Safe sedation of children for diagnostic and therapeutic procedures
This article will discuss how sedation can be safely performed. The depth of sedation has been classified into minimal, moderate and deep according to the National Institute for Health and Care Excellence. Amongst others, benefits of sedation include increased parental and child satisfaction, increased cost benefits for the hospital and reduced adverse effects of general anaesthesia such as emergence delirium and postoperative nausea and vomiting. Safe sedation can be used for a wide range of procedures, most commonly for CT and MRI. Others include removing drains, changing burns dressings, simple plastic surgery procedure...
Source: Anaesthesia and intensive care medicine - April 23, 2016 Category: Anesthesiology Source Type: research

Paediatric day case surgery
This article discusses the role of preoperative assessment and the need to consider each case individually despite robust inclusion/exclusion criteria. Optimization of preoperative hydration, pain management and prevention of postoperative nausea and vomiting are highlighted as important factors to successful day case surgery. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - April 23, 2016 Category: Anesthesiology Source Type: research

Neuraxial anaesthesia in paediatrics
Publication date: Available online 20 April 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Justin Long, Amod Sawardekar, Santhanam Suresh Neuraxial anaesthesia is a valuable aid in the practice of paediatric anaesthesia. Spinal and epidural blockade are used as either the sole anaesthetic or as an adjunct to general anaesthesia, and often confer significant postoperative analgesia. Caudal epidural anaesthesia is used extensively for lower abdominal, urological, and orthopaedic procedures in the setting of outpatient surgery. Lumbar and thoracic epidural infusions via a catheter can provide analge...
Source: Anaesthesia and intensive care medicine - April 21, 2016 Category: Anesthesiology Source Type: research

Pain assessment in children
This article outlines the different tools available for pain assessment in infants and children (excluding neonates). (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - April 21, 2016 Category: Anesthesiology Source Type: research

Principles of paediatric anaesthesia
This article provides an overview of the practical aspects of paediatric anaesthesia, with particular emphasis on airway and fluid management. Common dilemmas that may be encountered during preoperative assessment are highlighted, including the child with asthma, obstructive sleep apnoea and the particularly anxious child. In light of the findings of the fourth National Audit Project (NAP4), strategies for managing the child with the difficult airway are discussed. The rationale for the use of isotonic perioperative fluids is outlined, along with the management of intraoperative blood loss. The increasingly recognized prob...
Source: Anaesthesia and intensive care medicine - April 21, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for carotid surgery
Publication date: Available online 31 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Katherine Livingstone, Indran Raju Carotid endarterectomy (CEA) is a surgical procedure to prevent strokes in patients with atheromatous disease at the carotid bifurcation. The effectiveness of CEA has been established in large clinical trials. Patients should have surgery performed within 2 weeks from the onset of symptoms. This time frame presents a challenge to the anaesthetist and surgeon in risk stratifying and optimizing patients for surgery. Optimization includes blood pressure (BP) control and use of...
Source: Anaesthesia and intensive care medicine - March 31, 2016 Category: Anesthesiology Source Type: research

Applied cardiovascular physiology
Publication date: Available online 29 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Jon Hopper, Carla Gould Maintaining an equilibrium between oxygen supply and demand is a principal function of the cardiovascular system. In times of altered metabolic demand mechanisms exist to maintain the balance between supply and demand. Exercise, haemorrhage and pregnancy all lead to changes in oxygen demand and subsequently modification of cardiac output. The main response to isotonic exercise is an increased cardiac output by autonomically mediated increases in heart rate and venous return. This allo...
Source: Anaesthesia and intensive care medicine - March 29, 2016 Category: Anesthesiology Source Type: research

Insertion of a chest drain for pneumothorax
This article examines the indications for chest drain insertion for pneumothorax and the choice of drain. The equipment required is outlined and the positioning and preparation for the procedure described, including the choice of pre-medication. Techniques for insertion of both Seldinger-style and wide-bore chest drain are also described, including safe administration of local anaesthesia for intercostal block. The procedures outlined include how to place securing sutures and the preferred alternative to the old ‘purse-string’ technique for later closure of a tract following wide-bore chest drain. Troubleshooti...
Source: Anaesthesia and intensive care medicine - March 26, 2016 Category: Anesthesiology Source Type: research

Preoperative assessment of patients for major vascular surgery
Publication date: Available online 22 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): James W. Durrand, Gerard R. Danjoux Effective preoperative evaluation of patients prior to major vascular surgery remains a significant multidisciplinary challenge. Focussed preoperative evaluation targeted to organ systems can mitigate the combined effects of inherently high-risk surgical procedures undertaken in a patient population with well-recognized comorbidity. Careful history and examination, supported by appropriate investigations and specialist input, remains the cornerstone of this process, with r...
Source: Anaesthesia and intensive care medicine - March 22, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for the ruptured aortic aneurysm
We present the key components of emergency anaesthesia for both OAR and EVAR and describe clinical dilemmas arising at preoperative and intraoperative stages. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 21, 2016 Category: Anesthesiology Source Type: research

Self-assessment
Publication date: Available online 19 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Vijayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 19, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for elective open abdominal aortic surgery
Publication date: Available online 14 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Alastair Duncan, Adam Pichel The prevalence of abdominal aortic aneurysm (AAA) and the number of patients undergoing aneurysm repair is increasing. The UK has worked hard to reduce its operative mortality rates for elective open AAA repair with the introduction of a quality improvement programme and death from ruptured aortic aneurysm through the national screening programme. Despite the increased prevalence of disease and intervention, the popularity of open repair is diminishing since the advent of endovas...
Source: Anaesthesia and intensive care medicine - March 15, 2016 Category: Anesthesiology Source Type: research

Postoperative care and analgesia in vascular surgery
Publication date: Available online 11 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Rachael L. Bird, Ian Nesbitt Patients undergoing major vascular surgery are high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Reduction of myocardial oxygen demand is key: stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia. Continuation of preoperative risk reduction strategies in...
Source: Anaesthesia and intensive care medicine - March 12, 2016 Category: Anesthesiology Source Type: research

Neurological and humoral control of blood pressure
Publication date: Available online 11 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Peadar B. O’Donohoe, Jaideep J. Pandit There is a relationship between arterial blood pressure, cardiac output and vascular resistance which can be described mathematically, and helps us to understand the short-term control of blood pressure in the terms of a hydraulic system. The sensors in this system are the arterial baroreceptors which mediate changes in the hydraulic system through control of the autonomic nervous system, which in turn influences heart rate, inotropy and vascular tone. Altering th...
Source: Anaesthesia and intensive care medicine - March 12, 2016 Category: Anesthesiology Source Type: research

Risk modification and preoperative optimization of vascular patients
This article summarizes currently accepted best practice for risk modification and preoperative optimization prior to vascular surgery. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 12, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for vascular surgery on the extremities
Publication date: Available online 12 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Richard J. Telford Peripheral arterial surgery is challenging, operations are frequently long and associated with insidious blood loss. Because of the high incidence of co-morbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 12, 2016 Category: Anesthesiology Source Type: research

Total intravenous anaesthesia
Publication date: Available online 8 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Christopher Hawthorne, Nick Sutcliffe Driven by better understanding of the pharmacokinetic principles involved and improvements in infusion pump technology, total intravenous anaesthesia (TIVA) has become more popular and has many potential advantages. Application of the three-compartment model can be used to calculate the plasma and theoretical effect-site concentrations of anaesthetic drugs for a given dosing regimen. Initially, manual dosing schedules were developed to permit TIVA, but such regimes were i...
Source: Anaesthesia and intensive care medicine - March 10, 2016 Category: Anesthesiology Source Type: research

The anaesthetic machine
Publication date: Available online 8 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Geraint Briggs, Jessica Maycock In 1917, Dr Henry Edmund Gaskin Boyle OBE developed his continuous-flow anaesthesia machine, the design of which is the forerunner of all modern anaesthetic machines. This prototype has undergone significant changes to increase the efficiency of anaesthesia and patient safety. Gases (oxygen, nitrous oxide and air) arrive at the machine via the hospital's piped medical gases and vacuum system via colour-coded tubing. Cylinders attached to the back of the machine provide a back-u...
Source: Anaesthesia and intensive care medicine - March 10, 2016 Category: Anesthesiology Source Type: research

Principles of artificial ventilation
Publication date: Available online 8 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Ben Brown, Justin Roberts The application of intermittent positive pressure ventilation (IPPV) during the 1952 Copenhagen polio epidemic led to the development of the world's first intensive care unit. The requirement for ventilatory support is the most common indication for intensive therapy unit (ITU) admission and is a defining feature of the speciality. Ventilator technology continues to develop and there are many ways to deliver IPPV. The variety of modes of ventilation is increasingly complex and expand...
Source: Anaesthesia and intensive care medicine - March 10, 2016 Category: Anesthesiology Source Type: research

Principles of anaesthetic vaporizers
Publication date: Available online 5 March 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Judith Young, Vikas Kapoor Vaporizers are an integral part of modern-day anaesthesia, allowing the delivery of safe concentrations of volatile anaesthetic agent. Over time, vaporizer design has improved to be closer to the ideal. Today, vaporizers can be classified as ‘variable bypass’, where a portion of the fresh gas flow passes through the vaporizing chamber, or ‘measured flow’, where the flow of volatile agent is separately measured as it passes under pressure into the fresh gas fl...
Source: Anaesthesia and intensive care medicine - March 5, 2016 Category: Anesthesiology Source Type: research

Practical aspects of ultrasound-guided regional anaesthesia
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Pavan Kumar B.C. Raju, Calum R.K. Grant Ultrasound-guided regional anaesthesia is increasingly popular, offering the user a number of advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). These include a more accurate understanding of individual patient anatomy, identification of needle tip position and the ability to assess local anaesthetic spread in relation to a target nerve. An understanding of the basic principles and commonly used terminologies of ultrasound ...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Postoperative analgesia
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Jessica L.R. Chapman, Abdul G. Lalkhen Pain should be regarded as a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved by an approach which acknowledges the complex interactions between biological, psychological and sociocultural factors. Effective pain management requires thorough patient preparation and education to manage expectations and a robustly structured inpatient service for postoperative pain management and c...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Patient selection for day surgery
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Leanne Darwin Day surgery is a planned pathway delivered by a multidisciplinary team and is perhaps better described as ‘same day surgery’. In 2000 the NHS set a target of performing 75% of operations as same day surgery but practice varies widely; an assessment of 10 procedures easily performed as same day surgery showed rates varying from 19% to 90% by procedure and the potential day case rate was not being reached for any procedure. There is a move to ‘treat day surgery as the norm&rsq...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Action potential: generation and propagation
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Allan Fletcher In the normal resting state, the plasma membrane of nerve and muscle cells generates a transmembrane electrical potential difference – the intracellular surface of the membrane being approximately 70–80mV negative to the extracellular surface. This is a result of markedly different concentrations of ions inside and outside the cell, together with different membrane permeabilities to different ions that permits K+ ions to flow down their concentration gradient from inside to outsi...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Intravenous regional anaesthesia
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew R. Checketts Intravenous regional anaesthesia was first described in 1908 by the versatile German surgeon August Bier. The technique is still widely known as the ‘Bier's block’ and, if carried out by appropriately trained practitioners, is a useful regional anaesthetic technique for short surgical procedures on the forearm, lower leg or foot. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Systemic toxic effects of local anaesthetics
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Christina Beecroft, Gillian Davies Systemic toxicity from local anaesthetic agent use is a rare but potentially life-threatening complication. It most commonly occurs following inadvertent intravascular injection. High plasma levels of local anaesthetic lead to central nervous system and cardiovascular toxicity. Treatment of toxicity is mainly supportive; however, there is now evidence for the use of lipid emulsions in the management of severe local anaesthetic toxicity. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Omics and anaesthesia: pharmacogenomics, proteomics and metabolomics
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): David G. Lambert There has been an explosion of interest in the simultaneous study of a large number of biologically relevant molecules, the most well-known example being the study of a large number of genes or genomics with these large number of genes forming the genome. Similarly, the study of the translation products of these genes: proteins (the proteome) can be investigated in proteomics and metabolic products (metabolome) in metabolomics (or metabonomics). It is possible to compare, for example, the ...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Upper limb nerve blocks
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): David M. Coventry, Pavan Kumar B.C. Raju Brachial plexus blockade is commonly used for a variety of upper limb surgical procedures and the introduction of ultrasound guidance has led to re-evaluation of many of the approaches. Large-scale studies examining both efficacy and complications of ultrasound-guided techniques compared with nerve stimulation are lacking, but there is a growing body of research to support the routine use of ultrasound. Interscalene block remains the approach of choice for shoulder...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Anaesthetic breathing systems
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Katie Gott, Stuart Dolling A breathing system is a series of components assembled to allow delivery of oxygen and other anaesthetic gases to the patient as well as assisting the removal of carbon dioxide. There are elements that feature in all anaesthetic breathing systems regardless of classification and the layout of individual breathing systems determines their clinical application and use. These will be discussed further in this article together with a brief summary of the use of carbon dioxide absorb...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Intravenous anaesthetic agents
This article summarizes drug properties frequently used for intravenous anaesthetic induction. The mechanism of general anaesthesia is still unknown, hence physicochemical properties, metabolism and side effects are often more relevant than the way that the way they act to cause unconsciousness. This article also highlights new developments in drug administration and some newer agents. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Nerve cell function and synaptic mechanisms
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Allan Fletcher Nerve cells (neurones) are ‘excitable’ cells that can transduce a variety of stimuli into electrical signals, continuously sending information about the external and internal environment (in the form of sequences of action potentials) to the central nervous system (CNS). Interneurones in the CNS integrate this information and send signals along output (efferent) neurones to various parts of the body for the appropriate actions to be taken in response to environmental changes. Net...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Effects of smoking on health and anaesthesia
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Phillippa Shorrock, Nawar Bakerly Legislation prohibiting smoking in workplaces and enclosed public places was introduced in England in July 2007. This, in addition to the 2012 prohibition of tobacco promotion, and the increased use of e-cigarettes, are all changing our smoking behaviour as a nation. Nevertheless tobacco remains a major factor in disease development and smokers continue to present a number of anaesthetic challenges. Perioperative smoking cessation is beneficial and NHS support is availabl...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Pharmacokinetic variation
Publication date: Available online 23 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Marc Chikhani, Jonathan G. Hardman Pharmacokinetics is the study of how a drug is handled within the body. Variation in drug absorption, distribution, metabolism or excretion will alter drug concentration at the target site. Appreciation of the principle causes of pharmacokinetic variation will ensure avoidance of sub-therapeutic drug regimes and unnecessary side effects through over-dosage. The processes of absorption, distribution, metabolism and excretion can be affected by a number of physiological, p...
Source: Anaesthesia and intensive care medicine - February 25, 2016 Category: Anesthesiology Source Type: research

Complications of regional anaesthesia
Publication date: Available online 22 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Megan C. Dale, Matthew R. Checketts Complications of regional anaesthesia can be divided into those specific to central neuraxial blockade, those specific to peripheral nerve blockade, and those that pertain to both. Fortunately, severe complications – namely, spinal cord damage, vertebral cord haematoma and epidural abscess – are rare. Here we have given an overview of these complications, with reference to updated incidences available following the 3rd National Audit Project (NAP3) of the Ro...
Source: Anaesthesia and intensive care medicine - February 23, 2016 Category: Anesthesiology Source Type: research

Peripheral nerve catheter techniques
Publication date: Available online 22 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Shilpa Munirama, Graeme McLeod Peripheral nerve catheter techniques provide pain relief on movement for upper and lower limb arthroplasty and limb amputation and improve limb blood flow. Perineural infusion of local anaesthetic minimizes perioperative opioid consumption and, in doing so, reduces opioid-related side effects. Good pain relief accelerates rehabilitation and has the potential to reduce hospital length of stay. However, few studies have investigated the effect of perineural infusion on long-te...
Source: Anaesthesia and intensive care medicine - February 23, 2016 Category: Anesthesiology Source Type: research

Lower limb nerve blocks
Publication date: Available online 22 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Calum R.K. Grant, Pavan Kumar B.C. Raju Peripheral nerve blocks are increasingly used for a wide range of surgical procedures involving the lower limb. A number of techniques can be used to provide anaesthesia and highly effective postoperative analgesia, offering an alternative to general anaesthesia in some cases, minimizing the requirement for strong opiates and improving the quality of recovery following surgery. Ultrasound-guided nerve localization offers several potential advantages when performing ...
Source: Anaesthesia and intensive care medicine - February 23, 2016 Category: Anesthesiology Source Type: research

Risks of perioperative blood transfusions
This article outlines the risks associated with perioperative transfusions and discusses the current recommendations for transfusion and use of alternatives to blood transfusion. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 4, 2016 Category: Anesthesiology Source Type: research

Physiology of haemostasis
Publication date: Available online 4 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): James Sira, Lorna Eyre Haemostasis is a complex and sophisticated process that requires the interplay of multiple physiological pathways. Cellular and molecular mechanisms interact to seal damaged blood vessels with localized clot formation preventing significant bleeding. Once vascular integrity is restored, clot breakdown occurs and normal haemostasis is reinstated. Thrombohaemorrhagic imbalance may occur in the perioperative period or during critical illness, leading to an increased risk of thrombosis, ...
Source: Anaesthesia and intensive care medicine - February 4, 2016 Category: Anesthesiology Source Type: research

Jehovah's Witnesses
Publication date: Available online 1 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Catherine Brydon The Jehovah's Witness society is a Christian movement established 140 years ago. It has around 7 million members worldwide who believe that the Bible prohibits the transfusion of blood and its primary components. Some minor components of plasma and clotting factors may be acceptable to some members of the faith. Similarly some will accept intraoperative cell salvage where their own blood from the surgical site can be aspirated and returned to them provided the blood remains within a cl...
Source: Anaesthesia and intensive care medicine - February 2, 2016 Category: Anesthesiology Source Type: research

Clinical aspects of coagulation and haemorrhage
Publication date: Available online 1 February 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Robert H. Broomhead, Alice E. Myers, Susan V. Mallett Haemostasis is a complex physiological cascade that results in cessation of bleeding following injury. Inherited bleeding diatheses and hypercoagulable diseases remain a source of patient morbidity that should be recognized and managed. Liver disease should be seen as a heterogeneous group of disorders with unpredictable coagulation effects. The CRASH II trial, recent recommendation by the European Medicines Agency for re-licensing of Trasylol (aprotin...
Source: Anaesthesia and intensive care medicine - February 2, 2016 Category: Anesthesiology Source Type: research

Strategies to avoid intraoperative blood transfusion
This article addresses the current evidence base for intraoperative strategies to avoid blood transfusion in these settings. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 31, 2016 Category: Anesthesiology Source Type: research

Capillary dynamics and the interstitial fluid–lymphatic system
Publication date: Available online 30 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Jim Waterhouse, Marina Sawdon, Emrys Kirkman The capillaries are the ‘business end’ of the circulatory system, where materials exchange between the plasma and tissues. Water-soluble molecules can diffuse through pores in the capillaries, and a Gibbs–Donnan equilibrium exists between the plasma and interstitium. There are several types of capillaries, which vary in their anatomical integrity and permeability. There is also a bulk flow of fluids between the plasma and interstitium, describ...
Source: Anaesthesia and intensive care medicine - January 31, 2016 Category: Anesthesiology Source Type: research

Characteristics of special circulations
Publication date: Available online 28 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Marina Sawdon Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on...
Source: Anaesthesia and intensive care medicine - January 30, 2016 Category: Anesthesiology Source Type: research

Pre-optimization of the anaemic patient
This article will give an overview of the approach to a patient found to be anaemic before surgery. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 30, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for patients with sickle cell disease (and other haemoglobinopathies)
Publication date: Available online 29 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Robert Jackson, Moira O'Meara Sickle cell disease is a common inherited disorder of haemoglobin associated with significant morbidity and mortality. It is associated with the haemoglobin S variant of haemoglobin, which comprises abnormal β globin chains that are the result of a mutation to chromosome 11. Under adverse conditions the β globin chains undergo polymerization, leading to deformation of red cells and subsequent sickling crises. Individuals with sickle cell disease develop multisystem c...
Source: Anaesthesia and intensive care medicine - January 30, 2016 Category: Anesthesiology Source Type: research

Cardiac output measurement
Publication date: Available online 29 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Gilbert Cardiac output measurement is used to guide fluid and inotropic drug therapy. Techniques employ modelling of the circulation to derive estimates of cardiac output from readily measured variables, including thermodilution, analysis of arterial pressure waveforms, Doppler measurements of blood flow velocity, and electrical bioimpedance. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 30, 2016 Category: Anesthesiology Source Type: research

Drugs affecting coagulation
Publication date: Available online 25 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Balraj Appadu, Katrina Barber For more than half a century, heparin and vitamin K antagonists have defined anticoagulant therapy in both the short-term and long-term management of thrombotic diseases. However, the limitations of these traditional anticoagulants have prompted the development of new drugs. In the past 15 years new agents with improved safety profile and greater ease of use that target almost every step of the coagulation cascade have been developed. These include factor Xa inhibitors an...
Source: Anaesthesia and intensive care medicine - January 26, 2016 Category: Anesthesiology Source Type: research

Pharmacological modulation of cardiac function and blood vessel calibre
This article considers the global control of the system through to local and regional regulation of blood flow, and how the system may be manipulated at every stage. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 26, 2016 Category: Anesthesiology Source Type: research

Central venous cannulation: ultrasound techniques
Publication date: Available online 25 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Simon Flood, Andrew Bodenham Central venous cannulation is commonly undertaken by a range of specialities in diverse clinical settings. Central veins may be cannulated by the landmark, ultrasound-guided or open surgical cut-down techniques. Complications of central venous catheter (CVC) insertion are common and may lead to significant morbidity and very occasional mortality. Two-dimensional ultrasound-guided central venous catheter placement has been shown by randomized controlled trials to be superior to ...
Source: Anaesthesia and intensive care medicine - January 26, 2016 Category: Anesthesiology Source Type: research

Cardiac arrhythmias in the critically ill
Publication date: Available online 25 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): James Gray, Paul Haydock, Adrian Wong, J M Tom Pierce Arrhythmias are a common problem in the critically ill and they can have significant effects on patient outcome. They often require immediate and swift action and it is, therefore, essential that clinicians have a structured approach to the recognition and management of arrhythmias. Here, we provide a framework for the appropriate management of the more frequently encountered cardiac arrhythmias in critical care. We include the algorithms from the 201...
Source: Anaesthesia and intensive care medicine - January 26, 2016 Category: Anesthesiology Source Type: research