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Patrick Sullivan. Ottawa Anesthesia Primer
Ottawa Anesthesia Primer. An essential primary text for medical students and residents completing a rotation in anesthesia
Inside Cover
Authors
Forward
Chapter 1. Rotational Learning Objectives
SPECIFIC KNOWLEDGE AND SKILLS OBJECTIVES (expanded from general objectives)
References:
Chapter 2. Anesthesia Overview
Anesthetic Modalities:
The Scope of Anesthetic Practice:
References:
Chapter 3. Preoperative Evaluation
History of Presenting Illness:
Anesthetic History:
Problem Identification:
Review of Systems:
Cardiovascular System:
The Respiratory System:
The Central Nervous and Musculoskeletal Systems:
The Gastrointestinal and Hepatic Systems:
The Endocrine System:
The Renal System:
The Hematologic System:
Pediatrics:
The Elderly:
Obesity:
Patients with Cancer:
Investigations:
Summative Risk and The Risk of Anesthesia:
Perioperative Risk Assessment:
ASA Physical Status Classification:
Cardiac Risk:
Current Medications and Allergies:
Physical Examination:
Preoperative Preparation:
Proposed Plan for Anesthetic Technique:
References:
Additional Resources:
Chapter 4. Premedication
Reasons for prescribing a preoperative medication:
Preoperative Medications:
General contraindications to the use of a premedication:
References:
Additional Resources:
Chapter 5. Getting Started
Preparing the OR:
Medications:
Intravenous Preparation:
Patient Safety:
Hand Hygiene:
Monitoring Procedures:
ECG Monitoring:
Intravenous Access:
Placement of the Intravenous:
Size of Intravenous Catheter:
Intravenous Insertion Technique:
Clinical Pearls of Intravenous Access:
General Anesthesia Induction:
References:
Additional resources:
Chapter 6. Intubation and Anatomy of the Airway
History:
Examination of the Upper Airway:
BONES:
The Four Step Upper Airway Examination:
1st Step: Assess Temporomandibular Joint Mobility
2nd Step: Assess Mouth Opening and Assign Mallampati Classification
3rd Step: Assess Thyromental Distance and Mandibular Protrusion
4th Step: Assess Range of Motion of the Cervical Spine
Evaluation of the Lower Airway:
A BASIC MAD POSTER
Tracheal Intubation:
I: Position the patient:
II. Open the patient’s mouth:
III. Laryngoscopy:
IV. Insertion of the ETT:
V. Confirmation of correct ETT placement:
Difficulty with Intubation:
Upper Airway Obstruction:
Complications of Laryngoscopy and Intubation:
Laryngospasm:
References:
Additional Video Resources:
Chapter 7. Intubation Decisions and Challenges
Indications for tracheal intubation:
Goals for Intubation:
Tracheal intubation:
Case I:
Management of the difficult airway:
The four levels of airway management:
Management of a difficult intubation:
Video Laryngoscopy:
Case II:
Case III:
Case IV:
Case V:
Criteria for extubation:
Additional Case Studies:
References:
URL Resources:
Additional Video Resources:
Chapter 8. The Laryngeal Mask Airway Device (LMAD)
What is the difference between a LMAD and a tracheal tube?
Does the LMAD protect the patient against gastric aspiration?
Which patients would be suitable candidates for general anesthesia with a LMAD?
Which patients are not suitable candidates for a LMAD?
How do you position a LMAD?
How do you remove the LMAD?
Other Laryngeal Mask Airway Devices:
Modifications to the Classic LMATM
Challenges encountered with insertion and positioning of a LMAD
Intubating LMADs
Exchanging a LMA for an ETT in a Patient with a Difficult Airway
Laryngeal Mask Airway Devices in Emergency Settings
References:
Additional Video Resources:
Chapter 9. Rapid Sequence Induction
The 5 Classic Components of a Rapid Sequence Induction
1. Preoxygenation
2. Cricoid pressure
3. Administration of Intravenous Anesthetics and Muscle Relaxants
4. Endotracheal Intubation
5. Confirmation of ETT Placement
Modifications to the Rapid Sequence Induction
Clinical Case
References:
Chapter 10. Monitoring in Anesthesia
What should we monitor?
Required monitoring:
I. Oxygenation:
II. Ventilation
Invasive Monitoring:
Pulmonary Artery Catheter:
New Minimally Invasive Monitors:
Echocardiography:
IV. Anesthetic Depth:
VI. Monitoring Neuromuscular Function:
VII. Urine Output Monitoring:
References:
Supplementary Resources:
Additional Video Resources:
Chapter 11. General Intravenous Anesthetic Agents
I. Basic Pharmacological Principles:
Propofol:
Propofol Dose:
Propofol Pharmacodynamics:
Ketamine:
Ketamine Pharmacodynamics:
Etomidate:
Etomidate Pharmacodynamics:
Thiopental:
Thiopental Pharmacodynamics:
III. Level of Sedation:
Sedation in the Intensive Care Unit:
Benzodiazepines:
Benzodiazepine Pharmacodynamics:
Dexmedetomidine:
Dexmedetomidine Pharmacodynamics:
References:
Reference Texts:
Chapter 12. Neuromuscular Blocking Agents
Classification:
Considerations for choosing a muscle relaxant include:
Non-Depolarizing Muscle Relaxants (NDMRs):
Mivacurium:
Cisatracurium:
Rocuronium:
Pancuronium:
D-Tubocurare:
Depolarizing Muscle Relaxants:
Physical-Chemical Properties:
Phase I and Phase II Blocks:
Plasma Cholinesterase:
Succinylcholine Pharmacodynamics:
Hyperkalemia Following Succinylcholine:
Specific Diseases:
Dosage & Administration:
Indications:
Contraindications to succinylcholine:
Reversal of Neuromuscular Blockade:
Monitoring Neuromuscular Function and Timing of Reversal:
References:
Additional Resources:
Chapter 13. Inhalational Anesthetics
Mechanism of Action:
Minimum Alveolar Concentration (MAC):
Onset of Action:
Transfer from Alveoli to Brain:
Advantages and Differences in Volatile Anesthetic Agents:
Isoflurane:
Sevoflurane:
Desflurane:
Nitrous Oxide:
Titration of Anesthetic Agents:
References:
Additional Resources:
Chapter 14. Opioid Agonists and Antagonists
Opioid Pharmacodynamics
Morphine:
Meperidine:
Oxycodone and Oxycontin:
Codeine:
Tramadol:
Hydromorphone:
Fentanyl:
Sufentanil:
Remifentanil:
Methadone:
Buprenorphine:
Opioid Antagonists:
Resources:
References:
Chapter 15. Local Anesthetics
Mechanism of Action:
Basic Structure and Classification:
Biophysical Features:
Pharmacodynamics:
Pharmacokinetics:
Clinical Application:
Local Anesthetic Formulations:
Local Anesthetic Toxicity:
Local Anesthetic Allergy:
Conclusion:
References:
Chapter 16. Regional Anesthesia
The Spectrum of Regional Anesthesia:
Topical Anesthesia:
Infiltration Anesthesia:
Intravenous Regional Anesthesia (Bier block):
Peripheral Nerve and Plexus Blocks:
Recommended Strategies to Minimize Nerve Injuries:
Neuraxial Anesthesia (Spinal & Epidural):
Neuraxial Physiology and Pharmacology:
Neuraxial Opioids:
Cardiovascular Effects of Neuraxial Anesthesia:
Other Non-Cardiovascular Effects of Neuraxial Anesthesia:
Neuraxial Technique:
Complications:
Postdural Puncture Headache:
Transient Neurologic Symptoms (TNS):
Regional Anesthetic Blocks:
Summary:
References:
Resources:
Additional Resources:
Recommended URL Resources:
Chapter 17. Acute Pain Management
Acute Pain Neuronal Pathways and Mechanisms:
Clinical Relevance of Acute Pain Pathophysiology:
Realistic goals of analgesic therapy might include:
Pharmacological Management of Acute Pain:
Multimodal Analgesia:
The Analgesic Ladder for Acute Pain:
Step One of the Analgesic Ladder
Acetaminophen:
Nonsteroidal anti-inflammatory drugs (NSAIDs):
II. Step Two of the Acute Pain Analgesic Ladder:
Tramadol and its inherent multimodal action:
Tapentadol:
Low-Dose Potent Opioid Use in Step Two of the Analgesic Ladder:
Codeine as a Second Step Analgesic Option: Codeine is a Prodrug and not a Weak Opioid:
References:
URL Resources:
Chapter 18. Chronic Pain
Physical examination:
Investigations:
Treatment:
Myofascial Pain Syndrome:
Fibromyalgia:
Diabetic Neuropathy:
Post-herpetic Neuralgia:
Complex Regional Pain Syndrome (CRPS):
Oncologic Pain:
Suggestions for the Management of Chronic Pain Patients presenting for Surgery:
Resources:
References:
Chapter 19. Obstetrical Anesthesia
Physiological Changes:
Psychoprophylaxis:
Parenteral Opioids:
Nitrous Oxide:
Epidural Patient Information Card
Labour Epidural Risks:
Combined Spinal Epidural Analgesia (CSE):
Postdural Puncture Headache (PDPH):
Cesarean Delivery:
Spinal Anesthesia for Cesarean Delivery:
Epidural Anesthesia for Cesarean Delivery:
General Anesthesia for Cesarean Delivery:
Intrapartum hemorrhage vs Postpartum hemorrhage:
Placenta Placenta:
Abruptio Placenta:
Uterine Rupture:
Postpartum Hemorrhage:
References:
Additional Resources:
Chapter 20. Neonatal Resuscitation
Overview: Neonatal Resuscitation Basics
Normal Fetal Heart Rate (FHR):
APGAR Score:
Primary vs Secondary Apnea:
Fetal Circulation:
What happens immediately after delivery?
Which infants require resuscitation?
Fetal Heart Rate Patterns
What should be done if the infant appears distressed?
What is meconium?
Equipment Needed for Neonatal Resuscitation
The Basics of Neonatal Resuscitation
Technique of Positive Pressure Ventilation (PPV)
Re-evaluate the Heart Rate
Chest Compressions:
What is the proper technique for administering chest compressions to an infant?
Endotracheal intubation is indicated when:
Oxygen
Naloxone
Epinephrine
When should I give epinephrine?
How will I know if the infant is hypovolemic?
Clinical signs of hypovolemia resulting from an acute loss of > 20% of the blood volume include:
Special Considerations
Resources:
Recommended Web Links:
Chapter 21. Intravenous Fluids and Blood Component Therapy
Body fluid distribution:
Fluid requirements:
Maintenance Fluids:
Fluid Deficit:
Ongoing losses:
Crystalloids and colloids:
Normal saline:
Ringer’s lactate:
5% Dextrose in Water (D5W):
“2/3, 1/3” and ½ NS with D5W:
Hypertonic saline:
Synthetic starches:
Albumin:
Blood components:
Blood products:
Plasma:
Platelets:
Cryoprecipitate:
Autologous blood:
Blood Loss:
Massive transfusion:
Complications of transfusion:
Blood conservation strategies:
Intraoperative Cell Salvage:
References:
Chapter 22. Common Perioperative Problems
A General Approach to Emergency Problems:
1. Evaluate the patient to ensure an adequate and unobstructed airway
Hypotension
Other Forms of Shock:
Nausea and Vomiting:
Ondansetron:
Dexamethasone:
Haloperidol:
Dimenhydrinate:
Other Anti-Emetic Options:
Postoperative Agitation and Delirium:
Treatment:
References:
Chapter 23. Managing the Circulation
Cardiac Cycle:
Systole:
Diastole:
Cardiac Output:
Stroke Volume:
Preload:
Afterload:
Contractility:
Heart Rate:
Blood Pressure:
General Anesthesia:
Regional Anesthesia:
Advanced Cardiac Life Support (ACLS):
ACLS in the Perioperative Period:
Perioperative ACLS:
References:
Additional Resources:
Chapter 24. Hypoxemia and Oxygen Therapy
Causes of Hypoxia:
Hypoxemia:
Oxygen therapy:
CPAP/BPAP:
Supraglottic Airways:
Causes of Hypoxemia:
I. Decreased Inspired Oxygen Concentration (FiO2):
II. Decreased Alveolar Ventilation:
III. Increased Dead Space Ventilation:
IV. Increased Shunt:
V. Decreased Diffusion:
Tissue Hypoxia:
Oxygen Toxicity:
Resources:
References:
Additional Resources:
Chapter 25. Unusual Anesthetic Complications
I. Malignant Hyperthermia (MH)
How serious is it?
Who is susceptible?
What anesthetic agents trigger MH?
What anesthetic agents are safe?
What is the pathogenesis of MH?
How do you treat an MH crisis?
Post MH crisis treatment:
Postoperative Fever:
II: Aspiration Syndrome
What can we do to prevent aspiration?
What are some factors that predict the severity of the aspiration?
What are the consequences of gastric aspiration?
Diagnosis of aspiration:
Treatment of aspiration:
III. Negative Pressure Pulmonary Edema (NPPE)
Who is at risk of NPPE?
How can it be prevented?
Treatment of NPPE:
Allergic Reactions:
What is the difference between an anaphylactoid and anaphylactic reaction?
How does anaphylaxis present in the perioperative period?
How do we treat anaphylaxis once it is recognized?
Review Questions:
References:
Additional Resources:
Chapter 26. Pediatric Anesthesia
Introduction:
Preparation for Anesthesia and Surgery:
Preoperative Sedation:
Preoperative Fasting:
OR Monitoring:
Induction and Maintenance of Anesthesia:
Inhalational Induction
Intravenous Induction:
Intramuscular Induction Agents:
Basic Pediatric Anatomy and Physiology
Should a cuffed or uncuffed endotracheal tube (ETT) be used in children?
Physiology
Cardiac Murmurs:
Renal:
Hepatic:
Temperature regulation:
Upper Respiratory Tract Infection (URI) and Surgery
Obstructive Sleep Apnea:
Sickle Cell Disease:
Exposure to Chicken Pox:
Emergence Delirium (ED)
Laryngospasm:
Post-intubation Croup:
Postoperative Nausea and Vomiting:
Postoperative Pain Management:
Non Steroidal Anti-Inflammatory Drugs:
Opioids:
Caudal Blockade:
Anesthetic Neurotoxicity in the Developing Brain:
Clinical Case:
References:
Recommended Links:
