Anatomy for Anaesthetists

366 Pages·2004·7.76 MB·English

by  Harold Ellis

AFAA01 11/11/03 13:38 Page i
Anatomy for Anaesthetists
..
This page intentionally left blank
AFAA01 11/11/03 13:38 Page iii
ANATOMY FOR
ANAESTHETISTS
HAROLD ELLIS
CBE, MA, DM, FRCS, FACS(Hon)
Clinical Anatomist,
Guy’s King’s and St Thomas’s School of Biomedical Sciences, London
Emeritus Professor of Surgery,
University of London
STANLEY FELDMAN
BSc, MB, FRCA
Emeritus Professor of Anaesthetics,
Charing Cross and Westminster Medical School
WILLIAM HARROP-GRIFFITHS
MA, MB, BS, FRCA
Consultant Anaesthetist,
St Mary’s Hospital, Paddington, London
with a chapter on the
Anatomy of Pain
contributed by
ANDREW LAWSON
FFARCSI, FANZCA, FRCA, MSc
Consultant in Anaesthesia and Pain Management,
Royal Berkshire Hospital, Reading
Eighth edition
.. ..
AFAA01 11/17/03 10:26 Page iv
© 1963, 1969, 1977, 1983, 1988, 1993, 1997, 2004 Library of Congress Cataloging-in-Publication Data
by Blackwell Science Ltd Ellis, Harold, 1926–
a Blackwell Publishing company Anatomy for anaesthetists / Harold Ellis, Stanley
Blackwell Science, Inc., 350 Main Street, Malden, Feldman, William Harrop-Griffiths; with a chapter
Massachusetts 02148-5020, USA on the Anatomy of pain contributed by Andrew
Blackwell Publishing Ltd, 9600 Garsington Road, Lawson.—8th ed.
Oxford OX4 2DQ, UK p. ; cm.
Blackwell Science Asia Pty Ltd, 550 Swanston Street, Includes bibliographical references and index.
Carlton, Victoria 3053, Australia ISBN 1-4051-0663-8
1. Human anatomy. 2. Anesthesiology.
The right of the Author to be identified [DNLM: 1. Anatomy. 2. Anesthesia.
as the Author of this Work has been QS 4 E47a 2003] I. Feldman, Stanley A.
asserted in accordance with the II. Harrop-Griffiths, William. III. Title.
Copyright, Designs and Patents Act 1988.
QM23.2.E42 2003
All rights reserved. No part of 611′.0024617—dc22
this publication may be reproduced, 2003020753
stored in a retrieval system, or ISBN 1405 1066 38
transmitted, in any form or by any
means, electronic, mechanical, A catalogue record for this title is available from the
photocopying, recording or otherwise, British Library
except as permitted by the UK
Copyright, Designs and Patents Act Set in 10/13.5pt Sabon by Graphicraft Limited,
1988, without the prior permission Hong Kong
of the publisher. Printed and bound in Denmark, by Narayana Press,
Odder
First published 1963
Second edition 1969 Commissioning Editor: Stuart Tayler
Third edition 1977 Editorial Assistant: Katrina Chandler
Reprinted 1979 Production Editor: Rebecca Huxley
Fourth edition 1983 Production Controller: Kate Charman
Fifth edition 1988
Reprinted 1990 For further information on Blackwell Publishing,
Sixth edition 1993 visit our website:
Reprinted 1995 http://www.blackwellpublishing.com
Seventh edition 1997
Reprinted 1998
Italian first edition 1972
Japanese fourth edition 1989
German fifth edition 1992
.. ..
AFAA01 11/11/03 13:38 Page v
Contents
Part 1: The Respiratory Pathway 1
The Mouth 3
The Nose 7
The Pharynx 16
The Larynx 26
The Trachea 42
The Main Bronchi 48
The Pleura 50
The Lungs 53
Part 2: The Heart 71
The Pericardium 73
The Heart 75
Developmental Anatomy 86
Part 3: The Vertebral Canal and its Contents 95
The Vertebrae and Sacrum 97
The Spinal Meninges 119
The Spinal Cord 125
Part 4: The Peripheral Nerves 137
The Spinal Nerves 139
The Cervical Plexus 146
The Brachial Plexus 153
The Thoracic Nerves 180
The Lumbar Plexus 183
The Sacral and Coccygeal Plexuses 192
Part 5: The Autonomic Nervous System 213
Introduction 215
The Sympathetic System 218
The Parasympathetic System 228
Part 6: The Cranial Nerves 233
Introduction 235
The Olfactory Nerve (I) 238
The Optic Nerve (II) 239 v
.. ..
AFAA01 11/11/03 13:38 Page vi
vi Contents
The Oculomotor Nerve (III) 242
The Trochlear Nerve (IV) 244
The Trigeminal Nerve (V) 245
The Abducent Nerve (VI) 266
The Facial Nerve (VII) 267
The Auditory (Vestibulocochlear) Nerve (VIII) 272
The Glossopharyngeal Nerve (IX) 273
The Vagus Nerve (X) 276
The Accessory Nerve (XI) 282
The Hypoglossal Nerve (XII) 283
Part 7: The Anatomy of Pain 285
Introduction 287
Classification of Pain 288
Peripheral Receptors and Afferent fibres 288
The Spinal Cord and Central Projections 290
Modulation of Pain 294
The Gate Control Theory of Pain 295
The Sympathetic Nervous System and Pain 296
Part 8: Zones of Anaesthetic Interest 297
The Thoracic inlet 299
The Diaphragm 305
The Intercostal Spaces 311
The Abdominal Wall 318
The Antecubital Fossa 324
The Great Veins of the Neck 330
The Orbit and its Contents 336
Index 349
.. ..
AFAA01 11/11/03 13:38 Page vii
Acknowledgements
The first two editions of this textbook were prepared in collaboration with that
skilled medical artist Miss Margaret McLarty. The illustrations for the sixth
edition were almost all drawn or redrafted by Rachel Chesterton; we thank her
for the excellent way in which they have been executed. Further illustrations for
the seventh and this edition were prepared by Jane Fallows with great skill.
vii
.. ..
AFAA01 11/11/03 13:38 Page viii
Introduction
The anaesthetist requires a particularly specialized knowledge of anatomy. Some
regions of the body, for example the respiratory passages, the major veins and
the peripheral nerves, the anaesthetist must know with an intimacy of detail that
rivals or even exceeds that of the surgeon; other areas can be all but ignored.
Although formal anatomy teaching is no longer part of the syllabus of the FRCA
in the UK, its importance for the safe practice of anaesthesia is recognized by
the examiners, who always include questions on anatomy related to anaesthesia
in this examination. The role of anatomy in anaesthetic teaching is often con-
sidered merely as a prerequisite for the safe practice of local anaesthetic blocks.
However, it is also important in understanding the anatomy of the airway, the
function of the lungs, the circulation, venous access, monitoring neuromuscular
block and many other aspects of practical anaesthesia. For this reason, this book
is not intended to be a textbook for regional anaesthetic techniques; there are
many excellent books in this field. It is an anatomy book written for anaesthetists,
keeping in mind the special requirements of their daily practice.
In this eighth edition, we have revised much of the text, we have taken the
opportunity to expand and update the sections of special interest to anaesthetists
and we have included new and improved illustrations. William Harrop-Griffiths
of St Mary’s Hospital, London, joins us as our new co-author. He brings with
him special expertise in modern anaesthetic technology and has greatly assisted
us in updating the text and illustrations. Dr Andrew Lawson has fully updated
his important section on the Anatomy of Pain and has given valuable advice on
procedures relevant to the practice of pain medicine.
viii
..
AFAC01 11/11/03 13:39 Page 1
Part 1
The Respiratory Pathway
..