Cover -- Title Page -- Copyright -- Dedication -- Contributors -- Preface -- Acknowledgments -- Contents -- SECTION I: CARDIOVASCULAR PHYSIOLOGY AND PHARMACOLOGY -- 1. Cardiovascular Physiology: A Primer -- Introduction -- Embryologic development of the heart -- Electrical conduction -- Cardiac myocyte -- Sarcomere -- Organization of myocytes -- Length-tension relationship -- A heart chamber and external work -- The chamber wall -- Atria -- Ventricle -- Preload and compliance -- Ventricular work -- Starling curve -- Myocardial oxygen consumption -- Control systems -- The cardiovascular control system -- Stretch receptors: Pressure sensors -- Atrial baroreceptors -- Arterial baroreceptors -- Effectors and physiologic reserves for the healthy individual -- The cardiovascular system integration -- Effect of anesthesia providers and our pharmacology on the cardiovascular system -- The surgical patient -- The anesthetic choice -- Treating the cause: Goal-directed therapy -- 2. Cardiovascular Drugs -- Introduction -- Drug dosage calculations -- Vasoactive inotrope scoring -- Drug receptor interactions -- Receptor activation -- Pharmacogenetics and genomics -- Guidelines for prevention and treatment of cardiovascular disease -- CAD -- CHF -- Hypertension -- Atrial fibrillation prophylaxis -- Resuscitation of patients in cardiac arrest after cardiac surgery -- Resuscitation after cardiopulmonary arrest -- Vasopressors -- (Sa(B-Adrenergic receptor pharmacology -- Vasopressin pharmacology and agonists -- Angiotensin II -- Positive inotropic drugs -- Treatment of low CO -- cAMP-dependent agents -- cAMP-independent agents -- (Sb(B-Adrenergic receptor-blocking drugs -- Actions -- Advantages of (Sb(B-adrenergic-blocking drugs -- Disadvantages -- Distinguishing features of (Sb(B-blockers -- Clinical use -- Vasodilator drugs -- Comparison -- Specific agents.

Calcium channel blockers -- General considerations -- Clinical effects common to all CCBs -- Specific intravenous agents -- Pharmacologic control of HR and rhythm -- Overview of antiarrhythmic medications -- Supraventricular arrhythmias -- Diuretics -- Actions -- Adverse effects -- Specific drugs -- Pulmonary hypertension -- SECTION II: GENERAL APPROACH TO CARDIOTHORACIC ANESTHESIA -- 3. The Cardiac Surgical Patient -- Introduction -- Patient presentation -- Clinical perioperative risk assessment-multifactorial risk indices -- Functional status -- Genomic contributions to cardiac risk assessment -- Risk associated with surgical problems and procedures -- Preoperative medical management of cardiovascular disease -- Myocardial ischemia -- Congestive heart failure -- Dysrhythmias -- Hypertension -- Cerebrovascular disease -- Noninvasive cardiac imaging -- Echocardiography -- Preoperative testing for myocardial ischemia -- Cardiac catheterization -- Overview -- Assessment of coronary anatomy -- Assessment of left ventricular function -- Assessment of valvular function -- Interventional cardiac catheterization -- Percutaneous coronary intervention (PCI) -- Preoperative management of patients with prior interventional procedures -- Management of preoperative medications -- (Sb(B-Adrenergic blockers -- Statins (HMG-CoA inhibitors) -- Anticoagulant and antithrombotic medication -- Antihypertensives -- Antidysrhythmics -- 4. Monitoring the Cardiac Surgical Patient -- Introduction -- Cardiovascular monitors -- Electrocardiogram (ECG) -- Intermittent noninvasive blood pressure (BP) monitors -- Physics and technical aspects for accurate intravascular pressure measurements -- Arterial catheterization -- Central venous pressure (CVP) -- Pulmonary artery catheter (PAC) -- Cardiac output (CO) -- Echocardiography -- Temperature.

Indications: Cardiopulmonary bypass (CPB) and hypothermia -- Sites of measurement -- Risks of temperature monitoring -- Recommendations for temperature monitoring -- Renal function -- Indications for monitoring -- Urinary catheter -- Electrolytes -- Acute kidney injury (AKI) -- Neurologic function -- General considerations -- Indications for monitoring neurologic function -- Physiologic and metabolic monitoring -- Monitors of central nervous system (CNS) electrical activity -- Monitors of regional cerebral metabolic function -- Near-infrared spectroscopy (NIRS) and cerebral oximetry -- Monitors of CNS embolic events -- Monitors of splanchnic perfusion and venous function -- Cardiac surgical procedures with special monitoring considerations -- Off-pump coronary artery bypass (OPCAB) -- OPCAB monitoring -- Deep hypothermic circulatory arrest (DHCA) -- Thoracoabdominal aortic aneurysm (TAAA) -- Additional resources -- 5. Transesophageal Echocardiography -- Basic principles of ultrasound imaging -- Basic principles of Doppler echocardiography -- Doppler echocardiography -- The Bernoulli equation -- Modes of cardiac ultrasound imaging -- M-mode echocardiography -- Two-dimensional (2D) echocardiography -- Pulsed-wave Doppler (PWD) -- Continuous-wave Doppler (CWD) -- Color-flow Doppler (CFD) -- Tissue Doppler -- Indications for transesophageal echocardiography (TEE) during cardiac surgery -- Safety, contraindications, and risk of TEE -- Preoperative screening -- TEE probe insertion and manipulation -- Complications of TEE -- Intraoperative TEE examination -- Probe insertion -- Probe manipulation -- Machine settings -- TEE views -- Examination of specific structures -- Monitoring applications of TEE -- Assessing preload -- Measuring intracardiac pressures -- Measuring cardiac output -- Detecting myocardial ischemia -- Intracardiac air.

TEE for specific types of surgery -- Coronary artery bypass grafting (CABG) -- Valve repair surgery -- Valve replacement surgery -- Surgery for congenital heart disease -- Surgery for infective endocarditis -- Surgery for hypertrophic obstructive cardiomyopathy -- Thoracic aortic surgery -- Transplantation surgery -- Ventricular assist device implantation -- Minimally invasive cardiac surgery -- Transcatheter valve interventions -- Three-dimensional (3D) echocardiography -- Fundamental limitations of ultrasound imaging -- Computed rendering of 2D images into 3D -- Real-time insonation of a volume of tissue -- 3D image display and manipulation -- 6. Induction of Anesthesia and Precardiopulmonary Bypass Management -- Introduction -- Premedication -- Preinduction period -- Basic monitors -- Invasive monitors -- Clinical tips -- Last-minute checks -- Induction -- Attenuation of hemodynamic responses -- Guiding principles -- Anticipated difficult intubation -- Drugs and pharmacology for induction of anesthesia -- Opioids -- Other intravenous (IV) anesthetic agents -- Inhalational agents -- Muscle relaxants -- Applications of old drugs in sick patients -- Inhalational induction in very sick patients -- Immediate postinduction period -- Management of events between anesthetic induction and cardiopulmonary bypass (CPB) -- General principles -- Preincision -- Incision -- Opening the sternum -- During and after sternal spreading -- Concerns with cardiac reoperation ("redo heart") -- Concerns with urgent or emergent cardiac operation -- Internal mammary artery (IMA) and radial artery dissection -- Sympathetic nerve dissection -- Perioperative stress response -- Treatment of hemodynamic changes -- Preparation for cardiopulmonary bypass -- 7. Management of Cardiopulmonary Bypass -- Preparations for cardiopulmonary bypass (CPB).

Assembling and checking the CPB circuit -- Anesthesiologist's pre-CPB checklist -- Management of arterial and venous cannulation -- Commencement of CPB -- Establishing "full flow" -- Initial CPB checklist -- Cessation of ventilation and lung management -- Monitoring -- Adequacy of perfusion -- Typical CPB sequence -- Typical coronary artery bypass graft (CABG) operation -- Typical aortic valve replacement (or repair) operation -- Typical mitral valve replacement (or repair) operation -- Typical combined procedures -- Maintenance of CPB -- Anesthesia -- Hemodynamic management -- Fluid management and hemodilution -- Management of anticoagulation -- Temperature management -- ECG management -- Myocardial protection -- Arterial blood gas and acid-base management -- Management of serum electrolytes -- Management of blood glucose -- Rewarming, aortic cross-clamp release, and preparation for weaning -- Rewarming -- Release of aortic cross-clamp -- Preparation for weaning from CPB -- Organ protection during CPB -- Renal protection -- Brain protection -- Myocardial protection -- Inflammatory response to CPB -- Lung protection -- Splanchnic and gastrointestinal protection -- Prevention and management of adverse events, complications, and catastrophes associated with CPB -- Malposition of arterial cannula -- Reversed cannulation -- Obstruction to venous return -- High pressure in the arterial pump line -- Massive gas embolism -- Failure of oxygen supply -- Pump or oxygenator failure -- Clotted oxygenator or circuit -- Dislodgement of cannula or tubing rupture -- Heater-cooler malfunction -- Minimally invasive surgical techniques requiring CPB -- Port-access surgery -- Minithoracotomy -- Minimally invasive mitral valve surgery -- Minimally invasive aortic valve surgery -- Choice of cardioplegia -- Management of unusual or rare conditions affecting bypass.

Sickle cell trait and disease.

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Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2021. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.