Contents

Contents
Section I: General Considerations
1. General Principles for Emergency Anesthesia .................................................................................................... 3
Manju N Gandhi, Kanchan R Rupwate, Kamlesh G Gotiwale, Manish B Kotwani
•
•
•
•
•
•
Definition of Emergency Surgery
Definition of Urgent Surgery
Environment Consideration and Preparedness
Preoperative Assessment
Emergency Investigations
Preanesthetic Preparation
4
4
4
5
5
5
2. Medical Disorders and Emergency Anesthesia ................................................................................................ 18
Manju N Gandhi, Amala G Kudalkar, Kamlesh G Gotiwale, Devendra W Thakare
•
•
•
•
•
•
•
•
Patient with Thyroid Disease
Patient with Diabetic Mellitus
Patient with Renal Disease
Patient with Hypertension
Patient with Ischemic Heart Disease
Patient with Valvular Heart Disease
Patient with Chronic Obstructive Pulmonary Disease (COPD)
Patient with Liver Disease
20
25
29
33
36
41
45
48
3. Choice of Anesthetic Agents for Emergency Surgery ..................................................................................... 54
Aparna A Nerurkar, Deepti M Kotwani, Manju N Gandhi
•
•
•
•
•
•
•
•
Intravenous Induction Agents
Inhalational Anesthetic Agents
Neuromuscular Blocking Agents
Nondepolarizing Neuromuscular Blocking Agents
Antagonism of Residual Neuromuscular Blockade
Opioids
Individual Opioids
Benzodiazepines
55
60
64
66
68
70
73
76
4. Blood and Blood Component Therapy in Emergency Anesthesia ............................................................... 80
Aparna A Nerurkar, Manish B Kotwani
•
•
•
•
•
•
Technical Aspects of Blood Component Administration
Massive Blood Transfusion
Practical Approach to Massive Blood Transfusion
Treatment of Other Factor Deficiencies
Checklist for Giving Blood and Blood Components
Future Goals
82
86
86
95
96
97
xiv
A Practical Approach to Anesthesia for Emergency Surgery
Section II: Cardiovascular Emergency Procedures
5. Anesthesia for Emergency Myocardial Revascularization ........................................................................... 103
Section 1: Anaesthesia for Neurosurgical Procedures
Manju N Gandhi, Aparna A Nerurkar
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Indications for Emergency Revascularization
Patient Profile
Investigations
Treatment Options
Stabilization
Monitoring
Percutaneous Coronary Intervention
Premedication
Induction
Other Cardiovascular Drugs to be Kept Ready
Maintenance
Coagulation Considerations
Protamine Administration
Temperature Maintenance
Systemic Inflammatory Response Syndrome
Myocardial Protection
Choice of Ionotropes/Vasopressors/Vasodilators
Postoperative Management
Role of Regional Anesthesia
Management of Post MI Complications
104
104
106
107
107
109
110
112
112
114
114
114
115
115
115
115
115
116
116
116
6. Anesthesia for Emergency Valvular Heart Procedure ................................................................................... 120
Kanchan R Rupawate, Shalaka A Gandhi, Manju N Gandhi
•
•
•
•
•
•
•
Mitral Stenosis (MS)
Goals of Perioperative Management
Monitoring
Anesthetic Management
Acute Mitral Regurgitation
Aortic Stenosis (AS)
Acute Aortic Incompetence (AAI)
121
123
123
124
124
126
128
7. Anesthesia for Emergency Blalock-Taussig Shunt ........................................................................................ 136
Manju N Gandhi, Aparna A Nerurkar, Deepti M Kotwani
•
•
•
•
•
•
Types Of Shunts
Clinical Presentation
Laboratory Studies
Hypercyanotic (TET) Spells
Management of Anesthesia
Operative Details of a modified Blalock-Taussig Shunt
137
138
140
141
141
144
Contents
xv
8. Anesthesia for Emergency Vascular Surgery .................................................................................................. 147
Kanchan R Rupwate, Kamlesh G Gotiwale, Manju N Gandhi
•
•
•
•
•
•
•
•
•
•
•
Pathophysiology of Aortic Occlusion and Reperfusion
Aortic Cross-clamping
Aortic Unclamping
Preoperative Evaluation
Emergency Abdominal Aorta Repair
Anesthesia for Emergency Thoracoabdominal Aorta (TAA) Repair
Anesthetic Management
Anesthesia for Emergency Endovascular Aortic Repair
Anesthesia for Emergency Lower Extremity Revascularization
Cardiac Trauma and Great Vessel Injury
Anesthesia for Emergency Pulmonary Embolectomy
148
148
148
148
149
151
151
153
154
155
156
9. Anesthesia for Cardioversion ............................................................................................................................. 160
Aparna A Nerurkar, Manish B Kotwani
•
•
•
•
•
Basic Principles
Indications and Contraindications
Contraindications
Overview of the Procedure
Anesthesia for Cardioversion
161
161
162
162
163
Section III: General Surgery
10. Anesthesia for Intestinal Obstruction ............................................................................................................... 171
Amala G Kudalkar, Trupti S Pethkar
•
•
•
•
Etiology
Pathophysiology
Fluid Shifts
Plan of Anesthesia
172
173
178
184
11. Anesthesia for Abdominal Sepsis ..................................................................................................................... 190
Amala G Kudalkar
•
•
•
•
•
•
•
•
•
•
•
What is Sepsis?
Postoperative Peritonitis
Pathophysiology
Physiological Sequelae of Sepsis
Clinical Features
Role of Anesthesiologist in the Management of Abdominal Sepsis
Preoperative Assessment and Optimization
History
Examination
Investigations
Initial Resuscitation
191
192
192
193
195
196
196
196
196
197
198
xvi
A Practical Approach to Anesthesia for Emergency Surgery
•
•
•
•
•
•
•
Volume of Resuscitation
Colloids or Crystalloids
Diagnosis
Antibiotic Therapy
Source Control
Use of Vasopressors and Inotropes
Premedication
199
199
200
200
200
200
201
Section 1: Anaesthesia for Neurosurgical Procedures
12. Gastrointestinal Bleeding .................................................................................................................................... 206
Amala G Kudalkar, Devendra W Thakare
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Occult Bleeding
Upper Gastrointestinal Bleeding
Clinical Features
Diagnosis
Early Pharmacological Management
Management of Nonvariceal Upper Gastrointestinal Bleeding
Acid Suppression and Agents to Arrest Bleeding
Surgical Management
Child-pugh’s Grading of Chronic Liver Disease
Sengstaken-Blakemore Tube
Management of Bleeding Varices not Controlled by Endoscopy
Lower Gastrointestinal Bleeding
Anesthetic Considerations
General Approach to the Patient with Acute GI Hemorrhage
Anesthesia for Injection of Bleeding Esophageal Varices
Preanesthetic Management
Postanesthetic Management
207
207
209
209
211
211
212
213
213
214
215
215
216
216
217
217
218
Section IV
IV:: Obstetric Emergencies
13. Anesthesia Management of Pregnant Patient for Emergency Surgery ...................................................... 223
Smita S Lele, Preeti Rustagi
•
•
•
•
•
•
•
•
•
•
•
•
Altered Maternal Physiology and its Anesthetic Implications
Cardiovascular System
Fetal Effects from Anesthesia and Surgery
Uteroplacental Perfusion and Fetal Oxygenation
Prevention of Preterm Labor
Practical Considerations
Anesthetic Management for Nonobstetric Surgery
Premedication
Special Situations
Anesthetic Management
General Anesthesia
Regional Anesthesia
224
225
226
228
229
229
229
230
232
236
236
237
Contents
xvii
14. Pregnancy Induced Hypertension and Anesthesia ........................................................................................ 240
Shantanu B Kulkarni, Urvi H Desai, Manju N Gandhi
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Classification
Preeclampsia
Eclampsia
HELLP Syndrome
Chronic Hypertension
Incidence and Predisposing Factors
Etiology
Classification of Preeclampsia
Pathophysiology
Cardiovascular System
Anesthetic Implications
Respiratory System
Anesthetic Implications
Central Nervous System
Anesthetic Implications
Kidney
Anesthetic Implications
Liver
Anesthetic Implications
Fetoplacental Unit
Hematological Unit
Anesthetic Implications
Management
Preoperative Assessment
Monitoring
Analgesia for Labor and Vaginal Delivery
Epidural Analgesia
Technique
Combined Spinal and Epidural Analgesia (CSE)
Choice of Anesthesia for Cesarean Section
Regional Anesthesia
Technique for Regional Anesthesia
General Anesthesia
Management of Pulmonary Edema
Eclampsia
Principles of Treatment of Eclampsia
Magnesium Therapy
Anesthetic Management
Management of Patient with HELLP Syndrome
240
240
240
240
240
241
241
241
241
241
241
242
242
242
242
242
242
242
242
242
242
243
243
243
244
244
244
244
244
245
245
245
245
246
246
247
247
247
248
xviii
A Practical Approach to Anesthesia for Emergency Surgery
15. Anesthesia for Hemorrhagic Obstetric Patient ............................................................................................... 250
Smita S Lele, Urvi H Desai, Manju N Gandhi
•
•
•
•
•
Suggested Plan for Anesthesia
Antepartum Hemorrhage (APH)
Postpartum Hemorrhage (PPH)
Management of Hemorrhagic Shock in Obstetric Patients
Management of Disseminated Intravascular Coagulation (DIC)
254
254
258
260
261
16. Anesthesia for Pregnant Patient with Medical Disorders ............................................................................ 265
Shantanu B Kulkarni, Preeti Rustagi, Smita S Lele, Manju N Gandhi
Section 1: Anaesthesia for Neurosurgical Procedures
•
•
•
•
•
•
•
•
•
Cardiovascular Diseases
Anemia
Obesity
Thyroid Disorders
Diabetes Mellitus
Viral Hepatitis
Renal Diseases in Pregnancy
Malaria
Human Immunodeficiency Virus (HIV)
266
277
278
282
286
288
291
294
295
Section V
ediatric Emergencies
V:: Neonatal and P
Pediatric
17. General Consideration in Neonatal and Pediatric Emergency Surgeries ................................................. 303
Anila D Malde, Nilam D Virkar
•
•
•
•
•
•
•
•
Physiology
Pharmacology
Preoperative Assessment
Preoperative Preparation
Induction of Anesthesia
Early Postinduction Period
Emergence and Extubation
Basic Postoperative Care
304
310
312
312
313
314
317
317
18. Anesthetic Management of Neonatal Thoracic Emergencies ...................................................................... 321
Anila D Malde
• Congenital Diaphragmatic Hernia
• Esophageal Atresia and Tracheoesophageal Fistula
• Congenital Lobar Emphysema (CLE)
322
330
337
19. Anesthesia for Neonatal and Pediatric Abdominal Emergencies ............................................................... 345
Anila D Malde, Trupti S Pethkar, Aklesh S Tandekar
• Abdominal Wall Defects
• Congenital Hypertrophic Pyloric Stenosis
• Necrotizing Enterocolitis
346
351
354
Contents
•
•
•
•
•
•
Intestinal Obstruction
Meconium Ileus
Malrotation and Volvulus
Anorectal Malformation
Intussusception
Roundworm Obstruction
xix
358
360
362
363
364
365
Section VI: ENT and Ophthalmic Emergencies
20. Anesthesia for Post-tonsillectomy Bleeding Patient ...................................................................................... 371
Swati S Chhatrapati, Nilam D Virkar, Anila D Malde
• Anesthetic Considerations in Post-tonsillectomy Bleeding
372
21. Anesthetic Considerations in Deep Neck Space Infections ......................................................................... 377
Anila D Malde, Swati S Chhatrapati
•
•
•
•
•
•
•
Deep Neck Infections: A Constant Challenge
Retropharyngeal Space
Lateral Pharyngeal Space
Peritonsillar Space
Submandibular Space
Risk Factors for the Development of Deep Neck Infections
Management of Airway
377
379
379
379
380
380
385
22. Anesthesia for Removal of Foreign Body from Airway and Upper Digestive Tract ............................. 388
Anila D Malde, Swati S Chhatrapati
• Foreign Body Aspiration
• Foreign Body in the Upper Digestive Tract
389
398
23. Anesthesia for Ophthalmic Emergencies ......................................................................................................... 402
Swati S Chhatrapati, Nishant S Bawankule
• Types of Ophthalmologic Emergencies
• Common Types of Eye Injury
• Anesthetic Management of Penetrating Eye Injury
402
403
403
Section VII: Neurosurgical Emergencies
24. Anesthesia for Neurosurgical Decompression ................................................................................................ 411
Hemangi S Karnik, Naina P Dalvi, Dhawal R Wadaskar
• Applied Neurophysiology
• Anesthesia for Emergency Craniotomy
• Specific Emergency Conditions
411
420
427
xx
A Practical Approach to Anesthesia for Emergency Surgery
25. Anesthesia for Cerebrovascular Emergencies ................................................................................................. 432
Hemangi S Karnik
•
•
•
•
Intracranial Aneurysms
Arteriovenous Malformation (AVM)
Spontaneous Intracerebral Hemorrhage (SICH)
Acute Ischemic Stroke
432
439
441
444
Section VIII: T
rauma
Trauma
26. Anesthesia for Head Injuries .............................................................................................................................. 451
Hemangi S Karnik, Jyoti S Magar, Devangi A Parikh
•
•
•
•
•
Head Injury
Immediate Assessment
Diagnosis of Head Injury
Immediate Management
Monitoring Injured Brain
452
457
458
459
466
Section 1: Anaesthesia for Neurosurgical Procedures
27. Anesthesia for Acute Spine injury .................................................................................................................... 473
Naina P Dalvi, Devangi A Parikh, Hemangi S Karnik
•
•
•
•
•
•
•
•
•
•
•
Epidemiology
Mechanism of Spinal Cord Injuries
Pathophysiology
Classification
Role of Anesthesiologist in ASCI
Clinical Clearance or Radiological Diagnosis of Spine Injury
General Management
Surgical Intervention
Intraoperative Management
Plan for Airway Management in a Patient with Cervical Spine Injury
Complications in Spine Surgery
474
474
475
476
476
479
479
481
481
483
485
28. Anesthesia for Thoracic Trauma ........................................................................................................................ 488
Jyoti S Magar, Deepali P Thakur
•
•
•
•
Airway Assessment and Management
Circulation
Maintenance of Anesthesia
Invasive Monitoring
490
494
500
501
29. Anesthesia for Abdominal Trauma ................................................................................................................... 508
Hemangi S Karnik, Nazmeen I Sayed
•
•
•
•
Relevant Anatomy
Specific Organ Injuries
Immediate Assessment and Resuscitation
Diagnosis of Abdominal Trauma
508
509
510
512
Contents
•
•
•
•
•
•
•
•
•
Pathophysiology of Hemorrhagic Shock
Resuscitation
Surgical Management
Anesthetic Management
Intraoperative Concerns
Emergence and Tracheal Extubation
Damage Control Surgery (DCS)
Abdominal Compartment Syndrome (ACS)
Associated Conditions
xxi
513
513
517
517
520
522
522
523
524
30. Anesthesia for Pelvic and Long Bone Fractures ............................................................................................. 527
Jyoti S Magar, Hema B Gupta
•
•
•
•
•
•
Pelvic Fractures
Associated Injuries
Long Bone Fractures
Primary Survey and Resuscitation
Definitive Management
Anesthetic Considerations
528
529
530
530
531
533
31. Anesthesia for Patients with Crush Injury ...................................................................................................... 538
Naina P Dalvi, Dhawal R Wadaskar
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Pathophysiology of Crush Injury
Toxins Released in Crush Injury
Clinical Presentation
Prehospital Care
Emergency Management
Stabilization of Hemodynamic Status
Surgical Management of Crush Injury
Complications after Crush Injury
Compartment Syndrome
Measurement of Intracompartmental Pressures
Rhabdomyolysis
Pathophysiology
Clinical Features
Investigations
Management
Anesthesia in Crush Injury Patients
538
539
539
539
540
540
541
541
541
541
541
542
542
542
542
542
32. Anesthetic Considerations in Blast and Burn Injuries .................................................................................. 546
Jyoti S Magar, Deepali P Thakur
•
•
•
•
•
Etiology
Mechanism of Injury in Blast
Burns
Pathophysiology of Burns
Resuscitation
547
548
555
556
558
xxii
A Practical Approach to Anesthesia for Emergency Surgery
33. Anesthesia for Maxillofacial and Upper Airway Trauma ............................................................................ 565
Geeta A Patkar, Hema B Gupta
•
•
•
•
•
•
Related Anatomy of Upper Airway and Maxillofacial Structures
Mechanisms of Injury to the Maxillofacial Structures and Upper Airway
Maxillofacial Fractures
Associated Injuries and their Implications
Acute Management
Elective Management
566
568
569
570
570
573
Section IX: Miscellaneous
34. Anesthesia for Emergency Microvascular Surgeries .................................................................................... 579
Shakuntala N Basantwani, Sohini S Shah
• Practical Considerations in Management of Patients
582
Section 1: Anaesthesia for Neurosurgical Procedures
35. Anesthesia for Emergency Renal Transplant .................................................................................................. 588
Shakuntala N Basantwani, Geeta A Patkar, Nazmeen I Sayed
•
•
•
•
•
•
•
•
•
•
•
Types of Renal Transplantation
Contraindications for Cadaveric Organ Donation
Diagnosis of Brain Death
Organ Dysfunction in Cadaver and its Management
Kidney Recipient
Pathophysiology of Chronic Renal Failure (CRF)
Dialysis
Preoperative Assessment
Preoperative Investigations and Preparation
Anesthetic Management
Surgical Steps
589
589
590
591
593
594
597
598
599
36. Role of Anesthesiologist in Disaster Management ........................................................................................ 606
Kanchan R Rupwate, Shalaka A Gandhi, Manju N Gandhi
•
•
•
•
•
•
•
•
•
•
•
Definition of Disaster
Types of Disaster
Phases of Disaster Management
Activities Involved in Disaster Management
Prehospital Response Service
Emergency Reception, Triage and Resuscitation Service
Emergency Operative and Postoperative Service
Psychological Rehabilitation Aftercare Service
Specific Conditions of Disaster
Radiation Management
Special Considerations
607
607
607
608
612
612
613
614
615
617
617
Index .......................................................................................................................................................................... 619
`