Pain in oncology, and especially in patients with advanced disease, is an essential issue which cannot be overlooked. Today, pain is worldwide recognised as a very complex symptom which includes different aspects such as somatic, spiritual, social and psychological pain. Practical and scientific knowledge of pain in cancer should be part of the pre and post training of general practioners and oncologists. This manual reflects the opinion of different authors, contributors to pain clinic. These guidelines cover all different aspects of cancer pain. It responds to a need for information, education and training in the field of diagnosis and treatment of cancer pain. The reader will find useful information and suggestions as how to diagnose and treat pain from a pharmacological, surgical and psychosocial point of vIew. Pain therapy is a very important part of quality of life; due to its relevance, we think that this manual will be a useful tool for all health professionals, and we are grateful to Drs. K. Foley and F. De Conno for their generous contribution in making this effort successful. Alberto Costa Director European School of Oncology Vlll Acknowledgements The European School of Oncology wishes to acknowledge Janssen Pharmaceutica for an educational grant for the sponsorship of this manual. Pain - definitions, classification and pain. Patients who are aware that their causes pain is temporary have a more positive attitude.

This critical care medicine book substantially differs from others due to the range of peculiarities that characterize it. Since it deals with acute patients in critical conditions, this is, as it were, a 'borderline'book, in the sense that it is intended for those, who, in their activity, need a continuous and in-depth interdisciplinary approach to optimize the quality of the treatments offered to critically-ill patients. This book helps to have a better understanding of the current limits of human intervention and aims at supplying updated guidelines; in particular, it is intended for those who, although having to guarantee continuity and top-quality therapies, must decide when and why the collaboration with and intervention by experts is necessary

At the APICE '96 research scientists and clinicians were provided with updated guidelines for the treatment of patients with acute and chronic critical conditions. This volume contains 100 chapters,in which the main pathophysiological concepts were reviewed, with special emphasis on the cardiovascular, respiratory, metabolic, and neurologic systems. Special reference is made to the pharmacologic and biotechnologic strategies currently being used to support those vital functions that are affected by severe and sometimes devastating diseases. The topics of infection, sepsis,and SIRS have been reviewed and updated in keeping with the most recent information available, and particular focus has been directed to ethics.

Das Buch richtet sich vor allem an junge Anasthesiologen und Assistenzarzte auf Intensivstationen, die die Technik der transoesophageale Echokardiographie erlernen moechten, aber ebenso an Kardiologen und Internisten, die Patienten kardiologisch betreuen.

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."

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.

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."

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.

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.

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.

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.

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.

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.

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.

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.

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."

Filled with clinical information and practical advice, this second edition of the Oxford Handbook of Perioperative Practice has been substantially updated to reflect changes in the field. Taking a logical sequence to follow the journey of the patient from anaesthesia to surgery, then on to the post-anaesthetic recovery area, it provides guidance on all aspect of patient care and support. Specialty surgery, such as bariatric surgery, has been included in a new chapter to cover developments in the field and the increase in NHS provision of these services since the first edition was published. This has been reflected in covering the pre-surgical requirements to newer types of surgery, including psychological interventions and implications for practitioners who need to cover anaesthetics, surgery, and post-anaesthetic care separately. With easy to access information about essential information and various medical conditions, this volume has been written by expert teaching staff and clinicians who work within the speciality. Unique and indispensable, this book gives a wealth of practical information at your fingertips.

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.