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A DVA NCED A NESTHESIA
R EV IEW
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本书版权归Oxford University Press所有
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A DVA NCED A NESTHESIA
R EV IEW
EDITED BY
Alaa Abd-Elsayed
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Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: Abd-Elsayed, Alaa, editor.
Title: Advanced anesthesia review / [edited by] Alaa Abd-Elsayed.
Other titles: Advanced anesthesia review (Abd-Elsayed)
Description: New York, NY : Oxford University Press, [2023] |
Includes bibliographical references and index.
Identifiers: LCCN 2021039926 (print) | LCCN 2021039927 (ebook) |
ISBN 9780197584521 (paperback) | ISBN 9780197584545 (epub) |
ISBN 9780197584552 (OxMed)
Subjects: MESH: Anesthesia | Handbook
Classification: LCC RD81 (print) | LCC RD81 (ebook) | NLM WO 231 |
DDC 617.9/6—dc23
LC record available at https://lccn.loc.gov/2021039926
LC ebook record available at https://lccn.loc.gov/2021039927
DOI: 10.1093/med/9780197584521.001.0001
1 3 5 7 9 8 6 4 2
Printed by Marquis, Canada
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To my parents, my wife, and my two beautiful kids, Maro and George
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CONTENTS
14. High-Altitude Anesthesia
xvii
xix
Preface
Contributors
Basic Sciences
Part 1: Monitoring Methods
1. Vascular Pressures
Amit Prabhakar and Adnan Raslan
2. Brain and Spinal Cord Function
Vicko Gluncic
3. Mixed Venous Oxygen Saturation
Heather Christopherson and Ettore Crimi
4. Cardiac Output
Adambeke Nwozuzu and Ettore Crimi
5. Coagulation Monitors
Christopher Giordano and Gabriella Tom Williams
6. Ultrasound-Guided Placement of Vascular Catheters
Harsh Rawal and Rany T. Abdallah
7. Point-of-Care Ultrasound (POCUS)
Harsh Rawal and Rany T. Abdallah
8. ASA Monitoring Standards
Nikki Eden and Shobana Rajan
Part 2: Ventilators
9. Continuous Positive Airway Pressure and Positive
End-Expiratory Pressure
Breethaa Janani Selvamani and Archit Sharma
10. Nebulizers, Humidifiers, Drug Delivery Systems
Nasir Hussain and Alaa Abd-Elsayed
11. Electrical, Fire, and Explosion Hazards
Suleman Sheikh and Stacey Watt
Part 3: Anesthesia Procedures, Methods,
and Techniques
12. Controlled Hypotension
Anthony Alexander and Feodor J. Gloss
13. Hyperbaric Medicine: Indications for and
Application of Hyperbaric Oxygen Therapy
Derek Brady Covington and Christopher Giordano
Part 4: Nervous System
15. Central and Peripheral Nervous Systems
Syed Sohaib Nasim and Steven Minear
16. Drug Metabolism
Theodore Jeske and Nebojsa Nick Knezevic
17. Intracranial Pressure
John S. Shin and Timothy T. Bui
18. Brain Volume
John S. Shin and Timothy T. Bui
19. Increased Intracranial Pressure and Herniation
Syed Sohaib Nasim and Steven Minear
20. Electroencephalograms
Rany T. Abdallah and Gabriel M. Coleman
21. Evoked Potentials: Look at Effect of All Agents on
SSEPs and Which Is Most Sensitive and Most Resistant
Timothy Ford and Alaa Abd-Elsayed
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Clinical Sciences
Part 5: Regional Anesthesia
22. Common Complications of Local Anesthetics
Rewais B. Hanna and Alaa Abd-Elsayed
23. Peripheral and Autonomic Nerve Blocks
James Flaherty and Federico Jimenez-Ruiz
24. Autonomic Nerve Blocks: Stellate, Celiac, and
Lumbar Sympathetic
Steven Ethier and Keth Pride
25. Peripheral Nerve Blocks (Head)
Keth Pride and Scott Blaine
26. Peripheral Nerve Blocks (Neck)
Scott Blaine and Keth Pride
27. Extremity Nerve Blocks
James Flaherty and Federico Jimenez-Ruiz
28. Truncal Nerve Blocks
Elizabeth Scholzen and Lisa Klesius
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39
Mark Dearden
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29. Spine-Related Procedures
Mary Ghaly and Sherif Zaky
30. Diagnosis and Management of Local Anesthetic
Systemic Toxicity (LAST)
Kristopher M. Schroeder and Andrew Pfaff
31. Intravenous Lipid Emulsion Therapy and the
American Society of Regional Anesthesia Checklist
for Local Anesthetic Toxicity
Kristopher M. Schroeder and Andrew Pfaff
32. Role of Regional Anesthesia in Enhanced Recovery
Protocols
Kristopher M. Schroeder and Andrew Pfaff
33. Innervation of Pelvic Structures
Peter Yi and Kevin E. Vorenkamp
Part 6: Pharmacology
34. General Concepts in Pharmacology
Daniel Gonzalez Kapp
35. Pharmacogenetics and Genetic Factors in Drug
Dose-Response Relationships
Daniel Gonzalez Kapp
36. Malignant Hyperthermia
Peter Papapetrou and Kris Ferguson
37. Butyrylcholinesterase (Pseudocholinesterase) Deficiency
Brian Harris and Kris Ferguson
38. Prolonged QT Syndrome
Kris Ferguson and Peter Papapetrou
39. Rapid Metabolizers
Nicholas M. Parker
40. Addiction
Anuj A. Shah and Christine S. Zaky
41. Anesthetic Implications of Addiction
Brian Harris and Kris Ferguson
42. Addiction Versus Tolerance
Anuj A. Shah and Christine S. Zaky
43. CNS Drugs for Nonanesthetic Use
Nitin Sekhri and Kevin Hui
44. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Lauren McGinty
45. Acetaminophen
Ifomachukwu Uzodinma
46. α2-Agonists
Nimit K. Shah and Piotr Al-Jindi
47. Tranquilizers
Rohit Aiyer and Sarah Money
48. Antidepressants, Antiparkinson Drugs
Dustin Latimer and Elyse M. Cornett
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49. Arousal Agents
Greta Nemergut
50. Antiemetics
Jeffery James Eapen and Jason Bang
51. Antiaspiration Medications
Nimit K. Shah and Abed Rahman
52. Chronic Opioid Dependence and Therapy
Nicholas M. Parker
53. Sympathetic Nervous System: Anatomy, Drugs,
Receptors, and Transmitters
Shelley George
54. Parasympathetic Nervous System: Anatomy,
Transmitters, Receptors, Drugs
Maria E. Munoz-Allen
Part 7: Centr al Nervous System
55. Anatomy of the Nervous System
Timothy Cutler and Sherif Zaky
56. Neurological Disorders
Maryam Jowza and Dominika James
57. Musculoskeletal System
Sarah Money and Rohit Aiyer
58. Epilepsy
Maryam Jowza and Dominika James
59. Coma: Diagnosis and Management
Hess Robertson and Philip G. Boysen
60. Therapeutic Barbiturate Coma
Syed A. Rahman
61. Drug Intoxication
Sarah C. Smith
62. Paraplegia, Quadriplegia, Spinal Shock,
Autonomic Hyperreflexia, Acute Spinal
Cord Injury
Peter Papapetrou and Kris Ferguson
63. Airway Management in Cervical Spine Disease
Balram Sharma and Evgeny Romanov
64. Tetanus
Patrick Forrest
65. Positioning and Anesthesia in Sitting Position
Sohail K. Mahboobi and Alexander Rothkrug
66. Air Embolism
Samuel Linares and Ned F. Nasr
67. Cerebral Protection
Roy Kim and Alaa Abd-Elsayed
68. Intracranial Aneurysms and Arteriovenous
Malformation
Kenan Alkhalili and Ned F. Nasr
viii • Contents
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69. Interventional Neuroradiology
Kenan Alkhalili and Ned F. Nasr
70. Pituitary Adenomas
Benjamin B. G. Mori and Ned F. Nasr
71. Fluid Management in Neurosurgery
Rotem Naftalovich and Daniel Denis
72. Spinal Fluid Drainage
Deepak Agarwal and Lovkesh L. Arora
73. Stereotactic and Gamma-Knife Techniques,
Deep Brain Stimulator Placement, Intraoperative
Wake-Up Techniques
Roy Kim and Alaa Abd-Elsayed
74. Ventriculostomy
Roy Kim and Alaa Abd-Elsayed
75. Awake Craniotomy
John S. Shin and Timothy T. Bui
76. Postoperative Visual Loss
Camila Teixeira and Steven Minear
77. Hypothermia
Jarrod Bang and Archit Sharma
78. Monitored Anesthesia Care and Sedation
Nikki Eden and Shobana Rajan
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90. Lung Volume
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Sarah Helwege and Archit Sharma
91. Pulmonary Function Tests
Sarah Helwege and Archit Sharma
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Part 8: Respir atory System Anatomy
79. Divisions of Bronchoscopic Anatomy
205
Matthew Gunst and Christopher Giordano
80. Bronchial and Pulmonary Circulations
207
Jordan Brewer and Christopher Giordano
81. Lung Mechanics
209
Evan Davidson and Ettore Crimi
82. Normal Acid-Base Regulation
211
Erica Alcibiade and Maggie W. Mechlin
83. Effects of Imbalance on Electrolytes and Organ Perfusion 213
Sarah Maben
214
84. Strong Ionic Difference
Christopher Giordano and Ravi Patel
85. Arterial Blood Gas Interpretation
217
Sarah Maben
86. The Anion Gap and Metabolic Acidosis
220
Scott Stayner and Kris Ferguson
87. Temperature Effect on Blood Gases:
Alpha-Stat Versus pH-Stat
222
Sohail K. Mahboobi and Faraz Mahmood
88. Lung Function and Cell Processes
225
Amit Prabhakar and Matt Warth
89. Ventilation-Perfusion
227
Jarrod Bang and Archit Sharma
Part 9: Clinical Science
92. Obstructive Lung Disease
Bryan J. Hierlmeier and Anesh Rugnath
93. Restrictive Lung Disease
Binoy Samuel and Justin Merkow
94. Management of Patients With Respiratory
Disease: Intraoperative Management
Dmitry Roberman and Felipe F. Suero
95. Respiratory Adjuncts: Heliox, Nitric Oxide,
Epoprostenol, and Intraoperative Steroids
Michelle McMaster
96. Preoperative Evaluation and Preparation of the
Patient With Pulmonary Disease
Anna-Kaye Brown and Ellen Hauck
97. Choice of Anesthesia/Anesthetic Techniques
in Thoracic Surgery
Callan Bialorucki
98. Nonpulmonary Surgery, Including
Mediastinoscopy and Bronchoscopy
Christopher O. Fadumiye
99. Thoracic and Pulmonary Surgery
Al-Awwab Mohammad Dabaliz and
Christina Stachur
100. Bronchopleural Fistula
Adam Lepkowsky and Dane Coyne
101. Advanced Anesthesia Review: One-Lung Ventilation
Sohail K. Mahboobi and Dillon B. Coplai
102. Thoracoscopy
Al-Awwab Mohammad Dabaliz and
Christina Stachur
103. Postoperative Pain
Nasir Hussain and Tristan E. Weaver
104. Ventilator Support and Extubation Criteria
Benjamin B. G. Mori and Abayomi Akintorin
105. Management of Respiratory Failure
Phil Boysen and Patrick Newman
106. Mode of Ventilation
Katarina Kapisoda and Ettore Crimi
107. BiPAP, Airway Pressure Release Ventilation,
and Prone Ventilation
Neisaliz Marrero-Figueroa and Ettore Crimi
108. Sleep Apnea
Sohail K. Mahboobi
Contents • ix
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109. Complications and Side Effects of Mechanical
Ventilation
Sohail K. Mahboobi and Mahad Sohail
110. Volutrauma, Barotrauma, and Biotrauma
Sohail K. Mahboobi and Joshua F. Bolanos
111. Management of Bronchospasm
Jeffery James Eapen and Jason Bang
112. Lung Transplantation
Yamah Amiri and Dinesh J. Kurian
Part 10: Cardiovascular System Anatomy
113. Normal Anatomy of Heart and Major Vessels
Marc Rodrigue and Subramanya Bandi
114. Echo Heart Anatomy
Christina Gibson and Matthew McConnell
115. Cardiac Catheterization
Virgilio de Gala and Iwan Sofjan
Part 11: Clinical Sciences
116. Ischemic Heart Disease
Daniel Ramirez Parga and Tatiana Jamroz
117. Coronary Artery Bypass Procedures
Andaleeb A. Ahmed
118. Valvular Heart Disease
Michael Morkos and Matthew McConnell
119. Subacute Bacterial Endocarditis Prophylaxis
Melissa Anne Burger and Todd Everett Jones
120. Conduction Abnormalities and Rhythm Defects
Ellyn Gray and Archit Sharma
121. Pacemakers and Automated Implantable
Cardioverter/Defibrillator (AICD) Implantation
Jayakar Guruswamy and Snigdha Parikh
122. Perioperative Implications of Pacemakers
and AICDs
Jayakar Guruswamy and Snigdha Parikh
123. Ventricular Synchronization
Jayakar Guruswamy and Snigdha Parikh
124. Ablations, Cryotherapy, and Maze Procedure
Anna Moskal
125. Heart Failure and Cardiomyopathy
Lovkesh L. Arora and Surangama Sharma
126. Systolic Versus Diastolic Dysfunction
Andaleeb A. Ahmed and Sohail K. Mahboobi
127. Postobstructive Pulmonary Edema
Benjamin Kloesel and Balazs Horvath
128. Pulmonary Hypertension
Frank Barrack and Bryan Noorda
129. Heart Transplantation
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James Leonardi and Daniel Cormican
130. Cardiac Tamponade
Ravi K. Grandhi and Alaa Abd-Elsayed
131. Constrictive Pericarditis
Ravi K. Grandhi and Alaa Abd-Elsayed
132. Mechanical Circulatory Assist Devices
James Leonardi and Daniel Cormican
133. Cardiopulmonary Bypass
Kim Sung and Lovkesh L. Arora
134. Myocardial Preservation During Cardiac Surgery
Jay Trusheim and Marisa Pappas
135. Preconditioning
Mada Helou and Ryan Nazemian
136. Off-Pump Coronary Artery Bypass (OPCAB)
Ryan Krebs and Joseph Sanders
137. Minimally Invasive Direct Coronary Artery
Bypass Grafting (MIDCAB)
John K. Kim and Iwan Sofjan
138. Percutaneous Valve Repair/Replacement
Asif Neil Mohammed and Iordan Potchileev
139. Intra-Aortic Balloon Pumps
Frank Barrack and Bryan Noorda
140. Extracorporeal Membrane Oxygenation (ECMO)
Michael Morkos and Daniel Cormican
141. Ventricular Assist Devices
Priyanka H. Patel and Matthew McConnell
142. Pulmonary Embolism
Lovkesh L. Arora and Surangama Sharma
143. Pulmonary Edema
Sangini Punia and Lovkesh L. Arora
144. Hypertension
Kim Sung and Lovkesh L. Arora
145. Effect of Intracardiac Shunts on Inhalation
Induction
Elie Geara and Caroline Alhaddadin
Part 12: Vascular Diseases
146. Carotid Endarterectomy
Ravi K. Grandhi and Claire Joseph
147. Peripheral Arteriosclerotic Disease
Racha Tadros and Nasir Hussain
148. Aortic Aneurysms
Jarrod Bang and Lovkesh L. Arora
149. Advanced Cardiopulmonary Resuscitation:
Adults and Children
Donnie Laborde
x • Contents
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169. Complications of Transurethral Resection of
the Prostate
Part 13: Gastrointestinal and
Hepatic Systems
150. Parenteral Nutrition
Mohamed Fayed and Arif Valliani
151. Morbid Obesity/Anesthesia for Bariatric Surgery
Vincent Roth and Christopher Giordano
152. Postoperative Hepatic Dysfunction
Peter Nielson and Michael Kaufman
153. Liver Transplant Surgery
John Mattimore and Michael Kaufman
154. Anesthesia for Upper and Lower GI Endoscopy
Ethan H. Leer
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Jacob Justinger and Soozan S. Abouhassan
393
Part 15: Hematologic System
170. Anemia
Victoria Shapiro and Heather Brosnan
171. Polycythemia
Victoria Shapiro and Heather Brosnan
172. Thrombocytopenia and Thrombocytopathy
Victoria Shapiro and Michael Chang
173. Congenital and Acquired Factor Deficiencies
Meghan C. Hughes and Alaa Abd-Elsayed
174. Disseminated Intravascular Coagulation
Gretchen A. Lemmink and Jay Conhaim
175. Fibrinolysis
Colby B. Tanner and Elaine A. Boydston
176. Anticoagulants and Antagonists
Suhas Devangam and Gretchen A. Lemmink
177. Coagulopathy in Trauma Patients
Timothy Ford and Alaa Abd-Elsayed
178. Hemoglobinopathies and Porphyrias
Elizabeth Haynes and Nasir Hussain
179. Transfusion Indications and Reactions
Courtney L. Scott and Elaine A. Boydston
180. Complications of Transfusion
Courtney R. Jones and Maggie W. Mechlin
181. Transfusion Therapy for Massive Hemorrhage
Colby B. Tanner and Elaine A. Boydston
182. Transfusion Ratios
Albert Lee and Nathan Schulman
183. Use of Uncrossmatched Products
Christina Stachur
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Part 14: Renal and Urinary Systems/
Electrolyte Balance
155. Renal Anatomy
Erika Taco and Edward Noguera
156. Pathophysiology of Renal Disease
Erika Taco and Edward Noguera
157. Management in Renal Failure and Arteriovenous
(AV) Shunts
Lacey Haugen and Jai Jani
158. Anesthetic Management of Kidney Transplantation
Mada Helou and Ryan Nazemian
159. Anesthesia for Extracorporeal Shock Wave
Lithotripsy
Alain Harb and Elie Geara
160. Perioperative Oliguria and Anuria
Brent Earls and Eellan Sivanesan
161. Dialysis and Hemofiltration
Michael J. Gyorfi and Alaa Abd-Elsayed
162. Pharmacologic Prevention and Treatment of
Renal Failure
Anureet Walia and Archit Sharma
163. Urologic Surgery
Allison K. Dalton
164. Perioperative Electrolyte Abnormalities
Brent Earls and Eellan Sivanesan
165. Fluid Therapy and Homeostasis
Miguel Rovira and Christopher Giordano
166. Fluid Balance During Surgery: The Role of the
Endothelial Glycocalyx
Charlotte Streetzel and Christopher Giordano
167. Assessment of Fluid Responsiveness and GoalDirected Therapies
Jacqueline Sohn and Connor McNamara
168. Esophageal Doppler
Roy Kim and Alaa Abd-Elsayed
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Part 16: Endocrine and Metabolic Systems
184. Anatomy of the Endocrine System
Ruzanna Nalbandyan and
Nawal E. Ragheb-Mueller
185. Hypopituitary Disease
Ruzanna Nalbandyan and
Nawal E. Ragheb-Mueller
186. Thyroid Gland
Evgenev Romanov and Edward Noguera
187. Parathyroid Disease
Karel T. S. Valenta and Kenneth S. Toth
188. Adrenal Disease
Allison K. Dalton
Contents • xi
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189. Carcinoid Syndrome
Sabrina S. Sam and Nawal E. Ragheb-Mueller
190. Diabetes Mellitus
Benjamin B. G. Mori and Piotr Al-Jindi
191. Pancreas Transplantation
Gorneva Maria and Tzonkov Anna
Part 17: Neuromuscular Diseases
and Disorders
192. Multiple Sclerosis
Justin L. O’Farrell and Maxim S. Eckmann
193. Motor Neuron Diseases
Allison K. Dalton
194. Guillain-Barré Syndrome
Justin L. O’Farrell and Maxim S. Eckmann
195. Charcot-Marie-Tooth Disease
Anthony Fritzler
196. Muscular Dystrophies
Maura C. Berkelhamer
197. Mitochondrial Myopathies
Maura C. Berkelhamer
198. Myasthenia Gravis
Michael Morkos and Daniel Cormican
199. Lambert-Eaton Myasthenic Syndrome
Sabrina S. Sam and Syena Sarrafpour
200. Congenital Myasthenic Syndromes
Sabrina S. Sam and Nawal E. Ragheb-Mueller
201. Ion Channel Myotonias, Myotonia Congenita,
and Acquired Neuromyotonia
Meghan C. Hughes and Alaa Abd-Elsayed
202. Hyperkalemic Periodic Paralysis
Brett Simmons and David Matteson
203. Hypokalemic Periodic Paralysis
Brett Simmons and David Matteson
Part 18: Clinical Subspecialties
204. Painful Disease States
Timothy Rushmer and Alaa Abd-Elsayed
205. Cancer Pain
Kevin E. Vorenkamp and Alaa Abd-Elsayed
206. Acute and Chronic Neck and Low Back Pain
Richard Tennant and Alaa Abd-Elsayed
207. Neuropathic Pain States
Robert H. Jenkinson and Alaa Abd-Elsayed
208. Complex Regional Pain Syndrome
Kim Mauer and Alaa Abd-Elsayed
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209. Postherpetic Neuralgia
Alaa Abd-Elsayed and Kim Mauer
210. Phantom Limb Pain
Kim Mauer and Alaa Abd-Elsayed
211. Peripheral Neuropathies
Kim Mauer and Alaa Abd-Elsayed
212. Postoperative Epidural Analgesia
Timothy Rushmer and Alaa Abd-Elsayed
213. Neuraxial Opioids
Robert H. Jenkinson and Alaa Abd-Elsayed
214. Patient-Controlled Analgesia
Robert H. Jenkinson and Alaa Abd-Elsayed
215. Systemic Multimodal Analgesia
Richard Lennertz and Kristin Bevil
216. Continuous Spinal and Epidural Anesthesia
Brook Girma and Alan D. Kaye
217. Neurolytic and Nonneurolytic Blocks in Pain
Management
Timothy Rushmer and Alaa Abd-Elsayed
218. World Health Organization (WHO)
Analgesic Ladder
Robert H. Jenkinson and Alaa Abd-Elsayed
Part 19: Pediatric Anesthesia
219. Apparatus and Breathing Circuits
Jamie W. Sinton
220. Endotracheal Tube Selection
Balazs Horvath and Benjamin Kloesel
221. Warming Devices
Eric Brzozowski and Shelley Ohliger
222. Premedications
Natalie R. Barnett and Ilana R. Fromer
223. Agents, Techniques, and Mapleson Circuits
Jamie W. Sinton
224. Induction Techniques
Sadiq S. Shaik and Lydia C. Boyette
225. Anesthetic Actions Different From Adults
Christopher O. Fadumiye
226. Drug Toxicities Preferentially Occurring in Children
Caylynn Yao and Elisha Peterson
227. Opioid Dosing and Sensitivity—Pediatrics
Rewais B. Hanna and Alaa Abd-Elsayed
228. Neuromuscular Blockers
Harsh Nathani and Chike Gwam
229. Regional Anesthesia
Cassandra Hoffmann and Tiffany Frazee
xii • Contents
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230. Fluid Therapy and Blood Replacement
Iana Bilga and Anna Tzonkov
231. NPO Guidelines for Pediatric Patients
Jonathan W. Klein
232. Problems in Intubation and Extubation
Balazs Horvath and Benjamin Kloesel
233. Neonatal Physiology
Nupur Dua and Ilana R. Fromer
234. Cardiovascular System
Bilga Iana and Chike Gwam
235. Metabolism, Fluid Distribution, and
Renal Function
Elizabeth Kremen and Sahel Keshavarzi
236. Thermal Regulation
David Bennett and Shelley Ohliger
237. Fetal Hemoglobin
Alex Y. Chung and Dominic S. Carollo
238. Prematurity
Michael J. Gyorfi and Alaa Abd-Elsayed
239. Bronchopulmonary Dysplasia
Jonathan W. Klein
240. Congenital Heart and Major Vascular Disease
Jamie W. Sinton
241. Cyanotic Defects
Jamie W. Sinton
242. Acyanotic Defects
Jamie W. Sinton
243. Pulmonary Hypertension
Benjamin Kloesel and Balazs Horvath
244. Major Vascular Malformations
Benjamin Kloesel and Balazs Horvath
245. Altered Uptake/Distribution of Intravenous
and Inhalation Anesthetics
Jamie W. Sinton
246. Cardiac Surgery: Corrective and Palliative
Jamie W. Sinton
247. Noncardiac Surgery
Jamie W. Sinton
248. Chronic Congenital Heart Disease
Jamie W. Sinton
249. Congenital Diaphragmatic Hernia
Cassandra Wasson and Christina D. Diaz
250. Tracheoesophageal Fistula
Cassandra Wasson and Christina D. Diaz
251. Neonatal Lobar Emphysema
Jamie W. Sinton
590
592
593
598
601
603
605
607
610
612
613
616
618
621
624
627
630
633
252. Pyloric Stenosis
Mariam Batakji and Christina D. Diaz
253. Necrotizing Enterocolitis
Cassandra Wasson and Christina D. Diaz
254. Omphalocele and Gastroschisis
Rami Edward Karroum
255. Meconium Aspiration Syndrome
Harsh Nathani and Chike Gwam
256. Respiratory Distress Syndrome
Jamie W. Sinton
257. Myelomeningocele
Rami Edward Karroum
258. Pneumo-, Hemo-, and Chylothoraces
Michael J. Gyorfi and Alaa Abd-Elsayed
259. Upper Respiratory Infections (Colds, Epiglottitis,
Laryngotracheobronchitis), Bronchopulmonary
Dysplasia, Cystic Fibrosis
Irim Salik and Ashley Kelley
260. Musculoskeletal Disease
Jamie W. Sinton
261. Hydrocephalus
Jamie W. Sinton
262. Developmental Delay, Autism, and
Cerebral Palsy
Maura C. Berkelhamer
263. Childhood Obesity
Irim Salik
264. Skeletal Abnormalities in Children
Gina Montone and Jonathan Adams
265. Trisomy 21 (Down Syndrome) and
VATER Association
Mariam Batakji and Christina D. Diaz
266. Chromosomal Abnormalities and Other
Common Pediatric Syndromes
Mariam Batakji and Christina D. Diaz
267. Juvenile Idiopathic Arthritis
Anthony Fritzler
268. Malignant Hyperthermia in Children
Narbeh Edjiu and Howard B. Gutstein
648
651
653
655
657
660
662
665
667
669
672
674
676
678
681
683
635
639
642
644
Part 20: Anesthetic Implications
for Common Nonneonatal Pediatric
Subspecialty Surgery
269. Otolaryngology
Timothy Ford and Alaa Abd-Elsayed
270. Neurosurgery
Itamar Latin and Kasia Rubin
Contents • xiii
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271. Thoracic Surgery
Alina Lazar
272. General and Urologic Surgery
Arif Valliani and Nimesh Patel
273. Orthopedic Surgery
Alina Lazar
274. Anesthesia for Pediatric Ophthalmologic Surgeries
Nupur Dua and Wendy Nguyen
275. Pediatric Ambulatory Surgery
Megan Rodgers McCormick
276. Systemic Medications and Routes of
Administration: Multimodal Analgesia
Samiya L. Saklayen and Thomas Graul
277. Regional Techniques
Alina Lazar
278. Pediatric Management of Postoperative Nausea
and Vomiting
Lisgelia Santana
279. Pediatric Sedation
Kasia Rubin
280. Pediatric Anesthesia Outside the Operating Room
Hannah Masters and Christina D. Diaz
Part 21: Obstetric Anesthesia
281. Maternal Physiology
Nimit K. Shah and Piotr Al-Jindi
282. Placenta
Roneisha McLendon
283. Drugs and Adjuvants
M. Anthony Cometa and Jordan Thompson
284. Oxytocic Drugs
Piotr Al-Jindi and Nimit K. Shah
285. Tocolytic Drugs
Piotr Al-Jindi and Bethany Potere
286. Mechanisms of Placental Transfer and Placental
Transfer of Specific Drugs
Muhammad Fayyaz Ahmed and Ihab Kamel
287. Fetal Disposition of Drugs
Afshin Heidari and Ben Aquino
288. Drug Effects on the Newborn
Ben Aquino
289. Amniotic Fluid
James Urness and Ami Attali
290. Labor Analgesia
Ifomachukwu Uzodinma and Piotr Al-Jindi
291. Systemic Medications
Ifomachukwu Uzodinma and Piotr Al-Jindi
694
696
698
700
704
707
709
711
713
715
721
723
725
727
729
731
733
735
737
739
742
292. Other Blocks
Mark L. Stram
293. Complications of Obstetric Anesthesia
Peter Lampert and Kristopher M. Schroeder
294. Physiology of Labor
Nwadiogo Ejiogu and Barbara Orlando
295. Influence of Anesthetic Technique on Labor
Mary J. Im and Ihab Kamel
296. Cesarean Section
Piotr Al-Jindi and Ami Attali
297. Anesthesia for Cerclage or Nonobstetric Surgery
Rowaa Ibrahim and Ami Attali
298. Ectopic Pregnancy
Edward Noguera
299. Spontaneous Abortion
Joshua D. Younger and Monica Prasad
300. Gestational Trophoblastic Disease
Joshua D. Younger
301. Autoimmune Disorders
Anuschka Bhatia and Kevin W. Chung
302. Endocrine Disorders
Eric P. Zhou and Kevin W. Chung
303. Heart Disease
Muhammad Fayyaz Ahmed and Ihab Kamel
304. Hematologic Disorders
Benjamin M. Hyers and Kevin W. Chung
305. Hypertension
Muhammad Fayyaz Ahmed and Ihab Kamel
306. Neurologic Disorders
Katrina Brakoniecki and Kevin W. Chung
307. Respiratory Disorders
Devin O’Conor and Kevin W. Chung
308. Renal Changes in Pregnancy
Jarna Shah
309. Fetal Monitoring
Shuchi Jain and Joshua D. Younger
310. Preeclampsia and Eclampsia
Alina Genis
311. Supine Hypotensive Syndrome
Muhammad Fayyaz Ahmed and Ihab Kamel
312. Aspiration of Gastric Contents
Muhammad Fayyaz Ahmed and Ihab Kamel
313. Embolic Disorders
Muhammad Fayyaz Ahmed and Ihab Kamel
314. Antepartum Hemorrhage
Mary J. Im and Ihab Kamel
xiv • Contents
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747
750
752
754
756
758
760
761
763
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768
771
774
776
778
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315. Postpartum Hemorrhage
Mary J. Im and Ihab Kamel
316. Cord Prolapse
Muhammad Fayyaz Ahmed and Ihab Kamel
317. Retained Placenta
Muhammad Fayyaz Ahmed and Ihab Kamel
318. Dystocia, Malposition, and Malpresentation
Diana Feinstein and Daniella Miele
319. Maternal Cardiopulmonary Resuscitation
Steven Zhou and Nasir Hussain
320. Fever and Infection
Helen Pappas and Elizabeth Lange
321. Preterm Labor
Erika Taco and Kevin Spencer
322. Trial of Labor After Cesarean Delivery
Piotr Al-Jindi and Nasir Hussain
323. Multiple Gestation
Steven Knoblock and Joshua D. Younger
324. Neonatal Resuscitation
Irim Salik and Tara Doherty
325. Apgar Scoring
Muhammad Fayyaz Ahmed and Ihab Kamel
326. Umbilical Cord Blood Gas
Pritee Tarwade and Christine Acho
327. Intrauterine Surgery
Jarna Shah
328. Anesthetic Considerations in Breastfeeding
Lora B. Levin and Jeffrey W. Cannon
Part 22: Otorhinolaryngology (ENT)
Anesthesia
329. Airway Endoscopy, Microlaryngeal Surgery, and
Laser Surgery
Rotem Naftalovich and James Schiffenhaus
330. Hazards and Complications
Rotem Naftalovich and Manan Nimish Shah
331. Intraoperative Thyroid and Parathyroid Function
Monitoring
Kelsey E. Lacourrege and Alan D. Kaye
332. Nerve Injury Monitoring During ENT Surgery
Garrett W. Burnett
Part 23: Miscellaneous
333. Liposuction
Alexandra N. Cole and Balram Sharma
334. Anesthesia for Laparoscopic Surgery
Maria F. Ramirez and J. P. Cata
795
797
799
801
803
805
807
809
811
813
817
819
821
822
827
829
831
832
837
838
335. Ophthalmologic Anesthesia
Camila Teixeira and Steven Minear
336. Orthopedic Anesthesia: Tourniquet
Management, Complications of Orthopedic
Surgery, Regional Versus General Anesthesia
Alberto Thomas and Jason Bang
337. Anesthesia for the Trauma Patient
Alexander Rothkrug and Karim Fikry
338. Anesthesia for MRI
Adi Cosic and Soozan S. Abouhassan
339. Hemorrhagic Shock
Colby B. Tanner and Elaine A. Boydston
340. Management of Traumatic Brain Injury
Bharathram Vasudevan and Ned F. Nasr
341. Mass Casualty Events
Ashok Kumar Manepalli and Stacey Watt
342. Chemical and Biological Warfare
Cassian Horoszczak and Stacey Watt
343. Anesthesia for Outpatient Surgery
M. Anthony Cometa and Christopher Giordano
344. Patient Selection and Preoperative
Management
Anna Moskal
345. Discharge Criteria and Postoperative Follow-up
Matthew T. Connolly and Alaa Abd-Elsayed
346. Office-Based Anesthesia (OBA)
Afshin Heidari and Ben Aquino
347. Geriatrics
Maggie W. Mechlin and Courtney R. Jones
348. Pharmacological Implications: Effect of
Inhalational Agents on All Organs
Dillon Tinevez and Jai Jani
349. Shock States
Nikki Eden and Shobana Rajan
350. Systemic Inflammatory Response Syndrome
Maria Gorneva and Anna Tzonkov
351. Multiple Organ Dysfunction Syndrome
Peter Shehata and Wael Ali Sakr Esa
352. Prescription Medication Overdose
Peter Huynh and Alaa Abd-Elsayed
353. Carbon Monoxide Poisoning
Ben Aquino
354. Drowning
Derek Brady Covington and
Christopher Giordano
355. Infection Control
David Jury and Edward Noguera
Contents • x v
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845
848
850
852
854
857
860
862
865
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869
871
873
877
879
880
882
884
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356. Needle-Stick Injury
Ramsey Saad and Joseph Salama Hanna
357. Intravascular Catheter and Urinary Catheter
Infections
Zhe Ma and Kevin W. Chung
358. Ventilator-Associated Pneumonia
Robert M. Owen and Kevin W. Chung
359. Antimicrobials
Mo Shirur and Kevin W. Chung
360. Mechanical Ventilation
Mena Abdelmalak and Kevin W. Chung
361. Postoperative Headache
Feroz Osmani and Kevin W. Chung
Part 24: Special Problems in
Anesthesiology
362. Electroconvulsive Therapy
Garrett W. Burnett
363. Organ Donors and Procurement
Michael J. Gyorfi and Alaa Abd-Elsayed
364. Brain Death
Shahla Siddiqui
365. Radiological Procedures
Shahla Siddiqui
366. Ethics, Practice Management, Professionalism,
and Medicolegal Issues
Shahla Siddiqui
367. Ethics: Advance Directives/Do Not
Resuscitate Orders
Shahla Siddiqui
368. Malpractice
Priyanka Ghosh
889
892
894
896
898
901
905
908
910
911
913
914
916
369. Initial Certification, Recertification, Maintenance
of Certification, and Related Issues
Katya H. Chiong and Soozan S. Abouhassan
370. Costs of Medical/Anesthesia Care and Operating
Room Management
Evan E. Lebovitz and Mitchell H. Tsai
371. Definitions
Joseph Salama Hanna and Ramsey Saad
372. Medication Errors: Assessment and Prevention
Joseph Salama Hanna and Ramsey Saad
373. Reporting: Mandatory and Voluntary Systems,
Legal Requirements, Anesthesia Quality
Institute, and Physician Quality Reporting System
Ramsey Saad and Joseph Salama Hanna
374. Safety Practices
Ramsey Saad and Joseph Salama Hanna
375. Root Cause Analysis
Luis Tueme and Nawal E. Ragheb-Mueller
376. Crisis Management and Teamwork
Mollie K. Lagrew and Christopher Giordano
377. Quality Improvement
Joseph J. McComb and Corinne K. Wong
378. Six Sigma and Lean Operations for the
Anesthesiologist
Caitlin N. Curcuru and Dinesh J. Kurian
379. Barriers to Quality Improvement
Ramsey Saad and Joseph Salama Hanna
380. Federal Regulatory Requirements and Quality
Payment Programs
Ramsey Saad and Joseph Salama Hanna
Index
x vi • Contents
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929
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CONTR IBUTOR S
Rany T. Abdallah, MD, PhD, MBA
Andaleeb A. Ahmed, MBBS, MPH
Center for Interventional Pain and Spine
Milford, DE, USA
Clinical Assistant Professor
Department of Anesthesiology
Tufts University School of Medicine
Lahey Hospital and Medical Center
Burlington, MA, USA
Mena Abdelmalak, MD, MBF
Department of Anesthesiology, Perioperative, and Pain
Medicine
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Muhammad Fayyaz Ahmed, MBBS, MD
Assistant Professor
Department of Clinical Anesthesiology
Lewis Katz School of Medicine
Temple University
Philadelphia, PA, USA
Alaa Abd-Elsayed, MD, MPH, FASA
Associate Professor of Anesthesiology
Medical Director, UW Health Pain Services
University of Wisconsin School of Medicine and Public
Health
Madison, Wisconsin, USA
Rohit Aiyer, MD
Assistant Professor - Staff Physician
Department of Anesthesiology, Pain Management, and
Perioperative Medicine
Henry Ford Health System
Detroit, MI, USA
Soozan S. Abouhassan, MD, FASA
Assistant Professor, Division Chief General Anesthesia
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Abayomi Akintorin, MD
Cook County Health Systems
Chicago, IL, USA
Christine Acho, DO
Department of Anesthesiology Critical Care
University of Michigan
Ann Arbor, MI, USA
Thomas Alberto, MD
Department of Anesthesia and Pain Management
Cook County Health and Hospital Systems
Chicago, IL, USA
Jonathan Adams, MD
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Erica Alcibiade, DO
Department of Anesthesiology
University of Cincinnati
Cincinnati, OH, USA
Deepak Agarwal, MBBS, MD
Staff Anesthesiologist
Department of Anesthesiology
HSHS St. John’s Hospital
Springfield, IL, USA
Anthony Alexander, MBBS
Department of Anesthesiology
Cook County Health and Hospital Systems
University of Cincinnati College of Medicine
Chicago, IL, USA
xix
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Caroline Alhaddadin, MBBS
Natalie R. Barnett, MD
Department of Anesthesia and Pediatric
University Hospitals/ Case Western Reserve University
Cleveland, OH, USA
Icahn School of Medicine
New York, NY, USA
Frank Barrack, MD
Piotr Al-Jindi, MD
Anesthesiology Program Director
Department of Anesthesiology and Pain Management
Cook County Health
Chicago, IL, USA
Kenan Alkhalili, MD
Department of Anesthesia
Cook County Health and Hospital Systems
Chicago, IL, USA
Allegheny Health Network Anesthesia Residency
Pittsburgh, PA, USA
Mariam Batakji, MD
Pediatric Anesthesiology
Department of Pediatric Anesthesiology
Medical College of Wisconsin
Milwakee, WI, USA
David Bennett, MD
Department of Anesthesiology and Perioperative Medicine
University Hospitals
Cleveland, OH, USA
Yamah Amiri, MBBS
Department of Anesthesia and Critical Care
University of Chicago
Chicago, IL, USA
Maura C. Berkelhamer, MD
Assistant Professor
Department of Anesthesiology
Northwestern University
Chicago, IL, USA
Director, Pediatric Perioperative Medicine
Assistant Professor of Anesthesiology and Pediatrics
Department of Anesthesiology and Perioperative Medicine
University Hospital Case Medical Center
Rainbow Babies and Children’s Hospital
Cleveland, OH, USA
Lovkesh L. Arora, MBBS, MD, FASA
Kristin Bevil, MS
Clinical Associate Professor
Department of Anesthesiology
University of Iowa Health Care
Iowa City, IA, USA
Assistant Professor
Department of Anesthesiology
University of Wisconsin School of Medicine and Public
Health
Madison, WI, USA
Ben Aquino, MD
Ami Attali, DO
Division Chief Obstetrical High Risk Anesthesiology,
Medical Director High Risk Obstetrical Optimization Clinics
Department of Anesthesiology, Pain Management, and
Perioperative Medicine
Henry Ford Health System
Detroit, MI, USA
Subramanya Bandi, MD
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Jarrod Bang, MD
Adult Cardiothoracic Anesthesia
Department of Anesthesia
University of Iowa
Iowa City, IA, USA
Jason Bang, MD
Anuschka Bhatia, MD
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Callan Bialorucki, MD
Department of Anesthesiology
The Ohio State University Wexner Medical Center
Columbus, OH, USA
Scott Blaine, DO
Department of Anesthesiology
University of Wisconsin School of Medicine and Public
Health
Madison, WI, USA
Joshua F. Bolanos, MD
Department of Anesthesiology
Beth Israel Lahey Health
Burlington, MA, USA
Department of Anesthesia and Pain Management
Cook County Health and Hospital Systems
Chicago, IL, USA
x x • Con t r i bu tor s
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Elaine A. Boydston, MD
Garrett W. Burnett, MD
Assistance Clinical Professor
Department of Anesthesiology and Perioperative Medicine
University of California Los Angeles
Los Angeles, CA, USA
Assistant Professor
Department of Anesthesiology, Perioperative, and Pain
Medicine
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Lydia C. Boyette, DO, MBA, CA-1, PGY-2
Jeffrey W. Cannon, MD
Department of Anesthesiology
University of Central Florida
Orlando, FL, USA
Department of Anesthesiology and Perioperative Medicine
University Hospitals/Case Western Reserve University
Cleveland, OH, USA
Phillip G. Boysen, MD, MBA
Dominic S. Carollo, MD
Professor
Department of Anesthesiology
University of Mississippi Medical Center
Jackson, MI, USA
Senior Staff Anesthesiologist and Senior Lecturer
Department of Anesthesiology and Perioperative Medicine
Ochsner Healthcare System
New Orleans, LA, USA
Katrina Brakoniecki, MD, MSc
J. P. Cata
Regional Anesthesia and Acute Pain
Department of Anesthesiology
Saint Francis Hospital and Medical Center
Hartford, CT, USA
Anesthesiology and Surgical Oncology Research Group
Houston, TX, USA
Michael Chang, MD
Jordan Brewer, MD
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Department of Anesthesiology
University of Florida College of Medicine
Gainesville, FL, USA
Katya H. Chiong, MD, FASA
Heather Brosnan, MD
Department of Anesthesiology
Westchester Medical Center/New York Medical College
Valhalla, NY, USA
Assistant Professor and Senior Attending Physician
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center/Case Western
Reserve University School of Medicine
Cleveland, OH, USA
Anna-Kaye Brown, DO
Department of Anesthesiology
Lewis Katz School of Medicine at Temple University
Pittsburgh, PA, USA
Eric Brzozowski, MD
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Timothy T. Bui, MD
Department of Anesthesiology and Perioperative Medicine
University of California, Los Angeles
Los Angeles, CA, USA
Heather Christopherson, MD
Department of Anesthesiology
University of Central Florida/HCA GME Consortium,
Orlando
Ocala Health, Florida
Ocala, FL, USA
Alex Y. Chung, MD
Anesthesiologist
Department of Anesthesia
Cincinnati Children Hospital Medical Center
Cincinnati, OH, USA
Kevin W. Chung, MD
Melissa Anne Burger, MD
Assistant Professor
Department of Anesthesiology and Surgery
University of Florida College of Medicine
Gainesville, FL, USA
Anesthesiologist
Department of Anesthesiology, Perioperative and Pain
Medicine
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Con t r i bu tor s • x x i
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Alexandra N. Cole, MD
Ettore Crimi, MD
Department of Anesthesia
Lahey Hospital and Medical Center
Burlington, MA, USA
Associate Professor - Program Director Anesthesiology
Residency Program
Department of Anesthesiology
University of Central Florida
Orlando, FL, USA
Gabriel M. Coleman, BSc
Physician
Philadelphia College of Osteopathic Medicine
Philadelphia, PA, USA
Caitlin N. Curcuru, MD
Department of Anesthesia and Critical Care
The University of Chicago
Chicago, IL, USA
M. Anthony Cometa, MD
Clinical Assistant Professor
Department of Anesthesiology
University of Florida
Gainesville, FL, USA
Timothy Cutler, DO
Department of Family Medicine
Firelands Regional Medical Center
Sandusky, OH, USA
Jay Conhaim, MD
Department of Anesthesiology
University of Cincinnati Medical Center
Cincinnati, OH, USA
Al-Awwab Mohammad Dabaliz, MD, MBBS
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Matthew T. Connolly, MD
Cardiologist
Orthopaedic Hospital of Wisconsin-Glendale, USA
Dillon B. Coplai, MD
Department of Anesthesia
Lahey Clinic
Burlington, MA, USA
Allison K. Dalton, MD
Associate Professor, Director of Anesthesia Critical Care
Associate Chairman of Education
Department of Anesthesia and Critical Care
University of Chicago
Chicago, IL, USA
Evan Davidson, MD
Daniel Cormican, MD
Department of Anesthesiology
University of Central Florida/HCA GME Consortium,
Orlando
Ocala Health Florida
Ocala, FL, USA
Attending Anesthesiologist and Intensivist
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Elyse M. Cornett, PhD
Mark Dearden, MD, MPH
Assistant Professor and Director of Research
Department of Anesthesiology
LSU Health Shreveport
Shreveport, LA, USA
Assistant Professor
Department of Anesthesiology
University of Cincinnati
Cincinnati, OH, USA
Adi Cosic, DO
Virgilio de Gala, MD
Department of Anesthesiology
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Anesthesiologist
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Derek Brady Covington, MD
Department of Anesthesiology
University of Florida College of Medicine
Gainesville, FL, USA
Daniel Denis, DO
Department of Anesthesia and Perioperative Care
Rutgers–New Jersey Medical School
Newark, NJ, USA
Dane Coyne, MD
Assistant Professor of Anesthesiology
Department of Anesthesia and Perioperative Medicine
University Hospitals
Cleveland, OH, USA
x x ii • Con t r i bu tor s
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Suhas Devangam, MD
Nwadiogo Ejiogu, MD
Department of Anesthesiology
University of Cincinnati Medical Center
Cincinnati, OH, USA
OB Anesthesia
St. Luke’s and Mount Sinai West Hospitals
New York, NY, USA
Christina D. Diaz, MD, FASA, FAAP
Steven Ethier, DO
Professor
Department of Anesthesiology
Medical College of Medicine/ Children’s Wisconsin
Milwaukee, WI, USA
Staff Anesthesiologist
Department of Anesthesiology
William Beaumont Hospital
Royal Oak, MI, USA
Tara Doherty, DO
Christopher O. Fadumiye, MD
Pediatric Anesthesiology
New York Medical College Maria Fareri Children’s
Hospital
Westchester Medical Center
New York, NY, USA
Assistant Professor
Department of Anesthesiology
Medical College of Wisconsin
Milwaukee, WI, USA
Mohamed Fayed, MD, MSc
Nupur Dua, MBBS, MD
Department of Anesthesiology
Henry Ford Health system
Detroit, MI, USA
Department of Anesthesiology
University of Minnesota
Minneapolis, MN, USA
Diana Feinstein, DO
Jeffery James Eapen, MD
Department of Anesthesiology and Pain Management
Cook County Health Systems
Chicago, IL, USA
Assistant Professor
Lewis Katz School of Medicine
Temple University
Philadelphia, PA, USA
Brent Earls, MD
Kris Ferguson, MD
Anesthesiology
Department of Anesthesiology
Johns Hopkins University
Baltimore, MD, USA
Clinical Assistant Professor of Medical School Regional
Campuses, Medical College of Wisconsin
Department of Interventional Pain Management
Aspirus Health System
Antigo, WI, USA
Maxim S. Eckmann, MD
University of the Incarnate Word School of Medicine
San Antonio TX, USA
Vice Chairman, Clinical Research
Department of Anesthesiology
UT Health
San Antonio, TX, USA
Karim Fikry, MD
Clinical Assistant Professor
Department of Anesthesia
Lahey Hospital and Medical Center
Burlington, MA, USA
James Flaherty, MD
Nikki Eden, DO
Cook County Health Systems
Chicago, IL, USA
Assistant Professor
Department of Anesthesiology
University of Minnesota
Minneapolis, MN, USA
Narbeh Edjiu, MD
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Timothy F. Flanagan, MD
Clinical Associate
Department of Anesthesiology
Beth Israel Lahey Health
Burlington, MA, USA
Con t r i bu tor s • x x iii
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Timothy Ford, MD
Christopher Giordano, MD
Department of Anesthesiology
University of Wisconsin at Madison
Madison, WI, USA
Department of Anesthesiology
University of Florida College of Medicine
Gainesville, FL, USA
Patrick Forrest, MD
Brook Girma, MD
Senior Staff Physician
Department of Anesthesiology
Henry Ford Health System
Detroit, MI, USA
Department of Anesthesiology
Louisiana State University School of Medicine
Shreveport, LA, USA
Feodor J. Gloss, DO
Tiffany Frazee, MD
Cook County Health and Hospitals System
Chicago, IL, USA
Assistant Professor and Division Chief
Department of Pediatric Anesthesiology
Rainbow Babies and Children’s Hospital
Cleveland, OH, USA
Vicko Gluncic, MD, PhD
Department Chair and System Chair for Anesthesia - Sinai
Health System
Department of Anesthesiology
Mount Sinai Hospital - Sinai Health System
Chicago, IL, USA
Anthony Fritzler, MD, FASA
Anesthesiologist
Department of Anesthesiology and Pain Medicine
Akron Children’s Hospital
Akron, OH, USA
Maria Gorneva, MD
Cook County Health and Hospitals System
Chicago, IL, USA
Ilana R. Fromer, MD
Assistant Professor
Department of Anesthesiology
University of Minnesota
Ravi K. Grandhi, MD, MBA
Medical Director
Department of Anesthesiology
Nazareth Hospital
Philadelphia, PA, USA
Elie Geara, MD
Rainbow Babies and Children’s Hospital
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Thomas Graul, DO
Alina Genis, MD
Department of Anesthesiology
NYMC at Westchester Medical Center
Valhalla, NY, USA
Assistant Professor
Department of Anesthesiology
The Ohio State University
Columbus, OH, USA
Shelley George, MD
Ellyn Gray, MD
Department of Anesthesiology
Clinical Assistant Professor (Adjunct), Anesthesiology
Temple University, Lewis Katz School of Medicine,
Pennsylvania, USA
Department of Anesthesia
University of Iowa Carver College of Medicine
Iowa City, IA, USA
Matthew Gunst, MD
Mary Ghaly, MD
Assistant Professor
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Priyanka Ghosh, MD
Remedy Medical Group
San Francisco, CA, USA
Christina Gibson, DO
Department of Anesthesiology
University of Florida College of Medicine
Gainesville, FL, USA
Jayakar Guruswamy, MBBS, MD
Assistant Professor
Department of Anesthesiology, Pain Management, and
Perioperative Medicine
Henry Ford Health System
Detroit, MI, USA
Allegheny Health Network
Pittsburgh, PA, USA
x x iv • Con t r i bu tor s
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Howard B. Gutstein, MD
Lacey Haugen, DO
Vice Chair, Research
Academic Officer
Anesthesiology Institute
Allegheny Health Network
Pittsburgh, PA, USA
Cardiothoracic
Department of Cardiothoracic Anesthesia
Cleveland Clinic Main Campus
Cleveland, OH, US
Elizabeth Haynes, MD
Chike Gwam, MBBS
Department of Anesthesiology
The Ohio State University
Columbus, OH, USA
Associate Professor
Department of Anesthesiology
Cook County Health and Hospitals System
Chicago, IL, USA
Afshin Heidari, MD
Anesthesiologist and Interventional Pain
Department of Anesthesiology and Pain Medicine
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Michael J. Gyorfi, MD
Department of Anesthesiology
The University of Wisconsin
Madison, WI, USA
Mada Helou, MD
Florian Hackl, MD
Clinical Assistant Professor in Anesthesiology
Department of Anesthesia
Lahey Hospital and Medical Center
Burlington, MA, USA
Assistant Professor of Anesthesiology, Program Director for
Anesthesiology
Department of Anesthesiology and Preoperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Joseph Salama Hanna, MD
Sarah Helwege, DO
Anesthesiology/Pain Medicine Staff, Clinical Assistant
Professor Wayne State University School of Medicine
Department of Anesthesiology, Pain Management and
Perioperative Medicine
Henry Ford Health System
Detroit, MI, USA
Visiting Professor
Department of Anesthesiology
University of Iowa Hospitals and Clinics
Iowa City, IA, USA
Rewais B. Hanna, MD
Department of Anesthesiology
University of Wisconsin School of Medicine and Public Health
Madison, WI, USA
Bryan J. Hierlmeier, MD
Associate Professor
Department of Anesthesiology
University of Mississippi Medical Center
Jackson, MS, USA
Cassandra Hoffmann, MD
Alain Harb, MD
Pediatric Anesthesia
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Assistant Professor, Director Pediatric Regional Anesthesia
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center, Rainbow
Babies and Children’s Hospital
Cleveland, OH, USA
Brian Harris, MD
Cassian Horoszczak, MD
Department of Sleep Medicine
UCLA
Los Angeles, CA, USA
Department of Anesthesiology
University at Buffalo
Buffalo, NY, USA
Ellen Hauck, DO, PhD
Balazs Horvath, MD, FASA
Professor
Department of Anesthesiology
Temple University
Philadelphia, PA, USA
Associate Professor
Department of Anesthesiology
University of Minnesota
Minneapolis, MN, USA
Con t r i bu tor s • x x v
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Meghan C. Hughes, MD, MPH
Tatiana Jamroz, MD
Department of Family Medicine
Aspirus Hospital
Wausau, WI, USA
Section Head, Cardiac Division
Department of Anesthesiology
Cleveland Clinic Florida
Weston, FL, USA
Kevin Hui, MD
Jai Jani, BMedSci, BMBS
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, US
Assistant Professor
Department of Anesthesia and Pain Management
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Nasir Hussain, MD, MSc
Department of Anesthesiology
The Ohio State University
Wexner Medical Center
Columbus, OH, USA
Robert H. Jenkinson, MD
Peter Huynh, MD
Assistant Professor
Department of Anesthesiology
University of Utah
Salt Lake City, UT, USA
Benjamin M. Hyers, MD
Theodore Jeske, DO
Department of Anesthesiology, Perioperative and
Pain Medicine
Icahn School of Medicine at Mount Sinai Hospital
New York, NY, USA
Department of Anesthesiology
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Federico Jimenez-Ruiz, MD
Department of Anesthesiology
University of Minnesota
Minneapolis, MN, USA
Bilga Iana, MD
Department of Anesthesia and Pain Management
Cook County Health and Hospital System
Chicago, IL, USA
Courtney R. Jones, MD
Rowaa Ibrahim, MD
Department of Anesthesiology, Pain Management, and
Perioperative Medicine
Henry Ford Health Systems
Detroit, MI, USA
Assistant Professor
Department of Anesthesiology
University of Cincinnati
Cincinnati, OH, USA
Todd Everett Jones, MD
Department of Anesthesiology
Division of Cardiothoracic Anesthesia
University of Florida College of Medicine
Gainesville, FL, USA
Mary J. Im, MD, MPH
Clinical Assistant Professor
Department of Anesthesiology, Perioperative, and
Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Claire Joseph, DO
Attending Anesthesiologist
Department of Anesthesiology, Perioperative Medicine
and Pain Management; Division of Cardiac
Anesthesia
Maimonides Medical Center
Brooklyn, New York, USA
Shuchi Jain, DO
Department of Anesthesiology
Henry Ford Health System
Detroit, MI, USA
Dominika James, MD
Associate Professor of Anesthesiology and Pain Medicine
Department of Anesthesiology
University of North Carolina at Chapel Hill
Chapel Hill, NC, USA
Maryam Jowza, MD
Associate Professor
Department of Anesthesiology
University of North Carolina at Chapel Hill
Chapel Hill, NC, USA
x x vi • Con t r i bu tor s
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David Jury, MD, MS
Ashley Kelley, MD
Staff Intensivist and Anesthesiologist, Clinical Assistant
Professor, CCLCM
Department of Intensive Care and Resuscitation, Anesthesia
Institute
Cleveland Clinic
Cleveland, OH, USA
Assistant Professor
Department of Pediatric Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Jacob Justinger, MD
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center/ Case
Western Reserve University
Cleveland, OH, USA
Sahel Keshavarzi, MD
Anesthesiologist
Department of Anesthesiology
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
John K. Kim, MD
Attending Anesthesiologist
Department of Anesthesiology
North Shore University Hospital
Manhasset, NY, USA
Ihab Kamel, MD, MEHP, FASA
Professor, Vice Chair for Education
Department of Anesthesiology
Temple University
Philadelphia, PA, USA
Roy Kim, MD
Katarina Kapisoda, MD
Department of Anesthesiology
University of Central Florida/HCA GME Consortium,
Orlando
Ocala Health Florida
Ocala, FL, USA
Daniel Gonzalez Kapp, PharmD, BCOP, BCPS
UW Health
Madison, WI, USA
Rami Edward Karroum, MD
Staff Anesthesiologist, Clinical Assistant Professor
Department of Pediatric Anesthesia
Akron Children’s Hospital
Akron, OH, USA
Assistant Professor
Department of Anesthesiology and Pain Medicine
University of Wisconsin
Madison, WI, USA
Jonathan W. Klein, DO, FAOCA, DAOBA
Pediatric and Congenital Cardiac Anesthesiologist
Department of Anesthesia and Pain Medicine
Akron Children’s Hospital
Akron, OH, USA
Vice-Chairman of the American Osteopathic Board of
Anesthesiology
Adjunct Clinical Assistant Professor of Anesthesiology
Ohio University Heritage College of Osteopathic Medicine
Clinical Assistant Professor of Surgery, NEOMED
Department of Anesthesia and Pain Medicine
Lisa Klesius, MD
Michael Kaufman, MD, FASA
Assistant Clinical Professor and Interim Chair, Director of
Transplant Anesthesia
Department of Anesthesiology and Interventional Pain
Management
Lahey Hospital and Medical Center
Burlington, MA, USA
Alan D. Kaye, MD, PhD
Provost, Vice Chancellor of Academic Affairs, Chief
Academic Officer, Professor, Director
Anesthesiology and Pharmacology, Toxicology, and
Neurosciences
Louisiana State University Health Sciences Center
Shreveport, LA, USA
Assistant Professor
Department of Anesthesiology
University of Wisconsin Hospital and Clinics
Madison, WI, USA
Benjamin Kloesel, MD, MSBS
Assistant Professor
Department of Anesthesiology
University of Minnesota
Minneapolis, MN, USA
Nebojsa Nick Knezevic, MD, PhD
Vice Chair for Research and Education
Department of Anesthesiology Pain Management
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Con t r i bu tor s • x x vii
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Steven Knoblock, CRNA
Alina Lazar, MD
Nurse Anesthetist
Department of Anesthesia
Henry Ford Health System
Detroit, MI, USA
Assistant Professor
Department of Anesthesia and Critical Care
University of Chicago
Chicago, IL, USA
Ryan Krebs, DO
Evan E. Lebovitz, MD, MBA
Henry Ford Health System
Detroit, MI, USA
Assistant Professor
Department of Anesthesiology and Perioperative Medicine
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Elizabeth Kremen, MBBS
Department of Anesthesiology
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Albert Lee, MD
Anesthesiology Critical Care Medicine Physician
Department of Anesthesiology and Perioperative Medicine
UCLA
Los Angeles, CA, USA
Dinesh J. Kurian, MD, MBA
Assistant Professor
Department of Anesthesia and Critical Care
University of Chicago
Chicago, IL, USA
Ethan H. Leer, MD
Assistant Professor
Department of Anesthesiology
Westchester Medical Center
Valhalla, New York, USA
Donnie Laborde, DC, FACO
American Heart Association Instructor
Shreveport, LA, USA
Gretchen A. Lemmink, MD
School of Medicine
Louisiana State University School of Medicine in
New Orleans
New Orleans, LA, USA
Assistant Professor of Anesthesiology and Critical Care
Medicine
Department of Anesthesiology
University of Cincinnati College of Medicine
Cincinnati, OH, USA
Peter Lampert, MD
Richard Lennertz, MD, PhD
Department of Anesthesiology
University of Wisconsin School of Medicine and
Public Health
Madison, WI, USA
Assistant Professor
Department of Anesthesiology
University of Wisconsin—Madison
Madison, WI, USA
Elizabeth Lange, MD
James Leonardi, MD
Assistant Professor
Department of Anesthesiology
Northwestern University Feinberg School of Medicine
Chicago, IL, USA
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Kelsey E. Lacourrege, BS, MD, MPH
Adam Lepkowsky, MD
Department of Internal Medicine
LSU Health Shreveport
Baton Rouge, LA, USA
Department of Anesthesia and Perioperative Medicine
University Hospitals Cleveland Medical Center/Case Western
Reserve University
Cleveland, OH, USA
Itamar Latin, MD
Lora B. Levin, MD
Clinical Assistant Professor
Department of Anesthesiology
Western Michigan University
Kalamazoo, MI, USA
Chief, Obstetric Anesthesia
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Dustin Latimer, MD
x x viii • Con t r i bu tor s
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Samuel Linares, MD
Kim Mauer, MD
Department of Anesthesiology and Pain Management
Cook County Health Systems
Chicago, IL, USA
Anesthesiology
Department of Anesthesiology
Oregon Health and Science University
Portland, OR, USA
Zhe Ma, MD
Department of Anesthesiology, Perioperative and
Pain Medicine
Icahn School of Medicine at Mount Sinai Hospital
New York, NY, USA
Joseph J. McComb, DO, MBA
Vice Chair, Quality and Performance Improvement
Department of Anesthesiology
Temple University School of Medicine
Philadelphia, PA, USA
Sarah Maben, MD
Matthew McConnell, MD
Staff Intensivist and Anesthesiologist
Department of Anesthesiology
Lahey Hospital and Medical Center
Burlington, MA, USA
Department of Anesthesiology
Allegheny General Hospital
Allegheny Health Network
Pittsburgh, PA, USA
Sohail K. Mahboobi, MD, FASA
Assistant Clinical Professor
Department of Anesthesiology and Interventional Pain
Management
Lahey Hospital and Medical Center
Burlington, MA, USA
Megan Rodgers McCormick, DO
Ashok Kumar, MD
Lauren McGinty, PharmD, BCOP
Anesthesiologist
Department of Anesthesiology
University at Buffalo
Buffalo, NY, USA
Clinical Hematology and Oncology Pharmacist
Department of Pharmacy
UW Health—University Hospital
Madison, WI, USA
Mollie K. Lagrew, MD
Roneisha McLendon, MD, MS
Department of Internal Medicine
University of Florida College of Medicine
Gainesville, FL, USA
Obstetric Anesthesiologist, Associate Program Director
Department of Anesthesiology
Ochsner Health
New Orleans, LA, USA
Physician, Pediatric Anesthesiologist
Department of Anesthesiology and Perioperative Medicine
Rainbow Babies and Children’s Hospital
Cleveland, OH, USA
Neisaliz Marrero-Figueroa, MD
Department of Anesthesiology
University of Central Florida/HCA GME Consortium, Orlando
Ocala Health, FL, USA
Hannah Masters, MD
Anesthesiology
Medical College of Wisconsin Affiliated Hospitals
Milwaukee, WI, USA
Michelle McMaster, BSN, MD
Associate Professor
Department of Anesthesiology
Lewis Katz School of Medicine
Philadelphia, PA, USA
Connor McNamara, MD, MS
Allegheny Health Network
Pittsburgh, PA, USA
Assistant Professor, Critical Care Anesthesiology; Program
Director, Critical Care Anesthesiology
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
John Mattimore, MD
Maggie W. Mechlin, MD
Staff Anesthesiologist
Department of Anesthesiology and Interventional Pain
Management
Lahey Hospital and Medical Center
Burlington, MA, USA
Assistant Professor
Department of Anesthesiology
University of Cincinnati College of Medicine
Cincinnati, OH, USA
David Matteson, MD, MS
Con t r i bu tor s • x x i x
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Justin Merkow, MD
Rotem Naftalovich, MD, MBA
Assistant Professor
Department of Anesthesia
University of Colorado
Denver, CO, USA
Assistant Professor, Head of Neurosurgical Anesthesia
Department of Anesthesiology
Rutgers, New Jersey Medical School
Newark, NJ, USA
Daniella Miele, DO
Ruzanna Nalbandyan, MD
Adjunct Assistant Professor
Department of Anesthesiology
Temple University Hospital
Philadelphia, PA, USA
Anesthesiologist
Department of Anesthesiology
Grand Strand Medical Center
Myrtle Beach, SC, USA
Steven Minear, MD
Syed Sohaib Nasim, MD
Associate Professor
Department of Anesthesia
Cleveland Clinic Florida
Reston, FL, USA
Department of Anesthesiology
Cleveland Clinic Florida
Weston, FL, USA
Ned F. Nasr, MD
Asif Neil Mohammed, MD
Assistant Professor
Department of Anesthesiology
University of Miami
Coral Gables, FL, USA
Vice Chairman
Department of Anesthesiology and Pain Management
Cook County Health and Hospital Systems
Chicago, IL, USA
Harsh Nathani, MBChB
Sarah Money, MD
Associate Professor
Department of Pain Division
Henry Ford Health System
Detroiy, MI, USA
Gina Montone, MD
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Cook County Health Systems
Chicago, IL, USA
Ryan Nazemian, MD, PhD
PhD candidate in Clinical Translational Science
program
Anesthesiology and Preoperative Medicine
University Hospitals Cleveland Medical Center/Case
Western Reserve University
Case Western Reserve University
Cleveland, OH, USA
Benjamin B. G. Mori, MD
Department of Anesthesia
Cool County Health
Chicago, IL, USA
Michael Morkos, MD
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Anna Moskal
Department of Anesthesiology
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Maria E. Munoz-Allen, MD
Associate Professor Clinical Anesthesia
Department of Anesthesiology
Temple University Hospital
Philadelphia, PA, USA
Greta Nemergut, PharmD
Clinical Pharmacist
UW Health Department of Pharmacy
University of Wisconsin Hospital and Clinics
Madison, WI, USA
Patrick Newman, MD
Assistant Professor
Department of Anesthesiology
University of Mississippi Medical Center
Jackson, MI, USA
Wendy Nguyen, MD, M Ed
Assistant Professor
Department of Anesthesiology
University of Minnesota Medical School
Minneapolis, MN, USA
x x x • Con t r i bu tor s
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Peter Nielson, MD
Peter Papapetrou, MD
Clinical Associate
Department of Anesthesiology
Lahey Hospital and Medical Center
Burlington, MA, USA
Physician
Department of Anesthesiology and Interventional
Pain Management
Altru Health System
Grand Forks, ND, USA
Edward Noguera, MD
Lahey Clinic
Anesthesiologist/Intensivist
Medical Director SICU/CVICU
Cleveland Clinic Florida
Weston, FL, USA
Helen Pappas, MD, FASA
Bryan Noorda, MD
Marisa Pappas, MD
Anesthesia Residency
Allegheny Health Network
Pittsburgh, PA, USA
Cardiac Anesthesiologist
Department of Anesthesiology
VA
New Orleans, LA, USA
Assistant Professor
Department of Anesthesiology
Northwestern University Feinberg School of Medicine
Chicago, IL, USA
Adambeke Nwozuzu, MD, MHS
Department of Anesthesiology
University of Central Florida/HCA GME Consortium,
Orlando
Ocala Health, Florida
Ocala, FL, USA
Daniel Ramirez Parga, MD
Department of Anesthesiology
Children’s Hospital at Montefiore
Bronx, NY, USA
Snigdha Parikh, DO
Devin O’Conor, MD
Department of Anesthesiology
Icahn School of Medicine at Mount Sinai Hospital
New York, NY, USA
Department of Anesthesiology, Pain Management, and
Perioperative Medicine
Henry Ford Health System
Detroit, MI, USA
Justin L. O’Farrell, BS
Nicholas M. Parker, PharmD, RPh, CNSC
School of Medicine
University of the Incarnate Word School of Osteopathic
Medicine
San Antonio, TX, USA
Clinical Pharmacist
Surgery and Surgical Nutrition Support
UW Health
Madison, WI, USA
Shelley Ohliger, MD
Nimesh Patel, MD, BSc (Hons)
Assistant Professor
Department of Anesthesiology
University Hospitals/Rainbow Babies & Children’s Hospital
Cleveland, OH, USA
Department of Anesthesiology, Pain Management and
Perioperative Medicine
Henry Ford Health System
Detroit,MI, USA
Barbara Orlando, MD, PhD
Priyanka H. Patel, DO
OB Anesthesia Attending
St. Luke’s and Mount Sinai West Hospitals
New York, NY, USA
Department of Anesthesiology
Allegheny General Hospital
Allegheny Health Network
Pittsburgh, PA, USA
Feroz Osmani, MD
Icahn School of Medicine at Mount Sinai Hospital
New York, NY, USA
Robert M. Owen, MD
Icahn School of Medicine at Mount Sinai Hospital
New York, NY, USA
Ravi Patel, MD
Department of Anesthesiology
University of Miami Hospital and Jackson Memorial
Hospital
Miami, FL, USA
Con t r i bu tor s • x x x i
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Elisha Peterson, MD, FAAP, FASA
Shobana Rajan, MD
Assistant Professor
Division of Anesthesiology, Pain, and Perioperative Medicine
Children’s National Hospital
Washington, DC, USA
Anesthesiology Institute
Allegheny Health Network
Pittsburgh, PA, USA
Maria F. Ramirez, MD
Andrew Pfaff, MD
Assistant Professor
Department of Anesthesiology and Perioperative Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX, USA
Physician
Department of Anesthesiology
Ascension St. Vincent
Evansville,IN, USA
Adnan Raslan, MD
Bethany Potere, MD, MSc
Department of Anesthesiology
Emory University School of Medicine
Atlanta, GA, USA
Department of Anesthesiology
Ohio State University
Columbus, Ohio, USA
Harsh Rawal, MD
Amit Prabhakar, MD, MS
Academic Hospitalist
Department of Internal Medicine
University of Connecticut
Hartford, CT, USA
Assistant Professor
Department of Anesthesiology
Division of Critical Care
Emory University School of Medicine
Atlanta, GA, USA
Dmitry Roberman, DO
Monica Prasad, B.S in Biochemical Engineering
Medical Doctor
Wayne State University School of Medicine
Detroit, MI, USA
Anesthesiologist
Department of Anesthesiology
Temple University Health System
Philadelphia, PA, USA
Hess Robertson, MD
Keth Pride, MD
Assistant Professor
Department of Anesthesiology
University of Mississippi Medical School
Jackson, MS, USA
Associate Professor
Department of Anesthesiology, Chronic Pain
University of Wisconsin hospital and clinics
Madison, WI, USA
Marc Rodrigue, DO
Sangini Punia, MBBS
Department of Anesthesiology
Allegheny Health Network
Pittsburgh, PA, USA
Clinical Assistant Professor
Department of Anesthesia
University of Iowa Health Care
Carver College of Medicine
Iowa City, IA, USA
Evgeny Romanov, MD
Lahey Clinic
Burlington, MA, USA
Nawal E. Ragheb-Mueller, DO, PhD, MPH, FASA
Attending Physician
Department of Anesthesiology and Pain Medicine
Cook County Hospital and Health Systems
Chicago, IL, USA
Vincent Roth, MD
Abed Rahman, MD
Alexander Rothkrug, MD
Cook County Health and Hospitals System
Chicago, IL, USA
Clinical Associate
Department of Anesthesiology and Interventional
Pain Medicine
Lahey Hospital and Medical Center
Burlington, MA, USA
Syed A. Rahman, MD
Department of Anesthesiology and Pain management
John H Stroger hospital of Cook County Health Systems
Chicago, IL, USA
Department of Anesthesiology
University of Southern California
Los Angeles, CA, USA
x x x ii • Con t r i bu tor s
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Miguel Rovira, MD
Binoy Samuel, MD
Department of Anesthesiology
University of Florida
Gainesville, FL, USA
Department of Anesthesia and Pain Management
Cook County Health and Hospital Systems
Chicago, IL, USA
Kasia Rubin,MD, MBA
Joseph Sanders, MD
Associate Professor
Department of Anesthesiology
Cleveland Clinic Lerner College of Medicine of Case Western
Reserve University
Cleveland, OH, USA
Program Director Adult Cardiothoracic Anesthesiology
Department of Anesthesiology
Henry Ford Health System
Detroit, MI, USA
Lisgelia Santana, MD, FAAP
Anesh Rugnath, MD
Associate Professor
Department of Anesthesiology
University of Mississippi Medical Center
Jackson, MS, USA
Timothy Rushmer, MD
Department of Anesthesiology
University of Wisconsin School of Medicine and
Public Health
Madison, WI, USA
Ramsey Saad, MD
Anesthesiology
Department of Anesthesiology
Henry Ford Health System
Detroit, MI, USA
Director of Pediatric Pain Management
Pediatric Anesthesiologist
Department of Anesthesiology
Nemours Children’s Hospital
Associate Professor
University of Central Florida College of Medicine
Orlando, FL, USA
Syena Sarrafpour, MD
Beth Israel Deaconess Medical Center
Department of Anesthesia, Critical Care, and Pain Medicine
Harvard Medical School
Boston, MA, USA
James Schiffenhaus, MD
Department of Anesthesiology
Rutgers, New Jersey, Medical School
Newark, NJ, USA
Samiya L. Saklayen, MD
Assistant Professor
Department of Anesthesiology
The Ohio State University
Columbus, OH, USA
Elizabeth Scholzen, MD, MHA
Wael Ali Sakr Esa, MD, PhD, MBA, FASA
Kristopher M. Schroeder, MD, FASA
Section Head Orthopedic Anesthesia
Department of General Anesthesia
Cleveland Clinic Foundation
Cleveland, OH, USA
Professor
Department of Anesthesiology
University of Wisconsin School of Medicine and Public Health
Madison, WI, USA
Irim Salik, MD
Nathan Schulman, MD
Associate Professor of Anesthesiology/ Associate
Program Director
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Assistant Clinical Professor
UCLA Department of Anesthesiology and Perioperative
Medicine
Los Angeles, CA, USA
Department of Anesthesiology
University of Wisconsin Hospital and Clinics
Madison, WI, USA
Courtney L. Scott, MD
Sabrina S. Sam, MD
Cook County Health Systems
Chicago, IL, USA
UCLA Department of Anesthesiology and Perioperative
Medicine
David Geffen School of Medicine at UCLA
Los Angeles, CA, USA
Con t r i bu tor s • x x x iii
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Nitin Sekhri, MD
Balram Sharma, MD
Medical Director of Pain Management
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Assistant Professor
Department of Anesthesiology
Lahey Hospital and Medical Center
Burlington, MA, USA
Breethaa Janani Selvamani, MBBS
Surangama Sharma, MD
Department of Anesthesia
University of Iowa Hospitals
Iowa City, IA, USA
Clinical Assistant Professor
Department of Anesthesia
University of Iowa Health Care
Iowa City, IA, USA
Anuj A. Shah, MD, DO
Department of Physical Medicine and Rehabilitation
Rehabilitation Institute of Michigan (Detroit Medical Center)
Detroit, MI, USA
Peter Shehata, DO, MA
Department of Anesthesiology
Cleveland Clinic Foundation
Cleveland, OH, USA
Jarna Shah, MD
Assistant Professor
Department of Anesthesiology
University of Arkansas for Medical Sciences
Little Rock, AR, USA
Suleman Sheikh, DO
Manan Nimish Shah, MD
John S. Shin, MD
Anesthesiologist
Department of Anesthesia and Perioperative Care
Rutgers University
Newark, NJ, USA
Assistant Clinical Professor
Department of Anesthesiology and Perioperative
Medicine
David Geffen School of Medicine at UCLA
Los Angeles, CA, USA
Department of Anesthesiology
University at Buffalo
Buffalo, NY, USA
Nimit K. Shah, MBBS, FRCA, FCARCSI, DA,
DNB, EDAIC, EDRA
Mo Shirur, MD
Department of Anesthesiology, Perioperative and
Pain Medicine
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Department of Anesthesiology
Cook County Health and Hospitals System
Chicago, IL, USA
Sadiq S. Shaik, MD
Assistant Anesthesiology Professor
University of Central Florida College of Medicine
Pediatric Anesthesiologist
Nemours Children’s Hospital
Orlando, FL, USA
Shahla Siddiqui, MD, DABA, MSc, FCCM
Department of Anesthesia, Critical Care, and
Pain Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MA, USA
Victoria Shapiro, DO
Brett Simmons, MD, MS
Clinical Assistant Professor
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Allegheny Health Network
Pittsburgh, PA, USA
Jamie W. Sinton, MD
Archit Sharma, MD, MBA,FASA
Associate Professor
Department of Anesthesia
University of Iowa Hospitals Carver College of Medicine
Iowa City, IA, USA
Assistant Professor
Department of Anesthesiology, Perioperative and
Pain Medicine
Baylor College of Medicine
Houston, TX, USA
x x x iv • Con t r i bu tor s
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Eellan Sivanesan, MD
Felipe F. Suero, MD, FASA
Assistant Professor
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins University - School of Medicine
Baltimore, MD, USA
Assistant Professor
Department of Anesthesia
Temple-North Campus (FCCC/JEANES H.), TEMPLE
Philadelphia, PA, USA
Sarah C. Smith, MD
Kim Sung, MD
Assistant Professor
Department of Anesthesiology
Westchester Medical Center
New York Medical College
Valhalla, NY, USA
Physician, Cardiothoracic Anesthesiologist
Department of Anesthesia
University of Iowa Hospitals and Clinic
Iowa City, IA, USA
Erika Taco, MD
Iwan Sofjan, MD
Department of Anesthesiology
Henry Ford Health System
Detroit, MI, US
Assistant Professor
Department of Anesthesiology
Westchester Medical Center
Valhalla, NY, USA
Racha Tadros, MD, MSc
Mahad Sohail
Department of Anesthesiology and Critical Care Medicine
Beth Israel Deaconess Medical Center
Boston, MA, USA
Department of Anesthesiology
The Ohio State University
Wexner Medical Center
Columbus, OH, USA
Colby B. Tanner, MD
Jacqueline Sohn, DO
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Assistant Clinical Professor
Department of Anesthesiology and Perioperative Medicine
UCLA Health
Los Angeles, CA, USA
Kevin Spencer, MD
Pritee Tarwade, MD
Anesthesiologist
Henry Ford Health System
Mayo Clinic
Department of Anesthesiology–Critical Care
Rochester, MN, USA
Christina Stachur, MD, MPH
Assistant Professor
Department of Anesthesiology and Perioperative Medicine
University Hospitals Cleveland Medical Center
Cleveland, OH, USA
Camila Teixeira, MD
Clinical Researcher
Department of Anesthesiology
Cleveland Clinic Florida
Weston, FL, USA
Scott Stayner, MD, PhD
Surgery Center Medical Director
Department of Pain Medicine
Nura Pain Clinics
Minneapolis, MN, USA
Richard Tennant
Department of Anesthesiology
University of Wisconsin School of Medicine and
Public Health
Madison, WI, USA
Mark L. Stram, MD
Clinical Assistant Professor
Department of Anesthesiology
University of Wisconsin School of Medicine and
Public Health
Madison, WI, USA
Jordan Thompson, MD
Department of Anesthesiology
University of Florida College of Medicine
Gainesville, FL, USA
Dillon Tinevez, MD
Charlotte Streetzel
Department of Anesthesiology
University of Florida College of Medicine
Gainesville, FL, USA
Department of Anesthesiology
Advocate Illinois Masonic Medical Center
Chicago, IL, USA
Con t r i bu tor s • x x x v
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Gabriella Tom Williams, MD
Kevin E. Vorenkamp, MD, FASA
Department of Anesthesiology
University of Florida
Gainesville, FL, USA
Chief, Division of Pain Medicine
Department of Anesthesiology
Duke University
Durham, NC, USA
Kenneth S. Toth, MD
Anureet Walia, MD
Cook County Health and Hospital Systems
Chicago, IL, USA
Assistant Professor
Department of Anesthesia
University of Iowa Hospitals and Clinics Carver College of
Medicine
Iowa City, Iowa, USA
Jay Trusheim, MD
Department of Anesthesia
Ochsner Health System
New Orleans, LA, USA
Matt Warth, BS
Mitchell H. Tsai, MD, MMM, FASA, FAACD
Professor
Department of Anesthesiology
Department of Orthopaedics and Rehabilitation (by courtesy)
Department of Surgery (by courtesy)
University of Vermont Larner College of Medicine
Burlington, VT, USA
Georgia State University
Lawrenceville, GA, USA
Cassandra Wasson, DO
Anesthesiology
Medical College of Wisconsin
Milwaukee, WI, USA
Luis Tueme, MD
Stacey Watt, MD, MBA, FASA
Assistant Professor
Department of Anesthesiology
UT Health and Science Center at San Antonio
San Antonio, IL, USA
Clinical Professor and Anesthesiology Residency Program
Director
Department of Anesthesiology
University at Buffalo
Buffalo, NY, USA
Anna Tzonkov, MD
Tristan E. Weaver, MD
Attending Anesthesiologist
Department of Anesthesiology
Cook County Health
Chicago, IL, USA
Assistant Professor
Department of Anesthesiology
The Ohio State University
Wexner Medical Center
Columbus, OH, USA
James Urness, MD
Department of Anesthesiology
Henry Ford Hospital
Detroit, MI, USA
Corinne K. Wong, MD
Department of Anesthesiology
United Anesthesia Services
Bryn Mawr, PA, USA
Ifomachukwu Uzodinma, MD
Anesthesiologist and Pain Medicine Physician
Department of Anesthesiology and Pain Management
Cook County Health and Hospital Systems
Chicago, IL, USA
Caylynn Yao, MD
Department of Anesthesiology
MedStar Georgetown University Hospital
Washington, DC, USA
Karel T. S. Valenta, MD
Department of Anesthesiology and Pain Management
Cook County Health and Hospital Systems
Chicago, IL, USA
Bharathram Vasudevan, MBBS, MD
Peter Yi, MD, MSEd
Assistant Professor
Department of Anesthesiology and Critical Care
Duke University
Durham, NC, USA
Department of Anesthesiology
Cook County Health and Hospital Systems
Chicago, IL, USA
x x x vi • Con t r i bu tor s
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Joshua D. Younger, MD
Sherif Zaky, MD, MSc, PhD
Associate Chief, Division of Obstetric Anesthesia
Department of Anesthesiology, Pain Management, and
Perioperative Medicine
Henry Ford Health System
Detroit, MI, USA
Associate Professor and Medical Director
Department of Anesthesiology and Pain Management
Ohio University- Firelands Health System
Westlake, OH, USA
Eric P. Zhou, MD
Christine S. Zaky, MS
M.D. Candidate
Stritch School of Medicine, Loyola University Chicago
Westlake, OH, USA
Department of Biological Sciences
University of Pittsburgh
Pittsburgh, PA, USA
Department of Anesthesiology, Critical Care and Pain Medicine
Boston Children’s Hospital, Harvard Medical School
Boston, MA, USA
Steven Zhou, BA, MD
Clinical Instructor House Staff
Department of Anesthesiology
The Ohio State University
Columbus, OH, USA
Con t r i bu tor s • x x x vii
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Part 1
MONITOR ING METHODS
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1.
VASCULAR PR ESSUR ES
Amit Prabhakar and Adnan Raslan
i n t roDuC t ion
pressure monitoring in order to help increase accuracy and
prevent end-organ damage. Invasive monitoring involves arterial cannulation with a catheter, which is then connected
to a fluid-filled and pressurized tubing system. The catheter
senses the dynamic changes in blood flow. This mechanical
energy is then converted into an electrical signal, which is
then displayed as a waveform on a monitor.1
The most common vascular pressures include arterial
blood pressure, central venous pressure (CVP), pulmonary pressures, and left ventricular end-diastolic pressure
(LVEDP). This chapter reviews the fundamentals of these
aforementioned vascular pressures and the clinical relevance of each.
C e n t r A L V e nous Pr e s s u r e
A rt e r i A L b L o oD Pr e s s u r e
Central venous pressure is an invasive vascular pressure
measured most commonly by cannulation of the subclavian
vein, internal jugular vein, or femoral vein. CVP is used to
measure right atrial pressure and approximate right heart
function. The ideal catheter position is at the cavoatrial
junction. The catheter is connected to a pressurized, fluidfilled system that converts the mechanical energy from
dynamic blood flow to an electrical impulse. This impulse
is then converted to a tracing displayed on a monitor. As
seen in Figure 1.1, the CVP waveform is broken down into
three positive deflections (a, c, and v waves) and two negative slopes (x and y descents). The waves correspond with
atrial contraction, tricuspid valve closure, and right atrial
filling, respectively. The x descent corresponds to atrial relaxation, and the y descent corresponds to early ventricular
filling with diastolic relaxation. The normal range of CVP
is between 0 and 10 mm Hg and ideally measured at the
level of the tricuspid valve.
Fluctuations in blood pressure can result in systemic
malperfusion and subsequently result in end-organ damage.
Arterial blood pressure measurements are the foundation of
systemic blood pressure calculations and can be derived by
either noninvasive or invasive methods. It is imperative for
clinicians practicing in the perioperative space to understand the intricacies of the different measuring techniques.
Intermittent noninvasive blood pressure monitoring is done
by inflating a pneumatic cuff, which first occludes arterial
blood flow and then slowly deflates until blood flow resumes.1
Noninvasive techniques are most commonly performed
via the automated oscillometric method; however, the
manual auscultatory method may still be used in certain
clinical situations. The manual auscultatory method involves
auscultation of the Korotkoff sounds as the pneumatic cuff is
deflated to distinguish both the systolic and diastolic blood
pressures. The automated oscillometric method involves a
computer that analyzes the oscillations of the artery as the
cuff is deflated. Rapidly increasing oscillations represent
the systolic blood pressure, while the diastolic blood pressure is represented by rapidly decreasing oscillations.1,2 The
mean arterial pressure (MAP) is identified as the point of
maximum oscillations. The most common sites for noninvasive blood pressure monitoring include the arms and legs.
Normal systolic and diastolic blood pressure ranges are 120–
140 and 60–80 mm Hg, respectively.
Clinical scenarios in which there are significant
perturbations in arterial pressure warrant invasive blood
Pu L Mon A rY A rt e rY Pr e s s u r e
Pulmonary artery pressure (PAP) is an invasive measurement
that is most commonly facilitated by central venous cannulation with a catheter in the pulmonary artery. Similar to
systemic arterial blood pressure, PAP includes both systolic
and diastolic components predicated by the different stages
of cardiac contraction. A normal value for systolic PAP is
15–25 mm Hg, and the normal diastolic PAP is 8–12 mm
3
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EKG
a
CVP
Figure 1.1
c
x
v
y
a wave
End Diastole
RA contraction
c wave
Early Systole
TV cusps bulge into RA
x descent
Mid Systole
RA relaxation
v wave
Late Systole
Rapid filling of RA
y descent
Early Diastole
Early ventricular filling
Central venous pressure tracing and interpretation. RA, right atrium; TV, tricuspid valve.
Hg. The placement of a pulmonary artery catheter (PAC)
is facilitated by an inflatable balloon and also has several
orifices to facilitate blood draws. PACs are most often used
to guide intravascular resuscitation and facilitate serial hemodynamic monitoring throughout the perioperative period for major vascular or cardiothoracic surgeries.
Pu L Mon A rY C A Pi L L A rY
W e D g e Pr e s s u r e
Pulmonary capillary wedge pressure (PCWP), also known
as pulmonary artery occlusion pressure, is used as an indirect measurement of left atrial pressure. It is measured
by advancing a PAC into the distal pulmonary vasculature and inflating the balloon at the end of the catheter,
thus occluding vascular flow. The lack of forward pulmonary blood flow allows for left atrial pressure calculations.
PCWP can be used to characterize the severity of left-sided
cardiac function and differentiate potentially confounding
cardiopulmonary pathologies. A normal PCWP ranges between 6 and 12 mm Hg.3 In a patient with a right-to-left
shunt, it is better to use CO2 to inflate the balloon as it is
safer if the balloon ruptures. For accurate measurement, the
PAC should be placed in zone 3.
L e F t V e n t r iC u L A r e n D Di A s toL iC Pr e s s u r e
Left ventricular end-diastolic pressure is the pressure in
the left ventricle at the end of diastole immediately before
contraction. This invasive measurement is most commonly
obtained during cardiac catheterization. LVEDP measurement is dependent on both intravascular volume status and
left ventricular compliance. Thus, it is a helpful marker to
identify and quantitate the severity of left ventricular systolic or diastolic dysfunction. LVEDP, left ventricle ejection fraction, and systemic blood pressure are among the
strongest predictors of morbidity and mortality in regard
to ischemic heart disease, cardiac surgery, and left heart
catheterization.4
A n e s t h e t iC C on s i De r At ion s
A RT E R I A L PR E S S U R E S
The accuracy of noninvasive arterial measurements may
be limited by certain clinical features, such as prior lymph
node dissection, presence of preexisting vascular access,
patient movement, significant atherosclerotic disease, and
body habitus. 2 It is imperative that the appropriate cuff
size is used to ensure accuracy. A cuff that is either too
small or too large can result in an overestimation or underestimation, respectively. Potential complications of
noninvasive arterial measurements include neuropathic
pressure injury, paresthesia, compartment syndrome, and
thrombophlebitis. 2
Invasive arterial blood pressure measurement via an arterial line allows for continuous blood pressure monitoring
during longer surgeries with the potential for significant hemodynamic fluctuations. The most common sites for cannulation include the radial, brachial, axillary, and femoral
arteries. Complications associated with invasive arterial
lines include infection, distal ischemia, nerve injury, hematoma formation, vasospasm, and thrombosis.5 An Allen
test can be used prior to radial artery cannulation to assess
the adequacy of collateral circulation in the hand; however,
there are conflicting views on its ability to reliably predict
ischemic injury.
C E N T R A L V E NOUS PR E S S U R E
Elevations in CVP can be seen in patients with heart failure
due to poor contractility, tricuspid regurgitation, and pulmonary artery stenosis. These pathologies lead to poor forward flow and venous congestion. Decreases in CVP can
occur in the setting of decreased venous return, such as hypovolemia or vasodilation.
PU L MON A RY A RT E RY PR E S S U R E
A number of disease processes can affect pulmonary circulation and lead to increases in the pulmonary vascular
pressures, ultimately affecting the function of the right
4 • Mon itor i ng M et hoDs
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