4th Edition
Editor Sampa Dutta Gupta MBBS DMCW MD(Anes) DCC(Cardiac Anes) MAMS
Associate Professor Department of Anesthesiology Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital Kolkata, West Bengal, India
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Anesthesiology Updates for Postgraduates
First Edition: 2010
Second Edition: 2011
Third Edition: 2012
Fourth Edition: 2014
9789351520962
Printed at
5Dedicated to
7Contributors
- Anil Agarwal md
- Professor and Head
- Department of Anesthesiology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Anupam Goswami md
- Professor and Head
- Department of Cardiac Anesthesiology
- Institute of Postgraduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Arif Ahmed md
- Clinical Fellow
- Singapore General Hospital
- Singapore
- Ashok Kumar Saxena md fams
- Professor and Ex-Head
- Department of Anesthesiology
- University College of Medical Sciences
- New Delhi, India
- Baljit Singh md
- Director and Professor
- Department of Anesthesiology
- GB Pant Hospital
- New Delhi, India
- Bibhukalyani Das md
- Former Professor and Head
- Department of Anesthesiology
- Nil Ratan Sarkar (NRS)
- Medical College and Hospital
- Kolkata, West Bengal, India
- Chandan Kumar Mandal dnb
- Post-Doctoral Fellow
- Rabindranath Tagore International
- Institute of Cardiac Sciences (RTIICS)
- Kolkata, West Bengal, India
- Chiranjib Bhattacharyya md
- Associate Professor
- Institute of Postgraduate
- Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Dalim Kumar Baidya md
- Assistant Professor
- Department of Anesthesiology and Intensive care
- All India Institute of Medical Sciences
- New Delhi, India
- Deepak K Tempe md frca fams
- Dean
- Maulana Azad Medical College and Associated GB Pant, Guru Nanak Eye Center (GNEC) and Lok Nayak Hospitals
- New Delhi, India
- Dhanee Majhi md Student
- Department of Anesthesiology
- SCB Medical College and Hospital
- Cuttack, Odisha, India
- Dilip K Pawar md
- Professor
- Department of Anesthesiology
- All India Institute of Medical Sciences
- New Delhi, India
- Indira Malik md
- Assistant Professor
- Department of Anesthesiology and Intensive Care
- GB Pant Hospital
- New Delhi, India
- Jatisankar Rudra md
- Head
- Department of Anesthesiology
- Calcutta National Medical College
- Kolkata, West Bengal, India
- Jayashree Sood md ffarcs pgdhhm
- Chairperson
- Department of Anesthesiology
- Pain and Perioperative Medicine
- Sir Ganga Ram Hospital
- New Delhi, India
- Jaydeb Prakash Kundu md ffarcs
- Former Professor and Head
- Department of Anesthesiology
- Nil Ratan Sarkar (NRS) Medical College
- Kolkata, West Bengal, India
- JV Divatia md
- Professor and Head
- Department of Anesthesiology
- Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Jyotsna Goswami md
- Senior Consultant and Head
- Department of Anesthesia and Critical Care
- Tata Medical Center
- Kolkata, West Bengal, India
- Kanak Kanti Kundu da md
- Professor and Head
- Department of Anesthesiology
- Institute of Postgraduate
- Medical Education and Research (IPGMER)
- Kolkata, West Bengal, India
- Koel Mitra md
- Assistant Professor
- Department of Anesthesiology
- Medical College Kolkata
- Kolkata, West Bengal, India
- LD Mishra md phd fica
- Professor and Head
- Department of Anesthesiology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Mahendra Kumar da md
- Director and Professor
- Department of Anesthesia
- Guru Teg Bahadur Hospital
- New Delhi, India
- Maupali Ghosh mbbs md student
- Department of Anesthesiology
- Institute of Postgraduate
- Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Minati Choudhury md
- Additional Professor
- Department of Cardiac Anesthesia
- Cardiothoracic and Neurosciences Center
- All India Institute of Medical Sciences
- New Delhi, India
- Mohona Mukherjee md
- RMO-Cum-Clinical Tutor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Nibedita Pani md
- Professor and Head
- Department of Anesthesiology and Critical Care
- SCB Medical College and Hospital
- Cuttack, Odisha, India
- Pooja Banerjee md student
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Prithwis Bhattacharyya md pdcc
- Professor and Head
- Department of Anesthesiology
- North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)
- Shillong, Meghalaya, India
- Purnima Mukherjee md
- Former Professor and Head
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Rahul Guha Biswas md pdcc
- Postdoctoral Fellow (Canada)
- Senior Consultant
- Cardiac Anesthesia and Intensive Care
- NH-Rabindranath Tagore International Institute of Cardiac Sciences (RTICCS)
- Kolkata, West Bengal, India
- Rajan Singh msc
- Clinical Fellow
- Department of Gastroenterology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Rajat Choudhuri mbbs md
- Assistant Professor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Rajib Samal md
- Assistant Professor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Ratul Kundu md
- RMO-Cum-Clinical Tutor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Sumitra Bakshi md
- Associate Professor
- Department of Anesthesiology
- Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- S Parashar md pdcc (neuroanesthesia)
- Student and Senior Resident
- Department of Anesthesiology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Sabyasachi Das md
- Professor
- Department of Anesthesiology
- Dean, North Bengal Medical College
- Darjeeling, West Bengal, India
- Saikat Sengupta md dnb mnams
- Professor
- Department of Anesthesia
- Apollo Hospitals Education and Research Foundation
- Senior Consultant
- Apollo Gleneagles Hospitals
- Kolkata, West Bengal, India
- Samarendra Pal da md
- Former Professor and Head
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Samarendra Samui md
- Assistant Professor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Sampa Dutta Gupta mbbs dmcw md(anes) dcc(cardiac anes) mams
- Associate Professor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Sanghamitra Mishra md
- Professor
- Department of Anesthesiology
- Pain, Palliative and Critical Care
- Institute of Medical Sciences and SUM Hospital
- Bhubaneswar, Odisha, India
- Shalini Chaudhuri md student
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Simantika Ghosh dnb
- Fellow
- Tata Medical Center
- Kolkata, West Bengal, India
- Sagarmoy Basu md (cal) da (london) fica
- Professor and Ex-Head
- Calcutta National Medical College
- Kolkata, West Bengal, India
- Soumendu Pal md dm (cardiac anesth)
- Associate Consultant
- Department of Cardiac Anesthesia
- Fortis Memorial Research Institute
- Gurgaon, Haryana, India
- Souvik Maitra md
- Senior Resident
- Department of Anesthesiology and Intensive Care
- All India Institute of Medical Sciences (AIIMS)
- New Delhi, India
- Srabani Basu md
- In-charge
- Department of Anesthesiology and Surgical Intensive Care Unit
- BR Singh Hospital
- Kolkata, West Bengal, India
- Subrata Pahari md
- Professor and Head
- Department of Anesthesiology
- Medical College Kolkata
- Kolkata, West Bengal, India
- Sudakshina Mukherji md
- Professor
- Bankura Sammilani Medical College
- Bankura, West Bengal, India
- Sudeshna Bhar (Kundu) md
- Assistant Professor
- Department of Anesthesiology
- Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital
- Kolkata, West Bengal, India
- Sujeet Kumar Singh Gautam md
- Assistant Professor
- Department of Anesthesiology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Sukdev Nayak md pgdm dip pall med (wales) llb
- Professor and Head
- Department of Anesthesiology
- All India Institute of Medical Sciences
- Bhubanswar, Odisha, India
- Sumanta Dasgupta md
- Additional Chief Health Director
- Department of Anesthesiology and Critical Care Central Hospital
- South-Eastern Railway
- Kolkata, West Bengal, India
- Sushil Kumar msc
- Clinical Fellow
- Department of Gastroenterology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Sushma Bhatnagar md
- Professor and Head
- Anesthesiology, Pain and Palliative Care
- Dr Bhim Rao Ambedkar (BRA)
- Institute Rotary Cancer Hospital
- All India Institute of Medical Sciences
- New Delhi, India
- Uday C Ghoshal md dnb dm facg rff
- Professor
- Department of Gastroenterology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
Anesthesiology Updates for Postgraduates first published in 2010 has achieved increasing acclaim with each successive two editions. In this edition, some esteemed teachers and examiners across the country have put forth their suggestions on some commonly encountered long and short cases for final MD, DA and DNB practical examination of anesthesiology. This addition has been made with the intention of spreading the mode of discussion of some eloquent teachers of anesthesiology, whose suggestions are worth to include in achieving a good anesthetic management skill for a postgraduate student. Senior esteemed teachers can count on years of experience to direct students for logistic approach of Must Know part during their training period through an easy-to-follow sequence of chapters. No small book can do justice to a large syllabus of anesthesiology for postgraduates, but, chapters of this edition are backed up with an information-packed references which provide succinct and up-to-date advice for practical application along with the new insights into the decision-making process. This book may be used as a learning aid or as a checklist for preparation of postgraduate practical examination of students of anesthesiology.
Sampa Dutta Gupta
12Preface to the Third Edition
This book has evolved over last eight years from the interactions between teachers and postgraduate students from eight annual postgraduate assemblies conducted by Department of Anesthesiology of Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal, India.
The greater part of the book is distilled from the work of eminent and dedicated teachers and their experiences of sharing knowledge with their beloved students. The book is not a substitute for the major anesthetic texts, but concentrates on principles of management of the most challenging anesthetic cases.
The book has resulted in the concept of “Educational spiral”, to understand the need to identify what are ‘essential’ and what are ‘not so essential’. Knowledge gathering may spiral out from core knowledge, without which the basic objective of the book would remain unfilled. Must learn area based on the health need of patients, task to be performed by the students for patients and community need depending on the socioeconomic situations, resources available and keeping pace with the scientific advancements.
We have been encouraged by many postgraduate students who have told us that discussions of postgraduate assemblies helped them immensely in preparation for their examination. Topics are chosen for review based on questions and contentions raised by anesthesiology residents. Based on their needs, with an aim to prepare themselves for various postgraduates examinations, we are delighted to have been able to provide this assistance and hope that the book will be even more useful to them.
I like to express my deep gratitude to all those who have nobly contributed to the book, to the reader for their interest and to those who have offered constructive criticism.
Sampa Dutta Gupta
13Preface to the Second Edition
The first edition of this book has achieved its purpose in the last one year, having helped our beloved students to prepare their curriculum. We are thankful to all our postgraduate students for their review, criticism, patience and perseverance which have helped us to refine the second edition and screen out certain unintentional errors.
Despite our sincere efforts, the first edition of the book was printed with some technical errors. Therefore, in this edition, the entire book has been revised, with a view to eliminate errors and to incorporate valuable suggestions from the readers. With an aim to update the topics in tune to the recent trends of MD, DA or DNB examination, we have added some new chapters to the book. However, in the interest of the readers, in order to limit the number of pages for ease of reading, we have been unable to include certain previous chapters. This edition will act as a supplement to the previous edition. It is our firm conviction that the book will be of substantial help to all postgraduate students.
The inspiration, encouragement, inputs and moral support we have received from all the students and teachers are commendable. We express immense gratitude to all our students and teachers for their inspiration and incredible support.
Sampa Dutta Gupta
Sudeshna Bhar (Kundu)
14Preface to the First Edition
Reading of leading anesthetic texts is essential for success in clinical anesthesiology, but memorization and subsequent recall of important points may be difficult. This book aims to provide guidance to the postgraduate students of anesthesiology to provide safe anesthesia practice in the perioperative period in line with modern concepts with safety.
The greater part of this book is distilled from the work of eminent and dedicated teachers and their experiences of sharing knowledge with their beloved students. The book is not a substitute for the major anesthetic texts, but concentrates on principles of management of the most challenging anesthetic cases.
The book has evolved over last six years from the interactions between teachers and postgraduate students from six annual postgraduate assemblies conducted by Department of Anesthesiology of Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India.
We have been encouraged by many postgraduate students who have told us that discussions of postgraduate assemblies helped them immensely in preparation for their examination. Topics are chosen for review based on questions and contentions raised by anesthesiology residents. Based on their needs, with an aim to prepare themselves for various postgraduates examinations, we are delighted to have been able to provide this assistance and hope that the book will be even more useful to them.
We would like to express our deep gratitude to all those who have nobly contributed to the book, to the reader for their interest and to those who have offered constructive criticism.
Sampa Dutta Gupta
Sudeshna Kundu
15Acknowledgments
I would like to extend my sincere gratitude to Professor Pradip Kumar Mitra, Director, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal, India, for this constant encouragement and inspiration.
My sincere thanks to Sagarmoy Basu, DA (London) MD, Professor and Ex-Head, Calcutta National Medical College (CNMC), Kolkata, West Bengal; Purnima Mukherjee, DA MD, Professor and Ex-Head, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal; Amitava Rudra, MD FAMS, Professor and Ex-Head, Calcutta National Medical College, Kolkata, West Bengal; Samarendra Pal, DA MD, Professor and Ex-Head, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal; and Nitish Kumar Gazi, DA MD, Professor and Ex-Head, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal, India, for their whole-hearted support and encouragement for this difficult task.
I thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director-Publishing), Mr KK Raman (Production Manager), Mr Sunil Kumar Dogra (Production Executive), Mr Neelambar Pant (Production Coodinator), Mr Akhilesh Kumar Dubey, Mr Chandra Dutt (Typesetter), Mr Hazra (Kolkata Branch) and the entire team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their help in bringing out the book.