On 16 October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic effect of diethyl ether in a public demonstration in the "ether dome" of the Bulfinch Building of the Massachusetts General Hospital in Boston. The patient, Gilbert Abbott, suffered no pain, and the surgeon, Dr. John C. Warren, was able to complete a suture ligature of a vas cular tumor of the jaw without the hurry that until then was so necessary. The operation proved a failure, since the tumor recurred; but the demonstration of ether's anesthetic effect was a great success. Operative pain was conquered, and surgery could advance from a crude and unscientific practice where speed was paramount, and the major body cavities could not be entered, into the unique blend of science and art that it is now. "Gentlemen, this is no hum bug," supposedly muttered Warren, perhaps the last noncontroversial assess ment of anesthesiology to be made by a surgeon. The screams of resisting patients in pain were stilled, and quiet entered the operating room for the first time. But the new science of pain relief was quickly wrapped in controversy. An argument immediately arose as to who could legitimately claim primacy for the discovery. Morton's attempt to hide the true nature of his anesthetic agent, coupled with an effort to patent the discovery, clouded his reputation and stimulated other claimants to push themselves forward."

Manual of Local Anaesthesia in Dentistry is the third edition of this highly illustrated guide, which provides an overview of anatomy, neurophysiology and anaesthetic techniques in dentistry. Divided into seven sections, this book begins with a history of anaesthesia, followed by applied anatomy of maxilla and mandible, neurophysiology and pharmacology. Subsequent sections cover indications and contraindications of local anaesthesia, equipment, techniques of local anaesthesia including new injection techniques, complications and their management. The final section is brand new to this edition and features guidelines for managing exposure to blood borne pathogens, and a chapter featuring questions and answers on anaesthesia topics. Other new chapters in this edition include Ergonomics in Dental Practice, Local Anaesthesia in Children, and Medical Emergencies in Dental Office. Manual of Local Anaesthesia in Dentistry is enhanced by over 270 full colour images and illustrations, making this an ideal visual guide for undergraduates and practising dental professionals. Key Points Third edition of this highly illustrated manual Previous edition published 2009 (9788184487015) Three new chapters and one brand new section: Guidelines for Managing Occupational Exposures to Blood Borne Pathogens 272 full colour illustrations and images

In susceptible individuals, malignant hyperthermia (MH) can be triggered by various anesthetics during surgery. First described in 1960, research since then has concentrated on reducing the very high mortality rate associated with MH. Although significant progress in treatment has been made with the introduction of dantrolene sodium in 1979, many questions remain unanswered. Following on the results of more than 30 years of investigative efforts, the Third International Symposium on MH was held in Hiroshima, Japan, in 1994, immediately before the Seventh International Workshop on MH. Specialists in the field discussed the most up-to-date findings from the point of view of clinical classification, history, and incidence based on the evidence of epidemiology, diagnostic muscle testing, genetics, and biochemistry. These proceedings of the symposium present important keys to understanding the mechanism of MH and related syndromes at the genetic level and include procedures for the monitoring and care of patients. This volume will be invaluable not only for surgeons and anesthesiologists but also for physiologists and researchers.

Final FRCA: 300 SBAs offers a wealth of exam questions focussing on the new SBA format. With so few resources available for candidate wishing to practice the new exam format, Final FRCA: 300 SBAs will ensure that trainees have sufficient experience to ensure success in the exam. Presented as 10 complete SBA mock paper sections, and featuring the most up-to-date and comprehensive coverage of practice questions, the content is carefully designed to test knowledge and improve exam technique. Covering the full breadth of the syllabus with particular focus on clinical scenarios, Final FRCA: 300 SBAs provides the definitive SBA revision guide to maximise chances of exam success. 300 SBAs providing large number of questions in the new exam format Answers feature detailed explanations to consolidate knowledge Tables, diagrams and graphs to assist in understanding answers and help clarify complex concepts A further reading reference is provided with each SBA question to aid understanding of answers Up to date and relevant SBA questions reflect RCA style questioning, along with accepted current practice and guidelines

Theodore H. Stanley, M.D. W. Clayton Petty, M.D. Anesthesiology 1986 contains the Refresher Course manuscripts of the presentations of the 31st Annual Postgraduate Course in Anesthesiology which took place at the Westin Hotel Utah Convention Center in Salt Lake City, Utah, February 14-18, 1986. The chapters reflect recent and future developments in anesthetic techniques, monitoring instruments and devices, and anesthetic drugs. The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehi cl e to bri ng many of the 1 atest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesi a expressed at the conference. Thi s book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarlze the most salient points. This textbook is the fourth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. TABLE OF CONTENTS PHARMACOLOGY The New Neuromusucular Blocking Agents D. Ryan Cook, M.D.

One of the most exciting developments in medicine in this century has been the discovery of opioid receptors and their pharmacology. The breadth of know- edge derived from such discovery has truly changed the practice of medicine today. The acceptance by the clinicians of the research data obtained by the basic scientist on spinal opioids is truly amazing. The clinical sequelae of the discovery of opioid receptors has been the development of the technique of intraspinal administration of opioids. In the last decade much has been written about indications, effects, and side effects of intraspinal opioids. The technique has become commonplace for cancer and postoperative pain. However, no standards of care and management of patients with spinally administered opioids have been developed. We need these standards to be developed and universally followed. The monograph was conceived to update clinicians on the applied pharma cology of spinal opioids. We were fortunate to have Drs. N. Rawal and D. Coombs agree to edit this monograph. They have been able to assemble world-renowned experts as contributing authors. It is our hope that the con tents of this book will be stimulating, informative, and useful to the reader. PREFACE Much has been written about the subject of spinal opioid analgesia, includ ing several notable reviews. We were stimulated to assemble this particular volume in this important series on pain management initiated by Dr. Raj for a number of reasons."

The prevalence of obesity, an important risk factor for various diseases, has increased markedly worldwide in recent years. The results of long-term dietary behavioural therapy, however, remain sadly inadequate, with a relapse rate of about 90%. Surgery is still the only effective treatment for these patients. The annual number of weight loss operations performed in the United States in the early 1990s totaled only about 16,000, but by 2005 the figure exceeded 200,000. The anesthetic care of severely obese patients entails particular issues, and difficulties are believed to escalate in the presence of co-morbidities. Despite this, outcome data in respect of anesthetic care and pain management are still scarce. Anesthetic Management of the Obese Patient considers a wide range of important practical issues and controversies. Key questions in preoperative, intraoperative, and postoperative management are carefully addressed, and different approaches are evaluated, casting light on their effectiveness and limitations. Written by world leaders in the field, this book will be an invaluable aid for anesthesiologists.

Key Clinical Topics in Anaesthesia presents a brand new addition to the forthcoming Key Clinical Topics series. Key Clinical Topics in Anaesthesia provides a comprehensive overview of the subject, comprising over 100 carefully selected topics in alpha order that together provide an extensive understanding of anaesthetic management. This collection of highly practical guides systematically addresses anaesthetic management techniques for a large number of clinical settings, as well as summarising important areas such as Ethics and Nutrition. Edited by experienced specialists, with contributions from consultants who have recognised expertise in their field, this book provides an authoritative and up-to-date guide on anaesthesia. Designed to enable rapid access to core information, Anaesthesia offers effective exam revision and the ideal quick reference for day-to-day practice. Over 100 topics presented in alpha order, from Airway - Assessment to Ventilation Strategies Effective exam revision for FRCA and EDA candidates Succinct coverage of anaesthetic treatment modalities and complications Includes clinical photos and diagrams to improve understanding of concepts Contributions from experienced specialists to ensure authoritative, accurate content

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo."

Inhalational anaesthesia was the first medical and scientific technique to become a legitimate means of pain relief. Its introduction to medicine in 1846 sparked one of the most intense public debates of the period. It challenged religious principles and at its center posed one of medicine's fundamental questions: risk versus benefit of medical intervention. This book explains how the introduction of anaesthesia intertwines with a wide variety of other nineteenth century medical and cultural issues: the growing elitism of surgery, the emerging professionalism of medicine, the popular and progressive culture of science and the secularization of society.

The focus of this volume is the "state of the art" of Intensive and Critical Care Medicine as well as new insights into basic science, clinical research and therapeutic interventions. Structured in four parts, the volume opens with few chapters devoted to the beginning and development of the WSICCM, to procedures standardization, recommendations and quality of care improvement, with particular reference to the definition of clinical governance, professionalism and ethics. In the second part, the authors describe the practical clinical approach to critical illness; among the topics dealt with, the reader will find monitoring and management of shock states; acute pain management, airway management, ALI/ARDS and protective lung ventilation; the problem of weaning; antibiotics policy, sepsis and organ dysfunction. The third part of the book is related to some special conditions of countries with limited resources, such as management of obstetrics at high risk, malaria, AIDS, blood transfusion and its components. The last part of the book is structured to present some crucial issues of the intensive and critical care arena, in particular evidence-based practice, the role of the e-distance learning for information and the promotion of CME programs; last but not least, trauma care, disaster and natural disaster medicine are also discussed; a final chapter on the Guidelines of the World Health Organization (WHO) on Disaster Medicine is included.

Theodore H. Stanley, M. D. What's New in, Anesthesiology in 1988 contains the Refresher Course manuscripts of the presentations of the 33rd Annual Postgraduate Course in Anesthesiology which took place at the Marriott Hotel Convention Center in Salt Lake City, Utah, February 19-23, 1988. The chapters reflect new data, ideas and concepts within the general framework of most recent developments in "evaluation and monitoring cardiac function before, during and after surgery," "new anesthetics and their actions on the heart and peripheral vasculature, and other organ systems," "metabolism and elimination of anesthetics and anesthetic adjuvants," and "recent developments in the anesthetic management of patients with congenital heart disease, renal and pulmonary dysfunction, and diabetes insipidus. " In addition, there are chapters on new developments in "obstetrics," "regional anesthesia," and "anesthetic management of the newborn. " The purposes of the textbook are to 1) act as a reference for the anesthesio logists attending the meeting, and,2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the sixth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City."

by E.K. ZSIGMOND, M.D. Department of Anesthesiology University of Illinois Chicago U.S.A. It is, indeed, a distinct honor and privilege to be invited by the authors to write a preface to this monumental monograph, Regional Opioid Analgesia. Regional Opioid Analgesia is a colossal undertaking by Drs. De Castro, Meynadier and Zenz shortly after the introduction of this revolutionary approach to pain relief which opened a new epoch in analgesiology. This is, indeed, the first authentic and comprehensive textbook encompassing the current knowl edge on this novel approach to pain relief. We are indebted to the authors for introducing the new opioids to regional analgesia with the scientists, who de veloped the potent short and ultrashort acting opioids with high therapeutic indices, which many researchers dreamt about but never before materialized. The side effect liabilities of these new opioids are minute as compared to morphine and meperidine. Regional Opioid Analgesia could not have been more authentically written than by Drs. De Castro, Zenz and Meynadier, who have conducted daily clinical investigations on all known opioids for regional analgesia as well as for neurolept analgesia. Therein lies the great value of this monograph: it is the most authentic work on this topic."

Chronic and persistent pain, which is a problem for the individual who suffers and the society that has to deal with it, has become increasingly appreciated. Over the last three decades, several books and journals have been specifically devoted to the topic of pain, especially chronic and persistent pain. It has been increasingly recognized that chronic and persistent pain, unlike acute pain, involves significant psychosocial factors and requires treatment strategies that deal with these issues. All measurements and factors that affect improvement seem to be in the psychosocial area rather than the medical/ biological/physical areas. Psychosocial conveys the importance of the environmental and interpersonal factors of the patient's functioning. The writing of this book has brought together some of the leading researchers and clinicians in the area of managing the patient with chronic pain. The authors express their opinions based on experience and review of the literature available to date. Each of the chapters focuses on an important element of the assessment and/or treatment intervention utilized for the individual with chronic pain. The concluding chapter summarizes the status of the assessment and treatment strategies for those patients.

This method of local anaethesia, developed by a dermatologist and a pharmacologist, is presented to demonstrate its use in cosmetic liposuction and other procedures. Richly illustrated to show details of the technique and with serialphotographs of many clinical cases, the book explains the advantages of this new technique and provides practical instruction in how to perform it.

A HISTORY OF MALIGNANT HYPERTHERMIA Malignant hyperthermia (MH) is a hereditary disorder of muscle. Undoubtedly, individuals have possessed this trait since time immemorial. However, because the trait is usually only unmasked in the presence of potent inhalational anaesthetic agents or non-depolarizing skeletal muscle relaxants, the existence of malignant hyperthermia was not suspected until we" after the dawn of the modern anaesthetic era. In the early years of ether and chloroform anaesthesia, monitoring was minimal. Body temperature was never measured. A finger on the pulse, and observation of respirations and skin colour were the most that could be expected. Death was not infrequent and usually unexplained (1). By the beginning of the twentieth century, reports of fulminant fever and tachycardia (rapid heart rate) during or immediately after anaesthesia often ending in death, were being described with increasing frequency in the medical literature (2-6). As a number of cases from New York had occurred during summer months, they were initially thought to be a form of heat stroke due to overly hot operating theatres (2-6). However, one enterprising anaesthetist (5: ' checked the weather reports for the days on which some of these so called "heat strokes" had occurred. He found that on the days i'n question the ambient 0 temperature had never been in excess of 72 F. Environmental heat, therefore, could not have been a cause of at least some of these reactions.

Thousands of articles and many books have been published on the acquired immunodeficiency syndrome (AIDS). There are, however, no studies or case reports and only several articles published on the anesthetic considerations for a person with AIDS or in pain with AIDS. There is no literature on the pain management of AIDS patients. Writing on this subject must be considered trailblazing. The reason anesthesiologists should know about AIDS has rapidly extended from concern over transmission of infection to anesthetic and analgesic considerations. The anesthesiologist may also be part of a pain management team on either an acute or a chronic pain service. The requirement may be to treat an HIV -positive or AIDS patient acutely postoperatively or in consult to a psychiatric, medical, or surgical service. In a pain clinic setting, the anesthesiologist may be concerned with diagnosis, treatment, or referral for other multidisciplinary consultation. The earlier question of central nervous system involvement in AIDS is now moot, rapidly replaced with the knowledge that the eNS, if not primarily infected, is so shortly thereafter. Protected by the blood-brain barrier, the eNS becomes both a sanctuary and reservoir for HIV. Because neurologic complications of HIV are common, and since knowledge of the nervous system is essential for anesthetic and pain management, it is important to review HIV infection of the nervous system.

The pain center/clinic is in the stage of transition. It has come a long way since chronic pain was a nonexistent entity and patients with difficult pain problems did not receive well-deserved attention or were lost in the busy practices of vari ous specialty clinics. Thirty-five years ahead of the rest of us, John]. Bonica was the first physician who had a clear vision of a pain center's potential. Twenty years later, in response to loud public demands for relief of chronic pain, this idea was put into practice by a number of others on a somewhat larger scale. A team of specialists from various disciplines, trained in the management of chronic pain, now offer approaches ranging from simple outpatient care to inpatient hospital ization for comprehensive care including drug detoxification, behavior modi fication, and total rehabilitation of these patients. Hospitals have entered this arena with renewed enthusiasm. The pain center/clinic is now an established, ac cepted, and expanding method of providing care for chronic pain patients. The chapters in this book are based on examples of multidisciplinary projects that deal comprehensively with management of chronic pain. Aimed primarily at the pain center/clinic in the university hospital setting, this book ranges from his torical perspectives to current pain centers with their less orthodox methods of re lieving chronic pain to the future of algology as a specialty."

Using sample administrative and clinical protocols that any hospital can use, this book gives a detailed account of how to set up and run an observation unit and reviews all medical conditions in which observation medicine may be beneficial. In addition to clinical topics such as improving patient outcomes and avoiding readmissions, it also includes practical topics such as design, staffing, and daily operations; fiscal aspects, such as coding, billing, and reimbursement; regulatory concerns, such as aligning case management and utilization review with observation; nursing considerations; and more. The future of observation medicine, and how it can help solve the healthcare crisis from costs to access, is also discussed. Although based on US practices, this book is also applicable to an international audience, and contains instructions for implementing observation in any setting or locale and in any type of hospital or other appropriate facility.

Here is the perfect text you need to provide your learners with real-life clinical scenarios that are ideal for Case-Based Learning and Discussion. Presents real-world patients in a real-world clinical setting, making learning fun and engaging. The Case-Based Learning approach focuses learners and clinicians on the key elements for each diagnosis and helps develop a deep understanding of how to diagnose and treat each condition. Covers everyday clinical problems such as arthritis, deltoid ligament strain, Achilles tendinitis and tendon rupture, bunion and bunionette pain, plantar fasciitis, metatarsalgia, and more. Cases unfold just the way they do in your clinic. Each case is accompanied with thoughtful clinical commentary and key messages from the author. Each chapter uses high-quality radiographic images, clinical photos, and full-color drawings to facilitate a clear, easy-to-understand approach to evaluation and diagnosis. An ideal self-assessment and review tool for pain medicine practitioners and trainees, as well as those preparing for the American Board of Anesthesiology Pain Medicine certification and recertification exam. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Here is the perfect text you need to provide your learners with real-life clinical scenarios that are ideal for Case-Based Learning and Discussion. Presents real-world patients in a real-world clinical setting, making learning fun and engaging. The Case-Based Learning approach focuses learners and clinicians on the key elements for each diagnosis and helps develop a deep understanding of how to diagnose and treat each condition. Covers everyday clinical problems such as costosternal syndrome, Tietze's syndrome, devil's grip, fractured ribs, post-thoracotomy pain, acute and chronic pancreatitis, diverticulitis, and more. Cases unfold just the way they do in your clinic. Each case is accompanied with thoughtful clinical commentary and key messages from the author. Each chapter uses high-quality radiographic images, clinical photos, and full-color drawings to facilitate a clear, easy-to-understand approach to evaluation and diagnosis. An ideal self-assessment and review tool for pain medicine practitioners and trainees, as well as those preparing for the American Board of Anesthesiology Pain Medicine certification and recertification exam. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

In this issue of Anesthesiology Clinics, guest editors Drs. Alison J. Brainard and Lyndsay M. Hoy oversee the topic of Total Well-being. Articles in this issue highlight perspectives from across multiple subsets of anesthesiology, including nutrition, arts and humanities, coaching, and the inequalities of medicine. The editors' goal is that readers will come away inspired, informed, and excited to create an approach for total well-being that can be tailored to their workplace and lives. Contains 19 practice-oriented topics including women in anesthesiology; parenting/lactation in anesthesia; intensivists and wellness, post-pandemic; early-career physician burnout; integrating antiracism into MedEd with health humanities program; and more. Provides in-depth clinical reviews on total well-being, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

The third edition of Cardiopulmonary Bypass offers a comprehensive, and up-to-date reference text to extracorporeal cardiopulmonary support. This book provides a clinically-focused tutorial with chapters spanning the technical aspects, patient related considerations, and human factors essential to contemporary practice of cardiopulmonary bypass. Written concisely to allow the reader to gain and apply critical knowledge to the clinical setting and featuring artwork that has been extensively updated to include numerous figures and color plates imbedded into each chapter. A remarkable collection of international experts in the fields of perfusion, anesthesiology, and cardiac surgery were recruited to co-author chapters, providing a multidisciplinary approach to case management. This completely updated edition includes expanded content on developments in minimally invasive extracorporeal circulation, anticoagulation, organ injury, and human factors. The comprehensive coverage of perfusion practice in a concise, highly illustrated format makes it the go-to, portable reference manual for perfusionists, cardiac surgeons, and anesthesiologists.

Treatments, Mechanisms, and Adverse Reactions of Anesthetics and Analgesics is an essential read for anyone working in pain management. The book addresses the onset of pain, the cause of the pain, and the administration of analgesia or anesthesia. The etiology of pain is complex and multi-factorial, which is made more complex with the use of analgesics and local or general anesthetics. This volume works to clarify all of the subjects pertinent to anesthesia and the brain, from their variety, modes of action, and adverse effects.

In spite of today's increasing body of knowledge in regard to central nervous func tion and/or the mode of action of centrally active compounds, little is done to monitor those patients which are at risk of cerebral lesions either in the OR or in the ICU. Due to the inconsistency of reports regarding the application and the benefits computerized EEG and/or evoked potential monitoring will bring to the clinician, physicians still are reluctant to get involved with a technique, which they think, will have little or no effect on the outcome of a patients well being. However, due to the development in computer technology, data acquisition and comprehension, it now is possible to monitor such a viable organ as the Central Nervous System (CNS) on a routine base without being a specialist in neurology or electroencephalography. Thus, the book is intended to guide the clinician to use BEG and evoked potential monitoring in a day to day situation, without going too deep into technical details. As an improvement of cerebral care is needed, various representative cases underline the interpretation of EEG power spectra and evoked potential changes in regard to the underlying clinical situation. It is hoped that this book will serve as a guide to anyone who considers cerebral monitoring a necessity in today's patient care. This may be the anesthesiologist, the intensive care therapist, the nurse anesthetist as well as the medical personnel in the lCU setting."