Complications in Anesthesia - 2nd Edition

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COMPLICATIONS IN ANESTHESIA, 2nd edition ISBN-13: 978-1-4160-2215-2

ISBN-10: 1-4160-2215-5
Copyright © 2007, 1999 by Saunders, an imprint of Elsevier Inc.

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Notice

Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate.
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 the practitioner,
relying on his or her own experience and knowledge of the patient, 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 Editors assumes any liability for any injury
and/or damage to persons or property arising out of or related to any use of the material contained in this
book.
The Publisher

Library of Congress Cataloging-in-Publication Data

Complications in anesthesia / [edited by] John L. Atlee. -- 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-4160-2215-5
1. Anesthesia--Complications. I. Atlee, John L.
[DNLM: 1. Anesthesia--adverse effects. 2. Anesthetics--adverse effects. WO 245 C7369 2007]
RD82.5.C63 2007
617.9′6041--dc22 2006040549

Executive Publisher: Natasha Andjelkovic

Developmental Editor: Jean Nevius
Publishing Services Manager: Tina Rebane
Project Manager: Amy Norwitz
Marketing Manager: Dana Butler

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

FM-X2215 8/19/06 3:25 PM Page v

To all who have contributed to this work, and to the patients we serve.
FM-X2215 8/19/06 3:25 PM Page vii

Preface
An ounce of prevention is worth a pound of cure.
–ANONYMOUS

The second edition of Complications in Anesthesia, like its using the same headings. Schematics, figures, and tables are
first edition, is intended to provide all practitioners of anes- used liberally to illustrate key points or to summarize impor-
thesia and critical care medicine with a comprehensive source tant information. Key references are listed at the end of each
of information for most complications that might be faced chapter under “Further Reading,” avoiding in-text citations
in clinical practice. Topics are addressed in ten sections: that might distract the reader. Some chapters contain foot-
Pharmacology; General Anesthesia; Regional Anesthesia and notes that provide further explanations. In this way, the
reader can gain useful insight into a topic of interest in the
Pain Management; Cardiothoracic and Vascular Surgery;
minimal amount of time and with maximal retention. Also,
Physiologic Imbalance and Coexisting Disease; Equipment thumb indexing and liberal cross-referencing are intended to
and Monitoring; Pediatrics and Neonatology; Neurosurgery, reduce the need for time-consuming index searches. Finally,
Ophthalmology, and ENT; Other Surgical Subspecialties under Further Reading, in text, or in footnotes, there are ref-
(subdivided into Obstetrics and Gynecology, General Surgery, erences to Web sites for more or updated information. In that
Urologic Surgery, and Orthopedic Surgery); and Special way, the reader can keep abreast of new developments.
Topics (subdivided into Postanesthesia Care Unit, Diagnostic I hope this unconventional treatment of complications in
or Therapeutic Intervention, and Medicolegal Aspects). anesthesia and critical care will serve several purposes: first,
Section Editors were selected based on their special expertise to permit quick location and researching of topics of interest
and knowledge of the topics addressed in each section. to busy practitioners in the least amount of time; second, to
Each chapter is presented in a highly structured format organize the thought processes involved in medical decision-
(in accordance with problem-based learning) under the fol- making in an attractive format—i.e., akin to Sherlock Holmes’
lowing headings and subheadings: Case Synopsis, Problem “who done it?”; and third and most importantly, to reduce
Analysis (divided into Definition, Recognition, Risk the risk to our patients for unexpected and untoward events.
Assessment, Implications), Management, and Prevention; in
chapters with more than one topic, each topic is addressed John L. Atlee, MD

vii
FM-X2215 8/19/06 3:25 PM Page ix

Contributors
Mark Abel, MD Lori A. Aronson, MD, FAAP
Clinical Assistant Professor, Department of Anesthesiology, Assistant Professor of Clinical Anesthesia and Pediatrics,
Mount Sinai Medical Center, New York, New York Department of Anesthesia, University of Cincinnati College
Vaporizers of Medicine; Assistant Professor, Clinical Anesthesia and
Pediatrics, Department of Anesthesia, Cincinnati Children’s
Gaury S. Adhikary, MD, FRCA Hospital Medical Center, Cincinnati, Ohio
Assistant Professor, Department of Anesthesiology, Hypoxemia
University of Michigan Hospitals, Ann Arbor, Michigan
Carbon Dioxide Absorbers John L. Atlee, MD
Professor of Anesthesiology, Department of Anesthesiology,
Medical College of Wisconsin, Milwaukee, Wisconsin
Maurice S. Albin, MD, MSc (Anes)
Professor of Anesthesiology, Department of Anesthesiology, Adenosine; Disorders of Potassium Balance; Nonbarbiturate
University of Alabama School of Medicine, Birmingham, Anesthetics; Chemotherapeutic Agents; Cardiac Risk
Alabama Assessment; Postobstruction Pulmonary Edema; Perioperative
Tachyarrhythmias; Tachyarrhythmias with Ventricular
Venous Air Embolism
Preexcitation; Long QT Syndromes and Ventricular
Arrhythmias; Patients with Cardiac Rhythm Management
Stacey L. Allen, MD Devices; Disorders of Water Homeostasis: Hyponatremia and
Assistant Professor of Anesthesiology, Department of Hypernatremia
Anesthesiology, University of Texas Health Science Center at
San Antonio, San Antonio, Texas Michael S. Avidan, MD
Corneal Injury; Open Globe Injury Associate Professor of Anesthesiology and Surgery; Division
Chief, CT Anesthesiology and CT Intensive Care,
Steven J. Allen, MD Washington University School of Medicine, St. Louis,
Professor of Anesthesiology, Ohio State University College Missouri
of Medicine; Chief Executive Officer, Columbus Children’s HIV Infection and AIDS
Hospital, Columbus, Ohio
Autonomic Hyperreflexia Isaac Azar, MD
Professor of Anesthesiology, Albert Einstein College of
Medicine; Consultant, Department of Anesthesiology,
Jonathan M. Anagnostou, MD Beth Israel Medical Center, New York, New York
Associate Professor of Clinical Anesthesia, Department
of Anesthesia, Indiana University School of Medicine; Scavenging Systems
Staff Anesthesiologist, Medical Director of Respiratory Care,
Department of Anesthesia, Respiratory Care, Indiana James E. Baker, MD, FRCPC
University Hospital, Indianapolis, Indiana Assistant Professor and Anesthesiologist, Department of
Anesthesia and Perioperative Care, University of California,
Blood and Blood Products: Hepatitis and HIV
San Francisco, San Francisco, California
Postoperative Pulmonary Hypertension
Maged Argalious, MD
Staff Anesthesiologist, Departments of General Narayan Baliga, MD
Anesthesiology and Critical Care Medicine, Cleveland Clinic Staff Anesthesiologist, Kenosha Hospital and Medical
Foundation, Cleveland, Ohio Center, Kenosha, Wisconsin
Complications of Trauma Surgery Difficult Airway: Opiate-Induced Muscle Rigidity

George A. Arndt, MD Shahar Bar-Yosef, MD

Professor (CHS), Department of Anesthesiology, Assistant Professor, Department of Anesthesiology and
University of Wisconsin Medical School, Madison, Critical Care, Duke University School of Medicine, Durham,
Wisconsin North Carolina
Difficult Airway: Cannot Ventilate, Cannot Intubate Complications of Laparoscopic Surgery

ix
FM-X2215 8/19/06 3:25 PM Page x

x Contributors

Juliana Barr, MD Lois L. Bready, MD

Associate Professor, Department of Anesthesiology, Professor and Vice Chair, Department of Anesthesiology,
Stanford University School of Medicine, Stanford, University of Texas Health Science Center at San Antonio,
California; Staff Intensivist and Anesthesiologist, Veterans San Antonio, Texas
Affairs Palo Alto Health Care System, Anesthesiology Corneal Injury
Service, Palo Alto, California
Reversal Agents: Naloxone and Flumazenil Thomas P. Broderick, MD
Assistant Professor, Department of Anesthesiology,
Curtis L. Baysinger, MD University of Wisconsin Hospital and Clinics, Madison,
Associate Professor, Department of Anesthesiology, Wisconsin
Vanderbilt University School of Medicine, Nashville, Preanesthetic Evaluation: Inadequate or Missing Test Result
Tennessee
Hypertensive Disorders of Pregnancy David L. Brown, MD
Edward Rotan Distinguished Professor and Chairman,
Eric Bedell, MD Department of Anesthesiology and Pain Medicine, M.D.
Associate Professor, Department of Anesthesiology, Anderson Cancer Center, Houston, Texas
University of Texas Medical Branch, Galveston, Celiac Plexus Block: Side Effects and Complications
Texas
Posterior Fossa Surgery Adrie Bruijinzeel, MD
Assistant Professor, Department of Psychiatry, Evelyn and
Joan Benca, MD William McKnight Brain Institute, University of Florida
Associate Professor, Department of Anesthesiology, College of Medicine, Gainesville, Florida
University of Wisconsin Hospital and Clinics, Madison, Chemical Dependency: Opioids
Wisconsin
Bronchospasm Brenda A. Bucklin, MD
Associate Professor of Anesthesiology, Department of
Patrick E. Benedict, MD Anesthesiology, University of Colorado Health Sciences
Assistant Professor of Anesthesiology, University of Center, Denver, Colorado
Michigan Medical School, Ann Arbor, Michigan Fetal Distress
Transesophageal Echocardiography
Matthew D. Caldwell, MD
David G. Bjoraker, MD Assistant Professor, Department of Anesthesiology,
Associate Professor, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor,
University of Florida College of Medicine, Gainesville, Michigan
Florida Pulmonary Artery Pressure Monitoring
Anaphylaxis and Anaphylactoid Reactions
William R. Camann, MD
Susan Black, MD Associate Professor, Department of Anesthesia, Harvard
Professor, Department of Anesthesiology, Medical School; Director of Obstetric Anesthesia, Brigham
University of Alabama School of Medicine, and Women’s Hospital, Boston, Massachusetts
Birmingham, Alabama Pulmonary Aspiration in the Parturient
Antidepressants
Maria I. Castro, PhD
William S. Blau, MD, PhD Assistant Professor, Department of Anesthesiology,
Associate Professor of Anesthesiology, University of University of Arkansas for Medical Sciences, Little Rock,
North Carolina School of Medicine, Chapel Hill, Arkansas
North Carolina Class II Antiarrhythmic Drugs: β-Blockers—Heart Block or
Opioid Tolerance Bradycardia

Steffan Blumenthal, MD Kevin P. Chan, MD

Assistant Professor, Department of Anesthesiology and Fellow in Cardiovascular Anesthesia, Stanford University
Reanimation, Orthopedic University Clinic Balgrist/Zurich, School of Medicine, Stanford, California
Zurich, Switzerland Nonbarbiturate Anesthetics
Interscalene Nerve Block: Potential Severe Complications
Mark A. Chaney, MD
John C. Boncyk, MD Associate Professor of Anesthesiology, Department of
Assistant Professor, Department of Anesthesiology, Anesthesia and Critical Care, University of Chicago Pritzker
University of Wisconsin Hospital and Clinics, Madison, School of Medicine, Chicago, Illinois
Wisconsin Perioperative Myocardial Ischemia and Infarction; Adverse
Perioperative Hypoxia Neurologic Sequelae: Central Neurologic Impairment;
Hypercoagulable States: Thrombosis and Embolism
Alain Borgeat, MD
Professor and Chief of Staff, Department of Anesthesiology Amit V. Chawla, MD
and Reanimation, Orthopedic University Clinic Consultant, Department of Anesthesia, Guy’s Hospital,
Balgrist/Zurich, Zurich, Switzerland London, United Kingdom
Interscalene Nerve Block: Potential Severe Complications Inspiratory and Expiratory Gas Monitoring
FM-X2215 8/19/06 3:25 PM Page xi

Contributors xi

David C. H. Cheng, MD, MSc, FRCPC James C. Crews, MD

Professor and Chair, Department of Anesthesia and Associate Professor of Anesthesiology, Section of Regional
Perioperative Medicine, University of Western Ontario; Anesthesia and Acute Pain Management, Department of
Anesthesiologist in Chief, London Health Sciences Center Anesthesiology, Wake Forest University School of Medicine,
and St. Joseph’s Health Care, London, Ontario, Winston-Salem, North Carolina
Canada Infectious Complications of Central Neuraxial Block
Fast-Track Cardiac Surgery
Deborah A. Davis, MD
S. Devi Chiravuri, MD Clinical Professor of Anesthesiology, Department of
Assistant Professor, Department of Anesthesiology, Anesthesiology, Thomas Jefferson University – Jefferson
University of Michigan Medical School, Ann Arbor, Medical College, Philadelphia, Pennsylvania; Pediatric
Michigan Anesthesiologist/Intensivist, Nemours Cardiac Center,
Rapid Fluid and Blood Delivery Systems A.I. duPont Hospital for Children, Wilmington,
Delaware
Gordon Lee Collins, MD Pulmonary Hypertension
Clinical Fellow, Department of Anesthesiology, Washington
University School of Medicine, St. Louis, Missouri Martin L. De Ruyter, MD
Complications after Pneumonectomy Associate Professor of Anesthesiology, Department of
Anesthesiology, Kansas University School of Medicine,
Lois A. Connolly, MD Kansas City, Kansas
Associate Professor, Department of Anesthesiology, Hyperglycemia and Diabetic Ketoacidosis; Sarcoidosis
Medical College of Wisconsin, Froedtert Memorial Lutheran
Hospital, Milwaukee, Wisconsin Hernando De Soto, MD
Unstable Cervical Spine, Atlantoaxial Subluxation Associate Professor, Department of Pediatric Anesthesia,
University of Florida Health Science Center; Staff
D. Ryan Cook, MD Anesthesiologist/Medical Director of the OR, Department
Professor of Anesthesiology, Department of Anesthesiology, of Anesthesiology, SHANDS Jacksonville, Jacksonville,
Children’s Hospital of Pittsburgh, Pittsburgh, Florida
Pennsylvania Difficult Pediatric Airway
Hypoglycemia and Hyperglycemia
Donn M. Dennis, MD, FAHA
Scott D. Cook-Sather, MD Joachim S. Gravenstein, MD, Professor of Anesthesiology,
Assistant Professor of Anesthesia, Department of Department of Anesthesiology, University of Florida College
Anesthesiology and Critical Care Medicine, University of of Medicine, Gainesville, Florida; Vice President-
Pennsylvania School of Medicine; Associate Pharmacology, ARYx Therapeutics, Inc., Santa Clara,
Anesthesiologist, Children’s Hospital of Philadelphia, California
Philadelphia, Pennsylvania Class III Antiarrhythmic Drugs: Potassium Channel Blockers;
Ophthalmic Problems and Complications Class IV Antiarrhythmic Drugs: Calcium Channel Blockers

Victoria Coon, CRNA, MS Ronak Desai, DO

Perioperative Director and Anesthesiology Department Resident, CA-2, Department of Anesthesia and Critical
Administrator, Kaiser Permanente, West Los Angeles, Care, University of Chicago Pritzker School of Medicine,
Los Angeles, California Chicago, Illinois
Quality Assurance; Cost Containment Peripheral Vascular Surgery

John R. Cooper, Jr., MD Cheryl DeSimone, MD

Clinical Associate Professor of Anesthesiology, University of Associate Professor of Anesthesiology, Obstetrics and
Texas Health Science Center; Associate Chief, Gynecology, Department of Anesthesiology, Albany Medical
Cardiovascular Anesthesia; Co-Director, Cullen College; Director of Obstetric Anesthesia, Albany Medical
Cardiovascular Research Laboratories, Texas Heart Institute, Center, Albany, New York
Houston, Texas Embolic Events of Pregnancy
Troubleshooting Common Problems during
Cardiopulmonary Bypass Cyrus DeSouza, MB,BS, FANZCA
Acting Assistant Professor, Cardiothoracic Anesthesiologist,
Charles J. Coté, MD Department of Anesthesiology, University of Washington
Director of Clinical Research in Pediatric Anesthesia, Medical Center, Seattle, Washington; Staff Specialist
Department of Anesthesiology, Massachusetts General Anaesthetist, Department of Anaesthetics, St. Georges
Hospital, Boston, Massachusetts Hospital, Sydney, NSW, Australia
Sedation of Pediatric Patients Chronotropic Drugs

Douglas B. Coursin, MD Clifford S. Deutschman, MD

Professor of Anesthesiology and Internal Medicine, Professor, Department of Anesthesia and Surgery,
Department of Anesthesiology, University of Wisconsin Hospital of the University of Pennsylvania, Philadelphia,
School of Medicine and Public Health, Madison, Pennsylvania
Wisconsin Sepsis, Systemic Inflammatory Response Syndrome, and Multiple
Adrenal Insufficiency Organ Dysfunction Syndrome
FM-X2215 8/19/06 3:25 PM Page xii

xii Contributors

Pema Dorje, MD Brenda G. Fahy, MD, FCCP, FCCM

Clinical Assistant Professor, Department of Anesthesiology, Professor, Department of Anesthesiology, University of
University of Michigan Medical School, Ann Arbor, Kentucky; Director of Critical Care, Department of
Michigan Anesthesiology, AB Chandler Medical Center,
Arterial Blood Pressure Monitoring Lexington, Kentucky
Disorders of Water Homeostasis: Hyponatremia and
Anthony R. Doyle, BSc, MB,BS, FRCA Hypernatremia
Formerly, Visiting Instructor in Anesthesiology, University of
Michigan Medical School, Ann Arbor, Michigan; Zhuang T. Fang, MD, MSPH
Consultant Anaesthetist, Dorset County Hospital, Assistant Clinical Professor, Department of Anesthesiology,
Dorchester, United Kingdom David Geffen School of Medicine at University of California,
Fires in the Operating Room Los Angeles, Los Angeles, California
Unanticipated Hospital Admission and Readmission
Kenneth Drasner, MD
Professor, Department of Anesthesiology and Perioperative Doron Feldman, MD
Care, University of California, San Francisco, San Francisco, Associate Professor of Clinical Anesthesiology, State
California University of New York at Buffalo School of Medicine;
Local Anesthetic Neurotoxicity: Cauda Equina Syndrome Attending in Anesthesiology, Children’s Hospital of Buffalo,
Buffalo, New York
Catherine Drexler, MD The Hostile-Combative Patient
Vice Chair, Department of Anesthesiology, Columbia-
St. Mary’s-Milwaukee Campus, Milwaukee, Lynne R. Ferrari, MD
Wisconsin Associate Professor, Department of Anesthesia, Harvard
Angioedema and Urticaria Medical School; Medical Director, Perioperative Services,
Children’s Hospital, Boston, Massachusetts
Ellen Duncan, MD Adenotonsillectomy
Tejas Anesthesia, San Antonio, Texas
Open Globe Injury Matthew P. Feuer, MD
Staff Anesthesiologist, Department of Anesthesiology,
Virginia Mason Medical Center, Seattle, Washington
Martin W. Dünser, MD
Resident in Anesthesiology and Critical Care Medicine, Spinal Anesthesia: Post–Dural Puncture Headache
Department of Anesthesiology and Critical Care Medicine,
Medical University Innsbruck, Innsbruck, Austria Stephanie S. F. Fischer, MD
Visiting Associate in Cardiothoracic and Critical Care,
Vasopressors: Vasoconstrictor Drugs
Division of Pediatric Anesthesiology, Duke University School
of Medicine, Durham, North Carolina
Jörg Dziersk, MD, FRCA Cardiomyopathies
Assistant Professor of Anesthesiology, Department of
Anesthesiology, University of Washington School of
Medicine, Seattle, Washington
M. Pamela Fish, MB,ChB
Associate Professor, Department of Anesthesiology, Stanford
Vasodilator Drugs University School of Medicine, Stanford, California; Staff
Physician, Veterans Affairs Palo Alto Health Care System,
Michael P. Eaton, MD Palo Alto, California
Associate Professor, Department of Anesthesiology, Antiemetic Drugs
University of Rochester School of Medicine and Dentistry,
Rochester, New York Randall Flick, MD, MPH
Proportioning Systems; Patient Warming Systems Assistant Professor of Anesthesiology and Pediatrics,
Department of Anesthesiology and Pediatrics, Mayo Clinic
Charles E. Edmiston, Jr., MS, PhD College of Medicine; Chair, Section of Pediatric
Associate Professor, Department of Surgery; Director, Anesthesiology, Mayo Clinic, Rochester, Minnesota
Surgical Microbiology Research Laboratory, Medical College Anterior Mediastinal Mass
of Wisconsin, Milwaukee, Wisconsin
Nosocomial Infections: Bacterial Pneumonia Michael P. Ford, MD
Assistant Professor of Anesthesiology, Department of
James B. Eisenkraft, MD Anesthesiology, University of Wisconsin Medical School,
Professor of Anesthesiology, Mount Sinai School of Madison, Wisconsin
Medicine, New York, New York Preanesthetic Evaluation: False-Positive Tests; Difficult Airway:
Vaporizers Cannot Ventilate, Cannot Intubate

John Ellis, MD Jennifer T. Fortney, MD

Professor of Anesthesiology, Department of Anesthesia Assistant Clinical Professor, Department of Anesthesiology,
and Critical Care, University of Chicago Pritzker School of Duke University School of Medicine, Durham, North
Medicine, Chicago, Illinois Carolina
Carotid Endarterectomy; Thoracic Aortic Aneurysm Fat Embolism Syndrome
FM-X2215 8/19/06 3:25 PM Page xiii

Contributors xiii

James M. T. Foster, MD Mark S. Gold, MD

Clinical Assistant Professor of Anesthesiology, Department Distinguished Professor and Chief, Departments of
of Anesthesiology, State University of New York at Buffalo Psychiatry, Neuroscience, Anesthesiology, Community
School of Medicine; Director of Anesthesiology Services, Health and Family Medicine, Evelyn and William McKnight
Kaleida Health, Buffalo, New York Brain Institute, University of Florida College of Medicine,
The Hostile-Combative Patient Gainesville, Florida
Chemical Dependency: Opioids; Chemical Dependency:
Melissa Franckowiak, MD Nonopioids
Resident, Department of Anesthesiology, State University of
New York at Buffalo School of Medicine, Buffalo, New York Stuart Grant, MD
Cardioversion Assistant Professor, Department of Anesthesiology, Duke
University School of Medicine, Durham, North Carolina
Eugene B. Freid, MD Continuous Nerve Blocks: Perineural Local Anesthetic Infusion
Associate Professor, Departments of Anesthesiology and
Pediatrics, University of North Carolina Hospitals, Chapel Glenn P. Gravlee, MD
Hill, North Carolina Professor, Department of Anesthesiology, Ohio State
Succinylcholine University Hospitals, Columbus, Ohio
Hemodilution and Blood Conservation
Kimberly Frost-Pineda, MD
Assistant in Psychiatry, Department of Psychiatry, Director Ivar Gunnarsson, MD
of Public Health Research, University of Florida College of Landspítali—háskólasjúkrahús, Reykjavik, Iceland
Medicine, Gainesville, Florida Oxygen Flush Valve
Chemical Dependency: Opioids; Chemical Dependency:
Nonopioids Mary Ann Gurkowski, MD
Professor of Anesthesiology, University of Texas Health
Jeffrey L. Galinkin, MD Science Center at San Antonio; Clinical Staff/Director of
Associate Professor, Department of Anesthesia, Children’s Medical Students, Department of Anesthesiology/Cross-
Hospital, Denver, Colorado appointed to Otorhinolaryngology, University Hospital;
Fetal Intrauterine Surgery Attending Staff, Department of Anesthesiology, Audie
Murphy Veterans Affairs Hospital, San Antonio, Texas
Arjunan Ganesh, MD Foreign Body Aspiration
Assistant Professor of Anesthesia, Department of Anesthesia,
University of Pennsylvania School of Medicine; Assistant
Anesthesiologist, Department of Anesthesiology and Critical
Jacob Gutsche, MD
Physician, Department of Anesthesia, Hospital of the
Care Medicine, Children’s Hospital of Philadelphia,
University of Pennsylvania, Philadelphia, Pennsylvania
Philadelphia, Pennsylvania
Sepsis, Systemic Inflammatory Response Syndrome, and Multiple
Upper Respiratory Tract Infection
Organ Dysfunction Syndrome
Hind M. Gautam, MD
Clinical Assistant Professor, Department of Anesthesiology, Thomas S. Guyton, MD
Veterans Affairs Medical Center, Buffalo, New York Staff Anesthesiologist, Methodist Healthcare of Memphis,
Memphis, Tennessee
Magnetic Resonance Imaging
Magnesium; Antibiotics
Rodolfo Gebhardt, MD
Assistant Professor of Clinical Anesthesiology, Department Ali Habibi, MD
of Anesthesiology, Department of Clinical Anesthesiology, Adjunct Clinical Faculty, Anesthesiology, Stanford University
Veterans Affairs Medical Center, Buffalo New York School of Medicine, Stanford, California
Uncontrolled Pain Antihistamines: H1- and H2-Blockers

Jeremy M. Geiduschek, MD Saeed Habibi, MD

Clinical Professor, Department of Anesthesiology, University Chair, Department of Anesthesiology, Columbia–
of Washington School of Medicine; Director, Clinical St. Mary’s–Milwaukee Campus, Milwaukee, Wisconsin
Anesthesia Services, Department of Anesthesiology, Angioedema and Urticaria
Children’s Hospital and Regional Medical Center, Seattle,
Washington Charles B. Hantler, MD
Intraoperative Cardiac Arrest Professor, Department of Anesthesiology, Washington
University School of Medicine, St. Louis, Missouri
J. C. Gerancher, MD Bradyarrhythmias
Associate Professor and Section Head, Regional
Anesthesia and Acute Pain Management, Department of H. David Hardman, MD, MBA
Anesthesiology, Wake Forest University School of Assistant Clinical Professor, Department of Anesthesiology,
Medicine, Winston-Salem, North Carolina Duke University School of Medicine, Durham, North
Epidural Anesthesia: Unintended Intrathecal Injection; Epidural Carolina
Anesthesia: Unintended Subdural Injection Extremity Tourniquets
FM-X2215 8/19/06 3:25 PM Page xiv

xiv Contributors

Barry A. Harrison, MB,BS Liana Hosu, MD

Assistant Professor of Anesthesiology, Department of Assistant Professor of Anesthesia and Pediatrics,
Anesthesiology, Mayo Clinic College of Medicine, Department of Anesthesiology, University of Cincinnati
Jacksonville, Florida College of Medicine; Staff Anesthesiologist,
Hyperglycemia and Diabetic Ketoacidosis; Sarcoidosis Department of Anesthesiology, Cincinnati
Children’s Hospital Medical Center, Cincinnati,
Joy L. Hawkins, MD Ohio
Professor of Anesthesiology and Director of Obstetric Postoperative Apnea in Infants
Anesthesia, University of Colorado School of Medicine,
Denver, Colorado Kate Huncke, MD
Nonobstetric Surgery during Pregnancy Clinical Associate Professor, Department of Anesthesiology,
New York University School of Medicine, New York,
Christopher M. B. Heard, MB,ChB, FRCA New York
Research Assistant Professor, Department of Anesthesiology Radiation Oncology
and Division of Pediatric Critical Care, State University of
New York at Buffalo School of Medicine; Assistant
Attending, Children’s Hospital of Buffalo, Buffalo, New York Samuel A. Irefin, MD
Magnetic Resonance Imaging; Alleged Malpractice; The Hostile- Associate Professor of Anesthesiology,
Combative Patient Cleveland Clinic Lerner College of Medicine;
Staff Anesthesiologist, Department of Anesthesiology
Stephen O. Heard, MD and Critical Care Medicine, Cleveland Clinic Foundation,
Interim Chair, Professor of Anesthesiology and Surgery, Cleveland, Ohio
University of Massachusetts Medical School, Worcester, Complications of Thyroid Surgery
Massachusetts
Perioperative Care of Immunocompromised Patients William Jacobs, MD
Associate Professor, Departments of Psychiatry and
James R. Hebl, MD Anesthesiology, University of Florida College of Medicine,
Assistant Professor, Department of Anesthesiology, Mayo Gainesville, Florida
Clinic College of Medicine, Rochester, Minnesota Chemical Dependency: Opioids; Chemical Dependency:
Anticoagulants and Peripheral Nerve Block Nonopioids

Robert F. Helfand, MD Eric Jacobsohn, MB,ChB, MHPE, FRCPC

Associate Professor, Cleveland Clinic Lerner College of
Associate Professor of Anesthesiology, Department of
Medicine; Staff Anesthesiologist; Vice Chairman,
Anesthesiology, Washington University School of Medicine,
Department of General Anesthesiology; Section Head of
St. Louis, Missouri
Orthopedic Anesthesia, Glickman Urological Center,
Cleveland Clinic Foundation, Cleveland, Ohio Complications after Pneumonectomy
Thromboembolic Complications
J. Michael Jaeger, MD, PhD
Rosemary Hickey, MD Associate Professor of Anesthesiology and Neurological
Professor and Program Director, Department of Surgery; Director, Thoracic Anesthesia, Department of
Anesthesiology, University of Texas Health Science Center Anesthesiology, University of Virginia Health Sciences
at San Antonio, San Antonio, Texas Center, Charlottesville, Virginia
Intracranial Hypertension Class IV Antiarrhythmic Drugs: Calcium Channel
Blockers
George A. Higgins, BSN, MS, CRNA
Adjunct Faculty, Department of Nursing, University of Michael F. M. James, MB,ChB, PhD, FRCA,
Southern California; Senior Nurse Anesthetist, Department
of Anesthesiology, Department of Veterans Affairs Medical
FCA(SA)
Professor and Head, Department of Anesthesia,
Center, Los Angeles, California
University of Cape Town; Professor and
Embolization Procedures Chief Anaesthetist, Department of Anaesthesia,
Groote Schuur Hospital, Cape Town, Western Cape,
Scott Holliday, MD South Africa
Resident, Department of Anesthesiology, University of Texas
Complications of Adrenal Surgery
Health Science Center at San Antonio, San Antonio, Texas
Foreign Body Aspiration
Gregory M. Janelle, MD
William Hope, MD, PhD Assistant Professor, Chief of Cardiovascular Anesthesia,
Assistant Professor, Department of Anesthesiology, Medical Department of Anesthesiology, University of Florida College
College of Wisconsin, Froedtert Memorial Lutheran Hospital of Medicine, Gainesville, Florida
East, Milwaukee, Wisconsin Phosphodiesterase Inhibitors
Laryngeal and Tracheal Injury
David R. Jobes, MD
Terese T. Horlocker, MD Professor of Anesthesia, Department of Anesthesia and
Professor, Department of Anesthesiology, Mayo Clinic Critical Care Medicine, Children’s Hospital of Philadelphia,
College of Medicine, Rochester, Minnesota Philadelphia, Pennsylvania
Spinal Hematoma; Persistent Paresthesia Complications of Massive Transfusion
FM-X2215 8/19/06 3:25 PM Page xv

Contributors xv

Nicola Jones, MA, MB,BS, DTM&H, MRCP, Jonathan T. Ketzler, MD

MRCPath, PhD Associate Professor of Anesthesiology; Associate Director,
Consultant in Microbiology and Infectious Diseases, Trauma and Life Support Center, Department of
Departments of Microbiology and Infectious Diseases, Anesthesiology, University of Wisconsin School of Medicine
Nuffield Department of Clinical Laboratory Sciences, and Public Health, Madison, Wisconsin
John Radcliffe Hospital, University of Oxford, Oxford, Adrenal Insufficiency
United Kingdom
HIV Infection and AIDS Evan D. Kharasch, MD, PhD
Assistant Dean for Clinical Research; Professor and
Shailendra Joshi, MD Research Director, Department of Anesthesiology,
Assistant Professor of Anesthesiology, Department of University of Washington School of Medicine, Seattle,
Anesthesiology, College of Physicians and Surgeons of Washington
Columbia University, New York, New York Volatile Anesthetics: Organ Toxicity
Arteriovenous Malformation: Normal Perfusion Pressure
Breakthrough M. Sean Kincaid, MD
Resident, Department of Anesthesiology, University of
Zeev N. Kain, MD Washington Medical Center, Seattle, Washington
Professor of Anesthesiology, Department of Anesthesiology, Head Injury
Yale University School of Medicine, New Haven,
Connecticut Kathryn P. King, MD
Perioperative Psychological Trauma Associate Clinical Professor, Department of Anesthesiology,
Duke University School of Medicine, Durham,
Wendy B. Kang, MD North Carolina
Associate Professor and Chair, Residency Education Methylmethacrylate
Committee, Department of Anesthesiology, University of Texas
Health Science Center at San Antonio, San Antonio, Texas
Kai T. Kiviluoma, MD, PhD
Retrobulbar Block Associate Professor, Department of Anaesthesiology,
University of Oulu Faculty of Medicine; Head of the
Shubjeet Kaur, MD Department, Paediatric Anaesthesia, Oulu University
Clinical Vice Chair, Department of Anesthesiology, Hospital, Oulu, Finland
University of Massachussets Memorial Medical Center,
Disorders of Potassium Balance
Worcester, Massachusetts
Perioperative Care of Immunocompromised Patients
Jerome M. Klafta, MD
Robert D. Kaye, MD Associate Professor and Associate Chair for Education,
Assistant Professor of Clinical Anesthesiology and Pediatrics, Department of Anesthesia and Critical Care,
State University of New York at Buffalo School of Medicine; University of Chicago Pritzker School of Medicine,
Attending Anesthesiologist, Children’s Hospital of Buffalo, Chicago, Illinois
Buffalo, New York Mediastinal Masses
Alleged Malpractice
Pattricia S. Klarr, MD
Paul E. Kazanjian, MD Clinical Assistant Professor, Department of Anesthesiology,
Clinical Assistant Professor, Department of Anesthesiology, University of Michigan Medical School;
University of Michigan Medical School, Ann Arbor, Associate Clinical Director, Department of Anesthesiology,
Michigan University of Michigan Medical Center, Ann Arbor,
Fires in the Operating Room; Pulmonary Artery Pressure Michigan
Monitoring Laser Complications

Jeffrey S. Kelly, MD Sandra L. Kopp, MD

Associate Professor of Anesthesiology, Section of Critical Instructor, Department of Anesthesiology, Mayo Clinic
Care, Wake Forest University School of Medicine, College of Medicine, Rochester, Minnesota
Winston-Salem, North Carolina Supraclavicular and Infraclavicular Block:
Complications from Toxic Ingestion Pneumothorax
Kevin J. Kelly, MD
Professor and Chair, Department of Pediatrics; Donald A. Kroll, MD, PhD
Associate Dean, School of Medicine, Children’s Mercy Staff Anesthesiologist, Department of Surgery, Veterans
Hospital and Clinics, University of Missouri, Kansas City, Affairs Medical Center, Biloxi, Mississippi
Missouri Quality Assurance; Cost Containment; Adverse Outcomes:
Latex Reactions in Health Care Personnel Withheld Information or Misinformation

Robert E. Kettler, MD Kenneth Kuchta, MD

Associate Professor, Department of Anesthesiology, Medical Assistant Clinical Professor, Department of
College of Wisconsin, Froedtert Memorial Lutheran Hospital Anesthesiology, David Geffen School of Medicine
East, Milwaukee, Wisconsin at University of California, Los Angeles, Los Angeles,
Patients with Seizure Disorders; Latex Reactions in California
Health Care Personnel Misidentification of a Patient
FM-X2215 8/19/06 3:25 PM Page xvi

xvi Contributors

C. Dean Kurth, MD Ray P. Liao, MD

Professor of Anesthesia and Pediatrics, University of Acting Assistant Professor, Department of Anesthesiology,
Cincinnati College of Medicine, Anesthesiologist-in-Chief; University of Washington School of Medicine, Seattle,
Chair, Institute for Pediatric Research; Cincinnati Children’s Washington
Hospital Medical Center, Cincinnati, Ohio Inotropic Drugs
Postoperative Apnea in Infants
Spencer S. Liu, MD
Arthur M. Lam, MD, FRCPC Clinical Professor of Anesthesiology, Department of
Professor of Anesthesiology, Department of Anesthesiology, Anesthesiology, Virginia Mason Medical Center, Seattle,
University of Washington School of Medicine; Head of Washington
Neuroanesthesia, Harborview Medical Center, Seattle, Spinal Anesthesia: Post–Dural Puncture Headache
Washington
Head Injury Emilio B. Lobato, MD
Professor of Anesthesiology, Department of Anesthesiology,
Jeffrey L. Lane, MD University of Florida College of Medicine; Chief,
Assistant Professor of Clinical Anesthesia and Director, Cardiovascular Anesthesia, Department of Anesthesia
Human Simulation Laboratory, Department of Anesthesia, Service, Malcom Randall Veterans Affairs Hospital,
Indiana University School of Medicine; Staff Anesthesiologist, Gainesville, Florida
Clarian Health Partners, Indianapolis, Indiana Digitalis
Postoperative Respiratory Insufficiency
Robert G. Loeb, MD
Paul B. Langevin, MD Associate Professor of Anesthesiology, University of Arizona
Associate Professor, Department of Anesthesiology, Veterans College of Medicine, Tucson, Arizona
Affairs–West Haven, West Haven, Connecticut Flowmeters
Chemotherapeutic Agents
Celeste M. Lombardi, MD
Melissa A. Laxton, MD Fellow in Interventional Pain Medicine, Department of
Assistant Professor of Anesthesiology, Wake Forest Anesthesiology, University of Florida College of Medicine,
University School of Medicine, Winston-Salem, Gainesville, Florida
North Carolina Chronic Nonsteroidal Anti-inflammatory Drug Use
Pituitary Tumors: Diabetes Insipidus
Prashant Lotlikar, MD
Marcia M. Lee, MD, MBA Clinical Assistant Professor, Department of Anesthesiology,
Assistant Chief, Department of Anesthesiology, University of Texas Health Science Center, Texas Heart
Kaiser Permanente–South Bay, Harbor City, California Institute, Houston, Texas
Awareness under Anesthesia Troubleshooting Common Problems during
Cardiopulmonary Bypass
Mijin Lee, MD
Assistant Clinical Professor, Department of Anesthesiology, Michelle L. Lotto, MD
David Geffen School of Medicine at University of California, Assistant Professor of Anesthesiology, Department of
Los Angeles, Los Angeles, California General Anesthesiology and Critical Care Medicine,
Anesthesia for Electroconvulsive Therapy Cleveland Clinic Lerner College of Medicine; Associate
Staff Anesthesiologist, Cleveland Clinic Foundation,
Peter J. Lee, MD, MPH Cleveland, Ohio
Formerly, Assistant Professor, Department of Complications of Spinal Surgery
Anesthesiology, University of Michigan Medical School,
Ann Arbor, Michigan Katarzyna Luba, MD
Central Venous Pressure Monitoring Assistant Professor of Clinical Anesthesiology, Department
of Anesthesia and Critical Care, University of Chicago
Philip Levin, MD Pritzker School of Medicine, Chicago, Illinois
Associate Professor, Department of Anesthesiology, David Perioperative Management of Patients with Muscular
Geffen School of Medicine at University of California, Dystrophy
Los Angeles, Los Angeles, California
Postoperative Delirium Stewart J. Lustik, MD
Associate Professor of Anesthesiology, University of
Jerrold H. Levy, MD Rochester School of Medicine and Dentistry, Rochester,
Professor and Department Chair/Research, Department of New York
Anesthesiology, Emory University School of Medicine, Proportioning Systems; Patient Warming Systems
Atlanta, Georgia
Perioperative Hypertension Vinod Malhotra, MD
Professor and Vice Chair for Clinical Affairs,
Ian Lewis, MB,BS, MRCP, FRCA Department of Anesthesiology, Weill Medical College of
Associate Professor, Department of Anesthesiology, University Cornell University, New York–Presbyterian Hospital,
of Michigan Medical School, Ann Arbor, Michigan New York, New York
Surgical Diathermy and Electrocautery Complications of Transurethral Surgery