Traumatic brain injury: initial resuscitation and transfer
Publication date: Available online 29 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Puntis, Toby Thomas Traumatic brain injury (TBI) is common and is associated with significant morbidity and mortality. The initial resuscitation and management of patients with TBI is focused on limiting secondary brain injury and this may be complex in patients with significant injuries to other organ systems. The transport of critically ill brain-injured patients for definitive treatment also carries significant risks which must be managed. This review describes the initial resuscitation and transfer ...
Source: Anaesthesia and intensive care medicine - March 30, 2017 Category: Anesthesiology Source Type: research

Intracranial pressure and cerebral haemodynamics
Publication date: Available online 29 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Ashwini Oswal, Ahmed K. Toma Intracranial pressure (ICP) refers to the pressure within the skull, which is determined by the volumes of the intracranial contents; blood, brain and cerebrospinal fluid. Monro–Kellie homeostasis stipulates that a change in the total intracranial volume is accompanied by a change in the ICP, which is more precisely described by the intracranial pressure–volume relationship. Maintenance of a relatively constant ICP is essential for maintenance of the cerebral perfusion p...
Source: Anaesthesia and intensive care medicine - March 30, 2017 Category: Anesthesiology Source Type: research

Cardiovascular system: critical incidents
Publication date: Available online 28 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Amit Goswami, Ruth Spencer Cardiovascular events are an important group of critical incidents in anaesthesia. They include hypotension, hypertension, myocardial ischaemia/infarction, arrhythmias, and; cardiac arrest. These incidents require prompt recognition and treatment. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 29, 2017 Category: Anesthesiology Source Type: research

Anaesthesia for endoscopic surgery
Publication date: Available online 9 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael H. MacMillan, Marie Davidson Anaesthesia for endoscopic airway surgery involves unique challenges. The anaesthetist and surgeon are working in close anatomical proximity and the concept of shared airway is never more relevant. Understanding the planned procedure and the needs of the surgeon for access to the surgical field will enable the provision of anaesthesia and airway management using a variety of techniques. Planning for safe induction, maintenance and emergence of anaesthesia will also ...
Source: Anaesthesia and intensive care medicine - March 8, 2017 Category: Anesthesiology Source Type: research

Adverse drug reactions
Publication date: Available online 6 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew Charlton, Jonathan Thompson Adverse drug reactions (ADRs) are a common and important cause of morbidity and mortality. They occur frequently in patients undergoing anaesthesia or in Intensive Care. ADRs occur by a number of mechanisms, some of which remain unclear, but several risk factors have been identified. It is increasingly recognized that pharmacogenetic factors are important in determining susceptibility to ADRs. Medical practitioners should be aware of their responsibility to report ADRs and kno...
Source: Anaesthesia and intensive care medicine - March 6, 2017 Category: Anesthesiology Source Type: research

Alternative techniques for tracheal intubation
Publication date: Available online 6 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Karen McCluskey, Miriam Stephens Conventional direct laryngoscopy with the curved Macintosh blade is a fundamental skill for all anaesthetists and has been the cornerstone of airway management for many years. This technique relies on the operator aligning the oro-pharyngo-laryngeal structures and inserting an endotracheal tube into the trachea under direct vision. There is a recognized failure rate with this technique and thus alternative techniques for tracheal intubation should be available for use in difficul...
Source: Anaesthesia and intensive care medicine - March 6, 2017 Category: Anesthesiology Source Type: research

Gas, tubes and flow
Publication date: Available online 3 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Mark A. Henderson, Colin Runcie Optimizing the flow of both liquids and gases is crucial to many areas of anaesthetic and critical care practice. In this article, we describe the physical principles which govern the flow of gases and present scenarios from clinical practice to illustrate these concepts. The difference between laminar and turbulent flow is explained along with the factors which determine the nature of the fluid flow. The Venturi Effect, Bernoulli Principle and Coanda Effect are also described wit...
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Airway trauma
Publication date: Available online 3 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Deirdre Conway, Craig S. Urquhart Airway trauma should be considered according to location and mechanism of injury. Mechanism of airway trauma can be broadly classified as blunt, penetrating and thermal/chemical. Airway strategy and planning is key to safe management. These patients may be challenging to manage and complicated by polytrauma. It is essential to remember that the patient's airway may deteriorate rapidly and contingency planning for this should be in place. A structured approach to the patient is e...
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Histamine and antihistamines
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Amr M. Mahdy, Nigel R. Webster Histamine is one of the most extensively studied biological amines in medicine. It stimulates smooth muscle contraction and gastric acid secretion, increases vascular permeability, functions as a neurotransmitter, and plays various roles in immunomodulation, allergy, inflammation, haematopoiesis and cell proliferation. Histamine exerts its effects through four receptors, designated H1–H4. H1 and H2 receptors are widely distributed, H3 receptors are mainly presynaptic, and H4 ...
Source: Anaesthesia and intensive care medicine - March 1, 2017 Category: Anesthesiology Source Type: research

Transtracheal jet ventilation
This article will examine the indications for TTJV and physiology behind its mechanism of action. We will also describe the equipment required, technique and potential complications. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 1, 2017 Category: Anesthesiology Source Type: research

Percutaneous tracheostomy and cricothyrotomy techniques
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Nicola Doody, Neil Smart Percutaneous tracheostomy is an increasingly common procedure performed in the intensive care unit setting. This review discusses the evidence behind its use, provides detailed description of the techniques, and considers the principles of post-tracheostomy care based on recent national audit. It also outlines the most recent recommendations for emergency front of neck access, an essential skill for all anaesthetists and other emergency specialists. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 1, 2017 Category: Anesthesiology Source Type: research

Obstructive sleep apnoea and anaesthesia
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Kim Flatman, Diana Raj Obstructive sleep apnoea is the most prevalent sleep disorder, affecting up to 5% of the population. It can have profound effects on patients perioperatively and can have a considerable impact on morbidity and mortality. Patients require thorough preoperative assessment including the taking of a detailed history, the use of scoring systems to assess severity (such as the STOP-Bang questionnaire) and physical examination with particular attention to the airway. Elective surgery patients who...
Source: Anaesthesia and intensive care medicine - March 1, 2017 Category: Anesthesiology Source Type: research

Ear, nose and throat emergencies
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Dmitrijs Sokolovs, Ker Wei Tan Airway emergencies comprise a diverse group of conditions, which affect upper and lower airways, and have potential for rapid deterioration and lethal outcome unless managed promptly and efficiently. The latter depends on individual skills and effective interaction between anaesthetists, ENT surgeons and other members of the team. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 1, 2017 Category: Anesthesiology Source Type: research

Shock: causes, initial assessment and investigations
Publication date: Available online 29 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul Teirney, Bilal Ahmed, Alistair Nichol Shock may result from a number of distinct disease processes and it is commonly associated with trauma, infection and cardiovascular dysfunction. Shock results in significant morbidity and mortality and is a leading cause of death in hospital patients. In order to improve patient outcomes it is important to recognize shock early, then assess and treat the shocked patient in a systematic way. While the cause of the shocked state is sometimes obvious, in more difficult...
Source: Anaesthesia and intensive care medicine - January 28, 2017 Category: Anesthesiology Source Type: research

Ischaemic cardiogenic shock
Publication date: Available online 19 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Arne Diehl Recognition of cardiogenic shock in the setting of myocardial ischaemia has important prognostic and therapeutic implications. Mortality remains high in the order of 50%, despite introduction of urgent revascularization. Resuscitative efforts should focus to avoid multi-organ dysfunction with further spiralling instability that commonly is irreversible. To interrupt these processes, timely recognition and restoration of adequate perfusion is mandatory. The therapeutic means to achieve this beyond e...
Source: Anaesthesia and intensive care medicine - January 19, 2017 Category: Anesthesiology Source Type: research

The management of pulmonary embolism
Publication date: Available online 19 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Jane E. Lewis, David V. Pilcher Pulmonary embolism (PE) is a significant cause of hospitalization, morbidity and mortality and frequently triggers referral to critical care services. Critically ill patients are also at increased risk of developing venous thrombo-embolism (VTE) and acute PE. Critical care clinicians should be confident in their approach to the patient with suspected and diagnosed PE. Furthermore, the co-morbid conditions in this patient group may present additional challenges both in diagnosis...
Source: Anaesthesia and intensive care medicine - January 19, 2017 Category: Anesthesiology Source Type: research

Electrolyte disorders in  the critically ill
This article provides a review of and guide to the aetiology, analysis, and management of major electrolytes disorders in the critically ill. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Maintenance of anaesthesia
Publication date: Available online 18 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Thomas E.F. Walton, James Palmer The maintenance phase of general anaesthesia begins immediately following induction of, and ends immediately prior to emergence from, a state of intended unrousable unconsciousness. Maintenance of anaesthesia requires the application of a wide range of knowledge and skills, demanding a solid grounding in basic science, practical abilities and team management. These factors are considered in this article. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Macronutrients, minerals, vitamins and energy
Publication date: Available online 18 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell Carbohydrates have the general formula C n (H2O) n . Monosaccharides have between three and six carbon atoms and exist as chains or ring structures. As rings, they link with other monosaccharide rings. The major carbohydrate in humans is glucose, which is stored as glycogen: branching chains of glucose molecules. Fat (triglyceride), which makes up adipose tissue, consists of three fatty acids bonded to glycerol, but other lipids include phospholipids and steroids. Proteins are composed of chains...
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Databases
Publication date: Available online 18 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): James Berrington A database is a structured collection of records or data that is stored in a computer so that it can be consulted by a program to answer queries. Records retrieved through queries become information that can be used to make decisions. A database consists of one or more tables containing records of values for fields that pertain to the attributes of the object being represented by the table. Relational databases contain multiple tables that are linked by means of key fields. A database managem...
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Local anaesthetic agents
Publication date: Available online 18 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Malachy O. Columb, David Cegielski, Daniel Haley Local anaesthetics are weak bases and consist of a lipophilic aromatic ring, a link and a hydrophilic amine. The chemistry of the link classifies them as amides or esters. They act by blocking the sodium ionophore, especially in the activated state of the channel, and frequency dependence can be shown. The speed of onset is related to dose and proportion of drug in the unionized lipid-soluble form, which in turn is determined by the pK a and the ambient pH. Loc...
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Protective mechanisms of the body
Publication date: Available online 18 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell The surface of the body and the openings of the various body cavities (respiratory tract, gastrointestinal tract, genitourinary tract) are at potential risk from injury and from pathogenic bacteria. The surface of the skin is acidic and inhibits the growth of organisms. Non-pathogenic bacteria (commensals) compete with pathogens for space and nutrients and so inhibit their growth. The openings to the various body cavities are lined with mucous membrane which traps bacteria and other particles. S...
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Anaesthetic records
This article explores their multiple purposes and the guidelines for their content. It also discusses the practical means of documenting the events that take place during an anaesthetic episode and the benefits and drawbacks of automated electronic records. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

Intermediary metabolism
Publication date: Available online 18 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell Carbohydrate and fat form the immediate and long-term energy stores of the body. Protein constitutes the active (functional) cell mass and is also an energy source but, normally, a relatively minor one. All three macronutrients are interrelated. Proteins are synthesized from amino acids derived from ingested protein. Glucose and fat provide energy via adenosine triphosphate. The brain and red blood cells can only obtain their energy from glucose. Glucose is oxidized via the glycolytic and the tr...
Source: Anaesthesia and intensive care medicine - January 18, 2017 Category: Anesthesiology Source Type: research

The treatment of hypertension in pregnancy
Publication date: Available online 9 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Umbareen Siddiqi, Felicity Plaat Maternal deaths from complications of pregnancy; so-called ‘direct deaths’, including hypertensive disorders, are now less than from indirect causes, (medical conditions that may be exacerbated by pregnancy). The direct death rate in the UK has fallen significantly over the past 5 years. The death rate from hypertensive disorders is at its lowest ever: 0.25/100 × 103 maternities [95%CI 0.09–0.55]. In other words there is one death from hypertensive disor...
Source: Anaesthesia and intensive care medicine - January 9, 2017 Category: Anesthesiology Source Type: research

Principles of anaesthesia for term neonates
Publication date: Available online 9 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Kylie McGregor Anaesthesia for term neonates is associated with increased perioperative morbidity and mortality and as a result should be reserved for specialized paediatric centres. Neonatal systems are immature and are undergoing rapid growth and development. Neonates are uniquely different in how they respond to surgery, drugs and fluids and this response varies across the neonatal period. Many of the physiological differences in neonates are a reflection of their high metabolic rate, increase in oxygen dem...
Source: Anaesthesia and intensive care medicine - January 9, 2017 Category: Anesthesiology Source Type: research

Adaptation for life after birth: a review of neonatal physiology
This article combines well established and contemporary information to summarize a systems-based approach to traditional neonatal physiology. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 5, 2017 Category: Anesthesiology Source Type: research

Acute pain management in the neonate
Publication date: Available online 3 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Glyn Williams Acute pain management in the neonatal period remains a challenge for the clinician. Responses to pain and analgesic intervention are developmentally influenced and cannot be not directly extrapolated from the older child. Successful and safe intervention will minimize acute physiological and behavioural distress, reduce pain scores and potentially improve short- and long-term outcomes. This requires an understanding of the physiology and pharmacology in this age group alongside a multi-modal appr...
Source: Anaesthesia and intensive care medicine - January 3, 2017 Category: Anesthesiology Source Type: research

Resuscitation of the newborn
This article outlines the cascade of evidence-based interventions that include and follow on from airway support in those newborns requiring ongoing assistance. These comments are based around the International Liaison Committee of Resuscitation (ILCOR) 2010 and 2015 Consensus on Science statements and subsequent guideline reviews. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 30, 2016 Category: Anesthesiology Source Type: research

Neonatal pharmacology
Publication date: Available online 28 December 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Brian J. Anderson Neonatal anaesthesia dosing needs to be based on physiological characteristics of the newborn, pharmacokinetic knowledge, pharmacodynamic considerations and the adverse effects profile. Disease processes and treatments in this group are distinct from adults. Immaturity of enzyme, anatomical and physiological systems cause extensive variability of drug disposition and drug response in neonates. This is further compounded by pharmacogenomic influences. Postmenstrual age is a reasonable measur...
Source: Anaesthesia and intensive care medicine - December 28, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for specialist surgery in infancy
Publication date: Available online 26 December 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Amanda Dalton, Graham Knottenbelt Specialist surgery in infancy provides unique and significant challenges for paediatric anaesthetists. Both common (inguinal hernias and hypertrophic pyloric stenosis) and less common conditions (tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos (omphalocele), gastroschisis and congenital lobar emphysema) require a sound understanding of the relevant pathology and the particular issues that may be encountered in order to safely anaesthetise these infan...
Source: Anaesthesia and intensive care medicine - December 26, 2016 Category: Anesthesiology Source Type: research

Special considerations in the premature and ex-premature infant
Publication date: Available online 26 December 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Geoff Frawley Ex-premature infants and children are a heterogenous population, ranging from healthy children born at 36 weeks' gestation to formerly extremely premature children with significant medical issues that affect anaesthetic care. Preterm birth is associated with perinatal mortality, neurological disability (including cerebral palsy), severe morbidity in the first weeks of life, prolonged hospital stay after birth, readmission to hospital in the first year of life and increased risk of chronic lung ...
Source: Anaesthesia and intensive care medicine - December 26, 2016 Category: Anesthesiology Source Type: research

Anaesthesia in the elderly
Publication date: Available online 1 December 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): David J. Chambers, Martin W.B. Allan Older people are undergoing increasingly complex surgery with much greater mortality and morbidity than the younger adult population. In this article, we discuss the physiological changes that take place in the older patient, and how these may affect anaesthetic technique. Perioperative risk in the elderly is discussed, with focus on emergency surgery and frailty. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 1, 2016 Category: Anesthesiology Source Type: research

Local anaesthesia for ocular surgery
Publication date: Available online 30 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Heather Rodgers, Rachael Craven Local anaesthesia is the technique of choice for a large number of ophthalmic procedures, including cataract surgery. For some procedures topical anaesthesia is sufficient; for more complex procedures a local anaesthetic block will be needed. Sharp needle techniques previously favoured, whilst still useful, have become less common than the cannula-based sub-Tenon’s block. This provides favourable operating conditions with a lower risk of complications. Patients should be...
Source: Anaesthesia and intensive care medicine - November 30, 2016 Category: Anesthesiology Source Type: research

Data, information, knowledge and wisdom
Publication date: Available online 30 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul Cooper The relationship between data, information, knowledge and wisdom is explained. The growth of the Internet is changing the traditional hierarchies of ‘experts’ and changing ways of disseminating information. In the growing area of knowledge management, the Internet is enabling new ways of collecting, organizing and disseminating knowledge. Data mining is the application of improved techniques of data organization and storage and analysis to large datasets and has led to the discovery o...
Source: Anaesthesia and intensive care medicine - November 30, 2016 Category: Anesthesiology Source Type: research

Anaphylaxis
Publication date: Available online 29 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Jessica Chapman, Abdul G. Lalkhen Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction. The pathophysiology of anaphylaxis can be described as immunologic and non-immunologic. Classification can be based on the time course of the anaphylactic reaction which may be uniphasic, biphasic or protracted. There are many triggers for anaphylaxis; the most commonly identified are food, drugs and venom. Perioperative anaphylaxis is a serious complication reported in up to 1...
Source: Anaesthesia and intensive care medicine - November 29, 2016 Category: Anesthesiology Source Type: research

Physiology of ageing
Publication date: Available online 26 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Victoria Scott-Warren, Simon Maguire The impact that ageing has on organisms is a complex interaction between the processes of ageing at a cellular, organ and integrated systems level, and the effects of environmental factors such as nutrition, infection and trauma. Recovery from an insult that triggers a pathological response is never complete. The incremental fall in possible performance is part of the progressive diversity in ‘physiology’ that is the true hallmark of ageing. In this article we...
Source: Anaesthesia and intensive care medicine - November 26, 2016 Category: Anesthesiology Source Type: research

Ocular anatomy and physiology relevant to anaesthesia
This article discusses anatomy of the orbit and eye, and includes rudimentary ocular physiology. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 26, 2016 Category: Anesthesiology Source Type: research

Pathophysiology of respiratory disease and its significance to anaesthesia
Publication date: Available online 26 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): S. Kimber Craig, Li Fang Significant changes occur in the respiratory physiology of healthy patients during anaesthesia. In patients with underlying respiratory pathology, these changes in respiratory physiology may lead to clinical problems during the conduct of anaesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anaesthetist to account for the potential complications of these conditions and manage the anaesthetic accordingly. (...
Source: Anaesthesia and intensive care medicine - November 26, 2016 Category: Anesthesiology Source Type: research

Care of the eye during anaesthesia and intensive care
Publication date: Available online 26 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Anthony O'Driscoll, Emert White Perioperative eye injuries and blindness are rare but important complications of anaesthesia. The three causes of postoperative blindness are ischaemic optic neuropathy, central retinal artery thrombosis (these can exist in tandem and have been described as ischaemic oculopathies) and cortical blindness. This review aims to improve anaesthetists' knowledge of orbital anatomy, ocular physiology and the mechanisms of perioperative eye injuries to help reduce their occurrence. (S...
Source: Anaesthesia and intensive care medicine - November 26, 2016 Category: Anesthesiology Source Type: research

Critical incidents: the respiratory system
Publication date: Available online 26 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Edward T.C. Miles, Timothy M. Cook Respiratory complications are expensive, not just in terms of the overall litigation burden faced by anaesthetists but also, far more importantly, the mortality and morbidity burden faced by our patients. Critical incidents arising in the respiratory system can cause rapid deterioration if left unchecked: trauma to airway structures can be debilitating or even life-threatening; hypoxaemia may result in damage to other organ systems, most notably the brain. Each patient carr...
Source: Anaesthesia and intensive care medicine - November 26, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for paediatric eye surgery
Publication date: Available online 27 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Ian D.M. Davies, Steven M. Sale Local anaesthesia is often the technique of choice for ophthalmic procedures performed on adults; however, general anaesthesia is usually required for procedures on children. The majority of paediatric patients are fit and healthy but there is a minority in whom the presenting eye complaint is related to a congenital disorder, which may have significant bearing on the conduct of anaesthesia. Management of the airway and presentation of a quiescent eye for surgery are key consi...
Source: Anaesthesia and intensive care medicine - November 26, 2016 Category: Anesthesiology Source Type: research

Eye signs in anaesthesia and intensive care medicine
Publication date: Available online 25 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Rahul Bajekal, Francoise Bari Eye signs are of limited value in assessing the level of sedation or general anaesthesia. Horner's syndrome is an important complication of excessively high neuraxial block. Eye opening is part of the Glasgow Coma Scale, and pupil size and reaction have important implications in the intensive care setting. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 24, 2016 Category: Anesthesiology Source Type: research

Tracheal intubation
Publication date: Available online 25 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Elizabeth B.M. Thomas, Susan Moss Tracheal intubation is the placement of a tube into the trachea. It provides the gold standard for airway protection ensuring the trachea and lungs are protected from the aspiration of stomach contents. The tube can be used for ventilation permitting oxygen delivery and the removal of carbon dioxide; it also has a role in delivering drugs. If the tracheal tube is misplaced and not recognized, then hypoxia will occur which may be fatal. Tracheal intubation was first recorded ...
Source: Anaesthesia and intensive care medicine - November 24, 2016 Category: Anesthesiology Source Type: research

General anaesthesia for ophthalmic surgery
Publication date: Available online 25 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Nicholas C.B. Pritchard Local anaesthesia for eye surgery is increasingly popular, but there will always be a need for general anaesthesia. Patients may refuse local anaesthesia, may be unable to keep still or lie flat for the duration of surgery or lack the mental facility to cooperate whilst awake. Young children and those with allergy to local anaesthetic also need general anaesthesia. Careful patient preparation is important before surgery. Glycaemic control in patients with diabetes, adjustments to warf...
Source: Anaesthesia and intensive care medicine - November 24, 2016 Category: Anesthesiology Source Type: research

Therapeutic hypothermia and acute brain injury
This article will review the putative mechanisms of hypothermia-induced neuroprotection, the technical considerations for the clinician wishing to use TTM, and review the evidence for the clinical application of TTM after acute brain injury. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

The management of ischaemic stroke
Publication date: Available online 20 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Robin S. Howard Ischaemic stroke often leads devastating long-term neurological sequelae. There are five interventions that improve the outcome after a stroke: management within a stroke unit, intravenous thrombolysis, mechanical clot retrieval, aspirin within 48 hours, and decompressive hemicraniectomy for malignant middle cerebral artery (MCA) stroke. The benefits of intravenous thrombolysis up to 4.5 hours are now well established, but the recent development of clot retrieval has radically altered the acut...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Anaesthesia for interventional neuroradiology
Publication date: Available online 20 October 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Baljit S. Phull, Ian Appleby The volume and range of procedures undertaken by interventional neuroradiologists have significantly expanded in recent years. They are now treating many conditions previously considered untreatable or only amenable to open surgical techniques. To facilitate the close cooperation required between radiologists and anaesthetists necessary for the successful outcome of these complex and lengthy procedures, it is important for the anaesthetist to have an appreciation of the physiopath...
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Applied cerebral physiology
This article reviews cerebral metabolism and cerebral blood flow and techniques by which both can be monitored. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research

Cerebrospinal fluid and its physiology
This article describes the anatomy and physiology of cerebrospinal fluid and the abnormalities that can result in hydrocephalus. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 28, 2016 Category: Anesthesiology Source Type: research