This monograph presents electric therapy for the reduction of pain in a different way than the classical well known manner to use electric currents of various kinds for this purpose. It started when Melzack and Wall published their theory of pain. But contrary to most researchers, the author looked for a proof which objectively could demonstrate, that electric current would have an influence on nerve fibers conducting pain. Starting from this model of demonstration, an optimal type of current could be selected as well as optimal electrode positions and sizes of electrodes. It is an absolute new approach presenting the results of applying the type of current to more than 17.000 patients suffering from any kind of pain. Anatomic sketches and photo-documentation of electrode positions for many conditions allow the reader to obtain identical degree of pain reduction as the author describes from his great experience. In addition, a brief theoretical introduction and discussion of the influence of weather on pain is given. Practical forms for the management of pain are presented in an appendix. 256 references and a table of suitable apparatus with their essential technical characteristics facilitates correct application of this new principle.

'A Headache in the Pelvis is a lamp in the dark human suffering of chronic pelvic pain. This book is a precious document that will help many people.' Psychologist David Wise lived for 22 years with agonising chronic pelvic pain (also known as prostatitis/CPPS). There was seemingly no cure, until he began to make the connection between his anxiety and his physical pain. He enlisted renowned NeuroUrologist Dr Rodney Anderson from Stanford University to develop a revolutionary new method for muscle relaxation. Amazingly, a third of their patients were able to stop taking drugs within six months of beginning their new daily, holistic muscle relaxation treatment. Sufferers of chronic pelvic pain are living a life of quiet desperation. For the first time, there is a solution that is helping patients empower themselves in their own healing and gain control over their chronic pain. Patients and medical practitioners across the US and UK have called this method 'life-changing'. This audiobook is for patients who have tried everything to cure themselves of chronic pelvic pain and for the clinicians who want to work with their patients towards a long-term solution.

Ein vertieftes pathophysiologisches Verstandnis der respiratorischen Insuffizienz und die technischen Entwicklungen der letzten Jahre haben die Beatmung, uber die reine Substitution bei Atmungsausfall durch zentrale oder periphere Atemlahmung hinaus, zu einer Therapie der respiratorischen Insuffizienz und pulmonaler Erkrankungen werden lassen. Es gibt heute ein breites Indikationsspektrum fur vielerlei Beatmungsverfahren, die von einfachen Atemhilfen bis hin zu komplexen, computergesteuerten Beatmungsmustern und zur Lungenersatztherapie reichen. Dieses Buch enthalt neben den pathophysiologischen Grundlagen eine systematische Darstellung der Verfahren und Gerate und gibt Anasthesisten und Intensivmedizinern wertvolle Hinweise fur indikationsgerechte Entscheidungen.

Developments in surgery have enabled more ambitious operations to be attempted than ever before, while similar advances in anaesthesia and monitoring have meant that many patients who were previously considered unfit now undergo surgery. It is essential that standards of patient care during surgery are continued post-operatively until the depressant effects of anaesthesia have worn off and it is safe for patients to return to the wards or to their homes. The importance of adequate supervision by well-trained nurs ing staff in properly equipped surroundings has been recognised by the introduction of recovery rooms in most hospitals. Despite this, many patients still emerge from anaesthesia in wards or departments where they are supervised by inexperienced nursing staff in unfamiliar surroundings. Recovery from anaesthesia may be accompanied by a variety of dangerous and potentially fatal complications, many of which can be avoided by the detection of early warning signs and the institution of appropriate therapy before an irreversible situation is allowed to develop. This book describes the major complications liable to be encountered and suggests how they may be avoided by careful monitoring, vigilant nursing and sound organisation. The patient's behaviour at recovery is influenced by his pre-operative condition, by drug therapy pre- and intra-operatively and by the nature of the surgery, and sections have been devoted to these aspects since a basic understanding of them is essential in anticipating events in the recovery room."

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.

Epidural opioids are widely used in the management of post- operative pain. On the basis of an extensive review of the literature the authors here present their own interpretation of current knowledge of how the distribution and effectiveness of epidurally administered opiods are fundamentally determined. They conclude that all opioids that are currently being used to treat postoperative epidural pain carry the potential risk of severe side effects if the dose regimens are not tailored to the patients individual analgesic need. This book will serve to stimulate new ideas among pain specialistst.

E.MARTIN Acute pain services are now established worldwide and guidelines have been drawn for the management of acute pain resulting from surgical or medical procedures and trauma. However, the treatment of pain after surgery is still inadequate and no progress has been made in recent years in several coun tries, including Germany. There are still innumerable patients who find the is also no early postoperative period to be an unpleasant experience. There doubt that pain plays a role in the pathogenesis of postoperative complica tions that could be avoided with effective pain management. However, concern about side effects and inadequate knowledge of the pharmacokinet ics and -dynamics of drugs is still putting constraints on treatment. An acute pain service should be responsible for adequately treating pain, training medical and nursing staff, and evaluating new and existing methods of treatment. As anesthesiologists deal with pain in the operating theater, it is not surprising that they claim a leading role for themselves in acute pain services choosing from the various postoperative pain treatment options."

This book is a critical response to a range of problems - some theoretical, others empirical - that shape questions surrounding the lived experience of suffering. It explores how moral and ethical questions of personal suffering are experienced, contested, negotiated and institutionalised. Bodies and Suffering investigates the moral labour and significance invested in actions to care for others, or in failing to do so. It also explores circumstances - personal, political and social - under which that which is perceived as non-moral becomes moral. Drawing on case studies and empirical research, Bodies and Suffering examines the idea of the suffering body across different cultures and contexts and the experience and treatment of these suffering bodies. The book draws on theories of affect, embodiment, the phenomenology of illness and moralities of care, to produce a nuanced understanding of suffering as being located across the assumed borders of time, space, bodies, persons and things. Suitable for bioethicists, medical anthropologists, health sociologists and body studies scholars, Bodies and Suffering will also be of use on health science courses as essential reading on suffering bodies, mental health and morality and ethics issues.

The second edition of this text catches the specialty of anesthesia at what will probably prove to be the apex of its influence and recognition amongst the specialties of medicine. The scientific basis of the specialty is becoming increasingly well delineated. Anesthesiologists have established themselves in local, regional, and national forums as spokespersons not only for the specialty, but also for medicine in general. And the specialty at last may be emerging from the stereotype of a faceless, inarticulate, shy and retiring figure, whose outstanding characteristic was the cloying odor of diethel ether! Technology has moved into the specialty on seven league boots. Just as an example, the basic design of the anesthesia machine was stable between the early 1950s and certainly the late 1970s. Suddenly, in the blink of an eye, our anesthesia machines are becoming intelligent, are utilizing heads-up displays, and are becoming more and more capable of writing the anesthesia record. Monitoring standards for anesthesia have burgeoned to the point that almost every aspect of the specialty is impinged upon by some rule and some "thou will or thou will not. " The importation and creation of terminology is exploding. In fact, one of the problems in updating this book was deciding when to stop. The author hopes that the goal of creating a snapshot in time through definitions of commonly used words and phrases has been achieved.

H. KIESEWETTER, J. KosciELNY, and F. JuNG Tbe byperoncotic colloid-osmotic pressure of tbe 10% Haes solution causes an increased intravascular volume because free tissue water flows into the vascular system [206]. Witb a volume expansion effect of about 50% an increase in intravascular volume of 750 ml (500 mi Haes and 250 mi tissue water) is expected immediately after hypervolemic hemodilution, after isovolemic bemodilution only an in crease of 250 mi ( only tissue water due to a pblebotomy of 500 mi). The blood is diluted by overloading the vascular system [245]. After isovolemic bemodilution tbe dilution effect is more marked due to the pblebotomy. Estimated by means of the total protcin concentration (Fig. 67) the dilution of plasma was 22% 1 h after isovolemic hemodilution but only 14% after bypervolemic bemodilution. Tbe plasma dilutions were almost confirmed by the concentration changes of albumin (Fig. 68). Therefore, the mixing ratio is 4. 1 to 1 (plasma to bydroxyetbyl starcb) for bypervolemic infusion of 500 ml Haes-sterillO% (200/0. 5) and 3. 7 to 1 for isovolemic dilution. Consequently, the hydroxyethyl starch concentration after isovolemic hemodilution was signifi- cantly bigher at all measuring times tban after hypervolemic hemodilution (Fig. 61). If tbe infusion was performed quickly so that no renal output of the Haes solution could ensue, a mean bydroxyetbyl starch concentration of 10. 3 g per liter plasma would be expected immediately after isovolemic hemodilution for tbe above mixing ratio, and one of 9. 0 g after hypervolemic bemodilution.

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.

That pain is a serious clinical problem, which requires considerable effortsby physicians and the nursing staff, has been stressed in numerous publications. Transdermal application is well known for a variety of drugs, including cardiovascular drugs, antiemetics and hormones. Some years ago, first experience was also made with transdermally administered opiates from which the transdermal therapeutic system (TTS) fentanyl has now been approved by the American Food and Drug Administration. The book presents the results of the first international workshop "Transdermal Fentanyl," held September 27 -28, 1990 in Cologne, FRG. This workshop was intended to facilitate a critical evaluation of theoretical and clinical studies with the new, non-invasive fentanyl application and to provide an opportunity for an exchange of ideas about its value for pain management, anaesthesiology and future investigations in this field. Topics covered by the book are physiology of transdermal permeation, experience with other transdermal systems, the present state of acute and chronic pain management and experimental and clinical studies with transdermal fentanyl, with special concern to analgesic efficacy and side effects. Readers will easily find out that the experts appreciated transdermal analgesia but also warned against an uncritical optimism. TTS fentanyl can be a valuable tool in the clinicians' armentarium against pain. It should be kept in mind, however, that it represents a new administration mode, not a new drug, and that the sustained, non-invasive application requires well reflected diagnosis and good general standards of pain management.

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."

Disturbances in peripheral O extraction can be produced in dogs treated with 2 endotoxin and thereby provide an opportunity to test theories for the origin of pathological O supply dependency or to try different treatment modalities. The 2 most serious deficiency in the current animal models is the inability to mimic the increased O demand that is observed in patients at 02 delivery rates in excess of 2 normal. A particular feature of this increased O demand is that it apparently does 2 not stimulate increased 02 extraction, although the limitation in O extraction has 2 not been explored in patients by lowering 02 supply, for obvious reasons. At least two possibilities to account for increased 02 demand could be investigated in animal models, however. The amount of 02 that is utilized in extramitochondrial pathways, which is normally on the order of 10%, may be greatly increased in ARDS and sepsis by O radical formation. There is presently no information 2 concerning how much 02 might be used in this way. Another strong possibility is that mitochondrial injury, perhaps as a result of 02 radical formation, uncouples oxidative phosphorylation. Some evidence presently in the literature supports this idea [19]. Indeed, the association of increased blood lactate levels with higher than expected 02 demands makes uncoupling a very attractive hypothesis that warrants further investigation in animal models using such agents as 2,4-dinitrophenol. References 1.

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.

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.

Written and edited by experts in the field, the Handbook of Clinical Anaesthesia provides all the essential practical knowledge required by anaesthetists on co-existing medical conditions, operative procedures, and techniques. The fourth edition retains the concise and comprehensive nature of the third, giving readers all they need to know about each part of the FRCA syllabus in short, digestible, practical entries. The first part covers Patient Conditions; the second Surgical Procedures; and the third Anaesthetic Factors. Each part is subdivided into chapter on each organ system, and each chapter is divided into bite-sized entries. These are in alphabetical order, and cover all common and rare conditions that anaesthetists will encounter within their practice. Avoiding prolonged discussion and multiple references, this is the ideal book to 'dip into' either for specific advice or general education, providing quick and reliable information. This is the most thorough handbook to cover the entire FRCA syllabus in a consistent and instructive manner. It continues to be accessible and relevant to all anaesthetists from middle grade trainee up to consultant/specialist.

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."

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."

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.

Tiel I Grundlangen.- 1 Historische Einfuhrung.- 2 Spezielle Anatomie des Halses und der oberen Atemwege.- 3 Erkennen eines schwierigen Atemwegs.- 4 UEberwachung der Sicherung freier - Atemwege Monitoring.- Tiel II Klinisches Atemwegsmanagement.- 5 Algorithmus.- 5.1 Einfuhrung.- 5.2 Mainzer Algorithmus zur Atemwegssicherung wahrend klinischer Anasthesie.- 5.3 The New Haven Algorithm for the Evaluation of the "Unknown" Airway.- 6 Standardsituationen des erwartet schwierigen Atemwegs.- 6.1 Halswirbelsaulenpathologien und Atemwegsmanagement.- 6.2 Der schwierige Atemweg in der Mund-Kiefer-Gesichtschirurgie - Anatomie und haufige Krankheitsbilder.- 6.3 Fremdkoerperaspiration.- 6.4 Klinisches Atemwegsmanagement - Besonderheiten im Kindesalter.- 6.5 Grundlagen, Indikation und Durchfuhrung der Ein-Lungen-Ventilation.- 7 Der unerwartet schwierige Atemweg.- 7.1 Allgemeine Grundlagen.- 7.2 Algorithmen, Richtlinien, Empfehlungen.- 7.3 Apnoische Oxygenierung.- Tiel III Praklinisches Atemwegsmanagement.- 8 Philosophie und Konzept.- 9 Algorithmus - Praklinisches Atemwegsmanagement.- 10 Vorgehen bei speziellen Verletzungsmustern und Krankheitsbildern.- 10.1 Atemwegsmanagement bei Schadel-Hirn-Trauma, Halsverletzungen und beim Einklemmungstrauma.- 10.2 Anaphylaxie, Veratzungen, Verbrennungen.- 10.3 Atemwegsobstruktion, Fremdkoerperaspiration.- 11 Besonderheiten im Kindesalter: Krupp/Pseudokrupp, Epiglottitis.- Tiel IV Besonders empfohlene Techniken und Instrumente.- 12 Notfallbeatmung mit einfachen Hilfsmitteln.- 13 Endotracheale Intubation.- 13.1 Allgemeine Grundlagen.- 13.2 Laryngoskope und Intubationsspatel.- 13.3 Intubation Techniques for Unanticipated Difficult Direct Laryngoscopy: Stylets and Introducers.- 13.4 Starre Tracheoskope/Bronchoskope ("Notrohr").- 13.5 Intubationsfiberskope.- 13.5.1 Flexible Intubationsfiberskope.- 13.5.2 Starre Intubationsfiberskope.- 13.5.3 Fiberoptische Intubation - Wiederaufbereitung.- 13.6 Endotrachealtuben.- 14 Alternative Techniken und Instrurnente.- 14.1 Larynxmaske.- 14.2 Intubationslarynxmaske.- 14.3 Larynxtubus.- 14.4 Combitube - OEsophagotrachealer Doppellumentubus.- 14.5 EasyTube.- 14.6 Jet-Ventilation/tracheale Sauerstoffinsufflation.- 15 Chirurgischer Zugang zum schwierigen Atemweg.- V Qualitatsmanagement, Ausbildung und Training.- 16 Qualitatsmanagernent und Dokumentation.- 17 Ausbildung und Training.- 17.1 Ziele/Zielgruppen.- 17.2 Atemwegsmanagement-Training an der Klinik fur Anasthesiologie des Klinikums der Johannes Gutenberg-Universitat Mainz.- 17.3 Airway Education.- VI Ausblick und Zukunftsperspektiven.- 18 Intubationsfiberskope (starr/flexibel) fur die Praklinik.- 19 Videolaryngoscopy.- 20 Fiberendoskope fur die Neonatologie.

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.