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

Anaesthesia outside the theatre environment
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Jan M. Dieleman , David J. Daly Remote anaesthesia is the provision of anaesthesia and sedation outside the theatre environment. The diverse range of locations, procedures and patient groups can provide a challenge to the anaesthesia team. Anaesthetists must maintain the same high standards as in the operating room, which requires appropriate facilities and staff, as well as suitable pre- and post-anaesthesia care. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Spinal cord injury
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Bob Winter , Hina Pattani , Emma Temple With an annual incidence of 13 per million, around 40,000 people in the UK live with spinal cord injury (SCI). The extent of morbidity and mortality and thus quality of life, is highly dependent on meticulous management from the first point of contact with medical services. Treatment is focussed on reducing the risk of further cord injury and prevention of secondary (penumbral) damage through avoidable complications. As key members of trauma, theatre, intensive care ...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Drowning and immersion injury
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): F. Eduardo Martinez , Andrew J. Hooper Drowning is a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium. It is a frequent cause of unintentional injury deaths and public health initiatives to prevent drowning are important as there are no specific interventions proven to improve outcomes in drowning victims. Risk factors for drowning include inadequate supervision, recreational or occupational access to water, risk-taking behaviour and underlying medical condit...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Critical care management of inhalational injury and severe burns
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Dominic Trainor , Jason McClure Inhalational injury and severe burns are common. Most will present to district general hospitals and thus an understanding of how to assess and manage these patients is vital for all practising anaesthetists with on-call commitments. In this article we emphasize the requirement for a highly functioning multidisciplinary approach with excellent communication both within and between treating teams. We will challenge the dogmatic approach to airway management and discuss the in...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Chest trauma
This article summarises major life-threatening injuries in thoracic trauma. Timing, clinical features, necessary investigations and interventions are described within the clinical approach of primary and secondary surveys. Emphasis is on immediate resuscitation with some discussion on further management. Injuries included are tension pneumothorax, open pneumothorax, massive haemothorax, pericardial tamponade, aortic injuries, cardiac injuries, lung contusion, flail chest, diaphragmatic injury, airway injury and oesophageal rupture. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Management of shock in trauma
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Jonathan D. Pearson , Jonathan A. Round , Michael Ingram Shock is failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, although it is recognized the trauma patient may present with non-haemorrhagic shock. The ‘lethal triad’ of metabolic acidosis, hypothermia, and acute coagulopathy seen in trauma patients has been fundamental to the development of the cur...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Management of major trauma
This article will review these reports, discuss the changes that have occurred in recent years in the organization of the care of major trauma and describe the anaesthetic management of this important group of patients. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Pain priorities in pre-hospital care
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Charlotte Small , Dominic Aldington Pain management in the pre-hospital environment is a priority following life- and limb-saving manoeuvres. Pain should be assessed and documented then managed according to a multimodal model. Even in the context of environmental challenges and limited resources, pharmacological, physical and psychological interventions can all be used to provide effective analgesia and relieve suffering prior to and during transfer to hospital. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthetic priorities in pre-hospital trauma care
Publication date: September 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 9 Author(s): Phil Docherty , Adrian Mellor The approach to pre-hospital trauma care has undergone some changes in recent years. Some of the lessons have been learnt from the military as a direct result from experiences in recent conflicts. Personnel involved in pre-hospital care need to be aware of the dangers at the scene and have the ability to work with and liaise with other emergency services. Control of any massive haemorrhage needs to be gained as a priority before moving on to the more familiar Airway, Breathing...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

MCQs
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Vijayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

The pancreas
This article looks at the physiology of each of the hormones and enzymes released by the pancreas, the factors influencing their secretion, and how their secretion is coordinated. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Thyroid and parathyroid hormones and calcium homeostasis
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Iain Campbell The thyroid gland is under the control of thyroid-stimulating hormone (TSH) from the pituitary. It secretes thyroxine (T4) and triiodothyronine (T3). Iodine is essential for the synthesis of thyroid hormones. T4 is probably converted to T3 in peripheral tissues. Thyroid hormones have a role in growth and development, but their principal effect is the control of basal metabolic rate. Deficiency or excess affects all the tissues of the body, reducing or increasing the metabolic rate, resulting i...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Adrenocortical hormones
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Iain Campbell The adrenal glands lie on top of the kidneys. The adrenal medulla produces catecholamines and the adrenal cortex produces three types of steroid hormone (mineralocorticoids (aldosterone), glucocorticoids (cortisol) and androgens (dehydroepiandrosterone, DHEA)). All are synthesized from cholesterol. Cortisol secretion is controlled by adrenocorticotrophic hormone from the pituitary. It rises in response to stress and is essential for life. It stimulates gluconeogenesis, breaking down lean tissu...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Hypothalamic–pituitary–adrenal function: anaesthetic implications
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Grainne Nicholson , George M. Hall Surgery, trauma and critical illness evoke a series of hormonal and metabolic changes commonly referred to as the stress response. Activation of the hypothalamic–pituitary–adrenal axis results in increased secretion of hormones such as cortisol. Anaesthesia can suppress adrenocortical secretion either by an effect at the hypothalamus, for example by a decrease in neural input with regional anaesthesia, or by a direct effect on the adrenal cortex, for example by...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Pharmacological control of blood sugar
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Giridhar Tarigopula , Melanie J. Davies Diabetes is a chronic and progressive metabolic disorder characterized by hyperglycaemia. The two main types of diabetes are type 1 diabetes (T1DM) where there is complete lack of insulin and type 2 diabetes (T2DM) which may be due to a combination of insulin resistance and relative insulin deficiency due to impaired β-cell function. Good control of blood glucose near physiological limits is vital to reduce long-term microvascular and macrovascular complications ...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Recognition and management of phaeochromocytoma
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Inas Ahmed , Chandran Jepegnanam Phaeochromocytomas are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a workup for multiple endocrine neoplasia or during unrelated surgery. Better understanding of catecholamine physiology and advances in preoperative preparation has significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and l...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Thyroid disease and thyroid surgery
This article focuses on disorders of thyroid function and their management, thyroid malignancy, surgery of the thyroid gland and the perioperative anaesthetic management of patients undergoing thyroidectomy. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthetic management of diabetes
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Inas Ahmed , Swamy Mruthunjaya Diabetes is a complex metabolic disorder that is increasing in incidence globally. It is the most common non-communicable disease worldwide. Diabetic patients pose a challenge to anaesthesia and surgery due to the organs and systems affected by the disease. Good glycaemic control perioperatively is essential to minimize complications. There is an increasing number of therapies to control diabetes, and this is rapidly evolving, so a multidisciplinary approach to the management ...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthesia for obesity surgery
This article will discuss the different types of obesity surgery commonly performed, and the practical aspects of how to manage these patients both perioperatively and postoperatively. The principles described can be utilised in the management of obese patients attending for other types of surgery. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthesia in the obese patient
This article will present important aspects related to pathophysiology and pharmacology. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Clinical aspects of endocrinology: parathyroid and adrenal gland disorders
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 Author(s): Inese Kutovaja , Kailash Bhatia The parathyroid glands are responsible for calcium homeostasis, which is necessary for appropriate functioning of the musculoskeletal and nervous system. Parathyroid adenoma remains the most common indication for surgery. The adrenal cortex is mainly responsible for secretion of mineralocorticoids, glucocorticoids and androgens whereas the medulla consists of pre-ganglionic sympathetic ganglion, which secretes epinephrine, nor-epinephrine and dopamine. Adrenocortical dis...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Contents
Publication date: October 2014 Source:Anaesthesia & Intensive Care Medicine, Volume 15, Issue 10 (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

Anaesthesia for surgery of the trachea and main bronchi
Publication date: Available online 8 October 2014 Source:Anaesthesia & Intensive Care Medicine Author(s): Alistair Macfie , Philip McCall Major surgery on the trachea and airway is an anaesthetic challenge, which necessitates the simultaneous control of the airway, maintenance of gas exchange and good surgical exposure. Advance planning, good communication and teamwork among surgeon, anaesthetist and theatre staff are never more important. A major indication for laryngeal and tracheal surgery is laryngotracheal stenosis, a rare condition, which can cause significant morbidity and life-threatening airway obstructi...
Source: Anaesthesia and intensive care medicine - October 12, 2014 Category: Anesthesiology Source Type: research

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

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

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

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

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

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

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

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

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

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

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

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

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

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