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Textbook of Anaesthesia www.-.harcourt-international.com Bringing you products from all Harcourt Health Sciences companies including Bailliére Tindall, Churchill Livingstone, Mosby and W.B. Saunders © Browse for latest information on new books, journals and electronic products TT nom ome RU PAUL ee OP Reld oR Laat Re ea aS CO oe eee Perea er © Keep up to date with our extensive publishing programme in your field by r Renan aeact sary cl rte © Secure online ordering with prompt delivery, as well as full eerame ened aim Chae tris © News of special features and promotions If you are based in the following countries, please visit the country-specific site to receive full details of product availability and local ordering information USA: www-harcourthealth.com Canada: www.harcourtcanada.com Australia: www.harcourt.com.au FP eaiiere Tinga BD owurcauuvnesione NAMosby [&) w.8. SAUNDERS This page intentionally left blank CommisianingEsier Michel Parkinson Projet Developmen Mager Sarah Keer Keet ‘royet Conner Frances Aleck Daajger Esk Bighnd Textbook of Anaesthesia EDITED ay Alan R Aitkenhead 1s..1o rca Professor of Anaesthes UK David J Rowbotham wo since rrca Professor of Anaesthesia and Pain Management University Department of Anaesthesia, Critial Care and Pain Management Leicester Royal Infirmary Leicester UK Graham Smith 1s. :1i00) mo exca University Department of Anaesthesia, Critical Care and Pain Management Leicester Royal lnfrmary Leicester UK FOURTH EDITION Churchill Lvngstone ‘An inprint of Ev See Lined © Harcowt Publishers Limited 2001 (© Eevee Science Limited 2002, All right reserved [No pat of his publcation may be reproduce, steed in 3 retinal system, op tansitted nan form or by ans means, {leconic, mechanical, photocopying, recording or others, Uvithout eter the pie persusion oF the publishes or 3 Irene persituny rei copying athe United Kingdom sued by the Copright Lnemsing Ageox), 90 Tottenham (Court Road, London WIT ALD. Rermsone may be sought directly trom Ehevier's Health Sciences Rights Department Jn ibelphia, USA: phone: (41) 215 238 7849 (1) 215 238 2289, emai: helpermissonsleeiercom You may also complete sour request online va the Ekeier Saeace homepage (hips wel coe), by selecting, “Customer Suppoet an then Obtaining Permissions int published 1985 Sccond eon 1990 hid edition 1996 Main ction ISBN 0443063818 Repeited 2002, 2003, Ingerational edition ISBN O44 3065 Repeired 2002, 2008 British Library Cataloguing in Publication Data ‘Acaaloge ror fr this book is avilable tom the Bish ary Libeary of Congress Cataloging in Publication Data catalog recor oe this book sealable from the Library of anaes ‘Medial knowlege is constantly changing. As new infoemation Iecomes avaible, changes treatment eocedures, ‘equipment and the use of drugs become neces The ‘tors ators sonenbutos andthe pablsers hae, a {tis pombe, taken cae ro ennire th the information ven in thi teats accurate and wp to date. However, rears are strong ase to conf hat ee information, eapeially wth regard to deug usage, canis wi he ts legition find sana ya our sores or books, Jouraisendmutimesio Inthe heatradences wrormalaaviedwalthcom slarnee Prine in Spin Preface ns fourth edition oF vextbook of Anaestnesa nas been designed with the same objectives as those underlying former editions: the dum hasbeen to prove 4 readable, comprehenne, and concise text to sats dhe needs of new rere nto anaesthesia daring the Hest oo ears oF wining aba aso presen eis ins! eiiphine as anintegrated development from base sciences. We hoped that this approitn ts the fin elon would ako provide 3 sasictory Primer for rsnees i those counties where examinations feature the cay sages ung Tae response to tte Hine eins clearly demonstrated that til provide suitable reading for anaes thet studying for the Part 1 ETARCS (lar Patt 1 ERCA) ccumination, the European Diploma of Anaesthesiology, and proved tobe usfl fora wider audience including medical practi Uiners ging owanunal ansaid seas ut deve counties and non-medical staf invaved fllime in anesthesia and nurse anaesthetist In 1990, the Royal College of Anscsthetsts changed the m1 labs fr its FRA examination by reverting to 3 two-part exami months after commencing training, has 2 very broad syllabus cing bath basic science and lincal practice of amacithe sia, whilst the Final FRCA examination is designed to examine knowledge and practice in clinical measurement and more spe