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BASIC SCIENCE FOR ANAESTHETISTS
This is a revised edition of a book originally titled Anaesthetic Data Interpretation. The
new title better reflects the contents of the book, which contains additional chapters rel-
evant to the Primary FRCA examination. New topics covered include the ventilatory
response to oxygen and carbon dioxide, which is now a core knowledge requirement,
new concepts in cardiovascular physiology, receptor types and the molecular actions
of anaesthetics. Some of the revisions reflect advances in technology; for example, the
uses of the capnograph and the oxygen analyser have advanced considerably in recent
years. The aim is to provide a concise and understandable review of the physics,
mathematics, statistics, physiology and pharmacology of anaesthesia. Basic Science for
Anaesthetists is a concise and informative text, which will be invaluable for trainee
anaesthetists and an aid to teaching for the trainers.
S
YLVA D OLENSKA qualified from Charles University, Prague, trained as an anaes-
thetist in the UK and is currently Consultant Anaesthetist at William Harvey Hospital,
Ashford, Kent. She has also acquired the KSS Deanery Certificate in Teaching. Her
other key professional interests are airway management and obstetric anaesthesia.
BASIC SCIENCE FOR
ANAESTHETISTS
BY
SYLVA DOLENSKA MD LMSSA FRCA
Consultant Anaesthetist, Department of Anaesthetics,
The William Harvey Hospital, Ashford, Kent, UK
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK
First published in print format
ISBN-13 978-0-521-67602-1
ISBN-13 978-0-511-16895-6
© Cambridge University Press 2006
Every effort has been made in preparing this publication to provide accurate and up-to-
date information which is in accord with accepted standards and practice at the time of
publication. Although case histories are drawn from actual cases, every effort has been
made to disguise the identities of the individuals involved. Nevertheless, the authors,
editors and publishers can make no warranties that the information contained herein is
totally free from error, not least because clinical standards are constantly changing through
research and regulation. The authors, editors and publishers therefore disclaim all liability
for direct or consequential damages resulting from the use of material contained in this
publication. Readers are strongly advised to pay careful attention to information provided
by the manufacturer of any drugs or equipment that they plan to use.
2006
Information on this title: www.cambridge.org/9780521676021
This publication is in copyright. Subject to statutory exception and to the provision of
relevant collective licensing agreements, no reproduction of any part may take place
without the written
p
ermission of Cambrid
g
e University Press.
ISBN-10 0-511-16895-0
ISBN-10 0-521-67602-9
Cambridge University Press has no responsibility for the persistence or accuracy of urls
for external or third-party internet websites referred to in this publication, and does not
g
uarantee that any content on such websites is, or will remain, accurate or a
pp
ro
p
riate.
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
paperback
eBook (NetLibrary)
eBook (NetLibrary)
paperback
To my husband
CONTENTS
List of abbreviations and symbols page xi
List of figure captions xiii
Forewords xvii
Preface xxi
Preface to the second edition xxiii
Part 1: Physics, mathematics, statistics, anaesthetic
apparatus 1
1. Gas compression, relationship of volume, pressure
and temperature
2
2. Real gas compression 4
3. Flow and resistance 8
4. Heat, vaporization and humidification 14
5. Simple mechanics 1: mass, force, pressure 18
6. Simple mechanics 2: work and power 22
7. Mathematical concepts 26
8. Exponentials 1: the curves 30
9. Exponentials 2: properties of exponential decay curve 36
10. Descriptive statistics 40
11. Presentation of data 44
12. Receiver operating characteristic curve 48
13. Gas supply and pressure 52
14. The circle system 54
15. The Mapleson A (Magill) breathing system 58
16. T-pieces 60
17. Lung filling with automatic lung ventilators 62
Part 2: Clinical measurement 67
1. Basic measurement concepts
68
2. Electromanometers, frequency response and
damping
72
3. Pulse oximeter principle 76
vii
Contents
4. Oxygen content and oxygen tension measurement 80
5. Capnography 86
6. [H+], pH and its measurement 92
7. Principles of measurement of volume and flow in
gases and liquids
96
8. Cardiac output measurement by thermal dilution
technique
100
9. Measurement of the mechanical properties of the
chest
102
10. Lung volumes and their measurement 104
Part 3a: Physiology: the cardiovascular system 109
1. The cardiac cycle and the intravascular pressure
waveforms
110
2. Cardiovascular effects of intermittent positive
pressure ventilation
114
3. Control of cardiac output, regulation of cardiac
function
116
4. Cardiac cycle: pressure-volume relationships 118
5. Blood pressure and blood volume relationship 122
6. Cerebral blood flow 124
7. Coronary circulation 128
Part 3b: Physiology: the respiratory system 133
1. Oxyhaemoglobin dissociation curve
134
2. Respiratory mechanics 1: Static properties, factors
affecting compliance, closing volume
136
3. Respiratory mechanics 2: Dynamic properties,
factors affecting resistance
142
4. Ventilation–perfusion relationship 146
5. Oxygen cascade, oxygen therapy and shunt fraction 152
6. Gas R line, solution of the ventilation/perfusion
model
156
7. Ventilatory response to oxygen 160
8. Ventilatory response to carbon dioxide 162
viii
Contents
Part 4: Pharmacology 165
1. Drug elimination
166
2. Uptake and distribution of inhalational anaesthetic
agents
170
3. Pharmacodynamic effects of drugs 174
4. Minimum alveolar concentration and lipid solubility 180
5. Receptor types, molecular action of anaesthetics 182
6. Context sensitive half-time 186
Index 191
ix
. pharmacology of anaesthesia. Basic Science for Anaesthetists is a concise and informative text, which will be invaluable for trainee anaesthetists and an aid to teaching for the trainers. S YLVA. Hospital, Ashford, Kent. She has also acquired the KSS Deanery Certificate in Teaching. Her other key professional interests are airway management and obstetric anaesthesia. BASIC SCIENCE FOR ANAESTHETISTS BY SYLVA. 189 xvi FOREWORD The syllabus for the Primary FRCA examination is broad, covering basic anaesthesia and associated skills together with an in depth knowledge of the principles of basic science
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