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.

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.

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."

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.

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.

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.

Addresses the most important aspect of anaesthetic training - learning in the operating suite. It has been written by experts in this area from both the UK and the USA to assist both experienced and new trainers. It is particularly helpful to advanced trainees who are just developing their teaching skills. The information is clearly presented and can easily be incorporated into the practice of clinical anaesthesia. It provides an unequivocal guide to the process of developing a safe and conscientious colleague from the novice anaesthetist in their first few days to the latter days of advanced training just prior to independent practice. Written by specialists in anesthetics from the UK and US, this text addresses the learning that takes place in the operating room Coverage includes many aspects of the pedagogical project, from providing the right environment for learning and clinical supervision to the ethics of learning on patients, and problem-based learning (PBL); clinical teachinggiving feedback and monitoring progress; and using simulators for teachingtechnical and non-technical skills that may be taught using simulation, how to set up a high-fidelity simulator center, and how to organize a major obstetric hemorrhage "fire drill."

Ophthalmic Anaesthesia is a new textbook written by an international group of authors who are recognized experts in the fields of anaesthesia and ophthalmology. Covering the entire subspecialty of anaesthesia for surgery of the eye, the book offers chapters on a variety of subjects including: the history of ophthalmic anaesthesia, physiology and pharmacology, anatomy, pre-operative assessment, paediatric anaesthesia, orbital regional anaesthesia, general anaesthesia, complications, high-volume cataract surgery, and future developments. Written by both academicians and experienced clinicians, this is a well-referenced and illustrated text describing the techniques used in the anaesthetic management of patients undergoing the most commonly performed surgical procedures in the world.

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."

This edition of the companion volumes Muscle Pain: Understanding the Mech- isms and Muscle Pain: Diagnosis and Treatment is essential reading for those interested in clinical approaches to acute and chronic pain conditions involving muscle tissues and in the mechanisms underlying these conditions. The volumes cover a very important topic in pain medicine, since muscle pain is very common and can often be dif?cult to diagnose and treat effectively. Furthermore, chronic pain involving muscle and other components of the musculoskeletal system increases with age, such that it is a common complaint of those of us who are middle-aged or older. Indeed, as changing population demographics in "west- nized" countries result in higher proportions of the population living longer and being middle-aged and elderly, chronic muscle pain will likely become even more of a health problem. In the case of acute muscle pain, this can often be very intense, and in the short term can limit or modify the use of components of the musculoskeletal system associated with the sensitive muscle. Chronic muscle pain can also be intense, as well as unpleasant and disabling, and it is in many cases the over-riding symptom of most musculoskeletal disorders that are associated with long-term deleterious changes in musculoskeletal function.

Predictive control is a powerful tool in dealing with those processes with large time delays. Generalized Predictive Control (GPC) is the most popular approach to the subject, and this text discusses the application of GPC starting with the concept of long-range predictive control and its need in medicine (particularly automated drug deliveries). The concept of adaptation is also emphasized with respect to patient-to-patient parameter variations. Subsequent chapters discuss interactions, comparisons and various aspects of GPC. The book concludes by putting into perpective the generic nature of the architecture built around GPC and which provides model-based fault diagnosis with control.

This treatise commemorates the 32nd anniversary of the first successful allogenic kidney transplant in a human being and the beginning of a con tinuing challenge for well over a generation of anesthesiologists. If compari sons can be permitted, this epoch-making event can be ranked with the first pulmonary lobectomy and subsequently the initial ligation of a patent ductus arteriosus in the late 1930s when thoracic and cardiac surgery began. Was it merely a coincidence that brought these events to the fore so close upon one another after many years of ideation and frustration? Not so, according to Lewis Thomas, for this was the time of medicine's second revolution-its transformation from an empirical art into a powerfully effective science. The remote Galenic conception of disease with its emphasis on disturbed body humors was about to be supplanted by effective therapeutics, as signified by the introduction of the sulfonamides and antibiotics for the specific treatment of infection. Anesthesiology had been dormant up to that era, still relying upon a few agents, more or less utilized from the beginning, and purveyed by a handful of specialists who had not yet begun to ask the scientific questions necessary for their maturation into a bona fide discipline. However, anesthesiology was in evitably caught in the ferment, for as Peter Caws observed, "It serves to re mind us that the development of science is a step-wise process: nobody starts from scratch and nobody gets very far ahead of the rest."

Theodore H. Stanley, M. D. Anesthesiology and the Heart contains the Refresher Course manuscripts of the presentations of the 35th Annual Postgraduate Course in Anesthesiology which took place at The Cliff Conference Center in Snowbird, Utah, February 16-20, 1990. The chapters reflect new data and concepts within the general framework of "evaluating myocardial function," "pharmacology and the cardiac patient," "anesthesia for patients with cardiac disease," and "stress, cardiopulmonary bypass, coagulation problems and related issues. " The purposes of the textbook are to 1) act as a reference for the anesthesiologists 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 eighth 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. vii LIST OF CoNTIUBUTDRS Bailey, P. L. Department of Anesthesiology, The University of Utah School of Medicine, Salt Lake City, UT 84132, U. S. A. Barash, P. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, U. S. A. Covino, B. G.

The ability to interface patient monitors directly to a computer, and generate a clinical record has existed for over 20 years. However, the acceptance of comprehensive electronic medical records in anesthesia has been slow to develop. Experts anticipate this reluctance is changing because of enhanced patient care through the use of detailed health information record systems. Anesthesia Informatics provides the health informatician and administrator with a comprehensive overview of this blossoming technology. With contributions from leaders in the field, this user-friendly guide addresses how this technology has enhanced both the need for and the ability to collect and apply data in an acute care setting. It also offers invaluable insight on the business implications and the rationales required to make a purchase decision. Each section outlines need to know information to help the reader with the implementation and utilization of an Anesthesia Information Management System. Useful case scenarios focus on the ideal components (anesthesia record, business rationale, communication, collaboration, and training) of a fully automated record-keeping system.

Neuroanesthesia contains the edited presentations of the 42nd Annual Postgraduate Course in Anesthesiology given by the Department of Anesthesiology at the University of Utah School of Medicine, February 1997. The chapters reflect recent advances in neurophysiology, pharmacology and monitoring related to the practice of neuroanesthesiology. The sections on central nervous system trauma, intraoperative management, brain protection and postoperative care provide a conceptual framework for current clinical practices. This textbook is the fifteenth in a continuing series documenting the proceedings of the Postgraduate Course of the Department of Anesthesiology of the University of Utah School of Medicine. It reflects, as well as past and future volumes, the rapid and continuing evolution of anesthesia in the last years of the twentieth century.

For many of the millions of people who undergo anaesthesia each year, it is the source of great fear and fascination. In Counting Backwards, anaesthetist Henry Jay Przybylo has written an unforgettable account of the routine procedure's daily dramas and fundamental mysteries. Przybylo has administered anaesthesia more than 30,000 times on newborn babies, screaming toddlers and sullen teenagers, his own son and even a gorilla. With compassion and candour, he weaves his experiences into stories that explore the nature of consciousness, the politics of pain relief and the wonder of modern medicine. Through its intense and humane tales of mistakes, near-disasters, life-saving successes and moments of grace, Counting Backwards shines a light on a fascinating but unexplored corner of the medical world.

Some important constraints of anesthesia must be taken into consideration when the pharmacological properties of modern anesthetics are discussed. The most imp- tant of these could be that the target effect be achieved preferably within seconds, at most within a few minutes. Similarly, offset of drug action should be achieved within minutes rather hours. The target effects, such as unconsciousness, are pot- tially life-threatening, as are the side effects of modern anesthetics, such as respi- tory and cardiovascular depression. Finally, the patient's purposeful responses are not available to guide drug dosage, because, either the patient is unconscious, or more problematically, the patient is aware but unable to communicate pain because of neuromuscular blockade. These constraints were already recognised 35 years ago, when in 1972 Volume XXX entitled "Modern Inhalation Anesthetics" appeared in this Handbook Series. The present volume is meant as a follow up and extension of that volume. At the beginning of the 1970's anesthesia was commonly delivered by inhalation, with only very few exceptions. The clinical understanding of that time considered anesthesia as a unique state achieved by any of the inhalation anesthetics, in- pendent of their specific molecular structure. "The very mechanism of anesthetic action at the biophase" was discussed within the theoretical framework of the "u- tary theory of narcosis".