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MCQsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Tags: Test yourself Source Type: journals

Laboratory tests in hepatic failureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
[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)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Tags: Erratum Source Type: journals

Osmolarity and partitioning of fluidsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 membr...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Iain Campbell Tags: Physiology Source Type: journals

Acid–base balance: maintenance of plasma pHEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 respi...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: John C. Atherton Tags: Physiology Source Type: journals

Techniques of epidural blockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 regi...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Barrie Fischer Tags: CORE - Technical skills Source Type: journals

Spinal anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Christina L. Beecroft Tags: CORE - Technical skills Source Type: journals

Does regional anaesthesia improve outcome?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 regio...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Barrie Fischer Tags: Regional anaesthesia Source Type: journals

Regional anaesthesia in patients taking anticoagulant drugsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Matthew R. Checketts Tags: Regional anaesthesia Source Type: journals

Adjuvant agents in regional anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Sudhakar R. Marri, Matthew R. Checketts Tags: Regional anaesthesia Source Type: journals

Anatomy of the spinal nerves and dermatomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 suppl...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Harold Ellis Tags: Regional anaesthesia Source Type: journals

The anatomy of the epidural spaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Al...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Harold Ellis Tags: Regional anaesthesia Source Type: journals

The spinal cord and its membranesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 des...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Harold Ellis Tags: Regional anaesthesia Source Type: journals

The sacrum and caudal blockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 sacroc...
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: Harold Ellis Tags: Regional anaesthesia Source Type: journals

Medical gases, their storage and deliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Authors: David Highley Tags: Clinical anaesthesia Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - October 27, 2009 Category: Anesthesiology Source Type: journals

MCQsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Tags: Test yourself Source Type: journals

Special considerations in paediatric intensive careEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Norbert R. Froese Tags: Paediatrics - critical care Source Type: journals

Transporting critically ill childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Peter-Marc Fortune, Stephen Playfor Tags: Paediatrics - critical care Source Type: journals

Anaesthetic implications of congenital heart disease for children undergoing non-cardiac surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 systemi...
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Michelle C. White Tags: Paediatrics Source Type: journals

Associated medical conditions in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Elena Fernandez, Jo Challands Tags: Paediatrics Source Type: journals

Preoperative assessment and preparation for anaesthesia in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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'...
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Judith A. Short, Deepak Malik Tags: Paediatrics Source Type: journals

Equipment and monitoring for paediatric anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 es...
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Graham Bell, James Limb Tags: Paediatrics Source Type: journals

Positioning the surgical patientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Stephen J. Washington, Glyn J. Smurthwaite Tags: Clinical anaesthesia Source Type: journals

Equipment for airway managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Alastair K. Ross, David R. Ball Tags: Clinical anaesthesia Source Type: journals

Suction devicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 disp...
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Andrew Shannon, Arthur Goldsmith Tags: Clinical anaesthesia Source Type: journals

Humidification devicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 h...
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Authors: Arthur Goldsmith, Andrew Shannon Tags: Clinical anaesthesia Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - September 30, 2009 Category: Anesthesiology Source Type: journals

MCQsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Tags: Test yourself Source Type: journals

Cardiopulmonary transplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ec...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Barbora Parizkova, I. Gavin Wright Tags: Cardiac anaesthesia Source Type: journals

Mechanical support of the heartEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Barbora Parizkova, I. Gavin Wright, Emma J. Birks Tags: Cardiac anaesthesia Source Type: journals

Grown-up congenital heart diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Lucy Hepburn, Andrea A. Kelleher Tags: Cardiac anaesthesia Source Type: journals

Anaesthesia for patients with cardiac disease undergoing non-cardiac surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, includin...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: K. Moyna Bill Tags: Cardiac anaesthesia Source Type: journals

Cardiac arrhythmias in the critically illEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Sarah Napier, Tom Pierce Tags: Cardiac anaesthesia Source Type: journals

Postoperative care of the adult cardiac surgical patientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 complica...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Alison D. Parnell, Nicholas J. Massey Tags: Cardiac anaesthesia Source Type: journals

Transoesophageal echocardiography in cardiac anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 outc...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Alan Ashworth, Andrew Roscoe Tags: Cardiac anaesthesia Source Type: journals

Anaesthesia for off-pump coronary artery bypass grafting surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 electrocardiog...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: R. Peter Alston Tags: Cardiac anaesthesia Source Type: journals

Cardiopulmonary bypassEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Saran Woods, Stephen J. Gray Tags: Cardiac anaesthesia Source Type: journals

Principles of cardiac anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ind...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: John W.W. Gothard, James W. Keogh Tags: Cardiac anaesthesia Source Type: journals

Preoperative assessment for cardiac surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Authors: Caroline Evans, Robert Abel Tags: Cardiac anaesthesia Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - August 31, 2009 Category: Anesthesiology Source Type: journals

MCQsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Tags: Test yourself Source Type: journals

Data quality and clinical auditEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article briefly defines the audit cycle and goes on to consider a typical data model. The various elements of the data model are defined, the understanding of which should enable individuals to avoid pitfalls in data collection and ensure that the data they collect for clinical audit are of the highest quality. (Source: Anaesthesia and intensive care medicine)
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Authors: Ranjit Verma Tags: Statistics Source Type: journals

Drugs acting on the heart: heart failure and coronary insufficiencyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 d...
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Authors: Alcira Serrano-Gomez, Jonathan Thompson Tags: Pharmacology Source Type: journals

Drugs acting on the heart: antihypertensive drugsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Authors: Nadia Ladak, Jonathan Thompson Tags: Pharmacology Source Type: journals

Drugs acting on the heart: anti-arrhythmicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-a...
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Authors: Marcus Wood, Jonathan Thompson Tags: Pharmacology Source Type: journals

Electromechanical coupling and regulation of force of cardiac contractionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 activit...
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Authors: Emrys Kirkman Tags: Physiology Source Type: journals

Electrocardiogram and arrhythmiasEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Anaesthesia and intensive care medicine - July 28, 2009 Category: Anesthesiology Authors: Rajender Singh, Jeremy J. Murphy Tags: Physiology Source Type: journals