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Yearbook of Anesthesiology-5
Raminder Sehgal, Anjan Trikha
1:
Ventilator-Associated Pneumonia
INTRODUCTION
DEFINITIONS
ETIOPATHOGENESIS
Sources of Colonizing Bacteria
Microbial Entry Mechanisms
MICROBIOLOGY
DIAGNOSIS and CLINICAL FEATURES of VAP
CLINICAL STRATEGY FOR VENTILATOR-ASSOCIATED PNEUMONIA
BACTERIOLOGICAL STRATEGY
PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA
General Measures
Reduction in Aspiration Past the Cuff
Enhancement of Bacterial Clearance
Ventilator Bundle
ANTIMICROBIAL TREATMENT
CONCLUSION
2:
Awareness Under Anesthesia
INTRODUCTION
NEUROBIOLOGY OF CONSCIOUSNESS AND TAXONOMY OF MEMORY
DEFINITION AND INCIDENCE OF AWARENESS
TYPES OF AWARENESS
CAUSES OF AWARENESS
Intentional Provision of Light Anesthesia
Inadvertent Provision of Light Anesthesia
Increased Anesthetic Requirements
Human Factors Attributing to Awareness
RISK FACTORS FOR INTRAOPERATIVE AWARENESS
DURATION OF AWARENESS
METHODS TO PREVENT AWARENESS
Preoperative Measures
Intraoperative Choice of Anesthetic Technique and Drugs
ROLE OF MONITORING TO PREVENT INTRAOPERATIVE AWARENESS
Isolated Forearm Technique
End Tidal Anesthetic Agent Concentration
Processed EEG Monitors
Evoked Responses as Monitors of Depth of Anesthesia
GUIDELINES FOR THE USE OF DEPTH OF ANESTHESIA MONITORS
DETECTION OF AWARENESS
CONSEQUENCES OF INTRAOPERATIVE AWARENESS
MANAGEMENT OF INTRAOPERATIVE AWARENESS
CONCLUSION
3:
Postoperative Vision Loss
INTRODUCTION
PATHOPHYSIOLOGY
VISION LOSS AFTER SPINE SURGERY
Ischemic Optic Neuropathy (ION)
Anterior Ischemic Optic Neuropathy (AION)
Posterior Ischemic Optic Neuropathy (PION)
Mechanism for Ischemic Optic Neuropathy
Retinal Ischemia: Branch and Central Retinal Artery Occlusion
POSTOPERATIVE VISION LOSS AFTER CARDIAC SURGERY
POSTOPERATIVE VISION LOSS AFTER HEAD AND NECK SURGERY
PERIOPERATIVE VISUAL LOSS IN OTHER SURGERIES
OTHER CAUSES OF POSTOPERATIVE VISION LOSS
Cortical Blindness
Posterior Reversible Encephalopathy Syndrome (PRES)
AMERICAN SOCIETY OF ANESTHESIOLOGISTS PRACTICE ADVISORY TO DECREASE ISCHEMIC OPTIC NEUROPATHY AND POSTOPERATIVE VISION LOSS
CONCLUSION
4:
Malignant Hyperthermia: A Brief Review and Urgent Implications for India
INTRODUCTION
EPIDEMIOLOGY
PATHOLOGY
PATHOGENESIS
GENETICS OF MALIGNANT HYPERTHERMIA
CLINICAL FEATURES
DIAGNOSIS AND TREATMENT
PREVENTION
CONCLUSION
5:
Role of Renin Angiotensin System in Cardiovascular Homeostasis
INTRODUCTION
CLASSICAL SYSTEM OF RENIN ANGIOTENSIN SYSTEM
ALTERNATE OR EXPANDED RENIN ANGIOTENSIN SYSTEM MODEL
CARDIOVASCULAR ACTIONS OF RENIN ANGIOTENSIN SYSTEM
RENIN ANGIOTENSIN SYSTEM AND BLOOD PRESSURE REGULATION UNDER ANESTHESIA
CONCERNS OF PERIOPERATIVE RENIN ANGIOTENSIN SYSTEM ANTAGONISM
Risk of Intraoperative Hypotension and Renin Angiotensin System Antagonists
Risk of Postoperative Renal Injury
Withdrawal Hypertension
Risk of Exaggerated Hypertension in Response to Noxious Stimuli
Renin Angiotensin System Antagonism and Regional Anesthesia
Benefits of Continued Use of Renin Angiotensin System Inhibitors in the Perioperative Period
CONCLUSION
6:
Tissue Oxygenation: The Trail of Oxygen
INTRODUCTION
COMPOSITION OF AIR
CHEMISTRY OF OXYGEN
PHYSIOLOGY OF OXYGEN
TRANSPORT OF OXYGEN IN BLOOD
OXYHEMOGLOBIN DISSOCIATION CURVE
OXYGEN DELIVERY AND OXYGEN CONSUMPTION
MIXED AND CENTRAL VENOUS OXYGENATION
HYPEROXIA
REACTIVE OXYGEN SPECIES
ADMINISTRATION OF OXYGEN
CONCLUSION
7:
Art of Tracheal Extubation and Reintubation
INTRODUCTION
PREDICTING “AT RISK” TRACHEAL EXTUBATION
Anatomic Factors
Pathologic Factors
Mechanical Factors
DEEP versus AWAKE TRACHEAL EXTUBATION
IDENTIFICATION OF PRE-EXTUBATION AIRWAY EDEMA
Gentle Laryngoscopy
Pre-extubation Flexible Fiberoptic Examination of the Airway
Imaging Techniques
Cuff Leak Test
MANAGING THE ROUTINE AND DIFFICULT TRACHEAL EXTUBATION
Strategy for Routine “Low Risk” Tracheal Extubation
Strategy for Difficult “At Risk” Tracheal Extubation
REINTUBATION STRATEGY
EXCHANGING the tracheal tube
CONCLUSION
8:
Pharmacological Therapies for Blood Loss in the Perioperative Period: Current Status
INTRODUCTION
PREOPERATIVE PHARMACOLOGICAL THERAPY
INTRAOPERATIVE PHARMACOLOGICAL THERAPY
POSTOPERATIVE MEASURES
CONCLUSION
9:
Recent Advances in Oncoanesthesia
INTRODUCTION
ANESTHESIA AND CANCER RECURRENCE
NEWER TOOLS FOR AIRWAY EVALUATION
HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
Surgical Procedure
Pathophysiological Effects of HIPEC
Anesthetic Management
INTRAOPERATIVE RADIATION THERAPY
ANESTHESIA FOR PALLIATIVE SURGERY
Role of Anesthesiologist
Ethical Concerns and Dilemmas
PERIOPERATIVE MANAGEMENT OF PATIENTS ON OPIOIDS
Perioperative Management
CONCLUSION
10:
Recent Update in Fibromyalgia Management
INTRODUCTION
ETIOLOGY AND PATHOGENESIS
Pain Processing in Fibromyalgia
Autonomic and Endocrine System
Sleep Disturbances
Genetic Factors
DIAGNOSIS
Modified ACR Criteria for Diagnosis of Fibromyalgia7
MANAGEMENT OF FIBROMYALGIA SYNDROME
Pharmacological Management
Alpha 2 Delta Ligands
Reuptake Inhibitors of Serotonin and Norepinephrine
Substance P Antagonists
Opioid Antagonists
Cannabinoids
L- Carnitine
Growth Hormone Agonist
NMDA Antagonists
5-HT3 Receptor Antagonists
Sodium Oxybate
Flupirtine
Modafinil
Vitamin D
Nonpharmacological Management
Aerobic Exercises
Baleneotherapy and Hydrotherapy
Tai Chi
Diet Therapy
Tender Point Injection (TPI)
Cognitive Behavioral Therapy
CONCLUSION
11:
Organ Transplanted Patient for Incidental Surgery
INTRODUCTION
COMMON INDICATIONS FOR INCIDENTAL SURGERY
Related to Transplant
Unrelated to Transplant
ANESTHETIC CONSIDERATIONS
Preanesthetic Evaluation and Preparation
Immunosuppressive Therapy and Anesthesia
Anesthetic Management
ORGAN SPECIFIC CONSIDERATIONS
Heart Transplant
Goals of Anesthesia
Lung Transplant
Goals of Anesthesia
Liver Transplant
Goals of Anesthesia
Kidney Transplant
Goals of Anesthesia
Intestinal Transplant
Goals of Anesthesia
Pancreatic Transplant
CONCLUSION
12:
Cardiomyopathy During Pregnancy
INTRODUCTION
HISTORICAL BACKGROUND
PREVALENCE
ETIOLOGY
CLINICAL FEATURES
SPECIAL INVESTIGATIONS
PREOPERATIVE OPTIMIZATION
ANESTHETIC MANAGEMENT
Labor Analgesia
Cesarean Section
POSTOPERATIVE MANAGEMENT
CONCLUSION
13:
Closed-Loop Systems in Anesthesia
INTRODUCTION
DEVELOPMENT OF AUTOMATED DRUG DELIVERY: TARGET CONTROLLED INFUSIONS
CONCEPT OF CLOSED-LOOP CONTROL SYSTEMS
CLOSED-LOOP-GUIDED ANESTHESIA DELIVERY SYSTEMS
SCOPE OF CLOSED-LOOP ANESTHESIA IN CARDIAC SURGERY
STUDIES ON CLOSED-LOOP CONTROL OF ANESTHESIA IN CARDIAC SURGERY
CLOSED-LOOP ANESTHESIA OF INHALATIONAL AGENTS
OTHER CLOSED LOOP SYSTEMS OF INTEREST DURING ANESTHESIA: BLOOD PRESSURE CONTROLLER
FUTURE
14:
Ketamine: Present Status in Anesthesia Practice
INTRODUCTION
PHARMACOKINETICS AND PHARMACODYNAMICS
ROUTES AND DOSE OF ADMINISTRATION
MECHANISM OF ACTION
INDICATIONS OF USE
General Anesthesia
Analgesia
Acute Pain
Postoperative Pain
Chronic Pain
Cancer Pain
Sedation Outside the Operating Room
Fiberoptic Intubation
Burns
Prehospital Use
Peripheral and Topical Ketamine
Neuroprotection
Anti-inflammatory
Delirium
Critical Care
ADVERSE EFFECTS AND CONTRAINDICATIONS
CONCLUSION
15:
Continuous Peripheral Nerve Blocks
INTRODUCTION
HISTORY
INDICATIONS OF CONTINUOUS PERIPHERAL NERVE BLOCKS
CONTRAINDICATIONS OF CONTINUOUS PERIPHERAL NERVE BLOCKS
Acute Pain
Rehabilitation Program
Chronic Pain
Cancer Pain
TECHNIQUE OF CONTINUOUS PERIPHERAL NERVE BLOCKS
Preparation
Precautions
Nerve Stimulator
Ultrasound
Medications and Delivery Options
OTHER ISSUES
Anticoagulation and Continuous Peripheral Nerve Blocks
SINGLE SHOT PERIPHERAL NERVE BLOCK
COMPLICATIONS OF CONTINUOUS PERIPHERAL NERVE BLOCKS
Minor Complications
Major Complications
CONCLUSION
16:
Mechanisms of Pain and Analgesia
INTRODUCTION
DEFINITIONS
PERIPHERAL MECHANISMS OF NOCICEPTIVE PAIN
PERIPHERAL MECHANISMS OF NEUROPATHIC PAIN
PERIPHERAL MECHANISMS OF ANALGESIA
DORSAL HORN AND SPINAL MECHANISMS OF PAIN
THE GATE THEORY
ASCENDING SPINAL PATHWAYS
DORSAL HORN AND SPINAL MECHANISMS OF ANALGESIA
SUPRASPINAL MECHANISMS OF PAIN
SUPRASPINAL MECHANISMS OF ANALGESIA
GLIAL CELLS AND PAIN
17:
Anesthesia for Parathyroid Surgery
INTRODUCTION
HYPERPARATHYROIDISM
Primary Hyperparathyroidism (PHPT)
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
HYPERCALCEMIC CRISIS
Bisphosphonates
Calcitonin
Phosphate Solution
Plicamycin (Mithramycin)
Glucocorticoids
Dialysis
Surgery
INDICATIONS FOR SURGERY
SURGICAL APPROACHES
ANESTHETIC IMPLICATIONS
PREOPERATIVE ASSESSMENT AND PREPARATION
Investigations and Diagnosis
Biochemical
Ultrasonography
Radiological
Skeletal Imaging
Preoperative Imaging: Venous Sampling
Nasendoscopy
Preoperative Optimization
MANAGEMENT OF ANESTHESIA
Local/Regional Anesthesia
General Anesthesia
Premedication
Monitoring
Airway Device
Anesthetic Technique
Intraoperative Neuromonitoring
POSTOPERATIVE MANAGEMENT
Postoperative Glottic Observation
Postoperative Analgesia
Postoperative Care
CONCLUSION
18:
Preoperative Anemia and Anesthesia
INTRODUCTION
PATHOPHYSIOLOGY
COMPENSATORY MECHANISMS IN ANEMIA
CLINICAL PRESENTATION
TREATMENT
MINIMAL ACCEPTABLE LEVEL OF HEMOGLOBIN AND NEED FOR PREOPERATIVE TRANSFUSION
ANESTHETIC CONSIDERATIONS
Avoid Hypoxia
Minimize Decrease in Cardiac Output
Avoid Factors Leading to Left Shift of Oxygen Dissociation Curve
Close Monitoring to Assess and Treat Inadequate Perfusion and Oxygenation
Regional Anesthesia Techniques
RARE TYPES OF ANEMIAS
Sickle Cell Anemia
Thalassemia
Cytoskeletal Anemias (Hereditary Spherocytosis and Elliptocytosis)
Autoimmune Hemolytic Anemia
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
Drug Induced Anemias
CONCLUSION
19:
Ischemia-Reperfusion Injury
INTRODUCTION
PATHOPHYSIOLOGY
Molecular Mechanisms
Cellular Mechanisms
ISCHEMIC PRECONDITIONING AND POSTCONDITIONING
ORGAN SYSTEMS: CARDIOVASCULAR SYSTEM
Monitoring and Assessment
ORGAN SYSTEMS: RENAL SYSTEM
ORGAN SYSTEMS: HEPATOBILIARY SYSTEM
ORGAN SYSTEMS: CENTRAL NERVOUS SYSTEM
ORGAN SYSTEMS: PULMONARY SYSTEM
OTHER SYSTEMS
ANESTHESIA AND ISCHEMIA-REPERFUSION INJURY
THERAPEUTIC TARGETS: FAILURE TO TRANSLATE BENCH TO BEDSIDE
20:
Anesthesia for Thoracic, Aortic and Thoracoabdominal Aortic Surgery
INTRODUCTION
ANATOMY OF AORTA
THORACIC AORTIC ANEURYSM
AORTIC DISSECTION
PREPARATION AND MONITORING
ANESTHETIC TECHNIQUE
NEUROPROTECTIVE STRATEGIES DURING AORTIC ARCH REPAIR
Selective Antegrade Cerebral Perfusion
Retrograde Cerebral Perfusion
SPINAL CORD ISCHEMIA AND PROTECTION
RENAL ISCHEMIA AND PROTECTION
COAGULATION AND METABOLIC MANAGEMENT
CONCLUSION
21:
ACLS Approach and Anesthesia Practice
INTRODUCTION
ACLS APPROACH IN PERIOPERATIVE SITUATIONS
Preanesthetic Assessment (PAC) and Immediate Preoperative Period
Intraoperative Period
Induction and Emergence
Maintenance
Immediate Postoperative Period
ARREST AND INTEGRATED POSTCARDIAC ARREST CARE
CONCLUSION
ACKNOWLEDGMENTS
22:
Ambulatory Surgery for the Obese
INTRODUCTION
SELECTION OF OBESE PATIENT FOR AMBULATORY SURGERY
PREOPERATIVE ASSESSMENT
Respiratory Assessment
Cardiovascular Assessment
Endocrinological Assessment
Airway Assessment
Preoperative Investigations
GUIDELINES TO SELECT PATIENTS FOR DAYCARE PROCEDURES
PREMEDICATION AND PREOPERATIVE INSTRUCTIONS
ANESTHETIC MANAGEMENT
General Anesthesia
Sedation and Analgesia
Positioning
Preoxygenation
Intubation
Maintenance of Anesthesia
Regional Anesthesia
Tracheal Extubation
POSTOPERATIVE MANAGEMENT
Pain Management
Postoperative Nausea and Vomiting
Criteria for Shifting the Patients to an Unmonitored Setting
Instructions before Discharge
CONCLUSION
23:
Video-Assisted Thoracoscopic Surgery: Anesthetic Considerations
INTRODUCTION
INDICATIONS
SURGICAL PROCEDURE
ANESTHETIC CONSIDERATIONS
Local/Regional Anesthesia
General Anesthesia
Choice of Endotracheal Tube
Drugs and Technique
Monitoring
Postoperative Analgesia
Complications
CONSIDERATIONS FOR GERIATRIC PATIENTS
CONSIDERATIONS FOR PEDIATRIC PATIENTS
CONCLUSION
Journal Scan
BACKGROUND
ABSTRACT
COMMENTARY
REFERENCES
BACKGROUND
ABSTRACT
COMMENTARY
REFERENCES
BACKGROUND
ABSTRACT
COMMENTARY
Take Home Message
Role of Tests for Platelet Functions and Transfusions
REFERENCES
BACKGROUND
ABSTRACT
COMMENTARY
REFERENCES
BACKGROUND
ABSTRACT
COMMENTARY
REFERENCES
BACKGROUND
ABSTRACT
COMMENTARY
REFERENCES
INDEX
TOC
Index
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