Barash, Cullen, and Stoeltings Clinical Anesthesia, 9e (Sep 9, 2023)_(1975199073)_(LWW).pdf

Covering the full spectrum of clinical issues and options in anesthesiology, Barash, Cullen, and Stoelting's Clinical Anesthesia, Ninth Edition, edited by Drs. Bruce F. Cullen, M. Christine Stock, Rafael Ortega, Sam R. Sharar, Natalie F. Holt, Christopher W. Connor, and Naveen Nathan, provides insightful coverage of pharmacology, physiology, co-existing diseases, and surgical procedures. This award-winning text delivers state-of-the-art content unparalleled in clarity and depth of coverage, as well robust multimedia features that equip you to effectively apply today's standards of care and make optimal clinical decisions on behalf of your patients. Comprehensively covers the entire field of anesthesiology with a practical, clinical focus throughout Features extensive multimedia content, including more than 300 updated procedural videos and 190 narrated interactive clinical vignettes Includes Key Points in every chapter, with corresponding numbers in the chapter margins for quick reference Highlights key references to quickly direct you to the most important and high-yield further reading Contains useful appendices with formulas, pacemaker and implantable cardiac defibrillator protocols, information on herbal medications, an atlas of echocardiography, and more Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech. Cover Title Page Copyright Dedication Preface Contributing Authors Contents Multimedia Contents Section 1: Introduction and Overview 1. The History of Anesthesia Anesthesia Before Ether Physical and Psychological Anesthesia Early Analgesics and Soporifics Inhaled Anesthetics Almost Discovery: Hickman, Clarke, Long, and Wells Public Demonstration of Ether Anesthesia Chloroform and Obstetrics Anesthesia Principles, Equipment, and Standards Control of the Airway Tracheal Intubation Advanced Airway Devices Early Anesthesia Delivery Systems Alternative Circuits Ventilators Carbon Dioxide Absorption Flowmeters Vaporizers Patient Monitors Electrocardiography, Pulse Oximetry, and Capnography Safety Standards The History of Anesthetic Agents and Adjuvants Inhaled Anesthetics Intravenous Anesthetics Local Anesthetics Opioids Muscle Relaxants Antiemetics Anesthesia Subspecialties Regional Anesthesia Cardiovascular Anesthesia Pediatric Anesthesia Neuroanesthesia Obstetric Anesthesia Transfusion Medicine Professionalism and Anesthesia Practice Organized Anesthesiology Academic Anesthesiology Establishing a Society Conclusions 2. The Practice of Anesthesiology Introduction The Practice of Anesthesiology The Value of Anesthesiologists Perioperative Surgical Home Enhanced Recovery after Surgery Practice Parameters: Standards, Guidelines, and Advisories Operating Room Management Physician Executive Roles and Additional Training Advocacy/Participation Accreditation, Training, and Certification Initial Certification Maintenance of Certification Financial Aspects of Anesthesia Practice Introduction Basics of Anesthesia Billing and Reimbursement Coding Billing Medical Direction and the Anesthesia Care Team Model What are Medical Direction and Medical Supervision? Who are “Qualified Individuals”? Payment for Anesthesia Care How Does Medical Direction or Supervision Affect Reimbursement? Government versus Commercial Insurance Payments Balance Billing and the No Surprises Act Summary and Future Directions Quality and Safety Regulatory Center for Medicare and Medicaid Services The Joint Commission Health Insurance Portability and Accountability Act State Regulations Conclusion Support Employment Markets Choosing a Practice Life Outside of Clinical Practice Wellness and Burnout Financial Wellness Debt Burden and Debt Repayment Savings, Budgeting, and Retirement Planning Protecting Assets: Insurance The Future Global and Public Health Green or “Clean” Anesthesia Artificial Intelligence and the Future of Anesthesia Care Conclusion 3. Occupational Health and Well-Being Introduction Physical Hazards Ergonomics Inhalation Anesthetics Levels of Waste Anesthetic Gases Health Consequences of WAG Exposure Surgical Smoke Radiation Noise Interpersonal Issues Night Call, Sleepiness, and Fatigue Substance Use Disorders Infectious Hazards Standard and Transmission-Based Precautions Respiratory Viruses Influenza Viruses Avian Influenza A Human Respiratory Syncytial Virus Severe Acute Respiratory Syndrome Enteric Infections DNA Viruses Rubella Measles (Rubeola) Viral Hepatitis Pathogenic Human Retroviruses Risk of Occupational HIV Infection Postexposure Treatment and Prophylactic Antiretroviral Therapy Prion Diseases Tuberculosis Impairment and Disability The Aging Anesthesiologist Mortality Among Anesthesiologists Suicide Psychological Considerations Stress Impact of Adverse Events Well-Being, Burnout, and Workplace Culture Burnout Well-Being Nutrition, Diet, and Fitness Mindfulness Creating a Culture of Support Conclusion 4. Anesthetic Risk, Quality Improvement, and Liability Anesthesia Risk Mortality and Major Morbidity Related to Anesthesia Risk Management Conceptual Introduction Risk Management in Anesthesia Informed Consent Record Keeping What to Do After an Adverse Outcome Special Circumstances: “Do Not Resuscitate” National Practitioner Data Bank Quality Improvement and Patient Safety in Anesthesia Structure, Process, and Outcome: The Building Blocks of Quality Continuous Quality Improvement Tracking Adverse Events for Anesthesia CQI Programs Joint Commission Requirements for Quality Improvement Alternative Payment Models and Pay for Performance Clinical Outcomes Registries in Anesthesiology Professional Liability The Tort System Duty Breach of Duty Causation Damages Standard of Care Causes of Anesthesia-Related Lawsuits What to Do When Sued Acknowledgments 5. Electrical Safety and Fires in the Operating Room Fundamental Principles of Electricity Electrical Circuits with Oscillating Voltages Electrical Shock Causes of Electric Shock Grounded Electrical Power Common Safety Features of a Grounded Electrical Power System Power Receptacles Ground-Isolated Electrical Power The Line Isolation Monitor Microshock Safety Features within Monitors Electrosurgery Electromagnetic Interference Emergency Backup Power Regulations and Building Codes Operating Room Fires American Society of Anesthesiologists Fire Prevention Practice Advisory Fire Triangle/Tetrahedron Flammability, Oxygen Concentration, Gas Density, and Nitrous Oxide Assessing Fire Risk during the Presurgical Timeout OR Fires and Lessons from Closed Claims and Review Findings Why Is 2 L/min O2 via Nasal Cannula or Face Mask Not Safe for High–Fire-Risk Cases? On-Patient versus In-Patient Fires Airway Fires Laser-Related Airway Fires Tracheostomy Fires Tonsillectomy Fires Eye Surgery Fires Abdominal Surgery/Colonoscopy Fires Thoracic Surgery Fires Electrical Equipment Fire Fire Prevention Fire Response Section 2: Basic Science and Fundamentals 6. Genomic Basis of Perioperative Precision Medicine Scientific Rationale for Perioperative Precision Medicine Human Genomic Variation Profiling the Regulatory Genome to Understand Perioperative Biology and Discover Biomarkers of Organ Injury and Adverse Outcomes Epigenetics: The Link between Environment and Genes Overview of Genetic Epidemiology and Functional Genomic Methodology Genomics and Perioperative Risk Profiling Predictive Biomarkers for Perioperative Adverse Cardiac Events Perioperative Myocardial Infarction and Ventricular Dysfunction Perioperative Atrial Fibrillation Genetic Variants and Postoperative Event-Free Survival Genetic Susceptibility to Adverse Perioperative Neurologic Outcomes Genetic Susceptibility to Adverse Perioperative Kidney Outcomes Genetic Variants and Risk for Postoperative Acute Lung Injury Pharmacogenomics and Anesthesia Genetic Variability in Response to Anesthetic Agents Genetic Variability in Pain Response Genetic Variability in Response to Other Drugs Used Perioperatively Conclusions and Future Directions 7. Experimental Design and Statistics Introduction Foundations Data Structure Descriptive Statistics Central Location Spread or Variability Types of Research Design Experimental Medicine: Management of Bias Sampling Experimental Constraints Control Groups Random Allocation of Treatment Groups Blinding Experimental Medicine: Data Analysis Null Significance Hypothesis Test Formulation Logic of Proof Sample Size Calculations Sample Test Statistics The Fickle P Value The Bayesian Alternative Experimental Medicine: Statistical Tests Interval Data Confidence Intervals t-Test Analysis of Variance Robustness and Nonparametric Tests Binary Variables Confidence Intervals on Proportions Hypothesis Testing Linear Regression Epidemiology Multivariable Linear Regression Univariable and Multivariable Logistic Regression Propensity Score Matching and Analysis Systematic Reviews and Meta-Analyses Big Data Conclusions Interpretation of Results Statistical Resources Statistics and Anesthesia 8. Inflammation, Wound Healing, and Infection Introduction Infection Control Hand Hygiene Antisepsis Role of Single-Use Disposables in Infection Control Antibiotic Prophylaxis Mechanisms of Wound Repair The Initial Response to Injury Resistance to Infection Proliferation Neovascularization Collagen and Extracellular Matrix Deposition Epithelialization Maturation and Remodeling Wound Perfusion and Oxygenation Patient Management Preoperative Preparation Intraoperative Management Volume Management Postoperative Management Summary 9. The Allergic Response Introduction Basic Immunologic Principles Antigens Thymus-Derived (T-cell) and Bursa-Derived (B-cell) Lymphocytes Antibodies Effector Cells and Proteins of the Immune Response Cells Proteins Effects of Anesthesia on Immune Function Hypersensitivity Responses (Allergy) Type I Reactions Type II Reactions Type III Reactions (Immune Complex Reactions) Type IV Reactions (Delayed Hypersensitivity Reactions) Intraoperative Allergic Reactions Anaphylactic Reactions IgE-Mediated Pathophysiology Molecular Mediators of Anaphylaxis Peptide Mediators of Anaphylaxis Arachidonic Acid Metabolites Kinins Platelet-Activating Factor Recognition of Anaphylaxis Non–IgE-Mediated Reactions Complement Activation Nonimmunologic Release of Histamine Treatment Plan Initial Therapy Secondary Treatment Perioperative Management of the Patient with Allergies Immunologic Mechanisms of Drug Allergy Evaluation of Patients with Allergic Reactions Testing for Allergy Agents Implicated in Allergic Reactions Antibiotics Latex Allergy Local Anesthetics Neuromuscular Blocking and Reversal Agents Summary 10. Mechanisms of Anesthesia and Consciousness What Is Anesthesia? How Is Anesthesia Measured? What Is the Chemical Nature of Anesthetic Target Sites? The Meyer–Overton Rule Exceptions to the Meyer–Overton Rule Lipid versus Protein Targets Lipid Theories of Anesthesia Protein Theories of Anesthesia Evidence for Anesthetic Binding to Proteins Summary How Do Anesthetics Interfere with the Electrophysiologic Function of the Nervous System? Neuronal Excitability Synaptic Transmission Presynaptic Effects Postsynaptic Effects Summary Potential Anesthetic Targets GABA-Activated Ion Channels Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels Two-Pore Potassium Channels Sodium Channels T-Type Calcium Channels Shaker Potassium Channels NMDA-Subtype Glutamate-Activated Ion Channels Mitochondrial Complex I Synaptic Vesicle Release Machinery Summary How and Where in the Central Nervous System Do Anesthetics Work? Spinal Cord—Immobility Brainstem—Autonomic Control Mechanisms of Anesthesia—Lessons from Sleep Subcortical and Cortical Structures—Unconsciousness Subcortical Structures—Regulation of Arousal and Sleep Thalamus and Cerebral Cortex—Arousal and Content of Consciousness Hippocampus, Amygdala, and Cerebral Cortex—Amnesia Summary Conclusions Acknowledgments 11. Basic Principles of Clinical Pharmacology Pharmacokinetic Principles Drug Absorption and Routes of Administration Transfer of Drugs across Membranes Intravenous Administration Oral Administration Transcutaneous Administration Intramuscular and Subcutaneous Administration Intrathecal, Epidural, and Perineural Injection Inhalational Administration Drug Distribution Redistribution Drug Elimination Biotransformation Reactions Phase I Reactions Cytochrome P450 Enzymes Phase II Reactions Genetic Variations in Drug Metabolism Chronologic Variations in Drug Metabolism Renal Drug Clearance Hepatic Drug Clearance Pharmacokinetic Models Physiologic versus Compartment Models Pharmacokinetic Concepts Volume of Distribution Total Drug (Elimination) Clearance Elimination Half-Life Effect of Hepatic or Renal Disease on Pharmacokinetic Parameters Nonlinear Pharmacokinetics Compartmental Pharmacokinetic Models One-Compartment Model Two-Compartment Model Three-Compartment Model Noncompartmental (Stochastic) Pharmacokinetic Models Neural Networks and Artificial Intelligence Pharmacodynamic Principles Drug–Receptor Interactions Desensitization and Downregulation of Receptors Agonists, Partial Agonists, and Antagonists Dose–Response Relationships Concentration–Response Relationships Combined Pharmacokinetic–Pharmacodynamic Models Population Pharmacokinetic–Pharmacodynamic Models Therapeutic Thresholds and Therapeutic Window Drug Interactions Pharmaceutical (Physiochemical) Interactions In Vitro Interactions In Vivo Interactions Pharmacokinetic Interactions Absorption (Uptake) Distribution Metabolism Pharmacodynamic Interactions Serotonin Syndrome Clinical Applications of Pharmacokinetics and Pharmacodynamics to the Administration of Intravenous Anesthetics Rise to Steady-State Concentration Manual Bolus and Infusion Dosing Schemes Pharmacokinetic Simulation Software Context-Sensitive Decrement Time Context-Sensitive Time to Recovery Soft Pharmacology and Anesthesiology Target-Controlled Infusions Time to Maximum Effect Compartment Concentration (Tmax) Volume of Distribution at Peak Effect (VDPE) Front-End Pharmacokinetics Closed-Loop Infusions Response Surface Models of Drug–Drug Interactions Conclusion Section 3: Core Principles 12. Cardiac Anatomy and Physiology Introduction Gross Anatomy Valves Conduction System Coronary Anatomy Coronary Physiology Cardiac Myocyte Anatomy and Function Ultrastructure Contractile Apparatus Proteins Ca2+-Myofilament Interaction Myosin–Actin Interaction Laplace’s Law The Cardiac Cycle Pressure–Volume Diagrams Determinants of Cardiac Performance Heart Rate Preload Afterload Myocardial Contractility Evaluation of Diastolic Function Relaxation LV Filling Compliance Pericardial Restraint Determinants of Atrial Function Pathophysiology of Heart Failure Presentation Diagnosis Functional Characteristics 13. Autonomic and Cardiovascular Pharmacology Introduction Cholinergic Drugs Cholinergic Agonists Cholinesterase Inhibitors Muscarinic Antagonists Muscarinic Antagonist Toxicity Fundamentals of Catecholamine Pharmacology Epinephrine Norepinephrine Dopamine Dobutamine Isoproterenol Selective Beta2-Adrenoceptor Agonists Fenoldopam Sympathomimetics Ephedrine Phenylephrine Alpha1-adrenoceptor Antagonists Alpha2-adrenoceptor Agonists: Clonidine and Dexmedetomidine Beta-Adrenoceptor Antagonists (Beta-Blockers) Propranolol Metoprolol Atenolol Esmolol Labetalol Carvedilol Phosphodiesterase Inhibitors Levosimendan Digitalis Glycosides Vasopressin Nitrovasodilators Nitroglycerin Sodium Nitroprusside Hydralazine Calcium Channel Blockers Nifedipine Nicardipine Clevidipine Nimodipine Diltiazem Verapamil Angiotensin Converting Enzyme Inhibitors Angiotensin Receptor Blockers Acknowledgments 14. Autonomic Nervous System Anatomy and Physiology Anesthesia and the Autonomic Nervous System Functional Anatomy Central Autonomic Organization Peripheral Autonomic Nervous System Organization Sympathetic Nervous System Parasympathetic Nervous System Autonomic Innervation Peripheral Circulation Lungs Autonomic Nervous System Transmission Parasympathetic Nervous System Transmission Sympathetic Nervous System Transmission Receptors Cholinergic Receptors Adrenergic Receptors α-Adrenergic Receptors α-Adrenergic Receptors in the Cardiovascular System α-Adrenergic Receptors in the Central Nervous System α Receptors in the Kidney β-Adrenergic Receptors β Receptors in the Cardiovascular System β Receptors in the Kidney Dopaminergic Receptors Other Receptors Serotonin Adrenergic Receptor Numbers and Sensitivity Autonomic Nervous System Reflexes and Interactions Baroreceptors Denervated Heart Interaction of Autonomic Nervous System Receptors Interaction with Other Regulatory Systems Clinical Autonomic Nervous System Pharmacology Mode of Action Ganglionic Drugs Agonists Antagonists Cholinergic Drugs Muscarinic Agonists Direct Cholinomimetics Indirect Cholinomimetics Muscarinic Antagonists Atropine-Like Drugs Central Anticholinergic Syndrome45 Autonomic Syndromes and Autonomic Regulation Horner Syndrome Diabetic Neuropathy Orthostatic Hypotension Monoamine Oxidase Inhibitors Tricyclic Antidepressants Selective Serotonin Reuptake Inhibitors 15. Respiratory Function in Anesthesia Introduction Respiratory Mechanics Equation of Motion Work and Power of Breathing Elastic Forces Measuring Elastic Forces during Anesthesia Driving Pressure Esophageal Pressure and Chest Wall Compliance Changes in Elastic Forces under Anesthesia Resistive Forces Anatomy of the Airways Airway Resistance Tissue Resistance Measurement of Resistance Changes in Resistance during Anesthesia Intrinsic PEEP Gas Exchange Impairments in Gas Exchange during Anesthesia Oxygen Carbon Dioxide Control of Breathing Chemical Feedback of Breathing Reflexive Control of Breathing CO2 Exchange under Anesthesia Lung Volumes and Capacities Pulmonary Function Tests Forced Vital Capacity Forced Expiratory Volume Forced Expiratory Flow Flow–Volume Loops Carbon Monoxide Diffusing Capacity Practical Application of Pulmonary Function Tests Summary 16. Acid–Base, Fluids, and Electrolytes Acid–Base Equilibrium Acid–Base Interpretation and Treatment Metabolic Acidosis Metabolic Alkalosis Respiratory Alkalosis Respiratory Acidosis Diagnosis of Acid–Base Disorders and Interpretation of Arterial Blood Gas Examples Fluid Management Physiology Body Fluid Compartments Distribution of Infused Fluids Regulation of Osmolarity and Circulating Volume Fluid Replacement Therapy Maintenance Requirements for Water, Sodium, and Potassium Dextrose Surgical Fluid Requirements Water and Electrolyte Composition of Fluid Losses Influences of Perioperative and Intraoperative Fluid Infusion Rates on Clinical Outcomes Colloids, Crystalloids, and Hypertonic Solutions Physiology and Pharmacology Clinical Implications of Choice between Alternative Fluids Implications of Crystalloid and Colloid Infusions on Intracranial Pressure Buffered versus Nonbuffered Crystalloid Clinical Implications of Hypertonic Fluid Administration Fluid Status: Assessment and Monitoring Conventional Clinical Assessment Intraoperative Clinical Assessment Electrolytes Sodium Physiologic Role Hyponatremia Hypernatremia Potassium Physiologic Role Hypokalemia Hyperkalemia Calcium Physiologic Role Hypocalcemia Hypercalcemia Magnesium Physiologic Role Hypomagnesemia Hypermagnesemia Phosphorus Physiologic Role Hypophosphatemia Hyperphosphatemia 17. Hemostasis and Transfusion Medicine Introduction Hemostasis and Coagulation Primary Hemostasis Adherence Activation Stabilization Inhibition Mechanisms of Antiplatelet Medications Secondary Hemostasis Inhibition of Clotting Factors Fibrinolysis Inhibition of Fibrinolysis Laboratory Evaluation of Hemostasis Laboratory Evaluation of Primary Hemostasis Laboratory Evaluation of Secondary Hemostasis and Coagulation Mixing Studies Viscoelastic Testing Diagnosis of Thromboembolic Disorders Congenital Risk Factors for Thrombosis Acquired Risk Factors for Thrombosis Monitoring Anticoagulation Therapeutic Agents Warfarin Anticoagulation Heparin Anticoagulation Testing Blood Component Production Blood Collection Component Processing and Storage Plasma Derivatives RBC and Platelet Substitutes Blood Products and Transfusion Practice Compatibility Testing Red Blood Cells Physiologic Compensation for Anemia Platelets Plasma Products Cryoprecipitate Fibrinogen Concentrate Emerging Blood Products The Risks of Blood Product Administration Infectious Risks of Blood Product Administration Human Immunodeficiency Virus Hepatitis C Virus Hepatitis B Virus Human T-Cell Lymphotropic Virus-1 and Virus-2 Cytomegalovirus Emerging Infections Bacterial Contamination Noninfectious Risks of Blood Product Administration Immune-Mediated Transfusion Reactions Transfusion-Related Immunomodulation Nonimmune-Mediated Transfusion Reactions Patient Blood Management Preoperative Anemia Management Perioperative Iron Supplementation Perioperative Erythropoietin Autologous Blood Transfusion Perioperative Blood Salvage Disorders of Hemostasis: Diagnosis and Treatment Disorders of Primary Hemostasis Disorders of Secondary Hemostasis The Hemophilias Hereditary Hypercoagulability Acquired Disorders of Hemostasis Vitamin K Deficiency Liver Disease Disseminated Intravascular Coagulation (DIC) Anticoagulation and Pharmacologic Therapy Anticoagulation Regimens and Associated Anesthetic Concerns Cyclooxygenase Inhibitors Phosphodiesterase Inhibitors ADP Receptor Antagonists GP IIb/IIIa Receptor Antagonists Protease-Activated Receptor (PAR)-1 Antagonist Vitamin K Antagonists New Oral Anticoagulants Heparin Therapy Indirect Factor Xa Antagonists Heparin-Induced Thrombocytopenia Parenteral Direct Thrombin Inhibitors Recombinant Activated Factor VII Prothrombin Complex Concentrates Desmopressin Antifibrinolytic Therapy Lysine Analog Conclusions Section 4: Anesthetic Drugs and Adjuvants 18. Inhaled Anesthetics Introduction Pharmacokinetic Principles Unique Features of Inhaled Anesthetics Speed, Gas State, and Route of Administration Physical Characteristics of Inhaled Anesthetics Gases in Mixtures Gases in Solution Anesthetic Transfer: Machine to Central Nervous System Uptake and Distribution FA/FI Rise in FA in the Absence of Uptake Rise in FA in the Presence of Uptake Distribution (Tissue Uptake) Metabolism Overpressurization and the Concentration Effect Second Gas Effect Ventilation Effects Perfusion Effects Ventilation–Perfusion Mismatching Elimination Percutaneous and Visceral Loss Diffusion between Tissues Exhalation and Recovery Diffusion Hypoxia Clinical Overview of Current Inhaled Anesthetics Isoflurane Desflurane Sevoflurane Xenon Nitrous Oxide Neuropharmacology of Inhaled Anesthetics Minimum Alveolar Concentration The Effect of Age on MAC Other Alterations in Neurophysiology Cerebral Metabolic Rate and Electroencephalogram Cerebral Blood Flow, Flow–Metabolism Coupling, and Autoregulation Intracerebral Pressure Cerebral Blood Flow Response to Hypercapnia and Hypocapnia Cerebral Protection Postoperative Cognitive Dysfunction Processed Electroencephalograms and Neuromonitoring Nitrous Oxide The Circulatory System Hemodynamics Myocardial Contractility Other Circulatory Effects Coronary Steal, Myocardial Ischemia, and Cardiac Outcome Cardioprotection from Volatile Anesthetics Autonomic Nervous System The Pulmonary System General Ventilatory Effects Ventilatory Mechanics Response to Carbon Dioxide and Hypoxemia Bronchiolar Smooth Muscle Tone Mucociliary Function Pulmonary Vascular Resistance Hepatic Effects Neuromuscular System and Malignant Hyperthermia Uterine Tone, Genetic Markers, Fetal Development, and Neonatal Neurobehavioral Outcomes Anesthetic Degradation by Carbon Dioxide Absorbers Compound A Carbon Monoxide and Heat Anesthetic Metabolism Fluoride-Induced Nephrotoxicity Environmental Effects of Volatile Anesthetics Clinical Utility of Volatile Anesthetics For Induction of Anesthesia For Maintenance of Anesthesia Acknowledgments 19. Intravenous Anesthetics Pharmacokinetics: General Principles for Intravenous Anesthetics Propofol Introduction Pharmacokinetics Pharmacodynamics Central Nervous System Effects Cardiovascular Effects Respiratory System Effects Clinical Uses Side Effects Etomidate Introduction Pharmacokinetics Pharmacodynamics and Clinical Uses Side Effects Ketamine Introduction Pharmacokinetics Pharmacodynamics Clinical Uses Anesthesia Sedation Analgesia Chronic Pain Depression Side Effects Dexmedetomidine Introduction Pharmacokinetics Pharmacodynamics Clinical Uses Side Effects Benzodiazepines Introduction Pharmacokinetics Pharmacodynamics and Clinical Uses Side Effects Barbiturates Introduction Pharmacokinetics Pharmacodynamics Central Nervous System Effects Cardiovascular Effects Respiratory System Effects Clinical Uses Side Effects New Intravenous Anesthetics Propofol Formulations 20. Opioids Introduction History The Endogenous Opioid System Multifunctional Opioids Nociception and Pain Opioids and Opioid Mechanisms Classification of Exogenous Opioids Central Opioid Analgesia Peripheral Opioid Analgesia Opioid-Induced Hyperalgesia and Opioid Tolerance Opioid Tolerance to Respiratory Depression Opioid Pharmacokinetics and Pharmacodynamics Opioid Pharmacokinetics Metabolism: Which Pathways and Metabolites Are Clinically Relevant? Morphine Piperidines Methadone Naloxone Pharmacodynamics: Which End Point Serves the Clinician Best? Pharmacodynamics: Pain Relief Morphine Fentanyl Sufentanil Remifentanil Buprenorphine Oliceridine Pharmacogenetics Opioid-Induced Respiratory Depression Mechanisms of Opioid-Induced Respiratory Depression Incidence and Risk Factors of Opioid-Induced Respiratory Depression Opioid-Induced Respiratory Depression versus Opioid Analgesia Combining Opioids and Central Depressants Reversal of Opioid-Induced Respiratory Depression Monitoring Monitoring of Nociception during Anesthesia and Surgery Monitoring on the Ward Other Opioid-Related Side Effects Nausea and Vomiting Smooth Muscle Effects Cardiovascular Effects 21. Neuromuscular Blocking Drugs Introduction Physiology Nerve Propagation and Nerve Terminal Presynaptic Events Neuromuscular Junction Post Synaptic Events Receptor Up- and Downregulation Pharmacology Characterization of Neuromuscular Blocking Drugs Interpatient Variation Depolarizing Neuromuscular Blocking NMB Drug: Succinylcholine Depolarizing Blockade Characteristics Pharmacology of Succinylcholine Succinylcholine Side Effects Succinylcholine Clinical Uses Succinylcholine Contraindications Nondepolarizing Neuromuscular Blocking Drugs Characteristics of Nondepolarizing Neuromuscular Blocking Drugs Drug Classification of Nondepolarizing Neuromuscular Blocking Drugs Onset of Action of Nondepolarizing Neuromuscular Blocking Drugs Duration of Action of Nondepolarizing Neuromuscular Blocking Drugs Aminosteroids Benzylisoquinolinium Drugs Adverse Effects of Nondepolarizing Neuromuscular Blocking Drugs Nondepolarizing Neuromuscular Blocking Drug Interactions Nondepolarizing Neuromuscular Blocking Drug Altered Responses Monitoring Neuromuscular Blockade History and Clinical Significance of Monitoring Neuromuscular Blockade Time and Clinical Assessment of Neuromuscular Blockade Peripheral Nerve Stimulators Quantitative Monitoring Differential Muscle Sensitivity to Neuromuscular Blockade Receptor Occupancy to Stimulation Response Relationship Adoption of Quantitative Monitoring into Clinical Practice Reversal of Neuromuscular Blockade Depth of Block Definitions Anticholinesterase Drugs Factors Affecting Neostigmine Reversal Neostigmine Dosing Other Effects of Neostigmine Neostigmine Weakness Neostigmine Cost Variation Over Time Edrophonium Selective Relaxant Binding Drugs: Sugammadex Selective Relaxant Binding Drugs: Future Drugs 22. Local Anesthetics Mechanisms of Action of Local Anesthetics Anatomy of Nerves Electrophysiology of Neural Conduction and Voltage-Gated Sodium Channels Molecular Mechanisms of Local Anesthetics Mechanism of Nerve Blockade Pharmacology and Pharmacodynamics Chemical Properties and Relationship to Activity and Potency Additives to Increase Local Anesthetic Activity Epinephrine Alkalinization of Local Anesthetic Solution Opioids α2-Adrenergic Agonists Steroids Liposomes Pharmacokinetics of Local Anesthetics Systemic Absorption Distribution Elimination Clinical Pharmacokinetics Clinical Use of Local Anesthetics Toxicity of Local Anesthetics Local Anesthetic Systemic Toxicity (LAST) Central Nervous System Toxicity Cardiovascular Toxicity Clinical Presentation of LAST Incidence of LAST Prevention and Treatment of LAST Treatment of Systemic Toxicity from Local Anesthetics Neural Toxicity of Local Anesthetics Transient Neurologic Symptoms after Spinal Anesthesia Myotoxicity of Local Anesthetics Allergic Reactions to Local Anesthetics Future Therapeutics and Modalities Section 5: Preoperative Assessment and Perioperative Monitoring 23. Preoperative Patient Assessment and Management Introduction Changing Concepts in Preoperative Evaluation Approach to the Healthy Patient Patient Identification, Diagnosis, and Planned Procedure Response to Previous Anesthetics Medications/Allergies Screening Patients Using a Systems Approach Airway Pulmonary System Cardiovascular System Neurologic System Endocrine System Evaluation of the Patient With Known Systemic Disease Cardiovascular Disease Identifying Clinical Risk Factors Identifying Patients at Risk for Atherosclerotic Cardiac Disease Importance of Surgical Procedure Calculation of Risk to Predict Perioperative Morbidity Preoperative Cardiac Testing Special Patient Populations Pulmonary Disease Smoking Asthma Obstructive Sleep Apnea (OSA) Endocrine Disease Diabetes Mellitus Thyroid and Parathyroid Diseases Adrenal Disorders Renal Disease Liver Disease Infectious Disease Other Diseases Preoperative Laboratory Testing Defining Normal Values Risks and Costs versus Benefits Clinical Considerations for Laboratory Testing Summary of the Preoperative Evaluation Preparation Smoking Cessation Continuing Current Medications/Treatment of Coexisting Diseases β-Blockers Anticoagulation Aspirin Statins Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Prevention of Perioperative Pulmonary Aspiration ASA Fasting Guidelines Recommendations for Clear Liquids: At Least 2 Hours Recommendations for Breast Milk: At Least 4 Hours Recommendations for Infant Formula, Nonhuman Milk, and Light Meal: At Least 6 Hours Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration Psychological Preparation/Premedication Psychological Preparation Premedication Benzodiazepines Diphenhydramine Opioids Dexmedetomidine Anticholinergics Antibiotic Prophylaxis Summary of Patient Preparation 24. Rare Coexisting Diseases Musculoskeletal Diseases Muscular Dystrophy and Congenital Myopathy Duchenne Muscular Dystrophy Becker Muscular Dystrophy Emery–Dreifuss Muscular Dystrophy Limb-Girdle Muscular Dystrophy Facioscapulohumeral Muscular Dystrophy Oculopharyngeal Muscular Dystrophy Congenital Muscular Dystrophy and Myopathy Management of Anesthesia Myotonic Dystrophy Myotonic Dystrophy Type 1 Myotonic Dystrophy Type 2 Management of Anesthesia Skeletal Muscle Channelopathies Hyperkalemic Periodic Paralysis Hypokalemic Periodic Paralysis Andersen–Tawil Syndrome Management of Anesthesia Myasthenia Gravis Management of Anesthesia Myasthenic Syndrome Guillain–Barré Syndrome