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Yearbook of Anesthesiology-6
Raminder Sehgal, Anjan Trikha
CHAPTER 1:
Immune Modulating Diet in Critically Ill: Myth or Reality
INTRODUCTION
ENTERAL VERSUS PARENTERAL NUTRITION
INFLAMMATION AND IMMUNE RESPONSE
IMMUNONUTRITION AND PHARMACONUTRITION
ROLE OF INDIVIDUAL IMMUNONUTRIENTS
Arginine
Glutamine
Omega-3 Fatty Acids, Gamma-Linolenic Acid and Antioxidants
Selenium
CONCLUSION
CHAPTER 2:
Medicolegal Issues in Anesthesia
INTRODUCTION
COMMON CAUSES OF LITIGATIONS
LEGAL ASPECTS OF ANESTHESIA
DOCTOR-PATIENT RELATIONSHIP
Duty of Care
Standard of Care
Minimum Monitoring Standards of Anesthesia
INTRAOPERATIVE LEGAL REQUISITES
Response to an Adverse Event
Documentation
POSTOPERATIVE LEGAL REQUISITES
Care of a Patient after the Bad Outcome
STRATEGIES TO REDUCE ADVERSE PATIENT OUTCOMES
ELEMENTS OF MEDICAL NEGLIGENCE
PROFESSIONAL LIABILITY
TIME LIMITATION AND COURT JURISDICTION24
OUTCOME OF A COURT TRIAL
CONCLUSION
CHAPTER 3:
Regional Anesthesia in Children
INTRODUCTION
UPPER EXTREMITY BLOCKS
Axillary Block
Anatomy and Indications
Technique
Complications
Interscalene Approach
Anatomy and Indications
Technique
Complications
Supraclavicular Approach
Anatomy and Indications
Technique
Complications
Infraclavicular Approach
Anatomy and Indications
Technique
Complications
TRUNCAL BLOCKS
Transversus Abdominis Plane Block
Anatomy and Indications
Technique
Complications
Ilioinguinal and Iliohypogastric Nerve Block
Anatomy and Indications
Technique
Complications
Rectus Sheath Block
Anatomy and Indications
Technique
Complications
LOWER EXTREMITY BLOCKS
Lumbar Plexus Block
Anatomy and Indications
Technique
Complications
Femoral Nerve Block
Anatomy and Indications
Technique
Complications
Sciatic Nerve Blocks
Anatomy and Indications
Technique
Complications
Saphenous Nerve Block
Anatomy and Indications
Technique
Complications
CONCLUSION
CHAPTER 4:
Pain in Children: Assessment and Management Strategies
INTRODUCTION
ASSESSMENT OF PAIN IN CHILDREN
Subjective Methods of Pain Assessment
Visual Analog Scale
Color Graded Scale
Verbal Scale (Self Reporting with Words)
Objective Methods of Pain Assessment
Behavioral Measures
Behavioral Scales
Measurement of Physiological Variables
Biological Markers
MANAGEMENT STRATEGIES FOR POSTOPERATIVE PAIN IN CHILDREN
Minor Surgery
Major Surgery
Systemic Analgesia with Opioids
Use of Non-narcotic Analgesics
Role of Parent and Patient Information
Procedure Related Pain
FUTURE PERSPECTIVES IN PAIN MANAGEMENT
CONCLUSION
CHAPTER 5:
Severity of Illness Scoring Systems and Their Clinical Relevance
INTRODUCTION
BRIEF HISTORY
DEVELOPMENT OF SCORING MODEL
SEVERITY OF ILLNESS MODELS
Acute Physiology and Chronic Health Evaluation
First Generation–APACHE I
Second Generation–APACHE II
Third Generation–APACHE III
Fourth Generation–APACHE IV
Simplified Acute Physiologic Score
Mortality Prediction Model
Sequential (Sepsis-related) Organ Failure Assessment
Multiple Organ Dysfunction Score
Logistic Organ Dysfunction Score
COMPARISON OF SCORING MODELS
USES OF SEVERITY-OF-ILLNESS SYSTEMS
ICU Performance and Cost of Care
Clinical Trials
Decision Support
CONCLUSION
CHAPTER 6:
Transdermal Drug Delivery
INTRODUCTION
PHYSIOLOGY OF SKIN AND PATHWAYS OF DRUG TRANSPORT
PHARMACOKINETICS OF TRANSDERMAL DELIVERY
DESIGN AND TYPES OF TRANSDERMAL PATCHES
Single Layered Adhesive Patch
Multilayered Adhesive Patch
Reservoir System
Matrix System
Hybrid Patches
DRUGS USED AS TRANSDERMAL PATCHES
Transdermal Opioids
Fentanyl
Buprenorphine
Uses
Initiations and Titrations of Transdermal Opioids
Transdermal Nonsteroidal Anti-inflammatory Drug
Transdermal Local Anesthetics
Five Percent Lignocaine Patch
Synera or Rapydan Patch
NOVEL METHODS OF TRANSDERMAL DRUG DELIVERY
Iontophoresis
Ultrasound
Invasive Methods
Nanocarriers
Liposomes
CONCLUSION
CHAPTER 7:
Peripheral Opioid Receptors
INTRODUCTION
OPIOID RECEPTORS
MECHANISM OF ACTION
PERIPHERAL OPIOID RECEPTORS LOCATION
PLASTICITY AND REGULATION OF OPIOID RECEPTOR
ENDOGENOUS OPIOID LIGANDS
MIGRATION OF OPIOID PEPTIDE-PRODUCING CELLS TO INFLAMED TISSUE AND RELEASE OF PEPTIDES FROM IMMUNE CELLS
MODULATION OF PAIN AND INFLAMMATION VIA PERIPHERAL OPIOID RECEPTORS
POTENTIAL FOR CLINICAL APPLICATIONS
NOVEL PERIPHERALLY RESTRICTED OPIOID AGONISTS
FUTURE RESEARCH
CONCLUSION
CHAPTER 8:
Dexmedetomidine: Perioperative Applications and Limitations
INTRODUCTION
PHYSIOLOGY
MECHANISM OF ACTION
CLINICAL APPLICATONS
Perioperative Use for Improving Hemodynamics
Perioperative Analgesic
Awake Fiberoptic Intubation
Adjuvant to General Anesthetics
Adjuvants with Locoregionals
As Novel Agent in Special Situations
DEXMEDETOMIDINE IN PEDIATRIC ANESTHESIA
Anxiolysis
Procedural Sedation
Radiological Procedures
Intraoperative Use
Postoperative Use
CONCLUSION
CHAPTER 9:
Pheochromocytoma: Current Concepts and Management of Laparoscopic Excision
INTRODUCTION
ANATOMY
SIGNS AND SYMPTOMS
PEDIATRIC PHEOCHROMOCYTOMA
INCIDENTALOMAS
PATHOPHYSIOLOGY OF HYPERTENSION
GENETIC BASIS OF PHEOCHROMOCYTOMA
DIAGNOSIS
Biochemical Evaluation
Anatomic and Functional Localization4,15,16
PREOPERATIVE PREPARATION
Alpha Blockers
Beta Blockers
Calcium Channel Blockers
Alpha-methyl-para Tyrosine
Combined Medical Blockade (MPT Combined with Alpha-Blockade)
Cardiovascular Evaluation
SURGERY FOR PHEOCHROMOCYTOMA
Preoperative Explanation and Premedication
Premedication
OT Preparation
Analgesia After Laparoscopic Adrenalectomy
Pheochromocytoma during Pregnancy
CONCLUSION
CHAPTER 10:
Perioperative Anaphylaxis
INTRODUCTION
PATHOPHYSIOLOGY
RISK FACTORS
PERIOPERATIVE TRIGGERS
CLINICAL FEATURES
Grades of Severity of Immediate Hypersensitivity Reactions
DIAGNOSIS
DIFFERENTIAL DIAGNOSES
INVESTIGATIONS
Tryptase
Plasma Histamine
Urine Histamine
TREATMENT
Airway
Epinephrine
Intravenous Fluid Resuscitation
Other Drugs
PREVENTION OF ANAPHYLAXIS
FUTURE ANESTHESIA MANAGEMENT
CHAPTER 11:
Effect of Anesthesia on Perioperative Immunity
INTRODUCTION
COMPONENTS OF IMMUNE RESPONSE
Innate or Nonspecific Immunity
Acquired or Specific Immunity
PERIANESTHESIA STRESSORS
ANESTHESIA AND IMMUNITY
ANESTHETIC AGENTS AND IMMUNITY
Inhalational Agents and Immune Functions
Intravenous Agents and Immune Functions
Opioids and Immune Functions33,34
ANESTHETIC TECHNIQUES AND MALIGNANCY
Response of Intact Immunity to Tumor
Effect of Surgery on Metastatic Development35
Effect of Anesthetic Agents on Malignancy and Metastatic Development35
Effect of Regional Anesthesia on Malignancy36–39
Effect of Blood Transfusion
ANESTHESIA AND ANAPHYLAXIS
IMMUNE FUNCTION AND PERIANESTHESIA CARE: CLINICAL IMPLICATIONS
CONCLUSION
CHAPTER 12:
Nontechnical Skills for the Healthcare Provider: Bringing about Changes in Outlook, Protocols and Policies
INTRODUCTION
GENESIS OF NONTECHNICAL SKILLS IN HEALTH CARE
CLASSIFICATION AND NONTECHNICAL SKILL ASSESSMENT TOOLS
Categories of Nontechnical Skills
Grading of Nontechnical Skills
PRACTICAL APPLICATIONS OF NONTECHNICAL SKILLS ASSESSMENT
Case 1: ENT list—A case of Adenotonsillectomy
Case 2: Plastic Surgical Team—Surgical Resident under Observation
Case 3: Endoscopy List—High Turnover Short Case Scenario where Intravenous Anesthesia was Administered Using Infusion Pumps
Case 4: Orthopedics List—Scoliosis Surgery where Neuro-monitoring was Used
MINOR ERROR CLASSIFICATION
CHECKLISTS
HUMAN ERRORS RESULTING FROM TECHNOLOGY MISMATCH
THE EPIDEMIC OF PREVENTABLE DEATHS
CONCLUSION
CHAPTER 13:
Enhanced Recovery After Surgery
INTRODUCTION
COMPONENTS OF ENHANCED RECOVERY PROTOCOLS (FIG. 13.1)
Preoperative
Counseling
Cessation of Smoking
Cessation of Alcohol Abuse
Anemia Correction
Prehabilitation
Preoperative Nutrition
Fasting
Oral Carbohydrate Preloading
Avoidance of Mechanical Bowel Preparation
Thromboembolism Prophylaxis
Antibiotic Prophylaxis
Preanesthetic Medication
Perioperative
Anesthesia Technique
Surgical Approach
High Inspired Oxygen
Perioperative Fluid Administration
Prevention of Hypothermia
Nausea and Vomiting Prophylaxis
Postoperative
Postoperative Analgesia
Postoperative Glycemic Control
Early Postoperative Mobilization
Early Enteral Diet
Early Discharge
IMPLEMENTATION
CONCLUSION
CHAPTER 14:
Pharmacokinetics in Obstetric Patients
INTRODUCTION
PHARMACOKINETIC CHANGES
Absorption and Uptake
Distribution
Protein Binding
Metabolism
Elimination
PLACENTAL DRUG TRANSFER
PHARMACOKINETICS OF COMMON ANESTHETIC DRUGS DURING PREGNANCY
Inhalational Anesthetics
Intravenous Anesthetics
Neuromuscular Blockers
Analgesics
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Vasopressors and Chronotropic Agents
Local Anesthetics
EFFECT OF ANESTHETIC DRUGS ON DEVELOPING FETUS
Category A: “No Risk”
Category B: “No Evidence of Risk in Humans”
Category C: “Risk cannot be Ruled Out”
Category D: “Potential Evidence of Risk”
Category X: “Contraindicated in Pregnancy”
NITROUS OXIDE AND SAFETY IN PREGNANCY
CONCLUSION
CHAPTER 15:
Opioid-induced Hyperalgesia
INTRODUCTION
HISTORICAL CONSIDERATIONS
OPIOID-INDUCED HYPERALGESIA AND OPIOID TOLERANCE
EXPERIMENTAL EVIDENCE FOR EXISTENCE OF OIH
CLINICAL EVIDENCE FOR OIH
PATHOGENESIS OF OIH
Desensitization of the Receptors
Activation of Adenylate Cyclase Activity
Activation of NMDA Receptors
Antiopioid Protein Release
Facilitation of Descending Pain Pathways
5HT3–Induced Upregulation of Genes Responsible for Nociception
Inhibition of P Glycoprotein System
Opioid-induced Neuronal Apoptosis
Abnormal Catechol-O-Methyl Transferase (COMT) Activity
SITES OF OIH DEVELOPMENT
REVERSING THE EFFECTS OF OIH
TREATMENT STRATEGIES
CONCLUSION
CHAPTER 16:
Anesthetic Management of Faciomaxillary Trauma
INTRODUCTION
INCIDENCE AND ETIOLOGY OF MAXILLOFACIAL TRAUMA
ANATOMY
CLINICAL PRESENTATION
Upper Face Fractures
Mid-face Fractures
Lower Face Fractures
Pan-facial Fractures
AIRWAY MANAGEMENT
Airway Assessment
Other Related Assessments
BASIC AIRWAY MANAGEMENT TECHNIQUES
Standard Intubation
Intubating Stylets and Airway Adjuncts
Rescue Techniques
Supraglottic Devices
Direct and Indirect—Vision Devices
Infra-Glottic Airway Devices: Cricothyroidotomy
Retrograde Intubation
FACTORS AFFECTING EMERGENCY AIRWAY MANAGEMENT IN MAXILLOFACIAL TRAUMA
MANAGEMENT OF HEMORRHAGE
OTHER CARE
ELECTIVE OR LATE MANAGEMENT
ANESTHESIA MANAGEMENT
POSTOPERATIVE CARE
CONCLUSION
CHAPTER 17:
Critical Care in Head Injured Patients
INTRODUCTION
MANAGEMENT OF TRAUMATIC BRAIN INJURY IN INTENSIVE CARE UNIT
Assessment and Resuscitation
Radiological Investigations
Indications of CT Scan
Monitoring
Ventilatory Support
Hemodynamic Support
Intracranial Pressure Monitoring
Analgesia and Sedation
Fluid Administration
Temperature Control
Antiseizures Prophylaxis
Deep Venous Thrombosis Prophylaxis
Stress Ulcer Prophylaxis
Role of Nutrition
Endocrine Disorders
Damage Control Care
Indications for Surgery
Other Considerations
Predicting Outcome
CONCLUSION
CHAPTER 18:
Mechanical Ventilation: Tidal Volume, PEEP and Recruitment
INTRODUCTION
VENTILATOR-INITIATED LUNG INJURY
Conventional Ventilatory Strategy
Volutrauma
Baby Lung
Shear Stress and Atelectotrauma
Biotrauma
TIDAL VOLUME IN ACUTE RESPIRATORY DISTRESS SYNDROME
Optimal Tidal Volume in Acute Respiratory Distress Syndrome9
Implications of Using Low Tidal Volumes
POSITIVE END-EXPIRATORY PRESSURE
How should PEEP be Applied?
Oxygenation Criteria
Best Compliance
Respiratory Mechanics to Determine Positive End-expiratory Pressure
How to Obtain the PV Curve?
Setting PEEP without PV Loops
Transpulmonary Pressure Measurement to Set PEEP
Is High PEEP Necessary?
Predicting Adverse Responses to PEEP
CONCEPT OF DRIVING PRESSURE
RECRUITMENT MANEUVER
Techniques of Recruitment
Efficacy and Safety of RM
PRONE POSITION
LOW TIDAL VOLUMES AND PEEP IN PATIENTS WITH NORMAL LUNGS?
CHAPTER 19:
Palliative and Hospice Care: Need of the Hour to Improve Quality and Quantity of Life
INTRODUCTION
HISTORICAL PERSPECTIVE OF PALLIATIVE CARE
SCOPE OF PALLIATIVE CARE
COMPONENTS OF PALLIATIVE CARE
CORE COMPETENCIES REQUIRED IN PALLIATIVE CARE
PALLIATIVE CARE IN INDIA
HOW TO START PALLIATIVE CARE SERVICES?
HOW TO IMPLEMENT PALLIATIVE CARE PROGRAM IN INDIA?
CONCLUSION
CHAPTER 20:
Update on Anesthesia for Ophthalmic Surgery
INTRODUCTION
RETINOPATHY OF PREMATURITY
Anesthesia/Sedation for Laser Therapy
Anesthetic Management During ROP Surgery
Postoperative Care
ULTRASOUND-GUIDED OPHTHALMIC BLOCKS
SUB-TENON'S BLOCK
Sub-Tenon's Block Technique
SEDATION DURING OPHTHALMIC PROCEDURES
ANTIPLATELET AND ANTICOAGULANT THERAPY AND OPHTHALMIC ANESTHESIA
CONCLUSION
CHAPTER 21:
Perioperative Neurological Complications
INTRODUCTION
POSTOPERATIVE DELIRIUM
POSTOPERATIVE COGNITIVE DYSFUNCTION
POSTOPERATIVE VISUAL LOSS
SPINAL CORD ISCHEMIA
STROKE
NEUROEXCITATORY PHENOMENON
COMPLICATIONS OF NEURAXIAL ANESTHESIA
CRANIAL NERVE INJURIES
PERIPHERAL NERVE INJURIES
CONCLUSION
CHAPTER 22:
Perioperative Beta Blockers: To Use or Not to Use
INTRODUCTION
BENEFICIAL EFFECTS OF BETA BLOCKERS
McSPI and DECREASE I: The Edifice
Perioperative Ischemic Evaluation (POISE) Trial: The Pause Effect
POST POISE: The Course Correction
BETA BLOCKERS AND NONCARDIAC SURGERY
BETA BLOCKERS AND CARDIAC SURGERY
BETA BLOCKERS FORMULATION AND TITRATION
CONCLUSION
CHAPTER 23:
Biomarkers in Anesthesiology
INTRODUCTION
BIOMARKERS OF CARDIOVASCULAR SYSTEM
C-reactive Protein
Cardiac Troponins
B-type Natriuretic Peptide
Soluble Urokinase Plasminogen Activation Receptor
BIOMARKERS OF KIDNEY INJURY
Neutrophil Gelatinase-associated Lipocalin
N-Acetyl-B-D-Glucosaminidase
Plasma and Urinary Cystatin-C (P-cystatin C and U-cystatin C)
BIOMARKERS OF GUT FAILURE
Citrulline Levels
Fatty Acid-binding Protein
Procalcitonin
MicroRNA (miRNA)
BIOMARKERS OF BRAIN DAMAGE AND POCD
S100B Biomarker
Metalloproteinase
A-II Spectrin Breakdown Product (SBDP) 145,150,120
CONCLUSION
Journal Scan
BACKGROUND
COMMENTARY
REFERENCES
BACKGROUND
COMMENTARY
REFERENCES
BACKGROUND
COMMENTARY
REFERENCES
BACKGROUND
COMMENTARY
Intrathoracic Pressure Regulation Therapy
Advanced Intrathoracic Pressure Regulation
Head-Up CPR
Reperfusion Injury Protection
The Resuscitation Bundle
Clinical Implications and the Future
REFERENCES
INDEX
TOC
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