Perioperative Medicine

Perioperative Medicine

Managing for Outcome

2nd Edition - February 16, 2021

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  • Authors: Mark Newman, Lee Fleisher, Clifford Ko, Michael (Monty) Mythen
  • Hardcover ISBN: 9780323567244
  • eBook ISBN: 9780323567206

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Description

Based on the most current evidence and best practices, Perioperative Medicine: Managing for Outcome, 2nd Edition, is an easy-to-follow, authoritative guide to achieving optimal outcomes in perioperative care. Written and edited by recognized authorities in anesthesiology and surgical critical care, this fully updated edition helps you think critically about complex, long-term issues surrounding the care of the surgical patient, providing decision trees that define strategies to enhance the medical outcome of care.

Table of Contents

  • Cover image
  • Title page
  • Table of Contents
  • Copyright
  • Dedication
  • Contributors
  • Acknowledgment
  • Part I: Introduction and Background
  • 1: Implications of Perioperative Morbidity for Long-Term Outcomes
  • Abstract
  • Cardiac Injury
  • Pulmonary Injury
  • Neurologic Injury
  • Renal Injury
  • Association Versus Causality
  • Conclusion
  • 2: The Inflammatory Response to Surgery
  • Introduction
  • Conclusions
  • 3: The Coagulation Cascade in Perioperative Organ Injury
  • Abstract
  • Significance of Perioperative Organ Injury
  • Current Understanding of Coagulation and the Fibrinolytic Process
  • How Does Inflammation Interfere With/Change the Coagulation Process?
  • Perioperative Monitoring of Coagulation
  • Alteration of Coagulation Status During Perioperative Period
  • Postoperative Activation of Coagulation
  • Consequences of Dysregulated Coagulation
  • Summary and Recommendations
  • Part II: Preoperative Assessment
  • 4: The Value of Preoperative Assessment
  • Abstract
  • Value
  • Preoperative Assessment Elements
  • Goals of Preoperative Assessment
  • Conclusions
  • 5: Perioperative Cardiac Risk Assessment in Noncardiac Surgery
  • Abstract
  • Introduction
  • Preoperative History and Physical Examination
  • ECG
  • Metabolic Equivalents
  • Risk Assessment
  • Risk Models
  • Interventions: Preoperative Coronary Revascularization
  • Percutaneous Coronary Intervention
  • Coronary Artery Bypass Grafting
  • Summary
  • 6: Cardiovascular Risk Assessment in Cardiac Surgery
  • Abstract
  • Purpose of Risk Assessment Before Cardiac Surgery
  • Outcome Measurement in Cardiac Surgery
  • Development of Perioperative Risk Assessment for Cardiac Surgery
  • Established Risk Assessment Models in Cardiac Surgery
  • 7: Central Nervous System Risk Assessment: Preventing Postoperative Brain Injury
  • Abstract
  • Postoperative Delirium
  • Emergence Delirium
  • Treatment of Postoperative Delirium After the Immediate Recovery Period
  • Postoperative Cognitive Dysfunction
  • Seizure Disorders and Epilepsy
  • Recent Concussion
  • Stroke Risk
  • Prior Stroke
  • Risk for Hypoxic-Ischemic Injury
  • Implanted Neurostimulator and Other Devices
  • 8: Risk Assessment and Perioperative Renal Dysfunction
  • Influence of Surgery and Anesthesia on Renal Perfusion
  • Patient Characteristics and the Risk of Postoperative Acute Kidney Injury
  • Surgical Interventions Associated With Substantial Intraoperative Renal Ischemia
  • Perioperative Testing of Renal Function
  • Perioperative Renal Risk Scoring Algorithms
  • Conclusion
  • 9: Pulmonary Risk Assessment
  • Abstract
  • Introduction
  • Epidemiology
  • Definition
  • Etiology and Pathophysiology
  • Preoperative Pulmonary Evaluation for Nonthoracic Surgery
  • Patient Factors
  • Physical Examination
  • Surgical Factors
  • Preoperative Tests
  • Risk Prediction Scores
  • Evaluation Paradigm for Nonthoracic Surgery
  • Evaluation of the Lung Resection Candidate
  • Conclusion
  • 10: Hematologic Risk Assessment
  • Red Blood Cell Transfusion
  • Hemostasis
  • Preoperative Risk Assessment
  • Laboratory Testing
  • Management of Patients Under Antiplatelet Therapy
  • Management of Patients on Anticoagulation Therapy
  • Summary
  • Part III: Preservation of Organ Function and Prevention and Management of Perioperative Organ Dysfunction
  • Section 1: Cardiovascular System
  • 11: Prevention of Ischemic Injury in Cardiac Surgery
  • Abstract
  • Perioperative Ischemia Prevention Strategies
  • Intraoperative Ischemia-Prevention Strategies
  • 12: Prevention of Ischemic Injury in Noncardiac Surgery
  • Abstract
  • Introduction
  • Pathophysiology and Natural History of Perioperative Ischemia
  • Preoperative Optimization
  • Intraoperative Management
  • Future Directions in Ischemia Prevention/Management
  • 13: Treatment of Perioperative Ischemia, Infarction, and Ventricular Failure in Cardiac Surgery
  • Abstract
  • Perioperative Myocardial Ischemia and Infarction
  • Perioperative Ventricular Dysfunction and Failure
  • 14: Perioperative Management of Valvular Heart Disease
  • Abstract
  • Preoperative Assessment
  • Preoperative Preparation
  • Intraoperative Management
  • Postoperative Management
  • Specific Valvular Lesions
  • Summary and Recommendations
  • 15: Prevention and Management of Perioperative Dysrhythmias
  • Abstract
  • Introduction
  • Mechanisms of Arrhythmia Generation
  • Contributing Factors
  • Types of Tachyarrhythmias
  • Bradyarrhythmias
  • Diagnosis and Medical Therapy for Arrhythmias
  • Interventions for Cardiac Arrhythmias
  • Conclusion
  • Section 2: Renal System
  • 16: Perioperative Fluid Management
  • Abstract
  • Overview
  • Physiological Stressors of Venous and Arterial Volume
  • Liberal Versus Restrictive Fluid Therapy
  • Maintaining Normal Intravascular Volume During Perioperative Period
  • Maintaining Optimal Hemoglobin Levels and Nadir Hematocrit
  • Laparoscopic Surgery
  • Emergency General Surgery
  • Summary: Perioperative Fluid and Hemodynamic Plan
  • 17: Preservation of Renal Function
  • Abstract
  • Introduction
  • Renal Physiology
  • Diagnosis of Acute Kidney Stress/Injury
  • Mechanisms of Surgery-Related Acute Renal Injury
  • Renal Preservation: Best Practices
  • Summary and Future Directions in Renal Preservation
  • 18: Evaluation and Treatment of Acute Oliguria
  • Abstract
  • Pathophysiology
  • Evaluation of Patients With Oliguria
  • Treatment
  • Conclusion
  • 19: Perioperative Management of Renal Failure and Renal Transplant
  • Abstract
  • Introduction
  • Acute Renal Failure
  • Chronic Renal Failure
  • Pathophysiology of Chronic Renal Failure
  • Pharmacology in Chronic Renal Failure
  • Intraoperative Considerations
  • Kidney Transplantation
  • Summary
  • Section 3: Pulmonary System
  • 20: Prevention and Treatment of Postoperative Pulmonary Complications
  • Abstract
  • Introduction
  • Prevention
  • Treatment of PPC
  • Conclusions
  • Section 4: Central Nervous System
  • 21: Carotid and Intracranial Surgery
  • Abstract
  • Anesthesia for Carotid Surgery
  • Anesthesia for Intracranial Surgery
  • Procedure-Specific Issues
  • Management of Intracranial Hypertension
  • Summary
  • 22: Protecting the Central Nervous System During Cardiac Surgery
  • Abstract
  • Introduction
  • Neurological Injury After Cardiac Surgery with Cardiopulmonary Bypass
  • Neurologic Injury After Off-pump Coronary Artery Bypass Grafting
  • Neurological Injury After Transcatheter Aortic Valve Replacement
  • Neurologic Injury During Thoracic Aortic Surgery
  • Conclusions
  • 23: Preservation of Spinal Cord Function
  • Abstract
  • Introduction
  • Traumatic Spinal Cord Injury
  • Paraplegia After Thoracic or Thoracoabdominal Aortic Aneurysm Repair
  • Spinal Cord Injury From Central Neuraxial Anesthesia and Analgesia
  • Spinal Cord Injury and Spine Surgery
  • Anesthetic and Medical Management of the Patient With Existing or Prior Spinal Cord Injury
  • 24: Perioperative Management of Acute Central Nervous System Injury
  • Abstract
  • Introduction
  • Monitoring Neurologic Examination
  • Mental Status, Cranial Nerves, Motor and Sensorial Function, and Reflexes
  • Intracranial Hypertension
  • Factors That Exacerbate Intracranial Hypertension
  • Two Types of Intracranial Hypertension
  • Presentation
  • ICP Monitoring
  • Waveform Analysis
  • Treatment of Intracranial Hypertension
  • Intracranial Hypertension/Cerebral Herniation Treatment Algorithm
  • Hyperventilation
  • Hyperosmolar Therapy
  • Efficacy of HTS for Reduction of ICP
  • CSF Drainage
  • CBV Decreasing Drugs
  • Decompressive Craniectomy
  • Airway Evaluation and Management
  • Cardiovascular
  • Perioperative Management of Adults With Acute Spinal Cord Injury
  • Section 5: Gastrointestinal System
  • 25: Prevention and Treatment of Gastrointestinal Morbidity
  • Abstract
  • Aspiration of Gastric Contents
  • Postoperative Nausea and Vomiting
  • Postoperative Ileus
  • Conclusions
  • Section 6: Hematology and Coagulation
  • 26: Prevention and Management of Deep Vein Thrombosis and Pulmonary Embolism
  • Abstract
  • Pathophysiology
  • Prevention
  • Diagnosis
  • Treatment of Venous Thromboembolism
  • Complications of Treatment
  • Reversal of Anticoagulation
  • Special Considerations
  • 27: Perioperative Management of Bleeding and Transfusion
  • Abstract
  • Introduction
  • Preoperative Assessment of Bleeding Risk
  • Intraoperative Management
  • Section 7: Infections
  • 28: Prevention of Perioperative Surgical Site Infection
  • Abstract
  • Introduction
  • Surgical Site Infection
  • Prevention of Surgical Site Infection
  • Prion Disease and the Operating Room
  • Section 8: Obstetric
  • 29: Perioperative Protection of the Pregnant Woman
  • Abstract
  • Introduction
  • Causes of Maternal Morbidity and Mortality
  • Anesthetic Causes of Morbidity and Mortality
  • Thromboembolism and Thrombophilia
  • Hypertensive Disorders of Pregnancy
  • Cardiac Disease in Pregnancy
  • Pulmonary Hypertension
  • Reduction of Perioperative Anesthesia Risk
  • Obesity
  • Airway Management
  • Peripartum and Postpartum Hemorrhage
  • 30: Preservation of Fetal Viability During Noncardiac Surgery
  • Abstract
  • Should the Pregnant Patient Undergoing Surgery During Pregnancy Be Tilted?
  • Does Anesthesia During Pregnancy Have an Effect on the Fetus?
  • Management of Hypotension During Surgery on Pregnant Patients
  • Monitoring Fetal Heart Rate During Nonobstetric Surgery
  • Do Pregnant Patients Undergoing Nonobstetric Surgery Have Full Stomachs?
  • Use of 100% Oxygen During Nonobstetric Surgery
  • Should Hyperventilation Be Avoided in Pregnant Patients Undergoing Nonobstetric Surgery?
  • Risk of Preterm Labor or Miscarriage in Nonobstetric Surgery
  • Conclusions
  • Part IV: Early Postoperative Care
  • Section 9: Specific Operations
  • 31: Cardiac Surgery
  • Abstract
  • Transport and Initial Assessment
  • Respiratory Management
  • Stabilization Phase
  • Postoperative Complications
  • Gastrointestinal Complications
  • Fast-Tracking
  • Summary
  • 32: General Thoracic Surgery
  • Abstract
  • Preoperative Pulmonary Function Assessment
  • Prevention of Postoperative Pulmonary Complications
  • Prevention of Arrhythmia
  • Enhanced Recovery After Thoracic Surgery
  • 33: Major Abdominal Surgery
  • Abstract
  • Introduction
  • Pulmonary Management
  • Fluid Management
  • Postoperative Nausea and Vomiting and Ileus
  • Nutrition
  • Surgical Site Infections
  • Conclusion
  • 34: Major Orthopedic Surgery
  • Abstract
  • Care After Total Joint Arthroplasty
  • Care After Spine Surgery
  • Conclusions
  • 35: Solid Organ Transplantation
  • Abstract
  • Types of Donors
  • Immunosuppression
  • Liver Transplantation
  • Kidney Transplantation
  • Pancreas Transplantation
  • Intestinal Transplantation
  • Heart Transplantation
  • Lung Transplantation
  • Infections
  • Conclusion
  • 36: Multisystem Trauma
  • Abstract
  • Resuscitation
  • Special Considerations in Trauma
  • Other Postinjury Considerations
  • Summary
  • 37: Neurosurgery
  • Abstract
  • Neurologic Support
  • Respiratory Support
  • Cardiovascular Support
  • Fluid and Electrolyte Support
  • Hematologic Support
  • Gastrointestinal and Endocrine Support
  • Infectious Disease
  • Section 10: Specific Problems
  • 38: Sepsis and Septic Shock
  • Abstract
  • Introduction
  • History
  • Epidemiology
  • Pathophysiology
  • Clinical Features
  • Future Directions
  • Conclusions
  • 39: Acute Respiratory Failure
  • Abstract
  • Definition
  • Hypoxemic Respiratory Failure
  • Hypercapnic Respiratory Failure
  • Acute Respiratory Failure in the Perioperative Patient
  • Principles of Management
  • Summary
  • 40: Endocrine and Electrolyte Disorders
  • Abstract
  • Introduction
  • Endocrine Dysfunction
  • Conclusion
  • 41: Improving Pain and Outcomes in the Perioperative Setting
  • Abstract
  • The Growth of Unidimensional Pain Assessment Tools
  • The Importance of Multidimensional Assessment
  • An Increased Focus on Perioperative Functional Outcomes
  • Future Directions: Risk Predictive Tools and Personalized Pain Medicine
  • Clinical Phenotyping: Cluster Analysis
  • Genetic Risks Predictors
  • Biomarkers of Risk: Cytokine Profiling
  • Optimization
  • Summary and Recommendations
  • 42: Postoperative Cognitive Dysfunction and Delirium
  • Abstract
  • Introduction
  • Conclusions
  • 43: Role of Palliative Care
  • Abstract
  • Defining Palliative Care
  • The Multidisciplinary Team
  • Palliative Care and Hospice
  • Primary versus Specialist Palliative Care
  • Advance Care Planning
  • Symptom Management
  • End-of-life Care
  • Impact on Outcomes
  • Palliative Care for the Surgical Patient
  • Disease-Specific Palliative Care
  • Palliative Care for Non-cancer Patients
  • Pediatrics
  • Conclusions
  • Part V: Conflicting Outcomes Value Based Care
  • 44: Economic Analysis of Perioperative Optimization
  • Abstract
  • Health-Care Interventions as Investments
  • Health-Care Economic Studies Offer Challenges
  • Costs—What Exactly Do We Mean?
  • Benefits: Clinical Effectiveness and Utility
  • Types of Economic Analysis
  • Conclusion
  • 45: Improving Health-Care Quality Through Measurement
  • Abstract
  • What Is Quality in Health-Care?
  • Why Improve Quality?
  • Framework for Measuring Quality
  • Development and Endorsement of Quality Measures
  • Uses of Quality Measures
  • Quality Improvement
  • Accreditation and Verification
  • Public Reporting and Transparency
  • Value-Based Health-Care and Paying for Performance
  • Conclusions
  • 46: Delivering Value Based Care: The UK Perspective
  • Abstract
  • Introduction: Rising Demand and Resource Constraint
  • The Cost and Value of Surgery
  • Shared Decision Making
  • Preoperative Optimization
  • Intraoperative Care
  • Postoperative Care and Recovery
  • Conclusions
  • 47: Transitions From Hospital to Home
  • Abstract
  • Paths from Hospital to Home
  • Factors Associated with Nonhome Discharge
  • Planning for Transitions
  • Costs of Failed Transitions
  • Ensuring the Transition
  • Putting it all Together
  • Index

Product details

  • No. of pages: 720
  • Language: English
  • Copyright: © Elsevier 2021
  • Published: February 16, 2021
  • Imprint: Elsevier
  • Hardcover ISBN: 9780323567244
  • eBook ISBN: 9780323567206

About the Authors

Mark Newman

Affiliations and Expertise

Merael H. Harmel Professor and Chairman, Department of Anesthesiology; Professor of Medicine, Duke University School of Medicine; Medical Director, Global Perioperative Research Organization (GPRO), Duke University Medical Center, Durham, NC

Lee Fleisher

Affiliations and Expertise

Robert Dunning Dripps Professor and Chair of Anesthesiology and Critical Care Medicine, Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Clifford Ko

Affiliations and Expertise

Professor, Department of Surgery, Director, UCLA Center for Surgical Outcomes and Quality, Los Angeles, California

Michael (Monty) Mythen

Affiliations and Expertise

Smiths Medical Professor of Anaesthesia and Critical Care, University College London, London, UK

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