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Contrary to the popular belief,'Le sommeil n'est plus milieu s(lr'(J. Cocteau, cf. Cl. Gaultier, Pathologie respiratoire du sommeil, La Presse Medicale, 16, 561-563, 1987), and anesthesia is even less safe. Sudden Infant Death Syndrome, Obstructive Sleep Apnea, Ondine's Curse and various respiratory complications of general anesthesia are not so rare; as a matter of fact they happen much too frequently. The idea of organizing another symposium dealing with breathing in sleep and anesthesia has been discussed almost immediately after we said'good bye'to the Organizers of the excellent Paris meeting'The Regulation of Respiration during Sleep and Anesthesia'(R.S. Fitzgerald, H. Gautier, S. Lahiri eds., Advances in Experimental Medicine and Biology, vol. 99, Plenum, New York 1978). Taking into account the impressive amount of data that have emerged during the last few years, we have decided that we shall meet and discuss them; we hoped also that the publication of the scientific material might be useful for everybody interested in the physiology and pathophysiology of breathing, anesthesia and sleep. So we met in Warsaw under the auspices of the European Society for Clinical Respiratory Physiology and the Polish Academy of Sciences, we discussed vividly many fascinating papers presented by our Colleagues from Europe and America and Plenum Press has published the proceedings. I hope that the final result will satisfy the reader.

Theodore H. Stanley, M. D. Anesthesiology and the Heart contains the Refresher Course manuscripts of the presentations of the 35th Annual Postgraduate Course in Anesthesiology which took place at The Cliff Conference Center in Snowbird, Utah, February 16-20, 1990. The chapters reflect new data and concepts within the general framework of'evaluating myocardial function,''pharmacology and the cardiac patient,''anesthesia for patients with cardiac disease,'and'stress, cardiopulmonary bypass, coagulation problems and related issues.'The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the eighth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. vii LIST OF CoNTIUBUTDRS Bailey, P. L. Department of Anesthesiology, The University of Utah School of Medicine, Salt Lake City, UT 84132, U. S. A. Barash, P. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, U. S. A. Covino, B. G.

This book records the presentations given at a workshop held in Bonn in May 1994. The aim of the meeting was to bring together scientists from various disciplines and clinicians to discuss within a group of experts the theoretical, medical, engineering, and regulatory aspects of automated control of therapeutic interventions in. anaesthesiology. The meeting was considered a continuation of a preceding work­ shop on'Quantitation, Modelling and Control in Anaesthesia'[1], which was held also in Bonn 10 years ago in May 1984. That workshop dealt with problems of how to quantitate concepts like anaesthetic depth, how to model anaesthetic drug disposition, how to link phar­ macokinetics and pharmacodynamics, and how to use such concepts for the control of anaesthetic drug delivery. With respect to these topics the current proceedings have simultaneously both a broadened and a narrowed perspective. It is broadened in so far as the topics of the workshop did not focus exclusively on anaesthetic drugs and the control of their delivery, but did also discuss anaesthesia machine monitoring and patients therapeutic monitoring as well as control of blood pressure and artificial ventilation. The proceedings have nar­ rowed the perspective insofar as they do not intensively discuss the processes of quantitation and modelling but presuppose them and give more room to control, especially automated control. During the past 10 years informatics has tremendously expanded its knowledge and methods applicable to control problems.

This book is based on the proceedings of a conference held in Tubingen, West Germany, in 1981, at which anesthesiologists, neuro­ surgeons, pathologists and neurophysiologists met to consider the place of controlled hypotension in neurosurgery. In the first part of the book alternative methods of inducing hypotension are considered, and it is important to emphasize that the techniques which are suitable for neurosurgery may not be so for other types of surgery, and vice versa. In neurosurgery, and par­ ticularly in aneurysm surgery, the emphasis is on lowering intra­ luminal pressure and not mainly on reducing blood flow or limiting tissue oozing. Another special consideration in neurosurgery is the influence of drugs used to induce hypotension on intracranial pressure, with nitroprusside (NTP), and especially nitroglycerine, increasing ICP in the closed skull and increasing brain'bulk'when the skull is open. These and other points are extensively covered. The use of a non-essential technique like controlled hypotension demands that the procedure should carry minimal risk to the patient. Contributions in part IV consider the neuropathology associated with too severe a lowering of oxygen supply through hypotension. In the clinical avoidance of such ischemic changes in individual patients, monitoring of the brain electrical function is much the most import­ ant and practical approach and is discussed in part III. The Editors hope that the publication of these contributions to the Tubingen Symposium will help in the effective and safe appli­ cation of the technique of controlled hypotension in neurosurgery.

Anesthesiology and the Cardiovascular Patient contains the edited presentations of the 41st Annual Postgraduate Course in Anesthesiology, February 1996. The chapters reflect new data and concepts within the general framework of the pathophysiology and management of surgical candidates with cardiovascular disease. The textbook will serve as a vehicle to bring many of the latest concepts in anesthesiology to those who did not attend the conference. Each chapter is a brief but sharply focused glimpse of the current interest in anesthesia. This volume, as well as past and future volumes, reflects the rapid and continuing evolution of anesthesiology in the late twentieth century.

Theodore H. Stanley, M. D. Anesthesia and the Lung contains the Refresher Course manuscripts of the presentations of the 34th Annual Postgraduate Course in Anesthesiology which took place at The Cliff Conference Center in Snowbird, Utah, February 17-21, 1989. The chapters reflect recent advances in the diagnosis, pre-, intra-, and postoperative anesthetic management of patients with lung disease, presenting for pulmonary and non-pulmonary surgery. They also deal with ventilation-perfusion issues, the lung as a metabolic organ, the effects of anesthesia on pulmonary mechanics and pulmonary blood flow. In addition there are chapters that will focus around hypoxia; regional differences in the lung; pulmonary surfactant; recent advances in the understanding of pulmonary edema; high altitude disease; anesthesia and the control of breathing; recent developments in oximetry; instrumentation designed to measure pulmonary oxygen tension, P0 and PC0 trans­ 2 2 cutaneously; differential lung ventilation; reactive airways; septic shock; the adult respiratory distress syndrome and numerous aspects of ventilatory support. The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presenta­ tion. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia expressed at the conference.

Pain Management and Anesthesiology contains the presentations made at the 43rd Annual Postgraduate Course in Anesthesiology sponsored by the University of Utah and held at Snowbird, Utah, USA, February 20-24, 1998. This volume addresses recent advances in the understanding of the basic science and clinical management of pain. The textbook includes sections on recent advances in the understanding of pain signal processing, as well as reviews of the clinical management of acute, chronic, cancer-related, and pediatric pain. In addition, this text includes a discussion of the behavioral assessment and treatment of the pain patient. This textbook is the sixteenth in a continuing series documenting the proceedings of the postgraduate course.

Neuroanesthesia contains the edited presentations of the 42nd Annual Postgraduate Course in Anesthesiology given by the Department of Anesthesiology at the University of Utah School of Medicine, February 1997. The chapters reflect recent advances in neurophysiology, pharmacology and monitoring related to the practice of neuroanesthesiology. The sections on central nervous system trauma, intraoperative management, brain protection and postoperative care provide a conceptual framework for current clinical practices. This textbook is the fifteenth in a continuing series documenting the proceedings of the Postgraduate Course of the Department of Anesthesiology of the University of Utah School of Medicine. It reflects, as well as past and future volumes, the rapid and continuing evolution of anesthesia in the last years of the twentieth century.

Theodore H. Stanley, M.D. Anesthesiology and Pain Management contains the Refresher Course manuscripts of the presentations of the 36th Annual Postgraduate Course in Anesthesiology which took place at The Cliff Conference Center in Snowbird, Utah, February 22-26, 1991. The chapters reflect new data and concepts within the general framework of'pain research and basic science,''clinical topics in pain management.'The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the ninth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. ix list of Contributors Ashburn, Michael A. Department of Anesthesiology, University of Utah, Salt Lake City, Utah Basbaum, Allan Department of Anatomy & Physiology, University of California - San Francisco, San Francisco, California Bonica, John J. Department of Anesthesiology, The University of Washington, Seattle, Washington Cousins, Michael J.

The management of the critically ill patients has been in the past few years a discipline at the forefront of development which continues to make progress with the support of basic and clinical research. This work is a collection of material that deals with the management of critically ill patients, published on the occasion of the 13th APICE congress in November 1998, which celebrated 40 years of Critical Care Medicine.

Anesthesiology and Pain Management contains the edited presentations of the 39th Annual Postgraduate Course in Anesthesiology, February 1994. The chapters reflect new data concepts within the general framework of `pain research and basic science', and `clinical topics in pain management'. The purpose of the textbook is to serve as a vehicle to bring many of the latest concepts in anesthesiology to those who did not attend the conference, within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the current interests in anesthesia. This volume, as well as past and future volumes, reflects the rapid and continuing evolution of anesthesiology in the late twentieth century.

Developing sectors in the intensive care field - and in critical care medicine in general - require specific levels of competence having a same common denominator: an in-depth knowledge of human pathophysiology. Although this volume presents plenty of topics in constant evolution, as witnessed by the collection of chapters compiled by several researchers, this edition includes, in particular, fields in which decision making at the patient's bedside prevails over theoretical argumentation. In other words, the first and foremost message this edition wants to provide is for the reader to focus his/her attention on evidence-based medicine.

Whilst the incidence of memory and awareness in anaesthesia appears not to be on the increase, the phenomenon is receiving growing attention from patients, anaesthetists, researchers and, of course, the media. This volume brings together recent advances in the wide-ranging area of research into this multi-faceted phenomenon. It is divided into four sections: monitoring depth of anaesthesia, learning and memory in anaesthesia, clinical measurement and brain function during anaesthesia, and awareness and psychological consequences of awareness during anaesthesia.