1. JOHN L. ATLEE, MD Professor of Anesthesiology Department of
Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin
BRENDA A. BUCKLIN, MD Associate Professor of Anesthesiology
Department of Anesthesiology University of Colorado Health Sciences
Center Denver, Colorado MARK A. CHANEY, MD Associate Professor of
Anesthesiology Department of Anesthesia and Critical Care
University of Chicago Pritzker School of Medicine Chicago, Illinois
DONN M. DENNIS, MD, FAHA Joachim S. Gravenstein, MD, Professor of
Anesthesiology Department of Anesthesiology University of Florida
College of Medicine Gainesville, Florida Vice
President-Pharmacology, ARYx Therapeutics, Inc. Santa Clara,
California JOHN ELLIS, MD Professor of Anesthesiology Department of
Anesthesia and Critical Care University of Chicago Pritzker School
of Medicine Chicago, Illinois JOEL M. GUNTER, MD Professor of
Clinical Anesthesia and Pediatrics Department of Anesthesia
University of Cincinnati School of Medicine Attending
Anesthesiologist Department of Anesthesia Childrens Hospital
Medical Center Cincinnati, Ohio ROSEMARY HICKEY, MD Professor and
Program Director Department of Anesthesiology University of Texas
Health Science Center at San Antonio San Antonio, Texas BRIAN M.
ILFELD, MD Associate Professor Department of Anesthesia University
of California, San Diego San Diego, California DONALD A. KROLL, MD,
PHD Staff Anesthesiologist Department of Surgery Veterans Affairs
Medical Center Biloxi, Mississippi TERRI G. MONK, MD Professor
Department of Anesthesiology Duke University Medical Center Durham,
North Carolina TIMOTHY E. MOREY, MD Associate Professor of
Anesthesiology Department of Anesthesiology University of Florida
College of Medicine Gainesville, Florida MICHAEL J. MURRAY, MD, PHD
Professor of Anesthesiology and Chair Department of Anesthesiology
Mayo Clinic College of Medicine Jacksonville, Florida NADER D.
NADER, MD Associate Professor of Anesthesiology, Surgery and
Pathology State University of New York at Buffalo School of
Medicine Buffalo, New York MICHAEL F. OCONNOR, MD Associate
Professor Department of Anesthesia and Critical Care University of
Chicago Pritzker School of Medicine Chicago, Illinois KERRI M.
ROBERTSON, MD Associate Clinical Professor of Anesthesiology Chief,
General, Vascular, High-Risk Transplant and Surgical Critical Care
Medicine Division Chief, Transplant Services Duke University School
of Medicine Department of Anesthesiology Durham, North Carolina
SCOTT R. SPRINGMAN, MD Professor Departments of Anesthesiology and
Surgery University of Wisconsin Medical School Madison, Wisconsin
KEVIN K. TREMPER, MD Professor and Chairman Department of
Anesthesiology University of Michigan Medical Center Ann Arbor,
Michigan B. CRAIG WELDON, MD Associate Professor Department of
Anesthesiology and Pediatrics Duke University School of Medicine
Durham, North Carolina Section Editors FM-X2215 8/19/06 3:25 PM
Page ii
2. 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA
19103-2899 COMPLICATIONS IN ANESTHESIA, 2nd edition ISBN-13:
978-1-4160-2215-2 ISBN-10: 1-4160-2215-5 Copyright 2007, 1999 by
Saunders, an imprint of Elsevier Inc. All rights reserved. No part
of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without
permission in writing from the publisher. Permissions may be sought
directly from Elseviers Health Sciences Rights Department in
Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239
3805, e-mail: [email protected]. You may also complete
your request on-line via the Elsevier homepage
(http://www.elsevier.com), by selecting Customer Support and then
Obtaining Permissions. Library of Congress
Cataloging-in-Publication Data Complications in anesthesia /
[edited by] John L. Atlee. -- 2nd ed. p. ; cm. Includes
bibliographical references and index. ISBN 1-4160-2215-5 1.
Anesthesia--Complications. I. Atlee, John L. [DNLM: 1.
Anesthesia--adverse effects. 2. Anesthetics--adverse effects. WO
245 C7369 2007] RD82.5.C63 2007 617.96041--dc22 2006040549
Executive Publisher: Natasha Andjelkovic Developmental Editor: Jean
Nevius Publishing Services Manager: Tina Rebane Project Manager:
Amy Norwitz Marketing Manager: Dana Butler Printed in the United
States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1
Notice Knowledge and best practice in this field are constantly
changing. As new research and experience broaden our knowledge,
changes in practice, treatment, and drug therapy may become
necessary or appropriate. Readers are advised to check the most
current information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of
the practitioner, relying on his or her own experience and
knowledge of the patient, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all
appropriate safety precautions. To the fullest extent of the law,
neither the Publisher nor the Editors assumes any liability for any
injury and/or damage to persons or property arising out of or
related to any use of the material contained in this book. The
Publisher FM-X2215 8/19/06 3:25 PM Page iv
3. To all who have contributed to this work, and to the
patients we serve. FM-X2215 8/19/06 3:25 PM Page v
4. An ounce of prevention is worth a pound of cure. ANONYMOUS
Preface vii The second edition of Complications in Anesthesia, like
its first edition, is intended to provide all practitioners of
anes- thesia and critical care medicine with a comprehensive source
of information for most complications that might be faced in
clinical practice. Topics are addressed in ten sections:
Pharmacology; General Anesthesia; Regional Anesthesia and Pain
Management; Cardiothoracic and Vascular Surgery; Physiologic
Imbalance and Coexisting Disease; Equipment and Monitoring;
Pediatrics and Neonatology; Neurosurgery, Ophthalmology, and ENT;
Other Surgical Subspecialties (subdivided into Obstetrics and
Gynecology, General Surgery, Urologic Surgery, and Orthopedic
Surgery); and Special Topics (subdivided into Postanesthesia Care
Unit, Diagnostic or Therapeutic Intervention, and Medicolegal
Aspects). Section Editors were selected based on their special
expertise and knowledge of the topics addressed in each section.
Each chapter is presented in a highly structured format (in
accordance with problem-based learning) under the fol- lowing
headings and subheadings: Case Synopsis, Problem Analysis (divided
into Definition, Recognition, Risk Assessment, Implications),
Management, and Prevention; in chapters with more than one topic,
each topic is addressed using the same headings. Schematics,
figures, and tables are used liberally to illustrate key points or
to summarize impor- tant information. Key references are listed at
the end of each chapter under Further Reading, avoiding in-text
citations that might distract the reader. Some chapters contain
foot- notes that provide further explanations. In this way, the
reader can gain useful insight into a topic of interest in the
minimal amount of time and with maximal retention. Also, thumb
indexing and liberal cross-referencing are intended to reduce the
need for time-consuming index searches. Finally, under Further
Reading, in text, or in footnotes, there are ref- erences to Web
sites for more or updated information. In that way, the reader can
keep abreast of new developments. I hope this unconventional
treatment of complications in anesthesia and critical care will
serve several purposes: first, to permit quick location and
researching of topics of interest to busy practitioners in the
least amount of time; second, to organize the thought processes
involved in medical decision- making in an attractive formati.e.,
akin to Sherlock Holmes who done it?; and third and most
importantly, to reduce the risk to our patients for unexpected and
untoward events. John L. Atlee, MD FM-X2215 8/19/06 3:25 PM Page
vii
5. Mark Abel, MD Clinical Assistant Professor, Department of
Anesthesiology, Mount Sinai Medical Center, New York, New York
Vaporizers Gaury S. Adhikary, MD, FRCA Assistant Professor,
Department of Anesthesiology, University of Michigan Hospitals, Ann
Arbor, Michigan Carbon Dioxide Absorbers Maurice S. Albin, MD, MSc
(Anes) Professor of Anesthesiology, Department of Anesthesiology,
University of Alabama School of Medicine, Birmingham, Alabama
Venous Air Embolism Stacey L. Allen, MD Assistant Professor of
Anesthesiology, Department of Anesthesiology, University of Texas
Health Science Center at San Antonio, San Antonio, Texas Corneal
Injury; Open Globe Injury Steven J. Allen, MD Professor of
Anesthesiology, Ohio State University College of Medicine; Chief
Executive Officer, Columbus Childrens Hospital, Columbus, Ohio
Autonomic Hyperreflexia Jonathan M. Anagnostou, MD Associate
Professor of Clinical Anesthesia, Department of Anesthesia, Indiana
University School of Medicine; Staff Anesthesiologist, Medical
Director of Respiratory Care, Department of Anesthesia, Respiratory
Care, Indiana University Hospital, Indianapolis, Indiana Blood and
Blood Products: Hepatitis and HIV Maged Argalious, MD Staff
Anesthesiologist, Departments of General Anesthesiology and
Critical Care Medicine, Cleveland Clinic Foundation, Cleveland,
Ohio Complications of Trauma Surgery George A. Arndt, MD Professor
(CHS), Department of Anesthesiology, University of Wisconsin
Medical School, Madison, Wisconsin Difficult Airway: Cannot
Ventilate, Cannot Intubate Lori A. Aronson, MD, FAAP Assistant
Professor of Clinical Anesthesia and Pediatrics, Department of
Anesthesia, University of Cincinnati College of Medicine; Assistant
Professor, Clinical Anesthesia and Pediatrics, Department of
Anesthesia, Cincinnati Childrens Hospital Medical Center,
Cincinnati, Ohio Hypoxemia John L. Atlee, MD Professor of
Anesthesiology, Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, Wisconsin Adenosine; Disorders of Potassium
Balance; Nonbarbiturate Anesthetics; Chemotherapeutic Agents;
Cardiac Risk Assessment; Postobstruction Pulmonary Edema;
Perioperative Tachyarrhythmias; Tachyarrhythmias with Ventricular
Preexcitation; Long QT Syndromes and Ventricular Arrhythmias;
Patients with Cardiac Rhythm Management Devices; Disorders of Water
Homeostasis: Hyponatremia and Hypernatremia Michael S. Avidan, MD
Associate Professor of Anesthesiology and Surgery; Division Chief,
CT Anesthesiology and CT Intensive Care, Washington University
School of Medicine, St. Louis, Missouri HIV Infection and AIDS
Isaac Azar, MD Professor of Anesthesiology, Albert Einstein College
of Medicine; Consultant, Department of Anesthesiology, Beth Israel
Medical Center, New York, New York Scavenging Systems James E.
Baker, MD, FRCPC Assistant Professor and Anesthesiologist,
Department of Anesthesia and Perioperative Care, University of
California, San Francisco, San Francisco, California Postoperative
Pulmonary Hypertension Narayan Baliga, MD Staff Anesthesiologist,
Kenosha Hospital and Medical Center, Kenosha, Wisconsin Difficult
Airway: Opiate-Induced Muscle Rigidity Shahar Bar-Yosef, MD
Assistant Professor, Department of Anesthesiology and Critical
Care, Duke University School of Medicine, Durham, North Carolina
Complications of Laparoscopic Surgery Contributors ix FM-X2215
8/19/06 3:25 PM Page ix
6. Juliana Barr, MD Associate Professor, Department of
Anesthesiology, Stanford University School of Medicine, Stanford,
California; Staff Intensivist and Anesthesiologist, Veterans
Affairs Palo Alto Health Care System, Anesthesiology Service, Palo
Alto, California Reversal Agents: Naloxone and Flumazenil Curtis L.
Baysinger, MD Associate Professor, Department of Anesthesiology,
Vanderbilt University School of Medicine, Nashville, Tennessee
Hypertensive Disorders of Pregnancy Eric Bedell, MD Associate
Professor, Department of Anesthesiology, University of Texas
Medical Branch, Galveston, Texas Posterior Fossa Surgery Joan
Benca, MD Associate Professor, Department of Anesthesiology,
University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Bronchospasm Patrick E. Benedict, MD Assistant Professor of
Anesthesiology, University of Michigan Medical School, Ann Arbor,
Michigan Transesophageal Echocardiography David G. Bjoraker, MD
Associate Professor, Department of Anesthesiology, University of
Florida College of Medicine, Gainesville, Florida Anaphylaxis and
Anaphylactoid Reactions Susan Black, MD Professor, Department of
Anesthesiology, University of Alabama School of Medicine,
Birmingham, Alabama Antidepressants William S. Blau, MD, PhD
Associate Professor of Anesthesiology, University of North Carolina
School of Medicine, Chapel Hill, North Carolina Opioid Tolerance
Steffan Blumenthal, MD Assistant Professor, Department of
Anesthesiology and Reanimation, Orthopedic University Clinic
Balgrist/Zurich, Zurich, Switzerland Interscalene Nerve Block:
Potential Severe Complications John C. Boncyk, MD Assistant
Professor, Department of Anesthesiology, University of Wisconsin
Hospital and Clinics, Madison, Wisconsin Perioperative Hypoxia
Alain Borgeat, MD Professor and Chief of Staff, Department of
Anesthesiology and Reanimation, Orthopedic University Clinic
Balgrist/Zurich, Zurich, Switzerland Interscalene Nerve Block:
Potential Severe Complications Lois L. Bready, MD Professor and
Vice Chair, Department of Anesthesiology, University of Texas
Health Science Center at San Antonio, San Antonio, Texas Corneal
Injury Thomas P. Broderick, MD Assistant Professor, Department of
Anesthesiology, University of Wisconsin Hospital and Clinics,
Madison, Wisconsin Preanesthetic Evaluation: Inadequate or Missing
Test Result David L. Brown, MD Edward Rotan Distinguished Professor
and Chairman, Department of Anesthesiology and Pain Medicine, M.D.
Anderson Cancer Center, Houston, Texas Celiac Plexus Block: Side
Effects and Complications Adrie Bruijinzeel, MD Assistant
Professor, Department of Psychiatry, Evelyn and William McKnight
Brain Institute, University of Florida College of Medicine,
Gainesville, Florida Chemical Dependency: Opioids Brenda A.
Bucklin, MD Associate Professor of Anesthesiology, Department of
Anesthesiology, University of Colorado Health Sciences Center,
Denver, Colorado Fetal Distress Matthew D. Caldwell, MD Assistant
Professor, Department of Anesthesiology, University of Michigan
Medical School, Ann Arbor, Michigan Pulmonary Artery Pressure
Monitoring William R. Camann, MD Associate Professor, Department of
Anesthesia, Harvard Medical School; Director of Obstetric
Anesthesia, Brigham and Womens Hospital, Boston, Massachusetts
Pulmonary Aspiration in the Parturient Maria I. Castro, PhD
Assistant Professor, Department of Anesthesiology, University of
Arkansas for Medical Sciences, Little Rock, Arkansas Class II
Antiarrhythmic Drugs: -BlockersHeart Block or Bradycardia Kevin P.
Chan, MD Fellow in Cardiovascular Anesthesia, Stanford University
School of Medicine, Stanford, California Nonbarbiturate Anesthetics
Mark A. Chaney, MD Associate Professor of Anesthesiology,
Department of Anesthesia and Critical Care, University of Chicago
Pritzker School of Medicine, Chicago, Illinois Perioperative
Myocardial Ischemia and Infarction; Adverse Neurologic Sequelae:
Central Neurologic Impairment; Hypercoagulable States: Thrombosis
and Embolism Amit V. Chawla, MD Consultant, Department of
Anesthesia, Guys Hospital, London, United Kingdom Inspiratory and
Expiratory Gas Monitoring x Contributors FM-X2215 8/19/06 3:25 PM
Page x
7. Contributors xi David C. H. Cheng, MD, MSc, FRCPC Professor
and Chair, Department of Anesthesia and Perioperative Medicine,
University of Western Ontario; Anesthesiologist in Chief, London
Health Sciences Center and St. Josephs Health Care, London,
Ontario, Canada Fast-Track Cardiac Surgery S. Devi Chiravuri, MD
Assistant Professor, Department of Anesthesiology, University of
Michigan Medical School, Ann Arbor, Michigan Rapid Fluid and Blood
Delivery Systems Gordon Lee Collins, MD Clinical Fellow, Department
of Anesthesiology, Washington University School of Medicine, St.
Louis, Missouri Complications after Pneumonectomy Lois A. Connolly,
MD Associate Professor, Department of Anesthesiology, Medical
College of Wisconsin, Froedtert Memorial Lutheran Hospital,
Milwaukee, Wisconsin Unstable Cervical Spine, Atlantoaxial
Subluxation D. Ryan Cook, MD Professor of Anesthesiology,
Department of Anesthesiology, Childrens Hospital of Pittsburgh,
Pittsburgh, Pennsylvania Hypoglycemia and Hyperglycemia Scott D.
Cook-Sather, MD Assistant Professor of Anesthesia, Department of
Anesthesiology and Critical Care Medicine, University of
Pennsylvania School of Medicine; Associate Anesthesiologist,
Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
Ophthalmic Problems and Complications Victoria Coon, CRNA, MS
Perioperative Director and Anesthesiology Department Administrator,
Kaiser Permanente, West Los Angeles, Los Angeles, California
Quality Assurance; Cost Containment John R. Cooper, Jr., MD
Clinical Associate Professor of Anesthesiology, University of Texas
Health Science Center; Associate Chief, Cardiovascular Anesthesia;
Co-Director, Cullen Cardiovascular Research Laboratories, Texas
Heart Institute, Houston, Texas Troubleshooting Common Problems
during Cardiopulmonary Bypass Charles J. Cot, MD Director of
Clinical Research in Pediatric Anesthesia, Department of
Anesthesiology, Massachusetts General Hospital, Boston,
Massachusetts Sedation of Pediatric Patients Douglas B. Coursin, MD
Professor of Anesthesiology and Internal Medicine, Department of
Anesthesiology, University of Wisconsin School of Medicine and
Public Health, Madison, Wisconsin Adrenal Insufficiency James C.
Crews, MD Associate Professor of Anesthesiology, Section of
Regional Anesthesia and Acute Pain Management, Department of
Anesthesiology, Wake Forest University School of Medicine,
Winston-Salem, North Carolina Infectious Complications of Central
Neuraxial Block Deborah A. Davis, MD Clinical Professor of
Anesthesiology, Department of Anesthesiology, Thomas Jefferson
University Jefferson Medical College, Philadelphia, Pennsylvania;
Pediatric Anesthesiologist/Intensivist, Nemours Cardiac Center,
A.I. duPont Hospital for Children, Wilmington, Delaware Pulmonary
Hypertension Martin L. De Ruyter, MD Associate Professor of
Anesthesiology, Department of Anesthesiology, Kansas University
School of Medicine, Kansas City, Kansas Hyperglycemia and Diabetic
Ketoacidosis; Sarcoidosis Hernando De Soto, MD Associate Professor,
Department of Pediatric Anesthesia, University of Florida Health
Science Center; Staff Anesthesiologist/Medical Director of the OR,
Department of Anesthesiology, SHANDS Jacksonville, Jacksonville,
Florida Difficult Pediatric Airway Donn M. Dennis, MD, FAHA Joachim
S. Gravenstein, MD, Professor of Anesthesiology, Department of
Anesthesiology, University of Florida College of Medicine,
Gainesville, Florida; Vice President- Pharmacology, ARYx
Therapeutics, Inc., Santa Clara, California Class III
Antiarrhythmic Drugs: Potassium Channel Blockers; Class IV
Antiarrhythmic Drugs: Calcium Channel Blockers Ronak Desai, DO
Resident, CA-2, Department of Anesthesia and Critical Care,
University of Chicago Pritzker School of Medicine, Chicago,
Illinois Peripheral Vascular Surgery Cheryl DeSimone, MD Associate
Professor of Anesthesiology, Obstetrics and Gynecology, Department
of Anesthesiology, Albany Medical College; Director of Obstetric
Anesthesia, Albany Medical Center, Albany, New York Embolic Events
of Pregnancy Cyrus DeSouza, MB,BS, FANZCA Acting Assistant
Professor, Cardiothoracic Anesthesiologist, Department of
Anesthesiology, University of Washington Medical Center, Seattle,
Washington; Staff Specialist Anaesthetist, Department of
Anaesthetics, St. Georges Hospital, Sydney, NSW, Australia
Chronotropic Drugs Clifford S. Deutschman, MD Professor, Department
of Anesthesia and Surgery, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania Sepsis, Systemic
Inflammatory Response Syndrome, and Multiple Organ Dysfunction
Syndrome FM-X2215 8/19/06 3:25 PM Page xi
8. Pema Dorje, MD Clinical Assistant Professor, Department of
Anesthesiology, University of Michigan Medical School, Ann Arbor,
Michigan Arterial Blood Pressure Monitoring Anthony R. Doyle, BSc,
MB,BS, FRCA Formerly, Visiting Instructor in Anesthesiology,
University of Michigan Medical School, Ann Arbor, Michigan;
Consultant Anaesthetist, Dorset County Hospital, Dorchester, United
Kingdom Fires in the Operating Room Kenneth Drasner, MD Professor,
Department of Anesthesiology and Perioperative Care, University of
California, San Francisco, San Francisco, California Local
Anesthetic Neurotoxicity: Cauda Equina Syndrome Catherine Drexler,
MD Vice Chair, Department of Anesthesiology, Columbia- St.
Marys-Milwaukee Campus, Milwaukee, Wisconsin Angioedema and
Urticaria Ellen Duncan, MD Tejas Anesthesia, San Antonio, Texas
Open Globe Injury Martin W. Dnser, MD Resident in Anesthesiology
and Critical Care Medicine, Department of Anesthesiology and
Critical Care Medicine, Medical University Innsbruck, Innsbruck,
Austria Vasopressors: Vasoconstrictor Drugs Jrg Dziersk, MD, FRCA
Assistant Professor of Anesthesiology, Department of
Anesthesiology, University of Washington School of Medicine,
Seattle, Washington Vasodilator Drugs Michael P. Eaton, MD
Associate Professor, Department of Anesthesiology, University of
Rochester School of Medicine and Dentistry, Rochester, New York
Proportioning Systems; Patient Warming Systems Charles E. Edmiston,
Jr., MS, PhD Associate Professor, Department of Surgery; Director,
Surgical Microbiology Research Laboratory, Medical College of
Wisconsin, Milwaukee, Wisconsin Nosocomial Infections: Bacterial
Pneumonia James B. Eisenkraft, MD Professor of Anesthesiology,
Mount Sinai School of Medicine, New York, New York Vaporizers John
Ellis, MD Professor of Anesthesiology, Department of Anesthesia and
Critical Care, University of Chicago Pritzker School of Medicine,
Chicago, Illinois Carotid Endarterectomy; Thoracic Aortic Aneurysm
Brenda G. Fahy, MD, FCCP, FCCM Professor, Department of
Anesthesiology, University of Kentucky; Director of Critical Care,
Department of Anesthesiology, AB Chandler Medical Center,
Lexington, Kentucky Disorders of Water Homeostasis: Hyponatremia
and Hypernatremia Zhuang T. Fang, MD, MSPH Assistant Clinical
Professor, Department of Anesthesiology, David Geffen School of
Medicine at University of California, Los Angeles, Los Angeles,
California Unanticipated Hospital Admission and Readmission Doron
Feldman, MD Associate Professor of Clinical Anesthesiology, State
University of New York at Buffalo School of Medicine; Attending in
Anesthesiology, Childrens Hospital of Buffalo, Buffalo, New York
The Hostile-Combative Patient Lynne R. Ferrari, MD Associate
Professor, Department of Anesthesia, Harvard Medical School;
Medical Director, Perioperative Services, Childrens Hospital,
Boston, Massachusetts Adenotonsillectomy Matthew P. Feuer, MD Staff
Anesthesiologist, Department of Anesthesiology, Virginia Mason
Medical Center, Seattle, Washington Spinal Anesthesia: PostDural
Puncture Headache Stephanie S. F. Fischer, MD Visiting Associate in
Cardiothoracic and Critical Care, Division of Pediatric
Anesthesiology, Duke University School of Medicine, Durham, North
Carolina Cardiomyopathies M. Pamela Fish, MB,ChB Associate
Professor, Department of Anesthesiology, Stanford University School
of Medicine, Stanford, California; Staff Physician, Veterans
Affairs Palo Alto Health Care System, Palo Alto, California
Antiemetic Drugs Randall Flick, MD, MPH Assistant Professor of
Anesthesiology and Pediatrics, Department of Anesthesiology and
Pediatrics, Mayo Clinic College of Medicine; Chair, Section of
Pediatric Anesthesiology, Mayo Clinic, Rochester, Minnesota
Anterior Mediastinal Mass Michael P. Ford, MD Assistant Professor
of Anesthesiology, Department of Anesthesiology, University of
Wisconsin Medical School, Madison, Wisconsin Preanesthetic
Evaluation: False-Positive Tests; Difficult Airway: Cannot
Ventilate, Cannot Intubate Jennifer T. Fortney, MD Assistant
Clinical Professor, Department of Anesthesiology, Duke University
School of Medicine, Durham, North Carolina Fat Embolism Syndrome
xii Contributors FM-X2215 8/19/06 3:25 PM Page xii
9. Contributors xiii James M. T. Foster, MD Clinical Assistant
Professor of Anesthesiology, Department of Anesthesiology, State
University of New York at Buffalo School of Medicine; Director of
Anesthesiology Services, Kaleida Health, Buffalo, New York The
Hostile-Combative Patient Melissa Franckowiak, MD Resident,
Department of Anesthesiology, State University of New York at
Buffalo School of Medicine, Buffalo, New York Cardioversion Eugene
B. Freid, MD Associate Professor, Departments of Anesthesiology and
Pediatrics, University of North Carolina Hospitals, Chapel Hill,
North Carolina Succinylcholine Kimberly Frost-Pineda, MD Assistant
in Psychiatry, Department of Psychiatry, Director of Public Health
Research, University of Florida College of Medicine, Gainesville,
Florida Chemical Dependency: Opioids; Chemical Dependency:
Nonopioids Jeffrey L. Galinkin, MD Associate Professor, Department
of Anesthesia, Childrens Hospital, Denver, Colorado Fetal
Intrauterine Surgery Arjunan Ganesh, MD Assistant Professor of
Anesthesia, Department of Anesthesia, University of Pennsylvania
School of Medicine; Assistant Anesthesiologist, Department of
Anesthesiology and Critical Care Medicine, Childrens Hospital of
Philadelphia, Philadelphia, Pennsylvania Upper Respiratory Tract
Infection Hind M. Gautam, MD Clinical Assistant Professor,
Department of Anesthesiology, Veterans Affairs Medical Center,
Buffalo, New York Magnetic Resonance Imaging Rodolfo Gebhardt, MD
Assistant Professor of Clinical Anesthesiology, Department of
Anesthesiology, Department of Clinical Anesthesiology, Veterans
Affairs Medical Center, Buffalo New York Uncontrolled Pain Jeremy
M. Geiduschek, MD Clinical Professor, Department of Anesthesiology,
University of Washington School of Medicine; Director, Clinical
Anesthesia Services, Department of Anesthesiology, Childrens
Hospital and Regional Medical Center, Seattle, Washington
Intraoperative Cardiac Arrest J. C. Gerancher, MD Associate
Professor and Section Head, Regional Anesthesia and Acute Pain
Management, Department of Anesthesiology, Wake Forest University
School of Medicine, Winston-Salem, North Carolina Epidural
Anesthesia: Unintended Intrathecal Injection; Epidural Anesthesia:
Unintended Subdural Injection Mark S. Gold, MD Distinguished
Professor and Chief, Departments of Psychiatry, Neuroscience,
Anesthesiology, Community Health and Family Medicine, Evelyn and
William McKnight Brain Institute, University of Florida College of
Medicine, Gainesville, Florida Chemical Dependency: Opioids;
Chemical Dependency: Nonopioids Stuart Grant, MD Assistant
Professor, Department of Anesthesiology, Duke University School of
Medicine, Durham, North Carolina Continuous Nerve Blocks:
Perineural Local Anesthetic Infusion Glenn P. Gravlee, MD
Professor, Department of Anesthesiology, Ohio State University
Hospitals, Columbus, Ohio Hemodilution and Blood Conservation Ivar
Gunnarsson, MD Landsptalihsklasjkrahs, Reykjavik, Iceland Oxygen
Flush Valve Mary Ann Gurkowski, MD Professor of Anesthesiology,
University of Texas Health Science Center at San Antonio; Clinical
Staff/Director of Medical Students, Department of
Anesthesiology/Cross- appointed to Otorhinolaryngology, University
Hospital; Attending Staff, Department of Anesthesiology, Audie
Murphy Veterans Affairs Hospital, San Antonio, Texas Foreign Body
Aspiration Jacob Gutsche, MD Physician, Department of Anesthesia,
Hospital of the University of Pennsylvania, Philadelphia,
Pennsylvania Sepsis, Systemic Inflammatory Response Syndrome, and
Multiple Organ Dysfunction Syndrome Thomas S. Guyton, MD Staff
Anesthesiologist, Methodist Healthcare of Memphis, Memphis,
Tennessee Magnesium; Antibiotics Ali Habibi, MD Adjunct Clinical
Faculty, Anesthesiology, Stanford University School of Medicine,
Stanford, California Antihistamines: H1- and H2-Blockers Saeed
Habibi, MD Chair, Department of Anesthesiology, Columbia St.
MarysMilwaukee Campus, Milwaukee, Wisconsin Angioedema and
Urticaria Charles B. Hantler, MD Professor, Department of
Anesthesiology, Washington University School of Medicine, St.
Louis, Missouri Bradyarrhythmias H. David Hardman, MD, MBA
Assistant Clinical Professor, Department of Anesthesiology, Duke
University School of Medicine, Durham, North Carolina Extremity
Tourniquets FM-X2215 8/19/06 3:25 PM Page xiii
10. Barry A. Harrison, MB,BS Assistant Professor of
Anesthesiology, Department of Anesthesiology, Mayo Clinic College
of Medicine, Jacksonville, Florida Hyperglycemia and Diabetic
Ketoacidosis; Sarcoidosis Joy L. Hawkins, MD Professor of
Anesthesiology and Director of Obstetric Anesthesia, University of
Colorado School of Medicine, Denver, Colorado Nonobstetric Surgery
during Pregnancy Christopher M. B. Heard, MB,ChB, FRCA Research
Assistant Professor, Department of Anesthesiology and Division of
Pediatric Critical Care, State University of New York at Buffalo
School of Medicine; Assistant Attending, Childrens Hospital of
Buffalo, Buffalo, New York Magnetic Resonance Imaging; Alleged
Malpractice; The Hostile- Combative Patient Stephen O. Heard, MD
Interim Chair, Professor of Anesthesiology and Surgery, University
of Massachusetts Medical School, Worcester, Massachusetts
Perioperative Care of Immunocompromised Patients James R. Hebl, MD
Assistant Professor, Department of Anesthesiology, Mayo Clinic
College of Medicine, Rochester, Minnesota Anticoagulants and
Peripheral Nerve Block Robert F. Helfand, MD Associate Professor,
Cleveland Clinic Lerner College of Medicine; Staff
Anesthesiologist; Vice Chairman, Department of General
Anesthesiology; Section Head of Orthopedic Anesthesia, Glickman
Urological Center, Cleveland Clinic Foundation, Cleveland, Ohio
Thromboembolic Complications Rosemary Hickey, MD Professor and
Program Director, Department of Anesthesiology, University of Texas
Health Science Center at San Antonio, San Antonio, Texas
Intracranial Hypertension George A. Higgins, BSN, MS, CRNA Adjunct
Faculty, Department of Nursing, University of Southern California;
Senior Nurse Anesthetist, Department of Anesthesiology, Department
of Veterans Affairs Medical Center, Los Angeles, California
Embolization Procedures Scott Holliday, MD Resident, Department of
Anesthesiology, University of Texas Health Science Center at San
Antonio, San Antonio, Texas Foreign Body Aspiration William Hope,
MD, PhD Assistant Professor, Department of Anesthesiology, Medical
College of Wisconsin, Froedtert Memorial Lutheran Hospital East,
Milwaukee, Wisconsin Laryngeal and Tracheal Injury Terese T.
Horlocker, MD Professor, Department of Anesthesiology, Mayo Clinic
College of Medicine, Rochester, Minnesota Spinal Hematoma;
Persistent Paresthesia Liana Hosu, MD Assistant Professor of
Anesthesia and Pediatrics, Department of Anesthesiology, University
of Cincinnati College of Medicine; Staff Anesthesiologist,
Department of Anesthesiology, Cincinnati Childrens Hospital Medical
Center, Cincinnati, Ohio Postoperative Apnea in Infants Kate
Huncke, MD Clinical Associate Professor, Department of
Anesthesiology, New York University School of Medicine, New York,
New York Radiation Oncology Samuel A. Irefin, MD Associate
Professor of Anesthesiology, Cleveland Clinic Lerner College of
Medicine; Staff Anesthesiologist, Department of Anesthesiology and
Critical Care Medicine, Cleveland Clinic Foundation, Cleveland,
Ohio Complications of Thyroid Surgery William Jacobs, MD Associate
Professor, Departments of Psychiatry and Anesthesiology, University
of Florida College of Medicine, Gainesville, Florida Chemical
Dependency: Opioids; Chemical Dependency: Nonopioids Eric
Jacobsohn, MB,ChB, MHPE, FRCPC Associate Professor of
Anesthesiology, Department of Anesthesiology, Washington University
School of Medicine, St. Louis, Missouri Complications after
Pneumonectomy J. Michael Jaeger, MD, PhD Associate Professor of
Anesthesiology and Neurological Surgery; Director, Thoracic
Anesthesia, Department of Anesthesiology, University of Virginia
Health Sciences Center, Charlottesville, Virginia Class IV
Antiarrhythmic Drugs: Calcium Channel Blockers Michael F. M. James,
MB,ChB, PhD, FRCA, FCA(SA) Professor and Head, Department of
Anesthesia, University of Cape Town; Professor and Chief
Anaesthetist, Department of Anaesthesia, Groote Schuur Hospital,
Cape Town, Western Cape, South Africa Complications of Adrenal
Surgery Gregory M. Janelle, MD Assistant Professor, Chief of
Cardiovascular Anesthesia, Department of Anesthesiology, University
of Florida College of Medicine, Gainesville, Florida
Phosphodiesterase Inhibitors David R. Jobes, MD Professor of
Anesthesia, Department of Anesthesia and Critical Care Medicine,
Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
Complications of Massive Transfusion xiv Contributors FM-X2215
8/19/06 3:25 PM Page xiv
11. Contributors xv Nicola Jones, MA, MB,BS, DTM&H, MRCP,
MRCPath, PhD Consultant in Microbiology and Infectious Diseases,
Departments of Microbiology and Infectious Diseases, Nuffield
Department of Clinical Laboratory Sciences, John Radcliffe
Hospital, University of Oxford, Oxford, United Kingdom HIV
Infection and AIDS Shailendra Joshi, MD Assistant Professor of
Anesthesiology, Department of Anesthesiology, College of Physicians
and Surgeons of Columbia University, New York, New York
Arteriovenous Malformation: Normal Perfusion Pressure Breakthrough
Zeev N. Kain, MD Professor of Anesthesiology, Department of
Anesthesiology, Yale University School of Medicine, New Haven,
Connecticut Perioperative Psychological Trauma Wendy B. Kang, MD
Associate Professor and Chair, Residency Education Committee,
Department of Anesthesiology, University of Texas Health Science
Center at San Antonio, San Antonio, Texas Retrobulbar Block
Shubjeet Kaur, MD Clinical Vice Chair, Department of
Anesthesiology, University of Massachussets Memorial Medical
Center, Worcester, Massachusetts Perioperative Care of
Immunocompromised Patients Robert D. Kaye, MD Assistant Professor
of Clinical Anesthesiology and Pediatrics, State University of New
York at Buffalo School of Medicine; Attending Anesthesiologist,
Childrens Hospital of Buffalo, Buffalo, New York Alleged
Malpractice Paul E. Kazanjian, MD Clinical Assistant Professor,
Department of Anesthesiology, University of Michigan Medical
School, Ann Arbor, Michigan Fires in the Operating Room; Pulmonary
Artery Pressure Monitoring Jeffrey S. Kelly, MD Associate Professor
of Anesthesiology, Section of Critical Care, Wake Forest University
School of Medicine, Winston-Salem, North Carolina Complications
from Toxic Ingestion Kevin J. Kelly, MD Professor and Chair,
Department of Pediatrics; Associate Dean, School of Medicine,
Childrens Mercy Hospital and Clinics, University of Missouri,
Kansas City, Missouri Latex Reactions in Health Care Personnel
Robert E. Kettler, MD Associate Professor, Department of
Anesthesiology, Medical College of Wisconsin, Froedtert Memorial
Lutheran Hospital East, Milwaukee, Wisconsin Patients with Seizure
Disorders; Latex Reactions in Health Care Personnel Jonathan T.
Ketzler, MD Associate Professor of Anesthesiology; Associate
Director, Trauma and Life Support Center, Department of
Anesthesiology, University of Wisconsin School of Medicine and
Public Health, Madison, Wisconsin Adrenal Insufficiency Evan D.
Kharasch, MD, PhD Assistant Dean for Clinical Research; Professor
and Research Director, Department of Anesthesiology, University of
Washington School of Medicine, Seattle, Washington Volatile
Anesthetics: Organ Toxicity M. Sean Kincaid, MD Resident,
Department of Anesthesiology, University of Washington Medical
Center, Seattle, Washington Head Injury Kathryn P. King, MD
Associate Clinical Professor, Department of Anesthesiology, Duke
University School of Medicine, Durham, North Carolina
Methylmethacrylate Kai T. Kiviluoma, MD, PhD Associate Professor,
Department of Anaesthesiology, University of Oulu Faculty of
Medicine; Head of the Department, Paediatric Anaesthesia, Oulu
University Hospital, Oulu, Finland Disorders of Potassium Balance
Jerome M. Klafta, MD Associate Professor and Associate Chair for
Education, Department of Anesthesia and Critical Care, University
of Chicago Pritzker School of Medicine, Chicago, Illinois
Mediastinal Masses Pattricia S. Klarr, MD Clinical Assistant
Professor, Department of Anesthesiology, University of Michigan
Medical School; Associate Clinical Director, Department of
Anesthesiology, University of Michigan Medical Center, Ann Arbor,
Michigan Laser Complications Sandra L. Kopp, MD Instructor,
Department of Anesthesiology, Mayo Clinic College of Medicine,
Rochester, Minnesota Supraclavicular and Infraclavicular Block:
Pneumothorax Donald A. Kroll, MD, PhD Staff Anesthesiologist,
Department of Surgery, Veterans Affairs Medical Center, Biloxi,
Mississippi Quality Assurance; Cost Containment; Adverse Outcomes:
Withheld Information or Misinformation Kenneth Kuchta, MD Assistant
Clinical Professor, Department of Anesthesiology, David Geffen
School of Medicine at University of California, Los Angeles, Los
Angeles, California Misidentification of a Patient FM-X2215 8/19/06
3:25 PM Page xv
12. C. Dean Kurth, MD Professor of Anesthesia and Pediatrics,
University of Cincinnati College of Medicine,
Anesthesiologist-in-Chief; Chair, Institute for Pediatric Research;
Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio
Postoperative Apnea in Infants Arthur M. Lam, MD, FRCPC Professor
of Anesthesiology, Department of Anesthesiology, University of
Washington School of Medicine; Head of Neuroanesthesia, Harborview
Medical Center, Seattle, Washington Head Injury Jeffrey L. Lane, MD
Assistant Professor of Clinical Anesthesia and Director, Human
Simulation Laboratory, Department of Anesthesia, Indiana University
School of Medicine; Staff Anesthesiologist, Clarian Health
Partners, Indianapolis, Indiana Postoperative Respiratory
Insufficiency Paul B. Langevin, MD Associate Professor, Department
of Anesthesiology, Veterans AffairsWest Haven, West Haven,
Connecticut Chemotherapeutic Agents Melissa A. Laxton, MD Assistant
Professor of Anesthesiology, Wake Forest University School of
Medicine, Winston-Salem, North Carolina Pituitary Tumors: Diabetes
Insipidus Marcia M. Lee, MD, MBA Assistant Chief, Department of
Anesthesiology, Kaiser PermanenteSouth Bay, Harbor City, California
Awareness under Anesthesia Mijin Lee, MD Assistant Clinical
Professor, Department of Anesthesiology, David Geffen School of
Medicine at University of California, Los Angeles, Los Angeles,
California Anesthesia for Electroconvulsive Therapy Peter J. Lee,
MD, MPH Formerly, Assistant Professor, Department of
Anesthesiology, University of Michigan Medical School, Ann Arbor,
Michigan Central Venous Pressure Monitoring Philip Levin, MD
Associate Professor, Department of Anesthesiology, David Geffen
School of Medicine at University of California, Los Angeles, Los
Angeles, California Postoperative Delirium Jerrold H. Levy, MD
Professor and Department Chair/Research, Department of
Anesthesiology, Emory University School of Medicine, Atlanta,
Georgia Perioperative Hypertension Ian Lewis, MB,BS, MRCP, FRCA
Associate Professor, Department of Anesthesiology, University of
Michigan Medical School, Ann Arbor, Michigan Surgical Diathermy and
Electrocautery Ray P. Liao, MD Acting Assistant Professor,
Department of Anesthesiology, University of Washington School of
Medicine, Seattle, Washington Inotropic Drugs Spencer S. Liu, MD
Clinical Professor of Anesthesiology, Department of Anesthesiology,
Virginia Mason Medical Center, Seattle, Washington Spinal
Anesthesia: PostDural Puncture Headache Emilio B. Lobato, MD
Professor of Anesthesiology, Department of Anesthesiology,
University of Florida College of Medicine; Chief, Cardiovascular
Anesthesia, Department of Anesthesia Service, Malcom Randall
Veterans Affairs Hospital, Gainesville, Florida Digitalis Robert G.
Loeb, MD Associate Professor of Anesthesiology, University of
Arizona College of Medicine, Tucson, Arizona Flowmeters Celeste M.
Lombardi, MD Fellow in Interventional Pain Medicine, Department of
Anesthesiology, University of Florida College of Medicine,
Gainesville, Florida Chronic Nonsteroidal Anti-inflammatory Drug
Use Prashant Lotlikar, MD Clinical Assistant Professor, Department
of Anesthesiology, University of Texas Health Science Center, Texas
Heart Institute, Houston, Texas Troubleshooting Common Problems
during Cardiopulmonary Bypass Michelle L. Lotto, MD Assistant
Professor of Anesthesiology, Department of General Anesthesiology
and Critical Care Medicine, Cleveland Clinic Lerner College of
Medicine; Associate Staff Anesthesiologist, Cleveland Clinic
Foundation, Cleveland, Ohio Complications of Spinal Surgery
Katarzyna Luba, MD Assistant Professor of Clinical Anesthesiology,
Department of Anesthesia and Critical Care, University of Chicago
Pritzker School of Medicine, Chicago, Illinois Perioperative
Management of Patients with Muscular Dystrophy Stewart J. Lustik,
MD Associate Professor of Anesthesiology, University of Rochester
School of Medicine and Dentistry, Rochester, New York Proportioning
Systems; Patient Warming Systems Vinod Malhotra, MD Professor and
Vice Chair for Clinical Affairs, Department of Anesthesiology,
Weill Medical College of Cornell University, New YorkPresbyterian
Hospital, New York, New York Complications of Transurethral Surgery
xvi Contributors FM-X2215 8/19/06 3:25 PM Page xvi
13. Contributors xvii Christina M. Matadial, MD Assistant
Professor, Department of Anesthesiology, Leonard M. Miller School
of Medicine at the University of Miami; Staff Physician, Department
of Anesthesiology, Jackson Memorial Hospital, Miami, Florida
Surgery in the Morbidly Obese Viktoria D. Mayr, MD Resident in
Anesthesiology and Critical Care Medicine, Department of
Anesthesiology and Critical Care Medicine, Medical University
Innsbruck, Innsbruck, Austria Vasopressors: Vasoconstrictor Drugs
Deborah A. McClain, MD Chief, Anesthesiology Section, Veterans
Affairs Medical Center, Biloxi, Mississippi Delayed Emergence
Thomas McCutchen, MD Assistant Professor, Department of
Anesthesiology, Wake Forest University School of Medicine,
Winston-Salem, North Carolina Epidural Anesthesia: Unintended
Intrathecal Injection; Epidural Anesthesia: Unintended Subdural
Injection David L. McDonagh, MD Resident, Department of
Anesthesiology, Duke University School of Medicine, Durham, North
Carolina Autonomic Dysreflexia Susan B. McDonald, MD Staff
Anesthesiologist, Department of Anesthesiology, Virginia Mason
Medical Center, Seattle, Washington Side Effects of Neuraxial
Opioids Lynda J. Means, MD Professor of Anesthesia and Surgery,
Department of Anesthesia, Indiana University School of Medicine,
Indianapolis, Indiana Postobstruction Pulmonary Edema in Pediatric
Patients Mark Meyer, MD Assistant Professor of Clinical Anesthesia,
Department of Anesthesia, University of Cincinnati College of
Medicine; Assistant Professor, Clinical Pediatrics, Cincinnati
Childrens Hospital Medical Center, Cincinnati, Ohio Perioperative
Aspiration Pneumonitis Mohammed Minhaj, MD Assistant Professor,
Department of Anesthesia and Critical Care, University of Chicago
Pritzker School of Medicine, Chicago, Illinois Adverse Neurologic
Sequelae: Peripheral Nerve Injury Vivek Moitra, MD Assistant
Professor of Anesthesiology, Department of Anesthesiology, College
of Physicians and Surgeons of Columbia University, New York, New
York Carotid Endarterectomy Constance L. Monitto, MD Assistant
Professor of Anesthesiology, Department of Anesthesiology and
Critical Care Medicine, Johns Hopkins Medical Institute, Baltimore,
Maryland Muscle Relaxants Terri G. Monk, MD Professor, Department
of Anesthesiology, Duke University Medical Center, Durham, North
Carolina Intraoperative Penile Erection; Complications of Radical
Urologic Surgery Lisa M. Montenegro, MD Assistant Professor of
Anesthesiology, University of Pennsylvania School of Medicine and
Childrens Hospital of Philadelphia; Attending Anesthesiologist,
Department of Anesthesiology, Childrens Hospital of Philadelphia,
Philadelphia, Pennsylvania Complications of Massive Transfusion
Timothy E. Morey, MD Associate Professor of Anesthesiology,
Department of Anesthesiology, University of Florida College of
Medicine, Gainesville, Florida Magnesium; Antibiotics Lucille A.
Mostello, MD Assistant Professor of Anesthesiology and Pediatrics,
Department of Anesthesiology, George Washington University School
of Medicine; Staff Anesthesiologist, Department of Anesthesiology,
Childrens National Medical Center, Washington, DC Latex Allergy
Isobel Muhiudeen-Russell, MD Professor, Department of Anesthesia,
University of California, San Francisco, San Francisco, California
Postoperative Pulmonary Hypertension J. Thomas Murphy, MD, FRCPC
Associate Professor, Department of Anesthesiology, University of
Kentucky College of Medicine, Lexington, Kentucky Disorders of
Water Homeostasis: Hyponatremia and Hypernatremia Catherine
Friederich Murray Research Associate, Department of Anesthesiology,
Mayo Clinic College of Medicine, Jacksonville, Florida Parkinsons
Disease; Alzheimers Disease Michael J. Murray, MD, PhD Professor of
Anesthesiology and Chair, Department of Anesthesiology, Mayo Clinic
College of Medicine, Jacksonville, Florida Parkinsons Disease;
Alzheimers Disease David Muzic, MD Fellow in Cardiac Anesthesia,
Department of Anesthesia and Critical Care, University of Chicago
Pritzker School of Medicine, Chicago, Illinois Adverse Neurologic
Sequelae: Central Neurologic Impairment Nader D. Nader, MD
Associate Professor of Anesthesiology, Surgery and Pathology, State
University of New York at Buffalo School of Medicine, Buffalo, New
York Uncontrolled Pain; Hemodynamic Instability; Cardioversion
FM-X2215 8/19/06 3:25 PM Page xvii
14. Carsten Nadjat-Haiem, MD Assistant Professor, Department of
Anesthesiology, David Geffen School of Medicine at University of
California, Los Angeles, Los Angeles, California Syringe Swaps
Mohamed Naguib, MB,Bch, MSc, FFARCSI, MD Professor, Department of
Anesthesia, Roy J. and Lucille A. Carver College of Medicine,
University of Iowa, Iowa City, Iowa Myasthenic Disorders Bhiken
Naik, MD Fellow, Department of Anesthesiology, University of
Florida College of Medicine, Gainesville, Florida Intrathecal
Opiates; Ketamine; Steroids David A. Nakata, MD Associate Clinical
Professor and Vice Chair, Residency Development, Department of
Anesthesia, Indiana University School of Medicine, Indianapolis,
Indiana Postoperative Peripheral Neuropathy; Intractable Nausea and
Vomiting Charles A. Napolitano, MD, PhD Associate Professor;
Director, Division of Cardiothoracic Anesthesia; Co-Director,
Residency Program, Department of Anesthesiology, University of
Arkansas for Medical Sciences, Little Rock, Arkansas Class II
Antiarrhythmic Drugs: -BlockersHeart Block or Bradycardia Bradly J.
Narr, MD Associate Professor and Chair, Department of
Anesthesiology, Mayo Clinic College of Medicine, Rochester,
Minnesota Porphyrias Krishna M. Natrajan, MB,BS, FRCA Assistant
Professor of Adult and Pediatric Cardiothoracic Anesthesiology,
Department of Anesthesiology, University of Washington School of
Medicine; Attending Anesthesiologist, Department of Anesthesiology,
University of Washington Medical Center, Seattle, Washington
Inotropic Drugs Norah Naughton, MD Associate Professor of
Anesthesiology and Associate Professor of Obstetrics and
Gynecology, University of Michigan Medical School, Ann Arbor,
Michigan Intracranial Pressure Monitoring Patrick Neligan, MD
Assistant Professor, Department of Anesthesia, University of
Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Metabolic Acidosis and Alkalosis Philippa Newfield, MD Assistant
Clinical Professor of Anesthesia and Neurosurgery, University of
California, San Francisco, School of Medicine; Attending
Anesthesiologist, Department of Anesthesiology, California Pacific
Medical Center, San Francisco, California Intracranial Aneurysms:
Rebleeding; Intracranial Aneurysms: Vasospasm and Other Issues
Hector F. Nicodemus, MD Pediatric Anesthesiologist, Department of
Anesthesiology, Holy Cross Hospital, Silver Spring, Maryland
Delayed Emergence in Pediatric Patients Susan C. Nicolson, MD
Professor of Anesthesia, Department of Anesthesia, University of
Pennsylvania School of Medicine; Division Director, Cardiothoracic
Anesthesia, Department of Anesthesiology and Critical Care
Medicine, Childrens Hospital of Philadelphia, Philadelphia,
Pennsylvania Upper Respiratory Tract Infection Susan H. Noorily, MD
Clinical Professor, Department of Anesthesiology, University of
Texas Health Science Center at San Antonio, San Antonio, Texas
Laryngoscopy and Microlaryngoscopy Mark Nunnally, MD Assistant
Professor, Department of Anesthesia and Critical Care, University
of Chicago Pritzker School of Medicine, Chicago, Illinois
Postoperative Acute Renal Failure; Metabolic Acidosis and Alkalosis
Christopher J. OConnor, MD Associate Professor, Department of
Anesthesiology, Rush University Medical Center, Chicago, Illinois
Abdominal Aortic Aneurysm Repair Michael F. OConnor, MD Associate
Professor, Department of Anesthesia and Critical Care, University
of Chicago Pritzker School of Medicine, Chicago, Illinois Thermally
Injured Patients Jerome F. OHara, Jr., MD Associate Professor,
College of Medicine, Case Western Reserve University; Vice
Chairman, Department of General Anesthesiology; Section Head of
Anesthesia, Glickman Urological Center, Urology Department,
Cleveland Clinic Foundation, Cleveland, Ohio Complications of
Lithotripsy Maria A. K. O .. hrn, MD Anesthesiology Associates of
North Florida, PA, North Florida Regional Medical Center,
Gainesville, Florida Nondepolarizing Neuromuscular Relaxants Nollag
ORourke, MD Fellow in Obstetric Anesthesia, Department of
Anesthesia, Brigham and Womens Hospital, Boston, Massachusetts
Pulmonary Aspiration in the Parturient Sheela S. Pai, MD Assistant
Professor, Department of Anesthesiology, Baylor College of
Medicine; Staff Anesthesiologist, Department of Anesthesiology and
Critical Care, Michael E. DeBakey Veterans Affairs Medical Center,
Houston, Texas Mechanical Assist Devices Craig M. Palmer, MD
Professor of Clinical Anesthesiology; Director, Obstetric
Anesthesia, University of Arizona College of Medicine, Tucson,
Arizona Preterm Labor xviii Contributors FM-X2215 8/19/06 3:25 PM
Page xviii
15. Contributors xix C. Lee Parmley, MD, JD Professor of
Anesthesiology, Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, Tennessee Autonomic Hyperreflexia Komal
Patel, MD Fellow in Cardiac Anesthesia, Department of Anesthesia
and Critical Care, University of Chicago Pritzker School of
Medicine, Chicago, Illinois Hypercoagulable States: Thrombosis and
Embolism D. Janet Pavlin, MD Professor, Department of
Anesthesiology, University of Washington School of Medicine; Head
of Teaching and Research in Ambulatory Anesthesia, Department of
Anesthesia, University of Washington Medical Center, Seattle,
Washington Postoperative Urinary Retention Padmavathi Perala, MD
Anesthesiologist, Department of Anesthesiology, Veterans Affairs
Medical Center, Buffalo, New York Hemodynamic Instability Patricia
H. Petrozza, MD Professor of Anesthesiology, Associate Dean for
Graduate Medical Education, Wake Forest University School of
Medicine, Winston-Salem, North Carolina Pituitary Tumors: Diabetes
Insipidus Linda S. Polley, MD Associate Professor, Department of
Anesthesiology, University of Michigan Medical School, Ann Arbor,
Michigan Postpartum Hemorrhage David Porembka, FCCM Professor of
Anesthesia, Surgery and Internal Medicine (Cardiology), Department
of Anesthesiology; Associate Director of Surgical Intensive Care;
Director of Perioperative Echocardiography, University of
Cincinnati College of Medicine, Cincinnati, Ohio Postoperative
Respiratory Failure Claudia Praetel, MD Research Fellow, Department
of Anesthesiology, College of Physicians and Surgeons of Columbia
University, New York, New York Nitrous Oxide: Neurotoxicity Joseph
Previte, MD Associate Professor of Pediatrics and Anesthesiology,
Project Leader of Anesthesia Centricity IS, Cincinnati Childrens
Hospital Medical Center, Cincinnati, Ohio Anesthetic Complications
of Fetal Surgery: EXIT Procedures; Perioperative Aspiration
Pneumonitis Richard C. Prielipp, MD, FCCM JJ Buckley Professor and
Chair, Department of Anesthesiology, University of Minnesota
Medical School, Minneapolis, Minnesota Hypothyroidism: Myxedema
Coma; Hyperthyroidism: Thyroid Storm William Prince, MD Department
of Anesthesiology, Kaiser Permanente Oakland Medical Center,
Oakland, California Central Venous Pressure Monitoring Lester T.
Proctor, MD Professor, Departments of Anesthesiology and
Pediatrics, University of Wisconsin Medical School, Madison,
Wisconsin Blood and Blood Products: Transfusion Reaction Donald S.
Prough, MD Professor and Chair, Department of Anesthesiology,
University of Texas Medical Branch, Galveston, Texas Perioperative
Fluid Management; Posterior Fossa Surgery M. J. Pekka Raatikainen,
MD Division of Cardiology, Oulu University Central Hospital, Oulu,
Finland Adenosine; Class III Antiarrhythmic Drugs: Potassium
Channel Blockers Lee M. Radke, DDS Assistant Professor, Oral and
Maxillofacial Surgery, Medical College of Wisconsin, Froedtert
Memorial Lutheran Hospital, Milwaukee, Wisconsin Dental Injuries
Sivam Ramanathan, MD Professor of Anesthesiology, University of
Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh,
Pennsylvania Humidifiers; Peripartum Neurologic Complications James
G. Ramsay, MD Professor of Anesthesiology, Program Director,
Anesthesiology Critical Care Medicine, Department of Anesthesia,
Emory University School of Medicine; Anesthesiology Service Chief,
Department of Anesthesiology, Emory University Hospital, Atlanta,
Georgia Central Venous Pressure Monitoring Monica N. Riesner, MD
Lecturer, Obstetric Anesthesia, Department of Anesthesiology,
University of Michigan Medical School, Ann Arbor, Michigan
Postpartum Hemorrhage Edward T. Riley, MD Associate Professor,
Department of Anesthesia, Stanford University School of Medicine,
Stanford, California Antihistamines: H1- and H2-Blockers Pamela R.
Roberts, MD, FCCM, FCCP Professor and Division Chief, Critical Care
Medicine, John A. Moffitt Endowed Chair, Department of
Anesthesiology, University of Oklahama Health Science Center,
Oklahoma City, Oklahoma Hypothyroidism: Myxedema Coma;
Hyperthyroidism: Thyroid Storm FM-X2215 8/19/06 3:25 PM Page
xix
16. Kerri M. Robertson, MD Associate Clinical Professor of
Anesthesiology; Chief, General, Vascular, High-Risk Transplant and
Surgical Critical Care Medicine Division; Chief, Transplant
Services, Duke University School of Medicine, Department of
Anesthesiology, Durham, North Carolina Postoperative Hepatic
Dysfunction; Complications of Carcinoid Tumors; Complications of
Deliberate Hypotension: Visual Loss Marnie Robinson, MD Assistant
Professor of Anesthesiology and Pediatrics, Department of
Anesthesiology, University of Cincinnati College of Medicine,
Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio
Anesthetic Complications of Fetal Surgery: EXIT Procedures John B.
Rose, MD Director, Pain Management Service, Department of
Anesthesiology and Critical Care Medicine, Childrens Hospital of
Philadelphia, Philadelphia, Pennsylvania Delayed Emergence in
Pediatric Patients Mark I. Rossberg, MD Assistant Professor of
Anesthesiology, Department of Anesthesia and Critical Care
Medicine, Johns Hopkins Medical Institute, Baltimore, Maryland
Postintubation Croup David M. Rothenberg, MD Professor of
Anesthesiology; Associate Dean, Academic Affiliations; Co-Medical
Director, Surgical Intensive Care Unit, Rush University Medical
Center, Chicago, Illinois Acute Pancreatitis Daniel D. Rubens,
MB,BS, FANZCA Assistant Professor, Department of Anesthesia,
University of Washington School of Medicine, Childrens Hospital and
Regional Medical Center, Seattle, Washington Intraoperative Cardiac
Arrest Senthilkumar Sadhasivam, MD Assistant Professor in
Anesthesia and Pediatrics, Department of Anesthesia, University of
Cincinnati College of Medicine, Cincinnati Childrens Hospital
Medical Center, Cincinnati, Ohio Postoperative Nausea and Vomiting
Tetsuro Sakai, MD, PhD Resident, Department of Anesthesiology,
University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania Complications in Orthopedic Outpatients Not Receiving
Peripheral Nerve Blocks Francis V. Salinas, MD Clinical Assistant
Professor, Department of Anesthesiology, University of Washington
School of Medicine; Staff Anesthesiologist, Department of
Anesthesiology, Virginia Mason Medical Center, Seattle, Washington
Local Anesthetic Systemic Toxicity Theodore J. Sanford, Jr., MD
Clinical Professor of Anesthesiology, Department of Anesthesiology,
University of Michigan Medical School, Ann Arbor, Michigan
Difficult Airway: Opiate-Induced Muscle Rigidity Ramachandran
Satya-Krishna, MD, FRCA Lecturer, Department of Anesthesiology,
University of Michigan Medical School, Ann Arbor, Michigan;
Consultant, Department of Anaesthesia, John Radcliffe Hospital,
Oxford, United Kingdom Anesthesia Circuit Scott R. Schulman, MD
Associate Professor of Anesthesiology and Pediatrics, Division of
Pediatric Anesthesia and Critical Care Medicine, Duke University
Medical Center, Durham, North Carolina Malignant Hyperthermia
Annette Schure, MD Anesthesiologist and Pediatric Anesthesiologist,
Department of Anesthesia, Tufts-New England Medical Center, Boston,
Massachusetts Thoracic Aortic Aneurysm Jeffrey J. Schwartz, MD
Associate Professor, Department of Anesthesiology, Yale University
School of Medicine; Attending Physician, Department of
Anesthesiology, Yale-New Haven Hospital, New Haven, Connecticut
Electrical Safety Christian Seefelder, MD Assistant in Anaesthesia,
Harvard Medical School; Instructor in Anaesthesia, Department of
Anaesthesiology, Perioperative and Pain Medicine, Childrens
Hospital, Boston, Massachusetts Air Emboli Rajamani Sethuraman, MD,
FRCA Consultant Anaesthetist, Department of Anaesthesia, Princess
Alexandra Hospital, Essex, United Kingdom Intravenous Drug Delivery
Systems Christoph N. Seubert, MD Assistant Professor, Department of
Anesthesiology, University of Florida College of Medicine,
Gainesville, Florida Barbiturates: Porphyrias Jack S. Shanewise, MD
Chief, Division of Cardiothoracic Anesthesiology, Department of
Anesthesiology, College of Physicians and Surgeons of Columbia
University, New York, New York Transesophageal Echocardiography
Kelly T. Shannon, MD Associate Professor of Anesthesiology,
University of Pittsburgh School of Medicine; Associate Chief,
Department of Anesthesiology, Magee-Womens Hospital, Pittsburgh,
Pennsylvania Humidifiers Gauhar Sharih, MD, FRCA Formerly, Visiting
Instructor, Department of Anesthesiology, University of Michigan
Medical School, Ann Arbor, Michigan; Specialist Registrar,
Department of Anaesthetics, City Hospital, Birmingham, West
Midlands, United Kingdom Inspiratory and Expiratory Gas Monitoring
xx Contributors FM-X2215 8/19/06 3:25 PM Page xx
17. Contributors xxi Aarti Sharma, MD, DA(UK) Assistant
Professor of Anesthesiology, Department of Anesthesiology, Weill
Medical College of Cornell University; Attending Anesthesiologist,
Department of Anesthesiology, New YorkPresbyterian Hospital, New
York, New York Complications of Deliberate Hypotension: Visual Loss
Robert N. Sladen, MD Professor and Vice Chair, Department of
Anesthesiology; Chief, Division of Critical Care, College of
Physicians and Surgeons of Columbia University, New York, New York
Postoperative Acute Renal Failure; Hypothermia Peter D. Slinger, MD
Professor of Anesthesia, Department of Anesthesiology, Toronto
General Hospital, Toronto, Ontario, Canada One-Lung Ventilation Tod
B. Sloan, MD Professor of Anesthesiology, University of Colorado
Health Sciences Center, Denver, Colorado Spinal Cord Injury
Jonathan H. Slonin, MD Chief Resident, Department of
Anesthesiology, Leonard M. Miller School of Medicine at the
University of Miami, Miami, Florida Surgery in the Morbidly Obese
Paul Smythe, MD Assistant Professor of Anesthesiology, University
of Michigan Medical School; Adjunct Clinical Lecturer in Dentistry,
Department of Oral and Maxillofacial Surgery/Hospital Dentistry,
University of Michigan School of Dentistry, Ann Arbor, Michigan
Intracranial Pressure Monitoring Jennifer E. Souders, MD Clinical
Associate Professor, Department of Anesthesiology, University of
Washington School of Medicine, Seattle, Washington Venous Air
Embolism Scott R. Springman, MD Professor, Departments of
Anesthesiology and Surgery, University of Wisconsin Medical School,
Madison, Wisconsin Preanesthetic Evaluation: False-Positive Tests;
Preanesthetic Evaluation: Inadequate or Missing Test Result James
M. Steven, MD Associate Professor of Anesthesia and Pediatrics,
Department of Anesthesia, University of Pennsylvania School of
Medicine; Chief Medical Officer, Childrens Hospital of
Philadelphia, Philadelphia, Pennsylvania Upper Respiratory Tract
Infection Robert K. Stoelting, MD Emeritus Professor and Chair,
Department of Anesthesia, Indiana University School of Medicine,
Indianapolis, Indiana Postoperative Peripheral Neuropathy;
Intractable Nausea and Vomiting Mark D. Stoneham, MD, FRCA Honorary
Senior Clinical Lecturer, Nuffield Department of Anaesthesia, John
Radcliffe Hospital, Oxford, United Kingdom Pulse Oximetry E. Price
Stover, MD* Clinical Assistant Professor, Department of Anesthesia,
Stanford University Medical Center, Stanford, California
Nonbarbiturate Anesthetics Laura Stover, MD, MASc, FRCP(C) Acting
Instructor, Department of Anesthesiology, University of Washington
School of Medicine; Acting Instructor, Department of Cardiothoracic
Anesthesiology, University of Washington Medical Center, Seattle,
Washington; Assistant Professor of Anesthesiology, Hamilton Health
Sciences, Hamilton, Ontario, Canada Drugs Affecting the
Renin-Angiotensin System Vijayendra Sudheendra, MD Clinical
Instructor, Department of Surgery and Anesthesiology, Brown
University School of Medicine; Staff Anesthesiologist, Miriam
Hospital, Providence, Rhode Island; Chief of Anesthesia, East Bay
Surgery Center, Swansea, Massachusetts Complications of
Transurethral Surgery Kevin J. Sullivan, MD Assistant Professor of
Anesthesiology, Mayo Clinic College of Medicine; Clinical Assistant
Professor of Pediatrics, University of Florida College of Medicine,
Jacksonville; Staff Member, Department of Anesthesiology, Nemours
Childrens Clinic; Staff Pediatric Anesthesiologist and Intensivist,
Department of Anesthesia and Critical Care Medicine, Wolfson
Childrens Hospital, Jacksonville, Florida Anticholinergics;
Hypothermia in Pediatric Patients Christer H. Svensn, MD Associate
Professor, Department of Anesthesiology, University of Texas
Medical Branch, Galveston, Texas Perioperative Fluid Management
James F. Szocik, MD Associate Professor, Department of
Anesthesiology, University of Michigan Medical School; Chair,
Technical Support Committee, Department of Anesthesiology,
University of Michigan Medical Center, Ann Arbor, Michigan Pipeline
Source Failure Kenichi A. Tanaka, MD Assistant Professor,
Department of Anesthesiology, Emory University School of Medicine,
Atlanta, Georgia Perioperative Hypertension Mark D. Tasch, MD
Associate Professor of Clinical Anesthesia, Department of
Anesthesia, Indiana University School of Medicine, Indianapolis,
Indiana Pulmonary Aspiration *Deceased FM-X2215 8/19/06 3:25 PM
Page xxi
18. Peter Tassani-Prell, MD Professor of Cardiac Anesthesia,
Department of Anesthesia, German Heart Center Munich, Mnchen,
Germany Anticoagulation Initiation and Reversal for Cardiac
Surgery; Bleeding after Cardiac Surgery Lisa Thannikary, MD Adjunct
Assistant Professor, Department of Anesthesiology, University of
Florida College of Medicine, Gainesville, Florida Intrathecal
Opiates; Ketamine; Steroids Klaus D. Torp, MD Assistant Professor
of Anesthesiology, Department of Anesthesiology, Mayo Clinic
College of Medicine, Jacksonville, Florida Perioperative Management
of Dialysis-Dependent Patients Laurence C. Torsher, MD Assistant
Professor of Anesthesiology, Department of Anesthesiology, Mayo
Clinic College of Medicine, Rochester, Minnesota Perioperative Care
for Patients with Hepatic Insufficiency (Cirrhosis) Mark F.
Trankina, MD Staff Anesthesiologist, Carraway Methodist Medical
Center and University of Alabama Hospital at Birmingham,
Birmingham, Alabama Class I Antiarrhythmic Drugs: Ventricular
Proarrhythmia Kenneth W. Travis, MD Associate Professor Emeritus,
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center,
Lebanon, New Hampshire Postobstruction Pulmonary Edema Lawrence C.
Tsen, MD Associate Professor of Anesthesia, Department of
Anesthesia, Harvard Medical School; Director of Anesthesia, Center
for Reproductive Medicine, Department of Anesthesiology,
Perioperative and Pain Medicine, Brigham and Womens Hospital,
Boston, Massachusetts Antepartum Hemorrhage Avery Tung, MD
Associate Professor, Department of Anesthesia and Critical Care,
University of Chicago Pritzker School of Medicine, Chicago,
Illinois Major Organ System Dysfunction after Cardiopulmonary
Bypass; Mechanical Assist Devices; Thermally Injured Patients
Manuel C. Vallejo, MD, DMD Associate Professor, Department of
Anesthesiology, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania Peripartum Neurologic Complications Gail
A. Van Norman, MD Clinical Associate Professor of Anesthesiology,
Affiliate Associate Professor of Medical History and Ethics,
University of Washington School of Medicine, Seattle, Washington;
Physician, Department of Anesthesiology, St. Joseph Medical Center,
Tacoma, Washington Patient Confidentiality; Do-Not-Resuscitate
Orders in the Operating Room; The Jehovahs Witness Patient Karen M.
Van Tassel, MD Chief Resident, Department of Anesthesiology, Duke
University Medical Center, Durham, North Carolina Malignant
Hyperthermia Gurinder M. S. Vasdev, MB,BS Assistant Professor of
Anesthesiology, Department of Anesthesiology, Mayo Clinic College
of Medicine, Rochester, Minnesota Cardiopulmonary Bypass in
Pregnancy Melissa M. Vu, MD Instructor of Anesthesiology,
Department of Anesthesiology, Mayo Clinic College of Medicine,
Jacksonville, Florida Hyperthermia Mehernoor F. Watcha, MD
Associate Professor of Anesthesia, Department of Anesthesiology and
Critical Care Medicine, University of Pennsylvania School of
Medicine, Childrens Hospital of Philadelphia, Philadelphia,
Pennsylvania Postoperative Nausea and Vomiting Eileen Watson, MD
Clinical Assistant Professor, Department of Anesthesiology, State
University of New York at Buffalo; Attending Anesthesiologist,
Childrens Hospital of Buffalo, Buffalo, New York Hemodynamic
Instability B. Craig Weldon, MD Associate Professor, Department of
Anesthesiology and Pediatrics, Duke University School of Medicine,
Durham, North Carolina Cardiomyopathies; Emergence Agitation Robert
S. Weller, MD Associate Professor of Anesthesiology, Department of
Anesthesiology, Wake Forest University School of Medicine; Staff
Anesthesiologist, Department of Anesthesiology, North Carolina
Baptist Hospitals, Inc., Winston-Salem, North Carolina Psoas
Compartment Block: Potential Complications Lynda Wells, MD
Associate Professor of Anesthesiology, University of Virginia
Health System, Charlottesville, Virginia Pediatric Neurosurgery
Volker Wenzel, MD, MSc Associate Professor of Anesthesiology and
Critical Care Medicine, Department of Anesthesiology and Critical
Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
Vasopressors: Vasoconstrictor Drugs Harshdeep Wilkhu, MD Clinical
Assistant Professor, Department of Anesthesiology, University of
Florida College of Medicine, Gainesville, Florida Nonbarbiturate
Anesthetics xxii Contributors FM-X2215 8/19/06 3:25 PM Page
xxii
19. Contributors xxiii Brian A. Williams, MD Associate
Professor, Department of Anesthesiology, University of Pittsburgh
School of Medicine; Director of Outpatient Regional Anesthesia
Service, Department of Anesthesiology, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania Complications in
Orthopedic Outpatients Not Receiving Peripheral Nerve Blocks Glyn
D. Williams, MB,ChB, FFA Associate Professor, Department of
Anesthesia, Stanford University School of Medicine, Lucile Packard
Childrens Hospital, Palo Alto, California Catheter Ablation for
Arrhythmias Lisa Wise-Faberowski, MD Assistant Professor,
Departments of Anesthesiology and Pediatrics, University of
Colorado School of Medicine, Denver, Colorado Antidepressants; Air
Emboli Eric P. Wittkugel, MD Associate Professor of Clinical
Anesthesia and Critical Care; Staff Anesthesiologist; Director,
Preoperative Services, Cincinnati Childrens Hospital Medical
Center, Cincinnati, Ohio Pediatric Laryngospasm David J. Wlody, MD
Clinical Associate Professor of Anesthesiology and Vice Chair for
Clinical Affairs, Department of Anesthesiology, State University of
New York-Downstate Medical Center; Interim Chair, Department of
Anesthesiology, Long Island College Hospital, Brooklyn, New York
Postpartum Headache Other Than PostDural Puncture Headache Gilbert
Y. Wong, MD Assistant Professor of Anesthesiology and Consultant
Physician, Division of Pain Medicine, Department of Anesthesiology,
Mayo Clinic College of Medicine, Rochester, Minnesota Celiac Plexus
Block: Side Effects and Complications Brian J. Woodcock, MD
Assistant Professor of Anesthesiology, Department of
Anesthesiology, University of Michigan Medical School, Ann Arbor,
Michigan Mechanical Ventilators Christopher C. Young, MD, FCCM
Assistant Clinical Professor of Surgery, Associate Clinical
Professor of Anesthesiology, Chief of Critical Care Medicine
Division, Department of Anesthesiology, Duke University School of
Medicine, Durham, North Carolina Hypothermia William L. Young, MD
James P. Livingston Professor and Vice Chair, Department of
Anesthesia and Perioperative Care, University of California, San
Francisco, San Francisco General Hospital, San Francisco,
California Arteriovenous Malformation: Normal Perfusion Pressure
Breakthrough Christine M. Zainer, MD Assistant Professor of
Anethesiology, Department of Anesthesiology, Medical College of
Wisconsin, Froedtert Memorial Lutheran Hospital East, Milwaukee,
Wisconsin Herbals and Alternative Medicine Mark A. Zakowski, MD
Chief, Section of Obstetric Anesthesia, Department of
Anesthesiology, Cedars-Sinai Medical Center, Los Angeles,
California Peripartum Neurologic Complications Paul B. Zanaboni,
MD, PhD Anesthesiologist, St. Johns Mercy Health Care, St. Louis,
Missouri Bradyarrhythmias R. Victor Zhang, MD, PhD Assistant
Professor, Department of Anesthesiology, University of Florida
College of Medicine, Gainesville, Florida a2-Adrenoreceptor
Agonists FM-X2215 8/19/06 3:25 PM Page xxiii
20. First, I wish to acknowledge the contributions to this work
of my wife Barbara, my in-house administrative and editorial
assistant. Thank you, Barbara! Your literary skills (you did major
in English and minor in Philosophy) were much needed and greatly
appreciated! I am deeply indebted to the Section Editors for this
edition of Complications in Anesthesia, some of whom were Section
Editors for the first edi- tion as well. Organizing the topics for
their sections or subsections, recruiting con- tributors, and
seeing to it that the chapter manuscripts were submitted and
pre-edited in a timely fashion were some of their tasks. Special
appreciation goes to Natasha Andjelkovic (Executive Publisher),
Jean Nevius (Senior Developmental Editor), and Amy Norwitz (Senior
Project Manager). Once again, I salute Lewis Reines (former
President of WB Saunders) and Leslie Day (former Medical Editor at
WB Saunders), who in 1996-1997 convinced me of the need for this
conceptu- ally new work as a resource for busy practitioners in
anesthesia and critical care. Finally, I express my sincere
appreciation to John P. Kampine, MD, PhD, former Professor and
Chair of the Department of Anesthesiology at the Medical College of
Wisconsin, and to my colleagues in that department (some of whom
have con- tributed to this work) for providing me the time and
encouragement for yet again undertaking this work. John L. Atlee,
MD Acknowledgments xxv FM-X2215 8/19/06 3:25 PM Page xxv
21. VASOACTIVE DRUGS Vasodilator Drugs Jrg Dziersk 1 Case
Synopsis A 90-year-old man with severe aortic stenosis, stable
angina, and pulmonary hyperten- sion has surgery under general
anesthesia for a femoral neck fracture. Owing to the associated
cardiac morbidities, the anesthesiologist inserts a pulmonary
artery catheter. Despite maintenance of normoxemia and mild
hypocapnia, the patients pulmonary artery pressure rises from 60/25
to 70/35 mm Hg and is associated with signs of right ventricular
strain. A nitroglycerin infusion is started at 0.2 g/kg per minute.
The pulmonary artery pressure returns to near baseline values, and
the systemic blood pressure decreases from 125/90 to 75/30 mm Hg.
PHARMACOLOGY PROBLEM ANALYSIS Definition Left-sided heart disease
(e.g., mitral valve disease, aortic stenosis, left ventricular
failure) often causes significant pul- monary venous pressure
elevation and leads to compensa- tory pulmonary artery (PA)
hypertension. Chronic elevation of PA pressure promotes
compensatory right ventricular (RV) hypertrophy and pulmonary
vascular remodeling. This, in turn, results in increased pulmonary
vascular resist- ance (PVR). For such patients, acute (or
acute-on-chronic) increases in PA pressure are often poorly
tolerated. The consequences are RV dilatation, significant
tricuspid regur- gitation, and reduced cardiac output secondary to
reduced venous return and impaired left ventricular filling.
Together, they may lead to a downward spiral. When RV systolic
pressure exceeds aortic blood pressure, RV coronary perfu- sion is
limited to diastole, which may further impair RV performance.
Vasodilating drugs act by reducing the contraction of vascular
smooth muscle cells through a reduction in cyto- plasmic Ca2+
concentration [Ca2+ ]. Vascular smooth muscle relaxation may be
mediated by the following: Increased intracellular cyclic adenosine
monophosphate (e.g., 2-adrenoceptor agonists, epoprostenol)
Increased intracellular cyclic guanosine monophosphate (e.g.,
nitric oxide, nitroglycerin, sodium nitroprusside, brain
natriuretic peptide) KATP channel-opening-related hyperpolarization
(e.g., diazoxide) 1-Adrenoceptor antagonism (e.g., phentolamine)
Ca2+ channel blockade (e.g., diltiazem, nicardipine, verapamil)
Reduction of central sympathetic tone (e.g., clonidine) Properties
of an ideal vasodilator for perioperative use include (1) short
onset time, (2) short to intermediate duration of action, (3)
elimination independent of organ function (i.e., renal or hepatic),
and (4) lack of serious side effects or toxicity. At this time,
there is no single drug that meets all these criteria. Clinical
actions, mechanisms of action, and side effects of vasodilators
currently available for intra- venous or inhalational
administration are listed in Table 1-1. Recognition Systemic
vasodilatation causes a decline in systemic blood pressure, the
extent of which depends on circulating blood volume and venous
return (cardiac preload), the adequacy of compensatory mechanisms
(i.e., reflex increase in heart rate and contractility), and the
cardiac ejection fraction (normal or reduced). The skin appears
warm and may be flushed, with a shortened capillary refill time.
Organ dys- function may occur if systemic blood pressure is below
the respective autoregulation threshold or if flow in a vascular
territory is pressure dependent (e.g., in the presence of coro-
nary artery disease, renal artery stenosis, head injury).
Myocardial injury, acute renal failure, or neurologic deficits are
typical examples of complications of systemic hypoten- sion.
Computation of systemic vascular resistance quantifies the average
degree of vasodilatation (or vasoconstriction) in the whole body,
but it requires a precise measurement of mean arterial pressure and
central venous pressure, as well as a determination of cardiac
output. A PA catheter equipped for thermodilution cardiac output is
necessary. In the presence of PA hypertension, systemic vasodilata-
tion may allow right-to-left shunting of blood through a patent
foramen ovale, leading to a diminished arterial oxygen saturation.
Reduced RV preload due to venous pool- ing and RV myocardial
perfusion pressure may compromise RV performance and result in a
low cardiac output state. Risk Assessment Vasodilator therapy has
an increased potential to cause com- plications in patients with
the following conditions: Hypovolemia Stenotic valvular lesions
(especially severe aortic stenosis) Hypertrophic-obstructive
cardiomyopathy 3 Ch001-X2215 8/12/06 3:05 PM Page 3
22. 4 Section 1 Pharmacology Table 11 Vasodilators Available
for Intravenous or Inhalational Administration Principal Action and
Drug Class and Drug* Terminal Half-life Mechanism of Action Side
Effects and Problems 1-Antagonists Arterial > venous
vasodilatation Labetalol 5-8 hr Competitive adrenoceptor blockade
Bradycardia (1: = 1:7) Drug fever Phentolamine 19 min (IV)
Competitive 1- = 2-adrenoceptor Reflex tachycardia blockade
Hypoglycemia Direct action on VSM Urapidil 2.7 hr Competitive
1-adrenoceptor blockade 2-Adrenoceptor Competitive 2-adrenoceptor
block Agonists Clonidine 8-16 hr Central sympathetic vasomotor tone
Bradycardia Inhibits peripheral NE release Potentiates
anesthetic/narcotic sedation Slow IV onset (30-60 min) Nitric Oxide
and Activation of guanylyl cyclase cGMP Donors Nitric oxide 6 sec
Inhibits platelet aggregation Pulmonary edema secondary to
contaminants (NO2) and metabolites (peroxynitrite)
Methemoglobinemia Nitroglycerin 2-8 min Venous > arterial
vasodilatation Tachyphylaxis NO or S-nitrosothiol release by
Methemoglobinemia metabolism activation of guanylyl cyclase Sodium
nitroprusside 3-4 min Arterial venous vasodilatation Cyanide
toxicity, especially with higher NO release by red cell metabolism
doses and lengthy infusions activation of guanylyl cyclase
Thiocyanate toxicity (lengthy infusions) Methemoglobinemia Reflex
tachycardia Calcium Channel Block L-type Ca2+ channels
Vasodilatation unpredictable Blockers Primary arterial dilators (no
Little effect in PA HTN venodilatation at therapeutic doses)
Diltiazem 3-6 hr Moderate negative inotrope AV conduction blockade
Nicardipine 8.6 hr Does not block L-type cardiac Ca2+ (infusions 48
hr) channels (little or no effect on contractility or AV
conduction) Verapamil 2-8 hr Significant negative inotrope
Depresses sinus node Blocks AV node conduction Longer half-life
with chronic use Angiotensin-Converting Arterial vasodilatation
Enzyme Inhibitors Vascular remodeling Enalaprilat 11 hr Inhibits
generation of angiotensin II Possibly severe (first dose)
Stimulates kallikrein-kinin system Acute renal failure K+ ,
especially with renal failure No effect on PA HTN (given acutely)
Slow IV onset (>15 min) Prostaglandins with Activation of
adenylyl cyclase cAMP Severe systemic hypotension with IV VSM
Relaxing Effect dosing (common) Inhibition of platelet aggregation
and adhesion Alprostadil (PGE1) 5-10 min Stimulates coughing
(inhalational use) Epoprostenol (PGI2) 3-5 min Iloprost 13-30 min
Natriuretic Peptides Arterial and venous vasodilatation Brain
natriuretic 18 min Stimulation of natriuretic peptide peptide
receptor A activation of guanylyl cyclase domain cGMP Inhibits
renin-aldosterone axis Miscellaneous Agents Adenosine 7.5) may
produce further pulmonary vasorelaxation but adversely affects
oxygen delivery and enzyme function. High endogenous catecholamine
levels cause pul- monary vasoconstriction through the stimulation
of 1- adrenoceptors. These high levels can be avoided or treated by
providing adequate anesthetic depth and postoperative analgesia.
Finally, it should be remembered that lung inflation above
functional residual capacity causes a progressive increase in PVR.
Ventilator settings should be adjusted, based on the patients
pulmonary function, to provide ade- quate oxygenation and carbon
dioxide elimination while keeping mean intrathoracic pressure to a
minimum. Pharmacologic pulmonary vasodilatation without con-
comitant systemic vasodilatation, as was required in the case
described here, can be attained in two ways: 1. Inhalation of a
short-acting vasodilator, such as nitric oxide (NO) or prostacyclin
(epoprostenol) 2. Coadministration of an intravenous pulmonary
vasodila- tor (e.g., nitroglycerin, nitroprusside, epoprostenol)
and a pulmonary vasculature-sparing vasoconstrictor (e.g.,
vasopressin or its synthetic analogue terlipressin). NO activates
soluble guanylyl cyclase to increase cyclic guanosine monophosphate
levels in vascular smooth muscle. It is inactivated by the heme
moiety of hemoglobin and superoxide anions and has a blood
half-life of approxi- mately 6 seconds. Therefore, inhaled NO
affects predominantly PHARMACOLOGY Chapter 1 Vasodilator Drugs 5
Table 11 Vasodilators Available for Intravenous or Inhalational
Administrationcontd Principal Action and Drug Class and Drug*
Terminal Half-life Mechanism of Action Side Effects and Problems
Diazoxide 20-45 hr Opens KATP channels hyperpolarization Sodium and
water retention and arteriolar vasodilatation Hyperglycemia
Fenoldopam 5-10 min Dopamine (DA1) agonist Reflex tachycardia
arteriolar vasodilatation Hypokalemia Nausea Hydralazine 2-4 min
Arterial vasodilatation only Slow IV onset (5-15 min) Reflex
tachycardia (quite common) Sodium and water retention Lupus-like
syndrome (slow acetylators) *Drugs with vasodilator activity used
principally for their sympathomimetic effects (e.g., 2-adrenoceptor
agonists, phosphodiesterase-3 inhibitors) are not included.
Urapidil is widely used in Europe but is currently not available in
the United States. AV, atrioventricular; cAMP, cyclic adenosine
monophosphate; cGMP, cyclic guanosine monophosphate; HTN,
hypertension; IV, intravenous; NE, norepinephrine; NO, nitric
oxide; NO2, nitrogen dioxide; PA, pulmonary artery; PG,
prostaglandin; VSM, vascular smooth muscle. Ch001-X2215 8/12/06
3:05 PM Page 5
24. the tone of pulmonary vessels in ventilated lung areas but
has negligible effects on systemic vascular resistance. Broader
application is currently limited by its very high cost and the
special equipment required for its administration. Prostacyclin
(PGI2, epoprostenol) and its synthetic ana- logue iloprost are the
most potent pulmonary vasodilators known. Their main application is
continuous infusion in cases of severe pulmonary hypertension.
Their vasodilator action is mediated by cyclic adenosine
monophosphate. Intravenous administration frequently causes
prohibitive systemic hypotension, but when administered via inhala-
tion, the effectiveness is comparable to that of inhaled NO.
Arginine vasopressin is a vasoactive nonapeptide pro- duced in the
hypothalamus. It is an agonist at three specific receptor types.
Stimulation of the V1a receptor results in con- traction of
systemic vascular smooth muscle by means of an intracellular
activation pathway shared with angiotensin II. Successful use of
arginine vasopressin in vasodilatory shock after cardiopulmonary
bypass and in hyperdynamic septic shock has been reported. The
advanced cardiovascular life support guidelines of 2000 recommend
vasopressin as an alternative to epinephrine in patients with
refractory ventricular fibrillation. In contradistinction to the
pul- monary vascular effects of other vasoconstrictors (e.g., 1-
adrenoceptor agonists, angiotensin II), vasopressin has been shown
to cause pulmonary and cerebral artery vasodilatation, possibly
through receptor-mediated local NO release. It may be the
vasopressor drug of choice in patients with signifi- cantly
elevated PVR or RV failure. PREVENTION Preventing the complications
of vasodilator use is based on an understanding of the patients
pathophysiology and the pharmacology of available drugs.
Vasodilators are used to advantage based on their specific
profiles, always keeping in mind any undesired or dangerous side
effects. For instance,in a patient with aortic stenosis and
coronary artery disease, both systemic hypotension and tachycardia
must be avoided. In the case described in this chapter,
nitroglycerin would be a reasonable choice for treatment of
pulmonary hypertension, because it produces less relaxation of
systemic resistance vessels than do other pulmonary vasodilators
and does not cause a reflex tachycardia. Use of vasodilators in the
perioperative period should take into account the common occurrence
of hypovolemia due to preoperative fluid restriction,
intraoperative fluid shifts or blood loss, and globally or
regionally reduced sym- pathetic tone in anesthetized patients.
Careful dose titration of vasodilators is advisable and is
facilitated by using drugs with short half-lives. Vasodilator
therapy for pulmonary hypertension coincides with the appropriate
manipulation of physiologic factors known to affect PVR.
Inhalational administration of NO or epoprostenol, if feasible, may
help avoid unwanted systemic venodilatation or arterial
vasodilatation effects. Finally, always keep in mind that
adrenoceptor antago- nists and vasodilators attenuate sympathetic
responses, possibly masking the clinical signs of inadequate depth
of anesthesia.The use of a depth-of-anesthesia monitor is encour-
aged, especially when neuromuscular blockers are used. Further
Reading Balser JR, Butterworth J: Cardiovascular drugs. In Hensley
FA Jr, Martin DE, Gravlee GP (eds): A Practical Approach to Cardiac
Anesthesia, 3rd ed. Philadelphia, JB LippincottWilliams &
Wilkins, 2003. Barnes PJ, Liu SF: Regulation of pulmonary vascular
tone. Pharmacol Rev 47:87-131, 1995. Eagle KA, Berger PB, Calkins
H, et al: ACC/AHA Guideline Update on Peri- operative
Cardiovascular Evaluation for Noncardiac Surgery, 2002. American
College of Cardiology Web site available at http://www.acc.org/
clinical/ guidelines/perio/dirIndex.htm Frishman WH, Sonnenblick
EH, Sica DH (eds): Cardiovascular Pharmacotherapeutics, 2nd ed. New
York, McGraw-Hill, 2003. Katzung BG (ed): Basic & Clinical
Pharmacology, 9th ed. New York, Lange Medical Books/McGraw-Hill,
2004. Malouf JF, Enriquez-Sarano M, Pellikka PA, et al: Severe
pulmonary hypertension in patients with severe aortic valve
stenosis: Clinical profile and prognostic implications. J Am Coll
Cardiol 40:789-795, 2002. Olschewski H, Rose F, Schermuly R, et al:
Prostacyclin and its analogues in the treatment of pulmonary
hypertension. Pharmacol Ther 102:139-153, 2004. Reich DL, Bodian
CA, Krol M, et al: Intraoperative hemodynamic predic- tors of
mortality, stroke, and myocardial infarction after coronary artery
bypass surgery. Anesth Analg 89:814-822, 1999. 6 Section 1
Pharmacology Ch001-X2