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Keyword indexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Source Type: journals

Training guidelines for ultrasound: worldwide trendsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article covers current provision of training in echocardiography and ultrasound in areas relevant to anaesthetists who are working in critical care (including accident and emergency) and complex surgery (mainly cardiac). (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Sean Bennett Source Type: journals

Ultrasound in traumaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapi...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: James C.R. Rippey, Alistair G. Royse Source Type: journals

Epiaortic ultrasound assessment of the aorta in cardiac surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The dislodgement of atheroma from the ascending aorta and proximal arch is a major cause of stroke and neurological injury following cardiac surgery. The accurate detection of atheroma prior to aortic manipulation is necessary to facilitate surgical strategies to reduce the risk of embolisation.The traditional method for atheroma detection is manual palpation by the surgeon. This technique misses about half the number of the atheroma lesions, as the soft (non-calcified) lesions offer little resistance to the surgeon's fingers. Trans-oesophageal echocardiography (TOE) is commonly used in cardiac surgery, but the interpositi...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Alistair George Royse, Colin Forbes Royse Source Type: journals

Goal-directed fluid management with trans-oesophageal DopplerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Major surgery is associated with significant trauma and is a potential cause of multiple system organ failure and death. Measurement of cardiac output using a variety of techniques during the perioperative period has enabled practitioners to proactively optimise stroke volume and cardiac output in an attempt to reduce postoperative complications. Although pulmonary artery catheter has been widely used and considered as the gold standard for measuring cardiac output, recent advancement of technology has seen the development of a number of less-invasive haemodynamic monitors. Oesophageal Doppler ultrasonography is a minimall...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Anthony M. Roche, Timothy E. Miller, Tong J. Gan Source Type: journals

Ultrasound-guided nerve blocks: efficacy and safetyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focusses on the recent growing evidence to support the benefits of its use in nerve and plexus blocks. Common complications of nerve blocks can be avoided with ultrasound but have still been reported. Anatomical variants have been demonstrated by ultrasound and it has proved to be useful in performing regional anaesthesia in difficult situations or where peripheral nerve stimulation is unsuccessful or inappropriate. (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Paul Warman, Barry Nicholls Source Type: journals

Ultrasound guided vascular access: efficacy and safetyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarises the literature on complication rates, efficacy and safety of ultrasound-guided vascular access procedures and describes a practical method of ultrasound-guided central venous access and arterial catheterisation. (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Ajay Kumar, Alwin Chuan Source Type: journals

Limited transthoracic echocardiography assessment in anaesthesia and critical careEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The use of echocardiography in anaesthesia and critical care started with transoesophageal echocardiography, whereas transthoracic echocardiography was largely the domain of the cardiologist. In recent times, there has been a change in focus towards transthoracic echocardiography owing to the development of small and portable, yet high-fidelity, echocardiography machines. The cost has reduced, thereby increasing the availability of equipment. A parallel development has been the concept of limited transthoracic echocardiography that can be performed by practitioners with limited experience. The basis of these examinations i...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: John G. Faris, Michael G. Veltman, Colin F. Royse Source Type: journals

Ultrasound-guided haemodynamic state assessmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The haemodynamic state refers to the integration of myocardial and vascular systems, and involves both left and right hearts, and systolic and diastolic phases. The assessment of the haemodynamic state can be performed with echocardiography, and provides a higher level of diagnosis than conventional pressure- and flow-based monitoring. Whilst hypotension alerts the practitioner about the existence of haemodynamic abnormality, it does not provide sufficient information to identify the cause or the underlying haemodynamic state. The premise of haemodynamic state monitoring is that better diagnosis will lead to more rational ...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Colin Forbes Royse Source Type: journals

The impact of routine Trans-oesophageal Echocardiography (TOE) in cardiac surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Trans-oesophageal echocardiography (TOE) has profoundly changed cardiac surgery and the role of the cardiac anaesthesiologist. It has been the driving force for a real-time diagnostic and decision-making partnership between cardiac anaesthesiologists and cardiac surgeons that has significantly advanced the safety and effectiveness of modern cardiac surgery. With the information provided by TOE, anaesthesiologists and surgeons may redirect the care of cardiac surgical patients to decrease morbidity and mortality. As a result, routine intra-operative TOE is an expectation in many cardiac surgical practices. While some collea...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Georges Desjardins, Michael Cahalan Source Type: journals

Use of ultrasound in the ICUEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Echography has developed as an indispensable tool in diagnosis and subsequent therapy in the critically ill. Although pulmonary and abdominal ultrasounds play a major role in their management, this article will discuss the advantages and indications of echocardiography in the intensive care unit (ICU). The assessment of morphological abnormalities, left or right ventricular malfunction, pulmonary arterial hypertension and valvular dysfunctions is a routine indication of echocardiography. Actually, besides contractility, several preload and even afterload indicators can also be assessed. In short, this bedside tool rapidly ...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Jan Poelaert Source Type: journals

Ultrasound use in non-cardiac surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article gives the anaesthesiolgoist an overview about the relevant indications for ultrasound in non-cardiac surgical patients. Other chapters will focus in more detail on different aspects of ultrasound use in non-cardiac anaesthesia.Echocardiography is a monitoring tool for cardiac structures and function. In the anaesthetized patient the transoesophageal approach is preferred due to the unrestricted ultrasound view to the heart. Its use for non-cardiac surgery is discussed.The use of transcutaneous ultrasound in anaesthesia is mainly interventional: The puncture rate for vascular access e.g. central venous catheter...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Ulrich Schwemmer, Joerg Brederlau, Norbert Roewer Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
When I first learnt echocardiography in 1995, it was with the cardiologists and therefore predominantly transthoracic echocardiography. As a cardiac anaesthetist, I had to use transoesophageal echocardiography, and furthermore, it had to be at an advanced or diagnostic level. This was hampered by few standards and even fewer educational materials. It was terribly controversial, with many practitioners more concerned about the risk of oesophageal rupture, rather than the potential benefit that echocardiography could provide to patients undergoing cardiac surgery. In cardiac anaesthesia, the uptake of TOE was very rapid, bec...
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Authors: Colin F. Royse Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - August 31, 2009 Category: Anesthesiology Source Type: journals

Keyword indexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Source Type: journals

Influence of fluid therapy on the haemostatic system of intensive care patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Haemostatic alterations associated with the use of fluids are related to non-specific dilutional effects and colloid-specific effects, such as acquired von Willebrand syndrome, inhibition of platelet function and fibrin polymerization. Judging by currently available evidence, dextran, hetastarch and pentastarch have a more pronounced impact than tetrastarch, gelatin and albumin. In patients with hypocoagulability, tetrastarch appears to be a suitable volume expander due to its high safety index and volume efficacy. Gelatins have lower inhibitory effects on clot strength compared with tetrastarch, but their volume efficacy ...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Sibylle A. Kozek-Langenecker Source Type: journals

Pharmacokinetic aspects of fluid therapyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Peri-operative fluid therapy continues to be an exercise in empiricism, with nagging questions about efficacy and complications. Pharmacokinetics is used for studying the time dependency of administered drugs. Volume kinetics is a pharmacokinetic approach describing the peak effects and clearance of intravenously infused fluids. It clarifies the absorption, distribution, metabolism and excretion of an intravenous fluid bolus. This could possibly allow for more rational design of intravenous fluid paradigms to improve clinical fluid therapy. This chapter briefly summarizes currently accepted principles of fluid therapy, dis...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Christer H. Svensen, Peter M. Rodhe, Donald S. Prough Source Type: journals

Relevance of non-albumin colloids in intensive care medicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Current guidelines on initial haemodynamic stabilization in shock states suggest infusion of either natural or artificial colloids or crystalloids. However, as the volume of distribution is much larger for crystalloids than for colloids, resuscitation with crystalloids alone requires more fluid and results in more oedema, and may thus be inferior to combination therapy with colloids. This chapter describes the currently available synthetic colloid solutions [i.e. dextran, gelatin and hydroxyethyl starch (HES)] in detail, and critically discusses their specific effects including potential adverse effects. Literature was sel...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Christian Ertmer, Sebastian Rehberg, Hugo Van Aken, Martin Westphal Source Type: journals

Relevance of albumin in modern critical care medicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The relevance of albumin administration in the critical care setting remains controversial. We know that albumin has numerous important physiological effects and many potentially beneficial effects in critical illness. We also know that hypoalbuminaemia is common in critically ill patients and is associated with worse outcomes. And we know that routine administration of albumin for fluid resuscitation is not warranted. Albumin may be useful in some patients, especially those with hypoalbuminaemia at risk of complications or those with liver insufficiency. Further studies are needed to clarify what precise role albumin has ...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Jean-Louis Vincent Source Type: journals

Isotonic and hypertonic crystalloid solutions in the critically illEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Disorders of fluid and electrolyte balance in the critically ill are volume-related, compositional, or both. Targeting ‘normal’ values for plasma volume, osmolality and electrolytes might not be optimal in conditions as diverse as intracranial trauma/haemorrhage, hepatic encephalopathy, abdominal hypertension, or major surgery, because a hyperosmolar state seems to favourably affect tissue (brain and intestinal) oedema formation. However, adequately powered studies regarding the impact of hypertonic saline on outcome are lacking. Isotonic crystalloids are the cornerstone of resuscitation and must be balanced against na...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Michael Bauer, Andreas Kortgen, Christiane Hartog, Niels Riedemann, Konrad Reinhart Source Type: journals

Monitoring fluid therapyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hypovolaemia is a common cause of circulatory failure in the perioperative period. However, only 50% of critically ill patients respond to volume expansion with an adequate increase in cardiac output. Therefore, in daily clinical practice it is still a challenge to assess each subject's individual position on the Starling curve in order to optimize cardiac preload and avoid deleterious fluid overload. Recently, systolic pressure variation, stroke volume variation, and pulse pressure variation have been introduced as dynamic variables of fluid responsiveness which reflect ventilation-induced cyclic changes in left ventricul...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Jochen Renner, Jens Scholz, Berthold Bein Source Type: journals

The ‘third space’ – fact or fiction?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
For decades, the ‘third space’ was looked upon as an actively consuming compartment. Therefore, perioperative fluid regimens were traditionally based on a generous replacement of this assumed primary loss, in addition to deficits due to insensible perspiration and fasting. The practical consequence was an extremely positive fluid balance in order to maintain blood volume during major surgery. Whereas the insensible perspiration and the preoperative deficits are in fact often negligible, and the third space appears to be only a fictional construct, the excess fluid most likely accumulates interstitially. Such shifting i...
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Matthias Jacob, Daniel Chappell, Markus Rehm Source Type: journals

Infusion therapy in anaesthesia and intensive care: Let's stop talking about ‘wet’ and ‘dry’!Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Topics related to fluid management are among the most controversially and intensively discussed ones in both research and daily clinical practice. In this issue of Best Practice & Research Clinical Anaesthesiology entitled ‘VOLUME REPLACEMENT IN ANAESTHESIA AND INTENSIVE CARE’, hot topics in this field are thoroughly outlined by internationally recognised experts in this field. (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Authors: Martin Westphal, Jens Scholz, Hugo Van Aken, Berthold Bein Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - June 1, 2009 Category: Anesthesiology Source Type: journals

Keyword indexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Source Type: journals

Machine learning techniques to examine large patient databasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Computerization in healthcare in general, and in the operating room (OR) and intensive care unit (ICU) in particular, is on the rise. This leads to large patient databases, with specific properties. Machine learning techniques are able to examine and to extract knowledge from large databases in an automatic way. Although the number of potential applications for these techniques in medicine is large, few medical doctors are familiar with their methodology, advantages and pitfalls. A general overview of machine learning techniques, with a more detailed discussion of some of these algorithms, is presented in this review. (Sou...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Geert Meyfroidt, Fabian Güiza, Jan Ramon, Maurice Bruynooghe Source Type: journals

Tele ICU: paradox or panacea?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Telemedicine has been studied in the intensive care unit for several decades, but many questions remain unanswered regarding the costs and the benefits of its application. Telemedicine ICU (Tele-ICU) is an electronic means to link physical ICUs to another location which assists in medical decision making. Given the shortage of intensive care physicians in the US, Tele-ICU systems could be an efficient mechanism for physicians to manage a larger number of critical care patients. This chapter will examine the current state of telemedicine in an age of rapidly expanding medical information technology and increasing demand for...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Adam Sapirstein, Nazir Lone, Asad Latif, James Fackler, Peter J. Pronovost Source Type: journals

Closed-loop control for intensive care unit sedationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The potential clinical applications of active control for pharmacology in general, and anesthesia and critical care unit medicine in particular, are clearly apparent. Specifically, monitoring and controlling the depth of anesthesia in surgery and the intensive care unit is of particular importance. Nonnegative and compartmental models provide a broad framework for biological and physiological systems, including clinical pharmacology, and are well suited for developing models for closed-loop control for drug administration. These models are derived from mass and energy balance considerations that involve dynamic states whos...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Wassim M. Haddad, James M. Bailey Source Type: journals

Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
New modes of mechanical ventilation with advanced closed loops are now available, and in the future these could assume a greater role in supporting critically ill patients in intensive care units (ICUs) for several reasons. Two modes of ventilation – proportional assist ventilation and neurally adjusted ventilatory assist – deliver assisted ventilation proportional to the patient's effort, improving patient–ventilator synchrony. Also, a few systems that automate the medical reasoning with advanced closed-loops, such as SmartCare and adaptive support ventilation, have the potential to improve knowledge transfer by con...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: François Lellouche, Laurent Brochard Source Type: journals

Towards closed-loop glycaemic controlEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Blood glucose control performed by intensive care unit (ICU) nurses is becoming standard practice for critically ill patients. New algorithms, ranging from basic protocols to elementary computerized protocols to advanced computerized protocols, have been presented during the last years aiming to reduce the workload of the medical team. This paper gives an overview of the different types of algorithms and their features. Performance comparisons between different algorithms are avoided as blood glucose sampling frequencies and protocol durations were not similar among different studies and even within studies. Particularly a...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Tom Van Herpe, Bart De Moor, Greet Van den Berghe Source Type: journals

Computer protocols: how to implementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Variation in clinical practice impedes control, is associated with unwanted and widespread error, and may preclude replicability. Methodologic replicability enhances our ability to detect signals of interest by both increasing the signal through consistent application of the intervention, and by reducing the obscuring effects of noise. Decision-support tools are intended to standardize some aspect of clinical care and thereby help lead to uniform implementation of clinical interventions. This is realized by explicit replicable computer protocols that can produce appropriate patient-specific decisions and introduce control ...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: A.H. Morris, E. Hirshberg, K.A. Sward Source Type: journals

Smart alarms from medical devices in the OR and ICUEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Alarms in medical devices are a matter of concern in critical and perioperative care. The high rate of false alarms is not only a nuisance for patients and caregivers, but can also compromise patient safety and effectiveness of care. The development of alarm systems has lagged behind the technological advances of medical devices over the last 20 years. From a clinical perspective, major improvements in alarm algorithms are urgently needed. This review gives an overview of the current clinical situation and the underlying problems, and discusses different methods from statistics and computational science and their potential...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Michael Imhoff, Silvia Kuhls, Ursula Gather, Roland Fried Source Type: journals

Computerized physician order entry in critical careEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Computerized physician order entry means prescribing of medication and ordering laboratory tests or radiology examinations in an electronic way instead of using paper forms. In itself, it offers advantages such as legible orders, faster order completion, inventory management and automatic billing. If combined with clinical decision support, the real benefits of CPOE become apparent in the first place by prevention of medication errors and adverse drug events. On the contrary, if CPOE configuration is not done carefully, adverse drug events can be facilitated. Therefore, and for reasons of end-user acceptance, implementatio...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Kirsten Colpaert, Johan Decruyenaere Source Type: journals

Impact of computerized information systems on workload in operating room and intensive care unitEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. The scarce studies looking at workload variations associated with the implementation of a CIS, only focus on direct workload discarding indirect changes in workload. Descriptions of the various methods to quantify workload are provided.The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, ...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: R.J. Bosman Source Type: journals

How to implement information technology in the operating room and the intensive care unitEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. This chapter reviews the present literature. Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare in...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Geert Meyfroidt Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The tasks of a clinician in the operating room (OR) or the intensive care unit (ICU) have become increasingly complex: not only because medical knowledge grows exponentially every year, but also because the regulatory and administrative burden on clinicians is rising. The clinical information systems (CIS) that are currently on the market are capable of supporting the clinical and organisational management of our ICUs and ORs. Currently only a minority of them are computerized. This way, healthcare is decades behind other businesses such as industry, aviation or banking. Apart from the CIS, information technology (IT) is e...
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Authors: Geert Meyfroidt, Greet Van den Berghe Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - March 1, 2009 Category: Anesthesiology Source Type: journals

Thermoregulation in anesthesia and intensive care medicine. Preface.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PMID: 19137806 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Kurz A Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Physiology of thermoregulation.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Core body temperature is one of the most tightly regulated parameters of human physiology. At any given time, body temperature differs from the expected value by no more than a few tenths of a degree. However, slight daily variations are due to circadian rhythm, and, in women, monthly variations are due to their menstrual cycle. Importantly, both anesthesia and surgery dramatically alter this delicate control, and as a result intraoperative core temperatures 1 to 3 degrees C below normal are not uncommon. Consequently, perioperative hypothermia leads to a number of complications including postoperative shivering (which...
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Kurz A Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Perioperative complications of hypothermia.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Perioperative hypothermia is a common and serious complication of anesthesia and surgery and is associated with many adverse perioperative outcomes. It prolongs the duration of action of inhaled and intravenous anesthetics as well as the duration of action of neuromuscular drugs. Mild core hypothermia increases thermal discomfort, and is associated with delayed post anaesthetic recovery. Mild hypothermia significantly increases perioperative blood loss and augments allogeneic transfusion requirement. Only 1.9 degrees C core hypothermia triples the incidence of surgical wound infection following colon resection and incr...
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Reynolds L, Beckmann J, Kurz A Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Incidence of inadvertent perioperative hypothermia is still high, and thus thermoregulatory standards are warranted. This review summarizes current evidence of thermal management during anaesthesia, referring to recognized clinical queries (temperature measurement, definition of hypothermia, risk factors, warming methods, implementation strategies). Body temperature is a vital sign, and 37 degrees C is the mean core temperature of a healthy human. Systematic review shows that for non-invasive temperature monitoring the oral route is the most reliable; infrared ear temperature measurement is inaccurate. Intraoperatively...
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Torossian A Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Hyperthermia during anaesthesia and intensive care unit stay.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article is designed to give an overview on the various causes of hyperthermia with special emphasis on fever during general and regional anaesthesia in general and neurological critical care patients. PMID: 19137810 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Lenhardt R, Grady M, Kurz A Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Hypothermia during cardiac surgery.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This chapter describes the incidence, mechanisms and possible consequences of hypothermia during cardiac surgery, including protection against ischaemia, alteration of the coagulation cascade and the inflammatory response. Various temperature-specific topics related to cardiac surgery are discussed, including the use of hypothermia or normothermia during cardiopulmonary bypass, and the temperature reached during rewarming at the end of cardiopulmonary bypass and its deleterious consequences for the brain (postoperative neurocognitive dysfunction). Various locations for monitoring body temperature and their correlation ...
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Campos JM, Paniagua P Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Therapeutic hypothermia after cardiac arrest and myocardial infarction.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
About 17 million people worldwide die from cardiovascular diseases each year. Impaired neurologic function after sudden cardiac arrest is a major cause of death in these patients. Up to now, no specific post-arrest therapy was available to improve outcome. Recently, two randomized clinical trials of mild therapeutic hypothermia after successful resuscitation from cardiac arrest showed improvement of neurological outcome and reduced mortality. A broad implementation of this new therapy could save thousands of lives worldwide, as only 6 patients have to be treated to get one additional patient with favourable neurologica...
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Holzer M, Behringer W Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Thermoregulatory management for mild therapeutic hypothermia.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and dis...
Source: Best Practice and Research. Clinical Anaesthesiology - December 1, 2008 Category: Anesthesiology Authors: Kimberger O, Kurz A Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Infectious disease and perioperative infections. Preface.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PMID: 18831294 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology)
Source: Best Practice and Research. Clinical Anaesthesiology - September 1, 2008 Category: Anesthesiology Authors: Nemergut EC Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Central venous catheter-associated infections.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Most patients in the hospital need vascular access: a peripheral venous line, a short-term non-cuffed central venous catheter (CVC), a long-term cuffed CVC, an implantable port or an arterial line. Such devices, although often indispensable and of benefit, may have the disadvantage of mechanical complications, local exit-site infections or catheter-associated bloodstream infections (CRBSI). Apart from peripheral venous lines, non-cuffed CVCs are the most frequent catheter type in hospitals. The risk for CRBSI of such catheters is high with an incidence density of 2 to 7 episodes per 1000 catheter-days depending on ward...
Source: Best Practice and Research. Clinical Anaesthesiology - September 1, 2008 Category: Anesthesiology Authors: Zingg W, Cartier-Fässler V, Walder B Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Sternal wound infections.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Deep sternal wound infections (DSWI) continue to be a relatively uncommon event occurring in about 1%-2% of all patients undergoing cardiac surgery. However, the sheer number of cardiac surgery patients and the relatively high mortality associated with DSWIs makes them of clinical relevance. This review will describe the current incidence of DSWIs and their associated morbidity and mortality as well as risk factors for the development of this complication. The microbiology of DSWIs will be reviewed and strategies to prevent these complications will be discussed with a focus on interventions that may be undertaken by th...
Source: Best Practice and Research. Clinical Anaesthesiology - September 1, 2008 Category: Anesthesiology Authors: Mauermann WJ, Sampathkumar P, Thompson RL Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Ventilator-associated pneumonia: problems with diagnosis and therapy.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The diagnosis of ventilator-associated pneumonia, VAP, is problematic because of a lack of objective tools that are utilized to make an assessment of bacterial-induced lung injury in a heterogeneous group of hosts. Clinical symptoms and signs are used to identify patients that may have a "lung infection". However, the symptoms and signs can be produced by a myriad of other conditions. Recent clinical data also suggests bacterial-induced pathologic processes occur prior to the onset of the symptoms and signs. Utilizing bacterial culture alone, health care practitioners are forced to wait for days for results and will ha...
Source: Best Practice and Research. Clinical Anaesthesiology - September 1, 2008 Category: Anesthesiology Authors: Wiener-Kronish JP, Dorr HI Tags: Best Pract Res Clin Anaesthesiol Source Type: journals

Infectious complications of regional anesthesia.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although individual cases have been reported in the literature, serious infections of the central nervous system (CNS) such as arachnoiditis, meningitis, and abscess following spinal or epidural anesthesia are rare. However, recent epidemiologic series from Europe suggest that the frequency of infectious complications associated with neuraxial techniques may be increasing. Importantly, while meningitis and epidural abscess are both complications of neuraxial block, the risk factors and causative organisms are disparate. For example, staphylococcus is the organism most commonly associated epidural abscess; often these i...
Source: Best Practice and Research. Clinical Anaesthesiology - September 1, 2008 Category: Anesthesiology Authors: Horlocker TT, Wedel DJ Tags: Best Pract Res Clin Anaesthesiol Source Type: journals