By Philippa Newfield, James Cottrell MD
Thoroughly up-to-date, the fifth version of the Handbook of Neuroanesthesia is a necessary advisor to perioperative administration of neurosurgical sufferers.
Written in an summary structure for speedy reference, this instruction manual offers targeted information regarding the anesthetic administration of neurosurgical and neuroradiologic methods and the in depth care of neurosurgical sufferers in addition to those that have sustained irritating mind and spinal wire injury.
Each bankruptcy additionally comprises medical instances, summaries, and bankruptcy highlights, giving readers all of the info had to optimistically placed what they discovered to take advantage of in genuine existence neuroanesthesia and neurocritical care instances.
• very important pre-operative, post-operative, intra-operative, and peri-operative strategies are generally covered
• New bankruptcy on details expertise to lead readers to on-line scientific assets and seek modalities
• web site references indexed in each one chapter
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ACP Medicine. In Gibbons RJ (ed): Cardiovascular Medicine IX. , 2004. 25 CHAPTER 2 Valvular Heart Disease Adriana Herrera Preoperative Evaluation History and Physical Examination Drug Therapy Laboratory Data Presence of Prosthetic Heart Valves Prevention of Bacterial Endocarditis Mitral Stenosis Pathophysiology Diagnosis Treatment Management of Anesthesia Mitral Regurgitation Pathophysiology Diagnosis Treatment Management of Anesthesia Mitral Valve Prolapse Diagnosis Management of Anesthesia In the past 2 decades, there have been major advances in understanding the natural history of valvular heart disease and in improving cardiac function in patients with valvular heart disease.
Diagnosis The definitive diagnosis of MVP is based on echocardiographic findings. It has been defined as valve prolapse of 2 mm or more above the mitral annulus. MVP can occur with or without leaflet thickening and with or without mitral regurgitation. Patients with redundant and thickened leaflets have a primary (anatomic) form of MVP. This form of MVP typically occurs in patients with connective tissue diseases or in elderly men. Patients with mild bowing and normal-appearing leaflets have a normal variant (functional) form of MVP, and their risk of adverse events is probably no different than that of the general population.
When the mitral valve area is less than 1 cm2, a mean atrial pressure of about 25 mm Hg is necessary to maintain adequate left ventricular filling and resting cardiac output. Pulmonary hypertension is likely if the left atrial pressure is chronically above 25 mm Hg. When the mitral transvalvular pressure gradient is higher than 10 mm Hg (normally < 5 mm Hg), it is likely that mitral stenosis is severe (Table 2-6). When mitral stenosis is severe, any additional stress such as fever or sepsis may precipitate pulmonary edema.