Sektion A.- 1 Qualitatssicherung und Risikomanagement.- Qualitatsmanagement.- "Risikomanagement".- Verhalten bei und nach Zwischenfallen.- Resumee.- 2 Risikovermeidung - Simulatoren in der Anasthesie.- Training am Simulator.- Konzepte des Krisenmanagements.- Chancen und Perspektiven durch Simulatortraining.- 3 Monitoringstandards.- Bedeutung von Standards.- Monitoringparameter.- Empfehlungen deutschsprachiger Fachgesellschaften.- Europaische Norm EN 740.- Zusammenfassung.- Sektion B.- 4 Herz-Kreislauf-System.- Intraoperativer Herz-Kreislauf-Stillstand.- Akuter Myokardinfarkt, akute Myokardischamie.- Arrhythmien.- Herzschrittmacherpatienten.- 5 Respirationstrakt.- Monitoring zur Erkennung respiratorischer Komplikationen.- Respiratorische Insuffizienz.- Veranderung der respiratorischen Funktion unter der Anasthesie.- Dekompensation der respiratorischen Funktion (bei vorbestehenden pulmonalen Funktionseinschrankungen).- Atemwegsobstruktion.- Akut auftretende pulmonale Funktionseinschrankungen.- Fehlerhaftes oder fehlerhaft verwendetes Anasthesiegerat.- 6 Neurologie.- Erhoehter intrakranieller Druck.- Postoperative emotionale Stoerungen.- Nichterwachen nach Anasthesie.- Postoperative Verwirrtheitszustande.- Das zentral-anticholinergische Syndrom.- 7 Renales System.- Beurteilung der Nierenfunktion.- Veranderung der Nierenfunktion unter Anasthesie.- Oligurie.- Polyurie.- Anasthesie bei Patienten mit eingeschrankter oder fehlender Nierenfunktion.- Harnretention.- 8 Perioperativ relevante Stoerungen des Flussigkeitsund Elektrolythaushaltes.- Physiologie.- Stoerungen des Flussigkeitshaushalts.- Stoerungen des Elektrolythaushalts.- 9 Stoerungen der Synthese oder der Funktion des Hamoglobins.- Sichelzellerkrankung.- Porphyrien.- Methamoglobinamie.- 10 Gerinnungsstoerungen - Thrombose - Lungenembolie.- Physiologie - Pharmakologie.- Diagnostik.- Therapie.- Haufige perioperative Gerinnungsstoerungen.- Thrombose.- Lungenembolie.- Heparininduzierte Thrombozytopenie.- 11 Endokrines System.- Diabetes mellitus.- Schilddrusenfunktionsstoerungen.- Funktionsstoerungen der Nebenschilddruse.- Funktionsstoerungen der Nebenniere.- Stoerungen der Hypophyse.- Adipositas.- 12 Lebererkrankungen und Anasthesie.- Anatomie und Physiologie.- Pathologie und Pathophysiologie.- Medikamentenclearance.- Anasthesievorbereitung bei Lebererkrankungen.- Anasthesie.- Volatile Anasthestika.- Sektion C.- 13 Unmittelbare Reaktionen auf Lokalanasthetika.- Systemische Reaktionen.- Methamoglobinamie.- Allergie.- Lokale Intoxikation des Gewebes.- Systemische Reaktionen aufVasokonstriktoren.- Wertung.- 14 Ruckenmarknahe Leitungsanasthesien (RMNLA).- Kardiovaskulare Veranderungen.- Ploetzlicher Herzstillstand.- Ateminsuffizienz.- UEbelkeit und Erbrechen.- Blasen- und Darmstoerungen.- Postspinaler Kopfschmerz.- Ruckenschmerzem.- Akzidenteile intravasale Injektion.- Massive Epiduralanasthesie.- Totale Spinalanasthesie.- Katheterkomplikationen.- Bronchospasmus.- Neurologische Komplikationen.- Gerinnungshemmende Medikamente und RMLNA.- Aseptische Meningitis.- Pneumozephalus.- Praexistente Erkrankungen des Zentralnervensystems.- Diabetes und periphere Neuropathie.- Wertung.- 15 Brachiale Plexusblockade.- 16 Intravenoese Regionalanasthesie.- 17 Epidurale Opioide.- 18 Neurolytische Blockaden.- Neurolytische Substanzen.- Allgemeine Komplikationen.- Spezielle neurolytische Blockaden.- Sektion D.- 19 Kombinierte Anasthesieverfahren.- Neurologische Komplikationen.- Hamodynamische Komplikationen.- Weitere potentielle Komplikationen.- 20 Atemwegssicherung.- Erschwerte bzw. unmoegliche Intubation.- Larynxmaske.- 21 Aspiration und praoperative Nahrungskarenz.- Inzidenz perioperativer Aspiration.- Lagerung.- Ursachen und Risikofaktoren der perioperativen Aspiration.- Praoperative Nahrungskarenz.- 22 Kritische Stoerungen der Beatmung.- Pathophysiologie.- Ursachen fur Stoerungen der Ventilation, ihre Behandlung bzw. Vermeidung.- Verlegte Atemwege

PROFESSOR SIR KENNETH L. STUART Pain control has become one ofmedicine's most rapidly growing disciplines, and Iwelcome the opportunity to write this foreword to abook that Iam sure will make its own unique contribution to advancing this discipline. My pleasure in writing it is heightened by my pride in the fact that its editor was at one time an undergraduate student of mine at the University of the West Indies in Jamaica. One of the uncertainties teachers always face is that they can never predict how their charges will turn out. This uncertainty has been happily resolved. Dr. Parris' professional career has been marked by the same dedication and commitment that characterized his undergraduate days and that clearly has been brought to the preparation of this scholarly and practical work. Pain reliefhas been until recently acomparatively neglected field. Its neglect was determined not so much by lack ofprofessional awareness ofits import ance but mainly because so little could be done about it in the past.

Although the perioperative care of patients by anesthesiologists draws on diverse clinical skills, the principles of anesthesiology and pain management are rooted in the neurosciences. The Neuroscientific Foundations of Anesthesiology thoroughly examines the anesthetic modulation of the central, peripheral, and autonomic nervous systems and will help redefine anesthesiology as a fundamentally neuroscientific field. The book is organized by sections, with each focusing on a different part of the nervous system. State-of-the-art chapters written by thought-leaders in anesthesiology and neuroscience provide a novel and invaluable resource.

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."

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.

Saving lives through organ transplantation has become increasingly possible thanks to advances in research and care. Today, the complex field of transplantation continues to develop rapidly, fuelled by demographic change and further evolutions in scientific understanding. The Oxford Textbook of Transplant Anaesthesia and Critical Care has been written and edited by pioneers in the field of organ transplantation with an international team of authors, in order to equip anaesthetists and intensivists with the knowledge and training necessary to provide high quality and evidence-based care. The text addresses fundamentals aspects of scientific knowledge, care of the donor patient, transplant ethics and special considerations. Dedicated sections address each of the major organs; kidney, pancreas, liver, heart and lung, intestinal and multivisceral. Within each organ-based section, expert authors explore underlying disease, planning for transplantation, specialized procedures, perioperative and critical care management as well as post-transplant considerations. Focus points for future developments in transplant immunology are also set out, inspiring current practitioners to engage with current clinical research and help participate in the further advancement of the science of transplantation. The print edition of the Oxford Textbook of Transplant Anaesthesia and Critical Care comes with a year's access to the online version on Oxford Medicine Online. By activating your unique access code, you can read and annotate the full text online, follow links from the references to primary research materials, and view, enlarge and download all the figures and tables.

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."

Anesthesia for the New Millenium: Modern Anesthetic Clinical Pharmacology contains the refresher course lectures of the 1999 meeting and is a review of the current state of the art in anesthesia clinical pharmacology. The authors of the individual chapters are among the world's most widely recognized experts in the pharmacology of perioperative medicine. The book features sections on new pharmacology concepts, new drug delivery techniques, recently released drugs and novel thinking about older drugs. It also addresses several areas that have recently emerged as very hot clinical and research topics, including depth of anesthesia monitoring technology and anesthesia drug interactions. The textbook is the seventeenth in a continuing series documenting the proceedings of the postgraduate course.

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.

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 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."

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.

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.

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.

Offering highly visual, easy-to-read coverage of the full range of anesthesia equipment in use today, this authoritative reference is your go-to text for objective, informed answers to ensure optimal patient safety. Anesthesia Equipment, 3rd Edition, provides detailed information on the intricate workings of each device or workstation, keeping you fully up to date and helping you meet both equipment and patient care challenges. Remains unequalled in both depth and breadth of coverage, offering readable, concise guidance on all aspects of today's anesthesia machines and equipment. Details the latest machines, vaporizers, ventilators, breathing systems, vigilance, ergonomics, and simulation. Improves your understanding of the physical principles of equipment, the rationale for its use, delivery systems for inhalational anesthesia, systems monitoring, hazards and safety features, maintenance and quality assurance, special situations/equipment for non-routine adult anesthesia, and future directions for the field. Includes ASA Practice Parameters for care, and helps you ensure patient safety with detailed advice on risk management and medicolegal implications of equipment use. Highlights the text with hundreds of full-color line drawings and photographs, graphs, and charts. 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."

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.