Preface
Contributors
Abbreviations
PART I INTRODUCTION
Chapter 1 General anaesthesia
Ian Harley
Introduction
General anaesthesia
Protective reflexes
Triad of anaesthesia
Components of anaesthesia
Depth of anaesthesia
Lack of movement
Guedel’s planes of anaesthesia
Measuring depth of anaesthesia
Mechanisms of action
Volatile anaesthetics
IV anaesthetic agents
Adjuvants
Choice of anaesthetic technique
Balanced anaesthesia
Awareness
Incidence
Causes
Informed consent
Management
Conclusion
Chapter 2 Regional anaesthesia
Ian Harley
Introduction
Localisation
Nerve stimulators
Ultrasound guidance
Plexus blocks
Brachial plexus block
Central neural blockade
Spinal anaesthesia
Epidural anaesthesia
Caudal block
Complications of regional techniques
Neuraxial blockade and anticoagulation
Spinal headache
Combined spinal epidural
Choice of spinal or epidural technique
Bier’s block
Chapter 3 Sedation
Ian Harley
Introduction
Indications
Techniques
Reassurance
Oral sedation
Inhalational sedation
IV sedation
Side-effects and problems
Principles of safe IV sedation
Time
Facilities
IV access
Personnel
Monitoring
Recovery and discharge
PART II PHYSIOLOGY AND PHARMACOLOGY
Chapter 4 Anaesthetic drugs
Ian Harley
Introduction
Pharmacokinetics
Compartment model
Volume of distribution
Clearance
Half-life
Rate constant
Protein binding
Ionisation
Potency
Efficacy
Pharmacodynamics
Receptors
Inhaled anaesthetic agents
Induction agents
Propofol
Thiopentone
Volatile anaesthetic agents
Halothane
Enflurane
Isoflurane
Desflurane
Nitrous oxide
Opioids
Morphine
Pethidine
Fentanyl
Alfentanyl
Remifentanil
Naloxone
Tramadol
Benzodiazapines
Midazolam
Diazepam
Alpha agonists
Clonidine
Dexmedetomidine
Muscle relaxants
Depolarising muscle relaxants
Non-depolarising muscle relaxants
Reversal agents
Anticholinesterases
Specific reversal agents
Anticholinergics
Antiemetics
Metoclopramide
Dexamethasone
Serotonin antagonists
Scopolamine
Chapter 5 Fluids and electrolytes
Graeme Duke and Ian Harley
Body water
Sodium
Potassium
IV fluids
Distribution of IV fluids
Crystalloid
Colloid
Fluid replacement
Maintenance
Paediatric fluid maintenance
Fluid loss
Assessment of severity of fluid loss
Replacement of blood loss
Chapter 6 Neuromuscular junction
Ian Harley
Introduction
Cholinergic receptors
Motor neurone
Acetylcholine
Neuromuscular junction
Prejunctional receptors
Postjunctional receptor
Muscle relaxants
Non-depolarising muscle relaxants
Depolarising muscle relaxants
Reversal of muscle relaxants
Chapter 7 Anaesthesia in the elderly
Antony Leaver
Introduction
Physiology of ageing
Preoperative assessment and preparation
Premedication
Anaesthetic technique
General anaesthesia
Analgesia
Regional anaesthesia
Intraoperative care
Recovery and postoperative care
Postoperative analgesia
Postoperative cognitive dysfunction
Conclusion
Chapter 8 Temperature control
David Andrews
Introduction
Thermal compartments
Dissipation of heat to the environment
Physiology of thermoregulation
Cold responses
Warm responses
The thermoneutral zone
Effects of general anaesthesia on body temperature
Effects of regional anaesthesia on body temperature
Paediatric patients
Effects of hypothermia
Prevention of hypothermia
Conclusion
PART III PERIOPERATIVE MANAGEMENT
Chapter 9 Preoperative assessment, premedication and consent
Phillipa Hore
The preoperative visit
Elective surgery
Emergency surgery
Patient history
Cardiovascular system
Respiratory system
Gastrointestinal system
Endocrine system
Renal system
Nervous system
Haematological system
Recreational drug use
Pregnancy
Medical problems specifically related to presenting condition
Past anaesthetic history
Family history
Current drug therapy
Herbal medicines
Drug allergies and sensitivities
Examination
Airway
Venous access
Site of proposed regional block
Investigations
Medical fitness for anaesthesia
Preoperative instructions
Fasting
Other instructions
Premedication
Aims
Classes of premedicant agent
Other medications
Administration
Informed consent
Chapter 10 Perioperative management of common medical problems
Phillipa Hore
Introduction
Obesity
Definition
Associated medical problems
Anaesthetic implications
Surgical implications
Diabetes mellitus
Concurrent medical disorders
Perioperative metabolic management
Asthma
Pathophysiology
Anaesthetic management of the asthmatic
Conclusion
Chapter 11 Anaesthetic emergencies
Phillipa Hore
Introduction
Airway problems
Difficult and failed intubation
Misplaced ETT
Laryngospasm
Bronchospasm
Pneumothorax
Aspiration
Cardiovascular emergencies
Cardiac arrest
Gas embolism
Drug-related emergencies
Anaphylaxis
Suxamethonium apnoea
Malignant hyperthermia
Equipment
Potential problems
Prevention
Management
Anaesthetic technique
Administration of incorrect drug
Intra-arterial injection
High-spinal anaesthesia
Intra-operative problem solving
Hypoxia
Hypercarbia
Hypocarbia
Hypotension
Hypertension
High airway pressure
Chapter 12 Postoperative care and complications
Fred Rosewarne
Post-anaesthetic care unit
Transport to the PACU
Handover
Observations
Discharge from PACU
Staffing
Post-operative complications
Respiratory
Cardiovascular
Neurological
Gastrointestinal
Pain
Miscellaneous
Wound infection
Pressure sores
Haemorrhage
Medication withdrawal
Rashes
Cough and sore throat
Conclusion
PART IV RESUSCITATION
Chapter 13 Airway management
Jon Graham
Introduction
Providing a patient airway
Airway assessment
Effective ventilation
Monitoring
Airway patency
Airway management
Manipulation of head and neck positioning
Oral and nasal airways
Bag and mask ventilation
Laryngeal mask
Intubation
Surgical airway
Conclusion
Chapter 14 Blood and blood products
Ian Harley
Components of blood
Whole blood
Red blood cells
Indications for transfusion
Uses of blood products
Fresh frozen plasma
Platelets
Cryoprecipitate
Factor VIII concentrate or antihaemophilic factor
Prothrominex
Recombinant activated factor VII
Human albumin 40 g/L
Human albumin 200 g/L
Blood-sparing therapies
Autologous transfusion
Haemodilution
Blood salvage
Postoperative blood salvage
Reversal of anticoagulation prior to surgery
Type of surgery
Indication for anticoagulation
Specific anticoagulants
Chapter 15 Cardiopulmonary resuscitation
Peter Morley
Introduction
Basic life support
When to start CPR
Initial assessment and management
Establishing airway and ventilation
External cardiac compression
Defibrillation
Advanced life support
Precordial thump
Chest compressions
Monitoring the quality of CPR
Airway management during CPR
Ventilation during CPR
IV cannulation
Drug administration during CPR
Other routes of administration
Identification of reversible causes of arrest
Post-resuscitation care
Induced hypothermia
Other factors in post-resuscitation care
Medical emergency team
Pre-MET
Prediction of outcome
Conclusion
PART V SUB-SPECIALITIES OF ANAESTHESIA
Chapter 16 Cardiac anaesthesia
Ian Harley
Introduction
Preoperative assessment
Coronary artery disease
Valvular disease
Other procedures
Day-of-surgery admission
Premedication
Valvular access and monitoring
TOE
Induction and maintenance
Blood and blood products
Heparin and protamine
Bypass
Myocardial protection
Weaning from bypass
The intraaortic counterpulsation balloon pump
Pacing
ICU
Postoperative pain
Minimally invasive surgery
Off-pump surgery
New developments
Robotics
Endovascular surgery
Percutaneous and trans-apical aortic valve replacement
Chapter 17 Anaesthesia for vascular surgery
David Scott
Introduction
Patient factors
Ischaemic heart disease
Diabetes
Hypertension
Pulmonary disease
Surgical factors
Specific procedures
Aortic surgery
Carotid endarterectomy
Peripheral vascular surgery
Endovascular surgery
Regional anaesthesia
Risk evaluation
Chapter 18 Thoracic anaesthesia
Phillipa Hore
Preoperative assessment and preparation
History and examination
Investigations
Preoperative management
Monitoring
Cardiovascular
Oxygen and ventilation
Other monitors
Patient positioning
Procedures
Bronchoscopy
Mediastinal procedures
Thoracotomy
Thoracoscopy and video-assisted thoracic surgery
Bronchopleural fistula repair
Other procedures
Chapter 19 Neuroanaesthesia
Phillipa Hore
Introduction
Neurophysiology
Cerebral blood flow
Cerebral perfusion pressure
Intracranial pressure
Preoperative evaluation
Proposed surgery
Neurological status
General medical status
Preoperative preparation and monitoring
Premedication
Vascular access
Monitoring
Positioning
Anaesthesia
Anaesthetic drugs
Anaesthetic induction
Anaesthetic maintenance
Emergence and extubation
Specific problems
Hypertension
Brain swelling
Cerebral ischaemia
Cerebral protection
Specific procedures
Intracranial procedures
Spinal surgery
Peripheral nerve procedures
Conclusion
Chapter 20 Obstetric anaesthesia
Maggie Wong
Physiological considerations
Cardiovascular system
Haematological system
Respiratory system
Gastrointestinal system
Analgesia for labour
Epidural analgesia
Anaesthesia for caesarean section
General principles
Regional anaesthesia
General anaesthesia
Crisis management
Massive transfusion
Key considerations
Chapter 21 Paediatric anaesthesia
Rob McDougall & Adam Skinner
Introduction
Functional anatomy and physiology
Airway
Breathing
Circulation
Pharmacology
Fluids and electrolytes
Metabolism
Thermoregulation
Hepatobiliary physiology
Renal physiology
Immune system
Equipment
Ventilation equipment
Laryngoscopes
Temperature maintenance
Monitoring
Preoperative preparation
Assessment
Premedication
Induction and maintenance
Induction
Maintenance
Regional techniques
Emergence
Postoperative care
Specific common procedures
Tonsils and adenoids
Inguinal hernia
Circumcision
Conclusion
Chapter 22 Urological anaesthesia
Ian Harley
Introduction
Innervation
Preoperative assessment
Anaesthetic technique
Blood requirements
Procedures
Percutaneous nephrolithotomy
ESWL
TURP
Radical prostatectomy
TRUS biopsy
Robotic surgery
Chapter 23 Dental anaesthesia
Kit James & Tony Bajurnow
Introduction
Indications for general anaesthesia
Behavioural issues and premedication
Shared airway
Anaesthetic considerations
Retained throat pack
Cardiac dysrhythmias
Patient positioning
Trismus
Dental damage
Postoperative analgesia
Antibiotic prophylaxis
Dental labelling
Chapter 24 Day case anaesthesia
Phillipa Hore
Rationale for day case surgery
Determination of case suitability
Patient criteria
Surgical criteria
Facility criteria
Preoperative preparation
Patient assessment
Patient consent
Patient instructions
Anaesthetic approaches
Premedication
General anaesthesia
Regional anaesthesia
Management of postoperative complications
Nausea and vomiting
Pain
Patient discharge
Discharge criteria
Postoperative instructions
Unanticipated hospital admissions
Chapter 25 Ophthalmic anaesthesia
Ian Harley
Introduction
Intraocular pressure
Physiology
Effects of anaesthesia
Oculocardiac reflex
Topical eye anaesthesia
Eye blocks
Retrobulbar eye block
Peribulbar eye block
Sub-Tenon’s eye block
Retinal surgery
Penetrating eye injury
Chapter 26 Bariatric anaesthesia
Ian Harley
Introduction
BMI
Assessment and investigations
General
Anaesthetic
Preparation
Premedication
Positioning
Monitoring
Airway
Ventilation
Drugs
Analgesia
Postoperative care
Natural history and complications
PART VI PAIN
Chapter 27 Pain
Jane Trinca & Ian Harley
Definition of pain
Taxonomy
Overview of concepts of neurophysiology
The gate theory of pain
Acute pain
Physiology of pain
Adverse effects of acute pain
Measurement of pain
Visual analogue scale
Numerical rating scale
Verbal descriptor scale
Functional activity score
Postoperative pain
Pharmacological treatment of pain
Sites of action of analgesics
Paracetamol
NSAIDs
Opioids
Tramadol
Ketamine
TCAs
Gabapentoids
LA agents
Conclusion
Analgesic ladder
Glossary
PART VII EQUIPMENT
Chapter 28 The anaesthetic machine
Fred Rosewarne
Introduction
Types of anaesthetic machines
Boyles machines
Electronically controlled anaesthetic machines
Components of an anaesthetic machine
High-pressure system
Wall outlets
Cylinders
Pressure gauges
Regulators
Low-pressure system
The oxygen failure device
Flow meters
Antihypoxia device
Backbar
Common gas outlet
Breathing systems
Circle systems
T-piece rebreathing systems
Scavenging
Hazards associated with scavenging
Chapter 29 Defibrillators
Fred Rosewarne
Defibrillation
Causes
Factors determining likelihood of successful defibrillation
Equipment
Waveform
Energy
Transthoracic impedance
Classification
Conventional
Synchronised cardioversion
Semi-automated external defibrillation
Automated external defibrillator
Automated implantable carioverter defibrillators
Hazards
Inappropriate shock delivery
Unsuccessful defibrillation
Injury and equipment damage
Chapter 30 Monitoring
Ian Harley
Introduction
Aims of monitoring
Role of anaesthetist
Minimal standards
Cardiovascular monitoring
ECG
BP
Pulse oximetry
Central venous pressure
Pulmonary artery catheters
Cardiac output
CO monitoring devices
Urine output
Temperature
Gas supply and ventilation
O2 alarms
Ventilator alarms
Capnography
Agent monitoring
Oesophageal stethoscope
Other monitors
BIS monitoring
Nerve stimulators
Chapter 31 Electrical safety
Fred Rosewarne
Forms of electrical current
Electrocution
Factors determining the physiological impact of an electric current
Macro- and microshock
Electrical safety
Patient procedures
Patient treatment areas
Specialised wiring systems and protective circuitry
Medical equipment
Chapter 32 Pacemakers and implantable defibrillators
Ian Harley
Introduction
Interactions in the perioperative period
Magnets
Management of patients with pacemakers
Assessment
Preparation
Monitoring
Minimising interference
Postoperative management
Special situations
MRI
Electroconvulsive therapy
Lithotripsy
Insertion of a CRMD
Anaesthetic considerations
Classification of pacemakers and defibrillators
PART VIII THE ANAESTHETIC ENVIRONMENT
Chapter 33 Anaesthetic assistance
Fred Rosewarne
Introduction
Equipment preparation
Patient checking
Anaesthesia
Monitoring
Induction
Maintenance
Extubation
Regional anaesthesia
Post anaesthesia
Leaving the operating theatre
Equipment decontamination
Chapter 34 Lasers and laser safety
Fred Rosewarne
Introduction
Characteristics of lasers
Laser components
Anaesthesia and laser surgery
Principal concerns
Specific hazards
Hazards
Eye damage
Airway fires
Airborne contaminants
Miscellaneous
Laser safety
Laser equipment design
The Laser Safety Committee
Laser safety protocols
Chapter 35 MRI and anaesthesia
Ian Harley
Introduction
How MRI works
The magnet
Anaesthesia and MRI
Static magnetic field
Radiofrequency effects
Environment
Noise
Effects of monitoring on scan
Exposure to magnetic resonance
Anaesthesia for MRI
Infants
Intensive care patients
Monitoring
Equipment
The future
Index |
