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Anestesia clínica BARASH, CULLEN & STOELTING

9.ª EDICIÓN

Bruce F. Cullen

M. Christine Stock

Rafael Ortega

Sam R. Sharar

Natalie F. Holt

Christopher W. Connor

Anestesia clínica BARASH, CULLEN & STOELTING

9. a EDICIÓN

Bruce F. Cullen, MD Professor Emeritus Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington M. Christine Stock, MD Professor Emerita Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Rafael Ortega, MD Professor and Chair Department of Anesthesiology Boston University Chobanian & Avedisian School of Medicine Boston, Massachusetts

Sam R. Sharar, MD Professor 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 Adjunct Professor Department of Anesthesiology Yale School of Medicine Medical Director Ambulatory Procedures Unit VA Connecticut Healthcare System West Haven, Connecticut Christopher W. Connor, MD, PhD Associate Professor Department of Anaesthesia Harvard Medical School Brigham and Women’s Hospital Boston, Massachusetts Naveen Nathan, MD Department of Anesthesiology, Critical Care and Pain Medicine University of Chicago Pritzker School of Medicine NorthShore University Health System Chicago, Illinois

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 e-mail: consultas@wolterskluwer.com

Revisión científica Iliada Guadalupe Cantarell Martínez Médico Anestesióloga. Hospital General Balbuena, México.

Leticia Leal Gudiño Médico Anestesióloga, Posgrado en Medicina del Dolor, Posgrado en Anestesia Regional y Maestría en Ciencias de la Salud. INR LGII. México.

Bardo Andrés Lira Mendoza Especialista en Medicina de Urgencias, diplomado en Medicina de Aviación. Adscrito al Servicio de Urgencias del Hospital General de Zona 32, IMSS. México.

Gabriel E. Mejía Terrazas Médico Anestesiólogo. Posgrado en Algología y en Anestesia Regional. Doctorado en Ciencias Medicas. Hospital Ángeles Metropolitano. México.

Christian Nilo Schultz Médico Anestesiólogo. MBA Facultad de Economía y Negocios. Universidad de Chile. Expresidente de la Sociedad de Anestesiología de Chile, Chile.

Edwin Enrique Peñate Suárez Médico con especialidad en Anestesiología. Magíster en Docencia Universitaria. Clínica Del Prado y Hospital General de Medellín. Colombia.

Emmanuel Sabino Pérez Meléndez Posgrado en Anestesia Cardiovascular, Diplomado en Anestesia Regional y Accesos Vasculares guiados por Ultrasonido. INR LGII. México.

Antoni Sabate Pes Doctor en Medicina. Profesor de Anestesiología, Facultad de Medicina, Universidad de Barcelona. Senior Docente, Hospital Universitari de Bellvitge. España.

María Margarita Viteri Toro Médico cirujana especialista en Anestesia y Reanimación. Máster en Anestesia y Analgesia Regional Guiada por Ecografía. Instituto de Ortopedia Infantil Roosevelt y Hospital Universitario Clínica San Rafael. Bogotá, Colombia.

Traducción Doctores de Palabras

Dirección editorial: Carlos Mendoza Editora de desarrollo: Núria Llavina

Gerente de mercadotecnia: Pamela González Cuidado de la edición: Doctores de Palabras Adaptación de portada: Alberto Sandoval Impresión: QUAD / Impreso en México

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 solo 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 científica, 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 © 2025 Wolters Kluwer ISBN de la edición en español: 978-84-19663-98-6 Depósito legal: M-17424-2024 Edición en español de la obra original en lengua inglesa Barash, Cullen, and Stoelting’s Clinical Anesthesia , 9. a edición, editada por Bruce Cullen, Sam Sharar y colaboradores y publicada por Wolters Kluwer Copyright © 2024 Wolters Kluwer Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Two Commerce Square 2001 Market Street Philadelphia, PA 19103 ISBN de la edición original: 978-1-975199-07-4

Paul G. Barash, MD 1942-2020 Editor emérito y cofundador de las obras «Fundamentos de anestesia clínica» y «Anestesia clínica». Excatedrático de Anestesiología y Decano asociado para asuntos clínicos, Escuela de Medicina de la Universidad de Yale. Clínico eminente y médico académico, educador galardonado, editor incansable, mentor generoso, fanático de los Yankees, carismático y amable, hombre de familia y amigo.

Michael K. Cahalan, MD 1949-2019 Editor emérito de las obras «Fundamentos de anestesia clínica» y «Anestesia clínica». Excatedrático de Anestesiología, Universidad de Utah. Pionero y reconocido experto mundial en ecocardiografía clínica, autor, editor y mentor. Líder amable y justo guiado por la compasión y una fuerte brújula moral. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Prefacio

Le damos la bienvenida a la 9. a edición de Anestesia clínica. Desde que se publicó la 1. a edición en 1990, el equipo edito rial, dirigido por los editores fundadores Paul G. Barash, Bruce F. Cullen y Robert K. Stoelting, ha publicado nuevas edicio nes aproximadamente cada 4 años, res pondiendo al rápido ritmo de evolución del conocimiento y la práctica clínica en nuestra especialidad. Cada nueva edi ción incluía no solo contenido impreso convencional actualizado en forma de texto escrito, tablas y figuras, sino tam bién varias herramientas de aprendizaje novedosas, incluido un manual clínico, baterías de preguntas y respuestas de opción múltiple, podcasts y un espec tro creciente de contenido multimedia innovador en un formato de libro elec trónico totalmente interactivo y portátil (p. ej., videos tutoriales, viñetas clínicas narradas y atlas completo de ecografía y ecocardiografía). Cuando se publicó la 8. a edición de Anestesia clínica en el 2017, ninguno de nosotros podía haber predicho dos

clínica . Experto ampliamente aclamado en anestesia cardíaca y pionero en eco cardiografía, se desempeñó como Jefe de Anestesiólogos para el Servicio Cardíaco Pediátrico y Adulto durante la mayoría de sus 22 años en la Universidad de California, San Francisco, luego como profesor y también impartió la Cátedra de Anestesiología en la Universidad de Utah durante 15 años. Mike desempeñó un papel decisivo en la supervisión de todos los aspectos del material relacio nado con el corazón en Anestesia clínica y supervisó personalmente la inclusión del atlas de video y de los apéndices de ecografía y ecocardiografía. Paul y Mike serán extrañados, pero también recorda dos con cariño. Esta 9. a edición marca una impor tante transición adicional en la historia de Anestesia clínica , ya que el editor co fundador, Bruce Cullen, es quien revisa las últimas pruebas de imprenta. El nombre de Bruce ha sido sinónimo de la serie durante casi cuatro décadas, co menzando con su concepción a media

Bruce F. Cullen, MD

dos de la década de 1980. Desde entonces, Bruce ha brindado mucho más que su peso editorial para las nueve ediciones de Anestesia clínica , para todas las ediciones del Manual de anestesia clínica y para las dos ediciones de los Fundamentos de anestesia clínica . Considerado du rante mucho tiempo como un profesional ampliamente capacitado y educador clínico centrado en los alumnos, su excepcional redacción científica, redes de colaboradores y habilidades editoriales, han defi nido la creación y evolución continua de esta serie, siempre dirigida a los estudiantes y profesionales clínicos de la anestesiología. Para nosotros, como coeditores, Bruce ha sido nuestro modelo a seguir, nuestro confidente y nuestro amigo; estaremos siempre en deuda con su amabilidad y generosidad. En concreto, ¿cuáles son los cambios y mejorías clave que los lec tores deben esperar de esta 9. a edición? Primero, y en reconocimiento al gigantesco compromiso y dedicación de los editores fundadores de la serie, el título del libro de texto ha sido cambiado a Barash, Cullen y Stoelting. Anestesia clínica . Además, dos nuevos editores, Christopher W. Connor y Naveen Nathan, se han unido a nuestro equipo, seleccio nados específicamente por su experiencia reconocida internacional mente en formatos educativos novedosos, plataformas de enseñanza multimedia y como educadores clínicos excepcionales. Debido a que un sello distintivo de Anestesia clínica es la presentación de conceptos tanto antiguos como emergentes de una manera fácilmente accesi ble, comprensible, clínicamente útil y «fresca», también hemos ac tualizado nuestro equipo de colaboradores: 7 de los 59 capítulos del texto fueron escritos de novo por nuevos equipos de autores expertos emergentes en sus campos. Al mismo tiempo, los autores que hemos conservado revisaron detalladamente sus capítulos con conceptos y datos recientemente reconocidos, en particular en aquellos temas que experimentan crecimiento rápido y cambios de paradigmas en el co nocimiento y la comprensión, como la genómica perioperatoria (ca pítulo 6: Base genómica de la medicina perioperatoria de precisión) y tanto la fisiopatología como la atención clínica relacionadas con las afecciones por COVID-19 (capítulo 57: Cuidados intensivos). Por último, el contenido multimedia interactivo de esta edición, al que se puede acceder cómodamente a través del libro electrónico

eventos inesperados en el horizonte que incidirían enormemente nuestras vidas personales, profesionales y editoriales, retrasando así la producción de esta 9. a edición. Primero y sin duda, la pandemia de COVID-19 implicó un saldo devastador en varios frentes, pero parti cularmente en los que trabajamos en sistemas de atención médica. Es tas alteraciones (de las que apenas estamos empezando a salir ahora) provocaron una mortalidad muy importante e impedimentos que amenazaron nuestra propia salud durante la prestación de la atención médica rutinaria a los pacientes, así como exigentes aumentos, tanto físicos como emocionales, de la carga de trabajo, los riesgos laborales y el agotamiento entre aquellos de nosotros que somos proveedores sanitarios. En estas circunstancias, la actualización de Anestesia clí nica , obviamente, cedió su sitio a prioridades más importantes. El segundo desafío enfrentado fue la muerte inesperada de dos fuerzas indelebles detrás de la serie formada por Anestesia clínica y su complemento Fundamentos de anestesia clínica : el editor fundador Paul Barash y el editor Michael Cahalan. Paul falleció pacíficamente en junio del 2020 dejando un legado de excelencia en su vida profesio nal como profesor emérito de Anestesiología, expresidente del depar tamento y decano asociado de Asuntos Clínicos de la Universidad de Yale, entre muchos otros roles de liderazgo nacional. Fue un maestro talentoso y galardonado que asesoró desinteresadamente en numero sas cátedras a jefes de sección y a un amplio espectro de aprendices, así como a cada uno de nosotros, sus coeditores. Paul fue la fuerza im pulsora detrás de cada una de las primeras ocho ediciones de Anestesia clínica , de todas las ediciones del Manual de anestesia clínica y de la edición inaugural de Fundamentos de anestesia clínica . Reclutado por un editor para escribir un libro de texto completo sobre anestesiolo gía, se encargó de reclutar a Bob Stoelting y a Bruce Cullen para que le ayudaran como editores fundadores de Anestesia clínica . También fue el editor gerente de facto de todas las ediciones y desempeñó un papel decisivo en la publicación del Manual de anestesia clínica , así como en la mayoría de los componentes multimedia de las versiones digitales del libro de texto original. Mike falleció después de una corta enferme dad, en el 2019, habiendo servido como coeditor para tres ediciones de Anestesia clínica y en la edición inaugural de Fundamentos de anestesia

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Prefacio

incluido con la versión impresa de este texto en equipos de escritorio y dispositivos portátiles, se ha ampliado de manera importante con nuevos temas y se presenta en un esquema actualizado de color. Se agregaron íconos a lo largo de los capítulos para alertar a los lectores sobre el contenido multimedia relacionado (así como de las caracte rísticas «clave»):

De manera enfática deseamos expresar nuestra extrema gratitud a los colaboradores individuales cuyo arduo trabajo y dedicación, en particular durante la pandemia de COVID-19, hicieron posible la pro ducción de esta edición. A pesar de lo que ha sido una de las épocas más exigentes física y emocionalmente para los anestesiólogos y especialis tas relacionados, el compromiso simultáneo de nuestros colaboradores con nuestros aprendices y colegas ha sido realmente excepcional. Por último, gracias a nuestros colegas de Wolters Kluwer, que demuestran continuamente su compromiso con la excelencia en la publicación médica, que proporcionan un valioso apoyo editorial y que hacen que las etapas finales de la producción sean una verdadera alegría. Bruce F. Cullen, MD M. Christine Stock, MD

Video Viñeta clínica interactiva (VCI) Punto clave 1

La 9. a edición contiene, en todo el espectro de su contenido, más de 300 videos y 192 VCI accesibles a través de la versión electrónica. Cada VCI consiste en una breve presentación de casos seguida de una serie de preguntas que incitan al alumno a generar sus propias respuestas. Los tipos de pregunta incluyen opciones múlti ples, verdadero o falso y otros formatos interactivos como identificar elementos en una figura y relacionar listas de elementos. Tanto las respuestas correctas como las incorrectas obtienen una retroalimenta ción inmediata y brindan al alumno la oportunidad de comparar sus respuestas con una explicación apropiada.

Rafael Ortega, MD Sam R. Sharar, MD Natalie F. Holt, MD, MPH Christopher W. Connor, MD, PhD Naveen Nathan, MD

Colaboradores

Ramon E. Abola, MD Clinical Associate Professor of Anesthesiology Department of Anesthesiology Renaissance School of Medicine at Stony Brook University Stony Brook, New York

Honorio T. Benzon, MD Professor Emeritus of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois Robert Bishop, MD Assistant Clinical Professor of Anesthesiology Department of Anesthesiology and Pain Medicine UC Davis School of Medicine UC Davis Medical Center Sacramento, California Jessica R. Black, MD Associate Professor of Anesthesiology Department of Anesthesiology and Critical Care UC San Diego School of Medicine San Diego, California Michelle Y. Braunfeld, MD Clinical Professor of Anesthesiology (Retired) Division of Anesthesiology and Perioperative Medicine David Geffen School of Medicine at UCLA Los Angeles, California Karolina Brook, MD Assistant Professor of Anesthesiology Department of Anesthesiology Boston University Chobanian & Avedisian School of Medicine Brenda A. Bucklin, MD, MEHP, FASA Professor of Anesthesiology Associate Dean for Continuing Medical Education Department of Anesthesiology University of Colorado School of Medicine Aurora, Colorado Nelson Burbano-Vera, MD Chief, Division of Pediatric Cardiothoracic Anesthesiology Department of Pediatric Anesthesiology Cleveland Clinic Foundation Cleveland, Ohio Boston Medical Center Boston, Massachusetts Brent T. Boettcher, DO Associate Professor of Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin

Abey Abraham, MD Chief Fellow Department of Cardiothoracic Anesthesiology Cleveland Clinic Foundation Cleveland, Ohio

Pudkrong K. Aicholz, MD Assistant Professor

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Shamsuddin Akhtar, MBBS Professor Department of Anesthesiology and Pharmacology

Yale School of Medicine New Haven, Connecticut

Trefan Archibald, MD Acting Assistant Professor of Anesthesiology and Critical Care Medicine Department of Anesthesiology University of Washington School of Medicine Seattle, Washington

Ruben J. Azocar, MD, MHCM, FASA, FCCM VP Perioperative Services Beth Israel Deaconess Medical Center Boston, Massachusetts

Douglas R. Bacon, MD, MA Professor and Chair (Retired) Department of Anesthesiology University of Mississippi Medical Center Jackson, Mississippi Gina Cleopatra Badescu, MD Anesthesiologist, Cardiothoracic Anesthesiology Everett, Washington Christopher R. Barnes, MD, FCCM Assistant Professor Department of Anesthesiology and Critical Care Medicine Harborview Medical Center Seattle, Washington John Patrick F. Bebawy, MD Professor of Anesthesiology & Neurological Surgery Chief of Neurosurgical Anesthesiology Program Director, Neurosurgical Anesthesiology Fellowship Program Northwestern University Feinberg School of Medicine Chicago, Illinois

Louanne M. Carabini, MD, MA Associate Professor of Anesthesiology

Section of Anesthesiology and Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois Maurizio Cereda, MD Member of the Faculty of Anesthesia Department of Anesthesia, Critical Care and Pain Medicine Harvard Medical School Massachusetts General Hospital Boston, Massachusetts Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Itay Bentov, MD, PhD Associate Professor Anesthesiology and Pain Medicine Adjunct Associate Professor Department of Medicine Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington

Colaboradores

Amy Chen, MD Assistant Clinical Professor of Anesthesiology Department of Anesthesiology and Pain Medicine UC Davis School of Medicine UC Davis Medical Center Sacramento, California

Christopher W. Connor, MD, PhD Associate Professor Department of Anaesthesia Harvard Medical School Brigham and Women’s Hospital Boston, Massachusetts C. Michael Crowder, MD, PhD Professor of Anesthesiology and Pain Medicine Department of Anesthesiology and Pain Medicine Adjunct Professor of Genome Sciences Mitochondrial and Metabolism Center University of Washington School of Medicine Seattle, Washington Albert Dahan, MD, PhD Professor Head of Research Head and Founder, Anesthesia and Pain Research Unit Department of Anesthesiology Leiden University Medical Center Leiden, The Netherlands

Surendrasingh Chhabada, MD Assistant Professor Departments of Pediatric Anesthesiology and Outcomes Research Cleveland Clinic Foundation Cleveland, Ohio

Christine Choi, MD Assistant Clinical Professor Department of Anesthesiology UC San Diego School of Medicine La Jolla, California

Sung-Wook Choi, MD Assistant Professor Department of Anesthesia and Perioperative Medicine Division of Pediatric Anesthesia Medical University of South Carolina Shawn Jenkins Children’s Hospital Charleston, South Carolina Adam J. Claessens, DO Acting Assistant Professor of Anesthesiology Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington Amalia Cochran, MD Professor and Vice Chair of Professional Development Department of Surgery University of Florida College of Medicine Gainesville, Florida

Karen B. Domino, MD, MPH Professor

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine University of Washington Medical Center Seattle, Washington

Thomas J. Ebert, MD, PhD Professor of Anesthesiology Department of Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin Jan Ehrenwerth, MD Professor Emeritus of Anesthesiology Department of Anesthesiology

Steven P. Cohen, MD Professor of Anesthesiology and Critical Care Medicine; Neurology; Physical Medicine and Rehabilitation; Psychiatry and Behavioral Sciences Department Anesthesiology and Critical Care Medicine Johns Hopkins School of Medicine Professor of Physical Medicine and Rehabilitation; Anesthesiology Uniformed Services University of the Health Sciences Walter Reed National Military Medical Center Baltimore, Maryland Edmond Cohen, MD, FASA Professor of Anesthesiology and Thoracic Surgery Director of Thoracic Anesthesia Department of Anesthesiology, Perioperative and Pain Medicine Icahn School of Medicine at Mount Sinai New York, New York Melissa L. Coleman, MD Associate Professor of Anesthesiology Division of Anesthesiology and Perioperative Medicine Penn State University College of Medicine Milton S. Hershey Medical Center Hershey, Pennsylvania Christopher M. Conley, MD Clinical Associate Professor of Anesthesiology and Pediatrics Department of Anesthesiology Boston University Chobanian & Avedisian School of Medicine

Yale School of Medicine Yale New Haven Hospital New Haven, Connecticut

James B. Eisenkraft, MD Professor Department of Anesthesiology, Perioperative and Pain Medicine Icahn School of Medicine at Mount Sinai Mount Sinai Medical Center New York, New York

Holly B. Ende, MD Associate Professor of Anesthesiology Department of Anesthesiology Vanderbilt University School of Medicine Vanderbilt University Medical Center Nashville, Tennessee

Alex S. Evers, MD Henry E. Mallinckrodt Professor of Anesthesiology Department of Anesthesiology Washington University School of Medicine St. Louis, Missouri

Rachel M. Feldman, MD Assistant Professor of Anesthesiology

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle Children’s Hospital Seattle, Washington

Boston Medical Center Boston, Massachusetts

Colaboradores

Ana Fernandez-Bustamante, MD, PhD Associate Professor of Anesthesiology Department of Anesthesiology University of Colorado School of Medicine Aurora, Colorado Gabrielle Fisher, MD Assistant Professor Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston, South Carolina

Nikolaus Gravenstein, MD Jerome H. Modell, MD, Professor of Anesthesiology Professor of Neurosurgery and Periodontology Department of Anesthesiology University of Florida College of Medicine UF Health Shands Hospital Gainesville, Florida Dennis Grech, MD Vice Chairman Clinical Affairs Associate Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Rutgers Robert Wood Johnson Medical School Loreta Grecu, MD Associate Professor of Anesthesiology Cardiothoracic Anesthesiology and Critical Care Division Duke University School of Medicine Duke University Medical Center Durham, North Carolina Benjamin F. Gruenbaum, MD, PhD Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Jacksonville, Florida New Brunswick, New Jersey University Hospital, Rutgers Newark, New Jersey

Michael A. Fowler, MD, MBA Associate Professor of Anesthesiology Division of Transplant Anesthesia University of Florida College of Medicine UF Health Shands Hospital Gainesville, Florida

Julie K. Freed, MD, PhD Associate Professor of Anesthesiology and Physiology Medical College of Wisconsin Milwaukee, Wisconsin Tong Joo (TJ) Gan, MD, MBA, MHS Professor and Division Head Division of Anesthesiology, Critical Care and Pain Medicine The University of Texas, MD Anderson Cancer Center Houston, Texas Timothy G. Gaulton, MD, MSc Faculty of Anesthesia Harvard Medical School Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Steven Gayer, MD, MBA, FASA Professor of Anesthesiology and Ophthalmology Department of Anesthesiology Bascom Palmer Eye Institute University of Miami Miller School of Medicine Miami, Florida Katherine R. Gentry, MD, MA Associate Professor of Anesthesiology Department of Anesthesiology and Pain Medicine Seattle Children’s Hospital University of Washington School of Medicine Seattle, Washington Sofia Geralemou, MD Clinical Assistant Professor of Anesthesiology Department of Anesthesiology Renaissance School of Medicine at Stony Brook University Stony Brook, New York Rafael Mauricio Gonzalez, MD Clinical Associate Professor Department of Anesthesiology Boston University Chobanian & Avedisian School of Medicine Boston, Massachusetts

Stella Haddadin, BS, PharmD Clinical Pharmacist Department of Pharmacy Advent Health Orlando, Florida

Carin A. Hagberg, MD, FASA Chief Academic Officer Bud Johnson Clinical Distinguished Chair Division of Anesthesiology, Critical Care and Pain Medicine The University of Texas MD Anderson Cancer Center Houston, Texas Michael L. Hall, MD Associate Professor of Anesthesiology and Pain Medicine

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington

Matthew R. Hallman, MD, MS Associate Professor

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington

Dustin Hang, MD Assistant Professor of Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin Elizabeth E. Hansen, MD, PhD Assistant Professor

Stuart Alan Grant, MD Professor and Chief of Regional Anesthesia Department of Anesthesiology University of North Carolina School of Medicine Chapel Hill, North Carolina

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine

Pediatric Anesthesiologist Seattle Children’s Hospital Seattle, Washington

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Colaboradores

Jennifer M. Hargrave, DO, FAOCA, FASA CTA Fellowship Program Director Vice-Chair of Education Department of Cardiothoracic Anesthesiology Cleveland Clinic Foundation Cleveland, Ohio

Keith A. Howell, MD Associate Professor of Anesthesiology Department of Anesthesiology University of Florida College of Medicine UF Health Gainesville, Florida Michelle L. Humeidan MD, PhD Associate Professor of Clinical Anesthesiology Department of Anesthesiology The Ohio State University College of Medicine The Ohio State University Wexner Medical Center Columbus, Ohio Robert W. Hurley, MD, PhD, FASA Associate Dean, Faculty Development Professor, Department of Anesthesiology Professor, Department of Neurobiology and Anatomy Wake Forest University School of Medicine Executive Director, Pain Service Line Atrium Health Winston-Salem, North Carolina

Stephen C. Haskins, MD Clinical Associate Professor of Anesthesiology Weill Cornell Medical College Department of Anesthesiology, Critical Care & Pain Management Hospital for Special Surgery New York, New York

Tara M. Hata, MD Vice Chair, Department of Pediatric Anesthesia Anesthesiology Institute Cleveland Clinic Foundation Cleveland, Ohio Laurence M. Hausman, MD Vice Chairman Academic Affiliations Medical Director Ambulatory Anesthesia

Professor of Anesthesiology and Perioperative and Pain Medicine Department of Anesthesiology, Perioperative and Pain Medicine Icahn School of Medicine at Mount Sinai New York, New York Christopher L. Heine, MD Assistant Professor Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston, South Carolina Laura B. Hemmer, MD, FASA Associate Professor of Anesthesiology and Neurological Surgery Department of Anesthesiology Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital Chicago, Illinois University of Colorado School of Medicine Adjoint Professor of Pharmaceutical Sciences University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences University of Colorado Hospital Aurora, Colorado Erica L. Holland, MD Assistant Professor of Pediatric Anesthesiology and Pain Medicine Thomas K. Henthorn, MD Professor of Anesthesiology Department of Anesthesiology

Jaime B. Hyman, MD Associate Professor of Anesthesiology Department of Anesthesiology

Yale School of Medicine New Haven, Connecticut

Jerry Ingrande, MD, MS Clinical Professor Department of Anesthesiology UC San Diego School of Medicine Staff Anesthesiologist Department of Anesthesiology San Diego VA Medical Center San Diego, California

Adam K. Jacob, MD Associate Professor of Anesthesiology and Perioperative Medicine Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Rochester, Minnesota Rebecca L. Johnson, MD, FASA Associate Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Rochester, Minnesota Sarah S. Joo, MD Clinical Professor of Anesthesiology Department of Anesthesiology, Perioperative and Pain Medicine Icahn School of Medicine at Mount Sinai Mount Sinai Morningside and West Hospitals New York, New York Sharma E. Joseph, MD, MPH Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Tufts University School of Medicine

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle Children’s Hospital Seattle, Washington

Robert S. Holzman, MD, MA (Hon), FAAP Professor of Anaesthesia Harvard Medical School Senior Associate in Anesthesiology Department of Anesthesiology, Critical Care and Pain Medicine Boston Children’s Hospital Boston, Massachusetts

Tufts Medical Center Boston, Massachusetts

Jonathan D. Katz, MD Clinical Professor of Anesthesiology Department of Anesthesiology

Harriet W. Hopf, MD Professor

Departments of Anesthesiology and Biomedical Engineering Spencer Fox Eccles School of Medicine at the University of Utah Salt Lake City, Utah

Yale School of Medicine New Haven, Connecticut

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Colaboradores

Christopher D. Kent, MD Professor

Justin B. Long, MD, MHI Associate Professor of Anesthesiology and Pediatrics Emory University School of Medicine Director, Pediatric Cardiac Anesthesiology Children’s Healthcare of Atlanta Atlanta, Georgia Isaac Luria, MS, MD Assistant Professor of Anesthesiology Departments of Anesthesiology and Acute Pain Service University of Florida College of Medicine UF Health Shands Hospital Gainesville, Florida Stephen M. Macres, Pharm D, MD Clinical Professor of Anesthesiology Director of Perioperative Pain Services Department of Anesthesiology and Pain Medicine UC Davis School of Medicine UC Davis Medical Center Sacramento, California Yasdet Maldonado, MD, MMM, FASE Associate Professor Department of Cardiothoracic Anesthesiology Cleveland Clinic Foundation Cleveland, Ohio

Department of Anesthesiology & Pain Medicine University of Washington School of Medicine University of Washington Medical Center Seattle, Washington

Sandeep Khanna, MD, FASA Associate Program Director, Anesthesiology Residency Department of Cardiothoracic Anesthesiology, General Anesthesiology & Outcomes Research Cleveland Clinic Foundation Cleveland, Ohio Meghan A. Kirksey, MD, PhD Clinical Assistant Professor of Anesthesiology Weill Cornell Medical College Department of Anesthesiology, Critical Care & Pain Management Hospital for Special Surgery New York, New York Sandra L. Kopp, MD Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Rochester, Minnesota Sundar Krishnan, MBBS Associate Professor of Anesthesiology Divisions of Cardiac Anesthesia and Critical Care Medicine Duke University School of Medicine Durham, North Carolina Catherine M. Kuhn, MD Professor of Anesthesiology, Associate Dean for Graduate Medical Education Department of Anesthesiology Duke University School of Medicine Duke University Health System Durham, North Carolina Jerrold H. Levy, MD, FAHA, FCCM Professor of Anesthesiology, Critical Care, and Surgery (Cardiothoracic) Duke University School of Medicine Durham, North Carolina Michael Hua-Gen Li, MD, MPHTM, GCCT, FANZCA Adult Cardiac Anesthesia Fellow Division of Cardiac Anesthesiology Lauren Kemp Licina, MD Staff Anesthesiologist Department of Pediatric and Congenital Cardiac Anesthesiology Cleveland Clinic Foundation Cleveland, Ohio Yi Lin, MD, PhD Clinical Assistant Professor of Anesthesiology Department of Anesthesiology, Critical Care & Pain Management Hospital for Special Surgery New York, New York Duke University Hospital Durham, North Carolina

Peter Mancini, MD Assistant Professor of Clinical Anesthesiology

Yale School of Medicine New Haven, Connecticut

Gerard R. Manecke, MD Professor Emeritus Department of Anesthesiology UC San Diego School of Medicine La Jolla, California

Joseph H. McIsaac III, MD, MS, MBA, CPE, FASA Clinical Professor Anesthesiology Department of Anesthesiology University of Connecticut School of Medicine

Chief of Trauma Anesthesia Department of Anesthesiology Hartford Hospital Hartford, Connecticut

Sara E. Meitzen, MD Associate Professor of Anesthesiology Department of Anesthesiology and Critical Care UC San Diego School of Medicine La Jolla, California

Shawn L. Mincer, MSW Research Coordinator

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine University of Washington Medical Center Seattle, Washington

Candice K. Morrissey, MD, MSPH Associate Professor Department of Anesthesiology Spencer Fox Eccles School of Medicine at the University of Utah Salt Lake City, Utah Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Scott Lindberg, MD, FASA Clinical Assistant Professor Department of Anesthesiology and Critical Care Houston Methodist Hospital Houston, Texas

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Colaboradores

Shivani G. Mukkamala, MD Assistant Professor of Anesthesiology and Pediatrics

Paul S. Pagel, MD, PhD Staff Physician, Anesthesiology Service Clement J. Zablocki Veterans Affairs Medical Center

Emory University School of Medicine Department of Pediatric Anesthesiology Children’s Healthcare of Atlanta Atlanta, Georgia

Professor of Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin

Ben J. A. Palanca, MD, PhD, MSCI Associate Professor Department of Anesthesiology Washington University School of Medicine in St. Louis St. Louis, Missouri Raymond S. Park, MD Assistant Professor of Anaesthesia Harvard Medical School Department of Anesthesiology, Critical Care and Pain Medicine Boston Children’s Hospital Boston, Massachusetts Jeffrey J. Pasternak, MS, MD Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Rochester, Minnesota Feyce M. Peralta, MD, MS Associate Professor and Vice Chair for Faculty Development & Diversity, Equity, and Inclusion Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois

Michael J. Murray, MD, PhD, MCCM, FASA Professor of Anesthesiology and Internal Medicine (Cardiology) University of Arizona College of Medicine

Director of ICU Integration Medical Director CV ICU Banner University Medical Center Phoenix Phoenix, Arizona Ariana M. Nelson, MD Clinical Associate Professor of Anesthesiology

Division of Pain Medicine UCI School of Medicine Irvine, California

Marieke Niesters, MD, PhD Anesthesiologist—Pain specialist Department of Anesthesiology Leiden University Medical Center Leiden, The Netherlands

Mark C. Norris, MD Clinical Professor of Anesthesiology Department of Anesthesiology Boston University Chobanian & Avedisian School of Medicine

Boston Medical Center Boston, Massachusetts

Dasun S. Peramunage, MD Acting Assistant Professor

Benjamin O’Brien, MD, FRCA, FFICM, FFMLM, MHBA Professor of Cardiac Anesthesiology and Intensive Care Medicine Department of Cardiac Anesthesiology and Intensive Care Medicine Deutsches Herzzentrum der Charité Berlin/Germany E. Andrew Ochroch, MD, MSCE Professor of Anesthesiology Department of Anesthesiology and Critical Care Perelman School of Medicine at the University of Pennsylvania University of Pennsylvania Health System Philadelphia, Pennsylvania

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington

James M. Peyton, MBChB, MRCP, FRCA Assistant Professor of Anaesthesia Harvard Medical School Department of Anesthesiology, Critical Care and Pain Medicine Boston Children’s Hospital Boston, Massachusetts Mihai V. Podgoreanu, MD Associate Professor and Chief, Cardiothoracic Anesthesiology Department of Anesthesiology Duke University School of Medicine Durham, North Carolina

Bukola Ojo, MD Assistant Professor of Anesthesiology

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle Children’s Hospital Seattle, Washington Charles W. Otto, MD, FCCM Professor Emeritus of Anesthesiology Department of Anesthesiology University of Arizona College of Medicine Tucson, Arizona

Angela L. Pollak, MD Assistant Professor of Anesthesiology Division of Cardiothoracic Anesthesiology Duke University School of Medicine Duke University Medical Center Durham, North Carolina Jamie R. Privratsky, MD, PhD Assistant Professor Department of Anesthesiology Duke University School of Medicine Durham, North Carolina

Frank J. Overdyk, MSEE, MD Adjunct Professor of Anesthesiology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead, New York

Nathan Leon Pace, MD, MStat Professor of Anesthesiology

Bridget P. Pulos, MD, FASA Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Rochester, Minnesota

Department of Anesthesiology, Perioperative and Pain Medicine Spencer Fox Eccles School of Medicine at the University of Utah Salt Lake City, Utah

Colaboradores

William P. Qiao, MD Assistant Attending Anesthesiologist Department of Anesthesiology, Critical Care & Pain Management Hospital for Special Surgery New York, New York

Elizabeth H. Sinz, MD, MEd, FCCM, FSSH Professor of Anesthesiology and Perioperative Medicine Associative Dean for Clinical Simulation Department of Anesthesiology and Perioperative Medicine Penn State College of Medicine Penn State Health Milton S. Hershey Medical Center Hershey, Pennsylvania

Sally E. Rampersad, BM, DCH, FRCA Attending Anesthesiologist and Professor Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle Children’s Hospital Seattle, Washington

Nikolaos J. Skubas, MD, DSc Professor and Chair Department of Cardiothoracic Anesthesiology Cleveland Clinic Foundation Cleveland, Ohio

Glenn Ramsey, MD Professor of Pathology

Ian R. Slade, MD Assistant Professor

Northwestern University Feinberg School of Medicine Medical Director, Patient Blood Management Program Northwestern Memorial Hospital Chicago, Illinois Kevin T. Riutort, MD, MS Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Jacksonville, Florida Gerardo Rodriguez, MD Associate Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Division of Critical Care Medicine

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Harborview Medical Center Seattle, Washington Hugh M. Smith, MD, PhD Anesthesiologist Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Rochester, Minnesota

Terry Smith, PhD Associate Professor Department of Anesthesiology Leiden University Medical Center Leiden, The Netherlands

Rutgers Robert Wood Johnson Medical School Robert Wood Johnson University Hospital New Brunswick, New Jersey

Jennifer Smith, MD Assistant Professor Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston, South Carolina

William H. Rosenblatt, MD Professor Department of Anesthesiology

Yale School of Medicine New Haven, Connecticut

Ellen M. Soffin, MD, PhD Clinical Associate Professor of Anesthesiology Weill Cornell Medical College Department of Anesthesiology, Critical Care & Pain Management Hospital for Special Surgery New York, New York Nicole Z. Spence, MD Assistant Professor of Anesthesiology, Director of Acute Pain Service Department of Anesthesiology Boston University Chobanian & Avedisian School of Medicine

Richard W. Rosenquist, MD Chairman Department of Pain Management Cleveland Clinic Foundation Cleveland, Ohio

Usha Saldanha, MD Assistant Professor of Anesthesiology and Pain Medicine Department of Anesthesiology and Pain Medicine UC Davis School of Medicine UC Davis Medical Center Sacramento, California

Boston Medical Center Boston, Massachusetts

Jeffrey J. Schwartz, MD Associate Professor Department of Anesthesiology Yale School of Medicine Yale New Haven Hospital New Haven, Connecticut

Mark Stafford-Smith, MD, CM FRCP(C), MBA, FASE Professor of Anesthesiology Duke University School of Medicine Duke University Medical Center Durham, North Carolina

Andrew F. Stasic, MD Associate Professor Emeritus Department of Anesthesia—Pediatric Anesthesia Indiana University School of Medicine Indianapolis, Indiana Randolph H. Steadman, MD, MS Professor and Carole Walter Looke Centennial Chair Department of Anesthesiology and Critical Care Houston Methodist Hospital Houston, Texas

Sam R. Sharar, MD Professor

Vice Chair for Faculty Affairs and Development Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington

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Colaboradores

Alecia L. S. Stein, MD Associate Professor of Clinical Anesthesia Division of Anesthesiology, Perioperative Medicine and Pain Management University of Miami Miller School of Medicine Bascom Palmer Eye Institute Miami, Florida David F. Stowe, MD, PhD Professor of Anesthesiology and Physiology Medical College of Wisconsin Milwaukee, Wisconsin Madhav Swaminathan, MD, MMCi, FASE Professor and Vice-Chair Department of Anesthesiology Duke University School of Medicine Durham, North Carolina Martin Szafran, MD Partner Anesthesiologist, Board Member Department of Dupage Valley Anesthesiologists Edward-Elmhurst Health Naperville, Illinois

Elizabeth A. Valentine, MD Associate Professor of Clinical Anesthesiology Department of Anesthesiology and Critical Care Perelman School of Medicine at the University of Pennsylvania University of Pennsylvania Health System Philadelphia, Pennsylvania Amy E. Vinson, MD Assistant Professor of Anaesthesia Harvard Medical School Department of Anesthesiology, Critical Care and Pain Medicine Boston Children’s Hospital Boston, Massachusetts

Daniel L. Wang, MD Resident Physician of Anesthesiology Department of Anesthesiology and Critical Care UC San Diego School of Medicine La Jolla, California

Wade A. Weigel, MD Staff Anesthesiologist Department of Anesthesiology Virginia Mason Franciscan Health Seattle, Washington

Anthony Tanella, MD Assistant Professor of Anesthesiology Department of Anesthesiology

Cynthia A. Wong, MD Professor and Chair of Anesthesia Department of Anesthesia University of Iowa Carver College of Medicine Iowa City, Iowa Susan Wright, MB, BS, FRCA, FFICM Consultant Anaesthetist Department of Perioperative Medicine

Yale School of Medicine New Haven, Connecticut

Stephan R. Thilen, MD, MS Associate Professor

Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Seattle, Washington

St. Bartholomew’s Hospital London, United Kingdom

Joshua M. Tobin, MD, MSc Professor of Anesthesiology Division of Trauma Anesthesiology University of Texas Health—San Antonio San Antonio, Texas

Daniel J. Wyler, MS, MD Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center Cleveland, Ohio Victor W. Xia, MD Clinical Professor Division of Anesthesiology and Perioperative Medicine David Geffen School of Medicine at UCLA Ronald Reagan UCLA Medical Center Los Angeles, California

Klaus D. Torp, MD Assistant Professor of Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Jacksonville, Florida Chi-Ho Ban Tsui, MD, MSc Professor of Anesthesiology Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine Stanford, California

Jon Y. Zhou, MD Anesthesiologist Department of Anesthesia

Cristiane M. Ueno, MD, FACS Associate Professor Department of Plastic Surgery The Ohio State University College of Medicine Columbus, Ohio

Contenido

Sección 1 INTRODUCCIÓN Y REVISIÓN GENERAL 1 Historia de la anestesia 1 MELISSA L. COLEMAN • ADAM K. JACOB • SANDRA L. KOPP • HUGH M. SMITH • DOUGLAS R. BACON 2 La práctica de la anestesiología 25 RAFAEL MAURICIO GONZALEZ • MARK C. NORRIS • KAROLINA BROOK • RUBEN J. AZOCAR 3 Salud y bienestar laborales 52 AMY E. VINSON • ROBERT S. HOLZMAN • JONATHAN D. KATZ 4 Riesgos de la anestesia, mejoras en la calidad y responsabilidades legales 78 IAN R. SLADE • CHRISTOPHER D. KENT • SHAWN L. MINCER • KAREN B. DOMINO 5 Uso seguro de la electricidad y prevención de incendios 92 ISAAC LURIA • JAN EHRENWERTH • NIKOLAUS GRAVENSTEIN Sección 2 INVESTIGACIÓN BÁSICA Y FUNDAMENTOS 6 Base genómica de la medicina perioperatoria de precisión 123 MIHAI V. PODGOREANU

Sección 3 PRINCIPIOS BÁSICOS

12 Anatomía y fisiología del corazón 261 PAUL S. PAGEL • DUSTIN HANG • BRENT T. BOETTCHER • JULIE K. FREED • DAVID F. STOWE

13 Farmacologías neurovegetativa y cardiovascular 291

PAUL S. PAGEL • DUSTIN HANG • BRENT T. BOETTCHER • JULIE K. FREED

14 Anatomía y fisiología del sistema nervioso autónomo 321 LORETA GRECU

15 Función respiratoria durante la anestesia 349 TIMOTHY G. GAULTON • MAURIZIO CEREDA 16 Equilibrio ácido-básico, líquidos y electrólitos 362 TREFAN ARCHIBALD • DASUN S. PERAMUNAGE • CHRISTOPHER R. BARNES 17 Hemostasia y transfusiones 398 LOUANNE M. CARABINI • GLENN RAMSEY

Sección 4 ANESTÉSICOS Y SUS ADYUVANTES

7 Diseño experimental y estadística 151 NATHAN LEON PACE

18 Anestesia inhalatoria 437 THOMAS J. EBERT

8 Inflamación, cicatrización de las heridas e infección 169 HARRIET W. HOPF • AMALIA COCHRAN • CRISTIANE M. UENO • CANDICE K. MORRISSEY

19 Anestésicos intravenosos 463

RAMON E. ABOLA • SOFIA GERALEMOU • MARTIN SZAFRAN • TONG JOO (TJ) GAN

9 Respuesta alérgica 188 JERROLD H. LEVY

20 Opiáceos 482

ALBERT DAHAN • MARIEKE NIESTERS • TERRY SMITH • FRANK J. OVERDYK

10 Mecanismos de la anestesia y el estado consciente 203 C. MICHAEL CROWDER • BEN J. A. PALANCA • ALEX S. EVERS 11 Principios básicos de farmacología clínica 225 JERRY INGRANDE • THOMAS K. HENTHORN

21 Bloqueadores neuromusculares 505

WADE A. WEIGEL • STUART ALAN GRANT • STEPHAN R. THILEN

22 Anestésicos locales 529 WILLIAM P. QIAO • YI LIN

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