Published June 2004 ...

Edited by: Jonathan H Mackay & Joseph E Arrowsmith

Hardback cover - 367 pages. B&W and colour illustrations

66 Chapters in 11 Sections

Publisher: Cambridge University Press Greenwich Medical Media

ISBN: 1-841101-33-8 / 0-521-86841-6
Price:  £45.00 / €65.00

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Reviews

Ross J. British Journal of Anaesthesia 2005;94(6):868.

Motta P. Anesthesia & Analgesia 2006;102(2):657.

Cousins J. Perfusion 2006;21(3):193.
Synopsis

Core Topics in Cardiac Anaesthesia has been written by a multidisciplinary team of international authors. The aims are to provide: a concise introduction to trainees, comprehensive coverage of all key issues, extensive illustrations to facilitate learning and recall, an emphasis on pathophysiology as the key to understanding the principles of practice of cardiothoracic anaesthesia and intensive care.

Readership

Anaesthetic, intensive care and surgical trainees.
Cardiothoracic critical care practitioners, ICU nurses and operating department personnel.

Foreword

Cardiac anaesthesia brings many divergent disciplines into one unifying practice, making it one of the most complex anaesthetic specialties. It requires an understanding of pathology, physiology, pharmacology, internal medicine, cardiology, cardiac surgery and intensive care. The ever-expanding nature of the specialty presents considerable challenges for both the veryday practitioner and the trainee - for whom this text is particularly targeted

In this day and age, when a vast amount of information is already available both in print and on-line, one may be forgiven for questioning the need for yet another printed textbook. By way of an answer, the Editors (both of whom have worked in the UK and the USA) have produced a textbook (rather than a cookbook) that addresses a relatively unfilled need - a source that is specifically directed towards those who represent the future of our specialty. By incorporating contributions from authors from many countries, the Editors have largely avoided national and institutional bias

Today's anaesthetic trainees are confronted with the seemingly impossible task of assimilating, understanding and memorizing an almost infinite body of information. Those who succeed in this task are invariably those who can confidently identify core principles without getting distracted by minute details. The Editors never intended to produce an exhaustive reference and the need to consult other sources of detailed information has, therefore, not been completely eliminated. This book does, however, provide the trainee with a very convenient framework onto which further knowledge can be added as it is acquired. The manner in which the authors have organized and presented information in this book should help the reader to more quickly see the 'bigger picture' and appreciate the subtleties of cardiac anaesthesia.

Hilary P Grocott MD FRCPC
Associate Professor of Anesthesiology
Mark F Newman MD
Merel H Harmel Chair and Professor of Anesthesiology
Duke University, Durham, North Carolina, USA
Preface

This book is primarily aimed at anaesthetic trainees in the first 3-6 months of subspecialty training in cardiac anaesthesia and critical care. It is our response to the many trainees who have regularly asked us to recommend a small textbook on cardiac anaesthesia.

We reralise that it is impossible to provide a truly comprehensive review of cardiac anaesthesia in ~120,000 words but hope that this book provides a sound grounding in all of the topic topics. The content of this book has been very much guided by the Royal College of Anaesthetists' CCST in Anaesthesia manual, The Society of Cardiovascular Anesthesiologists' Program Requirements for Resident Education, and recent examination papers from the United Kingdom, North America and Australasia.

Our instructions to contributing authors and editorial aims were simple; produce a concise yet comprehensive overview of the subject emphasising pathophysiology, basic scientific principles and key elements of practice. We Hope that the use of a presentation format that relies on figures and tables in preference to text will aid comprehension and recall. We have endeavoured to avoid repetition of information, long lists of references and institutional bias. We trust that the curious trainee will turn to the larger textbooks and the Internet for more detailed discussions and exhaustive literature reviews. Finally, we hope that many sections of this book will also appeal to those preparing trainees for examinations and to clinical nurse specialists working in the field of cardiothoracic intensive care.

We would like to thank all of those who have made the puiblication of this volume possible; our international panel of contributors for taking the time to share their knowledge and expertise; Gill Clark and Gavin Smith of Green Medical Media for their encouragement, advice and patience; and our Specialist Registrars for their advice and proof reading. Last, we wish to thank our families for their willing, and occasionally unwilling, support during this enterprise.

Jon Mackay MRCP FRCA
Joe Arrowsmith MD FRCP FRCA
Consultant Anaesthetists, Papworth Hospital, Cambridge, UK
January 2004

For Nigel, Rebecca and Alexander Eastwood

This book is dedicated to the memory of Dr Nigel Eastwood (a Consultant in Anaesthesia and Intensive Care at the North Staffordshire Hospital and formerly a Critical Care Fellow at Duke University Medical Center, Durham, NC, USA), his wife Rebecca and their son Alexander who were killed in a car crash whilst on holiday in northern Spain in July 2002. Despite serious injuries, their infant daughter Cecily survived the crash. BBC News

Contents

1. Anatomy and physiology

  • Cardiac embryology & anatomy. MJ Goddard.

  • Cardiac electrophysiology. DW Wheeler & AA Grace.

  • Cardiac excitation-contraction coupling. KH McKinlay & JV Booth.

  • Ventricular performance. P White & JE Arrowsmith.

  • Coronary physiology. J Byrne & P MacCarthy.

  • Cardiovascular control mechanisms. JJ Walton & AM Cohen.

  • Anaesthesia & the cardiovascular system. JJ Walton & AM Cohen.

2. Cardiac pharmacology

  • Cardiac receptors. MV Podgoreanu & JV Booth.

  • Antihypertensive drugs (vasodilators). SJ Gray & CS Moore.

  • Inotropes. A Cohen & S Ghosh.

  • Anti arrhythmic drugs. SL Misso & RO Shaw.

  • Haematological. JH Mackay & CS Moore.

  • Opioids. M Prabhu.

  • Effects of cardiopulmonary bypass & haemodilution. B Murali.

3. Diagnosis coronary heart disease

  • Symptom and signs of cardiovascular disease. JE Arrowsmith.

  • Non-invasive diagnostic techniques. CP Searl & R Coulden.

  • Invasive diagnostic techniques. CP Searl.

4. Cardiac surgery for anaesthetists

  • Patient selection and risk stratification. SAM Nashef.

  • Basic principles of cardiac surgery. SAM Nashef.

  • Myocardial protection. DP Jenkins.

  • Preconditioning and stunning. WE Johnston.

  • Prosthetic valves. K Grixti.

5. Monitoring

  • Pulmonary artery flotation catheter. MJT Lanzinger & JB Mark.

  • Transoesophageal echocardiography. RMO Hall.

  • TOE assessment of LV Function. J Graham & JH Mackay.

  • The brain. JE Arrowsmith.

6. Routine coronary heart surgery (On bypass)

  • Premedication, induction and maintenance. AI Gardner & PR Joshi.

  • Conduct and monitoring of cardiopulmonarey bypass. D Gifford & SJ Gray.

  • The early postoperative period. Maura Screaton.

7. Anaesthetic management of specific disorders

  • Coronary heart surgery (Off-bypass). IM Davies & AT Lovell.

  • Aortic valve disease. JH Mackay & JE Arrowsmith.

  • Mitral valve disease. JH Mackay / FC Wells.

  • Redo surgery and aneurysmectomy. J Graham.

  • Aortic dissection. AC Knowles & JD Kneeshaw.

  • Aortic arch surgery. AC Knowles & JD Kneeshaw.

  • Descending thoracic aorta surgery. EJS Taylor & JH Mackay.

  • Permanent pacemakers and implantable defibibrillators. JA Chandler & JH Mackay.

  • Anaesthesia and electrophysiological disorders. DW Wheeler.

  • Cardiomyopathy. JH Mackay & F Falter.

  • Cardiothoracic transplantation. F Falter & JH Mackay.

8. Paediatric cardiac anaesthesia

  • General principles. IA Walker & JH Smith.

  • Conduct of anaesthesia. IA Walker & JH Smith.

  • Operations for common congenital heart lesions. DJ Barron & KP Morris.

  • Postoperative care of paediatric patient. FE Reynolds & KP Morris.

9. Cardiopulmonary bypass and the anaesthetist (Specific issues)

  • Cardiopulmonary bypass equipment. D Gifford & SJ Gray.

  • Failure to wean from bypass (IABP, VADs etc). S Colah & SJ Gray.

  • Management of cardiopulmonary bypass coagulopathy. JH Mackay & JE Arrowsmith.

  • Inflammatory response to cardiopulmonary bypass. RJ De Silva & A Vuylsteke.

  • Controversies in cardiopulmonary bypass. AC Knowles & SL Misso.

  • Deep hypothermic circulatory arrest. SL Misso & AC Knowles.

  • Cardiopulmonary bypass emergencies. DJ Daly.

10. Cardiac intensive care

  • Cardiovascular complications. TWR Lee & JH Mackay.

  • Cardiopulmonary resuscitation in the cardiac ICU. JH Mackay & JE Arrowsmith.

  • Respiratory complications. MK Prasad & F Falter.

  • The gut and nutritional management. AM Campbell & MG Mythen.

  • Renal complications and the role of haemofiltration. WT McBride & J Skoyles.

  • Central nervous system dysfunction and cardiopulmanry byass. JE Arrowsmith.

11. Miscellaneous topics

  • Grown-up congenital heart (GUCH) disease. M Barnard.

  • The pregnant patient. JE Arrowsmith & JH Mackay.

  • Regional anaesthesia. D Ray & TWR Lee.

  • Pain management. I Hardy.

  • Haematological conditions and cardiac surgery. JH Mackay & JE Arrowsmith.

  • Temperature and rewarming. D Duthie.

  • Microbiology. J Foweraker.

  • Cardiopulmonary bypass for non-cardiac surgery. R Rajamohan.

  • The cardiac patient undergoing non-cardiac surgery. JE Arrowsmith & JH Mackay.

Contributors

Joseph E Arrowsmith. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
Mathew Barnard. Consultant Anaesthetist, University College Hospitals, London, UK.
David J Barron. Consultant Surgeon, Birmingham Childrens Hospital, Birmingham, UK.
John V Booth. Assistant Professor of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Jonathan Byrne. Department of Cardiology, Guys, Kings & St Thomas' Hospitals, London, UK.
Anne Campbell. Consultant Anaesthetist, University College Hospitals, London, UK.
Jim A Chandler. Fellow in Cardiothoracic Anaesthesia, Papworth Hospital, Cambridge, UK.
Alan M Cohen. Consultant Anaesthetist, Bristol Royal Infirmary, Bristol, UK.
Simon Colah. Perfusionist, Cambridge Perfusion Services, Cambridge, UK.
Richard Coulden. Consultant Radiologist, Papworth Hospital, Cambridge, UK.
David J Daly. Consultant Anaesthetist, The Alfred Hospital, Melbourne, Australia.
Ian M Davies. Consultant Anaesthetist, Bristol Royal Infirmary, Bristol, UK.
Ravi J DeSilva. SpR in Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
David Duthie. Consultant Anaesthetist, St James' Hospital, Leeds, UK.
Florian Falter. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
Juliet Foweraker. Consultant Microbiologist, Papworth Hospital, Cambridge, UK.
Andrew I Gardner. Consultant Anaesthetist, Sir Charles Gairdner Hospital, Perth, Australia.
Sunit Ghosh. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
David Gifford. Perfusionist, Cambridge Perfusion Services, Cambridge, UK.
Martin J Goddard. Consultant Pathologist, Papworth Hospital, Cambridge, UK.
Andrew A Grace. Consultant Cardiologist, Papworth Hospital, Cambridge, UK.
Jon Graham. Clinical Fellow in Anaesthesia, Austin & Repatriation Hospital, Melbourne, Australia.
Stephen J Gray. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
Kenneth Grixti. Consultant Anaesthetist, St Lukes Hospital, Gwardamangia, Malta.
Roger MO Hall. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
Ian Hardy. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
David P Jenkins. Consultant Cardiothoracic Surgeon, Papworth Hospital, Cambridge, UK.
William E Johnston. Professor of Anesthesiology, Southwestern Medical Center, Dallas, TX, USA.
Purna R Joshi. Associate Professor of Anesthesiology, Tribhuvan University Hospital, Kathmandu, Nepal.
John D Kneeshaw. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
Andrew C Knowles. Consultant Anaesthetist, Royal Victoria Hospital, Blackpool, UK.
Marcella JT Lanzinger. Duke University Medical Center, Durham, NC, USA.
Trevor WR Lee. Assistant Professor of Anesthesia, St Boniface Hospital, Winnipeg, Canada.
A Tim Lovell. Consultant Anaesthetist, Bristol Royal Infirmary, Bristol, UK.
Philip MacCarthy. Consultant Cardiologist, Kings College Hospital, London, UK.
Jonathan H Mackay. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
Jonathan B Mark. Professor of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
William T McBride. Consultant Anaesthetist, Royal Victoria Hospital, Belfast, UK.
Kenneth H McKinlay. Anesthesia Fellow, Duke University Medical Center, Durham, NC, USA.
Sonia L Misso. Consultant Anaesthetist, Prince Charles Hospital, Brisbane, Australia.
Colin S Moore. Anaesthetic SpR, Edinburgh, UK.
Kevin P Morris. Consultant Paediatric Intensivist, Birmingham Childrens Hospital, Birmingham, UK.
Bala Murali. Consultant Anaesthetist, City Hospital, Stoke on Trent, UK.
Michael G "Monty" Mythen. Portex Professor of Anaesthesia, Institute of Child Health, London, UK.
Samer AM Nashef. Consultant Cardiothoracic Surgeon, Papworth Hospital, Cambridge, UK.
M V Podgoreanu. Associate Professor of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Mahesh Prabhu. Consultant Anaesthetist, Freeman Hospital, Newcastle, UK.
M Krishna Prasad. Consultant Anaesthetist, Global Hospitals, Hyderabad, India.
Ramaswamy Rajamohan. Anaesthetic SpR, Papworth Hospital, Cambridge, UK.
Fiona E Reynolds. Consultant Anaesthetist, Birmingham Childrens Hospital, Birmingham, UK.
Maura Screaton. Critical Care Practitioner, Papworth Hospital, Cambridge, UK.
Cait P Searl. Consultant Anaesthetist, Freeman Hospital, Newcastle, UK.
Rosalyn O Shaw. Consultant Anaesthetist, Brisbane, Australia.
Julian Skoyles. Consultant Anaesthetist, City Hospital, Nottingham, UK.
Jon H Smith. Consultant Anaesthetist, Freeman Hospital, Newcastle, UK.
Emma JS Taylor. Consultant Anaesthetist, St Thomas' Hospital, London, UK.
Isabeau A Walker. Consultant Anaesthetist, Hospital for Sick Children, Great Ormond Street, London, UK.
Jon J Walton. Visiting Instructer in Anesthesia, University of Michigan, Ann Arbor, MI, USA.
Francis C Wells. Consultant Cardiothoracic Surgeon, Papworth Hospital, Cambridge, UK.
Dan W Wheeler. Lecturer in Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
Paul White. Clinical Scientist, Papworth Hospital, Cambridge, UK.
Alain Vuylsteke. Consultant Anaesthetist, Papworth Hospital, Cambridge, UK.
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