Anestesia clínica
Publicación animada
8 . ª E D I C I Ó N Anestesia clínica
Paul G. Barash Bruce F. Cullen
Robert K. Stoelting Michael K. Cahalan M. Christine Stock
Rafael Ortega Sam R. Sharar Natalie F. Holt
Incluye contenido adicional en línea AMPLE
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Anestesia clínica
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Anestesia clínica 8 a EDICIÓN
E D I TA D O P O R
M. Christine Stock, MD Professor
Paul G. Barash, MD Emeritus Professor and Past Chair Department of Anesthesiology Yale University School of Medicine Honorary Attending Anesthesiologist
Department of Anesthesiology Feinberg School of Medicine Northwestern University Chicago, Illinois
Yale-New Haven Hospital New Haven, Connecticut Bruce F. Cullen, MD Emeritus Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington Robert K. Stoelting, MD Emeritus Professor and Past Chair Department of Anesthesia
Rafael Ortega, MD Professor Vice-Chairman of Academic Affairs Department of Anesthesiology Boston University School of Medicine Boston, Massachusetts Sam R. Sharar, MD Professor
School of Medicine Indiana University Indianapolis, Indiana Michael K. Cahalan, MD Professor and Chair Department of Anesthesiology School of Medicine The University of Utah Salt Lake City, Utah Vice-Chair for Faculty Affairs and Development Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington Natalie F. Holt, MD, MPH Assistant Professor Department of Anesthesiology Yale University School of Medicine Medical Director Ambulatory Procedures Unit VA Connecticut Healthcare System West Haven, Connecticut AMPLE
Av. Carrilet, 3, 9.a planta, Edificio D - Ciutat de la Justícia 08902 L’Hospitalet de Llobregat Barcelona (España) Tel.: 93 344 47 18 Fax: 93 344 47 16 Correo electrónico: consultas@wolterskluwer.com
Traducción Martha Elena Araiza Martínez Médico Cirujano Germán Arias Rebatett Cirujano General José Rafael Blengio Pinto Médico Cirujano Bernardo Muñoz Médico Cirujano José Luis González Cirujano general
Revisión científica Dr. Oscar Giovanni Calvo Arias Médico anestesiólogo. Hospital General de Zona 29 IMSS, México Dra. Iliáda Guadalupe Cantarell Martínez Médico Anestesiólogo; Jefe de Servicio de Anestesia e inhaloterapia. Hospital General de Zona 29 IMSS; Anestesióloga adscrita. Hospital General de Balbuena, México Dr. Antonio Castellanos Olivares
Dirección editorial: Carlos Mendoza Editor de desarrollo: Núria Llavina Gerente de mercadotecnia: Juan Carlos García Cuidado de la edición: M&N Medical Solutrad S.A. de C.V. Maquetación: M&N Medical Solutrad S.A. de C.V. Adaptación de portada: Jesús Esteban Mendoza Murillo Impresión: C&C Offset-China/Impreso en China AMPLE Se han adoptado las medidas oportunas para confirmar la exactitud de la información presentada y describir la práctica más aceptada. No obstante, los autores, los redactores y el editor no son responsables de los errores u omisiones del texto ni de las consecuencias que se deriven de la aplicación de la información que incluye, y no dan ninguna garantía, explícita o implícita, sobre la actualidad, integridad o exactitud del contenido de la publicación. Esta publicación contiene información general relacionada con tratamientos y asistencia médica que no debería utilizarse en pacientes individuales sin antes contar con el consejo de un profesional médico, ya que los tratamientos clínicos que se describen no pueden considerarse recomendaciones absolutas y universales. El editor ha hecho todo lo posible para confirmar y respetar la procedencia del material que se reproduce en este libro y su copyright. En caso de error u omisión, se enmendará en cuanto sea posible. Algunos fármacos y productos sanitarios que se presentan en esta publicación sólo tienen la aprobación de la Food and Drug Administration (FDA) para uso limitado al ámbito experimental. Compete al profesional sanitario averiguar la situación de cada fármaco o producto sanitario que pretenda utilizar en su práctica clínica, por lo que aconsejamos consultar con las autoridades sanitarias competentes. Derecho a la propiedad intelectual (C. P. Art. 270) Se considera delito reproducir, plagiar, distribuir o comunicar públicamente, en todo o en parte, con ánimo de lucro y en perjuicio de terceros, una obra literaria, artística o cientí- fica, o su transformación, interpretación o ejecución artística fijada en cualquier tipo de soporte o comunicada a través de cualquier medio, sin la autorización de los titulares de los correspondientes derechos de propiedad intelectual o de sus cesionarios. Reservados todos los derechos. Copyright de la edición en español © 2018 Wolters Kluwer ISBN de la edición en español: 978-84-17033-35-4 Depósito legal: M-2879-2018 Edición en español de la obra original en lengua inglesa Clinical Anesthesia de Paul G. Barash, Michael K. Cahalan, Bruce F. Cullen, M. Christine Stock, Robert K. Stoelting, Rafael Ortega, 8ª ed., publicada por Wolters Kluwer Copyright © 2017 Wolters Kluwer Two Commerce Square 2001 Market Street Philadelphia, PA 19103 ISBN de la edición original: 978-1-4963-3700-9 Médico anestesiólogo; Maestro en Ciencias Médicas; Jefe del Servicio de Anestesiología. UMAE Hospital de Especialidades “Dr. Bernardo Sepúlveda G”. Centro Médico Nacional Siglo XXI, IMSS; Profesor titular del Curso universitario de especialización en Anestesiología; Presidente del Consejo Consultivo del Colegio Mexicano de Anestesiología; Presidente del Colegio de Médicos Postgraduados del IMSS, México Dr. Juan Carlos de la Cuadra Fontaine Profesor Asociado Adjunto, División de Anestesiología, Escuela de Medicina. Pontificia Universidad Católica de Chile Santiago, Chile Dra. Alma Delia Domínguez Marín Médico Anestesiólogo, Medicina del Dolor y Cuidados Paliativos. Hospital Juárez de México, México Dra. Diana Finkel Médico Anestesiólogo; Médica Experta en Medicina del Dolor. Universidad de Buenos Aires; Diplomada en Cuidados Paliativos. Universidad del Salvador; Especialista en Estadística en Ciencias de la Salud. Instituto del Cálculo, Facultad de Ciencias Exactas. Universidad de Buenos Aires, Argentina Dra. Leticia Leal Gudiño Médico Anestesiólogo; Posgrado en Medicina del Dolor y en Anestesia Regional; Médico Adscrito; Profesora Titular del Curso de Alta Especialidad en Anestesia Regional. Instituto Nacional de Rehabi- litación Luis Guillermo Ibarra Ibarra, México Dr. Alberto Martínez Hernández Médico Anestesiólogo; Presidente del Colegio Potosino de Anestesiología; Médico adscrito al Hospital General de Zona 50 IMSS; Médico adscrito al Hospital General del ISSSTE. San Luis Potosí, México Dr. Gabriel E. Mejía Terrazas Médico Anestesiólogo-Algólogo, Maestro en Ciencias Médicas. Clínica del Dolor. Hospital Ángeles. México Dra. Jaqueline Morales Nuño Médico Anestesióloga; Posgrado en Anestesia Regional; Médico Adscrito en el Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México Dr. Christian Nilo Schultz Médico Anestesiólogo, MBA Facultad de Economía y Negocios. Universidad de Chile; ex Presidente de la Sociedad de Anestesiología de Chile, Chile Dr. Edwin Enrique Peñate Suárez Especialista de Anestesiología y Reanimación. Pontificia Universidad Javeriana, Colombia; Profesor Asociado. Universidad del Quindío, Colombia; Magister en Educación Superior, Mención Docencia Universitaria. Universidad Arturo Prat, Chile Dra. Blanca Estela Rico Arroyo Hospital General de Zona 29 IMSS; Maestra en Gestión directiva en servicios de salud; Staff médico. Hospital Ángeles Mocel, México Dra. Aurora Roan González Médico Anestesióloga. Hospital General de Zona 29 IMSS; Profesora de asignatura de campo clínico; Facultad de Estudios Superiores Iztacala. Universidad Nacional Autónoma de México, México Dra. Frida Mariana Romero Loyola Médico Anestesiólogo General; Maestría en Gestión Directiva en Salud. Hospital General Regional 196 IMSS, México Dr. Antoni Sabaté Pes Profesor de Anestesiología. Facultad de Medicina de la Universidad de Barcelona; Jefe de Servicio de Anestesiología, Reanimación, Dolor. Hospital Universitario de Bellvitge. Barcelona, España Dra. María Margarita Viteri Toro Médica Cirujana; Anestesióloga. Pontificia Universidad Javeriana. Bogotá, Colombia
Para todos los estudiantes de anestesiólogía
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Colaboradores
Itay Bentov, MD, PhD Associate Professor Anesthesiology and Pain Medicine Adjunct Associate Professor Department of Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Honorio T. Benzon, MD Professor of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Marcelle E. Blessing, MD
Ramon Abola, MD Assistant Professor Department of Anesthesiology
Stony Brook Medicine Stony Brook, New York Ron O. Abrons, MD Associate Professor Department of Anesthesiology The University of Iowa Hospitals and Clinics Iowa City, Iowa Shamsuddin Akhtar, MD Associate Professor Department of Anesthesiology and Pharmacology Yale University School of Medicine New Haven, Connecticut Michael L. Ault, MD, FCCP, FCCM Associate Professor of Anesthesiology, Medical Education, Neurological Surgery and Surgery Chief and Fellowship Program Director, Section of Critical Care Medicine Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Douglas R. Bacon, MD, MA Professor and Chair Department of Anesthesiology University of Mississippi Medical Center Jackson, Mississippi Gina C. Badescu, MD Division of Cardiothoracic Anesthesiology Maui Memorial Medical Center Wailuku, Hawaii Dalia Banks, MD, FASE Clinical Professor Division Chief of Cardiothoracic Anesthesiology Director of Cardiothoracic Anesthesiology Fellowship Clinical Director of Sulpizio CVC and PTU University of California San Diego San Diego, California Paul G. Barash, MD Professor Emeritus and Past Chair Department of Anesthesiology Yale-New Haven Hospital New Haven, Connecticut John F. Bebawy, MD Associate Professor of Anesthesiology & Neurological Surgery Northwestern University Feinberg School of Medicine Chicago, Illinois
Assistant Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Michelle Y. Braunfeld, MD Professor and Vice Chair Department of Anesthesiology David Geffen School of Medicine at UCLA Chair, Department of Anesthesiology Greater Los Angeles VA Hospital Los Angeles, CA
Ferne R. Braveman, MD Vice-Chair for Clinical Affairs Director of Division of Obstetrical Anesthesiology Professor of Anesthesiology and Obstetrics, Gynecology and Reproductive Medicine Department of Anesthesiology
Yale School of Medicine New Haven, Connecticut Sorin J. Brull, MD, FCARCSI (Hon) Professor of Anesthesiology Department of Anesthesiology Mayo Clinic College of Medicine
Yale University School of Medicine Honorary Attending Anesthesiologist Brenda A. Bucklin, MD Professor of Anesthesiology University of Colorado School of Medicine Aurora, Colorado Michael K. Cahalan, MD Professor and Chair Department of Anesthesiology The University of Utah School of Medicine Salt Lake City, Utah AMPLE Mayo Clinic Florida Jacksonville, Florida
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Colaboradores
Albert Dahan, MD, PhD Department of Anesthesiology Leiden University Medical Center Leiden, The Netherlands Rossemary De La Cruz, MD Academic, Media, and Risk Management Associate Department of Anesthesiology Boston Medical Center Boston, Massachusetts Steven Deem, MD Director, Neurocritical Care Swedish Medical Center Physicians Anesthesia Service Clinical Professor of Anesthesiology University of Washington Seattle, Washington Stephen F. Dierdorf, MD Professor of Clinical Anesthesia Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston, South Carolina Karen B. Domino, MD, MPH Professor and Vice-Chair for Clinical Research Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington Thomas J. Ebert, MD, PhD Vice-Chair for Education Professor of Anesthesiology Medical College of Wisconsin and Zablocki VA Medical Center Milwaukee, Wisconsin Jan Ehrenwerth, MD Professor Emeritus Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut
Levon M. Capan, MD Professor of Clinical Anesthesiology
New York University School of Medicine Associate Director of Anesthesia Service Bellevue Hospital Center New York, New York Louanne M. Carabini, MD Assistant Professor Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Christopher G. Choukalas, MD, MS Associate Clinical Professor Department of Anesthesia and Perioperative Care University of California, San Francisco San Francisco VA Medical Center San Francisco, California
Amalia Cochran, MD, MA Associate Professor of Surgery Vice-Chair of Education and Professionalism University of Utah School of Medicine Salt Lake City, Utah Edmond Cohen, MD Professor of Anesthesiology and Thoracic Surgery Director of Thoracic Anesthesia Icahn School of Medicine at Mount Sinai New York, New York Christopher M. Conley, MD Clinical Assistant Professor of Anesthesiology Boston University School of Medicine Boston, Massachusetts Christopher W. Connor, MD, PhD Associate Professor of Anesthesiology and Biomedical Engineering Department of Anesthesiology
Boston Medical Center Boston, Massachusetts C. Michael Crowder, MD, PhD John H. Eichhorn, MD Professor of Anesthesiology College of Medicine Provost’s Distinguished Service Professor Department of Anesthesiology University of Kentucky Medical Center Lexington, Kentucky James B. Eisenkraft, MD Professor Department of Anesthesiology Icahn School of Medicine at Mount Sinai New York, New York Alex S. Evers, MD Henry S. Mallinckrodt Professor and Head Department of Anesthesiology Professor of Developmental Biology and Internal Medicine Washington University School of Medicine St. Louis, Missouri AMPLE Allan J. Treuer Endowed Professor and Chair Department of Anesthesiology and Pain Medicine Adjunct Professor of Genome Sciences University of Washington School of Medicine Seattle, Washington Marie Csete, MD, PhD President and Chief Scientist Huntington Medical Research Institutes Pasadena, California Professor of Anesthesiology Keck USC School of Medicine Los Angeles, California Visiting Associate Medical Engineering California Institute of Technology Pasadena, California Bruce F. Cullen, MD Emeritus Professor
Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington
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Colaboradores
Matthew R. Hallman, MD Assistant Professor
Ana Fernandez-Bustamante, MD, PhD Associate Professor Department of Anesthesiology University of Colorado School of Medicine Aurora, Colorado Lynne R. Ferrari, MD Chief, Perioperative Anesthesia
Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington Kylene E. Halloran, MD Assistant Professor of Anesthesiology Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire Stephen C. Haskins, MD Assistant Anesthesiologist Hospital for Special Surgery Clinical Assistant Professor of Anesthesiology Weill Cornell Medical College New York, New York J. Steven Hata, MD, MSc Vice Chairman, Education Continuum
Medical Director, Operating Rooms and Perioperative Programs Department of Anesthesiology, Perioperative and Pain Medicine Boston Children’s Hospital Boston, Massachusetts Scott M. Fishman, MD Professor, Department of Anesthesiology and Pain Medicine Chief, Division of Pain Medicine Vice-Chair, Department of Anesthesiology and Pain Medicine Director, Center for Advancing Pain Relief University of California Davis School of Medicine Sacramento, California Michael A. Fowler, MD, MBA Assistant Professor Residency Program Director VCU Department of Anesthesiology Richmond, Virginia J. Sean Funston, MD Professor Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas Tong J. Gan, MD, MHS, FRCA Professor and Chairman Department of Anesthesiology
Center for Critical Care Anesthesiology Institute
Cleveland Clinic Cleveland, Ohio Tara M. Hata, MD Clinical Assistant Professor Department of Pediatric Anesthesia Cleveland Clinic Cleveland, Ohio Laurence M. Hausman, MD Professor of Anesthesiology Vice-Chair, Academic Affiliations Director, Ambulatory Anesthesia Department of Anesthesiology Perioperative and Pain Medicine Icahn School of Medicine at Mount Sinai New York, New York Salim M. Hayek, MD, PhD Professor
Stony Brook University Stony Brook, New York Steven I. Gayer, MD Professor of Anesthesiology University of Miami Health System Miami, Florida Sofia Geralemou, MD Department of Anesthesiology Stony Brook University Hospital Stony Brook, New York Loreta Grecu, MD Dhanesh K. Gupta, MD Professor of Anesthesiology Chief of Neuroanesthesiology Department of Anesthesiology Duke University Medical Center Durham, North Carolina Carin A. Hagberg, MD Joseph C. Gabel Professor and Chair Department of Anesthesiology UTHealth Medical School Houston, Texas Department of Anesthesiology Case Western Reserve University Chief, Division of Pain Medicine University Hospitals Cleveland Medical Center Cleveland, Ohio Christopher L. Heine, MD Assistant Professor Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston, South Carolina Thomas K. Henthorn, MD Professor, Anesthesiology Department of Anesthesiology University of Colorado Aurora, Colorado Simon C. Hillier, MB, ChB Professor Departments of Anesthesiology and Pediatrics Geisel School of Medicine Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire AMPLE Clinical Associate Professor of Anesthesiology Stony Brook University School of Medicine Stony Brook, New York
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Colaboradores
Christopher D. Kent, MD Associate Professor Department of Anesthesiology and Pain Medicine University of Washington Seattle, Washington Meghan A. Kirksey, MD, PhD Assistant Attending Anesthesiologist Hospital for Special Surgery Clinical Assistant Professor of Anesthesiology Weill Cornell Medical College New York, New York Sandra L. Kopp, MD Associate Professor of Anesthesiology Department of Anesthesiology Mayo Clinic College of Medicine Rochester, Minnesota Catherine Kuhn, MD Director & Associate Dean, Graduate Medical Education Designated Institutional Official Professor of Anesthesiology Department of Anesthesiology Duke University Durham, North Carolina Jerrold Lerman, MD, FRCPC, FANZCA Clinical Professor of Anesthesiology Women and Children’s Hospital of Buffalo State University of New York Buffalo, New York Jerrold H. Levy, MD, FAHA, FCCM Professor of Anesthesiology Associate Professor of Surgery Division of Cardiothoracic Anesthesiology and Critical Care Duke University School of Medicine Co-Director, Cardiothoracic ICU
Natalie F. Holt, MD, MPH Assistant Professor Department of Anesthesiology Yale University School of Medicine Medical Director Ambulatory Procedures Unit VA Connecticut Healthcare System West Haven, Connecticut
Robert S. Holzman, MD, MS (Hon), FAAP Senior Associate in Perioperative Anesthesiology Department of Anesthesiology, Perioperative and Pain Medicine Boston Children’s Hospital
Professor of Anesthesia Harvard Medical School Boston, Massachusetts Harriet W. Hopf, MD Professor and Vice-Chair Department of Anesthesiology University of Utah School of Medicine Salt Lake City, Utah Robert W. Hurley, MD, PhD Professor and Vice-Chair Department of Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin Adam K. Jacob, MD Associate Professor of Anesthesiology Mayo Clinic College of Medicine Rochester, Minnesota Farid Jadbabaie, MD Associate Professor of Medicine (Cardiology) Director of Echocardiography Laboratory VA Connecticut Healthcare System
Yale School of Medicine New Haven, Connecticut Rebecca L. Johnson, MD Assistant Professor of Anesthesiology Department of Anesthesiology Mayo Clinic College of Medicine Rochester, Minnesota Sharma E. Joseph, MD Instructor of Anesthesia Boston University School of Medicine Department of Anesthesiology Hospital for Special Surgery New York, New York AMPLE Boston Medical Center Boston, Massachusetts Jonathan D. Katz, MD Clinical Professor of Anesthesiology Yale University School of Medicine Professor of Anesthesiology Frank H. Netter MD School of Medicine at Quinnipiac University Attending Anesthesiologist St. Vincent’s Medical Center Bridgeport, Connecticut Duke University Hospital Durham, North Carolina Adam D. Lichtman, MD, FASE Associate Professor of Anesthesiology Director of Vascular Anesthesia Weill Cornell Medical College New York Presbyterian Hospital New York, New York J. Lance Lichtor, MD Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Yi Lin, MD, PhD Assistant Attending Anesthesiologist Hospital for Special Surgery New York, New York Spencer S. Liu, MD Clinical Professor of Anesthesiology Weill College of Medicine at Cornell University
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Colaboradores
Shawn L. Mincer, MSW Research Coordinator Department of Anesthesiology and Pain Medicine University of Washington Seattle, Washington Peter G. Moore, MBBS, PhD, FANZCA, FICM Professor of Anesthesiology and Pain Medicine and Internal Medicine University of California, Davis Health System Sacramento, California Candice Morrissey, MD, MSPH Assistant Professor Department of Anesthesiology
Justin B. Long, MD, FAAP Assistant Professor
Emory University School of Medicine Department of Pediatric Anesthesiology Children’s Healthcare of Atlanta at Henrietta Egleston Hospital for Children Atlanta, Georgia Stephen M. Macres, MD, PharmD Professor
Department of Anesthesiology and Pain Medicine University of California Davis Medical Center Sacramento, California Peter Mancini, MD Assistant Clinical Professor Department of Anesthesiology Yale University School of Medicine New Haven, CT Aaron J. Mancuso, MD Assistant Professor of Anesthesiology Geisel School of Medicine Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire Gerard Manecke, MD Chair, Department of Anesthesiology
University of Utah Salt Lake City, Utah Michael J. Murray, MD, PhD Department of Critical Care Medicine Geisinger Medical Center Danville, Pennsylvania Sawyer A. Naze, MD Resident
Department of Anesthesiology Feinberg School of Medicine Northwestern University Chicago, Illinois
UCSD Medical Center San Diego, California Melissa M. Masaracchia, MD Assistant Professor of Anesthesiology Dartmouth-Hitchcock Medical Center
Steven M. Neustein, MD Professor of Anesthesiology Icahn School of Medicine at Mount Sinai New York, New York
Geisel School of Medicine Lebanon, New Hampshire
Marieke Niesters, MD, PhD Department of Anesthesiology Leiden University Medical Center Leiden, The Netherlands Mark C. Norris, MD Director of Obstetric Anesthesia Boston Medical Center
Joseph P. Mathew, MD, MHSC, MBA Jerry Reves, MD, Professor and Chairman
Department of Anesthesiology Duke University Medical Center Durham, North Carolina
Kathryn E. McGoldrick, MD, FCAI (Hon) Professor and Chair of Anesthesiology, Emeritus Advisory Dean, Emeritus New York Medical College Valhalla, New York Accreditation Council for Graduate Medical Education Department of Institutional Accreditation Chicago, Illinois Joseph H. McIsaac III, MD, MS Associate Clinical Professor of Anesthesiology Associate Adjunct Professor of Biomedical Engineering University of Connecticut Avon, CT Sanford M. Miller, MD Clinical Professor (Emeritus) of Anesthesiology NYU School of Medicine Former Assistant Director of Anesthesiology Bellevue Hospital Center New York, New York Associate Professor of Medicine Department of Anesthesiology University of Arizona College of Medicine Tucson, Arizona AMPLE Clinical Professor of Anesthesiology Boston University School of Medicine Boston, Massachusetts E. Andrew Ochroch, MD, MSCE Professor of Anesthesiology, Critical Care, and Surgery University of Pennsylvania Philadelphia, Pennsylvania Rafael Ortega, MD Professor Vice-Chairman of Academic Affairs Department of Anesthesiology Boston University School of Medicine Boston, Massachusetts Charles W. Otto, MD, FCCM Professor of Anesthesiology
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Colaboradores
Wanda M. Popescu, MD Associate Professor of Anesthesiology Director, Thoracic and Vascular Anesthesia Division Co-Director, Grand Rounds Yale School of Medicine New Haven, Connecticut Karen L. Posner, PhD Research Professor Laura Cheney Professor in Anesthesia Patient Safety Department of Anesthesia and Pain Medicine University of Washington Seattle, Washington Jamie R. Privratsky, MD Department of Anesthesiology Duke University Medical Center Durham, North Carolina Donald S. Prough, MD Rebecca Terry White Distinguished Professor Chair of Anesthesiology The University of Texas Medical Branch at Galveston Galveston, Texas Glenn Ramsey, MD Professor Department of Pathology Feinberg School of Medicine Northwestern University Medical Director Blood Bank Northwestern Memorial Hospital Chicago, Illinois Kevin T. Riutort, MD, MS USAP Colorado Greenwood Village, Colorado Gerardo Rodriguez, MD Assistant Professor Department of Anesthesiology Boston University School of Medicine Director, East Newton Surgical Intensive Care Unit Boston Medical Center Boston, Massachusetts G. Alec Rooke, MD, PhD Professor of Anesthesiology and Pain Medicine University of Washington Seattle, Washington Stanley H. Rosenbaum, MA, MD Professor of Anesthesiology, Internal Medicine and Surgery Yale University School of Medicine New Haven, Connecticut Meg A. Rosenblatt, MD Site Chair, Department of Anesthesiology, Mount Sinai West
Frank Overdyk, MSEE, MD Department of Anesthesiology Roper St. Francis Health System Charleston, South Carolina Nathan Leon Pace, MD, MStat Professor Department of Anesthesiology
University of Utah Salt Lake City, Utah Paul S. Pagel, MD, PhD Staff Physician Anesthesiology Service Clement J. Zablocki VA Medical Center Milwaukee, Wisconsin Ben Julian Palanca, MD, PhD, MSc Assistant Professor Department of Anesthesiology Washington University School of Medicine St. Louis, Missouri Raymond S. Park, MD Assistant in Perioperative Anesthesia Department of Anesthesiology, Perioperative and Pain Medicine Harvard Medical School Boston, Massachusetts Jeffrey J. Pasternak, MS, MD Associate Professor of Anesthesiology Mayo Clinic College of Medicine Rochester, Minnesota Albert C. Perrino Jr Professor Yale University School of Medicine Chief, Anesthesiology VA Connecticut Healthcare System New Haven, Connecticut Carly Peterson, MD, FRCPC Division of Cardiothoracic Anesthesia Department of Anesthesiology and Pain Medicine University of Washington Seattle, Washington University of Washington Attending Anesthesiologist Department of Anesthesiology & Pain Medicine Seattle Children’s Hospital Seattle, Washington Mihai V. Podgoreanu, MD Perioperative Genomics Program Division of Cardiothoracic Anesthesia and Critical Care Boston Children’s Hospital Instructor in Anaesthesia
Andrew J. Pittaway, BM, BS FRCA Associate Residency Program Director Associate Professor Mount Sinai St. Luke’s New York, New York AMPLE Department of Anesthesiology Duke University Medical Center Durham, North Carolina Professor of Anesthesiology Professor of Orthopaedics
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Colaboradores
Hugh M. Smith, MD Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester, Minesota Terry Smith, PhD Associate Professor Department of Anesthesiology Leiden University Medical Center Leiden, The Netherlands Ellen M. Soffin, MD, PhD Assistant Attending Anesthesiologist Hospital for Special Surgery New York, New York Karen J. Souter, MB, BS, FRCA, MACM Professor Department of Anesthesiology and Pain Medicine University of Washington Seattle, Washington Bruce D. Spiess, MD, FAHA Professor and Associate Chair (Research) Department of Anesthesiology
William H. Rosenblatt, MD Professor of Anesthesiology Yale University School of Medicine New Haven, Connecticut Richard W. Rosenquist, MD Chairman Pain Management Department Anesthesiology Institute
Cleveland Clinic Cleveland, Ohio Antonio F. Saad, MD, MFM/CCM Fellow, Anesthesia and Obstetrics and Gynecology University of Texas Medical Branch Galveston, Texas Aaron Sandler, MD Assistant Professor of Anesthesiology Department of Anesthesiology Duke University Durham, North Carolina Barbara M. Scavone, MD Professor of Anesthesia and Critical Care, and Obstetrics and Gynecology University of Chicago Chicago, Illinois Corey Scher, MD Clinical Professor of Anesthesiology New York University School of Medicine-Bellevue Hospital Center New York, New York Jeffrey J. Schwartz, MD Associate Professor Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Sam R. Sharar, MD Professor
University of Florida Gainesville, Florida Mark Stafford-Smith, MD, CM, FRCP Professor of Anesthesiology Vice-Chair of Education Fellowship Education Director Adult Cardiothoracic Anesthesiology Fellowship
Department of Anesthesiology Duke University Medical Center Durham, North Carolina Andrew F. Stasic, MD Associate Professor of Clinical Anesthesia Department of Anesthesia Indiana University School of Medicine Riley Hospital for Children Indianapolis, Indiana Randolph H. Steadman, MD, MS Professor and Vice-Chair Department of Anesthesiology and Perioperative Medicine
Vice-Chair for Faculty Affairs and Development Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington Aarti Sharma, MD Associate Professor of Clinical Anesthesiology Department of Anesthesiology Feinberg School of Medicine Northwestern University Chicago, Illinois AMPLE Department of Anesthesiology Weill Cornell Medical College New York Presbyterian Hospital New York, New York Benjamin M. Sherman, MD Cardiothoracic Anesthesiology TeamHealth Anesthesia Legacy Good Samaritan Hospital Portland, Oregon Nikolaos J. Skubas, MD, DSc, FASE, FACC Professor of Anesthesiology and Cardiothoracic Surgery Weill Cornell Medicine Director, Cardiac Anesthesia NewYork-Presbyterian Hospital New York, New York UCLA Health System Los Angeles, California Robert K. Stoelting, MD Emeritus Professor and Past Chair Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana M. Christine Stock, MD Professor
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Colaboradores
Cristiane M. Ueno, MD Assistant Professor Division of Plastic, Hand and Reconstructive Surgery West Virginia University Morgantown, West Virginia Elizabeth A. Valentine, MD Assistant Professor Department of Anesthesiology and Critical Care Perelman School of Medicine at the Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Amy E. Vinson, MD, FAAP Assistant in Perioperative Anesthesia Department of Anesthesia, Perioperative and Pain Medicine Harvard Medical School Boston, Massachusetts J. Scott Walton, MD Associate Professor Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston, South Carolina Cindy J. Wang, MD Assistant Professor of Anesthesiology Boston Children’s Hospital Instructor in Anaesthesia
David F. Stowe, MD, PhD Professor of Anesthesiology and Physiology Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center Departments of Anesthesiology and Physiology Medical College of Wisconsin Milwaukee, Wisconsin Wariya Sukhupragarn, MD Associate Professor Department of Anesthesiology Faculty of Medicine
Chiang Mai University Chiang Mai, Thailand
Santhanam Suresh, MD, FAAP Arthur C. King Professor and Chair Department of Pediatric Anesthesiology
Ann and Robert H. Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago, Illinois Christer H. Svensén, MD, PhD, Lt Cdr, EDA, MBA
Professor, Senior Consultant Director of Doctoral Education KarolinskaInstitutet
Department of Clinical Science and Education Section of Anaesthesiology and Intensive Care Södersjukhuset, Stockholm, Sweden Associate Professor, University of Texas Medical Branch, UTMB Health, Department of Anesthesiology Galveston, Texas Martin Szafran, MD Assistant Professor Department of Anesthesiology
Weill Cornell Medicine New York, New York Mary E. Warner, MD Associate Professor of Anesthesiology Mayo Clinic College of Medicine Rochester, Minnesota Cynthia A. Wong, MD Professor and Chair Department of Anesthesia University of Iowa Carver College of Medicine Iowa City, Iowa
Stony Brook University Stony Brook, New York Paul C. Tamul, DO Assistant Professor Departments of Anesthesiology and Neurological Surgery Feinberg School of Medicine Northwestern University Chicago, Illinois Stephen J. Thomas, MD Topkin-Van Poznak Professor and Vice-Chairman Department of Anesthesiology Weill Medical College Cornell University Attending Anesthesiologist New York Presbyterian Hospital New York, New York Ban C. H. Tsui, Dip Eng, BSc, MSc, MD, FRCP Pediatric and Adult Anesthesiologist Alberta Heritage Foundation for Medical Research Clinical Scholar Site Chief, Anesthesia Cross Cancer Institute, Edmonton Professor Department of Anesthesiology and Pain Medicine Stollery Children’s Hospital/University of Alberta Hospital Edmonton, Alberta, Canada James R. Zaidan, MD, MBA Professor and Chair Emeritus Department of Anesthesiology Emory University School of Medicine Atlanta, Georgia Joshua Zimmerman, MD Associate Professor Director of Perioperative Echocardiography Department of Anesthesiology University of Utah School of Medicine Salt Lake City, Utah AMPLE
Prefacio
El uso innovador de recursos audiovisuales es la marca distintiva de la serie Clinical Anesthesia . La integración de diversos materiales educativos en la estructura de cada capítulo sirve para enriquecer la experiencia del lector y ha sido parte de la serie desde la 2ª edición de Clinical Anesthesia en 1995, en la que los editores introdujeron la Lippincott Raven Interactive Library en CD-ROM. Con el libro como publicación clave, se agregaron otros libros relevantes a la biblioteca, lo que facilitó los temas con referencias cruzadas de Clinical Anesthe- sia . Este CD recibió el prestigioso International Folio Infobase Industry Award como el Mejor CD-ROM de Ciencia, Tecnología, Medicina. Con la 4ª edición de Clinical Anesthesia en 2002, introdujimos el primer software de anestesia diseñado específicamente para asisten- tes digitales personales ( Palm Pilot PDA ) y, junto con la 6ª edición en 2009, implantamos otro elemento novedoso en los libros de anestesia: el podcast . En 2013 publicamos la 7ª edición de Clinical Anesthesia con la plataforma electrónica más robusta hasta ahora. Esta nutrida historia de avances vanguardistas en la presenta- ción de material educativo en diversos formatos para enriquecer los distintos estilos de aprendizaje continúa en la 8ª edición de Aneste- sia clínica . Las nuevas Viñetas clínicas interactivas narradas son un producto audiovisual innovador que sumerge a los espectadores en un aula de clases virtual en el que un maestro los guía por una exposición enfocada sobre temas clínicos frecuentes e infrecuentes. Se presenta una pregunta clínica y se da tiempo a los espectadores para que desarrollen una respuesta apropiada. Luego, los especta- dores ven y escuchan la aparición de la respuesta paso a paso. La prueba inicial de este concepto tuvo una retroalimentación muy positiva y en la actualidad contamos con más de 175 viñetas en la biblioteca. En la 8ª edición de Anestesia clínica usamos una serie de iconos en los márgenes del texto para alertar al lector sobre puntos clave y sobre material audiovisual disponible: Aunque el libro representa el trabajo y la aportación de todos los editores, es esencial reconocer al Dr. Rafael Ortega y su personal, a las doctoras Faina Kotova y Rosemary De La Cruz (Departamento de Anestesiología, Boston University) por su inmensa contribución a la creación de las viñetas clínicas interactivas narradas de esta edición. Las actualizaciones importantes en el libro impreso incluyen capítulos nuevos sobre farmacología cardiovascular y una exposi- ción enfocada sobre fármacos del sistema nervioso autónomo en el capítulo de farmacología autonómica. Hemos ampliado los apén- dices con secciones de video sobre ecocardiografía transtorácica, incluidos los exámenes FAST y FOCUS, así como más de 90 ejem- plos de video adicionales de ecocardiogramas transesofágicos que demuestran las principales aplicaciones clínicas de esta poderosa técnica de imagen. La sección Actualizaciones clínicas es popular entre nuestros lectores como una forma de mantenerse actualizado en la bibliografía médica contemporánea, y en la 8ª edición tiene un perfil más amplio. Un elemento importante es que el capítulo Video Viñeta clínica interactiva Punto clave
sobre riesgos laborales se amplió para ejercer énfasis sustancial en el tema del bienestar del médico (consideraciones emocionales, nutrición, intervenciones para el estilo de vida y concientización). Con algo de tristeza, tras 25 años nos despedimos del título acompañante de Anestesia clínica , el Manual de anestesia clínica . Debido a los avances en las plataformas digitales y la publicación de la 8ª edición completada con todos los recursos adicionales, los editores consideraron que era momento de dejarlo ir. En esta edición damos la bienvenida a dos editores nuevos: el Dr. Sam Sharar y la Dra. Natalie Holt. Tanto Sam como Natalie tienen experiencia en la logística de la serie Clinical Anesthesia . Sam fue fundamental en el nuevo libro dirigido a estudiantes jóvenes y residentes en anestesiología, Barash. Fundamentos de anestesia clí- nica , mientras que Natalie ha estado a cargo de las actualizaciones clínicas mencionadas antes. Deseamos expresar nuestro aprecio a todos nuestros colabora- dores, cuyo conocimiento, trabajo intenso, dedicación y presenta- ciones puntuales de los capítulos nos permitieron mantener una alta calidad durante el trabajo con un programa de producción ajustado. Nuestros lectores proporcionaron comentarios esencia- les para el proceso editorial de mejora continua de Anestesia clí- nica . También agradecemos a nuestros asistentes administrativos, incluida Gail Norup. Deseamos agradecer a nuestro editor en Wol- ters Kluwer, Keith Donnellan, por su compromiso con la excelencia. Por último, tenemos una deuda de gratitud con los editores de desa- rrollo Grace Caputo y Brendan Huffman, el administrador de mer- cadotecnia Dan Dressler y con Chris Miller, gerente de producción en Aptara. Su gestión cotidiana de este proyecto resultó en una publicación que rebasó las expectativas de los editores. Como se indicó en las ediciones anteriores, el descubrimiento y la aplicación de anestesia es la contribución individual más impor- tante de la medicina estadounidense a la humanidad. Los principa- les logros de la cirugía contemporánea no podrían haber ocurrido sin la visión de los pioneros en la anestesiología. Esta declaración fue retomada por el cirujano autor Atul Gawande, que en el artículo “Two Hundred Years of Surgery” ( New England Journal of Medicine ), señala: La chispa transformadora crucial – el momento que cambió no sólo el futuro de la cirugía, sino el de la medicina en su conjunto – fue la publicación del 18 de noviembre de 1846 del estudio revolucionario de Henry Jacob Bigelow “Insensibilidad durante las cirugías, producida por inhalación”. Los editores esperan que cada página de Anestesia clínica evoque el orgullo de ser parte de la especialidad de la anestesiología y sus logros para la mejora de la humanidad.
1 Rafael Ortega, MD Sam R. Sharar, MD Natalie F. Holt, MD AMPLE Paul G. Barash, MD Bruce F. Cullen, MD Robert K. Stoelting, MD Michael K. Cahalan, MD M. Christine Stock, MD
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Índice de contenidos
Sección 1 INTRODUCCIÓN Y GENERALIDADES
Sección 3 PRINCIPIOS DE CUIDADOS BÁSICOS
1
Historia de la anestesia 1 ADAM K. JACOB • SANDRA L. KOPP • DOUGLAS R. BACON • HUGH M. SMITH
12
Anatomía y fisiología cardiaca 277 PAUL S. PAGEL • DAVID F. STOWE Farmacología cardiovascular 301 PAUL S. PAGEL • LORETA GRECU Anatomía y fisiología del sistema nervioso autónomo 333 LORETA GRECU Función respiratoria en la anestesia 361 PAUL C. TAMUL • MICHAEL L. AULT Fisiología de líquidos, electrólitos y equilibrio acidobásico 384 DONALD S. PROUGH • J. SEAN FUNSTON • ANTONIO F. SAAD • CHRISTER H. SVENSÉN
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Alcance de la práctica profesional 26 JOHN H. EICHHORN
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Medicina laboral 65 JONATHAN D. KATZ • ROBERT S. HOLZMAN • AMY E. VINSON
4 Riesgo anestésico, mejora de la calidad y responsabilidades legales 91 KAREN L. POSNER • CHRISTOPHER D. KENT • SHAWN L. MINCER • KAREN B. DOMINO 5 Medidas de seguridad relacionadas con la energía eléctrica y los incendios 109 JAN EHRENWERTH
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Hemostasia y medicina transfusional 419 LOUANNE M. CARABINI • GLENN RAMSEY
Sección 2 BASES CIENTÍFICAS Y FUNDAMENTOS
Sección 4 FÁRMACOS ANESTÉSICOS Y ADYUVANTES
6
Bases genómicas de la medicina perioperatoria 141 MIHAI V. PODGOREANU • JOSEPH P. MATHEW
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Anestésicos inhalados 459 THOMAS J. EBERT • SAWYER A. NAZE
7 Diseño experimental y estadística 165 NATHAN LEON PACE AMPLE 8 Inflamación, cicatrización e infección 183 HARRIET W. HOPF • AMALIA COCHRAN • CRISTIANE M. UENO • CANDICE MORRISSEY 9 La respuesta alérgica 204 JERROLD H. LEVY 10 Mecanismos de la anestesia y la conciencia 219 C. MICHAEL CROWDER • BEN JULIAN PALANCA • ALEX S. EVERS Principios básicos de la farmacología clínica 241 DHANESH K. GUPTA • THOMAS K. HENTHORN 11 19 Anestésicos intravenosos 486 RAMON ABOLA • SOFIA GERALEMOU • MARTIN SZAFRAN • TONG J. GAN Opioides 505 ALBERT DAHAN • MARIEKE NIESTERS • TERRY SMITH • FRANK OVERDYK 20 21 Bloqueadores neuromusculares 527 SORIN J. BRULL 22 Anestésicos locales 564 YI LIN • SPENCER S. LIU
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Índice de contenidos
Sección 5 VALORACIÓN PREOPERATORIA Y VIGILANCIA PERIOPERATORIA
Sección 7 ATENCIÓN EN SUBESPECIALIDADES ANESTÉSICAS
23
Valoración y tratamiento preoperatorios del paciente 585 TARA M. HATA • J. STEVEN HATA Enfermedades concurrentes raras 612 STEPHEN F. DIERDORF • J. SCOTT WALTON • ANDREW F. STASIC • CHRISTOPHER L. HEINE La estación de trabajo de anestesia y sistemas de administración de anestésicos inhalados 644 KEVIN T. RIUTORT • JAMES B. EISENKRAFT Técnicas de monitorización comúnmente utilizadas en anestesia 706 CHRISTOPHER W. CONNOR • CHRISTOPHER M. CONLEY Ecocardiografía 731 ALBERT C. PERRINO JR • WANDA M. POPESCU • FARID JADBABAIE • NIKOLAOS J. SKUBAS
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Anestesia para neurocirugía 1003 JOHN F. BEBAWY • JEFFREY J. PASTERNAK
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Anestesia para cirugía torácica 1029 JAMES B. EISENKRAFT • EDMOND COHEN • STEVEN M. NEUSTEIN Anestesia para cirugía cardiaca 1077 NIKOLAOS J. SKUBAS • ADAM D. LICHTMAN • CINDY J. WANG • AARTI SHARMA • STEPHEN J. THOMAS
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39
25
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Anestesia para cirugía vascular y endovascular 1112 ELIZABETH A. VALENTINE • E. ANDREW OCHROCH Anestesia en obstetricia 1144 FERNE R. BRAVEMAN • BARBARA M. SCAVONE • MARCELLE E. BLESSING • CYNTHIA A. WONG
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Anestesia neonatal 1178 JUSTIN B. LONG • SANTHANAM SURESH Anestesia pediátrica 1219 JERROLD LERMAN
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Sección 6 MANEJO BÁSICO EN ANESTESIA
Sección 8 ANESTESIA PARA CIRUGÍA ESPECIALIZADA
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Manejo de la vía respiratoria 767 WILLIAM H. ROSENBLATT • RON O. ABRONS • WARIYA SUKHUPRAGARN Posición del paciente y lesiones potenciales 809 MARY E. WARNER • REBECCA L. JOHNSON
Cuidados anestésicos monitorizados 826 MELISSA M. MASARACCHIA • KYLENE E. HALLORAN • AARON J. MANCUSO • SIMON C. HILLIER Aparato urinario y anestesia para cirugía urológica 1400 MARK STAFFORD-SMITH • AARON SANDLER • JAMIE R. PRIVRATSKY • CATHERINE KUHN AMPLE Anestesia ambulatoria 847 J. LANCE LICHTOR • PETER MANCINI Anestesia extrahospitalaria 863 LAURENCE M. HAUSMAN • MEG A. ROSENBLATT Anestesia fuera del quirófano 880 KAREN J. SOUTER • ANDREW J. PITTAWAY • CARLY PETERSON Anestesia del paciente anciano 897 ITAY BENTOV • G. ALEC ROOKE Anestesia del neuroeje 914 MARK C. NORRIS Anestesia para cirugía laparoscópica y robótica 1261 GERARDO RODRIGUEZ • SHARMA E. JOSEPH Anestesia y obesidad 1277 ANA FERNANDEZ-BUSTAMANTE • BRENDA A. BUCKLIN El hígado: cirugía y anestesia 1298 RANDOLPH H. STEADMAN • MICHELLE Y. BRAUNFELD Función endocrina 1327 JEFFREY J. SCHWARTZ • SHAMSUDDIN AKHTAR • STANLEY H. ROSENBAUM 45 46 47 48 Anestesia en cirugía otorrinolaringológica 1357 LYNNE R. FERRARI • RAYMOND S. PARK 49 Anestesia en cirugía oftalmológica 1373 KATHRYN E. McGOLDRICK • STEVEN I. GAYER 50 44
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Bloqueo de nervios periféricos 945 BAN C. H. TSUI • RICHARD W. ROSENQUIST
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Índice de contenidos
Sección 10 APÉNDICES
51
Anestesia para cirugía ortopédica 1441 MEGHAN A. KIRKSEY • STEPHEN C. HASKINS • ELLEN M. SOFFIN • SPENCER S. LIU
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Anestesia para trasplante 1458 MARIE CSETE • GERARD MANECKE • DALIA BANKS
APÉNDICE 1: Fórmulas 1708
1749
APÉNDICE 2: Atlas de electrocardiografía 1710 GINA C. BADESCU • BENJAMIN M. SHERMAN • JAMES R. ZAIDAN • PAUL G. BARASH APÉNDICE 3: Protocolos del uso de marcapasos y de desfibriladores cardiacos implantables 1724 GINA C. BADESCU • BENJAMIN M. SHERMAN • JAMES R. ZAIDAN • PAUL G. BARASH APÉNDICE 4: Estándares, directrices y declaraciones de la American Society of Anesthesiologists 1732 APÉNDICE 5: Algoritmo para la ventilación y la intubación difícil 1741
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Traumatismo y quemaduras 1486 LEVON M. CAPAN • SANFORD M. MILLER • COREY SCHER
Sección 9 TRATAMIENTO POSTANESTÉSICO, CUIDADOS INTENSIVOS Y TRATAMIENTO DEL DOLOR
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Recuperación postanestésica 1537 MICHAEL A. FOWLER • BRUCE D. SPIESS
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Tratamiento agudo del dolor 1562 STEPHEN M. MACRES • PETER G. MOORE • SCOTT M. FISHMAN Tratamiento del dolor crónico 1607 HONORIO T. BENZON • ROBERT W. HURLEY • SALIM M. HAYEK Medicina de cuidados intensivos 1632 MATTHEW R. HALLMAN • CHRISTOPHER G. CHOUKALAS • STEVEN DEEM Reanimación cardiopulmonar 1661 CHARLES W. OTTO Preparación para desastres 1686 JOSEPH H. McISAAC III • CARIN A. HAGBERG • MICHAEL J. MURRAY
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APÉNDICE 6: Protocolo para hipertermia maligna 1743
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APÉNDICE 7: Productos fitoterapéuticos 1744
APÉNDICE 8: Atlas de ultrasonido y ecocardiografía (en línea) JOSHUA ZIMMERMAN • ROSSEMARY DE LA CRUZ • MICHAEL K. CAHALAN
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Índice alfabético de materias 1749
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AMPLE
Contenido en línea
El material audiovisual en línea se encuentra disponible en inglés
Viñetas clínicas interactivas 1.1 Historically Important Articles 2.1 Perioperative Surgical Home
23.4 Implantable Cardiac Defibrillators (ICD) 23.5 Cigarette Smoking 23.6 Asthma 23.7 Obstructive Sleep Apnea 23.8 Preoperative Medication Management 23.9 Lithium 23.10 Prevention of Pulmonary Aspiration 24.1 Duchenne Muscular Dystrophy
3.1 Needlestick Injuries 5.1 Electrosurgical Unit 5.2 Convective Warming Blankets 5.3 Methylene Blue 5.4 Airway Fire 6.1 Genetic Variability and Pain Response 7.1 Statistical Methods 8.1 Methicillin-Resistant Staphylococcus Aureus
24.2 Myasthenia Gravis 24.3 Multiple Sclerosis 24.4 Malignant Hyperthermia
8.2 Surgical Site Infection 9.1 Transfusion Reaction 9.2 Anaphylaxis 9.3 Latex Allergy 10.1 Mechanism of Anesthesia
24.5 Acute Intermittent Porphyria 24.6 Pseudocholinesterase Deficiency 24.7 G6PD Deficiency 24.8 Sickle Cell Disease 24.9 Rheumatoid Arthritis 25.1 Anesthesia Machine Checkout
11.1 Serotonin Syndrome 12.1 Junctional Rhythm 12.2 Wolff-Parkinson White Syndrome 13.1 Catecholamines 13.2 Dopamine 13.3 Dexmedetomidine 13.4 Nitroprusside 14.1 Catecholamines 14.2 Postoperative Delirium 15.1 Venous Air Embolism 15.2 Postoperative Pulmonary Complications 16.1 Fluid Replacement 16.2 Hypertonic Saline 16.3 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) 16.4 Hyperkalemia in ESRD 16.5 Hypercalcemia 16.6 Carcinoid Syndrome 17.1 Anti-thrombin III deficiency 17.2 Blood Type, Screening and Crossmatching 17.3 Amniotic Fluid Embolism 17.4 Jehovah’s Witness 17.5 Von Willebrand Disease 17.6 Heparin-Induced Thrombocytopenia 17.7 Tranexamic Acid 18.1 Xenon 18.2 Postoperative Cognitive Dysfunction 18.3 CO 2 Elevation 19.1 Etomidate 19.2 Ketamine 19.3 Dexmedetomidine 20.1 Methadone 20.2 Naloxone 21.1 Sugammadex 22.1 Local Anesthestic Systemic Toxicity 23.1 Herbal Supplements 23.2 Bleomycin 23.3 Subacute Bacterial Endocarditis Prophylaxis AMPLE 25.2 Loss of Pipeline Oxygen 26.1 Central Venous Access 26.2 Pulmonary Artery Catheter Complications 26.3 Processed EEG Monitoring 27.1 Transesophageal Echocardiography (TEE) 27.2 Atrial Myxoma 27.3 Patent Foramen Ovale 28.1 Hereditary Hemorrhagic Telangiectasia (HHT) 28.2 Endobronchial Intubation 28.3 Aspiration Pneumonitis 28.4 Endotracheal Tube Cuff 28.5 Methemoglobinemia 29.1 Ulnar Nerve Neuropathy 29.2 Sitting Position 29.3 Venous Air Embolism 30.1 Failed Monitored Anesthesia Care 31.1 Ambulatory Anesthesia 31.2 Pediatric Upper Respiratory Infection 32.1 Office-Based Anesthesia 32.2 Tuberous Sclerosis 33.1 MRI Safety 33.2 Electroconvulsive Therapy 35.1 Loss of Resistance 35.2 Nausea after Spinal 35.3 Postdural Puncture Headache (PDPH) 35.4 Myomectomy 36.1 Trigeminal Neuralgia 36.2 Interscalene Block 36.3 Bier Block 37.1 Evoked Potentials 37.2 Mannitol 37.3 Postoperative Visual Loss 38.1 One Lung Ventilation 34.1 Elderly Changes 34.2 Elderly Changes 2 34.3 Geriatric Anesthesia
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