The Anaesthesia Science Viva Book

571 Pages·2016·12.73 MB·English

The Anaesthesia Science Viva Book
Third Edition
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The Anaesthesia
Science Viva Book
THIRD EDITION
Clinical Science as Applied to Anaesthesia,
Intensive Therapy and Chronic Pain
A Guide to the Oral Questions
SIMON BRICKER
TheCountessofChesterHospital,
Chester,UK
Medical illustrations by
CELYN BRICKER
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DOI:10.1017/9781316651841
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Secondedition©SimonBricker2009
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Firstpublished2004
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Thirdedition2017
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Names:Bricker,Simon,author.
Title:Theanaesthesiasciencevivabook:clinicalscienceasappliedtoanaesthesia,intensivetherapy,
andchronicpain:aguidetotheoralquestions/SimonBricker;medicalillustrationsbyCelynBricker.
Description:Thirdedition.|Cambridge;NewYork,NY:CambridgeUniversityPress,2017.|
Includesbibliographicalreferencesandindex.
Identifiers:LCCN2017019176|ISBN9781316608814(pbk.:alk.paper)
Subjects:|MESH:Anesthesia|ClinicalMedicine|StudyGuide
Classification:LCCRD82.3|NLMWO18.2|DDC617.9/6076–dc23
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To Imogen
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Contents
Preface tothe Third Edition page xiii
Preface tothe Second Edition xv
Preface tothe First Edition xvii
1 Advice onAnswering Clinical Science Viva Questions 1
TheClinical ScienceViva (Structured Oral Examination) 1
TheMarkingSystem 2
Appearanceand Affect 2
Oral Questions 3
Why Do They Have to AskThese Kinds of Question? 6
ABrief Historyof Anaesthesia’s InferiorityComplex 6
Strategies for AnsweringClinical ScienceQuestions 7
AndFinally:Information, Understanding and ‘Buzzwords’ 10
2 Anatomy and Its Applications 13
TheCerebral Circulation 13
Brain Stem Death Testing 16
TheInternal Jugular Vein 19
Ocular Anatomy 22
ThePituitary 26
TheAutonomic Nervous System 30
TheTrigeminal Nerve 32
TheNose 35
TheSensoryNerve Supplyto the Face 37
TheSensoryNerve Supplyto the Scalp 39
TheCervical Plexus 41
TheLarynx 43
TheInnervation of the Larynx 46
TheAnatomyoftheTrachea and Bronchi 48
TheSurface Anatomy of the Neck (PercutaneousTracheostomyand
Cricothyroidotomy) 51
TheStellateGanglion 54
TheParavertebralSpace 56
ThePleura 59
TheMediastinum 61
Myocardial Blood Supply 63
Myocardial Innervation 66
TheIntercostal Nerves 68
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Contents
The Diaphragm 70
The Liver 73
The Spleen 76
The Blood Supplyto the Abdominal Viscera(theSplanchnic
Circulation) 78
The CoeliacPlexus 80
The Blood Supplyto the Spinal Cord 82
The Lumbar Sympathetic Chain 84
The Anterior Abdominal Wall 86
The Innervation of the Inguinal Region 88
The BrachialPlexus 90
The Ulnar Nerve 94
The Radial Nerve 96
The Median Nerve 98
The Antecubital Fossa 99
The Arterial Supply of the Hand 101
AnatomyRelevant to Subarachnoid (Spinal) Anaesthesia 103
The Extradural (Epidural) Space 108
The Sacrum 112
The Blood Supplyto the Lower Limb 114
The Femoral Triangle 117
The Femoral Nerve 118
The Sciatic Nerve 122
The SensoryInnervation of the Foot 124
Cross-Sectional Areas of Interest (Eye, Neck, Lower Thoracic
and Lumbar Regions) 126
3 Physiology 131
Pneumothorax 131
Control of Breathing 134
Apnoeaand Hypoventilation 138
Compliance 140
The Failing Lung 142
Bronchomotor Tone (Asthma) 146
Smoking andAnaesthesia 148
Non-Respiratory Functions of the Lung 150
One-Lung Ventilation (One-Lung Anaesthesia) 152
Pulmonary Oedema 154
Pulmonary Hypertension 156
Hypoxic Pulmonary Vasoconstriction (HPV) 157
The Oxygen–Haemoglobin Dissociation Curve 159
Hyperbaric Oxygen 161
Oxygen Toxicity 164
Pre-Operative Assessment of Cardiac Function 166
Mitral Valve Disease 168
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Contents
Aortic Valve Disease 171
Oxygen Delivery 174
Sepsis 175
Central VenousPressure and Cannulation 179
Fluid Therapy 182
Massive Haemorrhage:CompensatoryResponses andManagement 186
Blood Groups 188
Complicationsof Blood Transfusion 191
Anaemia 194
Postpartum andMassiveObstetric Haemorrhage 197
Physiological Changes of Late Pregnancy Relevantto General
Anaesthesia 199
Non-Obstetric Surgery in Pregnancy 202
Pre-Eclampsia 205
CirculatoryChangesatBirth (CongenitalHeart Disease) 207
Physiologyand Clinical Anatomy of the Infant and Neonate 210
Laparoscopy 214
TheProne Position in Anaesthesia 216
Intracranial Pressure 218
Cerebral Blood Flow 223
PostoperativeCognitive Dysfunction andDelirium 226
Intraocular Pressure 229
TheNeuromuscular Junction 232
PostoperativeNauseaand Vomiting 234
Obesity 237
ThePhysiology of Ageing 239
The‘Stress Response’to Surgery 242
TheGlucocorticoidResponse to Surgery 244
Adrenaline (Epinephrine) 246
5-Hydroxytryptamine (Serotonin) 248
Cytochrome(s)P450 251
Nitric Oxide 253
Plasma Proteins 255
Thyroid Function 257
Nutrition 259
Electroconvulsive Therapy 263
Pain Pathways 265
TheComplex Regional Pain Syndrome (CRPS) 267
Diabetic Ketoacidosis (DKA and HONK) 270
Spinal Cord Injury 273
Immunology (and Drug Reactions) 276
Latex Allergy 279
Jaundice 281
TheArterial Tourniquet 283
Arterial Cross-Clamping 286
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Contents
4 Pharmacology 289
Mechanisms of Action of General Anaesthetics 289
Chirality 292
Propofol 294
Ketamine 296
Thiopental and Etomidate 299
Inhalational Agents:Sevoflurane 302
Inhalational Agents:Desflurane 304
Inhalational Agents:Isoflurane 306
Inhalational Agents:Xenon 307
Inhalational Agents:NitrousOxide 309
Inhalational Agents:Comparison with the Ideal 312
Neuromuscular Blocking Drugs (and Sugammadex) 316
Suxamethonium 320
Opiates/Opioids 322
Local Anaesthetics: Actions 326
Local Anaesthetics: Toxicity 332
Local Anaesthetics: Influenceson Onset andDuration 335
Bupivacaine, Ropivacaine, Lidocaine andPrilocaine 338
SpinalAdjuncts to Local Anaesthetics 342
Induced Hypotension 344
Clonidine (and Dexmedetomidine) 347
Antibiotics 349
Anticholinesterases 353
Anti-Arrhythmic Drugs 355
β-Adrenoceptor Blockers 360
Anti-Hypertensive Drugs and Anaesthesia 362
Hypotension andIts Management 364
Inotropes 367
Drugs Used in the Treatment of Nausea and Vomiting 370
Drug Overdose:Prescribed and Therapeutic Drugs 373
Recreational Drugs and Drugs of Abuse 377
Drugs AffectingMood 380
Drugs AffectingCoagulation 382
Tranexamic Acid 388
Cyclo-Oxygenase (COX) Enzyme Inhibitors 390
Magnesium Sulphate 393
Tocolytics (Drugs That Relax the Uterus) 395
Uterotonics (Drugs That Stimulatethe Uterus) 397
Drugs Used in Parkinson’s Disease 399
Target-ControlledInfusion (TCI) 403
Conscious Sedation 408
Drugs Used to Treat DiabetesMellitus 410
Chemotherapeutic (Cytotoxic) Drugs 414
Bioavailability 416
Pharmacogenomics 418
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