The decisive factor in trauma is that many processes first occur at the cellular level before they can be determined in laboratory tests, and recognition of them has only recently found its way into intensive care practice. Yet knowledge of the pathophysiology of these processes is essential for an early diagnosis of multiple organ failure and the implementation of adequate therapy, which ultimately make the patient's survival possible. Professor Schlag, an internationally renowned scientist and clinician, has been concerned with the basic pathophysiological principles of shock for many years. In this book he has brought together for the first time an international team of authors primarily from the USA and Europe, who present their collective findings of trauma, shock, development of the organ in shock and early failure and of sepsis-like syndrome, and development of septic multiple organ failure. Patienten mit Multiorganversagen haben immer noch eine schlechte Prognose in der intensivmedizinischen Behandlung, insbesondere wenn sie noch zusatzlich in einen septischen Schock geraten. Hier hilft auch oft eine breite Abdeckung mit modernsten Antibiotika nicht weiter. Neue Ansatze fur eine Therapie dieser problempatienten haben sich in den letzten Jahren durch Erkenntnisse der pathophysiologischeen Vorgange die zum Schock fuhren ergeben. Herr Professor Schlag hat als anerkannte Kapazitat auf dem Gebiet der Traumatologie und Schockforschung fur dieses erste umfassende Werk zu den Grundlagen des Multiorganversagens eine beeindruckende Liste von mehr als 50 international renommierten Autoren zusammenbekommen. Das Buch ist nicht nur eine Aufarbeitung aller Grundlagen des Schocks und Multiorganversagens sondern zudem ein ausgezeichnetes Nachschlagewerk fur jeden intensivmedizinisch tatigen Klinikarzt, egal ob er aus der Anasthesie, der Inneren Medizin oder der Unfallchirurgie kommt."

Dieser Band gibt die Referate des 4. Internationalen An{sthesie-Symposiums, 15.-17. Juni 1989 wieder. Amerikanische und europ{ische Spezialisten der unter- schiedlichsten Fachgebiete diskutieren neueste Entwicklungen der Labor- und klinischen Forschung.

Perinatal medicine, which is concerned with the problems of the fetus and newborn, has rapidly developed in the last two decades as an important and challenging specialty. Rapid advances in the field, coupled with tech nological advances, now are making survival of infants with weights as low as 500 grams possible. Ventilator care for severe respiratory problems is on the verge of being replaced by surfactant replacement therapy; on the other hand, development of such technologies as extracorporeal mem brane oxygenation and jet ventilation has revolutionized the care of these sick infants. The advances taking place today in the field of perinatal medicine make periodic updates, like the one provided by this volume, a virtual necessity for clinicians and paramedical personnel alike. A distinguished group of specialists in various aspects of perinatal medicine has contributed to this book. Their wide-ranging experience and points of view should make this book a valuable reference for all physicians and allied health personnel involved in the care of the high-risk fetus and newborn. MANOHAR RATHI, M.D. Acknowledgements. I am grateful to the contributors for their cooperation in preparing the manuscripts, to my associates for their help and support, and to the publishers for their continued interest in this work. Above all, I thank Ms. Rose Aiello-Lech and Ms. MaryAnn Cichowski for their hard work in making this publication possible."

This volume is a compilation of papers presented at the Tenth International Symposium on Brain Edema held on October 20-23, 1996, in San Diego, California. This follows the sequence of meetings that was initiated 31 years ago in the First International Symposium held in Vienna. Subsequent symposiums were held in Mainz, Montreal, Berlin, Groningen, Tokyo, Baltimore, Bern, and Tokyo CY okohama). A considerable number of papers was chosen from over 100 papers that were received. The organizers wish to thank the Advisory Committee for the excellent work done in selection of the papers. We also wish to thank all the persons who contributed to the success of the Tenth International Symposium, especially the staff who worked behind the scenes. These papers were reviewed, edited, approved or disapproved by the Editorial Board. Those manuscripts that were felt not pertinent to this publication were not accepted by the Editorial Board. Therefore, the excellent quality of those that are in the book are a reflection of the authors' dedication and work and that of those of the Editorial Board in their review process. For the reader's convenience, the papers are structured according to the various disease processes which are associated with the primary topic: hypertension, hydrocephalus, infection, ischemia, tumor, etc. We do hope that the reader will enjoy the articles and that they will provide an impetus and insight for future work.

Local anesthetics are among the most widely used drugs. Their development over the past century ranges from a documented influence on Freud's Interpretation of Dreams 1 to the synthesis of the ubiquitously popular lidocaine, as described in Chapter 1. For surgical procedures the use of regional, epidural and intrathecal local anesthesia has increased continuously during the past decade. Local anesthetics are also applied by physicians to ameliorate unpleasant sensations and reactions to other procedures, such as tracheal intubation. The presence or the threat of cardiac arrhythmias is often countered by chronic administration oflocal anesthetic-like agents, such as lidocaine or procainamide. Relief of acute pain, accompanying dental manipulations, for example, and of chronic pain are also accomplished with traditional local anesthetics. And over-the-counter formula tions of topical local anesthetics provide practitioners of solar indiscretion welcome relief from their otherwise unaccommodating sunburn. In all these applications the final effect of the local anesthetic is an inhibition of electrical activity, accomplished as a reduction or total blockade of action potentials. The primary site of action is the sodium channel, a transmembrane protein which is essential for the influx of sodium ions that subserves impulse generation and propagation in nerves, skeletal muscle, and heart. The detailed mechanisms oflocal anesthetic action are still being investigated and Chapter 2 of this volume provides a current overview of that subject."

In January 1980, the First Symposium on the Measurement of Tis sue Oxygen Pressure in Patients was held in Frankfurt. After a 4-year "rest period," the organizers of the 1984 symposium, Profes sor R. Huch of Zurich and Dr. J. Hauss of Munster, together with myself, extended another invitation to come to Frankfurt to find out what had gone on in the field of oxygen pressure measurement and its application in clinical medicine. As the following presentations will show, the application of oxygen pressure measurements has been broadened considerably. Furthermore, technological advances have been made, particularly with the increased use of computers. For various reasons, including technical ones, these methods have not been adapted as widely as one would want. Although con gresses on tissue oxygen pressure have been held in the last few years, the clinical aspect of tissue P0 measurement has not been 2 dealt with in such a concentrated and comprehensive way since 1980. It therefore seemed necessary to hold such a symposium, not only for scientific reasons, but also to enable a larger group of clini cians to gain insight into the importance of the possibilities these methods offer."

Are you looking for the essentials you need to learn the basics of echography for anesthesiology, intensive care and emergency medicine? This is what this book offers you! These few pages condense the essential knowledge to make getting started with echography in emergency situations easier. Ultrasounds are presented in great detail in order to facilitate and optimize the medical diagnosis process. As a doctor, you will first be placed in front of the machine in order to take the pictures that will serve to answer the questions asked. Just as the author did, you will realize that, when facing the patient with the machine, the best echographic examination is worth nothing without a good clinical examination. As a "beginner's guide", this book also offers self-training procedure that lays the foundations of the "FAST" learning method. This FAST Program of Echography allows you to learn the process by watching, feeling and talking. This training course is based on an ancient methodology that centers on the learning of a manual gesture: 'practice makes perfect'. This book will show you that you can quickly master this Program of Echography, and will in turn increase your self-confidence when taking care of your patients. Have a nice trip through the fascinating world of ultrasounds!

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.

Contrary to common belief, infectious diseases are not as well under control as we would like. We are now at a crossroads regarding the impact of the environment on infectious diseases. Renewed interest in biological weapons and the emergence of new pathogens, coupled with a better understanding of the impact of infectious agents on other conventional diseases, has led us to realise that we can no longer remain complacent about the impact of infectious agents on human, animal and crop health. The present book first discusses current and emerging military and civilian policies on the environment. In addition, the impact of environmental biology on the future of space exploration is discussed, especially in reference to the Mars mission. There follows a discussion of the state of bacteria in the environment, with a presentation of current and emerging techniques of microbial investigation. Finally, two case studies are presented on the impact of these techniques on both political and environmental problems.

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.

Thoracic anaesthesia is regarded as a post fellowship sub-speciality within anaesthesia, and can be daunting. This handbook provides an easily accessible, informative, and palatable guide to this often complex subject. The text is sub-divided into basic sciences, pre-operative assessment, diagnostic procedures, and an anaesthetist's walk-through of key thoracic surgical procedures. It concludes with an emergency section covering thoracic anaesthesia emergencies, critical care, and the thoracic surgical patient, and ends with essential guidance on the relevant practical procedures necessary to manage cases. The text provides an essential reference for the core curriculum of the Fellowship of the Royal College of Anaesthetists and for the day-to-day practice of post fellowship anaesthetists alike. The discussions of the surgical procedures are simple, highlighting the poignant stages that can affect the anaesthetic management of the patient. The authors use the very latest evidence in order to keep the reader up to speed with developments in the field. Whether on-call, running day-to-day lists or working within critical care, this indispensable guidebook will optimise the preparedness of all staff in dealing with any case, whether simple or complex.

Until recently, endocrinology and critical care medicine were two specialties in medicine that were rather uncomfortable with each other and hence quite i- lated. Fortunately, these two 'alien' disciplines have joined forces in successful attempts to perform high quality research in order to clarify the unknown. By integrating endocrinology in critical care medicine, or vice-versa depending on the specialty of the observer, new experimental and clinical data on the complex endocrine and metabolic derangements accompanying non-endocrine severe i- nesses came available which generated important novel insights with relevant clinical implications. In addition, the state of the art diagnosis and management of primary endocrine diseases that represent life-threatening situations leading to ICU admission has been updated. This issue of Contemporary Endocrinology aims at compiling the new ?ndings. The book indeed covers both areas of 'Acute Endocrinology' that are often taking care of at very distant sites within hospitals. The ?rst part deals with the classical life-threatening illnesses caused by primary endocrine diseases such as thyrotoxicosis, hypothyroidism, acute adrenal crisis, acute calcium disorders, pheochromocytoma, severe hyper- and hypoglycemia . The second part looks at endocrinology from the ICU side, starting with a g- eral overview of the dynamic neuroendocrine and metabolic stress responses in the condition of intensive care-dependent, non-endocrine critical illness.

Sepsis is a very important public health problem. It is widely acknowledged that the severe inflammatory response syndrome/severe sepsis paradigm fails to stratify sepsis patients adequately. This book reviews in detail how sepsis should be managed on the basis of a novel approach to staging. The PIRO (predisposing factors, infection, response, organ dysfunction) model was first proposed at the start of the decade on a theoretical basis and has now been translated into a practical approach for use at the bedside. It is loosely based on the TNM staging system for cancers, with points being allocated to each of the four aforementioned key characteristics of the septic process. The proposed PIRO framework facilitates evaluation of factors that are important in the pathogenesis of severe sepsis and in the development of treatment strategies. This book clearly explains the advantages of the PIRO approach in different settings and will be of value to all practitioners concerned with the management of sepsis.

This text covers new innovations and concepts in pediatric thoracic surgery practice, basic science and evidence, and the technical aspects of common and rare operative procedures.

It is essential for pediatric surgical trainees and consultants with interest in pediatric thoracic surgery. Providing comprehensive coverage of newer developments, it is also a useful reference work for pediatric and thoracic surgeons and a valuable guide for surgeons (adult or pediatric) managing pediatric thoracic surgery on occasional basis or only during acute emergency.Covering the subjects within pediatric thoracic surgery (non-cardiac) in significant depth, this book acts as a reference text for consultants undertaking pediatric thoracic work as well as for pediatric respiratory, anesthetists and fetal medicine doctors. Topics within this book will also be of interest to pediatric respiratory physicians and pediatric oncologists.

This book opens with a unique historical review of natural amputations due to congenital absence, disease, frostbite, animal trauma, and to punishment and ritual. The advent of surgical amputation and its difficulties form a major part of the book, summarising the evolution of the control of haemorrhage and infection, pain relief, techniques, instrumentation, complications, prostheses, results and case histories. Alternative procedures, increasingly important in the last two centuries, are also debated.

This is the first text to systematically review the evidence for obstetric anesthesia and analgesia.

Evidence-based practice is now being embraced worldwide as a requirement for all clinicians; in the everyday use of anesthesia and analgesia for childbirth, anesthetists will find this synthesis of the best evidence an invaluable resource to inform their practice.

Contributions from anesthetic specialists trained in the skills of systematic reviewing provide a comprehensive and practical guide to best practice in normal and caesarean section childbirth.

This book, coming from one of the world's leading obstetric centers and the cradle of evidence-based medicine, is a much needed addition to the obstetric anesthesia literature.

88 short papers originating from the 12th International Symposium on Intracranial Pressure and Brain Monitoring held in August 2004 in Hong Kong present experimental as well as clinical research data on invasive and non-invasive intracranial pressure and brain biochemistry monitoring. The papers have undergone a peer-reviewing and are organized in nine sections: ICP management in head injury, neurochemical monitoring, intracranial hypertension, neuroimaging, hydrocephalus, clinical trails, experimental studies, brain compliance and biophysics.

Physicians, nurses, and safety experts comprehensively review sedation and analgesia to provide a completely new reference guide to safe sedation practices consistent with existing guidelines. Starting with an integrated review of the basic physiology and neurobiology of the sedated state, the authors proceed through clinical guidelines and practices, and conclude with an examination of quality-outcome measures and processes. They also review current mandates for safe sedation practices and address the key clinical issues of pharmacology, monitoring, and recovery. Special tables and figures throughout the book summarize protocols, regulatory requirements, recommended dosages, monitoring requirements, and quality assurance tools.

In preparation for the quadrennial international IPRAS conference, leading plastic surgeons worldwide have been asked by the International Confederation for Plastic, Reconstructive and Aesthetic Surgery to contribute their most up-to-date findings, research results, and experiences in their area of expertise. The book is structured according to the major fields of plastic surgery, and the reader is thus offered insight into the most significant contributions to the international community, as well as into new developments, tricks, and refinements in the field.

This book is about visions and pioneers in the field share their innovations with the reader.

Innovations in Plastic and Aesthetic Surgery will not only give plastic surgeons up-to-date knowledge of new developments, but will inspire with its innovations, many of which have not been published before."

Written by a highly regarded expert in the field of obstetric anesthesia

Handy point of care

Up-to-date information on the subject

Good board review tool

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.

The only available resource to provide cutting-edge, in-depth coverage of the links between obesity and anesthesia in surgery, the reader-friendly Handbook of Perioperative Anesthesia: Complications and Challenges of the Obese Patient guides the practicing anesthesiologist through each stage of surgery for the obese patient. This clinically relevant text thoroughly illustrates the unique challenges and complications the anesthesiologist faces when supervising and administering drug delivery during surgery. Practical and hands-on, this source also advises the anesthesiologist on how to avoid potential risks and ensure speedy patient recovery post-operation. Easily referenced, this handbook clearly addresses treatment and management of the obese patient in the three chronological stages of surgery: Preoperative - includes information on systemic patient evaluation and surgery preparation, emphasizing related areas of concern in the obese patient (cardiac, pulmonary, endocrine, and others) to help the anesthesiologist foresee how a patient will fare during surgery Intraoperative - provides a thorough discussion of the latest in procedural technique, drug and fluid administration, patient monitoring, and airway management Postoperative - steps the anesthesiologist can take following surgery to optimize patient results In addition, this handbook explores special situations that anesthesiologists may encounter during surgery, including the needs of pregnant and pediatric patients, as well as patients with needs outside of the hospital setting.

This book helps prepare anesthesiology residents for safe practice of pediatric anesthesia. It features 26 index cases, which are classic clinical scenarios - all covering a spectrum of pediatric anesthesia, neuro-anesthesia, cardiac anesthesia, regional anesthesia, and anesthesia and critical care medicine. Chapters are divided into case-based formats with each chapter containing a scenario layout, useful equipment, major teaching points for an after simulation debrief, and a learner evaluation form. This tiered education method will assist learners in working though essential team building skills, increasing their knowledge base and finally having concrete items in which to further their professional skills. Each chapter starts with a learning objective and presents the simulation case before launching into the case progression, detailing how the simulated patient's vital signs, physical exam findings, and clinical picture change over the course of the simulation. They are concluded with a master checklist of items the learner should accomplish during the course of the simulation along with a section summary and important teaching points. Pediatric and Adult Anesthesiology Simulation Education is designed to be used by both academic programs and private practice groups. It is beneficial to anesthesiology residents who are currently in training as well as those who have recently graduated and are preparing for board exams.

This second edition of the Handbook of Ambulatory Anesthesia has been completely updated and expanded to reflect current practice guidelines and trends in ambulatory anesthesia. This practical manual covers preoperative evaluation, patient and procedure selection, anesthetic techniques, postoperative management, and quality assurance. Additionally, the editors have included all new information on anesthesia for minimally invasive surgery as well as office-based procedures. Written and edited by experts who have developed successful practices at the world's leading institutions, Handbook of Ambulatory Anesthesia includes a broad representation of perspectives and approaches for practitioners in every ambulatory setting.

Learn to prevent, recognize, and manage complications of local anesthesia administration. Written by Dr. Stanley Malamed, the leading expert on anesthesia in dentistry, the Handbook of Local Anesthesia, 7th Edition covers all the latest advances in science, instrumentation, and pain control techniques. From basic concepts to specific injection techniques, from dosage charts to the proper care and handling of equipment, this how-to guide provides in-depth, full-color coverage of key anesthesia topics, including specific hazards and errors in technique that may result in complications. Recognized as THE local anesthesia textbook in dentistry for over 30 years, the seventh edition has been thoroughly updated with the latest in safe anesthesia practices in dentistry. Written by Dr. Stanley Malamed, one of the most in-demand and globally recognized experts on dental anesthesia and sedation. Full-color photographs and line drawings enhance important points throughout book. Step-by-step procedures cover the techniques for administering intraoral anesthesia. Detailed descriptions of routes of anesthesia administration included throughout text. Logical Organization of content divides book into four parts including -Drugs, The Armamentarium, Techniques of Regional Anesthesia in Dentistry, and Complications, Legal Considerations, Questions, and the Future NEW! Updated and enhanced content throughout reflects latest research evidence. NEW! Two added chapters cover problems in achieving pain control and their solutions; and recent advances in local anesthesia. NEW! Addition of an Expert Consult Site allows you to search the entire book electronically.