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2018 morgan mikhail’s clinical anesthesiology 6th ed

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Contents
ChapterAuthors
Contributors
ResearchandReview
Foreword
Preface

1ThePracticeofAnesthesiology
SECTION

I

AnestheticEquipment&Monitors

2TheOperatingRoomEnvironment
CharlesE.Cowles,Jr.,MD,MBA,FASA

3BreathingSystems
4TheAnesthesiaWorkstation
5CardiovascularMonitoring
6NoncardiovascularMonitoring
SECTION

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II

ClinicalPharmacology

7PharmacologicalPrinciples
8InhalationAnesthetics
9IntravenousAnesthetics
10AnalgesicAgents
11NeuromuscularBlockingAgents
12CholinesteraseInhibitors&OtherPharmacologicalAntagonists
toNeuromuscularBlockingAgents

13AnticholinergicDrugs
14AdrenergicAgonists&Antagonists
15HypotensiveAgents
16LocalAnesthetics
17AdjunctstoAnesthesia
SECTION

III

AnestheticManagement

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18PreoperativeAssessment,Premedication,&Perioperative
Documentation

19AirwayManagement
20CardiovascularPhysiology&Anesthesia
21AnesthesiaforPatientswithCardiovascularDisease
22AnesthesiaforCardiovascularSurgery
23RespiratoryPhysiology&Anesthesia
24AnesthesiaforPatientswithRespiratoryDisease
25AnesthesiaforThoracicSurgery
26Neurophysiology&Anesthesia
27AnesthesiaforNeurosurgery
28AnesthesiaforPatientswithNeurological&PsychiatricDiseases
29AnesthesiaforPatientswithNeuromuscularDisease
30KidneyPhysiology&Anesthesia
31AnesthesiaforPatientswithKidneyDisease
32AnesthesiaforGenitourinarySurgery
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33HepaticPhysiology&Anesthesia
MichaelRamsay,MD,FRCA

34AnesthesiaforPatientswithLiverDisease
MichaelRamsay,MD,FRCA

35AnesthesiaforPatientswithEndocrineDisease
36AnesthesiaforOphthalmicSurgery
37AnesthesiaforOtolaryngology–Head&NeckSurgery
38AnesthesiaforOrthopedicSurgery
EdwardR.Mariano,MD,MAS

39AnesthesiaforTrauma&EmergencySurgery
BrianP.McGlinch,MD

40Maternal&FetalPhysiology&Anesthesia
MichaelA.Frölich,MD,MS

41ObstetricAnesthesia
MichaelA.Frölich,MD,MS

42PediatricAnesthesia
43GeriatricAnesthesia
44Ambulatory&Non–OperatingRoomAnesthesia
SECTION

RegionalAnesthesia&Pain
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IV

Management

45Spinal,Epidural,&CaudalBlocks
46PeripheralNerveBlocks
SarahJ.Madison,MDandBrianM.Ilfeld,MD,MS(Clinical
Investigation)

47ChronicPainManagement
BruceM.Vrooman,MD,MS,FIPPandRichardW.Rosenquist,MD

48EnhancedRecoveryProtocols&OptimizationofPerioperative
Outcomes
GabrieleBaldini,MD,MScandTimothyMiller,MBChBFRCA

SECTION

V

Perioperative&CriticalCare
Medicine

49ManagementofPatientswithFluid&ElectrolyteDisturbances
50Acid–BaseManagement
51FluidManagement&BloodComponentTherapy
52Thermoregulation,Hypothermia,&MalignantHyperthermia
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53NutritioninPerioperative&CriticalCare
54AnestheticComplications
55CardiopulmonaryResuscitation
N.MartinGiesecke,MDandGeorgeW.Williams,MD,FASA,FCCP

56PostanesthesiaCare
57CommonClinicalConcernsinCriticalCareMedicine
58InhalationTherapy&MechanicalVentilationinthePACU&
ICU

59Safety,Quality,&PerformanceImprovement
Index

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ChapterAuthors
GabrieleBaldini,MD,MSc
AssociateProfessor
MedicalDirector,MontrealGeneralHospitalPreoperativeCentre
DepartmentofAnesthesia
McGillUniversityHealthCentre
MontrealGeneralHospital
Montreal,Quebec,Canada

JohnF.ButterworthIV,MD
ProfessorandChairman
DepartmentofAnesthesiology
VirginiaCommonwealthUniversitySchoolofMedicine
VCUHealthSystem
Richmond,Virginia

CharlesE.Cowles,Jr.,MD,MBA,FASA
AssociateProfessor/AssistantClinicalDirector
DepartmentofAnesthesiologyandPerioperativeMedicine
UniversityofTexasMDAndersonCancerCenter
Houston,Texas

MichaelA.Frölich,MD,MS
ProfessorandAssociateViceChairforResearch
DepartmentofAnesthesiologyandPerioperativeMedicine
UniversityofAlabamaatBirmingham
Birmingham,Alabama

N.MartinGiesecke,M.D.
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ProfessorandViceChairmanforAdministrativeAffairs
DepartmentofAnesthesiology
McGovernMedicalSchool
UniversityofTexasHealthScienceCenteratHouston
Houston,Texas

BrianM.Ilfeld,MD,MS(ClinicalInvestigation)
ProfessorofAnesthesiology,InResidence
DivisionofRegionalAnesthesiaandPainMedicine
DepartmentofAnesthesiology
UniversityofCaliforniaatSanDiego
SanDiego,California

DavidC.Mackey,MD
Professor
DepartmentofAnesthesiologyandPerioperativeMedicine
UniversityofTexasMDAndersonCancerCenter
Houston,Texas

SarahMadison,MD
AssistantProfessor
DepartmentofAnesthesiology,Perioperative&PainMedicine
StanfordUniversity
Stanford,California

EdwardR.Mariano,MD,MAS
Professor
DepartmentofAnesthesiology,Perioperative&PainMedicine
StanfordUniversitySchoolofMedicine
Chief,Anesthesiology&PerioperativeCareService
AssociateChiefofStaff,InpatientSurgicalServices
VeteransAffairsPaloAltoHealthCareSystem
PaloAlto,California

BrianP.McGlinch,M.D.

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AssistantProfessor
DepartmentofAnesthesiology
UniversityofMinnesota
Minneapolis,Minnesota
Colonel,MedicalCorps,UnitedStatesArmyReserve
CommandSurgeon
84thTrainingCommand
FortKnox,Kentucky

TimothyMiller,MBChBFRCA
AssociateProfessor
Chief,DivisionofGeneral,VascularandTransplantAnesthesia
DepartmentofAnesthesiology
DukeUniversitySchoolofMedicine
Durham,NorthCarolina

MichaelRamsay,MD,FRCA
Chairman,DepartmentofAnesthesiology
BaylorUniversityMedicalCenter
BaylorScottandWhiteHealthCareSystem
Professor
TexasA&MUniversityHealthCareFaculty
Dallas,Texas

RichardW.Rosenquist,MD
Chairman,DepartmentofPainManagement
ClevelandClinic
Cleveland,Ohio

BruceM.Vrooman,MD,MS,FIPP
Chief,SectionofPainMedicine
Dartmouth-HitchcockMedicalCenter
AssociateProfessorofAnesthesiology
GeiselSchoolofMedicineatDartmouth
Lebanon,NewHampshire

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JohnD.Wasnick,MD,MPH
StevenL.BerkEndowedChairforExcellenceinMedicine
ProfessorandChair
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
SchoolofMedicine
Lubbock,Texas

GeorgeW.Williams,MD,FASA,FCCP
ViceChairforCriticalCareMedicine
AssociateProfessorofAnesthesiologyandNeurosurgery
ProgramDirector,CriticalCareMedicineFellowship
UniversityofTexasHealthScienceCenteratHouston–McGovernMedical
School
Houston,Texas

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Contributors
KallolChaudhuri,MD,PhD
Professor
DepartmentofAnesthesia
WestVirginiaUniversitySchoolofMedicine
Morgantown,WestVirginia

SwapnaChaudhuri,MD,PhD
Professor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

LydiaConlay,MD
Professor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

JohannesDeRiese,MD
AssistantProfessor
DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

SuzanneN.Northcutt,MD
AssociateProfessor
DepartmentofAnesthesia

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TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

AschrafN.Farag,MD
AssistantProfessor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

PranavShah,MD
AssistantProfessor
DepartmentofAnesthesiology
VCUSchoolofMedicine
Richmond,Virginia

RobertJohnston,MD
AssociateProfessor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

SabryKhalil,MD
AssistantProfessor
DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

SanfordLittwin,MD
AssistantProfessor
DepartmentofAnesthesiology
St.Luke’sRooseveltHospitalCenterandColumbiaUniversityCollegeof
PhysiciansandSurgeons
NewYork,NewYork

AlinaNicoara,MD

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AssociateProfessor
DepartmentofAnesthesiology
DukeUniversityMedicalCenter
Durham,NorthCarolina

NitinParikh,MD
AssociateProfessor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

CooperW.Phillips,MD
AssistantProfessor
DepartmentofAnesthesiology
UTSouthwesternMedicalCenter
Dallas,Texas

ElizabethR.Rivas,MD
AssistantProfessor
DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

BettinaSchmitz,MD,PhD
AssociateProfessor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

ChristianeVogt-Harenkamp,MD,PhD
AssistantProfessor
DepartmentofAnesthesia
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

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DeniseJ.Wedel,MD
ProfessorofAnesthesiology
MayoClinic
Rochester,Minnesota

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ResearchandReview
ChaseClanton,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

AaronDarais,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityMedicalCenter
Lubbock,Texas

JacquelineE.Geier,MD
FormerlyResident,DepartmentofAnesthesiology
St.Luke’sRooseveltHospitalCenter
NewYork,NewYork

BrianHirsch,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

ShaneHuffman,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityMedicalCenter
Lubbock,Texas

RahulK.Mishra,MD
FormerlyResident,DepartmentofAnesthesiology

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TexasTechUniversityMedicalCenter
Lubbock,Texas

CeciliaN.Pena,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityMedicalCenterHospital
Lubbock,Texas

SpencerThomas,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

TrevorWalker,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityMedicalCenter
Lubbock,Texas

CharlotteM.Walter,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityMedicalCenter
Lubbock,Texas

KarvierYates,MD
FormerlyResident,DepartmentofAnesthesiology
TexasTechUniversityMedicalCenter
Lubbock,Texas

ShirazYazdani,MD
AssistantProfessor
DepartmentofAnesthesiology
TexasTechUniversityHealthSciencesCenter
Lubbock,Texas

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Foreword
WhenanewresidencytrainingprograminanesthesiawasbeginninginRwanda
in2006,wewerelookingforasuitabletextbooktorecommendtothetrainees.
WechoseClinicalAnesthesiologybyMorganandMikhail.Iamhappytostate
thattoday,12yearslater,theresidentsarestillmakingthesamechoice.Over
onethirdofallcopiesofthelasteditionweresoldoutsideofNorthAmericathus
underliningthepopularityofthistextbookaroundtheworld.
Amajorchangeineditorsandauthorsoccurredwiththe5theditionanditis
clearthattheystayedtruetotheidealsoftheoriginaleditors.Nowin2018,the
6theditionispresentedtous.Thetextcontinuestobesimple,concise,and
easilyreadable.TheuseofKeyConceptsatthebeginningofeachchapteris
veryusefulandfocusesthereader’sattentionontheimportantpoints.The
authorshaveworkedhardnottoincreasethesizeofthebookbuttoupdatethe
material.Expandedchaptersoncriticalcare,onenhancedrecoveryafter
anesthesia,andontheuseofultrasoundwillbeveryusefultoreaders.This
textbookcontinuestoprovideacomprehensiveintroductiontotheartand
scienceofanesthesia.
Congratulationstotheauthorsandeditorsontheirfinework.
AngelaEnrightMB,FRCPC
PastPresident,WorldFederationofSocietiesofAnaesthesiologists(WFSA)

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Preface
My,howtimeflies!Canhalfadecadealreadyhavepassedsincewelastedited
thistextbook?Yet,thetimehaspassedandourfieldhasundergonemany
changes.Wearegratefultothereadersofthefiftheditionofourtextbook.The
widespreaduseofthisworkhaveensuredthatthetimeandeffortrequiredto
produceasixtheditionarejustified.
Aswastrueforthefifthedition,thesixtheditionrepresentsasignificant
revision.Afewexamplesareworthnoting:
•Thosefamiliarwiththesequenceandgroupingofcontentinthefifthedition
willnoticethatchaptershavebeenreorderedandcontentbrokenoutor
consolidatedtoimprovetheflowofinformationandeliminateredundancy.
•Thealertreaderwillnotethatthesectiononcriticalcaremedicinehasbeen
expanded,reflectingtheincreasingnumberofverysickpatientsforwhom
wecare.
•Enhancedrecoveryaftersurgeryhasprogressedfromanimportantconceptto
acommonlyusedacronym(ERAS),aspecialtysociety,and(soon)standard
ofcare.
•Ultrasoundhasneverbeenmoreimportantinanesthesiapractice,anditsuse
invariousproceduresisemphasizedthroughoutthetextbook.
Somethingsremainunchanged:
•Wehavenotburdenedourreaderswithlargenumbersofunnecessary
references.Wehopethatlonglistsofreferencesattheendoftextbook
chapterswillsoongothewayofthelibrarycardcatalogandlong-distance
telephonecharges.Weassumethatourreadersareasfondof(andlikelyas
facilewith)GoogleScholarandPubMedasarewe,andcangeneratetheir
ownlistsofreferenceswhenevertheylike.WecontinuetoprovideURLsfor
societies,guidelines,andpracticeadvisories.
•WecontinuetoemphasizeKeyConceptsatthebeginningofeachchapter
thatlinktothechapterdiscussion,andcasediscussionsattheend.

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•Wehavetriedtoprovideillustrationsandimageswhenevertheyimprove
theflowandunderstandingofthetext.
Onceagain,thegoalexpressedinthefirsteditionremainsunchanged:“to
provideaconcise,consistentpresentationofthebasicprinciplesessentialtothe
modernpracticeofanesthesia.”And,onceagain,despiteourbestintentions,we
fearthaterrorswillbefoundinourtext.Wearegratefultothemanyreaders
whohelpedimprovethelastedition.Pleaseemailusatmm6edition@gmail.com
whenyoufinderrors.Thisenablesustomakecorrectionsinreprintsandfuture
editions.
JohnF.Butterworth,IV,MD
DavidC.Mackey,MD
JohnD.Wasnick,MD,MPH

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