Associate Editors vii
Contributors ix
Preface xix
Laurence C. Torsher, Richard P. Dutton, Thomas M. McLoughlin Jr, and Francis V. Salinas
The Meaning of Consent and Its Implications for Anesthesiologists 1
Elizabeth H. Wilson and Christopher M. Burkle
Introduction 1
History of informed consent 2
Discussion 4
Elements of informed consent 4
Type and amount of information to be provided 6
Separate anesthesia informed consent 6
Written versus verbal informed consent 7
Patient do-not-resuscitate orders and informed consent during the perioperative period 7
Informed consent in unique anesthesia practice settings 8
Summary 17
Disclosure 18
Anesthetic Choices for Intrapartum Cesarean Delivery in Patients with Epidural Labor Analgesia 23
Unyime Ituk and Cynthia A. Wong
Introduction 23
Epidural anesthesia: conversion from epidural labor analgesia 24
Choice of local anesthetic agents for extension of epidural labor analgesia to surgical anesthesia 26
Analgesic adjuvants for epidural anesthesia 28
Predictors of failure to extend epidural labor analgesia for cesarean delivery 29
Management of failed epidural anesthesia 29
Practical tips for converting epidural labor analgesia to surgical anesthesia 32
General anesthesia for intrapartum cesarean delivery 36
Spinal or combined spinal-epidural for intrapartum cesarean delivery 37
Summary 37
Disclosure 38
Foundations for Success in the Transition to Private Practice 41
Richard P. Dutton and Robert Koehler
Introduction 41
Knowledge 42
How the work is done 42
Where the money comes from 44
How you will get paid, and why it matters 46
What local knowledge do I need? 48
Intangibles 54
What is different on day 1? 54
All settled now; how do I get involved? 56
What if I still want to teach or do research? 58
What if I get it wrong? 59
Summary 60
Disclosure 60
Anesthetic Considerations for Endovascular Neurologic, Vascular, and Cardiac Procedures 63
Kamilla Esfahani, Brittany A. Bunker, Scott J. Heller, Edward G. O’Connor, Susan M. Walters, and Amanda M. Kleiman
General endovascular procedural considerations 63
Anticoagulation 64
Contrast 64
Positioning 64
Anesthetic considerations 65
Neurologic endovascular procedures 65
Preoperative assessment 65
Endovascular vascular procedures 72
Preoperative assessment 72
Endovascular cardiac procedures 80
Preoperative assessment 80
Summary 91
Disclosure 91
Conflicts of interest 91
Update on Ketamine 97
Jon Y. Zhou, Perry Hamilton, Stephen Macres, Matthew Peña, and Schirin Tang
Introduction 97
Pharmacology and mechanisms of action 98
Pharmacokinetics 99
Pharmacodynamics 99
Ketamine and acute perioperative pain management 100
Dosing 100
Patient selection/indications 101
Contraindications/adverse effects 101
Monitoring/supervision guidelines 102
Emergency room use of ketamine 102
Ketamine for chronic pain 103
ketamine 103
Oral ketamine 104
Intranasal ketamine 104
Transdermal ketamine 104
Ketamine and sedation 105
Ketamine and major depressive disorder 107
Abuse potential and regulations 110
Summary 110
Disclosure 110
Whole Blood in Modern Anesthesia Practice 115
Christopher T. Stephens, Johanna B. de Haan, Srikar Jonna, and Srikanth Sridhar
Military whole-blood experience 116
US civilian trauma center experience 117
Prehospital whole-blood experience 118
Obstetric whole-blood experience 119
Whole blood in other clinical settings 120
Considerations with whole-blood use 121
Immunologic concerns 122
ABO typing and compatibility 123
Hemolysis and surveillance after whole blood administration 123
Rh incompatibility 124
Circulatory overload 126
Summary and future directions 126
Care points 127
Disclosure 127
The Anesthesiologist’s Role in Teaching Airway Management to Nonanesthesiologists: Who, Where, and How 131
Thomas E. Grissom and Ron E. Samet
Introduction 131
What does it mean to be proficient in airway management? 133
Where should this take place and who should be teaching? 141
Do you need to teach direct laryngoscopy, video laryngoscopy, or both? 145
What is the role of simulation? 145
What is on the horizon for airway management training? 148
Summary 150
Care Points 151
Disclosure 151
The Effect of Analgesia and Anesthesia on Postpartum Depression 157
Philip Heesen, Sharon Orbach-Zinger, Sophie Grigoriadis, Stephen Halpern, and Leonid A. Eidelman
Introduction 157
Definition and diagnosis 158
Neuraxial analgesia and postpartum depression 160
Screening 162
Summary 162
Disclosure 163
Cannabinoids-based Medicine Pharmacology, Drug Interactions, and Perioperative Management of Surgical Patients 167
Samer Narouze, Natalie Strand, and Priodarshi Roychoudhury
Introduction 168
Cannabis and cannabinoids 168
Δ9-Tetrahydrocannabinol 168
Cannabidiol 171
Perioperative management of patients on cannabinoids 173
Physiologic effects of cannabis 173
Cannabis products and route of administration 175
Cannabis drug interactions 176
Specific considerations for perioperative management 176
Cannabis intoxication 180
Cannabis intoxication delirium 181
Acute neurocognitive impairment 181
Motor-Sparing Peripheral Nerve Blocks for Shoulder, Knee, and Hip Surgery 189
Sebastián Layera, Mohammed Saadawi, De Q. Tran, and Francis V. Salinas
Introduction 190
Diaphragm-sparing nerve blocks for shoulder surgery 191
Sensory innervation of the shoulder joint and overlying cutaneous area 191
Strategies to minimize hemidiaphragmatic paresis after interscalene brachial plexus block 191
C7 nerve root block 192
Supraclavicular brachial plexus approach 192
Upper (superior) trunk block 192
Suprascapular nerve block 193
Costoclavicular brachial plexus block approach 195
Summary of hemidiaphragmatic paresis-sparing strategies for shoulder surgery 195
Motor-sparing nerve blocks for total knee replacement 196
Introduction and sensory innervation of the knee 196
Topographic distribution of the peripheral nerves supplying the anteromedial knee 196
Femoral triangle block versus adductor canal block 197
Femoral triangle block versus placebo 197
Femoral triangle block versus periarticular local anesthetic infiltration analgesia 198
Combined femoral triangle block with local anesthetic infiltration analgesia versus local anesthetic infiltration analgesia alone 199
Single-injection versus continuous femoral triangle block 199
Summary of anatomic and clinical evidence of femoral triangle blocks and adductor canal blocks 199
Obturator nerve block 200
Infiltration between the popliteal artery and the capsule of the posterior knee block 200
Popliteal plexus block 201
Summary of evidence for obturator nerve, infiltration between the popliteal artery and the capsule of the posterior knee, and popliteal plexus blocks 201
Motor-sparing nerve blocks for hip surgery 202
Summary 202
Emergency Anesthesia in Resource-Limited Areas 209
Seung Lee, Azuka Onye, and Asad Latif
Introduction 209
General considerations for working in resource-limited areas 210
Overall Considerations and Constraints in Resource-Limited Areas 210
Disaster Relief Efforts in Resource-Limited Areas 213
Role of the Anesthesia Provider Outside the Operating Room 214
Anesthetic technique and perioperative care 215
Preoperative Considerations in Emergency Anesthesia 215
Intraoperative Considerations in Emergency Anesthesia 217
Anesthetic Plan 219
Postoperative Considerations in Emergency Anesthesia 223
Summary 224
Disclosure 225
Anesthesia for Obstetric Disasters 229
Kristen L. Fardelmann and Aymen Awad Alian
Maternal mortality 229
Cardiac arrest in pregnancy 230
Obstetric complications 231
Obstetric Hemorrhage 231
Amniotic Fluid Embolism/Anaphylactoid Syndrome of Pregnancy 236
Hypertensive Emergency in Pregnancy 237
HELLP Syndrome 241
Anesthesia complications 242
High Neuraxial Anesthesia Blockade 242
Local Anesthetic Systemic Toxicity 244
Difficult Airway 244
Disclosure 247
Anesthesia for the Patient with Severe Liver Failure 251
Aidan Spring, Jagroop S. Saran, Sinead McCarthy, and Stuart A. McCluskey
Introduction 251
Cause of liver disease 253
Risk stratification 254
Assessment and investigations 255
Preoptimization 257
Intraoperative management 258
Monitoring 258
Anesthetic Medications 258
Sedative-Hypnotics 258
Analgesics 259
Neuromuscular Blockade 259
Volatile Anesthetics 259
Coagulation 259
Postoperative Analgesia 259
Considerations for specific procedures 260
Cardiac Surgery 260
Trauma 261
Anesthesia for transhepatic portosystemic shunt and minor procedures 262
Abdominal surgery 262
Conflicts of Interest 263
The Future Directions of Research in Cardiac Anesthesiology 269
Jessica Spence and C. David Mazer
Knowledge gaps that need to be addressed 270
Mitigating the Inflammatory Effects of Cardiopulmonary Bypass 270
Diagnosis and Management of Perioperative Myocardial Infarction after Cardiac Surgery 271
Neurologic Outcomes of Cardiac Surgery 272
Transfusion Strategies in Cardiac Surgery 274
Optimizing the Long-Term Outcomes of Patients after Valve Surgery 274
New approaches to research in cardiac anesthesia 275
Novel Analytical Techniques 276
Pragmatic Trials 277
Adaptive Trial Designs 279
Summary 280
Acknowledgments 280
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