Clinical notes for the FRCA

580 Pages·2011·7.479 MB·English

by  Charles D Deakin

Clinical Notes
for the
FrCa
For Maddie
Commissioning Editor: Timothy Horne/Jeremy Bowes
Development Editor: Nicola Lally
Project Manager: Annie Victor
Designer: Stewart Larking
Illustration Manager: Bruce Hogarth
Illustrator: Gillian Richards
Third EdiTion
Clinical Notes
for the
FRCA
Charles D. Deakin
mA mD mb bChir FRCp FRCA FERC
Consultant Anaesthetist
Shackleton Department of Anaesthetics
Southampton University Hospital NHS Trust
Southampton
UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2011
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First edition 1996
Second edition 2000
Third edition 2011
ISBN : 978-0-7020-3525-8
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Notices
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge
in evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is
the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.
The
Publisher's
policy is to use
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Printed in China
Contents
1. Cardiovascular system 1
Anaesthesia and cardiac disease 1
Cardiac surgery 14
Major vascular surgery 25
Hypotensive anaesthesia 31
2. Respiratory system 35
Assessing the airway 35
Anaesthesia and respiratory disease 44
Thoracic anaesthesia 57
Mechanical ventilation 63
3. Neurology 70
Neurology and neuromuscular disorders 70
Neuroanaesthesia 74
Autonomic nervous system 84
4. Other systems 88
Dental anaesthesia 88
Anaesthesia for ear, nose and throat surgery 91
Anaesthesia and liver disease 94
Anaesthesia for ophthalmic surgery 98
Anaesthesia for orthopaedic surgery 105
Anaesthesia and renal failure 113
Anaesthesia for urological surgery 118
5. Metabolism 120
Endocrinology 120
Malignant hyperthermia 129
Anaesthesia for the morbidly obese patient 134
Metabolic response to stress 138
Thermoregulation 141
6. General 150
Anaesthesia for the elderly 150
Anaphylactic reactions 154
Blood 161
Burns 175
Day-case anaesthesia 180
Depth of anaesthesia 185
General topics 187
vi CoNTENTs
Diseases of importance to anaesthesia 195
Infection control 200
Mechanisms of anaesthesia 201
organ donation and transplantation 204
Post-anaesthetic recovery 210
Postoperative nausea and vomiting (PoNV) 212
Preoperative assessment 215
Resuscitation 217
statistics 229
Trauma management 237
7. Intensive care 249
Acute respiratory distress syndrome (ARDs) 249
Cardiovascular system 254
Fluid and electrolyte balance 260
Methicillin resistant staphylococcus aureus (MRsA) 269
Nitric oxide 270
Non-invasive ventilation 273
Nutrition 274
oxygen transport 278
Renal replacement therapy 281
scoring systems 288
sedation 291
sepsis 292
systemic inflammatory response syndrome 293
8. Obstetrics 296
Anaesthesia for non-obstetric surgery during pregnancy 296
Regional anaesthesia 297
Maternal and fetal physiology 303
9. Paediatrics 310
General paediatrics 310
Paediatric cardiology 326
10. Pain 332
Pain assessment 332
Physiology and treatment of pain 333
Epidural and spinal anaesthesia 348
11. Pharmacology 364
Anaesthetic gases 364
Drug interactions 367
Ecstasy 371
Levosimendan 372
CoNTENTs vii
Intravenous induction agents 372
Local anaesthetics 376
Neuromuscular blockade 381
opioids and other analgesics 388
Volatile agents 393
12. Equipment 398
Anaesthetic equipment 398
Breathing circuits 402
Circle systems 404
Monitoring 409
Physics 417
13. Reports 421
Anaesthetic guidelines 421
National Confidential Enquiries into Perioperative
Deaths (NCEPoD) 434
summary of guidelines for the treatment
of obstetric haemorrhage in women who
refuse blood transfusion 440
Reports on Confidential Enquiries into Maternal and
Child Health 441
Appendix 445
syllabus for the primary FRCA examination 445
syllabus for the final FRCA examination 481
Regulations: Primary and final FRCA examination
regulations 527
Appendices to regulations 537
Index 543
Preface
Since the first edition of this book in 1996, both clinical anaesthesia and
the associated Royal College of Anaesthetists' (RCoA) examinations have
progressed significantly. Clinical anaesthesia has advanced considerably in
many areas with emphasis on improving the patient experience. New drugs
and techniques have refined and improved the delivery of anaesthesia, and
the avalanche of guidelines and reports have focused on improving clinical
standards and reducing morbidity and mortality. The RCoA Primary and Final
FRCA examinations have both undergone revision and restructuring.
This third edition is completely rewritten and improves on the successful
first two editions by incorporating these changes and improving many areas
of the original book. All anaesthetic literature has been extensively reviewed
to distil the important details, particularly those relevant to the exam, while
aiming to keep the text detailed but concise. Summaries of guidelines and
reports of relevance to clinical anaesthesia and the FRCA examinations have
also been updated, together with references for key areas.
While this text has areas of interest for most anaesthetists, all of it is of
relevance to those sitting the FRCA exams – to whom I wish every success.
C.D.D. January 2011
Abbreviations
AAG α acid glycoprotein
1
AAGBI Association of Anaesthetists of Great Britain and Ireland
ACE Angiotensin converting enzyme
ACh Acetylcholine
ACS Abdominal compartment syndrome
ACTH Adrenocorticotrophic hormone
ADH Antidiuretic hormone
AIO Ambulance incident officer
AKI Acute kidney injury
ALS Advanced life support
ANS Autonomic nervous system
Ao Aorta
APTR Activated partial thromboplastin time ratio
ARDS Acute respiratory distress syndrome
ATLS Advanced trauma life support
A-V Atrioventricular
BBB Blood–brain barrier
BMI Body mass index
CABG Coronary artery bypass graft
cAMP Cyclic adenosine monophosphate
CBF Cerebral blood flow
CCF Congestive cardiac failure
cGMP Cyclic guanosine monophosphate
CMR Cerebral metabolic rate
CMV Cytomegalovirus
CNS Central nervous system
CO Cardiac output
COPD Chronic obstructive pulmonary disease
CPAP Continuous positive airway pressure
CPP Coronary perfusion pressure
CPR Cardiopulmonary resuscitation
CVA Cerebrovascular accident (stroke)
CVP Central venous pressure
CVS Cardiovascular system
CPR Cardiopulmonary resuscitation
CXR Chest X-ray
DAG Di-acylglycerol
DIC Disseminated intravascular coagulation
DO Oxygen delivery
2
dTC Tubocurarine
ECG Electrocardiograph
ECMO Extracorporeal membrane oxygenation