F O U R T H E D I T I O N Handbook for Stoelting’s Anesthesia and Co-Existing Disease ROBERTA L HINES, MD Nicholas M Greene Professor and Chairman Department of Anesthesiology Yale University School of Medicine Chief of Anesthesiology Yale-New Haven Hospital New Haven, Connecticut KATHERINE E MARSCHALL, MD Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist Yale-New Haven Hospital New Haven, Connecticut 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 HANDBOOK FOR STOELTING’S ANESTHESIA AND CO-EXISITING DISEASE Copyright © 2013, 2009, 2002, 1993 by Saunders, an imprint of Elsevier Inc ISBN: 978-1-4377-2866-8 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Library of Congress Cataloging-in-Publication Data Handbook for Stoelting’s anesthesia and co-existing disease / [edited by] Roberta L Hines, Katherine E Marschall -4th ed    p ; cm  Companion to: Stoelting’s anesthesia and co-existing disease 6th ed c2012  Includes bibliographical references and index  ISBN 978-1-4377-2866-8 (pbk : alk paper)  I Stoelting, Robert K II Hines, Roberta L III Marschall, Katherine E IV Stoelting’s anesthesia and coexisting disease  [DNLM: Anesthesia adverse effects Handbooks Anesthesia adverse effects Outlines Anesthesia methods Handbooks Anesthesia methods Outlines Anesthetics adverse effects Handbooks Anesthetics adverse effects Outlines Intraoperative Complications Handbooks Intraoperative Complications Outlines WO 231] 617.9’6 dc23 Executive Content Strategist: William Schmitt Content Development Manager: Lucia Gunzel Publishing Services Manager: Anne Altepeter Senior Project Manager: Cheryl A Abbott Design Direction: Louis Forgione Printed in the United States of America Last digit is the print number:  9  8  7  6  5  4  3  2  2012028212 C O N T R I B U T O R S Shamsuddin Akhtar, MD Associate Professor of Anesthesiology Director, Medical Student Education Yale University School of Medicine New Haven, Connecticut Brooke E Albright, MD Captain, U.S Air Force Staff Anesthesiologist Landstuhl Regional Medical Center Landstuhl/Kirchberg, Germany Sharif Al-Ruzzeh, MD, PhD Resident in Anesthesiology Yale-New Haven Hospital New Haven, Connecticut Ferne R Braveman, MD Professor of Anesthesiology Vice-Chair of Clinical Affairs Chief, Division of Obstetrics Anesthesia Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Michelle W Diu, MD, FAAP Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Samantha A Franco, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Loreta Grecu, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Alá Sami Haddadin, MD, FCCP Assistant Professor, Division of Cardiothoracic Anesthesia and Adult Critical Care Medicine Medical Director, Cardiothoracic Intensive Care Unit Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Laura L Hammel, MD Assistant Professor of Anesthesiology and Critical Care University of Wisconsin Hospital and Clinics Madison, Wisconsin Michael Hannaman, MD Assistant Professor, Department of Anesthesiology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin Antonio Hernandez Conte, MD, MBA Assistant Professor of Anesthesiology Co-Director, Perioperative Transesophageal Echocardiography Cedars-Sinai Medical Center Partner, General Anesthesia Specialists Partnership, Inc Los Angeles, California Adriana Herrera, MD Assistant Professor of Anesthesiology Associate Residency Program Director Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Zoltan G Hevesi, MD, MBA Professor of Anesthesiology and Surgery University of Wisconsin University of Wisconsin Hospital and Clinics Madison, Wisconsin iii iv Contributors Roberta L Hines, MD Nicholas M Greene Professor and Chairman Department of Anesthesiology Yale University School of Medicine Chief of Anesthesiology Yale-New Haven Hospital New Haven, Connecticut Natalie F Holt, MD, MPH Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut; Attending Physician, West Haven Veterans Affairs Medical Center West Haven, Connecticut Viji Kurup, MD Associate Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut William L Lanier, Jr., MD Professor of Anesthesiology College of Medicine Mayo Clinic Rochester, Minnesota Thomas J Mancuso, MD, FAAP Associate Professor of Anesthesia Harvard Medical School Senior Associate in Anesthesia Director of Medical Education Children’s Hospital of Boston Boston, Massachusetts Raj K Modak, MD Assistant Professor of Cardiac and Thoracic Anesthesia Director, Cardiac Anesthesia Fellowship Program Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Tori Myslajek, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Adriana Dana Oprea, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Jeffrey J Pasternak, MD Assistant Professor of Anesthesiology College of Medicine Mayo Clinic Rochester, Minnesota Wanda M Popescu, MD Associate Professor of Anesthesiology Director, Thoracic Anesthesia Section Yale University School of Medicine New Haven, Connecticut Ramachandran Ramani Associate Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Katherine E Marschall, MD Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist Yale-New Haven Hospital New Haven, Connecticut Robert B Schonberger, MD, MA Fellow of Cardiac and Thoracic Anesthesia Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Veronica A Matei, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Denis Snegovskikh, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Contributors Gail A Van Norman, MD Professor Director, Pre-Anesthesia Clinic Department of Anesthesiology and Pain Medicine University of Washington Seattle, Washington Hossam Tantawy, MD Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Russell T Wall, III, MD Vice-Chair and Program Director Department of Anesthesiology Georgetown University Hospital Professor of Anesthesiology and Pharmacology Senior Associate Dean Georgetown University School of Medicine Washington, DC Kelley Teed Watson, MD Clinical Assistant Professor Yale University School of Medicine New Haven, Connecticut; Cardiothoracic Anesthesiologist Department of Anesthesiology Self Regional Healthcare Greenwood, South Carolina v P R E F A C E The fourth edition of the Handbook for Stoelting’s Anesthesia and Co-Existing Disease is intended to provide a ready source of information about the impact of disease states on the management of patients in the perioperative period The handbook uses an outline format that follows the chapters and headings that appear in the sixth edition of Stoelting’s Anesthesia and Co-Existing Disease so readers can refer to corresponding areas in the textbook for more detailed information The handbook thus serves as a more portable counterpart to the textbook that can be reviewed on site in the operating room or at other anesthetizing locations Much of the information in the handbook is presented in tables, illustrations, and algorithms This format helps with rapid access to salient aspects of particular medical conditions We wish to thank Dr Gail A Van Norman for her invaluable help in redacting the text Roberta L Hines Katherine E Marschall vii C H A P T E R Ischemic Heart Disease Ischemic heart disease affects approximately 30% of patients undergoing surgery in the United States Angina pectoris, acute myocardial infarction (MI), and sudden death are often the first manifestations of this disease Cardiac dysrhythmias are the major cause of sudden death The two most important risk factors for the development of coronary artery atherosclerosis are male gender and increasing age (Table 1-1) Presentation of patients with ischemic heart disease can include chronic stable angina or an acute coronary syndrome (ACS) ACS can manifest as STelevation MI (STEMI) or unstable angina/non–ST-elevation MI (UA/NSTEMI) I. ANGINA PECTORIS Angina pectoris occurs when there is a mismatch of oxygen delivered to the myocardium (supply) and myocardial oxygen consumption (demand) Stable angina typically develops in the setting of partial occlusion or significant (>70%) chronic narrowing of a segment of coronary artery When the imbalance between myocardial oxygen supply and demand becomes critical, congestive heart failure (CHF), electrical instability with dysrhythmias, and MI can result A Diagnosis The pain of angina pectoris is generally described as retrosternal chest discomfort, pain, pressure, or heaviness that often radiates to the neck, left shoulder, left arm, or jaw and occasionally to the back or down both arms Angina may also cause epigastric discomfort resembling indigestion, chest tightness, or shortness of breath Discomfort usually lasts several minutes and follows a crescendo-decrescendo pattern; a sharp pain lasting only a few seconds or a dull ache lasting for hours is rarely angina Stable angina is unchanged in frequency or severity over months or longer Unstable angina (UA) is angina at rest, of new onset, or of increased severity or frequency compared with previously stable angina Chest wall tenderness suggests a musculoskeletal origin of chest pain Sharp retrosternal pain exacerbated by deep breathing, coughing, or change in body position suggests pericarditis Esophageal spasm can produce discomfort similar to angina pectoris and may be similarly relieved by administration of nitroglycerin Electrocardiography a Standard Electrocardiography Subendocardial ischemia is associated with ST-segment depression during anginal pain Variant angina (angina that results from coronary vasospasm) is characterized by ST elevation during anginal pain T-wave inversion may be present In patients with chronic T wave inversion, ischemia may be associated with “pseudonormalization” of T waves to the upright position during episodes of ischemia b Exercise Electrocardiography Exercise electrocardiography can detect signs of myocardial ischemia in relationship to chest pain A new murmur of mitral regurgitation or a decrease in blood pressure during exercise increases the diagnostic value of this test Exercise testing may be contraindicated in some conditions (e.g., severe aortic stenosis, severe hypertension (HTN), acute myocarditis, uncontrolled CHF, infective endocarditis) and may not be possible in patients who cannot exercise or if other conditions interfere ... Between Myocardial Oxygen Delivery and Myocardial Oxygen Requirements DECREASED OXYGEN DELIVERY Decreased coronary blood flow Tachycardia Diastolic hypotension Hypocapnia (coronary artery vasoconstriction)... endarterectomy, head and neck surgery, intraperitoneal and intrathoracic surgery, orthopedic surgery, prostate surgery Low-risk surgery Endoscopic surgery, superficial surgery, cataract surgery, breast... ischemia by optimizing myocardial oxygen supply and reducing myocardial oxygen demand and (2) to monitor for and treat ischemia Factors influencing the balance of myocardial oxygen demand and supply