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Ehab Farag · Maged Argalious John E. Tetzlaff · Deepak Sharma Editors Basic Sciences in Anesthesia 123 Basic Sciences in Anesthesia Ehab Farag Maged Argalious John E. Tetzlaff Deepak Sharma Editors Basic Sciences in Anesthesia Editors Ehab Farag Maged Argalious Departments of General Anesthesia and Outcomes Center for Anesthesiology Education, Anesthesiology Research, Anesthesiology Institute Institute Cleveland Clinic Lerner College of Medicine, Case Cleveland Clinic Lerner College of Medicine Western University Cleveland, OH, USA Cleveland, OH, USA Deepak Sharma John E. Tetzlaff Department of Anesthesiology & Pain Medicine Department of General Anesthesia, Anesthesiology University of Washington Institute Seattle, WA, USA Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland, OH, USA ISBN 978-3-319-62065-7 ISBN 978-3-319-62067-1 (eBook) https://doi.org/10.1007/978-3-319-62067-1 Library of Congress Control Number: 2017960173 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, com- puter software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland V Thanks to my mother, my late father, and my brother and his family for their help, support, and prayers. Ehab Farag Thanks to my parents whose passion for research and scientific discovery proved to be contagious. Thanks to my wife Nermine for her unrelenting faith, her unconditional love, and her impressive emotional intelligence. Thanks to my children Daniel and Sandra, for their cheerful and joyous personalities and their genuine love of family. Maged Argalious Thanks to my wife, Susan, for her patience and tolerance of my late nights that were part of my participation in this project. John E. Tetzlaff My sincerest thanks to my parents Mrs. Renu and Col. PC Sharma, my teachers, and my dear wife Madhu and daughters Deeya and Drishti for their constant support, love, and encouragement. Deepak Sharma Preface The basic sciences are the essence of anesthesiol- successful study. Every chapter highlights key top- ogy. Therefore, the American Board of Anesthesi- ics and includes questions testing comprehension ology (ABA) includes an examination on the basic of the respective subject matter. Moreover, sug- sciences for the ABA certification. The lack of a gested references are included for further research specific book dedicated to the basic sciences in in the basic sciences. anesthesiology has driven us to compose this book. We tried our best to follow the syllabus of We would like to thank our colleagues for their the ABA basic sciences examination in order to hard work and dedication in writing the book. In create an accurate resource for study. The motto of addition, we would like to thank Ms. Maureen this book is to follow Alexander Pope’s advice in K. Pierce and Joanna Renwick from Springer 1709: "A little learning is a dangerous thing; drink International Publishing for their perseverance deep, or taste not the Pierian spring: there shallow during the process. droughts intoxicate the brain, and drinking largely sobers us again." This message is still relevant At the end, we hope this book will be helpful in today in the field of anesthesiology. preparing for the ABA basic science examination as well as serve as a tool for practicing anesthesi- The content of each chapter of the book is presented ologists who would like to refresh their knowledge in a comprehensive manner and is conducive for in basic sciences. Ehab Farag Maged Argalious John E. Tetzlaff Cleveland, USA Deepak Sharma Seattle, USA VII Contents I Applied Anatomy 1 Peripheral Nerve Block Anesthesia ..................................................................................................................... 3 Sree Kolli and Loran Mounir Soliman 2 Central Neuraxial Anatomy and Anesthetic Application (Central Neuraxial Blockade) ................................................................................................................................... 17 Nathan J. Harrison, Laurie S. Daste, Gary S. McDaniel Jr, Matthew E. Patterson, and Maged Guirguis 3 Anatomy of the Brain and Spinal Cord.............................................................................................................. 41 Matthew K. Whalin and Sona Shah Arora 4 Anatomy of the Airway/Airway Management ............................................................................................. 61 Sekar S. Bhavani and Basem Abdelmalak II Pharmacology 5 Pharmacology: General Concepts ........................................................................................................................ 95 Yaqi Hu and Kamal Maheshwari 6 Pharmacology of Non-opioid Intravenous Anesthetics ........................................................................ 107 Mohamed Abdalla 7 P harmacology of Opioids .......................................................................................................................................... 123 Juan P. Cata and Shreyas P. Bhavsar 8 Clinical Pharmacology of Drugs Acting at the Neuromuscular Junction. .................................. 139 J. Ross Renew, Sorin J. Brull, and Mohammed Naguib 9 Pharmacology of Local and Neuraxial Anesthetics .................................................................................. 161 Hesham Elsharkawy and Sree Kolli 10 Pharmacology of Inhaled Anesthetics .............................................................................................................. 177 Elizabeth Demers Lavelle and Swamy Kurra 11 Cardiovascular Anatomy and Pharmacology ............................................................................................... 195 Maria Bauer 12 R espiratory Pharmacology ....................................................................................................................................... 229 Ahmad Maher Adi 13 R enal Pharmacology ..................................................................................................................................................... 239 Sekar S. Bhavani 14 Pharmacology of Anticoagulants, Antithrombotics, and Antiplatelet Drugs ........................ 249 G. Burkhard Mackensen 15 Perioperative Intravenous Fluid Therapy ....................................................................................................... 259 Marta Kelava, David S. Youssef, and Maged Argalious V III Contents III Physiology 16 Central and Peripheral Nervous Systems ........................................................................................................ 271 Jia W. Romito, Ravi Bhoja, and David L. McDonagh 17 C ardiovascular Physiology ....................................................................................................................................... 299 Sandeep Khanna 18 Respiratory System Physiology ............................................................................................................................. 329 Siddharth Pawan Dugar, Mani Latifi, and Eduardo Mireles-Cabodevila 19 Physiology of the Autonomic Nervous System ........................................................................................... 355 Brian K. Johnson 20 Physiology of Temperature Control .................................................................................................................... 365 Kurt Ruetzler and Andrea Kurz 21 G astrointestinal/Hepatic Physiology ................................................................................................................. 373 Allen Keebler 22 R enal Physiology ............................................................................................................................................................. 379 Reem Khatib 23 Physiology of the Endocrine System and Metabolic Complications in Anesthesia ................................................................................................................................... 405 Michael Erin Schoor and Shaheen Shaikh IV Anesthetic Management Topics 24 Preoperative Evaluation of Patients Undergoing Non- cardiac Surgery .................................... 429 Elizabeth A. M. Frost and Daniel Katz 25 P remedication ................................................................................................................................................................... 441 Kenneth C. Cummings III 26 Monitored Anesthesia Care ...................................................................................................................................... 451 Ihab Adly Riad and Basem Abdelmalak 27 B lood Products Transfusion ..................................................................................................................................... 465 Jacek B. Cywinski 28 C omplications in Anesthesia ................................................................................................................................... 483 Fenghua Li and Parikshith Sumathi 29 The Postoperative Period .......................................................................................................................................... 505 Verghese T. Cherian 30 Perioperative Pain Management .......................................................................................................................... 515 Juan P. Cata and Javier D. Lasala 31 Special Problems in Anesthesia. ............................................................................................................................ 527 John E. Tetzlaff IX Contents V Physics in Anesthesia 32 The Anesthesia Machine. ............................................................................................................................................ 539 Mark Teen, Theresa Barnes, and Ehab Farag 33 Physical Measurements in Anesthesia .............................................................................................................. 565 Anthony James Cartwright and D. John Doyle 34 B reathing Systems .......................................................................................................................................................... 587 Jack Buckley and Myroslav Figura 35 P hysics of Instrumentation ....................................................................................................................................... 597 Verghese T. Cherian and Arne O. Budde 36 Electrical Safety in the Operating Room ......................................................................................................... 613 D. John Doyle 37 M echanical Ventilation ................................................................................................................................................ 627 Aaron J. Douglas 38 Statistics Made Simple: Introduction to Biostatistics and Research Design for the Anesthesiologist ............................................................................................................................ 637 Edward J. Mascha Contributors Mohamed Abdalla, MD Sekar S. Bhavani, MD, MS, FRCS(I) Department of Anesthesiology Cleveland Clinic Lerner College of Medicine Cleveland Clinic Lerner College of Medicine Anesthesiology Institute, Cleveland Clinic of Case Western Reserve University Cleveland, OH, USA Cleveland, OH, USA [email protected]; [email protected] Department of Cardiothoracic Anesthesiology Shreyas P. Bhavsar, DO Anesthesiology Institute, Cleveland Clinic Department of Anesthesiology and Perioperative Cleveland, OH, USA Medicine, Division of Anesthesiology and Critical Care [email protected] The University of Texas MD Anderson Cancer Center Houston, TX, USA Basem Abdelmalak, MD [email protected] Anesthesia for Bronchoscopic Surgery Center for Sedation Departments of General Anesthesiology and Outcomes Ravi Bhoja, MD Research, Cleveland Clinic Department of Anesthesiology and Pain Management Cleveland, OH, USA University of Texas Southwestern Medical Center [email protected] Dallas, TX, USA [email protected] Maged Argalious Center for Anesthesiology Education Sorin J. Brull, MD, FCARCSI (Hon) Anesthesiology Institute Department of Anesthesiology and Perioperative Cleveland Clinic Lerner College of Medicine Medicine Cleveland, OH, USA Mayo Clinic College of Medicine [email protected] Jacksonville, FL, USA [email protected] Ahmad Maher Adi, MD Department of Cardiothoracic Anesthesiology and Jack Buckley, MD Critical Care, Cleveland Clinic Department of Anesthesiology Cleveland, OH, USA UCLA Medical Center [email protected] Los Angeles, California, USA [email protected] Sona Shah Arora, MD Department of Anesthesiology Arne O. Budde, MD, DEAA Emory University School of Medicine Department of Anesthesiology Grady Memorial Hospital and Perioperative Medicine Atlanta, GA, USA Penn State Health, Milton S. Hershey Medical Center [email protected] Hershey, PA, USA [email protected] Theresa Barnes, MD, MPH Department of Anesthesiology Anthony James Cartwright, MB, ChB, MRCS Cleveland Clinic Foundation (Eng.), FRCA Cleveland, OH, USA Anesthesiology Institute, Cleveland Clinic Abu Dhabi [email protected], [email protected] Abu Dhabi, United Arab Emirates [email protected] Maria Bauer, MD Department of Anesthesiology Juan P. Cata, MD and Critical Care Medicine Department of Anesthesiology The Johns Hopkins Hospital and Perioperative Medicine Baltimore, MD, USA The University of Texas – MD Anderson Cancer Center [email protected]; [email protected] Anesthesiology and Surgical Oncology Research Group Houston, TX, USA [email protected]; [email protected]