Anaesthesia and Intensive Care A-Z: An Encyclopedia of Principles and Practice

624 Pages·2013·13.734 MB·English

by  Steven M. Yentis, Nicholas P. Hirsch, James K Ip

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Anaesthesia
and Intensive
Care A–Z
An Encyclopaedia of Principles
and Practice
FIFTH EDITION
Steve M Yentis BSc MBBS MD MA FRCA
Consultant Anaesthetist, Chelsea and Westminster Hospital;
Honorary Reader, Imperial College London, UK
Nicholas P Hirsch MBBS FRCA FRCP FFICM
Consultant Anaesthetist, The National Hospital for Neurology and Neurosurgery;
Honorary Senior Lecturer, The Institute of Neurology, London, UK
James K Ip BSc MBBS FRCA
Specialty Registrar, Imperial School of Anaesthesia, London, UK
Original contributions by Gary B Smith BM FRCA FRCP
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2013
© 2013 Elsevier Ltd. All rights reserved.
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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).
First edition 1993
Second edition 2000
Third edition 2004
Fourth edition 2009
Fifth edition 2013
ISBN 978-0-7020-4420-5
1 British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
2 Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating 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 parties for whom they have a
professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and 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 law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
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Preface
In the 20 years since the publication of the first edition of activities performed by our anaesthetic, intensive care,
of our textbook, we have been delighted to find that nursing and other colleagues, and also reflects the ever-
‘the A–Z’ has been adopted by both trainees and estab- changing field in which we work.
lished practitioners alike. Whilst our original idea was to
The publication of a textbook requires the support of
produce a readily accessible source of information for
a multitude of people. We are indebted to our colleagues,
those sitting the Royal College of Anaesthetists’ Fellow-
both junior and senior, who have gently criticised previ-
ship examinations, it is now obvious that the book
ous editions; their suggestions have been invaluable and
appeals to a far wider readership. We hope that the A–Z
have directly resulted in changes found in each new
will continue to be useful to all staff who help us care
edition over the years. We also thank the staff of Elsevier
for patients on a daily basis, as well as to anaesthetists
and their predecessors for their support during the life
and intensivists of all grades.
of this project. Finally, this is the first edition of the A–Z
As with previous new editions, each entry has been on which two of the original authors, SMY and NPH,
reviewed and, where appropriate, revised, and new ones have worked without the third, Gary Smith, though his
inserted. For the first time, we have compiled a struc- contributions exist throughout the book in both the
tured checklist of entries, at the back of the book, that format and content of entries from previous editions. We
we hope will be useful to those planning their revision shall both miss Gary’s expertise, input and good humour,
for exams. but are delighted to welcome James Ip to the team.
The difference between the list of entries in the first
edition and those in the current one continues to increase, SMY
with a huge expansion of new entries and revision of NPH
existing ones. This change acknowledges the enormous
JKI
breadth of information needed to satisfy the vast range
v
Explanatory notes
Arrangement of text Recommended International
Entries are arranged alphabetically, with some related Non-proprietary Names (rINNs)
subjects grouped together to make coverage of one Following work undertaken by the World Health Organ-
subject easier. For example, entries relating to tracheal ization, recent European law requires the replacement
intubation may be found under I as in Intubation, awake; of existing national drug nomenclature with rINNs. For
Intubation, blind nasal, etc. most drugs, rINNS are identical to the British Approved
Name (BAN). The Medicines Control Agency (UK) has
Cross-referencing
proposed a two-stage process for the introduction of
Bold type indicates a cross-reference. An abbreviation
rINNs. For substances where the change is substantial,
highlighted in bold type refers to an entry in its fully
both names will appear on manufacturers’ labels and
spelled form. For example, ‘ARDS may occur . . .’ refers
leaflets for a number of years, with the rINN preceding
to the entry Acute respiratory distress syndrome. Further
the BAN on the drug label. For drugs where the change
instructions appear in italics.
presents little hazard, the change will be immediate.
For some drugs which do not appear in either of the
References
above two categories, the British (or USP) name may
Reference to a suitable article is provided at the foot of
still be used.
the entry where appropriate.
There are over 200 affected drugs, many of them no
Proper names
longer available. Affected drugs that are mentioned in
Where possible, a short biographical note is provided
this book (though not all of them have their own entries)
at the foot of the entry when a person is mentioned.
are listed below – though please note that, in common
Dates of birth and death are given, or the date of descrip-
with the British Pharmacopoeia, the terms ‘adrenaline’
tion if these dates are unknown. No dates are given
and ‘noradrenaline’ will be used throughout the text in
for contemporary names. Where more than one epony-
preference to ‘epinephrine’ and ‘norepinephrine’ respec-
mous entry occurs, e.g. Haldane apparatus and
tively, because of their status as natural hormones.
Haldane effect, details are given under the first entry.
Thus (with the exception of adrenaline and noradrena-
The term ‘anaesthetist’ is used in the English sense,
line), the format for affected drugs is rINN (BAN), e.g.
i.e. a medical practitioner who practises anaesthesia;
Tetracaine hydrochloride (Amethocaine). Non-BAN,
the terms ‘anesthesiologist’ and ‘anaesthesiologist’ are
non-rINN names are also provided for certain other
not used.
drugs (for example, Isoproterenol, see Isoprenaline) to
Drugs help direct non-UK readers or those unfamiliar with UK
Individual drugs have entries where they have especial terminology.
relevance to, or may by given by, the anaesthetist or
intensivist. Where many different drugs exist within the Examination revision checklist
same group, for example β-adrenergic receptor antago- At the back of the book is a checklist based on entries
nists, those which may be given intravenously have their of particular relevance to examination candidates, that
own entry, whilst the others are described under the have been classified and listed alphabetically in order to
group description. The reader is referred back to entries support systematic study of examination topics accord-
describing drug groups and classes where appropriate. ing to the subject area.
continued over page
vii
Explanatory notes
continued
BAN rINN
Adrenaline Epinephrine
Amethocaine Tetracaine
Amoxycillin Amoxicillin
Amphetamine Amfetamine
Amylobarbitone Amobarbital
Beclomethasone Beclometasone
Benzhexol Trihexyphenidyl
Benztropine Benzatropine
Busulphan Busulfan
Cephazolin Cefazolin
Cephradine Cefradine
Cephramandole Ceframandole
Chlormethiazole Clomethiazole
Chlorpheniramine Chlorphenamine
Corticotrophin Corticotropin
Cyclosporin Ciclosporin
Dicyclomine Dicycloverine
Dothiepin Dosulepin
Ethamsylate Etamsylate
Ethacrynic acid Etacrynic acid
Frusemide Furosemide
Indomethacin Indometacin
Lignocaine Lidocaine
Methohexitone Methohexital
Methylene blue Methylthioninium chloride
Noradrenaline Norepinephrine
Oxpentifylline Pentoxifylline
Phenobarbitone Phenobarbital
Sodium cromoglycate Sodium cromoglicate
Sulphadiazine Sulfadiazine
Sulphasalazine Sulfasalazine
Tetracosactrin Tetracosactide
Thiopentone Thiopental
Tribavarin Ribavarin
Trimeprazine Alimemazine
viii

Abbreviations
ACE inhibitors angiotensin converting enzyme GFR glomerular filtration rate
inhibitors GIT gastrointestinal tract
ACTH adrenocorticotrophic hormone GTN glyceryl trinitrate
ADP adenosine diphosphate HCO − bicarbonate
3
AF atrial fibrillation HDU high dependency unit
AIDS acquired immune deficiency syndrome HIV human immunodeficiency virus
cAMP cyclic adenosine monophosphate HLA human leucocyte antigen
APACHE acute physiology and chronic health 5-HT 5-hydroxytryptamine
evaluation
ICP intracranial pressure
ARDS acute respiratory distress syndrome
ICU intensive care unit
ASA American Society of Anesthesiologists
IgA, IgG, etc., immunoglobulin A, G, etc.
ASD atrial septal defect
im intramuscular
ATP adenosine triphosphate
IMV intermittent mandatory ventilation
AV atrioventricular
IPPV intermittent positive pressure ventilation
bd twice daily
iv intravenous
BP blood pressure
IVRA intravenous regional anaesthesia
CMRO cerebral metabolic rate for oxygen
2 JVP jugular venous pressure
CNS central nervous system
LMA laryngeal mask airway
CO carbon dioxide
2 MAC minimal alveolar concentration
COPD chronic obstructive pulmonary disease
MAP mean arterial pressure
CPAP continuous positive airway pressure
MH malignant hyperthermia
CPR cardiopulmonary resuscitation
MI myocardial infarction
CSE combined spinal–extradural
MODS multiple organ dysfunction syndrome
CSF cerebrospinal fluid
MRI magnetic resonance imaging
CT computed tomography
mw molecular weight
CVA cerebrovascular accident
NAD(P) nicotinamide adenine dinucleotide
CVP central venous pressure (phosphate)
CVS cardiovascular system NHS National Health Service
CXR chest X-ray NICE National Institute for Health and Clinical
DIC disseminated intravascular coagulation Excellence
DNA deoxyribonucleic acid NMDA N-methyl-D-aspartate
2,3-DPG 2,3-diphosphoglycerate N O nitrous oxide
2
DVT deep vein thrombosis NSAID non-steroidal anti-inflammatory drug
ECF extracellular fluid O oxygen
2
ECG electrocardiography od once daily
EDTA ethylenediaminetetraacetate ODA/P operating department assistant/practitioner
EEG electroencephalography PCO2 partial pressure of carbon dioxide
EMG electromyography PE pulmonary embolus
ENT ear, nose and throat PEEP positive end-expiratory pressure
FEV1 forced expiratory volume in 1 s PO2 partial pressure of oxygen
FIO2 fractional inspired concentration of oxygen PONV postoperative nausea and vomiting
FRC functional residual capacity pr per rectum
FVC forced vital capacity qds four times daily
G gauge RNA ribonucleic acid
GABA γ-aminobutyric acid RS respiratory system
ix
Abbreviations
sc subcutaneous TIVA total intravenous anaesthesia
SIRS systemic inflammatory response syndrome TPN total parenteral nutrition
SLE systemic lupus erythematosus TURP transurethral resection of prostate
SVP saturated vapour pressure UK United Kingdom
SVR systemic vascular resistance US(A) United States (of America)
SVT supraventricular tachycardia VF ventricular fibrillation
TB tuberculosis V(cid:31)/Q(cid:31) ventilation/perfusion
tds three times daily VSD ventricular septal defect
TENS transcutaneous electrical nerve stimulation VT ventricular tachycardia
x
A
A severity characterisation of trauma (ASCOT). impair ventilation and be associated with reduced
Trauma scale derived from the Glasgow coma scale, sys- venous return, cardiac output, renal blood flow and urine
tolic BP, revised trauma score, abbreviated injury scale output. Increased CVP may lead to raised ICP. Diag-
and age. A logistic regression equation provides a prob- nosed by clinical features and intra-abdominal pressure
ability of mortality. Excludes patients with very poor or measurement (performed via a bladder catheter or
very good prognoses. Has been claimed to be superior nasogastric tube, in combination with a water column
to the trauma revised injury severity score system, manometer).
although is more complex. Management includes laparotomy ± silastic material
Champion HR, Copes WS, Sacco WJ, et al (1996). J to cover the abdominal contents. Paracentesis may be
Trauma; 40: 42–8 effective if raised intra-abdominal pressure is due to
accumulation of fluid, e.g. ascites. Full resuscitation must
A–adO2, see Alveolar–arterial oxygen difference be performed before decompression as rapid release of
pressure may result in sudden washout of inflammatory
ABA, see American Board of Anesthesiology mediators from ischaemic tissues, causing acidosis and
hypotension. Mortality of the syndrome is 25–70%.
Abbott, Edward Gilbert, see Morton, William Malbrain ML, Cheatham ML, Kirkpatrick A et al (2006).
Intensive Care Med; 32: 1722–32, and Cheatham ML,
Abbreviated injury scale (AIS). Trauma scale first Malbrain ML, Kirkpatrick A (2007). Intensive Care
described in 1971 and updated many times since. Com- Med; 33: 951–62
prises a classification of injuries with each given a six- See also, Compartment syndromes
digit code (the last indicating severity, with 1 = minor
and 6 = fatal). The codes are linked to International Abdominal field block. Technique using 100–200 ml
Classification of Diseases codes, thus aiding standardisa- local anaesthetic agent, involving infiltration of the skin,
tion of records. The anatomical profile is a refinement subcutaneous tissues, abdominal muscles and fascia. Pro-
in which the locations of injuries are divided into four vides analgesia of the abdominal wall and anterior peri-
categories; the AIS scores are added and the square toneum, but not of the viscera. Now rarely used. Rectus
root taken to minimise the contribution of less severe sheath block, transversus abdominis plane block, iliac
injuries. crest block and inguinal hernia field block are more
Copes WS, Lawnick M, Champion HR, Sacco WJ (1988). specific blocks.
J Trauma; 28: 78–86
Abdominal sepsis, see Intra-abdominal sepsis
Abciximab. Monoclonal antibody used as an antiplate-
let drug and adjunct to aspirin and heparin in high-risk Abdominal trauma. May be blunt (e.g. road traffic acci-
patients undergoing percutaneous coronary interven- dents) or penetrating (e.g. stabbing, bullet wounds).
tion. Consists of Fab fragments of immunoglobulin Often carries a high morbidity and mortality because
directed against the glycoprotein IIb/IIIa receptor on injuries may go undetected. Massive intra-abdominal
the platelet surface. Inhibits platelet aggregation and blood loss or abdominal compartment syndrome may
thrombus formation; effects last 24–48 h after infusion. follow. The abdomen can be divided into three areas:
Careful consideration of risks and benefits should ◗ intrathoracic: protected by the bony thoracic cage.
precede use since risk of bleeding is increased. Licensed Contains the spleen, liver, stomach and diaphragm.
for single use only. Injury may be associated with rib fractures. The dia-
● Dosage: initial loading of 250 µg/kg over 1 min iv, phragm may also be injured by blows to the lower
followed by iv infusion of 125 ng/kg/min (max 10 µg/ abdomen (which impart pressure waves to the dia-
min) 10–60 min (up to 24 h in unstable angina) before phragm) or by penetrating injuries of the chest.
angioplasty with 125 µg/kg/min (up to 10 µg/min for ◗ true abdomen: contains the small and large bowel,
12 h afterwards). bladder and, in the female, uterus, fallopian tubes
● Side effects: bleeding, hypotension, nausea, bradycar- and ovaries.
dia. Thrombocytopenia occurs rarely. ◗ retroperitoneal: contains the kidneys, ureters, pan-
creas and duodenum. May result in massive blood
Abdominal compartment syndrome. Combination of loss from retroperitoneal venous injury.
increased intra-abdominal pressure and organ dysfunc- ● Management:
tion (e.g. following abdominal trauma or extensive ◗ basic resuscitation as for trauma generally.
surgery) resulting from haemorrhage or expansion of ◗ initial assessment: examination of the anterior
the third space fluid compartment. May also follow liver abdominal wall, both flanks, back, buttocks,
transplantation, sepsis, burns and acute pancreatitis. perineum (and in men, the urethral meatus) for
Intra-abdominal pressures above 20–25 cmHO may bruises, lacerations, entry and exit wounds. Signs
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