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Clinical Anesthesia Fundamentals LWBK1406-FM.indd 3 23/02/15 9:36 AM Clinical Anesthesia Fundamentals Edited By Paul G. Barash, MD Professor Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist Yale-New Haven Hospital New Haven, Connecticut Bruce F. Cullen, MD Emeritus Professor Department of Anesthesiology University of Washington School of Medicine Seattle, Washington Robert K. Stoelting, MD Emeritus Professor and Past Chair Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana Michael K. Cahalan, MD Professor and Chair Department of Anesthesiology The University of Utah School of Medicine Salt Lake City, Utah M. Christine Stock, MD Professor and Chair Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Rafael Ortega, MD Professor Vice-Chairman of Academic Affairs Department of Anesthesiology Boston University School of Medicine Boston, Massachusetts Sam R. Sharar, MD Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington LWBK1406-FM.indd 5 23/02/15 9:36 AM Acquisitions Editor: Brian Brown Product Development Editor: Nicole Dernoski Editorial Assistant: Lindsay Burgess Production Project Manager: Priscilla Crater Design Coordinator: Doug Smock Illustration Coordinator: Jennifer Clements Manufacturing Coordinator: Beth Welsh Marketing Manager: Daniel Dressler Prepress Vendor: Aptara, Inc. Copyright © 2015 Wolters Kluwer Health All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer Health at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Clinical Anesthesia Fundamentals / edited by Paul G. Barash, Bruce F. Cullen, Robert K. Stoelting, Michael K. Cahalan, M. Christine Stock, Rafael Ortega, Sam R. Sharar. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4511-9437-1 (alk. paper) I. Barash, Paul G., editor. [DNLM: 1. Anesthesia. 2. Anesthesiology. 3. Anesthetics. WO 200] RD81 617.9′6—dc23 2014047607 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com LWBK1406-FM.indd 6 23/02/15 9:36 AM For all students of anesthesiology LWBK1406-FM.indd 7 23/02/15 9:36 AM Contributors Ron O. Abrons, MD Yogen G. Asher, MD Assistant Professor Department of Anesthesiology The University of Iowa Carver College of Medicine Director, Airway Management Training and Research The University of Iowa Hospitals and Clinics Iowa City, Iowa Clinical Instructor of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Ashley N. Agerson, MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Attending Physician Northwestern Memorial Hospital Chicago, Illinois Shireen Ahmad, MD Professor and Associate Chair Faculty Development Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Shamsuddin Akhtar, MD Associate Professor Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Aymen A. Alian, MD, MB, BCh Associate Professor Department of Anesthesia Yale University School of Medicine Associate Director of Ambulatory Surgery Yale New Haven Hospital New Haven, Connecticut Abbas Al-Qamari, MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Gina C. Badescu, MD Department of Anesthesiology Yale-New Haven Hospital Stratford, Connecticut Paul G. Barash, MD Professor Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist Yale-New Haven Hospital New Haven, Connecticut John F. Bebawy, MD Assistant Professor Departments of Anesthesiology and Neurological Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois Honorio T. Benzon, MD Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Attending Anesthesiologist Northwestern Memorial Hospital Chicago, Illinois Wendy K. Bernstein, MD, MBA Associate Professor Department of Anesthesiology University of Maryland School of Medicine Director, Simulation Program University of Maryland Hospital Baltimore, Maryland ix LWBK1406-FM.indd 9 23/02/15 9:36 AM x Contributors Sanjay M. Bhananker, MD, FRCA Armagan Dagal, MD, FRCA Associate Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle Children’s Hospital Seattle, Washington Associate Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Alexander M. DeLeon, MD Resident in Anesthesiology Department of Anesthesiology Boston University School of Medicine Boston Medical Center Boston, Massachusetts Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Associate Chair, Education Northwestern Memorial Hospital Chicago, Illinois Sorin J. Brull, MD, FCARCSI (Hon) Talmage D. Egan, MD Professor Department of Anesthesiology Mayo Clinic College of Medicine Jacksonville, Florida Professor Department of Anesthesiology University of Utah School of Medicine Salt Lake City, Utah Louanne M. Carabini, MD Ryan J. Fink, MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Attending Anesthesiologist Northwestern Memorial Hospital Chicago, Illinois Assistant Professor of Anesthesiology Anesthesiology and Perioperative Medicine Oregon Health and Science University Portland, Oregon Jessica Black, MD Niels Chapman, MD Professor Department of Anesthesiology University of New Mexico School of Medicine Albuquerque, New Mexico Casper Claudius, MD, PhD Staff Specialist Department of Intensive Care Copenhagen University Hospital Copenhagen, Denmark Christopher W. Connor, MD, PhD Assistant Professor Departments of Anesthesiology and Biomedical Engineering Boston University School of Medicine Director of Research Boston Medical Center Boston, Massachusetts LWBK1406-FM.indd 10 Jorge A. Gálvez, MD Associate Professor Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine Pediatric Anesthesiologist The Children’s Hospital of Philadelphia Philadelphia, Pennsylvania Susan Garwood, MB, ChB Associate Professor Department of Anesthesiology Yale University School of Medicine Attending Physician Yale New Haven Hospital New Haven, Connecticut R. Mauricio Gonzalez, MD Clinical Assistant Professor Department of Anesthesiology Boston University School of Medicine Vice Chair of Clinical Affairs, Quality and Patient Safety Boston Medical Center Boston, Massachusetts 23/02/15 9:36 AM Contributors Andreas Grabinsky, MD Natalie F. Holt, MD, MPH Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Assistant Professor Department of Anesthesiology Yale University School of Medicine Medical Director Ambulatory Procedures Unit Veterans Affairs CT Healthcare System West Haven, Connecticut Loreta Grecu, MD Assistant Professor Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist Yale New Haven Hospital New Haven, Connecticut Dhanesh K. Gupta, MD Associate Professor Departments of Anesthesiology and Neurological Surgery Northwestern University Feinberg School of Medicine Director of Neuroanesthesia Research Northwestern Memorial Hospital Chicago, Illinois Matthew R. Hallman, MD, MS Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Director, Critical Care Medicine Fellowship Harborview Medical Center Seattle, Washington Elizabeth E. Hankinson, MD Chief Resident Department of Anesthesiology University of Washington Harborview Medical Center Seattle, Washington Christopher J. Hansen, DO Resident in Anesthesiology Department of Anesthesiology Boston School of Medicine Boston, Massachusetts Thomas K. Henthorn, MD Professor and Chair Department of Anesthesiology University of Colorado School of Medicine University Hospital Aurora, Colorado LWBK1406-FM.indd 11 xi Robert S. Holzman, MD, MA (Hon.), FAAP Professor Department of Anesthesia Harvard Medical School Senior Associate in Perioperative Anesthesia Boston Children’s Hospital Boston, Massachusetts Yulia Ivashkov, MD Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Aaron M. Joffe, DO Associate Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Kyle E. Johnson, MD Cardiothoracic Anesthesiologist Department of Anesthesiology Medical Anesthesia Consultants McLeod Regional Medical Center Florence, South Carolina Antoun Koht, MD Professor of Anesthesiology, Neurological Surgery, and Neurology Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Tom C. Krejcie, MD Professor and Associate Chair of Medical Technology Department of Anesthesiology Northwestern University Feinberg School of Medicine Associate Chief Medical Officer Northwestern Memorial Hospital Chicago, Illinois 23/02/15 9:36 AM xii Contributors Sundar Krishnan, MBBS Candice R. Montzingo, MD, FASE Clinical Assistant Professor Divisions of Cardiothoracic Anesthesia and Critical Care University of Iowa Carver College of Medicine University of Iowa Hospitals and Clinics Iowa City, Iowa Associate Professor Department of Anesthesiology University of Utah Salt Lake City, Utah Kelly A. Linn, MD Assistant Professor Department of Anesthesiology Medical College of Wisconsin Staff Physician Clement J. Zablocki Veterans Affairs Medical Center Milwaukee, Wisconsin Joseph Louca, MD Assistant Professor of Anesthesiology Department of Anesthesiology Boston University School of Medicine Boston, Massachusetts Sofia Maldonado-Villalba, MD Resident in Anesthesiology Department of Anesthesiology Boston University School of Medicine Boston, Massachusetts Jonathan B. Mark, MD Professor Department of Anesthesiology Duke University Medical Center Chief, Anesthesiology Service Veterans Affairs Medical Center Durham, North Carolina Katherine Marseu, MD Lecturer Department of Anesthesia and Pain Medicine University of Toronto Staff Anesthesiologist University Health Network-Toronto General Hospital Toronto, Ontario, Canada Roger S. Mecca, MD Clinical Professor of Anesthesiology Department of Anesthesiology and Perioperative Care University of California at Irvine Orange, California LWBK1406-FM.indd 12 Wissam Mustafa, MD Resident in Anesthesiology Department of Anesthesiology Boston Medical Center Boston University Boston, Massachusetts Naveen Nathan, MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital Chicago, Illinois R. Dean Nava, Jr., MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Isuta Nishio, MD Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Attending Anesthesiologist VA Puget Sound Health Care System Seattle, Washington Mark C. Norris, MD Director of Obstetric Anesthesia Department of Anesthesiology Boston Medical Center Boston, Massachusetts Adriana Dana Oprea, MD Assistant Professor Department of Anesthesiology Yale University School of Medicine Associate Director, Preadmission Testing Clinic Yale New Haven Hospital New Haven, Connecticut Rafael Ortega, MD Professor Vice-Chairman of Academic Affairs Department of Anesthesiology Boston University School of Medicine Boston, Massachusetts 23/02/15 9:36 AM Contributors Paul S. Pagel, MD, PhD Babak Sadighi, MD Staff Physician Department of Anesthesiology Clement J. Zablocki Veterans Affairs Medical Center Milwaukee, Wisconsin Resident Department of Anesthesiology Boston University School of Medicine Boston Medical Center Boston, Massachusetts Melissa L. Pant, MD Attending Anesthesiologist Department of Anesthesiology Northwestern Lake Forest Hospital Lake Forest, Illinois Ramesh Ramaiah, MD, FCARCSI, FRCA Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Attending Anesthesiologist Harborview Medical Center Seattle, Washington Glenn Ramsey, MD Professor Department of Pathology Northwestern University Feinberg School of Medicine Medical Director, Blood Bank Northwestern Memorial Hospital Chicago, Illinois Meghan E. Rodes, MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Attending Physician Northwestern Memorial Hospital Chicago, Illinois Gerardo Rodriguez, MD Assistant Professor Department of Anesthesiology Boston University School of Medicine Director, East Newton Surgical Intensive Care Unit Boston Medical Center Boston, Massachusetts William H. Rosenblatt, MD Professor of Anesthesiology Department of Anesthesiology Yale University School of Medicine Attending Physician Yale New Haven Hospital New Haven, Connecticut LWBK1406-FM.indd 13 xiii Roya Saffary, MD Resident Department of Anesthesiology Boston Medical Center Boston, Massachusetts Francis V. Salinas, MD Clinical Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Staff Anesthesiologist Virginia Mason Medical Center Seattle, Washington Barbara M. Scavone, MD Professor Department of Anesthesia and Critical Care; Obstetrics and Gynecology University of Chicago Chief, Division of Obstetric Anesthesia University of Chicago Medicine Chicago, Illinois Alan Jay Schwartz, MD, MSEd Professor Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine Director of Education Children’s Hospital of Philadelphia Philadelphia, Pennsylvania Sam R. Sharar, MD Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Benjamin M. Sherman, MD Department of Cardiothoracic Anesthesiology VA Medical Center West Haven, Connecticut 23/02/15 9:36 AM xiv Contributors Sasha Shillcutt, MD, FASE Elizabeth M. Thackeray, MD, MPH Associate Professor Department of Anesthesiology University of Nebraska Medical Center Director of Perioperative Echocardiography The Nebraska Medical Center Omaha, Nebraska Associate Professor Department of Anesthesiology University of Utah School of Medicine Salt Lake City, Utah Peter Slinger, MD, FRCPC Professor Department of Anesthesia University of Toronto Staff Anesthesiologist Toronto General Hospital Toronto, Ontario, Canada Karen J. Souter, MB, BS, FRCA Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Vice Chair for Education University of Washington Medical Center Seattle, Washington Paul A. Stricker, MD Assistant Professor Department of Anesthesiology and Critical Care Medicine University of Pennsylvania Perelman School of Medicine Attending Anesthesiologist The Children’s Hospital of Philadelphia Philadelphia, Pennsylvania James E. Szalados, MD, MBA, Esq., FCCP, FCCM, FCLM Director, Surgical Critical Care and SICU Director Critical Care Telemedicine Services Rochester Regional Health System Rochester General Hospital Rochester, New York Professor of Anesthesiology and Medicine University of Rochester School of Medicine Chief, Surgical Critical Care and Critical Care Telemedicine Medical Director, Surgical and Neurocritical Care Units Rochester General Hospital Rochester, New York LWBK1406-FM.indd 14 Joshua M. Tobin, MD Director, Trauma Anesthesiology Department of Anesthesiology University of Southern California Keck School of Medicine Los Angeles County Hospital Los Angeles, California Amy E. Vinson, MD, FAAP Instructor in Anesthesia Department of Anesthesiology, Perioperative, and Pain Medicine Harvard Medical School Assistant in Perioperative Anesthesia Boston Children’s Hospital Boston, Massachusetts Peter von Homeyer, MD, FASE Assistant Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Attending Physician University of Washington Medical Center Seattle, Washington Mary E. Warner, MD Department of Anesthesiology Mayo Clinic Rochester, Minnesota James R. Zaidan, MD, MBA Professor and Past Chair Department of Anesthesiology Emory University Hospital Atlanta, Georgia 23/02/15 9:36 AM Preface In the current era of health care reform, we are surrounded by changes in every aspect of clinical patient care, from incorporation of electronic health records to the emergence of novel health care delivery models. Concurrent with these new paradigms in health care delivery is an equally exciting evolution in medical education, as teachers at all levels—from basic science instructors to clinical care mentors—face three critical challenges: (1) exposing trainees to the rapidly expanding volumes of biomedical and biopsychosocial discovery, (2) translating such advances into cost-effective and patient-centered clinical applications, and (3) using novel teaching methods that target the cognitive needs and learning tools demanded by “digital native” learners of the millennial generation. Clinical Anesthesia Fundamentals is our response to these challenges, specifically designed to fill the void in anesthesia and perioperative care education exemplified by the early trainee’s question “Where can I go to most efficiently learn the fundamentals of anesthesia care?” Clinical Anesthesia Fundamentals is a complete, yet succinct introduction to the essential clinical principles and practices for early learners of anesthesia – students and residents. In contrast to Clinical Anesthesia, 7th Edition and other compendium textbooks of anesthesia that typically comprise 1,500 to 3,000 pages in print form and are comprehensive references for both the veteran practitioner and the seasoned trainee, Clinical Anesthesia Fundamentals is a fraction this size in its print form, and its liberal use of graphic and tabular presentations emphasize elemental concepts that facilitate trainees to thoughtfully apply their basic science knowledge to the clinical setting. More importantly, Clinical Anesthesia Fundamentals capitalizes on novel and emerging digital teaching tools designed both to appeal to millennial learners and to reinforce content acquisition through complementary methods of content delivery. First, the book was designed from the “ground up” as a fully interactive digital resource that includes enhanced and innovative displays of text content, figures, and tables, over 130 videos and animated graphics, and quick links to Web-based reference citation sources. Second, content delivery and eventual mastery are reinforced by several novel tools including “Did You Know” statements of key clinical pearls, multiple-choice questions and explanatory answers in both written and video formats, and interactive video exercises that review key content. All electronic components of the book are viewable through any browser and as a download to one’s smartphone or tablet, thus providing immediate and ubiquitous access for the reader. The 44 concise chapters are organized into three sections targeting the early learner of anesthesia—an Introduction to the History and Future of Anesthesiology; the Scientific and Technical Foundations of Anesthesia (including relevant organ anatomy and physiology, pharmacology, and basic clinical technology); and the Clinical Practice of Anesthesia (including basic and specialty aspects of perioperative care both within and outside the operating room, pain management, critical care, and provider wellness). xv LWBK1406-FM.indd 15 23/02/15 9:36 AM xvi Preface Consistent with the unique purpose of the book, 57 of the 74 contributing authors are new to the Clinical Anesthesia series, including many whose specific academic interests in medical education bring new perspective and energy to the presentation of fundamental clinical content. The book concludes with a series of Appendices, carefully selected for their reference value and clinical relevance to early anesthesia trainees, including essential physiologic formulas/ definitions, an electrocardiography atlas, pacemaker/defibrillator protocols, common herbal medications, and key standards/algorithms from the American Society of Anesthesiologists, American Heart Association, Anesthesia Patient Safety Foundation, and Malignant Hyperthermia Association of the United States. In summary, Clinical Anesthesia Fundamentals provides early anesthesia learners with effortless print and digital access to essential anesthesia principles, procedures, and protocols in a succinct and user-friendly format that leverages complementary learning tools to reinforce content delivery. By avoiding the comprehensive (and potentially overwhelming) detail of compendium textbooks that is no doubt indispensable for advanced trainees and veteran practitioners, we hope that Clinical Anesthesia Fundamentals will provide early anesthesia learners with a solid foundation to begin their careers, and prepare them for both more advanced and lifelong learning in our specialty. We wish to express our appreciation to all our knowledgeable and dedicated contributors who exceeded our challenge to present fundamental content in a novel, yet highly concise format. We also are indebted to the anesthesia trainees who provided invaluable advice and feedback on the scope and content of the book in its various development phases. Lastly, we would like to thank our editors at Lippincott Williams & Wilkins-Wolters Kluwer, Brian Brown and Keith Donnellan, for their commitment to excellence. Finally, we owe a debt of gratitude to Nicole Dernoski, Product Development Editor at LWW; Chris Miller, Production Manager at Aptara; and Dan Dressler, Marketing Manager at LWW whose day-to-day management of this endeavor resulted in a publication that exceeded the Editor’s expectations. LWBK1406-FM.indd 16 23/02/15 9:36 AM Contents Section I: Introduction 1. History and Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Rafael Ortega and Christopher J. Hansen Section II: Scientific and Technical Foundations of Anesthesia Part A: Core Organ Functions: Anatomy & Physiology 2. The Respiratory System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Abbas Al-Qamari and R. Dean Nava, Jr. 3. Cardiovascular Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . 41 Sam R. Sharar and Peter von Homeyer 4. Central and Autonomic Nervous Systems. . . . . . . . . . . . . . . . . . . . . 69 Loreta Grecu 5. The Renal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Susan Garwood 6. Liver Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Niels Chapman Part B: Pharmacology 7. Principles of Pharmacokinetics and Pharmacodynamics . . . . . . . . . 119 Dhanesh K. Gupta and Thomas K. Henthorn 8. Inhalational Anesthetic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Ramesh Ramaiah and Sanjay M. Bhananker 9. Intravenous Anesthetics and Sedatives. . . . . . . . . . . . . . . . . . . . . . . 151 Christopher W. Connor, Babak Sadighi, and Jessica Black 10. Analgesics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Elizabeth M. Thackeray and Talmage D. Egan 11. Neuromuscular Blocking Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Sorin J. Brull and Casper Claudius 12. Local Anesthetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Francis V. Salinas 13. Cardiovascular Pharmacology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Kelly A. Linn and Paul S. Pagel Part C: Technology 14. The Anesthesia Workstation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Naveen Nathan and Tom C. Krejcie 15. Standard Anesthesia Monitoring Techniques and Instruments. . . . . 277 Ryan J. Fink and Jonathan B. Mark xvii LWBK1406-FM.indd 17 23/02/15 9:36 AM xviii Contents Section III: Clinical Practice of Anesthesia 16. Preoperative Evaluation and Management. . . . . . . . . . . . . . . . . . . . 297 Natalie F. Holt 17. Coexisting Diseases Impacting Anesthetic Management . . . . . . . . . 321 Gerardo Rodriguez 18. Endocrine Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 Shamsuddin Akhtar 19. General Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Mark C. Norris and Roya Saffary 20. Airway Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373 Ron O. Abrons and William H. Rosenblatt 21. Regional Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395 Alexander M. DeLeon and Yogen G. Asher 22. Patient Positioning and Potential Injuries. . . . . . . . . . . . . . . . . . . . . 413 Mary E. Warner 23. Fluids and Electrolytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 Elizabeth E. Hankinson and Aaron M. Joffe 24. Blood Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 Louanne M. Carabini and Glenn Ramsey 25. Ambulatory Anesthesia, Monitored Anesthesia Care, and Office-Based Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469 Meghan E. Rodes and Shireen Ahmad 26. Spine and Orthopedic Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . 489 Yulia Ivashkov and Armagan Dagal 27. Anesthesia for Laparoscopic and Robotic Surgeries. . . . . . . . . . . . . 509 Adriana Dana Oprea 28. Anesthetic Considerations for Patients with Obesity, Hepatic Disease, and Other Gastrointestinal Issues. . . . . . . . . . . . . 519 Sundar Krishnan 29. Anesthesia for Otolaryngologic and Ophthalmic Surgery . . . . . . . . 539 R. Mauricio Gonzalez, Joseph Louca, and Sofia Maldonado-Villalba 30. Anesthesia for Neurosurgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557 John F. Bebawy and Antoun Koht 31. Obstetric Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577 Melissa L. Pant and Barbara M. Scavone 32. Trauma and Burn Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 607 Joshua M. Tobin and Andreas Grabinsky 33. Neonatal and Pediatric Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . 627 Jorge A. Gálvez, Paul A. Stricker, and Alan Jay Schwartz 34. Anesthesia for Thoracic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 653 Katherine Marseu and Peter Slinger 35. Cardiac Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669 Candice R. Montzingo and Sasha Shillcutt LWBK1406-FM.indd 18 23/02/15 9:36 AM Contents xix 36. Anesthesia for Vascular Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . 687 Wendy K. Bernstein and Kyle E. Johnson 37. Management of Acute and Chronic Pain. . . . . . . . . . . . . . . . . . . . . 699 Ashley N. Agerson and Honorio T. Benzon 38. Nonoperating Room Anesthesia and Special Procedures. . . . . . . . . 721 Karen J. Souter and Isuta Nishio 39. Postoperative Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733 Roger S. Mecca 40. Complications, Risk Management, Patient Safety, and Liability . . . 747 James E. Szalados 41. Critical Care Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 Matthew R. Hallman 42. Anesthesia for Urologic Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . 785 Aymen A. Alian 43. Electrical Safety and Fire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 797 Christopher W. Connor and Wissam Mustafa 44. Wellness Principles and Resources for Anesthesiologists . . . . . . . . . 811 Amy E. Vinson and Robert S. Holzman Section IV: Appendices A. Formulas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 825 B. Atlas of Electrocardiography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 829 Gina C. Badescu, Benjamin Sherman, James R. Zaidan, and Paul G. Barash C. Pacemaker and Implantable Cardiac Defibrillator Protocols. . . . . . . . 853 Gina C. Badescu, Benjamin Sherman, James R. Zaidan, and Paul G. Barash D.American Heart Association (AHA) Resuscitation Protocols. . . . . . . . 867 E.American Society of Anesthesiologists Standards, Guidelines, and Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879 F. The Airway Approach Algorithm and Difficult Airway Algorithm. . . 897 G.Malignant Hyperthermia Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . 899 H.Herbal Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 901 Answer Section. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 909 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 943 LWBK1406-FM.indd 19 23/02/15 9:36 AM