This critical care medicine book substantially differs from others due to the range of peculiarities that characterize it. Since it deals with acute patients in critical conditions, this is, as it were, a 'borderline'book, in the sense that it is intended for those, who, in their activity, need a continuous and in-depth interdisciplinary approach to optimize the quality of the treatments offered to critically-ill patients. This book helps to have a better understanding of the current limits of human intervention and aims at supplying updated guidelines; in particular, it is intended for those who, although having to guarantee continuity and top-quality therapies, must decide when and why the collaboration with and intervention by experts is necessary

At the APICE '96 research scientists and clinicians were provided with updated guidelines for the treatment of patients with acute and chronic critical conditions. This volume contains 100 chapters,in which the main pathophysiological concepts were reviewed, with special emphasis on the cardiovascular, respiratory, metabolic, and neurologic systems. Special reference is made to the pharmacologic and biotechnologic strategies currently being used to support those vital functions that are affected by severe and sometimes devastating diseases. The topics of infection, sepsis,and SIRS have been reviewed and updated in keeping with the most recent information available, and particular focus has been directed to ethics.

Das Buch richtet sich vor allem an junge Anasthesiologen und Assistenzarzte auf Intensivstationen, die die Technik der transoesophageale Echokardiographie erlernen moechten, aber ebenso an Kardiologen und Internisten, die Patienten kardiologisch betreuen.

Ein vertieftes pathophysiologisches Verstandnis der respiratorischen Insuffizienz und die technischen Entwicklungen der letzten Jahre haben die Beatmung, uber die reine Substitution bei Atmungsausfall durch zentrale oder periphere Atemlahmung hinaus, zu einer Therapie der respiratorischen Insuffizienz und pulmonaler Erkrankungen werden lassen. Es gibt heute ein breites Indikationsspektrum fur vielerlei Beatmungsverfahren, die von einfachen Atemhilfen bis hin zu komplexen, computergesteuerten Beatmungsmustern und zur Lungenersatztherapie reichen. Dieses Buch enthalt neben den pathophysiologischen Grundlagen eine systematische Darstellung der Verfahren und Gerate und gibt Anasthesisten und Intensivmedizinern wertvolle Hinweise fur indikationsgerechte Entscheidungen.

Local Anaesthesia in Dentistry is a practical guide for both students and general practitioners to this essential area of clinical practice.
Highly illustrated in full colour throughout, the book provides clear and practical guidance to the administration of local anaesthesia. The book introduces the reader to the concept of nerve conduction and pain as well as providing an explanation of the anatomy of the trigeminal nerve. Further chapters cover such key areas of practice as regional anaesthesia, local anaesthesia in children, pharmacology, local and systemic complications, general practical aspects, the prevention of side effects and legal aspects.

Developments in surgery have enabled more ambitious operations to be attempted than ever before, while similar advances in anaesthesia and monitoring have meant that many patients who were previously considered unfit now undergo surgery. It is essential that standards of patient care during surgery are continued post-operatively until the depressant effects of anaesthesia have worn off and it is safe for patients to return to the wards or to their homes. The importance of adequate supervision by well-trained nurs ing staff in properly equipped surroundings has been recognised by the introduction of recovery rooms in most hospitals. Despite this, many patients still emerge from anaesthesia in wards or departments where they are supervised by inexperienced nursing staff in unfamiliar surroundings. Recovery from anaesthesia may be accompanied by a variety of dangerous and potentially fatal complications, many of which can be avoided by the detection of early warning signs and the institution of appropriate therapy before an irreversible situation is allowed to develop. This book describes the major complications liable to be encountered and suggests how they may be avoided by careful monitoring, vigilant nursing and sound organisation. The patient's behaviour at recovery is influenced by his pre-operative condition, by drug therapy pre- and intra-operatively and by the nature of the surgery, and sections have been devoted to these aspects since a basic understanding of them is essential in anticipating events in the recovery room."

H. KIESEWETTER, J. KosciELNY, and F. JuNG Tbe byperoncotic colloid-osmotic pressure of tbe 10% Haes solution causes an increased intravascular volume because free tissue water flows into the vascular system [206]. Witb a volume expansion effect of about 50% an increase in intravascular volume of 750 ml (500 mi Haes and 250 mi tissue water) is expected immediately after hypervolemic hemodilution, after isovolemic bemodilution only an in crease of 250 mi ( only tissue water due to a pblebotomy of 500 mi). The blood is diluted by overloading the vascular system [245]. After isovolemic bemodilution tbe dilution effect is more marked due to the pblebotomy. Estimated by means of the total protcin concentration (Fig. 67) the dilution of plasma was 22% 1 h after isovolemic hemodilution but only 14% after bypervolemic bemodilution. Tbe plasma dilutions were almost confirmed by the concentration changes of albumin (Fig. 68). Therefore, the mixing ratio is 4. 1 to 1 (plasma to bydroxyetbyl starcb) for bypervolemic infusion of 500 ml Haes-sterillO% (200/0. 5) and 3. 7 to 1 for isovolemic dilution. Consequently, the hydroxyethyl starch concentration after isovolemic hemodilution was signifi- cantly bigher at all measuring times tban after hypervolemic hemodilution (Fig. 61). If tbe infusion was performed quickly so that no renal output of the Haes solution could ensue, a mean bydroxyetbyl starch concentration of 10. 3 g per liter plasma would be expected immediately after isovolemic hemodilution for tbe above mixing ratio, and one of 9. 0 g after hypervolemic bemodilution.

The second edition of this text catches the specialty of anesthesia at what will probably prove to be the apex of its influence and recognition amongst the specialties of medicine. The scientific basis of the specialty is becoming increasingly well delineated. Anesthesiologists have established themselves in local, regional, and national forums as spokespersons not only for the specialty, but also for medicine in general. And the specialty at last may be emerging from the stereotype of a faceless, inarticulate, shy and retiring figure, whose outstanding characteristic was the cloying odor of diethel ether! Technology has moved into the specialty on seven league boots. Just as an example, the basic design of the anesthesia machine was stable between the early 1950s and certainly the late 1970s. Suddenly, in the blink of an eye, our anesthesia machines are becoming intelligent, are utilizing heads-up displays, and are becoming more and more capable of writing the anesthesia record. Monitoring standards for anesthesia have burgeoned to the point that almost every aspect of the specialty is impinged upon by some rule and some "thou will or thou will not. " The importation and creation of terminology is exploding. In fact, one of the problems in updating this book was deciding when to stop. The author hopes that the goal of creating a snapshot in time through definitions of commonly used words and phrases has been achieved.

That pain is a serious clinical problem, which requires considerable effortsby physicians and the nursing staff, has been stressed in numerous publications. Transdermal application is well known for a variety of drugs, including cardiovascular drugs, antiemetics and hormones. Some years ago, first experience was also made with transdermally administered opiates from which the transdermal therapeutic system (TTS) fentanyl has now been approved by the American Food and Drug Administration. The book presents the results of the first international workshop "Transdermal Fentanyl," held September 27 -28, 1990 in Cologne, FRG. This workshop was intended to facilitate a critical evaluation of theoretical and clinical studies with the new, non-invasive fentanyl application and to provide an opportunity for an exchange of ideas about its value for pain management, anaesthesiology and future investigations in this field. Topics covered by the book are physiology of transdermal permeation, experience with other transdermal systems, the present state of acute and chronic pain management and experimental and clinical studies with transdermal fentanyl, with special concern to analgesic efficacy and side effects. Readers will easily find out that the experts appreciated transdermal analgesia but also warned against an uncritical optimism. TTS fentanyl can be a valuable tool in the clinicians' armentarium against pain. It should be kept in mind, however, that it represents a new administration mode, not a new drug, and that the sustained, non-invasive application requires well reflected diagnosis and good general standards of pain management.

Disturbances in peripheral O extraction can be produced in dogs treated with 2 endotoxin and thereby provide an opportunity to test theories for the origin of pathological O supply dependency or to try different treatment modalities. The 2 most serious deficiency in the current animal models is the inability to mimic the increased O demand that is observed in patients at 02 delivery rates in excess of 2 normal. A particular feature of this increased O demand is that it apparently does 2 not stimulate increased 02 extraction, although the limitation in O extraction has 2 not been explored in patients by lowering 02 supply, for obvious reasons. At least two possibilities to account for increased 02 demand could be investigated in animal models, however. The amount of 02 that is utilized in extramitochondrial pathways, which is normally on the order of 10%, may be greatly increased in ARDS and sepsis by O radical formation. There is presently no information 2 concerning how much 02 might be used in this way. Another strong possibility is that mitochondrial injury, perhaps as a result of 02 radical formation, uncouples oxidative phosphorylation. Some evidence presently in the literature supports this idea [19]. Indeed, the association of increased blood lactate levels with higher than expected 02 demands makes uncoupling a very attractive hypothesis that warrants further investigation in animal models using such agents as 2,4-dinitrophenol. References 1.

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.

Regional Anaesthesia: A Pocket Guide is an essential companion to the practice of regional anaesthesia for consultants and trainees in the specialty. Filled with practical advice and carefully designed for ease of use, this book is the helpful aid to practice that anaesthetists have been waiting for. The book covers all the major blocks by anatomical region, from the head and upper extremities, to the lower extremities and para-axial region. The technique for each procedure is prefaced by information on its difficulty, indications, contraindications, and potential side-effects. Every procedure is also accompanied by a range of high-quality clinical photographs and anatomical drawings that demonstrate the importance of applying anatomical knowledge in practical anaesthetic procedures. Regional anaesthesia is a fast-moving specialty, and this book takes into account recent advances in ultrasound-guided techniques with a strong focus on real-time observation of needle placement. Landmark-placed blocks have are also covered for clinicians without access to ultrasound technology. Regional Anaesthesia: A Pocket Guide is a unique compilation of anaesthetic techniques that offers support and guidance for any trainee or specialist in their every day practice.

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."

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 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.

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 .