The development of accurate hormonal assays in recent years has evoked much interest in the area of anaesthesia and surgery. In an effort to allow an exchange of ideas and new information in this area, the First International Symposium on Endocrinology in Anaesthesia and Surgery was held in Bonn during September 1978. The contents of this book represent much of the information presented by the leading authorities in this field. The presentations were grouped in three areas: 1. Basic problems of endocrinology in anaesthesia and surgery; 2. The response of the endocrine system to anaesthesia and surgery; 3. Hormone and anaesthetic management of endocrine disease. As with any multi-authored text, there is both repetition and diversity but hopefully the reader will be able to obtain much of the useful information. As Editors, we wish to express our deep appreciation to Profes sor R. Frey and Springer-Verlag for including this book in the series on "Anaesthesiology and Intensive Care Medicine." H. Stoeckel T. Oyama Table of Contents I. Basic Problems of Endocrinology in Anaesthesia and Surgery H. Breuer Basic Principles Regulating the Endocrine System . . . . . . . .. 3 G. Wesemann and E. Grote Pathophysiology of Intra- and Postoperative Stress .. . . . . .. 10 M. Trede Surgical Treatment of Endocrine Disorders .. . . . . . . . . . .. 24 T. Oyama Influence of Anaesthesia on the Endocrine System ... . . . .. 39 L. Nocke-Finck Radioimmunological Determination of Hormones."

Die Behandlung der aktuten respiratorischen Insuffizienz steht hiiufig im Mittelpunkt therapeutischer Bemiihungen warnend der postoperativen Phase sowie in der Intensivmedizin. Entsprechend lag und liegt das wissenschaftliche Hauptinteresse zahlreicher Arbeitsgruppen verschiedenster medizinischer Fachrichtunge- von der Physiologie liber die Pathologie, Rontgenologie, Chirurgie, Innere Medizin bis hin zur Aniisthesiologie und Intensivmedizi- im Bemiihen, den Pathomechanismus der akuten respiratorischen Insuffizienz aufzukliiren und hieraus therapeutische Konsequenzen zu entwickeln. Das vorliegende Heft beinhaltet Vortriige, die auf einem inter- nationalen Symposium, veranstaltet yom Institut flir Aniisthesiolo- gie der Universitiit MUnchen, gehalten worden sind. Die themati- sche Palette reicht von der Darstellung der normalen Lungenfunk- tion bis hin zur Diskussion detaillierter Fragen der Beeinflussung von PEEP auf die Hamodynamik. Es wird die pathologische Anato- mie der akuten respiratorischen Insuffizienz dargestellt, das rontge- nologische Substrat bei dieser Erkrankung diskutiert und die ver- schiedensten therapeutischen Verfahren werden angesprochen. Von besonderem Interesse wird flir Experten die Diskussion der Frage nach der Bedeutung des !lerzens, insbesondere des rechten Ven- trikels unter den Bedingungen der respiratorischen Insuffizienz sein. Es ist das liel der Zusammenstellung der verschiedenen Sympo- siumsbeitrlige, fdr Studenten wie auch fUr Arzte, die an Fragen der Intensivmedizin interessiert sind, eine lesenswerte Arbeitsgrundlage zu schaffen. Mein Dank gilt deshalb den Autoren sowie dem Springer-Verlag.

This book has a twofold purpose, first to provide information for beginners about the pitalls and hazards of anaesthesia and second to help the occasional anaesthetist in remote areas when confronted with requests to anaesthetise for unfamiliar surgical operations. The book is not intended to replace any standard text for anaesthetic examinations, and indeed, its lack of information about basic sciences makes it unsuitable for such a purpose. The contents can be regarded as a distillate of 45 years of practical anaesthesia, in both primitive and sophisticated conditions, from the ether and chloroform rag and bottle days onwards through cyclopropane, trichloroethylene, relaxants and lytic cocktails to halothane. The only operation mentioned of which I have no practical experience is thymectomy and removal of an argentaffinoma. I have never knowingly encountered malignant hyperpyrexia, but had one experience of what we called ether convulsions with hyperpyrexia, which could have been, and probably was, the same thing. An attempt has been made to arrange the book in four logical sections. It begins with the hazards of preparation-assessment of risks to patients particularly, but Part I also includes chapters on medicolegal and occupational hazards to anaesthetists.

This volume contains the results of the 7th International Symposium on Acute Care, held in Rio de Janeiro from 21st to 24th November 1977. I would like to thank all the participants for their wonderful cooperation which made this Symposium a real success. I am especially grateful to the excellent speakers from all special ist fields and from all nations: I assure you, we all learned a great deal I would also like to thank the members of the organizing and scientific committees whose combined efforts ensured the smooth running of the Symposium, a meeting with a high-level discussion of scientific and philosophic problems as its goal. But first and foremost, we should like to express profound gratitude to the man whose idea it was to hold an annual conference in Rio: Dr. Brenildo Tavares, the Director of the Rio Symposia on Acute Care. He is one of the great pioneers of intensive, critical, acute, and emergency care, not only in.south America, but allover the world. The secret of the success of his symposia lies in his interdisciplinary and international approach. The symposia have brought together a great number of people who have since become close friends and continue to meet throughout the world. We all congratulate and thank him and wish him much success in the future."

The question how to induce general anaesthesia without problems has been asked repeatedly by anaesthetists and pharmacologists. P. A. JANSSEN developed etomidate and published this substance in 1971 as "a potent short-acting and relatively atoxic intravenous hypnotic agent in rats". In 1974 after several years of experimental and clinical trial the barbiturate-free hypnotic etomidate (soon marketed as Hypnomidate) was introduced to numerous auditors at the occasion of the IV. European Congress of Anaesthesiologists in Madrid. As the authors extended their essays, the actuality of the present book is given. The conclusion mentions the new solution of etomidate base in 35 % propylene glycol. It is expected that the disadvantageous effects - venous pain during injection and associated involuntary muscle movement- will largely be eliminated by using the new formula of etomidate after premedication of fentanyl. Mlinchen, August 1977 Alfred DOENICKE TABLE OF CONTENTS The Experimental Pharmacology of Etomidate, a New Potent, Short-Acting Intravenous Hypnotic (R. S. RENEMAN and P. A. JANSSEN) *. . . . ** 1 Protein Binding of Etomidate (G. A. MANNES and A. DOENICKE) ****. . . 6 The Effect of Intra-Arterial Injection of Etomidate and Thiopental on the Skeletal Muscle- and Arterial Wall-Structures (R. S. RENEMAN, F. VERHEYEN, R. KRUGER, W. VAN GERVEN and M. BORGES) . . *. . ** 9 Interaction between Etomidate and the Antihypertensive Agents Propanolol andoC-Methyl-Dopa (R. S. RENEMAN, W. VAN GERVEN and R. KRUGER) **. *. . . 15 Teratogenicity of Etomidate (A. DOENICKE and M. HAEHL) *. **. *.

Emergency care is improving throughout the world and thousands of lives are being saved each year. However, there are still too many patients who die before help reaches them in the form of advanced rescue and definitive emergency care techniques. In an effort to improve emergency care throughout the world, the International Committee of Emergency and Disaster Medicine meets bi annually. This meeting takes place in Mainz, Germany in September in order to discuss issues, exchange information, and establish re commendations designed to improve emergency care. The group is in dependent of political, national, racial, religious, or commercial influences and, in this sense, similar to the Club of Rome which attempts advances in sociology, biology and natural sciences. There fore, the organization could be called the "Club of Mainz" for the field of emergency and disaster medicine. The following book contains the proceedings of the International Symposiom on "Mobile Intensive Care Units and Advanced Emergency Care Units" at Mainz from September 24-27, 1973, and the discussions evoked by the first activities of the "Club of Mainz" and the inter nationally acknowledged "Recommendations." At this time we also announce the next meeting and International Symposium on Disaster Medicine, open to the public, organized by the "Club of Mainz" (October 1 - 2, 1977)."

Summary . . 373 381 Subject Index -IX- List of Contributors AGUADO-MATORRAS, A. , Dr. , Anesthesiologia y Reanimacion, Ciudad Sanitaria de la S. S. "La Paz", Madrid, Spanien ARIAS, A. , Dr. , Fundacion Jimenez Diaz, Madrid, Spanien ARNDT, J. 0. , Prof. , Dr. , Abteilung fUr Experimentelle Anaesthesiolo- gie der Universitat Dusseldorf BARUSCO, G. , Dr. , Anestesiologia e Rianimazione, Universitadi Pa- dova, Italien BECERRA, J. B. , Dr. , Fundacion Jimenez Diaz, Madrid, Spanien BEER, D. , Priv. -Doz. , Dr. , Institut fUr Anaesthesiologie der Chirur- gischen Uni versitatsklinik Munchen BEER, R. , Prof. , Dr. , Institut fUr Anaesthesiologie der Chirurgischen Universitatsklinik Munchen BERGIER, M. , Dr. , Departement d' Anesthesie et Reanimation, Hopital Nord, Marseille, Frankreich BERGMANN, H. , Prim. Prof. , Dr. , Institut fUr Anaesthesie mit Blut- zentrale a. O. Krankenhaus der Stadt Linz, Osterreich BIMAR, J. , Prof. , Dr. , Departement d' Anesthesie et Reanimation, Hopital Nord, Marseille, Frankreich BOSTEM, F. , Dr. , Electroencephalographie, Universite de Liege, Ho- pital de Baviere, Liege, Belgien BUZELLO, W. , Dr. , Institut fUr Anaesthesiologie der Universitatskli- niken Freiburg CASTRANEDA-CASADO, J. , Dr. , Anestesiologia y Reanimacion, Ciudad Sanitaria de la S. S. "La Paz", Madrid, Spanien CHACORNAC, R. , Dr. , Departement d' Anesthesie et Reanimation, Ho. . pital Neurologique, Lyon, Frankreich DAMIA, G. , Prof. , Dr. , Anestesiologia e Rianimazione, Inst. "E. Ve- cela", Universita di Milano, Italien DELEUZE, R. , Prof. , Dr.

Everyone experiences pain, whether it's emotional or physical, chronic or acute. Pain is part of what it means to be human, and so an understanding of how we relate to it as individuals - as well as cultures and societies - is fundamental to who we are. In this important new book, the first in Routledge's new Critical Approaches to Health series, Robert Kugelmann provides an accessible and insightful overview of how the concept of pain has been understood historically, psychologically, and anthropologically. Charting changes in how, after the development of modern painkillers, pain became a problem that could be solved, the book articulates how the possibilities for living with pain have changed over the last two hundred years. Incorporating research conducted by the author himself, the book provides both a holistic conception of pain and an understanding of what it means to people experiencing it today. Including critical reflections in each chapter, Constructing Pain offers a comprehensive and enlightening treatment of an important issue to us all and will be fascinating reading for students and researchers within health psychology, healthcare, and nursing.

Endocrinology is a rapidly developing field with many new concepts. In addition, many new hormones have been described since 1960. The structural analysis and synthesis of several intestinal hormones such as gastrin, secretin, glucagon and cholecystokinin have been achieved. Several hypothalamic hormones controlling pituitary function have been identified and in certain cases synthesized. The existence of hormonal peptides se creted from ectopic sites has been recognized. The development of new techniques of hormone assay has stimulated studies on the effects of anesthetics on the endocrine system. Although the endocrine response to anesthesia is less than its response to major surgical procedures, the effects of anesthesia on metabolism and on the autonomie nervous system are substantial. The primary purpose of this book is to increase the safety of patients undergoing anesthesia by making available the latest developments in this field. The major subjects examined in the book are endocrine responses to anesthesia and surgery, the effects of endocrine disease on anesthesia and sur gery, and pre-operative and post-operative management of patients with endocrine disease. The book is designed for students, residents and practicing physicians in the field of anesthesia and surgery. Many tables and figures are empIoyed to improve the presentation, particuIarly those relating to pharmacology and to the practical aspects of therapy."

Lest the reader be discouraged, let us state unequivocally and at the very beginning that this is not, nor will it develop into, a treatise on information or decision or communication theory. It is true that on occasion some ideas or concepts will be borrowed from these areas, and it is also true that on some other occasions we might offer examples of what communication theory, or decision theory, are all about. Nevertheless, this will be done for the primary purpose of showing where and how further exploration of these areas of endeavour might lead to further and better understanding of our problems, and possibly lead the way to sounder planning and more workable solutions. The more sophisticated will find a paucity of illustrations and a minimal mathematical treatment of the subject. This has been done for two specific reasons; the first being that additional graphic representation or mathema tical manipulations would not have contributed materially to a better under standing of the subject, at least in the context in which it is being presented."

During the recent years the basic sciences have become a major stimulant toward progress in medicine. Technique itself plays a vital role in today's medicine. With the increasing complexity of equipment, hazards related to malfunction and misuse have grown proportionally. The machine used with insufficient knowledge could become a deadly instrument. The basic elements of the anaesthesia machine, their design, and the physical basis for their function is discussed in the monography by the engineer, Peter 1. Schreiber. His knowledge is based upon fifteen years experience in the medical equipment industry in both Germany and the United States as well as his teaching activities in various medical schools. Detailed knowledge of equipment and the related physical laws has gained increasing importance in the training of anaesthesiologists. Fundamental knowledge of the design, function, and performance of an anaesthesia machine is the key to the art of its use. Mainz/Rhine, December 1971 Dr. RUDOLF FREY, F.F.A.R.C.S. Professor of Anaesthesiology Johannes Gutenberg-University Acknowledgements I wish to thank Dr. STANLEY W. WEITZNER, Professor, Department of Anesthesiology, State University of New York, Downstate Medical Center, for his helpful criticism of the chapter dealing with the per formance and classification of ventilators. I also want to thank Mr. DAVID F. BOERNER for his assistance in rewording the language and physiochemical terminology of the manu script."

This practical book provides a handy reference for the doctor confronted with patients complaining of headache. Headache is one of the most common complaints seen in the outpatient or ambulatory care setting, and may be caused by a wide variety of conditions. This book clearly explains up-to-date headache epidemiology, impact, and pathogenesis, and walks the reader through the steps to evaluating and treating the patient presenting with primary or secondary headache disorders. Also included are reviews of common headache comorbidities, including cardiovascular disease and stroke, epilepsy, fibromyalgia and mood disturbance. Copious use of easy-to-understand figures, tables, and algorithms make this book a useful and practical tool in the clinic. Guidance on selecting diagnostic tests and specific treatment protocols are provided. Treatment recommendations are evidence-based with full referencing and include emerging therapies. Sections on evaluating and treating headaches in children, women during pregnancy, and the elderly complete this comprehensive reference. The likely readership will include the following: neurologists, general physicians, doctors in training, hospital pharmacists, primary care physicians, nurses and nurse practitioners.

This book offers a thorough foundation for acupuncturists on the eight extraordinary vessels in Classical Chinese medicine. The contents cater for the beginner by providing a basic level introduction to the theory and practical application of the eight extraordinary vessel system to acupuncture practice and the healing process. History, the vessels, the pulses, point combinations and safety protocols are all covered, and case studies help demonstrate how this knowledge can be used in treatment. The book includes many helpful illustrations as well as sections on common problems particularly suited to 8EV treatment such as fertility, depression and emotional pain.

Epidural Anaesthesia: Images, Problems and Solutions brings together the most comprehensive collection of post-block epidurograms in the world into a single volume. With accompanying X-rays and contrast injection images, it clearly explains why an epidural block has failed and provides practical advice on how to avoid complications in the future. Key featuers: Contains over 180 clearly labelled X-rays and contrast injection images to help you learn using these examples. Uses X-rays and contrast injection images rather than more complext imaging technologies, to allow quick assessment of blocks in the most basic radiology department. Written by a world-renowned expert, providing consistency of style and approach throughout. Companion website contains downloadable images as well as moving X-rays of contrast injection, 3D reconstructions and explanatory cartoons. This unique book for specialist and trainee anaesthetists demonstrates, with simple X-rays and contrast injection, why epidurals are occasionally imperfect. Epidural Anaesthesia: Images, Problems and Solutions will enable you to refine your technique and avoid adverse outcomes in practice.

Part of the What Do I Do Now? Pain Medicine series, this timely volume presents clinical scenarios exploring headache medicine and treatments. Headache Medicine is a complex and constantly developing field, often relying on outdated and time-intensive textbooks. The purpose of this book is to educate readers on the diagnosis and management of commonly encountered headache disorders through brief discussion of relevant and specific cases. The book begins with Headache Medicine clinical pearls and red flags. It progresses through primary and secondary headache disorders, using cases to illustrate presentations and then help to guide an approach to evaluation and management. The book follows the same order as the International Classification of Headache Disorders (ICHD-3). Topics include migraines, cluster headaches, neuropathic eye pain, and trigeminal and occipital neuralgia. This handy guide will be of use to physicians and advanced practitioners (nurse practitioners and physician assistants) interested in the practice of Headache Medicine, emergency room and urgent care physicians, neurologists, internists, psychiatrists, physiotherapists, residents, and medical students undergoing a Neurology or Headache Medicine rotation.

During the First European Congress of Anesthesiology, held in Vienna, Austria, in September, 1962, panel discussions on nineteen different subjects were held, each lasting approxi mately three hours. One, concerning Controversial Aspects of Resuscitation, was later edited by its chairman, PETER SAFAR, and published in 1963. At the request of the publisher, the discussion on hypnosis has been edited in a similar manner. The participants in the discussion on Hypnosis in Anes thesiology had agreed, prior to the meeting, on a list of questions to be debated, and Dr. STOKVIS' introductory statement on the nature of hypnosis was circulated among them in appropriate translations in order to give the debate a starting point. It had also been agreed that no formal papers should be read after this introduction, and that the participants should use at will the German, English or French language. Following each contribution it was the chairman's task to give a brief summary in the two other languages. Discussion was therefore somewhat slowed down and occasionally rendered difficult by misunderstandings or the omission of details. Drs. GUEGUEN, MOSCONI, and VOLGYESI, who were not able. to attend, had sent written contributions which the chairman presented briefly during the discussion. The present text has been worked out of the tape recording of the discussion and the chairman's correspondence with the panelists some time after the meeting. Whenever the original contributions were in French or German, the English translation has been the chairman's."

The First European Congress of Anesthesiology in Vienna, Austria in September, 1962 presented 19 Symposium discussions, each lasting approximately 3 hours. Unlike most of these panels, the one on Resuscitation was a free discussion on controversial topics, without presentation of formal papers. In spite of the spontaneity of the unrehearsed questions and ans wers, the participants feit that an edited version of this Symposium should be published. The reasons for publication included the inter national character of the group of participants and the recent general interest in respiratory and circulatory resuscitation. A presentation of accepted resuscitation techniques was omitted, because of lack of time and because the Symposium was held pri marily for trained anesthesiologists, most of whom have first-hand experience with resuscitation and should be familiar with the accepted modern methods. Only controversial topics, which seemed to be of interest to those with personal experience in the application and the research of resuscitation, were included."

Given the heightened focus on the opioid crisis and its intersection with adequate chronic pain management, there is an impetus to shift patient care toward self-management and comprehensive interdisciplinary modalities. However, despite the evidence base for efficacy, pain psychology remains largely relegated to the complementary and alternative medicine designations and medical providers struggle to search for trained pain psychologists in their community. This unique book makes core psychological techniques accessible to medical providers and allied health professionals who are on the front lines of routine communication with patients living with chronic pain. Practical suggestions and vignettes demonstrate how to briefly and effectively incorporate key concepts from Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy, Motivational Interviewing and other orientations into any health care setting.

This book aims to provide an overview of the basics of anesthesia for neurotrauma. It showcases how management of different neurotrauma cases may differ, especially those involving spine and or polytrauma. It provides quick and easy access to understand anesthesia for neurotrauma.

Pain in one form or another is probably the most common symptom presented to medical and healthcare professionals. Long a subject of biomedical interest, more recent biopsychosocial theories have extended the study of pain as a concept which is highly individual in the way it is experienced. Today s landscape offers a broad array of approaches to understanding pain and, crucially, to alleviating its impact. This concise and accessible volume aims to make sense of what is at first sight an eclectic mix of theoretical and practical work on pain, from a distinctly sociological perspective. While there has been much quantitative medical research on pain, in exploring sociology s important contributions to this field Elaine Denny offers insight into the world of those living with pain and the meaning it has in their lives. She provides readers with a range of explanations of pain and various influences on the experience of pain, critically analysing competing schools of thought and embedding this work in the everyday practice of providing care. The result is an illuminating volume for students of health and medical professions studying pain, the body, and the sociology of health and illness.

This pack brings together two essential texts on the clinical specialties, covering all core topics for a value-for-money price. Updated with the latest advice and clinical guidelines, packed full of high-quality illustrations, boxes, tables, and classifications, and with a brand new chapter on how to survive your junior doctor years and beyond, the Oxford Handbook of Clinical Specialties is ideal for both study and use at direct point of care. Each chapter is clear and concise and filled with medical gems, with features including ribbons to mark your most-used pages and mnemonics to help you memorize and retain key facts. With reassuring and friendly advice throughout, this is the ultimate guide and revision tool for every medical student and junior doctor for each clinical specialty placement. Accompanying this resource is the fourth edition of Oxford Assess and Progress: Clinical Specialties which features over 400 Single Best Answer questions that are mapped to the medical school curricula. Packed with questions written by experienced doctors in each specialty, and rooted in real-life clinical encounters, this revision tool is an authoritative guide for students. Further reading resources and cross-references to the Oxford Handbook of Clinical Specialties have been fully updated to expand your revision further on topics you find challenging.

Introduction to Pain and its relation to Nervous System Disorders provides an accessible overview of the latest developments in the science underpinning pain research, including, but not limited to, the physiological, pathological and psychological aspects. This unique book fills a gap in current literature by focussing on the intricate relationship between pain and human nervous system disorders such as Autism, Alzheimer Disease, Parkinson s Disease, Depression and Multiple Sclerosis. This fully illustrated, colour handbook will help non-experts, including advanced undergraduate and new postgraduate students, become familiar with the current, wide-ranging areas of research that cover every aspect of the field from chronic and inflammatory pain to neuropathic pain and biopsychosocial models of pain, functional imaging and genetics. Contributions from leading experts in neuroscience and psychiatry provide both factual information and critical points of view on their approach and the theoretical framework behind their choices. An appreciation of the strengths and weaknesses of brain imaging technology applied to pain research in humans provides the tools required to understand current cutting edge literature on the topic. Chapters covering placebo effects in analgesia and the psychology of pain give a thorough overview of cognitive, psychological and social influences on pain perception. Sections exploring pain in the lifecycle and in relation to nervous system disorders take particular relevance from a clinical point of view. Furthermore, an intellectually stimulating chapter analysing the co-morbidity of pain and depression provides a philosophical angle rarely presented in related handbooks. The references to external research databases and relevant websites aim to prompt readers to become critical and independent thinkers, and motivate them to carry out further reading on these topics. Introduction to Pain and its relation to Nervous System Disorders is essential reading for advanced undergraduate and postgraduate students in neuroscience, medical and biomedical sciences, as well as for clinical and medical healthcare professionals involved in pain management.