Editorial Board
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 1, 2014 Category: Anesthesiology Source Type: research

Anaesthesia in the obese patient
This article will present important aspects related to pathophysiology and pharmacology. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 28, 2014 Category: Anesthesiology Authors: Andrew Brammar, Mark Forrest Tags: Endocrinology Source Type: research

Recognition and management of phaeochromocytoma
Phaeochromocytomas are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a workup for multiple endocrine neoplasia or during unrelated surgery. Better understanding of catecholamine physiology and advances in preoperative preparation has significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection is associated with reduced hospital stay and earlier mobilisation. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 28, 2014 Category: Anesthesiology Authors: Inas Ahmed, Chandran Jepegnanam Tags: Endocrinology Source Type: research

Clinical aspects of endocrinology: parathyroid and adrenal gland disorders
The parathyroid glands are responsible for calcium homeostasis, which is necessary for appropriate functioning of the musculoskeletal and nervous system. Parathyroid adenoma remains the most common indication for surgery.The adrenal cortex is mainly responsible for secretion of mineralocorticoids, glucocorticoids and androgens whereas the medulla consists of pre-ganglionic sympathetic ganglion, which secretes epinephrine, nor-epinephrine and dopamine. Adrenocortical disease results in disturbance of water balance, electrolytes, cardiovascular instability and metabolic disturbances. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 26, 2014 Category: Anesthesiology Authors: Inese Kutovaja, Kailash Bhatia Tags: Endocrinology Source Type: research

Adrenocortical hormones
The adrenal glands lie on top of the kidneys. The adrenal medulla produces catecholamines and the adrenal cortex produces three types of steroid hormone (mineralocorticoids (aldosterone), glucocorticoids (cortisol) and androgens (dehydroepiandrosterone, DHEA)). All are synthesized from cholesterol. Cortisol secretion is controlled by adrenocorticotrophic hormone from the pituitary. It rises in response to stress and is essential for life. It stimulates gluconeogenesis, breaking down lean tissue, and is anti-inflammatory. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 26, 2014 Category: Anesthesiology Authors: Iain Campbell Tags: Physiology Source Type: research

Thyroid and parathyroid hormones and calcium homeostasis
The thyroid gland is under the control of thyroid-stimulating hormone (TSH) from the pituitary. It secretes thyroxine (T4) and triiodothyronine (T3). Iodine is essential for the synthesis of thyroid hormones. T4 is probably converted to T3 in peripheral tissues. Thyroid hormones have a role in growth and development, but their principal effect is the control of basal metabolic rate. Deficiency or excess affects all the tissues of the body, reducing or increasing the metabolic rate, resulting in hypothermia or hyperthermia, respectively. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 26, 2014 Category: Anesthesiology Authors: Iain Campbell Tags: Physiology Source Type: research

Hypothalamic–pituitary–adrenal function: anaesthetic implications
Surgery, trauma and critical illness evoke a series of hormonal and metabolic changes commonly referred to as the stress response. Activation of the hypothalamic–pituitary–adrenal axis results in increased secretion of hormones such as cortisol. Anaesthesia can suppress adrenocortical secretion either by an effect at the hypothalamus, for example by a decrease in neural input with regional anaesthesia, or by a direct effect on the adrenal cortex, for example by etomidate. For patients undergoing routine surgery an increase in cortisol secretion is unnecessary, uneventful recovery occurs in the presence of circu...
Source: Anaesthesia and intensive care medicine - August 26, 2014 Category: Anesthesiology Authors: Grainne Nicholson, George M. Hall Tags: Pharmacology Source Type: research

The pancreas
Although only the same weight as an apple, the pancreas fulfils endocrine and exocrine functions, and coordinates metabolism throughout the body. For example, insulin, perhaps the best-known pancreatic hormone, not only influences glucose metabolism but also helps to regulate protein and fat metabolism (thus explaining why diabetes is more than just a disease of sugar). The secretion of pancreatic hormones is highly coordinated to exert a concerted effect on the metabolism of a range of organs, from adipose tissue to muscle. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 26, 2014 Category: Anesthesiology Authors: Garry D. Tan Tags: Physiology Source Type: research

MCQs
Which of the following are true about the mechanism of action and side effects of drugs used in the management of diabetes? (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 26, 2014 Category: Anesthesiology Authors: Viyayanand Nadella, Henry G.W. Paw Tags: Test yourself Source Type: research

Anaesthetic management of diabetes
Diabetes is a complex metabolic disorder that is increasing in incidence globally. It is the most common non-communicable disease worldwide. Diabetic patients pose a challenge to anaesthesia and surgery due to the organs and systems affected by the disease. Good glycaemic control perioperatively is essential to minimize complications. There is an increasing number of therapies to control diabetes, and this is rapidly evolving, so a multidisciplinary approach to the management of these patients is recommended, and increasingly the patients themselves should be participating in managing their diabetes as long as possible. (S...
Source: Anaesthesia and intensive care medicine - August 23, 2014 Category: Anesthesiology Authors: Inas Ahmed, Swamy Mruthunjaya Tags: Endocrinology Source Type: research

Pain priorities in pre-hospital care
Pain management in the pre-hospital environment is a priority following life- and limb-saving manoeuvres. Pain should be assessed and documented then managed according to a multimodal model. Even in the context of environmental challenges and limited resources, pharmacological, physical and psychological interventions can all be used to provide effective analgesia and relieve suffering prior to and during transfer to hospital. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Charlotte Small, Dominic Aldington Tags: Trauma Source Type: research

Chest trauma
This article summarises major life-threatening injuries in thoracic trauma. Timing, clinical features, necessary investigations and interventions are described within the clinical approach of primary and secondary surveys. Emphasis is on immediate resuscitation with some discussion on further management. Injuries included are tension pneumothorax, open pneumothorax, massive haemothorax, pericardial tamponade, aortic injuries, cardiac injuries, lung contusion, flail chest, diaphragmatic injury, airway injury and oesophageal rupture. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Bevan Roodenburg, Owen Roodenburg Tags: Trauma Source Type: research

Spinal cord injury
With an annual incidence of 13 per million, around 40,000 people in the UK live with spinal cord injury (SCI). The extent of morbidity and mortality and thus quality of life, is highly dependent on meticulous management from the first point of contact with medical services. Treatment is focussed on reducing the risk of further cord injury and prevention of secondary (penumbral) damage through avoidable complications. As key members of trauma, theatre, intensive care and pain teams, anaesthetists and intensivists play a crucial role in influencing patient outcome. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Bob Winter, Hina Pattani, Emma Temple Tags: Trauma Source Type: research

Critical care management of inhalational injury and severe burns
Inhalational injury and severe burns are common. Most will present to district general hospitals and thus an understanding of how to assess and manage these patients is vital for all practising anaesthetists with on-call commitments. In this article we emphasize the requirement for a highly functioning multidisciplinary approach with excellent communication both within and between treating teams. We will challenge the dogmatic approach to airway management and discuss the increasing problem of fluid creep. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Dominic Trainor, Jason McClure Tags: Trauma Source Type: research

Management of major trauma
This article will review these reports, discuss the changes that have occurred in recent years in the organization of the care of major trauma and describe the anaesthetic management of this important group of patients. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Jeremy Henning, Katherine Woods Tags: Trauma Source Type: research

The metabolic and endocrine response to trauma
Metabolic and endocrine pathways are central to the body's compensatory response to trauma. They drive mobilization of energy substrates, volume conservation and haemostasis via activation of the hypothalamic pituitary adrenal axis, the sympathetic nervous system and an inflammatory response. As clinicians, we can intervene in these pathways, however optimal management of anaesthesia, fluids, transfusion, nutrition and the use of steroids remain controversial and to be determined. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Jennifer Hastings, Amy Krepska, Owen Roodenburg Tags: Trauma Source Type: research

MCQs
Which of the following are true about the blood supply and the presentation of various spinal cord injuries? (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Vijayanand Nadella Tags: Test yourself Source Type: research

Pain priorities in pre-hospital care
Pain management in the pre-hospital environment is a priority following life- and limb-saving manoeuvres. Pain should be assessed and documented then managed according to a multimodal model. Even in the context of environmental challenges and limited resources, pharmacological, physical and psychological interventions can all be used to provide effective analgesia and relieve suffering prior to and during transfer to hospital. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Charlotte Small, Dominic Aldington Source Type: research

Chest trauma
This article summarises major life-threatening injuries in thoracic trauma. Timing, clinical features, necessary investigations and interventions are described within the clinical approach of primary and secondary surveys. Emphasis is on immediate resuscitation with some discussion on further management. Injuries included are tension pneumothorax, open pneumothorax, massive haemothorax, pericardial tamponade, aortic injuries, cardiac injuries, lung contusion, flail chest, diaphragmatic injury, airway injury and oesophageal rupture. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Bevan Roodenburg, Owen Roodenburg Source Type: research

Spinal cord injury
With an annual incidence of 13 per million, around 40,000 people in the UK live with spinal cord injury (SCI). The extent of morbidity and mortality and thus quality of life, is highly dependent on meticulous management from the first point of contact with medical services. Treatment is focussed on reducing the risk of further cord injury and prevention of secondary (penumbral) damage through avoidable complications. As key members of trauma, theatre, intensive care and pain teams, anaesthetists and intensivists play a crucial role in influencing patient outcome. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Bob Winter, Hina Pattani, Emma Temple Source Type: research

Critical care management of inhalational injury and severe burns
Inhalational injury and severe burns are common. Most will present to district general hospitals and thus an understanding of how to assess and manage these patients is vital for all practising anaesthetists with on-call commitments. In this article we emphasize the requirement for a highly functioning multidisciplinary approach with excellent communication both within and between treating teams. We will challenge the dogmatic approach to airway management and discuss the increasing problem of fluid creep. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Dominic Trainor, Jason McClure Source Type: research

Management of major trauma
This article will review these reports, discuss the changes that have occurred in recent years in the organization of the care of major trauma and describe the anaesthetic management of this important group of patients. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Jeremy Henning, Katherine Woods Source Type: research

The metabolic and endocrine response to trauma
Metabolic and endocrine pathways are central to the body's compensatory response to trauma. They drive mobilization of energy substrates, volume conservation and haemostasis via activation of the hypothalamic pituitary adrenal axis, the sympathetic nervous system and an inflammatory response. As clinicians, we can intervene in these pathways, however optimal management of anaesthesia, fluids, transfusion, nutrition and the use of steroids remain controversial and to be determined. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Jennifer Hastings, Amy Krepska, Owen Roodenburg Source Type: research

MCQs
Which of the following are true about the blood supply and the presentation of various spinal cord injuries? (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 31, 2014 Category: Anesthesiology Authors: Viyayanand Nadella, Henry G W Paw Source Type: research

Anaesthesia outside the theatre environment
Remote anaesthesia is the provision of anaesthesia and sedation outside the theatre environment. The diverse range of locations, procedures and patient groups can provide a challenge to the anaesthesia team. Anaesthetists must maintain the same high standards as in the operating room, which requires appropriate facilities and staff, as well as suitable pre- and post-anaesthesia care. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2014 Category: Anesthesiology Authors: Jan M. Dieleman, David J. Daly Tags: Trauma Source Type: research

Anaesthetic priorities in pre-hospital trauma care
The approach to pre-hospital trauma care has undergone some changes in recent years. Some of the lessons have been learnt from the military as a direct result from experiences in recent conflicts. Personnel involved in pre-hospital care need to be aware of the dangers at the scene and have the ability to work with and liaise with other emergency services. Control of any massive haemorrhage needs to be gained as a priority before moving on to the more familiar Airway, Breathing and Circulation approach. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2014 Category: Anesthesiology Authors: Phil Docherty, Adrian Mellor Tags: Trauma Source Type: research

Drowning and immersion injury
Drowning is a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium. It is a frequent cause of unintentional injury deaths and public health initiatives to prevent drowning are important as there are no specific interventions proven to improve outcomes in drowning victims. Risk factors for drowning include inadequate supervision, recreational or occupational access to water, risk-taking behaviour and underlying medical conditions. Pathophysiological events in the process of drowning are secondary to hypoxaemia that results from the immersion injury. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2014 Category: Anesthesiology Authors: F. Eduardo Martinez, Andrew J. Hooper Tags: Trauma Source Type: research

Anaesthesia outside the theatre environment
Remote anaesthesia is the provision of anaesthesia and sedation outside the theatre environment. The diverse range of locations, procedures and patient groups can provide a challenge to the anaesthesia team. Anaesthetists must maintain the same high standards as in the operating room, which requires appropriate facilities and staff, as well as suitable pre- and post-anaesthesia care. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2014 Category: Anesthesiology Authors: Jan M. Dieleman, David J. Daly Source Type: research

Anaesthetic priorities in pre-hospital trauma care
The approach to pre-hospital trauma care has undergone some changes in recent years. Some of the lessons have been learnt from the military as a direct result from experiences in recent conflicts. Personnel involved in pre-hospital care need to be aware of the dangers at the scene and have the ability to work with and liaise with other emergency services. Control of any massive haemorrhage needs to be gained as a priority before moving on to the more familiar Airway, Breathing and Circulation approach. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2014 Category: Anesthesiology Authors: Phil Docherty, Adrian Mellor Source Type: research

Drowning and immersion injury
Drowning is a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium. It is a frequent cause of unintentional injury deaths and public health initiatives to prevent drowning are important as there are no specific interventions proven to improve outcomes in drowning victims. Risk factors for drowning include inadequate supervision, recreational or occupational access to water, risk-taking behaviour and underlying medical conditions. Pathophysiological events in the process of drowning are secondary to hypoxaemia that results from the immersion injury. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 30, 2014 Category: Anesthesiology Authors: F Eduardo Martinez, Andrew J. Hooper Source Type: research

Pharmacology of plasma expanders
Plasma expanders are used to restore the circulating volume of a hypovolaemic patient. Typically, colloids are used to expand the plasma volume, although combinations of hypertonic crystalloid and colloid have recently been used. The currently available colloids vary in their physicochemical, pharmacodynamics and pharmacokinetic properties. In particular, they differ in molecular weight, which partly determines their duration of action, and in their ability to expand the plasma volume. Dextran, hydroxyethyl starch and hypertonic colloid solutions improve oxygen flux within the microcirculation. (Source: Anaesthesia and int...
Source: Anaesthesia and intensive care medicine - July 29, 2014 Category: Anesthesiology Authors: Robert McCahon, Jonathan Hardman Tags: Pharmacology Source Type: research

Management of shock in trauma
Shock is failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, although it is recognized the trauma patient may present with non-haemorrhagic shock. The ‘lethal triad’ of metabolic acidosis, hypothermia, and acute coagulopathy seen in trauma patients has been fundamental to the development of the current approach to management of traumatic shock. Damage control resuscitation encompasses key resuscitative strategies including hypotensive resuscitation, the use of blood and ...
Source: Anaesthesia and intensive care medicine - July 29, 2014 Category: Anesthesiology Authors: Jonathan D. Pearson, Jonathan A. Round, Michael Ingram Tags: Trauma Source Type: research

Pharmacology of plasma expanders
Plasma expanders are used to restore the circulating volume of a hypovolaemic patient. Typically, colloids are used to expand the plasma volume, although combinations of hypertonic crystalloid and colloid have recently been used. The currently available colloids vary in their physicochemical, pharmacodynamics and pharmacokinetic properties. In particular, they differ in molecular weight, which partly determines their duration of action, and in their ability to expand the plasma volume. Dextran, hydroxyethyl starch and hypertonic colloid solutions improve oxygen flux within the microcirculation. (Source: Anaesthesia and int...
Source: Anaesthesia and intensive care medicine - July 29, 2014 Category: Anesthesiology Authors: Robert McCahon, Jonathan Hardman Source Type: research

Management of shock in trauma
Shock is failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, although it is recognized the trauma patient may present with non-haemorrhagic shock. The ‘lethal triad’ of metabolic acidosis, hypothermia, and acute coagulopathy seen in trauma patients has been fundamental to the development of the current approach to management of traumatic shock. Damage control resuscitation encompasses key resuscitative strategies including hypotensive resuscitation, the use of blood and ...
Source: Anaesthesia and intensive care medicine - July 29, 2014 Category: Anesthesiology Authors: Jonathan D. Pearson, Jonathan A. Round, Michael Ingram Source Type: research

Contents
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 22, 2014 Category: Anesthesiology Source Type: research

Editorial Board
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 22, 2014 Category: Anesthesiology Source Type: research

Contents
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 28, 2014 Category: Anesthesiology Source Type: research

Editorial Board
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 28, 2014 Category: Anesthesiology Source Type: research

Identification of the difficult airway
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 28, 2014 Category: Anesthesiology Authors: Ian Calder Tags: Dental / maxillofacial anaesthesia Source Type: research

Flexible fibre-optic intubation
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 28, 2014 Category: Anesthesiology Authors: Sandi Wylie, Ian Calder Tags: Dental / maxillofacial anaesthesia Source Type: research

Sedation for dental and other procedures
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 28, 2014 Category: Anesthesiology Authors: Carol J. Peden, Sara-Catrin Cook Tags: Dental / maxillofacial anaesthesia Source Type: research

MCQs
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 27, 2014 Category: Anesthesiology Authors: Viyayanand Nadella, Henry GW. Paw Source Type: research

Anaesthesia for facial trauma
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 26, 2014 Category: Anesthesiology Authors: Joy E. Curran Source Type: research

Dental damage in anaesthesia
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 16, 2014 Category: Anesthesiology Authors: Jeremy Windsor, Jane Lockie Source Type: research

MCQs
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 16, 2014 Category: Anesthesiology Authors: Vijayanand Nadella, Henry G.W. Paw Tags: Test yourself Source Type: research

General anaesthesia for dentistry
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 14, 2014 Category: Anesthesiology Authors: Susan Hutchinson Source Type: research

Pharmacokinetic analysis
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 14, 2014 Category: Anesthesiology Authors: William J.D. Whiteley, Jonathan G. Hardman Source Type: research

Anaesthesia for maxillofacial surgery
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 13, 2014 Category: Anesthesiology Authors: Louisa Pavlakovic, Gene Lee Source Type: research

Data quality and clinical audit
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 13, 2014 Category: Anesthesiology Authors: Ranjit Verma Source Type: research

Modes of drug elimination and bioactive metabolites
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 13, 2014 Category: Anesthesiology Authors: Shruti Chillistone, Jonathan G. Hardman Source Type: research