A thorough understanding of the basic principles of cardiovascular physiology is essential for effective and safe patient management in the perioperative period. This information provides a theoretical rationale for the use of drugs, intravenous infusions, and other therapeutic measures to…
The human heart beats billions of times during the course of a normal life span, with each beat representing the amalgamation of electrical, biochemical, and mechanical events that occur over milliseconds. This chapter reviews the cellular and molecular processes that…
Historical Perspective The nondepolarizing neuromuscular blocking agent (NMBA) d-tubocurarine has been used for 500 years as a paralyzing poison. In the 16th century, Sir Walter Raleigh reported that hunters in South America were using darts and arrows dipped in curare…
The neuromuscular junction (NMJ) is among the most studied of all synapses and serves as a prototype for understanding communication between neurons and effector cells within the central and peripheral nervous systems. Complete understanding of the development and function of…
The term nonopioid analgesics seems to imply a motley group of agents self-consciously trying to establish their parity with their famously potent cousins: the opioid family. With contemporary understanding of the complexities of both acute and chronic pain, the importance…
Historical Perspective The use of opium for treating pain dates back to at least ancient Egypt, but the modern opioid era began in 1804 when German pharmacist Friedrich Wilhelm Sertürner discovered the naturally occurring opioid morphine. Morphine and opium were…
Historical Perspective The white “latex” juice of the poppy plant is the source of more than 20 opiate alkaloids. Opium, a word derived from the Greek word for juice, is the brownish residue observed after the poppy's juice is desiccated.…
Systems Physiology Management of Perioperative Pain Despite significant progress in our mechanistic understanding of the nociceptive system, inadequately treated perioperative pain remains a significant problem. A third of patients undergoing surgery continue to suffer from moderate to severe pain, resulting…
Core body temperature is highly regulated in humans by the autonomic nervous system and the hypothalamus. General anesthesia, neuraxial anesthesia and analgesia, and drugs such as opioids all reduce the ability of the hypothalamus to regulate core temperature. Thus without…
The autonomic nervous system (ANS) maintains homeostasis by integrating signals from peripheral and central sensors to modulate organ perfusion and function. Autonomic “tone” maintains cardiac muscle, visceral organs, and vascular smooth muscle in a state of intermediate function. From this…