Kaplan's Cardiac Anesthesia: In Cardiac and Noncardiac Surgery, 7e

 

Description:

Now in a revised and expanded 7th Edition, Kaplan’s Cardiac Anesthesia helps you optimize perioperative outcomes for patients undergoing both cardiac and noncardiac surgery.

Dr.

Joel L.

Kaplan, along with associate editors, Drs.

John G.

T.

Augoustides, David L.

Reich, and Gerard R.

Manecke, guide you through today’s clinical challenges, including the newest approaches to perioperative assessment and management, state-of-the art diagnostic techniques, and cardiovascular and coronary physiology.

Complete coverage of echocardiography and current monitoring techniques.

Guidance from today’s leaders in cardiac anesthesia, helping you avoid complications and ensure maximum patient safety.

More than 800 full-color illustrations.

A new section on anesthetic management of the cardiac patient undergoing noncardiac surgery.

New availability as an eBook download for use the in OR.

Online-only features, including quarterly updates, an ECG atlas.

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an increased number of videos, including 2-D and 3-D TEE techniques in real time.

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and an Annual Year End Highlight from the Journal of Cardiovascular Anesthesia that’s posted each February.

 

 

Table of Contents:

 

A Textbook for All Anesthesiologists

Video Contents

Section I Preoperative Assessment and Management

1 Assessment of Cardiac Risk and the Cardiology Consultation

 Sources of Perioperative Myocardial Injury in Cardiac Surgery

 Assessment of Perioperative Myocardial Injury in Cardiac Surgery

 Cardiac Risk Assessment and Cardiac Risk Stratification Models in Patients Undergoing Cardiac Surgery

 Specific Risk Conditions

 Assessment of Cardiac Risk in Patients Undergoing Noncardiac Surgery

 Conclusions

References

2 Cardiovascular Imaging

 Echocardiography

 Myocardial Nuclear Scintigraphy

 Cardiac Computed Tomography

 Cardiovascular Magnetic Resonance Imaging

 Invasive Coronary Angiography

 Vascular Imaging

 Summary

References

3 Cardiac Catheterization Laboratory

 Catheterization Laboratory Facilities: Radiation Safety and Image Acquisition

 Patient Selection for Catheterization

 Cardiac Catheterization Procedures

 Valvular Pathology

 Angiography

 Interventional Cardiology: Percutaneous Coronary Intervention

 Specific Interventional Devices

 Other Catheter-Based Percutaneous Therapies

 Other Catheter-Based Intracardiac Procedures

 The Catheterization Laboratory and the Anesthesiologist

References

4 Cardiac Electrophysiology

 Electrophysiologic Principles

 Specific Arrhythmias

 Ventricular Arrhythmias

 Implantable Cardioverter-Defibrillators

References

5 Cardiac Implantable Electrical Devices

 Radiology Imaging Issues

 Pacemakers

 Implantable Cardioverter-Defibrillators

 Summary

 Glossary

 Cautions

References

Section II Cardiovascular Physiology, Pharmacology, Molecular Biology, and Genetics

6 Cardiac Physiology

 Functional Implications of Gross Anatomy

 Cardiac Myocyte Anatomy and Function

 Laplace's Law

 The Cardiac Cycle

 Determinants of Pump Performance

 Coupling, Energetics, and Efficiency

 Evaluation of Diastolic Function

 Pericardial Forces

 Determinants of Atrial Function

References

7 Coronary Physiology and Atherosclerosis

 Anatomy and Physiology of Blood Vessels

 Determinants of Coronary Blood Flow

 Coronary Pressure-Flow Relations

 Atherosclerosis

 Pathophysiology of Coronary Blood Flow

 Future Directions

References

8 Molecular and Genetic Cardiovascular Medicine

 Machinery Behind the Cardiac Rhythm: Ion Channels

 Controlling Cardiac Functioning: Receptors

 Anesthetic Actions

 Genetic Cardiovascular Medicine

 Acknowledgments

References

9 Systemic Inflammation

 Terminology

 Systemic Inflammation and Cardiac Surgical Procedures

 Endotoxemia

 Splanchnic Perfusion

 Postoperative Complications Attributable to Inflammation

 Summary

References

10 Pharmacology of Anesthetic Drugs

 Volatile Agents

 Intravenous Induction Agents

 Individual Agents

 Opioids in Cardiac Anesthesia

 Effects of Cardiopulmonary Bypass on Pharmacokinetics and Pharmacodynamics

 Acknowledgments

References

11 Cardiovascular Pharmacology

 Antiischemic Drug Therapy

 Drug Therapy for Systemic Hypertension

 Pharmacotherapy for Acute and Chronic Heart Failure

 Pharmacotherapy for Cardiac Arrhythmias

References

Section III Monitoring

12 Electrocardiographic Monitoring

 Historical Perspective

 Basic Electrophysiology and Electrical Anatomy of the Heart

 Electrocardiographic Changes With Myocardial Ischemia

 Electrocardiographic Changes With Pacemakers, Respirations, Electrolytes, and Medications

 Normal Electrocardiogram: Cardiac Cycle

 Atrial Fibrillation

 Atrial Flutter

 Atrioventricular Block

 Atrioventricular Dissociation

 Bundle Branch Block

 Coronary Artery Disease

 Digitalis Effect

 Electrolyte Disturbances

 Hypothermia

 Multifocal Atrial Tachycardia

 Paroxysmal Atrial Tachycardia

 Pericarditis

 Pericardial Tamponade

 Pneumothorax

 Premature Atrial Contraction

 Premature Ventricular Contraction

 Pulmonary Embolus

 Sinus Bradycardia

 Sinus Arrhythmia

 Sinus Arrest

 Sinus Tachycardia

 Subarachnoid Hemorrhage

 Torsades de Pointes

 Ventricular Fibrillation

 Ventricular Tachycardia

 Wolff-Parkinson-White Syndrome

 Pacing

 Acknowledgments

Bibliography

References

13 Monitoring of the Heart and Vascular System

 Hemodynamic Monitoring

 Arterial Pressure Monitoring

 Central Venous Pressure Monitoring

 Pulmonary Arterial Pressure Monitoring

 Special Purpose Pulmonary Artery Catheters

 Cardiac Output Monitoring

 Left Atrial Pressure Monitoring

 Coronary Sinus Catheterization

 Analysis and Interpretation of Hemodynamic Data

 Pulse Oximetry

 Oxygen Transport Calculations

 Summary

References

14 Basic Intraoperative Transesophageal Echocardiography

 Basic Concepts

 Imaging Techniques

 Echocardiographic Scanners

 Equipment

 Image Storage

 Complications

 Safety Guidelines and Contraindications

 Credentialing

 Technique of Probe Passage

 Comprehensive Intraoperative Multiplane Transesophageal Echocardiographic Examination

 Clinical Applications

 Hemodynamic Assessment

 Cardiac Output

 Contrast Applications

 Valvular Evaluation

 Myocardial Ischemia Monitoring

References

15 Transesophageal Echocardiography

 The Development of a Perioperative Echocardiography Service

 Three-Dimensional Transesophageal Echocardiography

 Perioperative Echocardiographic Evaluation of Valves

 Transesophageal Echocardiography for Interventional Procedures

 Strain, Strain Rate, and Doppler Tissue Imaging

 Myocardial Disease

 Aortic Evaluation

 Pericardial Disease

 Evaluation of Cardiac Masses

References

16 Decision Making and Perioperative Transesophageal Echocardiography

 Decision-Making Process

 Myxomatous Degeneration of the Mitral Valve and Mitral Regurgitation

 Management of Ischemic Mitral Regurgitation During Coronary Artery Bypass Grafting

 Functional Mitral Regurgitation in the Setting of Aortic Stenosis

 Management of Previously Undiagnosed Aortic Valve Disease

 Cardiac Function and New Regional Wall Motion Abnormalities

 Transesophageal Echocardiography as a Rescue Device: Management of Marked Hemodynamic Instability

 Pericardial Effusion and Cardiac Tamponade

 Occult Congenital Abnormalities: Persistent Left-Sided Superior Vena Cava

 Occult Congenital Abnormalities: Atrial Septal Defects and Patent Foramen Ovale

 Ascending Aorta: A Source of Embolization

 Case Study 2: Putting It All Together: A Case Study in Acute Aortic Syndromes

References

17 Education and Simulation in Echocardiography

 Early Development

 Commercialization

 Online Learning

 Simulating Pathologic Conditions

 Evidence for Simulation

 Assessment

 Future of Echocardiography Education

References

18 Central Nervous System Monitoring

 Electroencephalography

 Auditory-Evoked Potentials

 Transcranial Doppler Ultrasound

 Jugular Bulb Oximetry

 Cerebral Oximetry

 Multimodality Neuromonitoring

 Summary

 Disclosure and Acknowledgment

References

19 Coagulation Monitoring

 Hemostasis

 Monitoring Heparin Effect

 Heparin Neutralization

 Tests of Coagulation

 Monitoring Fibrinolysis

 Monitoring the Thrombin Inhibitors

 Evaluation of Prolonged Activated Partial Thromboplastin Time

 Monitoring Platelet Function

 Bedside Coagulation and Platelet Function Testing

 Summary

References

Section IV Anesthesia for Cardiac Surgical Procedures

20 Anesthesia for Myocardial Revascularization

 Epidemiology

 Pathophysiology of Coronary Artery Disease

 Risk Assessment in Patients Scheduled for Coronary Artery Bypass Grafting

 Anesthesia for Coronary Artery Bypass Grafting

 Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass

 Minimally Invasive Coronary Artery Surgery

 Conclusions

References

21 Valvular Heart Disease

 Pathophysiology

 Aortic Stenosis

 Hypertrophic Cardiomyopathy

 Aortic Regurgitation

 Mitral Regurgitation

 Mitral Stenosis

 Tricuspid Regurgitation

 Innovations in Valve Repair

 New Techniques for Mitral Valve Repair

 Case Study 1: Transapical Aortic Valve Implantation

 Case Study 2: Robotically Assisted Mitral Valve Repair

 Case Study 3: Mitral Valve Repair With Systolic Anterior Motion After Bypass Needing Additional Repair

References

22 Congenital Heart Disease in Adults

 Noncardiac Surgery in Adults With Congenital Heart Disease

 General Noncardiac Issues With Longstanding Congenital Heart Disease

 Cardiac Issues

 Case Study 1: Atrial Septal Defect

 Case Study 2: Anomalous Left Main Coronary Artery

References

23 Thoracic Aorta

 Anatomy of the Aorta

 General Considerations for the Perioperative Care of Aortic Surgical Patients

 Thoracic Aortic Aneurysm

 Aortic Dissection

 Penetrating Atherosclerotic Ulcer

 Traumatic Aortic Injury

 Aortic Atheromatous Disease

 Takayasu Arteritis

 Aortic Coarctation

 Illustrative Transesophageal Echocardiography Cases

References

24 Uncommon Cardiac Diseases

 Cardiac Tumors

 Cardiomyopathy

 Mitral Valve Prolapse

 Patent Foramen Ovale

 Pulmonary Hemorrhage

 Pericardial Heart Disease

 Combined Carotid and Coronary Artery Disease

 Coronary Arteriovenous Fistula

 Cardiac Surgery During Pregnancy

 Risks of Human Immunodeficiency Virus Transmission

 Renal Insufficiency and Cardiac Surgery

 Hematologic Problems in Patients Undergoing Cardiac Surgery

 Acknowledgments

References

25 Anesthesia for Heart, Lung, and Heart-Lung Transplantation

 Heart Transplantation

 Lung Transplantation

 Heart-Lung Transplantation

References

26 Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

 Classification of Pulmonary Hypertension

 Pathophysiology

 Clinical Manifestations

 Diagnostic Evaluation

 Operation

 Anesthetic Management of Patients Undergoing Pulmonary Thromboendarterectomy

 Management of the Postoperative Patient

 Nonsurgical Approach to Chronic Thromboembolic Disease

 Intraoperative Echocardiography in Patients With Chronic Thromboembolic Pulmonary Hypertension

 Pulmonary Thromboendarterectomy in Patients With Sickle Cell Disease

 Outcome and Future of Chronic Thromboembolic Pulmonary Hypertension

References

27 Procedures in the Hybrid Operating Room

Procedures

Miscellaneous Procedures

References

28 Mechanical Assist Devices for Heart Failure

 The Current Era of Mechanical Circulatory Support

 Mechanical Circulatory Support: Theory and Practice

 Short-Term Support

 Long-Term Support

 Complications of Mechanical Circulatory Support

 Total Artificial Hearts

 Perioperative Anesthetic Considerations for VAD Support

 Potential Effects of LVAD Support on Right Ventricular Function

 Anesthetic Considerations for SynCardia Total Artificial Heart Implantation

 Conclusion

References

29 Reoperative Cardiac Surgery

 Reoperative Cardiac Surgery

 Emergency Reexploration

References

30 Patient Safety in the Cardiac Operating Room

 The Science of Safety

 Human Error

 Teamwork and Communication

 Interventions to Improve Patient Safety

 Medication Safety

 Reducing System Vulnerability

 Culture of Safety

References

Section V Extracorporeal Circulation

31 Cardiopulmonary Bypass Management and Organ Protection

 Historical Perspective on Cardiopulmonary Bypass

 Goals and Mechanics of Cardiopulmonary Bypass

 Physiologic Parameters of Cardiopulmonary Bypass

 End-Organ Effects of Cardiopulmonary Bypass

 Central Nervous System Injury

 Acute Kidney Injury

 Myocardial Injury

 Gastrointestinal Complications

 Lung Injury During Cardiac Surgery

 Management of Bypass

 Initiation and Discontinuation of Bypass Support: An Overview

 Perfusion Emergencies

 Special Patient Populations

 Minimally Invasive Surgery and Cardiopulmonary Bypass

References

32 Extracorporeal Devices and Related Technologies

 Mechanical Devices

 Electronic Perfusion Records

 Extracorporeal Circuitry

 Cardioplegia Delivery

 The Heart-Lung Machine Priming Solutions

 Coated Circuits

 Perfusion Practices

 Methods of Extracorporeal Circulation

 Summary

References

33 Extracorporeal Membrane Oxygenation

 History, Evolution, and Current Status of ECMO

 ECMO Physiology and Gas Exchange

 Management of Venoarterial ECMO

 Management of Venovenous ECMO

 Expanded Indications for Venovenous ECMO

 Anticoagulation for ECMO

 Complications in ECMO

 Summary

References

34 Blood and Fluid Management During Cardiac Surgery

 Transfusion Guidelines

 Blood Groups and Transfusion

 Genetic Causes of Hemorrhage

 Bleeding After Cardiac Surgery

 Replacement Therapy

 Lowest Hematocrit on Cardiopulmonary Bypass

 Conclusions

References

35 Transfusion Medicine and Coagulation Disorders

 Overview of Hemostasis

 Heparin

 Alternative Modes of Anticoagulation

 Protamine

 Bleeding Patient

References

36 Discontinuing Cardiopulmonary Bypass

 General Preparations

 Preparing the Lungs

 Preparing the Heart

 Final Considerations and Preparations

 Routine Weaning From Cardiopulmonary Bypass

 Pharmacologic Management of Ventricular Dysfunction

 Intraaortic Balloon Pump Counterpulsation

References

Section VI Postoperative Care

37 Fast-Track Postoperative Cardiac Recovery and Outcomes

 Fast-Track Cardiac Surgical Care

 Initial Management of Patients in Fast-Track Cardiac Anesthesia: The First 24 Hours

 Management of Postoperative Complications

References

38 Postoperative Cardiovascular Management

 Oxygen Transport

 Temperature

 Assessment of the Circulation

 Postoperative Myocardial Dysfunction

 Postoperative Myocardial Ischemia

 Therapeutic Interventions

 Postoperative Hypertension

 Postoperative Vasodilation

 Coronary Artery Spasm

 Decreased Contractility

 Right-Sided Heart Failure

 Cardiac Tamponade

 Transplanted Heart

 Advances in Cardiovascular Surgery and Postoperative Management

References

39 Postoperative Respiratory Care

 Risk Factors for Respiratory Insufficiency

 Additional Therapy in Patients With Acute Lung Injury or Acute Respiratory Distress Syndrome

 Impediments to Weaning and Extubation

 Modes of Ventilator Support

 Liberation From Mechanical Support (Weaning)

 Conclusions

References

40 Central Nervous System Dysfunction After Cardiopulmonary Bypass

 Categorization of Central Nervous System Injury

 Neuropsychologic Dysfunction

 Mechanisms of Brain Injury

 Cerebral Blood Flow

 Cardiopulmonary Bypass Equipment

 Cerebroprotective Strategies

 Procedural Risk

 Minimal Access Surgery and Circulatory Support

References

41 Long-Term Complications and Management

 Infections After Cardiac Surgery

 Acute Kidney Injury

 Nutritional Support

 Complications of Transcatheter Aortic Valve Replacement

 Complications of Minimally Invasive Cardiac Surgery

 Complications of Mechanical Assist Devices

 Patient and Family Support, Palliative Care, and End-of-Life Issues

References

42 Postoperative Pain Management for the Cardiac Patient

 Pain and Cardiac Surgery

 Potential Clinical Benefits of Adequate Postoperative Analgesia

 Techniques Available for Postoperative Analgesia

 Local Anesthetic Infiltration

 Nerve Blocks

 Opioids

 Patient-Controlled Analgesia

 Nonsteroidal Antiinflammatory Agents

 Alpha2-Adrenergic Agonists

 Intrathecal and Epidural Techniques

 Multimodal Analgesia

 How Important Is Postoperative Pain After Cardiac Surgery?

 Conclusions

References

Section VII The Cardiac Patient for Noncardiac Surgery

43 Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery

 Preoperative Cardiac Assessment: Categorizing Risk

 Preoperative Cardiac Assessment: Risk Model Calculators

 Perioperative Cardiac Assessment: Algorithmic Approach

 Management of Perioperative Anemia

 Pulmonary Vascular Disease and Right Ventricular Dysfunction

 Summary

References

44 The Patient With Coronary Stents Undergoing Noncardiac Surgery

 Optimal Stenting Technique

 Types of Stents

 Vascular and Biologic Response to Stent Placement

 Antiplatelet Therapy

 Long-Term Antiplatelet Management

 Noncardiac Surgery and Coronary Stents

 An Integrated Approach

References

45 Ventricular Assist Devices, Cardiac Transplants, and Implanted Electrical Devices in Noncardiac Surgery

 Ventricular Assist Devices

 Anesthesia for Noncardiac Surgery After Heart Transplantation

 Cardiovascular Implantable Electronic Device Management in Noncardiac Surgery

References

46 Echocardiography in Noncardiac Surgery

 Rescue Echocardiography

 Transesophageal Echocardiography as a Monitor in Noncardiac Surgical Procedures

 Transthoracic Echocardiography

 Conclusion

References

47 Goal-Directed Fluid Therapy, Enhanced Recovery, and the Perioperative Surgical Home for Cardiac Patients in Noncardiac Surgery

 Goal-Directed Fluid Therapy

 Enhanced Recovery

 Perioperative Surgical Home

References

48 Vascular Surgery

 General Considerations in Perioperative Management for Vascular Surgery

 Carotid Artery and Cerebrovascular Disease

 Abdominal Aortic Disease

 Lower Extremity Arterial Disease

References

49 The Cardiac Patient for Thoracic Noncardiac Surgery

 Anesthetic Management for Pulmonary Resection in the Patient With Cardiac Disease

 Lung Isolation for Cardiac Patients Having Thoracic Procedures

 Management of One-Lung Ventilation

 Transesophageal Echocardiography for Noncardiac Thoracic Surgery

 Airway Surgery

 Pulmonary Hemorrhage

 Mediastinal Masses

 Vascular Anomalies With Airway Compression

References

50 The Pregnant Patient With Cardiac Disease

 Diagnosis of Heart Disease During Pregnancy

 Cardiac Risk Stratification During Pregnancy

 Pregnancy and Cardiac Disease

 Management of Labor and Delivery in Women With Cardiac Disease

 Noncardiac Surgical Procedures During Pregnancy in Women With Cardiac Disease

 Peripartum Cardiomyopathy

 Advanced Cardiac Life Support in the Pregnant Woman

References

51 Critical Care Medicine in the Operating Room

 Perioperative Triage

 Neurologic System

 Cardiovascular System

 Pulmonary System

 Hematology

 Sepsis

References

52 Perioperative Care to Reduce Major Adverse Cardiac Events and Mortality in Noncardiac Surgical Procedures

 Perioperative Myocardial Infarction or Injury

 Medications and Percutaneous Interventions to Prevent and Treat Perioperative Major Adverse Cardiac Events

 Treatment of Perioperative Myocardial Infarction

 Perioperative Care to Reduce Mortality Rates in Noncardiac Surgical Procedures

References

Index