HENSLEY's Practical Approach to Cardiothoracic Anesthesia. Print + eBook with Multimedia

Contributors
Preface
Acknowledgments
Contents
SECTION I: FOUNDATIONS AND GENERAL PRINCIPLES
1. Practical Anatomy of the Heart
I. Introduction
II. Content
A. Embryologic Development of the Heart
B. Structural Basics
C. Right Atrium
D. Right Ventricle
E. Tricuspid Valve
F. Pulmonary Valve
G. Left Atrium
H. Left Ventricle
I. Mitral Valve
J. Aortic Valve
III. Summary
2 Cardiovascular Physiology: A Primer
I. Introduction
II. Embryologic Development of the Heart
III. Organization of Myocytes
IV. Electrical Conduction
V. Length-Tension Relationship
VI. Heart Chambers and External Work
A. The Chamber Wall
B. Atria
C. Ventricle
D. Preload, Contractility, and Compliance
E. Ventricular Work
F. Starling Curve
G. Myocardial Oxygen Consumption and ATP Production
H. Oxygen Supply by Capillaries
VII. Control Systems
VIII. The Cardiovascular Control System
IX. Arterial Baroreceptors
X. Atrial Receptors
XI. Chemoreceptors
XII. Effectors and Physiologic Reserves for the Healthy Individual
XIII. The Cardiovascular System Integration
XIV. Effect of Anesthesia Providers and Our Pharmacology on the Cardiovascular System
A. The Surgical Patient
B. The Anesthetic Choice
C. Treating the Cause: Goal-Directed Therapy
3 Pharmacology
I. Introduction
II. Pharmacologic Principles
A. Pharmacokinetics
B. Drug Delivery Time
C. Pharmacodynamics
D. Combined Pharmacokinetic and Pharmacodynamic Models
E. Drug Variability
F. Pharmacogenomics
III. Inotropes
A. Epinephrine (Adrenaline)
B. Norepinephrine (Levophed)
C. Dobutamine (Dobutrex, Inotrex)
D. Isoproterenol (Isuprel)
E. Dopamine (Intropin)
F. Ephedrine (Akovaz, Corphedra)
G. Milrinone (Primacor)
H. Digoxin (Lanoxin)
I. Levosimendan (Simdax)
J. Glucagon (Glucagen)
IV. Vasopressors
A. Phenylephrine (Neo-Synephrine)
B. Vasopressin (Vasostrict)
C. Norepinephrine (Noradrenaline, Levophed)
D. Ephedrine (Akovaz, Corphedra)
E. Angiotensin II (Giapreza)
F. Corticosteroids (Hydrocortisone)
G. Nitric Oxide Scavengers (Methylene Blue, Hydroxocobalamin [Cyanokit])
V. Vasodilators
A. Nitroglycerin (Glyceryl Trinitrate)
B. Nitroprusside (Nipride)
C. Hydralazine (Apresoline)
D. Nicardipine (Cardene)
E. Clevidipine (Cleviprex)
VI. Antiarrhythmic Drugs
A. Class I Antiarrhythmics: Sodium Channel Blockers (Figure 3.9)
B. Class II Antiarrhythmics: β-Blockers
C. Class III Antiarrhythmics: Potassium Channel Blockers
D. Class IV: Calcium Channel Blockers
E. Class V Antiarrhythmics: Other
VII. Pulmonary Vasodilators
A. Inhaled Nitric Oxide
B. Inhaled Epoprostenol/Prostacyclin/Prostaglandin I2 (Flolan, Veletri)
C. Inhaled Milrinone
VIII. Anticoagulants
A. Heparin—Unfractionated Heparin (UFH)
B. Protamine
C. Bivalirudin (Angiomax)
D. Argatroban
IX. Antifibrinolytics
A. EACA (Amicar)
B. TXA (Cyklokapron, Lysteda)
C. Aprotinin
SECTION II: EQUIPMENT AND TECHNOLOGY
4 Cardiac Ultrasound
I. Introduction
II. Basic Principles of Ultrasound
A. Physics
B. Probe Selection
C. Ultrasound Modes
III. Appropriate Use of Transesophageal Echocardiography
A. Indications for Intraoperative Transesophageal Echocardiography
B. Contraindications for Transesophageal Echocardiography
C. Complications
IV. Probe Insertion, Manipulation, and Machine Knobology
A. TEE Probe Insertion
B. TEE Probe Manipulation
C. Transesophageal Echocardiography Machine Knobology
V. Intraoperative Transesophageal Echocardiography Examination
A. Comprehensive Exam
B. Left Ventricle
C. Right Ventricle
D. Interventricular Septum
E. Right Atrium
F. Interatrial Septum
G. Left Atrium
H. Aortic Valve
I. Mitral Valve
J. Tricuspid Valve
K. Pulmonic Valve
L. Aorta
M. Pericardium
VI. POCUS
A. Definition of POCUS
B. Evaluation of Cardiac Function
C. Hemodynamic Monitoring
D. Assessment of Pulmonary Disorders
VII. Summary
5 Perianesthetic Monitoring
I. Introduction
II. Cardiovascular Monitors
A. Electrocardiogram
B. Blood Pressure
C. Central Venous Pressure Monitoring
D. Pulmonary Artery Catheter
E. Cardiac Output
F. Echocardiography
III. Temperature
A. Indications: Cardiopulmonary Bypass CPB and Hypothermia
B. Sites of Measurement
IV. Renal Function
A. Indications for Monitoring
B. Urinary Catheter
C. Electrolytes
V. Neurologic Function
A. General Considerations
B. Indications for Monitoring Neurologic Function
C. Physiologic and Metabolic Monitoring
D. Monitors of Central Nervous System Electrical Activity
E. Near-Infrared Spectroscopy Cerebral Oximetry
F. Monitors of Central Nervous System Embolic Events
6 Pacemakers and Implantable Cardioverter Defibrillators: Indications, Function, Perioperative Evaluation and Management
I. Overview/Prevalence
II. Cardiac Implantable Electronic Devices Types and Function
A. Basic Components of Transvenous Cardiac Implantable Electronic Devices
B. Pacing/Implantable Pacemakers
C. Leadless Pacemakers
D. Temporary Cardiac Pacing
E. Pacing and Sensing Thresholds
F. Implantable Cardioverter-Defibrillators
G. Subcutaneous Implantable Cardioverter-Defibrillators
H. Cardiac Resynchronization Therapy
III. Cardiac Implantable Electronic Device Malfunction and Perioperative Considerations
A. Battery Depletion
B. Lead Dislodgment
C. Electromagnetic Interference
IV. Perioperative Assessment and Management
A. Preoperative Assessment
B. Intraoperative Management
C. Postoperative Management
V. Summary
7 Cardiopulmonary Bypass
I. Introduction: Patient Safety in the Cardiac Operating Room
II. General Aspects of Cardiopulmonary Bypass
A. Principle of the Cardiopulmonary Bypass Circuit
B. Equipment and Physiology
III. Type of Circuits
IV. Priming Volume and Autologous Priming
V. Pump Flow Management
A. Pulsatile Versus Continuous Flow
VI. Protocols and Standards
A. Preparations for Cardiopulmonary Bypass
B. Initiation of Cardiopulmonary Bypass
C. Blood Pressure Management on Cardiopulmonary Bypass
D. Aortic Cannulation
E. Venting of the Left Ventricle
F. Anticoagulation
G. Temperature Management
H. Ventilation, Acid-Base, Electrolyte, and Glucose Management
VII. Initiation of Cardiopulmonary Bypass: Establishing “Full Flow”
A. Adequacy of Perfusion
VIII. Anesthesia Management for Cardiopulmonary Bypass Cases
A. Preoperative Assessment
B. Pharmacologic Treatment During Cardiopulmonary Bypass
IX. Weaning From Cardiopulmonary Bypass
A. Separation From Cardiopulmonary Bypass
X. Prevention and Management of Adverse Events Associated With Cardiopulmonary Bypass
A. The Human Factor: Standards, Checklists, and Communication
B. Management of Unusual or Rare Conditions Affecting Bypass
8 Extracorporeal Membrane Oxygenation for Pulmonary or Cardiac Support
I. History of Extracorporeal Membrane Oxygenation
II. Extracorporeal Membrane Oxygenation Physiology
III. Cannulation Strategies
A. Venovenous
B. Venoarterial
IV. Indications for Extracorporeal Membrane Oxygenation in Respiratory Failure
A. Bridge to Recovery
B. Bridge to Transplant
V. Indications for Extracorporeal Membrane Oxygenation in Cardiac Failure
A. Bridge to Recovery
B. Bridge to Left Ventricular Assist Device or Transplantation
VI. Extracorporeal Membrane Oxygenation Management
A. Invasive Mechanical Ventilation Practices
B. Anticoagulation and Transfusion Strategies
C. Early Mobilization
D. Weaning ECMO
VII. Extracorporeal Membrane Oxygenation Transport
VIII. Complications
IX. Economic Considerations
X. Ethical Considerations
9 Devices for Cardiac Support and Replacement
I. Introduction
II. History
III. Indications
A. Bridge to Recovery
B. Bridge to Transplantation
C. Destination Therapy
IV. Classification and Attachment Sites of Ventricular Assist Devices
A. Left Ventricular Assist Device
B. Right Ventricular Assist Device
C. Biventricular Assist Device
D. Total Artificial Heart
V. Mechanical Assistance Systems
A. Pulsatile
B. Continuous Flow
VI. Intraoperative Considerations
A. Anesthetic Considerations
B. Surgical Techniques
C. Initiation of Support for Left Ventricular Assist Device
D. Initiation of Support for Biventricular Assist Device
E. Initiation of Support for Right Ventricular Assist Device
VII. Postoperative Management and Complications
A. Right-Sided Circulatory Failure
B. Hemorrhage
C. Thromboembolism
D. Infection
E. Device Malfunction
VIII. Weaning From Ventricular Assist Device Support
IX. Management of the Patient With Ventricular Assist Device for Noncardiac Surgery
X. Intra-aortic Balloon Pump Circulatory Assistance
A. Indications for Placement
B. Contraindications to Placement
C. Functional Design
D. Intra-aortic Balloon Pump Placement
E. Intra-aortic Balloon Pump Control
F. Intra-aortic Balloon Pump Weaning
G. Management of Anticoagulation During Intra-aortic Balloon Pump Assistance
H. Complications
I. Limitations
SECTION III: CARDIAC ANESTHESIA
10 Preparation for Cardiac Surgery
I. Introduction
II. Risk Assessment
A. Society of Thoracic Surgeons Score
B. European System for Cardiac Operative Risk Evaluation II
III. Preanesthetic Evaluation
A. Assessment of Preoperative Medical Conditions
B. Optimization of Patients With Active COVID-19
C. Indications for Intra-aortic Balloon Pump and Impella Insertion
D. Risk Factors for Developing Mediastinitis and Wound Infections
IV. Management of Preoperative Medications
A. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
B. Antiplatelet Therapy
C. Anticoagulation Bridging
V. Management of Cardiac Implantable Electronic Devices
VI. Enhanced Recovery After Surgery and Enhanced Recovery After Cardiac Surgery
A. Frailty and Prehabilitation
B. Nonsteroidal Anti-inflammatory Drugs
C. Acetaminophen
D. Gabapentinoids
VII. Summary
11 Structural Heart and Electrophysiology
I. Introductiong
II. Transcatheter Aortic Valve Replacement
III. The Transseptal Puncture: Principles and Imaging
A. Introduction
B. Procedural Techniques and Principles
C. Echocardiographic Imaging Considerations
D. Site-Specific Transseptal Puncture
E. Complications
IV. Mitral Valve Transcatheter Edge-to-Edge Repair
A. Introduction
B. Patient Selection
C. Available Devices
D. Contraindications
E. Procedural Techniques
F. Potential Complications
G. Periprocedural Anesthetic Management
V. Transcatheter Mitral Valve Replacement
A. Introduction
B. Patient Selection
C. Available Devices
D. Contraindications
E. Procedural Techniques
F. Potential Complications
G. Periprocedural Anesthetic Management
VI. Left Atrial Appendage Occlusion Devices
A. Introduction
B. Patient Selection
C. Available Devices
D. Contraindications
E. Procedural Techniques
F. Potential Complications
G. Periprocedural Anesthetic Management
VII. Transcatheter Prosthetic Paravalvular Defect Closures
A. Introduction
B. Patient Selection
C. Available Devices
D. Contraindications
E. Procedural Techniques
F. Potential Complications
G. Periprocedural Anesthetic Management
VIII. Complex Atrial Septal Defect Closures
A. Introduction
B. Patient Selection
C. Available Devices
D. Contraindications
E. Procedural Techniques
F. Potential Complications
G. Periprocedural Anesthetic Management
IX. Electrophysiology Procedures: Anesthetic Considerations
A. Introduction and Preoperative Assessment
B. Atrial Flutter and Atrial Fibrillation Ablations
C. Supraventricular Tachycardia Ablations
D. Ventricular Tachycardia Ablations
E. Device Implants: Pacemakers and Implantable Cardioverter-Defibrillators
F. Lead Extractions
X. Conclusions
12 Myocardial Revascularization
I. Background on Coronary Artery Disease
A. Prevalence and Economic Impact
B. Symptoms and Progression of Coronary Artery Disease
C. Historical Perspective of Coronary Artery Bypass Grafting
D. Racial Differences in Risk of Coronary Artery Disease and Need for Coronary Artery Bypass Grafting
E. Evaluating Risk of Morbidity and Mortality After Surgery
F. Effectiveness of Coronary Artery Bypass Grafting as a Therapeutic Option
II. Myocardial Oxygen Demand and Supply
A. Introduction
B. Coronary Artery Anatomy
C. Determinants of Myocardial Oxygen Supply
D. Determinants of Myocardial Oxygen Demand
III. Monitoring for Myocardial Ischemia
A. Introduction
B. Electrocardiogram Monitoring
C. Pulmonary Artery Pressure Monitoring
D. Transesophageal Echocardiography
IV. Anesthetic Agents Used During Cardiac Revascularization Surgery
A. Induction Agents and Hypnotics
B. Volatile Agents and Effect on Myocardial Function
C. Opioids
D. Muscle Relaxant and Reversal
V. Perioperative Approach for Myocardial Revascularization Procedures
A. Preoperative Assessment
B. Intraoperative Approach
C. Nonopioid Analgesic Management and Regional Techniques
D. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting
E. Special Circumstances
VI. Causes and Treatment of Perioperative Myocardial Ischemia
A. Intraoperative Period Before Coronary Artery Intervention or Manipulation
B. During Coronary Artery Intervention With or Without Cardiopulmonary Bypass
C. Treatment of Myocardial Ischemia
D. Other Clinical Challenges in Myocardiac Revascularization Surgery
VII. Anesthesia for Hybrid Cardiac Procedures
A. Introduction/Background
B. Coronary Artery Bypass Grafting in a Hybrid Room
13 Aortic Valve Repair and Replacement
I. Introduction
II. Stenotic Versus Regurgitant Lesions
A. Valvular Stenosis
B. Valvular Regurgitation
III. Structural and Functional Response to Valvular Heart Disease
A. Cardiac Remodeling
B. Ventricular Function
IV. Pressure-Volume Loops
V. Aortic Stenosis
A. Natural History
B. Pathophysiology
C. Preoperative Evaluation and Assessment of Severity
D. Timing and Type of Intervention
E. Goals of Intraoperative Management
F. Postoperative Care
VI. Hypertrophic Cardiomyopathy
A. Natural History
B. Pathophysiology
C. Preoperative Evaluation and Assessment of Severity
D. Timing and Type of Intervention
E. Goals of Perioperative Management
VII. Aortic Regurgitation
A. Natural History
B. Pathophysiology
C. Preoperative Evaluation and Assessment of Severity
D. Timing and Type of Intervention
E. Goals of Perioperative Management
VIII. Mixed Valvular Lesions
A. Aortic Stenosis and Mitral Stenosis
B. Aortic Stenosis and Mitral Regurgitation
C. Aortic Stenosis and Aortic Regurgitation
D. Aortic Regurgitation and Mitral Regurgitation
E. Multivalve Surgical Procedures
IX. Prosthetic Valves
A. Essential Characteristics of Prosthetic Heart Valves
B. Types of Prosthetic Valves
C. Echocardiographic Evaluation of Prosthetic Valves in the Aortic Position
x. Prophylaxis of Bacterial Endocarditis
14 Mitral, Tricuspid, and Pulmonic Valves
I. Introduction
II. Stenotic Versus Regurgitant Lesions
A. Valvular Stenosis
B. Valvular Regurgitation
III. Structural and Functional Response to Valvular Heart Disease
A. Cardiac Remodeling
B. Ventricular Function
C. Pressure-Volume Loops
IV. Echocardiography and Valvular Heart Disease
V. Mitral Valve Stenosis
A. Etiology
B. Symptoms
C. Pathophysiology
D. Echocardiography in Mitral Stenosis
E. Timing and Type of Intervention
F. Goals of Perioperative Management
VI. Mitral Valve Regurgitation
A. Natural History
B. Pathophysiology
C. Intracardiac Hemodynamics and Cardiac Remodeling
D. Transesophageal Echocardiography Examination
E. Surgical Intervention
F. Transcatheter Intervention
G. Goals of Perioperative Management
H. Anesthetic Management
VII. Tricuspid Valve Stenosis
A. Natural History
B. Pathophysiology
C. Calculation of Severity
D. Transesophageal Echocardiography
E. Medical and Surgical Therapy
F. Goals of Perioperative Management
VIII. Tricuspid Valve Regurgitation
A. Natural History
B. Pathophysiology
C. Transesophageal Echocardiography Evaluation and Grading of Severity of Tricuspid Regurgitant
D. Pressure Wave Abnormalities
E. Medical and Surgical Intervention
F. Goals of Perioperative Management
IX. Pulmonic Stenosis
A. Etiology
B. Symptoms
C. Quantification and Classification
D. Natural Progression
E. Pressure Wave Abnormalities
F. Transesophageal Echocardiography
G. Surgical Intervention
H. Goals of Perioperative Management
X. Pulmonic Regurgitation
A. Etiology
B. Symptoms
C. Transesophageal Echocardiography
D. Surgical Intervention
E. Anesthetic Management
XI. Prosthetic Valves
A. Essential Characteristics of Prosthetic Valves
B. Types of Prosthetic Valves
15 Right Heart Disease Assessment and Management
I. Importance of Right Ventricular Function in Cardiac Surgery
A. Overview
B. Definitions
II. Preoperative Evaluation
A. Overview
B. History and Physical Examination
C. Preoperative Testing
III. Hemodynamic Assessment
A. Pressure-Volume Loop
B. Pulmonary Artery Catheter
IV. Echocardiographic Assessment of Right Heart Function
A. Cardiac Assessment of Right Heart Function
B. Extracardiac Assessment of Right Heart Function
V. Management of Right Ventricular Dysfunction
A. General Principles
B. Preload
C. Afterload
D. Contractility and Right Ventricular Perfusion
E. Temporary Mechanical Support
VI. Summary
16 Anesthetic Considerations for Surgical Myectomy in Patients With Hypertrophic Cardiomyopathy
I. Introduction
II. Hypertrophic Cardiomyopathy
A. Epidemiology, Morphology, Histopathology, Genetics
B. Pathophysiology
C. Clinical Presentation and Diagnosis
D. Natural History
E. Surgical Treatment
III. Anesthetic Considerations
A. Preoperative Encounter
B. Intraoperative Management
C. Intraoperative Monitoring
D. Early Postoperative Care
IV. Surgical Subgroups and Anesthetic Considerations
A. Apical Myectomy
B. Pulmonary Hypertension
C. Hypertrophic Cardiomyopathy in Children
D. Right Ventricular Hypertrophy
V. Summary
17 Adult Congenital Heart Disease (Basics)
I. Introduction
A. Definition
B. Epidemiology
C. Providing Health Care Access
D. Role of the Cardiothoracic Anesthesiologist
E. Nomenclature for Congenital Heart Disease
F. Classification of Severity of Congenital Disease
II. Perioperative Considerations for Patients With Adult Congenital Heart Disease
A. Preoperative History and Physical
B. Extracardiac Organ System Involvement
C. Preoperative Imaging, Testing, and Laboratories
D. Intraoperative Monitoring and Access
E. General Considerations for Redo Sternotomies
F. Air Emboli and Air Vigilance Prophylaxis
G. Endocarditis Prophylaxis
H. Arrhythmias and Electrophysiologic Devices
I. Anticoagulation
J. High-Risk Populations
K. Collateral Circulation
L. Common Surgical Palliations
III. Shunt Lesions
A. Atrial Septal Defects
B. Ventricular Septal Defect
C. Atrioventricular Septal Defects
D. Patent Ductus Arteriosus
E. Partial Anomalous Pulmonary Venous Return
F. Anesthetic Management for Shunt Lesions
IV. Obstructive Lesions
A. Cor triatriatum
B. Congenital Left-Sided Outflow Obstruction
C. Congenital Mitral Stenosis
D. Congenital Right-Sided Obstruction
V. Complex Lesions
A. Ebstein Anomaly
B. Shone Complex
C. Tetralogy of Fallot
D. Transposition of the Great Arteries
E. Persistent Truncus Arteriosus
VI. Single Ventricle Defects
A. Surgical Stages of Palliation
B. Fontan Physiology and Anesthetic Management
VII. Conclusion
18 Pericardial Disease and Tamponade
I. Introduction
II. Pericardial Anatomy and Physiology
III. Causes of Pericardial Disease
IV. Pericarditis
A. Natural History
B. Pathophysiology
C. Diagnostic Evaluation and Assessment
D. Treatment
E. Goals of Perioperative Management
V. Constrictive Pericarditis
A. Natural History
B. Pathophysiology
C. Diagnostic Evaluation and Assessment
D. Treatment
E. Goals of Perioperative Management
VI. Pericardial Effusion and Tamponade
A. Natural History
B. Pathophysiology
C. Diagnostic Evaluation and Assessment
D. Treatment
E. Goals of Perioperative Management
19 Cardiac Masses
I. Cardiac Tumors
A. Introduction
B. Epidemiology
C. Clinical Presentation
D. Diagnosis of Cardiac Tumors
E. Primary Cardiac Tumors: Benign
F. Primary Cardiac Tumors: Malignant
G. Metastatic Cardiac Cancer
H. Cardiac Tumor Imitators
I. Key Anesthetic Considerations and Management
II. Endocarditis
A. Epidemiology and Natural History
B. Pathophysiology and Etiology
C. Presentation and Diagnosis
D. Echocardiographic Assessment
E. Timing and Type of Intervention
F. Perioperative Anesthetic Considerations
G. Summary for Endocarditis Management
III. Cardiac Thrombus
A. Introduction
B. Left-Sided Cardiac Thrombus
C. Right-Sided Cardiac Thrombus
D. Summary for Pulmonary Embolism Management
IV. Anatomic Variants
20 Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Thromboendarterectomy
I. Introduction to Pulmonary Hypertension
A. Classification
B. Pathophysiology
C. Clinical Manifestations
D. Clinical Diagnosis
E. Treatment
II. Pulmonary Thromboendarterectomy
A. History
B. Surgical Management
C. Anesthetic Management
D. Complications
III. Special Consideration
A. Sickle Cell Disease
B. Cold Agglutinins
C. Heparin-Induced Thrombocytopenia
D. Use of Extracorporeal Membrane Oxygenator Life Support
21 Heart Transplantation
I. Heart Failure
A. Etiology
B. Pathophysiology
C. Medical Management of Heart Failure
D. Mechanical Circulatory Support Devices
II. Cardiac Transplant Recipient Characteristics
A. Cardiac Transplantation Indications
B. Cardiac Transplantation Contraindications
III. The Cardiac Transplant Donor
A. Donor Selection
B. Determination of Brain Death
C. Pathophysiology of Brain Death
D. Management of the Cardiac Transplant Donor
E. Anesthetic Management of the Donor
F. Organ Harvest Technique
IV. Surgical Techniques for Cardiac Transplantation
A. Orthotopic Cardiac Transplantation
B. Heterotopic Cardiac Transplantation
V. Preoperative Management of the Cardiac Transplant Patient
A. Timing and Coordination
B. Preoperative Evaluation
VI. Anesthetic Management of the Cardiac Transplant Recipient
A. Premedication
B. Importance of Aseptic Technique
C. Monitoring
D. Considerations for Repeat Sternotomy
E. Anesthetic Induction
F. Anesthetic Maintenance
G. Cardiopulmonary Bypass
VII. Postcardiopulmonary Bypass
A. Autonomic Denervation of the Transplanted Heart
B. Right Ventricular Dysfunction
C. Left Ventricular Dysfunction
D. Coagulation
E. Renal Dysfunction
F. Pulmonary Dysfunction
G. Hyperacute Allograft Rejection
VIII. The Role of Intraoperative Transesophageal Echocardiography
IX. Cardiac Transplantation Survival and Complications
A. Infection
B. Acute Rejection
C. Graft Failure and Cardiac Allograft Vasculopathy
D. Renal Insufficiency
E. Malignancy
F. Immunosuppressive Drug Side Effects
G. Postoperative Vasoplegia Syndrome
X. Pediatric Cardiac Transplantation
XI. Combined Heart-Lung Transplantation
XII. Anesthesia for the Patient With History of Heart Transplant
A. Physiology of the Previously Transplanted Patient
B. Pharmacology of the Previously Transplanted Patient
C. Preoperative Evaluation
D. Anesthesia Management
E. Pregnancy Following Cardiac Transplantation
XIII. Future Directions
SECTION IV: THORACIC ANESTHESIA
22 Lung Transplantation
I. End-Stage Pulmonary Disease
A. Epidemiology
B. Etiology and Pathophysiology of End-Stage Pulmonary Disease
II. Lung Transplant Recipient Characteristics
A. Recipient Selection Criteria: Indications and Contraindications
B. Medical Evaluation of Lung Transplant Candidates
C. Impact of the COVID-19 Pandemic
III. The Lung Transplant Donor
A. Selection Criteria for the Donor Lung
B. Procurement Procedure
IV. Choice of Lung Transplant Procedure
A. Single-Lung Transplantation
B. Bilateral Sequential Lung Transplantation
C. Heart-Lung Transplantation
D. Living donor lobar lung transplantation (LDLLT)
V. Preanesthetic Considerations
VI. Anesthetic Management of the Lung Transplant Recipient
A. Induction of Anesthesia
B. Maintenance of Anesthesia
C. Surgical Procedures and Anesthesia-Related Interventions
VII. Postoperative Management and Complications
A. Respiratory and Cardiovascular Support
B. Primary graft dysfunction
C. Immunosuppressive drug regimens
D. Postoperative Complications
E. The vagus, phrenic, and recurrent laryngeal nerves are jeopardized during lung transplantation
F. Postoperative airways complications
VIII. Outcomes
A. Survival
B. Exercise tolerance
C. Posttransplant lymphoproliferative disorders
IX. Special Considerations for Pediatric Lung Transplantation
A. Epidemiology
B. Outcome
C. Pathophysiology
D. Donor Lungs
E. Intubation
X. Anesthesia for the Post–Lung-Transplant Patient
XI. Future Directions
23 Anesthetic Management for Thoracic Aortic Aneurysm and Dissection
I. Classification and Natural History
A. Aneurysm
B. Dissection
C. Thoracic Aortic Rupture
II. Diagnosis
A. Clinical Signs and Symptoms
B. Diagnostic Tests
C. Indications for Endovascular and Open Surgical Repair
III. Preoperative Management of Patients Requiring Surgery of the Thoracic Aorta
A. Blood Pressure Management
B. β-Blockers
C. Vasodilators
D. Bleeding and Transfusion
E. Assessment of Other Organ Systems
F. Pain Management
IV. Surgical and Anesthetic Considerations
A. Goal of Surgical Therapy (From Aortic Aneurysm, Dissection, Rupture, or Penetrating Ulcer)
B. Overview of Intraoperative Anesthetic Management (for Aortic Aneurysm, Dissection, Rupture, or Penetrating Ulcer)
C. Ascending Aortic Surgery
D. Anesthetic Considerations for Ascending Aortic Surgery
E. Aortic Arch Surgery
F. Anesthetic Considerations for Aortic Arch Surgery
G. Descending Thoracic and Thoracoabdominal Aortic Surgery
H. Anesthetic Considerations in Descending Thoracic Aortic Surgery
I. Endovascular Graft Repair of the Thoracic Aorta
J. Anesthetic Considerations for Patients Undergoing Endovascular Stent Graft Repair of the Thoracic Aorta
24 Anesthesia for Esophageal Surgery
I. Introduction
II. Preoperative Assessment
A. Overview and Patient Factors
B. Procedural and Operation Factors
III. Intraoperative Management
A. Positioning
B. Monitoring and Access
C. Anesthetic Technique
IV. Operations for Gastroesophageal Reflux Disease
A. Disease Overview
B. Traditional Operative Approaches
C. Newer Therapies
V. Operations for Paraesophageal Hernia Repair
A. Hernia Types
B. Operative Approaches
VI. Operations for Achalasia
VII. Operations for Esophageal Diverticula
VIII. Other Endoscopic Esophageal Procedures/Surgeries
A. Foreign Body
B. Esophageal Stricture
C. Esophageal Varices
IX. Esophagectomy
A. Transhiatal
B. Ivor Lewis
C. McKeown
D. Anesthetic Management
X. Repair of Esophageal Perforation or Rupture
XI. Repair of Tracheoesophageal Fistula
25 Anesthetic Management for Surgery of the Lungs and Mediastinum
I. Preoperative Assessment
A. Overview
B. Risk Stratification
II. Intraoperative Management
A. Lung Separation
B. Positioning
C. Intraoperative Monitoring
D. Anesthetic Technique
E. Management of One-Lung Ventilation
III. Specific Procedures
A. Thoracotomy
B. Video-Assisted Thoracoscopic Surgery
C. Bronchopleural Fistula
D. Bullae and Blebs
E. Abscesses, Bronchiectasis, Cysts, and Empyema
F. Mediastinoscopy
G. Anterior Mediastinal Mass
H. Tracheal and Bronchial Stenting
I. Tracheal Resection
J. Pulmonary Hemorrhage
K. Post-Tracheostomy Hemorrhage
IV. Lung Volume Reduction Surgery
A. Anesthetic Management for Lung Volume Reduction Surgery
B. Endobronchial Valves and Blockers for Lung Volume Reduction
C. Conclusions
26 Anesthetic Management for Interventional Pulmonology Procedures
I. Introduction
A. Indications
B. Alternatives
II. Anesthetic Approaches
A. Local: Airway Topicalization
B. Sedation: Monitored Anesthesia Care
C. General Anesthesia
III. Procedural Approaches
A. Flexible Bronchoscopy
B. Endobronchial Ultrasound Bronchoscopy
C. Navigational Bronchoscopy
D. Robotic-Assisted Bronchoscopy
E. Rigid Bronchoscopy
F. Pleuroscopy
IV. Diagnostic Techniques
A. Bronchoalveolar Lavage
B. Transbronchial Needle Aspiration
C. Spray Cryotherapy
D. Transbronchial Lung Cryobiopsy
V. Therapeutic Techniques
A. Airway Dilation
B. Airway Stent Placement (and Removal)
C. Endobronchial Valves
D. Bronchial Thermoplasty
E. Laser Debulking
F. Cryoablation
G. Whole Lung Bronchopulmonary Lavage
H. Foreign Body Removal
VI. Preoperative Assessment for Interventional Pulmonology Procedures
VII. Management of Interventional Pulmonology–Specific Intraprocedural Complications
A. Airway Irritability
B. Airway Loss
C. Airway Bleeding
D. Airway Fire
E. Pneumothorax
F. Failure to Extubate
SECTION V: PERIOPERATIVE MEDICINE
27 Perioperative Evaluation
I. Introduction
II. Noncardiac Evaluation
A. Laboratory Tests
B. Noncardiac-Specific Imagining
III. Cardiac-Specific Evaluation
A. Resting Electrocardiogram
B. Echocardiography
C. Diagnostic Cardiac Catheterization
D. Computed Tomographic Coronary Angiography
E. Aortic Assessment With Computed Tomography
F. Cardiac Magnetic Resonance Imaging
G. Provocative Testing
28 Patient Blood Management
I. Introduction
A. Practice Patterns Vary Widely for Transfusion of All Three Major Blood Components in Cardiac Surgery
B. Patient Blood Management Programs
C. Complications of Transfusion
II. Red Blood Cell Transfusion and Clinical Outcomes
A. Hemoglobin Transfusion Trigger Trials
B. Intraoperative Transfusion Triggers
C. Red Blood Cell Storage Duration
III. Component Therapy
A. Restrictive Red Blood Cell Transfusion Practices
B. Platelet Therapy
C. Plasma Therapy
D. Cryoprecipitate
E. Massive Transfusion and Component Ratios
IV. Blood Conservation Measures
A. Preoperative Anemia Management
B. Antifibrinolytics
C. Acute Normovolemic Hemodilution
D. Methods Used by Perfusionists
E. Viscoelastic Testing
V. Conclusion
29 Preservation of End-Organ Function
I. Introduction
II. Kidneys
A. Diagnosis and Epidemiology
B. Biomarkers
C. Implementation of the Kidney Disease Improving Global Outcome Care Bundle
D. Pharmacologic Strategies
E. Remote Ischemic Preconditioning
III. Brain
A. Neurocognitive Disorders
B. Perioperative Stroke
C. Seizures
IV. Heart and Circulatory System
A. Low Cardiac Output Syndrome
B. Postoperative Arrhythmias
C. Vasodilatory Shock
VI. Lung
VII. Gastrointestinal Organs
VIII. Summary
30 Regional Anesthesia Techniques for the Cardiac Surgery Population
I. Introduction
II. Regional Anesthesia Techniques
A. Neuraxial Blocks
B. Paravertebral Blocks
C. Chest Wall Fascial Plane Blocks
D. Special Situations
E. Rectus Sheath Blocks
III. Selection of Technique
A. Distribution of Pain
B. Timing of Technique
IV. Dosing and Safety Considerations
V. Limitations of Regional Anesthesia Techniques
VI. Summary
31 Postoperative Care of the Cardiac Surgical Patient
I. Transition From Operating Room to Intensive Care Unit
A. General Principles
B. The Transport Process
II. Transfer of Care to the Intensive Care Unit Team
A. Importance of Handoffs
B. Logistics
C. Transition to Intensive Care Unit Monitors
D. Initial Ventilator Settings
E. The Actual Handoff
F. Laboratory Tests/Electrocardiogram/Chest Radiograph
III. Mechanical Ventilation After Cardiac Surgery
A. Hemodynamic Response to Positive-Pressure Ventilation and Predictable Pulmonary Changes After Sternotomy and Thoracotomy
B. Choosing Modes of Ventilation
C. Weaning From Mechanical Ventilation Is Multifactorial
D. Liberation From Mechanical Ventilation
E. Rapid Mechanical Ventilation Weaning for Fast-Track Patients (<6 Hours)
IV. Principals of Fast-Tracking
A. Goals of Fast-Tracking
V. Enhanced Recovery After Cardiac Surgery
A. Goals of Enhanced Recovery After Cardiac Surgery
VI. Hemodynamic Management in the Postoperative Period
A. Monitoring for Ischemia
B. Ventricular Dysfunction After Cardiac Surgery
C. Fluid Management
D. Managing Hypotension
E. Dysrhythmia Management
F. Pulmonary Hypertension
VII. Postoperative Bleeding
A. Risk Factors
B. Monitoring
C. Treatment
VIII. Postoperative Pain Management Following Cardiac Surgery
A. Appropriate Pain Management
B. Immediately Postoperative
C. Following Extubation
IX. Metabolic Abnormalities
A. Electrolyte Abnormalities
B. Shivering
C. Acidosis
D. Glucose Management
X. Complications in the First 24 Hours
A. Pulmonary Complications
B. Bleeding
C. Cardiac Tamponade
D. Hemothorax
E. Acute Graft Closure
F. Prosthetic Valve Failure
G. Neurologic Dysfunction
H. Acute Kidney Injury
XI. Discharge From the Intensive Care Unit
XII. The Transplant Patient
XIII. Patients With Mechanical Assist Devices
A. Intra-Aortic Balloon Pump
B. Ventricular Assist Device
C. Extracorporeal Membrane Oxygenation
XIV. Family Issues in the Postoperative Period
A. Family Visitation
B. The Role of Family Support
32 Practice Management, Quality Assurance and Improvement, and Ethical and Legal Issues in Cardiothoracic Anesthesiology
I. Introduction
II. Practice Management
A. Staffing a Cardiac Operating Room
B. Billing and Coding for Anesthesia Services
C. Ancillary Services
D. Echocardiography Services
III. Patient Safety and Quality Improvement
A. Call for Patient Safety and Improvement
B. Comprehensive Approach to Quality
C. National Quality Organizations
D. Performance Assessment and Shared Accountability
E. Value-Based Healthcare
F. Metric-Driven Strategy
G. Quality Improvement Program Development
H. The “Swiss Cheese” Model of System Failure
I. Categorization of Safety Events and Process Improvement
J. Mitigating Risk: Crisis Management and Teamwork Training
K. Barriers to Quality Improvement and Future Directions
IV. Ethical and Legal Issues
A. Introduction
B. Informed Consent
C. Confidentiality (Patient Privacy)
D. Conflict of Interest
E. End-of-Life Care and Ethical Conflicts
F. Transplant Ethics
G. Professionalism
V. Summary
Index

Offering a comprehensive, up-to-date overview of the field, Hensley’s Practical Approach to Cardiothoracic Anesthesia, Seventh Edition, edited by Drs. Karsten Bartels, Amanda A. Fox, Andrew D. Shaw, Kimberly Howard-Quijano, and Robert H. Thiele, is an ideal reference and review tool for fellows, residents, and practicing anesthesiologists. Concisely written and readily accessible, it combines the depth of a reference book with the no-nonsense guidance of a clinically-oriented handbook. This edition has been newly reorganized for current practice patterns and to better align with the ACGME requirements for adult cardiothoracic anesthesiology.

• Presents information in a concise, bulleted format, making it easy to read and absorb key points
• Key points are identified at the beginning of each chapter and in the margins with clinical pearls appearing throughout the text
• Provides up-to-date coverage of cardiac physiology and pharmacology, pre-procedural patient preparation, anesthetic management of specific disorders and procedures, post-procedural management, and more
• Prepares you for the new ABA certifying exam for adult cardiac anesthesiology
• Offers the experience and expertise of three new co-editors and nearly 70 contributors from over 35 institutions
• Over 30 echocardiography clips demonstrate assessment of valve disorders, arythmias and more. 
• A valuable resource for anesthesia residents, fellows in cardiac anesthesia, anesthesiology practitioners, perfusionists, and CRNAs