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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recognizing the critically ill patient
Publication date: Available online 25 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Kathryn A. Bennett, Laura C. Robertson, Mohammed Al-Haddad Critical illness is a life-threatening multisystem process that can result in significant morbidity or mortality. In most patients, critical illness is preceded by a period of physiological deterioration; but evidence suggests that the early signs of this are frequently missed. All clinical staff have an important role to play in implementing an effective ‘Chain of Response’ that includes accurate recording and documentation of vital s...
Source: Anaesthesia and intensive care medicine - January 26, 2016 Category: Anesthesiology Source Type: research

Leadership in healthcare
Publication date: Available online 21 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Robin D.C. Kumar, Noshaba Khiljee Effective leadership by healthcare professionals is vital in modern healthcare settings. The major factor underpinning this is the drive to improve the quality of healthcare provision on a background of ever increasing healthcare demands and need for increased efficiency and productivity. There are many reasons why quality improvement programmes fail, however the lack of engagement of medical staff and their resistance to change are amongst the most important factors. Clin...
Source: Anaesthesia and intensive care medicine - January 23, 2016 Category: Anesthesiology Source Type: research

Cardiopulmonary resuscitation and post-resuscitation care
Publication date: Available online 18 January 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Jonathan Mackenney, Jasmeet Soar Survival following cardiac arrest depends on early recognition and effective treatment with high-quality chest compressions with minimal interruption, ventilation, treatment of reversible causes, and defibrillation if appropriate. Successfully resuscitated patients can develop a ‘SIRS-like’ post-cardiac arrest syndrome. Post-cardiac arrest care includes coronary reperfusion, control of oxygenation and ventilation, circulatory support, glucose control, treatment ...
Source: Anaesthesia and intensive care medicine - January 20, 2016 Category: Anesthesiology Source Type: research

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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