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EDITION 4
Lee A. Fleisher, MD
Robert D. Dripps Professor and Chair of
Anesthesiology and Critical Care Medicine
Professor of Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania
Michael F. Roizen, MD
Roizen Family Chair
Wellness Institute
Professor of Anesthesiology
Chief Wellness Officer
The Cleveland Clinic
Cleveland, Ohio
Jeffrey D. Roizen, MD, PhD

Assistant Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Division of Endocrinology and Diabetes
The Children’s Hospital of Philadelphia
@ejournals
1600 John F. Kennedy Blvd.
Philadelphia, Pennsylvania 19103-2899
ESSENCE OF ANESTHESIA PRACTICE, FOURTH EDITION ISBN: 978-0-323-39497-0
Copyright © 2018 by Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing from
the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our
arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be
found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds, or experiments described herein. In using such information or methods they
should be mindful of their own safety and the safety of others, including parties for whom they have a professional
responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability
for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or
from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2011, 2002, and 1997
Library of Congress Cataloging-in-Publication Data

Names: Fleisher, Lee A., editor. | Roizen, Michael F., editor. | Roizen,
Jeffrey D., editor.
Title: Essence of anesthesia practice / [edited by] Lee A. Fleisher, Michael
F. Roizen, Jeffrey D. Roizen.
Description: Fourth edition. | Philadelphia, Pennsylvania :
Elsevier/Saunders
[2018] | Includes bibliographical references and index.
Identifiers: LCCN 2017003040 | ISBN 9780323394970 (pbk. : alk. paper)
Subjects: | MESH: Anesthesia | Anesthetics | Handbooks
Classification: LCC RD81 | NLM WO 231 | DDC 617.9/6--dc23 LC record available at
https://lccn.loc.gov/2017003040
Executive Content Strategist: Dolores Meloni

Senior Content Development Specialist: Rae Robertson
Publishing Services Manager: Julie Eddy
Book Production Specialist: Clay S. Broeker
Design Direction: Patrick Ferguson
Printed in the United States of America

To our patients who deserve the best care given their medical conditions and medications.
To their anesthesiologists, nurse anesthetists, internists, and pediatricians who are looking for
the newest information to ensure that best care.
To our loved ones who supported us in supporting you!
v
Contributors
Daniel Abraham, MD Ahmed Alshaarawi, MS Christophe Aveline, MD

Instructor of Anesthesiology and Critical Care Faculty Instructor and Registered Nurse Anesthetist Anesthesiologist
Medicine Anesthesiology and Perioperative Medicine Department of Anesthesia and Surgical Intensive Care
Johns Hopkins University School of Medicine Nurse Anesthesia Program Centre Hospitalier Privé Sévigné
Baltimore, Maryland Oregon Health and Science University Cesson Sévigné, France
Polymyositis Portland, Oregon Carbamazepine-Oxcarbazepine
Foreign Body Aspiration
Taiwo Aderibigbe, MD Lambert-Eaton Myasthenic Syndrome Diana Ayubcha, DO, MS
Anesthesiology Resident Instructor
Department of Anesthesiology and Critical Care David Amar, MD Hospital of the University of Pennsylvania
Hospital of the University of Pennsylvania Director of Thoracic Anesthesia Philadelphia, Pennsylvania
Philadelphia, Pennsylvania Program Director, Thoracic Anesthesia Fellowship Myoclonic Epilepsy With Ragged Red Fibers
Liddle Syndrome Memorial Sloan Kettering Cancer Center Valproate
Charles Ahere, MD Weill Cornell Medical College
New York, New York
Muhammad Azam, MBBS, MD,
Assistant Professor
Paroxysmal Atrial Tachycardia FRCS (Eng)
University of Mississippi Medical Center Associate Professor
Jackson, Mississippi Department of Anesthesiology
Sleep Apnea, Obstructive Corey Amlong, MD, MS University of Colorado
Assistant Professor Aurora, Colorado
Aliya Ahmed, FFARCSI, MHPE Department of Anesthesiology
University of Wisconsin School of Medicine and
Multisystem Organ Failure, Lung Dysfunction in
Professor
Public Health
Department of Anaesthesiology
Madison, Wisconsin Catherine R. Bachman, MD
Aga Khan University Assistant Professor
Karachi, Pakistan Alpha2 Adrenergic Agonists
Department of Anesthesia and Critical Care
Hormone Replacement Therapy University of Chicago
Zirka H. Anastasian, MD Chicago, Illinois
Zulfiqar Ahmed, MD, FAAP Assistant Professor of Anesthesiology
Columbia University Medical School
Rett Syndrome
Director of Pediatric Anesthesia and CME
New York, New York
Anesthesia Associates of Ann Arbor Andrew D. Badley, MD
CONTRIBUTORS
Cerebrovascular Transient Ischemic Attack
Ann Arbor, Michigan Professor of Infectious Diseases
Clinical Assistant Professor Mayo Clinic and Foundation
Wayne State University T. Anthony Anderson, MD, PhD Rochester, Minnesota
Detroit, Michigan Assistant Professor of Anesthesia Cytomegalovirus Infection
Goldenhar Syndrome Harvard Medical School
Assistant Anesthetist, Department of Anesthesia,
Daniel Bainbridge, MD, FRCPC
Antony Aho, MBChB, FANZCA Critical Care and Pain Medicine
Massachusetts General Hospital Associate Professor
Consultant Anaesthetist Department of Anesthesiology and Perioperative
Boston, Massachusetts
Department of Anaesthesia Medicine
Asthma, Acute
Waikato Hospital Western University
Brain Death
Hamilton, New Zealand London, Canada
Dabigatran Patent Foramen Ovale
Solomon Aronson, MD, MBA,
Shamsuddin Akhtar, MD FACC, FCCP, FAHA, FASE Emily Baird, MD, PhD
Associate Professor, Anesthesiology and Pharmacology Professor Assistant Professor
Department of Anesthesiology Duke University School of Medicine Department of Anesthsiology and Perioperative
Yale University School of Medicine Executive Vice Chair, Department of Anesthesiology Medicine
New Haven, Connecticut Duke University Health System Oregon Health and Science University
Diabetic Ketoacidosis Vice Chair and Director of Business Development Portland, Oregon
Fat Embolism Duke Private Diagnostic Clinic Eclampsia
Board of Managers
Duke Connective Care
David B. Albert, MD Durham, North Carolina Sohail Bampoe, MBBS, BSc,
Administrative Vice Chair and Director
Outpatient Anesthesia
Myxoma AICSM, FRCA
Consultant in Anaesthesia and Perioperative Medicine
Department of Anesthesiology
New York University Hospital for Joint Diseases Lance C. Atchley, MD University College London Hospitals NHS
Resident Foundation Trust
Clinical Associate Professor of Anesthesiology
Department of Anesthesiology and Critical Care London, United Kingdom
Hospital of the University of Pennsylvania Thalassemia
New York University
New York, New York Philadelphia, Pennsylvania
Osteoporosis Juvenile Gaucher Disease (Type III/Subacute Oliver Bandschapp, MD
Neuronopathic) Privatdozent of Anesthesiology and Intensive Care
Medicine
Navid Alem, MD
Assistant Clinical Professor John G. Augoustides, MD Department of Anesthesia, Surgical Intensive Care,
Assistant Professor of Anesthesiology and Critical Prehospital Emergency Medicine and Pain Therapy
Department of Anesthesiology and Perioperative Care
Care University of Basel
University of California Irvine School of Medicine
Hospital of the University of Pennsylvania Basel, Switzerland
Irvine, California
Philadelphia, Pennsylvania Fasmilial Periodic Paralysis
Cocaine
Sildenafil Citrate
vii
Contributors
Shawn Banks, MD G. Richard Benzinger, MD, PhD Stephanie Black, MD, EdM
Associate Professor of Anesthesiology Associate Professor Assistant Professor
University of Miami Miller School of Medicine Department of Anesthesiology Department of Anesthesiology and Critical Care
Miami, Florida Washington University School of Medicine Medicine
Burn Injury, Chemical St. Louis, Missouri Perelman School of Medicine at the University of
Burn Injury, Flame Intraoperative Recall Pennsylvania
Paul G. Barash, MD Bryce C. Bernard, MD Philadelphia, Pennsylvania
Down Syndrome
Professor Resident, Anesthesiology
Duchenne Muscular Dystrophy (Pseudohypertrophic
Department of Anesthesiology University of Pittsburgh Medical Center
Muscular Dystrophy)
Yale University School of Medicine Pittsburgh, Pennsylvania
New Haven, Connecticut Hypokalemia
Aortic Regurgitation Mary A. Blanchette, MD
Gianluca Bertolizio, MD Medical Director of Multnomah Pavilion Ambulatory
Kathleen E. Barrett, MD Assistant Professor and Anesthesiologist Anesthesia
Assistant Professor
Assistant Professor of Anesthesiology Department of Anesthesia
Department of Anesthesiology and Perioperative
Department of Anesthesiology Montreal Children’s Hospital
Medicine
University of Florida McGill University
Oregon Health and Sciences University
Gainesville, Florida Montreal, Canada
Portland, Oregon
Ulcerative Colitis, Chronic Hypoplastic Left Heart Syndrome
Multiple Endocrine Neoplasia Type 1 and 2
Mark J. Baskerville, MD, JD, MBA Sumita Bhambhani, MD Yiliam F. Rodriguez Blanco, MD
Assistant Professor Assistant Professor
Associate Professor of Clinical Anesthesiology
Department of Anesthesiology and Perioperative Department of Anesthesiology
Chief of Cardiothoracic Anesthesia and Director of
Medicine Temple University Hospital
Clinical Research
Oregon Health and Science University Philadelphia, Pennsylvania
Department of Anesthesiology, Perioperative Medicine,
Portland, Oregon Epidermolysis Bullosa
and Pain Management
Cardiac Tamponade
Division of CVT Anesthesia
Shobana Bharadwaj, MBBS University of Miami Miller School of Medicine
Burton D. Beakley, MD Assistant Professor Miami, Florida
Anesthesiologist Department of Anesthesiology Bronchiolitis Obliterans Syndrome
CONTRIBUTORS
Department of Anesthesiology University of Maryland School of Medicine

Tulane University Baltimore, Maryland
New Orleans, Louisiana Preeclampsia Krishna Boddu, MBBS, MD, DNB,
Dandelion FANZCA
Associate Professor
Dehydroepiandrosterone
Drug Abuse, Lysergic Acid Diethylamide
Anuj Bhatia, MBBS, MD, FRCA, Department of Anesthesiology
Hyponatremia FFPMRCA, FRCPC (Anesthesia and Director, Acute Pain Medicine
Tissue Plasminogen Activator Pain Medicine), FIPP, EDRA, CIPS University of Texas Medical School at Houston
Assistant Professor Memorial Hermann Hospital
Department of Anesthesiology and Pain Management Houston, Texas
Shawn T. Beaman, MD University Health Network, Women’s College Pyridostigmine Bromide
Associate Professor Hospital, and Mount Sinai Hospital
University of Pittsburgh
University of Toronto Richard Boortz-Marx, MD, MS
Toronto, Canada Associate Professor
Pittsburgh, Pennsylvania Osteoarthritis Department of Anesthesia and Pain Medicine
Hypokalemia
Director of Pain Medicine
W. Scott Beattie, MD, PhD Frederic T. Billings IV, MD, MSc University of North Carolina
Assistant Professor of Anesthesiology and Medicine Chapel Hill, North Carolina
R. Fraser Elliot Chair in Cardiac Anesthesia Spasmodic Torticollis
Vanderbilt University Medical Center
Department of Anesthesia and Pain Medicine Nashville, Tennessee
University Health Network
Professor
Statins Greg Bordelon, MD
Department of Anesthesia Assistant Professor of Clinical Anesthesia
University of Toronto Barkha Bindu, MD, DNB Louisiana State University Health Science Center
Toronto, Canada Department of Neuroanaesthesia and Critical Care New Orleans, Louisiana
Calcium-Channel Blockers Neurosciences Centre Multiple Myeloma
All India Institute of Medical Sciences
Victoria M. Bedell, MD, PhD New Delhi, India Cecil O. Borel, MD
Transverse Myelitis Professor
Anesthesiology Resident
Department of Clinical Anesthesiology and Critical Department of Anesthesiology
Care David J. Birnbach, MD, MPH Associate Professor
Hospital of the University of Pennsylvania Miller Professor and Vice Provost Department of Surgery (Neurosurgery)
Philadelphia, Pennsylvania Senior Associate Dean for Quality, Safety and Risk Duke University
Rheumatic Fever (Acute) and Rheumatic Heart Disease Director, University of Miami–Jackson Memorial Durham, North Carolina
Hospital Center for Patient Safety Myasthenia Gravis
Miller School of Medicine
Erez Ben-Menachem, MBCHB,
FANZCA, FCICM
University of Miami Gregory H. Botz, MD, FCCM
Miami, Florida Distinguished Teaching Professor
Anesthesiologist HELLP Syndrome Professor of Anesthesiology and Critical Care
Department of Anesthesia
University of Texas MD Anderson Cancer Center
St. Vincent’s Hospital
Houston, Texas
St. Vincent’s Clinical School
Cardiomyopathy, Alcoholic
University of New South Wales
Sydney, Australia
viii Systemic Lupus Erythematosus
Contributors
Andrew Bowdle, MD, PhD Jessica L. Brodt, MBBS John F. Butterworth, MD

Professor of Anesthesiology and Pharmaceutics Clinical Assistant Professor Professor and Chairman
Department of Anesthesiology Department of Anesthesiology Department of Anesthesiology
University of Washington Division of Cardiac Anesthesia Virginia Commonwealth University School of
Seattle, Washington Stanford University Medicine
Hypertriglyceridemia Palo Alto, California Richmond, Virginia
Mitral Valve Prolapse Hypothyroidism
Jason C. Brainard, MD
Assistant Professor and Anesthesia and Critical Care Todd A. Bromberg, MD Kelly Byrne, MBChB, FANZCA
Department of Anesthesiology Pain Management Fellow Consultant Anaesthetist
University of Colorado School of Medicine Department of Anesthesiology Department of Anaesthesia
Aurora, Colorado University of North Carolina Waikato Hospital
Acute Respiratory Distress Syndrome Chapel Hill, North Carolina Hamilton, New Zealand
Spasmodic Torticollis Dabigatran
Jess Brallier, MD
Assistant Professor Daniel R. Brown, MD, PhD Jacqueline Cade, MBBS, BMed-
Department of Anesthesiology Professor of Anesthesiology Sc, FANZCA
Icahn School of Medicine at Mount Sinai College of Medicine, Mayo Clinic Consultant Anesthesiologist
New York, New York Rochester, Minnesota Royal Melbourne Hospital
Parkinson Disease (Paralysis Agitans) Endocarditis Melbourne, Australia
Lysosomal Storage Disorders
Michelle Braunfeld, MD Robert H. Brown, MD, MPH
Professor and Vice Chair Professor Andrew J.D. Cameron, MBChB,
Department of Anesthesiology and Perioperative
Medicine
The Johns Hopkins School of Medicine
Departments of Anesthesiology and Critical Care
FANZCA
Specialist Anaesthetist
David Geffen School of Medicine at University of Medicine; Medicine, Division of Pulmonary Department of Anaesthesia and Pain Medicine
California Los Angeles Medicine; and Radiology Middlemore Hospital
Chief, Department of Anesthesiology The Johns Hopkins School of Medicine Auckland, New Zealand
Greater Los Angeles Veterans Hospital The Johns Hopkins Bloomberg School of Public Obsessive-Compulsive Disorder
Los Angeles, California Health Department of Environmental Health and
Diarrhea, Acute and Chronic Engineering
Drug Overdose, Rat Poison (Warfarin Toxicity) The Johns Hopkins Medical Institutions Caroline M. Cardy, BSc, BM, BCh,
CONTRIBUTORS
Baltimore, Maryland DPhil, MRCP
Peter H. Breen, MD, FRCPC Latex Allergy Consultant Rheumatologist
Associate Professor (Tenured) Worcestershire Acute Hospitals NHS Trust
Past Chairman Claude Brunson, MD Worchester, United Kingdom
Department of Anesthesiology Assistant Professor Takayasu Disease
School of Medicine Department of Anesthesiology
University of California, Irvine University of Mississippi School of Medicine Martin J. Carney, BS
Attending Anesthesiologist Jackson, Mississippi Senior Medical Student
UCI Medical Center Sleep Apnea, Obstructive Tulane University School of Medicine
Orange, California New Orleans, Louisiana
Carbon Monoxide Poisoning
Cyanide Poisoning
Trent Bryson, MD Bipolar Disorder
Assistant Professor
Department of Anesthesiology and Pain Management Michael Carrigan, MD
Marjorie Brennan, MD University of Texas Southwestern Resident
Assistant Professor of Anesthesiology and Pediatrics Dallas, Texas Department of Anesthesiology and Perioperative
George Washington University School of Medicine Blebs and Bullae Medicine
and Health Sciences Oregon Health and Science University
Division of Anesthesiology, Sedation, and Perioperative
Medicine
Marek Brzezinski, MD, PhD Portland, Oregon
Professor Cogan Syndrome
Children’s National Health System Department of Anesthesia and Perioperative Care
Washington, District of Columbia
Carnitine Deficiency
University of California San Francisco School of Juan P. Cata, MD
Medicine Assistant Professor
San Francisco, California Department of Anesthesiology and Perioperative
Megan A. Brockel, MD Atrial Flutter Medicine
Assistant Professor of Anesthesiology University of Texas MD Anderson Cancer Center
University of Colorado School of Medicine
Pediatric Anesthesiologist
Donal J. Buggy, MD, FRCPI, FCAI, Founder and Chair
Anesthesiology and Surgical Oncology Research
Children’s Hospital Colorado FRCA Group (ASORG)
Aurora, Colorado Full Professor of Anaesthesia Houston, Texas
Mucopolysaccharidoses Mater Misericordiae University Hospital Chemotherapeutic Agents
University College
Dublin, Ireland
Melissa Brockerville, MD, FRCPC Lymphomas Davide Cattano, MD, PhD, DABA
Clinical Fellow Associate Professor
Department of Anesthesia and Pain Medicine Department of Anesthesiology
University of Toronto Kristen Burton, MD The McGovern Medical School
Toronto Western Hospital Anesthesia Resident University of Texas Health Science Center
Toronto, Canada Department of Anesthesiology and Critical Care Houston, Texas
Seizures, Absence (Petit Mal) Hospital of the University of Pennsylvania Angiotensin II Receptor Blocking Drugs
Philadelphia, Pennsylvania Phencyclidine
Ludwig Angina
ix
Contributors
Charles B. Cauldwell, PhD, MD Marc Chikhani, BMedSci, BMBS, Benjamin T. Cobb, MD

Volunteer Clinical Professor FRCA, FFICM Clinical Instructor
Department of Anesthesiology and Pain Medicine Clinical Assistant Professor Department of Anesthesiology and Critical Care
University of California Davis Department of Anaesthesia and Critical Care Perelman School of Medicine at the University of
Sacramento, California School of Medicine, University of Nottingham Pennsylvania
Pierre Robin Sequence Nottingham, United Kingdom Resident Physician
Hyperaldosteronism, Primary Department of Anesthesiology and Critical Care
John N. Cefalu, MD, MS Hyperaldosteronism, Secondary Hospital of the University of Pennsylvania
Intern
Proton Pump Inhibitors
Department of Anesthesiology Rishi Chokshi, MD Uterine Rupture
Louisiana State University Resident
New Orleans, Louisiana Department of Anesthesiology and Critical Care
Red Yeast Rice (Cholestin) Hospital of the University of Pennsylvania Neal H. Cohen, MD, MPH, MS
Philadelphia, Pennsylvania Professor of Anesthesia and Perioperative Care and
Maurizio Cereda, MD Hereditary Hemorrhagic Telangiectasia (Osler-Weber- Medicine
Vice Dean
Assistant Professor Rendu Disease)
University of California San Francisco School of
Department of Anesthesiology and Critical Care
Medicine
Perelman School of Medicine at the University of Sau Yee Chow, MBBS, MMed San Francisco, California
Pennsylvania
(Anaes) Pneumocystis jirovecii Pneumonia
Senior Resident
Acute Respiratory Distress Syndrome Singhealth Anaesthesiology Residency Program
Singapore, Singapore Robert I. Cohen, MD, Med
Thomas M. Chalifoux, MD Mitochondrial Disorders
Assistant Professor of Anesthesia
Harvard Medical School
Acute Pain and Regional Anesthesia
Children’s Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Lester C. Chua, MD Department of Anesthesia, Critical Care and Pain
Attending Anesthesiologist Medicine
Coarctation of the Aorta Department of Anesthesiology Beth Israel Deaconess Medical Center
UMMS-Baystate Boston, Massachusetts
Debbie A. Chandler, MD Springfield, Massachusetts Benzodiazepines
Assistant Professor Preeclampsia Conversion Disorder (Functional Neurologic Symptom
Louisiana State University Health Science Center Disorder)
CONTRIBUTORS
Shreveport, Louisiana
Tranexamic Acid
Christopher Ciarallo, MD
Department of Anesthesiology Michelle R. Cole, MB, ChB
Denver Health Medical Center Anaesthetic Registrar
Vikas Chauhan, MBBS, MD Pediatric Anesthesiology University College London Hospitals
Senior Resident The Children’s Hospital London, United Kingdom
Department of Neuroanaesthesiology and Critical Assistant Professor P2Y12 Receptor Blockers
Care Department of Anesthesiology Thalassemia
All India Institute of Medical Sciences University of Colorado
New Delhi, India Denver, Colorado
Nelson Syndrome Cromolyn Sodium Sheela Pai Cole, MD
Clinical Associate Professor
Anesthesiology and Perioperative and Pain Medicine
Theodore G. Cheek, MD Sophia T. Cisler, MD, MSEd Stanford University
Associate Professor Resident Physician Stanford, California
Departments of Anesthesia and Obstetrics and Hospital of the University of Pennsylvania Atrial Fibrillation
Gynecology Philadelphia, Pennsylvania Transfusion-Related Acute Lung Injury
Director of Obstetric Anesthesia Deep Vein Thrombosis Ventricular Fibrillation
Hospital of the University of Pennsylvania
Pennsylvania, Philadelphia
St. John’s Wort (Hypercium perforatum)
Franklyn P. Cladis, MD, FAAP Aisling Conran, MD
Associate Professor of Anesthesiology Director of Office Based Anesthesia
The Children’s Hospital of Pittsburgh of UPMC West Central Anesthesia
Shane V. Cherry, MD University of Pittsburgh School of Medicine Staff Anesthesiologist
Resident Physician Pittsburgh, Pennsylvania Central Dupage Hospital
Department of Anesthesiology, Perioperative Medicine Craniosynostosis Winfield, Illinois
and Pain Management Hirschsprung Disease Tacrolimus (FK-506)
Jackson Memorial Hospital
University of Miami Miller School of Medicine
Miami, Florida
Anthony J. Clapcich, MD Daniel Cormican, MD
Associate Clinical Professor Staff Anesthesiologist and Intensivist
Encephalopathy, Hypertensive Department of Anesthesiology Cardiothoracic Anesthesiology and Critical Care
Columbia University Medicine
Albert T. Cheung, MD Director, Pediatric Cardiothoracic Anesthesia Department of Anesthesiology
Professor Director, Difficult Airway Simulation Program Allegheny Health Network
Department of Anesthesiology Children’s Hospital of New York-Presbyterian Pittsburgh, Pennsylvania
Stanford University School of Medicine New York, New York Hypokalemia
Stanford, California Double Aortic Arch
Mitral Stenosis
Elyse M. Cornett, BS
Mitral Valve Prolapse
Syndrome of Inappropriate Antidiuretic Hormone
Richard C. Clarke, MD Clinical Research Coordinator, Anesthesiology
Assistant Professor of Clinical Anesthesiology Louisiana State University Health Sciences Center
Department of Anesthesiology Shreveport, Louisiana
Louisiana State University School of Medicine Amyotrophic Lateral Sclerosis
New Orleans, Louisiana S-Adenosyl-L-Methionine
Hypopituitarism Tranexamic Acid
x
Contributors
Vincent S. Cowell, MD D’andra J. Davis, MD Onur Demirci, MD

Associate Professor, Anesthesiology Assistant Professor Assistant Professor of Anesthesiology
Temple University Health System Department of Anesthesiology Department of Anesthesiology and Perioperative
Philadelphia, Pennsylvania Louisiana State University School of Medicine Medicine
Cancer, Breast New Orleans, Louisiana Mayo Clinic
Hemophilia Tetracyclines Rochester, Minnesota
Aspiration, Perioperative
Paula A. Craigo, MD Jeffrey D. Davis, MD Sarcoma
Consultant, Anesthesiology and Perioperative Resident Physician
Medicine Department of Anesthesiology and Critical Care Ranjit Deshpande, MBBS
Mayo Clinic Medicine Assistant Professor of Anesthesiology
Rochester, Minnesota Oregon Health and Science University Director of Transplant Anesthesiology
Aspiration, Perioperative Portland, Oregon Yale School of Medicine
Pulmonary Hypertension Yale New Haven Hospital
Efrain I. Cubillo, MD New Haven, Connecticut
Pain Medicine Fellow Peter J. Davis, MD Carcinoid Syndrome
Diabetes, Type II (Noninsulin-Dependent)
Department of Anesthesia and Pain Dr. Joseph H. Marcy Endowed Chair in Pediatric
Beth Israel Deaconess Medical Center Anesthesia
Boston, Massachusetts Professor of Anesthesia and Pediatrics Dawn P. Desiderio, MD
Herniated Nucleus Pulposus University of Pittsburgh School of Medicine Vice Chair
Anesthesiologist-in Chief Department of Anesthesiology and Critical Care
Christopher J. Cullom, MD Children’s Hospital of Pittsburgh of UPMC
Medicine
Memorial Sloan Kettering Cancer Center
Resident Physician
Tulane University Wilms Tumor New York, New York
Department of Anesthesia Cancer, Esophageal
New Orleans, Louisiana Sara K. Davis, CRNA
Alagille Syndrome Instructor Tricia Desvarieux, MD
Antipsychotics Anesthesiology and Perioperative Medicine Assistant Professor of Anesthesiology and Critical
Blue Cohosh (Caulophyllum thalictroides) Oregon Health and Sciences University Care
Bulimia Nervosa Portland, Oregon Department of Anesthesiology
Cranberry Wolff-Parkinson-White Syndrome George Washington University School of Medicine
Ehlers-Danlos Syndrome and Health Sciences
CONTRIBUTORS
Gout
Schizophrenia
Bracken J. De Witt, MD, PhD Washington, District of Columbia
Chagas Disease
Assistant Professor
Wegener Granulomatosis (Granulomatosis With Department of Anesthesia
Polyangiitis) Louisiana State University Health Sciences Center Sarah Deverman, MD
New Orleans, Louisiana Assistant Professor, Pediatric Anesthesiology
Craig E. Cummings, MD Ephedra (Ma-Huang) Department of Anesthesiology and Perioperative
Assistant Professor of Anesthesiology Medicine
Medical College of Wisconsin
Clement J. Zablocki Veterans Affairs Medical Center
Stacie Deiner, MS, MD Oregon Health and Sciences University
Portland, Oregon
Associate Professor of Anesthesia, Neurosurgery,
Milwaukee, Wisconsin Tetralogy of Fallot
Geriatrics and Palliative Care
Familial Dysautonomia (Riley-Day Syndrome) Icahn School of Medicine at Mount Sinai
New York, New York Pascale Dewachter, MD, PhD
Chris J. Curatolo, MD, MEM Parkinson Disease (Paralysis Agitans) Anesthesiologist
Fellow, Division of Pain Management Service d’Anesthésie-Réanimation
Department of Anesthesiology, Perioperative and Pain
Medicine
Francina Del Pino, MD Groupe Hospitalier de Paris-Seine-Saint-Denis
Assistance Publique-Hôpitaux de Paris and INSERM
Fellow, Pediatric Anesthesiology
The Mount Sinai Hospital UMR-S970, Sorbonne Paris Cité
UPMC Children’s Hospital of Pittsburgh
Icahn School of Medicine at Mount Sinai Paris, France
New York, New York Mastocytosis
Craniosynostosis
Naltrexone
Paul J. Delahoussaye, MD Ketan Dhatariya, MBBS, MSc, MD,

Pikulkaew Dachsangvorn, MD Anesthesiology Resident MS, FRCP
Assistant Professor of Pediatric Anesthesiology Consultant in Diabetes and Endocrinology
Department of Anesthesia
Oregon Health and Science University Elsie Bertram Diabetes Centre
Louisiana State University Health Sciences Center
Portland, Oregon Norfolk and Norwich University Hospitals NHS
New Orleans, Louisiana
Becker Disease Foundation Trust
Myotonia Dystrophica (Myotonic Dystrophy, Steinert
CHARGE Association Norwich, United Kingdom
Disease)
Metformin (Glucophage)
William H. Daily, MD Ellise Delphin, MD Oral Hypoglycemic Agents
Assistant Professor Chair and Professor of Anesthesiology
Department of Anesthesiology Albert Einstein College of Medicine Christian Diez, MD, MBA
University of Texas Health Science Center Associate Professor and Vice Chair of Clinical Affairs
Montefiore Medical Center
Houston, Texas University of Miami Miller School of Medicine
New York, New York
Hypophosphatemia Miami, Florida
Antithrombin III Deficiency
Burn Injury, Electrical
Ahmed M. Darwish, MD Carotid Sinus Syndrome
Associate Professor of Anesthesiology and Surgery Encephalopathy, Hypertensive
Keck School of Medicine
University of Southern California
Los Angeles, California
Lyme Disease
xi
Contributors
M. Veronica Dioverti, MD Thomas J. Ebert, MD, PhD Jonathan P. Eskander, MD, MBA
Instructor in Medicine Professor of Anesthesiology Resident
Department of Infectious Diseases Department of Anesthesiology Department of Anesthesiology
Mayo Clinic Medical College of Wisconsin Tulane/LSU Health
Rochester, Minnesota Clement J. Zablocki Veterans Affairs Medical Center New Orleans, Louisiana
Cytomegalovirus Infection Milwaukee, Wisconsin Gingko biloba
Familial Dysautonomia (Riley-Day Syndrome)
Jeffrey B. Dobyns, DO Nauder Faraday, MD MPH
Assistant Professor of Anesthesiology and Matthias Eikermann, MD, PhD Professor, Anesthesiology/Critical Care Medicine,
Perioperative Medicine Clinical Director Surgery, and Medicine
University of Alabama at Birmingham School of Department of Anesthesia, Critical Care, and Pain Johns Hopkins University School of Medicine
Medicine Medicine Baltimore, Maryland
Birmingham, Alabama Massachusetts General Hospital Thrombocytopenia
Hepatitis, Halothane Boston, Massachusetts
Swallowing Disorders Sarah C. Fausel, BA
Karen B. Domino, MD, MPH Medical Student
Professor and Vice Chair for Clinical Research Seth Eisdorfer, MD School of Medicine
Department of Anesthesiology and Pain Medicine Assistant Professor Oregon Health and Science University
University of Washington School of Medicine Department of Anesthesiology Portland, Oregon
Seattle, Washington University of Colorado School of Medicine Anemia, Hemolytic
Silicosis Section of Pediatric Anesthesiology Central Neurogenic Hyperventilation
Children’s Hospital Colorado
Andra E. Duncan, MD, MS Aurora, Colorado
Gonorrhea
William J. Fawcett, FRCA,
Assistant Professor FFPMRCA
Department of Cardiothoracic Anesthesiology Consultant in Anaesthesia and Pain Medicine
Cleveland Clinic Lerner College of Medicine Karim El Harchaoui, MD, PhD Department of Anaesthetics
Cleveland, Ohio Department of Anesthesiology Royal Surrey County Hospital
Cardiomyopathy, Restrictive Gelre Hospital Apeldoorn Guildford, United Kingdom
Apeldoorn, The Netherlands Honorary Senior Lecturer
Lauren K. Dunn, MD, PhD Spinal Muscular Atrophy University College London
Assistant Professor London, United Kingdom
Amir Elhassan, MD
CONTRIBUTORS
University of Virginia Acetaminophen

Charlottesville, Virginia Assistant Professor
Pituitary Tumors Department of Anesthesiology Michael Feduska, MD
Louisiana State University Health Sciences Center Assistant Professor of Clinical Anesthesiology and
Silvia Duong, BScPhm, PharmD New Orleans, Louisiana
Hepatitis, Alcoholic
Critical Care
Assistant Professor Department of Anesthesiology and Critical Care
Myotonia Dystrophica (Myotonic Dystrophy, Steinert Hospital of the University of Pennsylvania
Jewish General Hospital, Herzl Family Medicine
Disease) Philadelphia, Pennsylvania
Center
Tetracyclines Inhaled Bronchodilators
Department of Family Medicine
McGill University
Montreal, Canada Nabil M. Elkassabany, MD, MSCE James J. Fehr, MD
Bisphosphonates Assistant Professor Professor of Pediatric Anesthesiology and Critical Care
Department of Anesthesiology and Critical Care Washington University School of Medicine
Frank W. Dupont, MD Perelman School of Medicine at the University of
Pennsylvania
St. Louis, Missouri
Assistant Professor of Anesthesia and Critical Care Mucopolysaccharidoses
Department of Anesthesia and Critical Care
Delirium (Postanesthetic)/Dementia
University of Chicago Medicine Jared Feinman, MD
Chicago, Illinois Assistant Professor
Dilated Cardiomyopathy Anila B. Elliott, MD Department of Anesthesiology and Critical Care
Epsilon-Aminocaproic Acid (Amicar) Resident Hospital of the University of Pennsylvania
Department of Anesthesiology and Perioperative Philadelphia, Pennsylvania
L. Jane Easdown, MD, MHPE Medicine
Oregon Health and Science University
Aortic Stenosis
Associate Professor
Portland, Oregon
Heart Disease, Congenital Laura H. Ferguson, MD
Vanderbilt University Medical Center Assistant Clinical Professor
Nashville, Tennessee Department of Anesthesiology
Cerebral Arteriovenous Malformations Matthew B. Ellison, MD University of Pittsburgh Medical Center St. Margaret
Trigeminal Neuralgia (Tic Doloureux) Associate Professor Pittsburgh, Pennsylvania
Department of Anesthesiology Glaucoma, Open-Angle
R. Blaine Easley, MD West Virginia University School of Medicine
Morgantown, West Virginia
Assistant Professor
Rifampin Ana Fernandez-Bustamante, MD,
Medicine
PhD
Associate Professor
Johns Hopkins Hospital Hamdy Elsayed-Awad, MD Department of Anesthesiology
Baltimore, Maryland Associate Professor University of Colorado School of Medicine
Creatinine Department of Anesthesiology Aurora, Colorado
Licorice (Glycyrrhiza glabra) The Ohio State University Hypoxemia
Wexner Medical Center
Columbus, Ohio
Acute Intermittent Porphyria
xii
Contributors
Rohesh J. Fernando, MD Glucose-6-Phosphate Dehydrogenase Deficiency

Goodpasture Syndrome
Alexander Fort, MD
Assistant Professor of Anesthesiology Fellow, Critical Care Medicine
Wake Forest University School of Medicine Hashimoto Thyroiditis Department of Anesthesiology and Critical Care
Winston-Salem, North Carolina Hepatitis, Viral Medicine
Fabry Disease Hereditary Hemorrhagic Telangiectasia (Osler-Weber- Hospital of the University of Pennsylvania
Rendu Disease) Philadelphia, Pennsylvania
Hypertension
Marla B. Ferschl, MD Hypophosphatemia
Noonan Syndrome
Associate Professor of Clinical Anesthesia Juvenile Gaucher Disease (Type III/Subacute
Division of Pediatric Anesthesia Neuronopathic) Patrick J. Forte, MD
Department of Anesthesia and Perioperative Care Klippel-Feil Syndrome Associate Professor
University of California, San Francisco Leukotriene Antagonists Department of Anesthesiology
San Francisco, California Liddle Syndrome University of Pittsburgh
Myelomeningocele Long QT Syndrome Pittsburgh, Pennsylvania
Monoamine Oxidase Inhibitors; Reversible Inhibitors of Ulcerative Colitis, Chronic
John Fiadjoe, MD Monoamine Oxidase
Assistant Professor Myasthenia Gravis Caroline D. Fosnot, DO, MS
Department of Anesthesiology and Critical Care Neuroleptic Malignant Syndrome Assistant Professor
Medicine Nitroglycerin Department of Anesthesiology and Critical Care
Children’s Hospital of Philadelphia Noonan Syndrome Perelman School of Medicine at the University of
Hospital of the University of Pennsylvania Osteoporosis Pennsylvania
Philadelphia, Pennsylvania Paget Disease Philadelphia, Pennsylvania
Craniofacial Clefts Papillomatosis Otitis Media
Phenytoin
Phytosterols
R. Ryan Field, MD Polymyositis Charles Fox III, MD
Assistant Clinical Professor Pompe Disease Professor and Chair
Department of Anesthesiology and Perioperative Care Postoperative Encephalopathy, Metabolic Department of Anesthesiology
University of California Irvine Health Pseudoephedrine Louisiana State University Health
Orange, California Pyridostigmine Bromide University Hospitals
Neurofibromatosis Renal Failure, Chronic Shreveport, Louisiana
Rett Syndrome Amyotrophic Lateral Sclerosis
Aaron M. Fields, MD Reye Syndrome Galactosemia
CONTRIBUTORS
San Antonio, Texas Rheumatoid Arthritis
Pickwickian Syndrome Scleroderma Steven M. Frank, MD
Selective Estrogen Receptor Modulators Associate Professor
Smallpox
Gordon N. Finlayson, BSc, MD, Spasmodic Torticollis
Medicine
FRCP Spinal Cord Injury Johns Hopkins Medical Institutions
Cardiothoracic Anesthesiologist and Intensivist Sildenafil Citrate Baltimore, Maryland
Department of Anesthesiology St. John’s Wort (Hypercium perforatum) Anemia, Megaloblastic
University of British Columbia Stevens-Johnson Syndrome Polycythemia Vera
Vancouver General Hospital Subphrenic Abscess
Vancouver, Canada Supraventricular Tachycardia (Tachyarrhythmias)
Guillain-Barré Syndrome Syndrome X Geoff Frawley, MBBS, FANZCA
Tacrolimus (FK-506) Anaesthetist
Department of Anaesthesia and Pain Management
Gregory W. Fischer, MD Upper Respiratory Infections
Royal Children’s Hospital
Professor and Chairman Urinary Lithiasis
Urticaria, Cold Anaesthesia and Pain Management Research Group
Department of Anesthesiology and Critical Care Murdoch Children’s Research Institute
Medicine Valerian (Valeriana officinalis)
Varicella-Zoster Virus Clinical Associate Professor
Memorial Sloan Kettering Cancer Center Department of Paediatrics
New York, New York Warfarin (Coumadin)
Melbourne University
Ventricular Septal Rupture (Defect), Postmyocardial Melbourne, Australia
Infarction Melinda L. Fleming, MD, FRCPC Crouzon Syndrome
Program Director
Lee A. Fleisher, MD Postgraduate Anesthesiology Residency Program
Julie K. Freed, MD, PhD
Robert D. Dripps Professor and Chair of Assistant Professor
Departments of Anesthesiology and Perioperative Anesthesiologist
Anesthesiology and Critical Care Adult Cardiothoracic
Perelman School of Medicine at the University of Medicine and Pediatrics
Queen’s University Medical College of Wisconsin
Pennsylvania Milwaukee, Wisconsin
Philadelphia, Pennsylvania Kingston, Canada
Tracheoesophageal Fistula (Congenital) Endocardial Cushion Defect (Atrioventricular Canal)
Addison Disease
Angina, Chronic Stable
ACE Inhibitors Ronda R. Flower, MD Lewis Fry, MBBS, BMedSci
Antianxiety Medications Assistant Professor of Clinical Anesthesia (Student)
Aspirin (Acetylsalicyclic Acid) Department of Anesthesiology Medical Student
Autoimmune Diseases, Cold Louisiana State University School of Medicine Monash University
Beckwith-Widemann Syndrome New Orleans, Louisiana Melbourne, Australia
Bernard-Soulier Syndrome Bulimia Nervosa Substance Abuse Disorder (Perioperative)
Carpenter Syndrome (Acrocephalopolysyndactyly Type II)
Chagas Disease
Chromium David N. Flynn, MD, MBA Robert A. Fry, MBChB, FANZCA
Resident of Anesthesiology Consultant Anaesthetist
Creatinine
Department of Anesthesiology Auckland City Hospital
Cromolyn Sodium
University of Pennsylvania Auckland, New Zealand
Dandy-Walker Syndrome
Philadelphia, Pennsylvania Substance Abuse Disorder (Perioperative)
Deep Vein Thrombosis
Friedreich Ataxia Hypoparathyroidism
xiii
Contributors
William R. Furman, MD, MMHC Chris Giordano, MD Taras Grosh, MD

Vice President, Regional Perioperative Service Line Associate Professor of Anesthesiology Pain Medicine Fellow
Dartmouth Hitchcock Medical Center University of Florida Baystate Medical Center
Lebanon, New Hampshire Gainesville, Florida Springfield, Massachusetts
Interim Chair Diuretics Myoclonic Epilepsy With Ragged Red Fibers
Department of Anesthesiology Valproate
Darthmouth Geisel School of Medicine Sharmil S. Gohil, MD
Hanover, New Hampshire
Emphysema
Resident Physician Anurag Gupta, DA, DNB, DESA
Department of Anesthesiology and Critical Care Associate Consultant, Anaesthesiology
Hospital of the University of Pennsylvania VPS Rockland Hospital, Qutub
Elizabeth Mahanna Gabrielli, MD Philadelphia, Pennsylvania New Delhi, India
Clinical Associate Vitamin B12/Folate Deficiency Behçet Disease
Medicine
Perelman School of Medicine at the University of
Hernando Gomez, MD, MPH Arun K. Gupta, MBBS, MD,
Pennsylvania
Assistant Professor of Critical Care Medicine, FIRAPM, FICCM
Emergency Medicine and Clinical and Translational Consultant in Anaesthesia
Philadelphia, Pennsylvania Science Department of Critical Care Medicine Raja Hospital NWSR
Intracranial Hypertension Center for Critical Care Nephrology, Cardiopulmonary Punjab, India
Physiology Laboratory, CRISMA, and the Vascular Scheie Syndrome (Mucopolysaccharidosis Type IS)
Zoe S. Gan, BA Medicine Institute
Medical Student University of Pittsburgh Medical Center
University of North Carolina School of Medicine Pittsburgh, Pennsylvania Kathryn C. Hall, MD
Chapel Hill, North Carolina Necrotizing Fasciitis Instructor of Anesthesiology
Nonsteroidal Anti-Inflammatory Drugs Department of Anesthesiology and Critical Care
Alanna E. Goodman, MD Philadelphia, Pennsylvania
Jonathan Gavrin, MD Anesthesiologist Leukotriene Antagonists
Clinical Professor Providence Medical Center
Department of Anesthesiology and Critical Care Everett, Washington
Hospital of the University of Pennsylvania Do Not Resuscitate Orders Michael A. Hall, MD
Philadelphia, Pennsylvania Instructor of Anesthesiology
Gold (Auranofin, Aurothioglucose, Aurothiomalate) Stephanie R. Goodman, MD Hospital of the University of Pennsylvania
CONTRIBUTORS
Professor of Anesthesiology at CUMC Philadelphia, Pennsylvania

Steven Gayer, MD, MBA Department of Anesthesiology Goodpasture Syndrome
Professor of Anesthesiology and Ophthalmology Columbia University Leukotriene Antagonists
Miller School of Medicine New York, New York Portal Hypertension
University of Miami Pregnancy, Maternal Physiology
Miami, Florida
N. James Halliday, MB, ChB,
Glaucoma, Closed-Angle Ori Gottlieb, MD FCA(I)
Associate Professor Professor of Clinical Anesthesiology
Julie Gayle, MD Department of Anesthesia and Critical Care Associate Departments of Anesthesiology, Perioperative
Assistant Professor Chief Medical Information Officer Medicine and Pain Management
Department of Anesthesiology University of Chicago University of Miami
Louisiana State University School of Medicine Chicago, Illinois Miami, Florida
New Orleans, Louisiana Melatonin (N-Acetyl-5-Methoxytryptamine, Bevitamel, Diaphragmatic Hernia (Congenital)
Hypertension, Uncontrolled With Cardiomyopathy Vitamist, Melatonex)
David Hallsworth, BA Hons

Jeremy M. Geiduschek, MD Veena Graff, MD (Oxon), BM, BCh, FRCA
Clinical Professor Assistant Professor of Anesthesiology and Critical
Consultant Anaesthetist
Department of Anesthesiology and Pain Medicine Care
Oxford University Hospitals NHS Foundation Trust
University of Washington School of Medicine Department of Anesthesiology and Critical Care
Oxford, United Kingdom
Acting Director, Department of Anesthesiology and Perelman School of Medicine at the University of
Von Hippel-Lindau Disease
Pain Medicine Pennsylvania
Director of Cardiovascular Anesthesiology Philadelphia, Pennsylvania
Seattle Children’s Hospital Buprenorphine Travis W. Hammond, DO
Seattle, Washington Raynaud Phenomenon Senior Resident
Mitochondrial Myopathy Department of Anesthesiology
West Virginia University
Nikolaus Gravenstein, MD
Rebecca M. Gerlach, MD, FRCPC Professor of Anesthesiology
Herpes, Type I
Assistant Professor University of Florida College of Medicine
Director, Anesthesia Perioperative Medicine Clinic Gainesville, Florida
Department of Anesthesia and Critical Care Diuretics Karen Hand, MB, BS
University of Chicago Department of Anesthesiology
Chicago, Illinois Oregon Health and Science University
Churg-Strauss Syndrome Karina Gritsenko, MD Portland, Oregon
Program Director, Regional Anesthesia and Acute Pain Anaphylaxis
Medicine Fellowship
Ghaleb A. Ghani, MB BCh Director, Regional Anesthesia and Acute Pain
Associate Professor Medicine Resident Rotations Raafat S. Hannallah, MD, FAAP
Department of Anesthesiology Assistant Professor of Anesthesiology, Family and Professor Emeritus of Anesthesiology and Pediatrics
Emory University Medical School Social Medicine, and Physical Medicine and George Washington University School of Medicine
Atlanta, Georgia Rehabilitation Division of Anesthesiology, Pain and Perioperative
Glomus Jugulare Tumors Albert Einstein College of Medicine Medicine
Montefiore Medical Center Children’s National Health System
New York, New York Washington, District of Columbia
Colchicine Anhidrosis (Congenital Anhidrotic Ectodermal Dysplasia)
xiv
Contributors
C. William Hanson III, MD, FCCM John A. Helmstetter, MD Charles W. Hogue Jr., MD
Professor of Anesthesiology and Critical Care Anesthesia Resident Professor of Anesthesiology and Critical Care
Hospital of the University of Pennsylvania LSU Health Sciences Center Medicine
Philadelphia, Pennsylvania New Orleans, Louisiana Chief
Bronchitis, Chronic Evening Primrose Division of Adult Anesthesia
Hypercalcemia Johns Hopkins University School of Medicine
Charles B. Hantler, MD Lithium Carbonate (Lithobid) Johns Hopkins Hospital
Baltimore, Maryland
Professor
Department of Anesthesiology Adrian Hendrickse, BM, FRCA Chagas Disease
Washington University School of Medicine Associate Professor
St. Louis, Missouri Department of Anesthesiology Natalie F. Holt, MD, MPH
Adrenal Insufficiency, Acute or Secondary University of Colorado Assistant Professor
Aurora, Colorado Department of Anesthesiology
Jonathan G. Hardman, BMedSci Disseminated Intravascular Coagulation Yale School of Medicine
New Haven, Connecticut
(Hons), BM, BS, FANZCA, FRCA,
DM Greg Hertel, MD Staff Anesthesiologist and Medical Director
Ambulatory Procedures Unit
Resident
Professor and Head of Department Veterans Affairs Healthcare System, West Haven
Anaesthesia and Critical Care Campus
University of Pennsylvania
School of Medicine West Haven, Connecticut
University of Nottingham Diabetes Insipidus
Hepatopulmonary Syndrome
Nottingham, United Kingdom
Hyperaldosteronism, Primary
Hyperaldosteronism, Secondary Eric J. Heyer, MD, PhD Jiri Horak, MD
Anesthesiology Resident
Professor Emeritus of Anesthesiology and Neurology
Matthew Hart, MS, CRNA Special Research Scientist
Department of Neurological Surgery University of Pennsylvania
Chief Nurse Anesthetist Philadelphia, Pennsylvania
Columbia University
Department of Anesthesia and Perioperative Medicine Noonan Syndrome
New York, New York
Cerebrovascular Transient Ischemic Attack
Portland, Oregon
Bronchiectasis Lyndsay M. Hoy, MD
James G. Hilliard, MS, CRNA Clinical Instructor
CONTRIBUTORS
Timothy Heinke, MD Instructor, School of Medicine
Department of Anesthesia and Perioperative Medicine Philadelphia, Pennsylvania
Assistant Professor of Anesthesia Neuroleptic Malignant Syndrome
Medical University of South Carolina Selective Estrogen Receptor Modulators
Portland, Oregon
Charleston, South Carolina
Ginseng
Coronary Artery Disease (Left Main and Non–Left
Main Disease) Nathaniel N. Hsu, MD
Roberta Hines, MD Instructor and OB Anesthesia Fellow
Anesthesiology and Critical Care
Erik M. Helander, MBBS Nicholas M. Greene Professor
Department of Anesthesiology Hospital of the University of Pennsylvania
Anesthesiology Resident Philadelphia, Pennsylvania
Yale University School of Medicine
Louisiana State University Health Sciences Center Abruptio Placentae
New Haven, Connecticut
New Orleans, Louisiana Pregnancy, Intra-Abdominal
Lesch-Nyhan Syndrome
Hypermagnesemia
Opitz-Frias Syndrome (The G Syndrome)
Lipidemias
Stephanie Huang, MD
Mark Helfaer, MD Natalia Hnatiuk, MD Resident Physician
Professor of Anesthesiology and Critical Care University of Pennsylvania
Pediatrics and Nursing Philadelphia, Pennsylvania
Medicine
University of Pennsylvania Glucose-6-Phosphate Dehydrogenase Deficiency
American Anesthesiology
Royal Oak, Michigan
Friedreich Ataxia
Subclavian Steal Syndrome Julie L. Huffmyer, MD
Associate Professor of Anesthesiology
Joshua A. Heller, MD Anthony M.-H. Ho, MD, FRCPC, Department of Anesthesiology
Assistant Professor University of Virginia
Icahn School of Medicine at Mount Sinai FCCP Charlottesville, Virginia
Mount Sinai West and Mount Sinai St. Luke’s Professor and Director of Pediatric Anesthesia Cystic Fibrosis
Hospitals Department of Anesthesiology and Perioperative
New York, New York Medicine
Marfan Syndrome Queen’s University Hayden R. Hughes, JD, MD
Kingston, Canada Assistant Professor
Tracheoesophageal Fistula (Congenital) University of Alabama at Birmingham
Lori B. Heller, MD Birmingham, Alabama
Medical Director Anemia, Chronic Disease/Inflammation
Swedish Blood Management Program Rosemary M.G. Hogg, MB, ChB,
Department of Anesthesiology FRCA, MD James W. Ibinson, MD, PhD
Division of Cardiac Anesthesia Consultant Anaesthetist
Assistant Professor
Clinical Instructor Belfast Health and Social Care Trust
Department of Anesthesiology and Clinical and
University of Washington Belfast, Northern Ireland
Translational Science Institute
Seattle, Washington Chondroitin Sulfate
University of Pittsburgh
Pseudoephedrine
Glaucoma, Open-Angle
xv
Contributors
Karen E. Iles, PhD Andrea Johnson, DO Adam M. Kaye, PharmD, FASCP,

Associate Professor Pediatric Anesthesiology Fellow FCPhA
University of Alabama at Birmingham Department of Anesthesiology and Perioperative Clinical Professor of Pharmacy
Birmingham, Alabama Medicine Department of Pharmacy Practice
Folic Acid Oregon Health and Science University Thomas J. Long School of Pharmacy and Health
Portland, Oregon Sciences
Christina Iliadis, DO Apert Syndrome (Acrocephalosyndactyly Type 1 and 2)
DiGeorge Syndrome
University of the Pacific
Resident Physician Stockton, California
Department of Anesthesiology and Critical Care Androstenedione
Hospital of the University of Pennsylvania David Johnson, MD β-Sitosterol
Philadelphia, Pennsylvania Anesthesiology Resident Tranexamic Acid
Papillomatosis Department of Anesthesiology and Critical Care
Urticaria, Cold University of Pennsylvania Alan David Kaye, MD, PhD
Philadelphia, Pennsylvania Professor and Chair
Robert M. Insoft, MD Dandy-Walker Syndrome Department of Anesthesiology
NICU Medical Director Professor
Newborn Medicine Jordan B. Johnson, MD Department of Pharmacology
Brigham and Women’s Hospital Resident in Anesthesiology Louisiana State University Health Sciences Center
Boston, Massachusetts Department of Anesthesiology and Perioperative New Orleans, Louisiana
Necrotizing Enterocolitis Medicine Acidosis, Renal Tubular
Oregon Health and Science University Alagille Syndrome
Amyotrophic Lateral Sclerosis
Michael G. Irwin, MB, ChB, MD, Portland, Oregon
Acquired Immunodeficiency Syndrome Androstenedione
FRCA, FCAI, FANZCA, FHKAM Antipsychotics
Head β-Sitosterol
Department of Anaesthesiology Mark R. Jones, MD Bipolar Disorder
University of Hong Kong Resident Physician Blue Cohosh (Caulophyllum thalictroides)
Chief of Service Department of Anesthesiology, Critical Care, and Pain Bulimia Nervosa
Queen Mary Hospital Medicine Cerebral Palsy
Hong Kong, China Beth Israel Deaconess Medical Center Cranberry
Nonstatin Hypolipidemic Agents Harvard Medical School Dandelion
Boston, Massachusetts Dehydroepiandrosterone
Androstenedione
Unyime S. Ituk, MBBS, FCARCSI
CONTRIBUTORS
Drug Abuse, Lysergic Acid Diethylamide

β-Sitosterol Echinococcosis
Assistant Professor Cerebral Palsy
Department of Anesthesia Ehlers-Danlos Syndrome
Echinococcosis Evening Primrose
University of Iowa Ginger (Zingiber officinale)
Iowa City, Iowa Fish Oil
Glycine Galactosemia
Cardiomyopathy, Peripartum Hyperkalemia Garlic (Allium sativum)
Nutraceuticals Ginger (Zingiber officinale)
Bozena R. Jachna, MD Nutritional Support Gingko biloba
Instructor Glucocorticoids
Harvard Medical School Edmund H. Jooste, MD Glycine
Department of Anesthesia, Critical Care and Associate Professor of Anesthesiology Gout
Perioperative Medicine Clinical Director of Pediatric Cardiac Anesthesiology Headache, Migraine
Beth Israel Deaconess Medical Center Department of Anesthesiology, Pediatric Division Hepatitis, Alcoholic
Boston, Massachusetts Duke University Herpes, Type II
Phenytoin Durham, North Carolina Hypercalcemia
Coarctation of the Aorta Hyperkalemia
Pankaj Jain, MD Hypermagnesemia
Hypernatremia
Cardiothoracic Anesthesiology Fellow Matthew B. Jordan, MD Hypertension, Uncontrolled With Cardiomyopathy
Department of Cardiothoracic Anesthesiology Resident
Cleveland Clinic Hyponatremia
Cleveland, Ohio Hypopituitarism
West Virginia University School of Medicine
Cardiomyopathy, Restrictive Lipidemias
Lithium Carbonate (Lithobid)
Rifampin
Multiple Myeloma
Michael F.M. James, MBChB, PhD, Myotonia Dystrophica (Myotonic Dystrophy, Steinert
FRCA, FCA(SA) Zeev N. Kain, MD, MBA Disease)
Emeritus Professor Professor and Chair Nutraceuticals
Department of Anaesthesia and Perioperative Department of Anesthesiology and Perioperative Care Nutritional Support
Medicine University of California Irvine School of Medicine Red Yeast Rice (Cholestin)
University of Cape Town Irvine, California S-Adenosyl-L-Methionine
Cape Town, South Africa Cocaine Schizophrenia
Thyroid Neoplasms Neurofibromatosis Tetracyclines
Tissue Plasminogen Activator
Adrian P. Jennings, MA, BM, BCh, Meredith Ann Kato, MD Tranexamic Acid
Wegener Granulomatosis (Granulomatosis With
MRCP, FRCA, PGCME Assistant Professor
Polyangiitis)
Consultant Anaesthetist Department of Anesthesiology and Perioperative
The Dudley Group of Hospitals NHS Foundation Medicine
Trust Oregon Health and Science University Jessica Kaye
West Midlands, United Kingdom Portland, Oregon Undergraduate
Takayasu Disease Preterm Infant University of Pacific Pharmacy School
Stockton, California
Androstenedione
xvi
Contributors
Rachel J. Kaye Todd J. Kilbaugh, MD Arthur Kitt, MD, MPH

Undergraduate Assistant Professor of Anesthesiology, Critical Care Assistant Professor of Anesthesiology and Critical
Department of Biochemistry Medicine, and Pediatrics Care
Bowdoin College Department of Anesthesiology and Critical Care Pain Medicine Division
Brunswick, Maine Medicine Hospital of the University of Pennsylvania
Bipolar Disorder The Children’s Hospital of Philadelphia Philadelphia, Pennsylvania
Dehydroepiandrosterone Perelman School of Medicine at the University of Reflex Sympathetic Dystrophy (Complex Regional Pain
Fish Oil Pennsylvania Syndrome)
Galactosemia Philadelphia, Pennsylvania
Glycine
Hyperkalemia
Atrial Septal Defect, Ostium Primum
Kawasaki Disease
Ryan J. Kline, MD
Resident
Lipidemias Department of Anesthesiology
Nutritional Support Shanique Brown Kilgallon, MD Louisiana State University Health Science Center
Assistant Professor New Orleans, Louisiana
A. Murat Kaynar, MD, MPH Anesthesiology and Critical Care Medicine Multiple Myeloma
Associate Professor The Children’s Hospital of Philadelphia
Program Director, Anesthesiology Critical Care
Medicine Fellowship
Apnea of the Newborn
Rebecca Y. Klinger, MD, MS
Assistant Professor
Departments of Critical Care Medicine and Department of Anesthesiology
Anesthesiology
University of Pittsburgh School of Medicine
David Y. Kim, MD Division of Cardiothoracic Anesthesia
Staff Anesthesiologist Duke University
Pittsburgh, Pennsylvania Team Health/Dignity Health System Durham, North Carolina
Necrotizing Fasciitis San Francisco, California Myxoma
Complement Deficiency
Miklos D. Kertai, MD, PhD Joshua Knight, MD
Associate Professor of Anesthesiology with Tenure
Jerry H. Kim, MD Resident Physician
Assistant Professor Department of Anesthesiology
Duke University Medical Center Department of Anesthesiology and Pain Medicine University of Pittsburgh Medical Center
Durham, North Carolina Seattle Children’s Hospital Pittsburgh, Pennsylvania
Congestive Heart Failure Seattle, Washington Atrioventricular and Bifascicular Heart Block
Mitochondrial Myopathy
Mary A. Keyes, MD Paul R. Knight III, MD, PhD
CONTRIBUTORS
Clinical Professor of Anesthesiology
Michael R. King, MD SUNY Distinguished Professor
Instructor Anesthesiology
David Geffen School of Medicine Northwestern University Feinberg School of Medicine State University of New York at Buffalo
University of California Los Angeles Attending Anesthesiologist Buffalo, New York
Los Angeles, California Lurie Children’s Hospital of Chicago IgA Deficiency
Reye Syndrome Chicago, Illinois Immune Suppression
Malignant Hyperthermia and Other Anesthetic-Induced Q Fever
Sabry Khalil, MD Myodystrophies Rocky Mountain Spotted Fever
Staff Neuroanesthesiologist
Ochsner Health System
New Orleans, Louisiana
Jeffrey R. Kirsch, MD W. Andrew Kofke, MD, MBA,
Assistant Professor
Professor and Chair FCCM
Department of Anesthesiology and Perioperative Professor
University of Queensland Medicine Director of Neuroanesthesia
Brisbane, Australia Associate Dean for Clinical and Veterans Affairs Co-Director of Neurocritical Care
Multiple Sclerosis Oregon Health and Science University Departments of Anesthesia and Neurosurgery
Portland, Oregon University of Pennsylvania
Robyna Irshad Khan, FCPS (Anes- Acquired Immunodeficiency Syndrome Philadelphia, Pennsylvania
thesiology), MHSc (Bioethics) Amphetamines Seizures, Epileptic
Associate Professor Bronchiectasis
Cogan Syndrome
Department of Anaesthesiology
Aga Khan University De Morsier Syndrome Antoun Koht, MD
Foreign Body Aspiration Professor
Karachi, Pakistan
Gastrinoma Departments of Anesthesiology, Neurological Surgery,
Hormone Replacement Therapy
Ginseng and Neurology
Histiocytosis Northwestern University Feinberg School of Medicine
Wajid M. Khan, MBBS, FCPS, Lambert-Eaton Myasthenic Syndrome Chicago, Illinois
FCAI, DPMCAI Marijuana Infratentorial Tumors
Anesthesiologi Pericardial Effusion Supratentorial Brain Tumors
Mater Misericordiae University Hospital Thiazolidinediones
University College Vitamin K Deficiency Guy Kositratna, MD
Dublin, Ireland Wolff-Parkinson-White Syndrome Visiting Scholar
Lymphomas Department of Anesthesiology and Critical Care
John Kissko III, BCE, MS, MD University of Pennsylvania
Puneet Khanna, MBBS, MD Assistant Professor of Clinical Anesthesiology and Philadelphia, Pennsylvania
Assistant Professor Critical Care Seizures, Epileptic
Department of Anaesthesiology, Pain Medicine and Attending Anesthesiologist
Critical Care Hospital of the University of Pennsylvania Alf Kozian, MD, PhD
All India Institute of Medical Sciences Philadelphia, Pennsylvania Assistant Professor
New Delhi, India Cephalopelvic Disproportion Department of Anesthesiology and Intensive Care
Sturge-Weber Syndrome Ludwig Angina Medicine
Uterine Rupture Otto-von-Guericke-University Magdeburg
Magdeburg, Germany
Niemann-Pick Disease xvii
Contributors
Benjamin H. Krasne, MD Ryan E. Lauer, MD Laeben Lester, MD

Anesthesiologist Assistant Professor Assistant Professor
University of Miami Department of Anesthesiology Department of Anesthesiology and Critical Care
Miami, Florida Loma Linda University School of Medicine Medicine
Carotid Sinus Syndrome Loma Linda, California Johns Hopkins University School of Medicine
Bronchopulmonary Dysplasia Baltimore, Maryland
Molly Kraus, MD Single (Including Common) Ventricle
Senior Associate Consultant Elizabeth Laverriere, MD, MPH
Department of Anesthesiology and Perioperative Resident Physician Jerrold H. Levy, MD, FAHA, FCCM
Medicine Department of Anesthesiology Professor of Anesthesiology, Associate Professor of
Mayo Clinic University of Pennsylvania Surgery
Phoenix, Arizona Philadelphia, Pennsylvania Duke University School of Medicine
Insulinoma Atrial Septal Defect, Ostium Primum Co-Director, Cardiothoracic ICU
Duke University Hospital
Nathan Kudrick, MD Ronit Lavi, MD Durham, North Carolina
Allergy
Assistant Professor Associate Professor and Director of Resident Research
Anticoagulation, Preoperative
Department of Anesthesiology and Perioperative Care Department of Anesthesia and Perioperative Medicine
University of California Irvine University of Western Ontario
Irvine, California London, Canada Nicholas A. Levy, MBBS, FRCA,
Rheumatoid Arthritis Patent Foramen Ovale FFICM, BSc
Consultant in Anaesthesia and Perioperative Medicine
Madhuri S. Kurdi, MD Chris C. Lee, MD, PhD Department of Anaesthesia and Perioperative
Professor Associate Professor Medicine
Department of Anesthesiology Department of Anesthesiology West Suffolk Hospital
Karnataka Institute of Medical Sciences Washington University Suffolk, England
Hubli, India St. Louis, Missouri Metformin (Glucophage)
Henoch-Schönlein Purpura Scoliosis and Kyphosis Oral Hypoglycemic Agents
Carmen Labrie-Brown, MD H. Thomas Lee, MD, PhD Kristen L. Lienhart, MD

Assistant Professor of Clinical Anesthesiology Professor and Director of Transplantation Anesthesiology Assistant Professor
Louisiana State University Health Sciences Center Department of Anesthesiology Department of Anesthesiology
CONTRIBUTORS
School of Medicine Columbia University Medical Center University of Arkansas for Medical Sciences
New Orleans, Louisiana New York, New York Little Rock, Arkansas
Cerebral Palsy Riley-Day Syndrome (Familial Dysautonomia, Hereditary Diabetes, Type III (Gestational Diabetes Mellitus)
and Sensory Autonomic Neuropathy Type III)
J. Lance LaFleur, MD, MBA Karen S. Lindeman, MD
Department of Anesthesiology Marshall K. Lee, MD Associate Professor
University of Texas Medical School Assistant Professor Department of Anesthesiology/Critical Care Medicine
Houston, Texas Department of Anesthesiology and Perioperative The Johns Hopkins University
Pyridostigmine Bromide Medicine Baltimore, Maryland
Oregon Health and Science University Placenta Previa
Kirk Lalwani, MB, BS, FRCA, MCR Portland, Oregon
Professor of Anesthesiology and Pediatrics Complement Deficiency Regina Linganna, MD
Vice-Chair for Faculty Development Resident Physician
Director, Pediatric Anesthesiology Fellowship Program Susan M. Lee, MD, FRCPC, MAS Department of Anesthesiology and Critical Care
Anesthesiology and Perioperative Medicine (Clinical Research) Hospital of the University of Pennsylvania
Oregon Health and Science University Assistant Adjunct Professor
Portland, Oregon Long QT Syndrome
University of California San Francisco
Anemia, Hemolytic San Francisco, California
Central Neurogenic Hyperventilation Anesthesiologist Ronald S. Litman, DO
Echinacea (American Coneflower, Purple Coneflower, E. Royal Columbian Hospital Professor of Anesthesiology and Pediatrics
Angustifolia, E. Purpurea, E. Pallida) New Westminster, Canada Perelman School of Medicine at the University of
Tetanus Nicotine Replacement Therapies Pennsylvania
William L. Lanier, MD Mark J. Lema, MD, PhD Philadelphia, Pennsylvania
Professor of Anesthesiology Klippel-Feil Syndrome
SUNY Distinguished Service Professor and Chair
Department of Anesthesiology Malignant Hyperthermia and Other Anesthetic-Induced
Mayo Clinic Myodystrophies
Jacobs School of Medicine and Biomedical Sciences
Rochester, Minnesota University at Buffalo
Hyperglycemia Buffalo, New York Geoffrey L. Liu, BA
Alkylating Agents Medical Student
Gregory J. Latham, MD Bleomycin Tulane University School of Medicine
Associate Professor, Anesthesiology and Pain Medicine New Orleans, Louisiana
Director, Pediatric Cardiac Anesthesiology Fellowship Maggie Lesley, MD Hyperparathyroidism
University of Washington Assistant Professor
Seattle Children’s Hospital Department of Anesthesiology and Critical Care
Seattle, Washington Medicine
Transposition of the Great Arteries Johns Hopkins University School of Medicine
Baltimore, Maryland
Jaundice
xviii
Contributors
Henry Liu, MD S. Nini Malayaman, MD Jonathan B. Mark, MD

Clinical Professor of Anesthesiology Assistant Professor of Anesthesiology Professor of Anesthesiology
Department of Anesthesiology and Perioperative Department of Anesthesiology and Perioperative Duke University Medical Center
Medicine Medicine Chief, Anesthesiology Service
Drexel University College of Medicine, Hahnemann Drexel University College of Medicine, Hahnemann Veterans Affairs Medical Center
University Hospital University Hospital Durham, North Carolina
Philadelphia, Pennsylvania Philadelphia, Pennsylvania Cardiomyopathy, Ischemic
Calcium Deficiency/Hypocalcemia Factor V Leiden Mutation
Factor V Leiden Mutation Sinisa Markovic, MD
Fanconi Syndrome
Graves Disease
Gaurav Malhotra, MD Clinical Assistant Professor
Assistant Professor Department of Anesthesiology
Hyperparathyroidism Department of Anesthesiology Jacobs School of Medicine and Biomedical Sciences
Procainamide (Procan, Procanbid, Pronestyl) Perelman School of Medicine at the University of State University of New York at Buffalo
Pennsylvania Attending Anesthesiologist
Renyu Liu, MD, PhD Philadelphia, Pennsylvania Department of Anesthesiology
Associate Professor Appendicitis, Acute Western New York Healthcare System
Department of Anesthesiology and Critical Care Hepatopulmonary Syndrome Buffalo, New York
Perelman School of Medicine at the University of Portal Hypertension Rocky Mountain Spotted Fever
Pennsylvania
Carnitine Kenneth F. Mancuso, MD, MPH David P. Martin, MD, PhD
Assistant Professor Vice-Chair for Safety and Quality
Department of Anesthesiology Associate Professor of Anesthesiology and
Elvedin Luković, MD, PhD Louisiana State University Health Sciences Center Perioperative Medicine
Resident Physician New Orleans, Louisiana Mayo Clinic
Department of Anesthesiology Tissue Plasminogen Activator Rochester, Minnesota
New York-Presbyterian Hospital Poliomyelitis
The Virginia Apgar Research Fellow
Department of Anesthesiology Mark G. Mandabach, MD
Columbia University Medical Center Assistant Professor Courtney G. Masear, MD
New York, New York Department of Anesthesiology and Perioperative Assistant Professor
Riley-Day Syndrome (Familial Dysautonomia, Hereditary Medicine Department of Anesthesiology and Critical Care
and Sensory Autonomic Neuropathy Type III) University of Alabama at Birmingham School of Medicine
Medicine The Johns Hopkins University
CONTRIBUTORS
Birmingham, Alabama Baltimore, Maryland
Philip D. Lumb, MB, BS, MCCM Hepatitis, Halothane Placenta Previa
Keck School of Medicine of the University of Southern
California Dennis T. Mangano, MD, PhD Cory D. Maxwell, MD, FASE
Editor-in-Chief Director and Founder Assistant Professor of Anesthesiology
The Journal of Critical Care McSPI Research Group Durham VA Medical Center
Los Angeles, California San Francisco, California Assistant Professor of Anesthesiology
Lyme Disease Myocardial Ischemia Department of Anesthesiology
Cardiothoracic Division
Astri M.V. Luoma, MBChB, FRCA Luiz Maracaja, MD Duke University
Durham, North Carolina
Consultant Neuroanaesthetist Assistant Professor
Cardiomyopathy, Ischemic
National Hospital for Neurology and Neurosurgery Department of Anesthesiology
University College London Hospitals NHS University of Texas Health Science Center at San
Foundation Trust Antonio Lynne G. Maxwell, MD, FAAP
London, United Kingdom San Antonio, Texas Senior Anesthesiologist
Creutzfeldt-Jakob Disease Mitral Regurgitation Department of Anesthesiology and Critical Care
Pertussis (Whooping Cough) Medicine
Anne M. Lynn, MD The Children’s Hospital of Philadelphia
Professor, Anesthesiology and Pediatrics (Adjunct) Inna Maranets, MD Emeritus Professor, Anesthesiology and Critical Care
Perelman School of Medicine at the University of
University of Washington School of Medicine Assistant Professor
Pennsylvania
Seattle Children’s Hospital Department of Anesthesiology
Seattle, Washington University of Connecticut School of Medicine
Duodenal Atresia
Jeune Syndrome (Asphyxiating Thoracic Dystrophy) Attending Anesthesiologist
St. Francis Hospital and Medical Center
Jonathan G. Ma, MD Hartford, Connecticut C. David Mazer, MD, FRCPC
Resident Eisenmerger Syndrome Professor of Anesthesia and Physiology
Department of Anesthesiology Pyloric Stenosis Department of Anesthesia
Louisiana State University Treacher Collins Syndrome Keenan Research Center in the Li Ka Shing
New Orleans, Louisiana Knowledge Institute of St. Michael’s Hospital
Gingko biloba Piedad Cecilia Echeverry Marín, University of Toronto
Toronto, Canada
Herpes, Type II
Hypernatremia
MD Cilostazol
Hypertension, Uncontrolled With Cardiomyopathy Coordinator of National Committee of Pediatric
Hypopituitarism Anesthesia Niamh A. McAuliffe, MBBCh,
Tetracyclines Colombian Society of Anesthesia FCARCSI, FRCPC
Instituto de Ortopedia Infantil Roosevelt Staff Anesthesiologist
Emily J. MacKay, DO Bogota, Colombia St. Michael’s Hospital
Cardiothoracic Anesthesia Fellow Scimitar Syndrome Lecturer
Department of Anesthesiology and Critical Care University of Toronto
Hospital of the University of Pennsylvania Toronto, Canada
Philadelphia, Pennsylvania Cilostazol
Pneumonia, Community-Acquired
xix
Preface
It has been 6 years since the last edition of Essence of Anesthesia Practice was published and
2 decades since the first edition. The goal of this text was, and continues to be, to provide a
concise summary that allows you to act for your patient with more complete knowledge of the
pathophysiology of both common and rare conditions seen in the perioperative period as well
as the medications used to treat these conditions. We have eliminated the summaries for surgi-
cal procedures in favor of more rare diseases as well as general drugs that patients take on an
outpatient basis.
These summaries are structured in a defined way to enable you to focus on the key facts and
issues as well as the anticipated concerns regarding these conditions and medications in order
that you, the anesthesiologists, can function as perioperative physicians and provide optimal care
of the patient. We have done PubMed and Google searches, selected key references, read the
articles and case reports, and boiled the hours of reading into 10 minutes of summary with all
the key points highlighted. Treatments, including medications for chronic conditions, continue
to evolve, and it is difficult to keep up with the perioperative implications and appropriate pre-
operative evaluation without this effort. We also felt that in previous editions we did not include
as many uncommon conditions as we would like and as you wanted. We therefore enrolled more
than 500 authors, some of whom wrote the original chapters and many of whom are new, and
have either updated the original chapters or added new topics to address these concerns in the
fourth edition of Essence of Anesthesia Practice.
PREFACE
This edition continues to improve and update the material that went before and to add the
most up-to-date topics and new medications. We continue to include a large section on herbal
medications given their popularity and common use by our surgical patients. We believe that the
current format lends itself to quick review and orientation of the practitioner to perioperative
implications at the point of care.
We wish to thank the authors of the previous edition upon which many of the new authors
produced revised chapters. We also thank Dolores Meloni, our Executive Content Strategist at
Elsevier, and Rae Robertson, our Senior Content Development Specialist, for ensuring that our
book received appropriate editing and development as well as providing the relentless support
for this text to be published in a timely manner.
Lee A. Fleisher, MD
Michael F. Roizen, MD
Jeffrey D. Roizen, MD, PhD
xxxi
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of Echo de Paris
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
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you are located before using this eBook.
Title: Echo de Paris
Author: Laurence Housman
Release date: November 2, 2023 [eBook #72010]
Language: English
Original publication: New York: D. Appleton and Company, 1924
Credits: Bob Taylor, Charlene Taylor and the Online Distributed

Proofreading Team at https://www.pgdp.net (This file was
produced from images generously made available by The
Internet Archive)
*** START OF THE PROJECT GUTENBERG EBOOK ECHO DE

PARIS ***
Echo de Paris
Echo de Paris
BY
Laurence Housman
Author of “Angels and Ministers,” “Prunella,”

“An Englishwoman’s Love-Letters,” Etc.
D. Appleton and Company

New York Mcmxxiv
Copyright, 1924, by
D. Appleton and Company
Printed in the United States of America

Foreword
I N a book of political dialogues, published a year ago, I explained

(perhaps unnecessarily) that they were entirely unauthentic—a
personal interpretation, given in dramatic form, of certain minds and
events that had gone to make
history.
But the dialogue which here follows differs from those, in that it
has a solid basis in fact, and that I myself was a participant in the
conversation which, as here recorded, is but a free rendering of what
was then actually said.
And if it would interest any of my readers to know where these
paraphrases of memory stand nearest to fact, they will find them in
those passages dealing with the writings of Carlyle, the Scotsman’s
worship of success, and the theory of the complete life of the artist.
Other references by the way were the bird with the Berkeleyan
philosophy, and the novels of Mr. Benjamin Swift. The rest is my own
development of the main theme, though it may well be that, here and
there, I have remembered better than I know.
The scene, as regards its setting—the outside of a Paris
restaurant—is true to history; and if, toward the end, a touch of
drama has been introduced, the reader will understand that it is more
symbolic than actual. The non-arriving guest, with the unreal name,
did not, on that occasion, even begin to arrive. He was,
nevertheless, a very real element in the tragic situation which I have
tried to depict; and it is likely enough that there were more of his kind
than one knew—that he was generic rather than individual.
My choice of initials to represent those who appear upon the
scene—a convenient device for the better ordering of the printed
page—was not made with any intention to disguise identity where
that could be of interest; but it seemed better manners, in a scene
where only one character really counted, to adopt the unobtrusive
formula, except in speeches where the names occur naturally. The
friendly “R.R.” is dead, and will be easily identified; the rest are still
living. And though, for the most part, they were listeners not
speakers, I have no reason for leaving them out of a scene which,
after nearly twenty-five years, I remember so well.
My original intention was to include this dialogue in my book of
Dethronements; but I was warned by a good authority that if I did so
the interest of my commentators would be largely diverted from the
political theme to the personal; there was also a certain objection to
including in a set of purely imaginary dialogues another which was
so largely founded on fact. I decided, therefore, to let this other
“dethronement” stand alone in its first appearing, as different in kind
from the rest.
But though different, my reason for writing it was precisely the
same. It is, like those others, a record of failure; and failures interest
me more, generally, than success. If I am asked why, my answer is
that they seem to reveal human nature more truly, and, on the whole,
more encouragingly, than anything else in the world. The way a man
faces failure is the best proof of him. What he has done before
matters little, or only in a minor degree, if as the outcome of all, in
the grip of final and irretrievable ruin, he retains the stature of a man.
That places him far more truly than the verdicts of juries, or the
judgment of contemporary society. Sometimes he may prove his
worth more surely by failure than by success, sometimes may only
just manage to hold his ground; but if he is able to do that without
complaint or greedy self-justification, and without speaking bitterly of
those who have compassed his downfall, even so something stands
to his credit, and there is a balance on the right side.
And so, the longer I live, the more do failures attract me, making
me believe not less in human nature, but more. There are financial
vulgarians of our own day whom, in prison, one might find lovable—
and so be brought nearer to the great common heart which, with its
large tolerance for ill-doers in their gambling day of success, has
found them lovable even when they were at their worst. For it is not
only Art which holds up the mirror to Nature, or reflects most
flatteringly the coarsest of its features. The British public flourishes
its mirror, with all the self-satisfaction of a barber displaying his own
handicraft, before characters of a certain type; and a man may follow
a thoroughly vicious career with great success, so long as he does it
in a thoroughly British way. But what a pity that the mirror should
cease from its obsequious civility just when its hero, overwhelmed in
failure and disgrace, becomes so much more worthy of study and
deserving of sympathy than ever before.
And here, I suppose, lies the great difference between the mirror
of Art and the mirror of popular opinion: the mirror of Art is not
broken in a tantrum when the object becomes less acceptable to the
public gaze. But the public is shocked in its sense of decency when it
finds it has been looking at itself under an alias, applauding its own
sorry features in the mask of success. The mask falls away, and
there, instead, are the quite ordinary features of a poor human
criminal, very like all the rest of us, if only it could be known: no
wonder, then, that the mirror gets broken. In the mirror there is no
such break: the interest holds on.
And so, from the non-popular standpoint, I had sufficient reason
for putting on record my last meeting with so conspicuous a failure
as Oscar Wilde. Our previous acquaintance, except by
correspondence, had been very slight. Only once before had I met
him at a friend’s house. He was then at the height of his fame and
success, and I an unknown beginner, still undecided whether to be
book-illustrator or author. But I had recently published a short story,
with illustrations of my own, in the Universal Review; and a few
minutes after our introduction Mr. Wilde turned and, addressing me
for the first time, said: “And when, pray, are we to have another work
from your pen?”
Like most of his remarks, the enquiry was phrased with a certain
decorative solemnity, in excess of what the occasion required; but
the kindness and the courtesy of it were very real, and of course it
pleased and encouraged me. I learned later that a certain descriptive
phrase, “The smoke of their wood-fires lay upon the boughs, soft as
the bloom upon a grape,” had attracted him in my story; he had
quoted it as beautiful, adding that one day he should use it himself,
and, sure enough, in The Picture of Dorian Grey, I came upon it not
long afterwards, slightly altered; and again I was pleased and
complimented; for it meant that he had really liked something in my
story, and had not praised merely to please.
I did not see him again to speak to, until we met in Paris some
seven years later, the year before his death.
Upon his release from prison I had sent him my recently published
book, All-Fellows: seven legends of lower Redemption, hoping that
its title and contents would say something on my behalf, which, in his
particular case, I very much wished to convey. A fortnight later a
courteous and appreciative letter reached me from the south of
France, telling me incidentally that by the same post had come a
copy of A Shropshire Lad, sent with the good wishes of the author,
whom he had never met. “Thus you and your brother,” he wrote,
“have given me a few moments of that rare thing called happiness.”
From that time on I sent him each of my books as they appeared,
and received letters of beautifully ornate criticism; and as I passed
through Paris on my way back from Italy in the autumn of 1899, we
met once more in the company of friends.
My memory of him upon that occasion inclines me to believe that
those are right who maintain that as a personality he was more
considerable than as a writer. The brilliancy of conversation is
doubtfully reproduced in the cold medium of print, and I may have
wholly failed to convey the peculiar and arresting quality of what, by
word of mouth, sounded so well. But the impression left upon me
from that occasion is that Oscar Wilde was incomparably the most
accomplished talker I had ever met. The smooth-flowing utterance,
sedate and self-possessed, oracular in tone, whimsical in substance,
carried on without halt, or hesitation, or change of word, with the
quiet zest of a man perfect at the game, and conscious that, for the
moment at least, he was back at his old form again: this, combined
with the pleasure, infectious to his listeners, of finding himself once
more in a group of friends whose view of his downfall was not the
world’s view, made memorable to others besides myself a reunion
more happily prolonged than this selected portion of it would
indicate.
But what I admired most was the quiet, uncomplaining courage
with which he accepted an ostracism against which, in his lifetime,
there could be no appeal. To a man of his habits and temperament—
conscious that the incentive to produce was gone with the popular
applause which had been its recurrent stimulus—the outlook was
utterly dark: life had already become a tomb. And it is as a
“monologue d’outre tombe” that I recall his conversation that day;
and whether it had any intrinsic value or no, it was at least a
wonderful expression of that gift which he had for charming himself
by charming others.
Among the many things he touched on that day (of which only a
few disjointed sentences now remain to me), one note of enthusiasm
I have always remembered, coming as it did so strangely from him,
with his elaborate and artificial code of values, based mainly not on
the beauty of human character, but on beauty of form—when, with a
sudden warmth of word and tone, he praised Mrs. Gladstone for her
greatness and gentleness of heart: “her beautiful and perfect charity”
I think was the phrase he used, adding: “But then, she was always
like that.”
None of us knew her; but from that day on, the warmth and
humility of his praise left an impression upon my mind, which a
reading of her life only two years ago came to confirm. Perhaps—I
like to think that it was possible—an expression of her “beautiful and
perfect charity” had come to him personally, so making her stand
differently in his eyes from the rest of the world.
Echo de Paris
Echo de Paris
A Study from Life
The echo is from as far back as the year 1899. It is late
September. By the entrance of a café, on a street
opening into the Place de l’Opera, three Englishmen
sit waiting at a small table, relieved for the moment
from the solicitations of the garçon anxious to serve
them their aperitifs. It is all very well for the café to call
itself the “Vieille Rose”: no doubt by gaslight it lives
charmingly up to its name; but seen in the noonday’s
glare, its interior upholsterings are unmistakably
magenta. From the warm sunshade of its awning the
street view is charming; and while one of the trio
watches it benevolently with an accustomed eye, the
other two, encountering Paris for the first time, find in
its brisk movement the attraction of novelty. But it is a
reversion to English habit which makes one of them
presently look at his watch a little anxiously.
l.h. Is he generally so late as this?
r.r. Generally never as early.
l.h. You are sure you said the Café Vieille Rose?
r.r. (with a disarming smile). As well as I could, my dear L.H. I
can’t say it quite like you.
l.h. I don’t pretend to talk French: hearing it spoken absorbs all
my faculties.
r.r. Oh, but you should! They are so charming about it: they
pretend to understand you.
l.h. Well, I did screw up courage to go to a French barber
yesterday.
r.r. Ah! That explains it. I was wondering.
l.h. You might well. When I looked in the glass after he had
finished me I saw myself no longer English, but Parisian.
r.r. (enjoying himself). No, L.H., no! Not Parisian, I assure you!—
Alsatian.
l.h. No longer English was all that mattered: “tout à fait
transformé,” as I managed to say to the man. And he—magnificently:
“Mais oui, Monsieur, c’était bien necessaire!” Is that what you call
French politeness?
r.r. Rather the “amour propre” of the artist, I should say.
l.h. In this nation of artists one gets too much of it.
h.a. There isn’t such a thing as a nation of artists. The French only
appear so because they take a more transparent pride in themselves
than we do. They haven’t yet discovered that modesty is the best
vanity.
r.r. Is that your own, Herbie, or did you get it from Oscar
yesterday?
h.a. No. I didn’t see him. I invented it as I got up this morning,
meaning to let it occur as an impromptu. Now it’s gone.
r.r. Oh, no. Say it again, my dear boy, say it again! We shall all be
charmed: so will he.
l.h. Look; there he is! Who’s with him?
r.r. Davray. I asked Davray to go and bring him, so as to make
sure. You know him, don’t you? You like him?
l.h. A Frenchman who can talk English always goes to my heart.
r.r. Davray is Anglomaniac: he not only talks it, he thinks it: signs
himself “Henry,” like an Englishman, and has read more of your
books than I have.
l.h. One?
r.r. Don’t be bitter, L.H. I read them—in the reviews—regularly.
(While they talk, a fiacre, disentangling itself from the
traffic of the main thoroughfare, draws up at the
newspaper-kiosk on the further side of the street, and
discharges its occupants: one small, alert, and
obviously a Frenchman; the other large and sedate,
moving with a ponderous suavity, which gives him an
air of importance, almost of dignity. But though he has
still a presence, its magnificence has departed.
Threading his way indolently across the traffic, his eye
adventures toward the waiting group. Met by the
studied cordiality of their greetings, his face
brightens.)
r.r. Oscar, L.H. thinks you are late.
o.w. Thought I was going to be late, you mean, my dear Robbie. If
I were, what matter? What are two minutes in three years of
disintegrated lifetime? It is almost three years, is it not, since we
missed seeing each other?
(This studied mention of a tragic lapse of time is not quite
as happy as it would like to be, being too deliberate
an understatement. The tactful “Robbie” hastens to
restore the triviality suitable to the occasion.)
r.r. Oscar, when did you learn to cross streets? I have just seen
you do it for the first time. In London you used to take a cab.
o.w. No, Robbie, the cab used to take me. But here the French
streets are so polite; one gets to the right side of them without
knowing it. (He turns to L.H.) How delightfully English of you to think
that I was going to be late!
l.h. I thought you might have done as I am always doing—gone to
the wrong place, or lost your way.
o.w. But that is impossible! In Paris one can lose one’s time most
delightfully; but one can never lose one’s way.
h.a. With the Eiffel Tower as a guide, you mean?
o.w. Yes. Turn your back to that—you have all Paris before you.
Look at it—Paris vanishes.
r.r. You might write a story about that, Oscar.
o.w. In natural history, Robbie, it has already been done.
Travellers in South America tell of a bird which, if seen by you
unawares, flies to hide itself. But if it has seen you first, then—by
keeping its eye on you—it imagines that it remains invisible, and
nothing will induce it to retreat. The bird-trappers catch it quite easily
merely by advancing backwards. Now that, surely, is true philosophy.
The bird, having once made you the object of its contemplation, has
every right to think (as Bishop Berkeley did, I believe) that you have
no independent existence. You are what you are—the bird says, and
the Bishop says—merely because they have made you a subject of
thought; if they did not think of you, you would not exist. And who
knows?—they may be right. For, try as we may, we cannot get
behind the appearance of things to the reality. And the terrible
reason may be that there is no reality in things apart from their
appearances.
h.d. You English are always talking what you think is philosophy,
when we should only call it theology.
o.w. How typical of the French mind is that word “only”! But what
else, my dear Davray, was the thought of the eighteenth century, so
far as it went, but an attempt to bring Religion and Philosophy
together in the bonds of holy matrimony?
r.r. The misalliance which produced the French Revolution.
o.w. Robbie, you must not be so brilliant before meals! Or do you
wish to divert my appetite? May a guest who was supposed to be
late enquire—when, precisely?
r.r. The situation, my dear Oscar, is of your own making. You
insisted upon ortolans; L.H. telegraphed for them; they have only just
arrived.
o.w. If they are still in their feathers, let them fly again! A flight of
ortolans across Paris: how romantic, how unexplainable!
h.a. Oh, no! Let’s wait for them, please! I want to taste one: I never
have.
o.w. So young, and already so eager for disappointment! Why
give up imagination? “Ortolan,” the word, is far more beautiful than
when it is made flesh. If you were wise you would learn life only by
inexperience. That is what makes it always unexpected and
delightful. Never to realize—that is the true ideal.
l.h. Still, one goes on liking plovers’ eggs after eating them: at
least, I do.
o.w. Ah, yes; an egg is always an adventure: it may be different.
But you are right; there are a few things—like the Nocturnes of
Chopin—which can repeat themselves without repetition. The genius
of the artist preserves them from being ever quite realized. But it has
to be done carelessly.
(There is a pause, while L.H., with due enquiry of each,
orders the aperitifs.)
r.r. Oscar, why did you choose the “Vieille Rose”?
o.w. Will you believe me, Robbie, when I say—to match my
complexion? I have never before seen it by daylight. Is it not a
perfect parable of life, that such depravity by gaslight should become
charming? Will our host allow us to have white wine as a corrective?
An additional red might be dangerous.
(And with the colour-scheme of the approaching meal
made safe, he continues to charm the ears of himself
and of his listeners.)
I chose it also for another and a less selfish reason. It is here I once
met a woman who was as charming as she was unfortunate, or as
she would have been, but for the grace that was in her. To say that
she was entirely without beauty is to put it mildly; but she accepted
that gift of a blind God with so candid a benevolence, and cultivated
it with so delicate an art, that it became a quality of distinction,
almost of charm. She was the belle amie of a friend of mine, whose
pity she had changed to love. He brought me here to meet her,
telling me of the rare reputation she had acquired in this city of
beautiful misalliances, as being a woman of whom nobody could
possibly say that she was merely plain. And here, upon this spot, in
the first few moments of our meeting, she challenged me, in the
most charming manner possible, for that which a woman so rarely
seeks to know—the truth about herself. “Tell me, Monsieur,” she said
—but no: it can only be told in French: “Dites moi, Monsieur, si je ne
suis pas la femme la plus laide à Paris?” And for once in my life I
was able to please a woman merely by telling her the truth; and I
replied, “Mais, Madame, dans tout le monde!”
r.r. A poem, in six words! What did she say?
o.w. What could she say, Robbie? She was delighted. To that
impossible question which she had the courage to ask I had given
the only impossible answer. Upon that we became friends. How
much I have wished since that we could have met again. For the
unbeautiful to have so much grace as to become charming is a
secret that is worth keeping; and one the keeping of which I should
have liked to watch. I would not have asked to know it for myself, for
then it would no more be a mystery; but—merely to see her keeping
it. In Paris (where almost everything is beautiful), they were very
happy together. Now they are gone to America; and in that country,
from which all sense of beauty has flown, perhaps she is no longer
able to keep, as a secret, that which there would be no eyes to
interpret. When I was in America, I did not dare to tell America the
truth; but I saw it clearly even then—that the discovery of America
was the beginning of the death of Art. But not yet; no, not yet!
Whistler left America in order to remain an artist, and Mr. Sargent to
become one, I believe.... But now, tell me of England: who are the
new writers I ought to be reading, but have not?
l.h. Isn’t to be told what you ought to like rather irritating?
o.w. But I did not say “like”; I said “read.” There are many things
one ought to read which one is not bound to like: Byron, Wordsworth
—even Henry James, if Robbie will allow me to say so. But tell me
whom you yourself find interesting. I shall, at least, be interested to
know why. I have already had two books—from you and your brother
—which have interested me.
l.h. Like you, as regards my own, I should be interested to know
why?
o.w. Yours interested me—shall I confess?—partly because a few
years ago it would have interested me so much less. For at that time,
believing that I had discovered—that, in a way, I represented the
symbol of my age, I was only interested in myself. Now, in an age to
which I do not belong, I find myself interested in others. Robbie, who
is the most sincere of flatterers, would have me believe that in this
transfer of interest I am making a poor exchange. I am not sure. Till
recently, absorbed in myself, I might have missed that new strange
writer of things impossible in life, who writes under the name of
Benjamin Swift. Ought I to have done so? His style has the gleam of
a frozen fire. He writes like a sea-pirate driven by contrary winds to a
vain search for tropical forests at the North Pole. Why does he look
at life only in profile, as though, met face to face, it might mean death
to him? Is he as mysterious, as unaccountable to himself, as he
seems to others?
l.h. I don’t know whether the fact that he is a well-to-do Scotsman,
who finished his education at a German university, can be said to
account for him. We have met, and I find him interesting. He reminds
me, somehow, of a lion turned hermit, wearing a hair-shirt, and
roaring into it to frighten out the fleas. In other words, he is full of
contradictions, and revels in them even while they torment him.
o.w. A Scotsman? That explains everything. For a man to be both
a genius and a Scotsman is the very stage for tragedy. He
apparently perceives it. Generally they are unaware of it.
r.r. My dear Oscar, why cannot a Scotsman be a genius as
comfortably as anyone else?
o.w. I ought to have said “artist”: I meant artist. It is much easier
for a Scotsman to be a genius than to be an artist. Mr. Gladstone, I
believe, claimed to be a Scotsman whenever he stood for a Scottish
constituency or spoke to a Scottish audience. The butter-Scotch
flavour of it makes me believe it was true. There was no art in that;
and yet how truly typical! It was always so successful....

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