Duke's Anesthesia Secrets

481 Pages·2015·9.45 MB·English

by  James Duke

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DUKE’S 9
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ANESTHESIA
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DUKE’S 9
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ANESTHESIA
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FIFTH EDITION s
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JAMES C. DUKE, MD, MBA†
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Associate Professor of Anesthesiology
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University of Colorahdo Health Sciences Center
Aurora, Colorado
Associate Direc tor [Retired]
Department Gof Anesthesiology
Denver Health Medical Center
DenverR, Colorado
†Deceased
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BRIAN M. KEECH, MD, FAAP
d Assistant Professor of Anesthesiology
University of Colorado Health Sciences Center
e Aurora, Colorado
Staff Anesthesiologist
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Department of Anesthesiology
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n Denver Health Medical Center
Denver, Colorado
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1600 John F. Kennedy Blvd.
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Ste 1800
Philadelphia, PA 19103-2899
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ANESTHESIA SECRETS, FIFTH EDITION ISBN: 978-0-323249775 i
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Copyright © 1996 by Hanley & Belfus
Copyright © 2011, 2006, 2000 by Mosby, Inc., an affiliate of Elsevier Inc. a
Copyright © 2016 by Saunders, an imprint of Elsevier Inc.
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All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any /
means, electronic or mechanical, including photocopying, recording, or any information storage and retrrieval
system, without permission in writing from the publisher. Details on how to seek permission, further e
information about the Publisher’s permissions policies and our arrangements with organizations such as
the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our wesbsite:
www.elsevier.com/permissions.
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein). /
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Notices .
Knowledge and best practice in this field are constantly changingt. As new research and experience
broaden our understanding, changes in research methods, profeassional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
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and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
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parties for whom they have a professional responsibility.
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With respect to any drug or pharmaceutical products identified, readers are advised to check the most
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current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended sdose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
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knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the tlaw, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury atnd/or damage to persons or property as a matter of products liability,
negligence or otherwise, hor from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

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Library of Congress Cataloging-in-Publication Data
AnesthesRia secrets / [edited by] James C. Duke.—Fifth edition.
p. ; cm.
Includes bibliographical references and index.
VISBN 978-0-323-24977-5 (pbk.)
I. Duke, James, 1957- , editor.
d [DNLM: 1. Anesthesia—Examination Questions. 2. Anesthesiology—methods—Examination
Questions. 3. Anesthetics—Examination Questions. WO 218.2]
RD82.3
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617.9'6—dc23
2014027621
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i Content Strategist: James Merritt
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Content Development Specialists: Kelly McGowan/Lucia Gunzel
Publishing Services Manager: Hemamalini Rajendrababu
U Project Manager: Umarani Natarajan
Designer: Steven Stave
Illustrations Manager: Emily Costantino
Marketing Manager: Melissa Darling
Printed in the USA
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Dedicated to Renee, My Wonderful Wife and Companion, to Dr. Philip Mehler, r
and to the Many Contributors to Anesthesia Secrets. e
James C. Duke
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To my wife Molly, thank you for all your love and support, and to my Mom, Dad and brother
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for always being there for me.
/ Brian M. Keech
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DEDICATION TO
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DR. DUKE, MD, MBA
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This dedication is for Dr. James Duke, co-editor of this fifth edition of Anesthesia Secrets and alsot
editor of the previous four editions of this text. Sadly, Dr. Duke recently passed after a two-y/ear
struggle with a brain tumor. r
Dr. Duke, or Jim as he was known at Denver Health, was a superbly talented anestheesiologist
both for complicated elective cases as well as for those critically injured trauma patients seen at
Denver Health, where Dr. Duke worked the last 20 years of his almost three-decsade career. In
addition, while at Denver Health, he quickly distinguished himself as someone who was passionate
about quality of care, process improvement and patient safety. Soon after joiniung Denver Health,
he was appointed Associate Director of the Anesthesia Department, a position he admirably held
until his medical retirement in 2013. /
Moreover, his leadership skills earned him an appointment to thre Denver Health Medical
Executive Committee, for which he held the role of Secretary of thec Medical Staff, and ultimately
was appointed President of the Medical Staff, which he held until his retirement.
Dr. Duke was a superb educator, beloved and respected by. the hundreds of students and resi-
dents with whom he interacted during his career. His assiduotus dedication to the Anesthesia Secrets
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text is a testament to his commitment to medical education.
Dr. Duke was a true “renaissance” man. He was an affable person, with impeccable tastes in
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clothing, food, motorcycles, and gardening. His subtle southern drawl was a perfect complement
to his overall persona. /
Jim will be sorely missed. His contribut/ion to Denver Health and its anesthesia department,
to the next generation of medical professio:nals, and to humanity are unassailable and indeed most
impressive. The legacy he has formallys established with the Anesthesia Secrets text will continue
to be impactful for many generations to come and will keep him in our collective memories for
many years forthwith. p
t Philip S. Mehler, MD, FACP, FAED
t Glassman Professor of Medicine
h University of Colorado
Denver Health Medical Center and
The University of Colorado
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Denver, CO
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CONTRIBUTORS 9
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Rita Agarwal, MD Rachel D. Clopton, MD
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Professor of Anesthesiology, Director of Fellowship, Pediatric Anesthesia, Children’s
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Pediatric Education, Department of Hospital Colorado, University of Colorado
Anesthesiology, University of Colorado, Hospital, Aurora, CO e
Aurora, CO
Mary DiMiceli, MD s
Pediatric Anesthesiology Program Director,
OB Anesthesiology Fellow, Obstetric
Anesthesiology, Children’s Hospital
Anesthesia, Vanderbilt Uuniversity Hospital,
Colorado, Aurora, CO
Nashville, TN
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Benjamin Atwood, MD James C. Duke, MD, rMBA (Deceased)
Anesthesia Resident, Department of Associate Directcor, Retired, Anesthesiology,
Anesthesia, Critical Care and Pain Denver Health Medical Center,
Medicine, Massachusetts General Hospital, Denver, C.O
Boston, MA t
Clinical Fellow in Anesthesia, Harvard Mattheaw J. Fiegel, BA, MD
Medical School, Boston, MA Associate Professor, Anesthesiology,
kUniversity of Colorado Hospital,
Daniel R. Beck, MD, MS Aurora, CO
Assistant Professor, Cardiothoracic /
Jacob Friedman, MD
Anesthesiologist, Department of /
Assistant Professor, Department of
Anesthesiology, University of Colorado:,
Anesthesiology, University of Colorado
Veterans Affairs Medical Center, s
Health Sciences Center, Aurora, CO
Denver, CO
p Staff Anesthesiologist, Department of
Anesthesiology, Denver Veteran’s Affairs
Bethany Benish, MD
t Hospital, Denver, CO
Assistant Professor of Anesthesiology,
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Department of Anesthesiology, University Robert Friesen, MD
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of Colorado, Aurora, CO Professor, Anesthesiology, Children’s Hospital
Attending Anesth esiologist, Department of Colorado, Aurora, CO
AnesthesioloGgy, Denver Health Medical Professor, Department of Anesthesiology,
Center, Denver, CO University of Colorado School of Medicine,
Denver, CO
Mark ChaRndler, MD
Assistant Professor, University of Andrea J. Fuller, MD
Colorado Health Sciences Center, Assistant Professor of Anesthesiology,
VAurora, CO University of Colorado Health Sciences
Anesthesiologist, Department of Center, Aurora, CO
d Anesthesiology, Denver Health Medical
James B. Haenel, RRT
Center, Denver, CO Surgical Critical Care Specialist, Surgery,
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Denver Health Medical Center, Denver, CO
Christopher Ciarallo, MD, FAAP
t Assistant Professor, Department of Michelle Dianne Herren, MD
i Anesthesiology, University of Colorado Pediatric Anesthesiologist, Department of
n School of Medicine, Aurora, CO Anesthesiology, University of Colorado
Director of Pediatric Anesthesiology, Hospital, Aurora, CO
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Department of Anesthesiology, Denver Pediatric Anesthesiologist, Denver Health
Health Medical Center, Denver, CO Medical Center, Denver, CO
Pediatric Anesthesiologist, Anesthesiology, Pediatric Anesthesiologist, Children’s Hospital
Children’s Hospital Colorado, Aurora, CO Colorado, Aurora, CO
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Daniel J. Janik, MD Philip R. Levin, MD
Associate Professor, Department of Clinical Professor, Department of
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Anesthesiology, University of Colorado Anesthesiology, David Geffen School of
School of Medicine, Aurora, CO Medicine at UCLA, Los Angeles, CA
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Co-director Intraoperative Neuromonitoring,
Ana M. Lobo, MD, MPH i
Anesthesiology, University of Colorado
Assistant Professor of Anesthesiology, h
Hospital, Aurora, CO
Department of Anesthesiology, Yale New
Gillian E. Johnson, MD Haven Hospital, New Haven, CT a
Anesthesiologist, Pikes Peak Anesthesia,
Christopher M. Lowry, MD t
Colorado Springs, CO
Assistant Professor of Medicine, Departmen/t
Jeffrey L. Johnson, MD of Cardiology, University of Colorado,r
Assistant Professor of Surgery, University Aurora, CO e
of Colorado Health Sciences Center, Director of Cardiac Electrophysiology,
Aurora, CO Department of Cardiology, Desnver Health
Director, Surgical Intensive Care, Denver Medical Center, Denver, CO
Health Medical Center, Denver, CO Staff Electrophysiologist, Deupartment of
Cardiology, University of Colorado
Alma N. Juels, MD Hospital, Aurora, C/O
Assistant Professor, Department of r
Anesthesiology, University of Colorado, Howard Miller, McD
Aurora, CO Associate Director, Anesthesiology, Denver
Attending Physician, Department of Health M.edical Center, Denver, CO
Anesthesiology, Denver Health Medical Associatet Professor, Department of
Center, Denver, CO Aneasthesiology, University of Colorado
School of Medicine, Aurora, CO
Rachel M. Kacmar, MD k
Assistant Professor, Department of Aaron Murray, MD
Anesthesiology, University of Colorado, /Assistant Professor, Department of
Aurora, CO / Anesthesiology, University of Colorado
: Health Sciences Center, Aurora, CO
Brian M. Keech, MD, FAAP s Anesthesiologist, Department of
Staff Anesthesiologist, Denver Health Anesthesiology, Denver Health Medical
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Medical Center, Denver, CO Center, Denver, CO
Assistant Professor of Anesthesiology,
University of Colorado Scthool of Medicine, Malcolm Packer, MD
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Denver, CO Associate Professor of Anesthesiology,
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Department of Anesthesiology, University
Michael Kim, BA, DO of Colorado Denver, CO

Anesthesia Resident, Anesthesiology, Attending Anesthesiologist, Department of
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University of Colorado Health Sciences Anesthesiology, Denver Health and
Center, Aurora, CO Hospitals Authority; Children’s Hospital
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Renee Kolte-Edwards, MD
Anesthesiologist, Anesthesiology, Altru Gurdev S. Rai, MD
VHealth System, Grand Forks, ND Chief, Anesthesia, Eastern Colorado Health
Care System/Denver Veterans Affairs
Jason P. Krutsch, MD
Medical Center, Denver, CO
d Associate Professor, Pain Medicine Fellowship
Assistant Professor, Department of Anesthesia,
Site Director, Department of
e Anesthesiology, University of Colorado, University of Colorado, Aurora, CO
Denver, CO Prairie N. Robinson, MD
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Anesthesiology Resident, University of
i Sunil Kumar, MD, FFARCS
n Assistant Professor, Department of Colorado Health Sciences Center,
Aurora, CO
Anesthesiology, University of Colorado
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Health Sciences Center, Aurora, CO Olivia Romano, MD
Anesthesiologist, Department of Assistant Professor, Department of
Anesthesiology, Denver Health Medical Anesthesiology, University of Colorado
Center, Denver, CO Anschutz Medical Campus, Aurora, CO
CONTRIBUTORS  xv
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Michael M. Sawyer, MD Laurie M. Steward, MD
Assistant Professor of Anesthesiology, Pediatric Anesthesiologist and Senior
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Department of Anesthesiology, University Instructor, Department of Anesthesiology,
of Colorado Health Hospital Association, Children’s Hospital Colorado, Aurora, CO
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Denver, CO
Mark Twite, MA, MB, BChir, FRCP i
Lawrence I. Schwartz, MD Director of Pediatric Cardiac Anesthesia, h
Associate Professor, Department of Department of Anesthesiology, Children’s
Anesthesiology, Children’s Hospital Hospital and University of Colorado, a
Colorado, University of Colorado, Aurora, CO
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Aurora, CO
Ronald Valdivieso, MD /
Tamas Seres, MD Associate Professor, Department of r
Associate Professor, Department of Anesthesiology, University of Coloerado,
Anesthesiology, University of Colorado, Aurora, CO
Aurora, CO Nathaen Weitzel, MD s
Robert Slover, MD Associate Professor, Departmuent of
Anesthesiology, University of Colorado,
Director of Pediatrics, The Barbara Davis
Center for Diabetes, University of Aurora, CO /
Colorado, Aurora, CO Barbara Wilkey, MDr
Assistant Professcor, Department of
Robin Slover, MD
Anesthesiology, University of Colorado,
Associate Professor, Department of .
Aurora, CO
Anesthesiology, University of Colorado, t
Aurora, CO Jennifear Zieg, MD
Medical Director, Pain Consultation Services, Senior Instructor, Anesthesiology, Children’s
Anesthesiology, Children’s Hospital kHospital Colorado, University of Colorado
Colorado, Aurora, CO Hospital, Aurora, CO
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PREFACE 9
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In this fifth edition of Anesthesia Secrets, the goal continues to be concise presentation of a widet
range of topics important to anyone interested in anesthesiology. My goal has always been not/ to
merely offer a few words suitable for the sake of familiarity, but to provide appropriate deprth to
allow readers to integrate the concerns of this field into their wider knowledge of meedicine in
general. It is my hope for medical students that both rotating through the anesthesia clinical ser-
vices elective and reviewing Anesthesia Secrets contributes to their decision to enters this esteemed
profession.
I am humbled by the reception Anesthesia Secrets has received since thue first edition was
published in 1996. I take it as an affirmation that my contributors and I have a good idea of the
important concepts in the field, as much as they can be described in a tex/t of this size. I thank my
contributors for this edition and all previous editions. Over the years rmy contributors have gone
on to successful careers across the country, yet their imprint remaicns throughout. Although they
may no longer be listed as authors, they nonetheless have my thanks.
And to you, the reader, thank you for making Anesthesia. Secrets a part of your educational
program. t
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James C. Duke, MD, MBA
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It has been an honor for me to work with Dr. /Jim Duke and the contributors of the now rightly
named, Duke’s Anesthesia Secrets, FIFTH ED/ITION. From using this series as a medical student,
resident, fellow and now attending anesth:esiologist, I can attest to its excellence. Whether used
as a quick reference for the most salienst topics in anesthesiology, or as a starting point for more
in-depth study, its quality is unmatched.
Thank you for choosing Dukep’s Anesthesia Secrets, FIFTH EDITION as your study aid. I hope
you enjoy using it as much as we have enjoyed preparing it for you.
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t Brian M. Keech, MD, FAAP
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