Fundamentals of Anaesthesia Edited by Colin Pinnock Ted Lin Tim Smith Associate Editor Robert Jones © 1999 Greenwich Medical Media Ltd. 137 Euston Road London NW1 2AA ISBN 1 900151618 First Published 1999 While the advice and information in this book is believed to be true and accurate, neither the authors nor the publisher can accept any legal responsibility or liability for any loss or damage arising from actions or decisions based in this book. The ultimate responsibility for the treatment of patients and the interpretation lies with the medical practitioner. The opinions expressed are those of the authors and the inclusion in this book relating to a particular product, method or technique does not amount to an endorsement of its value or quality, or of the claims made of it by its manufacture. Every effort has been made to check drug dosages; however, it is still possible that errors have occurred. Furthermore, dosage schedules are constantly being revised and new side effects recognised. For these reasons, the medical practitioner is strongly urged to consult the drug companies' printed instructions before administering any of the drugs recommended in this book. Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The right of Colin Pinnock, Ted Lin and Tim Smith to be identified as editors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Project Manager Gavin Smith Production and Design by Saxon Graphics Limited, Derby Printed in Great Britain by Ashford Colour Press Ltd This book is dedicated to Samuel and Edd PREFACE The advent of a syllabus for the FRCA examination, itself a requirement of the STA, seemed to me to provide an ideal opportunity for a dedicated revision textbook. It will therefore be of no surprise to readers that this volume mirrors closely the syllabus for the primary FRCA in both structure and content. Having enlisted the willing help of my two co-editors, Tim Smith and Ted Lin, we set about recruiting authors to contribute. Chapter authors have been chosen for their ability and known prowess as teachers and a deliberate policy of not inviting `usual' contributions from frequently seen names was taken. Having said that, several primary examiners appear as contributors and within each chapter coverage of revision topics has been kept as appropriate to the examination as possible. To reduce the variability that is the bane of multi author texts I have personally edited every chapter to ensure consistency of style and it is a reflection of the workload involved that it has taken three years to complete this project. I am grateful to all contributing authors for their tolerance and good humour during alteration of their golden prose. Whilst no single book can cover the entire syllabus as a `one stop' aid, the majority of material covered in the examination is detailed within these pages. Some items lately included in the syllabus, after completion of the manuscript, will be added in future editions (such as the anatomy pertaining to ankle block). Candidates will, however, be well served if this book is used as a general basis for revision. I am extremely grateful to Rob Jones who has been responsible for generating virtually all the artwork within this text, the few other diagrams being credited to their sources. Thanks are also due to both my co-editors for their extensive work and dedication. If this volume enables any candidate to pass the primary examination, who would not have done so otherwise, then our job will have been well done. C A PINNOCK JULY 1999 SECTION EDITORS Section 1: Clinical Anaesthesia C A Pinnock and R P Jones Section 2: Physiology E S Lin and C A Pinnock Section 3: Pharmacology C A Pinnock and T C Smith Section 4: Physics and Clinical Measurement E S Lin and T C Smith CONTRIBUTORS Dr B L Appadu Consultant Anaesthetist Leicester Royal Infirmary Leicester Dr I T Campbell Senior Lecturer in Anaesthesia University of Manchester Dr G Cavill Consultant Anaesthetist Wansbeck General Hospital Northumberland Dr D R Duthie Consultant Anaesthetist Glenfield Hospital Leicester Dr H B J Fischer Consultant Anaesthetist Alexandra Hospital Redditch Dr G C Fisher Consultant Anaesthetist Russells Hall Hospital Dudley Dr S Graham Consultant Anaesthetist Royal Victoria Infirmary Newcastle upon Tyne Dr D Green Specialist Registrar Queen Elizabeth Hospital Birmingham Dr R M Haden Consultant Anaesthetist Alexandra Hospital Redditch Dr C D Hanning Consultant Anaesthetist Leicester Royal Infirmary Leicester Dr M Horsefield Lecturer in Physics Leicester Royal Infirmary Leicester Dr M J Jones Consultant Anaesthetist Glenfield Hospital Leicester Dr R P Jones Staff Grade Anaesthetist Alexandra Hospital Redditch Dr K E Lewis Consultant Anaesthetist Princess of Wales Hospital Bridgend West Glamorgan Dr E S Lin Consultant Anaesthetist Glenfield Hospital Leicester Dr D Liu Consultant Anaesthetist Bedford Hospital Bedford Dr C J Lote Senior Lecturer University of Birmingham Birmingham Dr M C Mushambi Consultant Anaesthetist Leicester Royal Infirmary Leicester Dr J R Neilson Consultant in Haematology Russell Hall Hospital Dudley Dr J P Nolan Consultant Anaesthetist Royal United Hospital Bath