Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
A Primer of Anesthesia
Rajeshwari Subramaniam
SECTION 1: THE PREOPERATIVE PERIOD
CHAPTER 1:
Intravenous Anesthetic Agents and Opioids
MISCELLANEOUS EFFECTS
Pharmacokinetics
Dosage and Administration
Adverse Effects and Problems with Thiopentone
Indications
Absolute Contraindications
Precautions
Propofol (Fig. 1.3)
Physical Properties
Pharmacology
Central Nervous System
Cardiovascular System
Respiratory System
Skeletal Muscle, Gastrointestinal System, Uterus and Placenta
Hepatorenal Effects
Pharmacokinetics
Administration
Adverse Effects
Cardiovascular Depression
Pain on Injection
Allergic Reactions
Indications
Induction of Anesthesia
Sedation During Surgery
Total Intravenous Anesthesia
Sedation in ICU
Absolute Contraindications
Precautions
Ketamine Hydrochloride
Pharmacology
Central Nervous System
Cardiovascular System
Respiratory System
Other Systems
Pharmacokinetics
Administration
Adverse Effects
Indications
Patient in Shock for Emergency Surgery (e.g. Splenic/Hepatic/Thoracic Injury)
Pediatric Anesthesia
The Poor-risk Elderly Patient
Difficult Locations
Treatment of Postoperative or Intractable Pain
Change of Wound Dressing
Developing Countries
Absolute Contraindications
Precautions
Benzodiazepines
Pharmacology
Mechanism of Action
Central Nervous System
Muscle Relaxation
Respiratory System
Cardiovascular System
Pharmacokinetics
Midazolam (Fig. 1.6)
Dosage
Diazepam (Fig. 1.7)
Flumazenil
Side Effects and Contraindications of Flumazenil
Re-sedation
Convulsions
Intracranial Pressure Increase
OPIOID (NARCOTIC) ANALGESICS
Classification
Opiate Receptors
Endogenous Opioid Agonists
Mechanism and Sites of Action
Agonists, Antagonists, and Partial Antagonists
Actions
Analgesia
Respiratory System
Cardiovascular System
Nausea and Vomiting
Cough Suppression
Gastrointestinal Tract
Other Effects
Morphine (Fig. 1.8)
Pethidine (Fig. 1.9)
Fentanyl (Fig. 1.10)
Alfentanil
Sufentanil
Remifentanil
Tramadol
Pentazocine
Naloxone
STATE WHETHER TRUE (T) OR FALSE (F)
CHAPTER 2:
Inhalational Anesthetic Agents
POTENCY OF INHALATIONAL ANESTHETIC AGENTS
Minimum Alveolar Concentration
Dose-response Curve
PHYSICAL PRINCIPLES
Saturated Vapour Pressure
PHARMACOKINETICS
Solubility/Partition Coefficient
Uptake of Anesthetic Agents
Factors Affecting Rate of Uptake
Metabolism and Excretion of Inhalational Anesthetics
PHARMACODYNAMICS
Mayer-Overton Theory
Pressure Reversal and Critical Volume Hypothesis
Multi-site Expansion Hypothesis
Other Theories
ANESTHETICS IN CLINICAL USE
Physical
Pharmacological
SPECIAL FEATURES ABOUT INDIVIDUAL INHALATION AGENTS
Halothane (Fig. 2.1)
Enflurane (Fig. 2.2)
Isoflurane(Fig. 2.3)
Sevoflurane (Fig. 2.4)
Desflurane (Fig. 2.5)
Diethyl Ether (Fig. 2.6)
Nitrous Oxide
STATE WHETHER TRUE (T) OR FALSE (F)
CHAPTER 3:
Physiology of Neuromuscular Blockade and Neuromuscular Pharmacology
ANATOMY AND PHYSIOLOGY OF THE NEUROMUSCULAR JUNCTION
How does Neuromuscular Transmission Occur?
Role of Acetylcholinesterase
Action of ACh on Nicotinic Receptors
NEUROMUSCULAR BLOCKING DRUGS
Mechanism of Action of Muscle Relaxants
Properties of an Ideal Muscle Relaxant
CLASSIFICATION OF MUSCLE RELAXANTS (TABLE 3.1)
DEPOLARIZING RELAXANTS
Clinical Uses of Suxamethonium
Undesirable Effects Associated Specifically with the use Succinylcholine
NONDEPOLARIZING RELAXANTS
Side Effects of Neuromuscular Blocking Drugs
Interactions of Nondepolarizing Muscle Relaxants
ANTAGONISM OF RESIDUAL NEUROMUSCULAR BLOCKADE
Pharmacokinetics
Neuromuscular Diseases Altering the Action of Muscle Relaxants
Issues with Neuromuscular Blockade in the Intensive Care Unit
MONITORING OF NEUROMUSCULAR BLOCK
Terminology used in Nerve Stimulation
Patterns of Stimulation
MCQs
CHAPTER 4:
The Anesthesia Machine
THE ANESTHESIA BREATHING CIRCUITS
The Mapleson Breathing Circuits
CHAPTER 5:
Preoperative Evaluation of Patients
FASTING GUIDELINES: PREMEDICATION AND OTHER DRUGS
Fasting Guidelines
Premedication
ANESTHETIC IMPLICATIONS OF CONCURRENT DISEASE
Bronchial Asthma
Preoperative Assessment
Preoperative Optimization
Goals of Optimization
Optimal Anesthetic Technique
Choice of Anesthesia and Goals of Anesthetic Management
Diabetes Mellitus
Physiological Derangement
Preoperative Assessment
Optimal Anesthetic Management
Anesthetic Technique
Valvular Heart Disease
General Evaluation
Premedication
Anticoagulant Therapy
Monitoring and anesthetic agents
Hypertension
Physiological derangement in hypertension:
Preoperative Optimization
Preoperative Evaluation
Investigations
Premedication
Anesthetic Management
Anemia
Anesthetic Technique, Monitoring and Precautions in the Anemic Patient
MCQs
SECTION 2: THE INTRAOPERATIVE PERIOD
CHAPTER 6:
Monitoring the Patient Under Anesthesia
COMMON MONITORING TECHNIQUES
ECG Monitoring: Indications and Contraindications
Non-invasive Blood Pressure (NIBP) Monitoring
Pulse Oximetry (Fig. 6.6)
Principles (Fig. 6.7)
Capnography
Principles of Capnography (Figs 6.8A and B)
How is Appropriate Monitoring for a Patient Selected?
STATE WHETHER TRUE (T) OR FALSE (F))
CHAPTER 7:
Vascular Cannulation
STEPS IN INSERTING AN IV CANNULLA
TECHNIQUE OF CENTRAL VENOUS CANNULATION
TECHNIQUE OF ARTERIAL CANNULATION
CHAPTER 8:
Airway Management
PROBLEMS WITH MASK VENTILATION
Laryngoscopy (Figs 8.10 A to D)
Intubation
Selection of Appropriate Tube Size
Inflating the Cuff with Air
The Laryngeal Mask Airway (LMA)
‘RAPID SEQUENCE□ INDUCTION AND INTUBATION (FIG. 8.14)
Management of Airway Obstruction and Failed Intubation
DIFFICULT AIRWAY ALGORITHM
AIRWAY EQUIPMENT
The Oropharyngeal (Guedel□s) Airway
The Nasopharyngeal Airway (Figs 8.17A and B)
The Face Mask (Fig. 8.18A)
The Endotracheal Tube
Parts
Possible Problems with Endotracheal Tubes
The Combitube
Magill Intubating Forceps ((Fig. 8.26)
The Laryngoscope (Figs 8.27 A and B)
The Malleable Stylet (Figs 8.28A and B)
MCQs
CHAPTER 9:
Neuraxial (Spinal and Epidural) Blockade
ADVANTAGES OF NEURAXIAL BLOCK FOR SURGERY
INDICATIONS FOR SPINAL/EPIDURAL ANESTHESIA
WHY IS EPIDURAL ANESTHESIA COMBINED WITH GENERAL ANESTHESIA SOMETIMES?
ANATOMY OF THE VERTEBRAL COLUMN AND THE SPINAL CORD
PHARMACOLOGY OF LOCAL ANESTHETIC AGENTS
Physicochemical Properties of LA Agents
PHYSIOLOGICAL EFFECTS OF NEURAXIAL BLOCKADE
Somatic Blockade
Autonomic Blockade
Contraindications to Neuraxial Blockade
PREOPERATIVE PREPARATION OF THE PATIENT PRIOR TO NEURAXIAL BLOCK
Psychological Preparation
Physical Preparation
OPERATION THEATER MANAGEMENT-PREPARATION AND MONITORING
EPIDURAL ANESTHESIA
COMPLICATIONS SPECIFIC TO EPIDURAL TECHNIQUE
SUBARACHNOID ((SPINAL)) ANESTHESIA ((FIG. 9.17)
DIFFERENCES BETWEEN EPIDURAL AND SPINAL BLOCKADE
ASSESSMENT OF EFFECTIVENESS OF SPINAL/EPIDURAL BLOCK
SEDATION
PRECAUTIONS
CAUDAL ANESTHESIA (TABLE 9.4)
Technique
Complications of Caudal Block
Combined Spinal-Epidural Anesthesia (CSE) Technique (Fig. 9.22)
MCQs
CHAPTER 10:
Peripheral Nerve Blocks
INTRODUCTION
TECHNIQUE
Electrical Nerve Stimulators (Fig. 10.1)
Nerve Localization
ADVANTAGES
INDICATIONS
CONTRAINDICATIONS
COMPLICATIONS (TABLE 10.1)
UPPER LIMB BLOCKS
INTERSCALENE BLOCK
Maneuvers to Accentuate the Landmarks
SUPRACLAVICULAR BLOCK
INFRACLAVICULAR BLOCK (SUPERIOR CORD BLOCK))
AXILLARY BLOCK
DIGITAL NERVE BLOCK
Technique
LOWER LIMB ANATOMY
Gross Anatomy
The Lumbar Plexus
The Sacral Plexus
Surface Anatomy
Anterior Superior Iliac Spine (ASIS)
Pubic Tubercle
Posterior Superior Iliac Spine (PSIS)
Greater Trochanter
The Ischial Tuberosity
FEMORAL NERVE BLOCK
SCIATIC NERVE BLOCK
Infragluteal Approach
ANKLE BLOCK
Anatomy
Technique
Posterior Tibial Nerve
Sural Nerve
Deep Peroneal Nerve
Superficial Peroneal Nerve
Saphenous Nerve
BLOCKS FOR HERNIA SURGERY
Ilioinguinal Nerve Block
Iliohypogastric Block
Genitofemoral Nerve
PENILE BLOCK
Anatomy (Fig. 10.18)
Technique of Dorsal Penile Nerve Block
Pitfalls and Complications
RECENT ADVANCES IN PERIPHERAL NERVE BLOCKADE
The Stimulating Catheter Technique
Ultrasound Guided Blocks
CONCLUSION
ACKNOWLEDGEMENT
CHAPTER 11:
Fluid Therapy and Transfusion
WHAT ARE CRYSTALLOIDS?
Salient Features
1. 5% Dextrose
Disadvantage
2. 0.9% Sodium Chloride (Normal Saline)
Disadvantages
3. “Balanced” Salt Solutions
Disadvantages
PERIOPERATIVE FLUID REPLACEMENT GUIDELINES
REPLACEMENT FLUIDS – COLLOIDS
1. Gelatins
2. Dextrans
3. Starches: Hydroxy Ethyl Starch (HES)
Degradation:
BLOOD TRANSFUSION
What are the Complications of Blood Transfusion?
DIAGNOSIS AND CORRECTION OF SOME COMMON ELECTROLYTE ABNORMALITIES
Effect of Infusion of 2 L Crystalloid Load on TBW and its Distribution in a 70 kg Adult
HYPERNATREMIA AND ITS MANAGEMENT
Clinical Manifestations of Hypernatremia
Example
HYPONATREMIA AND ITS MANAGEMENT
DISORDERS OF POTASSIUM HOMEOSTASIS
Clinical Features of Hypokalemia
Treatment of Hypokalemia (Fig. 11.11)
Anesthetic Implications of Hypokalemia and Precautions during Anesthesia
HYPERKALEMIA—CAUSES, DIAGNOSIS AND TREATMENT
Anesthetic Considerations and Precautions
Principles of Treatment (Fig. 11.13)
HYPERCALCEMIA AND HYPOCALCEMIA
Hypercalcemia-causes, Treatment and Anesthetic Implications
Causes of Hypercalcemia (Table 11.12)
Clinical Manifestations
Treatment
Anesthetic Considerations for Hypercalcemia
HYPOCALCEMIA
Anesthetic Considerations
SECTION 3: THE POSTOPERATIVE PERIOD
CHAPTER 12:
Post-anesthesia Care
INTRODUCTION
Where is the Patient Observed during Postoperative Period?
General Management
COMPLICATIONS
What are the Possible Respiratory Complications?
How do you Manage a Patient with Respiratory Compromise?
Circulatory Complications
Hypotension
How do you Manage a Patient with Hypotension?
Hypertension
Dysrhythmias
Electrocardiographic Changes
Failure to Regain Consciousness
Nausea and Vomiting
Hypothermia and Shivering
MISCELLANEOUS
CONCLUSION
MCQs
CHAPTER 13:
Oxygen Therapy
LOW FLOW SYSTEMS
How can you Estimate the FiO2 Provided by Low Flow Systems?
RESERVOIR SYSTEMS
A. The Reservoir Cannula (Fig. 13.3)
B. Reservoir Masks
C. Oxygen Tent
D. Oxygen Hood
HIGH FLOW SYSTEMS
A. Entrainment Devices
Numerical Examples
Example
B. Blenders
STATE WHETHER TRUE (T) OR FALSE (F)
CHAPTER 14:
Infection and the Anesthesiologist
ANTIGENIC STRUCTURE AND TRANSMISSION
Transmission from Patient to Anesthesiologist
Risk of Transmission of Bloodborne Viruses to Health Care Workers
Patient to Patient Transmission
Anesthesiologist to Patient Transmission
Transmission-based Precautions
Determination of the Exposure Code (EC) (Fig. 14.9)
Post-exposure Management
First Aid
What Measures should be taken when Exposure to a HBV-positive Patient□s Blood Occurs?
CONCLUSION
MCQs
SECTION 4: CRITICAL CARE
CHAPTER 15:
Care of the Patient in the ICU
DESIGN OF THE INTENSIVE CARE UNIT [ICU]
STAFFING IN THE ICU
ADMISSION TO INTENSIVE CARE UNIT
MONITORING IN THE INTENSIVE CARE UNIT
RESPIRATORY ISSUES IN ICU
POSITIVE PRESSURE VENTILATION [PPV]
CARDIOVASCULAR ISSUES IN ICU
RENAL PROBLEMS IN ICU
NUTRITION IN THE ICU
ETHICAL ISSUES IN ICU
MCQs
CHAPTER 16:
Cardiopulmonary Resuscitation
ADVANCED CARDIAC LIFE SUPPORT (ACLS)
Defibrillation
Access for Medications
Securing the Airway (Fig. 16.8)
DRUGS
Post-resuscitation Care
CPR FOR INFANTS AND CHILDREN
COMPLICATIONS OF BLS
Drugs Used in CPR and their Doses
MCQs
INDEX
TOC
Index
×
Chapter Notes
Save
Clear
