Frontmatter.qxd 18/7/05 3:18 PM Page ii Commissioning Editor: Natasha Andjelkovic Project Development Manager: Joanne Scott Project Manager: Anne Dickie Cover Designer: Jayne Jones Text Designer: Stewart Larking Illustration Manager: Mick Ruddy Illustrator: Antbits Illustration Marketing Manager(s) (UK/USA): Brant Emery/Emily M Christie Frontmatter.qxd 18/7/05 3:18 PM Page iv 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 work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: telephone: (+1) 215 239 3804; fax: (+1) 215 239 3805; or, e-mail: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. ISBN 0 3230 3707 0 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 Notice Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from this publication. The Publisher Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Frontmatter.qxd 18/7/05 3:18 PM Page viii 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 viii Frontmatter.qxd 18/7/05 3:18 PM Page ix 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 ix Frontmatter.qxd 18/7/05 3:18 PM Page x List of Contributors John P Adams MB ChB MRCP FRCA Mark C Bellamy MA MB BS FRCA Iain T Campbell MB BS MD FRCA Consultant in Anaesthesia and Intensive Care Professor of Critical Care Anaesthesia Consultant Anaesthetist Department of Anaesthesia Intensive Care Unit Department of Anaesthesia Leeds General Infirmary St James’s University Hospital University Hospital of South Manchester Leeds Leeds Manchester UK UK UK Maria G Annetta MD Keith H Berge MD Franco Carli MD MPhil FRCA FRCPC Assistant Professor Assistant Professor of Anesthesiology Professor of Anesthesia Universita Cattolica Mayo Clinic College of Medicine Department of Anesthesia Rome Rochester, Minnesota McGilll University Health Centre Italy USA Montreal, Quebec Canada James Arden MD PhD Thomas JJ Blanck MD PhD Consultant Anaesthetist Professor and Chairman of Anesthesiology Surinder PS Cheema MBBCh DA FRCA Department of Anaesthesia Professor of Physiology and Neuroscience Consultant Anaesthesiologist King’s College Hospital Department of Anesthesiology Dept of Anaesthetics London NYU Medical Center Bradford Royal Infirmary UK New York, New York Bradford USA UK Solomon Aronson MD FRCA Professor of Anesthesiology Andrew R Bodenham FRCA Andrew T Cohen MBChB DRCOG FRCA Department of Anesthesiology Consultant in Anaesthesia and Intensive Care Consultant in Anaesthesia and Intensive Care Duke University Medical Center Medicine Department of Anaesthesia Durham, North Carolina Department of Anaesthesia St James’s University Hospital USA Leeds General Infirmary Leeds Leeds UK Helen A Baghdoyan PhD UK Professor of Anesthesiology and Pharmacology Joan P Desborough MBChB FRCA MD Department of Anesthesiology Francis Bonnet MD FRCA Consultant Anaesthetist The University of Michigan Professor of Anesthesiology Anaesthetic Department Ann Arbor, Michigan Department of Anesthesia Reanimation Epsom and St Helier NHS Trust USA Hospital Tenon Surrey Paris UK Jeffrey R Balser MD PhD France Associate Vice Chancellor for Research, Marc L Dickstein MD Professor of Anesthesiology and Pharmacology Timothy J Brennan PhD MD Associate Professor of Anesthesiology Vanderbilt University Medicine Center Associate Professor of Anesthesia and Columbia University Nashville, Tennessee Pharmacology New York, New York USA Department of Anesthesia USA University of Iowa Hospitals and Clinics Christofer D Barth MD Iowa City, Iowa Xueqin Ding MD PhD Fellow, Cardiothoracic Anesthesia USA Research Fellow Cleveland Clinic Foundation Center for Anesthesiology Research Cleveland, Ohio Marek Brzezinski MD The Cleveland Clinic Foundation USA Anesthesiology Fellow Cleveland, Ohio Department of Anesthesiology USA Marcus R Beadle MB BS FRCA Duke University Medical Center Specialist Registrar Anaesthetics Durham, North Carolina James D Dodman MBBS FRCA Department of Anaesthesia USA Specialist Registrar in Anaesthesia St James’s University Hospital Department of Anaesthesia Leeds Donal J Buggy MB ChB (Hons) MD MSc DME Leeds General Infirmary UK FRCPI FCA (Ire) FRCA Leeds Honorary Senior Lecturer in Anaesthesia UK Paul CW Beatty PhD MSc BSc C Eng FIPEM Department of Anaesthesia Senior Lecturer in Biomedical Engineering National University of Ireland Imaging Science and Biomedical Engineering Mater Misericordiae University Hospital University of Manchester Dublin Manchester Republic of Ireland UK x Frontmatter.qxd 18/7/05 3:18 PM Page xi List of Contributors Mary Doherty MB ChB FCA(Ire) Helen F Galley PhD FIMLS Norman L Herman MD PhD Specialist Registrar in Anaesthesia Senior Lecturer Assistant Professor Anesthesiology (Retired); Department of Anaesthesia Institute of Medical Sciences Associate Attending Anesthesiology (Retired) Mater Misericordiae University Hospital University of Aberdeen Weill Medical College of Cornell University Dublin Aberdeen New York, New York Republic of Ireland UK USA Marcel E Durieux MD PhD Susan Garwood MBChB FRCA Sue A Hill MA (Cantab) PhD (Cantab) FRCA Dip Professor of Anesthesiology & Neurological Associate Professor of Anesthesiology Comp Dip Stats Surgery Department of Anesthesiology Consultant Neuroanaesthetist Department of Anesthesiology Yale University School of Medicine Shackleton Department of Anaesthesia University of Virginia Health System New Haven, Connecticut Southampton University Hospitals Trust Charlottesville, Virginia USA Southampton USA UK Kevin J Gingrich MD Thomas J Ebert MD PhD Associate Professor of Anesthesiology Andrew T Hindle MB ChB BSc(Hons) DA FRCA Professor of Anesthesiology and Staff NYU School of Medicine Consultant Anaesthetist Anesthesiologist Department of Anesthesiology Department of Anaesthesia Department of Anesthesiology New York, New York Warrington Hospital The Medical Center of Wisconsin USA Warrington Milwaukee, Wisconsin UK USA Jean-Antoine Girault MD PhD Director of Research Kirk Hogan MD JD Simon M Enright MBChB FRCA Laboratory of Signal Transduction and Plasticity Professor of Anesthesiology Clinical Director, ICU in the Nervous System Department of Anesthesiology Pinderfields Hospital Institut du Fer à Moulin University of Wisconsin Hospitals and Clinics Wakefield Paris Madison, Wisconsin UK France USA John R Feiner MD Andrew P Gratrix MBChB FCARCSI Philip M Hopkins MB BS MD FRCA Associate Professor Specialist Registrar in Anaesthesia and Intensive Professor of Anaesthesia Department of Anesthesia and Perioperative Care Medicine Academic Unit of Anaesthesia Care Pinderfields Hospital St James’s University Hospital University of California Wakefield Leeds San Francisco, California UK UK USA Roger Hainsworth MB ChB PhD DSc Simon J Howell MBBS MA (Cantab) MRCP FRCA Gary Fiskum PhD Emeritus Professor of Applied Physiology MSc MD Professor and Vice-Chair for Research of Institute for Cardiovascular Research Senior Lecturer in Anesthesia Anesthesiology University of Leeds Academic Unit of Anaesthesia Department of Anesthesiology Leeds Leeds General Infirmary University of Maryland School of Medicine UK Leeds Baltimore, Maryland UK USA Neil L Harrison BA PhD Professor of Anesthesiology and Pharmacology Michael J Hudspith MB BS BSc PhD FRCA Patricia Fogarty-Mack MD Department of Anesthesiology Consultant in Pain Management and Anesthesia Associate Professor of Clinical Anesthesiology, Weill Medical College of Cornell University Norfolk & Norwich University Hospital Director Neuroanesthesiology New York, New York Norwich Department of Anesthesiology USA UK Weill Medical College of Cornell University New York, New York Paul M Heerdt MD PhD Uday Jain PhD MD USA Associate Professor of Anesthesiology and Department of Anesthesia Pharmacology St Mary’s Medical Center Manuel L Fontes MD Weill Medical College of Cornell University San Francisco, California Associate Professor of Anesthesiology and New York, New York USA Critical Care USA Department of Anesthesiology Peter M Kimpson MB ChB BSc FRCA Weill Medical College of Cornell University Hugh C Hemmings Jr MD PhD Lecturer in Anaesthesia New York, New York Professor of Anesthesiology and Pharmacology Academic Unit of Anaesthesia USA Department of Anesthesiology St James’s University Hospital Vice Chair of Research Leeds Kirsty Forrest MBChB BSc (Hons) FRCA Weill Medical College of Cornell University UK Lecturer in Anaesthesia New York, New York Academic Unit of Anaesthesia USA Leeds General Infirmary Leeds UK xi Frontmatter.qxd 18/7/05 3:18 PM Page xii List of Contributors H Thomas Lee MD PhD Thomas S McDowell MD PhD Klaus T Olkkola MD PhD Assistant Professor of Anesthesiology Assistant Professor of Anesthesiology Professor and Chairman Department of Anesthesiology Department of Anesthesiology Department of Anaesthesiology and Intensive Colombia University Medical Center University of Wisconsin Care Medicine New York, New York Madison, Wisconsin Turku University Hospital USA USA Turku Finland Jerrold Lerman MD FRCPC FANZCA Gregory A Michelotti PhD Clinical Professor of Anesthesia Assistant Research Professor Beverley A Orser MD PhD FRCPC Department of Anesthesiology Duke University Medical Center Professor of Physiology and Anesthesia; Canada Woman and Children’s Hospital of Buffalo Durham, North Carolina Research Chair in Anesthesia Buffalo, New York USA Department of Physiology USA University of Toronto Salim Mujais MD Toronto, Ontario Cynthia A Lien MD Vice President Medical Affairs Canada Professor of Clinical Anesthesiology Renal Divison Department of Anesthesiology Baxter Healthcare Corporation Gavril W Pasternak MD PhD Weill Medical College of Cornell University McGaw Park, Illinois Anne Burnett Tandy Chair of Neurology; Member New York, New York USA and Attending Neurologist; Head, Laboratory of USA Molecular Neuropharmacology Rajesh Munglani MB BS FRCA Memorial Sloan-Kettering Cancer Center Martin J London MD Consultant in Pain Management New York, New York Professor of Clinical Anesthesia West Suffolk Hospital USA Department of Anesthesia and Perioperative Bury St Edmonds and BUPA Lea Hospital Care Cambridge Misha A Perouansky MD University of California UK Associate Professor of Anesthesiology San Francisco, California Department of Anesthesiology USA Paul G Murphy MA MB ChB FRCA University of Wisconsin Medical School Consultant in Anaesthesia and Intensive Care Madison, Wisconsin Andrew B Lumb MB BS FRCA Department of Anaesthesia USA Consultant Anaesthetist Leeds General Infirmary Department of Anaesthesia Leeds Raymond M Planinsic MD St James’s University Hospital UK Director of Hepatic, Intestinal and Multivisceral Leeds Transplantation Anesthesiology and Associate UK Paul A Murray PhD Professor of Anesthesiology Carl E Wasmuth Endowed Chair and Director of UPMC Presbyterian/Montefiore Ralph Lydic PhD Anesthesiology Research, Professor of Pittsburgh, Pennsylvania Bert La Du Professor of Anesthesiology and Anesthesiology USA Associate Chair for Research Center for Anesthesiology Research Department of Anesthesiology The Cleveland Clinic Foundation Alison J Pittard MBChB MD FRCA The University of Michigan Cleveland,Ohio Consultant in Anaesthesia and Intensive Care Ann Arbor, Michigan USA Department of Anaesthesia USA Leeds General Infirmary Timothy J Ness MD PhD Leeds Ken Mackie MD Simon Gelman Endowed Professor of UK Professor of Anesthesiology, Adjunct Professor of Anesthesiology Physiology and Biophysics Department of Anesthesiology Brian J Pollard BPharm MB ChB MD FRCA Department of Anesthesiology University of Alabama at Birmingham Professor of Anaesthesia University of Washington Birmingham, Alabama Department of Anaesthesia Seattle, Washington USA Manchester Royal Infirmary USA Manchester Ramona Nicolau-Raducu MD UK Abhiram Mallick MD FRCA FFARCSI Instructor of Anesthesiology and Fellow of Consultant in Anaesthesia and ICM Hepatic Transplantation Anesthesiology Ian Power MD FRCA FFPMANZCA FANZCA FRCS Department of Anaesthesia UPMC Presbyterian/Montefiore Ed FRCP Edin Leeds General Infirmary Pittsburgh, Pennsylvania Professor of Anaesthesia, Critical Care and Pain Leeds USA Medicine UK Department of Clinical and Surgical Sciences Daniel Nyhan MD MRCPI The University of Edinburgh Emmanuel Marret MD Professor of Anesthesiology and Critical Care Edinburgh Associate Professor of Anesthesiology Medicine, Chief, Division of Cardiac Anesthesia, UK Department of Anesthesia Reanimation Vice Chairman Hospital Tenon Department of Anesthesiology and Critical Care Christopher B Prior BSc PhD Paris Medicine Senior Lecturer in Pharmacology France The Johns Hopkins Hospitals Department of Physiology and Pharmacology Baltimore, Maryland University of Strathclyde Ian G Marshall BSc PhD USA Glasgow Department of Biomedical Sciences UK University of Central Lancashire Preston UK xii Frontmatter.qxd 18/7/05 3:18 PM Page xiii List of Contributors Kane O Pryor MD Steven L Shafer MD David F Stowe BA MA MD PhD Instructor in Anesthesiology Professor of Anesthesia, Adjunct Professor of Professor of Anesthesiology and Physiology Department of Anesthesiology Biopharmaceutical Science Medical College of Wisconsin Weill Medical College of Cornell University Anesthesiology Service Milwaukee, Wisconsin New York, New York PAVAHCS USA USA Palo Alto, California USA Robert E Study MD PhD Andrew Quinn MB ChB FRCA Staff Anesthesiologist Specialist Registrar in Anaesthesia Stanton K Shernan MD First Colonies Anesthesia Associates Department of Anaesthesia Director of Cardiac Anesthesia Suburban Hospital St James’s University Hospital Department of Anesthesiology, Perioperative Bethesda, Maryland Leeds and Pain Medicine USA UK Brigham and Women’s Hospital Havard Medical School Richard Teplick MD Robert E Rosenthal MD Boston, Massachusetts Chief of Staff; Associate Dean for Clinical Affairs Professor of Surgery, Program in Trauma; Section USA University of South Alabama Hospitals Chief Hyperbaric Medicine Mobile, Alabama R Adams Cowley Shock Trauma Center Philip J Siddall MBBS PhD FFPMANZCA USA University of Maryland School of Medicine Clinical Senior Lecturer Baltimore, Maryland Pain Management Research Institute Dafydd Thomas MB ChB FRCA USA University of Sydney Consultant in Intensive Care Royal North Shore Hospital Intensive Therapy Unit David J Rowbotham MBChB MD FRCA MRCP Sydney, New South Wales Morriston Hospital Professor of Anaesthesia and Pain Management Australia Swansea University of Leicester and University Hospitals of UK Leicester Jeffrey H Silverstein MD Leicester Vice Chair for Research Stephen J Thomas MD UK Department of Anesthesiology Topkins-Van Poznak Distinguished Professor of Mount Sinai School of Medicine Anesthesiology John J Savarese MD New York, New York Department of Anesthesiology Professor and Chairman, USA Weill Cornell Medical College Department of Anesthesiology New York, New York Weill Medical College of Cornell University Karen H Simpson MBChB USA New York, New York Consultant in Pain Medicine and Anaesthesia USA Pain Management Service Annemarie Thompson MD St James’s University Hospital Assistant Professor of Anesthesiology and Thomas Schricker MD PhD Leeds Medicine Assistant Professor UK Department of Anesthesiology Department of Anesthesia Vanderbilt University Medical Center McGilll University Health Centre Nikolaos Skubas MD Nashville, Tennessee Montreal, Quebec Assistant Professor of Anesthesiology USA Canada Department of Anesthesiology Weill Cornell Medical College Howard M Thompson MD Debra A Schwinn MD New York, New York Consultant in Anesthesia and Pain Management James B Duke Professor of Anesthesiology, USA Pilgrim Hospital Professor of Pharmacology/Cancer Biology & Boston Surgery, Vice-Chairman of Research and Director Tod B Sloan MD MBA PhD UK of Perioperative Genomics and Head of Professor of Anesthesiology Molecular Pharmacology Laboratories Department of Anesthiology Simon Turner BSc(Hons) MBChB FRCA Duke University Medical Center University of Colorado Health Sciences Center Clinical Lecturer in Anaesthesia Department of Anesthesiology Denver, Colorado Academic Unit of Anaesthesia Durham, North Carolina USA Leeds General Infirmary USA Leeds Richard M Smiley MD Ph D UK Professor of Clinical Anesthesiology Jane E Sellors MBChB FRCA Columbia University Robert A Veselis MD Consultant Paediatric Anaesthetist New York, New York Associate Professor of Anesthesiology, Department of Anaesthesia USA Director, Neuroanesthesiology Research St James’s University Hospital Laboratory Leeds Ian Smith BSc MD FRCA Department of Anesthesiology/Critical Care UK Senior Lecturer in Anaesthesia Medicine University Hospital of North Staffordshire Memorial Hospital in Memorial Sloan-Kettering John W Severinghaus MD Stoke-on-Trent Cancer Center Professor Emeritus UK New York, New York Department of Anesthesia and Perioperative Care USA University of California San Francisco School of Nina J Solenski MD Medicine Associate Professor of Neurology San Francisco, California Department of Neurology USA University of Virginia School of Medicine Charlottesville, Virginia USA xiii Frontmatter.qxd 18/7/05 3:18 PM Page xiv List of Contributors Mladen Vidovich MD Ian G Wilson MBChB FRCA William L Young MD Department of Medicine Consultant Paediatric Anesthetist Professor of Anesthesia Northwestern University Department of Anaesthesia Department of Anesthesia and Perioperative Care Chicago, Illinois St James’s University Hospital UCSF USA Leeds San Francisco, California UK USA David O Warner MD Professor of Anesthesiology Jay Yang MD PhD Michael Zaugg MD DEAA Mayo Clinic College of Medicine Professor of Anesthesiology, Director of Head of Cardiovascular Anesthesia Laboratory Rochester, Minnesota Neurobiology Research in Anesthesia Institute of Anesthesiology USA Columbia University University Hospital College of Physicians & Surgeons Zurich Nigel R Webster MBChB PhD FRCA FRCP FRCS New York, New York Switzerland Professor of Anaesthesia and Intensive Care USA Academic Unit of Anaethesia and Intensive Care Institute of Medical Sciences University of Aberdeen Aberdeen UK xiv Frontmatter.qxd 18/7/05 3:18 PM Page xv Acknowledgement We would like to acknowledge our mentors and students, who have taught us and from whom we continue to learn. Dedication To our wives Katherine Albert and Carmel Hopkins, whose countless contributions and support were vital. xv