How to Survive in Anaesthesia: A Guide for Trainees, Third Edition

206 Pages·2007·4.84 MB·English

by  Neville Robinson

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How to
Survive in
Anaesthesia
Aguidefortrainees
THIRDEDITION
i
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How to
Survive in
Anaesthesia
A guide for trainees
THIRD EDITION
Neville Robinson
DepartmentofAnaesthesia
NorthwickParkandStMark’sHospitals
Harrow,Middlesex
George Hall
DepartmentofAnaesthesia
StGeorge’sHospitalMedicalSchool
UniversityofLondon
London
iii
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(cid:2)C 2007NevilleRobinson&GeorgeHall
PublishedbyBlackwellPublishingLtd
BMJBooksisanimprintoftheBMJPublishingGroupLimited,usedunderlicence
BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts02148-5020,USA
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Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or
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Firsteditionpublished1997
Secondeditionpublished2002
Thirdeditionpublished2007
1 2007
ISBN-13:978-1-4051-46456
ISBN-10:1-4051-46451
LibraryofCongressCataloging-in-PublicationData
Robinson,Neville.
Howtosurviveinanaesthesia:aguidefortrainees/NevilleRobinson,GeorgeHall.–3rded.
p.;cm.
Includesindex.
ISBN-13:978-1-4051-4645-6(paperback)
ISBN-10:1-4051-4645-1(paperback)
1.Anesthesiologists–Trainingof. 2.Anesthesiology–Studyandteaching.
3.Anesthesia. I.Hall,GeorgeM.(GeorgeMartin) II.Title.
[DNLM:1.Anesthesia–methods. WO200R663h2007]
RD81.R6322007
617.9(cid:3)60071–dc22
2006021260
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iv
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Contents
Listofboxes,vii
Listoffigures,xi
Listoftables,xii
Prefacetothethirdedition,xiii
Prefacetothesecondedition,xiv
Prefacetothefirstedition,xv
PartI: Nutsandbolts,1
Chapter1: Evaluationoftheairway,3
Chapter2: Controloftheairway,8
Chapter3: Trachealintubation,13
Chapter4: Failedintubationdrill,18
Chapter5: Vascularaccess,21
Chapter6: Intravenousfluids,25
Chapter7: Theanaestheticmachine,28
Chapter8: Anaestheticbreathingsystems,36
Chapter9: Ventilatorsandotherequipment,42
Chapter10: Monitoringinanaesthesia,46
PartII: Crisesandcomplications,53
Chapter11: Cardiacarrest,55
Chapter12: Haemorrhageandbloodtransfusion,61
Chapter13: Anaphylacticreactions,68
Chapter14: Malignanthyperthermia,72
Chapter15: Stridor–upperairwayobstruction,77
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vi Contents
Chapter16: Pneumothorax,82
Chapter17: Commonintraoperativeproblems,85
Chapter18: Postoperativeproblems,92
Chapter19: Anaestheticmishaps,100
PartIII: Passingthegas,105
Chapter20: Preoperativeevaluation,107
Chapter21: Recognitionandmanagementofthesickpatient,112
Chapter22: Principlesofemergencyanaesthesia,115
Chapter23: Regionalanaesthesia,123
Chapter24: Anaesthesiaforgynaecologicalsurgery,133
Chapter25: Anaesthesiaforurologicalsurgery,139
Chapter26: Anaesthesiaforabdominalsurgery,147
Chapter27: AnaesthesiafordentalandENTsurgery,152
Chapter28: Anaesthesiafororthopaedicsurgery,158
Chapter29: Anaesthesiafordaycasesurgery,164
Chapter30: Managementofthepatientintherecoveryarea,167
Chapter31: Postoperativeanalgesia,171
Chapter32: Managementofheadinjuries,177
Chapter33: Anaesthesiainthecorridor,181
Chapter34: Anaestheticaphorisms,185
Index,189
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List of boxes
1.1 Assessmentoftheairway,3
1.2 Medicalfeaturesofdifficultairwayintubation,4
1.3 Anatomicalfeaturesofdifficultairwaycontrolandintubation,4
2.1 Methodsofairwaycontrol,5
3.1 Intubationtechniques,13
3.2 Clinicalsignsusedtoconfirmtrachealintubation,14
3.3 Technicalteststoconfirmintubation,15
3.4 Complicationsoftrachealintubation,17
4.1 Initialcourseofactionforfailedintubation,18
4.2 Subsequentdecisionsforconsiderationafterfailedintubation,19
5.1 Complicationsofinternaljugularveincatheterisation,23
5.2 Variantsincentralvenouspressure,23
7.1 Anaestheticmachinecomponents,28
7.2 Oneatmosphereofpressure(variousunits),28
7.3 Anaestheticmachinechecklist,32
8.1 Anaestheticbreathingcircuitcomponents,36
8.2 Functionsofbagsinbreathingsystems,37
9.1 Typesofventilators,42
9.2 Suctiondevicecomponents,44
9.3 Scavengingsystemcomponents,44
10.1 Anaesthesiamonitoringrequirements,46
10.2 Patientmonitoringdevices,48
10.3 Specialisedpatientmonitoringdevices,49
10.4 Causesoflowoxygensaturation,50
10.5 CommoncausesofhighandlowP CO ,51
a 2
11.1 Adultbasiclifesupport,57
11.2 Adultadvancedlifesupportincardiacarrest,57
11.3 Potentiallyreversiblecausesofcardiacarrest,57
12.1 Bloodlossestimation,61
12.2 Additivesusedinredcellstorage,62
12.3 Bloodtransfusioncomplications,64
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viii Listofboxes
12.4 Bloodvolumeformulae,66
13.1 Signsofsevereallergicdrugreactions,68
13.2 Anaphylaxis–immediatemanagement,69
13.3 Anaphylaxis–secondarymanagement,70
14.1 Clinicalsignsofmalignanthyperthermia(MH),74
14.2 Metabolicsignsofmalignanthyperthermia,74
14.3 Overallmanagementplanformalignanthyperthermia,75
14.4 Anaesthesiainsuspectedmalignanthyperthermia,76
15.1 Commoncausesofupperairwayobstruction,77
15.2 Symptomsandsignsofupperairwayobstruction,78
16.1 Causesofpneumothorax,82
16.2 Signsofpneumothoraxinanaesthesia,83
17.1 Commoncausesofintraoperativeproblems,86
17.2 Drugtreatmentoflife-threateningarrhythmias,87
17.3 Majorcausesofintraoperativehypotension,88
17.4 Causesofintraoperativehypertension,89
17.5 Managementoflaryngospasm,89
17.6 Differentialdiagnosesofwheeze,90
18.1 Signsofairwayobstruction,92
18.2 Commoncausesofpostoperativeairwayobstruction,93
18.3 Commoncausesoffailuretobreathe,94
18.4 Unusualcausesoffailuretobreathepostoperatively,94
18.5 Signsofadequateneuromuscularfunction,94
18.6 Factorsassociatedwithpostoperativevomiting,96
18.7 Causesofdelayedrecovery,97
18.8 Factorspredisposingtopostoperativehypothermia,98
18.9 Preventionofbodyheatloss,98
18.10 Causesofhyperthermia,98
20.1 Classificationofoperations,107
20.2 ASAphysicalstatusclasses,108
20.3 Specificassessmentofobesity,109
20.4 Basicpreoperativetests,109
20.5 Reasonsforpremedication,110
21.1 Principlesofcareinthesicksurgicalpatient,112
22.1 Componentsofgeneralanaesthesia,115
22.2 Classificationofanaesthetictechniques,116
22.3 Methodsoffacilitatingtrachealintubation,117
22.4 Managementofendotrachealintubationwhenrisk
ofaspiration,118
22.5 Majorsideeffectsofsuxamethonium,120
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Listofboxes ix
22.6 Highriskfactorsforregurgitation,121
22.7 Signsofpulmonaryaspiration,121
23.1 Symptomsandsignsoflocalanaesthetictoxicity,124
23.2 Recommendationsforthesafeuseofepinephrineinlocal
anaestheticsolutions,124
23.3 Requirementsbeforestartingregionalanaesthesia,125
23.4 Absoluteandrelativecontraindicationstoepiduralanaesthesia,126
23.5 Majorcomplicationsofepiduralanalgesia,129
23.6 Othercomplicationsofepiduralanalgesia,129
23.7 Complicationsofepiduralopiates,130
23.8 Factorsinfluencingdistributionoflocalanaesthetic
solutionsinCSF,131
24.1 AdvantagesofCO useinpneumoperitoneumformation,133
2
24.2 Problemsarisingfromgasinsufflation,134
24.3 Complicationsfromneedleortrocharinsertion,135
24.4 Anaestheticproblemsoflaparoscopicsurgery,135
24.5 Anaestheticconsiderationsinectopicpregnancy,136
24.6 AnaestheticconsiderationsforERPC,137
25.1 Requirementsforurologicalirrigatingfluid,139
25.2 Factorsinfluencingtheabsorptionofglycine,140
25.3 AnaestheticproblemsforTURP,140
25.4 Symptomsandsignsofacutewaterintoxication
(TURPsyndrome),141
25.5 BloodtestsinsuspectedTURPsyndrome,141
25.6 ManagementofwaterintoxicationinTURPsyndrome,142
25.7 AnaesthesiaforTURP,143
25.8 AdvantagesanddisadvantagesofregionalanaesthesiaforTURP,144
25.9 AdvantagesanddisadvantagesofgeneralanaesthesiaforTURP,144
25.10 Specificconsiderationsinrenalsurgery,145
26.1 Specificpreoperativeproblemsinabdominalsurgery,147
26.2 Complicationsofhypokalaemia,148
26.3 Perioperativeconsiderationsforabdominalsurgery,148
26.4 Specificpostoperativeproblemsinabdominalsurgery,149
26.5 Anaestheticproblemsofanalsurgery,150
27.1 Anaesthetictechniquesfordentalsurgery,153
27.2 Considerationsforgeneralanaesthesiaindentalsurgery,153
27.3 Anaestheticconsiderationsfortonsillectomy,155
27.4 Anaestheticproblemsinthebleedingtonsil,155
27.5 Anaestheticconsiderationsformiddleearsurgery,156
27.6 Techniquesforinducedhypotension,157
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x Listofboxes
28.1 Generalconsiderationsinorthopaedicanaesthesia,158
28.2 Anaestheticconsiderationsandtechniquesforarmsurgery,160
28.3 Anaestheticconsiderationsandtechniquesforhipsurgery,161
28.4 Advantagesanddisadvantagesofregionalanaesthesia
forhipsurgery,161
28.5 Advantagesanddisadvantagesofgeneralanaesthesia
forhipsurgery,162
28.6 Anaestheticconsiderationsforspinalsurgery,162
29.1 Selectionguidelinesfordaycasesurgery,164
29.2 Dischargecriteriafordaycasesurgery,165
30.1 Mainobjectivesofcareintherecoveryarea,167
30.2 Causesofearlypostoperativehypoxaemia,168
30.3 Typicalcriteriafordischargefromrecovery,169
31.1 Claimedadvantagesofgoodpostoperativeanalgesia,171
31.2 Factorsinfluencingpostoperativepain,172
31.3 Generalplanofpostoperativeanalgesia,173
31.4 MainsideeffectsofNSAIDs,174
31.5 Majorsideeffectsofsystemicopiates,174
32.1 Causesofsecondarybraindamageaftertrauma,177
32.2 Indicationsforendotrachealintubationinthehead-injured
patient,178
32.3 Guidelinesfortransferringhead-injuredpatients,180
33.1 Minimumrequirementsforconductofanaesthesia,181
33.2 Considerationsforelectroconvulsivetherapyanaesthesia,182
33.3 Anaestheticconsiderationsforpatienttransfer,183
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List of figures
1.1 StructuresseenonopeningofmouthforMallampatiGrades1–4,5
1.2 Lineshowsthethyromentaldistancefromthethyroidcartilagetothe
tipofthechin,6
2.1 Laryngealmaskcorrectlypositionedbeforeinflation,withthetipof
themaskinthebaseofthehypopharynx,9
2.2 Typicalendotrachealtube,10
2.3 Viewofthelarynxobtainedbeforeintubation,11
3.1 Anoesophagealdetector,16
7.1 Apressure-reducingvalve,30
7.2 Flowmeterneedlevalverotameter,31
8.1 Maplesonclassificationofrebreathingsystems.Arrowsindicate
directionoffreshgasflow(FGF),39
8.2 Coaxialsystemsof(A)Bainand(B)Lack,40
22.1 Applicationofcricoidpressure,119
23.1 Anatomyoftheepiduralspace,125
23.2 Tuohyneedle,epiduralcatheterandfilter,127
xi