MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Anaesthesia and intensive care medicine' source. Sat, 20 Mar 2010 13:42:27 +0100 http://www.medworm.com/index.php?rid=3295408&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202991000024X%2Fabstract%3Frss%3Dyes (pages 98–100) Which of the following are true regarding local anaesthetic toxicity and management? (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295408 Tue, 23 Feb 2010 13:41:19 +0100 3295408 http://www.medworm.com/index.php?rid=3295407&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003129%2Fabstract%3Frss%3Dyes Abstract: The body is made up of cells, which are composed of a membrane enveloping a nucleus and cytoplasm. The nucleus contains the genetic material of the body that controls its identity and determines the precise function of the cell. All cells have the potential to perform all functions, but in reality only carry out a limited number. The functions that a cell can perform are controlled by the genes. The cytoplasm contains a number of specialized organelles (many of which are common to all cells), which carry out many functions such as protein synthesis (ribosomes), protein breakdown (lysosomes), and the supply of energy, ATP (in the mitochondria). Protein synthesis is carried out in the ribosomes under the control of DNA. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295407 Tue, 23 Feb 2010 13:41:19 +0100 3295407 http://www.medworm.com/index.php?rid=3295406&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003191%2Fabstract%3Frss%3Dyes Abstract: Local anaesthetics are weak bases and consist of a lipophilic aromatic ring, a link and a hydrophilic amine. The chemistry of the link classifies them as amides or esters. They act by blocking the sodium ionophore, especially in the activated state of the channel, and frequency dependence can be shown. The speed of onset is related to dose and proportion of drug in the unionized lipid-soluble form, which in turn is determined by the pKa and the ambient pH. Local anaesthetic agents, being weak bases, are bound in the plasma to α1-acid glycoproteins, influencing duration of action. Esters undergo hydrolysis by esterases in the plasma. Amides are subject to phase I and II hepatic cytochrome P450 metabolism. The development of the S-enantiomers, levobupivacaine and ropivacaine, has ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295406 Tue, 23 Feb 2010 13:41:19 +0100 3295406 http://www.medworm.com/index.php?rid=3295405&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003178%2Fabstract%3Frss%3Dyes Abstract: Intravenous regional anaesthesia was first described in 1908 by the versatile German surgeon, August Bier. The technique is still widely known as the ‘Bier's Block’ and, if carried out by appropriately trained practitioners, is a useful regional anaesthetic technique for short surgical procedures on the forearm, lower leg or foot. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295405 Tue, 23 Feb 2010 13:41:19 +0100 3295405 http://www.medworm.com/index.php?rid=3295404&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003208%2Fabstract%3Frss%3Dyes Abstract: Peripheral nerve catheter techniques provide pain relief on movement for upper and lower limb arthroplasty and amputation. The optimal perineural concentration and volume of ropivacaine and levobupivacaine are not known for upper or lower limb block. The most common complication associated with perineural infusion is infection and, thus, aseptic technique is necessary for both insertion of catheters and use of elastomeric balls. Compared with parenteral opioids, perineural infusion of local anaesthetic accelerates rehabilitation and reduces hospital length of stay. However, little evidence exists regarding surgical outcomes, particularly those concerned with functional wellbeing. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295404 Tue, 23 Feb 2010 13:41:18 +0100 3295404 http://www.medworm.com/index.php?rid=3295403&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003221%2Fabstract%3Frss%3Dyes Abstract: Peripheral nerve blocks are increasingly used for a wide range of surgical procedures involving the lower limb. A number of techniques can be used to provide anaesthesia and highly effective postoperative analgesia – in particular following lower limb arthroplasty – that may result in improved functional recovery and shorter in-patient stay. Ultrasound-guided nerve localization offers several potential advantages when performing femoral, popliteal and distal sciatic nerve block; however, neurostimulation remains a useful and widely used aid to lower limb regional anaesthesia practice. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295403 Tue, 23 Feb 2010 13:41:18 +0100 3295403 http://www.medworm.com/index.php?rid=3295402&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900318X%2Fabstract%3Frss%3Dyes Abstract: Brachial plexus blockade is commonly used for a variety of upper limb surgical procedures and the introduction of ultrasound guidance has led to re-evaluation of many of the approaches. Large-scale studies examining both efficacy and complications of ultrasound-guided techniques compared with nerve stimulation are lacking, but there is a growing body of research to support the routine use of ultrasound. Interscalene block remains the approach of choice for shoulder surgery but phrenic nerve blockade remains common, even using low volumes of local anaesthetic. Of the currently available studies comparing the other approaches, there seems to be little difference in efficacy between axillary, supraclavicular and infraclavicular approaches for elbow, forearm and hand surgery when equ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295402 Tue, 23 Feb 2010 13:41:18 +0100 3295402 http://www.medworm.com/index.php?rid=3295401&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003117%2Fabstract%3Frss%3Dyes Abstract: Systemic toxicity from local anaesthetic agent use is a rare, but potentially life-threatening, complication. It most commonly occurs with inadvertent intravascular injection. High plasma levels of local anaesthetic lead to central nervous system and cardiovascular toxicity. Treatment of toxicity is mainly supportive; however, there is now evidence for the use of lipid emulsions in the management of severe local anaesthetic toxicity. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295401 Tue, 23 Feb 2010 13:41:18 +0100 3295401 http://www.medworm.com/index.php?rid=3295400&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003154%2Fabstract%3Frss%3Dyes Abstract: The leg below the knee receives all its motor, and much of its sensory innervation from the two terminal branches of the sciatic nerve: the tibial and common peroneal nerves. The tibial nerve supplies the muscles of the posterior (flexor) compartment of the leg and the intrinsic muscles of the plantar foot, as well as the skin of the back of the leg (sural nerve) and the plantar skin. The common peroneal nerve is the only palpable nerve in the lower limb as it winds around the neck of the fibula (where it may be injured). It divides into the superfical peroneal nerve, which supplies the two peroneal foot evertor muscles, and the deep peroneal, supplying the extensor group, as well as sensory supply to the front of the leg and dorsum of the foot, which is reinforced by two sensory... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295400 Tue, 23 Feb 2010 13:41:18 +0100 3295400 http://www.medworm.com/index.php?rid=3295399&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003130%2Fabstract%3Frss%3Dyes Abstract: The lumbar plexus is derived from the anterior primary rami of L1, L2, L3, and part of L4. It may also receive a contribution from T12. Its major derivatives are the femoral and the obturator nerves. The sacral plexus arises from the anterior primary rami of the five sacral nerves and the coccygeal nerve, together with the lumbosacral trunk, an important contribution which comprises the whole of L5 together with a contribution from L4. Its terminal branches are the sciatic and the pudendal nerve. In addition, both plexuses have numerous collateral muscular and cutaneous branches, and the sacral plexus gives rise to the pelvic parasympathetic outflow from S2 and S3. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295399 Tue, 23 Feb 2010 13:41:18 +0100 3295399 http://www.medworm.com/index.php?rid=3295398&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003142%2Fabstract%3Frss%3Dyes Abstract: The brachial plexus derives from C5, C6, C7, C8 and T1 nerves. It is made up of five roots, between the scalene muscles, three trunks (upper, middle and lower) lying in the posterior triangle, each of which divide into anterior and posterior divisions behind the clavicle to form lateral, medial and posterior cords in the upper axilla. The plexus gives rise to the definitive motor and cutaneous nerve supply to the upper limb. The plexus can be blocked by local anaesthetic infiltration at its root/trunk level in the fascial sheath compartment between the scalenes, or as it crosses the first rib. Block can also be performed around the axillary artery. Peripherally, the nerves may be blocked at the elbow, wrist or finger level. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295398 Tue, 23 Feb 2010 13:41:17 +0100 3295398 http://www.medworm.com/index.php?rid=3295397&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003166%2Fabstract%3Frss%3Dyes Abstract: Complications of regional anaesthesia can be divided into those specific to central neuraxial blockade, those specific to peripheral nerve blockade, and those that pertain to both. Fortunately, severe complications – namely, spinal cord damage, vertebral cord haematoma and epidural abscess – are rare. Here, with reference to updated incidences available following the Third National Audit Project (NAP3) of the Royal College of Anaesthetists, an overview of these complications of regional anaesthesia is given. A thorough knowledge of anatomy and pharmacology, and a meticulous, unhurried technique are essential to prevent such complications. When considering the use of a regional anaesthetic technique, the risks and benefits for that patient should be assessed on a case-by-case ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295397 Tue, 23 Feb 2010 13:41:16 +0100 3295397 http://www.medworm.com/index.php?rid=3295396&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029910000275%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295396 Tue, 23 Feb 2010 13:41:16 +0100 3295396 http://www.medworm.com/index.php?rid=3295395&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029910000251%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3295395 Tue, 23 Feb 2010 13:41:16 +0100 3295395 http://www.medworm.com/index.php?rid=3205560&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003075%2Fabstract%3Frss%3Dyes (pages 62–64) Which are true of the management and ethics of a Jehovah's Witness patient? (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205560 Tue, 26 Jan 2010 13:41:40 +0100 3205560 http://www.medworm.com/index.php?rid=3205559&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002756%2Fabstract%3Frss%3Dyes Abstract: Sympathomimetics such as noradrenaline, adrenaline and dopamine all have a positive inotropic effect and may be useful in treating different aspects of cardiovascular collapse. Digoxin, which inhibits the cardiac Na+/K+ ATPase pump and the phosphodiesterase III inhibitors milrinone and amironone, which both increase in cAMP may also be useful for treatment of angina and heart failure respectively. The cardiac effects of β-blockers, L-type Ca2+ channel antagonists, K+ channel openers, I(f) inhibitors and nitrovasodilators and their role in angina are described in this article. The list of pharmacological control mechanisms that regulate the calibre of blood vessels is ever-expanding and, for ease of understanding, they have been divided into neural, humoral and local mechanisms c... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205559 Tue, 26 Jan 2010 13:41:38 +0100 3205559 http://www.medworm.com/index.php?rid=3205558&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002653%2Fabstract%3Frss%3Dyes Abstract: Plasma expanders are used to restore the circulating volume of a hypovolaemic patient. Typically, colloids are used to expand the plasma volume, although combinations of hypertonic crystalloid and colloid have recently been used. The currently available colloids vary in their physico-chemical, pharmaco-dynamic and pharmaco-kinetic properties. In particular, they differ in molecular weight, which partly determines their duration of action, and in their ability to expand the plasma volume. Dextran, hydroxyethyl starch and hypertonic colloid solutions improve oxygen flux within the microcirculation. Despite their benefits, the use of dextran and high molecular weight starches is limited by their negative impact on coagulation. In addition, these macro-molecules may also induce acute... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205558 Tue, 26 Jan 2010 13:41:38 +0100 3205558 http://www.medworm.com/index.php?rid=3205557&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002744%2Fabstract%3Frss%3Dyes Abstract: 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 Starling forces. Originally, these forces were thought to cause fluids to leave the capillaries at the arteriolar end and return at the venular end; the role of the lymphatics was to provide an ‘overflow’ mechanism due to protein leakage out of the capillaries. More recent work indicates that this concept needs modificati... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205557 Tue, 26 Jan 2010 13:41:37 +0100 3205557 http://www.medworm.com/index.php?rid=3205556&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002719%2Fabstract%3Frss%3Dyes Abstract: Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on vascular smooth muscle to cause vessel relaxation and hence increase blood flow. Cerebral blood flow is primarily regulated by a myogenic mechanism whereby increases in transmural pressure stretch the vascular smooth muscle, which responds by contracting. Renal blood flow is regulated by bo... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205556 Tue, 26 Jan 2010 13:41:37 +0100 3205556 http://www.medworm.com/index.php?rid=3205555&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002641%2Fabstract%3Frss%3Dyes Abstract: The Jehovah's Witness Yearbook reports more than 7 million followers worldwide (150,000 in the UK). Followers interpret the Bible literally, especially Acts 15:28 ‘to keep abstaining from … blood’. This includes whole blood, packed red cells, plasma, white cells and platelets and, for some, organ transplantation. Anaesthetic techniques to reduce blood loss include avoidance of medications that may cause bleeding, perioperative iron supplements, erythropoietin, antifibrinolytics, invasive monitoring, careful positioning to avoid venous congestion, induced hypotension, and regional anaesthesia aiming for a bloodless surgical field. Cell salvage, pre-operative autologous transfusion and acute normovolaemic haemodilution may be options, and careful choice of a surgical techniqu... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205555 Tue, 26 Jan 2010 13:41:37 +0100 3205555 http://www.medworm.com/index.php?rid=3205554&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002689%2Fabstract%3Frss%3Dyes Abstract: Measurement of cardiac output has important implications within both operating room and critical care environments. Persistently low cardiac output has been shown to be associated with longer intensive care stays, and increased morbidity and mortality. Clinical indicators correlate poorly with actual values, and monitoring is therefore essential to accurately measure and guide therapeutic manipulation of cardiac output. Here, we provide an overview of the many different techniques available for the measurement of cardiac output, an explanation of the principles on which they are based, and a description of some of their practical advantages and limitations. The techniques described include: intermittent and continuous indicator dilution techniques (warm and cold thermodilution, d... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205554 Tue, 26 Jan 2010 13:41:36 +0100 3205554 http://www.medworm.com/index.php?rid=3205553&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002884%2Fabstract%3Frss%3Dyes Abstract: Fluid therapy has, traditionally, been guided by static markers of cardiac preload such as central venous pressure and pulmonary artery wedge pressure. Fluid responsiveness, or an increase in stroke volume in response to fluid, is poorly predicted by these variables. This has led to increased interest in variables such as the fluctuation in blood pressure and stroke volume in response to mechanical ventilation. These changes are caused by the reduction in venous return associated with positive-pressure ventilation, which, in turn, leads to a reduction in left ventricular stroke volume and arterial pressure. These cyclical changes, termed systolic pressure variation, pulse pressure variation and stroke volume variation, predict fluid responsiveness more accurately than static mark... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205553 Tue, 26 Jan 2010 13:41:36 +0100 3205553 http://www.medworm.com/index.php?rid=3205552&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909003105%2Fabstract%3Frss%3Dyes Abstract: Comprehension of the physiology of intravenous fluids is crucial to ensuring their safe and appropriate use. The commonly utilized fluids have differing duration of actions and adverse effects. Knowledge of the methods of collection and storage of blood underpins the practice of blood product transfusion and the prevention of harm to patients receiving them. Although continuing efforts are made to ensure safety of donated blood the preferred solution of blood substitutes is still being pursued, but has not been perfected. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205552 Tue, 26 Jan 2010 13:41:36 +0100 3205552 http://www.medworm.com/index.php?rid=3205551&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002690%2Fabstract%3Frss%3Dyes Abstract: Clinical strategies to avoid blood transfusion are now considered a routine part of the peri-operative management of any patient presenting for major surgery. The universal introduction of pre-assessment clinics in the UK and the increasing acceptance of the need for multidisciplinary team (MDT) meetings mean that anaesthetists now play a major role in reducing the need for peri-operative transfusion. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205551 Tue, 26 Jan 2010 13:41:36 +0100 3205551 http://www.medworm.com/index.php?rid=3205550&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002707%2Fabstract%3Frss%3Dyes Abstract: Here, we provide an overview of viral hepatitis, the risks of transmission and new developments in the treatment of infected individuals. Acute hepatitis is a potentially fatal disease and, when not fatal, can lead to a chronic viral carrier status with the attendant risks of cirrhosis and hepatocellular carcinoma. Liver transplantation is often the only hope for survival, but advances in antiviral therapies are improving the outlook for those with chronic viral hepatitis. There are challenges to the anaesthetist who necessarily undertakes invasive procedures in such patients and may need to anesthetize them at any stage of their illness. There are complications relevant to intensive care management, and safety measures that clinicians need to adopt in the clinical environment. T... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205550 Tue, 26 Jan 2010 13:41:36 +0100 3205550 http://www.medworm.com/index.php?rid=3205549&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002720%2Fabstract%3Frss%3Dyes Abstract: HIV is a blood-borne viral infection that has implications for anaesthesia and intensive care. HIV was initially described in 1981 and it was associated with very high mortality when patients were admitted to intensive care. There have been several advances in the management of HIV patients over the past decades. Antiretroviral therapy is targeted to individuals with high viral load and or symptoms apart from CD4 count. This approach not only helps to keep patients free of symptoms for a long period of time but also contributes to better survival duration and outcome when patients are admitted to intensive care. It has been a challenge to anaesthetize this group of patients because drug interaction is a potential risk and regional anaesthesia may be potentially hazardous if a cau... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205549 Tue, 26 Jan 2010 13:41:36 +0100 3205549 http://www.medworm.com/index.php?rid=3205548&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029910000056%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205548 Tue, 26 Jan 2010 13:41:36 +0100 3205548 http://www.medworm.com/index.php?rid=3205547&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029910000032%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3205547 Tue, 26 Jan 2010 13:41:36 +0100 3205547 http://www.medworm.com/index.php?rid=3093436&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002902%2Fabstract%3Frss%3Dyes (pages 32–5) Which are true characteristics of fluid flows? (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093436 Thu, 17 Dec 2009 13:41:19 +0100 3093436 http://www.medworm.com/index.php?rid=3093435&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002665%2Fabstract%3Frss%3Dyes Abstract: Gases behave as ‘fluids’ under flow conditions. There are two main flow patterns: laminar and turbulent. Here, we review the flow characteristics of gases and how they relate to the airway and endotracheal tubes. An understanding of these characteristics can be manipulated to improve flow in clinical situations; for example, using a gas with a lower density than air such as heliox reduces turbulent flow and may be helpful in patients with airway obstruction. The Bernoulli principle and Venturi effect have been used to develop fixed-performance masks, jet ventilators and suction devices. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093435 Thu, 17 Dec 2009 13:41:19 +0100 3093435 http://www.medworm.com/index.php?rid=3093434&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002732%2Fabstract%3Frss%3Dyes Abstract: Induction of anaesthesia aims to produce a rapid, smooth transition from consciousness to unconsciousness by achieving adequate concentration of anaesthetic agents in the central nervous system. Careful planning is required, which includes pre-operative assessment, consent and explanation to the patient, and checking of all equipment and drugs. There are two main methods of inducing anaesthesia: inhalational and intravenous. The choice will depend upon patient and surgical factors as well as the anaesthetist's preference and experience. Rapid sequence induction is a modified induction technique (usually intravenous, but can be inhalational) used when there is increased risk of aspiration of gastric contents. At induction of anaesthesia, there is great physiological change; the co... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093434 Thu, 17 Dec 2009 13:41:18 +0100 3093434 http://www.medworm.com/index.php?rid=3093433&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002628%2Fabstract%3Frss%3Dyes Abstract: The femoral triangle is important in puncture and exposure of the femoral artery, block dissection of the groin lymph nodes and surgery of the great saphenous vein at its termination. The great (long) saphenous vein passes upwards from in front of the medial malleolus to a hand's breadth behind the patella to pierce the deep fascia at the groin to enter the common femoral vein. The landmark for this is one finger's breadth medial to the femoral pulse, which is located half way between the anterior superior iliac spine and the pubic symphysis. The small (short) saphenous vein commences behind the lateral malleolus and ascends behind the calf to enter the popliteal vein at the popliteal fossa. Both veins have numerous tributaries and perforators, guarded by valves, which join the d... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093433 Thu, 17 Dec 2009 13:41:18 +0100 3093433 http://www.medworm.com/index.php?rid=3093432&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002616%2Fabstract%3Frss%3Dyes Abstract: The great veins of the neck are of considerable importance, for example, in cannulation for a central venous line. The internal jugular vein commences as the continuation of the sigmoid sinus and emerges from the jugular foramen with the IX, X and XI cranial nerves. It terminates behind the manubrio-sternal joint by joining the subclavian vein to form the brachiocephalic vein. Its surface markings are the depression between the two heads of the sternocleidomastoid. In the neck the internal jugular vein lies in the carotid sheath with the carotid artery and the vagus nerve; the cervical sympathetic chain lies immediately behind. The subclavian vein commences as the continuation of the axillary vein at the lateral border of the first rib. It passes across the first rib superficial ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093432 Thu, 17 Dec 2009 13:41:18 +0100 3093432 http://www.medworm.com/index.php?rid=3093431&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002458%2Fabstract%3Frss%3Dyes Abstract: Central venous cannulation is commonly undertaken by a range of specialties in diverse clinical settings. Central veins may be cannulated by the landmark, ultrasound-guided or open surgical cut-down techniques. Complications of central venous catheter (CVC) insertion are common and may lead to significant morbidity and very occasional mortality. Two-dimensional ultrasound-guided central venous catheter placement has been shown by randomized controlled trials to be superior to the landmark technique. It reduces both the number of needle passes required for successful placement and the incidence of complications. Constant needle-tip visualization is a challenge for the novice operator. The National Institute of Clinical Excellence (NICE) recommends that following appropriate traini... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093431 Thu, 17 Dec 2009 13:41:18 +0100 3093431 http://www.medworm.com/index.php?rid=3093430&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900263X%2Fabstract%3Frss%3Dyes Abstract: Sedation is necessary for the care of most critically ill patients and yet it is not without risk. No agent is ideal and each has potentially deleterious sequelae, particularly in the context of organ dysfunction. Tailoring the regimen to each individual patient is essential but certain strategies such as the protocolized use of sedation scoring systems and daily interruptions have been shown to enhance patient outcome. Here, we review these subjects and the evidence that underscores current clinical practice. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093430 Thu, 17 Dec 2009 13:41:18 +0100 3093430 http://www.medworm.com/index.php?rid=3093429&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002434%2Fabstract%3Frss%3Dyes Abstract: Survival following cardiac arrest depends on early recognition and treatment. Current guidelines encourage good-quality chest compressions, ventilation and defibrillation if appropriate. Interruptions to chest compressions should be minimized. Successfully resuscitated patients develop a ‘sepsis-like’ post-cardiac arrest syndrome. The intensive care post-resuscitation ‘care bundle’ includes coronary reperfusion, control of ventilation, circulatory support, glucose control, treatment of seizures and therapeutic hypothermia. Prognostication in comatose survivors is difficult. One-third of cardiac arrest survivors admitted to intensive care are discharged home. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093429 Thu, 17 Dec 2009 13:41:17 +0100 3093429 http://www.medworm.com/index.php?rid=3093428&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002446%2Fabstract%3Frss%3Dyes Abstract: The catastrophic deterioration of a patient is usually preceded by a series of physiological signs. These signs have been categorized as early or late and have been used to formulate early-warning systems. Early-warning scoring systems are key tools for outreach services, allowing them to identify patients at risk of developing severe adverse events, such as death, cardiac arrest and emergency admission to the Intensive Care Unit. Assessment of the critically ill patient should follow the ABCDE (airway, breathing, circulation, disability and environment) format. This allows a systematic approach in examining the patient for signs of critical illness and with the incorporation of a scoring system can help to guide further management. Scores derived from early-warning systems can b... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093428 Thu, 17 Dec 2009 13:41:17 +0100 3093428 http://www.medworm.com/index.php?rid=3093427&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002872%2Fabstract%3Frss%3Dyes Abstract: Both legal and ethical issues may be encountered by intensive care practitioners on a regular basis. A keen knowledge of the law and of professional guidelines will assist decision-making in challenging clinical cases. Four bioethical principles can be utilized in ethical dilemmas to provide a framework upon which to base moral decisions. Being able to assess mental capacity and ascertain a patient's best interests are both key requisites for the intensive care practitioner. The application of these principles to common scenarios is discussed. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093427 Thu, 17 Dec 2009 13:41:17 +0100 3093427 http://www.medworm.com/index.php?rid=3093426&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900294X%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093426 Thu, 17 Dec 2009 13:41:17 +0100 3093426 http://www.medworm.com/index.php?rid=3093425&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002926%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3093425 Thu, 17 Dec 2009 13:41:17 +0100 3093425 http://www.medworm.com/index.php?rid=3031529&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002604%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031529 Fri, 27 Nov 2009 13:40:59 +0100 3031529 http://www.medworm.com/index.php?rid=3031528&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002173%2Fabstract%3Frss%3Dyes Abstract: The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or post-operative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the CNS or... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031528 Fri, 27 Nov 2009 13:40:59 +0100 3031528 http://www.medworm.com/index.php?rid=3031527&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002215%2Fabstract%3Frss%3Dyes Abstract: The body, in broad terms, is divided into intra- and extracellular fluid compartments, of which the extracellular consists of intravascular and interstitial compartments. The osmotic pressure of all of these compartments is equal, but their composition is different. This difference and the shifts in fluid between the intra- and extracellular compartments are brought about, in part, by the presence of intracellular proteins, which are negatively charged but which have no osmotic effect and cannot pass across cell membranes, and also by the inability of charged electrolytes to pass across cell membranes except via specialized transport proteins. Intake of fluid is in part voluntary but fluid is also present in food and is derived from the oxidation of food. Fluid balance is control... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031527 Fri, 27 Nov 2009 13:40:59 +0100 3031527 http://www.medworm.com/index.php?rid=3031526&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002227%2Fabstract%3Frss%3Dyes Abstract: The volumes of different compartments of body water are first considered in this article, with a description of how these can be measured by the ‘dye-dilution’ method. Then the physicochemical properties of water, inorganic ions and organic molecules are discussed in terms of the biological roles that they perform. Particular emphasis is placed on amphipathic molecules and their three-dimensional structure in aqueous and non-aqueous environments. The movement of water and dissolved substances across a membrane separating two compartments is described in some detail. To illustrate the different possibilities, several examples are described where the properties of the separating membrane and the solutions in the two compartments differ. This section of the article covers osmoti... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031526 Fri, 27 Nov 2009 13:40:59 +0100 3031526 http://www.medworm.com/index.php?rid=3031525&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002264%2Fabstract%3Frss%3Dyes Abstract: Post-operative nausea and vomiting (PONV) is a common clinical problem with widespread effects on morbidity, patient satisfaction and cost. Although a myriad of risk factors have been postulated as having the potential to increase its incidence, a risk scoring system using four factors – female sex, non-smoking status, past history of PONV and use of post-operative opioids – identifies most at-risk individuals. Prevention and treatment is multi-factorial and aimed at risk-reduction, pharmacological and non-pharmacological techniques. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031525 Fri, 27 Nov 2009 13:40:59 +0100 3031525 http://www.medworm.com/index.php?rid=3031524&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002239%2Fabstract%3Frss%3Dyes Abstract: Venous thromboembolism is common in the perioperative period. Difficulties with diagnosis and the risks of treatment make prevention a clinical imperative. Preoperative risk assessment and appropriate prophylaxis is important to minimize morbidity and mortality. A range of mechanical and pharmacological interventions have been shown to significantly reduce the risk. A number of anaesthetic interventions are also recommended. Newer oral anticoagulants have been recommended for use after specific high-risk procedures. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031524 Fri, 27 Nov 2009 13:40:59 +0100 3031524 http://www.medworm.com/index.php?rid=3031523&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002252%2Fabstract%3Frss%3Dyes Abstract: Recovery is defined as a return to original state. With regards to post-anaesthetic care, it implies the return of normal physiological function following the derangement of anaesthesia and surgery, particularly cardiovascular/respiratory function and the reflexes of airway protection. The purpose of the recovery room is to monitor for return of function, support until that time, and prevent or treat complications as required. All patients after general, epidural or spinal anaesthesia should be recovered in a specially designated area that complies with the standards and recommendations from the 2002 guidance from the Association of Anaesthetists. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031523 Fri, 27 Nov 2009 13:40:59 +0100 3031523 http://www.medworm.com/index.php?rid=3031522&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002161%2Fabstract%3Frss%3Dyes Abstract: Perioperative fluid therapy remains a controversial topic despite much research. Here, we review the different types of fluids, what to use in different circumstances and some of the controversies associated with fluid use. Crystalloids are fluids with small water-soluble molecules that can easily cross semi-permeable membranes. Saline-based fluids stay mainly within the extracellular compartment. Glucose solutions provide free water that diffuses across all the fluid compartments of the body. Colloids are fluids with larger, more insoluble molecules that do not readily cross membranes. Gelatins, dextrans and hydroxyethyl starches are effective intravascular volume expanders but are associated with numerous complications including anaphylaxis, renal failure and coagulation change... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031522 Fri, 27 Nov 2009 13:40:59 +0100 3031522 http://www.medworm.com/index.php?rid=3031521&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002240%2Fabstract%3Frss%3Dyes This article is written primarily from the perspective of seeing a patient in a preoperative assessment clinic rather than immediately before the operation. Patients may have already been identified as having potential anaesthetic or airway problems, and as there is more time to consider further investigations, the anaesthetist must be prepared for a more detailed analysis and discussion of the risks involved.Here we describe a framework, based on the recommendations of the American Heart Association for deciding if further investigations are indicated to stratify the risk of a perioperative cardiac event. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031521 Fri, 27 Nov 2009 13:40:59 +0100 3031521 http://www.medworm.com/index.php?rid=3031520&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002781%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031520 Fri, 27 Nov 2009 13:40:59 +0100 3031520 http://www.medworm.com/index.php?rid=3031519&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002768%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=3031519 Fri, 27 Nov 2009 13:40:59 +0100 3031519 http://www.medworm.com/index.php?rid=2928224&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002422%2Fabstract%3Frss%3Dyes For further relevant MCQs, see Anaesthesia and Intensive Care Medicine 7: 436 (www.anaesthesiajournal.co.uk) (pages 528–9) (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928224 Tue, 27 Oct 2009 13:40:56 +0100 2928224 http://www.medworm.com/index.php?rid=2928223&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002410%2Fabstract%3Frss%3Dyes [Anaesthesia and Intensive Care Medicine 2009; 326–7] Unfortunately, the first author's name was misspelt in the article Laboratory tests in hepatic failure in the July 2009 issue. The correct author details are reproduced here. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928223 Tue, 27 Oct 2009 13:40:56 +0100 2928223 http://www.medworm.com/index.php?rid=2928222&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002070%2Fabstract%3Frss%3Dyes Abstract: Substances move down concentration gradients. When fluids are mixed together, they diffuse down their own concentration gradients and come to a dynamic equilibrium such that the concentrations of the various substances in all parts of the medium are the same. When two solutions are separated by a semipermeable membrane (i.e. permeable to the solvent (water) but not the solutes), water moves down its concentration gradient such that the osmotic pressure on both sides of the membrane is the same. Cell membranes are effectively semipermeable membranes. Water passes freely but the movement of solutes across the membrane, particularly charged molecules, is usually via a specific carrier protein. This may sometimes involve the expenditure of energy. (Source: Anaesthesia and intensive c... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928222 Tue, 27 Oct 2009 13:40:56 +0100 2928222 http://www.medworm.com/index.php?rid=2928221&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002082%2Fabstract%3Frss%3Dyes Abstract: Homeostatic control of plasma pH (range 7.38–7.42) – defence of the alkaline environment in the face of massive daily acid production – is an essential requirement for life. This is achieved through three lines of defence: physico-chemical buffering, rapid respiratory changes in pCO2, and slow renal changes in H+ excretion and HCO3− reabsorption and production. Disturbances in acid–base balance are described according to the cause of a primary change in either pCO2 (respiratory acidosis, respiratory alkalosis) or plasma HCO3− concentration (metabolic acidosis, metabolic alkalosis). Buffering and respiratory changes minimize changes in pH; full compensation is effected through renal changes in reabsorption of filtered HCO3− and secretion of H+, leading to generation ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928221 Tue, 27 Oct 2009 13:40:55 +0100 2928221 http://www.medworm.com/index.php?rid=2928220&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002276%2Fabstract%3Frss%3Dyes Abstract: Spinal, epidural and caudal blockade are the three components of central neuraxial blockade, and provide surgical anaesthesia and postoperative analgesia for sub-umbilical surgery (thoracic epidurals provide effective analgesia but not anaesthesia for thoracic and upper abdominal surgery). While spinal and caudal blocks are usually performed as single-shot bolus techniques in adults and provide 2–4 h postoperative analgesia, epidural techniques can provide prolonged postoperative analgesia by inserting an epidural catheter and infusing a dilute local anaesthetic and opioid drug combination. Although useful regional anaesthetic techniques, all three are invasive procedures, can be technically difficult, and have the potential to cause serious adverse events (direct needle trauma... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928220 Tue, 27 Oct 2009 13:40:55 +0100 2928220 http://www.medworm.com/index.php?rid=2928219&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900215X%2Fabstract%3Frss%3Dyes Abstract: Spinal anaesthesia is the injection of local anaesthetic into the subarachnoid space. It is a simple technique that can be used to provide surgical anaesthesia for procedures involving the abdomen, pelvis and lower limbs. To perform the technique safely, it is important to understand the physiology of the block and the pharmacology of the drugs commonly used. Although serious complications are rare, they must be recognized and managed quickly. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928219 Tue, 27 Oct 2009 13:40:55 +0100 2928219 http://www.medworm.com/index.php?rid=2928218&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002136%2Fabstract%3Frss%3Dyes Abstract: There is conclusive evidence that regional anaesthesia techniques provide a quality of postoperative analgesia that is better than systemic opioid techniques. Continuous, effective postoperative analgesia is a worthwhile humanitarian aim in its own right, but regional anaesthesia also has the potential to improve the functional outcome from surgery. Proving that regional anaesthesia can influence the outcome of surgery is challenging; many studies are inconclusive with methodological weaknesses making comparison difficult and offering conflicting evidence. Large systematic reviews offer better evidence that regional anaesthesia improves outcome but effective analgesia alone will not markedly change surgical outcome. A postoperative lumbar epidural infusion will have no long-lasti... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928218 Tue, 27 Oct 2009 13:40:55 +0100 2928218 http://www.medworm.com/index.php?rid=2928217&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002148%2Fabstract%3Frss%3Dyes This article attempts to put the risks of these complications into context, with reference to different classes of anticoagulant drugs. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928217 Tue, 27 Oct 2009 13:40:55 +0100 2928217 http://www.medworm.com/index.php?rid=2928216&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002069%2Fabstract%3Frss%3Dyes Abstract: Adjuvant drugs are agents that, when co-administered with local anaesthetic agents, may improve the speed of onset, the quality and/or duration of analgesia. A wide range of drugs have been assessed for both neuraxial and peripheral nerve blocks. Here, we review the adjuvants used in clinical practice in the UK and also briefly mention other drugs that have been used for neuraxial administration to provide perioperative analgesia. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928216 Tue, 27 Oct 2009 13:40:55 +0100 2928216 http://www.medworm.com/index.php?rid=2928215&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002094%2Fabstract%3Frss%3Dyes Abstract: There are 31 pairs of spinal nerves: eight cervical, 12 thoracic, five lumbar, five sacral and one coccygeal. They form by fusion of a posterior sensory spinal root (bearing its posterior root ganglion) with an anterior motor root. These join at each intervertebral foramen. Typically, the nerve then divides into a posterior and an anterior primary ramus. The former supplies the vertebral muscles and dorsal skin. The anterior primary ramus in the thoracic region bears a white ramus communicans to the sympathetic ganglion. Each spinal nerve receives a grey ramus from the sympathetic chain. The nerves T2–T12 supply the skin and muscles of the trunk sequentially. The other nerves are arranged into the cervical, brachial, lumbar and sacral plexuses. The cervical plexus supplies the ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928215 Tue, 27 Oct 2009 13:40:55 +0100 2928215 http://www.medworm.com/index.php?rid=2928214&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002100%2Fabstract%3Frss%3Dyes Abstract: The epidural space is important to the anaesthetist as the site for epidural block. It surrounds the spinal part of the dura and extends from the foramen magnum of the skull to the sacral hiatus. It contains the vertebral plexus of veins, small arteries, lymphatics and the epidural fat. This fat is loose and allows injected fluid to diffuse through it. The space projects through each intervertebral canal to lie behind the parietal pleura, whose negative pressure is transmitted to it. Anteriorly, the space lies against the posterior aspects of the vertebral bodies covered by the posterior longitudinal ligament. Also connecting the vertebral bodies are the anterior vertebral longitudinal ligament and the intervertebral discs, made up of the annulus fibrosus and the central nucleus ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928214 Tue, 27 Oct 2009 13:40:54 +0100 2928214 http://www.medworm.com/index.php?rid=2928213&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002392%2Fabstract%3Frss%3Dyes Abstract: The spinal cord is 45 cm long in the adult. In the early foetus, it extends the length of the vertebral canal; differential growth results in its termination at L3 in the newborn. In the adult it terminates, as the conus medullaris, at the disc between L1 and L2, although there is a range from T12 to L3. Inferiorly, the nerve roots form the cauda equina, while the lower end of the cord is attached by the filum terminale, of pia mater, to the coccyx. The dural sac terminates usually at the second segment of the sacrum. The cord receives its arterial supply from the anterior and posterior spinal arteries, which descend from the foramen magnum. They are reinforced serially via the intervertebral foramina from segmental vessels, especially the arteria magna. The three layers of the m... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928213 Tue, 27 Oct 2009 13:40:54 +0100 2928213 http://www.medworm.com/index.php?rid=2928212&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002112%2Fabstract%3Frss%3Dyes Abstract: Typically, the sacrum represents five fused sacral vertebrae. Variations are common: lumbarization of S1, sacralization of L5 and fusion of the coccyx. Frequently, a degree of spina bifida occulta is seen. The sacrum has a central mass, four anterior sacral foramina and a lateral mass. The foramina transmit the anterior primary rami of S1–S4. The wings of the sacrum (the alae) are crossed by the lumbosacral trunk, L4 and L5, which joins the sacral plexus. Posteriorly, a median crest ends below as the sacral hiatus, bearing the cornu on either side. The hiatus is covered posteriorly by the tough posterior sacrococcygeal ligament. The posterior sacral foramina transmit the posterior roots of S1–S4. The auricular surface lies laterally and forms the sacroiliac joint with the co... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928212 Tue, 27 Oct 2009 13:40:54 +0100 2928212 http://www.medworm.com/index.php?rid=2928211&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002203%2Fabstract%3Frss%3Dyes Abstract: Medical gas production supply and distribution is a closely regulated process with many intrinsic safety designs and procedures. Supply and storage of both bulk and cylinder based systems are reviewed together with the production of common anaesthetic gases. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928211 Tue, 27 Oct 2009 13:40:54 +0100 2928211 http://www.medworm.com/index.php?rid=2928210&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002483%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928210 Tue, 27 Oct 2009 13:40:54 +0100 2928210 http://www.medworm.com/index.php?rid=2928209&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900246X%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2928209 Tue, 27 Oct 2009 13:40:54 +0100 2928209 http://www.medworm.com/index.php?rid=2859861&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002124%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859861 Wed, 30 Sep 2009 23:00:00 +0100 2859861 http://www.medworm.com/index.php?rid=2859860&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001520%2Fabstract%3Frss%3Dyes This article reviews critical therapies and techniques which help define care in the PICU, and outlines the management of acute lung injury, traumatic brain injury and septic shock. Neonatal and cardiac intensive care medicine topics are outside the scope of this article. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859860 Wed, 30 Sep 2009 23:00:00 +0100 2859860 http://www.medworm.com/index.php?rid=2859859&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029908002518%2Fabstract%3Frss%3Dyes We present a summary and discussion of the structured approach that has been developed, documented and taught in detail in the Paediatric and Neonatal Safe Transfer and Retrieval Course facilitated by the Advanced Life Support Group. This includes an overview of transfer organization and equipment considerations and limitations. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859859 Wed, 30 Sep 2009 23:00:00 +0100 2859859 http://www.medworm.com/index.php?rid=2859858&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900174X%2Fabstract%3Frss%3Dyes Abstract: Children with congenital heart disease (CHD) are at increased risk of cardiac arrest and 30-day mortality from major and minor surgical procedures compared with healthy children. Therefore, a prerequisite for anaesthetizing these children is a thorough knowledge of the specific cardiac anatomy, cardiorespiratory physiology and the potential risk of complications for each individual case. Anaesthetists must be familiar with not only the normal, series cardiac circulation but also the parallel (or balanced) and single-ventricle circulations. Anaesthetists must also understand the complex interaction between systemic and pulmonary vascular resistance and the many factors that influence these variables, and be aware of the four major complications associated with CHD and know which c... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859858 Wed, 30 Sep 2009 23:00:00 +0100 2859858 http://www.medworm.com/index.php?rid=2859857&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001933%2Fabstract%3Frss%3Dyes Abstract: An understanding of the risk factors associated with anaesthesia in children with acute or chronic associated medical conditions is important to direct the pre-operative assessment and preparation and to optimize the anaesthetic plan in order to anticipate and prevent perioperative complications. Here, we outline the relevant clinical features and anaesthetic management of some common medical conditions in children. For routine pre-operative assessment, see pages 489–94 (in this issue). (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859857 Wed, 30 Sep 2009 23:00:00 +0100 2859857 http://www.medworm.com/index.php?rid=2859856&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001702%2Fabstract%3Frss%3Dyes Abstract: Providing anaesthesia for children presents many challenges, but careful preoperative assessment and preparation can enable the experience to be positive for the child, the parents and the anaesthetist. The aims of the preoperative assessment are to gather information from the notes, child and family, plan an appropriate anaesthetic technique, allow assessment of risk, deliver information to the child and family and enable a degree of psychological preparation for the anaesthetic experience. Here, we discuss aspects of paediatric preoperative assessment and preparation that are designed to facilitate the patient's experience of anaesthesia with maximum efficiency and minimum upheaval. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859856 Wed, 30 Sep 2009 23:00:00 +0100 2859856 http://www.medworm.com/index.php?rid=2859855&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001921%2Fabstract%3Frss%3Dyes Abstract: The most recent change in paediatric anaesthetic equipment has been the shift from re-useable to disposable items. This, with the notable patent expiry of the laryngeal mask, has opened the door to multiple manufacturers with new versions of well-known devices. All new devices must have a CE mark, which demonstrates that they are ‘fit for purpose’. This gives the user some reassurance that the materials are appropriate (e.g. only medical-grade silicone is used). The CE standards have little to do with efficacy and users should be aware that newer devices may not have been tested in clinical trials; this is especially true of the paediatric sizes of new items. Monitoring standards are the same for children and adults (www.aagbi.org/publications/guidelines/docs/standardsofmonit... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859855 Wed, 30 Sep 2009 23:00:00 +0100 2859855 http://www.medworm.com/index.php?rid=2859854&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001969%2Fabstract%3Frss%3Dyes Abstract: Optimal surgical positioning aids surgical access and reduces the risk of injury to the patient. Safe positioning represents a considerable challenge, and to achieve these goals it is imperative that the anaesthetist, surgeon and theatre personnel work together as a well-coordinated team. Malpositioning is associated with significant morbidity, and nerve injuries are a common complication. Here, some of the key measures are described that will enable safe positioning of the patient and that will reduce the risk of injury during surgery. A number of physiological changes that occur in the common positions utilized for surgical procedures are also described. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859854 Wed, 30 Sep 2009 23:00:00 +0100 2859854 http://www.medworm.com/index.php?rid=2859853&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001714%2Fabstract%3Frss%3Dyes We describe the ‘RAW’ approach (Ready, Able, Willing) and list five phases of airway management in which equipment is used. These are: facemask ventilation with adjuncts, airway clearance with suction or foreign body removal, use of supraglottic airway devices, tracheal intubation with a variety of laryngoscopes including the flexible fibre-optic bronchoscope and subglottic management using cricothyroidotomy or tracheostomy. Tracheal tubes and aids for placement are described. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859853 Wed, 30 Sep 2009 23:00:00 +0100 2859853 http://www.medworm.com/index.php?rid=2859852&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001726%2Fabstract%3Frss%3Dyes Abstract: A suction device is an essential piece of equipment needed for the care of anaesthetized or critically ill patients. Medical suction is the physical process bringing about the aspiration and displacement of fluids and solids by a vacuum, from the patient's airway device or clinical environment. The efficiency of different types of suction equipment is determined by the maximum displacement and degree of subatmospheric pressure created by individual models. The relative significance of these efficiency criteria varies depending on the device's clinical purpose. An example is the high degree of vacuum and high displacement crucial for the emergency suction of vomit from the pharynx. The components of suction apparatus include the pump, suction controller, collection vessel, transfe... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859852 Wed, 30 Sep 2009 23:00:00 +0100 2859852 http://www.medworm.com/index.php?rid=2859851&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001738%2Fabstract%3Frss%3Dyes Abstract: Because dry gases can damage respiratory mucosa, lung structure and function, gases need to be humidified for mechanically ventilated patients. Heat and moisture exchangers (HMEs) are the most commonly used humidification devices. They are inexpensive and simple, with additional bacterial and viral filtration properties. Although different brands of HMEs can seem to be similar, the humidification efficiency varies widely. The best performing, achieving absolute humidity of more than 30 mg/l, are often composite hygroscopic HMEs. These are appropriate devices for many patients on critical care units. The limited humidification efficiency of many HMEs makes them appropriate only for short-term use in anaesthesia. Hot water humidifiers (HWHs) are capable of delivering inspired gases... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859851 Wed, 30 Sep 2009 23:00:00 +0100 2859851 http://www.medworm.com/index.php?rid=2859850&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002306%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859850 Wed, 30 Sep 2009 23:00:00 +0100 2859850 http://www.medworm.com/index.php?rid=2859849&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909002288%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2859849 Wed, 30 Sep 2009 23:00:00 +0100 2859849 http://www.medworm.com/index.php?rid=2753547&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001891%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753547 Mon, 31 Aug 2009 23:00:00 +0100 2753547 http://www.medworm.com/index.php?rid=2753546&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001490%2Fabstract%3Frss%3Dyes Abstract: More than 5260 cardiopulmonary transplants were carried out worldwide between January 2006 and June 2007 across 204 centres. Heart transplantation is a proven surgical option for selected patients who have advanced heart failure refractory to surgical or medical management. Lung transplantation is the definitive treatment for end-stage lung disease for patients who have failed medical therapy. More than 90% of adult patients presenting for heart transplantation have dilated cardiomyopathy or ischaemic cardiomyopathy. Anaesthetic principles for heart transplantation include full monitoring with transoesophageal echocardiography, cardiostable anaesthesia and cardiac support, and assessment and treatment of pulmonary vascular hypertension. Median survival after cardiac transplantati... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753546 Mon, 31 Aug 2009 23:00:00 +0100 2753546 http://www.medworm.com/index.php?rid=2753545&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001489%2Fabstract%3Frss%3Dyes Abstract: Mechanical 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. Implantation usually requires sternotomy with or without cardiopulmonary bypass, but percutaneous devices exist. Cardiostable anaesthesia with inotropic support is vital. Problems include bleeding versus thrombosis, high pulmonary vascular resistance, right heart failure and late infections. Transoesophageal echocardiogr... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753545 Mon, 31 Aug 2009 23:00:00 +0100 2753545 http://www.medworm.com/index.php?rid=2753544&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001519%2Fabstract%3Frss%3Dyes Abstract: With advances in early treatment, babies with congenital heart disease are now usually surviving to adulthood. They are, therefore, increasingly presenting as adults to non-specialist units for medical care. A simple classification of grown-up congenital heart (GUCH) disease into simple shunts, or obstructive, regurgitant and complex lesions can help clinicians to understand the anatomical arrangement and physiological implications of the specific cardiac lesion presented. This has clear implications for the conduct of anaesthesia. In all unrepaired or palliated lesions it is valuable to discuss the patient with the cardiologist responsible for the patient's long-term care first. Issues specific to the conduct of anaesthesia in these patients include the need to maintain sinus rh... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753544 Mon, 31 Aug 2009 23:00:00 +0100 2753544 http://www.medworm.com/index.php?rid=2753543&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001684%2Fabstract%3Frss%3Dyes Abstract: One of the biggest challenges for anaesthetists today is the safe conduct of anaesthesia for patients who might be elderly, have pre-existing cardiac disease and are scheduled to undergo non-cardiac surgery. Within the financial constraints of today's health services, the appropriate investigations need to be decided and performed for these patients in order to inform the anaesthetist, surgeon and the patient of the risk of surgery. These should be undertaken only if they will influence management of the patient. The preoperative assessment will help with the formation of a perioperative management plan, including preoperative optimization and postoperative care, in order to minimize the risk of an adverse outcome. The most recent guidelines for preoperative cardiovascular evalua... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753543 Mon, 31 Aug 2009 23:00:00 +0100 2753543 http://www.medworm.com/index.php?rid=2753542&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900191X%2Fabstract%3Frss%3Dyes Abstract: Arrhythmias are a common problem in the critically ill and they can have significant effects on patient outcome. They often require immediate and swift action and it is, therefore, essential that clinicians have a structured approach to the recognition and management of arrhythmias. Here, we provide a framework for the appropriate management of the more frequently encountered cardiac arrhythmias in critical care. We illustrate the different arrhythmias discussed with sample ECGs to aid in their recognition, and we include the algorithms from the Resuscitation Council Guidelines for reference. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753542 Mon, 31 Aug 2009 23:00:00 +0100 2753542 http://www.medworm.com/index.php?rid=2753541&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001660%2Fabstract%3Frss%3Dyes Abstract: Most patients are ready to be transferred to a ward after 24–48 hours on a cardiac intensive care unit (CICU); however, several potential complications can occur during this period. The risks during transfer from theatre to CICU increase if a long distance is involved. A thorough handover to nursing staff is mandatory. Problems with blood pressure and arrhythmias are common on the CICU. Drugs or pacing can be used to manipulate heart rate. Patients undergoing hypothermic cardiopulmonary bypass are at greater risk of hypothermia postoperatively. Active and passive warming methods are imperative to avoid complications of hypothermia. Multiple factors can cause postoperative cardiac surgical bleeding. Despite efforts to correct clotting abnormalities, patients occasionally need to... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753541 Mon, 31 Aug 2009 23:00:00 +0100 2753541 http://www.medworm.com/index.php?rid=2753540&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001544%2Fabstract%3Frss%3Dyes Abstract: Echocardiography 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 from 0° to 180°, enabling three-dimensional assessment of the structure of interest. Intraoperative TOE has been shown to improve outcome in mitral valve surgery and is frequently used by the surgeon as an aid in deciding whether to repair or replace the valve. TOE has become an important investigation... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753540 Mon, 31 Aug 2009 23:00:00 +0100 2753540 http://www.medworm.com/index.php?rid=2753539&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001672%2Fabstract%3Frss%3Dyes Abstract: Coronary artery bypass grafting (CABG) surgery may be undertaken with or without cardiopulmonary bypass (CPB) that is on- or off-pump. Although mortality and the incidences of coronary artery graft occlusion, myocardial infarction and stroke are equivalent, off-pump is associated with less blood loss, transfusion, requirement for inotropes, atrial fibrillation and chest infection compared with on-pump CABG surgery. Traditional high-dose opioid techniques of general anaesthesia should be avoided and either inhalation or total intravenous (IV) anaesthesia may be used. Meticulous monitoring, including electrocardiograph (ECG) and invasive arterial pressure measurement, is required. During grafting, good communication between anaesthetist and surgeon is essential. Maintenance of dias... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753539 Mon, 31 Aug 2009 23:00:00 +0100 2753539 http://www.medworm.com/index.php?rid=2753538&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001908%2Fabstract%3Frss%3Dyes Abstract: The success of cardiac surgery is the result of revolutionary thinking by those who were unafraid to take risks in the 1950s, when cardiopulmonary bypass was in its infancy. The development of the heart–lung machine has moved a long way from the cumbersome screen oxygenator to today's modern disposable hollow-fibre units. Perfusionists are one part of a team of highly skilled professionals dedicated to delivering the best quality care. Perfusion science is going through a number of changes, many of which are focused on receiving recognition from the Health Professions Council. Hospitals can enact local policies enabling perfusionists under the supervision of consultants to administer drugs on bypass. Regulation of parameters on cardiopulmonary bypass remains controversial. Best... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753538 Mon, 31 Aug 2009 23:00:00 +0100 2753538 http://www.medworm.com/index.php?rid=2753537&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001507%2Fabstract%3Frss%3Dyes This article describes the anaesthetic management of patients undergoing cardiac surgery. The techniques used are principally those applied to patients with ischaemic heart disease, which represents 56% of all cardiac surgery carried out in the UK. Where appropriate, management strategies for those patients with aortic and mitral valve disease are discussed. Monitoring techniques used for cardiac anaesthesia are detailed along with a description of peripheral arterial and central venous cannulation. The use of pulmonary artery catheterization, transoesophageal echocardiography, near infrared spectroscopy and bispectral index monitoring are also discussed in relation to the cardiac patient. Induction and maintenance of anaesthesia is covered, with a summary of the relevant agents used, part... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753537 Mon, 31 Aug 2009 23:00:00 +0100 2753537 http://www.medworm.com/index.php?rid=2753536&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001532%2Fabstract%3Frss%3Dyes Abstract: Preoperative assessment enables anaesthetists to tailor an anaesthetic to an individual patient. Established classification systems give objectivity to a patient's description of his or her effort limitation. Anaesthetists need a working knowledge of the preoperative investigations. They also need to understand risk stratification tools for cardiac surgery to answer questions from patients that relate to the risks of surgery and anaesthesia. Most preoperative medications should be continued until surgery. Antiplatelet therapy should be discontinued 7 days before surgery, if possible. Anaesthetists should explain the likely events in the anaesthetic room, such as the placement of venous and arterial cannulae before preoxygenation and induction of anaesthesia as well as the likely ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753536 Mon, 31 Aug 2009 23:00:00 +0100 2753536 http://www.medworm.com/index.php?rid=2753535&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001994%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753535 Mon, 31 Aug 2009 23:00:00 +0100 2753535 http://www.medworm.com/index.php?rid=2753534&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001970%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2753534 Mon, 31 Aug 2009 23:00:00 +0100 2753534 http://www.medworm.com/index.php?rid=2642061&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001453%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642061 Tue, 28 Jul 2009 10:37:22 +0100 2642061 http://www.medworm.com/index.php?rid=2642060&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001015%2Fabstract%3Frss%3Dyes This article briefly defines the audit cycle and goes on to consider a typical data model. The various elements of the data model are defined, the understanding of which should enable individuals to avoid pitfalls in data collection and ensure that the data they collect for clinical audit are of the highest quality. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642060 Tue, 28 Jul 2009 10:37:22 +0100 2642060 http://www.medworm.com/index.php?rid=2642059&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001465%2Fabstract%3Frss%3Dyes Abstract: Heart failure (HF) and coronary insufficiency are common among intensive care patients or those undergoing surgery. Both conditions can present as an acute decompensated state with high mortality or with a more stable, chronic course. Although similar drugs can be used to treat both conditions, an understanding of the respective pathological processes enables better targeting of treatment. Several drugs have been recently developed for HF and coronary insufficiency. It is increasingly appreciated that HF is not a single entity: the pathophysiology, treatment and prognosis depend on whether systolic or diastolic dysfunction predominates, and whether the condition is stable and compensated or acute and decompensated. Acute decompensated heart failure (ADHF) is treated with diuretic... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642059 Tue, 28 Jul 2009 10:37:21 +0100 2642059 http://www.medworm.com/index.php?rid=2642058&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001088%2Fabstract%3Frss%3Dyes Abstract: Antihypertensive 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 anaesthestic technique; or to reduce postoperative cardiovascular complications. Here, we discuss the physiology of blood pressure control, the pharmacology of antihypertensive drugs, current guidelines and practical applications of antihypertensive therapy. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642058 Tue, 28 Jul 2009 10:37:21 +0100 2642058 http://www.medworm.com/index.php?rid=2642057&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001106%2Fabstract%3Frss%3Dyes Abstract: Arrhythmias are common in patients undergoing anaesthesia and surgery or in those in intensive care. They are associated with a variety of underlying disorders or disease states. Arrhythmias must be identified promptly and managed appropriately. In many cases, this involves prevention or correction of precipitating factors and sometimes non-pharmacological treatments (cardioversion or surgical ablation), but anti-arrhythmic drugs are often required. These drugs are categorized according to their mechanism of action using the Vaughan Williams system. However, this is less useful in determining the choice of anti-arrhythmic in clinical practice. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642057 Tue, 28 Jul 2009 10:37:21 +0100 2642057 http://www.medworm.com/index.php?rid=2642056&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001039%2Fabstract%3Frss%3Dyes Abstract: Cardiac muscle fibres, like skeletal muscle fibres, are divided into sarcomeres, the basic unit of contraction. The contractile elements include actin, myosin, tropomyosin and troponin. The myosin molecules are arranged into thick filaments, while the actin molecules form the basis of the thin filaments. The troponin and tropomyosin are attached to the thin filaments as in skeletal muscle. In contrast to fast skeletal muscle fibres, which need to produce repetitive mechanical action only for short periods before resting, and hence can accrue an oxygen debt, cardiac muscle fibres need to perform repetitive activity for long periods (a lifetime) without rest. Consequently, cardiac muscle fibres are much more dependent on the utilization of oxygen and have an abundance of mitochondr... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642056 Tue, 28 Jul 2009 10:37:21 +0100 2642056 http://www.medworm.com/index.php?rid=2642055&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900109X%2Fabstract%3Frss%3Dyes Abstract: Introduced by Einthoven, electrocardiography remains the most common diagnostic procedure readily available to the physician in primary and secondary care. It is a graphical display of the electrical potential difference as it spreads through the heart and is recorded at the body surface. The electrocardiogram (ECG) is an indispensable tool to screen and monitor cardiac patients. Exercise ECG is used to diagnose coronary artery disease and ambulatory ECG to assess arrhythmias. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642055 Tue, 28 Jul 2009 10:37:21 +0100 2642055 http://www.medworm.com/index.php?rid=2642054&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001040%2Fabstract%3Frss%3Dyes Abstract: The heart has all the components necessary to initiate and maintain a regular heartbeat, without the need for external influence. Thus, a transplanted heart without nervous connection, or a heart completely removed from the body, if adequately perfused with oxygen, beats rhythmically. In the normal intact body, the function of the nervous and humoral regulation is to modulate the activity of the heart, though some aspects of modulation are intrinsic properties of cardiac muscle. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642054 Tue, 28 Jul 2009 10:37:21 +0100 2642054 http://www.medworm.com/index.php?rid=2642053&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001027%2Fabstract%3Frss%3Dyes Abstract: 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 and passes through the atrioventricular (AV) valves into the ventricles. The semilunar valves, between the ventricles and the arteries, are closed as arterial pressure exceeds ventricular pressure. Under normal circumstances, 70% of ventricular filling occurs by late diastole. (Source... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642053 Tue, 28 Jul 2009 10:37:21 +0100 2642053 http://www.medworm.com/index.php?rid=2642052&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001477%2Fabstract%3Frss%3Dyes Abstract: Cardiac output is the volume of blood ejected per ventricle per minute and is a measure of cardiac performance. It is the product of the strength of ventricular contraction, which determines how much blood is ejected (stroke volume), and the heart rate. Factors that control the force of contraction include the degree of myocardial stretch or Starling's Law, which is determined by venous return, and also the amount of cytosolic calcium present in muscle cells, which is influenced by sympathetic nerves and circulating catecholamines. Heart rate is also under the influence of the autonomic nervous system and circulating catecholamines. Forces opposing cardiac output include arterial blood pressure and, therefore, peripheral resistance to blood flow. (Source: Anaesthesia and intensiv... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642052 Tue, 28 Jul 2009 10:37:20 +0100 2642052 http://www.medworm.com/index.php?rid=2642051&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001428%2Fabstract%3Frss%3Dyes Abstract: Defibrillation is the only effective, and therefore life-saving, treatment for ventricular fibrillation. Defibrillators are devices that store and then discharge pre-programmed quantities of electrical energy through the heart to synchronously depolarize myocytes and allow return of sinus rhythm. Energy is supplied from batteries and is stored in a capacitor before being discharged through leads to electrodes and then across the heart either directly or via the chest. The ratio of charge stored to potential difference is known as capacitance and will determine the energy discharged by the defibrillator. Capacitance is equal to charge/voltage, and energy is equal to charge × voltage. Inductors and other electronic components are used to ensure that the waveform of the discharge i... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642051 Tue, 28 Jul 2009 10:37:20 +0100 2642051 http://www.medworm.com/index.php?rid=2642050&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900112X%2Fabstract%3Frss%3Dyes Abstract: Inotropes increase the force of contraction of cardiac muscle and thereby increase cardiac output. In general, they are used to prevent anaerobic metabolism by improving oxygen delivery to the tissues. Inotropic agents have varying pharmacological profiles; drug selection according to the clinical circumstance enables benefits to be maximized while minimizing side effects. Most inotropes act to increase intracellular calcium levels. Adrenoceptor agonists (e.g. epinephrine) achieve this by activating adenylate cyclase and increasing cyclic adenosine monophosphate (cAMP) levels and protein kinase activity, which potentiates the opening of voltage-gated calcium channels and increases the amount of calcium released from the sarcoplasmic reticulum. Phosphodiesterase inhibitors (e.g. m... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642050 Tue, 28 Jul 2009 10:37:20 +0100 2642050 http://www.medworm.com/index.php?rid=2642049&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001052%2Fabstract%3Frss%3Dyes Abstract: The mediastinum is the area of the thorax that lies between the two pleural sacs. It is further divided by an imaginary line passing from the manubriosternal junction (angle of Louis) in front and the T4/T5 vertebral junction behind into a superior and inferior compartment. The inferior mediastinum contains the heart, within its pericardial sac, together with the descending aorta and lower oesophagus. The contents of the superior mediastinum comprise the retrosternal structures, the remnant of thymus and the great veins. These are made up as follows: the right and left brachiocephalic veins form from the internal jugular/subclavian junction behind each sternoclavicular joint. The right passes directly downwards; the left passes obliquely to join the right at the level of the firs... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642049 Tue, 28 Jul 2009 10:37:19 +0100 2642049 http://www.medworm.com/index.php?rid=2642048&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001076%2Fabstract%3Frss%3Dyes Abstract: The normal heart is the size of the patient’s closed fist. The venae cavae drain into the right atrium, which bears the fossa ovalis and receives the coronary sinus and the anterior cardiac vein. The atrium empties into the right ventricle through the tricuspid valve. Both ventricles have trabeculated walls (trabeculae carneae), and from some project the papillary muscles, bearing the chordae tendinae attached to the free borders of the tricuspid valve. The same arrangement is seen on the left side. The right ventricle leads to the pulmonary trunk, guarded by its three valve cusps. Oxygenated blood returns to the left atrium via the four pulmonary veins and passes to the left ventricle via the mitral valve. Exit is through the tricuspid aortic valve. The right and left coronary... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642048 Tue, 28 Jul 2009 10:37:19 +0100 2642048 http://www.medworm.com/index.php?rid=2642047&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001775%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642047 Tue, 28 Jul 2009 10:37:19 +0100 2642047 http://www.medworm.com/index.php?rid=2642046&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001751%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2642046 Tue, 28 Jul 2009 10:37:19 +0100 2642046 http://www.medworm.com/index.php?rid=2585589&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001301%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585589 Tue, 30 Jun 2009 23:00:00 +0100 2585589 http://www.medworm.com/index.php?rid=2585588&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000666%2Fabstract%3Frss%3Dyes Abstract: Gastric disorders occur spontaneously and as a side effect of anaesthesia or surgery. In anaesthesia, the use of opioids is the most common causative factor. The most commonly used drug treatments are antiemetics, drugs reducing gastric acidity and prokinetic agents. Drugs reducing gastric acidity range from simple antacids to receptor antagonists (e.g. muscarinic, histamine H2, cholecystokinin B), which reduce gastric secretion. Functional dyspepsia, or pain or discomfort in the upper abdomen, has multifactorial causes and patients can be divided into subgroups according to their response to drugs. Most gastrointestinal infections are viral, but Helicobacter pylori has been associated with gastric ulcers; antibiotics can be used in this case. (Source: Anaesthesia and intensive c... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585588 Tue, 30 Jun 2009 23:00:00 +0100 2585588 http://www.medworm.com/index.php?rid=2585587&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000678%2Fabstract%3Frss%3Dyes Abstract: Lipid-soluble drugs are metabolized by the body to water-soluble compounds in order to be excreted in the urine. Usually, these metabolites are inactive, but sometimes drugs are converted into metabolites that are pharmacologically active. A pro-drug is a drug that is inactive in its own right but is metabolized in the body to an active compound. An example is cyclophosphamide, which is metabolized to phosphoramide mustard in the liver, thus reducing intestinal toxicity. Alternatively, the parent drug is active and then metabolized into another active drug that can have either beneficial or adverse effects. Morphine-6-glucuronide is an important example of an active metabolite that has useful analgesic activity in its own right, but it can cause respiratory depression. (Source: A... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585587 Tue, 30 Jun 2009 23:00:00 +0100 2585587 http://www.medworm.com/index.php?rid=2585586&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900068X%2Fabstract%3Frss%3Dyes Abstract: Convulsants and respiratory stimulant drugs increase reflex excitability but have little effect on mental function. Although many have been used as respiratory stimulants in the past, only doxapram has a sufficiently wide margin of safety to be used for this purpose in modern medicine. The psychomotor stimulants that produce excitement, locomotor stimulation and euphoria are rarely used clinically for this purpose, but they can cause unpredictable hypotension and modified responses to other drugs if they are being misused by a patient who then presents for anaesthesia and surgery. Methylphenidate and dexamphetamine can be useful in the treatment of attention deficit hyperactivity disorder, and dexamphetamine and modafinil can be useful in narcolepsy. Cocaine is still used as a lo... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585586 Tue, 30 Jun 2009 23:00:00 +0100 2585586 http://www.medworm.com/index.php?rid=2585585&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001003%2Fabstract%3Frss%3Dyes Abstract: Carbohydrates, mostly as starch, are digested by salivary and pancreatic amylases to di-, tri- and oligosaccharides, then to monosaccharides by saccharidases on the wall of the small intestine, following which they are absorbed. Proteins are absorbed as amino acids and small peptides that are broken down further, in the cell, to amino acids. Monosaccharides and amino acids pass to the liver via the portal vein. Fats are digested and absorbed as free fatty acids and glycerides and are then mostly reconstituted to triglycerides in the mucosal cells of the small intestine. They combine with phospholipids and a protein to form chylomicrons, which pass via the lymphatics and the thoracic duct into the general circulation. Fatty acids are released in the tissues and are then either re-... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585585 Tue, 30 Jun 2009 23:00:00 +0100 2585585 http://www.medworm.com/index.php?rid=2585584&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001118%2Fabstract%3Frss%3Dyes Abstract: The gastrointestinal tract is composed of smooth muscle arranged in two layers: longitudinal and circular. Although its activity is influenced by the autonomic nervous system, it is mainly under local reflex control mediated by an enteric nervous system and local hormones. The motility of the gastrointestinal tract has several different well-defined patterns. Its function is to move the gastrointestinal contents through the various phases of homogenization (mixing), digestion, absorption and elimination. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585584 Tue, 30 Jun 2009 23:00:00 +0100 2585584 http://www.medworm.com/index.php?rid=2585583&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001295%2Fabstract%3Frss%3Dyes Abstract: Food is divided into digestible portions in the mouth and swallowed – a complex reflex process involving several cranial nerves. The stomach homogenizes food, begins digestion and regulates the rate at which food enters the duodenum. Pancreatic juices containing powerful digesting enzymes are added and digestion is completed in the small intestine. The large bowel dehydrates the gastrointestinal contents. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585583 Tue, 30 Jun 2009 23:00:00 +0100 2585583 http://www.medworm.com/index.php?rid=2585582&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900071X%2Fabstract%3Frss%3Dyes Abstract: The liver is one of the most important organs in the body and serves a variety of important functions including metabolic, vascular, immunological, secretory and excretory functions. It plays a key role in the carbohydrate, protein and fat metabolism in the human body. In this article, we outline a brief overview of the metabolic functions. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585582 Tue, 30 Jun 2009 23:00:00 +0100 2585582 http://www.medworm.com/index.php?rid=2585581&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000721%2Fabstract%3Frss%3Dyes Abstract: The liver is the second largest organ in the human body. Traditionally, the anatomy of the liver has been described on the basis of its external appearance/gross anatomy. However, with the increase in surgical procedures, for example resection and transplant, the need for a more functional description of the liver based on its vascular and biliary architecture evolved. Different models of functional anatomy of the liver have been described in the literature in the past, but Couinaud’s model of functional anatomy of the liver is the most popular. The liver has dual vascular supply, with most of its supply coming from the portal vein and the remainder through the hepatic artery. In this article, we outline the functional anatomy of the liver along with its blood supply. (Source: ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585581 Tue, 30 Jun 2009 23:00:00 +0100 2585581 http://www.medworm.com/index.php?rid=2585580&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000964%2Fabstract%3Frss%3Dyes Abstract: As with so many different forms of anaesthesia, anaesthesia for minimally invasive surgery is dependent on the type of surgery being performed and the impact of the surgical procedure itself on the human body. With an increase in the number of surgical specialties embracing laparoscopic procedures, anaesthetists must consider the risks and benefits to the patient. On the whole, laparoscopic procedures are well tolerated. The advantages of laparoscopic surgery compared with open procedures are associated with reduced morbidity and mortality. The reductions in acute pain and postoperative respiratory tract infections and ileus allow earlier mobilization and lead to earlier discharge. Laparoscopy also improves the cosmetic appearance. It improves the view of the operative field and ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585580 Tue, 30 Jun 2009 23:00:00 +0100 2585580 http://www.medworm.com/index.php?rid=2585579&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000988%2Fabstract%3Frss%3Dyes Abstract: Laboratory tests of liver function are widely used and often poorly understood. As in any field of medicine, they should be used as part of a diagnostic process involving history-taking and clinical examination. Interpretation of tests will depend on the situation in which they are used: to obtain a diagnosis, to assess prognosis in acute or chronic liver failure or to monitor disease progression and response to treatment. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585579 Tue, 30 Jun 2009 23:00:00 +0100 2585579 http://www.medworm.com/index.php?rid=2585578&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000976%2Fabstract%3Frss%3Dyes Abstract: Advanced liver disease is a classic example of multisystem failure resulting from a single-organ disease. Historically, even minor surgery on patients with cirrhosis resulted in high mortality. Liver transplantation has dramatically improved the prognosis for these patients. It is important for clinicians to understand the multisystem sequelae of end-stage liver disease in order to assess risk and manage patients appropriately. Recognition of severe disease is crucial; improved perioperative care has not significantly reduced operative mortality. These patients should be referred for transplant assessment or, if surgery for unrelated conditions is considered, should be managed in specialist centres. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585578 Tue, 30 Jun 2009 23:00:00 +0100 2585578 http://www.medworm.com/index.php?rid=2585577&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001064%2Fabstract%3Frss%3Dyes Abstract: Anaesthetists are frequently presented with patients who have gastrointestinal problems that need either emergency or elective surgery. The anaesthetist is concerned with the primary surgical diagnosis and the secondary dysfunction of other organ systems. In the emergency situation, the airway, breathing and circulation should first be assessed and problems dealt with as they are identified, followed by as full a general assessment as is possible in the time available. In the elective situation, assessment follows the more traditional approach of history, examination and investigation. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585577 Tue, 30 Jun 2009 23:00:00 +0100 2585577 http://www.medworm.com/index.php?rid=2585576&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900099X%2Fabstract%3Frss%3Dyes Abstract: The rectus abdominis occupies two-thirds of the anterior abdominal wall and is contained with the rectus sheath, made up of the aponeuroses of the lateral muscles – the external and the internal oblique and the transversus abdominis. The mid-line is marked by the linea alba and the lateral edge of rectus by the linea semilunaris. The rectus sheath is fused anteriorly to muscle but is free posteriorly, and contains the inferior and superior epigastric vessels. The space between rectus and the posterior sheath allows local anaesthetic to travel in this plane when performing a rectus block. The abdominal wall is innervated by the anterior primary rami of T7 to L1, T10 supplying the level of the umbilicus. The inguinal canal is the oblique passage taken through the lower abdominal ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585576 Tue, 30 Jun 2009 23:00:00 +0100 2585576 http://www.medworm.com/index.php?rid=2585575&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900157X%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585575 Tue, 30 Jun 2009 23:00:00 +0100 2585575 http://www.medworm.com/index.php?rid=2585574&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001556%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2585574 Tue, 30 Jun 2009 23:00:00 +0100 2585574 http://www.medworm.com/index.php?rid=2458934&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000952%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458934 Mon, 01 Jun 2009 04:00:00 +0100 2458934 http://www.medworm.com/index.php?rid=2458933&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000629%2Fabstract%3Frss%3Dyes Abstract: A wide variety of patients present for urological surgery, from young fit patients to the elderly with multiple co-morbidities. Urological surgery ranges from minor, minimally invasive procedures to major surgery with significant physiological disturbance. It presents several specific challenges to anaesthetists. In day-case urology, a rapid turnover of patients, many of whom are elderly with significant co-morbidity, is required. General anaesthesia, with the patient breathing spontaneously through a laryngeal mask, is often used. Transurethral resection of prostate (TURP) has a specific complication, TURP syndrome, which occurs when excess irrigation fluid is absorbed, causing hypervolaemia and hyponatraemia. Spinal anaesthesia is often chosen because it allows early identifica... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458933 Mon, 01 Jun 2009 04:00:00 +0100 2458933 http://www.medworm.com/index.php?rid=2458932&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000708%2Fabstract%3Frss%3Dyes Abstract: Impaired renal function is increasingly common amongst hospital patients and is associated with significant morbidity and mortality. There has been a recent shift from traditional methods of assessing the glomerular filtration rate (GFR) towards biochemistry laboratories routinely reporting formulaic estimates of GFR. Knowledge of the treatment of and pathophysiological complications associated with chronic kidney disease are essential for anaesthetists and intensivists to provide safe and effective care to these patients. The term acute kidney injury (AKI) is now preferred to refer to the full spectrum of acute renal failure. The consensus definition and classification of AKI has recently been modified in the light of evidence that small changes in serum creatinine are associate... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458932 Mon, 01 Jun 2009 04:00:00 +0100 2458932 http://www.medworm.com/index.php?rid=2458931&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000630%2Fabstract%3Frss%3Dyes Abstract: The human kidney provides essential regulatory and excretory functions. Body water content, plasma electrolyte composition and plasma pH are all under the regulatory control of the kidney. In addition, the kidney provides a path of excretion for blood-borne, water-soluble, low-molecular-weight compounds. These include the end-products of protein metabolism, such as urea and creatinine, as well as foreign compounds with similar physicochemical characteristics and their metabolites. Endocrine activity of the human kidney includes the secretion of the hormones erythropoietin and renin and the activation of vitamin D by hydroxylation to its 1,25-dihydroxycholecalciferol form. The renal blood flow is immense, constituting 25% of resting cardiac output. The glomeruli form 170–200 lit... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458931 Mon, 01 Jun 2009 04:00:00 +0100 2458931 http://www.medworm.com/index.php?rid=2458930&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000903%2Fabstract%3Frss%3Dyes Abstract: The kidney carries out many key functions in the body, including the maintenance of fluid, acid–base and electrolyte homeostasis, the removal of nitrogenous waste, the production of erythropoietin, the hydroxylation of vitamin D and an important influence on regulation of blood pressure. This perhaps explains the increased risk of morbidity and mortality postoperatively in patients with acute or chronic renal impairment. Identification of these patients preoperatively allows the assessment of risk to both the kidneys and other organs. Protective measures can then be used in these patients with close monitoring to minimize poor outcomes. Clinical assessment of kidney function involves a thorough history and physical examination, with supplementary blood and radiological investig... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458930 Mon, 01 Jun 2009 04:00:00 +0100 2458930 http://www.medworm.com/index.php?rid=2458929&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000642%2Fabstract%3Frss%3Dyes Abstract: The primary function of the kidney is to maintain fluid and electrolyte homeostasis. Each day the kidney must excrete 1500 ml of water and any excess ingested sodium, potassium, magnesium and phosphate. The kidney also plays a key role in calcium homeostasis. Of the total number of patients in intensive care 3–25% will develop acute renal failure and patients with chronic renal disease will frequently present for surgery. The treatments for renal dysfunction may themselves cause disturbance in fluid and electrolyte homeostasis, particularly the use of diuretics and renal replacement therapy. Loss of normal renal function may lead to major changes in fluid and sodium balance. Volume status assessment will be required in patients with renal dysfunction because they are at risk of... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458929 Mon, 01 Jun 2009 04:00:00 +0100 2458929 http://www.medworm.com/index.php?rid=2458928&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000654%2Fabstract%3Frss%3Dyes Abstract: The lower urinary tract has two complementary functions. For the majority of the time it accepts and stores the urine excreted from the kidneys. It then expels the urine when required. In order to protect the kidneys the intravesical pressure needs to remain below that in the ureters during the storage phase. During the voiding phase the vesico-ureteric reflux has to be prevented and the bladder emptied completely. The anatomy of the lower urinary tract and in particular the neurological control mechanisms are vital in achieving these functions. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458928 Mon, 01 Jun 2009 04:00:00 +0100 2458928 http://www.medworm.com/index.php?rid=2458927&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000939%2Fabstract%3Frss%3Dyes Abstract: The three fluid compartments of the body are interdependent. Their homeostasis relies on systems that regulate water balance and, as the principal extracellular solute, sodium balance. Maintenance of plasma volume is essential for adequate tissue perfusion. Regulation of plasma osmolality, which is determined primarily by the serum sodium concentration, is essential for the preservation of normal cell volume and function. The importance of osmoregulation is best illustrated by the consequences of a rapid fall or rise in serum osmolality, which can cause permanent neurological damage and death through shrinkage or swelling of cells. It is tempting to attribute control of plasma sodium concentration to sodium balance, but there is no direct relationship between plasma sodium and re... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458927 Mon, 01 Jun 2009 04:00:00 +0100 2458927 http://www.medworm.com/index.php?rid=2458926&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000915%2Fabstract%3Frss%3Dyes Abstract: Correction of disturbances in acid–base balance is achieved by: physicochemical buffering by extracellular and intracellular buffer systems (instantaneous), alveolar ventilation to control pCO2 (rapid), and renal compensation (long term). Buffering and changes in ventilation limit changes in pH but cannot return acid–base status to normal. The kidney has a pivotal role: disturbances can be completely corrected through changes in H+ secretion and HCO3− reabsorption and production. HCO3− reabsorption is modified by changes in GFR (filtered load), changes in extracellular volume and by hormones which modify Na+ reabsorption via the Na+–H+ exchanger in renal tubular cells. Changing the activity of this exchanger influences H+ secretion and, hence, HCO3− reabsorption. Chro... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458926 Mon, 01 Jun 2009 04:00:00 +0100 2458926 http://www.medworm.com/index.php?rid=2458925&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000927%2Fabstract%3Frss%3Dyes Abstract: Homeostatic and excretory functions of the kidney depend on blood flow (∼25% cardiac output) and glomerular ultrafiltration (∼20% renal plasma flow). Blood flow distribution is not uniform, with only 10% reaching the medulla. Selectivity of ultrafiltration is related to molecular size, shape and electrostatic charge of molecules, and structure of the glomerular capillary barrier with its negatively charged glycoproteins. Ultrafiltration, determined by the balance between hydrostatic and colloid osmotic pressures (Starling forces) in the glomerular capillary and Bowman’s space, occurs along the length of the capillary: hydrostatic pressure is relatively unchanged and always exceeds plasma colloid osmotic pressure plus pressure in Bowman’s space. Ultrafiltration is influenc... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458925 Mon, 01 Jun 2009 04:00:00 +0100 2458925 http://www.medworm.com/index.php?rid=2458924&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000617%2Fabstract%3Frss%3Dyes This article explains the purpose of each portion of the nephron and the transport systems and hormones involved in the normal function of the nephron in the formation of urine. The article includes a discussion of commonly used drugs that affect nephron function. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458924 Mon, 01 Jun 2009 04:00:00 +0100 2458924 http://www.medworm.com/index.php?rid=2458923&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000897%2Fabstract%3Frss%3Dyes Abstract: The kidneys are placed retroperitoneally on the posterior abdominal wall, the right lower than the left. At the renal hilum are found, from before back, the renal vein, artery, pelvis of the ureter and a small posterior artery branch. There are also lymphatics and sympathetic fibres (T12–L1), which account for referred renal pain to the lower abdominal wall and external genitalia. The pelvis of the ureter divides into two or three major calyces, which divide into minor calyces, each indented by a renal papilla, onto which discharge the renal tubules. The three fascial layers are: the capsule, which is easily stripped from the healthy kidney; the perinephric fat; and the investing renal fascia, which adheres to the structures at the hilum and usually tamponades a closed rupture ... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458923 Mon, 01 Jun 2009 04:00:00 +0100 2458923 http://www.medworm.com/index.php?rid=2458922&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001337%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458922 Mon, 01 Jun 2009 04:00:00 +0100 2458922 http://www.medworm.com/index.php?rid=2458921&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909001313%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2458921 Mon, 01 Jun 2009 04:00:00 +0100 2458921 http://www.medworm.com/index.php?rid=2417492&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000885%2Fabstract%3Frss%3Dyes (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417492 Fri, 01 May 2009 04:00:00 +0100 2417492 http://www.medworm.com/index.php?rid=2417491&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000320%2Fabstract%3Frss%3Dyes Abstract: Heat and temperature are both measures of the energy possessed by molecules of a substance. Heat refers to total kinetic and potential energy; temperature refers to average kinetic energy. The coldest predicted temperature is absolute zero. The triple point defines the unique temperature and pressure at which the solid, liquid and vapour phases of a pure substance coexist. The international temperature scale of 1990 attempts to standardize temperature measurement by defining various fixed points. Temperature may be measured mechanically by the expansion of solids, liquids or gases. Electrical measurement methods include thermocouples, thermistors, semiconductors and resistance thermometers. Liquid crystal and electromagnetic radiation thermometers are also used. Measuring body te... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417491 Fri, 01 May 2009 04:00:00 +0100 2417491 http://www.medworm.com/index.php?rid=2417490&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000940%2Fabstract%3Frss%3Dyes Abstract: Organ donation and transplantation, in all forms and phases, engage clinically with anaesthesia and critical care. Although undoubtedly a major medical achievement, and of significant benefit to the recipient and some consolation to bereaved families, cadaveric donation poses a series of ethical challenges that warrant addressing by the profession if public confidence is to be maintained. The original bedrock of donation, brainstem death, was formulated at a time of medical paternalism and can be viewed today as conceptually vulnerable, anachronistic and a barrier to changing donation practice. Subsequent recruitment strategies, although understandable from a utilitarian perspective, appear insensitive to ethical principles, the law and a public expectation of transparency and pr... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417490 Fri, 01 May 2009 04:00:00 +0100 2417490 http://www.medworm.com/index.php?rid=2417489&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000575%2Fabstract%3Frss%3Dyes Abstract: Patients who have undergone previous organ transplantation represent a considerable therapeutic challenge to the anaesthetist. Although a transplant may have restored normal or near-normal function for that organ, the original underlying pathology often persists. In addition, undesirable effects of immunosuppressant drugs, particularly calcineurin inhibitors, may give rise to damage to other organs and organ systems. Diabetes, hyperlipidaemia and accelerated vascular and renal damage are a common feature. The majority of post-transplant patients require treatment for these phenomena. Common medications include statins, antihypertensives and sometimes prophylaxis against nosocomial infection. When managing post-transplant patients, both drugs and pathology have to be taken into ac... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417489 Fri, 01 May 2009 04:00:00 +0100 2417489 http://www.medworm.com/index.php?rid=2417488&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000605%2Fabstract%3Frss%3Dyes Abstract: The liver and its diseases can affect drug metabolism, and drugs can modify liver function. Ethanol produces dose-dependent liver damage and is the commonest cause of cirrhosis, and aspirin has been associated with Reye’s syndrome in children, which involves fatty degeneration of the viscera and liver failure. Most inhalational anaesthetic agents have been associated with postoperative liver dysfunction, but much of the literature concerns halothane. Halothane-associated hepatitis has been attributed to a direct effect of halothane or a metabolite upon liver cells, whereas fulminating hepatic failure has been attributed to an immune reaction following repeat halothane exposure. (Source: Anaesthesia and intensive care medicine) Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417488 Fri, 01 May 2009 04:00:00 +0100 2417488 http://www.medworm.com/index.php?rid=2417487&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000368%2Fabstract%3Frss%3Dyes Abstract: Approximately 2000 kidney transplants are performed every year in the UK. Owing to advances in surgical technique and immunosuppression therapy, transplantation is now the preferred method of renal replacement therapy for most patients with established renal failure (ERF). Donor organs have traditionally been harvested from deceased heart-beating donors but other forms of donation (e.g. non-heart-beating donors and living donors) are increasingly being utilized. Patients with ERF have complex multisystem disease and are a high-risk group for anaesthesia and surgery. Cardiovascular disease is common and is the main cause of mortality following transplantation. Major preoperative considerations include evaluation of cardiorespiratory function and assessment of fluid and electrolyte... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417487 Fri, 01 May 2009 04:00:00 +0100 2417487 http://www.medworm.com/index.php?rid=2417486&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000423%2Fabstract%3Frss%3Dyes Abstract: Transplantation medicine is a complex, multi-faceted area, requiring the involvement of many specialist teams. The ultimate goal is to improve the length and quality of life in a patient with an irreversible terminal disease. Because resources are limited, the greatest challenges lie in prioritizing patients, exploring ways to enhance the donor pool and maximizing the outcome from available organs. The purpose of this article is to provide an overview of the perioperative aspects of liver and pancreatic transplantation in adults. A detailed account of the different surgical techniques, the various immunosuppression regimes and the ever-changing criteria for organ allocation are beyond the scope of this article and will therefore be mentioned only briefly. (Source: Anaesthesia and... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417486 Fri, 01 May 2009 04:00:00 +0100 2417486 http://www.medworm.com/index.php?rid=2417485&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS147202990900037X%2Fabstract%3Frss%3Dyes Abstract: In recent years there has been increasing interest in the idea that allogeneic blood transfusions (ABTs) may be associated with immunosuppression. This syndrome has been termed transfusion-related immunomodulation (TRIM). TRIM was first demonstrated in the renal transplant setting, when significantly improved renal allograft survival after transplant was seen in patients who had received ABTs before transplant. There remains much controversy regarding the possible mechanisms of TRIM and its clinical significance. Mechanisms may be specifically human leucocyte antigen dependent or related to non-specific bioactive soluble factors. It is likely that transfused allogeneic white blood cells (WBCs) are responsible for the majority of TRIM effects. After ABT there is impaired natural k... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417485 Fri, 01 May 2009 04:00:00 +0100 2417485 http://www.medworm.com/index.php?rid=2417484&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000691%2Fabstract%3Frss%3Dyes Abstract: An allograft is tissue transplanted from another individual within the same species. Mechanical trauma to a graft and recipient transplant site along with graft-derived proinflammatory mediators stimulate a non-specific innate immune response. Dendritic cells and macrophages present foreign antigen to the adaptive immune system cells and thus initiate a specific and directed response. In order to respond to a specific pathogen, an individual must be able to recognize foreign cells as non-self. Major and minor histocompatibility antigens (MHCs) and the ABO blood group antigens are central to distinguishing one human from another and therefore in recognizing self from non-self. Genetic polymorphism describes genes encoded by varying alleles resulting in varied phenotypes within a s... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417484 Fri, 01 May 2009 04:00:00 +0100 2417484 http://www.medworm.com/index.php?rid=2417483&cid=s_33863_5_f&fid=33863&url=http%3A%2F%2Fwww.anaesthesiajournal.co.uk%2Farticle%2FPIIS1472029909000587%2Fabstract%3Frss%3Dyes Abstract: There is no statutory definition of death in the UK, but death is accepted as the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe. Brainstem death is considered equivalent to somatic death. Brainstem death testing is a formalized process divided into three stages: preconditions, exclusions and clinical testing. The confirmation of brainstem death allows for heart-beating organ donation to proceed. The increasing demand for transplantable organs has not been matched by available heart-beating organ donors, leading to renewed interest in non-heart-beating donation. Improved preservation techniques and better assessment of organ function have enabled transplant teams to procure kidneys, livers, lungs and other tissue... Anaesthesia and intensive care medicine journals http://www.medworm.com/rss/comments.php?id=2417483 Fri, 01 May 2009 04:00:00 +0100 2417483