In the past ten years, full-scale simulation training has become dramatically more evident in undergraduate and graduate medical education. This increase has been due pri marily to two factors: the development of new computer-driven technology and an interest in simulation-specific training techniques. Technologically, simulators have evolved from simple anatomical reproductions to full-scale accurate reproductions of anatomy and physiology powered by multiple computers. High-technology simulation centers run by teams of faculty are emerging as integral tools in fulfilling medical centers' educational missions. In addition, educational techniques specific to simulation, which have been de veloped and used by other industries for over half a century, are being applied to medical training. Aviation and aerospace have used sophisticated simulation since the 1950s to train pilots and astronauts. Extrapolating these methods for use in the medical world has been a natural course of events, particularly in specialties that require some of the same basic thought processes and interactions required of the pilot or astronaut. It is not surprising, then, that anesthesiology would be the medical specialty to take the lead in adding simula tion training to its educational programs. The anesthesiologist's job in the operating room is similar to that of a pilot in a cockpit, not in the specific tasks, but in decision making, technological and human interfaces, and crisis management."

Chronic knee, hip and back pain is a problem of epidemic proportions leaving millions of sufferers desperate to find relief. But after trying invasive surgery and countless therapies, all claiming to eliminate chronic musculoskeletal pain, why are so many still suffering with indescribable pain?

The answer is that a source of chronic musculoskeletal pain has - until now - remained unknown. For this reason, the best that health care practitioners can do in some cases is to help patients simply manage their chronic muscle and joint pain.

In his groundbreaking book, Chronic Pain Expert Prof/Dr Brian A Rothbart finally reveals his discovery of a previously unknown source of chronic pain and his therapy secret to success for thousands of his patients who now live pain free lives.

In this passionate and easy to understand book, you will discover: Why current treatments for chronic muscle and joint pain dont work What is the solution to end your chronic musculoskeletal pain permanently How to quickly determine if Professor Rothbarts therapy is for you How, through advanced technology, your body will heal itself for good Resulting from Professor Rothbarts 40 years in research and clinical practice, this revolutionary therapy has proven successful where other therapies have failed.

Because of Professor Rothbarts devotion to helping others, he now shares his discoveries and therapy with the public, in order to reach out to you, the chronic pain sufferer, and offer you a permanent solution and improved quality of life. Through this innovative therapy, you can join the thousands of people worldwide who are now living forever free from chronic muscle and joint pain

The intended audiences are: People suffering from chronic muscle and joint pain who have tried everything and nothing has permanently worked to eliminate their pain Health care practitioners, both allopathic and alternative

Physicians, nurses, and safety experts comprehensively review sedation and analgesia to provide a completely new reference guide to safe sedation practices consistent with existing guidelines. Starting with an integrated review of the basic physiology and neurobiology of the sedated state, the authors proceed through clinical guidelines and practices, and conclude with an examination of quality-outcome measures and processes. They also review current mandates for safe sedation practices and address the key clinical issues of pharmacology, monitoring, and recovery. Special tables and figures throughout the book summarize protocols, regulatory requirements, recommended dosages, monitoring requirements, and quality assurance tools.

Anesthesia and the Central Nervous System is a textbook for a postgraduate course as well as a reference for all anesthesiologists which presents many of the latest concepts in anesthesiology within a brief formal presentation. An outstanding faculty presents topics relating to the biochemistry, physiology, and pharmacology of the nervous system, the anesthetic management of intracranial and spinal cord surgery, and the intensive care management of central nervous system disease. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia. This textbook is the eleventh in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City.

Sektion A.- 1 Qualitatssicherung und Risikomanagement.- Qualitatsmanagement.- "Risikomanagement".- Verhalten bei und nach Zwischenfallen.- Resumee.- 2 Risikovermeidung - Simulatoren in der Anasthesie.- Training am Simulator.- Konzepte des Krisenmanagements.- Chancen und Perspektiven durch Simulatortraining.- 3 Monitoringstandards.- Bedeutung von Standards.- Monitoringparameter.- Empfehlungen deutschsprachiger Fachgesellschaften.- Europaische Norm EN 740.- Zusammenfassung.- Sektion B.- 4 Herz-Kreislauf-System.- Intraoperativer Herz-Kreislauf-Stillstand.- Akuter Myokardinfarkt, akute Myokardischamie.- Arrhythmien.- Herzschrittmacherpatienten.- 5 Respirationstrakt.- Monitoring zur Erkennung respiratorischer Komplikationen.- Respiratorische Insuffizienz.- Veranderung der respiratorischen Funktion unter der Anasthesie.- Dekompensation der respiratorischen Funktion (bei vorbestehenden pulmonalen Funktionseinschrankungen).- Atemwegsobstruktion.- Akut auftretende pulmonale Funktionseinschrankungen.- Fehlerhaftes oder fehlerhaft verwendetes Anasthesiegerat.- 6 Neurologie.- Erhoehter intrakranieller Druck.- Postoperative emotionale Stoerungen.- Nichterwachen nach Anasthesie.- Postoperative Verwirrtheitszustande.- Das zentral-anticholinergische Syndrom.- 7 Renales System.- Beurteilung der Nierenfunktion.- Veranderung der Nierenfunktion unter Anasthesie.- Oligurie.- Polyurie.- Anasthesie bei Patienten mit eingeschrankter oder fehlender Nierenfunktion.- Harnretention.- 8 Perioperativ relevante Stoerungen des Flussigkeitsund Elektrolythaushaltes.- Physiologie.- Stoerungen des Flussigkeitshaushalts.- Stoerungen des Elektrolythaushalts.- 9 Stoerungen der Synthese oder der Funktion des Hamoglobins.- Sichelzellerkrankung.- Porphyrien.- Methamoglobinamie.- 10 Gerinnungsstoerungen - Thrombose - Lungenembolie.- Physiologie - Pharmakologie.- Diagnostik.- Therapie.- Haufige perioperative Gerinnungsstoerungen.- Thrombose.- Lungenembolie.- Heparininduzierte Thrombozytopenie.- 11 Endokrines System.- Diabetes mellitus.- Schilddrusenfunktionsstoerungen.- Funktionsstoerungen der Nebenschilddruse.- Funktionsstoerungen der Nebenniere.- Stoerungen der Hypophyse.- Adipositas.- 12 Lebererkrankungen und Anasthesie.- Anatomie und Physiologie.- Pathologie und Pathophysiologie.- Medikamentenclearance.- Anasthesievorbereitung bei Lebererkrankungen.- Anasthesie.- Volatile Anasthestika.- Sektion C.- 13 Unmittelbare Reaktionen auf Lokalanasthetika.- Systemische Reaktionen.- Methamoglobinamie.- Allergie.- Lokale Intoxikation des Gewebes.- Systemische Reaktionen aufVasokonstriktoren.- Wertung.- 14 Ruckenmarknahe Leitungsanasthesien (RMNLA).- Kardiovaskulare Veranderungen.- Ploetzlicher Herzstillstand.- Ateminsuffizienz.- UEbelkeit und Erbrechen.- Blasen- und Darmstoerungen.- Postspinaler Kopfschmerz.- Ruckenschmerzem.- Akzidenteile intravasale Injektion.- Massive Epiduralanasthesie.- Totale Spinalanasthesie.- Katheterkomplikationen.- Bronchospasmus.- Neurologische Komplikationen.- Gerinnungshemmende Medikamente und RMLNA.- Aseptische Meningitis.- Pneumozephalus.- Praexistente Erkrankungen des Zentralnervensystems.- Diabetes und periphere Neuropathie.- Wertung.- 15 Brachiale Plexusblockade.- 16 Intravenoese Regionalanasthesie.- 17 Epidurale Opioide.- 18 Neurolytische Blockaden.- Neurolytische Substanzen.- Allgemeine Komplikationen.- Spezielle neurolytische Blockaden.- Sektion D.- 19 Kombinierte Anasthesieverfahren.- Neurologische Komplikationen.- Hamodynamische Komplikationen.- Weitere potentielle Komplikationen.- 20 Atemwegssicherung.- Erschwerte bzw. unmoegliche Intubation.- Larynxmaske.- 21 Aspiration und praoperative Nahrungskarenz.- Inzidenz perioperativer Aspiration.- Lagerung.- Ursachen und Risikofaktoren der perioperativen Aspiration.- Praoperative Nahrungskarenz.- 22 Kritische Stoerungen der Beatmung.- Pathophysiologie.- Ursachen fur Stoerungen der Ventilation, ihre Behandlung bzw. Vermeidung.- Verlegte Atemwege

PROFESSOR SIR KENNETH L. STUART Pain control has become one ofmedicine's most rapidly growing disciplines, and Iwelcome the opportunity to write this foreword to abook that Iam sure will make its own unique contribution to advancing this discipline. My pleasure in writing it is heightened by my pride in the fact that its editor was at one time an undergraduate student of mine at the University of the West Indies in Jamaica. One of the uncertainties teachers always face is that they can never predict how their charges will turn out. This uncertainty has been happily resolved. Dr. Parris' professional career has been marked by the same dedication and commitment that characterized his undergraduate days and that clearly has been brought to the preparation of this scholarly and practical work. Pain reliefhas been until recently acomparatively neglected field. Its neglect was determined not so much by lack ofprofessional awareness ofits import ance but mainly because so little could be done about it in the past.

Although the perioperative care of patients by anesthesiologists draws on diverse clinical skills, the principles of anesthesiology and pain management are rooted in the neurosciences. The Neuroscientific Foundations of Anesthesiology thoroughly examines the anesthetic modulation of the central, peripheral, and autonomic nervous systems and will help redefine anesthesiology as a fundamentally neuroscientific field. The book is organized by sections, with each focusing on a different part of the nervous system. State-of-the-art chapters written by thought-leaders in anesthesiology and neuroscience provide a novel and invaluable resource.

On 16 October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic effect of diethyl ether in a public demonstration in the "ether dome" of the Bulfinch Building of the Massachusetts General Hospital in Boston. The patient, Gilbert Abbott, suffered no pain, and the surgeon, Dr. John C. Warren, was able to complete a suture ligature of a vas cular tumor of the jaw without the hurry that until then was so necessary. The operation proved a failure, since the tumor recurred; but the demonstration of ether's anesthetic effect was a great success. Operative pain was conquered, and surgery could advance from a crude and unscientific practice where speed was paramount, and the major body cavities could not be entered, into the unique blend of science and art that it is now. "Gentlemen, this is no hum bug," supposedly muttered Warren, perhaps the last noncontroversial assess ment of anesthesiology to be made by a surgeon. The screams of resisting patients in pain were stilled, and quiet entered the operating room for the first time. But the new science of pain relief was quickly wrapped in controversy. An argument immediately arose as to who could legitimately claim primacy for the discovery. Morton's attempt to hide the true nature of his anesthetic agent, coupled with an effort to patent the discovery, clouded his reputation and stimulated other claimants to push themselves forward."

In susceptible individuals, malignant hyperthermia (MH) can be triggered by various anesthetics during surgery. First described in 1960, research since then has concentrated on reducing the very high mortality rate associated with MH. Although significant progress in treatment has been made with the introduction of dantrolene sodium in 1979, many questions remain unanswered. Following on the results of more than 30 years of investigative efforts, the Third International Symposium on MH was held in Hiroshima, Japan, in 1994, immediately before the Seventh International Workshop on MH. Specialists in the field discussed the most up-to-date findings from the point of view of clinical classification, history, and incidence based on the evidence of epidemiology, diagnostic muscle testing, genetics, and biochemistry. These proceedings of the symposium present important keys to understanding the mechanism of MH and related syndromes at the genetic level and include procedures for the monitoring and care of patients. This volume will be invaluable not only for surgeons and anesthesiologists but also for physiologists and researchers.

Explore the biomechanics of 30 key yoga asanas, in-depth and from every angle, and master each pose with confidence and control. Introducing Science of Yoga - an all-encompassing science book to help you better understand yoga anatomy in order to perfect your practice and poses Did you know that yoga practice can help treat age-related memory loss better than brain-training games? Recent scientific research now supports what were once anecdotal claims about the benefits of yoga to every system in the body. Science of Yoga provides a detailed insight into variations of key yoga poses and the specific benefits of different styles of yoga on the human body, system by system. Dive right in to discover: -Specially commissioned CGI artworks show 30 asanas in depth and detail the physics of the pose - 16 spreads of clear, easy-to-understand scientific facts and research answering key questions around ancient and modern claims - Illustrated section on the benefits of yoga on the human body system by system - Easy-to-understand research is presented in an easy-to-understand format with illustrated pullouts, debunking the myths and explaining the scientific facts, from breathing techniques to mindfulness Science of Yoga is a riveting read, and reveals how your blood flow, respiration, muscles and joints work below the surface of each yoga pose, whilst teaching you to achieve technical excellence in your practice, from the comfort of your own home. The first yoga book on the market to combine detailed anatomical drawings, pose mechanics and key scientific research, Science of Yoga is a must-have volume for yoga beginners and professionals alike, seeking an accessible and easy-to-read guide on the effects of yoga on the human body from a scientific standpoint. Whether you're looking to take up yoga this New Year, or your yoga poses are already perfect, this science book sets out to separate the facts of yoga from the myths, with proven scientific research.

Over the past two decades attention to family issues in relation to chronic pain has been on the rise. There has been a proliferation of research and clinical literature in the field since the first major review on this topic was conducted in 1982. However, no comprehensive review book has been published. Generally speaking, the role of the family in chronic pain literature has been reported from four perspectives: (1) family factors in the etiology of chronic pain; (2) role of spouse in the perpetuation of pain behaviors; (3) impact of chronic pain on family functioning and on the health of spouse and children; and (4) family therapy for these families.

The main thrust of this book will be the issues of impact on the family and therapy. The broader literature of family issues in medical disorders will be incorporated into the body of the book to allow the reader to become familiar with some of the common problems shared by medically ill and chronic pain families and many problems that appear to be specifically associated with chronic pain. The book will offer clinical guidelines in conducting family assessment and couple and family therapy for these patients. This book will not be simply an update, but will adopt a fresh approach to this complex clinical area. The book will have 10 chapters. Each chapter will report the current state of knowledge through a comprehensive review of the most recent literature, and discuss relevant clinical issues through extensive use of case illustrations. The chapters will be designed to bring the reader up to date on the literature as well as provide clinical guidelines for practice.

One of the most exciting developments in medicine in this century has been the discovery of opioid receptors and their pharmacology. The breadth of know- edge derived from such discovery has truly changed the practice of medicine today. The acceptance by the clinicians of the research data obtained by the basic scientist on spinal opioids is truly amazing. The clinical sequelae of the discovery of opioid receptors has been the development of the technique of intraspinal administration of opioids. In the last decade much has been written about indications, effects, and side effects of intraspinal opioids. The technique has become commonplace for cancer and postoperative pain. However, no standards of care and management of patients with spinally administered opioids have been developed. We need these standards to be developed and universally followed. The monograph was conceived to update clinicians on the applied pharma cology of spinal opioids. We were fortunate to have Drs. N. Rawal and D. Coombs agree to edit this monograph. They have been able to assemble world-renowned experts as contributing authors. It is our hope that the con tents of this book will be stimulating, informative, and useful to the reader. PREFACE Much has been written about the subject of spinal opioid analgesia, includ ing several notable reviews. We were stimulated to assemble this particular volume in this important series on pain management initiated by Dr. Raj for a number of reasons."

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.

Anesthesia for the New Millenium: Modern Anesthetic Clinical Pharmacology contains the refresher course lectures of the 1999 meeting and is a review of the current state of the art in anesthesia clinical pharmacology. The authors of the individual chapters are among the world's most widely recognized experts in the pharmacology of perioperative medicine. The book features sections on new pharmacology concepts, new drug delivery techniques, recently released drugs and novel thinking about older drugs. It also addresses several areas that have recently emerged as very hot clinical and research topics, including depth of anesthesia monitoring technology and anesthesia drug interactions. The textbook is the seventeenth in a continuing series documenting the proceedings of the postgraduate course.

The prevalence of obesity, an important risk factor for various diseases, has increased markedly worldwide in recent years. The results of long-term dietary behavioural therapy, however, remain sadly inadequate, with a relapse rate of about 90%. Surgery is still the only effective treatment for these patients. The annual number of weight loss operations performed in the United States in the early 1990s totaled only about 16,000, but by 2005 the figure exceeded 200,000. The anesthetic care of severely obese patients entails particular issues, and difficulties are believed to escalate in the presence of co-morbidities. Despite this, outcome data in respect of anesthetic care and pain management are still scarce. Anesthetic Management of the Obese Patient considers a wide range of important practical issues and controversies. Key questions in preoperative, intraoperative, and postoperative management are carefully addressed, and different approaches are evaluated, casting light on their effectiveness and limitations. Written by world leaders in the field, this book will be an invaluable aid for anesthesiologists.

In recent years there have been a number of significant developments of natural products for the treatment of rheumatic diseases, pain and gastro-intestinal ulcers and inflammation. The volume covers some of these novel developments of natural products which are of current and future interest as therapies for the above-mentioned conditions. Most available volumes cover a wide range of biological and technicological aspects of natural products and their discovery, some involving synthesis and properties of chemical compounds. The difference in this volume is that the natural products have a focus on their therapeutic effects on pain, arthritic and gastrointestinal diseases. Some of the natural products covered are either at the experimental stage of development while others are well-established clinically-used products. Each has its own unique place in therapy.

Inhalational anaesthesia was the first medical and scientific technique to become a legitimate means of pain relief. Its introduction to medicine in 1846 sparked one of the most intense public debates of the period. It challenged religious principles and at its center posed one of medicine's fundamental questions: risk versus benefit of medical intervention. This book explains how the introduction of anaesthesia intertwines with a wide variety of other nineteenth century medical and cultural issues: the growing elitism of surgery, the emerging professionalism of medicine, the popular and progressive culture of science and the secularization of society.

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo."

Although pain is widely recognized by clinicians and researchers as an experience, pain is always felt in a patient-specific way rather than experienced for what it objectively is, making perceived meaning important in the study of pain. The book contributors explain why meaning is important in the way that pain is felt and promote the integration of quantitative and qualitative methods to study meanings of pain. For the first time in a book, the study of the meanings of pain is given the attention it deserves. All pain research and medicine inevitably have to negotiate how pain is perceived, how meanings of pain can be described within the fabric of a person's life and neurophysiology, what factors mediate them, how they interact and change over time, and how the relationship between patient, researcher, and clinician might be understood in terms of meaning. Though meanings of pain are not intensively studied in contemporary pain research or thoroughly described as part of clinical assessment, no pain researcher or clinician can avoid asking questions about how pain is perceived or the types of data and scientific methods relevant in discovering the answers.

This volume provides an up-to-date account of the achievements pertaining to the application of capsaicin and capsaicin-like molecules in the therapy of various human ailments such as pain, non-allergic rhinitis, obesity, tumors and gastrointestinal, dermatologic and urologic disorders. It discusses the basic functionsof the capsaicin receptor (TRPV1), its mechanisms of action and its role in physiological and pathological processes. The text focuses on the most recent progress in the use of capsaicin and capsaicin-like molecules as a therapeutic agent and highlights potential pharmaceutical implications of further TRPV1 research. The chapters are written by noted experts in their fields of endeavor. This book offers both clinicians and researchers valuable resource and reference material on the subject that will stimulate future research. "

The focus of this volume is the "state of the art" of Intensive and Critical Care Medicine as well as new insights into basic science, clinical research and therapeutic interventions. Structured in four parts, the volume opens with few chapters devoted to the beginning and development of the WSICCM, to procedures standardization, recommendations and quality of care improvement, with particular reference to the definition of clinical governance, professionalism and ethics. In the second part, the authors describe the practical clinical approach to critical illness; among the topics dealt with, the reader will find monitoring and management of shock states; acute pain management, airway management, ALI/ARDS and protective lung ventilation; the problem of weaning; antibiotics policy, sepsis and organ dysfunction. The third part of the book is related to some special conditions of countries with limited resources, such as management of obstetrics at high risk, malaria, AIDS, blood transfusion and its components. The last part of the book is structured to present some crucial issues of the intensive and critical care arena, in particular evidence-based practice, the role of the e-distance learning for information and the promotion of CME programs; last but not least, trauma care, disaster and natural disaster medicine are also discussed; a final chapter on the Guidelines of the World Health Organization (WHO) on Disaster Medicine is included.

Theodore H. Stanley, M. D. What's New in, Anesthesiology in 1988 contains the Refresher Course manuscripts of the presentations of the 33rd Annual Postgraduate Course in Anesthesiology which took place at the Marriott Hotel Convention Center in Salt Lake City, Utah, February 19-23, 1988. The chapters reflect new data, ideas and concepts within the general framework of most recent developments in "evaluation and monitoring cardiac function before, during and after surgery," "new anesthetics and their actions on the heart and peripheral vasculature, and other organ systems," "metabolism and elimination of anesthetics and anesthetic adjuvants," and "recent developments in the anesthetic management of patients with congenital heart disease, renal and pulmonary dysfunction, and diabetes insipidus. " In addition, there are chapters on new developments in "obstetrics," "regional anesthesia," and "anesthetic management of the newborn. " The purposes of the textbook are to 1) act as a reference for the anesthesio logists attending the meeting, and,2) serve as a vehicle to bring many of the latest 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 anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the sixth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City."

by E.K. ZSIGMOND, M.D. Department of Anesthesiology University of Illinois Chicago U.S.A. It is, indeed, a distinct honor and privilege to be invited by the authors to write a preface to this monumental monograph, Regional Opioid Analgesia. Regional Opioid Analgesia is a colossal undertaking by Drs. De Castro, Meynadier and Zenz shortly after the introduction of this revolutionary approach to pain relief which opened a new epoch in analgesiology. This is, indeed, the first authentic and comprehensive textbook encompassing the current knowl edge on this novel approach to pain relief. We are indebted to the authors for introducing the new opioids to regional analgesia with the scientists, who de veloped the potent short and ultrashort acting opioids with high therapeutic indices, which many researchers dreamt about but never before materialized. The side effect liabilities of these new opioids are minute as compared to morphine and meperidine. Regional Opioid Analgesia could not have been more authentically written than by Drs. De Castro, Zenz and Meynadier, who have conducted daily clinical investigations on all known opioids for regional analgesia as well as for neurolept analgesia. Therein lies the great value of this monograph: it is the most authentic work on this topic."