Table Of Content

Anesthesia Emergencies This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter cov- ered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or effi cacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. Anesthesia Emergencies K eith J . R uskin, MD Professor of Anesthesiology and Neurosurgery Yale University School of Medicine New Haven, Connecticut S tanley H . R osenbaum, MD Professor of Anesthesiology, Medicine, and Surgery Yale University School of Medicine New Haven, Connecticut 1 3 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2011 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Anesthesia emergencies / [edited by] Keith J. Ruskin, Stanley H. Rosenbaum. p. ; cm. Includes bibliographical references and index. ISBN 978-0-19-539671-3 1. Anesthetic emergencies—Handbooks, manuals, etc. I. Ruskin, Keith. II. Rosenbaum, Stanley H. [DNLM: 1. Anesthesia—Handbooks. 2. Emergencies—Handbooks. WO 39 A579 2011] RD82.5.A55 2011 617.9´6042—dc22 2010003454 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper Contents Series Preface vii Preface ix Managing Emergencies: Lessons Learned from Aviation xi Contributors xv 1 Airway Emergencies Sekar S. Bhavani and D. John Doyle 1 2 Cardiovascular Emergencies Ajoy Katari and Benjamin A. Kohl 25 3 Equipment Problems James B. Eisenkraft 63 4 Ethical Considerations Robert B. Schonberger and Stanley H. Rosenbaum 77 5 Metabolic and Endocrine Emergencies Lewis J. Kaplan 85 6 Miscellaneous Problems Keith J. Ruskin 127 7 Neurosurgical and Neurologic Emergencies Ira J. Rampil 143 8 Obstetric Emergencies Robert Gaiser 165 S 9 Pediatric Emergencies T N E Jessica L. Wagner 203 T N O 1 0 Postanesthesia Care Unit C Sean M. Quinn and Keith A. Candiotti 239 1 1 Procedures Ramachandran Ramani and Ala Haddadin 267 1 2 Regional Anesthesia Complications Raymond S. Sinatra and Dan B. Froicu 297 1 3 Respiratory Emergencies Vivek K. Moitra and Tricia E. Brentjens 313 1 4 Surgical Emergencies Linda L. Maerz and Stephen M. Luczycki 337 1 5 Thoracic Emergencies Marc S. Azran and Michael Nurok 363 vi Index 389 Series Preface Emergency physicians care for patients with any condition that may be encountered in an emergency department. This requires that they know about a vast number of emergencies, some common and many rare. Physicians who have trained in any of the subspe- cialties – cardiology, neurology, OBGYN and many others — have narrowed their fi elds of study, allowing their patients to benefi t accordingly. The Oxford University Press Emergencies series has combined the very best of these two knowledge bases, and the result is the unique product you are now holding. Each handbook is authored by an emergency physician and a sub-specialist, allowing the reader instant access to years of expertise in a rapid access patient-centered format. Together with evidence-based recom- mendations, you will have access to their tricks of the trade, and the combined expertise and approaches of a sub-specialist and an vii emergency physician. Patients in the emergency department often have quite different needs and require different testing from those with a similar emergency who are in-patients. These stem from different priorities; in the emergency department the focus is on quickly diagnosing an undiffer- entiated condition. An emergency occurring to an in-patient may also need to be newly diagnosed, but usually the information available is more complete, and the emphasis can be on a more focused and in-depth evaluation. The authors of each Handbook have produced a guide for you wherever the patient is encountered, whether in an out-patient clinic, urgent care, emergency department or on the wards. A special thanks should be extended to Andrea Seils, Senior Editor for Medicine at Oxford University Press for her vision in bringing this series to press. Andrea is aware of how new electronic media have impacted the learning process for physician-assistants, medical students, residents and fellows, and at the same time she if a fi rm believer in the value of the printed word. This series contains the proof that such a combination is still possible in the rapidly changing world of information technology. Over the last twenty years, the Oxford Handbooks have become an indispensable tool for those in all stages of training throughout the world. This new series will, I am sure, quickly grow to become the E standard reference for those who need to help their patients when C A faced with an emergency. F E R P Jeremy Brown, MD S E Series Editor RI E Associate Professor of Emergency Medicine S The George Washington University Medical Center viii Preface Anesthesiology is unique among medical specialties, in that most anesthetics and surgical procedures are uneventful. Critical events can, however, occur without warning, are usually sudden, and may be life-threatening. Anesthesiologists must be ready to detect and manage unpredicted emergencies at any time. The initial response to a critical event may determine its outcome. A recent study found that early recognition and effective management of complications were as important as their avoidance in improving mortality during surgery. 1 The use of checklists and estab- lished procedures, long an accepted practice in aviation, can help health care providers quickly establish a diagnosis and begin treatment. A nesthesia Emergencies can be used to prepare for emergencies that may occur in the future, and to deal with critical events as they happen. ix Anesthesia Emergencies is written to help an anesthesia provider deal with common complications or unforeseen emergencies during the perioperative period. Chapters have been organized alphabetically, and each section within a chapter is arranged alphabetically by type of problem. Critical information has been highlighted. Each chapter contains one or more references to textbook chapters or review articles that will provide additional information. Emergency readiness requires that the caregiver have the knowledge, skills, and equipment necessary to resolve the problem. This book will ideally be used to prepare for emergencies before they occur. The authors recommend that if a specifi c type of problem can be anticipated (e.g., massive hemorrhage in a postpartum patient being brought to the operating room) the appropriate chapter should be reviewed beforehand. All personnel on the care team should be briefed on the critical events most likely to occur, and the actions that will be taken during an emergency. This book can be used out- side of the operating room to prepare for future events by reviewing a section and thinking through the steps that would be needed for successful resolution of the problem. Ideally, Anesthesia Emergencies will be one part of an organized approach that includes simulation and training in crisis resource management. The authors recommend that when an emergency occurs, the anesthesia provider call for help as quickly as possible and 1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009 Oct 1;361(14):1368–1375.