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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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