During the last 20 years two groups of investigators have concerned themselves with the problem of acid-base regulation at various body temperatures. Each group, in professional isolation, pursued a separate path. Surgeons and anesthe tists developed techniques and tools for hypothermic cardio-pulmonary by-pass operations and based their rationale for acid-base management on in vitro models of blood behavior. Physiologists and biochemists, on the other hand, endeavored to understand acid-base regulation in living organisms naturally subjected to changes in body temperature. Only in the last decade has there been an increasing awareness that each group could benefit from the other's experiences. With this goal in mind members of both groups were invited to present their views and observations in the hope of arriving at a better understanding of acid-base management during hypothermia and gaining a greater insight into the factors which control acid-base regulation during normothermia. This led to the presen tation of the present volume with the aim of providing the clinician with a survey of present theories and the resulting strategies for management of the hypother mic patient. Acknowledgment The editors express their great appreciation to Miss Augusta Dustan for her dedicated effort in the preparation and editing of the manuscripts. Contributors Heinz Becker, M. D. Department of Surgery, University of California Medical Center, Los An geles, Los Angeles, CA 90024, U. S. A. Gerald D. Buckberg, M. D. Department of Surgery, University of California Medical Center, Los An geles, CA 90024, U. S. A.

Interest in comparative acid-base physiology has considerably grown during last decades even in the absence of major technical or conceptual advances. This is firstly because it has become clear that the extracellular acid-base state reflects the performance of many exchange functions at the organism level: respiration and ventilation of the gas exchange surfaces, metab olism, iono-and osmoregulation. Such functions are much in fluenced by ambient conditions, and the measurement of acid base parameters thus provides useful information about the organism's responses to environmental challenges. Secondly, many processes at the molecular level are now known to be pH sensitive, and acid-base regulation thus appears to be a major requirement for the functional integrity of cells and organisms. How extracellular acid-base balance can be maintained in a wide variety of animals living in different conditions is the sub ject of this book. The approach is comparative and environ mental throughout. All body fluids share similar buffer proper ties, and common physicochemical principles apply to any acid base system. However, in accord with differing designs and con straints along animal evolution, varying effector organs and mechanisms are at work to maintain an appropriate acid-base state in the organism. Particular emphasis is placed on the fun damental differences between water and air breathers and on the acid-base and respiratory problems arising at the transition from an aquatic to a terrestrial life. Also the complex array of factors influencing the acid-base state in water-dwelling animals is thoroughly discussed.

On 16 October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic effect of diethyl ether in a public demonstration in the "ether dome" of the Bulfinch Building of the Massachusetts General Hospital in Boston. The patient, Gilbert Abbott, suffered no pain, and the surgeon, Dr. John C. Warren, was able to complete a suture ligature of a vas cular tumor of the jaw without the hurry that until then was so necessary. The operation proved a failure, since the tumor recurred; but the demonstration of ether's anesthetic effect was a great success. Operative pain was conquered, and surgery could advance from a crude and unscientific practice where speed was paramount, and the major body cavities could not be entered, into the unique blend of science and art that it is now. "Gentlemen, this is no hum bug," supposedly muttered Warren, perhaps the last noncontroversial assess ment of anesthesiology to be made by a surgeon. The screams of resisting patients in pain were stilled, and quiet entered the operating room for the first time. But the new science of pain relief was quickly wrapped in controversy. An argument immediately arose as to who could legitimately claim primacy for the discovery. Morton's attempt to hide the true nature of his anesthetic agent, coupled with an effort to patent the discovery, clouded his reputation and stimulated other claimants to push themselves forward.

Rev. ed of: How to understand acid-base. c1981.

This volume is one of those published from the proceedings of the invited lectures to the First International Congress of Comparative Physiology and Biochemistry I organized at Liege (Belgium) in August 1984 under the auspices of the Section of Comparative Physiology and Biochemistry of the International Union of Biological Sciences. In a general foreword to these different volumes, it seems to me appropriate to consider briefly what may be the comparative approach. Living organisms, beyond the diversity of their morphological forms, have evolved a widespread range of basic solutions to cope with the different problems, both organisma1 and environmenta1 with which they are faced. Soon after the turn of the century, some biologists realized that these solutions can be best comprehended in the frame work of a comparative approach integrating results of physiologica1 and biochemica1 studies done at the organismic, cellular and molecular levels. The development of this approach amongst both physiologists and biochemists remained, however, extremely slow until recently.

Surviving Hypoxia: Mechanisms of Control and Adaptation is a synthesis of findings and thoughts concerning hypoxia. The thermodynamics of hypoxia are discussed in detail, including acid-base balance and self-pollution resulting from the accumulation of anaerobic end-products. The book focuses on descriptions and discussions of common facets, contrasting solutions in a variety of physiological hypoxia defense strategies, including those shown by plants, invertebrates, and vertebrates. Special treatment is given to the distinctive problems that hypoxia presents to vulnerable organs such as the kidney, liver, and brain. It also addresses pathological events in addition to protective mechanisms. Clinical implications of basic research are examined in the book, which provides new insights into underlying pathological processes occuring in hypoxic-induced organ failure and indicates new paths for successful clinical intervention. Surviving Hypoxia: Mechanisms of Control and Adaptation is an excellent reference for all researchers interested in the physiological effects of hypoxia, underlying pathological events, and protective mechanisms.

A broad-ranging, authoritative and accessible review of exciting discoveries in acid-base regulation in animals and plants, together with a critical look at techniques and tools.

Handbook of Blood Gas/Acid-Base Interpretation, 2nd edition, simplifies concepts in blood gas/acid base interpretation and explains in an algorithmic fashion the physiological processes for managing respiratory and metabolic disorders. With this handbook, medical students, residents, nurses, and practitioners of respiratory and intensive care will find it possible to quickly grasp the principles underlying respiratory and acid-base physiology, and apply them. Uniquely set out in the form of flow-diagrams/algorithms charts, this handbook introduces concepts in a logically organized sequence and gradually builds upon them. The treatment of the subject in this format, describing processes in logical steps makes it easy for the reader to cover a difficult- and sometimes dreaded- subject rapidly.