Clinical information systems in the intensive care unit
Publication date: Available online 19 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Christopher Mason, Tim Leong Clinical information systems (CIS) are used to collect, process, and present data for use in patient care. Common applications in the intensive care unit are charting, computerized physician order entry (CPOE), clinician decision support (CDS), and health information exchange. Benefits of CIS include increased efficiency, increased quality of care, and improved data availability, structure, and security. Possible risks include certain errors, reduced speed and efficiency, and l...
Source: Anaesthesia and intensive care medicine - January 20, 2016 Category: Anesthesiology Source Type: research

Hypovolaemia
Publication date: Available online 19 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Laura Kettley, Aidan Marsh The determination of intravascular volume in haemodynamically unstable patients is key to subsequent management. Administration of fluid remains the cornerstone of treatment but fluid loading in those patients not responsive to fluid is detrimental to outcome, as interstitial oedema impedes tissue oxygenation. Traditionally, static markers of cardiac preload such as central venous pressure have guided fluid therapy. Such markers have been shown to poorly predict fluid responsiven...
Source: Anaesthesia and intensive care medicine - January 20, 2016 Category: Anesthesiology Source Type: research

Status epilepticus: an intensive care medicine problem
This article will arm the critical are trainee with the theoretical knowledge required to effectively manage this particularly vulnerable cohort of patients. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 20, 2016 Category: Anesthesiology Source Type: research

Ethical issues in resuscitation and intensive care medicine
Publication date: Available online 17 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Lucy Modra, Andrew Hilton Intensive care medicine is richly endowed with ethical dilemmas, including decision making on behalf of incompetent patients, withdrawal of treatment decisions and rationing of limited resources. Intensive care physicians need to be attuned to these ethical aspects of their practice. Beauchamp and Childress' four principles of medical ethics provide a useful approach to ethical problems. However, the principles provide a framework rather than an ‘answer’. The advent of...
Source: Anaesthesia and intensive care medicine - January 18, 2016 Category: Anesthesiology Source Type: research

Consent in children
This article discusses consent in children for both treatment and research. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 20, 2015 Category: Anesthesiology Source Type: research

Principles of intravenous drug infusion
Publication date: Available online 10 November 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Johan F. Coetzee It is possible to establish and maintain targeted blood and effect-site drug concentrations with reasonable accuracy using a ‘bolus, elimination, transfer’ (BET) infusion regimen. Simulation software that employs pharmacokinetic models can be used to drive infusion pumps or to design manually controlled BET infusions. Prolonged infusions can result in prolonged recovery times. However, the elimination half-lives of infused lipid soluble drugs have little or no relevance to rate...
Source: Anaesthesia and intensive care medicine - November 20, 2015 Category: Anesthesiology Source Type: research

Update on ENT anaesthesia
Publication date: Available online 11 November 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Peter Harper, Lindsay Rawling, Zoë Brown This review is an update of anaesthesia for common elective paediatric ear, nose and throat (ENT) procedures. ENT is the most frequently performed surgery in children. These often-complex procedures are increasingly booked as day cases but judicious selection of suitable children is important. Suitability may be determined by preoperative assessment of co-morbidities, consequences of the child's presenting pathology (e.g. obstructive sleep apnoea) or a histor...
Source: Anaesthesia and intensive care medicine - November 20, 2015 Category: Anesthesiology Source Type: research

Inhalational anaesthetics
Publication date: Available online 11 November 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Moppett Inhalational anaesthetic agents include the halogenated organic compounds (halothane, enflurane, desflurane, isoflurane and sevoflurane), nitrous oxide and xenon. Their mechanism of action is becoming increasingly understood as well as the clinically important differences between agents. The use of xenon is relatively new and may assume greater importance in the future because of the environmental impact of the older agents. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 20, 2015 Category: Anesthesiology Source Type: research

Rehabilitation and critical illness
Publication date: Available online 14 November 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Shannon L. Goddard, Brian H. Cuthbertson Patients who survive critical illness experience reduced health-related quality of life (HRQOL), impaired physical and cognitive functioning as well as psychological morbidity. These changes may be inter-connected and in part may relate to the loss of physical function at the time of critical illness. Rehabilitation of critically ill patients has largely focused on the post-acute and home phases of recovery. However, recent data show that it is safe, feasible and b...
Source: Anaesthesia and intensive care medicine - November 20, 2015 Category: Anesthesiology Source Type: research

Haematological problems in intensive care
Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Marija Nedeljkovic, Amanda K. Davis Anaemia is common in the ICU patient and is usually due to the interplay between many different factors. Although often this can be safely managed conservatively, red cell transfusion is commonly required. Patients who refuse blood products and patients with critical bleeding pose a particular management challenge. Coagulopathy is also frequently encountered in ICU. It is critical to evaluate the causes and bleeding risk in such patients, as this will determine the subse...
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Assessment and management of the predicted difficult airway in babies and children
Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul A Baker, Jamuna Navaratnarajah, Ann E Black Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important a...
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Management of severe sepsis
Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Dashiell Gantner, Chris Mason Severe sepsis is a heterogenous condition affecting multiple organ systems, and is commonly encountered in the hospital setting due to both community and nosocomial infections. Although the incidence of severe sepsis has increased over the past decades, there is evidence that mortality in developed world settings has improved. Management of the septic patient involves rapid evaluation and prompt initiation of both supportive and specific therapies. Such patients commonly requi...
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Acute and chronic airway obstruction in children
Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Gary M. Doherty Airway obstruction is more common in children than in adults. This is because of subtle anatomical differences in the childhood airway and an increased propensity to infection. Effects of obstruction manifest more quickly in children because of a smaller airway diameter, reduced physiological reserve and easily fatigued respiratory muscles. The anaesthetist may encounter airway obstruction in children both outside and within the operating theatre. Problems can be either anticipated or u...
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Nosocomial infections in the intensive care unit
This article summarizes the pathogenesis, risk factors, microbiology, diagnosis, prevention and treatment of VAP, CLASI and nosocomial UTI in the adult ICU. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Developmental anatomy of the airway
Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Niall Wilton, Corina Lee, Edward Doyle The airway develops from the primitive foregut at four weeks' gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight bladed...
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Acid–base physiology: new concepts
Publication date: November 2015 Source:Anaesthesia & Intensive Care Medicine, Volume 16, Issue 11 Author(s): Tom Hickish, Andrew D. Farmery The traditional approach to acid–base physiology is based on the Henderson–Hasselbalch equation which is derived from the CO 2 / HCO 3 − buffer system. However, it is becoming increasingly recognized that this is an incomplete analysis as it focuses on only one of the six reactions involving H+ and can lead to the incorrect assumption that CO2 and HCO 3 − are independently adjusted factors that ultimately determine pH. In 1983, Stewart,...
Source: Anaesthesia and intensive care medicine - November 1, 2015 Category: Anesthesiology Source Type: research

Medical gases, their storage and delivery
This article reviews the production, storage and delivery of commonly used anaesthetic gases, following the gases from production to delivery. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 11, 2015 Category: Anesthesiology Source Type: research

Techniques of epidural block
Publication date: Available online 26 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Barrie Fischer, Oscar Domingo Bosch Epidural blocks can be performed at any level from the cervical spine down to the sacral hiatus. A lumbar epidural can provide surgical anaesthesia and postoperative analgesia for sub-umbilical surgery, whereas a thoracic epidural will provide effective analgesia but not anaesthesia for thoracic and upper abdominal surgery. A bolus epidural injection will last 2–4 hours, using a long-acting local anaesthetic; for prolonged postoperative analgesia, an epidural cat...
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Does regional anaesthesia improve outcome after surgery?
Publication date: Available online 26 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Barrie Fischer, Oscar Domingo Bosch There is conclusive evidence that regional anaesthesia provides better postoperative analgesia than systemic opioid techniques. Regional anaesthesia also has the potential to improve the functional outcome from surgery, although proving this in a clinically relevant way is challenging; many studies are inconclusive with methodological weaknesses making comparison difficult and offering conflicting evidence. Systematic reviews offer better evidence that regional anaesth...
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Adjuvant agents in regional anaesthesia
Publication date: Available online 26 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Sudhakar R Marri Adjuvant agents are pharmacological drugs that, when co-administered with local anaesthetic agents, may improve the speed of onset, the quality and/or duration of analgesia. A wide range of drugs have been assessed for both neuraxial and peripheral nerve blocks. Here, we review the adjuvants used in clinical practice in the UK and also briefly mention other drugs that have been used for neuraxial administration and peripheral nerve blockade to provide perioperative analgesia. (Source: Ana...
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Regional anaesthesia in patients taking anticoagulant drugs
This article attempts to put the risks of these complications into context, with reference to different classes of anticoagulant drugs. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Patient positioning in anaesthesia
We describe the considerations for the anaesthetist when positioning the surgical patient. We discuss the positions commonly used for surgical patients and relate the challenges associated with each of these positions; challenges which can be physical as well as physiological. Staffing and equipment provision levels must be commensurate with the degree of physical effort and the complexity predicted in positioning an individual patient. The anaesthetist also needs to consider the relatively restricted access to the patient for intervention when in the prone or lateral positions. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Osmolarity and partitioning of fluids
This article first outlines definitions and descriptions of key terms that will be used in the discussions that follow including osmolarity, osmolality, osmotic and oncotic pressure. The physicochemical properties of water, ions and organic molecules are discussed in terms of their biological roles. Similarly, the interactions of amphipathic molecules and their three-dimensional structures in aqueous and non-aqueous environments are then explored. The movement of solutes and solvents across semipermeable membranes is considered and an assessment is made of the contribution of such mechanisms to normal physiology. Firstly, ...
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Spinal anaesthesia
Publication date: Available online 26 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Christina L. Beecroft Spinal anaesthesia is the injection of local anaesthetic into the subarachnoid space. It is a simple technique that can be used to provide surgical anaesthesia for procedures involving the abdomen, pelvis and lower limbs. To perform the technique safely it is important to understand the physiology of the block and the pharmacology of the drugs commonly used. Although serious complications are rare, they must be recognized and managed quickly. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Premedication
Publication date: Available online 1 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): James Palmer Premedication is any drug or therapy administered before surgery. In the past this has mainly been used for the control of autonomic responses to anaesthetic agents, and for facilitating gas induction when this was the norm. Premedication declined from being almost universal until the 1980s to a much lower level today. The decline has been associated with a change in the type of premedication from sedative and antisialagogue to analgesia, anti-reflux and other diverse agents aimed at optimizing ...
Source: Anaesthesia and intensive care medicine - October 4, 2015 Category: Anesthesiology Source Type: research

Postoperative care of the adult cardiac surgical patient
Publication date: Available online 11 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Christopher P. Press, Jonathan H. Rosser, Alison D. Parnell Most patients are ready to be transferred to a ward after 24–48 hours on a cardiac intensive care unit (CICU); however, several potential complications can occur during this period. The risks during transfer from theatre to CICU increase if a long distance is involved. A thorough handover to nursing staff is mandatory. Problems with blood pressure and arrhythmias are common on the CICU. Patients undergoing hypothermic cardiopulmonary bypa...
Source: Anaesthesia and intensive care medicine - September 11, 2015 Category: Anesthesiology Source Type: research

Adult congenital heart disease
Publication date: Available online 8 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Jonathan Weale, Andrea A. Kelleher Continued advances in the understanding and management of congenital heart disease (CHD) mean that over 90% of children born with CHD now survive to adulthood. This in turn results in greater numbers of adult patients presenting for medical and surgical care at non-specialist centres. A simple classification of adult congenital heart disease (ACHD) according to complexity can help clinicians to understand the implications of the specific cardiac anomaly encountered. Issu...
Source: Anaesthesia and intensive care medicine - September 8, 2015 Category: Anesthesiology Source Type: research

Preoperative assessment for cardiac surgery
This article describes a structured approach to anaesthetic pre-assessment for patients undergoing cardiac surgery. Commonly used preoperative scoring systems are introduced, and the application and interpretation of commonly employed cardiac investigations are summarized. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 8, 2015 Category: Anesthesiology Source Type: research

Cardiopulmonary transplantation
Publication date: Available online 8 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Barbora Parizkova, I Gavin Wright More than 7000 cardiopulmonary transplants were carried out worldwide in 2012 across the 388 centres reporting to the International Registry. The Registry of the International Society for Heart and Lung Transplantation reported 4196 heart transplants and 3812 lung transplants worldwide in 2012. The 100,000th heart transplant mark has been passed. Heart transplantation is a proven surgical option for selected patients who have advanced heart failure refractory to surgical ...
Source: Anaesthesia and intensive care medicine - September 8, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for off-pump coronary artery bypass grafting surgery
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): R Peter Alston Coronary artery bypass grafting (CABG) surgery may be undertaken with or without cardiopulmonary bypass (CPB) that is on- or off-pump. Although off-pump has a slightly higher mortality, it associated with a lower incidences of short-term complications, compared with on-pump CABG surgery favouring enhanced recovery. High-dose opioid techniques of general anaesthesia should be avoided and either inhalation or total intravenous (IV) anaesthesia may be used. Monitoring should include a five-lead...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Inotropes
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): David J. Mayhew, Kenneth Palmer Inotropes are a heterogenous group of drugs that modify calcium handling and alter the force of myocardial contraction. Catecholamines, and their synthetic analogues, increase intracellular calcium by activating cyclic adenosine monophosphate (cAMP) or inositol triphosphate (IP3). Phosphodiesterase inhibitors block phosphodiesterase 3, which in turn reduces catabolism of cyclic nucleotides cAMP and cyclic guanosine monophosphate (cGMP), again increasing intracellular calciu...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Mechanical support of the heart
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Barbora Parizkova, I Gavin Wright, Emma J Birks Mechanical support of the heart can be offered to patients who are refractory to pharmacological treatment, therapy for coronary or valvular disease or resynchronization therapy. Ventricular assist devices enable end-organ perfusion in the setting of heart failure. This can be temporary (as a bridge to recovery or transplantation) or permanent (destination therapy). Devices can be extracorporeal or implanted, and generated flows can be pulsatile or non-puls...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Transoesophageal echocardiography in cardiac anaesthesia
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Christine Herr, Andrew Roscoe Echocardiography is the most widely used minimally invasive investigation to diagnose heart disease. Transoesophageal echocardiography (TOE) was first introduced perioperatively in the 1980s and is now an important monitoring tool for patients undergoing cardiac surgery. Because of the close proximity of the oesophagus to the heart, TOE facilitates the acquisition of high-resolution images. The TOE probe is a multiplane transducer. This means that the image planes can be rota...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Principles of cardiac anaesthesia
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): David Alexander Cardiac surgical outcomes in the UK have consistently improved despite increasing procedure complexity and ‘sicker’ patients. Numerous anaesthetic techniques are employed with no definitive evidence clearly demonstrating superiority of one particular technique. Patient safety is paramount and various monitoring techniques used to enhance safety and ensure effective anaesthesia are outlined. Management of bleeding, particularly in complex cases, is a major component of cardiac an...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Suction devices
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Tom Kennedy, Ruth Herod Suction devices have widespread uses in the clinical environment. The process of suction is the removal of fluid or other debris using a vacuum, and the properties of suction devices are governed by the physics of the flow of fluid through a tube. The rate of flow is dependent on the radius, length and pressure difference across the ends of the tube. A pump is used to create the vacuum, the efficiency of which depends on the maximum displacement and degree of sub-atmospheric pressu...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for patients with cardiac disease undergoing non-cardiac surgery
Publication date: Available online 5 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): K Moyna Bill One of the biggest challenges for anaesthetists today is the safe conduct of anaesthesia for patients who might be elderly, have pre-existing cardiac disease and are scheduled to undergo non-cardiac surgery. Within the financial constraints of today's health services, the appropriate investigations need to be decided and performed for these patients in order to inform the anaesthetist, surgeon and the patient of the risk of surgery. These should be undertaken only if they will influence manage...
Source: Anaesthesia and intensive care medicine - September 6, 2015 Category: Anesthesiology Source Type: research

Postoperative nausea and vomiting
This article outlines the physiology, reviews the available drugs and suggests a structure using risk stratification that helps to plan sensible clinical management. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 15, 2015 Category: Anesthesiology Source Type: research

Preoperative assessment in patients presenting for elective surgery
This article provides a systematic approach to the assessment process. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 6, 2015 Category: Anesthesiology Source Type: research

Extubation and emergence
Publication date: Available online 4 August 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Andrew Dalton, Lynsey Foulds, Claire Wallace Emergence and extubation are times of increased risk during anaesthesia. More complications occur then than at induction. The majority of problems are airway related due to airway obstruction, hypoxia, aspiration, airway trauma or post-obstructive pulmonary oedema. Other problems include a delayed recovery of consciousness, cardiovascular instability and delirium. Prompt identification and treatment of the underlying cause is essential to prevent serious morbidit...
Source: Anaesthesia and intensive care medicine - August 4, 2015 Category: Anesthesiology Source Type: research

The organization and composition of body fluids
Publication date: Available online 1 August 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Benjamin R. Waterhouse, Andrew D. Farmery The water contained in the body is divided amongst compartments of differing sizes and compositions. The dynamic balance across these compartments is an essential component of normal physiology. Here, the calculation of these volumes by measuring the dilution of markers able to permeate specific compartments is considered. Furthermore, the potential disadvantages to the approach are discussed. The differences in ionic concentration between intracellular and extracell...
Source: Anaesthesia and intensive care medicine - August 2, 2015 Category: Anesthesiology Source Type: research

Assessment of the emergency surgical patient
Publication date: Available online 30 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Caroline Lake It is well known that emergency surgical patients have a higher risk of postoperative morbidity and mortality than those having elective procedures. A systematic preoperative assessment forms an important part of identifying risk factors and reducing their impact. Patients may require simultaneous resuscitation and assessment. Further deterioration in the patient's condition must not occur as a result of delays in decision-making or awaiting results of investigations. A risk assessment score is u...
Source: Anaesthesia and intensive care medicine - July 31, 2015 Category: Anesthesiology Source Type: research

Prevention of deep vein thrombosis and pulmonary embolism
Publication date: Available online 30 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Ravindra Cooray, Caroline Lake Venous thromboembolism is a major cause of perioperative morbidity and mortality. Immobilized medical patients are also at risk. Long-term sequelae represent a chronic health burden. Hospitalized patients should be assessed for their risk of thromboembolism and bleeding at regular intervals. Risk stratification, using recommended models can be used to guide the choice of thromboprophylaxis. Both mechanical and pharmacological interventions reduce the incidence of venous thromboe...
Source: Anaesthesia and intensive care medicine - July 31, 2015 Category: Anesthesiology Source Type: research

Physiology and pharmacology of nausea and vomiting
Publication date: Available online 29 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Barbara J. Pleuvry The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ...
Source: Anaesthesia and intensive care medicine - July 30, 2015 Category: Anesthesiology Source Type: research

Regurgitation and aspiration
Publication date: Available online 30 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Luke Yarlett, Tracey Eastaugh-Waring Regurgitation and aspiration remains one of the major complications of general anaesthesia. Aspiration is defined as oropharyngeal or gastric content entering the airway below the level of the vocal cords. This can cause morbidity and mortality by direct effects of the particulate, acid-related damage and bacterial pneumonia. It occurs largely in patients with risk factors although occasionally in patients that are low risk. Anaesthetic technique should be adjusted dependi...
Source: Anaesthesia and intensive care medicine - July 30, 2015 Category: Anesthesiology Source Type: research

Patient recovery and the post-anaesthesia care unit (PACU)
Publication date: Available online 30 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Nick Preston, Maggie Gregory Patient recovery is the time from the end of anaesthesia/surgery to regaining full control of airway reflexes. During recovery immediate postoperative complications may arise. Major complications arise in 3–17% of inpatient surgical procedures. These complications should be managed either in theatre or in a designated recovery area (post-anaesthesia care unit). (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2015 Category: Anesthesiology Source Type: research

Fluid therapy for anaesthetists and intensivists
This article summarizes the physiology of fluid and electrolyte homeostasis and the latest evidence for each of the common fluids available. We aim to highlight specific circumstances where the choice of fluid may vary from normal practice. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2015 Category: Anesthesiology Source Type: research

Humidification devices
Publication date: Available online 21 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): David R. Ball Humidification is a process of adding water vapour to a volume of one or more gases. Natural humidification is achieved in the nasal cavity, but this process is often bypassed during anaesthesia and critical care. Various devices are used for artificial humidification, the most common is heat and moisture exchanger combined with a microbial filter. Electrically heated water baths may be used; new devices are combined with high-flow oxygen delivery to provide non-invasive respiratory support. (Sou...
Source: Anaesthesia and intensive care medicine - July 23, 2015 Category: Anesthesiology Source Type: research

Equipment for airway management
Publication date: Available online 20 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): David R. Ball Airway management provides gas exchange, protects the lungs from injury and permits treatment. This requires safe, effective and reliable use of equipment, often in combination. A management plan with backup plans is essential, but a sequence of logical plans forming an airway management strategy is better. Correct equipment use needs correct knowledge, skill and attitudes. There are five approaches to airway management in which equipment is used: facemask ventilation with adjuncts, airway cleara...
Source: Anaesthesia and intensive care medicine - July 20, 2015 Category: Anesthesiology Source Type: research

Safeguarding for anaesthetists: working to protect children
Publication date: Available online 17 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Kathy Wilkinson, Alistair J. Cranston An awareness of what may constitute neglect or ill treatment to children and young people is important for all healthcare staff, and prevention of harm is everyone's business. Whilst it is relatively unusual to see serious signs of abuse in a routine surgical context, anaesthetists also see children in many different settings and should be able clearly to communicate their concerns. Whilst there are differences in both relevant law and statutory advice in the various part...
Source: Anaesthesia and intensive care medicine - July 18, 2015 Category: Anesthesiology Source Type: research

Developmental paediatric anaesthetic pharmacology
Publication date: Available online 15 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Tom G. Hansen Safe and effective drug therapy in neonates, infants and children require detailed knowledge about the ontogeny of drug disposition and action as well how these interact with genetics and co-morbidity of children. Recent advances in developmental pharmacology in children follow the increased understanding of the impact of growth and development on drug disposition (ADME: absorption, distribution, metabolism and excretion). Numerous approaches have been used to determine optimal dosing of drugs in...
Source: Anaesthesia and intensive care medicine - July 17, 2015 Category: Anesthesiology Source Type: research