Foundations of Anesthesia: Basic Sciences for Clinical Practice, Second Edition

917 Pages·2005·0.58 MB·English

by  Hugh C. Hemmings BS MD PhD

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An imprint of Elsevier Limited
First edition 2000
©2006, Elsevier Limited. All rights reserved.
The right of Hugh C Hemmings Jr and Philip M Hopkins to be identified as authors of this
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Act 1988.
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Foreword
Drs Hemmings and Hopkins have assembled seventy three effect quantitative recovery to the volatility of ether rather than
chapters written by well-recognized authorities from both sides to the possibility of its metabolism by the body. The importance
of the Atlantic. Though the sea of knowledge is never full, they of water solubility on the speed of anesthetic action was soon
have completed an extraordinary and successful labor in produc- elucidated by Seymour Kety. So opened a new era in the
ing a significant tidal surge that will be regarded as the high water scientific understanding of what had previously been largely a
mark to be noted by generations of anesthesiologists yet unborn. clinical art.
Essential to the understanding of this text is the editors’ When Dr Hemmings honored me by asking me to write this
conviction that the successful practice of the art of anesthesia piece, I asked myself not only what to say, but also who might
requires a sound understanding of the underlying scientific prin- have said it very well in the past. The answer rose immediately
ciples’. This quotation from the invitational letter to each contrib- to mind: more than 30 years ago, John Severinghaus wrote the
utor summarizes the philosophy which underlines the entire foreword for the first edition of John Nunn’s classic book on
work. The seventy three chapters are grouped under eight major respiratory physiology- a book which, like this one, combined
headings (General Principles, Neurosciences, Cardiovascular and correlated basic science with clinical practice. He chose the
system, Respiratory system, Pathological sciences, Renal system, title ‘ A Flame for Hypos’, and illustrated it with a photograph
Gastrointestinal system and metabolism, and Adaptive phys- of a lighted candle before the statue of the god of sleep. No one
iology). Within each section of the book, there are chapters that has ever said it so well. Never have I read a more beautiful
cover the essential basic science information necessary for the foreword and append a part of it here with the permission of Dr
understanding of the section’s utility in clinical practice. Severinghaus (who himself has contributed a chapter to this
The amount of basic science information has grown tremen- book). So from the work of many minds and hands this book
dously during my half century in medicine. When I started my goes forth, that we too, by understanding the process, may
training, I was initially taught clinical anesthesia by very skillful better the art.
nurse anesthetists who were far more concerned with the art of Alan Van Poznak, M.D.
anesthesia. Scientific information was scarce. John Snow’s clas- New York City
sic monograph on the inhalation of the vapor of ether was one 1999
of the first publications to provide a scientific basic for the
practice of our art. In 1924, Howard Haggard published five The world will little note nor long remember what I say here, but
classic papers in the Journal of Biological Chemistry on the it can never forget what we did here.
uptake and elimination of diethyl ether, attributing his failure to Abraham Lincoln, Gettysburg November 19, 1863
The lighted candle respires and we call it flame. The body
respires and we call it life. Neither flame nor life is substance,
but process. The flame is as different from the wick and wax as
life from the body, as gravitation from the falling apple, or love
from a hormone. Newton taught science to have faith in processes
as well as substances–to compute, predict and depend upon an
irrational attraction. Caught up in enlightenment, man began to
regard himself as a part of nature, a subject for investigation. The
web of self-knowledge, woven so slowly between process and
substance, still weaves physiology, the process, and anatomy, the
substances, into the whole cloth of clinical medicine. Within this
multihued fabric, the warp fibres of process shine most clearly
in the newest patterns, among which must be numbered
anesthesiology.
And what of the god of sleep, patron of anesthesia? The
centuries themselves number more than 21 since Hypnos
wrapped his cloak of sleep over Hellas. Now before Hypos, the
Excerpted from the foreword to the first edition (1969) of
artisan, is set the respiring flame–that he may, by knowing the
Applied Respiratory Physiologyby John F. Nunn, reprinted with
process, better the art.
the permission of Butterworth-Heinemann
John W Severinghaus
San Francisco
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Preface
The successful practice of the art of anesthesia, critical care and review of specialized research areas for the scientist. Rather, the
pain medicine demands a sound understanding of underlying fundamental information necessary to understand ‘why’ and
scientific concepts and familiarity with the evolving vocabulary ‘how’ is stressed, and basic concepts are related to relevant
of medical science. This is recognized in the postgraduate exami- anesthesia situations. The style stresses a conceptual approach to
nations in anesthesia in North America, Europe and Australasia, learning, using factual information to illustrate the concepts.
for which a thorough understanding of the relevant basic Chapters are self-contained with minimal repetition, and include
sciences is required. Furthermore, many trainees in anesthesia a short list of Key References and suggestions for Further
come to view learning the basic sciences to the required depth Reading to stimulate further exploration of interesting topics.
as a necessary chore. This is disappointing to those of us who This style and approach is modeled after the ground-breaking
find the scientific basis for our clinical practice to be a constant text Scientific Foundations of Anaesthesia,edited by Cyril Scurr
source of interest, fascination and, indeed, sometimes excite- and Stanley Feldman, updated to cover the revolutionary devel-
ment. Part of the problem is that basic science texts directed opments in modern molecular biology and physiology. Recog-
towards anesthetists tend to be fact, rather than concept- nizing that graphics are the most expressive way of conveying
oriented, and therefore difficult to read and to learn from. concepts, full-color illustrations facilitate use of the book as a
Foundations of Anesthesia: Basic Sciences for Clinical Practice learning aid and make it enjoyable to read.
second edition, provides comprehensive coverage in a single text The second edition of Foundations of Anesthesia: Basic
of the principles and clinical applications of the four major areas Sciences for Clinical Practice includes a number of notable
of basic science that are relevant to anesthesia practice: molec- developments. Text boxes are included to highlight important
ular and cell biology, physiology, pharmacology, and physics and points with particular relevance to clinical implications for the
measurement. The approach is integrated and systems oriented, practice of anesthesia. Important key words from the American
avoiding the artificial boundaries between the basic sciences. in-training examination are highlighted in the index. A number
Recognizing that no single author possesses the breadth and of new chapters have been incorporated: Adverse Drug
depth of understanding of all relevant subjects, each chapter is Reactions, Sensory Systems, Physiology of Pain, General
authored by an expert in that area. These authorities represent Anesthetics: Mechanisms of Action, Consciousness and
many of the finest institutions of North America, the United Cognition, Sleep and Anesthesia, Ischemic Brain Injury, Blood
Kingdom and Europe to take advantage of the globalization of Constituents and Transfusion and Hemostasis and Coagulation.
medicine facilitated by electronic communication. This allows An accompanying CD includes the figures and tables to facilitate
an international presentation of current anesthesia science pre- teaching from the text and a searchable index. These improve-
sented by relevant experts at the cutting edge of anesthesia ments significantly enhance the use of Foundations of Anesthesia:
research and education. Basic Sciences for Clinical Practice as a tool for learning,
Each chapter stresses the scientific principles necessary to teaching and review of the fundamental concepts essential to
understand and manage various situations encountered in anes- anesthesiology, pain and critical care medicine.
thesia. Detailed explanations of techniques are avoided since
this information is available in many clinical subspecialty anes-
thesia texts. Nor is this book intended to provide a detailed Hugh C Hemmings Jr and Philip M Hopkins 2005
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