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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Acute liver failure
This article provides a practical approach to the diagnosis and management of critically ill patients with ALF. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 27, 2015 Category: Anesthesiology Source Type: research

Nutritional support in the critically ill
Publication date: Available online 26 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Marcia McDougall Nutritional support in Intensive Care requires a multidisciplinary approach involving intensivists, surgeons, nurses, dietitians and pharmacists. Many critically ill patients are already malnourished on admission, either due to pre-existing disease, the acute illness or alcohol and drug use. Challenges include identifying malnourished patients, preventing refeeding syndrome, placing feeding tubes and lines, preventing and treating complications, calculating calorific requirements, maintaini...
Source: Anaesthesia and intensive care medicine - February 27, 2015 Category: Anesthesiology Source Type: research

Central nervous system infections in intensive care patients
This article discusses the aetiology, bacteriology, presentation and management of these conditions. They all carry serious morbidity and mortality and most patients are cared for in the critical care setting. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 27, 2015 Category: Anesthesiology Source Type: research

Intensive care unit acquired weakness
Publication date: Available online 27 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Robert John , Smita Bapat Intensive care unit acquired weakness is a broad clinical term that describes an acute neuromuscular impairment that commonly affects patients during critical illness. It is prevalent in this cohort of patients, and can be further defined by electrophysiological studies and muscle biopsies. Both limb and respiratory muscles are affected in this condition, which results in a prolonged length of stay, increased mortality and long-term disability. Early mobilization of patients and th...
Source: Anaesthesia and intensive care medicine - February 27, 2015 Category: Anesthesiology Source Type: research

Monitoring arterial blood pressure
This article reviews the physical principles of both non-invasive and invasive methods of arterial blood pressure measurement. Recent developments in ‘continuous’ non-invasive monitoring techniques are also outlined. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Measurement of humidity
This article describes the physical chemistry of evaporation with particular relation to water. The concept of humidity is defined, and factors which influence humidity are discussed in a practical context. The clinical importance of measurement and control of humidity is illustrated. Commonly used methods of measuring humidity are described, and their underlying physical principles are explained. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for joint replacement surgery
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Y.F. Shiu , J.C. Lawmin With the ageing population, there is increasing demand for joint replacement surgery. Common joint replacement surgeries include hip, knee, elbow and ankle replacement. Elderly patients with multiple co-morbidities presenting for joint replacement surgery often pose challenges to our anaesthetic management. Careful preoperative assessment, perioperative anaesthetic plan and postoperative analgesic management can facilitate success of the surgery and avoid complications. (Source: Anae...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Regional anaesthesia for orthopaedic procedures
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Sophie E. Liu , Michael G. Irwin Regional anaesthesia is well suited to orthopaedic surgery for anatomical reasons and can reduce complications from general anaesthesia. A reduction in pain scores, drowsiness and nausea can improve postoperative mobility and facilitate earlier hospital discharge. Disadvantages to regional anaesthesia include block failure, nerve injury and local anaesthetic toxicity. Complications are rare but can be reduced by the use of ultrasound and nerve stimulation, performing the blo...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Central venous pressure and pulmonary artery pressure monitoring
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Gilbert Central venous pressure and pulmonary artery pressure are used as measures of cardiovascular filling. While pressure–volume relationships are not constant, trends in central venous pressure give an indication of increasing or decreasing right ventricular filling, while pulmonary artery pressure gives an indirect indication of left ventricular filling pressure. Cardiac output can be estimated by use of thermodilution. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Preoperative assessment of the orthopaedic patient
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Sebastian S.P. Chan , Michael G. Irwin Patients undergoing orthopaedic surgery range from the young and fit to the frail elderly. A proper and goal-directed preoperative assessment is necessary, in particular for geriatric hip fracture populations, to identify and optimize co-morbidities, develop an individualized perioperative care plan and minimize postoperative complications. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Measurement of gas volume and gas flow
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Tom West , Abrie Theron Accurate measurement of gas flow and volume is vital for the safe conduct of anaesthesia. Gas volume, and hence gas flow, may be measured directly with devices such as the vitalograph; however these devices have limited use in clinical practice, as they are bulky and unsuitable for measurement of continuous flow. This has led to the development of techniques that measure gas flow indirectly by using physical properties of the gas. Methods include mechanical devices such as the variab...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Drugs used to treat joint and muscle disease
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): David G. Lambert Joint disease: Arthritis can be simply broken into osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is treated with symptomatic pain relief and surgery. RA is a chronic autoimmune disease that causes inflammation of joints (leading to their destruction), tissues around joints and other organ systems. Treatment (for pain) of RA in the first instance is with non-steroidal anti-inflammatory drugs, with second-line treatment using disease-modifying antirheumatic drugs (DMARDs). DMAR...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for plastic and reconstructive surgery
Publication date: Available online 19 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Henry C.Y. Mak , Michael G. Irwin Plastic and reconstructive surgery aims to restore normal and functional anatomy following tissue destruction or impaired wound healing. The techniques required depend on the complexity of the wound, from simple closure to flap reconstruction. More complicated wounds with large skin defects may need free flap transfer for optimal functional and cosmetic results. Flap failure is a major potential complication and perioperative anaesthetic management plays an important role i...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Physics of ultrasound
This article will explain these principles, including the use of Doppler ultrasound and the interpretation of common artefacts. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for fractured neck of femur
Publication date: Available online 20 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Stanley Sau Ching Wong , Michael G. Irwin Fracture of the femoral neck is a common injury in the elderly, and many patients have significant co-morbidities. Effective management requires a multidisciplinary approach involving anaesthetists, medical physicians and orthopaedic surgeons. Although early surgery within 24–48 hours is beneficial, there may be medical conditions that need prior optimization. Both general anaesthesia and regional neuroaxial anaestheisa can be used, although it appears regiona...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Anaesthesia for spinal surgery
Publication date: Available online 20 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Anuradha Sharma , Jean-Claude Lawmin , Michael G. Irwin Spinal surgery encompasses a wide variety of procedures (elective and emergency) in a range of patients from the very young to the elderly. Patients may suffer from multiple co-morbidities and systemic diseases (e.g. rheumatoid arthritis, ankylosing spondylitis) which will be addressed within the scope of this article. Anaesthetic management of these cases includes thorough pre-operative assessment and optimization and careful perioperative management ...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Procedures under tourniquet
Publication date: Available online 20 February 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Silky Wong , Michael G. Irwin Limb tourniquets are commonly used to help facilitate surgery by producing less blood in the surgical field. This may also shorten operative time and reduce intraoperative blood loss. These advantages need to be weighed against potential complications such as post-tourniquet syndrome, skin damage, deep vein thrombosis, rhabdomyolysis and ischaemic pain. Physiological changes in the cardiovascular, respiratory, metabolic, haematological and neurological systems also occur. (Sour...
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Physics of gases
This article will outline the physics of gases and discuss the phases of matter, the gas laws, and Dalton's law of partial pressures. It will define pressure, illustrate laminar and turbulent flow, and explain the Bernoulli principle and the Coanda effect. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 24, 2015 Category: Anesthesiology Source Type: research

Thoracic surgical radiographic and CT pathology
Publication date: Available online 21 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Annette Johnstone , Hilary Moss Imaging plays a central role in the diagnosis of thoracic pathology and in the staging, management and surveillance of thoracic malignancy. An abnormal chest X-ray (CXR) frequently alerts the physician to the possibility of an underlying malignancy. Computed tomography (CT) is routinely performed to stage a suspected bronchogenic malignancy, assess treatment options, perform CT-guided biopsy if required and in surveillance for recurrent disease. Both investigations are quick, ...
Source: Anaesthesia and intensive care medicine - January 23, 2015 Category: Anesthesiology Source Type: research

Applied respiratory physiology
Publication date: Available online 17 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Derek Randles , Stuart Dabner Anaesthesia has many effects on respiratory physiology, the knowledge of which is relevant to clinical practice. Anaesthesia causes decreased muscle tone in the upper airway, which can lead to airway obstruction. Pulmonary hypoventilation occurs in the spontaneously breathing patient. There is a progressive decrease in the ventilatory response to CO2 with increasing concentration of volatile agents, and even low doses of volatile have a profound effect on the ventilatory respons...
Source: Anaesthesia and intensive care medicine - January 17, 2015 Category: Anesthesiology Source Type: research

Measurement of respiratory function: an update on gas exchange
Publication date: Available online 15 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Salahuddin Mahmood Qureshi Gas exchange is the main function of the lungs. Oxygen and carbon dioxide diffuse along their partial pressure gradient across the alveolar-capillary membrane. Lungs have a large reserve for gas exchange. Alveolar ventilation and pulmonary circulation are closely matched to provide efficient gas exchange in the lungs. Hypoxaemia often results from mismatch in ventilation–perfusion. Gas exchange can be impaired in various disease states. Measurement of the diffusing capacity f...
Source: Anaesthesia and intensive care medicine - January 16, 2015 Category: Anesthesiology Source Type: research

Extremes of barometric pressure
Publication date: Available online 16 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Jane E. Risdall , David P. Gradwell Ascent to elevated altitude, commonly achieved through flight, by climbing or by residence in highland regions, exposes the individual to reduced ambient pressure. Although there are physical manifestations of this exposure as a consequence of Boyle’s law, the primary physiological challenge is of hypobaric hypoxia. The acute physiological and longer-term adaptive responses of the cardiovascular, respiratory, haematological and neurological systems to altitude are de...
Source: Anaesthesia and intensive care medicine - January 16, 2015 Category: Anesthesiology Source Type: research

Interpreting the chest radiograph
Publication date: Available online 16 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Ian J. Runcie A methodical system for looking at every chest radiograph is suggested. Readers are encouraged to decide whether an opacity on a chest radiograph is due to pleural, alveolar or interstitial pathology and then to consider the cause. Lung and pleural masses are considered and contrasted and the features of asbestos exposure listed. Special consideration is given to the problems of interpretation of the chest radiograph in the intensive care unit (ICU), and the various appearances of lines and tub...
Source: Anaesthesia and intensive care medicine - January 16, 2015 Category: Anesthesiology Source Type: research

Preoperative assessment for thoracic surgery
Publication date: Available online 16 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Brian F. Keogh , David Alexander Preoperative assessment of thoracic surgical patients is a multidisciplinary process designed to offer appropriate surgical treatment with acceptable risk. UK guidelines for pulmonary resection associated with malignant disease have reviewed available evidence concerning operative risk. Patients displaying cardiopulmonary physiological parameters above previously recommended threshold values remain classified as good risk. Less certainty exists about the utility of predicted ...
Source: Anaesthesia and intensive care medicine - January 16, 2015 Category: Anesthesiology Source Type: research

Pharmacological treatment of bacterial infections of the respiratory tract
Publication date: Available online 14 January 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Bethan L. Barker , Chris Brightling Bacterial infection of the respiratory tract is amongst the commonest presentations to primary and secondary care. In addition to supportive care the mainstay of pharmacotherapy is antibiotics. Antibiotic treatment of bacterial infections of the respiratory tract needs to consider patient factors such as age, co-morbidities, location, previous antibiotic use, microbiological results and allergy. The emergence of multi-drug-resistant bacteria, partly a consequence of inappr...
Source: Anaesthesia and intensive care medicine - January 14, 2015 Category: Anesthesiology Source Type: research