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

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