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Anaesthesia for neurological surgery
BRITISH JOURNAL OF ANAESTHESIA
568 Moglichkeit physiologische Signale direkt in reeller Zeit zu iibertragen Gelegenheit, die Genauigkeit der Messungen zu verbessern, die Zahl und den Bereich physiologischer variabler Werte, wie sie fur den Patienten wichtig sind, zu erweitern, und verlasslichere Methoden fiir die klinische Beurteilung zu enrwickeln.
EL USO DE ESLABONES DE DATOS TELEFONICOS ANALOGOS PARA LA TRANSMISION DE SElVALES FISIOLOGICAS RESUMEN
BOOK REVIEW Anaesthesia for neurological surgery (1971). By P. B. McComish and P. O. Bodley, Published by Lloyd-Luke, London. Pp. 412; indexed; illus. Price £5.50. It is a case of much-better-late-than-nevi;r that this book has only recently come for review after its publication in mid-1971. The two authors, presumably writing from experience gained mainly at th: Regional Centre for Neurosurgery at Oldchurch Hospital, Essex, have succeeded admirably in their intention to present a broad view of anaesthetic techniques for neurological surgery, to the extent of producing virtually the complete textbook. The first chapter reviews the early development of techniques of neurosurgical anaesthesia—Horsley's 30 minute operations, his "pain graph" for the safe use of chloroform (2% a rather high "unequilibrated MAC" for scalp incision?), and his belief that the relief of cerebral compression would allow more anaesthetic to reach th; brain. Thereafter the perspective of history is never lost; this is just one aspect of the authors' generally studious approach which helps to sustain the reader's interest. The three main sections deal with the intracranial contents and the pathology of raised pressure, with basic techniques of neurosurgical anaesthesia, and then with the specific management of individual surgical procedures. There is also a short chapter on electrophysiological investigations of surgical relevance, an appendix of drug names, a general biblography, and a satisfactory index; overall, including the printing and proof reading, the production has achieved a high standard. There are over 90 figures, and particularly useful are the frequent brief descriptions of surgical pathology (see, for instance, all the possible sites for cerebro-vascular aneurysms).
In the more controversial areas of neurosurgical anaesthesia (for example, surgery for subarachnoid haemorrhage and in the posterior fossa, the use of the sitting position, the apparent trust in neuroleptanalgesia in face of the established dangers of opiates), it takes an anaesthetist more than a few years before he can begin to evaluate objectively his personal experience. Thus, clinical impressions alone tend to dictate actions, which are sometimes quite unsuited to another neurosurgical environment. Here, the writers have scrutinised the literature widely, and have shown a genuine fairness to all published opinions (a refreshing feature, and far too rare these days). In just a few instances, perhaps, quotations from previous books are really clinical impressions without data to substantiate, and ths authors' own views are not always clearly defined. However, their approach is safe, and more suitable for teaching purposes than a highly personal documentation. As well as to the authors, this book is also a credit to tho!*5 not-so-few anaesthetists who have shown a persisting loyalty to neurosurgery; yes, they have tolerated boredom at times (less, probably, than imagined by their non-participating colleagues on the side-lines), but have derived satisfaction from avoiding faults which would go unnoticed in other fields, from being occupied at times in critical manoeuvres which are most unlikely to be delegated to "auxiliaries" of whatever description, and from a bitter chance than many have to engage actively in pre- and postoperative care. Neurosurgical techniques have far to progress, and the active participation of discerning anaesthetists can only be stimulated by books as good as this one. It is highly recommended. R. A. Millar
Downloaded from http://bja.oxfordjournals.org/ at Cornell University Library on July 27, 2015
Ha sido desarrollado un eslahx5n de datos, que opera por el principio de la modulation de la frecuencia, para transmitir senates fisioldgicas en forma analoga por una red telefonica. Las senates transmitidas han incluido los complejos del ECG y EEG, contornos de la presi<5n
arterial y presion venosa central, formas ondulatorias del neumotacograma y pletismograma y curvas de dilucidn de un colorante, aunque practicamente cualquier serial fisiologica es adecuada para este tipo de tratamiento. Durante estos dos ultimos afios el eslabonaje de datos ha sido utilizado constantemente entre St. Peter's Hospital, Covent Garden, y el Research Department of Anaesthetics en el Royal College of Surgeons para facilitar el tratamiento por computador de senates fisiologicas y hasta tres senales han sido enviadas simultaneamente. El uso con exito de este eslabdn de datos analogos de tres canales combinado con la aplicacidn del computador digital provee una neuva dimension en la investigation clinica y tratamiento de los pacientes. Especialmente la posibilidad de tratar las senales fisioldgicas en linea en el tiempo real ofrece la oportunidad de mejorar la exactitud de las mediciones, aumentar el niimero y amplitud de las variables fisiologicas adecuadas para el examen del paciente y desarrollar metodos seguros para la evaluation clinica.
568 Moglichkeit physiologische Signale direkt in reeller Zeit zu iibertragen Gelegenheit, die Genauigkeit der Messungen zu verbessern, die Zahl und den Bereich physiologischer variabler Werte, wie sie fur den Patienten wichtig sind, zu erweitern, und verlasslichere Methoden fiir die klinische Beurteilung zu enrwickeln.
EL USO DE ESLABONES DE DATOS TELEFONICOS ANALOGOS PARA LA TRANSMISION DE SElVALES FISIOLOGICAS RESUMEN
BOOK REVIEW Anaesthesia for neurological surgery (1971). By P. B. McComish and P. O. Bodley, Published by Lloyd-Luke, London. Pp. 412; indexed; illus. Price £5.50. It is a case of much-better-late-than-nevi;r that this book has only recently come for review after its publication in mid-1971. The two authors, presumably writing from experience gained mainly at th: Regional Centre for Neurosurgery at Oldchurch Hospital, Essex, have succeeded admirably in their intention to present a broad view of anaesthetic techniques for neurological surgery, to the extent of producing virtually the complete textbook. The first chapter reviews the early development of techniques of neurosurgical anaesthesia—Horsley's 30 minute operations, his "pain graph" for the safe use of chloroform (2% a rather high "unequilibrated MAC" for scalp incision?), and his belief that the relief of cerebral compression would allow more anaesthetic to reach th; brain. Thereafter the perspective of history is never lost; this is just one aspect of the authors' generally studious approach which helps to sustain the reader's interest. The three main sections deal with the intracranial contents and the pathology of raised pressure, with basic techniques of neurosurgical anaesthesia, and then with the specific management of individual surgical procedures. There is also a short chapter on electrophysiological investigations of surgical relevance, an appendix of drug names, a general biblography, and a satisfactory index; overall, including the printing and proof reading, the production has achieved a high standard. There are over 90 figures, and particularly useful are the frequent brief descriptions of surgical pathology (see, for instance, all the possible sites for cerebro-vascular aneurysms).
In the more controversial areas of neurosurgical anaesthesia (for example, surgery for subarachnoid haemorrhage and in the posterior fossa, the use of the sitting position, the apparent trust in neuroleptanalgesia in face of the established dangers of opiates), it takes an anaesthetist more than a few years before he can begin to evaluate objectively his personal experience. Thus, clinical impressions alone tend to dictate actions, which are sometimes quite unsuited to another neurosurgical environment. Here, the writers have scrutinised the literature widely, and have shown a genuine fairness to all published opinions (a refreshing feature, and far too rare these days). In just a few instances, perhaps, quotations from previous books are really clinical impressions without data to substantiate, and ths authors' own views are not always clearly defined. However, their approach is safe, and more suitable for teaching purposes than a highly personal documentation. As well as to the authors, this book is also a credit to tho!*5 not-so-few anaesthetists who have shown a persisting loyalty to neurosurgery; yes, they have tolerated boredom at times (less, probably, than imagined by their non-participating colleagues on the side-lines), but have derived satisfaction from avoiding faults which would go unnoticed in other fields, from being occupied at times in critical manoeuvres which are most unlikely to be delegated to "auxiliaries" of whatever description, and from a bitter chance than many have to engage actively in pre- and postoperative care. Neurosurgical techniques have far to progress, and the active participation of discerning anaesthetists can only be stimulated by books as good as this one. It is highly recommended. R. A. Millar
Downloaded from http://bja.oxfordjournals.org/ at Cornell University Library on July 27, 2015
Ha sido desarrollado un eslahx5n de datos, que opera por el principio de la modulation de la frecuencia, para transmitir senates fisioldgicas en forma analoga por una red telefonica. Las senates transmitidas han incluido los complejos del ECG y EEG, contornos de la presi<5n
arterial y presion venosa central, formas ondulatorias del neumotacograma y pletismograma y curvas de dilucidn de un colorante, aunque practicamente cualquier serial fisiologica es adecuada para este tipo de tratamiento. Durante estos dos ultimos afios el eslabonaje de datos ha sido utilizado constantemente entre St. Peter's Hospital, Covent Garden, y el Research Department of Anaesthetics en el Royal College of Surgeons para facilitar el tratamiento por computador de senates fisiologicas y hasta tres senales han sido enviadas simultaneamente. El uso con exito de este eslabdn de datos analogos de tres canales combinado con la aplicacidn del computador digital provee una neuva dimension en la investigation clinica y tratamiento de los pacientes. Especialmente la posibilidad de tratar las senales fisioldgicas en linea en el tiempo real ofrece la oportunidad de mejorar la exactitud de las mediciones, aumentar el niimero y amplitud de las variables fisiologicas adecuadas para el examen del paciente y desarrollar metodos seguros para la evaluation clinica.