1.The Practice of Anesthesiology 1
Case Discussion:Medical Malpractice 10
Ⅰ．ANESTHESIC EQUIPMENT＆MONITORS 15
2.The Operating Room:Medical Gas Systems,Environmental Factors,＆Electrical Safety 15
Case Discussion:Checking Out the Medical Gas System in a New Operating Room 25
3.Breathing Systems 27
Case Discussion:Unexplained Light Anesthesia 37
4.The Anesthesia Machine 40
Case Discussion:Detection of a Leak 56
5.Airway Management 59
Profiles in Anesthetic Practice:Laryngospasm:A Continuing Problem&C.Philip Larson,Jr.,MDCM,MA 78
Case Discussion:Evaluation＆Management of a Difficult Airway 80
6.Patient Monitors 86
Profiles in Anesthetic Practice:If There Were Only One Monitor&Wendell C.Stevens,MD 94
Profiles in Anesthetic Practice:Application of the Basic Physical Examination to Intraoperative Monitoring&John R.Moyers,MD 118
Case Discussion:Monitoring During Magnetic Resonance Imaging 123
Ⅱ．CLINICAL PHARMACOLOGY 127
7.Inhalational Anesthetics 127
Case Discussion:Closed-circuit Anesthesia 146
8.Nonvolatile Anesthetic Agents 151
Profiles in Anesthetic Practice:Rational Administration of Intravenous Anesthesia&J.G.Reves,MD 162
Case Discussion:Premedication of the Surgical Patient 175
9.Neuromuscular Blocking Agents 178
Profiles in Anesthetic Practice:A Current Practice of Relaxation&John J.Savarese,MD 192
Case Discussion:Delayed Recovery from General Anesthesia 197
10.Cholinesterase Inhibitors 199
Case Discussion:Respiratory Failure in the Recovery Room 205
11.Anticholinergic Drugs 207
Case Discussion:Central Anticholinergic Syndrome 210
12.Adrenergic Agonists＆Antagonists 212
Case Discussion:Pheochromocytoma 222
13.Hypotensive Agents 224
Case Discussion:Controlled Hypotension 231
14.Local Anesthetics 233
Case Discussion:Local Anesthetic Overdose 240
15.Adjuncts to Anesthesia 242
Case Discussion:Management of Patients at Risk for Aspiration Pneumonia 250
Ⅲ．REGIONAL ANESTHESIA＆PAIN MANAGEMENT 253
16.Spinal,Epidural,＆Caudal Blocks&Wayne Kleinman,MD 253
Case Discussion:Neuraxial Anesthetia for Lithotripsy 280
17.Peripheral Nerve Blocks 283
Case Discussion:Dyspnea Following Interscalene Block 308
18.Pain Management 309
Profiles in Anesthetic Practice:Should Patients Suffer Because Physicians Are Afraid?&Carl C.Hug,Jr.,MD,PhD 344
Case Discussion:Analgesia Following Thoracoabdominal Surgery 356
Ⅳ．PHYSIOLOGY,PATHOPHYSIOLOGY,＆ANESTHETIC MANAGEMENT 359
19.Cardiovascular Physiology＆Anesthesia 359
Case Discussion:A Patient with a Short P-R Interval 381
20.Anesthesia for Patients with Cardiovascular Disease 386
Case Discussion:Hip Fracture in an Elderly Woman Who Fell 427
21.Anesthesia for Cardiovascular Surgery 433
Case Discussion:A Patient for Cardioversion 472
22.Respiratory Physiology＆Anesthesia 475
Case Discussion:Unilaterally Diminished Breath Sounds during General Anesthesia 509
23.Anesthesia for Patients with Respiratory Disease 511
Case Discussion:Laparscopic Surgery 522
24.Anesthesia for Thoracic Surgery 525
Case Discussion:Mediastinal Adenopathy 550
25.Neurophysiology＆Anesthesia 552
Case Discussion:Postoperative Hemiplegia 564
26.Anesthesia for Neurosurgery 567
Profiles in Anesthetic Practice:Anesthesia for Neuronavigation&Robert F.Bedford,MD 570
Case Discussion:Resection of a Pituitary Tumor 581
27.Anesthesia for Patients with Neurologic＆Psychiatric Diseases 583
Case Discussion:Anesthesia for Electroconvulsive Therapy 594
28.Management of Patients with Fluid＆Electrolyte Disturbances 597
Case Discussion:Electrolyte Abnormalities Following Urinary Diversion 624
29.Fluid Management＆Transfusion 626
Case Discussion:A Patient with Sickle Cell Disease 640
30.Acid-Base Balance 644
Case Discussion:A Complex Acid-Base Disturbance 660
31.Renal Physiology＆Anesthesia 662
Case Discussion:Intraoperative Oliguria 677
32.Anesthesia for Patients with Renal Disease 679
Case Discussion:A Patient with Uncontrolled Hypertension 689
33.Anesthesia for Genitourinary Surgery 692
Case Discussion:Hypotension in the Recovery Room 705
34.Hepatic Physiology＆Anesthesia 708
Case Discussion:Coagulopathy in a Patient with Liver Disease 717
35.Anesthesia for Patients with Liver Disease 723
Case Discussion:Liver Transplantation 732
36.Anesthesia for Patients with Endocrine Disease 736
Case Discussion:Multiple Endocrine Neoplasia 750
37.Anesthesia for Patients with Neuromuscular Disease 752
Case Discussion:Anesthesia for Muscle Biopsy 759
38.Anesthesia for Ophthalmic Surgery 761
Case Discussion:An Approach to a Patient with an Open Eye＆a Full Stomach 768
39.Anesthesia for Otorhinolaryngologic Surgery 771
Case Discussion:Bleeding Following Sinus Surgery 779
40.Anesthesia for Orthopedic Surgery 782
Case Discussion:Managing Blood Loss in Jehovah's Witnesses 790
41.Anesthesia for the Trauma Patient 793
Case Discussion:Anesthetic Management of the Burn Patient 801
42.Maternal＆Fetal Physiology＆Anesthesia 804
Case Discussion:Postpartum Tubal Ligation 816
43.Obstetric Anesthesia 819
Case Discussion:Appendicitis in a Pregnant Woman 846
44.Pediatric Anesthesia 849
Profiles in Anesthetic Practice:Heart Rate Response to Surgical Incision in Children&John F.Ryan,MD,MEd 858
Case Discussion:Masseter Spasm＆Malignant Hyperthermia 869
45.Geriatric Anesthesia 875
Case Discussion:The Elderly Patient with a Fractured Hip 880
46.Outpatient Anesthesia&Stuart Ackerman,MD 882
Case Discussion:Monitored Anethesia Care for Eye Surgery 886
Ⅴ．SPECIAL PROBLEMS 889
47.Anesthetic Complications&Joseph T.Nitti,MD,＆Gary J.Nitti,MD 889
Profiles in Anesthetic Practice:The Seated Position——Gone Forever?&M.Jane Matjasko,MD,＆Douglas G.Martz,MD 894
Case Discussion:Unexplained Intraoperative Tachycardia＆Hypertension 909
48.Cardiopulmonary Resuscitation 912
Profiles in Anesthetic Practice:Management of the Difficult Airway by Anesthesiologists&David J.Cullen,MD,MS 914
Case Discussion:Intraoperative Hypotension＆Cardiac Arrest 925
49.Postanesthesia Care 936
Profiles in Anesthetic Practice:Routine Postoperative Suctioning:A Bad Idea&Frederic A.Berry,MD 942
Case Discussion:Fever＆Tachycardia in a Young Adult Male 947
50.Critical Care 951
Case Discussion:An Obtunded Young Woman 990
Index 993