A comprehensive survey of recent advances is given in this Update. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects.

Only very few therapeutic modalities are used as extensively as mechanical ventilation in intensive care units, during anaesthesia and in emergency situations. Hence theoretical and practical knowledge in this technique had to be made available to workers in a number of medical specialities. In addition to anaesthetists, who are most familiar with artificial ventilation for historical and practical reasons, surgeons, internists, paediatricians and emergency physicians also need a foundation. Furthermore, the widespread application of this life-supporting method requires that paramedical personnel such as nurses and respiratory therapists be trained to use mechanical ventilation, to understand how it works and to be aware of specific side effects and dangers. This book, edited by Fran ois Lemaire, is a well-designed present ation of a number of the relevant aspects, types and problems of mechanical ventilation which are important for physicians and paramedical personnel who use it. After a description of the technical principles and maintenance of an artificial ventilator, the main part of the book is devoted to the most frequently used types of mechanical respiratory support, with their specific indications, the pathophysiology of their effects on pulmonary gas exchange and the specific choice and regulation ofthe mechanical variables involved. Older and new types of ventilatory support are discussed; there is a good balance of enough specific information for the inexperienced as well as a critical analysis of the indications for more exotic techniques, such as mandatory minute ventilation, independent lung ventilation and airway pressure release."

Filled with clinical information and practical advice, this second edition of the Oxford Handbook of Perioperative Practice has been substantially updated to reflect changes in the field. Taking a logical sequence to follow the journey of the patient from anaesthesia to surgery, then on to the post-anaesthetic recovery area, it provides guidance on all aspect of patient care and support. Specialty surgery, such as bariatric surgery, has been included in a new chapter to cover developments in the field and the increase in NHS provision of these services since the first edition was published. This has been reflected in covering the pre-surgical requirements to newer types of surgery, including psychological interventions and implications for practitioners who need to cover anaesthetics, surgery, and post-anaesthetic care separately. With easy to access information about essential information and various medical conditions, this volume has been written by expert teaching staff and clinicians who work within the speciality. Unique and indispensable, this book gives a wealth of practical information at your fingertips.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1990 represents the series' continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

At present there are going on decisive developments in the introduc- tion of physiological thinking into anaesthesiological practice. These innovative motion comprises applications taken from space physiolo- gy, closed-circuit ventilation systems, neurophysiologic control of cir- culation and ventilation together with innovative aspects of circulation physiology and respiration physiology. Involved are innovative aspects of neuromuscular blockade, volatile anaesthetics, cardiorespiratoric monitoring, haemodilution and blood substitution. Special emphasis is put on demonstrating the closed circuit system as a combination of anaesthesia system and monitoring system in daily clinical routine. Additional knowledge and investigation are stimu- lated in the fields of anaesthesia, neurophysiology, pharmacology, space medicine and metabolic physiology using non-invasive methods of monitoring like the evaluation or the neurovegetative status of man and its addaptive changes. Combining these aspects and systems will provide a quite new analytic and synergetic power in the direction of physiological anaesthesia and monitoring which finally will result in a totally new system of a physiological "micro-anaesthesia". We recommend this bock therefore to all anaesthetists, clinical physiologists and pharmacologists as well as to physicists and engi- neers interested in innovative and non-invasive methods in physiologi- of closed systems.

This book comprises structured questions and answers that closely simulate the structured oral examination (SOE) format of The Royal College of Anaesthetists' final FRCA examination. The style of exam questions has changed over the years and this book matches the most recent changes in this updated exam. It will consist of ten sets (chapters) of complete SOE papers. Each SOE set (chapter) includes one long case, three short cases and four different applied basic science topics (anatomy, physiology, pharmacology and clinical measurement). As this book will be presented in the format of complete examination papers, it will enable candidates to assess their knowledge and skills. It will also assist trainers in setting up mock exams. With thorough revision of this book, trainees can confidently sit their exams. The authors have been organising final FRCA viva courses for the past five years, running four exam preparation courses a year, attended by about 200 trainees each year. This book includes updated knowledge based on the syllabus and more recent questions asked in the FRCA examination. It is, therefore, essential study material for trainees and a great educational tool for trainers. This book will also help candidates all over the world to pass highly competitive postgraduate examinations in anaesthesia. It is an invaluable educational resource for all anaesthetists.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1989 represents the series' continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

Lacking the capacity to store oxygen, the human organism depends on having an unimpaired and continuous supply of oxygen for its survival. Life-threatening disturbances can be encountered by the clinician at any step in the oxygen cascade from ambient air to tissue metabolism. It is therefore necessary for the mechanisms of oxygen uptake, transport, distribution and diffusion into tissues as well as the unaffected cellular metabolism to be well understood and monitored. An international symposium focusing on these issues was held in Munster, FRG, May 11-12, 1990. This book contains the lectures held at the symposium, and thus provides an excellent basis for further discussion.

Some data-analytic methods excel by their sheer elegance. Their basic principles seem to have a particular attraction, based on a intricate combination of simplicity, deliberation, and power. They usually balance on the verge of two disciplines, data-analysis and foundational measurement, or statistics and psychology. To me, unfolding has always been one of them. The theory and the original methodology were created by Clyde Coombs (1912-1988) to describe and analyze preferential choice data. The fundamental assumptions are truly psy chological; Unfolding is based on the notion of a single peaked preference function over a psychological similarity space, or, in an alternative but equivalent expression, on the assumption of implicit comparisons with an ideal alternative. Unfolding has proved to be a very constructive data-analytic principle, and a source of inspiration for many theories on choice behavior. Yet the number of applications has not lived up to the acclaim the theory has received among mathematical psychologists. One of the reasons is that it requires far more consistency in human choice behavior than can be expected. Several authors have tried to attenuate these requirements by turning the deterministic unfolding theory into a probabilistic one. Since Coombs first put forth a probabilistic version of his theory, a number of competing proposals have been presented in the literature over the past thirty years. This monograph contains a summary and a comparison of unfolding theories for paired comparisons data, and an evaluation strategy designed to assess the validity of these theories in empirical choice tasks."

This small but information-packed book is the first to focus exclusively on iatrogenic vascular injuries. It is a timely first, for the scope and magnitude of this subject have reached almost epidemic proportions recently, as a result of exponential increases in the use of invasive diagnostic and therapeutic procedures by almost every medical and surgical speciality. The data on vascular trauma from "civilian" experiences are becoming dominated by injuries of iatrogenic cause. Even were it not for medical-legal liability, the importance of prompt recognition and correct treatment of injuries that we ourselves cause is obvious, as is the need for preventive measures to be clearly identified and adopted. This book serves these needs well through a nicely balanced focus on prevention, on the one hand, with its comprehensive review of epidemiology and etiology, and on management, on the other, with its practical comments on diagnosis, treatment and outcome. The organization of this book makes it very usable. After chapters on both arterial and venous catheterization injuries, there follows a thorough analysis of injuries associated with percutaneous transluminal angioplasty and other endovascular procedures. Then, after a chapter on noninvasive vascular injuries, there follows a series of chapters dealing with vascular injuries associated with the practice of specific specialties: radiation therapy, orthopedics, neurosurgery (especially lumbar disc surgery), gynecology, head and neck surgery, urology, adult general surgery, and pediatric surgery.

The primary mission of the medical school is to create new doctors. Once the medical student has received his or her doctorate, the medical school's interest in, and acceptance of, responsibility for the continued professional development of the physician ceases almost entirely. Yet, with scientific advances in medicine increasing exponentially and the inevitable erosion of memory with time, teachings from our schools of medicine become increasingly irrelevant, forgotten, or both. To maintain competence, the physician must continuously re-educate him- or herself. CME-Continuing Medical Education-will probably never attain the status of the medical school's degree-granting undergraduate program, but medical schools and their faculties must recognize their responsibil ity, not only for creating competent physicians but also for maintaining that competence. With these words I introduced the first volume of Preanesthetic Assessment in 1986. The series was a product of a Continuing Medical Education program initiated by the Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center. Controversy continues to exist over the lasting educational value of conferences that bring physicians together. Moreover, because of time or financial con straints, only a small number of anesthesiologists are able to attend seminars on a frequent basis. By producing a monthly, current, clinical series in conjunction with Anesthesiology News over these 4 years, we have been able to make state-of-the-art analyses available to all anesthesiologists."

Quantitative anaesthesia - exact registration of the degree of anaesthesia - has long been the anaesthetist's dream. Such pre cision could decrease the risk for the patient. Can -this dream now be realized in the foreseeable future? And can the quantifi cation be technically verified? This workshop was organized for these questions to be discussed by a group of experts. Schleswig-Holstein was a logical location for such a gathering. Medical and associated technical advances have socioeconomic consequences: in Schleswig-Holstein there are nowadays more jobs in medical technology than in the traditional shipbuilding industry. The encouragement of medical research and related technical innovation is thus a central component of public poli cy. One result of this emphasis was the recent setting up of a study group on medical technology, one of the aims of which is to provide a forum in Schleswig-Holstein for meetings such as this. The intention is to consolidate Schleswig-Holstein's reputation as a centre for both medical-technical development and scien tific discussion. The organizers of this scientific workshop thank the Schleswig Holstein Ministry of Economics and Transport and Dragerwerk AG for their support.

Respiration is a unique topic among various subdisciplines of physiology. Physiolo gists and clinicians are now able to communicate quantitative functional properties of lung mechanics and gas exchange in the language of the engineer, physicist and mathematician. This is largely due to intensive and stimulating work during the last decades of brilliant minds in a handful of excellent schools in the international family of physiologists. Among these founders of respiratory physiology are a number of clinicians, and they have. taken significant ,part both in shaping the theoretical knowledge to clinical applicability and developing technical devices for diagnosis and therapy in pulmonology. However, the theory behind the evaluation of measure ments, and their interpretation in terms of clinical function tests, is so confusingly complex that the ordinary physician, not specifically trained in respiratory physiol ogy, finds himself unable to critically apply these techniques. We, therefore, need descriptions of respiratory physiology and of its clinical application presented in the language of the clinician. And that is what this book is meant to be. Written by an expert in electrical and biomedical engineering, and by an expert in intensive care medicine, this text constitutes an "operational manual" of clinical respiratory physiology. It does not intend to be another textbook of basic respiratory physiology or pathophysiology. This book not only addresses practical clinicians, particularly those of intensive care medicine, by describing the essentials of clinically relevant respiratory knowledge.

Written and edited by experts in the field, the Handbook of Clinical Anaesthesia provides all the essential practical knowledge required by anaesthetists on co-existing medical conditions, operative procedures, and techniques. The fourth edition retains the concise and comprehensive nature of the third, giving readers all they need to know about each part of the FRCA syllabus in short, digestible, practical entries. The first part covers Patient Conditions; the second Surgical Procedures; and the third Anaesthetic Factors. Each part is subdivided into chapter on each organ system, and each chapter is divided into bite-sized entries. These are in alphabetical order, and cover all common and rare conditions that anaesthetists will encounter within their practice. Avoiding prolonged discussion and multiple references, this is the ideal book to 'dip into' either for specific advice or general education, providing quick and reliable information. This is the most thorough handbook to cover the entire FRCA syllabus in a consistent and instructive manner. It continues to be accessible and relevant to all anaesthetists from middle grade trainee up to consultant/specialist.

In 1981, the Institute of Anesthesiology at the Ludwig Maximil- ian University of Munich organized a first international sympo- sium on inhalation anesthetics. In 1982, the most important con- tributions were published in the series Anaesthesiology and Inten- sive Care Medicine. At that time, the interest of European anes- thesiologists was focused on isoflurane, which had just been in- troduced for clinical purposes. Studies on this product had al- ready been appearing for years in the American literature. This book deals once more with all three inhalation anesthetics, but places particular emphasis on isoflurane. In contrast to the situa- tion in 1981, extensive experimental and clinical investigations on isoflurane have by now become available in the European litera- ture. From its conception, the objective of this symposium was not to discuss the relative value of inhalation anesthesia (bal- anced anesthesia) as compared with intravenous anesthesia. On the contrary, the major effects and interactions of isoflurane were to be explored. The side effects and their relative significance in different patient groups were also of interest. eurrent knowledge concerning a range of topics related to inhalation anesthetics (es- pecially isoflurane) was to be presented in a comprehensive and critical manner. The effects of isoflurane on the cardiovascular system were the focus of interest during the symposium and are accordingly dealt with extensively in this volume. The comparative effects on cor- onary perfusion of isoflurane, enflurane, and halothane are de- scribed in detail.

This book is intended to bring together data and clinical guidelines for those involved in the practice of anaesthesia, whether they be specialists or not. It is designed to be a true handbook that will accompany its owner into the operating theatre, where it will serve as a practical reference guide, not as a textbook. We welcome comment, criticism, and suggestions for improvement of the contents; correspondence may be addressed to the authors at P. O. Box 63, Tygerberg 7505, Republic of South Africa. We wish to acknowledge help received from our colleagues over the years of publication: Dr. T.J.V.Voss, Prof. G.G.Harrison, Dr. C. M. Lewis, Dr. W. B. Murray, Prof. A. R. Coetzee, and Dr. W. L. van der Merwe. Acknowledgement is also made to "Anaesthesia Guidelines," long since out of print, on which the first edition of this handbook was based in 1978. Tygerberg, South Africa, May 1987 P.A.Foster l.A. Roelofse v Contents Chapter 1 I. Pre-anaesthetic Assessment and Preparation 3 A. Anaesthetic Risk Assessment 3 B. Cardiac Risk Index . . . . . . 6 C. Respiratory Risk Assessment 7 D. Hepatic Reserve and Anaesthetic Risk 8 E. Pre-anaesthetic Check List . . . . . . . 8 F. Detailed Check of Anaesthetic Machine 10 G. Requirements for Paediatric Anaesthesia .

This volume contains the lectures and discussion papers presented at the II. In ternational Symposium on Innovations in Management, Technology and Phar macology held on 26-28 May 1984 in Liidenscheid. This symposium delt with fur ther developments in the sector of the closed-circuit system; non-invasive mea surement and monitoring systems; new aspects of cardiovascular and pulmonary physiology; oxygen-transporting substances; and particular questions in pharma cology. The purpose of this meeting was to allow a mutual international exchange of news on interesting new developments, particularly as these relate to the closed-circuit system, and the encouragement of further scientific developments. It must be made clear that the large-scale introduction of the closed-circuit sys tem has to be the occasion of completely new quality standards both in anesthesia and in all related technological sectors, combined with the highest demands in terms of precision and measuring techniques. The conventional and still quite crude clinical anesthetic procedures will have to make way for much more phys iological, micromolecular precision techniques, which will compare with our present methods rather in the same way as a microelectrode to a spear and will allow new levels of achievement in anesthesiology. All our tasks will need to be rethought and thoroughly understood from these aspects. Some anesthesists, physiologists and engineers already see the closed-circuit system as a challenge, while for others this system will still mean a great deal of work and creativity be fore the problems are finally solved in the future."

Major conduction blocks utilizing local anesthetics or opiates are find ing ever increasing applications in daily routine. However, two serious drawbacks are associated with their use: hypotension during surgery and the development of tolerance in long-term epidural analgesia. When opiates are injected epidurally or intrathecally, numerous side effects such as itching, nausea and vomiting, or respiratory depression have been reported. The pathophysiology of complications arising during a major conduction block and measures to prevent them were discussed by 19 experts at the 4th International Symposium at DUsseldorf. This volume contains 21 papers presented on three topics: 1. tachyphylaxis in long-term epidural anesthesia, 2. hypotension due to epidural and spinal anesthesia, and 3. effects and dangers of epidural and intrathecal opiates. With regard to the safety of our patients during anesthesia, current practices of preventing complications were evaluated, and preliminary guidelines for a more rational approach toward prevention and treat ment based on a knowledge of pathophysiologic mechanisms were developed. It is our hope that the anesthesiologist will profit from the discussion of regional anesthesia contained in this volume, many aspects of which have never before been presented in such detail."

thesiologist, were not included. Perhaps the next symposium will have a paper on his many contributions. Even though his dates are not quite modem (1813-1858), his accomplishments were, especially his book On Chloroform and Other Anaesthetics (1858), the first comprehensive textbook on anaesthesia [2]. There has been a real renaissance of interest in the history of anaesthesia. Among those responsible for this rebirth, besides Dr. Rupreht and Dr. Erdmann, are Dr. Selma Calmes and Dr. Rod Calverley, now on the Board of the new American society, the Anesthesia History Association. It held its inaugural meeting in Atlanta, Georgia, during the annual meeting of the American Society of Anesthesiologists, on 9 October 1983. The meeting was well attended, and the evening was profitable and delightful. Mention should also be made of the accomplishments of the nurse anaesthetists [3]. They are many in number, and generally they work under the direction of a physician- anaesthesiologist. Although modem anaesthesia was Ameriea's first great medieal diseovery, it soon traversed the globe and found worldwide acceptance. The British, for example, have made many coeval and historie contributions. Besides Dr. Duncum one thinks of Prof. T. Cecil Gray, who pioneered the British use ofeurare [4], andDr. J. Alfred Lee, whowas a pioneerin the use ofspin~l anaesthesia and is currently working on the fifth edition of a textbook on spinal analgesia [7]. Dr.

In spite of all the progress made by modern science and technology in penetrating the mysteries of nature and providing new possibilities for its transformation, we remain largely helpless in the face of such natural phenomena as earthquakes, tsunami, typhoons, floods, and droughts. Natural disasters occur suddenly, but with periodicity, and man has been confronted by their devastating consequences throughout history. The way people deal with these problems is primarily predetermined: by charac ter, by conditions, and by the social and economic development of society. Industri ous efforts to reconstruct nature, and exploitation of her resources, have brought about additional damage, and there is the apparent danger that our interference with the atmosphere and other areas such as climate, soil, and hydrology has initiated devastating processes which may well be irreversible. As a result, the effects of natural disasters, and all the ensuing repercussions, become ever more aggravating. Their scope becomes global, and for the time being we have no effective countermeasures at our disposal with which to fight them. The contemporary world, then, faces the interconnected and interdependent phenomena of ecological crises and natural disasters: the problem of protecting man from the environment, and the concurrent problem of protecting the environment from man."

R. Droh Ladies and gentlemen. dear friends and colleagues. we welcome you very cordially to our symposium "Innovations in Management and Technic and Pharmacol ogy." We are very glad that you have come to Liidenscheid and we do hope that our programme will fulfil your expectations. We decided to hold this symposium, because it is getting more and more dif ficult to select innovations at international congresses around the world which are important for our clinical work. Now and in the future our intention is to present the actual state of technology. management and pharmacology. We would be very glad to receive your suggestions for further symposia. The industry has the same problems as we have. They do not only have to search for those things which can be realized and which are desirable, but also for those things which can be sold. But the industry must also be stimulated by the inventors and by the users, so we want to bring together the industry, the physicians and the inventors for fruitful discussions. And we hope that in the fu ture the industry will provide us more quickly with those technical and organiz ational aids that we need. We want the indu try no longer running behind the market but heading the market. At present too many interesting developments are killed by so-called market analysis, in the beliefing that such analysis can always prove what cannot be sold. In anaesthesia many companies are always busy with the same product."

Almost a hundred years passed from the time of the first description of an intracranial aneurysm by Morgagni in 1761 to the year 1859, when Sir William Withey Gull arrived at the conclusion that haemorrhage in the subarachnoid space is caused by ruptured aneurysms. The introduction of lumbar puncture by Quincke 1891 and cerebral angiography by Moniz 1927 made it possible to establish the diagnosis of haemorrhage and its source. In recent decades the problems of treatment have come into prominence, first of all because of the inadequacy of conservative methods of treatment in most of the cases, and from surgical experience and its limitations which became apparent before very long. Because of the erratic development of neurosurgery and vascular surgery, above all, since the technique of microsurgery has been used, the entire removal of the source of haemorrhage has become a possibility, even though there were still quite different views taken regarding the most convenient time for surgical intervention, apart from the prevailing local conditions 134, 143, 144,261. In an up-to-date plan of treatment of subarachnoid haem orrhage (SAH) conservative measures are appropriate for bridging the pre-operative period, and must be considered the only solution in those cases in which the source of haemorrhage cannot be found. As far as the effectiveness of such conservative therapy is con cerned, the rate of re bleeding and the mortality provide sufficient comment.

Written by residents and attendings at the world-renowned Massachusetts General Hospital Department of Anesthesia, Clinical Anesthesia Procedures of the Massachusetts General Hospital, Tenth Edition, offers current, comprehensive, and concise guidelines on all facets of anesthesia, perioperative care, critical care, and pain management. Emphasizing the clinical fundamentals necessary for patient safety and optimal outcomes, this trusted guide provides fast answers to the most frequent problems encountered in daily anesthetic practice, making it an invaluable resource for practicing anesthesiologists and residents as well as nurse anesthetist trainees and practitioners. Focuses on the clinical fundamentals needed for the safe delivery of anesthesia and perioperative care in day-to-day practice. Uses an easy-to-scan outline format that progresses intuitively from preoperative evaluation through administration of anesthesia to perioperative issues for each subject. Updated and reorganized table of contents in addition to chapters on evaluating the patient, anesthesia for pediatric surgery and care of the neonate, non-operating room anesthesia and pain management. Includes new chapters on the basics of echocardiography, anesthesia for orthopedic surgery, anesthesia for transplant surgery and vascular access. Features appendices covering drugs and intravenous antibiotics. Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.