Textbook of Anaesthesia, Fourth Edition

821 Pages·2001·104.95 MB·English

by  Alan R. Aitkenhead BSc MD FRCA

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Textbook of
Anaesthesia
Commissioning Editor: Michael Parkinson
Project Development Manager: Sarah Keer-Keer
Project Controller: Frances Affleck
Designer: Erik Bigland
Textbook of
Anaesthesia
EDITED BY
Alan R Aitkenhead B MD
SC
Professor of Anaesthesia
University Department of Anaesthesia and Intensive Care
Queen's Medical Centre
Nottingham
UK
David J Rowbotham MDMRCPFRCA
Professor of Anaesthesia and Pain Management
University Department of Anaesthesia, Critical Care and Pain Management
Leicester Royal Infirmary
Leicester
UK
Graham Smith
BSc (Rons) MD FRCA
Professor of Anaesthesia
University Department of Anaesthesia, Critical Care and Pain Management
Leicester Royal Infirmary
Leicester
UK
FOURTH EDITION
CHURCHILL
LIVINGSTONE
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2001
Churchill Livingstone
An imprint of Elsevier Science Limited
© Harcourt Publishers Limited 2001
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First published 1985
Second edition 1990
Third edition 1996
Fourth edition 2001
Main edition
ISBN 0443063818
Reprinted 2002, 2003
International edition
ISBN 0443063915
Reprinted 2002, 2003
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British
Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of
Congress
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Preface
This fourth edition of Textbook of Anaesthesia has been designed immunology, the kidney, metabolism, and endocrinology. In addi-
with the same objectives as those underlying former editions; the tion, we have rearranged chapters throughout the book in an
aim has been to provide a readable, comprehensive, and concise attempt to produce a more logical structure. In the second section
text to satisfy the needs of new recruits into anaesthesia during the on Practice of Anaesthesia, we have retained much of the content
first two years of training and also present this clinical discipline as of previous editions but following the policy introduced in the
an integrated development from basic sciences. We hoped that this third edition, we have changed approximately one third of the
approach in the first edition would also provide a satisfactory authors. We again emphasise that this is not a reflection of the
primer for trainees in those countries where examinations feature quality of the contributions of the previous authors, to whom we
in the early stages of training. The response to the first edition are extremely grateful; our intentions are simply to ensure that
clearly demonstrated that it did provide suitable reading for anaes- fresh minds are applied to the subject matter and to avoid the risks
thetists studying for the Part I FFARCS (later Part 1 FRCA) which could be associated with asking authors merely to update
examination, the European Diploma of Anaesthesiology, and their contributions. As in past editions, we are grateful to the
equivalent examinations in other parts of the world. The book also authors of all our chapters for the quality of the revisions which
proved to be useful for a wider audience including medical practi- they have made in this edition and we are also indebted to the
tioners giving occasional anaesthetics in rural areas or developing many reviewers and readers of the book who have been sufficiently
countries and non-medical staff involved full-time in anaesthesia interested to provide helpful comments and draw our attention to
such as operating department practitioners, anaesthetic assistants, mistakes and typographical errors.
and nurse anaesthetists. We are grateful to all our contributors for allowing us to under-
In 1990, the Royal College of Anaesthetists changed the syl- take widespread revision of manuscripts in an attempt to achieve
labus for its FRCA examination by reverting to a two-part exami- uniformity of style. In addition we are indebted to the publishers
nation. The Primary, intended to be taken twelve to eighteen who have arranged for redrawing of all figures and incorporation
months after commencing training, has a very broad syllabus of a large number of new additional figures in a standardised for-
encompassing both basic science and clinical practice of anaesthe- mat. Our gratitude must be recorded to Mrs Christine Gethins in
sia, whilst the Final FRCA examination is designed to examine Leicester and Ms Lynne Chapman in Nottingham for substantial
knowledge and practice in clinical measurement and more spe- secretarial assistance. Because of the additional work involved in
cialised aspects of clinical anaesthesia. this larger fourth edition and to provide some youth to the
In order to achieve our basic objective of producing within a editorial team, we have also invited David Rowbotham to join the
single book a text suitable as both an introduction to the clinical editors.
practice of anaesthesia and also one which is appropriate reading We hope that this fourth edition will continue to be as popular
for the Primary FRCA examination, we have made substantial as the previous editions of Textbook, and that it will continue to
changes to this fourth edition of Textbook, most noticeably serve as a useful introductory text for those beginning a career in
by increasing the basic science content. The changes produced, anaesthesia. Our aim has been to try to encompass, as far as is
in comparison with the third edition, are evident most ostensibly possible within a readable text, the syllabus for the new Primary
by a marked increase in size by incorporation of an additional FRCA examination, and hopefully this aim will also have been
19 chapters. For editorial convenience we have divided the book achieved. Previous anaesthetic trainees have also found our book
into two main sections: Principles of Anaesthesia and Practice of useful as a revision manual for the Final FRCA examination;
Anaesthesia. This is not intended to separate or compartmentalise although that is not the primary purpose of this text, nonetheless
basic science and clinical practice; indeed both basic science and it may be helpful in this context. The incorporation of useful
clinical practice are intertwined in most chapters. appendices and practical information on the conduct of anaesthe-
In the section on Principles of Anaesthesia, we have incorpo- sia within most specialist areas of anaesthesia should ensure that it
rated most of the new chapters in order to cover areas which remains useful both as a practical guide in the operating theatre
were not addressed in previous editions and which are now part of and also a foundation of theoretical knowledge.
the syllabus for the Primary FRCA examination. There are new
chapters on statistics, cellular physiology and pharmacology, three Alan R Aitkenhead, Nottingham
additional chapters on the cardiovascular system, three on the Graham Smith and David J Rowbotham, Leicester
nervous system, three on the gastrointestinal tract, and others on 2001
Vll
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Contributors
Alan R Aitkenhead BSc MD FRCA John Curran PhD FRCA
Professor of Anaesthesia, University Department of Consultant Anaesthetist, Department of Anaesthesia,
Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham City Hospital, Nottingham, UK
Nottingham, UK
Eric de Melo FRCA
John I Alexander FRCA Consultant Anaesthetist, Department of Anaesthesia,
Consultant Anaesthetist, Department of Anaesthesia, University Hospitals of Leicester NHS Trust,
Bristol Royal Infirmary, Bristol, UK Leicester Royal Infirmary, Leicester, UK
Robert Atcheson MD FRCA David R Derbyshire FRCA
Consultant Anaesthetist, Department of Anaesthesia, Consultant Anaesthetist, Department of Anaesthesia,
Royal Hallamshire Hospital, Sheffield, UK Warwick General Hospital, Warwick, UK
Bryn R Baxendale FRCA Christopher Dodds FRCA
Consultant Anaesthetist, Department of Anaesthesia, Consultant Anaesthetist, Department of Anaesthesia,
Queen's Medical Centre, Nottingham, UK South Cleveland Hospital, Middlesbrough, UK
Jennifer Benton FRCA David J R Duthie MD FRCA
Associate Specialist in Anaesthesia, Department of Consultant Anaesthetist, University Department of
Anaesthesia, Derriford Hospital, Plymouth, UK Anaesthesia, Critical Care and Pain Management,
Glenfield General Hospital, Leicester, UK
Tim Bourne FRCA
Consultant Anaesthetist, Department of Anaesthesia, Neil D Edwards FRCA
University Hospitals of Leicester NHS Trust, Consultant Anaesthetist, Department of Anaesthesia,
Leicester Royal Infirmary, Leicester, UK Royal Hallamshire Hospital, Sheffield, UK
Donal Buggy MSc MRCPI (Dublin) DME FFARCSI Christopher D Elton FRCA
Senior Lecturer, University Department of Anaesthesia, Consultant Anaesthetist, Department of Anaesthesia,
Critical Care & Pain Management, Leicester General Hospital, University Hospitals of Leicester NHS Trust,
Leicester, UK Leicester Royal Infirmary, Leicester. UK
Aiden Byrne FRCA David Fell FRCA
Consultant Anaesthetist, Department of Anaesthesia, Consultant Anaesthetist, Department of Anaesthesia,
Morriston Hospital, Swansea, UK University Hospitals of Leicester NHS Trust,
Leicester Royal Infirmary, Leicester, UK
D Paul Cartwright FRCA
Consultant Anaesthetist, Department of Anaesthesia, Helen F Galley PhD
Derby City General Hospital, Derby, UK Senior Lecturer, Academic Unit of Anaesthesia,
University of Aberdeen, Aberdeen, UK
Paul R Clarke MRCP FRCA
Consultant Anaesthetist, Academic Unit of Anaesthesia, Keith J Girling FRCA
St James's University Hospital, Leeds, UK Consultant Anaesthetist, Department of Anaesthesia,
Queen's Medical Centre, Nottingham, UK
Beverley J Collett FRCA
Consultant Anaesthetist, Department of Anaesthesia, Neville W Goodman FRCA
University Hospitals of Leicester NHS Trust, Consultant Anaesthetist, Department of Anaesthesia,
Leicester Royal Infirmary, Leicester, UK Southmead Hospital, Bristol, UK
IX