Clinical Anesthesia 4th edition (January 2001): by MD Paul G. Barash (Editor), MD Bruce F. Cullen (Editor), MD Robert K. Stoelting (Editor) By Lippincott Williams & Wilkins Publishers By OkDoKeY Clinical Anesthesia CONTENTS Editors Preface Contributing Authors Dedication I INTRODUCTION TO ANESTHESIA PRACTICE Chapter 1. The History of Anesthesiology Judith A. Toski, Douglas R. Bacon, and Rod K. Calverley Chapter 2. Practice Management George Mychaskiw II and John H. Eichhorn Chapter 3. Experimental Design and Statistics Nathan Leon Pace Chapter 4. Hazards of Working in the Operating Room Arnold J. Berry and Jonathan D. Katz Chapter 5. Professional Liability, Risk Management, and Quality Improvement Karen L. Posner, Frederick W. Cheney, and Donald A. Kroll Chapter 6. Value-Based Anesthesia Practice, Resource Utilization, and Operating Room Management Kenneth J. Tuman and Anthony D. Ivankovich II BASIC PRINCIPLES OF ANESTHESIA PRACTICE Chapter 7. Cellular and Molecular Mechanics of Anesthesia Alex S. Evers Chapter 8. Electrical Safety Jan Ehrenwerth Chapter 9. Acid-Base, Fluids, and Electrolytes Donald S. Prough and Mali Mathru Chapter 10. Hemotherapy and Hemostasis Charise T. Petrovitch and John C. Drummond III BASIC PRINCIPLES OF PHARMACOLOGY IN ANESTHESIA PRACTICE Chapter 11. Basic Principles of Clinical Pharmacology Robert J. Hudson Chapter 12. Autonomic Nervous System: Physiology and Pharmacology Noel W. Lawson and Joel O. Johnson Chapter 13. Nonopioid Intravenous Anesthesia Jen W. Chiu and Paul F. White Chapter 14. Opioids Barbara A. Coda Chapter 15. Inhalation Anesthesia Thomas J. Ebert and Phillip G. Schmid III Chapter 16. Muscle Relaxants David R. Bevan and Francçois Donati Chapter 17. Local Anesthetics Spencer S. Liu and Peter S. Hodgson IV PREPARING FOR ANESTHESIA Chapter 18. Preoperative Evaluation Lee A. Fleisher Chapter 19. Anesthesia for Patients with Rare and Coexisting Diseases Stephen F. Dierdorf Chapter 20. Malignant Hyperthermia and Other Pharmacogenetic Disorders Henry Rosenberg, Jeffrey E. Fletcher, and Barbara W. Brandom Chapter 21. Preoperative Medication John R. Moyers and Carla M. Vincent Chapter 22. Delivery Systems for Inhaled Anesthetics J. Jeffrey Andrews and Russell C. Brockwell Chapter 23. Airway Management William H. Rosenblatt Chapter 24. Patient Positioning Mark A. Warner and John T. Martin Chapter 25. Monitoring the Anesthetized Patient Glenn S. Murphy and Jeffrey S. Vender V MANAGEMENT OF ANESTHESIA Chapter 26. Epidural and Spinal Anesthesia Christopher M. Bernards Chapter 27. Peripheral Nerve Blockade Michael F. Mulroy Chapter 28. Anesthesia for Neurosurgery Audrée A. Bendo, Ira S. Kass, John Hartung, and James E. Cottrell Chapter 29. Respiratory Function in Anesthesia M. Christine Stock Chapter 30. Anesthesia for Thoracic Surgery James B. Eisenkraft, Edmond Cohen, and Steven M. Neustein Chapter 31. Cardiovascular Anatomy and Physiology Carol L. Lake Chapter 32. Anesthesia for Cardiac Surgery Serle K. Levin, W. Chase Boyd, Peter T. Rothstein, and Stephen J. Thomas Chapter 33. Anesthesia for Vascular Surgery John E. Ellis, Michael F. Roizen, Srinivas Mantha, Gary Tzeng, and Tina Desai Chapter 34. Anesthesia and the Eye Kathryn E. McGoldrick Chapter 35. Anesthesia for Otolaryngologic Surgery Alexander W. Gotta, Lynne R. Ferrari, and Colleen A. Sullivan Chapter 36. The Renal System and Anesthesia for Urologic Surgery Terri G. Monk and B. Craig Weldon Chapter 37. Anesthesia and Obesity and Gastrointestinal Disorders F. Peter Buckley and Kenneth Martay Chapter 38. Anesthesia for Minimally Invasive Procedures Anthony J. Cunningham and Noreen Dowd Chapter 39. Anesthesia and the Liver Phillip S. Mushlin and Simon Gelman Chapter 40. Anesthesia for Orthopaedic Surgery Terese T. Horlocker and Denise J. Wedel Chapter 41. Anesthesia and the Endocrine System Jeffrey J. Schwartz, Stanley H. Rosenbaum, and George J. Graf Chapter 42. Obstetric Anesthesia Alan C. Santos, David A. O'Gorman, and Mieczyslaw Finster Chapter 43. Neonatal Anesthesia Frederic A. Berry and Barbara A. Castro Chapter 44. Pediatric Anesthesia Joseph P. Cravero and Linda Jo Rice Chapter 45. Anesthesia for the Geriatric Patient Stanley Muravchick Chapter 46. Anesthesia for Ambulatory Surgery J. Lance Lichtor Chapter 47. Monitored Anesthesia Care Simon C. Hillier Chapter 48. Trauma and Burns Levon M. Capan and Sanford M. Miller Chapter 49. The Allergic Response Jerrold H. Levy Chapter 50. Drug Interactions Carl Rosow Chapter 51. Anesthesia Provided at Alternative Sites Charles E. Laurito Chapter 52. Anesthesia for Organ Transplantation Leonard L. Firestone and Susan Firestone VI POST ANESTHESIA AND CONSULTANT PRACTICE Chapter 53. Postoperative Recovery Roger S. Mecca Chapter 54. Management of Acute Postoperative Pain Timothy R. Lubenow, Anthony D. Ivankovich, and Robert J. McCarthy Chapter 55. Chronic Pain Management Stephen E. Abram and Christian R. Schlicht Chapter 56. ICU: Critical Care Morris Brown Chapter 57. Cardiopulmonary Resuscitation Charles W. Otto APPENDIX: Electrocardiography James R. Zaidan and Paul G. Barash Edited by Paul G. Barash, MD Professor, Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist Yale–New Haven Hospital New Haven, Connecticut Bruce F. Cullen, MD Professor, Department of Anesthesiology University of Washington School of Medicine Anesthesiologist-in-Chief Harborview Medical Center Seattle, Washington Robert K. Stoelting, MD Professor and Chair, Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana PREFACE The twelve years since the publication of the first edition of Clinical Anesthesia have witnessed some of the most significant advances our specialty has ever seen. In 1989, the term “managed care” was a new phrase in the health-care lexicon. In contrast, both the medical and economic considerations now play an important role in the care of all patients. The mortality rate from all anesthetic causes has plummeted, and operating rooms are now considered among the safest sites in the hospital. Anesthesiologists are pioneers in maintaining a safe environment for our patients, and the techniques we have used are now being emulated and adopted by initiatives from the federal government and other medical specialties. In addition, anesthesiologists are now “perioperative physicians” supervising care in a variety of locations from preoperative evaluation clinics, to intensive care units and pain clinics, and to operating room sites as varied as the cardiac OR and a physician’s office. Finally, both critical care and pain are now recognized subspecialties of anesthesiology, pediatric anesthesia is now recognized for fellowship status, and certification can be achieved for transesophageal echocardiography. It is with this background of vast change that we have undertaken the editorial process for the fourth edition of Clinical Anesthesia. New paradigms for OR management and cost containment are highlighted. Our safety and that of our patients is extensively reviewed with particular emphasis on latex allergy. Recent developments are enhancing our understanding of the mechanism of action of anesthetics, and this research has important implications for the creation of new anesthetic agents. The preanesthetic clinic is becoming a major focus of activity, since it serves as an important gateway to the OR. Efficient, medically appropriate, and cost-effective care is covered extensively. With the rapid proliferation of new drugs, publicity about medical errors related to drug administration, and public concern about herbal preparations, the addition of an entirely new chapter on drug interactions and anesthesia is timely. Newer monitoring techniques, including transesophageal echocardiography and transcranial Doppler, are discussed in several chapters including those on neuroanesthesia, cardiac anesthesia, and monitoring. Minimally invasive surgery presents challenges to the anesthesiologist and enhances our ability to contribute significantly to the care of the patient. Here again, in addition to a chapter specifically focused on minimally invasive surgical procedures, a number of contributors have emphasized the critical issues for patient management in their individual chapters. With an increasing number of patients in the geriatric age group, even relatively noncomplex surgical procedures pose a significant anesthetic challenge. The geriatrics chapter has been considerably revised to reflect this concern. As trauma continues to be a leading cause of mortality and morbidity in the United States, the updated chapter on anesthesia for trauma provides an excellent review of the many new methods for treatment of trauma patients. The extensive use of conscious sedation protocols not only in the OR but throughout the hospital has placed the anesthesiologist in a leadership role for our peers. The relevant chapter serves to prepare us to enter these discussions with a broad base of information. Recently, no area in anesthesiology has garnered more attention and controversy than office-based anesthesia. The complexities of administering an anesthetic in this environment are reviewed by national leaders in this field. In addition to these subjects, each of the other chapters has been extensively revised for the current edition, with emphasis on up-to-date information and relevance to contemporary anesthetic clinical care. The hallmark of Clinical Anesthesia is the presentation of concepts in a crisp and clinically useful manner. Clinical options are prioritized by the contributors, each of whom is a recognized expert within the scope of his/her chapter. As editors, we have eliminated duplication among chapters and have presented an integrated approach to the specialty of anesthesiology. On occasion, however, redundancy and even disagreement in approaches to patient management have been kept because they also reflect the realities of the practice of anesthesiology. We hope that you, the reader, will benefit from this new edition, and we trust that it will improve your understanding of the field and your clinical care of patients. We welcome your comments and suggestions as to how we may continue to make Clinical Anesthesia—and its companion handbook, review book, and CD-ROM—as useful as possible to clinicians, residents, and students. Finally, we wish to express our gratitude to the individual contributors whose hard work and dedication expedited the development and production of this edition. We also acknowledge the support of our administrative assistants, Gail Norup, Karen Rutherford, and Deanna Walker, each of whom gave unselfishly of her time to facilitate the editorial process. Thanks to our colleagues at Lippincott Williams & Wilkins who continually demonstrate their commitment to excellence in medical publishing: Craig Percy, Executive Editor; Tanya Lazar, Developmental Editor; Andrea Allison-Williams, Administrative Assistant; and Mary McDonald and Peggy Gordon at P.M. Gordon Associates for making the final stages of production a joy. Paul G. Barash, M.D. Bruce F. Cullen, M.D. Robert K. Stoelting, M.D. CONTRIBUTING AUTHORS Stephen E. Abram, MD Professor and Chair Department of Anesthesiology University of New Mexico School of Medicine Albuquerque, New Mexico J. Jeffrey Andrews, MD Professor and Vice-Chair for Clinical Development Department of Anesthesiology University of Alabama School of Medicine Birmingham, Alabama Douglas R. Bacon, MD Associate Professor Department of Anesthesiology Mayo Clinic Rochester, Minnesota Audreée A. Bendo, MD Associate Professor Department of Anesthesiology SUNY Health Science Center at Brooklyn Brooklyn, New York Christopher M. Bernards, MD Associate Professor Department of Anesthesiology University of Washington School of Medicine Seattle, Washington Arnold J. Berry, MD, MPH Professor Department of Anesthesiology Emory University School of Medicine Atlanta, Georgia Frederic A. Berry, MD Professor of Anesthesiology and Pediatrics Department of Anesthesiology University of Virginia Health Sciences Center Charlottesville, Virginia David R. Bevan, MD Professor and Head Department of Anaesthesia University of British Columbia Faculty of Medicine Vancouver, British Columbia W. Chase Boyd, MD Assistant Professor Department of Anesthesiology Cornell University–New York Hospital New York, New York Barbara W. Brandom, MD Professor University of Pittsburgh School of Medicine Children’s Hospital of Pittsburgh Department of Anesthesiology Pittsburgh, Pennsylvania Russell C. Brockwell, MD Assistant Professor Department of Anesthesiology University of Alabama School of Medicine Birmingham, Alabama Morris Brown, MD Professor of Anesthesiology Wayne State University School of Medicine Chairman Department of Anesthesiology Henry Ford Hospital Detroit, Michigan F. Peter Buckley, MD Associate Professor Department of Anesthesiology University of Washington School of Medicine Medical Director Pain and Toxicity Program Fred Hutchinson Cancer Research Center Seattle, Washington Rod K. Calverley* Clinical Professor of Anesthesiology University of California, San Diego, School of Medicine La Jolla, California Levon M. Capan, MD Associate Professor New York University School of Medicine New York, New York Barbara A. Castro, MD Assistant Professor of Anesthesiology and Clinical Pediatrics University of Virginia School of Medicine Charlottesville, Virginia Frederick W. Cheney, MD Professor and Chair Department of Anesthesiology University of Washington School of Medicine Seattle, Washington Jen W. Chiu, MBBS, MMed, DEAA Associate Consultant Department of Anesthesiology K Women’s and Children’s Hospital Singapore Barbara A. Coda, MD Assistant Professor Department of Anesthesiology University of Washington School of Medicine Harborview Medical Center Seattle, Washington Edmond Cohen, MD Associate Professor of Anesthesiology Director of Thoracic Anesthesia Mount Sinai School of Medicine of New York University New York, New York James E. Cottrell, MD Professor and Chairman Department of Anesthesiology SUNY Health Science Center at Brooklyn Brooklyn, New York Joseph P. Cravero, MD Assistant Professor of Anesthesiology and Pediatrics Department of Anesthesiology Dartmouth Medical School Hanover, New Hampshire Anthony J. Cunningham, MD Professor Department of Anaesthesia Beaumont Hospital Dublin, Ireland Tina Desai, MD Instructor Department of Surgery University of Chicago Pritzker School of Medicine Chicago, Illinois Stephen F. Dierdorf, MD Professor Department of Anesthesiology Indiana University School of Medicine Indianapolis, Indiana Francçois Donati, MD Professor and Chair Department of Anaesthesia University of Montreal Montreal, Quebec Noreen Dowd, MD Professorial Unit Beaumont Hospital Dublin, Ireland John C. Drummond, MD, FRCPC Professor and Chair Department of Anesthesiology University of California, San Diego, School of Medicine La Jolla, California Thomas J. Ebert, MD, PhD Professor Department of Anesthesiology Medical College of Wisconsin Milwaukee, Wisconsin Jan Ehrenwerth, MD Professor Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut John H. Eichhorn, MD Professor and Chair Department of Anesthesiology University of Mississippi School of Medicine and Medical Center Jackson, Mississippi James B. Eisenkraft, MD Professor of Anesthesiology Director of Anesthesia Research Mt. Sinai School of Medicine of New York University New York, New York John E. Ellis, MD Associate Professor Department of Anesthesia and Critical Care University of Chicago Pritzker School of Medicine Chicago, Illinois Alex S. Evers, MD Professor and Chair Department of Anesthesiology Washington University School of Medicine St. Louis, Missouri Lynne R. Ferrari, MD Associate Professor Department of Anesthesiology Harvard Medical School Medical Director of Perioperative Services Children’s Hospital Boston, Massachusetts Mieczyslaw Finster, MD Professor of Anesthesiology, Obstetrics, and Gynecology Department of Anesthesiology Columbia University College of Physicians and Surgeons New York, New York Leonard L. Firestone, MD Safar Professor and Chair Department of Anesthesiology and Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Susan Firestone, MD Associate Professor Department of Anesthesiology and Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Lee A. Fleisher, MD Associate Professor Department of Anesthesiology and Critical Care Johns Hopkins University School of Medicine Baltimore, Maryland Jeffrey E. Fletcher, PhD Vice President, Scientific Affairs Trinity Communications Conshohocken, Pennsylvania Simon Gelman, MD, PhD Professor and Chair Department of Anesthesiology, Perioperative and Pain Medicine Harvard Medical School Brigham and Women’s Hospital Boston, Massachusetts Hugh C. Gilbert, MD Associate Professor Department of Anesthesiology Northwestern University Medical School Evanston Hospital Evanston, Illinois Alexander W. Gotta, MD Professor of Anesthesiology Department of Anesthesiology SUNY Health Science Center at Brooklyn Brooklyn, New York George J. Graf, MD Assistant Clinical Professor Department of Anesthesiology UCLA School of Medicine Attending Departments of Internal Medicine and Anesthesiology Cedars Sinai Medical Center Los Angeles, California John Hartung, PhD Associate Professor Department of Anesthesiology SUNY Health Science Center at Brooklyn Brooklyn, New York Simon C. Hillier, MB, ChB, FRCA Associate Professor Department of Anesthesiology Indiana University School of Medicine Riley Hospital for Children Indianapolis, Indiana Peter S. Hodgson, MD The Daniel Moore/D. Bridenbaugh Fellow in Regional Anesthesia Virginia Mason Medical Center Seattle, Washington Terese T. Horlocker, MD Assistant Professor Department of Anesthesiology Mayo Clinic Rochester, Minnesota Robert J. Hudson, MD, FRCPC Professor of Anesthesia University of Manitoba Faculty of Medicine St. Boniface General Hospital Winnipeg, Manitoba Anthony D. Ivankovich, MD Professor and Chair Department of Anesthesiology Rush Medical College Rush-Presbyterian-St. Luke’s Medical Center Chicago, Illinois Joel O. Johnson, MD Department of Anesthesiology and Perioperative Medicine University of Missouri, Columbia Columbia, Missouri Ira S. Kass, PhD Professor of Anesthesiology and Physiology and Pharmacology Department of Anesthesiology SUNY Health Science Center at Brooklyn Brooklyn, New York Jonathan D. Katz, MD Associate Clinical Professor Department of Anesthesiology Yale University School of Medicine Attending Anesthesiologist St. Vincent’s Medical Center Bridgeport, Connecticut Donald A. Kroll, MD, PhD Professor Department of Anesthesiology UT Memphis College of Medicine Chief of Anesthesiology Memphis Veterans Affairs Medical Center Memphis, Tennessee Carol L. Lake, MD Professor and Chair Department of Anesthesiology Associate Dean for Continuing Medical Education University of Louisville Louisville, Kentucky Charles E. Laurito, MD Medical Director, Center for Pain Management and Rehabilitation Medicine University of Illinois at Chicago Chicago, Illinois Noel W. Lawson, MD Professor and Chair Department of Anesthesiology and Perioperative Medicine University of Missouri School of Medicine, Columbia Columbia, Missouri Serle K. Levin, MD Assistant Professor Department of Anesthesiology Cornell University–New York Hospital New York, New York Jerrold H. Levy, MD Professor Department of Anesthesiology Emory University School of Medicine Atlanta, Georgia J. Lance Lichtor, MD Professor Department of Anesthesia and Critical Care University of Chicago Pritzker School of Medicine Chicago, Illinois Spencer S. Liu, MD Staff Anesthesiologist Virginia Mason Medical Center Seattle, Washington Timothy R. Lubenow, MD Associate Professor Department of Anesthesiology Rush Medical College Rush-Presbyterian-St. Luke’s Hospital Medical Center Chicago, Illinois Srinivas Mantha, MD Associate Professor Department of Anesthesiology in Intensive Care Nizam’s Institute of Medical Sciences Hyderabad, India Kenneth Martay, MD Acting Assistant Professor Department of Anesthesiology University of Washington School of Medicine Seattle, Washington John T. Martin, MD Professor Emeritus Department of Anesthesiology Medical College of Ohio at Toledo Toledo, Ohio Mali Mathru, MD Professor Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas Robert J. McCarthy, Pharm D Associate Professor Department of Anesthesiology Rush Medical College Rush-Presbyterian-St. Luke’s Medical Center Chicago, Illinois Kathryn E. McGoldrick, MD Professor Department of Anesthesiology Yale University School of Medicine New Haven, Connecticut Roger S. Mecca, MD Executive Director, Surgical Services Danbury Hospital Danbury, Connecticut Sanford M. Miller, MD Assistant Professor of Clinical Anesthesiology New York University School of Medicine New York, New York Terri G. Monk, MD Professor Department of Anesthesiology University of Florida College of Medicine Gainesville, Florida John R. Moyers, MD Professor Department of Anesthesia University of Iowa College of Medicine Iowa City, Iowa Michael F. Mulroy, MD Staff Anesthesiologist Virginia Mason Medical Center Seattle, Washington Stanley Muravchick, MD, PhD Professor Department of Anesthesia University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Glenn S. Murphy, MD Associate Professor Department of Anesthesiology Northwestern University Medical School Evanston Hospital Evanston, Illinois Phillip S. Mushlin, MD, PhD Associate Professor Department of Anesthesiology, Perioperative and Pain Medicine Harvard Medical School Brigham and Women’s Hospital Boston, Massachusetts George Mychaskiw II, DO Associate Professor of Anesthesiology, Surgery, and Physiology Director, Cardiac Anesthesiology University of Mississippi School of Medicine and Medical Center [...]... Regional Anesthesia in the Nineteenth Century Into the Twentieth Century Spinal Anesthesia Epidural Anesthesia Twentieth-Century Regional Anesthesia The Quest for Safety in Anesthesiology Alternative Circuits Flow Meters Vaporizers Ventilators Anesthesia Machine and Equipment Monitors Patient Monitors Electrocardiography, Pulse Oximetry, and Carbon Dioxide Measurement Tracheal Intubation in Anesthesia. .. currently taught Twentieth-Century Regional Anesthesia Surgery on the extremities lent itself to other regional anesthesia techniques At first, they were combined with general anesthesia In 1902, Harvey Cushing coined the phrase “regional anesthesia for his technique of blocking either the brachial or sciatic plexus under direct vision during general anesthesia to reduce anesthesia requirements and provide... wrote the classic text, Pediatric Anesthesia At the same time, a second pediatric anesthesiologist, Margot Deming, was the Director of Anesthesia at the Children's Hospital of Philadelphia Pediatric anesthesia also figured in the career of Doreen Vermeulen-Cranch, who had earlier initiated thoracic anesthesia in The Netherlands and pioneered hypothermic anesthesia Obstetric anesthesia also figured prominently... became editor of the first journal devoted to anesthesia, Current Researches in Anesthesia and Analgesia, the precursor of Anesthesia and Analgesia, the oldest journal of the specialty As well as fostering the organization of the International Anesthesia Research Society (IARS) in 1925, Francis and his wife Laurette McMechan became overseas ambassadors of American anesthesia Since Laurette was French, it... ANESTHESIOLOGY Clinical Anesthesia CHAPTER 1 THE HISTORY OF ANESTHESIOLOGY JUDITH A TOSKI, DOUGLAS R BACON, AND ROD K CALVERLEY* The Early History of Anesthesiology “Prehistory” Almost Discovery: Clarke, Long, and Wells W T G Morton and October 16, 1846 A “Blessing” to Obstetrics John Snow: The First Anesthesiologist Nineteenth-Century British Anesthesia After John Snow Late Nineteenth-Century Anesthesia. .. regarded anesthesia as a technical craft that could be left to anyone Some hospitals preferred to pay a salary to an anesthesia nurse while gaining a profit from the fees charged for that person's services The most compelling argument to be advanced in favor of nurse anesthesia was that of skill: a trained nurse who administered anesthetics every working day was to be preferred to a physician who gave anesthesia. .. later received the first academic appointment in anesthesia in the western United States when she became Clinical Professor of Anesthesia at the University of California, San Francisco Botsford also served as the president of the Associated Anesthetists of the United States and Canada One of the first physicians to actually declare himself a “specialist in anesthesia was Sydney Ormond Goldan of New York,... of cocaine for spinal anesthesia After studying Goldan's early career, Raymond Fink recognized in him some of the qualities of many modern anesthesiologists: “He was brimful of enthusiasm for anesthesia, an excellent communicator and a prolific writer, a gadgeteer and the owner of several patents of anesthesia equipment.”73 At a time when many surgeons considered that spinal anesthesia did away with... spinal anesthesia, with mention of cerebrospinal fluid, injection of cocaine, and an appropriately short onset of action In a comparative review of the original articles by Bier, Tuffier, and Corning, it was concluded that Corning's injection was extradural, and Bier merited the credit for introducing spinal anesthesia. 25 INTO THE TWENTIETH CENTURY Spinal Anesthesia Fourteen years passed before spinal anesthesia. .. escape of CSF and urged that the skin and deeper tissues be infiltrated beforehand with local anesthesia, as had been urged earlier by William Halsted and the foremost advocate of infiltration anesthesia, Carl Ludwig Schleich of Berlin An early American specialist in anesthesia, Ormond Goldan, published an anesthesia record appropriate for recording the course of “intraspinal cocainization” in 1900 . current edition, with emphasis on up-to-date information and relevance to contemporary anesthetic clinical care. The hallmark of Clinical Anesthesia is the presentation of concepts in a crisp and clinically. Dowd Chapter 39. Anesthesia and the Liver Phillip S. Mushlin and Simon Gelman Chapter 40. Anesthesia for Orthopaedic Surgery Terese T. Horlocker and Denise J. Wedel Chapter 41. Anesthesia and the Endocrine. Chair, Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana PREFACE The twelve years since the publication of the first edition of Clinical Anesthesia have witnessed