Commonly encountered central nervous system infections in the neurointensive care unit
Publication date: March 2018 Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3 Author(s): Rachel Herbert, Carmel Curtis The central nervous system (CNS) may be infected by a number of organisms including bacteria, viruses, fungi, and protozoa. Non-infectious causes such as autoimmune and vascular conditions may present with similar clinical syndromes necessitating the appropriate laboratory requests and good diagnostics. CNS infections are associated with significant morbidity and mortality, often requiring surgical intervention and admission to neurointensive care units. Common infection diagnoses ...
Source: Anaesthesia and intensive care medicine - February 28, 2018 Category: Anesthesiology Source Type: research

Update on the management of status epilepticus
Publication date: March 2018 Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3 Author(s): Marco Paris, Ugan Reddy Status epilepticus (SE) it is widely recognized as the second most common and life-threatening neurological emergency after stroke, which carries a high mortality and morbidity. The main goal of treatment is to emergently stop clinical and electrographic seizure activity. Most authorities agree on three-line treatment for SE with administration of benzodiazepines followed by longer-acting anti-epileptic agents and finally, if seizures persist, the administration of general anaesthetic ag...
Source: Anaesthesia and intensive care medicine - February 28, 2018 Category: Anesthesiology Source Type: research

Anaesthesia for thoracic surgery
This article will focus primarily on the anaesthetic management of major lung resections, procedures which are generally performed for malignant disease and which can confer significant mortality and morbidity. The equipment needed and ventilatory strategies during one lung anaesthesia will be discussed and the important changes in respiratory physiology that occur will be looked at in detail. Recent advances in pain management necessitate that postoperative analgesic regimens are covered in some depth. There has been an increase in the number of video-assisted thoracoscopic surgery (VATS) cases and the merits and anaesthe...
Source: Anaesthesia and intensive care medicine - November 29, 2017 Category: Anesthesiology Source Type: research

Basic principles of lasers
This article explores the properties of laser; its physical principles; and the main components required to produce a laser beam. The specific properties of laser render it an extremely useful clinical tool in a variety of circumstances. The application of laser also brings potential hazards, which are discussed, along with the safety measures utilised to minimize the associated risk. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 17, 2017 Category: Anesthesiology Source Type: research

Measurement of gas concentrations
This article will provide an overview of the techniques used for gas analysis and their associated potential sources of error. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - November 15, 2017 Category: Anesthesiology Source Type: research

Fluid balance
Publication date: Available online 11 November 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Emrys Kirkman, Peter Tryphonopoulos, Christopher Harle 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 alve...
Source: Anaesthesia and intensive care medicine - November 12, 2017 Category: Anesthesiology Source Type: research

Principles of pressure transducer function and sources of error in clinical use
This article aims to furnish the reader with this level of understanding in order to inform their academic and clinical practice. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 28, 2017 Category: Anesthesiology Source Type: research

Ethics in clinical trials
Publication date: Available online 25 September 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Kirsteen A. Jones, Michael Semple Although one of the first pieces of legislation to address ethical issues in clinical trials was drawn up following the findings from the Nuremberg Trials, only in the most recent clinical research have the principles of beneficence, non-maleficence, autonomy and justice been considered and informed consent plays a major role. In the UK, the National Research Ethics Service and the Medicines and Healthcare Products Regulatory Agency require compliance with Good Clinical Pra...
Source: Anaesthesia and intensive care medicine - September 25, 2017 Category: Anesthesiology Source Type: research

Starvation, exercise and the stress response
We describe how the body adapts to decreased nutrient supply, increased energy demands and to stress. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 19, 2017 Category: Anesthesiology Source Type: research

Thyroid, parathyroid hormones and calcium homeostasis
Publication date: Available online 18 August 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Rebecca Summers, Ross Macnab The thyroid gland secretes thyroxine (T4) and triiodothyronine (T3) in response to thyroid-stimulating hormone release from the anterior pituitary gland. Iodine is essential for the synthesis of thyroid hormones. T4 and T3 increase the basal metabolic rate, heat production, and help to maintain normal growth and development. Serum calcium levels are under very tight control. The majority of calcium is found in bones. Calcium and phosphate levels are maintained by four hormones &nda...
Source: Anaesthesia and intensive care medicine - August 18, 2017 Category: Anesthesiology Source Type: research

Hormonal control of metabolism: regulation of plasma glucose
Publication date: Available online 15 August 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Niroshini Nirmalan, Mahesh Nirmalan Blood glucose concentrations are required to be maintained within a narrow therapeutic range in order to ensure the normal functioning of the body. This is accomplished through a complex, interactive, finely coordinated neuro-endocrine regulatory process. Hormonal control through the opposing actions of insulin and glucagon secreted by the islet cells of the pancreas serve as the primary response mechanism to avert post-prandial hyperglycaemia and fasting hypoglycaemia. In a...
Source: Anaesthesia and intensive care medicine - August 17, 2017 Category: Anesthesiology Source Type: research

Homeostasis in dynamic self-regulatory physiological systems
Publication date: Available online 16 August 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Niroshini Nirmalan, Mahesh Nirmalan Understanding the general principles of homeostasis and its regulation in health and disease is key to managing patients in intensive care units and operating theatres. In these environments, it is crucial to realize that physiological control is a dynamic process aimed at achieving a balance between two opposing sets of factors. Whereas one set of factors (e.g. the sympathetic nervous system) attempt to increase a physiological variable of interest at any given time, opposi...
Source: Anaesthesia and intensive care medicine - August 17, 2017 Category: Anesthesiology Source Type: research

Recognition and management of phaeochromocytoma and paraganglioma
Publication date: Available online 17 August 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Henry Wang, Chandran Jepegnanam Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% t...
Source: Anaesthesia and intensive care medicine - August 17, 2017 Category: Anesthesiology Source Type: research

Flexible fibreoptic intubation
Publication date: Available online 27 July 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Vera Sokolova, Dmitrijs Sokolovs Flexible fibreoptic intubation offers options of airway control in awake and asleep patients, in cases with limited or absent mouth opening and complex anatomy. It may be used as a first choice or a rescue technique. Despite its limitations, for example in situations with significant airway blood or secretions, and airway obstruction, it is a valuable core skill for every anaesthetist. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 27, 2017 Category: Anesthesiology Source Type: research

Critical care management of severe burns and inhalational injury
Publication date: Available online 21 June 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Andrew Clarey, Dominic Trainor Anaesthetists and critical care physicians involved in emergency care provision, must be equipped with the knowledge and skills to accurately assess and initiate treatment in patients with severe burns. This summary aims to review airway management and fluid resuscitation in addition to sedation and analgesic choices. Some of the dogma involved in current aspects of modern burns care will also be questioned. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 21, 2017 Category: Anesthesiology Source Type: research

Mathematical concepts
Publication date: Available online 9 June 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Ming Wilson Some concepts in anaesthesia can be explained by exponentials, logarithms, differentiation and integration. The aim of this article is to discuss these mathematical principles and demonstrate their importance in clinical anaesthesia. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 10, 2017 Category: Anesthesiology Source Type: research

Mechanics (including force, mass, and acceleration)
This article introduces essential concepts and illustrates them with practical examples. Topics include: Newton’s Laws of Motion; instantaneous and average quantities; the relationships between distance, speed, displacement, velocity and acceleration; gravity, mass and weight; inertia and momentum; energy and power; and translational and rotational motion. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 9, 2017 Category: Anesthesiology Source Type: research

Electricity and magnetism
This article introduces essential concepts of electricity and magnetism relevant to anaesthesia. Simple analogies are used to explain current electricity and the action of electronic components in common use. The concept of electric and magnetic fields is introduced with examples of their practical application. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 7, 2017 Category: Anesthesiology Source Type: research

Processing, storage and display of physiological measurements
Publication date: Available online 7 June 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Thomas E.F. Walton, Lucinda A. Hardy Modern anaesthesia demands the monitoring of many biological variables. It is no longer sufficient to be satisfied by a patient of good colour with a temporal pulse of reasonable character, volume and rate, though in times of power loss and technological malfunction these are skills that may still be relied upon! The journey of a biological variable from patient to monitor requires several distinct processes, often imagined within a singular ‘black box’: (i) detect...
Source: Anaesthesia and intensive care medicine - June 7, 2017 Category: Anesthesiology Source Type: research

Cervical spine disease and anaesthesia
Publication date: Available online 9 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Robin Kumar, Christopher Taylor Surgery on the cervical spine is commonly performed to relieve compression of the spinal cord (myelopathy), a nerve root (radiculopathy) or to provide bony stabilization to prevent secondary neurological injury. The pathological causes of myelopathy and radiculopathy are a common consequence of osteoarthritis or less commonly due to disc herniation, tumours, trauma, infection and multisystem disease, and in some conditions as a result of their associated pathologically or surgically...
Source: Anaesthesia and intensive care medicine - May 10, 2017 Category: Anesthesiology Source Type: research

Cervical spine radiology
Publication date: Available online 9 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Sina Kafiabadi, Prem Rangi Plain radiographs continue to play an important role in the assessment of the cervical spine, despite an ever-increasing uptake of cross sectional imaging. They are widely available and utilized in the setting of trauma to assess for cervical spine injury and stability as an integral part of the trauma series. Furthermore they can provide vital information such as dynamic stability in patients with underlying rheumatological conditions, most importantly rheumatoid arthritis. A systematic...
Source: Anaesthesia and intensive care medicine - May 10, 2017 Category: Anesthesiology Source Type: research

Neuromuscular disorders: relevance to anaesthesia and intensive care
Publication date: Available online 8 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Joanna Roberts, Ugan Reddy Neuromuscular diseases are relatively rare but it is important for both anaesthetists and intensivists to have a working knowledge of the common diseases, as they may complicate general anaesthesia and result in neurogenic respiratory failure. The most common neurological condition seen in the intensive care unit is that of critical illness neuropathy; this subject is covered elsewhere in the journal. The diseases most commonly encountered in general anaesthetic practice include motor ne...
Source: Anaesthesia and intensive care medicine - May 8, 2017 Category: Anesthesiology Source Type: research

Monitoring techniques; neuromuscular blockade and depth of anaesthesia
This article outlines the physical principles underlying peripheral nerve stimulation and depth of anaesthesia monitoring in relation to anaesthesia. The patterns of nerve stimulation most commonly used in clinical practice are described including train-of-four, double burst stimulation and tetanic stimulation, as well as methods used to measure motor response. The key technologies currently used to monitor level of consciousness during anaesthesia are also described, namely methods based on electroencephalography and stimulus evoked potentials, including limitations of their use. Published clinical guidelines on the use o...
Source: Anaesthesia and intensive care medicine - May 8, 2017 Category: Anesthesiology Source Type: research

Neuromuscular blocking agents and reversal agents
Publication date: Available online 8 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Khorat Farooq, Jennifer M. Hunter The neuromuscular junction consists of the motor nerve terminal, the synaptic cleft and post-synaptic nicotinic receptors on the motor end-plate of striated muscle. Neuromuscular blocking drugs are categorized into depolarizing and non-depolarizing agents. They are structurally related to acetylcholine (ACh), containing at least one positively charged quaternary ammonium radical that binds to the nicotinic receptor. Depolarizing agents (e.g. suxamethonium) act as agonists like ACh...
Source: Anaesthesia and intensive care medicine - May 8, 2017 Category: Anesthesiology Source Type: research

Postoperative care of neurosurgical patients: general principles
Publication date: Available online 8 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Gahan Bose, Astri M.V. Luoma The primary aim of care immediately after neurosurgery is to detect and prevent neurological deterioration while supporting systemic and neurological homoeostasis. Surgical-, anaesthetic- or disease- related factors may contribute to a slow return or failure to regain a patient's preoperative status. A period of specific monitoring and observation by nursing and medical staff accustomed to neurosurgical and neurocritical care procedures should be planned for the immediate postoperative...
Source: Anaesthesia and intensive care medicine - May 8, 2017 Category: Anesthesiology Source Type: research

Capillary dynamics and the interstitial fluid –lymphatic system
Publication date: Available online 8 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Marina Sawdon, Emrys Kirkman The capillaries are the ‘business end’ of the circulatory system, where materials exchange between the plasma and tissues. Water-soluble molecules can diffuse through pores in the capillaries, and a Gibbs–Donnan equilibrium exists between the plasma and interstitium. There are several types of capillaries, which vary in their anatomical integrity and permeability. There is also a bulk flow of fluids between the plasma and interstitium, described by the Starl...
Source: Anaesthesia and intensive care medicine - May 8, 2017 Category: Anesthesiology Source Type: research

The cell membrane and receptors
Publication date: Available online 8 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Allan Fletcher The plasma membrane forms the interface between the cell and its environment. It is composed essentially of a phospholipid matrix and many different types of protein molecules which may be embedded within the matrix (integral proteins) or more loosely associated with the cytoplasmic ‘face’ of the membrane (peripheral proteins). The passage of essential ions and molecules across the membrane is controlled by integral proteins acting as channels or transporters. Intercellular communication...
Source: Anaesthesia and intensive care medicine - May 8, 2017 Category: Anesthesiology Source Type: research

Pituitary disease and anaesthesia
Publication date: Available online 5 April 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Vivienne Hannon, Ian Appleby Patients with pituitary gland tumours comprise a significant proportion of the neurosurgical population, making transphenoidal pituitary surgery a relatively common procedure. These patients present unique anaesthetic challenges resulting from hormone hypersecretion, pituitary hypofunction or tumour mass effect. To understand this pathophysiology requires knowledge of normal pituitary anatomy and physiology. Respiratory and cardiovascular sequelae of pituitary tumours also pose anaes...
Source: Anaesthesia and intensive care medicine - April 11, 2017 Category: Anesthesiology Source Type: research

Neuromonitoring
Publication date: Available online 7 April 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Malcolm E. Smith, Martin Smith Management of acute brain injury is based on a central concept that prevention of secondary hypoxic/ischaemic injury is associated with improved outcomes. While clinical assessment of neurological state remains fundamental to neuromonitoring, several techniques are available for global and regional brain monitoring that provide assessment of cerebral perfusion, oxygenation and metabolic status, and early warning of impending brain hypoxia/ischaemia. Developments in multimodality mo...
Source: Anaesthesia and intensive care medicine - April 11, 2017 Category: Anesthesiology Source Type: research

Management of sub-arachnoid haemorrhage
Publication date: Available online 2 April 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Kate Sherratt, Ugan Reddy Spontaneous subarachnoid haemorrhage (SAH) is a neurovascular emergency with sudden onset, which requires rapid recognition and early treatment to minimize the occurrence of serious complications. The most common cause is a cerebral aneurysm, which develops at areas of turbulent flow, especially within the circle of Willis. Initial aims are to provide appropriate resuscitation to the patient and to maintain cerebral oxygenation and perfusion. Anaesthesia involves prompt airway control a...
Source: Anaesthesia and intensive care medicine - April 3, 2017 Category: Anesthesiology Source Type: research

Clinical neuroprotection and secondary neuronal injury mechanisms
Publication date: Available online 31 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Katharine Hunt, Gahan Bose Cerebral injury is a common cause of severe morbidity and mortality and is frequently encountered by anaesthetists and intensive care physicians in clinical practice. Insults may arise from a variety of medical and surgical conditions, including stroke, subarachnoid haemorrhage, central nervous system infection, epilepsy, post-cardiac arrest, and traumatic brain injury (TBI). Although the primary damage to brain tissue may be irreversible, aggressive early treatment may limit the ensu...
Source: Anaesthesia and intensive care medicine - April 1, 2017 Category: Anesthesiology Source Type: research

Reflexes: principles and properties
Publication date: Available online 31 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): James Waterhouse, Iain Campbell The body responds to changing circumstances and environmental threats both consciously and subconsciously. The cognitive response to a physical threat normally involves movement mediated by skeletal muscle. There are a number of control mechanisms ‘hardwired’ into the nervous system that enable muscle systems to respond in an integrated fashion without involving a conscious decision, although the subject is usually conscious of what has happened. These include the str...
Source: Anaesthesia and intensive care medicine - April 1, 2017 Category: Anesthesiology Source Type: research

The brain: functional divisions
Publication date: Available online 30 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Leo Donnelly The incompletely separated cerebral hemispheres consist of a thin outer folded cortex of grey matter containing organized neuronal cell bodies and interneurons. Some of the surface convolutions subserve particular sensory or motor functions. Incoming afferent and projected efferent fibres constitute the underlying white matter, which connects different parts of each hemisphere, the hemispheres to each other and (as the corona radiata) to subcortical nuclei, especially components of the deeply-embed...
Source: Anaesthesia and intensive care medicine - March 31, 2017 Category: Anesthesiology Source Type: research

Hypoxic –ischaemic brain injury following cardiac arrest
Publication date: Available online 30 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Robin S. Howard Hypoxic–ischaemic brain injury (HIBI) has become an increasingly common cause of admission to intensive care units (ICUs) and prolonged or permanent neurological disability. It is essential to provide an accurate prognosis to guide management. Following restoration of spontaneous circulation (ROSC) clinical assessment is often difficult and ancillary investigation is necessary. Outcome depends on the severity of the initial insult, the effectiveness of immediate resuscitation and transfer,...
Source: Anaesthesia and intensive care medicine - March 31, 2017 Category: Anesthesiology Source Type: research

Critical care management of adult traumatic brain injury
Publication date: Available online 29 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Puntis, Martin Smith Severe traumatic brain injury (TBI) is associated with significant morbidity and mortality. The critical care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension, hypoxaemia, hypo- and hyperglycaemia and hyperthermia, and maintenance of adequate cerebral perfusion and oxygenation. Management protocols have evolved with internat...
Source: Anaesthesia and intensive care medicine - March 30, 2017 Category: Anesthesiology Source Type: research

Traumatic brain injury: initial resuscitation and transfer
Publication date: Available online 29 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Puntis, Toby Thomas Traumatic brain injury (TBI) is common and is associated with significant morbidity and mortality. The initial resuscitation and management of patients with TBI is focused on limiting secondary brain injury and this may be complex in patients with significant injuries to other organ systems. The transport of critically ill brain-injured patients for definitive treatment also carries significant risks which must be managed. This review describes the initial resuscitation and transfer ...
Source: Anaesthesia and intensive care medicine - March 30, 2017 Category: Anesthesiology Source Type: research

Intracranial pressure and cerebral haemodynamics
Publication date: Available online 29 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Ashwini Oswal, Ahmed K. Toma Intracranial pressure (ICP) refers to the pressure within the skull, which is determined by the volumes of the intracranial contents; blood, brain and cerebrospinal fluid. Monro–Kellie homeostasis stipulates that a change in the total intracranial volume is accompanied by a change in the ICP, which is more precisely described by the intracranial pressure–volume relationship. Maintenance of a relatively constant ICP is essential for maintenance of the cerebral perfusion p...
Source: Anaesthesia and intensive care medicine - March 30, 2017 Category: Anesthesiology Source Type: research

Cardiovascular system: critical incidents
Publication date: Available online 28 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Amit Goswami, Ruth Spencer Cardiovascular events are an important group of critical incidents in anaesthesia. They include hypotension, hypertension, myocardial ischaemia/infarction, arrhythmias, and; cardiac arrest. These incidents require prompt recognition and treatment. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 29, 2017 Category: Anesthesiology Source Type: research

Anaesthesia for endoscopic surgery
Publication date: Available online 9 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael H. MacMillan, Marie Davidson Anaesthesia for endoscopic airway surgery involves unique challenges. The anaesthetist and surgeon are working in close anatomical proximity and the concept of shared airway is never more relevant. Understanding the planned procedure and the needs of the surgeon for access to the surgical field will enable the provision of anaesthesia and airway management using a variety of techniques. Planning for safe induction, maintenance and emergence of anaesthesia will also ...
Source: Anaesthesia and intensive care medicine - March 9, 2017 Category: Anesthesiology Source Type: research

Adverse drug reactions
Publication date: Available online 6 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew Charlton, Jonathan Thompson Adverse drug reactions (ADRs) are a common and important cause of morbidity and mortality. They occur frequently in patients undergoing anaesthesia or in Intensive Care. ADRs occur by a number of mechanisms, some of which remain unclear, but several risk factors have been identified. It is increasingly recognized that pharmacogenetic factors are important in determining susceptibility to ADRs. Medical practitioners should be aware of their responsibility to report ADRs and kno...
Source: Anaesthesia and intensive care medicine - March 7, 2017 Category: Anesthesiology Source Type: research

Alternative techniques for tracheal intubation
Publication date: Available online 6 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Karen McCluskey, Miriam Stephens Conventional direct laryngoscopy with the curved Macintosh blade is a fundamental skill for all anaesthetists and has been the cornerstone of airway management for many years. This technique relies on the operator aligning the oro-pharyngo-laryngeal structures and inserting an endotracheal tube into the trachea under direct vision. There is a recognized failure rate with this technique and thus alternative techniques for tracheal intubation should be available for use in difficul...
Source: Anaesthesia and intensive care medicine - March 7, 2017 Category: Anesthesiology Source Type: research

Gas, tubes and flow
Publication date: Available online 3 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Mark A. Henderson, Colin Runcie Optimizing the flow of both liquids and gases is crucial to many areas of anaesthetic and critical care practice. In this article, we describe the physical principles which govern the flow of gases and present scenarios from clinical practice to illustrate these concepts. The difference between laminar and turbulent flow is explained along with the factors which determine the nature of the fluid flow. The Venturi Effect, Bernoulli Principle and Coanda Effect are also described wit...
Source: Anaesthesia and intensive care medicine - March 3, 2017 Category: Anesthesiology Source Type: research

Airway trauma
Publication date: Available online 3 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Deirdre Conway, Craig S. Urquhart Airway trauma should be considered according to location and mechanism of injury. Mechanism of airway trauma can be broadly classified as blunt, penetrating and thermal/chemical. Airway strategy and planning is key to safe management. These patients may be challenging to manage and complicated by polytrauma. It is essential to remember that the patient's airway may deteriorate rapidly and contingency planning for this should be in place. A structured approach to the patient is e...
Source: Anaesthesia and intensive care medicine - March 3, 2017 Category: Anesthesiology Source Type: research

Histamine and antihistamines
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Amr M. Mahdy, Nigel R. Webster Histamine is one of the most extensively studied biological amines in medicine. It stimulates smooth muscle contraction and gastric acid secretion, increases vascular permeability, functions as a neurotransmitter, and plays various roles in immunomodulation, allergy, inflammation, haematopoiesis and cell proliferation. Histamine exerts its effects through four receptors, designated H1–H4. H1 and H2 receptors are widely distributed, H3 receptors are mainly presynaptic, and H4 ...
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Transtracheal jet ventilation
This article will examine the indications for TTJV and physiology behind its mechanism of action. We will also describe the equipment required, technique and potential complications. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Percutaneous tracheostomy and cricothyrotomy techniques
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Nicola Doody, Neil Smart Percutaneous tracheostomy is an increasingly common procedure performed in the intensive care unit setting. This review discusses the evidence behind its use, provides detailed description of the techniques, and considers the principles of post-tracheostomy care based on recent national audit. It also outlines the most recent recommendations for emergency front of neck access, an essential skill for all anaesthetists and other emergency specialists. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Obstructive sleep apnoea and anaesthesia
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Kim Flatman, Diana Raj Obstructive sleep apnoea is the most prevalent sleep disorder, affecting up to 5% of the population. It can have profound effects on patients perioperatively and can have a considerable impact on morbidity and mortality. Patients require thorough preoperative assessment including the taking of a detailed history, the use of scoring systems to assess severity (such as the STOP-Bang questionnaire) and physical examination with particular attention to the airway. Elective surgery patients who...
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Ear, nose and throat emergencies
Publication date: Available online 2 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Dmitrijs Sokolovs, Ker Wei Tan Airway emergencies comprise a diverse group of conditions, which affect upper and lower airways, and have potential for rapid deterioration and lethal outcome unless managed promptly and efficiently. The latter depends on individual skills and effective interaction between anaesthetists, ENT surgeons and other members of the team. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 2, 2017 Category: Anesthesiology Source Type: research

Shock: causes, initial assessment and investigations
Publication date: Available online 29 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul Teirney, Bilal Ahmed, Alistair Nichol Shock may result from a number of distinct disease processes and it is commonly associated with trauma, infection and cardiovascular dysfunction. Shock results in significant morbidity and mortality and is a leading cause of death in hospital patients. In order to improve patient outcomes it is important to recognize shock early, then assess and treat the shocked patient in a systematic way. While the cause of the shocked state is sometimes obvious, in more difficult...
Source: Anaesthesia and intensive care medicine - January 29, 2017 Category: Anesthesiology Source Type: research

Ischaemic cardiogenic shock
Publication date: Available online 19 January 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Arne Diehl Recognition of cardiogenic shock in the setting of myocardial ischaemia has important prognostic and therapeutic implications. Mortality remains high in the order of 50%, despite introduction of urgent revascularization. Resuscitative efforts should focus to avoid multi-organ dysfunction with further spiralling instability that commonly is irreversible. To interrupt these processes, timely recognition and restoration of adequate perfusion is mandatory. The therapeutic means to achieve this beyond e...
Source: Anaesthesia and intensive care medicine - January 20, 2017 Category: Anesthesiology Source Type: research