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

Associated medical conditions in children
Publication date: Available online 10 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Alana Kirkwood , Elena Fernandez Children with acute and chronic associated medical conditions often present for surgical and radiological procedures. An understanding of the implications of these conditions for anaesthesia is important in preventing perioperative adverse events. In this article, we outline the relevant clinical features of some of the commonly encountered associated medical conditions and provide guidance on the current practice in the anaesthetic management of these conditions. (Source: Anaes...
Source: Anaesthesia and intensive care medicine - July 11, 2015 Category: Anesthesiology Source Type: research

Preoperative assessment and preparation for anaesthesia in children
We describe below the elements of preoperative assessment that will prepare the family and staff for a smooth and safe anaesthetic process. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 11, 2015 Category: Anesthesiology Source Type: research

Induction of anaesthesia
Publication date: Available online 10 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Eleanor Chapman , Kate O'Connor General anaesthesia is a temporary state of unconsciousness that is induced to facilitate a therapeutic procedure. Induction is the first stage of a sequential process. It commences with patient preparation and assessment away from theatre, and continues in the safe and monitored environment of the anaesthetic room or operating theatre, where the administration of drugs and airway interventions take place. The anaesthetic then transits through maintenance, emergence and recovery ...
Source: Anaesthesia and intensive care medicine - July 11, 2015 Category: Anesthesiology Source Type: research

Equipment and monitoring for paediatric anaesthesia
Publication date: Available online 10 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): David Leslie , Stephen Froom , Christopher Gildersleve There have been considerable developments in the equipment and monitoring available for paediatric anaesthesia over the past 3 years. Advances in airway management have come about primarily through the increased use of videolaryngoscopes. Numerous second-generation supraglottic airway devices are also now available with features aimed at improving both their safety profile and utility during difficult airway management. Concerns surrounding the endocrine ef...
Source: Anaesthesia and intensive care medicine - July 11, 2015 Category: Anesthesiology Source Type: research

Anaesthetic implications of congenital heart disease for children undergoing non-cardiac surgery
Publication date: Available online 10 July 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Savini Wijesingha , Michelle White Children with congenital heart disease (CHD) are at increased risk of morbidity, perioperative cardiac arrest and 30-day mortality from major and minor surgical procedures compared to healthy children. Factors associated with greatest risk are the complexity of cardiac disease and the physiological status of the child. Therefore the anaesthetist must understand balanced and single ventricle circulations and be able to assess the effects of four major complications of CHD: card...
Source: Anaesthesia and intensive care medicine - July 11, 2015 Category: Anesthesiology Source Type: research

Therapeutic issues in transplant patients
Publication date: Available online 21 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Mark C. Bellamy , Alexander Scott Patients who have undergone previous organ transplantation represent a considerable therapeutic challenge to the anaesthetist. Although a transplant may have restored normal or near-normal function for that organ, the original underlying pathology often persists. In addition, undesirable effects of immunosuppressant drugs, particularly calcineurin inhibitors, may give rise to damage to other organs and organ systems. Diabetes, hyperlipidaemia and accelerated vascular and renal ...
Source: Anaesthesia and intensive care medicine - June 21, 2015 Category: Anesthesiology Source Type: research

Measuring temperature
Publication date: Available online 20 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): E Byron Howells In the perioperative period patients tend to lose heat and become hypothermic. An understanding of the causes and prevention of heat loss is therefore important to the anaesthetist. Heat and temperature are measures of energy. Heat is a measure of the total kinetic energy (joules, J) of a body, and depends on the size of the body and its specific heat capacity. Temperature is a measure of the average kinetic energy, and describes the potential for heat transfer from a body at high temperature to...
Source: Anaesthesia and intensive care medicine - June 20, 2015 Category: Anesthesiology Source Type: research

Inflammation, immunity and allergy
Publication date: Available online 13 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Cormac O'Connor , Alistair Nichol Injury or foreign invasion will instigate a cascade of events directed at eliminating the intruder and augmenting the healing process. This involves the uniting of two separate process (inflammatory and immune processes) to provide an effective host defence. Chemical mediators converge on the site of tissue damage and exert local and distant effects. The immune response is divided into innate and acquired immunity. The immediate, non-specific innate response, combined...
Source: Anaesthesia and intensive care medicine - June 13, 2015 Category: Anesthesiology Source Type: research

Organ donation and management of the potential organ donor
Publication date: Available online 10 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Cariad Findlater , Euan M. Thomson Solid organ transplant offers the hope of disease cure for hundreds of thousands of patients worldwide. Not only does it increase life expectancy and improve the quality of life, it unburdens health services and offers long-term financial savings. The clinician's role in early identification and management of potential donors ensures that the maximum number of people can benefit from this life changing intervention. A chronic shortfall in transplantable organs has led to broad...
Source: Anaesthesia and intensive care medicine - June 10, 2015 Category: Anesthesiology Source Type: research

The immune system
Publication date: Available online 6 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Allwyn M. Cota , Mark J. Midwinter The immune system provides the body with both non-specific and specific defence against pathogens. It can recognize foreign from self. The immune system is composed of lines of defence and can mount responses by cellular and humoral mechanisms. It also has memory, allowing a quicker and heightened response on subsequent exposure. It achieves these effects by a complex interaction between the clotting, complement and kinin systems, endothelial cells and the cells and proteins of...
Source: Anaesthesia and intensive care medicine - June 7, 2015 Category: Anesthesiology Source Type: research

Brain stem death
Publication date: Available online 6 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael McLaughlin , Barbara Miles The concept of brain and brain stem death developed from the observation of patients in apnoeic coma. Specific pre-conditions must be met before the diagnosis can be made through the clinical testing of brain stem function. Although the exact definition of brain death and some of the details for testing vary across the globe, the majority of tests carried out are similar. We define brain stem death and the clinical tests used to confirm it. The use of ancillary testing can have...
Source: Anaesthesia and intensive care medicine - June 7, 2015 Category: Anesthesiology Source Type: research

Immunological response to infection: inflammatory and adaptive immune responses
Publication date: Available online 5 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Peter J. Wood The immediate response to infection involves the innate immune system, which consists of many cell types and factors. The cells of the innate immune system include the different types of white blood cells and tissue residing cells such as macrophages and mast cells. This immediate response to infection involves an inflammatory response which locally causes vasodilation and increased vascular permeability, thereby promoting the recruitment of cells and soluble factors from the bloodstream. Systemic ...
Source: Anaesthesia and intensive care medicine - June 6, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for renal transplantation: an update
This article describes the assessment of the patient for renal transplantation, the perioperative management and the aims in the postoperative period. These patients present a unique set of challenges to the anaesthetist, who has a crucial role in the immediate success of the transplanted organ. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 6, 2015 Category: Anesthesiology Source Type: research

Immunology of transplantation
Publication date: Available online 6 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Allwyn M. Cota , Mark J. Midwinter Understanding the interaction of foreign tissue with the recipient immune system is key to improving results from organ transplantation. Responses are mediated by the humoral and cellular arms of the host immune system towards the tissues of the transplant. Unchecked this can lead to rejection of the graft. Improvements in immunosuppressive therapy have countered these reactions to a degree but are not without side effects. Future work is directed at improving graft tolerance w...
Source: Anaesthesia and intensive care medicine - June 6, 2015 Category: Anesthesiology Source Type: research

Cardiopulmonary transplantation: anaesthetic implications
Publication date: Available online 6 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Chris Durkin , Mark Buckland Heart and lung transplantation rates continue to rise with median survival rates of 11 and 7 years, respectively. Lung transplantation is definitive therapy for end-stage lung disease with indications categorized as suppurative, obstructive, restrictive and pulmonary vascular. Surgical options include single lung, bilateral sequential single lung, and heart lung transplantation. All have their own intraoperative challenges, especially at induction, commencement of positive pressure v...
Source: Anaesthesia and intensive care medicine - June 6, 2015 Category: Anesthesiology Source Type: research

Ethical issues in organ transplantation
This article reviews contemporary debates in vital organ transplantation, including the merits of ‘opt in’ versus ‘opt out’ donor registries and the ‘dead donor rule’. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 5, 2015 Category: Anesthesiology Source Type: research

Anaesthesia and intensive care for adult liver transplantation
Publication date: Available online 4 June 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Craig Beattie , Michael A. Gillies This review describes the preoperative assessment and listing of the patient for liver transplantation and some of the specific perioperative challenges this group of patients present to the anaesthetist. The principles of the early postoperative management in the intensive care unit are discussed as well as some of the signs of early graft dysfunction. Increasingly unwell patients receiving grafts that may come from more marginal donors present significant challenges to the tr...
Source: Anaesthesia and intensive care medicine - June 5, 2015 Category: Anesthesiology Source Type: research

Fluid and electrolyte problems in renal dysfunction
Publication date: Available online 16 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Jennifer Oldridge , Swati Karmarkar The primary function of the kidney is to maintain fluid and electrolyte homeostasis. Each day the kidney must excrete 1500 ml of water and any excess ingested sodium, potassium, magnesium and phosphate. The kidney also plays a key role in calcium homeostasis. Of the total number of patients in intensive care 3–25% will develop acute kidney injury and patients with chronic renal disease will frequently present for surgery. The treatments for renal dysfunction may themselv...
Source: Anaesthesia and intensive care medicine - May 16, 2015 Category: Anesthesiology Source Type: research

Renal failure and its treatment
Publication date: Available online 16 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Andrew Martin , John MacDonald , John Moore Kidney disease can be defined as acute or chronic kidney injury. Acute kidney injury is measured directly via glomerular filtration rate and indirectly via urea and electrolyte levels. Acute kidney injury can be classified via the RIFLE criteria. Chronic kidney injury is a progressive and irreversible condition, which is defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/minute/1.73 m2 or the presence of one or more markers of chronic kidney d...
Source: Anaesthesia and intensive care medicine - May 16, 2015 Category: Anesthesiology Source Type: research

Preoperative assessment of the patient with kidney disease
This article focuses on the clinical anaesthetic assessment of the renal patient prior to surgery. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - May 16, 2015 Category: Anesthesiology Source Type: research

Role of the kidney in acid–base balance
Publication date: Available online 14 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): John C. Atherton Correction of disturbances in acid–base balance is achieved by: physicochemical buffering by extracellular and intracellular buffer systems (instantaneous), alveolar ventilation to control pCO2 (rapid), and renal compensation (long term). Buffering and changes in ventilation limit changes in pH, but cannot return acid–base status to normal. The kidney has a pivotal role: disturbances can be completely corrected through changes in H+ secretion and HCO3 − reabsorption and product...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Micturition
Publication date: Available online 14 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Simon Fulford The lower urinary tract has two complementary functions. For the majority of the time it accepts and stores the urine excreted from the kidneys. It then expels the urine when required. In order to protect the kidneys the intravesical pressure needs to remain below that in the ureters during the storage phase. During the voiding phase the vesico-ureteric reflux has to be prevented and the bladder emptied completely. The anatomy of the lower urinary tract and in particular the neurological control me...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Regulation of fluid and electrolyte balance
Publication date: Available online 14 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Jonathan D. Louden The three fluid compartments of the body are interdependent. Their homeostasis relies on systems that regulate water balance and, as the principal extracellular solute, sodium balance. Maintenance of plasma volume is essential for adequate tissue perfusion. Regulation of plasma osmolality, which is determined primarily by the serum sodium concentration, is essential for the preservation of normal cell volume and function. The importance of osmoregulation is best illustrated by the consequences...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Renal blood flow, glomerular filtration and plasma clearance
Publication date: Available online 14 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): John C. Atherton Homeostatic and excretory functions of the kidney depend on blood flow (∼25% cardiac output) and glomerular ultrafiltration (∼20% renal plasma flow). Blood flow distribution is not uniform, with only 10% reaching the medulla. Selectivity of ultrafiltration is related to molecular size, shape and electrostatic charge of molecules, and structure of the glomerular capillary barrier with its negatively charged glycoproteins. Ultrafiltration, determined by the balance between hydrostatic and ...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for urological surgery
Publication date: Available online 14 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Hazem H. Alaali , Michael G. Irwin Anaesthesia is commonly used to facilitate urological procedures and many patients are elderly with multiple co-morbidities. Urological procedures range from minor day case to major surgery in which extensive resources are needed both intra- and postoperatively. For simple day case procedures like cystoscopy or ureteroscopy, general anaesthesia is most commonly used because it allows for early ambulation. Transurethral resection of the prostate (TURP) needs special attention. T...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

The function of the nephron and the formation of urine
This article explains the purpose of each portion of the nephron and the transport systems and hormones involved in the normal function of the nephron in the formation of urine. The article includes a discussion of commonly used drugs that affect nephron function. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Anatomy of the kidney and ureter
Publication date: Available online 15 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Zia Moinuddin , Raman Dhanda A good understanding of the anatomy of the kidney and ureter is imperative while dealing with patients with abdominal trauma and those undergoing abdominopelvic surgery. The kidneys are situated in the retroperitoneum and are enveloped by the renal fascia. The renal fascia prevents the extravasation of blood during renal trauma. The lower poles of the kidneys are more prone to trauma as they are inferior to the 12th rib. However, due to the proximity of the kidneys to the lower ribs ...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Statistics for clinical trials and audit
This article covers the application of statistics to clinical trials and audit, including the basic types of study design, bias, power analysis, guides to good clinical practice, the presentation of results and applications in quality assurance. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Laboratory tests of renal function
Publication date: Available online 15 May 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Laura Chadwick , Ross Macnab The human kidney provides essential regulatory and excretory functions. Body water content, plasma electrolyte composition and plasma pH are all under the regulatory control of the kidney. In addition, the kidney provides a path of excretion for blood-borne, water-soluble, low-molecular-weight compounds. These include the end-products of protein metabolism, such as urea and creatinine, as well as foreign compounds with similar physicochemical characteristics and their metabolites. En...
Source: Anaesthesia and intensive care medicine - May 15, 2015 Category: Anesthesiology Source Type: research

Control of cardiac function: an overview
Publication date: Available online 7 April 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Andrew Chaytor Cardiac output is the volume of blood ejected per ventricle per minute and is a measure of cardiac performance. It is the product of the strength of ventricular contraction, which determines how much blood is ejected (stroke volume), and the heart rate. Factors that control the force of contraction include the degree of myocardial stretch or Starling's Law, which is determined by venous return, and also the amount of cytosolic calcium present in muscle cells, which is influenced by sympathetic ne...
Source: Anaesthesia and intensive care medicine - April 8, 2015 Category: Anesthesiology Source Type: research

Electrocardiogram and arrhythmias
Publication date: Available online 6 April 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Rajender Singh , Jeremy J. Murphy Introduced by Einthoven, electrocardiography remains the most common diagnostic procedure readily available to the physician in primary and secondary care. It is a graphical display of the electrical potential difference as it spreads through the heart and is recorded at the body surface. The electrocardiogram (ECG) is an indispensable tool to screen and monitor cardiac patients. Exercise ECG is used to diagnose coronary artery disease and ambulatory ECG to assess arrhythmias. ...
Source: Anaesthesia and intensive care medicine - April 7, 2015 Category: Anesthesiology Source Type: research

Initiation and regulation of the heartbeat
Publication date: Available online 7 April 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Emrys Kirkman The heart has all the components necessary to initiate and maintain a regular heartbeat, without the need for external influence. Thus, a transplanted heart without nervous connection, or a heart completely removed from the body, if adequately perfused with oxygen, beats rhythmically. In the normal intact body, the function of the nervous and humoral regulation is to modulate the activity of the heart, though some aspects of modulation are intrinsic properties of cardiac muscle. (Source: Anae...
Source: Anaesthesia and intensive care medicine - April 7, 2015 Category: Anesthesiology Source Type: research

Electromechanical coupling and regulation of force of cardiac contraction
Publication date: Available online 7 April 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Emrys Kirkman Cardiac muscle fibres, like skeletal muscle fibres, are divided into sarcomeres, the basic unit of contraction. The contractile elements include actin, myosin, tropomyosin and troponin. The myosin molecules are arranged into thick filaments, while the actin molecules form the basis of the thin filaments. The troponin and tropomyosin are attached to the thin filaments as in skeletal muscle. In contrast to fast skeletal muscle fibres, which need to produce repetitive mechanical action only for short...
Source: Anaesthesia and intensive care medicine - April 7, 2015 Category: Anesthesiology Source Type: research

Mechanical events and the pressure–volume relationships
Publication date: Available online 4 April 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Emrys Kirkman Depolarization of cardiac muscle fibres spreads from fibre to fibre throughout the myocardium. In a single fibre, contraction starts just after depolarization and lasts until just after repolarization is complete. The atria contract, completing the filling of the ventricles and thus enhancing their action. In the absence of effective atrial contraction (e.g. atrial fibrillation) cardiac output is decreased on average by 15%. During diastole, when cardiac muscle is relaxed, blood returns to the hea...
Source: Anaesthesia and intensive care medicine - April 5, 2015 Category: Anesthesiology Source Type: research

Drugs acting on the heart: heart failure and coronary insufficiency
Publication date: Available online 1 April 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Takashi Kudo , Jonathan P. Thompson Heart failure (HF) and coronary insufficiency are common amongst surgical and critical care patients. Both are chronic conditions interrupted by acute episodes. HF activates neurohormonal mechanisms that worsen renal and cardiac function. Acute heart failure commonly presents with dyspnoea as a consequence of systolic and/or diastolic dysfunction. Goals of treatment are symptom relief, to maintain tissue perfusion and optimize cardiac function. Diuretics and vasodilators are ...
Source: Anaesthesia and intensive care medicine - April 3, 2015 Category: Anesthesiology Source Type: research

Physical principles of defibrillators
Publication date: Available online 31 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Alice Braga , Robin Cooper Defibrillators are employed in the treatment of cardiac arrhythmias in both emergency and elective settings. Components of a defibrillator include: a power source, a capacitor, an inductor, a rectifier and a transformer. The different components allow electrical energy to be modulated and stored, and alter the timing, magnitude, and waveform of the delivered energy. Modern defibrillators employ biphasic waveform technology to increase safety and efficacy. Automated machines increase ...
Source: Anaesthesia and intensive care medicine - March 31, 2015 Category: Anesthesiology Source Type: research

Drugs acting on the heart: anti-arrhythmics
This article describes the mechanisms of action of the common anti-arrhythmic agents, their use in clinical practice and a review of recent guidelines for the management of common arrhythmias. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 31, 2015 Category: Anesthesiology Source Type: research

Drugs acting on the heart: antihypertensive drugs
Publication date: Available online 30 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew Charlton , Jonathan Thompson Antihypertensive drugs are used commonly in anaesthesia and intensive care medicine. Patients might require antihypertensive drugs before surgery for the treatment of essential hypertension, pre-eclampsia or, occasionally, for conditions such as phaeochromocytoma; during surgery as part of a deliberate hypotensive anaesthetic technique; or to reduce postoperative cardiovascular complications. Here, we discuss the physiology of blood pressure control, the pharmacology of ant...
Source: Anaesthesia and intensive care medicine - March 30, 2015 Category: Anesthesiology Source Type: research

Clinical negligence
Publication date: Available online 7 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Robert Palmer , Mary C. Maclachlan Clinical negligence cases are based on the assumption that a doctor owes patients a duty to take reasonable care when treating or advising them. Doctors breach this duty if their treatment falls below the standard expected by a responsible body of medical opinion. The doctor will be held to have acted negligently. A patient may then have a claim for compensation if, and only if, the patient can prove, on the balance of probabilities, that the negligence has caused physical or ...
Source: Anaesthesia and intensive care medicine - March 8, 2015 Category: Anesthesiology Source Type: research

Consent
Publication date: Available online 4 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Stuart M. White , Mark Ashley Morally, ‘consent’ allows an autonomous patient to determine what treatments they will accept or refuse. The law relating to medical consent protects such self-determination, and allows for treatment decisions to be made for patients who cannot decide for themselves. Consent is valid if it is given voluntarily by a competent patient and is based on the information provided to them. Information must be provided about what is to be done and why, and what the foreseeable r...
Source: Anaesthesia and intensive care medicine - March 4, 2015 Category: Anesthesiology Source Type: research

Statistics in medicine
This article covers the basic principles of statistics in medicine. Topics covered include types of data, descriptive statistics (mean, median, mode, percentiles), the normal distribution, confidence intervals and the standard error of the mean, hypothesis testing and the choice of statistical tests, type I and II errors, contingency tables, correlation and regression, and meta-analysis. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 4, 2015 Category: Anesthesiology Source Type: research

Management of status epilepticus
Publication date: Available online 4 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Abhik Bhattacharjee , Nicholas Hirsch Status epilepticus is the second most common neurological emergency after stroke and carries considerable mortality and morbidity. Successful treatment of SE requires rapid treatment if complications are to be avoided. Current guidelines suggest a protocol driven management consisting of three consecutive interventions – administration of benzodiazepines followed by longer-acting anti-epileptic agents and finally, if seizures persist, the administration of general ana...
Source: Anaesthesia and intensive care medicine - March 4, 2015 Category: Anesthesiology Source Type: research

Decompensated liver cirrhosis
Publication date: Available online 3 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Tom G. Bird , Prakash Ramachandran , Euan Thomson The incidence of liver disease continues to increase and is now one of the leading causes of death in the United Kingdom. The increasing prevalence of viral hepatitis combined with a surge in the incidence of both alcohol and obesity related liver disease mean that critical care units are increasingly being called upon to assist in managing those with life-threatening complications of end-stage liver disease. Decompensated cirrhosis is not a single organ illness...
Source: Anaesthesia and intensive care medicine - March 3, 2015 Category: Anesthesiology Source Type: research

Acute kidney injury and the critically ill
Publication date: Available online 3 March 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Bilal Ahmed , Jina Hanna , Alistair Nichol Acute renal failure (ARF) is commonly encountered in the intensive care unit. It is associated with considerable morbidity and mortality. There are many possible aetiologies in the critically ill, including nephrotoxic agents, hypovolaemia and sepsis. Whilst many classification systems for ARF exist, the RIFLE (Risk, Injury, Failure, Loss, End-stage) criteria and the Acute Kidney Injury Network (AKIN) criteria are the most commonly utilized. Many supportive therapies a...
Source: Anaesthesia and intensive care medicine - March 3, 2015 Category: Anesthesiology Source Type: research

Acute pancreatitis: an intensive care perspective
Publication date: Available online 27 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Nessa Dooley , Simon Hew , Alistair Nichol Acute pancreatitis (AP) is a sudden inflammation of the pancreas, which is often mild and resolves spontaneously. However if severe, it can cause significant morbidity and mortality and requires management in the Intensive Care Unit. The diagnosis of AP is made, using a combination of clinical symptoms, elevations in pancreatic enzymes and/or characteristic findings on computer tomography. In 2012, the Atlanta Symposium revised the classification of pancreatitis in...
Source: Anaesthesia and intensive care medicine - February 28, 2015 Category: Anesthesiology Source Type: research

Gastrointestinal problems in intensive care
Publication date: Available online 26 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Gerard J. Fennessy , Stephen J. Warrillow Gastrointestinal problems are common in ICU patients and include both surgical and non-surgical problems. A high index of suspicion and regular clinical assessment and are necessary due to difficulty evaluating critically ill and ventilated patients. Gastrointestinal failure may complicate or even precipitate multiorgan failure with systemic inflammatory response due to bacterial translocation. Intra-abdominal hypertension can be under-recognized and causes renal fa...
Source: Anaesthesia and intensive care medicine - February 27, 2015 Category: Anesthesiology Source Type: research

Special senses
This article gives a brief description of the neural mechanisms and pathways responsible for vision, hearing, smell, balance and taste. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 27, 2015 Category: Anesthesiology Source Type: research