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Publisher: Elsevier   (Total: 3161 journals)

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Showing 1 - 200 of 3161 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 35, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 24, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 98, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 418, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
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: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 266, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 163, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 25)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 60, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 18, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
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: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
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: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 404, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 18)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 14)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 47, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 351, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 465, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 52, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 53, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 58, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 48)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 221, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 28, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 18, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 42, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 186, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 203, SJR: 1.58, CiteScore: 3)

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Journal Cover
Anaesthesia & Intensive Care Medicine
Journal Prestige (SJR): 0.138
Number of Followers: 63  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1472-0299
Published by Elsevier Homepage  [3161 journals]
  • Principles of artificial ventilation
    • Abstract: Publication date: Available online 23 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Ben Brown, Justin Roberts The application of intermittent positive pressure ventilation (IPPV) during the 1952 Copenhagen polio epidemic led to the development of the world's first intensive care unit. The requirement for ventilatory support is the most common indication for intensive therapy unit (ITU) admission and is a defining feature of the specialty. Ventilator technology continues to develop and there are many ways to deliver IPPV. The variety of modes of ventilation is increasingly complex and expanding, without evidence that any one mode is associated with improved outcome. Ventilatory support is part of the treatment for a range of conditions including acute respiratory failure, raised intracranial pressure (ICP) and circulatory shock. Ventilator-associated lung injury is reduced by using low tidal volumes and limiting plateau airway pressure to less than 30 cmH2O. Prolonged artificial ventilation has an associated morbidity and mortality and thus should be reviewed by an expert clinician on a daily basis. Weaning aims to identify those patients who will be able to breathe spontaneously. Protocols exist to facilitate timely extubation without the need for re-intubation.
       
  • The anaesthetic machine
    • Abstract: Publication date: Available online 18 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nicholas Record, Christina Beecroft Modern anaesthetic machines have improved greatly since 1917 when Boyle modified the American Gwathmey apparatus of 1912 to develop the ubiquitous continuous flow anaesthetic machine. Despite this, the basic principles and many components remain, albeit in modernized form. Gas is still supplied to the machine from a high-pressure source which is stepped down to a safe pressure supplying the breathing system. Flowmeters control gas flow and allow for adjustment of different inspired concentrations of gases. A vaporizer adds anaesthetic vapour to the inspired gas which is then delivered to the patient via a dedicated breathing system. But modern improvements in safety, requirements for increased monitoring and improved technology have driven change in the anaesthetic machine. Modern anaesthetic workstations employ digital technology to deliver safe and measured anaesthesia to patients. Despite improvements in safety and reliability, routine checking of anaesthetic machines before use is essential. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) have developed a standardized checklist for users to ensure all components of the anaesthetic machine are functioning appropriately.
       
  • Postoperative analgesia
    • Abstract: Publication date: Available online 18 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Katharine C. Ireland, Abdul G. Lalkhen Pain is a complex experience consisting of sensory, affective, behavioural and physiological components. Pain management is therefore best achieved through an approach which acknowledges the complex interaction between biological, psychological and sociocultural factors. Effective pain management requires preoperative patient engagement and education in order to manage expectations and a structured inpatient service to facilitate evidence-based postoperative pain management and continuous staff education. Multimodal postoperative analgesia, built on an opioid-sparing ethos, is one component of postoperative pain management and is essential for achieving patient satisfaction and enhanced recovery. Effective pain management facilitates early mobilization and a reduction in respiratory and cardiac complications, reducing the stress response to surgery in turn improving wound healing and recovery. Inadequate pain control can lead to higher morbidity and mortality, prolonged hospital stays and the development of chronic postoperative pain.
       
  • Intravenous anaesthetic agents
    • Abstract: Publication date: Available online 18 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Kenichi Ode This article gives an overview of drugs frequently used for intravenous anaesthetic induction, as well as a brief overview of total intravenous anaesthesia. Physio chemical properties of intravenous anaesthetic drugs, their clinical and adverse effects are summarized. The article also discusses the historical context on the introduction of intravenous anaesthetic agents and highlights developments of novel agents.
       
  • Anaesthetic breathing systems
    • Abstract: Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Andrew Donnelly, Stuart Dolling A breathing system is a series of components that allows the delivery of oxygen and other anaesthetic gases to the patient as well as aiding in the removal of carbon dioxide. There are key elements that feature in all anaesthetic breathing systems with numerous classification systems used. The layout of individual breathing systems determines their clinical application and use. All of the above will be discussed further in this article as well as a brief summary of the use of carbon dioxide absorbers and their function.
       
  • The principles of anaesthetic vaporizers
    • Abstract: Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Paul Wasik, Ravi Anandampillai Fluorinated hydrocarbons have transformed inhalational anaesthesia, and vaporizers are essential for safe and accurate delivery of these agents. The modern day vaporizers have evolved considerably since the ether inhaler invented by John Snow in 1847 and are robust, precise and efficient. For an anaesthetist to administer safe inhalational anaesthetic, it is important to understand the physical principles of the various inhalational anaesthetic agents along with the working principles of the vaporizers. Almost all modern vaporizers are located outside the circle system and the have multiple safety mechanisms in place.
       
  • Total intravenous anaesthesia
    • Abstract: Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Eoghan McGrenaghan, Ming Wilson Total intravenous anaesthesia (TIVA) is a technique to induce and maintain general anaesthesia exclusively with intravenous anaesthetic agents, thereby avoiding the use of inhalational agents. It is essential that all practicing anaesthetists are competent in the delivery of TIVA and able to perform it safely. TIVA is necessitated in a wide variety of clinical situations when the delivery of inhalational agents is absolutely or relatively contraindicated; for example, in patients with malignant hyperthermia or severe postoperative nausea and vomiting. In other situations, it may not be possible or practical to deliver inhalational anaesthesia such as during patient transfer or anaesthesia for airway surgery. This article describes the use of target controlled infusion models and principles, which enable anaesthetists to deliver TIVA safely. The Association of Anaesthetists of Great Britain and Ireland and the Society of Intravenous Anaesthesia have produced Guidelines for safe practice of TIVA in 2018.
       
  • Inhalational anaesthetic agents
    • Abstract: Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma Temple, Matt Wiles The continued development of anaesthetic agents since the late 18th century has paved the way for the progression of surgical techniques. Inhalational agents are used worldwide for the delivery of safe, effective anaesthesia. These include the volatile agents halothane, isoflurane, sevoflurane and desflurane, in addition to the anaesthetic gases nitrous oxide and xenon. Although the newer volatiles have an improved safety profile in comparison to older agents, the ideal anaesthetic agent remains elusive. It is vital for anaesthetists to understand the physical properties, pharmacodynamics and pharmacokinetics of the individual inhalational anaesthetic agents so that the most appropriate agent for a patient or procedure is selected and administered correctly.
       
  • Pharmacokinetic variation
    • Abstract: Publication date: Available online 17 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Danielle V. Eusuf, Elizabeth Thomas Pharmacokinetics is the study of how the body handles an administered drug, including absorption, distribution, metabolism and excretion. Pharmacokinetic variation is when there is variability in the drug concentration at the effector site after administration of a standard dose. This can result in one dose of a drug being ineffective in one patient, but potentially toxic with unwanted side effects in another. There are four factors which are responsible for pharmacokinetic variation: absorption, distribution, metabolism and excretion. This article will review how physiological, pathological and pharmacological processes can influence all of these factors.
       
  • Patient selection for day case surgery
    • Abstract: Publication date: Available online 14 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Alexandra Humphreys, Mary Stocker Day surgery provides many benefits to patients and trusts. Currently, almost all surgery should be performed as day case or very short stay and as such the criteria for suitability for day case surgery have been much expanded over recent decades. Social and medical criteria should rarely prevent successful day case surgery; we present suggestions whereby historic barriers to discharge can be overcome. We discuss the suitability of surgical procedures to be performed as a day case and explain how emergency pathways can be utilised to enable an additional cohort of patients be treated as a day case. These suggestions will permit the vast majority of patients to reap the benefits of undergoing their procedure as a day case.
       
  • Effects of smoking on health and anaesthesia
    • Abstract: Publication date: Available online 14 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Phillippa Shorrock, Nawar Bakerly Legislation prohibiting smoking in workplaces and enclosed public places was introduced in England in July 2007. This, in addition to the 2012 prohibition of tobacco promotion, and the increased use of e-cigarettes, are all changing our smoking behaviour as a nation. Nevertheless tobacco remains a major factor in disease development and smokers continue to present a number of anaesthetic challenges. Perioperative smoking cessation is beneficial and NHS support is available to facilitate this. The use of e-cigarettes to aid smoking cessation is increasing in popularity but their role within the perioperative period to facilitate reduction and cessation is ill-defined.
       
  • Self-assessment
    • Abstract: Publication date: Available online 14 January 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
  • Self-assessment
    • Abstract: Publication date: Available online 20 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Nosocomial infections in the ICU
    • Abstract: Publication date: Available online 18 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Stuart Edwardson, Chris Cairns Nosocomial infections are a major cause of avoidable morbidity, mortality and extended length of stay in ICU. Prevention of these infections is key. Continual surveillance, audit and hand hygiene are therefore vital. The recent introduction of ‘care bundles’ grouping best practices for care of invasive devices have proven highly successful for reducing the rates of nosocomial infection in the ICU. Despite these strategies patients in the ICU are still twice as likely to contract a nosocomial infection compared to the general hospital population. Furthermore, the microbes involved tend to be more difficult to eradicate due to increasing microbial resistance. The most common nosocomial infections contracted in critical care are ventilator-associated pneumonia, central line-associated blood stream infection and urinary catheter-related urinary tract infection. Timely recognition and management of these conditions is key to providing best care within the ICU. The focus of therapy should always be targeted to specific microbes with information guided by initial cultures and sensitivities. This, combined with regular liaison with local microbiology colleagues, will ensure the best treatment with the least risk of causing selective pressures and further multi drug resistance.
       
  • Recognition of the critically ill patient and escalation of therapy
    • Abstract: Publication date: Available online 17 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Amy Brown, Apoorva Ballal, Mo Al-Haddad Critical illness often involves multiple organ failures and is associated with significant morbidity and mortality. In the vast majority of patients, there is a recognizable period of physiological deterioration which heralds the development of organ failure and critical illness. Despite efforts to improve the detection and management of critical illness, signs of deterioration are often missed and decisions to move patients to critical care units are delayed. Standardized approaches which implement an effective ‘chain of response’ are now utilized worldwide. They focus on attempting to reduce the incidence of serious adverse events (SAEs) such as in-hospital cardiac arrest and unplanned intensive care unit (ICU) admission using preventative measures. These systems should include: accurate recording and documentation of vital signs, recognition and interpretation of abnormal values, rapid bedside patient assessment by trained teams and appropriate interventions. Early warning systems (EWS) are an important part of this and can help identify patients at risk of deterioration and SAEs. Assessment of the critically ill patient should be undertaken by an appropriately trained clinician and follow a structured ABCDE (airway, breathing, circulation, disability and exposure) format. This facilitates correction of life-threatening problems by priority and provides a standardized approach between professionals. Lastly, timely support and input from members of the critical care team are vital to ensure optimal outcomes for critically ill patients.
       
  • Principles of intravenous drug infusion
    • Abstract: Publication date: Available online 15 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): David J. Chambers Intravenous infusions are required when a drug has a short half-life or a narrow therapeutic window. Pharmacokinetic models are employed to calculate the infusion rate for a particular target plasma concentration. While the one-compartment model is based on relatively simple mathematics, it is of little practical use. Multi-compartment models involve complex mathematics: a bolus-infusion regimen requires a variable-infusion rate. In clinical practice, this means incorporating the pharmacokinetic models into specially designed target-controlled infusion pumps. The physicochemical properties of different drugs result in very different behaviours, especially following cessation of intravenous infusion.
       
  • Consent and children
    • Abstract: Publication date: Available online 14 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Caoimhe Casby, Barry Lyons The law relating to consent for medical interventions in children is complex. Children, when they are old or mature enough, can consent for themselves. When they are unable to do so, consent must be sought from someone with parental responsibility. This article discusses consent, and its refusal, to medical interventions by children and adolescents.
       
  • Developmental anatomy of the airway
    • Abstract: Publication date: Available online 14 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Niall Wilton, Henrik Hack The airway develops from the primitive foregut at 4 weeks’ gestation. Congenital anomalies may result when this process is abnormal. The anatomy of the airway at birth is uniquely different from older children and adults, with a large tongue, long floppy epiglottis, large occiput and cephalad larynx. These features affect the technique required for facemask ventilation, supraglottic airway use and endotracheal intubation. A neutral head position and straight bladed laryngoscope are usually used for intubation. Neonates are also obligate nasal breathers and simultaneously suckle and breath. Minute volume is rate dependent and the highly compliant chest easily displays sternal and intercostal recession during respiratory distress, and early onset of fatigue. From the neonatal period onwards the anatomy gradually begins to resemble that of adults. The cricoid descends caudally, the epiglottis becomes firmer and shorter, and the relatively large occiput recedes. The conventional wisdom of the cricoid ring being the narrowest part of the paediatric airway is not supported by contemporary investigation. The consequence of these findings on endotracheal tube selection and the rationale for increasing use of cuffed endotracheal tubes in children is discussed.
       
  • Assessment and management of the predicted difficult airway in babies and
           children
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Paul A. Baker Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts.
       
  • Haematological problems in the intensive care unit
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Katherine L. McDowall, Katrina Parsons, Gillian A. Horne Patients admitted to the intensive care unit can be affected by a range of haematological problems, either as a consequence of primary haematological disease or, more commonly, with haematological problems arising as a consequence of other disease processes. The haematological malignancies are individually relatively rare conditions, but collectively account for a significant proportion of cancer diagnoses. This group of conditions may cause patients to become critically ill and require intensive care support for a number of reasons.
       
  • Sepsis in 2018: a review
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Catherine Wentowski, Nishith Mewada, Nathan D. Nielsen Sepsis is responsible for tremendous morbidity, mortality and healthcare expenditure worldwide. Recently, the conceptualization of sepsis has shifted away from one based upon the inflammatory response to infection to one based upon a dysregulated immune response and resulting organ dysfunction. Revised definitions of sepsis and septic shock have been proposed in order to improve the specificity of the diagnostic criteria and to provide tools to facilitate accurate and timely (i.e. early) diagnoses at the bedside. The crux of sepsis management remains early identification and diagnostic testing, early antimicrobial therapy, and early haemodynamic resuscitation. The most recent guidelines recommend that first steps in this process should take place within one hour from when sepsis is suspected. Additional important new elements in the most recent sepsis management guidelines include the use of dynamic parameters to assess fluid responsiveness, a conservative fluid strategy following initial resuscitation (with ‘de-resuscitation’ when possible), serial re-assessments of haemodynamic status, and adaptable treatment plans. This article provides a summary of the most recent clinical evidence and professional guidelines for the diagnosis and treatment of the sepsis in the critical care setting.
       
  • Update on ENT anaesthesia in children
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Randa Ridgway, Tristan Dumbarton, Zoë Brown This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing number are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea, but judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including the potential role for dexmedetomidine and recent advances using transnasal humidified rapid insufflation ventilatory exchange.
       
  • Acute and chronic airway obstruction in children
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Earlene E. Armstrong, Graham Bell Airway management is one of the fundamental skills of any anaesthetist. Considerable anatomical changes occur between birth and adulthood during the development of the paediatric airway. Knowledge of these changes will influence airway planning during childhood. Airway obstruction complicates airway management and any anaesthetist working with children should be able to assess the airway for the presence of obstruction and generate a differential diagnosis of cause. This article aims to summarize key anatomical features of the paediatric airway, common causes of airway obstruction in children and provide suggestions for how to manage these patients.
       
  • Physical rehabilitation and critical illness
    • Abstract: Publication date: Available online 13 December 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): David M. Griffith, Tim S. Walsh Survivors of critical illness suffer a range of physical, psychological and social problems known together as the post-ICU syndrome. Physical weakness is common, long lasting, and interferes with quality of life for many ICU survivors. Physical weakness observed close to the time of ICU discharge is likely be caused by the disordered physiology and immobility associated with critical illness. These factors may be less important in the long term, where pre-existing frailty may be more important. A large number of trials have tested physical interventions (exercise, passive and active mobilization, and neuromuscular electrical stimulation) delivered during and after critical illness. At this time, the evidence suggests that early mobilization can improve important short-term outcomes (such as length of stay, duration of mechanical ventilation, functional independence and mobility), but have not been shown to affect long term outcomes. No physical intervention delivered after ICU discharge has demonstrated effectiveness. This article describes the physical problems experienced by ICU survivors, and provides an up to date review of critical care physical intervention trials.
       
  • Pharmacological modulation of cardiac function and blood vessel calibre
    • Abstract: Publication date: Available online 20 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Christopher P. Hebbes Inadequate end organ perfusion and tissue hypoxia is an end point of many disease processes in critical illness. Maintenance of organ perfusion and therefore tissue Oxygenation is critical to patient management in the perioperative period. Global blood flow is determined by a balance of neurohormonal factors, with autoregulation ultimately determining local flow. These factors modulate cardiac output and vasomotor tone. Pharmacological manipulation of both the myocardium and vasculature at the level of the autonomic nervous system (via α or β adrenoceptors), cardiac muscle (e.g. calcium sensitisation via Levosimendan), or locally (e.g. via regional or neuraxial local anaesthetic blockade) is commonly used in anaesthesia to mitigate the effects of critical illness and perioperative stress responses. This enables maintenance of organ perfusion through modulating vascular tone or cardiac output. This article considers the global control of the system through to local and regional regulation of blood flow, and how the system may be manipulated at every level.
       
  • Cardiopulmonary resuscitation and post-resuscitation care
    • Abstract: Publication date: Available online 17 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Michael O'Connor, C Stephanie Cattlin Survival and subsequent good neurological outcome following cardiac arrest depends on prompt diagnosis, good quality cardiopulmonary resuscitation (CPR) with minimal interruptions and rapid defibrillation, if appropriate. In the post resuscitation phase, diagnosis and treatment of the underlying cause for the arrest with avoidance of hypotension, hyperthermia, hyperoxia, hyper/hypoglycaemia and management of seizure activity confers the best chances of a successful outcome. Early prognostication of survivors is difficult and should be done by experts using a variety of proven modalities.
       
  • Central venous cannulation
    • Abstract: Publication date: Available online 14 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Peter B Williamson, C Stephanie Cattlin Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.
       
  • Pain, agitation and delirium in the intensive care unit
    • Abstract: Publication date: Available online 14 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Christopher McGovern, Richard Cowan, Richard Appleton, Barbara Miles Pain, agitation and delirium are common during critical illness and are associated with many adverse consequences. A key aim of critical care is the facilitation of a calm, comfortable patient who can interact with their family and staff. Intensive care unit (ICU) patients frequently have pain from a variety of sources, many of which are not readily appreciated or actively managed. This article explores the challenges of assessing pain in the ICU and outlines methods that can be used to better identify and manage pain in this patient group. Agitation in ICU is often multifactorial, with many of its sources under-recognized. We will discuss the potential reasons that ICU patients become agitated, methods for measuring agitation and the actions that can be taken to alleviate it. Although the use of sedative and anxiolytic drugs is common in ICU, their use is not without risks. This article will outline these risks, the variety of drugs available and how to use these drugs to a targeted effect. We will also explore delirium, its risk factors, precipitants and associated morbidity and mortality. This article will discuss how to diagnose delirium and the methods used to prevent and manage it.
       
  • Drugs affecting coagulation
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Balraj Appadu, Katrina Barber For more than half a century, heparin and vitamin K antagonists have defined anticoagulant therapy in both the short-term and long-term management of thrombotic diseases. However, the limitations of these traditional anticoagulants have prompted the development of new drugs. In the past 15 years new agents with improved safety profile and greater ease of use that target almost every step of the coagulation cascade have been developed. These include factor Xa inhibitors and direct thrombin inhibitors. The mechanism of action of these new anticoagulants and also the ‘older’ agents are reviewed in this article.
       
  • Hypovolaemia
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sally K. El-Ghazali, C. Stephanie Cattlin Hypovolaemia is defined as inadequate filling of the circulation and can be divided into absolute and relative hypovolaemia. The total body water accounts for 60% of a patient's body composition and is subdivided into extracellular and intracellular fluid compartments. The critical loss appears to be about 30% of the blood volume (1500–2000 ml). In order to limit the physiological effects of hypovolaemia, there are changes within the cardiovascular, renal and haematological systems to help minimize ongoing losses. The history and physical examination may give an indication that a patient is hypovolaemic. However, clinical signs may be a late manifestation of hypovolaemia as up to 15% of the blood volume can be lost before signs and symptoms are evident. It is of vital importance to measure fluid responsiveness in hypovolaemic patients to ensure patients are adequately resuscitated.
       
  • Ethical issues in resuscitation and intensive care
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Grant Lewis, Paul McConnell With continued advances in resuscitation and organ support, modern intensive care medicine is redefining life and death. Yet for all our progress, more life at any costs may not be an outcome that a patient wishes or finds tolerable. As medical paternalism is stripped away and the subjective wishes of the patient becomes the focus of our care, how we offer, deliver and discontinue therapies become paramount. When our patients themselves though may not be able to communicate their wishes as a result of both their pathology and our therapies in the intensive care unit, we are presented with ethical, moral and practical dilemmas as to how we may best care for them and act in their best interests.
       
  • Self-assessment
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
 
 
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