Preoperative assessment for cardiac surgery
This article provides an overview of history, examination and preoperative management of patients undergoing cardiac surgery. Scoring systems and practical investigations are reviewed. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Transoesophageal echocardiography in cardiac anaesthesia
Publication date: July 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 7Author(s): Christine Herr, Andrew RoscoeAbstractEchocardiography is the most widely used minimally invasive investigation to diagnose heart disease. Transoesophageal echocardiography (TOE) was first introduced perioperatively in the 1980s and is now an important monitoring tool for patients undergoing cardiac surgery. Because of the close proximity of the oesophagus to the heart, TOE facilitates the acquisition of high-resolution images. The TOE probe is a multiplane transducer. This means that the image planes can be rotated fr...
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Cardiopulmonary bypass
Publication date: July 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 7Author(s): Hannah Kiziltug, Guillermo MartinezAbstractThe primary function of the cardiopulmonary bypass (CPB) machine is to provide oxygenated blood flow to the systemic circulation while providing the surgeon with a motionless, bloodless surgical field. The CPB circuit consists of a reservoir, blood pump, oxygenator, heat exchanger, arterial filter, cardioplegia delivery device and cannulae, interconnected by various sized tubing. The venous cannula directs blood away from the heart and lungs via the CBP circuit and the arteri...
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Mechanical support of the heart
Publication date: July 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 7Author(s): Guarang Vaidya, Barbora Parizkova, Emma J BirksAbstractMechanical support of the heart can be offered to patients who are refractory to pharmacological treatment, therapy for coronary or valvular disease or resynchronization therapy. Ventricular assist devices enable end-organ perfusion in the setting of heart failure. This can be temporary (as a bridge to recovery or transplantation) or permanent (destination therapy). Devices can be extracorporeal or implanted, and generated flows can be pulsatile or non-pulsatile. ...
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Drugs acting on the heart: antihypertensive drugs
Publication date: July 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 7Author(s): Matthew Charlton, Jonathan ThompsonAbstractAntihypertensive drugs are used commonly in anaesthesia and intensive care medicine. Patients might require antihypertensive drugs before surgery for the treatment of essential hypertension, pre-eclampsia or, occasionally for conditions such as phaeochromocytoma; during surgery as part of a deliberate hypotensive anaesthetic technique; or to reduce postoperative cardiovascular complications. Here, we discuss the physiology of blood pressure control, the pharmacology of antihy...
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Self-assessment
Publication date: July 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 7Author(s): Vijayanand Nadella (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: July 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 7Author(s): (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Preoperative assessment and preparation for safe paediatric anaesthesia
Publication date: Available online 30 June 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Matthew Harvey, Tim Geary The delivery of anaesthesia to children and young people provides unique challenges. A careful, systematic approach to assessment and preparation can deliver a positive experience for the child, carers and staff while mitigating potential complications. Preparation for anaesthesia should encompass information gathering, assessment and planning for anatomical, physiological, social and behavioural elements specific to the child and the surgery. Delivery of appropriate information, consen...
Source: Anaesthesia and intensive care medicine - July 1, 2018 Category: Anesthesiology Source Type: research

Equipment and monitoring in paediatric anaesthesia
This article will discuss all of these devices and techniques with particular emphasis on paediatric anaesthetic practice. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - June 27, 2018 Category: Anesthesiology Source Type: research

Drugs acting on the heart: antiarrhythmics
Publication date: Available online 28 May 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Christopher Hebbes, Jonathan P. Thompson Arrhythmias are abnormalities of cardiac rate or rhythm occurring for a variety of reasons. They are common in the perioperative period and in intensive care. Causes may reflect an underlying heritable predisposition, the presence of new pathology either of the heart or conducting system, or as a result of systemic illness. Targets for antiarrhythmics include myocardial ion channels, muscarinic or nicotinic acetylcholine receptors, adrenergic or adenosine receptors. Arrhyt...
Source: Anaesthesia and intensive care medicine - May 29, 2018 Category: Anesthesiology Source Type: research

The principles of cardiac anaesthesia
Publication date: Available online 29 May 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Charlesworth, Petr Martinovsky Despite the origins of cardiac surgery and anaesthesia involving experimentation and danger, modern practice has evolved to dramatically reduce risk and increase patient safety. Outcomes from cardiac surgery in the UK are consistently improving despite an aging population, increasing clinical complexity and an increasing incidence of chronic conditions such as anaemia and frailty. The management of bleeding is a great challenge to the surgeon and anaesthetist; knowledge of n...
Source: Anaesthesia and intensive care medicine - May 29, 2018 Category: Anesthesiology Source Type: research

Anaesthesia for off-pump coronary artery bypass grafting
Publication date: Available online 9 May 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Leon Dryden, Marco Maccario Achieving surgical revascularization of the heart, while avoiding the insult of cardiopulmonary bypass, is particularly desirable in specific high-risk patient groups. The relatively recent advances in surgical technique allowing high-quality grafting without mechanical arrest have led to an increase in popularity of off-pump coronary artery bypass surgery. Nonetheless, operating on the beating heart, manipulating it and purposely inducing ischaemia, invariably has significant haemodyna...
Source: Anaesthesia and intensive care medicine - May 21, 2018 Category: Anesthesiology Source Type: research

Mechanical events and the pressure –volume relationships
Publication date: Available online 10 May 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Emrys Kirkman Depolarization of cardiac muscle fibres spreads from fibre to fibre throughout the myocardium. In a single fibre, contraction starts just after depolarization and lasts until just after repolarization is complete. The atria contract, completing the filling of the ventricles and thus enhancing their action. In the absence of effective atrial contraction (e.g. atrial fibrillation) cardiac output is decreased on average by 15%. During diastole, when cardiac muscle is relaxed, blood returns to the heart...
Source: Anaesthesia and intensive care medicine - May 21, 2018 Category: Anesthesiology Source Type: research

Control of cardiac function
Publication date: Available online 10 May 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Charlesworth, Andrew Knowles An understanding of the core cardiovascular physiological principles is fundamental to delivering clinical care to patients. In order to successfully deliver oxygen and other nutrients to end organs whist eliminating waste products, cardiac output is manipulated through the control of heart rate, blood pressure, stroke volume, preload, afterload and contractility. Though controlled through intrinsic physiological mechanisms in health, the delivery of fluids, drugs, external/el...
Source: Anaesthesia and intensive care medicine - May 21, 2018 Category: Anesthesiology Source Type: research

Function of the nephron and the formation of urine
This article will discuss the structure and function of each segment of the nephron, and the physiology pertaining to the formation of urine. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - April 10, 2018 Category: Anesthesiology Source Type: research

Renal physiology: acid –base balance
Publication date: Available online 5 April 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Andrew D. McTavish, Manu-Priya Sharma Acid–base balance is a fundamental part of human homeostasis. The human body has evolved a system which allows exquisite control, involving multi-organ systems, over the pH of the intracellular and extracellular fluid. The Henderson–Hasselbalch equation relates pH to the dissociation constant, pK a, and relative concentrations of dissociated and undissociated acid. One of the clinical applications of this equation is in the use of local anaesthetic agents, applyi...
Source: Anaesthesia and intensive care medicine - April 5, 2018 Category: Anesthesiology Source Type: research

Renal physiology: blood flow, glomerular filtration and plasma clearance
Publication date: Available online 30 March 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Clodagh Mangan, Martyn C. Stott, Raman Dhanda The kidney depends on its blood flow (20–25% cardiac output) and glomerular ultrafiltration (20% renal plasma flow) to perform it's homoeostatic and excretory functions. More than 90% of blood flow serves the cortex. Selectivity of molecular filtration in the glomerulus is related to molecular size, shape and electrostatic charge of molecules, and structure of the glomerular filtration barrier with its negatively charged glycoproteins. Ultrafiltration is deter...
Source: Anaesthesia and intensive care medicine - March 31, 2018 Category: Anesthesiology Source Type: research

Preoperative assessment for patients with renal impairment
This article aims to provide a context and structure for the preoperative assessment of patients with renal impairment irrespective of its cause. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - March 29, 2018 Category: Anesthesiology Source Type: research

Acid –base physiology: new concepts
Publication date: Available online 26 March 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Tom Hickish, Andrew D. Farmery The traditional approach to acid–base physiology is based on the Henderson–Hasselbalch equation which is derived from the CO 2 / HCO 3 − buffer system. However, it is becoming increasingly recognized that this is an incomplete analysis as it focuses on only one of the six reactions involving H+ and can lead to the incorrect assumption that CO2 and HCO 3 − are independently adjusted factors that ultimately determine pH. In 1983, Stewart, a Canadian physi...
Source: Anaesthesia and intensive care medicine - March 27, 2018 Category: Anesthesiology Source Type: research

Anaesthesia for major spinal surgery
Publication date: Available online 12 March 2018 Source:Anaesthesia & Intensive Care Medicine Author(s): Roger Ho, Michael G. Irwin Major spinal surgery is performed for a wide variety of conditions including degenerative diseases, scoliosis and autoimmune diseases. Anaesthesia often presents several challenges to the anaesthetist. Careful pre-anaesthetic assessment and planning is important as patients may have multiple comorbidities. Important perioperative issues to consider include aspects of airway management, neurophysiological monitoring, patient positioning, blood conservation strategies, pain management a...
Source: Anaesthesia and intensive care medicine - March 12, 2018 Category: Anesthesiology Source Type: research

Measurement of respiratory function: gas exchange and its clinical applications
Publication date: February 2018 Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 2 Author(s): Salahuddin M. Qureshi, Rehan Mustafa Gas exchange is the main function of the lungs. Lungs have a large reserve for gas exchange. Oxygen and carbon dioxide diffuse along their partial pressure gradient across the alveolar–capillary membrane. Alveolar ventilation and pulmonary circulation are closely matched to provide efficient gas exchange in the lungs. Hypoxaemia often results from mismatch in ventilation–perfusion. Gas exchange can be impaired in various disease states. Measurement of the diff...
Source: Anaesthesia and intensive care medicine - February 28, 2018 Category: Anesthesiology Source Type: research

Preoperative assessment for thoracic anaesthesia
Publication date: February 2018 Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 2 Author(s): Brian H. Harte, Peter Moran, Brian F. Keogh, David Alexander Preoperative assessment of patients for thoracic surgery is a multidisciplinary process designed to offer appropriate surgical treatment with acceptable risk. UK guidelines for pulmonary resection associated with malignant disease involved review of available evidence concerning operative risk. Patients displaying cardiopulmonary physiological parameters above previously recommended threshold values remain classified as acceptable risk. However, le...
Source: Anaesthesia and intensive care medicine - February 28, 2018 Category: Anesthesiology Source Type: research

Thoracic surgical radiographic and CT pathology: radiology in the radical treatment of lung cancer
Publication date: February 2018 Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 2 Author(s): Jim Zhong, Hilary Moss Radiology has an important role in the diagnosis, staging and treatment of lung cancer and can offer minimally invasive therapies for poor surgical candidates. Radiology is also important in the follow up of patients after treatment, the assessment of treatment complications and detection of recurrent disease. Understanding the normal post-operative and post-radiation appearances, and recognizing early and late complications is useful for all clinicians involved in the care of patients...
Source: Anaesthesia and intensive care medicine - February 28, 2018 Category: Anesthesiology Source Type: research

Statistics in clinical trials and audit
This article covers the application of statistics to clinical trials and audit, including the basic types of study design, bias, power analysis, guides to good clinical practice, the presentation of results and applications in quality assurance. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - February 28, 2018 Category: Anesthesiology Source Type: research

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