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Clinical Anesthesia
Arun Kumar Paul
CHAPTER 1:
Anaesthesia and Liver Diseases
FUNCTIONS OF LIVER
Carbohydrate Metabolism
Protein Synthesis
Coagulation
Drug Metabolism
Hydrolysis of Ester Linkages
Bilirubin Metabolism
Reticuloendothelial Activity
LIVER FUNCTION TESTS
METABOLISM OF DRUGS
COMMON DRUGS ASSOCIATED WITH LIVER DYSFUNCTION
EFFECTS OF ANAESTHETICS ON LIVER
POSTOPERATIVE LIVER DYSFUNCTION (JAUNDICE)
Causes
Treatment of Postoperative Jaundice
OTHER FACTORS INFLUENCING LIVER FUNCTION DURING ANAESTHESIA
CLINICAL EFFECTS OF LIVER DISEASE
GRADING OF ENCEPHALOPATHY
MODIFIED CHILD'S GROUPING OF THE SEVERITY OF LIVER DISEASE
Prognostic Scoring
Treatment of Encephalopathy
ANAESTHESIA IN LIVER DISEASE
ANAESTHESIA IN OBSTRUCTIVE JAUNDICE
Preoperative Preparation
Anaesthetic Management
LAPAROSCOPIC CHOLECYSTECTOMY
PORTAL HYPERTENSION
Preoperative Preparation
Special Note
LIVER TRANSPLANTATION
Anaesthetic Management
CHAPTER 2:
Anaesthesia and Renal Diseases
FUNCTIONS OF KIDNEY
RENAL FUNCTION TESTS
EFFECTS OF ANAESTHETICS AND OTHER FACTORS ON KIDNEY
POSTOPERATIVE RENAL FAILURE
Causes
Management
ANAESTHESIA IN PATIENTS WITH RENAL DISEASE
Preoperative Assessment
Some Specific Problems
Anaesthesia
CAUSES OF ACUTE RENAL FAILURE
Renal Causes
Postrenal Causes
Prerenal Causes
CAUSES OF CHRONIC RENAL FAILURE
CLINICAL FEATURES OF RENAL FAILURE
BIOCHEMICAL FEATURES OF RENAL FAILURE
TREATMENT OF RENAL FAILURE
Main Guidelines
RENAL TRANSPLANTATION
Anaesthetic Management
NEPHROLITHIASIS
Extracorporeal Shock Wave Lithotripsy
ANAESTHESIA IN TRANSURETHRAL RESECTION OF PROSTATE (TURP)
Problems of Anaesthesia
Investigations
Anaesthetic Management
Dilutional Hyponatraemia
Management of TURP Syndrome
CHAPTER 3:
Anaesthesia for ENT Surgery
ANAESTHESIA IN EAR SURGERY
MINOR OPERATIONS LIKE MYRINGOTOMY
ANAESTHESIA FOR MIDDLE EAR SURGERY
ANAESTHESIA FOR NASAL AND SINUS SURGERY
Minor Surgery of the Nose
Major Surgery of the Nose
Epistaxis
Anaesthesia
ANAESTHESIA FOR TONSILLECTOMY
Anaesthesia
POSTOPERATIVE BLEEDING TONSIL
ENDOSCOPY
Indications
Problems of Anaesthesia
Anaesthetic Management
NERVES INVOLVED DURING LARYNGOSCOPY
TOPICAL LARYNGEAL BLOCK
Block of Glossopharyngeal Nerve
Superior Laryngeal Nerve Block
DIRECT LARYNGOSCOPY
LASER SURGERY
LARYNGEAL TRAUMA/TRACHEAL TRAUMA
Types
Problems
Anaesthetic Management
TRACHEAL STENOSIS
Anaesthesia
MAJOR HEAD AND NECK SURGERY
ANAESTHESIA FOR LARYNGECTOMY
PHARYNGOLARYNGECTOMY
Problems of Anaesthesia
MICROLARYNGOSCOPY
Anaesthesia
Other Techniques of Anaesthesia
TRACHEOSTOMY
Indications
Advantages
Advantages of Tracheostomy as Compared to Endotracheal Intubation
Technique
Complications
Tracheostomy Tube
Recommended Sizes:
CHAPTER 4:
Anaesthesia for Ophthalmic Surgery
INTRAOCULAR PRESSURE
OCULOCARDIAC REFLEX
COMMON DRUG INTERACTIONS
SOME FACTORS THAT MAY INCREASE IOP
SOME FACTORS THAT MAY REDUCE IOP
ANAESTHESIA FOR OPHTHALMIC SURGERY
ANAESTHESIA FOR STRABISMUS SURGERY
ANAESTHESIA FOR CATARACT OPERATION
Problems
Anaesthetic Management
MANAGEMENT OF ANAESTHESIA IN GLAUCOMA PATIENTS
Salient Points
ANAESTHESIA IN PATIENT WITH PENETRATING EYE INJURY
ANAESTHESIA FOR RETINAL DETACHMENT SURGERY
RETROBULBAR BLOCK
Special Note
Exophthalmos
Enophthalmos
CHAPTER 5:
Dental Anaesthesia
SPECIFIC PROBLEMS RELATED TO DENTAL ANAESTHESIA
PREOPERATIVE ASSESSMENT
PREOPERATIVE PREPARATION
PREOPERATIVE MEDICATION
ANAESTHESIA
Mouth Packs
Endotracheal Intubation
Position in Dental Chair
MONITORING
POSTOPERATIVE CARE
Intravenous Sedation
Relative Analgesia
LOCAL ANAESTHESIA FOR DENTAL EXTRACTION
Mandibular Block
CHAPTER 6:
Paediatric Anaesthesia
PHYSIOLOGICAL ASPECTS OF NEONATES AND CHILDREN
Salient Features
Pharmacologic Considerations
CONDUCT OF ANAESTHESIA IN PAEDIATRIC PATIENTS
PREANAESTHETIC ASSESSMENT AND PREPARATION FOR SURGERY IN CHILDREN
Medical History
General Condition
Respiration
Cardiovascular System
Renal Function and Fluid Balance
Temperature
Liver
Psychological Aspects
Consent
Laboratory Investigations
Haemoglobin
Anaemia
Blood Transfusion
Preoperative Starvation
Miscellaneous
Premedication
ANAESTHESIA IN CONGENITAL DIAPHRAGMATIC HERNIA
Anaesthetic Management
Premedication
Anaesthesia
Operation
Postoperative Care
Complications
OESOPHAGEAL ATRESIA WITH OR WITHOUT TRACHEO-OESOPHAGEAL FISTULA
Types
Clinical Features
Preoperative Preparation
Anaesthesia
Postoperative Care
Surgical Approach
Postoperative Complications
HYPERTROPHIC PYLORIC STENOSIS
CLEFT LIP AND CLEFT PALATE
ANAESTHESIA IN SURGERY OF ABDOMINAL WALL DEFECTS IN CHILDREN
Gastroschisis
Exomphalos (Omphalocele)
Prune-belly Syndrome
Bladder Exstrophy (Ectopia Vesicae)
Incisional Hernia
INTRAVENOUS FLUID THERAPY IN PAEDIATRIC SURGERY
Indications
Fluid Balance in a Child
Water Balance
Electrolyte Balance
INTRAVENOUS FLUID THERAPY DURING PAEDIATRIC SURGERY
RESUSCITATION OF NEWBORN
Asphyxia Neonatorum
Clinical Effects
Assessment
RESUSCITATION
CHAPTER 7:
Anaesthesia in Endocrine Disorders
DIABETES MELLITUS
TYPES OF DIABETES MELLITUS
DIAGNOSIS
COMPLICATIONS OF DIABETES MELLITUS
TREATMENT
ANAESTHETIC MANAGEMENT
Preoperative Evaluation
Preoperative Preparation
Perioperative Insulin Therapy
Alternative Regimen
Anaesthesia
MANAGEMENT IN PRESENCE OF KETOACIDOSIS
Postoperative Care
Common Postoperative Complications in Diabetes
HYPEROSMOLAR HYPERGLYCAEMIC NONKETOTIC COMA
HYPOGLYCAEMIA
Clinical Features
Treatment
THYROID DISEASE AND ANAESTHESIA
THYROID PHYSIOLOGY
THYROID FUNCTION TESTS
HYPERTHYROIDISM
Clinical Features
Management
Preparation for Anaesthesia in Patients with Thyrotoxicosis
Premedication
Anaesthesia
Postoperative Care
THYROID CRISIS (STORM)
Management
Preventive Measures
Treatment
POSTOPERATIVE HYPOTHYROIDISM
Postoperative Hypoparathyroidism
Treatment
HYPOTHYROIDISM
ANAESTHESIA IN HYPOTHYROID PATIENTS
ENLARGED THYROID
Indications of Surgery
Clinical Examination and Investigations
Premedication
Anaesthesia
Postoperative Care
MYXOEDEMA COMA
Management
HYPERTHYROIDISM
HYPOTHYROIDISM
DISORDERS OF THE PARATHYROID GLANDS
HYPERPARATHYROIDISM
Surgical Management
Indication
HYPOPARATHYROIDISM
Diagnosis
Treatment
DISEASES OF ADRENAL GLANDS
PHEOCHROMOCYTOMA
Clinical Features
Phentolamine Test
Histamine Test
Preoperative Evaluation
Premedication
ANAESTHETIC MANAGEMENT
Blood Pressure Maintenance during Anaesthesia
CUSHING'S SYNDROME
Preoperative Evaluation
Preoperative Preparation
Anaesthesia
Postoperative Care
Possible Complications
ADRENOCORTICAL SUPPRESSION
Preoperative Evaluation
Anaesthetic Considerations
CHAPTER 8:
Nutritional Disorders
ANAESTHESIA IN OBESE PATIENTS
Pathophysiology
Problems of Anaesthesia
Anaesthesia
Clinical Manifestations
Examination
Investigations
Preoperative Preparation
Regional Anaesthesia
General Anaesthesia
Postoperative Care
NUTRITIONAL THERAPY
Enteral Nutrition
Complications of Tube Feeding
Bolus Feeding
Intravenous Feeding
Total Parenteral Nutrition
CHAPTER 9:
Anaesthesia for the Geriatric Patient
PATHOPHYSIOLOGY IN OLD AGE
Cardiovascular System
Respiratory System
Nervous System
Renal Function
Liver Function
OTHER CHANGES IN OLD AGE
Pharmacology
ANAESTHETIC MANAGEMENT
Preanaesthetic Assessment and Preparation
Premedication
Anaesthesia
Postoperative Care
Delayed Recovery of Consciousness
Respiratory Depression
Postoperative Hypotension
Fluid Management
CHAPTER 10:
Obstetric Anaesthesia and Analgesia
PHYSIOLOGICAL CHANGES IN PREGNANCY
UTEROPLACENTAL CIRCULATION
PHYSIOLOGY OF LABOUR AND PAIN PATHWAYS INVOLVED
Innervation of Birth Canal
Considerations Regarding the Foetus
PLACENTAL TRANSFER OF DRUGS
PAIN RELIEF IN LABOUR
ANAESTHESIA FOR CAESAREAN SECTION
Advantages of Regional Anaesthesia
Disadvantages
Advantages of General Anaesthesia
Disadvantages
TECHNIQUE OF LUMBAR EPIDURAL BLOCK
Problems Associated with Epidural Anaesthesia
SPINAL ANAESTHESIA
Advantages of Spinal Anaesthesia
Disadvantages
GENERAL ANAESTHESIA
Standard Technique of General Anaesthesia
Management of a Difficult Airway in the Parturient
ANAESTHESIA IN PREGNANT MOTHERS FOR COINCIDENTAL SURGERY
Special Note
PATHOLOGICAL CONDITIONS ASSOCIATED WITH PREGNANCY AND LABOUR
Recent Classification
PRE-ECLAMPSIA AND ECLAMPSIA
Clinical Features
Management
Anaesthetic Management
AMNIOTIC FLUID EMBOLISM
Investigations
Managementhasis
PRETERM LABOUR
MULTIPLE GESTATION
ANTEPARTUM HAEMORRHAGE
UTERINE RUPTURE
Problems
RETAINED PLACENTA AND POSTPARTUM HAEMORRHAGE
Treatment of Postpartum Haemorrhage
DIABETES IN PREGNANCY
Management of Hyperglycaemia
JAUNDICE IN PREGNANCY
HEART DISEASE AND PREGNANCY
RESPIRATORY DISEASE AND PREGNANCY
Clinical Manifestations
MANAGEMENT
Prevention
Treatment
CHAPTER 11:
Anaesthesia for Neurosurgery
CEREBROSPINAL FLUID
Characteristics of CSF
CEREBRAL BLOOD FLOW
Factors Regulating the Cerebral Blood Flow
Effect of Drugs Commonly used in Anaesthesia on CBF
PATHOPHYSIOLOGY OF CEREBRAL CIRCULATION
Circulation in and around Tumours
Circulation in Areas of Partial Vascular Occlusion
Cerebral Oxygenation
INTRACRANIAL TENSION
Probable Causes of Raised Intracranial Pressure
Clinical Effects of Raised Intracranial Pressure
Problems of Raised Intracranial Tension
Probable Causes of Rise of Intracranial Tension during Operation
Management of Raised Intracranial Tension (ICT) during Operation
NEUROSURGICAL OPERATIONS
POSITION OF PATIENTS IN NEUROSURGERY
A SHORT REVIEW OF SOME NEUROSURGICAL PROCEDURES
A. Diagnostic Procedures
Problems
B. Intracranial Operations
Anaesthetic Technique
C. Spinal Operations
An Outline of Anaesthetic Technique
SPINAL CORD INJURY
Pathophysiology
Management of Anaesthesia in Case of Spinal Cord Transection
D. Role of the Anaesthesiologist in Patients with Cerebrovascular Diseases
TRANSIENT ISCHAEMIC ATTACKS
CAROTID ENDARTERECTOMY
Problems of Anaesthesia
Anaesthesia
General Anaesthesia
STROKE
Management of Stroke
HEAD INJURY
Assessment
Pathological Changes in Head Injury
Emergency and Conservative Management of Head Injury
Assessment of Head Injury
Diagnosis of Brainstem Death
Anaesthesia in a Case of Head Injury
COMA
Investigations
Management
CEREBRAL OEDEMA
Types
Diagnosis
Investigations
Management
Vasogenic Cerebral Oedema
Cytogenic Cerebral Oedema
Osmotic Cerebral Oedema
Effects of Cerebral Oedema on Brain Function
Cerebral Oedema and Cerebral Blood Flow
Cerebral Oedema and Brain Shift
CONTROLLED HYPOTENSION IN CRANIOTOMY
Indications
A Brief Outline for Inducing Hypotension
ANAESTHESIA FOR MYELOMENINGOCELE
Preanaesthetic Assessment and Preparation
Anaesthesia
ANAESTHESIA FOR HYDROCEPHALUS
Anaesthetic Management
EPILEPSY
Types of Seizures
Problems of Anaesthesia
Anaesthetic Management
STATUS EPILEPTICUS
Treatment
SEIZURES AND ANAESTHETIC DRUGS
MYASTHENIA GRAVIS
Clinical Manifestations
Diagnosis
Treatment
Anaesthetic Considerations
MYASTHENIC CRISIS
CHAPTER 12:
Anaesthesia and Cardiovascular Diseases
PREOPERATIVE ASSESSMENT OF CARDIOVASCULAR STATUS
History
Physical Examination
Investigations
Special Investigations
Problems Related to Common Drugs
Risk of Noncardiac Surgery
Anaesthetic Considerations
ANAESTHESIA FOR CARDIAC CATHETERISATION
Problems of Anaesthesia
Aims to Produce Near-ideal Conditions for Cardiac Catheterisation
Sedation
General Anaesthesia
ANAESTHESIA IN PATIENTS WITH ISCHAEMIC HEART DISEASE
Preanaesthetic Assessment
Anaesthesia
A Standard Technique of General Anaesthesia
Perioperative Reinfarction following Noncardiac Surgery
Indications of Coronary Artery bypass Graft
ANAESTHESIA IN PATIENTS WITH COR PULMONALE
Pathophysiology
Preanaesthetic Assessment
Investigations
Preoperative Treatment
Anaesthetic Management
ANAESTHESIA AND THE HYPERTENSIVE PATIENT
Pathophysiology
Problems of Anaesthesia
Anaesthetic Management
Anaesthesia
CONGESTIVE CARDIAC FAILURE
CARDIAC PACING
Common Indications for Temporary Pacing
Common Indications for Permanent Pacing
Diagnosis of different blocks
PLACEMENT OF PACEMAKERS
Types of Pacemakers
Complications of Cardiac Pacing
Anaesthesia for Insertion of Pacemaker
ANAESTHESIA IN PATIENTS WITH PACEMAKER
Preanaesthetic Assessment
Anaesthesia
PATENT DUCTUS ARTERIOSUS
Anaesthetic Management
COARCTATION OF AORTA
Anaesthetic Implications
MITRAL STENOSIS
Pathophysiology
Preanaesthetic Assessment
Problems of Anaesthesia
Main Anaesthetic Considerations
Anaesthetic Management
Mitral incompetence
Preoperative Assessment
Special Problems
• Main Anaesthetic Considerations
Anaesthetic Management
AORTIC STENOSIS
Clinical Features
Investigations
Anaesthetic Implications
AORTIC REGURGITATION
Clinical Features
Anaesthetic Implications
ATRIAL SEPTAL DEFECT
Clinical Features
Management of Anaesthesia
VENTRICULAR SEPTAL DEFECT
Anaesthetic Management
TETRALOGY OF FALLOT
Treatment of Fallot's Tetralogy
Anaesthetic Management
CARDIOMYOPATHIES
Dilated (congestive) Cardiomyopathy
Anaesthetic Considerations
Hypertrophic Cardiomyopathy
Treatment
Anaesthetic Considerations
Restrictive Cardiomyopathy
Obliterative Cardiomyopathy
CARDIOGENIC PULMONARY OEDEMA
Clinical Features
Management
CARDIOVERSION
Indications
Relative Contraindications
Management of Cardioversion
Adverse Effects
PERICARDIAL EFFUSION: CARDIAC TAMPONADE
Clinical Features
Management
Management of Anaesthesia
CHRONIC CONSTRICTIVE PERICARDITIS
Anaesthetic Management
CHAPTER 13:
Anaesthesia and Respiratory Diseases
PREANAESTHETIC ASSESSMENT
History
Physical Examination
Routine Investigations
Other Radiological Investigations
Pulmonary Function Tests
ANAESTHETIC MANAGEMENT
Preoperative Preparation
Premedication
Anaesthesia
Postanaesthetic Care
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Clinical Features
Investigations
Management
Management of Acute Exacerbations
Anaesthesia in Cases with COPD
Preoperative Evaluation
General Anaesthesia
Postoperative Care
BRONCHIAL ASTHMA
Problems of Anaesthesia
Preanaesthetic Preparation
Anaesthesia
Postoperative Care
PNEUMOTHORAX
Types of Pneumothorax
Diagnosis
Prevention of Pneumothorax
Treatment of Pneumothorax
ASPIRATION PNEUMONITIS
Pathophysiology
Clinical Features
Prophylactic Measures
Management
PLEURAL EFFUSIONS
Treatment
Anaesthetic Implications
EMPYEMA
Clinical Manifestations and Diagnosis
Management
LUNG ABSCESS
Clinical Manifestations and Diagnosis
Treatment
PULMONARY EMBOLISM
Clinical Manifestations
Treatment
ADULT RESPIRATORY DISTRESS SYNDROME
Pathophysiology
Clinical Manifestations
Diagnosis
Management
CHAPTER 14:
Anaesthesia for Day-Case Surgery
ANAESTHETIC MANAGEMENT
Regional Anaesthesia
MONITORED ANAESTHESIA CARE
Inhalation Anaesthesia
Intravenous Anaesthesia
Endotracheal Intubation
Muscle Relaxants
Maintenance of Anaesthesia
Total Intravenous Anaesthesia
Recovery from General Anaesthesia
Postoperative Care
Discharge
CHAPTER 15:
Miscellaneous
PROBLEMS OF ANAESTHESIA
ANAESTHESIA
ACUTE EFFECTS OF INGESTION OF ALCOHOL
CHRONIC EFFECTS OF ALCOHOL
PROBLEMS OF ANAESTHESIA
ANAESTHESIA
EMERGENCY ANAESTHESIA
Treatment of Acute Alcohol Toxicity
PATHOPHYSIOLOGY
PREOPERATIVE PREPARATION OF THE FEBRILE PATIENT
ANAESTHETIC IMPLICATIONS
Anaesthetics and Relaxants
CLINICAL FEATURES
LABORATORY FINDINGS
DIAGNOSIS
GUIDELINES OF MANAGEMENT
Anaesthesia in Patients Susceptible to Malignant Hyperpyrexia
PROBLEMS RELATED TO FULL STOMACH
PREVENTION OF VOMITING
ANAESTHESIA
MANAGEMENT OF BURNS
ANAESTHETIC IMPLICATIONS
AIRWAY BURN
BASIC CARDIAC LIFE SUPPORT
Mechanism of Producing a Cardiac Output by Chest Compressions
ADVANCED CARDIAC LIFE SUPPORT
PHARMACOLOGICAL SUPPORT
Ventricular Fibrillation
Cardiac Asystole
Electromechanical Dissociation
Post Resuscitation Care
Cardiovascular Effects of Posture
RESPIRATORY EFFECTS OF POSTURE
POSTURE AND RENAL FUNCTION
OPERATIVE POSITIONS
Supine Position
Prone Position
Sitting Posture
Lateral Position
Lithotomy Position
Trendelenburg Position
Ante-Trendelenburg Position
Tonsillar Position
POSTURE AND SPINAL/EPIDURAL ANAESTHESIA
OPERATIVE AND POSTOPERATIVE COMPLICATIONS OF BODY POSTURE
Side Effects
ANAESTHETIC MANAGEMENT
AMBIENT ATMOSPHERE IN HIGH ALTITUDE
PATHOPHYSIOLOGY OF HIGH ALTITUDE
Cardiovascular Changes
Pulmonary Changes
Kidney Changes
Hazards of High Altitude Exposure
ACUTE MOUNTAIN SICKNESS
CHRONIC MOUNTAIN SICKNESS
ANAESTHETIC PROBLEMS
Spinal Analgesia and Local Nerve Blocks
PATHOPHYSIOLOGY
CAUSES
CLINICAL FEATURES
DIAGNOSIS
MANAGEMENT
Bibliography
INDEX
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