A comprehensive survey of recent advances is given in this Update. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects.

Since 1961, when pain therapy was introduced by Bonica, the- re have been world-wide efforts to establish basic regimens for the treatment of chronic pain. Yet many patients still continue to suffer from intractable pain despite the availa- bility of effective treatment that would greatly improve their quality of life. The lack of specialists familiar with recent developments is one of the causes. There is con- sequently a great demand for interdisciplinary pain clinics and specialist training programs. This book constitutes both a valuable introduction and an overview of current basic regimens and the latest sophisticated techniques in pain therapy.

Aimed at health care professionals and their colleagues, ministers of religion and funeral directors, this comprehensive work of reference describes the complex procedures required when someone dies. The information should be of value to all those who are concerned with the correct handling of situations as diverse as fatal mass disasters and the rites that are associated with those who hold unfamiliar religious beliefs. The guide is in three parts: legal and technical aspects; considerations for the living, care of the dying, and death with dignity; and religious, ethnic and cultural aspects of dying and death. The author combines medico-legal facts and practical, sensitive advice.

No matter what questions arise in practice or while preparing for boards, Pain Management Secrets, 3rd Edition has the answers. A two-color page layout, portable size, and a list of the "Top 100 Secrets" in pain management help you better meet the challenges you face today. You'll find all the features you rely on from the Secrets Series (R)-a question-and-answer format, lists, mnemonics, tables and an informal tone-that make reference fast and easy. The proven Secrets Series (R) format gives you the most return for your time - concise, easy to read, engaging, and highly effective. Covers the full range of essential topics in pain management for in-training or practicing professionals. Top 100 Secrets and Key Points boxes provide a fast overview of the secrets you must know for success in practice and on exams. Portable size makes it easy to carry with you for quick reference or review anywhere, anytime. Fully updated throughout, with new chapters on the latest areas in pain medicine, clear illustrations and figures, and a list of current websites that expedite study and review. Written and fully updated by internationally known pain medicine experts, including new editors Drs. Andrew Dubin and Julie Pilitsis. NEW! Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

Only very few therapeutic modalities are used as extensively as mechanical ventilation in intensive care units, during anaesthesia and in emergency situations. Hence theoretical and practical knowledge in this technique had to be made available to workers in a number of medical specialities. In addition to anaesthetists, who are most familiar with artificial ventilation for historical and practical reasons, surgeons, internists, paediatricians and emergency physicians also need a foundation. Furthermore, the widespread application of this life-supporting method requires that paramedical personnel such as nurses and respiratory therapists be trained to use mechanical ventilation, to understand how it works and to be aware of specific side effects and dangers. This book, edited by Fran ois Lemaire, is a well-designed present ation of a number of the relevant aspects, types and problems of mechanical ventilation which are important for physicians and paramedical personnel who use it. After a description of the technical principles and maintenance of an artificial ventilator, the main part of the book is devoted to the most frequently used types of mechanical respiratory support, with their specific indications, the pathophysiology of their effects on pulmonary gas exchange and the specific choice and regulation ofthe mechanical variables involved. Older and new types of ventilatory support are discussed; there is a good balance of enough specific information for the inexperienced as well as a critical analysis of the indications for more exotic techniques, such as mandatory minute ventilation, independent lung ventilation and airway pressure release."

The fifth edition of this popular textbook continues to provide a solid foundation of pharmacological knowledge for all those working in anaesthesia and intensive care. The content has been thoroughly revised to include expanded chapters with clearer figures, ensuring readers are kept abreast of the ever-changing landscape of clinical pharmacology. Conveniently divided into four sections covering the basic principles of pharmacology, core drugs in anaesthetic practice, cardiovascular drugs, and other important drugs and complemented by new diagrams, tables and chemical formulae to facilitate learning. All four chapters on core drugs in anaesthetic practice have been updated along with others exploring applied pharmacokinetic models, antimicrobials, and drugs used in diabetes. An ideal aid to study and practice for junior and trainee anaesthetists and intensive care specialists preparing for exams. Also an invaluable resource for theatre practitioners, ICU nurses and physicians working in areas that demand a solid knowledge of pharmacology.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1990 represents the series' continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

At present there are going on decisive developments in the introduc- tion of physiological thinking into anaesthesiological practice. These innovative motion comprises applications taken from space physiolo- gy, closed-circuit ventilation systems, neurophysiologic control of cir- culation and ventilation together with innovative aspects of circulation physiology and respiration physiology. Involved are innovative aspects of neuromuscular blockade, volatile anaesthetics, cardiorespiratoric monitoring, haemodilution and blood substitution. Special emphasis is put on demonstrating the closed circuit system as a combination of anaesthesia system and monitoring system in daily clinical routine. Additional knowledge and investigation are stimu- lated in the fields of anaesthesia, neurophysiology, pharmacology, space medicine and metabolic physiology using non-invasive methods of monitoring like the evaluation or the neurovegetative status of man and its addaptive changes. Combining these aspects and systems will provide a quite new analytic and synergetic power in the direction of physiological anaesthesia and monitoring which finally will result in a totally new system of a physiological "micro-anaesthesia". We recommend this bock therefore to all anaesthetists, clinical physiologists and pharmacologists as well as to physicists and engi- neers interested in innovative and non-invasive methods in physiologi- of closed systems.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1989 represents the series' continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

Lacking the capacity to store oxygen, the human organism depends on having an unimpaired and continuous supply of oxygen for its survival. Life-threatening disturbances can be encountered by the clinician at any step in the oxygen cascade from ambient air to tissue metabolism. It is therefore necessary for the mechanisms of oxygen uptake, transport, distribution and diffusion into tissues as well as the unaffected cellular metabolism to be well understood and monitored. An international symposium focusing on these issues was held in Munster, FRG, May 11-12, 1990. This book contains the lectures held at the symposium, and thus provides an excellent basis for further discussion.

Some data-analytic methods excel by their sheer elegance. Their basic principles seem to have a particular attraction, based on a intricate combination of simplicity, deliberation, and power. They usually balance on the verge of two disciplines, data-analysis and foundational measurement, or statistics and psychology. To me, unfolding has always been one of them. The theory and the original methodology were created by Clyde Coombs (1912-1988) to describe and analyze preferential choice data. The fundamental assumptions are truly psy chological; Unfolding is based on the notion of a single peaked preference function over a psychological similarity space, or, in an alternative but equivalent expression, on the assumption of implicit comparisons with an ideal alternative. Unfolding has proved to be a very constructive data-analytic principle, and a source of inspiration for many theories on choice behavior. Yet the number of applications has not lived up to the acclaim the theory has received among mathematical psychologists. One of the reasons is that it requires far more consistency in human choice behavior than can be expected. Several authors have tried to attenuate these requirements by turning the deterministic unfolding theory into a probabilistic one. Since Coombs first put forth a probabilistic version of his theory, a number of competing proposals have been presented in the literature over the past thirty years. This monograph contains a summary and a comparison of unfolding theories for paired comparisons data, and an evaluation strategy designed to assess the validity of these theories in empirical choice tasks."

Abundant evidence indicates that TENS can be used effectively to alleviate certain pain syndromes. For patients suffering from chronic musculo-skeletal pain in particular, TENS offers an alternative means of pain management. This book addresses the need among physiotherapists for a practical manual on the application of this relatively new technique. Numerous illustrations provide guidelines for the choice of stimulation parameters, the selection of electrode positions, as well as other aspects related to technique. A brief introduction to the neurophysiological mechanisms of pain and the pain-relieving effects of TENS is also given. These special features make this comprehensive presentation of particular interest to physiotherapists and clinicians actively engaged in the management of patients suffering from pain.

This volume reviews the state-of-the-art in osteoarthritis. The pathogenetic roles of mechanical, systemic and inflammatory factors and the importance of neurogenic factors in pain management and in the causes of disease are considered. Of particular value is the review of the implications of pathogenetic mechanisms in future modes of management. The concept of "activated arthrosis" is given special attention. Finally, controversial issues and new areas for investigation are discussed. The book will help the clinician and the investigator consider the importance of addressing different phases and subtypes of osteoarthritis in planning treatment.

This small but information-packed book is the first to focus exclusively on iatrogenic vascular injuries. It is a timely first, for the scope and magnitude of this subject have reached almost epidemic proportions recently, as a result of exponential increases in the use of invasive diagnostic and therapeutic procedures by almost every medical and surgical speciality. The data on vascular trauma from "civilian" experiences are becoming dominated by injuries of iatrogenic cause. Even were it not for medical-legal liability, the importance of prompt recognition and correct treatment of injuries that we ourselves cause is obvious, as is the need for preventive measures to be clearly identified and adopted. This book serves these needs well through a nicely balanced focus on prevention, on the one hand, with its comprehensive review of epidemiology and etiology, and on management, on the other, with its practical comments on diagnosis, treatment and outcome. The organization of this book makes it very usable. After chapters on both arterial and venous catheterization injuries, there follows a thorough analysis of injuries associated with percutaneous transluminal angioplasty and other endovascular procedures. Then, after a chapter on noninvasive vascular injuries, there follows a series of chapters dealing with vascular injuries associated with the practice of specific specialties: radiation therapy, orthopedics, neurosurgery (especially lumbar disc surgery), gynecology, head and neck surgery, urology, adult general surgery, and pediatric surgery.

The primary mission of the medical school is to create new doctors. Once the medical student has received his or her doctorate, the medical school's interest in, and acceptance of, responsibility for the continued professional development of the physician ceases almost entirely. Yet, with scientific advances in medicine increasing exponentially and the inevitable erosion of memory with time, teachings from our schools of medicine become increasingly irrelevant, forgotten, or both. To maintain competence, the physician must continuously re-educate him- or herself. CME-Continuing Medical Education-will probably never attain the status of the medical school's degree-granting undergraduate program, but medical schools and their faculties must recognize their responsibil ity, not only for creating competent physicians but also for maintaining that competence. With these words I introduced the first volume of Preanesthetic Assessment in 1986. The series was a product of a Continuing Medical Education program initiated by the Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center. Controversy continues to exist over the lasting educational value of conferences that bring physicians together. Moreover, because of time or financial con straints, only a small number of anesthesiologists are able to attend seminars on a frequent basis. By producing a monthly, current, clinical series in conjunction with Anesthesiology News over these 4 years, we have been able to make state-of-the-art analyses available to all anesthesiologists."

Quantitative anaesthesia - exact registration of the degree of anaesthesia - has long been the anaesthetist's dream. Such pre cision could decrease the risk for the patient. Can -this dream now be realized in the foreseeable future? And can the quantifi cation be technically verified? This workshop was organized for these questions to be discussed by a group of experts. Schleswig-Holstein was a logical location for such a gathering. Medical and associated technical advances have socioeconomic consequences: in Schleswig-Holstein there are nowadays more jobs in medical technology than in the traditional shipbuilding industry. The encouragement of medical research and related technical innovation is thus a central component of public poli cy. One result of this emphasis was the recent setting up of a study group on medical technology, one of the aims of which is to provide a forum in Schleswig-Holstein for meetings such as this. The intention is to consolidate Schleswig-Holstein's reputation as a centre for both medical-technical development and scien tific discussion. The organizers of this scientific workshop thank the Schleswig Holstein Ministry of Economics and Transport and Dragerwerk AG for their support.

Respiration is a unique topic among various subdisciplines of physiology. Physiolo gists and clinicians are now able to communicate quantitative functional properties of lung mechanics and gas exchange in the language of the engineer, physicist and mathematician. This is largely due to intensive and stimulating work during the last decades of brilliant minds in a handful of excellent schools in the international family of physiologists. Among these founders of respiratory physiology are a number of clinicians, and they have. taken significant ,part both in shaping the theoretical knowledge to clinical applicability and developing technical devices for diagnosis and therapy in pulmonology. However, the theory behind the evaluation of measure ments, and their interpretation in terms of clinical function tests, is so confusingly complex that the ordinary physician, not specifically trained in respiratory physiol ogy, finds himself unable to critically apply these techniques. We, therefore, need descriptions of respiratory physiology and of its clinical application presented in the language of the clinician. And that is what this book is meant to be. Written by an expert in electrical and biomedical engineering, and by an expert in intensive care medicine, this text constitutes an "operational manual" of clinical respiratory physiology. It does not intend to be another textbook of basic respiratory physiology or pathophysiology. This book not only addresses practical clinicians, particularly those of intensive care medicine, by describing the essentials of clinically relevant respiratory knowledge.

Sportliche HAchstleistungen werden heute oft nur noch unter Schmerzen erbracht und viele Sporttreibende leiden unter schmerzhaften Bewegungs- und LeistungseinschrAnkungen. Der mit groAen Schmerzen verbundene Tod einer begabten Hochleistungssportlerin ging in jA1/4ngster Vergangenheit durch alle Medien. In diesem Buch wird erstmals der aktuelle Themenbereich Schmerz und Sport aus interdisziplinArer Sicht umfassend abgehandelt. Sportmediziner, OrthopAden, Physiologen, Schmerz- und Physiotherapeuten, Psychologen, Trainer und Sportler vermitteln in ihren BeitrAgen wichtige Hinweise fA1/4r eine richtige und schmerzfreie SportausA1/4bung und eine interdisziplinAre schmerztherapeutische Versorgung der sporttreibenden BevAlkerung. AuAerdem wird die Frage angesprochen, inwieweit es vertretbar ist, das physiologische Warnsignal Schmerz durch Arztliche und andere MaAnahmen auszuschalten. Ein aktuelles Buch zu einem aktuellen Thema.

In 1981, the Institute of Anesthesiology at the Ludwig Maximil- ian University of Munich organized a first international sympo- sium on inhalation anesthetics. In 1982, the most important con- tributions were published in the series Anaesthesiology and Inten- sive Care Medicine. At that time, the interest of European anes- thesiologists was focused on isoflurane, which had just been in- troduced for clinical purposes. Studies on this product had al- ready been appearing for years in the American literature. This book deals once more with all three inhalation anesthetics, but places particular emphasis on isoflurane. In contrast to the situa- tion in 1981, extensive experimental and clinical investigations on isoflurane have by now become available in the European litera- ture. From its conception, the objective of this symposium was not to discuss the relative value of inhalation anesthesia (bal- anced anesthesia) as compared with intravenous anesthesia. On the contrary, the major effects and interactions of isoflurane were to be explored. The side effects and their relative significance in different patient groups were also of interest. eurrent knowledge concerning a range of topics related to inhalation anesthetics (es- pecially isoflurane) was to be presented in a comprehensive and critical manner. The effects of isoflurane on the cardiovascular system were the focus of interest during the symposium and are accordingly dealt with extensively in this volume. The comparative effects on cor- onary perfusion of isoflurane, enflurane, and halothane are de- scribed in detail.

This book is intended to bring together data and clinical guidelines for those involved in the practice of anaesthesia, whether they be specialists or not. It is designed to be a true handbook that will accompany its owner into the operating theatre, where it will serve as a practical reference guide, not as a textbook. We welcome comment, criticism, and suggestions for improvement of the contents; correspondence may be addressed to the authors at P. O. Box 63, Tygerberg 7505, Republic of South Africa. We wish to acknowledge help received from our colleagues over the years of publication: Dr. T.J.V.Voss, Prof. G.G.Harrison, Dr. C. M. Lewis, Dr. W. B. Murray, Prof. A. R. Coetzee, and Dr. W. L. van der Merwe. Acknowledgement is also made to "Anaesthesia Guidelines," long since out of print, on which the first edition of this handbook was based in 1978. Tygerberg, South Africa, May 1987 P.A.Foster l.A. Roelofse v Contents Chapter 1 I. Pre-anaesthetic Assessment and Preparation 3 A. Anaesthetic Risk Assessment 3 B. Cardiac Risk Index . . . . . . 6 C. Respiratory Risk Assessment 7 D. Hepatic Reserve and Anaesthetic Risk 8 E. Pre-anaesthetic Check List . . . . . . . 8 F. Detailed Check of Anaesthetic Machine 10 G. Requirements for Paediatric Anaesthesia .

This volume contains the lectures and discussion papers presented at the II. In ternational Symposium on Innovations in Management, Technology and Phar macology held on 26-28 May 1984 in Liidenscheid. This symposium delt with fur ther developments in the sector of the closed-circuit system; non-invasive mea surement and monitoring systems; new aspects of cardiovascular and pulmonary physiology; oxygen-transporting substances; and particular questions in pharma cology. The purpose of this meeting was to allow a mutual international exchange of news on interesting new developments, particularly as these relate to the closed-circuit system, and the encouragement of further scientific developments. It must be made clear that the large-scale introduction of the closed-circuit sys tem has to be the occasion of completely new quality standards both in anesthesia and in all related technological sectors, combined with the highest demands in terms of precision and measuring techniques. The conventional and still quite crude clinical anesthetic procedures will have to make way for much more phys iological, micromolecular precision techniques, which will compare with our present methods rather in the same way as a microelectrode to a spear and will allow new levels of achievement in anesthesiology. All our tasks will need to be rethought and thoroughly understood from these aspects. Some anesthesists, physiologists and engineers already see the closed-circuit system as a challenge, while for others this system will still mean a great deal of work and creativity be fore the problems are finally solved in the future."

Largely reorganised and much expanded in this second edition, Practice and Procedures brings together in a single volume general methods of pain assessment and presents the wide range of therapies that can be provided by a range of health care disciplines. Authored by a multidisciplinary team of experts, chapters can stand alone for readers looking for a general overview of the methods of techniques for pain management available to them or work to complement chapters in the preceeding three volumes, providing practical procedures and applications in the management of acute, chronic and cancer pain. The book is divided into three parts. Part One covers the principles of measurement and diagnosis, including history taking and examination, the selection of pain measures, diagnostic tests and novel imaging techniques. Part Two discusses the full range of therapeutic protocols available, from pharmacological therapies, through psychological techniques, physical therapy and international procedures, to techniques specific to pain assessment and management in paediatric patients. Part Three provides information on planning, conducting, analysing and publishing clinical trials, with invaluable guidance on the techniques of systematic review and meta-analysis in pain research. Part Four considers the role of multidisciplinary pain management teams, their organization, their place within different health care systems, and how best to manage change when implementing such a service. Part Five concludes the volume, investigating the use of guidelines, standards and quality improvement initiatives in the management of post-operative pain, and discussing the expert medicolegal report.

Major conduction blocks utilizing local anesthetics or opiates are find ing ever increasing applications in daily routine. However, two serious drawbacks are associated with their use: hypotension during surgery and the development of tolerance in long-term epidural analgesia. When opiates are injected epidurally or intrathecally, numerous side effects such as itching, nausea and vomiting, or respiratory depression have been reported. The pathophysiology of complications arising during a major conduction block and measures to prevent them were discussed by 19 experts at the 4th International Symposium at DUsseldorf. This volume contains 21 papers presented on three topics: 1. tachyphylaxis in long-term epidural anesthesia, 2. hypotension due to epidural and spinal anesthesia, and 3. effects and dangers of epidural and intrathecal opiates. With regard to the safety of our patients during anesthesia, current practices of preventing complications were evaluated, and preliminary guidelines for a more rational approach toward prevention and treat ment based on a knowledge of pathophysiologic mechanisms were developed. It is our hope that the anesthesiologist will profit from the discussion of regional anesthesia contained in this volume, many aspects of which have never before been presented in such detail."