Hensley's Practical Approach to Cardiothoracic Anesthesia

1. I. Introduction - p. 2 2. II. Content - p. 2 3. III. Summary - p. 6 4. 2 Cardiovascular Physiology: A Primer - p. 8 5. I. Introduction - p. 9 6. II. Embryologic Development of the Heart - p. 9 7. III. Organization of Myocytes - p. 9 8. IV. Electrical Conduction - p. 12 9. V. Length-Tension Relationship - p. 15 10. VI. Heart Chambers and External Work - p. 17 11. VII. Control Systems - p. 22 12. VIII. The Cardiovascular Control System - p. 22 13. IX. Arterial Baroreceptors - p. 24 14. X. Atrial Receptors - p. 25 15. XI. Chemoreceptors - p. 26 16. XII. Effectors and Physiologic Reserves for the Healthy Individual - p. 27 17. XIII. The Cardiovascular System Integration - p. 30 18. XIV. Effect of Anesthesia Providers and Our Pharmacology on the Cardiovascular System - p. 32 19. 3 Pharmacology - p. 35 20. I. Introduction - p. 36 21. II. Pharmacologic Principles - p. 36 22. III. Inotropes - p. 40 23. IV. Vasopressors - p. 49 24. V. Vasodilators - p. 56 25. VI. Antiarrhythmic Drugs - p. 60 26. VII. Pulmonary Vasodilators - p. 69 27. VIII. Anticoagulants - p. 71 28. IX. Antifibrinolytics - p. 76 29. SECTION II: EQUIPMENT AND TECHNOLOGY - p. 81 30. 4 Cardiac Ultrasound - p. 82 31. I. Introduction - p. 82 32. II. Basic Principles of Ultrasound - p. 83 33. III. Appropriate Use of Transesophageal Echocardiography - p. 84 34. IV. Probe Insertion, Manipulation, and Machine Knobology - p. 85 35. V. Intraoperative Transesophageal Echocardiography Examination - p. 86 36. VI. POCUS - p. 101 37. VII. Summary - p. 103 38. 5 Perianesthetic Monitoring - p. 105 39. I. Introduction - p. 106 40. II. Cardiovascular Monitors - p. 106 41. III. Temperature - p. 135 42. IV. Renal Function - p. 136 43. V. Neurologic Function - p. 136 44. 6 Pacemakers and Implantable Cardioverter Defibrillators: Indications, Function, Perioperative Evaluation and Management - p. 142 45. I. Overview/Prevalence - p. 143 46. II. Cardiac Implantable Electronic Devices Types and Function - p. 143 47. III. Cardiac Implantable Electronic Device Malfunction and Perioperative Considerations - p. 150 48. IV. Perioperative Assessment and Management - p. 151 49. V. Summary - p. 154 50. 7 Cardiopulmonary Bypass - p. 156 51. I. Introduction: Patient Safety in the Cardiac Operating Room - p. 156 52. II. General Aspects of Cardiopulmonary Bypass - p. 157 53. III. Type of Circuits - p. 161 54. IV. Priming Volume and Autologous Priming - p. 161 55. V. Pump Flow Management - p. 161 56. VI. Protocols and Standards - p. 162 57. VII. Initiation of Cardiopulmonary Bypass: Establishing “Full Flow” - p. 167 58. VIII. Anesthesia Management for Cardiopulmonary Bypass Cases - p. 168 59. IX. Weaning From Cardiopulmonary Bypass - p. 169 60. X. Prevention and Management of Adverse Events Associated With Cardiopulmonary Bypass - p. 171 61. 8 Extracorporeal Membrane Oxygenation for Pulmonary or Cardiac Support - p. 174 62. I. History of Extracorporeal Membrane Oxygenation - p. 175 63. II. Extracorporeal Membrane Oxygenation Physiology - p. 175 64. III. Cannulation Strategies - p. 176 65. IV. Indications for Extracorporeal Membrane Oxygenation in Respiratory Failure - p. 179 66. V. Indications for Extracorporeal Membrane Oxygenation in Cardiac Failure - p. 182 67. VI. Extracorporeal Membrane Oxygenation Management - p. 184 68. VII. Extracorporeal Membrane Oxygenation Transport - p. 187 69. VIII. Complications - p. 187 70. IX. Economic Considerations - p. 187 71. X. Ethical Considerations - p. 188 72. 9 Devices for Cardiac Support and Replacement - p. 190 73. I. Introduction - p. 191 74. II. History - p. 191 75. III. Indications - p. 192 76. IV. Classification and Attachment Sites of Ventricular Assist Devices - p. 193 77. V. Mechanical Assistance Systems - p. 194 78. VI. Intraoperative Considerations - p. 195 79. VII. Postoperative Management and Complications - p. 198 80. VIII. Weaning From Ventricular Assist Device Support - p. 199 81. IX. Management of the Patient With Ventricular Assist Device for Noncardiac Surgery - p. 199 82. X. Intra-aortic Balloon Pump Circulatory Assistance - p. 200 83. SECTION III: CARDIAC ANESTHESIA - p. 205 84. 10 Preparation for Cardiac Surgery - p. 206 85. I. Introduction - p. 206 86. II. Risk Assessment - p. 206 87. III. Preanesthetic Evaluation - p. 208 88. IV. Management of Preoperative Medications - p. 214 89. V. Management of Cardiac Implantable Electronic Devices - p. 215 90. VI. Enhanced Recovery After Surgery and Enhanced Recovery After Cardiac Surgery - p. 216 91. VII. Summary - p. 219 92. 11 Structural Heart and Electrophysiology - p. 222 93. I. Introductiong - p. 223 94. II. Transcatheter Aortic Valve Replacement - p. 223 95. III. The Transseptal Puncture: Principles and Imaging - p. 224 96. IV. Mitral Valve Transcatheter Edge-to-Edge Repair - p. 225 97. V. Transcatheter Mitral Valve Replacement - p. 228 98. VI. Left Atrial Appendage Occlusion Devices - p. 231 99. VII. Transcatheter Prosthetic Paravalvular Defect Closures - p. 233 100. VIII. Complex Atrial Septal Defect Closures - p. 235 101. IX. Electrophysiology Procedures: Anesthetic Considerations - p. 236 102. X. Conclusions - p. 238 103. 12 Myocardial Revascularization - p. 240 104. I. Background on Coronary Artery Disease - p. 241 105. II. Myocardial Oxygen Demand and Supply - p. 243 106. III. Monitoring for Myocardial Ischemia - p. 247 107. IV. Anesthetic Agents Used During Cardiac Revascularization Surgery - p. 250 108. V. Perioperative Approach for Myocardial Revascularization Procedures - p. 253 109. VI. Causes and Treatment of Perioperative Myocardial Ischemia - p. 258 110. VII. Anesthesia for Hybrid Cardiac Procedures - p. 261 111. 13 Aortic Valve Repair and Replacement - p. 265 112. I. Introduction - p. 266 113. II. Stenotic Versus Regurgitant Lesions - p. 266 114. III. Structural and Functional Response to Valvular Heart Disease - p. 267 115. IV. Pressure-Volume Loops - p. 268 116. V. Aortic Stenosis - p. 268 117. VI. Hypertrophic Cardiomyopathy - p. 279 118. VII. Aortic Regurgitation - p. 284 119. VIII. Mixed Valvular Lesions - p. 290 120. IX. Prosthetic Valves - p. 291 121. x. Prophylaxis of Bacterial Endocarditis - p. 294 122. 14 Mitral, Tricuspid, and Pulmonic Valves - p. 297 123. I. Introduction - p. 298 124. II. Stenotic Versus Regurgitant Lesions - p. 298 125. III. Structural and Functional Response to Valvular Heart Disease - p. 299 126. IV. Echocardiography and Valvular Heart Disease - p. 299 127. V. Mitral Valve Stenosis - p. 300 128. VI. Mitral Valve Regurgitation - p. 306 129. VII. Tricuspid Valve Stenosis - p. 316 130. VIII. Tricuspid Valve Regurgitation - p. 317 131. IX. Pulmonic Stenosis - p. 320 132. X. Pulmonic Regurgitation - p. 321 133. XI. Prosthetic Valves - p. 322 134. 15 Right Heart Disease Assessment and Management - p. 325 135. I. Importance of Right Ventricular Function in Cardiac Surgery - p. 325 136. II. Preoperative Evaluation - p. 328 137. III. Hemodynamic Assessment - p. 329 138. IV. Echocardiographic Assessment of Right Heart Function - p. 332 139. V. Management of Right Ventricular Dysfunction - p. 336 140. VI. Summary - p. 340 141. 16 Anesthetic Considerations for Surgical Myectomy in Patients With Hypertrophic Cardiomyopathy - p. 343 142. I. Introduction - p. 343 143. II. Hypertrophic Cardiomyopathy - p. 344 144. III. Anesthetic Considerations - p. 349 145. IV. Surgical Subgroups and Anesthetic Considerations - p. 352 146. V. Summary - p. 353 147. 17 Adult Congenital Heart Disease (Basics) - p. 355 148. I. Introduction - p. 356 149. II. Perioperative Considerations for Patients With Adult Congenital Heart Disease - p. 361 150. III. Shunt Lesions - p. 373 151. IV. Obstructive Lesions - p. 389 152. V. Complex Lesions - p. 395 153. VI. Single Ventricle Defects - p. 403 154. VII. Conclusion - p. 408 155. 18 Pericardial Disease and Tamponade - p. 411 156. I. Introduction - p. 411 157. II. Pericardial Anatomy and Physiology - p. 412 158. III. Causes of Pericardial Disease - p. 413 159. IV. Pericarditis - p. 413 160. V. Constrictive Pericarditis - p. 416 161. VI. Pericardial Effusion and Tamponade - p. 423 162. 19 Cardiac Masses - p. 432 163. I. Cardiac Tumors - p. 433 164. II. Endocarditis - p. 438 165. III. Cardiac Thrombus - p. 440 166. IV. Anatomic Variants - p. 443 167. 20 Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Thromboendarterectomy - p. 445 168. I. Introduction to Pulmonary Hypertension - p. 445 169. II. Pulmonary Thromboendarterectomy - p. 447 170. III. Special Consideration - p. 452 171. 21 Heart Transplantation - p. 455 172. I. Heart Failure - p. 456 173. II. Cardiac Transplant Recipient Characteristics - p. 460 174. III. The Cardiac Transplant Donor - p. 462 175. IV. Surgical Techniques for Cardiac Transplantation - p. 466 176. V. Preoperative Management of the Cardiac Transplant Patient - p. 467 177. VI. Anesthetic Management of the Cardiac Transplant Recipient - p. 469 178. VII. Postcardiopulmonary Bypass - p. 470 179. VIII. The Role of Intraoperative Transesophageal Echocardiography - p. 472 180. IX. Cardiac Transplantation Survival and Complications - p. 473 181. X. Pediatric Cardiac Transplantation - p. 474 182. XI. Combined Heart-Lung Transplantation - p. 475 183. XII. Anesthesia for the Patient With History of Heart Transplant - p. 475 184. XIII. Future Directions - p. 479 185. SECTION IV: THORACIC ANESTHESIA - p. 483 186. 22 Lung Transplantation - p. 484 187. I. End-Stage Pulmonary Disease - p. 485 188. II. Lung Transplant Recipient Characteristics - p. 487 189. III. The Lung Transplant Donor - p. 489 190. IV. Choice of Lung Transplant Procedure - p. 490 191. V. Preanesthetic Considerations - p. 492 192. VI. Anesthetic Management of the Lung Transplant Recipient - p. 493 193. VII. Postoperative Management and Complications - p. 500 194. VIII. Outcomes - p. 501 195. IX. Special Considerations for Pediatric Lung Transplantation - p. 502 196. X. Anesthesia for the Post–Lung-Transplant Patient - p. 502 197. XI. Future Directions - p. 503 198. 23 Anesthetic Management for Thoracic Aortic Aneurysm and Dissection - p. 506 199. I. Classification and Natural History - p. 507 200. II. Diagnosis - p. 509 201. III. Preoperative Management of Patients Requiring Surgery of the Thoracic Aorta - p. 513 202. IV. Surgical and Anesthetic Considerations - p. 514 203. 24 Anesthesia for Esophageal Surgery - p. 544 204. I. Introduction - p. 544 205. II. Preoperative Assessment - p. 545 206. III. Intraoperative Management - p. 546 207. IV. Operations for Gastroesophageal Reflux Disease - p. 548 208. V. Operations for Paraesophageal Hernia Repair - p. 549 209. VI. Operations for Achalasia - p. 549 210. VII. Operations for Esophageal Diverticula - p. 550 211. VIII. Other Endoscopic Esophageal Procedures/Surgeries - p. 551 212. IX. Esophagectomy - p. 552 213. X. Repair of Esophageal Perforation or Rupture - p. 553 214. XI. Repair of Tracheoesophageal Fistula - p. 554 215. 25 Anesthetic Management for Surgery of the Lungs and Mediastinum - p. 557 216. I. Preoperative Assessment - p. 557 217. II. Intraoperative Management - p. 563 218. III. Specific Procedures - p. 575 219. IV. Lung Volume Reduction Surgery - p. 584 220. 26 Anesthetic Management for Interventional Pulmonology Procedures - p. 588 221. I. Introduction - p. 588 222. II. Anesthetic Approaches - p. 589 223. III. Procedural Approaches - p. 591 224. IV. Diagnostic Techniques - p. 595 225. V. Therapeutic Techniques - p. 597 226. VI. Preoperative Assessment for Interventional Pulmonology Procedures - p. 600 227. VII. Management of Interventional Pulmonology–Specific Intraprocedural Complications - p. 600 228. SECTION V: PERIOPERATIVE MEDICINE - p. 603 229. 27 Perioperative Evaluation - p. 604 230. I. Introduction - p. 604 231. II. Noncardiac Evaluation - p. 604 232. III. Cardiac-Specific Evaluation - p. 607 233. 28 Patient Blood Management - p. 614 234. I. Introduction - p. 614 235. II. Red Blood Cell Transfusion and Clinical Outcomes - p. 617 236. III. Component Therapy - p. 620 237. IV. Blood Conservation Measures - p. 624 238. V. Conclusion - p. 627 239. 29 Preservation of End-Organ Function - p. 631 240. I. Introduction - p. 631 241. II. Kidneys - p. 632 242. III. Brain - p. 637 243. IV. Heart and Circulatory System - p. 640 244. VI. Lung - p. 644 245. VII. Gastrointestinal Organs - p. 644 246. VIII. Summary - p. 645 247. 30 Regional Anesthesia Techniques for the Cardiac Surgery Population - p. 649 248. I. Introduction - p. 649 249. II. Regional Anesthesia Techniques - p. 650 250. III. Selection of Technique - p. 661 251. IV. Dosing and Safety Considerations - p. 663 252. V. Limitations of Regional Anesthesia Techniques - p. 664 253. VI. Summary - p. 664 254. 31 Postoperative Care of the Cardiac Surgical Patient - p. 667 255. I. Transition From Operating Room to Intensive Care Unit - p. 668 256. II. Transfer of Care to the Intensive Care Unit Team - p. 669 257. III. Mechanical Ventilation After Cardiac Surgery - p. 670 258. IV. Principals of Fast-Tracking - p. 673 259. V. Enhanced Recovery After Cardiac Surgery - p. 673 260. VI. Hemodynamic Management in the Postoperative Period - p. 673 261. VII. Postoperative Bleeding - p. 674 262. VIII. Postoperative Pain Management Following Cardiac Surgery - p. 675 263. IX. Metabolic Abnormalities - p. 676 264. X. Complications in the First 24 Hours - p. 676 265. XI. Discharge From the Intensive Care Unit - p. 677 266. XII. The Transplant Patient - p. 677 267. XIII. Patients With Mechanical Assist Devices - p. 677 268. XIV. Family Issues in the Postoperative Period - p. 678 269. 32 Practice Management, Quality Assurance and Improvement, and Ethical and Legal Issues in Cardiothoracic Anesthesiology - p. 680 270. I. Introduction - p. 680 271. II. Practice Management - p. 681 272. III. Patient Safety and Quality Improvement - p. 684 273. IV. Ethical and Legal Issues - p. 695 274. V. Summary - p. 701 275. Index - p. 703