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.

Low back pain is described as a very common condition that tends to affect about 70% of the population at some point in time with varying degrees of symptom severity. Although definitions vary, sciatic pain is generally defined as back-related pain radiating to the leg (normally below the knee and into the foot and toes) and is one of the commonest variations of low back pain. Patients with sciatica typically experience a more persistent and severe type of pain, a less favorable outcome, consume more healthcare resources and have more prolonged disability and absence from work than those with low back pain alone. Managing Sciatica and Radiculopathies in Primary Care Practice provides a comprehensive, up-to-date overview of the subject and key information for primary care practitioners about low back pain in patients, including definitions and causes, current management approaches, diagnostic and treatment algorithms, as well as clinical practice guidelines.

Many drugs used in current anesthetic practice are administered intravenously. An appreciation of their kinetics and dynamics is of great assistance in determining the most appropriate drug to use, and optimal dosage regimens for any given patient. This book is specially oriented to the requirements of anesthesiologists. It will enable the student of those subjects to gain enough knowledge to make these subjects usable in daily anesthetic practice. As such it is intermediate in difficulty between mathematically oriented texts, and those which only offer a very qualitative understanding of these subjects. Practical applications and examples of the uses to which kinetic and dynamic principles can be put in daily practice are emphasized and illustrated. Basic principles and techniques with which the reader can perform kinetic and dynamic calculations are explained simply and demonstrated in detail using examples derived from clinical practice. Two appendices provide kinetic and dynamic data on the most commonly used anesthetic drugs. The last chapters use the principles discussed in the first chapters to show how variations of normal physiology and disease affect drug kinetics and dynamics. This is especially valuable to the clinician as it enables clinically useful, albeit qualitative, predictions to be made of the direction of any change of kinetic and dynamic parameters of drugs due to these factors.

Anesthesiology and Pain Management contains the edited presentations of the 39th Annual Postgraduate Course in Anesthesiology, February 1994. The chapters reflect new data concepts within the general framework of `pain research and basic science', and `clinical topics in pain management'. The purpose of the textbook is to serve as a vehicle to bring many of the latest concepts in anesthesiology to those who did not attend the conference, within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the current interests in anesthesia. This volume, as well as past and future volumes, reflects the rapid and continuing evolution of anesthesiology in the late twentieth century.

Sleep and anesthesia resemble in many ways at a first glance. The most prominent common feature of course is the loss of consciousness, i.e. the loss of awareness of external stimuli. However a closer look at the loss of consciousness reveals already a difference between sleep and anesthesia: anesthesia is induced by an anesthetic drug whereas we may fall asleep without external cause. Other questions may arise about the difference of the two effects: do we dream during surgery under anesthesia, do we feel pain during sleep? Essentially, we may ask: what is common and what are the differences between sleep and anesthesia? To answer these questions, we may take a look at the neural origin of both effects and the involved physiological pathways. In which way do they resemble? Moreover, we ask what are the detailed features of normal sleep and general anesthesia as applied during surgery and which features exist in both phenomena? If yes in which way? To receive answers to these questions, it is necessary to consider several experimental techniques that reveal underlying neural mechanisms of sleep and anesthesia. Moreover, theoretical models of neural activity may model both phenomena and comes up with predictions or even theories on the underlying mechanisms. Such models may attack several different description levels, from the microscopic level of single neurons to the macroscopic level of neural populations. Such models may give deeper insight into the phenomena if their assumptions are based on experimental findings and their predictions can be compared to experimental results. This comparison step is essential for valuable theoretical models. The book is motivated by two successful workshops on anesthesia and sleep organized during the Computational Neuroscience Conferences in Toronto in 2007 and in Berlin 2009. It aims to cover all the previous aspects with a focus on the link to experimental findings. It elucidates important issues in theoretical models that at the same time reflect some current major research interests. Moreover it considers some diverse issues which are very important to get an overview of the fields. For instance, the book discusses not only neural activity in the brain but also the effects of general anesthesia on the cardio-vascular system and the spinal cord in the context of analgesia. In addition, it considers different experimental techniques on various spatial scales, such as fMRI and EEG-experiments on the macroscopic scale and single neuron and LFP-measurements on the microscopic scale. In total all book chapters reveal aspects of the neural correlates of sleep and anesthesia motivated by experimental data. This focus on the neural mechanism in the light of experimental data is the common feature of the topics and the chapters. In addition, the book aims to clarify the shared physiological mechanisms of both phenomena, but also reveal their physiological differences.

When I first proposed this book, one of the hopes was that it would be the stage upon which would be conducted a quiet, well reasoned discussion of the various techniques of stereotactic radio surgery. At that time, there was quite a bit of rancorous debate that tended to obscure the scientific and medical merits of each of the separate methods. At the present time, I am happy to report that the field of stereotactic radiosurgery is much less riven by such inappropriate posturing. The field has taken many steps towards maturity, both technically and medically. In the course of this mat uration process, there have been many grandiose plans and speeches made on behalf of stereotactic radiosurgery. Inevitably, the reality will not live up to the hype, but such is the natural course of devel opment in these sorts of matters. However, even though events may not match our hopes, we should keep in mind the words of Herbert Parker. Recognizing that new modalities for the treatment of cancer do not stand much chance of revolutionary success, nevertheless, he quite correctly pointed out that " . . . with any type of radiatiQn, the margin between success and failure is small. If the chance of success is a little greater . . . thi~ might well be classed as a great advance. " Mark H.

This book is the first of four books on the core principles of acute neurology. This book is a primer - and a great deal more - on how to clinically recognize acute brain injury and to treat its consequences. Acute brain injury often changes the dynamics of cerebral blood flow, cerebrospinal fluid mechanics and eventually intracranial pressure. And furthermore, acute brain and spine injury impacts on heart function, blood pressure control, breathing regulation and even gastric and bladder function. It is necessary to not only understand these fundamentals but also how certain measures could influence or correct these manifestations. Major concepts are illustrated to facilitate understanding. Each chapter concludes with a section that explains its relevance to clinical practice.The book truly combines basic neuroscience with practical know- how in an easy to read prose useful for both the novice and expert.

The first of its kind, this book describes pediatric palliative care in more than 23 countries. Each region in the world is covered and countries included are both resource poor and rich. Authors are multidisciplinary and regarded nationally and internationally in their field. Clinicians, advocates, policymakers, funders, and researchers will learn how programs were developed and implemented in each country. Authors describe children for whom pediatric palliative care is needed and provided for in their country. When applicable, a brief history of pediatric palliative care is included noting especially policy changes and legislative acts. For example, the chapter on Poland describes how pediatric palliative care grew from the Catholic church into a national movement spearheaded by several health care workers. The Pole national spirit that brought them through a change in political regime has also been a driving force in the pediatric palliative care movement. The chapter on South Africa, for example, illustrates how a resource poor country has been able to leverage philanthropic and government funding tomake its dream of having an infrastructure of pediatric palliative care a reality. These are just a few examples of the inspiring stories that are included in this book. Readers from countries who wish to start a pediatric palliative care program, or advance an existing program, will learn valuable lessons from others who have faced similar barriers. Introduction and concluding chapters highlight the strengths and weaknesses of the modern pediatric palliative care movement."

Authored by "a superb clinician and award-winning teacher,"* Near Misses in Pediatric Anesthesiology, Second Edition is a thorough updating and significant expansion of this popular case book in the newest anesthesiology subspecialty to be approved by the American Board of Medical Specialties. The book comprises 87 true-story clinical "near misses," including 40 cases that are brand new. Recommendations, references, and discussion accompany each case. The cases provide an ideal basis for problem-centered learning and also model how to learn from experience and to maintain professionalism during the lifelong development of clinical expertise. Dr. Brock-Utne's latest case book provides a pediatric complement to his bestselling Case Studies of Near Misses in Clinical Anesthesia (Springer, 2012) and Clinical Anesthesia: Near Misses and Lessons Learned (Springer, 2008) . * Jay B. Brodsky, MD, from the Foreword.

Chronic pain is one of the most common and debilitating health care conditions, and among the most notoriously challenging to treat. Chronic non-cancer pain presents a significant burden to society in terms of lost workforce productivity and significant healthcare resource utilization and cost. Although controversies persist surrounding the use of opioid analgesics, consensus now exists among medical experts that they can be useful for carefully selected patients. Safe opioid prescribing, however, hinges on effective risk management. All clinicians who treat pain with opioids are obliged to implement therapy according to accepted principles of prescribing and to minimize the risk of misuse, abuse, addiction, and diversion through risk assessment and management strategies. Proper risk assessment allows for a care plan that is structured to optimize therapeutic outcomes while minimizing risks of potential opioid-related morbidities or problematic drug-related behaviors as effectively as possible. Opioid Management Tools and Tips provides health professionals with basic guidance, tools, and resources for identifying patients who may be at risk for opioid misuse and effective managing the risk of abuse, addiction, and diversion. This second edition contains updated guidelines on opioid selection as well as legal and regulatory resources.

This book is the first of its kind - a comprehensive reference for anesthesia and perioperative clinicians involved in aortic surgery. With a primary focus on anesthesia for various aortic surgical procedures, including endovascular aortic surgery, the title also provides expanded coverage of CNS monitoring and protection, intraoperative transesophageal echocardiography, renal and spinal cord protection during surgery, management of aortic trauma, and postoperative care. Written by top cardiac anesthesiologists, surgeons, and intensivists, this indispensable reference provides everything you need to know about the burgeoning field of aortic surgery in one handy volume.

The International Hypoxia Symposium convenes biannually to bring together international experts from many fields to explore the state of the art in normal and pathophysiological responses to hypoxia. Representatives from five continents and 32 countries joined together in February 2003 for four days in the dramatic mountains of Banff, Alberta. As editors of the Proceedings of the International Hypoxia Symposia, we strive to maintain a 26 six year tradition of presenting a stimulating blend of clinical and basic science papers focused on hypoxia. Topics covered in 2003 include hibernation and hypoxia, hypoxia and fetal development and new advances in high altitude pathophysiology, oxidative stress and membrane damage, hypoxic regulation of blood flow, heat shock proteins in hypoxia, and future directions in hypoxia research. In 2003 we also had the privilege ofhonoring John W. Severinghaus as a friend, colleague, mentor and inspiration to many in the field. Tom Hornbein's personal tribute to John Severinghaus is the first chapter in this volume, followed by an entertaining update of the history of the discovery of oxygen written by John Severinghaus.

Pain management is an essential part of clinical practice for all healthcare providers from trainees, physician assistants and nurse practitioners through to practising physicians. Problem-Based Pain Management is a collaboration between experts in anesthesiology, geriatric medicine, neurology, psychiatry and rehabilitation which presents a multidisciplinary management strategy. Over 60 chapters follow a standard, easy-to-read, quick access format on: clinical presentation, signs and symptoms, lab tests, imaging studies, differential diagnosis, pharmacotherapy, non-pharmacologic approach, interventional procedure, follow-up and prognosis. The broad spectrum of topics include headache, neck and back pain, bursitis, phantom limb pain, sickle cell disease and palliative care. Unlike other large, cumbersome texts currently available, this book serves as a quick, concise and pertinent reference in the diagnosis and management of common pain syndromes.

Several new developments in the field of neuroimmunology with focus on the brain-to-immune system communication have been the incentive for this PIR volume. It covers topics such as brain-immune interactions, the impact of stress on the immune response, pain and immunosuppression, the modulation of inflammation and pain by the sympathetic nervous system, consequences of nerve injury for the immune system, neuronal mechanisms of immune cell recruitment, and the modulation of the immune response by corticotropin-releasing hormone or adenosine. The authors are a unique group of scientists who are all interested in brain-to-immune interactions; however, each from a different perspective. The volume will serve both neurobiologists and immunologists to understand the influence of the central nervous system on peripheral inflammation. Many aspects of this book will also be stimulating for researchers in the pain field.

Despite numerous reports of cerebral damage in cardiac surgery, the subject has not been given the attention it requires. This book, with a preface by Torkel Aberg, will remedy that situation. The causes and incidence of pre- and post-operative cerebral damage are considered in the first section. Cardiac surgery patients frequently have preoperative cerebral impairment, not suprising when one considers the impaired circulation from a damaged heart and the brain's prodigious need for blood. Moreover, several perioperative aspects of surgical procedures have been considered as possible causes of cerebral dysfunction, for example: microbubbles, toxic by-products, non-pulsatile blood flow. The second section describes how imaging techniques (CT scan, MRI, regional cerebral blood flow imaging), and functional assessment techniques. (PET scan, EEG, BEAM and evoked potentials) can be used to measure cerebral damage. In the third section, psychometric and neuropsychological techniques are used to assess impaired mental abilities (abstract thinking, language, memory, visuo-spatial ability, mental flexibility, attention and concentration). The final section explores the relationship between cerebral dysfunction and psychopathology (several types of depression, anxiety, and aspects of organic brain syndrome, delirium and dementia).

COX-2 inhibitors are important drugs with analgesic and anti-inflammatory effects. The discovery of COX-2, the evolution of drug development in this field and the implications of these developments in patient therapy are topics of this volume. This book presents both pre-clinical and clinical information and is important for clinicians interested in the latest information about this class of drugs, for researchers and for students in the field.

This volume contains selected works from the 25th Anniversary of the International Conference on Intracranial Pressure (ICP) held in Williamsburg, Virginia. The theme of the meeting was Intracranial Pressure and Neuromonitoring and focused on all the current state of the art brain monitoring methodologies and their application to brain injury. The brain monitoring techniques covered a wide spectrum from neurochemical monitoring of the injured brain to specialized techniques for assessing shunt function in normal pressure hydrocephalus. It also includes the most recent advances in monitoring of the brain oxygen levels using electrodes or the less invasive Near Infrared Sprectroscopy devices. Controversial issues regarding the management of ICP and CPP or both are also addressed and there are several works dealing with this topic. Of particular interest is the group of papers describing diagnosis and outcome in normal pressure hydrocephalus. It is the first compilation of papers which covers all the latest brain monitoring studies in both ischemia, trauma and hydrocephalus. The manuscripts in this volume have been selected from over 300 abstracts submitted to this international symposium. The abstracts are also published in order to provide the most comprehensive view of the progress made in brain injury research.

Charles Ernest Overton's 1901 monograph Studien aber die Narkose has become a scientific classic in a number of different fields. This book represents the first English translation, and in fact the first translation into any other language, of the original German work. In addition to. the edited translation, this volume contains introductory chapters by Keith Miller, Peter Winter and Leonard Firestone and myself. As editor, I have attempted above all else to ensure that the translation faithfully represents Overton's ideas and data, while making the material readily understandable to the modem scientific reader. This has frequently required that extremely long sentences, common in turn-of the-century German but considered cumbersome today, be simplified into two or even three sentences. In addition, I have paid particular attention to the correct translation of scientific terms, and I accept complete responsibility for any inaccuracies in this area. Overton's original contents list included headings and subheadings, but only a fraction of these appear in the original text. For the sake of clarity they have all been included in the body of the translated work. Also included is an index containing all chemicals mentioned in the book, along with their Chemical Abstracts System Registry Numbers for un ambiguous identification, a complete list of Overton's publications (Appendix B), and a list of all biographical articles about Overton and articles dealing specifically with analyses of his data (Appendix C)."

During the last decade, the effects of anaesthetics on cerebral blood flow, cerebral metabolic rate of oxygen and intracranial pressure have been studied experimentally and clinically. In this review studies of CBF and CMRO2 during craniotomy have been performed with the classical technique described by Kety and Schmidt. In chapter 1 general considerations concerning the effects of anaesthetics on cerebral blood flow and metabolism are reviewed. In chapters 2 and 3 the effects of inhalation agents and hypnotics on flow and metabolism are considered. Chapters 4 and 5 cover the effects of central analgetics, and neuromuscular blocking agents. In chapter 6 the effects of other drugs in common use in neuroanaesthetic practice are summarized. Chapter 7 considers the effects of drugs used for controlled hypotension. In chapter 8 the application of Kety's method in studies of CBF and metabolism is reviewed, the studies of cerebral circulation and metabolism during nine different techniques of anaesthesia for craniotomy are presented, and other studies of cerebral circulation during neuroanaesthesia are reviewed. In chapter 9 considerations concerning central and cerebral hemodynamics during anaesthesia in the sitting position are considered. This review is primarily addressed to anaesthetists, but it will also be of interest to those working within neurosurgery, neuroradiology and clinical neurophysiology.

Drug dosage in renal insufficiency has become an toxication. In 1975, his Poison Index was pub important facet of nephrology, a subspeciality of lished, first in German, and two years later in internal medicine which is only 30 years young but English, with supplements in 1979 and 1983. This constantly growing in scope and importance. Two volume has become an obligatory reference in more thirds of all drugs are partially, mainly, or exclu than 2500 dialysis units. sively excreted by the kidneys. In the presence of Based on GOnter Seyffart's experience and renal insufficiency, dose adjustments are therefore knowledge in this field, the plans for this book obligatory. In patients on dialysis, drug elimination matured in 1984, a logical step in view of his by this route must also be considered. untiring effort and diligence. In order to deal with As the reader of this book will discover, 20 more than 1200 different drugs and almost 4000 percent of currently used drugs are contraindicated references, 21 contributors were sollicited, while it where there is any degree of renal insufficiency, took six years to complete the work. The major and for at least another 60 percent a dose reduc share of the effort was thus left to the main author tion is required. It is obvious, therefore, that the and editor and he has produced a concise work of detailed knowledge required can never be com impressive clarity.

Numerous improvements in our understanding of the mechanisms that underlie neuropathic pain states have come from the development of animal models, most of which involve partial peripheral nerve injury. The animal models have shown that nerve injury initiates a cascade of events resulting in altered neurochemistry and molecular biology of the peripheral neurons, the dorsal root ganglion cell, and changes in neurotransmitter and receptor expression in the dorsal horn of the spinal cord. Moreover, nerve injury produces anatomical changes with functional consequences.
This volume summarises the current understanding of the pathophysiological processes in the peripheral and central nervous system that contribute to the neuropathic pain. It provides a timely review of neuropathic pain mechanisms, written by experts in the field.

Pain Management and Anesthesiology contains the presentations made at the 43rd Annual Postgraduate Course in Anesthesiology sponsored by the University of Utah and held at Snowbird, Utah, USA, February 20-24, 1998. This volume addresses recent advances in the understanding of the basic science and clinical management of pain. The textbook includes sections on recent advances in the understanding of pain signal processing, as well as reviews of the clinical management of acute, chronic, cancer-related, and pediatric pain. In addition, this text includes a discussion of the behavioral assessment and treatment of the pain patient. This textbook is the sixteenth in a continuing series documenting the proceedings of the postgraduate course.

Currently blood is a volatile issue. The safety of blood and the quantification of transfusion risks have been dominant themes that have stimulated the development of alternative approaches in this rapidly developing area. In clinical medicine conventional blood and its components are used in supportive therapies dependent on the choice of apparent uncritical trigger factors. A compounding factor is depth of prospective clinical trials for evidence. Such trials in critical care areas would be of enormous value, not only in recording adverse effects and under-transfusion, but also indicating the value of decision analysis and cost-effectiveness in transfusion practice. Alternative approaches include the use of cytokines, growth factors, humanised monoclonal antibodies, recombinant plasma factors, and buffy coat derived natural human interferons. These are being increasingly implemented in the clinic. Solutions for oxygen transport are being developed and fibrinogen coated microcapsules are being investigated for thrombocytopenia. In surgical patients, various crystalloid and colloid combinations are explored as volume replacements. To avoid allogeneic transfusions, beneficial blood saving methods include various strategies, such as autologous deposits, normovolemic haemodilution and various agents including aprotinin, tranecamic acid, desmopressin and erythropoietin, but their use in hospital shows considerable variations. That umbilical cord blood could be a significant source of allogeneic stem cells in related and unrelated transplantation is illustrated by the increasing number of cord blood banks in Europe and elsewhere. Future blood resources are likely to face several challenges: immediate challenges relate to increased regulatory and political oversights; intermediate solutions would offer some improvements in public health and alleviate public fear but probably not address the economic challenges thrust upon the medical care system. As we approach the year 2000, the major concerns about transfusion medicine remain its logistics, safety and effectiveness. This theme is presented in the proceedings of the 22nd International Symposium on Blood Transfusion, developed in 21 up-to-date topics, collected and discussed in four sections. This book will be of timely value to students, professionals and all others interested or involved in the field of transfusion medicine, whether clinical or related.

Since its launch in 1998 the European Society for Intravenous Anaesthesia (EuroSIVA) has come a long way in providing educational material and supporting the research and clinical application of intravenous anaesthesia. After the first two annual meetings held in Barcelona and Amsterdam in 1998 and 1999, three other successful meetings took place in Vienna, Gothenburg and Nice in 2000, 2001 and 2002. Next to these main meetings, starting in the year 2000, a smaller winter meeting has been organised every last week of January in Crans Montana, Switzerland. Both the main summer and the winter meetings breathe the same atmosphere of sharing the latest on intravenous anaesthesia research in the presence of a friendly environment and good company. Since the first meetings the educational tools of EuroSIVA have increased in quantity and technical quality allowing digital slide and video presentation along with the use of the computer simulation program TIVAtrainer during the speaker sessions and the workshops. Furthermore, EuroSIVA now exploits a website www. eurosiva. org that allows for continuous exchange of information on intravenous anaesthesia, the TIVAtrainer, the EuroSIVA meetings and online registration for these meetings. The EuroSIVA is currently engaged in friendly contacts with the Asian Oceanic Society for Intravenous Anaesthesia (AOSIVA), the United Kingdom Society for Intravenous Anaesthesia (UKSIVA), the Korean Society for Intravenous Anaesthesia (KSIVA), the European Society of Anaesthesiology (ESA) and the International Society for Applied Pharmacology (ISAP).