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Eclampsia a rare complication: A reminder that magnesium sulphate saves livesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Posterior Reversible Encephalopathy Syndrome (PRES) in a patient of eclampsia with ‘partial’ HELLP-syndrome presenting with status-epilepticus The case highlights a rare but interesting condition; posterior reversible encephalopathy syndrome (PRES) a clinicoradiological syndrome associated with hypertensive disorders, which has only been recognised since 1996. There have been several other obstetric cases of PRES reported, all of which seem to have a similarly good neurological outcome. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Jackie Durbridge Tags: Letters to the Editor Source Type: journals

Acid–base disturbances: A need to reunify clinical and scientific medicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Disturbances of acid–base homeostasis are a well recognised and clinically significant element of acute illness and physiological derangements. Over many decades, there have been high profile changes in perspectives of the interpretation, clinical effects, diagnostic significance and management of such metabolic alterations. One of the side-effects of these challenges has been to place a shroud of confusion over many aspects of understanding in acid–base physiology, and this decade is no different from others in adding further to this state. More importantly perhaps, is that the more the academic arguments reign over t...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: J.M. Handy Tags: Letters to the Editor Source Type: journals

Therapeutic adjuncts in sepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This is a very interesting and timely discussion of some controversial and not so controversial aspects of treatment adjuncts in sepsis. Critical care medicine is in a mild confusional state at present with surviving sepsis recommendations falling from grace and seemingly robust studies being unrepeatable or contradicted by further studies. None of the adjunct treatments described is the magic bullet but might they be sufficient to gain an edge in the treatment of this devastating and costly disease? (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Rick Keays Tags: Letters to the Editor Source Type: journals

Sodium bicarbonate—the bicarbonate challenge test in metabolic acidosis: A practical considerationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article explores the combination of a bicarbonate challenge test with defined endpoints of haemodynamic resuscitation as a semi-quantitative method for differentiating between simultaneous reasons for severe metabolic acidosis. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Mark G.A. Palazzo Tags: Metabolic Source Type: journals

Adjunctive therapy of severe sepsis and septic shock in adultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Sepsis continues to be a major unresolved medical challenge of the present. Despite earlier diagnosis and treatment initiation, source control, improvements in the standard of care and attempts at standardization of treatment and resuscitation protocols intensive care unit mortality rates for severe sepsis is 32.2% and 54.1% for septic shock. Further reduction in mortality may be achievable through knowledge and use of the expanding field of adjunctive therapy: a supplement to optimal, supportive, intensive therapy and antibiotic treatment.Numerous and unsuccessful trials targeted at inhibiting various essential i...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: T.H. Andersen, T.H. Jensen, L.W. Andersen Tags: Sepsis Source Type: journals

Posterior reversible encephalopathy syndrome (PRES) in a patient of eclampsia with ‘partial’ HELLP syndrome presenting with status-epilepticusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the management of a 21y-female with peripartum eclampsia and ‘partial’ HELLP syndrome (haemolysis, elevated liver enzymes and low-platelets) presenting with status-epilepticus. She had neurological, cardiovascular, hepatic, renal and hematological involvement along with electrolyte abnormalities. Early diagnosis along with timely supportive therapy resulted in the successful management of this challenging case. Recent understanding on the pathophysiology of this uncommon condition is discussed. We highlight the importance to obstetricians, intensive-care physicians and anesthesiologists of recognizing such ca...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Harihar V. Hegde, Raghavendra P. Rao Tags: Obstetrics Source Type: journals

Glycopeptide resistant enterococci: What's the problem?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article had the aim to give an overview on problems associated to the spread of GRE and to provide some recommendation about the management of infected or colonized patients. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: G. Birgand Tags: Infectious Disease Source Type: journals

AMPA receptors: New targets for psychiatric disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: AMPA receptors are one of the major excitatory receptors within the CNS with many of their functional effects being mediated by alterations in their trafficking to the cell surface and targeting into the synapse. Integral to these functions, and consequently, AMPA receptor activity is a class of proteins termed transmembrane AMPA receptor regulatory proteins (TARPs) which also possess diverse effects on AMPA receptor pharmacology. Incredibly, despite the evident importance of TARPs in AMPA receptor function, very few studies even allude to the potential significance of their potential role within the glutamatergic...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: P.S. Donoghue Tags: Focus on: Glutamate Neuropharmacology Source Type: journals

The dopamine and glutamate theories of schizophrenia: A short reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Schizophrenia is a psychiatric disorder involving the impairment of normal thinking, emotion, and everyday behaviours. Characteristics of schizophrenia can be divided into positive, negative and cognitive symptoms. Contributory factors of the disorder include genetics, early environmental factors and neuropsychological factors. Many years of research has investigated the dopamine hypothesis and glutamate hypothesis of schizophrenia, but more recently the field is scrutinizing the combined interactions of the glutamatergic and dopaminergic systems. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: A. Bradford Tags: Focus on: Glutamate Neuropharmacology Source Type: journals

The current understanding of motor neuron diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Motor Neuron Disease is a term defining a group of neurodegenerative diseases, in which motor neurons degenerate, leading to muscle wasting, paralysis and ultimately death. Here I review the current understanding of Amyotrophic Lateral Sclerosis (ALS), the most common form of MND, looking particularly at the causative factors, and the available treatments for the disease. Familial ALS can be caused by a mutation in SOD1; research into the effects of this mutation has given an insight into the mechanisms by which MND progresses. Mutant SOD1 causes the initiation and progression of MND via protein aggregation, disr...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Emma Burvill Tags: Focus on: Glutamate Neuropharmacology Source Type: journals

The role of AMPA receptor-mediated excitotoxicity in ALS: Is deficient RNA editing to blame?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by selective degeneration of upper and lower motor neurons. To date, glutamate modulator riluzole is the only drug that has proved effective against disease progression. Based on this evidence, it has been proposed that glutamate excitotoxicity contributes to the neurodegeneration observed in ALS, with α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs) emerging as a likely candidate for glutamate receptor-mediated excitotoxicity. The calcium (Ca2+) conductance of AMPARs is determined by the presence of the ed...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Kathryn Duncan Tags: Focus on: Glutamate Neuropharmacology Source Type: journals

Focus on Glutamate NeuropharmacologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The neuropharmacology focus in this double issue includes a number of reviews with a common thread, namely the glutamatergic system, including aspects of glutamate receptor regulation, molecular RNA editing and excitotoxicity, with therapeutic implications in Motor neuron disease, schizophrenia and clinical depression, a highly debilitating spectrum of diseases and disorders which affect, in the main, relatively young adults. Exciting new insights through basic research have provided new therapeutic targets and rationale strategies which are reviewed in this focus. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Paul L. Chazot Tags: Focus on: Glutamate Neuropharmacology Source Type: journals

Case ScenarioEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Neuropathic pain and drug safety MCQs and self-assessmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Pain management: from basics to clinical practiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Pain is fundamentally important to the human condition. It is the most common symptom experienced by patients in critical care and all those in the health care service should have a basic understanding of the mechanisms underlying pain and how best to treat patients in the clinical setting. Based on this basic understanding, it is thus essential to identify and understand the rational for pain relief and the strategies available. This excellent and timely publication brings together a collection of academics, clinical directors, consultants, specialist registrars and even a final year medical student, each contributing a c...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Paul L. Chazot Tags: Focus on: Neuropathic Pain and Appraising Drug Safety Source Type: journals

Appraising the post-marketing safety of medicines: A description of national and international pharmacovigilance with a focus on medicines used in chronic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We describe the role of pharmacovigilance in detecting and evaluating emerging evidence of adverse drug reactions, i.e. “signals” using the New Zealand Pharmacovigilance Centre as an example. The benefits to individual patient safety through a medical warning system are of particular relevance to anaesthetic practice. Effective and holistic pharmacovigilance relies on voluntary reporting systems for all therapeutic products, prescription or cohort event monitoring of selected medicines and vaccines, and specific monitoring of medication error. Ongoing development of computational methods for data-mining in the voluntar...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Ruth L. Savage, Desiree L. Kunac, Jeanette Johansson Tags: Focus on: Neuropathic Pain and Appraising Drug Safety Source Type: journals

Complex regional pain syndrome – Mechanisms, diagnosis, and managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article explores an interdisciplinary setting with comprehensive approach (pharmacological, interventional, and psychological in conjunction with rehabilitation pathway) as the protocol for the practical management of CRPS. Insight in predisposing factors may facilitate early diagnosis and elucidate underlying mechanisms that could provide targets for pharmacotherapy. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Edward A. Shipton Tags: Focus on: Neuropathic Pain and Appraising Drug Safety Source Type: journals

Voltage-gated sodium channels in nociception and their potential as targets for new drugs in treatment of chronic neuropathic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Voltage-gated sodium channels are important in the pathophysiology of chronic neuropathic pain and as targets for analgesic drugs. This review will cover the molecular structure and signalling roles for this ion channel super-family with a focus on the channels thought to be involved in nociception. We highlight the mode of action of current analgesic drugs and the difficulty of treating chronic inflammatory or neuropathic pain states. The discovery of key channel classes, or familial mutations, associated with chronic pain syndromes has resulted in intensive drug discovery programmes. The quest for selective drug...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: George Lees, Edward Shipton Tags: Focus on: Neuropathic Pain and Appraising Drug Safety Source Type: journals

Novel targets in pain research: The case for CB2 receptors as a biorational pain targetEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: The prevalence of neuropathic pain is rising, and is expected to further increase in aging populations. However, drug treatment for neuropathic pain remains inadequate, with the best available treatments having limited efficacy and dose-limiting side effects. Cannabinoids have been shown in clinical trials to be moderately effective at reducing neuropathic pain, but doses of cannabinoids currently in use are severely curtailed by psychoactive side effects through actions on the cannabinoid CB1 receptor. A relatively new class of drugs, selective cannabinoid CB2 receptor agonists, have shown considerable efficacy ...
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: Philip W. Brownjohn, John C. Ashton Tags: Focus on: Neuropathic Pain and Appraising Drug Safety Source Type: journals

Chronic issues: Intractable pain and appraising drug safety post-launchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This issue of current anaesthesia and critical care covers two long standing problems in pharmacology: (i) how important it is to appraise drug safety objectively beyond clinical trials (using a combination of spontaneous and longitudinal reporting) and (ii) how difficult it is to treat patients in the chronic pain clinic effectively with currently available drugs. All of the contributing authors are experts in these fields in New Zealand. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Authors: George Lees Tags: Focus on: Neuropathic Pain and Appraising Drug Safety Source Type: journals

Editorial Board & Aims and ScopeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - September 9, 2009 Category: Anesthesiology Source Type: journals

A review of postoperative pain management and the challengesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Inadequate postoperative pain management is an international problem and the need to improve its management is well documented. This review outlines some of the commonly used treatments such as multimodal analgesia, patient controlled analgesia, epidurals, perineural infusions and adjuvant drugs. Barriers to improvement including inaccurate pain assessment, communication issues, knowledge deficits, difficulties integrating evidence into practice and the challenges in the modern healthcare environment will be discussed. Following this, some options for the way forward will be outlined. A continued focus on improvin...
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: Allison Taylor, Linda Stanbury Tags: Acute Pain Source Type: journals

Peripheral mechanism of muscle pain: An updateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: There are many conditions accompanied by muscle pain/hyperalgesia. Despite the large number of people who are suffering from musculoskeletal pain, understanding of its mechanism is quite limited. Many muscle pain conditions are considered to be somehow related to muscle exertion, in the presence or absence of muscle ischemia, therefore, this review introduces recent results obtained from delayed onset muscle soreness model by lengthening contraction (eccentric contraction), together with recent advances in muscle pain research with a focus on topics such as temporomandibular joint disorders and glutamate, nerve gr...
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: Kazue Mizumura Tags: Muscle Physiology Source Type: journals

Infection in the intensive care unit (ICU)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Healthcare-associated infections (HAIs) are a hugely topical issue, attracting unprecedented public and political interest.With regards to the ICU, both the ward environment and susceptible population make the patients particularly vulnerable to a range of infections. The causative organisms are often different to those causing disease in the community, or even for the rest of the hospital. Therefore management of the infected ICU patient is complicated and requires careful consideration. In addition, the emergence of multi-drug resistant organisms further complicates treating such patients as they tend to be more...
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: Rishi Dhillon, John Clark Tags: Infections Source Type: journals

Continuing professional development: Cardiothoracic surgery MCQs and self-assessment answersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
a, c, e (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Continuing professional development: Cardiothoracic surgery MCQs and self-assessmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Complications of angioplasty include (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Echocardiography in cardiac anaesthesia and intensive careEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Echocardiography or cardiac ultrasound has long been established as an important cardiac imaging technique for acquiring real-time information about cardiac anatomy and function. The technological aspect of this cardiac ultrasound platform continues to evolve, recent developments such as real-time 3D scanning are currently being assimilated into clinical practice first in transthoracic scanning and now in transoesophageal scanning. Echocardiography use is migrating across patient populations and different specialities – there is currently much discussion on how best to adopt the technique for the general intensi...
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: S.N. Fletcher Tags: Focus On: Cardiothoracic Surgery Source Type: journals

Anaesthesia for endobronchial intervention and tracheobronchial stentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: There is an increasing use of large airway stents for non-malignant disease processes. As advances in stent development and manufacture are made, there are more patients being treated with airway stents. Stenting can be short term or long term and can be used for the management of large airway obstruction where surgery carries both morbidity and mortality.Pre-operative assessment is particularly important and may determine which of the wide range of techniques that have been used is most appropriate for the individual case.The anaesthetic management of patients with stents already in situ is becoming more importan...
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: C. Jones, A.J. Crerar-Gilbert, B.P. Madden Tags: Focus On: Cardiothoracic Surgery Source Type: journals

Percutaneous valve replacement and repair in the adult: Techniques and anaesthetic considerationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Standard treatment for valvular heart diseases such as aortic stenosis and mitral regurgitation includes replacement or repair of the valve. This will require median sternotomy and cardiopulmonary by-pass. In elderly patients with co-morbidity the risks from surgery increase and some patients may be classified as too high risk for surgery.Developments in percutaneous catheter delivered systems make it feasible that non-invasive valve repair and replacement can be performed. Those patients unsuitable for surgical treatment can be offered these procedures. We review the procedures available and the outcome data. We ...
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: Alex Dewhurst, Tom Rawlings Tags: Focus On: Cardiothoracic Surgery Source Type: journals

Anaesthesia and coronary artery stentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article will explain the differences between types of coronary artery stent, their different issues, and discuss the current evidence for the perioperative management of these patients. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: C. Jones, B. Liban Tags: Focus On: Cardiothoracic Surgery Source Type: journals

EditorialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This issue of the journal is devoted to cardiothoracic topics. The contributors all come from a single unit – the Cardiothoracic Unit of St George's Hospital in London. The face of cardiology, cardiothoracic surgery and anaesthesia is changing relatively quickly, reflecting the fast advances and innovations in these fields. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Authors: J. Bernard Liban Tags: Focus On: Cardiothoracic Surgery Source Type: journals

Editorial Board & Aims and ScopeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - June 14, 2009 Category: Anesthesiology Source Type: journals

The brain is the target organ in cardiorespiratory reanimationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Steinmetz has published a very good review updating current information on cardiac arrest, related to actual recommendations and guidelines on this subject. We will focus our commentaries about the effects of hypoxia and ischemia on the brain after cardiac arrest. The human brain uses approximately 20% of the cardiac in a way that cerebral blood flow (CBF) is tightly regulated to meet the brain's metabolic demands. The CBF dropping to less than 20mL/100gm/min produces ischemic neuronal activity reduction, but still reversible neuronal changes. CBF values less than 10mL/100gm/min result in irreversible ischemic neuronal da...
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Calixto Machado, Jesus Perez, Claudio Scherle, Alejandro Areu, Alejandro Vazquez Tags: Letter to the Editor Source Type: journals

Neuroprotective function in brain microgliaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Microglia are uniformly distributed throughout the central nervous system. The number of microglia is thought to make up 5–20% of the entire glial cell population. Origin of microglia has been discussed for several decades. Recently, microglia are widely considered to originate from mesodermal monocyte/macrophage cell lineage, because of similarities in cell surface molecular phenotype. In normal adult brain, microglia have finely branched and ramified cell processes that extend in all directions, and survey the brain microenvironment. When the brain is injured by trauma, stroke and other neurodegenerative disor...
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Yoshihisa Kitamura, Daijiro Yanagisawa, Kazuyuki Takata, Takashi Taniguchi Tags: Basic Science Source Type: journals

Continuing Professional Development: Emergency care MCQs and self-assessment answersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Question 1. True: a, c, e (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Continuing professional development: Emergency care MCQs and self-assessment questionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hypoxaemia occurs much more rapidly if airway obstruction appears in (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Clinical management of patients with head injuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Traumatic brain injury (TBI) is one of the major causes of disability, death and health related cost to our society. An organized trauma system from the site of accident to the Intensive Care Unit is the cornerstone of treatment of TBI patients. Treatment in the emergency room must focus on swift normalization of blood pressure and oxygenation. During tracheal intubation cervical spine protection and the risk of aspiration, must be balanced against the risk of hypotension and hypercapnia. Both hyper- and hypoventilation can be deleterious in TBI patients, and consequently, they should be normoventilated as guided ...
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Niels Juul, Birgitte Duch, Mads Rasmussen Tags: Focus On: Emergency Care Source Type: journals

Circulatory failure in severe sepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Severe sepsis is a leading cause of death and characterised by infection-induced endothelial and cardiac dysfunction leading to hypovolaemia, maldistribution of flow, tissue ischaemia and organ failure. A clinical approach with focus on cardiovascular diagnostics and rational goal-directed therapy is likely to reduce the high mortality. The treatment involves focus control, broad-spectrum antibiotics, target-oriented fluid therapy and vasopressor and inotropic agents guided by frequent reassessments of the patients' response to intervention. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Nicolai Haase, Jonathan White, Anders Perner Tags: Focus On: Emergency Care Source Type: journals

Intravenous access in the emergency patientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article outlines different techniques for gaining peripheral, central and intraosseus access. We go through some of the vast amount of evidence supporting the use of real-time ultrasonography and describe its use and common pitfalls. Ultrasound equipment is readily available in almost every hospital but is often not used. Our hope is that this article can give physicians and nurses some means to increase their success rates and decrease the amount of time they spend on gaining intravenous access. Hopefully patient satisfaction will increase at the same time. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Ulrik Grevstad, Peter Gregersen, Lars S. Rasmussen Tags: Focus On: Emergency Care Source Type: journals

Cardiac arrest – Midway between two guidelines: From an anaesthesiologist's point of viewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Cardiac arrest is singly one of the most important conditions to recognize and treat well. In order to ensure the optimal treatment and uniform implementation worldwide, guidelines are published every fifth year. A considerable amount of research is done, and although there have been advances, there is always room for improvement. Prospective studies of cardiac arrest in humans are extremely difficult to conduct, especially randomised studies, and the number of patients involved in the studies is sparse. This paper provides updated available information on cardiac arrest, as well as a discussion of recommendations...
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Jacob Steinmetz Tags: Focus On: Emergency Care Source Type: journals

The clinical management of airway obstructionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides an overview of the anatomy, physiology and causes of airway obstruction. Algorithms used in its management are described, and the possibilities for future training for this rare event will be considered. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: E.M. Flavell, M.R. Stacey, J.E. Hall Tags: Focus On: Emergency Care Source Type: journals

Emergency careEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The management of emergency patients is a major challenge. Time is the limiting factor and any delay in treatment must be carefully balanced against the risk of further deterioration in patient condition. The patient history is commonly incomplete and previous medical records may not be available. Anaesthesiologists are key players in the team taking care of emergency patients because we have the skills to assess and support vital functions no matter if the patient is undergoing surgery or not. The initial evaluation of any emergency patient is based on the traditional algorithm looking at airway, breathing, and circulatio...
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Authors: Lars S. Rasmussen Tags: Focus On: Emergency Care Source Type: journals

Editorial Board & Aims and ScopeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - May 10, 2009 Category: Anesthesiology Source Type: journals

Bioequivalence and non-inferiority trialsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: The aim of this article is to describe the rationale and principles of bioequivalence and non-inferiority analysis and describe some recent applications in extending equivalence techniques to simple physiological measures in anaesthetic research. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Authors: Malachy O. Columb, Jan M. Lutz Tags: Statistics Source Type: journals

Transfusion related lung injury. TRALIEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Transfusion related lung injury is almost certainly related to the administration of blood products containing antibodies in the plasma. Those antibodies may have developed during pregnancy or following blood transfusion. They react with specific ‘cognate’ antigens in the recipient and in some patients, but not all, this results in an acute lung injury pattern. The problem resides in the plasma, so the incidence with FFP is far higher than with red cells.Blood transfusion services have adopted several ways of reducing risk such as using untransfused male donors. Leucodepletion may also have a benefit.Diagnosis...
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Authors: Neil Soni Tags: Haematology Source Type: journals

The Mental Capacity Act and the elderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: The Mental Capacity Act 2005 has considerable implications for critical care practitioners and particularly in relation to treatment of elderly patients. The full Act came into force on 1st October 2007. The Act sets down decision specific criteria for the assessment of capacity, and “best interests” principles to enhance decision making for patients without capacity. Patients undergoing serious treatment must have an Independent Mental Capacity Advocate appointed if there is no one appropriate to consult in determining the patient's interests. A person may be appointed as personal attorney under a Lasting Pow...
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Authors: Barry Speker OBE, Paula Scully Tags: Medico-Legal Issues Source Type: journals

Continuing professional development: Regional anaesthesia MCQs and self-assessment answersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Spinal anaesthesia; the following increase the likelihood of spread. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Continuing professional development: Regional anaesthesia MCQs and self-assessment questionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Spinal anaesthesia; the following increase the likelihood of spread. (Source: Current Anaesthesia and Critical Care)
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Tags: Continuing Professional Development Source Type: journals

Stimulating nerve catheters in regional anaesthesiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: The practice of regional anaesthesia has evolved from mechanically stimulating a nerve with a needle and thereby eliciting paraesthesia to the fine art of using state-of-the art electrolocation using peripheral nerve stimulators and insulated needles. The stimulating nerve catheter is a very useful addition to the armamentarium of the regional anaesthesia practitioner. The stimulating nerve catheter makes it possible to verify the perineural location before delivering targeted continuous infusion of local anaesthetic for extended pain relief. The increasing use of ultrasound in echolocation of neural structures ha...
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Authors: Leo M. Jeyaraj, Ahmed A. Aziz, Andrew Babu Tags: Focus On: Regional Anaesthesia Source Type: journals

Ultrasound-guided regional anaesthesia and paediatric surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Summary: Regional anaesthesia is an important part of paediatric anaesthesia and plays a key role in peri-operative multimodal analgesic regimens. In recent years, the popularity of ultrasound-guided nerve blocks has significantly increased out of the recognition of its higher efficacy and safety. Its importance is further enhanced in paediatrics and especially in neonates as there are restrictions in the volume and maximum dosage of local anaesthetic that can be used. Ultrasound has allowed the usage of significantly smaller doses and concentrations by direct deposition of the drug around the nerve. It also allows the dyn...
Source: Current Anaesthesia and Critical Care - April 1, 2009 Category: Anesthesiology Authors: Ahmed Rashad Aziz, Nahla Farid, Amr Abdelaal Tags: Focus On: Regional Anaesthesia Source Type: journals