Handbook of Anaesthesia & Peri-Operative Medicine

Handbook of Anaesthesia & Peri-operative Medicine
Title Page
Copyright
Contents
Contributors
Preface
Abbreviations
Acknowledgements
Section 1: Applied science
Chapter 1: Intravenous agents
Introduction
Propofol
Clinical uses and indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Central nervous system
Cardiovascular system
Respiratory system
Other effects
Thiopental
Clinical uses and indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Central nervous system
Cardiovascular system
Respiratory system
Other effects
Intra-arterial injection
Ketamine
Clinical uses and indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Central nervous system
Cardiovascular system
Respiratory system
Other effects
Etomidate
Clinical uses and indications
Structure and physical properties
Mechanism of action
Pharmacokinetics and pharmacodynamics
Clinical effects
Central nervous system
Cardiovascular system
Metabolic system
Midazolam
Clinical uses and indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Central nervous system
Cardiovascular and respiratory systems
Other effects
Total intravenous anaesthesia (TIVA)
Case scenario 1
Case scenario 2
Further reading
Chapter 2: Inhalational agents
Introduction
Mechanism of action
Potency
Onset of action
Concentration delivered
Lung ventilation
Rate of uptake from the alveoli
Blood:gas solubility
Concentration effect
Second gas effect
Metabolism of inhalational anaesthetics
Metabolism of nitrous oxide
Metabolism of sevoflurane
Nitrous oxide
General properties
Clinical effects
Central nervous system
Respiratory system
Cardiovascular system
Gastrointestinal system
Isoflurane
General properties
Clinical effects
Central nervous system
Respiratory system
Cardiovascular system
Other effects
Sevoflurane
General properties
Clinical effects
Central nervous system
Respiratory system
Cardiovascular system
Other effects
Desflurane
General properties
Clinical effects
Central nervous system
Respiratory system
Cardiovascular system
Halothane
General properties
Clinical effects
Central nervous system
Respiratory system
Cardiovascular system
Other effects
Xenon
General properties
Case scenario 1
Further reading
Chapter 3: Neuromuscular blocking drugs
Introduction
Depolarising muscle relaxants (DMR)
Suxamethonium
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Non-depolarising muscle relaxants (NDMR)
Vecuronium
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Rocuronium
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Atracurium
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Mivacurium
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Reversal agents
Anticholinesterases
Neostigmine
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Sugammadex
Indications
Structure and physical properties
Mechanism of action
Pharmacokinetics
Clinical effects
Newer muscle relaxants
Case scenario 1
Case scenario 2
Further reading
Chapter 4: Analgesic drugs
Introduction
Paracetamol
Mechanism of action
Presentation
Dose
Pharmacokinetics
Drug interactions
Toxicity
Adverse effects
Clinical uses
Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism of action
Presentation
Pharmacokinetics
Drug interactions
Adverse effects
Other side effects
Contraindications of NSAIDs
Clinical uses
Opioids
Opioid receptors
Mechanism of action
Pharmacokinetics
Clinical effects
Central nervous system
Respiratory system
Cardiovascular system
Gastrointestinal system
Renal system
Other effects
Contraindications
Side effects
Commonly used opioids for peri-operative analgesia
Morphine
Fentanyl
Pharmacodynamics
Pharmacokinetics
Alfentanil
Pharmacodynamics
Pharmacokinetics
Metabolism
Remifentanil
Pharmacodynamics
Pharmacokinetics
Metabolism
Side effects
Clinical uses
Case scenario 1
Case scenario 2
Case scenario 3
Further reading
Chapter 5: Local anaesthetics
Introduction
Local anaesthetic mechanism of action
Pharmacodynamics
Structure
Potency
Duration of action
Onset of action
Vasodilation and vasoconstriction
Cardiovascular system
Central nervous system
Pharmacokinetics
Absorption
Distribution
Metabolism and elimination
Commonly used local anaesthetic agents
Amides
Lidocaine
Bupivacaine
Levobupivacaine
Ropivacaine
Prilocaine
Esters
Cocaine
Amethocaine, also known as tetracaine
Eutectic mixture of local anaesthetic (EMLA)
Case scenario 1
Case scenario 2
Further reading
Chapter 6: Peri-operative monitoring
Introduction
Standards of monitoring
Minimal monitoring
Specific situations
Clinical monitoring
Monitoring display unit
Electrocardiography
ECG configurations
ECG interference
Pulse oximetry
Mechanism
Inaccuracies with the pulse oximeter
Non-invasive blood pressure (NIBP) monitoring
Automated methods
NIBP monitoring disadvantages
Invasive blood pressure monitoring
Arterial line waveform
Damping and resonance
Practical problems with IBP monitoring
Cardiac output monitoring
Minimally invasive cardiac output monitoring
Invasive cardiac output monitoring
Central venous pressure monitoring
Sites of insertion
Complications of insertion
CVP waveform
Oxygen measurement
Capnography
Normal capnograph waveform
Uses of capnography
Airway
Breathing
Circulation
Metabolism
Measurement of EtCO2
Mainstream and sidestream sampling
Infrared spectroscopy
Errors in capnography
Measurement of vapour concentration
Ventilatory parameters
Modes of ventilation
Volume and flow measurement
Ventilator alarms
Neuromuscular monitoring
Peripheral nerve stimulators
Patterns of nerve stimulation
Objective assessment of response
Criteria for adequate reversal
Clinical signs
Objective method
Depth of anaesthesia monitoring
Bispectral Index
Entropy
Other methods
Monitoring temperature
Non-electrical methods
Electrical methods
Sites of measurement
Case scenario 1
Case scenario 2
Further reading
Chapter 7: Anaesthetic machines
Introduction
The modern anaesthetic machine
Gas supply
Piped gas supply
Cylinders
Gas flow measurement
Vapourisers
Gas delivery: breathing systems and ventilators
Scavenging
Monitoring
Safety features of modern machines
Case scenario 1
Further reading
Chapter 8: Patient positioning for surgery
Introduction
Supine position
Physiological considerations
Respiratory
Cardiovascular
Gastrointestinal
Anatomical considerations
Peripheral nervous system
Pressure areas
Eyes
Lateral position
Physiological considerations
Respiratory
Cardiovascular
Anatomical considerations
Peripheral nerves and pressure areas
Eyes
Lloyd-Davies and lithotomy position
Physiological considerations
Respiratory
Cardiovascular
Gastrointestinal
Anatomical considerations
Peripheral nerves
Pressure areas
Eyes
Head-up, deck chair and sitting position
Physiological considerations
Respiratory
Cardiovascular
Gastrointestinal
Anatomical considerations
Peripheral nerves
Pressure areas
Eyes
Trendelenburg position
Physiological considerations
Respiratory
Cardiovascular
Gastrointestinal
Anatomical considerations
Peripheral nerves and pressure areas
Eyes
Prone position
Physiological considerations
Respiratory
Cardiovascular
Anatomical considerations
Airway
Pressure areas
Peripheral nerves
Eyes
Cardiac arrest
Case scenario 1
Case scenario 2
Further reading
Chapter 9: Regional anaesthesia
Introduction
General considerations
Advantages of regional anaesthesia
Disadvantages of regional anaesthesia
Contraindications
Complications of regional anaesthesia
Safety and procedural considerations
Local anaesthetics
Volume and concentration
Calculating drug dosage
Local anaesthetic adjuncts
Neuraxial blockade
Contraindications
Subarachnoid (spinal) blockade
Indications
Risks of subarachnoid block
Relevant anatomy
Performing the subarachnoid block
Assessment of block height
Choice of local anaesthetic for subarachnoid block
Troubleshooting and tips
Epidural anaesthesia
Indications
Contraindications
Relevant anatomy
Performing an epidural
Troubleshooting and tips
Benefits after epidural analgesia
Combined spinal/epidural (CSE)
Peripheral techniques
Equipment and procedure
Field infiltration
Intravenous regional anaesthesia
Peripheral plexus blocks
Compartment blocks
Case scenario 1
Case scenario 2
Further reading
Section 2: Peri-operative medicine
Chapter 10: Pre-operative anaesthetic assessment
Introduction
ASA Physical Status grading
History taking
Respiratory system
Cardiovascular system
Gastrointestinal system
Genitourinary system
Endocrine system
Central nervous system
Otorhinolaryngeal system
Musculoskeletal system
Anticoagulants
Family history and previous anaesthetic experience
Social history
Clinical examination
Laboratory investigations
Specialist investigations
Respiratory system
Cardiovascular system
Endocrine system
Central nervous system
Otorhinolaryngeal system
Miscellaneous
Risk stratification for surgery
Lee’s Revised Cardiac Risk Index
ACC/AHA Cardiac Risk Stratification for Non-cardiac Surgical Procedures
High risk (reported cardiac risk often >5%)
Intermediate risk (reported cardiac risk >1% but <5%)
Low risk (reported cardiac risk generally <1%)
Surgical Outcome Risk Tool (www.sortsurgery.com)
Pre-operative fasting
Adults
Children
Chewing gum
Case scenario 1
Further reading
Chapter 11: Peri-operative pharmacology
Introduction
Respiratory pharmacology
Inhaled beta-agonists and anticholinergic drugs
Steroids
Theophylline
Leukotriene inhibitors
Endocrine pharmacology
Glucocorticoids
Hypoglycaemic drugs
Thyroid medication
Oral contraception/hormonal therapy
Pain pharmacology
Multimodal analgesia
Chronic opioid medication
Cardiac pharmacology
Beta-blockers
Calcium channel blockers
Diuretics
ACE inhibitors/angiotensin-2 receptor blockers
Statins
Psychotropic pharmacology
Antidepressants
Mood stabilisers
Antipsychotics
Antithrombotic pharmacology
Antiplatelet agents
Warfarin
Heparin
Other agents
Case scenario 1
Case scenario 2
Further reading
Chapter 12: Peri-operative fluid therapy
Introduction
Why should I give intravenous fluids?
When should I give intravenous fluids?
Pre-operative fasting
Insensible evaporative losses
The third space
Hypervolaemia and renal excretion
The endothelial glycocalyx
Replacing blood with crystalloids
Vasodilatation following induction
Fluid therapy indications
Resuscitation
Routine maintenance
Replacement
Redistribution
Which intravenous fluids should I use?
Crystalloids
Normal (0.9%) saline
Compound sodium lactate solution (Hartmann's solution)
Colloids
How much volume should I give?
Volume estimation by calculation
Goal-directed therapy (GDT)
Individual considerations
Case scenario 1
Case scenario 2
Further reading
Chapter 13: Peri-operative blood transfusion
Introduction
Physiology of blood loss
Clinical presentation of blood loss
Indications and haemoglobin triggers for transfusion
Contraindications to blood transfusion
Massive haemorrhage
Management of massive haemorrhage
Practical procedure of blood transfusion
The steps involved in blood transfusion
Blood products
Platelets
Fresh frozen plasma
Cryoprecipitate
Factor VIII and IX concentrates
Prothrombin complex concentrates
Immunoglobulins
Jehovah’s Witnesses
Legal and ethical issues
Pre-operative management
Intra-operative management
Surgical management
Postoperative management
Cell salvage
Collection
Separation and washing
Retransfusion
Benefits of cell salvage
Risks of cell salvage
Case scenario 1
Case scenario 2
Further reading
Chapter 14: Peri-operative temperature regulation
Introduction
Physiology
Afferent input
Central integrating system
Efferent response
Anaesthesia and temperature regulation
Phase 1
Phase 2
Phase 3
Consequences of peri-operative hypothermia
Prevention and management of hypothermia
Pre-operative
Intra-operative
The National Institute for Health and Care Excellence (NICE) guidelines
Pre-operative phase
On admission to the hospital
Intra-operative phase
Postoperative phase
Case scenario 1
Further reading
Chapter 15: Anaesthesia and endocrine disease
Introduction
Thyroid abnormality
Pre-operative assessment
History
Examination
Investigations
Intra-operative management
Premedication
Choice of anaesthetic technique
General anaesthesia
Postoperative complications
Adrenocortical disorders
Hyperaldosteronism
Cushing’s syndrome
Adrenocortical insufficiency (Addison’s disease)
Diabetes mellitus
Pre-operative assessment
Intra-operative management
Choice of anaesthetic technique
Postoperative care
Pituitary disease
Acromegaly
Central diabetes insipidus
Intra-operative management
Choice of anaesthetic technique
Postoperative care
Porphyria
Pre-operative assessment
Intra-operative management
Implications for anaesthesia
Postoperative care
Case scenario 1
Case scenario 2
Further reading
Chapter 16: Anaesthesia and cardiovascular disease
Introduction
Hypertension
Antihypertensive medication
The use of drugs that block the renin‐angiotensin system in the perioperative period
Pre-operative evaluation and investigations
Investigations
Peri-operative management
Conduct of anaesthesia
Induction of anaesthesia
Maintenance
Management of intra-operative hypertensive crisis
Recovery
Ischaemic heart disease
Peri-operative risks associated with ischaemic heart disease
Pre-operative evaluation and investigations of patients with suspected ischaemic heart disease
Coronary artery bypass surgery (CABG) before non-cardiac surgery
Surgery after coronary revascularisation procedures
Peri-operative management of patients who underwent percutaneous coronary intervention and stent insertion within the high-risk period
Peri-operative medical therapy
Conduct of anaesthesia
Cardiomyopathy
Hypertrophic obstructive cardiomyopathy (HOCM)
Dilated cardiomyopathy
Restrictive cardiomyopathy
Conduct of anaesthesia
Pacemakers
Peri-operative management
Pre-operative evaluation
Conduct of anaesthesia
Defibrillation during surgery
Postoperative management
Valvular heart diseases
Aortic stenosis
Pathophysiology
Investigations
Conduct of anaesthesia
Aortic regurgitation
Pathophysiology
Investigations
Conduct of anaesthesia
Mitral stenosis
Pathophysiology
Investigations
Conduct of anaesthesia
Mitral regurgitation
Pathophysiology
Investigations
Conduct of anaesthesia
Patients with prosthetic valves
Peri-operative antibiotic prophylaxis for patients with valvular heart diseases
Case scenario 1
Case scenario 2
Case scenario 3
Case scenario 4
Case scenario 5
Further reading
Chapter 17: Anaesthesia and respiratory disease
Introduction
General principles
Drugs affecting the respiratory system
Surgical effects on the respiratory system
Asthma
Pathophysiology
Anaesthetic management
Chronic obstructive pulmonary disease
Pathophysiology
Anaesthetic management
Restrictive lung disease
Pathophysiology
Anaesthetic management
Pulmonary hypertension
Pathophysiology
Anaesthetic management
Case scenario 1
Case scenario 2
Further reading
Chapter 18: Anaesthesia and obesity
Introduction
Anaesthetic implications of obesity
Respiratory system
Cardiovascular system
Gastrointestinal system
Endocrine system
Practical considerations
Drug handling
Pre-operative assessment
Regional anaesthesia
Conduct of anaesthesia
Positioning and pre-oxygenation
Postoperative management
Case scenario 1
Case scenario 2
Further reading
Chapter 19: Postoperative recovery and care
Introduction
Common postoperative problems
Pain
Gut dysfunction
Postoperative hypoxaemia
Catabolism
Immobilisation
Principles of enhanced recovery
Pre-operative management
Preadmission counselling
Pre-operative optimisation
Premedication
Antimicrobial prophylaxis
Standardised anaesthetic technique
Fluid management
Postoperative nausea and vomiting
Surgical technique
Nasogastric tubes
Maintenance of normothermia
Postoperative management
Analgesia
Surgical drains
Venous thromboembolism (VTE) prophylaxis
Prevention of postoperative ileus
Postoperative analgesia regimens
Postoperative nutrition
Glucose control
Early mobilisation
Benefits and limitations of enhanced recovery
Case scenario 1
Case scenario 2
Further reading
Section 3: Airway management
Chapter 20: Airway management
Introduction
The unconscious patient and the airway
Basic airway management
Basic airway adjuncts
Oropharyngeal airway (Guedel airway)
Technique of inserting an oropharyngeal airway
Nasopharyngeal airway
Technique of inserting a nasopharyngeal airway
Ventilation
Airway management techniques
Face mask ventilation
One-person face mask ventilation
Two-person face mask ventilation
Face mask ventilation following induction of general anaesthesia
Supraglottic airway device (SAD)
Technique of inserting a SAD (LMA or i-gel®)
Advantages of SADs
Contraindications
Laryngoscopy and tracheal intubation
Technique of direct laryngoscopy
Videolaryngoscopy
Complications
Cricothyroidotomy
Tracheostomy
Complications of tracheostomies
Types of tracheostomy tubes (Figure 20.12)
Single-lumen tubes
Double-cannula tracheostomy tubes
Uncuffed tracheostomy tubes
Fenestrated tracheostomy tubes
Adjustable flange tracheostomy tubes
Peri-operative airway management
Pre-operative airway assessment
Clinical examination
Special investigations
Intra-operative airway management
Pre-oxygenation
Management of the difficult airway
Anticipated difficult airway with no upper airway obstruction
Anticipated difficult face mask ventilation
Anticipated difficult tracheal intubation
Deciding on awake or post-induction tracheal intubation
Anticipated difficult airway with upper airway obstruction
Unanticipated difficult tracheal intubation
Extubation
Case scenario 1
Case scenario 2
Case scenario 3
Further reading
Section 4: Specialty-specific procedures
Chapter 21: Head and neck procedures
Introduction
Dental extractions
Surgical considerations
Unrestricted access to the oral cavity
The choice of airway
Throat packs
Patient position
Local anaesthetics and vasoconstrictors
Anaesthetic considerations
Shared airway
Choice of muscle relaxant
Maintenance of anaesthesia
Analgesia
Dental extraction in children
Special care dentistry
Dental abscesses
Surgical considerations
Anaesthetic considerations
Maxillofacial trauma
Facial fractures
Surgical considerations
Anaesthetic considerations
Radical neck dissection
Surgical considerations
Anaesthetic considerations
Thyroidectomy
Surgical considerations
Anaesthetic considerations
Case scenario 1
Case scenario 2
Case scenario 3
Further reading
Chapter 22: Anaesthesia and ENT surgery
Introduction
Adenotonsillectomy
Surgical considerations
Anaesthetic considerations
Obstructive sleep apnoea (OSA)
Shared airway management
Induction and maintenance of anaesthesia
Extubation and recovery
Analgesia
Postoperative nausea and vomiting (PONV)
The ‘bleeding’ tonsil
Anaesthetic issues
Anaesthetic management
Adult tonsillectomy
Nasal and sinus surgery
Surgical considerations
Anaesthetic considerations
Intra-operative management
Ear surgery
Surgical considerations
Anaesthetic considerations
Myringotomy/grommet insertion
Myringoplasty, tympanoplasty and mastoid surgery
Prolonged anaesthetic
Surgical requirement for a bloodless field
Effect of nitrous oxide (N₂O) diffusion on middle ear pressure
Facial nerve monitoring
Postoperative nausea and vomiting (PONV)
Microlaryngoscopy
Surgical considerations
Anaesthetic considerations
Conventional ventilation using a microlaryngeal (MLT) tube
Jet ventilation techniques (Figure 22.3)
Laser ENT surgery
Surgical considerations
General considerations
Anaesthetic considerations
Risk of airway fire
Preventing damage to the eyes and skin
Concerns about laser plume
Management of an airway fire
Surgical tracheostomy
Surgical considerations
Anaesthetic considerations
Tracheostomy to relieve airway obstruction
Laryngectomy
Surgical considerations
Partial laryngectomy
Supraglottic laryngectomy
Total laryngectomy
Anaesthetic considerations
Pre-operative
Intra-operative
Postoperative
Case scenario 1
Case scenario 2
Further reading
Chapter 23: Neurosurgical procedures
Introduction
Cerebral circulation
Control of intracranial pressure (ICP)
Management of a raised ICP
Specific strategies to reduce ICP
Effect of anaesthetic agents on ICP
Neurosurgical intervention to control ICP
General considerations in neuroanaesthesia
Pre-operative assessment
Intra-operative management
Reversal and extubation
Postoperative pain control
Postoperative care
Anaesthesia for specific neurosurgical procedures
Traumatic brain injury and emergency surgery
Other considerations
Evacuation of intracranial haematomas
Surgical considerations
Anaesthetic considerations
Ventriculoperitoneal shunt
Surgical considerations
Anaesthetic considerations
Craniotomy for space-occupying lesions
Surgical considerations
Anaesthetic considerations
Clipping of intracranial aneurysms
Surgical considerations
Anaesthetic considerations
Induction and maintenance
Emergence and recovery
Postoperative care
Cervical spinal surgery
Surgical considerations
Anaesthetic considerations
Transnasal transsphenoidal excision of pituitary adenomas
Surgical considerations
Anaesthetic considerations
Interventional neuroradiological procedures
Surgical considerations
Anaesthetic considerations
Case scenario 1
Case scenario 2
Further reading
Chapter 24: Thoracic procedures
Introduction
Shared airway and lung
The lateral decubitus position
Open chest wall and positive pressure ventilation
Collapse of the operated or non-dependent lung
Double-lumen tubes
Bronchial blockers
Management of one-lung anaesthesia
Isolation and control of ventilation
Management of hypoxia during one-lung ventilation
Removal of the DLT/blocker
Pre-operative assessment of thoracic surgical patients
Pre-operative investigations
Assessment of cardiopulmonary interaction
Radiological investigations
Endoscopic procedures for diagnosis and staging
Risk stratification
Pre-operative interventions and premedication
Anaesthesia for specific thoracic procedures
Bronchoscopy
Surgical considerations
Anaesthetic considerations
Cervical mediastinoscopy
Surgical considerations
Anaesthetic considerations
Oesophagoscopy
Surgical considerations
Anaesthetic considerations
Thoracoscopy and VATS
Surgical considerations
Anaesthetic considerations
Thoracotomy
Surgical considerations
Anaesthetic considerations
Bronchopleural fistula
Surgical considerations
Anaesthetic considerations
Empyema and decortication
Surgical considerations
Anaesthetic considerations
Postoperative care for thoracic surgery patients
Fluid balance
Physiotherapy and mobilisation
Chest drainage
Antibiotics
Case scenario 1
Case scenario 2
Further reading
Chapter 25: Cardiac procedures
Introduction
Physiological considerations
Preload
Afterload
Contractility
Cardiac output, blood pressure and systemic vascular resistance relationship
Pre-operative work-up for cardiac surgery
History, examination and investigations
History
Examination
Investigations
Routine tests
Specific tests and the information obtained
Assessment of functional status
Risk stratification
Advice regarding the patient’s regular medications
Conduct of anaesthesia for routine cardiac surgery and cardiopulmonary bypass
Premedication
Preparation prior to commencing anaesthetic
Induction
Post-induction and maintenance
Post-induction events
Maintenance
Cardiopulmonary bypass: equipment, conduct and management
Equipment
Components of the CPB circuit
Arterial (aortic), venous and cardioplegia cannulae
Perfusion tubing
Venous reservoir
Mechanical pump heads
Membrane oxygenator
Heat exchanger
Gas supply system
Filters
Suckers and vents
Conduct of CPB
Maintenance and management of CPB
Anticoagulation
Heparin
Protamine
Coagulation monitoring and conservation of blood
In-line monitoring
Cardiovascular management
Maintenance of temperature and acid base control
Myocardial protection
Filtration
Systemic adverse effects of CPB
Weaning
Decannulation
Failure to wean from CPB
Pharmacological support
Adrenaline
Dopamine
Dobutamine
Noradrenaline
Metaraminol
Phenylephrine
Phosphodiesterase (PDE) III inhibitors (inodilators)
Levosimendan
Vasopressin
Calcium
Mechanical support
Intra-aortic balloon pump (IABP)
Extracorporeal membrane oxygenation (ECMO)
Assist devices
Transfer to the ICU
Routine postoperative care
Day 0: immediate postoperative course
Day 1 and later
Anaesthesia for specific cardiac procedures
Coronary artery bypass grafting (CABG)
Surgical considerations
Anaesthetic considerations
Off-pump CABG
Surgical considerations
Anaesthetic considerations
Aortic valve surgery
Surgical considerations
Indications for surgery for aortic valve disease
Anaesthetic considerations
Aortic stenosis
Aortic regurgitation
Mitral valve surgery
Surgical considerations
Indications for mitral valve surgery
Anaesthetic considerations
Aortic dissection
Surgical considerations
Anaesthetic considerations
Pericardectomy
Surgical considerations
Anaesthetic considerations
Redo heart surgery
Surgical considerations
Anaesthetic considerations
Pre-operative
Induction
Case scenario 1
Further reading
Chapter 26: Abdominal procedures
Introduction
Gastrectomy
Surgical considerations
Anaesthetic considerations
Cholecystectomy
Surgical considerations
Anaesthetic considerations
Laparotomy
Surgical considerations
Anaesthetic considerations
Laparoscopic abdominal surgery
Surgical considerations
Anaesthetic considerations
Laparoscopic colorectal surgery
Surgical considerations
Anaesthetic considerations
Peri-anal surgery
Surgical considerations
Anaesthetic considerations
Anti-reflux surgery
Surgical considerations
Anaesthetic considerations
Whipple’s procedure (pancreaticoduodenectomy)
Surgical considerations
Anaesthetic considerations
Liver resection
Surgical considerations
Anaesthetic considerations
Case scenario 1
Case scenario 2
Further reading
Chapter 27: Emergency surgical procedures
Introduction
What is an emergency procedure?
Common emergency procedures
Pre-operative assessment
Urgency
Medical history
Presenting condition
Drug history
Anaesthetic history
Physiological assessment
Airway assessment
Risk stratification in emergencies
Intra-operative management
Aspiration risk
Hypovolaemia
Unstable cardiac disease
Sepsis
Arrhythmias
Analgesia
Postoperative care
Case scenario 1
Case scenario 2
Further reading
Chapter 28: Obstetric anaesthesia
Introduction
Physiology of pregnancy
Cardiovascular system
Respiratory system
Airway
Gastrointestinal system
Renal
Haematological
Central nervous system
Endocrine system
Other systems
Pain relief in labour
Non-pharmacological
Pharmacological
Central neuraxial blockade
Operative delivery
Pre-operative assessment
Urgency
Principles of management
In utero resuscitation
Spinal anaesthesia
Epidural anaesthesia
General anaesthesia (GA)
Manual removal of placenta/perineal repair
Non-obstetric procedures during pregnancy
Post-partum haemorrhage
Pre-eclampsia
Case scenario 1
Case scenario 2
Further reading
Chapter 29: Paediatric anaesthesia
Introduction
Airway
Anatomy and physiology
Implications for anaesthesia
Respiratory system
Anatomy and physiology
Implications for anaesthesia
Cardiovascular system
Implications for anaesthesia
Other considerations
Common cases in neonates
Anaesthetic considerations
Common surgical procedures in infants
Common procedures in older Infants and children
Dental procedures
Urological procedures
Ophthalmic procedures
Orthopaedic procedures
Case scenario 1
Further reading
Section 5: Peri-operative emergencies
Chapter 30: Airway and respiratory problems
Introduction
Hypoxia
Causes
Management
Prevention
Hypercapnia
Causes
Management
Prevention
Hypocapnia
Causes
Management
Prevention
Bronchospasm
Causes
Management
Prevention
Laryngospasm
Causes
Management
Prevention
Aspiration
Causes
Management
Prevention
Case scenario 1
Further reading
Chapter 31: Cardiovascular problems
Introduction
Hypotension
Causes
Management
Prevention
Hypertension
Causes
Management
Prevention
Tachycardia
Causes
Management
Prevention
Bradycardia
Causes
Management
Prevention
Narrow complex tachycardia
Causes
Management
Prevention
Broad complex tachycardia
Causes
Management
Prevention
Pulmonary embolus (PE)
Causes
Symptoms and signs
Management
Prevention
Acute coronary syndrome
Causes
Symptoms and signs
Management
Prevention
Cardiac arrest
Reversible causes
Prevention
Case scenario 1
Further reading
Chapter 32: Metabolic problems
Introduction
Anaphylaxis
Causes
Signs and symptoms
Management
Prevention
Hypoglycaemia
Causes
Symptoms and signs
Management
Prevention
Hyperglycaemia
Causes
Signs and symptoms
Management
Prevention
Electrolyte imbalance — hyponatraemia
Causes
Symptoms and signs
Management
Electrolyte imbalance — hypernatraemia
Causes
Signs and symptoms
Management
Electrolyte imbalance — hypokalaemia
Causes
Signs and symptoms
Management
Electrolyte imbalance — hyperkalaemia
Causes
Signs and symptoms
Management
Thyroid storm
Causes
Signs and symptoms
Diagnosis
Management
Malignant hyperthermia
Signs
Management
Case scenario 1
Further reading
Chapter 33: Neurological problems
Introduction
Seizures
Types of seizure
Causes
Management
Prevention
Postoperative confusion
Causes
Management
Prevention
Local anaesthetic toxicity
Symptoms and signs
Management
Prevention
Case scenario 1
Further reading
Section 6: Critical care medicine
Chapter 34: General critical care management
Introduction
Care bundles
The ventilator care bundle
The central line bundle
Checklists
FASTHUG
FLATHUG components
Nutrition
Enteral feeding
Immune modulators
Complications associated with enteral feeding
Parenteral nutrition
Refeeding syndrome
Case scenario 1
Further reading
Chapter 35: Sepsis
Introduction
What is sepsis?
Other inflammatory effects
Diagnosis of sepsis
Stage one
Stage two
Stage three
Septic shock
Management of sepsis
Immediate treatment
Administer high-concentration oxygen
Blood cultures and other cultures depending on the likely source
Administer intravenous antibiotics
Intravenous fluid resuscitation
Measure haemoglobin and lactate
Measure the urine output hourly
Further treatment
Cardiovascular support
Respiratory support
Renal support
Other therapies
Nutrition
Corticosteroids
Glucose control
Thromboprophylaxis
Stress ulcer prophylaxis
Case scenario 1
Further reading
Chapter 36: Ventilatory support
Introduction
Lung compliance
Respiratory failure
Oxygen
Ventilatory support
Continuous positive airway pressure (CPAP)
Bi-level non-invasive ventilation
Invasive mechanical ventilation
Acute respiratory distress syndrome
Lung protective ventilation
Extracorporeal membrane oxygenation (ECMO)
Case scenario 1
Case scenario 2
Case scenario 3
Further reading
Section 7: Pain medicine
Chapter 37: Management of chronic pain
Introduction
Anatomy and physiology of pain
Nociceptors
Primary afferent neurons and the spinal cord
Secondary afferent neurons
Tertiary afferent neurons and the pain matrix
Inhibitory pain mechanisms
Visceral pain
Neuropathic pain
Assessment of patients with chronic pain
Management of chronic pain (Figure 37.3)
Pharmacological management of pain
Other agents
Non-pharmacological pain management
Case scenario 1
Case scenario 2
Further reading
Index
Other books in the series
Back Cover