Perioperative Medicine for the Junior Clinician

J. Symons, The Alfred Hospital, Victoria, Australia;

P. Myles, The Alfred Hospital, Victoria, Australia;

R. Mehra, The Alfred Hospital, Victoria, Australia;

C. M. Ball, The Alfred Hospital, Victoria, Australia

Contributors (Online Only)

Foreword xxiv
Michael (Monty) Mythen

Preface xxv
Paul Myles

Acknowledgements xxvii

Abbreviations (Online Only)

About the companion website xxxvii

Part I Introduction 1

1 The role of the perioperative medicine physician 3
Mike Grocott

2 The role of the preadmission clinic 6
James Tomlinson

3 Consent 11
Justin Burke

4 The early postoperative round 15
Debra Devonshire and Paul Myles

5 Quality improvement and patient safety 18
Stuart Marshall

6 Intraoperative and postoperative monitoring 22
Philip Peyton

7 Drugs used for anaesthesia and sedation 28
Alex Konstantatos

8 The recovery room 33
Arvinder Grover

9 Perioperative genomics 38
Christopher Bain and Andrew Shaw

Part II Preoperative risk assessment 43

10 Perioperative medication management 45
Paul Myles

11 The cardiac patient for non?]cardiac surgery 51
Howard Machlin

12 Cardiovascular risk assessment in cardiac surgery 57
Christopher Duffy

13 Preoperative cardiac testing 61
Joshua Martin and Peter Bergin

14 Airway assessment and planning 68
Pierre Bradley and Joel Symons

15 Pulmonary risk assessment 74
David Daly

16 Preoperative cardiopulmonary exercise testing 79
Chris Snowden and Serina Salins

17 Anaemia 85
Amanda Davis and Angus Wong

18 Central nervous system risk assessment 90
Richard Stark

19 Risk assessment for perioperative renal dysfunction 94
David McIlroy

20 Medical futility and end?]of?]life care 98
Mark Shulman and Matthew Richardson

21 The surgical safety checklist 102
Pedro Guio?]Aguilar and Russell Gruen

Part III Perioperative investigations 107

22 Preoperative investigations (non?]cardiac surgery) 109
Arvinder Grover

23 Postoperative investigations 114
Arvinder Grover

Part IV Specific medication management and prophylaxis 119

24 Thromboprophylaxis 121
Amanda Davis

25 Anticoagulants and antiplatelet agents 128
David Daly

26 Diabetes medication 136
Shane Hamblin

27 Steroid medication 144
Shane Hamblin

28 Opioids and opioid addiction 148
Meena Mittal, Nicholas Christelis and David Lindholm

29 Antibiotic prophylaxis 154
Allen Cheng

30 Antibiotic prophylaxis for endocarditis 158
Denis Spelman

Part V Perioperative management of organ dysfunction and specific population groups 163

31 Coronary artery disease and coronary stents 165
Sesto Cairo

32 Hypertension 170
Steven Fowler and Terry Loughnan

33 Arrhythmias 175
Andrew Robinson

34 Pacemakers and implanted defibrillators 182
Andrew Robinson

35 Heart failure 188
Vanessa van Empel and Dion Stub

36 Aortic stenosis 193
Rishi Mehra

37 Pulmonary hypertension 198
Mark Buckland

38 Endocarditis, myocarditis and cardiomyopathy 203
Enjarn Lin

39 Acute lung injury 212
Paul Nixon and David Tuxen

40 Obstructive sleep apnoea 217
Matthew Naughton

41 Asthma 223
Alan Young

42 Chronic obstructive pulmonary disease 229
Jeremy Wrobel and Trevor Williams

43 Non?]small cell lung cancer 235
Robert Stirling

44 Gastrointestinal disease 242
Lauren Beswick and William Kemp

45 Hepatic disease 245
Lauren Beswick and William Kemp

46 Oliguria 249
Paul Myles

47 Acute kidney injury 254
Lloyd Roberts and Owen Roodenburg

48 Renal transplantation 259
Solomon Menahem

49 Diabetes mellitus 264
David Story

50 Thyroid disorders 268
Shane Hamblin

51 Parathyroid disorders 272
Shane Hamblin

52 Adrenal disorders 277
Jonathan Serpell

53 Carcinoid syndrome 281
Alexandra Evans

54 Intracranial surgery 286
Hilary Madder

55 Carotid surgery 292
Matthew Claydon

56 Epilepsy 301
Richard Stark

57 Neuromuscular disease 304
Erik Andersen and Andrew Kornberg

58 Trauma: pretheatre management 309
John Moloney

59 Traumatic brain injury 314
Winifred Burnett

60 Maxillofacial injuries 322
Joel Symons and Charles Baillieu

61 Spinal injuries (excluding cervical spine) 329
Susan Liew

62 Cervical spine injuries 337
Peter Hwang and Jin Tee

63 Chest injuries 343
Silvana Marasco

64 Abdominal injuries 349
Katherine Martin

65 Burns 354
Jamie Smart

66 Bleeding disorders 360
Paul Coughlan

67 Human immunodeficiency virus infection 366
Anna Pierce

68 Exposure to blood?]borne viruses 370
Anna Pierce

69 The patient with psychiatric illness 374
Steven Ellen and James Olver

70 Obstetric patients having non?]obstetric surgery 377
Maggie Wong

71 The elderly patient 382
Yana Sunderland

72 Allergies and anaphylaxis 386
Helen Kolawole

73 Obesity 390
Jennifer Carden

74 Goal?]directed therapy 395
Andrew Toner and Mark Hamilton

75 Fluids and electrolytes 400
David Story

76 Electrolyte abnormalities 404
Lloyd Roberts and Carlos Scheinkestel

77 Blood transfusion 410
Amanda Davis

78 Organ donation 416
Steve Philpot and Joshua Ihle

Part VI Early postoperative care 421

79 Postoperative nausea and vomiting 423
Joel Symons

80 Postoperative fluid therapy 430
Dashiell Gantner

81 Ventilation strategies 435
John Botha

82 Sepsis and the inflammatory response to surgery 440
Tomás Corcoran and Kajari Roy

83 Nutritional support 445
Craig Walker

84 Postoperative surgical complications 449
Katherine Martin

85 Postoperative chest pain 453
Shane Nanayakkara and Peter Bergin

86 Postoperative shortness of breath 459
KJ Farley and Deirdre Murphy

87 Postoperative hypotension 467
Steven Fowler

88 Myocardial injury after non?]cardiac surgery 472
Fernando Botto and PJ Devereaux

89 Aspiration 476
Alan Kakos

90 Postoperative delirium and postoperative cognitive dysfunction 480
Brendan Silbert and Lisbeth Evered

91 Postoperative hyperthermia 485
Glenn Downey

92 Perioperative hypothermia 493
John Monagle and Shashikanth Manikappa

Part VII Pain management 499

93 Acute pain 501
Alex Konstantatos

94 Neuropathic pain 507
Tim Hucker

95 The chronic pain patient 511
Carolyn Arnold