Smith and Aitkenhead’s Textbook of Anaesthesia Content Strategist: Jeremy Bowes Content Development Specialists: Mike Parkinson and Alexandra Mortimer Project Manager: Sukanthi Sukumar Designer: Christian Bilbow Illustration Manager: Jennifer Rose Illustrator: Graeme Chambers Marketing Manager: Deborah Watkins Smith and Aitkenhead’s Textbook of Anaesthesia Sixth Edition ALAN R. AITKENHEAD Emeritus Professor of Anaesthesia Division of Anaesthesia and Intensive Care Queen's Medical Centre Nottingham, UK IAIN K. MOPPETT Associate Professor and Honorary Consultant Division of Anaesthesia and Intensive Care Queen's Medical Centre Nottingham, UK JONATHAN P. THOMPSON Senior Lecturer/Hon Consultant in Anaesthesia and Critical Care University of Leicester and UHL NHS Trust Leicester Royal Infirmary Leicester, UK © 2013, Elsevier Limited. All rights reserved. First edition 1985 Second edition 1990 Third edition 1996 Fourth edition 2001 Fifth edition 2007 The right of A.R. Aitkenhead, I.K. Moppett and J.P. Thompson to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-7020-4192-1 / IE 978-0-8089-2429-6 Ebook ISBN: 978-0-7020-5112-8 The Publisher's policy is to use paper manufactured from sustainable forests Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 CONTENTS PREFACE ........................................................ix 10 DRUGS USED IN RENAL DISEASE .........168 JUSTIAAN C. SWANEVELDER LIST OF CONTRIBUTORS ...............................xi 11 METABOLISM, THE STRESS RESPONSE 1 GENERAL PRINCIPLES TO SURGERY AND PERIOPERATIVE OF PHARMACOLOGY ...............................1 THERMOREGULATION ........................180 ALAN R. AITKENHEAD CHARLES D. DEAKIN 2 INHALATIONAL ANAESTHETIC AGENTS .................................................14 12 FLUID, ELECTROLYTE AND ACID–BASE BALANCE .............................................199 MARY C. MUSHAMBI GARETH WILLIAMS 3 INTRAVENOUS ANAESTHETIC AGENTS .................................................37 13 HAEMATOLOGICAL DISORDERS ALAN R. AITKENHEAD AND BLOOD TRANSFUSION ................216 MARTIN BEED 4 LOCAL ANAESTHETIC AGENTS ..............56 GRAEME A. MCLEOD n TIM G. HALES 14 BASIC PHYSICS FOR THE 5 ANALGESIC DRUGS ................................69 ANAESTHETIST ....................................236 PATRICK MAGEE LESLEY A. COLVIN 6 MUSCLE FUNCTION AND 15 ANAESTHETIC APPARATUS ..................262 NEUROMUSCULAR BLOCKADE .............87 MARY C. MUSHAMBI n SATYA FRANCIS JENNIFER M. HUNTER 16 CLINICAL MEASUREMENT AND 7 SEDATIVE AND ANXIOLYTIC MONITORING ......................................312 DRUGS .................................................105 SIMON SCOTT MATTHEW WILES 17 PREOPERATIVE ASSESSMENT AND 8 DRUGS ACTING ON THE PREMEDICATION .................................357 CARDIOVASCULAR SYSTEM .................116 IAIN K. MOPPETT n ALAN R. AITKENHEAD JONATHAN P. THOMPSON 9 DRUGS ACTING ON THE RESPIRATORY 18 INTERCURRENT DISEASE AND SYSTEM ................................................155 ANAESTHESIA ......................................377 ANDREW LUMB n SIMON FLOOD SUSAN NIMMO n GRAHAM R. NIMMO v vi CONTENTS 19 CONSENT AND INFORMATION 32 NEUROSURGICAL ANAESTHESIA .........640 FOR PATIENTS .....................................422 MICHAEL H. NATHANSON IAIN K. MOPPETT n ALAN R. AITKENHEAD 33 ANAESTHESIA FOR THORACIC 20 THE OPERATING THEATRE SURGERY ..............................................657 ENVIRONMENT ....................................428 DAVID J.R. DUTHIE ALAN R. AITKENHEAD 34 ANAESTHESIA FOR CARDIAC 21 THE PRACTICAL CONDUCT SURGERY ..............................................674 OF ANAESTHESIA .................................444 ANDREW KLEIN n JOSEPH E. ARROWSMITH DAVID FELL n DAVID KIRKBRIDE 35 OBSTETRIC ANAESTHESIA AND 22 MANAGEMENT OF THE DIFFICULT ANALGESIA ..........................................690 AIRWAY ................................................462 MELANIE DAVIES n DAVID G. BOGOD TIM COOK n TOM SIMPSON 36 PAEDIATRIC ANAESTHESIA ..................731 23 MANAGEMENT OF THE HIGH-RISK ERIC DE MELO SURGICAL PATIENT ..............................497 37 EMERGENCY ANAESTHESIA .................751 JONATHAN WILSON RICHARD GRIFFITHS n JOHN DELOUGHRY 24 LOCAL ANAESTHETIC TECHNIQUES....514 38 ANAESTHESIA OUTSIDE THE DAVID M. COVENTRY OPERATING THEATRE .........................769 25 ANAESTHESIA FOR THE BARIATRIC SALLY HANCOCK PATIENT ...............................................550 39 ANAESTHESIA FOR THE PATIENT NICHOLAS REYNOLDS WITH A TRANSPLANTED 26 DAY-CASE ANAESTHESIA .....................560 ORGAN ................................................784 JEREMY A. LANGTON CHRISTOPHER SNOWDEN 27 ANAESTHESIA FOR GYNAECOLOGICAL 40 POSTOPERATIVE CARE ........................794 AND GENITOURINARY SURGERY .........568 ALAN R. AITKENHEAD MARTIN BEED 41 POSTOPERATIVE PAIN .........................822 28 ANAESTHESIA FOR ORTHOPAEDIC K. ELAINE TIGHE SURGERY ..............................................578 42 POSTOPERATIVE NAUSEA JONATHAN G. HARDMAN n NIGEL M. BEDFORTH AND VOMITING ...................................843 29 ANAESTHESIA FOR ENT, CAMERON WEIR MAXILLOFACIAL AND DENTAL SURGERY ..............................................590 43 COMPLICATIONS DURING ANAESTHESIA ......................................853 NICHOLAS J. CHESSHIRE JONATHAN G. HARDMAN n NIGEL M. BEDFORTH 30 OPHTHALMIC ANAESTHESIA ...............601 CHANDRA KUMAR n SEAN WILLIAMSON 44 QUALITY AND SAFETY IN ANAESTHESIA .................................887 31 ANAESTHESIA FOR VASCULAR, RAVI P. MAHAJAN n IAIN K. MOPPETT ENDOCRINE AND PLASTIC SURGERY ..............................................620 45 THE INTENSIVE CARE UNIT .................902 JONATHAN P. THOMPSON ANDREW BODENHAM n LORNA EYRE CONTENTS vii 46 MANAGEMENT OF CHRONIC PAIN .....932 Appendix B DATA, STATISTICS BEVERLY J. COLLETT n MARGARET BONE AND CLINICAL TRIALS .........................974 IAIN K. MOPPETT 47 RESUSCITATION ..................................948 JERRY P. NOLAN Appendix C CLINICAL DATA ...................996 GERRIE VAN DER WALT n HANNAH KING Appendix A TRAINING AND ASSESSMENT IN ANAESTHESIA .................................966 LIAM BRENNAN Intentionally left as blank PREFACE T In addition, we have rearranged the order of chapters he objective of the sixth edition of Textbook of into a more logical format. Anaesthesia remains the same as that of previous edi- We asked a number of senior, experienced authors tions, namely to provide a concise, easy-to-read text with expertise in their subject to modify or completely for novices in anaesthesia and an essential resource re-write their contributions. We have also recruited 25 for those preparing for the Primary Examinations new authors to ensure the invigoration of the text by of the Royal College of Anaesthetists. Candidates fresh younger minds. We are grateful to all the authors for these examinations require an extensive knowl- for their contributions and we also thank our review- edge of the basic sciences underpinning anaesthe- ers and readers who have made helpful suggestions, sia, critical care and pain management, and the many of which have influenced the planning of the clinical knowledge and skills expected in those who new edition. We are also grateful to the publishers who have completed at least 12-18 months in a full-time have cooperated in our desire to make fundamental training post. changes. In preparing the present edition, there have been We hope that the sixth edition will be as popular many significant modifications. The title has been as previous editions and remain the book of choice changed to ‘Smith and Aitkenhead’s Textbook of for trainees embarking on a career in anaesthesia. Anaesthesia’ to reflect the enormous contributions of Although this book is aimed primarily at the novice Professor Graham Smith to the first five editions. Two trainee, we are aware that many anaesthetists study- new editors have joined the editorial team to replace ing for the Final FRCA examinations use Textbook of Professors Smith and Rowbotham. After extensive and Anaesthesia when revising the basics; we hope that careful review, we felt that it was essential to continue this will continue. We are also aware that the book is to cover in detail the basic sciences which have direct used by trainee anaesthetists in many countries other and close clinical relevance. Indeed, without this in- than the UK; of course, the training needs are the formation, it is not possible to understand the clinical same although the examination structures differ. We material described in the book. We have introduced also believe that this is more than a book suitable for new chapters dealing with consent and information examination preparation; it continues to be a practi- for patients, management of the difficult airway, man- cal guide for all anaesthetists and other healthcare agement of the high-risk patient, anaesthesia for ab- professionals involved in the care of patients in the dominal surgery and in the obese patient, anaesthetic perioperative period. considerations in transplant patients, safety and qual- ity improvement, resuscitation, and education and A.R. Aitkenhead, Nottingham training. We have also combined the subjects of clini- I.K. Moppett, Nottingham cal measurement and monitoring into a single chapter. J.P. Thompson, Leicester ix