Anatomy for Anaesthetists

This new 9th edition has been fully revised and updated to incorporate developments in regional techniques and the increased use of ultrasound.

Harold Ellis, CBE, MA, DM, MCh, FRCS, FRCP, FRCOG FACS (Hon)
Clinical Anatomist, Guy’s, King’s and St Thomas’s School of Biomedical Sciences; and Emeritus
Professor of Surgery, Charing Cross and Westminster Medical School, London, UK

Andrew Lawson, FFARCSI, FANZCA, FRCA, MSc
Hon. Consultant in Pain Medicine, Chelsea & Westminster Hospital, London, UK

Preface to the Ninth (Jubilee) Edition, xi

Foreword to the First Edition, xiii

Introduction to the First Edition, xiii

Acknowledgements to the Ninth (Jubilee) Edition, xv

Part 1: The Respiratory Pathway, Lungs, Thoracic Wall and Diaphragm

The mouth, 3

The palate, 3

The nose, 6

The paranasal sinuses, 9

Blood supply, 10

Nerve supply, 11

Structure, 13

The functions of the nose, 13

The pharynx, 15

The nasopharynx, 15

The oropharynx, 16

Vascular, lymphatic and nerve supply, 17

The laryngopharynx, 18

The structure of the pharynx, 18

The muscles of the pharynx, 19

Deglutition, 21

The larynx, 24

The laryngeal cartilages, 24

The laryngeal ligaments, 26

The muscles of the larynx, 33

Blood supply, 36

Lymph drainage, 36

Nerve supply, 37

Structure, 42

The trachea, 42

Relations, 43

Vascular, lymphatic and nerve supply, 46

The main bronchi, 46

The pleura, 48

The lines of pleural reflection, 48

The intercostal spaces, 51

The intercostal muscles, 52

The neurovascular bundle, 53

The mediastinum, 56

The lungs, 57

The lung lobes, 61

The relationships at the root of the lung, 62

The bronchopulmonary segments, 63

Bronchoscopic anatomy, 66

The structure of the lung and bronchial tree, 67

The pulmonary blood supply, 69

Lymphatics, 71

Innervation, 71

The development of the respiratory tract, 71

The diaphragm, 72

Anatomical features, 72

The diaphragm as a muscle of respiration, 75

The diaphragm and the ‘cardiac sphincter’, 75

The development of the diaphragm, 76

Part 2: The Heart and Great Veins of the Neck

The pericardium, 81

The heart, 82

The chambers of the heart, 84

The conducting system of the heart, 88

The blood supply of the heart, 89

Nerve supply, 90

Surface markings, 90

Developmental anatomy, 92

The development of the heart, 92

The development of the aortic arches and their derivatives, 93

The fetal circulation, 95

Congenital abnormalities of the heart and great vessels, 96

The great veins of the neck, 98

Part 3: The Vertebral Canal and its Contents

The vertebrae and sacrum, 109

The vertebrae, 109

The cervical vertebrae, 109

The thoracic vertebrae, 113

The lumbar vertebrae, 114

The sacrum, 120

Vertebral anomalies, 125

The intervertebral ligaments, 127

The spinal meninges, 130

The dura mater, 130

The arachnoid mater, 131

The pia mater, 131

The compartments related to the spinal meninges, 132

The cerebrospinal fluid, 136

The spinal cord, 137

The structure of the cord, 139

Blood supply, 142

Part 4: The Peripheral Nerves

The spinal nerves, 149

Meningeal relations, 149

Vertebral relations, 149

The paravertebral space, 150

The posterior primary rami, 151

The anterior primary rami, 154

The cervical plexus, 156

Formation of the plexus, 156

Summary of branches, 157

The stellate ganglion, 161

The brachial plexus, 165

Formation of the plexus, 165

The relations of the brachial plexus, 168

The branches of the brachial plexus, 169

Supraclavicular branches of the brachial plexus, 174

Infraclavicular branches of the brachial plexus, 174

Variations, 188

The segmental innervation of the upper limb, 190

The thoracic nerves, 190

Anterior primary rami, 190

The lumbar plexus, 192

Formation of the plexus, 193

Distribution of the lumbar plexus, 195

The sacral and coccygeal plexuses, 201

Formation of the plexuses, 202

Relations, 202

Summary of the branches of the sacral plexus, 204

The collateral branches, 204

The terminal branches, 205

The sciatic foramina, 219

The coccygeal plexus, 219

The segmental innervation of the lower limb, 220

Part 5: The Autonomic Nervous System

Introduction, 225

Autonomic afferents, 227

The sympathetic system, 228

Spinal level, 228

The sympathetic trunk, 228

The ganglia of the sympathetic trunk, 231

The plexuses of the sympathetic system, 236

Higher sympathetic centres, 239

The parasympathetic system, 239

The cranial outflow, 239

The sacral outflow, 241

Afferent parasympathetic fibres, 241

Part 6: The Cranial Nerves

Introduction, 245

The basic plan of the cranial nuclei, 245

The olfactory nerve (I), 247

The optic nerve (II), 249

The oculomotor nerve (III), 251

The trochlear nerve (IV), 253

The trigeminal nerve (V), 254

The ophthalmic nerve (V), 258

The maxillary nerve (V), 261

The mandibular nerve (V), 268

The abducent nerve (VI), 275

The facial nerve (VII), 275

The auditory (vestibulocochlear) nerve (VIII), 279

The glossopharyngeal nerve (IX), 281

The vagus nerve (X), 284

Course and relations, 285

The branches and distribution of the vagus nerve, 287

The accessory nerve (XI), 289

The hypoglossal nerve (XII), 290

Part 7: Miscellaneous Zones of Interest

The thoracic inlet, 295

Outlines and boundaries, 295

The 1st rib, 295

Cervical ribs, 297

Surface markings, 297

The antecubital fossa, 298

Boundaries, 298

Roof, 298

Contents, 298

Structures of clinical importance, 300

The orbit and its contents, 303

The bony orbit, 303

The orbital foramina, 305

The subdivisions of the orbit, 305

The eyeball, 306

Contents of the eyeball, 308

The orbital muscles, 309

The fascial sheath of the eye, 310

The eyelids and conjunctiva, 311

The lacrimal apparatus, 312

The abdominal wall, 314

Landmarks, 314

Fascia, 315

Muscles, 315

Blood supply, 319

Nerve supply, 319

Part 8: The Anatomy of Pain

Introduction, 323

Classification of pain, 324

Peripheral receptors and afferent fibres, 324

Peripheral sensitization, 325

Cutaneous nociceptors, 325

Other somatic structures, 325

Visceral nociception, 326

The spinal cord and central projections, 326

The dorsal horn, 326

Ascending systems, 328

Spinothalamic tract, 328

Spinoreticular tract, 329

Cerebral processing and the pain matrix, 329

Modulation of pain signals, 330

Cortical modulation, 330

Descending inhibitory pathways, 331

The gate control theory of pain, 332

Central sensitization of pain, 332

The autonomic nervous system and pain, 333

Index, 335

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