Pharmacology and Physiology for Anesthesia

Foundations and Clinical Application

2nd Edition - October 19, 2018

Authors: Hugh C. Hemmings, Talmage D. Egan

Hardback ISBN:

9 7 8 - 0 - 3 2 3 - 4 8 1 1 0 - 6

eBook ISBN:

9 7 8 - 0 - 3 2 3 - 5 6 8 8 6 - 9

Pharmacology and physiology are the foundation of every anesthesia provider’s training and clinical competency. Pharmacology and Physiology for Anesthesia: Foundations and… Read more

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Pharmacology and physiology are the foundation of every anesthesia provider’s training and clinical competency. Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application, 2nd Edition, delivers the information you need in pharmacology, physiology, and molecular-cellular biology, keeping you current with contemporary training and practice. This thoroughly updated edition is your one-stop, comprehensive overview of physiology, and rational anesthetic drug selection and administration, perfect for study, review, and successful practice.

Cover image
Title Page
Table of Contents
Copyright
Dedication
Contributors
Preface to the Second Edition
Excerpts from the Preface to the First Edition
Section I Basic Principles of Pharmacology
Introduction
1 Mechanisms of Drug Action
Abstract
The Receptor Concept
Pharmacodynamics
Pharmacogenetics
Drug Discovery
Novel Antidotes
Key Points
Key References
References
2 Pharmacokinetic and Pharmacodynamic Principles for Intravenous Anesthetics
Abstract
Historical Perspective
Unique Aspects of Anesthetic Pharmacology
Clinical Pharmacology
Pharmacologic Modeling
Pharmacologic Simulation
PK-PD Model Simulation and Anesthesia Posology
PK-PD Models and Technology
Emerging Developments
Key Points
Key References
References
3 Pharmacokinetics of Inhaled Anesthetics
Abstract
Historical Perspective
Classes of Inhaled Anesthetics
Physical Properties
Measuring Anesthetic Potency as MAC
Monitoring Inhaled Anesthetic Delivery
Metabolism and Degradation
Uptake and Distribution
Emerging Developments
Key Points
Outline
Background
Liquids, Gases, and Vapors
Liquefaction and Vaporization
Gas Laws
Humidity
Gas Conditions
References
Outline
Background
Calibration and Preparation Before Use
Monitoring Methods
Technologies
References
Key References
References
4 Drug Metabolism and Pharmacogenetics
Abstract
Evolutionary Perspective
Pharmacogenetics, Pharmacogenomics, and Variability in Drug Responses
Pharmacokinetic Considerations
Pharmacogenomics and Drugs Commonly Used in Anesthesia (Table 4.15)
Emerging Developments
Key Points
Key References
References
5 Physiology and Pharmacology of Obesity, Pediatrics, and the Elderly
Abstract
Obese Patients
Pediatric Patients
Elderly Patients
Emerging Developments
Key Points
Key References
References
6 Pharmacodynamic Drug Interactions
Abstract
History
Study of Drug Interactions
Response Surface Models
Understanding Drug Interactions Among Commonly Used Anesthetic Drugs
Emerging Developments
Key Points
Key References
References
7 Adverse Drug Reactions
Abstract
Definition
Drug Administration Errors
Types of Adverse Drug Reactions
Emerging Developments
Key Points
Key References
References
Section II Nervous System
Introduction
8 Central Nervous System Physiology
Abstract
Historical Perspective
Glia
The Neuron
The Brain: Structure Determines Function
Emerging Developments
Key Points
Outline
Background
Basic Electrical Concepts
Electrical Hazards
Reference
Key References
References
9 Central Nervous System Physiology
Abstract
Cerebrovascular Anatomy
Regulation of Cerebral Blood Flow
Cerebral Spinal Fluid Dynamics
Pathophysiology of Cerebral Ischemia
Key Points
Key References
References
10 Pharmacology of Intravenous Anesthetics
Abstract
History of Intravenous Anesthesia
Pharmacologic Targets of Intravenous Anesthetics in the Central Nervous System
Individual Agents
Benzodiazepines
Emerging Developments
Key Points
Key References
References
11 Pharmacology of Inhaled Anesthetics
Abstract
Historical Perspective
Structure-Activity Relationships
Mechanisms of Action
Nonanesthetic Effects
Adverse Effects
Unique Features of Individual Agents
Drug Interactions
Factors Influencing MAC
Common Clinical Indications and Considerations
Emerging Developments–
Key Points
Key References
References
12 Drugs for Neuropsychiatric Disorders
Historical Perspective
Antidepressant Drugs
Anxiolytic Drugs
Antipsychotic Drugs
Mood Stabilizer Drugs
Psychostimulants
Pharmacologic Treatment of Parkinson Disease
Pharmacologic Treatment of Myasthenia Gravis
Antiepileptic Drugs
Drugs of Abuse
Emerging Developments
Key Points
Key References
References
13 Autonomic Nervous System
Abstract
Historical Considerations
Anatomy and Physiology
Cellular Physiology
Autonomic Nervous System Reflexes
Anesthesia, Disease, and the Autonomic Nervous System
Emerging Developments
Key Points
Key References
References
14 Autonomic Nervous System Pharmacology
Historical Perspective
Structure and Mechanism of Adrenergic Receptors
Endogenous Catecholamines
Indirect-Acting Sympathomimetics
Adrenergic Blocking Drugs
Inhibition of Synthesis, Storage, and Release of Norepinephrine
Parasympathetic Pharmacology
Emerging Developments
Key Points
Key References
References
15 Thermoregulation
Abstract
Normal Physiologic Thermoregulation
Anesthetic Effects on Thermoregulation
Effects of Anesthetic Techniques and Agents
Consequences of Thermal Dysregulation Related to Anesthesia
Measuring Temperature Intraoperatively
Prevention and Correction of Intraoperative Hypothermia
Emerging Developments
Key Points
Key References
References
16 Nociceptive Physiology
Systems Physiology
Peripheral Nociception
Signal Processing in the Dorsal Horn
Supraspinal Structures
Descending Pathways
Emerging Developments
Key Points
Key References
References
17 Intravenous Opioid Agonists and Antagonists
Abstract
Historical Perspective
Basic Pharmacology
Metabolism
Clinical Pharmacology
Clinical Application
Emerging Developments
Key Points
Key References
References
18 Nonintravenous Opioids
Abstract
Historical Perspective
Basic Pharmacology
Clinical Pharmacology
Clinical Applications
Emerging Developments
Key Points
Key References
References
19 Nonopioid Analgesics
Abstract
NSAID History
Nonsteroidal Antiinflammatory Drugs and Acetaminophen
Special Populations
Drugs Used for the Treatment of Neuropathic Pain
Tricyclic Antidepressants
Gabapentin and Pregabalin
Special Populations
Emerging Developments
Key Points
Key References
References
20 Local Anesthetics
Abstract
Historical Perspective
Chemical Structure and Physicochemical Properties
Specific Local Anesthetics
Emerging Developments
Key Points
Outline
Background
Ultrasound Wave Generation: Transducers, Frequency, Attenuation
Ultrasound Wave–Tissue Interaction: Resolution
Enhancement of Echogenicity
Doppler Ultrasound
Safety of Ultrasound Imaging
Key Concepts
References
Key References
References
21 Neuromuscular Physiology and Pharmacology
Abstract
Overview of Neuromuscular Transmission
Structure and Function of the Neuromuscular Junction
Quantal Theory of Neuromuscular Transmission
Synaptic Vesicles and Recycling
Nerve Terminal Action Potential
Acetylcholinesterase
Acetylcholine Receptors
Plasticity of the Neuromuscular Junction
Age-Associated Changes in the Neuromuscular Junction
Clinical Implications—Actions of Neuromuscular Blocking Drugs
Neuromuscular Junction in Disease and Injury
Emerging Developments
Key Points
Key References
References
22 Neuromuscular Blockers and Reversal Drugs
Abstract
Historical Perspective
Neuromuscular Blocking Agents
Monitoring Neuromuscular Function
Structure–Activity Relationships
Neuromuscular Blocking Agents
Postoperative Residual Neuromuscular Block
Use in Critical Care
Antagonism of Residual Neuromuscular Block
Emerging Developments
Key Points
Key References
References
Section III Cardiovascular System
Introduction
23 Cardiovascular Physiology
Abstract
Historical Perspective
Cardiac Excitation
Excitation-Contraction Coupling
Vascular Regulation
Emerging Developments
Key Points
Key References
References
24 Cardiovascular Physiology
Abstract
Cardiac Physiology
Hemodynamics and Systemic Vascular Control
Factors Influencing the Balancing Between Capillary Filtration and Absorption
Major Cardiovascular Reflexes
Tissue Oxygen Transport
Determinants of Myocardial Oxygen Supply and Demand
Emerging Developments
Key Points
A The Aortic Arch in an Idealized Anatomic Drawing
B Arteries of the Upper Extremity in an Idealized Anatomic Drawing
C Relationships of the Subclavian Vessels, Scalene Muscles, and Brachial Plexus Visualized in an Idealized Anatomic Drawing and by Ultrasonography
D The Profunda Artery as Visualized in an Anatomic Dissection and by Ultrasonogaphy
E the Brachial Artery as Visualized in an Anatomic Dissection and by Ultrasonography
F The Ulnar and Radial Arteries as Visualized in an Anatomic Dissection and by Ultrasonography
References
Outline
Background
Fluid Flow
Viscosity
Types and Properties of Flow
Flow Meters
Outline
Background
Noninvasive Blood Pressure Measurement
Continuous, Invasive Blood Pressure Monitoring
References
Key References
References
25 Vasopressors and Inotropes
Abstract
Historical Perspective
Structure-Activity Relationships
Mechanisms
Pharmacodynamics and Drug Interactions
Pharmacogenetics
Individual Drugs
Rational Drug Selection
Emerging Developments
Key Points
Key References
References
26 Antihypertensive Drugs and Vasodilators
Abstract
Historical Perspective
Sites and Mechanisms of Antihypertensive and Vasodilator Drugs
Basic Pharmacology and Mechanisms of Action of Individual Drug Classes
Pharmacokinetics, Pharmacodynamics, and Adverse Effects
Pharmacotherapy of Hypertension
Hypertension and Anesthesia
Pulmonary Vasodilators
Emerging Developments
Key Points
Key References
References
27 Antiarrhythmic Drugs
Abstract
Historical Perspective
Basic Pharmacology
Clinical Pharmacology
Clinical Application
Emerging Developments
Key Points
Key References
References
28 Cardiopulmonary Resuscitation
Abstract
Historical Perspective
Cardiopulmonary Resuscitation
Emerging Developments
Key Points
Key References
References
Section IV Pulmonary System
Introduction
29 Pulmonary Physiology
Abstract
Pulmonary Ventilation
The Airway
Oxygenation
Active Control of Pulmonary Vascular Resistance
Control of Breathing
Emerging Developments
Key Points
Outline
Background
Blood Gas Measurement Instrumentation
Sampling for Blood Gas Analysis
References
Outline
Background
Medical Gas Cylinders
Pressure Measurement and Regulation of Gases
References
Outline
Background
Pulse Oximetry Probe
Principle
Limitations of Pulse Oximetry
References
Key References
References
30 Pulmonary Pharmacology
Abstract
β2-Adrenoceptor Agonists
Anticholinergics
Inhaled Corticosteroids
Methylxanthines and Phosphodiesterase Inhibitors
Leukotriene Receptor Inhibitors and 5-Lipoxygenase Inhibitors
Monoclonal Antibodies
Anesthetic Agents as Bronchodilators
Mucolytic Therapies
Emerging Developments
Key Points
Key References
References
Section V Gastrointestinal and Endocrine Systems
Introduction
31 Liver and Gastrointestinal Physiology
Liver
Gastrointestinal Tract
Emerging Developments
Key Points
Key References
References
32 Liver and Gastrointestinal Pharmacology
Abstract
Liver Pharmacology
Anesthetic Drugs and the Liver
Gastrointestinal Pharmacology
Emerging Developments
Key Points
Key References
References
33 Nutritional and Metabolic Therapy
Abstract
Fasting in the Perioperative Period
Benefits of Early Enteral Feeding
Timing of Nutrient Delivery
Pharmaconutrition-Immunonutrition
Specific Nutrients
Timing of Delivery of Nutrients as Pharmacologic Agents
Use of Protocols Enhance Safe Delivery of Nutrients
Emerging Developments
Conclusion
Key Points
Key References
References
34 Pharmacology of Postoperative Nausea and Vomiting
Abstract
Historical Perspective
Mechanisms of Nausea and Vomiting
Serotonin Receptor Antagonists
Granisetron and Dolasetron
Dopamine Receptor Antagonists
Corticosteroids
NK1 Receptor Antagonists
H1-Receptor Antagonists
GABA Receptor Agonists
Opioid Receptor Antagonists
Cannabinoids
Risk-Based Prophylaxis
Multimodal Therapy
Emerging Developments
Key Points
Key References
References
35 Endocrine Physiology
Abstract
Pituitary Physiology
Parathyroid Physiology
Thyroid Physiology
Adrenal Gland Physiology
Adrenal Medulla Physiology
Pancreas Physiology
Emerging Developments
Key Points
Key References
References
36 Endocrine Pharmacology
Abstract
Drugs to Treat Disorders of the Endocrine Pancreas
Drugs to Treat Disorders of the Hypothalamic-Pituitary-End-Organ Axis
Growth Hormone, Prolactin, and Related Drugs
Key Points
Key References
References
37 Physiology and Pharmacology of Obstetric Anesthesia
Abstract
Physiology
Pharmacology
Emerging Developments
Key Points
Acknowledgments
Key References
References
Section VI Immunity and Infection
Introduction
38 Chemotherapy, Immunosuppression, and Anesthesia
Abstract
Chemotherapy
Monoclonal Antibodies
Antimetastasis Therapy
Immunotherapy
How Anesthetics Might Affect Cancer
Key Points
Key References
References
39 Infection, Antimicrobial Drugs, and Anesthesia
Abstract
Historical Perspective
Introduction
Surgical Antibiotic Prophylaxis
Clinical Pharmacology of Common Perioperative Antimicrobial Agents
Selection of Antimicrobial Agents for SSI Prevention
Dosing and Administration of Prophylactic Antibiotics
Clostridium Difficile Infection
Cost Containment
Summary
Emerging Developments
Key Points
Key References
References
Section VII Fluid, Electrolyte, and Hematologic Homeostasis
Introduction
40 Renal Physiology
Abstract
Renal Blood Flow and Glomerular Filtration Rate
Age-Related Renal Changes
The Nephron
Water and the Kidney
Salt and the Kidney
Potassium and the Kidney
Toxin and Metabolite Excretion
Acid–Base Balance
Renal Hormone Production
Risk of Perioperative Acute Kidney Injury
Acute Kidney Injury in Surgical Patients
Assessment and Management of Acute Kidney Injury
Intraoperative Management of Renal Function
Anesthetic Drugs and Impaired Renal Function
Common Perioperative Medications That Impair Renal Function
Perioperative Renal Replacement Therapy
Hepatorenal Syndrome
Emerging Developments
Key Points
Key References
References
41 Intravascular Volume Replacement Therapy
Abstract
Historical Perspective
Conventional Concepts
Body Fluid Dynamics (Modeling Fluid Therapy)
Guiding Principles and Clinical Implications
Emerging Developments
Key Points
Key References
References
42 Electrolytes and Diuretics
Abstract
Electrolytes
Potassium
Calcium
Phosphate
Magnesium
Diuretics
Emerging Developments
Key Points
Key References
References
Section VIII Blood and Hemostasis
Introduction
43 Blood and Coagulation
Abstract
Normal Hemostatic Mechanisms
Hypocoagulability: Perioperative Bleeding
Hemostatic Testing
Blood Conservation
Key Points
Key References
References
44 Transfusion and Coagulation Therapy
Hemoglobin and Volume Replacement Therapies
Hemostatic Interventions and Coagulation Therapies
Special Considerations
Emerging Developments
Key Points
Key References
References
45 Anticoagulant and Antiplatelet Therapy
Normal Platelet Function and Hemostasis
Mechanisms of Thrombin and Fibrin Generation
Indirect Inhibitors of Thrombin Generation
Direct Thrombin Inhibitors
Antiplatelet Agents
Emerging Developments
Key Points
Key References
References
Index