Cover
Title Page
Contributors
Preface
Acknowledgements
Abbreviations
About the companion website
1 An introduction to anaesthesia
1. General anaesthesia
2. Local and regional anaesthesia
3. Anaesthesia today
4. Anaesthesia in the future
5. FURTHER INFORMATION
2 Anaesthetic assessment and preparation for surgery
1. The preoperative assessment clinic
2. The anaesthetic assessment
3. Assessing the risk of postoperative nausea and vomiting
4. The examination
5. Investigations
6. Risks associated with anaesthesia and surgery
7. Obtaining informed consent
8. FURTHER INFORMATION
3 Anaesthetic equipment and monitoring
1. Airway equipment
2. The safe delivery of anaesthesia
3. Measurement and monitoring
4. Further information
4 Drugs and fluids used during anaesthesia
1. Premedication
2. Intravenous anaesthetic drugs
3. Inhaled anaesthetic drugs
4. Malignant hyperpyrexia (hyperthermia)
5. Total intravenous anaesthesia
6. Neuromuscular blocking drugs
7. Analgesic drugs
8. Regulation of opioid drugs
9. Non‐steroidal anti‐inflammatory drugs (NSAIDs)
10. Antiemetics
11. Local anaesthetic drugs
12. Calculation of doses
13. Intravenous fluids
14. Risks of blood and blood product transfusions
15. FURTHER INFORMATION
5 The practice of general anaesthesia
1. Preoperative checks
2. Preparation for anaesthesia
3. Induction of anaesthesia
4. Maintaining the airway
5. Difficult and failed intubation
6. Aspiration of gastric contents
7. Keeping patients warm
8. Maintenance of anaesthesia
9. Transfer into the operating theatre
10. Emergence from anaesthesia
11. Anaesthetists and non‐technical skills
12. FURTHER INFORMATION
6 Local and regional anaesthesia
1. The role of local and regional anaesthesia
2. Local and regional anaesthetic techniques
3. Monitoring during local and regional anaesthesia
4. Complications of central neural blockade
5. Local anaesthetic toxicity
6. Regional anaesthesia: in awake or anaesthetized patients?
7. FURTHER INFORMATION
7 Specialized areas of anaesthesia
1. Anaesthesia for emergency surgery
2. Reducing the risks of aspiration
3. Anaesthesia for obstetric patients
4. Anaesthesia for thoracic surgery
5. Anaesthesia for the overweight and obese patient
6. Anaesthesia for children
7. FURTHER INFORMATION
8 Recovery from anaesthesia
1. The postanaesthesia care unit
2. Postoperative complications and their management
3. Postoperative intravenous fluid therapy
4. Postoperative analgesia
5. Enhanced recovery
6. FURTHER INFORMATION
9 Perioperative medical emergencies
1. Section 1: Recognition and assessment
2. Section 2: Management of common emergencies
3. FURTHER INFORMATION
Index
The Lecture Notes series
End User License Agreement

List of Tables

Chapter 02
1. Table 2.1 Baseline investigations in patients with no evidence of concurrent disease (ASA I).
2. Table 2.2 New York Heart Association (NYHA) classification of cardiac function compared to the Specific Activity Scale.
3. Table 2.3 Anaerobic threshold (AT) values used to predict risk and the need for an increased level of care postoperatively.
4. Table 2.4 World Health Organization classification of obesity based on body mass index (BMI).
5. Table 2.5 STOP‐BANG tool used to screen for sleep apnoea.
6. Table 2.6 Cardiorespiratory warning signs in obese patients.
7. Table 2.7 ASA physical status scale.
8. Table 2.8 Obesity Surgery Mortality Risk Score.
Chapter 03
1. Table 3.1 Medical gas cylinder colours.
2. Table 3.2 Uses of waveform capnography.
3. Table 3.3 Factors affecting the central venous pressure.
Chapter 04
1. Table 4.1 Intravenous drugs used for the induction of anaesthesia and their effects.
2. Table 4.2 Inhalational anaesthetic drugs and their effects.
3. Table 4.3 Factors affecting the minimum alveolar concentration (MAC) of inhalational anaesthetic drugs.
4. Table 4.4 Important side‐effects of suxamethonium.
5. Table 4.5 Non‐depolarizing neuromuscular blocking drugs.
6. Table 4.6 Central and peripheral effects of opioids.
7. Table 4.7 The pure opioid agonists used in anaesthesia.
8. Table 4.8 Relative and absolute contraindications to the use of NSAIDs in anaesthesia.
9. Table 4.9 Commonly used antiemetic drugs, dose and ideal timing.
10. Table 4.10 Local anaesthetic drugs.
11. Table 4.11 Composition of crystalloids.
12. Table 4.12 Composition of colloids.
Chapter 05
1. Table 5.1 Complications of peripheral venous cannulation.
2. Table 5.2 Complications of internal jugular vein cannulation.
3. Table 5.3 Common indications for tracheal intubation.
4. Table 5.4 The ABCDE checklist used when moving a patient.
Chapter 06
1. Table 6.1 Incidence of common complications with spinal anaesthesia.
Chapter 07
1. Table 7.1 Comorbidities associated with obesity.
2. Table 7.2 Suggested drug doses.
3. Table 7.3 Parental responsibility.
4. Table 7.4 Useful paediatric formulas.
Chapter 08
1. Table 8.1 Minimum criteria for discharge from the postanaesthesia care unit.
2. Table 8.2 Effect of alveolar oxygen concentration on oxygen content of blood.
3. Table 8.3 A simple practical scoring system for acute pain.
4. Table 8.4 Morphine preparations.
Chapter 09
1. Table 9.1 Aims of the outreach team.
2. Table 9.2 SBAR and RSVP communication tools.
3. Table 9.3 Causes of acute upper airway obstruction.
4. Table 9.4 Characteristics of airway noises to assist in localizing the level of airway obstruction.
5. Table 9.5 Causes of breathing problems.
6. Table 9.6 Causes of systemic hypotension.
7. Table 9.7 Common causes of a decreased conscious level.
8. Table 9.8 Glasgow Coma Scale.
9. Table 9.9 Causes of pulmonary oedema.
10. Table 9.10 Advantages and disadvantages of direct arterial blood pressure measurement.
11. Table 9.11 Aetiology of acute kidney injury.
12. Table 9.12 Differentiation of pre‐renal from intrinsic renal failure.

List of Illustrations

Chapter 01
1. Figure 1.1 (a) Replica of the ether inhaler used by William Morton to give the first public demonstration of general anaesthesia, 16 October 1846, in Massachusetts General Hospital.
2. Figure 1.2 Young child being ventilated by hand via a tracheostomy during the 1952 polio epidemic in Copenhagen.
Chapter 02
1. Figure 2.1 The pharyngeal structures seen during the Mallampati assessment. Grade I: Hard palate (a), soft palate (b), uvula (c), fauces (d), tonsillar pillars (e) and posterior pharyngeal wall (f) are visible. Grade II: Hard palate, soft palate, uvula, fauces and posterior pharyngeal wall visible. Grade III: Hard palate, soft palate and base of uvula visible. Grade IV: Only hard palate visible.
2. Figure 2.2 The thyromental distance.
3. Figure 2.3 Cardiopulmonary exercise test taking place.
Chapter 03
1. Figure 3.1 Plastic, disposable facemask.
2. Figure 3.2 Oropharyngeal and nasopharyngeal airways.
3. Figure 3.3 Supraglottic airway devices. (a) Disposable LMA. (b) LMA Pro‐Seal^TM. (c) i‐gel^TM.
4. Figure 3.4 Tracheal tubes: (a) standard, (b) preformed (RAE tube), (c) reinforced tube, (d) double‐lumen tube.
5. Figure 3.5 (a) Macintosh laryngoscope. (b) McCoy laryngoscope. Note lever on handle to flex the tip. (c) McCoy laryngoscope with tip flexed. (d) Glidescope^® with view of larynx seen on screen.
6. Figure 3.6 Fibreoptic bronchoscope.
7. Figure 3.7 Optical stylets. Bonfils (above), Shikani (below).
8. Figure 3.8 A typical difficult airway trolley.
9. Figure 3.9 Oxygen, air and nitrous oxide flowmeters on an anaesthetic machine.
10. Figure 3.10 Sevoflurane vaporizer (left) and desflurane vaporizer (right) on an anaesthetic machine. Note the interlock positioned between the coloured dials to prevent simultaneous delivery of both vapours.
11. Figure 3.11 (a) Diagrammatic representation of a circle system (I, inspiratory; E, expiratory valves). (b) Circle system on an anaesthetic machine. Most of the components shown in the diagram are integrated; only the inspiratory and expiratory tubing, the reservoir bag and soda lime container are obvious.
12. Figure 3.12 Modern integrated anaesthetic machine and monitors.
13. Figure 3.13 Close‐up of controls and display of the anaesthetic machine in Figure 3.12.
14. Figure 3.14 Safety cannula. Once the needle is withdrawn from the cannula, the tip is protected to reduce the risk of a needle‐stick injury.
15. Figure 3.15 Integrated monitor displaying ECG and heart rate, invasive blood pressure (arterial waveform), pulse oximeter waveform, end‐tidal carbon dioxide concentration and waveform, inspired and expired oxygen and desflurane concentrations, saturation and temperature.
16. Figure 3.16 Transoesophageal Doppler monitor and oesophageal probe.
17. Figure 3.17 (a) Narrow waveform typical of hypovolaemia. Note: Cardiac output (CO) 3.6 L/minute, stroke volume (SV) 39 mL, heart rate (HR) 91/minute. (b) Broadening of the waveform after giving the patient an IV fluid challenge. Note improvement in haemodynamics: CO 6.3 L/minute, SV 84 mL, HR 76/minute.
18. Figure 3.18 (a) Pulse contour (LIthium Dilution Cardiac Output (LiDCO)) monitor. Note: BP 125/67 mmHg, MAP 89 mmHg, HR 96/minute, stroke volume (nSV) 72 mL, stroke volume variation (SVV) 17%. (b) After a fluid challenge, note improvement in haemodynamics: BP 134/69 mmHg, mean arterial pressure (MAP) 95 mmHg, HR 90/minute, nSV 78 mL, SVV 9%.
19. Figure 3.19 BIS device and representative features for given BIS values.
Chapter 05
1. Figure 5.1 (a) CVP catheter being inserted using ultrasound guidance. (b) Ultrasound screen showing relative positions of the internal jugular vein (IJV) and carotid artery (CA).
2. Figure 5.2 Sagittal section of the head and neck showing how the tongue contributes to airway obstruction.
3. Figure 5.3 Mask being held on patient’s face. Note the use of the little finger to apply a jaw thrust.
4. Figure 5.4 (a–d) The sequence for inserting an oropharyngeal airway.
5. Figure 5.5 (a–c) The sequence for inserting a nasopharyngeal airway.
6. Figure 5.6 (a–e) Sequence for the insertion of a cuffed supraglottic airway device.
7. Figure 5.7 (a) Diagrammatic representation of the ideal view of the larynx at laryngoscopy. (b) Photograph showing tip of epiglottis during laryngoscopy.
8. Figure 5.8 Fibreoptic intubating bronchoscope. A tracheal tube has been mounted ready to advance into the trachea.
9. Figure 5.9 Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.
10. Figure 5.10 The supine position.
11. Figure 5.11 The lateral position.
12. Figure 5.12 The prone position.
Chapter 06
1. Figure 6.1 (a) Ultrasound image of anatomy for TAP block. (1) Internal oblique, (2) transversus abdominis, (3) peritoneal cavity, (4) bowel. (b) Ultrasound image of TAP block. (1) Internal oblique, (2) displaced transversus abdominis, (3) pool of local anaesthetic solution. Dotted line indicates position of needle.
2. Figure 6.2 (a) Placement of the needle tip for epidural anaesthesia. (b) Placement of the needle tip for spinal (intrathecal) anaesthesia.
3. Figure 6.3 Spinal anaesthesia. The 25 G needle has been inserted via an introducer and CSF can be seen dripping from the hub.
4. Figure 6.4 Photomicrograph showing the shape of a bevel needle (top) and ‘pencil point’ needle (below).
Chapter 07
1. Figure 7.1 Cricoid pressure (Sellick’s manoeuvre).
2. Figure 7.2 Patient (volunteer) positioned on operating table with 15° left lateral tilt.
3. Figure 7.3 Left‐sided double‐lumen tube, arrows showing direction of gas flow. (a) Ventilation of both lungs. (b) Ventilation of left lung, deflation of right lung.
4. Figure 7.4 Ramping pillow used to facilitate laryngoscopy and intubation. The horizontal line indicates the optimal head extension with the external auditory meatus level with the sternum.
Chapter 08
1. Figure 8.1 Graph showing the relationship between PaCO₂ and alveolar ventilation.
2. Figure 8.2 Graph showing the relationship between PaO₂ and alveolar ventilation at two different inspired oxygen concentrations.
3. Figure 8.3 (a) Hudson mask. (b) Nasal catheters in position.
4. Figure 8.4 (a) Hudson mask with reservoir. (b) High‐airflow oxygen enrichment (HAFOE; Venturi) mask.
5. Figure 8.5 Treatment pathway for postoperative nausea and vomiting (PONV).
6. Figure 8.6 Sites of actions of analgesic drugs. CSF, cerebrospinal fluid; IM, intramuscular; IV, intravenous; NMDA, N‐methyl‐D‐aspartate; NSAID, non‐steroidal anti‐inflammatory.
7. Figure 8.7 Some commonly used nerve blocks. TAP, transversus abdominis plane.
Chapter 09
1. Figure 9.1 The National Early Warning Scoring system.
2. Figure 9.2 Head tilt and chin lift.
3. Figure 9.3 Algorithm for emergency tracheostomy management.
4. Figure 9.4 Algorithm for emergency laryngectomy management.
5. Figure 9.5 Chest X‐ray showing acute pulmonary oedema.
6. Figure 9.6 CT pulmonary angiogram showing ‘saddle’ embolus in the pulmonary artery.
7. Figure 9.7 Twelve‐lead ECG showing a STEMI; inferior myocardial infarction with ST segment elevation in leads II, III and aVF.
8. Figure 9.8 Adult Advanced Life Support (ALS) algorithm.
9. Figure 9.9 Simultaneous check of breathing and pulse to confirm cardiac arrest.
10. Figure 9.10 Chest compressions during CPR. Note hand position in the middle of the lower half of the sternum.
11. Figure 9.11 Self‐adhesive pads being applied with on‐going chest compressions.
12. Figure 9.12 CT brain showing large low‐density area in the right frontoparietal region, consistent with an ischaemic stroke.

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1

First edition 1997. © Carl L. Gwinnutt
Second edition 2004. © Carl L. Gwinnutt
Third edition 2008. © Carl L. Gwinnutt
Fourth edition 2012 © 2012 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging‐in‐Publication Data

Names: Gwinnutt, Carl L., author. | Gwinnutt, Matthew, author.
Title: Lecture notes. Clinical anaesthesia/Matthew Gwinnutt, Carl Gwinnutt.
Other titles: Clinical anaesthesia
Description: Fifth edition. | Chichester, West Sussex, UK ; Hoboken, NJ :
John Wiley & Sons Inc., 2017. | Carl Gwinnutt's name appears first on the
previous edition. | Includes bibliographical references and index.
Identifiers: LCCN 2016011445 | ISBN 9781119119821 (pbk.) | ISBN 9781119119845
(Adobe PDF) | ISBN 9781119119852 (epub)
Subjects: | MESH: Anesthesia | Anesthetics
Classification: LCC RD81 | NLM WO 200 | DDC 617.9/6–dc23
LC record available at http://lccn.loc.gov/2016011445

A catalogue record for this book is available from the British Library.

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Cover image: John Wiley and Sons Ltd.

Preface

It is only four years since the last edition of this book, but changes continue apace and the time had come to ensure that Lecture Notes, Clinical Anaesthesia reflected these changes and also responded to the feedback received around the previous edition. The first major change is the new Chapter 1, ‘An introduction to anaesthesia’. We hope you will take the time to have a look at this, even if only briefly, as we have tried to provide an insight into how the specialty has developed and where it is heading. It is estimated that around 70% of all hospital patients encounter an anaesthetist at some point during their admission, hardly surprising when we consider how broad the scope of the specialty of anaesthesia has become and the numerous professionals working together as part of the team. Therefore, we have approached the task of writing of this edition with the team in mind, and hope that it will be useful not only for medical students but also for trainees in anaesthesia and other acute specialties, trainee physician’s assistants in anaesthesia, operating department practitioners and recovery nurses.

As would be expected, the content has been fully updated to reflect areas where there have been changes in clinical practice, new guidelines and new equipment or drugs. We have increased coverage of the perioperative management of the overweight and obese patient to reflect the increasing frequency with which this group of patients is encountered and, in response to numerous requests, we have for the first time included an introduction to some basic aspects of paediatric anaesthesia. Other new topics include an outline of enhanced recovery after surgery (ERAS) and the importance of anaesthetists’ non‐technical skills (NTS). Given the likely future expansion of anaesthetists into the developing field of perioperative care, we felt it appropriate to keep and expand slightly the chapter detailing the recognition and management of some of the more common perioperative medical emergencies.

Apart from updating the contents, there are two key changes in this edition compared to previous ones. Firstly, to help you take a structured approach to learning about anaesthesia, we have included a series of objectives at the start of each chapter. These are divided into two sections: firstly, the knowledge you should aim to acquire by reading each chapter, and secondly, an indication of the skills that we feel are important and are based upon the former. We hope this will give you a clearer idea of what you should try and achieve during an anaesthetic attachment. For those of you using this book who are not medical students, we feel these learning objectives are equally relevant and achievable.

The second change is an attempt to encourage you to use the vast resources available via the internet. The potential problem with this approach is that there is little quality control over what is available. Therefore, we have only included links to web sites we know, have checked and believe are reliable. For those of you using a hard copy of the book, interesting and useful web sites are numbered within the text, for example [2.2], and the web address is listed in the ‘Further information’ section at the end of the chapter. For those of you using the e‐book, the numbers within the text are hyperlinked directly to an organization’s web site or a specific article. We hope you will use this and feel free to feed back your thoughts and comments.

Finally, we close by repeating the same message as in previous editions – we hope that you will enjoy this book but, more importantly, that it helps you provide better care for your patients. If it has, tell your friends, if it hasn’t, tell us! We hope that it is improving each time, but it still is and will always remain ‘work in progress’.

Abbreviations

AAGBI: Association of Anaesthetists of Great Britain and Ireland
ABG: arterial blood gas
ABW: adjusted body weight
ACD‐A: anticoagulant citrate dextrose solution A
ACE‐I: angiotensin converting enzyme inhibitor
ACS: acute coronary syndrome
ADH: antidiuretic hormone
AIM: Acute Illness Management
AKI: acute kidney injury
ALERT: Acute Life‐threatening Event Recognition and Treatment
ALS: Advanced Life Support
AMI: acute myocardial infarction
ANTT: antiseptic no‐touch technique
APL: adjustable pressure limiting
APLS: Advanced Paediatric Life Support
ARDS: acute respiratory distress syndrome
ASA: American Society of Anesthesiologists
AT: anaerobic threshold
ATN: acute tubular necrosis
AV: atrioventricular
BIS: bispectral index
BMI: body mass index
BNF: British National Formulary
BiPAP: bilevel positive airway pressure
BP: blood pressure
BTS: British Thoracic Society
CAP: community‐acquired pneumonia
CCrISP: Care of the Critically Ill Surgical Patient
CCU: coronary care unit
CEPOD: Confidential Enquiry into Perioperative Death
CNS: central nervous system
CO₂: carbon dioxide
COPD: chronic obstructive pulmonary disease
COX: cyclo‐oxygenase
CPAP: continuous positive airway pressure
CPR: cardiopulmonary resuscitation
CPX: cardiopulmonary exercise
CRP: C‐reactive protein
CRT: capillary refill time
CSF: cerebrospinal fluid
CT: computed tomography
CTPA: computed tomography pulmonary angiography
CVC: central venous catheter
CVP: central venous pressure
CVS: cardiovascular system
CXR: chest X‐ray
DAS: Difficult Airway Society
DBP: diastolic blood pressure
DBS: double‐burst simulation
DNACPR: do not attempt cardiopulmonary resuscitation
DS: degrees of substitution
DVT: deep venous thrombosis
ECF: extracellular fluid
ECG: electrocardiogram
EEG: electroencephalograph
EMLA: eutectic mixture of local anaesthetics
ENT: ear, nose and throat
EPLS: European Paediatric Life Support
ETC: European Trauma Course
ETT: exercise tolerance test
EWS: Early Warning Score
FAST: focused assessment with sonography in trauma
FBC: full blood count
FEEL: focused echocardiography in emergency life support
FEV₁: forced expiratory volume in 1 second
FFP: fresh frozen plasma
FICM: Faculty of Intensive Care Medicine
FiO₂: fractional inspired oxygen concentration
FRC: functional residual capacity
FRCA: Fellow of the Royal College of Anaesthetists
FVC: forced vital capacity
GCS: Glasgow Coma Scale
GFR: glomerular filtration rate
GI: gastrointestinal
GTN: glyceryl trinitrate
HAFOE: high‐airflow oxygen enrichment
HAP: hospital‐acquired pneumonia
Hb: haemoglobin
HbA1c: glycosylated haemoglobin
HDU: high‐dependency unit
HIV: human immunodeficiency virus
HR: heart rate
HRT: hormone replacement therapy
5‐HT: 5‐hydroxytryptamine
HTLV: human T‐cell lymphotrophic virus
IBW: ideal body weight
ICF: intracellular fluid
ICM: intensive care medicine
ICP: intracranial pressure
ICU: intensive care unit
I:E ratio: inspiratory:expiratory ratio
ILMA: intubating LMA
IM: intramuscular
INR: international normalized ratio
IPPV: intermittent positive pressure ventilation
IR: immediate release
ITU: intensive therapy unit
IV: intravenous
IVC: inferior vena cava
IVRA: intravenous regional anaesthesia
JVP: jugular venous pressure
K⁺: potassium ions
kPa: kilopascals
LA: local anaesthetic
LBBB: left bundle branch block
LBW: lean body weight
LED: light‐emitting diode
LFT: liver function test
LMA: laryngeal mask airway
LMWH: low molecular weight heparin
LP: lumbar puncture
LSD: lysergic acid diethylamide
LVF: left ventricular failure
MAC: minimum alveolar concentration
MAP: mean arterial pressure
MET: metabolic equivalent; medical emergency team
MH: malignant hyperpyrexia
MHRA: Medicines and Healthcare products Regulatory Agency
MI: myocardial infarction
MODS: multiple organ dysfunction syndrome
MR: modified release
MRI: magnetic resonance imaging
Na⁺: sodium ions
NCEPOD: National Confidential Enquiry into Patient Outcome and Death
NEWS: National Early Warning Score
NIBP: non‐invasive blood pressure
NICE: National Institute for Health and Care Excellence
NMDA: N‐methyl‐D‐aspartate
N₂O: nitrous oxide
NPSA: National Patient Safety Agency
NSAID: non‐steroidal anti‐inflammatory drug
NSTEMI: non‐ST segment elevation myocardial infarction
NYHA: New York Heart Association
OCP: oral contraceptive pill
ODP: operating department practitioner
OHS: obesity hypoventilation syndrome
OLV: one‐lung ventilation
OSA: obstructive sleep apnoea
OSAHS: obstructive sleep apnoea and hypopnoea syndrome
OS‐MRS: Obesity Surgery Mortality Risk Score
OTC: over the counter
PA(A): physician’s assistant (anaesthesia)
PaCO₂: arterial partial pressure of carbon dioxide
PACU: postanaesthesia care unit
PCA: patient‐controlled anaesthesia
PCI: percutaneous coronary intervention
PCV: pressure‐controlled ventilation
PDPH: postdural puncture headache
PE: pulmonary embolism
PEA: pulseless electrical activity
PEEP: positive end expiratory pressure
PEF: peak expiratory flow
PEFR: peak expiratory flow rate
PMGV: piped medical gas and vacuum system
PaO₂: arterial partial pressure of oxygen
POCT: point of care testing
PONV: postoperative nausea and vomiting
PPCI: primary percutaneous coronary intervention
PPI: proton pump inhibitor
psi: pounds per square inch
PSV: pressure support ventilation
PT: prothrombin time
pVT: pulseless ventricular tachycardia
RBBB: right bundle branch block
ROSC: return of spontaneous circulation
RRT: renal replacement therapy
RSI: rapid‐sequence induction
RSVP: Reason, Story, Vital signs, Plan
SBAR: Situation, Background, Assessment, Response
SBP: systolic blood pressure
SGA: supraglottic airway
SIRS: systemic inflammatory response syndrome
SOBA: Society for Obesity and Bariatric Anaesthesia
SpO₂: peripheral oxygen saturation
STEMI: ST segment elevation myocardial infarction
SVC: superior vena cava
TAP: transversus abdominis plane
TBW: total body weight
TCI: target‐controlled infusion
TIVA: total intravenous anaesthesia
TOF: train‐of‐four
TTE: transthoracic echocardiography
U&E: urea and electrolytes
VCO₂: carbon dioxide production
VF: ventricular fibrillation
VIE: vacuum‐insulated evaporator
VO₂: oxygen consumption
V/Q: ventilation/perfusion ratio
VT: ventricular tachycardia
VTE: venous thromboembolism
WBC: white blood cell
WHO: World Health Organization