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Clinical Anesthesia
Fundamentals
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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
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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]
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LWW.com
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For all students of anesthesiology
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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).
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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.
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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
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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
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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
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