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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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.

The single best answer format of questions is invaluable in assessing a trainee's clinical skills and problem-solving abilities. It allows the trainee to demonstrate application of their knowledge to clinical practice. This book comprises six sets of practice papers. Each set contains 30 single best answer questions which cover topics including clinical anaesthesia, pain and intensive care. The questions are based on the recent changes introduced to the written part of the final FRCA examination. The best possible answer to a given clinical scenario is substantiated by a detailed explanation drawn from recent review articles and textbooks in clinical anaesthesia. These questions will enable candidates to assess their clinical knowledge and skills in problem-solving, data interpretation and decision making. This book is essential study material for candidates sitting postgraduate examinations in anaesthesia and intensive care medicine. It is not only an essential guide for trainees but also an invaluable educational resource for all anaesthetists.

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.

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.

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.

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.

In recent years capnography has gained a foothold in the medical field and is fast becoming a standard of care in anaesthesiology and critical care medicine. In addition, newer applications have emerged which have expanded the utility of capnographs in a number of medical disciplines. This new edition of the definitive text on capnography reviews every aspect of this valuable diagnostic technique. An introductory section summarises the basic physiology of carbon dioxide generation and transport in the body. A technical section describes how the instruments work, and a comprehensive clinical section reviews the use of capnography to diagnose a wide range of clinical disorders. Edited by the world experts in the technique, and with over 40 specialist contributors, Capnography, second edition, is the most comprehensive review available on the application of capnography in health care.

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.

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

Ambulatory care can be a challenging setting in which to provide anesthesia - not all patients are suitable for rapid discharge post-operatively and opinions differ as to which types of surgery should be performed as day cases. This comprehensive guide delivers up-to-date, evidence-based advice on how to provide optimal anesthesia care for ambulatory surgery. Written by a leading clinical anesthesiologist, it provides clear guidance about how to handle particular patients in particular situations. The evidence and scientific knowledge for each issue are presented with reference to major studies and review papers, followed by practical advice based on the author's continuous clinical and scientific experience over 30 years. Topics include planning, equipping and staffing ambulatory units, pharmacology, basic concepts of ambulatory care, pre- and post-operative issues and current controversies. Clinical Ambulatory Anesthesia is essential reading for the clinical, postgraduate anesthesiologist as well as nurse anesthetists involved with ambulatory care.

The core clinical competencies in anesthesiology can be pretty blurry just how do they apply to real life? This book answers this question, incorporating the core clinical competencies into an engaging format that anesthesiologists like case studies. So, far from being a dry and dusty volume of forgotten lore, this book actually makes learning the competencies fun Written in the same engaging style as a number of other anesthesia books (specifically, the Board Stiff opus) by leading anesthesiologists from leading medical centers across the United States, this book will bring the core clinical competencies to life for residents, attendings, and medical students alike.

Simplify, simplify! Henry David Thoreau For writers of technical books, there can be no better piece of advice. Around the time of writing the first edition - about a decade ago - there were very few monographs on this s- ject: today, there are possibly no less than 20. Based on critical inputs, this edition stands thoroughly revamped. New chapters on ventilator waveforms, airway humidification, and aerosol therapy in the ICU now find a place. Novel software-based modes of ventilation have been included. Ventilator-associated pneumonia has been se- rated into a new chapter. Many new diagrams and algorithms have been added. As in the previous edition, considerable energy has been spent in presenting the material in a reader-friendly, conv- sational style. And as before, the book remains firmly rooted in physiology. My thanks are due to Madhu Reddy, Director of Universities Press - formerly a professional associate and now a friend, P. Sudhir, my tireless Pulmonary Function Lab technician who found the time to type the bits and pieces of this manuscript in between patients, A. Sobha for superbly organizing my time, Grant Weston and Cate Rogers at Springer, London, Balasaraswathi Jayakumar at Spi, India for her tremendous support, and to Dr. C. Eshwar Prasad, who, for his words of advice, I should have thanked years ago. vii viii Preface to the Second Edition Above all, I thank my wife and daughters, for understanding.

The world is experiencing an obesity epidemic. In both industrialized and emerging countries, the percentage of adults and children with obesity is increasing annually. It is no longer unusual to encounter a patient with extreme or morbid obesity in the operating room; these patients are routinely scheduled for every type of surgical procedure. Everyone involved in the peri-operative management of the surgical patient with morbid obesity - surgeons, anesthesiologists, internists, psychologists, nurses, nutritionists, respiratory therapists - must be aware of the special needs of these patients. Morbid Obesity: Peri-operative Management, 2nd edition considers the perioperative care of the morbidly obese patient, from preoperative preparation to intraoperative management and through to their postoperative course. Edited by leading experts in the management of the morbidly obese surgical patient, Morbid Obesity: Peri-operative Management, second edition, provides clear, practical clinical guidance on the management of the extremely obese surgical patient.

Drs. Eduardo D. Bruera and Russell K. Portenoy have completely revised and updated the widely respected Cancer Pain: Assessment and Management for the second edition of this unanimously praised book. This is a comprehensive, clinically oriented review of all aspects of the complex and multidimensional problem of cancer pain. The unique characteristics of cancer pain, including pathophysiology, clinical assessment, diagnosis, and pharmacological and nonpharmacological management are all discussed here in detail. Internationally recognized leaders in cancer pain research have contributed to many new chapters, including neuraxial analgesia, hospice and institution-based palliative care programs, bone pain, and cancer pain and palliative care in the developing world. Cancer Pain continues to be a scholarly but accessible text that is an essential resource for physicians, nurses, and medical students who treat suffering from cancer pain. Per the New England Journal of Medicine, This book should be in the library of every physician who comes into contact with patients with pain. It is truly superb.