Chapters authored
Current Perspectives on Cardiomyopathies
Cardiomyopathy is a disease of the heart muscle that can affect any age group or gender and can be acquired or inherited. Its literal meaning is “heart muscle disease” and refers to the deterioration of the function of the myocardium for any reason. Cardiomyopathy affects the shape, function, and/or electrical system of the heart. Patients with cardiomyopathy can present to anaesthesiologists in emergency situations or as elective cases. The patients are usually not aware of their condition and may be diagnosed at the time of pre-anaesthetic check-up. Advanced cases are always a challenge to the anaesthesiologist as they are most commonly complicated by progressive cardiac failure. Patients with cardiomyopathy are often at risk of dysrhythmias or sudden cardiac death. This chapter describes the main features and perioperative management of patients with cardiomyopathies undergoing non-cardiac surgery. In general, the optimal anaesthetic management of patients with cardiomyopathy requires good preoperative assessment, close perioperative monitoring, suitable anaesthetic agents, optimal perioperative fluid management, and an overall stable hemodynamic status.
Part of the book: Current Topics in Intensive Care Medicine
Adjuvant Drugs to Local Anesthetics
Local anesthetics have a potential to be used in a wide variety of situations including central neuraxial blocks, peripheral nerve blocks, intravenous, and local infiltration both for surgeries and acute and chronic pain management. Their use can be limited by their duration of action and the dose-dependent adverse effects on the cardiac and central nervous system. Adjuvants are drugs which, when co-administered along with local anesthetic agents, improve the latency of onset and duration of analgesia and counteract disadvantageous effects of local anesthetics. There is a wide armamentarium of adjuvant drugs to choose to be added in neuraxial and peripheral nerve blocks. They can be broadly divided into non-opioids and opioids, with non-opioids being vasoconstrictors, α2-adrenoceptor agonists, anti-inflammatory agents, acetylcholine esterase inhibitors (neostigmine), adenosine, ketorolac, midazolam, magnesium, and sodium bicarbonate and opioids being lipophilic (fentanyl and sufentanil) and hydrophilic (morphine).
Part of the book: Topics in Local Anesthetics