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Recent hematocrit/hemoglobin level. There is no universally accepted minimum hematocrit before anesthesia. Hematocrits of 25% to 30% (approximate hemoglobin 8 g/dL) are well tolerated by the otherwise healthy individual but could result in ischemia in the patient with CAD. The etiology and duration of anemia should be ascertained. If the cause is not readily apparent, a surgical delay may be indicated to allow for further workup. The healthy patient undergoing a minimally invasive procedure does not need a routine hematocrit screen.

Histamine antagonists produce a dose-related decrease in gastric acid production. Cimetidine (Tagamet), 200 to 400 mg orally or intravenously, and ranitidine (Zantac), 150 to 300 mg orally or 50 to 100 mg intravenously or intramuscularly, significantly reduce the volume and the acidity of gastric secretions. , the night before and the morning of surgery) are the most effective, although parenteral administration may be used to achieve a rapid (<1 hour) onset. Cimetidine prolongs the elimination of many drugs, including theophylline, diazepam, propranolol, and lidocaine, potentially increasing the toxicity of these agents.

Finally, this handbook could not have been revised without the endless love, support, and patience of my wife, Patti, and son, Daniel. Richard M. Pino, MD, PhD, FCCM CONTENTS Contributors Preface PART I: EVALUATING THE PATIENT BEFORE ANESTHESIA 1 Evaluating the Patient Before Anesthesia Jessie L. Cassada and Laurie Shapiro 2 Specific Considerations with Cardiac Disease Christina Anne Jelly and Olof Viktorsdottir 3 Specific Considerations with Pulmonary Disease Yiuka Leung and Kenneth E. Shepherd 4 Specific Considerations with Renal Disease Samuel Vanderhoek and William Benedetto 5 Specific Considerations with Liver Disease Matthew C.

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