Manual of Anesthesia Practice

Because of the dynamic nature of medical practice and drug selection and dosage, users are advised that decisions regarding drug therapy must be based on the independent judgment of the clinician, changing information about a drug (e.g., as reflected in the literature and manufacturer’s most current product information), and changing medical practices. While great care has been taken to ensure the accuracy of the

information presented, users are advised that the authors, editors, contributors, and publisher make no warranty, express or implied, with respect to, and are not responsible for, the currency, completeness, or accuracy of the information contained in this publication, nor for any errors, omissions, or the application of this information, nor for any consequences arising therefrom. Users are encouraged to confirm the information contained herein with other sources deemed authoritative. Ultimately, it is the responsibility of the treating physician, relying on experience and knowledge of the patient, to determine dosages and the best treatment for the patient. Therefore, the author(s), editors, contributors, and the publisher make no

warranty, express or implied, and shall have no liability to any person or entity with regard to claims, loss, or damage caused, or alleged to be caused, directly or indirectly, by the use of information

contained in this publication. Further, the author(s), editors, contributors, and the publisher are not responsible for misuse of any of the information provided in this publication, for negligence by the user, or for any typographical errors.

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Fundamentals of Anaesthesia

I am privileged to have led the creation of the third edition of this popular Primary FRCAtext, ably helped bymy three co-editors. Once again, feedback from users of the book has helped enormously in developing FoA3. TheRoyalCollege of Anaesthetists’ publication of the Primary syllabus within theCompetency-based Training Framework has led us to include that knowledge base, uniquely referenced to Fundamentals, in a new Appendix. A number of new contributors have enhanced the proportion of current and past
examiners amongst our writers. The greater use of colour allows the reader to navigate more easily, and changes to technique boxes make that information easier to assimilate. This edition contains a number of new chapters in addition to widespread updates, and has been thoroughly copy-edited by Hugh Brazier to an unrivalled standard of consistency over the previous editions.

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Anaesthesia for Medical Students

The first public demonstration of ether was by W.T.G. Morton in the Etherdome of the Massachusetts General Hospital in 1846. Ether anaesthesia became widely available and would soon be followed by chloroform and nitrous oxide. Surgeons were not particular about who poured the ether or
chloroform so long as someone was there to do the job. It was not until the early 1920's that physicians began to show interest in anaesthesia as a specialty. By the end of World War I1 the infant specialty was firmly established and university training programs began. The emphasis has traditionally been on
postgraduate teaching. Why has undergraduateanaesthesia teachingbeen neglected or de-emphasized? It was
because the medical school curriculum was controlled by older, traditional disciplines that were unwilling to
relinquish time for competing specialties. This was complicated by the fact that anaesthetists originally worked only in the operating room, and found it difficult to be freed from that responsibility
to undertake teaching outside the operating room. Anaesthesia has expanded to include other services
which include Intensive Care, Acute and Chronic Pain Services, Malignant Hyperthermia Diagnostic Services, and a Pre-admission Unit. Anaesthetists have developed many skills which are
valuable to physicians, regardless of their discipline. They have become specialists in applied physiology, pharmacology and resuscitation of acutely traumatized patients. The importance of imparting these skills and knowledge to medical students has been realized by those responsible for medical school
curricula. Accreditation bodies are demanding that anaesthetists teach medical
students. When the new curriculum, founded on problem-based learning, was adopted in
the Faculty of Medicine at the University of Ottawa, anaesthesia was given responsibilities in the program. Each student must spend two weeks in an anaesthesia rotation and many anaesthetists
participate in small group sessions. Dr. Patrick Sullivan found that an anaesthesia
manual, which would meet the needs of medical students submerged in a new curriculum, was not available.
The manual he and his co-authors have written covers all of the important material a medical student must and should know. It is best taught by anaesthetists because it falls almost exclusively in their domain. The
organization of the manual makes it essential reading for students rotating through anaesthesia who want to
optimize their brief exposure to anaesthesia, which has so much to offer.


J. Earl Wynands, M.D.
Professor and Chairman
Department of Anaesthesia
University of Ottawa

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