The sixth edition of Kaplan's Cardiac Anesthesia has been written to further improve the anesthetic management of the patient with cardiac disease undergoing both cardiac and noncardiac surgery. Since publication of the first edition in 1979, at the beginning of the modern era of cardiac surgery, continued advances in the field have made cardiac anesthesia the leading subspecialty of anesthesiology. To maintain its place as the standard reference textbook in the field, this edition has been completely revised, expanded, and updated throughout to reflect the ongoing changes in cardiovascular care, especially the rapid growth and use of ultrasound and other imaging technologies. Significant contributions to the text have been made by leading cardiologists and cardiac surgeons to fully cover the broader aspects of the total care of the cardiac patient.
This edition is subtitled The Echo Era to emphasize today's expanded role of transesophageal echocardiography (TEE) and other ultrasound techniques in the perioperative period. The developments leading to the clinical use of TEE are described, and many of the authors discuss the expanding applications in monitoring and diagnosis by the modern cardiac anesthesiologist. Specific clinical situations are described using the decision-making process highlighted by Weiss and Savino: (1) framing the question asked of the anesthesiologist/echocardiographer; (2) collecting echocardiographic and nonechocardiographic information; (3) making the clinical decision based on integration of knowledge, framing, and information; and (4) implementing the recommendations after a full discussion with the surgeon and other clinicians (e.g., cardiologists).
These case discussions dealing with clinical decision making are augmented by the full-color presentation of the text, multiple color echo and Doppler images, cine clips, and supplementary material on the Expert Consult premium website accompanying the print version of the text. The website also will be used to update the book as new material appears between editions. Some of the new information will be provided by integrating key clinical areas first described in the Journal of Cardiothoracic and Vascular Anesthesia. The reader will be able to move seamlessly from the text to the new electronic information technology available with the book.
The content of the sixth edition ranges from the basic sciences through translational medicine to the clinical care of the sickest and most complex cardiac patients. The final section of this edition is entitled “Education in Cardiac Anesthesia” and emphasizes reducing errors to further improve the quality of our patient care. Training and certification in cardiovascular anesthesia are discussed, as well as the educational process and certification available for TEE. Because of the success of the new teaching aides used in the last edition, the Key Points of each chapter appear at the start of the chapters, and Teaching Boxes appear with many of the important “take-home messages.” The emphasis throughout the book is on using the latest scientific developments to guide proper therapeutic interventions in the perioperative period.
Kaplan's Cardiac Anesthesia: The Echo Era was written by acknowledged experts in each specific area or related specialties. It is the most authoritative and up-to-date collection of material in the field. Each chapter aims to provide the scientific foundation in the area as well as the clinical basis for practice, and outcome information is included when it is available. All of the chapters have been coordinated in an effort to maximize the clinical utility. Whenever possible, material has been integrated from the fields of anesthesiology, cardiology, cardiac surgery, physiology, and pharmacology to present a complete clinical picture. Thus, this edition should continue to serve as the definitive text for cardiac anesthesia residents, fellows, attendings, practitioners, cardiologists, cardiac surgeons, intensivists, and others interested in the management of the patient with cardiac disease for either cardiac or noncardiac surgery.
Cardiac anesthesia is a complex and comprehensive field of medicine, incorporating many aspects of the specialties of anesthesiology, cardiology, and cardiac surgery. Monitoring modalities always have been an integral part of the practice and have provided us with data to improve our therapeutic interventions. Over the past 30 years, these monitors have become progressively more sophisticated. Many of these monitoring techniques have been adapted from cardiologists and then applied to the cardiac surgical setting. This has been true of electrocardiographic monitoring, with the introduction of the V5 lead for the intraoperative detection of myocardial ischemia modified from its use during exercise tolerance testing. The pulmonary artery catheter (PAC) was developed for use in the coronary care unit by Dr. Swan, but as he told me, the perioperative use of the PAC in high-risk patients with heart failure and cardiogenic shock was a better role for it, and this use would outlast its role for cardiologists; it turned out to be very true!
Now, we have arrived at the echo era in which TEE—adapted from transthoracic echocardiography use in cardiology—is used widely in cardiac anesthesia for monitoring, diagnosis, and helping to guide the surgery in procedures such as mitral valve repairs. This technique certainly has led to changes in the operative procedures, as well as improvements in our care and choices of pharmacologic treatments, as pointed out in this edition. However, the practice of cardiac anesthesia is and always has been more than the interpretation of any one monitor. Those who believe and emphasize that obtaining certification in TEE makes an anesthesiologist into a cardiac anesthesiologist are sadly mistaken. The practice of cardiac anesthesia includes the use and interpretation of TEE, as it does with other monitors, but it also includes much, much more, and explains the overall size and depth of this book, incorporating all of the areas involved in the complete care of a cardiac surgical patient. It was this overall care in the perioperative period that led J. Willis Hurst, MD, one of the world's leading cardiologists, to state, in his foreword to the first edition of Kaplan's Cardiac Anesthesia, that “This cardiologist views the modern cardiac anesthesiologist with awe.”
The editors gratefully acknowledge the contributions made by the authors of each of the chapters. They are the dedicated experts who have made the field of cardiac anesthesia what it is today and are the teachers of our young colleagues practicing anesthesiology around the world. This book would not have been possible without their hard work and expertise.
Joel A Kaplan, MD, CPE, FACC
Foreword
Medicine is in constant flux. Humans constantly are pushing the realm of scientific discovery into meaningful medical applications that ultimately alleviate suffering. The art and science of anesthesia care, as the practice of medicine, continues to progress significantly, especially in cardiac anesthesia. Our responsibilities have expanded beyond creating insensitivity to pain to the practice of sophisticated medical techniques based on fundamental scientific principles. As a specialty, we are much more involved in disease assessment and physiologic manipulation. The distinctions among anesthesiologist, diagnostician, and even interventionalist have blurred. The cardiac anesthesiologists' pivotal role constantly is growing in the successful outcome of a patient population that is becoming ever more complex.
These advances in our specialty come from our ever-expanding knowledge of cardiopulmonary physiology, biochemistry, pharmacology, and neuroscience. However, much of our deeper understanding has come from advancements in technology. This edition of Kaplan's Cardiac Anesthesia comes at a time that witnesses the practice of our subspecialty at a major crossroads. Cardiac surgery is undergoing a revolution in the way both simple and complex heart disease will be treated. Simultaneously, anesthesiology and cardiology are undergoing major advancements in imaging. Regional anesthesia now moves beyond the art of landmark assessment to the science of looking and guiding. In cardiology, it is fascinating to see that as new imaging or quantification technologies are brought online, new physiologic variables of the heart are discovered, rediscovered, or simply appreciated better. Moreover, newer imaging methodologies will serve as the eyes for catheter-guided hands in what can only be called a revolution in the development of new cardiac implantables and repair techniques that avoid sternotomy and cardiopulmonary bypass. Enter the “Echo Era.”
We have moved away from an era of palpation of the post-mitral repair thrill to sophisticated techniques to quantify a myriad of cardiac physiologic parameters. We are also moving away from an era of opening the chest to operate on the still heart. Newer image-guided procedures ultimately will lead to less invasive incisions, less infection, and less end-organ insult from cardiopulmonary bypass. Cardiopulmonary bypass will still predominate over the next few years, but this decade will witness an explosion of newer catheter-based techniques that avoid reanimating the nonbeating heart. Imaging will be the cornerstone of these new minimally invasive procedures. Advances in materials science and microelectronics ultimately will put three-dimensional eyes onto the tips of catheters, and these procedures will be performed by physicians who now operate inside the beating heart. Valve surgery is changing in a major way with adult senile calcific stenosis. Progressive change is accelerating transcatheter aortic valve intervention (TAVI). More than 20,000 cases have been performed. These procedures already avoid sternotomy and cardiopulmonary bypass to the point at which some patients are treated without endotracheal intubation and general anesthesia. Time will tell whether this procedure can be done safely. Nonetheless, the course is set and clear; cardiopulmonary bypass has brought us into the 21st century and imaging will advance us in the decades to come. Cardiac anesthesiologists now face a career-changing decision: will they embrace being key members of the new interventional team, or will they be content to be sideline observers of these new procedures?
The pivotal role of echocardiography as both monitoring and diagnostic tool evidenced itself in the 1990s with mitral valve repair. The technology revolution is only going to accelerate. New advancements will include technologies that look at structures with more detail in space and time. Ultimately, newer parallel-processing algorithms in beamforming and automated machine analysis of cardiac images will allow assessment of 3D regurgitant volume, myocardial contraction, and full four-chamber and valvular quantification. Because computers have become more powerful, imaging will be embraced only as it progresses in simplicity.
This new echo era will advance both diagnostics and therapeutic guidance. I have been most privileged that my path from medical student to cardiac anesthesiologist has been mentored by Drs. Kaplan, Reich, and Savino. This edition's framework, penned by a world-renowned group of experts, not only is current and complete but also will equip its readers well for the dynamic ride to come.
Ivan S. Salgo, MD, MS
Chief of Cardiovascular Investigations, Ultrasound Philips Healthcare Andover, Massachusetts
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
- Videos: View video clips on all aspects of cardiac anesthesia.
- Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation.
New to this edition
- Update your understanding cardiovascular and coronary physiology, and the latest advances in molecular biology and inflammatory response mechanisms.
- Master the newest approaches to perioperative assessment and management, including state-of-the art diagnostic techniques.
- Tap into the latest knowledge about 2D and 3D transesophageal echocardiography, anesthesia delivery for minimally invasive/robotic cardiac surgery, assist devices and artificial hearts, cardiac pacing, cardiac resynchronization therapy, ablation techniques, and more.
- Access the complete contents online as well as an ECG atlas, and view 2-D and 3-D TEE techniques in real time, at www.expertconsult.com.
- Clearly visualize techniques with over 800 full-color illustrations.
Contents
SECTION I - Preoperative Assessment and Management
- 1 - Assessment of Cardiac Risk and the Cardiology Consultation
- 2 - Cardiovascular Imaging
- 3 - Cardiac Catheterization Laboratory: Diagnostic and Therapeutic Procedures in the Adult Patient
- 4 - Cardiac Electrophysiology: Diagnosis and Treatment
SECTION II - Cardiovascular Physiology, Pharmacology, Molecular Biology, and Genetics
- 5 - Cardiac Physiology
- 6 - Coronary Physiology and Atherosclerosis
- 7 - Molecular and Genetic Cardiovascular Medicine
- 8 - Systemic Inflammation
- 9 - Pharmacology of Anesthetic Drugs
- 10 - Cardiovascular Pharmacology
SECTION III - Monitoring
- 11 - Evolution of Perioperative Echocardiography
- 12 - Intraoperative Transesophageal Echocardiography
- 13 - Decision Making and Perioperative Transesophageal Echocardiography
- 14 - Monitoring of the Heart and Vascular System
- 15 - Electrocardiographic Monitoring
- 16 - Central Nervous System Monitoring
- 17 - Coagulation Monitoring
SECTION IV - Anesthesia and Transesophageal Echocardiography for Cardiac Surgery
- 18 - Anesthesia for Myocardial Revascularization
- 19 - Valvular Heart Disease: Replacement and Repair
- 20 - Congenital Heart Disease in Adults
- 21 - Thoracic Aorta
- 22 - Uncommon Cardiac Diseases
- 23 - Anesthesia for Heart, Lung, and Heart-Lung Transplantation
- 24 - Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension
- 25 - Cardiac Pacing and Defibrillation
- 26 - Procedures in the Hybrid Operating Room
- 27 - New Approaches to the Surgical Treatment of End-Stage Heart Failure
SECTION V - Extracorporeal Circulation
- 28 - Cardiopulmonary Bypass Management and Organ Protection
- 29 - Extracorporeal Devices and Related Technologies
- 30 - Blood and Fluid Management during Cardiac Surgery
- 31 - Transfusion Medicine and Coagulation Disorders
- 32 - Discontinuing Cardiopulmonary Bypass
SECTION VI - Postoperative Care
- 33 - Postoperative Cardiac Recovery and Outcomes
- 34 - Postoperative Cardiovascular Management
- 35 - Postoperative Respiratory Care
- 36 - Central Nervous System Dysfunction after Cardiopulmonary Bypass
- 37 - Long-Term Complications and Management
- 38 - Postoperative Pain Management for the Cardiac Patient
SECTION VII - Education in Cardiac Anesthesia
- 39 - Reducing Errors in Cardiac Anesthesiology
- 40 - Cardiac Anesthesia: Training, Qualifications, Teaching, and Learning
- 41 - Transesophageal Echocardiography: Training and Certification
Electrocardiogram Atlas: A Summary of Important Changes on the Electrocardiogram
- Lead Placement
- Normal Electrocardiogram—Cardiac Cycle
- Arrhythmias
- Coronary Artery Disease
- Other Important ECG Changes
Product Details
- Hardcover: 1120 pages
- Publisher: Saunders; 6 edition (April 8, 2011)
- Language: English
- ISBN-10: 1437716172
- ISBN-13: 978-1437716177
List Price: $299.00