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Abbreviations

Symbols ± plus or minus ? questionable ∼ approximately ° C degrees centigrade ° F degrees Fahrenheit 1° primary; first degree 2° secondary; second degree 3° third degree ΔΔ delta gap A A-a alveolar-arterial AA arachidonic acid AAA abdominal aortic aneurysm A-aDO 2 alveolar-arterial oxygen delivery AAT alpha 1 -antitrypsin; automatic atrial tachycardia AAP American Academy of Pediatrics abd abdomen; abdominal ABG arterial blood gas ABI…

Pediatric Events

Acute Hemorrhage in the Pediatric Patient Definition Acute hemorrhage in the pediatric patient is the acute loss of a large volume of blood and can be either overt or covert. Overt Can be visualized in the surgical field, on sponges, or in the suction containers Covert No outward sign of bleeding (e.g., retroperitoneal hemorrhage, blood loss hidden in the drapes) Etiology Bleeding from a large blood…

Obstetric Events

Amniotic Fluid Embolism (Anaphylactoid Syndrome of Pregnancy) Definition Amniotic fluid embolism (AFE) is thought to be an abnormal maternal immune response to fetal antigens when the maternal-fetal immunological barrier is breached during labor, pregnancy termination, or shortly after delivery. It results in a triad of hypoxemia, hypotension, and coagulopathy. Etiology The etiology of cardiovascular collapse is not clear but may result from activation of a cascade…

Cardiac Anesthesia Events

Cardiac Laceration Definition A cardiac laceration is an inadvertent incision into the right atrium, right ventricle, great vessels, or vein graft(s) during sternotomy or resulting from other traumatic injury Etiology Adhesion of scar tissue and/or myocardial tissue to the sternum CPR Penetrating chest trauma (e.g., gunshot wound, knife injury, MVA) Typical Situations Patients who have had a previous sternotomy (“redo” sternotomy), especially those with vein grafts…

Equipment Events

Carbon Monoxide in the Anesthesia Circuit Definition Carbon monoxide present in the anesthesia breathing circuit Etiology Carbon monoxide is produced by degradation of volatile anesthetic agents in the presence of desiccated CO 2 absorbents The amount of carbon monoxide produced depends upon the degree of desiccation, temperature in the breathing circuit, volatile anesthetic concentration, and fresh gas flow Production is greatest with absorbents containing strong bases…

Neurologic Events

Central Nervous System Injury Definition A central nervous system (CNS) injury is any new neurologic deficit presenting after anesthesia that can be localized anatomically to the brain or spinal cord. Etiology Cerebral ischemia Global Focal Cerebral hemorrhage Cerebral embolism Increased ICP Hypoglycemia Direct trauma or surgical injury to CNS Injection of neurolytic solutions into the cerebrospinal fluid or into CNS Epidural or subdural hematoma Typical Situations…

Metabolic Events

Addisonian Crisis (Acute Adrenal Insufficiency) Definition Addisonian crisis, or acute adrenal insufficiency, is a relative or absolute deficiency of adrenal corticosteroid hormones resulting in hemodynamic or other compromise. Etiology Primary adrenal insufficiency (Addison disease) Secondary adrenal insufficiency (pituitary disease) Failure of hormone synthesis Etomidate inhibits adrenal corticosteroid synthesis (should be used with caution in critically ill patients) Typical Situations Patients who have primary or secondary adrenal…

Pulmonary Events

Airway Burn Definition Airway burn is thermal or chemical injury to the mucosa of the airway between the mouth and the alveoli. Etiology Inhalation of hot gases From breathing circuit Direct exposure to fire Exposure to smoke or toxic gases Ignition of the ETT during laser surgery Typical Situations Patients with acute burns Laser surgery in the pharynx, the larynx, or the tracheobronchial tree Tracheostomy using…

Cardiovascular Events

Acute Coronary Syndrome Definition Acute coronary syndrome (ACS) is an acute imbalance between myocardial O 2 supply and demand that leads to ischemia and infarction. ACS is classified as being unstable angina, non–ST segment elevation myocardial infarction (NSTEMI), or STEMI. Etiology Total or subtotal coronary artery occlusion Primary ACS results from coronary artery occlusion Plaque disruption with thrombus formation Coronary vasospasm from endothelial dysfunction or drug…

Generic Events

Acute Hemorrhage Definition Acute hemorrhage is the acute loss of a large volume of blood and can be either overt or covert. Overt Can be visualized in the surgical field, on sponges, or in the suction containers Covert No outward sign of bleeding (e.g., retroperitoneal or intrapleural hemorrhage, blood loss hidden in drapes) Etiology Bleeding from large blood vessel (artery or vein) secondary to surgical manipulation,…

Debriefing

What Is Debriefing? The concept of debriefing after a challenging event has become commonplace in the health care simulation world, but debriefing as we describe it in this chapter includes a systematic discussion of any immersive event, real or simulated. We explore the debriefing process and its potential to spur reflection and affect learning across a broad spectrum of clinical activities and environments. Although simulations are…

Teaching Anesthesia Crisis Resource Management

This book attempts to lay out the principles of learning and teaching anesthesia crisis resource management (ACRM) in anesthesia practice. Although the principles can be summarized in a book, and even represented on a single reminder graphic, mastering and honing these skills requires various sorts of hands-on practice. Some practice can occur during real patient care. Principles of teamwork and decision making are exercised in almost…

Principles of Anesthesia Crisis Resource Management

Resource Management Is a Crucial Skill for Anesthesia Professionals The concept of resource management is borrowed directly from the domain of aviation. It should be no surprise that we turned to other complex, dynamic systems such as aviation and nuclear power for useful parallels. These industries have directly addressed issues of optimal crisis management performance by the humans “in the loop.” In the case of military…

Fundamentals of Dynamic Decision Making in Anesthesia

This book is about decision making and crisis management in anesthesia. What is a crisis ? It is “a time of great danger or trouble whose outcome decides whether possible bad consequences will follow.” For our purposes, the time of great danger is typically a brief, intense event or sequence of events that offers a clear and present danger to the patient. Almost by definition, a…

Future Advances in Neuroanesthesia

Numerous clinical situations remain as problematic issues which continue to vex neuroanesthesiologists and neurointensivists as they work to optimize outcomes for their patients. Nascent research ongoing at this time may provide a window to a future approach to these problems. In this chapter we review many of these new research areas and speculate as to how they may eventually translate to clinical care of neurosurgical patients…

Information Management and Technology

Introduction Harvey Cushing, an American neurosurgeon, recognized that the perioperative environment required detailed data collection. Working with colleagues in the 1890s, he is credited with bringing the intraoperative anesthetic record into popular use. This early pen and paper example of information technology in the operating room has been in existence for over 100 years and is the primary method of documenting anesthesia care for many practitioners.…

The Pituitary Gland and Associated Pathologic States

The pituitary is often referred to as the “master” hormonal gland because of the innumerable influences it exerts over physiologic homeostasis. It is located in the sella turcica, a bony cavity at the base of the skull in close proximity to the undersurface of the brain. Pituita , latin for phlegm, was the source of the name of the pituitary gland, implying early perceptions of its…

Ethical Considerations in the Care of Patients with Neurosurgical Disease

Acknowledgment The authors express their gratitude to previous authors of this chapter: Alex John London, Angelique Reitsma, and Connie Zuckerman. Research advances and heightened clinical capabilities have enabled those who care for patients with neurosurgical disease to make great strides toward restoring the health and well- being of such patients and reducing morbidity and mortality. Yet for every new technologic advance and clinical application, new issues…

Anesthesia for Neurosurgery in the Pregnant Patient

Introduction Neurologic disorders requiring surgical intervention during pregnancy are not uncommon, and many anesthesiologists eventually encounter a pregnant woman in need of a neurosurgical procedure. The anesthetic management of such patients can be complicated by the physiologic changes that occur during pregnancy. These changes might require adjustments in anesthetic management that would be inappropriate for a nonpregnant patient with the same neurosurgical condition. Maternal well-being must…

Chronic Pain Management

Introduction The successful treatment of pain in the preoperative patient is important with all surgical specialties, but in many instances it is more critical in the patient undergoing neurosurgical or spinal based surgeries. Attention to the hemodynamic swings associated with pain in the immediate postoperative period, with mindful management, sets the patient up for an expedited and uncomplicated recovery. Acute pain can commonly increase sympathetic tone,…