Perioperative Medicine

Based on the most current evidence and best practices, Perioperative Medicine: Managing for Outcome, 2nd Edition, is an easy-to-follow, authoritative guide to achieving optimal outcomes in perioperative care. Written and edited by recognized authorities in anesthesiology and surgical critical care, this fully updated edition helps you think critically about complex, long-term issues surrounding the care of the surgical patient, providing decision trees that define strategies to enhance the medical outcome of care.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Acknowledgment
Part I: Introduction and Background
1: Implications of Perioperative Morbidity for Long-Term Outcomes
Abstract
Cardiac Injury
Pulmonary Injury
Neurologic Injury
Renal Injury
Association Versus Causality
Conclusion
2: The Inflammatory Response to Surgery
Introduction
Conclusions
3: The Coagulation Cascade in Perioperative Organ Injury
Abstract
Significance of Perioperative Organ Injury
Current Understanding of Coagulation and the Fibrinolytic Process
How Does Inflammation Interfere With/Change the Coagulation Process?
Perioperative Monitoring of Coagulation
Alteration of Coagulation Status During Perioperative Period
Postoperative Activation of Coagulation
Consequences of Dysregulated Coagulation
Summary and Recommendations
Part II: Preoperative Assessment
4: The Value of Preoperative Assessment
Abstract
Value
Preoperative Assessment Elements
Goals of Preoperative Assessment
Conclusions
5: Perioperative Cardiac Risk Assessment in Noncardiac Surgery
Abstract
Introduction
Preoperative History and Physical Examination
ECG
Metabolic Equivalents
Risk Assessment
Risk Models
Interventions: Preoperative Coronary Revascularization
Percutaneous Coronary Intervention
Coronary Artery Bypass Grafting
Summary
6: Cardiovascular Risk Assessment in Cardiac Surgery
Abstract
Purpose of Risk Assessment Before Cardiac Surgery
Outcome Measurement in Cardiac Surgery
Development of Perioperative Risk Assessment for Cardiac Surgery
Established Risk Assessment Models in Cardiac Surgery
7: Central Nervous System Risk Assessment: Preventing Postoperative Brain Injury
Abstract
Postoperative Delirium
Emergence Delirium
Treatment of Postoperative Delirium After the Immediate Recovery Period
Postoperative Cognitive Dysfunction
Seizure Disorders and Epilepsy
Recent Concussion
Stroke Risk
Prior Stroke
Risk for Hypoxic-Ischemic Injury
Implanted Neurostimulator and Other Devices
8: Risk Assessment and Perioperative Renal Dysfunction
Influence of Surgery and Anesthesia on Renal Perfusion
Patient Characteristics and the Risk of Postoperative Acute Kidney Injury
Surgical Interventions Associated With Substantial Intraoperative Renal Ischemia
Perioperative Testing of Renal Function
Perioperative Renal Risk Scoring Algorithms
Conclusion
9: Pulmonary Risk Assessment
Abstract
Introduction
Epidemiology
Definition
Etiology and Pathophysiology
Preoperative Pulmonary Evaluation for Nonthoracic Surgery
Patient Factors
Physical Examination
Surgical Factors
Preoperative Tests
Risk Prediction Scores
Evaluation Paradigm for Nonthoracic Surgery
Evaluation of the Lung Resection Candidate
Conclusion
10: Hematologic Risk Assessment
Red Blood Cell Transfusion
Hemostasis
Preoperative Risk Assessment
Laboratory Testing
Management of Patients Under Antiplatelet Therapy
Management of Patients on Anticoagulation Therapy
Summary
Part III: Preservation of Organ Function and Prevention and Management of Perioperative Organ Dysfunction
Section 1: Cardiovascular System
11: Prevention of Ischemic Injury in Cardiac Surgery
Abstract
Perioperative Ischemia Prevention Strategies
Intraoperative Ischemia-Prevention Strategies
12: Prevention of Ischemic Injury in Noncardiac Surgery
Abstract
Introduction
Pathophysiology and Natural History of Perioperative Ischemia
Preoperative Optimization
Intraoperative Management
Future Directions in Ischemia Prevention/Management
13: Treatment of Perioperative Ischemia, Infarction, and Ventricular Failure in Cardiac Surgery
Abstract
Perioperative Myocardial Ischemia and Infarction
Perioperative Ventricular Dysfunction and Failure
14: Perioperative Management of Valvular Heart Disease
Abstract
Preoperative Assessment
Preoperative Preparation
Intraoperative Management
Postoperative Management
Specific Valvular Lesions
Summary and Recommendations
15: Prevention and Management of Perioperative Dysrhythmias
Abstract
Introduction
Mechanisms of Arrhythmia Generation
Contributing Factors
Types of Tachyarrhythmias
Bradyarrhythmias
Diagnosis and Medical Therapy for Arrhythmias
Interventions for Cardiac Arrhythmias
Conclusion
Section 2: Renal System
16: Perioperative Fluid Management
Abstract
Overview
Physiological Stressors of Venous and Arterial Volume
Liberal Versus Restrictive Fluid Therapy
Maintaining Normal Intravascular Volume During Perioperative Period
Maintaining Optimal Hemoglobin Levels and Nadir Hematocrit
Laparoscopic Surgery
Emergency General Surgery
Summary: Perioperative Fluid and Hemodynamic Plan
17: Preservation of Renal Function
Abstract
Introduction
Renal Physiology
Diagnosis of Acute Kidney Stress/Injury
Mechanisms of Surgery-Related Acute Renal Injury
Renal Preservation: Best Practices
Summary and Future Directions in Renal Preservation
18: Evaluation and Treatment of Acute Oliguria
Abstract
Pathophysiology
Evaluation of Patients With Oliguria
Treatment
Conclusion
19: Perioperative Management of Renal Failure and Renal Transplant
Abstract
Introduction
Acute Renal Failure
Chronic Renal Failure
Pathophysiology of Chronic Renal Failure
Pharmacology in Chronic Renal Failure
Intraoperative Considerations
Kidney Transplantation
Summary
Section 3: Pulmonary System
20: Prevention and Treatment of Postoperative Pulmonary Complications
Abstract
Introduction
Prevention
Treatment of PPC
Conclusions
Section 4: Central Nervous System
21: Carotid and Intracranial Surgery
Abstract
Anesthesia for Carotid Surgery
Anesthesia for Intracranial Surgery
Procedure-Specific Issues
Management of Intracranial Hypertension
Summary
22: Protecting the Central Nervous System During Cardiac Surgery
Abstract
Introduction
Neurological Injury After Cardiac Surgery with Cardiopulmonary Bypass
Neurologic Injury After Off-pump Coronary Artery Bypass Grafting
Neurological Injury After Transcatheter Aortic Valve Replacement
Neurologic Injury During Thoracic Aortic Surgery
Conclusions
23: Preservation of Spinal Cord Function
Abstract
Introduction
Traumatic Spinal Cord Injury
Paraplegia After Thoracic or Thoracoabdominal Aortic Aneurysm Repair
Spinal Cord Injury From Central Neuraxial Anesthesia and Analgesia
Spinal Cord Injury and Spine Surgery
Anesthetic and Medical Management of the Patient With Existing or Prior Spinal Cord Injury
24: Perioperative Management of Acute Central Nervous System Injury
Abstract
Introduction
Monitoring Neurologic Examination
Mental Status, Cranial Nerves, Motor and Sensorial Function, and Reflexes
Intracranial Hypertension
Factors That Exacerbate Intracranial Hypertension
Two Types of Intracranial Hypertension
Presentation
ICP Monitoring
Waveform Analysis
Treatment of Intracranial Hypertension
Intracranial Hypertension/Cerebral Herniation Treatment Algorithm
Hyperventilation
Hyperosmolar Therapy
Efficacy of HTS for Reduction of ICP
CSF Drainage
CBV Decreasing Drugs
Decompressive Craniectomy
Airway Evaluation and Management
Cardiovascular
Perioperative Management of Adults With Acute Spinal Cord Injury
Section 5: Gastrointestinal System
25: Prevention and Treatment of Gastrointestinal Morbidity
Abstract
Aspiration of Gastric Contents
Postoperative Nausea and Vomiting
Postoperative Ileus
Conclusions
Section 6: Hematology and Coagulation
26: Prevention and Management of Deep Vein Thrombosis and Pulmonary Embolism
Abstract
Pathophysiology
Prevention
Diagnosis
Treatment of Venous Thromboembolism
Complications of Treatment
Reversal of Anticoagulation
Special Considerations
27: Perioperative Management of Bleeding and Transfusion
Abstract
Introduction
Preoperative Assessment of Bleeding Risk
Intraoperative Management
Section 7: Infections
28: Prevention of Perioperative Surgical Site Infection
Abstract
Introduction
Surgical Site Infection
Prevention of Surgical Site Infection
Prion Disease and the Operating Room
Section 8: Obstetric
29: Perioperative Protection of the Pregnant Woman
Abstract
Introduction
Causes of Maternal Morbidity and Mortality
Anesthetic Causes of Morbidity and Mortality
Thromboembolism and Thrombophilia
Hypertensive Disorders of Pregnancy
Cardiac Disease in Pregnancy
Pulmonary Hypertension
Reduction of Perioperative Anesthesia Risk
Obesity
Airway Management
Peripartum and Postpartum Hemorrhage
30: Preservation of Fetal Viability During Noncardiac Surgery
Abstract
Should the Pregnant Patient Undergoing Surgery During Pregnancy Be Tilted?
Does Anesthesia During Pregnancy Have an Effect on the Fetus?
Management of Hypotension During Surgery on Pregnant Patients
Monitoring Fetal Heart Rate During Nonobstetric Surgery
Do Pregnant Patients Undergoing Nonobstetric Surgery Have Full Stomachs?
Use of 100% Oxygen During Nonobstetric Surgery
Should Hyperventilation Be Avoided in Pregnant Patients Undergoing Nonobstetric Surgery?
Risk of Preterm Labor or Miscarriage in Nonobstetric Surgery
Conclusions
Part IV: Early Postoperative Care
Section 9: Specific Operations
31: Cardiac Surgery
Abstract
Transport and Initial Assessment
Respiratory Management
Stabilization Phase
Postoperative Complications
Gastrointestinal Complications
Fast-Tracking
Summary
32: General Thoracic Surgery
Abstract
Preoperative Pulmonary Function Assessment
Prevention of Postoperative Pulmonary Complications
Prevention of Arrhythmia
Enhanced Recovery After Thoracic Surgery
33: Major Abdominal Surgery
Abstract
Introduction
Pulmonary Management
Fluid Management
Postoperative Nausea and Vomiting and Ileus
Nutrition
Surgical Site Infections
Conclusion
34: Major Orthopedic Surgery
Abstract
Care After Total Joint Arthroplasty
Care After Spine Surgery
Conclusions
35: Solid Organ Transplantation
Abstract
Types of Donors
Immunosuppression
Liver Transplantation
Kidney Transplantation
Pancreas Transplantation
Intestinal Transplantation
Heart Transplantation
Lung Transplantation
Infections
Conclusion
36: Multisystem Trauma
Abstract
Resuscitation
Special Considerations in Trauma
Other Postinjury Considerations
Summary
37: Neurosurgery
Abstract
Neurologic Support
Respiratory Support
Cardiovascular Support
Fluid and Electrolyte Support
Hematologic Support
Gastrointestinal and Endocrine Support
Infectious Disease
Section 10: Specific Problems
38: Sepsis and Septic Shock
Abstract
Introduction
History
Epidemiology
Pathophysiology
Clinical Features
Future Directions
Conclusions
39: Acute Respiratory Failure
Abstract
Definition
Hypoxemic Respiratory Failure
Hypercapnic Respiratory Failure
Acute Respiratory Failure in the Perioperative Patient
Principles of Management
Summary
40: Endocrine and Electrolyte Disorders
Abstract
Introduction
Endocrine Dysfunction
Conclusion
41: Improving Pain and Outcomes in the Perioperative Setting
Abstract
The Growth of Unidimensional Pain Assessment Tools
The Importance of Multidimensional Assessment
An Increased Focus on Perioperative Functional Outcomes
Future Directions: Risk Predictive Tools and Personalized Pain Medicine
Clinical Phenotyping: Cluster Analysis
Genetic Risks Predictors
Biomarkers of Risk: Cytokine Profiling
Optimization
Summary and Recommendations
42: Postoperative Cognitive Dysfunction and Delirium
Abstract
Introduction
Conclusions
43: Role of Palliative Care
Abstract
Defining Palliative Care
The Multidisciplinary Team
Palliative Care and Hospice
Primary versus Specialist Palliative Care
Advance Care Planning
Symptom Management
End-of-life Care
Impact on Outcomes
Palliative Care for the Surgical Patient
Disease-Specific Palliative Care
Palliative Care for Non-cancer Patients
Pediatrics
Conclusions
Part V: Conflicting Outcomes Value Based Care
44: Economic Analysis of Perioperative Optimization
Abstract
Health-Care Interventions as Investments
Health-Care Economic Studies Offer Challenges
Costs—What Exactly Do We Mean?
Benefits: Clinical Effectiveness and Utility
Types of Economic Analysis
Conclusion
45: Improving Health-Care Quality Through Measurement
Abstract
What Is Quality in Health-Care?
Why Improve Quality?
Framework for Measuring Quality
Development and Endorsement of Quality Measures
Uses of Quality Measures
Quality Improvement
Accreditation and Verification
Public Reporting and Transparency
Value-Based Health-Care and Paying for Performance
Conclusions
46: Delivering Value Based Care: The UK Perspective
Abstract
Introduction: Rising Demand and Resource Constraint
The Cost and Value of Surgery
Shared Decision Making
Preoperative Optimization
Intraoperative Care
Postoperative Care and Recovery
Conclusions
47: Transitions From Hospital to Home
Abstract
Paths from Hospital to Home
Factors Associated with Nonhome Discharge
Planning for Transitions
Costs of Failed Transitions
Ensuring the Transition
Putting it all Together
Index

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Perioperative Medicine

Managing for Outcome

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Mark F. Newman

Lee A. Fleisher

Clifford Ko

Michael (Monty) Mythen