Miller's Anesthesia, 2-Volume Set

1. Section I. INTRODUCTION - p. 1 2. 1. The Scope of Modern Anesthetic Practice - p. 2 3. 2. Anesthesia and Global Health Equity - p. 10 4. Introduction - p. 11 5. Section 1: Anesthesia and “Global Health Equity” - p. 11 6. Section 2: Evolution of Anesthesia Care Models and Challenges Around the World - p. 34 7. Section 3: Essentials for Practice in Resource-Variable Settings - p. 37 8. Conclusions - p. 44 9. Appendix 2.1. Links and Useful Resources - p. 44 10. 3. Perioperative Medicine - p. 48 11. 4. Informatics in Perioperative Medicine - p. 60 12. 5. Quality Improvement in Anesthesia Practice and Patient Safety - p. 77 13. 6. Human Behavior and Simulation in Anesthesia - p. 98 14. 7. Ethical Aspects of Anesthesia Care - p. 114 15. Section II. Anesthetic Physiology - p. 131.e2 16. 8. Consciousness, Memory, and Anesthesia - p. 134 17. 9. Sleep Medicine - p. 152 18. Physiology of Normal Sleep - p. 152 19. Neuroanatomy of Sleep - p. 156 20. How to Assess Sleep - p. 157 21. Sleep and Breathing - p. 160 22. Sleep and Anesthesia: Two Unequal Twins Influencing Perioperative Medicine - p. 167 23. Sleep and Sedation in the Intensive Care Unit - p. 173 24. 10. Cerebral Physiology and the Effects of Anesthetic Drugs - p. 180 25. Anatomy of the Cerebral Circulation - p. 181 26. Effects of Anesthetics on Cerebral Blood Flow and Cerebral Metabolic Rate - p. 198 27. Other Effects of Anesthetics on Cerebral Physiology - p. 208 28. Cerebral Physiology in Pathologic States - p. 210 29. 11. Neuromuscular Physiology and Pharmacology - p. 225 30. 12. Respiratory Physiology and Pathophysiology - p. 245 31. Respiratory Physiology is Central in the Practice of Anesthesia - p. 245 32. Ventilation - p. 245 33. Diffusion of Gas - p. 247 34. Lung Perfusion and V˙/Q˙ Match - p. 247 35. Respiratory Gas Transport - p. 250 36. Mechanics and Lung Volumes - p. 252 37. Control of Breathing - p. 255 38. Mechanisms of Hypoxemia and Hypercapnia - p. 258 39. Lung Function Tests - p. 262 40. Effect of Anesthesia on Respiratory Physiology - p. 264 41. Mechanical Ventilation During Anesthesia - p. 266 42. Postoperative Respiratory Complications - p. 268 43. 13. Cardiac Physiology - p. 273 44. 14. Gastrointestinal and Hepatic Physiology, Pathophysiology, and Anesthetic Considerations - p. 293 45. Anatomy of the Gastrointestinal and Hepatic Systems - p. 293 46. Gastrointestinal and Hepatic Physiology - p. 293 47. Assessment of the Gastrointestinal and Hepatic Systems - p. 293 48. Pathophysiology of the Gastrointestinal and Hepatic Systems - p. 293 49. Anesthetic Considerations of Gastrointestinal and Hepatic Systems in Health and Disease - p. 293 50. 15. Renal Anatomy, Physiology, Pharmacology, and Evaluation of Function - p. 330 51. 16. Basic Principles of Pharmacology - p. 347 52. 17. Inhaled Anesthetics: Mechanisms of Action - p. 372 53. History - p. 373 54. Integrated Effects on Central Nervous System Function - p. 375 55. Identification of Molecular Sites of Anesthetic Action - p. 379 56. Cellular Mechanisms - p. 385 57. Simple Circuits and Complex Networks - p. 387 58. Research Strategies for the Future - p. 389 59. Summary - p. 392 60. 18. Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity - p. 395 61. Introduction - p. 396 62. Uptake and Distribution of Inhaled Anesthetics - p. 396 63. Synthesis of the Model and Inhaled Anesthetic Induction: PK/PD - p. 406 64. Metabolism and Toxicity of Inhaled Anesthetics - p. 412 65. 19. Pulmonary Pharmacology of Inhaled Anesthetics - p. 426 66. Introduction - p. 426 67. Bronchomotor Tone - p. 426 68. Mucociliary Function and Surfactant - p. 433 69. Pulmonary Hemodynamics - p. 436 70. Control of Respiration - p. 441 71. Inhaled Anesthetics and Acute Lung Injury - p. 448 72. Nonvolatile Inhaled Agents - p. 449 73. Summary - p. 453 74. 20. Inhaled Anesthetic Delivery Systems - p. 457 75. Standards and Guidelines for Anesthesia Workstations - p. 459 76. Functional Anatomy of the Anesthesia Workstation - p. 459 77. Checking Your Anesthesia Workstation - p. 504 78. 21. Intravenous Anesthetics - p. 512 79. Introduction - p. 513 80. Intravenous Anesthetic Agents - p. 513 81. Summary - p. 550 82. 22. Opioids - p. 555 83. Introduction - p. 555 84. Pharmacology of Opioids - p. 555 85. Neurophysiologic Effects of Opioids - p. 567 86. Respiratory Effects of Opioids - p. 576 87. Cardiovascular Effects of Opioids - p. 580 88. Endocrinologic Effects of Opioids and Stress Responses - p. 582 89. Effects of Opioids on Digestive Organs - p. 583 90. Other Opioid Effects - p. 585 91. Pharmacokinetics and Pharmacodynamics of Opioids - p. 588 92. Anesthetic Techniques Using Opioids - p. 596 93. Other Opioid Agonists - p. 603 94. Agonist–Antagonist Opioid Compounds - p. 607 95. Opioid Antagonists - p. 610 96. Drug Interactions with Opioids - p. 613 97. 23. Intravenous Drug Delivery Systems - p. 623 98. Introduction - p. 623 99. Pharmacokinetic Considerations - p. 624 100. Pharmacodynamic Considerations - p. 629 101. Designing Dosing Regimens - p. 643 102. Intravenous Infusion Devices and Technologies - p. 649 103. Future Perspectives - p. 669 104. 24. Pharmacology of Neuromuscular Blocking Drugs and Antagonists (Reversal Agents) - p. 674 105. History and Clinical Use of Neuromuscular Blocking Agents - p. 675 106. Principles of Action of Neuromuscular Blocking Drugs at the Neuromuscular Junction - p. 676 107. Pharmacology of Succinylcholine - p. 676 108. Nondepolarizing Neuromuscular Blocking Drugs - p. 681 109. Reversal (Antagonism) of Neuromuscular Block - p. 708 110. Current Antagonism Practice - p. 708 111. Drugs Used to Antagonize (Reverse) Neuromuscular Block - p. 715 112. 25. Local Anesthetics - p. 742 113. 26. Immune Implications of Anesthesia Care and Practice - p. 768 114. Section III. Anesthesia Management - p. 780.e1 115. 27. Risk of Anesthesia - p. 782 116. Introduction - p. 782 117. Framework of Perioperative Risk - p. 783 118. Issues Related to Study Design - p. 784 119. Risks Related to Patient Characteristics - p. 793 120. Special Patient Groups - p. 796 121. Risks Directly Related to the Anesthetic Drug - p. 801 122. Risks Related to Surgery - p. 802 123. Risks Related to the Location of Surgery and Postoperative Monitoring - p. 803 124. Risks Related to the Anesthesia Provider - p. 803 125. Improving Anesthesia Safety - p. 804 126. Summary - p. 805 127. Acknowledgments - p. 806 128. 28. Preoperative Evaluation - p. 808 129. Evolution of Pre-Anesthesia Evaluation - p. 808 130. Goals and Benefits of Pre-Anesthesia Evaluation - p. 809 131. Clinical Examination During Preoperative Evaluation - p. 809 132. Frailty, Geriatric Conditions, and the Older Surgical Patient - p. 816 133. Preoperative Evaluation of Patients with Coexisting Disease - p. 819 134. Preoperative Laboratory and Diagnostic Studies - p. 858 135. Preoperative Risk Assessment - p. 861 136. Preoperative Medication Management - p. 862 137. Planning for Anesthesia - p. 864 138. Regulatory Issues - p. 864 139. Preoperative Evaluation Clinic - p. 865 140. Conclusion - p. 868 141. 29. Anesthetic Implications of Concurrent Diseases - p. 873 142. Introduction - p. 873 143. Cardiovascular Disease - p. 874 144. Pulmonary Disease - p. 880 145. Renal Disease - p. 883 146. Hepatobiliary Disease - p. 884 147. Neurologic and Neuromuscular - p. 886 148. Endocrine and Metabolic - p. 891 149. Rheumatic and Connective Tissue Diseases - p. 907 150. Infectious Diseases - p. 913 151. Genetic Diseases - p. 915 152. Toxic Ingestions and Drug Abuse - p. 917 153. Allergy and Anaphylaxis - p. 919 154. Hematologic Disorders - p. 921 155. 30. Patient Positioning and Associated Risks - p. 930 156. 31. Neuromuscular Disorders and Other Genetic Disorders - p. 959 157. Malignant Hyperthermia - p. 960 158. Mh-Associated Syndromes/Pathological Conditions - p. 968 159. Other Neuromuscular Disorders - p. 971 160. Endocrine and Metabolic Myopathies - p. 980 161. Mitochondrial Diseases and Mitochondrial Myopathies - p. 981 162. Periodic Paralyses - p. 983 163. Acquired Neuromuscular Diseases - p. 985 164. Summary - p. 990 165. 32. Cardiovascular Monitoring - p. 994 166. Heart Rate and Pulse Rate Monitoring - p. 995 167. Electrocardiography (ECG) Monitoring - p. 995 168. Blood Pressure Monitoring - p. 1003 169. Central Venous Pressure Monitoring - p. 1016 170. Pulmonary Artery Catheter Monitoring - p. 1023 171. Cardiac Output Monitoring - p. 1034 172. 33. Perioperative Echocardiography and Point-of-Care Ultrasound (POCUS) - p. 1043 173. Introduction - p. 1043 174. History of Perioperative Echocardiography - p. 1043 175. Principles of Ultrasound - p. 1044 176. Ultrasound Modalities - p. 1045 177. Three-Dimensional Image Acquisition - p. 1047 178. Indications and Practice Guidelines - p. 1049 179. Transesophageal Echocardiography Examination - p. 1050 180. Epicardial and Epiaortic Imaging - p. 1050 181. Transthoracic Echocardiography Examination - p. 1051 182. Qualitative Assessment of the Heart - p. 1053 183. Quantitative Assessment - p. 1055 184. Hemodynamic Failure and Shock - p. 1062 185. Intraoperative Transesophageal Echocardiography – Noncardiac Surgery - p. 1066 186. Intraoperative Transesophageal Echocardiography – Cardiac Surgery - p. 1068 187. Intraprocedural Transesophageal Echocardiography – Structural Heart Interventions - p. 1071 188. Emerging Technologies - p. 1073 189. Perioperative Transthoracic Echocardiography and Focused Cardiac Ultrasound (FoCUS) - p. 1073 190. Critical Care and Perioperative Care - p. 1075 191. Training and Certification - p. 1080 192. Future Directions - p. 1081 193. 34. Implantable Cardiac Pulse Generators: Pacemakers and Cardioverter-Defibrillators - p. 1085 194. 35. Neurophysiologic Monitoring - p. 1099 195. Monitoring Modalities - p. 1100 196. Clinical Applications of Neurophysiologic Monitoring - p. 1115 197. Nonsurgical Factors Influencing Monitoring Results - p. 1126 198. Anesthetic Optimization During Multimodality Neurophysiologic Monitoring - p. 1128 199. Summary - p. 1130 200. 36. Monitoring the Brain’s Response to Anesthesia and Surgery - p. 1133 201. 37. Respiratory Monitoring - p. 1153 202. Overview of Respiratory Monitoring - p. 1153 203. The Physical Examination - p. 1155 204. Pulse Oximetry - p. 1156 205. Mixed Venous Oxygen Saturation - p. 1161 206. Tissue Oxygenation - p. 1162 207. Capnometry and Capnography - p. 1163 208. Blood Gas Analysis - p. 1167 209. Monitoring Lung Flows, Volumes, and Pressures - p. 1172 210. Plethysmographic Monitoring - p. 1181 211. Respiratory Rate Monitoring: Apnea Monitoring - p. 1181 212. Imaging for Respiratory Monitoring - p. 1182 213. Point-of-Care Tests - p. 1185 214. Respiratory Monitoring in Special Conditions - p. 1186 215. Automated Data Systems - p. 1188 216. Additional Monitored Variables - p. 1188 217. 38. Renal Pathophysiology and Treatment for Perioperative Ischemia and Nephrotoxic Injury - p. 1195 218. 39. Neuromuscular Monitoring - p. 1209 219. 40. Airway Management in the Adult - p. 1227 220. Introduction - p. 1227 221. Algorithms for Management of the Difficult Airway - p. 1228 222. Functional Airway Anatomy - p. 1230 223. Airway Assessment - p. 1232 224. Physiologic Concepts for Airway Management - p. 1234 225. Anesthesia for Airway Management - p. 1235 226. Mask Ventilation - p. 1241 227. Supraglottic Airway - p. 1243 228. Tracheal Intubation - p. 1246 229. Emergency Invasive Airway Access - p. 1260 230. Extubation of the Trachea - p. 1261 231. Dissemination of Critical Airway Information - p. 1263 232. Summary - p. 1264 233. 41. Spinal, Epidural, and Caudal Anesthesia - p. 1267 234. Principles - p. 1267 235. Practice - p. 1267 236. Historical Perspectives - p. 1267 237. Anatomy - p. 1268 238. Anatomic Variations - p. 1269 239. Mechanism of Action - p. 1270 240. Physiologic Effects - p. 1272 241. Indications - p. 1274 242. Contraindications - p. 1274 243. Spinal Anesthesia - p. 1275 244. Epidural Anesthesia - p. 1286 245. Combined Spinal–Epidural - p. 1292 246. Caudal Anesthesia - p. 1293 247. Complications - p. 1294 248. Outcomes - p. 1299 249. Recent Advances - p. 1300 250. 42. Peripheral Nerve Blocks and Ultrasound Guidance for Regional Anesthesia - p. 1305 251. 43. Perioperative Fluid and Electrolyte Therapy - p. 1331 252. Physiology - p. 1332 253. Fluid Pharmacology - p. 1342 254. Clinical Fluid and Electrolyte Management - p. 1349 255. 44. Perioperative Acid–Base Balance - p. 1374 256. 45. Patient Blood Management: Transfusion Therapy - p. 1398 257. Evolution and Recent History of Blood Transfusion Therapy - p. 1398 258. Blood Procurement - p. 1399 259. Blood Component Therapy: Indications for Transfusion - p. 1404 260. Synthetic Oxygen-Carrying Substances - p. 1411 261. Autologous Blood - p. 1412 262. Compatibility Testing - p. 1416 263. Maximal Surgical Blood Order Schedule - p. 1418 264. Emergency Transfusion - p. 1419 265. Fresh Whole Blood - p. 1419 266. Complications - p. 1420 267. Citrate Intoxication and Hyperkalemia - p. 1423 268. Temperature - p. 1423 269. Acid–Base Abnormalities - p. 1423 270. Transfusion Reactions - p. 1423 271. Leukoreduction and Irradiation of Blood Transfusions - p. 1427 272. Informed Consent - p. 1429 273. 46. Patient Blood Management: Coagulation - p. 1432 274. Volume 2 - p. 1456.e5 275. Section IV. Adult Subspecialty Management - p. 1456.e5 276. 47. Management of the Patient with Chronic Pain - p. 1458 277. 48. Palliative Medicine - p. 1476 278. What Is Palliative Medicine? - p. 1476 279. Where Is Palliative Care Delivered? - p. 1478 280. Differences Between Hospice Care and Palliative Care - p. 1482 281. Anesthetic Concerns in the Patient Receiving Palliative Care - p. 1483 282. Communication - p. 1484 283. Prognosis - p. 1490 284. The Dying Process - p. 1499 285. 49. Anesthesia for Thoracic Surgery - p. 1505 286. Introduction - p. 1505 287. Concomitant Medical Conditions - p. 1509 288. Difficult Endobronchial Intubation - p. 1518 289. Prediction of Desaturation During One-Lung Ventilation - p. 1518 290. Assessment for Repeat Thoracic Surgery - p. 1518 291. Intraoperative Monitoring - p. 1519 292. Invasive Hemodynamic Monitoring - p. 1519 293. Other Monitoring Technology - p. 1520 294. Indirect Cardiac Output - p. 1521 295. Lung Isolation - p. 1521 296. Difficult Airways and One-Lung Ventilation - p. 1531 297. Management of Lung Isolation for Thoracic Surgery and COVID-19 Patients - p. 1531 298. Lung-Isolation Techniques in Patients with a Tracheostomy in Place - p. 1532 299. Anesthetic Management - p. 1534 300. Management of One-Lung Ventilation - p. 1535 301. Hypoxic Pulmonary Vasoconstriction - p. 1537 302. Ventilation Strategies During OLV - p. 1538 303. Prediction of Hypoxemia During One-Lung Ventilation - p. 1540 304. Treatment of Hypoxemia During One-Lung Ventilation - p. 1540 305. Anesthetic Management for Common Surgical Procedures - p. 1544 306. Pulmonary Surgery - p. 1548 307. Lobectomy - p. 1550 308. Pneumonectomy - p. 1550 309. Limited Pulmonary Resections: Segmentectomy and Wedge Resection - p. 1552 310. Anesthetic Management for Specific Surgical Procedures - p. 1553 311. Anesthesia for Tracheal Resection - p. 1556 312. Blebs, Bullae, Cysts, and Pneumatoceles - p. 1559 313. Lung Transplantation - p. 1561 314. Pulmonary Hemorrhage - p. 1563 315. Pulmonary Thromboendarterectomy - p. 1564 316. Bronchopulmonary Lavage - p. 1564 317. Mediastinal Masses - p. 1565 318. Thymectomy for Myasthenia Gravis - p. 1567 319. Postoperative Management - p. 1568 320. Postoperative Analgesia - p. 1569 321. 50. Anesthesia for Cardiac Surgical Procedures - p. 1577 322. Cardiovascular Disease in the 21st Century - p. 1577 323. Evaluation and Monitoring - p. 1579 324. Premedication - p. 1592 325. Induction of Anesthesia - p. 1592 326. The Pre–Cardiopulmonary Bypass Period - p. 1593 327. Onset of Cardiopulmonary Bypass - p. 1594 328. Weaning from Cardiopulmonary Bypass - p. 1594 329. Termination of Cardiopulmonary Bypass - p. 1596 330. Chest Closure - p. 1598 331. Transport to the Intensive Care Unit - p. 1599 332. The Post-Bypass Period: Common Problems After Cardiopulmonary Bypass - p. 1599 333. Management of Cardiopulmonary Bypass - p. 1612 334. Pathophysiology of Coronary Disease - p. 1625 335. On-Pump Coronary Artery Bypass Grafting Surgery - p. 1626 336. Off-Pump Coronary Artery Bypass Surgery - p. 1628 337. Minimally Invasive Coronary Artery Bypass Surgery - p. 1629 338. Total Endoscopic Coronary Artery Bypass - p. 1630 339. Hybrid Coronary Revascularization - p. 1631 340. Mitral Valve Disease - p. 1631 341. Aortic Valve Disease - p. 1642 342. Other Valvular Disease - p. 1647 343. Surgical Management of Heart Failure - p. 1651 344. Heart Failure - p. 1665 345. Congenital Heart Disease in Adults - p. 1667 346. Other Cardiac Procedures - p. 1672 347. 51. Anesthesia for Correction of Cardiac Arrhythmias - p. 1683 348. 52. Anesthesia for Vascular Surgery - p. 1696 349. Preoperative Evaluation - p. 1696 350. Abdominal Aortic Reconstruction - p. 1701 351. Thoracoabdominal Aortic Surgery - p. 1711 352. Endovascular Aortic Repair Surgery - p. 1718 353. Hybrid Arch Repairs - p. 1725 354. Carotid Endarterectomy - p. 1726 355. Endovascular Treatment of Carotid Disease: Carotid Artery Stenting - p. 1735 356. Lower Extremity Revascularization - p. 1736 357. 53. Anesthesia for Neurologic Surgery and Neurointerventions - p. 1740 358. Recurrent Issues in Neuroanesthesia - p. 1741 359. Specific Procedures - p. 1758 360. 54. Anesthesia for Bariatric Surgery - p. 1784 361. 55. Anesthesia and the Renal and Genitourinary Systems - p. 1804 362. Innervation of the Genitourinary System - p. 1805 363. Renal Blood Flow - p. 1806 364. Anesthesia for Patients with Renal Disease - p. 1807 365. Renal and Genitourinary Procedures - p. 1817 366. Postoperative Management of the Patient with Renal Disease - p. 1829 367. 56. Anesthesia for Abdominal Organ Transplantation - p. 1833 368. Kidney Transplantation - p. 1835 369. Pancreas Transplantation - p. 1844 370. Liver Transplantation (LT) - p. 1849 371. Intestinal, Liver–Intestinal, and Multivisceral Transplant - p. 1864 372. Conclusion - p. 1867 373. 57. Anesthesia for Organ Procurement - p. 1871 374. 58. Anesthesia for Obstetrics - p. 1884 375. Physiologic Changes During Pregnancy and Delivery - p. 1885 376. Uteroplacental Physiology - p. 1890 377. Labor Progress - p. 1891 378. Labor Analgesia - p. 1895 379. Anesthesia Considerations for Operative Delivery - p. 1900 380. Anesthesia for Cesarean Delivery - p. 1900 381. Postcesarean Pain Control and Recovery - p. 1905 382. Complications of Regional Anesthesia - p. 1905 383. Maternal Comorbidities - p. 1908 384. Anesthesia for Malpresentation and External Cephalic Version - p. 1911 385. Obstetric Emergencies - p. 1911 386. Nonobstetric Surgery During Pregnancy - p. 1915 387. 59. Anesthesia for Fetal Surgery and Other Fetal Therapies - p. 1921 388. Indications, Procedures, and Outcomes - p. 1924 389. Twin Reversed Arterial Perfusion Sequence - p. 1927 390. Preoperative Assessment and Counseling - p. 1939 391. Intraoperative Management and Considerations - p. 1939 392. Postoperative Management and Considerations - p. 1945 393. Management of Ex Utero Intrapartum Treatment (EXIT) Procedure - p. 1945 394. Conclusions and Future Considerations - p. 1947 395. 60. Anesthesia for Orthopedic Surgery - p. 1952 396. Preoperative Evaluation - p. 1953 397. Special Considerations for Conditions Leading to Orthopedic Surgery - p. 1963 398. Orthopedic Procedures in Children with Special Conditions - p. 1966 399. Perioperative Management of the Orthopedic Patient - p. 1969 400. Anesthesia for Spine Surgery - p. 1978 401. 61. Geriatric Anesthesia - p. 1984 402. 62. Anesthesia for Trauma - p. 2000 403. Introduction - p. 2000 404. Prioritizing Trauma Care - p. 2001 405. Emergency Airway Management - p. 2005 406. Resuscitation from Hemorrhagic Shock - p. 2011 407. Trauma to the Central Nervous System - p. 2025 408. Orthopedic and Soft Tissue Trauma - p. 2031 409. Other Traumatic Injuries - p. 2034 410. Selected Patient Populations - p. 2037 411. Postoperative Care - p. 2038 412. Summary - p. 2040 413. 63. Prehospital Care for Medical Emergencies and Trauma - p. 2044 414. 64. Biologic, Natural, and Human-Induced Disasters: The Role of the Anesthesiologist - p. 2057 415. 65. Anesthesia for Ophthalmic Surgery - p. 2085 416. 66. Anesthesia for Otolaryngologic and Head–Neck Surgery - p. 2103 417. 67. Anesthesia for Robotic Surgery - p. 2130 418. 68. Ambulatory (Outpatient) Anesthesia - p. 2149 419. Introduction - p. 2149 420. Benefits of Ambulatory Surgery - p. 2150 421. Facilities for Ambulatory Surgery - p. 2150 422. Patient Selection Criteria - p. 2151 423. Preoperative Assessment - p. 2155 424. Patient Preparation - p. 2157 425. Anesthetic Techniques - p. 2159 426. Monitoring Depth of Anesthesia - p. 2169 427. Recovery from Ambulatory Anesthesia - p. 2169 428. Postoperative Pain - p. 2171 429. Postoperative Nausea and Vomiting - p. 2173 430. Enhanced Recovery after Surgery (ERAS) - p. 2175 431. Special Areas - p. 2176 432. Home Readiness and Beyond - p. 2178 433. 69. Non–Operating Room Anesthesia - p. 2185 434. 70. Clinical Care in Extreme Environments:: Physiology at High Altitude and in Space - p. 2211 435. Introduction to Altitude and Explanation of Hypobaric Hypoxia and Its Effect on Physiologic Performance - p. 2211 436. Physiologic Responses to Hypoxia/Acclimatization - p. 2211 437. Altitude Illness - p. 2215 438. Special Situations at Altitude - p. 2219 439. Anesthesia at Altitude - p. 2219 440. Space Medicine - p. 2221 441. The Environmental Challenges Posed by Spaceflight - p. 2222 442. Cardiovascular Physiology During Spaceflight - p. 2224 443. Pulmonary Physiology During Spaceflight - p. 2225 444. Musculoskeletal Physiology During Spaceflight - p. 2226 445. Central Nervous System and Psychological Challenges During Spaceflight - p. 2226 446. The Effect of Spaceflight on Other Physiologic Systems (Including the Immune and Gastric Systems) - p. 2228 447. Potential Medical Scenarios During Manned Space Missions - p. 2228 448. Thoughts and Considerations for Anesthetic Provision in Space - p. 2229 449. 71. Clinical Care in Extreme Environments:: High Pressure, Immersion, Drowning, Hypo-, and Hyperthermia - p. 2234 450. Introduction - p. 2235 451. Effects of Increased Gas Pressure - p. 2235 452. Hyperbaric Oxygen Therapy - p. 2238 453. Physiology of Immersion - p. 2251 454. Drowning - p. 2252 455. Hypothermia - p. 2254 456. Hyperthermia - p. 2258 457. Section V. Pediatric Anesthesia - p. 2263.e7 458. 72. Pediatric Anesthesia - p. 2266 459. Physiological Considerations - p. 2266 460. Pharmacology - p. 2271 461. Anesthetic Drugs - p. 2273 462. Anesthetic Management - p. 2279 463. Anesthetic Management for Specific Pediatric Conditions and Procedures - p. 2290 464. Conclusion - p. 2297 465. 73. Anesthesia for Pediatric Cardiac Surgery - p. 2300 466. Unique Features of Pediatric Cardiac Anesthesia - p. 2301 467. Congenital Heart Disease - p. 2303 468. Anesthetic Management - p. 2310 469. Cardiopulmonary Bypass - p. 2318 470. Postoperative Management - p. 2333 471. Anesthesia for Heart and Lung Transplantation - p. 2337 472. Anesthesia for Closed-Heart Operations - p. 2339 473. Anesthesia for Cardiac Catheterization - p. 2340 474. Adult Congenital Heart Disease - p. 2345 475. Pediatric Cardiac Electrophysiology - p. 2347 476. Advances in Resynchronization Therapy - p. 2348 477. Anesthesia for Noncardiac Surgery - p. 2349 478. Offsite Anesthesia in Cardiac Surgery Patients - p. 2349 479. 74. Regional Anesthesia in Children - p. 2354 480. Introduction - p. 2354 481. Indications, Contraindications, and Complications - p. 2354 482. Safety, Precautions, and Discharge Criteria - p. 2359 483. Relevant Differences Between Children and Adults - p. 2360 484. Pharmacology of Local Anesthetics and Additives - p. 2363 485. General Technique and Equipment Consideration - p. 2369 486. Specific Regional Techniques - p. 2373 487. 75. Pediatric and Neonatal Critical Care - p. 2411 488. Relationship Between the Intensive Care Unit and the Operating Room - p. 2411 489. Family Partnered Care in the Pediatric Intensive Care Unit (PICU) - p. 2412 490. Disclosure of Medical Errors - p. 2412 491. Organization of the Pediatric Intensive Care Unit - p. 2413 492. Cardiovascular System - p. 2413 493. Common Cardiovascular Disease States - p. 2414 494. Cardiovascular Pharmacology - p. 2416 495. Disorders of Cardiac Rhythm - p. 2420 496. Hypertension - p. 2422 497. Neonatal Resuscitation - p. 2422 498. Phases of Resuscitation - p. 2427 499. Interventions During the Cardiac Arrest (No Flow) and Cardiopulmonary Resuscitation (Low Flow) - p. 2429 500. Postresuscitation Myocardial Dysfunction - p. 2432 501. Ventricular Fibrillation and Ventricular Tachycardia in Children - p. 2434 502. Respiratory System - p. 2435 503. Central Nervous System - p. 2454 504. Renal System - p. 2461 505. Endocrine System - p. 2464 506. Gastrointestinal System - p. 2466 507. Hematology - p. 2469 508. Oncology - p. 2471 509. Immunity and Infection - p. 2473 510. Pediatric Trauma - p. 2475 511. Section VI. Postoperative Care - p. 2481.e12 512. 76. The Postanesthesia Care Unit - p. 2484 513. Admission to the Postanesthesia Care Unit - p. 2485 514. The Standards for Postanesthesia Care - p. 2485 515. Early Postoperative Physiologic Changes - p. 2486 516. Transport to the Postanesthesia Care Unit - p. 2486 517. Upper Airway Obstruction - p. 2487 518. Management of Upper Airway Obstruction - p. 2489 519. Differential Diagnosis of Arterial Hypoxemia in the Postanesthesia Care Unit - p. 2490 520. Pulmonary Edema - p. 2491 521. Monitoring and Treatment of Hypoxemia - p. 2492 522. Oxygen Delivery Systems - p. 2493 523. Hemodynamic Instability - p. 2494 524. Myocardial Ischemia: Evaluation and Treatment - p. 2496 525. Cardiac Arrhythmias - p. 2497 526. Renal Dysfunction - p. 2498 527. Postoperative Hypothermia and Shivering - p. 2500 528. Postoperative Nausea and Vomiting - p. 2501 529. Delirium - p. 2502 530. Emergence Excitement - p. 2502 531. Delayed Awakening - p. 2503 532. Discharge Criteria - p. 2503 533. Infection Control - p. 2504 534. Postoperative Management of Patients Undergoing Transcatheter Aortic Valve Replacement and Transcatheter Mitral Valve Repair - p. 2505 535. Immediate Postoperative Care of Craniotomies - p. 2506 536. Potentially Devastating Visual Complications - p. 2507 537. Future Considerations - p. 2507 538. Summary - p. 2509 539. 77. Acute Postoperative Pain - p. 2512 540. Fundamental Considerations - p. 2512 541. Systemic Analgesic Techniques - p. 2516 542. Regional Analgesic Techniques (see also Chapters 41 and 42Chapter 41Chapter 42) - p. 2521 543. Other Techniques - p. 2530 544. Postoperative Analgesia in Special Populations - p. 2530 545. Inpatient Pain Services - p. 2534 546. 78. Perioperative Neurocognitive Disorders - p. 2538 547. Section VII. Critical Care Medicine - p. 2549.e3 548. 79. Critical Care Anesthesiology - p. 2552 549. 80. Neurocritical Care - p. 2570 550. Intracranial Physiology and Cerebrovascular Autoregulation - p. 2571 551. General Cardiopulmonary Considerations - p. 2573 552. Fluids, Electrolytes, Blood Glucose Concentration - p. 2573 553. Temperature Control - p. 2574 554. Monitoring - p. 2574 555. Common Diseases in the Neurocritical Care Unit - p. 2579 556. Postoperative Neurosurgical Care - p. 2590 557. Brain Death - p. 2591 558. Ethical Considerations - p. 2591 559. Conclusion - p. 2591 560. 81. Extracorporeal Membrane Oxygenation and Cardiac Devices - p. 2596 561. 82. Cardiopulmonary Resuscitation and Advanced Cardiac Life Support - p. 2616 562. Section VIII. Ancillary Responsibilities and Problems - p. 2650.e4 563. 83. Burn Management - p. 2652 564. Introduction - p. 2653 565. Pathophysiology - p. 2654 566. Hemodynamic Alterations - p. 2655 567. Inhalation Injury - p. 2656 568. Acute Management - p. 2659 569. Estimation of Size and Depth of Burn Injury - p. 2660 570. Fluid Resuscitation - p. 2661 571. Electrical Injury - p. 2663 572. Chemical Burns - p. 2664 573. Cold Injury - p. 2664 574. Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis - p. 2665 575. Special Considerations - p. 2665 576. Infection Control - p. 2666 577. Metabolic Considerations - p. 2667 578. Nutrition - p. 2668 579. Anesthetic Management - p. 2668 580. Postoperative Care - p. 2676 581. Pain Management - p. 2677 582. Conclusion - p. 2678 583. 84. Occupational Safety, Infection Control, and Substance Use Disorders - p. 2681 584. 85. Emergency Preparedness in Health Care - p. 2703 585. 86. Clinical Research - p. 2709 586. 87. Interpreting the Medical Literature - p. 2727 587. Index - p. i1