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270 ● AnesthesiA student survivAl Guide Table 17.3 Ischemic cardiac disease. Disease Definition Coronary artery disease narrowing of coronary arteries from atherosclerosis ischemic heart disease Myocardial O 2 demand not met by coronary blood flow Acute coronary syndrome / myocardial ischemia term that includes any of the life threatening conditions below which represent acute myocardial ischemia Angina pectoris Myocardial ischemia with chest discomfort stable angina exercise induced chronic angina pectoris unstable angina Myocardial ischemia at rest or with minimal exertion variant angina discomfort from coronary artery vasospasm non-st-segment elevation myocardial infarction (nsteMi) st-segment elevation myocardial infarction (steMi) Myocardial ischemia from a partially occlusive coronary thrombus Myocardial ischemia from a totally occlusive coronary thrombus also indicated in patients with unstable angina or Non ST Segment Elevation MI (NSTEMI) who are in shock, and in STEMI. Coronary artery bypass graft surgery is used for patients with >50% stenosis of the left main coronary artery and patients with two and three vessel disease who have either reduced left ventricular contractile function or diabetes. Valvular Disease Common causes for mitral stenosis (MS) are rheumatic fever and congenital stenosis. It can lead to pulmonary edema and left ventricular failure. Mild MS is a valve area of £2 cm 2 and critical MS is £1 cm 2 . Treatment is medical therapy, balloon mitral valvuloplasty, open mitral commissurotomy, or mitral valve replacement. During anesthesia it is important to maintain sinus rhythm (atrial kick provides 40% of ventricular filling), preload, stroke volume, and low/normal heart rate (to allow time for filling). Avoid drops in SVR and prevent increases in PVR by preventing hypoxia, hypercarbia, and acidosis. Mitral regurgitation (MR) can be caused by myxomatous mitral valve disease resulting in prolapse, ruptured chordae, or flail segments of the mitral valve. Other causes of mitral regurgitation include ischemic heart disease, which can result in left ventricular enlargement, mitral annulus abnormalities, or necrosis of papillary muscle structures. Other less common etiologies include endocarditis, rheumatic heart disease, and hypertrophic cardiomyopathy. Acute MR leads to high pulmonary pressures and pulmonary congestion, whereas chronic MR can
PhysiOlOGy And AnesthesiA fOr CArdiAC And thOrACiC surGery ● 271 be more compensated with lower pulmonary artery pressures but a low cardiac output. Medical treatment includes inotropic agents and vasodilators. Surgical treatment is with mitral valve repair or replacement. During anesthesia, avoid myocardial depression and increases in SVR (will worsen regurgitation), while maintaining a normal/high heart rate (less time for regurgitation). Aortic stenosis (AS) is caused by senile degenerative disease, congenital bicuspid aortic valve, or rheumatic heart disease. Male gender, hypercholesterolemia, and smoking are risk factors. Blood flow is obstructed during systole which results in concentric left ventricular hypertrophy. There is a fixed stroke volume and filling is 40% dependent on the atrial kick. Mild AS is a valve area
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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The Preoperative Patient Evaluation
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THe PreoPerATIve PATIenT evAluATIon
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Therapy-based indications radiation
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Table 8.5 Formulation an anesthetic
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Anesthesia Equipment and Monitors B
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AnesthesiA eQuiPment And mOnitOrs
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● ● ● AnesthesiA eQuiPment An
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Table 11.3 Data typically obtained
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Anesthetic Techniques: General, Sed
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Anesthetic techniques: GenerAl, sed
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Table 12.2 Stages of general anesth
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Table 12.6 (continued) Anesthetic t
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Perioperative Acute and Chronic Pai
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PerioPerAtive ACute And ChroniC PAi
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Chapter 27 Postoperative Anesthesia
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POstOPerAtive AnesthesiA CAre unit
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Introduction to Critical Care Bever
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introduction to criticAl cAre ● 4
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SVR = [(MAP - CVP)/CO] ´ 80 introd
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● ● ● ● ● introduction to
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Chapter 29 Professionalism, Safety,
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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