Oxford american handbook of anesthesiology

A

OXFORD MEDICAL PUBLICATIONS

Oxford American Handbook of

Anesthesiology

i



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Published and forthcoming Oxford American Handbooks
Oxford American Handbook of Clinical Medicine
Oxford American Handbook of Anesthesiology
Oxford American Handbook of Clinical Dentistry
Oxford American Handbook of Clinical Surgery
Oxford American Handbook of Critical Care
Oxford American Handbook of Emergency Medicine
Oxford American Handbook of ENT and Head and Neck Surgery
Oxford American Handbook of Nephrology and Hypertension
Oxford American Handbook of Obstetrics and Gynecology
Oxford American Handbook of Pediatrics
Oxford American Handbook of Psychiatry
Oxford American Handbook of Respiratory Medicine

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Oxford American
Handbook of

Anesthesiology
Patrick M. McQuillan

Professor, Anesthesiology and Pediatrics
Department of Anesthesia
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
Hershey, Pennsylvania

With

Keith G. Allman

Consultant Anaesthetist
Royal Devon and Exeter Healthcare
NHS Trust, UK

Iain H. Wilson

Consultant Anaesthetist

Royal Devon and Exeter Healthcare
NHS Trust, UK

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A

Great Clarendon Street, Oxford OX2 6DP
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Oxford is a registered trademark of Oxford University Press
in the UK and in certain other countries.
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press, 2008
The moral rights of the authors have been asserted.

Database right, Oxford University Press (maker).
First published 2008
All rights reserved. No part of this publication may be reproduced,
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without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
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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 book in any other binding or cover
and you must impose the same condition on any acquirer.
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging in Publication Data
McQuillan, Patrick M.
Oxford American handbook of anesthesiology / Patrick M. McQuillan;
with Keith G. Allman, Iain H. Wilson.
p. ; cm.
Adapted from: Oxford handbook of anaesthesia / edited by Keith G.
Allman and Iain H. Wilson. 2nd ed. 2006.
Includes bibliographical references and index.
ISBN-13: 978–0–19–530120–5 (alk. paper)
1. Anesthesiology—Handbooks, manuals, etc.
[DNLM: 1. Anesthesia—methods—Handbooks. 2. Anesthetics—Handbooks.
3. Surgical Procedures, Operative—Handbooks. WO 39 M4787o 2008]
I. Title: Handbook of anesthesiology. II. Allman, Keith. III. Wilson, Iain, Dr.
IV. Oxford handbook of anaesthesia. V. Title.
RD82.2.M42 2008
617.9’6—dc22
2007043122

Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India
Printed in China
on acid-free paper by
Phoenix Offset
ISBN 978–0–19–530120–5 (flexicover)
10 9 8 7 6 5 4 3 2 1
Oxford University Press makes no representation, express or implied, that the drug dosages in this
book are correct. Readers must therefore always check the product information and clinical
procedures with the most up-to-date published product information and data sheets provided by
the manufacturers and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the text or for the
misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and
recommendations are for the non-pregnant adult who is not breast-feeding.

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Preface
The first edition of the Oxford Handbook of Anaesthesia was released in
the United Kingdom in 2000. The handbook proved popular in many
countries throughout the world and low cost editions were made available
in several developing countries. The handbook was found to be a practical
guide to anesthesia providing concise and readily available information
and advice for many common problems encountered in clinical practice.

In 2006 the editors and Oxford University Press decided to release an
American edition. Americanizing a principally international text involves
much more than merely changing the ae’s and oe’s to e, and the common
expressions used in the UK to those more familiar in the United States.
Although anesthesia practice is remarkably similar around the world,
there are distinct differences. Every attempt was made to update and
adapt recommendations, guidelines, and references of primarily UK organizations and councils to their American counterparts such as the changes
made in the Difficult Airway Algorithm, ACLS, and PALS. Drugs and drug
formularies vary widely throughout the world. Again, every attempt was
made to include only those drugs available in the United States.
Much of anesthesia practice is personal preference and, as we know,
there are many ways to do things right. Thus, readers will find that what
is reflected in many of the chapters is relative to the author’s own preferences. Examples include the choice of induction agents, narcotics (such
as alfentanil or remifentanil) vasodilators, ionotropes, and vasopressors.
In those instances a variety of options have been included in the text.
In addition to the chapters on preoperative assessment and specific
anesthesia techniques, readers will find Chapter 42 of interest. It includes
a variety of anesthesia data. This chapter provides, in one convenient
location, information on physiologic testing, equations, normal values, and
useful web sites that frequently are difficult to locate and require reviewing
a variety of sources.
I hope you will find this edition a valuable addition to your clinical
practice and please note that any omissions or errors are solely my
responsibility.
Best regards,
Patrick M. McQuillan, MD
2007

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Acknowledgments
This edition would not be possible without, and I am particularly grateful
for, the expert editorial assistance of the team at the Oxford University
Press in New York, the guidance and counsel of Keith Allman and Iain
Wilson, and the exceptional proofreading skills of Angela Amin, MD,
Steven Rath, MD, and Roger Williams, MD, whom I am sure will have
long and productive careers, hopefully in academic anesthesiology.
I would like to thank the following individuals for their contributions:
Barry Baker, Anna Batchelor, Mark Bellamy, Simon Berg, Colin Berry,
Hannah Blanshard, Andrew Bodenham, Bruce Campbell, John Carlisle,
Tracey Clayton, David Conn, Tim Cook, Julius Cranshaw, Adrian Dashfield, Peter Davies, John Dean, James Eldridge, Rhys Evans, Andrew
Farmery, Simon Galloway, Richard Griffiths, Carl Gwinnutt, Jane Halsall,
Mark Hamilton, Jeffrey Handel, Paul Harvey, Graham Hocking, Kath
Jenkins, Gavin Kenny, Bruce McCormick, Andrew McIndoe, Alexander
Manara, Paul Marshall, Alan Merry, Quentin Milner, Julia Munn, Peter
Murphy, Monty Mythen, Barry Nicholls, Richard Nickalls, Jerry Nolan,

Aidan O'Donnell, Jonathan Purday, Fred Roberts, Anne Rossiter, Matt
Rucklidge, John Saddler, David Sanders, Babinder Sandhar, Robert Self,
Peter Shirley, Paul Sice, Michael Sinclair, Mark Stoneham, James
Szymankiewicz, Richard Telford, Stephen Townley, Anne Troy, David
Walker, Jon Warwick, Gavin Werrett, Ralph Worms, and Gordon Yuill.
My personal thanks are also extended to Julien F. Biebuyck, MD, PhD
for his inspiration and encouragement to follow an academic anesthesia
career, Berend Mets, MBChB, PhD, FRCA, FFASA for his personal guidance and mentorship, all of my anesthesia and surgical colleagues who
make it a pleasure to come to work every day, our patients whose health
is improved by our efforts, and, foremost, my wife and family who unselfishly share their time with my profession.
Patrick M. McQuillan, MD

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Contents

Symbols and abbreviations xiii
Preoperative Assessment and
Preparation for Anesthesia
1 General Considerations

1

2 Consent and Anesthetic Risk

17

3 Cardiovascular Disease

43

4 Perioperative Arrhythmias

83

5 Respiratory Disease

99

6 Renal Disease

129

7 Hepatic Disease

139

8 Endocrine and Metabolic Disease

155

9 Bone, Joint, and Connective Tissue Disorders

193

10 Hematological Disorders

205

11 Neurological and Muscular Disorders

237

12 Psychiatric Disorders and Drugs

275

13 Uncommon Conditions

291

Anesthesia for Surgical Specialties
14 Cardiac Surgery

329

15 Thoracic Surgery

367

16 Neurosurgery

401

17 Vascular Surgery

439

18 Orthopedic Surgery

463

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1CONTENTS

19

Plastic Surgery

515

20

General Surgery

537

21

Liver Transplantation and Resection

563

22

Endocrine Surgery

575

23

Urological Surgery

587

24

Gynecological Surgery

611

25

Ear, Nose, and Throat Surgery

629

26

Maxillofacial and Dental Surgery

659

27

Ophthalmic Surgery

673

28

Same-Day Surgery

695

29

Laser Surgery

703

30

CT and MRI Imaging

709

31

Anesthesia for the Elderly

719

Obstetric Anesthesia and Analgesia
32

Obstetric Anesthesia and Analgesia

727

Pediatric and Neonatal Anesthesia
33

Pediatric and Neonatal Anesthesia

793

Anesthetic Emergencies

34

The Critically Ill Patient

853

35

Anesthetic Emergencies

897

Practical Anesthesia
36

Airway Assessment and Management

961

37

Common Issues in Anesthesia

995

38

Blood Products and Fluid Therapy

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1CONTENTS 1

xi

Acute Pain
39

Acute Pain

1065

40

Postoperative Nausea and Vomiting

1089

Regional Anesthesia
41

Regional Anesthesia

1097

42

Anesthesia Data

1149

Index 1177

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Symbols and abbreviations
AAA
AADR
AAS
ABC
ABG
ACE
ACT

ACTH
ADH
AF
AFOI
AICD
AIDS
ALS
ALT
ANH
AP
APL
APTR
APTT
AR
ARDS
ARF
AS
ASA
ASD
ASRA
AST
ATLS
ATP
AV

abdominal aortic aneurysm
anesthetic adverse drug reactions
atlantoaxial sublimation
airway, breathing, circulation
arterial blood gas

angiotensin-converting enzyme
activated clotting time
adrenocorticotrophic hormone
antidiuretic hormone
atrial fibrillation
awake fiber optic intubation
automatic implantable cardioverter defibrillator
acquired immunodeficiency syndrome
advanced life support
alanine aminotransferase
acute normovolemic hemodilution
anteroposterior
adjustable pressure limiting (valve)
activated partial thromboplastin ratio
activated partial thromboplastin time
aortic regurgitation
acute respiratory distress syndrome
acute renal failure
aortic stenosis
American Society of Anesthesiologists
atrial septal defect
American Society of Regional Anesthesia and Pain Medicine
aspartate transaminase
advanced trauma life support
adenosine triphosphate
atrioventricular

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1SYMBOLS AND ABBREVIATIONS

AVM
AVSD
BBV
bid
BiPAP
BLS
BMI
BP
bpm
BSS
BURP
C&S
CABG
CBC
CBF
CC
CCU
CHD
CHF
Ch
CICV
CJD

CK
CMV
CNS
COAD
COETT
COHb
COPA
COPD
COX
CPAP
CPB
CPDA
CPK
CPP

arteriovenous malformation
atrioventricular septal defect
blood borne virus
twice daily (bis diem)
biphasic positive airways pressure
basic life support
body mass index
blood pressure
beats per minute
balanced salt solution
backward upward and rightwards pressure
culture and sensitivity
coronary arterial bypass graft
complete blood count
cerebral blood flow

creatinine clearance
coronary care unit
congenital heart disease
congestive heart failure
Charrère (French) gauge (also FG or Fr)
can’t intubate, can’t ventilate
Creutzfeldt–Jacob disease
creatine kinase
cytomegalovirus
central nervous system
chronic obstructive airway disease
cuffed oral endotracheal tube
carboxyhemoglobin
cuffed oropharyngeal airway
chronic obstructive pulmonary disease
cyclo-oxygenase
continuous positive airway pressure
cardiopulmonary bypass
citrate phosphate dextrose adenine
creatine (phospho) kinase
cerebral perfusion pressure

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1SYMBOLS AND ABBREVIATIONS 1

CPR

CPX
CRF
CRP
CSE
CSF
CT
CVA
CVE
CVP
CVS
CXR
DCR
DDAVP
DIC
DLT
DMARD
DVT
ECF
ECG
ECM
ECT
EDD
EEG
EF
EMD
EMG
EMLA
ENT
EPO
ERCP

ERPC
ESR
ETCO2
ETT/ET
EUA

cardiopulmonary resuscitation
cardiopulmonary exercise testing
chronic renal failure
C-reactive protein
combined spinal/epidural
cerebrospinal fluid
computed tomogaphy
cerebrovascular accident
cerebrovascular episode/event
central venous pressure
cardiovascular system
chest X-ray
dacrocystorhinostomy
Desmopressin
disseminated intravascular coagulation
double-lumen [endobronchial] tube
disease modifying antirheumatoid drug
deep vein thrombosis
extracellular fluid
electrocardiogram
external cardiac massage
electroconvulsive therapy
estimated date of delivery
electroencephalogram

ejection fraction
electromechanical dissociation
electromyograph
eutectic mixture of local anesthetic
ear, nose, and throat
erythropoietin
endoscopic retrograde cholangio-pancreatography
evacuation of retained products of conception
erythrocyte sedimentation rate
end tidal carbon dioxide
endotracheal tube
examination under anesthesia

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1SYMBOLS AND ABBREVIATIONS

FB
foreign body
FES
fat embolism syndrome
FEV1
forced expiration in 1 s

FFP
fresh frozen plasma
FG
French gauge (also Fr or Ch)
FGF
fresh gas flow
FiO2
fractional inspired oxygen content
FLMA
flexible laryngeal mask airway
FM
face mask
Fr
French gauge (also FG or Ch)
FRC
functional residual capacity
FTSG
full thickness skin graft
FVC
forced vital capacity
G
Gauge (standard wire gauge)
G-6-PD
glucose-6-phosphate dehydrogenase
GA
general anesthetic
GCS
Glasgow coma score
GEB
gum elastic bougie

GFR
glomerular filtration rate
GI(T)
gastrointestinal (tract)
GU
gentourinary
HAS
human albumin solution
HbC/HbD/
hemoglobin C/D/F/S
HbF/HbS
HBV/HCV hepatitis B/C virus
Hct
hematocrit
HELLP
hemolysis, elevated liver enzymes, low platelets
HES
hydroxyethyl starches
HFO
high-frequency oscillation
HIB
Hemophilus influenze B
HIT
heparin-induced thrombocytopenia
HME
heat and moisture exchanger
HOCM

hypertrophic obstructive cardiomyopathy

HR

heart rate

HRT
hs

hormone replacement therapy
hours of sleep

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1SYMBOLS AND ABBREVIATIONS 1

I:E ratio

inspired:expired ratio

IABP
ICP
ICU
ID
IDDM
IDT
IHD
ILMA
IM

IMC

intra-aortic balloon pump
intracranial pressure
intensive care unit
internal diameter
insulin-dependent diabetes mellitus
intradermal testing
ischemic heart disease
intubating laryngeal mask airway
intramuscular
intermediate care unit

INR

international normalized ratio

IO
IOP
IPPV
ICU
ITP
IV
IVC
IVCT
IVH
IVI
IVRA
JVP
LA

LCNT
LFT
LMA

intra-osseous
intraocular pressure
intermittent positive pressure ventilation
intensive care unit
idiopathic thrombocytopenic purpura
intravenous(ly)
inferior vena cava
in vitro muscle contracture test
intraventricular hemorrhage
intravenous infusion
intravenous regional anesthesia
jugular venous pressure
local anesthetic
lateral cutaneous nerve of thigh
liver function test
laryngeal mask airway

LMWH

low-molecular-weight heparin

LP
LSCS
LSD
LV
LVEDP

LVF
LVH

lumbar puncture
lower segment Cesarean section
lysergic acid diethylamide
left ventricle/ventricular
left ventricular end diastolic pressure
left ventricular failure
left ventricular hypertrophy

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1SYMBOLS AND ABBREVIATIONS

MAC
MAO

minimum alveolar concentration
monoamine oxidase

MAOB
MAOI

MAP
MCV
MEAC
MEN
MH
MI
MIBG
MR
MRI
MRSA
MSO4
MUA
MUGA
MVA
MW
NCA
NG
NIBP
NICU
NIDDM
NIPPV
NMB
NMBD
NMDA

monoamine oxidase B
monoamine oxidase inhibitor
mean arterial pressure
mean corpuscular volume
minimum effective analgesic concentration

multiple endocrine neoplasia
malignant hyperthermia
myocardial infarction
meta-iodobenzylguanidine
mitral regurgitation
magnetic resonance imaging
methicillin-resistant Staphylococcus aureus
morphine sulphate (for text only)
manipulation under anesthesia
multigated acquisition scan
motor vehicle accident
molecular weight
nurse-controlled analgesia
nasogastric
noninvasive blood pressure
neonatal intensive care unit
noninsulin-dependent diabetes mellitus
noninvasive positive pressure ventilation
neuromuscular blockade
neuromuscular blocking drugs
N-methyl-D-aspartate

NPO

non per os (nothing by mouth)

NR
NSAID
NTG
OCP

OLEM
OLV
OR

not recommended
nonsteroidal anti-inflammatory drug
nitroglycerine
oral contraceptive pill
optimal laryngeal external manipulation
one-lung ventilation
operating room

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1SYMBOLS AND ABBREVIATIONS 1

ORIF
OSA
P–v O2
PA
PAC
PACU
PaCO2
PaO2
PAO2
PAOP
PAP

PAW
PAWP
PCA
PCEA
PCI
PCP
PCWP
PDA
PE
PEA
PEEP
PEFR
PEP

open reduction internal fixation
obstructive sleep apnea
mixed venous partial pressure of oxygen
pulmonary artery/arterial
pulmonary artery catheter
Post Anesthetic Care Unit
arterial partial pressure of carbon dioxide
arterial partial pressure of oxygen
alveolar partial pressure of oxygen
pulmonary artery occlusion pressure
pulmonary artery pressure
airway pressure
pulmonary artery wedge pressure
patient-controlled analgesia
patient-controlled epidural analgesia
percutaneous coronary intervention

Primary Care Physician
pulmonary capillary wedge pressure
patent ductus arteriosus
pulmonary embolism
pulseless electrical activity
positive end expiratory pressure
peak expiratory flow rate
postexposure prophylaxis

PICU

pediatric intensive care unit

PLMA

proseal laryngeal mask airway

PND
PNS
PO
PONV
POP
PR
prn/PRN
PS
PT
PTH

paroxysmal nocturnal dyspnea
peripheral nerve stimulator

per os (oral)
postoperative nausea and vomiting
plaster of paris
per rectum
as required (pro re nata)
pulmonary stenosis
prothrombin time
parathyroid hormone

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1SYMBOLS AND ABBREVIATIONS

PVC
PVR
qd
qid
RA
RAE
RAST
rEPO
RIMA
ROSC

RS
RSI
RV
rVIIa
S–v O2
SA
SAH
SaO2
SBE
SC
ScvO2
SEA
SHOT
SIADH
SIRS
SjO2
SL
SLE
SLT
SMR
SNP
SpO2
SPT
STSG
SSRI
STEMI

polyvinyl chloride
pulmonary vascular resistance
once daily (for text only)

four times daily (quater die sumendus)
rheumatoid arthritis
Ring, Adair, and Elwyn [tube]
radioallergosorbent test
recombinant erythropoietin
reversible inhibitor of monoamine oxidase A
restoration of a spontaneous circulation
respiratory system
rapid sequence induction
right ventricle/ventricular
recombinant factor VIIa
mixed venous oxygen saturation
sinoatrial
subarachnoid hemorrhage
arterial oxygen saturation
subacute bacterial endocarditis
subcutaneous
central venous oxygen saturation
spinal epidural abscess
serious hazards of transfusion
syndrome of inappropriate antidiuretic hormone
systemic inflammatory response syndrome
jugular venous oxygen saturation
sublingual
systemic lupus erythematosus
single lumen tube
submucous resection
sodium nitroprusside
peripheral oxygen saturation
skin-prick test

split thickness skin graft
selective serotonin reuptake inhibitor
ST elevation myocardial infarction

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1SYMBOLS AND ABBREVIATIONS 1

(S)TOP
SV
SVC
SVR
SVT
T&S
TB
TBSA
TBW
TCA
TCI
tid
TEDS
TEE
TEG
TENS
TFT
THR
TIA

TIPS
TIVA
TKR
TMJ
TNF
TNS
TOF
TPN
TRALI
TRAM
TTI
TTP
TURP
TUVP
UA
UPPP
URTI

(suction) termination of pregnancy
spontaneous ventilation
superior vena cava
systemic vascular resistance
supraventricular tachycardia
type and screen
tuberculosis
total body surface area
total body water
tricyclic antidepressant
target-controlled infusion
three times daily (ter die sumendus)

thromboembolism stockings
transesophageal echocardiography
thrombelastograph
transcutaneous electric nerve stimulation
thyroid function tests
total hip replacement
transient ischemic attack
transjugular intrahepatic portal-systemic shunt procedure
total intravenous anesthesia
total knee replacement
temporomandibular joint
tumor necrosis factor
transient neurologic symptom
train of four
total parenteral nutrition
transfusion-related acute lung injury
transverse rectus abdominis muscle
transfusion-transmitted infection
thrombotic thrombocytopenic purpura
transurethral resection of the prostate
transurethral vaporization of the prostate
urinalysis
uvulopalatopharyngoplasty
upper respiratory tract infection

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1SYMBOLS AND ABBREVIATIONS

V/Q
VAE
VATS
VF
VIP
VP
VR
VSD
VT
Vt or VT
VWF
WBC
WPW
X-match

ventilation/perfusion
venous air embolism
video-assisted thoracoscopic surgery
ventricular fibrillation
vasoactive intestinal peptide
venous pressure
ventricular rate
ventricular septal defect
ventricular tachycardia

tidal volume
Von Willebrand factor
white blood cell count
Wolff–Parkinson–White
crossmatch

JCAHO discourages the use of the following abbreviations in a patient
chart and recommend writing out the words listed in the right column:
AD
AS
AU
cc
DPT
OD
os
OS
OU
QD
QOD
sc or sq
u
ug
MS or MSO4
MgSO4

right ear
left ear
each ear
ml
DTaP

right eye
po
left eye
each eye
daily
every other day
subQ or subcutaneous
units
mcg
morphine or morphine sulfate
magnesium sulfate

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Chapter 1

1

General Considerations
Good Practice 2
Preoperative Testing 4
Premedication 6
Preoperative Fasting 8
Prophylaxis of Venous Thromboembolism 10
Perioperative Guidelines for Body-Piercing Jewelry 14

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