Databook of Anaesthesia and Critical Care Medicine

204 Pages·1987·1.78 MB·English

by  Prof. Dr. Patrick Anthony Foster

P. A. Foster J. A. Roelofse
Databook
of Anaesthesia
and Critical Care
Medicine
Fourth, Revised and Enlarged Edition
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Prof. Dr. Patrick Anthony Foster Dr. James A. Roelofse
University of Stellenbosch, Faculty of Medicine,
Department of Anaesthesia, P. O. Box 63,
ZA-7505 Tygerberg, South Mrica
The three previous editions were published in 1978, 1980, and 1982 by
Medishield Corporation Limited, London.
ISBN-13: 978-3-540-17794-4 e-ISBN-13: 978-3-642-72655-2
DOl: 10.1007/978-3-642-72655-2
Library of Congress Cataloging in Publication Data. Main entry under title:
Foster, P. A. (Patrick Anthony), Databook of anaesthesia and critical care medicine. Bibliography:
p. 1. Anesthesiology. 2. Critical care medicine. I. Roelofse, J. A. (James A.), 1942- . II. Title.
[DNLM: 1. Anesthesiology-handbooks. 2. Critical Care-handbooks. WO 231 F756d] RD82.F67
1987 617'.96 87-9653
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is con
cerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, re
production on microfilms or in other ways, and storage in data banks. Duplication of this publication or
parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965,
in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecu
tion act of the German Copyright Law.
© Springer-Verlag Berlin Heidelberg 1987
The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a
specific statement, that such names are exempt from the relevant protective laws and regulations and
therefore free for general use.
Product Liability: The publisher can give no guarantee for information about drug dosage and application
thereof contained in this book. In every individual case the respective user must check its accuracy by
consulting other pharmaceutical literature.
Typesetting, printing, and bookbinding: Appl, Wemding
2119/3140-543210
Preface to the Fourth Edition
This book is intended to bring together data and clinical guidelines
for those involved in the practice of anaesthesia, whether they be
specialists or not. It is designed to be a true handbook that will
accompany its owner into the operating theatre, where it will serve
as a practical reference guide, not as a textbook.
We welcome comment, criticism, and suggestions for improvement
of the contents; correspondence may be addressed to the authors
at P. O. Box 63, Tygerberg 7505, Republic of South Africa.
We wish to acknowledge help received from our colleagues over
the years of publication: Dr. T.J.V.Voss, Prof. G.G.Harrison,
Dr. C. M. Lewis, Dr. W. B. Murray, Prof. A. R. Coetzee, and
Dr. W. L. van der Merwe.
Acknowledgement is also made to "Anaesthesia Guidelines", long
since out of print, on which the first edition of this handbook was
based in 1978.
Tygerberg, South Africa, May 1987 P.A.Foster
l.A. Roelofse
v
Contents
Chapter 1
I. Pre-anaesthetic Assessment and Preparation 3
A. Anaesthetic Risk Assessment 3
B. Cardiac Risk Index . . . . . . 6
C. Respiratory Risk Assessment 7
D. Hepatic Reserve and Anaesthetic Risk 8
E. Pre-anaesthetic Check List . . . . . . . 8
F. Detailed Check of Anaesthetic Machine 10
G. Requirements for Paediatric Anaesthesia . 12
H. Ventilator Settings in Paediatric Circuits 13
I. Ventilator Settings in Adult Circuits. . . 13
J. Guidelines for Endotracheal Tube Sizes 14
K. Catheter Sizes . . . . . . . . . 15
L. Hypodermic Needle Gauges. 16
M. Particle Sizes ........ . 16
N. Mortality and Morbidity .. . 17
O. Postoperative Recovery Score 18
Jl. Anaesthetic Physical Constants . 19
A. Physical Properties of Inhalational Agents 19
B. Vapour Pressure Graphs . . . . . . . . . . 22
C. Volatile Anaesthetic Concentrations (Copper Kettle) 23
D. Vaporizer Splitting Ratios ...... . 23
E. The Gas Laws . . . . . . . . . . . . . . . . . . 25
F. Gas Cylinder Pressures and Constants . . . . 27
G. Flammability Limits of Volatile Anaesthetics. 31
H. Saturated Water Vapour Pressures from 0° to 58°C (mm Hg) 32
I. Composition of Atmospheric Air 33
J. Atmospheric Pressure ... 33
K. Species Variations of MAC ... 34
II I. Normal Values of Blood Components . 35
A. Normal Blood Biochemical Values 35
B. Moles and Equivalent Weights 36
C. Normal Haematological Values .. 37
D. Normal Coagulation Values .... 38
E. Blood Components and Clotting Factors . 38
VII
F. Oxyhaemoglobin-Dissociation Curves and P Values .......... 40
G. Some Causes of Shifts in Oxyhaemoglobin Affinity and Factors That
Influence Pso ................. 41
H. Hypothermia Corrections for pC02 and pH 41
IV. Cardiovascular. Renal. and CSF Values. 44
A. Normal Cardiovascular Values ..... 44
B. The Blood Pressure Cuff . . . . . . . . . 44
C. Calibrating Intra-arterial Pressure Monitors 45
D. Normal Values for Intracardiac Pressures (mm Hg) 47
E. Derived Haemodynamic Parameters . . . 48
F. Renal Function Tests with Normal Values 50
G. Liver Function Tests . . . . . . . . . 51
H. Normal Cerebrospinal Ruid Values. . . . 52
Chapter 2
I. Respiratory Parameters. 55
A. Gas Rows in Anaesthetic Circuits. 55
B. Low-Row Anaesthetic Techniques 58
C. Capnography . . . . . . . . . . . . 60
D. Simple Pulmonary Function Values. 61
E. Pulmonary Function Tests . . . . . . 62
F. Row Volume Curves . . . . . . . . . 65
G. Some Clinical Tests of Respiratory Function . 66
H. Normal Neonatal Values. . . . . . . . . . . . 69
I. Radford's Ventilation Nomogram . . . . . . . 69
J. Blood-Gas Parameters in Various Acid-Base Disturbances
(Henderson-Hasselbach) . . . . . . . . . . . . . . . . . . . . . . . . . . 71
K. Correction of Metabolic Acidosis Based upon Base Excess and Body
Weight. . . . . . . . . . . . 71
L. Oxygen Delivery to Tissues 72
M. Reading a Chest X-Ray .. 73
II. Respiratory Assessment and Support . 76
A. Indications and Contraindications for Endotracheal Intubation 76
B. Pre-and Postoperative Respiratory Considerations 78
C. Indications for Respiratory Support. . . . . 79
D. Criteria for Weaning from Respirator. . . . 79
E. Outline of Cardiopulmonary Resuscitation. 80
III. Blood and Ruid Replacement 83
A. Normal Blood Volumes . 83
B. Significant Volume Losses 83
VIII
C. General Intravenous Fluid Requirements .. 83
D. Intraoperative Fluid Requirements . . . . . . 85
E. Neonatal and Paediatric Fluid Requirements 86
F. Standard Blood Orders for Elective Surgical Procedures . 88
G. Blood Products Available . . . . . . . . . . . . . . . . 92
H. Suggested Treatment of Blood Loss During Surgery. . . . . . . . . . . . . 92
I. Composition of Representative Intravenous Solutions ........... 94
J. Indications for Total Parenteral Nutrition .................. 96
K. Guidelines for Total Parenteral Nutrition. . . . . . . . . . . . . . . . . 96
L. Some Indications for Haemodynamic Monitoring and Manipulation . . . 97
Chapter 3
I. Drugs and Doses 105
A. Standard Drugs and Doses in Anaesthesia 105
B. Opioid Receptors and Agonists . . 113
C. Total Intravenous Anaesthesia . . 114
D. Action of Antiarrhythmic Drugs. 117
E. Antiarrhythmic Drugs ..... . 119
F. Vasodilators . . . . . . . . . . . . 121
G. Some Preferred Drugs for Caesarean Section 123
H. Diabetes Mellitus ............... . 124
I. Cardiac Stimulants . . . . . . . . . . . . . . . 125
J. Suggested Concentrations for Use as Continuous Infusions ........ . 126
K. Bronchodilators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
L. Growth Charts ................................. . 128
M. Common Pharmacokinetic Terminology . . . . . . . 128
N. Some Pharmacokinetic Values for Anaesthetic Drugs 130
O. Drugs Influencing Intracranial Pressure 131
P. Assessment of Neuromuscular Block ........ . 132
Chapter 4
1. Clinical Problems and Solutions . 137
A. Potential Drug Interaction with Drugs Used in Anaesthesia . . . . . . . .. 137
B. Causes of Bleeding During Anaesthesia 139
C. Treatment of Postoperative Pain. 140
D. Transfusion Reactions . . . 143
E. Air Embolism - Diagnosis. . . . 144
F. The Full Stomach. . . . . . . . . 145
G. Prevention and Treatment of Aspiration Pneumonitis . . . . . . . . . . .. 146
H. The Acute Asthmatic Attack. . . . . 148
I. Correct Intubation of the Trachea . . . . . . . . . . . . . . . . . . . . . . .. 148
IX
J. Pulmonary Embolism ............................. 151
K. Respiratory Depression During and Mter Anaesthesia . . . . . 153
L. Malignant Hyperpyrexia. . . . . . . . . . . . . . . . . . . . . 154
M. Anaesthesia for the Diabetic Patient .................... 156
N. Delayed Recovery Mter Anaesthesia . . . . . . . . . . . . . . . . . . . . 158
O. Causes of Coma ................................ 158
P. Complications of Local Anaesthesia .. . . . . . . . . . . . .. 159
Q. Hypotension and Anaesthesia. . . . . . . . . . . .. . . . . . . . . . .. 160
R. The Adrenal Cortex and Anaesthesia . . . . . . . . . . . . . . . . . . . . .. 162
S. Osmotic Diuretics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 163
T. Porphyria and Anaesthesia. . 164
U. Placental Transfer of Drugs . 167
v. Correction of Hyperkalaemia 169
II. Miscellaneous . . . . . . . . . . 170
A. Apgar Scoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 170
B. Neurobehavioural Assessment of the Newborn . . . . . . . . . . . . . . .. 170
C. Postoperative Reinfarction Rate Mter Previous Myocardial Infarction . .. 172
D. Coma Scales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
E. Nomograms for Estimation of Body Surface Area. . . . . . . . . . . . .. 175
F. Growth Tables for Infants and Children . . . . . . . . . . . . . . . . . .. 177
G. Sensory Charts . . . . 178
H. Exponentials .................................. 179
I. SI Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 180
J. Blood Chemistry Units and Conversion Factors . . . . . . . . . . . . . . .. 182
K. Useful Conversion Factors. . . . . . . . . . . . . . . . . . . . . . . . . . .. 183
L. The World Federation of Societies of Anaesthesiology (WFSA) . . . . .. 184
M. ISO Standards ............ . . . . . . . . .. 186
N. Setting an Intravenous Infusion. . . . . . . . . . . . . . . . . . . . . . . .. 187
O. Syringe Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 187
P. Simple Hand-Held Computer Programs . 188
Q. Greek Alphabet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 203
x
Chapter 1
I. Pre-anaesthetic Assessment and Preparation
A. Anaesthetic Risk Assessment
1. New York Heart Association Functional Classification
Class 1 No limitation of activity
Class 2 Some limitation of heavy exertion, but can walk three blocks
without shortness of breath, or climb a flight of stairs (3 m)
Class 3 Some limitation of ordinary activity, with difficulty in walking
three blocks or climbing a flight of stairs
Class 4 Shortness of breath at rest
2. ASA Classification of Physical Status
Class I Normal healthy patient
Class II A patient with mild systemic disease
Class III A patient with systemic disease severe enough to limit activity
but not incapacitating
Class IV A patient with severe incapacitating systemic disease that is a
constant threat to life
Class V Moribund patient not expected to survive 24 h with our without
surgery
E Emergency operation - the symbol "E" is appended to the
appropriate classification
The ASA classification has limitations for predicting anaesthetic and surgi
cal risk, owing to the omission of important factors such as extremes of
age, duration of surgery, immediate preoperative investigations and treat
ments, and the competence of the surgeon. The following classification,
adapted from Prof. Lutz (Mannheim), includes most important risk factors.
3