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Publisher: Elsevier   (Total: 3181 journals)

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Showing 1 - 200 of 3181 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 442, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 320, 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: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, 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: 7, 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: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, 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: 187, 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: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, 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: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, 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: 15, 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: 34, 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: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, 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: 20, 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: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, 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: 52, 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: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, 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: 9, 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: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
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: 5)
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: 18, 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: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, 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: 6)
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: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, 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: 424, 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: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 384, 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: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 482, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, 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: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, 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: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, 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: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, 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: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
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: 264, 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: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, 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: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, 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: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 210, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, 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: 226, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
Anaesthesia & Intensive Care Medicine
Journal Prestige (SJR): 0.138
Number of Followers: 67  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1472-0299
Published by Elsevier Homepage  [3181 journals]
  • Management of the airway in intensive care
    • Abstract: Publication date: Available online 25 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Miles Beeny, Arno Crous Airway management in the intensive care unit (ICU) is largely uneventful; there is a higher incidence of airway difficulties, however, than those encountered in the operating suite. Management of the airway in the ICU presents challenges unique to this environment that must be coped with by a multidisciplinary team that may be less experienced in airway management than clinicians in the operating theatre. The risks associated with this situation, we believe, may be ameliorated by planning and forethought. This article outlines some of the specific difficulties faced by clinicians in ICU and attempts to provide some guidance as to how these may be overcome, or at least abated. Drug and equipment choices are discussed. A suggestion for a difficult airway algorithm for use in the ICU is put forward. The timing of tracheostomy is discussed. Finally, the importance of the team and the human factors that are at play are touched upon.
       
  • Ventilatory support in the intensive care unit
    • Abstract: Publication date: Available online 21 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Eumorfia Kondili, Athanasia Proklou, Aikaterini Vaporidi This article focuses on the functional features of positive-pressure ventilators, the modes of invasive and non-invasive mechanical ventilation, and the main ventilator settings. It also highlights the potential complications of mechanical ventilation, the basic principles of weaning, and the pathophysiological basis of patient-ventilator dyssynchrony.
       
  • Self-assessment
    • Abstract: Publication date: Available online 19 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
  • Field anaesthesia and critical care equipment used by the British Military
    • Abstract: Publication date: Available online 19 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma L. Watson, Jonathan A. Round This article provides a description and discussion of the key equipment used by the British Defence Medical Services (DMS) to provide anaesthesia and critical care in the field. There is a need to balance equipment clinical capability against its suitability for use in the field. By necessity, military anaesthesia and critical care equipment should be robust, portable, compact, easy to use, easy to maintain and clean, and require minimal consumables.
       
  • Strong ion analysis at the bedside
    • Abstract: Publication date: Available online 18 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nithin Abraham Raju, Ryan Hughes, Matthew J. Brain Quantitative physicochemical models of human acid–base physiology filled a void between clinical acid–base analysis and general fluid physiology. Established approaches centred on the Henderson–Hasselbalch (HH) equation allow satisfactory bedside exploration of respiratory perturbations, but do not fully elucidate mechanisms of common non-respiratory ‘metabolic’ components. Though useful at the bedside, commonly used ‘rules of thumb’ that classify disturbances based on quantification of bicarbonate relative to CO2 have also fostered a language that often misrepresents bicarbonate physiology. The physicochemical model is frequently perceived as too complex for bedside use, however a set of simplified screening questions based on Stewart's model can be utilized to aid acid-base interpretation. Examples using this approach are included in an online appendix. Emphasis is placed on understanding the consequences of hypoalbuminaemia, volume status, tonicity and chloride derangements as these are common in ICU patients.
       
  • Disinfection, sterilization and disposables
    • Abstract: Publication date: Available online 18 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Anthony J. Wilson, Sandeep Nayak Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether.
       
  • Initial assessment and management of trauma encountered in the field
    • Abstract: Publication date: Available online 17 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma Coley, Sarah Fadden This article covers the principles of trauma care relating to specific competencies within the military higher training module. The majority of these principles relate to the pre-hospital assessment and management of patients, introducing some of the nuances of military medicine in comparison to civilian practice.
       
  • The poisoned patient
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nora Gonzalez, Fin O'Sullivan Poisoning is a common reason for admission to the intensive care unit. The majority of patients are due to deliberate self-harm with common poisons; however, there are occasional unusual poisons which require more detailed assessment. Patients are often obtunded or unwilling to co-operate so a knowledge of toxidromes to recognize symptoms that are related to groups of drugs that act on receptors is essential. Management of poisoned patients is generally supportive, including measures to reduce absorption and increase elimination, as well as the use of specific antidotes and techniques to remove poisons.
       
  • Asthma and chronic obstructive pulmonary disease in the intensive care
           unit
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): David Tuxen, Mark Hew There are many pitfalls in the management of patients with asthma or COPD especially when their condition becomes severe enough to warrant intensive care. Mortality in both groups remains significant. Standard principles of oxygen and drug administration and mechanical ventilation technique used for other critically ill patients can all cause problems in this patient group. Recognition of the presence of airflow obstruction, the potential for dynamic hyperinflation and careful adherence to the principles of therapy specific to this group are required to avoid complications. This article addresses the physiological derangements in airflow obstruction, their treatment consequences and how to avoid the management pitfalls that are important contributors to the morbidity and mortality of both conditions.
       
  • Surgical diathermy and electrical hazards: causes and prevention
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): James H. MacG Palmer The hospital environment is both unique and unusual in that electrical equipment is directly applied to the human body. From this application either capacitive or resistive coupling may lead to current flow and harm. Surgical diathermy, patient monitoring and imaging, although universal, are often misunderstood, and many clinicians are ignorant of their principles and hazards. Electrical equipment in hospital therefore has the potential to lead to serious injury or death. This article outlines the basic physics of electricity, in particular the principles behind diathermy, the hazards posed by it and by other devices and the various measures available to reduce the risk of these.
       
  • Chemical casualties – Recognition and management
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Kevin Wu, Fin O'Sullivan Poisoning with chemical agents was once thought to be confined to the battlefield. However, over the past decade there has been an increase in the use of chemical weapon agents and toxic industrial chemicals as weapons of terror. As well as use during conflict, these poisons have been used in other attacks with deadly effects. These agents require particular treatments that fall out with standard medical practice to reduce harm and prevent contamination of medical treatment facilities. The risk of a mass casualty incident with a deliberate or accidental release is a possibility.
       
  • Acute respiratory distress syndrome
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Robert Hart, Euan Black Acute respiratory distress syndrome (ARDS) is a devastating clinical condition characterized by poor gas exchange and bilateral interstitial opacification demonstrated on chest imaging. Despite years of research, the mortality associated with ARDS remains high. Early recognition and treatment of the underlying cause, combined with strategies to reduce ventilator-induced lung injury are key to optimising the likelihood of survival. This article will provide an update on the most recent evidence base on clinical practice, including the use of acute severe respiratory failure bundles and extracorporeal techniques to support lung protective ventilation.
       
  • Extracorporeal support of the respiratory system
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma L. Hartley, Stuart Gillon In the last 20 years there have been significant advances in extracorporeal support of the respiratory system. What once was a highly complex intervention, undertaken as a salvage procedure in a handful of patients, has become more wide spread, both in terms of availability and underlying indications. We review the principles of equipment; physiological control of oxygenation and decarboxylation; associated complications; and role in clinical practice. The evidence for extracorporeal life support in this rapidly evolving field of organ support is critiqued.
       
  • Community-acquired pneumonia
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Russell Allan Community-acquired pneumonia (CAP) is a common inflammatory process contained within the lung tissue in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response and these patients may require admission to the intensive care unit (ICU). The CURB-65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigations permit pathogen-speciflc antibiotic therapy and provide epidemiological data. Appropriate and timely administration of antibiotics is the mainstay of treatment. Complications include empyema, treatment failure, sepsis, respiratory failure and death.
       
  • Paediatric chronic pain
    • Abstract: Publication date: Available online 26 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Paul M. Rolfe Chronic pain in childhood is common and if untreated may lead to significant pain-related disability, emotional disturbance and poor school attendance. Many children and adolescents are successfully managed outside of specialist paediatric pain management clinics in a wide range of clinical settings. However, some children require the expertise of a multidisciplinary pain management team in a dedicated paediatric centre. Following multidisciplinary assessment an individualized pain management plan is agreed with the family. Treatment options can be classified into pharmacological, physical and psychological therapies. The aim of treatment is to facilitate a restoration of function for the child, working with the family as a whole.
       
  • Pharmacology in the management of chronic pain
    • Abstract: Publication date: Available online 26 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Grace Nisbet, Arun Sehgal Pharmacological treatment can play an important role in the successful management of chronic pain and should be prescribed as part of a biopsychosocial approach. When planning a pharmacological strategy for chronic pain it is important to consider the nature and likely source of the pain. This article will summarize common pharmacological options in current clinical use for the management of chronic pain.
       
  • Self-assessment
    • Abstract: Publication date: Available online 16 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Visceral pain
    • Abstract: Publication date: Available online 13 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Anu Kansal, John Hughes Pain is one of the most common symptoms that patient presents with. Visceral organs were thought to be insensitive to pain in the past, but we now know this is not true. It is more common than somatic pain and originates from the internal organs in the thorax, abdomen or pelvis. These organs are innervated by the parasympathetic (vagus and sacral parasympathetic fibres) and sympathetic (thoracolumbar sympathetic chain: T1–L2) nervous systems. The afferent and efferent fibres to the organs accompany the sympathetic nervous system. The sensory system to the gut is specialized and divided into an enteric and extrinsic nervous system. The physiology of visceral pain is poorly understood compared to somatic pain, but it is well established that peripheral and central sensitization along with dysregulation of the descending pathways plays a significant role. Pain originating from visceral organs is usually diffuse, dull aching, poorly localized and can be associated with phenomenon such as referred somatic pain, referred hyperalgesia, visceral hyperalgesia and viscero-visceral hyperalgesia. Treatment of visceral pain involves identifying and treating the cause, if identified, and the management of pain. Patient education and information plays an important part in management along with pharmacological and non-pharmacological treatments.
       
  • Critical care transfers: core principles and logistics
    • Abstract: Publication date: Available online 10 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Euan J. McIntosh, Chris Lochrin, Wayne Auton In the UK over 11,000 critically ill patients are transferred between hospitals each year. In addition, a significant number of critically ill patients are transferred to hospital from locations outside hospital such as rural general practice surgeries or the community. While specialist teams are available for some transfers, the majority are conducted by teams from the referring hospital. The aim of this article is to give an overview of the principles of critical care transfer, transfer platforms and the importance of a structured approach.
       
  • Chronic pain: psychological formulation and MDT working
    • Abstract: Publication date: Available online 10 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Jo Burrell, Louise Robinson Chronic pain is complex and often a challenge to manage. Patients’ expectations are frequently at odds with the treatment outcomes which can be a significant source of distress. Pain is best understood within the biopsychosocial model. Clinical psychologists work as part of the multidisciplinary pain team to draw together information and develop an understanding of how to support patients to live well while experiencing ongoing pain. This article presents two alternative models for formulating and providing therapy for individuals experiencing chronic pain; cognitive behaviour therapy and acceptance and commitment therapy. Psychologically informed strategies to support healthcare professionals in their interactions with people with chronic pain are presented.
       
  • Radiofrequency techniques in pain management
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Victor Mendis, Ramy Mottaleb, Sahiba Sethi Radiofrequency techniques are minimally invasive procedures used to provide prolonged pain relief compared to local anaesthetic blocks and forms part of a multidisciplinary approach in managing chronic pain. A generator produces a high-frequency current that passes from an electrode to an earthing plate. The electromagnetic field created around the tip of the electrode then has an effect on the surrounding nervous tissue resulting in pain relief.
       
  • Pain management in palliative care: art or science
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Brigid Bassam Pain management in palliative care is both an art and a science. Essential to good pain control is an understanding not only of the pathophysiology of the origin of the pain, but also the impact that the pain is having, as the palliative patient may have to live with the symptoms of disease for months or even years. Interventions can then be targeted and at various times, may include a range of pharmacological treatments, psychological or spiritual support and possibly the involvement of other specialties to alleviate a particular problem.
       
  • Complex neuropathic pain states
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rhian P. Lewis, Indre Kriukelyte In this article we discuss complex neuropathic pain states: diabetic peripheral neuropathic pain (DPNP), phantom limb pain (PLP), central post-stroke pain (CPSP), and complex regional pain syndrome (CRPS). Pain in these conditions can often be severe, significantly affect quality of life and be resistant to current treatment options. Multidisciplinary assessment and treatment is essential.
       
  • Implantable technology for pain management
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): G. Baranidharan, Ibrahim Mohamed Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact in patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation.
       
  • Physiology of patient transfer by land and air
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): James J. Hale, David P. Hall, Mark J.G. Dunn Patient transfer is an important part of many patients’ journeys through the healthcare system. In the UK, the majority of transfers are undertaken by land ambulance but some are by air utilizing helicopters or fixed wing aircraft. The transfer of patients is challenging often involving unstable critically ill patients, trainee staff, time pressure, out of hours work and unfamiliar transfer equipment. Patients are exposed to a number of physical factors including acceleration and deceleration, decreased barometric pressure, noise, vibration, reduced humidity and altered ambient temperatures. These factors have a significant effect on patient physiology and it is important that clinicians understand these effects and integrate them with planning and decision making. Other challenges include staff fatigue, communication difficulties, the effects of transfer on medical equipment and the hazards of caring for patients in confined spaces for prolonged periods of time.
       
  • Drugs affecting the autonomic nervous system
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Matthew Charlton, Jonathan P. Thompson The autonomic nervous system (ANS) is a complex system of nervous and humoral mechanisms that modulates the function of the autonomous or visceral organs. Autonomic control of organs aims to maintain homoeostasis in health. Many drugs used in clinical practice can have either primary or secondary effects on the function of autonomic nervous system.
       
  • Opioids in the management of persistent non-cancer pain
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Shun Yamanaka, Lucy Miller One in five Europeans suffers from persistent pain which, for the majority, is non-oncological in origin. Patients with persistent non-cancer pain (PNCP) are a heterogeneous group in whom there is significant biological, psychological and societal comorbidity. Recently, there has been a large increase in opioid prescribing for PNCP, despite its limited evidence base and adverse side effect profile, including opioid dependence. This review examines the effectiveness and safety of long-term opioids in PNCP, as well as current best practice guidelines on the initiation, monitoring and titration of opioids in the out-patient setting.
       
  • Percutaneous cervical cordotomy for cancer-related pain
    • Abstract: Publication date: Available online 6 September 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Manish Gupta, Manohar L. Sharma The anatomic rationale of cordotomy involves interruption of pain fibres in the spinothalamic tract. Cordotomy is indicated in cancer patients with limited life expectancy who have severe, unilateral pain. The goal in patients with limited life expectancy should be to improve the quality of survival, which includes improving the patient's ability to interact with others, and to reduce the amount of time spent in contact with healthcare providers. Analgesic optimization alone may fail to adequately control cancer related pain. When successful, percutaneous cervical cordotomy allows significant reduction in pain medications, and reduces the need for clinic visits. Percutaneous procedures are preferred over open procedures for their lower morbidity. The percutaneous cervical cordotomy procedure is technically not simple and requires considerable skills of the physician performing the procedure.
       
  • Obstetric haemorrhage
    • Abstract: Publication date: Available online 29 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rosanne Ching, Thomas Mount, Kirsty MacLennan Obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. It is the leading obstetric cause for admission to intensive care units. Knowledge of risk factors and early recognition of haemorrhage enables rapid activation of a coordinated multidisciplinary team response. Clear unit protocols for the management of massive haemorrhage that are reinforced by team drills help to increase awareness in the multidisciplinary team, improve performance and thus can improve patient outcome. Pharmacological agents and surgical manoeuvres are reviewed in the article, as are blood conservation techniques.
       
  • Self-assessment
    • Abstract: Publication date: Available online 26 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
  • Assessment of the fetus before and during labour
    • Abstract: Publication date: Available online 21 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Harriet Lamb, Alexander Heazell Perinatal death or cerebral palsy are devastating events for families. In an attempt to prevent these pregnancy outcomes, fetal wellbeing is assessed during labour by a variety of means. In this review, the most common means to confirm fetal wellbeing, the rationale for their use and evidence of their efficacy are discussed. With respect to labour, the indications for continuous electronic fetal monitoring are presented, together with a guide to interpretation of cardiotocograph (CTG) or fetal scalp blood samples (FBS).
       
  • Obstetric emergencies
    • Abstract: Publication date: Available online 21 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Brynmor A. Summers, Graeme G. Flett For more than 60 years the Confidential Enquires into Maternal Deaths triennial reports and later reports from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have helped build a picture of maternity care within the United Kingdom (UK), highlighting not only our successes but failures in caring for women within the puerperal period. Despite most obstetric emergencies being well described and having clear management strategies and guidance, there continues to be substandard management with poor outcomes recorded. This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the MBRRACE-UK report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care, but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner.
       
  • Regional anaesthesia for caesarean section and what to do if it fails
    • Abstract: Publication date: Available online 20 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sophie A. Kimber Craig Regional anaesthetic techniques are the most frequently used type of anaesthetic used for caesarean deliveries. They have a better safety profile than general anaesthesia in the pregnant woman. The choice of whether to use a spinal, epidural or combined spinal–epidural technique will depend on patient and surgical factors. Particular care is required in those receiving therapeutic anticoagulation or with clotting abnormalities. Women should be provided with information regarding the risks and intended benefits of the different techniques to make an informed choice regarding mode of anaesthesia. All women having caesarean deliveries must have vital sign monitoring, antacid prophylaxis and intraoperative venous thromboembolic prophylaxis. A left lateral tilt must be maintained until delivery of the baby to reduce the effects of aortocaval compression. Adequate anaesthesia must be confirmed prior to commencing surgery and strategies for managing failed spinal anaesthesia should be considered. Breakthrough pain during caesarean delivery is a distressing complication and must be addressed. General anaesthesia should be offered and, if declined, the woman's pain must be adequately managed with alternative analgesic methods. These include nitrous oxide, opioids and local anaesthetic infiltration.
       
  • Post-dural puncture headache in the parturient
    • Abstract: Publication date: Available online 20 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Amit R. Panigrahi, Cathy Armstrong Post-dural puncture headache (PDPH) is a common and debilitating complication of central neuraxial blockade in the parturient. The obstetric population is at particular risk with up to 80% of women developing symptoms after accidental dural puncture during labour epidural insertion. PDPH typically develops 24–48 hours post puncture and is classically described as an occipito-frontal headache with postural features. Diagnosis and assessment should include consideration of other potential causes of post-partum headache. Initial treatment of PDPH includes adequate hydration and analgesics. Epidural blood patch (EBP) remains the gold standard treatment. It is more successful if performed over 24–48 hours after the development of symptoms. Complete and permanent relief of symptoms following a single EBP occurs in up to one third of cases where headache follows ADP with an epidural needle. Complete or partial relief may be seen in 50–80% overall. Higher success rates are achieved following a second EBP. There is now UK national guidance on the treatment of post dural puncture headache published by the Obstetric Anaesthetists Association (OAA).
       
  • Tropical diseases and anaesthesia
    • Abstract: Publication date: Available online 20 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Victoria Howell, Tom Bashford The range of infectious diseases encountered while working overseas in resource limited settings varies enormously depending on where in the world one is working, although the majority of low and middle income countries lie within the tropics. Human immunodeficiency virus (HIV), tuberculosis (TB) and malaria are commonly encountered when working in tropical countries and may have an impact upon anaesthesia, either as a direct result of the condition or due to interaction with the drugs used in its management. Other infections such as dengue are less likely to be encountered in a patient undergoing anaesthesia, but may be seen in patients in a high dependency or intensive care unit. Furthermore, the chronic effects of some of these diseases may impact upon anaesthesia or have complications that require surgery. It is essential therefore that the anaesthetist working within these populations has an appreciation of the tropical diseases that are endemic, set against the wider backdrop of a resource-limited population where malnutrition, poorly managed non-communicable disease and trauma may all complicate the clinical picture.
       
  • Cardiac disease in pregnancy
    • Abstract: Publication date: Available online 20 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Amanda Zacharzewski, Ross Macnab Cardiac disease is a significant cause of maternal mortality. In the UK in the last maternal mortality report, it was the leading cause of indirect maternal deaths (2.39 deaths per 100,000 maternities). The overall rate of maternal mortality from cardiac disease has significantly increased over the last three decades, with this increase being mostly attributable to deaths from ischaemic heart disease, myocardial infarction and peripartum cardiomyopathy. Conditions such as pulmonary hypertension, rheumatic heart disease and congenital cardiac lesions also significantly contribute to the mortality figures. With the current increase in age of mothers, increasing rate of maternal obesity and improved survival of children with congenital heart disease, more mothers will require careful cardiovascular assessment and monitoring of their pregnancies. Many women with cardiac conditions will aim to manage their peripartum care in a specialist centre; however, in an emergency they may present to any delivery suite in any hospital. This means it is essential for all obstetric anaesthetists to have a good understanding of different cardiac conditions and how the physiological changes of pregnancy may affect cardiac function.
       
  • The ethics of pregnancy testing
    • Abstract: Publication date: Available online 19 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma Sharkey, Siân Griffiths Anaesthesia, surgery and ionizing radiation may all prove harmful to an undetected pregnancy. Elective procedures should be deferred at least until the second trimester to reduce the risk of teratogenicity or spontaneous abortion. If surgery cannot be delayed, anaesthetic or surgical techniques can be modified, and the use of intraoperative ionizing radiation avoided where possible. Determination of pregnancy status is mandated by current national guidelines prior to any procedure that may compromise the mother or fetus. In the vast majority of cases where the patient has the capacity to consent, there are no ethical or clinical dilemmas. However, girls under the age of 16 years have differing levels of capacity, resulting in various ethical concerns. Guidelines produced by the Royal College of Paediatric and Child Health provide a template to ensure departments maintain national standards, protecting patients from harm while assuring patient confidentiality and autonomy are respected.
       
  • Human factors in obstetrics
    • Abstract: Publication date: Available online 19 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Paul Young, Kirsty Maclennan The importance of human factors is becoming increasingly recognized in the healthcare profession. Lack of situational awareness, poor communication and inadequate leadership compounded by unfamiliar teams in a rapidly deteriorating clinical situation put obstetric patients at particular risk. There is much to be learnt from other high-risk industries including aviation and the military. Increasing awareness and training in human factors and utilization of communication tools (such as SBAR) and prompts (including emergency checklists) can help to promote a safer environment.
       
  • Obtaining consent for obstetric procedures
    • Abstract: Publication date: Available online 19 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Katrina Henderson, Siân Griffiths Consent is a process that involves information disclosure of a proposed treatment or intervention. It includes a discussion of the risks relevant to that particular patient as well as the benefits and alternative options. The process must be clearly documented to provide a legal justification for treatment. Obtaining informed consent can be a challenge when a labouring woman is in severe pain or under the influence of strong analgesics. High-risk women should be encouraged to attend pre-assessment clinics to enable adequate time to process the information discussed. Pregnant women are presumed competent and are entitled to refuse treatment even if this risks their life or the life of their fetus. Rarely, if a woman is not considered competent to make decisions for herself, clinicians should take into account the underlying reasons and consider proceeding in their best interests under the doctrine of necessity or apply to the courts for approval of an intervention. This article summarizes current guidelines in relation to consent that have been updated to reflect recent case law.
       
  • Challenges in healthcare delivery in developing nations
    • Abstract: Publication date: Available online 17 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Victoria Yates, Emma Lillie The Lancet Commission outlines a vision of universal access to safe emergency and essential surgery. Global disparities in perioperative outcomes are recognized, with resource poor environments and a workforce crisis particularly challenging low- and middle-income countries to provide safe surgical and anaesthesia care. Bridging the gap to achieve universal access is a substantial undertaking and requires collaboration with high-income countries. Global partnerships are abundant and mutually beneficial, aiming to alleviate the workforce crisis, provide education, training and expertise and raise standards of care in host developing countries. Clinical, leadership and management experience gained in low resource settings is valued by healthcare systems in high-income countries, acknowledged by curriculum for developing world anaesthesia. Further challenges to healthcare delivery, training and implementation of change are influence by government policy, cultural traditions, expectations and work ethic. This article describes challenges through reflection on personal experience in Zambia.
       
  • Acute pain management and perioperative drugs used in low-resource
           settings
    • Abstract: Publication date: Available online 17 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Hannah Phelan, Tim Johnson The choice of drugs used during the perioperative period in low-resourced settings is dictated by numerous factors. The lack of a reliable supply of essential medications coupled with limited provision of trained staff and necessary equipment are the main causative factors. Drugs used may be unfamiliar to anaesthetists from well-resourced settings and those available can vary greatly from day-to-day. For this reason, it is important to develop an understanding of these drugs and their delivery. The management of acute pain benefits from a structured approach such as that used in the RAT model (recognize, assess, treat) from the Essential Pain Management course. This article provides an understanding of the choice of anaesthetic and analgesic drugs used in a low-resourced setting with a focus on those used less commonly in a well-resourced setting.
       
  • Anaesthetic equipment in low and low-middle income countries
    • Abstract: Publication date: Available online 17 August 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Claire E. Adams, Michael Dobson There is a discrepancy between healthcare need and the ability to provide safe anaesthesia in low/low-middle income countries (LMICs). There is a shortage of medically trained anaesthetists. Most anaesthetics are provided by non-physician anaesthetists who may not have studied the core sciences underpinning anaesthesia, but are clinically very competent. Poor infrastructure is common, such as a shortage of piped medical gases and critical care beds. Safe anaesthesia depends on effective technology, and on consumables such as cannulae, and drugs, all of which are under-provided resources in LMICs. Much of the equipment used in the developed world is unsuitable for use in LMICs. Anaesthetic equipment used in LMICs, such as draw-over breathing systems and oxygen concentrators, may be unfamiliar to developed world anaesthetists. Cleaning and maintenance of equipment is usually the responsibility of the anaesthetist, who needs a good understanding of how it works.
       
 
 
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