Fundamentals of Anaesthesia

931 Pages·2009·9.7 MB·English

by  Tim Smith

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Fundamentals of Anaesthesia
Third Edition
i
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ii
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Fundamentals
of Anaesthesia
Third Edition
Edited by
Tim Smith
Colin Pinnock
Ted Lin
Associate Editor
Robert Jones
iii
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cambridgeuniversitypress
Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore,Sa˜oPaulo,Delhi
CambridgeUniversityPress
TheEdinburghBuilding,CambridgeCB28RU,UK
PublishedintheUnitedStatesofAmericabyCambridgeUniversityPress,NewYork
www.cambridge.org
Informationonthistitle:www.cambridge.org/9780521692496
(cid:1)c CambridgeUniversityPress2008
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithout
thewrittenpermissionofCambridgeUniversityPress.
FirstpublishedbyGreenwichMedicalMedia1999
Secondeditionpublished2003
ThirdeditionpublishedbyCambridgeUniversityPress2008
PrintedintheUnitedKingdomattheUniversityPress,Cambridge
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary
LibraryofCongressCataloguinginPublicationdata
ISBN978-0-521-69249-6hardback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceor
accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto
inthispublicationanddoesnotguaranteethatanycontentonsuch
websitesis,orwillremain,accurateorappropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateand
up-to-dateinformationwhichisinaccordwithacceptedstandardsandpracticeat
thetimeofpublication.Althoughcasehistoriesaredrawnfromactualcases,every
efforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.
Nevertheless,theauthors,editorsandpublisherscanmakenowarrantiesthatthe
informationcontainedhereinistotallyfreefromerror,notleastbecauseclinical
standardsareconstantlychangingthroughresearchandregulation.Theauthors,
editorsandpublishersthereforedisclaimallliabilityfordirectorconsequential
damagesresultingfromtheuseofmaterialcontainedinthisbook.Readers
arestronglyadvisedtopaycarefulattentiontoinformationprovidedbythe
manufacturerofanydrugsorequipmentthattheyplantouse.
iv
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to Beccy, Jane, Linda and Marlene
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vi
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Contents
Listofcontributors pageviii 14 Physiologyofpregnancy 492
Prefacetothefirstedition x 15 Fetalandnewbornphysiology 507
Prefacetothesecondedition xi
Prefacetothethirdedition xii Section3: Pharmacology
Howtousethisbook xiii 1 Physicalchemistry 512
Acknowledgements xiv 2 Pharmacodynamics 523
Listofabbreviations xvi 3 Pharmacokinetics 533
4 Mechanismsofdrugaction 548
Section1: Clinicalanaesthesia 5 Anaestheticgasesandvapours 565
1 Preoperativemanagement 1 6 Hypnoticsandintravenousanaesthetic
2 Inductionofanaesthesia 25 agents 577
3 Intraoperativemanagement 44 7 Analgesicdrugs 592
4 Postoperativemanagement 57 8 Neuromuscularblockingagents 617
5 Specialpatientcircumstances 77 9 Localanaestheticagents 628
6 Thesurgicalinsult 104 10 Centralnervoussystempharmacology 640
7 Regionalanaesthesiaandanalgesia 115 11 Autonomicnervoussystempharmacology 652
8 Principlesofresuscitation 135 12 Cardiovascularpharmacology 667
9 Majortrauma 156 13 Respiratorypharmacology 680
10 Clinicalanatomy 173 14 Endocrinepharmacology 686
15 Gastrointestinalpharmacology 693
Section2: Physiology 16 Intravenousfluids 699
1 Cellularphysiology 200 17 Pharmacologyofhaemostasis 704
2 Bodyfluids 220 18 Antimicrobialtherapy 710
3 Haematologyandimmunology 232 19 Clinicaltrials:designandevaluation 722
4 Musclephysiology 253
5 Cardiacphysiology 266 Section4: Physics,clinical
6 Physiologyofthecirculation 297 measurementandstatistics
7 Renalphysiology 325 1 Appliedphysics 727
8 Respiratoryphysiology 358 2 Clinicalmeasurement 797
9 Physiologyofthenervoussystem 388 3 Anaestheticequipment 839
10 Physiologyofpain 412 4 Basicstatistics 876
11 Gastrointestinalphysiology 436
12 Metabolismandtemperatureregulation 454 Appendix:PrimaryFRCASyllabus 895
13 Endocrinology 473 Index 910
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Contributors
DrB.L.Appadu DrS.Hill
ConsultantAnaesthetist ConsultantAnaesthetist
PeterboroughGeneralHospital SouthamptonGeneralHospital
Peterborough Southampton
DrI.T.Campbell DrJ.M.James
ReaderinAnaesthesia ConsultantAnaesthetist
UniversityofManchester BirminghamHeartlandsHospital
Birmingham
DrG.Cavill
ConsultantAnaesthetist DrR.P.Jones
WansbeckGeneralHospital AssociateSpecialistinAnaesthesia
Northumberland WithybushHospital
Haverfordwest
DrH.B.J.Fischer
ConsultantAnaesthetist DrK.M.Kerr
AlexandraHospital ConsultantAnaesthetist
Redditch AlexandraHospital
Redditch
DrS.Graham
ConsultantAnaesthetist DrE.S.Lin
TheJamesCookUniversityHospital ConsultantAnaesthetist
Middlesbrough GlenfieldHospital
Leicester
DrA.K.Gupta
DirectorofNeurocriticalCareandConsultant DrD.Liu
Anaesthetist ConsultantAnaesthetist
Addenbrooke’sHospital BedfordHospital
Cambridge Bedford
DrR.M.Haden ProfessorC.J.Lote
ConsultantAnaesthetist ProfessorofExperimentalNephrology
AlexandraHospital UniversityofBirmingham
Redditch Birmingham
DrC.D.Hanning DrT.J.McLeod
ConsultantAnaesthetist ConsultantAnaesthetist
LeicesterRoyalInfirmary BirminghamHeartlandsHospital
Leicester Birmingham
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Listofcontributors ix
DrM.C.Mushambi DrJ.Skoyles
ConsultantAnaesthetist ConsultantAnaesthetist
LeicesterRoyalInfirmary NottinghamCityHospital
Leicester Nottingham
DrJ.R.Neilson DrT.C.Smith
ConsultantinHaematology ConsultantAnaesthetist
RussellsHallHospital AlexandraHospital
Dudley Redditch
DrJ.P.Nolan DrJ.Stone
ConsultantAnaesthetist ConsultantMicrobiologist
RoyalUnitedHospital GloucesterRoyalHospital
Bath Gloucester
DrA.Ogilvy
DrJ.L.C.Swanevelder
ConsultantAnaesthetist
ConsultantAnaesthetist
LeicesterGeneralHospital
GlenfieldHospital
Leicester
Leicester
DrM.Paleologos
DrA.J.Stronach
RoyalNorthShoreHospital
ConsultantAnaesthetist
Sydney
AlexandraHospital
Australia
Redditch
DrS.M.Parr
DrM.Tidmarsh
ConsultantAnaesthetist
ConsultantAnaesthetist
SolihullHospital
CityGeneral&MaternityHospitals
Solihull
Carlisle
DrC.A.Pinnock
ConsultantAnaesthetist DrL.A.G.Vries
AlexandraHospital ConsultantAnaesthetist
Redditch AlexandraHospital
Redditch
ProfessorI.Power
ProfessorofAnaesthesia,Critical ProfessorA.R.Wolf
CareandPainMedicine ProfessorofAnaesthesia
RoyalInfirmaryHospital BristolChildren’sHospital
Edinburgh Bristol
DrA.M.Sardesai DrJ.K.Wood
ConsultantAnaesthetist ConsultantHaematologist
Addenbrooke’sHospital LeicesterRoyalInfirmary
Cambridge Leicester
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Preface to the first edition
TheadventofasyllabusfortheFRCAexamination,itself theirtoleranceandgoodhumourduringalterationoftheir
a requirement of the STA, seemed to me to provide an goldenprose.
idealopportunityforadedicatedrevisiontextbook.Itwill Whilstnosinglebookcancovertheentiresyllabusas
therefore be of no surprise to readers that this volume a ‘one stop’ aid, the majority of material covered in the
mirrorscloselythesyllabusfortheprimaryFRCAinboth examination is detailed within these pages. Some items
structureandcontent. lately included in the syllabus, after completion of the
Havingenlistedthewillinghelpofmytwoco-editors, manuscript,willbeaddedinfutureeditions(suchasthe
Tim Smith and Ted Lin, we set about recruiting authors anatomypertainingtoankleblock).Candidateswill,how-
tocontribute.Chapterauthorshavebeenchosenfortheir ever,bewellservedifthisbookisusedasageneralbasis
ability and known prowess as teachers and a deliberate forrevision.
policyofnotinviting‘usual’contributionsfromfrequently I am extremely grateful to Rob Jones, who has been
seen names was taken. Having said that, several primary responsibleforgeneratingvirtuallyalltheartworkwithin
examinersappearascontributorsandwithineachchapter this text, the few other diagrams being credited to their
coverageofrevisiontopicshasbeenkeptasappropriateto sources.
theexaminationaspossible. Thanks are also due to both my co-editors for their
To reduce the variability that is the bane of multi- extensiveworkanddedication.Ifthisvolumeenablesany
author texts I have personally edited every chapter to candidatetopasstheprimaryexamination,whowouldnot
ensure consistency of style and it is a reflection of the havedonesootherwise,thenourjobwillhavebeenwell
workloadinvolvedthatithastakenthreeyearstocomplete done.
thisproject.Iamgratefultoallcontributingauthorsfor
C.A.Pinnock
July1999