INDEX

Page numbers in boldface type indicate complete chapters. Page numbers followed by t indicate tables; f, figures.

A

ABCs (airway, breathing, circulation), of trauma

management, 373Abdominal surgeryperioperative morbidity and mortality associated

with, 280tpulmonary function testing prior to, 73, 73t

Abdominal wall, peripheral nerve block anesthesia

for, 471ABO blood genotype, 47–48, 48tAbortion, spontaneous, inhalational anesthesia-

related, 81Acceleromyography, 101Acetaminophen, as acute pain treatment, 528–529Acetazolamide, 310t

Acetylcholine, 95synthesis and degradation of, 12

Acetylcholine receptors, 95, 96, 97Acetylcholinesterase, side effects of, 102–103Acetylcholinesterase inhibitors, 102Acid-base analysis

physiological approach (Stewart model) for, 25stepwise approach in, 29

Acid-base balanceorgans involved n, 26–27regulation of, 24–25

Acid-base disorders, compensation mechanisms in,25, 25t, 26, 26t

Acid-base status, 24Acidemia, 27, 29Acidosislactic, as blood transfusion indicator, 43metabolic, 25t, 26tanion gap, 24b, 29

in liver transplantation patients, 484non-anion gap, 29brenal failure-related, 311saline solutions-related, 33

respiratory, 25t, 26, 26tin trauma patients, 378

Activated clotting time (ACT), 55

in cardiopulmonary bypass patients, 488–489Activated partial thromboplastin time (aPTT), 54Acute respiratory distress syndrome (ARDS),

285–292in burn patients, 381

Acute respiratory distress syndrome (ARDS)(Continued)

definition of, 285–286refractory, 289

Addictiondefinition of, 338opioids-related, 529

Addisonian crisis, 355

Adenosinecontraindications to, 212pulmonary circulation effects of, 299as pulmonary hypertension treatment, 295

Adenosine monophosphate, cyclic (cAMP), 113Adrenal gland, functions and regulation of, 354Adrenal insufficiency

in burned patients, 382perioperative, 356

b-Adrenergic agonistsas asthma treatment, 268, 269tas chronic obstructive pulmonary disease

treatment, 281t

side effects and limitations of, 114Adrenergic agonists, as hypotension treatment, 205a-Adrenergic antagonists. See Alpha blockersb-Adrenergic antagonists. See Beta blockersAdrenergic receptors, 11end-organ effects of, 11t

Adrenocortical insufficiency, 355, 356

Adrenocorticotropic hormone (ACTH), 354Adult respiratory distress syndrome. See Acute

respiratory distress syndrome (ARDS)Adverse drug reactions. See also names of

specific drugsin geriatric patients, 434–435

Afentanil, 83tAfterload, epidural anesthesia-related reduction

in, 462Agglutinins, 47–48, 47tAgglutinogens, 47–48, 47tAgitation, emergent, in pediatric patients, 402Air, as laparoscopic insufflation gas, 512t

Air embolism, 378, 379cardiopulmonary bypass-related, 491central venous catheterization-related, 185, 186pulmonary artery catheterization-related, 189venous, 145–146

541

542 INDEX

Airwaydifficult, 59, 61, 65, 66fas aspiration risk factor, 275

inhalation injury-related edema of, 381

injuries to, 378endotracheal intubation-related, 495

laryngeal mask, 63, 66f, 399, 399t, 403laser surgery of, 519as fire cause, 520–521, 521b

nasal, 61oral, 61

pediatric, comparison with adult airway, 394, 394tsurface tension in, 18

Airway disease, obstructive, 70Airway management, 58–67airway assessment in, 58in cervical spine injury patients, 374–375

in eclampsia patients, 428–429emergent, with uncleared cervical spine, 374–375in obese patients, 360, 362in postanesthetic care unit patients, 225in spinal cord injury patients, 377in trauma patients, 374

Airway obstruction

asthma-related, 278burn-related, 381carotid endarterectomy-related, 262flow-volume loops in, 71, 73fin neonates, 387patient position-related, 144, 145

Alanine aminotransferase, as hepatocellular damageindicator, 302

Albuminbuffering function of, 26hepatic synthesis of, 302use in fluid resuscitation, 33t, 35

Albuterol

as allergic reaction treatment, 367as asthma treatment, 268, 269tas chronic obstructive pulmonary disease

treatment, 281tAlcohol, absorption and metabolism of, 336Alcohol abuse

adverse physical effects of, 304t, 336, 337as liver disease risk factor, 304t

Alcohol dehydrogenase, 336Alcoholic patients, perioperative assessment of, 337Alcohol withdrawal, 338Aldosterone, 34, 354

Aldrete Score, for postanesthesia patient evaluation,222, 223t

Alkalemia, 29consequences of, 27–28

Alkaline phosphatase, as biliary tract functionindicator, 302

Alkalosis

metabolic, 25t, 26t, 29respiratory, 25t, 26, 26t

Allen’s test, 195–196

Allergic reactions, 364–368asthmatic, 267to local anesthetics, 106, 466treatment of, 366–367

Alpha2-agonists, role in anesthesia, 15Alpha blockersas hypertension treatment, 202tpharmacology of, 15as pulmonary hypertension treatment, 295

Altitude, effect on vaporizer function, 134, 135Alveolar-arterial oxygen gradient (A-a gradient)

Alveolar gas equation, 19Alveolar pressure, 19Alveolar ventilation, relationship with partial pressure

of carbon dioxide (PCO2), 22Alveoliin pediatric patients, 395t

surface tension in, 18Alzheimer’s disease, 332–333Ambulatory patients, in postanesthesia care

units, 227Ambulatory procedures, local anesthetics for, 456American College of Cardiologists/American Heart

Association

aortic valve replacement guidelines of, 248cardiac risk assessment guidelines of, 126, 127mitral valve replacement guidelines of, 249–250,

251American Society of Anesthesiologistsanesthesia monitoring standards of, 245, 438

obstructive sleep apnea checklist of, 361–362physical status classification scale of, 123–124Task Force on Sedation and Analgesia, 438

Aminoamides, 105, 105f, 109e-Aminocaproic aid, use in heart transplantation

patients, 476–477Aminoesters, 105, 105f, 109

Aminophylline, as chronic obstructive pulmonarydisease treatment, 281t

Amitriptyline, as chronic pain treatment, 536tAmnesic drugs, 208use in cardiopulmonary bypass patients, 488

Amphetamines, as hyperthermia risk factor,

221Amrinone, hemodynamic profile of, 112Amyotropic lateral sclerosis (ALS), 331Analgesiaversus anesthesia, 464epidural

in aortic surgery patients, 256in obstetric patients, 420, 421

neuraxial, 88Anaphylactic reactions, 367to blood transfusion, 44, 45t

Anaphylactoid reaction, 364Anaphylaxis

contrast media-related, 440definition of, 364in the operating room, 364

INDEX 543

Anemiaacute normovolemic, 43in burned patients, 383cirrhosis-related, 302

dilutional, of pregnancy, 414Anesthesiaversus analgesia, 464awareness during, 207–209depth ofassessment of, 209continuum of, 438

light, 207–208outside the operating room, 437–444pediatric, 394–403

Anesthesia delivery systems. See Anesthesiamachines

Anesthesia gases. See also Inhalational anesthetics

available on anesthesia machines, 130Anesthesia machines, 130–136, 137–141breathing circuits on, 137–139, 137f,

138f, 140bdisconnection of, 138–139Mapleson, 137–138, 137f

Datex-Ohmeda, 130, 135

definition of, 130Diameter-Index-Safety-System (DISS), 132Drager, 130, 135flowmeters of, 132gas regulators on, 130–131gas supply for, 130, 131

for magnetic resonance imaging suites, 443–444preparation for malignant hyperthermia patients,

135–136, 326safety and fail-safe systems of, 132, 133fscavenger systems of, 130, 136vaporizers of, 133–134, 135–136

Anesthesiologists

radiation exposure protection in, 442role in sedation and analgesia standards

establishment, 438Aneurysmaortic, 254–255abdominal, rupture of, 257

surgical repair of, 256intracranial, rebleeding of, 263, 508as intracranial pressure increase cause, 318trupture of, as subarachnoid hemorrhage

cause, 263subarachnoid hemorrhage-related, 263–264

Aneurysm clipping, 263Aneurysm surgery, brain protection during, 264–265Anginagrading of, 230myocardial ischemia-related, 230pulmonary hypertension-related, 294valvular heart disease-related, 244

Angioedema, anaphylaxis-related, 364Angiography, coronary, for ischemic heart disease

evaluation, 232

Angioplasty, balloon, 233Angiotensin, laparoscopy-related increase in, 515Angiotensin-converting enzyme inhibitors (ACEIs)as heart failure treatment, 239, 241

as hypertension treatment, 201, 202tas pulmonary hypertension treatment, 295

Angiotensin receptor blockersas heart failure treatment, 241as hypertension treatment, 202t

Anion gap, 24b, 28–29Ankle nerve block, 470t

Antacids, preoperative administration of, 120–121in morbidly obese patients, 122

Antibiotic prophylaxisin burned patients, 383in pediatric heart disease patients, 397

Antibiotics

allergic reactions to, 364as chronic bronchitis treatment, 283interaction with neuromuscular blocking

agents, 99Anticholinergicsas asthma treatment, 268, 269tas chronic obstructive pulmonary disease

treatment, 281t, 282as hyperthermia risk factor, 221preoperative administration of, 119–120, 120tin pediatric patients, 121

side effects of, 120tuse in electroconvulsive therapy, 523

Anticholinergic syndrome, central, 120Anticholinesterases, use in chronic obstructive

pulmonary disease patients, 282Anticoagulants

as atrial fibrillation treatment, 213interaction with fish oil, 370preoperative termination of, 126

as pulmonary hypertension treatment, 296–297use in cardiopulmonary bypass patients, 488–489

Anticonvulsants, as pain treatment, 536tAntidepressants. See also Tricyclic antidepressantspreoperative administration of, 118use in geriatric patients, 522

Antidiuretic hormone, 382. See also Vasopressinrelease of, 31–32, 32tsynthesis of, 32

Antiemetics, preoperative administration of, 120–121Antifibrinolytic agents, use in heart transplantation

patients, 476–477

Antihistaminesas allergic reaction treatment, 367as hyperthermia risk factor, 221

Antihypertensive agents, 201, 202tperioperative use of, 202, 203, 204tuse during pregnancy, 427

Antileukotrienes, as chronic obstructive pulmonary

disease treatment, 281tAntithrombin III, 52–53Antithyroid drugs, 353

544 INDEX

Anxietyawareness during anesthesia-related, 208blood loss-related, 374thyperthyroidism-related, 353

in parents of pediatric patients, 395–396preoperative, 118in pediatric patients, 121, 395

as respiratory alkalosis cause, 26Aortic cross-clamping and unclamping, 255, 256, 489Aortic dissection, as aortic stenosis cause, 247–248Aortic insufficiency, 246f, 247–248, 248t, 249, 252

Aortic stenosis, 245–246, 247, 252Aortic surgery, 254–258as renal insufficiency risk factor, 316

Aortic valve replacement, 246, 247, 248, 249Aortic vascular disease. See Aorto-occlusive diseaseAortocaval compression syndrome, 414, 415

Aorto-occlusive disease, 254–258Apgar score, 417, 417tApneapostoperative, in premature infants, 392–393in premature infants, 388t

Aprotinin, allergic reactions to, 365Arginine vasopressin. See Vasopressin

Arrhythmias, 210–216as active cardiac condition, 126, 127digoxin toxicity-related, 211electrical burns-related, 386electrocardiographic findings in, 163halothane-related, 79

methadone-related, 339succinylcholine-related, 97

Arterial blood gas (ABG) analysis. See also Blood gasanalysis

in asthmatic patients, 268in chronic obstructive pulmonary disease patients,

279

in congestive heart failure patients, 241normal values at sea level, 24, 24tduring pregnancy, 413, 413t

Arteriovenous malformations, cerebral, 265Aspartate aminotransferase, as hepatocellular

damage indicator, 302

Aspiration, 274–277of acidic fluid, 275definition of, 274of gastric contents, 64as acute respiratory distress syndrome risk

factor, 287t

in alcohol abusers, 336as wheezing cause, 283

in morbidly obese patients, 122of nonacidic fluid, 275of particulate food matter, 275as pneumonitis cause, 120–121pulmonary, in liver transplantation patients,

483risk factors for, 511–512treatment for, 276–277

Aspirinanticoagulant activity of, 53use in cardiopulmonary bypass patients, 492

Asthma

clinical features of, 278definition of, 267diseases which mimic, 267preoperative management in, 270pulmonary function test abnormalities in, 70, 71tas respiratory acidosis cause, 26treatment of, 268–269, 269t, 270

types of, 267Atelectasis, in obese patients, 360Atherosclerosis, as aorto-occlusive disease cause, 254Atopy, as latex allergy risk factor, 366Atracuriumallergic reactions to, 364–365

loading dose of, 359tas nondepolarizing neuromuscular blocking

agent, 98tuse in chronic obstructive pulmonary disease

patients, 282use in renal insufficiency patients, 315

Atrial fibrillation, 212

digoxin-related, 163hyperthyroidism-related, 353paroxysmal, 213pulmonary hypertension-related, 294with rapid ventricular response, 212valvular heart disease-related, 244

Atrial kick, 294Atrioventricular dissociation, 210–211, 213Atrioventricular heart block, 211second-degree, 210third-degree (complete), 210–211

Atrioventricular node dysfunction, 211Atropine

as chronic obstructive pulmonary diseasetreatment, 281t

side effects of, 120, 120tas sinus bradycardia treatment, 210use in pediatric patients, 121

Autoimmune disease, as liver disease risk factor, 304t

Autonomic denervation, of transplanted hearts, 477Autonomic dysfunction, 15Autonomic hyperreflexia, 377Autonomic nervous systemanatomy and function of, 9–16in Guillain-Barre syndrome, 331

Auto-positive-end expiratory pressure (auto-PEEP),152, 153, 153f, 155

Autoregulation, of cerebral blood flow, 260Autoregulation breakthrough, 265Avian influenza, blood transfusion-related

transmission of, 44Awakening, from anesthesia, 223

intracranial pressure control during, 321slow, 226–227after craniotomy, 508

INDEX 545

Awareness, during anesthesiaduring anesthesia, 207–209in cardiopulmonary bypass patients, 488classification of, 207

Axillary arteryas arterial pressure monitoring cannulation site,

196, 196fas cardiopulmonary bypass cannulation site,

487–488Axillary nerve block, 469t

B

Back pain, epidural anesthesia-related, 465Baclofen, as chronic pain treatment, 536tBacteria, antibiotic-resistant, 383Bacterial infections, blood transfusion-related

transmission of, 44

Barbiturate coma, 322Bariatric surgery, 362–363Baricity, 452Baroreceptor reflex, in pediatric patients, 394Barotrauma, positive-end expiratory pressure-related,

153Base deficit, 28

"Beach chair" position, 145Beck’s triad, 376Benzocaine, as methemoglobinemia cause, 110Benzodiazepinesaction mechanism of, 93as chronic pain treatment, 536t

intravenous administration of, 93oversedation with, 93–94as preoperative sedation, 118–119use inliver disease patients, 306morbidly obese patients, 122

Beta blockers

as chronic pain treatment, 536tcontraindications to, 211as heart failure treatment, 239, 241as hypertension treatment, 201, 202tindications for, 14interaction with neuromuscular blocking

agents, 99as ischemic heart disease treatment, 233perioperative use of, 9as pulmonary hypertension treatment, 295side effects of, intraoperative treatment of, 15as sinus tachycardia treatment, 211

Beta1-blockers, action mechanism and side effectsof, 14

Beta2-blockers, side effects of, 14Bicarbonatearterial blood gas analysis value of, 28buffering function of, 26

Bier blocks, 467–469

Biliary tractobstruction of, 305tsurgical reconstruction of, 485

Bilirubinin neonates, 387–388unconjugated, 304t

Bispectral index (BI), 209

Bladder, epidural anesthesia-related distentionof, 462

Blindness. See also Vision losspostoperative, 147–148

Bloodarterial, color of, 182donated

alternatives to, 49screening of, 44storage of, 46

oxygen content of, calculation of, 21, 22Blood-borne transmission, of Infectious disease, 44Blood circulation. See Blood flow

Blood cross-matching, 48, 48tBlood flowcerebralautoregulation of, 260effect of inhalational anesthetics on, 321factors affecting, 321bischemic, 260

normal, 260regulation of, 318–319, 319f

coronarydeterminants of, 230normal, 229

hepatic, effect of inhalational anesthetics on,

305–306pulmonary, 293effect of adenosine on, 299effect of inhalational agents on, 296–297

renal, 309–311in burned patients, 382

uterine, during pregnancy, 411t, 414

Blood gas analysis, 24–30pH-stat and a-stat methods of, 490

Blood loss. See also Hemorrhageacceptable (ABL), in pediatric patients, 400effect on vital signs, 374tin excisional burn surgery, 385

in liver transplantation patients, 484in pediatric patients, 400, 401t

Blood pressure. See also Hypertension; Hypotensiondiastolic, in pediatric patients, 394disturbances of, 201–206. See also Hypertension;

Hypotension

as hypovolemia indicator, 37systoliceffect of blood loss on, 374tin pediatric patients, 394

Blood pressure monitoringintra-arterial, 194–200in obese patients, 360

Blood screening, 48Blood transfusions, 43–50adverse reactions to, 44–45, 45t, 49, 50

546 INDEX

Blood transfusions (Continued)autologous, 49central venous catheterization for, 186in emergency situations, 48, 50

hemoglobin level as indicator for, 126infectious disease transmission in, 44massive, complications of, 48–49, 53, 287tphysiologic indicators for, 43, 44

Blood types/typing, 47–48, 47tBlood typing, 48Blood urea nitrogen (BUN), 311–312, 312t, 313–314

Blood volumeestimated, in pediatric patients, 399, 400, 400tin obese patients, 358during pregnancy, 412t

"Blue bloaters," 279Body composition, aging-related changes in, 433–434

Body temperature. See also Thermoregulationdisturbances in, 217–221monitoring of, 97, 438

Body watercompartments and distribution of, 31, 31fregulation of, 31–32

Brachial artery, as arterial pressure monitoring

cannulation site, 196, 196fBrachial plexusinjuries toanesthetic technique-related, 146patient position-related, 144–145, 146

patient position-related injury to, 144–145, 146

as somatosensory-evoked potential recording site,500

surgical exploration of, 502Brachial plexus blocksas acute pain treatment, 533local anesthestic vascular absorption in, 107

Bradycardia

antihypertensive agents contraindicated in, 211causes of, 210bfetal, 416hypothyroidism-related, 380intraoperative treatment of, 15opioids-related, 90

in pediatric patients, 394in infants, 389tin premature infants, 388t

reflex, 120sinus, 210digoxin toxicity-related, 211

spinal anesthesia-related, 452, 453Brainanesthetic requirements in, 505electrical activity monitoring in, 209respiration center of, 22

Brain protection, 264–265, 506–507Brain tumors, 93, 509

Breathing. See also Ventilationeffect of carbon dioxide and oxygen on, 22physiologic work of, 17, 18

Breathing (Continued)work ofin obese patients, 358in pediatric patients, 398

positive-end expiratory pressure-relatedincrease in, 153

Breathing circuits, on anesthesia machines.See Anesthesia machines, breathing circuits on

Bronchial blockade, 378, 493, 495, 496–497, 497tBronchiolitis, 70Bronchitis

asthmatic, 278chronic, 278, 283pulmonary function test abnormalities in, 70

Bronchoconstriction, histamine receptor stimulation-related, 284

Bronchodilator therapy, preoperative, 272

Bronchospasmanaphylaxis-related, 364asthma-related, 267, 271–273inhalation injury-related, 381intraoperative, 271–273, 283

Bronchusright and left main stem, 494

tears of, 378width estimation of, 493, 494t

Brooke formula, modified, 383–384Buffer systems, of the body, 26Bundle-branch blocks, 158left, 157, 158, 158f, 167

right, 157, 158, 158f, 166–167pulmonary artery catheterization-related, 189

Bupivacainecardiotoxicity of, 108, 109as epidural anesthetic, 462tpotency of, 107tas spinal anesthesia, 451t, 456

use inin cesarean sections, 423tobstetric patients, 420–421, 423tpediatric patients, 401

Buprenorphine, 82equianalgesic doses of, 532t

Burger’s disease, 533Burned patients, 380–386Burnsclassification of, 380on the neck, 59thoracic, 17

Butorphanol, 82equianalgesic doses of, 532tuse in obstetric patients, 419t

C

Caffeine-halothane contracture test, 325Calcium, homeostasis of, 357

Calcium channel blockersas hypertension treatment, 201, 202tinteraction with neuromuscular blocking agents, 99

INDEX 547

Calcium channel blockers (Continued)nondihydropyridine, contraindication to, 211as pulmonary hypertension treatment, 295

Calcium sensitizers, 117

Cancer. See also specific types of canceras pain cause, 537

Capillary refill rate, effect of blood loss on, 374tCapnography, 175–179Capnometry, differentiated from capnography, 175Carbamazepine, as chronic pain treatment, 536tCarbon dioxide. See also End-tidal carbon dioxide

(ETCO2)blood transport of, 21as chemistry panel value, 28correlation with partial pressure of carbon dioxide,

176effect on breathing, 22

elimination from anesthesia circuits, 139exhaled, capnographic measurement of, 175–179increase of, as hypercarbia cause, 22, 23as insufflation gas, 512, 512t, 513, 516–517

Carbon dioxide absorbents, effect of inhalationalanesthetic by-products, 80–81

Carbon monoxide poisoning, 78, 80, 381–382, 385

Carboxyhemoglobin, effect on pulse oximetryaccuracy, 172

Cardiac arrest, during spinal anesthesia, 453Cardiac conditions, active, 126, 127Cardiac filling pressure, incorrect interpretation

of, 153

Cardiac functionevaluation of, 126, 127, 231in pediatric cardiac surgery patients, 409

Cardiac index, 238pulmonary artery catheterization measurement

of, 188Cardiac output

in burn patients, 381calculation of, 238central venous pressure as indicator of,

184exercise-related increase in, 238hypercarbia-related increase in, 23

in hypertension, 201in obese patients, 358passage through shunts, 21in pediatric patients, 394in neonates, 387

postpartum, 411t

during pregnancy, 411tpulmonary artery catheterization measurement

of, 188Cardiac pacing, postbypass, 490Cardiac risk, perioperative, assessment guidelines

for, 127, 128tCardiac surgery

lung isolation use in, 493minimally-invasive, 511as renal insufficiency risk factor, 316

Cardiac surgery patients, peripheral neuropathyin, 146

Cardiomyopathy, dilated, 236, 236tCardioplegia, 489

Cardiopulmonary bypass, 487–492as acute respiratory distress syndrome

risk factor, 287tcomplications of, 491–492difficulty in weaning from, 491in heart transplantation patients, 476–477left ventricular dysfunction after, 477

myocardial protection during, 489, 491patient preparation for, 476right left ventricular dysfunction after, 477termination of, 477

Cardiopulmonary bypass circuits, 487priming solutions for, 488

Cardiovascular collapse, 376, 378local anesthetics-related, 108–109

Cardiovascular diseasealcohol abuse-related, 336, 337congenital, 404–410in pediatric patients, 397–398, 404–410in pregnant patients, 430–431

Cardiovascular drugs. See also names ofspecific drugs

benefits of, 112use during perioperative period, 233

Cardiovascular systemaging-related changes to, 432

effect of alcohol on, 336effect of burns on, 381effect of cirrhosis on, 301effect of hypothermia on, 218teffect of local anesthetics on, 108–109effect of myotonic dystrophy on, 328effect of opioids on, 85

effect of patient positioning on, 142pediatriccomparison with adult, 394neonatal, 387

Cardioversion, chemical, 212Cardioverter-defibrillators, implantable, 214

Carotid arteriescentral venous catheterization-related injury to, 186pulmonary artery catheterization-related injury to, 189

Cataracts, electrical burns-related, 386Catecholamines, 11effect on uteroplacental perfusion, 415

synthetic pathway of, 13fCatheterizationarterial, for blood pressure measurement, 194–200damping coefficients in, 196, 197, 198flushing of, 199in valvular heart disease patients, 245

cardiac, for pulmonary hypertension evaluation, 295

central venous, 180–187catheter placement in, 180, 180f, 181–182,

183, 186

548 INDEX

Catheterization (Continued)catheter removal in, 187complications of, 185f, 186in obese patients, 360

types of catheters used in, 181epidural, in pregnant patients, 361Foley embolectomy, 495, 496–497pulmonary artery, 188–193catheter kinking during, 189–190effect on patient outcomes, 189in ischemic heart disease patients, 234

in valvular heart disease patients, 245waveforms of, 190, 191–192, 191f, 192f

Cauda equina syndrome, 109, 452Caudal anesthesia, 458in pediatric patients, 400–401, 401t

Caudal nerve blocks, 107

Central anticholinergic syndrome, 120Central nervous system. See also Braineffect of alcohol abuse on, 336effect of hypothermia on, 218teffect of local anesthetics on, 108, 109pregnancy-related changes in, 413

Central somatosensory conduction time, 501

Central venous pressure (CVP)as cardiac output indicator, 184influences on, 184measurement of, 182normal values for, 185, 188during pregnancy, 411t

pulmonary artery catheterization measurementof, 188

relationship to right ventricular preload, 184–185as volume status indicator, 185f, 186waveforms of, 183–184, 183f, 186, 190, 190f

Cephalosporins, use in penicillin-allergic patients, 365Cerebral cortex, peripheral neural neurosensory

pathway to, 500Cerebral perfusion, effect of inhalational anesthesia

on, 261Cerebral perfusion pressurein craniotomy patients, 508determinants of, 318

intraoperative monitoring of, 261Cerebral perfusion pressure breakthrough, 265Cerebrospinal fluidas intracranial pressure determinant, 317local anesthetic injected into, 452lumbosacral volume of, 452

spinal anesthesia resorption from, 451Cerebrovascular disease, 259–266. See also Strokein aorto-occlusive disease patients, 255preoperative risk assessment of, 128

Cerebrovascular insufficiency, 259Cervical spine injuries, airway management in,

374–375

Cesarean section, anesthesia forepidural, 423–424general, 424, 425

Cesarean section, anesthesia for (Continued)as hypotension cause, 415regional, 415spinal, 423–424, 423t

Cetacaine, use in awake intubation, 64tChagas’ disease, 44Chamomile, 369Chemical burns, 380Chest wall, peripheral nerve block anesthesia for, 471Child-Turcotte-Pugh Score, 302–303, 303t, 306Chloroprocaine

maximum safe doses of, 107tpotency of, 107tuse as epidural anesthetic, 462t, 464use in obstetric patients, 420, 421

Cholecystitis, acalculous, 382Cholinergic receptors, end-organ effects of, 12t

Chondroitin 4-sulfate, 369Chronic obstructive pulmonary disease (COPD),

278–284in aorto-occlusive disease patients, 254"blue bloaters" in, 279definition of, 278"pink puffers" in, 279

as postoperative pulmonary complication riskfactor, 125, 125t

pulmonary elastic recoil in, 17Cirrhosis, 301–302alcoholic, 337cardiovascular physiology in, 480

central nervous system dysfunction associatedwith, 300

definition of, 300Hepatopulmonary syndrome of, 301hepatorenal syndrome of, 301as hyponatremia cause, 38tpreoperative risk assessment in, 302–303

pulmonary hypertension associated with, 301Cisatracurium, as nondepolarizing neuromuscular

blocking agent, 98tCitrate, accumulation during in liver transplantation,

484Clevidipine

action mechanisms and action sites of, 115hemodynamic profile of, 115

Clonidine, perioperative use of, 9Closing capacity, 17Coagulation, 51–57Coagulation factors. See also specific coagulation

factorsas liver function indicators, 302during pregnancy, 411–412pregnancy-related increase in, 412t

Coagulation pathways, intrinsic and extrinsic, 51–52Coagulation system, cardiopulmonary bypass-related

activation of, 488, 490

Coagulation tests, 54in pregnant patients, 428preoperative, 125t, 127

INDEX 549

Coagulopathiesin burned patients, 385cirrhosis-related, 302cyanotic heart disease-related, 406

in heart transplantation patients, 476herbal supplement-related, 371–372, 520in liver transplantation patients, 483, 484, 485massive blood transfusion-related, 48medication-related, 454in trauma patients, 378

Cocaine, 339, 340–341, 340b

as hyperthermia risk factor, 221use in awake intubation, 64t

Cocaine withdrawal, 340Codeine, 83tequianalgesic doses of, 532tmetabolism of, 87

Cognitive dysfunction, postoperativecardiopulmonary bypass-related, 491in geriatric patients, 434–435

Colloid solutions, 34–35allergic reactions to, 364use in burned patients, 383–384

Coma

acidemia-related, 27barbiturate, 322cardiopulmonary bypass-related, 491myxedema, 352

Compartment syndromesabdominal, 376

universal theory of, 376Complex regional pain syndrome I (CRPS I), 537Complex regional pain syndrome II (CRPS II), 537Compliance, pulmonaryin acute respiratory distress syndrome, 288dynamic and static, 18in mechanical ventilation, 154

Conduction, as heat loss mechanism, 219Conduction block, 452Confusion, acidemia-related, 27Congenital heart disease, 404–410cyanotic, 406, 406b, 407–408, 407tin pediatric patients, 397–398

in pregnant patients, 430–431Congestive heart failure, 236diastolic, 115, 116as hyponatremia cause, 38tleft-to-right shunt-related, 397signs and symptoms of, 231

treatment of, 117Connective tissue disease, as pulmonary hypertension

risk factor, 293Constipation, hypothyroidism-related, 380Consultations, preoperative, 125–126Continuous positive airway pressure (CPAP), use in

lung isolation, 497

Contrast media, soluble, 440–441, 441tContusionsmyocardial, 377–378pulmonary, 287t

Convection, as heat loss mechanism, 219Cornea, patient positioning-related injury to, 147Coronary arteries, anatomy of, 229Coronary artery bypass grafting, prior to

noncardiac surgery, 232Coronary artery diseasein aorto-occlusive disease patients, 254diabetes-related, 343electrocardiographic findings in, 159, 159fas heart failure cause, 236, 236thypothyroidism treatment in, 352–353

in liver disease patients, 480in liver transplant patients, 480

Coronary syndromes, unstable, 126, 127Corticosteroidsas allergic reaction prophylaxis, 367as asthma treatment, 268, 269t, 271

as chronic obstructive pulmonary diseasetreatment, 281t

for intracranial pressure reduction, 319perioperative supplemental, 356use in spinal cord injury patients, 377

Corticotropin-releasing hormone, 354Cortisol

as chronic obstructive pulmonary diseasetreatment, 281t

comparison with exogenous steroids, 355–356,355t

laparoscopy-related increase in, 515synthesis and function of, 354

Cortisone, potency of, 355tCoughasthma-related, 267bronchitis-related, 278chronic obstructive pulmonary disease-related, 279emphysema-related, 278heart failure-related, 240

Craniotomyanesthesia for, 505–510in pediatric patients, 510

Creatinine, 311–312, 312t, 313–314, 433Creatinine clearance rate, 310, 312tCreutzfeldt-Jakob disease, 44

Critically-ill patients, mechanical ventilation in,149–156

Cromolyn sodium, 269, 281tCryoprecipitates, 51Crystalloid solutionscomposition of, 35, 35t

effect on intracranial pressure, 320–321use in patients undergoing cesarean section, 415

Crystal methamphetamine, 341Cushing reflex, 317, 509–510Cyanosisasthma-related, 268congenital heart disease-related, 406, 406b,

407–408, 407tpulmonary hypertension-related, 294

Cyclobenzaprine, as chronic pain treatment, 536tCyclooxygenase-1 (COX-1) agents, 533

550 INDEX

Cyclooxygenase-2 (COX-2) agents, 533Cystic fibrosis, pulmonary function test abnormalities

in, 70Cytomegalovirus infection, as hepatocellular injury

cause, 305t

D

Damage control surgery, 375–376, 378Damping coefficient, 197, 198, 198fDantroleneeffect on skeletal muscle, 99

as malignant hyperthermia prophylaxis, 326as malignant hyperthermia treatment, 324, 325, 326

Dead spacealveolar, anatomic, and physiologic, 21positive-end expiratory pressure-related increase

in, 153

during pregnancy, 412tDeliriumcentral anticholinergic syndrome-related, 120in geriatric patients, 434–435

Dependence, definition of, 338DepoDur, 88Depression. See also Antidepressants

awareness during anesthesia-related, 208electroconvulsive therapy for, 522–526

Dermatitis, contact, 364Desfluraneas carbon monoxide poisoning cause, 80chemical structure of, 75, 75f

metabolic products of, 79–80physical properties of, 76tsomatosensory-evoked potential effects of, 502tvaporizer delivery of, 134, 135

Dexamethasoneas chronic obstructive pulmonary disease

treatment, 281t

potency of, 355tDexmedetomidine (Precedex), 440, 444Dextrans, use in resuscitation, 35, 36tDiabetes insipidus, 32–34, 33tDiabetes mellitus, 343–350in aorto-occlusive disease surgical patients,

255, 256glucose control in, 345oral hypoglycemic agent therapy for, 344postoperative management in, 347in pregnant patients, 430preoperative evaluation in, 345

types of, 343urgent surgery in, 348

Diacetylmorphine, 83tDiaphragmcarbon dioxide insufflation-related dysfunction

of, 513patient positioning-related displacement of,

144–145respiratory function of, 17

Diarrhea, bloody, 382

Diastolic dysfunction, 201, 238–239, 239fDiazepamas chronic pain treatment, 536tintravenous administration of, 93

as preoperative sedation, 119tsomatosensory-evoked potential effects of, 502tuse in pediatric patients, 396t

Dietary Supplement Health and EducationAct (1994), 369

Diffusion, impaired, as hypoxemia cause, 20Diffusion capacity, single-breath (DLCO), 69–70, 71t

Digitalis, as intraoperative inotrope, 114Digoxin, as arrhythmia cause, 163, 2111,25-Dihydroxyvitamin D, 357Diltiazem, contraindication to, 211Dipyridamole thallium imaging, 232Disseminated intravascular coagulation, 53, 55, 56

in pregnant patients, 430treatment of, 54

Distal pulse amplification, 198–199Diureticsaction sites of, 309, 310tas hypertension treatment, 201, 202tas hyponatremia cause, 38t, 482

loop, 310tosmotic, 310tpotassium-sparing, 310tas hyperkalemia cause, 482

as pulmonary hypertension treatment,296–297

side effects of, 309, 310tthiazide, 310t

Dobutamine, hemodynamic profiles of, 113–114Dopamine, 11hemodynamic profiles of, 113laparoscopy-related increase in, 515limitations of, 115, 116–117

renal effects of, 314synthesis of, 11–12

Dorsalis pedis artery, as arterial pressure monitoringcannulation site, 196, 196f

Doxacurium, as nondepolarizing neuromuscularblocking agent, 98t

Droperidol, 502tDrug abusers, nitrous oxide toxicity in, 78Drug delivery systems, implantable, 539Drug metabolismin burned patients, 382effect of hypothermia on, 220, 221

effect of liver disease on, 483in neonates, 387

Drugs. See also names of specific drugshepatotoxicity of, 304tas hyperthermia risk factor, 221as perioperative hypotension risk factor, 204

Duchenne muscular dystrophy, 327

Ductal-dependent lesions, 408Dynamic compliance, 18Dysplasia, bronchopulmonary, 388t

INDEX 551

Dyspneaacute respiratory distress syndrome-related, 288asthma-related, 267chronic obstructive pulmonary disease-related, 279

heart failure-related, 236, 240pulmonary hypertension-related, 294

Dystrophin, 327

E

Echinacea, 369Echocardiography

for aortic insufficiency evaluation, 248, 248tfor aortic stenosis evaluation, 246, 246tfor congestive heart failure evaluation, 240–241for ischemic heart disease evaluation, 232for mitral stenosis evaluation, 249, 249tfor pulmonary hypertension evaluation, 295

stress, for ischemic heart disease evaluation, 232transesophagealin high-risk cardiac surgical patients, 234during valvular heart disease surgery, 244–245

for valvular heart disease evaluation, 244–245Eclampsia, 428–429Ecstasy (3,4-methylenedioxymethamphetamine), 341

Edemaof the airway, 381cerebral, 265, 347pulmonary, 17burn-related, 381heart failure-related, 236

negative-pressure, 225–226Edrophonium, 102, 282Eisenmenger’s syndrome, 397, 404Elderly patients. See also Geriatric anesthesiaantidepressant therapy in, 522trauma in, 378

Elective surgery, in hypothyroid patients, 353, 356

Electrical burns, 380, 386Electrocardiography (ECG), 157–167during anesthesia, 438in arrhythmias, 163, 215–216in bundle-branch blocks, 157, 158, 158f,

159, 166–167

in congestive heart failure, 240in coronary artery disease, 159, 159fdelta wave pattern on, 214–215exercise, 231in hypercalcemia, 165–166, 165fin hyperkalemia, 163, 163f

in hypocalcemia, 165, 165fin hypokalemia, 163–164, 164fin hypothermia, 219–220in hypothyroidism, 162large R wave in V1 on, 157, 166bin myocardial infarction, 159–160, 160f, 161,

161f, 162, 162f

preoperative, 124, 125tin geriatric patients, 434in obese patients, 359

Electrocardiography (ECG) (Continued)prolonged QT interval on, 166in pulmonary hypertension, 294P waves, in ventricular tachycardia, 213, 214

QRS complexmagnesium sulfate-related widening of, 428in ventricular tachycardia, 213

QT interval, prolonged, 214ST-segment on, 159–160, 160f, 161, 161t, 162,

162f, 16312-lead, in ischemic heart disease, 233–234

in valvular heart disease, 244Electroconvulsive therapy (ECT), 522–526Electroencephalography (EEG)for brain protection assessment, 506during carotid endarterectomy, 262processed, 209

Electrolyte disturbances, 38–42in liver transplantation patients, 482

Embolism. See also Air embolismfat, 287tas valvular heart disease cause, 244

EMLA cream, use in pediatric patients, 396Emphysema

clinical features of, 278pulmonary function test abnormalities in,

70, 71tas respiratory acidosis cause, 26

Encephalopathyhepatic, 300

Wernicke’s, 336, 337Endarterectomy, carotid, 260, 261, 262Endocarditis, infectiveas aortic stenosis cause, 247–248subacute, 409–410

Endocrine disordersas metabolic alkalosis cause, 29

nondiabetic, 351–357Endocrine system, effect of burns on, 382Endoscope, development of, 515Endotracheal intubationawake, 63–64, 64tblind, 63

in diabetic patients, 346difficulty in weaning from, 18head position during, 62f, 148indications for, 58in laser surgery of the airway patients, 520in pediatric patients, 402

Endotracheal tubescuffed, for pediatric patients, 398double-lumen, 493, 494, 494t, 495, 496,

497, 497tleakage of, in pediatric patients, 394tfor lung isolation, 494f, 495for pediatric patients, 394t, 398–399, 398t

Robertshaw, 494fsize of, for pediatric patients, 398, 398ttypes of, 61–63

552 INDEX

Endovascular repair, of the aorta, 256–257End-tidal carbon dioxide (ETCO2)correlation with partial pressure of carbon dioxide,

176

decrease, 177definition of, 175–176importance of, 175increase, 177–178

Enfluranechemical structure of, 75fsomatosensory-evoked potential effects of, 502t

Enterocolitis, necrotizing, 388tEnvironmental exposure, as chronic obstructive

pulmonary disease cause, 278Enzyme deficiencies, as unconjugated bilirubin

cause, 304tEphedrine

effects and doses of, 14as hypotension treatment, 415perioperative use of, 12–14

Ephredra, 369–370Epidural analgesiain aortic surgery patients, 256in obstetric patients, 420, 421

Epidural anesthesia, 458–465caudal, in pediatric patients, 400–401, 401tcombined with general anesthesia, 464–465combined with spinal anesthesia, 424, 464comparison withgeneral anesthesia, 459

spinal anesthesia, 459complications of, 461, 465contraindications to, 460–461differentiated from spinal anesthesia, 43epidural, 108in geriatric patients, 434with heparin use, 454–455

lumbar, 460motor blocks associated with, 463–464neurotoxicity of, 109–110preoperative evaluation prior to, 459–460segmental, 464use in

multiple sclerosis patients, 333obstetric patients, 421–422pulmonary hypertension patients, 297

Epidural nerve block, local anesthetic vascularabsorption in, 107

Epidural space, anatomy of, 458

Epidural steroids, as radiculopathic pain treatment,538–539

Epinephrine, 11as allergic reaction treatment, 367as asthma treatment, 269tas chronic obstructive pulmonary disease

treatment, 281t

coadministration with local anesthetics, 108, 463hemodynamic profiles of, 113laparoscopy-related increase in, 515synthesis of, 11–12

Epinephrine (Continued)use in cesarean sections, 423tuse in pediatric patients, 399

Epoprostenol, 299

Epstein-Barr virus infection, 305tErb’s point, 500Erythropoietin, 49Esmolol, 204t, 211Esophageal surgery, lung isolation use in, 493Esophagus, accidental intubation of, 176Estimated fluid deficits (EFD), in pediatric patients,

399Etidocaine, potency of, 106, 107tEtomidatecardiovascular effects of, 90as induction agent, 91tintracranial pressure effects of, 320

as sedative, 91tsomatosensory-evoked potential effects of, 502tuse inburned patients, 382critically ill patients, 92

Evaporation, as heat loss mechanism, 219Evoked response monitoring, for anesthesia depth

assessment, 209Exercise, effect on cardiac output, 238Exercise intolerancechronic obstructive pulmonary disease-related, 279heart failure-related, 236valvular heart disease-related, 244

Exercise tolerance, as cardiac function indicator, 231Expiration, muscles responsible for, 17Extubationin chronic obstructive pulmonary disease patients,

284criteria for, 65, 361tin obese patients, 361, 361t

100% oxygen administration prior to, 67Eye injuryin hyperthyroid patients, 353patient positioning-related, 147

F

Factor II, 337Factor V, 337Factor Va, 487Factor VII, 337, 412t, 488Factor VIIa, 487recombinant, 56

Factor VIII, 53–54, 302, 412tFactor VIIIa, 487Factor IX, 412tFactor X, 337, 412tFactor XII, 412tFasting, preoperative, 124, 124t, 274–275Fast tracking, 222, 488

Fat embolism syndrome, 287tFatigueheart failure-related, 236, 240hyperthyroidism-related, 353

INDEX 553

Fatigue (Continued)hypothyroidism-related, 380pulmonary hypertension-related, 294

Febrile reactions, to blood transfusion, 45

Femoral arteryas arterial pressure monitoring cannulation site,

196, 196fas cardiopulmonary bypass cannulation site,

487–488Femoral nerve, effect of patient positioning on, 144Femoral nerve blocks, 107, 470t

Femoral vein, as central venous catheter insertionsite, 181

Femur, fractures of, 375–376Fenoldopam, 115–116Fenoterol, 268, 281tFentanyl, 83t, 455

as acute pain treatment, 530, 533in awake intubation, 64tcomparison with morphine, 85duration of action of, 85, 86teffect on pulmonary vascular resistance, 406elimination half-life of, 85equianalgesic doses of, 532t

loading dose of, 359tonset of action of, 85, 86tpeak effect of, 85, 86tsomatosensory-evoked potential effects of, 502ttransdermal, equianalgesic doses of, 532tuse in

liver transplantation patients, 483obstetric patients, 419t, 422tpediatric patients, 396t

Fentanylx, use in obstetric patients, 423tFetal heart rate monitoring, 416, 416fFetus, nitrous oxide toxicity in, 78Feverfew, 369, 371

Fibrin degradation products, 55Fibrinogen, pregnancy-related increase in, 412tFibrinolysis, 52pregnancy-related increase in, 412t

Fibromyalgia, 538Fibrosis, pulmonary, 17

FiO2. See Fractional concentration of oxygen ininspired gas (FiO2)

Firesas burn cause, 380in operating rooms, 520–521, 521b

Fish oil, 369, 370

Fistulas, tracheoesophageal, 390, 391Flashbacks, awareness during anesthesia-related, 208Flow-volume loops, 71–72, 72f, 73fFludrocortisone, potency of, 355tFluid loss, intraoperative, 36–37Fluid management, 31–37in acute respiratory distress syndrome, 289–290

in burned patients, 383–384during craniotomy, 506in hepatorenal syndrome patients, 301for hyponatremia control, 38–39

Fluid management (Continued)for intracranial pressure control, 319, 320–321intraoperative, 36–37in pediatric patients, 399–400

of traumatic brain injury patients, 322–323Fluid retention, heart failure-related, 236Fluid status, central venous pressure as indicator

of, 185fFlumazenil, side effects of, 94Fluorideas anesthetic metabolic product, 80

nephrotoxicity of, 314Fluoxetine, as chronic pain treatment, 536tFluphenazine, as chronic pain treatment, 536tFood and Drug Administration (FDA), 369Forced expiratory flow at 50% of forced vital capacity/

forced inspiratory flow at 50% of forced vital

capacity (FEF50/FIF50), 71Forced expiratory volume in one second (FEV1), 70f

in obstructive airway diseases, 70during pregnancy, 412t

Forced expiratory volume in one second (FEV1)/forcedvital capacity (FVC) ratio, 74

in obstructive airway diseases, 70, 71t

in restrictive airway diseases, 71tForced vital capacity (FVC), 74Fractional concentration of oxygen in inspired gas (FiO2)

low, as hypoxemia cause, 19, 20during organ harvesting, 474–475oxygen therapy-related increase in, 224, 224t

prior to extubation, 67Fractional excretion of sodium (FENa), 312tFrank-Starling law, 238Fresh frozen plasma, indications for use of, 55Functional residual capacity (FRC), 69f, 70fdefinition of, 17determination of, 69

during pregnancy, 412trelationship to closing capacity, 17

G

Gabapentin, as pain treatment, 536tGallamine, use in renal insufficiency patients, 315t

Ganglia, sympathetic, 10, 10fGarlic, 369, 371Gasesavailable on anesthesia machines, 130for insufflation, 512, 512t

Gas flow, pulmonary resistance to, 17, 18

Gastric acid secretion blockers, preoperativeadministration of, 119t, 120–121

Gastric emptying, in neonates, 387–388Gastroesophageal refluxin neonates, 387–388in obese patients, 358–359

Gastrointestinal system

acid-base balance function of, 27effect of alcohol on, 337effect of burns on, 382pregnancy-related changes in, 413

554 INDEX

Gastrokinetic agents, preoperative administration of,119t, 120–121, 274–275

Gastroschisis, 390, 391–392differentiated from omphalocele, 391

Gate theory, of pain, 539General anesthesiain carotid endarterectomy patients, 261for cesarean sections, 424, 425in chronic obstructive pulmonary disease patients,

282, 283combined with epidural anesthesia, 464–465

comparison with epidural anesthesia, 459definition of, 439teffect on renal function, 314in geriatric patients, 434heat loss during, 218in hypertensive patients, 204

in ischemic heart disease patients, 234for laparoscopic procedures, 516patient discharge following, 227in pediatric patients, 402–403pulmonary function effects of, 280ventilation-perfusion mismatch-exacerbating

effect of, 20

Geriatric anesthesia, 432–436Ginger, 369, 371Ginkgo, 369, 370Ginseng, 369, 370Glasgow Coma Scale (GCS), 373tGlideScope, 61

Glomerular filtration, 309Glomerular filtration rate, 312aging-related decrease in, 433

Glomerulonephropathy, during pregnancy, 430Glossopharyngeal nerve block, 64Glucocorticoidsas hypothalamic-pituitary-adrenal axis disruption

cause, 355use in cardiopulmonary bypass patients, 476

Gluconeogenesis, in neonates, 387Glucosamine, 369Glucoseneonates’ need for, 387

perioperative monitoring of, 349Glucose-containing intravenous fluids, 399–400contraindication to, 320–321, 322

Glucose control, in diabetes patients, 345Glucose infusion, in diabetic patients, 347Glucose metabolism, effect of insulin therapy

on, 345g-Glutamyltransferase, as biliary tract function

indicator, 302Glycopyrrolateas chronic obstructive pulmonary disease

treatment, 281tas preoperative sedation, 119t

side effects of, 120tuse in awake intubation, 64tuse in morbidly obese patients, 122

Glycosides, cardiac, as pulmonary hypertensiontreatment, 296–297

Goiter, 353Gold salts, as asthma treatment, 269

Goodpasture’s syndrome, 364Graves’ disease, 352, 353Guillain-Barre syndrome, 331–332Gynecologic procedures, minimally-invasive, 511

H

Hagen-Poiseuille relationship, 18

Half-time, context-sensitive, 86, 87fHaloflurane, physical properties of, 76tHaloperidol, as chronic pain treatment, 536tHalothaneas cardiac arrhythmia cause, 79as hypercyanotic spell cause, 407–408

somatosensory-evoked potential effectsof, 502t

Hand, blood supply to, 195Headachescontrast media-related, 441tpheochromocytoma-related, 15–16postdural puncture, 452, 453, 461, 465

Head and neck, examination of, 59–60Head positioning, during endotracheal intubation,

62f, 148Healthcare workers, latex allergy in, 366, 367–368Heart, effect of hypothermia on, 218tHeart block

atrioventricular, 211second-degree, 210third-degree, 210–211

intraoperative treatment of, 15pulmonary artery catheterization-related, 189

Heart failure, 236–243. See also Congestive heartfailure

anesthetic induction in, 475decompensated, 126, 127, 240, 242–243definition of, 236diastolic, 115, 116obesity-related, 358refractory, end-stage, 241

right-sided, 279treatment for, 241–242

Heart-lung transplantation, 296–297Heart murmursdiastolic, 244heart failure-related, 240

during pregnancy, 411systolic, 244valvular heart disease-related, 244

Heart rateeffect of blood loss on, 374tepidural anesthesia-related decrease in, 462fetal, monitoring of, 416, 416f

in pediatric patients, 394during pregnancy, 411ttherapeutic reduction in, 212

INDEX 555

Heart sounds, during pregnancy, 411Heart transplantation, 241, 473–479cardiopulmonary bypass in, 476–477as retransplantation, 473

Heat exhaustion, 220Heat intolerance, hyperthyroidism-related, 353Heat loss. See also Hypothermiain the operating room, 218, 219, 220

Heat stroke, 220Heliox, as asthma-related bronchospasm

treatment, 272

Heliumas laparoscopic insufflation gas, 512tuse in stridorous patients, 18

HELLP syndrome, 427Hematocritas blood transfusion indicator, 50

in chronic obstructive pulmonary disease, 279preoperativemeasurement of, 124, 125tminimum acceptable, 124

Hematologic systemcirrhosis-related disorders of, 302effect of burns on, 383

effect of hypothermia on, 218tpregnancy-related changes in, 411–412, 411t, 412t

Hematomacervical, 354epidural, 318t, 461reabsorption of, 304t

Hemodialysis, 316Hemodilutioncardiopulmonary bypass-related, 490isovolemic, 503normovolemic, 43

Hemodynamicseffect of patient positioning on, 513

of heart transplant recipients, 475laparoscopy-related changes in, 513, 514t, 515postanesthesia, 223

Hemofiltration, during cardiopulmonary bypass, 476Hemoglobinas blood transfusion indicator, 43, 44, 50, 126

pregnancy-related decrease in, 412tpreoperative measurement of, 124, 125t

Hemoglobin saturationarterial, 169functional compared with fractional, 173

Hemoglobin solutions, 49–50

Hemolysis, as unconjugated bilirubin cause, 304tHemolytic transfusion reactions, 44, 45, 45t, 47Hemorrhageantepartum, 429gastrointestinal, 300, 382in heart transplant recipients, 476–477intracerebral, as intracranial pressure increase

cause, 318tintraventricular, in premature infants, 388tpulmonary, 189

Hemorrhage (Continued)risk assessment for, 51, 54subarachnoid, 505, 508, 509spontaneous, 262–263

warfarin-related, 127Hemostasis, 51Hemothorax, 185, 186, 189Henderson-Hasselbalch equation, 28Heparinallergic reactions to, 365anticoagulant activity of, 54

low-molecular-weight, 455perioperative administration of, 127reversal of, 490unfractionated, 454–455use in arterial transducer systems, 199

Hepatic function. See Liver function

Hepatitisas hepatocellular injury cause, 305tviral, as liver disease risk factor, 304t

Hepatobiliary system, effect of alcohol on, 337Hepatocellular injury, 304, 305tassessment of, 302

Hepatopulmonary syndrome, 301, 482

Hepatorenal syndrome, 301Herbal supplements, 369–372Herniacongenital diaphragmatic, 390hiatal, 358–359

Herniated disks, as radiculopathy cause, 538–539

Hetastarch (hydroxyethyl starch), 35, 36tHip, dislocation of, 143Histamine, opioids-related release of, 84Histamine receptor antagonistsas allergic reaction prophylaxis, 367preoperative administration of, 120–121in morbidly obese patients, 122

use in chronic obstructive pulmonary diseasepatients, 284

Hoarseness. See also Stridorhypothyroidism-related, 380

Human immunodeficiency virus (HIV) infectionblood transfusion-related transmission of, 44

as pulmonary hypertension risk factor, 293Hunt-Hess classification, of post-subarachnoid

hemorrhage neurologic status, 262–263Hydralazine, 115, 204tHydrocephalus, as intracranial pressure increase

cause, 318t

Hydrocodone, 83tequianalgesic doses of, 532t

Hydromorphone, 83tas acute pain treatment, 528–529, 530duration of action of, 85, 86tequianalgesic doses of, 532tonset of action of, 85, 86t

peak effect of, 85, 86tas seizure risk factor, 86

Hydroxyethyl starch (Hetastarch), 35, 36t

556 INDEX

Hyperbilirubinemiaconjugated, 303, 304unconjugated, 303, 304, 304t

Hypercalcemia, electrocardiographic findings in,

165–166, 165fHypercapniacerebrovascular disease-related, 260minute ventilation during, 22

Hypercarbiacauses of, 22–23effect on pulmonary arterial pressure, 296

maternal, effect on uteroplacental perfusion, 415signs and symptoms of, 23

Hyperchloremia, 42Hypercoagulable states, during pregnancy,

411–412, 418Hypercyanotic spells, 407–408, 407t

Hyperglycemiablood glucose reduction in, 347complications of, 345in diabetic patients, 345effect on intracranial pressure, 320–321

Hyperkalemia, 40–41acidemia-related, 27

electrocardiographic findings in, 163, 163fin liver transplantation patients, 482, 484succinylcholine-related, 97

Hyperlipidemia, fish oil treatment of, 370Hypernatremia, 39, 40tHyperperfusion, cerebral, carotid endarterectomy-

related, 262Hypertensionalcohol abuse-related, 336antihypertensive agent treatment of, 201, 202,

202t, 203carotid endarterectomy-related, 262causes of, 201

as cerebrovascular ischemic event risk factor, 260definition and classification of, 201diabetes-related, 343diastolic, 201electroconvulsive therapy-related, 522–523, 524ephedra-related, 369–370

general anesthesia use in, 204intraoperative, 203, 203tmalignant, 201as intracranial pressure increase cause, 318t

obesity-related, 358pheochromocytoma-related, 15–16

physiologic processes in, 201postoperative, 203, 226pregnancy-associated, 426, 426t, 427, 428, 428t,

430, 431prevalence and significance of, 201pulmonary, 293–299cirrhosis-related, 482

congenital heart disease-related, 404as crisis, 405definition of, 293

Hypertension (Continued)effect on perioperative risk, 405intraoperative management of, 296portal, 301–302, 482

treatment of, 295, 405tregional anesthesia use in, 203systemic, 201untreated, 202

Hyperthermia, 220, 221definition of, 220intraoperative treatment of, 221

malignant, 97, 221, 324–326, 329bcomparison with neuroleptic malignant

syndrome, 326relationship to muscular dystrophy, 327

Hyperthyroidism, 353–354diagnosis of, 351t

Hyperventilationacidemia-related, 27effect on intracranial pressure, 320

Hypervolemiacentral venous pressure in, 185fsplanchnic, cirrhosis-related, 484

Hypnotic agents. See also

use in craniotomy patients, 507Hypocalcemia, 41–42, 357alkalemia-related, 28electrocardiographic findings in, 165, 165fin liver transplantation patients, 484renal failure-related, 311

Hypocapniacerebrovascular disease-related, 260

Hypocarbiaeffect on somatosensory-evoked potentials, 503maternal, effect on uteroplacental perfusion, 415

Hypoglycemic agents, oral, 344Hypokalemia, 39, 40

alkalemia-related, 28electrocardiographic findings in, 163–164, 164fin liver transplantation patients, 482

Hypomagnesemia, 41, 42alkalemia-related, 28

Hyponatremia, 38–39, 38t

in liver transplantation patients, 482, 484Hypoparathyroidism, functional, 357Hypophosphatemia, alkalemia-related, 28Hypoplastic left heart syndrome, 408, 409fHypotensionanaphylaxis-related, 364

aortic unclamping-related, 255as blood transfusion indicator, 43carotid endarterectomy-related, 262effect on somatosensory-evoked potentials, 503effect on uteroplacental perfusion, 415epidural anesthesia-related, 461hypocalcemia-related, 41

hypomagnesemia, 41hypovolemia-related, 33in infants, 389t

INDEX 557

Hypotension (Continued)in liver transplantation patients, 484, 485orthostatic, postoperative, 9patient positioning-related, 145

peri-induction, 9perioperative, 204–206joint cement-related, 204–205

postoperative, 226spinal anesthesia-related, 415, 452thyrotoxicosis-related, 354in unconscious patients, 373

Hypothalamic-pituitary-adrenal axis, 354glucocorticoid-related disruption of, 355

Hypothermia, 217, 219–220, 220bduring cardiopulmonary bypass, 476definition of, 217–218effect on drug action and metabolism, 220

effect on organ systems, 218tin geriatric patients, 434hypothyroidism-related, 380in infants, 389, 389tas intraoperative brain protection, 506levels of, 487massive blood transfusion-related, 49

in pulmonary hypertension patients, 296rewarming treatment of, 220stages of, 217–218in trauma patients, 375, 378use in cardiopulmonary bypass, 487

Hypothyroidism, 245, 352, 353

electrocardiographic findings in, 162as hyponatremia cause, 38tprimary, diagnosis of, 351tsecondary, diagnosis of, 351t

Hypoventilationcontrolled, with permissive hypercapnia, 153–154as hypercarbia cause, 22

as hypoxemia cause, 20opioids-related, 224postanesthesia, 223

Hypovolemiablood pressure as indicator of, 37in burned patients, 385

in burn patients, 381central venous pressure in, 185fdiagnosis of, 37hypernatremia-related, 39in pediatric patients, 400as perioperative hypotension cause, 204

renal function in, 314Hypoxemiaacute lung injury-related, 285talveolar-arterial oxygen gradient incauses of, 19–20, 20bas hepatocellular injury cause, 305tpartial pressure of carbon dioxide oxygen in arterial

blood inpartial pressure of oxygen in arterial blood inas respiratory alkalosis cause, 26

Hypoxiadiffusion, 77–78effect on pulmonary arterial pressure, 296effect on somatosensory-evoked potentials, 503

in infants, 389tmaternal, effect on uteroplacental perfusion, 415minute ventilation during, 22in obese patients, 360during one-lung ventilation, 498postoperative management of, 225

I

Ibuprofen, as pain treatment, 536tIleus, 382Immune-complex formation, 364Immune systemeffect of blood transfusions on, 46

effect of burns on, 383Implantable drug delivery systems, 539Induction, of anesthesiain chronic obstructive pulmonary disease

patients, 282in end-stage liver disease patients, 482–483in heart failure patients, 475, 477

in pediatric patients, 395–396, 397preoxygenation before, 67rapid-sequence, 65–67in pediatric patients, 396in trauma patients, 374

speed of, factors affecting, 77, 78

steal, in pediatric patients, 396use inpediatric patients, 396trauma patients, 374

Induction agents. See also specific induction agentsfor asthmatic patients, 270for burned patients, 385–386

intravenous, 90for liver disease patients, 306respiratory effects of, 91somatosensory-evoked potential effects of, 502tfor trauma patients, 375

Infants. See also Neonates

airway of, 394tcardiovascular system of, 394estimated blood volume in, 400tintraoperative problems in, 389, 389tintubation in, 402perioperative fluid management in, 399

prematureanesthetic risk in, 387common health problems in, 388, 388tpostoperative apnea in, 392–393retinopathy in, 388, 388t

Infectionsin burned patients, 385

central venous catheterization-related,185, 186

pulmonary artery catheterization-related, 189

558 INDEX

Infectious disease, blood transfusion-relatedtransmission of, 44

Inflammatory bowel disease, 304tInfluenza, avian, 44

Informed consent, 123Inhalational anesthetics, 75–81. See also specific

inhalational anestheticsbiotransformation of, 79–80cardiovascular effects of, 79, 80tcerebral blood flow effects of, 321cerebral perfusion and metabolic rate effects

of, 261chemical structures of, 75, 75fcirculatory effects of, 80tflammability of, 75hepatic blood flow effects of, 305–306ideal, 75

interaction withcarbon dioxide absorbents, 139neuromuscular blocking agents, 99

physical properties of, 76tpotencies of, 75pulmonary circulation effects of, 296–297renal function effects of, 314

side effects/toxicity of, 75, 79–80liver dysfunction, 304–305respiratory depression, 224teratogenicity, 81

for single-lung ventilation, 498somatosensory-evoked potential effects of,

502t, 503use inalcoholic or alcohol-intoxicated patients, 337burned patients, 382cardiopulmonary bypass patients, 488craniotomy patients, 507muscular dystrophy patients, 327

neonates, 387pediatric patients, 396

ventilatory effects of, 78–79Inhalation injury, 381of burned patients, 385

Inotropes, 112–117as right ventricular failure treatment, 296

Inspiration, muscles responsible for, 17Insufflationcomplications of, 516–517gases for, 512, 512t

Insulin infusion, 347

Insulin pumps, subcutaneous, 347–348Insulin resistance, acidemia-related, 27Insulin therapy, 344, 345, 348teffect on glucose metabolism, 345intraoperative, 346–347

Intensive care units (ICUs)aortic surgery patients in, 257

ventilator use in, 139, 150"fighting the,", 155trigger variables in, 151

Intercostal muscles, respiratory function of, 17Intercostal nerve blocks, 107, 471, 533International Association for the Study of Pain, 535International normalized ratio (INR), 55, 302

Interscalene nerve blocks, 469tIntestines, epidural anesthesia-related contraction

of, 462Intra-abdominal pressurecarbon dioxide insufflation-related increase in, 513effect of patient positioning on, 142effect on organ perfusion, 514–515

in obesity, 358–359safe increase in, 513–514

Intraclavicular nerve blocks, 469tIntracranial disease, 259–266Intracranial elastance, 318, 318f, 319Intracranial pressure, elevated

succinylcholine-related, 97Trendelenburg position-related, 144

Intracranial pressure (ICP)during anesthesia, 319, 320–321determinants of, 317elevated, 317–323in craniotomy patients, 508, 509–510

definition of, 317electroconvulsive therapy-related, 522–523positive-end expiratory pressure-related, 153symptoms and consequences of, 317–318

Intracranial surgery, anesthesia for, 505–510Intragastric pressure, in obesity, 358–359

Intrathecal delivery. See also Spinal anesthesiaof drugs, 539

Intravenous access, in obese patients, 360Intravenous analgesia, use during labor and

delivery, 419, 419tIntravenous anestheticsideal, 90

loading dose of, in obese patients, 359, 359tuse in pulmonary hypertension patients, 297

Intravenous drug abuse, as valvular heart diseasecause, 244

Intravenous induction agents, use in pediatricpatients, 396, 397

Intraventricular conduction delays, 158Intubation. See also Endotracheal intubationaccidental esophageal, 176in asthmatic patients, 271

Iodide, in thyroid hormone synthesis, 351Iodine, radioactive, as hyperthyroidism

treatment, 353Ipratropium, 281tIschemiacardiacas hypotension cause, 205–206myocardial. See Myocardial ischemia

cerebral, 260

global compared with focal, 259end-organ, cyanotic heart disease-related, 406as hepatocellular injury cause, 305t

INDEX 559

Ischemia (Continued)radial artery thrombosis-related, 195–196subendocardial, 408

Ischemic heart disease, 229–235preoperative risk assessment of, 128

Isofluranechemical structure of, 10, 75fas hypercyanotic spell cause, 407–408metabolic products of, 79–80physical properties of, 76tsomatosensory-evoked potential effects of, 502t

Isoproterenol, hemodynamic profiles of, 113–114

J

Jaundice, definition of, 241–242"Jaws of steel." See Masseter muscle rigidity (MMR)Jet ventilation, in laser surgery of the airway, 519Joint cement, as hypotension cause, 204–205Jugular veinsas central venous catheter insertion site, 181

distention ofchronic obstructive pulmonary disease-related,

279heart failure-related, 240pulmonary hypertension-related, 294valvular heart disease-related, 244

K

Kava, 369, 370

Kernicterus, in neonates, 387–388Ketaminecardiovascular effects of, 90contraindication in brain tumor patients, 93contraindication to, 234, 320, 322effect on pulmonary vascular resistance, 406as induction agent, 91t

as preoperative sedation, 91t, 119tside effects of, 92somatosensory-evoked potential effects of, 502tuse inburned patients, 382electroconvulsive therapy, 524

pediatric patients, 396, 396tKetorolac, as acute pain treatment, 533Kidneyin acid-base balance regulation, 26anatomy of, 308–309effect of hypothermia on, 218tfunctions of, 309

intraoperative protection for, 314Korsakoff’s psychosis, 336

L

Labetalol, perioperative use of, 204tLabor and deliveryanalgesia use during, 419, 419tepidural analgesia use during, 420epidural anesthesia use during, 419t, 422–423

local anesthetics use during, 420–421pain associated with, 414physiologic changes during, 414

Labor and delivery (Continued)preterm, 429stages of, 414–415

Laboratory testing, preoperative, 124, 125t, 126

of asthmatic patients, 268of burned patients, 385of diabetic patients, 346of geriatric patients, 434of obese patients, 360

Lambert-Eaton myasthenic syndrome, 329–330Laminar gas flow, 18, 22

Laminectomy, pain associated with, 539Laparoscopic surgery, 511–517contraindications to, 511–512in obese patients, 360

Laplace’s law, 18, 237Laryngeal mask airway (LMAs), 63, 66f, 399, 399t, 403

Laryngoscopes, 58, 61Laryngoscopy, difficulties in, 58, 59Laryngospasm, 225in pediatric patients, 402

Larynxanatomy of, 60blood supply and innervation of, 60

visualization of, 61Lasers, definition of, 518Laser surgery, 518–521Lateral decubitus position, 143f, 144, 498Lateral femoral cutaneous nerve, patient

positioning-related injury to, 144

Latexdefinition of, 365occupational exposure to, 367–368

Latex allergy, 365, 366, 367–368"Lawnchair-recumbent" position, 143fLeft atrial pressure (LAP), measurement of, 192, 193Left ventricle, cardiopulmonary bypass-related

distention of, 489Left ventricular dysfunctionafter cardiopulmonary bypass, 477heart failure-related, 237

Left ventricular ejection fraction, in heart failure,238–239, 240, 241

Left ventricular end-diastolic pressure (LVEDP)in aortic insufficiency, 249in aortic stenosis, 246, 246f, 247measurement of, 192

Left ventricular end-diastolic volume (LVEDV),measurement of, 192

Left ventricular hypertrophydefinition of, 244electrocardiographic findings in, 157heart failure-related, 240hypertension-related, 201

Left-ventricular pressure-volume loops, 239fLeft ventricular systolic dysfunction, 250–251

Left ventricular vents, 489Left ventricular volume, in heart failure, 238–239, 239fLeft ventricular volume overload, 247–248, 247f

560 INDEX

Leukotriene inhibitors, as asthma treatment, 269Levobupivacaine, 110, 451tLevodopa, 332Levorphanol, equianalgesic doses of, 532t

Levosimendan, 115, 117Levothyroxine, 352–353Lidocaineas epidural anesthetic, 462t, 464maximum safe doses of, 107tpotency of, 107tas spinal anesthesia, 451t

as transient neurologic syndrome cause, 456use inawake intubation, 64tcesarean sections, 423tobstetric patients, 420, 421

Lipid infusion, as local anesthesia toxicity treatment,

110Lita-Tube, 272Lithium, interaction with neuromuscular blocking

agents, 99Lithotomy position, 142–143, 143f, 144Liverin acid-base balance regulation, 27

as alcohol metabolism site, 336anatomy and function of, 300effect of hypothermia on, 218tpregnancy-related changes in, 413

Liver disease. See also Cirrhosischolestatic, 302

end-stageanesthesia induction in, 482–483cardiovascular physiology in, 480differentiated from hepatorenal syndrome, 301as indicator for liver transplantation, 480, 481t

intraoperative management of, 306parenchymal, 300

preoperative management of, 306risk assessment for, 303, 304t

Liver functionaging-related changes in, 433in burned patients, 382in neonates, 387–388

perioperative, 300–307Liver function testing, 302for cholestatic liver disease diagnosis, 302for congestive heart failure assessment, 241for hepatic cell damage assessment, 302preoperative, 302–303

Liver transplantation, 480–486contraindications to, 480, 481tindications for, 480, 481t

Liver transplant patients, coronary artery disease in,480

Lobectomy, morbidity and mortality associated with,280–281, 280t

Local anesthetics, 105–111action mechanism of, 106, 106fallergic reactions to, 106, 365

Local anesthetics (Continued)for ambulatory procedures, 456classification off, 105, 109coadministration with opioids, 88

duration of action of, 107, 109for epidural anesthesia, 462, 462t, 464interaction with neuromuscular blocking agents, 99intravascular injections of, 461for laparoscopic procedures, 515maximum safe doses of, 107, 107tmetabolism of, 105

new, 110–111onset time of, 107, 109potency of, 106, 107t, 109spinal, 451–457systemic vascular absorption of, 108toxicity of, 108–109

in Bier blocks, 468–469cardiotoxicity, 108–109lipid infusion treatment of, 110neurotoxicity, 109, 333

use inanticoagulated patients, 454obstetric patients, 420–421

Long QT syndrome, congenital, 214Lorazepam, 93, 536tLou Gehrig’s disease, 331Low back pain, 538Lumbar epidural anesthesia, 460Lumbar plexus blocks, 470t

Lumbar spinal anesthesia, 533Lung. See also Pulmonary function; Pulmonary

function testingin acid-base balance regulation, 26acute injury to, 285, 285tblood transfusion-related injury to, 45, 45t,

46, 47

elastic recoil of, 17pulmonary artery catheter positioning in, 193zones of West in, 19

Lung capacity, 68, 69ftotal, 70fin obstructive and restrictive lung

diseases, 70fduring pregnancy, 412t

Lung diseaseacute, 289trestrictive, obesity-related, 362

Lung isolation techniques, 378, 493–499bronchial blockade, 493, 495, 496–497, 497tdouble-lumen endotracheal tubes, 493, 494,

494t, 495, 496, 497, 497tLung recruitment maneuver, 290, 291tLung resection surgery, 280–281, 280t, 283Lung scans, for pulmonary hypertension evaluation,

295

Lung transplantation, as pulmonary hypertensiontreatment, 296–297

Lung volume, 68, 69f

INDEX 561

M

Magnesium, interaction with neuromuscular blockingagents, 99

Magnesium sulfate

as asthma-related bronchospasm treatment, 272complications of, 428as preeclampsia treatment, 427, 428

Magnetic resonance imaging (MRI) suites, 442,443–444

Maintenance anesthesiain asthmatic patients, 270–271

in chronic obstructive pulmonary disease patients,282

in heart transplant patients, 475–476, 477intracranial pressure management during, 320

Malaria, 44Mallampati classification, of the oropharynx,

59, 59fMarfan syndrome, 244, 247–248Mask ventilation, difficult, 64Masseter muscle rigidity (MMR), 325–326in pediatric patients, 402

Maximal inspiratory force, in obese patients, 361tMaximal oxygen consumption during exercise (VO2)

implication for blood transfusion, 43peak, in heart transplantation patients, 474

McGill Pain Questionnaire, 527Mean arterial pressure (MAP), 318effect of induction agents on, 90, 91tduring pregnancy, 411t

Mechanical ventilation. See also Ventilatorsin acute respiratory distress syndrome patients,

288, 290in acute respiratory failure patients, 151, 152,

154, 154–155in asthmatic patients, 271compliance in, 154

in critically-ill patients, 149–156in hypothermic patients, 220indications for, 149, 155peak pressure in, 154positive-pressure, 149, 155. See also Positive

end-expiratory pressure (PEEP)

effect on pulmonary artery occlusion pressure,191–192

as perioperative hypotension cause, 204postoperative, 284pressure-control, 150–151pressure-control continuous mandatory

(PC-CMV), 149pressure-support, 150–151split-lung, 156static pressure in, 154volume control-assist control, 149, 150volume control-synchronized intermittent

mandatory, 149, 150

volume control versus pressure control, 149Median nerve, as somatosensory-evoked potential

stimulation site, 500, 501t

Mediastinal mass, anterior, flow-volume loops in,71–72

MELD (Model for End-stage Liver Disease), 302–303,480

Memory, classification of, 207Memory deficits, cardiopulmonary bypass-related, 491Memory loss, 370Meningocele, as latex allergy risk factor, 366Mental status. See also Cognitive dysfunction;

Confusion; Delirium; Memory losseffect of blood loss on, 374t

Meperidine, 83tcharacteristics of, 88as chronic pain treatment, 536tequianalgesic doses of, 532tas preoperative analgesia, 119tside effects of, 85, 530

allergic reactions, 365, 530seizures, 86

somatosensory-evoked potential effects of, 502tuse inliver disease patients, 307obstetric patients, 419t, 422t

Mepivacaine, potency of, 107t

Metabolic disordersacid-base analysis of, 29as liver disease risk factor, 304tmassive blood transfusion-related, 48

Metabolic ratecerebral, 261

in hyperthyroidism, 353Metabolism, effect of hypothermia on, 218tMetaproterenol, 281tMethadone, 83tadverse effects of, 87, 339as chronic pain treatment, 536tequianalgesic doses of, 532t

Methamphetamine, crystal, 341Methemoglobin, effect on pulse oximetry accuracy,

172Methemoglobinemia, 110Methohexital, 524, 525Methotrexate, as asthma treatment, 269

Methylene blue, effect on pulse oximetry accuracy,172

3,4-Methylenedioxymethamphetamine, 341Methylmethacrylate, as hypotension cause, 204–205Methylnaltrexone, 84–85Methylprednisolone

as chronic obstructive pulmonary diseasetreatment, 281t

potency of, 355tO-Methyltransferase (COMT), 12Methylxanthines, as chronic obstructive pulmonary

disease treatment, 281tMetoclopramide

contraindication in Parkinson’s disease, 332preoperative administration of, 119t, 274–275

in morbidly obese patients, 122

562 INDEX

Metocurine, use in renal insufficiency patients, 315tMetoprolol, contraindication to, 211Mexiletine, as chronic pain treatment, 536tMidazolam

cardiovascular effects of, 90intravenous administration of, 93, 94loading dose of, 359tas preoperative sedation, 119tsomatosensory-evoked potential effects of, 502tuse as induction agent, 91tuse as sedative, 91t

use in awake intubation, 64tuse in cardiopulmonary bypass patients, 488use in pediatric patients, 395, 396t, 402

Milrinone, hemodynamic profile of, 112Mineralocorticoids, 355tMinimal alveolar concentration (MAC)

as anesthetic gas potency measure, 9, 75,76, 78

hypernatremia-related increase in, 39in hyperthyroidism, 353–354in hypothyroidism, 352in pediatric patients, 399

Minimally-invasive surgery, 511–517Minute ventilationduring hypercapnia and hypoxia, 22during hyperthermia, 220during pregnancy, 412t

Mitral regurgitation, 250–253, 251t, 252fMitral stenosis, 249–250, 249t, 252

as heart failure cause, 236tMitral valve replacement, 249–250, 251, 253Mivarcurium, 98tMixed venous oxygen saturation (SvO2),

measurement of, 188Model for End-stage Liver Disease (MELD), 302–303,

480

Monetlukast, 281tMonitoringAmerican Society of Anesthesiologists’ standards

for, 438of aortic surgery patients, 255, 257–258of burned patients, 385

during carotid endarterectomy, 261of craniotomy patients, 505–506during electroconvulsive therapy, 523–524of fetal heart rate, 416, 416fof glucose levels, 349of heart failure patients, 237

of heart transplantation patients, 476of intraoperative ischemia, 234in magnetic resonance imaging suites, 443of neonates, 389of obese patients, 360of patients receiving analgesia, 532in postanesthetic care units, 222

of pregnant patients, 428of pulmonary hypertension patients, 296of valvular heart disease patients, 245

Monoamine oxidase, 12Monoamine oxidase inhibitors, as hyperthermia

risk factor, 221Morbidity, perioperative, 280–281, 280t

Morphine, 83tas acute pain treatment, 528–529, 533allergic reactions to, 365as chronic pain treatment, 536tdifferentiated from opioid agonist-antagonists, 531duration of action of, 85, 86tequianalgesic doses of, 532t

intrathecal administration of, 455onset of action of, 85, 86tpeak effect of, 85, 86tas preoperative analgesia, 119tside effects of, 85somatosensory-evoked potential effects of, 502t

use in liver disease patients, 307use in obstetric patients, 422tin cesarean sections, 423t

use in renal failure patients, 86Morphine-3-glucuronide, 86Morphine-6-glucuronide, 86, 530Mortality, perioperative, 280–281, 280t

in geriatric patients, 435–436Motor-evoked potentials, 255Multiple sclerosis, 333, 334Muscarcinic antagonists, properties of, 15Muscle relaxants. See Neuromuscular blocking agentsMuscular dystrophies, 157, 327

myotonic, 327, 328Myasthenia gravis, 328–329Myelomeningocele, as latex allergy risk

factor, 366Myocardial hypertrophy, 238Myocardial infarctionelective surgery following, 234

electrocardiographic findings in, 159–160, 160f,161, 161f, 162, 162f

perioperative, 230posterior, 157prior, 231recent, 231

surgery-related reinfarction of, 234Myocardial ischemiaas blood transfusion indicator, 43clinical manifestations of, 230intraoperative detection of, 234perioperative, 231

Myocardial oxygen delivery, determinants of, 230Myocardial oxygen demand, determinants of,

229, 230Myocardial protection, during cardiopulmonary

bypass, 489, 491Myocardium, contusions of, 377–378Myocytes, cardiac, 113

Myofascial pain syndrome, 538Myoglobinuria, 382, 386Myotonic dystrophy, 327, 328

INDEX 563

N

Nalbuphineequianalgesic doses of, 532tuse in obstetric patients, 419t

Naloxone, 82–83, 85Narcotics. See also Opioidsdefinition of, 82

Nasal airways, 61Nasal discharge, in pediatric patients, 128–129Nasogastric intubation, in liver transplantation

patients, 483

Natriuretic peptide, b-type, 116Natural frequency, 197Nauseaheart failure-related, 240opioids-related, 84postoperative, 223, 227

contrast media-related, 441tin pediatric patients, 401spinal anesthesia-related, 452

Neck, examination of, 59–60Neonates, 404–410anesthetic risk in, 387Apgar Score evaluation of, 417, 417t

cardiovascular system of, 394estimated blood volume in, 400tmedical emergencies in, 390

Neostigmine, 102, 282Nephrectomy, donor, minimally-invasive, 513Nephropathies, salt-wasting, 38t

Nephrotic syndrome, 38tNerve blocks. See also Peripheral nerve blocks;

types of specific nerve blocksas chronic pain treatment, 537local anesthetic vascular absorption in, 107use in awake intubation, 64

Nerve injuries

patient positioning-related, 144pulmonary artery catheterization-related, 189spinal anesthesia-related, 454

Nerve stimulation, for neuromuscular blockadeassessment, 99, 100, 101

acceleromyography, 101

adequate, for surgical purposes, 101double-burst, 100in obese patients, 361patterns of, 99, 101simplest mode of, 99tetanic, 100, 101

train-of-four method, 99, 100, 101Nerve stimulators, characteristics of, 99Nervous system. See also Autonomic nervous system;

Central nervous system; Parasympatheticnervous system

aging-related changes to, 433Neurohumeral system, in heart failure, 239

Neuroleptic malignant syndrome, 326Neuroleptics, as chronic pain treatment, 536t

Neurologic diseases/disordersalcohol abuse-related, 336cardiopulmonary bypass-related, 491degenerative, 331–335

Neuromuscular blockadein chronic obstructive pulmonary disease patients,

282for facilitation of mechanical ventilation, 155–156nerve stimulation assessment of, 99, 100, 101acceleromyography, 101adequate, for surgical purposes, 101

as basis for neuromuscular blockade reversal,102

double-burst, 100, 103tpatterns of, 99, 101simplest mode of, 99single twitch, 99, 101f, 103t

tetanic, 100, 101, 101f, 103ttrain-of-four method, 99, 100, 101, 101f, 103t

residual, 223reversal of, 102–103, 103tin chronic obstructive pulmonary disease

patients, 282in obese patients, 361

Neuromuscular blocking agents, 96. See also namesof specific neuromuscular blocking agents

action potentiation of, 99allergic reactions to, 364–365benefits and risks of, 96as chronic pain treatment, 536t

drug interactions of, 99effect on intracranial pressure, 321as hypertension treatment, 202tnondepolarzing, 96, 98–99, 98t, 103somatosensory-evoked potential effects of, 502tuse inalcoholic patients, 337

burned patients, 385cardiopulmonary bypass patients, 488craniotomy patients, 507hypothermic patients, 220mechanically-ventilated patients, 155–156multiple sclerosis patients, 334

muscular dystrophy patients, 327myasthenia gravis patients, 328–329myotonic dystrophy patients, 328renal insufficiency patients, 315, 315t

Neuromuscular disorders, as respiratory acidosiscause, 26

Neuromuscular junction, anatomy of, 95, 95fNeuromuscular transmission, 96Neuropathic pain, 529, 535, 537–538Neuropathies, 331–335autonomicdiabetic, 345–346as perioperative hypotension cause, 204

patient positioning-related, 142–143, 146–147perianesthetic, 146

564 INDEX

Neuropathies (Continued)peripheral, in cardiac surgery patients, 146upper-extremity, 146–147

Neurosurgery

minimally-invasive, 511somatosensory-evoked potential monitoring during,

502Neurotoxicity, of local anesthetics, 109Neurotransmission, 105Nicardipine, 115Nitrates

action mechanisms and action sites of, 114antianginal effects of, 114–115

Nitric oxidepotentiation of, 299properties of, 297–298pulmonary hypertension-related decrease in, 293

as pulmonary hypertension treatment, 298side effects of, 478use in heart transplantation patients, 478

Nitroglycerinaction mechanisms and action sites of, 114perioperative use of, 204tprophylactic intraoperative infusion of, 233

as tachyphylaxis cause, 115Nitrous oxidechemical structure of, 75fcontraindications toelevated intracranial, 322pneumothorax, 78

effect on pulmonary circulation, 296–297as laparoscopic insufflation gas, 512tphysical properties of, 76tsecond gas effect of, 77–78somatosensory-evoked potential effects of, 502tteratogenicity of, 81toxicity of, 78, 81

use in anesthesia machines, 130, 131use in laparoscopy, 515

Nitrous oxide tanks, for anesthesia machines, 131Nitrovasodilators. See also Nitrates; Nitroglycerin;

Sodium nitroprusside; Vasodilatorsaction mechanisms and action sites of, 114

as pulmonary hypertension treatment, 297as tachyphylaxis cause, 115

Nociceptive pain, 535Nociceptors, 535Nonsteroidal anti-inflammatory drugs (NSAIDs)as acute pain treatment, 528–529, 533

as chronic pain treatment, 536t, 537complications of, 533cost of, 533

Norepinephrine, 11as allergic reaction treatment, 367hemodynamic profiles of, 113interaction with indirect-acting sympathomimetics, 9

laparoscopy-related increase in, 515metabolism of, 12synthesis of, 11–12

Nortriptyline, as chronic pain treatment, 536tNovoSeven, 565’-Nucleotidase, as biliary tract function indicator,

302

Nutritional deficiencies, alcohol abuse-related, 337

O

Obesity, 358–363as aorto-occlusive disease risk factor, 254definition of, 358, 358tmorbid

as aspiration risk factor, 512definition of, 358timplication for preoperative management, 122

physiologic and systemic disorders associatedwith, 358–359, 362

Obesity-hypoventilation syndromes.

See also Obstructive sleep apneaas respiratory acidosis cause, 26

Obstetric anesthesia. See PregnancyObstructive sleep apnea, 361–362in pediatric patients, 403as postoperative pulmonary complication risk

factor, 125t

Obturator nerve, patient positioning-related injuryto, 144

Occupational exposure, as chronic obstructivepulmonary disease cause, 278

Omega-3 fatty acids, 370Omeprazole, 119t

Omphalocele, 390, 391–392differentiated from gastroschisis, 391

Operating roompatient transport from, 222presence of pediatric patients’ parents in, 395–396

Opiates, definition of, 82Opioid abuse, 82, 338–339

Opioid agonist-antagonists, 82, 531equianalgesic doses of, 532t

Opioid agonists, equianalgesic doses of, 532tOpioid receptors, 82, 84t, 88, 531Opioids, 82–89as acute pain treatment, 528–530

addiction risk with, 529administration routes for, 83, 529–530cardiovascular effects of, 90as chronic pain treatment, 536tin combination with epidural anesthetics, 463commonly used, 82, 83t

context-sensitive half-time of, 86, 87fdefinition of, 82dependence on, 82endogenous, 82epidural, 422use in obstetric patients, 423

equianalgesic doses of, 83t, 85, 532t

exogenous, 82intracranial pressure effects of, 320intravenous administration of, 532

INDEX 565

Opioids (Continued)neuraxial, 88, 531as postoperative pain treatment, 203, 205as premedication, 119

respiratory depressant effects of, 224as respiratory depression cause, 85, 86, 86fside effects of, 83, 84, 85, 119, 531somatosensory-evoked potential effects of, 502tspinal (intrathecal), 422, 455, 533, 539use in obstetric patients, 422t, 423t

tolerance to, 82, 338

use inburned patients, 382cardiopulmonary bypass patients, 488chronic obstructive pulmonary disease patients,

282craniotomy patients, 507

liver disease patients, 307morbidly obese patients, 122neonates, 387obstetric patients, 419pediatric patients, 399

Opioid withdrawal, 339Oral airways, 61

Oral cavity, physical examination of, 58, 59, 59fOral intake, in postanesthetic care unit patients, 227Organ donors, for heart transplantation, 474Oropharynx, Mallampati classification of, 59, 59fOrthopedic injuries, damage control treatment of,

375–376

Orthopedic proceduresminimally-invasive, 511somatosensory-evoked potential monitoring

during, 502Osmolality, of serum, 36Overweight, definition of, 358tOxycodone, 83t

as chronic pain treatment, 536tequianalgesic doses of, 532t

Oxygeneffect on breathing, 22as laparoscopic insufflation gas, 512tuse in anesthesia machines, 130–131, 132

Oxygenationarterial, blood gas assessment of, 24extracorporeal, 272methods for improvement of, 60monitoring standards for, 438

Oxygenators, types of, 488

Oxygen consumptionfactors affecting, 22hyperthermia-related increase in, 220in obesity, 358during pregnancy, 411t, 412t

Oxygen content, arterial and venous, 21, 22Oxygen delivery (DO2crit), critical level, 43

Oxygen saturationin arterial blood (SaO2)pulse oximetry measurement of, 168–174

Oxygen tanks, for anesthesia machines, 131,132–133

Oxygen therapydeleterious effects of, in chronic obstructive

pulmonary disease patients, 280effect on inspired oxygen concentration (FiO2),

224, 224tfor pulmonary hypertension, 296–297in single-ventricle patients, 408

Oxyhemoglobin dissociation curve, 170–171, 170f,171t

Oxyhemoglobin saturation, measurement of, 168Oxymorphone, 83t, 530equianalgesic doses of, 532t

P

Pacing, cardiac, postbypass, 490

Painacute, 527–534definition of, 527, 535differentiated from chronic pain, 527management of, 527–534undertreatment of, 527

assessment of, 527, 528f

cancer-related, 537chronicacute pain associated with, 530definition of, 535differentiated from acute pain, 527management of, 535–540

definition of, 535as fifth vital sign, 531gate theory of, 539perception of, 535postoperative, 223epidural anesthesia-related, 465as hypertension cause, 203

postlaminectomy, 539Pain scales, 527, 528fPalpitationsheart failure-related, 240pheochromocytoma-related, 15–16

Pancreatitis

as acute respiratory distress syndrome riskfactor, 287t

alcoholic, 337Pancuroniumas nondepolarizing neuromuscular blocking

agent, 98t

use in renal insufficiency patients, 315tParalytics. See Neuromuscular blocking agentsParasitic infections, blood transfusion-related

transmission of, 44Parasympathetic nervous system, anatomy and

function of, 9–10, 9t, 10f, 11Parathyroid hormone, 357

Parents, of pediatric patients, 395–396Paresthesia, spinal anesthesia-related sensitivity

to, 452

566 INDEX

Parkinson’s disease, 332Parkland formula, 383–384Paroxetine, as chronic pain treatment, 536tPartial pressure of carbon dioxide in arterial blood

(PaCO2), 24in chronic obstructive pulmonary disease, 279–280correlation with end-tidal carbon dioxide, 176effect of carbon dioxide insufflation on, 513

Partial pressure of carbon dioxide (PCO2), relationshipto alveolar ventilation, 22

in presence of opioids, 85, 86f

Partial pressure of oxygen in arterial blood (PaO2), 24Partial thromboplastin time (PTT), 54pregnancy-related decrease in, 412tpreoperative, 127

Partition coefficients, 76, 76tPatent ductus arteriosus, 388t, 408

Patient-controlled analgesia (PCA), 529, 530–531, 532use in obstetric patients, 419

Patient-controlled epidural anesthesia (PCEA), 421Patient foramen ovale, in craniotomy patients, 507Patient positioning, 142–148of craniotomy patients, 507of laparoscopy patients, 513

of obese patients, 360physiologic changes associated with, 142of pregnant patients, 146

Pavulon, as myopathy cause, 271Peak pressure, in mechanical ventilation, 154Pediatric patients, 394–403. See also Infants;

Neonatesburn injuries in, 380laparoscopy in, 516obese, 361bariatric surgery in, 362–363

obstructive sleep apnea in, 361preoperative medication in, 121

respiratory infections in, 128–129PEEP. See Positive end-expiratory pressure (PEEP)Pelvis, fractures of, 375–376Penicillin, allergic reactions to, 365Pentazocine, 82Pentoprazole, 119t

Percutaneous coronary interventions, 232–233prior to noncardiac surgery, 232

Perfusion. See also Cerebral perfusionin burn patients, 381effect of intra-abdominal pressure on, 514–515uteroplacental, factors affecting, 415

zones of West in, 19Perfusion lung scans, for pulmonary hypertension

evaluation, 295Peripheral nerve blocks, 466–472of the anterior abdominal wall, 471of the chest wall, 471lower-extremity, 469–470, 470t

onset of anesthesia in, 107risks of, 466upper-extremity, 467–469, 469t

Peripheral nerveslithotomy position-related injury to, 142–143localization of, 467somatosensory-evoked potentials of, 500–504

Peroneal nerve, patient positioning-related injuryto, 144

pH, 27Pharmacokinetics. See also Drug metabolism;

names of specific drugsin obese patients, 359

Pharmacology. See also Drug metabolism; names

of specific drugsof anesthetic drugs, in children, 399

Pharynx, Mallampati classification of, 59, 59fPhencyclidine (PCP), 341–342Phenothiazines, contraindication in Parkinson’s

disease, 332

Phenylephrinecoadministration with local anesthetics, 108effects and doses of, 14perioperative use of, 12–14use in awake intubation, 64t

Pheochromocytomadefinition of, 354

perioperative management of, 16symptoms and diagnosis of, 15–16

Phlebostatic axis, 190Phosphate, buffering function of, 26Phosphodiesterase inhibitors, 112, 113definition of, 299

as pulmonary hypertension treatment, 295pH-stat method, of blood gas analysis, 490Physical statusclassification scale for, 123–124of heart transplantation candidates, 475

"Pink puffers," 279Pipecuronium, 98t, 315t

Placentaanatomy of, 415transport of substances across, 415

Placental abruption, 429Placenta previa, 429Plasma proteins, pregnancy-related decrease in, 413

Plasma volume, pregnancy-related increase in, 412tPlastic surgery, minimally-invasive, 511Platelet abnormalities, 53cardiopulmonary bypass-related, 490

Platelet countduring pregnancy, 412t

preoperative, 53Pneumonectomy, morbidity and mortality associated

with, 280–281, 280tPneumonitis, aspiration, 120–121, 274Pneumoperitoneum, 514, 515, 516–517Pneumothoraxcentral venous catheterization-related, 185, 186

as contraindication to nitrous oxide, 78, 79fpulmonary artery catheterization-related, 189tension, 376, 378

INDEX 567

Poliomyelitis, 334Polycythemia, cyanotic heart disease-related, 406Polyneuropathy, critical illness, 334–335Poppy, as opioid source, 82

Porphyria, 91Portal vein, as hepatic blood supply source, 306Positive end-expiratory pressure (PEEP)auto (intrinsic), 152, 153, 153f, 155, 283optimal, 152role of, 152side effects of, 153

use inacute lung injury patients, 285–286, 285tacute respiratory distress syndrome patients,

285–286, 285tlung isolation, 497

Postanesthetic care, 222–228for aortic surgery patients, 257–258

Postanesthetic care units (PACUs), 222hypoxia management in, 225patient discharge from, 227–228patient selection for, 222

Postoperative nausea and vomiting (PONV),223, 227

contrast media-related, 441tin pediatric patients, 401spinal anesthesia-related, 452

Postpoliomyelitis syndrome, 334Posttraumatic stress disorder, intraoperative

awareness-related, 208

Potassium. See also Hypekalemia; Hypokalemiaas hypokalemia treatment, 40

Prayer sign, 346Prednisoneas chronic obstructive pulmonary disease

treatment, 281tpotency of, 355t

Preeclampsia, 426, 426t, 427, 428, 428t, 431Pregabalin, as chronic pain treatment, 536tPregnancy, 411–418, 419–425. See also Labor

and deliveryarterial blood gas values during, 413, 413tas aspiration risk factor, 511

cardiovascular changes during, 411, 411t, 418cardiovascular disease during, 430–431diabetes during, 343, 430hematologic changes during, 411–412, 412thigh-risk, 426–431laparoscopy during, 516

local anesthesia toxicity during, 108nonobstetric surgery during, 417–418obesity during, 361renal disease during, 430thyroid function testing during, 351tin trauma patients, 378

Pregnancy testing, preoperative, 125t

Pregnant patients, positioning of, 146Preloadeffect of vascular drugs on, 112

Preload (Continued)left ventricular, central venous pressure in, 185right ventricular, central venous pressure in, 184–185

Preoperative evaluation, 123–129of asthma patients, 268of burned patients, 384, 385of diabetic patients, 345of electroconvulsive therapy patients, 523of obese patients, 359–360prior to epidural anesthesia, 459–460

Preoperative management

of aortic surgery patients, 254–255of neonates, 389of reactive airway disease patients, 270

Preoperative medication, 118–122in pediatric patients, 121, 395, 396, 396t, 402somatosensory-evoked potential effects of, 502t

Pressure overload, in valvular heart disease, 244Pressure-volume loopsin aortic insufficiency, 248in aortic regurgitation, 247fin aortic stenosis, 246, 246fdefinition of, 245in mitral regurgitation, 251–252

in mitral stenosis, 250normal, 245, 245f

Prilocaine, 110Prion-mediated diseases, 44Procainemaximum safe doses of, 107t

potency of, 107tPromethazine, 119tProne position, 143f, 144–145mechanical ventilation in, 154–155

Propofolallergic reactions to, 364cardiovascular effects of, 90, 91t

contraindications to, 93effect on systemic and pulmonary vascular

resistance, 406loading dose of, 359tpulmonary effects of, 297somatosensory-evoked potential effects of, 502t

use as induction agent, 91tuse as sedative, 91tuse inburned patients, 382electroconvulsive therapy, 524pediatric patients, 396

Propofol infusion syndrome, 92–93Propranolol, perioperative use of, 204tProptosis, 353Propylthiouracil, 353Prostaglandins, as pulmonary hypertension

treatment, 295Prostanoid analogs, 299

Prostanoids, 298–299Protamine, allergic reactions to, 365Protein, buffering function of, 26

568 INDEX

Protein C, 52–53Protein S, 52–53Prothrombin time (PT), 55as hepatic synthetic function indicator, 302

pregnancy-related decrease in, 412tpreoperative, 127

Proton pump inhibitors, preoperative administrationof, 119t

Pseudoaddiction, definition of, 338Pseudocholinesterasedeficiencies in, 97–98

in liver transplantation patients, 483in obese patients, 359

Psychogenic pain, 535Psychological disorders, awareness during

anesthesia-related, 208Psychological preparation, preoperative, 118

Pulmonary arterycatheterization of. See Catheterization, pulmonary

arteryhypertension of. See Hypertension, pulmonaryrupture of, 189

Pulmonary artery occlusion pressure (PCAP)normal values for, 188

waveforms of, 191–192, 191f, 192f, 193, 193fPulmonary artery pressure (PPA)

effect of intravenous anesthetics on, 297elevated, treatment of, 295pulmonary artery catheterization measurement

of, 188

in pulmonary hypertension, 293Pulmonary complications, postoperative, 125, 125trisk factors for, 68

Pulmonary functioneffect of laparoscopy on, 514, 514t, 515effect of patient positioning on, 513effect of surgery and anesthesia on, 73

in neonates, 387normal, 300relationship to perioperative morbidity and

mortality, 280–281, 280tPulmonary function testing, 68–74definition of, 68

preoperative, 125t, 280–281of asthmatic patients, 268of obese patients, 360

in pulmonary hypertension, 294Pulmonary risk, perioperative, 280–282, 280tPulmonary stenosis, 406–407

Pulmonary system. See Respiratory systemPulmonary vascular resistance (PVR)calculation of, 294, 405–406conditions that increase, 404beffect of anesthetic drugs on, 406in pediatric heart disease patients, 397during pregnancy, 411t

pulmonary artery catheterization measurementof, 188

in single ventricle patients, 408

Pulse oximetry (SpO2), 168–174comparison with oxygen saturation in arterial

blood (SaO2)false readings on, 171–172

in magnetic resonance imaging suites, 443–444normalization procedure in, 169R/IR ratio in, 169–170, 172transmission and reflection, 168

Pulse pressure, effect of blood loss on, 374tPumping effect, 134Pump prime, 488

P waves, in ventricular tachycardia, 213, 214Pyloric stenosis, 390, 392, 393

Q

QRS complexmagnesium sulfate-related widening of, 428in ventricular tachycardia, 213

QT interval, prolonged, 214

R

Radial arteryas arterial pressure monitoring site, 195–196as source of blood supply to the hand, 195, 196

Radiation, as heat loss mechanism, 219

Radiation exposuremeasurement of, 441, 441tprotection from, 442, 444

Radiculopathy, herniated disks-related, 538–539Radioactive iodine, as hyperthyroidism treatment, 353Rales

bilateral, 225–226heart failure-related, 240

Ranitidine, as preoperative medication, 119tReactive airway disease, 267–273. See also Asthma;

Chronic obstructive pulmonary disease (COPD);Emphysema

definition of, 267

pulmonary function test abnormalities in, 70, 71tReciprocal change, 162Recurrent laryngeal nerve, thyroid surgery-related

injury to, 354Red blood cell transfusions, 378Red blood cell volume, pregnancy-related increase in,

412tReflex sympathetic dystrophy (complex regional pain

syndrome I), 537Regional anesthesia. See also Spinal anesthesiain anticoagulated patients, 454in carotid endarterectomy patients, 261

in chronic obstructive pulmonary disease patients,282

in diabetic patients, 348in geriatric patients, 434in heart failure patients, 242in hypertensive patients, 203as hypotension cause, 205

intravenous. See Bier blockfor laparoscopic procedures, 515in multiple sclerosis patients, 333

INDEX 569

Regional anesthesia (Continued)in neonates, 393in obese patients, 360in pediatric patients, 400–401

Remifentanil, 83t, 87, 307loading dose of, 359tuse in electronconvulsive therapy, 524

Renal disease, in pregnant patients, 430Renal failureacute, 301in aortic aneurysm surgical patients, 256

in burned patients, 382dopamine treatment of, 116–117perioperative, 311, 314

acute, dopamine treatment of, 115in aorto-occlusive disease patients, 254chronic, hyperkalemia associated with, 41

contrast media-related, 440morphine-related respiratory depression in, 86opioid metabolism in, 86postoperative, 311

Renal function, 308–316aging-related changes in, 433during aortic surgery, 256

in burned patients, 382effect of anesthetics on, 314–315intraoperative protection of, 314, 316in neonates, 387

Renal function tests, 311–312, 312t, 313–314Renal insufficiency, 314

neuromuscular blocking agent use in, 315, 315tperioperative management of, 315–316

Renal reserve, loss of, 314Renal systemeffect of hypothermia on, 218tpregnancy-related changes in, 413

Renin, laparoscopy-related increase in, 515

Renin-angiotensin system antagonists, as hypotensioncause, 205

Reperfusionin liver transplantation, 485–486neuroexcitation associated with, 506–507

Reperfusion syndrome, 484–485

Residual capacity, effect of patient positioningon, 142

Residual volume (RV), 70fin obstructive lung disease, 71tduring pregnancy, 412t

Resin triiodothyronine uptake test, 351, 351t

Respiration center, of the brain, 22Respiratory depression, induction agent-related, 91Respiratory distress syndrome. See also Acute

respiratory distress syndrome (ARDS)in neonates, 392in premature infants, 388t

Respiratory drive, chronic obstructive pulmonary

disease-related decrease in, 279–280Respiratory failure, mechanical ventilation in,

151, 152

Respiratory muscles, 17Respiratory rateeffect of blood loss on, 374tduring intubation, in obese patients, 361t

in pediatric patients, 394during pregnancy, 412t

Respiratory systemaging-related changes to, 432effect of alcohol on, 336effect of burns on, 381effect of hypothermia on, 218t

effect of myotonic dystrophy on, 328effect of patient positioning on, 142pediatric, comparison with adult, 394, 395tphysiology of, 17–23pregnancy-related changes in, 412–413, 412t

Respiratory tract infections

as acute respiratory distress syndrome risk factor,287t

in pediatric patients, 128–129recurrent, as chronic obstructive pulmonary disease

risk factor, 278upper, in pediatric patientsimplication for general anesthesia, 402–403

as tonsillectomy contraindication, 128–129Resuscitationof aortic surgery patients, 257of burned patients, 383, 385colloid solution use in, 34–35during spinal anesthesia, 453

of traumatic brain injury patients, 322–323Retinopathy, of prematurity, 388, 388tRevascularization, coronary, 232, 241Reverse steal effect, 260Reversible ischemic neurologic deficit, 259Revised Cardiac Risk Index, 127, 128tRewarming, as hypothermia treatment, 220

Rh blood genotype, 47–48, 48tantigens of, 48

Rheumatic fever, as valvular heart disease cause, 244Right left ventricular failure, after cardiopulmonary

bypass, 477, 478Right left ventricular function, intraoperative

evaluation of, 478Right ventricle, blood supply to, 294Right ventricular end-diastolic pressure (RVEDP),

pulmonary hypertension-related increase in, 293Right ventricular hypertrophy, pulmonary

hypertension-related, 293

Right ventricular outflow tract obstruction (RVOT),397

Ringer’s lactate solution, 383–384, 399–400Robin Hood effect, 260Rocuroniumallergic reactions to, 364–365loading dose of, 359t

metabolism of, 98–99as nondepolarizing neuromuscular blocking

agent, 98t

570 INDEX

Rofecoxib, as chronic pain treatment, 536tRopivacaine, 110as epidural anesthetic, 462tpotency of, 107t

as spinal anesthesia, 451tuse in obstetric patients, 420, 421

Rule of nines, for estimation of burn injury severity,384, 384t

S

St. John’s wort, 369, 371

Saline solutionsas hyperchloremia cause, 42hypertonic, 36as metabolic acidosis cause, 33

Saphenous nerve, patient positioning-related injuryto, 144

Scalds, 380Sciatic nerve, patient positioning-related injury to, 144Sciatic nerve blocks, 107, 470tScintigraphy, exercise thallium, 231Scopolamineas preoperative sedation, 119tside effects of, 120, 120t

Second gas effect, 77–78Secrets, Top 100, 1–8Sedation. See also Preoperative medicationadministration by nonanesthesiologists, 439–440conscious, levels of, 438, 439–440, 439toutside the operating room, 437–444in pediatric patients, 121, 395

Sedativesspinal anesthesia-related sensitivity to, 452, 453use in hypothermic patients, 220

Segmental block, 464Seizurescardiopulmonary bypass-related, 491

eclampsia-related, 428–429electroconvulsive therapy-related, 522–523, 524, 525local anesthetics-related, 109opioids-related, in renal failure patients, 86tramadol-related, 88

Selective serotonin reuptake inhibitors, as chronic

pain treatment, 536tSepsisas acute respiratory distress syndrome cause,

287, 287tas hepatocellular injury cause, 305t

Serotonin syndrome, 528–529

Sertraline, as chronic pain treatment, 536tSerum, osmolality of, 36Sevofluranechemical structure of, 10, 75fmetabolic products of, 80physical properties of, 76tsomatosensory-evoked potential effects of, 502t

Shivering, 219Shivering, as heat production mechanism, 219in neonates, 387

Shockburn-related, 383–384cardiogenic, 115, 116hypovolemic, treatment for, 374

neurogenic, in spinal cord injury patients, 377septic, 115, 116

Shunt fraction, calculation of, 21, 22Shuntsabsolute, 21calculation of, 405as hypoxemia cause, 20

left-to-right, 397tcardiac effects of, 404effect on pediatric inhalational induction, 397pulmonary vascular effects of, 404

right-to-left, 397tcyanotic heart disease-related, 406, 407–408,

407feffect on pediatric inhalational induction, 397tetralogy of Fallot-related, 407f

Sildenafil, 299Sinoatrial node dysfunction, 211Sitting position, 143f, 145, 507Skin, burn-related damage of, 380

Sleep apnea, obstructive, 361–362in pediatric patients, 403as postoperative pulmonary complication risk

factor, 125tSleep-disordered breathing. See also Sleep apnea,

obstructive

in pediatric patients, 403Sleep disturbancesawareness during anesthesia-related, 208fibromyalgia-related, 538

Smokingas aorto-occlusive disease cause, 254as cerebrovascular ischemic events cause, 260

as chronic obstructive pulmonary disease cause,278, 279

as postoperative pulmonary complication cause,125t

Smoking cessation, preoperative, 126Sodium. See also Hypernatremia; Hyponatremia

normal concentration of, 38Sodium nitroprussideaction mechanisms and action sites of, 114perioperative use of, 204tas pulmonary hypertension treatment, 297as tachyphylaxis cause, 115

Sodium thiopentalallergic reactions to, 364cardiovascular effects of, 90, 91tcerebral protective profile of, 93contraindications to, 90–91intra-arterial injection of, 90loading dose of, 359t

somatosensory-evoked potential effects of, 502tuse in burned patients, 382use in pediatric patients, 396

INDEX 571

Somatosensory-evoked potentials (SSEPs), 255,500–504

Spinal anesthesia, 451–457. See also Epiduralanesthesia

combined with epidural anesthesia, 464in obstetric patients, 424

comparison withepidural anesthesia, 459general anesthesia, 451

complications of, 452, 454continuous, 456–457

contraindications to, 454differentiated from epidural anesthesia, 43in geriatric patients, 434with heparin use, 454–455lumbar levels of administration of, 452neurotoxicity of, 109–110

in pregnant patients, 428termination of effect of, 451"total," 453, 461, 463use in multiple sclerosis patients, 333

Spinal cord injuryas latex allergy risk factor, 366management of, 377

Spinal cord stimulators, 539Spinal surgerysomatosensory-evoked potential monitoring

during, 500–504as visual loss cause, 147–148

Spirometry, 69, 74

preoperative, 68SpO2. See Pulse oximetryStatic compliance, 18Static pressure, in mechanical ventilation, 154a-stat method, of blood gas analysis, 490Stents, coronary, 233bare metal, 128

drug-eluting, 128, 233Sternocleidomastoid musclerespiratory function of, 17as somatosensory-evoked potential recording

site, 500Sternotomy, repeat, 476

Steroidsexogenous, comparison to cortisol, 355–356, 355tinteraction with neuromuscular blocking

agents, 99as multiple sclerosis treatment, 333perioperative supplemental, 356

Stress, effect on insulin secretion, 345Stress hormones, release during cardiopulmonary

bypass, 489Stress testing, prior to noncardiac surgery, 231Stridoreffect of helium on, 18in pediatric patients, 402

postextubation, 225Stroke, 259atrial fibrillation-related, 213

Stroke (Continued)cardiopulmonary bypass-related, 491carotid endarterectomy-related, 262

Stroke index, pulmonary artery catheterization

measurement of, 188Stroke volumein obesity, 358during pregnancy, 411tpulmonary artery catheterization measurement

of, 188Stump pressure, as cerebral perfusion indicator, 261

Subarachnoid block. See Spinal anesthesiaSubarachnoid space, local anesthetic injection into,

461, 463Subclavian artery, pulmonary artery catheterization-

related injury to, 189Subclavian vein, as central venous catheter

insertion site, 180–181Succinylcholineaction mechanism of, 96allergic reactions to, 364–365contraindication in muscular dystrophy patients, 327as hyperkalemia cause, 41indications for, 96–97

loading dose of, 359tside effects of, 97use inburned patients, 385chronic obstructive pulmonary disease

patients, 282

electroconvulsive therapy, 525renal insufficiency patients, 315spinal cord injury patients, 377

Sufentanil, 83t, 455loading dose of, 359tsomatosensory-evoked potential effects of, 502tuse in obstetric patients, 422t

Sugammadex, 102Supine position, 142, 143fSupraclavicular nerve block, 469tSurface tension, of small airways and alveoli, 18Surgery. See also specific types of surgeryfollowing percutaneous coronary intervention,

232–233as myocardial ischemia risk factor, 231

Sweatingdrug-induced, 221hyperthermia-related, 220pheochromocytoma-related, 15–16

Sympathetic nervous systemanatomy and function of, 9–10, 9t, 10fpostganglionic adrenergic receptors of, 11, 11t

Sympathomimetic amines, 113Sympathomimeticsdefinition of, 12direct-acting, 12–14

as hyperthermia risk factor, 221indirect-acting, 9perioperative use of, 12–14

572 INDEX

Syncopecongenital long QT syndrome-associated, 214pheochromocytoma-related, 15–16pulmonary hypertension-related, 294

Syndrome of inappropriate secretion of antidiuretichormone, 34, 38t

Systemic vascular resistance (SVR)calculation of, 405–406in hypertension, 201during pregnancy, 411tpulmonary artery catheterization measurement

of, 188Systolic dysfunction, 238, 239f

T

Tachycardiaanaphylaxis-related, 364

atrial, 211, 212as blood transfusion indicator, 43electroconvulsive therapy-related, 524hyperthermia-related, 220hyperthyroidism-related, 353narrow-complex, differential diagnosis for, 212tparoxysmal supraventricular, 212

postoperative, 226sinus, 211supraventricularwith aberrance, 213–214narrow-complex, 214–215

ventricular

digoxin toxicity-related, 211monomorphic, 213, 214polymorphic, 214

wide-complex, 213–215, 215fTachyphylaxis, nitrovasodilators-related, 115Tachypneaacute respiratory distress syndrome-related, 288

asthma-related, 268chronic obstructive pulmonary disease-related,

279Tamponade, cardiac, 376, 378as perioperative hypotension cause, 204

Tapendatol, 530

Temperature, effect on somatosensory-evokedpotentials, 503

Temperature disturbances, 217–221Temperature monitoring, intraoperative, 97Temporomandibular junction, functional assessment

of, 59

Terbutalineas asthma treatment, 268, 269tas chronic obstructive pulmonary disease

treatment, 281tTetracainemaximum safe doses of, 107tpotency of, 107t

as spinal anesthesia, 451tuse in cesarean sections, 423t

Tetralogy of Fallot, 397, 406–407, 407f"Tet spells," 397, 406–407

Theophyllineas asthma treatment, 269, 269tas chronic obstructive pulmonary disease

treatment, 281t

Thermal burns, 380Thermogenesis, 219Thermoregulation, 217effect of epidural anesthesia on, 462effect of spinal anesthesia on, 454in neonates, 387

Thiopental. See Sodium thiopental

Third-space losses, 36–37Thoracic duct, central venous catheterization-related

puncture of, 185, 186Thoracic paravertebral nerve block, 471Thoracic surgerylung isolation use in, 493, 498

morbidity and mortality associated with, 280tpulmonary function testing prior to, 73, 73t

Thoracoscopic procedures, 511Thrombin, burn-related deficiency of, 383Thrombin time, preoperative, 127Thrombocytopeniacirrhosis-related, 302

dilutional, 53, 54preeclampsia-related, 428

Thromboelastography (TEG), 54, 56, 56f, 57Thromboembolismcentral venous catheterization-related, 185perioperative prophylaxis against, 127

pregnancy-related, 411–412Thyroglobulin, iodination of, 351Thyroidectomy, surgical subtotal, 353Thyroid function tests, 351, 351tThyroid hormoneinotropic effect of, 117synthesis of, 351

Thyroid hormone replacement therapy, 352–353Thyroiditis, Hashimoto’s, 352Thyroid-stimulating hormone, 351, 351tThyroid storm (thyrotoxicosis), 354, 356Thyroid surgery, complications of, 354Thyrotoxicosis (thyroid storm), 354, 356

Thyroxine, 351, 351tTibial artery, posterior, as arterial pressure monitoring

cannulation site, 196Tibial nerve, posterior, as somatosensory-evoked

potential stimulation site, 501tTidal volume

of anesthesia ventilators, 141during extubation, in obese patients, 361tinhalational anesthesia-related decrease in, 78as neuromuscular function indicator, 103tduring pregnancy, 412tratio to physiologic dead space (VD/VT), 21

Tolerance, definition of, 338

Tonicity, regulation of, 31–32Tonsillectomy, respiratory infections as

contraindication to, 128–129Topical agents, for acute pain treatment, 528–529

INDEX 573

Top 100 Secrets, 1–8Torque control blockers. See Univent tubesTorsades de pointes, 87, 214, 214fTotal body surface area (TBSA), of burn injuries,

383–384, 384tTotal lung capacity, 70fin obstructive and restrictive lung diseases, 70fduring pregnancy, 412t

Total parenteral nutrition, as hepatocellular injurycause, 305t

Trachea

intubation of. See Endotracheal intubationtears of, 378width estimation of, 493, 494t

Tracheostomy, 59Train-of-four assessment, of neuromuscular blockade,

99, 100, 101

Tramadol, 83t, 88, 528–529Tranexamic acid, use in heart transplantation patients,

476–477Transfusion-related acute lung injury (TRALI), 45,

45t, 46, 47Transfusion therapy, 43–50Transient ischemic attacks (TIAs), 259

cardiopulmonary bypass-related, 491Transient neurologic syndrome, 455–456Transport, of patients, 222Transsphenoidal surgery, 509Transtracheal ventilation, 65Transverse abdominis plane nerve block, 471

Trauma, 373–379as acute respiratory distress syndrome risk factor,

287tas aspiration risk factor, 511

Trauma patients, 373–379elderly, 378pregnant, 378

Traumatic brain injury, 322–323Trendelenburg position, 142, 143f, 144hemodynamic and pulmonary effects of, 513reverse, hemodynamic and pulmonary effects

of, 513during spinal anesthesia, 452

Triamcinolone, potency of, 355tTricyclic antidepressantsas chronic pain treatment, 536t, 537as hyperthermia risk factor, 221

Trigger points, 538Triiodothyronine, synthesis of, 351

Tubocurarine, 282, 315tTubulointerstitial disease, during pregnancy, 430Turbulent gas flow, 18, 22

U

Ulcers, Curling’s, 382Ulnar artery, as arterial pressure monitoring

cannulation site, 196Ulnar nerve, patient positioning-related injury to, 146Umbilical cord, anatomy of, 415

Unconscious patients, with hypotension, 373

Univent tubes, 495, 496, 497tUniversal precautions, 366Upper respiratory tract infections, in pediatric patientsimplication for general anesthesia, 402–403

as tonsillectomy contraindication, 128–129Uremia, renal failure-related, 311Urine output, as renal function indicator, 314Urologic procedures, laparoscopic, 511Urticaria, 45, 364, 441tUteroplacental perfusion, 415Uterus

postpartum atony of, 429–430, 431rupture of, 429

V

Valerian, 369, 370Valproic acid, as chronic pain treatment, 536tValvotomy, aortic balloon, 247–248Valvular heart disease, 244–253as active cardiac condition, 126, 127

as heart failure cause, 236, 236tVaporization, 133Vaporizers, 133–134, 135–136removal from anesthesia machines, 135–136

Varices, esophagogastric, cirrhosis-related, 301–302Vasa previa, 429

Vascular resistance, uterine, 415Vascular surgery, somatosensory-evoked potential

monitoring during, 502Vasoconstrictionacidemia-related, 27cerebral, alkalemia-related, 27hypoxic pulmonary, 21, 78–79, 280, 297

Vasoconstrictor agentsconcurrent use with phosphodiesterase inhibitor,

112as pulmonary hypertension treatment, 296

Vasodilationhyperthermia-related, 220

pulmonary, alkalemia-related, 27Vasodilator agents, 112–117action mechanisms and action sites of, 115–116direct-acting, as pulmonary hypertension

treatment, 296limitations of, 112as pulmonary hypertension treatment, 295, 297,

298, 482Vasoplegia, 491Vasopressinaction mechanism of, 116deficiency of, 33texcessive, 33–34

laparoscopy-related increase in, 515as shock treatment, 115, 116

Vasospasm, 263alkalemia-related, 27subarachnoid hemorrhage-related, 263–264, 509

VD/VT, calculation of, 21Vecuronium

loading dose of, 359t

574 INDEX

Vecuronium (Continued)metabolism of, 98–99as nondepolarizing neuromuscular blocking

agent, 98t

Venovenous bypass, 483Ventilation. See also Mechanical ventilationalveolar, during pregnancy, 412tanesthesia-related impairment of, 223arterial blood gas assessment of, 24effect of inhalational anesthetics on, 78–79effect of patient positioning on, 142

epidural anesthesia-related changes in, 462jet, in laser surgery of the airway, 519lung protective, in neonates, 392mask, difficult, 64monitoring standards for, 438prone, 290–292

pulse oximetry as indicator for, 173single-lung, 378, 493, 497–498, 497tspontaneous, in laser surgery of the airway, 519transtracheal, 65zones of West in, 19

Ventilation-perfusion mismatch (V/Q)in chronic obstructive pulmonary disease patients,

280general anesthesia-related exacerbation of, 20as hypoxemia cause, 20patient positioning-related, 144

Ventilator bundle, 153Ventilators

on anesthesia machinesin one-lung ventilation, 139, 140, 140b,

497–498in intensive care units (ICU), 139, 150"fighting the,", 155, 155settings for acute respiratory failure, 152trigger variables in, 151

for magnetic resonance imaging suites, 443–444Ventricle, single, 408, 409fVentricular arrhythmias, 214Ventricular assist devices (VAD), 473, 477Ventricular failure, 408Ventricular hypertrophy, right, 157, 158, 158f

Ventricular obstruction, 408, 408bVerapamil, contraindications to, 211, 295Vercuronium, as myopathy cause, 271Video-assisted thoracic surgery, 511Viral infections. See also specific virusesupper respiratory tract, in pediatric patients,

128–129Visceral pain, 529, 535Vision losscardiopulmonary bypass-related, 491postoperative, 147–148

Visual analog pain scales, 527, 528fVital capacity (VC)

during extubation, in obese patients, 361tin neonates, 387during pregnancy, 412t

Vital signseffect of blood loss on, 374tin pediatric patients, 394, 395

Vitamin(s), incidence of use, 369

Vitamin B12, interaction with nitrous oxide, 78, 81Vitamin B12 deficiency, as nitrous oxide risk factor, 78Vitamin E, effects of, 370Vitamin K, deficiency of, 54, 302Vocal cords, thyroid surgery-related injury to, 354Volatile anesthetics. See Inhalational anestheticsVolume loading, endogenous, 296

Volume overload, in valvular heart disease, 244Volume status, assessment of, 33, 34in hepatorenal syndrome patients, 301in neonates, 388

VO2 (maximal oxygen consumption during exercise)implication for blood transfusion, 43

peak, in heart transplantation patients, 474Vomitingheart failure-related, 240as metabolic alkalosis cause, 29postoperative, 223, 227in pediatric patients, 401spinal anesthesia-related, 452

W

Warfarin, as intraoperative hemorrhage risk factor,127

Water intoxication, 33–34Weight gain, hypothyroidism-related, 380Weight loss, bariatric surgery for, 362–363Wheezingasthma-related, 267, 268

chronic obstructive pulmonary disease-related, 279as contraindication to elective surgery, 272heart failure-related, 240inhalation injury-related, 381intraoperative, 271–272differential diagnosis of, 283

Wire-guided endobronchial blockers, 495, 496, 497tWolff-Parkinson-White (WPW) syndrome, 157,

214–215, 215fWorld Health Organization (WHO), analgesic ladder of,

528–529, 528fWound healing, effect of hypothermia on, 218t

X

X-rays, chestfor acute lung injury evaluation, 285t

for chronic obstructive pulmonary diseaseevaluation, 279

for congestive heart failure evaluation, 240in obese patients, 360preoperative, 124, 125t, 360for pulmonary hypertension evaluation, 294

Z

Zaprinast, 299

Zileuton, as chronic obstructive pulmonary diseasetreatment, 281t

Zones of West, 19, 193