Preoperative evaluation of neurosurgical patients
This article focuses on the required preoperative preparation of neurosurgical patients. Intracranial and spinal surgery are associated with significant morbidity (23.6% and 11.2%, respectively), with overall 30-day mortality around 0.4–2.3% for intracranial surgery. Preoperative assessment must consider the surgical procedure being undertaken, pathology and its presentation, as well as patient-related factors that can be optimized prior to surgery. It also allows preoperative risk stratification and shared decision-making, informed consent and appropriate planning of perioperative care. Careful documentation of preo...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Prion diseases
Publication date: Available online 21 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Michelle Leemans The prion diseases, or transmissible spongiform encephalopathies (TSEs), are a group of neurodegenerative diseases. They are caused by an abnormal form of a naturally occurring cellular protein, known as prion protein. All prion diseases are fatal and without cure. Although all are rare, interest has increased over the last 20 years due to the appearance of a new prion disease called variant Creutzfeldt–Jakob disease. This disease is transmissible via medical devices and blood and there...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Hypothalamic and pituitary function
Publication date: Available online 22 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell The endocrine system consists of groups of cells (glands) that secrete messengers (hormones), which affect distant groups of cells (target organs). It controls mainly basal processes. Hormonal action may be on receptors in the target cell membrane (e.g. leading to alterations in membrane channel properties), in which case it is rapid, or it may affect gene function and thus protein synthesis, in which case the onset of action is relatively slow. Endocrine function is controlled via single and mu...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for neurosurgery
Publication date: Available online 24 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Oliver Hambidge, Robert John Neuroanaesthesia is an expanding speciality that requires a good understanding of neurophysiology as well as the pathophysiology of raised intracranial pressure. Neuroanaesthetists need to ensure neurosurgical patients maintain an adequate cerebral perfusion pressure intraoperatively, while providing optimum operating conditions. To achieve this, a balanced anaesthetic technique preventing hypertensive surges and optimizing cerebral venous drainage by careful patient positioning i...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Pharmacological and pathological modulation of cerebral physiology
This article outlines the effect of anaesthesia on cerebral physiology and reviews the pathophysiology of traumatic brain injury and subarachnoid haemorrhage. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Ion channels, receptors, agonists and antagonists
This article describes the physiology of ion channels and the principal molecular mechanisms responsible for modulating their activity by commonly used drugs in anaesthesia and intensive care. The concept of efficient and selective transport of ions across ‘impermeable’ plasma membranes is introduced, together with the mechanisms influencing electrochemical signalling within cells. The classification and composition of voltage-gated ion channels are described in the context of their contribution to action potential generation in excitable cells. Drug–receptor interaction of the four main classes of recept...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

The management of haemorrhagic stroke
Publication date: Available online 26 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Robin S. Howard Intracerebral haemorrhage (ICH) accounts for 8–13% of all strokes and results from a variety of disorders. ICH is more likely to result in death or major disability than ischaemic stroke or subarachnoid haemorrhage. Rapid imaging allows early diagnosis and characterization of the localization and severity of the haemorrhage. Patients with acute ICH should be managed in an intensive care unit. Treatment entails general supportive care, control of blood pressure (BP) and intracranial press...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Clinical approach to comatose patients
Publication date: Available online 29 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Joanne Tan, Marco Fedi The nature of consciousness itself belongs within a group of ‘underdetermined questions’ to which we might not be able to find an answer. Similarly, we have a limited understanding of disorders of consciousness. In this brief article, we discuss a practical approach to the comatose patient and the importance of promptly identifying the cause to prevent permanent neurologic damage. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Neurosurgical techniques in the management of chronic pain
Publication date: Available online 28 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul Eldridge Neurosurgical treatments for pain can be classified into three categories: treatment of the cause, neuromodulation and neuroablative techniques in order of preference of application. In general, it is important to be able offer all treatments in a pluripotential context. All of these treatments are now delivered in a multidisciplinary context, with other adjunctive treatments including pain medicine, cognitive techniques and pain management programmes. There is increasing emphasis on outcome m...
Source: Anaesthesia and intensive care medicine - September 28, 2016 Category: Anesthesiology Source Type: research

Pharmacology in the management of chronic pain
Publication date: Available online 28 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew Roe, Arun Sehgal Management of chronic pain should be achieved with a biopsychosocial approach and often requires multidisciplinary input. Pharmacological treatment can play an important role in the successful management of chronic pain. When planning a pharmacological strategy for chronic pain it is important to consider the nature and likely source of the pain. This review article will summarize common pharmacological options in current clinical use for the management of chronic pain. (Source: Ana...
Source: Anaesthesia and intensive care medicine - September 28, 2016 Category: Anesthesiology Source Type: research

Paediatric chronic pain
Publication date: Available online 27 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul M. Rolfe Chronic pain in childhood is common and if untreated may lead to significant pain-related disability, emotional disturbance and poor school attendance. These children and adolescents are often successfully managed outside of specialist paediatric pain management clinics in a wide range of clinical settings. However, some children require the expertise of a multidisciplinary pain management team in a dedicated paediatric centre. Following multidisciplinary assessment an individualized pain mana...
Source: Anaesthesia and intensive care medicine - September 27, 2016 Category: Anesthesiology Source Type: research

Implantable technology for pain management
Publication date: Available online 26 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Sanad Hadidi, G. Baranidharan Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact in patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral n...
Source: Anaesthesia and intensive care medicine - September 26, 2016 Category: Anesthesiology Source Type: research

Management of pain in the terminally ill
Publication date: Available online 23 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Siobhan E. King, Joseph Paul Hawkins, Jonathan MJ. Valentine Pain management in the terminally ill can be complex and challenging necessitating a holistic approach. Multimodal analgesic strategies are usually employed to successfully manage pain and other symptoms. There are now a variety of opioid formulations available to treat moderate to severe pain. Neuropathic and cancer-induced bone pain can be difficult to treat, but newer drugs are available in addition to a number of established interventional pro...
Source: Anaesthesia and intensive care medicine - September 23, 2016 Category: Anesthesiology Source Type: research

Radiofrequency techniques in pain management
Publication date: Available online 23 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Victor Mendis, Ramy Mottaleb, Ming Fung Radiofrequency techniques are minimally invasive procedures used to provide prolonged pain relief compared to local anaesthetic blocks and forms part of a multidisciplinary approach in managing chronic pain. A generator produces a high-frequency current that passes from an electrode to an earthing plate. The electromagnetic field created around the tip of the electrode then has an effect on the surrounding nervous tissue resulting in pain relief. (Source: Anaesthesia ...
Source: Anaesthesia and intensive care medicine - September 23, 2016 Category: Anesthesiology Source Type: research

Opioids in the management of persistent non-cancer pain
This article reviews the evidence for the effectiveness of long-term opioids in the management of PNCP, the current guidelines and the associated adverse affects. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 23, 2016 Category: Anesthesiology Source Type: research

Drugs affecting the autonomic nervous system
Publication date: Available online 23 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew Charlton, Jonathan P. Thompson The autonomic nervous system (ANS) is a complex system of nervous and humoral mechanisms that modulates the function of the autonomous or visceral organs. Autonomic control of organs aims to maintain homoeostasis in health. Many drugs used in clinical practice can have either primary or secondary effects on the function of autonomic nervous system. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 23, 2016 Category: Anesthesiology Source Type: research

Complex neuropathic pain states
Publication date: Available online 23 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Rhian P. Lewis, Indre Kriukelyte In this article we discuss complex neuropathic pain states: diabetic peripheral neuropathic pain (DPNP), phantom limb pain (PLP), central post-stroke pain (CPSP), and complex regional pain syndrome (CRPS). Pain in these conditions can often be severe, significantly affect quality of life and be resistant to current treatment options. Multidisciplinary assessment and treatment is essential. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 23, 2016 Category: Anesthesiology Source Type: research

Psychology and chronic pain
Publication date: Available online 23 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Elizabeth S. Davey Chronic pain is an area that does not sit well with a traditional dualist medical perspective. Alternative hypotheses suggesting changes within the central nervous system or to sensory control systems add to our understanding of persistent pain. Normal responses to painful stimuli, including interruption of activity and interference of behaviour, are psychological factors that play an important role in pain responses. The way in which health professionals communicate with patients about t...
Source: Anaesthesia and intensive care medicine - September 22, 2016 Category: Anesthesiology Source Type: research

Surgical diathermy and electrical hazards: causes and prevention
This article outlines the basic physics of electricity, in particular the principles behind diathermy, the hazards posed by it and by other devices and the various measures available to reduce the risk of these. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Visceral pain
Publication date: Available online 8 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Anu Kansal, John Hughes Pain is one of the commonest symptoms the patient presents with. Visceral organs were thought to be insensitive to pain in the past but now we know this not to be true. It is more common than somatic pain and originates from the internal organs in the thorax, abdomen or pelvis. These organs are innervated by parasympathetic (vagus and sacral parasympathetic fibres) and sympathetic (thoracolumbar sympathetic chain – T1–L2) nervous systems. The afferent and efferent fibres t...
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Asthma and chronic obstructive pulmonary disease in the intensive care unit
This article addresses the physiological derangements in airflow obstruction, their treatment consequences and how to avoid the management pitfalls that are important contributors to the morbidity and mortality of both conditions. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Ventilatory support in the intensive care unit
This article focuses on a classification of modes of mechanical ventilation, the indications for and complications of invasive and non-invasive mechanical ventilation and the recent evidence on adjuncts to mechanical ventilation. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Risk assessment in anaesthesia
Publication date: Available online 9 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Judith H. Tomlinson, Suneetha Ramani Moonesinghe National audit indicates that formal and documented assessment of perioperative risk is performed infrequently and inadequately by clinicians in the preoperative period. Many tools exist to assist the anaesthetist with this role and should be used in conjunction with clinical judgement. The presence of frailty has been found to increase the risk of adverse outcome following surgery and guidance recommends frailty screening as part of a preoperative assessment ...
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Physicochemical acid –base at the bedside
Publication date: Available online 12 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Ryan Hughes, Matthew J. Brain Quantitative physicochemical models of human acid–base physiology filled a void between clinical acid–base analysis and general fluid physiology. Established approaches centred on the Henderson–Hasselbalch (HH) equation allow satisfactory bedside exploration of respiratory perturbations, but do not fully elucidate mechanisms of common non-respiratory ‘metabolic’ components. Though useful at the bedside, commonly used ‘rules of thumb’ th...
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Management of the poisoned patient
Publication date: Available online 13 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Micheala M. McGlone, Stewart C. Teece Poisoning is a common reason for attendance to emergency departments, medical assessment and critical care areas. This, in the main, is due to deliberate self-harm, however, there is an increasing concern that toxins may be deliberately released as part of a terrorist attack. In many cases it can be unclear from the history the exact toxins responsible. Knowledge of toxidromes, a group of symptom clusters identified by the receptors targeted may guide further management...
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Disinfection, sterilization and disposables
Publication date: Available online 14 September 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Anthony J. Wilson, Sandeep Nayak Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involv...
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Management of the airway in intensive care
This article outlines some of the specific difficulties faced by clinicians in ICU and attempts to provide some guidance as to how these may be overcome, or at least abated. Drug choices are discussed, as are equipment choices. A suggestion for a difficult airway algorithm for use in the ICU is put forward. The timing of tracheostomy is discussed. Finally, the importance of the team and the human factors that are at play are touched upon. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 18, 2016 Category: Anesthesiology Source Type: research

Genesis of chronic pain
Publication date: Available online 3 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Bharti Seth, Lorraine de Gray The theories behind the evolution of the genesis of chronic pain are explored from a historical perspective. The major focus of the article explores the biomedical and the psychosocial factors that contribute to the genesis of chronic pain in particular how the physical and psychological interact together. Risk factors and pre-existing determinants are discussed. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 4, 2016 Category: Anesthesiology Source Type: research

Opioid mechanisms and opioid drugs
Publication date: Available online 3 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): John McDonald, David G. Lambert The opioid system comprises four receptor subtypes: μ (MOP), κ (KOP), δ (DOP), now called the ‘classical’ opioid receptors, and the ‘non-classical’ nociceptin/orphanin FQ peptide (N/OFQ) receptor (NOP). Selective endogenous peptides, cleaved from larger precursor proteins, have been identified for all subtypes. Both classical and non-classical opioid receptors couple to inhibitory, pertussis toxin-sensitive G-proteins. Opioid receptors activ...
Source: Anaesthesia and intensive care medicine - August 4, 2016 Category: Anesthesiology Source Type: research

The role of physiotherapy in the management of chronic pain
Publication date: Available online 3 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Judith Semmons The role of physiotherapy in managing chronic pain is challenging. A multidisciplinary approach incorporating several specialities within the pain clinic is recommended. Treatment focuses on the bio–psycho–social model: part of the clinician's skill is to assess which part or parts of this bio–psycho–social ‘equation’ influence the patient's pain. In addition, three key physiotherapy treatments are described: education, patient empowerment and promoting exercis...
Source: Anaesthesia and intensive care medicine - August 4, 2016 Category: Anesthesiology Source Type: research

Non-opioid analgesics
This article will give an overview of the pain pathway, highlight therapeutic targets and revisit common non-opioid analgesic agents currently in use. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 4, 2016 Category: Anesthesiology Source Type: research

Assessment of acute and chronic pain
Publication date: Available online 4 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Tim McCormick, Simon Law Acute and chronic pain states overlap in chronology and pathophysiology but both can remain under-managed. Assessment aims to elucidate underlying pain generators that can then guide treatment strategies. Assessment should be regularly repeated to assess efficacy of treatments and the presence of side effects. Self-report questionnaires are available to assist in diagnosis and monitoring of pain and its related dimensions but they do not replace a thorough assessment by an experienced c...
Source: Anaesthesia and intensive care medicine - August 4, 2016 Category: Anesthesiology Source Type: research

Techniques of opioid administration
Publication date: Available online 4 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Christopher J.G. Green, Yoong Chuan Tay Opiates remain the mainstay of the management of severe pain in acute, chronic and palliative settings across all population ages. Pharmacological advancement allows alternative routes of drug delivery best suited to individual patients and their conditions, with improved efficacy and safety. The different approaches to administration vary in their convenience, both to staff and patients, which can translate to differences in prescription compliance. Furthermore, the choi...
Source: Anaesthesia and intensive care medicine - August 4, 2016 Category: Anesthesiology Source Type: research

Acupuncture in pain management
Publication date: Available online 1 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Sau Hsien Yap Acupuncture has a long history and is used globally to treat many conditions. In the UK, it is commonly used in the treatment of chronic pain. Here, fundamental features of acupuncture, its indications and some scientific findings on the mechanism of action are discussed. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 3, 2016 Category: Anesthesiology Source Type: research

Use of atypical analgesics by intravenous infusion (IV) for acute pain: evidence base for lidocaine, ketamine and magnesium
Publication date: Available online 1 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Ross J. Vanstone, Mark Rockett Atypical analgesics include antiepileptics and other membrane stabilizers (lidocaine and mexiletine), antidepressants, α-2-noradrenergic agonists, N-methyl-D-aspartate (NMDA) antagonists, corticosteroids and cannabinoids. This review will focus on three drugs commonly infused as co-analgesics. We will review the theoretical mechanisms of action, efficacy and clinical effectiveness of lidocaine, ketamine and magnesium. The evidence base supporting their use has expanded in re...
Source: Anaesthesia and intensive care medicine - August 3, 2016 Category: Anesthesiology Source Type: research

Anatomy, physiology and pharmacology of pain
Publication date: Available online 2 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael J. Hudspith Pain is a complex emotional experience arising from integrated processing of nociceptive input subject to inhibitory and excitatory modulatory influences at multiple levels of the neuraxis. Transmembrane protein ion channels transduce mechanical, thermal and chemical tissue injury into electrophysiological signals that are transmitted to supraspinal structures via multiple synapses that exhibit neuroplasticity dependent upon coincident neuronal and glial activation. There are therefore multi...
Source: Anaesthesia and intensive care medicine - August 3, 2016 Category: Anesthesiology Source Type: research

The neurobiology of chronic pain states
Publication date: Available online 3 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Anthony Dickenson Plasticity enables alterations in transmission in nociceptive systems. It is this plasticity in the nervous system that can alter the linear relation between noxious stimuli and the perception of pain. In this way, a number of CNS mechanisms can alter neuronal activity, leading to abnormal ongoing and stimulus-evoked pains due to peripheral and central changes. Peripheral nerves can become sensitized, spinal cord neurons can be rendered hyperexcitable and ascending projections to higher centre...
Source: Anaesthesia and intensive care medicine - August 3, 2016 Category: Anesthesiology Source Type: research

The role of regional anaesthesia in the management of acute pain
Publication date: Available online 3 August 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Laura Perry, James Stimpson Regional anaesthesia is a powerful tool in the management of acute pain and offers additional advantages, although there are caveats. For certain sub-groups of patients the advantages are greater than others; either in avoidance of opioid-based analgesic regimes, or benefits related to the direct use of local anaesthetics. The future role of regional anaesthesia in the context of acute pain is expanding, and key directions are focussing its role as part of a multimodal enhanced recov...
Source: Anaesthesia and intensive care medicine - August 3, 2016 Category: Anesthesiology Source Type: research

The role of occupational therapy in pain management
Publication date: Available online 30 July 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Wendy Hill Occupation is central to human behaviour. Occupational therapy is based on the premise that there is an intrinsic relationship between occupations, health and wellbeing. Chronic pain restricts the performance of activities that individuals need to, want to and are expected to perform. As activity performance is central to an individual's identity, these restrictions can further impact the person's psychological health and wellbeing. Occupation is not performed in isolation and the inability to fulfil ...
Source: Anaesthesia and intensive care medicine - July 30, 2016 Category: Anesthesiology Source Type: research

Total intravenous anaesthesia in children: a  practical guide
This article will discuss topics relevant to administration of TIVA in children – the potential benefits of TIVA, challenges and some clinical examples of its use. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 20, 2016 Category: Anesthesiology Source Type: research

Anxiolytics, sedatives and hypnotics
Publication date: Available online 1 July 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Clemens Barends, Anthony Absalom Anxiolytics and sedatives are used in current anaesthetic practice for two main reasons: for anxiolysis before surgery and as adjuvants during anaesthesia. A wide choice of agents are available. Their safety profile is dependent on their pharmacokinetic and pharmacodynamic profiles, patient co-morbidity and the experience of the clinician using them. All sedative drugs have the potential to cause severe respiratory depression, and hence they should only be used with standard ph...
Source: Anaesthesia and intensive care medicine - July 1, 2016 Category: Anesthesiology Source Type: research

Obstetric haemorrhage
Publication date: Available online 1 July 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Thomas Mount, Kirsty MacLennan Obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. It is the leading obstetric cause for admission to intensive care units. Knowledge of risk factors and early recognition of haemorrhage enables rapid activation of a coordinated multidisciplinary team response. Clear unit protocols for the management of massive haemorrhage that are reinforced by team drills help to increase awareness in the multidisciplinary team, improve performance and thus c...
Source: Anaesthesia and intensive care medicine - July 1, 2016 Category: Anesthesiology Source Type: research

Obstetric emergencies
This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the MBRRACE-UK report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 1, 2016 Category: Anesthesiology Source Type: research

Human factors in obstetrics
Publication date: Available online 1 July 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Stephanie Monks, Kirsty Maclennan The importance of human factors is becoming increasingly recognized in the healthcare profession. Lack of situational awareness, poor communication and inadequate leadership compounded by unfamiliar teams in a rapidly deteriorating clinical situation put obstetric patients at particular risk. There is much to be learnt from other high-risk industries including aviation and the military. Increasing awareness and training in human factors and utilization of communication tools (...
Source: Anaesthesia and intensive care medicine - July 1, 2016 Category: Anesthesiology Source Type: research

Regional anaesthesia for caesarean section and what to do if it fails
Publication date: Available online 19 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Sophie A. Kimber Craig Regional anaesthetic techniques are now the most frequently used type of anaesthetic used for caesarean deliveries. They have a better safety profile than general anaesthesia in the pregnant woman. The choice of whether to use a spinal, epidural or combined spinal-epidural technique will depend on patient and surgical factors. Particular care should be taken to those receiving therapeutic anticoagulation or with clotting abnormalities. Women should be provided with appropriate informatio...
Source: Anaesthesia and intensive care medicine - June 29, 2016 Category: Anesthesiology Source Type: research

Failed intubation in obstetrics
Publication date: Available online 21 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Rhys Clayton, Jehan Abdulmajeed Failed intubation in obstetrics remains a topical issue, a rare but potentially devastating complication of obstetric general anaesthesia. Recent guidelines have been produced following several years of collaborative work between the Difficult Airway Society (DAS) and Obstetric Anaesthetist's Association (OAA). Whilst deaths from failed intubation have declined significantly over 30 years, the incidence of failed intubation remains fairly constant at 1:300, with latest studies ...
Source: Anaesthesia and intensive care medicine - June 29, 2016 Category: Anesthesiology Source Type: research

Post-dural puncture headache in the parturient
Publication date: Available online 25 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Dipali Verma, Cathy Armstrong Post-dural puncture headache (PDPH) is one of the most common and debilitating complications of central neuraxial blockade in the parturient. The obstetric population is at particular risk with up to 80% of women developing symptoms after accidental dural puncture during labour epidural insertion. PDPH typically develops 24–48 hours post puncture and is classically described as an occipito-frontal headache with postural features. Diagnosis and assessment should include cons...
Source: Anaesthesia and intensive care medicine - June 29, 2016 Category: Anesthesiology Source Type: research

Neurological complications in obstetric regional anaesthesia
Publication date: Available online 25 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): David J. Chambers, Allison C.L. Howells Postnatal neurological complications occur uncommonly, and are more likely to be the consequence of labour than central neuraxial blockade (CNB). Due to the temporal relationship with regional blockade, the anaesthetist is often the first physician notified when a woman reports postpartum neurological symptoms. Anaesthetists must therefore be able to differentiate between the causes of neurological injury, and recognize the rare injury that requires immediate interventi...
Source: Anaesthesia and intensive care medicine - June 29, 2016 Category: Anesthesiology Source Type: research

Obtaining consent for obstetric procedures
Publication date: Available online 16 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Sarah Nour, Siân Griffiths Consent is a process that involves information disclosure of a proposed treatment or intervention. It includes a discussion of the risks relevant to that particular patient as well as the benefits and alternative options. The process must be clearly documented to provide a legal justification for treatment. Obtaining informed consent can be a challenge when a labouring woman is in severe pain or under the influence of strong analgesics. High-risk women should be encouraged to ...
Source: Anaesthesia and intensive care medicine - June 16, 2016 Category: Anesthesiology Source Type: research

The ethics of pregnancy testing
Publication date: Available online 16 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Emma Sharkey, Siân Griffiths Anaesthesia, surgery and ionizing radiation may all prove harmful to an undetected pregnancy. Elective procedures should be deferred at least until the second trimester to reduce the risk of teratogenicity or spontaneous abortion. If surgery cannot be delayed, anaesthetic or surgical techniques can be modified, and the use of intraoperative ionizing radiation avoided where possible. Determination of pregnancy status is mandated by current national guidelines prior to any pro...
Source: Anaesthesia and intensive care medicine - June 16, 2016 Category: Anesthesiology Source Type: research