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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clinical Professor of Anesthesiology Assistant Professor of Anesthesiology Professor of Anesthesiology
Department of Anesthesiology and Perioperative Department of Anesthesiology and Perioperative Duke University Medical Center
Medicine Medicine Chief, Anesthesiology Service
Drexel University College of Medicine, Hahnemann Drexel University College of Medicine, Hahnemann Veterans Affairs Medical Center
University Hospital University Hospital Durham, North Carolina
Philadelphia, Pennsylvania Philadelphia, Pennsylvania Cardiomyopathy, Ischemic
Calcium Deficiency/Hypocalcemia Factor V Leiden Mutation
Factor V Leiden Mutation Sinisa Markovic, MD
Fanconi Syndrome
Graves Disease
Gaurav Malhotra, MD Clinical Assistant Professor
Assistant Professor Department of Anesthesiology
Hyperparathyroidism Department of Anesthesiology Jacobs School of Medicine and Biomedical Sciences
Procainamide (Procan, Procanbid, Pronestyl) Perelman School of Medicine at the University of State University of New York at Buffalo
Pennsylvania Attending Anesthesiologist
Renyu Liu, MD, PhD Philadelphia, Pennsylvania Department of Anesthesiology
Associate Professor Appendicitis, Acute Western New York Healthcare System
Department of Anesthesiology and Critical Care Hepatopulmonary Syndrome Buffalo, New York
Perelman School of Medicine at the University of Portal Hypertension Rocky Mountain Spotted Fever
Pennsylvania
Carnitine Kenneth F. Mancuso, MD, MPH David P. Martin, MD, PhD
Assistant Professor Vice-Chair for Safety and Quality
Department of Anesthesiology Associate Professor of Anesthesiology and
Elvedin Luković, MD, PhD Louisiana State University Health Sciences Center Perioperative Medicine
Resident Physician New Orleans, Louisiana Mayo Clinic
Department of Anesthesiology Tissue Plasminogen Activator Rochester, Minnesota
New York-Presbyterian Hospital Poliomyelitis
The Virginia Apgar Research Fellow
Department of Anesthesiology Mark G. Mandabach, MD
Columbia University Medical Center Assistant Professor Courtney G. Masear, MD
New York, New York Department of Anesthesiology and Perioperative Assistant Professor
Riley-Day Syndrome (Familial Dysautonomia, Hereditary Medicine Department of Anesthesiology and Critical Care
and Sensory Autonomic Neuropathy Type III) University of Alabama at Birmingham School of Medicine
Medicine The Johns Hopkins University
CONTRIBUTORS
Birmingham, Alabama Baltimore, Maryland
Philip D. Lumb, MB, BS, MCCM Hepatitis, Halothane Placenta Previa
Keck School of Medicine of the University of Southern
California Dennis T. Mangano, MD, PhD Cory D. Maxwell, MD, FASE
Editor-in-Chief Director and Founder Assistant Professor of Anesthesiology
The Journal of Critical Care McSPI Research Group Durham VA Medical Center
Los Angeles, California San Francisco, California Assistant Professor of Anesthesiology
Lyme Disease Myocardial Ischemia Department of Anesthesiology
Cardiothoracic Division
Astri M.V. Luoma, MBChB, FRCA Luiz Maracaja, MD Duke University
Durham, North Carolina
Consultant Neuroanaesthetist Assistant Professor
Cardiomyopathy, Ischemic
National Hospital for Neurology and Neurosurgery Department of Anesthesiology
University College London Hospitals NHS University of Texas Health Science Center at San
Foundation Trust Antonio Lynne G. Maxwell, MD, FAAP
London, United Kingdom San Antonio, Texas Senior Anesthesiologist
Creutzfeldt-Jakob Disease Mitral Regurgitation Department of Anesthesiology and Critical Care
Pertussis (Whooping Cough) Medicine
Anne M. Lynn, MD The Children’s Hospital of Philadelphia
Professor, Anesthesiology and Pediatrics (Adjunct) Inna Maranets, MD Emeritus Professor, Anesthesiology and Critical Care
University of Washington School of Medicine Assistant Professor
Pennsylvania
Seattle Children’s Hospital Department of Anesthesiology
Seattle, Washington University of Connecticut School of Medicine
Duodenal Atresia
Jeune Syndrome (Asphyxiating Thoracic Dystrophy) Attending Anesthesiologist
St. Francis Hospital and Medical Center
Jonathan G. Ma, MD Hartford, Connecticut C. David Mazer, MD, FRCPC
Resident Eisenmerger Syndrome Professor of Anesthesia and Physiology
Department of Anesthesiology Pyloric Stenosis Department of Anesthesia
Louisiana State University Treacher Collins Syndrome Keenan Research Center in the Li Ka Shing
New Orleans, Louisiana Knowledge Institute of St. Michael’s Hospital
Gingko biloba Piedad Cecilia Echeverry Marín, University of Toronto
Toronto, Canada
Herpes, Type II
Hypernatremia
MD Cilostazol
Hypertension, Uncontrolled With Cardiomyopathy Coordinator of National Committee of Pediatric
Hypopituitarism Anesthesia Niamh A. McAuliffe, MBBCh,
Tetracyclines Colombian Society of Anesthesia FCARCSI, FRCPC
Instituto de Ortopedia Infantil Roosevelt Staff Anesthesiologist
Emily J. MacKay, DO Bogota, Colombia St. Michael’s Hospital
Cardiothoracic Anesthesia Fellow Scimitar Syndrome Lecturer
Department of Anesthesiology and Critical Care University of Toronto
Hospital of the University of Pennsylvania Toronto, Canada
Philadelphia, Pennsylvania Cilostazol
Pneumonia, Community-Acquired
xix
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
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
Department of Anesthesiology, Perioperative and Pain
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
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
Another random document with
no related content on Scribd:
long snake-like figure of the mountain lion come in long bounds across the
snow.
As the boy faced about, the great reddish brute paused for a moment,
crouching, its belly almost on the snow, for the last rush; its ears flattened
back, its yellow eyes ablaze with murder, and its white fangs gleaming in the
starlight. But a foe in the open can always be tackled and fought outright,
and the flash of the good Winchester was redder than the anger in the wild
beast's eyes, and the sharp, clear ring of the little rifle was a more unerring
presage of death than even the scream of the mountain lion.
Over and over the great beast rolled, dyeing the snow with his blood, and
Snap, standing beside him, guessed him at a good ten feet six inches from
the tip of his snout to the tip of his tail.
Having skinned the panther (for in the West this animal is called
indifferently mountain lion, catamount, panther, and a good many more
names), Snap once more plodded homewards, utterly worn out with fatigue
and excitement.
The sound of his rifle had attracted the notice of old Wharton, who now
rode towards him, leading a spare pony for his use. Although there was
much to tell, the two rode home almost in silence, for the spell of the night
was upon them, and, besides, their whole minds were absorbed in the
wonderful spectacle before them.
IN THE WOOD
Suddenly great flames of rosy red had risen from behind the distant
mountains, and reached like the fingers of some great hand across the
heavens. The whole sky was full of the rosy light, the stars had turned white
and pale. The great spokes of flame seemed to tremble with heat, like the hot
air round a chimney on a day in June; then gradually they grew paler and
almost died out, only to flash out again directly in brighter glory. It was the
Aurora Borealis!
CHAPTER XV
FOUNDING 'BULL PINE' FIRM
I must ask my readers to skip nine months or so, during which time
Snap's hands were full of the varied work and sport of ranche life. It was just
before the autumn round-up, and he and Nares were riding round the home
ranche together. For a moment or two Nares pulled up on a bluff from which
you could see far afield, and, looking out over his lands, sighed.
'I shall be sorry to leave it all,' he said, 'but I must, Snap! You did not
know that I had sold the ranche?'
'Sold the ranche! No, indeed! But do you mean it?' replied Snap.
'Yes. This will be my last round-up, and I suppose I ought not to grumble.
I've got to go home and look after the brewery at home. My brother's health
has broken down, and I am the only other man fit for the work in the family.
You know I learnt the game before I took to ranching, and, as I've made
ranching pay, and sold the place and part of the herd well, I, as I said before,
ought not to grumble. But,' he added after a while, 'I do. I shall leave my
heart at Rosebud.'
Then they touched their horses and rode on for a while.

'Do the boys know?' asked Snap.
'No. I've told old Dick. He has known all along. I shall tell the boys, all of
them, before the round-up, and of course I've made arrangements for them to
stay on with the new boss if they like,' replied Nares.
'What is Dick going to do?' was the next question.
'Dick!' replied the cattle-baron; 'oh, Dick's an old fool. He says he has had
one boss, but he doesn't mean to have another. He goes when I do. I think if
he had any capital he would set up in a small way for himself. You see, if he
takes his pay in cows, as he very likely will do, he could start from here with
a little band of nearly fifty. And you, Snap, will stop on, of course?'
'I don't know. I don't think so,' replied the boy. 'I wonder——'
'Wonder! What do you wonder? What is the conundrum?' asked Nares.
'Well, just this: if Dick goes, would he take me along as a cowboy or

junior partner, and would he want two more boys who would be glad to
work for their grub?'
'Two more boys!' cried Nares; 'why, where are they coming from? Are
you and Dick going to take all the boys off the ranche?'
'No,' answered Snap; 'but I was just going to show you this letter when
you began about the sale of the ranche,' and as he said so the boy drew a
very bulky packet from his pocket. 'This,' he went on, 'I got yesterday from
the two Winthrops, the fellows, you know, who came out with me and
stopped at Wapiti.'
'I remember,' replied Nares; 'stopped with a premium-snatcher, didn't

they? Well, I suppose they have got pretty well skinned?'
'Pretty well,' replied his companion; 'but listen. I'll not read their letter,
but skim it for you. Frank writes—he, you know, was the big one. He begins
by "climbing down," says I was right about not paying a premium, and all
that sort of thing; then he goes on to tell his story, says that Jonathan
Brown's ranche was only 360 acres, all told, and his men—"foreman,
cowboys, helps, labourers, &c."—all lived under one skin, and that a black
one. One nigger did everything until the Winthrops came, and when they
came they were expected to share the nigger's work, food, and bed.'
'Oh, come!' cried the boss, 'I call that playing the game pretty low down!
Did the Winthrops stand that?'
'Well, you see, Brown had the dollars, so what could they do?' replied
Snap. 'Of course they slept on the floor by themselves, but they had to do the
work. They learned to split rails and make a fence, because Brown wanted
his land enclosed. They learned to "do chores" because there was no one else
to do them; they helped to cut the corn, and were kept at work at hay harvest
until 9.30 P.M. more than once. All this they bore unmurmuringly; but it
seems old Brown tells everyone that they are his "newies," that he has got
them there out of charity to his sister, whose ne'er-do-weel children they are,
and they don't like that; the old blackguard is always drunk, and they don't
like that. There is no ranching or farming in a large way for them to learn,
and they don't like that; and finally, though he has had 200l. premium and a
year's labour out of them, he won't even now give them as much as he gives
the nigger, and you bet they don't like that. So they are coming out here to
look for work,' concluded Snap.
'The deuce, they are! Have they any money?' asked Nares.
'Not much, I should think; for, you see, they have thrown away their
premium.'
'Well, I'll tell you what you had better do, if they are agreeable. Get old
Dick to take you in as working partners. The old boy is very fond of you,
and if you and the Winthrops could club together four or five hundred
pounds from home, now that you have had some experience, and put it into a
small lot of cattle, it might suit old Dick; and if it suited him, and this range
of which he talks really exists, it would be a first-rate chance for you and
your friends. I'll let you have the cattle cheap,' Nares concluded.
Snap had been looking very anxious during this conversation. Now his
keen young face brightened. He saw a chance for himself and his friends.
'But don't you think such an arrangement would be rather unfair to
Wharton?' he asked.
'No, not a bit,' answered Nares stoutly. 'You are a really good man about a
ranche now, and those two boys looked really likely lads, especially that big,
fair-haired fellow; and then, too, Wharton has no capital worth speaking of.'
'I'll sound him anyhow, that can do no harm,' was Snap's comment; 'the
boys will be here in a day or two.'
'Very well, if they are here when the round-up is going on they can lend a
hand about the camp and make themselves useful, and after that you and
Wharton can go with them to find this ranche.'
'Thanks,' replied Snap, and the man and boy bent from their saddles and
shook hands warmly.
If Nares was going to leave the Rosebud, Snap was not going to stay.
That at any rate was clear to our hero's mind. More than that—if old
Wharton would only take him into his venture there was nothing that he
would like better. This, too, was clear to Snap's mind.
At the first opportunity the boy sounded old Wharton on the subject. He
had not to beat about the bush long.
'Why, lad,' the old fellow cried, 'that is just what I was wanting to say to
you, only I thought that the life might be a bit too hard, and the profits come
mighty slowly; for you know,' he added, 'we must keep putting the income
into the herd for a good many years before we draw anything out for
ourselves.'
'Never mind that, Dick,' replied Snap; 'can you do with my two friends?'
'Well,' the old man answered, with anything but a cheerful face, 'I don't go
much on tender-feet myself, and I don't go for to say that I make a specialty
of home-reared aristocrats; but you say as they'll work and have the dollars
—I guess we mout as well try 'em.'
And so that was settled. At last, after over a year, Snap wrote home a
request that 200l. (half of all he possessed in this world) might be put to his
credit at a Chicago bank, and advised the Winthrops to do the same.
Although strongly prejudiced against tender-feet as a class, Snap's friends

were lucky enough to make a very favourable impression at Rosebud from
the first, for, instead of driving over in a buggy from the railway depot,
Frank and Towzer trudged in on foot, brown as berries, all their earthly
goods in two small bundles which they carried on their backs, and ten dollars
apiece in their pockets, earned by driving cattle up from the South, earning
money by coming over two or three States on foot, instead of paying money
to come on the cars.
When they first landed in America, not much more than a year before, the
three lads who now stood, shaking hands and laughing, at Rosebud were
fair-skinned, soft-handed lads, full of pluck, but looking to others for advice.
Now they were men—hard and brown, with a quiet tone of decision in their
voices, knowing how hard a dollar is to earn, and having some idea of the
necessity of holding on to it when earned.
Wharton confessed that he liked the look of them, and the four set about
making arrangements for their journey at once.
It seemed that years ago, when hunting in a range of mountains to the

west of Rosebud, Wharton had been snowed up and obliged to winter in a
certain valley which he christened Bull Pine Park, because it was surrounded
by a number of Scotch firs, called 'bull pines' by the Yankees. Here, it seems,
he noticed that hundreds and thousands of deer came in to winter, finding
ample food and shelter in what was a sheltered basin of enormous extent,
full of sweet, sun-dried, yellow grass, and protected by the shape of the land
and the timber. To the old man's eye it was a type of what a range should be
—a small range, that is to say—and he had kept his own counsel and waited
until he had capital enough to stock his park and start on his own account.
His only doubt was as to the Indians. True, he had seen none when there, or
he might never have come back; but the valley was a long way from the
frontier ranches, was very full of game, and on the stream which watered it
he had noticed signs of what looked like a large annual fishing-camp. It was
Wharton's intention, after the round-up, to revisit his valley with his three
partners, to carefully reconnoitre the feeding-grounds, build a shanty, and, if
possible, put up a corral, make certain about the nature and disposition of his
red-skinned neighbours, and then, if all was satisfactory, return to Rosebud
and drive in his cattle in the early spring.
Nares had given his old foreman leave to run his cattle and half-a-dozen
of Snap's with the Rosebud herd until the spring, when the Bull Pine Firm,
as Snap proudly called it, would come over to Rosebud and drive off about
one hundred and twenty beasts as the nucleus of their future herd.
During the round-up the two young Winthrops won the good opinion of
everyone by their reckless riding, and still more by the songs they sang over
the camp fire at night. Towzer even had a banjo, the parting present of
Jumbo, Jonathan Brown's black factotum, and with this he was kept
uncommonly busy all night, being excused all share in the cooking
arrangements in return for his music.
'Towzer, give us old Jumbo's own song,' said Frank one night, when all
the old favourites had been sung more than once.
'Which?' asked Towzer, 'Jumbo had such a varied répertoire.'
'Oh, the one for Saturday night, when Brown came back drunk from the
depot. You know,' he added, turning to the rest, 'this old nigger used to
amuse himself by ridiculing his "boss" in nigger melodies. Play up, Towzer.'
So adjured, Towzer twisted his face into a suitable grin, and sang:
Oh, massa! him feel sickly,

Oh, massa 'gwine to die.
Him feel so awful empty,
Him feel so awful dry.
Oh, den he take to whisky,

To whisky made from rye,
It make him feel so frisky,
It make him feel so spry.
Oh, den he chuckle fit to bust,
An' next he almoss' cry.
Dat's how de whisky's in his nose,
De water in his eye.
'Poor old Jumbo!' added Towzer, 'unless Brown gets some more pups
soon, I'm afraid he will have no time for cultivating the Muses.'
'Oh, never fear for Jumbo,' replied Nares; 'as long as there are papers to
advertise in, and no way of scourging these premium-snatchers for obtaining
money under false pretences, your friend Mr. Jonathan Brown will have
plenty of farm-pups, and Jumbo plenty of unpaid 'helps.'
CHAPTER XVI
BEARS
The round-up was over, and the boys had all gone to their different
ranges; Nares had left for England, and outside the ranche-house stood half-
a-dozen ponies saddled and bridled, and tied up to the split-rail fence of the
corral. Two more, loaded with flour-sacks, pots and pans, a sack of beans,
and a side of bacon, stood with them. Amongst the ponies was the old
Cradle, and beside him Dick Wharton's favourite horse. The Bull Pine Firm
was just going to start on its travels, and Texan and 'the Judge,' as two of the
other cowboys were called, had agreed to accompany the expedition and
bring back the ponies after reaching the burnt-wood hills. Old Wharton had
determined only to take ponies thus far, except for a couple of baggage-
animals for which he carried feed, as by so doing the party would be able to
make a short cut through a grassless and difficult mountain country.
As the party stood round, drinking a stirrup-cup to old Wharton's success,
Texan was heard to remark:
'Say! this pison's pretty strong.'
'What's the matter with the pison, Texan? What in thunder air you
grumbling at now?' said the Judge. 'I reckon it's pretty good rye, anyways.'
'Well, pard, I ain't going to quarrel with the rye; but I ain't drunk, am I?
There's no skim milk got into my boots yet, is there?' asked Texan.
'Wal, no,' replied his friend, 'but what are you driving at?'
'Thet's it,' replied Texan, pointing straight overhead, 'but if I didn't think
that it must be the "tangle-legs" that done it, I'd say that theer were a balloon.
It ain't an eagle, anyway.'
They all looked up, and sure enough far overhead was a big round
bubble, as it were, floating rapidly to the north-west. There was no doubt
about it. By using their glasses they could even distinguish the car of the
balloon, but even Snap's glasses (the best of the lot) could help them no
further than that. They could not make out any figure in the car.
'I guess it's a runaway balloon from Chicago or St. Paul,' said Wharton,
'and kicky no one's in it, too. I wish I had the dollars that toy cost, but I
reckon no one will ever catch it this side the Rockies.'
For a time they stood watching this ship of the sky drifting ever further
and further from their sight, and rising, it seemed to them, ever higher and
higher above the earth. At last it faded altogether from their sight, and the
sky looked as calm and unruffled as if no lost bark had ever rushed through
it.
'It's going our way,' said Wharton, 'pretty straight. I wonder, now, if those
superstitious Johnnies one meets sometimes would call that a lucky or an
unlucky omen?'
'A deuced unlucky one,' said Snap, 'if it makes us stand here talking and
star-gazing any longer. We've got fifty miles between us and our night camp.
Let's skip!'
It was a formidable little party which left the ranche that day. Of course,
Snap and Wharton and the two Winthrops were armed for a winter
campaign. Each carried a Winchester repeating-rifle, and old Wharton would
not part with his six-shooter. The boys, not having been brought up to the
use of six-shooters, wisely contented themselves with their rifles. Their two
companions were also armed with rifles, intending to do a little hunting to
supply the ranche with fresh meat on the way home.
For the first few miles the pack-animals were hurried along briskly, partly
because everyone's spirits were too high to brook of a slower pace, and
partly in order to give those cunning beasts no chance of returning to the
home-ranche. In spite, however, of all precautions, and the careful
arrangement of a diamond hitch by Texan, one of the ponies managed to get
rid of his pack in the first mile. On starting, this animal, a sorrel, had
appeared as fat as a brewer's horse, and, in spite of Texan's slaps and kicks,
in spite of his knee planted firmly against its barrel, whilst both his strong
hands tugged at the lash-rope, the sorrel's waist refused to contract an inch.
Once he was fairly on his way, his corpulence vanished as if by magic. With
both heels in the air, he shot through his drivers, plunged amongst some
timber, dived under a fallen tree which lay across the path about three feet
from the ground, left part of his load here—frying-pans without their
handles, and kettles with their sides squeezed in—and then with a roll, a
squeal, and a final kick left pack and pack-saddle on the track, and departed
homewards.
'Guess it ain't much good following that beast,' said Wharton. 'If you don't
mind, Snap, your old Cradle is about the only horse in this outfit that will
carry a pack, and if you'll let us pack the load on him you can ride my pony.
I'll tramp it.'
'Not a bit of it, Wharton,' replied Snap, 'I'm the youngest. I'll walk.'
'Well, we'll walk and ride in turns,' said the old man. 'I don't know that
there is much more fun in riding a walking horse in this timber than in
tramping it yourself.'
This being arranged, the Cradle took up the load, Snap congratulating
himself that by this arrangement his old favourite would go with him all the
way to winter quarters.
Upon the second evening the party camped early. You soon tire of beans
and bacon, especially when you can see signs of deer on all sides, and the
river looks alive with fish.
At three our friends came to an excellent little prairie of half-a-dozen

acres, all bright and green with grass. Bound this little forest oasis stood tall
bull pines, and across the river, which was within a stone's throw of the
camping-ground, the belt of burnt-wood, at which Texan and the Judge were
to turn back, commenced.
'I'll tell you what, Dick,' said Texan, 'it won't do to cross the river to-
night. We'll say good-bye right here to-morrow morning, and some of us can
just run round about and see if we can get any venison for dinner, whilst the
others fix the camp. I'll do the camp-fixing myself, if you like. Who else will
volunteer?'
Of course everyone said that they would stop and fix the camp; but
eventually it was arranged that Wharton and the Judge should take one beat
to the west of the camp, while Snap, with young Towzer under his wing,
should go towards the east; the other two staying in camp.
The youngest Winthrop begged so hard to go that Snap took compassion

on him, although he would infinitely rather have gone out alone.
The course which Snap and Towzer took led them along a fair-sized
stream, which joined the main river not far from camp. Towzer had on his
first pair of mocassins, and, as the forest was open and the boy light, he
made very little noise as he went. Now and then, though, you might have
seen him flinch and almost come down with an expression of agony upon his
face. He had not yet learnt to feel with his feet, as it were, before putting
them down, and had suddenly thrown all his weight on some sharp-pointed
snag of dead wood, or merciless flint, which reminded him that an English
shooting-boot, although noisy, has its advantages.
Stooping down by the river, Snap looked long and fixedly at a track.
'The cattle have been along here, haven't they, Snap?' asked Towzer.
'Whose cattle would they be?'
'Cattle don't eat fish, as a rule, Towzer,' replied Snap in a whisper, for
some of the tracks were pretty fresh; 'and look here, the beasts which made
these tracks picked these bones,' and, so saying, he held up the backbone of a
large salmon, picked as clean as if it had been prepared as an anatomical
specimen.
All along the bank of the stream a regular road was beaten down, one
track on another, until at last all was so confused and level that Towzer's
mistake was an easy one to make. But on one side of the main path Snap had
been able to distinguish a few distinct and separate tracks, and it was as he
looked up from one of these that he said:
'No, these aren't cattle, young 'un; these are bears, and a rare big gang of
them, too.'
Towzer's first expression of delight rather faded away as he looked

behind and round him, where the great bull pines stood grey and silent on all
sides, and the further you peered into them the darker looked the gloom of
the forest. It was not a pleasant idea that the gloomy, quiet forest might be
full of unseen grizzlies.
'Are they grizzlies, do you think, Snap?' asked the boy.
'Can't say for certain,' replied that now experienced hunter, 'but I expect
there are some of all sorts about. You see the river is full of salmon, which
have run up to spawn, and the bears are down here for the fishing season.'
Leaving the river, Snap and his friend crossed two or three deep dingles,
or, as they would call them in America, little canyons, and in half an hour's
time were creeping very cautiously along the brow of a ridge through the big
trees, on which the light of the sun gleamed redly. That sun was now low in
the skies, and every moment Snap expected to catch sight of a stately stag
tossing his head and leading his hinds in single file from the timber to the
feeding-grounds.
'Halloo,' whispered he, suddenly holding up his hand as a sign for silence
to Towzer, 'what is the matter with the robber-birds?'
Towzer listened. A lot of birds just over the ridge were chattering noisily,
like jays in an English covert when the beaters are coming through. Snap
signed to the boy to follow, and both crept cautiously to the top of the ridge.
On the very top was a kind of table-land, and, looking through the trees
with their backs to the sun, neither of our friends could see anything.
Creeping back again, Snap ran along the hill and came up to the top of the
ridge again in such a position as to have the noisy jays between himself and
the sinking sun. For a moment he could still see nothing. Then a stick
cracked under his companion's foot, and the quick movement of a dark mass
in amongst the pines caught and arrested his attention. He had never seen a
grizzly before, but he needed no one to tell him what the great brute was
before him, with its whole body on the alert to detect the source of the sound
it had heard.
The sun threw a red glow on the scene, which looked like blood about the
body of the deer on which the grizzly was feeding. The brute had his claws
on his victim's shoulder, from which he was tearing strips of flesh as he lay
muttering and growling by its side. As the twig cracked he rose and sat
looking over his shoulder in the direction from which the sound came.
Snap remembered old Wharton's words as he looked at the bear: 'Thet's

about his favourite position when he once glimpses you, and don't know
whether to come or go; but don't you shoot then, there's nothing to hit but his
jaw or his shoulder, and you won't kill him quick enough to be safe that
way.' Remembering these words, Snap kept his hand off his rifle and waited
until the bear should give him a better chance; but before this happened there
was a report, which deafened our hero, right by his ear; the bear spun round
with a roar, and then stood tearing at the ground and tossing the earth in the
air in a paroxysm of rage.
Snap hardly dared to breathe, but if his words were inaudible his lips
seemed to say to the reckless youngster beside him, 'Keep still for your life,
he may not see you.'
Neither of the boys was well hidden—in fact, Snap was not hidden at all;
but by remaining rigid, as if he was cut out of stone, the short-sighted beast
did not distinguish him from the pines around him. Luckily, too, he did not
notice the smoke curling from Towzer's rifle.
To the boys the bear was plain enough with his back to the sunlight; but
they themselves were in shadow.
'Good heavens, there's another!' cried Towzer, in a whisper so audible that

the huge, shaggy beast which the unfortunate boy had wounded dropped on
all fours and came a dozen yards towards them, stopping again with his
sharp, fierce snout in the air, trying to catch the wind of his unseen enemies.
At that moment Snap gave all up as lost, for not only had he seen the bear
which had drawn the exclamation from Towzer, but he had seen two other
great grey forms amongst the timber on his right. Gripping the boy's arm
with nervous hand, he drew him down beside him:
'Towzer, is there any tree on your left that you could get up in less than
ten seconds to save your life?'
Snap's white-drawn face showed that he was in earnest, and Towzer

looked desperately round. Like Snap, he had spent many a half-holiday at
Fernhall birds'-nesting, and with climbing-irons to help him there were very
few trees which he could not have climbed in time; but to climb a tree in ten
seconds for your life is quite another matter.
'There, there's the best,' cried Snap out loud, pointing to a young bull pine
with a lot of short stumps of branches not far from the ground. Of course,
they might break off, and then it would be only a bare pole to swarm; but it
was the smallest tree, and the best chance, for all that.
'Now run,' shouted Snap, 'run for your life, and don't look back,' and as he
spoke he pushed the boy from him and jumped up.
With a roar that sounded like a curse, it was so human in its rage, the bear
saw both boys, and half turned towards the running figure. In that moment
Snap's rifle rang out and the bear rolled over.
He knew, without looking, that the others had seen him; and one was
charging straight at him, while with low, angry growls the other two had
trotted into the open. A glance showed him Towzer halfway up his tree. And
yet all this was seen at once without an effort, whilst all his strength and
attention was devoted to pumping up another cartridge into his Winchester
repeater.
There is only one fault in these excellent weapons, and that is a terrible
one. In some of the old-fashioned commoner rifles of this sort the cartridges
occasionally get jammed. This had happened now to Snap. His rifle had
jammed, the empty cartridge would not come out, and there he stood
defenceless with a charging bear almost on the top of him.
Grasping the barrel with both hands, he had just time to hurl the useless
weapon with all his strength at the head of the grizzly and spring to one side.
He had a glimpse of a devilish head, with ears laid back, and fiery eyes, and
long white fangs gleaming from a shaggy mass of grey fur, going over him
at railroad speed. Instinctively he had rolled away as he fell, as a rider rolls
from a fallen horse, and the pace of the bear's charge and the downward
slope of the ground had taken the heavy beast past the prostrate boy.
In a moment Snap was on his legs again, and, dodging behind the first
tree he came to, he scrambled up it.
'Hurry, Snap, hurry!' shrieked Towzer in a voice of agony, and just as our
hero drew up his foot he heard a snort almost against his heel, and a tearing
sound as a great flake of bark was torn from the stem of the pine by the
claws of the bear.
It was a sight to make any man's flesh creep which met the boy's eyes
when he looked down from a point of safety some twenty feet up the pine.
Reared on end, his huge claws stretching upwards, his red jaws open,
muttering and moaning after the prey which had escaped him, one of the
bears leaned against the pine to which Snap clung. Two others, growling
from time to time, prowled round and round the foot of the tree, and in the
middle of the little plateau the wounded bear kept up a succession of moans
and growls as it struggled to its feet and fell back again time after time,
dying, but bent on vengeance still.
Towzer was safe in his tree. Snap's rifle lay broken on the ground, and
Towzer's with a dozen undischarged cartridges in it lay not far from the
wounded bear. 'Ah!' Snap thought, 'if I only had that here!' Towzer, of
course, in his desperate flight had thrown away his arms. Even had he had a
sling to his rifle it would hardly have been possible to climb with it, and
without a sling, and with a grizzly's teeth and claws behind, Towzer did well
to drop his weapon and trust to speed and Snap's self-devotion.
'Snap,' Towzer called from his tree, 'I don't think much of this. I can't hold
on very long. Are those brutes likely to wait long?'
'All night, I should think,' replied Snap.
This seemed too much for Winthrop, and a silence ensued; the boys
clinging desperately to their uncomfortable perches, and the bears prowling
up and down like sentries on their beat.
This went on for nearly an hour, and there was no change, and seemed
likely to be none. The sun's last red glow was on the forest floor; the
uncertain light made the great grey forms which went so silently backwards
and forwards look even more horrible and monstrous to the eyes of their
hapless victims, but two at any rate of the three were still on guard.
'Let's try a shout for help,' said Towzer; 'all together, Snap!'
'Coo-èy! coo-èy!' cried the boys, and as they cried the great grey forms
paused in their silent walk, and sent a chorus of hollow growls to swell the
sound. Other growls from the forest shadows, too, told the boys that, though
they could only see the wounded bear and another, the others were not far
off.
By-and-by the moon rose, and a silver light showed the scene in new and
horrible distinctness. The one bear was dead. Stark and stiff he lay by his last
victim, and silver light and ebon shadow were distributed evenly over the
bodies of bear and stag, murderer and murdered.
A breaking bough and a quick scraping sound broke the silence.
'By Jove, that was a shave!' panted Towzer's young voice.

'What are you at, you little idiot?' cried Snap.
'Jolly nearly fell out of this tree,' replied the boy.
'Went to sleep, I suppose?' said Snap in a tone of disgust.
'I don't know about that,' said Towzer, in a piteous tone, 'but I cannot hold
on to these clothes-pegs much longer.'
The clothes-pegs were the short stumps of boughs to which the boy had
been clinging.
'Snap, couldn't we make a fight of it? I want my supper,' added Towzer,

'and there's only one bear now.'
'How are we to fight? I've got no rifle, and without that you are more
likely to satisfy the bear's appetite than your own,' replied Snap.
'Well, I'll tell you what,' said the reckless youngster, 'I can't stay up here
all night if you can, and, if you are game to come down and try for that rifle,
I am.'
'How do you mean? The bear would get you before you could get to it.
Look at him watching you now. Nice, pleasant face for a photograph, hasn't
he?' added Snap.
In spite of the danger and the eeriness of the whole thing, Towzer laughed
as he saw the great brute sitting half upright on its hams, its ears cocked
sharply up to listen.
'I don't suppose the old brute will understand English,' said Towzer, 'so
look here! My tree is an easy one to get up. I can almost swing myself out of
a bear's reach from the ground. If you will be ready I'll come down and draw
the brute after me. Whilst he hunts me to my tree you dash in and get my
rifle. If you are quick and lucky you'll get back before he twigs you. Why, it
will be just like prisoner's base, when we were first-form boys at the Dame's
school.
'Yes,' muttered Snap, 'with our lives for forfeit if we are caught! Well, all
right, Towzer,' he cried aloud, 'are you sure you can get back safely?'
'Yes, never mind me,' sang out Towzer; 'look here!'
And, sliding down, the boy just touched the ground, and as the bear rose
swung himself back again, chuckling, 'Don't you wish you may get it?'
'All right, then, if you have made up your mind let us do it now; give me
a moment to slide down close to the ground,' shouted Snap; 'keep the bear
looking at you for a moment.'
'All right,' answered the young 'un, rattling about amongst the bushes
with his leg as he hung from the lowest bough of his tree.
The bear was up, and coming slowly towards Towzer, growling horribly.
The boy's blood ran cold, but he had given his word to Snap, and he did not
mean to go back.
'Now!' shouted Snap.
At the cry the bear turned round towards Snap, and as he did so Towzer
dropped to the ground and ran forward into the open with a shout.
For a moment the bear hesitated, then, with a roar that shook the pines,
dashed at him. Towzer turned, and never in all his life, not even when he
made his celebrated 'run-in' for the school-house with the football under his
arm, did he go so fast or dodge so nimbly as he did that night.
As Towzer turned, Snap's lithe figure slipped noiselessly through the

moonlight, and, not daring to look at anything else, dashed straight at the
rifle.
Did the dead bear move, or was it only fancy? Fancy, surely! And now he
had his hand on the rifle and turned to see a ghastly sight. Towzer stretched
up at his bough and missed it. The bear was just behind, there was no time
for another effort, and the boy was driven past his one chance of safety.
Catching at the trunk of a big bull pine, Towzer swung round it, dodged the
bear, and once more tried for his tree. This time he reached the bough, but
even then, blown as he was, the bear must have reached and pulled him
down, had not a ball from Snap's rifle broken the brute's spine as he reared
up on end to make his attack.
Utterly spent, Towzer dropped back beside the bear and staggered across
to where Snap still lay, his rifle resting on the body of the first bear, from
behind which he had just fired. Together the boys sat and looked at one
another, too shaken and tired to speak.
At last, Towzer, looking anxiously round, said, 'Those others won't come
back, will they?'
'I don't know; if they do, I hope they will put us out of our misery quickly.
I didn't know that I had any nerves before, but they are jumping like peas in
a frying-pan to-night. Let's go.'
And very cautiously they went, creeping through the dim aisles of the
forest, starting at every sound, and far more frightened at the meeting than
was even the big stag which met them face to face just before they got clear
of the timber. They never even thought of firing at him, although he was so
fair a shot, and his great sides shook with inches of fat, until the camp-fire
shone through the trees, and then it was too late to remember that they had
gone out for venison and come back without any.
'Well, Towzer, I suppose we must put up with beans and bacon again to-
night—unless,' with a grin, 'you'd care to go down and catch us a salmon, or
fetch a steak from the dead stag up there,' said Snap, pointing back over his
shoulder.
But Towzer had had enough sport for one day, and did not volunteer; and,
indeed, it was not necessary, for the others had killed a hind, and the boys
told their story in short, broken sentences, with a savoury rib in one hand and
a pannikin of tea in the other. They almost thought bear-shooting good sport
by the time they had finished supper.

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Essence of Anesthesia Practice, Fourth

Edition Lee A. Fleisher

Essence of Anesthesia Practice E Book 4th Edition,

Wound Care Essentials: Practice Principles Fourth

CISSP Practice Exams, Fourth Edition Shon Harris

Lovers in Essence: A Kierkegaardian Defense of Romantic

Emily's Essence Lila Fox

Effective Instructional Strategies: From Theory to

The Assessment of L2 Written English across the MENA

Miller's Anesthesia 9th Edition Gropper Michael A.

Jeffrey D. Roizen, MD, PhD

ESSENCE OF ANESTHESIA PRACTICE, FOURTH EDITION ISBN: 978-0-323-39497-0

Copyright © 2018 by Elsevier Inc. All rights reserved.

Previous editions copyrighted 2011, 2002, and 1997

Library of Congress Cataloging-in-Publication Data

Executive Content Strategist: Dolores Meloni

Printed in the United States of America

Daniel Abraham, MD Ahmed Alshaarawi, MS Christophe Aveline, MD

Department of Anesthesiology University of Maryland School of Medicine

Andrew Bowdle, MD, PhD Jessica L. Brodt, MBBS John F. Butterworth, MD

Charles B. Cauldwell, PhD, MD Marc Chikhani, BMedSci, BMBS, Benjamin T. Cobb, MD

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

FOUNDING 'BULL PINE' FIRM

Then they touched their horses and rode on for a while.

'What is Dick going to do?' was the next question.

'Wonder! What do you wonder? What is the conundrum?' asked Nares.

'Well, just this: if Dick goes, would he take me along as a cowboy or

'I remember,' replied Nares; 'stopped with a premium-snatcher, didn't

Although strongly prejudiced against tender-feet as a class, Snap's friends

It seemed that years ago, when hunting in a range of mountains to the

'Which?' asked Towzer, 'Jumbo had such a varied répertoire.'

Oh, massa! him feel sickly,

Oh, den he take to whisky,

'Say! this pison's pretty strong.'

At three our friends came to an excellent little prairie of half-a-dozen

The youngest Winthrop begged so hard to go that Snap took compassion

Towzer's first expression of delight rather faded away as he looked

'Are they grizzlies, do you think, Snap?' asked the boy.

Snap remembered old Wharton's words as he looked at the bear: 'Thet's

'Good heavens, there's another!' cried Towzer, in a whisper so audible that

Snap's white-drawn face showed that he was in earnest, and Towzer

'All night, I should think,' replied Snap.

ESSENCE OF ANESTHESIA PRACTICE, FOURTH EDITION ISBN: 978-0-323-39497-0