Pre-optimization of the anaemic patient
Publication date: Available online 21 February 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Alwyn KotzéAbstractPreoperative anaemia is common. Its prevalence varies according to the population studied and the definition of what constitutes anaemia. Where the widely accepted definition of the World Health Organization is used (haemoglobin concentration
Source: Anaesthesia and intensive care medicine - February 22, 2019 Category: Anesthesiology Source Type: research

Cardiac output measurement
Publication date: Available online 22 February 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Benjamin Kolb, Vikas KapoorAbstractCardiac output measurement has become increasingly important in anaesthesia and critical care, particularly with the growing emphasis on perioperative medicine. Flow cannot be measured by any direct means and therefore models are employed to deduce useful information from other parameters. Numerous techniques are available, each with advantages and disadvantages in terms of invasiveness and validity. Often a balance is struck between invasiveness and validity of the measurements,...
Source: Anaesthesia and intensive care medicine - February 22, 2019 Category: Anesthesiology Source Type: research

Anaesthesia for patients with sickle cell and other haemoglobinopathies
Publication date: Available online 22 February 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Lorna CJ. Sissons, Kailash BhatiaAbstractSickle cell disease is an autosomal recessive multi-systemic condition, caused as a result of a mutation in chromosome 11 resulting in production of abnormal beta globin of haemoglobin or HbS. The abnormality under specific conditions results in polymerization of the globin chain resulting in deformed sickle-shaped red cells. These haemolyse under adverse conditions resulting in occlusion within the circulatory system resulting in cardiorespiratory, neurological, renal, mus...
Source: Anaesthesia and intensive care medicine - February 22, 2019 Category: Anesthesiology Source Type: research

Contents
Publication date: February 2019Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 2Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 7, 2019 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: February 2019Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 2Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 7, 2019 Category: Anesthesiology Source Type: research

Principles of artificial ventilation
Publication date: Available online 23 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Ben Brown, Justin RobertsAbstractThe application of intermittent positive pressure ventilation (IPPV) during the 1952 Copenhagen polio epidemic led to the development of the world's first intensive care unit. The requirement for ventilatory support is the most common indication for intensive therapy unit (ITU) admission and is a defining feature of the specialty. Ventilator technology continues to develop and there are many ways to deliver IPPV. The variety of modes of ventilation is increasingly complex and expand...
Source: Anaesthesia and intensive care medicine - January 24, 2019 Category: Anesthesiology Source Type: research

Intravenous anaesthetic agents
This article gives an overview of drugs frequently used for intravenous anaesthetic induction, as well as a brief overview of total intravenous anaesthesia. Physio chemical properties of intravenous anaesthetic drugs, their clinical and adverse effects are summarized. The article also discusses the historical context on the introduction of intravenous anaesthetic agents and highlights developments of novel agents. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 20, 2019 Category: Anesthesiology Source Type: research

Postoperative analgesia
Publication date: Available online 18 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Katharine C. Ireland, Abdul G. LalkhenAbstractPain is a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved through an approach which acknowledges the complex interaction between biological, psychological and sociocultural factors. Effective pain management requires preoperative patient engagement and education in order to manage expectations and a structured inpatient service to facilitate evidence-based postoperative pain manage...
Source: Anaesthesia and intensive care medicine - January 20, 2019 Category: Anesthesiology Source Type: research

The anaesthetic machine
Publication date: Available online 18 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nicholas Record, Christina BeecroftAbstractModern anaesthetic machines have improved greatly since 1917 when Boyle modified the American Gwathmey apparatus of 1912 to develop the ubiquitous continuous flow anaesthetic machine. Despite this, the basic principles and many components remain, albeit in modernized form. Gas is still supplied to the machine from a high-pressure source which is stepped down to a safe pressure supplying the breathing system. Flowmeters control gas flow and allow for adjustment of different...
Source: Anaesthesia and intensive care medicine - January 20, 2019 Category: Anesthesiology Source Type: research

Inhalational anaesthetic agents
Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma Temple, Matt WilesAbstractThe continued development of anaesthetic agents since the late 18th century has paved the way for the progression of surgical techniques. Inhalational agents are used worldwide for the delivery of safe, effective anaesthesia. These include the volatile agents halothane, isoflurane, sevoflurane and desflurane, in addition to the anaesthetic gases nitrous oxide and xenon. Although the newer volatiles have an improved safety profile in comparison to older agents, the ideal anaesthetic ag...
Source: Anaesthesia and intensive care medicine - January 18, 2019 Category: Anesthesiology Source Type: research

Total intravenous anaesthesia
This article describes the use of target controlled infusion models and principles, which enable anaesthetists to deliver TIVA safely. The Association of Anaesthetists of Great Britain and Ireland and the Society of Intravenous Anaesthesia have produced Guidelines for safe practice of TIVA in 2018. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 18, 2019 Category: Anesthesiology Source Type: research

The principles of anaesthetic vaporizers
Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Paul Wasik, Ravi AnandampillaiAbstractFluorinated hydrocarbons have transformed inhalational anaesthesia, and vaporizers are essential for safe and accurate delivery of these agents. The modern day vaporizers have evolved considerably since the ether inhaler invented by John Snow in 1847 and are robust, precise and efficient. For an anaesthetist to administer safe inhalational anaesthetic, it is important to understand the physical principles of the various inhalational anaesthetic agents along with the working pri...
Source: Anaesthesia and intensive care medicine - January 18, 2019 Category: Anesthesiology Source Type: research

Anaesthetic breathing systems
Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Andrew Donnelly, Stuart DollingAbstractA breathing system is a series of components that allows the delivery of oxygen and other anaesthetic gases to the patient as well as aiding in the removal of carbon dioxide. There are key elements that feature in all anaesthetic breathing systems with numerous classification systems used. The layout of individual breathing systems determines their clinical application and use. All of the above will be discussed further in this article as well as a brief summary of the use of ...
Source: Anaesthesia and intensive care medicine - January 18, 2019 Category: Anesthesiology Source Type: research

Pharmacokinetic variation
This article will review how physiological, pathological and pharmacological processes can influence all of these factors. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 17, 2019 Category: Anesthesiology Source Type: research

Self-assessment
Publication date: Available online 14 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 15, 2019 Category: Anesthesiology Source Type: research

Effects of smoking on health and anaesthesia
Publication date: Available online 14 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Phillippa Shorrock, Nawar BakerlyAbstractLegislation prohibiting smoking in workplaces and enclosed public places was introduced in England in July 2007. This, in addition to the 2012 prohibition of tobacco promotion, and the increased use of e-cigarettes, are all changing our smoking behaviour as a nation. Nevertheless tobacco remains a major factor in disease development and smokers continue to present a number of anaesthetic challenges. Perioperative smoking cessation is beneficial and NHS support is available t...
Source: Anaesthesia and intensive care medicine - January 15, 2019 Category: Anesthesiology Source Type: research

Patient selection for day case surgery
Publication date: Available online 14 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Alexandra Humphreys, Mary StockerAbstractDay surgery provides many benefits to patients and trusts. Currently, almost all surgery should be performed as day case or very short stay and as such the criteria for suitability for day case surgery have been much expanded over recent decades. Social and medical criteria should rarely prevent successful day case surgery; we present suggestions whereby historic barriers to discharge can be overcome. We discuss the suitability of surgical procedures to be performed as a day...
Source: Anaesthesia and intensive care medicine - January 15, 2019 Category: Anesthesiology Source Type: research

Contents
Publication date: January 2019Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 1Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 9, 2019 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: January 2019Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 1Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - January 9, 2019 Category: Anesthesiology Source Type: research

Self-assessment
Publication date: Available online 20 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 20, 2018 Category: Anesthesiology Source Type: research

Nosocomial infections in the ICU
Publication date: Available online 18 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Stuart Edwardson, Chris CairnsAbstractNosocomial infections are a major cause of avoidable morbidity, mortality and extended length of stay in ICU. Prevention of these infections is key. Continual surveillance, audit and hand hygiene are therefore vital. The recent introduction of ‘care bundles’ grouping best practices for care of invasive devices have proven highly successful for reducing the rates of nosocomial infection in the ICU. Despite these strategies patients in the ICU are still twice as like...
Source: Anaesthesia and intensive care medicine - December 19, 2018 Category: Anesthesiology Source Type: research

Recognition of the critically ill patient and escalation of therapy
Publication date: Available online 17 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Amy Brown, Apoorva Ballal, Mo Al-HaddadAbstractCritical illness often involves multiple organ failures and is associated with significant morbidity and mortality. In the vast majority of patients, there is a recognizable period of physiological deterioration which heralds the development of organ failure and critical illness. Despite efforts to improve the detection and management of critical illness, signs of deterioration are often missed and decisions to move patients to critical care units are delayed. Standar...
Source: Anaesthesia and intensive care medicine - December 18, 2018 Category: Anesthesiology Source Type: research

Developmental anatomy of the airway
Publication date: Available online 14 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Niall Wilton, Henrik HackAbstractThe airway develops from the primitive foregut at 4 weeks’ gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults, with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight bladed laryngosco...
Source: Anaesthesia and intensive care medicine - December 15, 2018 Category: Anesthesiology Source Type: research

Consent and children
This article discusses consent, and its refusal, to medical interventions by children and adolescents. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 15, 2018 Category: Anesthesiology Source Type: research

Principles of intravenous drug infusion
Publication date: Available online 15 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): David J. ChambersAbstractIntravenous infusions are required when a drug has a short half-life or a narrow therapeutic window. Pharmacokinetic models are employed to calculate the infusion rate for a particular target plasma concentration. While the one-compartment model is based on relatively simple mathematics, it is of little practical use. Multi-compartment models involve complex mathematics: a bolus-infusion regimen requires a variable-infusion rate. In clinical practice, this means incorporating the pharmacok...
Source: Anaesthesia and intensive care medicine - December 15, 2018 Category: Anesthesiology Source Type: research

Acute and chronic airway obstruction in children
This article aims to summarize key anatomical features of the paediatric airway, common causes of airway obstruction in children and provide suggestions for how to manage these patients. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 14, 2018 Category: Anesthesiology Source Type: research

Update on ENT anaesthesia in children
This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing number are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea, but judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including the potential role for dexmedetomidine and recent adv...
Source: Anaesthesia and intensive care medicine - December 14, 2018 Category: Anesthesiology Source Type: research

Sepsis in 2018: a review
This article provides a summary of the most recent clinical evidence and professional guidelines for the diagnosis and treatment of the sepsis in the critical care setting. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 14, 2018 Category: Anesthesiology Source Type: research

Assessment and management of the predicted difficult airway in babies and children
This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 14, 2018 Category: Anesthesiology Source Type: research

Physical rehabilitation and critical illness
This article describes the physical problems experienced by ICU survivors, and provides an up to date review of critical care physical intervention trials. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 13, 2018 Category: Anesthesiology Source Type: research

Haematological problems in the intensive care unit
Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Katherine L. McDowall, Katrina Parsons, Gillian A. HorneAbstractPatients admitted to the intensive care unit can be affected by a range of haematological problems, either as a consequence of primary haematological disease or, more commonly, with haematological problems arising as a consequence of other disease processes. The haematological malignancies are individually relatively rare conditions, but collectively account for a significant proportion of cancer diagnoses. This group of conditions may cause patients ...
Source: Anaesthesia and intensive care medicine - December 13, 2018 Category: Anesthesiology Source Type: research

Contents
Publication date: December 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 12Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 1, 2018 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: December 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 12Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - December 1, 2018 Category: Anesthesiology Source Type: research

Pharmacological modulation of cardiac function and blood vessel calibre
This article considers the global control of the system through to local and regional regulation of blood flow, and how the system may be manipulated at every level. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 21, 2018 Category: Anesthesiology Source Type: research

Cardiopulmonary resuscitation and post-resuscitation care
Publication date: Available online 17 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Michael O'Connor, C Stephanie CattlinAbstractSurvival and subsequent good neurological outcome following cardiac arrest depends on prompt diagnosis, good quality cardiopulmonary resuscitation (CPR) with minimal interruptions and rapid defibrillation, if appropriate. In the post resuscitation phase, diagnosis and treatment of the underlying cause for the arrest with avoidance of hypotension, hyperthermia, hyperoxia, hyper/hypoglycaemia and management of seizure activity confers the best chances of a successful outc...
Source: Anaesthesia and intensive care medicine - November 17, 2018 Category: Anesthesiology Source Type: research

Self-assessment
Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 14, 2018 Category: Anesthesiology Source Type: research

Ethical issues in resuscitation and intensive care
Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Grant Lewis, Paul McConnellAbstractWith continued advances in resuscitation and organ support, modern intensive care medicine is redefining life and death. Yet for all our progress, more life at any costs may not be an outcome that a patient wishes or finds tolerable. As medical paternalism is stripped away and the subjective wishes of the patient becomes the focus of our care, how we offer, deliver and discontinue therapies become paramount. When our patients themselves though may not be able to communicate their...
Source: Anaesthesia and intensive care medicine - November 14, 2018 Category: Anesthesiology Source Type: research

Hypovolaemia
Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sally K. El-Ghazali, C. Stephanie CattlinAbstractHypovolaemia is defined as inadequate filling of the circulation and can be divided into absolute and relative hypovolaemia. The total body water accounts for 60% of a patient's body composition and is subdivided into extracellular and intracellular fluid compartments. The critical loss appears to be about 30% of the blood volume (1500–2000 ml). In order to limit the physiological effects of hypovolaemia, there are changes within the cardiovascular, renal and ...
Source: Anaesthesia and intensive care medicine - November 14, 2018 Category: Anesthesiology Source Type: research

Drugs affecting coagulation
Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Balraj Appadu, Katrina BarberAbstractFor more than half a century, heparin and vitamin K antagonists have defined anticoagulant therapy in both the short-term and long-term management of thrombotic diseases. However, the limitations of these traditional anticoagulants have prompted the development of new drugs. In the past 15 years new agents with improved safety profile and greater ease of use that target almost every step of the coagulation cascade have been developed. These include factor Xa inhibitors and...
Source: Anaesthesia and intensive care medicine - November 14, 2018 Category: Anesthesiology Source Type: research

Pain, agitation and delirium in the intensive care unit
This article explores the challenges of assessing pain in the ICU and outlines methods that can be used to better identify and manage pain in this patient group. Agitation in ICU is often multifactorial, with many of its sources under-recognized. We will discuss the potential reasons that ICU patients become agitated, methods for measuring agitation and the actions that can be taken to alleviate it. Although the use of sedative and anxiolytic drugs is common in ICU, their use is not without risks. This article will outline these risks, the variety of drugs available and how to use these drugs to a targeted effect. We will ...
Source: Anaesthesia and intensive care medicine - November 14, 2018 Category: Anesthesiology Source Type: research

Central venous cannulation
Publication date: Available online 14 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Peter B Williamson, C Stephanie CattlinAbstractCentral venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital. (Source:...
Source: Anaesthesia and intensive care medicine - November 14, 2018 Category: Anesthesiology Source Type: research

Contents
Publication date: November 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 11Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 25, 2018 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: November 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 11Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 25, 2018 Category: Anesthesiology Source Type: research

Self-assessment
Publication date: Available online 9 October 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 11, 2018 Category: Anesthesiology Source Type: research

Adjuvant agents in regional anaesthesia
Publication date: Available online 9 October 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Mark Gallagher, Calum RK. GrantAbstractThe addition of adjuvant agents to intrathecal and epidural anaesthetic techniques is well established, in particular opioids and clonidine. These adjuvants are utilized to improve the quality of anaesthesia and analgesia. Several other adjuvants have been studied but ongoing concerns surrounding safety and efficacy may limit their use in clinical practice. Epinephrine has for many years been administered in combination with local anaesthetic, although more recently a diverse r...
Source: Anaesthesia and intensive care medicine - October 9, 2018 Category: Anesthesiology Source Type: research

Contents
Publication date: October 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 10Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 5, 2018 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: October 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 10Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 5, 2018 Category: Anesthesiology Source Type: research

Does regional anaesthesia improve outcome?
Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Kathryn Hill, Alan JR. MacfarlaneAbstractOutcome after surgery is of interest to the patient, the surgeon and the healthcare institution. There is conclusive evidence that regional anaesthesia is associated with superior analgesic outcomes compared to opioid-based analgesic techniques and may also reduce chronic pain. While better pain control and avoiding a general anaesthetic may alone be regarded as significant outcome benefits, regional anaesthesia and analgesia may influence many other important outcomes. Re...
Source: Anaesthesia and intensive care medicine - October 5, 2018 Category: Anesthesiology Source Type: research

Spinal anaesthesia
Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Amy LK. Sadler, Paul DW. FettesAbstractSpinal anaesthesia involves the injection of local anaesthetic solution into the intrathecal space. It is a widely practiced anaesthetic technique that can provide surgical anaesthesia for procedures below the umbilicus. Due to the proximity of the central nervous system, safe practice is of paramount importance and requires a good understanding of relevant anatomy, physiology and pharmacology. Complications are rare but need to be recognized and managed rapidly and appropri...
Source: Anaesthesia and intensive care medicine - October 5, 2018 Category: Anesthesiology Source Type: research

Patient positioning in anaesthesia
We describe the considerations for the anaesthetist when positioning the surgical patient. We discuss the positions commonly used for surgical patients and relate the challenges associated with each of these positions, challenges which can be physical as well as physiological. Staffing and equipment provision levels must be adequate to cope with the complexity predicted in positioning an individual patient. The anaesthetist also needs to consider the relatively restricted access to the patient for intervention when in the prone or lateral positions. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 5, 2018 Category: Anesthesiology Source Type: research