Anesthesia Student Survival Guide A Case-Based Approach Jesse M. Ehrenfeld Richard D. Urman B. Scott Segal Editors Third Edition 123 Anesthesia Student Survival Guide Jesse M. Ehrenfeld Richard D. Urman • B. Scott Segal Editors Anesthesia Student Survival Guide A Case-Based Approach Third Edition Editors Jesse M. Ehrenfeld Richard D. Urman Department of Anesthesiology Department of Anesthesiology Medical College of Wisconsin Perioperative and Pain Medicine Milwaukee, WI, USA Brigham & Women’s Hospital Harvard Medical School B. Scott Segal Boston, MA, USA Department of Anesthesiology Wake Forest University School of Medicine Winston Salem, NC, USA ISBN 978-3-030-98674-2 ISBN 978-3-030-98675-9 (eBook) https://doi.org/10.1007/978-3-030-98675-9 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword to the Third Edition As an anesthesiologist and Harvard medical student educator, I have met few people more dedicated to the art of teaching and the experience of learning than Drs. Ehrenfeld, Urman, and Segal. Now I have the privilege of introducing the third edition of their exciting new textbook of anesthesiology written especially for medical students. Anesthesia Student Survival Guide: A Case- Based Approach is a wonderful synthesis of the broad scope and key concepts of anesthesiology. The book is presented in an easy format for a medical student to learn and absorb during the typi- cally brief 1–4-week exposure to the specialty. Students come to their anesthesia rotation with a basic science foundation and little to no familiarity with the types of clinical challenges facing the anesthesiologist. They typically have even less exposure to the thinking and behaviors required to success- fully meet those challenges. Drs. Ehrenfeld, Urman, and Segal have created a textbook which not only delivers concise and logi- cal anesthesiology content but also demonstrates the connection between the student’s basic knowledge of anatomy, physiology, pharmacology, and the clinical art and science of anesthesiology. The educational format enables students to move up the taxon- omy of learning behaviors by helping them synthesize and apply what they learn to sample cases. The book begins with a historic overview and introduction of the anesthesiology specialty. In addition, the introduction instructs students on how to practically get the most out of their anesthesia rotation. The pharmacologic principles on intravenous and inhala- v vi Foreword to the Third Edition tional anesthetic agents, local anesthetics, muscle relaxants, and sedatives are presented in the next five chapters. The all-important preoperative patient evaluation, airway evaluation, and monitor- ing are covered in the following three chapters. Pharmacology is then put together with the patient history and physiology to help the student understand the choice of anesthetic techniques, fluid management, common anesthetic problems, and subspecialty management. Postoperative PACU and ICU care with an emphasis on pain and organ system derangement are reviewed. Lastly, the book discusses the complex and contempo- rary topics of professionalism, teamwork, quality assurance, and ethics in anesthesia in a clear and forthright manner. Drs. Ehrenfeld, Urman, and Segal clarify and solidify periop- erative concepts with their use of a case-based study tool at the end of each chapter. The cases are practical and help to contextu- alize anesthesia principles. As a medical student educator, I know that case studies are indeed one of the best strategies to help stu- dents transition from the classroom to the clinical environment. These cases are illustrative, thought provoking, and a stimulus for further discussion that will help students gain the most from their exposure to anesthesia practice. The topics are judiciously chosen and are widely applicable to patient care both within and outside the operating room. It will help all students develop the necessary skills to become better perioperative caregivers. This third reiteration of the book is a valuable guide for all students, whether or not they become anes- thesiologists, because they will come away with an appreciation of how anesthesiologists apply their understanding of human physiology and pharmacology to provide safe and effective medi- cal care to patients. Boston, MA, USA Jennifer M. McSweeney, MD Preface We are excited to introduce the new and updated third edition of Anesthesia Student Survival Guide: A Case-Based Approach. As with the prior editions, our goal was to provide a concise, easy-to- use, and up-to-date introduction to the practice of anesthesiology. This book is unique in many ways and is primarily intended for students during their anesthesia rotation, although junior residents may also find it useful. The book covers both basic and advanced topics and includes case studies designed to help apply theoretical knowledge to real patient situations. In order to get the most out of the book, when reading a particular section, we suggest you first read the case associated with the section, followed by the chapter, and then try to answer the questions in the case on your own before reading our sample answer. This will help you focus your reading and retain as much of the key information as possi- ble because each case will provide a context in which the material is presented. As educators, we are indebted to generations of students at our respective institutions – Medical College of Wisconsin, Harvard Medical School, and Wake Forest School of Medicine – who inspired us to write this practical “survival” guide, and we are thankful for the support and expertise of our contributors. We would also like to thank Dr. Joseph Garfield for his out- standing editorial contributions to the previous editions, and Mr. Judd Harly Taback and Dr. Zina Matlyuk for their tireless support, encouragement, and guidance. Finally, a special thanks to our families. vii viii Preface As you discover the exciting world of anesthesiology, we hope that you find our updated edition of the Anesthesia Student Sur- vival Guide : A Case-Based Approach an essential tool! Milwaukee, WI, USA Jesse M. Ehrenfeld Boston, MA, USA Richard D. Urman Winston-Salem, NC, USA B. Scott Segal Prior Edition Contributors We would like to thank the authors who contributed to the first two editions of Anesthesia Student Survival Guide: A Case-Based Approach Basem Abdelmalak Jerome M. Adams Joshua H. Atkins Rana Badr Sheila Ryan Barnett Shawn T. Beaman Tarun Bhalla Ruma Bose Elifce O. Cosar Francis X. Dillon D. John Doyle Patrick J. Forte Amit Gupta Emily M. Hayden Mark A. Hoeft Stephen M. Howell Adam Kingeter Payal Kohli David C. Lai Alvaro A. Macias Matthew D. McEvoy Brian C. McLean ix x Prior Edition Contributors David G. Metro R. Dean Nava Jr Beverly J. Newhouse Arti Ori Anthony R. Plunkett Stephen D. Pratt Amanda J. Rhee Thomas M. Romanelli Mario Serafini Timothy J. Shiveley Linda Shore-Lesserson Roy G. Soto Jenna L. Walters Andrea Westman John W. Wolfe