Cover -- Half-title -- Title -- Copyright -- Contents -- Preface -- Contributors -- 1 Perioperative management of cardiovascular disease -- Introduction -- Assessment via history, examination and investigations -- Cardiac risk and surgery -- Cardiac risk and anaesthesia -- Ischaemic heart disease and angina -- Hypertension -- Cardiac failure -- Cardiac dysrhythmias -- Valvular heart disease -- Pacemakers -- Conclusion -- Further reading -- 2 Perioperative management of respiratory disease -- Common diseases -- Asthma -- Chronic obstructive pulmonary disease (COPD) -- Others -- History -- Examination and investigations -- Pulmonary function tests (in average adult) -- Preoperative optimisation -- Anaesthesia -- Postoperative period -- Further reading -- 3 Perioperative care of children -- Introduction -- Preoperative preparation -- Assessment -- Common problems -- Coughs and colds -- Asthma -- Heart murmurs -- Premedication -- Postoperative care of children -- Fluid management -- Postoperative analgesia -- Further reading -- 4 Perioperative management of the obese patient -- Definitions -- Cardiovascular system -- Respiratory system -- Gastrointestinal system -- Pharmacokinetics -- Preoperative assessment -- Preoperative investigations -- Premedication -- Intraoperative management -- Positioning -- Regional anaesthesia -- Postoperative period -- Obese patients in the intensive care unit -- Further reading -- 5 Perioperative management of the elderly patient -- Introduction -- Physiology of ageing -- Cardiovascular system -- Changes -- Implications -- Respiratory system -- Changes -- Implications -- Central nervous system -- Changes -- Implications -- Peripheral nervous system and neuromuscular function -- Changes -- Implications -- Autonomic nervous system -- Changes -- Implications -- Renal system -- Changes -- Body composition and metabolism.

Changes -- Implications -- Haematological and immune systems -- Changes -- Implications -- Drugs -- Pharmacokinetics -- Preoperative assessment -- Postoperative care -- Hypertension -- Causes -- Hypotension -- Causes -- Further reading -- 6 Perioperative management of emergency surgery -- Preoperative phase -- Fluid status -- Normal volumes -- Deficits -- Why? -- How much fluid? -- Full stomach -- Full stomach management -- Fitness for anaesthesia -- Pregnancy -- Perioperative phase -- Preparation -- Analgesia -- Induction of anaesthesia -- Failed intubation -- Postoperative phase -- NCEPOD -- Further reading -- 7 Perioperative fluid management -- Volume -- Electrolytes -- Sodium -- Potassium -- Recommended reading -- 8 Perioperative management of coagulation -- The coagulation pathway -- 1. Fibrinolytic system -- 2. Antithrombin III -- Coagulation studies -- Anticoagulants -- Blood products -- Common coagulation problems -- The patient on warfarin -- Liver disease -- Disseminated intravascular coagulopathy (DIC) -- Massive transfusion -- Others -- 9 Perioperative management of steroid therapy -- Introduction -- The importance of adequate cortisol production -- Cortisol production and steroid therapy -- Preoperative assessment -- How much additional steroids are required? -- Further reading -- 10 Perioperative management of endocrine disease -- Disorders of the thyroid gland -- Goitres -- Hypothyroidism (myxoedema) -- Hyperthyroidism (thyrotoxicosis) -- Disorders of the parathyroid glands -- Primary, secondary and pseudo-hyperparathyroidism -- Hypoparathyroidism -- Disorders of the pituitary gland -- Acromegaly -- Diabetes insipidus (DI) -- Hypopituitarism -- Disorders of the adrenal glands -- Adrenocortical insufficiency -- Cushing's syndrome -- Secretagogue tumours or APUDomas -- Multiple endocrine neoplasia/adenomatosis (MEN) -- Further reading.

11 Perioperative management of diabetes -- Introduction -- Preoperative preparation -- Preoperative assessment -- Preoperative planning -- How to manage diabetes during surgery -- (i) Basic principles during the operation -- (ii) Diet only therapy -- (iii) Patients on tablet only therapy -- (iv) Patients on insulin therapy -- (v) Glucose-insulin infusions -- 1. Intravenous dextrose with sliding scale insulin pump -- 2. GKI (Glucose Potassium Insulin) infusion -- (vi) Changing from intravenous to subcutaneous insulin -- Discharge of patient following surgery -- Further reading -- 12 Causes and treatment of aspiration -- Introduction -- Pathophysiology -- History and examination -- Investigations -- Management -- Outcome -- Further reading -- 13 Transfusion and blood products -- What is allogenic blood? -- Who should blood be given to? -- How to give blood -- Adverse effects -- Transfusion reactions -- Immunomodulation -- Transmission of infectious diseases -- Pulmonary dysfunction -- Massive transfusion -- Strategies for avoiding blood transfusion -- Artificial 'blood' -- Further reading -- 14 The critically ill patient -- Introduction -- Diagnosis of the critically ill patient -- Patients at risk of critical illness -- Antecedents and signs of critical illness -- Initial management of the critically ill patient -- Immediate assessment -- A - Airway -- B - Breathing -- C - Circulation -- D - Dysfunction of the CNS -- E - Exposure -- Full assessment -- Transfer to ICU -- Initial care on the ICU -- a. Sedation and analgesia -- b. Ventilation -- c. Cardiovascular support -- d. Other measures -- Care of the ICU patient's family -- Further reading -- 15 Inotropes -- Introduction -- Sympathomimetics -- Endogenous catecholamines -- Synthetic agents -- Other inotropes -- Phosphodiesterase inhibitors -- Drugs increasing intracellular calcium.

Practical application -- Choice of inotrope -- Further reading -- 16 Arterial blood gases -- Assessment of the adequacy of ventilation/gas exchange -- Ventilation -- Oxygenation -- Acid-base balance -- Respiratory disturbances -- Metabolic disturbances -- Further reading -- 17 Drugs used in anaesthesia and sedation -- Anaesthetic agents -- Volatile agents -- Effects on other systems -- Nitrous oxide/N2O -- Intravenous anaesthetics -- Neuromuscular blocking agents -- Drugs and the autonomic nervous system -- Opioids -- Sedation -- Further reading -- 18 Local anaesthetics -- Pharmacology -- 1. Structure -- 2. Mechanism of action -- A. Speed of onset -- B. Potency -- C. Duration of action -- Complications of local anaesthetics -- A. Systemic toxicity -- B. Allergic reactions -- C. Local infection -- D. Trauma -- E. Unintentional blockade of other nerves -- F. Methaemoglobinaemia -- Commonly used local anaesthetic agents -- Lignocaine (Lidocaine) -- Bupivacaine -- EMLA® cream -- AMETOP® -- Further reading -- 19 Monitoring used in the perioperative period -- Introduction -- Clinical observation -- Oxygenation status -- Cardiovascular system -- Respiratory function and airway patency -- Renal function -- Basic monitoring devices -- Pulse oximetry -- Description -- Indications -- Disadvantages -- Non-invasive blood pressure monitoring -- Description -- Indications -- Disadvantages -- Electrocardiography -- Description -- Indications -- Disadvantages -- Temperature measurement -- Description -- Indications -- Capnometry -- Description -- Invasive pressure monitoring -- General principles -- Invasive arterial pressure monitoring -- Description -- Indications -- Central venous pressure monitoring -- Description -- Indications -- Problems -- The pulmonary artery catheter -- Description -- Indications -- Further reading.

20 Deep vein thrombosis and thrombo-embolic disease prophylaxis -- Background -- Diagnosis -- Differential diagnosis -- Complications -- Prophylaxis -- Risk factors for venous thrombo-embolism -- Background factors -- Disease or surgical procedure -- Classification of risk of DVT and PE for hospital patients -- Prophylactic measures related to risk -- Differences between unfractionated and low molecular weight heparin -- Treatment -- Further reading -- 21 Postoperative nausea and vomiting -- Physiology -- Pharmacology -- Antimuscarinic drugs -- Dopamine antagonists -- Phenothiazines -- Butyrophenones -- Benzamides -- Domperidone -- 5HT receptor antagonists -- Corticosteroids -- The prevention and treatment of PONV -- Patient factors -- Surgical factors -- Anaesthetic factors -- A multi-modal approach to PONV -- Further reading -- 22 The management of perioperative pain -- The pain pathways -- Methods of treating postoperative pain -- Modes of action and side effects of analgesic drugs -- Assessment of pain severity -- Pain intensity scoring -- Considerations when prescribing analgesics for postoperative pain -- Further reading -- 23 High dependency and recovery units -- Need for immediate access to anaesthetic assistance -- Monitors -- Respiratory complications -- 1. Airway obstruction -- 2. Hypoxaemia -- 3. Hypoventilation -- Circulatory complications -- 1. Hypotension -- 2. Hypertension -- 3. Arrhythmias -- Conscious level -- Analgesia -- Management of nausea and vomiting -- Communication is essential -- Special considerations -- Day surgery -- Paediatrics -- Further reading -- 24 Postoperative hypoxia -- Aetiology, assessment and management -- The postoperative patient -- Increased oxygen demand in the postoperative patient -- Decreased oxygen supply in the postoperative patient -- Assessment and management of the hypoxic postoperative patient.

Causes of postoperative hypoxia.