Nurse Anesthesia

7th Edition - January 23, 2022
Authors: Sass Elisha, Jeremy S. Heiner, John J. Nagelhout
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 1 1 9 4 - 4
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 7 8 6 4 - 0

Gain the knowledge and skills you need for clinical anesthesia practice! Written specifically for nurse anesthetists, Nurse Anesthesia, 7th Edition provides a solid foundatio… Read more

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Gain the knowledge and skills you need for clinical anesthesia practice! Written specifically for nurse anesthetists, Nurse Anesthesia, 7th Edition provides a solid foundation in scientific principles and evidence-based practice. Coverage includes a review of pharmacology, pharmacokinetics and pharmacodynamics, drug receptor concepts, intravenous agents, neuromuscular blocking agents, and more, followed by a discussion of anesthesia equipment and clinical monitoring, preoperative preparation of the patient, and the use of anesthesia for a variety of surgical procedures. From a team of expert authors led by Sass Elisha, Jeremy S. Heiner, and John J. Nagelhout, this text helps you prepare for certification and also provides a key reference for CRNAs to use in daily practice.

Cover image
Title page
Table of Contents
Copyright
Contributors
Foreword
Preface
Unit I. Professional Issues
1. Nurse Anesthesia: A History of Challenge
The Discovery of Modern Anesthesia
Historical Antecedents of the Nurse as an Anesthetist
Anesthesia: Medicine, Nursing, Dentistry, or What?
Organizing Nationally: “We Who Are Most Interested”
World War II and Nurse Anesthetists
A Short-Lived Peace for Nurse Anesthetists and the Nation
The New Age American Health Care: the 1960s
The 1970s
Federal Legislative Initiatives in the 1980s
CRNA Achievements of the 1980s
The Call for Health Care Reform in the 1990s
Doctoral Preparation of Nurse Anesthetists Achieved
Military Anesthesia
International Federation of Nurse Anesthetists
Progress in Anesthesia
Summary
2. Nurse Anesthesia Specialty Practice and Education in the United States
Nurse Anesthesia Educational Requirements
Certified Registered Nurse Anesthetist Practice
AANA Organizational Structure and Function
Summary
3. Patient-Centered Care, Cultural Competence, and Nurse Anesthesia Practice
Health Care Disparities
Patient-Centered Care: What It Is and Why It Is Important
Measurement of Health Care Quality in Anesthesia
Summary
Unit II. Scientific Foundations
4. Nurse Anesthesia Research: Empowering Decision Making Through Evidence-Based Practice
Methods of Knowing
The Nature of Research
The Eight Critical Stages in the Research Process
Evidence-Based Practice: Empowering Decision Making Through Research
Evidence-Based Practice in Nurse Anesthesia
Summary
5. General Principles, Pharmacodynamics, and Drug-Receptor Concepts
Receptor Structure
Drug-Response Equation
Pharmacogenetics
Population Variability
Drug Dose Response
Drug-Receptor Interactions
Drug Antagonism
Summary
6. Pharmacokinetics
Properties That Influence Pharmacokinetic Activity
Other Factors That Influence Pharmacokinetics
Pharmacogenetics and Pharmacogenomics
Summary
7. Pharmacokinetics of Inhalation Anesthetics
Primary Factors Controlling Uptake, Distribution, and Elimination of Anesthetics
Pediatrics
Other Factors
Summary
8. Inhalation Anesthetics
Relationship Between Chemical Structure and Agent Characteristics
Pharmacodynamics
Minimum Alveolar Concentration
Influence of Inhalation Agents on Organs And Systems
Inhalation Anesthetics and Pregnancy
Summary
9. Intravenous Induction Agents
Nonbarbiturate Intravenous Anesthetics
Benzodiazepines
Anesthetic Neurotoxicity
Summary
10. Local Anesthetics
Anatomy of the Peripheral Nerve
Neuron Electrophysiology and the Action Mechanism of Local Anesthetics
Chemical Structure of Local Anesthetics
Pharmacodynamics and Pharmacokinetic Concepts
Local Anesthetic Systemic Toxicity
Clinical Use of Local Anesthetics
Summary
11. Opioid and Nonopioid Analgesics
Opioids
Individual Opioids
Opioid-Sparing Anesthesia
Summary
12. Neuromuscular Blocking Agents, Reversal Agents, and Their Monitoring
History
Monitoring of Neuromuscular Blockade
Depolarizing Agents
Nondepolarizing Agents
Reversal of Neuromuscular Blockade
Cholinesterase Inhibitors
Anticholinergics
Summary
13. Autonomic and Cardiac Pharmacology
Autonomic Drugs—Sympathomimetic Amines
Direct-Acting α-Agonists
Mixed Function Agonists
Selective β2-Agonists
α-Receptor Antagonists
β-Adrenergic Blocking Agents
Statins
Antiplatelet Drugs
Cholinergics
Anticholinergics
Direct Vasodilators
Calcium Channel Blockers
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Receptor Blockers
Anesthesia Management of Patients Taking Angiotensin Axis Blockers
Catecholamine-Depleting Agents
Tyrosine Hydroxylase Inhibitors
Catechol-O-Methyltransferase Inhibitors
Cardiac Glycosides
Management of Specific Diseases
Preoperative Administration of Cardiac Drugs
Summary
14. Additional Drugs of Interest
Perioperative Antibiotics
Antiemetics and Perioperative Nausea and Vomiting
Psychiatric Drugs and Anesthesia
Summary
15. Chemistry and Physics of Anesthesia
General Chemistry: Matter and Energy
Atomic Structure
Molecular Bond Types
Bond Breaking
Organic Compounds
Solubility
Diffusion
Newtonian Physics
Newton’s Laws of Motion
Force
Pressure
Thermodynamics
Energy
Entropy
Temperature
Kinetic Molecular Theory
Gas Laws
Fluid Flow
Waves
Quantum Physics
Electromagnetic Radiation/Matter Interaction
Radiography
Gas Analysis
Pulse Oximetry
Lasers
Summary
Unit III. Technology Related to Anesthesia Practice
16. Anesthesia Equipment
Organization of the Anesthesia Workstation
Supply
Processing
Delivery
Disposal
Risk Management
SUMMARY
17. Clinical Monitoring I: Cardiovascular System
Electrocardiogram Monitoring
Central Venous and Arterial Hemodynamic Measurements
Preload Assessment: Static and Dynamic Indices
Arterial Pressure Monitoring
Transesophageal Echocardiography Monitoring
Summary
18. Clinical Monitoring II: Respiratory and Metabolic Systems
Monitoring Standards
Closed-Claims Analyses
Alarm Fatigue
Systematic Approach to Monitoring
Airway Monitoring
Anesthesia Education and Patient Monitoring
Summary
19. Clinical Monitoring III: Neurologic System
Electroencephalogram
Processed Eeg Waveforms
Monitors For Assessing Cns Blood Flow And Oxygenation
Evoked Potentials
Bispectral Index
Summary
Umit IV. Preoperative Preparation
20. Preoperative Evaluation and Preparation of the Patient
Preanesthesia Assessment Clinic
Chart Review
Patient Interview
Patient Evaluation: Overview of Systems
Diagnostic Testing
Fasting Considerations
American Society of Anesthesiologists Physical Status Classification System
Preventing Operative Errors
Summary
Unit V. Intraoperative Management
21. Fluids, Electrolytes, and Goal-Directed Therapy
Fluid Volume, Types of Fluids, And Overview of Fluid Management
Normal Physiologic Distribution and Regulation of Fluids
Composition and Relative Advantages of Various Intravenous Fluids
Impact of Surgery and Anesthesia on Vascular Flow and Organ Perfusion
Historical Approach to Fluid Management
Perioperative Goal-Directed Fluid Therapy
Electrolyte Balance
summary
22. Blood and Blood Component Therapy
Estimated Blood Volume and Loss
Transfusion Indicators
Patient Blood Management
Conservation Strategies
Compatibility of Transfusion
Emergency Transfusions
Massive Transfusion Protocols
Blood Components
Transfusion Practice Guidelines
Storage of Blood
Ringer Lactate And Blood Transfusions
Blood Transfusion Complications
Summary
23. Positioning for Anesthesia and Surgery
Physiologic Effects of Surgical Positions
Pathophysiology of Nerve Injury
Factors Contributing To Nerve Injuries
Patient-Related Factors Contributing To Nerve Injuries
Perioperative Neuropathies
Brachial Plexus Injuries
Spinal Cord Injury
Postoperative Visual Loss
Other Position-Related Injuries
Surgical Positioning
Closed-Claims Studies
Summary
24. Airway Management
Anatomy and Physiology of the Airway
Airway Evaluation
Tracheal Intubation
Management of the Difficult and Failed Airway
Airway Blocks
Cricoid Pressure
Adjunct Airway Equipment and Techniques
Tracheal Extubation
Complications of Airway Management
Summary
25. Cardiovascular Anatomy, Physiology, Pathophysiology, and Anesthesia Management
Cardiovascular System
Vascular System
Hypertension
Mitral Stenosis
Mitral Regurgitation and Insufficiency
Aortic Stenosis
Aortic Insufficiency
Mitral Valve Prolapse
Cardiomyopathy
Summary
26. Anesthesia for Cardiac Surgery
Anesthetic Management of General Cardiac Surgery
Anesthetic Considerations for Specific Cardiac Diseases and Surgical Procedures
Summary
27. Perioperative Management for Patients With Cardiac Devices
Review of Pacemakers
Review of Implantable Cardioverter Defibrillators
Perioperative Period
Summary
28. Anesthesia for Vascular Surgery
Peripheral Vascular Disease
Abdominal Aortic Aneurysms
Abdominal Aortic Reconstruction
Thoracic Aortic Aneurysms
Aortic Dissection
Descending Thoracic And Thoracoabdominal Aneurysms
Endovascular Aortic Aneurysm Repair
Cerebrovascular Insufficiency And Carotid Endarterectomy
Carotid Artery Angioplasty Stenting
Summary
29. Respiratory Anatomy, Physiology, Pathophysiology, and Anesthesia Management
Anatomy And Physiology of The Respiratory System
Anatomic Structures of the Respiratory System
Mechanics of Breathing
Gas Exchange in The Lungs
Pulmonary Blood Flow
Acid-Base Balance
Control of Breathing
Respiratory System Pathology
Pulmonary Function Testing
Chronic Obstructive Pulmonary Disease
Asthma
Pulmonary Hypertension
Cor Pulmonale
Pulmonary Embolism
Restrictive Pulmonary Diseases
Aspiration Pneumonitis
Acute Respiratory Distress Syndrome
Transfusion-Related Pulmonary Disease
Drug-Induced Pulmonary Disease
Pulmonary Oxygen Toxicity
Autoimmune Disorders
Flail Chest
Pneumothorax
Atelectasis
Pleural Effusion
Skeletal Disorders
Summary
30. Anesthesia for Thoracic Surgery
Preoperative Preparation
Lateral Decubitus Position
One-Lung Ventilation
Anesthetic Management During One-Lung Ventilation
Thoracic Surgical Concerns
Complications After Thoracotomy
Summary
31. Neuroanatomy, Neurophysiology, and Neuroanesthesia
Organization of The Central Nervous System
Anatomy of The Central Nervous System
Peripheral Nervous System
Vasculature of The Central Nervous System
Electrophysiology
Neurotransmitters
Sensory Pathways
Motor Pathways
Neuroanesthesia
Intracranial Pressure
Neurophysiologic Monitoring
Anesthetic Considerations For Specific Procedures
Summary
32. Renal Anatomy, Physiology, Pathophysiology, and Anesthesia Management
Structure of the Kidney
Renal Physiology
Effects of Anesthesia on Normal Renal Function
Acute Kidney Injury
Chronic Kidney Disease
Preoperative Renal Assessment
Anesthetic Management of Patients with Advanced Renal Disease
Intravenous Fluid Management
Cystoscopy
Extracorporeal Shock Wave and Laser Lithotripsy
Percutaneous Nephrolithotomy
Transurethral Resection of the Prostate
Laparoscopic Urologic Surgery
Robotic Urologic Surgery
Renal Transplantation
Open Nephrectomy
Summary
33. Hepatobiliary and Gastrointestinal Disturbances and Anesthesia
Liver Disease
Diseases of The Biliary Tract
Diseases of The Esophagus
Diseases of The Stomach
Pancreatic Disease
Diseases of The Intestinal Tract
Splenic Disease
Carcinoid Tumors And Carcinoid Syndrome
summary
34. Anesthesia for Laparoscopic Surgery
Creation of the Pneumoperitoneum
Physiologic Effects of the Pneumoperitoneum
Cardiovascular Effects
Respiratory Effects
Complications of Laparoscopic Surgery
Anesthetic Management
Postoperative Concerns
The Future of Laparoscopic Surgery
Summary
35. Anesthesia for Robotic Surgery
History of Robotic Surgery
Robotic Systems
General Anesthetic Considerations
Considerations For Surgical Subspecialties
Summary
36. Musculoskeletal System Anatomy, Physiology, Pathophysiology, and Anesthesia Management
Overview of Neuromuscular Transmission
Muscle Physiology
Musculoskeletal Pathophysiology and Anesthesia
Summary
37. The Endocrine System and Anesthesia
General Principles of Endocrine Physiology
Pituitary Gland
Parathyroid Gland
Pancreas
Diabetes Mellitus
Adrenal Glands
Thyroid Gland
Summary
38. Hematology and Anesthesia
The Normal Vessel Wall
Vessel Injury
Cell-Based Theory of Coagulation
Fibrinolytic System
Anesthetic Implications
Specific Disorders
Other Considerations
Summary
39. Anesthesia for Burn Patients
Classification of Burn Injury
Etiologies of Burn Injuries
Treatment of The Burn Patient
Summary
40. Trauma Anesthesia
Etiology of Traumatic Injury
Coordinated Management of Care
Early Evaluation of The Trauma Patient And Common Injury Patterns
Blunt Versus Penetrating Trauma
The Abcds of Trauma Anesthesia
Special Topics In Trauma Anesthesia
Summary
41. Anesthesia for Transplant Surgery and Organ Procurement
History of Organ Transplantation
Renal Transplantation
Pancreas Transplantation
Liver Transplantation
Lung Transplantation
Intestinal Transplantation
Anesthetic Considerations for the Organ Donor
Summary
42. Outpatient Anesthesia
Features of Outpatient Surgery
Patient Selection
Patient Evaluation and Preparation
Premedication
Anesthetic Considerations
Postoperative Considerations
Summary
43. Anesthesia for Ear, Nose, Throat, and Maxillofacial Surgery
Functional Anatomy of The Head And Neck
Preparation And Considerations For Ear, Nose, And Throat Procedures
Specialized Equipment For Ear, Nose, And Throat Procedures
Special Considerations For Ear, Nose, And Throat Procedures
Select Techniques Commonly Used In Ear, Nose, And Throat Procedures
Procedures Involving The Face, Ear, Head, And Neck
Summary
44. Anesthesia for Ophthalmic Procedures
Ophthalmic Anatomy
Pharmacology: Ocular Medications and Anesthetic Agents
Select Ocular Anesthesia Techniques
Ocular Regional Anesthesia
Positive Orbital Pressure
Anesthesia Management
Ophthalmic Anesthesia Complications
Summary
45. Anesthesia for Orthopedics
Selected Comorbidities and Presurgical Conditions
Preoperative Concerns
Arthroscopy
Arthroplasty
Foot and Ankle Surgery
Forearm and Hand Surgery
Spinal Surgery
Special Considerations (Associated Concerns)
Summary
46. The Immune System and Anesthesia
The Immune System
Active And Passive Immunity
Hypersensitivity
Alloimmunity
Autoimmunity
Immunodeficiency Disorders
Cancers Of The Immune System
Surgery And The Immune System
Anesthesia And The Immune System
Anesthetic Management of The Immunocompromised Patient
summary
47. Anesthesia and Laser Surgery
Introduction
Basic Principles of Lasers
Laser Effects on Biologic Tissues
Surgical Lasers
Laser Safety
Surgical Fires
Anesthesia For Laser Procedures
summary
48. Obesity and Anesthesia Practice
Overview
Adipose Tissue
Causes of Obesity
Pathophysiology of Obesity
Pediatric Obesity
Maternal Obesity
Treatment of Obesity
Pharmacologic Considerations
Anesthetic Management: Preanesthetic Evaluation
Anesthetic Management: Preparation
Anesthetic Management: Maintenance
Anesthetic Management: Postoperative Care
Summary
49. Regional Anesthesia: Spinal and Epidural Anesthesia
Applied Anatomy And Physiology of The Central Neuraxis
Spinal Anesthesia
Epidural Anesthesia
Combined Spinal And Epidural Anesthesia
Caudal Anesthesia
Summary
50. Regional Anesthesia: Upper Extremity, Lower Extremity, and Truncal Blocks
Selection of Regional Anesthesia Techniques
Complications of Peripheral Nerve Blockade
BLock Techniques 1
Clinical Anatomy
Block Techniques 2
Summary
51. Obstetric Anesthesia
Anatomic And Physiologic Changes During Normal Pregnancy
Labor And Delivery
Analgesia For Labor And Vaginal Delivery
Anesthesia For Cesarean Delivery
Complications of Regional Anesthesia
Obstetric Complications
Anesthesia For The Pregnant Patient Undergoing A Nonobstetric Procedure
Neonatal Resuscitation
Summary
52. Neonatal Anesthesia
Developmental Considerations
Growth and Development
Anesthetic Pharmacologic Considerations in the Neonate
Drugs Used to Provide Neonatal Anesthesia
Fluid Management
Anesthetic Equipment
Preoperative Assessment
Anesthetic Considerations for Selected Cases
Summary
53. Pediatric Anesthesia
Pediatric Anatomy and Physiology
Pediatric Pharmacologic Considerations
Preoperative Assessment
Anesthetic Management
Postoperative Care
Regional Anesthesia
Outpatient Anesthesia
Pediatric Anesthetic Morbidity and Mortality
Summary
54. Geriatrics and Anesthesia Practice
Preoperative Assessment
Age-Related Physiologic Changes in the Older Adult
Issues of Specific Importance in the Older Adult Preoperative Assessment
Age-Related Pharmacologic Implications in the Older Adult
Comorbidity in the Older Adult
Ethical Issues in the Treatment of the Older Adult
Postoperative Delirium
Postoperative Cognitive Dysfunction
Summary
55. Postanesthesia Recovery
Postanesthesia Care Unit Admission
Anesthesia Report
Initial Postanesthesia Care Unit Assessment
Ongoing Assessment
Discharge From The Postanesthesia Care Unit
Summary
56. Acute Pain: Physiology and Management
Pain
Physiologic Consequences
Pharmacology
Acute Pain Management In Special Populations
Summary
57. Chronic Pain: Physiology and Management
Anatomy and Physiology of Pain
Pain Physiology
Pain Pathophysiology
Types of Chronic Pain
Treating Chronic Pain
Pharmacology
Targeted Pain Management
Age-Related Considerations
Patient-Centered Approach
Failure to Treat Pain
Summary
58. Non–Operating Room Anesthesia
Administration of Anesthesia in Remote Locations
Anesthesia for Specific Procedures in Remote Locations
Remote Anesthetic Monitoring Using Telecommunication Technology
Summary
59. Anesthesia Complications
Mortality in Anesthesia
Morbidity in Anesthesia
Emerging Areas of Anesthetic Morbidity and Mortality
Intraoperative Awareness
Opiate-Induced Respiratory Depression
Sedation and Anesthesia Outside of the Operating Room
Preanesthesia Shared Decision Making as Complication Prevention
Management of Complications
The Second Victim
The Human Factor in Complications
Summary
60. Crisis Resource Management and Patient Safety
Health Care Crises Events
Crisis Resource Management
Developing a Crisis Resource Management Program
Summary
61. Infection Control and Prevention
Introduction
Biology of Disease Transmission and the Anesthesia Work Environment
The Chain of Infection
Standard and Transmission-Based Precautions
Hand Hygiene
Personal Protective Equipment
Safe Injection Practices
Anesthesia Equipment and Environment Disinfection
Airway Management: Considerations Specific to Anesthesia Care
Transmission-Based Precautions
Anesthesia Care and Infection Control Following the Covid-19 Pandemic
Invasive Procedure Infection Control and Prevention
Health Care–Acquired Infections
Surgical Site Infection
Assessing Patient Risks During the Perioperative Phase
Common Surgical Site Infection Care Bundles and the Role of Anesthesia Providers in Preventing/Reducing Perioperative Surgical Site Infections
Health Care Worker Vaccinations and Screening
Health Care Worker Postexposure Prophylaxis
Summary
Index

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Sass Elisha

Jeremy S. Heiner

John J. Nagelhout