Short text book of anesthesia by ajay yadao pdf download




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SECTION 1 Fundamental Concepts


1. Applied Anatomy, Physiology and Physics

• Respiratory Physiology 3; • Foreign Body Aspiration 5; Regulation of Respiration 6; • Muscles of Respiration 6; Airway Resistance 6; • Ventilation/ Perfusion (V/Q) 6;

• Dead Space 7; • Oxygen and Carbon Dioxide in Blood 7; Abnormalities of Chest Movements 8; • Hypoxic Pulmonary Vasoconstriction 9;

• Pulmonary Function Tests 9; • Physics Related to Anesthesia 11;

• Venturi Principle 11; • Poynting Effect 11

SECTION 2 Equipment in Anesthesia 2. Anesthesia Delivery Systems (Anesthesia Machine and Circuits)

Anesthesia Machine 15

• High Pressure System 75; • Intermediate Pressure System 79; Low Pressure System 79; • Other Parts of Anesthesia Machine 22;

• Breathing Circuits 22; • Components of Closed Circuit 27;

• Checking of Anesthesia Machine and Circuits 29; Safety Features of Anesthesia Delivery Syst ems 30

3. Equipment

Equipment for Airway Management 32

Airways 32; • Facemasks 32; • AMBU Bag Resuscitator 32;

• Laryngoscopes 33; • Supraglottic Airway Devices 35;

• lnfraglottic Airway Devices 37; • Nasal Intubation 40

Other Equipment 42

• Oxygen Delivery Systems in Non-intubated Patient 42;

• Humidification Devices 43; • Static Current 43;

• Sterilization of Anesthesia Equipment 43

SECTION 3 Quintessential in Anesthesia 4. Preoperative Assessment and Premedication Preoperative Assessment 47; • Instructions 48; • Premedication 50

5. Difficult Airway Management

• Causes of Difficult Intubation/Difficult Airway 52;

• Assessment of Difficult Intubation 53; • Management 54

6. Monitoring in Anesthesia • Clinical Monitoring 57

Advance Monitoring (Instrumental Monitoring) 57

• Cardiovascular Monitoring 57; • Respiratory Monitoring 67;

• Temperature Monitoring 65; • Neuromuscular Monitoring 66;

• Central Nervous System (CNS) Monitoring 68; • Monitoring Blood Loss 69

7. Fluids and Blood Transfusion

• Fluids 77; 

• Crystalloids 77;

 • Colloids 72; 

• Fluid Management 73; 

Blood Transfusion 75; 

• Complications of Blood Transfusion 77;

• Autologous Blood Transfusion 79

SECTION 4 Introduction to Anesthesia

8. History of Anesthesia

• Nitrous Oxide 83; • Ether 83; • Chloroform 84;

• Intravenous Anesthetics 84; • Local Anesthesia 84; Muscle Relaxants 84; • Instruments 84

SECTION 5 General Anesthesia

9. Introduction to General Anesthesia • Components of General Anesthesia 87; • General Anesthesia Protocol (For a Normal Healthy Patient) 87; 

• Stages of Anesthesia 88

10. lnhalational Agents: General Principles and Individual Agents

• Classification 89; • Mechanism of Action of lnhalational Agents 89;

• Potency of lnhalational Agents 90; • Uptake and Distribution of

lnhalational Agents 90; • Augmented Inflow Effect, Concentration Effect, Second Gas Effect and Diffusion Hypoxia 97; • Systemic Effects of lnhalational Agents (including Side Effects and Toxicity) 92 Individual lnhalational Agents 94

• Nitrous Oxide 94; • Entonox 96; • Xenon 96; • Halothane 96;

• lsoflurane 98 Newer Agents 98

• Desflurane 98; • Sevoflurane 99 Agents No More in Clinical Use 100

• Enflurane 700; • Ether 700; • Methoxyflurane 102; • Cyclopropane 702;

• Trichloroethylene (Trilene) 702; • Chloroform 102 Contents

1 1. Gases Used in Anesthesia

• Oxygen 103; • Oxygen Deficiency (Hypoxia) 103; • Excessive Oxygen

(Oxygen Toxicity) 704; • Hyperbaric Oxygen 104; • Nitrous Oxide, Entonox and Xenon 105; • Nitric Oxide 705; • Air 705; • Carbon Dioxide 105;

• Helium/Heliox 105

12. Intravenous Anesthetics • Classification 106

Barbiturates 106 • Thiopentone 706; Nonbarbiturates 109

• Methohexitone 108

Propofol 109; • Etomidate 170; • Benzodiazepines 111; Ketamine 112; • Opioids 114; • Alpha 2 Adrenergic Agonists 178; Other Intravenous Anesthetics 120

13. Muscle Relaxants

• physiology of Neuromuscular Junction 722; Classification of Muscle Relaxants 124

• Neuromuscular Monitoring 723

• Depolarizing Agents 124; • Nondepolarizing Muscle Relaxants 127;

• Others 129; • Compounds Under Research 730; • Reversal of Block 131; Signs of Adequate Reversal 132; • Common Causes of Inadequate Reversal 133;

• Centrally Acting Muscle Relaxants 133

14. Perioperative Complications of General Anesthesia • Mortality 136

Respiratory Complications 136

• Hypoxia 136; • Hypercarbia 140;

• Cough/Hiccups 140

Cardiovascular Complications 140

• Hypocapnia 140;

• Hypertension 140; • Cardiac Arrhythmias 140;

• Myocardial lschemia 141; • Cardiac Arrest 141 Neurological Complications 141

• Hypotension 140;

• Convulsions 141; • Delayed Recovery 141; • Awareness (Inadequate Amnesia) 142; • Agitation, Delirium and Emergence Excitement 142;

• Postoperative Cognitive Dysfunction 142; • Permanent Brain Damage

• Cranial Nerve Palsies 142; • Extrapyramidal Side Effects 142;

• Peripheral Neuropathies 142

Gastrointestinal Complications 142

• Postoperative Nausea and Vomiting 142

Renal Complications 143 Hepatic Complications 143 Pain 143

Thermal Perturbations 143

• Hypothermia and Shivering 143; • Hyperthermia 743;

• Malignant Hyperthermia 144

Anaphylactic/ Anaphylactoid Reactions 146

Complications of Different Positions 146

• Lithotomy 146; • Trendelenburg 746; Ocular Complications 146 Fires and Electric Hazards in Operation Theater 147

• Precautions to Prevent Fire and Burns 747 Occupational Hazards 147

• Discharge Criteria from Postanesthesia Care Unit 748

• Sitting 746;

• Lateral and Prone 746

SECTION 6 Regional Anesthesia

15. Local Anesthetics Classification 751;

 • Mechanism of Action of Local Anesthetics 152; 

General Considerations in Action of Local Anesthetics 752;

 Systemic Effects and Toxicity 754; 

• Commercial Preparations 755; 

• Individual Agents 755; 

• Methods of Local Anesthesia 157; 

Causes of Failure of Local Anesthesia 758

16. Peripheral Nerve Blocks

• Technique 760; • Blocks of Upper Limb 760; • Blocks of Lower Limb 762;

• Blocks of the Head and Neck, Thoracic and Abdominal Area 762;

• Contraindications for Peripheral Nerve Blocks 763

17. Central Neuraxial Blocks (Spinal and Epidural Anesthesia)

• Applied Anatomy 764; • Advantages of Central Neuraxial Blocks (CNB) Over General Anesthesia (GA) 765; • Systemic Effects (Physiological Alterations) of Central Neuraxial Blocks 766; • Spinal Anesthesia (Subarachnoid Block, lntrathecal Block) 767; • Spinal Anesthesia in Children 173; • Saddle Block 773;

• Epidural (Extradural) Anesthesia (Also Called as Peridural Block) 774;

• Combined Spinal Epidural Anesthesia 776; • Caudal Block

(Epidural Sacral Block) 776; • Level of Block Required for Common Surgeries 779

SECTION 7 Anesthesia for Coexisting Diseases

18. Anesthesia for Cardiovascular Diseases (For Noncardiac Surgeries)

• lschemic Heart Disease 783; • Valvular Diseases 185;

• Congenital Heart Diseases 787; • Heart Failure 188; • Cardiomyopathies 188;

• Pericardia I Diseases (Constrictive Pericarditis/Cardiac Tamponade) 789; Contents •

• Considerations in Patients on Cardiac Implanted Electronic Devices (Pacemakers) 189; • Hypertension 189;

• Hypotension (Anesthesia for Shock Patients) 190

19. Anesthesia for Respiratory Diseases

• General Considerations in Management of Patient with Pulmonary Disease 192;

• Asthma 793; • Chronic Obstructive Pulmonary Disease (Chronic Bronchitis and Emphysema) 794; • Restrictive Lung Diseases 794; • Tuberculosis 194; • Respiratory Tract Infection 794;

• Operative Criteria forThoracot omy/ Pneumonectomy 795

20. Anesthesia for Central Nervous System Diseases

• Parkinson's Disease 196; • Alzheimer's Disease 196; • Epilepsy 796;

• Stroke 196; • Headache 196; • Multiple Sclerosis 197;

• Syringomyelia 797; • Amyotrophic Lateral Sclerosis 197;

• Guillain-Barre Syndrome (GBS) 197; • Autonomic Dysfunction 797;

• Spinal CordTransection 197; • Psychiatric Disorders 797

21 . Anesthesia for Hepatic Diseases

Preoperative Evaluation 799; • lntraoperative 199; • Anesthesia for Patients with Biliary Obstruction 200

22. Anesthesia for Renal Diseases and Electrolyte Imbalances

• Anesthetic Management of Patients with Renal Dysfunction 202;

• Anesthesia for Transurethral Resection of Prostate 203;

• Anesthesia for Patients with Electrolyte Imbalances 204

23. Anesthesia for Endocrinal Disorders

• Diabetes Mellitus 206; • Thyroid Dysfunctions 207; • Hypothyroidism 208;

• Adrenal Dysfunctions 208; • Pituitary Dysfunction 209

24. Anesthesia for Neuromuscular Diseases • Myasthenia Gravis 211; • Myasthenic Syndrome {Eaton-Lambert Syndrome) 212; • Familial Periodic Paralysis 272; • Muscular Dystrophies 212

25. Anesthesia for Immune Mediated and Infectious Diseases

• Rheumatoid Arthritis 214; • Ankylosing Spondylitis 214;

• Systemic Lupus Erythematosus 214; • Scleroderma 214;

• Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome 215

26. Anesthesia for Disorders of Blood

• Anemia 276; • Sickle Cell Disease 217; • Thalassemia 217;

• Polycythemia 217; • Disorders of Hemostasis 217;

• G6PD Deficiency 218; • Porphyria 218 •

SECTION 8 Subspecialty Anesthetic Management

27. Neurosurgical Anesthesia • Cerebral Physiology and Pharmacology 223; • General Considerations in Neurosurgical Patients 224; • Anesthesia for Conditions with Raised lntracranial Tension 225; • Anesthesia for Awake Craniotomies (Stereotactic Surgery) 228; • Anesthetic Management of Spine Surgeries 228

28. Anesthesia for Obstetrics 230

• Physiological Changes in Pregnancy 230; • Effect of Anesthetic Technique/ Drugs on Uteroplacental Circulation 231; • Transfer of Anesthetic Drugs to Fetal Circulation 231; • Anesthesia for Cesarean Section 231;

• Labor Analgesia (Painless Labor) 233; • Anesthesia for Manual Removal of Placenta 234; • Anesthesia for Non-obstetric Surgeries during Pregnancy 234

29. Pediatric Anesthesia  236

• Physiological/Anatomical Changes in Pediatric Population 236;

• Anesthetic Management 238; • Regional Anesthesia in Pediatric Patients 239; , Management of Neonatal Surgical Emergencies 240

30. Geriatric Anesthesia • Physiological Changes in Old Age 242;

• Anesthetic Management 242

31. Anesthesia for Obese Patients (Bariatric Anesthesia) • Preoperative Assessment 245; • lntraoperative 246;

32. Anesthesia for Laparoscopy

• Postoperative 246

• Gases for Creating Pneumoperitonium 248; • Pathophysiological Effects of Laparoscopy 248; • Complications of Laparoscopy 248;

• Anesthetic Management 250; • Contraindications for Laparoscopy 250

33. Anesthesia for Ophthalmic Surgery

• Preoperative Evaluation 252; • lntraoperative 252;

• Anesthesia 252; • General Anesthesia 253

34. Anesthesia for ENT Surgery

• Panendoscopy (Previously Called as Microlaryngeal Surgeries) 255;

• Anesthesia for Bronchoscopy 256; • Anesthesia for Adenotonsillectomy/ Tonsillectomy 256; • Anesthesia for Peritonsillar Abscess and Ludwig Angina 256; • Anesthesia for Ear Surgery 256;

• Anesthesia for Nasal Surgery 256; • Anesthesia for Parotid Surgery 257; Anesthesia for Obstructive Sleep Apnea Surgery 257; Anesthesia forTemporomandibular Joint (TMJ) Surgeries 257 Contents

35. Anesthesia for Trauma and Burns • Anesthesia for Trauma 258; • Anesthesia for Burns 260

36. Anesthesia for Orthopedics Complications of Orthopedic Surgery 262; 

• Anesthesia for Spine Surgery 264

• Choice of Anesthesia 263;

37. Anesthesia at Remote Locations

• Anesthesia at Low Barometric Pressure (High Altitude) 265;

• Anesthesia at High Pressure (in Hyperbaric Chamber) 265;

• Anesthesia Outside Operating Theater 265..................

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