Respiration: ventilation
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Siân Davies , Upma Misra Ventilation is the process by which air moves into and out of the lungs and is made available for gas exchange across the alveolar-capillary membrane. Ventilation occurs automatically in a continuous rhythmic pattern without any conscious effort. It is controlled by both neural and chemical inputs and is concerned with the homeostasis of oxygen and carbon dioxide as well as having a role in acid–base balance. Inspiration is an active process. The diaphragm is the main m...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Respiration: control of ventilation
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Emrys Kirkman Rhythmic ventilation is an automatic process controlled by the central nervous system. Groups of cells in the brainstem, predominantly the ventral and dorsal respiratory groups, are responsible for generating basic respiratory rhythm. This basic rhythm is subject to modulation by both conscious and reflex actions. In normal individuals the respiratory minute volume is set to closely regulate arterial carbon dioxide tension (PaCO2) at approximately 5.3 kPa, predominantly via a negative feedbac...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Fluid balance and non-respiratory functions of the lung
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Emrys Kirkman The primary function of the lung is gas exchange between alveolar gas and the blood flowing through the nearby capillaries. This stage of gas exchange takes place by diffusion. Because gases such as oxygen diffuse relatively slowly through liquids it is essential that the fluid barrier is kept as short as possible. Furthermore, it is vital that interstitial fluid does not escape into the alveoli because this would abolish gas exchange in the flooded alveoli and lead to shunt. A number of phys...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Common errors in clinical measurement
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Mike Weisz , Vanessa Johnston Inaccurate clinical measurement may lead to patient harm or sub-optimal care. As monitors become more complex the possibility of measurement error increases. Clinicians need to understand the causes of errors to avoid and correct them. In this article we will discuss errors associated with equipment commonly used in anaesthesia including pulse oximetry, capnography, ECG, non-invasive and invasive blood pressure, central venous pressure, gas flow and cardiac output measurement....
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Physical principles of LASER
This article outlines: the physical principles of laser; the properties of a laser light beam and the components required to produce it; the mechanisms of tissue damage dependent on the optical properties of tissues and the laser–tissue interaction; and some of the common medical uses of laser therapy. Hazards associated with laser use are discussed as are some of the safety precautions employed to ensure that risk to patients and staff is minimized. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Measurement of gas concentrations (O2, CO2, N2O and volatile agents)
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Shahood Ali , Jason Walker Analysis of respiratory gases is part of standard monitoring, and is used in operating theatres, intensive care units, and for patient transfer. Common methods for oxygen analysis include: galvanic (fuel) cell, Clark (polarographic) electrode, and paramagnetic analyser. Common methods for carbon dioxide measurement include: infrared absorption spectroscopy and Severinghaus electrode. Other methods utilize mass spectroscopy, Raman scattering, and the piezoelectric effect. (Source:...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Measurement of pulse oximetry, capnography and pH
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Jayaprakash J. Patil , Declan G. Maloney Measurement of arterial oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2) and pH are linked in this article as they all can be measured by photometric methods. The underlying physical principles, Beer–Lambert law, and other methods of measurement of pH are outlined including advantages and limitations of these techniques. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Respiratory system: applied pharmacology
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Richard L. Dodwell , Jonathan B. Kendall Manipulation of respiratory physiology by pharmacological intervention is a significant role of the anaesthetist and intensivist. Successful use of these various agents requires a thorough understanding of their mechanisms of actions, potential side-effects and limitations. These interventions involve changes in airway calibre, secretions and sensitivity of the airway to noxious stimuli. Other agents act to inhibit the depressant effect that sedatives may have on th...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Analgesia for thoracic surgery
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Andrew N. Davies , Christopher J. Rozario The pain of thoracic surgery is severe which if addressed correctly reduces morbidity and mortality. Pain arises from muscle dissection, rib retraction and intercostal nerve damage. Management is challenged by pre-existing respiratory and co-morbid disease. Thoracic epidural analgesia for thoracotomy is considered ideal, however paravertebral blockade as part of a multimodal approach increasingly offers a comparable solution. Post-thoracotomy pain syndrome is a sig...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Fibreoptic bronchoscopic positioning of double-lumen tubes
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Karen A. Foley , Peter Slinger Double-lumen tubes should be placed using a fibreoptic bronchoscope. This allows correct positioning of the bronchial lumen in the chosen mainstem bronchus. It also ensures that the blue bronchial cuff does not obstruct the side to be ventilated when it is inflated under direct vision. Fibreoptic bronchoscopy facilitates correct positioning of the ventilatory side slot of a right double-lumen tube over the right upper lobe bronchus. The anaesthetist must know the fibreoptic t...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Airway apparatus for thoracic surgery
This article outlines the development and use of the currently available double-lumen tubes and bronchus blockers. It concludes with comparison of the two methods of lung isolation. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Tests of pulmonary function before thoracic surgery
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Andrew N. Davies , Palanikumar Saravanan Respiratory complications contribute significantly to perioperative morbidity and mortality after surgery. There are evidence-based guidelines that support the use of pulmonary function tests (PFTs) and cardiopulmonary exercise testing (CPET) in the preoperative assessment of patients undergoing lung resection surgery to determine whether patients can tolerate the resection. Spirometry, lung volumes and flow–volume analysis provide information on the respirato...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Principles and practice of thoracic anaesthesia
Publication date: November 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 11 Author(s): Katheryn J. Fogg Thoracic anaesthesia is a large field. This review concentrates on anaesthesia for major thoracotomy and lung resection, which is most usually carried out for malignant disease. This is a relatively small patient population, but procedures carry significant mortality of up to 6% for pneumonectomy. Physiological changes that occur during anaesthesia and one lung ventilation (OLV) are discussed, and the optimal ventilatory management of these patients is covered. Postoperative management of ...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Principles of pressure transducer function, and sources of error in clinical use
This article examines the physical principles that underlie transducer function, and the potential sources of error and inaccuracy in routine clinical use. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Digestion and absorption
Publication date: Available online 27 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell Carbohydrates, mostly as starch, are digested by salivary and pancreatic amylases to disaccharides, trisaccharides and oligosaccharides, then to monosaccharides by saccharidases on the wall of the small intestine, following which they are absorbed. Proteins are absorbed as amino acids and small peptides that are broken down further, in the cell, to amino acids. Monosaccharides and amino acids pass to the liver via the portal vein. Fats are digested and absorbed as free fatty acids and glycerid...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Clinical aspects of hepatic disease
Publication date: Available online 27 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Czarina C.H. Leung , Karl K. Young Liver disease has a high prevalence in all parts of the world. Patients with advanced liver disease have poor outcome after surgery. Prognostic scoring systems help to identify patients at high risk. Chronic liver disease is associated with typical extra-hepatic manifestations, resulting from failure to clear endogenous vasodilators, splanchnic vasodilation, high cardiac output and decreased central blood volume. Some patients may develop complications, including hepatoren...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

The mouth, stomach and intestines
Publication date: Available online 27 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell Food is divided into digestible portions in the mouth and swallowed – a complex reflex process involving several cranial nerves. The stomach homogenizes food, begins digestion and regulates the rate at which food enters the duodenum. Pancreatic juices containing powerful digesting enzymes are added and digestion is completed in the small intestine. The large bowel dehydrates the gastrointestinal contents. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Gut motility and its control
Publication date: Available online 27 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Iain Campbell The gastrointestinal tract is composed of smooth muscle arranged in two layers: longitudinal and circular. Although its activity is influenced by the autonomic nervous system, it is mainly under local reflex control mediated by an enteric nervous system and local hormones. The motility of the gastrointestinal tract has several different well-defined patterns. Its function is to move the gastrointestinal contents through the various phases of homogenization (mixing), digestion, a...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Laboratory tests in liver failure
Publication date: Available online 27 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Frances Lui Laboratory tests of liver function are among most commonly ordered investigations. Interpretation of liver function tests requires analysis of metabolic and synthetic functions of the liver, with some parameters reflecting hepatocellular injury rather than measuring liver function per se. Laboratory liver function tests assist clinical assessment in identification of aetiology of liver failure, serial monitoring of disease progress, classifying severity and scoring systems, predicting deteriorat...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Anaesthesia for gastrointestinal surgery
This article will discuss how to recognize these problems and try to minimize their impact on recovery. A growing body of evidence shows that adoption of a package of care known collectively as enhanced recovery significantly reduces postoperative morbidity and reduces length of hospital stay. For anaesthetists the changes involve analgesic regimens and perioperative fluid and nutrition management. This evidence has been brought together in the national Enhanced Recovery After Surgery Programme and has been introduced to many hospitals for elective bowel surgery patients. The principles of the programme will be discussed. ...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Gastric disorders: modifications of gastric content, antacids and drugs influencing gastric secretions and motility
Publication date: Available online 28 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Daniel H.R. O’Neil , Anton Leonard Gastric disorders have clinical implications in both anaesthesia and critical care medicine. Aspiration of acidic gastric contents in the perioperative setting is linked to pneumonitis and later development of pneumonia. Pharmacological strategies to minimize this risk include histamine-2 receptor antagonists, sucralfate, proton pump inhibitors and sodium citrate. Use of gastric acid-suppressing therapy is widespread in critical care. The aim is to reduce the inciden...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Central nervous system stimulants: basic pharmacology and relevance to anaesthesia and critical care
Publication date: Available online 28 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Ryan Campbell , Simon P. Young Central nervous system (CNS) stimulants are common in clinical practice, and have a high potential for abuse. The CNS stimulants can be classified as analeptic stimulants, psychomotor stimulants, or methylxanthines. Doxapram activates peripheral chemoreceptors and central respiratory centres in a dose-dependent manner. Psychomotor stimulants (e.g. cocaine and amfetamines) increase sympathetic nervous system activity. Competition for various metabolic and transport processes ca...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Anaesthesia and minimally invasive surgery
This article will focus on the pathophysiological changes caused by CO2 pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Drugs and the liver
Publication date: Available online 29 November 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Rakesh Vaja , Navreet Ghuman The liver is a major organ with multiple functions. A number of drugs are metabolized by the liver during phase 1 and 2 reactions which include complex processes involving cytochrome P450 enzymes. Genetic and acquired variability in cytochrome P450 activity may have profound effects on pharmacokinetics. Additionally, drugs can also modify how the liver functions and cause dysfunction or even failure of the organ both by a direct effect on the liver or by alteration in liver bloo...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Special considerations in paediatric intensive care
This article reviews critical therapies and techniques that define care in the PICU, and outlines the management of acute lung injury, traumatic brain injury and septic shock. Neonatal and cardiac intensive care medicine topics are outside the scope of this article. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Transporting critically ill children
Publication date: December 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 12 Author(s): Peter-Marc Fortune , Kate Parkins , Stephen Playfor Increasing centralization of paediatric intensive care services and a reduction in the numbers of children cared for in adult intensive care units over the last 15–20 years has led to an increase in the numbers of critically ill children being transferred between clinical centres throughout the UK. Eighty percent of these retrievals are conducted by a specialist paediatric intensive care unit (PICU) team, 13% by a specialist non-PICU team, and only ...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Trauma and burns in children
Publication date: December 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 12 Author(s): Mark J. Ross , Jon G. McCormack Trauma is the leading cause of death and disability in children, most often resulting from blunt trauma sustained in motor vehicle accidents and falls. An immediate coordinated resuscitation may contribute to improved morbidity and mortality outcomes. A multi-professional approach to the treatment of critically injured children should be adopted; where the primary survey aims to identify and manage immediately life-threatening injuries to airway, breathing and circulation. F...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Intraosseous cannulation in children
Publication date: December 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 12 Author(s): Pauline M. Cullen This review outlines the current recommendations for use of intraosseous access in children. It describes the technique of intraosseous cannulation, anatomy, physiology and possible complications. It also briefly describes currently available devices that allow for rapid and effective intraosseous access in infants, children and young adults. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Transfusion guidelines in children: II
This article presents ways of achieving this goal and introduces the process of the safe administration of blood products where indicated. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Transfusion guidelines in children: I
This article will present information concerning blood transfusion thresholds in children, calculations for maximal tolerated blood loss and the concept of massive transfusion protocols. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Fluid and electrolyte balance in children
Publication date: December 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 12 Author(s): Mark Terris , Peter Crean Safe intravenous fluid prescription in children requires an understanding of certain basic principles to avoid adverse events. Careful consideration needs to be given to both the appropriate rate and composition of the fluids to be administered with frequent re-assessment. In this review we examine the indications for parenteral fluid management: maintenance requirements, correction of any deficit and replacement of ongoing losses. The role of non-osmotic secretion of antidiuretic...
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

Aetiology and outcome of paediatric cardiopulmonary arrest
This article looks at the causes of arrests in children, the likely outcomes, and the ways in which this can be improved. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 4, 2014 Category: Anesthesiology Source Type: research

SI units
This article summarizes the history and application of the Système Internationale (SI) of units. Non-SI units in common use in anaesthesia and standard units of digital information are also described. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Basic measurement concepts
Publication date: July 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 7 Author(s): Gary Thomas , Elana Owen Precise measurement of physiological parameters during anaesthesia is vital, and enables clinicians to deliver safe and appropriate care to patients. Monitoring devices are essential tools in the clinical environment, and accurate records of the measurements provided by these monitors must be kept. The physical parameter to be measured is known as a measurand. Examples of measurands in clinical practice include temperature, voltage and pressure. In the process of measurement, a measuran...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Mechanisms of action of general anaesthetic drugs
Publication date: July 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 7 Author(s): David G. Lambert Based on the diverse array of anaesthetic structures, a single anaesthetic target site seems unlikely. With the knowledge that anaesthesia likely results from central nervous system depression, it can be hypothesized that anaesthesia results from either enhanced inhibitory transmission or reduced excitatory transmission. Two main targets have been extensively described: GABAA receptors and N-methyl-d-aspartate (NMDA) glutamate receptors. On γ-aminobutyric acid (GABA) binding to GABAA rece...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Antidepressants and antipsychotics: anaesthetic implications
Publication date: July 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 7 Author(s): Faisal Rasool , Rahat Ghafoor , David G. Lambert According to the World Health Organization about 450 million people suffer from mental and behavioural disorder worldwide whereas depression has a lifetime prevalence of between 10 and 20%. Antidepressants are broadly divided into four main groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), atypical agents and monoamine oxidase inhibitors (MAOIs). Lithium is also occasionally used as an adjunct to treat refractive depressio...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Factors affecting drug absorption and distribution
Publication date: July 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 7 Author(s): Shruti Chillistone , Jonathan G. Hardman The pharmacokinetic properties of a drug comprise the relationship between its absorption, distribution and inactivation. The passage of drugs across cell membranes is a key part of most pharmacokinetic processes. The most important means by which a drug crosses cell membranes is passive diffusion, the rate of which is determined by molecular size, the concentration gradient, lipid solubility, degree of ionization of the drug and protein binding. Pharmacokinetic processe...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Mechanisms of drug interactions: pharmacodynamics and pharmacokinetics
Publication date: July 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 7 Author(s): Kathryn Corrie , Jonathan G. Hardman The classification of drug interactions is first considered in this article, with an explanation of the terminology. Emphasis is placed on the importance of the topic in relation to the polypharmacy employed in anaesthesia and critical care. Pharmacodynamic interactions are then discussed. Further classification of these interactions is explained using examples of drugs in everyday use in anaesthesia and critical care medicine. Non-specific pharmacodynamic interactions are c...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Data quality and clinical audit
This article briefly defines the audit cycle and goes on to consider a typical data model. The various elements of the data model are defined, the understanding of which should enable individuals to avoid pitfalls in data collection and ensure that the data they collect for clinical audit are of the highest quality. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Modes of drug elimination and bioactive metabolites
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Shruti Chillistone , Jonathan G. Hardman Drug elimination is the removal of active drug from the body. Metabolism takes place largely in the liver and produces water soluble metabolites which can be excreted in the bile or urine. Metabolism may also produce active or toxic metabolites or a pharmacologically active drug from an inactive prodrug. Most volatile anaesthetics are excreted unchanged via the lungs. Drug elimination can be affected by factors such as first-pass metabolism, genetic variants and variou...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Pharmacokinetic analysis
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): William J.D. Whiteley , Jonathan G. Hardman Pharmacokinetic analysis is an experimentally determined theory of how a drug behaves when in vivo. Volume of distribution, clearance and terminal half-life are defined. Compartmental modelling is introduced and some relevant graphs are described in this article. Applications of this theory in anaesthesia are considered. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthesia for maxillofacial surgery
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Louisa Pavlakovic , Gene Lee Maxillofacial surgery covers a broad range of procedures on the head and neck, combining oral and facial procedures with the ear, nose and throat (ENT), plastics, neurosurgery and base of skull specialities. The main issues are that of managing a shared airway, providing good head, neck and oral access, the potential for difficult airways and measures to reduce tissue bleeding and oedema, both intraoperatively and postoperatively. Good communication between all members of the team...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthesia for facial trauma
This article considers the causes of facial trauma and the differing patterns of injury seen. The relative strengths of the facial bones and Le Fort fractures lines are described. The important airway and other management issues for the initial acute phase and the later second-stage management for surgical treatment of facial fractures are discussed. The concern regarding actual and potential cerebrospinal fluid leak from Le Fort 2- and 3-level fractures is reviewed, and different strategies for airway management put forward. Specific difficulties with endotracheal intubation of patients with facial trauma are examined. Th...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Dental damage in anaesthesia
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Andrew Milne , Jane Lockie Damage to the teeth during general anaesthesia is a frequent cause of morbidity for patients and a source of litigation against anaesthetists. Most injuries occur as a result of laryngoscopy. To prevent damage during emergence from anaesthesia, bite blocks should be placed between molar teeth. However oropharyngeal airways may not prevent damage. Patients should be advised about the possibility of dental trauma during anaesthesia and should be advised to have preoperative dental tre...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

General anaesthesia for dentistry
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Susan Hutchinson Dental anaesthesia developed down a different pathway from the rest of anaesthesia. Techniques such as nasal mask anaesthesia in the sitting position were specific to dental surgery, which took place largely outside hospital in dental clinics. Now dental anaesthesia is confined to locations within the aegis of a hospital and anaesthetic techniques are similar to those in other surgical specialities. Dental surgery consists of extractions and conservation. Short procedures for the extraction o...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Sedation for dental and other procedures
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Carol J. Peden , Sara-Catrin Cook While sedation can improve the patient experience of unpleasant procedures, if performed poorly it has the potential to cause harm. Some authorities believe that patients’ protective reflexes are impaired at any level of sedation, and sedation merges into anaesthesia in a continuum of loss of consciousness. All anaesthetists should understand the definition of ‘conscious sedation’, and be aware of the concepts of ‘deep sedation’ and ‘monito...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Flexible fibre-optic intubation
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Sandi Wylie , Ian Calder Flexible fibre-optic intubation has been practised for 40 years. It is an enormously useful skill, but it is not always the most appropriate tactic to deploy. The great advantage of flexible endoscopy is that the passage of an endoscope is acceptable to conscious patients, so that a tracheal tube can be placed easily when face-mask ventilation or direct laryngoscopy is likely to be difficult. The best position for the endoscopist is by the patient’s side (whether the patient is ...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Identification of the difficult airway
Publication date: August 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 8 Author(s): Ian Calder Nearly all patients who are seriously difficult to manage are easily identified because they have grossly obvious abnormalities. Conversely, it is difficult to identify the few normal-looking patients that are difficult to manage. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Pharmacology of plasma expanders
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Robert McCahon , Jonathan Hardman 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 p...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

The metabolic and endocrine response to trauma
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Jennifer Hastings , Amy Krepska , Owen Roodenburg 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 controversi...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research