Comprehensive Clinical Anesthesia

This book is a comprehensive guide to clinical anaesthesia for practitioners and trainees.

Divided into eleven sections, the text begins with a general overview, followed by discussion on anaesthesia delivery systems, monitoring, and equipment. A complete section is dedicated to different drugs used in anaesthesia.

The next section covers anaesthesia for different types of surgeries in various body systems. The remaining chapters detail more subspecialty-specific anaesthesia including cardiac, obstetric, neuro, paediatric, transplant, and regional.

The book concludes with a section on postoperative care.  

Authored by highly experienced experts in the field, the text is further enhanced by illustrations and figures to assist learning.

Key points

• Comprehensive guide to clinical anaesthesia for practitioners and trainees
• Covers numerous types of anaesthesia for different surgeries and body systems
• Includes sections on pharmacology and postoperative care
• Highly experienced, expert author team

Contents
SECTION 1: ESSENTIALS FOR THE ANESTHETIST
1. Landmarks in the Evolution of Anesthesia.................................................................................................................................... 3
Chandrasekhar Krishnamurti
The Initial Phase 3
Evolution of Inhalational Anesthesia 3
Intravenous Anesthesia 4
Local and Regional Anesthesia 5
2. Patient and Personnel Safety in the Operation Theater ............................................................................................................. 6
Devi Prasad Samaddar, Santanu Bagchi
Common Safety Issues 6
3. Minimizing Errors in the Operating Theaters and PACU ..........................................................................................................14
R Ambulkar, Meenal Rana, Pankaj Singh Rana
Human Factors 14
System Factors 15
Culture of Patient Safety 16
Specific Considerations during Perioperative Period 17
Training 17
4. Quality Indicators in Anesthesia ....................................................................................................................................................19
Banambar Ray, Anand Mishra, Abhijeet Raha
Status in India 20
What is a Quality Indicator? 20
Quality Indicators in Anesthesia 21
Developing Quality Indicators 21
5. Soft Skills (Nontechnical Skills) and Anesthesiologist ..............................................................................................................24
Rajiv Chawla, Shagun Bhatia Shah, Mritunjay Kumar
Why NTS is Important in Anesthesia and Critical Care? 24
Various Nontechnical Skills Programs in Anesthesia 25
Nontechnical Skills: Training and Evaluation 27
Anesthesia Nontechnical Skills 27
Impact of Covid-19 Pandemic 29
6. Research and Statistics for the Anesthesiologist .......................................................................................................................31
Priya Ranganathan, CS Pramesh
Terms Used in Research Parlance 31
Directionality of Research Studies 31
Timing of Research Studies 31
Research Study Designs 32
Specific Types of Clinical Trials 33
Systematic Reviews and Meta-Analyses 34
Evidence Pyramid 34
Statistical Concepts 34
7. Strategies to Improve Postoperative Outcomes ........................................................................................................................37
Martin Thomas, Vandana Agarwal, S Ravishankar
Predicting Complications 37
Preparation/Optimization Before Surgery within a Realistic Time Period 39
Preventive Measures 41
Multidisciplinary and Patient-Centered Care 42
8. Preanesthesia Evaluation ................................................................................................................................................................44
Prithwis Bhattacharyya, Prakash Deb, Debasis Pradhan
History 44
Clinical Examination 44
Investigations 45
Airway Examination 45
Preoperative Risk Assessment Score and Predictive Models 47
Preoperative Risk Assessment Models 48
Preoperative Fasting 50
Preoperative Orders for Medication 50
Thromboprophylaxis 50
9. Physics for Anesthetists ...................................................................................................................................................................52
CL Gurudatt
Fluids 52
Flow 52
Gas Laws and Application in Anesthesia 56
10. Ethics and Law in Anesthesia .........................................................................................................................................................61
Bala Bhaskar S, Umesh Goneppanavar, M Manjuladevi
Preoperative Testing 61
Informed Consent and Informed Refusal 61
Death on Table and Advance Directives 62
Obstetric Anesthesia Practice 62
Pediatric Anesthesia Practice 63
Chronic Pain and Palliative Care 63
Ethics in Training 63
Ethics in Research and Publications 63
Ethics for the Specialist and the Specialty 63
Modern Anesthesia Delivery Systems ..........................................................................................................................................67
Vijaya P Patil, Gauri R Gangakhedkar
Power Supply 67
High-pressure System 67
Intermediate Pressure System 68
Low-pressure System 70
Hypoxia Prevention Devices 72
Scavenging 73
Anesthesia Machine Checklist 73
Safety Features 73
Recent Advances 73
12. Oxygen Therapy Devices and Anesthesia Breathing Circuits .................................................................................................77
Sohan Lal Solanki, Atul P Kulkarni
Oxygen Therapy Devices 77
Anesthesia Breathing Systems 80
13. Hemodynamic and Respiratory Monitoring ...............................................................................................................................87
Bindiya Salunke, Atul P Kulkarni
Cardiovascular Monitoring 87
Respiratory System Monitoring 95
14. Monitoring Neuromuscular Blockade and Reversal .................................................................................................................99
Nibedita Pani, Manisha Mund, Debasish Mahaptra
Neuromuscular Junction Physiology 99
Methods of Neuromuscular Monitoring 100
Pattern of Nerve Stimulation 101
15. Monitoring Coagulation and Anticoagulation ........................................................................................................................ 105
Divya Pal, Deepak Govil, Anant V Pachisia
Hemostasis 105
Point-of-care Coagulation Testing 107
Use of Mixing Studies 108
16. Role of Ultrasound in Anesthesia ............................................................................................................................................... 110
Shilpushp Bhosale, Atul P Kulkarni
Physics of Ultrasound 110
Modes of Imaging 111
Ultrasound-guided Procedures 111
Ultrasound Vascular Access 111
Ultrasound for Regional Anesthesia 111
Airway Assessment 112
Lung Ultrasound 113
Transthoracic Echocardiography 114
Transesophageal Echocardiography 115
Gastric Ultrasound 116
Ultrasound in Neuroanesthesia 116
17. Basic Pharmacology for Anesthetists ........................................................................................................................................ 121
S Ravishankar
Pharmacokinetics 121
Pharmacodynamics 130
18. Premedication in Anesthesia Practice ....................................................................................................................................... 142
Lalita Gouri Mitra, Aditi Suri, Neha Garg
Past, Present and Future of Premedication 142
Why Premedicate? 142
Methods of Premedication 144
Precautions to be Taken in Special Circumstances 147
19. Intravenous Anesthetic Agents................................................................................................................................................... 149
Malini Joshi, Atul P Kulkarni
History 149
Characteristics of an Ideal Intravenous Agent 149
Mechanism of Effects of Anesthetic Agents 149
Propofol (2,6-Diisopropylphenol) 150
Thiopentone-Sodium 5–Ethyl-5-(1-Methylbutyl)-2-Thiobarbiturate 151
Etomidate [Ethyl-1-(1-Phenylethyl)-1H-Imidazole-5-Carboxylate] 152
Ketamine [2-(2-Chlorophenyl)-2-(Methylamino)Cyclohexanone] 153
Newer Anesthetic Agents 154
20. Inhaled Anesthetic Agents ........................................................................................................................................................... 157
Nayana Amin, Mahima Gupta
History 157
Fluorinated Anesthetic Agents 157
Mechanism of Action of Inhalational Agents 157
Pharmacokinetics of Volatile Anesthetics 158
Clinical Relevance of the Physical Properties of the VA 159
Pharmacodynamics of Inhaled Anesthetic Agents 159
Ischemic Preconditioning 160
Nonanesthetic Uses of VA in Clinical Practice 161
21. Opioids Analgesics and Reversal Agents .................................................................................................................................. 163
Umamaheshwara Rao W, Muralidhar Joshi
History 163
Opioid Structure 163
Opioid Receptors and Physiology 163
Mechanism of Action of Opioids 164
Classification of Opioids 164
Opioid-mediated Analgesia 164
Opioid Side Effects 165
Metabolism, Excretion, and Drug Interactions 165
Morphine 166
Fentanyl and its Derivatives 167
Opioid Antagonists 169
22. Nonopioid Analgesics ................................................................................................................................................................... 171
Pradeep Bhatia, Bharat Paliwal, Kamlesh Kumari
Nonsteroidal Anti-inflammatory Drugs 171
Selective COX-2 Inhibitors 175
Acetaminophen 175
23. Neuromuscular Blocking Agents and Reversal Agents ......................................................................................................... 177
Anjali Savargaonkar, Shubhada Deshmukh, Charuta Gadkari
Mechanism of Action of Neuromuscular Blocking Agents 177
Depolarizing Neuromuscular Blocking Agents 177
Nondepolarizing Neuromuscular Blocking Agents 180
Clinical Management 183
Reversal Agents 184
24. Vasoactive Drugs in Anesthesia and Critical Care .................................................................................................................. 187
Ashish K Khanna, Bhavita Gaglani, Marc G Reichert, Aman M Irfanullah
Epinephrine 187
Isoproterenol 187
Dobutamine 187
Amrinone and Milrinone 188
Dopamine 188
Dopexamine 189
Norepinephrine 189
Phenylephrine 189
Ephedrine 189
Vasopressin and Analogs 189
Levosimendan 190
Methylene Blue 190
Angiotensin II 190
Nitroglycerin 190
Nitroprusside 191
25. Drugs for Local and Regional Anesthesia ................................................................................................................................. 192
Gaurav Kuthiala, Geeta Chaudhary
Mechanism of Action 192
Commonly Used Local Anesthetics 193
Recent Advances in Local Anesthesia 196
26. Antisepsis in Anesthesia Practice ............................................................................................................................................... 199
Chitra S Juwarkar, Deependra S Kamble
Definitions and Terminology 199
Disinfectants: Mechanism of Action and Application 199
Source of Infection 200
Source of Hospital Infections 201
Transmission of Hospital Infections 201
Prevention of Infection 201
Concepts of Zoning 202
Timing of Hand Hygiene 202
Method of Hand Hygiene 203
Anesthesia Equipment 203
Infection Control of Anesthetic Equipment 207
Classification of Medical Equipment 208
27. Adjunct Drugs in Anesthesia ....................................................................................................................................................... 210
Shikha Mehrotra, Vikas Kumar Gupta, Tripti Vatsalya
Antiemetic Drugs 213
Preventive Interventions 220
28. Airway Management ..................................................................................................................................................................... 227
Atul P Kulkarni, Vijaya P Patil
Anatomy Relevant to Airway Management 227
Assessment of Airway 228
Positioning for Laryngoscopy and Tracheal Intubation 232
Preoxygenation (Denitrogenation) and Apneic Oxygenation 232
Prevention of Aspiration of Gastric Content 233
Induction of Anesthesia 233
Mask Ventilation 233
Laryngoscopy and Intubation 233
Securing a Difficult Airway: Unanticipated Difficulty 234
Tracheal Intubation in a Patient with a Known Difficult Airway 234
Tracheal Extubation 240
Contentsxxvi
29. Anesthesia for Noncardiac Surgery in Patients with Cardiovascular Morbidity .............................................................. 242
Deepak K Tempe, Parin Lalwani
Coronary Artery Disease 242
Valvular Heart Disease 246
Congenital Heart Defects with Left-to-right Shunt 248
Dilated Cardiomyopathy 248
Patients with a Cardiac Implantable Electronic Devices:
Pacemakers and Implantable Cardioverter Defibrillator 249
30. Anesthesia for Noncardiac Thoracic Surgery ........................................................................................................................... 251
Madhavi Shetmahajan
Risk Assessment 252
Airway Management in Thoracic Surgery 253
Fluid Management in Thoracic Surgery 254
Monitoring in Thoracic Surgery 254
Pain Management 255
Anesthesia Management in Specific Surgeries 255
31. Anesthesia for Nonthoracic Surgery in Patients with Respiratory Morbidity .................................................................. 257
Anitha Nileshwar, Laxmi Shenoy, Nisha SM Jacob
Postoperative Pulmonary Complications 257
Preoperative Assessment 258
Risk Stratification 258
Preoperative Optimization 259
Intraoperative Management 259
Postoperative Management 261
32. Anesthesia for Genitourinary Surgery ...................................................................................................................................... 263
Sona Dave, Rameshwar Mhamane, Harsha VS
Renal Function Tests 263
Chronic Renal Failure 264
Anesthesia for Open Urological Surgeries 264
Anesthesia for Laparoscopic Urological Surgeries 264
Extracorporeal Shock Wave Lithotripsy 267
Endoscopic Urological Procedures 267
Percutaneous Nephrolithotomy 268
Robot-assisted Urological Procedures 268
33. Anesthesia for Patients with Hepatic Disorders for Liver Resection and Other Surgeries ............................................ 270
Malini Joshi, Ashwini Rane, Atul P Kulkarni
Anatomy and Blood Supply of Liver 270
Anesthetic Implications of Patients with Hepatic Diseases Undergoing Surgery 271
Anesthetic Management of Patients Undergoing Hepatic Resection 273
Strategies to Reduce Blood Loss 276
Other Procedures 277
34. Anesthesia for Head and Neck Surgeries.................................................................................................................................. 279
Swapnil Parab, Atul P Kulkarni
Preoperative Assessment and Optimization of Patients 279
Intraoperative Management of Head and Neck Surgeries 281
Postoperative Care 283
35. Anesthetic Management of Patients with Diabetes Mellitus............................................................................................... 285
Mritunjay Kumar, Rajeshwari S
Pathophysiology 285
Diagnosis and Categorization 285
Pharmacotherapy for Diabetes Mellitus 286
Perioperative Glycemic Management 286
Resuscitation in Intensive Care Unit 289
Anesthetic Considerations in Patients with Insulinoma 290
Symptoms 290
Diagnosis 291
Treatment 291
Preoperative Investigations 291
Surgical Management 291
Anesthetic Management 291
36. Anesthetic Concerns in Patients with Endocrine Disorders ................................................................................................. 293
Rajeshwari S, Manpreet Kaur Rajpal, Abhishek Nagarajappa
Disorders of the Hypothalamus and Pituitary 293
Craniopharyngioma 293
Anesthesia for Patients with Pituitary Gland Disorders 295
Anesthetic Concerns in Patients with Thyroid Disease for Thyroidectomy and Incidental Surgery 296
Preoperative Assessment 296
Thyroidectomy 297
Large Multinodular Goiter with Superior Vena Cava Syndrome for Thyroid Surgery 298
Patients with Thyroid Disease for Nonthyroid Surgery 298
Anesthesia for Parathyroid Disorders 299
Hyperparathyroidism 299
Hypoparathyroidism 301
Anesthetic Management of Carcinoid Tumors 301
Perioperative Management 302
Preoperative Assessment 302
Intraoperative Management 302
Induction 303
Maintenance 303
Vasoconstrictors 303
Postoperative Management 303
Anesthesia in Patients with Disorders of the Adrenal Gland 303
Anesthetic Considerations in a Patient with Pheochromocytoma 303
Cushing’s Syndrome and Cushing’s Disease: Anesthetic Concerns and Management 305
Anesthetic Concerns in Patients with Hyperaldosteronism (Conn’s Syndrome) 307
Symptoms 307
Effect of Aldosterone 307
Diagnosis 307
Preoperative Pharmacologic Therapy 307
Preoperative Evaluation 308
Anesthetic Management Concerns 308
Positioning 308
Intraoperative Concerns 308
Adrenal Insufficiency and the Steroid-dependent Patient 309
37. Anesthesia for Laser Surgery of the Airway ............................................................................................................................. 311
Sanjay M Upadhye, Meghana M Nadkarni, Chitra C Pitale
Lasers 311
Preoperative Assessment 311
Goals of Anesthesia 312
Challenges Faced by Anesthesiologist 312
Bronchoscopic Laser Treatments for Tumors of the Trachea and Bronchus 313
Hazards of Laser 314
38. Anesthesia for Ophthalmic Surgery........................................................................................................................................... 316
Jaichandran VV
Preoperative Assessment and Preparation 316
Anesthesia Management 317
Relevant Anatomy for Regional Ophthalmic Anesthesia 317
General Anesthesia for Ophthalmic Surgeries 319
Anesthetic Implications in Various Ophthalmology Subspecialties 319
39. Principles of Anesthesia for Patients with Trauma ................................................................................................................. 322
Rashid Manzoor Khan, Maher Al Bahrani, Aziz Haris
Anesthetic Management 322
40. Anesthesia for Cancer Surgery .................................................................................................................................................... 326
Jigeeshu V Divatia, Kaizeen Daruwalla
Pathophysiologic Disturbances Associated with Cancer 326
Oncoanesthesiology 327
Chemotherapeutic Agents and their Implications on Various Systems 329
Radiotherapy and its Implications on Perioperative Management 331
Onco-critical Care 331
41. Anesthesia for Vascular Surgery ................................................................................................................................................. 332
Prajakta Shinde, Amish Jasapara, Vijay Shetty
Common Principles for Vascular Anesthesia 332
Carotid Endarterectomy 332
Abdominal Aortic Aneurysm Surgery 334
Thoracoabdominal Aortic Procedures 336
42. Anesthesia for the Elderly ............................................................................................................................................................ 340
Eeshwar MV, Venkateswaran Ramkumar, Prabhu Manjunath
Physiological Changes in the Elderly Relevant to the Anesthesiologist 340
Pharmacological Principles in the Elderly 340
Conduct of Anesthesia 341
43. Anesthesia for Obese Patients .................................................................................................................................................... 345
Jayashree Sood, Nitin Sethi, Bhuwan Chand Panday
Classification of Obesity 345
Pathophysiology of Obesity 345
Pharmacology 346
Surgical Management of Obesity 347
Anesthesia Management 347
Anesthesia Considerations in a Postbariatric Surgery Patient 350
Daycare Surgery 350
44. Anesthesia for Patients with Burns ............................................................................................................................................ 351
Smita Prakash, Parul Mullick
Acute Burns 351
45. Anesthesia for Day-care Surgery ................................................................................................................................................ 357
Satish K Kulkarni, Sandeep S Kulkarni
Patient Selection 357
Anesthesia Techniques 358
Monitored Anesthesia Care 358
General Anesthesia 358
Regional Anesthesia 359
Discharge after Day-case Procedures 359
46. Anesthesia in Remote Locations................................................................................................................................................. 361
Madhavi D Desai, Anjali A Pingle
Special Problems during NORA 361
Communication is the Key 362
Preoperative Evaluation 363
Intraoperative Monitoring 363
Children and NORA 363
Procedural Sedation 364
Postoperative Care and Discharge 369
Complications at Remote Locations 369
47. Anesthesia for Emergency Surgery............................................................................................................................................ 371
Afzal Azim, Manish Gupta
Defining an Emergency Surgery 371
Preoperative Evaluation 372
Induction of Anesthesia 373
Maintenance of Anesthesia and Intraoperative Management 374
Postoperative Care 374
Improving Outcome (Role of Care Pathways) 374
48. Anesthesia Management of a Patient with Sepsis ................................................................................................................. 375
Bande BD, Suchitra Mohite, Asir Tamboli
Role of an Anesthesiologist in Sepsis Management 375
Sepsis Pathophysiology Relevant to Anesthesia 375
Optimization of the Sepsis Patient 376
Surgical Source Control Plan 376
Intraoperative Management 376
Central Neuraxial Blockade in Sepsis Patients 377
Anesthesia Concerns of Peripheral Regional Blocks in Patients with Sepsis 377
49. Management of Common Complications during Anesthesia ............................................................................................. 378
Anil Agarwal, Vansh Priya
Aspiration 378
Hypoxemia 379
High Airway Pressure 379
Anaphylaxis 380
Management 381
Hypotension 381
Hypertension 382
Hypothermia 382
Delayed Emergence 382
Arrhythmia 383
50. Anesthesia for Patients Undergoing Coronary Artery Bypass Grafting ............................................................................ 387
Gopinath Ramachandran, Ayya Syama Sundar, CH Ramakrishna Prasad
Determinants of Myocardial Oxygen Balance 387
Preoperative Evaluation 387
Anesthetic Management 388
Anesthesia for Off-pump Coronary Artery Bypass 389
51. Anesthesia for Patients Undergoing Valvular Heart Surgery............................................................................................... 392
Murali Chakravarthy, Geetha Muniraju, Rakesh Reddy
Mitral Stenosis 394
Mitral Stenosis in Pregnancy 395
Mitral Regurgitation 395
Aortic Valve Disease 396
Aortic Stenosis 396
Aortic Regurgitation 396
Surgery of the Pulmonary and Tricuspid Valves 397
52. Anesthesia for Patients Undergoing Congenital Heart Surgery ......................................................................................... 398
Praveen Kumar Neema, C Subramaniam, Bal Swaroop, Roopali Phulli
Classification 398
Physiology of Normal Circulation 399
Description of Acyanotic CHD 399
Description of Cyanotic CHD 400
Hemodynamic Goals in Cyanotic and Acyanotic CHD 402
Cardiopulmonary Bypass and Deep Hypothermic Circulatory Arrest 403
Modified and Conventional Ultrafiltration 404
Transesophageal Echocardiography 404
53. Neuromonitoring ........................................................................................................................................................................... 409
Pramod Kalgudi, Sangeetha RP, Sriganesh Kamath
Monitoring Depth of Anesthesia Using Raw and Processed EEG 409
Intraoperative Neurophysiological Monitoring 411
Working Principles 411
Classification 411
Evoked Responses 412
Neuromonitoring Techniques for Intracranial Pressure, Flow, and Oxygenation 416
54. Anesthesia for a Patient with Traumatic Brain Injury ............................................................................................................. 418
Prasanna Udupi Bidkar, Mukilan Balasubramanian
Definition, Classification, and Pathophysiology 418
Management of Patients with TBI 420
55. Anesthesia for Patients Undergoing Brain Tumor Surgery .................................................................................................. 425
Ashish Bindra, Niraj Kumar, Surya Kumar Dube
Anatomical Considerations 425
Cerebral Pathophysiology 425
Preanesthetic Evaluation 426
Contents xxxi
Intraoperative Management 427
Intraoperative Complications 430
Emergence 431
SECTION 7: OBSTETRIC ANESTHESIA
Section Editor: Sunanda Gupta
56. Labor Analgesia .............................................................................................................................................................................. 435
Sunanda Gupta, Alka Chhabra, Apoorva Gupta
Pain Pathways 435
Methods of Pain Relief during Labor 435
57. Anesthesia for Cesarean Section ................................................................................................................................................ 444
Kajal Jain, Vighnesh Ashok
Preoperative Evaluation and Assessment 444
Preoperative Preparation 444
Anesthetic Technique 445
Postoperative Analgesia 448
Conclusion and Future Prospects 448
58. Anesthesia for the High-risk Parturient .................................................................................................................................... 449
Aruna Parameswari, Akilandeswari Manickam
Pre-eclampsia and Eclampsia 449
Heart Disease in Pregnancy 452
Obese Parturient 455
Parturients at Risk of Obstetric Hemorrhage 457
SECTION 8: PEDIATRIC ANESTHESIA
Section Editor: Anila Malde
59. Anesthesia for Neonatal Emergencies ...................................................................................................................................... 463
Anila Malde
General Considerations 463
Congenital Diaphragmatic Hernia 466
Tracheoesophageal Fistula 468
Abdominal Wall Defects 472
Congenital Hypertrophic Pyloric Stenosis 473
Intestinal Obstruction 474
60. Preoperative Evaluation, Preparation, Induction, Maintenance, and
Emergence from Anesthesia in Children .................................................................................................................................. 479
Sandhya Yaddanapudi, Prerna Varma
Preoperative Evaluation 479
Preparation 480
Induction of Anesthesia 481
Maintenance of Anesthesia 485
Emergence 486
Perioperative Complications 487
61. Perioperative Fluid and Transfusion Therapy in Children ..................................................................................................... 489
Handattu Mahabaleswara Krishna, Savan Kumar Nagesh
Relevance of the Age Group of the Children 489
Volume of Fluids to be Administered in the Perioperative Period 490
Choice of Fluid Type in the Perioperative Period 491
Role of Newer Fluid Management Strategies in Children 492
Transfusion Therapy in Children 492
Strategies to Reduce Perioperative Blood Transfusion 493
Tests for Dynamic Coagulation in Pediatric Patients
SECTION 9: ANESTHESIA FOR TRANSPLANT SURGERY
62. Anesthesia for Renal Transplant ................................................................................................................................................. 497
PL Gautam, Suneet Kathuria, Shikha Gupta
Anesthetic Challenges 497
Anesthetic Management 498
Immunosuppression 500
Postoperative Management 500
Postoperative Pain Management 501
Postoperative Complications 501
63. Anesthesia for Liver Transplantation ......................................................................................................................................... 502
Lakshmi Kumar, Sindhu Balakrishnan, Anandajith Kartha
Preoperative Evaluation 503
Postoperative Care 508
64. Anesthesia for Multivisceral and Intestinal Transplant ......................................................................................................... 509
Vibhay V Kakhandki, Anand Putappa, Rohit Gaurav
Indications and Donor Selection 509
Types of Intestinal Transplantation 509
Preoperative Assessment 510
Intraoperative Anesthetic Management 510
Anesthesia for Intestinal Transplantation 515
Postoperative Management and Follow-up 515
Outcomes 516
65. Anesthesia for Heart Transplant ................................................................................................................................................. 517
Suresh Rao KG, Suresh Kumaran, KR Balakrishnan
History 517
Heart Failure 517
Indications 517
Contraindications 518
Recipient Selection 518
Donor Selection 518
Anesthetic Considerations 518
Surgical Considerations 519
Weaning Off Cardiopulmonary Bypass 519
Primary Graft Dysfunction 520
Immunosuppression 520
Rejection 521
66. Anesthesia for Lung Transplantation......................................................................................................................................... 522
Kiran Salaunkey, Chinmay Patvardhan, Abhi Misra
History 522
Surgical Approaches 522
Considerations for Listing 522
Contraindications 523
Preoperative Assessment 523
Conduct of Anesthesia 524
Surgical Technique 524
Intraoperative Management 524
Postoperative Intensive Care 525
Prophylactic Antimicrobials 526
SECTION 10: REGIONAL ANESTHESIA
Section Editor: Balavenkat Subramanian J
67. Neuraxial Blocks ............................................................................................................................................................................. 529
Nidhi Bhatia, Rakesh V Sondekoppam, Anju Grewal
Anatomy 529
Subarachnoid Block 530
Recent Developments: Neuraxial Ultrasound 533
Preprocedural Ultrasound Imaging 533
Epidural Anesthesia 533
68. Upper and Lower Limb Blocks..................................................................................................................................................... 541
Amjad Maniar, Rammurthy Kulkarni
Anatomy of the Brachial Plexus 541
Peripheral Nerve Blocks at the Level of Elbow and Wrist 544
Superficial Cervical Plexus Block 545
Lower Limb Blocks 545
69. Chest Wall Interfascial Plane Blocks ........................................................................................................................................... 550
Vivekanandan Natarajan, Balavenkat Subramanian J, Vishal Uppal
Relevant Anatomy 550
Block Techniques 551
Clinical Performance 554
70. Abdominal Interfascial Plane Blocks ......................................................................................................................................... 556
Sathish Rajaselvam, Vishal Uppal, Balavenkat Subramanian J
Anatomical Considerations 556
Subcostal Transversus Abdominis Plane Block 558
Lateral Transversus Abdominis Plane Block 558
Posterior Transversus Abdominis Plane Block 559
Ilioinguinal Nerve and Iliohypogastric Nerve Blocks 559
Rectus Sheath Block 559
Quadratus Lumborum Blocks 561
Clinical Performance 561
SECTION 11: POSTOPERATIVE CARE
71. Management of Patients in Postanesthesia Care Unit .......................................................................................................... 567
Subramani Kandasamy, Shoma V Rao, Pritish John Korula
Patient Handover 567
Monitoring 567
Postoperative Nausea and Vomiting 567
Airway and Respiratory Complications 568
Assessment and Management of Hemodynamic Issues 568
Neuromuscular Complications 570
Delayed Emergence 570
Discharge Criteria 571
72. Management of Complications after Anesthesia ................................................................................................................... 573
Rajesh Kumar Pande, Ravi Prakash, Maitree Pandey
Airway-related Complications 573
Cardiovascular Complications 573
Postoperative Pulmonary Complications 575
Drug-related Complications 575
Neurological Complications in the Perioperative Period 575
Postoperative Nausea and Vomiting 577
73. Temperature Management in Perioperative Period .............................................................................................................. 579
Barkha Bindu, Ashutosh Kaushal, Ashish Bindra
Physiology of Thermoregulation 579
Thermoregulation Under Anesthesia 580
Perioperative Temperature Monitoring and Management Guidelines 580
Common Perioperative Temperature Derangements and Management 580
Targeted Temperature Management 583
Future Trends 584
74. Cardiopulmonary Resuscitation ................................................................................................................................................. 586
Rakesh Garg, Indubala Maurya, Kanika Rustagi
Etiologies of Cardiac Arrest 586
Immediate Management of Cardiac Arrest 586
Management of Specific Arrhythmias 591
Resuscitation in Special Patient Groups or Situations 591
75. Massive Blood Transfusion and Management of Complications ........................................................................................ 594
Rahul Chaurasia, Abhishek Singh, Kapil Dev Soni
Epidemiology 594
Pathophysiology of Massive Blood Loss 594
General Principles for Transfusion Management 595
Packed Red Blood Cells 595
Selection of Compatible Blood Products 595
Complications of Massive Transfusion 599
76. Mechanical Ventilation in the Postsurgical Patient ................................................................................................................ 600
Rajesh Chawla, Roseleen Kaur Bali, Aakanksha Chawla Jain
Pathophysiology 600
Postoperative Ventilation 601
77. DVT Prophylaxis and Management of PE in the Postoperative Patient ............................................................................ 605
Rupak Kundu, Subhash Todi
Risk Stratification of Venous Thromboembolism in Surgical Patients According to type of Surgery 605
Validated Score for Assessment of VTE Risk in Surgical Patients 605
Current Recommendations for VTE Prevention in Orthopedic Surgical Patients 605
Current Recommendations for VTE Prevention in Nonorthopedic Surgical Patients 606
Approach to Diagnosis in a Suspected Case of Postoperative PE 607
Management of a Suspected Case of Postoperative VTE 607
Contraindication of Systemic Thrombolysis in PE 608
Management of a Postoperative Patient Bleeding after Systemic Thrombolysis 608
78. Perioperative Nutrition ................................................................................................................................................................. 610
Shilpushp Bhosale, Atul P Kulkarni
Causes of Malnutrition 610
Surgical Stress and Nutrition 610
Preoperative Nutritional Assessment 611
Management of Perioperative Nutrition 613
Nutrition Intervention in the Perioperative Period 613
Role of Immunonutrition in the Perioperative Period 614
79. Acute Pain Management .............................................................................................................................................................. 616
Sumitra Ganesh Bakshi, Sheetal Gaikwad, Gauri R Gangakhedkar
Acute Pain and the Need to Treat It 616
Acute Pain Services and Its Role 616
Multimodal Pain Management 617
Analgesics Used in Postoperative Period 618
80. Principles of Chronic Pain Management and Palliative Care ............................................................................................... 621
PN Jain, Anuja Damani, Arunangshu Ghoshal
Approach to Chronic Noncancer Pain Management in Adults 622
Approach to Cancer Pain Management in Adults 622
Approach to Chronic Pain Management in Special Populations 622
Use of Opioids in Chronic Noncancer Pain Management 624
Palliative Care 625
Index.........................................................................................................................................................................................................627

Author information

Atul P Kulkarni MD FISCCM PGDHHM FICCM
Professor and Head, Division of Critical Care

Vandana Agarwal MD FRCA
Professor

Vijaya P Patil MD Dip
Professor and Head, Division of Clinical Anesthesia

Jigeeshu V Divatia MD FISCCM FICCM
Professor and Head

All at Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India