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Publisher: Elsevier   (Total: 3175 journals)

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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 87, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 388, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 243, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 15, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 386, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 336, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 10, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 440, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 195, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 170, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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Journal Cover Anaesthesia & Intensive Care Medicine
  [SJR: 0.124]   [H-I: 9]   [62 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 1472-0299
   Published by Elsevier Homepage  [3175 journals]
  • Intensive care unit acquired weakness
    • Authors: Christopher Taylor
      Pages: 79 - 82
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Christopher Taylor
      Intensive care unit acquired weakness (ICUAW) is an acute clinical weakness that occurs in approximately 50% of ICU patients and is directly attributable to their critical care stay where other causes of weakness have been excluded. The condition is characterized by diffuse limb and respiratory muscle weakness with a relative sparing of the cranial/facial muscles and the autonomic nervous system. Patients with ICUAW are classified into three conditions: critical illness polyneuropathy (CIP), critical illness myopathy (CIM) or critical illness neuromyopathy (CINM) based on clinical criteria and further defined by electrophysiological studies and muscle biopsies. ICUAW is often a manifestation of immobility or a systemic inflammatory response syndrome especially in long-term ventilated patients who have had systemic sepsis/multiorgan failure or exposure to high-dose corticosteroids, neuromuscular blockers or hyperglycaemia. It is associated with prolonged weaning from mechanical ventilation, increased mortality/length of ICU stay and long term disability.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.009
       
  • Update on the management of status epilepticus
    • Authors: Marco Paris; Ugan Reddy
      Pages: 83 - 86
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Marco Paris, Ugan Reddy
      Status epilepticus (SE) it is widely recognized as the second most common and life-threatening neurological emergency after stroke, which carries a high mortality and morbidity. The main goal of treatment is to emergently stop clinical and electrographic seizure activity. Most authorities agree on three-line treatment for SE with administration of benzodiazepines followed by longer-acting anti-epileptic agents and finally, if seizures persist, the administration of general anaesthetic agents.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.008
       
  • Commonly encountered central nervous system infections in the
           neurointensive care unit
    • Authors: Rachel Herbert; Carmel Curtis
      Pages: 87 - 92
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Rachel Herbert, Carmel Curtis
      The central nervous system (CNS) may be infected by a number of organisms including bacteria, viruses, fungi, and protozoa. Non-infectious causes such as autoimmune and vascular conditions may present with similar clinical syndromes necessitating the appropriate laboratory requests and good diagnostics. CNS infections are associated with significant morbidity and mortality, often requiring surgical intervention and admission to neurointensive care units. Common infection diagnoses seen in the neurointensive care unit include meningitis, ventriculitis, encephalitis and abscesses, including brain and spine. New and emerging pathogens in ITU settings include Candida auris and multi-resistant Gram negative bacteria, which are easily transmissible and may threaten the antimicrobial choices available for patients.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.002
       
  • Gastrointestinal problems in intensive care
    • Authors: Mark Kubicki; Stephen J Warrillow
      Pages: 93 - 97
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Mark Kubicki, Stephen J Warrillow
      Gastrointestinal issues are common in ICU and include both surgical and non-surgical problems. A high index of suspicion and regular clinical assessment are necessary due to inherent difficulties evaluating critically ill and ventilated patients. Gastrointestinal failure may complicate or even precipitate multi-organ failure with systemic inflammatory response due to bacterial translocation. Intra-abdominal hypertension can be under-recognized and causes renal failure and other complications. Although colonic pseudo-obstruction is often conservatively managed, early recognition and treatment can prevent perforation. Stress-related mucosal bleeding is common in ICU, but serious gastrointestinal haemorrhage is rare. Early enteral nutrition and H2-receptor antagonists reduce the incidence of upper gastrointestinal bleeding in high-risk ICU patients. Although delayed bowel motions are the norm, lack of defecation may also occur. This does not necessarily equate to constipation and should only be treated if problems occur.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.011
       
  • Nutritional support in the critically ill
    • Authors: Robert I. Docking
      Pages: 98 - 100
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Robert I. Docking
      Nutritional support is a vital intervention in the critically ill that can adversely affect survival and morbidity. Many patients presenting to critical care have a degree of nutritional deficiency either due to chronic ill health or their presenting complaint and these have to be addressed. Critical illness itself affects the nutritional needs of patients, progressing from profound catabolism to a degree of anabolism and support must reflect these changes. Challenges exist in both the calculation of requirements and the provision of appropriate support, and the use of the multidisciplinary team is essential to provide high quality support. Calculations of nutritional requirements are complicated both by the nature of critical illness and the limited access to sources of information. Nutritional support itself can cause morbidity, either via unrecognized refeeding syndromes, or by complications of the chosen route of support and an appreciation of the evidence base is essential to make the right choice for patients.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.003
       
  • Decompensated liver cirrhosis
    • Authors: Jonathan Pearson; Euan Thomson
      Pages: 101 - 106
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Jonathan Pearson, Euan Thomson
      The incidence of liver disease continues to increase and is now one of the leading causes of death in the United Kingdom. The increasing prevalence of viral hepatitis combined with a surge in the incidence of both alcohol and obesity related liver disease mean that critical care units are increasingly being called upon to assist in managing those with life-threatening complications or end-stage liver disease. Decompensated cirrhosis is not a single organ illness but a complex multi-system disorder typified by impaired immunity, malnutrition and multi-organ failure and presents a significant challenge to the critical care physician. In this article we describe the epidemiology, aetiology and pathophysiology of decompensated liver disease and describe the management strategies of a range of resulting clinical complications.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.010
       
  • Acute liver failure
    • Authors: Wisam Al-Bassam; Stephen J. Warrillow
      Pages: 107 - 112
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Wisam Al-Bassam, Stephen J. Warrillow
      Acute liver failure (ALF) is a life-threatening condition with many possible causes. In developed countries, common causes include paracetamol overdose, toxin exposure (e.g. mushrooms) and idiosyncratic drug reactions. Viral hepatitis is much more common in developing countries, although must be considered in any location. The clinical syndrome of ALF is remarkably independent of the cause and comprises the following key features: jaundice, encephalopathy with cerebral oedema, coagulopathy, vasodilatory state, renal dysfunction, hypoglycaemia and immune dysfunction. Management of the patient with severe ALF is threefold in aim: (i) prevent further liver damage by treating the underlying cause of ALF where possible; (ii) prevent and treat complications of ALF (e.g. cerebral oedema, shock and infection); and (iii) early referral to specialist centre for consideration of liver transplantation. Despite modern intensive care practices, the mortality of severe ALF remains high. Optimal supportive care aims to extend the period available to source an organ for transplantation and/or to allow full recovery. This article provides a practical approach to the diagnosis and management of critically ill patients with ALF.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.012
       
  • Acute kidney injury and the critically ill
    • Authors: Laura Flood; Alistair Nichol
      Pages: 113 - 118
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Laura Flood, Alistair Nichol
      Acute renal failure is commonly encountered in the intensive care unit. It is associated with considerable morbidity and mortality. There are many possible aetiologies in the critically ill, including nephrotoxic agents, hypovolaemia and sepsis. While many classification systems for acute renal failure exist, the RIFLE (Risk, Injury, Failure, Loss, End-stage) criteria and the Acute Kidney Injury Network (AKIN) criteria are the most commonly utilized. Many supportive therapies are employed to minimize the degree of renal injury once recognized, such as fluid resuscitation and maintenance of an adequate mean arterial pressure (with the use of inotropes in persistent hypotension despite fluid and treatment of the underlying aetiology). However, if renal failure becomes established, then renal replacement therapy (RRT) may be needed to maintain homoeostasis. While there are no clear guidelines with respect to the ideal mode or timing of RRT, we will discuss pros and cons of the various bedside options.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.006
       
  • Acute pancreatitis: an intensive care perspective
    • Authors: Laura Flood; Alistair Nichol
      Pages: 119 - 124
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Laura Flood, Alistair Nichol
      Acute pancreatitis (AP) is a sudden inflammation of the pancreas, which is often mild and resolves spontaneously. However, if severe it can cause significant morbidity and mortality and commonly requires management in the intensive care unit. The diagnosis of AP involves a combination of clinical symptoms, elevations in pancreatic enzymes and/or characteristic findings on computer tomography. In 2012, the Atlanta Symposium revised the classification of pancreatitis into mild, moderate and severe. The key to appropriate management is identifying patients with severe AP, and initiating intensive care supports at an early stage. Scoring systems such as the Ranson/Imrie score, and the Acute Physiology and Chronic Health Evaluation II score are used to help determine severity. The general management involves physiological support, with fluid resuscitation, enteral feeding and support of the vital organs. The use of prophylactic antibiotics is currently not supported. Pancreatic collections should be drained by interventional radiology and sent for culture and antimicrobial sensitivity assessment. This review article outlines the assessment and management principles of severe pancreatitis in the intensive care setting.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.007
       
  • Digestion and absorption
    • Authors: Niall G. MacFarlane
      Pages: 125 - 127
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Niall G. MacFarlane
      Carbohydrates are digested by salivary and pancreatic amylases to di-, tri- and oligosaccharides, and then to monosaccharides by enzymes on the wall of the small intestine to allow them to be absorbed. Proteins are absorbed as amino acids and small peptides that are broken down to amino acids within the cells. Monosaccharides and amino acids pass into the liver via the portal vein. Fats are digested and absorbed as free fatty acids and glycerides that are then mostly reconstituted as triglycerides in the mucosal cells of the small intestine. They combine with phospholipids and a protein to form chylomicrons, which pass via the lymphatics and the thoracic duct into the systemic circulation. Fatty acids are re-esterified and stored as triglycerides in adipose tissue or oxidized for energy. Water is passively absorbed due to the osmotic gradient that results mainly due to the active absorption of sodium ions.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.001
       
  • The mouth, stomach and intestines
    • Authors: Stuart W. McDonald; Niall G. MacFarlane
      Pages: 128 - 132
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Stuart W. McDonald, Niall G. MacFarlane
      Food is chewed into digestible portions in the mouth and swallowed – a complex reflex process involving several cranial nerves. The stomach homogenizes food, begins digestion and regulates the rate at which food enters the duodenum. Pancreatic juices containing powerful digesting enzymes are added and digestion is completed in the small intestine. The large bowel dehydrates the gastrointestinal contents.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.003
       
  • Gut motility and its control
    • Authors: Niall G. MacFarlane
      Pages: 133 - 135
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Niall G. MacFarlane
      The gastrointestinal tract is composed of smooth muscle arranged in two layers: longitudinal and circular. Although its activity is influenced by the autonomic nervous system, it is mainly under local reflex control mediated by an enteric nervous system and local hormones. The motility of the gastrointestinal tract has several different well-defined patterns. Its function is to move the gastrointestinal contents through the various phases of homogenization (mixing), digestion, absorption and elimination.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.002
       
  • Statistics in medicine
    • Authors: Ian Kestin
      Pages: 136 - 143
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Ian Kestin
      This article covers the basic principles of statistics in medicine. Topics covered include types of data, descriptive statistics (mean, median, mode, percentiles), the normal distribution, confidence intervals and the standard error of the mean, hypothesis testing and the choice of statistical tests, type I and II errors, contingency tables, correlation and regression, and meta-analysis.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.005
       
  • Statistics in clinical trials and audit
    • Authors: Ian Kestin
      Pages: 144 - 148
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Ian Kestin
      This article covers the application of statistics to clinical trials and audit, including the basic types of study design, bias, power analysis, guides to good clinical practice, the presentation of results and applications in quality assurance.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.12.004
       
  • Self-assessment
    • Authors: Viyayanand Nadella
      Pages: 149 - 150
      Abstract: Publication date: March 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 3
      Author(s): Viyayanand Nadella


      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.013
       
  • Thoracic surgical radiographic and CT pathology: radiology in the radical
           treatment of lung cancer
    • Authors: Jim Zhong; Hilary Moss
      Pages: 41 - 49
      Abstract: Publication date: February 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 2
      Author(s): Jim Zhong, Hilary Moss
      Radiology has an important role in the diagnosis, staging and treatment of lung cancer and can offer minimally invasive therapies for poor surgical candidates. Radiology is also important in the follow up of patients after treatment, the assessment of treatment complications and detection of recurrent disease. Understanding the normal post-operative and post-radiation appearances, and recognizing early and late complications is useful for all clinicians involved in the care of patients with cancer.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.11.005
       
  • Interpreting the chest radiograph
    • Authors: Donna-Marie Rigby; Linda Hacking
      Pages: 50 - 54
      Abstract: Publication date: February 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 2
      Author(s): Donna-Marie Rigby, Linda Hacking
      Presented is an approach to a chest radiograph, paying particular attention to features commonly seen in the intensive care unit (ICU) with regards to iatrogenic lines and tubes, together with common pathologies that may be encountered. This is accompanied by helpful images to use as an aide memoire when reviewing ICU chest x-rays. Pitfalls in interpreting these often complex x-rays are also discussed.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.11.003
       
  • Preoperative assessment for thoracic anaesthesia
    • Authors: Brian H. Harte; Peter Moran; Brian F. Keogh; David Alexander
      Pages: 55 - 59
      Abstract: Publication date: February 2018
      Source:Anaesthesia & Intensive Care Medicine, Volume 19, Issue 2
      Author(s): Brian H. Harte, Peter Moran, Brian F. Keogh, David Alexander
      Preoperative assessment of patients for thoracic surgery is a multidisciplinary process designed to offer appropriate surgical treatment with acceptable risk. UK guidelines for pulmonary resection associated with malignant disease involved review of available evidence concerning operative risk. Patients displaying cardiopulmonary physiological parameters above previously recommended threshold values remain classified as acceptable risk. However, less certainty exists about the utility of predicted postoperative pulmonary function values and preoperative performance status to confer unacceptable risk. These guidelines suggest a tri-partite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and postoperative dyspnoea, to be discussed by the multidisciplinary team and with the patient.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2017.11.004
       
  • Micturition
    • Authors: Amanda Zacharzewski; Susie Davies
      Abstract: Publication date: Available online 10 April 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Amanda Zacharzewski, Susie Davies
      The lower urinary tract function is to store and void urine (micturition) that is produced by the kidneys and transferred via the ureters. The lower urinary tract consists of the bladder, urethra and (in males) the prostate. A complex interaction of central, autonomic and somatic innervation enables micturition to be under voluntary control. Common disorders of micturition include bladder outflow obstruction and overactive bladder syndrome, and management of these disorders may include conservative, pharmacological or surgical interventions.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.011
       
  • Function of the nephron and the formation of urine
    • Authors: Eloise A. Lawrence; Daniel Doherty; Raman Dhanda
      Abstract: Publication date: Available online 9 April 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Eloise A. Lawrence, Daniel Doherty, Raman Dhanda
      The nephron is the functional unit of the kidney involved in the critical interplay of fluid and electrolyte homeostasis by glomerular filtration, selective tubular reabsorption and secretion. This article will discuss the structure and function of each segment of the nephron, and the physiology pertaining to the formation of urine.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.03.001
       
  • Self-assessment
    • Authors: Viyayanand Nadella
      Abstract: Publication date: Available online 7 April 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Viyayanand Nadella


      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.03.002
       
  • Renal physiology: acid–base balance
    • Authors: Andrew D. McTavish; Manu-Priya Sharma
      Abstract: Publication date: Available online 5 April 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Andrew D. McTavish, Manu-Priya Sharma
      Acid–base balance is a fundamental part of human homeostasis. The human body has evolved a system which allows exquisite control, involving multi-organ systems, over the pH of the intracellular and extracellular fluid. The Henderson–Hasselbalch equation relates pH to the dissociation constant, pK a, and relative concentrations of dissociated and undissociated acid. One of the clinical applications of this equation is in the use of local anaesthetic agents, applying knowledge of pH and pK a to select the most appropriate drug. In order to exert such fine control over pH, buffer systems exist that rapidly permit correction of any deviance outside the normal range. The principal buffer system is the bicarbonate buffer system, mediated through carbonic anhydrase. The renal system exerts control over the ultimate fate of bicarbonate and hydrogen ions through a series of chemical reactions, culminating in the excretion of excess acid or base. Abnormalities in acid–base balance can have profound consequences and it is therefore vital to understand the basis of the abnormality in order to effectively treat the condition.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.015
       
  • Consent
    • Authors: Christopher Love; Nick Pace
      Abstract: Publication date: Available online 4 April 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Christopher Love, Nick Pace
      Morally, ‘consent’ allows an autonomous patient to determine what treatments they will accept or refuse. The law relating to medical consent protects such self-determination, and allows for treatment decisions to be made for patients who cannot decide for themselves. Consent is valid if it is given voluntarily by a competent patient and is based on the information provided to them. Information is provided about what is to be done and why, and what the foreseeable risks and consequences of treatment are. The onus is on the clinician to explain material risks that are significant to the patient. Competent patients understand, remember and use the information provided to them to either consent to, or refuse, treatment. Patients lacking capacity are protected by The Mental Capacity Act 2005, which obliges that medical treatment decisions made by third parties (doctors, defined proxies or the courts) to be both necessary and in the patient's best interests, in the absence of a valid advance directive. Consent relating to children, pregnant women, the mentally ill, emergencies and teaching requires special consideration.

      PubDate: 2018-04-15T22:38:44Z
       
  • Fluid and electrolyte problems in renal dysfunction
    • Authors: Hywel Garrard; Sian Jones
      Abstract: Publication date: Available online 30 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Hywel Garrard, Sian Jones
      Nephrons are the structural and functional units of the kidneys. The nephrons affect changes to blood plasma via filtration, reabsorption, secretion and excretion. Through these mechanisms the kidneys maintain homeostasis of electrolyte concentrations, fluid volume, osmolality and acid–base balance. In addition to the work of the nephrons, the kidneys have further roles in calcium homeostasis and synthesize the hormones erythropoietin and renin. Acute injury and chronic failure of the kidneys can impact on the kidneys ability to maintain homeostasis and manage fluids and electrolyte balance effectively. This poses challenges to the anaesthetist, perioperative physician and the intensivist in maintaining homeostasis and preventing further injury or damage to the kidneys following surgical or medical stresses. Derangement of electrolytes can be fatal. Recognition and prompt treatment of these abnormalities are essential.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.008
       
  • Regulation of fluid and electrolyte balance
    • Authors: Wael Maher; Ross Macnab
      Abstract: Publication date: Available online 30 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Wael Maher, Ross Macnab
      Adequate tissue perfusion and cellular function is dependent on the maintenance of effective circulatory volume and serum osmolality, respectively. As sodium is the principal extracellular cation with the inability to pass freely across the cellular membrane, it therefore has the greatest effect on extracellular fluid osmolality. The extracellular fluid (ECF) volume can increase or decrease independent of the surrounding osmolality, indicating that control of plasma osmolality and volume occur through distinct physiological processes. Disorders in sodium balance with consequent effect on osmolality come about mainly due to disturbances in water homeostasis rather than an abnormality of sodium intake or excretion.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.012
       
  • Laboratory tests of renal function
    • Authors: Catriona LM. Stewart; Tina Pasha
      Abstract: Publication date: Available online 30 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Catriona LM. Stewart, Tina Pasha
      The kidneys are vital organs in the management of fluid balance, waste product removal, electrolyte homeostasis, acid–base balance and endocrine function. Waste products removed by the kidney include urea, uric acid, creatinine and other foreign products with similar physiochemical properties. Urea and uric acid are by products of protein metabolism and creatinine is generated by the metabolism of creatine compounds from muscle. The kidney regulates fluid and electrolyte balance through controlling the composition and volume of urine. In the proximal convoluted tubule and the loop of Henle, 90% of sodium, potassium, calcium and magnesium are reabsorbed. Acid–base balance is achieved by regulating the excretion of hydrogen ions and bicarbonate buffering. The kidney also has a number of endocrine functions including the production of renin and erythropoietin as well as hydroxylation of vitamin D. The kidneys receive 25% of cardiac output, generating 170–200 litres of ultrafiltrate per day. Urine output is approximately 1.5 litres per day, which is concentrated ultrafiltrate through selective reabsorption of solutes and water. In this article we will discuss tests frequently used to assess renal function.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.010
       
  • Renal physiology: blood flow, glomerular filtration and plasma clearance
    • Authors: Clodagh Mangan; Martyn C. Stott; Raman Dhanda
      Abstract: Publication date: Available online 30 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Clodagh Mangan, Martyn C. Stott, Raman Dhanda
      The kidney depends on its blood flow (20–25% cardiac output) and glomerular ultrafiltration (20% renal plasma flow) to perform it's homoeostatic and excretory functions. More than 90% of blood flow serves the cortex. Selectivity of molecular filtration in the glomerulus is related to molecular size, shape and electrostatic charge of molecules, and structure of the glomerular filtration barrier with its negatively charged glycoproteins. Ultrafiltration is determined by the balance between hydrostatic and colloid osmotic pressures (Starling forces) in the glomerular capillary and Bowman's space. It is influenced by changes in renal plasma flow, altered surface area and changes in vascular resistance afforded by afferent and efferent arterioles (mediated by sympathetic nerve activity, vasoconstrictors and vasodilators). Autoregulation of renal plasma flow minimizes changes in volume of ultrafiltration (hence, filtered load) through myogenic and tubuloglomerular feedback mechanisms. Renal clearance measurements have practical application in terms of assessing renal plasma flow and glomerular filtration rate (creatinine, inulin) along with some other measurements but all have their limitations.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.013
       
  • Preoperative assessment for patients with renal impairment
    • Authors: Nicolas Rey de Castro; Jonathan Bannard-Smith
      Abstract: Publication date: Available online 28 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Nicolas Rey de Castro, Jonathan Bannard-Smith
      The kidneys play an essential role in homeostasis. They regulate crucial physiological variables including blood pressure, acid-base, fluid and electrolyte balance. With an ageing and increasingly diabetic population, the prevalence of chronic kidney disease is increasing. Acute kidney injury is also very common in hospitalized patients. It is therefore essential to identify patients with renal impairment and assess its impact on a patient's physiology, with aberrancies such as anuria, metabolic acidosis and hyperkalaemia all being potentially life-threatening if untreated. It is these physiological derangements that lead to the observed association of renal impairment with an increased perioperative morbidity and mortality. Prevention, identification and correction of the physiological consequences of renal impairment are vital in improving postoperative outcomes in these patients. This article aims to provide a context and structure for the preoperative assessment of patients with renal impairment irrespective of its cause.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.006
       
  • Renal failure and its treatment
    • Authors: Sarah Ng; James Hanison
      Abstract: Publication date: Available online 27 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Sarah Ng, James Hanison
      Acute kidney injury (AKI) is a common complication of acute illness. It is associated with significant morbidity and mortality as well as a high cost to healthcare systems. There are a broad range of causes of AKI which should be considered in a systematic fashion to avoid missing multiple potential causative factors. These include pre-renal causes from hypovolaemia, intrinsic renal causes such as glomerular diseases and post-renal obstructive causes. In the intensive care unit, two-thirds of AKI cases result from renal hypoperfusion, sepsis, contrast and nephrotoxic agents; up to 5% will require renal replacement therapy. Modalities of renal replacement therapy include intermittent haemodialysis, peritoneal dialysis and continuous haemofiltration. Continuous haemofiltration is usually favoured in the intensive care setting as it has greater haemodynamic stability and greater capacity to extract fluid from patients with fluid overload. Anticoagulation is recommended with haemodialysis and haemofiltration and systemic heparin, regional citrate or zero anticoagulation are the usual options.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.014
       
  • Acid–base physiology: new concepts
    • Authors: Tom Hickish; Andrew D. Farmery
      Abstract: Publication date: Available online 26 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Tom Hickish, Andrew D. Farmery
      The traditional approach to acid–base physiology is based on the Henderson–Hasselbalch equation which is derived from the CO 2 / HCO 3 − buffer system. However, it is becoming increasingly recognized that this is an incomplete analysis as it focuses on only one of the six reactions involving H+ and can lead to the incorrect assumption that CO2 and HCO 3 − are independently adjusted factors that ultimately determine pH. In 1983, Stewart, a Canadian physiologist, proposed that a fuller understanding of acid–base physiology required consideration of biological fluids as a complex dynamic system, taking into account the interactions of all the chemical species involved. He showed that the true independent variables controlling the pH of any given fluid compartment are: the difference in the concentration of ‘strong ions’; the total concentration of ‘weak acid’; and the PCO2. Importantly, H+ and HCO 3 − are dependent variables and it is incorrect to think of them as being specifically regulated to manipulate pH. This review will discuss the importance of pH homeostasis and highlight the implications of the Stewart approach in our understanding of acid–base control mechanisms and disorders. In particular, the true mechanisms by which the kidney regulates plasma pH will be discussed, emphasizing key misconceptions that have been propagated as a result of the traditional approach.

      PubDate: 2018-04-15T22:38:44Z
      DOI: 10.1016/j.mpaic.2018.02.007
       
  • Physics of gases
    • Authors: Natalie Thompson; Lucinda Hardy
      Abstract: Publication date: Available online 14 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Natalie Thompson, Lucinda Hardy
      This article will explore the physical principles of gases relevant to anaesthetic practice, including the kinetic theory of gases, phase transition, the application of the gas laws and factors affecting flow. It will also explain the Bernoulli principle and the Coanda effect.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.02.001
       
  • Preoperative assessment of the orthopaedic patient
    • Authors: Dilys H.Y. Kwok; Michael G. Irwin
      Abstract: Publication date: Available online 13 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Dilys H.Y. Kwok, Michael G. Irwin
      Patients undergoing orthopaedic surgery are quite a disparate group, ranging from the young and fit to the frail elderly. Careful pre-anaesthetic assessment and planning is necessary to identify and optimize comorbidities, and develop an individualized perioperative care plan to facilitate early rehabilitation.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.02.002
       
  • Regional anaesthesia for orthopaedic procedures
    • Authors: Sophie E. Liu; Michael G. Irwin
      Abstract: Publication date: Available online 13 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Sophie E. Liu, Michael G. Irwin
      Regional anaesthesia is apposite for orthopaedic surgery for anatomical reasons and to reduce complications from general anaesthesia. A reduction in pain scores, drowsiness and nausea can improve postoperative mobility and facilitate earlier hospital discharge. Disadvantages include block failure, nerve injury, possible loss of motor function and proprioception and local anaesthetic toxicity. Complications are rare but may be reduced by the use of ultrasound and nerve stimulation, performing the block on a conscious patient and stopping injection if there is pain or high resistance. Patients should be assessed preoperatively to rule out contraindications such as local infection or coagulopathy, and clear explanations of the procedure and any possible complications should be given. Patients should also be assessed postoperatively and any suspicious findings investigated promptly and followed up until there is complete resolution.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.006
       
  • Measurement of gas volume and gas flow
    • Authors: Tom West; Alexander Photiou
      Abstract: Publication date: Available online 13 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Tom West, Alexander Photiou
      Accurate measurement of gas flow and volume is vital for the safe conduct of anaesthesia. Gas volume, and hence gas flow, may be measured directly with devices such as the vitalograph; however, these devices have limited use in clinical practice as they are bulky and unsuitable for measurement of continuous flow. This has led to the development of techniques that measure gas flow indirectly by using physical properties of the gas. Methods include mechanical devices such as the variable orifice flow meter (Rotameter) or the peak flow meter. Various electrical techniques have also evolved such as the pitot tube flow meter and the pneumotachograph, which rely on differential pressure transducers. There is also the Wheatstone bridge circuit based on a hot wire anemometer, and a mechanical flow transducer that is reliant on an electrical strain gauge. More recently ultrasonic flow meters have been developed, which are advantageous as they have no moving parts and can be situated outside pipes and hence do not cause an increase in resistance to gas flow.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.02.004
       
  • Drugs used to treat joint and muscle disease
    • Authors: David G. Lambert
      Abstract: Publication date: Available online 12 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): David G. Lambert
      Joint disease: Arthritis can be simply broken into osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is treated with symptomatic pain relief and surgery. RA is a chronic autoimmune disease that causes inflammation of joints (leading to their destruction), tissues around joints and other organ systems. Treatment (for pain) of RA in the first instance is with non-steroidal anti-inflammatory drugs, with second-line treatment using disease-modifying antirheumatic drugs (DMARDs). DMARDs are a disparate group and include methotrexate, d-penicillamine, sulphasalazine, gold salts, antimalarial drugs and immunosuppressant drugs. The newer class of ‘biological’ DMARDs includes etanercept (tumour necrosis factor α (TNF-α) receptor–immunoglobulin G chimera), infliximab (monoclonal anti-TNF-α antibody), anakinra (interleukin 1 receptor antagonist) and rituximab (an anti-CD20 antibody that depletes B cells). Muscle disease: Myaesthenia gravis is an autoimmune disease targeted to muscle type nicotinic receptors. Treatment is based on improving neuromuscular function by: (i) increasing acetylcholine concentrations with neostigmine and pyridostigmine; (ii) immunosuppression; (iii) thymectomy; and (iv) plasmapheresis. General muscle spasticity can be caused by a wide range of conditions including multiple sclerosis, cerebral palsy, Parkinson’s disease and secondary to stroke. This can be treated centrally with baclofen, tizanidine and benzodiazepines or peripherally with dantrolene. Botulinum toxin inhibits the exocytosis of acetylcholine-containing vesicles and can be used for cervical dystonia, strabismus, blepharospasm, severe axillary hyperhidrosis and cosmetic procedures.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.008
       
  • Monitoring arterial blood pressure
    • Authors: Gary Thomas; David Rees
      Abstract: Publication date: Available online 12 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Gary Thomas, David Rees
      The accurate measurement of a patient's arterial blood pressure is vital as it enables clinicians to deliver safe and appropriate care. Blood pressure is a key measurement of haemodynamic status and is a marker of adequate organ perfusion and tissue flow. This article reviews the physical principles of both non-invasive and invasive methods of arterial blood pressure measurement. Recent developments in ‘continuous’ non-invasive monitoring techniques are also outlined.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.02.003
       
  • Procedures under tourniquet
    • Authors: Silky Wong; Michael G. Irwin
      Abstract: Publication date: Available online 12 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Silky Wong, Michael G. Irwin
      Limb tourniquets are commonly used to help facilitate surgery by producing less blood in the surgical field. This may also shorten operative time and reduce intraoperative blood loss. These advantages need to be weighed against potential complications such as post-tourniquet syndrome, skin damage, deep vein thrombosis, rhabdomyolysis and ischaemic pain. Physiological changes in the cardiovascular, respiratory, metabolic, haematological and neurological systems also occur.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.007
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      Abstract: Publication date: Available online 12 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.02.005
       
  • Anaesthesia for major spinal surgery
    • Authors: Roger Ho; Michael G. Irwin
      Abstract: Publication date: Available online 12 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Roger Ho, Michael G. Irwin
      Major spinal surgery is performed for a wide variety of conditions including degenerative diseases, scoliosis and autoimmune diseases. Anaesthesia often presents several challenges to the anaesthetist. Careful pre-anaesthetic assessment and planning is important as patients may have multiple comorbidities. Important perioperative issues to consider include aspects of airway management, neurophysiological monitoring, patient positioning, blood conservation strategies, pain management and specific complications such as perioperative visual loss.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.012
       
  • Measurement of humidity
    • Authors: Antony Wilkes; David Williams
      Abstract: Publication date: Available online 11 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Antony Wilkes, David Williams
      This article describes the physical chemistry of evaporation with particular relation to water. The concept of humidity is defined, and factors that influence humidity are discussed in a practical context. The clinical importance of measurement and control of humidity is illustrated. Commonly used methods of measuring humidity are described and their underlying physical principles are explained.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.009
       
  • Anaesthesia for joint replacement surgery
    • Authors: Yiu Chung Lau; Michael G. Irwin
      Abstract: Publication date: Available online 11 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Yiu Chung Lau, Michael G. Irwin
      Joint replacement, especially hip and knee, are increasingly common elective orthopaedic procedures. Patients who undergo these operations are usually elderly and may have multiple comorbidities requiring careful perioperative management. Specific issues include deep venous thromboembolism (DVT) prophylaxis and use of regional anaesthesia, potential blood loss and hypothermia, application of pneumatic tourniquet and use of bone cement, and postoperative mobilization. There is a trend for developing clinical pathways or protocols from preoperative assessment through postoperative pain management to improve outcomes and enhance recovery in these patients.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.011
       
  • Anaesthesia for fractured neck of femur
    • Authors: Stanley Sau Ching Wong; Michael G. Irwin
      Abstract: Publication date: Available online 11 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Stanley Sau Ching Wong, Michael G. Irwin
      Fracture of the femoral neck is a common injury in the elderly and many patients have significant comorbidities. Effective management requires a multidisciplinary approach including anaesthetists, geriatricians and orthopaedic surgeons. Strict adherence to clinical practice guidelines such as the American College of Cardiology and American Heart Association (ACC/AHA) may reduce unnecessary cardiac consultations. Although early surgery within 24–48 hours is beneficial, there may be medical conditions that need prior optimization. Both general and neuraxial anaesthesia can be used. Overall, there is no significant difference between them in terms of mortality and most complications including pneumonia and pulmonary embolism, although neuraxial anaesthesia is associated with reduced deep vein thrombosis. Pain management should begin preoperatively and a multimodal approach should be used. Peripheral nerve blocks can provide effective analgesia.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.010
       
  • Central venous pressure and pulmonary artery pressure monitoring
    • Authors: Michael Gilbert
      Abstract: Publication date: Available online 10 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Michael Gilbert
      Central venous pressure and pulmonary artery pressure are used as measures of cardiovascular filling. While pressure–volume relationships are not constant, trends in central venous pressure give an indication of increasing or decreasing right ventricular filling, while pulmonary artery pressure gives an indirect indication of left ventricular filling pressure. Cardiac output can be estimated by use of thermodilution.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.004
       
  • Physics of ultrasound
    • Authors: Alexander EJ. Powles; David J. Martin; Irving TP. Wells; Christopher R. Goodwin
      Abstract: Publication date: Available online 9 March 2018
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Alexander EJ. Powles, David J. Martin, Irving TP. Wells, Christopher R. Goodwin
      Ultrasound is a form of non-ionizing radiation that uses high-frequency sound waves to image the body. It is a real-time investigation which allows assessment of moving structures and also facilitates measurement of velocity and directionality of blood flow within a vessel. It can be used for a variety of purposes in the intensive care setting, for example to aid central venous catheter and pleural drain insertion. When using this imaging modality it is vital to understand the relevant physical principles and how the images are created. This article will explain these principles, including the use of Doppler ultrasound and the interpretation of common artefacts.

      PubDate: 2018-03-19T15:18:41Z
      DOI: 10.1016/j.mpaic.2018.01.005
       
 
 
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