This concise, evidence-based board review book, organized according to the ABA keyword list, covers all the fundamental concepts needed to pass written and re-certification board examinations. Each chapter begins with a case scenario or clinical problem from everyday practice, followed by concise discussion and clinical review questions and answers. Discussion progresses logically from preoperative assessment and intraoperative management to postoperative pain management, enhancing the reader's knowledge and honing diagnostic and clinical management skills. New guidelines and recently developed standards of care are also covered. Serving as a companion to the popular textbook Essential Clinical Anesthesia, this resourceful work reflects the clinical experiences of anesthesia experts at Harvard Medical School as well as individually known national experts in the field of anesthesiology. This practical review is an invaluable resource for anesthesiologists in training and practice, whether studying for board exams or as part of continuing education and ABA recertification.

This book is an up-to-date guide to the most widely debated practical and management issues in anesthesia and intensive care. It provides validated information on the state of the art regarding a wide range of topics, including choice of imaging techniques in the management of ARDS patients, the value and limits of continuous renal replacement therapy in intensive care, the prevention and treatment of postoperative shivering, the diagnosis and treatment of postoperative paralytic ileus, ways to prevent acute lung injury, the prevention of perioperative myocardial ischemia, and the management of invasive candidiasis in intensive care. All subjects are addressed in a lively and straightforward manner by recognized experts in the field. Anesthetists and intensivists, including trainees, will find Practical Issues in Anesthesia and Intensive Care 2013 to be an ideal source of rapidly retrievable practical information ."

Innovation, training and research are the pillars that support a process deriving from basic science and multi-professional/multidisciplinary interventions. The APICE 2012 yearbook deals with several innovations for optimising prevention and management measures for the critically ill, by integrating diagnostic procedures with pharmacological and technological options. Peri- and postoperative managements as well as treatment of surgical infections and of pain, new and old artificial ventilation strategies are some of the most relevant topics the volume deal with in this new edition. The volume focuses also on the improvement standards and quality of care; on the expanding concept of clinical governance and professionalism and on the importance of ethical principles for establishing a process of patient-centered and evidence-based care.

Maximum oxygen uptake during exercise is one of the best predictors of operative mortality and of prognosis in chronic cardiac or respiratory disease. Cardiopulmonary exercise tests (CPET) are therefore an increasingly common component of pre-operative assessment and the management of patients with chronic cardiopulmonary problems. Part of the Oxford Respiratory Medicine Library (ORML) series, A Practical Guide to the Interpretation of Cardiopulmonary Exercise Tests, Second Edition provides readers with a practical, concise, and accessible approach to all aspects of cardiopulmonary exercise tests (CPET). CPET is often perceived as being incredibly complex to evaluate so this book breaks down interpretation to simple steps, allowing readers to rapidly understand the key points underpinning the application and interpretation of CPET. The text is focused and with the use of a substantial number of figures, learning points, and self-test questions helps readers to build confidence in undertaking and interpreting CPET. The second edition has been extended and extensively revised in line with the latest international guidelines and evidence, and includes 16 fully updated chapters, 4 new chapters, and a new section of worked examples has been added.

The book presents more than 60 real-life cases which together memorably and succinctly convey the depth and breadth of clinical anesthesiology. Each chapter includes a case summary, questions, lessons learned, and selected references. Tables and distinctive visual synopses of key teaching points enhance many chapters. The cases have been selected by Dr. Benumof from the Morbidity and Mortality (M & M) conferences of the Department of Anesthesiology, University of California, San Diego, which he has moderated the last several years, and residents and junior faculty have crafted them into the chapters of this book. Structured in a novel way, the UCSD Anesthesiology M&Ms maximize teaching and learning, and these cases bring that experience right to the reader's finger tips. * Case coverage of respiration- and circulation-related problems, obstetrics, neurology, pain and regional anesthesia, pediatrics, outpatient surgery, and special topics * Resource for anesthesiology and critical care medicine trainees * Review tool for board certification or recertification * Fun reading - valuable lessons

Now in its sixth edition, the Handbook of Drugs in Intensive Care is the essential guide to using drugs safely and effectively in the intensive care setting. The book is split into two sections: an A-Z guide to the drugs available, and concise notes on the key topics and situations faced on a daily basis. The A-Z section provides succinct information on each drug including uses, limitations, administration directions and adverse effects. The second section details practice guidelines such as insulin therapy, Parkinson's disease therapy when nil-by-mouth, and drug dosing in renal failure. This revised edition includes seventeen new drug monographs and covers several new topics, including blood glucose management. A colour chart showing drug compatibility for intravenous administration is included at the back of the book. Presented in a concise, compact format, this book is an invaluable resource for doctors, nurses, pharmacists and other healthcare professionals caring for critically ill patients.

Analysis of blood gas can be a daunting task. However, it is still one of the most useful laboratory tests in managing respiratory and metabolic disorders. Busy medical students have struggled ineffectively with Hasselbach's modification of the Henderson equation, been torn between the Copenhagen and the Boston schools of thought; and lately, been confronted with the radically different strong-ion approach. In modern medical practice, the health provider's time is precious: it is crucial to retain focus on those aspects of clinical medicine that are of key importance. Adoption of an algorithm-based approach in the study of topics that are hard to understand (particularly those that are rooted in clinical physiology) can be extremely advantageous. Handbook of Blood Gas/Acid-Base Interpretation, 2nd edition, is organized in a logical sequence of flow charts that introduce concepts and gradually build upon them. This approach facilitates understanding and retention of the subject matter. Medical students, residents, nurses, and practitioners of respiratory and intensive care will find it possible to quickly grasp the principles underlying respiratory and acid-base physiology, and apply them effectively in clinical decision making.

Comprehensive Guide to Education in Anesthesia is the first single-source volume on the current practice of teaching and learning in this specialty which has long been at the forefront of innovation in medical education. It is edited by one of the great anesthesiology educators in the United States and brings together contributions from leading educators from across the US covering all aspects of anesthesiology education, from medical school and post-graduate training to board certification and continuing medical education.

Topics include best educational practices, closed claim analysis, giving feedback to superiors, residency and fellowship training and requirements, maintenance of certification, the role of simulation, interacting with other specialties, community and global outreach, and more. The book conveys the unique nature of the specialty and is aimed at medical students contemplating a career in anesthesiology, residents and fellows, educators, and administrators.

Brain Injury is the second volume in the book series, Molecular and Cellular Biology of Critical Care Medicine. In this volume, a group of internationally regarded experts in important areas of neuroscience and neurointensive care research address the molecular and cellular basis of acute brain injury. This text covers acute brain injury within a context relevant to the care of patients with critical neurologic injuries such as cardiac arrest, trauma and stroke. It includes recent data pertaining to established pathways such as neurotransmission, exitotoxicity, ionic-mechanisms, oxidative stress, inflammation, and cerebral vascular injury. In addition, rapidly developing areas such as cell signaling, adenosine pharmacology, apoptosis, mitochondrial dysfunction, neurocytoskeletal changes, and the role of trophic factors are reviewed from the level of in vitro modeling to human data. Other topics covered that are highly clinically relevant include the effect of genetic background and gender differences in outcome after brain injury, preconditioning, and the effects of currently used anesthetics and sedative agents in patients with brain injury.

This book provides a comprehensive overview of current standards of anesthesia and intensive care in neonates and children, with a view to promoting standardization in clinical practice.

The first part of the book, devoted to issues in intensive care, opens by considering scoring systems for the assessment of sick children. The diagnosis, prevention, and management of ventilator-associated pneumonia are then discussed, and the roles of high-frequency oscillatory ventilation and noninvasive respiratory support are reviewed. Further chapters address procedural sedation and analgesia in children, the progress toward open ICUs with liberal visiting policies, and advances in long-term home mechanical ventilation.

In the second part of the book, a range of important topics in anesthesia and perioperative medicine are discussed. After a review of safety issues, current trends in pediatric regional and locoregional anesthesia are described and a synopsis is provided on current knowledge regarding the use of central blocks in infants and children. Subsequent chapters are devoted to awareness monitoring, single-lung ventilation techniques, anesthesia in the context of severe prematurity, and emergence delirium.

"Pediatric Anesthesia, Intensive Care and Pain: Standardization in Clinical Practice" will be an extremely useful source of information for both novices and more experienced practitioners in the field."

Thousands of articles and many books have been published on the acquired immunodeficiency syndrome (AIDS). There are, however, no studies or case reports and only several articles published on the anesthetic considerations for a person with AIDS or in pain with AIDS. There is no literature on the pain management of AIDS patients. Writing on this subject must be considered trailblazing. The reason anesthesiologists should know about AIDS has rapidly extended from concern over transmission of infection to anesthetic and analgesic considerations. The anesthesiologist may also be part of a pain management team on either an acute or a chronic pain service. The requirement may be to treat an HIV -positive or AIDS patient acutely postoperatively or in consult to a psychiatric, medical, or surgical service. In a pain clinic setting, the anesthesiologist may be concerned with diagnosis, treatment, or referral for other multidisciplinary consultation. The earlier question of central nervous system involvement in AIDS is now moot, rapidly replaced with the knowledge that the eNS, if not primarily infected, is so shortly thereafter. Protected by the blood-brain barrier, the eNS becomes both a sanctuary and reservoir for HIV. Because neurologic complications of HIV are common, and since knowledge of the nervous system is essential for anesthetic and pain management, it is important to review HIV infection of the nervous system.

The administration of intravenous fluids is one of the most common and important therapeutic practices in the treatment of surgical, medical and critically ill patients. The international literature accordingly contains a vast number of works on fluid management, yet there is still confusion as to the best options in the various situations encountered in clinical practice. The purpose of this volume is to help the decision-making process by comparing different solution properties describing their indications, mechanisms of action and side-effects according to physiologic body water distribution, electrolytic and acid-base balance, and to clarify which products available on the market represent the best choice in different circumstances. The book opens by discussing in detail the concepts central to a sound understanding of abnormalities in fluid and electrolyte homeostasis and the effect of intravenous fluid administration. In the second part of the monograph, these concepts are used to explain the advantages and disadvantages of solutions available on the market in different clinical settings. Body Fluid Management: From Physiology to Therapy will serve as an invaluable decision-making guide, including for those who are not experts in the subject.

At the turn of the century it is appropriate to take stock of this relatively young but rapidly developing subject. For the first time, this book brings together information on the status of obstetric regional analgesia in many parts of the globe, and on the intriguing variability of maternal attitudes towards it. Advances in the field over the last decade in new applications, new drugs and techniques and new research tools are also reviewed. Controversial topics such as the effects of regional analgesia on the progress of and outcome of labour, the indications, contraindications and complications, and the place of regional anaesthesia for operative delivery are discussed by numerous experts in the field. The problem of consent and medicolegal aspects are also addressed. Regional Analgesia in Obstetrics should be read by all those involved in the medical care of women in childbirth. Professor Felicity Reynolds is Emeritus Professor of Obstetric Anaesthesia, St Thomas' Hospital, London, UK.

Practice Single Best Answer Questions for the Final FRCA: A Revision Guide covers the complete syllabus of this new-style exam. The book includes 10 papers, each of which consists of 30 questions on clinical anaesthesia, intensive care medicine and pain management. Each practice paper matches the style, number and level of questions that candidates will face in their FRCA exam. Written by a group of anaesthetists experienced in teaching clinical anaesthesia and preparing trainees for their exams, every question is supplemented with a thorough explanation, incorporating the latest research and guidelines, and further reading suggestions. The book also includes guidance on how to go about answering single best answer questions. Pitched at just the right level for the exam, Practice Single Best Answer Questions for the Final FRCA: A Revision Guide is an essential resource for all Final FRCA candidates.

This treatise commemorates the 32nd anniversary of the first successful allogenic kidney transplant in a human being and the beginning of a con tinuing challenge for well over a generation of anesthesiologists. If compari sons can be permitted, this epoch-making event can be ranked with the first pulmonary lobectomy and subsequently the initial ligation of a patent ductus arteriosus in the late 1930s when thoracic and cardiac surgery began. Was it merely a coincidence that brought these events to the fore so close upon one another after many years of ideation and frustration? Not so, according to Lewis Thomas, for this was the time of medicine's second revolution-its transformation from an empirical art into a powerfully effective science. The remote Galenic conception of disease with its emphasis on disturbed body humors was about to be supplanted by effective therapeutics, as signified by the introduction of the sulfonamides and antibiotics for the specific treatment of infection. Anesthesiology had been dormant up to that era, still relying upon a few agents, more or less utilized from the beginning, and purveyed by a handful of specialists who had not yet begun to ask the scientific questions necessary for their maturation into a bona fide discipline. However, anesthesiology was in evitably caught in the ferment, for as Peter Caws observed, "It serves to re mind us that the development of science is a step-wise process: nobody starts from scratch and nobody gets very far ahead of the rest."

Theodore H. Stanley, M.D. W. Clayton Petty, M.D. Anesthesiology 1986 contains the Refresher Course manuscripts of the presentations of the 31st Annual Postgraduate Course in Anesthesiology which took place at the Westin Hotel Utah Convention Center in Salt Lake City, Utah, February 14-18, 1986. The chapters reflect recent and future developments in anesthetic techniques, monitoring instruments and devices, and anesthetic drugs. The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehi cl e to bri ng many of the 1 atest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesi a expressed at the conference. Thi s book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarlze the most salient points. This textbook is the fourth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. TABLE OF CONTENTS PHARMACOLOGY The New Neuromusucular Blocking Agents D. Ryan Cook, M.D.

Brain injury is one of the most unacceptable complications sustained during heart surgery. This book presents the current results and thinking of a number of leading clinical investigators in this area. Nearly all have been active in serious studies designed to define various aspects of brain physiology, patho physiology, or protection during cardiac operations performed with cardio pulmonary bypass. We were particularly interested in obtaining contributions from younger investigators. Brain injury is a problem which has long troubled those involved with perioperative care of the cardiac surgical patient. The first chapter by Dr. Torkel Aberg presents a summary of his extensive investigations into this problem. It is intended both to present the perspective of a surgeon interested in this problem, and to serve as an introduction to the overall issue of avoiding brain injury during heart surgery. The next three chapters discuss the problem of perfusion pressure, outcome, and brain blood flow. Dr. Sarnquist's contribution stems from his extensive experience with low flow bypass as practiced at Stanford University and the results of the studies he performed in collaboration with Dr. Fish. Drs. Govier and Reves discuss in some detail the general effects of anesthetic agents upon brain metabolic needs as well as their important data demonstrating preserva tion of brain blood flow autoregulation during cardiopulmonary bypass (CPB) as practiced at the University of Alabama. Finally Dr."

The diagnosis of cancer inspires fear, in part because of the high mortality rate associated with most malignancies, and in part because of the perception that cancer is a painful disease. Recently compiled statistics tend to support patients' fears. Pain is a major symptom in 70% of patients with advanced cancer [1]. Half of all patients undergoing anticancer therapy experience pain [2]. It has been estimated by members of the World Health Organization that 3. 5 million people worldwide suffer from cancer pain. One study of the severity of cancer pain estimates that pain is moderate to severe in 50% of cancer pain patients, very severe or excruciating in 30% [3]. An analysis of several reports of patients in developed countries estimates that 50-80% of patients had inadequate relief [2]. In underdeveloped countries, adequacy of treatment may be far lower because of lack of availability of medical facilities and legal constraints on the use of potent narcotics. The picture need not be this bleak. The reality is that, for most patients, cancer pain is relatively easy to control with simple, inexpensive measures. Several studies have indicated that cancer pain can be well controlled with oral morphine in over 90% of patients [4,5]. Long-acting orally effective opiate preparations such as time release morphine, methadone, and levorphanol allow patients to sleep comfortably through the night. When the oral route is impossible, narcotics can be administered rectally or by intravenous or subcutaneous infusion.

One of the most exciting developments in medicine in this century has been the discovery of opioid receptors and their pharmacology. The breadth of know- edge derived from such discovery has truly changed the practice of medicine today. The acceptance by the clinicians of the research data obtained by the basic scientist on spinal opioids is truly amazing. The clinical sequelae of the discovery of opioid receptors has been the development of the technique of intraspinal administration of opioids. In the last decade much has been written about indications, effects, and side effects of intraspinal opioids. The technique has become commonplace for cancer and postoperative pain. However, no standards of care and management of patients with spinally administered opioids have been developed. We need these standards to be developed and universally followed. The monograph was conceived to update clinicians on the applied pharma cology of spinal opioids. We were fortunate to have Drs. N. Rawal and D. Coombs agree to edit this monograph. They have been able to assemble world-renowned experts as contributing authors. It is our hope that the con tents of this book will be stimulating, informative, and useful to the reader. PREFACE Much has been written about the subject of spinal opioid analgesia, includ ing several notable reviews. We were stimulated to assemble this particular volume in this important series on pain management initiated by Dr. Raj for a number of reasons."

On 16 October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic effect of diethyl ether in a public demonstration in the "ether dome" of the Bulfinch Building of the Massachusetts General Hospital in Boston. The patient, Gilbert Abbott, suffered no pain, and the surgeon, Dr. John C. Warren, was able to complete a suture ligature of a vas cular tumor of the jaw without the hurry that until then was so necessary. The operation proved a failure, since the tumor recurred; but the demonstration of ether's anesthetic effect was a great success. Operative pain was conquered, and surgery could advance from a crude and unscientific practice where speed was paramount, and the major body cavities could not be entered, into the unique blend of science and art that it is now. "Gentlemen, this is no hum bug," supposedly muttered Warren, perhaps the last noncontroversial assess ment of anesthesiology to be made by a surgeon. The screams of resisting patients in pain were stilled, and quiet entered the operating room for the first time. But the new science of pain relief was quickly wrapped in controversy. An argument immediately arose as to who could legitimately claim primacy for the discovery. Morton's attempt to hide the true nature of his anesthetic agent, coupled with an effort to patent the discovery, clouded his reputation and stimulated other claimants to push themselves forward."

Ronald Brisman, M.D. This book will discuss three areas where the The multiplicity of procedures with varying neurosurgeon may provide an important degrees of risks and benefits sometimes re contribution to the relief of intractable pain: quires a sequential approach, but always an trigeminal and other facial neuralgias, chronic individual one, matching an appropriate treat noncancer pain, and cancer pain. By one ment plan or procedure for a particular patient intervention, the neurosurgeon often may pro at a specific time in his or her illness. vide long-lasting pain relief. New techniques, The neurosurgical chapters in this book which have developed since the 1970s and represent my experience with several hundred continue to evolve, dominate the neurosur patients during a 12-year period from 1975 gical armamentarium because they are not only through 1987. I have relied heavily on the effective, but safe. These include percutaneous works of others, which have been quoted from radio frequency electrocoagulation for trigem the neurosurgical literature, but this book is inal neuralgia, spinal stimulation for chronic not meant to be encyclopedic. noncancer pain, and intraspinal morphine in At least as important as knowing when to fusion for cancer pain. operate is knowing when not to do so, and this Sometimes a procedure relieves pain but the is particularly true of the treatment of pain. pain recurs; it may be necessary to repeat the Most patients with pain do not require neuro procedure, which in the case of radiofrequency surgical intervention."