Innovation, training and research are the pillars that support a process deriving from basic science and multi-professional/multidisciplinary interventions. The APICE 2012 yearbook deals with several innovations for optimising prevention and management measures for the critically ill, by integrating diagnostic procedures with pharmacological and technological options. Peri- and postoperative managements as well as treatment of surgical infections and of pain, new and old artificial ventilation strategies are some of the most relevant topics the volume deal with in this new edition. The volume focuses also on the improvement standards and quality of care; on the expanding concept of clinical governance and professionalism and on the importance of ethical principles for establishing a process of patient-centered and evidence-based care.

The book presents more than 60 real-life cases which together memorably and succinctly convey the depth and breadth of clinical anesthesiology. Each chapter includes a case summary, questions, lessons learned, and selected references. Tables and distinctive visual synopses of key teaching points enhance many chapters. The cases have been selected by Dr. Benumof from the Morbidity and Mortality (M & M) conferences of the Department of Anesthesiology, University of California, San Diego, which he has moderated the last several years, and residents and junior faculty have crafted them into the chapters of this book. Structured in a novel way, the UCSD Anesthesiology M&Ms maximize teaching and learning, and these cases bring that experience right to the reader's finger tips. * Case coverage of respiration- and circulation-related problems, obstetrics, neurology, pain and regional anesthesia, pediatrics, outpatient surgery, and special topics * Resource for anesthesiology and critical care medicine trainees * Review tool for board certification or recertification * Fun reading - valuable lessons

Everyone knows what it feels like to be in pain. Scraped knees, toothaches, migraines, giving birth, cancer, heart attacks, and heartaches: pain permeates our entire lives. We also witness other people - loved ones - suffering, and we 'feel with' them.
It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what they describe as 'painful' has changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'.
Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment?
As Joanna Bourke shows in this fascinating investigation, people have come up with many different answers to these questions over time. And a history of pain can tell us a great deal about how we might respond to our own suffering in the present - and, just as importantly, to the suffering of those around us.

Analysis of blood gas can be a daunting task. However, it is still one of the most useful laboratory tests in managing respiratory and metabolic disorders. Busy medical students have struggled ineffectively with Hasselbach's modification of the Henderson equation, been torn between the Copenhagen and the Boston schools of thought; and lately, been confronted with the radically different strong-ion approach. In modern medical practice, the health provider's time is precious: it is crucial to retain focus on those aspects of clinical medicine that are of key importance. Adoption of an algorithm-based approach in the study of topics that are hard to understand (particularly those that are rooted in clinical physiology) can be extremely advantageous. Handbook of Blood Gas/Acid-Base Interpretation, 2nd edition, is organized in a logical sequence of flow charts that introduce concepts and gradually build upon them. This approach facilitates understanding and retention of the subject matter. Medical students, residents, nurses, and practitioners of respiratory and intensive care will find it possible to quickly grasp the principles underlying respiratory and acid-base physiology, and apply them effectively in clinical decision making.

A key requirement of the primary and final FRCA examinations is a sound understanding of the basic sciences behind anaesthetic practice. It is important to be able to describe these principles clearly, particularly in the viva section of the examinations. Featuring several new topics, this fully updated new edition of this best-selling book provides all the important graphs, definitions and equations which may be covered in the examinations, together with clear and concise explanations of how to present them to the examiner and why they are important. Packed full of precise, clear diagrams with well structured explanations, and with all key definitions, derivations and statistics, this is an essential study aid for all FRCA examination candidates.

Comprehensive Guide to Education in Anesthesia is the first single-source volume on the current practice of teaching and learning in this specialty which has long been at the forefront of innovation in medical education. It is edited by one of the great anesthesiology educators in the United States and brings together contributions from leading educators from across the US covering all aspects of anesthesiology education, from medical school and post-graduate training to board certification and continuing medical education.

Topics include best educational practices, closed claim analysis, giving feedback to superiors, residency and fellowship training and requirements, maintenance of certification, the role of simulation, interacting with other specialties, community and global outreach, and more. The book conveys the unique nature of the specialty and is aimed at medical students contemplating a career in anesthesiology, residents and fellows, educators, and administrators.

Essentials of Palliative Care is a to-the-point, clinically oriented resource for all members of the multidisciplinary palliative care team and trainees. It covers practical clinical topics, including assessment of the patient and pain and symptom management, and practical non-medical topics central to providing effective palliative care, including psychological management, guidance on how to help patients and their families through the many healthcare decision points they face, and sensitivity to the goals and culture of the patient. Review questions, with detailed answers, provide a convenient way for readers to test their knowledge.

Features:

. Concise, comprehensive, clinically focused

. Multiple choice review questions, with detailed answers

. Expert contributors from leading institutions

. Coordination of care by palliative care team a major focus

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Brain Injury is the second volume in the book series, Molecular and Cellular Biology of Critical Care Medicine. In this volume, a group of internationally regarded experts in important areas of neuroscience and neurointensive care research address the molecular and cellular basis of acute brain injury. This text covers acute brain injury within a context relevant to the care of patients with critical neurologic injuries such as cardiac arrest, trauma and stroke. It includes recent data pertaining to established pathways such as neurotransmission, exitotoxicity, ionic-mechanisms, oxidative stress, inflammation, and cerebral vascular injury. In addition, rapidly developing areas such as cell signaling, adenosine pharmacology, apoptosis, mitochondrial dysfunction, neurocytoskeletal changes, and the role of trophic factors are reviewed from the level of in vitro modeling to human data. Other topics covered that are highly clinically relevant include the effect of genetic background and gender differences in outcome after brain injury, preconditioning, and the effects of currently used anesthetics and sedative agents in patients with brain injury.

Acupuncture for Pain Management is intended as the premier resource for learning the fundamentals of the art of medical acupuncture. Edited by top pain medicine specialists at Harvard and UCLA, and based on their popular annual workshop at the American Society for Anesthesiologists, the book is the perfect synthesis of Western and Chinese medicine. Anesthesiologists, pain medicine specialists, primary care physicians, osteopaths, neurologists, psychiatrists, physical medicine and rehabilitation specialists, and other health professionals looking to add acupuncture to their repertoire will benefit from the concise and practical approach of the book. Features: Each individual meridian discussed in detail Acupuncture for 25 clinical conditions, including headache, menstrual pain, low back pain, insomnia, and more Aimed at acupuncturists as well as practitioners who want to add acupuncture to their clinical armamentarium

Those who do not feel pain seldom think that it is felt. SAMUEL JoHNSON, The Rambler, no. 48 (September 1, 1750) Who among us has not experienced the suffering of a patient with chronic disease, who in addition to the vicissitudes of fatigue, anxiety, and frustration, must also deal with the suffering of pain? Who among us has not considered, and then reconsidered, whether a patient's complaints are worthy of a narcotic and thence worried about the social and legal implications of chronic use? Who among us has not refused pain medications to our patients for fear that use was turning into abuse? Finally, who among us would not have liked a clinical guide to a myriad of syndromes, all of which have pain as their common denominator, in the hopes of developing some strategy to prioritize treatment. Our purpose in preparing The Pain Management Handbook is to provide the informa tion needed by clinicians to develop strategies that optimize pain management. It is the goal of the editors and authors that the present handbook, above all else, will be clinically useful. Its aim is to provide practical information regarding the diagnosis and treatment of disorders causing pain, along with tables and graphics to provide the busy practitioner with rapid access to relevant data.

This book provides a comprehensive overview of current standards of anesthesia and intensive care in neonates and children, with a view to promoting standardization in clinical practice.

The first part of the book, devoted to issues in intensive care, opens by considering scoring systems for the assessment of sick children. The diagnosis, prevention, and management of ventilator-associated pneumonia are then discussed, and the roles of high-frequency oscillatory ventilation and noninvasive respiratory support are reviewed. Further chapters address procedural sedation and analgesia in children, the progress toward open ICUs with liberal visiting policies, and advances in long-term home mechanical ventilation.

In the second part of the book, a range of important topics in anesthesia and perioperative medicine are discussed. After a review of safety issues, current trends in pediatric regional and locoregional anesthesia are described and a synopsis is provided on current knowledge regarding the use of central blocks in infants and children. Subsequent chapters are devoted to awareness monitoring, single-lung ventilation techniques, anesthesia in the context of severe prematurity, and emergence delirium.

"Pediatric Anesthesia, Intensive Care and Pain: Standardization in Clinical Practice" will be an extremely useful source of information for both novices and more experienced practitioners in the field."

Thousands of articles and many books have been published on the acquired immunodeficiency syndrome (AIDS). There are, however, no studies or case reports and only several articles published on the anesthetic considerations for a person with AIDS or in pain with AIDS. There is no literature on the pain management of AIDS patients. Writing on this subject must be considered trailblazing. The reason anesthesiologists should know about AIDS has rapidly extended from concern over transmission of infection to anesthetic and analgesic considerations. The anesthesiologist may also be part of a pain management team on either an acute or a chronic pain service. The requirement may be to treat an HIV -positive or AIDS patient acutely postoperatively or in consult to a psychiatric, medical, or surgical service. In a pain clinic setting, the anesthesiologist may be concerned with diagnosis, treatment, or referral for other multidisciplinary consultation. The earlier question of central nervous system involvement in AIDS is now moot, rapidly replaced with the knowledge that the eNS, if not primarily infected, is so shortly thereafter. Protected by the blood-brain barrier, the eNS becomes both a sanctuary and reservoir for HIV. Because neurologic complications of HIV are common, and since knowledge of the nervous system is essential for anesthetic and pain management, it is important to review HIV infection of the nervous system.

The administration of intravenous fluids is one of the most common and important therapeutic practices in the treatment of surgical, medical and critically ill patients. The international literature accordingly contains a vast number of works on fluid management, yet there is still confusion as to the best options in the various situations encountered in clinical practice. The purpose of this volume is to help the decision-making process by comparing different solution properties describing their indications, mechanisms of action and side-effects according to physiologic body water distribution, electrolytic and acid-base balance, and to clarify which products available on the market represent the best choice in different circumstances. The book opens by discussing in detail the concepts central to a sound understanding of abnormalities in fluid and electrolyte homeostasis and the effect of intravenous fluid administration. In the second part of the monograph, these concepts are used to explain the advantages and disadvantages of solutions available on the market in different clinical settings. Body Fluid Management: From Physiology to Therapy will serve as an invaluable decision-making guide, including for those who are not experts in the subject.

At the turn of the century it is appropriate to take stock of this relatively young but rapidly developing subject. For the first time, this book brings together information on the status of obstetric regional analgesia in many parts of the globe, and on the intriguing variability of maternal attitudes towards it. Advances in the field over the last decade in new applications, new drugs and techniques and new research tools are also reviewed. Controversial topics such as the effects of regional analgesia on the progress of and outcome of labour, the indications, contraindications and complications, and the place of regional anaesthesia for operative delivery are discussed by numerous experts in the field. The problem of consent and medicolegal aspects are also addressed. Regional Analgesia in Obstetrics should be read by all those involved in the medical care of women in childbirth. Professor Felicity Reynolds is Emeritus Professor of Obstetric Anaesthesia, St Thomas' Hospital, London, UK.

When a person suffers from advanced, progressive illness, palliative care -- treatments that improve the physical and psychological quality of life of patients and their families -- can be just as important as treatments that aim to slow or prevent disease progression. Aimed at general practitioners and trainees in the field, Palliative Care in Clinical Practice offers an accessible and practical introduction to palliative medicine, including a chapter devoted to each of the key areas of symptom management. Clearly and concisely written and fully illustrated throughout, it will be a useful resource for all healthcare professionals who wish to gain an understanding of this important aspect of medicine.

In anesthesia practice and treatment, pharmacology and therapeutics are intimately related, synergistic, and mutually reinforcing. Rapid advances in pharmacotherapy often offer myriad treatment options for clinicians to sort through when developing patient management strategies. In turn, the principles of clinical therapeutics are rooted in fundamental pharmacology. Clinicians must understand pharmacologic principles in order to formulate and implement therapeutic algorithms that maximize patient benefit. Pharmacology in Anesthesia Practice provides clinicians with a rapid and easy review of the most commonly utilized pharmacologic agents during perioperative care. Clinical application is emphasized throughout. It aims to offer clinicians point-of-care guidance from internationally recognized authors and centers of excellence.

Practice Single Best Answer Questions for the Final FRCA: A Revision Guide covers the complete syllabus of this new-style exam. The book includes 10 papers, each of which consists of 30 questions on clinical anaesthesia, intensive care medicine and pain management. Each practice paper matches the style, number and level of questions that candidates will face in their FRCA exam. Written by a group of anaesthetists experienced in teaching clinical anaesthesia and preparing trainees for their exams, every question is supplemented with a thorough explanation, incorporating the latest research and guidelines, and further reading suggestions. The book also includes guidance on how to go about answering single best answer questions. Pitched at just the right level for the exam, Practice Single Best Answer Questions for the Final FRCA: A Revision Guide is an essential resource for all Final FRCA candidates.

This book systematically introduces the Brain in Traditional Chinese Medicine (TCM) and its acupuncture treatments. It discusses the origin and development of the TCM Brain theory, and presents current research on brain and acupuncture, the unique brain related techniques such as scalp acupuncture and Dao-qi technique, the new developing acupuncture treatment methods for brain-related conditions, such as stroke, Parkinson's, dementia, Alzheimer's disease, multiple sclerosis, traumatic brain injury, autism, cerebral palsy and depression, anxiety, bipolar disorder among others. This book is of interest to TCM and acupuncture practitioners in the West, as well as acupuncture researchers and lecturers. It gives a new understanding of the brain and treatments for brain-related conditions from a complementary medicine point of view.

This treatise commemorates the 32nd anniversary of the first successful allogenic kidney transplant in a human being and the beginning of a con tinuing challenge for well over a generation of anesthesiologists. If compari sons can be permitted, this epoch-making event can be ranked with the first pulmonary lobectomy and subsequently the initial ligation of a patent ductus arteriosus in the late 1930s when thoracic and cardiac surgery began. Was it merely a coincidence that brought these events to the fore so close upon one another after many years of ideation and frustration? Not so, according to Lewis Thomas, for this was the time of medicine's second revolution-its transformation from an empirical art into a powerfully effective science. The remote Galenic conception of disease with its emphasis on disturbed body humors was about to be supplanted by effective therapeutics, as signified by the introduction of the sulfonamides and antibiotics for the specific treatment of infection. Anesthesiology had been dormant up to that era, still relying upon a few agents, more or less utilized from the beginning, and purveyed by a handful of specialists who had not yet begun to ask the scientific questions necessary for their maturation into a bona fide discipline. However, anesthesiology was in evitably caught in the ferment, for as Peter Caws observed, "It serves to re mind us that the development of science is a step-wise process: nobody starts from scratch and nobody gets very far ahead of the rest."

Theodore H. Stanley, M.D. W. Clayton Petty, M.D. Anesthesiology 1986 contains the Refresher Course manuscripts of the presentations of the 31st Annual Postgraduate Course in Anesthesiology which took place at the Westin Hotel Utah Convention Center in Salt Lake City, Utah, February 14-18, 1986. The chapters reflect recent and future developments in anesthetic techniques, monitoring instruments and devices, and anesthetic drugs. The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehi cl e to bri ng many of the 1 atest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesi a expressed at the conference. Thi s book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarlze the most salient points. This textbook is the fourth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. TABLE OF CONTENTS PHARMACOLOGY The New Neuromusucular Blocking Agents D. Ryan Cook, M.D.

Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr."

The diagnosis of cancer inspires fear, in part because of the high mortality rate associated with most malignancies, and in part because of the perception that cancer is a painful disease. Recently compiled statistics tend to support patients' fears. Pain is a major symptom in 70% of patients with advanced cancer [1]. Half of all patients undergoing anticancer therapy experience pain [2]. It has been estimated by members of the World Health Organization that 3. 5 million people worldwide suffer from cancer pain. One study of the severity of cancer pain estimates that pain is moderate to severe in 50% of cancer pain patients, very severe or excruciating in 30% [3]. An analysis of several reports of patients in developed countries estimates that 50-80% of patients had inadequate relief [2]. In underdeveloped countries, adequacy of treatment may be far lower because of lack of availability of medical facilities and legal constraints on the use of potent narcotics. The picture need not be this bleak. The reality is that, for most patients, cancer pain is relatively easy to control with simple, inexpensive measures. Several studies have indicated that cancer pain can be well controlled with oral morphine in over 90% of patients [4,5]. Long-acting orally effective opiate preparations such as time release morphine, methadone, and levorphanol allow patients to sleep comfortably through the night. When the oral route is impossible, narcotics can be administered rectally or by intravenous or subcutaneous infusion.