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Anesthesia Student Survival Guide: A Case-Based Approach is an indispensable introduction to the specialty. This concise, easy-to-read, affordable handbook is ideal for medical students, nursing students, and others during the anesthesia rotation. Written in a structured prose format and supplemented with many diagrams, tables, and algorithms, this pocket-sized guide contains essential material covered on the USMLE II-III and other licensing exams. The editors, who are academic faculty at Harvard Medical School, summarize the essential content with 32 informative and compelling case studies designed to help students apply new concepts to real situations. Pharmacology, basic skills, common procedures and anesthesia subspecialties are covered, too, with just the right amount of detail for an introductory text. The unique book also offers a section containing career advice and insider tips on how to receive good evaluations from supervising physicians. With its combination of astute clinical instruction, basic science explanation, and practical tips from physicians that have been there before, this handbook is your one-stop guide to a successful anesthesia rotation.

Inhoudsopgave

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Introduction to Anesthesiology

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Chapter 1. How to Be a “Star” Student, Career Options, and the Match

If your favorite place in the world is the operating room, be a surgeon. If your favorite place in the hospital is the operating room, be an anesthesiologist. For many, the practice of anesthesiology is the perfect blend of science, medical management, procedural skills, variety, and fun. Where else can you care for critically ill patients, listen to music, socialize with surgeons, and wear your pajamas all at the same time?
Roy G. Soto

Chapter 2. History of Anesthesia and Introduction to the Specialty

Welcome to the exciting and fast-paced specialty of Anesthesiology! As a medical student rotating through anesthesia, you are fortunate in being able to learn about anesthesia without having to give it on your own. In the past, despite having little or no prior experience, medical students were often the ones administering the anesthetics. The time honored tradition of “See one, do one, teach one” would not be invoked. Instead, a bottle of ether would be provided, and you would “pour one.” This is, in fact, what happened in 1894 to a third-year student at the Massachusetts General Hospital. He was called down from the seats in the famed hospital amphitheater, sent to a side room with a patient and an orderly, and told to put the patient to sleep for a surgical demonstration. Knowing nothing about the patient whatsoever, he proceeded the best he could under the orderly’s directions. The patient was finally brought into the amphitheater after an interminable amount of gagging. Once the operation began, there was a great gush of fluid from the patient’s mouth, most of which he inhaled, and he died. Despite this unfortunate turn of events, the operation was completed and was deemed a success. That evening, the student went to see the surgeon to atone for his sins - planning to then find a different occupation. He was told that he was not responsible for the man’s death, as he had a strangulated hernia, had been vomiting all night anyway, and that sort of thing happened frequently. The student was Harvey Cushing, who went on to become one of the world’s greatest neurosurgeons.
David C. Lai

Pharmacology

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Chapter 3. Pharmacology Principles

Understand the basic principles of pharmacokinetics such as drug absorption, distribution, metabolism, and excretion Learn the basic principles of pharmacodynamics such as drug potency, efficacy, and therapeutic index Discuss the concept of context-sensitive half-time
Jerome M. Adams, John W. Wolfe

Chapter 4. Pharmacology of Intravenous Anesthetic Agents

Learn the relative advantages of each of the commonly used intravenous induction agents (propofol, etomidate, ketamine, thiopental) iscuss the pharmacokinetic properties of each of the commonly used intravenous opioids (fentanyl, morphine, hydromorphone, remifentanil) Understand the differences between depolarizing and nondepolarizing neuromuscular blockers
Jerome M. Adams, John W. Wolfe

Chapter 5. Pharmacology of Inhalational Anesthetics

Learn the pharmacokinetic factors affecting the rate of induction and emergence with inhalational anesthetics Understand the concept of Minimum Alveolar Concentration (MAC) Know the key characteristics of the four most commonly used inhalational agents (nitrous oxide, isoflurane, desflurane, sevoflurane)
Jerome M. Adams, John W. Wolfe

Chapter 6. Pharmacology of Local Anesthetics

Understand the basic mechanisms of local anesthetic action and metabolism Appreciate the differences in the properties among commonly used local anesthetics Learn the signs of local anesthetic toxicity and its treatment
John W. Wolfe, Jerome M. Adams

Chapter 7. Pharmacology of Adjunct Agents

Understand the clinical properties and uses of direct and indirect-acting sympathomimetic drugs Learn the mechanism of action of antiemetic drugs Review the properties of nonsteroidal anti-inflammatory drugs
Jerome M. Adams, John W. Wolfe

Preoperative Considerations

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Chapter 8. The Preoperative Patient Evaluation

Understand the key aspects of a preoperative anesthetic evaluation Know how cardiovascular risk factors relate to intraoperative morbidityLearn the ASA physical status classification system
Amit Gupta, Elifce O. Cosar

Chapter 9. Airway Evaluation and Management

Review the anatomy relevant to airway management Understand the components of an airway examination Learn the principles of mask ventilation and intubation
Shawn T. Beaman, Patrick J. Forte, David G. Metro

Chapter 10. The Anesthesia Machine

Understand the flow of gas from the central hospital supply to the patient Learn the key components of an anesthesia machine (vaporizers, flowmeters, breathing circuits, scavenger system, alarms) Understand the safety mechanisms incorporated into the anesthesia machine
Alvaro A. Macias

Chapter 11. Anesthesia Equipment and Monitors

Learn the indications for applying the most common intraoperative monitors. Understand the principles behind each of the key physiologic monitors. Know the limitations associated with various types of monitoring
Basem Abdelmalak, D. John Doyle

Intraoperative Considerations

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Chapter 12. Anesthetic Techniques: General, Sedation, MAC

Learn how to prepare for the different phases of an anesthetic. Understand the continuum of sedation. Discuss the advantages and disadvantages of different anesthetic techniques
Brian C. McLean, Anthony R. Plunkett

Chapter 13. Anesthetic Techniques: Regional

Understand the different types of regional anesthetics (neuraxial, peripheral, intravenous). Learn indications, techniques, and potential complications associated with regional anesthesia. Review the relevant anatomy for regional anesthesia
Anthony R. Plunkett, Brian C. McLean

Chapter 14. Electrolytes, Fluids, Acid-Base Analysis, and Transfusion Therapy

Understand the risks and benefits of fluid replacement therapy options. Know how to calculate a patient’s fluid requirements and allowable blood loss. Learn the types of blood transfusion therapy available and their indications
Francis X. Dillon

Chapter 15. IV, Gastric Tube, Arterial & Central Line Placement Techniques

Learn anatomy, indications, and techniques associated with line placement Understand the complications associated with invasive lines Know how to select a site for cannulation
Francis X. Dillon

Chapter 16. Common Intraoperative Problems

Learn to identify common intraoperative problems including hypoxia, hypotension, and hypercarbia. Provide a differential diagnosis for each intraoperative problem based on available data. Identify the most important management options once a diagnosis is made.
Francis X. Dillon

Systems Physiology and Anesthetic Subspecialties

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Chapter 17. Physiology and Anesthesia for Cardiac and Thoracic Surgery

Learn relevant cardiovascular physiology and common pathologic conditions. Understand the anesthetic considerations for cardiac surgery. Learn thoracic physiology and anesthetic considerations for thoracic surgery.
Amanda J. Rhee, Linda Shore-Lesserson

Chapter 18. Physiology and Anesthesia for Neurologic, ENT, and Ophthalmologic Surgery

Understand the relationship between cerebral blood flow, PaO2, and PaCO2. Learn the effects of anesthetic agents on cerebral physiology. Know the anesthetic approaches used for ENT and ophthalmologic surgery.
Joshua H. Atkins

Chapter 19. Physiology and Anesthesia for Obstetrics

Learn the physiologic changes associated with pregnancy. Know the various methods of pain control available during labor. Understand the anesthetic management of the obstetric patient.
Stephen M. Howell, Mario Serafini

Chapter 20. Physiology and Anesthesia for General and Bariatric Surgery

Learn the pathophysiology of obesity and endocrine disorders. Understand the anesthetic considerations for bariatric surgery and common general surgical procedures. Learn about physiologic considerations that occur during laparoscopy.
Rana Badr

Chapter 21. Anesthesia for Urological Surgery

Learn the pertinent urinary system anatomy and physiology Understand anesthetic management of common urologic procedures Discuss common complications associated with urologic surgery
Payal Kohli

Chapter 22. Physiology and Anesthesia for Pediatric Surgery

Understand important anatomical and physiologic differences between pediatric and adults patients Know how to take an appropriate preanesthetic history for a pediatric patient Learn common anesthetic techniques used in pediatric patients
Thomas M. Romanelli

Chapter 23. Physiology and Anesthesia for Elderly Patients

Understand the physiologic changes associated with aging Learn the specific considerations for anesthetic management of the elderly Understand common postoperative anesthetic complications
Ruma Bose

Chapter 24. Ambulatory Surgery and Out-of-OR (OOR) Procedures

Learn about patient selection, intraoperative management and postoperative care of ambulatory patients Understand specific practices of ambulatory anesthesia such as fast-tracking and multimodal management of pain and PONV Understand the unique challenges of the OOR environment
Joshua H. Atkins

Chapter 25. Anesthesia for Trauma and Orthopedic Surgery

Review key mechanisms of injury that lead to trauma Learn the Glasgow coma scale and how to apply it Understand the approach to anesthesia for orthopedic surgery
Roy G. Soto

Postoperative Considerations

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Chapter 26. Perioperative Acute and Chronic Pain Management

Understand the basic neurophysiology of pain Understand the types of acute and chronic pain (i.e. nociceptive, inflammatory, neuropathic, and dysfunctional) Learn the common pain syndromes encountered in the pain clinic, and describe the basic treatment options
Mark A. Hoeft

Chapter 27. Postoperative Anesthesia Care Unit (PACU) and Common Postoperative Problems

Learn the key elements of a PACU sign-out Review the most common postoperative anesthetic complications Understand the criteria for discharge from the PACU
R. Dean Nava, Tarun Bhalla

Chapter 28. Introduction to Critical Care

Review basic concepts of oxygen balance in the body Understand the diagnosis and treatment of common conditions encountered in the intensive care setting such as shock, sepsis, and acute respiratory failure Learn the basic principles, indications, and complications associated with hemodynamic monitoring techniques such as arterial line, CVP and pulmonary artery catheter. Discuss different modes of mechanical ventilation
Beverly J. Newhouse

Special Topics

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Chapter 29. Professionalism, Safety, and Teamwork

Understand professionalism and its importance for the practice of anesthesiology Learn a simple approach to practicing “etiquette based medicine” Know how to avoid the common causes of communication failure
Sheila Ryan Barnett, Stephen D. Pratt

Chapter 30. Quality Assurance, Patient and Provider Safety

Learn about the need for and history of patient safety Discuss anesthesia-related patient safety data Understand national initiatives to improve patient safety
Arti Ori

Chapter 31. Ethical and Legal Issues in Anesthesia

Understand the principle and process of obtaining informed consent Learn the definition of medical malpractice and how to avoid frivolous claims Know the procedure for addressing DNR/DNI status in the operating room
Jesse M. Ehrenfeld

Chapter 32. Clinical Simulation in Anesthesia Education

Understand the different types of simulation and their uses Learn how crisis resource management can be used to manage a critical scenario Know the expectations of a trainee experiencing a medical simulation
Emily M. Hayden

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