How to Survive in Anaesthesia

229 Pages·2011·3.57 MB·English

by  Neville Robinson

How to Survive in Anaesthesia
How to
Survive in
Anaesthesia
A guide for trainees
FOURTH EDITION
Neville Robinson
DepartmentofAnaesthesia
NorthwickParkandStMark’sHospitals
Harrow,Middlesex
UK
George Hall
DepartmentofAnaesthesia
StGeorge’s
UniversityofLondon
London
UK
William Fawcett
DepartmentofAnaesthesia
RoyalSurreyCountyHospital
Guildford,Surrey
UK
A John Wiley & Sons, Ltd., Publication
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LibraryofCongressCataloging-in-PublicationData
Robinson,Neville.
Howtosurviveinanaesthesia:aguidefortrainees.–4thed./
NevilleRobinson,GeorgeHall,WilliamFawcett.
p.;cm.
Includesindex.
ISBN978-0-470-65462-0(pbk.)
1.Anesthesiologists–Trainingof. 2.Anesthesiology–Studyandteaching. 3.Anesthesia.
I.Hall,GeorgeM.(GeorgeMartin) II.Fawcett,William,1962- III.Title.
[DNLM:1.Anesthesia–methods.WO200]
RD81.R6552011
617.9(cid:3)6092–dc23 2011018481
AcataloguerecordforthisbookisavailablefromtheBritishLibrary.
Thisbookispublishedinthefollowingelectronicformats:ePDF9781119950431;WileyOnlineLibrary
9781119950462;ePub9781119950448
Setin9.5/12ptMinionbyAptaraInc.,NewDelhi,India
1 2012
ThisbookisdedicatedtoCharlotteFawcett
Contents
Listofboxes,ix
Listoffigures,xiii
Listoftables,xiv
Prefacetothefourthedition,xv
Prefacetothethirdedition,xvi
Prefacetothesecondedition,xvii
Prefacetothefirstedition,xviii
Let’sstartattheverybeginning...,xix
PartI:Nutsandbolts,1
Chapter1: Evaluationoftheairway,3
Chapter2: Controloftheairway,9
Chapter3: Trachealintubation,15
Chapter4: Failedintubationdrill,21
Chapter5: Vascularaccess,25
Chapter6: Intravenousfluids,29
Chapter7: Theanaestheticmachine,33
Chapter8: Anaestheticbreathingsystems,41
Chapter9: Ventilatorsandotherequipment,47
Chapter10: Monitoringinanaesthesia,51
PartII:Crisesandcomplications,57
Chapter11: Cardiacarrest,59
Chapter12: Haemorrhageandbloodtransfusion,69
vii
viii Contents
Chapter13: Anaphylacticreactions,77
Chapter14: Malignanthyperthermia,81
Chapter15: Localanaesthetictoxicity,87
Chapter16: Stridor–upperairwayobstruction,93
Chapter17: Pneumothorax,99
Chapter18: Commonintraoperativeproblems,103
Chapter19: Postoperativeproblems,111
Chapter20: Anaestheticmishaps,121
PartIII:Passingthegas,125
Chapter21: Preoperativeevaluation,127
Chapter22: Recognitionandmanagementofthesickpatient,133
Chapter23: Principlesofemergencyanaesthesia,137
Chapter24: Epiduralandspinalanaesthesia,145
Chapter25: Anaesthesiaforgynaecologicalsurgery,153
Chapter26: Anaesthesiaforurologicalsurgery,161
Chapter27: Anaesthesiaforabdominalsurgery,169
Chapter28: AnaesthesiafordentalandENTsurgery,175
Chapter29: Anaesthesiafororthopaedicsurgery,183
Chapter30: Anaesthesiafordaycasesurgery,191
Chapter31: Managementofthepatientintherecoveryarea,195
Chapter32: Postoperativeanalgesia,201
Chapter33: Managementofheadinjuries,207
Chapter34: Anaesthesiainthecorridor,211
Chapter35: Anaestheticaphorisms,217
Andfinally...,221
Index,223
List of boxes
1.1 Assessmentoftheairway,3
1.2 Medicalfeaturesofdifficultairway
intubation,4
1.3 Anatomicalfeaturesofdifficultairwaycontroland
intubation,4
2.1 Methodsofairwaycontrol,9
3.1 Intubationtechniques,15
3.2 Clinicalsignsusedtoconfirmtrachealintubation,16
3.3 Technicalteststoconfirmintubation,17
3.4 Complicationsoftrachealintubation,18
4.1 Initialcourseofactionforfailedintubation,21
4.2 Subsequentdecisionsforconsiderationafterfailed
intubation,22
5.1 Complicationsofinternaljugularveincatheterisation,27
5.2 Variantsincentralvenouspressure,27
7.1 Anaestheticmachinecomponents,33
7.2 Oneatmosphereofpressure(variousunits),33
7.3 Anaestheticmachinechecklist,37
8.1 Anaestheticbreathingcircuitcomponents,41
8.2 Functionsofbagsinbreathingsystems,42
9.1 Typesofventilators,47
9.2 Suctiondevicecomponents,49
9.3 Scavengingsystemcomponents,49
10.1 Anaesthesiamonitoringrequirements,51
10.2 Patientmonitoringdevices(essential),53
10.3 Specialisedpatientmonitoringdevices,53
10.4 Causesoflowoxygensaturation,55
10.5 CommoncausesofhighandlowP CO ,56
a 2
12.1 Bloodlossestimation,69
12.2 Additivesusedinredcellstorage,70
12.3 Bloodtransfusioncomplications,72
ix
x Listofboxes
12.4 Bloodvolumeformulae,74
12.5 Bloodtransfusionchecks,75
13.1 Signsofsevereallergicdrugreactions,77
13.2 Anaphylaxis–immediatemanagement,78
13.3 Anaphylaxis–secondarymanagement,79
14.1 Clinicalsignsofmalignanthyperthermia(MH),83
14.2 Metabolicsignsofmalignanthyperthermia,83
14.3 Overallmanagementplanformalignanthyperthermia,84
14.4 Anaesthesiainsuspectedmalignanthyperthermia,85
15.1 Recommendationsforthesafeuseofadrenalineinlocal
anaestheticsolutions,88
15.2 Signsofmildlocalanaesthetictoxcity,89
15.3 Signsofseverelocalanaesthetictoxicity,89
15.4 Immediatemanagementofseverelocalanaesthetictoxicity,90
15.5 Treatmentofseverelocalanaesthetictoxicitywithout
circulatoryarrest,90
15.6 Managementofcardiacarrestassociatedwithlocalanaesthetic
injection,90
16.1 Commoncausesofupperairwayobstruction,93
16.2 Symptomsandsignsofupperairwayobstruction,94
17.1 Causesofpneumothorax,99
17.2 Signsofpneumothoraxinanaesthesia,100
18.1 Commoncausesofintraoperativeproblems,104
18.2 Managementoflaryngospasm,105
18.3 Differentialdiagnosesofwheeze,105
18.4 Drugtreatmentoflife-threateningarrhythmias,107
18.5 Majorcausesofintraoperativehypotension,108
18.6 Causesofintraoperativehypertension,109
19.1 Signsofairwayobstruction,111
19.2 Commoncausesofpostoperativeairwayobstruction,112
19.3 Commoncausesoffailuretobreathe,113
19.4 Unusualcausesoffailuretobreathe,113
19.5 Signsofadequateneuromuscularfunction,114
19.6 Factorsassociatedwithpostoperativevomiting,115
19.7 Causesofdelayedrecovery,116
19.8 Factorspredisposingtopostoperativehypothermia,117
19.9 Preventionofbodyheatloss,117
19.10 Causesofhyperthermia,118
21.1 Classificationofoperations,127
21.2 ASAphysicalstatusclasses,128
21.3 Specificassessmentofobesity,129
Listofboxes xi
21.4 Basicandadvancedpreoperativetests,129
21.5 Reasonsforpremedication,131
22.1 Principlesofcareinthesicksurgicalpatient,133
23.1 Componentsofgeneralanaesthesia,137
23.2 Classificationofanaesthetictechniques,138
23.3 Methodsoffacilitatingtrachealintubation,139
23.4 Managementoftrachealintubationwhenriskof
aspiration,140
23.5 Majorsideeffectsofsuxamethonium,142
23.6 Highriskfactorsforregurgitation,143
23.7 Signsofpulmonaryaspiration,143
23.8 Levelsofcare,144
24.1 Requirementsbeforestartingregionalanaesthesia,145
24.2 Absoluteandrelativecontraindicationstoepidural
anaesthesia,146
24.3 Majorcomplicationsofepiduralanaesthesia,149
24.4 Othercomplicationsofepiduralanaesthesia,149
24.5 Complicationsofepiduralopioids,150
24.6 Factorsinfluencingdistributionoflocalanaestheticsolutions
inCSF,151
25.1 AdvantagesofCO useforpneumoperitoneum,153
2
25.2 Problemsarisingfromgasinsufflation,154
25.3 Complicationsfromneedleortrocharinsertion,155
25.4 Anaestheticproblemsoflaparoscopicsurgery,155
25.5 Anaestheticconsiderationsinectopicpregnancy,156
25.6 AnaestheticconsiderationsforERPC,157
26.1 Requirementsforurologicalirrigatingfluid,161
26.2 Factorsinfluencingtheabsorptionofglycine,162
26.3 AnaestheticproblemsforTURP,162
26.4 Symptomsandsignsofacutewaterintoxication
(TURPsyndrome),163
26.5 BloodtestsinsuspectedTURPsyndrome,163
26.6 ManagementofwaterintoxicationinTURPsyndrome,164
26.7 AnaesthesiaforTURP,165
26.8 Advantagesanddisadvantagesofregionalanaesthesia
forTURP,166
26.9 Advantagesanddisadvantagesofgeneralanaesthesia
forTURP,166
26.10 Specificconsiderationsinrenalsurgery,168
27.1 Specificpreoperativeproblemsinabdominalsurgery,169
27.2 Complicationsofhypokalaemia,170
xii Listofboxes
27.3 Perioperativeconsiderationsinabdominalsurgery,170
27.4 Specificpostoperativeproblemsinabdominalsurgery,171
27.5 Anaestheticproblemsofanalsurgery,173
28.1 Anaesthetictechniquesfordentalsurgery,176
28.2 Considerationsforgeneralanaesthesiaindentalsurgery,176
28.3 Anaestheticconsiderationsfortonsillectomy,178
28.4 Anaestheticproblemsinthebleedingtonsil,179
28.5 Anaestheticconsiderationsformiddleearsurgery,180
28.6 Techniquesforinducedhypotension,180
29.1 Generalconsiderationsinorthopaedicanaesthesia,183
29.2 Anaestheticconsiderationsandtechniquesfor
armsurgery,185
29.3 Anaestheticconsiderationsandtechniquesforhipandknee
surgery,186
29.4 Advantagesanddisadvantagesofregionalanaesthesiaforhip
andkneesurgery,186
29.5 Advantagesanddisadvantagesofgeneralanaesthesiaforhip
andkneesurgery,187
29.6 Anaestheticconsiderationsforspinalsurgery,188
30.1 Selectionguidelinesfordaycasesurgery,191
30.2 Dischargecriteriafordaycasesurgery,192
31.1 Mainobjectivesofcareintherecoveryarea,195
31.2 Causesofearlypostoperativehypoxaemia,196
31.3 Delayedrecoveryproblems,198
31.4 Typicalcriteriafordischargefromrecovery,199
32.1 Claimedadvantagesofgoodpostoperativeanalgesia,201
32.2 Factorsinfluencingpostoperativepain,202
32.3 Generalplanofpostoperativeanalgesia,202
32.4 MainsideeffectsofNSAIDs,204
32.5 Majorsideeffectsofsystemicopioids,204
33.1 Causesofsecondarybraindamageaftertrauma,207
33.2 Indicationsfortrachealintubationinthehead-injured
patient,208
33.3 Guidelinesfortransferringhead-injuredpatients,210
34.1 Minimumrequirementsforconductofanaesthesia,211
34.2 Considerationsforelectroconvulsivetherapyanaesthesia,212
34.3 Anaestheticconsiderationsforpatienttransfer,214