Now in a revised and expanded 7th Edition, Kaplan’s Cardiac Anesthesia helps you optimize perioperative outcomes for patients undergoing both cardiac and noncardiac surgery. Dr. Joel L. Kaplan, along with associate editors, Drs. John G. T. Augoustides, David L. Reich, and Gerard R. Manecke, guide you through today’s clinical challenges, including the newest approaches to perioperative assessment and management, state-of-the art diagnostic techniques, and cardiovascular and coronary physiology.
1. Cover image - p. i 2. Title Page - p. i 3. Table of Contents - p. i 4. Copyright - p. iv 5. Dedication - p. v 6. Contributors - p. vi 7. Preface - p. xv 8. Foreword - p. xvii 9. Video Contents - p. xxi 10. Section I Preoperative Assessment and Management - p. xxiii 11. 1 Assessment of Cardiac Risk and the Cardiology Consultation - p. 3 12. 2 Cardiovascular Imaging - p. 20 13. 3 Cardiac Catheterization Laboratory - p. 46 14. Catheterization Laboratory Facilities: Radiation Safety and Image Acquisition - p. 47 15. Patient Selection for Catheterization - p. 49 16. Cardiac Catheterization Procedures - p. 50 17. Valvular Pathology - p. 56 18. Angiography - p. 59 19. Interventional Cardiology: Percutaneous Coronary Intervention - p. 64 20. Specific Interventional Devices - p. 77 21. Other Catheter-Based Percutaneous Therapies - p. 81 22. Other Catheter-Based Intracardiac Procedures - p. 88 23. The Catheterization Laboratory and the Anesthesiologist - p. 89 24. References - p. 90 25. 4 Cardiac Electrophysiology - p. 96 26. 5 Cardiac Implantable Electrical Devices - p. 118 27. Section II Cardiovascular Physiology, Pharmacology, Molecular Biology, and Genetics - p. 136 28. 6 Cardiac Physiology - p. 143 29. Functional Implications of Gross Anatomy - p. 143 30. Cardiac Myocyte Anatomy and Function - p. 147 31. Laplace's Law - p. 150 32. The Cardiac Cycle - p. 150 33. Determinants of Pump Performance - p. 155 34. Coupling, Energetics, and Efficiency - p. 165 35. Evaluation of Diastolic Function - p. 166 36. Pericardial Forces - p. 173 37. Determinants of Atrial Function - p. 173 38. References - p. 174 39. 7 Coronary Physiology and Atherosclerosis - p. 179 40. 8 Molecular and Genetic Cardiovascular Medicine - p. 206 41. 9 Systemic Inflammation - p. 231 42. 10 Pharmacology of Anesthetic Drugs - p. 247 43. Volatile Agents - p. 248 44. Intravenous Induction Agents - p. 255 45. Individual Agents - p. 267 46. Opioids in Cardiac Anesthesia - p. 271 47. Effects of Cardiopulmonary Bypass on Pharmacokinetics and Pharmacodynamics - p. 281 48. Acknowledgments - p. 285 49. References - p. 285 50. 11 Cardiovascular Pharmacology - p. 292 51. Antiischemic Drug Therapy - p. 292 52. Drug Therapy for Systemic Hypertension - p. 306 53. Pharmacotherapy for Acute and Chronic Heart Failure - p. 312 54. Pharmacotherapy for Cardiac Arrhythmias - p. 332 55. References - p. 345 56. Section III Monitoring - p. 354 57. 12 Electrocardiographic Monitoring - p. 357 58. 13 Monitoring of the Heart and Vascular System - p. 390 59. Hemodynamic Monitoring - p. 390 60. Arterial Pressure Monitoring - p. 391 61. Central Venous Pressure Monitoring - p. 396 62. Pulmonary Arterial Pressure Monitoring - p. 403 63. Special Purpose Pulmonary Artery Catheters - p. 410 64. Cardiac Output Monitoring - p. 411 65. Left Atrial Pressure Monitoring - p. 416 66. Coronary Sinus Catheterization - p. 416 67. Analysis and Interpretation of Hemodynamic Data - p. 417 68. Pulse Oximetry - p. 419 69. Oxygen Transport Calculations - p. 420 70. Summary - p. 420 71. References - p. 420 72. 14 Basic Intraoperative Transesophageal Echocardiography - p. 427 73. Basic Concepts - p. 427 74. Imaging Techniques - p. 429 75. Echocardiographic Scanners - p. 434 76. Equipment - p. 436 77. Image Storage - p. 437 78. Complications - p. 440 79. Safety Guidelines and Contraindications - p. 441 80. Credentialing - p. 441 81. Technique of Probe Passage - p. 442 82. Comprehensive Intraoperative Multiplane Transesophageal Echocardiographic Examination - p. 442 83. Clinical Applications - p. 461 84. Hemodynamic Assessment - p. 477 85. Cardiac Output - p. 478 86. Contrast Applications - p. 479 87. Valvular Evaluation - p. 481 88. Myocardial Ischemia Monitoring - p. 498 89. References - p. 501 90. 15 Transesophageal Echocardiography - p. 505 91. The Development of a Perioperative Echocardiography Service - p. 505 92. Three-Dimensional Transesophageal Echocardiography - p. 506 93. Perioperative Echocardiographic Evaluation of Valves - p. 509 94. Transesophageal Echocardiography for Interventional Procedures - p. 583 95. Strain, Strain Rate, and Doppler Tissue Imaging - p. 595 96. Myocardial Disease - p. 605 97. Aortic Evaluation - p. 612 98. Pericardial Disease - p. 623 99. Evaluation of Cardiac Masses - p. 627 100. References - p. 628 101. 16 Decision Making and Perioperative Transesophageal Echocardiography - p. 635 102. 17 Education and Simulation in Echocardiography - p. 663 103. 18 Central Nervous System Monitoring - p. 677 104. 19 Coagulation Monitoring - p. 698 105. Hemostasis - p. 698 106. Monitoring Heparin Effect - p. 699 107. Heparin Neutralization - p. 705 108. Tests of Coagulation - p. 707 109. Monitoring Fibrinolysis - p. 709 110. Monitoring the Thrombin Inhibitors - p. 709 111. Evaluation of Prolonged Activated Partial Thromboplastin Time - p. 710 112. Monitoring Platelet Function - p. 710 113. Bedside Coagulation and Platelet Function Testing - p. 713 114. Summary - p. 723 115. References - p. 724 116. Section IV Anesthesia for Cardiac Surgical Procedures - p. 727 117. 20 Anesthesia for Myocardial Revascularization - p. 731 118. Epidemiology - p. 731 119. Pathophysiology of Coronary Artery Disease - p. 731 120. Risk Assessment in Patients Scheduled for Coronary Artery Bypass Grafting - p. 734 121. Anesthesia for Coronary Artery Bypass Grafting - p. 736 122. Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass - p. 755 123. Minimally Invasive Coronary Artery Surgery - p. 760 124. Conclusions - p. 761 125. References - p. 761 126. 21 Valvular Heart Disease - p. 770 127. Pathophysiology - p. 771 128. Aortic Stenosis - p. 774 129. Hypertrophic Cardiomyopathy - p. 785 130. Aortic Regurgitation - p. 790 131. Mitral Regurgitation - p. 794 132. Mitral Stenosis - p. 802 133. Tricuspid Regurgitation - p. 805 134. Innovations in Valve Repair - p. 807 135. New Techniques for Mitral Valve Repair - p. 808 136. Case Study 1: Transapical Aortic Valve Implantation - p. 809 137. Case Study 2: Robotically Assisted Mitral Valve Repair - p. 810 138. Case Study 3: Mitral Valve Repair With Systolic Anterior Motion After Bypass Needing Additional Repair - p. 811 139. References - p. 811 140. 22 Congenital Heart Disease in Adults - p. 818 141. 23 Thoracic Aorta - p. 843 142. Anatomy of the Aorta - p. 843 143. General Considerations for the Perioperative Care of Aortic Surgical Patients - p. 844 144. Thoracic Aortic Aneurysm - p. 847 145. Aortic Dissection - p. 864 146. Penetrating Atherosclerotic Ulcer - p. 869 147. Traumatic Aortic Injury - p. 870 148. Aortic Atheromatous Disease - p. 870 149. Takayasu Arteritis - p. 871 150. Aortic Coarctation - p. 871 151. Illustrative Transesophageal Echocardiography Cases - p. 872 152. References - p. 879 153. 24 Uncommon Cardiac Diseases - p. 883 154. Cardiac Tumors - p. 884 155. Cardiomyopathy - p. 901 156. Mitral Valve Prolapse - p. 932 157. Patent Foramen Ovale - p. 936 158. Pulmonary Hemorrhage - p. 939 159. Pericardial Heart Disease - p. 941 160. Combined Carotid and Coronary Artery Disease - p. 948 161. Coronary Arteriovenous Fistula - p. 951 162. Cardiac Surgery During Pregnancy - p. 953 163. Risks of Human Immunodeficiency Virus Transmission - p. 954 164. Renal Insufficiency and Cardiac Surgery - p. 956 165. Hematologic Problems in Patients Undergoing Cardiac Surgery - p. 958 166. Acknowledgments - p. 967 167. References - p. 967 168. 25 Anesthesia for Heart, Lung, and Heart-Lung Transplantation - p. 974 169. 26 Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension - p. 994 170. 27 Procedures in the Hybrid Operating Room - p. 1022 171. 28 Mechanical Assist Devices for Heart Failure - p. 1042 172. 29 Reoperative Cardiac Surgery - p. 1064 173. 30 Patient Safety in the Cardiac Operating Room - p. 1072 174. The Science of Safety - p. 1073 175. Human Error - p. 1075 176. Teamwork and Communication - p. 1082 177. Interventions to Improve Patient Safety - p. 1087 178. Medication Safety - p. 1092 179. Reducing System Vulnerability - p. 1099 180. Culture of Safety - p. 1100 181. References - p. 1102 182. Section V Extracorporeal Circulation - p. 1108 183. 31 Cardiopulmonary Bypass Management and Organ Protection - p. 1111 184. Historical Perspective on Cardiopulmonary Bypass - p. 1111 185. Goals and Mechanics of Cardiopulmonary Bypass - p. 1112 186. Physiologic Parameters of Cardiopulmonary Bypass - p. 1112 187. End-Organ Effects of Cardiopulmonary Bypass - p. 1112 188. Central Nervous System Injury - p. 1113 189. Acute Kidney Injury - p. 1124 190. Myocardial Injury - p. 1130 191. Gastrointestinal Complications - p. 1134 192. Lung Injury During Cardiac Surgery - p. 1135 193. Management of Bypass - p. 1138 194. Initiation and Discontinuation of Bypass Support: An Overview - p. 1139 195. Perfusion Emergencies - p. 1144 196. Special Patient Populations - p. 1147 197. Minimally Invasive Surgery and Cardiopulmonary Bypass - p. 1150 198. References - p. 1152 199. 32 Extracorporeal Devices and Related Technologies - p. 1162 200. Mechanical Devices - p. 1163 201. Electronic Perfusion Records - p. 1169 202. Extracorporeal Circuitry - p. 1171 203. Cardioplegia Delivery - p. 1182 204. The Heart-Lung Machine Priming Solutions - p. 1186 205. Coated Circuits - p. 1194 206. Perfusion Practices - p. 1195 207. Methods of Extracorporeal Circulation - p. 1200 208. Summary - p. 1205 209. References - p. 1207 210. 33 Extracorporeal Membrane Oxygenation - p. 1214 211. 34 Blood and Fluid Management During Cardiac Surgery - p. 1229 212. 35 Transfusion Medicine and Coagulation Disorders - p. 1248 213. Overview of Hemostasis - p. 1248 214. Heparin - p. 1258 215. Alternative Modes of Anticoagulation - p. 1265 216. Protamine - p. 1269 217. Bleeding Patient - p. 1276 218. References - p. 1284 219. 36 Discontinuing Cardiopulmonary Bypass - p. 1291 220. Section VI Postoperative Care - p. 1310 221. 37 Fast-Track Postoperative Cardiac Recovery and Outcomes - p. 1313 222. 38 Postoperative Cardiovascular Management - p. 1327 223. Oxygen Transport - p. 1327 224. Temperature - p. 1328 225. Assessment of the Circulation - p. 1329 226. Postoperative Myocardial Dysfunction - p. 1330 227. Postoperative Myocardial Ischemia - p. 1330 228. Therapeutic Interventions - p. 1331 229. Postoperative Hypertension - p. 1334 230. Postoperative Vasodilation - p. 1335 231. Coronary Artery Spasm - p. 1336 232. Decreased Contractility - p. 1336 233. Right-Sided Heart Failure - p. 1339 234. Cardiac Tamponade - p. 1343 235. Transplanted Heart - p. 1343 236. Advances in Cardiovascular Surgery and Postoperative Management - p. 1344 237. References - p. 1353 238. 39 Postoperative Respiratory Care - p. 1358 239. 40 Central Nervous System Dysfunction After Cardiopulmonary Bypass - p. 1374 240. Categorization of Central Nervous System Injury - p. 1375 241. Neuropsychologic Dysfunction - p. 1377 242. Mechanisms of Brain Injury - p. 1379 243. Cerebral Blood Flow - p. 1386 244. Cardiopulmonary Bypass Equipment - p. 1387 245. Cerebroprotective Strategies - p. 1389 246. Procedural Risk - p. 1394 247. Minimal Access Surgery and Circulatory Support - p. 1395 248. References - p. 1401 249. 41 Long-Term Complications and Management - p. 1407 250. 42 Postoperative Pain Management for the Cardiac Patient - p. 1425 251. Pain and Cardiac Surgery - p. 1426 252. Potential Clinical Benefits of Adequate Postoperative Analgesia - p. 1427 253. Techniques Available for Postoperative Analgesia - p. 1428 254. Local Anesthetic Infiltration - p. 1428 255. Nerve Blocks - p. 1430 256. Opioids - p. 1431 257. Patient-Controlled Analgesia - p. 1434 258. Nonsteroidal Antiinflammatory Agents - p. 1435 259. Alpha2-Adrenergic Agonists - p. 1438 260. Intrathecal and Epidural Techniques - p. 1439 261. Multimodal Analgesia - p. 1452 262. How Important Is Postoperative Pain After Cardiac Surgery? - p. 1453 263. Conclusions - p. 1453 264. References - p. 1454 265. Section VII The Cardiac Patient for Noncardiac Surgery - p. 1457 266. 43 Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery - p. 1461 267. 44 The Patient With Coronary Stents Undergoing Noncardiac Surgery - p. 1472 268. Optimal Stenting Technique - p. 1473 269. Types of Stents - p. 1473 270. Vascular and Biologic Response to Stent Placement - p. 1476 271. Antiplatelet Therapy - p. 1480 272. Long-Term Antiplatelet Management - p. 1485 273. Noncardiac Surgery and Coronary Stents - p. 1489 274. An Integrated Approach - p. 1494 275. References - p. 1494 276. 45 Ventricular Assist Devices, Cardiac Transplants, and Implanted Electrical Devices in Noncardiac Surgery - p. 1500 277. 46 Echocardiography in Noncardiac Surgery - p. 1515 278. 47 Goal-Directed Fluid Therapy, Enhanced Recovery, and the Perioperative Surgical Home for Cardiac Patients in Noncardiac Surgery - p. 1531 279. 48 Vascular Surgery - p. 1540 280. 49 The Cardiac Patient for Thoracic Noncardiac Surgery - p. 1564 281. 50 The Pregnant Patient With Cardiac Disease - p. 1582 282. 51 Critical Care Medicine in the Operating Room - p. 1600 283. 52 Perioperative Care to Reduce Major Adverse Cardiac Events and Mortality in Noncardiac Surgical Procedures - p. 1615 284. Index - p. 1637
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Now in a revised and expanded 7th Edition, Kaplan’s Cardiac Anesthesia helps you optimize perioperative outcomes for patients undergoing both cardiac and noncardiac surgery. Dr. Joel L. Kaplan, along with associate editors, Drs. John G. T. Augoustides, David L. Reich, and Gerard R. Manecke, guide you through today’s clinical challenges, including the newest approaches to perioperative assessment and management, state-of-the art diagnostic techniques, and cardiovascular and coronary physiology.
1. Cover image - p. i 2. Title Page - p. i 3. Table of Contents - p. i 4. Copyright - p. iv 5. Dedication - p. v 6. Contributors - p. vi 7. Preface - p. xv 8. Foreword - p. xvii 9. Video Contents - p. xxi 10. Section I Preoperative Assessment and Management - p. xxiii 11. 1 Assessment of Cardiac Risk and the Cardiology Consultation - p. 3 12. 2 Cardiovascular Imaging - p. 20 13. 3 Cardiac Catheterization Laboratory - p. 46 14. Catheterization Laboratory Facilities: Radiation Safety and Image Acquisition - p. 47 15. Patient Selection for Catheterization - p. 49 16. Cardiac Catheterization Procedures - p. 50 17. Valvular Pathology - p. 56 18. Angiography - p. 59 19. Interventional Cardiology: Percutaneous Coronary Intervention - p. 64 20. Specific Interventional Devices - p. 77 21. Other Catheter-Based Percutaneous Therapies - p. 81 22. Other Catheter-Based Intracardiac Procedures - p. 88 23. The Catheterization Laboratory and the Anesthesiologist - p. 89 24. References - p. 90 25. 4 Cardiac Electrophysiology - p. 96 26. 5 Cardiac Implantable Electrical Devices - p. 118 27. Section II Cardiovascular Physiology, Pharmacology, Molecular Biology, and Genetics - p. 136 28. 6 Cardiac Physiology - p. 143 29. Functional Implications of Gross Anatomy - p. 143 30. Cardiac Myocyte Anatomy and Function - p. 147 31. Laplace's Law - p. 150 32. The Cardiac Cycle - p. 150 33. Determinants of Pump Performance - p. 155 34. Coupling, Energetics, and Efficiency - p. 165 35. Evaluation of Diastolic Function - p. 166 36. Pericardial Forces - p. 173 37. Determinants of Atrial Function - p. 173 38. References - p. 174 39. 7 Coronary Physiology and Atherosclerosis - p. 179 40. 8 Molecular and Genetic Cardiovascular Medicine - p. 206 41. 9 Systemic Inflammation - p. 231 42. 10 Pharmacology of Anesthetic Drugs - p. 247 43. Volatile Agents - p. 248 44. Intravenous Induction Agents - p. 255 45. Individual Agents - p. 267 46. Opioids in Cardiac Anesthesia - p. 271 47. Effects of Cardiopulmonary Bypass on Pharmacokinetics and Pharmacodynamics - p. 281 48. Acknowledgments - p. 285 49. References - p. 285 50. 11 Cardiovascular Pharmacology - p. 292 51. Antiischemic Drug Therapy - p. 292 52. Drug Therapy for Systemic Hypertension - p. 306 53. Pharmacotherapy for Acute and Chronic Heart Failure - p. 312 54. Pharmacotherapy for Cardiac Arrhythmias - p. 332 55. References - p. 345 56. Section III Monitoring - p. 354 57. 12 Electrocardiographic Monitoring - p. 357 58. 13 Monitoring of the Heart and Vascular System - p. 390 59. Hemodynamic Monitoring - p. 390 60. Arterial Pressure Monitoring - p. 391 61. Central Venous Pressure Monitoring - p. 396 62. Pulmonary Arterial Pressure Monitoring - p. 403 63. Special Purpose Pulmonary Artery Catheters - p. 410 64. Cardiac Output Monitoring - p. 411 65. Left Atrial Pressure Monitoring - p. 416 66. Coronary Sinus Catheterization - p. 416 67. Analysis and Interpretation of Hemodynamic Data - p. 417 68. Pulse Oximetry - p. 419 69. Oxygen Transport Calculations - p. 420 70. Summary - p. 420 71. References - p. 420 72. 14 Basic Intraoperative Transesophageal Echocardiography - p. 427 73. Basic Concepts - p. 427 74. Imaging Techniques - p. 429 75. Echocardiographic Scanners - p. 434 76. Equipment - p. 436 77. Image Storage - p. 437 78. Complications - p. 440 79. Safety Guidelines and Contraindications - p. 441 80. Credentialing - p. 441 81. Technique of Probe Passage - p. 442 82. Comprehensive Intraoperative Multiplane Transesophageal Echocardiographic Examination - p. 442 83. Clinical Applications - p. 461 84. Hemodynamic Assessment - p. 477 85. Cardiac Output - p. 478 86. Contrast Applications - p. 479 87. Valvular Evaluation - p. 481 88. Myocardial Ischemia Monitoring - p. 498 89. References - p. 501 90. 15 Transesophageal Echocardiography - p. 505 91. The Development of a Perioperative Echocardiography Service - p. 505 92. Three-Dimensional Transesophageal Echocardiography - p. 506 93. Perioperative Echocardiographic Evaluation of Valves - p. 509 94. Transesophageal Echocardiography for Interventional Procedures - p. 583 95. Strain, Strain Rate, and Doppler Tissue Imaging - p. 595 96. Myocardial Disease - p. 605 97. Aortic Evaluation - p. 612 98. Pericardial Disease - p. 623 99. Evaluation of Cardiac Masses - p. 627 100. References - p. 628 101. 16 Decision Making and Perioperative Transesophageal Echocardiography - p. 635 102. 17 Education and Simulation in Echocardiography - p. 663 103. 18 Central Nervous System Monitoring - p. 677 104. 19 Coagulation Monitoring - p. 698 105. Hemostasis - p. 698 106. Monitoring Heparin Effect - p. 699 107. Heparin Neutralization - p. 705 108. Tests of Coagulation - p. 707 109. Monitoring Fibrinolysis - p. 709 110. Monitoring the Thrombin Inhibitors - p. 709 111. Evaluation of Prolonged Activated Partial Thromboplastin Time - p. 710 112. Monitoring Platelet Function - p. 710 113. Bedside Coagulation and Platelet Function Testing - p. 713 114. Summary - p. 723 115. References - p. 724 116. Section IV Anesthesia for Cardiac Surgical Procedures - p. 727 117. 20 Anesthesia for Myocardial Revascularization - p. 731 118. Epidemiology - p. 731 119. Pathophysiology of Coronary Artery Disease - p. 731 120. Risk Assessment in Patients Scheduled for Coronary Artery Bypass Grafting - p. 734 121. Anesthesia for Coronary Artery Bypass Grafting - p. 736 122. Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass - p. 755 123. Minimally Invasive Coronary Artery Surgery - p. 760 124. Conclusions - p. 761 125. References - p. 761 126. 21 Valvular Heart Disease - p. 770 127. Pathophysiology - p. 771 128. Aortic Stenosis - p. 774 129. Hypertrophic Cardiomyopathy - p. 785 130. Aortic Regurgitation - p. 790 131. Mitral Regurgitation - p. 794 132. Mitral Stenosis - p. 802 133. Tricuspid Regurgitation - p. 805 134. Innovations in Valve Repair - p. 807 135. New Techniques for Mitral Valve Repair - p. 808 136. Case Study 1: Transapical Aortic Valve Implantation - p. 809 137. Case Study 2: Robotically Assisted Mitral Valve Repair - p. 810 138. Case Study 3: Mitral Valve Repair With Systolic Anterior Motion After Bypass Needing Additional Repair - p. 811 139. References - p. 811 140. 22 Congenital Heart Disease in Adults - p. 818 141. 23 Thoracic Aorta - p. 843 142. Anatomy of the Aorta - p. 843 143. General Considerations for the Perioperative Care of Aortic Surgical Patients - p. 844 144. Thoracic Aortic Aneurysm - p. 847 145. Aortic Dissection - p. 864 146. Penetrating Atherosclerotic Ulcer - p. 869 147. Traumatic Aortic Injury - p. 870 148. Aortic Atheromatous Disease - p. 870 149. Takayasu Arteritis - p. 871 150. Aortic Coarctation - p. 871 151. Illustrative Transesophageal Echocardiography Cases - p. 872 152. References - p. 879 153. 24 Uncommon Cardiac Diseases - p. 883 154. Cardiac Tumors - p. 884 155. Cardiomyopathy - p. 901 156. Mitral Valve Prolapse - p. 932 157. Patent Foramen Ovale - p. 936 158. Pulmonary Hemorrhage - p. 939 159. Pericardial Heart Disease - p. 941 160. Combined Carotid and Coronary Artery Disease - p. 948 161. Coronary Arteriovenous Fistula - p. 951 162. Cardiac Surgery During Pregnancy - p. 953 163. Risks of Human Immunodeficiency Virus Transmission - p. 954 164. Renal Insufficiency and Cardiac Surgery - p. 956 165. Hematologic Problems in Patients Undergoing Cardiac Surgery - p. 958 166. Acknowledgments - p. 967 167. References - p. 967 168. 25 Anesthesia for Heart, Lung, and Heart-Lung Transplantation - p. 974 169. 26 Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension - p. 994 170. 27 Procedures in the Hybrid Operating Room - p. 1022 171. 28 Mechanical Assist Devices for Heart Failure - p. 1042 172. 29 Reoperative Cardiac Surgery - p. 1064 173. 30 Patient Safety in the Cardiac Operating Room - p. 1072 174. The Science of Safety - p. 1073 175. Human Error - p. 1075 176. Teamwork and Communication - p. 1082 177. Interventions to Improve Patient Safety - p. 1087 178. Medication Safety - p. 1092 179. Reducing System Vulnerability - p. 1099 180. Culture of Safety - p. 1100 181. References - p. 1102 182. Section V Extracorporeal Circulation - p. 1108 183. 31 Cardiopulmonary Bypass Management and Organ Protection - p. 1111 184. Historical Perspective on Cardiopulmonary Bypass - p. 1111 185. Goals and Mechanics of Cardiopulmonary Bypass - p. 1112 186. Physiologic Parameters of Cardiopulmonary Bypass - p. 1112 187. End-Organ Effects of Cardiopulmonary Bypass - p. 1112 188. Central Nervous System Injury - p. 1113 189. Acute Kidney Injury - p. 1124 190. Myocardial Injury - p. 1130 191. Gastrointestinal Complications - p. 1134 192. Lung Injury During Cardiac Surgery - p. 1135 193. Management of Bypass - p. 1138 194. Initiation and Discontinuation of Bypass Support: An Overview - p. 1139 195. Perfusion Emergencies - p. 1144 196. Special Patient Populations - p. 1147 197. Minimally Invasive Surgery and Cardiopulmonary Bypass - p. 1150 198. References - p. 1152 199. 32 Extracorporeal Devices and Related Technologies - p. 1162 200. Mechanical Devices - p. 1163 201. Electronic Perfusion Records - p. 1169 202. Extracorporeal Circuitry - p. 1171 203. Cardioplegia Delivery - p. 1182 204. The Heart-Lung Machine Priming Solutions - p. 1186 205. Coated Circuits - p. 1194 206. Perfusion Practices - p. 1195 207. Methods of Extracorporeal Circulation - p. 1200 208. Summary - p. 1205 209. References - p. 1207 210. 33 Extracorporeal Membrane Oxygenation - p. 1214 211. 34 Blood and Fluid Management During Cardiac Surgery - p. 1229 212. 35 Transfusion Medicine and Coagulation Disorders - p. 1248 213. Overview of Hemostasis - p. 1248 214. Heparin - p. 1258 215. Alternative Modes of Anticoagulation - p. 1265 216. Protamine - p. 1269 217. Bleeding Patient - p. 1276 218. References - p. 1284 219. 36 Discontinuing Cardiopulmonary Bypass - p. 1291 220. Section VI Postoperative Care - p. 1310 221. 37 Fast-Track Postoperative Cardiac Recovery and Outcomes - p. 1313 222. 38 Postoperative Cardiovascular Management - p. 1327 223. Oxygen Transport - p. 1327 224. Temperature - p. 1328 225. Assessment of the Circulation - p. 1329 226. Postoperative Myocardial Dysfunction - p. 1330 227. Postoperative Myocardial Ischemia - p. 1330 228. Therapeutic Interventions - p. 1331 229. Postoperative Hypertension - p. 1334 230. Postoperative Vasodilation - p. 1335 231. Coronary Artery Spasm - p. 1336 232. Decreased Contractility - p. 1336 233. Right-Sided Heart Failure - p. 1339 234. Cardiac Tamponade - p. 1343 235. Transplanted Heart - p. 1343 236. Advances in Cardiovascular Surgery and Postoperative Management - p. 1344 237. References - p. 1353 238. 39 Postoperative Respiratory Care - p. 1358 239. 40 Central Nervous System Dysfunction After Cardiopulmonary Bypass - p. 1374 240. Categorization of Central Nervous System Injury - p. 1375 241. Neuropsychologic Dysfunction - p. 1377 242. Mechanisms of Brain Injury - p. 1379 243. Cerebral Blood Flow - p. 1386 244. Cardiopulmonary Bypass Equipment - p. 1387 245. Cerebroprotective Strategies - p. 1389 246. Procedural Risk - p. 1394 247. Minimal Access Surgery and Circulatory Support - p. 1395 248. References - p. 1401 249. 41 Long-Term Complications and Management - p. 1407 250. 42 Postoperative Pain Management for the Cardiac Patient - p. 1425 251. Pain and Cardiac Surgery - p. 1426 252. Potential Clinical Benefits of Adequate Postoperative Analgesia - p. 1427 253. Techniques Available for Postoperative Analgesia - p. 1428 254. Local Anesthetic Infiltration - p. 1428 255. Nerve Blocks - p. 1430 256. Opioids - p. 1431 257. Patient-Controlled Analgesia - p. 1434 258. Nonsteroidal Antiinflammatory Agents - p. 1435 259. Alpha2-Adrenergic Agonists - p. 1438 260. Intrathecal and Epidural Techniques - p. 1439 261. Multimodal Analgesia - p. 1452 262. How Important Is Postoperative Pain After Cardiac Surgery? - p. 1453 263. Conclusions - p. 1453 264. References - p. 1454 265. Section VII The Cardiac Patient for Noncardiac Surgery - p. 1457 266. 43 Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery - p. 1461 267. 44 The Patient With Coronary Stents Undergoing Noncardiac Surgery - p. 1472 268. Optimal Stenting Technique - p. 1473 269. Types of Stents - p. 1473 270. Vascular and Biologic Response to Stent Placement - p. 1476 271. Antiplatelet Therapy - p. 1480 272. Long-Term Antiplatelet Management - p. 1485 273. Noncardiac Surgery and Coronary Stents - p. 1489 274. An Integrated Approach - p. 1494 275. References - p. 1494 276. 45 Ventricular Assist Devices, Cardiac Transplants, and Implanted Electrical Devices in Noncardiac Surgery - p. 1500 277. 46 Echocardiography in Noncardiac Surgery - p. 1515 278. 47 Goal-Directed Fluid Therapy, Enhanced Recovery, and the Perioperative Surgical Home for Cardiac Patients in Noncardiac Surgery - p. 1531 279. 48 Vascular Surgery - p. 1540 280. 49 The Cardiac Patient for Thoracic Noncardiac Surgery - p. 1564 281. 50 The Pregnant Patient With Cardiac Disease - p. 1582 282. 51 Critical Care Medicine in the Operating Room - p. 1600 283. 52 Perioperative Care to Reduce Major Adverse Cardiac Events and Mortality in Noncardiac Surgical Procedures - p. 1615 284. Index - p. 1637
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