Anesthesia, Or Anaesthesia (See Spelling Differences; From

8/14/2019 Anesthesia, Or Anaesthesia (See Spelling Differences; From

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ANESTHESIA

Anesthesia, oranaesthesia (seespelling differences; fromGreek -, an-, "without"; and , aisthsis, "sensation"), has

traditionally meant the condition of havingsensation(including the feeling ofpain) blocked or temporarily taken away. This allows

patients to undergosurgery and other procedures without the distress and pain they would otherwise experience. The word was coined

byOliver Wendell Holmes, Sr.in 1846.[1]Another definition is a "reversible lack of awareness," whether this is a total lack of awareness

(e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic or another nerve block would cause.

Anesthesia is a pharmacologically induced reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle

reflexes and decreased stress response.

Contents

[hide]

1 Terms

2 History

o 2.1 Herbal derivatives

o 2.2 Non-pharmacological methods

o 2.3 Early gases and vapors

o 2.4 Early local anesthetics

3 Anaesthesia providers

o 3.1 Anaesthesiologists/Anaesthetists (medically-

trained physicians)

o 3.2 Nurse anaesthetists

o 3.3 Anaesthesiologist assistants

o 3.4 Anaesthesia technicians

o 3.5 Operating Department Practitioners

o 3.6 Veterinary anaesthetists/anaesthesiologists

4 Anaesthetic agents

5 Anaesthetic equipment

6 Anaesthetic monitoring

7 Anaesthesia record

8 Anaesthesia information management system (AIMS)

9 See also

10 Notes

11 External links

[edit]Terms
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Today, the term general anaesthesia in its most general form can include:[2]

Analgesia: blocking theconscious sensation of pain;

Hypnosis produces unconsciousness but not necessarily freedom from pain registration;

Amnesia: preventingmemory formation; if you are unconscious, by definition you will be unable to recall events.

Paralysis: preventing unwanted movement or muscle tone;

Obtundation of reflexes, preventing exaggerated autonomic reflexes.

Patients undergoing anaesthesia usually undergo preoperative evaluation. It includes gathering history of previous anesthetics, and any

other medical problems, physical examination, ordering required blood work and consultations prior to surgery.

There are several forms of anaesthesia. The following forms refer to states achieved by anesthetics working on the brain:

General anaesthesia: "Drug-induced loss of consciousness during which patients are not arousable, even by painful

stimulation." Patients undergoing general anesthesia can often neither maintain their own airway nor breathe on their own. While

usually administered with inhalational agents, general anesthesia can be achieved withintravenous agents, such aspropofol.[3]

Deepsedation/analgesia: "Drug-induced depression of consciousness during which patients cannot be easily aroused but

respond purposefully following repeated or painful stimulation." Patients may sometimes be unable to maintain their airway and

breathe on their own.[3]

Moderate sedation/analgesia or conscious sedation: "Drug-induced depression of consciousness during which patients

respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation." In this state, patients can

breathe on their own and need no help maintaining an airway.[3]

Minimal sedation or anxiolysis: "Drug-induced state during which patients respond normally to verbal commands." Though

concentration, memory, and coordination may be impaired, patients need no help breathing or maintaining an airway.[3]

The level of anesthesia achieved ranges on a continuum of depth of consciousness from minimal sedation to general anesthesia. The

depth of consciousness of a patient may change from one minute to the next.

The following refer to the states achieved by anesthetics working outside of the brain:

Regional anaesthesia: Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body.

Administered with local anesthesia to peripheral nerve bundles, such as the brachial plexus in the neck. Examples include the

interscalene block for shoulder surgery, axillary block for wrist surgery, andfemoral nerveblock for leg surgery. While traditionally

administered as a single injection, newer techniques involve placement of indwellingcatheters for continuous or intermittent

administration of local anesthetics.

Spinal anaesthesia: also known as subarachnoid block. Refers to a Regional block resulting from a small volume of

local anesthetics being injected into the spinal canal. The spinal canal is covered by thedura mater, through which the spinal
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needle enters. The spinal canal containscerebrospinal fluid and the spinal cord. The sub arachnoid block is usually injected

between the 4th and 5thlumbarvertebrae, because the spinal cord usually stops at the 1st lumbar vertebra, while the canal

continues to the sacral vertebrae. It results in a loss of pain sensation and muscle strength, usually up to the level of the chest

(nipple line or 4th thoracic dermatome).

Epidural anesthesia: Regional block resulting from an injection of a large volume of local anesthetic into the epidural

space. The epidural space is a potential spacethat lies underneath theligamenta flava, and outside thedura mater(outside

layer of the spinal canal). This is basically an injection around the spinal canal.

Local anesthesia is similar to regional anaesthesia, but exerts its effect on a smaller area of the body.

[edit]History

[edit]Herbal derivatives

The first anesthesia (an herbal remedy) was administered in prehistory.Opium poppy capsules were collected in 4200 BC, and opium

poppies were farmed in Sumeria and succeeding empires. The use of opium-like preparations in anesthesia is recorded in theEbers

Papyrus of 1500 BC. By 1100 BC poppies were scored for opium collection in Cyprus by methods similar to those used in the present

day, and simple apparatus for smoking of opium were found in a Minoantemple. Opium was not introduced to India and China until 330

BC and 6001200 AD respectively, but these nations pioneered the use ofcannabisincense andaconitum.Sushruta Samhita, a 3rd

century B.C Indian text, advocates the use of wine with incense of cannabis for anaesthasia[4]. In the second century, according to

theBook of the Later Han andRecords of Three Kingdoms, the physician Hua Tuoperformed abdominal surgery using an unknown

anesthetic calledmafeisan ( "cannabis boil powder") dissolved in liquor. Throughout Europe, Asia, and the Americas a variety

ofSolanumspecies containing potenttropane alkaloids were used, such as mandrake,henbane,Datura metel, andDatura inoxia.

Classic Greek and Roman medical texts byHippocrates,Theophrastus,Aulus Cornelius Celsus,Pedanius Dioscorides, andPliny the

Elderdiscussed the use of opium and Solanum species. In 13th century ItalyTheodoric Borgognoniused similar mixtures along with

opiates to induce unconsciousness, and treatment with the combined alkaloids proved a mainstay of anesthesia until the nineteenth

century. In the Americascocawas also an important anesthetic used intrephiningoperations.Incanshamanschewed cocaleaves and

performed operations on the skull while spitting into the wounds they had inflicted to anesthetize the site.[citation needed]Alcohol was also

used, itsvasodilatoryproperties being unknown. Ancient herbal anesthetics have variously been calledsoporifics,anodynes,

andnarcotics, depending on whether the emphasis is on producing unconsciousness or relieving pain.

In the famous 10th centuryPersianwork, the Shahnameh, the author, Ferdowsi, describes acesarean sectionperformed

on Rudabehwhen giving birth, in which a specialwineagent was prepared as an anesthetic[5] by aZoroastrianpriest inPersia, and

used to produce unconsciousness for the operation. Although largely mythical in content, the passage does at least illustrate knowledge

of anesthesia in ancient Persia. Arabic and Iraniananesthesiologists were the first to utilize oral as well asinhalant anesthetics.

In Islamic Spain, Abulcasis andIbn Zuhr(Avenzoar), among other Muslim surgeons, performed hundreds ofsurgeries under inhalant

anesthesia with the use of narcotic-soakedsponges. Abulcasis and Avicenna wrote about anesthesia in their influential medical

encyclopedias, theAl-TasrifandThe Canon of Medicine.[6][7]
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The use of herbal anesthesia had a crucial drawback compared to modern practiceas lamented by Fallopius, "When soporifics are

weak, they are useless, and when strong, they kill." To overcome this, production was typically standardized as much as feasible, with

production occurring from specific famous locations (such as opium from the fields ofThebesin ancient Egypt). Anesthetics were

sometimes administered in the spongia somnifera, a sponge into which a large quantity of drug was allowed to dry, from which a

saturated solution could be trickled into the nose of the patient. At least in more recent centuries, trade was often highly standardized,

with the drying and packing ofopiumin standard chests, for example. In the 19th century, varying aconitum alkaloids from a variety of

species were standardized by testing withguinea pigs. Despite these refinements, the discovery ofmorphine, a purified alkaloid that

soon afterward could be injected byhypodermicfor a consistent dosage, was enthusiastically received and led to the foundation of the

modern pharmaceutical industry.

Another factor affecting ancient anesthesia is that drugs used systemically in modern times were often administered locally, reducing the

risk to the patient. Opium used directly in a wound acts on peripheralopioid receptorsto serve as an analgesic [citation needed], and a

medicine containingwillowleaves (salicylate, the predecessor ofaspirin) would then be applied directly to the source of

inflammation[citation needed].

In 1804, the Japanese surgeonSeish Hanaoka performed general anesthesia for the operation of a breast cancer (mastectomy), by

combining Chinese herbal medicine know-how and Western surgery techniques learned through "Rangaku", or "Dutch studies". His

patient was a 60-year-old woman named Kan Aiya.[8]He used a compound he called Tsusensan, based on the plantsDatura

metel,Aconitumand others.

[edit]Non-pharmacological methods

Hypnotismhave a long history of use as anesthetic techniques. Chilling tissue (e.g. withice) can temporarily cause nerve fibers (axons)

to stop conducting sensation, whilehyperventilationcan cause brief alteration in conscious perception of stimuli including pain

(seeLamaze).

In modern anesthetic practice, these techniques are seldom employed.

[edit]Early gases and vapors

Contemporary re-enactment of Morton's October 16, 1846, ether operation;daguerrotypebySouthworth & Hawes.
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In the West, the development of effective anesthetics in the 19th century was, with Listeriantechniques, one of the keys to successful

surgery. Henry Hill Hickman experimented withcarbon dioxidein the 1820s. Nitrous oxide was discovered in 1769 byJoseph

Priestley[9] and its anesthetic qualities were discovered by the British chemist Humphry Davyin 1799,[9] when he was an assistant

to Thomas Beddoes, and reported in a paper in 1800. But initially the medical uses of this so-called "laughing gas" were limitedits

main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by

American dentistWilliam Thomas Green Morton. Horace WellsofConnecticut, a traveling dentist, had demonstrated it the previous year

1845 atMassachusetts General Hospital. Wells made a mistake in choosing a particularly sturdy male volunteer, and the patient

suffered considerable pain. This lost the colorful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A

subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulfuric acid.

Anaesthesia pioneer Crawford W. Long

Another dentist,William E. Clarke, performed an extraction in January 1842 using a different chemical, diethyl ether(discovered

byValerius Cordusin 1540). In March 1842 inDanielsville, Georgia, Dr.Crawford Long was the first to use anesthesia during an

operation, giving it to his friend, who was also a school teacher (James M. Venable) before excising a cyst from his neck. Long got the

idea to do this from his observations at ether frolics. He noted that participants experienced bumps and bruises but afterward had no

recall of what had happened. He did not publicize this information until 1849.

On October 16, 1846, dentist William Thomas Green Morton, invited to the Massachusetts General Hospital, performed the first public

demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an

excision of a vascular tumor from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the

state produced ansthesia, and the procedure an ansthetic.

Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news

of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeonsincluding
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Liston, Dieffenbach, Pirogoff, and Symeundertook numerous operations with ether. An American-born physician, Boottwho had

traveled to Londonencouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was

the first case of an operator-anesthetist. On the same day, 19 December 1846 in Dumfries Royal Infirmary, Scotland, a Dr. Scott used

ether for a surgical procedure. The first use of anesthesia in the Southern Hemisphere took place in Launceston, Tasmania, that same

year. Ether has a number of drawbacks, such as its tendency to induce vomitingand its flammability. In England it was quickly replaced

withchloroform.

Discovered in 1831, the use of chloroform in anesthesia is usually linked to James Young Simpson, who, in a wide-ranging study of

organic compounds, found chloroform's efficacy on 4 November 1847. Its use spread quickly and gained royal approval in 1853

whenJohn Snow gave it to Queen Victoria during the birth ofPrince Leopold. Unfortunately, chloroform is not as safe an agent as ether,

especially when administered by an untrained practitioner (medical students,nurses, and occasionally members of the public were often

pressed into giving anesthetics at this time). This led to many deaths from the use of chloroform that (with hindsight) might have been

preventable. The first fatality directly attributed to chloroform anesthesia (Hannah Greener) was recorded on 28 January 1848.

John Snow of London published articles from May 1848 onwards 'On Narcotism by the Inhalation of Vapours' in the London Medical

Gazette. Snow also involved himself in the production of equipment needed for inhalational anesthesia.

The surgical amphitheater at Massachusetts General Hospital, or "ether dome," still exists today, although it is used for lectures and not

surgery. The public can visit the amphitheater on weekdays when it is not in use.

[edit]Early local anesthetics

The first effective local anesthetic wascocaine. Isolated in 1859, it was first used byKarl Koller, at the suggestion ofSigmund Freud, in

ophthalmic surgery in 1884.[9]Before that doctors had used a salt and ice mix for the numbing effects of cold, which could only have

limited application. Similar numbing was also induced by a spray of ether or ethyl chloride. A number of cocaine derivatives and safer

replacements were soon produced, including procaine(1905),Eucaine(1900),Stovaine(1904), and lidocaine(1943).

Opioids were first used by Racoviceanu-Piteti, who reported his work in 1901.

[edit]Anaesthesia providers

Physicians specializing in peri-operative care, development of an anesthetic plan, and the administration of anesthetics are known in the

United States as anesthesiologists and in the UK and Canada as anaesthetists oranaesthesiologists. All anesthetics in the UK,

Australia, New Zealand and Japan are administered by physicians. Nurse anesthetists also administer anesthesia in 109 nations .[10]In

the US, 35% of anesthetics are provided by physicians in solo practice, about 55% are provided by Anesthesia Care Teams (ACTs) with

anesthesiologists medically directing Anesthesiologist Assistants or CRNAs, and about 10% are provided by CRNAs in solo practice .[11]

[12][13] -[14]-[15]

[edit]Anaesthesiologists/Anaesthetists (medically-trained physicians)

File:Anaesthesia patient simulator.jpg

Anesthesiology students training with a patient simulator.
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CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services.

CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniquesgeneral,

regional, local, or sedation. CRNAs do not require Anesthesiologist supervision in any state and require surgeon/dentist/podiatrists to

sign and approve the chart for medicare billing in all but 16 states. Many states place restrictions on practice, and hospitals often

regulate what CRNAs and other midlevel providers can or can not do based on local laws, provider training and experience, and hospital

and physician preferences.[24]

[edit]Anaesthesiologist assistants

In the United States, anesthesiologist assistants (AAs) are graduate-level trained specialists who have undertaken specialized education

and training to provide anesthesia care under the direction of an Anesthesiologist. AAs typically hold a masters degree and practice

under Anesthesiologist supervision in 18 states through licensing, certification or physician delegation.[25]

In the UK, a similar group of assistants are currently being evaluated. They are named Physician's Assistant (Anaesthesia) (PAAs).

Their background can be nursing, Operating Department Practice, or another profession allied to medicine or a science graduate.

Training is in the form of a post-graduate diploma and takes 27 months to complete. Once finished, a masters degree can be

undertaken.[citation needed]

[edit]Anaesthesia technicians

Anesthesia technicians are specially trained biomedical technicians who assist anesthesiologists, nurse anesthetists, and

anesthesiologist assistants with monitoring equipment, supplies, and patient care procedures in the operating room. Commonly these

services are collectively called Perioperative services, and thus the term Perioperative Service Technician (PST) is used

interchangeably with Anesthesia Technician.

In New Zealand, an anaesthetic technician completes a course of study recognized by theNew Zealand Anaesthetic Technicians

Society[26] .

[edit]Operating Department Practitioners

In the United Kingdom,Operating Department Practitionersprovide close assistance and support to the anaesthetist(anaesthesiologist).

[citation needed] They can also assist with surgical procedures alongside the surgeon and provide Post-Operative Care to patients emerging

from anesthesia. ODPs can be found in the Operating Department, Accident and Emergency (providing advanced airway assistance),

Intensive Care Unit, High Dependency Unit and for specialist MRI scanners which require anesthetic cover. They also work with organ

retrieval teams in transplant surgery and attend pre hospital care to injury victims in the community and will undertake advanced

specialist training to carry out this work. They are state registered in the UK and their title, Operating Department Practitioner is a

protected title. The ODP is not a technician but a practitioner of peri-opertive care. ODPs also work in the f ield of teaching as lecturers,

resuscitation trainers and work in senior positions in management of operating theatre departments.

[edit]Veterinary anaesthetists/anaesthesiologists

Main article:Veterinary anesthesia

Veterinary anesthetists utilize much the same equipment and drugs as those who provide anesthesia to human patients. In the case of

animals, the anesthesia must be tailored to fit the species ranging from large land animals like horses or elephants to birds to aquatic
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animals like fish. For each species there are ideal, or at least less problematic, methods of safely inducing anesthesia. For wild animals,

anesthetic drugs must often be delivered from a distance by means of remote projector systems ("dart guns") before the animal can

even be approached. Large domestic animals, like cattle, can often be anesthetized for standing surgery using only local anesthetics

and sedative drugs. While most clinical veterinarians and veterinary technicians routinely function as anesthetists in the course of their

professional duties, veterinary anesthesiologists in the U.S. are veterinarians who have completed a two-year residency in anesthesia

and have qualified for certification by the American College of Veterinary Anesthesiologists.

[edit]Anaesthetic agents

Main article:Anesthetic

An anesthetic agent is a drug that brings about a state of anesthesia. A wide variety of drugs are used in modern anesthetic practice.

Many are rarely used outside of anesthesia, although others are used commonly by all disciplines. Anesthetics are categorized in to two

categories:general anestheticscause a reversible loss of consciousness (general anesthesia), while local anesthetics cause

reversible local anesthesiaand a loss ofnociception.

[edit]Anaesthetic equipment

Main article:Anaesthetic equipment

In modern anesthesia, a wide variety of medical equipment is desirable depending on the necessity for portable field use, surgical

operations or intensive care support. Anesthesia practitioners must possess a comprehensive and intricate knowledge of the production

and use of variousmedical gases, anesthetic agents and vapors, medicalbreathing circuitsand the variety ofanesthetic

machines (including vaporizers, ventilators and pressure gauges) and their corresponding safety features, hazards and limitations of

each piece of equipment, for the safe, clinical competence and practical application for day to day practice.

[edit]Anaesthetic monitoring

Patients being treated under general anesthetics must be monitored continuously to ensure the patient's safety. In the UK the

Association of Anaesthetists (AAGBI) have set minimum monitoring guidelines for General and Regional Anaesthesia. For minor

surgery, this generally includes monitoring ofheart rate(viaECGorpulse oximetry), oxygen saturation (via pulse oximetry), non-

invasive blood pressure, inspired and expired gases (foroxygen, carbon dioxide, nitrous oxide, and volatile agents). For moderate to

major surgery, monitoring may also includetemperature, urine output, invasive blood measurements (arterial blood pressure,central

venous pressure), pulmonary artery pressure and pulmonary artery occlusion pressure, cerebral activity (via EEGanalysis),

neuromuscular function (viaperipheral nerve stimulation monitoring), and cardiac output. In addition, the operating room's environment

must be monitored for temperature and humidity and for buildup of exhaledinhalational anestheticswhich might impair the health of

operating room personnel.

[edit]Anaesthesia record

The anesthesia record is the medical and legal documentation of events during an anesthetic.[27] It reflects a detailed and continuous

account of drugs, fluids, and blood products administered and procedures undertaken, and also includes the observation of

cardiovascular responses, estimated blood loss, urinary body fluids and data from physiologic monitors (Anesthetic monitoring, see
http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=14http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=14http://en.wikipedia.org/wiki/Anesthetichttp://en.wikipedia.org/wiki/Anesthetichttp://en.wikipedia.org/wiki/General_anesthetichttp://en.wikipedia.org/wiki/General_anesthetichttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Nociceptionhttp://en.wikipedia.org/wiki/Nociceptionhttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=15http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=15http://en.wikipedia.org/wiki/Anaesthetic_equipmenthttp://en.wikipedia.org/wiki/Anaesthetic_equipmenthttp://en.wikipedia.org/w/index.php?title=Breathing_circuits&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Breathing_circuits&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Breathing_circuits&action=edit&redlink=1http://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=16http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=16http://en.wikipedia.org/wiki/Heart_ratehttp://en.wikipedia.org/wiki/Heart_ratehttp://en.wikipedia.org/wiki/Heart_ratehttp://en.wikipedia.org/wiki/ECGhttp://en.wikipedia.org/wiki/ECGhttp://en.wikipedia.org/wiki/ECGhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Oxygen_saturationhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Body_temperaturehttp://en.wikipedia.org/wiki/Body_temperaturehttp://en.wikipedia.org/wiki/Arterial_blood_pressurehttp://en.wikipedia.org/wiki/Arterial_blood_pressurehttp://en.wikipedia.org/wiki/Central_venous_pressurehttp://en.wikipedia.org/wiki/Central_venous_pressurehttp://en.wikipedia.org/wiki/Central_venous_pressurehttp://en.wikipedia.org/wiki/EEGhttp://en.wikipedia.org/wiki/EEGhttp://en.wikipedia.org/w/index.php?title=Peripheral_nerve_stimulation_monitoring&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Peripheral_nerve_stimulation_monitoring&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Peripheral_nerve_stimulation_monitoring&action=edit&redlink=1http://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Inhalational_anestheticshttp://en.wikipedia.org/wiki/Inhalational_anestheticshttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=17http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=17http://en.wikipedia.org/wiki/#cite_note-26http://en.wikipedia.org/wiki/#cite_note-26http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=14http://en.wikipedia.org/wiki/Anesthetichttp://en.wikipedia.org/wiki/General_anesthetichttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/wiki/Local_anesthetichttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Nociceptionhttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=15http://en.wikipedia.org/wiki/Anaesthetic_equipmenthttp://en.wikipedia.org/w/index.php?title=Breathing_circuits&action=edit&redlink=1http://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=16http://en.wikipedia.org/wiki/Heart_ratehttp://en.wikipedia.org/wiki/ECGhttp://en.wikipedia.org/wiki/Pulse_oximetryhttp://en.wikipedia.org/wiki/Oxygen_saturationhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Body_temperaturehttp://en.wikipedia.org/wiki/Arterial_blood_pressurehttp://en.wikipedia.org/wiki/Central_venous_pressurehttp://en.wikipedia.org/wiki/Central_venous_pressurehttp://en.wikipedia.org/wiki/EEGhttp://en.wikipedia.org/w/index.php?title=Peripheral_nerve_stimulation_monitoring&action=edit&redlink=1http://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Inhalational_anestheticshttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=17http://en.wikipedia.org/wiki/#cite_note-26


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above) during the course of an anesthetic. The anesthesia record may be written manually on paper; however, the paper record is

increasingly replaced by an electronic record as part of an Anesthesia Information Management System (AIMS).

[edit]Anaesthesia information management system (AIMS)

An AIMSrefers to anyinformation systemthat is used as an automated electronic anesthesia record keeper (i.e., connection to patient

physiologic monitors and/or the anesthetic machine) and which also may allow the collection andanalysis of anesthesia-related

perioperative patientdata.

[edit]See also

Geriatric anaesthesia

Anaesthesia awareness

Anesthetic technician

Allergic reactions during anesthesia

ASA physical status classification system

Sedation

EEG measures during anesthesia

Patient safety

Perioperative mortality

Second gas effect

[edit]Notes

1. ^ Morris Fishbein, M.D., ed (1976). "Anesthesia". The New Illustrated Medical and Health Encyclopedia. 1 (Home Library Edition

ed.). New York, N.Y. 10016: H. S. Stuttman Co. pp. 87.

2. ^ Miller, Ronald (2005). Miller's Anesthesia. New York: Elsevier/Churchill Livingstone.ISBN 0443066566.

3. ^ abcd"Continuum Of Depth Of Sedation Definition Of General Anesthesia And Levels Of Sedation/Analgesia",American Society of

Anaesthesiologists, ASA, 2004-10-27

4. ^ Raju VK (2003)."Sushruta of ancient India". Retrieved 2007-05-24.

5. ^ Medicine throughout Antiquity. Benjamin Lee Gordon. 1949. p.306

6. ^ Dr. Kasem Ajram (1992). Miracle of Islamic Science, Appendix B. Knowledge House Publishers.ISBN 0911119434.7. ^ Sigrid Hunke (1969),Allah Sonne Uber Abendland, Unser Arabische Erbe, Second Edition, pp. 279280:

"The science of medicine has gained a great and extremely important discovery and that is the use of general anaesthetics for

surgical operations, and how unique, efficient, and merciful for those who tried it the Muslim anaesthetic was. It was quite different

from the drinks the Indians, Romans and Greeks were forcing their patients to have for relief of pain. There had been some

allegations to credit this discovery to an Italian or to an Alexandrian, but the truth is and history proves that, the art of using the
http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=18http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=18http://en.wikipedia.org/wiki/Anesthesia_Information_Management_Systemhttp://en.wikipedia.org/wiki/Anesthesia_Information_Management_Systemhttp://en.wikipedia.org/wiki/Information_systemhttp://en.wikipedia.org/wiki/Information_systemhttp://en.wikipedia.org/wiki/Information_systemhttp://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/wiki/Analysishttp://en.wikipedia.org/wiki/Analysishttp://en.wikipedia.org/wiki/Datahttp://en.wikipedia.org/wiki/Datahttp://en.wikipedia.org/wiki/Datahttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=19http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=19http://en.wikipedia.org/w/index.php?title=Geriatric_anaesthesia&action=edit&redlink=1http://en.wikipedia.org/wiki/Anaesthesia_awarenesshttp://en.wikipedia.org/wiki/Anaesthetic_Technicianhttp://en.wikipedia.org/wiki/Allergic_reactions_during_anaesthesiahttp://en.wikipedia.org/wiki/ASA_physical_status_classification_systemhttp://en.wikipedia.org/wiki/Sedationhttp://en.wikipedia.org/wiki/EEG_measures_during_anesthesiahttp://en.wikipedia.org/wiki/Patient_safetyhttp://en.wikipedia.org/wiki/Perioperative_mortalityhttp://en.wikipedia.org/wiki/Second_gas_effecthttp://en.wikipedia.org/wiki/Second_gas_effecthttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=20http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=20http://en.wikipedia.org/wiki/#cite_ref-0http://en.wikipedia.org/wiki/#cite_ref-miller_1-0http://en.wikipedia.org/wiki/Special:BookSources/0443066566http://en.wikipedia.org/wiki/Special:BookSources/0443066566http://en.wikipedia.org/wiki/Special:BookSources/0443066566http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-0http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-0http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-1http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-1http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-2http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-3http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-3http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-3http://www.asahq.org/publicationsAndServices/standards/20.pdfhttp://en.wikipedia.org/wiki/#cite_ref-Raju2003_3-0http://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=2;spage=119;epage=122;aulast=Rajuhttp://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=2;spage=119;epage=122;aulast=Rajuhttp://en.wikipedia.org/wiki/#cite_ref-4http://en.wikipedia.org/wiki/#cite_ref-5http://en.wikipedia.org/wiki/Special:BookSources/0911119434http://en.wikipedia.org/wiki/Special:BookSources/0911119434http://en.wikipedia.org/wiki/Special:BookSources/0911119434http://en.wikipedia.org/wiki/#cite_ref-6http://en.wikipedia.org/wiki/Sigrid_Hunkehttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=18http://en.wikipedia.org/wiki/Anesthesia_Information_Management_Systemhttp://en.wikipedia.org/wiki/Information_systemhttp://en.wikipedia.org/wiki/Anaesthetic_machinehttp://en.wikipedia.org/wiki/Analysishttp://en.wikipedia.org/wiki/Datahttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=19http://en.wikipedia.org/w/index.php?title=Geriatric_anaesthesia&action=edit&redlink=1http://en.wikipedia.org/wiki/Anaesthesia_awarenesshttp://en.wikipedia.org/wiki/Anaesthetic_Technicianhttp://en.wikipedia.org/wiki/Allergic_reactions_during_anaesthesiahttp://en.wikipedia.org/wiki/ASA_physical_status_classification_systemhttp://en.wikipedia.org/wiki/Sedationhttp://en.wikipedia.org/wiki/EEG_measures_during_anesthesiahttp://en.wikipedia.org/wiki/Patient_safetyhttp://en.wikipedia.org/wiki/Perioperative_mortalityhttp://en.wikipedia.org/wiki/Second_gas_effecthttp://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=20http://en.wikipedia.org/wiki/#cite_ref-0http://en.wikipedia.org/wiki/#cite_ref-miller_1-0http://en.wikipedia.org/wiki/Special:BookSources/0443066566http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-0http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-1http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-2http://en.wikipedia.org/wiki/#cite_ref-asadepth_2-3http://www.asahq.org/publicationsAndServices/standards/20.pdfhttp://en.wikipedia.org/wiki/#cite_ref-Raju2003_3-0http://www.ijo.in/article.asp?issn=0301-4738;year=2003;volume=51;issue=2;spage=119;epage=122;aulast=Rajuhttp://en.wikipedia.org/wiki/#cite_ref-4http://en.wikipedia.org/wiki/#cite_ref-5http://en.wikipedia.org/wiki/Special:BookSources/0911119434http://en.wikipedia.org/wiki/#cite_ref-6http://en.wikipedia.org/wiki/Sigrid_Hunke


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anaesthetic sponge is a pure Muslim technique, which was not known before. The sponge used to be dipped and left in a mixture

prepared from cannabis, opium, hyoscyamus and a plant called Zoan."

(cf. Prof. Dr. M. Taha Jasser,Anaesthesia in Islamic medicine and its influence on Western civilization, Conference on Islamic Medicine)

8. ^ Utopian surgery: Early arguments against anaesthesiain surgery, dentistry and childbirth

9. ^ abc Morris Fishbein, M.D., ed (1976). "Anesthesia". The New Illustrated Medical and Health Encyclopedia. 1 (Home Library Edition

ed.). New York, N.Y. 10016: H. S. Stuttman Co. pp. 89.

10. ^ "Nurse anesthesia worldwide: practice, education and regulation"(PDF). International Federation of Nurse Anesthetists. Retrieved

2007-02-08.

11. ^ "Is Physician Anesthesia Cost-Effective?". Anesth Analg. 2007-02-01. Retrieved 2007-02-15.

12. ^ "When do anesthesiologists delegate?". Med Care. 2007-02-01. Retrieved 2007-02-15.

13. ^ "Nurse anestheisa worldwide: practice, education and regulation"(PDF). International Federation of Nurse Anesthetists. Retrieved

2007-02-08.

14. ^ "Surgical mortality and type of anesthesia provider". AANA. 2007-02-25. Retrieved 2007-02-25.

15. ^ "Anesthesia Providers, Patient Outcomes, and Cost"(pdf). Anesth Analg. 2007-02-25. Retrieved 2007-02-25.

16. ^ "ASA Fast Facts: Anesthesiologists Provide Or Participate In 90 Percent Of All Annual Anesthetics". ASA. Retrieved 2007-03-22.

17. ^ http://en.wikipedia.org/wiki/Echocardiography#Transesophageal_echocardiogram

18. ^ www.harvardmedsim.org/

19. ^ med.stanford.edu/VAsimulator/medsim.html

20. ^ http://msmc.affinitymembers.net/simulator/intro2.html

21. ^ simcenter.duke.edu/

22. ^ http://aana.com/aboutaana.aspx?

ucNavMenu_TSMenuTargetID=127&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=38

23. ^ http://aana.com/BecomingCRNA.aspx?


24. ^ http://www.aana.com/Advocacy.aspx?


25. ^ "Five facts about AAs". American Academy of Anesthesiologist Assistants. Retrieved 2007-02-08.

26. ^ New Zealand Anaesthetic Technicians Society

27. ^ Stoelting RK, Miller RD: Basics of Anesthesia, 3rd edition, 1994.

[edit]External links

American Association of Nurse Anesthetists
http://en.wikipedia.org/wiki/Cf.http://en.wikipedia.org/wiki/Cf.http://www.islamset.com/hip/i_medcin/taha_jasser.htmlhttp://www.islamset.com/hip/i_medcin/taha_jasser.htmlhttp://www.islamset.com/hip/i_medcin/taha_jasser.htmlhttp://en.wikipedia.org/wiki/#cite_ref-7http://www.general-anaesthesia.com/http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-0http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-0http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-1http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-1http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-2http://en.wikipedia.org/wiki/#cite_ref-9http://ifna-int.org/ifna/e107_files/downloads/Practice.pdfhttp://ifna-int.org/ifna/e107_files/downloads/Practice.pdfhttp://en.wikipedia.org/wiki/#cite_ref-10http://www.anesthesia-analgesia.org/cgi/content/full/98/3/750#R7-138848http://en.wikipedia.org/wiki/#cite_ref-11http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=2725080&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=2725080&dopt=Abstracthttp://en.wikipedia.org/wiki/#cite_ref-12http://ifna-int.org/ifna/e107_files/downloads/Practice.pdfhttp://ifna-int.org/ifna/e107_files/downloads/Practice.pdfhttp://en.wikipedia.org/wiki/#cite_ref-13http://www.aana.com/news.aspx?ucNavMenu_TSMenuTargetID=171&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1606&terms=medical+direction+percent&searchtype=1&fragment=Truehttp://en.wikipedia.org/wiki/#cite_ref-14http://nursing.fiu.edu/anesthesiology/COURSES/Semester%203/NGR%206760%20ANE%20Prof%20Aspects/PROF%20Readings/Abenstein.pdfhttp://nursing.fiu.edu/anesthesiology/COURSES/Semester%203/NGR%206760%20ANE%20Prof%20Aspects/PROF%20Readings/Abenstein.pdfhttp://en.wikipedia.org/wiki/#cite_ref-15http://www.asahq.org/PressRoom/homepage.htmlhttp://www.asahq.org/PressRoom/homepage.htmlhttp://en.wikipedia.org/wiki/#cite_ref-16http://en.wikipedia.org/wiki/Echocardiography#Transesophageal_echocardiogramhttp://en.wikipedia.org/wiki/#cite_ref-17http://en.wikipedia.org/wiki/#cite_ref-18http://en.wikipedia.org/wiki/#cite_ref-19http://msmc.affinitymembers.net/simulator/intro2.htmlhttp://en.wikipedia.org/wiki/#cite_ref-20http://en.wikipedia.org/wiki/#cite_ref-21http://aana.com/aboutaana.aspx?ucNavMenu_TSMenuTargetID=127&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=38http://aana.com/aboutaana.aspx?ucNavMenu_TSMenuTargetID=127&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=38http://en.wikipedia.org/wiki/#cite_ref-22http://aana.com/BecomingCRNA.aspx?ucNavMenu_TSMenuTargetID=18&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1018http://aana.com/BecomingCRNA.aspx?ucNavMenu_TSMenuTargetID=18&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1018http://en.wikipedia.org/wiki/#cite_ref-23http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573http://en.wikipedia.org/wiki/#cite_ref-24http://www.anesthetist.org/content/view/14/38/http://en.wikipedia.org/wiki/#cite_ref-25http://www.nzats.co.nz/http://en.wikipedia.org/wiki/#cite_ref-26http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=21http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=21http://www.aana.com/http://en.wikipedia.org/wiki/Cf.http://www.islamset.com/hip/i_medcin/taha_jasser.htmlhttp://en.wikipedia.org/wiki/#cite_ref-7http://www.general-anaesthesia.com/http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-0http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-1http://en.wikipedia.org/wiki/#cite_ref-illustrated_8-2http://en.wikipedia.org/wiki/#cite_ref-9http://ifna-int.org/ifna/e107_files/downloads/Practice.pdfhttp://en.wikipedia.org/wiki/#cite_ref-10http://www.anesthesia-analgesia.org/cgi/content/full/98/3/750#R7-138848http://en.wikipedia.org/wiki/#cite_ref-11http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=2725080&dopt=Abstracthttp://en.wikipedia.org/wiki/#cite_ref-12http://ifna-int.org/ifna/e107_files/downloads/Practice.pdfhttp://en.wikipedia.org/wiki/#cite_ref-13http://www.aana.com/news.aspx?ucNavMenu_TSMenuTargetID=171&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1606&terms=medical+direction+percent&searchtype=1&fragment=Truehttp://en.wikipedia.org/wiki/#cite_ref-14http://nursing.fiu.edu/anesthesiology/COURSES/Semester%203/NGR%206760%20ANE%20Prof%20Aspects/PROF%20Readings/Abenstein.pdfhttp://en.wikipedia.org/wiki/#cite_ref-15http://www.asahq.org/PressRoom/homepage.htmlhttp://en.wikipedia.org/wiki/#cite_ref-16http://en.wikipedia.org/wiki/Echocardiography#Transesophageal_echocardiogramhttp://en.wikipedia.org/wiki/#cite_ref-17http://en.wikipedia.org/wiki/#cite_ref-18http://en.wikipedia.org/wiki/#cite_ref-19http://msmc.affinitymembers.net/simulator/intro2.htmlhttp://en.wikipedia.org/wiki/#cite_ref-20http://en.wikipedia.org/wiki/#cite_ref-21http://aana.com/aboutaana.aspx?ucNavMenu_TSMenuTargetID=127&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=38http://aana.com/aboutaana.aspx?ucNavMenu_TSMenuTargetID=127&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=38http://en.wikipedia.org/wiki/#cite_ref-22http://aana.com/BecomingCRNA.aspx?ucNavMenu_TSMenuTargetID=18&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1018http://aana.com/BecomingCRNA.aspx?ucNavMenu_TSMenuTargetID=18&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1018http://en.wikipedia.org/wiki/#cite_ref-23http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2573http://en.wikipedia.org/wiki/#cite_ref-24http://www.anesthetist.org/content/view/14/38/http://en.wikipedia.org/wiki/#cite_ref-25http://www.nzats.co.nz/http://en.wikipedia.org/wiki/#cite_ref-26http://en.wikipedia.org/w/index.php?title=Anesthesia&action=edit&section=21http://www.aana.com/


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Journals - Other Links to GP's Home Pages

Colleges and Medical Associations
http://www.asahq.org/http://ifna-int.org/ifna/http://www.barna.co.uk/http://www.sfar.org/http://www.dgf-online.de/http://www.siga-fsia.ch/http://www.siga-fsia.ch/http://www.nvam.nl/content.asphttp://www.aniva.se/http://www.iars.org/home/default.asphttp://msmc.affinitymembers.net/simulator/intro2.htmlhttp://www.criticalcarenews.com/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#19http://www.rnzcgp.org.nz/relevant-links/relevant-links/#20http://www.rnzcgp.org.nz/relevant-links/relevant-links/#2http://www.rnzcgp.org.nz/relevant-links/relevant-links/#21http://www.rnzcgp.org.nz/relevant-links/relevant-links/#3http://www.rnzcgp.org.nz/relevant-links/relevant-links/#22http://www.rnzcgp.org.nz/relevant-links/relevant-links/#4http://www.rnzcgp.org.nz/relevant-links/relevant-links/#23http://www.rnzcgp.org.nz/relevant-links/relevant-links/#5http://www.rnzcgp.org.nz/relevant-links/relevant-links/#24http://www.rnzcgp.org.nz/relevant-links/relevant-links/#6http://www.rnzcgp.org.nz/relevant-links/relevant-links/#25http://www.rnzcgp.org.nz/relevant-links/relevant-links/#7http://www.rnzcgp.org.nz/relevant-links/relevant-links/#26http://www.rnzcgp.org.nz/relevant-links/relevant-links/#8http://www.rnzcgp.org.nz/relevant-links/relevant-links/#27http://www.rnzcgp.org.nz/relevant-links/relevant-links/#9http://www.rnzcgp.org.nz/relevant-links/relevant-links/#28http://www.rnzcgp.org.nz/relevant-links/relevant-links/#10http://www.rnzcgp.org.nz/relevant-links/relevant-links/#29http://www.rnzcgp.org.nz/relevant-links/relevant-links/#11http://www.rnzcgp.org.nz/relevant-links/relevant-links/#30http://www.rnzcgp.org.nz/relevant-links/relevant-links/#12http://www.rnzcgp.org.nz/relevant-links/relevant-links/#31http://www.rnzcgp.org.nz/relevant-links/relevant-links/#13http://www.rnzcgp.org.nz/relevant-links/relevant-links/#32http://www.rnzcgp.org.nz/relevant-links/relevant-links/#14http://www.rnzcgp.org.nz/relevant-links/relevant-links/#33http://www.rnzcgp.org.nz/relevant-links/relevant-links/#15http://www.rnzcgp.org.nz/relevant-links/relevant-links/#34http://www.rnzcgp.org.nz/relevant-links/relevant-links/#16http://www.rnzcgp.org.nz/relevant-links/relevant-links/#35http://www.rnzcgp.org.nz/relevant-links/relevant-links/#17http://www.rnzcgp.org.nz/relevant-links/relevant-links/#36http://www.rnzcgp.org.nz/relevant-links/relevant-links/#18http://www.rnzcgp.org.nz/relevant-links/relevant-links/#37http://www.asahq.org/http://ifna-int.org/ifna/http://www.barna.co.uk/http://www.sfar.org/http://www.dgf-online.de/http://www.siga-fsia.ch/http://www.siga-fsia.ch/http://www.nvam.nl/content.asphttp://www.aniva.se/http://www.iars.org/home/default.asphttp://msmc.affinitymembers.net/simulator/intro2.htmlhttp://www.criticalcarenews.com/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#19http://www.rnzcgp.org.nz/relevant-links/relevant-links/#20http://www.rnzcgp.org.nz/relevant-links/relevant-links/#2http://www.rnzcgp.org.nz/relevant-links/relevant-links/#21http://www.rnzcgp.org.nz/relevant-links/relevant-links/#3http://www.rnzcgp.org.nz/relevant-links/relevant-links/#22http://www.rnzcgp.org.nz/relevant-links/relevant-links/#4http://www.rnzcgp.org.nz/relevant-links/relevant-links/#23http://www.rnzcgp.org.nz/relevant-links/relevant-links/#5http://www.rnzcgp.org.nz/relevant-links/relevant-links/#24http://www.rnzcgp.org.nz/relevant-links/relevant-links/#6http://www.rnzcgp.org.nz/relevant-links/relevant-links/#25http://www.rnzcgp.org.nz/relevant-links/relevant-links/#7http://www.rnzcgp.org.nz/relevant-links/relevant-links/#26http://www.rnzcgp.org.nz/relevant-links/relevant-links/#8http://www.rnzcgp.org.nz/relevant-links/relevant-links/#27http://www.rnzcgp.org.nz/relevant-links/relevant-links/#9http://www.rnzcgp.org.nz/relevant-links/relevant-links/#28http://www.rnzcgp.org.nz/relevant-links/relevant-links/#10http://www.rnzcgp.org.nz/relevant-links/relevant-links/#29http://www.rnzcgp.org.nz/relevant-links/relevant-links/#11http://www.rnzcgp.org.nz/relevant-links/relevant-links/#30http://www.rnzcgp.org.nz/relevant-links/relevant-links/#12http://www.rnzcgp.org.nz/relevant-links/relevant-links/#31http://www.rnzcgp.org.nz/relevant-links/relevant-links/#13http://www.rnzcgp.org.nz/relevant-links/relevant-links/#32http://www.rnzcgp.org.nz/relevant-links/relevant-links/#14http://www.rnzcgp.org.nz/relevant-links/relevant-links/#33http://www.rnzcgp.org.nz/relevant-links/relevant-links/#15http://www.rnzcgp.org.nz/relevant-links/relevant-links/#34http://www.rnzcgp.org.nz/relevant-links/relevant-links/#16http://www.rnzcgp.org.nz/relevant-links/relevant-links/#35http://www.rnzcgp.org.nz/relevant-links/relevant-links/#17http://www.rnzcgp.org.nz/relevant-links/relevant-links/#36http://www.rnzcgp.org.nz/relevant-links/relevant-links/#18http://www.rnzcgp.org.nz/relevant-links/relevant-links/#37


13/18

American Academy of Family Practice

American Medical Association

British Medical Association

Colleges of Medicine of South Africa

Irish College of General Practitioners

North of Scotland Institute of Postgraduate Medical Education

The Royal College of General Practitioners - UK

The Royal Australian College of General Practitioners

Wellington School of Medicine

University of Auckland Department of General Practice and Primary Health Care

WONCA - Global Family Doctor

Top

Cardiology

The Online Journal of Cardiology

Top

CME

Goodfellow Unit - An Auckland region RNZCGP CME provider

Dermnet for NZ GPs - Gain CME points here

Top

Dental

Dental Council of New Zealand

New Zealand Dental Association

The Dental Surgeon site

Top

Dermatology

American Academy of Dermatology

Australasian College of Dermatologists

Dermnet - NZ Dermatological Society

Archives of Dermatology

The Australasian Journal of Dermatology

International Journal of Dermatology

The British Journal of Dermatology

Top

Diabetes

AIDA - glucose insulin diabetes simulator software

Top

Drug Information

Mosby's Drug Consult

Pharmac

Top

Emergency Medicine

Emergency Medicine at NCEMI

Top

Enuresis

National Enuresis Society

Enuresis Clinic

Top
http://www.aafp.org/http://www.ama-assn.org/http://www.bma.org.uk/http://www.collegemedsa.ac.za/http://www.icgp.ie/http://www.nes.scot.nhs.uk/http://www.rcgp.org.uk/http://www.racgp.org.au/http://www.wnmeds.ac.nz/http://www.health.auckland.ac.nz/gp/http://www.globalfamilydoctor.com/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://sprojects.mmi.mcgill.ca/heart/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.fmhs.auckland.ac.nz/soph/centres/goodfellow/cpe/doctors.aspxhttp://www.dermnet.org.nz/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.dentalcouncil.org.nz/http://www.nzda.org.nz/http://www.dentalsurgeon.co.nz/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.aad.org/http://www.dermcoll.asn.au/http://www.dermnet.org.nz/http://archderm.ama-assn.org/http://www.blackwellpublishing.com/journal.asp?ref=0004-8380http://www.blackwellpublishing.com/journal.asp?ref=0011-9059http://www.blackwellpublishing.com/journal.asp?ref=0007-0963http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.2aida.org/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.mosby.com/Mosby/PhyGenRX/index.htmlhttp://www.pharmac.govt.nz/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.ncemi.org/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.bedwet.net/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.aafp.org/http://www.ama-assn.org/http://www.bma.org.uk/http://www.collegemedsa.ac.za/http://www.icgp.ie/http://www.nes.scot.nhs.uk/http://www.rcgp.org.uk/http://www.racgp.org.au/http://www.wnmeds.ac.nz/http://www.health.auckland.ac.nz/gp/http://www.globalfamilydoctor.com/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://sprojects.mmi.mcgill.ca/heart/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.fmhs.auckland.ac.nz/soph/centres/goodfellow/cpe/doctors.aspxhttp://www.dermnet.org.nz/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.dentalcouncil.org.nz/http://www.nzda.org.nz/http://www.dentalsurgeon.co.nz/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.aad.org/http://www.dermcoll.asn.au/http://www.dermnet.org.nz/http://archderm.ama-assn.org/http://www.blackwellpublishing.com/journal.asp?ref=0004-8380http://www.blackwellpublishing.com/journal.asp?ref=0011-9059http://www.blackwellpublishing.com/journal.asp?ref=0007-0963http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.2aida.org/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.mosby.com/Mosby/PhyGenRX/index.htmlhttp://www.pharmac.govt.nz/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.ncemi.org/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.bedwet.net/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#top


14/18

Evidence Based Medicine

Bandolier

Cochrane Library

Evidence-Based Medicine - Evidence-Based Medicine, a co-publication of the BMJ Publishing Group and the American

College of Physicians-American Society of Internal Medicine

Evidence-Based Medicine Resources - BMJ Publishing Group

Scharr Introduction to Evidence Based Practice on the Internet

Top

General

Medivision

Centres for Disease Control and Prevention

Effective Health Care Bulletins

Global Health Resourses.com

Global Family Doctor - WONCA Online

Health Communication Network

Health on the Net Foundation

HealthAtoZ.Com

Healthanswers

Healthworks

Health Reform.online

Housecall

Martindale's Health Science Guide -'98

Medical Matrix

Medicine Net

Medscape

Merck Manual

Primary Health Care Network

Resident Medical Officers Handbook

Reuters Health Information Services

University of Iowa - Family Practice Handbook

The Virtual Hospital

Top

Geriatric

Normal Aging Index

Top

Guidelines

Guideline Library - NZ Guidelines Group

Top

Immunisation

Immunisation Advisory Centre

Immunet

Top

Literature Reviews
http://www.medicine.ox.ac.uk/bandolier/http://www.thecochranelibrary.com/http://group.bmj.com/products/evidence-centre/evidence-based-medicine-resources/ebm-resources?grp=1http://www.shef.ac.uk/~scharr/ir/netting/http://www.rnzcgp.org.nz/relevant-links/relevant-links/#tophttp://www.medivision.com/http://www.cdc.gov/http://www.york.ac.uk/inst/crd/ehcb.htmhttp://www.globalhealthresources.com/default.htmhttp://www.globalfamilydoctor.com/http://www.hcn.net.au/http://www.hon.ch/http://www.healthatoz.com/http://www.healthanswers.com/http://www.healthworks.co.uk/http://www.worldbank.org/healthreform

Documents

Anesthesia, Or Anaesthesia (See Spelling Differences; From