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Anaesthesia at the district hospital Second edition Michael B. Dobson Chairman and Consultant Anaesthotist Nuffield Department of Anaesthetics John Radcliffe Hospital Oxford England illustrated by Derek Atherton and Elisabetta Sacco World Health Organization Geneva 2000 WHO Library Cataloguing in-Pubiication Data Dobson, Michae! 8. ‘Anaesthesia at the district hospltalMichael B, Dobson ilus- ‘uated by Dorok Atherton and Elsabetta Sacco — 2nd ed. Published in collaboration wth the World Fedoration of Societies of Anaesthesiologsts, {Anesthesia — methods 2Hospitals, District Manuals Tie ISBN 92 4 154527 5 (NUM Classification: WO 200) “The Weld Health Organization welcomes requests for permission to reproduce of tansiate its pubicallons, in part or in ful. Appl- cations and enquires should be addressed to the Otic of Publ- cations, World Health Organization, Goneva, Switzerland, which ‘willbe glad to provide the latest information on any changes made to th text, plans for new ealtons, and reprints and transitions already available. (© World Health Organization 2000 Publications of tho World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. llrightsreserved. “The designations employed and the presentation ofthe material in this publication do not imply the expression of any opinion what- ‘s02v6r on the part of the Secretariat of the World Health Organ- ization conceming the legal status of any country, terior, city or ‘rea oF of Is authorities, or concerning the delimitation af is ron- ‘irs or boundaries. ‘The mention of spectic companios or of certain manuiacturrs’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of similar nature that are not mentoned. Exors and omissions ‘excepted, the names of proprietary products are distinguished by inal capita letters. ‘The author alone is responsible for the views expressed in this publication, “Typeset in Hong Kong Printed in Bahvolo 98/12347 — Best-seVOxental — 2000 CONTENTS Preface to the second edition Preface to the first edition 1 Introduction 2 Fundamental techniques and skills Assessment of the critically ill and/or unconscious patient Care of the airway Failed intubation Care of the patient whose breathing is inadequate Management of the circulation Assessing the effects of treatment ‘Transportation of the critically ill patient When to abandon resuscitation The severely injured patient 3 Care of unconscious and anaesthetized patients General management Respiratory function in the anaesthetized patient ‘The cardiovascular system ‘Management of unexpected cardiorespiratory arrest 4 Principles of fluid and electrolyte therapy Fluid compartments of the body Fluid therapy Clinical assessment of fluid status Estimation of blood losses during surgery and the need for blood transfusion Specific losses and replacement Production of sterile fluids for intravenous use 5 Assessing the patient before anaesthesia Examining the patient Preoperative fasting and fluids Premedication for anaesthesia and surgery 6 General anaesthesia Before induction of anaesthesia Intravenous induction Intramuscular induction Inhalational induction Clinical use of anaesthetic equipment Draw-over apparatus Continuous-flow machines 57 57 68