The advances in the field of anaesthesiology and reanimation have contributed in all developed countries to the decrease in deaths occurring on the operating table (exitus in tabula), from the ratio 1: 100 (in the nineteenth century) down to approximately 1: 1000 (in the first half of the twentieth century) and finally to approxi mately 1: 10 000 (nowadays). Numerous human lives were saved not only through the intro duction of new medicine and methods but even more so by better training for the doctors and nurses who apply these new techni ques. I am happy about the splendid initiative of my student and friend Georg Kamm, which has now made these advances acces sible to the developing countries. He knows very well how to make his colleagues understand the theory and the practical side of modern anaesthesiology, under the most difficult conditions and in a completely different world, to such an extent that to day in his country all of his patients are given the benefit of the advances of medicine. There is nothing more rewarding for an academic teacher than to see how his students continue developing his ideas and spread them far and wide. I am therefore happy and proud to write this foreword for Georg Kamm, one of the pioneers of anaesthesiology in Africa."

The recent development of the use of spinal opiates as a rational therapy for pain rests on clear and certain experimental data. We have long known the spinal cord to be a highly complex structure. Anatomical studies of the substantia gelatinosa have repeatedly demonstrated signs of massive synaptic interaction between primary afferents, descending pathways and intrinsic neurons. Yet, to date that knowledge, insofar as clinical therapy is concerned, has permitted us only to destroy certain connections within the spinal cord in the hopes that the substrate mediating pain could be anatomically differentiated from those which mediate other function. Though cordotomies are clearly effective under certain circumstances, they suffer from the fact the spinal cord is not organized in such an anatomically discrete fashion as is often times drawn in basic medical text. Rather, functions intertwine exquisitely and specific physical interventions are no more likely to produce a specific effect than smashing of the fmgertip with a hammer will produce just a loss of the fingernail. The development of specific therapies of the spinal cord has come about by our growing aware ness of the intricate organization of the pharmacological substrates associated with specific neural function."

bei cardio-chirurgischen EingrifIen U. Brenken, G. Karliczek und H. Oldenziel Einleitung 1 2 Seit einigen Jahren werden an unserer Klinik Etomidate und Piritramid aufgrund der gUn* stigen Mitteilungen in der Literatur [3-9, 12, 13, 15, 17] routinemae,ig zur Narkoseeinlei- tung fill Koronar- und Klappenersatzoperationen eingesetzt. In dieser Untersuchung sollte gezeigt werden, inwieweit auch bei schwerstkranken Herzpatienten Narkosen ohne wesent- liche Veriinderungen der Haemodynamik eingeleitet werden konnen. Entsprechende Unter- suchungen haben sich bisher auf den Vorgang der Schlafinduktion beschrankt. In Wirklich- keit umfae,t die Narkoseeinleitung Muskelerschlaffung, endotracheale Intubation und den Ubergang zur kontrollierten Beatmung mit meist Lachgas-Sauerstoff. Diesen Sachverhalt ha- ben wir in unserer Untersuchung mitberiicksichtigt Methoden Die Messungen erfolgten an 12 Patienten mit ernster Koronarsklerose und an 12 weiteren Patienten mit Herzklappenfehlern im klinischen Stadium III, III bis IV und IV der NYHA- Klassifikation. Die verwendeten Mee,methoden wurden an anderer Stelle eingehend be- schrieben [10]. Praemedikation: 10-15 mg Valium, kein Atropin. Unter Lokalanaesthesie wurde ein 7-F-Swan-Ganz-Katheter (KMA) eingebracht. Nach Messung der Basiswerte: Herzfrequenz, arterieller Blutdruck (Riva-Rocci), zentralvenoser Druck, Pulmonalarteriendmck und Cardiac Output (Thermodilution) wurde die Anaesthesie durch langsame Injektion von Etomidate 0,2-0,3 mg/kg in 30 Sekunden und Piritramid 0,3-0,5 mg/kg eingeleitet. Bis zur Intuba- tion unter Pancuroniumbromid (pavulon) 0,1 mg/kg in der 5. Minute wurden die Patienten tiber eine Maske mit 100% Sauerstoff beatmet. Nach der Intubation erfolgte die Beatmung mit dem Servo-Ventilator mit einem Lachgas/Sauerstoffgemisch (Fi0 = 0,5). Es wurde eine 2 endexpiratorische CO -Konzentration von 5% angestrebt.

W.F. List Unter einer praoperativen Ambulanz soll eine Organisationsform verstanden werden, die eine fruhzeitige praoperative Befunderhebung zur Feststellung der Anasthesiefahigkeit und des Anasthesierisikos durch Anasthesiologen ermoglicht. Chirurgische Patienten mit elektiven Eingriffen sollen entweder noch vor ihrer Spitalsaufnahme oder aber unmittelbar nachher in einer derartigen Ambulanz gesehen werden. Die Untersuchungen werden in eigenen Raum- lichkeiten der Anasthesieabteilung bzw. des Anasthesieinstitutes oder der Anasthesieklinik durchgefuhrt. Dadurch ist die Gewahr gegeben, dass der Anasthesiologe schon fruhzeitig mit dem chirurgischen Patienten in Kontakt kommt und alle notwendigen Befunde zur Feststel- lung der Anasthesiefahigkeit (Narkosetauglichkeit) und des Anasthesierisikos erheben kann. Zwischen 25 und 40 % unserer Patienten zeigen neben der chirurgischen Erkrankung noch medizinische Befunde, die beachtet werden mussen (Kyei Mensah et al. 1974). Das operative Risiko und die Operationsletalitat wird durch medizinische Begleiterkrankungen deutlich er- hoht (Goldman et al. 1977). Bisher war es doch so - jedenfalls in meiner Institution - dass praoperative Befunde vom chirurgischen Patienten selbst in mehreren Ambulanzen und Labors zusammengetragen werden mussten. Dann wurde sehr oft vom Chirurgen ein Internist angefordert, der die Ope- rationstauglichkeit meist bei "schonender Narkose" feststellt. Der Anasthesiologe sah die Pa- tienten erst am Vorabend der Operation. Eine oft sehr lange Liste von Patienten musste in kur- zester Zeit beurteilt und pramediziert werden. Nicht selten musste die Anasthesiefahigkeit auch noch mit unzureichenden Befunden abgeklart werden. Ein Absetzen der Operation fuhrte zu Schwierigkeiten mit dem Patienten, mit dem Operationsprogramm und dem Chirurgen.

In clinical anaesthesiology the inhalation anaesthetics halothane (fluothane), enflurane and - in recent times - forane got a renaissance in clinical application. The reasons are not only the ad vantages of volatile anaesthetics, but also the fact that the investi gations of pharmacodynamics and pharmacokinetics of Lv. narcot ics showed negative aspects. It was the aim of the organizers of the symposium to give a survey of the present state of knowledge on inhalation anaesthetics, which is as up-to-date, critical as well as detailed as possible. Furthermore it was the intention to evaluate the recent advances made in the field of basic research. The first section of the symposium in particular enters into the question of the toxicity of volatile anaesthetics as well as their mechanisms of action. In a second main part the influences on cardiovascular system and on microcirculation are discussed. Apart from the extensive discussion of the advances in knowledge in the field of cardiovascular pathophysiology, the focal point of the contribut ions is made up of those with anaesthesia in coronary heart disease and cardiac insufficieny as well as the contribution on interactions of inhalation anaesthetics with cardiovascular drugs. In the third and fourth section the influences of volatile anaesthetics on cerebral, hepatic, renal and pulmonary function are dealt with as well as questions concerning the clinical application. Particular attention is given to the important problems of indicat ion in patients belonging to the extreme age groups."

The VIth World Congress of Anaesthesiology, held in Mexico City in 1976, offered several European participants the opportunity of discovering their community of views. The idea was then launched of establishing a forum for regular exchanges among academic anaesthetists from Europe. After many preliminary discussions, some thirty delegates or observers from the Societies of Anaes thesia of Austria, Belgium, Finland, France, German Federal Re public, Greece, Ireland, Italy, the Netherlands, Norway, Poland, Spain, Switzerland, United Kingdom and Yugoslavia met in Paris on 12 March 1977. They agreed to found a European Academy of Anaesthesiology. After a second meeting in Dublin, the Academy was officially created by a general assembly in Paris on 5 Septem ber 1978. Election of members took place for the first time on that date. Since then, the Academy has been functioning regular ly. Its membership presently stands at 180 from 26 European countries. Associate members will be elected for the first time this year. The total number of full members is limited by the statutes to five hundred. The Academy also has two other categories of members: hon orary and patrons. Five honorary members have so far been elec ted: Mrs. N. du Bouchet (France), Mr. H. Killian (German Federal Republic), Sir Robert Macintosh, Prof. W. W. Mushin (United King dom) and Dr. E. M. Papper (United States)."

Dieser Band ist die Fortsetzung von Beitragen internationaler Ex perten zur Physiologie und Pathophysiologie der ruckenmarksna hen Leitungsanaesthesien. Nachdem 1978 die Wirkung der Epiduralanaesthesie auf Kreis lauf und Atmung sowie auf die Stressreaktionen bei Operationen behandelt wurde, werden jetzt die Pharmakokinetik der Lokal anaesthetika, der Interaktion der Lokalanaesthetika mit Medika menten, die zusatzlich bei Regionalanaesthesien verabreicht werden und das Thromboembolierisiko bei Epiduralanaesthesie im Ver gleich zur Allgemeinnarkose angesprochen. Dabei wird insbesondere die klinisch wichtige Frage bespro chen, ob ruckenmarksnahe Leitungsanaesthesien bei Low-Dose Heparinisierung der Patienten durchgefiihrt werden durfen. AuEerdem wird der gegenwartige Stand der peripheren und ruckenmarksnahen Leitungsanaesthesien, vor aHem in den USA, aufgezeigt und mogliche neue Entwicklungen diskutiert. Diese Zusammenstellung soH dem Leser nicht das Lehrbuch ersetzen, sondern ihm einen raschen und umfassenden Dberblick uber den neuesten Stand der Entwicklung ermoglichen. Den Erfolg dieses Symposiums danken wir wiederum den in formativen und interessanten Beitragen der Referenten und Dis kussionsteilnehmer, sowie der groEzugigen Unterstutzung durch die Firma Astra Chemicals, Wedel/Holstein. Dusseldorf, im Oktober 1981 H.J. Wlist M. Zindler Inhaltsverzeichnis I. Pharmakokinetik der Lokalaniisthetika Vorsitz: B.G. Covino, Boston, USA und U. Borchard, DUsseldorf H. Stoeckel und P.M. Lauven Grundlagen der Pharmakokinetik . . . . . . . . . . . . . . . . . . . 3 Diskussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 11 . . . . . . B.G. Covino Pharmacokinetics of Local Anesthetics 12 Discussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 20 . . . . . . R. Dennhardt Pharmakokinetik und Metabolismus von Bupivacain ...... 21 Diskussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 30 . . . . . . L. Wiklund und A. Berlin-Wahlen The Influence of Liver Circulation of the Pharmacokinetics of Local Anaesthetics ... . . . . . . . . . . . . . . . . . .. . . 32 . . . . Discussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 41 . . . . . ."

Die Behandlung der aktuten respiratorischen Insuffizienz steht hiiufig im Mittelpunkt therapeutischer Bemiihungen warnend der postoperativen Phase sowie in der Intensivmedizin. Entsprechend lag und liegt das wissenschaftliche Hauptinteresse zahlreicher Arbeitsgruppen verschiedenster medizinischer Fachrichtunge- von der Physiologie liber die Pathologie, Rontgenologie, Chirurgie, Innere Medizin bis hin zur Aniisthesiologie und Intensivmedizi- im Bemiihen, den Pathomechanismus der akuten respiratorischen Insuffizienz aufzukliiren und hieraus therapeutische Konsequenzen zu entwickeln. Das vorliegende Heft beinhaltet Vortriige, die auf einem inter- nationalen Symposium, veranstaltet yom Institut flir Aniisthesiolo- gie der Universitiit MUnchen, gehalten worden sind. Die themati- sche Palette reicht von der Darstellung der normalen Lungenfunk- tion bis hin zur Diskussion detaillierter Fragen der Beeinflussung von PEEP auf die Hamodynamik. Es wird die pathologische Anato- mie der akuten respiratorischen Insuffizienz dargestellt, das rontge- nologische Substrat bei dieser Erkrankung diskutiert und die ver- schiedensten therapeutischen Verfahren werden angesprochen. Von besonderem Interesse wird flir Experten die Diskussion der Frage nach der Bedeutung des !lerzens, insbesondere des rechten Ven- trikels unter den Bedingungen der respiratorischen Insuffizienz sein. Es ist das liel der Zusammenstellung der verschiedenen Sympo- siumsbeitrlige, fdr Studenten wie auch fUr Arzte, die an Fragen der Intensivmedizin interessiert sind, eine lesenswerte Arbeitsgrundlage zu schaffen. Mein Dank gilt deshalb den Autoren sowie dem Springer-Verlag.

This book has a twofold purpose, first to provide information for beginners about the pitalls and hazards of anaesthesia and second to help the occasional anaesthetist in remote areas when confronted with requests to anaesthetise for unfamiliar surgical operations. The book is not intended to replace any standard text for anaesthetic examinations, and indeed, its lack of information about basic sciences makes it unsuitable for such a purpose. The contents can be regarded as a distillate of 45 years of practical anaesthesia, in both primitive and sophisticated conditions, from the ether and chloroform rag and bottle days onwards through cyclopropane, trichloroethylene, relaxants and lytic cocktails to halothane. The only operation mentioned of which I have no practical experience is thymectomy and removal of an argentaffinoma. I have never knowingly encountered malignant hyperpyrexia, but had one experience of what we called ether convulsions with hyperpyrexia, which could have been, and probably was, the same thing. An attempt has been made to arrange the book in four logical sections. It begins with the hazards of preparation-assessment of risks to patients particularly, but Part I also includes chapters on medicolegal and occupational hazards to anaesthetists.

The development of accurate hormonal assays in recent years has evoked much interest in the area of anaesthesia and surgery. In an effort to allow an exchange of ideas and new information in this area, the First International Symposium on Endocrinology in Anaesthesia and Surgery was held in Bonn during September 1978. The contents of this book represent much of the information presented by the leading authorities in this field. The presentations were grouped in three areas: 1. Basic problems of endocrinology in anaesthesia and surgery; 2. The response of the endocrine system to anaesthesia and surgery; 3. Hormone and anaesthetic management of endocrine disease. As with any multi-authored text, there is both repetition and diversity but hopefully the reader will be able to obtain much of the useful information. As Editors, we wish to express our deep appreciation to Profes sor R. Frey and Springer-Verlag for including this book in the series on "Anaesthesiology and Intensive Care Medicine." H. Stoeckel T. Oyama Table of Contents I. Basic Problems of Endocrinology in Anaesthesia and Surgery H. Breuer Basic Principles Regulating the Endocrine System . . . . . . . .. 3 G. Wesemann and E. Grote Pathophysiology of Intra- and Postoperative Stress .. . . . . .. 10 M. Trede Surgical Treatment of Endocrine Disorders .. . . . . . . . . . .. 24 T. Oyama Influence of Anaesthesia on the Endocrine System ... . . . .. 39 L. Nocke-Finck Radioimmunological Determination of Hormones."

This volume contains the results of the 7th International Symposium on Acute Care, held in Rio de Janeiro from 21st to 24th November 1977. I would like to thank all the participants for their wonderful cooperation which made this Symposium a real success. I am especially grateful to the excellent speakers from all special ist fields and from all nations: I assure you, we all learned a great deal I would also like to thank the members of the organizing and scientific committees whose combined efforts ensured the smooth running of the Symposium, a meeting with a high-level discussion of scientific and philosophic problems as its goal. But first and foremost, we should like to express profound gratitude to the man whose idea it was to hold an annual conference in Rio: Dr. Brenildo Tavares, the Director of the Rio Symposia on Acute Care. He is one of the great pioneers of intensive, critical, acute, and emergency care, not only in.south America, but allover the world. The secret of the success of his symposia lies in his interdisciplinary and international approach. The symposia have brought together a great number of people who have since become close friends and continue to meet throughout the world. We all congratulate and thank him and wish him much success in the future."

This book provides readers with an anaesthesia-focused alternative to general physiology textbooks. The new edition has been reorganised with the trainee anaesthesist in mind, into shorter bite-sized chapters ideal for exam revision. The content includes the physiology of all major organ systems, with specific emphasis on the nervous, respiratory, and cardiovascular systems as well as special sections on pain, aging, specific environments and obesity. Alongside the learning objectives, reflection points and a handy summary of physiological equations and tables, there is greater emphasis on clinical application in this fourth edition, with applied physiology included in almost every section.

Table of Contents

Preface to the first edition

Preface to the second edition

Preface to the third edition

Preface to fourth edition

Acknowledgements

Authors

Contributors

Section One: Basic Cell Physiology

1. Cell Components and Function

2. Physiology of Excitable Cells

3. Neurotransmitters and Receptors, Ion Channels, G Proteins and Second Messengers

Section Two: Physiology of the Nervous System

4. Neuronal Function

5. Blood–Brain Barrier and Cerebrospinal Fluid (CSF)

6. Cerebral Circulation

7. Spinal Cord: Anatomical and Physiological Features

8. Sensory System

9. Motor Function and Control: Descending Tracts

10. Autonomic Nervous System

11. Consciousness, EEG, Sleep and Emotions

Section Three: Muscle Physiology

12. Striated Muscles: Skeletal and Cardiac Muscles

13. Muscle Spindles, Golgi Tendon Organs and Spinal Reflexes

14. Smooth Muscle

Section Four: Respiratory Physiology

15. Functions of the Respiratory System

16. Mechanical Properties of the Lungs

17. Gas Exchange in the Lungs

18. Carriage of Oxygen in Blood

19. Carbon Dioxide Carriage in Blood

20. Pulmonary Circulation

21. Control of Ventilation

22. Applied Respiratory Physiology

Section Five: Cardiovascular Physiology

23. Functions of the Cardiovascular System

24. Electrical Properties of the Heart

25. Mechanical Events of the Cardiac Cycle

26. Pressure–Volume Loop of the Left Ventricle

27. Physical Factors Governing Blood Flow Through Vessels

28. The Systemic Circulation

29. Microcirculation

30. Venous Return and Vascular Function

31. Regulation of Arterial Blood Pressure

32. Integrated Cardiovascular Responses

Section Six: Gastrointestinal Physiology

33. Saliva, Swallowing, and Lower Oesophageal Sphincter

34. Stomach: Gastric Secretions, Motility, Digestion and Vomiting

35. The Small Intestine: Secretions, Digestion and Motility

36. The Large Intestine

Section Seven: Liver Physiology

37. Functions of the Liver

38. Liver Blood Flow

39. Liver Function Tests and Physiological Features of Liver Failure

Section Eight: Renal Physiology

40. Functions of the Kidneys and Functional Anatomy

41. Renal Blood Flow

42. Glomerular Filtration

43. Tubular Function

44. The Loop of Henle and Production of Concentrated Urine: Counter-Current Mechanisms of the Kidney

45. Overview of Renal Control of Acid–Base Balance

46. Applied Physiology: Renal Failure

Section Nine: Acid–Base Physiology

47. Basic Concepts of Acid–Base Physiology

48. Compensatory Mechanisms in Acid–Base Disorders

49. Clinical Aspects of Acid–Base Control

50. Anion Gap and Stewart’s Strong Ion Difference

Section Ten: Physiology of Blood

51. Cellular Components of Blood

52. Plasma: The Non-Cellular Components of Blood

53. Haemostasis

54. Blood Transfusion

Section Eleven: Physiology of the Immune System

55. Immune System and Innate Immunity

56. Acquired Immunity

57. Cytokines

58. Hypersensitivity

Section Twelve: Endocrine Physiology

59. General Aspects of Endocrine Physiology

60. Pituitary Gland

61. Hormones of the Pancreas

62. Thyroid Hormones and Calcium Metabolism

63. Hormones of the Adrenal Gland

64. Erythropoietin, Atrial Natriuretic Peptide and Sex Hormones

Section Thirteen: Metabolism, Nutrition, Exercise and Temperature Regulation

65. Metabolism

66. Nutrition

67. Exercise Physiology

68. Temperature Regulation

Section Fourteen: Physiology of Pain

69. Peripheral Mechanisms of Pain

70. Central Modulation of Pain

71. Pain Sensitization

Section Fifteen: Physiology of Pregnancy, Placenta, Neonate, Ageing and Obesity

72. Physiology of Pregnancy

73. Physiology of the Placenta

74. Physiology of the Neonate

75. Physiology of Ageing

76. Physiology of Obesity

Section Sixteen: Special Environments

77. Physiology Related to Special Environments

Further reading

Index

　

The question how to induce general anaesthesia without problems has been asked repeatedly by anaesthetists and pharmacologists. P. A. JANSSEN developed etomidate and published this substance in 1971 as "a potent short-acting and relatively atoxic intravenous hypnotic agent in rats". In 1974 after several years of experimental and clinical trial the barbiturate-free hypnotic etomidate (soon marketed as Hypnomidate) was introduced to numerous auditors at the occasion of the IV. European Congress of Anaesthesiologists in Madrid. As the authors extended their essays, the actuality of the present book is given. The conclusion mentions the new solution of etomidate base in 35 % propylene glycol. It is expected that the disadvantageous effects - venous pain during injection and associated involuntary muscle movement- will largely be eliminated by using the new formula of etomidate after premedication of fentanyl. Mlinchen, August 1977 Alfred DOENICKE TABLE OF CONTENTS The Experimental Pharmacology of Etomidate, a New Potent, Short-Acting Intravenous Hypnotic (R. S. RENEMAN and P. A. JANSSEN) *. . . . ** 1 Protein Binding of Etomidate (G. A. MANNES and A. DOENICKE) ****. . . 6 The Effect of Intra-Arterial Injection of Etomidate and Thiopental on the Skeletal Muscle- and Arterial Wall-Structures (R. S. RENEMAN, F. VERHEYEN, R. KRUGER, W. VAN GERVEN and M. BORGES) . . *. . ** 9 Interaction between Etomidate and the Antihypertensive Agents Propanolol andoC-Methyl-Dopa (R. S. RENEMAN, W. VAN GERVEN and R. KRUGER) **. *. . . 15 Teratogenicity of Etomidate (A. DOENICKE and M. HAEHL) *. **. *.

Emergency care is improving throughout the world and thousands of lives are being saved each year. However, there are still too many patients who die before help reaches them in the form of advanced rescue and definitive emergency care techniques. In an effort to improve emergency care throughout the world, the International Committee of Emergency and Disaster Medicine meets bi annually. This meeting takes place in Mainz, Germany in September in order to discuss issues, exchange information, and establish re commendations designed to improve emergency care. The group is in dependent of political, national, racial, religious, or commercial influences and, in this sense, similar to the Club of Rome which attempts advances in sociology, biology and natural sciences. There fore, the organization could be called the "Club of Mainz" for the field of emergency and disaster medicine. The following book contains the proceedings of the International Symposiom on "Mobile Intensive Care Units and Advanced Emergency Care Units" at Mainz from September 24-27, 1973, and the discussions evoked by the first activities of the "Club of Mainz" and the inter nationally acknowledged "Recommendations." At this time we also announce the next meeting and International Symposium on Disaster Medicine, open to the public, organized by the "Club of Mainz" (October 1 - 2, 1977)."

Summary . . 373 381 Subject Index -IX- List of Contributors AGUADO-MATORRAS, A. , Dr. , Anesthesiologia y Reanimacion, Ciudad Sanitaria de la S. S. "La Paz", Madrid, Spanien ARIAS, A. , Dr. , Fundacion Jimenez Diaz, Madrid, Spanien ARNDT, J. 0. , Prof. , Dr. , Abteilung fUr Experimentelle Anaesthesiolo- gie der Universitat Dusseldorf BARUSCO, G. , Dr. , Anestesiologia e Rianimazione, Universitadi Pa- dova, Italien BECERRA, J. B. , Dr. , Fundacion Jimenez Diaz, Madrid, Spanien BEER, D. , Priv. -Doz. , Dr. , Institut fUr Anaesthesiologie der Chirur- gischen Uni versitatsklinik Munchen BEER, R. , Prof. , Dr. , Institut fUr Anaesthesiologie der Chirurgischen Universitatsklinik Munchen BERGIER, M. , Dr. , Departement d' Anesthesie et Reanimation, Hopital Nord, Marseille, Frankreich BERGMANN, H. , Prim. Prof. , Dr. , Institut fUr Anaesthesie mit Blut- zentrale a. O. Krankenhaus der Stadt Linz, Osterreich BIMAR, J. , Prof. , Dr. , Departement d' Anesthesie et Reanimation, Hopital Nord, Marseille, Frankreich BOSTEM, F. , Dr. , Electroencephalographie, Universite de Liege, Ho- pital de Baviere, Liege, Belgien BUZELLO, W. , Dr. , Institut fUr Anaesthesiologie der Universitatskli- niken Freiburg CASTRANEDA-CASADO, J. , Dr. , Anestesiologia y Reanimacion, Ciudad Sanitaria de la S. S. "La Paz", Madrid, Spanien CHACORNAC, R. , Dr. , Departement d' Anesthesie et Reanimation, Ho. . pital Neurologique, Lyon, Frankreich DAMIA, G. , Prof. , Dr. , Anestesiologia e Rianimazione, Inst. "E. Ve- cela", Universita di Milano, Italien DELEUZE, R. , Prof. , Dr.

Containing 220 challenging clinical cases and illustrated with superb, high-quality images, this book covers a wide range of anaesthesia-related questions and answers from straightforward cases through to more challenging presentations. It is an invaluable text for anaesthesia professionals in practice and in training, both for those doctors preparing for higher examinations and for established physicians for their continuing professional development. Nurse anaesthetists, learning at an advanced level, will also benefit from these case discussions.

Endocrinology is a rapidly developing field with many new concepts. In addition, many new hormones have been described since 1960. The structural analysis and synthesis of several intestinal hormones such as gastrin, secretin, glucagon and cholecystokinin have been achieved. Several hypothalamic hormones controlling pituitary function have been identified and in certain cases synthesized. The existence of hormonal peptides se creted from ectopic sites has been recognized. The development of new techniques of hormone assay has stimulated studies on the effects of anesthetics on the endocrine system. Although the endocrine response to anesthesia is less than its response to major surgical procedures, the effects of anesthesia on metabolism and on the autonomie nervous system are substantial. The primary purpose of this book is to increase the safety of patients undergoing anesthesia by making available the latest developments in this field. The major subjects examined in the book are endocrine responses to anesthesia and surgery, the effects of endocrine disease on anesthesia and sur gery, and pre-operative and post-operative management of patients with endocrine disease. The book is designed for students, residents and practicing physicians in the field of anesthesia and surgery. Many tables and figures are empIoyed to improve the presentation, particuIarly those relating to pharmacology and to the practical aspects of therapy."

Lest the reader be discouraged, let us state unequivocally and at the very beginning that this is not, nor will it develop into, a treatise on information or decision or communication theory. It is true that on occasion some ideas or concepts will be borrowed from these areas, and it is also true that on some other occasions we might offer examples of what communication theory, or decision theory, are all about. Nevertheless, this will be done for the primary purpose of showing where and how further exploration of these areas of endeavour might lead to further and better understanding of our problems, and possibly lead the way to sounder planning and more workable solutions. The more sophisticated will find a paucity of illustrations and a minimal mathematical treatment of the subject. This has been done for two specific reasons; the first being that additional graphic representation or mathema tical manipulations would not have contributed materially to a better under standing of the subject, at least in the context in which it is being presented."

During the recent years the basic sciences have become a major stimulant toward progress in medicine. Technique itself plays a vital role in today's medicine. With the increasing complexity of equipment, hazards related to malfunction and misuse have grown proportionally. The machine used with insufficient knowledge could become a deadly instrument. The basic elements of the anaesthesia machine, their design, and the physical basis for their function is discussed in the monography by the engineer, Peter 1. Schreiber. His knowledge is based upon fifteen years experience in the medical equipment industry in both Germany and the United States as well as his teaching activities in various medical schools. Detailed knowledge of equipment and the related physical laws has gained increasing importance in the training of anaesthesiologists. Fundamental knowledge of the design, function, and performance of an anaesthesia machine is the key to the art of its use. Mainz/Rhine, December 1971 Dr. RUDOLF FREY, F.F.A.R.C.S. Professor of Anaesthesiology Johannes Gutenberg-University Acknowledgements I wish to thank Dr. STANLEY W. WEITZNER, Professor, Department of Anesthesiology, State University of New York, Downstate Medical Center, for his helpful criticism of the chapter dealing with the per formance and classification of ventilators. I also want to thank Mr. DAVID F. BOERNER for his assistance in rewording the language and physiochemical terminology of the manu script."

During the First European Congress of Anesthesiology, held in Vienna, Austria, in September, 1962, panel discussions on nineteen different subjects were held, each lasting approxi mately three hours. One, concerning Controversial Aspects of Resuscitation, was later edited by its chairman, PETER SAFAR, and published in 1963. At the request of the publisher, the discussion on hypnosis has been edited in a similar manner. The participants in the discussion on Hypnosis in Anes thesiology had agreed, prior to the meeting, on a list of questions to be debated, and Dr. STOKVIS' introductory statement on the nature of hypnosis was circulated among them in appropriate translations in order to give the debate a starting point. It had also been agreed that no formal papers should be read after this introduction, and that the participants should use at will the German, English or French language. Following each contribution it was the chairman's task to give a brief summary in the two other languages. Discussion was therefore somewhat slowed down and occasionally rendered difficult by misunderstandings or the omission of details. Drs. GUEGUEN, MOSCONI, and VOLGYESI, who were not able. to attend, had sent written contributions which the chairman presented briefly during the discussion. The present text has been worked out of the tape recording of the discussion and the chairman's correspondence with the panelists some time after the meeting. Whenever the original contributions were in French or German, the English translation has been the chairman's."

The First European Congress of Anesthesiology in Vienna, Austria in September, 1962 presented 19 Symposium discussions, each lasting approximately 3 hours. Unlike most of these panels, the one on Resuscitation was a free discussion on controversial topics, without presentation of formal papers. In spite of the spontaneity of the unrehearsed questions and ans wers, the participants feit that an edited version of this Symposium should be published. The reasons for publication included the inter national character of the group of participants and the recent general interest in respiratory and circulatory resuscitation. A presentation of accepted resuscitation techniques was omitted, because of lack of time and because the Symposium was held pri marily for trained anesthesiologists, most of whom have first-hand experience with resuscitation and should be familiar with the accepted modern methods. Only controversial topics, which seemed to be of interest to those with personal experience in the application and the research of resuscitation, were included."