Clinical Cases in Anesthesia E-Book

Francine S. Yudkowitz, Allan P. Reed

Description

Prepare for the oral boards with the thoroughly updated Clinical Cases in Anesthesia. This comprehensive and current anesthesia review tool presents case studies representing today's most commonly encountered clinical situations, equipping you to master the latest anesthesia treatment protocols and practice guidelines and achieve your very best score.

• Learn the most practical solutions to contemporary problems, and understand the relevant scientific and clinical principles, through actual case studies presented in a helpful Q&A format.

• Review the most recent knowledge with updated coverage of the cardiovascular, respiratory, and central nervous system; updated abdomen, trauma, and post-anesthesia care sections; and a completely new section on critical care.
• Stay abreast of the latest treatment options, practice guidelines, and pharmacology information with comprehensive updates throughout.

Sujets

• Médecine
• Spécialités médicales
• Médecine Générale
• Anesthesiology
• Medical

Informations

• Publié par: Saunders
• Date de parution: 20 décembre 2013
• Nombre de lectures: 0
• EAN13: 9780323186544
• Langue: English
• Poids de l'ouvrage: 10 Mo

Extrait

Clinical Cases in
Anesthesia
FOURTH EDITION
Allan P. Reed, MD
Professor, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New
York, New York
Francine S. Yudkowitz, MD, FAAP
Professor, Departments of Anesthesiology and Pediatrics, Icahn School of Medicine at Mount
Sinai, New York, New YorkTable of Contents
Cover image
Title page
Copyright
Dedication
Contributors
Preface to the fourth edition
SECTION 1: CARDIOVASCULAR SYSTEM
Case 1: Coronary artery disease
1 What are the determinants of myocardial oxygen supply?
2 Explain the determinants of myocardial oxygen consumption (demand).
3 What are the pharmacologic alternatives for treating myocardial ischemia in this
patient?
4 Describe the considerations for performing surgery on patients with drug-eluting
coronary stents.
5 Is perioperative β-adrenergic blockade indicated for this patient?
6 How should this patient be monitored intraoperatively?
Case 2: Recent myocardial infarction
1. How do you evaluate cardiac risk in a patient scheduled for noncardiac surgery?
2. How is cardiac status evaluated before elective noncardiac surgery?
3. What is the cardiac risk in this patient, and what additional investigations should
be performed?
4. What are the implications for anesthetic management when coronary
revascularization is performed before noncardiac surgery?5. Which intraoperative monitors would you use?
6. What additional drugs would you have prepared?
7. What anesthetic technique would you use?
8. How would you manage this patient postoperatively?
Case 3: Congestive heart failure
1 Name possible etiologies for dilated cardiomyopathy.
2 Explain the pathophysiology of dilated cardiomyopathy.
3 Which monitors would you use for this patient in the perioperative period?
4.  How would you anesthetize this patient?
Case 4: Aortic stenosis
1 Describe the symptoms of and long-term prognosis for aortic stenosis.
2 Identify the etiology of aortic stenosis.
3 What is the significance of aortic valve area and how is it calculated?
4 Why is it important to maintain sinus rhythm?
5 What is the treatment for supraventricular tachyarrhythmias or bradyarrhythmias?
6 How is hypotension best treated in a patient with aortic stenosis?
7 How would you anesthetize this patient for cardiac or noncardiac surgery?
8 What are anesthetic considerations for transcatheter aortic valve implantation?
Case 5: Mitral stenosis
1 What are the etiology and pathophysiology of mitral stenosis?
2 How are preload, afterload, heart rate, and contractility managed in patients with
mitral stenosis?
3 Explain methods for optimizing the patient’s condition preoperatively.
4 What intraoperative monitoring would be appropriate?
5 How would you anesthetize this patient?
6 Describe the treatment for hypotension in patients with mitral stenosis
7 What therapies are recommended for perioperative right ventricular failure?
8 Describe specific considerations for mitral valve repair, replacement, or
percutaneous techniques.Case 6: Hypertrophic obstructive cardiomyopathy
1 Describe the anatomic abnormalities in hypertrophic obstructive cardiomyopathy.
2 What changes in preload, afterload, heart rate, and contractility optimize
hemodynamic performance for patients with hypertrophic obstructive
cardiomyopathy?
3 What are the treatment options for hypertrophic obstructive cardiomyopathy?
4 What monitoring is required in patients with hypertrophic obstructive
cardiomyopathy?
5 What are the considerations for anesthetic management of patients with
hypertrophic obstructive cardiomyopathy?
6. What are special considerations for anesthetic management of labor and delivery
in patients with hypertrophic obstructive cardiomyopathy?
Case 7: Cardiac pacemakers and defibrillators
1 What are the different types of pacemakers?
2 How does a pacemaker work?
3 What do the pacemaker codes represent?
4 Explain physiologic pacing.
5 What is mode switching?
6 Describe rate-adaptive pacing
7 What is cardiac resynchronization therapy?
8 What is an implantable cardioverter-defibrillator?
9 How is a patient with a cardiac implantable electronic device managed in the
perioperative period?
10 How is the type of device present determined?
11 What is electromagnetic interference, and how does it affect cardiac implantable
electronic devices?
12 How do you determine if a patient is pacemaker dependent, and how should this
be managed in the perioperative period?
13 Should a magnet be used?
14 Does an implantable cardioverter-defibrillator have to be deactivated in the
perioperative period?
15 What should be done if a patient with a deactivated implantable
cardioverterdefibrillator experiences fibrillation?
16 How can one know if a cardiac implantable electronic device requires
interrogation before discharging the patient from an intensive care setting?Case 8: Cardiac tamponade
1 What is cardiac tamponade?
2 What are the etiologies of cardiac tamponade?
3 What are the signs and symptoms of cardiac tamponade?
4 How is cardiac tamponade diagnosed?
5 How does spontaneous respiration affect ventricular filling in cardiac tamponade?
6 What variants of cardiac tamponade have been described?
7 How is cardiac tamponade treated?
8 How would you anesthetize a patient with cardiac tamponade?
Case 9: Patient with a left ventricular assist device presenting for noncardiac surgery
1 What is a ventricular assist device?
2 What are important preanesthetic considerations for patients with a left ventricular
assist device?
3 What anesthetic agents and techniques are appropriate for a patient with a left
ventricular assist device?
4 What are the goals for fluid management in a patient with a left ventricular assist
device?
5 Should anticoagulation be reversed for the surgical procedure?
6 What antibiotic coverage is necessary for a patient with a left ventricular assist
device?
7 How should implantable cardioverter-defibrillators and pacemakers be managed
perioperatively in a patient with a left ventricular assist device?
8 Which monitoring devices are necessary for anesthetic management of a patient
with a left ventricular assist device?
9 When are central venous catheters or pulmonary artery catheters helpful in
patients with a left ventricular assist device?
10 What are the parameters on the heartmate II left ventricular assist device
console?
11 How long do heartmate II device batteries last?
12 What alarms might I hear annunciated, and of what alert conditions do I need to
be aware?
13 What are important postoperative considerations in a patient with a left
ventricular assist device?
Case 10: Noncardiac surgery after heart transplantation1 Explain the physiology of transplanted hearts.
2 Is reinnervation of the transplanted heart a concern?
3 Which immunosuppressive medications are typically used after heart
transplantation?
4 What are the preanesthetic concerns for patients with a heart transplant?
5 What anesthetic techniques are applicable to patients with a heart transplant?
6 Which intraoperative monitors are recommended for patients with a heart
transplant?
7 Which emergency drugs are likely to be effective in a patient with a heart
transplant?
8 When antagonizing neuromuscular blockade in a patient with a heart transplant,
do anticholinergics also need to be given?
Case 11: Coronary artery bypass grafting
1 What are the major determinants of myocardial oxygen supply and demand?
2 How is coronary artery disease treated, and which medications should be
continued perioperatively?
3 What are the preanesthetic concerns in a patient with coronary artery disease?
4 What anesthetic technique is used for coronary artery bypass grafting?
5 What intraoperative monitoring techniques can be used to detect myocardial
ischemia?
6 What are the advantages and disadvantages of on-pump versus off-pump
coronary artery bypass grafting?
7 What are unique anesthetic considerations related to off-pump coronary artery
bypass grafting?
SECTION 2: RESPIRATORY SYSTEM
Case 12: One-lung ventilation
1 Describe the anesthetic evaluation before lung resection.
2 How are ventilation and oxygenation monitored noninvasively during surgery, and
how do these monitors work?
3 What are the indications for one-lung ventilation?
4 Describe the use of single-lumen endotracheal tubes and bronchial blockers for
one-lung ventilation.
5 If a double-lumen tube is to be used, which would be preferable, a left-side or
right-side tube?6 Describe the proper technique for placing a double-lumen endobronchial tube.
7 How is correct positioning of the double-lumen endobronchial tube assessed?
8 What clinical problems are associated with placement and use of double-lumen
endobronchial tubes?
9 What complications are related to placing the patient in the lateral decubitus
position?
10 How are pulmonary perfusion and ventilation altered during one-lung ventilation?
11 How is hypoxemia that occurs during one-lung ventilation treated?
12 Describe the role of a thoracostomy tube after pulmonary resection.
13 Describe a commonly used pleural drainage system.
14 What are the potential complications after thoracotomy?
Case 13: Thoracoscopy
1 What procedures are performed under video-assisted thoracoscopy?
2 What are the advantages of video-assisted thoracoscopy over traditional
thoracotomy?
3 What anesthetic techniques can be used for video-assisted thoracoscopy?
4 How can hypoxemia from shunting during one-lung ventilation be treated?
5 What complications can occur with video-assisted thoracoscopy?
SECTION 3: CENTRAL NERVOUS SYSTEM
Case 14: Intracranial mass, intracranial pressure, venous air embolism, and
autoregulation
1 What is cerebral autoregulation?
2 What factors contribute to increased intracranial pressure?
3 How do anesthetic agents and vasoactive drugs affect cerebral blood flow and
intracranial pressure?
4 What are the signs and symptoms of increased intracranial pressure?
5 How is intracranial pressure monitored?
6 How is increased intracranial pressure treated?
7 How is venous air emb