Despite numerous reports of cerebral damage in cardiac surgery, the subject has not been given the attention it requires. This book, with a preface by Torkel Aberg, will remedy that situation. The causes and incidence of pre- and post-operative cerebral damage are considered in the first section. Cardiac surgery patients frequently have preoperative cerebral impairment, not suprising when one considers the impaired circulation from a damaged heart and the brain's prodigious need for blood. Moreover, several perioperative aspects of surgical procedures have been considered as possible causes of cerebral dysfunction, for example: microbubbles, toxic by-products, non-pulsatile blood flow. The second section describes how imaging techniques (CT scan, MRI, regional cerebral blood flow imaging), and functional assessment techniques. (PET scan, EEG, BEAM and evoked potentials) can be used to measure cerebral damage. In the third section, psychometric and neuropsychological techniques are used to assess impaired mental abilities (abstract thinking, language, memory, visuo-spatial ability, mental flexibility, attention and concentration). The final section explores the relationship between cerebral dysfunction and psychopathology (several types of depression, anxiety, and aspects of organic brain syndrome, delirium and dementia).

The topics in this book represent the presentations given at the First and Second Annual Meetings entitled "Critical Issues in Surgery" held at the Frenchman's Reef Beach Resort, st. Thomas, U.S. Virgin Islands, November 1992 and 1993. This symposium was sponsored by the Department of Surgery, and the Department of Nursing Education and Quality Assurance of Cooper Hospital/University Medical Center, the University of Medicine and Den tistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey, as well as the Academy of Medicine of New Jersey. Chapter authors were charged with the task of writing brief overviews of major issues related to the field of general surgery and critical care medicine. The book is specifically tailored to the needs of general surgeons, allied health professionals and nursing personnel involved in all phases of caring for the surgical patient. Although intended as a reference source with emphasis on up-dated approaches applied in general surgery, it is hoped that the discussion of these topics will compliment other texts and manuscripts. Obviously, a book of this length cannot cover the whole multidiSCiplinary and complex field of surgery. However, the co-editors are certain that the annual appearance of this text will highlight comprehensive, new and interesting approaches to the field of surgery."

A unique reference manual for academic surgeons, this book discusses every facet of surgical research. From getting grant money to choosing a topic, reviewing the literature, planning and conducting research, and reporting results.

Drug dosage in renal insufficiency has become an toxication. In 1975, his Poison Index was pub important facet of nephrology, a subspeciality of lished, first in German, and two years later in internal medicine which is only 30 years young but English, with supplements in 1979 and 1983. This constantly growing in scope and importance. Two volume has become an obligatory reference in more thirds of all drugs are partially, mainly, or exclu than 2500 dialysis units. sively excreted by the kidneys. In the presence of Based on GOnter Seyffart's experience and renal insufficiency, dose adjustments are therefore knowledge in this field, the plans for this book obligatory. In patients on dialysis, drug elimination matured in 1984, a logical step in view of his by this route must also be considered. untiring effort and diligence. In order to deal with As the reader of this book will discover, 20 more than 1200 different drugs and almost 4000 percent of currently used drugs are contraindicated references, 21 contributors were sollicited, while it where there is any degree of renal insufficiency, took six years to complete the work. The major and for at least another 60 percent a dose reduc share of the effort was thus left to the main author tion is required. It is obvious, therefore, that the and editor and he has produced a concise work of detailed knowledge required can never be com impressive clarity.

Neuroanesthesia contains the edited presentations of the 42nd Annual Postgraduate Course in Anesthesiology given by the Department of Anesthesiology at the University of Utah School of Medicine, February 1997. The chapters reflect recent advances in neurophysiology, pharmacology and monitoring related to the practice of neuroanesthesiology. The sections on central nervous system trauma, intraoperative management, brain protection and postoperative care provide a conceptual framework for current clinical practices. This textbook is the fifteenth in a continuing series documenting the proceedings of the Postgraduate Course of the Department of Anesthesiology of the University of Utah School of Medicine. It reflects, as well as past and future volumes, the rapid and continuing evolution of anesthesia in the last years of the twentieth century.

On 15 November 1997, the first international symposium "Neural and Chemical Control of Breathing: Pharmacological and Clinical Aspects" was held at Leiden University Medical Center on the occasion of the retirement of one of the members of the Control of Breathing Research Group of the Departments of Physiology and Anesthesiology, Dr. Aad Berkenbosch. Among others, Dr. Berkenbosch, played an important role in this research group, which made a large and significant contribution to scientific research on the regulation of breathing. This book presents the proceedings of that meeting together with papers of several authors who have strong bonds with the Leiden Departments of Physiology and Anesthesiology. All studies represent state of the art work on the subject of respiratory control and cardiovascular medicine, with emphasis on the physiological, pharmacological and anesthesiological aspects of both fields. The book is divided in several sections: Oxygen Physiology. Prof. John Severinghaus presents among other things his ideas on oxygen sensing and high altitude related diseases. Prof. Honda gives results from studies in a unique set of subjects without carotid bodies. The findings of Honda's group support the idea that an intact hypoxic drive from the carotid bodies is necessary for the generation of central hypoxic depression. Dr. Hans van Beek discusses the effects of hypoxia and hypercapnia on cardiac contractility in animal models. Prof. Oeseburg demonstrates the feasibility of Near Infra Red Oximetry for monitoring tissue oxygenation in patients. Central Chemoreception.

Pediatric and Obstetrical Anesthesia comprises the edited presentations of the 40th Annual Postgraduate Course in Anesthesiology, February 1995. The book reflects the most recent advances in the physiology, pharmacology and anesthetic management of patients with central nervous system disease. Subjects such as central nervous system trauma and brain protection are also dealt with. Obstetrical and pediatric patients constitute important and often challenging cases for the practicing anesthesiologist. This textbook is the thirteenth in a continuing series documenting the proceedings of the Postgraduate Course of the Department of Anesthesiology of the University of Utah School of Medicine.

The Manual of Geriatric Anesthesia is a practical guide for physicians, residents, and students interested in the care of the elderly patient undergoing surgery. Although primarily written for anesthesiologists, other perioperative physicians and nurses will also find the information highly valuable. Highlights of the text include concise and clear discussions of preoperative assessment, anesthetic administration, the immediate postoperative care, as well as the more classic 'geriatric' topics such as the hip fracture patient, cataract surgery, postoperative delirium, dementia, ethics and end of life care. Clinical geriatric principles are woven into the text so that the reader can develop skills in geriatrics and develop a broader understanding of terminology and principles used in geriatric medicine.

Eponyms are found throughout medicine. They provide succinct and convenient identification for diseases, syndromes, clinical signs, surgical instruments and operations. Anaesthetists use eponyms such as Magill forceps, Mallampati score, Sellick's manoeuvre and Mendelson's Syndrome. National and international anaesthesia societies have eponymous awards and lectures. This illustrated book has been written to describe who these notable individuals were, when and where they worked, why they invented equipment, a technique or a scoring system, and why they were chosen by their peers for eponymous honour.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

The prevalence of obesity, an important risk factor for various diseases, has increased markedly worldwide in recent years. The results of long-term dietary behavioural therapy, however, remain sadly inadequate, with a relapse rate of about 90%. Surgery is still the only effective treatment for these patients. The annual number of weight loss operations performed in the United States in the early 1990s totaled only about 16,000, but by 2005 the figure exceeded 200,000. The anesthetic care of severely obese patients entails particular issues, and difficulties are believed to escalate in the presence of co-morbidities. Despite this, outcome data in respect of anesthetic care and pain management are still scarce. Anesthetic Management of the Obese Patient considers a wide range of important practical issues and controversies. Key questions in preoperative, intraoperative, and postoperative management are carefully addressed, and different approaches are evaluated, casting light on their effectiveness and limitations. Written by world leaders in the field, this book will be an invaluable aid for anesthesiologists.

Professor Philip Bromage From the earliest stirrings of modern surgical anesthesia, novice surgeons struggling to learn from the living what there was a strong intuitive feeling that anesthesia of part they were denied an opportunity to learn from the dead_ of the body would be better for the patient than complete But that is largely nostalgia for a past era_ Today, the visual anesthesia of the whole organism. In 1848, James Young arts and the plastics industry have united to give us superb Simpson spent some time and effort seeking this elusive teaching models and techniques that did not exist a few goal, but after a few ingenious though unsuccessful experi decades ago, and they have developed two- and three ments, he gave up the search and turned back to general dimensional surrogate cadavers that are imbued with a anesthesia as the only practical solution to surgical pain more vivid artistry than ever existed on the marble slabs relief at that time_ amid the formalin reek of our old dissecting rooms_ earl Koller's simple but brilliant application of cocaine to This book is a fresh and highly successful attempt to repair some of the bridges that were burnt with the passing of the the eye in 1884 opened the door to a whole new universe of neural anatomy and pharmacology_ Within a decade or old anatomy days_ Together, the authors have contributed"

The Ottawa Anesthesia Primer is an essential primary text for medical students and residents completing a rotation in anesthesia. Written by over 40 authors and edited by Dr. Patrick Sullivan, the Ottawa Anesthesia Primer updates their previous popular text entitled Anesthesia for Medical Students. General and specific learning objectives have been carefully identified and can be tailored to the students unique needs during their rotation. In addition, each chapter begins with learning objectives and key points for the student. Throughout the text, emphasis has been given to knowledge, procedures and skills with a focus on preoperative assessment, securing intravenous access, airway management, basic resuscitation skills, acute pain management and the safe use of local anesthetics. Additionally, within the Primer's 26 chapters, anesthesiologists, anesthesia residents and physicians from other specialties will find valuable discussions on advanced topics including management of the difficult airway, regional anesthesia, acute pain, chronic pain, obstetrical anesthesia, management of the circulation and adult and neonatal resuscitation to name just a few. The revised text was renamed the Ottawa Anesthesia Primer recognizing that the content is suitable for medical care providers practicing in a wide variety of roles. Accompanying videos and hyperlinks to reference articles provide clinicians with immediate access up-to-date landmark articles. The reader has the option of viewing the Primer in a print or electronic format. The electronic ePrimer is available as an iBook that can be purchased for use on an iPad by downloading a free Apple application called iBooks. It is also available as an ePub version and a DRM pdf for viewing on other electronic readers. The ePrimer offers URL links, video links, and expanded case problem discussions. Selected URL addresses for additional resources are listed in the printed version of the Primer.

The past few years have seen the publication of a large number of articles and not a few books on the subject of relief of intractable pain. New ideas have been put forward on pain mechanisms, new methods of treatment have been reported and improved results c1aimed, and a growing catalogue of complications oftreatment has been recorded. The vast and expanding literature on the subject poses for the reader the dual problems of surveil lance and of assessment. The object of the present book is to provide a critical and constructive review of current writings and ideas on a wide range of aspects of the nature of intractable pain, particularly of present day practice and new ideas on treatment. Each chapter is written by an acknowledged authority and the approach throughout is practical rather than academic. In editing the individual chapters an effort was made to achieve a contemporary approach and to eliminate material which was unduly historicalor retrospective in content. At the same time the individ ual style of the authors was retained as far as possible. For decades chronic pain has been a therapeutic 'no man's land'. For the surgeon pain was an unfortunate complication wh ich not infrequently followed surgery; for the physician it was a distressing symptom in a number of disease syndromes; to the psychiatrist it was one of a number of features in many cases of mental illness."

"A Quick Reference Text" Easy to read and practical in design, Neurocritical Care is the book specialists will turn to for quick reference. It concentrates on management problems, from diagnostic procedures to therapeutic strategies. Exact descriptions are given for treatment procedures, and it is easy to find the appropriate treatment for a given patient. "International Expertise" More than 100 authors from North America have contributed to the book. The different strategies used on either side of the Atlantic have been described, the sections on neuroimaging have been reviewed by a neuroradiologist. "Comprehensive in Scope" Both frequent and rare neurological diseases that may require critical care treatment and subjects of more general interest such as monitoring strategies, ethical problems, brain death and neurological disorders in internal medicine have been covered. Pathophysiology is also discussed, insomuch as it is important for understanding the treatment strategies.

Foreword by Walter J. Freeman.

The induction of unconsciousness using anesthetic agents demonstrates that the cerebral cortex can operate in two very different behavioral modes: alert and responsive vs. unaware and quiescent. But the states of wakefulness and sleep are not single-neuron properties---they emerge as bulk properties of cooperating populations of neurons, with the switchover between states being similar to the physical change of phase observed when water freezes or ice melts. Some brain-state transitions, such as sleep cycling, anesthetic induction, epileptic seizure, are obvious and detected readily with a few EEG electrodes; others, such as the emergence of gamma rhythms during cognition, or the ultra-slow BOLD rhythms of relaxed free-association, are much more subtle. The unifying theme of this book is the notion that all of these bulk changes in brain behavior can be treated as phase transitions between distinct brain states.

Modeling Phase Transitions in the Brain contains chapter contributions from leading researchers who apply state-space methods, network models, and biophysically-motivated continuum approaches to investigate a range of neuroscientifically relevant problems that include analysis of nonstationary EEG time-series; network topologies that limit epileptic spreading; saddle--node bifurcations for anesthesia, sleep-cycling, and the wake--sleep switch; prediction of dynamical and noise-induced spatiotemporal instabilities underlying BOLD, alpha-, and gamma-band Hopf oscillations, gap-junction-moderated Turing structures, and Hopf-Turing interactions leading to cortical waves.

This book is the first of its kind - a comprehensive reference for anesthesia and perioperative clinicians involved in aortic surgery. With a primary focus on anesthesia for various aortic surgical procedures, including endovascular aortic surgery, the title also provides expanded coverage of CNS monitoring and protection, intraoperative transesophageal echocardiography, renal and spinal cord protection during surgery, management of aortic trauma, and postoperative care. Written by top cardiac anesthesiologists, surgeons, and intensivists, this indispensable reference provides everything you need to know about the burgeoning field of aortic surgery in one handy volume.

Brain resuscitation is the therapeutic intervention for critically ill patients with severe brain damage, particularly the types caused by ischemia and hypoxia. The The objective of the International Symposium on Brain Resuscitation held in Ube, Yamaguchi Japan October 31 to November 2 1988, and sponsored by Yamaguchi University and the Japanese Ministry of Education, was to review our recent progress in brain resuscitation and to discuss controversies both basic and clinical. To my knowledge, this symposium was the first held in Japan. Our understanding of neuronal dysfunction due to ischemic/hypoxic insults at organ, cellular, and molecular levels has advanced significantly in the last two decades. We had therefore intended that this international symposium should broadly cover the topics which are of interest to both basic researchers and clinicians. Three hundred and twenty-five attendants, including twenty scientists from eight different countries, actively participated in discussion and exchange of new ideas and thoughts concerning brain resuscitation. This book comprises the re ports presented during the symposium which consisted of two main parts: basic and clinical. Although one single meeting can never be expected to solve any problems, meetings often highlight areas of ignorance and problems which are ripe for solving. It has been hard to review all the papers because of the multi plicity of the discussed topics, but the overview on brain resuscitation by Profes sor Bo K. Siesjo and the summary by Professor J."

Neurophysiological recording is the major neuromonitoring technique employed in ICU. In addition, continuous recording of intracranial pressure has proved to provide infomation useful for critical care of the patient with severe brain damage. It is, however, difficult to assess neurochemical and/or metabolic environments of the brain with these conventional neuromoni toring techniques. Information regarding these changes, if available on a real-time basis, is undoubtedly useful for patient care. Many important developments in bedside techniques to monitor these changes have been achieved during the last few years. It was the consensus of the editors that a symposium to exchange knowledge concerning recent advances in such techniques would be valuable. With this background, the First International Symposium of Neuro chemical Monitoring in ICU held May 20-21, 1994, in Tokyo, Japan. It was not the intention of the organizers that this symposium should survey the whole field of neuromonitoring in ICU. The symposium was thus focused on clinical application of microdialysis, jugular venous oximetry, and near infrared spectroscopy, which currently appear to be the most promising techniques for monitoring neurochemical and metabolic changes in the brain in a clinical setting. We termed these techniques collectively as neuro chemical monitoring, contrasting them with neurophysiological monitoring in ICU. The concept that has motivated this symposium was to provide an opportunity to exchange up-to-date summaries on issues currently debated for these techniques. This volume is based on the papers presented at the symposium."

This aim of this book is to focus on a very common situation seen in medical practice, the acute catabolic state. This pathophysiological sit uation is rarely discussed as a separate entity, possibly because it is seen in all specialties of medicine and results from a great diversity of agents, insults, and diseases. It thus seemed to be high time to gather the most important and up-to-date knowledge on this entity, and the primary aim of the book is to offer a collection of updated information on the acute catabolic state. Another objective of the book is to make clear that, apart from the general response of the whole organism during the acute catabolic state, a series of organ-specific responses will also take place, which must also be considered during treatment. It has become very clear of these organ-spe from working on this book that current knowledge cific responses is very sparse and in some areas almost nonexistent; this book thus also focuses on the responses and changes which take place in different organs during the acute catabolic state and the inter action between these organs and their responses.

B. Raymond Fink Sheldon Roth and Keith Miller have asked me to record that the Third Conference on Molecular and Cellular Mechanisms of Anesthesia was held in Calgary last May "in my honor. " Such was my dear friends' gracious way of continuing a series that began at the University of Washington, where I hosted two, four, or five previous ones, 1,3-6 depending 2 on how far back one wishes to count. At that, Seattle took up where Paris left off in 1951. These occasions create their own unforgettable memories. This book captures the fine, invigorating ambience of the University of Calgary and the exciting explorations and com panionship of a gathering in a frontier territory of neuroscience. So, floreant symposia. They have progressively refined the quarry, from pathway to synapse to lipoprotein membrane to receptor and single channel, in heuristic convergences of neuronal physiology, biochemistry, and pharmacology. Nevertheless, the anesthesiologist in me senses a certain disquiet, a certain claustrophobia provoked by the narrow confines of micropipettes. How much more tubular must tunnel vision become before the desired broad view emerges? At present, the advances in molecular neurobiology seem continually to increase the apparent complexity of the total problem and the conceptual distance between the reductionists in the laboratories and the holists in the operating rooms. Happily, what is also growing is the excitement in trying to bridge the gap. Perhaps it would be timely to regard general anesthesia not as a state but as a syndrome."

The volatile anesthetics continue to be one of the most mysterious yet commonly used class of drugs in medical practice today. A prominent and troublesome side effect of volatile anesthetics is their ability to alter hemodynamics. This arises from two diverse but interrelated phenomena, depression of cardiac contractility and dilation of the vasculature. These effects of volatile anesthetics on cardiac and smooth muscle plus the action of volatile anesthetics on skeletal muscle in the malignant hyperthermic syndrome have led to concern about the interaction of volatile anesthetics (and other anesthetic agents) with calcium metabolism in the muscle cell. Many of the phenomena caused by anesthetics appear to have common mechanisms in all of the muscle types; however, the differences among skeletal, cardiac and smooth muscle also lead to distinct effects of the anesthetics in each. Given the diverse research disciplines which have been brought to hear on the mechanism of anesthetic alteration of contractility, the symposium from which this book originates was convened for the purpose of gathering those with common interests in anesthetic agents and their cellular and subcellular actions in muscle. The recent symposium had its origins in a small but exciting meeting that took place at the University of Texas at Houston in 1984. At that time, Robert Merin and Jacques Chelly convened a group of people who had interest in cardiac muscle and calcium antagonists.

One of the easiest things an anesthesiologist can do is to administer an anesthetic, and therein lies one of the major dangers of anesthesia. Like in flying and diving, if the rules are followed, mishaps should be very rare. The Art of Anesthesiology so often depends on anticipation of the unexpected, knowing the patient and doing something intelligent when the Science does not give a clear cut answer to a problem. The risks to our patients can, therefore, be markedly reduced, if we have a good grasp of the difficulties and dilemmas that they are prone to, before they are anesthetized. Herein lies the great value of preanesthetic assessment. Preanesthetic Assessment has now reached its third volume in the space of five years. Twenty-four new areas are covered with more than enough detailed information to satisfy the careful practitioner and the Board Examiner. Dr. Elizabeth Frost is to be congratulated on presenting a breadth of material that contains something useful and informative for everyone in training or practice. Subjects vary from the demands of the athlete to those of the Jehovah 's Witness, congenital disorders to pediatric and obstetrical quandaries. Other problem areas include drug abuse, endocrinology, the patient undergoing neuroradiology and a mixed bag of diseases that provide the unprepared anesthesiologist with problems.

In spite of today's increasing body of knowledge in regard to central nervous func tion and/or the mode of action of centrally active compounds, little is done to monitor those patients which are at risk of cerebral lesions either in the OR or in the ICU. Due to the inconsistency of reports regarding the application and the benefits computerized EEG and/or evoked potential monitoring will bring to the clinician, physicians still are reluctant to get involved with a technique, which they think, will have little or no effect on the outcome of a patients well being. However, due to the development in computer technology, data acquisition and comprehension, it now is possible to monitor such a viable organ as the Central Nervous System (CNS) on a routine base without being a specialist in neurology or electroencephalography. Thus, the book is intended to guide the clinician to use BEG and evoked potential monitoring in a day to day situation, without going too deep into technical details. As an improvement of cerebral care is needed, various representative cases underline the interpretation of EEG power spectra and evoked potential changes in regard to the underlying clinical situation. It is hoped that this book will serve as a guide to anyone who considers cerebral monitoring a necessity in today's patient care. This may be the anesthesiologist, the intensive care therapist, the nurse anesthetist as well as the medical personnel in the lCU setting."

An engaging and effective way to learn all the essential anesthesia procedures

More than any other text, "Anesthesia Unplugged," 2e disarmingly demystifies anesthesiology. Featuring an easy-to-navigate atlas-style design, this skill-sharpening book delivers step-by-step instruction on the entire spectrum of perioperative, ambulatory, regional, and general procedures.

Essential for anesthesiology residents, student registered nurse anesthetists, medical students with an interest in anesthesiology, and Intensive Care Unit personnel, "Anesthesia Unplugged," 2e features: Authoritative, complete coverage of all relevant anesthesia procedures, from the IV and laryngoscopy, to the combined spinal-epidural and transesophageal echocardiography An efficient organization featuring one procedure per chapter Critical information broken down into manageable chunks and templates - ideal for busy residents and clinicians 600 high-quality photographs and illustrations that put key anesthesia procedures into proper clinical perspective Amusing insights you won't get anywhere else with chapters that include: The Mask of Zorro: Mask Ventilation; Whiz-Bang Intubation Gizmos; PICC Lines - Just Really, Really Long IVs; Goodnight, Sleep Tight: Setup and Mask Induction for Pediatric Patients; The Lung's Not Down, You Idiot - Lung Isolation; Thoracic Epidurals--What's the Big Deal?; Stand By Me: The Femoral Arterial Line