 423tobstetric patients, 420, 421
Lipid infusion, as local anesthesia toxicity treatment,
110Lita-Tube, 272Lithium, interaction with neuromuscular blocking
agents, 99Lithotomy position, 142–143, 143f, 144Liverin acid-base balance regulation, 27
as alcohol metabolism site, 336anatomy and function of, 300effect of hypothermia on, 218tpregnancy-related changes in, 413
Liver disease. See also Cirrhosischolestatic, 302
end-stageanesthesia induction in, 482–483cardiovascular physiology in, 480differentiated from hepatorenal syndrome, 301as indicator for liver transplantation, 480, 481t
intraoperative management of, 306parenchymal, 300
preoperative management of, 306risk assessment for, 303, 304t
Liver functionaging-related changes in, 433in burned patients, 382in neonates, 387–388
perioperative, 300–307Liver function testing, 302for cholestatic liver disease diagnosis, 302for congestive heart failure assessment, 241for hepatic cell damage assessment, 302preoperative, 302–303
Liver transplantation, 480–486contraindications to, 480, 481tindications for, 480, 481t
Liver transplant patients, coronary artery disease in,480
Lobectomy, morbidity and mortality associated with,280–281, 280t
Local anesthetics, 105–111action mechanism of, 106, 106fallergic reactions to, 106, 365
Local anesthetics (Continued)for ambulatory procedures, 456classification off, 105, 109coadministration with opioids, 88
duration of action of, 107, 109for epidural anesthesia, 462, 462t, 464interaction with neuromuscular blocking agents, 99intravascular injections of, 461for laparoscopic procedures, 515maximum safe doses of, 107, 107tmetabolism of, 105
new, 110–111onset time of, 107, 109potency of, 106, 107t, 109spinal, 451–457systemic vascular absorption of, 108toxicity of, 108–109
in Bier blocks, 468–469cardiotoxicity, 108–109lipid infusion treatment of, 110neurotoxicity, 109, 333
use inanticoagulated patients, 454obstetric patients, 420–421
Long QT syndrome, congenital, 214Lorazepam, 93, 536tLou Gehrig’s disease, 331Low back pain, 538Lumbar epidural anesthesia, 460Lumbar plexus blocks, 470t
Lumbar spinal anesthesia, 533Lung. See also Pulmonary function; Pulmonary
function testingin acid-base balance regulation, 26acute injury to, 285, 285tblood transfusion-related injury to, 45, 45t,
46, 47
elastic recoil of, 17pulmonary artery catheter positioning in, 193zones of West in, 19
Lung capacity, 68, 69ftotal, 70fin obstructive and restrictive lung
diseases, 70fduring pregnancy, 412t
Lung diseaseacute, 289trestrictive, obesity-related, 362
Lung isolation techniques, 378, 493–499bronchial blockade, 493, 495, 496–497, 497tdouble-lumen endotracheal tubes, 493, 494,
494t, 495, 496, 497, 497tLung recruitment maneuver, 290, 291tLung resection surgery, 280–281, 280t, 283Lung scans, for pulmonary hypertension evaluation,
295
Lung transplantation, as pulmonary hypertensiontreatment, 296–297
Lung volume, 68, 69f
INDEX 561
M
Magnesium, interaction with neuromuscular blockingagents, 99
Magnesium sulfate
as asthma-related bronchospasm treatment, 272complications of, 428as preeclampsia treatment, 427, 428
Magnetic resonance imaging (MRI) suites, 442,443–444
Maintenance anesthesiain asthmatic patients, 270–271
in chronic obstructive pulmonary disease patients,282
in heart transplant patients, 475–476, 477intracranial pressure management during, 320
Malaria, 44Mallampati classification, of the oropharynx,
59, 59fMarfan syndrome, 244, 247–248Mask ventilation, difficult, 64Masseter muscle rigidity (MMR), 325–326in pediatric patients, 402
Maximal inspiratory force, in obese patients, 361tMaximal oxygen consumption during exercise (VO2)
implication for blood transfusion, 43peak, in heart transplantation patients, 474
McGill Pain Questionnaire, 527Mean arterial pressure (MAP), 318effect of induction agents on, 90, 91tduring pregnancy, 411t
Mechanical ventilation. See also Ventilatorsin acute respiratory distress syndrome patients,
288, 290in acute respiratory failure patients, 151, 152,
154, 154–155in asthmatic patients, 271compliance in, 154
in critically-ill patients, 149–156in hypothermic patients, 220indications for, 149, 155peak pressure in, 154positive-pressure, 149, 155. See also Positive
end-expiratory pressure (PEEP)
effect on pulmonary artery occlusion pressure,191–192
as perioperative hypotension cause, 204postoperative, 284pressure-control, 150–151pressure-control continuous mandatory
(PC-CMV), 149pressure-support, 150–151split-lung, 156static pressure in, 154volume control-assist control, 149, 150volume control-synchronized intermittent
mandatory, 149, 150
volume control versus pressure control, 149Median nerve, as somatosensory-evoked potential
stimulation site, 500, 501t
Mediastinal mass, anterior, flow-volume loops in,71–72
MELD (Model for End-stage Liver Disease), 302–303,480
Memory, classification of, 207Memory deficits, cardiopulmonary bypass-related, 491Memory loss, 370Meningocele, as latex allergy risk factor, 366Mental status. See also Cognitive dysfunction;
Confusion; Delirium; Memory losseffect of blood loss on, 374t
Meperidine, 83tcharacteristics of, 88as chronic pain treatment, 536tequianalgesic doses of, 532tas preoperative analgesia, 119tside effects of, 85, 530
allergic reactions, 365, 530seizures, 86
somatosensory-evoked potential effects of, 502tuse inliver disease patients, 307obstetric patients, 419t, 422t
Mepivacaine, potency of, 107t
Metabolic disordersacid-base analysis of, 29as liver disease risk factor, 304tmassive blood transfusion-related, 48
Metabolic ratecerebral, 261
in hyperthyroidism, 353Metabolism, effect of hypothermia on, 218tMetaproterenol, 281tMethadone, 83tadverse effects of, 87, 339as chronic pain treatment, 536tequianalgesic doses of, 532t
Methamphetamine, crystal, 341Methemoglobin, effect on pulse oximetry accuracy,
172Methemoglobinemia, 110Methohexital, 524, 525Methotrexate, as asthma treatment, 269
Methylene blue, effect on pulse oximetry accuracy,172
3,4-Methylenedioxymethamphetamine, 341Methylmethacrylate, as hypotension cause, 204–205Methylnaltrexone, 84–85Methylprednisolone
as chronic obstructive pulmonary diseasetreatment, 281t
potency of, 355tO-Methyltransferase (COMT), 12Methylxanthines, as chronic obstructive pulmonary
disease treatment, 281tMetoclopramide
contraindication in Parkinson’s disease, 332preoperative administration of, 119t, 274–275
in morbidly obese patients, 122
562 INDEX
Metocurine, use in renal insufficiency patients, 315tMetoprolol, contraindication to, 211Mexiletine, as chronic pain treatment, 536tMidazolam
cardiovascular effects of, 90intravenous administration of, 93, 94loading dose of, 359tas preoperative sedation, 119tsomatosensory-evoked potential effects of, 502tuse as induction agent, 91tuse as sedative, 91t
use in awake intubation, 64tuse in cardiopulmonary bypass patients, 488use in pediatric patients, 395, 396t, 402
Milrinone, hemodynamic profile of, 112Mineralocorticoids, 355tMinimal alveolar concentration (MAC)
as anesthetic gas potency measure, 9, 75,76, 78
hypernatremia-related increase in, 39in hyperthyroidism, 353–354in hypothyroidism, 352in pediatric patients, 399
Minimally-invasive surgery, 511–517Minute ventilationduring hypercapnia and hypoxia, 22during hyperthermia, 220during pregnancy, 412t
Mitral regurgitation, 250–253, 251t, 252fMitral stenosis, 249–250, 249t, 252
as heart failure cause, 236tMitral valve replacement, 249–250, 251, 253Mivarcurium, 98tMixed venous oxygen saturation (SvO2),
measurement of, 188Model for End-stage Liver Disease (MELD), 302–303,
480
Monetlukast, 281tMonitoringAmerican Society of Anesthesiologists’ standards
for, 438of aortic surgery patients, 255, 257–258of burned patients, 385
during carotid endarterectomy, 261of craniotomy patients, 505–506during electroconvulsive therapy, 523–524of fetal heart rate, 416, 416fof glucose levels, 349of heart failure patients, 237
of heart transplantation patients, 476of intraoperative ischemia, 234in magnetic resonance imaging suites, 443of neonates, 389of obese patients, 360of patients receiving analgesia, 532in postanesthetic care units, 222
of pregnant patients, 428of pulmonary hypertension patients, 296of valvular heart disease patients, 245
Monoamine oxidase, 12Monoamine oxidase inhibitors, as hyperthermia
risk factor, 221Morbidity, perioperative, 280–281, 280t
Morphine, 83tas acute pain treatment, 528–529, 533allergic reactions to, 365as chronic pain treatment, 536tdifferentiated from opioid agonist-antagonists, 531duration of action of, 85, 86tequianalgesic doses of, 532t
intrathecal administration of, 455onset of action of, 85, 86tpeak effect of, 85, 86tas preoperative analgesia, 119tside effects of, 85somatosensory-evoked potential effects of, 502t
use in liver disease patients, 307use in obstetric patients, 422tin cesarean sections, 423t
use in renal failure patients, 86Morphine-3-glucuronide, 86Morphine-6-glucuronide, 86, 530Mortality, perioperative, 280–281, 280t
in geriatric patients, 435–436Motor-evoked potentials, 255Multiple sclerosis, 333, 334Muscarcinic antagonists, properties of, 15Muscle relaxants. See Neuromuscular blocking agentsMuscular dystrophies, 157, 327
myotonic, 327, 328Myasthenia gravis, 328–329Myelomeningocele, as latex allergy risk
factor, 366Myocardial hypertrophy, 238Myocardial infarctionelective surgery following, 234
electrocardiographic findings in, 159–160, 160f,161, 161f, 162, 162f
perioperative, 230posterior, 157prior, 231recent, 231
surgery-related reinfarction of, 234Myocardial ischemiaas blood transfusion indicator, 43clinical manifestations of, 230intraoperative detection of, 234perioperative, 231
Myocardial oxygen delivery, determinants of, 230Myocardial oxygen demand, determinants of,
229, 230Myocardial protection, during cardiopulmonary
bypass, 489, 491Myocardium, contusions of, 377–378Myocytes, cardiac, 113
Myofascial pain syndrome, 538Myoglobinuria, 382, 386Myotonic dystrophy, 327, 328
INDEX 563
N
Nalbuphineequianalgesic doses of, 532tuse in obstetric patients, 419t
Naloxone, 82–83, 85Narcotics. See also Opioidsdefinition of, 82
Nasal airways, 61Nasal discharge, in pediatric patients, 128–129Nasogastric intubation, in liver transplantation
patients, 483
Natriuretic peptide, b-type, 116Natural frequency, 197Nauseaheart failure-related, 240opioids-related, 84postoperative, 223, 227
contrast media-related, 441tin pediatric patients, 401spinal anesthesia-related, 452
Neck, examination of, 59–60Neonates, 404–410anesthetic risk in, 387Apgar Score evaluation of, 417, 417t
cardiovascular system of, 394estimated blood volume in, 400tmedical emergencies in, 390
Neostigmine, 102, 282Nephrectomy, donor, minimally-invasive, 513Nephropathies, salt-wasting, 38t
Nephrotic syndrome, 38tNerve blocks. See also Peripheral nerve blocks;
types of specific nerve blocksas chronic pain treatment, 537local anesthetic vascular absorption in, 107use in awake intubation, 64
Nerve injuries
patient positioning-related, 144pulmonary artery catheterization-related, 189spinal anesthesia-related, 454
Nerve stimulation, for neuromuscular blockadeassessment, 99, 100, 101
acceleromyography, 101
adequate, for surgical purposes, 101double-burst, 100in obese patients, 361patterns of, 99, 101simplest mode of, 99tetanic, 100, 101
train-of-four method, 99, 100, 101Nerve stimulators, characteristics of, 99Nervous system. See also Autonomic nervous system;
Central nervous system; Parasympatheticnervous system
aging-related changes to, 433Neurohumeral system, in heart failure, 239
Neuroleptic malignant syndrome, 326Neuroleptics, as chronic pain treatment, 536t
Neurologic diseases/disordersalcohol abuse-related, 336cardiopulmonary bypass-related, 491degenerative, 331–335
Neuromuscular blockadein chronic obstructive pulmonary disease patients,
282for facilitation of mechanical ventilation, 155–156nerve stimulation assessment of, 99, 100, 101acceleromyography, 101adequate, for surgical purposes, 101
as basis for neuromuscular blockade reversal,102
double-burst, 100, 103tpatterns of, 99, 101simplest mode of, 99single twitch, 99, 101f, 103t
tetanic, 100, 101, 101f, 103ttrain-of-four method, 99, 100, 101, 101f, 103t
residual, 223reversal of, 102–103, 103tin chronic obstructive pulmonary disease
patients, 282in obese patients, 361
Neuromuscular blocking agents, 96. See also namesof specific neuromuscular blocking agents
action potentiation of, 99allergic reactions to, 364–365benefits and risks of, 96as chronic pain treatment, 536t
drug interactions of, 99effect on intracranial pressure, 321as hypertension treatment, 202tnondepolarzing, 96, 98–99, 98t, 103somatosensory-evoked potential effects of, 502tuse inalcoholic patients, 337
burned patients, 385cardiopulmonary bypass patients, 488craniotomy patients, 507hypothermic patients, 220mechanically-ventilated patients, 155–156multiple sclerosis patients, 334
muscular dystrophy patients, 327myasthenia gravis patients, 328–329myotonic dystrophy patients, 328renal insufficiency patients, 315, 315t
Neuromuscular disorders, as respiratory acidosiscause, 26
Neuromuscular junction, anatomy of, 95, 95fNeuromuscular transmission, 96Neuropathic pain, 529, 535, 537–538Neuropathies, 331–335autonomicdiabetic, 345–346as perioperative hypotension cause, 204
patient positioning-related, 142–143, 146–147perianesthetic, 146
564 INDEX
Neuropathies (Continued)peripheral, in cardiac surgery patients, 146upper-extremity, 146–147
Neurosurgery
minimally-invasive, 511somatosensory-evoked potential monitoring during,
502Neurotoxicity, of local anesthetics, 109Neurotransmission, 105Nicardipine, 115Nitrates
action mechanisms and action sites of, 114antianginal effects of, 114–115
Nitric oxidepotentiation of, 299properties of, 297–298pulmonary hypertension-related decrease in, 293
as pulmonary hypertension treatment, 298side effects of, 478use in heart transplantation patients, 478
Nitroglycerinaction mechanisms and action sites of, 114perioperative use of, 204tprophylactic intraoperative infusion of, 233
as tachyphylaxis cause, 115Nitrous oxidechemical structure of, 75fcontraindications toelevated intracranial, 322pneumothorax, 78
effect on pulmonary circulation, 296–297as laparoscopic insufflation gas, 512tphysical properties of, 76tsecond gas effect of, 77–78somatosensory-evoked potential effects of, 502tteratogenicity of, 81toxicity of, 78, 81
use in anesthesia machines, 130, 131use in laparoscopy, 515
Nitrous oxide tanks, for anesthesia machines, 131Nitrovasodilators. See also Nitrates; Nitroglycerin;
Sodium nitroprusside; Vasodilatorsaction mechanisms and action sites of, 114
as pulmonary hypertension treatment, 297as tachyphylaxis cause, 115
Nociceptive pain, 535Nociceptors, 535Nonsteroidal anti-inflammatory drugs (NSAIDs)as acute pain treatment, 528–529, 533
as chronic pain treatment, 536t, 537complications of, 533cost of, 533
Norepinephrine, 11as allergic reaction treatment, 367hemodynamic profiles of, 113interaction with indirect-acting sympathomimetics, 9
laparoscopy-related increase in, 515metabolism of, 12synthesis of, 11–12
Nortriptyline, as chronic pain treatment, 536tNovoSeven, 565’-Nucleotidase, as biliary tract function indicator,
302
Nutritional deficiencies, alcohol abuse-related, 337
O
Obesity, 358–363as aorto-occlusive disease risk factor, 254definition of, 358, 358tmorbid
as aspiration risk factor, 512definition of, 358timplication for preoperative management, 122
physiologic and systemic disorders associatedwith, 358–359, 362
Obesity-hypoventilation syndromes.
See also Obstructive sleep apneaas respiratory acidosis cause, 26
Obstetric anesthesia. See PregnancyObstructive sleep apnea, 361–362in pediatric patients, 403as postoperative pulmonary complication risk
factor, 125t
Obturator nerve, patient positioning-related injuryto, 144
Occupational exposure, as chronic obstructivepulmonary disease cause, 278
Omega-3 fatty acids, 370Omeprazole, 119t
Omphalocele, 390, 391–392differentiated from gastroschisis, 391
Operating roompatient transport from, 222presence of pediatric patients’ parents in, 395–396
Opiates, definition of, 82Opioid abuse, 82, 338–339
Opioid agonist-antagonists, 82, 531equianalgesic doses of, 532t
Opioid agonists, equianalgesic doses of, 532tOpioid receptors, 82, 84t, 88, 531Opioids, 82–89as acute pain treatment, 528–530
addiction risk with, 529administration routes for, 83, 529–530cardiovascular effects of, 90as chronic pain treatment, 536tin combination with epidural anesthetics, 463commonly used, 82, 83t
context-sensitive half-time of, 86, 87fdefinition of, 82dependence on, 82endogenous, 82epidural, 422use in obstetric patients, 423
equianalgesic doses of, 83t, 85, 532t
exogenous, 82intracranial pressure effects of, 320intravenous administration of, 532
INDEX 565
Opioids (Continued)neuraxial, 88, 531as postoperative pain treatment, 203, 205as premedication, 119
respiratory depressant effects of, 224as respiratory depression cause, 85, 86, 86fside effects of, 83, 84, 85, 119, 531somatosensory-evoked potential effects of, 502tspinal (intrathecal), 422, 455, 533, 539use in obstetric patients, 422t, 423t
tolerance to, 82, 338
use inburned patients, 382cardiopulmonary bypass patients, 488chronic obstructive pulmonary disease patients,
282craniotomy patients, 507
liver disease patients, 307morbidly obese patients, 122neonates, 387obstetric patients, 419pediatric patients, 399
Opioid withdrawal, 339Oral airways, 61
Oral cavity, physical examination of, 58, 59, 59fOral intake, in postanesthetic care unit patients, 227Organ donors, for heart transplantation, 474Oropharynx, Mallampati classification of, 59, 59fOrthopedic injuries, damage control treatment of,
375–376
Orthopedic proceduresminimally-invasive, 511somatosensory-evoked potential monitoring
during, 502Osmolality, of serum, 36Overweight, definition of, 358tOxycodone, 83t
as chronic pain treatment, 536tequianalgesic doses of, 532t
Oxygeneffect on breathing, 22as laparoscopic insufflation gas, 512tuse in anesthesia machines, 130–131, 132
Oxygenationarterial, blood gas assessment of, 24extracorporeal, 272methods for improvement of, 60monitoring standards for, 438
Oxygenators, types of, 488
Oxygen consumptionfactors affecting, 22hyperthermia-related increase in, 220in obesity, 358during pregnancy, 411t, 412t
Oxygen content, arterial and venous, 21, 22Oxygen delivery (DO2crit), critical level, 43
Oxygen saturationin arterial blood (SaO2)pulse oximetry measurement of, 168–174
Oxygen tanks, for anesthesia machines, 131,132–133
Oxygen therapydeleterious effects of, in chronic obstructive
pulmonary disease patients, 280effect on inspired oxygen concentration (FiO2),
224, 224tfor pulmonary hypertension, 296–297in single-ventricle patients, 408
Oxyhemoglobin dissociation curve, 170–171, 170f,171t
Oxyhemoglobin saturation, measurement of, 168Oxymorphone, 83t, 530equianalgesic doses of, 532t
P
Pacing, cardiac, postbypass, 490
Painacute, 527–534definition of, 527, 535differentiated from chronic pain, 527management of, 527–534undertreatment of, 527
assessment of, 527, 528f
cancer-related, 537chronicacute pain associated with, 530definition of, 535differentiated from acute pain, 527management of, 535–540
definition of, 535as fifth vital sign, 531gate theory of, 539perception of, 535postoperative, 223epidural anesthesia-related, 465as hypertension cause, 203
postlaminectomy, 539Pain scales, 527, 528fPalpitationsheart failure-related, 240pheochromocytoma-related, 15–16
Pancreatitis
as acute respiratory distress syndrome riskfactor, 287t
alcoholic, 337Pancuroniumas nondepolarizing neuromuscular blocking
agent, 98t
use in renal insufficiency patients, 315tParalytics. See Neuromuscular blocking agentsParasitic infections, blood transfusion-related
transmission of, 44Parasympathetic nervous system, anatomy and
function of, 9–10, 9t, 10f, 11Parathyroid hormone, 357
Parents, of pediatric patients, 395–396Paresthesia, spinal anesthesia-related sensitivity
to, 452
566 INDEX
Parkinson’s disease, 332Parkland formula, 383–384Paroxetine, as chronic pain treatment, 536tPartial pressure of carbon dioxide in arterial blood
(PaCO2), 24in chronic obstructive pulmonary disease, 279–280correlation with end-tidal carbon dioxide, 176effect of carbon dioxide insufflation on, 513
Partial pressure of carbon dioxide (PCO2), relationshipto alveolar ventilation, 22
in presence of opioids, 85, 86f
Partial pressure of oxygen in arterial blood (PaO2), 24Partial thromboplastin time (PTT), 54pregnancy-related decrease in, 412tpreoperative, 127
Partition coefficients, 76, 76tPatent ductus arteriosus, 388t, 408
Patient-controlled analgesia (PCA), 529, 530–531, 532use in obstetric patients, 419
Patient-controlled epidural anesthesia (PCEA), 421Patient foramen ovale, in craniotomy patients, 507Patient positioning, 142–148of craniotomy patients, 507of laparoscopy patients, 513
of obese patients, 360physiologic changes associated with, 142of pregnant patients, 146
Pavulon, as myopathy cause, 271Peak pressure, in mechanical ventilation, 154Pediatric patients, 394–403. See also Infants;
Neonatesburn injuries in, 380laparoscopy in, 516obese, 361bariatric surgery in, 362–363
obstructive sleep apnea in, 361preoperative medication in, 121
respiratory infections in, 128–129PEEP. See Positive end-expiratory pressure (PEEP)Pelvis, fractures of, 375–376Penicillin, allergic reactions to, 365Pentazocine, 82Pentoprazole, 119t
Percutaneous coronary interventions, 232–233prior to noncardiac surgery, 232
Perfusion. See also Cerebral perfusionin burn patients, 381effect of intra-abdominal pressure on, 514–515uteroplacental, factors affecting, 415
zones of West in, 19Perfusion lung scans, for pulmonary hypertension
evaluation, 295Peripheral nerve blocks, 466–472of the anterior abdominal wall, 471of the chest wall, 471lower-extremity, 469–470, 470t
onset of anesthesia in, 107risks of, 466upper-extremity, 467–469, 469t
Peripheral nerveslithotomy position-related injury to, 142–143localization of, 467somatosensory-evoked potentials of, 500–504
Peroneal nerve, patient positioning-related injuryto, 144
pH, 27Pharmacokinetics. See also Drug metabolism;
names of specific drugsin obese patients, 359
Pharmacology. See also Drug metabolism; names
of specific drugsof anesthetic drugs, in children, 399
Pharynx, Mallampati classification of, 59, 59fPhencyclidine (PCP), 341–342Phenothiazines, contraindication in Parkinson’s
disease, 332
Phenylephrinecoadministration with local anesthetics, 108effects and doses of, 14perioperative use of, 12–14use in awake intubation, 64t
Pheochromocytomadefinition of, 354
perioperative management of, 16symptoms and diagnosis of, 15–16
Phlebostatic axis, 190Phosphate, buffering function of, 26Phosphodiesterase inhibitors, 112, 113definition of, 299
as pulmonary hypertension treatment, 295pH-stat method, of blood gas analysis, 490Physical statusclassification scale for, 123–124of heart transplantation candidates, 475
"Pink puffers," 279Pipecuronium, 98t, 315t
Placentaanatomy of, 415transport of substances across, 415
Placental abruption, 429Placenta previa, 429Plasma proteins, pregnancy-related decrease in, 413
Plasma volume, pregnancy-related increase in, 412tPlastic surgery, minimally-invasive, 511Platelet abnormalities, 53cardiopulmonary bypass-related, 490
Platelet countduring pregnancy, 412t
preoperative, 53Pneumonectomy, morbidity and mortality associated
with, 280–281, 280tPneumonitis, aspiration, 120–121, 274Pneumoperitoneum, 514, 515, 516–517Pneumothoraxcentral venous catheterization-related, 185, 186
as contraindication to nitrous oxide, 78, 79fpulmonary artery catheterization-related, 189tension, 376, 378
INDEX 567
Poliomyelitis, 334Polycythemia, cyanotic heart disease-related, 406Polyneuropathy, critical illness, 334–335Poppy, as opioid source, 82
Porphyria, 91Portal vein, as hepatic blood supply source, 306Positive end-expiratory pressure (PEEP)auto (intrinsic), 152, 153, 153f, 155, 283optimal, 152role of, 152side effects of, 153
use inacute lung injury patients, 285–286, 285tacute respiratory distress syndrome patients,
285–286, 285tlung isolation, 497
Postanesthetic care, 222–228for aortic surgery patients, 257–258
Postanesthetic care units (PACUs), 222hypoxia management in, 225patient discharge from, 227–228patient selection for, 222
Postoperative nausea and vomiting (PONV),223, 227
contrast media-related, 441tin pediatric patients, 401spinal anesthesia-related, 452
Postpoliomyelitis syndrome, 334Posttraumatic stress disorder, intraoperative
awareness-related, 208
Potassium. See also Hypekalemia; Hypokalemiaas hypokalemia treatment, 40
Prayer sign, 346Prednisoneas chronic obstructive pulmonary disease
treatment, 281tpotency of, 355t
Preeclampsia, 426, 426t, 427, 428, 428t, 431Pregabalin, as chronic pain treatment, 536tPregnancy, 411–418, 419–425. See also Labor
and deliveryarterial blood gas values during, 413, 413tas aspiration risk factor, 511
cardiovascular changes during, 411, 411t, 418cardiovascular disease during, 430–431diabetes during, 343, 430hematologic changes during, 411–412, 412thigh-risk, 426–431laparoscopy during, 516
local anesthesia toxicity during, 108nonobstetric surgery during, 417–418obesity during, 361renal disease during, 430thyroid function testing during, 351tin trauma patients, 378
Pregnancy testing, preoperative, 125t
Pregnant patients, positioning of, 146Preloadeffect of vascular drugs on, 112
Preload (Continued)left ventricular, central venous pressure in, 185right ventricular, central venous pressure in, 184–185
Preoperative evaluation, 123–129of asthma patients, 268of burned patients, 384, 385of diabetic patients, 345of electroconvulsive therapy patients, 523of obese patients, 359–360prior to epidural anesthesia, 459–460
Preoperative management
of aortic surgery patients, 254–255of neonates, 389of reactive airway disease patients, 270
Preoperative medication, 118–122in pediatric patients, 121, 395, 396, 396t, 402somatosensory-evoked potential effects of, 502t
Pressure overload, in valvular heart disease, 244Pressure-volume loopsin aortic insufficiency, 248in aortic regurgitation, 247fin aortic stenosis, 246, 246fdefinition of, 245in mitral regurgitation, 251–252
in mitral stenosis, 250normal, 245, 245f
Prilocaine, 110Prion-mediated diseases, 44Procainemaximum safe doses of, 107t
potency of, 107tPromethazine, 119tProne position, 143f, 144–145mechanical ventilation in, 154–155
Propofolallergic reactions to, 364cardiovascular effects of, 90, 91t
contraindications to, 93effect on systemic and pulmonary vascular
resistance, 406loading dose of, 359tpulmonary effects of, 297somatosensory-evoked potential effects of, 502t
use as induction agent, 91tuse as sedative, 91tuse inburned patients, 382electroconvulsive therapy, 524pediatric patients, 396
Propofol infusion syndrome, 92–93Propranolol, perioperative use of, 204tProptosis, 353Propylthiouracil, 353Prostaglandins, as pulmonary hypertension
treatment, 295Prostanoid analogs, 299
Prostanoids, 298–299Protamine, allergic reactions to, 365Protein, buffering function of, 26
568 INDEX
Protein C, 52–53Protein S, 52–53Prothrombin time (PT), 55as hepatic synthetic function indicator, 302
pregnancy-related decrease in, 412tpreoperative, 127
Proton pump inhibitors, preoperative administrationof, 119t
Pseudoaddiction, definition of, 338Pseudocholinesterasedeficiencies in, 97–98
in liver transplantation patients, 483in obese patients, 359
Psychogenic pain, 535Psychological disorders, awareness during
anesthesia-related, 208Psychological preparation, preoperative, 118
Pulmonary arterycatheterization of. See Catheterization, pulmonary
arteryhypertension of. See Hypertension, pulmonaryrupture of, 189
Pulmonary artery occlusion pressure (PCAP)normal values for, 188
waveforms of, 191–192, 191f, 192f, 193, 193fPulmonary artery pressure (PPA)
effect of intravenous anesthetics on, 297elevated, treatment of, 295pulmonary artery catheterization measurement
of, 188
in pulmonary hypertension, 293Pulmonary complications, postoperative, 125, 125trisk factors for, 68
Pulmonary functioneffect of laparoscopy on, 514, 514t, 515effect of patient positioning on, 513effect of surgery and anesthesia on, 73
in neonates, 387normal, 300relationship to perioperative morbidity and
mortality, 280–281, 280tPulmonary function testing, 68–74definition of, 68
preoperative, 125t, 280–281of asthmatic patients, 268of obese patients, 360
in pulmonary hypertension, 294Pulmonary risk, perioperative, 280–282, 280tPulmonary stenosis, 406–407
Pulmonary system. See Respiratory systemPulmonary vascular resistance (PVR)calculation of, 294, 405–406conditions that increase, 404beffect of anesthetic drugs on, 406in pediatric heart disease patients, 397during pregnancy, 411t
pulmonary artery catheterization measurementof, 188
in single ventricle patients, 408
Pulse oximetry (SpO2), 168–174comparison with oxygen saturation in arterial
blood (SaO2)false readings on, 171–172
in magnetic resonance imaging suites, 443–444normalization procedure in, 169R/IR ratio in, 169–170, 172transmission and reflection, 168
Pulse pressure, effect of blood loss on, 374tPumping effect, 134Pump prime, 488
P waves, in ventricular tachycardia, 213, 214Pyloric stenosis, 390, 392, 393
Q
QRS complexmagnesium sulfate-related widening of, 428in ventricular tachycardia, 213
QT interval, prolonged, 214
R
Radial arteryas arterial pressure monitoring site, 195–196as source of blood supply to the hand, 195, 196
Radiation, as heat loss mechanism, 219
Radiation exposuremeasurement of, 441, 441tprotection from, 442, 444
Radiculopathy, herniated disks-related, 538–539Radioactive iodine, as hyperthyroidism treatment, 353Rales
bilateral, 225–226heart failure-related, 240
Ranitidine, as preoperative medication, 119tReactive airway disease, 267–273. See also Asthma;
Chronic obstructive pulmonary disease (COPD);Emphysema
definition of, 267
pulmonary function test abnormalities in, 70, 71tReciprocal change, 162Recurrent laryngeal nerve, thyroid surgery-related
injury to, 354Red blood cell transfusions, 378Red blood cell volume, pregnancy-related increase in,
412tReflex sympathetic dystrophy (complex regional pain
syndrome I), 537Regional anesthesia. See also Spinal anesthesiain anticoagulated patients, 454in carotid endarterectomy patients, 261
in chronic obstructive pulmonary disease patients,282
in diabetic patients, 348in geriatric patients, 434in heart failure patients, 242in hypertensive patients, 203as hypotension cause, 205
intravenous. See Bier blockfor laparoscopic procedures, 515in multiple sclerosis patients, 333
INDEX 569
Regional anesthesia (Continued)in neonates, 393in obese patients, 360in pediatric patients, 400–401
Remifentanil, 83t, 87, 307loading dose of, 359tuse in electronconvulsive therapy, 524
Renal disease, in pregnant patients, 430Renal failureacute, 301in aortic aneurysm surgical patients, 256
in burned patients, 382dopamine treatment of, 116–117perioperative, 311, 314
acute, dopamine treatment of, 115in aorto-occlusive disease patients, 254chronic, hyperkalemia associated with, 41
contrast media-related, 440morphine-related respiratory depression in, 86opioid metabolism in, 86postoperative, 311
Renal function, 308–316aging-related changes in, 433during aortic surgery, 256
in burned patients, 382effect of anesthetics on, 314–315intraoperative protection of, 314, 316in neonates, 387
Renal function tests, 311–312, 312t, 313–314Renal insufficiency, 314
neuromuscular blocking agent use in, 315, 315tperioperative management of, 315–316
Renal reserve, loss of, 314Renal systemeffect of hypothermia on, 218tpregnancy-related changes in, 413
Renin, laparoscopy-related increase in, 515
Renin-angiotensin system antagonists, as hypotensioncause, 205
Reperfusionin liver transplantation, 485–486neuroexcitation associated with, 506–507
Reperfusion syndrome, 484–485
Residual capacity, effect of patient positioningon, 142
Residual volume (RV), 70fin obstructive lung disease, 71tduring pregnancy, 412t
Resin triiodothyronine uptake test, 351, 351t
Respiration center, of the brain, 22Respiratory depression, induction agent-related, 91Respiratory distress syndrome. See also Acute
respiratory distress syndrome (ARDS)in neonates, 392in premature infants, 388t
Respiratory drive, chronic obstructive pulmonary
disease-related decrease in, 279–280Respiratory failure, mechanical ventilation in,
151, 152
Respiratory muscles, 17Respiratory rateeffect of blood loss on, 374tduring intubation, in obese patients, 361t
in pediatric patients, 394during pregnancy, 412t
Respiratory systemaging-related changes to, 432effect of alcohol on, 336effect of burns on, 381effect of hypothermia on, 218t
effect of myotonic dystrophy on, 328effect of patient positioning on, 142pediatric, comparison with adult, 394, 395tphysiology of, 17–23pregnancy-related changes in, 412–413, 412t
Respiratory tract infections
as acute respiratory distress syndrome risk factor,287t
in pediatric patients, 128–129recurrent, as chronic obstructive pulmonary disease
risk factor, 278upper, in pediatric patientsimplication for general anesthesia, 402–403
as tonsillectomy contraindication, 128–129Resuscitationof aortic surgery patients, 257of burned patients, 383, 385colloid solution use in, 34–35during spinal anesthesia, 453
of traumatic brain injury patients, 322–323Retinopathy, of prematurity, 388, 388tRevascularization, coronary, 232, 241Reverse steal effect, 260Reversible ischemic neurologic deficit, 259Revised Cardiac Risk Index, 127, 128tRewarming, as hypothermia treatment, 220
Rh blood genotype, 47–48, 48tantigens of, 48
Rheumatic fever, as valvular heart disease cause, 244Right left ventricular failure, after cardiopulmonary
bypass, 477, 478Right left ventricular function, intraoperative
evaluation of, 478Right ventricle, blood supply to, 294Right ventricular end-diastolic pressure (RVEDP),
pulmonary hypertension-related increase in, 293Right ventricular hypertrophy, pulmonary
hypertension-related, 293
Right ventricular outflow tract obstruction (RVOT),397
Ringer’s lactate solution, 383–384, 399–400Robin Hood effect, 260Rocuroniumallergic reactions to, 364–365loading dose of, 359t
metabolism of, 98–99as nondepolarizing neuromuscular blocking
agent, 98t
570 INDEX
Rofecoxib, as chronic pain treatment, 536tRopivacaine, 110as epidural anesthetic, 462tpotency of, 107t
as spinal anesthesia, 451tuse in obstetric patients, 420, 421
Rule of nines, for estimation of burn injury severity,384, 384t
S
St. John’s wort, 369, 371
Saline solutionsas hyperchloremia cause, 42hypertonic, 36as metabolic acidosis cause, 33
Saphenous nerve, patient positioning-related injuryto, 144
Scalds, 380Sciatic nerve, patient positioning-related injury to, 144Sciatic nerve blocks, 107, 470tScintigraphy, exercise thallium, 231Scopolamineas preoperative sedation, 119tside effects of, 120, 120t
Second gas effect, 77–78Secrets, Top 100, 1–8Sedation. See also Preoperative medicationadministration by nonanesthesiologists, 439–440conscious, levels of, 438, 439–440, 439toutside the operating room, 437–444in pediatric patients, 121, 395
Sedativesspinal anesthesia-related sensitivity to, 452, 453use in hypothermic patients, 220
Segmental block, 464Seizurescardiopulmonary bypass-related, 491
eclampsia-related, 428–429electroconvulsive therapy-related, 522–523, 524, 525local anesthetics-related, 109opioids-related, in renal failure patients, 86tramadol-related, 88
Selective serotonin reuptake inhibitors, as chronic
pain treatment, 536tSepsisas acute respiratory distress syndrome cause,
287, 287tas hepatocellular injury cause, 305t
Serotonin syndrome, 528–529
Sertraline, as chronic pain treatment, 536tSerum, osmolality of, 36Sevofluranechemical structure of, 10, 75fmetabolic products of, 80physical properties of, 76tsomatosensory-evoked potential effects of, 502t
Shivering, 219Shivering, as heat production mechanism, 219in neonates, 387
Shockburn-related, 383–384cardiogenic, 115, 116hypovolemic, treatment for, 374
neurogenic, in spinal cord injury patients, 377septic, 115, 116
Shunt fraction, calculation of, 21, 22Shuntsabsolute, 21calculation of, 405as hypoxemia cause, 20
left-to-right, 397tcardiac effects of, 404effect on pediatric inhalational induction, 397pulmonary vascular effects of, 404
right-to-left, 397tcyanotic heart disease-related, 406, 407–408,
407feffect on pediatric inhalational induction, 397tetralogy of Fallot-related, 407f
Sildenafil, 299Sinoatrial node dysfunction, 211Sitting position, 143f, 145, 507Skin, burn-related damage of, 380
Sleep apnea, obstructive, 361–362in pediatric patients, 403as postoperative pulmonary complication risk
factor, 125tSleep-disordered breathing. See also Sleep apnea,
obstructive
in pediatric patients, 403Sleep disturbancesawareness during anesthesia-related, 208fibromyalgia-related, 538
Smokingas aorto-occlusive disease cause, 254as cerebrovascular ischemic events cause, 260
as chronic obstructive pulmonary disease cause,278, 279
as postoperative pulmonary complication cause,125t
Smoking cessation, preoperative, 126Sodium. See also Hypernatremia; Hyponatremia
normal concentration of, 38Sodium nitroprussideaction mechanisms and action sites of, 114perioperative use of, 204tas pulmonary hypertension treatment, 297as tachyphylaxis cause, 115
Sodium thiopentalallergic reactions to, 364cardiovascular effects of, 90, 91tcerebral protective profile of, 93contraindications to, 90–91intra-arterial injection of, 90loading dose of, 359t
somatosensory-evoked potential effects of, 502tuse in burned patients, 382use in pediatric patients, 396
INDEX 571
Somatosensory-evoked potentials (SSEPs), 255,500–504
Spinal anesthesia, 451–457. See also Epiduralanesthesia
combined with epidural anesthesia, 464in obstetric patients, 424
comparison withepidural anesthesia, 459general anesthesia, 451
complications of, 452, 454continuous, 456–457
contraindications to, 454differentiated from epidural anesthesia, 43in geriatric patients, 434with heparin use, 454–455lumbar levels of administration of, 452neurotoxicity of, 109–110
in pregnant patients, 428termination of effect of, 451"total," 453, 461, 463use in multiple sclerosis patients, 333
Spinal cord injuryas latex allergy risk factor, 366management of, 377
Spinal cord stimulators, 539Spinal surgerysomatosensory-evoked potential monitoring
during, 500–504as visual loss cause, 147–148
Spirometry, 69, 74
preoperative, 68SpO2. See Pulse oximetryStatic compliance, 18Static pressure, in mechanical ventilation, 154a-stat method, of blood gas analysis, 490Stents, coronary, 233bare metal, 128
drug-eluting, 128, 233Sternocleidomastoid musclerespiratory function of, 17as somatosensory-evoked potential recording
site, 500Sternotomy, repeat, 476
Steroidsexogenous, comparison to cortisol, 355–356, 355tinteraction with neuromuscular blocking
agents, 99as multiple sclerosis treatment, 333perioperative supplemental, 356
Stress, effect on insulin secretion, 345Stress hormones, release during cardiopulmonary
bypass, 489Stress testing, prior to noncardiac surgery, 231Stridoreffect of helium on, 18in pediatric patients, 402
postextubation, 225Stroke, 259atrial fibrillation-related, 213
Stroke (Continued)cardiopulmonary bypass-related, 491carotid endarterectomy-related, 262
Stroke index, pulmonary artery catheterization
measurement of, 188Stroke volumein obesity, 358during pregnancy, 411tpulmonary artery catheterization measurement
of, 188Stump pressure, as cerebral perfusion indicator, 261
Subarachnoid block. See Spinal anesthesiaSubarachnoid space, local anesthetic injection into,
461, 463Subclavian artery, pulmonary artery catheterization-
related injury to, 189Subclavian vein, as central venous catheter
insertion site, 180–181Succinylcholineaction mechanism of, 96allergic reactions to, 364–365contraindication in muscular dystrophy patients, 327as hyperkalemia cause, 41indications for, 96–97
loading dose of, 359tside effects of, 97use inburned patients, 385chronic obstructive pulmonary disease
patients, 282
electroconvulsive therapy, 525renal insufficiency patients, 315spinal cord injury patients, 377
Sufentanil, 83t, 455loading dose of, 359tsomatosensory-evoked potential effects of, 502tuse in obstetric patients, 422t
Sugammadex, 102Supine position, 142, 143fSupraclavicular nerve block, 469tSurface tension, of small airways and alveoli, 18Surgery. See also specific types of surgeryfollowing percutaneous coronary intervention,
232–233as myocardial ischemia risk factor, 231
Sweatingdrug-induced, 221hyperthermia-related, 220pheochromocytoma-related, 15–16
Sympathetic nervous systemanatomy and function of, 9–10, 9t, 10fpostganglionic adrenergic receptors of, 11, 11t
Sympathomimetic amines, 113Sympathomimeticsdefinition of, 12direct-acting, 12–14
as hyperthermia risk factor, 221indirect-acting, 9perioperative use of, 12–14
572 INDEX
Syncopecongenital long QT syndrome-associated, 214pheochromocytoma-related, 15–16pulmonary hypertension-related, 294
Syndrome of inappropriate secretion of antidiuretichormone, 34, 38t
Systemic vascular resistance (SVR)calculation of, 405–406in hypertension, 201during pregnancy, 411tpulmonary artery catheterization measurement
of, 188Systolic dysfunction, 238, 239f
T
Tachycardiaanaphylaxis-related, 364
atrial, 211, 212as blood transfusion indicator, 43electroconvulsive therapy-related, 524hyperthermia-related, 220hyperthyroidism-related, 353narrow-complex, differential diagnosis for, 212tparoxysmal supraventricular, 212
postoperative, 226sinus, 211supraventricularwith aberrance, 213–214narrow-complex, 214–215
ventricular
digoxin toxicity-related, 211monomorphic, 213, 214polymorphic, 214
wide-complex, 213–215, 215fTachyphylaxis, nitrovasodilators-related, 115Tachypneaacute respiratory distress syndrome-related, 288
asthma-related, 268chronic obstructive pulmonary disease-related,
279Tamponade, cardiac, 376, 378as perioperative hypotension cause, 204
Tapendatol, 530
Temperature, effect on somatosensory-evokedpotentials, 503
Temperature disturbances, 217–221Temperature monitoring, intraoperative, 97Temporomandibular junction, functional assessment
of, 59
Terbutalineas asthma treatment, 268, 269tas chronic obstructive pulmonary disease
treatment, 281tTetracainemaximum safe doses of, 107tpotency of, 107t
as spinal anesthesia, 451tuse in cesarean sections, 423t
Tetralogy of Fallot, 397, 406–407, 407f"Tet spells," 397, 406–407
Theophyllineas asthma treatment, 269, 269tas chronic obstructive pulmonary disease
treatment, 281t
Thermal burns, 380Thermogenesis, 219Thermoregulation, 217effect of epidural anesthesia on, 462effect of spinal anesthesia on, 454in neonates, 387
Thiopental. See Sodium thiopental
Third-space losses, 36–37Thoracic duct, central venous catheterization-related
puncture of, 185, 186Thoracic paravertebral nerve block, 471Thoracic surgerylung isolation use in, 493, 498
morbidity and mortality associated with, 280tpulmonary function testing prior to, 73, 73t
Thoracoscopic procedures, 511Thrombin, burn-related deficiency of, 383Thrombin time, preoperative, 127Thrombocytopeniacirrhosis-related, 302
dilutional, 53, 54preeclampsia-related, 428
Thromboelastography (TEG), 54, 56, 56f, 57Thromboembolismcentral venous catheterization-related, 185perioperative prophylaxis against, 127
pregnancy-related, 411–412Thyroglobulin, iodination of, 351Thyroidectomy, surgical subtotal, 353Thyroid function tests, 351, 351tThyroid hormoneinotropic effect of, 117synthesis of, 351
Thyroid hormone replacement therapy, 352–353Thyroiditis, Hashimoto’s, 352Thyroid-stimulating hormone, 351, 351tThyroid storm (thyrotoxicosis), 354, 356Thyroid surgery, complications of, 354Thyrotoxicosis (thyroid storm), 354, 356
Thyroxine, 351, 351tTibial artery, posterior, as arterial pressure monitoring
cannulation site, 196Tibial nerve, posterior, as somatosensory-evoked
potential stimulation site, 501tTidal volume
of anesthesia ventilators, 141during extubation, in obese patients, 361tinhalational anesthesia-related decrease in, 78as neuromuscular function indicator, 103tduring pregnancy, 412tratio to physiologic dead space (VD/VT), 21
Tolerance, definition of, 338
Tonicity, regulation of, 31–32Tonsillectomy, respiratory infections as
contraindication to, 128–129Topical agents, for acute pain treatment, 528–529
INDEX 573
Top 100 Secrets, 1–8Torque control blockers. See Univent tubesTorsades de pointes, 87, 214, 214fTotal body surface area (TBSA), of burn injuries,
383–384, 384tTotal lung capacity, 70fin obstructive and restrictive lung diseases, 70fduring pregnancy, 412t
Total parenteral nutrition, as hepatocellular injurycause, 305t
Trachea
intubation of. See Endotracheal intubationtears of, 378width estimation of, 493, 494t
Tracheostomy, 59Train-of-four assessment, of neuromuscular blockade,
99, 100, 101
Tramadol, 83t, 88, 528–529Tranexamic acid, use in heart transplantation patients,
476–477Transfusion-related acute lung injury (TRALI), 45,
45t, 46, 47Transfusion therapy, 43–50Transient ischemic attacks (TIAs), 259
cardiopulmonary bypass-related, 491Transient neurologic syndrome, 455–456Transport, of patients, 222Transsphenoidal surgery, 509Transtracheal ventilation, 65Transverse abdominis plane nerve block, 471
Trauma, 373–379as acute respiratory distress syndrome risk factor,
287tas aspiration risk factor, 511
Trauma patients, 373–379elderly, 378pregnant, 378
Traumatic brain injury, 322–323Trendelenburg position, 142, 143f, 144hemodynamic and pulmonary effects of, 513reverse, hemodynamic and pulmonary effects
of, 513during spinal anesthesia, 452
Triamcinolone, potency of, 355tTricyclic antidepressantsas chronic pain treatment, 536t, 537as hyperthermia risk factor, 221
Trigger points, 538Triiodothyronine, synthesis of, 351
Tubocurarine, 282, 315tTubulointerstitial disease, during pregnancy, 430Turbulent gas flow, 18, 22
U
Ulcers, Curling’s, 382Ulnar artery, as arterial pressure monitoring
cannulation site, 196Ulnar nerve, patient positioning-related injury to, 146Umbilical cord, anatomy of, 415
Unconscious patients, with hypotension, 373
Univent tubes, 495, 496, 497tUniversal precautions, 366Upper respiratory tract infections, in pediatric patientsimplication for general anesthesia, 402–403
as tonsillectomy contraindication, 128–129Uremia, renal failure-related, 311Urine output, as renal function indicator, 314Urologic procedures, laparoscopic, 511Urticaria, 45, 364, 441tUteroplacental perfusion, 415Uterus
postpartum atony of, 429–430, 431rupture of, 429
V
Valerian, 369, 370Valproic acid, as chronic pain treatment, 536tValvotomy, aortic balloon, 247–248Valvular heart disease, 244–253as active cardiac condition, 126, 127
as heart failure cause, 236, 236tVaporization, 133Vaporizers, 133–134, 135–136removal from anesthesia machines, 135–136
Varices, esophagogastric, cirrhosis-related, 301–302Vasa previa, 429
Vascular resistance, uterine, 415Vascular surgery, somatosensory-evoked potential
monitoring during, 502Vasoconstrictionacidemia-related, 27cerebral, alkalemia-related, 27hypoxic pulmonary, 21, 78–79, 280, 297
Vasoconstrictor agentsconcurrent use with phosphodiesterase inhibitor,
112as pulmonary hypertension treatment, 296
Vasodilationhyperthermia-related, 220
pulmonary, alkalemia-related, 27Vasodilator agents, 112–117action mechanisms and action sites of, 115–116direct-acting, as pulmonary hypertension
treatment, 296limitations of, 112as pulmonary hypertension treatment, 295, 297,
298, 482Vasoplegia, 491Vasopressinaction mechanism of, 116deficiency of, 33texcessive, 33–34
laparoscopy-related increase in, 515as shock treatment, 115, 116
Vasospasm, 263alkalemia-related, 27subarachnoid hemorrhage-related, 263–264, 509
VD/VT, calculation of, 21Vecuronium
loading dose of, 359t
574 INDEX
Vecuronium (Continued)metabolism of, 98–99as nondepolarizing neuromuscular blocking
agent, 98t
Venovenous bypass, 483Ventilation. See also Mechanical ventilationalveolar, during pregnancy, 412tanesthesia-related impairment of, 223arterial blood gas assessment of, 24effect of inhalational anesthetics on, 78–79effect of patient positioning on, 142
epidural anesthesia-related changes in, 462jet, in laser surgery of the airway, 519lung protective, in neonates, 392mask, difficult, 64monitoring standards for, 438prone, 290–292
pulse oximetry as indicator for, 173single-lung, 378, 493, 497–498, 497tspontaneous, in laser surgery of the airway, 519transtracheal, 65zones of West in, 19
Ventilation-perfusion mismatch (V/Q)in chronic obstructive pulmonary disease patients,
280general anesthesia-related exacerbation of, 20as hypoxemia cause, 20patient positioning-related, 144
Ventilator bundle, 153Ventilators
on anesthesia machinesin one-lung ventilation, 139, 140, 140b,
497–498in intensive care units (ICU), 139, 150"fighting the,", 155, 155settings for acute respiratory failure, 152trigger variables in, 151
for magnetic resonance imaging suites, 443–444Ventricle, single, 408, 409fVentricular arrhythmias, 214Ventricular assist devices (VAD), 473, 477Ventricular failure, 408Ventricular hypertrophy, right, 157, 158, 158f
Ventricular obstruction, 408, 408bVerapamil, contraindications to, 211, 295Vercuronium, as myopathy cause, 271Video-assisted thoracic surgery, 511Viral infections. See also specific virusesupper respiratory tract, in pediatric patients,
128–129Visceral pain, 529, 535Vision losscardiopulmonary bypass-related, 491postoperative, 147–148
Visual analog pain scales, 527, 528fVital capacity (VC)
during extubation, in obese patients, 361tin neonates, 387during pregnancy, 412t
Vital signseffect of blood loss on, 374tin pediatric patients, 394, 395
Vitamin(s), incidence of use, 369
Vitamin B12, interaction with nitrous oxide, 78, 81Vitamin B12 deficiency, as nitrous oxide risk factor, 78Vitamin E, effects of, 370Vitamin K, deficiency of, 54, 302Vocal cords, thyroid surgery-related injury to, 354Volatile anesthetics. See Inhalational anestheticsVolume loading, endogenous, 296
Volume overload, in valvular heart disease, 244Volume status, assessment of, 33, 34in hepatorenal syndrome patients, 301in neonates, 388
VO2 (maximal oxygen consumption during exercise)implication for blood transfusion, 43
peak, in heart transplantation patients, 474Vomitingheart failure-related, 240as metabolic alkalosis cause, 29postoperative, 223, 227in pediatric patients, 401spinal anesthesia-related, 452
W
Warfarin, as intraoperative hemorrhage risk factor,127
Water intoxication, 33–34Weight gain, hypothyroidism-related, 380Weight loss, bariatric surgery for, 362–363Wheezingasthma-related, 267, 268
chronic obstructive pulmonary disease-related, 279as contraindication to elective surgery, 272heart failure-related, 240inhalation injury-related, 381intraoperative, 271–272differential diagnosis of, 283
Wire-guided endobronchial blockers, 495, 496, 497tWolff-Parkinson-White (WPW) syndrome, 157,
214–215, 215fWorld Health Organization (WHO), analgesic ladder of,
528–529, 528fWound healing, effect of hypothermia on, 218t
X
X-rays, chestfor acute lung injury evaluation, 285t
for chronic obstructive pulmonary diseaseevaluation, 279
for congestive heart failure evaluation, 240in obese patients, 360preoperative, 124, 125t, 360for pulmonary hypertension evaluation, 294
Z
Zaprinast, 299
Zileuton, as chronic obstructive pulmonary diseasetreatment, 281t
Zones of West, 19, 193