Miller's Anesthesia

1. Section I. Introduction - p. xxvii 2. 1. The Scope of Modern Anesthetic Practice - p. 2 3. 2. Anesthesia and Analgesia in the Global Context - p. 10 4. Introduction - p. 11 5. Section 1: Anesthesia and “Global Health” - p. 11 6. Section 2: Evolution of Anesthesia Care Models and Challenges Around the World - p. 31 7. Section 3: Essentials for Practice in Resource-Constrained Settings - p. 45 8. Appendix 1 Links and Useful Resources - p. 52 9. Conclusions - p. 56.e1 10. 3. Perioperative Medicine - p. 57 11. 4. Informatics in Perioperative Medicine - p. 67 12. 5. Quality Improvement in Anesthesia Practice and Patient Safety - p. 84 13. 6. Avoiding Patient Harm in Anesthesia: Human Performance and Patient Safety - p. 105 14. What this Chapter is About: An Overview - p. 106 15. Human Performance and Patient Safety in Anesthesia: Why is this Important? - p. 106 16. Nature of the Anesthesia Professional’s Operational Domain: A Dynamic and Complex Environment - p. 107 17. Nature of the Anesthesia Professional’s Work: Task Variation and Workload Management - p. 110 18. Patient Safety on the Individual and Team Level - p. 123 19. Patient Safety on the Organizational Level - p. 154 20. The Bigger Picture: Patient Safety Efforts on the U.S. National and International Level - p. 171 21. Conclusion and Outlook - p. 172 22. Appendix 6.1. Online Links and Valuable Public Sources - p. 173 23. 7. Patient Simulation - p. 179 24. What This Chapter Is About: An Overview - p. 179 25. Simulation in Anesthesia: Why Is It Important? - p. 179 26. Application of Simulation in Anesthesia and Health Care - p. 181 27. History, Development, and Types of Simulators and Simulation - p. 186 28. Simulation Fidelity and Classification of Simulators - p. 188 29. Sites of Simulation - p. 192 30. Simulation Team Training Participants: Who Should Be Trained and in What Composition? - p. 197 31. Patient Simulation Timing: Announced in Advance Versus Unannounced in Advance - p. 199 32. Scopes of Simulation in Health Care: The 12 Dimensions of Simulation - p. 199 33. Crisis Resource Management (ACRM; CRM): Part of Modern Patient Simulation Team Training - p. 202 34. Anatomy of a Patient Simulation Team Training Exercise - p. 205 35. Scenario Design and Execution: Knowing the Learning Objectives and Making It Real - p. 206 36. Debriefing: Heart and Soul of Patient Simulation - p. 210 37. Qualification and Certification of Simulation Instructors - p. 215 38. Accreditation of Simulation Programs, Sites, and Centers - p. 217 39. Benefits, Effectiveness, and Ecological Validity of Simulation Training - p. 218 40. Cost of Patient Simulation and Simulation Centers - p. 222 41. Using Simulation for Assessment of Clinical Performance - p. 223 42. Simulation Societies and Simulation Journals - p. 225 43. The Future of Patient Simulation in Anesthesia - p. 226 44. Appendix 7.1 Online Links and Useful Resources - p. 227 45. 8. Ethical Aspects of Anesthesia Care - p. 231 46. Section II. Anesthetic Physiology - p. 248.e2 47. 9. Consciousness, Memory, and Anesthesia - p. 250 48. 10. Sleep Medicine - p. 267 49. Definition of Sleep - p. 267 50. Physiology - p. 268 51. How to Assess Sleep - p. 272 52. Sleep and Breathing - p. 275 53. Sleep and Anesthesia: Two Unequal Twins Influencing Perioperative Medicine - p. 282 54. Sleep and Sedation in the Intensive Care Unit - p. 287 55. Acknowledgment - p. 290 56. 11. Cerebral Physiology and the Effects of Anesthetic Drugs - p. 294 57. The Anatomy of the Cerebral Circulation - p. 295 58. Effects of Anesthetics on Cerebral Blood Flow and Cerebral Metabolic Rate - p. 307 59. Other Effects of Anesthetics on Cerebral Physiology - p. 318 60. Cerebral Physiology in Pathologic States - p. 320 61. 12. Neuromuscular Physiology and Pharmacology - p. 333 62. 13. Respiratory Physiology and Pathophysiology - p. 354 63. Respiratory Physiology Is Central to the Practice of Anesthesia - p. 354 64. Pulmonary Physiology in Health - p. 354 65. Ventilation - p. 356 66. Static Lung Volumes—Functional Residual Capacity - p. 357 67. Respiratory Mechanics - p. 357 68. Distribution of Inspired Gas - p. 361 69. Perfusion - p. 363 70. Clinical Assessment of Lung Function - p. 364 71. Intraoperative Respiratory Events - p. 366 72. Ventilation-Perfusion Matching During Anesthesia - p. 372 73. Factors that Influence Respiratory Function During Anesthesia - p. 374 74. Lung Function After Cardiac Surgery - p. 380 75. Protective Ventilation - p. 381 76. Postoperative Physiotherapy - p. 381 77. Intraoperative Hyperoxia - p. 381 78. Effect of Sleep on Respiration - p. 381 79. 14. Cardiac Physiology - p. 384 80. 15. Gastrointestinal Physiology and Pathophysiology - p. 403 81. 16. Hepatic Physiology, Pathophysiology, and Anesthetic Considerations - p. 420 82. Anatomy of the Liver - p. 420 83. Hepatic Physiology - p. 424 84. Evaluation of the Liver - p. 427 85. Hepatic Pathophysiology - p. 431 86. Strategies for Minimizing Blood Loss - p. 438 87. 17. Renal Anatomy, Physiology, Pharmacology, and Evaluation of Function - p. 444 88. 18. Basic Principles of Pharmacology - p. 462 89. 19. Inhaled Anesthetics: Mechanisms of Action - p. 487 90. 20. Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity - p. 509 91. Introduction - p. 510 92. Uptake and Distribution of Inhaled Anesthetics - p. 510 93. Synthesis of the Model and Inhaled Anesthetic Induction: PK/PD - p. 520 94. Metabolism and Toxicity of Inhaled Anesthetics - p. 526 95. 21. Pulmonary Pharmacology and Inhaled Anesthetics - p. 540 96. Introduction - p. 540 97. Inhaled Anesthetics - p. 540 98. Mucociliary Function and Surfactant - p. 548 99. Nonvolatile Inhaled Agents - p. 564 100. Summary - p. 569 101. 22. Inhaled Anesthetics: Delivery Systems - p. 572 102. Standards and Guidelines for Anesthesia Workstations - p. 574 103. Functional Anatomy of the Anesthesia Workstation - p. 574 104. Checking Your Anesthesia Workstation - p. 627 105. 23. Intravenous Anesthetics - p. 638 106. Propofol - p. 639 107. Pharmacodynamics - p. 642 108. Uses - p. 646 109. Barbiturates - p. 648 110. Physicochemical Characteristics - p. 648 111. Pharmacokinetics - p. 649 112. Pharmacology - p. 650 113. Uses - p. 652 114. Benzodiazepines - p. 653 115. Pharmacodynamics - p. 655 116. Drug Interactions - p. 657 117. Uses - p. 657 118. Flumazenil - p. 660 119. Phencyclidines (Ketamine) - p. 661 120. Pharmacodynamics - p. 662 121. Etomidate - p. 666 122. Pharmacodynamics - p. 667 123. Uses - p. 669 124. Dexmedetomidine - p. 670 125. Effects on the Central Nervous System - p. 671 126. Central Nervous System Protection and Other Central Nervous System Effects - p. 672 127. Droperidol - p. 675 128. Pharmacodynamics - p. 675 129. Summary - p. 676 130. 24. Opioids - p. 680 131. Introduction - p. 680 132. Pharmacology of Opioids - p. 680 133. Neurophysiologic Effects of Opioids - p. 691 134. Respiratory Effects of Opioids - p. 699 135. Cardiovascular Effects of Opioids - p. 701 136. Endocrinologic Effects of Opioids - p. 704 137. Renal and Urodynamic Effects of Opioids - p. 706 138. Effects of Opioids on Digestive Organs - p. 707 139. Other Opioid Effects - p. 708 140. Pharmacokinetics and Pharmacodynamics of Opioids - p. 710 141. Anesthetic Techniques Using Opioids - p. 719 142. Other Opioid Agonists - p. 726 143. Agonist-Antagonist Opioid Compounds - p. 728 144. Opioid Antagonists - p. 731 145. Drug Interactions With Opioids - p. 733 146. 25. Nonopioid Pain Medications - p. 742 147. 26. Intravenous Drug Delivery Systems - p. 747 148. Introduction - p. 747 149. Pharmacokinetic Considerations - p. 749 150. Pharmacodynamic Considerations - p. 753 151. Designing Dosing Regimens - p. 762 152. Intravenous Infusion Devices and Technologies - p. 771 153. Future Perspectives - p. 787 154. 27. Pharmacology of Neuromuscular Blocking Drugs - p. 792 155. History and Clinical Use - p. 792 156. Principles of Action of Neuromuscular Blocking Drugs at the Neuromuscular Junction - p. 793 157. Pharmacology of Succinylcholine - p. 794 158. Nondepolarizing Neuromuscular Blocking Drugs - p. 799 159. Special Populations - p. 820 160. 28. Reversal (Antagonism) of Neuromuscular Blockade - p. 832 161. History - p. 832 162. Antagonism of Neuromuscular Blockade: Current Management Practices - p. 833 163. Drugs Used to Antagonize (Reverse) Neuromuscular Blockade - p. 841 164. 29. Local Anesthetics - p. 865 165. Section III. Anesthesia Management - p. 890.e3 166. 30. Risk of Anesthesia - p. 892 167. 31. Preoperative Evaluation - p. 918 168. Evolution of Preanesthesia Evaluation - p. 918 169. Goals and Benefits of Preanesthesia Evaluation - p. 919 170. Clinical Examination During Preoperative Evaluation - p. 919 171. Frailty, Geriatric Conditions, and the Older Surgical Patient - p. 926 172. Preoperative Evaluation of Patients With Coexisting Disease - p. 928 173. Special Issues in Preoperative Evaluation - p. 978 174. Preoperative Laboratory and Diagnostic Studies - p. 984 175. Preoperative Risk Assessment - p. 987 176. Preoperative Medication Management - p. 989 177. Planning for Anesthesia - p. 990 178. Regulatory Issues - p. 991 179. Preoperative Evaluation Clinic - p. 991 180. Conclusion - p. 994 181. 32. Anesthetic Implications of Concurrent Diseases - p. 999 182. Role of the Primary Care Physician or Consultant - p. 1000 183. Diseases Involving the Endocrine System and Disorders of Nutrition - p. 1001 184. Diseases Involving the Cardiovascular System - p. 1022 185. Disorders of the Respiratory and Immune Systems - p. 1031 186. Diseases of the Central Nervous System, Neuromuscular Diseases, and Psychiatric Disorders - p. 1038 187. Renal Disease and Electrolyte Disorders - p. 1043 188. Gastrointestinal and Liver Diseases - p. 1049 189. Hematologic Disorders and Oncologic Disease - p. 1051 190. Patients Given Drug Therapy for Chronic and Acute Medical Conditions - p. 1056 191. 33. Anesthetic Implications of Complementary and Alternative Therapies - p. 1065 192. 34. Patient Positioning and Associated Risks - p. 1079 193. Introduction - p. 1079 194. Physiologic Considerations of Positioning - p. 1080 195. General Positioning Considerations - p. 1080 196. Specific Positions - p. 1080 197. Peripheral Nerve Injury - p. 1094 198. Pressure Injuries - p. 1098 199. Bite Injuries - p. 1099 200. Anesthesia Outside the Operating Room - p. 1099 201. Perioperative Visual Loss - p. 1099 202. Conclusion - p. 1109 203. Disclosure - p. 1110 204. 35. Neuromuscular Disorders Including Malignant Hyperthermia and Other Genetic Disorders - p. 1113 205. Malignant Hyperthermia - p. 1113 206. Malignant Hyperthermia Is the Result of Abnormal Function of Muscle Calcium Release Units - p. 1116 207. Genetics - p. 1118 208. Fulminant Malignant Hyperthermia - p. 1120 209. Malignant Hyperthermia–Associated Syndromes - p. 1121 210. Diagnosis in the Operating Room and Postanesthesia Care Unit - p. 1123 211. Anesthesia for Susceptible Patients - p. 1125 212. Multiple Sclerosis - p. 1126 213. Motor Neuron Disorders - p. 1127 214. Guillain-Barré Syndrome - p. 1128 215. Hereditary Motor-Sensory Neuropathies, including Charcot-Marie-Tooth Disease - p. 1129 216. Duchenne Muscular Dystrophy and Becker Muscular Dystrophy - p. 1129 217. Limb-Girdle Muscular Dystrophy - p. 1132 218. Myotonic Dystrophy - p. 1133 219. Myotonia Congenita - p. 1133 220. Myotubular Myopathy - p. 1134 221. Metabolic Myopathies - p. 1134 222. Glycogen Storage Disease Type I - p. 1134 223. Glycogen Storage Disease Type II (Acid Maltase Deficiency) - p. 1135 224. Mitochondrial Myopathies - p. 1135 225. Myasthenia Gravis - p. 1137 226. Periodic Paralysis (Hyperkalemic, Hypokalemic, and Normokalemic) - p. 1139 227. Summary - p. 1140 228. 36. Cardiovascular Monitoring - p. 1145 229. Introduction to Cardiovascular Monitoring: Focused Physical Examination - p. 1146 230. Heart Rate and Pulse Rate Monitoring - p. 1146 231. Electrocardiography Monitoring - p. 1146 232. Blood Pressure Monitoring - p. 1157 233. Central Venous Pressure Monitoring - p. 1169 234. Pulmonary Artery Catheter Monitoring - p. 1176 235. Cardiac Output Monitoring - p. 1186 236. 37. Perioperative Echocardiography - p. 1194 237. Introduction - p. 1194 238. History of Perioperative Echocardiography - p. 1194 239. Principles of Ultrasound - p. 1195 240. Ultrasound Modalities - p. 1196 241. Three-Dimensional Image Acquisition - p. 1197 242. Indications and Practice Guidelines - p. 1200 243. Transesophageal Echocardiography Examination - p. 1200 244. Epicardial and Epiaortic Imaging - p. 1201 245. Transthoracic Echocardiography Examination - p. 1203 246. Qualitative Assessment - p. 1203 247. Quantitative Assessment - p. 1207 248. Hemodynamic Failure and Shock - p. 1212 249. Intraoperative Transesophageal Echocardiography - Noncardiac Surgery - p. 1216 250. Intraoperative Transesophageal Echocardiography - Cardiac Surgery - p. 1218 251. Intraprocedural Transesophageal Echocardiography- Structural Heart Interventions - p. 1220 252. Emerging Technologies - p. 1222 253. Perioperative Transthoracic Echocardiography and Focused Cardiac Ultrasound - p. 1223 254. Critical Care - p. 1224 255. Training and Certification - p. 1226 256. Future Directions - p. 1227 257. 38. Implantable Cardiac Pulse Generators: Pacemakers and Cardioverter-Defibrillators - p. 1231 258. 39. Neurologic Monitoring - p. 1243 259. Monitoring Modalities - p. 1244 260. Clinical Applications of Neurologic Monitoring - p. 1257 261. Nonsurgical Factors Influencing Monitoring Results - p. 1267 262. Summary - p. 1276 263. 40. Monitoring the State of the Brain and Central Nervous System During General Anesthesia and Sedation - p. 1279 264. 41. Respiratory Monitoring - p. 1298 265. Overview of Respiratory Monitoring - p. 1298 266. The Physical Examination - p. 1300 267. Pulse Oximetry - p. 1301 268. Mixed Venous Oxygen Saturation - p. 1305 269. Tissue Oxygenation - p. 1307 270. Capnometry and Capnography - p. 1308 271. Blood Gas Analysis - p. 1312 272. Monitoring Lung Flows, Volumes, and Pressures: - p. 1317 273. Plethysmographic Monitoring - p. 1325 274. Respiratory Rate Monitoring: Apnea Monitoring - p. 1326 275. Imaging for Respiratory Monitoring - p. 1327 276. Point of Care Tests - p. 1330 277. Respiratory Monitoring in Special Conditions - p. 1331 278. Automated Data Systems - p. 1333 279. Additional Monitored Variables - p. 1333 280. 42. Renal Pathophysiology and Treatment for Perioperative Ischemia and Nephrotoxic Injury - p. 1340 281. 43. Neuromuscular Monitoring - p. 1354 282. 44. Airway Management in the Adult - p. 1373 283. Introduction - p. 1373 284. Functional Airway Anatomy - p. 1374 285. Airway Assessment - p. 1378 286. Physiologic Concepts for Airway Management - p. 1380 287. Anesthesia for Airway Management - p. 1381 288. Mask Ventilation - p. 1387 289. Supraglottic Airways - p. 1388 290. Tracheal Intubation - p. 1392 291. Emergency Front of Neck Access - p. 1405 292. Extubation of the Trachea - p. 1407 293. Dissemination of Critical Airway Information - p. 1409 294. Summary - p. 1409 295. 45. Spinal, Epidural, and Caudal Anesthesia - p. 1413 296. Principles - p. 1413 297. Practice - p. 1413 298. Historical Perspectives - p. 1413 299. Anatomy - p. 1414 300. Anatomic Variations - p. 1415 301. Mechanism of Action - p. 1416 302. Physiologic Effects - p. 1417 303. Indications - p. 1420 304. Contraindications - p. 1420 305. Spinal Anesthesia - p. 1421 306. Epidural Anesthesia - p. 1432 307. Combined Spinal-Epidural - p. 1438 308. Caudal Anesthesia - p. 1439 309. Complications - p. 1440 310. Outcomes - p. 1445 311. Recent Advances - p. 1446 312. 46. Peripheral Nerve Blocks and Ultrasound Guidance for Regional Anesthesia - p. 1450 313. 47. Perioperative Fluid and Electrolyte Therapy - p. 1480 314. Physiology - p. 1481 315. Fluid Pharmacology - p. 1492 316. Clinical Fluid and Electrolyte Management - p. 1498 317. 48. Perioperative Acid-Base Balance - p. 1524 318. 49. Patient Blood Management: Transfusion Therapy - p. 1546 319. Evolution and Recent History of Blood Transfusion Therapy - p. 1546 320. Blood Procurement - p. 1547 321. Blood Component Therapy: Indications for Transfusion - p. 1552 322. Synthetic Oxygen-Carrying Substances - p. 1559 323. Autologous Blood - p. 1560 324. Compatibility Testing - p. 1564 325. Maximal Surgical Blood Order Schedule - p. 1566 326. Emergency Transfusion - p. 1566 327. Fresh Whole Blood - p. 1567 328. Complications - p. 1567 329. Citrate Intoxication and Hyperkalemia - p. 1570 330. Temperature - p. 1571 331. Acid-Base Abnormalities - p. 1572 332. Transfusion Reactions - p. 1572 333. Leukoreduction and Irradiation of Blood Transfusions - p. 1575 334. Informed Consent - p. 1576 335. 50. Patient Blood Management: Coagulation - p. 1579 336. VOLUME 2 - p. 1602.e6 337. Section IV. Adult Subspecialty Management - p. 1602.e6 338. 51. Management of the Patient with Chronic Pain - p. 1604 339. 52. Palliative Medicine - p. 1622 340. 53. Anesthesia for Thoracic Surgery - p. 1648 341. Introduction - p. 1648 342. Concomitant Medical Conditions - p. 1651 343. Difficult Endobronchial Intubation - p. 1660 344. Prediction of Desaturation During One-Lung Ventilation - p. 1661 345. Assessment for Repeat Thoracic Surgery - p. 1661 346. Intraoperative Monitoring - p. 1661 347. Invasive Hemodynamic Monitoring - p. 1662 348. Other Monitoring Technology - p. 1663 349. Indirect Cardiac Output - p. 1663 350. Lung Isolation - p. 1663 351. Difficult Airways and One-Lung Ventilation - p. 1672 352. Lung-Isolation Techniques in Patients With a Tracheostomy in Place - p. 1673 353. Anesthetic Management - p. 1676 354. Management of One-Lung Ventilation - p. 1677 355. Hypoxic Pulmonary Vasoconstriction - p. 1678 356. Ventilation Strategies During One-Lung Ventilation - p. 1680 357. Prediction of Hypoxemia During One-Lung Ventilation - p. 1681 358. Treatment of Hypoxemia During One-Lung Ventilation - p. 1682 359. Anesthetic Management for Common Surgical Procedures - p. 1685 360. Pulmonary Surgery - p. 1689 361. Lobectomy - p. 1690 362. Pneumonectomy - p. 1691 363. Limited Pulmonary Resections: Segmentectomy and Wedge Resection - p. 1693 364. Anesthetic Management for Specific Surgical Procedures - p. 1694 365. Anesthesia for Tracheal Resection - p. 1696 366. Blebs, Bullae, Cysts, and Pneumatoceles - p. 1700 367. Lung Transplantation - p. 1701 368. Pulmonary Hemorrhage - p. 1703 369. Pulmonary Thromboendarterectomy - p. 1704 370. Bronchopulmonary Lavage - p. 1705 371. Mediastinal Masses - p. 1705 372. Thymectomy for Myasthenia Gravis - p. 1707 373. Postoperative Management - p. 1708 374. Postoperative Analgesia - p. 1709 375. 54. Anesthesia for Cardiac Surgical Procedures - p. 1717 376. Cardiovascular Disease in the 21st Century - p. 1718 377. Approach to Anesthesia for the Adult Cardiac Patient - p. 1719 378. Cardiopulmonary Bypass - p. 1753 379. Specific Cardiovascular Disease States - p. 1766 380. Procedures in the Hybrid Operating Room - p. 1809 381. 55. Anesthesia for Correction of Cardiac Arrhythmias - p. 1815 382. 56. Anesthesia for Vascular Surgery - p. 1825 383. Preoperative Evaluation - p. 1825 384. Abdominal Aortic Reconstruction - p. 1830 385. Endovascular Aortic Repair Surgery - p. 1847 386. Hybrid Arch Repairs - p. 1854 387. Carotid Endarterectomy - p. 1855 388. Endovascular Treatment of Carotid Disease: Carotid Artery Stenting - p. 1864 389. Lower Extremity Revascularization - p. 1865 390. 57. Anesthesia for Neurologic Surgery and Neurointerventions - p. 1868 391. Recurrent Issues in Neuroanesthesia - p. 1869 392. Specific Procedures - p. 1885 393. 58. Anesthesia for Bariatric Surgery - p. 1911 394. 59. Anesthesia and the Renal and Genitourinary Systems - p. 1929 395. Innervation of the Genitourinary System - p. 1929 396. Anesthesia for Patients With Renal Disease - p. 1932 397. Renal and Genitourinary Procedures - p. 1942 398. Urogenital Pain Syndromes and Treatment - p. 1953 399. 60. Anesthesia for Abdominal Organ Transplantation - p. 1960 400. Kidney Transplantation - p. 1962 401. Pancreas Transplantation - p. 1969 402. Liver Transplantation - p. 1973 403. Conclusions - p. 1990 404. 61. Anesthesia for Organ Procurement - p. 1993 405. 62. Anesthesia for Obstetrics - p. 2006 406. Physiologic Changes During Pregnancy and Delivery - p. 2006 407. Uteroplacental Physiology - p. 2012 408. Labor Progress - p. 2013 409. Labor Analgesia - p. 2017 410. Anesthesia Considerations for Operative Delivery - p. 2022 411. Anesthesia for Cesarean Delivery - p. 2022 412. Postcesarean Pain Control and Recovery - p. 2026 413. Complications of Regional Anesthesia - p. 2026 414. Maternal Comorbidities - p. 2029 415. Opioid Dependence - p. 2032 416. Anesthesia for Malpresentation and External Cephalic Version - p. 2032 417. Obstetric Emergencies - p. 2032 418. Nonobstetric Surgery During Pregnancy - p. 2036 419. 63. Anesthesia for Fetal Surgery and Other Fetal Therapies - p. 2042 420. Indications, Procedures, and Outcomes - p. 2044 421. Twin Reversed Arterial Perfusion Sequence - p. 2048 422. Preoperative Assessment and Counseling - p. 2058 423. Intraoperative Management and Considerations - p. 2059 424. Postoperative Management and Considerations - p. 2064 425. Management of Ex Utero Intrapartum Treatment Procedure - p. 2065 426. Conclusions and Future Considerations - p. 2067 427. 64. Anesthesia for Orthopedic Surgery - p. 2071 428. Preoperative Evaluation - p. 2071 429. Special Considerations for Conditions Leading to Orthopedic Surgery - p. 2081 430. Orthopedic Procedures in Children with Special Conditions - p. 2084 431. Perioperative Management of the Orthopedic Patient - p. 2086 432. Anesthesia for Spine Surgery - p. 2095 433. 65. Geriatric Anesthesia - p. 2102 434. 66. Anesthesia for Trauma - p. 2115 435. Introduction - p. 2115 436. Prioritizing Trauma Care - p. 2116 437. Anesthesia in War and Austere Conditions - p. 2120 438. Emergency Airway Management - p. 2120 439. Resuscitation from Hemorrhagic Shock - p. 2126 440. Trauma to the Central Nervous System - p. 2138 441. Orthopedic and Soft Tissue Trauma - p. 2144 442. Other Traumatic Injuries - p. 2147 443. Selected Patient Populations - p. 2149 444. Postoperative Care - p. 2151 445. Summary - p. 2152 446. 67. Prehospital Care for Medical Emergencies and Trauma - p. 2156 447. 68. Biological, Natural, and Human-Induced Disasters: The Role of the Anesthesiologist - p. 2168 448. 69. Anesthesia for Ophthalmic Surgery - p. 2194 449. 70. Anesthesia for Otolaryngologic and Head-Neck Surgery - p. 2210 450. 71. Anesthesia for Robotic Surgery - p. 2236 451. 72. Ambulatory (Outpatient) Anesthesia - p. 2251 452. Introduction - p. 2251 453. Benefits of Ambulatory Surgery - p. 2252 454. Facilities for Ambulatory Surgery - p. 2252 455. Patient Selection Criteria - p. 2253 456. Preoperative Assessment - p. 2256 457. Patient Preparation - p. 2258 458. Anesthetic Techniques - p. 2260 459. Monitoring Depth of Anesthesia - p. 2269 460. Recovery from Ambulatory Anesthesia - p. 2270 461. Postoperative Pain - p. 2271 462. Postoperative Nausea and Vomiting - p. 2273 463. Special Areas - p. 2275 464. Home Readiness and Beyond - p. 2277 465. 73. Non-Operating Room Anesthesia - p. 2284 466. 74. Clinical Care in Extreme Environments: Physiology at High Altitude and in Space - p. 2313 467. Introduction to Altitude and Explanation of Hypobaric Hypoxia and Its Effect on Physiologic Performance - p. 2313 468. Physiologic Responses to Hypoxia/Acclimatization - p. 2313 469. Altitude Illness - p. 2317 470. Special Situations at Altitude - p. 2321 471. Anesthesia at Altitude - p. 2321 472. Space Medicine - p. 2323 473. The Environmental Challenges Posed by Spaceflight - p. 2324 474. Cardiovascular Physiology During Space Flight - p. 2326 475. Pulmonary Physiology During Space Flight - p. 2327 476. Musculoskeletal Physiology During Space Flight - p. 2327 477. Central Nervous System and Psychological Challenges During Space Flight - p. 2328 478. The Effect of Spaceflight on Other Physiologic Systems (Including the Immune and Gastric Systems) - p. 2330 479. Potential Medical Scenarios During Manned Space Missions - p. 2330 480. Thoughts and Considerations for Anesthetic Provision in Space - p. 2331 481. 75. Clinical Care in Extreme Environments: High Pressure, Immersion, Drowning, Hypo- and Hyperthermia - p. 2337 482. Introduction - p. 2338 483. Physiology of Immersion - p. 2338 484. Drowning - p. 2338 485. Hypothermia - p. 2341 486. Hyperthermia - p. 2344 487. Effects of Increased Gas Pressure - p. 2347 488. Hyperbaric Oxygen Therapy - p. 2351 489. Summary - p. 2363 490. Section V. Pediatric Anesthesia - p. 2366.e7 491. 76. Regional Anesthesia in Children - p. 2368 492. Introduction - p. 2368 493. Relevant Differences Between Children and Adults - p. 2368 494. Indications, Contraindications, and Complications - p. 2375 495. Selection of Materials and Anesthetic Solution - p. 2379 496. Anatomic Identification in Regional Anesthesia - p. 2381 497. Safety, Precautions and Discharge Criteria - p. 2382 498. Neuraxial Blocks - p. 2383 499. Upper Extremity Conduction Blocks - p. 2390 500. Lower Extremity Conduction Blocks - p. 2397 501. Truncal Blocks - p. 2404 502. Face, Head, and Neck Nerve Blocks - p. 2410 503. Other Procedures - p. 2416 504. 77. Pediatric Anesthesia - p. 2420 505. Physiologic Considerations - p. 2420 506. Pharmacology - p. 2427 507. Perioperative Management - p. 2436 508. Important Pediatric Anesthesia Scenarios - p. 2449 509. 78. Anesthesia for Pediatric Cardiac Surgery - p. 2459 510. Unique Features of Pediatric Cardiac Anesthesia - p. 2459 511. Anesthetic Management - p. 2469 512. Cardiopulmonary Bypass - p. 2478 513. Anticoagulation, Hemostasis, and Blood Conservation - p. 2490 514. Postoperative Management - p. 2493 515. Anesthesia for Heart and Lung Transplantation - p. 2496 516. Anesthesia for Closed-Heart Operations - p. 2499 517. Anesthesia for Interventional or Diagnostic Cardiac Procedures - p. 2500 518. Adult Congenital Heart Disease - p. 2504 519. Pediatric Cardiac Electrophysiology - p. 2506 520. Advances in Resynchronization Therapy - p. 2508 521. Anesthesia for Noncardiac Surgery - p. 2508 522. Offsite Anesthesia in Cardiac Surgery Patients - p. 2509 523. 79. Pediatric and Neonatal Critical Care - p. 2513 524. Relationship Between the Intensive Care Unit and the Operating Room - p. 2513 525. Family Partnered Care in the Pediatric Intensive Care Unit - p. 2514 526. Disclosure of Medical Errors - p. 2514 527. Organization of the Pediatric Intensive Care Unit - p. 2515 528. Cardiovascular System - p. 2515 529. Common Cardiovascular Disease States - p. 2516 530. Cardiovascular Pharmacology - p. 2520 531. Neonatal Resuscitation - p. 2524 532. Phases of Resuscitation - p. 2529 533. Interventions During the Cardiac Arrest (No Flow) and Cardiopulmonary Resuscitation (Low Flow) - p. 2531 534. Post-resuscitation Myocardial Dysfunction - p. 2534 535. Ventricular Fibrillation and Ventricular Tachycardia in Children - p. 2536 536. Respiratory System - p. 2537 537. Pulmonary Hypertension - p. 2556 538. Section VI. Postoperative Care - p. 2584.e12 539. 80. The Postanesthesia Care Unit - p. 2586 540. 81. Acute Postoperative Pain - p. 2614 541. 82. Cognitive Dysfunction and Other Long-Term Complications of Surgery and Anesthesia - p. 2639 542. Section VII. Critical Care Medicine - p. 2652.e4 543. 83. Critical Care Anesthesiology - p. 2654 544. 84. Neurocritical Care - p. 2671 545. 85. Extracorporeal Membrane Oxygenation and Cardiac Devices - p. 2694 546. 86. Cardiopulmonary Resuscitation and Advanced Cardiac Life Support - p. 2713 547. Section VIII. Ancillary Responsibilities and Problems - p. 2744.e3 548. 87. Acute and Anesthetic Care of the Burn-Injured Patient - p. 2746 549. Introduction - p. 2747 550. Pathophysiology - p. 2748 551. Hemodynamic Alterations - p. 2749 552. Inhalation Injury - p. 2750 553. Acute Management - p. 2753 554. Estimation of Size and Depth of Burn Injury - p. 2754 555. Fluid Resuscitation - p. 2754 556. Electrical Injury - p. 2757 557. Chemical Burns - p. 2757 558. Cold Injury - p. 2758 559. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - p. 2758 560. Special Considerations - p. 2759 561. Infection Control - p. 2760 562. Metabolic Considerations - p. 2761 563. Nutrition - p. 2761 564. Anesthetic Management - p. 2761 565. Intraoperative Management - p. 2762 566. Postoperative Care - p. 2769 567. Pain Management - p. 2770 568. Conclusion - p. 2771 569. 88. Occupational Safety, Infection Control, and Substance Abuse - p. 2774 570. 89. Clinical Research - p. 2795 571. 90. Interpreting the Medical Literature - p. 2813 572. Index - p. i1