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Anaesthesia for interventional neuroradiology
Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sarah J. Muldoon, Ian ApplebyAbstractThe volume and range of procedures undertaken by interventional neuroradiologists continues to expand. They are now treating many conditions previously considered untreatable or only amenable to open surgical techniques. To facilitate the close cooperation required between radiologists and anaesthetists necessary for the successful outcome of these complex and lengthy procedures, it is important for the anaesthetist to have an appreciation of the pathophysiology, potential multisys...
Source: Anaesthesia and intensive care medicine - December 13, 2019 Category: Anesthesiology Source Type: research

Applied cerebral physiology
This article reviews cerebral metabolism and blood flow, and the pressure dynamics within the cranial cavity. The brain functions within the confines of the cranial cavity and it is important to understand the dynamics of the parenchyma, cerebrospinal fluid and blood in relation to intracranial pressure (ICP) and metabolic needs. It requires an uninterrupted supply of oxygen and glucose to maintain its basal energy requirements and these are increased during periods of enhanced activity. Cerebral blood flow (CBF) is therefore critical for normal cerebral function. Its control is dictated by local intrinsic metabolic needs ...
Source: Anaesthesia and intensive care medicine - December 13, 2019 Category: Anesthesiology Source Type: research

Therapeutic hypothermia and acute brain injury
This article will review the basic science the practical aspects of delivering targeted temperature management and evaluate the evidence behind its use for acute brain injuries. With a lack of high-quality evidence for hypothermia, recent consensus statements are shifting the paradigm away from hypothermia to the maintenance of normothermia and prevention of pyrexia. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 13, 2019 Category: Anesthesiology Source Type: research

Tracheal intubation
Publication date: Available online 29 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Barry McGuire, Kimberley HodgeAbstractTracheal intubation is the act of placing a tube into the trachea. The tube enables oxygen delivery and removal of carbon dioxide, while also allowing for the administration of pharmacological agents. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protection against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but now indirect laryngoscopy (via a videolaryngoscope) is a com...
Source: Anaesthesia and intensive care medicine - November 30, 2019 Category: Anesthesiology Source Type: research

Perioperative anaphylaxis
Publication date: Available online 29 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nina Hjelde, Abdul G. LalkhenAbstractAnaphylaxis is defined as a ‘severe life-threatening generalized or systemic hypersensitivity reaction’. Anaphylactic shock is characterized by generalized vasodilation and increased capillary permeability, leading to reduction in cardiac output. The pathophysiology of anaphylaxis can be described as immunologic and non-immunologic. The National Audit Project 6 (NAP 6) has recently investigated perioperative anaphylaxis and this article will outline some key updates from their ...
Source: Anaesthesia and intensive care medicine - November 30, 2019 Category: Anesthesiology Source Type: research

Pathophysiology of respiratory disease and its significance to anaesthesia
Publication date: Available online 26 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): S Kimber CraigAbstractSignificant changes occur in the respiratory physiology of healthy patients during anaesthesia. In patients with underlying respiratory pathology, the changes in respiratory physiology may lead to additional clinical problems during the conduct of anaesthesia and in the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anaesthetist to account for the potential complications of these conditions and manage the anaesthetic accordingly. (S...
Source: Anaesthesia and intensive care medicine - November 27, 2019 Category: Anesthesiology Source Type: research

Critical incidents: the respiratory system
Publication date: Available online 26 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Edward TC. Miles, Tim M. CookAbstractRespiratory complications are expensive, not just in terms of the overall litigation burden faced by anaesthetists but also, and more importantly, the mortality and morbidity burden faced by our patients. Critical incidents arising in the respiratory system can cause rapid deterioration if left unchecked: trauma to airway structures can be debilitating or even life threatening; hypoxaemia may result in damage to other organ systems, most notably the brain. Each patient carries thei...
Source: Anaesthesia and intensive care medicine - November 27, 2019 Category: Anesthesiology Source Type: research

Anaesthesia in the elderly
Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): David J. ChambersAbstractOlder people are undergoing increasingly complex surgery with much greater mortality and morbidity than the younger adult population. In this article, we discuss the physiological changes that take place in the older patient, and how these may affect anaesthetic technique. Perioperative risk in the elderly is discussed, with focus on emergency surgery and frailty. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

General anaesthesia for ophthalmic surgery
Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Stuart Young, Aravind BasavarajuAbstractThe majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye surg...
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

Care of the eye during anaesthesia and intensive care
This article describes care of the eye during a period of vulnerability in anaesthesia and intensive care. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries will be covered as well as good practice points and preventative measures pertinent to all anaesthetists and critical care practitioners. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

Ocular anatomy and physiology relevant to anaesthesia
This article will discuss ocular anatomy in terms of the orbit and its contents, its associated muscles, nerves and blood supply, as well as basic ocular physiological principles. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

Regional anaesthesia for eye surgery
Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rachel Fulton, Craig UrquhartAbstractMany ophthalmic procedures are conducted under a range of local anaesthetic techniques. These range from topical drops through to sharp needle blocks with local anaesthetic. The most commonly used block is the sub-Tenon block; it provides excellent operating conditions while reducing complications and risks. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

Eye signs in anaesthesia and intensive care
This article describes the signs associated with iatrogenic injury to the eye in the operating theatre and the intensive care unit. Patients are at risk of corneal abrasions, exposure keratopathy and chemosis. The prone patient encounters an additional risk of ischaemic optic neuropathy and acute glaucoma. In the intensive care setting, the intensivist should be alert to signs of ocular infection, for example, conjunctivitis, microbial keratitis and endophthalmitis. In the trauma patient, careful evaluation of the eye is required to rule out sight-threatening conditions such as retrobulbar haemorrhage, globe rupture, orbit...
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

Physiology of ageing
Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Frances Young, Simon MaguireAbstractThe impact that ageing has on organisms is a complex interaction between the processes of ageing at a cellular, organ and integrated systems level, and the effects of environmental factors such as nutrition, infection and trauma. Recovery from an insult that triggers a pathological response is never complete. The incremental fall in possible performance is part of the progressive diversity in ‘physiology’ that is the true hallmark of ageing. In this article we will outline some ...
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research

Anaesthesia for eye surgery in paediatrics
Publication date: Available online 26 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Tom Y. Pettigrew, Sarah J. SmithAbstractChildren are rarely able to tolerate being awake for any type of surgery under local anaesthesia, therefore the majority of paediatric eye surgery is performed under general anaesthesia. Most patients presenting on a paediatric ophthalmology operating list will be otherwise healthy children who are suitable for day surgery. However, some children may have eye abnormalities as part of a congenital disorder. The perioperative plan should be formulated after assessment of the child...
Source: Anaesthesia and intensive care medicine - November 26, 2019 Category: Anesthesiology Source Type: research