Yearbook of Anesthesiology 8 1st Edition by Sehgal, Raminder, Trikha, Anjan ISBN 935270603X 978-9352706037

1 How to (Critically) Read A Research Article Narayana Yaddanapudi 1

Why we read? 1

Screening 1

Mechanics 3

Mental attitude 3

General tips 3

Organization of a research article 4

2 Residual Neuromuscular Block Prerana Nirav Shah Anita Saran 8

Incidence 9

Consequences of residual block 9

Preventive strategies 9

Assessment of residual neuromuscular block 10

Differential sensitivity of different muscle groups 10

Reversal drugs 11

Treatment of residual neuromuscular blockade 12

3 Positioning Hazards: Role and Responsibilities of an Anesthesiologist Sukhminder Jit Singh Bajwa Rashi Sarna 15

Anesthesia and positioning strategies 15

Significance of patient positioning 16

Prerequisites and precautions during positioning 16

Supine position 17

Lawn chair position 18

Frog-leg position 19

The Trendelenburg position 19

Reverse Trendelenburg position (head-up tilt) 20

Lithotomy position 20

Beach chair and sitting position 21

Prone position 23

Lateral decubitus position 25

Robotic surgery positioning 26

Anesthesia and critical care procedures 27

4 The Stress Response to Surgery and the Effect of Anesthesia Munisha Agarwal 33

The endocrine response to surgery 33

Metabolic effects of the endocrine response 35

Hematological and immunological effects of the stress response 36

Stimuli for the stress response 37

Effect of anesthesia on the stress response to surgery 38

Evaluation of the stress response 40

Modulators of the surgical stress response 40

5 Cardiac Risk Assessment Ramachandran Gopinath Monu Yadav 46

Approach to perioperative cardiac assessment for coronary artery disease patient 46

Assessment of the risk of perioperative MACE 47

Assessment of exercise and functional capacity 52

Ancillary preoperative cardiac testing 54

6 Anesthetic Implications of Pulmonary Hypertension Mukul Chandra Kapoor 58

Classification 58

Pathophysiology 60

Clinical features 61

Diagnostic evaluation 61

Medical therapy 63

Anesthetic implications 64

7 Cerebral Oxygenation Kiran Jangra Kajal Jain 70

Applied physics 70

Monitoring of cerebral oxygenation 71

8 Neuroprotection under Anesthesia Krishna HM 79

Surgeries where neuroprotection is relevant 79

Physiologically-based neuroprotection 80

Pharmacologically-based neuroprotection 81

Surgical strategies for neuroprotection 83

Neuroprotection in select procedures 83

9 End of Life Care in India: Problems and Solutions Raj Kumar Mani Shiv Kumar Iyer 86

Evolution of biomedical ethics 87

Need to bring ethical principles to the bedside 89

Shared decision-making model 89

Need to separate foregoing of life support from euthanasia 90

Contemporary practices across the world 91

Improving the legal framework for end of life care 91

Rationalizing the clinical decision-making and implementation 92

How to identify contexts for end of life care 92

Foregoing of life support pathway 93

End of life care improvement initiatives in India 94

10 Organophosphorus Poisoning Salkat Sengupta Chandrshish Chakravarty 98

Chemical description 99

Pathophysiology 99

Organophosphorus poisoning 99

Confirmation of diagnosis 101

Management of organopbosphorus poisoning 102

Intermediate syndrome 105

Organophosphorus-Induced delayed peripheral neuropathy 105

Factors affecting outcome in organophosphorus poisoning 106

11 Apneic Oxygenation Pradeep Bhatia Swati Chhabra 110

Physiology of apneic oxygenation 110

Preoxygenation and apneic oxygenation 111

Techniques for apneic oxygenation 112

Clinical applications of apneic oxygenation 116

Limitations of apneic oxygenation 118

Step-by-step approach to apneic oxygenation 119

12 Noninvasive Hemodynamic Monitoring Muralidhar Kanchi 123

Types of hemodynamic monitors 124

Noninvasive measurement of arterial blood pressure 124

Determination of filling pressures 126

Determination of cardiac output 127

13 Role of Extraglottic Devices in Children Deepanjali Pant Archna Koul 140

Indications 140

Types of extraglottic devices 141

Significance of anatomical differences from adults 141

Factors affecting correct placement 158

Selection of correct size or device 162

Removal of supraglottic airway devices 162

Extraglottic devices in pediatric trauma 163

Extraglottic devices and difficult airway 163

Neonates and extraglottic devices 165

Extraglottic devices in oral surgery 166

Nasopharyngeal airway versus laryngeal mask airway® for bronchoscopy 166

Advantages and disadvantages of extraglottic devices over endotracheal tube 167

Current overall status of extraglottic devices 167

14 Intraoperative Fluid Management for Neonates Ekta Rai 172

Historical facts 172

Neonatal physiology 172

Fluid loss 174

Coagulation system 174

Dextrose: To give or not to give 175

Surgical loss (isotonic fluid) 176

Role of colloids 176

Assessment of the hemodynamic status intraoperatively 177

Blood transfusion 177

Hyponatremia 178

15 Role of Stem Cell Therapy for Pain Naueen Malhotra 182

Stem cells 182

Low back pain 183

Osteoarthritis 184

Musculoskeletal diseases 186

Neuropathic pain 188

Risks and potential adverse effects of stem cell therapy 189

16 Postoperative Pulmonary Complications Following Noncardiac Surgery Faiza Ahmed Talukdar Priyam Saikia 192

Incidence 192

Impact of postoperative pulmonary complications 193

Pathophysiology 193

Risk factors for postoperative pulmonary complications 195

Predictive models for postoperative pulmonary complications 196

Preventive and management strategies 196

Anesthesia technique 198

17 Anesthetic Considerations in Patients with Chronic Kidney Disease Raj Tobin Gautam Girotra 205

Classification and etiology 205

Preoperative evaluation and risk stratification 207

Cardiovascular concerns 209

Pulmonary concerns 210

Gastrointestinal concerns 210

Anemia and coagulation disorders 210

Immune status concerns (surgical site infections and sepsis) 211

Glycemic control 211

Management of concurrent drugs 212

General perioperative considerations 212

Intraoperative considerations 213

Postoperative concerns 217

18 Massive Blood Transfusion Mritunjay Kumar Ankur Sharma 221

Definitions 221

Pathophysiology of massive blood toss 221

Massive blood transfusion guidelines 222

Massive transfusion protocols 222

Blood component ratios 224

Considerations during massive blood transfusion 224

Damage control resuscitation 226

Special population 226

When to terminate massive transfusion protocol 227

Limitations of massive transfusion protocols 227

Recent developments 227

Hemostatic agents 229

Blood salvage techniques 231

Artificial oxygen carriers 231

Complications of massive transfusion 233

Appendix 1 Sample massive transfusion protocol for trauma 240

19 Clinical Practice Guidelines: Medical Tool or a Legal Noose? Subrahmanyan Radkakrishna 242

Do we need guidelines? 243

What makes a good guideline? 243

Designing patient care in a hospital and using guidelines 244

Human error and the law: Can guidelines help minimize human error? 246

Bolan principle and the Bolitho test and their impact on clinical guidelines 247

Building a legal defense as a department 247

Safe working in an anesthetic department 248

Using the wisdom of the wise 249

20 Role of Continuous Renal Replacement Therapy in the Management of Acute Kidney Injury Kapil Dev Soni Richa Aggarwal 252

Acute kidney injury and renal replacement therapy 254

Modalities for renal replacement therapy 254

Timing of renal replacement therapy 255

Vascular access 256

Intermittent hemodialysis 256

Continuous renal replacement therapy 257

21 Truncal Blocks for Chronic Pain Management Ashok Jadon Rajendra Sahoo 267

Classification of truncal blocks 267

Thoracic truncal blocks 267

Abdominal truncal blocks 273

Pathophysiology of chronic pain and mechanism of action of truncal block 275

Complications of truncal blocks 276

22 Military Trauma Care: A Review of Current Concepts Brigadier Rangraj Setlur Colonel Nikahat Jahan 281

Assessment of blood loss 282

Quantum of fluid resuscitation 282

Choice of fluid 283

Stabilizing the clot 283

Other changes 285

23 What’s New in Obstetric Anesthesia and Analgesia Jan McConachie Ramesh Vedagiri Sai 288

Labor analgesia 288

Ultrasound for obstetric anesthesia 289

Spinal anesthesia induced hypotension 290

General anesthesia 293

Oxytocin 296

Maternal hemorrhage 297

24 Failed Epidural Block Deep Arora Deepak Pahwa 303

Definition 303

Incidence 304

Epidural anesthesia technique and relevant anatomy 304

Factors contributing to failure of epidural 306

Prediction of epidural failure 311

Prevention of epidural failure 311

Management of a tailed epidural block 314

25 Journal Scan Sunanda Gupta Aparna Sinha Ratender K Singh Susheela Taxak Pramod Kohli 321

Journal Scan 1 Sunanda Gupta 321

Journal Scan 2 Apama Sinha 324

Journal Scan 3 Ratender K Singh 328

Journal Scan 4 Susheela Taxak 330

Journal Scan 5 Pramod Kohli 334

Index 337