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."

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."

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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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.

A definitive, comprehensive text on the technological developments and clinical applications of this critical subject matter. Written for the entire heart surgery team, this volume covers the physiology of cardiopulmonary bypass, mechanics and components of the heart-lung machine, the conduct of cardiopulmonary bypass in cardiac surgery, non-cardiac applications of cardiopulmonary bypass, and mechanical assistance of the failing heart and lung. The authors also give special consideration to such areas as blood conservation in cardiac surgery, religions objections to blood transfusions, medical-legal aspects and cardiopulmonary bypass, as well as warm blood cardioplegia and normothermic cardiopulmonary bypass.

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."

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."

A panel of prominent clinician-scientists comprehensively reviews the latest developments in pediatric pain management, with special emphasis on the setting in which pain is detected and managed. The authors explore the cutting-edge of children's pain care in inpatient, outpatient, palliative care, school, and residential settings, and describe alternate approaches, including complementary and alternative medicine, pain management via the internet and information technology, and pain care in developing countries.

Neurocritical care as a subspecialty has grown rapidly over the last two decades and has reached a level of distinct maturity with the advent of newer monitoring, diagnostic and therapeutic modalities in a variety of brain and spinal cord injury paradigms. Handbook of Neurocritical Care, Second Edition remains true to the operative tenet that "time is brain," and rapid diagnosis and therapeutic interventions in these challenging patients cannot be overemphasized. The second edition of this important Handbook again serves as a quick, practical reference for those involved in the care of critically ill neurological and neurosurgical patients. The care provided to this subset of critically ill patients continues to be multidisciplinary and includes care rendered from colleagues in emergency medical services, emergency medicine, neurology, neurosurgery, anesthesiology, critical care, nursing and physician assistance. Fully updated, all of the chapters again consist of easy-to-read, bulleted points followed by a list of Key Points and important references allowing for rapid access to vital information critical for fast and timely decision making. The first section covers a myriad of important general principles while the second section addresses the major diagnostic categories of neurocritical care with several new topics; these include, for example, neuroleptic malignant syndrome and malignant hyperthermia, meningitis and encephalitis, and intraventricular hemorrhage. Readers will find the algorithms, tables, and illustrations throughout the book not only useful but truly invaluable in facilitating fast and accurate decision making. Accessible and comprehensive, Handbook of Neurocritical Care, Second Edition again fills a vital need by providing readers with a succinct and practical approach to the management of critically ill neurological and neurosurgical patients.

Monitoring in Anesthesia and Perioperative Care is a practical and comprehensive resource documenting the current art and science of perioperative patient monitoring, addressing the systems-based practice issues that drive the highly regulated health care industry of the early twenty-first century. Initial chapters cover the history, medicolegal implications, validity of measurement, and education issues relating to monitoring. The core of the book addresses the many monitoring modalities, with the majority of the chapters organized in a systematic fashion to describe technical concepts, parameters monitored, evidence of utility complications, credentialing and monitoring standards, and practice guidelines. Describing each device, technique, and principle of clinical monitoring in an accessible style, Monitoring in Anesthesia and Perioperative Care is full of invaluable advice from the leading experts in the field, making it an essential tool for every anesthesiologist.

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.

Essential Anesthesia is a concise, accessible introduction to anesthetic practice. Now in its second edition, it provides a thorough overview of the science and practice of anesthesia. Part I describes the evaluation of the patient, the different approaches to anesthesia, and the post-operative care of the patient in pain. Part II introduces the essentials of physiology and pharmacology and their role in understanding the principles of anesthesia. The final part presents a step-by-step description of 14 clinical cases. These clinical vignettes give a very real introduction to the practicalities of anesthesia and will give the non-anesthetist physician an idea of how to prepare a patient for a surgical procedure. All chapters have been expanded and updated and an entirely new chapter on safety in healthcare has been added. This is the perfect introductory text for medical students, junior doctors and all operating theatre and critical care staff.

The modern obstetric anaesthetist must not only provide safe and effective pain-relief in labour and anaesthesia for Caesarean section, but also understand the wider role of the anaesthetist in the management of the pregnant woman. Originally published in 2002, Textbook of Obstetric Anaesthesia is a comprehensive, fully illustrated account of all aspects of modern obstetric anaesthesia. It provides useful, practical, evidence-based information on all aspects of labour ward management. Written by a multidisciplinary team of expert contributors, it features comprehensive chapters covering everything from departmental audit to cutting-edge practice for neonatal resuscitation and administration of mobile epidurals. It will be useful for both the trainee and practising obstetric anaesthetist.

With the introduction of cardiac surgery more than five decades ago and the use of the heart-lung machine for open heart surgical procedures granting the surgeon unlimited time in which to operate inside the heart, a complex task has been given to the Perfusionist. With a pairing of a perfusionist and a surgeon for each chapter, this book is an essential collection of techniques and protocols to aid in decision making in the operating room.

Minimally invasive or laparoscopic surgery is becoming increasingly commonplace, as technology has enabled a minimally invasive approach to be offered as a feasible alternative to conventional open surgery for a number of important surgical procedures. This comprehensive, but concise and practically oriented introduction to the subject was first published in 2004 and will be of value to all anaesthetists with an interest in minimally invasive techniques. It begins by covering the key aspects of basic physiology, moves on to patient preparation and positioning, monitoring, the anaesthetic procedures themselves (including possible complications and contraindications and easy-to-follow 'how to' guides for a number of key procedures) and, finally, post-operative pain. Written by a leading expert in the field, from a well-known European centre of excellence, it is essential reading for anaesthetists and intensivists at all levels of expertise.

The increased complexity of spinal surgical procedures in recent years has required more sophisticated anesthetic management of patients undergoing these procedures. Spine surgery anesthesia is now recognized as a distinct sub-specialty, increasingly undertaken by general anesthesiologists as well as neuroanesthesiologists. Anesthesia for Spine Surgery describes the anesthetic management and surgical procedures at every vertebral level in both adult and pediatric patients. The most important related considerations are covered, including: * Postoperative pain management * One lung ventilation during anterior thoracic spine surgery * Intraoperative neuromonitoring * Fluid management Additional chapters review the radiological features of normal and abnormal spines, common complications of spine surgery and ASA closed claims relating to spine surgery anesthesia. Written by highly experienced neuroanesthesiologists and spine surgeons, Anesthesia for Spine Surgery is essential reading for trainee and practising anesthesiologists, neuroanesthesiologists and spine surgeons.

Bedside Procedures for the Intensivist delivers practical tips and clear, step-by-step instruction on the most common procedures in the ICU. The convenient and portable handbook focuses on ultrasound-guided techniques, including an introduction to ultrasound physics and principles, while individual chapters provide concise "how-to" text supplemented with numerous full-color figures and tables that summarize key content. Residents, fellows, and trainees in critical care will benefit from the detailing of indications and contraindications for performing core procedures, while more experienced intensivists will find the book a reliable source of review material. Key procedures described include: * Ultrasound-guided vascular access * Ultrasound-guided drainage * Focused echocardiography * Airway management * Dialysis and apheresis * Pericardiocentesis * Insertion of vena cava filters * Percutaneous dilational tracheostomy * Open tracheostomy * Transbronchial biopsy * Percutaneous endoscopic gastrostomy * Intracranial monitoring