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.

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."

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 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."

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.

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.

The complex healthcare needs of pregnant patients, where care is tailored to not one but two patients, pose specific challenges to anesthesiologists. This book provides concise, case-based discussion on the clinical scenarios and challenges faced in the provision of anesthesia and pain relief for expectant mothers. In the style of problem-based learning, each case is presented as a short scenario, followed by discussion of the causes, risk factors, management and controversies involved. The textbook features a wide range of cases, from common clinical scenarios that are experienced in day-to-day practice to the rare but significant pathologies less familiar to most clinicians. With a global base of contributors, the book is relevant to practice across the world. The concise format supports both trainee anesthesiologists in their initial experiences of obstetrics and exam preparation, and experienced clinicians in need of a reliable, quick-reference text.

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.

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.

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."

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.

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."

Dr. G. M. Woerlee is well known in my department both as a clinician and teacher. Years ofexperience have taught him that the problems discussed here have as yet not been treated in this way in any single work. In my opinion there is a real need for such abook, not only for resident and specialist anaesthetists, but also among surgeons and internists, specialist and trainee. Management of a patient in the operating room is a matter of teamwork, and knowledge of the problems encountered is the basis of any mutual understanding The information which has been assembled and clearly presented in this book should prove to be of great assistance in guiding our patients though an important phase of their lives. Professor Dr. Joh. Spierdijk, Department of Anaesthesia, University Hospital of Leyden, The Netherlands. vii PREFACE Much of the literature being published in the field of anesthesiology today concerns a narrow, in-depth scrutiny of a specific area or anesthetic technique that does not provide the novice with an overview ofthe perioperativeperiod and the commoneveryday problems faced by the anesthetist. Dr G. M. Woerlee of the University of Leiden with his book, "Com mon Perioperative Problems and the Anaesthetist," has filled a void in the current anes thetic literature. Dr Woerlee reviews in a straightforward, no-frills manner problems routinely encountered during the perioperative period. Other anesthesia textbooks do not cover the material in quite the same logical, step-by-step fashion."

Prepare for success on in-training, certifying, and recertification exams! Anesthesia Review: Blasting the Boards is a high-yield study guide designed to maximize your study time and help you ace the written boards. A full-color, outline format features bulleted lists and numerous diagrams to facilitate quick memorization and information retrieval. It's an ideal review resource for residents, CRNAs preparing for certification, and practitioners who need to recertify.Key Features 22 succinct chapters cover the five content areas tested - basic sciences, clinical sciences, organ-based basic and clinical sciences, clinical subspecialties, and special problems or issues in anesthesiology. Content is presented in high-yield, digestible chunks using a full-color, outline format . Anesthesiology keywords are highlighted for quick memorization and retrieval. Recently identified knowledge gaps are addressed in each chapter. Every chapter concludes with five or more multiple choice questions and explanations . Now with the print edition, enjoy the bundled interactive eBook edition, which can be downloaded to your tablet and smartphone or accessed online and includes features like: Complete content with enhanced navigation Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web Cross-linked pages, references, and more for easy navigation Highlighting tool for easier reference of key content throughout the text Ability to take and share notes with friends and colleagues Quick reference tabbing to save your favorite content for future use

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.

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.

Anesthesia Crash Course is uniquely positioned to address the needs of new trainees in anesthesia. This book is written in a conversational tone, avoiding unnecessary jargon and distilling the key concepts of anesthesia into easy-to-remember tidbits - an approach in increasing demand by medical students and junior physicians.
The audience for this book is chiefly new anesthesia residents, interns, medical students who rotate through anesthesia services, and nurse anesthetists. By demystifying the world of anesthesia, it provides a welcome resource to medical students and RNs who are considering additional training in this popular but poorly understood specialty. Surgical residents who feel they're not up to speed with what's happening on the other side of the "ether screen" would certainly also benefit from reading Anesthesia Crash Course.
New anesthesia trainees face an extremely daunting learning curve. As they progress through training, they will read longer and more detailed treatises on every aspect of modern anesthesia. It is not realistic to imagine that someone might finish such a book in the first week of his or her training! Anesthesia Crash Course wil serve as a bridge between a trainee's pre-anesthesia experience and more formal training. It can be read in the last month of internship, or in evenings while completing the first few weeks of anesthesia training. It can also serve as a medical student's accompaniment for a two-week anesthesia elective.

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.

Now in its fourth edition, Analgesia, Anaesthesia and Pregnancy is a concise guide to obstetric anaesthesia and analgesia. This essential text reviews every topic and clinical challenge faced during delivery and focuses on pre-empting problems and maximising quality of care. It also covers acute emergencies related to pregnancy. This new edition features eleven new chapters that cover the significant updates in the field over the last few years. Presented in a clearly structured format, this practical guide will be an invaluable source of key information for any anaesthetist encountering obstetric patients, whether they are a practised consultant or still in training. Obstetricians, neonatologists, midwives, nurses, and anaesthetic assistants in obstetric analgesia and anaesthesia who wish to extend or update their knowledge will also benefit from reading this book.

The accuracy with which clinicians can locate nerves and blood vessels has increased greatly with the development of portable handheld ultrasound scanners, and no specialty has felt the benefit more than anesthesia. This practical atlas of ultrasound anatomy addresses the two main challenges for anyone learning ultrasound-guided techniques: 1. Where do I place the probe? 2. What exactly am I looking at? Each nerve block or vascular access site is illustrated with: * An anatomical line illustration * A clinical photograph showing the correct ultrasound probe position * The ultrasound scan * A line illustration of the scan labelled to indicate the salient anatomical features All relevant anatomic regions are included: upper limb, lower limb, neck, thorax and abdomen. Concise notes for each entry indicate scan landmarks and give useful tips and advice on potential complications. Sonoanatomy for Anesthetists is an essential resource for anesthetists, intensivists and chronic pain specialists.