Main description:

Dr. G. M. Woerlee is well known in my department both as a clinician and teacher. Years ofexperience have taught him that the problems discussed here have as yet not been treated in this way in any single work. In my opinion there is a real need for such abook, not only for resident and specialist anaesthetists, but also among surgeons and internists, specialist and trainee. Management of a patient in the operating room is a matter of teamwork, and knowledge of the problems encountered is the basis of any mutual understanding! The information which has been assembled and clearly presented in this book should prove to be of great assistance in guiding our patients though an important phase of their lives. Professor Dr. Joh. Spierdijk, Department of Anaesthesia, University Hospital of Leyden, The Netherlands. vii PREFACE Much of the literature being published in the field of anesthesiology today concerns a narrow, in-depth scrutiny of a specific area or anesthetic technique that does not provide the novice with an overview ofthe perioperativeperiod and the commoneveryday problems faced by the anesthetist. Dr G. M. Woerlee of the University of Leiden with his book, "Com mon Perioperative Problems and the Anaesthetist", has filled a void in the current anes thetic literature. Dr Woerlee reviews in a straightforward, no-frills manner problems routinely encountered during the perioperative period. Other anesthesia textbooks do not cover the material in quite the same logical, step-by-step fashion.

Contents:

1 Preoperative Assessment.- 1.1 - Clinical preoperative assessment.- 1.2 - ASA - physical status classification.- 1.3 - Indications for immediate operation.- 2 Cardiovascular Disease and Anaesthesia.- 2.1 - Cardiovascular effects of anaesthesia & surgery.- 2.2 - Vasoactive and cardioactive drugs.- 2.3 - Clinical assessment of cardiovascular disease.- 2.4 - NYHA classification of cardiac functional disability.- 2.5 - Cardiac Operative Risk Index Score.- 2.6 - Hypertension.- 2.7 - Hypotension.- 2.8 - Heart failure.- 2.9 - Myocardial ischaemia.- 2.10 - Myocardial infarction.- 2.11 - Anticoagulant therapy in cardiac patients.- 2.12 - Subacute bacterial endocarditis prophylaxis.- 2.13 - Disorders of the cardiac valves and shunting.- 2.14 - Mitral stenosis.- 2.15 - Mitral regurgitation.- 2.16 - Mitral valve prolapse.- 2.17 - Aortic stenosis.- 2.18 - Aortic regurgitation.- 2.19 - Intracardiac shunting.- 3 Cardiac Arrhythmias.- 3.1 - Cardiac arrhythmias - general.- 3.2 - Antiarrhythmic drugs.- 3.3 - Specific cardiac arrhythmias.- 3.3.1 - Sinus tachycardia.- 3.3.2 - Sinus bradycardia.- 3.3.3 - Sick sinus syndrome.- 3.3.4 - Premature atrial contractions.- 3.3.5 - Atrial fibrillation.- 3.3.6 - Atrial flutter.- 3.3.7 - Atrioventricular (A-V) junctional disorders.- 3.3.8 - Paroxysmal supraventricular tachycardias (PSVT's).- 3.3.9 - Wolff-Parkinson-White (WPW) syndrome.- 3.3.10 - Atrioventricular (A-V) block.- 3.3.11 - Bundle branch block and bifascicular block.- 3.3.12 - Premature ventricular contractions.- 3.3.13 - Ventricular tachycardia.- 3.3.14 - Ventricular flutter/fibrillation.- 3.3.15 - Ventricular asystole.- 3.4 - Pacemakers.- 4 Respiratory Disease and Anaesthesia.- 4.1 - Blood gases - arterial and venous.- 4.2 - Calculation of expected PaO2.- 4.3 - Oxygen content and oxygen flux.- 4.4 - Respiratory function tests.- 4.5 - Pulmonary effects of anaesthesia and surgery.- 4.6 - Preoperative assessment of respiratory function & its consequences.- 4.7 - Upper respiratory tract infections and anaesthesia.- 4.8 - Pulmonary infections and anaesthesia.- 4.9 - Chronic obstructive airways disease.- 4.10- Upper airway obstruction.- 4.11 - Primary lung tumors.- 4.12 - Smoking.- 5 Haematological Problems and Anaesthesia.- 5.1 - Anaemia.- 5.2 - Sickle cell anaemia.- 6 Haemostatic Dysfunction.- 6.1 - Normal haemostasis.- 6.2 - Simple tests of haemostatic function.- 6.3 - Minimally acceptable perioperative haemostatic parameters.- 6.4 - Perioperative management of coagulation factor deficiencies.- 6.5 - Perioperative management of platelet disorders.- 6.6 - Anticoagulant drugs & surgery.- 6.7 - Drugs affecting haemostasis.- 6.8 - Assessment of haemostatic disorders.- 6.9 - Anaesthesia & surgery of patients with known haemostatic disorders.- 6.10 - Intraoperative haemostatic disorders.- 7 Endocrine Disorders.- 7.1 - Diabetes mellitus.- 7.2 - Hyperthyroidism and "thyroid storm".- 7.3 - Hypothyroidism.- 7.4 - Hyperadrenocorticism.- 7.5 - Hypoadrenocorticism.- 8 Neurological Disorders.- 8.1 - Cerebral function & abnormal physiology.- 8.2 - Classification of level of consciousness.- 8.3 - Raised intracranial pressure.- 8.4 - Head injury.- 8.5 - Disorders affecting neuromuscular function.- 8.6 - Baroreceptor reflexes & anaesthesia.- 9 Renal Dysfunction.- 9.1 - Assessment of renal function.- 9.2 - Effects of anaesthesia and surgery on renal function.- 9.3 - Threatened renal failure.- 9.4 - Renal failure.- 10 Hepatic Dysfunction.- 10.1 - Assessment of liver function.- 10.2 - Effects of anaesthesia and surgery on the liver.- 10.3 - Impaired liver function.- 11 Gastrointestinal Function.- 11.1 - The preoperative fast.- 11.2 - Effects of surgery & anaesthesia on gastrointestinal function.- 11.3 - Nausea and emesis.- 12 Electrolyte Disorders.- 12.1 - Hyponatremia & hypo-osmolality.- 12.2 - Hypernatremia & hyperosmolality.- 12.3 - Hypokalemia.- 12.4 - Hyperkalemia.- 12.5 - Hypocalcaemia.- 12.6 - Hypercalcemia.- 13 Disorders of Acid-Base Balance.- 13.1 - Definitions & diagnosis of acid-base disorders.- 13.2 - Factors modifying clinical manifestations of acid-base disorders.- 13.3 - Clinical acid-base disorders.- 14 Perioperative Fluid & Transfusion Therapy.- 14.1 - Normal fluid and electrolyte distribution.- 14.2 - Properties of intravenous fluids.- 14.3 - Principles of fluid therapy.- 14.4 - Hypovolemia.- 14.5 - Haemorrhage and blood transfusion.- 14.6 - Perioperative fluid therapy.- 15 Pharmacokinetics.- 15.1 - Pharmacokinetic principles.- 15.2 - Factors modifying drug kinetics.- Appendix - A.- Anaesthetic drug kinetic, dynamic & metabolic parameters.- Appendix - B.- Kinetic parameters of cardiovascular stimulant drugs.- Appendix - C.- Abbreviations.- Appendix - D.- Conversion factors.