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.

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."

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.

Hyperbaric oxygen application has now become a useful technique for both diagnostic and therapeutic purposes in CNS, cardiovascular and respiratory diseases, as well as in soft-tissue and orthopaedic pathologies and haematologic disorders. With a specific didactic approach, supported by numerous illustrations and tables, this volume aims to present all aspects of oxygen application under pressure not only to resolve some clinical problems, but also to improve recovery or to modify a negative illness evolution. Both scientists and practitioners will find this work a useful and updated reference book.

This book helps prepare anesthesiology residents for safe practice of pediatric anesthesia. It features 26 index cases, which are classic clinical scenarios - all covering a spectrum of pediatric anesthesia, neuro-anesthesia, cardiac anesthesia, regional anesthesia, and anesthesia and critical care medicine. Chapters are divided into case-based formats with each chapter containing a scenario layout, useful equipment, major teaching points for an after simulation debrief, and a learner evaluation form. This tiered education method will assist learners in working though essential team building skills, increasing their knowledge base and finally having concrete items in which to further their professional skills. Each chapter starts with a learning objective and presents the simulation case before launching into the case progression, detailing how the simulated patient's vital signs, physical exam findings, and clinical picture change over the course of the simulation. They are concluded with a master checklist of items the learner should accomplish during the course of the simulation along with a section summary and important teaching points. Pediatric and Adult Anesthesiology Simulation Education is designed to be used by both academic programs and private practice groups. It is beneficial to anesthesiology residents who are currently in training as well as those who have recently graduated and are preparing for board exams.

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."

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.

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."

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.

This book highlights remarkable new endoscopic, laparoscopic, and thoracoscopic approaches to the removal of surgical lesions for different pathologic conditions under general endotracheal anesthesia in infants and children. It details how newer techniques in airway management, monitoring, regional nerve blocks for these innovative minimally invasive approaches have resulted in a decrease in intraoperative and postoperative morbidity and early recovery process after pediatric anesthesia. This unique book contains features that provide the audience with several clinical scenarios where exceptional surgical outcomes are achieved with optimum pre-op preparation via collaborative team efforts. To date there is no other textbook emphasizing the anesthetic and surgical management during the most innovative advances in endoscopic surgery in children. Per oral endoscopic myotomy (POEM) for the definitive treatment of achalasia in children is probably the most advanced endoscopic surgery done successfully in children. POEM is the best example of endoscopic surgery performed via natural orifices known as the Natural orifice transluminal endoscopic surgery (NOTES). Another new laparoscopic surgical intervention -Median Arcuate Ligament surgical release for Median Arcuate Ligament Syndrome (MALS) for patients with Postural Orthostatic Tachycardia Syndrome (POTS) is described with established perioperative protocols emphasizing the need for early admission, intravenous hydration, and premedication. Novel approaches in the anesthetic management in children with short bowel syndrome for bowel lengthening techniques like the serial transverse enteroplasty (STEP) and in teenagers for laparoscopic bariatric surgery with adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) for morbid obesity are new areas that would enlighten the readers. Anesthetic Management in Pediatric General Surgery is an invaluable resource for pediatric anesthesiologists, surgeons, and their trainees specializing in the care of pediatric patients.

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."

Theodore H. Stanley, M. D. What's New in, Anesthesiology in 1988 contains the Refresher Course manuscripts of the presentations of the 33rd Annual Postgraduate Course in Anesthesiology which took place at the Marriott Hotel Convention Center in Salt Lake City, Utah, February 19-23, 1988. The chapters reflect new data, ideas and concepts within the general framework of most recent developments in "evaluation and monitoring cardiac function before, during and after surgery," "new anesthetics and their actions on the heart and peripheral vasculature, and other organ systems," "metabolism and elimination of anesthetics and anesthetic adjuvants," and "recent developments in the anesthetic management of patients with congenital heart disease, renal and pulmonary dysfunction, and diabetes insipidus. " In addition, there are chapters on new developments in "obstetrics," "regional anesthesia," and "anesthetic management of the newborn. " The purposes of the textbook are to 1) act as a reference for the anesthesio logists attending the meeting, and,2) serve as a vehicle to bring many of the latest 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 anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the sixth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City."

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."

The pain center/clinic is in the stage of transition. It has come a long way since chronic pain was a nonexistent entity and patients with difficult pain problems did not receive well-deserved attention or were lost in the busy practices of vari ous specialty clinics. Thirty-five years ahead of the rest of us, John]. Bonica was the first physician who had a clear vision of a pain center's potential. Twenty years later, in response to loud public demands for relief of chronic pain, this idea was put into practice by a number of others on a somewhat larger scale. A team of specialists from various disciplines, trained in the management of chronic pain, now offer approaches ranging from simple outpatient care to inpatient hospital ization for comprehensive care including drug detoxification, behavior modi fication, and total rehabilitation of these patients. Hospitals have entered this arena with renewed enthusiasm. The pain center/clinic is now an established, ac cepted, and expanding method of providing care for chronic pain patients. The chapters in this book are based on examples of multidisciplinary projects that deal comprehensively with management of chronic pain. Aimed primarily at the pain center/clinic in the university hospital setting, this book ranges from his torical perspectives to current pain centers with their less orthodox methods of re lieving chronic pain to the future of algology as a specialty."

It is a pleasure to have the privilege of writing the foreword for a book edited by Dr. Francis F. Foldes. Dr. Foldes has collected in one convenient place a discussion and description of enzyme systems of use to the anesthesiologist and to those other individuals, such as undergraduate and graduate students in related basic sciences, who will profit by and can make use of this body of information. The practicing anesthesiologist and those who work in related fields have become increasingly aware of the need to understand enzyme activities which influence the uptake, distribution, and excretion of those substances that are used in the anesthetic management of surgical patients. A variety of such is obvious when one considers that such diverse substances as activities and muscle re analgesic drugs, tranquilizers, hypnotics, anesthetic agents, laxants are strongly affected by these systems and have an influence over the basic understanding of how these drugs operate and act in the body, as well as providing a safety measure so necessary to the proper conduct of clinical anesthesia. The editor and his colleagues have rendered us a great service in collecting information that deals with the basic activity of enzymes including their structure, their kinetics, and to the degree that knowledge permits, mechanism of actions."

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."

All anesthesiologists eventually face the fear of a "near miss," when a patient's life has been put at risk. Learning from the experience is crucial to professionalism and the ongoing development of expertise. Drawing on forty-plus years of practice in major metropolitan hospitals in the United States, Norway, and South Africa, John Brock-Utne, MD presents 80 carefully selected cases that provide the basis for lessons and tips to prevent potential disaster. The cases emphasize problem-centered learning and span a broad range of topics-from an outbreak of operating room infection (could it be the anesthesia equipment?), complications of fiberoptic intubations, and problems with epidural drug pumps, to performing an urgent tracheostomy for the first time, working with an aggressive surgeon, and what to do when a patient falls off the operating table during surgery.80 true-story clinical "near misses" never before published, ideal for problem-centered learning, recommendations, references, and discussions accompany most cases, rich basis for teaching discussions both in or out of the operating room, settings include sophisticated as well as rudimentary anesthetic environments, complements the author's other case book, "Clinical Anesthesia: Near Misses and Lessons Learned" (Springer, 2008).

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Total intravenous anaesthesia (TIVA) is an innovative alternative to traditional inhalational anaesthesia. Often incorrectly perceived as overly complex, TIVA has numerous advantages over inhalational drugs, such as a lower risk of nausea, less pain and better cognitive recovery. Taking on TIVA is a practical, easy to read and engaging guide to TIVA. It demystifies this important technique and will empower the novice but also support more experienced practitioners. It is a clear step-by-step approach to treating everything from routine elective to paediatric, geriatric, obese and pregnant patients. Pharmacokinetic models, dosage calculations, and the use of TIVA in emergency medicine are also elucidated. Written by international experts in the field with many years of experience both conducting and teaching TIVA, this handbook is an essential resource for experienced and novice anaesthetists alike who want to improve their understanding and confidence with the technique.