Essence of Anesthesia Practice e Book 4th Edition Ebook PDF

Essence of Anesthesia Practice E Book
4th Edition, (Ebook PDF)

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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
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
Pittsburgh, Pennsylvania
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
Department of Anesthesiology
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,
Department of Anesthesiology and Critical Care
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
Hospital of the University of Pennsylvania
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
Hospital of the University of Pennsylvania
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
Pediatric Anesthesiologist
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
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
The Children’s Hospital of Philadelphia
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
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
Pediatric Anesthesiologist
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
Contributors
Brenda C. McClain, MD Kevin Miller, MD Roger A. Moore, MD

Professor Resident in Anesthesiology and Critical Care Associate Professor of Clinical Anesthesiology and
Department of Anesthesiology and Critical Care Department of Anesthesiology and Critical Care Critical Care
Saint Louis University Hospital of the University of Pennsylvania Department of Anesthesiology and Critical Care
St. Louis, Missouri Philadelphia, Pennsylvania Perelman School of Medicine at the University of
Cleft Palate Gold (Auranofin, Aurothioglucose, Aurothiomalate) Pennsylvania
Klinton McGhee, MD Wanda C. Miller-Hance, MD Anomalous Pulmonary Venous Drainage
Cancer, Lung Parenchyma
Research Fellow Professor of Anesthesiology and Pediatrics
Rheumatic Fever (Acute) and Rheumatic Heart Disease
Department of Anesthesiology Baylor College of Medicine
The Ohio State University Associate Director of Pediatric Cardiovascular
Wexner Medical Center Anesthesiology Klaus Morales dos Santos, MD
Columbus, Ohio Texas Children’s Hospital Staff Anesthesiologist
Acute Intermittent Porphyria Division of Pediatric Cardiovascular Anesthesiology Hospital e Maternidade Santa Joana
Houston, Texas São Paulo, Brazil
Jason L. McKeown, MD Ebstein Anomaly Cri Du Chat Syndrome (5P– Syndrome)
Osteogenesis Imperfecta
Medical Anesthesia Group, PA
Affiliate Faculty Mohammed M. Minhaj, MD, MBA
University of Tennessee Health Science Center, College Vice-Chair for Finance and Operations Debra E. Morrison, MD, FAAP
of Medicine Associate Chair for Faculty Development Health Sciences Clinical Professor
Memphis, Tennessee Department of Anesthesia and Critical Care University of California, Irvine School of Medicine
Capsaicin University of Chicago Medicine Director, Pediatric and Neonatal Anesthesia
Chicago, Illinois Department of Anesthesiology & Perioperative Care
Thomas M. McLoughlin Jr., MD Amniotic Fluid Embolism Medical Director for Sedation
University of California, Irvine Medical Center
Chair, Department of Anesthesiology
Lehigh Valley Health Network Nanhi Mitter, MD Orange, California
Botulism
Allentown, Pennsylvania, Professor of Surgery, Assistant Professor
Division of Surgical Anesthesiology Department of Anesthesiology and Critical Care
University of South Florida Morsani School of Medicine Claudie Mouton-Faivre, MD
Medicine Johns Hopkins Hospital Service de Dermato-Allergologie & Consultation
Tampa, Florida Baltimore, Maryland d’Allergo-Anesthésie
Coagulopathy, Factor IX Deficiency Chagas Disease Centre Hospitalier Universitaire de Nancy, Hôpital de
CONTRIBUTORS
Von Willebrand Disease Brabois

Alexander J.C. Mittnacht, MD Vandœuvre-lès-Nancy, France
Julie R. McSwain, MD, MPH Professor of Anesthesiology Mastocytosis
Assistant Professor Icahn School of Medicine at Mount Sinai
Department of Anesthesia and Perioperative Medicine Director, Pediatric Cardiac Anesthesia John R. Moyers, MD
Medical University of South Carolina Department of Anesthesiology Professor
Charleston, South Carolina Mount Sinai Medical Center Department of Anesthesia
Charcot-Marie-Tooth Disease New York, New York Carver College of Medicine
Ventricular Septal Defect (Congenital) University of Iowa
Diana Mekler, MD Iowa City, Iowa
Physical Medicine and Rehabilitation, Interventional Pain Raj K. Modak, MD Mesothelioma
Louisiana State University Assistant Professor of Anesthesiology
New Orleans, Louisiana Department of Anesthesiology Jesse J. Muir, MD
Headache, Migraine Yale University School of Medicine Assistant Professor
New Haven, Connecticut Department of Anesthesiology
William T. Merritt, MD, MBA Mitral Regurgitation
Pertussis (Whooping Cough)
Mayo Clinic Hospital
Phoenix, Arizona
Faculty
Insulinoma
Departments of Anesthesiology/Critical Care
Medicine and Surgery Pierre Moine, MD, PhD
Johns Hopkins Hospital Associate Professor Ray Munroe, MD
School of Arts and Sciences Department of Anesthesiology Anesthesiology Resident
Johns Hopkins University University of Colorado Hospital of the University of Pennsylvania
Baltimore, Maryland Aurora, Colorado Philadelphia, Pennsylvania
Jaundice Cryptococcus Infection Carpenter Syndrome (Acrocephalopolysyndactyly Type II)
Diphtheria Smallpox
David G. Metro, MD
Professor of Anesthesiology Vivek K. Moitra, MD, FCCM John M. Murkin, MD, FRCPC
Vice Chair for Education and Faculty Affairs Allen I. Hyman Associate Professor of Critical Care Department of Anesthesiology and Perioperative
University of Pittsburgh School of Medicine Anesthesiology at CUMC Medicine
Residency Program Director Chief, Division of Critical Care Medicine Schulich School of Medicine
UPMC Medical Education College of Physicians and Surgeons of Columbia University of Western Ontario
Pittsburgh, Pennsylvania University London, Canada
Atrioventricular and Bifascicular Heart Block New York, New York Thyroid Supplements
Hepatic Encephalopathy
David W. Miller, MD Sushila Murthy, MD, MPH
Associate Professor Tiffany Sun Moon, MD Instructor of Anesthesiology and Critical Care
Department of Anesthesiology and Perioperative Assistant Professor Department of Anesthesiology and Critical Care
Medicine Director of Resident Research Hospital of the University of Pennsylvania
University of Alabama at Birmingham Department of Anesthesiology and Pain Management Philadelphia, Pennsylvania
Birmingham, Alabama University of Texas Southwestern Medical Center Dipyridamole
Folic Acid Dallas, Texas
xx Methemoglobinemia
Contributors
Paul S. Myles, MB, MPH, MD, Viet Nguyen, MD Sinead Nyhan, MD

FCAI, FANZCA, FRCA, FAHMS Assistant Professor Anesthesiology Resident
Professor and Director of Anaesthesia and Department of Anesthesiology Department of Anesthesiology and Critical Care
Perioperative Medicine Louisiana State University Health Sciences Center Medicine
Alfred Hospital and Monash University School of Medicine Johns Hopkins Medicine
Melbourne, Australia New Orleans, Louisiana Baltimore, Maryland
Alpha1-Antitrypsin Deficiency Lithium Carbonate (Lithobid) Single (Including Common) Ventricle
Nader D. Nader, MD, PhD, FACC, Stavroula Nikolaidis, MD Peter M. Odor, BM, BCh, MA,
FCCP Associate Professor of Anesthesiology FRCA
Department of Anesthesiology Anaesthetic Specialist Registrar
Professor of Anesthesiology and Surgery
Texas A&M University St. George’s University Hospital
Research Professor of Pathology and Anatomical
Baylor Scott and White Healthcare London, United Kingdom
Sciences
Temple, Texas Ventricular Preexcitation Syndrome
State University of New York at Buffalo
Cardiomyopathy, Hypertrophic
Buffalo, New York
Immune Suppression Sheri Jones Oguh, MD
Sara Nikravan, MD Resident
Abhijit S. Nair, MD, FWAMS Assistant Professor
Director of Critical Care Ultrasound
Consultant Anesthesiologist University of Pennsylvania
Cardiac Anesthesiology and Critical Care Medicine Philadelphia, Pennsylvania
Basavatarakam Indo-American Cancer Hospital and
Stanford University Pompe Disease
Research Institute
Stanford, California
Hyderabad, India
Syndrome of Inappropriate Antidiuretic Hormone
Digitalis (Digoxin) Andrew Oken, MD
Associate Professor
Manchula Navaratnam, MBChB, Dolores B. Njoku, MD Department of Anesthesiology
Associate Professor
FRCA Anesthesiology and Critical Care Medicine, Pediatrics
Assistant Chief, Department of Anesthesiology
Clinical Assistant Professor and Pathology Section Chief, Cardiothoracic Anesthesiology
Department of Anesthesiology, Perioperative and Pain Johns Hopkins University Operative Care Division
Medicine Baltimore, Maryland Portland VA Medical Center
Stanford Children’s Hospital Subclavian Steal Syndrome Portland, Oregon
Palo, Alto, California
CONTRIBUTORS
Cardiomyopathy, Dilated
Truncus Arteriosus
Mary J. Njoku, MD Pulmonary Fibrosis, Idiopathic
Associate Professor
Mark T. Nelson, MD, MEd Department of Anesthesiology Onyi Onuoha, MD, MPH
Assistant Professor University of Maryland School of Medicine Assistant Professor of Clinical Anesthesiology
Department of Anesthesiology Baltimore, Maryland Department of Anesthesiology and Critical Care
Virginia Commonwealth University Encephalitis Medicine
Richmond, Virginia
Pulmonary Atresia
Katherine L. Norgaard, MD Pennsylvania
Instructor of Anesthesiology and Critical Care Hospital of the University of Pennsylvania
Edward C. Nemergut, MD Medicine Philadelphia, Pennsylvania
Frederic A. Berry Professor of Anesthesiology Johns Hopkins Medical Institutions Pregnancy-Induced Hypertension
Professor of Neurosurgery Baltimore, Maryland Vitamin B12/Folate Deficiency
Department of Anesthesiology Anemia, Megaloblastic
University of Virginia
Charlottesville, Virginia Nathan G. Orgain, MD
Cystic Fibrosis Fredrick Ntumy, MD Assistant Professor of Anesthesiology
Clinical Anesthesia Resident University of Utah School of Medicine
Pituitary Tumors
Department of Anesthesiology Salt Lake City, Utah
Oakland University William Beaumont School of Cigarette Smoking Cessation
Michael E. Nemergut, MD, PhD Medicine
Assistant Professor
Department of Anesthesiology and Preoperative
Royal Oak, Michigan Pedro Orozco, MD
Hemosiderosis, Pulmonary Clinical Instructor
Medicine
Mayo Clinic
Rochester, Minnesota Danuza Nunn, MS, CCC-SLP University of California Irvine
Speech Language Pathologist Irvine, California
Sickle Cell Disease
Massachusetts General Hospital Rheumatoid Arthritis
Boston, Massachusetts
Bradley K.W. Ng, MD, FRANZCP Swallowing Disorders Andreas M. Ostermeier, MD
Psychiatrist
Physician
Robina Private Hospital
Gold Coast Hospital and Health Service Ijeoma Nwachukwu, MD Clinic for Anesthesiology
Resident Physician University of Munich
Queensland, Australia
Department of Anesthesiology and Critical Care Munich, Germany
Obsessive-Compulsive Disorder
Hospital of the University of Pennsylvania Sleep Apnea, Central and Mixed
Thai T. Nguyen, MD, PhD Antianxiety Medications Ira Padnos, MD
Assistant Professor
Assistant Professor
Medicine Omonele O. Nwokolo, MD Department of Anesthesiology
Assistant Professor Louisiana State University School of Medicine
Johns Hopkins University
Department of Anesthesiology New Orleans, Louisiana
Baltimore, Maryland
University of Texas Lithium Carbonate (Lithobid)
ACE Inhibitors
Houston, Texas
Purpura, Thrombotic Thrombocytopenic
xxi
Contributors
Christopher R. Page, MD Prakash A. Patel, MD Philip Peng, MBBS, FRCPC,

Assistant Professor of Anesthesiology Assistant Professor Founder (Pain Medicine)
Director, Acute Pain Service Department of Anesthesiology and Critical Care Professor
Stony Brook Medical Center Perelman School of Medicine at the University of Department of Anesthesiology and Pain Management
Stony Brook, New York Pennsylvania University Health Network and Mount Sinai Hospital
Nonsteroidal Anti-Inflammatory Drugs Philadelphia, Pennsylvania University of Toronto
Shy-Drager Disease Toronto, Canada
Paul S. Pagel, MD, PhD Osteoarthritis
Staff Physician Saumil J. Patel, MD
Anesthesia Service Housestaff Austin J. Peters, MD
Clement J. Zablocki Veterans Affairs Medical Center Department of Anesthesiology and Critical Care Anesthesiology Resident
Milwaukee, Wisconsin University of Pennsylvania Health System Department of Anesthesiology & Perioperative
Endocardial Cushion Defect (Atrioventricular Canal) Philadelphia, Pennsylvania Medicine
Shy-Drager Disease Oregon Health and Science University
Nirvik Pal, MBBS, MD Portland, Oregon
Assistant Professor Johanna Paterson, MBBS, BSc, Pericardial Effusion
Department of Anesthesiology FRCA, DipIMC
Virginia Commonwealth University Consultant Anaesthetist Charise T. Petrovitch, MD
Richmond, Virginia James Cook University Hospital Clinical Professor
Pulmonary Atresia Middlesborough, United Kingdom Department of Anesthesiology and Critical Care
P2Y12 Receptor Blockers Medicine
Ryan Palacio, MD George Washington University Hospital
Obstetric Anesthesiology Fellow Shilpadevi S. Patil, MD Chief
Anesthesia Section
Department of Anesthesiology and Critical Care Clinical Assistant Professor and Program Director
University of Chicago Department of Anesthesiology VA Medical Center
Chicago, Illinois Louisiana State University Health Sciences Center Washington, District of Columbia
Amniotic Fluid Embolism Shreveport, Louisiana Warfarin (Coumadin)
Tranexamic Acid
Tyler J. Paradis, MD Ethan Phan, MPH
Resident Anesthesiologist Olga Pawelek, MD Medical Student
Louisiana State University School of Medicine
Department of Anesthesiology and Perioperative Clinical Assistant Professor
CONTRIBUTORS
Medicine New Orleans, Louisiana

Oregon Health and Science University Dehydroepiandrosterone
University of Texas Health Science Center
Portland, Oregon Hyponatremia
Houston, Texas
Histiocytosis Purpura, Immune Thrombocytopenic
Dennis Phillips, DO
Megha Parekh, MD Ronald G. Pearl, MD, PhD Clinical Assistant Professor
Resident Physician Anesthesiology and Critical Care Medicine
Dr. Richard K. and Erika N. Richards Professor and
Department of Anesthesia and Perioperative Care University of Pittsburgh
Chair
University of California San Francisco School of Pittsburgh, Pennsylvania
Medicine Atrioventricular and Bifascicular Heart Block
Medicine
San Francisco, California Stanford University School of Medicine
Atrial Flutter Stanford, California Mark C. Phillips, MD
Pulmonary Embolism Assistant Professor
Richard K. Patch III, MD Department of Anesthesiology and Perioperative
Assistant Professor of Anesthesiology and Medicine Alessia Pedoto, MD Medicine
University of Alabama at Birmingham School of
Division of Critical Care Medicine, Department of Associate Attending
Anesthesiology and Perioperative Medicine Medicine
Memorial Sloan Kettering Cancer Center
Division of Pulmonary and Critical Care Medicine, Birmingham, Alabama
Department of Anesthesia and Critical Care Medicine
Department of Medicine Crohn Disease
New York, New York
Mayo Clinic Cancer, Esophageal
Rochester, Minnesota Lauren M. Nakazawa, MD
Renal Failure, Acute
Christine Peeters-Asdourian, MD Regional Anesthesiology and Acute Pain Medicine
Fellow
Director, BIDMC Pain Medicine Fellowship
Alopi Patel, MD Beth Israel Deaconess Medical Center Department of Anesthesiology
Resident Hospital for Special Surgery
Boston, Massachusetts
Department of Anesthesiology, Pain and Perioperative New York, New York
Assistant Professor of Anesthesia
Medicine Stevens-Johnson Syndrome
Icahn School of Medicine Harvard University Medical School
Mount Sinai St. Luke’s and West Hospitals Cambridge, Massachusetts Alexandria Piedmont, MD
New York, New York Herniated Nucleus Pulposus Anesthesiology Resident
Jehovah’s Witness Patient Department of Anesthesiology and Critical Care
Annie Lynn Penaco, MD University of Pennsylvania
Dilipkumar K. Patel, MD Pediatric Anesthesia Fellow Philadelphia, Pennsylvania
Associate Professor Pancreatitis
Lewis Katz School of Medicine at Temple University The Children’s Hospital of Pittsburgh of UPMC
Philadelphia, Pennsylvania Pittsburgh, Pennsylvania Evan G. Pivalizza, MD
Hypercholesterolemia Hirschsprung Disease Distinguished Teaching Professor
Leukemia Department of Anesthesiology
University of Texas Health Science Center
Houston, Texas
Purpura, Immune Thrombocytopenic
Purpura, Thrombotic Thrombocytopenic
xxii
Contributors
Nathan Poiro, MD Bronwyn R. Rae, MD, FANZCA, Norman Randolph, MD

Assistant Professor MPH Assistant Professor of Clinical Anesthesiology and
Department of Anesthesiology Attending Anesthesiologist Critical Care
Temple University Hospital Department of Anesthesiology Department of Anesthesiology and Critical Care
Philadelphia, Pennsylvania Lake Forest Hospital Hospital of the University of Pennsylvania
Leukemia Lake Forest, Illinois Philadelphia, Pennsylvania
Congenital Methemoglobinemia Proton Pump Inhibitors
Jahan Porhomayon, MD, FCCM
Associate Professor Muhammad B. Rafique, MD Girija Prasad Rath, MBBS, MD,
Department of Anesthesiology Associate Professor of Anesthesiology DM
University at Buffalo, The State University of New York McGovern Medical School Professor, Neuroanaesthesiology and Critical Care
Buffalo, New York University of Texas Health Science Center at Houston Neurosciences Centre
IgA Deficiency Houston, Texas All India Institute of Medical Sciences
Tuberculosis New Delhi, India
Amit Prabhakar, MD, MS Nelson Syndrome
Anesthesiology and Critical Care Medicine Fellow Jesse M. Raiten, MD
The Johns Hopkins Hospital Assistant Professor Selina Read, MD
Baltimore, Maryland Anesthesiology and Critical Care Department of Anesthesiology
Acidosis, Renal Tubular University of Pennsylvania Penn State Medical Center
Alagille Syndrome Philadelphia, Pennsylvania Hershey, Pennsylvania
Garlic (Allium sativum) Hyperglycemic Hyperosmolar State Upper Respiratory Infections
Glucocorticoids Multiple Organ Dysfunction Syndrome
Gout
Herpes, Type II Srijaya K. Reddy, MD, MBA
Hypernatremia Arvind Rajagopal, MD Assistant Professor of Anesthesiology and Pediatrics
Hypopituitarism Assistant Professor Division of Anesthesiology, Pain and Perioperative
Multiple Myeloma Rush University Medical Center Medicine
Red Yeast Rice (Cholestin) Chicago, Illinois Children’s National Health System/George
Phenylephrine (Neo-Synephrine) Washington University School of Medicine and
Ventricular Tachycardia Health Sciences
Donald S. Prough, MD Washington, District of Columbia
Rebecca Terry White Distinguished Chair
Department of Anesthesiology Srinivasan Rajagopal, MD Anhidrosis (Congenital Anhidrotic Ectodermal Dysplasia)
CONTRIBUTORS
University of Texas Medical Branch Assistant Professor
Galveston, Texas Department of Cardiothoracic Anesthesia Dallas D. Regan, DNP, CRNA
Renal Failure, Chronic University of Iowa Hospitals Nurse Anesthetist and Senior Instructor
Iowa City, Iowa Oregon Health and Science University
Mesothelioma Portland, Oregon
Bridget Perrin Pulos, MD Thiazolidinediones
Fellow in Regional Anesthesia and Acute Pain
Medicine Mohamed Ehab Ramadan,
Department of Anesthesiology and Critical Care MBBCh, MSC David L. Reich, MD
University of Pennsylvania Research Fellow President and Chief Operating Officer
Philadelphia, Pennsylvania Anesthesiology Department The Mount Sinai Hospital
Glucosamine Sulfate The Ohio State University Wexner Medical Center Horace W. Goldsmith Professor of Anesthesiology,
Columbus, Ohio Perioperative and Pain Medicine
Researcher Assistant of Anesthesiology Icahn School of Medicine at Mount Sinai
Kavitha Pundi, MD Theodor Bilharz Research Institute New York, New York
Advanced Imaging Fellow Ventricular Septal Defect (Congenital)
Giza, Egypt
Department of Pediatric Cardiology Ventricular Septal Rupture (Defect), Postmyocardial
Acute Intermittent Porphyria
Texas Children’s Hospital Infarction
Houston, Texas
Ebstein Anomaly Chandra Ramamoorthy, MD
Professor and Director of Pediatric Cardiac Anesthesia Clare H. Ridley, MD
Department of Anesthesia, Perioperative and Pain Cardiothoracic Anesthesiologist and Intensivist
Ferenc Puskas, MD, PhD Medicine Washington University
Associate Professor St. Louis, Missouri
Stanford Children’s Hospital
Department of Anesthesiology Adrenal Insufficiency, Acute or Secondary
Palo Alto, California
University of Colorado Truncus Arteriosus
Aurora, Colorado
Coronary Artery Spasm James M. Riopelle, MD
Justin D. Ramos, MD Professor of Clinical Anesthesiology
Resident Physician Louisiana State University Health Sciences Center
Aliaksei Pustavoitau, MD, MHS Department of Anesthesiology and Perioperative New Orleans, Louisiana
Assistant Professor Echinococcosis
Medicine
Department of Anesthesiology and Critical Care Oregon Health and Science University
Medicine
Johns Hopkins University School of Medicine
Portland, Oregon Stacey A. Rizza, MD, FIDSA
Acidosis, Lactic/Metabolic Associate Professor of Medicine
Baltimore, Maryland Sepsis, Severe Sepsis, and Septic Shock Department of Infectious Diseases
Jaundice
Thrombocytopenia Mayo Clinic
James A. Ramsey, MD Rochester, Minnesota
Assistant Professor Cytomegalovirus Infection
Carlos A. Puyo, MD, FCCP Department of Anesthesiology
Assistant Professor Multi-Specialty Division
Department of Anesthesiology Vanderbilt University School of Medicine
Division of Clinical and Translational Medicine Nashville, Tennessee
Washington University School of Medicine Syndrome X
St. Louis, Missouri
Mycoplasma pneumoniae Infection xxiii
Contributors
Amy C. Robertson, MD, MMHC Stanley H. Rosenbaum, MA, MD Benjamin Rubin, MD

Assistant Professor Professor of Anesthesiology, Internal Medicine, and Assistant Professor
Department of Anesthesiology Surgery Department of Anesthesiology and Critical Care
Vanderbilt University School of Medicine Director, Division of Perioperative & Adult Anesthesia University of Pennsylvania Health System
Vanderbilt University Medical Center Vice Chairman for Academic Affairs Interim Chief of Anesthesiology
Nashville, Tennessee Department of Anesthesiology Corporal Michael J. Crescenz VA Medical Center
Emphysema Yale School of Medicine Philadelphia, Pennsylvania
Waldenström Macroglobulinemia New Haven, Connecticut Pancreatitis
Carcinoid Syndrome
Stephen T. Robinson, MD Diabetes, Type II (Noninsulin-Dependent) Ryan E. Rubin, MD, MPH
Professor of Anesthesiology and Perioperative Medicine Anesthesiology Resident
Vice Chair for Clinical Anesthesia Andrew D. Rosenberg, MD Department of Anesthesiology
Oregon Health and Science University Chief, Department of Anesthesiology Louisiana State University
Portland, Oregon New York University Hospital for Joint Diseases Shreveport, Louisiana
Trimethaphan Executive Vice Chair, Department of Anesthesiology Hypertension, Uncontrolled With Cardiomyopathy
New York University School of Medicine Pickwickian Syndrome
Jeffrey D. Roizen, MD, PhD New York, New York
Assistant Professor of Pediatrics Cervical Disk Disease (Cervical Spine Disease)
Sarcoidosis
William L. Runcie, MD
Perelman School of Medicine at the University of Chief Resident
Pennsylvania Temple University Hospital
Division of Endocrinology and Diabetes Andrew L. Rosenberg, MD Philadelphia, Pennsylvania
The Children’s Hospital of Philadelphia Interim Chief Information Officer Hypercholesterolemia
Philadelphia, Pennsylvania University of Michigan Health System
Atrial Septal Defect, Ostium Secundum
Croup (Laryngotracheobronchitis)
Ann Arbor, Michigan
Myocardial Contusion (Blunt Cardiac Injury)
Thomas A. Russo, MD, CM
Professor and Chief
Dermatomyositis Division of Infectious Diseases
Epiglottitis
Glycogen Storage Diseases
Meg A. Rosenblatt, MD Vice Chair of Medicine
Professor of Anesthesiology and Orthopaedics Department of Medicine
Malnutrition Icahn School of Medicine at Mount Sinai Jacobs School of Medicine and Biomedical Sciences
Necrotizing Enterocolitis Chair, Department of Anesthesiology, Pain and State University of New York at Buffalo
Patent Ductus Arteriosus Perioperative Medicine Staff Physician
Physiologic Anemia and the Anemia of Prematurity Mount Sinai St. Luke’s and Mount Sinai West Western New York Veterans Administration
CONTRIBUTORS
Hospitals Healthcare System

Michael F. Roizen, MD New York, New York Buffalo, New York
Roizen Family Chair Jehovah’s Witness Patient Q Fever
Wellness Institute
Chief Wellness Officer
Steven Roth, MD Tarang Safi, MD
Professor and Chief, Neuroanesthesia Fellow, Cardiothoracic Anesthesiology
The Cleveland Clinic Department of Anesthesia and Critical Care Stanford University School of Medicine
Cleveland, Ohio University of Chicago Stanford, California
Dermatomyositis Chicago, Illinois Mitral Stenosis
Diabetes Type I (Insulin-Dependent) Postoperative Encephalopathy, Metabolic Transfusion-Related Acute Lung Injury
Hyperthyroidism
Myocardial Ischemia
Phenoxybenzamine Justin L. Rountree, MD Sanjoy Saha, BSc, MBBS, FRCA
Pheochromocytoma Assistant Professor Specialist Registrar in Anaesthesia
Propylthiouracil—Antithyroid Drugs Department of Anesthesiology Barts and The London School of Anaesthesia
Sickle Cell Trait University of North Carolina London, United Kingdom
Sleep Apnea, Central and Mixed Chapel Hill, North Carolina Ventricular Tachyarrhythmias
Sleep Apnea, Obstructive Cushing Syndrome
Misako Sakamaki, MD
Mark D. Rollins, MD, PhD Marc B. Royo, MD, MBA Clinical Assistant Professor
Professor and Sol M. Shnider Endowed Chair for Assistant Professor Department of Anesthesiology and Critical Care
Anesthesia Education Department of Anesthesiology and Critical Care Hospital of the University of Pennsylvania
Director of Obstetric and Fetal Anesthesia University of Pennsylvania Philadelphia, Pennsylvania
Departments of Anesthesia and Perioperative Care; Philadelphia, Pennsylvania Anxiety Disorders
Obstetrics, Gynecology and Reproductive Sciences; Atherosclerotic Disease
and Surgery Constipation
Delirium (Postanesthetic)/Dementia
Orlando J. Salinas, MD
University of California, San Francisco Assistant Professor of Anesthesiology
San Francisco, California Louisiana State University Medical Center
Myelomeningocele Marc A. Rozner, PhD, MD New Orleans, Louisiana
Professor Fish Oil
John F. Rompala, MD Department of Anesthesiology and Perioperative
Clinical Anesthesiologist, Portland VA Medical Center Medicine
Department of Cardiology
Jibin V. Samuel, MB, BS, MD
Assistant Professor, Oregon Health Sciences Pediatric Anesthesiologist
University University of Texas MD Anderson Cancer Center All Children’s Hospital
Portland, Oregon Houston, Texas Johns Hopkins Medicine
Bleomycin Sulfate Toxicity Chemotherapeutic Agents St. Petersburg, Florida
Implantable Cardioverter-Defibrillators Diaphragmatic Hernia (Congenital)
Pacemakers
Sydney E. Rose, MD
Regional and Pain Medicine Fellow
Portland, Oregon
xxiv Gaucher Disease
Contributors
Robert Sanders, BSc, MBBS, PhD, David L. Schreibman, MD Kumaran Senthil, MD

FRCA Assistant Professor Anesthesiology Resident
Assistant Professor Department of Anesthesiology Department of Anesthesiology and Critical Care
Department of Anesthesiology University of Maryland School of Medicine Medicine
University of Wisconsin School of Medicine and Baltimore, Maryland University of Pennsylvania School of Medicine
Public Health Encephalitis Philadelphia, Pennsylvania
Madison, Wisconsin Kawasaki Disease
Alpha2 Adrenergic Agonists Thomas Schricker, MD, PhD
Department of Anesthesia Tamas Seres, MD, PhD
Annie Santi, MD Royal Victoria Hospital Associate Professor
Resident Physician McGill University Health Centre Department of Anesthesiology
Department of Anesthesiology and Critical Care Montreal, Canada University of Colorado
Hospital of the University of Pennsylvania Insulin Aurora, Colorado
Philadelphia, Pennsylvania Posttransplant Lymphoproliferative Disorder
Paget Disease Armin Schubert, MD, MBA
Vice President of Medical Affairs Evan Serfass, MD, PhD
Hiroaki Sato, MD, PhD System Chair, Department of Anesthesiology Assistant Professor, Pediatric Anesthesia
Department of Anesthesia Ochsner Medical Center Department of Anesthesiology and Perioperative
Royal Victoria Hospital New Orleans, Louisiana Medicine
McGill University Health Centre Multiple Sclerosis Oregon Health and Science University
Montreal, Canada Portland, Oregon
Insulin Peter M. Schulman, MD Heart Disease, Congenital
Associate Professor
Luis R. Sauceda-Cerda, MD Department of Anesthesiology and Perioperative Daniel I. Sessler, MD
Resident Physician Medicine Michael Cudahy Professor and Chair
Department of Anesthesiology and Perioperative Medicine Oregon Health and Science University Department of Outcomes Research
Oregon Health and Science University Portland, Oregon Cleveland Clinic
Portland, Oregon Acidosis, Lactic/Metabolic Cleveland, Ohio
Amphetamines Implantable Cardioverter-Defibrillators Hypothermia, Mild
Marijuana Pacemakers
Sepsis, Severe Sepsis, and Septic Shock Navil F. Sethna, MD, FAAP
Puneet Sayal, MD, MSc
CONTRIBUTORS
Senior Associate in Anesthesia
Pain Medicine Fellow Alan Jay Schwartz, MD, MSEd Associate Professor of Anesthesiology
University of Texas MD Anderson Cancer Center Director of Education Harvard Medical School
Houston, Texas Department of Anesthesiology and Critical Care Medicine Department of Anesthesiology, Perioperative and Pain
Asthma, Acute The Children’s Hospital of Philadelphia Medicine
Professor of Clinical Anesthesiology and Critical Care Boston Children’s Hospital
Perelman School of Medicine at the University of Boston, Massachusetts
Thomas Schilling, MD, PhD, DEAA Pennsylvania Prader-Willi Syndrome
Clinical Assistant Professor Philadelphia, Pennsylvania
Department of Anesthesiology and Intensive Care
Medicine
Apnea of the Newborn Pranav R. Shah, MD
Otto-von-Guericke-University Magdeburg Assistant Professor
Magdeburg, Germany Jamie McElrath Schwartz, MD Divisions of Cardiac Anesthesiology and Critical Care
Niemann-Pick Disease Attending Physician Medicine
Department of Critical Care Medicine and Virginia Commonwealth University
Anesthesiology Richmond, Virginia
R. Alexander Schlichter, MD Children’s National Medical Center Sick Sinus Syndrome
Associate Professor of Clinical Anesthesiology and Assistant Professor
Critical Care
Chief of Neuroanesthesia, Hospital of the University
Department of Anesthesiology and Pediatrics
George Washington University School of Medicine
Ronak Shah, MD
of Pennsylvania Assistant Professor, Adult Cardiothoracic
Washington, District of Columbia
Chief of Anesthesia for Interventional Radiology, Anesthesiology
Single (Including Common) Ventricle
Hospital of the University of Pennsylvania Department of Anesthesiology and Critical Care
Philadelphia, Pennsylvania Hospital of the University of Pennsylvania
Arnold-Chiari Malformation (Chiari Malformation Type II) John W. Sear, MA, PhD, MBBS, Philadelphia, Pennsylvania
Chiari Malformations FFARCS, FANZCA Myocarditis
Seizures, Epileptic Professor
Nuffield Department of Anaesthetics Jessica L. Shanahan, MD
Eric Schnell, MD, PhD University of Oxford
Oxford, United Kingdom
Director of Preadmission Services
Staff Anesthesiologist Department of Anesthesiology
VA Portland Health Care System VA Boston Healthcare System
Assistant Professor Sankalp Sehgal, MD West Roxbury, Massachusetts
Department of Anesthesiology and Perioperative Attending Anesthesiologist Brain Death
Medicine Department of Anesthesiology
Oregon Health and Science University Division of Cardiothoracic Anesthesiology Ankur Sharma, MBBS, MD, DNB,
Portland, Oregon
Phenothiazines
New York Presbyterian/Weill Cornell Medicine
New York, New York
MNAMS, FCCS
Senior Research Associate
Graves Disease Department of Anesthesia, Critical Care and Pain
Robert B. Schonberger, MD Medicine
Fellow of Cardiothoracic Anesthesia and Clinical Sudipta Sen, MBBS All India Institute of Medical Sciences
Research Assistant Professor Ansari Nagar, India
Department of Anesthesiology Department of Anesthesiology Saethre-Chotzen Syndrome
Yale University School of Medicine Louisiana State University Health Sciences Center
New Haven, Connecticut Shreveport, Louisiana
Aortic Regurgitation S-Adenosyl-L-Methionine xxv
Contributors
Joanne Shay, MD, MBA Ashish C. Sinha, MD, PhD, MBA Janelle B. Snoddy, MD
Assistant Professor Professor Resident Physician
Director of Pediatric Remote Anesthesia Services Department of Anesthesiology Department of Anesthesiology and Critical Care
Pediatric Anesthesiology and Critical Care Medicine Katz School of Medicine Hospital of the University of Pennsylvania
Johns Hopkins University School of Medicine Temple University Philadelphia, Pennsylvania
Baltimore, Maryland Philadelphia, Pennsylvania Spinal Cord Injury
Anemia, Aplastic Cancer, Bladder
Candidiasis
CREST Syndrome
Cobin D. Soelberg, MD, JD, MBe
Stephen J. Shepherd, MBBS, Depression, Unipolar
Assistant Professor
MRCP, FRCA, FFICM Mediastinal Masses
Department of Anesthesia and Perioperative Medicine
Oregon Health and Sciences University
Consultant in Anaesthesia and Intensive Care Morbid Obesity Portland, Oregon
St. Bartholomew’s Hospital
Wilson Disease
London, United Kingdom
Fluoxetine (Prozac) Renu Sinha, MBBS, MD
Professor
Department of Anaesthesiology, Pain Medicine and
Betsy Ellen Soifer, MD, PhD
Veena Sheshadri, MBBS, MD Critical Care
Anesthesiologist
Operative Care Division
Clinical Fellow All India Institute of Medical Sciences Portland Veterans Affairs Medical Center
Department of Anesthesia and Pain Medicine New Delhi, India Associate Professor of Anesthesiology and
University of Toronto Sturge-Weber Syndrome Perioperative Care
Toronto Western Hospital
Toronto, Canada
Seizures, Tonic-Clonic (Grand Mal) Eellan Sivanesan, MD Portland, Oregon
Department of Anesthesiology, Perioperative Medicine Subphrenic Abscess
and Pain Management
Ramchandra Vinayak Shidhaye, University of Miami Amy O. Soleta, MD
MD, DA Miami, Florida Assistant Professor
Professor Bronchiolitis Obliterans Syndrome Anesthesiology and Perioperative Medicine
Department of Anesthesiology Oregon Health and Science University
L.N. Medical College and J.K. Hospital Daniel C. Sizemore, MD Portland, Oregon
Bhopal, India Program Director, Anesthesiology Residency Kava
Rubella and Congenital Rubella Syndrome Vice Chair for Academic Affairs Plagiocephaly
Assistant Professor
CONTRIBUTORS
Jeffrey S. Shiffrin, MD Department of Anesthesiology Molly Solorzano, MD

Associate Professor West Virginia University Instructor
Department of Anesthesiology Morgantown, West Virginia Mayo Clinic Hospital
University of Colorado Herpes, Type I Phoenix, Arizona
Aurora, Colorado Insulinoma
Physostigmine, Eserine Sara M. Skrlin, MD
Staff Anesthesiologist Aris Sophocles, MD
Adam Shomstein, DO, MBA VA Portland Health Care System Department of Anesthesiology
Physical Medicine and Rehabilitation and Portland, Oregon Children’s Hospital
Interventional Pain Hypomagnesemia Denver, Colorado
Louisiana State University Magnesium Sulfate Patent Ductus Arteriosus
Headache, Migraine Kieran A. Slevin, MD Roy G. Soto, MD
Medical Director Residency Program Director and Professor
Daniel Siker, MD North American Spine and Pain Consultants Department of Anesthesiology
Staff Physician Hainesport, New Jersey Beaumont Health System
Department of Pediatrics and Anesthesiology Autonomic Dysreflexia Royal Oak, Michigan
Medical College of Wisconsin Hemosiderosis, Pulmonary
Milwaukee, Wisconsin Tod B. Sloan, MD, MBA, PhD
Cherubism Professor Emeritus
University of Colorado Medical School
Joan Spiegel, MD
Assistant Professor
George Silvay, MD, PhD Aurora, Colorado Department of Anesthesia, Critical Care and Pain
Professor Infratentorial Tumors Medicine
Department of Anesthesiology Supratentorial Brain Tumors Harvard Medical School
Ichan School of Medicine at Mount Sinai Beth Israel Deaconess Medical Center
New York, New York Kathleen A. Smith, MD Boston, Massachusetts
Marfan Syndrome Associate Professor of Anesthesiology Chitosan
University of North Carolina Saw Palmetto
Gyaninder P. Singh, MD, DM Chapel Hill, North Carolina
Associate Professor Cushing Syndrome Raymond D. Sroka, MD, PharmD
Department of Neuroanaesthesiology and Critical Anesthesiologist and Assistant Director
Care Timothy E. Smith, MD Anesthesia Preoperative Evaluation Clinic
Neurosciences Centre, All India Institute of Medical Associate Professor, Pediatric Anesthesiology Department of Anesthesiology
Sciences Wake Forest Baptist Health Roswell Park Cancer Institute
New Delhi, India Winston-Salem, North Carolina Clinical Instructor and Academic Scholar
Transverse Myelitis Hydrocephalus Department of Anesthesia
State University of New York at Buffalo
Buffalo, New York
Alkylating Agents
xxvi
Contributors
Katherine Stammen, MD Jonathan M. Tan, MD, MPH James Joseph Thomas, MD

Assistant Professor of Anesthesiology Assistant Professor Assistant Professor
Assistant Residency Program Director Department of Anesthesiology and Critical Care Children’s Hospital Colorado
Course Director, Medical Student Education Perelman School of Medicine at the University of University of Colorado
Department of Anesthesiology Pennsylvania Aurora, Colorado
Louisiana State University Health Sciences Center The Children’s Hospital of Philadelphia Occipital Encephalocele
Shreveport, Louisiana Philadelphia, Pennsylvania
S-Adenosyl-L-Methionine Craniofacial Clefts Arlyne K. Thung, MD
Clinical Assistant Professor
Stanley W. Stead, MD, MBA Rob Tanzola, MD, FRCPC Nationwide Children’s Hospital
Clinical Professor of Anesthesiology and Perioperative Associate Professor The Ohio State University
Medicine Queen’s University Columbus, Ohio
University of California, Irvine Kingston, Canada Beckwith-Widemann Syndrome
President Churg-Strauss Syndrome Treacher Collins Syndrome
Stead Health Group, Inc.
Los Angeles, California
Blindness
Rayhan A. Tariq, MD Dawn D. Tiemann, MD
Resident Assistant Professor of Clinical Anesthesiology
Department Of Anesthesiology Department of Anesthesiology
John K. Stene, MD, PhD Drexel University College of Medicine Louisiana State University School of Medicine
Professor Philadelphia, Pennsylvania New Orleans, Louisiana
Department of Anesthesiology and Neurosurgery Fanconi Syndrome Nutraceuticals
Penn State Milton S. Hershey Medical Center Procainamide (Procan, Procanbid, Pronestyl)
Hershey, Pennsylvania Vasanti Tilak, MD
Vitamin B12 Carin Tauriello, MD Assistant Professor
Assistant Professor of Anesthesiology Department of Anesthesiology
Nathalie Stevenson, BSc, BM, State University of New York at Buffalo New Jersey Medical School, Rutgers
FRCA, FFICM Staff Anesthesiologist Newark, New Jersey
Consultant Roswell Park Cancer Institute Antithrombin III Deficiency
Intensive Care and Anaesthetics Buffalo, New York
Royal Free London NHS Foundation Trust Bleomycin Joseph R. Tobin, MD
London, United Kingdom Professor Emeritus
Magnus K. Teig, BMedSci (Hons),
CONTRIBUTORS
Ventricular Preexcitation Syndrome Department of Anesthesiology
MBChB, MRCP, FRCA, EDIC, FFICM Wake Forest School of Medicine
Rae Stewart, MD Assistant Professor Winston-Salem, North Carolina
Anesthesiology Resident Hydrocephalus
Department of Anesthesiology University of Michigan
Montefiore Medical Center Ann Arbor, Michigan R. David Todd, MD
New York, New York Cigarette Smoking Interventional Pain Medicine
Colchicine Tennessee Orthopaedic Alliance
René Tempelhoff, MD Nashville, Tennessee
Tracey L. Stierer, MD Professor of Anesthesiology and Neurological Surgery Glossopharyngeal Neuralgia
Assistant Professor of Anesthesiology and Critical Washington University School of Medicine
Care Medicine St Louis, Missouri Brandon M. Togioka, MD
Director of Ambulatory Anesthesia Division Seizures, Intractable Assistant Professor
Johns Hopkins University Anesthesiology and Perioperative Medicine
Baltimore, Maryland
Oral Contraceptives John E. Tetzlaff, MD Oregon Health and Science University
Portland, Oregon
Hemochromatosis
Cleveland Clinic Lerner College of Medicine of Case
David F. Stowe, MD, PhD Western Reserve University Pemphigus
Professor of Anesthesiology and Physiology Cleveland, Ohio
Medical College of Wisconsin Ankylosing Spondylitis De Q.H. Tran, MD, FRCPC
Adjunct Professor of Biomedical Engineering Degenerative Disk Disease Professor
Marquette University Montreal General Hospital
Senior Staff Anesthesiologist
Zablocki Veterans Medical Center Marie A. Theard, MD Department of Anesthesia
McGill University
Milwaukee, Wisconsin Assistant Professor
Montreal, Canada
Serotonin: Agonists, Antagonists, and Reuptake Inhibitors Department of Anesthesiology
Bisphosphonates
Washington University School of Medicine
St. Louis, Missouri
Erin A. Sullivan, MD Scoliosis and Kyphosis Kha M. Tran, MD
Associate Professor of Anesthesiology and Critical Associate Professor of Clinical Anesthesiology and
Care Medicine
Department of Anesthesiology Jacob Addison Thomas, MD Critical Care Medicine
University of Pittsburgh School of Medicine Resident Anesthesiologist
Pennsylvania
Pittsburgh, Pennsylvania Department of Anesthesiology and Critical Care
Attending Anesthesiologist
Sick Sinus Syndrome University of Pennsylvania
Director, Fetal Anesthesia Services
Medical Director, Bucks County Ambulatory Surgical
Associate Anesthesiologist
Dajin Sun, MD Department of Anesthesia Facility
Professor Emeritus The Children’s Hospital of Philadelphia
University of Iowa
Department of Anesthesiology Philadelphia, Pennsylvania
Iowa City, Iowa
School of Medicine at Jiaotong University Bilirubinemia of the Newborn
Monoamine Oxidase Inhibitors; Reversible Inhibitors of
Shanghai, China Monoamine Oxidase
Carnitine
xxvii
Contributors
Lien Tran, MD Shital Vachhani, MD Surbhi Virmani, MD, LLB

Assistant Professor Anesthesiologist Specialist Registrar
Louisiana State University School of Medicine University of Texas MD Anderson Cancer Center National Hospital for Neurology and Neurosurgery
New Orleans, Louisiana Houston, Texas London, United Kingdom
Hypermagnesemia Implantable Cardioverter-Defibrillators Creutzfeldt-Jakob Disease
Lipidemias
Marissa G. Vadi, MD, MPH Alexander A. Vitin, MD, PhD
Minh Chau Joe Tran, MD, MPH Assistant Professor of Anesthesiology Associate Professor
Pediatric Anesthesiologist Loma Linda University School of Medicine Department of Anesthesiology
Loma Linda University Medical Center Loma Linda, California University of Washington
Loma Linda VA Medical Center Bronchopulmonary Dysplasia Seattle, Washington
Just Oral Boards, LLC Silicosis
Loma Linda, California Ashley R. Valentine, MD, PhD
Achondroplasia, Dwarfism Resident Physician Marian E. Von-Maszewski, MD
Department of Anesthesia and Perioperative Medicine Assistant Professor
Erin Treasy, MD Oregon Health and Science University Department of Critical Care
Assistant Professor of Anesthesiology Portland, Oregon University of Texas MD Anderson Cancer Center
Department of Anesthesiology and Perioperative De Morsier Syndrome Houston, Texas
Medicine Gastrinoma Cardiomyopathy, Alcoholic
Drexel University College of Medicine
Hahnemann University Hospital
Elizabeth A. Valentine, MD Varuna Vyas, MBBS, MD
Assistant Professor Senior Resident
Calcium Deficiency/Hypocalcemia Department of Anesthesiology and Critical Care Department of Pediatrics
Perelman School of Medicine at the University of All India Institute of Medical Sciences
Kevin K. Tremper, PhD, MD Pennsylvania Ansari Nagar, India
Professor and Chair Philadelphia, Pennsylvania Saethre-Chotzen Syndrome
Department of Anesthesiology Peripheral Vascular Disease
University of Michigan Suchin R. Wadhwani, MD
Ann Arbor, Michigan
Cigarette Smoking
Manuel C. Vallejo, MD, DMD Anesthesiology Resident
Designated Institutional Official Department of Anesthesiology and Critical Care
Assistant Dean University of Pennsylvania
January Y. Tsai, MD
CONTRIBUTORS
Professor of Medical Education, Anesthesiology, and Philadelphia, Pennsylvania

Anesthesiologist Obstetrics and Gynecology Urinary Lithiasis
University of Texas MD Anderson Cancer Center West Virginia University School of Medicine
Houston, Texas
Pacemakers
Herpes, Type I
K. Karisa Walker, MD
Acting Assistant Professor
Rifampin Department of Anesthesiology and Pain Medicine
Lawrence C. Tsen, MD University of Washington School of Medicine
Associate Director Luke Van Alstine, MD Seattle Children’s Hospital
Center for Professionalism and Peer Support Instructor of Anesthesiology Seattle, Washington
Director of Anesthesia Mayo Clinic Jeune Syndrome (Asphyxiating Thoracic Dystrophy)
Center for Reproductive Medicine Rochester, Minnesota
Medicine
Poliomyelitis Russell T. Wall III, MD
Chair, Department of Anesthesiology
Brigham and Women’s Hospital
Associate Professor in Anaesthesia
Albert J. Varon, MD, MHPE, FCCM Medstar Georgetown University Hospital
Miller Professor and Vice Chair for Education Professor, Anesthesiology & Pharmacology
Harvard Medical School Department of Anesthesiology Georgetown University School of Medicine
Boston, Massachusetts University of Miami Miller School of Medicine Washington, District of Columbia
Pregnancy, Ectopic Miami, Florida Acromegaly
Burn Injury, Chemical Anorexia Nervosa
Kenneth J. Tuman, MD Burn Injury, Electrical
Professor and Chair
Burn Injury, Flame Jason D. Walls, MD
Assistant Professor
Rush University Medical Center
Chicago, Illinois
Lashmi Venkatraghavan, MBBS, Department of Anesthesiology and Critical Care
Phenylephrine (Neo-Synephrine) MD, DNB, FRCA, FRCPC Hospital of the University of Pennsylvania
Associate Professor Philadelphia, Pennsylvania
Ventricular Tachycardia
University of Toronto Arnold-Chiari Malformation (Chiari Malformation Type II)
Toronto Western Hospital Chiari Malformations
Mark Twite, MA, MB, BChir, FRCP Toronto, Canada Hypoparathyroidism
Director Occlusive Cerebrovascular Disease
Pediatric Cardiac Anesthesia
Seizures, Absence (Petit Mal) Brendan T. Wanta, MD
Seizures, Tomic-Clonic (Grand Mal) Assistant Professor of Anesthesiology
Children’s Hospital and University of Colorado Mayo Clinic
Denver, Colorado
Patent Ductus Arteriosus Francis Veyckemans, MD Rochester, Minnesota
Anesthesiologist Endocarditis
Department of Pediatric Anesthesia
Alexander Tzabazis, MD Hôpital Jeanne de Flandre Lucy Waskell, MD, PhD
Clinical Assistant Professor CHRU de Lille Professor of Anesthesia
Department of Anesthesiology, Perioperative and Pain Lille, France University of Michigan Medical School
Medicine Landouzy-Dejerine Dystrophy (Facioscapulohumeral Director, Anesthesia Research
Stanford University School of Medicine Muscular Dystrophy) Department of Anesthesiology
Stanford, California Veterans Affairs Medical Center
Narcolepsy Ann Arbor, Michigan
xxviii Penicillins
Contributors
Scott C. Watkins, MD John O.R. Whittle, FRCA Man Piu Wong, MD

Assistant Professor Locum Consultant Anaesthesia ACCM Fellow
Department of Anesthesiology Royal Free Hospital New York Presbyterian–Columbia University Medical
Division of Pediatric Cardiac Anesthesiology Honorary Clinical Lecturer in Perioperative Medicine Center
Monroe Carell Jr. Children’s Hospital at Vanderbilt University College New York, New York
University Medical Center London, United Kingdom Hepatic Encephalopathy
Nashville, Tennessee Ventricular Tachyarrhythmias
Alcohol Abuse Zerlina Wong, MD
Duminda N. Wijeysundera, MD, Critical Care Fellow
Menachem M. Weiner, MD PhD, FRCPC Anesthesiology and Perioperative Medicine
Associate Professor Associate Professor of Anesthesia Oregon Health and Science University
Department of Anesthesiology University of Toronto Portland, Oregon
Icahn School of Medicine at Mount Sinai Toronto, Canada Multiple Organ Dysfunction Syndrome
New York, New York Beta-Adrenergic Receptor Antagonists (Blockers)
Ventricular Septal Defect (Congenital)
Ventricular Septal Rupture (Defect), Postmyocardial
Calcium-Channel Blockers Anthony K. Woodall, MD
Senior Resident
Infarction
Danny Wilkerson, MD Department of Anesthesiology
Professor Louisiana State University Health Sciences Center
Toby N. Weingarten, MD Departments of Anesthesiology and Obstetrics and New Orleans, Louisiana
Professor of Anesthesiology Gynecology Hepatitis, Alcoholic
Department of Anesthesia and Perioperative Medicine College of Medicine
Mayo Clinic
Rochester, Minnesota
University of Arkansas for Medical Sciences Patrick F. Wouters, MD, PhD
Little Rock, Arkansas Department Chair
Amyloidosis Diabetes, Type III (Gestational Diabetes Mellitus) Anesthesia and Perioperative Medicine
Ghent University Hospital
Mitchell L. Weinstein, MD Nancy C. Wilkes, MD Ghent, Belgium
Assistant Professor of Clinical Anesthesiology and Professor of Anesthesiology Alpha1 Antagonists
Critical Care Medicine Medical Director, Ambulatory Surgery Center
University of Pennsylvania
Chief of Neuroanesthesia
Co-Division Chief, Ambulatory Anesthesia Melville Q. Wyche III, MD
University of North Carolina Hospitals Assistant Professor of Clinical Anesthesiology
Penn Presbyterian Medical Center Chapel Hill, North Carolina Department of Anesthesiology
CONTRIBUTORS
Diverticulosis Louisiana State University School of Medicine
Brain Injury, Traumatic Kartagener Syndrome New Orleans, Louisiana
Vitamin D Deficiency Hepatitis, Alcoholic
Mark S. Weiss, MD
Assistant Professor Glyn D. Williams, MBChB, FFA David A. Wyler, MD
Department of Anesthesiology and Critical Care Professor Assistant Professor
Perelman School of Medicine at the University of Department of Anesthesiology, Perioperative and Pain Departments of Anesthesiology and Neurological
Pennsylvania Medicine Surgery
Philadelphia, Pennsylvania Stanford University Division of Critical Care
Proton Pump Inhibitors Palo Alto, California Jefferson Hospital for Neuroscience
Rheumatic Fever (Acute) and Rheumatic Heart Disease Dextrocardia Thomas Jefferson University
Charles Weissman, MD Sylvia H. Wilson, MD Huntington Disease
Professor and Chair Associate Professor
Medicine
Department of Anesthesia and Perioperative Medicine Miguel A. Yaport, MD
Medical University of South Carolina Anesthesiology Resident
Hadassah-Hebrew University Medical Center Charleston, South Carolina University of Pennsylvania Health System
Hebrew University, Hadassah School of Medicine Charcot-Marie-Tooth Disease Philadelphia, Pennsylvania
Jerusalem, Israel Addison Disease
Encephalopathy, Metabolic
Encephalopathy, Postanoxic Jimmy Windsor, MD Bernard-Soulier Syndrome
Protein C Deficiency Director of Pediatric Cardiac Anesthesiology
Department of Anesthesiology and Critical Care Carl Ying, MD
University of New Mexico School of Medicine Anesthesia
Megan K. Werntz, MD Albuquerque, New Mexico Loma Linda University Medical Center
Anesthesiology Resident Tricuspid Atresia Loma Linda, California
Department of Anesthesiology and Perioperative Achondroplasia, Dwarfism
Medicine
Oregon Health and Science University Gregory A. Wolff, BS, MD
Portland, Oregon Resident Physician Jeongae Yoon, MD
Hemochromatosis Department of Anesthesiology Adult Cardiothoracic Anesthesia Fellow
Pemphigus University of Colorado Department of Anesthesiology and Critical Care
Aurora, Colorado Hospital of the University of Pennsylvania
Cromolyn Sodium Philadelphia, Pennsylvania
Gina Whitney, MD Buerger Disease (Thromboangiitis Obliterans)
Assistant Professor of Anesthesiology and Pediatrics
Pediatric Anesthesiology and Pediatric Intensive Care Michael Wollenberg, MD
Vanderbilt Children’s Hospital Assistant Professor
Vanderbilt University Medical Center Department of Anesthesiology and Perioperative
Nashville, Tennessee Medicine
Supraventricular Tachycardia (Tachyarrhythmias) Oregon Health and Science University
Portland, Oregon
Pulmonary Hypertension
xxix
Contributors
Francine S. Yudkowitz, MD, FAAP Paul Zanaboni, MD, PhD Elizabeth Y. Zhou, MD
Professor of Anesthesiology, Perioperative and Pain Associate Professor Assistant Professor
Medicine, and Pediatrics Department of Anesthesiology Adult Cardiothoracic Anesthesiology
Icahn School of Medicine at Mount Sinai Washington University School of Medicine Hospital of the University of Pennsylvania
Director, Pediatric Anesthesia St. Louis, Missouri Philadelphia, Pennsylvania
The Mount Sinai Hospital Cor Pulmonale Pericarditis, Constrictive
New York, New York
Congenital Pulmonary Lesions/Lobar Emphysema
Gastroesophageal Reflux in Children
Warren M. Zapol, MD Maurice S. Zwass, MD
Reginald Jenney Professor of Anaesthesia Professor of Anesthesia and Pediatrics
Moyamoya Department of Anesthesia Anesthesia and Perioperative Care
Massachusetts General Hospital University of California San Francisco
James R. Zaidan, MD, MBA Boston, Massachusetts San Francisco, California
Professor of Anesthesiology Nitric Oxide, Inhaled Croup (Laryngotracheobronchitis)
Department of Anesthesiology Epiglottitis
Associate Dean for GME
Emory University School of Medicine
Atlanta, Georgia
Mobitz I (Second-Degree Atrioventricular Block)
Mobitz II (Second-Degree Atrioventricular Block)
CONTRIBUTORS
xxx
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
Abbreviations
SYMBOLS ALS amyotrophic lateral sclerosis BOOP bronchiolitis obliterans with
± plus or minus ALT alanine aminotransferase cryptogenic organizing
? questionable Alv alveolar pneumonia
∼ approximately am morning BOS bronchiolitis obliterans syndrome
° C degrees centigrade AML acute myelogenous leukemia BP blood pressure
° F degrees Fahrenheit AMP adenosine monophosphate BPD bronchopulmonary dysplasia
1° primary; first degree ampl amplitude BPEG British Pacing and
2° secondary; second degree ANA antinuclear antibody Electrophysiology Group
3° third degree angio angiogram BPH benign prostatic hyperplasia/
ΔΔ delta gap ANS autonomic nervous system hypertrophy
ant anterior bpm beats per minute
A anticoag anticoagulation BPP biophysical profile
A-a alveolar-arterial AOM acute otitis media BRBPR bright red blood per rectum
AA arachidonic acid AP accessory pathway; action BS breath sounds
AAA abdominal aortic aneurysm potential; anteriorposterior BSA body surface area
A-aDO2 alveolar-arterial oxygen delivery APC activated protein C BT bleeding time; Blalock-Taussig
AAT alpha1-antitrypsin; automatic API alkaline protease inhibitor (shunt)
atrial tachycardia approx approximate; approximately BUN blood urea nitrogen
AAP American Academy of Pediatrics APTT activated partial thromboplastin BWS Beckwith-Wiedemann
abd abdomen; abdominal time syndrome
ABG arterial blood gas AR aortic regurgitation Bx biopsy
ABI aorto-bi-iliac bypass ARB angiotensin receptor BZD benzodiazepine
abd abdominal blocker
abn abnormal; abnormality ARDS acute respiratory distress C
ACE angiotensin-converting enzyme syndrome CA cancer, cold agglutinins
ACEI angiotensin-converting enzyme ARF acute renal failure ca. about (circa)
inhibitor art arterial Ca2+ calcium
ACG angle-closure glaucoma AS aortic stenosis CAB coronary artery bypass
Ach acetylcholine ASA acetylsalicylic acid; Adams- CABG coronary artery bypass graft
AChE acetylcholinesterase Stokes attack; American CACT carnitine-acylcarnitine
ACIP Advisory Committee on Society of Anesthesiologists translocase
Immunization Practices ASAP as soon as possible CAD coronary artery disease
ACL anterior cruciate ligament ASCVD atherosclerotic cardiovascular cAMP cyclic adenosine
ABBREVIATIONS
ACLS advanced cardiac life support disease monophosphate
ACOG American Congress of ASD atrial septal defect Cao2 arterial oxygen concentration
Obstetricians and ASRA American Society of Regional cardiopulm cardiopulmonary
Gynecologists Anesthesia CAS coronary artery spasm
ACS acute confusional state assoc associated CASS Coronary Artery Surgery Study
ACT activated clotting/coagulation AST aspartate aminotransferase CATCH 22 cardiac defect, abnormal facies,
time AT antithrombin thymic hypoplasia, cleft
ACTH adrenocorticotropic AT1 angiotensin receptor 1 palate, and hypocalcemia
ADEM acute disseminated ATG anti-thymus globulin (syndrome)
encephalomyelitis ATN acute tubular necrosis cath catheter; catheterization
ADH antidiuretic hormone ATP adenosine triphosphate; CBC complete blood count
ADHD attention-deficit hyperactivity antitachycardia pacing CBF cerebral blood flow
disorder Au gold CBG capillary blood glucose
ADI atlas-dens interval AV atrioventricular CBV cerebral blood volume
ADL activities of daily living AVB atrioventricular block CCAM congenital cystic adenomatoid
admin administration; administered AVM arteriovenous malformation malformation
ADP adenosine diphosphate AVR aortic valve replacement CCB calcium-channel blocker
AE alveolar echinococcus CCNU nitrosourea (lomustine)
AED automated external defibrillator B CD4 antigenic marker on helper/
AFE amniotic fluid embolism β-hCG beta human chorionic inducer T cells
AFIB atrial fibrillation gonadotropin CD4+ presence of CD4
AFLT atrial flutter BAER brainstem auditory evoked CDC Centers for Disease Control and
AFP alpha-fetoprotein response Prevention
AG anion gap BAL bronchoalveolar lavage CEA carotid endarterectomy
AH autonomic hyperreflexia BBB bundle branch block; blood- cGMP cyclic guanosine
AHQR Agency for Healthcare Research brain barrier monophosphate
and Quality BCI blunt cardiac injury C-GSF granulocyte colony-stimulating
AI aortic insufficiency BCNU nitrosourea (carmustine) factor
AICD automatic implantable BD Behçet disease CHARGE coloboma, congenital heart
cardioverter defibrillator BF bifascicular; blood flow defects, choanal atresia,
AIDS acquired immunodeficiency bid twice per day retardation of growth and/or
syndrome BIG botulism immune globulin other development, genital
AIH anesthetic-induced hepatitis bilat bilateral anomalies, and ear anomalies
AIM anesthetic-induced BIS bispectral index with deafness
myodystrophy BLS basic life support CHB complete heart block
AIP acute intermittent porphyria BLT bleomycin sulfate toxicity CHCT caffeine halothane contracture
AKA above-knee amputation; also BM bowel movement test
known as BMI body mass index CHD congenital heart disease;
AKI acute kidney injury BMP basic metabolic panel congenital heart defect
AKIN Acute Kidney Injury Network BMR basal metabolic rate ChE cholinesterase
ALA δ-aminolaevulinic acid
BMS bare metal stent CHF congestive heart failure
alb albumin BMT bone marrow transplantation CHO carbohydrate
alk phos alkaline phosphatase BMV bag mask ventilation CHTN congenital hypertension
A-line arterial line BNP brain natriuretic CI cardiac index; confidence
ALL acute lymphoblastic leukemia BO bronchiolitis obliterans interval xxxvii
Abbreviations
CIED cardiac implantable electronic CTX cyclophosphamide (Cytoxan) Dx diagnosis; diagnostic

device CV cardiovascular DXA dual-energy x-ray absorptiometry
CIN cervical intraepithelial neoplasia CVA cerebrovascular accident
circ circulation; circulatory CVC central venous catheter E
CJD Creutzfeldt-Jakob disease CVD cerebrovascular disease EACA epsilon-aminocaproic
CK creatine kinase CVL central venous line EBL estimated blood loss
CKD chronic kidney disease CVP central venous pressure EBT external beam therapy
CK-MB isoenzyme of creatine kinase CVS cardiovascular status EBV Epstein-Barr virus
with muscle and brain subunits CVHH continuous veno-venous EC eclampsia
CLL chronic lymphocytic leukemia hemofiltration ECA ethacrynic acid
cLQTS congenital long QT syndrome CXR chest x-ray ECC extracorporeal circulation
CLR chlorambucil CYP cytochrome P450 ECD endocardial cushion defect
CML chronic myelogenous leukemia cysto cystoscopy ECF extracellular fluid
CMP comprehensive metabolic panel ECFV extracellular fluid volume
CMRO2 cerebral metabolic rate of oxygen D ECG electrocardiogram
CMS Centers for Medicare and 2,3-DPG 2,3-diphosphoglyceric acid ECHO echocardiogram
Medicaid Services 2D two-dimensional ECMO extracorporeal membrane
CMT Charcot-Marie-Tooth disease d day oxygenation
CMV cytomegalovirus D&A drug(s) and alcohol ECoG electrocorticography
CMZ carbamazepine D and T diphtheria and tetanus ECT electroconvulsive therapy
CN cranial nerve; cyanide D/C discontinue(d) ED50 median effective dose
CNH central neurogenic D5 dextrose 5% in water EDAS encephalodural
hyperventilation DA dopamine arteriosynangiosis
CNS central nervous system DBP diastolic blood pressure EDTA ethylenediaminetetraacetic acid
CO carbon monoxide; cardiac output DC direct current EDV end-diastolic volume
CO2 carbon dioxide DCM dilated cardiomyopathy EEC ectrodactyly-ectodermal
coag coagulation DDAVP 1-deamino(8-d-arginine) dysplasia, cleft (syndrome)
COHb carboxyhemoglobin vasopressin; desmopressin EEG electroencephalogram
COM chronic otitis media acetate EENT eyes, ears, nose, throat
COMT catechol-o-methyltransferase DDT dichlorodiphenyltrichloroethane EF ejection fraction
conc concentration DEA Drug Enforcement Agency EGD esophagogastroduodenoscopy
COPD chronic obstructive pulmonary DEB dystrophic epidermolysis E-L Eaton-Lambert
disease bullosa ELBW extremely low birth weight
ABBREVIATIONS
COX cyclooxygenase dec decleration(s) ELISA enzyme-linked immunosorbent

COX-2 cyclooxygenase-2 deriv derivative(s) assay
cP centipoise derm dermatology EMD electromechanical dissociation
CP cerebellopontine (angle); DEXA dual-energy x-ray EMG electromyography
cerebral palsy; constrictive absorptiometry EMI electromagnetic interference;
pericarditis DFA direct immunofluorescent assay electromechanical
CPAP continuous positive airway DFT defibrillation threshold interference
pressure DGL deglycyrrhized licorice EMLA eutectic mixture of local
CPB cardiopulmonary bypass DGLA dihomo-γ-linolenic acid anesthetics
CPD cephalopelvic disproportion DHA docosahexaenoic acid endo endocrine
CPEO chronic progressive external DHEA dehydroepiandrosterone ENT ear, nose, and throat
ophthalmoplegia DHT dihydrotestosterone EP electrophysiologic
CPK creatine phosphokinase DI diabetes insipidus EPA eicosapentaenoic acid
CPM central pontine myelinolysis DIC disseminated intravascular EPI epinephrine
CPN central pontine myelinolysis coagulation EPO evening primrose oil
CPP cerebral perfusion pressure diff differential EPS electrophysiologic study;
CPR cardiopulmonary resuscitation Dig digoxin extrapyramidal side effects
CPT carnitine palmityl transferase DKA diabetic ketoacidosis ER emergency room
Cr creatinine DKS Damus–Kaye–Stansel ERCP endoscopic retrograde
CRAO central retinal artery occlusion (procedure) cholangiopancreatography
CrCl creatinine clearance DLB dementia with Lewy bodies ERV expiratory reserve volume
CREST calcinosis, Raynaud DLco carbon monoxide diffusion ES Eisenmenger syndrome
phenomenon, esophageal capacity in the lungs es estimated
dysmotility, sclerodactyly, DLT double lumen endotracheal tube ESLD end-stage liver disease
and telangiectasia DM diabetes mellitus ESM ethosuximide
CRF cancer-related fatigue DMARD disease-modifying antirheumatic esp especially
CRI chronic renal insufficiency drug ESR erythrocyte sedimentation rate
CRP c-reactive protein DMD Duchenne muscular dystrophy ESRD end-stage renal disease
CRPS complex regional pain syndrome DMR depolarizing muscle relaxant ESS endoscopic sinus surgery
CRS congenital rubella syndrome DMSO dimethylsufoxide ESU electrosurgery
CRRT continuous renal replacement DNA deoxyribonucleic acid ESV end-systolic volume
therapy DNR do not resuscitate ESWL extracorporeal shock wave
CRT cardiac resynchronization DOB dobutamine lithotripsy
therapy DOE dyspnea on exertion ET endotracheal
cryo cryoprecipitate DPI dry powder inhaler ETCO2 end-tidal carbon dioxide
CS chondroitin sulfate DPNB dorsal penile nerve block ETD eustachian tube dysfunction
C-section cesarean section dSSEP dermatomal somatosensory ETN2 end-tidal nitrogen
CSE combined spinal epidural evoked potentials ETOH ethanol
CSF cerebrospinal fluid DTIC dimethyltriazenoimidazole ETT endotracheal tube; exercise
CSH carotid sinus hypersensitivity carboxamide (dacarbazine) tolerance test
CSM carotid sinus massage DTPA diethylenetriaminepenta-acetic eval evaluation
C-spine cervical spine acid EVD external ventricular drain
CSS carotid sinus syndrome DTR deep tendon reflex Ex exercise
CT computed tomography; DTs delirium tremens exam examination
xxxviii connective tissue DVT deep vein thrombosis ext exterior
Abbreviations
F GI gastrointestinal HRCT high-resolution computed

5-FU 5-fluorouracil GLA γ-linolenic acid
tomography
F female(s) glu glucose HSAN hereditary and sensory
Fab fragment, antigen-binding GPi globus pallidus autonomic neuropathy
FAD flavin adenine dinucleotide GPN glossopharyngeal neuralgia HSCR Hirschsprung disease
FAO Food and Agriculture GTP guanosine triphosphate HSP Henoch-Schönlein purpura
Organization of the United GTT glucose tolerance test HSV herpes simplex virus
Nations GU genitourinary HSV-1 HSV type 1
FB foreign body GVHD graft versus host disease HSV-2 HSV type 2
FBC full blood count gyn gynecologic ht height
FBS fasting blood sugar Htn/HTN hypertension
FDA Food and Drug Administration H HUS hemolytic uremic syndrome
FDP fibrin-degradation product 5-HIAA 5-hydroxyindoleacetic acid HVPG hepatic venous pressure gradient
Fe iron 5-HT 5-hydroxytryptamine Hx history
Fe2+ ferrous H&N head and neck
Fe3+ ferric H&P history and physical I
FEES fiberoptic endoscopic evaluation H1 histamine receptor type 1 I&D incision and drainage
of swallowing H2 histamine receptor type 2 I/O intake-output
FEIBA factor eight inhibitor bypassing H2O water IABP intra-aortic balloon pump
activity HAART highly active antiretroviral IADH inappropriate antidiuretic
FEN fluids, electrolytes, and therapy hormone
nutrition HAF-PCM hypoalbuminemic form of IBD inflammatory bowel disease
FENa excreted fraction of filtered protein-calorie malnutrition IBS irritable bowel syndrome
sodium HAV hepatitis A virus IBW ideal body weight
FES fat embolism syndrome HB heart block ICA internal carotid artery
FEV forced expiratory volume Hb Hemoglobin ICD implantable cardioverter
FEV1 forced expiratory volume in 1 HbA1c glycosylated hemoglobin defibrillator
second HbM hemoglobin Milwaukee ICF intracellular fluid
FFA free fatty acid HbO2 oxyhemoglobin ICH intracranial hypertension
FFP fresh frozen plasma HBV hepatitis B virus ICP intracranial pressure
FHR fetal heart rate HCG or hCG human gonadotropic hormone ICU intensive care unit
FGF fibroblast growth factor HCM hypertrophic cardiomyopathy ID infectious disease
FGFR fibroblast growth factor HCN hydrogen cyanide IDDM insulin-dependent diabetes
ABBREVIATIONS
receptor Hct hematocrit mellitus
FIO2 fractional inspired oxygen HCTZ hydrochlorothiazide IDL intermediate-density lipoprotein
FIX factor IX HCV hepatitis C virus I:E inspiratory:expiratory ratio
FLAIR fluid-attenuated inversion HD heart disease; Hodgkin’s disease IFN interferon
recovery HDL high-density lipoprotein Ig immunoglobulin
FMTC familial medullary thyroid HDL-C HDL cholesterol IgA immunoglobulin A
carcinoma HDU high dependency unit IgE immunoglobulin E
FNA fine-needle aspiration HDV hepatitis D virus IgG immunoglobulin G
FOB fiberoptic bronchoscopy He helium IGF insulin-like growth factor
FOI fiber optic intubation HEENT head, eyes, ears, nose, throat IGF-I insulin-like growth factor I
FRC functional residual capacity HELLP hemolysis, elevated liver IgM immunoglobulin M
freq frequent; frequency enzymes, and low platelet IHD intermittent hemodialysis;
FS Fanconi syndrome count (syndrome) ischemic heart disease
FSBG fingerstick blood glucose heme hematology IL interleukin
FSH follicle-stimulating hormone HEPAT hepatic IM intramuscular
FSP fibrin split products HEV hepatitis E virus immuno immunologic
FT4E free thyroxine estimate HF heart failure in inch
FTT failure to thrive HFM hemifacial microsomia incl including
FVC forced vital capacity HFOV high-frequency oscillatory inf inferior
FVIII factor VIII ventilation info information
FVL factor V Leiden Hg mercury INFOSAN International Food Safeties
Hgb hemoglobin Authorities Network
G HGPRT hypoxanthine-guanine- INH isoniazid
G gauge phosphoribosyltransferase inj injection
G6PD glucose-6 phosphate HHS hyperglycemic hyperosmolar state INR international normalized ratio
dehydrogenase HHT hereditary hemorrhagic insp inspiratory
GA general anesthesia telangiectasia intox intoxication
GABA gamma-aminobutyric acid HHV-3-6 human herpes viruses intraop intraoperative
GAG glycosaminoglycan HIV human immunodeficiency virus IOL intraocular lens
GBE Ginkgo biloba extract
HLA human leukocyte antigen ION ischemic optic neuropathy
GBL gamma butyrolactone HLHS hypoplastic left heart syndrome IOP intraocular pressure
GBM glomerular basement membrane HMG CoA 3-hydroxy-3-methylglutaryl IP impedance plethysmography;
GCS Glasgow coma scale HMPV human metapneumovirus intraperitoneal;
G-CSF granulocyte colony-stimulating HMSN hereditary motor and sensory intraperitoneally
factor neuropathy IPPB intermittent positive pressure
GDM gestational diabetes mellitus HN2 nitrogen mustard breathing
GE gastroesophageal HNP hernia nuclei pulposi IPF idiopathic pulmonary fibrosis
GER gastroesophageal reflux h/o or H/O history of IPL intense pulsed light
GERD gastroesophageal reflux hosp hospitalization IPPV intermittent positive pressure
disease HPA hypothalamic-pituitary-adrenal ventilation
GFR glomerular filtration rate HPS hepatopulmonary syndrome iPTH intact parathyroid hormone
GGT gamma glutamyltransferase HPV hypoxic pulmonary IQ intelligence quotient
GH growth hormone vasoconstriction ITP immune thrombocytopenic
GHB gamma hydroxybutyrate h or hr hour(s) purpura
Gi inhibitory G protein HR heart rate IUGR intrauterine growth restriction xxxix
Abbreviations
IV intravenous M ms milliseconds
IVC inferior vena cava M male(s) MSK musculoskeletal
IVDU intravenous drug user M:F male to female ratio MSSA methicillin-sensitive
IVF intravascular fluid; intravenous M2 muscarinic Staphylococcus aureus
fluid MAC minimum alveolar MTTP microsomal triglyceride transfer
IVP intravenous pyelogram concentration; monitored protein
anesthesia care MTX methotrexate
J MACE minor adverse cardiac event MU million units
JEB junctional epidermolysis MAHA microangiopathic hemolytic mucocut mucocutaneous
bullosa anemia MUGA multiple gated acquisition
JGA juxtaglomerular apparatus MALA metformin-associated lactic musc muscular
JNC Joint National Committee acidosis MV mitral valve
JV jugular vein MAO monoamine oxidase MVA motor vehicle accident
JVD jugular venous distention MAOI monoamine oxidase inhibitor MVD microvascular decompression
JVP jugular venous pressure MAP mean arterial pressure MVP mitral valve prolapse
MAST medical antishock trousers MW molecular weight
K MAT multiform atrial tachycardia MYL Myleran (busulfan)
K+ potassium max maximum; maximal
KS Kartagener syndrome MBC maximal breathing capacity N
KSS Kearns-Sayre syndrome MC myotonia congenita N nitrogen
KUB kidney, ureter, and bladder MCV mean corpuscular volume n. nerve
MD muscular dystrophy N/A not applicable
L MDI metered-dose inhaler N/V nausea/vomiting
L left MEA multiple endocrine adenomas N2O dinitrogen monoxide (nitrous
LA left atrial; left atrium; linoleic mech mechanical; mechanism oxide)
acid; local anesthetic med medication Na+ sodium
lab laboratory MELAS mitochondrial NAAT nucleic acid amplification test
LAD left anterior descending encephalomyopathy, lactic NAC
N-acetyl-l-cysteine
(coronary artery) acidosis, and stroke-like NADH nicotinamide adenine
LAFB left anterior fascicular block symptoms dinucleotide reduced form
LAP left atrial pressure MEN multiple endocrine neoplasia NADPH nicotinamide adenine
lat lateral MEN I multiple endocrine neoplasia dinucleotide phosphate,
LBBB left bundle branch block type I reduced form
ABBREVIATIONS
LBM lean body mass MEN II multiple endocrine neoplasia NAPA N-acetyl procainamide

LCAT lecithin-cholesterol type II NASH non-alcoholic steatohepatitis
acyltransderase MEP motor/multimodality evoked naso nasograstric
LCH Langerhans cell histiocytosis potential NASPE North American Society of
LDH lactate dehydrogenase MERRF myoclonic epilepsy with ragged Pacing and Electrophysiology
LDL low-density lipoprotein red fibers NB nota bene (note well)
LDL-C LDL cholesterol MET metabolic equivalent NCS nerve conduction studies
L-DOPA levodopa Metab metabolism; metabolic NCV nerve conduction velocity
LE lower extremity metHb methemoglobin NDMB nondepolarizing neuromuscular
LES lower esophageal sphincter metHbemia methemoglobinemia blocker
LFT liver function test mets metastases NDMR nondepolarizing muscle relaxant
LGL Lown-Ganong-Levine MF-PCM marasmic form of protein Nd:YAG neodymium:yttrium-aluminum-
syndrome calorie malnutrition garnet
LH luteinizing hormone Mg2+ magnesium NE norepinephrine
LHON Leber hereditary optic MgSO4 magnesium sulfate NEB nebulizer
neuropathy MGUS monoclonal gammopathy of NEC necrotizing enterocolitis
LMA laryngeal mask airway undetermined significance neg negative
LMW low molecular weight MH malignant hyperthermia neuro neurologic
LMWH low molecular weight heparin MI myocardial infarction NF necrotizing fasciitis;
LOC level of consciousness; loss of MILS maternally inherited Leigh neurofibromatosis; neurologic
consciousness syndrome findings
LOS length of stay min minimal; minimum; minute NF-1 neurofibromatosis
LP lumbar puncture MIsch myocardial ischemia NG nasogastric
L-PAM melphalan (Alkeran) MIV mivacurium NGF nerve growth factor
LQTS long QT syndrome mm Hg millimeter(s) of mercury NGT nasogastric tube
LR lactated Ringer’s (solution) MMEFR maximal midexpiratory flow rate NH3 ammonia
LRI lower respiratory tract MMSE Mini–Mental State Examination NHANES National Health and Nutrition
infection mo month Examination Survey
LSB lumber sympathetic block mod moderate NHL non-Hodgkin’s lymphoma
LSD lysergic acid diethylamide MODS multiorgan dysfunction NHLBI National Heart, Lung, and
LTG lamotrigine syndrome Blood Institute
L-to-R left to right MOF multiple organ failure NIBP noninvasive blood pressure
LUQ left upper quadrant MP mucopolysaccharide NICU neonatal intensive care unit
LV left ventricle MPAP mean pulmonary artery NIDDM non–insulin-dependent diabetes
LVAD left ventricular assist device pressure mellitus
LVEDP left ventricular end-diastolic MPS mucopolysaccharidoses NIF negative inspiratory force
pressure MR mitral regurgitation NIH National Institutes of Health
LVEDV left ventricular end-diastolic MRA magnetic resonance NIPHS noninsulinoma pancreatogenous
volume angiography hypoglycemia syndrome
LVEF left ventricular ejection MRI magnetic resonance imaging NIRS near-infrared spectroscopy
fraction MRSA methicillin-resistant NK natural killer (cell)
LVF left ventricular failure Staphylococcus aureus NM neuromuscular
LVH left ventricular hypertrophy MS mental status; mitral NMB neuromuscular blockade
LVOT left ventricular outflow tract stenosis; multiple sclerosis; NMBA neuromuscular blocking agent
xl lytes electrolytes musculoskeletal NMBD neuromuscular blocking drug
Abbreviations
NMDA N-methyl-d-aspartate
PAT paroxysmal atrial tachycardia PONV postoperative nausea and
NMJ neuromuscular junction Paw mean airway pressure vomiting
nml normal PAWP pulmonary artery wedge pos positive
NMO neuromyelitis optica pressure poss possible; possibly
NMS neuroleptic malignant syndrome PBC primary biliary cirrhosis postop postoperative
NO nitric oxide PBF pulmonary blood flow PPAR peroxisome proliferator-
no. number PBG porphobilinogen activated receptor
nondep nondepolarizing PBS peripheral blood smear PPD purified protein derivative
NP nasopharyngeal PCA patient-controlled analgesia (tuberculin)
NP-D Niemann-Pick disease PCC prothrombin complex PPH persistent pulmonary
NPH neutral protamine Hagedorn concentrate hypertension
NPO nil per os (nothing by mouth) PCD primary ciliary dyskinesia PPHN persistent pulmonary
NPPB normal perfusion pressure PCI percutaneous coronary hypertension of newborn
breakthrough (syndrome) intervention PPI proton pump inhibitor
NRI nutritional risk index PCM protein calorie malnutrition Pplat plateau pressure
NRT nictotine replacement therapy PCO polycystic ovary ppm parts per million
NS normal saline (solution) Pco2 partial pressure of carbon PPV positive predictive value;
NSAID nonsteroidal anti-inflammatory dioxide positive pressure ventilation
drug PCP phencyclidine PR per rectum
NT nasotracheal PCR polymerase chain reaction PRA plasma renin activity
NTG nitroglycerin PCW post conceptual week(s) PRBCs packed red blood cells
NTP nucleoside triphosphate PCWP pulmonary capillary wedge preop preoperative
NYHA New York Heart Association pressure prep preparation
PD Parkinson disease; peritoneal prn as needed
O dialysis PRS Pierre Robin sequence
O2 oxygen PDA patent ductus arteriosus PS pulmonary stenosis
OA osteoarthritis PDE II phosphodiesterase III PSA prostate-specific antigen
OAVRT orthodromic atrioventricular (inhibitors) PSC primary sclerosing cholangitis
reciprocating tachycardia PDL pulsed dye laser PSG polysomnography
OB obstetric PDPH post-dural puncture headache PSVT paroxysmal supraventricular
OB/GYN obstetrics/gynecology PD/PK pharmacodynamic/ tachycardia
OC oral contraceptive pharmacokinetic psych psychological
OCD obsessive-compulsive disorder PE physical examination; pt patient
ABBREVIATIONS
OD overdose preeclampsia; pressure PT physical therapy; prothrombin
OFC occipital frontal circumference equalization; pulmonary time
OG orogastric embolism PTCA percutaneous transluminal
OGT orogastric tube PEAC prolonged expiratory apnea with coronary angioplasty
OGTT oral glucose tolerance test cyanosis PTH parathyroid hormone
OHS obesity hypoventilation PEEP positive end-expiratory pressure PTLD post transplant
syndrome PEF peak expiratory flow lymphoproliferative disease
OKT3 Ortho Kung T cell PEG percutaneous endoscopic pts patients
(muromonab-CD3) gastrostomy PTSD posttraumatic stress disorder
OLD obstructive lung disease PEP positive expiratory pressure PTT partial thromboplastin time
OM otitis media periop perioperative PTU propylthiouracil
OMIM Online Mendelian Inheritance PET positron emission tomography PUD peptic ulcer disease
in Man PETCO2 end-tidal partial pressure of pulm pulmonary
ONH optic nerve hypoplasia carbon dioxide PUVA psoralens plus ultraviolet A
OPHTH or PFO patent foramen ovale PVC polyvinyl chloride; premature
ophthal ophthalmologic PFT pulmonary function test ventricular contraction
OR operating room PG prostaglandin PVD peripheral vascular disease
ORIF open reduction internal fixation PGD2 prostaglandin D2 PVO2 partial pressure of oxygen,
ORTHO orthopedic PGE1 alprostadil (prostaglandin E1) venous
OSA obstructive sleep apnea pharm pharmaceutical; pharmacy PVR pulmonary vascular resistance
Osm osmole; osmolality pheo pheochromocytoma PVS primo vascular system
OTC over-the-counter pHTN pulmonary hypertension
physiol physiologic Q
P PID pelvic inflammatory disease Q perfusion
P phosphorus PIH pregnancy-induced q every
P(A-a)o2 alveolar-arterial oxygen hypertension q.a.m. every morning
difference PIP peak inspiratory pressure q.n. every night
PA plasma aldosterone; pulmonary pit pituitary q.p.m. every evening
artery PJP
Pneumocystis jirovecii pneumonia qhs every hour of sleep
PAC premature atrial contraction pKa negative logarithm of the qid four times per day
Paco2 partial pressure of carbon dissociation constant of an Qp:Qs ratio of pulmonary blood to
dioxide, arterial acid systemic blood flow
PACU postanesthesia care unit PKU phenylketonuria QRS Q wave, R wave, S wave
PAF platelet activating factor plt(s) platelet(s) QSART quantitative sudomotor
PAH pulmonary arterial hypertension pM picomolar autonomic reflex testing
PAIR puncture-aspiration-injection- pm evening
respiration PMI posterior myocardial infarction; R
palp palpation of point of maximal intensity R right
Pao2 partial pressure of oxygen in PMS premenstrual syndrome R/O or r/o rule out
arterial blood PNB peripheral nerve block RA rheumatoid arthritis; right
PAOP pulmonary artery occlusion PND paroxysmal nocturnal dyspnea atrial; right atrium
pressure PNS peripheral nervous system RAAS renin-angiotensin-aldosterone
PAP pulmonary artery pressure PO per os system
PAPVD partial anomalous pulmonary Po2 oxygen partial pressure RAD reactive airway disease
venous drainage PO4 phosphate RAE right atrial enlargement xli
Abbreviations
RAH right atrial hypertrophy SEB simplex epidermolysis TBI traumatic brain injury
RAI resting ankle index sec second(s) TBSA total body surface area
RAST radioallergosorbent test SEP sensory evoked potential TBW total body water
RBBB right bundle branch block SERM selective estrogen receptor TCA tricyclic antidepressant
RBC red blood cell modulator TCD transcranial Doppler
RBF renal blood flow SG specific gravity TCS Treacher Collins syndrome
RCM congenital methemoglobinemia SGOT aspartate aminotransferase; TCT thrombin clotting time
of the recessive type serum glutamic-oxaloacetic TEE transesophageal
RCRI Revised Cardiac Risk Index transaminase echocardiography
RCT randomized controlled trial SGPT alanine aminotransferase; TEF transesophageal fistula
RDA recommended daily allowance serum glutamate pyruvate TEG thromboelastography
RDS respiratory distress syndrome transaminase temp temperature
reg regular SIADH syndrome of inappropriate TEN toxic epidermal necrosis
rehab rehabilitation secretion of antidiuretic TENS transcutaneous electrical nerve
REM rapid eye movement hormone stimulation
reprod reproductive SICU surgical ICU tet tetralogy of Fallot
resp respiratory SIDS sudden infant death syndrome TFA trifluoroacetic acid
RFT respiratory function test SIRS systemic inflammatory response TFT thyroid function test
RH releasing hormone syndrome TGA transposition of the great
RHC right heart catheterization SJS Stevens-Johnson syndrome arteries
RHD rheumatic heart disease SJS-TEN Stevens-Johnson syndrome– TGF transforming growth factor
RHF right heart failure toxic epidermal necrolysis THAM tromethamine
RIA radioimmunoassay SL sublingual THC delta-9-tetrahydrocannabinol
RIPA ristocetin-induced platelet SLE systemic lupus erythematosus TIA transient ischemic attack
agglutination SMA superior mesenteric artery TIBC total iron-binding capacity
RLN recurrent laryngeal nerve SND sinus node dysfunction tid three times per day
RNA ribonucleic acid SNP single nucleotide polymorphism TIPS transjugular intrahepatic
ROM range of motion SNS sympathetic nervous system portosystemic shunt
ROP retinopathy of prematurity SOB shortness of breath TIVA total intravenous anesthesia
ROS review of systems SOBOE shortness of breath on exertion TJC The Joint Commission
ROSC return of spontaneous soln solution TKI tyrosine kinase inhibitor
circulation SPECT single-photon emission TLC total lung capacity/compliance
RPGN rapidly progressive computed tomography TM temporomandibular
ABBREVIATIONS
glomerulonephritis SpO2 oxygen saturation as measured TMEP telangiectasia macularis eruptive

RR respiratory rate by pulse oximetry perstans
RRP recurrent respiratory spont spontaneously TMJ temporomandibular joint
papillomatosis SQ subcutaneous; subcutaneously TMO trimethadione
RSV respiratory syncytial virus SSEP somatosensory evoked TMP/SMX trimethoprim/sulfamethoxazole
RT radiation therapy potential TN trigeminal neuralgia
RTA renal tubular acidosis SSP subclavian steal syndrome TNF tumor necrosis factor
RTK receptor tyrosine kinase SSRI selective serotonin reuptake TOF train-of-4; tetralogy of Fallot
R-to-L right-to-left inhibitor TOLAC trial of labor after cesarean
RUQ right upper quadrant SSS sick sinus syndrome TP total protein
RV residual volume; right ST spasmodic torticollis t-PA tissue plasminogen activator
ventricle STD sexually transmitted disease TPN total parenteral nutrition
RVE right ventricular enlargement stim stimulation TPR transient potential receptor
RVH right ventricular hypertrophy STN subthalamic nucleus TR tricuspid regurgitation
RVOT right ventricle outflow tract STSG split-thickness skin graft TRALI transfusion-related acute lung
Rx therapy; treatment; therapeutic STSS streptococcal toxic shock injury
syndrome TRH thyrotropin-releasing hormone
S Stz streptozocin TRPA1 transient receptor potential
S Svedberg unit sup superior ankyrin-1
S/P status post surg surgery; surgical TRPV1 transient receptor potential
SA sinoatrial; beta S/beta A globin SV stroke volume vanilloid-1
gene SVC superior vena cava TRUP transurethral resection of the
SAH subarachnoid hemorrhage SVO2 mixed venous continuous prostate
SAM systolic anterior motion oxygen saturation TSH thyroid-stimulating hormone
SAMe S-adenosyl-l-methionine SVR systemic vascular resistance TT thrombin time
SaO2 oxygen saturation in arterial SVT supraventricular tachycardia TTE transthoracic echocardiography
blood Sx signs and symptoms T-TEPA triethylene-thiophosphoramide
SAP systematic arterial pressure (thiotepa)
SAS sleep apnea syndrome T TTP thrombotic thrombocytopenic
SAT or sat saturation T temperature purpura
SBDP syndromic bile duct paucity T&C type and crossmatch TURBT transurethral resection of
SBE standard base excess; subacute T½ half-life bladder tumor
bacterial endocarditis T3 triiodothyronine TURP transurethral resection of the
SBP systolic blood pressure T4 thyroxine prostate
SCC squamous cell carcinoma TA tricuspid atresia TV tidal volume
SCD sudden cardiac death TACO transfusion-associated Tx transplant; transfusion
SCH succinylcholine circulatory overload TXA2 thromboxane A2
SCID severe combined TAH total abdominal hysterectomy TXA3 thromboxane A3
immunodeficiency TAPVD total anomalous pulmonary TXB2 thromboxane B2
SCLC small cell lung cancer venous drainage TZD thiazolidinedione
SCM sternocleidomastoid TAPVR total anomalous pulmonary
SCS spinal cord stimulation venous return U
SD standard deviation(s) TAVR transcatheter aortic valve UA urinalysis
SDH succinate dehydrogenase replacement UE upper extremity
xlii SDS Shy-Drager syndrome TB tuberculosis UGI upper gastrointestinal
Abbreviations
UK United Kingdom Vd volume of distribution VSD ventricular septal defect

UO urine output VEGF vascular endothelial growth VSS video swallow study
UP urticaria pigmentosa factor VT venous thrombosis; venous
URI or URTI upper respiratory tract vent ventilation thrombus
infection VEP visual evoked potential VTach ventricular tachycardia
urol urology; urologic VEPTR vertical expandable prosthetic VTE venous thromboembolism
US ultrasound titanium rib VVB venovenous bypass
USA United States of America VF or VFIB ventricular fibrillation VVI ventricular inhibited
UT urinary tract VGCC voltage gated calcium channel vWF von Willebrand factor
UTI urinary tract infection VHLD Von Hippel-Lindau disease
UV ultraviolet VIM ventralis intermedius nucleus W
UVGI ultraviolet germicidal irradiation VIPoma vasoactive intestinal peptide- w/ with
secreting tumors w/o without
V vit vitamin WBC white blood cell
V ventilation VKDB vitamin K deficient bleeding WHO World Health Organization
V/Q ventilation-perfusion VLBW very low birth weight wk week(s)
VACTERL vertebral, anal, cardiac, tracheal, VLDL very low density lipoprotein WPW Wolff-Parkinson-White
esophageal, renal, and limb VMA vanillylmandelic acid syndrome
VAE venous air embolism VO2 oxygen consumption per unit wt weight
VAP ventilator-associated pneumonia time
VAS Visual Analogue Scale vol volume XYZ
vasc vascular VP-16 etoposide Xe xenon
VATS video-assisted thoracoscopic VPA valproic acid XR x-ray
surgery VQ ventilation-perfusion XS excessive
VC vital capacity; vocal cord VR venous return y year(s)
VCO2 carbon dioxide consumption per VS vital signs
unit time vs. versus
ABBREVIATIONS
xliii
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Essence of Anesthesia Practice E Book

4th Edition, (Ebook PDF)

Jeffrey D. Roizen, MD, PhD

Vincent S. Cowell, MD D’andra J. Davis, MD Onur Demirci, MD

Paul J. Delahoussaye, MD Ketan Dhatariya, MBBS, MSc, MD,

University of Virginia Acetaminophen

Rohesh J. Fernando, MD Glucose-6-Phosphate Dehydrogenase Deficiency

William R. Furman, MD, MMHC Chris Giordano, MD Taras Grosh, MD

Professor of Anesthesiology at CUMC Philadelphia, Pennsylvania

David Hallsworth, BA Hons

Karen E. Iles, PhD Andrea Johnson, DO Adam M. Kaye, PharmD, FASCP,

Drug Abuse, Lysergic Acid Diethylamide

Rachel J. Kaye Todd J. Kilbaugh, MD Arthur Kitt, MD, MPH

Benjamin H. Krasne, MD Ryan E. Lauer, MD Laeben Lester, MD

Carmen Labrie-Brown, MD H. Thomas Lee, MD, PhD Kristen L. Lienhart, MD

Henry Liu, MD S. Nini Malayaman, MD Jonathan B. Mark, MD

Brenda C. McClain, MD Kevin Miller, MD Roger A. Moore, MD

Von Willebrand Disease Brabois

Paul S. Myles, MB, MPH, MD, Viet Nguyen, MD Sinead Nyhan, MD

Christopher R. Page, MD Prakash A. Patel, MD Philip Peng, MBBS, FRCPC,

Medicine New Orleans, Louisiana

Nathan Poiro, MD Bronwyn R. Rae, MD, FANZCA, Norman Randolph, MD

Amy C. Robertson, MD, MMHC Stanley H. Rosenbaum, MA, MD Benjamin Rubin, MD

Hospitals Healthcare System

Robert Sanders, BSc, MBBS, PhD, David L. Schreibman, MD Kumaran Senthil, MD

Jeffrey S. Shiffrin, MD Department of Anesthesiology Molly Solorzano, MD

Katherine Stammen, MD Jonathan M. Tan, MD, MPH James Joseph Thomas, MD

Lien Tran, MD Shital Vachhani, MD Surbhi Virmani, MD, LLB

Professor of Medical Education, Anesthesiology, and Philadelphia, Pennsylvania

Scott C. Watkins, MD John O.R. Whittle, FRCA Man Piu Wong, MD

Jeffrey D. Roizen, MD, PhD

CIED cardiac implantable electronic CTX cyclophosphamide (Cytoxan) Dx diagnosis; diagnostic

COX cyclooxygenase dec decleration(s) ELISA enzyme-linked immunosorbent

F GI gastrointestinal HRCT high-resolution computed

glomerulonephritis SpO2 oxygen saturation as measured TMEP telangiectasia macularis eruptive

UK United Kingdom Vd volume of distribution VSD ventricular septal defect

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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F GI gastrointestinal HRCT high-resolution computed

glomerulonephritis SpO2 oxygen saturation as measured TMEP telangiectasia macularis eruptive

UK United Kingdom Vd volume of distribution VSD ventricular septal defect